While epidemiologic studies indicate the prevalence of recent alcohol disorder in rural America approaches that of urban America, the limited research to date suggests that rural problem drinkers may be less likely to use services for alcohol problems than their urban counterparts. The overall goal of this proposal is to investigate why rural drinkers may be less likely to use services for their alcohol problems and explore what consequences this limited use has on their subsequent drinking and drinking-related problems. To accomplish this goal we propose to pursue four specific aims. First, we will investigate differences between rural and urban problem drinkers in any use of formal and informal services for alcohol problems. Second, we will identify factors which explain the reduced treatment rates we expect to observe among rural problem drinkers, using a modified Aday and Anderson model to examine policy-relevant predictors which are particularly important in rural areas. Third, we will investigate differences between rural and urban problem drinkers in how drinking and drinking-related problems change during six months following baseline. Fourth, we will analyze both treatment and non-treatment variables to identify factors which explain the rural-urban differences in course of drinking we expect to observe. To accomplish these aims, we propose to conduct a two wave prospective study of an estimated 700 problem drinkers identified in a probability-based random telephone survey.of community residents in six Southern states. Problem drinkers include over 200 drinkers with a one year DSM-lV diagnosis of alcohol abuse or dependence, plus an estimated 500 drinkers who are at risk for meeting diagnostic criteria for alcohol disorder in the next year. The study will collect baseline measures of an extensive array of predictors of service use including the actual and perceived availability, accessibility and affordability of alcohol treatment services, use of services for alcohol problems in alcohol treatment programs, mental health settings, general medical settings and self-help groups like Alcoholics Anonymous will be measured at baseline and six months. Changes in drinking and drinking-related problems will also be measured at the same intervals. If the expected gap in treatment rates has negative consequences for rural problem drinkers, the study will provide practical insights about how policy makers can effectively increase use of services for alcohol problems in rural areas. For example, this study can provide evidence about the relative promise of interventions which increase the availability versus the affordability of alcohol treatment services. If the expected gap has no discernible effect because, for example, the lay network in rural areas provides greater support for sobriety, this investigation will provide important knowledge about how the social network helps individuals control their drinking problems. We elected to conduct this research in the South to provide targeted information on how to better serve an understudied and underserved population. The database we will develop during this study will allow us to conduct subsequent analyses beyond the hypotheses detailed in this proposal, including an examination of intra-rural variation in use of services for alcohol problems and a more extended analysis of service issues for women and minority problem drinkers.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project (R01)
Project #
5R01AA010372-02
Application #
2046988
Study Section
Special Emphasis Panel (SRCA (66))
Project Start
1994-09-29
Project End
1998-05-31
Budget Start
1995-09-01
Budget End
1996-05-31
Support Year
2
Fiscal Year
1995
Total Cost
Indirect Cost
Name
University of Arkansas for Medical Sciences
Department
Psychiatry
Type
Schools of Medicine
DUNS #
City
Little Rock
State
AR
Country
United States
Zip Code
72205
Small, Jeon; Ounpraseuth, Songthip; Curran, Geoffrey M et al. (2012) Motivation to change as a mediator for the longitudinal relationships of gender and alcohol severity with one-year drinking outcome. J Stud Alcohol Drugs 73:504-13
Borders, Tyrone F; Curran, Geoffrey M; Mattox, Rhonda et al. (2010) Religiousness among at-risk drinkers: is it prospectively associated with the development or maintenance of an alcohol-use disorder? J Stud Alcohol Drugs 71:136-42
Nietert, Paul J; French, Michael T; Kirchner, Joann E et al. (2007) Utilization and cost of mental health, substance abuse, and medical services among at-risk drinkers. Med Care Res Rev 64:431-48
Chermack, Stephen T; Booth, Brenda M; Curran, Geoffrey M (2006) Gender differences in correlates of recent physical assault among untreated rural and urban at-risk drinkers: role of depression. Violence Vict 21:67-80
Booth, Brenda M; Kirchner, Joann E; Fortney, Stacy M et al. (2006) Measuring use of health services for at-risk drinkers: how brief can you get? J Behav Health Serv Res 33:254-64
Booth, Brenda M; Curran, Geoffrey M (2006) Variations in drinking patterns in the rural South: joint effects of race, gender, and rural residence. Am J Drug Alcohol Abuse 32:561-8
Nietert, Paul J; French, Michael T; Kirchner, Joann et al. (2004) Health services utilization and cost for at-risk drinkers: rural and urban comparisons. J Stud Alcohol 65:353-62
Booth, Brenda M; Curran, Geoffrey M; Han, Xiaotong (2004) Predictors of short-term course of drinking in untreated rural and urban at-risk drinkers: effects of gender, illegal drug use and psychiatric comorbidity. J Stud Alcohol 65:63-73
Fortney, John; Mukherjee, Snigdha; Curran, Geoffrey et al. (2004) Factors associated with perceived stigma for alcohol use and treatment among at-risk drinkers. J Behav Health Serv Res 31:418-29
Flynn, Heather A; Walton, Maureen A; Curran, Geoffrey M et al. (2004) Psychological distress and return to substance use two years following treatment. Subst Use Misuse 39:885-910

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