Perceived Barriers to Treatment for Alcohol Problems: A Latent Class Analysis

Objective: Low rates of alcohol treatment seeking have been shown to be associated with perceived barriers to treatment, but heterogeneity in patterns of perceived barriers has not been explored. The study analyzed data from a population-based sample of adults with alcohol abuse and dependence in order to describe latent classes of individuals who reported one or more of 15 perceived barriers to seeking alcohol treatment and to identify characteristics associated with class membership. Methods: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002). Analyses were restricted to treatment-naive adults with alcohol abuse or dependence who reported a perceived treatment need (N=1,053). Latent class analysis was performed to identify subgroups with respect to barriers to treatment. Latent class regression identified variables associated with each subgroup. Results: Two subgroups emerged: the low-barriers class (87%), characterized primarily by attitudinal barriers, and the high-barriers class (13%), characterized by significant attitudinal, financial, stigma, and readiness-for-change barriers. In both classes, the most frequently endorsed barrier was the attitudinal belief that "I should be strong enough" to handle the problem without treatment. Univariate analyses showed strong associations between membership in the high-barriers class and comorbid psychiatric disorders, alcohol dependence (compared with abuse), and a family history of alcohol problems. Multivariate analyses found significant associations with a lifetime anxiety disorder and with education level. Conclusions: Attitudinal barriers were most prevalent. Findings revealed a notable subgroup with multiple barriers, including financial and stigma-related barriers. This subgroup may require additional resources and support to enter treatment.