When Does Pressure Facilitate Help Seeking? 25 Year Trends and Correlates

描述（由申请人提供）：绝大多数有酒精问题的人不会通过治疗或自助团体（如匿名戒酒会）寻求帮助。一项公共政策回应是鼓励刑事司法系统和社会福利部门等机构强制要求有酒精问题的个人接受治疗。这些类型的压力往往作为最后通牒加以执行，并威胁不遵守将产生严重后果。然而，压力也可以在没有正式制裁威胁的情况下非正式地实施。来自家人、朋友和同事的少喝酒建议远比正式的机构压力要求治疗更常见（Room et al, 1996）。然而，非正式压力的影响研究很少。虽然有研究在单一时间点或地理上有限的样本中使用横断面设计检查了减少饮酒和进入治疗的压力的流行程度，但没有研究在美国国家样本中观察压力的趋势或它们在实质性时间段内的相关性。更重要的是，研究忽视了压力对不同条件下不同个体的影响。研究也忽略了不同时期的社会和政治特征如何影响压力的接受和影响。因此，政策制定者和治疗专业人员不知道什么时候应该鼓励家人、朋友和其他人向饮酒者施压，让他们做出改变，什么时候可能适得其反。这项研究将使用酒精研究小组（ARG）全国酒精调查（NAS）在25年（1984-2009）的六个不同时间点收集的数据（N = 2058至8000；汇总N=34,735）来描述饮酒者在过去一年和一生中从家人、朋友、医生、警察和工作场所收到的压力模式，要求他们在饮酒时“少喝酒或行为不同”。研究目的包括调查1)接受压力的个体的特征，2)接受压力如何与在匿名戒酒会和正规服务中寻求帮助有关，3)接受压力如何与寻求帮助和不寻求帮助的原因有关，4)各种因素如何缓和压力与寻求帮助之间的关系（例如，酒精相关后果，酒精依赖严重程度和对酒精的信念）。5)压力对饮酒者亚群体（例如，吸毒者、福利接受者、因酗酒被捕或被定罪的饮酒者和无保险者）的影响是如何变化的。最后，我们将利用年龄、时间段和出生队列（APC）分析，对接受压力的25年趋势及其对寻求帮助的影响进行建模。结果应有助于政策制定者和治疗提供者促进与理想结果相关的压力类型，例如增加接受治疗或参加AA会议的次数，并避免可能增加寻求帮助的阻力的适得其反的压力类型。

DESCRIPTION (provided by applicant): The vast majority of individuals with alcohol problems do not seek help through treatment or self help groups such as Alcoholics Anonymous. One public policy response has been to encourage institutions such as criminal justice systems and social welfare departments to mandate that individuals with alcohol problems enter treatment. These types of pressures are often implemented as ultimatums with the threat of serious consequences for noncompliance. However, pressure can also be implemented informally without the threat of formal sanctions. Suggestions to drink less from family, friends, and coworkers are far more common than formal institutional pressures mandating treatment (Room et al, 1996). However, the effects of informal pressures have been studied minimally. While studies have examined the prevalence of pressure to decrease drinking and enter treatment using cross sectional designs at a single time point or geographically limited samples, no studies have looked at trends of pressure in U.S. national samples or their correlates over substantive time periods. More importantly, studies have neglected to examine how the effects of pressure vary for different individuals under different conditions. Studies have also ignored how the social and political characteristics of different time periods might affect receipt and impact of pressure. Thus, policy makers and treatment professionals are uninformed about when they should encourage family, friends and others to pressure drinkers to make changes and when it might be counterproductive. This study will use data from the Alcohol Research Group (ARG) National Alcohol Survey (NAS) collected at six different time points over a 25 year period (1984-2009) (N's = 2,058 to 8,000; pooled N=34,735) to describe the patterns of pressure that drinkers received during the past year and lifetime from family, friends, physicians, police and the workplace to "drink less or act differently" when they drank. Study aims include investigation of 1) the characteristics of individuals who received pressure, 2) how receipt of pressure was related to help seeking in Alcoholics Anonymous and formal services, 3) how receipt of pressure was related to reasons for seeking and not seeking help, 4) how a variety of factors moderated the relationship between pressure and help seeking (e.g., alcohol related consequences, alcohol dependence severity, and beliefs about alcohol), and 5) how the impact of pressure varied for drinker subgroups (e.g., drug users, welfare recipients, drinkers arrested or convicted for alcohol offenses, and the uninsured). Last, we will model 25-year trends in receipt of pressure and its impact on help seeking using age, time period, and birth cohort (APC) analyses. Results should help policymakers and treatment providers facilitate the types of pressures that are associated with desirable outcomes, such as increasing treatment entry or attendance at AA meetings, and avoid counterproductive types of pressure that can increase resistance to help seeking. PUBLIC HEALTH RELEVANCE: Results will inform policy makers and treatment providers about the course of drinking related pressure over the past 25 years and the correlates of those changes. It will also show 1) whether those most in need of services received pressure and 2) how pressure was related to help seeking. Policy makers and treatment providers will be informed about when pressure facilitates help seeking and when it is counterproductive. Thus, they will be able to more effectively advise family and friends about how to address problem drinking. Because the study also assesses pressure from physicians, the workplace (e.g., employers, coworkers, and supervisors), and police officers, policy makers will also be able to provide guidance to these groups as well.