Drinking goal choice and outcomes in a Web-based alcohol intervention: results from VetChange.

OBJECTIVES The objectives of the paper are to describe characteristics of participants who chose moderation and abstinence drinking goals, and to examine post-treatment drinking outcomes based on patterns of goal choice during a Web-based alcohol intervention for returning U.S. Veterans. METHOD We conducted a descriptive secondary analysis of a subsample of 305 of 600 Veterans who participated in a clinical trial of VetChange, an 8-module, cognitive-behavioural intervention. Participants self-selected abstinence or moderation drinking goals, initially at Module 3, and weekly during subsequent modules. Alcohol use and alcohol-related problems were measured using the Alcohol Use Disorders Identification Test (AUDIT), Quick Drink Screen (QDS), and Short Inventory of Problems (SIP-2R). RESULTS Initial goal choices were 86.9% moderation and 13.1% abstinence. Approximately 20% of participants from each initial choice changed goals during the intervention; last goal choices were 68.6% moderation and 31.4% abstinence. Participants who initially chose moderation reported higher percent heavy drinking days at baseline; participants who initially chose abstinence were more likely to report recent substance abuse treatment and were older. Post-intervention levels of alcohol use and alcohol-related problems were significantly reduced in all goal-choice patterns (i.e., Moderation Only, Abstinence Only, Moderation to Abstinence, and Abstinence to Moderation; all measures p < 0.05 or less). Baseline drinking severity did not differentially relate to outcomes across goal-choice patterns. CONCLUSIONS Participants in a Web-based alcohol intervention for returning U.S. Veterans demonstrated improvements in drinking regardless of whether they chose an abstinence or moderation drinking goal, and whether the goal was maintained or changed over the course of the intervention.

[1]  R. Gallop,et al.  Six-month treatment outcomes of cocaine-dependent patients with and without PTSD in a multisite national trial. , 2007, Journal of studies on alcohol and drugs.

[2]  K. Jackson,et al.  Web-based alcohol prevention for incoming college students: a randomized controlled trial. , 2010, Addictive behaviors.

[3]  John A Cunningham,et al.  Comparison of a quick drinking screen with the timeline followback for individuals with alcohol problems. , 2003, Journal of studies on alcohol.

[4]  G. Schippers,et al.  Internet therapy versus internet self-help versus no treatment for problematic alcohol use: A randomized controlled trial. , 2011, Journal of consulting and clinical psychology.

[5]  D. Hodgins,et al.  Drinking goal selection in behavioral self-management treatment of chronic alcoholics. , 1997, Addictive behaviors.

[6]  P. Diggle,et al.  Analysis of Longitudinal Data , 2003 .

[7]  Heleen Riper,et al.  Effectiveness of E-Self-help Interventions for Curbing Adult Problem Drinking: A Meta-analysis , 2011, Journal of medical Internet research.

[8]  W. Miller,et al.  Client commitment language during motivational interviewing predicts drug use outcomes. , 2003, Journal of consulting and clinical psychology.

[9]  Amy Rubin,et al.  Web intervention for OEF/OIF veterans with problem drinking and PTSD symptoms: a randomized clinical trial. , 2013, Journal of consulting and clinical psychology.

[10]  P. Slade,et al.  Predictors of outcome type in treated problem drinkers. , 1986, Journal of studies on alcohol.

[11]  D. Kivlahan,et al.  The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. , 1998, Archives of internal medicine.

[12]  W. Miller,et al.  Designing studies to investigate client-treatment matching. , 1994, Journal of studies on alcohol. Supplement.

[13]  L. Sobell,et al.  Controlled drinking after 25 years: how important was the great debate? , 1995, Addiction.

[14]  M. Sanchez-Craig,et al.  Random assignment to abstinence and controlled drinking: evaluation of a cognitive-behavioral program for problem drinkers. , 1984, Journal of consulting and clinical psychology.

[15]  H. Delaney,et al.  A web application for moderation training: initial results of a randomized clinical trial. , 2009, Journal of Substance Abuse Treatment.

[16]  Scott T. Walters,et al.  A Controlled Trial of Web-Based Feedback for Heavy Drinking College Students , 2007, Prevention Science.

[17]  D. Hodgins.  Can Patients with Alcohol Use Disorders Return to Social Drinking? Yes, So What Should We Do about It? , 2005, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[18]  Linda C. Sobell,et al.  Problem Drinkers' Perceptions of Whether Treatment Goals Should Be Self-Selected or Therapist-Selected , 1992 .

[19]  M. Berglund,et al.  Changes of drinking goals in a two-year out-patient alcoholic treatment program. , 1989, Addictive behaviors.

[20]  R. Stephens,et al.  Comparison of participatively set and assigned goals in the reduction of alcohol use. , 2010, Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors.

[21]  Maristela Monteiro,et al.  AUDIT - The alcohol use disorders identification test: guidelines for use in primary care. , 2001 .

[22]  D. Doumas,et al.  Evaluation of two Web-based alcohol interventions for mandated college students. , 2009, Journal of substance abuse treatment.

[23]  G. Eysenbach.  The Law of Attrition , 2005, Journal of medical Internet research.

[24]  N. Heather,et al.  Initial preference for drinking goal in the treatment of alcohol problems: II. Treatment outcomes. , 2010, Alcohol and alcoholism.

[25]  L. Ray,et al.  Journal of Consulting and Clinical Psychology The Effects of Drinking Goal on Treatment Outcome for Alcoholism , 2012 .

[26]  D. Rubin.  INFERENCE AND MISSING DATA , 1975 .

[27]  R. Woolard,et al.  Can the short index of problems (SIP) be improved? Validity and reliability of the three-month SIP in an emergency department sample. , 2005, Journal of studies on alcohol.

[28]  R. Engels,et al.  Targeting young drinkers online: the effectiveness of a web-based brief alcohol intervention in reducing heavy drinking among college students: study protocol of a two-arm parallel group randomized controlled trial , 2011, BMC public health.

[29]  R. Glasgow,et al.  The delivery of public health interventions via the Internet: actualizing their potential. , 2009, Annual review of public health.

[30]  Richard A. Graber,et al.  Abstinence or controlled drinking goals for problem drinkers: A randomized clinical trial. , 1988 .

[31]  A. Bandura,et al.  Differential engagement of self-reactive influences in cognitive motivation , 1986, Organizational Behavior and Human Decision Processes.

[32]  P. Slade,et al.  A follow-up study of problem drinkers offered a goal choice option. , 1992, Journal of studies on alcohol.

[33]  R. Hester,et al.  Evaluation of two web-based alcohol interventions in the U.S. military. , 2011, Journal of studies on alcohol and drugs.

[34]  Peter J. Diggle,et al.  Testing for random dropouts in repeated measurement data. , 1989 .

[35]  John P. Allen,et al.  The alcohol use disorders identification test: an update of research findings. , 2007, Alcoholism, clinical and experimental research.

[36]  E. Strain,et al.  Pretreatment alcohol drinking goals are associated with treatment outcomes. , 2013, Alcoholism, clinical and experimental research.

[37]  Karen B DeSalvo,et al.  Dietary guidelines for Americans. , 2016, The American journal of clinical nutrition.

[38]  Ting-kai Li,et al.  Quantifying the risks associated with exceeding recommended drinking limits. , 2005, Alcoholism, clinical and experimental research.

[39]  K. Humphreys,et al.  How Internet technology can improve the quality of care for substance use disorders. , 2009, Current drug abuse reviews.

[40]  D. Foy,et al.  Goal choice of alcoholics: a comparison of those who choose total abstinence vs. those who choose responsible, controlled drinking. , 1978, Journal of clinical psychology.

[41]  A. Bandura.  Social Foundations of Thought and Action: A Social Cognitive Theory , 1985 .

[42]  T. M. Davis,et al.  Two brief alcohol-screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. , 2003, Archives of internal medicine.

[43]  S. Hall,et al.  Commitment to abstinence and acute stress in relapse to alcohol, opiates, and nicotine. , 1990, Journal of consulting and clinical psychology.

[44]  P. Booth,et al.  Problem drinkers' goal choice and treatment outcome: a preliminary study. , 1984, Addictive behaviors.

[45]  Judy Drennan,et al.  Online Alcohol Interventions: A Systematic Review , 2010, Journal of medical Internet research.

[46]  N. Heather,et al.  Initial preference for drinking goal in the treatment of alcohol problems: I. Baseline differences between abstinence and non-abstinence groups. , 2010, Alcohol and alcoholism.

[47]  A. Rubin,et al.  Web-Based Intervention for Returning Veterans with Symptoms of Posttraumatic Stress Disorder and Risky Alcohol Use , 2011, Journal of Contemporary Psychotherapy.

[48]  R. Engels,et al.  The effectiveness of the 'what do you drink' web-based brief alcohol intervention in reducing heavy drinking among students: a two-arm parallel group randomized controlled trial. , 2013, Alcohol and alcoholism.