Pretreatment changes in drinking: relationship to treatment outcomes

Pretreatment changes in alcohol use challenges the assumption that the major portion of the change process occurs after treatment entry. Greater understanding of the behavior change process prior to treatment has the potential to improve our understanding of behavioral changes during treatment. In this study, participants (N = 45) were recruited for a clinical trial examining multiple mechanisms of change in cognitive-behavioral treatment for alcohol dependence. Using data from both baseline and end of treatment assessments, several pretreatment intervals were created (e.g., a 2-week pre-phone call interval, phone call to baseline assessment, baseline assessment to first treatment). To examine pretreatment changes in drinking, percent days abstinent and drinks per drinking day were analyzed using multilevel growth curve modeling and repeated-measures ANOVAs. Initial examination of the data revealed significant increases in percent days abstinent and decreases in drinks per drinking day during the pretreatment intervals. Follow-up analyses also suggested that the majority of change in drinking occurs between the phone call and baseline assessment. Further examination of the data revealed two distinct patterns of pretreatment change: (a) rapid changers who maintained changes during the course of treatment and (b) gradual changers who changed more gradually during the course of treatment. Analyses revealed that rapid changers had significantly higher rates of abstinence and lower drinks per drinking day at 90 days posttreatment compared with gradual changers. Overall, the data suggest that a more systematic investigation of pretreatment changes in alcohol use is warranted. Future studies may yield insights resulting in more efficient treatment delivery and adaptations to treatment based on an individual's pretreatment change status.