Estimating Service Needs for Alcohol and Other Drug Users According to a Tiered Framework: The Case of the Sao Paulo, Brazil, Metropolitan Area

Objective: The purpose of this study was to estimate the need for population-level services for alcohol and other drug abuse in support of local planning. Method: Data were drawn from a subsample of 2,942 interviewees from the Sao Paulo Megacity Study, which evaluated mental health in the general population (18 years and older) of residents in the Sao Paulo metropolitan area. This population was classified into five hierarchical categories of severity, making it possible to obtain estimates of need for services, combining evaluation criteria regarding drug and alcohol use and general and mental health comorbidities over the last 12 months. For the at-risk groups in this population, estimates from the Potential Demand for the Use of Services survey interviews over the last year were generated. Results: Concerning the need for services, 86.5% of the population (Tier 1) had no problems related to drug and alcohol use, 8.9% (Tier 2) used heavily, 3.5% (Tiers 3, 4, and 5) met criteria for substance abuse disorders, among whom 1.3% (Tiers 4 and 5) require more specialized and intensive treatment and support. The following estimates for the Potential Demand for the Use of Services were found: 25.5% (Tier 3) and 51.1% (Tier 4), indicating that a significant number of individuals met criteria for substance abuse disorders but did not perceive any need for professional help or neglected the help available. Conclusions: In Sao Paulo there exists a large sector of the population that requires prevention strategies regarding the risks and harm resulting from alcohol and drug use, followed by a group requiring more specialized care. But a large number of substance users requiring specialized support did not use services and did not believe that they needed professional help.