Consideration of Contextual Factors in Understanding Treatment-Seeking for Hazardous Substance Use

Background: Despite high prevalence of substance-related problems and associated costs, rates of treatment-seeking and engagement for substance use (SU) remain low. Many treatment barriers have been cited to explain this discrepancy, and models of rational reasoning, such as the Theory of Planned Behavior (TPB), have demonstrated predictive ability in understanding help-seeking. However, current theories may not adequately capture external contextual factors, especially when assessing help-seeking for stigmatized conditions among those with minoritized identities. Objectives: This study aimed to examine the influence of both individual and contextual factors on help-seeking for treatment of problematic SU. Methods: In a sample of N = 243, TPB was used to predict SU treatment-seeking intentions and behaviors. Results: The findings suggested positive attitudes toward help-seeking and subjective norms that encourage SU treatment were associated with increased help-seeking intentions and behaviors, while perceived behavioral control appeared to negatively predict intentions for White participants and was unrelated to help-seeking for participants of color. A multigroup path analysis did not identify significant differences between groups. Given the differential impacts of racism and discrimination within racial/ethnic minority groups, TPB was then contextualized for Black (n = 106) and Hispanic (n = 40) participants through the addition of racism in healthcare, enacted SU stigma, and structural barriers. With the contextual variables included, the model significantly improved for Black participants but not for Hispanic participants. Conclusions: These findings contribute to the literature in highlighting the ways TPB may be similarly and differentially applied to SU treatment-seeking promotion efforts. The interplay of structural barriers, systemic racism, and substance-related stigma requires further attention, and future research should use longitudinal data to explore these relationships.