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


METHODS
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.


METHODS
Out-patient treatment.


METHODS
A total of 110 alcohol-dependent men and women.


METHODS
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.


RESULTS
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.
Litt
Mark D
MD
Department of Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT 06030, USA. litt@nso.uchc.edu
Kadden
Ronald M
RM
Kabela-Cormier
Elise
E
D000223:Adaptation, Psychological; D000428:Alcohol Drinking / Q000517:prevention & control / Q000523:psychology; D000437:Alcoholism / Q000523:psychology / Q000628:therapy*; D000553:Ambulatory Care; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods; D017060:Patient Satisfaction; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D019114:Remote Consultation; D020377:Self Efficacy; D016896:Treatment Outcome