Post-treatment Stage of Change Predicts 12-month Outcome of Treatment for Alcohol Problems

Abstract

Aims: To evaluate relationships between clients' self-reported ‘stage of change’ and outcomes after treatment for alcohol problems. Methods: Using data from the ‘United Kingdom Alcohol Treatment Trial’, clients who had received at least one session of treatment and who had complete data (n = 392) entered the analysis. Two continuous measures of drinking behaviour (% days abstinent (PDA) and drinks per drinking day (DDD)) and categorical outcomes at the 12-month follow-up were compared between clients in Pre-action and Action stages of change at either pre- or post-treatment assessment. Multiple and logistic regression analyses examined the relationships between stage of change and treatment outcomes, evaluating the strength of these relationships by controlling for likely confounders. Results: Pre-treatment stage of change did not predict outcome but post-treatment stage of change predicted PDA and DDD at the 12-month follow-up. In unadjusted and adjusted analyses, clients in Action at post-treatment were two to three times more likely to show a favourable categorical outcome, variously defined, than those in Pre-action. There were no differences between clients who had received Motivational Enhancement Therapy and those who had received Social Behaviour and Network Therapy in proportions maintaining or moving towards Action from before to after treatment. Conclusions: These findings confirm previous reports that motivational variables predict outcome of treatment but add that such a relationship is seen for post-treatment stage of change. For therapists, it would seem important to monitor the client's stage of change—which in good clinical practice often occurs in informal ways—and have strategies to deal with low motivation to change whenever it occurs throughout treatment. The findings are also consistent with a ‘common factors’ perspective on effective treatment for alcohol problems.

Posttreatment motivation and alcohol treatment outcome 9 months later: Findings from structural equation modeling.

“…The associations in this study were greatly reduced after adjusting for drinking behavior during treatment: Effect sizes were smaller and did not obtain statistical significance on the most stringent definitions of positive outcome (Heather & McCambridge, 2013). However, motivation to address alcohol problems will be highly interconnected with drinking behaviors before, during, and after treatment, making study of their effects complex (Rollnick, 1998).…”

Profiles of confidence and commitment to change as predictors of moderated drinking: A person-centered approach.

“…As a result, both constructs have been extensively researched as mechanisms of change in the abstinence-based addiction treatment literature and are demonstrated predictors of substance use and other addictive behavior outcomes, with self-efficacy as a more consistent predictor than motivation (Amrhein, Miller, Yahne, Palmer, & Fulcher, 2003; Apodaca & Longabaugh, 2009; Brown, Seraganian, Tremblay, & Annis, 2002; Campbell, Adamson, & Carter, 2010; Heather, McCambridge, & Ukatt Research Team, 2013; Hodgins, Ching, & McEwen, 2009; Kelly, Magill, & Stout, 2009; Kuerbis, Armeli, Muench, & Morgenstern, 2013; Litt, Kadden, Cooney, & Kabela, 2003; Moyers, Martin, Houck, Christopher, & Tonigan, 2009; Project MATCH Research Group, 1997, 1998; Witkiewitz, Hartzler, & Donovan, 2010). In cases where profiles have been identified, it has been useful in helping to determining differential treatment efficacy (e.g., Witkiewitz et al, 2010), such that those with low motivation are better helped by motivational enhancement therapy than cognitive behavioral therapy or 12-step facilitation.…”

Do Brief Alcohol Motivational Interventions Work Like We Think They Do?

“…There have been relatively few process studies of BMIs and most of these have relied on patient or clinician self-reports rather than trained observer ratings of intervention sessions themselves (Daeppen et al, 2007a; Heather et al, 2013; McCambridge, 2013; Orford et al, 2009a; Orford et al, 2009b). Many questions remain regarding how BMIs work and addressing these questions is important for improving their efficacy.…”

“…The United Kingdom Alcohol Treatment Trial (UKATT), compared two alcohol problem treatment modalities, social behaviour and network therapy and motivational enhancement therapy (UKATT Research Team, 2005). Among the treatment processes identified, Heather and McCambridge showed that there was a strong relationship between post-treatment readiness to change and treatment outcomes (Heather et al, 2013). In post-treatment interviews conducted with participants in order to identify which elements may have helped them change their drinking, UKATT participants mostly attributed change to the involvement of others in supporting behavior change, to the awareness of the consequences of drinking, and to general factors (determination, commitment, and decision; detoxification or medication; and feeling comfortable talking) (Orford et al, 2009b).…”