Prevention and Treatment of Alcohol Problems Research Opportunities (1990) / Chapter Skim
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11 Patient-Treatment Matching and Outcome Improvement in Alcohol Rehabilitation
11 Patient-Treatment Matching and Outcome Improvement in Alcohol Rehabilitation
Pages 231-246
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From page 231... ...
appropriate studies of patient-treatment matching can be accomplished only after careful specification of patient and treatment characteristics. In addition to making conceptual progress, researchers have investigated basic patient characteristics that are generally predictive of outcome across a variety of treatments.
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From page 232... ...
However, because randomized controlled trials are not appropriate or possible for all evaluation and treatment matching studies in all clinical settings, it is necessary to develop a range of rigorous, quasi-experimental designs. There have been few evaluations of patient treatment matching strategies outside of public or institutional settings that treat mainly lower socioeconomic strata patients.
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From page 233... ...
As discussed in Chapter 8, a number of measurement instruments have been developed to assess these problems, both at the time of admission, when such instruments serve as predictors of treatment outcome, and at follow-up points, when they function as outcome criteria. The social, psychological, and economic problems of alcohol-dependent patients may contribute to relapse and therefore should be targets for intervention during alcohol treatment (Finney and Moos, 1986~.
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From page 234... ...
Greater severity indicates generally worse treatment response, especially for outpatient treatments. This measure of overall impairment, irrespective of diagnosis, has been a good predictor across a variety of outcome domains and patient populations (McLellan et al., 1983a,b; Cooney et al., 1987; Rounsaville et al., 1987; Babor et al., 1988~.
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From page 235... ...
Although there has been progress in treatment process standardization, other areas still require work. New treatments are needed for specific segments of the population such as the cocaine-alcohol-dependent patient, the antisocial personality alcoholic, the alcoholic schizophrenic, and the medical patient with an alcohol-related disorder (e.g., alcohol cardiomyopathy, alcohol hypertension)
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From page 236... ...
Investigators have been attempting to match people to treatment settings (inpatient and outpatient) or treatment programs without knowing which factors are responsible for observed patient changes.
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From page 237... ...
Critical commentary is provided regarding the matching research conducted to date, along with suggestions for future methods to be applied and examples of specific types of studies that could be performed. Matching Before Treatment Starts: Special Populations and Self-Selection Ideally, the outcome evaluation researcher would like to examine the effects of a representative treatment program, technique, or modality on randomly selected patient samples that proportionally represent the total patient population.
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From page 238... ...
Matching or the prediction of outcome studies can be performed simultaneously with ongoing treatments as long as the questions addressed and the methodologies employed are suitable in the treatment context. The following questions represent opportunities for research on programs designed with specialized segments of the patient population in mind: · Do patients with the "right" patient profile stay longer, show more improvement, and remain improved longer than patients with the "wrong" profile?
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From page 239... ...
· Models of patient assignment to different levels of treatment intensity (e.g., Hoffman et al., 1987) should be evaluated in a series of controlled trials at various sites and with various segments of the patient population.
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From page 240... ...
Because of recently shortened periods of reimbursed care for primary rehabilitation and some new financial incentives to provide outpatient treatment, clinical programs are now devoting more time to the development of posttreatment continuing care programs and have attempted to bring the family of a patient into the continuing treatment process. The availability of these services provides an opportunity for patient-treatment matching research following the period of primary rehabilitation.
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From page 241... ...
Lower socioeconomic strata patients and those having more serious psychiatric problems do less well in treatment generally and fare particularly poorly in outpatient care. Such patient factors as the severity of alcohol dependence, family history of alcoholism, and presence of antisocial personality disorder have been generally predictive of poorer outcomes front all treatments but are not differentially predictive of response to specific treatments.
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From page 242... ...
We do not always know the extent to which different individuals in a single treatment receive the same types, amounts, or duration of treatment components. The often repeated claim that patient factors account for more outcome variation than treatment factors may be simply a function of the unavailability of treatment measurement instruments or the close association between certain client characteristics (e.g., age, marital status, antisocial personality)
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From page 243... ...
Post-treatment experiences and treatment outcome of alcoholic patients sur months and two years after hospitalization.
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From page 244... ...
Increased effectiveness of substance abuse treatment: A prospective study of patient-treatment Matching.
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From page 245... ...
Length of stay, neuropsychological performance and aftercare: Influences on alcohol treatment outcome.
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From page 246... ...
Woody, G
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