Alcohol and Addiction Research Domain Criteria and Alcohol Use Disorder Recovery

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Project Summary/Abstract The alcohol and addiction research domain criteria (AARDoC) has been proposed to provide a framework for understanding the nature of alcohol use disorder (AUD) in terms of psychological and biological constructs that can be traced to a specific behavioral function with an underlying biological basis (e.g., neural dysfunction). The AARDoC proposes that AUD develops, progresses, and is maintained because of heightened incentive salience for alcohol, greater negative emotionality, and/or impairments in executive functioning and impulsivity. AARDoC was proposed in 2015 with the goal of improving efforts at precision medicine for AUD. As such, it is critically important that clinical assessments based on the AARDoC framework be studied and validated in order to inform clinical decision making and precision medicine initiatives for AUD. The AARDoC may also have utility in predicting AUD treatment outcomes and AUD recovery. There is an accumulation of evidence that drinking reductions are both achievable and associated with improvements in functioning among individuals with AUD. Examining whether drinking reductions can be associated with meaningful recovery of functioning is critically important because many individuals do not seek treatment because they do not want to abstain from alcohol, yet treatment systems are mostly focused on abstinence as a necessary and sufficient condition for recovery. Expanding the definition of recovery to include non-abstinent recoveries and other functional outcomes could increase acceptability of non-abstinent treatment goals among providers, increase treatment seeking among those with AUD who are not willing to abstain completely, and ultimately reduce the public health burden of untreated AUD. To address these gaps in understanding, this study will build an empirical knowledge base regarding clinical assessments that could be used to identify the AARDoC constructs and will examine whether the AARDoC constructs are associated with a novel typology of alcohol recovery, defined by consumption and functioning, among individuals who receive alcohol treatment. To achieve the study aims, integrative data analysis of AARDoC constructs among more than 3600 individuals (n = 3,672) who participated in three publicly funded alcohol treatment studies will be examined. This research will examine a broad definition of recovery and prediction of AUD recovery up to 10 years following an AUD treatment episode. The results from this study will be directly applicable to clinical practice and future research on AUD precision medicine. Project Relevance This study seeks to gain a better understanding of variability among individuals with alcohol use disorder who are seeking treatment and predictors of recovery from alcohol use disorder. The results will build a scientific knowledge base that will help guide future precision medicine initiatives, alcohol treatment planning, and decision-making among clients, clinicians, program evaluators, and policy makers, which may ultimately improve clinical outcomes and decrease the public health burden of alcohol use disorder.