Profiles of recovery from alcohol use disorder at three years following treatment: can the definition of recovery be extended to include high functioning heavy drinkers?

Background Higher problem severity contraindicates moderation drinking in treatment samples, but has not been well investigated in natural recovery samples with more prevalent moderation outcomes, nor have single studies assessed multiple severity indicators. Therefore, we integrated 5 prospective studies of recent natural recovery attempts to identify multi‐indicator profiles that distinguished moderation from abstinence or unstable resolution involving relapse. The study evaluated whether moderation was distinguished by a generalized lower severity profile or whether more complex profiles better differentiated outcomes. Methods Community‐dwelling problem drinkers in the southeastern United States (N = 616, 67% male, 65% white, mean age = 46.5 years) enrolled soon after stopping alcohol misuse without treatment were followed prospectively for a year. Outcome predictors assessed at enrollment included preresolution drinking practices, alcohol‐related problems, alcohol dependence, and a behavioral economic measure of the reward value of drinking based on preresolution spending on alcohol versus saving for the future. Results Latent profile analysis of severity indicators supported a 4‐profile solution: (i) global low risk on all indicators, (ii) global high risk on all indicators, (iii) high risk limited to drinking practices only, and (iv) high risk limited to alcohol dependence and alcohol‐related problems only. Outcomes differed by profile membership (p < 0.01). Multinomial logistic regression analyses showed that the global low risk and heavy drinking risk only profiles were associated with stable moderation during the 1‐year follow‐up. The high dependence and alcohol problems risk profile was associated with both abstinence and relapse during the follow‐up (ps < 0.05). Conclusions Consistent with prior research, moderation was associated with lower alcohol dependence, problems, and reward value. Participants who simply drank heavily and did not have elevated risk on other indicators also had a higher probability of moderation. Results support using multidimensional severity indicators that encompass functional variables in addition to drinking practices to predict outcomes.

Section: Problem Severity Indicatorssupporting

confidence: 82%

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confidence: 99%

Preresolution Drinking Problem Severity Profiles Associated with Stable Moderation Outcomes of Natural Recovery Attempts

Tucker

Cheong

James

et al. 2020

“…Thus, caution should be taken when attempting to broaden the conceptualization of DSM‐5 recovery to include high‐risk drinking based on the findings that asymptomatic and symptomatic high‐risk drinkers had lower odds of AUD severity in terms of numbers of lifetime AUD symptomatology—they may not have been given sufficient time to reach their worst stage of AUD or achieve a stable recovery yet. It is recommended to expand recovery outcome measures to incorporate both physical health consequences and psychosocial functioning and follow up over a longer period of time (Wilson et al., ; Witkiewitz et al., ).…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Correlates of Past‐Year Recovery From DSM‐5 Alcohol Use Disorder: Results From National Epidemiologic Survey on Alcohol and Related Conditions‐III

Fan

Chou

Zhang

et al. 2019

Background:Little is known about remission, recovery, and other outcomes of alcohol use disorder (AUD) as defined by the DSM-5.Methods: Data from a large representative sample of the United States was used to examine correlates of past-year AUD status among individuals with prior-to-past-year AUD: persistent AUD, symptomatic high-risk drinking, asymptomatic high-risk drinking, symptomatic low-risk drinking, asymptomatic low-risk drinking (nonabstinent recovery, NAR), and abstainer (abstinent recovery, AR). Multiple logistic regression analyses were conducted to compare: (i) AR and NAR with persistent AUD, (ii) AR with NAR, and (iii) asymptomatic and symptomatic high-risk drinking with AR and NAR.Results: Among individuals with AUD prior to past year (n = 7,785), 34.2% were classified with persistent AUD, 8.8 and 1.6% were symptomatic high-risk and symptomatic low-risk drinkers, respectively, 21.5% were asymptomatic high-risk drinkers, 17.9% were asymptomatic low-risk drinkers, and 16.0% were abstainers. One-quarter of individuals with AUD prior to past year achieved AR or NAR without the benefit of treatment, while a much greater percentage of individuals achieving AR (43.2%) reported receiving treatment relative to those with NAR (12.3%). The number of lifetime AUD symptoms was greater among those achieving AR (among the treated) and lower among those achieving NAR relative to persistent AUD. The number of AUD symptoms was also greater among those achieving AR than NAR and lower among asymptomatic and symptomatic risk drinkers relative to those achieving AR and NAR. Consumption was greater among those achieving AR relative to those achieving NAR and greater among asymptomatic and symptomatic risk drinkers relative to AR and NAR. Odds of achieving AR or NAR relative to persistent AUD were generally lower among non-Hispanic Blacks and those with higher education, greater among women and married individuals, and lower among illicit drug users and individuals with histories of a personality disorder or mood/anxiety disorder.Conclusions: There appears to be a substantial level of recovery from AUD. Information on specific factors associated with AUD outcomes can be useful in targeting appropriate treatment efforts.

“…Similarly, recent empirical work using a data‐driven approach to define recovery has yielded findings that support an expanded definition that includes improved well‐being and functioning. In a secondary analysis of individuals in the outpatient arm of Project MATCH (Project MATCH Research Group, 1997), Witkiewitz and colleagues (2019) found 4 profiles (i.e., subgroups) of individuals defined by measures of alcohol use, alcohol‐related consequences, life satisfaction, and psychosocial functioning 3 years following treatment. These subgroups included: (i) low‐functioning frequent heavy drinkers (15.8%), (ii) low‐functioning infrequent heavy drinkers (16.1%), (iii) high‐functioning heavy drinkers (16.9%), and (iv) high‐functioning infrequent nonheavy drinkers (51.2%).…”

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confidence: 99%

“…In order to determine the generalizability of these results, we used an independent sample to replicate and extend the Witkiewitz et al’s (2019) findings by examining alcohol‐related outcomes and psychosocial functioning among individuals who completed a 3‐year follow‐up (Zarkin et al, 2008) following participation in the multisite trial of the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study (Anton et al, 2006). We hypothesized that a 4‐profile model would be replicated in the COMBINE study data, such that individuals would be classified as low‐functioning frequent heavy drinkers, low‐functioning infrequent heavy drinkers, high‐functioning heavy drinkers, and high‐functioning infrequent nonheavy drinkers at the 3‐year follow‐up.…”

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confidence: 99%

Can Alcohol Use Disorder Recovery Include Some Heavy Drinking? A Replication and Extension up to 9 Years Following Treatment

Witkiewitz

Pearson

Wilson

et al. 2020

Self Cite

Background Recent research indicates some individuals who engage in heavy drinking following treatment for alcohol use disorder fare as well as those who abstain with respect to psychosocial functioning, employment, life satisfaction, and mental health. The current study evaluated whether these findings replicated in an independent sample and examined associations between recovery profiles and functioning up to 6 years later. Methods Data were from the 3‐year and 7‐ to 9‐year follow‐ups of subsamples initially recruited for the COMBINE study (3‐year follow‐up: n = 694; 30.1% female, 21.0% non‐White; 7‐ to 9‐year follow‐up: n = 127; 38.9% female, 27.8% non‐White). Recovery at 3 years was defined by latent profile analyses including measures of health functioning, quality of life, employment, alcohol consumption, and cannabis and other drug use. Functioning at the 7‐ to 9‐year follow‐up was assessed using single items of self‐rated general health, hospitalizations, and alcohol consumption. Results We identified 4 profiles at the 3‐year follow‐up: (i) low‐functioning frequent heavy drinkers (13.9%), (ii) low‐functioning infrequent heavy drinkers (15.8%), (iii) high‐functioning heavy drinkers (19.4%), and (iv) high‐functioning infrequent drinkers (50.9%). At the 7‐ to 9‐year follow‐up, the 2 high‐functioning profiles had the best self‐rated health, and the high‐functioning heavy drinking profile had significantly fewer hospitalizations than the low‐functioning frequent heavy drinking profile. Conclusions Previous findings showing heterogeneity in recovery outcomes were replicated. Most treatment recipients functioned well for years after treatment, and a subset who achieved stable recovery engaged in heavy drinking and reported good health outcomes up to 9 years after treatment. Results question the long‐standing emphasis on drinking practices as a primary outcome, as well as abstinence as a recovery criterion in epidemiologic and treatment outcome research and among stakeholder groups and funding/regulatory agencies. Findings support an expanded recovery research agenda that considers drinking patterns, health, life satisfaction, and functioning.