New Access Routes to Undertreated Populations; How Do Problem Substance Users Recruited from An Unemployment office Differ from Drug Detoxification Treatment Inpatients?

Background: Only a minority of subjects with substance use disorders (SUD) are in addic-tion-specific treatment (treatment gap). A co-operation between an unemployment office and a psychiatric hospital was established for the assessment and counseling of long-term unemployed clients with SUD. We aim at validating whether such a treatment gap exists in that group, and whether clients from an unemployment office differed from a matched group of inpatient detoxi-fication patients with regard to socio-economic characteristics, substance use and treatment history, and prevalence of mental disorders Methods: Unemployment office clients (n=166) with a SUD were assessed using a standardized sociodemographic and clinical interview. They were compared with 83 inpatients from a local detoxification ward, matched for age, sex, and primary addictive disorder (matching ratio 2:1). 
Results: Most (75.9%) subjects were males, with an average age of 36.7 years. SUD mostly related to alcohol (63.9%) and cannabis (27.7%). Although most unemployment office clients had a long SUD history, only half of them had ever been in addiction-specific treatment during lifetime, and only one of four during the last year. There were no statistically significant differences between groups regarding age at onset of problematic substance use, proportion of migrants, and prevalence of comorbid mental disorders. The unemployment office sample showed lower levels of education (p< 0.001), job experience (p=0.009), and current employment rates (p< 0.001). Conversely, inpatients showed lower rates of imprisonment (p<0.001), more inpatient de-toxification episodes (p<0.03); and longer abstinence periods (p<0.005). 
Conclusions: There was a lifetime and recent treatment gap in the group of long-term unemployed subjects with alcohol and cannabis dependence.. The markedly lower educational attainment, chronic employment problems and higher degree of legal conflict in the client group, as compared with patients in detoxification treatment, might require specific access and treatment options. The co-operation between the psychiatric unit and the unemployment office facilitated access to that group.