Treatment for alcohol use disorder (AUD) often involves a course of counseling aimed at changing the patient's drinking behavior. Many studies have explored how alcohol use changes during and after treatment, but few have focused on change that occurs before treatment begins. However, there is evidence that having made the decision to seek professional help, some patients do reduce their drinking before their first treatment session ─ and these changes may be maintained during and after treatment. In a new study published in the journal Alcoholism: Clinical & Experimental Research, researchers from the University at Buffalo have identified patterns of pre-treatment change ─ and their relationship with treatment outcomes ─ among people seeking treatment for AUD.
Men and women (n = 205) responded to adverts for the outpatient treatment study and were subsequently screened by phone for eligibility. At a full baseline assessment one week later, participants used calendar-based techniques to recall their daily alcohol use over the previous 6 months, including an 8-week 'pre-treatment' period immediately before the first treatment session. Participants then began a 12-week program of abstinence-oriented cognitive behavioral therapy (CBT) and repeated the alcohol assessment at the end of the treatment, and again 3 and 6 months later. Behavior change was measured by the number of days per week that patients abstained from alcohol.
Three different pre-treatment trajectory classes were identified using statistical criteria. Class 1 was characterized by a high level of abstinence throughout the 8-week pre-treatment interval; Class 2 by low abstinence initially, then steady improvement from two weeks before screening; and Class 3 by very low abstinence pre-treatment aside from a rapid improvement following screening. The trajectories predicted different patterns of change during and after treatment. Class 3 participants, who were drinking near-daily before treatment and had more room for improvement, showed the greatest increase in weekly abstinence from the baseline assessment to all post-treatment timepoints; however, they remained less abstinent than Classes 1 and 2 at 6 months post-treatment. Class 2 participants showed the greatest increase in days abstinent per week during pre-treatment, but remained less abstinent than Class 1 participants. Class 1 participants, who had more limited scope for improvement, reported the highest level but the least increase in abstinence during treatment.
The findings highlight approaching participants as individuals with differing treatment needs and adapting treatment protocols to the pattern of pre-treatment change. Class 3-type participants, who demonstrate fewer pretreatment abstinent days, may require a longer course of treatment or additional support to increase the number of days abstinent. Class 1-type patients, who show little further change in daily abstinence after starting treatment, may benefit from alternative treatment goals, such as reducing the number of heavy-drinking days. Finally, Class 2-type patients, who show the greatest pre-treatment change, may benefit from an approach that consolidates and reinforces changes already made.
Stasiewicz, P.R., et al. (2019) The Identification of Pretreatment Trajectories of Alcohol Use and Their Relationship to Treatment Outcome in Men and Women With Alcohol Use Disorder. Alcoholism: Clinical and Experimental Research. doi.org/10.1111/acer.14216.