Impact of Pretreatment Change on Mechanism of Behavior Change Research: An Applied Example Using Alcohol Abstinence Self-Efficacy

Abstract

With the growing recognition that, for some, significant changes in drinking occur before the fi rst treatment session (i.e., pretreatment change), researchers have called for the careful assessment of when change occurs and its potential impact on mechanism of behavior change (MOBC) research. Using a commonly hypothesized MOBC variable, alcohol abstinence self-efficacy, the primary aim of this study was to examine the effect of pretreatment change on the study of MOBCs. Method: Sixty-three individuals diagnosed with alcohol dependence were recruited to participate in a 12-week cognitive-behavioral treatment. Participants completed weekly assessments of self-efficacy and drinking behaviors. Results: Multilevel time-lagged regression models indicated that pretreatment change significantly moderated the effect of self-efficacy on the number of drinking days, such that among those higher on pretreatment change, higher self-efficacy ratings predicted lower rates of drinking days in the week until the next treatment session. In contrast, pretreatment change did not moderate the effect of self-efficacy on the rate of heavy drinking days. Conclusions: Results from the current study add to a small but growing body of research highlighting the importance of pretreatment change when studying MOBCs. Further, these results provide important insights into the conditions in which self-efficacy may play an important role in treatment outcomes.

Factors influencing readiness to change in patients with alcoholic liver disease: A cross‐sectional study

“…However, the influence of self‐efficacy is more specifically for taking steps. Similar findings in previous studies (Ehret, Ghaidarov, & LaBrie, 2013; Noyes et al 2018) match with our results that individuals with higher alcohol abstinence self‐efficacy are more likely to take action to change alcohol use. The findings suggest that self‐efficacy can be essential for initiating change in alcohol use.…”

“…The findings suggest that self‐efficacy can be essential for initiating change in alcohol use. Individuals with higher self‐efficacy may be more ready to take steps for change and can better control alcohol consumption by adopting effective coping strategies when faced with temptations (Noyes et al, 2018). However, the subjects’ self‐efficacy to abstain from alcohol use, in general, was not ideal which indicates an area for improvement in this population.…”

“…Before making behavioural changes, individuals must have considerable confidence in making the changes and believe that they can achieve their goals (Bandura, 1977). Studies have shown that alcohol abstinence self‐efficacy was positively associated with alcohol treatment outcomes (Kelly, Hoeppner, Stout, & Pagano, 2012; Noyes et al 2018). Self‐efficacy to abstain from alcohol use is another possible factor affecting RC.…”

Apathy is associated with poorer abstinence self-efficacy in individuals with methamphetamine dependence

“…In the context of substance use, self-efficacy may be defined an individual’s confidence in their ability to abstain from using substances in the future. Abstinence self-efficacy is often a targeted goal during treatment, and is a significant predictor of successful treatment outcomes across various substances of abuse ( Ilgen et al, 2005 , Kadden and Litt, 2011 ) including tobacco ( Gwaltney, 2009 ), alcohol ( Adamson et al, 2009 , Kadam, 2017 , Moos and Moos, 2006 , Noyes, 2018 ), opioid ( Kadam, 2017 , Reilly, 1995 ), and cocaine dependence ( Wong, 2004 ). There is preliminary evidence of its impact on METH treatment outcomes; in a sample of Filipino METH users, lower abstinence self-efficacy and poorer coping were the strongest predictors of relapse, after considering factors like negative behavior states, motivation to change, and drug craving ( Tuliao & Liwag, 2011 ).…”

The Identification of Pretreatment Trajectories of Alcohol Use and Their Relationship to Treatment Outcome in Men and Women With Alcohol Use Disorder

“…For example, constructs relevant to the initiation and maintenance of behavior change should be assessed (e.g., commitment and self‐efficacy). Given how little is currently known about pretreatment change, and its potential influence on mechanisms of change and treatment outcomes (Hallgren et al, In press; Noyes et al, ; Stasiewicz et al, ), casting a wider net at this early stage of research may help to promote a better understanding of how people initiate such changes.…”