TOWARD A STEPPED CARE APPROACH TO TREATING PROBLEM DRINKERS - THE PREDICTIVE UTILITY OF WITHIN-TREATMENT VARIABLES AND THERAPIST PROGNOSTICRATINGS

Aims. Cost containment, a central issue in current health planning, en courages the use of brief interventions. Although brief interventions for problem drinkers have proved successful, a portion of such individ uals do not change their alcohol we during treatment. Design. Repeated measures design (pre-treatment, within-treatment and 6 months post-tr eatment). Setting and participants. To identify individuals at risk fa r continued problem drinking, predictors of post-treatment drinking we re examined for 212 problem drinkers who presented for treatment in an outpatient treatment clinic. Intervention. All participants completed a brief cognitive behavioral motivational intervention. Measurements. At the pre-treatment assessment demographic, drinking pattern, severi ty of dependence and other cognitive variables (e.g self-efficacy, goa l choice) were collected. Within-treatment, drinking pattern and cogni tive variables such as self-efficacy and goal choice were again measur ed. Findings. Regression analyses showed that therapist prognosis rati ngs contributed significantly to the prediction of outcome even when p re-treatment variables were controlled. However, when within-treatment variables were included in the prediction, variables such as within t reatment drinking eliminated the predictive utility of therapist progn osis ratings. This pattern held for both percentage of days abstinent and drinks per drinking day at a 6-month follow-up. Conclusions. It is suggested that a stepped care approach based on prediction models tha t include clients' within-treatment response can be applied to the tre atment of problem drinkers who show little initial response to treatme nt.