Differences in factors associated with first treatment entry and treatment re-entry among cocaine users
Cleusa P. Ferri, Michael Gossop, Sophia Rabe-Hesketh & Ronaldo R. Laranjeira
Many people with substance misuse problems do not seek treatment. The estimated ratio of untreated to treated individuals among problem drinkers, for example, has been estimated at between 3:1 to 13:1 (Cunningham et al., 1993). There are many reasons for not seeking treatment. These include not having a problem, not recognising a problem, fear of identification with an illegal and stigmatised behaviour, lack of access to services, unacceptability of existing services, as well as other reasons. Findings with regard to the severity of problems among treatment and non-treatment samples have been inconsistent. Several studies have found that severity of dependence was greater among cocaine users in treatment (Chitwood & Morningstar, 1985; Robson & Bruce, 1997). However, Carrol & Rounsaville (1992), after matching a treatment and a community sample in relation to a demographic profile, found higher levels of multiple drug use among users in the community. With regard to environmental circumstances and social-cultural context, Chitwood & Morningstar (1985) found that after matching patients in treatment and patients in the community in relation to dependence severity, the patients in treatment were more likely to suffer negative consequences from cocaine use and to have less social support. Other studies comparing drug users in treatment to those in the community have found that the level of drug use per se did not reliably differentiate help seekers from non-help seekers (Power, Hartnoll & Chalmers, 1992; Varney et al., 1995).