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戒酒互助会等自助组织寻求帮助。一种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。这些类型的压力通常被实施为最后通牒，威胁要对不遵守规定的人造成严重后果。然而，施压也可以在没有正式制裁威胁的情况下非正式地实施。建议少喝家人、朋友和同事的酒比要求治疗的正式机构压力要普遍得多(Room et al，1996)。然而，非正式压力的影响被研究得很少。虽然已经有研究在单个时间点或地理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率，但还没有研究关注美国全国样本中的压力趋势或它们在实质性时间段内的相关性。更重要的是，研究忽略了研究压力对不同个体在不同条件下的影响。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何时应该鼓励家人、朋友和其他人向饮酒者施压，迫使他们做出改变，以及何时可能适得其反。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)期间从六个不同的时间点收集的数据(N=2,058到8,000；汇总N=34,735)来描述饮酒者在过去一年和一生中受到的压力模式，这些压力来自家人、朋友、医生、警察和工作场所，要求他们在饮酒时“少喝酒或表现不同”。研究的目的包括调查1)承受压力的个人的特征；2)接受压力与戒酒互助会和正规服务求助之间的关系；3)接受压力与求助和不求助的原因之间的关系；4)各种因素如何调节压力和求助之间的关系(例如与酒精有关的后果、酒精依赖的严重程度和对酒精的看法)；以及5)压力对饮酒者亚群(例如吸毒者、福利接受者、因酒精罪行被捕或定罪的饮酒者，以及没有保险的人)的影响有何不同。最后，我们将使用年龄、时间段和出生队列(APC)分析来模拟25年来接受压力的趋势及其对寻求帮助的影响。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，如增加接受治疗或参加AA会议，并避免可能增加寻求帮助阻力的适得其反的压力类型。 公共卫生相关性：结果将向政策制定者和治疗提供者通报过去25年与饮酒有关的压力的过程以及这些变化的相关性。它还将显示1)那些最需要服务的人是否受到了压力，以及2)压力是如何与寻求帮助有关的。政策制定者和治疗提供者将被告知压力何时有助于寻求帮助，何时会适得其反。因此，他们将能够更有效地就如何解决饮酒问题向家人和朋友提供建议。由于这项研究还评估了来自医生、工作场所(例如，雇主、同事和主管)和警察的压力，政策制定者也将能够为这些群体提供指导。

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.