Outcome, attrition, and family–couples treatment for drug abuse: A meta-analysis and review of the controlled, comparative studies.

Abstract

This review synthesizes drug abuse outcome studies that included a family-couples therapy treatment condition. The meta-analytic evidence, across 1,571 cases involving an estimated 3,500 patients and family members, favors family therapy over (a) individual counseling or therapy, (b) peer group therapy, and (c) family psychoeducation. Family therapy is as effective for adults as for adolescents and appears to be a cost-effective adjunct to methadone maintenance. Because family therapy frequently had higher treatment retention rates than did nonfamily therapy modalities, it was modestly penalized in studies that excluded treatment dropouts from their analyses, as family therapy apparently had retained a higher proportion of poorer prognosis cases. Re-analysis, with dropouts regarded as failures, generally offset this artifact. Two statistical effect size measures to contend with attrition (dropout d and total attrition d) are offered for future researchers and policy makers.

A Preliminary trial of twelve-step facilitation and acceptance and commitment therapy with polysubstance-abusing methadone-maintained opiate addicts

“…Metaanalyses of psychotherapy studies that exclude those purely with substance abuse have found average dropout rates of about 50% across the treatment outcome literature (Wierzbicki & Pekarik, 1993). These rates are known to be higher for heroin addicts in particular (Stanton, 1997), and especially in the context of individual therapy (Stanton & Shadish, 1997). Considering all of these factors, we cannot yet say if the attrition in the ACT or ITSF conditions was large because it is not yet clear which benchmark to use.…”

The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials.

“…This estimate, based on eight data sets with over 2,000 total participants, is noticeably smaller than the AMI-assisted reduction of drinking by approximately 20 standard drinks per week reported herein. Additionally, Stanton and Shadish (1997) calculated a combined effect size of 0.38 for family therapy of drug addiction, which is in the same range as the AMI effect sizes in this review. Unfortunately, no good summary estimates exist at this time for the combined effect size of alcohol treatments, chiefly because of the paucity and poor quality of meta-analyses in this area (Wilson, 2000).…”

“…For each combined effect size, 95% confidence intervals were derived from the variance of d c (Hedges & Olkin, 1985, p. 113 To examine whether the efficacy of AMI interventions was sustained over time, we conducted the most rigorous test possible by examining only those studies that generated effect sizes at both posttreatment and at least one other follow-up period. In this way, the difference between posttreatment and follow-up results is not confounded with any other study features (Stanton & Shadish, 1997). For this subset of studies, Gleser and Olkin's (1994) procedure for stochastically dependent data was used.…”

Efficacy of self-administered treatments for depression and anxiety.

“…Methodological quality. The evidence relating methodological quality and effect size is mixed (e.g., Glass, McGaw, & Smith, 1981;Stanton & Shadish, 1997). We expanded the methodological quality scale developed by Miller et al (1995).…”