{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T13:35:04Z","timestamp":1774877704492,"version":"3.50.1"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u00a0months). Discontinuation was defined as \u226530 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2009=\u2009.385). 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\u201349.24]. In the landmark cohort (n\u2009=\u200950), early symptom improvement at 1\u00a0month was not significantly associated with subsequent discontinuation by 3\u00a0months (Firth OR 0.58, 95% CI 0.16\u20132.04).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/alcalc\/agag017","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T12:32:44Z","timestamp":1774873964000},"source":"Crossref","is-referenced-by-count":0,"title":["Demoralization, employment status, and early symptom reduction as correlates of treatment discontinuation in outpatient alcohol use disorder"],"prefix":"10.1093","volume":"61","author":[{"given":"Chung-Han","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Taichung Veterans General Hospital , No. 1650, Section 4, Taiwan Boulevard, Xitun District, Taichung 40705 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Beitou Dist., Taipei City 112304 ,","place":["Taiwan"]},{"name":"Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University , 145 Xingda Rd., South Dist., Taichung City 402202 ,","place":["Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2941-3023","authenticated-orcid":false,"given":"Chiann-Yi","family":"Hsu","sequence":"additional","affiliation":[{"name":"Biostatistics Task Force, Taichung Veterans General Hospital , No. 1650, Section 4, Taiwan Boulevard, Xitun District, Taichung 40705 ,","place":["Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9156-7413","authenticated-orcid":false,"given":"Ting-Gang","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Taichung Veterans General Hospital , No. 1650, Section 4, Taiwan Boulevard, Xitun District, Taichung 40705 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