Elucidating the Effect of Alcohol-Related Services on Abstinence, Recovery and Familial Functioning: A Propensity Score Matching Approach

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ABSTRACT Alcohol use disorder (AUD) causes immense global burden and has a significant impact on economic and societal functioning,1 as it affects 15.1 million adults.2 Efficacious treatments for AUDs have been well- established and researched within the literature, and there are numerous options for evidence-based therapies.3,4 The most commonly accessed treatments for AUD are alcohol-related services, such as self-help groups, outpatient clinics, and detoxification centers.4,5 Effectiveness studies assessing these alcohol-related services have found that though these services are effective at treating AUDs, there are numerous differences between individuals who receive alcohol-related services and individuals who do not.5,6 These differences cause inherent selection bias in studies of effectiveness, confounding findings regarding outcomes. Furthermore, current studies of alcohol-related services frequently define recovery outcomes as abstinence from drinking.7 However, this approach reduces variability in viable recovery outcomes, such as reduction of drinking behaviors to moderate levels, effectively reducing alcohol-related problems.8 In addition, reduction in drinking behaviors and alcohol-related problems should theoretically have an impact on broader aspects of functioning, particularly psychological and psychosocial functioning. Familial functioning in particular is an important aspect of daily life that is impacted by AUDs.9 Improved familial context has the capacity to reduce risk to family members, who are otherwise at heightened risk for emotional and behavioral problems when living with a family member with AUD.10 Yet these indices of functioning are rarely evaluated in alcohol-related services research.11 The current proposal seeks to investigate the effect of alcohol-related services after eliminating selection bias by using a propensity score matching approach to create a comparison group that is matched to the alcohol-related services group on all measured variables. Moreover, the current proposal will further add to the literature by broadening the assessment of outcomes to include variability in drinking behaviors, as well as familial functioning.