Tucker Jalie A, Cheong JeeWon, Chandler Susan D, Lambert Brice H, Pietrzak Brittney, Kwok Heather, Davies Susan L
Department of Health Education & Behavior, University of Florida, Gainesville, Florida.
Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama.
Alcohol Clin Exp Res. 2016 Dec;40(12):2676-2684. doi: 10.1111/acer.13245. Epub 2016 Oct 24.
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. This 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.
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 preresolution 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 preresolution year.
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 preresolution allocations to drinking and savings (odds ratio = 1.77, 95% confidence interval = 1.02 to 3.08, p < 0.05), suggesting it is associated with longer-term behavior regulation processes than abstinence.
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.
随着干预措施已从临床治疗扩展至包括针对酒精问题较轻者的简短干预，预测谁能实现稳定适度饮酒变得愈发重要。近期关于自然恢复的行为经济学（BE）研究表明，在较长时间范围内将金钱支出分配于酒精和为未来储蓄的活跃问题饮酒者，往往随后会有更好的恢复结果，包括维持稳定适度饮酒。本研究比较了基于金钱的“酒精 - 储蓄可自由支配支出”（ASDE）指数与行为冲动性和自我控制的多种BE类似测量方法的预测效用，这些方法很少被一起研究，以预测自然恢复尝试的结果。
社区居住的问题饮酒者在停止酗酒且未接受治疗后不久入组，前瞻性随访长达一年（N = 175 [75.4%为男性]，平均年龄 = 50.65岁）。他们完成了对解决问题前饮酒行为和问题的基线评估、类似行为选择任务（延迟折扣、改善 - 最大化和酒精购买任务），以及一项时间线回溯访谈，包括解决问题前一年的酒精支出与自愿储蓄相比（ASDE指数）。
多项逻辑回归模型显示，在BE测量中，与稳定戒酒或涉及复发的不稳定解决方式相比，只有ASDE指数能预测稳定适度饮酒。如假设的那样，稳定适度饮酒与解决问题前在饮酒和储蓄上更平衡的分配相关（优势比 = 1.77，95%置信区间 = 1.02至3.08，p < 0.05），表明它与比戒酒更长期的行为调节过程相关。
ASDE独特的预测效用可能基于其对情境因素的全面表征，以支持这种行为分配模式。稳定的低风险饮酒，而非戒酒，需要这样的调节过程。
