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

Abstract

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. Community-dwelling problem drinkers in the southeastern United States (N=616, 67% male, 65% white, mean age=46.5years) 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. 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). 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.