This 3-year R01 application submitted in response to PAR-14-051 proposes secondary data analyses of four completed prospective studies of the natural course of recovery from alcohol problems to identify mechanisms of change predicted by behavioral economic (BE) theory and research. Persons with addictive disorders tend to choose less valuable but more immediate options (e.g., drinking) over more valuable, delayed outcomes (e.g., job stability, saving for the future). Successful recovery likely involves shifting allocatin of behavior and resources in ways that lead to experiencing delayed non-drinking rewards (NDRs) of sobriety. BE research suggests this hypothesized mechanism of change, but most studies were cross-sectional and cannot explicate mechanisms. A unique repeated-measures prospective data set (N ~ 450) created by pooling data from four natural recovery studies will support investigation of longitudinal relationships predicted by BE theory and research concerning mechanisms. Predominantly treatment naive, community-dwelling problem drinkers were enrolled shortly after they stopped excessive drinking. Detailed behavioral records collected using expanded Timeline Follow back interviews assessed daily drinking, monetary allocation, and other NDR sources (e.g., positive life events) during the year before and the year after initial sobriety. Comprehensive measurement of monetary allocation patterns assessed shifting preferences for drinking and engaging in qualitatively different activities using a common metric (dollars). After assessment at enrollment covering the pre-resolution year, the same variables were assessed prospectively for a year or more, yielding 2-year records surrounding sobriety onset. Two studies also offered access to sobriety support during early recovery using an Interactive Voice Response (IVR) self-monitoring system. Advanced longitudinal analysis methods will be used to model trajectories of drinking behavior change contextualized within problem drinkers' changing personal economies to: (1) identify the timing, structures, and typologies of monetary re-allocation through the pre- and post- resolution years associated with stable and unstable resolution; and (2) evaluate effects of engaging in IVR self-monitoring on allocation patterns during early recovery. The main hypotheses are: (1) Resolution stability is promoted by shifts in behavioral allocation that increase the probability of NDR experiences. (2) Beneficial effects of IVR self-monitoring on resolution stability are mediated by its effect on pos-resolution behavioral re- allocation that improves NDR experiences. Results will elucidate natural trajectories of BE mechanisms of change and support new intervention approaches, targets, and change mechanisms not tied to treatment- produced change. The research provides a unique, powerful, cost-efficient opportunity to translate and test BE theory and change mechanisms and to investigate BE mechanisms in a phone-based intervention with broad dissemination potential. This is a public health priority because gains in population health likely will come from extending care to untreated problem drinkers who contribute much harm and cost of alcohol-related problems.
Understanding the mechanisms through which problem drinkers recover has potential to increase the appeal, effectiveness, and population impact of alcohol-related services. The proposed research will investigate how problem drinkers organize their behavior around present vs. future goals because successful recoveries likely involve a shift from a shorter to a longer view of the future and an attendant reallocation of behavior. The pathways, processes, and mechanisms of change by which problem drinkers achieve stable resolution will be investigated through secondary data analysis of a series of prospective studies of recovery attempts without formal treatment using a large, diverse community sample.
