Identifying Multiple Mechanisms of Change in Alcoholism Treatment
Condition: Alcohol Dependence
MeSH terms: Alcoholism
Study type: Interventional
Phase: Phase 4

Summary: 
      Cognitive-behavioral therapy (CBT) is an effective treatment for alcohol dependence, but
      little is known about how CBT works to achieve these effects. Although several possible
      mechanisms have been proposed to explain the effects of CBT, it is rare that more than one
      mechanism is studied. However, it may be the case that similar outcomes (e.g., abstinence)
      may be reached through multiple paths. Therefore, essential to conducting work on behavioral
      change mechanisms is distinguishing different courses or paths and moderating influences
      (Kazdin, 2007). In the present study, we will focus on 2 key mechanisms posited to underlie
      the effectiveness of CBT specifically, increasing self-efficacy and self-confidence and
      reducing positive outcome expectancies for alcohol use, and 2 key mechanisms posited to
      underlie the effectiveness of a wide range of therapeutic interventions, increasing the
      therapeutic alliance and reducing/regulating negative emotional states. For the present
      study, participants will be 72 alcohol dependent men and women who agree to participate in a
      12-week trial of CBT for alcohol dependence. In addition, comprehensive research assessments
      will be conducted with patients at baseline, end of treatment, and 3-months posttreatment.

      Specific Aim 1. To examine the within-treatment week-to-week relationship between ratings of
      4 key therapeutic mechanisms and alcohol involvement (operationalized as percent days
      abstinent {PDA} and drinks per drinking day {DDD}) during treatment. It is hypothesized that
      self-efficacy, outcome expectancies, therapeutic alliance (as rated by the patient and
      therapist), and negative affect assessed after any given treatment session will each predict
      alcohol involvement during the following week. Exploratory analyses also will investigate the
      relationship of a given week's alcohol involvement on each of the four key variables as
      assessed the following week.

      Specific Aim 2. To examine profiles of the four key mechanisms over the course of treatment
      in relation to alcohol involvement during treatment and during the 3-month follow-up period.
      These analyses will be descriptive/exploratory. It is expected that profiles will emerge with
      the key mechanisms that are associated with decreased alcohol involvement (for example, when
      the alliance is relatively strong throughout treatment or when the alliance grows stronger
      over the course of treatment, or when positive outcome expectancies grow weaker over the
      course of treatment, etc.). Similarly, it is hypothesized that profiles will emerge that are
      associated with little improvement in alcohol involvement (for example, when negative affect
      is relatively high throughout treatment or when self-efficacy weakens over the course of
      treatment).
    


Intervention name(s): Cognitive behavioral therapy for alcohol dependence
Intervention type(s): Behavioral
Intervention description(s): 12-session behavioral treatment that incorporates behavioral skills training targeting high-risk drinking behavior.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment