Engagement in alcohol‐free activities, community‐level economic disadvantage, and heavy drinking following alcohol treatment

The reinforcer pathology model proposed by Warren Bickel and colleagues focuses on within-individual motivational processes involving overvaluation of smaller immediate rewards relative to larger delayed rewards (delay discounting) and high drug reinforcing value (drug demand) as determinants of unhealthy substance use. We propose an extension of this model to incorporate broader socioecological factors (e.g., community-level economic environment) that may influence reward preference. Using a secondary data analysis of 1,726 individuals enrolled in a randomized clinical trial for alcohol use disorder conducted at 10 research units in the United States, this study examined alcohol-free activity engagement in predicting heavy drinking outcomes 12 months following treatment and moderation of these associations by community-level economic factors. Bayesian multilevel models indicated that engaging in more alcohol-free activities 6 months after treatment predicted lower heavy drinking frequency 12 months after treatment. Moreover, the association between alcohol-free activity engagement and lower heavy drinking frequency was stronger among participants living in more impoverished communities. These findings suggest that empirical work in the natural environment derived from the reinforcer pathology theory attend to broader environmental factors encompassed by socioecological models of health that may be critical to promote and sustain recovery from alcohol and other substance use disorders.