Development and Preliminary Support for the Lifecourse Alcohol Change Attempt Assessment for Individuals with Alcohol Dependence Histories

Background and Purpose: The social work profession has a rich history of providing assessment and treatment services to individuals with alcohol dependence. In an effort to provide social workers with insight into the lifecourse nature of alcohol behavior change attempts, the Lifecourse Alcohol Change Attempt Assessment (LACAA) was developed for assessing multiple formal, informal, and/or natural recovery change attempts across the lifecourse. The rationale for its development was influenced in part by the transtheoretical model of behavior change, which specifies that individuals typically experience multiple change attempts before reaching their ultimate behavior change goals. Methods: The LACAA is an innovative, structured interview protocol founded on the Timeline Followback method currently employed by social workers and other health care providers to assess individuals' alcohol consumption behaviors. The LACAA employs an individualized/personalized year-by-year lifecourse calendar in which retrospective key community dates (i.e., 9/11, sports records) and other individually specific key dates (i.e., major family/life events) serve as memory anchors for formal, informal, and natural recovery alcohol behavior change attempts. The initial set of interview questions asks when drinking was first started, when alcohol dependency symptoms were first experienced, when drinking was first recognized as problematic, what made an individual realize it was problematic, when cutting down or abstaining was first attempted, what was first attempted in order to cut down or abstain, what was the outcome of this first attempt, and what facilitated or interfered with the attempt. The problem recognition and change attempt questions are then repeated for each formal, informal, or natural recovery alcohol behavior change attempt identified across the lifecourse. Data for the present study were collected via interviews from 38 individuals with an alcohol dependence history who had been previous research participants at one site engaged in the National Institute on Alcohol Abuse and Alcoholism COMBINE Study. Six-week test-retest reliability of the LACAA was measured with a subset of 11 of the 38 participants. Results: Strong agreement was found for total number of alcohol behavior change attempts reported at time 1 and time 2 (ICC = 0.92). In addition, strong inter-rater reliability was found for matching change attempts across the two interviews (Kappa = 0.63). The LACAA manifested content validity in that participants reported varied alcohol behavior change attempts. Of the total number of attempts reported, 50.7% were identified as formal, 6.1% informal, 32.4% natural recovery, and 10.8% as other. Finally, criterion validity was indicated in that all participants reported the COMBINE study as one of their formal change attempts. Conclusions and Implications: The LACAA shows promise as a relatively brief social work approach to assessing formal, informal, and/or natural recovery alcohol behavior change attempts over the lifecourse of individuals with current or lifetime histories of alcohol dependence. The information obtained can help to identify factors likely to generate goodness-of-fit for social work interventions and can help to inform the development of intervention strategies for this population.