Advancing precision medicine through measurement of reward and relief drinking

About This Grant

Project Summary/Abstract American Indian and Alaska Native (AIAN) communities experience significant alcohol-related problems, further propagated by obstacles to beginning effective, high-quality treatment for alcohol use disorder (AUD). Precision medicine approaches to AUD treatment may make treatment more efficient and effective by individually tailoring AUD treatments to common etiological and maintenance mechanisms underlying AUD. For example, recent precision medicine efforts have identified that individuals who drink primarily in the context of reward (i.e., drinking for enhancement and social interaction) may respond better to naltrexone, whereas those who drink primarily in the context of relief (i.e., drinking to relieve negative physical and affective states) may respond better to acamprosate. However, extant measures used to classify reward and relief drinking tendencies do not account for the contextual factors associated with these constructs in AIAN peoples. Identifying relevant measures of reward and relief drinking tendencies in AIAN peoples may inform precision medicine research and reduce burden related to alcohol problems in AIAN. The proposed work will utilize a multi-method approach grounded in a community-engaged research framework to develop a tailored measure of reward and relief drinking by refining and expanding on several existing measures of reward and relief drinking and assess the construct validity of the newly developed measure in AIAN peoples. First, we will recruit AIAN people with AUD (N=20) to examine the content validity of three existing measures of reward and relief drinking and use cognitive interviewing methods to refine existing items and/or develop additional relevant items. Second, we will administer these items and any participant-identified additional items to a geographically varied sample (N=100) of AIAN with AUD. Using these data, we will then examine structural validity by identifying the hierarchical contributions of individual items to respective reward and relief drinking factors by conducting nonparametric item response theory (IRT) analyses. Lastly, we will utilize the refined measure to identify reward and relief drinking subgroups and examine comparative associations with convergent constructs to assess external validity. Ultimately, the proposed research will produce a construct-valid measure of reward and relief drinking informed by the lived experiences of AIAN peoples with AUD. The tailoring of an AIAN-specific measure of reward and relief drinking will play a direct role in improving alcohol problems in this population.