Factors mediating the association between drinking in the first year after alcohol treatment and drinking at three years

Objective: Previous research has shown a significant relationship between alcohol consumption in the first year following alcohol treatment admission and longer term functioning. This finding is clinically important and pertains to the clinical course of alcohol-use disorders (AUDs). This study investigated mediators of these relationships, focusing on the first year after treatment admission and alcohol consumption 3 years later. Method: Analyses were conducted on the outpatient Project MATCH (Matching Alcohol Treatment to Client Heterogeneity) sample at baseline (N = 952) and at Months 37-39 after treatment admission (n = 802; hereafter referred to as 3 years). Participants were classified as first-year "abstainer" "moderate drinker," or "heavy drinker." A model featuring three latent variables (psychosocial functioning, self-efficacy, and treatment experiences) whose indicators were collected at 15 months after treatment admission was initially tested for its fit to the data. The 3-year outcomes were percentage of days abstinent and drinks per drinking day. Each model was run on randomly split subsamples and then cross-validated on the remaining participants. Results: Model tests by use of structural equation modeling methods showed poor model fit, owing primarily to problems involving the psychosocial-functioning variable. Consequently, a reduced model was tested that dropped the psychosocial factor. Initial tests of this model showed an excellent fit to the data that replicated across subsamples and 3-year drinking variables at the over-all model and individual path levels. There was strong support for the hypothesis that the total effects of first-year alcohol use on 3-year drinking is mediated in part (31% and 23% for the two drinking outcomes) through self-efficacy to abstain from alcohol at 15 months. Conclusions: First-year posttreatment admission alcohol use predicts longer term (3-year) alcohol use, and a substantial portion of this relationship seems to be mediated through self-efficacy at 15 months to abstain from alcohol use. The apparent benefit of sustained abstinence in the first year may be in part the result of facilitation in the rate or strength of the acquisition of self-efficacy. Discussed are the clinical implications of these findings as well as directions for future research involving longitudinal studies of alcohol use, treatment experiences, psychosocial factors, and their interaction both within the first year and afterward in the determination of the clinical course of alcohol-use disorders.