IMPACT OF SERVICES ON PROBLEM DRINKING TRAJECTORIES

酒精领域的卫生服务研究的一些最基本的问题围绕着了解问题饮酒的长期过程，以及包括酒精治疗在内的服务、其他健康和人类服务以及自助如何影响这一过程。拟议的研究确定了消费模式的7年时间路径的决定因素，并改变了来自同一社区的大量治疗和未治疗的问题饮酒者的酒精相关问题。饮酒问题的时间路径或“轨迹”与酒精领域既有理论意义又有应用意义，饮酒问题越来越被视为慢性、周期性和复发性问题。这项研究阐述了广泛的健康和人类服务在酒精问题的长期过程中所起的潜在作用——随着时间的推移，在好转、保持不变或发展成更严重的问题上。这项研究追踪了一个大的、有代表性的问题饮酒者样本，他们在7年的时间里向一个县的公共和私人治疗系统的机构（N=927）提出了问题。同样，该研究还从同一县的家庭人口中抽取了一组未经治疗的酗酒者（N=672）。分析利用潜在曲线分析技术来比较问题饮酒轨迹的形状及其决定因素，在处理和未处理的样本中。分析首先确定个体特征（包括酒精中毒的遗传和发育倾向标记、人口统计学特征、成熟效应和心理脆弱性，包括精神严重程度、药物使用和依赖）在两组问题饮酒轨迹中所起的作用。接下来，他们研究了社会网络反应和自助在改变治疗和未治疗的问题饮酒者7年的酒精问题过程中所起的作用，以及一般健康和福利健康和人类服务的作用。最后一组分析建立在这些早期阶段的基础上，通过对问题饮酒轨迹上的特殊酒精治疗干预的持续和积累进行建模。然后，它对社会网络、自助和一般健康和福利服务提供者的干预在促进酒精治疗的长期效果方面所起的作用进行了更综合的因果解释。

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.