Test of motivational treatments to reduce alcohol use.

This study is the first large-scale trial of Functional Imagery Training (FIT). FIT aims to enhance the effectiveness of existing best treatment for alcohol use, Motivational lnterviewing (MI), by harnessing the motivational power of mental imagery. This study examines the additive effect of embedding FIT techniques within MI when treating Alcohol Use Disorder. There are three treatment arms: Motivational Interviewing (MI) - delivered by phone in two 1 hour calls over 1 week. Participants discuss the advantages and feasibility of reducing drinking, and therapists elicit emotional reactions and dissonance between core values and current behaviour. Motivational Interviewing plus Support (MI+S) – delivered by phone in 8 calls over 25 weeks (two 1 hour calls in Week 1 and six 15 minute calls in Weeks 2, 3, 5, 7, 13 and 19). Treatment contact time totals 3.5 hours. MI+S has the same initial sessions as MI. Later calls offer non-specific support and social reinforcement for progress and encourage brief relaxation practice, but do not shape new coping strategies unless a lapse occurs. A smartphone app developed for this study assists practice of progressive muscular relaxation, including an audio file to guide practice and photos of peaceful nature scenes. Participants can use the app and relaxation as often or as little as they choose. Functional Imagery Training (FIT) – delivered by phone in 8 calls over 25 weeks (two 1 hour calls in Week 1 and six 15 minute calls in Weeks 2, 3, 5, 7, 13 and 19). Treatment contact time totals 3.5 hours. Is based on MI+S but uses imagery throughout the sessions. During sessions, participants generate multisensory images about positive outcomes from controlling drinking, past success with self-control, and strategies to control drinking. Later sessions elicit achievements, outcomes and effective strategies, rehearsing imagery and making it routine by linking it to daily tasks. Mindfulness is practised instead of relaxation. A smartphone app developed for this study assists practice of imagery, including an audio file to guide practice and the ability to take photos to facilitate practice. Participants can use the app and imagery/mindfulness as often or as little as they choose. The treatments are manualised but are semi-structured, allowing some degree of personalisation according to the needs and circumstances of particular individuals. Therapy is delivered by postgraduate-qualified clinical psychologists and therapists receive supervision from senior clinicians throughout the trial. All sessions are audio-recorded and a random sample are rated for fidelity by appropriately qualified consultants who are independent of the trial and not involved in treatment or supervision.