388P
Incidence of Alcohol Problem Recognition and Treatment Utilization in a High-Risk Offspring of Twins Sample
Most (86-91%) persons with alcohol use disorders (AUDs) think that they do not need treatment and it is particularly uncommon for younger persons to think that they need help. Scant research has used longitudinal data to describe predictors of alcohol problem recognition, which is arguably a necessary component to perceiving a need for treatment. We identified predictors of incident alcohol problem recognition and treatment utilization in a sample of high risk emerging adults.
Methods
We analyzed two waves of data (W1-W2) from the Children of Alcoholics and Twins as Parents studies, which are combinable data sources due to their equivalent design (n=1,833). Interviews were conducted with offspring of Vietnam-era veteran twins recruited based on their combination of genetic and environmental risk for substance use disorders. We included respondents with >=1 DSM-IV AUD symptoms who reported that they never attended alcohol treatment and did not think that they had a drinking problem at W1, and continued to drink at W2. We assessed clinical characteristics including major depression and anxiety disorders, AUD symptoms, quantity and frequency of alcohol consumption, and a four-level variable indicating the combination of low vs. high genetic and environmental risk. Sociodemographic variables included race/ethnicity, gender, and age. Multivariable logistic regression analysis examined predictors of incident problem recognition and treatment utilization among 509 participants who met inclusion criteria. We used multiple imputation with chained equations to address panel attrition and missing data.
Results
Participants were 51% female, had a mean age of 23.0 (range 13-32), and experienced AUD symptoms for an average of 5.0 years (SD=3.5) at baseline. Over two years of follow-up, 8% had incident alcohol problem recognition and 8% had incident alcohol treatment. Males (OR=4.27, 95% CI=1.72-10.60) and those with a greater number of recent AUD symptoms (OR=1.73, 95% CI=1.35-2.22) were significantly more likely to have recognized their alcohol problems at follow-up. Those who thought that they had alcohol problems (OR=4.03, 95% CI=1.31-12.33) and those with a greater number of recent AUD symptoms (OR=1.3, 95% CI=1.1-1.6) were significantly more likely to have received alcohol treatment at follow-up. Using more alcohol than intended (OR=2.45, 95% CI=1.10-5.45), unsuccessful efforts to cut down or quit (OR=8.65, 95% CI=3.44-21.71), spending too much time drinking (OR=5.43, 95% CI=1.89-15.61), reducing important activities to use (OR=6.59, 95% CI=2.15-20.16), drinking despite medical or psychological problems (OR=4.40, 95% CI=1.68-11.48), drinking in hazardous situations (OR=6.73, 95% CI=2.45-18.49), and drinking despite social or interpersonal problems (OR=4.99, 95% CI=2.10-11.86) were significantly associated with problem recognition.
Conclusions
AUD symptoms that were tied to social, occupational, and psychological problems predicted incident alcohol problem recognition, whereas the classic symptoms of physiological dependence (i.e. tolerance and withdrawal) did not. Research on interventions to facilitate problem recognition and treatment utilization may wish to consider that real-life problems due to drinking may be perceived as more problematic than physiological dependence. Future work may wish to also analyze psychological factors (e.g. health beliefs) that could lead to problem recognition and treatment utilization.