Prevention and Treatment of Alcohol Problems Research Opportunities (1990) / Chapter Skim
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3 Individual-Environment Interactions: Focus on the Individual
3 Individual-Environment Interactions: Focus on the Individual
Pages 47-74
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From page 47... ...
The approaches chosen by the committee for inclusion in Part I are illustrative of the interactive perspective the committee believes would be most fruitful for prevention research in alcohol-related problems: that is, the individual in the context of the environment, both the specific drinking environment and the broader, total developmental setting. The first research approach uses life-course development and individual vulnerability as a framework for research to identify individuals, early in their lives, who may be at high risk of heavy alcohol use during adolescence.
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From page 48... ...
As stated by Zucker and Noll (1982:316~: A developmental view of behaviors, including that related to alcohol use and abuse, in its simplest form implies the ability to link age to drinking phenomena in an orderly way. The complexity of the problem, however, lies in the ability to trace out the vagaries of this process, and to specitr the exact pathways and interactions that both anticipate and produce the drinking behavior and problem or nonproblem sequelae.
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From page 49... ...
Examples of SAS predictors of later heavy alcohol use include poor school achievement and shy and aggressive classroom behavior, as rated by teachers (Kellam et al., 1975, 1983~. Risk Factors: Intraindividual and Environmental Domains A number of researchers have considered prevention from the vantage of intraindividual differences that are associated with the heavy use of alcohol.
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From page 50... ...
The Prospective Study: Characteristics and Advantages The goal of the life-course developmental approach to prevention is to identitr specific risk factors that may be useful in devising effective primary prevention programs. Prospective -50
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From page 51... ...
The prospective research strategy also allows for follow-up of multiple-problem outcomes. In the area of alcohol and other substance use, this capability is especially important because the heavy use of multiple substances combined with other problem outcomes is not uncommon (e.g., the co-occurrence of alcohol and drug abuse, of heavy alcohol use and major depression, and of substance abuse with schizophrenia spectrum disorders)
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From page 52... ...
In studies of the Woodlawn community in Chicago, aggressive behavior and the combination of aggressive and shy behavior in the first grade both were found to predict heavy alcohol use at ages 16 and 17 (Kellam, Brown, and Fleming, 1982; Kellam et al., 1983~. In a finding analogous to those results, McCord (1988b)
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From page 53... ...
will be all the more powerful. Research on Preventive Trials: Implications from Prospective Research Although more sophisticated prospective studies are needed to better understand the etiology of alcohol problems, there is already sufficient knowledge to direct preventive trials at specific modifiable antecedents of, and risk factors for, heavy alcohol use and other substance-related problem outcomes.
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From page 54... ...
, and childhood antisocial behavior has been found to be a risk factor for alcohol abuse (McCord and McCord, 1960; Robins, Bates, and O'Neal, 1962; Robins, 1966; Jones, 1968, 1971; Monnelly, Hartl, and Elderkin, 1983; Vaillant, 1983~. Should it be the case for the majority of individuals vulnerable to heavy alcohol use that these behaviors are learned responses rather than the product of a CNS dysfunction, it would be possible to develop and test preventive interventions that could be directed at modification of the behaviors themselves, modification of the environmental contingencies that reinforce and maintain the behaviors, or both.
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From page 55... ...
Femaleness as well as shyness appear to be strong inhibitors of both adolescent delinquency and substance use, and both variables are important to an understanding of the evolution of these outcomes. lithe following are opportunities for the next stage of prospective research into the etiology of heavy alcohol use from a developmental/epidemiological perspective: · The next stage of prospective research on heavy alcohol use and alcohol-related problems should be integrated with research into other problem outcomes (e.g., drug use, suicide, delinquency, mental disorders)
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From page 56... ...
Importance of Longitudinal Data Bases The longitudinal data on which life-course developmental research now rests are extremely important as a national resource for the next stage of prevention research. Yet some longitudinal data sets are in immediate jeopardy of disappearing due to a lack of funding.
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From page 57... ...
, and models based on cognitive social learning theory (Bandura, 1977, 1986; Blane and Leonard, 1987~. Alcohol-related problems have been conceptualized as resulting from low self-esteem and poor self-concept; moral deficiencies; underlying biochemical imbalances: inanDrooriate social norms within subcultures; or deficiencies in knowledge, attitudes, intentions, and alternative coping behaviors (Azjen and Fishbein, 1980; Perry, 1986~.
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From page 58... ...
there is minimization or denial of the long-term negative consequences. Individual variations exist in the severity of the immediate proximal demands, the social learning history and genetic vulnerability of the person, the availability of alcohol, the repertoire of current cognitive and behavioral coping skills, and the probability of perceived positive or negative consequences following behavior.
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From page 59... ...
· Recovery after episodes of abusive drinking will require interventions that are different from those used to prevent or reduce the likelihood of problems developing initially (e.g., relapse prevention coning skills trainings - r -- -= -- - ~~~ ~~ ~~~~~~~=, Implications of Social Learning Theory for Research on Prevention The central assumptions of a social learning perspective on the prevention of alcohol-related problems suggest various opportunities for prevention research. With respect to prevention, these assumptions place greater emphasis on the here-and-now (proximal)
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From page 60... ...
and Wilson (1988) draw attention to a social learning analysis of media portrayals of drinking that is relevant for prevention research (see Chapter 4~.
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From page 61... ...
Moderation or the controlled use of alcohol may be more acceptable as a goal for primary and secondary prevention programs than as an alternative to abstinence for the treatment of alcohol dependence (Heather and Robertson, 1983; Marlatt, 1984; Marlatt and Gordon, 1985~. Behavioral coping skills training methods can be used to achieve goals of either abstinence or moderate drinking.
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From page 62... ...
People can then be taught to titrate their blood alcohol level with such methods as spacing drinks over time, interchanging nonalcoholic drinks with alcoholic beverages, and consuming beverages with a lower alcohol content (Hay and Nathan, 1982; Miller and Munoz, 1982~. Cognitive Restructuring Cognitive restructuring interventions are based on social learning theory models that consider expectancy and self-efficacy to be critical elements in behavior change.
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From page 63... ...
For example, the perceived negative consequences of alcohol abuse may begin to outweigh the perceived benefits of use. Once individuals move from contemplation into readiness for action, the specific prevention strategies change from consciousness raising, support, and education to coping skills training.
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From page 64... ...
The committee recommends controlled trials to test the efficacy of matching versus mismatching or no matching. Suggested questions for testing include the following: Is it necessary to have special programs for adolescent children of alcoholics, or could they benefit as much as other adolescents from general coping skills training programs given to all adolescents as part of a brief, standardized curriculum package?
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From page 65... ...
Studies should focus on advancing theoretical models of diffusion by extending individual change concepts to group, social network, organizational, community, and higher levels of social structure. · Basic assessments, analogue research, and clinical trials are required that will focus on promising targets for preventive interventions and on understanding their mediating mechanisms -- when and why treatments work and on whom.
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From page 66... ...
Future researchers may find the matching of particular patterns of susceptibility vulnerability to specific preventive interventions a very fruitful avenue of investigation. REFERENCES Ablon, J
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From page 67... ...
Social learning theory of alcohol abuse.
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From page 68... ...
Siguardson. Inheritance of alcohol abuse: Cross-fostering analysis of adopted men.
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From page 69... ...
Prevention Research: Deterring Drug Abuse Among Children and Adolescents. NIDA Research Monograph No.
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From page 70... ...
C Personality correlates and antecedents of drinking patterns in adult males.
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From page 71... ...
Society, Culture and Drinking Patterns. New York: John Wiley and Sons, 1962.
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From page 72... ...
Binkoff et al. The relevance of social skills training for alcohol and drug abuse problems.
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From page 73... ...
The variability of drinking patterns and problems among young men, ages 16-31: A longitudinal study.
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From page 74... ...
Research on Alcoholism: Clinical Problems and Special Populations. Proceedings of the First Annual Alcoholism Conference of the National Institute on Alcohol Abuse and Alcoholism.
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