ABSTRACT. Objective: The extent to which problem drinkers transition into and out of problem drinking was examined using Markov modeling. Method: Study participants (N = 1,350) were randomly sampled from one county's general population and from consecutive admissions to public and private alcohol treatment programs in the same county, and they were assessed at 1-, 3-, 5-, and 7-year follow-ups. At baseline, all met the criteria for problem drinking. Individuals were classifi ed as "problem drinkers" if they reported at least two of three criteria (heavy episodic drinking, social consequences, dependence symptoms according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) during the prior 12 months. Results: Although all possible patterns were observed, a latent Markov model with heterogeneous transitions and fi ve patterns fi t the data. The sampling frame and baseline alcohol severity related to pattern. Conclusions: The data indicate that, although they do change over time, problem drinkers on the whole are more likely either to remain problem drinkers or to cease to be problem drinkers than they are to move into and out of problem-drinking status. Once they transition out of problem drinking, they are more likely to remain nonproblem drinkers. O NE OF THE UNRESOLVED QUESTIONS in alcohol-related research is that of behavioral stability among adult drinkers. To what extent will they alter their drinking? What is the probability someone will change his or her drinking behavior, and what factors infl uence this probability? Does this probability change over time? These questions have clinical signifi cance because relapse is common and affects the effi cacy and cost of treatment. Positive change is the goal of treatment, and community interventions are diffi cult to accomplish. If we understood how often and how likely changes in drinking behavior occur, and what factors infl uence these changes, more targeted and effective interventions could be developed, and family members of problem drinkers would have a better idea of what to expect. Demonstrating that individuals effectively move out of problem drinking may help reduce the stigma associated with alcohol problems and encourage problem drinkers to seek help. This study addressed one aspect of the stability of problem drinking by estimating the probability that a problem drinker from a representative sample would transition into and out of problem drinking, and whether that probability of change varies over 7 years.
Stability in problem drinking using a trajectories-based approachImprovements in longitudinal methods have made possible understanding changes in drinking behaviors and outcomes. A key fi nding from this research is that alcohol consumption is not necessarily a stable behavior, especially among heavy drinkers (Kaskutas et al