Help-seeking by substance abusers: the role of harm reduction and behavioral-economic approaches to facilitate treatment entry and retention.

Many substance abusers make repeated attempts to quit or control their drug use. Some attempts involve participation in formal treatment or self-help groups, but recovery also can occur outside the context of interventions (Sobell et al. 1991). It is important to determine what promotes helpseeking at some times and not others, and how influences on help-seeking may differ from influences on recovery (Tucker and Gladsjo 1993). Survey research has demonstrated that most substance abusers do not enter substance-focused treatments or self-help groups (Price et al. 1991; Regier et al. 1993), although those who seek care utilize other medical and mental health services with higher frequency than do individuals who do not have substance-related problems (Putnam 1982). The help-seeking problem thus involves underutilization of substance-focused services and overor misutilization of other health and mental health services. Importantly, interventions aimed strictly at treatment retention cannot address the more general problem of why so many substance abusers avoid traditional drug treatment programs, and efforts to increase appropriate care utilization require knowledge of the help-seeking process.