Reid K. Hester

Handbook of alcoholism treatment approaches: effective alternatives.

This is an absolutely indispensable resource for anyone working in the area of alcoholism treatment and research. Its focus is to match the client with the treatment program most suited to that specific client. Eleven of the most widely studied treatment approaches are covered in separate chapters, each written by an expert author or team in the modality. This is the most comprehensive review of alcohol treatment outcomes available anywhere. It discusses advances in evaluation, motivation, treatment outcomes, and protocols in treatment as well as practical suggestions and recommendations for assessment and treatment. Clinical Psychologists and Alcohol Treatment Specialists. A Longwood Professional Book.

The Effectiveness of Alcoholism Treatment

In 1979 we set out together on a journey. We decided to try to read every study that had ever been published (in languages we could understand) on the effectiveness of different approaches to treating alcohol problems. We had no idea what lay in store for us.

Matching Problem Drinkers With Optimal Treatments

It seems the most obvious of commonsense assertions: that individuals with varying needs and characteristics will respond optimally to different kinds of intervention, and therefore that clients should be matched with optimal approaches rather than all being treated in the same way. Indeed many if not most alcoholism treatment programs give lip service to the need for individually tailoring intervention programs. Yet this apparently simple and uncontentious assertion is, in fact, a highly complicated and interesting issue which—if taken seriously—has important research and clinical implications that are not only controversial, but potentially revolutionary, at least for alcoholism treatment practices as they currently exist in the United States.

The college drinker's check-up: Outcomes of two randomized clinical trials of a computer-delivered intervention

The objective of the study was to evaluate the effectiveness of a computer-delivered intervention (CDI) to reduce heavy drinking and alcohol-related problems in college students in two randomized clinical trials. In Experiment 1, we randomized 144 students to either the CDI or an assessment-only control group with follow-ups at 1 and 12 months. In Experiment 2, we randomized 82 students to either the CDI or a delayed-assessment control group with follow-up at 1 month. In Experiment 1, participants in both groups significantly reduced their drinking at both follow-ups. Compared to the control group, the CDI group reduced their drinking significantly more at 1 and 12 months on three drinking measures at α < .05. Using a more conservative, Bonferroni-adjusted criterion yielded one significant difference in a measure of heavier drinking at the 1 month follow-up. The mean between-groups effect sizes were d = .34 and .36 at 1 and 12 months, respectively. Experiment 2. Compared to the delayed assessment control group, the CDI group significantly reduced (by the Bonferroni-adjusted criterion) their drinking on all consumption measures. These results support the effectiveness of the CDI with heavy drinking college students when used in a clinical setting. In addition, the significant reductions in typical drinking in the control group in Experiment 1 and not in Experiment 2 combined with comparable baseline characteristics suggests that the control group in Experiment 1 demonstrated assessment reactivity.

Videotaped Training in Alcohol Counseling for Obstetric Care Practitioners: A Randomized Controlled Trial

OBJECTIVE To determine the feasibility of videotaped training for obstetric care practitioners in motivational interviewing skills that could be used in brief patient consultations on problem drinking. METHODS Thirty health care practitioners participated in a clinical trial using a 20-minute videotape to instruct them in motivational interviewing. Participants engaged in a pretest roleplay with an actress playing a drinking pregnant woman. Those randomly assigned to the experimental condition watched the motivational interviewing videotape. Control condition participants watched a 20-minute docudrama of a pregnant problem drinker. Both groups then engaged in a post-test roleplay similar to the pretest. Behavioral ratings of the roleplays and participant evaluations of the motivational interviewing video constituted the outcome measures. RESULTS Participant evaluations indicated that the training video was clear in explaining and demonstrating the principles and skills of motivational interviewing. Change in behavioral ratings from pretest to post-test showed significant differences in motivational interviewing skills between the experimental and control groups. Obstetric care practitioners who viewed the training video were rated as showing greater empathy, minimizing patient defensiveness, and supporting womens beliefs in their ability to change. CONCLUSION Obstetric care practitioners can improve their alcohol intervention skills through the use of a 20-minute videotaped instruction in motivational interviewing. Clinicians who improve their skills in motivational interviewing can intervene more effectively with their drinking pregnant patients. Using motivational interviewing with this population holds promise for helping prevent alcohol-related health problems.

A web application for moderation training: Initial results of a randomized clinical trial

Eighty-four heavy drinkers who responded to a newspaper recruitment advertisement were randomly assigned to receive either (a) training in a Moderate Drinking protocol via an Internet-based program (www.moderatedrinking.com) and use of the online resources of Moderation Management (MM; www.moderation.org) or (b) use of the online resources of MM alone. Follow-ups are being conducted at 3, 6, and 12 months. Results of the recently completed 3-month follow-up (86% follow-up) indicated both groups significantly reduced their drinking based on these variables: standard drinks per week, percent days abstinent, and mean estimated blood alcohol concentration (BAC) per drinking day. Both groups also significantly reduced their alcohol-related problems. Relative to the control group, the experimental group had better outcomes on percent days abstinent and log drinks per drinking day. These short-term outcome data provide evidence for the effectiveness of both the Moderate Drinking Web application and of the resources available online at MM in helping heavy drinkers reduce their drinking and alcohol-related problems.

ModerateDrinking.com and Moderation Management: Outcomes of a Randomized Clinical Trial With Non-Dependent Problem Drinkers

OBJECTIVE To evaluate the effectiveness of a web-based protocol, ModerateDrinking.com (MD; www.moderatedrinking.com) combined with use of the online resources of Moderation Management (MM; www.moderation.org) as opposed to the use of the online resources of MM alone. METHOD We randomly assigned 80 problem drinkers to either the experimental or control group with follow-ups at 3, 6, and 12 months. RESULTS Seventy-five participants (94%) had outcome data at 1 or more follow-up points, and 59 participants (73%) were assessed at all 3 follow-ups. Comparing baseline measures to the average outcomes at follow-ups indicated a significant overall reduction in both groups in alcohol-related problems and consumption variables. Compared with the control group, the experimental group had better outcomes on percent days abstinent. There was an interaction between intensity of drinking at baseline and treatment in determining outcomes assessing drinking. Less heavy drinkers in the experimental group had better outcomes on log mean blood alcohol content (BAC) per drinking day compared with the control group. Heavier drinkers did not differentially benefit from the MD program on this measure. Mixed model analyses in general corroborated these outcomes. CONCLUSION The outcome data provide partial evidence for the effectiveness of the MD web application combined with MM, compared with the effectiveness of the resources available online at MM by themselves.

Overcoming Addictions, a Web-Based Application, and SMART Recovery, an Online and In-Person Mutual Help Group for Problem Drinkers, Part 1: Three-Month Outcomes of a Randomized Controlled Trial

Background Overcoming Addictions (OA) is an abstinence-oriented, cognitive behavioral, Web application based on the program of SMART Recovery. SMART Recovery is an organization that has adapted empirically supported treatment strategies for use in a mutual help framework with in-person meetings, online meetings, a forum, and other resources. Objective To evaluate the effectiveness of OA and SMART Recovery (SR) with problem drinkers who were new to SMART Recovery. Our experimental hypotheses were: (1) all groups will reduce their drinking and alcohol/drug-related consequences at follow-up compared to their baseline levels, (2) the OA condition will reduce their drinking and alcohol/drug-related consequences more than the control group (SR), and (3) the OA+SR condition will reduce their drinking and alcohol/drug-related consequences more than the control group (SR only). Methods We recruited 189 heavy problem drinkers primarily through SMART Recovery’s website and in-person meetings throughout the United States. We randomly assigned participants to (1) OA alone, (2) OA+attend SMART Recovery (SR) meetings (OA+SR), or (3) attend SR only. Baseline and follow-ups were conducted via GoToMeeting sessions with a Research Assistant (RA) and the study participant. We interviewed significant others to corroborate the participant’s self-report. Primary outcome measures included percent days abstinent (PDA), mean drinks per drinking day (DDD), and alcohol/drug-related consequences. Results The intent-to-treat analysis of the 3-month outcomes supported the first hypothesis but not the others. Participants in all groups significantly increased their percent days abstinent from 44% to 72% (P<.001), decreased their mean drinks per drinking day from 8.0 to 4.6 (P<.001), and decreased their alcohol/drug-related problems (P<.001). Actual use relationships were found for the OA groups, between SR online meetings and improvement in PDA (r=.261, P=.033). In addition in the OA groups, the number of total sessions of support (including SR & other meetings, counselor visits) was significantly related to PDA (r=.306, P=012) and amount of improvement in alcohol-related problems (r=.305, P=.012). In the SR only group, the number of face-to-face meetings was significantly related to all three dependent variables, and predicted increased PDA (r=.358, P=.003), fewer mean DDD (r=-.250, P=.039), and fewer alcohol-related problems (r=-.244, P=.045), as well as to the amount of improvement in all three of these variables. Six-month follow-ups have been completed, and the results are currently being analyzed. Conclusions These results support our first experimental hypothesis but not the second or third. All groups significantly increased their PDA and decreased both their mean DDD and their alcohol-related problems, which indicates that both interventions being investigated were equally effective in helping people recover from their problem drinking. Trial Registration Clinicaltrials.gov NCT01389297; http://clinicaltrials.gov/ct2/show/NCT01389297 (Archived by WebCite at http://www.webcitation.org/6Hh5JC7Yw).

Web-based norms for the Drinker Inventory of Consequences from the Drinker's Checkup

To date, the only published norms for the Drinker Inventory of Consequences (DrInC) have come from a sample of heavy drinkers in Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) who were enrolling in a treatment program. We have generated an additional set of norms for the DrInC based on a large sample (N = 1,564) of heavy drinkers who have completed the DrInC as part of a Web-based brief motivational intervention, the Drinkers Checkup (DCU; www.drinkerscheckup.com). Although these drinkers were not seeking formal treatment, they were concerned enough about their drinking to pay

Claiming Positive Results From Negative Trials: A Cause for Concern in Randomized Controlled Trial Research - Author's Reply

25 to use the DCU. Comparing the means and decile scores for lifetime and recent total scores and subscale scores between the DCU and MATCH samples revealed that DrInC scores for the DCU sample were significantly lower than the MATCH sample. These findings have implications for giving normative feedback using the DrInC with non-treatment-seeking populations. The use and limitations of these findings are discussed.