Factors and processes influencing entry into alcohol treatment programs will be investigated among population-based samples of alcoholics and first admissions to alcoholism treatment agencies. The research will be guided by a comprehensive model of factors predicting entry into an alcohol treatment program. The model includes state-of-the-art conceptualization of biopsychological factors thought to influence the severity and chronicity of alcohol abuse and dependence; a comprehensive assessment of the severity and chronicity of alcohol problems, including blood and urine tests; informal pressure by family and friends and formal pressure by employers and the legal system to seek alcohol treatment; health beliefs; and stage of change in addictive behavior. In addition, factors associated with unassisted or natural recoveries will be investigated among population-based alcoholics. Population-based alcoholics will be recruited from two prospective alcohol epidemiologic studies and from the household sample employed as controls for cases of coronary heart disease and lung cancer in Research Components 2 and 3. It is estimated that 795 individuals having a lifetime DSM-III diagnosis of alcohol abuse/dependence will be available for study; a subset of 398 will have had symptoms in the past year. Samples will be available for study; a subset of 398 will have had symptoms in the past year. Samples will be merged and post-stratified on sex, race, education, and heavy drinking. A representative samples of Erie County residents entering alcohol treatment programs for the first time(N-616) will be recruited using data on number of previous admissions to alcohol treatment, county of residence, and key study factors. These data are available from the NYS Office of Substance Abuse Service Information System for clients seen in all 50 alcohol treatment agencies in Erie County, making the recruitment of this sample feasible and cost-efficient. Analyses will employ simple and multivariate logistic regression and structural equation modelling techniques, where appropriate. A better understanding of alcohol treatment seeking behavior and unassisted recovery is critical to the improvement of current efforts to intervene more effectively and efficiently at earlier stages of alcohol abuse and dependence.
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