A Longitudinal Investigation of Alcohol Problem Recognition and the Discussion of Alcohol Problems with Health Professionals From a High-Risk Offspring of Twins Sample
In the United States, just one in nine people with active alcohol use disorders (AUDs) receive treatment. The failure to perceive a need for treatment is the major “rate-limiting step” to seeking help for one’s alcohol problems. The transition into adulthood is a critical period for intervention and study, in which AUDs are highly prevalent, comorbid psychiatric disorders develop, and help seeking may or may not be initiated. While problem recognition and help seeking have a significant impact on individuals’ recovery from alcohol problems, scant research has evaluated these constructs using longitudinal methods. This study sought to disentangle the complex relationships between alcohol problem severity, psychiatric severity, problem recognition, and the discussion of alcohol problems with health professionals.
We analyzed three waves of data (W1-W3) from a high-risk offspring of twins sample. Structured diagnostic interviews for the DSM-IV were conducted with the offspring of Vietnam-era veteran twins who were recruited based on their combination of genetic and environmental risk for substance use disorders. The present study analyzed data from 753 respondents with one or more AUD symptoms during the study (mean age 22.8, 47.2% female). We measured alcohol problem severity as a latent variable constructed from DIS interview questions, and we measured psychiatric severity as latent variable constructed from the presence of four common depression and anxiety diagnoses. Covariates included race/ethnicity, gender, age, and a four-level variable indicating the combination of low vs. high genetic and environmental risk. Cross-lagged panel models in Mplus were used to estimate the relative contributions of alcohol problem severity and psychiatric severity on the subsequent recognition of alcohol problems and the discussion of alcohol problems with health professionals (also ascertained via self-report). Autoregressive paths controlled for the effects of variables upon themselves at later waves.
Alcohol problem recognition at W1 and W2 was positively associated with the discussion alcohol problems with health professionals at W2 (β=0.746, se=0.317, p=0.019) and W3 (β=1.108, se=0.357, p=0.002), respectively. Higher psychiatric severity at W1 and W2 was positively associated with the discussion of alcohol problems at W2 (β=0.262, SE=0.122, p=0.031) and W3 (β=0.922, SE=0.405, p=0.023), respectively. However, psychiatric severity did not significantly predict alcohol problem recognition. From W2 to W3 only, alcohol problem severity was inversely associated with alcohol problem recognition (β=-1.224, SE=0.618, p=0.048) and alcohol-related discussions with health professionals (β=-1.409, SE=0.623, p=0.024), from W2 to W3 only.
Conclusions and Implications
Psychiatric severity predicted increased help seeking, but this relationship was not explained by individuals’ own recognition of their alcohol problems. Rather, alcohol problem severity was inversely associated with problem recognition and help seeking at the last interview. It is known that people seek help for depression and anxiety far more often than for alcohol problems; thus, our findings may suggest that health professionals identify clients' alcohol problems and initiate alcohol-related discussions when help is sought for anxiety or depression. Effective prevention strategies may involve more aggressive alcohol screening and brief intervention among persons seeking help for mood and anxiety problems.