Bidirectional Prospective Associations Between Behavioral Economic Indicators and Drinking Patterns During Alcohol Use Disorder Natural Recovery Attempts

Public Health Significance Statement Most persons with alcohol-related problems do not seek help, many recover on their own, and studying natural recoveries has potential for increasing the appeal, effectiveness, and population impact of services for alcohol-related problems. This prospective study of natural recovery provided some support that alcohol demand metrics using the alcohol purchase task tracked shifts in drinking patterns during the year following initial cessation of heavy drinking without treatment. Alcohol demand metrics-particularly intensity or consumption when drinks are free-may be useful in clinical and field settings to assess the likelihood of maintaining recovery or resuming heavy drinking among persons attempting to recover. Objectives: Behavioral economic (BE) theory posits that harmful alcohol use is a joint product of elevated alcohol demand and preference for immediate over delayed rewards. Despite cross-sectional research support, whether expected bidirectional relations exist between BE indicators and drinking during recovery attempts is unknown. Therefore, this prospective research investigated quarter-by-quarter cross-lagged associations between BE simulation tasks and drinking following a natural recovery attempt. Higher demand and discounting in a given quarter should predict subsequent drinking. Conversely, drinking in a given quarter should predict subsequent higher demand and discounting. Method: Community-dwelling problem drinkers were enrolled shortly after stopping heavy drinking without treatment (N = 191). Drinking practices, problems, delay discounting, and alcohol demand (intensity, O-max, P-max,P- elasticity) were assessed at baseline and 3-, 6-, 9-, and 12-month follow-ups. Longitudinal cross-lagged models related each BE indicator in the previous quarter to drinking status in the next quarter, and vice versa. Results: Higher demand intensity (consumption when drinks are free) at Quarter 1 distinguished participants who drank heavily in Quarter 2 from those who abstained. In turn, heavy drinking participants in Quarter 2 had higher intensity at Quarter 3 than abstainers and moderate drinkers in Quarter 2, and higher intensity at Quarter 3 distinguished heavy drinkers in Quarter 4 from moderate drinkers (ps < .05). Hypothesized associations for other BE indices were inconsistent or partially supported. Conclusions: Alcohol purchase task metrics showed some hypothesized prospective associations with drinking during a natural recovery attempt, which supports their ecological validity as relapse risk indicators.