A meta‐analysis of the effectiveness of bibliotherapy for alcohol problems

Abstract

and the investigation of relational factors. In meta-analyses some variation will always exist, whether due to chance or to differences in trial context or content [5,6]. On its own, variance in a meta-analysis does not de-legitimize that meta-analysis, nor does it necessarily mask key causes of variation. Indeed, once these relational factors are specified , measured and tested in the same way in which specific factors are currently dealt with, meta-analyses of the trials of these new tests would still be subject to variation in outcome due to remaining unspecified factors. Miller & Moyers are right to point out that, in focusing exclusively on specific factors related to treatment content, research into addiction treatments may be overlooking important relational factors and their associated effects. However , in acknowledging genuine and measurable causes of variation-more trees, arguably-it is important that a true forest view is not obscured. Using existing methodology , findings can be aggregated without masking the impact of underlying mechanisms, as long as these potential mechanisms are identified in advance. Relational factors that can be measured empirically and in which therapists can be trained can be tested in randomized controlled trials, as has recently been done with empathy in the context of physician training [7,8]. Such trials could then be aggregated in meta-analyses. Even where not tested directly , the contribution of these relational factors could be examined in systematic reviews through meta-regression, as has already been performed with specific factors [9,10].

Differences in Baseline Characteristics and Outcomes at 1- and 2-Year Follow-up of Cancer Survivors Accrued via Self-Referral versus Cancer Registry in the FRESH START Diet and Exercise Trial

“…However, these findings differ from FRESH START in that they found no differences in weight loss by accrual source. Indeed, our study may be similar to a meta-analysis by Apodaca and Miller, who found that self-help bibliotherapy was less effective among drinkers who were identified through at risk screening than those who were self-referred (12 *P values reflect the difference between recruitment sources within each treatment arm. cIntervention arm, self-referred (n = 98) and registry (n = 155).…”

“…Servings per day of fruits and vegetables and percent energy from fat (total and saturated) were derived using the Diet History Questionnaire (16). Additionally, at baseline, the following additional measures were collected: sociodemographic characteristics (treatment, education, and income); cancer coping style (modified Mini-Mental Adjustment to Cancer subscale); barriers to exercise and eating a low-fat, high fruit and vegetable diet; quality-of-life (Functional Assessment of Cancer Therapy); risk for depression (Center for Epidemiologic Studies of Depression); social support (Duke Social Support Index); comorbidity; perceived health; self-efficacy and stage of readiness for exercising z150 min/wk, eating five or more servings of fruits and vegetables per day and consuming a low-fat diet; smoking; and weight status (12).…”

“…For example, differences in motivation have been observed among people who selfreferred to a weight management program versus those ascertained from clinics (11). Furthermore, self-referred problem drinkers were more likely to reduce alcohol consumption with bibliotherapy (self-help) than those identified through at-risk screening (12). Advertisement may yield cost savings by reducing recruitment duration (5); however, such strategies might yield biased samples whose characteristics and study performance are not generalizable to populations of interest (9,10).…”

Efficacy of the telephone-based Brief Motivational Intervention for alcohol problems in Brazil

“…35 Apodaca & Miller reviewed the value of self-help literature, which is often used as part of a brief alcohol intervention, in a meta-analysis. 36 These authors found that self-help materials can reduce the alcohol consumption of patients without a one-on-one consultation. Moreover, this intervention is cost-effective, given the large number of risky drinkers.…”

JEu me questionne : un programme désiré par les CSSS du Québec ?

“…Un programme d'autotraitement, à l'aide d'un manuel ou d'un site Internet, a déjà fait ses preuves pour diminuer ou cesser la consommation d'alcool (Apodaca & Miller, 2003 ;Marlatt et al, 1998). Notamment, le programme Alcochoix+, créé au Québec (Simoneau, Landry & Tremblay, 2004), est reconnu comme apportant des gains thérapeutiques aux personnes souhaitant réduire ou cesser leur consommation d'alcool.…”