Factors Associated with Help-Seeking and Change in Substance Use

找出与酒精或药物使用障碍患者改善和保持物质使用改善相关的因素，对于理解变化过程至关重要。鉴于大量有药物使用问题的个人从正式或非正式来源寻求援助，寻求帮助在变革进程中的作用本身就是一个重要的研究领域。使用大规模的国家数据集对这些领域进行的实证研究很少，这项工作也没有纵向检查行为变化。目前的提案使用来自全国酒精及相关疾病流行病学调查(NESARC)第一波和第二波的横断面和纵向数据来检查这些问题。这个项目的第一个目标是确定相关的因素 在终生被诊断为酗酒、吸毒或同时酗酒或吸毒的个人中，药物使用的变化(N=12,086)。假设选择的个人和环境变量将与变化相关，禁欲将与更严重的问题相关，与只有酒精障碍的人相比，有酒精和药物障碍的人的改善将与更多的法律后果有关。对于第一个目标，将使用马尔可夫模型来测试个人和环境因素对改进的预测能力。该项目的第二个目标是确定与这些人之间的求助有关的因素。假设个人和环境因素也将与求助有关，特定因素将预测使用12步援助而不是非12步援助，个人因素只有在酒精使用障碍的个人中才能更好地预测求助，而环境因素将更好地预测酒精和药物使用障碍的个人的求助。对于第二个目标，将使用潜在变量模型来检验个人和环境因素对求助的预测能力。第三个目标是确定在第一波(N=9,027)之前一年不再符合诊断标准的终生药物使用障碍患者中，与保持NESARC第一波到第二波改善相关的因素。假设身体健康、心理社会功能和负性生活事件将预测随着时间的推移变化的维持。对于第三个目标，马尔可夫模型将被用来预测从第一波到第二波的持续改善。这项研究的结果将提供关于行为变化的启动和维持的新信息，并可能对公共政策、预防和治疗努力做出重大贡献。

Identifying the factors associated with why people with an alcohol or drug use disorder improve and maintain improvement in their substance use is critical to understanding the change process. Given that a significant number of individuals with substance use problems seek assistance from formal or informal sources, the role of help-seeking in the change process is itself an important area for study. Little empirical research on these areas has been done using large-scale national datasets, and that work has not examined behavior change longitudinally. The current proposal uses cross sectional and longitudinal data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to examine these issues. The first objective of this project is to identify the factors associated with changes in substance use among individuals with a lifetime diagnosis of abuse or dependence for either alcohol, drugs, or both alcohol and drugs (N = 12,086). It is hypothesized that select personal and environmental variables will be associated with change, that abstinence will be associated with greater perceived severity of the problem, and that improvement among individuals with an alcohol and drug disorder will be associated with more legal consequences as compared to individuals with only an alcohol disorder. For this first objective Markov modeling will be used to test the predictive power of personal and environmental factors on improvement. The second objective of this project is to identify the factors associated with help-seeking among these same individuals. It is hypothesized that personal and environmental factors will also be associated with help-seeking, that specific factors will predict use of 12- step assistance versus non-12-step assistance, and that personal factors will be a better predictor of help-seeking among individuals with an alcohol use disorder only while environmental factors will be a better predictor of help-seeking among individuals with both alcohol and drug use disorders. For this second objective latent variable modeling will be used to test the predictive power of personal and environmental factors on help-seeking. The third objective is to identify the factors associated with maintaining improvement from Wave 1 to Wave 2 of NESARC among individuals with a lifetime substance use disorder who no longer met criteria for diagnosis in the year preceding Wave 1 (N = 9,027). It is hypothesized that physical health, psychosocial functioning, and negative life events will predict maintenance of change over time. For this third objective Markov modeling will be used to predict maintenance of improvement from Wave 1 to Wave 2. The results of this study will provide new information about the initiation and maintenance of behavior change, and may contribute significantly to informing public policy, prevention, and treatment efforts.