Constructs Derived From the Addiction Cycle Predict Alcohol Use Disorder Treatment Outcomes and Recovery 3 Years Following Treatment

Objective: The addiction cycle has been proposed as a framework for understanding the progression of alcohol use disorder (AUD) in terms of psychological and biological domains, including reward drinking/incentive salience, relief drinking/negative emotionality, and loss of control/executive functioning impairment. To have utility in clinical practice, self-report measures of these domains that are applicable across sociodemographic groups and associated with clinical outcomes are needed. This study sought to validate domains from self-report measures and to test whether domains are measurement invariant across sociodemographic groups and associated with treatment outcomes. Method: Secondary analysis of individuals with AUD (n = 3,092) who participated in two alcohol clinical trials, Project Matching Alcohol Treatment to Client Heterogeneity (MATCH) and COMBINE. Factor analytic methods were used to derive addiction cycle domains at baseline. These domains were then examined as predictors of outcomes. Results: Fifteen self-report items were used as indicators of the addiction cycle domains, with sociodemographic differences in measurement by sex, age, race, education, and AUD symptoms. Relief/negative emotionality and reward/incentive salience were significantly associated with outcomes at 1 and 3 years following treatment, and executive functioning also predicted nonabstinent recovery at 3 years. Conclusions: The results support the utility of domains relevant to the addiction cycle in predicting AUD treatment outcomes and recovery among individuals who sought treatment for AUD. The addiction cycle domains were more strongly associated with outcomes than other measures clinicians might use to predict outcomes (e.g., AUD symptoms). Future research should continue to develop and refine the items and test whether the addiction cycle domains can inform treatment planning. Public Health Significance Statement Addiction cycle domains of reward drinking/incentive salience, relief drinking/negative emotionality, and loss of control/executive functioning impairment identified from self-report measures and based on a neurobiological model of alcohol use disorder (AUD) may have clinical utility in predicting AUD treatment response and recovery outcomes. Individuals who enter treatment with higher negative emotionality are more likely to return to heavier drinking in the first year following treatment and have poorer long-term functioning.

Automated summary

This study aims to validate the utility of addiction cycle domains in predicting treatment outcomes and recovery among individuals with alcohol use disorder (AUD). The results showed that relief drinking/negative emotionality and reward drinking/incentive salience were significantly associated with treatment outcomes. Measurement of addiction cycle domains varied across different sociodemographic groups.