Mode of mutual-help group attendance: Predictors and outcomes in a US national longitudinal survey of adults with lifetime alcohol use disorder.

INTRODUCTION: Although attending substance use-focused mutual-help meetings online may reduce attendance barriers, associations of attendance mode with group participation and outcomes are unknown. Using longitudinal data from mutual-help group attendees, this study, after identifying differences in baseline characteristics by attendance mode, examined associations of attendance mode with mutual-help participation (number of meetings attended, involvement) and outcomes (alcohol abstinence, heavy drinking, alcohol problems). METHODS: The Peer Alternatives for Addiction Study 2021 Cohort sampled attendees of 12-step groups (e.g., Alcoholics Anonymous), Women for Sobriety, LifeRing Secular Recovery, and/or SMART Recovery in-person and/or online within 30 days before baseline. The baseline sample, recruited in fall 2021, was 531 adults with lifetime alcohol use disorder, followed at 6 (88 %) and 12 months (85 %). Differences in baseline characteristics by attendance mode were tested using Chi-squares and ANOVAs. GEE models examined associations of attendance mode, time, and their interactions with mutual-help group participation and alcohol outcomes. The in-person only mode was compared to the online-only, and to the in-person plus online, modes. RESULTS: At baseline, 53.7 % of participants had attended only online meetings in the past 30 days, 33.7 % had attended both in-person and online meetings, and 12.6 % had attended only in-person meetings. Online meeting attendees were less likely to endorse lifetime abstinence as an alcohol recovery goal than in-person-only meeting attendees. In adjusted models (including for recovery goal), those attending online meetings only, or both online and in-person meetings, attended a greater number of meetings compared to those attending only in-person meetings. However, online-only attendance was associated with less involvement than in-person-only attendance. In adjusted models, compared to baseline, involvement increased and outcomes improved at follow-ups. Adjusted models examining alcohol outcomes found that no attendance at mutual-help groups at follow-ups was associated with more heavy drinking compared to in-person-only attendance. CONCLUSIONS: Findings inform efforts to ascertain benefits of mutual-help group participation by suggesting that online attendance is associated with attending more meetings, less involvement, and lower endorsement of abstinence as a recovery goal, and is comparable to in-person attendance on alcohol outcomes. In-person attendance may be more beneficial for less heavy drinking than terminating attendance.

Prevalence and correlates of 12-step and second-wave mutual-help attendance in a nationally representative US sample.

BACKGROUND: Mutual-help organizations (MHOs) are effective community-based, recovery support options for individuals with alcohol and other drug use disorders (i.e., substance use disorder; SUD). Greater understanding of second-wave MHOs, such as SMART Recovery, can help build on existing research that has focused primarily on 12-step MHOs, such as Alcoholics Anonymous, to inform scientific, practice, and policy recommendations. METHODS: We conducted a secondary analysis of the National Recovery Study, a representative sample of US adults who resolved a substance use problem (N = 1984). Using survey-weighted estimates, we examined descriptive statistics for any lifetime, weekly lifetime, and past 90-day MHO attendance; we compared rates of 12-step and second-wave MHO attendance over time by descriptively examining distributions for calendar year of the first meeting attended. We also used two logistic regression models to examine demographic, substance use, clinical, and recovery-related correlates of weekly lifetime attendance separately for 12-step (n = 692) and second-wave MHOs (n = 32). RESULTS: For any attendance, 41.4% attended a 12-step MHO and 2.9% a second-wave MHO; for weekly attendance, 31.9% attended a 12-step MHO, and 1.7% a second-wave MHO. Two-thirds (64%) of initial second-wave attendance occurred between 2006 and 2017 compared to 22% of initial 12-step attendance during this time frame. Significant correlates of weekly 12-step MHO attendance included histories of SUD treatment and arrest. Significant correlates of weekly second-wave MHO attendance included Black identity (vs. White) and history of SUD medication. CONCLUSIONS: Attendance at second-wave MHOs is far less common than 12-step MHOs, but appears to be on the rise. Observed correlates of second-wave MHO attendance should be replicated in larger second-wave MHO samples before integrating these findings into best practices. Enhanced linkages from clinical and criminal justice settings to both second-wave and 12-step groups may help to "broaden the base" of MHOs.

Disparities in Alcoholics Anonymous Participation from 2000 to 2020 Among U.S. Residents With an Alcohol Use Disorder in the National Alcohol Survey.

OBJECTIVE: Mutual-help groups (MHGs) like Alcoholics Anonymous (AA) are effective for resolving alcohol use disorders (AUDs), but few studies have examined disparities in MHG participation, particularly recently. We used five waves of National Alcohol Survey data to investigate whether prevalence of AA attendance among those with a lifetime AUD differed by race/ethnicity, age, and sex, directly testing whether these associations varied with time. METHOD: Analyses pooled weighted data from 2000 to 2020, including only participants with a lifetime AUD and identifying as non-Hispanic White, Latinx/Hispanic, or non-Hispanic Black/African American (N = 8,876). Logistic regression models examined associations between lifetime AA attendance and survey year, race/ethnicity, age, and sex; models also tested for differences in demographic effects across survey year using interaction terms. RESULTS: In bivariate models, AA attendance was significantly less prevalent among participants identifying as Latinx/Hispanic (vs. White); ages 18-29 (vs. 30-64); and female (vs. male). Survey year was unrelated to AA attendance, and all interactions involving survey year were nonsignificant. In the final multivariate model (which controlled for severity and other help-seeking), disparities persisted for those identifying as Latinx/Hispanic (vs. White; adjusted odds ratio [aOR] = 0.63) and ages 18-29 (vs. 30-64; aOR = 0.35); AA attendance was also less prevalent among Black/African American (vs. White) participants (aOR = 0.59), but sex became nonsignificant. CONCLUSIONS: Results replicate and extend sparse findings regarding disparities in MHG attendance and suggest a stagnation in AA's growth and reach to underserved populations. Findings highlight the need to more effectively facilitate MHG attendance (and perhaps broader social network change) among racial/ethnic minorities and emerging adults.

Understanding the social and community support experiences of sexual and gender minority individuals in 12-Step programs.

Sexual and gender minority individuals (e.g., gay, bisexual, non-binary, transgender; SGMI) are 2-6 times as likely as cisgender heterosexual individuals to experience alcohol or other substance use disorders. SGMI participate in 12-Step groups, such as Alcoholics Anonymous (AA), at high rates. Though social support is an established mechanism through which 12-Step programs support reductions in substance use, little is known about SGMI's experiences of the social support in 12-Step programs. This qualitative study aims to understand the experiences of social and community support among SGMI involved in 12-Step programs. This study employed thematic analysis to interpret open-ended responses from 302 SGMI who had participated in 12-Step programs. Data was from The PRIDE Study, a large, national, online. longitudinal, cohort study of SGMI. Two themes emerged about how SGMI experienced social and community support in 12-Step programs: beneficial connections and harmful environments. Beneficial connections included a sense of community, shared experiences, and skills provision. Harmful environments included marginalization, oppression, violence, and bullying. This study highlights the variability of experiences of SGMI participating in 12-Step programs. These findings suggest that many SGMI may benefit from 12-Step programs but may need support in coping with potential harms that can emerge through participation.

Understanding the Shared Meaning of Recovery From Substance Use Disorders: New Findings From the What is Recovery? Study.

Background: Substance use disorder (SUD) resolution typically involves a long-term, comprehensive process of change now widely referred to as "recovery." Yet, definitions of recovery vary substantially, producing significant confusion. To support formal recovery definitions, we aimed to systematically identify recovery elements that are central to those in recovery and shared regardless of subgroup/pathway. Methods: Data were from the What is Recovery? Study, involving a diverse, national, online survey of people in recovery (N = 9341). Surveys included a 35-item recovery measure reflecting 4 domains; participants reported whether or not each element definitely belonged in their recovery definitions. Analyses examined item endorsements overall and among 30 subgroups defined a priori (by sociodemographics, substance use characteristics, and help-seeking history) to determine where items met study-specific centrality thresholds (ie, endorsement by ⩾80% and top-10 ranking, by endorsement level). We then classified items as "core" if meeting centrality thresholds both overall and for all 30 subgroups, and "prevalent" if meeting centrality thresholds overall and for 26 to 29 subgroups. Results: Four "core" recovery elements emerged, including a process of growth or development; being honest with oneself; taking responsibility for the things one can change; and reacting in a more balanced way. Four "prevalent" recovery elements also emerged, referencing the ability to enjoy life and handle negative feelings without substance use; abstinence and/or nonproblematic substance use; and living a life that contributes. Subgroups differing most in their endorsements included those reporting mild/moderate SUD severity; non-abstinent recovery; and no specialty treatment or mutual-help group attendance. Conclusions: Recovery elements identified here partially reflect some stakeholder definitions, but offer greater specificity and include novel elements (eg, personal integrity). Elements may point to areas of functioning that are damaged in the addiction process and can support an addiction-free life. Findings should inform institutional recovery definitions; SUD services and research; and communications about recovery.

Higher perceived stress during admission is associated with shorter retention in short-term residential substance use disorder treatment.

Introduction: Over one million people in the U.S. received residential treatment for a substance use disorder (SUD) in 2020. Longer treatment retention is associated with better outcomes (e.g., reduced substance use). Entering treatment with higher stress may be associated with shorter retention. This paper examines the impact of perceived stress at admission on SUD treatment retention in short-term residential treatment. Methods: A sample of 271 treatment episodes with admissions between October 2019 and February 2020 were collected from de-identified records of an urban mid-Atlantic adult 28-day short-term residential SUD treatment facility. Treatment completion involved finishing 28 days. Sociodemographic, substance use, perceived stress, and treatment discharge variables were analyzed. Bivariate analyses examined differences between treatment completion and early discharge, and Cox regression investigated the effect of perceived stress on treatment retention with covariates. Results: The sample was primarily male (73.8%) and non-Hispanic Black (71.6%). A majority used heroin as their primary substance (54.6%) and reported polysubstance use (72.3%). About half (51.3%) completed treatment, and completed an average of 18.7 (SD = 10.7) days. Those who prematurely discharged from treatment stayed an average of 8.9 (SD = 7.0) days. The Cox regression model found that higher perceived stress (adjusted hazard ratio (AHR) = 1.028; 95% CI = [1.005, 1.053], p =.019) and a race/ethnicity other than non-Hispanic Black (AHR = 1.546, 95% CI = [1.037, 2.305], p =.033) predicted premature discharge. Conclusions: Perceived stress at admission is associated with shorter treatment retention. Early stress management interventions may help increase treatment retention.

Neighborhood Contexts and Alcohol Use Disorder Among Mexican Americans Living in the US-Mexico Border Region.

AIMS: This study assessed contributions of exposure to neighborhood stressors (violent victimization, witnessing crime, greater alcohol and drug availability) to variation in alcohol use disorder (AUD) symptoms among drinkers in three cities in Texas, USA. METHODS: We used data from interviews conducted from 2011 to 2013 with Mexican-origin adults (ages 16-65) in the US-Mexico Study of Alcohol and Related Conditions who were past-year drinkers (N = 1960; 55% male) living in two cities in the Texas-Mexico border region (Laredo, n = 751 and Brownsville/McAllen, n = 814) and one interior comparison site (San Antonio, n = 771). Analyses (conducted in 2018 and 2019) examined overall and gender-stratified multilevel mediated effects of each border site (versus San Antonio) on AUD symptoms through the neighborhood-level factors, adjusting for individual- and neighborhood-level covariates. RESULTS: Overall, drinkers in Laredo reported more AUD symptoms than drinkers in the other cities, and their neighborhoods had more witnessing of crime and greater perceived drug availability, as well as higher levels of disadvantage and a lower proportion non-Hispanic White residents, than neighborhoods in San Antonio. Witnessing neighborhood crime was associated with increased AUD symptoms, while neighborhood disadvantage and proportion non-Hispanic White residents each were negatively associated with AUD symptoms. Perceived neighborhood insecurity, crime victimization, perceived neighborhood drug availability and neighborhood alcohol availability (off- and on-premise) were not significantly associated with AUD symptoms. Stratified models suggested possible gender differences in indirect effects through witnessing neighborhood crime. CONCLUSION: Reducing witnessing of neighborhood crime may help reduce AUD symptoms among adults living in the US border region.

Alcohol- and Drug-Related Mortality Among Adults Within and Outside the U.S.-Mexico Border Region.

OBJECTIVE: Although researchers and policy makers have often considered the U.S.-Mexico border region to be at high risk for substance use problems, epidemiological studies of this region have been hard to interpret because of their modest geographic coverage, reliance on self-report, and mixed results. The current study addresses limitations of existing studies and extends the knowledge base by comparing alcohol- and drug-related mortality in counties on versus off the border across all four U.S. border states. METHOD: Data were from the 2008-2017 Centers for Disease Control and Prevention WONDER Multiple Causes of Death data set, American Community Survey, and Rural Urban Continuum Codes, including all four border states. Spatial lag models tested differences across on- and off-border counties in total alcohol- and drug-related mortality ("total mortality"), alcohol-related mortality, and drug-related mortality. RESULTS: In multivariate models, mortality rates were significantly higher in off- versus on-border counties for all three outcomes (ps < .05). Rates for total mortality, alcohol-related mortality, and drug-related mortality were 28%, 82%, and 30% higher, respectively, off versus on the border. Border effects were similar, excluding California; robust over time; and stronger for Latinx versus White decedents. CONCLUSIONS: Results suggest a revised understanding of the border, revealing that residents of interior counties of border states are at highest risk of severe substance use consequences. Results are consistent with other research finding that border counties were protected against drug overdose deaths, particularly for Latinx residents.

Predictors and outcomes of online mutual-help group attendance in a national survey study.

INTRODUCTION: During the COVID-19 pandemic, online video platforms became the primary mode of accessing substance use-focused mutual-help group meetings, which may persist after in-person meetings are available again. This study examined the characteristics (demographic, substance use and recovery, and mutual-help group use) of attendees of online recovery support meetings, and associations of online meeting attendance with substance use outcomes, using national data (without ensured representativeness) collected before the pandemic. METHODS: Data were from the Peer Alternatives in Addiction (PAL) Study of attendees of 12-step groups (e.g., Alcoholics Anonymous), Women for Sobriety (WFS), LifeRing Secular Recovery (LifeRing), and SMART Recovery (SMART). The baseline sample, collected in 2015 (pre-pandemic), was 647 adults with lifetime alcohol use disorder who were surveyed online at baseline and 6-month (81%) and 12-month follow-up (83%). RESULTS: At baseline, 62% (n = 402) had attended an online mutual-help group meeting in their lifetime, and 36% (n = 236) had done so in the past 30 days. Bivariate analyses found that online meeting attendance was more likely among women than men, younger than older participants, and participants with more recent alcohol and drug use, and less abstinence self-efficacy. In addition, online meeting attendance was more likely among respondents who attended two or more different types of mutual-help groups (rather than just one type), and whose primary group was 12-step or WFS rather than LifeRing or SMART. Longitudinal analyses found an interaction between online meeting attendance (yes or no) and time on the outcomes of alcohol and total abstinence such that, compared to those who did not attend online meetings, online meeting attendees were less likely to be abstinent at baseline but were about the same on abstinence at 12 months. However, the interaction effect was attenuated when the model adjusted for mutual-help use characteristics. CONCLUSIONS: The findings inform mutual-help groups, providers, and researchers' efforts to sustain and expand this resource by suggesting that online meeting attendance may have appeal and be helpful to mutual-help group members who are earlier in their recovery.

Maintaining recovery from alcohol use disorder during the COVID-19 pandemic: The importance of recovery capital.

BACKGROUND: The potential impact of the COVID-19 pandemic on recovery from alcohol use disorder (AUD) has received scant attention to date. In response, we investigated the stability of recovery and identified correlates of relapse, with particular interest in differences between women and men. METHODS: Data were obtained in a national survey of adults with resolved alcohol use disorder who were not drinking heavily (n = 1492). We calculated summary statistics and modeled odds of mild relapse (i.e., resolved at the time of data collection), overall and stratified by gender. RESULTS: Equivalent large majorities of women and men reported that the COVID-19 pandemic had not affected their recovery at all (88.9% and 88.8%, respectively). Mild relapse events were infrequent, with only 45 participants (3.1%) reporting a resumption of drinking after being abstinent and 35 participants (2.7%) reporting an increase from previously moderated drinking, with no differences in prevalence between men and women. Recovery capital showed consistent and comparable protective effects for both women and men (adjusted odds ratio [aOR] 0.90; 95% confidence interval [95% CI] 0.84, 0.97; and aOR 0.93; 95% CI 0.88, 0.98, respectively). We did not find any effect of pandemic-related stressors; however, there were a number of distinct correlates of mild relapse for women and men. CONCLUSIONS: Recovery capital showed a consistently protective effect and may serve as a highly suitable intervention target as it is modifiable. Given gender differences, assessments of other key factors and tailored interventions targeting women and men may be necessary to ensure stable recovery.

Barriers to retention in substance use treatment: Validation of a new, theory-based scale.

PURPOSE: Few studies and no theory-based scales have addressed specific barriers to substance use disorder (SUD) treatment retention. The current study, building on the Theory of Planned Behavior (TPB), sought to (a) identify those barriers that are most strongly associated with treatment retention, and most common, and (b) develop and validate a new scale of retention barriers, focusing on TPB attitude and perceived control components. METHODS: The study administered surveys to 200 participants initiating SUD treatment at a public, outpatient program in Northern California; the analytic sample (N = 156) included only those not strongly coerced into treatment. Surveys included TPB-based measures of treatment barriers; other motivational readiness measures; treatment coercion and social desirability measures; and clinical severity variables and demographics. Discharge status was collected from program records. RESULTS: Item and scale analyses identified three dimensions of attitudinal barriers (i.e., Low Perceived Treatment Need/Value, Social Concerns, and Concerns about Missing Substances) and two dimensions of perceived control barriers (i.e., Personal Limitations and Basic Logistic Barriers). Results informed creation of a 19-item Barriers to Retention Scale (BRS) with 5 subscales and very good internal reliability (alpha = 0.88). While all subscale scores were correlated with treatment completion, only Concerns about Missing Substances and total BRS scores predicted treatment completion in multivariate analyses. CONCLUSIONS: The present study identified core dimensions of treatment retention barriers and developed a new scale predictive of treatment completion and potentially useful as a screener and in future research. Results suggest that interventions to improve retention should focus strongly on concerns about the negative impacts of abstaining from alcohol and drugs on craving and quality of life.

Rates and predictors of Alcoholics Anonymous attendance across sexual orientations.

Sexual minority (e.g., gay, lesbian, bisexual) individuals experience alcohol dependence at 2-6 times the rates of heterosexual individuals. Among the general population, Alcoholics Anonymous (AA) serves as the most common source of support for alcohol-related problems in the United States. Yet, relatively little is known about sexual minority involvement in AA, including rates and predictors of AA attendance among sexual minorities. This paper aims to: 1) Compare rates of AA attendance across sexual orientations; 2) Compare relationships between AA attendance and common predictors of AA attendance across sexual orientations. Using five waves of the National Alcohol Survey (N = 7862 respondents with at least one lifetime AUD symptom), this study found lesbian and bisexual women, but not gay and bisexual men, had greater odds of attending AA, even while controlling for lifetime AUD severity, gender, race/ethnicity, age, religiosity, and current income. Interaction models for women showed there was a stronger association between older age and AA attendance, a stronger association between greater religiosity and AA attendance, and a weaker association between lifetime AUD severity and AA attendance for sexual minority women relative to heterosexual women. This study did not find significant interactions between sexual orientation and these covariates for men. These results suggest AA may serve as a promising resource for sexual minority individuals experiencing alcohol-related problems, particularly for sexual minority women who are older, more religious, and have less severe AUD.

Racial/Ethnic Disparities in Mutual Help Group Participation for Substance Use Problems.

Mutual help groups are a ubiquitous component of the substance abuse treatment system in the United States, showing demonstrated effectiveness as a treatment adjunct; so, it is paramount to understand whether they are as appealing to, and as effective for, racial or ethnic minority groups as they are for Whites. Nonetheless, no known comprehensive reviews have examined whether there are racial/ethnic disparities in mutual help group participation. Accordingly, this study comprehensively reviewed the U.S. literature on racial/ethnic disparities in mutual help participation among adults and adolescents with substance use disorder treatment need. The study identified 19 articles comparing mutual help participation across specific racial/ethnic minority groups and Whites, including eight national epidemiological studies and 11 treatment/community studies. Most compared Latinx and/or Black adults to White adults, and all but two analyzed 12-step participation, with others examining "self-help" attendance. Across studies, racial/ethnic comparisons yielded mostly null (N = 17) and mixed (N = 9) effects, though some findings were consistent with a racial/ethnic disparity (N = 6) or minority advantage (N = 3). Findings were weakly suggestive of disparities for Latinx populations (especially immigrants, women, and adolescents) as well as for Black women and adolescents. Overall, data were sparse, inconsistent, and dated, highlighting the need for additional studies in this area.

Understanding differences in prescription drug misuse between two Texas border communities.

Objectives: The misuse of prescription drugs in the U.S. is an alarming public health crisis. Prior research at the U.S.-Mexico border has found high rates of prescription drug misuse, but with rates varying significantly across border communities. We aimed to examine a model of permissive climate measures and stress exposures as potential mediators of community differences in prescription drug misuse at the U.S.-Mexico border.Design: We analyzed data from the U.S.-Mexico Study of Alcohol and Related Conditions (UMSARC). Household, in-person interviews were conducted with Mexican-origin residents of the Texas border cities Laredo (n = 751) and Brownsville/McAllen (n = 814). Interviews assessed past-year misuse of any and pain-reliever prescription drugs. Drug availability, neighborhood safety, exposure to violence/crime, and social support were examined as potential mediators. Analyses were stratified by gender and employed regressions and mediation analysis with Mplus.Results: The past-year prevalence of any prescription drug misuse in Laredo was 26.3% among women and 24.4% among men, and in Brownsville/McAllen was 12.4% among men, and 6.7% among women. Mediation analysis revealed site effects via some of the hypothesized risk factors for men, but not for women. Specifically, for men, site effects on any and pain reliever prescription drug misuse were partially mediated via high drug availability and low family support.Conclusions: Past-year prescription drug misuse was over 3 times the 2015 national prevalence among both men and women in Laredo and calls for immediate attention. Findings regarding the model suggest drug availability and social support may be relevant to understanding community differences in prescription drug misuse among men living at the border, and that additional factors should be investigated to understand misuse among women living at the border.

Limited treatment accessibility: Implications for alcohol treatment disparities among Mexican Americans living in the U.S.-Mexico border region.

PURPOSE: Receipt of alcohol-related care for alcohol use is particularly low among those residing in the U.S.-Mexico border region. One reason for this disparity may be limited treatment accessibility, making it difficult for those who need it to access needed treatment. The current study assesses whether differences in treatment utilization are mediated by differences in treatment accessibility in cities within and outside of the border region. METHODS: We used data from the U.S.-Mexico Study of Alcohol and Related Conditions involving a probability sample of Mexican-origin adults surveyed in three cities in Texas (2011-2013). We included only participants with a lifetime history of alcohol use disorder (AUD) (n = 792). We examined two lifetime measures of self-reported alcohol treatment utilization: considering getting help for an alcohol problem and receipt of treatment. We geocoded locations of facilities listed in the SAMHSA National Directory of Drug and Alcohol Abuse Treatment Facilities. We considered three types of facilities: any outpatient treatment, programs offering fee assistance, and programs offering Spanish-language services. We measured treatment accessibility by density of treatment (i.e., number of facilities within a 20-mile radius of participant's residence) and proximity to treatment (i.e., travel time to nearest facility). We assessed direct and indirect effects of two cities in the border region (versus one nonborder city) on the outcomes through treatment accessibility using generalized structural equation models that accounted for clustering of respondents in cities and in neighborhoods, weighted for sampling and nonresponse and adjusted for covariates. RESULTS: Of 792 respondents with lifetime AUD, 22% had considered getting help and 11% had received treatment, with consideration of getting help being less likely in cities in the border region. We observed no significant differences in treatment receipt across cities. Reduced densities of all three types of treatment programs were significant mediators for the effect of residing in a border region on considering getting help. Time to nearest Spanish-language program also mediated the effect of residing in a border region on considering getting help for one city. CONCLUSIONS: Border cities had lower density of treatment and because treatment density was positively associated with considering getting help, residence in a city in the border region was associated with lower odds of considering getting help, regardless of type of treatment. These findings suggest increasing the number of treatment locations available within cities along the U.S.-Mexico border may encourage those with AUD to consider getting help.

Neighborhood Context and Drug Use Among Mexican Americans on and off the U.S.-Mexico Border.

OBJECTIVE: Prior research has suggested that drug use rates may be high at the U.S.-Mexico border, but in more recent research rates varied significantly between border communities. This study reports findings on the mediating influence of neighborhood-level variables on the observed difference in past-year drug use rates between two border sites and an interior site, focusing on Mexican Americans. METHOD: Data were analyzed from the U.S.-Mexico Study on Alcohol and Related Conditions (UMSARC) on 1,345 Mexican-origin respondents ages 18-40 from the border sites of Laredo and Brownsville/McAllen compared with the nonborder site of San Antonio, separately for men and women. Neighborhood-level variables (based on census tracts and block groups) included drug availability, neighborhood insecurity, crime victimization, crime witnessing, off-premise alcohol outlet density, on-premise alcohol outlet density, percentage crossing the border more than 100 times, neighborhood disadvantage, residential stability, and percentage of White/non-Hispanic. RESULTS: When individual sociodemographic characteristics were controlled for, lower drug use among men in Brownsville/McAllen (vs. San Antonio) was partially mediated by lower drug availability and lower perceived neighborhood insecurity whereas increased drug use among women in both Laredo and Brownsville/McAllen was partially mediated by the lower proportion of White/non-Hispanic residents compared with San Antonio. CONCLUSIONS: Neighborhood-level variables partially explain the heterogeneity in drug use across sites at the U.S.-Mexico border, but different factors appear to be operating for men compared with women. These findings suggest the potential importance of addressing neighborhood factors in reducing drug-related harm at the U.S.-Mexico border.

The Downward Spiral: Socioeconomic Causes and Consequences of Alcohol Dependence among Men in Late Young Adulthood, and Relations to Racial/Ethnic Disparities.

BACKGROUND: While young adults are generally at highest risk for alcohol problems, not all age out of problem drinking. Evidence suggests that Blacks and Latinos age out more slowly than Whites, particularly among men. Targeting men, we investigated whether differences in lifecourse SES might explain racial/ethnic disparities in alcohol dependence in late young adulthood, along with how experiencing alcohol dependence at that life stage relates to subsequent SES. METHODS: We used longitudinal, national data to (i) describe racial/ethnic disparities in late young adult alcohol dependence criteria (LYADC), (ii) examine whether income trajectory in early young adulthood contributes to these racial/ethnic disparities, and (iii) test whether LYADC reciprocally predicts income trajectory in early midlife. Data were from the 1979 National Longitudinal Survey of Youth (N = 3,993), which measured LYADC in 1994 (mean age = 33). Income trajectory classes were derived for early young adulthood (mean ages = 21 to 31) and, separately, early midlife (mean ages = 35 to 45). Analyses included negative binomial regressions and multinomial regressions. RESULTS: Both Black and US-born Latino men reported more LYADC than White men. Further, membership in the persistently low and slow increase (vs. stable middle) early young adult income trajectory classes was associated with more LYADC. Multivariate analyses suggested that Black-White disparities in LYADC were explained by early young adult income trajectories, whereas Latino-White disparities in the same were explained by both early young adult income trajectories and early education. In controlled models, more LYADC predicted a higher likelihood of membership in the persistently low (vs. stable middle) income trajectory class in early midlife. CONCLUSIONS: This study found that poorer SES in early adulthood contributes to alcohol dependence, which reciprocally contributes to poorer SES in early midlife. This cycle appears particularly likely to affect Black and US-born Latino men. Results underline the need to address socioeconomic factors in addressing racial/ethnic disparities in alcohol problems.

Ambivalent attendees: Transitions in group affiliation among those who choose a 12-step alternative for addiction.

BACKGROUND: Mutual-help alternatives for addiction are numerous, and research attests to the benefits of involvement in such alternatives. Yet, virtually nothing is known about affiliation patterns over time among 12-step alternatives. We investigated the patterns, correlates, and outcomes of transitions in affiliation (including changing groups and dropping out) within alternatives for alcohol problems. METHODS: We analyzed data from the Peer ALternatives for Addiction (PAL) Study, a longitudinal study comparing the nature and effectiveness of 12-step groups, WFS, LifeRing, and SMART (N = 647). First, using all data, we compared affiliation patterns over time across 12-step and 12-step alternative members at baseline. Second, analyzing exclusively 12-step alternative members at baseline, we compared baseline characteristics and 6-month outcomes of those who changed and dropped out of (vs. retained) their primary groups at 6 months. RESULTS: While drop-out rates were low, and similar, across groups, members of the alternatives were more likely (vs. 12-step) to change groups at 6 months, and transitioned predominantly to 12-step. Further, among the 12-step alternatives, both changing groups and dropping out was associated with lower group cohesion and satisfaction. Meanwhile, in multivariate analyses of 6-month outcomes, changing (vs. retaining) groups robustly predicted lower cohesion, higher negative affect, and lower quality of life, whereas dropping out was associated with lower odds of alcohol abstinence. CONCLUSIONS: While dropping out is known to be risky, changing groups is more common among the 12-step alternatives, and connotes risk of future problems that may be partially explained by dissatisfaction with the new group (usually 12-step).

Feasibility of a mail-in, self-administered dried blood spot collection method in national, population-based alcohol surveys in the United States.

BACKGROUND AND AIMS: Including a low-intensity blood collection method in population-based alcohol studies would advance our ability to study biological mechanisms related to alcohol. However, the likelihood of participation in such a blood collection method remains understudied. This study's primary aims were to (1) estimate the return rate of mail-in, self-administered dried blood spot (saDBS) samples in national surveys and (2) test correlates of returning a sample. DESIGN: Re-contact of all eligible participants from two telephone, population-based alcohol surveys followed by χ2 tests and multivariate logistic regression analysis. SETTING: Non-institutionalized US population in all 50 states and Washington, DC. PARTICIPANTS: Adults aged 18+ who reported drinking at least one alcoholic beverage in the past 12 months (assessed 2017-18). Contact was made with 680 eligible participants, and 257 consented. MEASUREMENTS: The return rate of saDBS samples was defined as the proportion of returned samples among those who were eligible and contacted. Key correlates examined were gender, age, race/ethnicity and education. FINDINGS: Among the 680 eligible people contacted, 179 (26.3%) returned a saDBS sample. Blacks [odds ratio (OR) = 0.58, 95% confidence interval (CI) = 0.35-0.95], Latinos (OR = 0.40, 95% CI = 0.23-0.69) and those with a high school education or less (OR = 0.50, 95% CI = 0.31-0.81). CONCLUSIONS: The likelihood of participating in mail-in, self-administered dried blood spot (saDBS) sampling among drinkers in the US general population appears low, and blacks, Latinos and people with lower levels of education appear less likely to provide a saDBS sample compared with whites and people with higher levels of education.

Gender Differences in Use of Alcohol Treatment Services and Reasons for Nonuse in a National Sample.

BACKGROUND: The majority of adults with alcohol use disorders do not obtain help, and women are less likely to utilize alcohol services than men. We sought to quantify gender differences in alcohol services utilization, overall and by type, using national longitudinal data and to explore potential gender differences in perceived need for help and reasons for not seeking help. METHODS: We analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions from White, African American, and Hispanic adults (n = 2,592) who met DSM-IV criteria for alcohol abuse or dependence at Wave 1 (2000 to 2001). We tested gender differences in Wave 2 (2004 to 2005) services utilization, perceived need for help, and treatment barriers using Rao-Scott chi-square tests and assessed predictors of outcomes in multivariable logistic regression, adjusting for problem severity, co-occurring disorders, and demographics. RESULTS: Women had much lower odds than men of utilizing any alcohol service (adjusted odds ratio [aOR] 0.53; 95% confidence interval [95% CI]: 0.33, 0.86), specialty services (aOR 0.41; 95% CI 0.19, 0.87), and 12-step groups (aOR 0.39; 95% CI 0.21, 0.71). Perceived need for help among those who had not used any services was very low (5%), with no gender difference. Further, men and women reported equivalent numbers of treatment barriers and the same rank order for the most frequently endorsed barriers. However, women were twice as likely as men to think a problem would get better by itself-the most frequent reason for not seeking help (47% vs. 24%, p < 0.001), and men were more likely than women to report unsuccessful past help-seeking and not thinking anyone could help (19% vs. 3%, p < 0.001 and 17% vs. 5%, p = 0.001, respectively). CONCLUSIONS: Consistent with previous studies, women were less likely to utilize alcohol services than men. Future interventions should address low problem recognition, and tailoring to gender-specific barriers may help close the disparity in services utilization.