Pretreatment Assessment-Related Reductions in Drinking Among Women With Alcohol Use Disorders

Abstract

Background: Preliminary studies have suggested that patients entering research trials for alcohol use disorders (AUDs) may show substantial reductions in drinking prior to beginning treatment. Objectives: Determine whether significant pretreatment reductions in drinking are present in a sample of alcohol-dependent women entering a psychotherapy trial for AUDs, and whether such pretreatment drinking reductions predict lower levels of drinking during and posttreatment. Method: The study included 136 women with DSM-IV alcohol dependence who participated in a trial of individual or couples-based cognitive behavioral therapy for AUDs. Repeated-measures ANOVAs were used to examine changes in drinking across the pretreatment assessment period, and hierarchical multiple regression was used to test whether pretreatment reductions in drinking predicted continued reduced drinking during treatment and follow-up at 12 months posttreatment. Results: Patients had significant reductions in drinking quantity and frequency throughout the pretreatment period, with one-third of the sample becoming abstinent prior to treatment. Controlling for baseline quantity and frequency of drinking, reductions in pretreatment drinking were predictive of reduced frequency of drinking within- and posttreatment, and lower quantity of drinking per drinking occasion in the within-treatment period but not the posttreatment period. Motivational level and treatment arm did not predict the level of change in drinking across the pretreatment period. Conclusions: The overall reductions in drinking are consistent with previous findings suggesting that female participants in AUD treatment trials can show a substantial amount of reduction in drinking during the pretreatment assessment phase, before therapy skills are imparted.

Keywords :

• Alcohol
• assessment reactivity
• assessment
• substance use
• alcohol dependence
• treatment
• women

THE AUTHORS

Blaise L. Worden, Ph.D. is a clinical psychologist at the Anxiety Disorders Center, Institute of Living, in Hartford, Connecticut. She engages in a combination of clinical work and research. She specializes in the treatment of anxiety and related disorders, particularly obsessive-compulsive spectrum disorders and substance use disorders. She has served as the primary investigator on several research projects, including studies of novel treatments for hoarding disorder, and for co-occurring anxiety and substance use disorders. Dr. Worden has been the author or co-author of several publications in scientific journals, and has spoken at national conferences for cognitive-behavioral therapy.

Elizabeth E. Epstein, Ph.D. is a Research Professor and Director of the Clinical Division at the Center of Alcohol Studies (CAS), Rutgers University, is on the Contributing Faculty, Graduate School of Applied and Professional Psychology (GSAPP) and The Department of Psychology at Rutgers University, and is an adjunct Clinical Associate Professor in the Department of Psychiatry, Rutgers/Robert Wood Johnson Medical School. Dr. Epstein received her Ph.D. in Clinical Psychology at the University of Connecticut and is a licensed psychologist in the state of New Jersey. She is Principal Investigator and/or co-investigator on several past and current clinical research grants funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and National Institute on Drug Abuse (NIDA). Her primary research activities involve development and testing of CBT models and mechanisms of change for substance use disorders, and in individual differences among substance abusers and impact on treatment response.

Barbara S. McCrady, Ph.D. is a Distinguished Professor of Psychology and Director of The Center on Alcoholism, Substance Abuse, and Addictions (CASAA) at the University of New Mexico. Dr. McCrady has focused her career on the development and testing of effective treatments for persons with substance use disorders, including cognitive behavior therapy, conjoint therapy, and Alcoholics Anonymous. She also has conducted cost effectiveness studies as well as controlled research treatment models for women. Her work has been funded by the NIH since 1979. Dr. McCrady has published more than 240 scientific articles, chapters, and books.