An analysis of relapse prevention factors and their ability to predict sustained abstinence following treatment completion.

BACKGROUND & OBJECTIVES: This study assessed the role of 14 specific relapse-prevention activities and their underlying factors in maintaining abstinence among subjects (N = 302) completing outpatient treatment for stimulant dependence. METHODS: We examined what broader dimensions might subsume the 14 items constituting the Drug Avoidance Activities checklist (Farabee et al. J Subst Abuse Treat 2002;23:343-350), and how well these derived factors predicted concurrent drug use at baseline and again 3 and 12 months later. RESULTS: Although four factors were identified consistently for the three time points, only avoidance strategies had sufficient internal consistency to be retained for further analysis. Controlling for age, gender, and ethnicity, the avoidance subscale was a significant predictor of UA results at all time periods: a one-point increase in the avoidance strategies scale was associated with an 86% increase in odds of a negative UA at baseline (OR = 1.86, 95% CI = 1.37-2.53, p < .001), a 77% increase at 3-month follow-up (OR = 1.77, CI = 1.37-2.29, p < .001), and a 37% increase at 12-month follow-up (OR = 1.37, CI = 1.04-1.81, p = .026). CONCLUSIONS: Although correlations of individual items with UA results showed statistically significant (p < .05) results for 8 of 14 items at one or more observation points, avoidance-related behaviors showed the strongest associations with sustained abstinence.

Common and specific effects of couples treatment for alcoholism: a test of the generic model of psychotherapy.

The generic model of psychotherapy (Orlinsky & Howard, 1987) eschews the view that inputs, processes or outputs associated with treatment exert linear and independent effects on outcomes. Variables within these three clusters must be viewed both within the context of time and through their interactions with other variables within a class. This study illustrates the use of this model by identifying common (comprising both traditional relationship factors and shared therapy ingredients) and specific factors in cognitive-behavioural (CB) and family systems (FS) treatments for alcoholic couples and tracking their contributions over two treatment phases - the acute phase, and the follow-up phase. While four process variables (therapy type, intensity of treatment, common elements and FS-specific procedures) contributed to outcomes during the active treatment phase, these variables became more interactive during follow-up. Indeed, high levels of both specific interventions of both treatments were negatively associated with benefit, if common factors were also frequently used during the acute phase. The best effects were obtained when common and specific interventions were counterbalanced, one being frequently used and the other being infrequently used. Implications for future alcohol treatment and recommendations for research on common and specific factors are discussed.

Why do older unhealthy drinkers decide to make changes or not in their alcohol consumption? Data from the Healthy Living as You Age study.

OBJECTIVES: To understand characteristics of older at-risk drinkers and reasons why they decide to change or maintain their alcohol consumption. DESIGN: Secondary analysis of data from a randomized controlled trial to reduce drinking in at-risk drinkers. SETTING: Three primary care sites in southern California. PARTICIPANTS: Six hundred thirty-one adults aged 55 and older who were at-risk drinkers at baseline, 521 of whom who completed a 12-month assessment. MEASUREMENTS: Sociodemographic and alcohol-related characteristics of 12-month assessment completers and noncompleters and among those completing the 12-month assessment by telephone or mail were compared using descriptive statistics. Reasons why respondents maintained or changed average alcohol consumption were asked of those who completed a 12-month assessment by telephone. Factors that might motivate at-risk drinkers to reduce drinking were asked about, and frequencies were calculated for these responses. RESULTS: Participants were primarily male, white, highly educated, and in good health. Those who responded to the 12-month assessment by mail were more likely to be working, to be in the intervention arm, and to drink more. Most who reduced alcohol consumption and heavy drinking did so because they thought it would benefit them. Those who did not thought that drinking was not a problem for them. Both groups cited their environment and circumstances as influencing their drinking. Remaining at-risk drinkers reported that medical evidence that alcohol was harming them would motivate them to reduce drinking. CONCLUSION: Older adults report that they reduce their drinking when they recognize that their drinking habits may be causing them harm; one's environment can hinder or help one to reduce drinking.