NDARC Technical Report No. 122 (2001)
The present study examined patterns of alcohol dependence and treatment seeking in Australia. Multivariate analyses were conducted to examine whether any observed associations remained after controlling for other factors including demographic variables and comorbid mental disorders.
The prevalence of DSM-IV alcohol dependence in the general Australian population was estimated at 4.1% and was three times more common in males than females, as well as being most common in the younger age groups.
Alcohol dependence was most common among single males 18 to 34 years of age. Those with comorbid anxiety, depression or other drug disorders were also more likely to be alcohol dependent.
Just under 30% of those with alcohol dependence sought help for a mental health problem in the past 12 months. Thus most people with these problems do not seek help. Treatment seeking was more common among females, the middle aged (35 to 54 years), the more highly educated, those with any affective, anxiety or other drug disorder, and those with moderate to severe mental or physical disability. The only variables to predict treatment seeking for those with alcohol dependence were sex (females) and having a comorbid affective disorder. However when males and females were analysed separately a trend was apparent for males with affective disorder to seek treatment and for females with an anxiety disorder to be more likely to seek treatment. There was only a (non-significant) trend for disability to predict treatment seeking in this group. This fits with the finding that disability did not relate to an alcohol misuse diagnosis i.e. these individuals do not regard themselves as disabled overall. Because of low numbers, no trends of significance were found when comorbid groups were analysed separately.
In the past 12 months, GPs were the most frequently consulted professionals by those with alcohol dependence (22%). Only 12% sought specialist mental health care and 10% sought other professional care. The most common treatments received were medicines (18% of those seeking help) and psychological/counseling interventions (18%), with 9% obtaining information and 8% receiving help with selfimprovement and practical issues. Most satisfaction was expressed for amount of medicines received compared with psychosocial and information interventions.
Amongst those with dependence who did not seek help, only 23% wanted any help which supports the notion that most people with alcohol dependence do not seek help because they do not see a need for help. Of those who wanted help, they most commonly wanted psychological/counseling types of treatment and least commonly wanted medical interventions. This, along with the greater satisfaction expressed for the amount of medical interventions received, suggests that medical needs are much better met than psychological and counseling needs. Specific barriers to treatment seeking were also investigated. The main reason for not getting help when a need was seen for it was ‘preferring to manage oneself’.
The findings from this survey suggest there is a need to increase public awareness of the risks involved in excessive alcohol use as many people do not perceive these problems. They also need to be convinced that there are effective treatment services available which may be more effective than trying to manage one’s own illness. Also the survey identified a demand for greater access to psychological and counseling services for problems associated with alcohol misuse. Given that alcohol problems develop and are maintained in a social and psychological context, it is important to address these basic psychosocial factors if sustained change is to occur. Medicines may be of assistance in this sense but alone they may be seen to be treating the symptoms and not the underlying causes of the problems.