IMPACT OF SERVICES ON PROBLEM DRINKING TRAJECTORIES

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Some of the most fundamental concerns for health services research in the alcohol field revolve around understanding the long-term course of problem drinking, and how services, including alcohol treatment, other health and human services, and self-help impact that course. The proposed study identifies the determinants of 7-year time paths of consumption patterns and changing alcohol-related problems in large samples of treated and untreated problem drinkers drawn from the same community. Time paths, or "trajectories" of problem drinking are of both theoretical and applied relevance to the alcohol field, where drinking problems are increasingly viewed as chronic, cyclical and relapsing. The study addresses the underlying roles that a wide spectrum of health and human services play in the long-term course of alcohol problems -- in getting better, staying the same, or progressing to more serious problems over time. The study follows a large, representative sample of problem drinkers presenting to agencies throughout a single county's public and private treatment system (N=927) over 7 years. It similarly follows a large comparison group of untreated problem drinkers drawn from that same county's household population (N=672). Analyses draw on latent curve analysis techniques to compare the shape of trajectories of problem drinking, and their determinants , in treated and untreated samples. Analyses begin by establishing the roles played by individual characteristics (including markers of genetic and developmental predispositions towards alcoholism, demographic characteristics, maturation effects, and psychological vulnerabilities, including psychiatric severity, drug use and dependence) on trajectories of problem drinking in the two groups. Next, they examine the roles that social network responses and self-help play in altering the 7-year course of alcohol problems in treated and untreated problem drinkers, and the role of general health and welfare health and human services as well. A final set of analyses builds on upon these earlier stages by modeling the persistence and cumulation of specialty alcohol treatment interventions on trajectories of problem drinking. It then develops more integrated causal explanations of the roles that social networks, self-help, and interventions by general health and welfare service providers play in contributing to the long-term effects of alcohol treatment.