Development and validation of the Loss of Control-Alcohol (LOSS-A) scale: A mixed methods study with adult drinkers

Although loss of control over alcohol use is an important premorbid risk factor for alcohol use disorder, its prevailing measures remain limited. As just one example, many items capture noncompulsive (e.g., social) reasons for exceeding drinking limits and may also fail to capture uncontrolled drinking for those with no intentions to moderate drinking. In a sample of adult drinkers, we developed and validated a novel survey to assess loss of control over alcohol to address these limitations.

Twenty-nine adults diverse in racial and ethnic identities and balanced on sex assigned at birth completed cognitive interviews to refine the item set. A quantitative survey was administered to 246 adults (55.7% White, 44.3% Black, 41.6% assigned male sex, 58.4% assigned female sex). The resultant items (Loss of Control-Alcohol [LOSS-A] scale) were administered alongside the AUDIT, Diagnostic and Statistical Manual of Mental Disorders, fifth edition-adapted alcohol use disorder symptoms, heavy drinking frequency, alcohol treatment history, and existing impaired control measures. Confirmatory factor analysis, item response theory, and a series of validity analyses were performed.

The LOSS-A scale was invariant by race and sex. After removing one item that showed differential item functioning by race, a one-factor model fits the data well (comparative fit index/Tucker-Lewis index = 1.00, root-mean-square error of approximation = 0.027, standardized root-mean-square residual = 0.030). The LOSS-A scale showed convergent and criterion validity as well as incremental predictive validity for several alcohol outcomes over existing loss of control and impaired control measures.

The eight-item LOSS-A scale is a brief and valid way to measure loss of control across a range of drinkers that addresses limitations of existing measures. (PsycInfo Database Record (c) 2026 APA, all rights reserved).