Drink Refusal Training Increases Abstinence from Alcohol

The COMBINE study of 2003 examined how behavioral modification and medication affected treatment outcome in people struggling with alcohol misuse. As a follow-up to that study, Katie Witkiewitz of the Department of Psychology at Washington State University evaluated the effectiveness of drink abstinence training as a component of COMBINE. Individuals with alcohol dependence can learn how to adaptively handle stressful situations without alcohol by developing drink refusal skills. But existing research in this area has yet to clarify why drink refusal skills increase abstinence. One theory is that individuals who possess the skills to effectively refuse alcohol increase their self-efficacy, perhaps due to cognitive changes that result from drink refusal training.

To better understand how drink refusal training helps alcohol-dependent individuals receiving cognitive behavioral interventions (CBI), and to what extent, Witkiewitz conducted a follow-up study on 776 individuals who were part of COMBINE. She found that after 16 weeks of training, participants had significant increases in abstinence. She also discovered that the participants who received the drink refusal training showed greater increases in self-efficacy than those who received CBI alone. Overall, drink refusal training was directly related to higher levels of abstinence at the conclusion of treatment. But Witkiewitz also realized that the participants who were receiving the drink refusal training actually saw increases in self-efficacy as early as 10 weeks into treatment. Positive changes in abstinence and self-efficacy were also maintained at 1-year follow-up.

Witkiewitz believes these findings are significant and should prompt researchers to focus on recognizing change during treatment as well as after treatment to measure the effectiveness of the treatment and how it influences particular behaviors and thoughts related to drinking abstinence. She noted that consistent with prior research, this most recent study demonstrates that any drink abstinence intervention that improves self-efficacy could positively affect treatment outcomes. Witkiewitz added, “Future research could examine whether self-efficacy is a specific mediator of skills training or whether significant changes in abstinence self-efficacy is a general mechanism of change following alcohol treatment.”

Witkiewitz, K., Donovan, D. M., Hartzler, B. (2012, January 30). Drink Refusal Training as Part of a Combined Behavioral Intervention: Effectiveness and Mechanisms of Change. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0026996

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  • Steph


    February 10th, 2012 at 6:09 PM

    Drink refusal training? Seriously? This would not have gone over too well when I was in college.
    I guess I can see how some people need to learn how to say no but this seems just a little weird.
    How about instead of telling them how to say no we do better at promoting the fact that a party or any social setting can be fun without always having to have a drink in hand?
    Giving someone a way to have fun without feeling like they are always having to deny themselves something that everyone else gets to enjoy would seem to be more positive.

  • brad


    February 11th, 2012 at 6:39 AM

    Ok so this is not the kind of addiction and alcohol abstinence that we are necessarily accustomed to hearing about but if it is working for some users then who am I to judge> Do I think that this is something that would work for a lot of people? Not really, I think that there has to be something with a little more substance there than just getting them to say no. Didn’t we already go through this whole just say no to drugs campaign 20 years ago and it really did not have that much overall impact on use and abuse numbers? But do I think that the whole thing has to be scrapped? No because treatment is not a one size fits all type of deal. It will work for some and not for others.

  • Frank H

    Frank H

    February 12th, 2012 at 10:51 AM

    Adding this to more traditional forms of addiction therapy could prove to be pretty useful. You can’t rely on one thing alone for the best treatment results, so why not give addicts a lot of different support systems to fall back on and hopefully there will be one that will help them when the times get a little tougher.

  • Dan


    February 13th, 2012 at 11:55 AM

    alcohol and other addictions are always vulnerable to relapse.Only the person battling these addictions can hinder that so if an external agent can help one in this then it sounds great!

  • Chris


    April 26th, 2012 at 8:31 AM

    Funny, because I was thinking that ‘no’ training would help people say no more often.

    I believe that heavy drinkers are programmed to say ‘Yes’ and that training where they say ‘no’ to a drink would help them to address this automatic response.

    This would be useful if the heavy drinker did this in combination with addressing the ‘reasons’ why they drink.

    This is not only useful for people who want to stop but also for people who want to moderate. There can a lot of peer pressure for people to drink more than they want to.

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