Addiction outcomes research
selected articles
Substance use itself is the essential outcome measure but it is difficult to capture succinctly
This next study is interesting for three reasons. First, the chosen measures are clinically useful and, therefore, ethically good data to collect routinely. Second, the profile is easy for all stakeholders to digest. Third, all the measures have published values for calculating clinically significant change. Have a look at why reliable and clinically significant change are important. You may also be interested in looking at types of outcome.
Important study :: Treatment outcomes at a glance?
This demonstration study is important because it shows how routine, clinically useful ratings can generate a statistically sophisticated outcome profile. The three measures are at the heart of addiction problems and, therefore, treatment outcomes: dependence (Leeds Dependence Questionnaire), psychological distress (CORE-10), and social wellbeing (Social Satisfaction Questionnaire).
The charts show outcomes for alcohol, heroin, methadone and stimulant treatment. Outcomes are in four categories: worse, no change, better and reliably and clinically significantly better. The profiles demonstrate distinct differences in outcome profiles for the different substances. The least change occurs with methadone. The best outcome means both reliable and clinically significant change have been achieved - this is the most exacting test of outcome.
Raistrick DS, Tober GW, Sweetman J, Unsworth S, Crosby H, & Evans T (2014) Measuring clinically significant outcomes – LDQ, CORE-10, and SSQ as dimension measures of addiction. The Psychiatrist 38: 112-115
Addiction treatments have been extensively researched. Key to success is making lifestyle changes and so it might be expected that the best outcomes have consistently come from interventions with their roots in behavioural psychology. Of course pharmacological treatments are also important but always as additions to a psychosocial intervention. Here are two meta-analyses of CBT…
Many addiction treatments have common elements but some are better than others
Meta-analysis :: How effective are some of the common treatment modalities?
These two meta-analyses are important in that they evaluate the effectiveness of some of the most popular interventions across a range of substance use problems.
The upper chart shows that CBT is much more effective than no treatment and improves with added social and pharmacological elements. The lower chart shows that CBT, CM, RP treatments all deliver similar and moderate effects when compared with each other but CBT plus CM is most effective.
The weakness of contingency management, rather like medication, is that the benefits drop off once the contingencies stop. This is because these interventions do not involve new learning, new ways of coping, in order to maintain behaviour change. Approximately one third of those in psychosocial treatment drop out.
Dutra L, Stathopoulou G, Basden SL, Leyro TM, Powers MB and Otto MW (2008) A Meta-Analytic Review of Psychosocial Interventions for Substance Use Disorders. American Journal of Psychiatry 165: 179-187
Magill M and Ray LA (2009) Cognitive behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials. Journal of Studies on Alcohol and Drugs 70: 516-27
