Prevention and Treatment of Alcohol Problems Research Opportunities (1990) / Chapter Skim
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8 Issues of Assessment, Methodology, and Research Design
8 Issues of Assessment, Methodology, and Research Design
Pages 149-168
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From page 149... ...
Interest in treatment evaluation research has been increasing within the alcohol field over the past 20 years. The dominant approach in both clinical practice and treatment evaluation research has been to ask: Is treatment effective?
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From page 150... ...
on research opportunities in the alcohol field has been diagnosis, including the tools for diagnostic assessment. The third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III)
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Research suggests that the severity of dependence predicts cravings for alcohol and failure to control drinking following relapse (Polich, Armor, and Braiker, 1981; Babor, Cooney, and Lauerman, 1987~. Although farther research is called for, it appears that the dependence syndrome construct has considerable promise for early detection, diagnosis, and treatment planning, at least in the European and North American countries in which most of the research has been conducted (Edwards, 1986~.
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From page 152... ...
All of these instruments generate reliable, standardized information that could be entered easily into a patient's hospital record to become part of the reporting statistics available to researchers, funding agencies, and health officials. Such data would be extremely useful as a basis for comparing programs and settings in terms of client characteristics and treatment effectiveness, in turn suggesting hypotheses for later clinical trials.
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This skepticism has generated a substantial amount of methodological research on the validity of verbal self-report methods; it has also stimulated the search for biological markers and other objective measures of alcohol consumption that are not as susceptible to response distortion (Babor, Stephens, and Marlatt, 1987; O'Farrell and Maisto, 1987~. Given the importance of accurate information about the patient's presenting symptoms, drinking history, and treatment outcome, research on the reliability and validity of assessment procedures should receive high priority.
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Alcohol research would benefit from a new generation of methodological studies directed at procedures to enhance the validity of verbal report data and at evaluating new procedures that provide objective indicators~of recent alcohol consumption. The generic term for factors that might influence verbal report information in a research context is response effects.
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From page 155... ...
and retrospective diary procedures should be evaluated to assess their ability to improve the reliability and validity of verbal reports by providing recall cues to respondents. · Because no single measure of alcohol consumption is entirely valid, most researchers recommend the use of convergent lines of evidence to establish drinking status or to measure drinking behavior.
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The Tabakoff team also found that platelet adenylate cyclase activity, after stimulation with quanine nucleotide, cesium fluoride, or prostaglandin E, was significantly lower in alcoholics, although the basal platelet adenylate cyclase activity was the same in alcoholics and controls. Because the alcoholics in this study had been abstinent for one to four years, the utilizer of these markers for treatment outcome evaluation is uncertain.
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The following opportunities for research on biological markers of treatment outcome should be pursued to improve the validity of treatment evaluation research: · Researchers should develop and test markers that are sensitive to moderate and heavy alcohol consumption. Markers that return to normal with the cessation of drinking and show prompt elevation at the initiation of drinking would be particularly useful in treatment outcome studies.
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ASSESSMENT OF TREATMENT PROCESS, QUALITY, AND OUTCOME Advances in assessment techniques have contributed to a more accurate estimation of the relative contributions of client characteristics, therapeutic interventions, program settings, and environmental variables to the success or failure of treatment. Treatment Variables The relevance of treatment research to policy and clinical practice is directly related to the ability of such research to evaluate the costs and effectiveness of different treatment interventions as they relate to specific types of individuals.
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From page 159... ...
GROWING SOPHISTICATION IN METHODOLOGICAL APPROACHES In recent years, a variety of research approaches have been developed for use in treatment evaluation. As portrayed in Table 8-1, a basic distinction is often made between two types of research strategies: true experimental designs and quasi-experimental designs (Campbell and Stanley, 1963~.
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Multicenter clinical trials represent the culmination of preclinical and small-scale studies. Quasi-Experimental Approaches In the alcohol field, true experimental designs, especially multicenter clinical trials, are difficult and expensive to carter out.
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The potential for weeding the more intensive, client-focused, multiprogram study designs to large-scale, representative sample surveys could constitute a significant advance in the treatment evaluation knowledge base. At present, the NDATUS is a brief questionnaire that requires the reporting unit to give its primary orientation (alcoholism, drug abuse, mixed)
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· Experimental research designs should be encouraged for alcoholism treatment evaluations whenever appropriate. When experimental designs are employed, there must be adequate specification of the client, program setting, therapist, and treatment variables that affect patient compliance and outcome.
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American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-III)
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Frank, B Telephone surveying for drug abuse: Methodological issues and an application.
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Future Directions in Alcohol Abuse Treatment Research. Research Monograph No.
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The utility of self-report and biological measures of alcohol consumption in alcoholism treatment outcome studies.
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Mechanism of increased gamma glutamyl transpeptidase after chronic alcohol consumption: Hepatic microsomal induction rather than dietary imbalance. Substance and Alcohol Actions/Misuse 1:423-428, 1980.
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T A national comparison of public and private sector alcoholism treatment delivery system characteristics.
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