Emotion differentiation among individuals in a randomized clinical trial for alcohol use disorder: Within- and between-person associations with affect, craving, and alcohol use in daily life.

Emotion differentiation refers to cognitively distinguishing among discrete, same-valenced emotions. Negative emotion differentiation (NED) is a transdiagnostic indicator of emotional functioning. The role of positive emotion differentiation (PED) in clinical disorders, including alcohol use disorder (AUD), is less understood. Further, despite consensus that emotions are highly variable, little is known about within-person fluctuations in NED/PED. The current study leveraged 84 consecutive daily smartphone surveys from participants (N = 181) in a clinical trial of cognitive behavioral therapy for AUD to investigate whether between-person differences in overall NED/PED, or within-person variability in daily NED/PED, were associated with affect intensity, craving, drinking, and heavy drinking in daily life. Subsequent analyses explored whether associations were moderated by baseline alexithymia. At the between-persons level, greater average PED, but not NED, was associated with lower heavy drinking odds. At the within-persons level, higher-than-usual PED was associated with lower negative affect and odds of any drinking. Individuals with baseline alexithymia had stronger negative within-person associations between daily NED and both any and heavy drinking. PED is a skill linked to less alcohol use between- and within-persons irrespective of baseline alexithymia, whereas greater daily NED appears especially important for reduced alcohol use among individuals with co-morbid AUD and alexithymia.

Mechanisms of behavior change during alcohol treatment among negative affect drinkers: A time-varying effect model analysis using 84 consecutive days of ecological momentary assessment.

OBJECTIVE: To better understand the timing and unique contribution of four potential mechanisms of behavior change (MOBC) during alcohol use disorder (AUD) treatment (negative affect, positive affect, alcohol craving, and adaptive alcohol coping), we used a time-varying effect modeling analytic approach to examine the change trajectories of alcohol abstinence, heavy drinking, the hypothesized MOBCs, and the time-varying associations between the MOBCs and alcohol outcomes. METHOD: Participants (N = 181; Mage = 50.8 years, SD = 10.6; 51% women; 93.5% Caucasian) were enrolled in a 12-week randomized clinical trial of cognitive behavioral outpatient treatment program for AUD. For 84 consecutive days, participants provided self-reports of positive and negative affect, craving, alcohol use, and adaptive alcohol coping strategies employed. RESULTS: Throughout the 84-day treatment window, higher daily average craving levels were associated with both decreased likelihood of alcohol abstinence and increased odds of heavy drinking, whereas higher adaptive alcohol coping was associated with increased odds of abstinence and decreased odds of heavy drinking. Higher negative affect was associated with decreased odds of abstinence in the first 10 days of treatment and increased odds of heavy drinking before Day 4 or Day 5. Higher positive affect was associated with decreased odds of heavy drinking during the first 4 or 5 days. CONCLUSIONS: The differential time-varying associations between negative affect, positive affect, alcohol craving, adaptive alcohol coping, and alcohol use provide insights into how and when each of the MOBCs is active during AUD treatment. These findings can help optimize the efficacy of future AUD treatments. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Development and psychometric properties of the Multidimensional Inventory of Recovery Capital (MIRC).

BACKGROUND: Researchers have developed several instruments to measure recovery capital-the social, physical, human, and cultural resources that help people resolve alcohol and other drug problems. However, existing measures are hampered by theoretical and psychometric weaknesses. The current study reports on process and psychometric outcomes for the Multidimensional Inventory of Recovery Capital (MIRC), a novel measure of recovery capital. METHODS: We used a three-phase, mixed methods approach to develop the MIRC. Individuals who identified as having resolved alcohol problems were recruited in each phase. Phase one focused on item development, with participants providing qualitative feedback on potential items. In phase two (pilot testing) and phase three (final psychometric evaluation), participants completed revised versions of the MIRC to assess its psychometric strength and item performance. RESULTS: Phase one (n=44) resulted in significant item alteration, culminating in a 48-item pilot measure. Pilot testing analyses (n=497) resulted in the deletion or replacement of 17 items. In the final psychometric evaluation (n=482), four additional items were deleted, resulting in a 28-item MIRC comprising four subscales measuring social, physical, human, and cultural capital. The psychometric properties of the final MIRC and its subscales ranged from sound to strong, with high response variability suggesting appropriate item discrimination. CONCLUSION: Results confirm the psychometric strength of the MIRC and underscore the importance of incorporating the insights of diverse samples of people in recovery. The MIRC holds promise as an assessment tool in future research and is available for use at no cost in treatment and community-based settings.

Pretreatment changes in drinking: A test of a tailored treatment approach.

BACKGROUND: Pretreatment reductions in drinking are well documented and have been demonstrated to predict posttreatment drinking outcomes. Making use of the predictive value of pretreatment change has great appeal in settings that place a premium on efficient clinical decisions regarding appropriate type and intensity of treatment. METHODS: This study investigates whether different types and intensities of treatment are appropriate and beneficial for individuals entering treatment for an alcohol use disorder (AUD; N = 201) who make more vs. less pretreatment change in their drinking during a 2-month pretreatment period. Based on an algorithm derived from pilot research, we derived two independent pretreatment change arms that we called Substantial Change and Minimal Change. Each arm was a parallel, sequentially randomized design consisting of a treatment group and an active control. The Substantial Change arm compared six sessions of relapse prevention treatment (RPT) with 12 sessions of cognitive behavioral therapy for AUD (CBT) as an active control. Both CBT and RPT occurred over a 12-week period. The Minimal Change arm compared 12 sessions of an integrated motivational intervention combined with CBT (MI/CBT) with 12 sessions of CBT as an active control. The outcome variables were changes in number of days abstinent (NDA) and number of days heavy drinking (NDH) per week. RESULTS: For the Substantial Change arm, a noninferiority analysis revealed that six sessions of RPT were noninferior to 12 sessions of CBT at each posttreatment assessment for both NDA and NDH. For the Minimal Change arm, a superiority analysis failed to detect that MI/CBT was superior to CBT at any posttreatment assessment for both NDA and NDH. CONCLUSIONS: In the substantial change arm, results suggest that offering a less intensive initial treatment, like RPT, may lower costs and conserve clinical resources. In the Minimal Change arm, results indicate the need to continue searching for a treatment or treatment enhancements to improve alcohol outcomes.

Qualitative insights in item development for a comprehensive and inclusive measure of recovery capital.

Background: Item specification is foundational to measurement development but rarely reported in depth. We address this gap by explicating our use of qualitative methods to ground and develop items for a new recovery capital measure, the Multidimensional Inventory of Recovery Capital. Method: We recruited a diverse sample of service providers (n = 9) and people in recovery from alcohol problems (n = 23) to provide feedback on an item pool assessing social, human, physical, community, and cultural capital. Using applied qualitative analysis, we coded findings from interviews and focus groups and made final decisions by consensus regarding item elimination, retention, or revision. This process yielded a 49-item draft measure. Results: Only nine items from an initial 90-item list were retained in their original form. Participant feedback guided item elimination, addition, and revision for linguistic or conceptual clarity. We detected little systematic variation in feedback based on income or race; however, there were stark divergences on particular items based on recovery pathway (i.e. 12-step versus other approaches). Conclusions: The high degree of alteration to the item pool highlights the importance of establishing validity with respondents. Response variation based on recovery pathway suggests the need for broad heterogeneity in respondents. Measures that are sensitive, psychometrically sound, and aligned with theory are critical for advancing research on recovery capital and related disparities for diverse populations.

The Shape of Change: Determining When Mechanisms of Behavior Change Are Active in Cognitive Behavioral Treatment for Alcohol Use Disorder Using Time-Varying Effect Modeling (TVEM).

OBJECTIVE: Research has identified several potential mechanisms of behavior change (MOBCs) in cognitive-behavioral therapy for alcohol use disorder, including alcohol abstinence self-efficacy (AASE), negative affect (NA), and positive affect (PA). However, little is known about when MOBCs affect clinical outcomes during alcohol use disorder treatment. Such information could advance MOBC research by identifying relationships between specific treatment content and variations in MOBCs. This study examined three MOBCs simultaneously to determine their timing and relative influence on percent days abstinent (PDA) and drinks per day (DPD). METHOD: Data were derived from a parent study assessing pretreatment change in drinking. Participants (n = 205) received 12 sessions of cognitive-behavioral therapy for alcohol use disorder. AASE, NA, and PA were measured at each treatment session, and time-varying effect models (TVEM) were used to examine their association with PDA and DPD. RESULTS: All three MOBCs were associated with PDA and DPD but varied with regard to time course, strength, and direction. For PDA, AASE was positively associated throughout treatment, NA was negatively associated from Sessions 1 to 10, and PA was positively associated from Sessions 1 to 3 and 11 to 12. For DPD, AASE was positively associated from Session 5 to the end of treatment, NA was positively associated throughout treatment although the strength of the association varied and was strongest at the beginning of treatment, and PA was positively associated from Sessions 5 to 12. CONCLUSIONS: Results show that MOBCs exert their effects at different times during treatment. In addition to replicating these results, future research should attempt to manipulate MOBCs directly and examine their influence on alcohol outcomes.