Alcoholism And Bad Neighborhoods: A Two-way Street

"Most studies have looked at the effects of neighborhood characteristics on alcohol use, and only a few have looked at alcohol dependence," said Anne Buu, research investigator of psychiatry at the University of Michigan and corresponding author. "None have looked at these effects over a time span as long as 12 years; most cover only a one- or two-year time span. In addition, we looked at these relationships bidirectionally, that is, the effects of alcohol dependence on place of residence, and the long-term effects of neighborhood on alcohol dependence."

"This type of research is quite innovative and reflects a growing interest in 'macro-level' influences on alcohol-related outcomes," said Ryan Trim, research psychologist at the VA San Diego Healthcare System. "Unlike the extensive research on individual- and family-level risk factors, studies examining the link between alcohol use and neighborhoods have only gained momentum in recent years. Since a large proportion of the risk for alcoholism is environmental -- approximately 40 percent -- it will be increasingly important for researchers and clinicians to have a better understanding of neighborhood-level influences on alcohol use."

Researchers recruited 206 Caucasian men, with an average age of 33 years, through community and district court recruitment from a four-county-wide region. Alcohol-dependence diagnoses were established through semi-structured diagnostic interviews. Residential addresses were noted at baseline, and then at three-year intervals for a 12-year period. Census-tract variables were used to identify neighborhood characteristics.

Analysis indicates that alcoholism has long-term negative effects on place of residence, and vice versa. First, the more alcohol problems a man has, the more likely he is going to remain in -- or migrate into -- a disadvantaged neighborhood. Second, recovery from alcoholism is both protective against a downward social drift and favorable to improved social conditions. In addition, living in worse neighborhoods appears to have an adverse effect on alcoholic symptomatology over time.

In short, said Buu, the causal relationship between alcoholism and neighborhood social environment is a two-way instead of a one-way street. "Continuous alcohol involvement has long-term negative effects on place of residence," she said. "In contrast, recovery from alcoholism is protective against downward social drift."

Both Buu and Trim said that these findings have implications for women, even though they were not among the target study population.

"The effects may be even stronger on women because alcoholic women have a high tendency to marry alcoholic men, referred to as 'assortative mating,' said Buu. "Alcoholic involvement of both partners could speed up the downward social drift."

Buu noted that the study's findings show that the damaging effects of alcoholism are much broader than simple health consequences. "The effects also have a long-term impact on quality of life, including where one lives and their quality of life. Social environment appears to play some role in keeping the disorder going, and possibly even making it worse: we can see effects going from community to individual, and from individual to social environment. Preventive efforts therefore may also have effects in both directions."

Trim added that the results have both cautionary and optimistic applications for alcohol misuse. "The findings highlight the far-reaching impact of alcohol problems on the type of neighborhood an individual could reside in as an adult. Thus, high-risk adults who drift into lower-SES neighborhoods will likely face even greater challenges at recovery due to lack of resources and increased environmental stressors. However, adults who successfully treat their alcohol problems early in life are no more likely to experience this downward social drift than non-alcoholics. I would hope these findings provide additional incentive to any individuals who are unsure or unwilling to enter treatment for alcohol-related problems."