Pathways of readiness to change young adult alcohol use : lessons learned from civilian community health facilities
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The primary aim of this study was to enhance understanding of readiness to change excessive alcohol use in young adults, ages 18-29 in order optimize clinical care for military personnel. Secondary data analysis was conducted using Structural Equation Modeling (SEM) with a proxy sample of community health center beneficiaries obtained from the 2009 Insight Project Research Group’s study on Screening Brief Intervention and Referral to Treatment (SBIRT) in the Harris County Hospital District (HCHD). Based on research-supported predictors of readiness to change alcohol use a multivariate model of pathways to readiness to change was created which incorporated psychological (i.e., emotional distress), behavioral (i.e., drinking severity, consequences severity), and maturation (i.e., age, marital status) factors, as well as demographic characteristics (i.e, race/ethnicity, gender). Multiple fit indices were used to assess the model fit with the data, while multiple group analysis was used to test for invariance between pathways to readiness to change for the young (18-29) and middle adult (30-60) groups. The study sample was ethnically diverse and consisted of 1,256 young adults and 4,623 middle adults. The proposed model showed a good fit with the InSight data set. Results demonstrated a strong path connecting emotional distress to both drinking severity and consequences severity, and then from consequence severity to readiness to change. Together, this path lends support to the concept that young adults are using alcohol to modulate their emotions and further, consequences may play an important role in readiness to chance excessive drinking. Variance detected in the multi-group analysis between young and middle adults also provided support for theory claiming differentiation of these groups, particularly as it relates to excessive drinking and readiness to change. Implications for future research and practice include the importance of replicating this and future studies with military samples. These findings lend support to the role of emotional distress and the coping theory paradigm in treating young adults. The military may be best served by continuing to support resources which promote healthy stress tolerance while simultaneously fostering proactive screening procedures and evidence-based care. Further, these findings also suggest that pathways to readiness to change may vary between young and middle adults, particularly as they relate to alcohol related consequences. Future research should focus on the role of consequences and the influence they may have in promoting readiness to change for each age group within the clinical setting.