From the, University of Florida, Gainesville, Florida.
Alcohol Clin Exp Res. 2020 Mar;44(3):738-745. doi: 10.1111/acer.14287. Epub 2020 Feb 18.
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 = 46.5 years) 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.
在治疗样本中，较高的问题严重程度预示着适度饮酒是不合适的，但在更多普遍存在适度饮酒结果的自然康复样本中，这一现象尚未得到充分研究，也没有单一研究评估过多种严重程度指标。因此，我们整合了 5 项近期自然康复尝试的前瞻性研究，以确定能够区分适度饮酒与戒酒或不稳定缓解后复饮的多指标特征。该研究评估了适度饮酒是否通过更普遍的低严重程度特征来区分，或者更复杂的特征是否能更好地区分结果。
我们在美国东南部的社区中招募了最近停止滥用酒精但未接受治疗的问题饮酒者（N=616，67%为男性，65%为白人，平均年龄为 46.5 岁），在他们停止饮酒后不久便进行前瞻性随访，为期 1 年。在入组时评估的预后预测指标包括复发前的饮酒行为、与酒精相关的问题、酒精依赖以及基于复发前饮酒支出与为未来储蓄的行为经济学指标来衡量的饮酒奖励价值。
严重程度指标的潜在剖面分析支持 4 种特征：（i）所有指标均为全球低风险，（ii）所有指标均为全球高风险，（iii）仅饮酒行为高风险，（iv）仅酒精依赖和与酒精相关的问题高风险。不同特征的结局不同（p<0.01）。多项逻辑回归分析表明，在 1 年随访期间，全球低风险和大量饮酒风险特征与稳定适度饮酒相关。高依赖和酒精问题风险特征与随访期间的戒酒和复饮均相关（p<0.05）。
与先前的研究一致，适度饮酒与较低的酒精依赖、问题和奖励价值相关。仅大量饮酒且其他指标无升高的参与者更有可能保持适度饮酒。结果支持使用多维严重程度指标来预测结局，这些指标涵盖了除饮酒行为外的功能变量。
