Pretreatment Alcohol Drinking Goals are Associated with Treatment Outcomes
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland. Alcoholism Clinical and Experimental Research
(Impact Factor: 3.21).
06/2013; 37(10). DOI: 10.1111/acer.12137
A large subset of patients who enter treatment for alcohol dependence report nonabstinent drinking goals (e.g., reduction in drinking) rather than abstinence, and this pretreatment goal choice may be associated with drinking outcomes and alcohol-related problems.
An analysis of the 16-week Combined Pharmacotherapies and Behavioral Interventions (COMBINE) study was conducted to determine the association between self-reported pretreatment drinking goal and drinking outcomes and alcohol-related problems. Participants who reported a nonabstinent drinking goal (n = 340) were matched with participants who reported an abstinent drinking goal (n = 340) on 3 variables believed to contribute to treatment outcomes: COMBINE experimental group, gender, and number of prebaseline heavy drinking days.
Analyses revealed no interaction between the COMBINE experimental group and drinking goal on outcome measures, so results were collapsed and examined as a function of drinking goal group. Participants who chose an abstinent drinking goal had significantly more weeks with no drinking or no heavy drinking, reported fewer heavy drinking days, reported fewer days with >1 drink, and were more likely to have a ≥50% decrease in drinks per day between baseline and week 16 of the intervention. However, both groups reported reductions over time in percent drinking days, mean drinks per day, number of heavy drinking days, and number of drinking days per week, and participants in both groups experienced significant reductions in alcohol-related problems and improvements in psychosocial functioning.
Results replicate and expand upon previous studies examining the association between drinking goal and treatment outcome. These data also provide support for the standard inclusion of drinking treatment goal as a stratification variable in study interventions or as a covariate in outcome analyses and highlight several areas that warrant additional research regarding patients who enter alcohol treatment with a nonabstinent drinking goal.
Available from: Tak Fung
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ABSTRACT: The present study examined the nature and impact of participant goal selection (abstinence versus moderation) in brief motivational treatment for pathological gambling via secondary analyses from a randomized controlled trial. The results demonstrated that the pattern of goal selection over time could be characterized by both fluidity and stability, whereby almost half of participants switched their goal at least one time, over 25 % of participants selected an unchanging goal of 'quit most problematic type of gambling', almost 20 % selected an unchanging goal of 'quit all types of gambling', and approximately 10 % selected an unchanging goal of 'gamble in a controlled manner.' The results also demonstrated that pretreatment goal selection was uniquely associated with three variables, whereby compared to participants who selected the goal to 'cut back on problem gambling', those who selected the goal to 'quit problem gambling' were more likely to have greater gambling problem severity, to have identified video lottery terminal play as problematic, and to have greater motivation to overcome their gambling problem. Finally, the results demonstrated that goal selection over time had an impact on the average number of days gambled over the course of treatment, whereby those with abstinence-based goals gambled significantly fewer days than those with moderation-based goals. Nevertheless, goal selection over time was not related to dollars gambled, dollars per day gambled, or perceived goal achievement. The findings do not support the contention that abstinence-based goals are more advantageous than moderation goals and are discussed in relation to the broader alcohol treatment literature.
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Patients entering treatment for alcohol problems do not have uniform treatment goals, and a pretreatment drinking goal has a significant impact on treatment outcome. The objective of this study was to understand better how an array of individual characteristics, including factors that affect treatment, are related to treatment goals before beginning alcohol treatment in the COMBINE (Combining Medications and Behavioral Interventions) Study.
Participants were alcohol-dependent individuals (N = 1,156; 357 women) recruited at 11 outpatient academic alcoholism-treatment clinics across the United States to participate in a randomized, double-blind, placebo-controlled trial that combined behavioral intervention with acamprosate and/or naltrexone. Treatment goal was coded as controlled drinking, conditional abstinence, or total abstinence. Multinomial logistic regressions assessed whether there were significant relationships between predictor variables and pretreatment goal selection.
Lower levels of alcohol-related consequences, lower readiness to change, higher family income, more daily drinkers in social network, and lack of prior treatment or Alcoholics Anonymous engagement predicted choice of a controlled drinking goal over a total abstinence goal. Fewer alcohol-related consequences, lower readiness to change, and more daily drinkers in-network predicted choice of a conditional abstinence goal over a total abstinence goal.
Higher levels of functioning, lower levels of consequences, no prior involvement in treatment and Alcoholics Anonymous, and a more drinking-saturated social environment are associated with the choice of a non-abstinence goal.
Available from: Franz Moggi
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ABSTRACT: Abstract This study examined whether patients' drinking goals at admission to and discharge from 12 residential alcohol use disorder treatment programmes were associated with alcohol-related outcomes at 1-year follow-up. Detoxified patients (N = 289) completed assessments at admission, after treatment, and at 1-year follow-up. Drinking goals of abstinence, conditional abstinence (in principle abstinence but potential occurrence of lapses or drinking, when urges are strong), and controlled drinking changed during treatment and predicted the 1-year follow-up outcomes (abstinence, number of standard drinks, and number of days to the first alcohol use). Goals at discharge had a better predictive value. The goal of abstinence at discharge had better outcomes than conditional abstinence; the poorest had controlled drinking.
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