A Pilot Study Of Barriers To Drug Dependence Treatment In China

Objective:The goals of the present study was to get a systematic and clear view of barriers to drug dependence treatment in China and to examine the reliability and validity of the Chinese version of the barriers to treatment inventory (BTI).Method:In this study, totally262substance users from three different clinic treatment units were investigated for a substance abuse assessment using BTI, diagnosed by DSM-IV. Multiple indicate and multiple cause (MIMIC) model was built to analize the internal treatment barriers, while latent class analysis (LCA) was done to the external treatment barriers.Results:1. We found the most common reported internal barriers to treatments were:"I can handle my drug use on my own"(31.3%),"My family will be embarrassed or ashamed if I go to treatment"1(30.1%),"privacy concerns"(>48.1%), while the most common reported external barriers to treatments were:"I have things to do at home that make it hard for me to get to treatment"(61.1%),"It will be hard for me to find a treatment program that fits my schedule"(60.3%),"I am moving too far away to get treatment"(56.9%),"I do not know where to go for treatment"(83.2%),"I have difficulty getting to and from treatment"(93.9%),"I have to wait for a long time to get treatment for temporary economic difficulties"(74.4%),"I have to go through too many steps to get into treatment"(87.8%).2. In the correlations analysis among Items in BTI, Item12"I’ve had a bad experience with treatment" has very small correlations with other Items of "Fear of drug treatment". In addition, the factor loading of Item12is small and not statistically significant (0.026, P=0.767); therefore, it was excluded from further analysis. Psychometrics testing showed that BTI achieved good to excellent levels of internal consistency and construct validity, criterion validity. The Chinese version of the barriers to treatment inventory (BTI) is reliable and valid.3. Different substance users reported different common barriers to drugs dependent treatment. For the internal treatment barriers, for age group, substance users younger than30reported more "negative social support"(NSS)(γ=-0.19, P=0.038) and "privacy concerns"(PC)(γ=-0.31, P<0.001) than those older than30. For primary drug use group, ice dependent inpatients reported more "absence of problem"(AP)(y=0.44, P<0.001), NSS (γ=0.25, P=0.010) and item14"being afraid of the people I might see in treatment" than other drugs dependent inpatients. For ever being in drug treatment group, substance users ever being in drug treatment reported more AP (γ=0.20, P=0.012) than those never being in drug treatment. For marital status group, substance users currently married reported more item17"hating being asked personal questions"(γ=-0.11, P=0.030) than those currently not married. For duration of using the most often used drug group, substance users displayed long-term histories of drug use reported more item5"I can handle my drug use on my own"(γ=-3.7, P<0.001) than those did not. For gender and education group, it reported little difference of barriers among all the substance users. For the external treatment barriers, the samples of drug users under study were classified into three distinctive classes. For Class1, Majority of the samples (59%) have an "Agree" or "Strongly Agree"response to all the external treatment barriers, which also can defined as "All Kinds of Barriers Class". For Class2, the substance users have a less "Agree" or "Strongly Agree" response to all the external treatment barriers, which also can defined as "Less Barriers Class". For Class3, there is a zero probability of giving an "Agree" or "Strongly Agree" response to "Time Conflict" items. However, everyone in this class had an "Agree" or "Strongly Agree" response to questions "I do not know where to go" and "I will have difficulty getting to and from treatment". In addition, almost everyone (98%) in this class agreed or strongly agreed that "I will have to go through too many steps to get into treatment", and the corresponding figure is90%for "Waiting list is too long". Since all the barriers that the participants in Class3encountered had to do with "Treatment Accessibility" or "Entry Difficulty", we define this class as "System-Level Barriers Class". The effects of individual characteristics on the latent class membership were estimated from a multinomial logit model. Conclusions:Firstly, in China, substance users encountered different barriers to drug dependence treatment. Substance users across different characteristics reported different barriers and were classified into distinctive classes who should be treated in different ways. Secondly, the revised Chinese version of the barriers to treatment inventory (BTI) has good validity and reliability and can be used as a tool to investigate the barriers to drug dependent treatment among Chinese drug users.