Life Events and Alcohol Use Disorder Clinical Course: Modeling the Dynamic Association

Date of Award

September 2014

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Psychology

Advisor(s)

Stephen A. Maisto

Keywords

Alcohol use, Clinical course, Cross-validation, Life events, Structural equation modeling

Subject Categories

Social and Behavioral Sciences

Abstract

Alcohol use disorder (AUD) continues to be a public health concern in the United States. The study of determinants of AUD's clinical course has received substantial empirical attention, with the goal of informing theory and clinical interventions. The dynamic model of relapse has been particularly influential in this regard. The occurrence of life events (LEs) is one hypothesized determinant of poor AUD treatment outcome within the dynamic model, such that proximal LEs and alcohol use have a reciprocal influence on each other in the context of distal LEs. However, despite over 35 years of study, the LEs- AUD treatment outcome relationship lacks consistent empirical support, which may be due to a lack of theoretically driven designs and corresponding statistical analyses. The purpose of this study was to elucidate the LEs-outcome relationship by statistically modeling the dynamic relationship between negative LEs and alcohol use post-treatment, as it is conceptualized within the dynamic model. Existing longitudinal data from 563 AUD treatment-seeking adults were randomly assigned to two samples. One sample (N = 282) was used to estimate a series of dynamic bivariate latent change score models that differentially relate latent indicators of distal and proximal LEs and alcohol use across 12 months. It was hypothesized that the model in which proximal LEs predict increases in alcohol use, and alcohol use predicts subsequent changes in proximal LEs across time will provide the best fit to the data, providing support for the LEs-outcome relationship as it is described in the dynamic model of relapse. Analyses were cross-validated on the second sample (N = 281) in order to determine the stability of findings. Results partially supported the hypotheses, such that the hypothesized model for each of the alcohol use outcomes (i.e., frequency, intensity, and heavy drinking) provided the best fit to the data, and these models were cross-validated. Proximal LEs were significantly associated with subsequent increases in heavy drinking, though heavy drinking was not a determinant of change in LEs. The bidirectional associations between LEs and alcohol use frequency and intensity were not statistically significant, suggesting that the models may have been underspecified. Additionally, more negative distal LEs were found to be associated with a greater increase in LEs, but not alcohol use, over the subsequent 12 months. Implications of these findings and future directions for research are discussed.

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