When Does Pressure Facilitate Help Seeking? 25 Year Trends and Correlates

Public Health Institute, Oakland CA

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Abstract

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.