After the training, drinkers were less distracted by pictures of alcohol, as indicated by faster reaction times on an alcohol-distraction test. On questionnaires, they reported fewer alcohol-related problems, said they felt more in control of their drinking, and were more willing to change. And they drank less: on average, the excessive drinkers drank 12 fewer units of alcohol per week. All improvements were statistically significant and were maintained “in the real world” at a three-month checkup, Cox says.
The findings are “promising” but not conclusive, says Reid Hester, director of research at Behavior Therapy Associates in Albuquerque, NM. Cox’s results show “very modest changes in drinking,” he says. He also raises concerns about the study design. “The follow-up was very short-term,” he notes. Reassessment is typically done one year after treatment, because alcohol abusers often go back to old drinking habits after showing initial improvement.
But controlled, longer-term, randomized trials are in progress, says Cox. In these trials, Cox’s group will compare alcohol abusers who receive no treatment, those who receive a different kind of treatment, those who receive the computer-based treatment, and those who receive both treatments. They will follow up after three and six months, and Cox hopes to publish the results in three years.
Rohsenow, too, raises concerns about Cox’s work. The cues that trigger an alcohol abuser’s drinking are numerous and personal, she says: “For one person, it might be a fight with the wife about the stepkids. For another, it might be sitting at home, alone, listening to country-western music.” These are “real situations” observed in her practice, she says. Using a “mechanical” technique to stamp out one general cue – the sight of an alcohol bottle – may make little difference; no conceivable treatment can stamp out all possible cues. Therefore, the best treatments identify an abuser’s personal triggers, re-create them in a treatment center using real drinks, and teach abusers to cope and resist – again and again. This is a proven tool for making lasting changes in the lives of “people with the most serious problems,” Rohsenow says.
Cox’s program “is not going to suddenly cure people with serious alcohol problems,” he acknowledges. “It is a tool to help people who are trying to control their drinking.” It is not a “panacea” meant to stand alone, he says, but a “component” to be incorporated into existing treatment programs. For instance, he thinks it could be useful for inpatient programs, just after detoxification, when cravings hit abusers hard. His program could help patients regain control over their distraction by alcohol before they enter the next phase of treatment. The program could also be used after a full course of treatment, to help prevent relapse. Eventually, it might become part of an outpatient program for less severe drinkers – used at home between counseling sessions to fight cravings, he says.Though testing is still under way, Cox has copyrighted his program and is talking to U.K. treatment agencies how it might be integrated into existing programs.