This is a competing continuation grant application which has been resubmitted. It seeks an additional 3 years of support to continue research on natural recoveries (self-change) from alcohol problems. Building on our previous research which examined factors that contribute to and maintain natural recoveries, we propose to foster natural recoveries among problem drinkers in the community who have not entered formal treatment. Our research and others clearly shows that there are multiple pathways to recovery. Several studies have shown that the majority of individuals with alcohol problems do not seek formal help or treatment and of these individuals some proportion recover on their own. Further, our research reveals that it is not widely known that person can recover without treatment. Importantly, the findings from natural recovery studies have distinct implications for the secondary prevention of alcohol problems. The current study will mail out to all residences in a large metropolitan city a pamphlet that will make them aware that natural recoveries are quite prevalent. Those who have ongoing problems will be encouraged to change their drinking on their own or with some guided assistance. The pamphlet invites individuals who want further information to call or write a number that is totally confidential. Respondents who call in and are suitable for the study will be sent a consent form and a baseline assessment questionnaire. Respondents will be mailed their assessment materials with instructions that completing the materials will help them to better evaluate their current drinking. On returning the signed consent form and questionnaires, subjects will be randomly assigned to one of two groups: (a) Guided Self-Change (GSC)); or (b) Educational Materials Control (EDC); or (b) Educational Materials Control (EDC). The GSC group will be motivational in nature, focusing on providing personalized advice for participants. Their materials will be computer analyzed and sent back to the respondents with instructions that they can use the materials to guide their own change process. Subjects in the EDC group will not be sent personalized feedback but will receive educational materials. The intervention will be planned to provide sufficient and understandable information so that respondents can determine whether they have an alcohol problem and whether they are suitable candidates to attempt self-change. When mailing in their materials they will also be asked to consent to a 1- year follow-up to evaluate whether the materials were of any help, whether they used any other services for alcohol problems, as well as asking what their drinking was like over the past year. While most respondents will be interviewed by phone, a subsample will be followed-up in person and ask to provide a collateral informant. This proposed intervention is consistent with an efficient approach to public health care where an individual is first provided with an intervention that is least intrusive, least invasive and least demanding of lifestyle change, but yet has a reasonable chance of succeeding. If this approach does not work, then the level of cre can be stopped up. Such an approach has the opportunity of reaching large numbers of individuals who are otherwise unwilling, not ready, or unmotivated to seek formal help or treatment.
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