Demoralization, employment status, and early symptom reduction as correlates of treatment discontinuation in outpatient alcohol use disorder

Abstract Background Treatment discontinuation is common in outpatient alcohol use disorder (AUD) care, and attendance-related missingness can complicate interpretation of early symptom change in naturalistic cohorts. Methods We followed 72 adults newly entering outpatient care for moderate-to-severe AUD at a tertiary hospital in Taiwan (baseline and 1, 3, and 6 months). Discontinuation was defined as ≥30 consecutive days without documented clinic contact. Symptom trajectories were modeled using generalized estimating equations with and without baseline severity adjustment; baseline correlates of 1-month discontinuation were estimated using Firth bias-reduced logistic regression, and early symptom change was evaluated in a landmark analysis restricted to participants retained to the 1-month visit. Results The demoralization-by-time interaction for Alcohol Use Disorders Identification Test (AUDIT) reduction was significant in unadjusted models but attenuated after adjusting for baseline AUDIT (P = .385). Regular employment was independently associated with higher odds of 1-month discontinuation [adjusted Firth odds ratio (OR) 7.67, 95% confidence interval (CI) 1.19–49.24]. In the landmark cohort (n = 50), early symptom improvement at 1 month was not significantly associated with subsequent discontinuation by 3 months (Firth OR 0.58, 95% CI 0.16–2.04). Conclusions After accounting for baseline severity, demoralization was not a robust determinant of symptom trajectories. Regular employment showed a consistent association with early discontinuation, suggesting potentially modifiable time- and access-related barriers; early symptom change should be interpreted as an attendance-conditioned correlate rather than a standalone prognostic marker.