Preparing Clients for Alcoholism Treatment: Effects on Treatment Participation
and Outcomes
Gerard J. Connors, Ph.D.
Kimberly S. Walitzer, Ph.D.
Kurt H. Dermen, Ph.D.
Research Institute on Addictions
University at Buffalo, The State University of New York
Abstracted from
Journal of Consulting and Clinical Psychology, 70, 1161-1169, 2002.
The purpose of this study was to examine whether participation in
one “preparatory” meeting
prior to the start of outpatient alcoholism treatment would result in increased
treatment attendance and drinking reduction.
Men and women entering outpatient
alcoholism treatment were assigned randomly to one of three types of
preparation: a role induction (RI) meeting, a motivational
interview (MI) meeting, or a no-preparation control group (CG).
“Role Induction” is designed to prepare clients
for treatment. It typically includes educating clients about the therapeutic
process and
what treatment
will entail, describing realistic expectations for change, and describing
what the counselor will expect of the client and what the client can
expect of the counselor.
“Motivational Interviewing” is designed to
increase clients’ motivation
for and commitment to change and to improve their compliance with treatment.
Key objectives for the clinician are to facilitate the client’s
awareness of the need to change, to increase the client’s motivation
to make change, and to discuss plans for change. Significant attention
is placed
on acknowledging and addressing client ambivalence about making changes.
Findings
- Clients who attended the MI preparatory
meeting attended more treatment sessions and had fewer heavy drinking
days during and 12 months
after treatment
than the CG clients.
- Clients who attended the MI meeting
also had more abstinent days during treatment and during the first
three months posttreatment,
compared to the CG
clients. This difference was not maintained through the remainder of the
12-month follow-up period.
- Clients who attended the RI meeting
showed no significant advantage over the CG clients. The only benefit
for those who attended the RI meeting
was a
more positive self-rating of general health.
Study Particulars
- Participants were 126 alcohol abusers – 87
men and 39 women – who
sought outpatient help for a drinking problem. Seventy-nine percent were
European American; 18 percent were African American. All met the
Diagnostic and Statistical Manual of Mental Disorders
(DSM-III-R; American Psychiatric Association, 1987)
criteria for alcohol abuse or dependence.
- Prior to entering treatment,
they reported an average of 10.4 abstinent days per month and 11.7 heavy
drinking days (more than six standard drinks) per
month. The participants had not been in treatment for
alcohol or substance abuse in the past year, had
been drinking in the previous three months, and
had a minimum sixth-grade reading level.
- Clients were assigned to one of the
three different types of preparation. Those assigned to receive RI
or MI were scheduled for that
meeting the week preceding
the start of the outpatient treatment. Therapists
conducting the preparatory meetings did not conduct the
outpatient treatment sessions.
- Treatment consisted of weekly individual
and group therapy sessions conducted over a 12-week period.
- The 12 individual sessions
were one hour in length and conducted from a detailed treatment manual
and session outlines. The sessions included problem-solving
techniques; relapse prevention; and discussion of
Alcoholics Anonymous and contracting to attend
AA. Clients also participated in twelve 90-minute
weekly group therapy sessions over the 12-week period.
Group topics included assertiveness, drink refusal,
relaxation, giving and receiving criticism, anger
awareness and management, and managing negative
thinking.
- Clients received periodic follow-up
research assessments during the 12 months following treatment.
Implications
- Previous research has shown a positive
relationship between length of treatment involvement and treatment
outcome. Since the MI preparatory
meeting
used in this study was associated with increased treatment
attendance, its use in other similar programs may
likewise increase treatment attendance and improve
outcomes.
- The present study has reasonably direct
generalization to outpatient treatment clinics and may potentially
be applied to other settings as well.
To the extent that it is an effective brief intervention, it may be
beneficial to use MI procedures with clients on a waiting
list for receiving treatment services.
Study Considerations
- The sample did not include individuals
mandated to treatment. Such individuals might not be ready to commit
to changing their drinking
and thus might respond
differently to the MI intervention. Individuals
who had been in treatment for substance abuse
during the previous year also were excluded. The nature
and extent to which the present findings would extend
to populations of mandated clients and recently-treated
clients is not clear.
- The sample included clients primarily
seeking treatment for an alcohol use disorder. Extension of these findings
to clients primarily
seeking treatment
for other substances of abuse also awaits further evaluation.
References
American Psychiatric Association. (1987). Diagnostic and statistical
manual of
mental disorders (3rd ed., rev.). Washington, DC: Author.
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