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

Objective: 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: (1) compare LSI scores between individuals with and without current AUD; and (2) examine whether LSI scores are associated with recent alcohol use and AUD symptomology.

Methods: 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.

Results: Individuals with AUD exhibited significantly poorer interpersonal, occupational, and personal health functioning, compared to 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.

Conclusion: 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 formal psychometric evaluation, and examine the effects of biological, demographic, and clinical factors.