Drug use and self-awareness of treatment need

Clinical neuroscience studies indicate that drug addiction may be characterized by impaired insight into one's illness severity and need for treatment, but the contributions of individual drug use patterns and/or use disorders to such impairment are not well-understood. The study described in this chapter used a large, nationally representative sample of individuals with substance use disorders (SUDs) to examine the relationship between drug use and one critical component of insight impairment: reduced awareness of treatment need. Data were drawn from the 2004–13 National Survey on Drug Use and Health. The sample included 40,932 respondents who met criteria for past-year alcohol and/or SUD and who provided information on substance-related and psychiatric treatment seeking during the past year. Within the sample with substance disorders, alcohol abuse (but not dependence) and having used any drug within the past month were associated with lower treatment need awareness. In contrast, substance dependence, early age of initiation, and heavier patterns of use were generally associated with higher treatment need awareness. To our knowledge, these results reflect the most comprehensive examination to date of individual drug use patterns and use disorders as they relate to the lack of awareness of treatment need in the general population, with results that can inform future hypothesis-driven research in the clinical laboratory. In turn, these results corroborate on a macroscopic-scale, previous laboratory-based clinical studies, which have similarly shown that alcohol and recent drug use are associated with low insight and self-awareness, highlighting the need for public health initiatives targeted to these populations. This study, by employing and integrating concepts and approaches from neuroscience and epidemiology, is consistent with the emerging and exciting field of population neuroscience.