A primary motivation for alcohol use among individuals with AUD is its negative reinforcement value via the relief of negative affect (NA; e.g., Stasiewicz and Maisto, 1993). NA is a feature of everyday life and may arise suddenly or in unpredictable situations (e.g., Baker et al., 2004; Koob et al., 2020). Consequently, when faced with increased NA following treatment, individuals are likely to resort to familiar behaviors for relief of NA (i.e., heavy alcohol use). A study examining the dynamic associations between negative affect and alcohol lapses concluded that individuals who reported greater negative affect following treatment were most likely to engage in heavy and frequent alcohol use and were very unlikely to engage in moderate drinking (Witkiewitz and Villarroel, 2009). Therefore, it follows that among individuals who are abstinent or have significantly reduced their drinking, those who are better able to manage NA would be less likely to resume a pattern of heavy or harmful drinking, as compared with individuals who continue to have trouble managing NA. Thus, NA is likely to play a role in alcohol recovery.

NIAAA has recently proposed a new operational definition of alcohol recovery, which is defined as achieving both remission from DSM-5 AUD and cessation of heavy drinking. This new definition of recovery also emphasizes the importance of biopsychosocial functioning and quality of life in maintaining and enhancing recovery outcomes (Hagman et al., 2022) and includes a duration component in response to the chronic and relapsing nature of AUD (Witkiewitz and Marlatt, 2007). Though its relationship to long term outcomes is currently understudied and requires validation, the NIAAA definition of recovery seeks to better characterize a group of individuals who are likely to achieve better post-treatment functioning, including more effective management and lower levels of negative affect. Indeed, effectively managing negative emotions without drinking has been endorsed by individuals in recovery as a top priority for maintaining recovery (Witkiewitz et al., 2020).

Recognizing the importance of NA in motivating alcohol use, negative emotionality is one of five domains that form the core functional elements of the Alcohol Addiction Research Domain Criteria (AARDoC), an organizational framework for research on processes that likely contribute to variability in AUD course and treatment (Litten et al., 2015). The Addictions Neuroclinical Assessment (ANA; Kwako et al., 2016) was developed from the AARDoC framework to help clinicians differentiate between AUD phentoypes based on etiology, prognosis, and treatment response. The ANA consists of three domains with relevance to the development and maintenance of addictive disorders: negative emotionality, incentive salience, and executive function. Nieto et al. (2021) conducted an evaluation of the ANA framework in a large sample of people who engage in unhealthy alcohol use. A factor analysis identified four functional domains that map onto and extend the proposed ANA domains. In addition to validating the three ANA domains, they found a fourth domain, alcohol-related consequences, which appears to reflect the negative emotional symptoms of withdrawal and other consequences of alcohol misuse. The ANA negative emotionality domain (ANA-NED) includes self-report assessment of various forms of negative affect including depression, anxiety, anhedonia, and hostility (Kwako et al., 2016). In the ANA-NED, measures of anxiety and depression had the highest factor loadings, a pattern also reported in individuals with AUD (Votaw et al., 2020) and among methamphetamine users (Nieto and Ray, 2022). Other studies have found that the ANA-NED is time- and gender-invariant in treatment-seeking samples and that higher scores on the NED are associated with both more frequent heavy drinking and drinking to regulate negative affect (Stein et al., 2021, Votaw et al., 2021). Thus, in recent attempts to validate the ANA framework, negative emotionality remains a theoretically and clinically important variable for characterizing heterogeneity in addictive behavior.

To fully realize the potential of the ANA, it is critical to elucidate each domain’s relationship to treatment response. Therefore, the primary purpose of the current study is to examine the relationship of ANA-NED to NIAAA recovery status among individuals who report drinking heavily in response to negative affect. Recovery status was selected as the outcome variable in response to an NIAAA initiative to stimulate research on a treatment outcome that holds potential for predicting improvements in biopsychosocial functioning and quality of life that often accompany addictive behavior change (Hagman et al., 2022). Also, given the paucity of research on the new NIAAA definition of recovery, the secondary purpose of this analysis is to examine the relationship of recovery status to 3- and 6-month drinking outcomes, thereby providing preliminary information on its criterion validity. We hypothesized that lower levels of end-of-treatment NA would be related to greater odds of attaining NIAAA recovery status and that, in turn, NIAAA recovery status would predict greater percent days abstinent and fewer percent heavy drinking days (PHDD) at the 3- and 6-month follow-up assessments.