Factor Associated w/ Help-Seeking & Change in Drug Abuse

确定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。鉴于有相当数量的物质使用问题的个人寻求正式或非正式来源的援助，寻求帮助在改变过程中的作用本身就是一个重要的研究领域。很少有实证研究在这些领域已经做了大规模的国家数据集，工作没有纵向研究行为变化。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1波和第2波的横截面和纵向数据来研究这些问题。本项目的第一个目标是确定相关因素 在终生诊断为酒精、药物或酒精和药物滥用或依赖的个体中，物质使用发生变化（N = 12，086）。据推测，选择个人和环境变量将与变化，禁欲将与更大的感知问题的严重性，并改善酒精和药物障碍的个人将与更多的法律的后果相比，只有酒精障碍的个人。对于第一个目标，马尔可夫模型将用于测试个人和环境因素对改善的预测能力。本项目的第二个目标是确定这些人寻求帮助的相关因素。据推测，个人和环境因素也将与寻求帮助，具体因素将预测使用12步援助与非12步援助，个人因素将是一个更好的预测寻求帮助的个人之间的酒精使用障碍，而环境因素将是一个更好的预测寻求帮助的个人之间的酒精和药物使用障碍。对于第二个目标，潜变量模型将被用来测试个人和环境因素对求助的预测能力。第三个目标是确定与维持改善从第1波到第2波的NESARC在个人与终身物质使用障碍谁不再符合诊断标准的前一年波1（N = 9，027）。据推测，身体健康，心理社会功能和负面的生活事件将预测随着时间的推移保持变化。对于第三个目标，将使用马尔可夫模型来预测从第一波到第二波的改善维持情况。这项研究的结果将提供有关行为改变的启动和维持的新信息，并可能有助于为公共政策，预防和治疗工作提供信息。

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.