The moderating role of social networks in the relationship between alcohol consumption and treatment utilization for alcohol-related problems

Inequity in clinical research access for service users presenting comorbidity within alcohol treatment settings: findings from a focused ethnographic study

BACKGROUND

While healthcare policy has fostered implementation strategies to improve inclusion and access of under-served groups to clinical care, systemic and structural elements still disproportionately prevent service users from accessing research opportunities embedded within clinical settings. This contributes to the widening of health inequalities, as the absence of representativeness prevents the applicability and effectiveness of evidence-based interventions in under-served clinical populations. The present study aims to identify the individual (micro), organisational (meso) and structural (macro) barriers to clinical research access in patients with comorbid alcohol use disorder and alcohol-related liver disease.

METHODS

A focused ethnography approach was employed to explore the challenges experienced by patients in the access to and implementation of research processes within clinical settings. Data were collected through an iterative-inductive approach, using field notes and patient interview transcripts. The framework method was utilised for data analysis, and themes were identified at the micro, meso and macro levels.

RESULTS

At the micro-level, alcohol-related barriers included encephalopathy and acute withdrawal symptoms. Alcohol-unrelated barriers also shaped the engagement of service users in research. At the meso-level, staff and resource pressures, as well as familiarity with clinical and research facilities were noted as influencing intervention delivery and study retention. At the wider, macro-level, circumstances including the 'cost of living crisis' and national industrial action within healthcare settings had an impact on research processes. The findings emphasise a 'domino effect' across all levels, demonstrating an interplay between individual, organisational and structural elements influencing access to clinical research.

CONCLUSIONS

A combination of individual, organisational and structural barriers, exacerbated by the COVID-19 pandemic, and the socioeconomic landscape in which the study was conducted further contributed to the unequal access of under-served groups to clinical research participation. For patients with comorbid alcohol use disorder and alcohol-related liver disease, limited access to research further contributes towards a gap in effective evidence-based treatment, exacerbating health inequalities in this clinical population.

Exposure to Alcohol-Related Content on Social-Media

Objective

Exposure to alcohol-related content is unavoidable on social media. In this study level of exposure to alcohol marketing content on Twitter and Instagram for those in recovery was examined, and the effectiveness of privacy settings to mitigate exposing content was assessed.

Methods

Four fictitious accounts were created on Instagram and Twitter in a case-control design in Spring 2022. All accounts followed 19 alcohol brands, with two accounts (1 male, 1 female) following only alcohol brand accounts while the other two (1 male, 1 female) additionally followed recovery resources. Four weeks of data collection were done with default privacy and advertisement settings, followed by two additional weeks of data collection with advertisement and privacy settings for blocking alcohol content.

Results

Privacy settings did not help with blocking the alcoholic brand-related photographic content on either platform, meaning that the accounts received the same amount of alcohol-related content from the accounts they were following with and without changing the privacy settings. However, Twitter algorithms were more effective in suppressing alcohol-related content for accounts following recovery resources and alcohol brands.

Conclusions

These results suggest that risks of exposure to triggering/cueing photographic alcohol content may outweigh the benefits of social media for social connection if an individual is considering seeking recovery.

Alcohol use and treatment utilization in a national sample of veterans and nonveterans

BACKGROUND

Research comparing prevalence of alcohol use problems and alcohol treatment utilization between veterans and nonveterans is lacking. Whether predictors of alcohol use problems and alcohol treatment utilization differ in veterans vs. nonveterans is also unclear.

METHODS

Using survey data from national samples of post-9/11 veterans and nonveterans (N = 17,298; 13,451 veterans, 3847 nonveterans), we investigated associations between veteran status and 1) alcohol consumption, 2) need for intensive alcohol treatment, and 3) past-year and lifetime alcohol treatment utilization. We also investigated associations between predictors and these three outcomes in separate models for veterans and nonveterans. Predictors included age, gender, racial/ethnic identity, sexual orientation, marital status, education, health coverage, financial difficulty, social support, adverse childhood experiences (ACEs), and adult sexual trauma.

RESULTS

Population weighted regression models demonstrated that veterans reported modestly higher alcohol consumption than nonveterans, but were not significantly more likely to need intensive alcohol treatment. Veterans and nonveterans did not differ in past-year alcohol treatment utilization, but veterans were 2.8 times more likely to utilize lifetime treatment than nonveterans. We found several differences between veterans and nonveterans in associations between predictors and outcomes. For veterans, being male, having higher financial difficulty, and lower social support were associated with need for intensive treatment, but for nonveterans, only ACEs were associated with need for intensive treatment.

CONCLUSIONS

Veterans may benefit from interventions with social and financial support to reduce alcohol problems. These findings can help to identify veterans and nonveterans who are more likely to need treatment.

Social network moderators of brief alcohol intervention impact

OBJECTIVE

This investigation examined the impact of social networks on drinking reduction efforts following a brief alcohol intervention. In a reanalysis of data from an earlier randomized controlled trial with nonstudent emerging adult drinkers (Lau-Barraco et al., 2018), we aimed to test three domains of preintervention social network features as potential factors influencing intervention response: (a) general network characteristics (i.e., network size, network stability), (b) general network alcohol use (i.e., network alcohol abstainers, network heavy/problem drinkers), and (c) risky peers in network (i.e., proportion of drinking buddies, presence of drinking buddies identified as heavy/problem drinker).

METHOD

Participants were 164 emerging adult heavy drinkers recruited from the community (65.9% men; mean age = 21.98 years; 56.2% ethnic minority). Participants were randomly assigned to either a brief personalized feedback intervention (PFI) or assessment-only control and provided data at 1-month and 3-month follow-ups.

RESULTS

Greater network stability and greater representation of alcohol abstainers in one's social network were associated with improved initial postintervention response. Heavy/problem drinkers in the network did not moderate initial postintervention effects on drinking outcomes, but there was potentially a stronger intervention effect on risk reduction for those with higher proportions of drinking buddies in their network.

CONCLUSIONS

Study findings provided evidence that a PFI was efficacious in mitigating some risky social network influence. However, findings did not support a consistent impact across all the network variables examined. Future research is needed to further clarify social network influences and how they may be targeted to enhance intervention efficacy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Effects of Social Network and Institutional Embeddedness on Household Consumption: Evidence from China Household Finance Survey

Consumer behavior is embedded in a certain social structure and social networks, and the scale and density of household social networks will be likely to affect consumption expenditure. To explore the impact of social networks and institutional embeddedness on household consumption, this study constructs a model of consumption influencing factors, and devises an empirical study using the data of China Household Finance Survey (CHFS). The results show some innovation. (1) The impact of household social networks on total household consumption is significant. A 1% increase in social networks spending boosts household consumption spending by 0.364%. (2) The institutional embeddedness will affect household consumption. Every 1% increase of social security account balance (the proxy variable of institutional embeddedness) can boost household consumption by 0.196%. This proves that the social insurance institution can enhance consumer confidence and promote current consumption growth. (3) The results of the robustness test confirmed that even after replacing the dependent variable with “the proportion of developmental consumption in total household consumption,” the influence of social networks and institutional embeddedness on consumption is still significant. Using the variable “communication expenses” instead of “gift income and expenditure” as the proxy variable of social networks, the estimation result is still robust. (4) Social networks have a significant influence on all types of household consumption except medical care consumption, but the degree of influence is different. Further discussion revealed that the estimation results are different for different regions in China, but the coefficients of core independent variables are not significantly different. This conclusion is different from people’s intuition, which holds that people in regions with low economic development rely more on social communication and spend more on social communication to maintain a certain social status. The conclusion of this paper is of great significance for formulating policies and institutions affecting residents’ consumption.

Investigating extra-medical opioid use and social networks among people with post-traumatic stress disorder

Introduction

Post-traumatic stress disorder (PTSD) and extra-medical opioid Use (EMOU) frequently co-occur. Few studies have examined the relationship between EMOU and social networks among people with PTSD. Accordingly, this study examined social networks in a sample of people with PTSD in the United States by assessing the association between social network size/diversity and lifetime EMOU status.

Methods

Data came from a cross-sectional, nationally representative sample of adults who participated in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) from 2012 to 2013. For people with past-year PTSD (unweighted n = 1,764), social network size and diversity were estimated by lifetime EMOU status. Multivariable logistic regression models examined the association between social network size, diversity, and EMOU adjusting for sociodemographics, cigarette use, major depression, and anxiety disorder.

Results

Between 2012-2013, 24% of people with PTSD had lifetime EMOU. Those with EMOU had a lower social network size and diversity than individuals without EMOU (14 vs. 17 persons, 4 vs. 5 groups, p-values < 0.05). In adjusted models, EMOU was significantly associated with social network diversity (AOR = 0.91; 95% CI: 0.82, 0.99), but not with social network size (AOR = 1.00; 95% CI: 0.98, 1.01).

Conclusions

Less diverse social networks were associated with lifetime EMOU among people with PTSD. Future research should examine associations between the quality of social networks and EMOU, ideally from longitudinal studies.

Depressive symptoms are related to boredom proneness in patients receiving hospital care, regardless of alcohol status, lifestyle, or social support

We examined the relationship between boredom proneness and psychological distress in patients receiving hospital care due either to excessive alcohol consumption or to gastrointestinal diseases. Sociodemographic data were collected together with boredom proneness subscales (internal/external lack of stimulation), psychological distress, physical activity, and social support. Boredom proneness due to a lack of external stimulation seemed to constitute a prominent personality trait in patients with alcohol consumption. But depressive symptoms were related only to boredom proneness due to a lack of internal stimulation in all patients, regardless of alcohol status, lifestyle, or social support. Potential implications for practice and future research are discussed.

Sexual orientation, treatment utilization, and barriers for alcohol related problems: Findings from a nationally representative sample

BACKGROUND

Gay, lesbian, and bisexual (GLB) individuals appear to have an increased likelihood of alcohol use disorders and treatment utilization for alcohol related problems compared to heterosexual individuals. Despite this increase, treatment utilization rates among GLB individuals remain low. In an effort to address this, our paper examined whether or not GLB individuals encounter unique barriers when pursuing treatment for alcohol related problems.

METHODS

Using data from the National Epidemiologic Survey on Alcohol Related Conditions (NESARC), we examined service sector specific factors, some of which included (a) utilization rates, (b) self-reported treatment barriers, and (c) whether or not there were emergent differences among GLB individuals, after controlling for socio-demographic and clinical characteristics.

RESULTS

Findings indicated that GLB individuals reported higher severity rates for alcohol use disorders when compared to heterosexual individuals, and were significantly more likely to utilize treatment services for alcohol related problems, however, not across all treatment sectors. While similar patterns were observed when examining barriers to treatment, bisexual individuals reported significantly more barriers than heterosexual and gay/lesbian individuals.

CONCLUSION

These findings underscored the importance of identifying and developing interventions that addresses treatment barriers associated with alcohol use service utilization among GLB populations, and creating improved outreach and education programs to better address stigmas associated with substance use and sexuality.

Utilization of Alcohol Treatment Among HIV-Positive Women with Hazardous Drinking

Hazardous alcohol consumption has been frequently reported among women with HIV infection and is associated with a variety of negative health consequences. Treatments to reduce alcohol use may bring in health benefits. However, little is known regarding the utilization of alcohol treatment services among HIV+ women with hazardous drinking. Using data from the Women's Interagency HIV Study (WIHS), this study assessed utilization of any alcohol treatment in the past 6 months and performed multivariable logistic regression to determine correlates of receipt of any alcohol treatment. Among 474 HIV+ women reporting recent hazardous drinking, less than one in five (19%) reported recent utilization of any alcohol treatment. Alcoholics Anonymous (AA) was the most commonly reported (12.9%), followed by inpatient detoxification (9.9%) and outpatient alcohol treatment program (7.0%). Half (51%) receiving any alcohol treatment reported utilization of multiple treatments. Multivariable analyses found alcohol treatment was more often utilized by those who had social support (odds ratio [OR]=1.68, 95% confidence interval [CI]=1.00 to 2.83), fewer economic resources (income ≤$12,000 vs. >$12,000, OR=3.10, 95% CI=1.53 to 6.27), higher levels of drinking (16-35 drinks/week vs. 12-15 drinks/week, OR=3.02, 95% CI=1.47 to 6.21; 36+ drinks/week vs. 12-15 drinks/week, OR=4.41, 95% CI=2.03 to 9.59), and those who reported any illicit drug use (OR=2.77, 95% CI=1.44 to 5.34). More efforts are needed to enhance the utilization of alcohol treatment. Our findings highlight the unique profile of those who utilized alcohol treatment. Such information is vital to improve treatment delivery to address unmet need in this particular population.

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings

PURPOSE

The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking.

METHOD

NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized.

RESULT

The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers.

CONCLUSIONS

Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.

Latent class analysis of alcohol treatment utilization patterns and 3-year alcohol related outcomes

People who obtain treatment for alcohol use problems often utilize multiple sources of help. While prior studies have classified treatment use patterns for alcohol use, an empirical classification of these patterns is lacking. For the current study, we created an empirically derived classification of treatment use and described how these classifications were prospectively associated with alcohol-related outcomes. Our sample included 257 participants of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who first received alcohol treatment in the 3-year period prior to their baseline interview. We used latent class analysis to identify classes of treatment users based on their patterns of treatment use of 13 types of alcohol treatment. Regression models examined how classes of treatment use at baseline were associated with alcohol-related outcomes assessed at a 3-year follow-up interview. Outcomes included a continuous measure of the quantity and frequency of alcohol use and DSM-IV alcohol use disorder status. Four classes of treatment users were identified: (1) multiservice users (8.7%), (2) private professional service users (32.8%), (3) alcoholics anonymous (AA) paired with specialty addiction service users (22.0%), and (4) users of AA alone (36.5%). Those who utilized AA paired with specialty addiction services had better outcomes compared to those who used AA alone. In addition to elucidating the most common treatment utilization patterns executed by people seeking help for their alcohol problems, the results from this study suggest that increased efforts may be needed to refer individuals across sectors of care to improve treatment outcomes.

Impact of trauma symptomatology on personal networks among substance using women

BACKGROUND

Interpersonal trauma poses challenges and complications to the development and maintenance of personal networks of substance using women. Few studies have examined its effects on personal network support availability and quality of relationships, limiting our understanding of the social context in which substance using women with a history of trauma are embedded.

METHODS

Women with substance use disorders (SUD) who received treatment at three county-funded, women-only intensive treatment programs (N=375) were interviewed at intake and at follow ups 1, 6, and 12 months later. A network software program, EgoNet, elicited 25 network members per respondent, social support availability, and the quality of network relationship at each assessment. Trauma symptomatology was assessed with Trauma Symptom Checklist-40 at intake.

RESULTS

Findings from longitudinal mixed model analyses indicated that higher levels of trauma symptomatology were associated with both a negative, critical quality and less closeness in network relationships over the 12 month study period. However, trauma symptoms were not related to the number of network members reported as providing emotional, concrete, or sobriety support. Effects of trauma symptoms on the support availability in the network and the quality of network relationships were consistent over the follow-up period.

CONCLUSIONS

Findings highlight the potential role of trauma symptoms in determining the quality of relationships within personal networks among women with SUD, suggesting the need for routine mapping of network relationships throughout treatment.