Access to Substance Abuse Treatment in Mexico:Preliminary Exploration of Gender Disparities

Background/Purpose: Reducing barriers to access substance abuse treatment (SAT) for individuals who use illegal substances is critical to improve population health in Mexico and the U.S.  In Mexico, rates of illicit substance use rose 87 percent between 2002 and 2011, with women reporting significant increases from 2008 to 2011. Unprecedented migratory patterns (i.e., mass returned migration) call for a transnational approach to increase access to care in Mexico in order to reduce substance use and its impact on health outcomes. Yet, few studies have relied on transnational approaches to examine perceived (stigma, denial, minimization) and actual barriers (no insurance, limited treatment options, cost) to access treatment. These barriers may impact women and migrants differently. Drawing from sex role socialization theory and a transnational social ecology framework, we examined Mexicans' gender, migration, income and perceived and actual barriers to access treatment.

Methods: We analyzed nationally representative household data collected in Mexico as part of the National Survey on Addictions. The sample included 16,249 respondents surveyed in 2011. To examine access to treatment for those in need, our analytical sample was limited to 967 respondents who reported ever using illegal drugs. We relied on a survey design logistic regression approach to model the dichotomous outcome (ever receiving substance abuse treatment). We relied also on survey probability weights to obtain estimates that were nationally representative. Our theoretical framework informed the examination of key independent variables, such as individuals' gender, migration, income,  perceived and actual barriers to access treatment and geographic region. Interaction terms on gender and barriers and gender and substance dependence were also included to test hypothesis on access disparities.

 Results: This analytical sample of individuals reporting ever using illegal drugs reported several barriers to access treatment. The regression models showed that compared to respondents who acknowledged their drug use problems, those who denied it were associated with lower odds of entering treatment (OR = 0.03, 95% CI = 0.11-0.12). Individuals reporting ever being dependent on any drug were 17 times more likely to enter treatment compared to individuals with no reports of dependence (OR = 17.73, 95% CI = 3.89-80.82). Females were less likely than males to enter treatment (OR = 0.07, 95% CI = 0.01-0.73), but females denying they had drug use problem were 21 times more likely to access treatment compared with males reporting no such denial (OR = 21.38, 95% CI = 1.79-25.70).  Finally, individuals who reported ever using illegal drugs and who lived in households with higher dependents on one income were less likely to enter treatment (OR = 0.75, 95% CI = 0.61-0.92).

 

Conclusions/Implications: This preliminary examination provides mixed findings for disparities in access to treatment based on gender and income for the general population in Mexico. Follow up studies that focus on high risk regions (e.g. border urban settings), where high rates of illicit substance use among women and poor treatment infrastructure pose a significant risk for both U.S. and Mexican communities will be discussed.