(WITHDRAWN) Social Support, Substance Use Disorders, and Engagement in Treatment in the United States

Background: This study investigated the association between poor social support and substance use disorders (SUD) and unmet need for treatment in the United States. This study hypothesized that poor perceived social support will be associated with increased risk of lifetime and past year SUD. This study also hypothesized that poor social support will be associated with greater risk of not receiving treatment compared to people with SUD who received treatment

Methods: Data came from Wave 3 of the National Epidemiological Survey on Alcohol and Related Conditions, a nationally representative study of 36309 adults over the age of 18 in the civilian noninstitutionalized population of the United States in 2013. Substance use disorders consisted of a dichotomous variable measuring if the participant met the DSM-5 diagnostic criteria for lifetime, past year SUD using the Alcohol Use Disorders and Associated Disabilities Interview (AUDADIS). Unmet need for treatment measured if the participant reported perceived need for treatment but did not receive care. Perceived social support was assessed using the Interpersonal Support Evaluation List which consisted of 12 question items scored on a 4-point Likert scale (alpha=.89).

Generalized linear modeling with a Poisson distribution and robust error covariance estimated associations between poor social support and relative risk (RR) of SUD and unmet need for treatment after adjusting for race, employment age, sex, receiving food stamps, employment and prior mental health treatment.

Results: Lifetime SUD was reported by 30.10% (n=10930) and past year SUD was reported by 18.99% (n=6896) of the sample. Among participants with past year SUD, unmet need for treatment was reported by 4.63% (319), 13.36% received treatment and 82.02% (5656) did not seek or receive treatment. Poor social support was associated with increased lifetime (RR=1.09, 95%CI 1.01, 1.18, p<.05) and past year substance use disorders (RR=1.14, 95%CI=1.03, 1.24, p<.001). Compared to White participants, Black (RR=.64, 95%CI=.60, .68, p<.001), Hispanic (RR=.61, 95%CI=.58, .65, p<.001) and Asian (RR=.38, 95%CI=.33, .42, p<.001) participants were less likely to report past year SUD. Participants who received food stamps (RR=1.35, 95%CI=1.26, 1.46, <.001) and were unemployed (RR=1.09, 95%CI=1.01, 1.18, p<.05) were more likely to report past year SUD. Poor social support was associated with increased risk of perceived unmet need for treatment (RR=1.54, 95%CI=1.03, 2.31, p<.05). Participants who were black (RR=2.46, 95%CI=1.74, 3.47, p<.001) and Hispanic (RR=1.90, 95%CI=1.31, 2.74, p<.001) were more likely to report unmet need for treatment.

Conclusion: The following study identified statistical relationships between poor social support and SUD and unmet need for treatment in a nationally representative sample of non-institutionalized people in the United States. Increasing social support may provide interpersonal methods of coping with stressors as alternatives to engaging in substance use. Moreover, increasing social support may reduce gaps in accessing treatment by providing access to emotional support, transportation, financial assistance and other material sources of support.