This competing renewal application proposes two prospective studies of environmental influences on recovery processes among problem drinkers with different help-seeking experiences, with emphasis on the underresearched process of natural recovery. The research is guided by a behavioral economic analysis of alcohol abuse and will investigate the natural forces that promote or undermine recovery pursued through different pathways, the circumstances conducive to help-seeking, and how interventions interact with the recovery process. Such data will inform the development of interventions that better capture the natural forces that support recovery and that appeal to the underserved majority of problem drinkers who avoid existing treatments. Two studies conducted during the current award indicated similarities in the molar environmental contexts that surrounded recoveries achieved with and without treatment or AA and will be further investigated in the renewal studies (#3 & #4) using more intensive, prospective methods. Study #3 will be a 2-year prospective follow-up of recently resolved problem drinkers with different help-seeking experiences (no assistance, AA only, or treatment participation, n = 50 per group). Using an expanded Timeline Followback methodology, the study will investigate weather a common molar environmental context supports recoveries achieved with and without interventions, how interventions interact with problem drinkers life circumstances and social networks, and the generality of outcome predictors across help-seeking groups. Study #4 will focus intensively on the natural recovery process. Using an innovative computerized telephone data collection system, untreated problem drinkers N = 45) will self-monitor their daily drinking and environmental variables for 4 months shortly after initial resolution. These data will support a fine-grained analysis of temporal relationships between drinking episodes, events, and behavioral economic variables and will help establish whether current knowledge about environmental influences on recovery and relapse obtained using treated alcoholics generalizes to untreated problem drinkers. A 12-month follow-up will relate the behavior patterns early in the recovery period to longer term drinking outcomes. Together, these process-oriented studies will advance knowledge about help-seeking and about the temporal dynamics of recovery and the role of contextual variables and interventions in promoting it.
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