Using Factor Mixture Models to Evaluate the Type A/B Classification of Alcohol Use Disorders in a Heterogeneous Treatment Sample

Abstract

Background The type A/B classification model for alcohol use disorders (AUDs) has received considerable empirical support. However, few studies examine the underlying latent structure of this subtyping model, which has been challenged as a dichotomization of a single drinking severity dimension. Type B, relative to type A, alcoholics represent those with early age of onset, greater familial risk, and worse outcomes from alcohol use. Method We examined the latent structure of the type A/B model using categorical, dimensional, and factor mixture models in a mixed gender community treatment-seeking sample of adults with an AUD. Results Factor analytic models identified 2-factors (drinking severity/externalizing psychopathology and internalizing psychopathology) underlying the type A/B indicators. A factor mixture model with 2-dimensions and 3-classes emerged as the best overall fitting model. The classes reflected a type A class and two type B classes (B1 and B2) that differed on the respective level of drinking severity/externalizing pathology and internalizing pathology. Type B1 had a greater prevalence of women and more internalizing pathology and B2 had a greater prevalence of men and more drinking severity/externalizing pathology. The 2-factor, 3-class model also exhibited predictive validity by explaining significant variance in 12-month drinking and drug use outcomes. Conclusions The model identified in the current study may provide a basis for examining different sources of heterogeneity in the course and outcome of AUDs.

Patterns and temporal change of psychopathological symptoms among inpatients with alcohol use disorder undergoing a twelve-step based treatment

“…Participants in the moderate and high severity symptomatic subgroups presented significantly higher rates of baseline harmful alcohol consumption. These findings are consistent with previous empirical research which have demonstrated that some subgroups of AUD with increased severity of alcohol misuse are also characterized with more serious internalizing and externalizing symptoms ( Hildebrandt et al, 2017 , Moss et al, 2010 ). Additionally, multivariate analyses identified the substantial role of baseline coping and conformity motives in the cases of the more severely affected classes.…”

“…Regarding the coping motives, it was assumed that that alcohol consumption serves as a form of emotion regulation among patients with a higher severity symptomatic level, which helps individuals mitigate and cope with unpleasant feelings and emotions ( Berking et al, 2011 ). Previous studies have also demonstrated that subtypes of AUD with elevated internalizing symptomatology show increased rates of drinking in order to relief or self-medicate psychological distress ( Hildebrandt et al, 2017 , Müller et al, 2019 ). In the case of conformity motives, it was hypothesized that the “high severity” symptomatic class might show tendencies also to use alcohol as a means for reducing symptoms related to social anxiety ( Villarosa, Madson, Zeigler-Hill, Noble, & Mohn, 2014 ).…”

“…Extensive empirical research suggests that AUD frequently co-occurs with diverse or even multiple forms of psychiatric disorders, such as major depressive disorder, panic disorder, obsessive-compulsive disorder, generalized anxiety disorder, post-traumatic stress disorder, social phobia, or antisocial personality disorder (for review, see Bradizza, Stasiewicz, & Paas, 2006 ). Comorbid externalizing and internalizing psychopathology are often associated with more severe subtypes of AUD in terms of clinical characteristics and prognosis (e.g., higher drinking severity, worse health status; Hildebrandt et al, 2017 , Moss et al, 2010 ) and harmful treatment-related consequences (e.g., higher level of treatment drop-out, increased vulnerability of early and long-term relapse after treatment; Farren and McElroy, 2010 , Krawczyk et al, 2017 ). Furthermore, some psychopathological symptoms (e.g., depression or anxiety symptoms) have an integral role in the pathology of AUD, such as progression into more pathological stages of AUD, motivation and maintenance of compulsive alcohol use, craving and relapses, or even during a period of long-term abstinence.…”

An Empirically Based Typology of Alcohol Users in a Community Sample Using Latent Class Analysis

“…In the severity-based latent class solution, the alcohol dependence related items [4][5][6][7] and negative consequences related items [8][9][10] were not separated, but were associated with each other. between Class 2 and Class 3) similar rates of alcohol consumption were observed.…”

“…Therefore, various multiclass models have also been assumed [5]. Current taxonomies consistently posit four alcohol drinking subgroups: low-severity, chronic severe, negative affect, and antisocial subtype [6][7][8]. Additionally, these models highlight the role of comorbid externalizing and internalizing psychopathological symptoms among AUD individuals.…”