Broadening the Base of Treatment for Alcohol Problems (1990) / Chapter Skim
Currently Skimming:
Chapter 5--Does treatment work?
Chapter 5--Does treatment work?
Pages 142-151
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 142... ...
~ ~ For example, the probability of a positive outcome in a psychotic, homeless individual presenting for treatment with delirium tremens is likely to be lower than that for a mildly anxious, socially stable individual presenting in a sober state without withdrawal symptoms, even assuming that each person receives appropriate treatment. Finally, there is an implication in the question that there may be a uniform criterion for "working," that is, some absolute standard for outcome.
|
From page 143... ...
Answering the Reframed Question: Methods If there has been a tendency to frame and to respond in a simplistic manner to questions regarding whether treatment works, there has also been a similar tendency in operation with respect to choosing the appropriate method for making such determinations. To wit: to determine whether treatment works, one conducts a randomized controlled trial (RCI~)
|
From page 144... ...
At the same time there is evidence that those who volunteer for random assignment to treatment have a systematically poorer prognosis than those who decline to volunteer (Longabaugh and Lewis, 1988~. Deeply felt ethical concerns may make it difficult for clinicians to entertain the possibility of referral to controlled trials.
|
From page 145... ...
Thus, there are difficulties in the application of RCIs to clinical treatment programs. Some of these problems have to do with the inherent attributes of the methodology itself, such as its complexity and the difficulties experienced by persons seeking treatment in understanding the concept of randomization.
|
From page 146... ...
Because in the usual outcome monitoring study there is no identical comparison group, this type of study does not prove that the good results observed were due to the treatment provided, although it does suggest that the program me be effective. However, if randomized controlled trials have suggested that the method of treatment being provided is effective, a greater level of confidence can be entertained that the treatment provided in the program monitored is eff~caciou~that it may have been a significant factor in producing the positive outcomes that were observed.
|
From page 147... ...
One estimate is that more than 600 treatment outcome studies have been completed, about half of which have been completed in the 1980s; among these there have been approximately 200 comparative clinical trials, about two-thirds of which have employed random assignment (Miller, 1988; IOM, 1989~. In addition to these original studies, the subject has been repeatedly reviewed over the last four decades (cf.
|
From page 148... ...
Posttreatment problems and experiences have been shown to be important determinants of outcome. Social skills training, marital and family therapy, antidepressant medication, stress management training, and the community reinforcement approach all show promise for promoting and prolonging favorable outcome.
|
From page 149... ...
The ongoing effort to provide appropriate answers to this reframed question requires the deployment of a variety of investigative methods. Although the randomized controlled trial ARCH has many advantages and should be more broadly used to answer questions of clinical relevance, it has disadvantages that tend to limit its widespread application in clinical treatment settings.
|
From page 150... ...
1978. Evaluating alcoholism treatment programs: An integrated approach.
|
From page 151... ...
1984. Physicians' reasons for not entering eligible patients in a randomized clinical trial of surgery for breast cancer.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.