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. 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...

The Identification of Pretreatment Trajectories of Alcohol Use and Their Relationship to Treatment Outcome in Men and Women With Alcohol Use Disorder

“…In the general psychotherapy literature, studies of pretreatment change have shown that symptom change consistently occurs after the initial phone call when an appointment is scheduled, before the first treatment session (Kindsvatter et al, ; Lawson, ; Ness and Murphy, ; Weiner‐Davis et al, ; West et al, ). In the substance abuse literature, a similar pattern has been observed in studies that report reductions in or cessation of use that occurs between the initial phone call and the first clinical research assessment (Epstein et al, ; Kaminer et al, ; Morgenstern et al, ; Ondersma et al, ; Penberthy et al, ; Sobell, ; Stasiewicz et al, ).…”

“…Several of these studies found changes in alcohol use after the initial phone call (when screening information is obtained), but before the baseline assessment (Epstein et al, ; Sobell, ; Stasiewicz et al, ). In 2 studies, greater pretreatment reductions in the quantity and frequency of alcohol use predicted better 3‐month (Stasiewicz et al, ) and 12‐month drinking outcomes (Epstein et al, ). Thus, it appears that significant change in drinking may occur after the decision to seek treatment but before the first treatment session, and that these changes often are maintained during and following a course of treatment.…”

“…However, reactivity cannot explain all such changes, as several studies show significant change occurring before the baseline assessment, when assessment reactivity is most likely to occur. Moreover, 2 studies showed change occurring between 2 and 4 weeks before the participant‐initiated phone call, thus further calling into question assessment reactivity as the sole explanation for pretreatment change (Sobell, ; Stasiewicz et al, ).…”

“…For example, constructs relevant to the initiation and maintenance of behavior change should be assessed (e.g., commitment and self‐efficacy). Given how little is currently known about pretreatment change, and its potential influence on mechanisms of change and treatment outcomes (Hallgren et al, In press; Noyes et al, ; Stasiewicz et al, ), casting a wider net at this early stage of research may help to promote a better understanding of how people initiate such changes.…”

Alcohol craving in patients diagnosed with a severe mental illness and alcohol use disorder: Bidirectional relationships between approach and avoidance inclinations and drinking.

“…Greater understanding of when avoidance inclinations shift and their subsequent influence on changes in drinking and treatment seeking behaviors may help elucidate processes by which people successfully overcome problematic alcohol use. Of particular interest are changes during pretreatment intervals, as they may predict decreases in drinking often observed prior to the first treatment session (e.g., Stasiewicz et al, in press; Epstein et al, 2005). Finally, future research identifying techniques that enhance or maintain avoidance inclinations may improve treatment outcomes by allowing individuals to successfully cope with acute rises in approach inclinations over the course of treatment.…”