Prospective Analysis of Behavioral Economic Predictors of Stable Moderation Drinking Among Problem Drinkers Attempting Natural Recovery

Abstract

Background As interventions have expanded beyond clinical treatment to include brief interventions for persons with less severe alcohol problems, predicting who can achieve stable moderation drinking has gained importance. Recent behavioral economic (BE) research on natural recovery has shown that active problem drinkers who allocate their monetary expenditures on alcohol and saving for the future over longer time horizons tend to have better subsequent recovery outcomes, including maintenance of stable moderation drinking. The present study compared the predictive utility of this money-based “Alcohol-Savings Discretionary Expenditure” (ASDE) index with multiple BE analogue measures of behavioral impulsivity and self-control, which have seldom been investigated together, to predict outcomes of natural recovery attempts. Methods Community-dwelling problem drinkers, enrolled shortly after stopping abusive drinking without treatment, were followed prospectively for up to a year (N = 175 [75.4% male], M age = 50.65 years). They completed baseline assessments of pre-resolution drinking practices and problems; analogue behavioral choice tasks (Delay Discounting, Melioration-Maximization, and Alcohol Purchase Tasks); and a Timeline Followback interview including expenditures on alcohol compared to voluntary savings (ASDE index) during the pre-resolution year. Results Multinomial logistic regression models showed that, among the BE measures, only the ASDE index predicted stable moderation drinking compared to stable abstinence or unstable resolutions involving relapse. As hypothesized, stable moderation was associated with more balanced pre-resolution allocations to drinking and savings (OR = 1.77, 95% CI = 1.02 ∼ 3.08, p < .05), suggesting it is associated with longer term behavior regulation processes than abstinence. Conclusions The ASDE's unique predictive utility may rest on its comprehensive representation of contextual elements to support this patterning of behavioral allocation. Stable low risk drinking, but not abstinence, requires such regulatory processes.

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

“…These relationships have not been well investigated among persons with AUD who attempted natural recovery, even though moderation is a relatively more common outcome in untreated samples, in part because treatment-seeking is associated with higher problem severity (Fan et al, 2019;Tucker et al, 2004), and most treatment programs emphasize abstinence. Therefore, in 5 prospective studies of natural recovery attempts guided by behavioral economics (Tucker et al, 2016(Tucker et al, , 2008(Tucker et al, , 2012(Tucker et al, , 2006(Tucker et al, , 2002, we investigated moderation predictors and replicated the support found in treatment studies for lower alcohol dependence and alcohol-related problems. We also developed and assessed a novel temporally sensitive behavioral economic measure of the reward value of drinking in relation to nondrinking commodities, the "Alcohol-Savings Discretionary Expenditure" (ASDE) index.…”

“…An expanded Timeline Followback (TLFB) interview (Sobell and Sobell, 1992;Vuchinich et al, 1988) conducted at both data collection points assessed drinking practices, income, and expenditures covering the preceding year, which generated detailed behavioral records covering the 2 years surrounding sobriety onset. Select studies also included interactive voice response data collection (Tucker et al, 2016(Tucker et al, , 2008(Tucker et al, , 2012 and had longer (Tucker et al, 2002(Tucker et al, , 2006 or more frequent (e.g., quarterly) follow-ups (2008,2012,2016). Measures are described next and in earlier publications.…”

“…Media advertisements in cities in Alabama, Florida, Georgia, Mississippi, and Tennessee sought research volunteers who had recently overcome a drinking problem on their own for 5 prospective studies of recovery attempts conducted from 1993 to 2015 (Tucker et al, 2016(Tucker et al, , 2008(Tucker et al, , 2012(Tucker et al, , 2006(Tucker et al, , 2002. One of these 5 studies (Tucker et al, 2006) also recruited a subsample who had received treatment or AA; resolution stability did not differ as a function of help-seeking status.…”

“…Accordingly, the ASDE index assessed relative monetary allocation to purchasing alcohol versus saving for the future prior to a natural recovery attempt. Even when drinking heavily, problem drinkers with more balanced ASDE indices—indicative of greater proportional savings and thus greater sensitivity to longer‐term contingencies—were more successful in maintaining moderation than those with less‐balanced indices (Tucker et al, , ).…”

Sex differences in the interacting roles of impulsivity and positive alcohol expectancy in problem drinking: A structural brain imaging study

“…However, laboratory studies suggested that impulsivity, when assessed in several different ways, does not directly predispose individuals to problem drinking (Mullen et al, 2016, Stevens et al, 2017). In community dwelling problem drinkers, a money-based “Alcohol-Savings Discretionary Expenditure” index but not analogous measures of behavioral impulsivity predicted stable moderation drinking (i.e., longer-term behavior regulation) compared to stable abstinence or relapse (Tucker et al, 2016). …”