Predictors of heavy drinking during and following treatment

Abstract

Alcohol dependence has been described as a relapsing condition and it has been proposed that alcohol lapses could potentially be explained by dynamic associations between contextual, interpersonal, and intrapersonal risk factors. Yet, few studies have tested the associations between risk factors in the prediction of lapse dynamics. The current study was a secondary analysis of data from the COMBINE study (n = 1,383; COMBINE Study Research Group, 2003). The goal of the current study was to examine static (alcohol dependence severity, treatment history, marital status, psychiatric symptoms) and dynamic (negative affect, craving, stress) predictors of heavy drinking during the course of treatment and up to one year following treatment. Results from dynamic latent difference score models indicated that higher levels of static and dynamic risk and increased dynamic risk over time were significantly associated with greater increases in heavy drinking. Likewise, more frequent heavy drinking and higher static risk predicted higher levels of dynamic risk. In addition, changes in dynamic risk factors significantly mediated the association between changes in heavy drinking and both psychiatric symptoms and treatment history. It is important to note that while the effects of static and dynamic risk factors in the prediction of heavy drinking were statistically significant, the magnitude of the effects were small. The current study provided partial support for a dynamic model of relapse; however future research using intensive longitudinal data collection and more advanced statistical techniques could further elucidate lapse dynamics and potentially improve relapse prevention planning.

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Figures

Figure 1

Bivariate latent difference score model of post-treatment percent heavy drinking days (PHD) and proximal risk (Prox). PSS = Perceived Stress Scale; Crave = craving as measured by Obsessive Compulsive Drinking Scale; AASE = Alcohol Abstinence Self-Efficacy scale; BSI-D = Depression subscale of the Brief Symptom Inventory; BSI-A = Anger subscale of the Brief Symptom Inventory; BSI-H = Hostility subscale of the Brief Symptom Inventory; p1-p3 = latent difference scores for proximal risk; d1-d3 = latent difference scores for percent heavy drinking days; βp = constant change coefficient for proximal risk; βd = constant change coefficient for percent heavy drinking days; αp = proportion change coefficient for proximal risk; αd = proportion change coefficient for percent heavy drinking days; γp = bivariate change coefficient for proximal risk regressed on percent heavy drinking days; γd = bivariate change coefficient for percent heavy drinking days regressed on proximal risk.

Figure 2

Bivariate latent difference score model of during treatment percent heavy drinking days and proximal risk. PSS = perceived stress scale; Crave = craving as measured by the Obsessive Compulsive Drinking Scale; Tense, Anger, Depres, and Fatigue = Tension, Anger, Depression, and Fatigue subscales of the Profile of Mood States. Parameters (βp, βd, αp, αd, γd) were identical to those presented in Figure 1 and are deleted from Figure 2 to simplify presentation.

Figure 3

Association between constant change in percent heavy drinking days and proximal risk following treatment.