Linda C. Sobell

Timeline Follow-Back

Although the measurement of drinking is necessary for assessing and evaluating the treatment of alcohol problems, this key dependent variable has not always been reported in outcome studies.1, 2, 3 Today, the issue is not whether to measure drinking, but how to measure drinking. Concerns about how best to measure drinking patterns and problems date back to at least 1926, when Pearl stressed the importance of separating steady daily drinkers from occasional heavy drinkers.4

The reliability of the Alcohol Timeline Followback when administered by telephone and by computer

The Alcohol Timeline Followback (TLFB) has been shown to be a psychometrically sound assessment instrument for obtaining retrospective daily estimates of alcohol consumption. These evaluations, however, have been limited to face-to-face paper-and-pencil interviews. As use of the TLFB method has increased, investigators have reported using the method to collect follow-up data by telephone. Also, as with many assessment instruments, a computerized version of the TLFB method has been developed. The psychometric characteristics of the TLFB method under these administration conditions have not been evaluated. This paper presents results from two studies showing that the Alcohol TLFB method can obtain reliable drinking data when administered over the telephone and by computer.

Recovery from alcohol problems with and without treatment: prevalence in two population surveys.

OBJECTIVES The purpose of this study was to determine the prevalence of recovery from alcohol problems with and without treatment, including whether such recoveries involved abstinence or moderate drinking. METHODS Data from two surveys of randomly selected adults in the general population were analyzed. Random-digit dialing was used to conduct telephone interviews with 11,634 and 1034 respondents. Respondents 20 years of age or older were categorized on the basis of drinking status and history. RESULTS Both surveys found that most individuals (77.5% and 77.7%) who had recovered from an alcohol problem for 1 year or more did so without help or treatment. A sizable percentage (38% and 63%) also reported drinking moderately after resolving their problem. CONCLUSIONS These two surveys are among the first to report prevalence rates for recovery from alcohol problems for treated and untreated individuals and for moderation and abstinence outcomes.

Individualized Behavior Therapy for Alcoholics

A behavior therapy for alcoholism was designed based on the rationale that alcoholic drinking is a discriminated, operant response. Treatment emphasized determining setting events for each subjects drinking and training equally effective alternative responses to those situations. Seventy male, hospitalized, Gamma alcoholics were assigned to a treatment goal of either nondrinking ( N =30) or controlled drinking ( N =40). Subjects of each group were then randomly assigned to either an experimental group receiving 17 behavioral treatment sessions or a control group receiving only conventional treatment. Treatment of experimental groups differed only in drinking behaviors allowed during sessions and electric shock avoidance schedules. Nondrinker experimental subjects shaped to abstinence, while controlled drinker experimental subjects practiced appropriate drinking behaviors with little shaping, a result attributed to instructions. Follow-up measuring drinking and other behaviors found that experimental subjects functioned significantly better after discharge than control subjects, regardless of treatment goal. Successful experimental subjects could apply treatment principles to setting events not considered during treatment, suggesting the occurrence of rule learning. Results are discussed as evidence that some “alcoholics” can acquire and maintain controlled drinking behaviors. Tra ditional treatment of alcoholics may be handicapped by unvalidated beliefs concerning the nature of the disorder.

Stepped Care as a Heuristic Approach to the Treatment of Alcohol Problems

A stepped care approach to treatment decisions for alcohol problems consists of the application of decision rules derived from practice in other areas of health care. The treatment used should be (a) individualized, (b) consistent with the research literature and supported by clinical judgment, and (c) least restrictive but still likely to be successful. Used in this way, stepped care emphasizes serving the needs of clients efficiently but without sacrificing quality of care. Issues concerning stepped care are discussed, and the application of a stepped care approach to alcohol treatment services is described.

Second year treatment outcome of alcoholics treated by individualized behavior therapy: results.

Abstract Second year treatment outcome results are reported for 69 of 70 male alcoholics who, while hospitalized at Patton State Hospital, served as subjects in an experiment evaluating ‘Individualized Behavior Therapy (IBT)’ techniques. Subjects were initially assigned to either a controlled drinking or non-drinking (abstinence) treatment goal. and were then randomly assigned to either an experimental group receiving IBT or a control group receiving conventional state hospital treatment oriented towards abstinence. Previously reported results found that IBT subjects functioned significantly better than control subjects throughout the first year of follow-up. Second year follow-up results found that IBT subjects treated with a controlled drinking goal functioned significantly better than their respective control subjects on a variety of measures, including drinking behavior. Differences between IBT subjects treated with a non-drinking goal and their control subjects did not retain statistical significance during the second year of follow-up. Individual drinking profiles are presented for all subjects. Only subjects treated by IBT with a goal of controlled drinking engaged in a substantial amount of limited, non-problem drinking during the second year interval, and those subjects also had more abstinent days than subjects in any other group. The nature of adequate follow-up procedures and measures is discussed. Implications of these findings for alcoholism treatment are considered.

Outpatient Alcoholics Give Valid Self-Reports

Thirty-nine male alcoholics in a voluntary outpatient treatment program were interviewed individually on two separate occasions about their social and drinking history. Critical test questions were identical for both interviews but embedded among different filler items. The validity of the subjectss self reports about both alcohol and nonalcohol-related questions was assessed through official records and documents. Self-reports of life history data provided by this group of outpatient alcoholics under specified interview procedures were highly reliable and valid. Differential item reliability and validity were obtained. Further, the value of using the technique of double interviews to predict valid and invalid self-reports is discussed. Suggestions for future research are offered.

Bridging the gap between scientists and practitioners: The challenge before us

The need to develop effective and efficient strategies for the dissemination of evidence-based health care has been recognized by governments, researchers, and clinicians alike. However, recognition and implementation are separate issues. If scientists are to have a significant impact on clinical practice, they will have to learn a new way of “doing business.” Lessons from the business community and from the field of diffusion of innovations research (dissemination research) have direct applicability to disseminating science-based clinical procedures. This paper presents two examples of the successful integration of science and clinical practice. The goal in each case was to address problems fundamental to dissemination research, specifically for addictions treatment. The first example demonstrates how scientists and practitioners successfully worked hand-in-hand to integrate science and practice, by creating a clinical protocol that subsequently served almost 300 clients. The second example describes the successful dissemination of a clinical research intervention into community settings. The key to effective dissemination was to make practitioners true partners in the research, development, and dissemination process. For the effective wedding of clinical science and practice on a wide scale, dissemination must be adopted as a value and become a major objective of health care organizations. Current health care emphasis on evidence-based practice suggests that alliances between practitioners and scientists will point the way to clinical standards of practice for the next millennium.

CROSS-CULTURAL EVALUATION OF TWO DRINKING ASSESSMENT INSTRUMENTS: ALCOHOL TIMELINE FOLLOWBACK AND INVENTORY OF DRINKING SITUATIONS

This article describes the psychometric characteristics of two major assessment instruments used in a World Health Organization (WHO) clinical trial: (a) Alcohol Timeline Followback (TLFB, which assesses daily drinking patterns), and (b) Inventory of Drinking Situations (IDS, which assesses antecedents to “heavy” drinking). Clients (N=308) were outpatient alcohol abusers from four countries (Australia, Canada, Mexico, and Sweden). Generally, the Alcohol TLFB and IDS were shown to be reliable and valid with outpatient alcohol abusers in four countries, and in three languages. These results suggest that the Alcohol TLFB and the IDS can be used in clinical and research settings with Swedish-, Spanish-, and English-speaking alcohol abusers.

Alcohol abusers who want to quit smoking: Implications for clinical treatment

Although most alcohol abusers are dependent on nicotine, studies of such individuals have been scarce. Consequently, little information is available for advising clients who wish to consider resolving both problems. Clients entering an outpatient alcohol treatment program who were also current smokers were asked about their temporal preferences for changing their alcohol and cigarette use. Over three-quarters of alcohol abusers who were also smokers when asked said they would be willing to consider stopping smoking during or after treatment for an alcohol problem. Individuals who were interested in quitting smoking cigarettes while in treatment for an alcohol problem were different from those who did not want to stop smoking, and such differences may influence their ability to successfully address both problems together. Compared to those who preferred to change their drinking first then address their smoking, those who said they would be willing to address both problems (i.e. smoking and drinking) together in treatment were not only considerably more likely to think that quitting smoking would affect quitting drinking, but also more likely to be planning to quit smoking in the next six months. These results suggest that some individuals whose alcohol problems are not severe and who also smoke cigarettes will be more receptive to a dual recovery approach than others. In the absence of research findings, health care practitioners who encounter individuals who drink heavily and smoke cigarettes should at a minimum explore the option of dual cessation with their clients. The clinical and research implications of the present results are discussed.