The Search for Mechanisms of Behavior Change in Evidence-Based Behavioral Treatments for Alcohol Use Disorders: Overview

National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Bethesda, MD 20892, USA.
Alcoholism Clinical and Experimental Research (Impact Factor: 3.21). 11/2007; 31(10 Suppl):1s-3s. DOI: 10.1111/j.1530-0277.2007.00487.x
Source: PubMed


Over the past three decades, the main question of interest to alcohol treatment researchers has concerned the main effects of a particular behavioral intervention or what works. Increasingly, alcohol treatment researchers are turning their attention to the underlying psychological, social, and even neurophysiologic processes or "active ingredients" that are driving therapeutic change.
The articles contained in this supplement to Alcoholism: Clinical and Experimental Research grew out of invited presentations given at a one-day satellite session immediately preceding the 28th Annual Meeting of the Research Society on Alcoholism (RSA). The conference was a collaborative effort of the Center on Alcoholism, Substance Abuse, and Addiction at the University of New Mexico, the Center on Addiction and Substance Abuse at Columbia University, Brown University, and the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health.
The conference featured a mix of full-length presentations on conceptual and methodological issues, reports of original research findings, and lively discussion among speakers and conference participants. Understanding mechanisms of behavior change will benefit the field by identifying the key aspects of therapy that must be present for maximum effect, irrespective of the specific technique being applied; provide a new way to approach patient-treatment interactions; and lay the groundwork for understanding how change is affected by social and other extratreatment factors.
Although not a new topic to the field, understanding mechanisms of behavior change has begun to capture the interest of an increasing number of alcohol treatment researchers. Understanding behavior change is an exceedingly complex enterprise and innovative thinking and creative research designs will be required to advance the field.

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    • "Mechanisms Research in AUD There is a relatively large research literature on AUD behavioral treatment mechanisms (Huebner and Tonigan 2007; Longabaugh et al. 2013). This research largely represents an extension of assumptions and methods used to test treatment efficacy (Kazdin and Nock 2003; Morgenstern and McKay 2007; Wampold 2001). "
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    ABSTRACT: Researchers have begun to apply cognitive neuroscience concepts and methods to study behavior change mechanisms in alcohol use disorder (AUD) treatments. This review begins with an examination of the current state of treatment mechanisms research using clinical and social psychological approaches. It then summarizes what is currently understood about the pathophysiology of addiction from a cognitive neuroscience perspective. Finally, it reviews recent efforts to use cognitive neuroscience approaches to understand the neural mechanisms of behavior change in AUD, including studies that use neural functioning to predict relapse and abstinence; studies examining neural mechanisms that operate in current evidence-based behavioral interventions for AUD; as well as research on novel behavioral interventions that are being derived from our emerging understanding of the neural and cognitive mechanisms of behavior change in AUD. The article highlights how the regulation of subcortical regions involved in alcohol incentive motivation by prefrontal cortical regions involved in cognitive control may be a core mechanism that plays a role in these varied forms of behavior change in AUD. We also lay out a multilevel framework for integrating cognitive neuroscience approaches with more traditional methods for examining AUD treatment mechanisms.
    Alcohol research : current reviews 09/2015; 37(1):29-38.
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    • "That is, behavior can be recorded where there is a clear " beginning " and " end, " and can be verified as occurring at a particular point in time, relative to another behavior. Third, daily process methods provide powerful temporal sequencing of antecedents and consequences of a particular behavior and thus allow researchers to meet the logical and rigorous methodological requirements for establishing mediation of factors that contribute to drinking (Huebner and Tonigan, 2007; Kazdin and Nock, 2003). "
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    ABSTRACT: Interactive and mobile technologies (i.e., smartphones such as Blackberries, iPhones, and palm-top computers) show promise as an efficacious and cost-effective means of communicating health-behavior risks, improving public health outcomes, and accelerating behavior change. The present study was conducted as a "needs assessment" to examine the current available mobile smartphone applications (e.g., apps) that utilize principles of ecological momentary assessment (EMA)-daily self-monitoring or near real-time self-assessment of alcohol-use behavior-to promote positive behavior change, alcohol harm reduction, psycho-education about alcohol use, or abstinence from alcohol. Data were collected and analyzed from iTunes for Apple iPhone(©) . An inventory assessed the number of available apps that directly addressed alcohol use and consumption, alcohol treatment, or recovery, and whether these apps incorporated empirically based components of alcohol treatment. Findings showed that few apps addressed alcohol-use behavior change or recovery. Aside from tracking drinking consumption, a minority utilized empirically based components of alcohol treatment. Some apps claimed they could serve as an intervention; however, no empirical evidence was provided. More studies are needed to examine the efficacy of mobile technology in alcohol intervention studies. The large gap between availability of mobile apps and their use in alcohol treatment programs indicates several important future directions for research.
    Alcoholism Clinical and Experimental Research 06/2011; 35(12):2209-15. DOI:10.1111/j.1530-0277.2011.01571.x · 3.21 Impact Factor
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    • "As all evidencebased treatments for alcohol use disorders do not include change plans, this suggests that the change plan may be a distinctive ingredient of BMI that partially accounts for its effectiveness. Because identifi cation of active ingredients of behavioral treatments is a high priority for mechanismsof-change research in alcohol (Huebner and Tonigan, 2007) and other psychiatric disorders (Kazdin and Nock, 2003), the present fi ndings suggest a signifi cant step toward identifying a mechanism of change. "
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    ABSTRACT: Few studies have examined the effects of brief motivational intervention components, such as change-plan completion, on treatment outcomes. This secondary analysis of an opportunistically recruited emergency-department sample of hazardous injured drinkers examines the potential predictive role of an alcohol-related change plan on treatment outcomes after accounting for pretreatment readiness. Written change plans were independently rated. A mediational analysis framework tested directional hypotheses between pretreatment readiness, change plan, and treatment outcomes using linear regressions. The baseline total Drinker Inventory of Consequences (DrInC) score was covaried on 12-month DrInC total score, in all analyses. Participants who completed a brief motivational intervention and a change plan were included (N = 333). Pretreatment readiness was negatively associated with alcohol consequences at 12 months, (beta = -.09, t(254) = -2.07, p < .05, and good-quality change plans, (beta = .18, t(320) = 4.37, p < .001. With change plan and readiness in the same model, the relationship between readiness and treatment outcomes became nonsignificant, but change plan remained a significant predictor of treatment outcomes in the expected direction, beta = -.17, t(254) = -2.89, p < .01. Follow-up generalized linear modeling including an interaction term (change plan and pretreatment readiness) revealed that those with high readiness and a good-quality change plan versus those with low readiness and a poor-quality change plan had better-than-predicted outcomes for either readiness or change plan alone. Study findings suggest that the change plan in brief motivational intervention may be an active ingredient of treatment associated with better outcomes over and above the influence of pretreatment readiness.
    Journal of studies on alcohol and drugs 09/2010; 71(5):726-33. DOI:10.15288/jsad.2010.71.726 · 2.76 Impact Factor
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