Quality of Research
Review Date: February 2010
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1DeMarce, J. M., Lash, S. J., Stephens, R. S., Grambow, S. C., & Burden, J. L. (2008). Promoting continuing care adherence among substance abusers with co-occurring psychiatric disorders following residential treatment. Addictive Behaviors, 33(9), 1104-1112. 
Lash, S. J., Stephens, R. S., Burden, J. L., Grambow, S. C., DeMarce, J. M., Jones, M. E., et al. (2007). Contracting, prompting, and reinforcing substance use disorder continuing care: A randomized clinical trial. Psychology of Addictive Behaviors, 21(3), 387-397.
Supplementary Materials Agrawal, S., Sobell, M. B., & Sobell, L. C. (2008). The Timeline Followback: A scientifically and clinically useful tool for assessing substance use. In R. F. Belli, F. P. Stafford, & D. F. Alwin (Eds.), Calendar and time diary methods in life course research (pp. 57-68). Washington, DC: Sage.
CPR fidelity protocol checklists and samples of letter and telephone follow-up prompts
DeMarce, J. M., Burden, J. L., Lash, S. J., Stephens, R. S., & Grambow, S. C. (2007). Convergent validity of the Timeline Followback for persons with comorbid psychiatric disorders engaged in residential substance use treatment. Addictive Behaviors, 32(8), 1582-1592.
Lash, S. J., Burden, J. L., Monteleone, B. R., & Lehmann, L. P. (2004). Social reinforcement of substance abuse treatment aftercare participation: Impact on outcome. Addictive Behaviors, 29(2), 337-342.
Lash, S. J., Petersen, G. E., O'Connor, E. A., Jr., & Lehmann, L. P. (2001). Social reinforcement of substance abuse aftercare group therapy attendance. Journal of Substance Abuse Treatment, 20(1), 3-8.
McLellan, A. T., Kushner, H., Metzger, D., Peters, R., Smith, I., Grissom, G., et al. (1992). The Fifth Edition of the Addiction Severity Index. Journal of Substance Abuse Treatment, 9(3), 199-213.
Tonigan, J. S., Miller, W. R., & Brown, J. M. (1997). The reliability of Form 90: An instrument for assessing alcohol treatment outcome. Journal of Studies on Alcohol, 58(4), 358-364.
Outcomes
| Outcome 1: Participation in aftercare treatment and self-help groups |
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Description of Measures
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Participation in aftercare treatment was measured as the number of months in which clients attended at least two aftercare sessions (individual or group therapy) as recorded in their medical records.
Participation in self-help groups was measured as the number of AA and NA self-help group meetings attended per month as reported using the Form-90 Interview (Form 90I). This instrument is a structured interview that uses a calendar-based method for assisting in the self-report of daily substance use and related behaviors during the prior 90 days. Assessments occurred at baseline (3 weeks after entry into residential treatment) and 3, 6, and 12 months after entry into residential treatment.
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Key Findings
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In a randomized clinical trial, graduates of a 28-day residential substance abuse treatment program at a VA medical center were assigned to one of two aftercare conditions during the final week of treatment: usual care (a standard aftercare orientation session) or usual care plus CPR. Findings from this study included the following:
- A higher percentage of CPR than usual care clients began aftercare treatment (94.7% vs. 82.7%; p = .02), completed at least 2 months of aftercare treatment (74.7% vs. 45.3%; p < .01), and completed at least 3 months of aftercare treatment (55% vs. 36%; p = .02). However, for both groups, the percentage of clients attending at least two aftercare therapy sessions per month gradually decreased across the 12 months of follow-up (p < .01).
- Among clients with co-occurring psychiatric and substance use disorders, a higher percentage of CPR than usual care clients began aftercare treatment (93.2% vs. 72.7%; p = .01) and completed at least 2 months of aftercare treatment (68.2% vs. 24.2%; p = .0001). The effect sizes for these group differences were medium (odds ratio = 5.13) and large (odds ratio = 6.70), respectively.
- CPR clients most frequently reported 4.0 months of aftercare treatment, compared with 3.0 months reported by usual care clients (p = .02).
- Although CPR clients reported more monthly AA/NA meetings attended during the follow-up period compared with baseline (p < .01), there was no group difference between CPR and usual care clients in reported monthly AA/NA meetings attended during the follow-up period.
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.4
(0.0-4.0 scale)
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| Outcome 2: Substance abstinence |
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Description of Measures
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Substance abstinence was measured by Form 90I, a structured interview that uses a calendar-based method for assisting in the self-report of daily substance use and related behaviors over the prior 90 days. Self-reported abstinence on Form 90I was verified by a collateral report using a collateral interview version of Form 90I, self-reported substance use using the Addiction Severity Index (ASI), urinalysis, and a measure of breath alcohol content (BAC) using a portable breathalyzer. The ASI is a semistructured interview that measures types and severity of problems in seven domains: medical, employment, alcohol use, drug use, legal status, family relations, and psychiatric functioning. Assessments occurred at baseline (3 weeks after entry into residential treatment) and 3, 6, and 12 months after entry into residential treatment.
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Key Findings
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In a randomized clinical trial, graduates of a 28-day residential substance abuse treatment program at a VA medical center were assigned to one of two aftercare conditions during the final week of treatment: usual care (a standard aftercare orientation session) or usual care plus CPR. Findings from this study included the following:
- A higher percentage of CPR than usual care clients reported at the 12-month follow-up that they had been abstinent for the prior 90-day period (56.9% vs. 37.3%; p = .03).
- Among clients with co-occurring psychiatric and substance use disorders, CPR clients were more likely than their usual care counterparts to report at the 12-month follow-up that they had been abstinent for the prior 90-day period (50% vs. 21.2%; p = .01). This group difference was associated with a medium effect size (odds ratio = 3.71).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.6
(0.0-4.0 scale)
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| Outcome 3: Substance use-related problems |
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Description of Measures
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Substance use-related problems were measured using the ASI, a semistructured interview that measures the types and severity of problems in seven domains: medical, employment, alcohol use, drug use, legal status, family relations, and psychiatric functioning. Assessments occurred at baseline (3 weeks after entry into residential treatment) and 3, 6, and 12 months after entry into residential treatment.
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Key Findings
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In a randomized clinical trial, graduates of a 28-day residential substance abuse treatment program at a VA medical center were assigned to one of two aftercare conditions during the final week of treatment: usual care (a standard aftercare orientation session) or usual care plus CPR. Findings from this study included the following:
- CPR clients had a larger reduction in self-reported alcohol-related problems (ASI composite problem score) than usual care clients from baseline to the 3-month follow-up (p = .024) but not from baseline to the 6- or 12-month follow-up.
- Clients in both conditions had decreases in self-reported problem severity (ASI composite problem scores) associated with alcohol use (p < .01), drug use (p < .01), employment (p < .01), family relations (p < .01), and legal status (p = .03) across the 12 months of follow-up.
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.5
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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26-55 (Adult)
55+ (Older adult)
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96.7% Male
3.3% Female
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53.3% Black or African American
45.3% White
1.3% Hispanic or Latino
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Participation in aftercare treatment and self-help groups
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3.5
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3.5
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3.0
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3.5
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4.0
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3.2
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3.4
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2: Substance abstinence
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4.0
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4.0
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3.0
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3.5
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4.0
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3.2
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3.6
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3: Substance use-related problems
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4.0
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4.0
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3.0
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3.5
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4.0
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2.5
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3.5
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Study Strengths The measure of participation in aftercare treatment, based on data from medical records, was easily validated. Drug and alcohol abstinence was measured by a self-report instrument with strong psychometric properties (Form 90I), with results verified by collateral reports, measures of BAC, and urinalysis. Assessments were carried out by trained graduate students blind to treatment condition. CPR therapists followed a manual and general scripts for telephone prompts, with ongoing supervision throughout the study. The study design included random assignment to conditions and an adequate sample size to ensure statistical power to detect outcome differences between conditions. Outcome findings were consistent across the multiple statistical approaches used to address missing data and client attrition.
Study Weaknesses About half the scheduled prompting phone calls were not conducted. No tested fidelity instrument was used. For the subgroup of participants with a co-occurring psychiatric diagnosis, logistic regression would have been more appropriate than multiple chi-square tests to determine condition differences in the outcomes.
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Readiness for Dissemination
Review Date: February 2010
Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.
Lash, S. J., Burden, J. L., & Parker, J. D. (2009). Contracts, Prompts and Reinforcement (CPR) contracting scripts. Salem, VA: Veterans Affairs Medical Center.
Lash, S. J., Burden, J. L., & Parker, J. D. (2009). Contracts, Prompts and Reinforcement (CPR) of substance abuse continuing care adherence and abstinence: A treatment manual. Salem, VA: Veterans Affairs Medical Center.
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
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3.4
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3.0
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3.9
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3.4
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Dissemination Strengths The treatment manual provides detailed, coherent descriptions of each program component, along with well-designed scripts for therapists to use. Specific information on selecting clients and implementing the intervention as an adjunct to an existing therapeutic program is provided. Training and support for implementation are available from the developer. Tools and protocols for measuring outcomes, along with specific guidance for ongoing supervision, support quality assurance.
Dissemination Weaknesses Little guidance is provided on how to adapt this intervention for use with specific cultural or ethnic groups. Some Web-based implementation materials are not readily accessible to all implementers. The implementation materials include a few typographical errors. No formalized training curriculum is available. Little support is provided for integrating quality assurance procedures with existing organizational processes.
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