Predictors of pretreatment commitment to abstinence: results from the COMBINE study.
OBJECTIVE
Patients entering treatment for alcohol problems do not have uniform treatment goals, and a pretreatment drinking goal has a significant impact on treatment outcome. The objective of this study was to understand better how an array of individual characteristics, including factors that affect treatment, are related to treatment goals before beginning alcohol treatment in the COMBINE (Combining Medications and Behavioral Interventions) Study.


METHODS
Participants were alcohol-dependent individuals (N = 1,156; 357 women) recruited at 11 outpatient academic alcoholism-treatment clinics across the United States to participate in a randomized, double-blind, placebo-controlled trial that combined behavioral intervention with acamprosate and/or naltrexone. Treatment goal was coded as controlled drinking, conditional abstinence, or total abstinence. Multinomial logistic regressions assessed whether there were significant relationships between predictor variables and pretreatment goal selection.


RESULTS
Lower levels of alcohol-related consequences, lower readiness to change, higher family income, more daily drinkers in social network, and lack of prior treatment or Alcoholics Anonymous engagement predicted choice of a controlled drinking goal over a total abstinence goal. Fewer alcohol-related consequences, lower readiness to change, and more daily drinkers in-network predicted choice of a conditional abstinence goal over a total abstinence goal.


CONCLUSIONS
Higher levels of functioning, lower levels of consequences, no prior involvement in treatment and Alcoholics Anonymous, and a more drinking-saturated social environment are associated with the choice of a non-abstinence goal.
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
Kelly S
KS
DeMartini
Boston University School of Medicine, Boston, Massachusetts.
Eric G
EG
Devine
University of Maryland, Baltimore County, Baltimore, Maryland.
Carlo C
CC
DiClemente
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, Martin Research and Consulting, Cambridge, Massachusetts.
Daniel J
DJ
Martin
Department of Psychology, University of California Los Angeles, Los Angeles, California, Department of Psychiatry and Biobehavioral Sciences Brain Research Institute, University of California Los Angeles, Los Angeles, California.
Lara A
LA
Ray
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, Yale Cancer Center, New Haven, Connecticut.
Stephanie S
SS
O'Malley
D000328:Adult; D064829:Alcohol Abstinence / Q000523:psychology; D000437:Alcoholism / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016320:Substance Abuse Treatment Centers / Q000379:methods; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology