Abstinence self-efficacy and alcohol use disorder 1-year treatment outcomes: Is high confidence overconfidence

Ilgen M, McKellar J, Tiet Q. Abstinence self-efficacy and alcohol use disorder 1-year treatment outcomes: Is high confidence overconfidence. Paper presented at: Research Society on Alcoholism Annual Scientific Meeting; 2004 Jun 1; Vancouver, Canada.

Introduction: A positive association has been established between abstinence self-efficacy and treatment outcome. Nonetheless, some treatment providers and researchers remain concerned that high levels of abstinence self-efficacy may indicate overconfidence and be associated with poorer prognosis. That is, overconfident patients' may have a tendency to place themselves in risky situations. The present study is designed to identify optimal levels of abstinence self-efficacy that predict abstinence at 1-year post-treatment.Methods: A total of 2,967 patients from fifteen residential substance use disorder treatment programs were assessed at treatment entry, discharge and 1-year follow-up. Patients reported baseline demographic information and ratings of self-efficacy, psychiatric symptomatology and substance use at all time points. All data were entered into a Receiver Operating Characteristic (ROC) analysis to assess the ability of each measure to predict 1-year abstinence and identify the optimal cut-offs for significant predictors. Results: The ROC analysis indicated that abstinence self-efficacy measured at discharge was the strongest predictor of 1-year abstinence, and the optimal cut-off for that variable was at the highest level of the variable (100% confident). For those who were 100% confident, 42% were abstinent at 1-year whereas for those with less than 100% confidence the rate of 1-year abstinence was 28%. Other variables which moderated the effects of discharge self-efficacy on 1-year abstinence were intake levels of alcohol use, intake levels of self-efficacy, and age. No evidence was found for a negative impact of overconfidence.Conclusions: Treatment providers should focus on increasing their patients' abstinence self-efficacy during treatment with the goal of achieving 100% self-efficacy. Although certain individuals may still be overly confident about their ability to remain abstinent, in general, high abstinence self-efficacy is associated with positive outcomes and concerns about overconfidence may be overstated.