IMPACT OF SERVICES ON PROBLEM DRINKING TRAJECTORIES

酒精领域健康服务研究的一些最基本的担忧围绕着理解问题饮酒的长期过程，以及包括酒精治疗、其他健康和人类服务以及自助服务在内的服务如何影响这一过程。这项拟议的研究从同一社区抽取了接受治疗和未治疗的问题饮酒者的大样本，确定了消费模式和改变酒精相关问题的7年时间路径的决定因素。问题饮酒的时间路径或“轨迹”与酒精领域有理论和应用上的相关性，在这个领域，饮酒问题越来越被视为慢性、周期性和复发。这项研究探讨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--在好转、保持不变或随着时间的推移进展为更严重的问题方面。这项研究跟踪了一个县的公共和私人治疗系统(N=927)在过去7年里向机构提供的具有代表性的大样本问题饮酒者。同样，从同一县的家庭人口(N=672)中抽取了一大批未经治疗的问题饮酒者作为对照。分析利用潜在曲线分析技术来比较问题饮酒的轨迹形状及其决定因素，在处理和未处理的样本中。分析首先确定两组中个体特征(包括酗酒遗传和发育倾向的标志、人口统计特征、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)对问题饮酒轨迹所起的作用。接下来，他们考察了社交网络反应和自助在改变接受治疗和未接受治疗的问题饮酒者七年的酒精问题病程中所起的作用，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，通过模拟特殊酒精治疗干预措施的持久性和累积对问题饮酒的轨迹进行建模。然后，它对社交网络、自助以及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影响中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.