Who achieves low risk drinking during alcohol treatment? An analysis of patients in three alcohol clinical trials.
- Authors
- Witkiewitz, Katie; Pearson, Matthew R; Hallgren, Kevin A; Maisto, Stephen A; Roos, Corey R; Kirouac, Megan; Wilson, Adam D; Montes, Kevin S; Heather, Nick
- Year
- 2017
- Journal
- Addiction (Abingdon, England)
- PMID
- 28511286
- DOI
- 10.1111/add.13870
- PMCID
- PMC5673549
BACKGROUND AND AIMS: There is evidence that low-risk drinking is possible during the course of alcohol treatment and can be maintained following treatment. Our aim was to identify characteristics associated with low-risk drinking during treatment in a large sample of individuals as they received treatment for alcohol dependence. DESIGN: Integrated analysis of data from the Combined Pharmacotherapies and Behavioral Intervention (COMBINE) study, Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) and the United Kingdom Alcohol Treatment Trial (UKATT) using repeated-measures latent class analysis to identify patterns of drinking and predictors of low-risk drinking patterns during treatment. SETTING: United States and United Kingdom. PARTICIPANTS: Patients (n = 3589) with alcohol dependence receiving treatment in an alcohol clinical trial were primarily male (73.0%), white (82.0%) and non-married (41.7%), with an average age of 42.0 (standard deviation = 10.7). MEASUREMENTS: Self-reported weekly alcohol consumption during treatment was assessed using the Form-90 and validated with biological verification or collateral informants. FINDINGS: Seven patterns of drinking during treatment were identified: persistent heavy drinking (18.7% of the sample), increasing heavy drinking (9.6%), heavy and low-risk drinking (6.7%), heavy drinking alternating with abstinence (7.9%), low-risk drinking (6.8%), increasing low-risk drinking (10.5%) and abstinence (39.8%). Lower alcohol dependence severity and fewer drinks per day at baseline significantly predicted low-risk drinking patterns [e.g. each additional drink prior to baseline predicted a 27% increase in the odds of expected classification in heavy drinking versus low-risk drinking patterns; odds ratio = 1.27 (95% confidence interval (CI) = 1.10, 1.47, P = 0.002]. Greater negative mood and more heavy drinkers in the social network were significant predictors of expected membership in heavier drinking patterns. CONCLUSIONS: Low-risk drinking is achievable for some individuals as they undergo treatment for alcohol dependence. Individuals with lower dependence severity, less baseline drinking, fewer negative mood symptoms and fewer heavy drinkers in their social networks have a higher probability of achieving low-risk drinking during treatment.
Patient Characteristics and Expected Classification in Classes 1–4 and 6–7 as Compared to Class 5 (Reference Class)Figure note. The y-axis is the odds ratio and the baseline covariates are represented by the x-axis. The left y-axis provides the odds ratios on a scale of 0 to 12 for the following covariates: sex, married, race, ADSS, PCTHD, mood, and DPDbl. The right y-axis provides the odds ratios on a scale of less than 0 to 2 for the age covariate and age x DPDbl and age x mood interactions. 95% confidence intervals are represented by the error bars. If the error bar crosses the 1.0 reference line then the odds ratio is not significant (p≥0.05) and the characteristic does not significantly predict expected odds of membership in a given latent class, as compared to the reference class. If the error bar is above the 1.0 reference line then the odds ratio is significant (p<0.05) and the characteristic predicts a significantly higher likelihood of expected membership in a given latent class, as compared to the reference class. If the error bar is below the 1.0 reference line then the odds ratio is significant (p<0.05) and the baseline characteristic predicts a significantly lower likelihood of expected membership in a given latent class, as compared to the reference class.Sex coded male = 1; Married coded married = 1; Race coded non-Hispanic White = 1; ADSS = alcohol dependence severity score; PCTHD = percent heavy drinkers in the social network; Mood = negative mood symptoms score; DPDbl = baseline drinks per week.
Patient Characteristics and Expected Classification in Classes 1–5 and 7 as Compared to Class 6 (Reference Class)Figure note. The y-axis is the odds ratio and the baseline covariates are represented by the x-axis. The left y-axis provides the odds ratios on a scale of 0 to 12 for the following covariates: sex, married, race, ADSS, PCTHD, mood, and DPDbl. The right y-axis provides the odds ratios on a scale of less than 0 to 2 for the age covariate and age x DPDbl and age x mood interactions. 95% confidence intervals are represented by the error bars. If the error bar crosses the 1.0 reference line then the odds ratio is not significant (p≥0.05) and the characteristic does not significantly predict expected odds of membership in a given latent class, as compared to the reference class. If the error bar is above the 1.0 reference line then the odds ratio is significant (p<0.05) and the characteristic predicts a significantly higher likelihood of expected membership in a given latent class, as compared to the reference class. If the error bar is below the 1.0 reference line then the odds ratio is significant (p<0.05) and the baseline characteristic predicts a significantly lower likelihood of expected membership in a given latent class, as compared to the reference class.Sex coded male = 1; Married coded married = 1; Race coded non-Hispanic White = 1; ADSS = alcohol dependence severity score; PCTHD = percent heavy drinkers in the social network; Mood = negative mood symptoms score; DPDbl = baseline drinks per week.
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