Alcohol use disorder severity and reported reasons not to seek treatment: a cross-sectional study in European primary care practices

Table 1 Categorization of reasons for not seeking treatment and matching of reasons reported in the present study to Saunders' theoretical framework

Saunders’ framework	Present study
Reasons related to the four steps of treatment seeking	Broader category	Subcategories
Denial of the problem	Lack of problem awareness	Drinking was no problem
		No help needed
		Normal consumption
		Consumption under control
		Nothing serious, no problem insight
Minimization of problem severity, rationalization	Other problem	Other problem was more prominent
	Other problem	Other substance problem was more prominent
	Cope alone	Acknowledgement of problem but not of its severity
Self-change, problem resolution without professional help, non-professional help	Cope alone	Wish to cope alone
		Reduction in drinking
		Non-professional support
Encounter insurmountable barriers; delay or avoid treatment, ongoing self-change efforts	Stigma or shame	Fear of stigma and shame
		Social pressure
		Drinking is private issue
	Encounter barriers	Lack of possibility or knowledge
		Lack of time
		Asked for help but did not get any
		Treatment was not affordable
		Wish not to stop drinking
		Treatment was not seen as an option
		No trust in treatment system
		The help needed was not offered