Little is known about variables that influence help-seeking for alcohol problems and natural recovery without treatment, but these data are crucial for increasing treatment utilization and for improving interventions to better capture the natural forces that produce abstinence. Environmental circumstances have a demonstrated influence on relapse and recovery in treated alcoholics and will be investigated in two studies using problem drinkers with different patterns of help-seeking. Collaterals will verify subject reports. Study #1 will involve a 3 X 2 design that includes 150 problem drinkers who vary in their help-seeking histories (no assistance; A.A. only; or treatment plus A.A.) and current drinking status (abstinent more than 2 years or currently engaging in problem drinking). Retrospective assessment of events over a 4-year period, beginning 2 years before initial abstinence for resolved subjects, or during a matched 4-year interval for nonresolved subjects, will differentiate the life circumstances and patterns of alcohol-related dysfunction related to initial abstinence, attained with or without assistance, from those associated with longterm maintenance. The main hypotheses are that (1) help-seeking will be associated with greater alcohol-related psychosocial dysfunction; (2) resolution will be associated with greater negative health consequences; and (3) resolved subjects will experience more negative events prior to resolution compared to nonresolved subjects and will show decreases in such events after resolution. Study #2 will entail a prospective assessment of environmental influences on the natural recovery process using 70 problem drinkers who have never received any assistance and who have attained abstinence in the recent past. The same general variable classes will be assessed during interviews conducted within 2-6 months after subjects have quit drinking and again 6, 12, 18, and 24 months later and will yield a continuous daily behavioral record of the 3-years surrounding initial resolution. These procedures will yield a fine-grained assessment of the environmental circumstances of individual subjects that are associated with recovery and relapses of varying severity, and will help establish whether current knowledge about the temporal dynamics of recovery and relapse obtained from treated alcoholics generalize to untreated problem drinkers.
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