Mark B. 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.

5-HT and alcohol abuse

Recent experimental data, both in animals and the clinic, suggest that drugs selectively interacting with the 5-HT system may reduce alcohol intake. Although the precise mechanisms underlying these drug effects are unknown, it seems that there are at least two pharmacological strategies available, described in this review by Edward Sellers and colleagues. The first is enhancement of 5-HT neuronal activity using compounds that will release 5-HT, block 5-HT reuptake, or act as selective 5-HT receptor agonists. A second approach involves selective 5-HT3 receptor antagonists. If the initial research findings with these drugs are confirmed and extended, they may present useful therapies for the treatment of alcohol abuse, especially if used in conjunction with psychosocial therapy.

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.

Alcoholics treated by individualized behavior therapy: one year treatment outcome.

Abstract One-year treatment outcome results are reported for 70 male alcoholics who, while hospitalized at Patton State Hospital, served as subjects in an experiment evaluating ‘Individualized Behavior Therapy (IBT)’ techniques. Initially, subjects had been assigned to a controlled drinking or non-drinking (abstinence) treatment goal, and then were randomly assigned to either an experimental group receiving IBT or a control group receiving conventional state hospital treatment. One year follow-up results demonstrated that IBT treated subjects had functioned significantly better than control subjects. Dependent variable measures included daily drinking disposition, general emotional adjustment, vocational satisfaction, occupational status, driving status and an index of residential status and stability. The results support the view that some ‘alcoholics’ can acquire and maintain controlled drinking behavior over at least a 1-yr follow-up interval. The difficulties of designing and applying sophisticated follow-up procedures and measures are discussed.

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.

Training social drinking as an alternative to abstinence for alcoholics

Thirteen hospitalized male alcoholics volunteered as subjects for a study to explore whether bar drinking habits typical of alcoholics (drinking straight liquor in large gulps and large amounts) could be changed to bar drinking habits typical of social drinkers (drinking mixed drinks in small sips and small amounts). During experimental drinking sessions in an especially equipped bar the subjects could avoid shock by drinking like a typical social drinker but received painful electric fingershock, 30% above or at individual pain threshold, whenever they behaved like alcoholics. The conditioning contingencies were explained to the subjects before the beginning of the experiment. Four of the subjects emitted the required behavioral repertoire in an exaggerated fashion from the first day of drinking: they never ordered more than three mixed drinks, and consumed these in exceedingly small sips (30 or more). The remaining nine subjects learned these behaviors over a period of 12–14 sessions. No attempt was made to establish the generalization of this newly acquired behavior after discharge from the hospital. The implications of the findings are discussed.