This PhD project will examine untreated remission from alcohol problems. This will involve understanding the way in which those with alcohol problems engage in ‘spontaneous remission’ or ‘natural recovery’ outside the treatment setting. A mixed methods approach will be adopted, as this will enable a broad understanding of a relatively under-studied phenomenon.
Professor Alison Ritter
Social Policy Research Centre, UNSW Sydney
Dr Kari Lancaster
Centre for Social Research in Health, UNSW Sydney
It is well established in the literature that those with Substance Use Disorders (SUD) are not likely to enter treatment. When estimating this treatment gap, unmet need estimates are frequently calculated, where the number of people meeting diagnostic criteria for a SUD and not receiving treatment are identified. As indicated by population based surveys, the unmet need for AOD treatment is estimated to be around 80%, suggesting that 80% of those meeting diagnostic criteria for a SUD do not receive treatment. When comparing unmet need estimates for each substance, alcohol emerges as the substance with the highest unmet need.
One response to the unmet need for alcohol treatment is to encourage governments to increase the availability and access to alcohol treatment. Another response (which is less explored) is to consider untreated remission – so consider the extent to which those meeting diagnostic criteria for an Alcohol Use Disorder enter ‘spontaneous remission’ or ‘natural recovery’ outside the treatment setting. It is this avenue which has been under-studied to date. Indeed, there are no Australian studies on untreated remission from alcohol use disorders.
The following questions will be addressed:
- To what extent does untreated remission exist, and how does this influence estimates of unmet need for treatment?
- What are the characteristics of those who engage in the process of untreated remission?
- How do those in remission without formal treatment differ to those in remission with formal treatment?
- How do we understand the experience of untreated remission, the mechanisms of change, and the role of identity and narrative in the process of untreated remission?
The project has three studies designed to address the above research questions:
- Study 1 will analyse the way in which estimates of untreated remission influence estimates of unmet need for treatment.
- Study 2 will compare the characteristics of those engaging in untreated remission, with those engaging in treated remission. Data will be generated through an online survey.
- Study 3 will analyse the experiences of untreated remission, by drawing on qualitative, in-depth interviews at two stages. Stage 1 will adopt a life curve and board drawing methodology as a way to understand the internal and external processes that participants attribute to the process of untreated remission, while at the same time understanding the manner in which participants organize and interpret these accounts in the form of identities and narratives. Stage 2 interviews will be conducted one year after Stage 1 interviews, and will aim to understand the stability and evolution of identities and narratives elucidated in the Stage 1 analysis.
A systematic review has been completed and submitted for publication. Online survey has been completed by 816 people, and data analysis has begun. Interviews have been started and are ongoing.
By estimating the extent of untreated remission, estimates of unmet need for alcohol treatment will be modified accordingly (this will assist governments and health planners to adjust the desired treatment coverage). By accounting for and understanding the nature of untreated remission, novel understandings of the remission process may emerge, which may assist in improving interventions (be it treatment based interventions (both formal and informal), community based interventions, and/or policy based interventions). Additionally, information on the nature of untreated remission may assist in the development of tailored interventions targeted at those most likely to benefit.