Behavioral Self-control Training Research Articles

Predictors of treatment outcome for individuals with alcohol use disorder with a goal of controlled drinking

BackgroundResearch is lacking on predictors of outcome for the treatment of alcohol use disorder (AUD) with a goal of controlled drinking (CD). The aim of the study was to investigate one-year outcomes of an RCT, investigating Behavioral Self-Control Training (BSCT) and Motivational Enhancement Therapy (MET) and predictors of positive outcome for weekly alcohol consumption, CD and symptom reduction in AUD.MethodsThis study is based on secondary analyses from a randomized controlled trial including 250 individuals with AUD (52% men) recruited from three specialized addiction clinics in Stockholm, Sweden. Linear and logistic mixed regression models were used for outcomes at 52 weeks, and linear and logistic regression models for the predictor analyses.ResultsBSCT was superior to MET for the change between baseline to 52 weeks for the outcome of CD, defined as low-risk drinking below ten standard drinks per week for both genders (p = 0.048). A total of 57% of individuals in BSCT attained a level of CD, as opposed to 43% in MET. Females were significantly better in attaining low-risk drinking levels compared to men. The predictor for obtaining CD and reducing weekly alcohol consumption, was a lower baseline alcohol consumption. Predictors of symptom reduction in AUD were lower baseline level of AUD, and a lower self-rated impaired control over alcohol consumption.ConclusionsBSCT was superior to MET in obtaining CD levels, and women were superior to men for the same outcome. The study corroborated baseline consumption levels as an important predictor of outcome in CD treatments. The study contributes with important knowledge on key treatment targets, and knowledge to support and advice patients in planning for treatment with a goal of controlled drinking.Trial registration: The original study was registered retrospectively at isrtcn.com (14539251).

Drink goal difficulty effect on outcomes in moderation-based alcohol treatment for sexual minority men

Sexual minority men (SMM) who drink heavily are at a greater risk for developing alcohol use disorders (AUD) and associated negative consequences. Barriers to treatment prevent SMM from accessing traditional care, and moderation-based alcohol treatment is a more desirable alternative. As such, investigating effective goal setting in moderation-based alcohol treatment, particularly, which goals yield the most effective outcomes, is warranted. Applying the tenets of Goal Setting Theory, this study explored the relationship between goal difficulty and goal achievement. In a secondary data analysis of a randomized controlled trial that delivered a combination of medication (i.e., naltrexone) and behavioral (i.e., Modified Behavioral Self-Control Training) treatment for SMM with AUD (N = 178), generalized estimating equations tested the effect of goal difficulty (defined as the proposed magnitude of change from current drinking in number of drinking days and number of heavy drinking days) on goal achievement at Months 0, 3, 6, and 9. Goal importance, self-efficacy, and AUD severity were tested as moderators. Findings yielded a significant positive relationship between goal difficulty and goal achievement for number of drinking days but a negative relationship for the number of heavy drinking days. Moderators of these relationships were not found. In order to increase the likelihood of achieving their goals in moderation-based alcohol treatment, SMM should initially consider setting more difficult goals for reducing drinking days. Additionally, goals of more conservative difficulty should be set for reducing heavy drinking days.

Alcohol Use and Anxiety: Diagnostic and Management Issues

Alcohol Use and Anxiety: Diagnostic and Management Issues

Controlled drinking: more than just a controversy

Purpose of Review: We intend to provide clinicians and clinical scientists with an overview of developments in the controlled-drinking literature, primarily since 2000. A brief description of the controversy surrounding controlled drinking provides a context for a discussion of various approaches to controlled drinking intervention as well as relevant clinical research. Recent Findings: Consistent with previous research, behavioral self-control training continues to be the most empirically validated controlled-drinking intervention. Recent research has focused on increasing both the accessibility/availability and efficacy of behavioral self-control training. Moderation-oriented cue exposure is a recent development in behaviorally oriented controlled drinking that yields treatment outcomes comparable to behavioral self-control training. The relative efficacy of moderation-oriented cue exposure versus behavioral selfcontrol training may vary depending on the format of treatment delivery (group versus individual) and level of drinking severity. In general, the efficacy of both techniques does not appear to vary as a function of drinking severity but may vary as a function of drinking-related self-efficacy. Guided-self change is a relatively new and brief cognitive-behavioral intervention that has demonstrated efficacy with problem drinkers. Interventions based on harm reduction principles have decreased alcohol use in various student populations. Finally, Moderation Management is the only self-help program that supports non-abstinence goals, a feature that makes it popular with problem drinkers who are avoidant of traditional treatment services. Summary: The controversial past of controlled drinking is slowly giving way to a hopeful future in which individuals are less likely to be forced into an abstinence-only treatment scenario. The enhanced accessibility of effective controlled-drinking interventions should significantly expand the treatment options of individuals within the full spectrum of alcohol-related problems.

Behavioral self-control training for problem drinkers: A meta-analysis of randomized control studies

A review of the literature uncovered 17 studies that have employed a randomized control design to investigate the efficacy of behavioral self-control training for problem drinking. A meta-analysis of these 17 studies showed that behavioral self-control training was superior to no intervention and alternative nonabstinence-oriented interventions in reducing both alcohol consumption and problematic drinking. The results of this meta-analysis also favored behavioral self-control training over traditional abstinence-oriented treatment, but the effect size fell short of statistical significance. Additional analyses found self-control training to be equally effective for use with alcohol-dependent and problem-drinking subjects and for follow-ups spanning several months to several years. The implications of these results for interventions with alcohol-abusing clients are discussed.

Long-term follow-up of behavioral self-control training.

Four samples of problem drinkers treated by behavioral self-control training were evaluated at 3.5, 5, 7 and 8 years following treatment, respectively. Of 140 cases, 99 (71%) were accounted for: 23 abstinent, 14 with controlled and asymptomatic drinking, 22 improved but still impaired, 35 unremitted and 5 deceased. Abstinent versus controlled-drinking outcomes were most strongly differentiated by pretreatment severity of alcohol problems and dependence and by the patients' pretreatment self-assessment and goals. Percentages of abstainers and of relapsed cases increased at long-term follow-ups. A reasonably constant percentage of known outcomes (14%) were clearly controlled and asymptomatic drinkers in each of the follow-up samples. Most of the long-term controlled drinkers had established this pattern within the first year following treatment. However, periods of controlled drinking during the first year did not reliably predict maintenance of this pattern. Successful asymptomatic drinkers were discriminable from other outcomes based on pretreatment characteristics.

Behavioral self-control training for problem drinkers: Components of efficacy.

Behavioral self-control training for problem drinkers: Components of efficacy.

Behavioral self-control training for problem drinkers: Components of efficacy.

Behavioral self-control training for problem drinkers: Components of efficacy.

Behavioral self-control training for problem drinkers: Components of efficacy.

Behavioral self-control training for problem drinkers: Components of efficacy.

Training in controlled drinking for early-stage problem drinkers.

SummaryForty‐eight early‐stage problem drinkers were recruited through a newspaper announcement and randomly assigned to one of four outpatient treatment groups: (1) Bibliotherapy‐ Behavioral Self‐Control Training (BSCT), (2) BSCT‐therapist directed, (3) Training in Coping Skills and (4) a combination of BSCT and Coping Skill Training. The weekly alcohol consumption in all groups decreased significantly from intake to 3, 6 and 12 month follow‐up. There were no significant differences among the groups. At the same time the number of life problems decreased significantly. The majority of the clients reduced their alcohol consumption during the assessment period, before treatment started. The absence of a non‐treatment control group means that we cannot be sure about the reasons for this early change. Theoretical implications of these results are discussed.

An evaluation of a controlled drinking program for drinking drivers.

The purpose of this study was to test the effectiveness of Behavioral Self-Control Training in terms of reductions in alcohol consumption and blood alcohol concentration generally, and determine if changes on these indices effect reductions in drinking-and-driving incidents, blood alcohol concentration during drinking-and-driving incidents, and reductions in life problems. Self-referred individuals who drink and drive were randomly assigned into one of two experimental conditions: 1) Behavioral Self-Control Training (BSCT), or 2) Conventional Alcohol Education (CAE). Behavioral Self-Control Training resulted in nonsignificant ( p > .05) reductions of: 1) alcohol consumption, 2) peak blood alcohol concentration, 3) drinking-and-driving episodes, 4) blood alcohol concentration during drinking-and-driving episodes, and 5) the severity of life problems. No significant differences were found between conditions on these variables. These results suggest that a controlled drinking goal may not be feasible for all drinking-and-driving populations.

Two-year follow-up of bibliotherapy and therapist-directed controlled drinking training for problem drinkers

Two-year blind fllow-up interviews were completed with 69 of 82 problem drinkers treated by behavioral self-control training offered in various formats including bibliotherapy, individual counseling, and group therapy. Corroborative data were obtained via breath tests and collateral interviews. Significant improvement observed on drinking and other measures at prior follow-up points was found to be maintained at 2 years. Stability of outcome over the 2-year period was found to be good, with more than 80% of clients showing equal or greater improvement at 24 months relative to any prior follow-up point. Relapse rates from controlled drinking were found to be similar to those from abstinent outcomes. Severity of problem drinking at intake remained the best single predictor of controlled drinking vs. abstinent outcomes, with more severe cases tending toward abstinence.

Addictive behaviors and life problems before and after behavioral treatment of problem drinkers

The broader impact of a behavioral self-control training intervention focusing on the reduction of alcohol consumption was examined in a sample of 93 problem drinkers (55 male). Individual life problems were assessed via the method of goal attainment scaling before and after treatment and at 3–6 months, 12 months and 24 months following termination. Alcohol and drug use, smoking and weight were also evaluated. At intake, women were more likely than men to be unmarried, married to a problem drinking spouse, or taking psychoactive prescription medication but less likely to be using illicit drugs, smoking or gambling. For both men and women negative emotional states and family discord headed the list of current life problems. Although intervention focused primarily on drinking behavior, the majority of other life problems also showed improvement at all follow-up points. Remission of life problems was associated with decreased alcohol consumption. Body weight tended to increase slightly after treatment but typically returned to or below baseline by later follow-ups. Overall rates of drug use and smoking showed little change; however, smoking cessation was associated with successful control or cessation of alcohol use and relapse to smoking coincided with unremitted drinking. Implications for treatment are considered.

Methylphenidate compared with behavioral self-control in attention deficit disorder

The effects of methylphenidate and behavioral self-control training on sustained attention were compared in 12 boys aged 6-9 years. Subjects were of low-average intelligence and had academic and behavioral problems including distractibility, short attention span, and impulsiveness. Treatment conditions (baseline, placebo, methylphenidate, and behavioral self-control training) were assigned according to a single-subject randomized blocks design. Attention was measured by the Children's Checking Test (CCT). Methylphenidate improved performance on the CCT and was superior to the other treatment conditions. Several children benefited from behavioral training, but statistical analysis of this change was nonsignificant. These results are consistent with and extend those of previous studies.

Methylphenidate Compared with Behavioral Self-Control in Attention Deficit Disorder

The effects of methylphenidate and behavioral self-control training on sustained attention were compared in 12 boys aged 6-9 years. Subjects were of low-average intelligence and had academic and behavioral problems including distractibility, short attention span, and impulsiveness. Treatment conditions (baseline, placebo, methylphenidate, and behavioral self-control training) were assigned according to a single-subject randomized blocks design. Attention was measured by the Children's Checking Test (CCT). Methylphenidate improved performance on the CCT and was superior to the other treatment conditions. Several children benefited from behavioral training, but statistical analysis of this change was nonsignificant. These results are consistent with and extend those of previous studies.

Group behavior therapy for problem drinkers.

Twenty-eight problem drinkers participated in behavioral training groups designed to teach moderate drinking. Both at termination and at follow-up, 70% were considered successful, showing significant reduction in alcohol consumption and in weekly peak blood alcohol concentration. Indices of severity of problem drinking were found to best predict outcome. Results are consistent with previous data regarding behavioral self-control training as a therapeutic intervention for early stage problem drinkers.

Relative effectiveness of bibliotherapy, individual and group self-control training in the treatment of problem drinkers

The effectiveness of 4 alternative forms of behavioral self-control training (BSCT) designed to reduce alcohol consumption was evaluated. Forty-one problem drinkers were assigned to 1 of 4 treatment conditions: (a) bibliotherapy, in which clients were evaluated and then provided with a self-help manual (Miller & Muñoz, 1976) and self-monitoring cards but were not given therapy sessions, (b) BSCT alone, consisting of 10 individual sessions following material presented in the manual, (c) BSCT plus relaxation training, being identical to (b) except that training in progressive deep muscle relaxation was added within the 10 sessions, and (d) group therapy identical in content to (c) but offered in a group rather than in individual format. Outcome data included information from client interviews, psychometric measures, self-monitoring cards, and interviews with significant others. All data sources indicated significant and substantial reduction in alcohol consumption, particularly in “alcoholismic” drinking patterns. No significant differences were found among the 4 treatment groups. The cost-effectiveness of a bibliotherapy approach was supported, consistent with prior research. Overall improvement rates were 84% and 69% at 3- and 12-month follow-up, respectively.

Prediction of abstinence, controlled drinking, and heavy drinking outcomes following behavioral self-control training.

Prediction of abstinence, controlled drinking, and heavy drinking outcomes following behavioral self-control training.

Prediction of abstinence, controlled drinking, and heavy drinking outcomes following behavioral self-control training.

Prediction of abstinence, controlled drinking, and heavy drinking outcomes following behavioral self-control training.

Behavioral self-control in treating procrastination of studying.

56 college students who procrastinated in studying were given either behavioral self-control training or a nondirective, attention-placebo control procedure. Experimental clients were exposed to training in either stimulus control, self-reinforcement, or a combination of the two. Half of these clients used self-punishment; half did not. Half were trained individually and half in groups of four. In terms of reported amount of study time and attitudes toward studying, experimental clients improved, whereas control clients did not. However, there were no significant differences among experimental subconditions. Neither control nor experimental conditions resulted in any significant change in over-all grade point average.