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Biomedical subjects

A Zweben

Publications and source records attributed to A Zweben.

18 recordsLinked to original sources
PubMed2000

Alcoholism treatment and medical care costs from Project MATCH.

AIMS: This paper examines the costs of medical care prior to and following initiation of alcoholism treatment as part of a study of patient matching to treatment modality. DESIGN: Longitudinal study with pre- and post-treatment initiation. MEASUREMENTS: The total medical care costs for inpatient and outpatient treatment for patients participating over a span of 3 years post-treatment. SETTING: Three treatment sites at two of the nine Project MATCH locations (Milwaukee, WI and Providence, RI). PARTICIPANTS: Two hundred and seventy-nine patients. INTERVENTION: Patients were randomly assigned to one of three treatment modalities: a 12-session cognitive behavioral therapy (CBT), a four-session motivational enhancement therapy (MET) or a 12-session Twelve-Step facilitation (TSF) treatment over 12 weeks. FINDINGS: Total medical care costs declined from pre- to post-treatment overall and for each modality. Matching effects independent of clinical prognosis showed that MET has potential for medical-care cost-savings. However, patients with poor prognostic characteristics (alcohol dependence, psychiatric severity and/or social network support for drinking) have better cost-savings potential with CBT and/or TSF. CONCLUSIONS: Matching variables have significant importance in increasing the potential for medical-care cost-reductions following alcoholism treatment.

Adult↗
PubMed1999

Development of a composite measure for assessing alcohol treatment outcome: operationalization and validation.

This article operationally describes and empirically validates a composite outcome measure developed for use in a multisite alcohol treatment matching study. Using empirically based clinical guidelines to establish alcohol consumption and alcohol-related problems criteria, 1,726 subjects were classified as abstinent, moderate drinking without problems, heavy drinking or problems, or heavy drinking and problems at intake and 3, 6, 9, 12, and 15 months postintake. Subjects with poorer composite outcome also had poorer outcomes related to quantity and frequency of alcohol consumption, alcohol-related problems, serum gamma-glutamyltranspeptidase and other nonalcohol-related measures assessing psychiatric dysfunction, psychosocial functioning, and purpose or meaning in life. Differences in the present composite measure relative to other categorical measures used in research to date and the potential for incorporating nonalcohol-specific variables into composite measures are discussed.

Adult↗
PubMed1998

Internal validity of Project MATCH treatments: discriminability and integrity.

Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) is a multisite collaborative project designed to evaluate patient-treatment interactions in alcoholism treatment. To evaluate whether major threats to the internal validity of the independent (treatment) variable in Project MATCH could be ruled out, we investigated several aspects of treatment integrity and discriminability. In this study, 1,726 alcohol-dependent participants at 10 sites were randomized to 3 treatments: cognitive-behavioral treatment (CBT), motivational enhancement therapy (MET), and 12-step facilitation (TSF). Participants received treatment either as outpatients or as aftercare following a more intensive inpatient or day hospital treatment. For both the outpatient and aftercare arms of the study, treatments were discriminable in that therapists implemented each of the treatments according to manual guidelines and rarely used techniques associated with comparison approaches. Participants received a high level of exposure to their study treatments, and the intended contrast in treatment dose between MET and the 2 more intensive treatments (CBT and TSF) was obtained. Alcoholics Anonymous involvement was significantly higher for participants assigned to TSF versus MET or CBT, whereas the treatments did not differ in utilization of other nonstudy treatments. Nonspecific aspects of treatment such as therapist skillfulness and level of the therapeutic alliance were comparable across treatment conditions.

Adult↗
PubMed1998

Network support for drinking, Alcoholics Anonymous and long-term matching effects.

AIMS: (1) To examine the matching hypothesis that Twelve Step Facilitation Therapy (TSF) is more effective than Motivational Enhancement Therapy (MET) for alcohol-dependent clients with networks highly supportive of drinking 3 years following treatment; (2) to test a causal chain providing the rationale for this effect. DESIGN: Outpatients were re-interviewed 3 years following treatment. ANCOVAs tested the matching hypothesis. SETTING: Outpatients from five clinical research units distributed across the United States. PARTICIPANTS: Eight hundred and six alcohol-dependent clients. INTERVENTION: Clients were randomly assigned to one of three 12-week, manually-guided, individual treatments: TSF, MET or Cognitive Behavioral Coping Skills Therapy (CBT). MEASUREMENTS: Network support for drinking prior to treatment, Alcoholics Anonymous (AA) involvement during and following treatment, percentage of days abstinent and drinks per drinking day during months 37-39. FINDINGS: (1) The a priori matching hypothesis that TSF is more effective than MET for clients with networks supportive of drinking was supported at the 3 year follow-up; (2) AA involvement was a partial mediator of this effect; clients with networks supportive of drinking assigned to TSF were more likely to be involved in AA; AA involvement was associated with better 3-year drinking outcomes for such clients. CONCLUSIONS: (1) In the long-term TSF may be the treatment of choice for alcohol-dependent clients with networks supportive of drinking; (2) involvement in AA should be given special consideration for clients with networks supportive of drinking, irrespective of the therapy they will receive.

Adult↗
PubMed1998

Actual and estimated replication costs for alcohol treatment modalities: case study from Project MATCH.

OBJECTIVE: As a first step in a thorough cost-effectiveness analysis of a randomized alcohol-treatment-matching trial (Project MATCH), the present study examines the relative costs of three manual-guided, individually delivered treatments and the costs of replicating them in nonresearch settings. METHOD: Costs of delivering a 12-session Cognitive Behavioral Therapy (CBT), a 4-session Motivational Enhancement Therapy (MET) and a 12- session Twelve-Step Facilitation (TSF) treatment over 12 weeks were assessed for three treatment sites at two of the nine Project MATCH locations (Milwaukee, WI, and Providence, RI). Research cost calculations included clinical, administrative and training/supervision variables in determining total treatment costs, average cost per contact hour and average cost per research participant. Investigators from all nine MATCH locations estimated direct clinical costs, administrative overhead costs and training/supervision costs for replicating these treatments. RESULTS: For Project MATCH, MET cost twice as much or more per patient contact hour (mean = $498) than CBT (mean = $198) and TSF (mean = $253) but was less costly per research participant (mean = $1,700) than both CBT (mean = $1,901) and TSF (mean = $1,969). For clinical replication, high end per patient costs ranged from $512 for MET to $750 for TSF to $788 for CBT: a cost savings for MET of $238 (32%) over TSF and $276 (35%) over CBT. CONCLUSIONS: As part of a randomized clinical trial, MATCH treatments are costly to produce. However, when estimates are used to project these costs to nonresearch clinical settings, the costs are greatly reduced. Whereas MET appears to be much less costly to deliver in nonresearch settings than the other two treatments, the estimated cost differentials are less than the 1:3 treatment session ratio for MET versus TSF or CBT.

Alcohol-Related Disorders↗
PubMed1998

Compliance with treatment and follow-up protocols in project MATCH: predictors and relationship to outcome.

Treatment and follow-up session attendance data from Project MATCH, a multisite clinical trial investigating patient-treatment matching, were analyzed to study compliance. High rates of compliance to both therapy and research protocols were achieved, enhancing treatment integrity and data quality. Strong baseline predictors of compliance did not emerge, and the small relationships found were consistent with reports from previous studies. Attendance at therapy sessions was moderately correlated with research follow-up participation. Treatment compliance predicted drinking outcome, underscoring the importance of retaining patients in treatment. Future studies should examine the associations between compliance and structural features of the treatment environment, treatment delivery, and context-features that are often under the control of the clinician/investigator.

Adult↗
PubMed1996

Composite outcome measures in alcoholism treatment research: problems and potentialities.

Alcoholism treatment researchers have increasingly incorporated multiple measures representing multiple dimensions in assessing treatment outcomes. However, no satisfactory model exists for examining the dynamic interrelationships of multiple measures in determining clinically meaningful and interpretable outcomes. One approach to analyzing multiple outcomes is to combine them into a composite measure. In their most elementary form, composite measures combine alcohol consumption and consumption-related problems dimensions into treatment outcome classifications. This paper discusses conceptual and methodological issues in studies reporting composite outcomes and provides a model and recommendations for using composite measures in alcohol treatment research.

Alcoholism↗
PubMed1994

Issues in the definition and measurement of drinking outcomes in alcoholism treatment research.

This article reviews methodological and conceptual issues regarding the choice of drinking outcome measures in alcoholism treatment research. The following issues are discussed: Should drinking outcomes be conceptualized in terms of an underlying unitary disorder, or should provision be made for independent outcomes that cover a wide variety of dimensions? Which drinking outcomes are typically measured in treatment evaluation studies and how are they operationalized? What are the empirical associations among drinking outcome measures? If multiple outcomes are measured, which should be given primary importance? Over what period of time should treatment outcome be evaluated? What procedures can be used to detect, correct or prevent the response bias associated with verbal report methods? Because outcome measures need to fit the hypotheses and practical needs of a particular study, it is unlikely that complete standardization can be achieved across all studies. Nevertheless, given the importance of drinking outcomes and the need for economy, two primary dependent measures are recommended: (1) proportion of available drinking days abstinent; and (2) intensity of drinking, as defined by the total amount consumed (in ounces absolute alcohol) during the follow-up period divided by the number of actual drinking days. This article also proposes a strategy that may help to guide the selection of outcome measures in future research.

Alcoholism↗
PubMed1994

Issues in the selection and development of therapies in alcoholism treatment matching research.

There are a large number of possible approaches to the treatment of alcohol abuse and dependence. From a practical and methodological standpoint, however, only a limited number of interventions can realistically be included in research studies of treatment matching. A key question in planning studies of matching is what treatments to include. The recent book by Beutler and Clarkin on systematic treatment selection in general psychotherapy provides a framework within which to discuss alcoholism treatment matching and the criteria applied to decisions concerning (1) modes of treatment, (2) treatment format, (3) specific therapeutic strategies and the (4) treatment setting. The methodological and practical issues raised and the decisions reached in Project MATCH are presented in each of these areas. The therapies chosen for Project MATCH, based on these criteria, are described.

Alcoholism↗
PubMed1994

Implementing treatment and protecting the validity of the independent variable in treatment matching studies.

Treatment matching research is predicated on heterogeneity among subjects and their differential response to treatments. The sine qua non of a treatment matching study is the integrity of the treatment variable, since detection of client-treatment interactions requires delivery of treatments that are highly specific, consistent and distinct. Matching research thus presents particular challenges in treatment implementation, as greater heterogeneity in subjects may generate a broader array of problems than study treatments are designed to address, leading to several potential threats to treatment integrity. Moreover, as practiced outside of research settings, treatments for alcoholism are marked by ideological heterogeneity and a lack of purity across approaches. In this article we describe the strategies used in Project MATCH to protect treatment integrity while treating a large and heterogeneous sample of alcoholics in a number of geographically distant sites. These include: strategies for treating a variety of alcoholics within a single treatment approach; development of clinical care guidelines and clinical deterioration criteria; specification of treatments in manuals with minimization of overlapping active ingredients; selection criteria for therapists intended to enhance both generalizability of findings as well as treatment integrity; and extensive therapist training and monitoring.

Alcoholism↗
PubMed1994

Issues in the development of subject recruitment strategies and eligibility criteria in multisite trials of matching.

Decision-making in selecting and recruiting subjects for treatment matching research is a complex process involving conceptual, methodological and practical considerations. In selecting clients, concerns arise about whether the criteria will produce a subject population that is (1) relevant to the dimensions associated with the treatment matching, (2) representative of persons typically seen in alcohol treatment settings and, for practical purposes, (3) able or willing to comply with the requirements of the study protocol. Also, in order to fulfill sampling requirements, it may be necessary to employ a variety of creative outreach methods. However, these recruitment mechanisms can pose additional logistical and methodological problems for the research. This article focuses on various issues arising in the selection and recruitment of subjects in matching research. Project MATCH serves to highlight issues related to client eligibility and recruitment and to discuss effective strategies for resolving these matters.

Adult↗
PubMed1989

The comparability of solicited versus clinic subjects in alcohol treatment research.

The increasing use of media advertisements to recruit subjects in alcohol treatment research has raised concerns about the comparability of such solicited subjects and subjects drawn from more traditional clinic populations. This paper, based on a study that involved both solicited and clinic subjects, identifies differences between the two types of subjects in terms of sociodemographic variables; pre-treatment drinking and marital adjustment; several dimensions of 'self-definition'; and three outcome measures. These findings suggest that there may be significant differences between solicited and clinic subjects and that these differences should be taken into account in the design of studies utilizing solicited subjects in order to determine the generalizability of the results.

Adult↗
PubMed1986

Problem drinking and marital adjustment.

To examine the interdependency between alcohol misuse and marital adjustment, emphasis was placed on investigating how different patterns of alcohol use vary with different levels of marital satisfaction, and how such relationships might be mediated by the sociobehavioral consequences of problem drinking within the family. It was found that the likelihood of marital disruption was greater in heavy drinking households than in nonheavy drinking households. However, differences between heavy drinking and nonheavy drinking settings with respect to the marital relationship became largely nonsignificant when the number of sociobehavioral consequences of alcohol use for the marriage was controlled. The relationship between patterns of alcohol misuse and marital adjustment seems to be complex and variable and is in need of further investigation. Findings in the present study are compared with other research on the alcoholic marriage. Recommendations are offered for future studies on this topic.

Adaptation, Psychological↗
PubMed1983

Reducing attrition from conjoint therapy with alcoholic couples.

Premature termination of treatment by the client has been a pervasive problem in the alcohol treatment field. This drop-out problem is compounded in conjoint therapy for alcoholic couples since most clients typically do not view the drinking problem from a systemic, interactional perspective. Within a short-term communication-interaction based conjoint therapy program offered to couples with an alcohol problem on an outpatient basis, specific mechanisms were developed to deal with client-initiated attrition from treatment. These procedures involve the systematic involvement of the spouse in all aspects of intake, assessment and treatment; the use of role induction in a pretherapy interview; and formal contracting during the beginning phase of therapy. Preliminary results suggest that these efforts may be effective in retaining more socially stable alcoholic clients. For the more transient, less socially stable group of individuals with alcohol-related difficulties, the above mechanisms may not be sufficient to forestall unplanned terminations. It is suggested that the latter group may require help to reduce stresses related to concrete concerns prior to receiving conjoint therapy for their alcohol problem.

Adult↗
PubMed1981

The efficacy of role induction in preventing early dropout from outpatient treatment of drug dependency.

A study was conducted to examine the impact of various role induction modalities in dealing with the problem of early dropout among substance abusing patients. Emphasis was placed on tracing the interdependency between patient misperceptions of treatment, termed level of discrepancy in treatment expectations (Level of DTE) and continuance. Results indicated that patients who were more favorably disposed to the program (low Level of DTE) were more likely to remain in care than those who were not (high Level of DTE) only if role induction was provided; in the absence of the pretreatment intervention, differences between high and low discrepant patients were virtually nonexistent. These data suggest that the real utility of role induction lies in its ability to confirm the expectations of low discrepant patients (in contrast to improving patient knowledge of therapy) while at the same time providing them with a mechanism to learn coping skills necessary for adjusting to a new program. For those classified as high discrepant patients, role induction alone was not sufficient to prevent early termination; the majority did not stay past four sessions. Implications for this group are that greater efforts should be made in responding to their concrete problems, actively engaging "significant other(s)" or providing them with an external support system in the form of a "buddy" at the point of entry, in order to forestall premature termination.

Adult↗
PubMed1979

Family care for the mentally ill: a new perspective.

Family care has been a subject of controversy since large numbers of discharged psychiatric patients have been placed in these homes. The debate has centered on whether such community facilities offer a meaningful alternative in caring for the mentally ill. Findings of a study dealing with the quality of care in the homes and factors deemed responsible for these conditions provide a new perspective on the dilemma.

Aftercare↗
PubMed1978

Human antithrombin III. Carbohydrate components and associated glycolipid.

Human antithrombin III was found to contain covalently linked N-acetylglucosamine, mannose, galactose, and sialic acid in a molar ratio of approximately 1:1:0.6:1. Sialic acid was released upon treatment with neuraminidase. The modified glycoprotein retained the capability to inhibit thrombin and to bind with heparin. Antithrombin III isolated by different procedures was also found to contain glucose in an approximately equimolar ratio with N-acetylglucosamine. Th" glucose-containing component was extractable with lipid solvents and shown to be beta-glucosylceramide. This glycolipid is tightly complexed with antithrombin III and could not be separated by fractional precipitations or ion exchange gels. Although it remains to be established whether the inhibitory actions of antithrombin III are affected by glucosylceramide, the relative amounts which are bound suggest that antithrombin III may be a significant carrier of the glycolipid.

Antithrombins↗