The needs of problematic drug misusers not in structured treatment – a qualitative study of perceived treatment barriers and recommendations for services

Aims: Little is currently known regarding treatment barriers amongst problematic drug users not in structured treatment. Much previous work accessed samples entering treatment or predates recent service changes. This study sought to access a ‘hard to reach’ out of structured treatment population, exploring reasons for not seeking treatment. Methods: A total of 43 drug users, self-selected as problematic and not currently in structured treatment, were identified via advertising at low-threshold services in Norfolk, and using snowballing methods. Qualitative focus groups and interviews were conducted. Data were thematically analysed aided by NVivo software. Findings: Key reported barriers to treatment are organized around system, social and personal/interpersonal dimensions. Barriers included perception of a long waiting time, stigma, and a perceived lack of understanding. Social barriers relating to localized group membership were particularly important. Conclusions: Identified barriers confirm previous research, sampling a new out of structured treatment rural population. Perceived barriers persist despite recent changes to treatment services. This could be addressed by improved advertising of service expectations and waiting times. Participants suggested, amongst other things, drop in clinics, increased primary care provision and outreach services to capture problematic drug users not in treatment. Simple practices including appointment reminders and flexibility over urine testing may improve treatment retention.