Behavioral economic indicators of drinking problem severity and initial outcomes among problem drinkers attempting natural recovery: a cross-sectional naturalistic study

BACKGROUND AND AIMS

Research using different behavioral economic (BE) and time perspective (TP) measures suggests that substance misusers show greater sensitivity to shorter-term contingencies than normal controls, but multiple measures have seldom been investigated together. This study evaluated the extent to which multiple BE and TP measures were associated with drinking problem severity, distinguished initial outcomes of natural recovery attempts and shared common variance. Hypotheses were (1) that greater problem severity would be associated with greater impulsivity and demand for alcohol and shorter TPs; and (2) that low-risk drinking would be associated with greater sensitivity to longer-term contingencies compared with abstinence.

DESIGN

Cross-sectional naturalistic field study.

SETTING

Southern United States.

PARTICIPANTS

Problem drinkers, recently resolved without treatment [n = 191 (76.44% male), mean age = 50.09 years] recruited using media advertisements.

MEASUREMENTS

Drinking practices, dependence levels and alcohol-related problems prior to stopping problem drinking were assessed during structured field interviews. Measures included the Zimbardo Time Perspective Inventory; BE analogue choice tasks [delay discounting (DD), melioration-maximization (MM), alcohol purchase task (APT)]; and the Alcohol-Savings Discretionary Expenditure (ASDE) index, derived from real spending on alcohol and voluntary savings during the year before problem cessation.

FINDINGS

Measures of demand based on real (ASDE) and hypothetical (APT) spending on alcohol were associated with problem severity (Ps < 0.05), but DD, MM and TP measures were not. More balanced pre-resolution spending on alcohol versus saving for the future distinguished low-risk drinking from abstinent resolutions (ASDE odds ratio =5.59; P < 0.001). BE measures did not share common variance.

CONCLUSIONS

Two behavioral assessment tools that measure spending on alcohol, the Alcohol Purchase Task and the Alcohol-Savings Discretionary Expenditure index, appear to be reliable in assessing the severity of drinking problems. The ASDE index also may aid choices between low-risk and abstinent drinking goals.

Prospective Analysis of Behavioral Economic Predictors of Stable Moderation Drinking Among Problem Drinkers Attempting Natural Recovery

BACKGROUND

As interventions have expanded beyond clinical treatment to include brief interventions for persons with less severe alcohol problems, predicting who can achieve stable moderation drinking has gained importance. Recent behavioral economic (BE) research on natural recovery has shown that active problem drinkers who allocate their monetary expenditures on alcohol and saving for the future over longer time horizons tend to have better subsequent recovery outcomes, including maintenance of stable moderation drinking. This study compared the predictive utility of this money-based "Alcohol-Savings Discretionary Expenditure" (ASDE) index with multiple BE analogue measures of behavioral impulsivity and self-control, which have seldom been investigated together, to predict outcomes of natural recovery attempts.

METHODS

Community-dwelling problem drinkers, enrolled shortly after stopping abusive drinking without treatment, were followed prospectively for up to a year (N = 175 [75.4% male], M age = 50.65 years). They completed baseline assessments of preresolution drinking practices and problems, analogue behavioral choice tasks (Delay Discounting, Melioration-Maximization, and Alcohol Purchase Tasks), and a Timeline Followback interview including expenditures on alcohol compared to voluntary savings (ASDE index) during the preresolution year.

RESULTS

Multinomial logistic regression models showed that, among the BE measures, only the ASDE index predicted stable moderation drinking compared to stable abstinence or unstable resolutions involving relapse. As hypothesized, stable moderation was associated with more balanced preresolution allocations to drinking and savings (odds ratio = 1.77, 95% confidence interval = 1.02 to 3.08, p < 0.05), suggesting it is associated with longer-term behavior regulation processes than abstinence.

CONCLUSIONS

The ASDE's unique predictive utility may rest on its comprehensive representation of contextual elements to support this patterning of behavioral allocation. Stable low-risk drinking, but not abstinence, requires such regulatory processes.

A Pooled Analysis of Reproductive Factors, Exogenous Hormone Use, and Risk of Multiple Myeloma among Women in the International Multiple Myeloma Consortium

BACKGROUND

Female sex hormones are known to have immunomodulatory effects. Therefore, reproductive factors and exogenous hormone use could influence the risk of multiple myeloma in women. However, the role of hormonal factors in multiple myeloma etiology remains unclear because previous investigations were underpowered to detect modest associations.

METHODS

We conducted a pooled analysis of seven case-control studies included in the International Multiple Myeloma Consortium, with individual data on reproductive factors and exogenous hormone use from 1,072 female cases and 3,541 female controls. Study-specific odds ratios and corresponding 95% confidence intervals (CI) were estimated using logistic regression and pooled analyses were conducted using random effects meta-analyses.

RESULTS

Multiple myeloma was not associated with reproductive factors, including ever parous [OR = 0.92; 95% confidence interval (CI), 0.68-1.25], or with hormonal contraception use (OR = 1.04; 95% CI, 0.80-1.36). Postmenopausal hormone therapy users had nonsignificantly reduced risks of multiple myeloma compared with never users, but this association differed across centers (OR = 0.65; 95% CI, 0.37-1.15, I(2) = 76.0%, Pheterogeneity = 0.01).

CONCLUSIONS

These data do not support a role for reproductive factors or exogenous hormones in myelomagenesis.

IMPACT

Incidence rates of multiple myeloma are higher in men than in women, and sex hormones could influence this pattern. Associations with reproductive factors and exogenous hormone use were inconclusive despite our large sample size, suggesting that female sex hormones may not play a significant role in multiple myeloma etiology.