Fostering self-change among problem drinkers: a proactive community intervention.

This paper describes the rationale and design for a recently implemented study involving a community-based intervention designed to foster self-change for individuals who otherwise would be unlikely to seek formal help or treatment for their alcohol problem. The study is based on research examining natural recovery processes with alcohol abusers and on clinical trials using a Guided Self-Change model of treatment with problem drinkers. Advertisements and mailed pamphlets are used to solicit individuals who wanted to change their drinking on their own using self-help materials. Respondents are screened and, if eligible, are randomly assigned to two conditions: Guided Self-Change (GSC) or Educational Materials Control (EMC) (projected N = 788): All subjects complete and mail in several brief assessment forms. Subjects in the GSC group receive advice and personalized feedback based on their assessment answers. Subjects in the EMC group receive educational pamphlets prepared for general medical and mental health settings. Subject characteristics and drinking-related history variables for the first 10% of the sample are presented. Subjects will be followed up at 12 months following the intervention.

[1]  L. Sobell,et al.  Treatment for problem drinkers: A public health priority. , 1993 .

[2]  D. Kandel.  Longitudinal research on drug use: Empirical findings and methodological issues , 1978 .

[3]  Evaluation of intrinsic and extrinsic motivation interventions with a self-help smoking cessation program. , 1991 .

[4]  O. Aasland,et al.  Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. , 1993, Addiction.

[5]  E. Wagner,et al.  Written personalized feedback and confidence in smoking cessation. , 1992 .

[6]  M. Hertzman.  Broadening the base of treatment for alcohol problems: a report which deserves to be debated. "Our vision": Chapter 1 of the Institute of Medicine Report. , 1991, British journal of addiction.

[7]  F. Ledwith.  Immediate and delayed effects of postal advice on stopping smoking. , 1984, Health bulletin.

[8]  M. Mahoney,et al.  Behavioral self-control , 1974 .

[9]  I. Janis,et al.  Decision Making: A Psychological Analysis of Conflict, Choice, and Commitment , 1977 .

[10]  D. Donovan,et al.  Relapse prevention in alcohol aftercare: effects on drinking outcome, change process, and aftercare attendance. , 1988, British journal of addiction.

[11]  F. Iber,et al.  Failure of a 2-hour motivational intervention to alter recurrent drinking behavior in alcoholics with gastrointestinal disease. , 1990, Journal of studies on alcohol.

[12]  S. Allsop,et al.  Relapse and alcohol problems. , 1989 .

[13]  W. Miller,et al.  Focused versus broad-spectrum behavior therapy for problem drinkers. , 1980, Journal of consulting and clinical psychology.

[14]  Linda C. Sobell,et al.  Timeline Follow-Back A Technique for Assessing Self-Reported Alcohol Consumption , 1992 .

[15]  L. Sobell,et al.  Recovery from alcohol problems with and without treatment: prevalence in two population surveys. , 1996, American journal of public health.

[16]  W. Miller,et al.  Handbook of Alcoholism Treatment Approaches: Effective Alternatives , 1995 .

[17]  W. Miller.  The addictive behaviors : treatment of alcoholism, drug abuse, smoking, and obesity , 1980 .

[18]  D. Kavanagh,et al.  Role of self-efficacy in predicting outcomes from a programme for controlled drinking. , 1991, Drug and alcohol dependence.

[19]  J. Orford,et al.  Abstinence or controlled drinking in clinical practice: a test of the dependence and persuasion hypotheses. , 1986, British journal of addiction.

[20]  D. Kavanagh,et al.  Moderating drinking by correspondence: an evaluation of a new method of intervention. , 1996, Addiction.

[21]  A. Ludwig.  Cognitive processes associated with "spontaneous" recovery from alcoholism. , 1985, Journal of studies on alcohol.

[22]  L. Sobell,et al.  Recovery from Alcohol Problems Without Treatment , 1991 .

[23]  T. Bien,et al.  Smoking and drinking: a review of the literature. , 1990, The International journal of the addictions.

[24]  Folke Dovring,et al.  Balance Sheet , 1972, Annual report - Society for Libyan Studies.

[25]  R. Richmond,et al.  One-year evaluation of three smoking cessation interventions administered by general practitioners. , 1993, Addictive behaviors.

[26]  M. Mahoney,et al.  Recent Developments in Cognitive Approaches to Counseling and Psychotherapy , 1988 .

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

[28]  M. M. Gross,et al.  Alcohol-related disabilities , 1977 .

[29]  W. Miller,et al.  Motivational Interviewing: Preparing People to Change Addictive Behavior , 1991 .

[30]  L. Kozlowski,et al.  Dual Recoveries from Alcohol and Smoking Problems , 1995 .

[31]  J. Orford.  Critical Conditions for Change in the Addictive Behaviors , 1986 .

[32]  S. Ha.  Spectrum of drinkers and intervention opportunities , 1990 .

[33]  L. Sobell,et al.  Problem Drinkers: Guided Self-Change Treatment , 1993 .

[34]  W F Velicer,et al.  A decisional balance measure and the stages of change model for weight loss. , 1988, The International journal of the addictions.

[35]  M. Grant,et al.  Alcoholism treatment in transition , 1980 .

[36]  H. Annis,et al.  Profile types on the Inventory of Drinking Situations: Implications for relapse prevention counseling. , 1995 .

[37]  D. Waldorf,et al.  Cocaine Changes: The Experience of Using and Quitting , 1992 .

[38]  L. Sobell,et al.  What triggers the resolution of alcohol problems without treatment. , 1993, Alcoholism, clinical and experimental research.

[39]  A. Zweben,et al.  The comparability of solicited versus clinic subjects in alcohol treatment research. , 1989, British journal of addiction.

[40]  W. Miller,et al.  Treating addictive behaviors : processes of change , 1986 .

[41]  R. Rychtarik,et al.  Broad-spectrum behavioral treatment for chronic alcoholics: effects of training controlled drinking skills , 1984 .

[42]  Are Drinkers Interested in Inexpensive Approaches to Reduce Their Alcohol Use? , 1990, Journal of drug education.

[43]  W. Cloud,et al.  The Elephant That No One Sees: Natural Recovery among Middle-Class Addicts , 1996 .

[44]  L. Mann.  Use of a “balance-sheet” procedure to improve the quality of personal decision making: A field experiment with college applicants☆ , 1972 .

[45]  P. Biernacki,et al.  Pathways from Heroin Addiction: Recovery Without Treatment , 1986 .

[46]  L. Sobell,et al.  What's in a label? The effects of substance types and labels on treatment considerations and stigma. , 1993, Journal of studies on alcohol.

[47]  R. Richmond,et al.  Multivariate models for predicting abstention following intervention to stop smoking by general practitioners. , 1993, Addiction.

[48]  V. Johnson.  Addictive Behaviors across the Life Span: Prevention, Treatment, and Policy Issues , 1995 .

[49]  N. Heather,et al.  Psychology and brief interventions. , 1989, British journal of addiction.

[50]  L C Sobell,et al.  Barriers to treatment: why alcohol and drug abusers delay or never seek treatment. , 1993, Addictive behaviors.

[51]  Anthony G. Greenwald,et al.  Psychological foundations of attitudes , 1968 .

[52]  S. Allsop,et al.  Relapse: a psychological perspective. , 1987, British journal of addiction.

[53]  W. Miller,et al.  Brief interventions for alcohol problems: a review. , 1993, Addiction.

[54]  W F Velicer,et al.  Decisional balance measure for assessing and predicting smoking status. , 1985, Journal of personality and social psychology.

[55]  C. Wilkinson,et al.  Motivation and addiction behaviour: a psychological perspective. , 1990, Drug and alcohol review.

[56]  L. Sobell,et al.  Portraying Alcohol Treatment Outcomes: Different Yardsticks of Success , 1995 .

[57]  I. Janis,et al.  13 – A Conflict-Theory Approach to Attitude Change and Decision Making1 , 1968 .

[58]  A. Meyers,et al.  Seeking help for drinking problems; a study in the Boston Metropolitan Area. , 1982, Journal of studies on alcohol.

[59]  H. A. Montgomery,et al.  What works? A methodological analysis of the alcohol treatment outcome literature. , 1994 .

[60]  I. Janis,et al.  Increasing adherence to a stressful decision via a motivational balance-sheet procedure: A field experiment. , 1975 .

[61]  H. Klingemann.  The motivation for change from problem alcohol and heroin use. , 1991, British journal of addiction.

[62]  H. Klingemann,et al.  Coping and maintenance strategies of spontaneous remitters from problem use of alcohol and heroin in Switzerland. , 1992, The International journal of the addictions.

[63]  S. Curry,et al.  Self-help interventions for smoking cessation. , 1993, Journal of consulting and clinical psychology.

[64]  R. Vuchinich,et al.  Environmental influences on relapse in substance use disorders. , 1990, The International journal of the addictions.

[65]  K. Fillmore.  Alcohol Use Across the Life Course: A Critical Review of 70 Years of International Longitudinal Research , 1988 .

[66]  M. Amodeo,et al.  Cognitive processes and abstinence in a treated alcoholic population. , 1990, The International journal of the addictions.

[67]  D. Cahalan.  Studying drinking problems rather than alcoholism. , 1987, Recent developments in alcoholism : an official publication of the American Medical Society on Alcoholism, the Research Society on Alcoholism, and the National Council on Alcoholism.

[68]  L. Sobell,et al.  A randomized trial comparing group versus individual Guided Self-Change treatment for alcohol and drug abusers , 1995 .