Transitioning Into and Out of Problem Drinking Across Seven Years

Abstract

ABSTRACT. Objective: The extent to which problem drinkers transition into and out of problem drinking was examined using Markov modeling. Method: Study participants (N = 1,350) were randomly sampled from one county's general population and from consecutive admissions to public and private alcohol treatment programs in the same county, and they were assessed at 1-, 3-, 5-, and 7-year follow-ups. At baseline, all met the criteria for problem drinking. Individuals were classifi ed as "problem drinkers" if they reported at least two of three criteria (heavy episodic drinking, social consequences, dependence symptoms according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) during the prior 12 months. Results: Although all possible patterns were observed, a latent Markov model with heterogeneous transitions and fi ve patterns fi t the data. The sampling frame and baseline alcohol severity related to pattern. Conclusions: The data indicate that, although they do change over time, problem drinkers on the whole are more likely either to remain problem drinkers or to cease to be problem drinkers than they are to move into and out of problem-drinking status. Once they transition out of problem drinking, they are more likely to remain nonproblem drinkers. O NE OF THE UNRESOLVED QUESTIONS in alcohol-related research is that of behavioral stability among adult drinkers. To what extent will they alter their drinking? What is the probability someone will change his or her drinking behavior, and what factors infl uence this probability? Does this probability change over time? These questions have clinical signifi cance because relapse is common and affects the effi cacy and cost of treatment. Positive change is the goal of treatment, and community interventions are diffi cult to accomplish. If we understood how often and how likely changes in drinking behavior occur, and what factors infl uence these changes, more targeted and effective interventions could be developed, and family members of problem drinkers would have a better idea of what to expect. Demonstrating that individuals effectively move out of problem drinking may help reduce the stigma associated with alcohol problems and encourage problem drinkers to seek help. This study addressed one aspect of the stability of problem drinking by estimating the probability that a problem drinker from a representative sample would transition into and out of problem drinking, and whether that probability of change varies over 7 years. Stability in problem drinking using a trajectories-based approachImprovements in longitudinal methods have made possible understanding changes in drinking behaviors and outcomes. A key fi nding from this research is that alcohol consumption is not necessarily a stable behavior, especially among heavy drinkers (Kaskutas et al

Temporal Stability of Heavy Drinking Days and Drinking Reductions Among Heavy Drinkers in the COMBINE Study

“…Additionally, these findings indicate that there are substantial reductions in drinking from baseline among individuals that we have traditionally labeled as treatment non-responders, based on the no heavy drinking responder definition. The notion that individuals can move in and out of heavy drinking and be functioning quite well is consistent with epidemiological data (Dawson et al, 2007; Delucchi and Weisner, 2010) and recent studies in AUD samples (Wilson et al, 2016; Witkiewitz et al, 2017). On average, the majority of patients (those in Class 1) show considerable improvements in the frequency and quantity of alcohol consumed during and after treatment, despite being categorized as non-responders by virtue of having had at least one heavy drinking day in a specific period during the clinical trial.…”

“…The present study can be viewed as providing a high-definition view of the temporal stability of drinking behavior from month-to-month during treatment, which has previously been assessed in different epidemiological and clinical samples over seven years (Delucchi and Weisner, 2010) and three years (Dawson et al, 2007). Consistent with these prior findings, our analyses showed increasing stability in drinking patterns, but are the first to highlight the relative stability of drinking behavior across four months of treatment, which has important research and clinical implications.…”

Following Problem Drinkers Over Eleven Years: Understanding Changes in Alcohol Consumption

“…But if that were the case, we should be seeing cycling up and down, which we do not. Additionally, as we have shown in other work, overall problem drinking is fairly steady, but one is more likely to stop problem drinking than to relapse (Delucchi and Weisner, 2010). Finally, it may be that, when we recontacted them, they felt pressured to say they were drinking less because somehow they were embarrassed to admit doing so.…”

Alcohol Screening and Changes in Problem Drinking Behaviors in Medical Care Settings: A Longitudinal Perspective

“…Note that, for both Models 1 and 2, respondents can move in and out of problem drinking status over the follow-up periods, and therefore problem drinkers and non-problem drinkers refer not to a fi xed set of respondents but to a changing set who are problem (or not problem) drinkers at the various follow-up waves. However, Delucchi and Weisner (2010) provide evidence of relative stability over time. The longitudinal models estimated provide, in a sense, an averaged relationship over time, while simultaneously accounting for within-individual correlation in error of prediction.…”

“…Examining volume consumed in the past 12 months, Delucchi et al (2004) found fi ve distinct drinking trajectories, described as early nondrinkers (reports of very low or no consumption across the four interviews, 8% of the sample), quitters (drinking 12 months prior to baseline but very low or no consumption afterward, 7%), gradual improvers (gradually decreasing volume over time, 12%), moderate drinkers (fairly constant and moderate consumption over time, 21%), and heavy drinkers (constant and higher consumption over time, 52%). Trajectories of problem drinking were explored in Delucchi and Weisner (2010), where fi ve trajectories were again found and were described as non-problem drinkers over time (42% of the sample), late problem drinkers (2%), early remitters (13%), later remitters (5%), and consistent problem drinkers (38%). Here in this study, an alternative method was used to capture heterogeneity in drinking behaviors found from previous analyses: namely, conditioning on the respondent's prior problem drinking state and examining the role of contact with medical settings in assessing the likelihood of problem drinking at the subsequent follow-up.…”