Pretreatment Changes in Drinking: A Test of a Tailored Treatment Approach

? DESCRIPTION (provided by applicant): This application is in response to PA-13-160, Alcohol Use Disorders: Treatment, Services, and Recovery Research. As stated in this Program Announcement, "because many individuals with alcohol use disorders change their drinking behavior without help from addiction treatment providers or self-help groups, it is as vital to understand how and why people change their drinking outside of specialized treatment settings as it is within them." Consistent with this notion of self-change, several studies, including a challenge grant funded under the American Recovery and Reinvestment Act (RC1 AA018986; PI-Stasiewicz), have reported that behavioral changes occur prior to initiating formal treatment. In our ARRA-funded Challenge grant we identified two distinct patterns of pretreatment change: 1) those who changed their drinking substantially during the pretreatment period and maintained those changes over the course of treatment and follow-up (i.e., rapid changers), and 2) those who made little or no change during the pretreatment period and changed gradually over the course of treatment (i.e., minimal changers; Stasiewicz et al., 2013a). Importantly, the rapid change group achieved and maintained superior treatment outcomes at posttreatment and at 3-month follow-up. Such substantial pretreatment changes have implications for how we adapt treatment for both rapid and minimal changers to optimize treatment efficiency and treatment outcomes. This application proposes to investigate whether different types and durations of treatment would be appropriate and beneficial for those who change their drinking more or less rapidly during an approximate 1-month pretreatment period. For example, rapid pretreatment changers might achieve good treatment outcomes with fewer treatment sessions that focus on relapse prevention, whereas minimal changers might benefit from enhanced treatment that addresses motivation to change and behavioral skills training. The design involves two separate two-group comparisons. The first comparison includes only rapid changers and will test whether 6 sessions of Relapse Prevention Treatment (RPT) is non-inferior to 12 sessions of standard Cognitive Behavior Therapy (CBT). The second comparison includes only minimal changers and will test whether 12 sessions of integrated Motivational Interviewing and CBT (MI/CBT) is superior to 12 sessions of standard CBT. All participants will be randomly assigned to treatment (i.e., rapid changers will receive either 6 RPT or 12 CBT sessions; minimal changers will receive either 12 MI/CBT sessions or 12 CBT sessions). Treatment-seeking men and women (N = 202) with a current DSM-V alcohol use disorder will participate. Follow-up interviews will occur at end-of- treatment and 3 and 6 months posttreatment. In summary, this study has the strong potential to substantially alter accepted paradigms of treatment by both increasing efficiency (with rapid changers) and increasing effectiveness (with minimal changers). Together, these innovations, if supported empirically and subsequently adopted in practice, could substantially reduce the burdens and costs associated with alcohol use disorders in the U.S.