The utility of a brief self-help booklet provided at assessment for alcohol treatment was evaluated using a quasi-experimental design (booklet provided to all clients for one month at a time, interspersed by one month of no booklets, for a 6-month period). While the booklet did not result in any significant reduction in client attrition, clients who received the booklet at their assessment were drinking less by the 6-month follow-up than those who did not receive the booklet. Limitations of this study, including the quasi-experimental design and the impact of the low baseline attrition rates, are discussed.
Client dropout is a concern for many addictions treatment agencies, with estimates of client attrition ranging from 20% to 80% Baekland et al., 1973, Gordis et al., 1981, Nirenberg et al., 1980, Rees, 1985, Smart & Gray, 1978 and Stasiewicz & Stalker, 1999. This attrition can occur right at the front door, as a substantial number of clients attending assessment do not return for further treatment. As a result, some individuals who are considering changing their alcohol or drug use may never receive treatment services. It is important, therefore, to provide clients with some useful materials at their assessment appointment, as this may be an agency’s only contact with many of its clients.
Materials provided at assessment should be able to serve a number of different functions. First, the materials should provide clients with an incentive to start working on their alcohol concerns right away, whether they return for treatment or not. This initial “strike while the iron is hot” approach could help clients reduce their drinking more effectively than leaving them to wait for the treatment to start. Second, the materials might help reduce client dropout at this initial stage. Brief motivational (e.g., Miller, Sovereign, & Krege, 1988) and self-help interventions Agostinelli et al., 1995, Cunningham et al., in press, Heather et al., 1990, Koski-Jännes, 1995 and Sanchez-Craig et al., 1996 have demonstrated efficacy. As such, materials provided at assessment have a good chance of impacting on drinking outcomes and of significantly improving the quality of care that treatment agencies provide for all of their clients, whether they return for further treatment or not. This trial employed a quasi-experimental design to evaluate one such motivational self-help booklet (“Alcohol and You”) with clients who have primary alcohol problems at the Addiction Research Foundation (ARF) site of the Centre for Addiction and Mental Health (Toronto, Canada).
