Interactive voice response for relapse prevention following cognitive-behavioral therapy for alcohol use disorders: A pilot study.

The efficacy of individual and group cognitive-behavioral therapy (CBT) for alcohol use disorders (AUDs) has been demonstrated multiple randomized clinical trials (Morgenstern & Longabaugh, 2000). CBT is grounded in Social Cognitive Theory (Bandura, 1977, 1986), which posits that maladaptive alcohol in use (or other behavioral health problems) is a result of personal skills deficits. In CBT, therapists instruct and support their clients in the use of a variety of inter- and intrapersonal coping skills and encourage their application in real-life situations. A number of studies have demonstrated that CBT for alcohol use disorders increases the development of coping skills (Chaney, O’Leary, & Marlatt, 1978; Monti et al., 1993; Oei & Jackson, 1980, 1982). Furthermore, skills use among clients in treatment for alcohol use disorders has a demonstrated impact on treatment outcome (Chung, Langenbucher, Labouvie, Pandina, & Moos, 2001; Connors, Maisto, & Zywiak, 1996; Litt, Kadden, Cooney, & Kabela, 2003; Miller, Westerberg, Harris, & Tonigan, 1996; Moser & Annis, 1996). Because relapse to drinking in the months following treatment is high (up to 80% at 12 months; Connors et al., 1996; Feeney, Young, Connor, Tucker, & McPherson, 2002; Hunt, Barnett, Branch, 1971; Litman, 1986; Lowman, Allen, Stout, & The Relapse Research Group, 1996; Miller et al., 1996; Moser & Annis, 1996), effort to support patients’ retention and use coping skills in the posttreatment period seems justified as a potential relapse prevention tool Extended treatment or aftercare often is available or affordable; thus, an accessible low-cost technology such as Interactive Voice Response (IVR) has promise as a means for maintaining patients’ connections to their therapeutic experience after discharge. IVR has been used to monitor alcohol use and related symptoms among individuals receiving alcohol brief intervention, with demonstrated therapeutic benefit when participant feedback was included (Aharonovich et al., 2006; Helzer et al., 2008). Feasibility studies of IVR symptom monitoring with untreated alcoholics and their spouses (Cranford, Tennen, & Zucker, 2010) and among individuals recently completing specialty treatment for alcohol use disorders (Mundt, Moore, & Bean, 2006; Simpson, Kivlahan, Bush, & McFall, 2005), have demonstrated good compliance and minimal measurement reactivity. The posttreatment IVR program described by Mundt et al. (2006) is the most sophisticated to date. The participant interface of their IVR program included a daily survey with branching logic based on whether or not the patient drank. Each branch lead to further assessment questions, then both branches concluded with a relapse risk questionnaire. The IVR system also provided feedback, encouragement, and support based on participants’ responses. Patients could leave a message and/or request a call-back from the therapist. The goal of the current study was to pilot test an IVR-based program, the Alcohol Therapeutic Interactive Voice Response (ATIVR), which was designed to facilitate the transition from outpatient Group CBT to the personal application of skills after Group CBT was completed. Using an uncontrolled, single-arm, pre–post design we examined the feasibility of incorporating ATIVR as a posttreatment addition to CBT at an outpatient clinic. A feasibility test is critical because client preferences for and engagement with automated treatments are largely unknown but they clearly will affect the utility, applicability, and efficacy of the treatment. In addition, we assessed the drinking outcomes of participants before and after 3 months of ATIVR, and their utilization of coping behaviors during the ATIVR phase.