Sex‐Dependent Alcohol Instrumentalization Goals in Non‐Addicted Alcohol Consumers versus Patients with Alcohol Use Disorder: Longitudinal Change and Outcome Prediction

Background Alcohol can be instrumentalized to achieve goals that without the drug would either not be achievable or would be so only with considerably more workload. While an understanding of the neurobiological mechanisms of alcohol instrumentalization is emerging, little information is available concerning instrumentalization goals in controlled consumers and how these goals change during the development of an alcohol use disorder (AUD). Methods We surveyed instrumentalization goals in 103 male and 78 female inpatients with AUD (before / after onset of the disorder) and compared them with the goals of 124 male and 96 female age‐matched non‐addicted controls. We also investigated whether instrumentalization goals predict 24‐month alcohol‐related hospital readmissions in the patients using a false discovery rate (FDR) approach. Results Separately for both sexes, the most frequently (>25%) self‐reported alcohol instrumentalization goals in patients were “stress coping,” “craving for alcohol,” and “reduction of anxiety and / or depressive mood” and in controls “facilitation of social interaction.” Relative to controls, and in a sex‐dependent manner, patients with AUD reported the goals “facilitation of social interaction” and “search for a partner” significantly less frequently and “reduction of anxiety and / or depressive mood,” “stress coping,” “improvement of sexual activity,” “improvement of concentration,” “euphoria,” and “craving for alcohol” more frequently. During the transition to addiction, many of the instrumentalization goals changed significantly, some in a sex‐dependent manner. In female AUD patients, a goal of “euphoria” nominally predicted a lower risk of alcohol‐related readmission, although not significantly when FDR corrected. Conclusions We identified cross‐sectional and intra‐individual differences in instrumentalization goals that support the assumption that the onset of an AUD coincides with a shift in instrumentalization goals from prosocial instrumentalization toward the self‐management of aversive mental states.