September/October 2001 Article 1 Article 2

Reducing Alcohol Consumption Among Heavily Drinking Women: Evaluating the Contributions of Life-Skills Training and Booster Sessions Gerard J. Connors, Ph.D. and Kimberly S. Walitzer, Ph.D. Research Institute on Addictions, University at Buffalo, The State University of New York Abstracted from Journal of Consulting and Clinical Psychology, 69, 447-456, 2001. General population surveys conducted over the past 15 years have consistently indicated a prevalence of frequent drinking and problematic drinking among women. In a national survey of over 5,000 adults (Clark & Hilton, 1991), 25% of the women were found to be weekly drinkers. Fourteen percent of the women reported one incident in the past year of memory loss, morning drinking, or trembling, and seven percent reported two or more such incidents. Tangible consequences in the past year, such as work, marital, legal, or health problems, were reported by 16% with one problem and 11% with two or more consequences. A recent study of women problem drinkers by Gerard J. Connors, Ph.D., RIA director and UB professor of psychology, and Kimberly S. Walitzer, Ph.D., deputy director and UB research assistant professor of psychology, focused on strategies for reducing alcohol consumption in this population. In addition to a 10-session drinking moderation program, the study also examined the effects of two enhancements to this treatment – life-skills training and booster sessions. Participants One hundred forty-four problem-drinking women participated in the study. The eligibility criteria included being 21 years of age or older, drinking at least 15 drinks per week or two drinking days of six drinks each day, and interest in reducing alcohol consumption. Exclusion criteria included previous hospitalization for drinking or drug use, detoxification from alcohol or any other drug, current alcohol-related legal charges, current psychiatric treatment, hospitalization during the past five years for psychiatric problems, medical problems or medications contraindicating moderate alcohol consumption, and pregnancy or attempting to become pregnant. Eligible women had to report no more than moderate levels of alcohol dependence symptoms (through a combination of interview and questionnaire measures), normal liver-function tests, and laboratory confirmation of absence of pregnancy. The Program The program consisted of 10 weekly, two-hour outpatient sessions conducted in small groups of three to six women and led by two female therapists. “Target exercises” or homework assignments were provided for the first nine treatment sessions and included exercises such as practicing drinking-reduction strategies, identifying high-risk situations, and weekly self-monitoring of alcohol consumption. Women who were randomly assigned to receive the life-skills enhancement also received seven hours of life-skills training on topics such as relaxation, problem solving, and communication. Women not receiving the life skills enhancement received instead seven hours of exposure to topics related to general health and life functioning. For those assigned to receive booster sessions, eight additional sessions were held over the six months follow- ing treatment. Results Significant increases were found in abstinent and light drinking days following participation in the 10-week group intervention. The changes exhibited by the women were maintained during the ensuing 18-month follow-up period (see Figure, below). Average Number of Days per Month Classified as Abstinent and Light Drinking The most intriguing findings in this study emerged from the evaluation of drinking outcomes as a function of pretreatment drinking patterns and exposure to the treatment enhancements. Women who were heavier drinkers at pretreatment (i.e., those with fewer abstinent-light drinking days) responded the most to the life-skills enhancement and the booster sessions. Among these women, receiving either of the treatment enhancements – life-skills training or booster sessions – was associated with a greater number of abstinent-light drinking days, relative to not receiving a treatment enhancement. The women who received both enhancements (life-skills and booster sessions) had even more abstinent-light drinking days, compared to the women who received only one of the two enhancements. In comparison, women who at pretreatment were the relatively lighter drinkers in the sample responded equally well to treatment, regardless of whether they received treatment enhancements. Although increases in abstinent and light drinking days were the primary objective, changes also were observed for negative consequences of drinking. Such consequences decreased significantly from pretreatment to immediately posttreatment. Analyses of drinking consequences experienced over the full 18-month follow-up period showed that the reductions in consequences observed immediately following treatment were maintained. The intervention also addressed frequency of heavy-drinking situations and degree of confidence about not drinking heavily in these situations. It was found that although the frequency of situations in which the women reported heavy drinking was similar from pretreatment to posttreatment, ratings of confidence in dealing with such situations increased over this period. General life functioning improved from pretreatment to posttreatment. The dimensions of improvement included self-esteem, assertiveness, and psychological functioning. Caveats It is important to highlight some factors that limit generalizability of these findings. First, the sample overall comprised women presenting with good prognostic characteristics (e.g., well educated, socially stable, and relatively low on alcohol dependence). The extent to which these outcomes would extend to populations with greater severity of alcohol dependence or lower levels of overall life-functioning capabilities is not known. Second, the women were self-referred, potentially bringing with them levels of motivation that might not be evident in other populations of problem-drinking women. Related to this, the study for ethical reasons did not include a no-treatment control group. The absence of such a comparison group precludes determination of whether the increases in abstinent-light drinking days were a result of the drinking-reduction treatment. Future Research • It may be informative in future studies to evaluate the interaction between pretreatment drinking levels and treat- ment interventions. The present findings suggest a matching effect that might be useful in the assignment of women problem drinkers to interventions that vary in the number and nature of enhancements. • Other enhancements might be investigated for women presenting with heavier levels of pretreatment drinking. Briefer forms of the present drinking-moderation treatment might yield comparable reductions in alcohol consumption and should be evaluated. Clinical Implications Women who are heavier drinkers before treatment show significantly greater increases in abstinent-light drinking days when treatment is supplemented with either life-skills or booster sessions. These heavy drinking women show even greater increases if they receive both supplements. Women who are lighter drinkers before treatment (i.e., more abstinent-light drinking days pretreatment) would be expected to respond equally well to the drinking-reduction component, regardless of whether supplemental enhance- ments are provided. References Clark, W.B., & Hilton, M.E. (1991). Alcohol in America: Drinking practices and problems. Albany: State University of New York Press. This research was supported by Grant AA08076 from the National Institute on Alcohol Abuse and Alcoholism. Article 1

William R. Greiner, President

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