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Lapses following Alcohol Treatment: Modeling the Falls From the Wagon

Katie Witkiewitz

ABSTRACT: Objective: This study investigated transitions between drinking and nondrinking during the first 12 months following treatment and whether transitions in posttreatment drinking are related to alcohol-dependence symptoms. Method: Data from individuals in the outpatient (n = 952) and aftercare (n = 774) arms of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) were included in the analyses. Drinking consequences, percentage of drinking days, and drinks per drinking day were used as indicators of drinking behavior. Latent transition analysis was used to estimate a model of drinking patterns, defined by transition probabilities between drinking classes, from immediately following treatment to 6 and 12 months following treatment. Results: Across both aftercare and outpatient samples, three drinking classes were identified at each time point: frequent heavy drinking with high consequences, moderate infrequent drinking with low consequences, and nondrinking with low consequences. Many participants maintained nondrinking, and, of those who drank, there was a trend toward transitioning to less drinking over time. Transition probabilities were noninvariant across treatment arms: The probability of transitioning from moderate drinking to frequent drinking was more than six times more likely in the aftercare arm, as compared with the outpatient arm. In both samples the transition to heavy drinking and membership in the heavy-drinking class were significantly positively related to alcohol dependence symptoms. There were no differences across MATCH treatment groups. Conclusions: This study examined transitions in post treatment drinking and the role of alcohol dependence in predicting posttreatment drinking. The results suggest a low probability of moderate drinking among individuals with greater alcohol dependence. (J. Stud. Alcohol Drugs 69: 594-604, 2008)