Public health initiatives utilize an ecological framework that focuses on multiple contextual targets of domain (e.g., individual, family, organizational, community and public policy) to understand, prevent and treat disease and disorder. Social context and environmental factors are viewed as critical to understanding the etiology and remediation of disease and health maintenance. However, substance abuse, a significant public health concern, has tended to focus on more individualistic models for understanding etiology and for designing change strategies (e.g., the Minnesota Model, the disease concept, individual treatment approaches such as motivational interviewing, cognitive-behavioral therapy, relapse prevention therapy), with only limited attention to social context referents' influence in the etiology, maintenance, and remediation of substance abuse disorders. Public health experts, social work practitioners, and substance abuse researchers from a variety of disciplines could benefit by more deliberately adopting an ecological and transactional approach to understanding and treating addiction.

Psychometric developments in substance abuse assessment have followed a similarly individualistic trajectory. Very scant attention has been given to developing more socio-ecologically based substance abuse assessment tools that would provide more contextual information to understanding substance abuse and recovery behavior. To this end, we have developed a new measure, based on constructs from the Theory of Planned Behavior (Ajzen, 1985). The Ecological Assessment of Substance-abuse Experiences (EASE) measure expands on the broad theoretical concepts from the TPB (attitude, outcome beliefs and social norms) by including a multidimensional social referent component, placing assessment in a larger socio-ecological context.

The instrument development process has undergone several iterations, with a most recent study conducted with an African-American sample of 103 treatment-seeking adults being served at outpatient and residential substance abuse treatment programs. Results from this study showed good instrument subscale reliabilities (á ranged from .70-.83), finding that all three social context referents (community, family and peers) were important predictors of behavioral change (â ranged from .289 to .643). Specifically, the stronger the relationship to community through drug use, the less likely action will be taken to change substance abusing behavior. In addition, the greater the fit of drugs/alcohol within the treatment-seeker's neighborhood, the less successful the treatment-seeker will be in maintaining control over substances. The higher the attitudinal congruence between the substance abuser and his/her family towards drug use, the more likely the treatment-seeker will be ready to change substance abusing behaviors.

Practice implications from this ongoing work include offering the field greater understanding of the social forces that would need to be leveraged to facilitate an individual's disengagement from risky substance abusing behaviors and to encourage engagement towards recovery-related behaviors. In addition, the development of community-based culturally-specific indigenous ‘fellowship' support models to facilitate communities' recovery engagement, will be discussed.