The two worlds of alcohol problems: Who is in treatment and who is not?

In the study “Women and Men in Swedish Alcohol and Drug Treatment,” it is possible to compare alcohol consumption and problems among respondents in the general population with those in clients entering alcohol treatment. The differences between these groups have led researchers to talk about the “two worlds” of alcohol problems–in general and in clinical populations. The aim of this article is to study the relative strength of factors in predicting entering and the clinical population. The studied factors are demographics and marginalization; volume and frequency of drinking; alcohol dependence; social response to drinking (suggestions to cut down or seek treatment by informal actors, e.g. family and friends, and formal actors such as employer, the social services or judicial system); and treatment history. The client sample includes 1202 clients (71% men) interviewed face-to-face when entering inpatient and outpatient treatment facilities in Stockholm. In the general population survey, 3557 persons aged 18–75 years were interviewed. The two samples differ significantly. As expected, clients were older, more marginalized and reported more severe alcohol problems, and many reported previous treatment experiences and social responses. Logistic regression analyses show that previous treatment, unemployment/institutionalization and having an unstable living situation are the strongest predictors of who is in treatment, followed by age, alcohol dependence and frequency of drinking. Formal pressures to cut down or seek treatment are also important and males are more likely to be in treatment. The results support a notion of the treatment system as a place for handling marginalized people, beyond and beside their extent of drinking.