Problem drinkers: evaluation of a stepped-care approach

Breslin, F. Curtis; Sobell, Mark B.; Sobell, Linda C.; Cunningham, John A.; Sdao‐Jarvie, Kathy; Borsoi, Diane

doi:10.1016/s0899-3289(99)00008-5

Cited by 57 publications

(33 citation statements)

References 24 publications

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“…This approach, sometimes referred to as an adaptive treatment or stepped care model, has been demonstrated to improve outcomes and conserve treatment resources in community-based substance abuse treatment programs (e.g., Breslin et al, 1999; Brooner et al, 2004; Brooner, Kidorf, Stoller, Neufeld, & Kolodner, 2007; Kidorf, Neufeld, King, Clark, & Brooner, 2007; Reid et al, 2003), and has recently shown promise for improving outcomes in drug courts (Marlowe et al, 2007, 2008). Adaptive treatment models adjust the type or dose of serveices administered to clients based on clients’ initial clinical presentation or ongoing performance in treatment (Murphy, Lynch, McKay, Oslin, & TenHave, 2007).…”

Section: Discussionmentioning

confidence: 99%

Outcome Trajectories in Drug Court

DeMatteo

Marlowe

Festinger

et al. 2009

Criminal Justice and Behavior

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Graduation rates in drug courts average 50% to 70%, but it is unclear what proportion of graduates responded to the drug court services and what proportion might not have had serious drug problems upon entry. This study cluster-analyzed urine drug screen results during the first 14 weeks of treatment on 284 participants from three misdemeanor drug courts. A four-cluster solution (R2 > .75) produced distinct subgroups characterized by (1) consistently drug-negative urine specimens (34% of the sample), (2) consistently drug-positive specimens (21%), (3) consistently missed urine specimens (26%), and (4) urine specimens that began as drug-positive but became progressively drug-negative over time (19%). These data suggest that approximately one-third of the participants might not have had serious drug problems upon entry. Approximately one-fifth appeared to respond to drug court services, and nearly one-half continued to exhibit problems after 14 weeks. Implications for adaptive programming in drug courts are discussed.

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Section: Discussionmentioning

confidence: 99%

Outcome Trajectories in Drug Court

DeMatteo

Marlowe

Festinger

et al. 2009

Criminal Justice and Behavior

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“…Recently, substance abuse researchers have proposed strategies composed of adaptive sequences of therapies, to more effectively manage the variable course of this disorder as well as the heterogeneity of response to standard interventions. In some cases these strategies incorporate cost and burden considerations such as the stepped care models (Sobel and Sobel, 2000;Breslin et al, 1999), which advocate beginning with a minimally intensive but effective therapy, transitioning to more intensive or other types of therapy only if indicated. Other related strategies involve increasing both intensity of therapy and encouragement to adhere when indicated (Brooner and Kidorf, 2002;Kidorf et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Developing adaptive treatment strategies in substance abuse research

Murphy

Lynch

Oslin

et al. 2007

Drug and Alcohol Dependence

188

155

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For many individuals, substance abuse possesses characteristics of chronic disorders in that individuals experience repeated cycles of cessation and relapse; hence viewing drug dependence as a chronic, relapsing disorder is increasingly accepted. The development of a treatment for a chronic disorder requires consideration of the ordering of treatments, the timing of changes in treatment, and the use of measures of response, burden and adherence collected during treatment to make further treatment decisions. Adaptive treatment strategies provide a vehicle through which these issues can be addressed and thus provide a means toward improving and informing the clinical management of chronic substance abuse disorders. The sequential multiple assignment randomized trial (SMART) is particularly useful in developing adaptive treatment strategies. Simple analyses that can be used with the SMART design are described. Furthermore the SMART design is compared with standard experimental designs.

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“…The dosage assignment of the adaptive components in Fast Track was time-varying, that is, the dosage was adjusted up to three times per year. Other examples of adaptive interventions and treatments include Borhani et al (1991), Breslin et al (1999), Brooner and Kidorf (2002), Dishion and Kavanagh (2000), Kreuter and Strecher (1996), Prochaska et al (2001), and Sobell (1999, 2000). Lavori and Dawson (1998) and Lavori et al (2000) discuss advantages of adaptive treatments in medical research.…”

mentioning

confidence: 99%

A Conceptual Framework for Adaptive Preventive Interventions

2004

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Recently, adaptive interventions have emerged as a new perspective on prevention and treatment.Adaptive interventions resemble clinical practice in that different dosages of certain prevention or treatment components are assigned to different individuals, and/or within individuals across time, with dosage varying in response to the intervention needs of individuals. To determine intervention need and thus assign dosage, adaptive interventions use prespecified decision rules based on each participant's values on key characteristics, called tailoring variables. In this paper, we offer a conceptual framework for adaptive interventions, discuss principles underlying the design and evaluation of such interventions, and review some areas where additional research is needed. Keywords adaptive interventions; prevention; research designFor most of the history of research-based interventions aimed at prevention and treatment, the composition and dosage of these interventions have been fixed, in other words, a single composition and dosage has been offered to all program participants. For example, a schoolbased drug abuse prevention curriculum might be delivered to all sixth graders. Every component of the intervention that may be necessary for any particular participant is included in the curriculum, and each child is given the same intervention. Although it is recognized that individuals may have different intervention needs, it is expected that the intervention is in no way diluted or made counterproductive if components that are particularly relevant for an individual are combined with components that may have less, or even no, relevance for that individual.Recently, adaptive interventions have emerged as a new perspective on research-based prevention and treatment. According to this perspective, the varying intervention needs of individuals may not be met optimally by using a single uniform composition and dosage. For this reason, an adaptive intervention assigns different dosages of certain program components across individuals, and/or within individuals across time. Dosage varies in response to the intervention needs of individuals, and dosages are assigned based on decision rules linking characteristics of the individual with specific levels and types of

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Problem drinkers: evaluation of a stepped-care approach

Cited by 57 publications

References 24 publications

Outcome Trajectories in Drug Court

Outcome Trajectories in Drug Court

Developing adaptive treatment strategies in substance abuse research

A Conceptual Framework for Adaptive Preventive Interventions

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