title: The role of community services and informal support on five-year drinking trajectories of alcohol dependent and problem drinkers.
abstract: OBJECTIVE
  The purpose of this study was to examine how informal support and community services impact the course of alcohol disorders by examining the trajectories of alcohol consumption over 5 years in dependent and problem drinkers.
  
  
  METHODS
  Alcohol dependent adults (n = 600) and problem drinkers (n = 992) were identified through probability surveys in the general population and in public and private treatment programs throughout a California county. Participants were interviewed at baseline and again 1, 3 and 5 years later. Models controlling for demographic characteristics, problem severity, community services and recovery-oriented social networks were estimated, using a multi-level, mixed model to predict alcohol consumption over time.
  
  
  RESULTS
  A significant trend of reduced drinking over time was observed for both dependent and problem drinkers. Recovery-oriented social networks and AA participation predicted decreased consumption for both groups. Contacts with medical, mental health, welfare and legal systems were predictive of reduced consumption for problem drinkers. In the dependent group, only contacts with mental health agencies marginally predicted decreased consumption.
  
  
  CONCLUSIONS
  Findings point to the importance of developing mechanisms for better identifying problem drinkers in the course of contacts with health and social service systems and for facilitating use of self-help groups and positive changes in social networks. Development of recovery-oriented social networks should be emphasized to extend the benefits of treatment for dependent individuals.
authors.affiliation: Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, Box F-0984, San Francisco, California 94143-0984, USA. conniew@lppi.ucsf.edu
authors.forename: Constance
authors.initials: C
authors.lastname: Weisner
authors.forename: Kevin
authors.initials: K
authors.lastname: Delucchi
authors.forename: Helen
authors.initials: H
authors.lastname: Matzger
authors.forename: Laura
authors.initials: L
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012944:Social Support; D012946:Social Welfare / Q000523:psychology / Q000706:statistics & numerical data* / Q000639:trends*