Toward a stepped care approach to treating problem drinkers: the predictive utility of within-treatment variables and therapist prognostic ratings

Breslin, F. Curtis; Sobell, Mark B.; Sobell, Linda C.; Buchan, Giao; Cunningham, John A.

doi:10.1046/j.1360-0443.1997.921114799.x

Cited by 36 publications

(46 citation statements)

References 23 publications

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“…The recommended time of use of the extended self-help interventions is 6 weeks, as this is the expected time period in which changes in problematic alcohol use are appearing [14]. Potential benefits have already been illustrated in studies on e-self-help interventions that induce behavioral change in the use of substances such as alcohol or tobacco [15] or that treat mental health disorders like depression and anxiety [16-18].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of E-Self-help Interventions for Curbing Adult Problem Drinking: A Meta-analysis

Riper¹,

Spek²,

Boon³

et al. 2011

J Med Internet Res

235

236

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BackgroundSelf-help interventions without professional contact to curb adult problem drinking in the community are increasingly being delivered via the Internet.ObjectiveThe objective of this meta-analysis was to assess the overall effectiveness of these eHealth interventions.MethodsIn all, 9 randomized controlled trials (RCTs), all from high-income countries, with 9 comparison conditions and a total of 1553 participants, were identified, and their combined effectiveness in reducing alcohol consumption was evaluated by means of a meta-analysis.ResultsAn overall medium effect size (g = 0.44, 95% CI 0.17-0.71, random effect model) was found for the 9 studies, all of which compared no-contact interventions to control conditions. The medium effect was maintained (g = 0.39; 95% CI 0.23-0.57, random effect model) after exclusion of two outliers. Type of control group, treatment location, type of analysis, and sample size did not have differential impacts on treatment outcome. A significant difference (P = .04) emerged between single-session personalized normative feedback interventions (g = 0.27, 95% CI 0.11-0.43) and more extended e- self-help (g = 0.61, 95% CI 0.33-0.90).ConclusionE-self-help interventions without professional contact are effective in curbing adult problem drinking in high-income countries. In view of the easy scalability and low dissemination costs of such interventions, we recommend exploration of whether these could broaden the scope of effective public health interventions in low- and middle-income countries as well.

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Section: Introductionmentioning

confidence: 99%

Effectiveness of E-Self-help Interventions for Curbing Adult Problem Drinking: A Meta-analysis

Riper¹,

Spek²,

Boon³

et al. 2011

J Med Internet Res

235

236

View full text Add to dashboard Cite

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“…However, these treatments do not work for everyone (Carroll, 2005) and this lack of treatment specificity raises a number of unique dilemmas. For instance, clinicians may wish to match individuals to treatments (Project MATCH Research Group, 1997), combine treatments to improve outcomes (Anton, et al, 2006), or provide treatments of increasing intensity based on client response (Breslin, Sobell, Sobell, Buchan, & Cunningham, 1997), but no consistent body of empirical evidence guides clinician treatment planning and implementation at the level of the individual client. Sequencing treatment according to a combination of costs, availability, and treatment intensity from least invasive to most invasive, or stepped care, has intuitive appeal, but lacks empirically derived heuristics to guide decision-making (Bower & Gilbody, 2005; M.…”

Section: Introductionmentioning

confidence: 99%

“…However, the efficiency of this algorithm is highly dependent upon a clinicians' ability to predict when a particular treatment is unlikely to work, so the next steps can be considered (Davison, 2000). The level of drinking within treatment is predictive of outcome (Breslin, et al, 1997), but clear empirically derived evidence about when to switch treatments does not exist for AUDs. Although the predictive validity of clinical judgment lacks strong empirical support (Dawes, Faust, & Meehl, 1989; Grove & Lloyd, 2006), complicated statistical models based on a range of baseline characteristics are unlikely to be adopted by clinicians.…”

Section: Introductionmentioning

confidence: 99%

When should clinicians switch treatments? An application of signal detection theory to two treatments for women with alcohol use disorders

Hildebrandt

McCrady

Epstein

et al. 2010

Behaviour Research and Therapy

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Statistical application of signal detection theory has been used to study the clinical utility of early treatment response in a range of treatments and psychiatric disorders. The current study sought to examine the predictive value of weekly within-treatment drinking using receiver operator curves (ROCs) and zero-inflated Poisson (ZIP) regression in102 women with alcohol use disorders (AUDs) randomized to either alcohol behavioral individual treatment (ABIT; n = 52) or alcohol behavioral couples treatment (ABCT; n = 50). ROC analyses indicated that failure to achieve or sustain abstinence by the end-of-treatment and one year follow-up was predicted with reasonable accuracy by week-4 percent days abstinent (PDA) in ABIT. ZIP models yielded similar results with evidence for within treatment PDA with week-6 PDA predicting both the abstinence as well as percent days drinking at the end-of-treatment and one year follow-up. Within-treatment PDA was a significantly better predictor of outcomes for ABIT than ABCT, despite a better overall treatment response for ABCT. Implications for stepped care models of alcohol treatment are discussed and recommendations for future research made.

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“…Rapid response, an early substantial decline in symptomatology within the first 1 – 4 weeks of treatment found in approximately one third of research subjects, has been described in a number of treatments for depression (Ilardi & Craighead, 1994; Tang & DeRubeis, 1999), alcohol use disorders (Breslin, Sobell, Sobell, Buchan, & Cunningham, 1997), panic disorder (Penava, Otto, Maki, & Pollack, 1998), irritable bowel syndrome (Lackner et al, 2010), bulimia (BN; Fairburn, Agras, Walsh, Wilson, & Stice, 2004; Jones, Peveler, Hope, & Fairburn, 1993; Marrone, Mitchell, Crosby, Wonderlich, & Jollie-Trottier, 2009), and, more recently, binge eating disorder (BED; Grilo, Masheb, & Wilson, 2006; Grilo & Masheb, 2007; Masheb & Grilo, 2007; Zunker et al, 2010). There is no accepted explanation as to why some persons have an early substantive treatment response and not others.…”

mentioning

confidence: 99%

Does rapid response to two group psychotherapies for binge eating disorder predict abstinence?

Safer

Joyce

2011

Behaviour Research and Therapy

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Objective Extend understanding of a rapid response (RR) to treatment by examining its prognostic significance at end-of-treatment (EOT) and 1 year follow-up within two group treatments for binge eating disorder (BED): Dialectical Behavior Therapy for BED (DBT-BED) and an active comparison group therapy (ACGT). Methods 101 adults with BED randomized to 20-weeks DBT-BED versus ACGT (Safer, Robinson, & Jo, 2010). RR defined as ≥ 65% reduction in the frequency of days of binge eating by week 4. RR across and within treatment conditions used to predict binge eating abstinence and secondary outcomes (e.g., binge eating pathology, treatment attrition) at EOT and 1 year follow-up Results (1) Significantly higher binge eating abstinence for rapid responders (RR; n = 41) vs. non-rapid responders (non-RRs; n = 60) at EOT (70.7% vs. 33.3%) and 1 year follow-up (70.7% vs. 40.0%), respectively, as well as improvement on most secondary measures (2) Significantly less attrition among RRs vs. non-RRs (3) Significantly higher binge eating abstinence rates at both time points for DBT-RRs vs. DBT-non-RRs, but not for ACGT RRs vs. ACGT-non-RRs,. Conclusions Current study extends prognostic significance of RR to 1 year follow-up. RR more prominent for those randomly assigned to DBT-BED than ACGT. Implications discussed.

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Toward a stepped care approach to treating problem drinkers: the predictive utility of within-treatment variables and therapist prognostic ratings

Abstract: It is suggested that a stepped care approach based on prediction models that include clients' within-treatment response can be applied to the treatment of problem drinkers who show little initial response to treatment.

Cited by 36 publications

References 23 publications

Effectiveness of E-Self-help Interventions for Curbing Adult Problem Drinking: A Meta-analysis

Effectiveness of E-Self-help Interventions for Curbing Adult Problem Drinking: A Meta-analysis

When should clinicians switch treatments? An application of signal detection theory to two treatments for women with alcohol use disorders

Does rapid response to two group psychotherapies for binge eating disorder predict abstinence?

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