Relations between impulsivity and drinking in adults with alcohol use disorder during recovery: A longitudinal observational cohort study.

BACKGROUND

Impulsivity is a multifaceted construct robustly associated with alcohol use disorder (AUD). Few studies, however, have examined its relations with drinking during a recovery attempt, and those that have typically used coarse measurements with few follow-up periods. This study examined prospective and reciprocal relations between multiple indices of impulsivity and drinking over a 1-year period among adults with AUD making a significant recovery attempt.

METHODS

Participants (N = 501, Mage = 41.4, 42.5% Male, 79% White) were enrolled at two sites. Longitudinal trajectories of alcohol use and impulsivity were examined using mixed effects and random-intercept cross-lagged panel models. Drinking variables included drinks per week (DpW), percent drinking days (%DD), and heavy drinking days (%HDD). Impulsivity variables included Negative/Positive Urgency, Sensation Seeking, Lack of Premeditation, Lack of Perseverance, and a delay discounting task.

RESULTS

Compared with baseline, significant decreases in multiple facets of impulsivity were observed during the follow-up. The most robust relations were for Negative Urgency, with bidirectional cross-lagged effects observed for all drinking outcomes (βs = 0.09-0.18, ps < 0.05) from months 3-12. Similarly, Positive Urgency forecasted subsequent %DD months 3-12 (βs = 0.06-0.08, ps < 0.05), and Lack of Perseverance predicted %HDD (βs = 0.062-0.066, ps < 0.05) from months 3-12. In other cases, drinking forecasted changes in impulsivity over time.

CONCLUSIONS

Findings highlight the malleability and predictive validity of impulsivity during AUD recovery, but reveal potential specificity by indicator and timeframe. The consistent later-stage bidirectional associations between Negative Urgency and drinking suggest the importance of continuing to address negative emotion regulation during the AUD recovery process.