© 2009 BY THE JOURNAL OF DRUG ISSUES

USING THE GROUP-BASED DUAL TRAJECTORY MODEL

TO ANALYZE TWO RELATED LONGITUDINAL OUTCOMES

HAIYI XIE, GREGORY J. MCHUGO, XIAOFEI HE, ROBERT E. DRAKE

The group-based latent trajectory model allows investigators to identify distinctive

trajectory groups based on relevant outcomes. Dual trajectory analysis enables
examination of the interrelationship between two outcomes simultaneously. This
paper describes the application of the group-based dual trajectory model in
mental health and substance abuse research. We analyzed two related recovery
outcomes: 1) social contact with non-substance abusing friends and 2) stage of
substance abuse treatment. We identified four groups for social contact and four
groups for substance abuse treatment. We then examined the interrelationship
between the two outcomes across the trajectory groups over 10 years. The two
outcomes are positively associated longitudinally and evolve in the same direction,
although for specific groups, the two outcomes do not covary. By examining
dynamic linkages across all trajectory groups between two longitudinal outcomes,
the dual model provides a more comprehensive and realistic understanding of the
underlying relationships between the two outcomes under investigation.

INTRODUCTION
In recent years, group-based trajectory models (Nagin, 2005) have become an
increasingly popular alternative method in longitudinal research. Applications of
this methodology are growing rapidly in criminology, psychology and substance
abuse research. Most applications have used the standard group-based model that
focuses on a single outcome variable. However, for co-occurring disorders and other
complex conditions with multi-dimensional outcomes, it may be more informative to

__________

Haiyi Xie is a Research Associate Professor in the Department of Community and Family Medicine, and
statistician at Dartmouth Psychiatric Research Center, Dartmouth Medical School. Gregory McHugo
is a Research Professor in the Department of Community and Family Medicine, the Department of
Psychiatry and the Dartmouth Psychiatric Research Center, Dartmouth Medical School. Xiaofei He is a
Research Assistant at the Dartmouth Psychiatric Research Center, Dartmouth Medical School. Robert
Drake is a Professor in the Department of Community and Family Medicine and the Department of
Psychiatry, and Director of the Dartmouth Psychiatric Research Center, Dartmouth Medical School.

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XIE, MCHUGO, HE, DRAKE

analyze two interrelated outcomes simultaneously. The group-based dual trajectory

model (Nagin & Tremblay, 2001), an extension of the standard group-based model,
is designed for this purpose.
In this paper, we illustrate the application of the group-based dual trajectory
model by analyzing two longitudinal outcomes in one of our longitudinal research
studies. The data for this illustrative example are from the New Hampshire Dual
Disorders Study (Drake et al., 1998), and the analysis was carried out using the
SAS procedure, “PROC TRAJ” (version 9), developed by Jones & Nagin (2007).

CONCEPTUAL DESCRIPTION OF GROUP-BASED TRAJECTORY MODEL

Over the last 10 to 15 years, random coefficient growth curve modeling has
become a centerpiece of longitudinal data analysis. The two main approaches to
this methodology are hierarchical linear modeling (Goldstein, 1987; Raudenbush
& Bryk, 2002) and structural equation modeling for growth curves (Muthén, 2004).
Starting in the late 1990s, a group-based approach for longitudinal data emerged as
a different analytical paradigm (Muthén & Shedden, 1999; Nagin, 1999).
Conventional random coefficient growth curve modeling is normal-based and
variable-centered. Its objective is to model the population average growth curve,
the individual deviations around population mean curves, and the variability within
each individual over time. Unlike random-effects growth curve modeling, group-
based modeling is a person-centered or subject-centered (treating the subject as
variable) and group-based (rather than individual subject-based) analytic approach. It
assumes that the study population is made up of a finite number of groups, or latent
classes, defined by distinctive patterns of growth. Its primary aim is to identify these
underlying groups and to classify individuals with a similar trajectory shape into
the same group. Statistical theory for the group-based trajectory model is based on
a nonparametric and semi-parametric statistical technique called, “finite mixture
modeling.” It approximates the underlying continuous population distribution
with discrete distributions and thus identifies distinctive groups or latent classes
that exist within the study population (Nagin, 2005). Group membership derives
from statistical approximation; it differs from pre-existing groups such as treatment
group, race, and gender.
The group-based model summarizes all of the heterogeneity at the group level
only; individuals within each group are assumed to be homogeneous. The group-
based model has been extended to a more complex framework termed “growth
mixture modeling” (Muthén & Muthén, 2000; Muthén & Shedden, 1999), which
allows modeling of individual heterogeneity in growth at both the individual and
group levels. The group-based model, also named “latent class growth analysis,” is
regarded as a restricted version of general growth mixture models by some authors
(Muthén, 2004).
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The group-based model has also been extended to dual trajectory analysis (Jones
& Nagin, 2007; Nagin & Tremblay, 2001). The standard group-based model, which
deals with a single outcome series only, is a univariate latent class trajectory analysis.
In contrast, the dual model is a multivariate or bivariate version of the group-based
model because it estimates jointly developmental trajectories of the two distinct but
related longitudinal outcome series.
In the substance abuse and mental health literature, the standard group-based
model as well as the general growth mixture model have been widely recognized
and increasingly used. However, group-based dual trajectory models have received
less attention and remain under-used. Our literature review revealed only a few
applications of this particular methodology (Barker et al., 2007; Chung, Maistro,
Cornelius, Martin, & Jackson, 2005; Jester et al., 2005; Jung & Wickrama, 2008;
Sullivan & Hamilton, 2007; Wanner, Vitaro, Ladouceur, Brendgen, & Tremblay,
2006). In the current paper, we introduce the group-based dual trajectory model to
applied researchers and demonstrate its utility by analyzing data from one of our
longitudinal research projects (Drake et al., 1998). This paper is intended to illustrate
the technique. The statistical theory behind the model was outlined in Nagin and
colleagues’ original work (Nagin, 1999, 2005; Nagin & Tremblay, 2001) and was
briefly reviewed in our previous paper (Xie, Drake, & McHugo, 2006). Readers
who are interested in technical details are referred to these works.

ADVANTAGES OF THE GROUP-BASED DUAL TRAJECTORY MODEL

Co-occurring disorders, or “comorbidity,” and heterotypic continuity (i.e.,
two behaviors that evolve over different time periods) are common phenomena
encountered in health and behavioral research. Some examples of the former are
substance abuse and criminal behavior, substance abuse and psychiatric symptoms,
substance abuse and gambling, and anxiety and depression. An example of the latter
includes childhood conduct disorders and adulthood anti-social behavior. Since
these behaviors and disorders interact with each other over time, or are related over
different time spans, it is theoretically more appealing to study these interrelated
phenomena simultaneously.
The longitudinal association between two outcome series can be assessed in the
conventional growth curve modeling framework, but the conventional approach can
only estimate the average association over heterogeneous subpopulations, thereby
“averaging” out the heterogeneities that exist among distinctive groups underlying
the general population. The standard group-based model reveals latent classes
or groups defined by heterogeneous longitudinal trajectory shapes in light of a
single outcome series, but it does not examine the possibility of different temporal
associations across different subgroups between the two related outcome series.

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The key innovation of the group-based dual model is its capacity for modeling
the interrelationship between two longitudinal outcomes. By summarizing this
interrelationship between two outcome series across various trajectory groups, the
dual model examines multiple and dynamic associations between the two outcomes
(Nagin, 2005). The group-based dual model is also flexible: it can be used to analyze
two parallel processes or two sequentially related processes. The two longitudinal
outcome series could be the same length or different lengths; they could also be the
same type or different types of data (e.g., continuous vs. dichotomous).

ILLUSTRATION
DATA SOURCE AND VARIABLES
Data for this illustrative analysis are from the New Hampshire Dual Disorders
Study. This study was a prospective, long-term follow-up of clients with severe and
persistent mental illness (schizophrenia, schizoaffective disorder, or bipolar disorder),
and co-occurring substance use disorder (alcohol and/or drugs). Between 1989 and
1992, 223 persons with co-occurring disorders from seven of New Hampshire’s 10
community mental health centers were randomized within sites to two treatment
conditions, Standard Case Management vs. Assertive Community Treatment, as a
means to deliver integrated dual disorder treatments. After three years, participants
were released from their experimental group assignments and followed for 14 more
years. The data were collected at baseline and every six months for the first three
years and then yearly afterwards. For this analysis, we used yearly data from the
baseline to the 10-year follow-up. The full sample of 223 subjects was included in
this analysis. By the end of 10 years, 160 of 223 participants remained in the study
(the attrition rate is 28%). Group-based modeling, relying on maximum likelihood
methods for parameter estimation, uses whatever data are available, so subjects with
incomplete data were still included in the analysis.
Two related outcome variables were used for this analysis: the frequency of
social contact with non-substance abusing friends (social contact), and the stage of
treatment and recovery (Substance Abuse Treatment Scale; SATS) (McHugo, Drake,
Burton, & Ackerson, 1995). Social contact is an ordinal variable (“about how often
do you do things with any of these friends who do not use alcohol or other drugs?),
but due to its skewness, it was recoded as a dichotomy (contact vs. no contact) for
this analysis. The SATS is an eight-point scale that indicates progressive participation
in treatment and movement towards stable recovery from substance use disorder:
1-2 = early and late stages of engagement, 3-4 = stages of persuasion, 5-6 = stages
of active treatment, and 7-8 = stages of relapse prevention and recovery. According
to the stage-wise model, patients are first engaged in a working alliance (engagement
stage); they are then helped to develop motivation for abstinence (persuasion stage);
next they participate in actively eliminating substance abuse (active treatment stage);
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and the final stage is relapse prevention and recovery. The SATS rating is an ordinal
variable; for this analysis it is treated as an approximately continuous variable.
Social contact and SATS were chosen for this analysis because the two measures
represent related, yet distinctive, long-term processes. They are indications of two
different aspects of recovery processes from co-occurring substance abuse and
psychiatric disorders. Recovery has been defined in numerous ways in the mental
health literature (Jacobson, 2004), and it has a different set of meanings in the field
of substance abuse. As documented in our previous report (Drake et al., 2006),
mental health clients’ writings and testimonies assert that recovery includes not just
controlling illnesses but also pursuing independent, active, and satisfying lives in the
community. Because many dually diagnosed clients report that the key challenge for
recovery is making friends who are not substance abusers, regular contact (at least
weekly) with peers who are not substance abusers is a key measure of recovery.
Thus, we used the SATS as a measure of recovery from substance abuse, and regular
social contact as a measure of social recovery.

AVERAGE TREND AND THE ASSOCIATION OF THE TWO LONGITUDINAL OUTCOMES

Before identifying subgroups defined by distinctive trajectories for each variable
and their interconnections across subgroups, we explored the overall, or average,
association between the two variables during the study period. First, we plotted the
proportions for social contact and mean scores of the SATS over 10 years (Figure
1). The plots show that both outcomes have a rising trend over 10 years with a faster
increase in the first three years; neither of them rises in a strictly linear fashion.
The upward trend for both outcomes suggests a positive longitudinal association
between them. Second, we examined their inter-correlation at each time point, as
well as overall, by collapsing over all time points. The correlation between them
ranges from 0.08 to 0.22 over time, and the overall correlation is 0.23. However,
these cross-sectional correlations neither reflect their longitudinal association, nor
the association of change over time. Third, we conducted a mixed-effects linear
model by treating the SATS as the outcome and social contact as a time-varying
covariate. The results of the mixed model with both fixed and random intercept,
linear time trend, and quadratic time trend indicate a positive relationship between
the two outcomes (β = 0.24, p = 0.006).1 The association between two different
types of longitudinal outcomes (e.g., binary vs. continuous) can be evaluated using
more sophisticated methods such as multivariate random-effects modeling in either
the standard mixed-effects modeling tradition (Fitzmaurice, Davidian, Verbeke,
& Molenberghs, 2008), or the latent variable modeling tradition (Muthén, 2001).
However, the simpler analysis is adequate for our purpose here.
The overall association between two average growth trajectories lacks
information. A likely possibility is that the study population is composed of several
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XIE, MCHUGO, HE, DRAKE

FIGURE 1A. SOCIAL CONTACT WITH NON-ABUSERS (YES) OVER 10 YEARS

FIGURE 1B. SUBSTANCE ABUSE TREATMENT SCALE (SATS) SCORE OVER 10 YEARS

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different longitudinal trajectory groups, but we are unable to discern these latent
groups and the unique relationships among them by looking at the overall average
association. Further investigation should ask questions such as: (1) Are there
heterogeneous trajectory groups in each outcome series? and (2) If so, how are the
two outcomes associated across different trajectory groups?

IDENTIFY THE OPTIMAL NUMBER OF LATENT TRAJECTORY GROUPS FOR EACH OUTCOME
Due to parameter proliferation with joint estimation in the dual model,
determining the optimal number of trajectory classes starts with estimation for single
outcome variables (Nagin & Tremblay, 2001). Thus, we first specified the univariate
model- logit model for social contact and censored-normal model for SATS and then
carried out separate estimation for each. The censored-normal model automatically
defaults to the normal model when a variable has no scale minimum or maximum.
Identifying latent trajectory groups within an average pattern requires a dynamic
model-fitting process with maximum likelihood estimation to determine the
optimal number of groups and to define the shape of the trajectory for each group
simultaneously. For each outcome, we began with a one-group model and continued
until the model with the optimal number of groups was fitted. For each group in each
model, the higher-order polynomials were fitted first. If the higher-order parameters
were not significant or if overall model fit was poorer, we excluded those higher-
order parameters and refitted the model. This estimation procedure yielded several
possible models, varying in the values of the growth parameters (that is, orders of
polynomials such as cubic, quadratic, linear or constant) in each group and in the
number of latent trajectory groups in each model.
The model with an optimal number of trajectory groups can be determined by
different approaches: (1) formal statistical testing using statistical criteria, such as
the Akaike Information Criterion, the Bayesian Information Criterion, or likelihood-
based tests such as the parametric bootstrap likelihood ratio test; (2) classification
quality reflected by the average posterior probabilities for each group or entropy
value; or (3) parsimony, theoretical justification, and interpretability (Jung &
Wickrama, 2008; Muthén & Muthén, 2000). We used the Bayesian Information
Criterion (BIC) because, to date, it has the widest consensus and is widely used in
this context (Collins, Fidler, Wugalter, & Long, 1993; Hagenaars & McCutcheon,
2002; Magidson & Vermunt, 2004; Muthén & Muthén, 2000; Nagin, 2005). BIC
favors a model with a higher likelihood value and fewer parameters (i.e., more
parsimonious) (Muthén & Muthén, 2000). The larger the BIC (smaller in absolute
values), the better the fit of the model. For our data, as shown in Table 1, the four-
group solution yielded the largest BIC values for both outcomes, in terms of number
of participants and number of observations. Trajectory groups identified for social

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XIE, MCHUGO, HE, DRAKE

FIGURE 2A. GROUP TRAJECTORIES FOR SOCIAL CONTACT

WITH NON-SUBSTANCE ABUSING FRIENDS

FIGURE 2B. GROUP TRAJECTORIES FOR STAGES OF SUBSTANCE ABUSE TREATMENT

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contact and substance abuse treatment and recovery, as well as the proportion of
estimated population in each group, are displayed in Figures 2a and 2b.
The four latent trajectory groups for social contact (Figure 2a) can be labeled as:
low social contact group (36.8%), steady (or gradual) increase in social contact group
(13.0%), early increase in social contact group (17.2%), and moderate increase in
social contact group (32.9%). The four latent trajectory groups for substance abuse
treatment and recovery (Figure 2b) can be labeled as: no recovery group (42.2%),
late recovery group (33.4%) and early recovery group (16.8%), and unstable/
relapsing group (7.6%).

DUAL TRAJECTORY MODEL: JOINT ANALYSIS

NUMBER OF TRAJECTORY GROUPS AND PROBABILITY OF GROUP MEMBERSHIP
Based on the results of univariate analysis, a dual trajectory model for both
social contact and substance abuse treatment and recovery was jointly estimated.
The number of optimal trajectory groups in the dual model usually is consistent with
those identified from the univariate models. Although univariate analyses resulted
in four trajectory groups for each outcome, to further ensure that the four-group
solution was the best model in the joint analysis, we fitted several joint models by

TABLE 1. USING BIC TO SELECT A MODEL WITH THE OPTIMAL NUMBER OF GROUPS

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varying the number of groups for each variable from three to five.2 It turned out
that the four-group solution for each outcome also had the best fit in terms of the
combination of subject level and observation level BIC value for the joint model
(Table 1). Thus, the same four-trajectory group models for each outcome were
identified as optimal from the joint analysis, and the shape of these trajectories also
stayed the same as those from the univariate model. However, the probabilities of
group membership are not exactly the same as those from the univariate model
(Table 2). For the substance abuse treatment and recovery, these proportions stay
about the same: no recovery group (43.0%), late recovery group (34.4%), early
recovery group (16.0%), and unstable/relapsing group (6.6%). For social contact,
there were some switches in group membership, but the probabilities of group
membership for each group were close to those from the univariate analysis. The
rank order of these proportions among the four groups stayed the same: the low
social contact group (35.7%) and the moderate increase in social contact group
(27.3%) remained the largest and the second largest group, followed by the early
increase in social contact group (20.6%) and the steady increase in social contact
group (16.5%).

INTERRELATIONSHIP ACROSS THE TRAJECTORY GROUPS BETWEEN THE TWO OUTCOMES

The aforementioned group membership probabilities are marginal probabilities,
which are not a unique feature of the dual trajectory model. A key advance of the
dual model over the standard group-based univariate model is the joint estimation
of interrelationships across the trajectory groups between the two outcomes. These
multidimensional relationships were assessed with estimated linkage probabilities,
which can be represented in three alternative ways: (1) probability of trajectory
group membership in substance abuse treatment and recovery conditional on

TABLE 2. COMPARING PROBABILITY OF GROUP MEMBERSHIP

FROM THE UNIVARIATE AND DUAL MODELS

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social contact, (2) probability of trajectory group membership in social contact

conditional on substance abuse treatment and recovery; and (3) joint probabilities
of trajectory group membership in both social contact and substance abuse
treatment and recovery.
Table 3a reports the probability of trajectory group membership in substance
abuse treatment and recovery conditional on social contact. The probabilities in
each row (across all categories of substance abuse treatment and recovery for a
given group of social contact) sum to 1.0. The Table shows that over half (55%) of
the individuals in the low social contact group are also in the no recovery group in
substance abuse treatment and recovery.
The steady increase in social contact group has a fairly similar trajectory shape to
the late recovery group, but the overlap between these two groups is only moderate
(25%). Instead, individuals in this group are mostly those from the no recovery
group (39%) and the early recovery group (36%) in substance abuse treatment and
recovery. For this particular group, progress in social contact and substance abuse
recovery do not necessarily evolve together.
The early increase in social contact group is composed mainly of individuals from
two recovery groups, the early recovery group (37%) and the late recovery group
(35%) in substance abuse treatment and recovery, which shows that social contact
and recovery from substance abuse evolve in the same direction. The trajectory
shape of the moderate increase in social contact group is somewhat similar to the
unstable/relapsing group in substance abuse treatment and recovery, but there is
minimal overlap between these two groups (11%). Instead, about half (51%) of
the individuals in this group actually belong to the no recovery group in substance
abuse treatment and recovery. This may not be too surprising, because the moderate
increase in social contact group gained contact only in the first two years, and then
stayed flat afterwards. In other words, except for initial improvement in the moderate
increase in social contact group, there has not been much change in either group (no
recovery group in substance abuse treatment and recovery vs. moderate increase in
social contact group) for the remainder of the 10 years.
Table 3b reports the probability of trajectory group membership in social contact
conditional on substance abuse treatment and recovery. The probabilities in each
column (across all categories of social contact for a given group of substance
abuse treatment and recovery) sum to 1.0. For the no recovery group, the largest
counterpart is the low social contact group (45%); for the early recovery group in
substance abuse treatment and recovery, the largest counterpart is the early increase
in social contact group (47%); and for the unstable/relapsing group in substance
abuse treatment and recovery, the largest counterpart in social contact is the moderate
increase in social contact group (47%). These results illustrate the high concordance

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between the two outcomes in their longitudinal course. Members in the late recovery
group in substance abuse treatment and recovery are more evenly distributed across
four trajectory groups in social contact, which implies a low correspondence in
change between substance abuse treatment and recovery and social contact for this
particular group.
Table 3c reports the joint probabilities of group membership for both substance
abuse treatment and recovery and social contact. The probabilities in all 16 cells
sum to 1.0. The table shows that the modal group is composed of those belonging
to both the low social contact group and the no recovery group (20%). Next, 14%
of those in the moderate increase in social contact group and the no recovery group
in substance abuse are the same individuals. Thirteen percent of individuals belong
to both the low social contact group and the late recovery group in substance abuse
treatment and recovery.
From the three sets of linkage probabilities presented in Tables 3a, 3b and 3c,
we can conclude, in general, that there is a fair amount of overlap or co-movement

TABLE 3A. PROBABILITY OF SATS GROUP CONDITIONAL ON SOCIAL CONTACT GROUP

1.00
1.00
1.00

TABLE 3B. PROBABILITY OF SOCIAL CONTACT GROUP CONDITIONAL ON SATS GROUP

TABLE 3C. JOINT PROBABILITY OF SOCIAL CONTACT GROUP AND SATS GROUP

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across most trajectory groups between social contact with non-substance abusers
and stage of substance abuse treatment and recovery. That is, the two outcomes are
positively related over time: less social contact with non-abusers is associated with
no or late recovery from substance abuse, and more frequent social contact with
non-abusers is associated with early recovery from substance abuse. However, for
some specific groups the pattern is not consistent, and the two outcome series do
not necessarily “travel together.” For example, the no recovery group in substance
abuse treatment and recovery has considerable overlap with the moderate increase
in social contact group, as evidenced from all three kinds of linkage probabilities.
Also, a sizeable group of individuals (39%) in the unstable/relapsing group in
substance abuse treatment and recovery are also those in the early increase in social
contact group.
By just focusing on the average association between the two outcomes series, we
would be blind to these different associations among the subgroups. By examining
the dynamic linkage across all trajectory groups, the dual model approach provides
a far richer, more comprehensive, and perhaps more realistic representation of the
underlying relationship between the two longitudinal outcome variables under
investigate.

DISCUSSION
A literature on the application of group-based trajectory models (Nagin, 2005)
has appeared in criminology, psychology and substance abuse research in recent
years. However, joint modeling of latent trajectory groups based on two relevant
longitudinal outcomes, an innovative method for quantifying comorbidity, is still
largely neglected and under-used. Theoretically as well as clinically, understanding
the dynamic relationship between two outcomes that evolve together over time may
be critical. For instance, researchers and clinicians want to answer the following
questions: Does substance abuse treatment also help psychiatric symptoms over
time? If so, is it the case for the population as a whole or just for a specific group?
In our illustration, we examined whether clients with more frequent social contact
with non-abusers are the ones with rapid recovery from substance abuse and vice
versa. If these two behaviors move in the same direction, an intervention could be
targeted at both; however, if these two behaviors go in opposite directions for some
specific groups, group-specific interventions should be considered.
In this paper, we addressed these questions by introducing and illustrating
a method designed for studying comorbidity in dynamic, multifaceted, and yet
more realistic, ways. The aim was to introduce this useful methodology to applied
researchers in substance abuse and mental health and hopefully to promote more
application of this method.

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Several caveats are worth mentioning. First, this is not intended to be a content-
centered paper. The analysis is “illustrative;” this was not a comprehensive study
focusing on the substantive meaning of the research. The paper is also not a statistical
paper, in that we omitted the technical aspects of the model and focused our attention
on the conceptual description and illustration of the application.
Second, as an introductory paper, we focused on examining interrelationships
across different latent trajectory groups between two longitudinal outcomes. This
is the model without covariates, or an unconditional model. It would be more
informative if we could go one step further by linking group membership and the
joint probabilities between two outcomes to individual-level covariates, and by
characterizing the subgroups in light of demographic variables and other background
characteristics. In other words, we would identify trajectory groups from two parallel
behaviors and their interactive movement as a function of covariates, and examine
demographic and clinical features of particular groups that may change in either the
same or in opposite directions. This step would yield a conditional model because
probabilities of dual trajectory group memberships would be conditional on a set of
covariates. However, as stated earlier, the current paper focuses on the unconditional
model.3 Future research should also combine this type of analysis with ethnographic
studies of social relationships and substance abuse recovery (Alverson, Alverson,
& Drake, 2001).
Finally, we chose to illustrate group-based models or latent class growth analysis
(Muthén & Shedden, 1999; Nagin, 1999), rather than growth mixture models
(Muthén & Muthén, 2000; Muthén & Shedden, 1999). The main consideration is that
for joint analysis of two outcomes with several possible latent groups identified for
each outcome, there would be many parameters to estimate, and the growth mixture
model would be complex. With a growth mixture model, we would also need to
include another layer of estimation, individual-level random growth parameters,
which would make an already complicated model even more complex with parameter
proliferation. This does not mean that growth mixture models are impossible for
the joint model. In fact, there have been successful applications of growth mixture
models in the dual trajectory analysis context (e.g., Jester et al., 2005). We have
presented the simpler model for introductory and illustrative purposes.

NOTES
1. The result was based on best-fit model. Interaction terms between social contact
and linear quadratic time trends were significant, thus they were excluded from
the model.
2. In terms of separate analysis, the joint models with less than three groups for
each variable are unlikely to have a better fit.

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3. A reviewer raised a question concerning whether or not the experiment had any
impact on the outcome. We included the group assignment variable in the initial
phase of model identification for each outcome respectively, and it resulted
in less than 10 clients who switched their group membership. The number of
trajectory groups and their trajectory shapes stayed the same. We conclude
that the impact of experimental group was minimal in the 10-year outcomes.

REFERENCES
Alverson, H., Alverson, M., & Drake, R.
2001 Social patterns of substance-use among people with dual diagnoses.
Mental Health Services Research, 3(1), 3-14.
Barker, E.D., Séguin, J.R., White, H.R., Bates, M.E., Lacourse, E., Carbonneau,
R., & Tremblay, R.E.
2007 Developmental trajectories of male physical violence and theft: Relations
to neurocognitive performance. Archives of General Psychiatry, 64, 592-
599.
Chung, T., Maistro, S.A., Cornelius, J.R., Martin, C.S., & Jackson, K.M.
2005 Joint trajectory analysis of treated adolescents’ alcohol use and symptoms
over 1 year. Addictive Behaviors, 30, 1690-1701.
Collins, L.M., Fidler, P.L., Wugalter, S.E., & Long, J.D.
1993 Goodness-of-fit testing for latent class models. Multivariate Behavioral
Research, 28, 375-389.
Drake, R., McHugo, G., Clark, R., Teague, G., Xie, H., & Miles, K.
1998 Assertive community treatment for patients with co-occurring severe
mental illness and substance abuse disorder: A clinical trial. American
Journal of Orthopsychiatry, 68(2), 201-215.
Drake, R., McHugo, G., Xie, H., Fox, M., Packard, J., & Helmstetter, B.
2006 Ten-year recovery outcomes for clients with co-occurring schizophrenia
and substance use disorders. Schizophrenia Bulletin, 32(2), 467-473.
Fitzmaurice, G., Davidian, M., Verbeke, G., & Molenberghs, G.
2008 Longitudinal data analysis: A handbook of modern statistical methods.
Boca Raton, FL: Taylor & Francis Group.
Goldstein, H.
1987 Multilevel statistical models (2nd ed.). London: Edward Arnold.
Hagenaars, J., & McCutcheon, A.
2002 Applied latent class analysis models. New York: Cambridge University
Press.

WINTER 2010 59

Downloaded from jod.sagepub.com at NANYANG TECH UNIV LIBRARY on June 4, 2016

XIE, MCHUGO, HE, DRAKE

Jacobson, N.
2004 In recovery: The making of mental health policy. Nashville, TN: Vanderbilt
University Press.
Jester, J.M., Nigg, J.T., Adams, K., Fitzgerald, H.E., Puttler, L.I., Wong, M.M., &
Zucker, R.A.
2005 Inattention/hyperactivity and aggression from early childhood to
adolescence: Heterogeneity of trajectories and differential influence of
family environment characteristics. Development and Psychopathology,
17, 99-125.
Jones, B., & Nagin, D.
2007 Advances in group-based trajectory modeling and SAS procedure for
estimating them. Sociological Methods and Research, 35(4), 542-571.
Jung, T., & Wickrama, K.A.S.
2008 An introduction to latent class growth analysis and growth mixture
modeling. Social and Personality Psychology Compass, 302-317 2(1).
Magidson, J., & Vermunt
2004 Latent class models. In D. Kaplan (Ed.), Handbook of quantitative
methodology for the social sciences (pp. 374-393). Newbury Park, CA:
Sage Publications.
McHugo, G.J., Drake, R.E., Burton, H.L., & Ackerson, T.H.
1995 A scale for assessing the stage of substance abuse treatment in persons with
severe mental illness. Journal of Nervous and Mental Disease, 183(12),
762-767.
Muthén, B.
2001 Latent variable mixture modeling. In G. Marcoulides & R. Schumacker
(Eds.), New developments and techniques in structural equation modeling
(pp. 1-33). Mahwah, NJ: Lawrence Erlbaum Associates.
Muthén, B.
2004 Latent variable analysis: Growth mixture modeling and related techniques
for longitudinal data. In D. Kaplan (Ed.), Handbook of quantitative
methodology for the social sciences (pp. 345-368). Newbury Park, CA:
Sage Publications.
Muthén, B., & Muthén, L.
2000 Integrating person-centered and variable-centered analyses: Growth
mixture modeling with latent trajectory classes. Alcoholism: Clinical and
Experimental Research, 24(6), 882-891.
Muthén, B., & Shedden, K.
1999 Finite mixture outcomes using the EM algorithm. Biometrics, 55, 463-
469.

60 JOURNAL OF DRUG ISSUES

Downloaded from jod.sagepub.com at NANYANG TECH UNIV LIBRARY on June 4, 2016

GROUP-BASED DUAL TRAJECTORY MODEL

Nagin, D.
1999 Analyzing developmental trajectories: A semiparametric, group-based
approach. Psychological Methods, 4(2), 139-157.
Nagin, D.
2005 Group-based modeling of development. Cambridge, MA: Harvard
University Press.
Nagin, D., & Tremblay, R.
2001 Analyzing developmental trajectories of distinct but related behaviors: A
group-based model. Psychological Methods, 6(1), 18-34.
Raudenbush, S., & Bryk, A.
2002 Hierarchical linear models: Applications and data analysis (2nd ed.).
Newbury Park, CA: Sage Publications.
Sullivan, C.J., & Hamilton, Z.K.
2007 Exploring careers in deviance: A joint trajectory analysis of criminal
behavior and substance use in an offender population. Deviant Behavior,
28, 497-523.
Wanner, B., Vitaro, F., Ladouceur, R., Brendgen, M., & Tremblay, R.E.
2006 Joint trajectories of gambling, alcohol and marijuana use during
adolescence: A person- and variable-centered developmental approach.
Addictive Behaviors, 31, 566-580.
Xie, H., Drake, R., & McHugo, G.
2006 Are there distinctive trajectory groups in substance abuse remission
over 10 years? An application of the group-based modeling approach.
Administration Policy in Mental Health and Mental Health Services
Research, 33, 423-432.

WINTER 2010 61

Downloaded from jod.sagepub.com at NANYANG TECH UNIV LIBRARY on June 4, 2016