Noelle K. Jensen

A randomized trial of individual and couple behavioral alcohol treatment for women.

Although alcohol use disorders (AUDs) adversely affect women, research on efficacious treatments for women is limited. In this randomized efficacy trial of 102 heterosexual women with AUDs, the authors compared alcohol behavioral couple therapy (ABCT) and alcohol behavioral individual therapy (ABIT) on percentage of days abstinent (PDA) and percentage of days of heavy drinking (PDH) over 6 months of treatment and 12 months of posttreatment follow-up. Baseline relationship functioning and comorbid disorders were tested as moderators of outcome. Piecewise linear growth models were used to model outcomes. During treatment, women increased their PDA and decreased their PDH, with significantly greater improvements in ABCT than in ABIT (d = 0.59 for PDA; d = 0.79 for PDH). Differences favoring ABCT were maintained during follow-up. Women with poorer baseline relationship functioning improved more on PDA during treatment with ABCT than with ABIT. For PDH, results during treatment and follow-up favored ABCT for women with better baseline relationship functioning. ABCT resulted in better outcomes than ABIT for women with Axis I disorders at the end of follow-up (PDA), and for women with Axis II disorders at the end of treatment (PDA) and at the end of follow-up (PDH).

Engagement and Retention in Outpatient Alcoholism Treatment for Women

Reviews of the dropout literature note significant attrition from addiction treatment. However, consistent predictors have not been identified and few studies have examined factors related to retention and engagement for women in gender-specific treatment. The current study consisted of 102 women and their partners randomized to individual or couples outpatient alcoholism treatment. Women attended more treatment sessions if they were assigned to individual treatment, older, had fewer symptoms of alcohol dependence, had more satisfying marital relationships, had spouses who drank, and had matched preference for treatment condition. Women were more engaged in treatment (ie, completed more assigned homework) if they had fewer children at home, fewer alcohol dependence symptoms, later age of onset of alcohol diagnosis, more satisfying marital relationships, and spouses who accepted or encouraged their drinking. Results highlight important associations of treatment and relationship variables with treatment retention and engagement.

What Do Women Want? Alcohol Treatment Choices, Treatment Entry and Retention

Study aims were to assess preferences for individual or conjoint treatment, differences between women with alcohol use disorders (AUDs) selecting each modality, and the impact on treatment entry and retention of providing a choice of treatments. During initial screening, women with AUDs in an intimate relationship with a male partner were given the choice of individual or conjoint treatment. After choosing a treatment modality and completing all assessments they entered one of two randomized trials testing different approaches to each treatment modality. Standardized measures were used to assess drinking quantity, frequency, and problems; motivation to change; and relationship satisfaction. Womens reasons for choice of treatment modality were coded using an iterative coding process. Results showed that women were more likely to select and follow through with individual than conjoint treatment. Women cited a desire to work on individual problems, lack of perceived support from their partner, and logistical issues as reasons for preferring individual treatment. Women in the two choice groups did not differ significantly on individual, partner, or relationship characteristics, but small to medium effect sizes suggested that women choosing individual treatment were more educated and less satisfied with their relationship, had fewer pretreatment heavy drinking days, and heavier drinking partners. Offering women a choice of treatment modality increased the probability of entering treatment, but not treatment attendance. Results suggest that barriers to couple therapy for women with AUDs need to be addressed to facilitate more widespread dissemination. Given womens preferences, it also is important to offer a range of treatments.

Changes in alcohol craving and consumption by phase of menstrual cycle in alcohol dependent women

The current study examines the menstrual cycle–alcohol relationship during 6 months of weekly outpatient sessions as part of a larger treatment outcome study for alcohol‐dependent females. Twelve premenopausal women in the clinical trial who were menstruating regularly and not on oral contraceptives kept a daily log of menstruation days, alcohol consumption and cravings. Three menstrual cycle phases were defined: menses, premenstrual, and “other.” Within subjects repeated measures analyses on the subsample of 12 women showed that, despite a lower average number of cravings, drinking frequency was higher in the premenstruum than the “other” phase in the first 3 months of treatment. In addition, according to a self‐report item on a measure given to 96 women in the larger study, 48 (69%) women under the age of 50 endorsed the premenstrual phase of the menstrual cycle as a drinking cue. Of these 48, 44% considered it a major drinking cue. These preliminary data support the value of continuing to investigate the relationship between phases of the menstrual cycle and alcohol consumption among female alcoholics.

Women with alcohol dependence: A randomized trial of couple versus individual plus couple therapy.

Couple therapy for women with alcohol use disorders (AUDs) yields positive drinking outcomes, but many women prefer individual to conjoint treatment. The present study compared conjoint cognitive-behavioral therapy (CBT) for women with AUDs to a blend of individual and conjoint therapy. Participants were 59 women with AUDs (95% Caucasian, mean age = 46 years) and their male partners randomly assigned to 12 sessions of Alcohol Behavioral Couple Therapy (ABCT) or to a blend of 5 individual CBT sessions and 7 sessions of ABCT (Blended-ABCT). Drinking and relationship satisfaction were assessed during and for 1-year posttreatment. Treatment conditions did not differ significantly on number of treatment sessions attended, percentage of drinking days (PDD), or percentage of heavy drinking days (PDH), during or in the 12 months following treatment. However, effect size estimates suggested a small to moderate effect of Blended-ABCT over ABCT in number of treatment sessions attended (d = -.41), and first- and second-half within treatment PDD (d = -.41, d = -.28), and PDH (d = -.46, d = -.38). Moderator analyses found that women lower in baseline sociotropy had lower PDH across treatment weeks 1-8 than in Blended-ABCT than ABCT and that women lower in self-efficacy had lower PDH during follow-up in Blended-ABCT than in ABCT. The 2 treatment groups did not differ significantly in within-treatment or posttreatment relationship satisfaction. Results suggest that blending individual and conjoint treatment yields similar or slightly better outcomes than ABCT, is responsive to womens expressed desire for individual sessions as part of their treatment, and decreases the challenges of scheduling conjoint sessions. (PsycINFO Database Record

When should clinicians switch treatments? An application of signal detection theory to two treatments for women with alcohol use disorders

Statistical application of signal detection theory has been used to study the clinical utility of early treatment response in a range of treatments and psychiatric disorders. The current study sought to examine the predictive value of weekly within-treatment drinking using receiver operator curves (ROCs) and zero-inflated Poisson (ZIP) regression in 102 women with alcohol use disorders (AUDs) randomized to either alcohol behavioral individual treatment (ABIT; n = 52) or alcohol behavioral couples treatment (ABCT; n = 50). ROC analyses indicated that failure to achieve or sustain abstinence by the end-of-treatment and one-year follow-up was predicted with reasonable accuracy by week 4 percent days abstinent (PDA) in ABIT. ZIP models yielded similar results with evidence for within-treatment PDA with week 6 PDA predicting both the abstinence as well as percent days drinking at the end-of-treatment and one-year follow-up. Within-treatment PDA was a significantly better predictor of outcomes for ABIT than ABCT, despite a better overall treatment response for ABCT. Implications for stepped care models of alcohol treatment are discussed and recommendations for future research made.

A randomized trial of female-specific cognitive behavior therapy for alcohol dependent women.

This study compared Female-Specific Cognitive Behavioral Therapy (FS-CBT) to evidence-based, gender-neutral CBT (GN-CBT; Epstein & McCrady, 2009) for women with alcohol use disorder (AUD). Women (N = 99) with AUD, mean age 48, were randomly assigned to 12 outpatient manual-guided sessions of FS-CBT (n = 44) or GN-CBT (n = 55). Women were assessed at baseline and 3, 9 and 15 months after baseline for drinking and for specific issues common among women with AUD. A FS-CBT protocol was developed that was discriminable on treatment integrity ratings from GN-CBT. No treatment condition differences were found in treatment engagement, changes in drinking, alcohol-related coping, abstinence self-efficacy, motivation to change, or constructs directly targeted in FS-CBT (sociotropy, autonomy, depression, anxiety). Women in both conditions were highly engaged and satisfied with treatment, and reported significant reductions in drinking and changes in desired directions for all other variables except social support for abstinence. In the year following treatment, women in the FS-CBT but not in the CBT condition reported an increase in percentage of abstainers in their social networks (0.69% per month, SE = 0.21, p = .002). The value and appeal of female-specific programming in AUD treatment has been established in the wider literature (Epstein & Menges, 2013), and the current study provides support for the use of the Female-Specific Cognitive Behavioral Therapy (FS-CBT) manual as an option that may yield outcomes similar to standard gender-neutral CBT for women with AUD. Future research should examine whether FS-CBT enhances treatment utilization for women.

Individual versus group female-specific cognitive behavior therapy for alcohol use disorder

OBJECTIVES To test group-based Female-Specific Cognitive Behavioral Therapy (G-FS-CBT) for women with Alcohol Use Disorder (AUD) against an individual Female-Specific Cognitive Behavioral Therapy (I-FS-CBT). This aims of this paper are to describe G-FS-CBT development, content, feasibility, acceptability, group process, engagement in treatment, and within- and post-treatment outcomes. METHODS Women with AUD (n=155) were randomly assigned to 12 manual-guided sessions of G-FS-CBT or I-FS-CBT; 138 women attended at least one treatment session. RESULTS Women in G-FS-CBT attended fewer sessions (M=7.6) than women in I-FS-CBT (M=9.7; p<.001). Women in both conditions reported high satisfaction with the treatments. Independent coders rated high fidelity of delivery of both G-FS-CBT and I-FS-CBT. Therapeutic alliance with the therapist was high in both conditions, with I-FS-CBT being slightly but significantly higher than G-FS-CBT. In the first six weeks of treatment, women in both treatment conditions significantly reduced their percent drinking days (PDD) and percent heavy days drinking (PHD) by equivalent amounts, maintained through the rest of treatment and the 12month follow up with no treatment condition effects. Women reported significant improvement in all but one of the secondary outcomes during treatment; gains made during treatment in depression, anxiety, autonomy, and interpersonal problems were maintained during the follow-up period, while gains made during treatment in use of coping skills, self-efficacy for abstinence, self-care, and sociotropy deteriorated over follow up but remained improved compared to baseline. CONCLUSIONS Findings support the feasibility, acceptability, and efficacy of a group format for female-specific CBT for AUD, a new 12-session, single gender, community friendly, group therapy with programming specifically for women. Similar, positive outcomes for individual and group treatment formats were found for drinking, mood, coping skills, self-confidence, interpersonal functioning, and self-care.