Twenty-one-year trends and correlates of pressure to change drinking

Improving assessment of alcohol treatment barriers among Latino and White adults with an alcohol use disorder: Development of the barriers to specialty alcohol treatment scale

INTRODUCTION

The present study's aims were two-fold. First, we sought to validate a novel measure to assess barriers to specialty alcohol treatment among White and Latino individuals with an alcohol use disorder (AUD): The Barriers to Specialty Alcohol Treatment (BSAT) scale. Second, we sought to demonstrate that the BSAT scale could be used to explain Latino-White disparities in barriers to alcohol treatment.

METHODS

In 2021, we recruited an online national sample of 1200 White and Latino adults with a recent AUD. Participants completed an online questionnaire that included the BSAT items. Confirmatory and exploratory factor analyses were conducted to validate the BSAT. Multiple group analyses across race/ethnicity and language were also performed using the final model.

RESULTS

The final model consisted of 36 items across 7 factors that reflect barriers related to low problem recognition, recovery goals, low perceived treatment efficacy, cultural factors, immigration-related concerns, low perceived social support, and logistical barriers. The final model's factor structure and factor loadings held up across race/ethnicity and language. The top endorsed barriers were low problem recognition, recovery goals, low perceived social support, logistical issues, and low perceived treatment efficacy. Compared to Whites, Latinos were more likely to report perceived lack of social support, logistical barriers, low perceived treatment efficacy, cultural barriers, and immigration-related concerns as barriers.

CONCLUSION

Findings provide empirical support for the validity of the BSAT scale, which offers improved measurement of specialty alcohol treatment barriers and can be used to explore Latino-White disparities in a future study.

Ten-Year Trend in Women's Reasons for Abstaining or Limiting Drinking: The 2000 and 2010 United States National Alcohol Surveys

BACKGROUND

Data on individual and cultural factors contributing to drinking can inform screening and brief intervention in clinical practice. Our aims were to examine 10-year trends in women's reasons for abstaining/limiting drinking and to document changes in associations with drinking status for population subgroups defined by race/ethnicity and age.

MATERIALS AND METHODS

Using repeated cross-sectional data from White, Black and Hispanic women in the 2000 and 2010 United States National Alcohol Surveys (combined N = 5501), population-weighted multiple linear and multinomial logistic regression models assessed changes in three reasons for abstaining or limiting drinking (health concerns, religious prohibition, and upsetting family or friends) and drinking status (past-year abstainer, low-risk drinker, or at-risk drinker), and their associations over time.

RESULTS

Adjusting for key demographics, reasons for limiting alcohol consumption declined in importance over time, with reductions in both health concerns and religious prohibition particularly noteworthy for older women of all three racial/ethnic backgrounds. Despite these reductions in importance, both health concerns and religious prohibition were most consistently associated with increased abstinence relative to low-risk drinking; these reasons were not strongly associated with at-risk drinking, however.

CONCLUSIONS

It is essential for healthcare providers and others to disseminate accurate information about the risks of drinking to counter cultural shifts that suggest greater acceptance of moderate-to-heavy drinking by women aged 40 and older.

US Adult Illicit Cannabis Use, Cannabis Use Disorder, and Medical Marijuana Laws: 1991-1992 to 2012-2013

Importance

Over the last 25 years, illicit cannabis use and cannabis use disorders have increased among US adults, and 28 states have passed medical marijuana laws (MML). Little is known about MML and adult illicit cannabis use or cannabis use disorders considered over time.

Objective

To present national data on state MML and degree of change in the prevalence of cannabis use and disorders.

Design, Participants, and Setting

Differences in the degree of change between those living in MML states and other states were examined using 3 cross-sectional US adult surveys: the National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991-1992), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002), and the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III; 2012-2013). Early-MML states passed MML between NLAES and NESARC ("earlier period"). Late-MML states passed MML between NESARC and NESARC-III ("later period").

Main Outcomes and Measures

Past-year illicit cannabis use and DSM-IV cannabis use disorder.

Results

Overall, from 1991-1992 to 2012-2013, illicit cannabis use increased significantly more in states that passed MML than in other states (1.4-percentage point more; SE, 0.5; P = .004), as did cannabis use disorders (0.7-percentage point more; SE, 0.3; P = .03). In the earlier period, illicit cannabis use and disorders decreased similarly in non-MML states and in California (where prevalence was much higher to start with). In contrast, in remaining early-MML states, the prevalence of use and disorders increased. Remaining early-MML and non-MML states differed significantly for use (by 2.5 percentage points; SE, 0.9; P = .004) and disorder (1.1 percentage points; SE, 0.5; P = .02). In the later period, illicit use increased by the following percentage points: never-MML states, 3.5 (SE, 0.5); California, 5.3 (SE, 1.0); Colorado, 7.0 (SE, 1.6); other early-MML states, 2.6 (SE, 0.9); and late-MML states, 5.1 (SE, 0.8). Compared with never-MML states, increases in use were significantly greater in late-MML states (1.6-percentage point more; SE, 0.6; P = .01), California (1.8-percentage point more; SE, 0.9; P = .04), and Colorado (3.5-percentage point more; SE, 1.5; P = .03). Increases in cannabis use disorder, which was less prevalent, were smaller but followed similar patterns descriptively, with change greater than never-MML states in California (1.0-percentage point more; SE, 0.5; P = .06) and Colorado (1.6-percentage point more; SE, 0.8; P = .04).

Conclusions and Relevance

Medical marijuana laws appear to have contributed to increased prevalence of illicit cannabis use and cannabis use disorders. State-specific policy changes may also have played a role. While medical marijuana may help some, cannabis-related health consequences associated with changes in state marijuana laws should receive consideration by health care professionals and the public.

A 10-year study of factors associated with alcohol treatment use and non-use in a U.S. population sample

BACKGROUND

This study seeks to identify changes in perceived barriers to alcohol treatment and predictors of treatment use between 1991-92 and 2001-02, to potentially help understand reported reductions in treatment use at this time. Social, economic, and health trends during these 10 years provide a context for the study.

METHODS

Subjects were Whites, Blacks, and Hispanics. The data were from the National Longitudinal Alcohol Epidemiologic Survey (NLAES) and the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). We conducted two analyses that compared the surveys on: (1) perceived treatment barriers for subjects who thought they should get help for their drinking, and (2) variables predicting past-year treatment use in an alcohol use disorder subsample using a multi-group multivariate regression model.

RESULTS

In the first analysis, those barriers that reflected negative beliefs and fears about seeking treatment as well as perceptions about the lack of need for treatment were more prevalent in 2001-02. The second analysis showed that survey year moderated the relationship between public insurance coverage and treatment use. This relationship was not statistically significant in 1991-92 but was significant and positive in 2001-02, although the effect of this change on treatment use was small.

CONCLUSIONS

Use of alcohol treatment in the U.S. may be affected by a number of factors, such as trends in public knowledge about treatment, social pressures to reduce drinking, and changes in the public financing of treatment.

Trends in Alcohol's Harms to Others (AHTO) and Co-occurrence of Family-Related AHTO: The Four US National Alcohol Surveys, 2000-2015

Various harms from others' drinking have been studied individually and at single points in time. We conducted a US population 15-year trend analysis and extend prior research by studying associations of depression with combinations of four harms - family/marriage difficulties, financial troubles, assault, and vandalism - attributed to partners or family members. Data come from four National Alcohol Surveys conducted by telephone in 2000, 2005, 2010, and 2015 (analytic sample = 21,184). Weighted logistic regression models estimated time trends adjusting for victim characteristics (gender, age, race/ethnicity, marital status, poverty, employment, family history of alcohol problems, and drinking maximum). The 2015 survey asked the source of the harm; we used similar models to examine characteristics, including anxiety and depression, associated with various combinations of family/marriage, financial, and assault harms due to partner's/spouse's/family members' drinking. A significant upward trend (P <0.001) from 2000 to 2015 was seen for financial troubles but not for other harms due to someone else's drinking. In 2015, depression and/or anxiety were strongly associated with exposures to harms and combinations of harms identified as stemming from drinking spouse/partner and/or family members. The results shed new light on 15-year trends and associations of harms with personal characteristics. A replicated finding is how the victim's own heavy drinking pattern is implicated in risks for exposures to harms from someone else's drinking. Documenting risk factors for and mental health impacts is important for interventions to reduce alcohol's harm to others.

Pressure to change drinking behavior: An exploratory analysis of US general population subgroups

BACKGROUND

General population studies have shown that pressure from others to change drinking can come from different sources. Receipt of informal pressure (IP) and formal pressure (FP) is known to vary by quantity and consequences of drinking, but less is known about how pressure varies among subgroups of the population.

METHOD

This exploratory study utilizes data from the National Alcohol Surveys from 1995-2010 (N=26,311) and examines associations between receipt of pressure and subgroups of drinkers.

RESULTS

Increased relative risk of receiving IP and FP were observed for individuals reporting an arrest for driving after drinking and illicit drug use while poverty and lack of private health insurance increased risk of receipt of formal pressures. Regular marijuana use increased IP.

CONCLUSION

The subgroups that were studied received increased pressures to change drinking behavior, though disentangling the societal role of pressure and how it may assist with interventions, help seeking, and natural recovery is needed.

A moderating role for gender in racial/ethnic disparities in alcohol services utilization: results from the 2000 to 2010 national alcohol surveys

BACKGROUND

Few nationally representative studies have examined racial/ethnic disparities in alcohol services utilization. Further, little is known about whether racial/ethnic disparities generalize across genders, and what factors account for these disparities. Thus, we aimed to describe the combined impact of race/ethnicity and gender on alcohol services utilization, and to explore the roles for social influence factors in explaining racial/ethnic and gender disparities.

METHODS

Data were pooled across the 2000, 2005, and 2010 National Alcohol Surveys. Outcomes included lifetime utilization of any services, specialty alcohol treatment, and Alcoholics Anonymous. Social influence factors were assessed as lifetime social pressures (i.e., pressures from a partner, friends, and/or family), legal consequences, and work-related consequences. Core analyses included only those with a lifetime alcohol use disorder (AUD).

RESULTS

Analyses revealed a pattern of lower services utilization among Latinos and Blacks (vs. Whites) and women (vs. men); further, race-by-gender interactions revealed that Black-White differences were limited to women, and provided some evidence of stronger Latino-White disparities among women (vs. men). Illustrating these patterns, among women, only 2.5% of Latinas and 3.4% of Blacks with a lifetime AUD accessed specialty treatment, versus 6.7% of Whites; among men, corresponding figures were 6.8% for Latinos, 12.2% for Blacks, and 10.1% for Whites. Racial/ethnic differences were typically robust (or stronger) when controlling for demographics and AUD severity. Evidence did not support a role for measured social influence factors in racial/ethnic disparities, but did suggest that these factors contribute to gender disparities, particularly among Whites and Blacks.

CONCLUSIONS

Findings for substantial Latino-White and Black-White disparities, especially among women, highlight the need for continuing research on explanatory factors and the development of appropriate interventions. Meanwhile, our evidence for persistent gender disparities and for social influence factors as drivers of these disparities tentatively suggests a need for intensified outreach to female heavy drinkers.

Gender and Social Pressure to Change Drinking Behavior: Results from the National Alcohol Surveys from 1984-2010

OBJECTIVE

Research shows social and institutional pressure influences drinking, yet determinants of who receives pressure are understudied. This paper examines age, time period, and birth cohort (APC) effects on pressure to stop or reduce drinking among U.S. men and women.

METHODS

Data were drawn from six National Alcohol Surveys (NAS) conducted from 1984 to 2010 (N=32,534). Receipt of pressure during the past year to quit or change drinking from formal (police, doctor, work) and informal (spouse, family, friends) sources was assessed.

RESULTS

Determinants of pressure were similar for men and women but varied in strength. They included younger age, less education, and younger cohort groups. Cohort effects were stronger for women than men.

CONCLUSIONS

Cohort effects among women may be due to increased alcohol marketing to younger women and the changing social contexts of their drinking. Future studies should assess associations between drinking contexts, pressures, and outcomes.

Pressure and help seeking for alcohol problems: trends and correlates from 1984 to 2005

BACKGROUND

Individuals with alcohol problems frequently report receipt of pressure from a variety of formal and informal sources. While some studies have shown a positive association between receipt of pressure and treatment seeking, other studies have not found a clear association. The mix of findings may be due to several study design factors including sample limitations, lack of contextual alcohol measures as moderators, and failure to include assessment of internal beliefs that relate to help seeking.

METHODS

Current drinkers from the National Alcohol Surveys (NAS) from 1984 to 2005 (N=16,183) were used to describe the association between pressure and help seeking using moderators that included frequent heavy drinking, alcohol related negative consequences, and beliefs about abstention or moderation of alcohol consumption.

RESULTS

The rate of help seeking in the past year was 1.6% across all NAS surveys with Alcoholics Anonymous being the predominant source of help sought followed by physical or mental health services. In 1984 and 1990 approximately 80% of those seeking help also received pressure. The percent declined to 57% in 1995 and leveled off at 64% in 2000 and 61% in 2005. Logistic regression models showed an association between past year receipt of pressure and help seeking. Frequent heavy drinking, alcohol related negative consequences, and strong beliefs about alcohol use were also associated with help seeking, however, they did not moderate the relationship between pressure and help seeking.

CONCLUSIONS

Pressure is associated with help seeking as are a variety of other factors, including heavy alcohol consumption, negative consequences, and strong beliefs about moderate alcohol use. However, the effect of these factors appears to be independent of pressure and not interactive. Future research needs to assess the types of pressure and impact on help seeking to inform public policy and treatment providers as to who receives what type of pressure, when it is helpful, and when it is counterproductive.

Pressure to Reduce Drinking and Reasons for Seeking Treatment

OBJECTIVE

Individuals with alcohol problems often receive pressure to change their drinking. However, when they enter treatment it is unclear how often it is because of the pressure they received or other reasons.

METHOD

A secondary analysis was conducted using four cross sectional National Alcohol Surveys (NASs) collected at 5-year intervals between 1995 and 2010. Treatment seekers (N=476) were interviewed about 1) all reasons for seeking treatment, 2) their primary reason, 3) lifetime heavy drinking, and 4) whether they ever received pressure from six different sources (spouse, family, friends, doctor, work and police).

RESULTS

Over 90% of the sample received pressure from at least one source. Thirty-four percent identified legal problems/felt forced as their primary reason for seeking treatment. Other primary reasons included a desire to improve relationships (25%) and health (15%). When asked about all reasons, 46% endorsed five or more reasons and 74% included legal problems/felt forced. When pressure was received from police it was often the primary reason for seeking treatment. When pressure was received from physicians or work, legal problems/felt forced was less likely to be the primary reason. Most reasons, including legal problems/felt forced, did not change significantly over time.

CONCLUSIONS

A primary reason for seeking alcohol treatment is drinking-related legal problems or feeling forced. However, legal problems/feeling forced occurs along with a variety of additional reasons. Future research should assess pathways between receipt of pressure from different sources, recognition of different types of problems, and reasons given for seeking treatment.