The proposed research will use existing data from the COMBINE study to evaluate mechanisms of behavior change following a combined behavioral intervention (CBI) for alcohol dependence. COMBINE (Combining Medications and Behavioral Interventions) was a multisite clinical trial conducted to evaluate the efficacy of two medications for alcohol dependence (naltrexone and acamprosate), when used in conjunction with one of two behavioral interventions (combined behavioral intervention (CBI) and medical management (MM)). The proposed research will focus specifically on individuals who were randomly assigned to the CBI conditions, these participants (n=776) received a maximum of 20 50-minute sessions delivered over 16 weeks. Within treatment assessment measures of mood state, perceived stress, craving, and drinking were administered at each treatment session. Post-randomization assessments of psychological, drinking-related, and behavioral outcomes were conducted at 8, 16, 26, 52, and 68 weeks. The CBI intervention incorporated components of motivation enhancement, cognitive behavioral and twelve-step facilitation therapies and was designed to maximize effects on the intended active ingredients of change. Using a multi-method analysis framework, the relationship between background variables, risk and protective factors, and treatment process measures, will be examined with respect to drinking outcomes (including quantity, frequency and drinking-related consequences). The primary analyses will incorporate a series of latent variable models to quantify individual heterogeneity in post-treatment drinking and the dynamic relationship between drinking behavior, treatment factors, and psychological processes. In addition, this study will incorporate a dynamical systems approach to examining the impact of two specific CBI modules, Mood Management and Coping with Craving and Urges, which are intended to change mood and craving, respectively. It is well-documented that a lack of effective coping responses increases relapse risk; and craving, mood and perceived stress have been identified as important mediators in the return to heavy drinking following treatment. However, the relationship between these variables in the relapse process has not been clearly established. Focusing on the process of relapse, rather than evaluating relapse as a dichotomous event, the proposed research will examine trajectories of drinking behavior and related consequences during treatment and in the first year following treatment for alcohol dependence. Specifically, the first goal of the proposed research is to model the discontinuity and complexity of drinking behavior patterns following treatment. The second goal is to quantify the relationship between processes of change during treatment, specific treatment modules intended to impact change mechanisms, and post-treatment drinking patterns. The abundance of alcohol treatment data makes the proposed research an important and cost-effective contribution to the study of what works and does not work in treatment; that is, what are the mechanisms of positive behavior change following alcohol treatment? In the United States, roughly 17.6 million people meet criteria for alcohol abuse or dependence and 12.5% of those individuals who meet criteria receive treatment for an alcohol problem. Of those who receive treatment, roughly 65-90% will have at least one drink in the first year following treatment and a large majority of individuals return for multiple treatments. Understanding the precipitants of heavy drinking following treatment as well as specific treatment techniques that help prevent heavy drinking following treatment is critical to improving existing treatments and helping prevent individuals from entering the revolving door of costly alcohol treatment programs. ? ? ?
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