(PS1-56) Treatment-seeking for Hazardous Substance Use: Utility of the Theory of Planned Behavior for Marginalized Communities

Introduction: Despite high prevalence of substance-related problems and associated costs, rates of treatment-seeking for substance use remain low, which may be especially true for marginalized racial and ethnic groups. Many 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.

Method: A community sample of individuals with hazardous substance use was recruited through an online crowdsourcing platform and invited to complete a confidential survey.

Results: TPB was used to predict treatment-seeking intentions and behaviors among People of Color (POC; n = 212) and White participants (n = 242). Models demonstrated good fit and accounted for 36% of the variance in help-seeking intentions and 8% of the variance in help-seeking behaviors for White participants, as well as 35% and 11%, respectively, for POC. Attitudes towards treatment-seeking and subjective norms had the strongest associations with help-seeking intentions for POC and White participants, respectively. Including contextual factors of racism in healthcare, substance use stigma, and structural barriers did not account for significant additional variance in the model, and there were no significant differences in paths between racial/ethnic subgroups. An exploratory model indicated family stigma may be an influential barrier to treatment-seeking for POC.


Conclusions: For the most part, TPB reliably predicted treatment-seeking behaviors and intentions for a community sample of individuals with hazardous substance use. Intervention efforts that emphasize positive beliefs about substance-related treatment and highlight social acceptance of addiction medicine may increase treatment-seeking intentions and behavioral follow-through. The complex interplay of structural barriers, systemic racism, and substance-related stigma deserves additional attention.