ABC-training as a new intervention for hazardous alcohol drinking: Two proof-of-principle randomized pilot studies

Background and Aims: ABC-training is a new intervention to encourage health behavior change that targets the automatic activation of adaptive beliefs (i.e. automatic inferences). The aim of this proof-of-principle study was to test the effectiveness of web-based ABC-training to change outcome expectancies of alcohol drinking in a sample of hazardous drinkers. 

Design: One exploratory and one confirmatory experiment with two between-subject conditions (online ABC- and control-training) and assessments at baseline and 1 week later (after three sessions of training). 

Setting: Participants recruited on Prolific Academic completed the web-based study. 

Participants: Adults with self-reported hazardous alcohol drinking (Experiment 1: 193 adults, United Kingdom, age mean = 46.7 years; Experiment 2: 282 adults, different nationalities, age mean = 38.3 years). 

Intervention and Comparator: ABC-training involved completing an online task that required choosing personally relevant alternative behaviors to drinking alcohol in personally relevant antecedent contexts to attain personally important outcomes. Comparator was control-training, in which participants selected both the alternative behaviors and alcohol drinking an equal number of times. Training was completed at baseline, after 3 days and after 1 week. 

Measurements: Primary outcome was change in automatic and self-reported (negative/positive) outcome expectancies of alcohol drinking from baseline to after 1 week. Secondary outcomes were change in weekly alcohol consumption, self-efficacy, craving and motivation (and approach-alcohol associations in Experiment 1). Moderators were baseline outcome scores, motivation, age and alcohol dependency. 

Findings: Findings of this study are as follows: stronger increase in negative outcome expectancies after ABC- than control-training (Experiment 1: self-report, 95% confidence interval of difference scores (CI_diff) = [0.04, Inf]; automatic, CI_diff = [0.01, Inf]; Experiment 2: self-report, CI_diff = [0.16, Inf]; automatic, CI_diff = [0.002, Inf]). Stronger reduction in self-reported positive outcome expectancies after ABC- than control-training (Experiment 1: CI_diff = [−Inf, −0.01]; Experiment 2: CI_diff = [−Inf, −0.21]) but mixed findings on automatic positive outcome expectancies (Experiment 1: CI_diff = [−Inf, 0.02]; Experiment 2: CI_diff = [−Inf, −0.001]). 

Conclusions: ABC-training may change outcome expectancies of alcohol consumption, but testing of clinically relevant effects in other samples is warranted.