Utility of different dimensional properties of drinking practices to predict stable low-risk drinking outcomes of natural recovery attempts

Cheong, JeeWon; Lindstrom, Katie; Chandler, Susan D.; Tucker, Jalie A.

doi:10.1016/j.addbeh.2020.106387

Cited by 13 publications

(11 citation statements)

References 30 publications

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“…When considered with our earlier findings concerning drinking outcomes and preresolution expenditure patterns (e.g., Cheong et al, 2020; Tucker et al, 2009, 2016; Tucker, Cheong et al, 2020), the results indicated that the RNA group showed greater variability in spending patterns compared to other outcome groups during the 2 years surrounding initial resolution. Prior to resolution, their discretionary spending favored proportionately higher savings for the future than spending on alcohol compared to the RA and UR groups.…”

Section: Discussionsupporting

confidence: 65%

“…By mid-year after initial resolution, however, their total spending was higher than the other outcome groups and had shifted in ways that entailed receipt of heretofore delayed large rewards (e.g., housing) that yield continued lifestyle benefits and involved some longer term financial commitments. Throughout the postresolution year, the RNA outcome group drank within a relatively tight band of limited drinking (Cheong et al, 2020), and their shifts in spending that were most distinguishing occurred after they had successfully limited their drinking for at least several months. Therefore, in line with the hypotheses, compared to the RA and UR outcome groups, the RNA group experienced higher value postresolution consumption bundles that should have served to reinforce and stabilize the shifted recovery behavior patterns while they engaged in some limited nonproblem drinking.…”

Section: Discussionmentioning

confidence: 99%

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Shifts in behavioral allocation patterns as a natural recovery mechanism: Postresolution expenditure patterns

Tucker

Cheong

Chandler

2021

Alcoholism Clin & Exp Res

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Background Behavioral economics predicts that recovery from Alcohol Use Disorder involves shifts in resource allocation away from drinking, toward valuable nondrinking rewards that reinforce and stabilize recovery behavior patterns. Further, these shifts should distinguish nonproblem drinking (moderation) outcomes from outcomes involving abstinence or relapse. To evaluate these hypotheses, 5 prospective studies of recent natural recovery attempts were integrated to examine changes in monetary spending during the year following the initial cessation of heavy drinking as a function of 1‐year drinking outcomes. Methods Problem drinkers from Southeastern U.S. communities (N = 493, 67% male, 65% white, mean age = 46.5 years) were enrolled soon after stopping heavy drinking without treatment and followed prospectively for a year. An expanded Timeline Followback interview assessed daily drinking and monetary spending on alcohol and nondrinking commodities during the year before and after recovery initiation. Results Longitudinal associations between postresolution drinking and spending were evaluated using MPlus v.8. Initial models evaluated whether changes in spending at 4‐month intervals predicted drinking outcomes at 1 year and showed significant associations in 6 commodity categories (alcohol, consumable goods, gifts, entertainment, financial/legal affairs, housing/durable goods/insurance; ps < 0.05). Cross‐lagged models showed that the moderation outcome group shifted spending mid‐year to obtain large rewards with enduring benefits (e.g., housing), whereas the abstinent and relapsed groups spent less overall and purchased smaller rewards (e.g., consumable goods, entertainment, and gifts) throughout the year. Conclusions Dynamic changes in monetary allocation occurred during the postresolution year. As hypothesized, compared to the groups who abstained or relapsed, the moderation group shifted spending in ways that, overall, yielded higher value alcohol‐free reinforcement that should reinforce recovery while they enjoyed some limited nonproblem drinking below heavy drinking thresholds. These findings add to evidence that moderation entails different behavioral regulation processes than abstinent and relapse outcomes, which were more similar to one another.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Shifts in behavioral allocation patterns as a natural recovery mechanism: Postresolution expenditure patterns

Tucker

Cheong

Chandler

2021

Alcoholism Clin & Exp Res

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“…As discussed elsewhere (Witkiewitz, 2013; Witkiewitz and Tucker, 2020), consumption‐based thresholds, such as the 4/5 heavy drinking definition, have not been well‐validated (Pearson et al, 2016), and they lack sensitivity and specificity for predicting problems related to alcohol use, health, and functioning (Pearson et al, 2017; Wilson et al, 2016), as we found here. Similar research on natural recovery from AUD without treatment found that a composite quantity–frequency index of prerecovery drinking did not predict 1‐year postrecovery outcomes, whereas functional indicators of problem severity did (e.g., alcohol‐related negative consequences, behavioral economic index of alcohol reward value; Cheong et al, 2020; Tucker et al, 2020). Other recent research among Veterans has found those with some heavy drinking occasions do not have worse outcomes with respect to brain health and cognitive functioning as compared to complete abstainers (Meyerhoff and Durazzo, 2020).…”

Section: Discussionmentioning

confidence: 84%

“…The current study and other recent work support an expanded definition of recovery to focus on a process of change characterized by improvements in well‐being, quality of life, and functioning (Witkiewitz et al, 2020). The push to extend beyond abstinence as a necessary condition for AUD recovery is based on quantitative data among diverse samples of treatment seekers and those who achieve natural recovery (Cheong et al, 2020; Kelly et al, 2018b; Meyerhoff and Durazzo, 2020; Wilson et al, 2016; Witkiewitz et al, 2019), qualitative data from individuals with AUD (Kaskutas et al, 2014; Kelly et al, 2018a; Neale et al, 2016), as well as by definitions provided by stakeholder groups (Ashford et al, 2019; SAMHSA, 2011).…”

Section: Discussionmentioning

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

Alcoholism Clin & Exp Res

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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.

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“…Achieving abstinence is associated with improvements in psychosocial functioning 4,5 and lower risk of physical health problems [6][7][8] . However, some individuals also attempt to recover from AUD by reducing their alcohol use (i.e., moderation or controlled drinking), and a number of empirical studies demonstrate that reducing alcohol consumption is also associated with improvements in functioning and health [9][10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

Can Individuals with Alcohol Use Disorder Achieve and Sustain Non-Abstinent Recovery? Non-Abstinent Outcomes 10 Years After Alcohol Use Disorder Treatment

Witkiewitz¹,

Wilson²,

Roos³

et al. 2020

Preprint

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Objective: Four decades ago the “controlled drinking” controversy roiled the alcohol field. Data have subsequently accumulated indicating that non-abstinent alcohol use disorder (AUD) recovery is achievable, but questions remain whether it is sustainable long-term. This study examined whether non-abstinent recovery at three years following AUD treatment is associated with better functioning at 10 years following treatment. Methods: Data were from the 10-year follow-up of Project MATCH (New Mexico site only, n=146; 30.1% female, 58.6% non-White). Recovery was defined by latent profile analyses based on psychosocial functioning and alcohol consumption three years following treatment. Drinking practices and consequences, depression, purpose in life, and anger were assessed 10 years following treatment. Distal outcome analyses examined differences in drinking and functional outcomes at 10 years as a function of the 3-year latent profiles. Analyses were pre-registered at https://osf.io/3hbxr. Results: Four latent profiles identified at three years following treatment (i.e., poor functioning frequent heavy drinkers, poor functioning infrequent heavy drinkers, high functioning heavy drinkers, and high functioning infrequent non-heavy drinkers) were significantly associated with outcomes ten years following treatment. The two high functioning profiles at three years had the highest level of functioning at ten years post-treatment, regardless of alcohol consumption level. Abstinence at three years did not predict better functioning at ten years. Conclusions: Non-abstinent AUD recovery is possible and is sustainable for up to 10 years following treatment. The current findings align with recent proposals to move beyond relying on alcohol consumption as a central defining feature of AUD recovery.

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Utility of different dimensional properties of drinking practices to predict stable low-risk drinking outcomes of natural recovery attempts

Cited by 13 publications

References 30 publications

Shifts in behavioral allocation patterns as a natural recovery mechanism: Postresolution expenditure patterns

Shifts in behavioral allocation patterns as a natural recovery mechanism: Postresolution expenditure patterns

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

Can Individuals with Alcohol Use Disorder Achieve and Sustain Non-Abstinent Recovery? Non-Abstinent Outcomes 10 Years After Alcohol Use Disorder Treatment

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