title: Factors mediating the association between drinking in the first year after alcohol treatment and drinking at three years.
abstract: 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.
  
  
  METHODS
  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 overall 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.
authors.affiliation: Department of Psychology, Center for Health and Behavior, 430 Huntington Hall, Syracuse University, Syracuse, New York 13244, USA. samaisto@syr.edu
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Maisto
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Clifford
authors.forename: Robert L
authors.initials: RL
authors.lastname: Stout
authors.forename: Christine M
authors.initials: CM
authors.lastname: Davis
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000523:psychology; D000437:Alcoholism / Q000534:rehabilitation*; D000553:Ambulatory Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D020377:Self Efficacy; D013695:Temperance / Q000523:psychology / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome
references.citation: Am Psychol. 1983 Oct;38(10):1036-44
references.pmid: 6314859
references.citation: J Stud Alcohol Suppl. 1994 Dec;12:92-100
references.pmid: 7723004
references.citation: Clin Psychol Rev. 2006 Mar;26(2):109-27
references.pmid: 16371242
references.citation: Am Psychol. 2004 May-Jun;59(4):224-35
references.pmid: 15149263
references.citation: J Stud Alcohol. 1992 May;53(3):249-61
references.pmid: 1583904
references.citation: J Stud Alcohol. 2001 Nov;62(6):817-25
references.pmid: 11838919
references.citation: Eval Health Prof. 1983 Mar;6(1):25-48
references.pmid: 10259949
references.citation: Alcohol Clin Exp Res. 1998 Sep;22(6):1300-11
references.pmid: 9756046
references.citation: Clin Psychol Rev. 2007 Jun;27(5):537-51
references.pmid: 17254686
references.citation: Drug Alcohol Depend. 2007 Jan 5;86(1):46-54
references.pmid: 16769181
references.citation: J Stud Alcohol. 1997 Jan;58(1):7-29
references.pmid: 8979210
references.citation: J Stud Alcohol. 2006 Nov;67(6):823-32
references.pmid: 17060998
references.citation: Arch Gen Psychiatry. 1961 Jun;4:561-71
references.pmid: 13688369
references.citation: J Stud Alcohol Drugs. 2007 May;68(3):419-27
references.pmid: 17446982
references.citation: J Nerv Ment Dis. 1980 Jan;168(1):26-33
references.pmid: 7351540
references.citation: J Stud Alcohol. 1994 Mar;55(2):141-8
references.pmid: 8189734
references.citation: Drug Alcohol Depend. 2003 Sep 10;71(3):281-94
references.pmid: 12957346
references.citation: J Stud Alcohol. 2002 Jul;63(4):397-403
references.pmid: 12160097
references.citation: J Stud Alcohol. 1998 Sep;59(5):591-8
references.pmid: 9718112
references.citation: J Stud Alcohol. 1980 May;41(5):397-416
references.pmid: 7412294
references.citation: Eval Rev. 2001 Apr;25(2):113-61
references.pmid: 11317714
references.citation: Addiction. 1996 Dec;91 Suppl:S173-89
references.pmid: 8997791