Methods for Estimating Long-term Drinking Trajectories for Individuals with Lifetime Alcohol Use Disorder

The physical, psychological, and social harms of alcohol use disorders represent an important public health problem and impose substantial costs. Alcohol dependence is a chronic, relapsing disease with many adverse consequences resulting from long-term consumption. To date no study has followed individuals for a long-enough time to analyze the long-term effectiveness and cost-effectiveness of alcohol treatment. We use three data sources to develop and externally validate transition probabilities between alcohol drinking states representing long-term drinking patterns. We use the National Epidemiologic Survey on Alcohol and Related Conditions to develop a set of multinomial logit models representing short-term drinking trajectories. We then use an iterative approach to calibrate short-term transitions to observed transitions from a matched set of patients from a separate 16-year study of alcohol consumption. We validate the transition probabilities using data from the National Survey on Drug Use and Health from 2002-2014. The resulting transition probabilities are representative of the U.S. population of individuals with lifetime alcohol use disorder who have engaged in formal treatment or self-help. The drinking trajectories developed in the current study will be used in a microsimulation model of the long-term costs and consequences of alcohol treatments.