Pretreatment changes in drinking: Relationship to treatment outcomes.

Abstract

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.

A network approach to modeling comorbid internalizing and alcohol use disorders.

“…We chose a 4-month window to assess alcohol use because drinking patterns immediately preceding treatment are typically not representative of the “typical” day-to-day drinking patterns that led to treatment (Stasiewicz et al, 2013). However, this design feature could have introduced ambiguity in the temporal priority between internalizing manifestations and alcohol use.…”

A contextual model of self-regulation change mechanisms among individuals with addictive disorders

“…As an example, for longitudinal designs with relatively spaced out assessment periods (e.g., during treatment and 2 months following treatment), self-regulation could be measured at baseline and during treatment and the outcome could be measured during the course of treatment and through a 2-month follow-up. It may also be important to consider changes in self-regulation and the outcome that might occur before treatment or during the early stages of treatment (Stasiewicz, Schlauch, Bradizza, Bole, & Coffey, 2013). For intensive longitudinal designs (e.g., using EMA with multiple assessment prompts per day for a 2-week period), researchers can evaluate more fine-grained temporal relationships, such as whether momentary self-regulatory behavior predicts subsequent substance use behavior during the same day.…”

Alcohol Use Disorder Treatment: The Association of Pretreatment Use and the Role of Drinking Goal

“…Positive changes in drinking behavior often occur before the start of treatment, and capturing such pretreatment change via trajectories may allow for a fuller picture of the change process. 39 Furthermore, drinking goal before treatment, which was assessed in the parent study via simple verbal inquiry, also seems to be clinically meaningful. That is, patients with a goal of abstinence may be more responsive to alcohol use disorder treatment in a primary care setting, 14 which seems to be the case in alcohol treatment settings as well.…”