Bidirectional prospective associations between behavioral economic indicators and drinking patterns during alcohol use disorder natural recovery attempts.

Abstract

Objectives: Behavioral economic (BE) theory posits that harmful alcohol use is a joint product of elevated alcohol demand and preference for immediate over delayed rewards. Despite cross-sectional research support, whether expected bidirectional relations exist between BE indicators and drinking during recovery attempts is unknown. Therefore, this prospective research investigated quarter-by-quarter cross-lagged associations between BE simulation tasks and drinking following a natural recovery attempt. Higher demand and discounting in a given quarter should predict subsequent drinking. Conversely, drinking in a given quarter should predict subsequent higher demand and discounting. Method: Community-dwelling problem drinkers were enrolled shortly after stopping heavy drinking without treatment (N = 191). Drinking practices, problems, delay discounting, and alcohol demand (intensity, O max , P max, elasticity) were assessed at baseline and 3-, 6-, 9-, and 12-month follow-ups. Longitudinal cross-lagged models related each BE indicator in the previous quarter to drinking status in the next quarter, and vice versa. Results: Higher demand intensity (consumption when drinks are free) at Quarter 1 distinguished participants who drank heavily in Quarter 2 from those who abstained. In turn, heavy drinking participants in Quarter 2 had higher intensity at Quarter 3 than abstainers and moderate drinkers in Quarter 2, and higher intensity at Quarter 3 distinguished heavy drinkers in Quarter 4 from moderate drinkers ( ps < .05). Hypothesized associations for other BE indices were inconsistent or partially supported. Conclusions: Alcohol purchase task metrics showed some hypothesized prospective associations with drinking during a natural recovery attempt, which supports their ecological validity as relapse risk indicators. Public Health Significance StatementMost persons with alcohol-related problems do not seek help, many recover on their own, and studying natural recoveries has potential for increasing the appeal, effectiveness, and population impact of services for alcohol-related problems. This prospective study of natural recovery provided some support that alcohol demand metrics using the alcohol purchase task tracked shifts in drinking patterns during the year following initial cessation of heavy drinking without treatment. Alcohol demand metricsparticularly intensity or consumption when drinks are free-may be useful in clinical and field settings to assess the likelihood of maintaining recovery or resuming heavy drinking among persons attempting to recover.

Longitudinal examination of alcohol demand and alcohol‐related reinforcement as predictors of heavy drinking and adverse alcohol consequences in emerging adults

“…The present study critically extends a sizeable body of cross‐sectional literature [18,32] and initial longitudinal work [48,49] by providing a robust longitudinal examination of prospective and bidirectional associations between key behavioral economic indicators and alcohol‐related outcomes among a relatively large sample of emerging adults. The results revealed several relationships that were consistent with behavioral economic predictions [14,15], in addition to others that were less consistent or not supported.…”

“…The present study critically extends a sizeable body of cross-sectional literature [18,32] and initial longitudinal work [48,49] by providing a robust longitudinal examination of prospective and bidirectional associations between key behavioral economic indicators and alcoholrelated outcomes among a relatively large sample of emerging adults.…”

“…Beyond these treatment studies, only two studies have examined the longitudinal relations between behavioral economic indicators of alcohol reinforcing value and drinking outcomes with multiple assessments. In a moderately sized sample of emerging adults who had recently made a natural recovery attempt (n = 191), Cheong et al [48] found evidence of bidirectional associations between demand intensity and heavy drinking across a 1-year follow-up period, but inconsistent results for other demand indicators. More recently, an observational study found that decreases in proportionate reinforcement were associated with decreases in alcohol problems in general, and demand indicators were selectively predictive in males and racial minority participants [49], providing further initial evidence.…”

Applying behavioral economics to understand changes in alcohol outcomes during the transition to adulthood: Longitudinal relations and differences by sex and race.

“…Gaume et al (2022) found that demand intensity, break point, O max , and sensitivity to changes in alcohol price predicted changes in alcohol use and problems over a 4-year period in a large sample of Swiss men who were 21 years old at baseline. Finally, one prospective study examined cross-lagged bidirectional associations quarter-to-quarter between BE demand and drinking status during the year following initiation of a natural recovery attempt among untreated problem drinkers (Cheong et al, 2023). Higher intensity in Quarter 1 distinguished participants who drank heavily in Quarter 2 from those who abstained.…”

Matching, behavioral economics, and teleological behaviorism: Final cause analysis of substance use and health behavior

“…These same relations were soon reported with other substance use disorder populations, including smokers (Bickel et al, 1999) and opiate users (Kirby et al, 1999), and a large literature on temporal discounting and substance use rapidly developed (summarized in Bickel & Marsch, 2001; Koffornus & Kaplan, 2018; Madden & Bickel, 2010). Discounting tasks robustly differentiate substance use groups defined by problem severity in cross‐sectional research, but their predictive utility has not been well established in longitudinal research (Cheong et al, 2022; de Wit & Mitchell, 2010).…”