ULTRABRIEF BEHAVIORAL ACTIVATION (UBA) FOR THE TREATMENT OF MILD/MODERATE ALCOHOL USE DISORDER

Background: Alcohol is a commonly used, intoxicating substance that activates the reward system and its reinforcing properties can lead to alcohol use disorder (AUD), a psychological disorder characterized by behavioral and physical symptoms of withdrawal, tolerance, and craving. There is a lack of brief interventions for treatment-seeking people with mild and moderate AUD who need support for turning their motivation into action and are unlikely to require more extensive, long-term treatment due to their lower symptom burden.Method: We examined if behavioral activation (BA), a client-centered behavioral psychotherapy modality with theoretical roots in reinforcement theory and behavioral economics, can fill this gap. BA increases response-contingent positive reinforcement of substance-free activities that serve as alternative reinforcers to substance use and has previously been shown to be effective for the treatment of people with SUD in a residential setting. Since there is no BA treatment for AUD described in the literature, we developed Ultrabrief Behavioral Activation (UBA), a single-session BA intervention for people with mild/moderate AUD who want to reduce their alcohol use. UBA employs a strength-based approach and was designed to decrease alcohol use by teaching the client to pursue positively reinforcing, alcohol-free activities that are individualized to their values. In this study, we examined the feasibility, acceptance, and preliminary efficacy of UBA in a controlled Phase 1b clinical trial. We hypothesized that UBA is feasible and accepted by clients, and that it shows preliminary efficacy in reducing alcohol use in treatment-seeking people with mild/moderate AUD.Results: In overall agreement with our hypotheses about feasibility and acceptability, we found that UBA was mostly feasible (4 out of 5 preregistered criteria mostly reached, criterion for homework completion was not met) and well accepted (all 3 preregistered criteria met). We did not find a statistically significant difference in reduction in alcohol use between the two groups and thus have not established evidence for efficacy of UBA with this pilot trial. Exploratory analysis of the treatment group showed that we did meet the pre-registered criterion for within group reduction in alcohol use as we found a statistically significant reduction with medium to large effect size for decrease in both percent drinking days (d = 0.48) and average alcohol consumption (d = 0.7) at the first follow-up in the UBA group. Our trial provides the basis for estimating the within- and between-group effect sizes, and thus the basis for future studies. Exploratory analysis suggests increase in behavioral activation and hedonic tone as potential mechanisms of action.Conclusion: Our study supports feasibility and acceptance of UBA. Given the generally small effect size of psychosocial treatments for AUD and, in particular, the challenge of demonstrating superiority of psychotherapy interventions to assessment-only control groups, future iterations of UBA may be worth continued examination in controlled clinical trials.