Heterogeneity in pathways to abstinence among women in treatment for alcohol use disorder

Abstract

Background Although many providers recommend alcohol abstinence as an initial step in the treatment of alcohol use disorders (AUD), there is a scarcity of research on specific behavioral strategies to achieve this step. The current study examined efficacy of a unique abstinence planning intervention for alcohol in a cognitive behavioral therapy (CBT) outpatient protocol. Design 128 women enrolled in a randomized controlled trial of CBT for AUD at a university-based clinic comprised the sample. Measurements Session 1 manual-guided interventions included an abstinence planning discussion in which each woman chose a specific plan for achieving initial abstinence in collaboration with her therapist. Drinking data were collected via participant logs during the 16 week within-treatment period and via Timeline Follow-Back interview at 12 month follow-up. Findings For 32.8% (n=42) of women who stopped drinking during the pre-treatment assessment period, their abstinence plan was to maintain abstinence (MA). 18.0% (n=23) of women chose a “cold turkey” approach (CT, abrupt cessation without medical assistance), and 46.1% (n=59) chose a “winding down” approach (WD, systematic reduction of drinking toward a specified quit date). Generalized Estimating Equations (GEE) analyses showed that type of abstinence plan chosen was differentially associated with percent days drinking (PDD) in later treatment (weeks 7–16) (p < .01) and during 12 month follow-up (p < .01). Women in the WD group had the highest PDD for both time frames and women in the CT group drank more frequently during later treatment compared to those in the MA group. The association between plan and PDD during follow-up was moderated by early treatment PDD (weeks 1–7; p < .01), such that women in the MA and WD groups had lower follow-up PDD if they were able to decrease their drinking during early treatment. Conclusions Women who were maintaining abstinence at treatment entry or had planned to stop using alcohol abruptly (i.e., “cold turkey”) after starting treatment had better overall drinking outcomes than those who chose to wind down. A plan to wind-down drinking appeared to be the most appealing option to women in the study and, among those who were able to successfully execute this winding down approach, was related to positive long-term drinking outcomes.

Gender Differences in Response to Alcohol Use Disorder Treatment: A Systematic Review

“…We included 24 original studies, with findings reported in 63 publications (Anton, Moak, Latham, et al, 2005;Anton, Moak, Waid, et al, 1999;Anton, O'Malley, et al, 2006;Babor, 1997;Baros, Latham, and Anton, 2008;Brown et al, 2007;Capone et al, 2011;Carroll et al, 1998;Cisler et al, 1998;Crouch, DiClemente, and Pitts, 2015;Cutler and Fishbain, 2005;Davis et al, 2002;DiClemente, 2011;Donovan et al, 2002;Dundon et al, 2008;Fals-Stewart and Birchler, 2002;Fals-Stewart, Birchler, and Kelley, 2006;Fals-Stewart, O'Farrell, and Lam, 2009;Friedmann et al, 2013;Friend and Pagano, 2007;Gamble et al, 2010;Gastfriend and the COMBINE Study Research Group, 2003;Greenfield et al, 2010;Hallgren, McCrady, and Epstein, 2016;Hallgren, Owens, et al, 2015;Holder et al, 2000;Holzhauer et al, 2017;Ilgen and Moos, 2005;Kelly and Hoeppner, 2013;Litt, Kadden, and Tennen, 2015;Lynch et al, 2010;Magura, Cleland, and Tonigan, 2013;Manuel, Houck, and Moyers, 2012;McCrady, Epstein, Cook, et al, 2009;McCrady, Epstein, Hallgren, et al, 2016;McCrady...…”

Applying methods for personalized medicine to the treatment of alcohol use disorder.

“…This suggests that personalized medicine methods should include assessments of the relieving and rewarding effects of alcohol. Other work uses complex methods such as factor mixture models and network analyses to identify individual characteristics which may moderate the effects of AUD treatment (Holzhauer et al, 2017(Holzhauer et al, , 2020 suggesting specific baseline characteristics which should be included in predictive models and also suggesting that multiway interactions are likely. This suggests that the method used for obtaining predictions with these variables should allow for those interactions.…”