Brief motivational interventions and
Behavioral self-control training:
A demonstration project with DWI offenders.
Report on Year 2
Date: August 6, 1998
By: Reid K. Hester, Ph.D. & Michael Sergent, M.A., Research Division
Introduction
This project has had two goals: to provide cost-effective treatment for DWI offenders in Torrance County and to evaluate its effectiveness. The project is examining the impact of providing a brief intervention and empirically supported self-help materials. Brief interventions hold great promise in reducing alcohol-related problems in DWI populations.
Participants received a brief motivational intervention known as the Drinker’s Check-up (DCU). They were also given a choice of two empirically supported self-help options: The Addictive Behaviors Change workbook (Horvath, 1996) or Behavioral Self-Control Training either via the Miller & Munoz (1984) book or the Behavioral Self-Control Training Program for Windows (BSCPWIN).
Clinical Phase of the Project Year 2
In Year 1 counselors received close clinical supervision on their cases on a regularly scheduled basis. They also had access to supervision whenever needed. Sessions were audio taped and those tapes were reviewed in supervision sessions. The closeness of this supervision helped to ensure close adherence to the clinical protocol. Although supervision was more intense during the initial phases of the project, it continued on a regular basis throughout year 1. In Year 2 counselors were supervised on an as needed basis. We decreased the intensity of supervision because of the high level of proficiency demonstrated by the counselors.
Referrals for the overall project began in mid-November, 1996. In Year 2 (July 1997-June 1998), we saw 27 clients. Of these 27, 21 had completed the active phase of treatment including the 3 month follow-up. There was a noticeable increase in referrals in July and August but declined substantively thereafter.
During Year 2, 24 clients had their 12 month follow-up windows. Of these 24, data have been collected on 14. We anticipate being able to get follow-up data from an additional 4-6. Between July 1 and November 1998 we will have conducted follow-ups on the remaining clients in the Year 1 cohort.
Results
We have pre-treatment on 27 clients in Year 2 (July, 1997-June, 1998) and 3 month follow-up data on 21. The additional 3 month follow-ups are still being scheduled. The table below contains pretreatment and 3 month follow-up data on three critical drinking variables: Average number of standard drinks per drinking day; total drinks per week; and estimated peak Blood Alcohol Concentration (BAC) per week. These numbers at 3 month follow-up reflect the drinking outcomes for those continuing to drink.
Average pretreatment levels (N=27) |
Average 3 month f-up levels (N=21) |
|
| Average number of standard drinks per drinking day | 10 |
3.4 |
| Total standard drinks per week | 27.7 |
6 |
| Estimated peak (BAC) per week | 114 mg% |
69 mg% |
At pre-treatment, clients were drinking, on average, the equivalent of 10 12 oz. beers per drinking day. They were achieving, during an average week, an estimated peak BAC of 114 mg%. This is heavy drinking by anybody’s standards. It is also clearly a high risk population for additional DWIs. These drinking data do not include 8 of the 27 (30%) individuals who were abstaining at the time of the initial assessment session.
At 3 month follow-up, 10 of the 21 individuals (45%) were abstaining. Of those clients who continued some drinking, they were, on average, drinking between 3 and 4 beers per drinking day with an estimated weekly peak BAC of 69mg%. Although the number of drinks per drinking occasion is within the range of moderate drinking, the peak BACs are still close enough to DWI per se levels to be of concern.
Not all individuals benefitted from this intervention. The follow-up results are somewhat skewed by the outcomes of two individuals. One did not change his drinking at all and has continued to achieve very high BACs (~250mg%). However, this client has continued to stay in touch with us as we continue to try to engage him in additional treatment. We have also attempted to refer him to Turquoise Lodge and these efforts are ongoing. We believe this reflects the importance of the 3 and 12 month follow-ups to assess progress or deterioration. The second individual reduced the frequency of drinking significantly but still achieved at least one high peak BAC prior to his 3 month follow-up. We are aware of 1 individual who re-offended.
The data we have thus far suggest that this program has had a impact on the drinking behaviors of most, but not all, participants. Their outcomes are consistent with other brief intervention trials and are comparable to more expensive and intensive treatment protocols. Given the budgetary constraints of Torrance County, we consider the funds spent on these brief interventions to be relatively cost-effective.
Anecdotal Information
Some of the benefits from participation in a program cannot always be captured by quantitative data. Below are some examples of benefits clients experienced while in the program.
All clients have blood work completed as part of the evaluation. The results of the lab work for one of the women clients was elevated on a number of measures. She was instructed to follow up with her personal physician because the results were suspicious. At three-month follow-up, the client reported that she had been diagnosed with cancer. Though the news was negative, the client felt she gained important information she would not have received had she not gone through the program. At twelve-month follow-up, she was grateful that she was able to catch the cancer early.
One of the male clients, was working in a bar, living in a small room next to the bar and had little else in his life. At three-month follow-up, he had joined the volunteer fire department, was planning to go to school, and found direction in his life. He appeared to be pleased with the fact that he had reduced his drinking and had begun to take charge of his life once again.
Another of the young women who came through the program had decided to become abstinent from alcohol. One of the factors impacting on her decision was the fact that her father was in prison because of a manslaughter conviction. Her father is an alcoholic and was intoxicated at the time the incident of the manslaughter took place. She had wanted to be sober to meet him when he was released on parole. She was able to meet that goal and was able to reunite with her father on a new level, sober. Her twelve-month follow-up session was held up because she was getting married and moving forward in her life.
These are but a few of the stories where clients have changed not only their drinking behavior but also their lives as a whole following 2 treatment sessions lasting a total of about 4 hours.
Current Status of Project
We are continuing to receive new referrals although the rate is slow. By the end of November we anticipate having completed our 12 month follow-ups for all clients in the Year 1 cohort. At that time we will provide a full report on the pretreatment characteristics, 3, and 12 month outcomes for that group of individuals.