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

Abstract

Background: Few studies have focused on behavioral changes that occur prior to entering treatment for an alcohol use disorder (AUD). In 2 studies (Psychol Addict Behav, 27, 2013, 1159 J Stud Alcohol, 66, 2005, 369), pretreatment reductions in alcohol use were associated with better treatment outcomes. Identifying patterns of pretreatment change has the potential to inform clinical decision making.Methods: This study sought to identify pretreatment change trajectories in individuals seeking outpatient treatment for AUD (N = 205) using finite mixture modeling based on changes in number of days abstinent per week (NDA).Results: The analysis identified 3 pretreatment trajectory classes. Class 1 (High Abstinence-Minimal Increase; HA-MI) (n = 64; 31.2%) reported a high level of pretreatment NDA with minimal change during an 8-week pretreatment interval. Class 2 (Low Abstinence-Steady Increase; LA-SI) (n = 73; 35.6%) reported a low level of pretreatment NDA followed by a steady increase beginning 2 weeks prior to the phone screen. Class 3 (Nonabstinent-Accelerated Increase; NA-AI) (n = 68; 33.2%) reported no or very low levels of pretreatment NDA but demonstrated an increase following the phone screen. With regard to within-treatment change, Class 1 demonstrated the least and Class 3 demonstrated the most change in NDA. From baseline to 6-month follow-up, Class 3 added 2.31 abstinent days per week, Class 2 added 0.69 days, and Class 1 added 0.63 days. The increase in NDA for Class 3 was significantly different from the other 2 classes; however, Class 3 reported fewer overall days abstinent at 6-month follow-up.Conclusions: Study results have clinical and research implications including recommended changes to treatment protocols and research designs. Understanding the impact of pretreatment trajectories of alcohol use on within-treatment and posttreatment outcomes may provide important information about adapting treatment to increase efficiency and effectiveness.

Culturally tailored evidence‐based substance use disorder treatments are efficacious with an American Indian Southwest tribe: an open‐label pilot‐feasibility randomized controlled trial

“…The high rates of PDA at baseline impacted our ability to demonstrate change and may reflect a number of factors. The high rates of PDA at baseline may reflect changes in drinking or substance use before treatment entry commonly found among outpatient treatment samples [66][67][68][69][70][71]. Although we did not see a change in PDA when we compared past 90 days to past 30 days at baseline, we did find a high percentage of the sample had been incarcerated in the baseline time period, which would contribute to higher PDA.…”

Baseline Drinking Patterns in Non-Treatment Seeking Problem Drinkers

“…Kaminer et al (2008) found that 51.4% of adolescents with alcohol and other substance use disorders reported abstinence from alcohol between intake and first session. Studies with adult populations reveal similar findings (Orford et al, 2006;Kindsvatter et al, 2010;Stasiewicz et al, 2019).…”

“…Individuals may have learned through past treatment that seeking treatment provides relief, which prompts them to initiate change. Additionally, pre-treatment change may be associated with lower perceived cost of alcohol use reduction, and individuals having greater confidence, commitment and motivation to abstaining (Stasiewicz et al, 2019). Altogether, these studies demonstrate that a sizeable number of individuals with AUD begin to reduce their drinking prior to treatment.…”

“…In fact, it is estimated that 77% of all people who resolved their alcohol-related problems did so without treatment (Sobell et al, 1996;Grella et al, 2009). Among those who do seek formal treatment, studies indicate that changes in drinking and substance use behavior may occur prior to the start of treatment (Ondersma et al, 2012;Stasiewicz et al, 2019). Perhaps as individuals become motivated to receive treatment, they also begin to alter their drinking in anticipation of the treatment process.…”

“…LA-SI represents individuals who reported low pre-treatment NDA and substantial linear increase beginning 2 weeks prior to the phone screen and continuing to the first interview. The NA-AI represents individuals who reported low or no pretreatment NDA and an accelerated increase following the phone screen and leading to the first treatment session (Stasiewicz et al, 2019). Regardless of the pattern, it is clear that pre-treatment drinking changes are common.…”