Drug treatment outcome methodology (1993-1997) strengths, weaknesses, and a comparison to the alcohol field (original) (raw)

Drug treatment outcome methodology (1993–1997)

Addictive Behaviors, 2002

Although several critiques of the methodology of alcohol treatment outcome studies have been published, similar reviews of the methodology of drug treatment outcome studies are lacking. This paper reviews the methodology of drug treatment outcome studies published from 1993 through 1997 and draws comparisons with the most recent methodological review of alcohol treatment outcome studies. Each drug study was evaluated as to whether the following types of data were reported: (1) demographic, (2) drug use, (3) study characteristics, and (4) outcome and follow-up information. Although results for drug studies showed some areas of strength compared to alcohol studies, in general, the weaknesses were similar to or worse than in the alcohol field, including inadequate reporting of demographic and drug use variables. Weaknesses in follow-up procedures were particularly notable. Suggestions for improving the reporting of methodological and outcome variables for drug treatment outcome studies are discussed. D

Alcohol treatment outcome methodology: State of the art 1989–1993

Addictive Behaviors, 1997

This article reviews the 61 alcohol treatment outcome studies published from 1989-1993 with respect to methodology. Although better assessment of subjects' pretreatment characteristics was noted, a minority of studies met even the basic requirements of experimental studies. Further. some reversals of methodological progress were observed in several areas. particularly in collecting outcome data from multiple sources. It is suggested that funding agencies and journal editors require that submissions meet minimum standards for adequate outcome evaluation. We would like to thank Karen Hobdon and Mariella DeFilippo for their assistance with this project. Requests for reprints should be sent to Curtis Breslin.

Alcohol treatment outcome evaluation methodology: State of the art 1980–1984

Addictive Behaviors, 1987

The methodology of alcohol treatment outcome studies published during two sequential intervals from 1976 through mid-1984 is critically reviewed. Although considerable methodological improvements have occurred over time, major methodological deficiencies continue to characterize much of the literature, with inadequate reporting of subjects' pretreatment characteristics (e.g., severity of dependence) being the most striking problem. Pervasive differences across studies regarding the types of data gathered and the ways in which findings are reported seriously impede attempts to compare studies and weaken the types of conclusions that can be drawn about treatment efficacy in general. It is suggested that journal editors establish standards of reporting for follow-up studies.

Outcomes of treatment interventions in drug abuse

Current Opinion in Psychiatry, 2001

This review examines the recent research on the outcomes of treatment in the field of drug addiction. The question of who does better in treatment is addressed, along with a consideration of the domains of outcome, such as the use of substances, retention in treatment and severity of addiction; physical and mental health; and economic costs to society, including crime and employment. Curr Opin Psychiatry 14:201±205.

Issues in the definition and measurement of drinking outcomes in alcoholism treatment research

Journal of Studies on Alcohol, Supplement, 1994

This article reviews methodological and conceptual issues regarding the choice of drinking outcome measures in alcoholism treatment research. The following issues are discussed: Should drinking outcomes be conceptualized in terms of an underlying unitary disorder, or should provision be made for independent outcomes that cover a wide variety of dimensions? Which drinking outcomes are typically measured in treatment evaluation studies and how are they operationalized? What are the empirical associations among drinking outcome measures? If multiple outcomes are measured, which should be given primary importance? Over what period of time should treatment outcome be evaluated? What procedures can be used to detect, correct or prevent the response bias associated with verbal report methods? Because outcome measures need to fit the hypotheses and practical needs of a particular study, it is unlikely that complete standardization can be achieved across all studies. Nevertheless, given the importance of drinking outcomes and the need for economy, two primary dependent measures are recommended: (1) proportion of available drinking days abstinent; and (2) intensity of drinking, as defined by the total amount consumed (in ounces absolute alcohol) during the follow-up period divided by the number of actual drinking days. This article also proposes a strategy that may help to guide the selection of outcome measures in future research. (J. Stud. Alcohol, Supplement No. 12:101-111, 1994) N A 1988 EDITORIAL, Arnold Relman stated, "We can no longer afford to provide health care without knowing more about its successes and faiIures." Applying this admonition to the treatment of alcoholism, the Institute of Medicine (1990, p. 326) recommended that "consensus must be achieved on the need for outcome determination, on the parameters to be used in determining outcome, and on the optimal way(s) to go about making outcome determinations." The goal of this article is to review methodological and conceptual issues regarding the choice of alcohol-related outcome measures in alcoholism treatment research. Alcoholrelated outcomes are the measures of drinking behavior, alcohol dependence symptoms and alcohol-related consequences that are directly attributable to drinking following treatment. A secondary goal of this article is to suggest ways that greater standardization could be introduced to the planning, execution and reporting of treatment research. Because

Outcome Measures in Medication Trials for Substance Use Disorders

Current Treatment Options in Psychiatry, 2015

There are multiple therapeutic options to treat tobacco (e.g., nicotine replacement therapies, varenicline) and alcohol (e.g., naltrexone, acamprosate) use disorders. In contrast, there are currently no FDA-approved pharmacotherapies to treat stimulant (e.g., cocaine, methamphetamine) use disorders. Based on a commentary published by FDA staff, a period of sustained abstinence appears required for regulatory approval of a first-in-class medication to treat stimulant use disorders. Certainly, achieving abstinence remains the goal of treatment in both real world medical practice and clinical trials. However, if a medication can help patients to significantly reduce stimulant use (short of achieving a sustained abstinence) while attempting to quit, such reductions could confer meaningful benefit. The FDA has adopted the Bpercentage of subjects with no heavy drinking days^as an endpoint for pharmacotherapy trials in alcohol use disorders; this suggests there may be a potential path forward for developing analogous, non-abstinence endpoints for stimulant use disorder trials. However, reductions in drug use per se (short of abstinence) must have prognostic value in order to be considered an acceptable basis for FDA approval. Thus, even if a medication can provide sustained reductions in drug use, the challenge ahead is to demonstrate that this Bsuccess^is accompanied by benefits that accrue in dimensions readily understood by patients and their families, and of sufficient value to be reimbursed by third party payers. Emerging data sets discussed in this paper indicate that endpoints other than abstinence may ultimately be validated as outcome measures in pharmacotherapy trials for stimulant use disorders.

Treating Alcohol and Drug Abuse – An Evidence Based Review

2003

This book was carefully produced. Nevertheless, editors, authors and publisher do not warrant the information contained therein to be free of errors. Readers are advised to keep in mind that statements, data, illustrations, procedural details or other items may inadvertently be inaccurate. Library of Congress Card No.: applied for A catalogue record for this book is available from the British Library. Bibliographic information published by Die Deutsche Bibliothek Die Deutsche Bibliothek lists this publication in the Deutsche Nationalbibliografie; detailed bibliographic data is available in the Internet at http://dnb.ddb.de.