INDIVIDUALIZED ASSESSMENT AND TREATMENT FOR ALCOHOL

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Despite the popularity of Cognitive-Behavioral Treatment (CBT) in substance use disorders, recent findings have indicated that CBT may be no more effective than other, less theoretically driven, treatments, and that CBT treatments often fail to result in coping skills acquisition. In order to explore the possibility that current manual-driven modes of CBT delivery may not be adequate to successfully teach coping skills, we are proposing a pilot project for the development of an individualized assessment and cognitive-behavioral treatment program (IATP) for alcohol-dependent persons, in which experience sampling conducted via random calls to cell-phones is used to provide data to create individualized treatment plans. Data collected during experience sampling will include momentary assessments of patients cognitions, affects, and coping behaviors with respect to drinking. Participants will be 112 men and women meeting criteria for alcohol dependence or alcohol abuse, who will be randomly assigned to either a standard packaged manual-driven cognitive-behavioral treatment program (PCBT) like that used in Project MATCH, or to IATP. Patients in both treatments will be asked to engage in experience sampling for two weeks prior to treatment, and for another two weeks after treatment has ended, in order to compare in-vivo measures of coping skills utilization, pre- and post-treatment, between the two groups. Therapy will be conducted over 12 sessions in both treatments. In IATP, the information gathered from experience sampling will form the basis of a functional analysis of patients' drinking and drinking urges during the monitoring period. Cognitive appraisals, moods and coping responses will be evaluated as antecedents and consequences of drinking behavior. Therapists will use the information to address specific cognitions, affects, and behaviors that are adaptive and maladaptive, and will work with the patient to substitute adaptive coping tactics instead. In PCBT the experience sampling data will not be specifically used in therapy, but will still provide in-vivo measures of drinking and coping skills. It is hypothesized that IATP will yield significantly better coping skills acquisition than will PCBT, and that change in coping skills will predict better post treatment outcomes for IATP. These results would have implications for our delivery of treatment, and for the validity of coping skills training for alcohol addiction. Specific Aims are as follows: 1. To determine whether an Individualized Assessment and Treatment Program (IATP) results in greater acquisition of coping skills than does a standard Packaged Cognitive-Behavioral Treatment (PCBT). H1: It is hypothesized that IATP will result in significantly greater increases in reported use of coping skills from pre- to post-treatment relative to PCBT. 2. To determine if coping skills acquisition in IATP accounts for treatment outcome over and above the contribution made by pretreatment individual differences (i.e., motivation and self-efficacy). H2: It is hypothesized that pre- to post-treatment increases in coping skills in the IATP condition will account for more variance in drinking outcomes at post-treatment than will pretreatment individual difference variables. 3. To determine whether IATP, based on functional analysis of in-vivo patient monitoring, will yield better outcomes at post-treatment than will PCBT H3: It is hypothesized that IATP will yield better drinking outcomes at post-treatment than will the standard packaged CB approach. Drinking outcomes will include proportion days abstinent, and proportion heavy drinking days during the treatment period.