This application is in response to PA-10-100, Alcohol Use Disorders: Treatment, Services Research, and Recovery. 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. These data challenge the assumption that the major portion of the change process occurs after treatment entry and suggest that behavior change must be examined through a broader lens (Willenbring, 2007). Therefore, this study will assess pretreatment changes in alcohol use in an effort to identify different trajectories of growth (i.e., latent classes), and examine the relatioship of pretreatment growth trajectories to alcohol treatment outcomes (e.g., drinks per drinking day). To examine potential predictors of pretreatment trajectory groups, variables derived from empirical studies of self-change and a model of health-behavior change, Self-Determination Theory (SDT), will be assessed (e.g., autonomy, commitment to change, self-efficacy). Finally, the relationship between pretreatment change trajectories and several treatment process variables (e.g., negative affect, alcohol abstinence self-efficacy) measured at weekly intervals during a 12-week course of cognitive-behavioral treatment for alcohol dependence will be explored. Participants will be 220 alcohol dependent men and women who agree to participate in a 12-week trial of cognitive-behavioral therapy (CBT) for alcohol dependence. The pretreatment phase of the study includes the initial phone screen and a comprehensive baseline assessment. Pretreatment drinking will be assessed across the following intervals;2-weeks prior to the phone screen, phone screen to baseline assessment, and baseline to the first treatment session. The treatment phase includes a 12-week course of outpatient Cognitive- Behavioral Treatment (CBT) for alcohol dependence (Kadden et al., 1992). Clinical research assessments will be conducted at baseline, end-of-treatment and at 3- and 6-months post-treatment. In summary, this would be the first study to take a systematic approach to investigating pretreatment changes in drinking and to examine the impact of such changes on treatment outcomes and behavioral treatment processes. Identifying subgroups of individuals based on their trajectory of pretreatment change has great potential for opening up new avenues of treatment development including the use of adaptive treatment designs based on pretreatment change patterns. These could include treatment approaches designed to reinforce or maintain changes already made (e.g., relapse prevention) as well as interventions that take aim at facilitating further change for those entering treatment with a more gradual trajectory of pretreatment change.
A greater understanding of behavioral changes made prior to treatment may improve understanding of behavioral changes during treatment. Such information has the potential to open up new avenues for treatment planning and treatment development including the use of adaptive treatment designs based on pretreatment change patterns.