Book contents
- Frontmatter
- Contents
- List of Contributors
- Preface
- Part I Unmet need: defining the problem
- Part II Unmet need: general problems and solutions
- Part III Unmet need: people with specific disorders
- Introduction
- 13 The unmet needs of people suffering from schizophrenia
- 14 The early course of schizophrenia: new concepts for early intervention
- 15 Unmet need in depression: varying perspectives on need
- 16 Unmet need following serious suicide attempt: follow-up of 302 individuals for 30 months
- 17 Met and unmet need for interventions in community cases with anxiety disorders
- 18 The unmet need for treatment in panic disorder and social phobia
- 19 Alcohol-use disorders: who should be treated and how?
- 20 Putting epidemiology and public health in needs assessment: drug dependence and beyond
- 21 Why are somatoform disorders so poorly recognized and treated?
- Part IV Unmet need: specific issues
- Part V Unmet need: conclusion
- Index
20 - Putting epidemiology and public health in needs assessment: drug dependence and beyond
from Part III - Unmet need: people with specific disorders
Published online by Cambridge University Press: 21 August 2009
- Frontmatter
- Contents
- List of Contributors
- Preface
- Part I Unmet need: defining the problem
- Part II Unmet need: general problems and solutions
- Part III Unmet need: people with specific disorders
- Introduction
- 13 The unmet needs of people suffering from schizophrenia
- 14 The early course of schizophrenia: new concepts for early intervention
- 15 Unmet need in depression: varying perspectives on need
- 16 Unmet need following serious suicide attempt: follow-up of 302 individuals for 30 months
- 17 Met and unmet need for interventions in community cases with anxiety disorders
- 18 The unmet need for treatment in panic disorder and social phobia
- 19 Alcohol-use disorders: who should be treated and how?
- 20 Putting epidemiology and public health in needs assessment: drug dependence and beyond
- 21 Why are somatoform disorders so poorly recognized and treated?
- Part IV Unmet need: specific issues
- Part V Unmet need: conclusion
- Index
Summary
Summary
This chapter makes a case for intervention at early stages of drug involvement, well before a drug user meets diagnostic criteria for drug dependence. The case for early intervention rests upon a foundation of epidemiological evidence about the person-to-person spread of drug taking and the quite rapid transition into drug taking and the drug dependence process, once an opportunity to try a drug has occurred. In addition, co-occurring psychiatric and behavioral disturbances among many drug-dependent individuals complicate clinical decisions about diagnosis and therapeutics. This complexity warrants the earlier rather than later attention of skilled clinicians.
Introduction
Over the years, our agenda for international meetings on psychiatric epidemiology has ranged from the question ‘what is a case?’ to ‘how many need treatment?’ These questions appeal to basic concepts from the theory of sets. Consider one set, consisting of all inhabitants of a mental health catchment area or a church/civil parish, such as were surveyed for mental disorders in Norway more than 150 years ago (Holst, translated by Massey, 1852). The members of this set can be sorted into two mutually exclusive and exhaustive subsets: set members who qualify as active ‘cases’ and set members who qualify as ‘non cases’. An alternative course of action is to sort the original set members into two subsets, one consisting of all people who need treatment and the other consisting of all those who do not.
Some observers will tell us that these two courses of action amount to one and the same thing. That is, cases need treatment services, whereas non cases do not. This represents a widely accepted conceptual model for needs assessment planning in the field of drug dependence.
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- Unmet Need in PsychiatryProblems, Resources, Responses, pp. 302 - 308Publisher: Cambridge University PressPrint publication year: 2000
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