Problem-drinking interventions should take a broader approach, rather than focusing only on those who are clinically alcoholic, according to research psychologist Linda C. Sobell, PhD, of Nova Southeastern University. In her acceptance of the Brady-Schuster Award at APA's 2003 Annual Convention in Toronto, Sobell called for psychologists and other substance abuse professionals to pay more attention to the full range of alcohol problems by offering multiple and varied behavior-change pathways--such as a mail intervention she and colleagues developed to target problem drinkers unwilling or unmotivated to seek help.
In research published in Alcoholism: Clinical and Experimental Research (Vol. 26, No. 6), Sobell and colleagues reported that problem drinkers--those who had more than 12 drinks per week or five or more drinks on five or more days in the previous year--significantly reduced their high-risk drinking behavior one year after the mail intervention.
In the study, 825 problem drinkers recruited through media advertisements were surveyed about their drinking habits and randomly assigned to one of two mail interventions. One provided personalized feedback describing each participants' drinking levels, high-risk situations and motivation for change; the other provided two informational pamphlets discussing the effects of alcohol and low-risk drinking guidelines.
One year later, participants who completed the follow-up reported a 28.3 percent reduction in drinks per week and 33.3 percent reduction in days of heavy or binge drinking. The kind of intervention--generic or personalized--didn't affect the rate of change.
Moreover, those who stated at the pre-intervention assessment that they were serious about reducing their drinking or that they intended to change had greater reductions in drinking at the one-year follow-up than other participants. Participants who expressed more confidence in their ability to change also demonstrated a greater reduction.
The results suggest that substance abuse professionals should devote more attention to increasing people's commitment to and confidence in changing, the researchers concluded.
However, although the reductions were substantial, several participants were still drinking above recommended levels, Sobell said. Nevertheless, reductions to the extent in the study have potential health benefits, such as reducing blood pressure and the risk of cardiovascular disease--and at a low cost to the public, Sobell said. In fact, the mail intervention cost between $45.56 and $96.98 per individual.
"The great majority of individuals who have an alcohol-related problem are the problem drinkers who won't come into the clinics," Sobell said. "In order to get these folks early, we need to provide services early on....This is a radical shift in thinking for the alcoholism field."
The Brady-Schuster Award is presented by APA's Div. 28 (Psychopharmacology and Substance Abuse) to honor a scientist whose research underscores the importance of behavioral science in psychopharmacology or substance abuse.
--D. SMITH BAILEY