Alcohol treatment outcome evaluation methodology: state of the art 1980-1984

Alcohol use disorder clinical course research: informing clinicians' treatment planning now and in the future

OBJECTIVE

The clinical course of alcohol use disorder (AUD) has been widely researched over the past half-century and has been used to advance our understanding of the treatment of AUD. Nevertheless, new directions in AUD clinical course research could enhance its value in informing clinical decision-making in patient-centered treatment of AUD.

METHOD

An overview, a critical analysis, and a discussion of AUD clinical course research are presented.

RESULTS

This article discusses three research directions that promote the advancement of the knowledge regarding the clinical course of AUD to better inform clinical decision-making in patient-centered treatment of AUD. Specifically, we hypothesized that (a) real-time data collection of the clinical course of AUD via ecological momentary assessment would help elucidate near real-time associations between risk factors and alcohol use, (b) future research designs should use person-centered and dynamic analyses of alcohol use over time, and (c) adaptive treatment designs would provide personalized and optimized AUD treatment. Consequently, the field will advance the development of clinical decision-making support systems to better inform clinicians and clients in making informed AUD treatment decisions. In addition, such research would advance clinical practice with more attention to theory and expansion of the study of the clinical course of AUD to include areas of life functioning besides alcohol use.

CONCLUSIONS

These research directions have the potential to build a scientific knowledge base that could improve our understanding of AUD among individuals with alcohol problems, would allow providers to predict patient outcomes during and after treatment, and would offer practical strategies regarding steps that could ultimately improve the clinical course of AUD.

Alcohol and drug treatment outcome studies: new methodological review (2005-2010) and comparison with past reviews

OBJECTIVE

Several methodological reviews of alcohol treatment outcome studies and one review of drug studies have been published over the past 40 years. Although past reviews demonstrated methodological improvements in alcohol studies, they also found continued deficiencies. The current review allows for an updated evaluation of the methodological rigor of alcohol and drug studies and, by utilizing inclusion criteria similar to previous reviews, it allows for a comparative review over time. In addition, this is the first review that compares the methodology of alcohol and drug treatment outcome studies published during the same time period.

METHOD

The methodology for 25 alcohol and 11 drug treatment outcome studies published from 2005 through 2010 that met the review's inclusion criteria was evaluated. The majority of variables evaluated were used in prior reviews.

RESULTS

The current review found that more alcohol and drug treatment outcome studies are now using continuous substance use measures and assessing problem severity. Although there have been methodological improvements over time, the current reviews differed little from their most recent past counterpart. Despite this finding, some areas, particularly the continued low reporting of demographic data, needs strengthening.

CONCLUSIONS

Improvement in the methodological rigor of alcohol and drug treatment outcome studies has occurred over time. The current review found few differences between alcohol and drug study methodologies as well as few differences between the current review and the most recent past alcohol and drug reviews.

Alcohol treatment research assessment exposure: a critical review of the literature

Alcohol treatment researchers have speculated about the benefits of research participation (e.g., research follow-up interviews functioning as aftercare) for more than 4 decades (Gallen, 1974). Alternatively, research participation can decrease study design sensitivity and hamper the interpretability of research findings. To the extent that the typical alcohol treatment trial is characterized by frequent and comprehensive data collection, accounting for potential research assessment-related effects is essential for proper interpretation of study findings. Given this background, the purpose of this article is to review the alcohol treatment research literature on assessment exposure resulting in subject reactivity. In addition, interventions that use data collection activities to inform clinical practice are receiving increased attention, and such interventions share common characteristics with research assessment-related clinical improvements. Therefore, a second purpose of this article is to compare and contrast these 2 influences of behavior change. Study findings indicate that during and posttreatment data collection activities (i.e., both research and clinical data) positively influence clinical outcomes, although there appears to be important differences in regard to the mechanisms by which these 2 data collection activities exert their influence. Understanding of mechanisms of behavior change, effect boundaries, and the conditions under which clinical improvement is most likely to occur is only at a rudimentary level.

The effectiveness of brief intervention among injured patients with alcohol dependence: who benefits from brief interventions?

BACKGROUND

Research investigating the differential effectiveness of Brief Motivational Interventions (BMIs) among alcohol-dependent and non-dependent patients in the medical setting is limited. Clinical guidelines suggest that BMI is most appropriate for patients with less severe alcohol problems. As a result, most studies evaluating the effectiveness of BMI have excluded patients with an indication of alcohol dependence.

METHODS

A randomized controlled trial of brief intervention in the trauma care setting comparing BMI to treatment as usual plus assessment (TAU+) was conducted. Alcohol dependence status was determined for 1336 patients using DSM-IV diagnostic criteria. The differential effectiveness of BMI among alcohol-dependent and non-dependent patients was determined with regard to volume per week, maximum amount consumed, percent days abstinent, alcohol problems at 6 and 12 months follow-up. In addition, the effect of BMI on dependence status at 6 and 12 months was determined.

RESULTS

There was a consistent interaction between BMI and alcohol dependence status, which indicated significantly higher reductions in volume per week at 6 and 12 months follow-up (beta=-.56, p=.03, beta=-.63, p=.02, respectively), maximum amount at 6 months (beta=-.31, p=.04), and significant decreases in percent days abstinent at 12 months (beta=.11, p=.007) and alcohol problems at 12 months (beta=-2.7, p(12)=.04) among patients with alcohol dependence receiving BMI. In addition, patients with alcohol dependence at baseline that received BMI were .59 (95% CI=.39-.91) times less likely to meet criteria for alcohol dependence at six months.

CONCLUSIONS

These findings suggest that BMI is more beneficial among patients with alcohol dependence who screen positive for an alcohol-related injury.

Ethnic differences in drinking outcomes following a brief alcohol intervention in the trauma care setting

BACKGROUND

Evidence suggests that brief interventions in the trauma care setting reduce drinking, subsequent injury and driving under the influence (DUI) arrest. However, evidence on the effectiveness of these interventions in ethnic minority groups is lacking. The current study evaluates the efficacy of brief intervention among whites, blacks and Hispanics in the United States.

METHODS

We conducted a two-group parallel randomized trial comparing brief motivational intervention (BMI) and treatment as usual with assessment (TAU+) to evaluate treatment differences in drinking patterns by ethnicity. Patients were recruited from a level 1 urban trauma center over a 2-year period. The study included 1493 trauma patients, including 668 whites, 288 blacks and 537 Hispanics. Hierarchical linear modeling was used to evaluate ethnic differences in drinking outcomes including volume per week, maximum amount consumed in 1 day, percentage days abstinent and percentage days heavy drinking at 6- and 12-month follow-up. Analyses controlled for age, gender, employment status, marital status, prior alcohol treatment, type of injury and injury severity. Special emphasis was given to potential ethnic differences by testing the interaction between ethnicity and BMI.

RESULTS

At 6- and 12-month follow-up, BMI significantly reduced maximum amount consumed in 1 day (P < 0.001; P < 0.001, respectively) and percentage days heavy drinking (P < 0.05; P < 0.05, respectively) among Hispanics. Hispanics in the BMI group also reduced average volume per week at 12-month follow-up (chi(2) = 6.8, df = 1, P < 0.01). In addition, Hispanics in TAU+ reduced maximum amount consumed at 6- and 12-month follow-up (P < 0.001; P < 0.001) and volume per week at 12-month follow-up (P < 0.001). Whites and blacks in both BMI and TAU+ reduced volume per week and percentage days heavy drinking at 12-month follow-up (P < 0.001; P < 0.01, respectively) and decreased maximum amount at 6- (P < 0.001) and 12-month follow-up (P < 0.001). All three ethnic groups In both BMI and TAU+ reduced volume per week at 6-month follow-up (P < 0.001) and percentage days abstinent at 6- (P < 0.001) and 12-month follow-up (P < 0.001).

CONCLUSIONS

All three ethnic groups evidenced reductions in drinking at 6- and 12-month follow-up independent of treatment assignment. Among Hispanics, BMI reduced alcohol intake significantly as measured by average volume per week, percentage days heavy drinking and maximum amount consumed in 1 day.

Reactivity to alcohol assessment measures: an experimental test

AIMS

Previous research has suggested that alcohol screening and assessment may affect drinking.

DESIGN

This study was a randomized test of reactivity to alcohol assessment questionnaires among a group of heavy drinking college students.

SETTING AND PARTICIPANTS

A total of 147 university students completed a screening questionnaire and were randomized to either immediate assessment or delayed assessment. The immediate assessment group completed a set of drinking questionnaires at baseline, 3, 6 and 12 months, while the delayed assessment group completed questionnaires only at 12 months.

MEASUREMENTS

Primary outcomes included overall volume of drinking, risky drinking and use of risk reduction behaviors.

FINDINGS

We found a significant effect of assessment on measures of risky drinking and risk reduction behaviors, but not on overall volume of drinking. Specifically, at 12 months, participants who had previously completed drinking assessments had a lower peak blood alcohol concentration (BAC) (d = -0.373), were more likely to report a low score on the Alcohol Use Disorders Identification Test (AUDIT; odds ratio = 2.55) and tended to use more strategies to moderate their alcohol consumption (d = 0.352). Risk reduction behaviors that were affected tended to be those that limited alcohol consumption, rather than those that minimized consequences.

CONCLUSIONS

These results may have implications for the development of brief interventions.

Dismantling motivational interviewing and feedback for college drinkers: a randomized clinical trial

Motivational interviewing (MI) is a counseling style that has been shown to reduce heavy drinking among college students. To date, all studies of MI among college students have used a format that includes a feedback profile delivered in an MI style. This study was a dismantling trial of MI and feedback among heavy-drinking college students. After an initial screen, 279 heavy-drinking students were randomized to (a) Web feedback only, (b) a single MI session without feedback, (c) a single MI session with feedback, or (d) assessment only. At 6 months, MI with feedback significantly reduced drinking, as compared with assessment only (effect size = .54), MI without feedback (effect size = .63), and feedback alone (effect size = .48). Neither MI alone nor feedback alone differed from assessment only. Neither sex, race or ethnicity, nor baseline severity of drinking moderated the effect of the intervention. Norm perceptions mediated the effect of the intervention on drinking. MI with feedback appears to be a robust intervention for reducing drinking and may be mediated by changes in normative perceptions.

Research with severely mentally ill Latinas: successful recruitment and retention strategies

Individuals from minority groups in the United States have been found less likely than non-Hispanic whites to participate in research studies. The recruitment and retention of individuals from minority groups has also proved challenging. We describe the challenges that we encountered in recruiting and retaining a sample of severely mentally ill Mexican and Puerto Rican ethnicity for a study of the context of HIV risk. We recruited women in San Diego County, California and northeastern Ohio who were between the ages of 18 and 50 and who had diagnoses of schizophrenia, bipolar disorder, or major depression. We identified challenges to recruitment and retention at the macro, mediator, and micro levels. We were able to retain 81.1% of the Puerto Rican cohort and 26.7% of the Mexican cohort over a 5-year period. The vast majority of barriers to recruitment and retention within the Puerto Rican cohort occurred at the micro (individual) level. Macro level barriers occurred more frequently and impacted retention to a greater extent within the cohort of Mexican women. Our experience underscores the importance of outreach to the community and the interaction between staff and individual participants. Diverse strategies are required to address the impact of migration on follow-up, which may vary across groups.

Alcoholism treatment outcome studies, 1970-1998. An expanded look at the nature of the research

We reviewed 701 alcohol treatment outcome studies reported between 1970 and 1998. Examining the nature of the research allows us to characterize this field of study, analyze trends over time, and improve upon this work in the future. For multiple-group studies, the majority of both investigators and participants were male, and participant characteristics were generally inconsistently surveyed and reported. Between the 1970s and the 1990s, research on pharmacological treatments and research conducted in outpatient settings became more common. Additionally, the types of outcome measures assessed varied more widely and were more likely to be continuous and quantifiable.

Methodological characteristics and quality of alcohol treatment outcome studies, 1970-98: an expanded evaluation

AIMS

To examine the methodological quality of the research literature examining treatment for alcohol use disorders.

DESIGN

In total, 701 studies first reported between 1970 and 1998 were evaluated with a scoring system covering 19 areas of research quality.

FINDINGS

Methodological quality improved from a score of 8.2 out of a possible 28.5 in the 1970s, to 10.6 in the 1990s. Strengths included reporting the initial number of participants and conducting follow-ups of 12 months or longer. Although the percentage of studies with adequate power also increased overall, the average statistical power of comparative studies to detect a medium-sized treatment effect was low (0.54).

CONCLUSIONS

Areas with room for improvement include: ensuring that follow-up data are collected when respondents are not under the influence of alcohol, testing for differential dropout among treatment groups with respect to participant background characteristics, reporting the number of individuals being treated in the programs from which samples are drawn, noting the reliability and validity of measures used and conducting process analyses to examine potential mechanisms underlying treatment effects.

Diagnosis, self-help, and maintenance care as key constructs in treatment research for "alcohol use disorders" (AUD)

OBJECTIVE

This study examines a sample of alcohol user treatment outcome studies to determine the amount of attention given to three areas of concern and cost-effectiveness in treatment research: patient diagnosis, use of self-help groups (e.g., Alcoholics Anonymous [AA]), and use of maintenance care services (also known as a "aftercare").

METHOD

A preliminary sample of 40 studies was coded for the degree of specific information provided to each of the three areas of interest.

RESULTS

Eight studies in the sample did not mention the diagnostic criteria used to determine patient addiction, 18 did not mention use, referral, or recommendation of AA, and 20 did not mention use, referral, or recommendation of maintenance care services.

CONCLUSIONS

As cost-effective additions to primary treatment, AA and maintenance care services deserve greater attention in the treatment of "substance abuse disorders." Researchers should also pay greater attention to patient diagnosis as an integral part of patient care. Finally, journal editors should institute minimum requirements for published reports ensuring that sufficient information on patient care is provided.

Does Alcoholics Anonymous work? The results from a meta-analysis of controlled experiments

This article reviews the outcome (usually abstinence at 12 months) of 21 controlled studies of AA, with emphasis on methodological quality. Severe selection biases compromised all quasi-experiments. Randomized studies yielded worse results for AA than nonrandomized studies, but were biased by selection of coerced subjects. Attending conventional AA meetings was worse than no treatment or alternative treatment; residential AA-modeled treatments performed no better or worse than alternatives; and several components of AA seemed supported (recovering alcoholics as therapists, peer-led self-help therapy groups, teaching the Twelve-Step process, and doing an honest inventory).

Stress, cognitive factors, and coping resources as predictors of relapse in alcoholics

One hundred alcohol-dependent individuals attending a detoxification unit were assessed on a variety of psychological, social and demographic variables. Sixty-one participants were contacted at follow-up over 1 year later. Alcohol consumption was assessed through self-report and corroborative information. Self-reported levels of stress and social support were also obtained. High self-efficacy predicted low levels of self reported drinking at follow-up. Negative coping predicted higher levels of drinking as reported by the corroborator. High levels of stress in the month prior to follow-up were related to self-reported poor drinking outcomes, while ongoing social support since treatment was associated with favorable drinking outcomes. Overall, higher levels of self-efficacy during detoxification and social support following treatment were the best predictors of a favourable drinking outcome.

Methodological and clinical challenges in evaluating treatment outcome of substance-related disorders and comorbidity

OBJECTIVE

To review the steps required to develop an outcome evaluation package and to report on the 12-month outcome of an integrated day program.

METHOD

Based on the identification of salient outcome predictors, standardized instruments were selected. A cohort of 78 patients was assessed at the time of admission to the program, at discharge, and 3, 6, and 12 months afterward.

RESULTS

Improvements were sustained over 1 year in all areas including treatment needs, quality of life, and readiness to change.

CONCLUSIONS

The gap between the "cultures" of treatment and research must be narrowed. Following evidence of a program's general effectiveness through outcome monitoring, a randomized control design is optimal for specific interventions. The optimal length of follow-up depends on the perceived confounds.

Alcohol treatment outcome methodology: state of the art 1989-1993

This article reviews the 61 alcohol treatment outcome studies published from 1989-1993 with respect to methodology. Although better assessment of subjects' pretreatment characteristics was noted, a minority of studies met even the basic requirements of experimental studies. Further, some reversals of methodological progress were observed in several areas, particularly in collecting outcome data from multiple sources. It is suggested that funding agencies and journal editors require that submissions meet minimum standards for adequate outcome evaluation.

Measuring outcomes in the treatment of alcohol dependency

The selective promotion of clinical services which have proven effectiveness is a movement that is gaining momentum within healthcare. Outcome evaluation in treatment services for alcohol dependency is given as an example of the methodological issues associated with the establishment of clinical efficacy. It is argued that the adoption of clear protocols for assessment, treatment and outcome are a prerequisite of the process. There are costs associated with in-house follow-up studies but the benefits of feedback are evident for patients and for staff providing their care. Although exposing service providers (and commissioners) to the possibility of negative feedback, outcome evaluation in the treatment of alcohol dependency should be an integral part of provision. The principle of systematic assessment of efficacy applies to healthcare provision generally and should include management, teaching, purchasing and policymaking.

Tracking procedures and attrition containment in a long-term follow-up of a community-based ADHD sample

Strategies are discussed for locating and interviewing a community-based sample of 492 adults, approximately half of whom were diagnosed in 1974 with ADHD. Completion rates, reasons for attrition, and amount of time and intensity of effort associated with subject location are reported. We found that 81% of the original sample had been located after 28 months, and that the reconstituted sample closely resembled the original larger childhood sample in background characteristics. Findings confirm that staff persistence was an important factor in containing attrition, and that longer contact intervals are likely to be a necessary feature of follow-up with socially and behaviorally disordered samples.

Alcoholism treatment outcome studies, 1980-1992: the nature of the research

We reviewed 339 alcoholism treatment outcome studies reported between 1980 and 1992. After comparing single and multiple treatment group studies, we focus on multiple-group studies, examining and comparing principal investigator and study characteristics, patient characteristics, treatment modalities and characteristics, and follow-up points and outcome variables in published and unpublished studies. This article provides an overview of the nature of the alcoholism treatment outcome research reported in the English language over the 13-year review period.

Alcoholism treatment outcome studies, 1980-1992: methodological characteristics and quality

We examine the methodological characteristics and provision of study information in 339 alcoholism treatment outcome studies reported between 1980 and 1992. We consider factors in four methodological domains: sampling and description of patients, specification of treatments, outcome variable assessment and follow-up, and treatment effect estimates; we also consider the methodological quality of the studies. Although methodological quality has improved over time, there remains room for improvement. Of special concern is the low statistical power of many studies. Multiple treatment group studies had an average .54 probability of detecting a treatment effect of medium size.

Explaining abstinence rates following treatment for alcohol abuse: a quantitative synthesis of patient, research design and treatment effects

We examined the relationships of treatment, patient and research design characteristics to treatment outcome (i.e. abstinence rates) in a sample of 150 treatment conditions drawn from 100 alcohol treatment outcome studies published between 1980 and 1992. Treatment characteristics were related to abstinence rates: more intensive treatments had higher abstinence rates than less intensive treatments, whereas treatments with an expressed goal other than abstinence had lower abstinence rates than treatments with an abstinence goal. When the public vs. private ownership status of the treatment facility was taken into account, the presence of behavioral elements in the treatment condition also was related to higher abstinence rates. Because of inconsistent reporting in primary studies, we assessed the effects of only one patient pre-treatment characteristic; treatment conditions with a higher proportion of socially stable patients had better outcomes. Research design characteristics were also related to abstinence rates. Treatment conditions with shorter follow-ups and treatments drawn from studies that did not use criteria to exclude more impaired subjects had better outcomes. We discuss possible reasons why our findings regarding the effects of treatment intensity and the use of exclusionary criteria differ from those in previous reviews.

Evaluating multiple outcomes and gender differences in alcoholism treatment

This study followed 592 alcoholics (180 women and 412 men) after discharge from inpatient treatment. Multiple measures of treatment outcome were used to broaden our understanding of the process of recovery from alcohol abuse, and how that process differs for men and women. Patients were interviewed by telephone between 3 and 15 months after discharge to gather information about post-treatment experiences including: relationship with family, role performance, psychological impairment, and effort toward recovery. Additionally, if any alcohol use took place after treatment, information was collected about the pattern of alcohol consumption. Results indicated being married is consistently related to less drinking for men, while for women, being married contributes to relapse in the short term. The determinants of each measure of outcome were different for women and men, indicating that the process of recovery is not the same for both genders. The study confirms that drinking is related to other adverse outcomes for men, but not necessarily for women. It is evidence that women and men have different post-treatment functioning, and that different characteristics are predictive of these outcomes.

Treatment outcome of 600 chemically dependent patients treated in a multimodal inpatient program including aversion therapy and pentothal interviews

A sample of 600 patients treated in a multimodal treatment program using aversion therapy and narcotherapy at three Schick freestanding addiction treatment hospitals and one Schick unit in a general hospital were followed-up. Contact was made a minimum of 12 months and as many as 20 months after completion of treatment (mean 14.7 mos.). Telephone contact was made by an independent research organization with 427 of the patients (71.2%). Of these, 65.1% were totally abstinent for 1 year after treatment and 60.2% were abstinent until follow-up a mean of 14.7 months later. Fifty-two percent of the alcoholics were using or dependent on other drugs at admission. Seventy-five of these treated for cocaine dependence and 47 treated for marijuana dependence. The cocaine 12 month and "total" abstinence (mean 14.7 mos.) rates for the 49 contacted patients were 83.7% and 81.6%, respectively. The marijuana 12 month and "total" abstinence (mean 14.7 mos.) rates for the 30 contacted patients was 70.0% for both groups. Abstinence rates for alcohol and/or other drugs were also calculated including noncontacted patients who had chart documented evidence of relapse. The most powerful predictor of success was whether or not all urges to drink or use had been eliminated (presumably by aversion therapy). Of additional importance was the use of support groups and reinforcement treatments after completion of the initial hospitalization. The two most prominent factors initiating a relapse were "intrapersonal determinants" such as stress from work or marriage/family relationships and "interpersonal determinants" such as being around others who were drinking/using or being at a celebration or special event. The two factors were of equal importance in the alcoholics. However, interpersonal determinants were far more important in the cocaine and marijuana treated patients. Increased utilization of reinforcement treatments was associated with decreased urges to drink/use and increased abstinence rates. In contrast, increased frequency of support group utilization was associated with increased urges to drink/use and lower abstinence rates. This suggests the need to take seriously patient reports of "urges" in the first year after treatment and to carefully assess the cause and initiate or update an individualized plan of treatment. Such treatment may include increased reinforcement treatments, treatment of depression, and additional assistance in coping with intrapersonal and interpersonal determinants of relapse.

Methodological issues in surveying older persons concerning drug use

Despite beliefs that surveys involving older persons are less valid than those with other groups (due to memory loss, etc.), empirical verifications do not support this. Certain factors related to reduced validity must be considered (e.g., little education) and the confounding factors of cohort and time of measurement must be evaluated. Persons presumably suffering from dementia and institutional residents may be needlessly excluded. Methods suggested for improving validity include: sampling techniques, proxy respondents, administration and instrumentation, and interviewer variables. It is important to cross-validate data from surveys by using several concurrent methods. Instruments developed with younger subjects may be inappropriate or invalid with elders.

Predictive factors for outcome of treatment for alcohol problems

Two samples of problem drinkers were followed up 2 and 4 years after they completed treatment. The first consisted of 72 men and 16 women admitted to a program for alcoholics (the inpatient sample), and the second, of 57 men and 35 women who participated in a program of outpatient treatment (the outpatient sample). At start of treatment, the outpatient sample, was generally characterized by a higher degree of social integration and more moderate alcohol problems than those found in the inpatient sample. These differences were sustained during the part of the follow-up period for which comparative data existed. In both samples it was possible to identify subgroups whose alcohol consumption throughout the observation period did not exceed average consumption in a comparative group of the Norwegian population. The most important predictive factors for alcohol consumption in the inpatient sample were degree of social integration, consumption before start of treatment, and sex. In the outpatient sample the most important factors were level of consumption and relative contribution of heavy drinking to the drinking pattern before start of treatment and the client's own goals as regards to alcohol. In both samples there was a close connection between alcohol consumed, total situation, and individual degree of satisfaction. For both groups, less frequent drinking and reduction of heavy drinking were most important for feeling satisfied with the drinking outcome. The therapeutic implications of the qualitative changes in drinking patterns are discussed.

A psychotherapeutic approach to substance abuse: preliminary observations

Twenty-four long-term substance abusers were told that addiction is an attempt to adapt to an insufficiency in natural neurochemicals that contribute to a sense of well-being; this insufficiency is experienced as a craving for abuse substances which mimic the missing anxiolytic and euphorigenic neurochemicals. They were also told that they could satisfy their cravings immediately and completely without taking abuse substances by intentionally restoring adequate levels of the depleted neurochemicals. To perform this self-regulation, they were taught a specific psychological technique that united reason and emotion in an unambivalent order to the brain. Nineteen abusers (79%) were able to use the procedure to relieve all substance cravings and withdrawal symptoms. Their remissions have lasted 41 to 66 months to date (July 1991). A replication of the findings reinforces the desirability of further studies of the treatment's effectiveness and mechanisms.

The anatomy of a follow-up

This article describes the methods that were used to maximize subject retention in an 8-12 year follow-up study of 454 men. Guidelines and suggestions are given regarding follow-up structure, strategies to relocate lost subjects, and efforts to maintain contact and ensure subject cooperation. Through these methods all 454 subjects have been located, and at the present time an estimated 98% or greater will be completely evaluated at follow-up. Hopefully these suggestions will be helpful to researchers and clinicians interested in longitudinal studies.

Alcohol abusers' perceptions of the accuracy of their self-reports of drinking: implications for treatment

Several major literature reviews have concluded that alcohol abusers generally give valid self-reports when interviewed under certain conditions. Nevertheless, across all studies a small proportion of alcohol abusers' self-reports continue to be suspect. Sources of invalidity may relate to subject factors or to circumstances under which data are collected. One novel way of gaining information about conditions possibly affecting the accuracy of alcohol abusers' self-reports is to ask the subjects themselves. In the present study, 208 alcohol abusers were asked about (a) how accurately different people they knew or lived with would report their (i.e., the subjects') drinking at different levels (e.g., abstinent, 1-4 drinks) compared to the subjects' own reports; (b) how accurate their own reports would be at different levels of ethanol consumption; and (c) how accurate their own reports would be when interviewed under different conditions (e.g., by phone, their therapist, a researcher, their employer). The results are largely consistent with studies that have empirically examined the validity of alcohol abusers' self-reports. Suggestions for future research and evaluation are offered.

Long-term abstinence from alcohol in patients receiving aversion therapy as part of a multimodal inpatient program

A sample of 200 patients who had been treated for alcoholism in a multimodal inpatient program that used aversion therapy as a treatment component was selected for outcome evaluation. One hundred sixty (80%) were located. A minimum of 13 months had elapsed since treatment (mean 20.5 months) collateral reports were used to verify self-reports in 36% of the cases. Abstinence status was determined for the first 12 months since treatment, the entire elapsed time since treatment (range 13 to 25 months, mean 20.5 months), and "current abstinence" (last 6 months). The abstinence rate for the first 12 months was 71.3%; for the total period since treatment, the rate was 65% (mean 20.5 months); the current abstinence rate was 78.1%. The data was also viewed from other perspectives. The findings of this study suggest that a multimodal alcoholism treatment program utilizing aversion conditioning is at least as acceptable to patients as counseling centered programs and can be expected to yield favorable abstinence rates.