An unexpected yet important finding from our ongoing study of Intensive Motivational Interviewing (IMI) for methamphetamine (MA) dependence is women with alcohol problems (N=87) are reducing their drinking significantly more if they are assigned to the IMI condition as opposed to a standard MI (SMI) comparison condition. Reduction of alcohol problems has been larger for women in the IMI condition at 4- and 6-month follow-up. Interestingly, trajectories show continuing declines in drinking problems during and after treatment, and differences between study conditions grow larger between 4-month (p<.05) and 6-month (p<.01) follow-up. Treatment effects at 6 months are medium to large, Cohen's d=0.63. There are no drinking differences by study condition for men. An important limitation of the current sample in terms of studying the intervention's effects on drinking is the current study targets persons with MA dependence. Alcohol problems are therefore secondary and typically participants enter with relatively low severity of alcohol problems and limited room for improvement. The primary goal of this application will be to test the efficacy of IMI for women with current alcohol dependence. Recruiting a larger sample of women with more serious drinking problems will enable demonstration of larger differences between study conditions. To assess if the trend of continuing improvement continues beyond 6 months we will interview women at 12 months. The sample will consist of 220 women randomly assigned to IMI (9 sessions) and or SMI (1 session plus 8 nutrition education sessions to achieve time equivalence of study conditions). All participants in both study conditions will receive 3 cognitive behavioral counseling groups each week. The study responds to PA-10-100, "Alcohol Use Disorders: Treatment, Services Research, and Recovery" (R01) issued by NIAAA. Our proposal addresses the priorities of this announcement by proposing a phase II randomized clinical trial that will compare IMI to SMI for alcohol dependent women. The study is also designed to respond to the PA's call for studies assessing the mechanisms of change. Unlike many previous studies of MI, we will employ limited exclusion criteria and will enroll participants who present some co-existing drug and psychiatric disorders. Thus, the study responds to the PA's call for studies on comorbidities. Procedures will draw from our current successful RCT assessing IMI for MA dependence. Successful aspects of the current study include accomplishment of recruitment goals, excellent adherence to the manual and research protocol, and excellent follow-up rates (>90%). The proposed study will take place at the same outpatient treatment program as the current study, New Leaf Treatment Center in Lafayette, California. Primary outcomes will be measures of drinking and alcohol problems assessed at baseline and 2, 6, and 12 months. Secondary outcomes will include the Addiction Severity Index, psychiatric problems and trauma symptoms. Quantitative and qualitative procedures will investigate potential mediators, including, retention, therapeutic alliance, self-efficacy, motivation, satisfaction, and outside services.
The Center for Disease Control estimated that problem drinking in the U.S. cost approximately $224 billion in 20061, which included expenses related to workplace productivity, healthcare, law enforcement, and motor vehicle accidents. Although effective treatments for alcohol problems exist, effect sizes are typically small or small-medium at best. Studies show that at treatment entry women have more medical, psychiatric, and adverse social consequences than their male counterparts. They are also at greater risk of dying from alcohol- related accidents. Drawing on very promising preliminary data regarding our intensive MI intervention, our study has the potential to significantly improve long-term alcohol treatment outcomes for women.