Identifying Modifiable Influences on Alcohol Problems in High-Risk Neighborhoods

描述（由申请人提供）：邻里环境可能对酒精后果产生负面影响，但很少有研究调查邻里、社会网络和个人因素之间的协同纵向相互关系如何与酒精问题的复发和恢复相关。随着时间的推移，缺乏对这些相互关系的了解限制了我们设计全面预防和治疗酒精问题的能力。为了解决现有文献中的重大空白，并为服务规划提供信息，本研究将描述抑制复发和支持康复的健康社区。该研究还将确定适合干预的缓冲因素，以帮助预防高风险社区居民的复发。我们建议开发和测试一个酒精问题复发和恢复的社会生态模型，以描述社区，社会网络和个人因素如何独立和相互作用地预测酒精问题和依赖的复发和恢复。研究的目的是：(1)描述县域范围内治疗设施、自助资源和酒精出口相对于社区社会经济资源、稳定性和无序性的分布；(2)研究这些邻里特征对复发、康复、治疗利用和自助参与的纵向影响；(3)识别随着时间的推移缓冲或加剧邻里效应的社会网络和个人因素；(4)测试随着时间的推移，问题饮酒者是否会“向下漂移”到高风险社区。该研究使用了11年来从治疗中心（N=926）和社区（N=672）收集的问题和依赖饮酒者的数据，这些数据来自一个人口结构多样化的城市和农村县。现有访谈数据将通过每次访谈的地理编码地址与社区指标（包括药物滥用治疗的地点和特点、自助资源和酒精销售点；社会经济资源；紊乱和犯罪）联系起来。分析方法包括邻域映射和空间随机效应模型，以及潜在增长曲线模型和潜在过渡分析等多层次纵向分析。这项研究对预防复发、提供正式的药物滥用治疗和自助以及与酒精出口有关的政策具有一些实际意义。这项创新的研究将有助于防止复发，通过确定具体的邻里触发可以在治疗期间解决。它还将确定可改变的因素，如社会网络对清醒的支持或参与自助活动，以减少生活在高风险社区的问题和依赖饮酒者所经历的负面后果，这些可以由治疗和预防专家解决。还可以开发辅助项目，帮助资金有限的客户改变住房，帮助他们在治疗后搬离高风险社区。研究结果还将说明，在哪些地方酒精出口尤其有害，并强调哪些地方需要新的治疗方案和自助团体。

DESCRIPTION (provided by applicant): Neighborhood contexts can negatively impact alcohol outcomes, but few studies have examined how synergistic longitudinal interrelationships between neighborhoods, social networks and individual factors relate to relapse and recovery from alcohol problems. Lack of knowledge about these interrelationships over time limits our ability to design comprehensive prevention and treatment to address alcohol problems. To address significant gaps in the extant literature and inform service planning, this study will characterize healthy neighborhoods that inhibit relapse and support recovery. The study will also identify buffering factors amenable to intervention that can help prevent relapse by residents of high-risk neighborhoods. We propose to develop and test a socioecological model of relapse and recovery from alcohol problems to describe how neighborhood, social network and individual factors independently and interactively predict relapse and recovery from alcohol problems and dependence over time. The research aims are: (1) Describe county-wide distribution of treatment facilities, self-help resources and alcohol outlets relative to neighborhood socioeconomic resources, stability and disorder over time; (2) Examine longitudinal effects of these neighborhood characteristics on relapse, recovery, treatment utilization and self-help involvement; (3) Identify social network and individual factors that buffer or exacerbate neighborhood effects over time; and (4) Test whether there is a "downward drift" of problem drinkers into high-risk neighborhoods over time. The study uses data collected over 11 years from problem and dependent drinkers recruited from treatment centers (N=926) and the community (N=672) in a demographically diverse urban and rural county. Existing interview data will be linked with neighborhood indicators (including locations and characteristics of substance abuse treatment, self-help resources and alcohol outlets; socioeconomic resources; disorder and crime) via geocoded addresses at each interview. Analyses include neighborhood mapping and spatial random effects models, as well as multilevel longitudinal analysis, such as latent growth curve modeling and latent transition analysis. The study has several practical implications for relapse prevention, provision of formal substance abuse treatment and self-help, and policy pertaining to alcohol outlets. This innovative study will help prevent relapse by identifying specific neighborhood triggers that can be addressed during treatment. It also will identify modifiable factors, such as social network support for sobriety or participation in self-help that reduce negative consequences experienced by problem and dependent drinkers who live in high-risk neighborhoods, which could be addressed by treatment and prevention specialists. Ancillary programs also could be developed to facilitate housing changes by clients with limited financial resources to help them move from high-risk neighborhoods after treatment. Findings also will illustrate where alcohol outlets are especially detrimental and highlight where new treatment programs and self-help groups are needed.