Karriker-Jaffe Katherine J, Witbrodt Jane, Mericle Amy A, Polcin Douglas L, Kaskutas Lee Ann
Alcohol Research Group, Public Health Institute, Emeryville, CA, USA.
Subst Abuse. 2020 Oct 26;14:1178221820933631. doi: 10.1177/1178221820933631. eCollection 2020.
This study tests a socioecological model of relapse and recovery using latent class growth mixture modeling to identify neighborhood, social network and individual-level predictors of alcohol dependence trajectories among a large, longitudinal sample of problem drinkers recruited from substance use treatment settings. We identified four distinct alcohol dependence trajectories: Stable Recovery/Low (Class 1); Relapsing/Rising (Class 2); Late Recovery/Declining (Class 3); and Chronic/High (Class 4). Neighborhood context (poverty and density of bars), social network characteristics (less involvement with Alcoholics Anonymous [AA], continued affiliation with heavy drinkers), and individual predisposing (psychiatric severity) and need (returning to treatment) characteristics each distinguished individuals in the Relapsing/Rising class from individuals in the Stable Recovery/Low class. Social network characteristics (AA involvement and continued affiliation with heavy drinkers) were the primary distinguishing factors for individuals in the Chronic/High class compared to the Late Recovery/Declining class. Study findings can be used to promote recovery and help prevent relapse by: guiding development of community-level interventions to improve social and physical environments; identifying potentially modifiable factors (social network support for sobriety, participation in self-help) to reduce negative consequences among problem drinkers who remain in high-risk neighborhoods; and contributing to ongoing discussions about new and continued licensing of alcohol outlets and regulation of alcohol sales to prevent alcohol problems in high-risk areas and among high-risk people.
本研究使用潜在类别增长混合模型来检验复发与康复的社会生态模型，以确定从物质使用治疗机构招募的大量问题饮酒者纵向样本中酒精依赖轨迹的邻里、社会网络和个体层面预测因素。我们确定了四种不同的酒精依赖轨迹：稳定康复/低水平（类别1）；复发/上升（类别2）；后期康复/下降（类别3）；以及慢性/高水平（类别4）。邻里环境（贫困程度和酒吧密度）、社会网络特征（较少参与戒酒互助会[AA]、与酗酒者持续交往），以及个体易感性（精神疾病严重程度）和需求（重返治疗）特征，均将复发/上升类别的个体与稳定康复/低水平类别的个体区分开来。与后期康复/下降类别相比，社会网络特征（参与戒酒互助会和与酗酒者持续交往）是慢性/高水平类别个体的主要区分因素。研究结果可用于促进康复并帮助预防复发，具体方式如下：指导社区层面干预措施的制定，以改善社会和物理环境；识别潜在可改变的因素（对戒酒的社会网络支持、参与自助），以减少仍处于高风险邻里环境中的问题饮酒者的负面后果；并为正在进行的关于酒精销售点新的和持续的许可证发放以及酒精销售监管的讨论做出贡献，以预防高风险地区和高风险人群中的酒精问题。
