Daily variations and factors related to alcohol avoidance motivation and alcohol use among adults who are unhoused.

Background

People who are unhoused have higher rates of alcohol use disorder (AUD). Understanding the contexts associated with alcohol avoidance motivation may inform interventions to increase motivation for behavior change within this population.

Objectives

Aim 1 examined daily variations in motivation among people who were unhoused with probable AUD. Aim 2 examined if motivation was associated with alcohol urge, negative affect (NA), positive affect (PA), and social situations with/without alcohol. Aim 3 examined if morning motivation, urge, NA, PA, and social situation predicted later alcohol use.

Methods

Secondary analyses from a clinical trial of adults with unstable housing and probable AUD (N = 70; nmale = 58, nfemale = 12) were conducted (NCT03746808). Participants completed ecological momentary assessments assessing motivation, urge, NA, PA, social situation, and alcohol use for 4 weeks. Multilevel models examined daily variability in motivation, as well as the between- and within-person effects of urge, NA, PA, and social situation on motivation and alcohol use.

Results

On average, participants rated their motivation to avoid alcohol as "Neutral" which remained stable within day (mean = 3.23). At the between-person level, higher average alcohol avoidance motivation was associated with lower average urge (CI: -0.70 to -0.22) and with lower odds of alcohol use (CI: 0.15 to 0.78). At the within-person level, higher alcohol avoidance motivation was associated with lower urge (CI: -0.18 to -0.06), higher NA (CI: 0.05 to 0.21), and higher PA (CI: 0.07 to 0.20).

Conclusions

This study identified situations that may be conducive to encouraging alcohol use change among people who are unhoused. Targeting in-the-moment affective and craving fluctuations may be keys to enhancing and maintaining motivation to avoid alcohol among people experiencing unstable housing.