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. ? ?
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