Impact of Services on Problem Drinking Trajectories

描述(由申请人提供)：酒精领域健康服务研究的基础是了解问题饮酒的长期过程，以及包括酒精治疗和自助在内的健康和人类服务如何影响这一过程。这项拟议的纵向研究从一个县的家庭人口(N=672)中抽取了具有代表性的依赖和问题饮酒者样本，确定了11年来消费模式和改变与酒精相关问题的时间路径的决定因素。没有其他关于这类饮酒者的研究使用了概率抽样的方法，反映了问题严重程度的范围，从问题饮酒者到酒精依赖者，并对他们进行了7年的定期跟踪。这项申请将这些后续行动延长至9年和11年。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，在酒精领域，饮酒问题越来越被视为慢性、周期性和复发。这项研究阐述了广泛的健康和公共服务在酒精问题的长期过程中所起的潜在作用--在人们变得更好、保持不变或进展为更严重的过程中 问题解决了。分析使用潜在曲线增长技术来比较问题饮酒轨迹的形状及其决定因素。分析首先确定个人特征(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，如精神严重程度、药物使用和依赖)影响问题饮酒的轨迹。接下来，我们考察社交网络反应和自助如何改变11年的酒精问题进程，以及一般健康和福利以及人类服务的影响。最后一组分析建立在 这些早期阶段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模拟，并制定综合的因果解释，解释社会网络、自助以及一般卫生和福利服务提供者的干预措施如何有助于酒精治疗的长期影响。

DESCRIPTION (provided by applicant): Fundamental to health services research in the alcohol field is an understanding of the long-term course of problem drinking and how health and human services, including alcohol treatment and self-help, impact that course. The proposed longitudinal study identifies the determinants of 11-year time paths of consumption patterns and changing alcohol-related problems in a representative sample of dependent and problem drinkers drawn from a single county's household population (N=672). No other study of such drinkers has used a probability sampling approach, reflecting the range of problem severity from problem drinkers to those who are alcohol dependent, and followed them regularly for 7 years. This application extends those follow-ups to 9 and 11 years. Time paths, or trajectories, of problem drinking have 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 people getting better, staying the same, or progressing to more serious problems over. Analyses use latent curve growth techniques to compare both the shape of trajectories of problem drinking and their determinants. Analyses begin by establishing the ways individual characteristics (including markers of genetic and developmental predispositions towards alcoholism, demographic characteristics, maturation effects, and psychological vulnerabilities, such as psychiatric severity, drug use, and dependence) affect trajectories of problem drinking. We next examine the manner in which social network responses and self-help alter the 11-year course of alcohol problems and the influence of general health and welfare and human services. A final set of analyses builds upon these earlier stages by modeling the persistence and cumulation of specialty alcohol treatment interventions on trajectories of problem drinking and develops integrated causal 'explanations of how social networks, self-help, and interventions by general health and welfare services providers contribute to the long-term effects of alcohol treatment.