More Than a Symptom Count: Measuring Functioning in Alcohol Use Disorder With the Life Stress Interview

The alcohol field has increasingly recognized that functioning plays a key role in the clinical course of alcohol use disorder (AUD). However, there remains a need for comprehensive instruments that capture functioning in this population. This study examined the utility of the UCLA Life Stress Interview Chronic Stress Assessment (LSI), a functional domains-based assessment widely used in mood disorder research, as a tool to measure functioning in key life domains in AUD. We (a) compared LSI scores between individuals with and without current AUD and (b) examined whether LSI scores are associated with recent alcohol use and AUD symptomology.

This secondary case-control study included 38 adults with AUD and 35 age- and biological sex-matched controls. The LSI was used to assess functioning in interpersonal, occupational, personal health, and family health domains over the prior 6 months. The Timeline Followback was used to assess recent alcohol use, and the Structured Clinical Interview for DSM-5 was used to assess AUD symptomology.

Individuals with AUD exhibited significantly poorer interpersonal, occupational, and personal health functioning, compared with controls. Among individuals with AUD, worse interpersonal, occupational, and personal health functioning correlated with a higher number of AUD symptoms, and both interpersonal and occupational functioning also correlated with greater recent alcohol use.

This secondary study provides preliminary support for the LSI as a tool to assess functioning in AUD, offering an unbiased, addiction-independent evaluation of functioning across key domains. Future work should replicate results in larger samples, conduct a formal psychometric evaluation, and examine the effects of biological, demographic, and clinical factors.