HiTOP-based Optimal Personalized Assignment to Abstinence from Alcohol: A Precision Medicine Approach

Abstract

Abstinence from drinking has traditionally been the primary goal of alcohol use disorder (AUD) treatment; however, there is evidence that individuals respond differently when trying to be abstinent from alcohol. The main goal of my study was to use a novel precision medicine approach to optimize assignment to short-term abstinence from alcohol based on a variety of individual characteristics. The sample consisted of 97 moderate-to-heavy drinkers aged 21-35. A within-subjects design was employed where each participant completed two counter-balanced intravenous alcohol sessions (one following abstinence and one during usual drinking). For the primary aim of this study (N = 47), crossover generalized outcome weighted learning was used to estimate an optimal individualized assignment rule to short-term abstinence based on prescriptive factors, including HiTOP-relevant dimensions and other characteristics. For a secondary aim (N = 50), logistic regression was used to test whether the subgroups estimated by the optimal rule were associated with a set of genetic and behavioral factors related to AUD, and subjective perceptions to alcohol intoxication. Findings showed that an estimated rule with higher granularity – higher-specificity traits and demographics – led to lower alcohol consumption overall compared with one-size-fits-all rules (i.e., assigning everyone to abstinence or assigning no one to abstinence). The effect sizes of the difference were small-to-medium and fell short of statistical significance. Family history of AUD had a positive trend association with benefit from abstinence, with one standard deviation increase in family history of AUD being associated with twice as high odds of being assigned to abstinence. Due to the limited sample size, the results should be interpreted with caution. Study results provided preliminary evidence that an individualized assignment rule based on relatively simple and easily accessible individual characteristics can lead to lower alcohol consumption than that observed if everyone or no one was assigned to abstinence (i.e., one-size-fits-all approach). Genetic predispositions reflected in family history of AUD may be a potential mechanism linking the assessed prescriptive factors with abstinence response, which is worth further exploration.