Examining heterogeneity in pathways between alcohol-related factors and drinking during topiramate pharmacotherapy: A person-specific analysis.

Abstract

Treatment for alcohol use disorder (AUD) is complicated by person-specific heterogeneity in factors related to AUD risk, maintenance, and recovery. To advance precision treatment, it is important to study sources of variability in the determinants of AUD treatment response. We analyzed interactive voice response data measuring nightly drinking, desire to drink, self-efficacy to resist drinking, and drinking expectancies from two, 12-week randomized placebo-controlled trials of topiramate for drinking reduction (N = 214). World Health Organization risk drinking levels were used to measure both pre-treatment alcohol use and treatment response (i.e., reductions in risk levels). Group iterative multiple method estimation was used to determine the presence and frequency of shared versus person-specific associations between alcohol-related factors and nightly drinking. Associations between indicators of person-specific heterogeneity and pre-treatment alcohol use severity or degree of treatment response were also examined. Few shared pathways between alcohol-related factors and nightly drinking were observed, indicating notable person-specific heterogeneity. Nightly drinking was most often associated with same-day self-efficacy, but only for a minority (i.e., less than 20%) of the full sample. Indicators of person-specific heterogeneity were not associated with pre-treatment alcohol use severity or degree of treatment response (p > .05). Patterns of risk for nightly drinking during topiramate treatment may be largely person specific. More research is needed to develop approaches that target person-specific risk to optimize treatment responses for all individuals receiving pharmacotherapy for AUD.