Screening and care for alcohol use disorder in France: expectations, barriers and levers using a mixed-methods approach.
BACKGROUND
The widespread under-screening and under-treatment of alcohol use disorder (AUD) contributes to its health and socioeconomic burden. We conducted a mixed-methods (qualitative and qualitative) study in people with alcohol use disorder (PWAUD) to explore their expectations, as well as barriers and levers to AUD care.


METHODS
Individuals with AUDIT > 15 (N = 179) were interviewed using computer-assisted interviews in several medical and non-medical sites (e.g., bars) (quantitative substudy). We also conducted semi-structured face-to-face interviews with 36 PWAUD (qualitative substudy). Using logistic regression, we explored factors associated with having previously received/sought care for AUD. Three major themes were identified in the qualitative textual analysis using a descending hierarchical classification.


RESULTS
Not socializing with heavy drinkers (AOR [95%CI]:3.84[1.66-8.85]), regular smoking (9.72[3.91-24.15]) and feeling discriminated against (2.35[1.10-5.05]) were independent levers to having sought/received care for AUD, while being aged < 50 and employment were independent barriers. The five predominant themes in PWAUD discourses emerging from the textual analysis were: drinking context, medical care, alcohol treatment, tobacco/addiction and family. When triangulating results from the logistic regression and the textual analysis, two barriers (social drinking and difficulties with the medical care system), and two levers (family influence and tobacco addiction), emerged.


CONCLUSION
These results underline the need for interventions targeting families and the social network to increase awareness about AUD and related care. Simplified and novel comprehensive care trajectories are urgently needed to reduce the clinical and public health burden of AUD.
['Costa|Marie|M|', 'Barré|Tangui|T|', 'Coste|Marion|M|', 'Yaya|Issifou|I|', 'Berenger|Cyril|C|', 'Tanti|Marc|M|', 'Cutarella|Christophe|C|', 'Mora|Marion|M|', 'Poloméni|Pierre|P|', 'Maynard|Marianne|M|', 'Teuma|Danielle|D|', 'Bazin|Michaël|M|', 'Maradan|Gwenaelle|G|', 'Roux|Perrine|P|', 'Carrieri|Patrizia Maria|PM|']
D000328:Adult D000437:Alcoholism D005260:Female D005602:France D006297:Health Services Accessibility D006801:Humans D008297:Male D008403:Mass Screening D008875:Middle Aged D009042:Motivation D036301:Qualitative Research D012959:Socioeconomic Factors D011795:Surveys and Questionnaires
Alcohol use disorder France Mixed-methods Textual analysis Access to care Semi-structured interviews Survey