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 1
Davidson, D., Gulliver, S. B., Longabaugh, R., Wirtz, P. W., & Swift, R. (2007). Building better cognitive-behavioral therapy: Is Broad-Spectrum Treatment more effective than motivational-enhancement therapy for alcohol-dependent patients treated with naltrexone? Journal of Studies on Alcohol and Drugs, 68(2), 238-247. 
Davidson, D., Wirtz, P. W., Gulliver, S. B., & Longabaugh, R. (2007). Naltrexone's suppressant effects on drinking are limited to the first 3 months of treatment. Psychopharmacology, 194(1), 1-10.
Longabaugh, R., Wirtz, P. W., Gulliver, S. B., & Davidson, D. (2009). Extended naltrexone and Broad Spectrum Treatment or motivational enhancement therapy. Psychopharmacology, 206(3), 367-376.
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.
Gulliver, S. B., Longabaugh, R., Davidson, D., & Swift, R. (2005). The development of a Broad Spectrum Treatment for patients with alcohol dependence in early recovery. Cognitive and Behavioral Practice, 12, 53-63.
Outcomes
| Outcome 1: Alcohol use |
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Description of Measures
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Alcohol use was measured as the median number of days to the first drink and the median number of days to the first heavy drinking day (at least five drinks for men, at least four drinks for women). Alcohol use data were gathered using the Timeline Followback (TLFB) interview, a calendar-based method for reconstructing days of drinking and other drug use over a specified time period.
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Key Findings
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In a randomized clinical trial, alcohol-dependent clients were assigned to one of four treatment conditions: long-term naltrexone treatment (24 weeks of naltrexone) or short-term naltrexone treatment (12 weeks of naltrexone and 12 weeks of placebo), each paired with 12 weeks of BST or 12 weeks of MET. Both the BST and MET groups received the first (90-minute) and second (30-minute) MET session. Subsequently, the BST groups received 9-14 sessions specific to psychosocial functioning levels across the 6 domains, and the MET groups received 2 more MET sessions. Outcome measurements occurred at baseline and at 12-week intervals from 12 to 72 weeks after treatment initiation. Among the findings from this study were the following:
- Clients in the BST plus long-term naltrexone condition reported the longest median time to the first drink (27.5 days) across the follow-up period compared with clients in the other three conditions (10 days for BST plus short-term naltrexone, 2 days for MET plus long-term naltrexone, and 6 days for MET plus short-term naltrexone; p < .02).
- Clients in the BST plus long-term naltrexone condition reported the longest time to the first day of heavy drinking (61 days) across the follow-up period compared with clients in the other three conditions (17 days for BST plus short-term naltrexone, 11 days for MET plus long-term naltrexone, and 20 days for MET plus short-term naltrexone; p < .03).
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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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2.7
(0.0-4.0 scale)
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| Outcome 2: Short-term alcohol abstinence |
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Description of Measures
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Short-term alcohol abstinence while on naltrexone therapy was measured as the percentage of days abstinent in the prior 90 days. Abstinence data were collected using the TLFB interview, a calendar-based method for reconstructing days of drinking and other drug use over a specified time period.
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Key Findings
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In a randomized clinical trial, alcohol-dependent clients were assigned to one of four treatment conditions: long-term naltrexone treatment (24 weeks of naltrexone) or short-term naltrexone treatment (12 weeks of naltrexone and 12 weeks of placebo), each paired with 12 weeks of BST or 12 weeks of MET. Both the BST and MET groups received the first (90-minute) and second (30-minute) MET session. Subsequently, the BST groups received 9-14 sessions specific to psychosocial functioning levels across the 6 domains, and the MET groups received 2 more MET sessions. Outcome measurements occurred at baseline and at 12-week intervals from 12 to 72 weeks after treatment initiation. Findings at the 12-week follow-up (at the end of psychosocial treatment) included the following:
- Clients who received BST plus naltrexone reported a higher percentage of days abstinent than clients receiving MET plus naltrexone (74.3% vs. 66.1%; p = .04). Regardless of condition assignment, the percentage of days abstinent was significantly related to the number of treatment sessions attended; that is, the higher the percentage of days abstinent, the more treatment sessions were attended (p < .003 for BST plus naltrexone, p < .027 for MET plus naltrexone).
- Among participants who had a relatively high level of support for drinking in their psychosocial network (top 50%) at baseline, clients receiving BST plus naltrexone reported a higher percentage of days abstinent than those receiving MET plus naltrexone (76.5% vs. 62.4%; p = .035) after adjusting for baseline alcohol use.
- Contrary to expectations, BST plus naltrexone clients with a relatively low level of psychosocial domain dysfunction (bottom 50%) at baseline reported a higher percentage of days abstinent than their counterparts receiving MET plus naltrexone (73.3% vs. 57.4%; p = .032) after adjusting for baseline alcohol use. Among participants who had a relatively high level of psychosocial domain dysfunction (top 50%) at baseline, the reported percentage of days abstinent did not differ between clients receiving BST plus naltrexone and those receiving MET plus naltrexone (73.1% vs. 73.4%) after adjusting for baseline alcohol use.
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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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2.7
(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)
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63% Male
37% Female
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90% White
3% American Indian or Alaska Native
3% Black or African American
3% Hispanic or Latino
1% Race/ethnicity unspecified
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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: Alcohol use
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3.0
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3.0
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2.5
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2.5
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2.0
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3.0
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2.7
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2: Short-term alcohol abstinence
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3.0
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3.0
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2.5
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2.5
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2.0
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3.0
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2.7
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Study Strengths
Extensive research has been conducted with the measures derived from the Timeline Followback method used in this study, and their psychometric properties are strong; they are the standard measures used in clinical research on alcohol dependence. The behavioral component of the intervention was based on manual-guided training. Attrition rates were acceptable at about 18% and were balanced across treatment conditions. This randomized clinical trial was adequately powered and used an appropriate intent-to-treat statistical strategy, an acceptable method for handling attrition, and a solid data analysis approach that included the evaluation of potential moderator effects for continued drinking behavior.
Study Weaknesses
The absence of any data to verify that the BST sessions differed from the MET sessions in their content raises the concern that the main difference between the two psychosocial conditions was simply the number of treatment sessions. Because a single therapist delivered both psychosocial conditions and treated most patients (89%) with likely knowledge of study hypotheses, it is conceivable that the comparison condition was less enthusiastically delivered than the experimental condition. The pairing of the first 12 weeks of BST with naltrexone precluded an independent determination of BST efficacy outside the context of naltrexone or some other type of medication. No special statistical models were used to estimate the impact of attrition on outcomes.
