Individualized assessment and treatment program for alcohol dependence: results of an initial study to train coping skills

Abstract

Aims: Cognitive-behavioral treatments (CBT) are among the most popular interventions offered for alcohol and other substance use disorders, but it is not clear how they achieve their effects. CBT is purported to exert its beneficial effects by altering coping skills, but data supporting coping changes as the mechanism of action are mixed. The purpose of this pilot study was to test a treatment in which coping skills were trained in a highly individualized way, allowing us to determine if such training would result in an effective treatment.

Design: Participants were assigned randomly to a comprehensive packaged CBT program (PCBT), or to an individualized assessment and treatment program (IATP). The IATP program employed experience sampling via cellphone to assess coping skills prior to treatment, and provided therapists with a detailed understanding of patients' coping strengths and deficits.

Setting: Out-patient treatment.

Participants: A total of 110 alcohol-dependent men and women.

Measurements: Participants in both conditions completed experience sampling of situations, drinking and coping efforts prior to, and following, 12 weeks of treatment. Time-line follow-back procedures were also used to record drinking at baseline and post-treatment.

Findings: IATP yielded higher proportion of days abstinent (PDA) at post-treatment (P < 0.05) than did PCBT, and equivalent heavy drinking days. IATP also elicited more momentary coping responses and less drinking in high-risk situations, as recorded by experience sampling at post-treatment. Post-treatment coping response rates were associated with decreases in drinking.

Conclusions: The IATP approach was more successful than PCBT at training adaptive coping responses for use in situations presenting a high risk for drinking. The highly individualized IATP approach may prove to be an effective treatment strategy for alcohol-dependent patients.

Figure 1

Example of a portion of a Functional Assessment (FA) chart delivered to IATP therapists prior to a patient starting treatment, based on pretreatment experience sampling records. The mood state ratings were derived from the highest of the four mood composite scores. (Fictitious patient).

Figure 2

Effects of treatment on drinking outcomes and on drinking consequences. Panel A, Percent Days Abstinent; Panel B, Percent heavy Drinking Days; Panel C, Proportion reporting continuous abstinence for previous 90 days; Panel D, DrInC scores.

Figure 3

Changes from pretreatment in proportions of coping responses employed in response to temptation episodes. Stars indicate those pre- to posttreatment coping changes by Condition that emerged as significant in logistic regression analyses of momentary data.