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National Institute on Alcohol Abuse and Alcoholism (NIAAA)

New research characterizes alcohol use disorder profiles to predict treatment outcomes

Research Update

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This article was first published in NIAAA Spectrum Volume 15, Issue 1.

Alcohol use disorder (AUD) is a heterogeneous disorder, meaning individuals with AUD differ in their clinical symptoms and in the biological and psychological factors that contribute to their disorder. A better understanding of individual differences in AUD could inform the development of tailored treatment approaches to increase treatment effectiveness. New research from the University of New Mexico, the University of Washington, and Syracuse University published in Psychology of Addictive Behaviors shows that assessing patients based on biological and psychological domains of addiction could be a good way to predict treatment outcomes.

Addiction to alcohol and other substances can be framed as a repeating cycle of three stages that link to and feed on each other. The binge/intoxication stage is characterized by seeking the positive feelings of reward associated with alcohol. This stage also leads to the development of incentive salience, in which an object or event associated with alcohol consumption can itself trigger powerful urges to drink. The negative affect stage is marked by seeking alcohol for relief from the negative emotional and physical pain as well as other unpleasant feelings brought on by withdrawal when a person stops drinking. The preoccupation/anticipation stage reflects changes in executive brain function that contribute to alcohol craving and loss of control over drinking.

Several years ago, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) established an Addictions Neuroclinical Assessment (ANA), a framework to better understand individual differences in AUD. The ANA incorporates measures related to incentive salience, negative emotionality, and changes in executive function. The current study built on previous research on these three addiction cycle domains and aimed to determine if a simplified assessment, which would be easier to implement in a broad range of clinical settings, could also be effective.

The researchers used existing data from two of the largest AUD treatment clinical trials ever conducted—Project MATCH, a national, multisite, randomized clinical trial of treatment matching for AUD; and the COMBINE Study (often referred to as COMBINE), the largest alcohol pharmacotherapy trial conducted in the United States. Using these data the researchers selected 15 measures corresponding to the three domains of the addiction cycle to determine if the domains could predict treatment outcomes among the participants. They found that the 15-measure assessment was specific enough—and generalizable enough across sociodemographic groups—to predict treatment outcomes.

Specifically, the researchers found that individuals with higher negative emotionality and incentive salience prior to receiving treatment were more likely to have a higher intensity and frequency of drinking at one and three years after treatment. Additionally, individuals with high negative emotionality prior to treatment had the lowest overall functioning at three years post-treatment. Moreover, while executive function measures were not related to later drinking patterns, individuals with more self-control and greater executive function were more likely to maintain a non-abstinent recovery. Future research will determine if individualized profiles such as these could help drive the use of tailored behavioral or medication treatment approaches for AUD.

Witkiewitz K, Stein ER, Votaw VR, Hallgren KA, Gibson BC, Boness CL, Pearson MR, Maisto SA. Constructs derived from the addiction cycle predict alcohol use disorder treatment outcomes and recovery 3 years following treatment. Psychol Addict Behav. 2022 Aug 11. Epub. PubMed PMID: 35951419

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