Finding success in failure: using latent profile analysis to examine heterogeneity in psychosocial functioning among heavy drinkers following treatment

Abstract

Aims To estimate differences in post-treatment psychosocial functioning among treatment “failures” (i.e., heavy drinkers, defined as 4+/5+ drinks for women/men) from two large multi-site clinical trials, and to compare these levels of functioning to those of the purported treatment “successes” (i.e., non-heavy drinkers). Design Separate latent profile analyses of data from COMBINE and Project MATCH, comparing psychosocial outcomes across derived classes of heterogeneous treatment responders. Setting Eleven U.S. academic sites in COMBINE, 27 U.S. treatment sites local to nine research sites in Project MATCH. Participants 962 individuals in COMBINE (69% male, 77% white, mean age: 44 years) treated January 2001 to January 2004 and 1,528 individuals in Project MATCH (75% male, 80% white, mean age: 40 years) treated April 1991 to September 1994. Measurements In COMBINE, we analyzed health, quality of life, mental health symptoms, and alcohol consequences 12-months post-baseline. In Project MATCH, we examined social functioning, mental health symptoms, and alcohol consequences 15-months post-baseline. Findings Latent profile analysis of measures of functioning in both samples supported a three-profile solution for the group of treatment “failures,” characterized by high-functioning, average-functioning, and low-functioning individuals. The high-functioning treatment “failures” were generally performing better across measures of psychosocial functioning at follow-up than participants designated treatment “successes” by virtue of being abstainers or light drinkers. Conclusions Current Food and Drug Administration guidance to use heavy drinking as indicative of treatment “failure” fails to take into account substantial psychosocial improvements made by individuals who continue to occasionally drink heavily post-treatment.

The search for an elusive cutoff remains: Problems of binary classification of heavy drinking as an endpoint for alcohol clinical trials

“…7; FDA, 2015) would suggest that the maximum number of drinks (i.e., the MXD variable in the current analyses) during an assessment window would be a more appropriate measure upon which to develop a cutoff for no heavy drinking. In the present study, the average and range of ideal cutoffs based on maximum drinks during an assessment period were substantially higher than the 4/5+ cutoff and again leads us to question whether the 4/5+ cutoff is a useful cutoff for clinical populations (Pearson et al, 2016a, 2016b; Wilson, Bravo, Pearson, and Witkiewitz, 2016). …”

“…Despite the limitations of the present study, our results add to the growing evidence that questions the unique predictive validity of the 4+/5+ binge/heavy drinking criteria (Pearson et al, 2016a, 2016b; Wilson et al, 2016; Witkiewitz, 2013). Importantly, the present study results provide evidence that using percent subjects with no heavy drinking days (PSNHDD) relying upon 4/5+ as the maximum number of drinks per occasion in a 90-day assessment window is an excessively restrictive outcome for clinical populations.…”

How Much Is Too Much? Patterns of Drinking During Alcohol Treatment and Associations With Post-Treatment Outcomes Across Three Alcohol Clinical Trials

“…The lowrisk drinking classes did not exceed 3 low-risk drinking days per week and thus were within the 7+/14+ weekly limits for low-risk drinking set by NIAAA (2005). Importantly, there is very little empirical research to validate 3/4 drinks per day or 7/14 drinks per week as ideal cutoffs , and there is evidence that some heavy drinking might not be significantly worse than low-risk drinking with respect to subsequent outcomes following AUD treatment (Aldridge et al, 2016;Wilson et al, 2016). More research is needed to quantify alternative outcome definitions that consider both intensity and frequency of drinking, and those outcome definitions that are based on harm-reduction goals (Aubin et al, 2015;Maremmani et al, 2015).…”

Commentary on Wilson et al. (2016): The meaning of success in failure

“…Wilson and colleagues [1], using latent class analysis of data from the well-known COMBINE (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence) [2] and Project MATCH (Matching Alcoholism Treatment to Client Heterogeneity) [3] intervention studies, present an innovative way of considering alcohol use disorder (AUD) treatment 'failures' as a non-monolithic group. These novel analyses reveal that individuals who engage in one or more episodes of heavy drinking over a 90-day period at 10-15-month follow-up fall into groups that can be characterized as low, average and high in terms of their psychosocial functioning.…”

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Commentary on Wilson et al (2016): The meaning of success in failureThe finding that some individuals who continue to engage in episodic heavy drinking following treatment for alcohol use disorders (AUDs) improve in other domains of psychosocial functioning raises the question of whether such individuals fare well despite, or as a consequence of, their continued drinking.Wilson and colleagues [1], using latent class analysis of data from the well-known COMBINE (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence) [2] and Project MATCH (Matching Alcoholism Treatment to Client Heterogeneity) [3] intervention studies, present an innovative way of considering alcohol use disorder (AUD) treatment 'failures' as a non-monolithic group. These novel analyses reveal that individuals who engage in one or more episodes of heavy drinking over a 90-day period at 10-15-month follow-up fall into groups that can be characterized as low, average and high in terms of their psychosocial functioning.

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