Andrew R. Morral

Assessing the helping alliance and its impact in the treatment of opiate dependence

This study assesses the relationship between the patient-counselor helping alliance (HA) and progress in methadone maintenance treatment. Questionnaire measures of HA were administered to 57 patients 1 and 3 months after admission. Three-month HA measures (especially counselors ratings) predicted reductions in drug use as measured by weekly urinalysis results and 6-month self-report data. HA was unrelated to treatment retention or improvement in psychiatric symptomatology. Moreover, controlling for urinalysis results in the previous month rendered insignificant the correlations between 3-month HA and subsequent drug use. Thus, this evaluation of the HAs unique contribution to the prediction of outcome suggests that the development of a positive HA may be more a marker of treatment progress than a necessary precursor of positive outcomes in the methadone maintenance treatment setting.

Evaluating Methods and Findings from a Study of State Gun Policies

I n January 2016, the RAND Corporation began work on Gun Policy in America, a research initiative that aims to create a resource where policymakers and the general public can access unbiased information that informs and enables the development of fair and effective firearm policies. Building on a long history of providing policymakers with objective, independent analyses of complex topics, RAND is developing policy analysis tools and research syntheses, grounded in science, with the goal of clarifying the effects of current and proposed firearm measures. We expect to release our initial research findings in the winter of 2016–2017. The Gun Policy in America initiative employs a mixed-methods approach that incorporates statistical modeling, expert elicitation, a systematic review and synthesis of the research literature, and other techniques that draw on RANDs expertise in objectively analyzing complex policy challenges. In March 2016, as RANDs research effort was getting under way, the British medical journal The Lancet published an article by Bindu Kalesan and colleagues titled Firearm Legislation and Firearm Mortality in the USA: A Cross-Sectional, State-Level Study (Kalesan et al., 2016a). The article examined the effects of 25 state firearm laws on gun deaths. Given the relevance of the findings to our ongoing research, we read the findings with great interest and care. In the course of that review, we identified a number of serious analytical errors that we suspected could undermine the articles conclusions. It is important to note that many—perhaps most—scientific articles include some mistakes, and normally this would not merit further attention. In this case, however, we could see that the articles unusually strong and significant effects were probably wrong but would dominate our synthesis of findings from the research literature. Moreover, we could not ignore the article without violating the rules of our systematic review. The reported findings appeared likely to support bad gun policies and to hurt future research efforts that could treat the many highly significant findings reported in the article as valid. We contacted the articles authors with our concerns but ultimately determined that new analyses were needed to test the validity of the published findings. We reconstructed the articles data set using information in the article and reanalyzed the articles models using the procedures documented in this report. This short technical report serves as a supplement to our comment published in The Lancet in response to the article and will be of …