From the, Washington University in St. Louis, (JLB, RT, MWF, KKB, VVM), St. Louis, Missouri.
Virginia Commonwealth University, (DMD, MS), Richmond, Virginia.
Alcohol Clin Exp Res. 2020 Mar;44(3):746-757. doi: 10.1111/acer.14290. Epub 2020 Feb 13.
There are gaps in the literature on service use (help-seeking and treatment utilization) for alcohol problems among those with alcohol use disorder (AUD). First, policy changes and cultural shifts (e.g., insurance) related to AUD have occurred over the last few decades, making it important to study generational differences. Second, multiple studies have found that females receive fewer services than males, and exploring whether these sex differences persist across generations can inform public health and research endeavors. The current study examined service use for alcohol problems among individuals with AUD. The aims were as follows: (i) to describe service use for alcohol problems; (ii) to assess generational differences (silent [b. 1928 to 1945], boomer [b. 1946 to 1964], generation X [b. 1965 to 1980], millennial [b. 1981 to 1996]) in help-seeking and treatment utilization; and (iii) to examine sex differences across generations.
Data were from affected family members of probands who participated in the Collaborative Study on the Genetics of Alcoholism (N = 4,405). First, frequencies for service use variables were calculated across generations. Pearson chi-square and ANOVA were used to test for differences in rates and types of service use across generations, taking familial clustering into account. Next, Cox survival modeling was used to assess associations of generation and sex with time to first help-seeking and first treatment for AUD, and time from first onset of AUD to first help-seeking and first treatment. Interactions between generation and sex were tested within each Cox regression.
Significant hazards were found in all 4 transitions. Overall, younger generations used services earlier than older generations, which translated into higher likelihoods of these behaviors. Regardless of generation, younger females were less likely to use services than males.
There are generational and sex differences in service use for alcohol problems among individuals with AUD. Policy and clinical implications are discussed.
在酒精使用障碍（AUD）患者中，关于酒精问题服务利用（寻求帮助和治疗利用）的文献存在空白。首先，过去几十年与 AUD 相关的政策变化和文化转变（例如，保险），使得研究代际差异变得很重要。其次，多项研究发现女性接受的服务少于男性，探索这些性别差异是否在代际间持续存在，可以为公共卫生和研究工作提供信息。本研究调查了 AUD 患者的酒精问题服务利用情况。目的如下：（i）描述酒精问题的服务利用情况；（ii）评估寻求帮助和治疗利用方面的代际差异（沉默一代[1928 年至 1945 年出生]、婴儿潮一代[1946 年至 1964 年出生]、X 一代[1965 年至 1980 年出生]、千禧一代[1981 年至 1996 年出生]）；（iii）检验各世代的性别差异。
数据来自参加酒精遗传合作研究的先证者受影响家属（N=4405）。首先，计算各世代服务利用变量的频率。考虑到家族聚集性，采用 Pearson χ2 检验和方差分析检验各世代间服务利用的比率和类型差异。接下来，采用 Cox 生存模型评估代际和性别与 AUD 首次寻求帮助和首次治疗的时间以及 AUD 首次发作与首次寻求帮助和首次治疗的时间之间的关联。在每个 Cox 回归中检验了世代和性别的交互作用。
所有 4 个过渡都存在显著的危险。总体而言，年轻的世代比年老的世代更早地利用服务，这转化为这些行为的可能性更高。无论世代如何，年轻的女性使用服务的可能性都低于男性。
AUD 患者中，酒精问题服务利用存在代际和性别差异。讨论了政策和临床意义。
