Psychology ETDs

Publication Date

Summer 6-19-2018


This study sought to establish the topography of drink refusal behaviors clients engage in while undergoing manual-guided Cognitive Behavioral Therapy (CBT) for Alcohol Use Disorders (AUD). Prior research has demonstrated that clients who receive specific skills training on how to assertively refuse drinks are less likely to relapse. Behavioral coding has been used previously to explore in-session behaviors by both client and therapist. Using this methodology, a coding manual (Drink Refusal and Motivation-Alcohol; DRAM-A) was developed for the present study. We sought to explore the relationship between differential types of drink refusal behaviors uttered by clients receiving treatment for AUD and drinking outcomes at 3 and 9 months post-treatment. Study materials were obtained as part of a larger study exploring efficacy of group versus individual CBT for AUD. Participants were 52 women randomized to the individual treatment condition. Using DRAM-A, trained coders evaluated and classified drink refusal training behaviors into different categories. Results demonstrated that the most commonly generated drink refusal behavior was Direct Refusal (n = 22), with 71% of clients who engaged in a roleplay demonstrating that skill. However, almost half of the sample (40.38%; n = 21) did not engage in the role-play exercise. Selection of specific drink refusal behaviors was not related to any specific client or therapist characteristics such as therapist gender, level of education, or client marital or employment status. The use of Direct Refusal in session was positively associated with a number of better drinking outcomes at 3 months post-treatment, such as: fewer heavy drinking days, F (1,28) = 7.20, p = .01), fewer total drinks consumed, F(1,28) = 12.50, p = .01, lower percentage of heavy drinking days, F (1,28) = 6.99, p = .01, greater percentage of abstinent days, F(1, 28) = 6.61, p = .02, fewer mean drinks per drinking day, F 1,21) = 5.07, p = .035), and more days of abstinence, F (1,28) = 6.61, p = .02. With the exception of total drinks consumed, similar results were found at 9 months post-treatment. At nine months post-treatment, women who used a Direct Refusal in session had a higher number of days abstinent from alcohol, F(1,26) = 8.47, p = .001; this effect was not observed at 3 months. Results suggest that having clients participate in drink refusal training with a therapist may be an important dimension to success in recovery.

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Level of Degree


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First Committee Member (Chair)

Barbara McCrady

Second Committee Member

J. Scott Tonigan

Third Committee Member

Jessica Goodkind

Fourth Committee Member

Kamilla Venner




alcohol, substance use, behavioral coding, motivation

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Psychology Commons