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'CHESS II' to target alcohol abuse

In an effort to help people struggling with alcohol abuse, Prof. David H. Gustafson (Industrial Engineering, UW-Madison) and his colleagues have embarked on an ambitious plan to modify their existing computer-based learning and decision support program, CHESS, to take into account the complex environment in which alcohol abuse is embedded. CHESS (the Comprehensive Health Enhancement Support System) as it stands now is essentially an interactive encyclopedia that can provide a user with voluminous amounts of health-related information, as well as a system to provide on-line support. For example, it has an instant library, and offers a question-and-answer format to give users valuable knowledge about a variety of health issues.

David H. Gustafson

David H. Gustafson (large image)

Gustafson and his UW-Madison colleagues, Prof. Linda Roberts (Child and Family Studies) and Prof. Michael Fleming (Family Medicine), are proposing to take CHESS to another level by incorporating information about environmental factors into the effort to stop drinking. This new system, known as CHESS II, is being modified and prepared for pilot testing with the aid of a seed grant from the Center for Human Performance and Risk Analysis. Gustafson is planning to test the revised system this spring.

"In order for us to really try to do something effective for this group of people, we have to recognize the kinds of things that lead them to drink; we have to try and overcome those," says Gustafson. "We're using a model that does that. The program follows a strategy that takes people from where they are, and moves them step by step through a change process." says Gustafson.

Gustafson contrasts this approach to the typical way a person might decide to abandon an unhealthful habit such as smoking. The decision may be made without taking into account all the links between smoking and the environment. For instance, sitting with a cup of coffee in the morning and reading the newspaper may be the stimulus for lighting up a cigarette. Without taking into account this sort of situation and its pleasures (and the entire environment with all of its complexities), an attempt to change can be doomed to failure, says Gustafson.

The system Gustafson and his colleagues are devising is a kind of road map that he hopes will allow users to avoid such pitfalls. The researchers have adapted a model of change developed by James Prochaska (University of Rhode Island) and Carlo DiClemente (University of Houston). Their approach sees a person trying to change behavior as going through several stages from the first somewhat dim awareness of a desire to change (pre-contemplation), to the actual active steps of change, be it weight loss or smoking cessation. Therefore, CHESS II will include modules dealing with the steps of: orientation (or thinking about changing); developing the motivation to change; planning the change; and actually making the change.

Eric Cheng, a research assistant in the Department of Industrial and Systems Engineering at the UW-Madison, has adapted the CHESS program to help in that effort. Among his innovations is employing a Microsoft character called Merlin, a cartoon wizard who will guide a person through CHESS II. Cheng has also developed a point/counterpoint presentation to help the user work through conflicts. Similar to the cartoon figures of an angel and a devil offering conflicting advice on how to behave, the point/counterpoint characters

Cheng has created represent the struggles a drinker faces when trying to quit. For example, the feeling that "I can take just one drink and no more," the notion that "I am really in control," might be countered with reminders that "Drinking has caused you harm and problems in the past" and that "When you drink, you end up fighting with your family."

CHESS II seeks to link drinking to the larger context through environmental assessments completed by users. "It gets them to start making better connections between what is happening with drinking and what is happening in work, home, and relationships. People may not be making those connections. Hopefully, we can get them to see those," Gustafson says.

CHESS II is also realistic in dealing with drinking. For example, Gustafson says, the software will address why a person may not want to quit drinking by asking about the benefits that the individual derives from alcohol, as well as discussing the benefits that may result from giving it up.

Importantly, CHESS II recognizes that an important reality of change is setbacks, "falling off the wagon." CHESS II tells users that such setbacks should be seen as learning opportunities, not failures. It helps each user to examine his or her environment, spot obstacles to be overcome, and prepare for potentially troublesome situations. For example, Cheng has built a calendar into CHESS II, to help people look ahead to times when drinking or the desire to drink is likely to increase (a party or a highly stressful event). That way, the user may be able to take steps to cope and avoid drinking in the anticipated environment.

CHESS II will also free itself from exclusive reliance on the computer. For example, if a user does not sign on for a week, CHESS II will call the participant and ask him or her to provide answers to questions about drinking using a touch-tone telephone. "This will be a mechanism to encourage them to get back on to CHESS," Gustafson notes.

The results of the pilot test, Gustafson hopes, will be the basis for moving CHESS into a wide range of other behavior change arenas, such as smoking cessation and weight loss. "This program is spawning a wealth of ideas on how to adapt CHESS to make it more effective in the behavior change area," says Gustafson.