5. Factors related to the initiation, maintenance, and treatment of substance dependence 5.1. Demand for treatment At most NGOs specialized in substance dependence, a substantial number of patients have presented for treatment in 2009 but have not initiated it or completed it. Among 774 substance users wishing to enroll in a treatment program, only 321 (42%) were able to access services provided at each of the NGOs interviewed. This finding is similar to a study conducted by Karam et al. (2006); comparing Lebanon to other countries, although the prevalence of disorders, including substance dependence, in Lebanon and West Europe is the same, the number of individuals not receiving treatment was considerably higher in Lebanon than in West Europe. This suggests the pressing need to identify factors related to the initiation of treatment, which may reflect personal factors of the treatment seeker, and/or increase the accessibility, whether in location, cost, hours of service, or capacity as well as service availability of all centers existing in Lebanon.
5.2. Perception of substance use Most substance users, whether seeking treatment at NGOs or accessed through outreach, had not sought treatment in the past, were not seeking treatment at the time of the interview (for outreach substance users), had discontinued treatment after the first consultation, or had not completed treatment because they were not willing to stop the use of substances or because they wished to stop on their own. They have also claimed that they had not sought or were not seeking treatment since they had not perceived addiction to be a problem. Most NGOs and psychiatrists confirm these points; psychiatrists noted an additional factor: high treatment cost. This factor, however, applies only to some settings as some NGOs provide treatment free of charge. All this points to the nature of drug use and addiction, and highlights the need for harm reduction interventions for these drug using populations. Nevertheless, it is important to mention that a much smaller number of NGOs and of both groups of substance users agreed with the fact that treatment was not completed because of lack or loss of commitment to treatment. Thus, it seems that this factor does not carry a lot of weight after treatment is initiated and other issues related to maintenance of treatment must therefore be addressed. Duration of treatment is a factor which many substance users agreed was an obstacle in completing treatment. 269