People with alcohol use disorder (AUD) commonly cut back on drinking in the weeks before entering treatment, a new study has affirmed. Further, this self-driven “pretreatment change” is linked to better outcomes up to one year following treatment. The findings help identify factors that may potentially improve treatment selection.

They also, arguably, warrant a new conceptualization of AUD treatment and recovery. It is increasingly recognized that many people who enter treatment have reduced their alcohol intake, sometimes substantially.

Some evidence suggests this self-directed action accounts for a meaningful proportion of the success attributed to treatment programs. Changes in drinking behavior frequently take place without professional involvement, and some amount of progress during formal treatment programs is also self-directed. In the case of alcohol, self-change may be more common than professionally guided change.

How pretreatment changes relate to recovery outcomes is not well explored, however. Research on “natural recovery”—self-change efforts—points to motivational and other factors, such as perspective shifting from shorter- to longer-term reward, while behavior change theory acknowledges that different stages of change call upon varying skills and attributes.

For the study in Alcohol: Clinical & Experimental Research, US researchers sought to confirm that people seeking treatment for AUD frequently engage in pretreatment change and examine how those efforts related to their alcohol use 12 months after treatment.

Investigators worked with 165 adults seeking outpatient treatment for AUD. The participants were undergoing a 12-week program of cognitive behavioral therapy (CBT) for AUD.

The intake interviews covered participants’ alcohol use over the previous six months—including the four-week “pretreatment” window preceding their first CBT session—as well as any negative consequences of their drinking; thoughts, actions, and experiences that help modify behaviors; and their readiness for change.

After each CBT session, participants completed surveys on their drinking behaviors and other factors. The researchers collected updated data at the end of treatment and at intervals up to 12 months later. Based on participants’ typical alcohol consumption before the pretreatment window, the researchers calculated the percent changes in certain drinking behaviors. They used statistical analysis to explore associations between pretreatment change, other factors, and recovery outcomes.

Nearly three in ten participants reported abstaining from alcohol one week before the start of treatment. Before their first CBT session, half of the participants had reduced their heavy drinking days by 70% and their number of drinking days by 50%; they maintained that change through one year following treatment.

who reported greater pretreatment reductions also reported higher percent days abstinent one week before treatment, during treatment, and one year later, as well as a lower percentage of heavy drinking days before and during treatment, compared to those with less pretreatment change.

Greater pretreatment change was associated with greater interpersonal problems and reflection on how drinking may affect others. The reductions in percent heavy drinking days and the increases in percent days abstinent were linked to pretreatment changes and interpersonal processes—heavy drinking to more negative alcohol-related consequences, a likely motivation for change, and abstinence to greater behavior change processes, such as supportive relationships.

The findings highlight the importance of pretreatment change in the study of AUD treatment and recovery outcomes and suggest that interpersonal processes, including awareness of the social impact of drinking, may play an important role. Positive outcomes commonly attributed to AUD treatment may be at least partly owed to self-change.