Short CommunicationUse of treatment strategies in a moderated drinking program for women
Highlights
► Heavy and light drinking negatively predicted strategy use during treatment. ► Treatment booster sessions are related to strategy use. ► Drinking reduction strategies predicted reduced drinking early posttreatment.
Introduction
Negative consequences associated with alcohol use exist on a continuum ranging from no consequences to severe consequences. Although most interventions focus on individuals with the most severe negative consequences, this population represents the minority of individuals experiencing alcohol use disorders. A significantly larger population is comprised of alcohol abusers who do not meet the criteria for severe physical dependence. This population represents a large number of individuals who might benefit from primary and secondary preventative interventions, including treatments focusing on moderating alcohol consumption.
The research on secondary prevention interventions with alcohol abusers has indicated that individuals – especially women – without histories of severe physical dependence on alcohol consistently demonstrate successful outcomes (e.g., Hester, 1995, Rosenberg, 1993, Sanchez-Craig et al., 1989). However, little is known about the extent to which the content of these treatment interventions relates to the outcomes observed. In one study, Connors, Tarbox, and Faillace (1992) found that reductions in drinking among problem drinkers in a drinking reduction program were associated with the posttreatment utilization of drinking reduction techniques.
Connors and Walitzer (2001) reported a drinking moderation intervention for alcohol abusing women that examined the effects of two enhancements to treatment — life skills training and booster sessions. Women, without histories of severe physical dependence on alcohol, exhibited significant increases in abstinent/light drinking days, decreases in negative consequences, and increases in self-efficacy and other life functioning during follow-up.
Baseline drinking moderated the effect of treatment enhancements on drinking outcome; women who were heavier drinkers at baseline reported greater improvement in abstinent/light drinking days when they received one or both treatment enhancements, relative to the women who were lighter drinkers at baseline. Walitzer and Connors (2007) observed these findings to be evident over 30 months posttreatment.
Using these data, we evaluated hypotheses regarding the relationships between strategy use, baseline and posttreatment drinking, and treatment enhancements. We first hypothesized that the frequency of baseline heavy drinking days would positively predict strategy use during treatment and that the frequency of baseline abstinent/light drinking days would negatively predict strategy use during treatment. Second, we predicted that participants receiving treatment enhancements – life skills training and booster sessions – would report increased strategy use, relative to participants who did not receive such enhancements. Finally, we predicted that baseline drinking would moderate the relationship between strategy use and drinking outcome, such that women who were relatively heavier drinkers at baseline would evidence a stronger relationship between strategy use and outcome compared to women who were relatively lighter drinkers at baseline.
Section snippets
Participants
One hundred forty-four women enrolled in a drinking moderation intervention for women seeking to reduce their alcohol consumption (Connors & Walitzer, 2001). Women had to be at least 21 years of age and drink at least 15 drinks per week or report six or more drinks two days per week. A series of criteria were used to exclude women with more than a moderate history of alcohol problems (described in Connors & Walitzer, 2001). The study was approved by the Research Institute on Addictions
Results
With respect to the prediction of strategy use during treatment by baseline drinking patterns, regression results indicated that PDH and PDA/L significantly predicted less strategy use (b = − 1.97, SE = .66, p < .01; b = − 1.51, SE = .53, p < .01, respectively), when controlling for the life skills treatment enhancement and ADS score.
Examining the effects of life skills, booster sessions, and time on strategy use during treatment, we found that the 2 × 2 × 4 (i.e., life skills × booster × time) repeated measures
Discussion
The most notable finding is that increased strategy use is associated with drinking outcomes only for relatively heavier baseline drinkers. Further, strategy use was important earlier following treatment as this association was seen only in the first 6 months posttreatment. It may be that over time, strategy use is normalized and less salient to the drinker, with explicit types of behaviors (e.g., drink substitution) becoming a less conscious effort.
Connors et al. (1992) found that strategy use
Role of funding source
Funding for this study was provided by NIAAA Grants R01-AA08076 and T32-AA007583. NIAAA had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the manuscript for publication.
Contributors
Dr. Mendoza conducted the statistical analysis, conducted the literature review, and wrote the first draft of the paper. Dr. Walitzer and Dr. Connors designed and implemented the Women and Health Project and had input into the analyses and writing of the paper. All three authors contributed to the development of the manuscript and approved it in its final form.
Conflict of interest
All authors declare that they have no conflicts of interest related to this manuscript.
Acknowledgments
We gratefully acknowledge the assistance of Rob Marczynski in the preparation of graphics.
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