Subgroups of anxiety and depression trajectories during early abstinence in alcohol use disorder

Symptoms of anxiety and depression are common during early abstinence and can precipitate relapse. Previous studies show that, on average, anxiety and depression symptoms are typically elevated at treatment intake and decline rapidly during the first month. However, alcohol use disorder (AUD) is clinically heterogeneous, and it remains unknown whether there are distinct subgroups in the trajectories of anxiety and depression symptoms or whether all individuals show the characteristic decline.

This study aimed to identify and characterize anxiety and depression trajectories in a large sample (n = 1005) of individuals with AUD during early abstinence. Deidentified electronic medical record data were obtained from a community substance use treatment program. Anxiety and depression symptoms were assessed weekly using the GAD-7 and PHQ-9 scales, respectively. Latent growth curve analyses were used to identify subgroups.

Three subgroups were identified for both anxiety and depression trajectories: low, high, and sustained. The low trajectory subgroup comprised the majority of individuals (73% for anxiety, 70% for depression) and showed rapid symptom reduction. The high trajectory symptom subgroup (22% for anxiety, 24% for depression) showed a slower decrease in symptoms. In comparison, the sustained trajectory symptom subgroup (5% for anxiety, 6% for depression) maintained high reported symptoms throughout treatment. The three trajectory subgroups differed in age, sex, co-occurring mental health and substance use disorders, and PTSD symptom severity scores.

These findings provide strong evidence for subtypes based on anxiety and depression symptom trajectories in early abstinence. Early identification of individuals in the sustained trajectory subgroup could improve treatment outcomes and reduce relapse risk.