Relationships among Interpersonal Stress, Affect Regulation, and Alcohol Lapse, S.A. Maisto (PI).

The maintenance of behavior change following alcohol use disorders (AUDs) treatment is perhaps the single biggest challenge facing AUD clinicians and clinical researchers. Research relevant to the question of maintenance of behavior change for alcohol use disorders (AUDs) treatment suggests that extratreatment and treatment factors in the first year following the initiation of treatment or following the completion of a treatment episode may be important determinants of longer-term AUD clinical course, say at 2 years or later. Drinking in the first year following treatment initiation seems to be one important determinant of longer-term alcohol use and functioning in related areas. The long-term objective of this application is to improve methods of intervention to help sustain changes initiated in treatment by further investigating the relationship between alcohol use and related factors in the first year. This application has two primary aims. The first primary aim is to investigate heterogeneity in alcohol consumption (percentage of days abstinent and drinks per drinking day) and psychosocial functioning during the first year after the initiation of alcohol treatment. Three secondary aims following this primary aim are (1) to examine the relationship between alcohol consumption patterns and psychosocial functioning patterns in the first year using latent growth modeling, (2) to conduct a latent transition analysis to investigate baseline predictors of changes from heavy drinking "states" to moderate drinking or abstinence, and the reverse, in the first 3 months following treatment initiation, and (3) to test the dynamic relationship among alcohol use, psychosocial functioning, and treatment involvement over the course of the first year by conducting an associative latent transition analysis, with treatment involvement as a time-varying covariate. The second primary aim is to conduct a substudy on a randomly selected half of the sample examining daily self-reports of alcohol use and proximal relapse risk factors during the first 3 months in near-real time by use of Interactive Voice Response (IVR) technology. The secondary aim following from this primary aim is to examine the within and between-person relationships between undesired levels of alcohol use (typically called "lapse" or "relapse") risk factors and alcohol consumption over the course of 3 months. We propose a 1-year observational, longitudinal study of the clinical course of men and women presenting for AUD outpatient treatment. Shortly upon treatment admission, individuals will be invited to participate in a study involving interview and other self-report data collection over the course of 1 year. The participants will be aged 18 years and older with a primary AUD diagnosis; individuals with other Axis I disorders except for schizophrenia, schizoaffective disorder, or manic depressive disorder will be eligible to participate in the study. Participants will be assessed at baseline, months 1, 2, 3, 6, 9, and 12. The IVR substudy will consist of the addition of 4 near-real time assessments daily for the first 90 days.