Search

There has been increasing recognition among alcohol treatment researchers that research assessment exposure subject reactivity effects can contribute to clinical outcomes, decrease study design sensitivity, and confound research findings. The present study is an experimental investigation of two of the more salient components of the research assessment interview (i.e., frequency and comprehensiveness) and their effects on clinical outcomes (Part I: Alcohol Use and Related Consequences) and treatment participation (Part II: Treatment Engagement and Involvement).The study design was a 2 (Frequency of Assessment) x 2 (Comprehensiveness of Assessment) completely randomized factorial, and study participants were randomly assigned, using an urn randomization procedure, to one of the resulting four experimental research assessment exposure conditions: (1) frequent-comprehensive, (2) frequent-brief, (3) infrequent-comprehensive, and (4) infrequent-brief. Study participants were recruited from one of two hospital-based outpatient alcohol- and other substance-abuse clinics. Two hundred thirty-five subjects were randomly assigned to one of the four research assessment exposure conditions.Research assessment exposure subject reactivity effects were related significantly to alcohol use and related negative consequences, such that subjects assigned to the infrequent-brief research assessment exposure condition reported the poorest outcomes.The research protocols used to study alcohol treatments have clinical efficacy and can alter the outcomes (e.g., alcohol use) under investigation. It is important for researchers to control/account for subject reactivity effects when conducting alcohol treatment outcome trials. Accurate interpretation of data derived from clinical trials of alcohol treatments necessitates taking research assessment exposure subject reactivity effects into consideration.

Objective: Previous research has shown a signifi cant rela- tionship between alcohol consumption in the fi rst year following alcohol treatment admission and longer term functioning. This fi nding is clinical- ly important and pertains to the clinical course of alcohol-use disorders (AUDs). This study investigated mediators of these relationships, focus- ing on the fi rst year after treatment admission and alcohol consumption 3 years later. Method: Analyses were conducted on the outpatient Project MATCH (Matching Alcohol Treatment to Client Heterogeneity) sample at baseline (N = 952) and at Months 37-39 after treatment admission (n = 802; hereafter referred to as 3 years). Participants were classifi ed as fi rst-year "abstainer," "moderate drinker," or "heavy drinker." A model featuring three latent variables (psychosocial functioning, self-effi cacy, and treatment experiences) whose indicators were collected at 15 months after treatment admission was initially tested for its fi t to the data. The 3- year outcomes were percentage of days abstinent and drinks per drinking day. Each model was run on randomly split subsamples and then cross- validated on the remaining participants. Results: Model tests by use of structural equation modeling methods showed poor model fi t, owing primarily to problems involving the psychosocial-functioning variable. Consequently, a reduced model was tested that dropped the psychosocial factor. Initial tests of this model showed an excellent fi t to the data that replicated across subsamples and 3-year drinking variables at the over- all model and individual path levels. There was strong support for the hypothesis that the total effects of fialcohol use on 3-year drink- ing is mediated in part (31% and 23% for the two drinking outcomes) through self-effi cacy to abstain from alcohol at 15 months. Conclusions: First-year posttreatment admission alcohol use predicts longer term (3- year) alcohol use, and a substantial portion of this relationship seems to be mediated through self-effi cacy at 15 months to abstain from alcohol use. The apparent benefi t of sustained abstinence in the fi rst year may be in part the result of facilitation in the rate or strength of the acquisition of self-effi cacy. Discussed are the clinical implications of these fi ndings as well as directions for future research involving longitudinal studies of alcohol use, treatment experiences, psychosocial factors, and their interaction both within the fi rst year and afterward in the determination of the clinical course of alcohol-use disorders. (J. Stud. Alcohol Drugs 69: 728-737, 2008)

This is the second of two articles in this issue on participant reactivity to alcohol treatment research assessment protocols. In the first article, Clifford et al. presented experimental evidence that the combination of less frequent and less comprehensive assessment results in the least assessment reactivity, as measured by alcohol use and related consequences at 1 year after admission for adult outpatient treatment for alcohol problems. In addition, Part I revealed that the presence of either frequent or comprehensive research assessment tends to result in a greater degree of reactivity. This article extends the analyses by Clifford et al. to treatment for substance use-disorders engagement and involvement across a 1-year follow-up.The design, participants, and procedures were identical to those described in Clifford et al. Treatment data were obtained from hospital records and participants' self-reports as part of the Timeline Followback interview.Analyses revealed several effects of frequency of assessment and comprehensiveness of assessment on treatment engagement or involvement. The reactivity effect observed varied with the dependent variable, which included if a participant presented for outpatient treatment (more likely in the comprehensive groups), the number of days of outpatient substance use-disorders treatment during follow-up (no reactivity effects), if a participant engaged in intensive treatment for substance-use disorders during follow-up (more likely for the frequent groups in Months 1-6, but the reverse in Months 7-12, and overall more likely in the brief conditions), and the number of days of intensive treatment for substance-use disorders during follow-up (more days in the frequent groups in Months 1-6, no frequency differences in Months 7-12, and overall more days in the brief groups), respectively. Additional analyses showed that treatment participation did not mediate the reactivity effects on alcohol use and related consequences reported by Clifford et al.Data provide experimental evidence for a causal relationship between frequency of assessment and comprehensiveness of assessment on substance abuse-treatment engagement and involvement. Future research should be directed at understanding the factors in the assessment process that determine reactivity effects.

The relationship between moderate alcohol consumption in the first year following alcohol treatment admission and longer-term functioning is clinically important and pertains to the clinical course of alcohol-use disorders. This study investigated these relationships, focusing on the first year posttreatment admission and 3 years later.Analyses were conducted on the outpatient Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) sample (n = 952 at baseline, and n = 802 at Months 37-39). Participants were classified as first-year "abstainer," "moderate drinker," or "heavy drinker."Drinker classification predicted percentage of days abstinent from alcohol, drinks per drinking day, and alcohol-related negative consequences at 3 years. The abstainers had better drinking outcomes than either of the other two groups, and the moderate drinkers' outcomes were better than those of the heavy drinkers. The heavy drinkers had a higher rate of negative consequences at 3 years than did the abstainers and the moderate drinkers, who did not differ from each other. Analyses of change in drinker status between 1 and 3 years explored variability in clinical course.First-year posttreatment alcohol use on the group level predicts longer-term alcohol use and related functioning, and moderate drinking may be considered a treatment goal option for some individuals. The data also reaffirm the variability among individuals in clinical course following alcohol treatment. Future research should aim to understand the factors that determine the maintenance of patterns of alcohol use that are not associated with the occurrence of alcohol-related negative consequences.