Alcohol Therapeutic Interactive Voice Response Study

This study tested a new way of using the telephone to help people retain the skills and motivation they learned during Cognitive Behavioral Therapy (CBT) for alcohol dependence. Study participants called in to an automated phone system to complete a daily survey and to practice specific skills acquired during their CBT sessions.

This Interactive Voice Response (IVR) system is a more elaborate "Therapeutic" IVR (TIVR) then the previously researched IVR systems. In addition to completing the daily survey, patients used this TIVR to review and/or practice the coping skills they learned in CBT and receive personalized feedback about their clinical progress.

The primary goal of this study was to test whether   the TIVR enhances the therapeutic effect of CBT for alcohol dependence.   Our long-term objective was to develop interventions specifically   designed to capitalize on the unique advantages of IVR. The public   health implications of effective, low-cost interventions for alcohol   dependence that can be accessed remotely are considerable.

Cognitive Behavioral Coping Skills for Alcohol Dependence

The following Cognitive Behavioral Skills are taught to patients during therapy and encouraged using the telephone system:

Coping with Cravings: Cravings and urges to drink or use drugs are normal and should be expected from time to time in your sobriety.

Managing Thoughts about Using: Challenge your thoughts about using.  Remember the negative outcome from using.

Problem Solving: Use your brain to solve problems and consider doing nothing, instead of reacting inpulsively.

Refusal Skills: The   more rapidly and convincingly you can say “no” to offers to drink and   pressures to use drugs, the less likely you are to relapse.

Coping with a Risk or Lapse: A slip or lapse is a major crisis in recovery. A plan in advance to cope with this crisis can help you get back on your horse and return to abstinence.

Managing Stress: The ability to manage stress boosts your well-being and fortifies your sobriety.

Managing Negative Thinking: Recognizing   and changing negative thought patterns and breaking negative thought   chains helps you handle difficult situations well.

Anger Awareness and Management: You   can gain insight into how specific events might influence your   thoughts, feelings and behaviors and use that insight to manage your   anger.

Social Support: There are different kinds of support, different sources of support, and different ways to get the help and support you need.

Listening: Listening   is an active skill, because it involves attending to and trying to   understand what the other person is communicating, rather than just   waiting for your own turn to talk.

Assertiveness: Assertive responses to difficult situations can reinforce your sobriety.

Increasing Pleasant Activities: When   you have more fun things to do you won’t use drugs or alcohol just to   create fun in your life and you will have more positive feelings about   yourself and sobriety.

Phone Script

The TIVR maintenance enhancement has four components:

Daily Self Monitoring Questionnaire This   is a 21-item questionnaire that the patient completes each day for   measures of daily coping, daily perceived pain control, and daily mood.   It also includes items asking about medication use and stress. This part   of the call takes approximately three minutes to complete. The   remaining therapeutic interactive voice response (TIVR) components are   optional and patients use them at will, as frequently or infrequently as   they like.  This component is designed to improve self-monitoring of   pain behavior, use of coping skills, and use of medication.

Review of Skills Participants are able access a   verbal review of eight different pain management skills they learned   during the 11 weeks of cognitive behavioral group therapy (relaxation   response, diaphragmatic breathing, positive self-talk, cognitive   restructuring, activity-rest pacing, distraction techniques, reappraisal   of pain, and defusing catastrophizing). Each review is approximately 5   minutes in length. The review messages are recorded in the voice of an   experienced therapist with a soothing telephone voice.

Guided Rehearsal of Pain Coping Skills (Practice Sessions) Patients   can access guided rehearsals of eight of the coping skills taught   during CBT (body scan relaxation, diaphragmatic breathing,   visualization, autogenic training, brief relaxation techniques   ("minis"), cognitive restructuring, and sleep induction). For example, a   patient who is feeling very tense or cannot fall asleep can call the   TIVR to access a 10-minute relaxation message. 

Monthly Therapist Feedback Message Once a month, Dr. Naylor analyzes computer-collated patient-specific   data and records a personalized message for each participant onto the   TIVR. These messages contain a summary of that person's daily reports to   the TIVR for the past month; insight into possible relationships   between use of coping skills, mood, stress and pain levels based on   these daily data; suggestions for other pain management tactics; and   verbal encouragement. Patients find these personalized monthly messages   to be both valuable feedback and a continuing positive connection with   the therapist. They also recognize that the value of the messages   increases with the frequency of their own use of the TIVR, especially   the Daily Questionnaire. Therefore, an important effect of the Monthly   Message is to increase self-monitoring and adherence to pain management   skills, and to improve overall motivation to remain engaged in the TIVR.


Pilot study supported by The University of Vermont Medical Center Patient Oriented Research grant to Dr. John E. Helzer, Principal   Investigator.

The R01 grant is supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) awarded to Dr. John E. Helzer, Principal Investigator.