Evaluating Readiness and Treatment Seeking Effects in a Pharmacotherapy Trial for Alcohol Dependence

Penberthy, J. Kim; Ait-Daoud, Nassima; Breton, Marc D.; Kovatchev, Boris; DiClemente, Carlo C.; Johnson, Bankole A.

doi:10.1111/j.1530-0277.2007.00448.x

Cited by 28 publications

(33 citation statements)

References 27 publications

(28 reference statements)

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“…Multiple studies have demonstrated significant reductions in alcohol consumption among some individuals prior to the onset of a course of treatment (e.g., Epstein et al, 2005; Kaminer, Burleson, & Burke, 2008; Morgenstern et al, 2007; Penberthy et al, 2007; Stasiewicz et al, 2013). In one of these reports, Stasiewicz et al (2013) identified a pair of pretreatment change patterns, one reflecting a rapid positive change in drinking (increases in abstinent days and decreases in drinks per drinking day) prior to the first treatment session and the second reflecting minimal change in drinking prior to the first treatment session.…”

mentioning

confidence: 99%

Therapeutic alliances predict session by session drinking behavior in the treatment of alcohol use disorders.

Connors¹,

Maisto²,

Schlauch³

et al. 2016

Journal of Consulting and Clinical Psychology

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Objective The therapeutic alliance is recognized as an important contributor to treatment outcomes. In this study, the session-to-session interplay of the alliance (as perceived by the patient) and alcohol involvement (drinking days and heavy drinking days between successive treatment sessions) was examined. The analyses also tested the extent to which pretreatment changes in drinking altered these interrelationships. Method Participants (N = 63) seeking treatment for an alcohol use disorder received 12-weeks of CBT for alcohol dependence and completed weekly assessments of the alliance. Results Higher session alliance scores at a given session significantly predicted lower alcohol involvement (both drinking days and heavy drinking days) in the period until the next treatment session, controlling for previous alcohol involvement. This relationship was further moderated by pretreatment change (changes in drinking prior to the first treatment session). Among those who demonstrated low pretreatment change, alliances continued to predict alcohol involvement. In contrast, alliances were not associated with alcohol involvement among those who significantly reduced their drinking prior to the first treatment session (high pretreatment changers). Finally, alcohol involvement during the period preceding a treatment session did not significantly predict alliance ratings. Conclusions These data demonstrate that more positive patient ratings of the alliance at any given treatment session are associated with less alcohol involvement during the period until the next treatment session, most particularly among patients who have not initiated reductions in their drinking prior to the first treatment session. For such patients, efforts to maximize therapeutic alliances may be warranted and productive.

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mentioning

confidence: 99%

Therapeutic alliances predict session by session drinking behavior in the treatment of alcohol use disorders.

Connors¹,

Maisto²,

Schlauch³

et al. 2016

Journal of Consulting and Clinical Psychology

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“…Interestingly, of the two studies to examine predictors of pretreatment change, only one found a positive relationship between alcohol problem severity and pretreatment change (Penberthy et al, 2007). There is also evidence of specific patterns of change (e.g., early rapid changers; Hildebrandt et al, 2011) and better 12-month outcomes for those demonstrating greater pretreatment reductions in the frequency and amount of alcohol consumed (Epstein et al, 2005).Although assessment reactivity is offered as a possible explanation for the results of several studies (e.g., Epstein et al, 2005;Kaminer et al, 2008), it cannot explain all pretreatment change, as studies show significant change occurring after the initial phone contact and before the first in-person clinical-research assessment (e.g., Epstein et al, 2005;Penberthy et al, 2007; Sobell, 2011). In addition, significant decreases in alcohol consumption are also noted several weeks before the phone call, suggesting that decision-making after seeing an advertisement for treatment may lead to successful behavior change (Sobell, 2011).…”

mentioning

confidence: 99%

Pretreatment Changes in Drinking: Relationship to Treatment Outcomes

Stasiewicz¹,

Schlauch²,

Bradizza³

et al. 2013

PsycEXTRA Dataset

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Pretreatment changes in alcohol use challenges the assumption that the major portion of the change process occurs after treatment entry. Greater understanding of the behavior change process prior to treatment has the potential to improve our understanding of behavioral changes during treatment. In this study, participants (N = 45) were recruited for a clinical trial examining multiple mechanisms of change in cognitive-behavioral treatment for alcohol dependence. Using data from both baseline and end of treatment assessments, several pretreatment intervals were created (e.g., a two-week pre-phone call interval, phone call to baseline assessment, baseline assessment to first treatment). To examine pretreatment changes in drinking, percent days abstinent and drinks per drinking day were analyzed using multi-level growth curve modeling and repeated measures ANOVAs. Initial examination of the data revealed significant increases in percent days abstinent and decreases in drinks per drinking day during the pretreatment intervals. Follow-up analyses also suggested that the majority of change in drinking occurs between the phone call and baseline assessment. Further examination of the data revealed two distinct patterns of pretreatment change: a) rapid changers who maintained changes during the course of treatment, and b) gradual changers who changed more gradually during the course of treatment. Analyses revealed that rapid changers had significantly higher rates of abstinence and lower drinks per drinking day at 90 days post-treatment compared to gradual changers. Overall, the data suggest that a more systematic investigation of pretreatment changes in alcohol use is warranted. Future studies may yield insights resulting in more efficient treatment delivery and adaptations to treatment based on an individual's pretreatment change status. Changes in addictive behavior frequently take place without professional treatment (Sobell et al., 1991). Indeed, unaided change may be more common than professionally-aided change in the case of alcohol problems (Sobell et al., 1996). Even among those who enter treatment, there is much in their accounts to suggest that a large component of the change process is self-directed (Orford et al., 2006a), with a few studies showing that significant changes in drinking occur prior to the first formal treatment session (e.g., Epstein et al., 2005; Sobell, 2011). As Orford (2006a) notes, these findings suggest that formal treatments are embedded within a much larger system of change-promoting elements occurring before, during, and after formal treatment. Furthermore, these data challenge the assumption that the majority of change occurs after treatment entry and suggests that behavior change must be examined through a broader lens (Willenbring, 2007). Although there is a wealth of research on behavioral change during and after treatment for alcohol use disorders, few studies have focused on pretreatment change, or change that occurs prior to the first formal treatment session. The aim o...

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“…In other words, although some participants received no active medication, all participants received CBT. Thus, it was not possible to explore whether the results of the present study are unique to CBT or represent a typical response to psychosocial treatment (Penberthy et al, 2007).…”

Section: Limitations and Future Directionsmentioning

confidence: 67%

“…Specifically, stage of change subscale scores and self-efficacy (i.e., confidence to abstain from drinking and temptation to drink) measured at pretreatment were strong predictors of posttreatment drinking outcomes (Project MATCH Research Group, 1997, 1998. In a previous study in our research clinic, we found that initial motivation to change was one of the strongest predictors of decreased alcohol consumption at the end of the pharmacobehavioral trial (Penberthy et al, 2007). These findings, however, have not been consistently demonstrated.…”

mentioning

confidence: 84%

Impact of Motivational Changes on Drinking Outcomes in Pharmacobehavioral Treatment for Alcohol Dependence

Penberthy

Hook

Vaughan

et al. 2011

Alcoholism: Clinical and Experimental Research

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Reductions in drinking occur and are predicted by increased motivation to change, reduced temptation to drink, and increased confidence to abstain in this population of alcoholic-dependent individuals. Early and late onset and heavy drinkers and those taking medications displayed differential changes in drinking behavior, some of which were explained by the mediating effects of self-efficacy. This is a first step in understanding more about which alcoholic individuals respond best to treatment and what mechanisms may be involved in the changes in drinking and drinking-specific changes in frequency and intensity of drinking.

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Evaluating Readiness and Treatment Seeking Effects in a Pharmacotherapy Trial for Alcohol Dependence

Cited by 28 publications

References 27 publications

Therapeutic alliances predict session by session drinking behavior in the treatment of alcohol use disorders.

Therapeutic alliances predict session by session drinking behavior in the treatment of alcohol use disorders.

Pretreatment Changes in Drinking: Relationship to Treatment Outcomes

Impact of Motivational Changes on Drinking Outcomes in Pharmacobehavioral Treatment for Alcohol Dependence

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