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（如匿名酗酒者）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有酗酒问题的个人接受治疗。这些类型的压力往往作为最后通牒来实施，并威胁说不遵守将产生严重后果。然而，也可以在不威胁正式制裁的情况下非正式地施加压力。来自家人、朋友和同事的少喝酒的建议远比要求治疗的正式机构压力更常见（Room et al，1996）。然而，对非正式压力的影响研究甚少。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普遍性，但没有研究研究美国国家样本中的压力趋势或其相关性。更重要的是，研究忽略了在不同条件下，压力对不同个体的影响如何变化。研究还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他们何时应该鼓励家人，朋友和其他人向饮酒者施加压力以做出改变，以及何时可能适得其反。这项研究将使用酒精研究小组（ARG）国家酒精调查（NAS）在25年内6个不同时间点收集的数据（1984-2009年）（N = 2，058至8，000;合并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，警察和工作场所在喝酒时“少喝酒或采取不同的行动”。研究目的包括调查1）接受压力的个人的特征，2）接受压力如何与在酗酒者匿名会和正式服务中寻求帮助有关，3）接受压力如何与寻求和不寻求帮助的原因有关，4）各种因素如何调节压力和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），以及5）压力的影响如何针对饮酒者亚组变化（例如，吸毒者、福利领取者、因酗酒而被捕或被定罪的饮酒者以及没有保险的人）。最后，我们将使用年龄，时间段和出生队列（APC）分析来模拟25年的压力接收趋势及其对寻求帮助的影响。研究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，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：研究结果将告知政策制定者和治疗提供者关于过去25年来饮酒相关压力的过程以及这些变化的相关性。它还将显示1）最需要服务的人是否受到压力，以及2）压力与寻求帮助的关系。决策者和治疗提供者将了解压力何时有利于寻求帮助，何时起反作用。因此，他们将能够更有效地建议家人和朋友如何解决饮酒问题。因为这项研究还评估了来自医生的压力，工作场所（例如，雇主、同事和主管）以及警察、决策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.