Individualized assignment to short-term alcohol abstinence: A proof-of-concept human laboratory study using psychopathology dimensions

Background: Alcohol risk prevention strategies have recently incorporated temporary, short-term abstinence to reduce overall alcohol risk and health and social impacts on both individuals and society. However, experimental research in animals and humans has shown that, for some, short-term abstinence followed by reinstatement of drinking escalates, instead of reduces, subsequent alcohol use. The goal of this project was to conduct a proof-of-concept study using a novel precision approach to optimize assignment to short-term abstinence. Methods: The sample consisted of 48 healthy adults aged 21-35 (Median=24.5, Interquartile Range (IQR)= 6, 67% female, 83% White) who endorsed moderate-to-heavy alcohol use. Participants completed two counterbalanced intravenous alcohol self-administration sessions, one following a two-week period of alcohol abstinence and one during usual drinking. Crossover generalized outcome weighted learning was used to estimate an optimal individualized assignment rule for short-term abstinence, based on relevant psychopathology dimensions and other individual characteristics as prescriptive factors. Results: Findings showed that an estimated rule with higher granularity - higher-specificity traits and demographics - led to lower overall alcohol consumption compared to one-size-fits-all rules. The effect sizes of the difference were small-to-medium but did not reach statistical significance, likely due to the small sample size. Discussion: Results provide preliminary evidence that individualized assignment rules based on simple, accessible characteristics warrant further examination as an approach to identify individuals who could benefit from short-term alcohol abstinence. This line of research has significant long-term implications for tailoring interventions to individual needs, thereby enhancing outcomes. Further research steps are necessary to realize its full impact.