Development and Validation of a Novel Survey Instrument to Assess Loss of Control over Alcohol Use: The Loss of Control-Alcohol (LOSS-A) Scale

Background: Loss of control over alcohol use is a component of impaired control and an important premorbid risk factor for alcohol use disorder (AUD). Prevailing assessments of loss of control over alcohol use have important limitations. For instance, many items imply intentions to limit drinking (e.g., drink more than intended?), which would not be endorsed by individuals who exhibit uncontrolled drinking with no intentions to moderate their behavior. Existing items have also been shown to be frequently endorsed when drinking limits are exceeded for non-compulsive (e.g., social) reasons. Thus, we developed and validated a novel loss of control survey whose content focused more on the thoughts, feelings, and motivations underlying loss of control and deemphasized intentions to limit drinking. Methods: 29 adults diverse in racial and ethnic identities and balanced on sex assigned at birth completed cognitive interviews to test the interpretability of devised loss of control items and to refine the item set. A quantitative survey was administered to 246 adults (55.7% White, 44.3% Black, 41.6% assigned male sex, 58.4% assigned female sex) to test the validity of refined items. The resultant loss of control items (the Loss of Control-Alcohol [LOSS-A] scale) were administered alongside measures of alcohol problems (AUDIT, DSM-5 AUD symptom scores), heavy drinking frequency, alcohol treatment history, and existing impaired control measures. Results: The LOSS-A scale showed excellent psychometric properties that did not differ by race or assigned sex. It showed incremental predictive utility for several alcohol outcomes over existing loss of control and impaired control measures. Conclusions. The final eight-item LOSS-A scale is a brief and valid way to measure loss of control across a wide range of drinkers that addresses limitations of existing measures.