Treatment May Influence Self-Report and Jeopardize Our Understanding of Outcome

Abstract

ABSTRACT. Objective: Standardized measures of self-reported alcohol use are the predominant method by which change in alcohol use following interventions is evaluated. This study examined whether the invariance of the test-retest pretreatment Alcohol Use Disorders Identifi cation Test (AUDIT) was affected by the treatment experience. In this study, the intervening exposure was to motivational interviewing (MI) versus community service (CS), the treatment-as-usual control group. Method: Analyses were conducted on a subsample of court-referred 16-to 21-year-olds recruited into a randomized controlled trial examining the effects of MI on alcohol use and police charges for risky driving and/or drinking. Youths were randomized to CS or MI. A subsample of 478 participants, who at baseline completed the AUDIT in reference to alcohol use for the 6 months before their conviction, later repeated the AUDIT at treatment completion, in reference to the same 6-month baseline period. Results: At completion of treatment, participants receiving CS had a signifi cant decrease in baseline AUDIT scores, whereas those in MI reported no signifi cant change. The difference between the two groups was signifi cant (p = .02). Also, of those who reported no drinking before treatment, after receiving MI, 33.5% changed their response and acknowledged pretreatment drinking, compared with only 8.3% in CS. Conclusions: These results suggest that treatment received may differentially affect a standardized measure of self-reported risky drinking. This effect may be attributable to the treatment experience and/or the experience of the control group. Possible explanations for the effect are explored, including more honesty because of a trusting therapeutic alliance and a response shift bias. Differential change in self-report might affect treatment outcome assessment. Depending on the treatment contrasts, research that relies on pre-to post-treatment changes in self-report may be underestimating treatment effects. (J. Stud. Alcohol Drugs, 74, 770-776, 2013)

A Randomized Controlled Trial of a Telephone Intervention for Alcohol Misuse With Injured Emergency Department Patients

“…We found that TBMI participants after their first intervention call reported more pre-ED visit alcohol use than they had previously reported in the ED whereas HS participants did not. This finding replicates results found in an earlier study with court adjudicated adolescents 19 and may indicate that the intervention influences participant’s alcohol use recall by encouraging reflection and more self-disclosure about alcohol use and sways self-reported data. As we have only self-reports of alcohol use and no objective measure of drinking, we are unable to test this hypothesis.…”

“…Participants completed the initial baseline questionnaire during recruitment in the ED and follow-up questionnaires at 4, 8, and 12 months after recruitment. In addition, based on findings from another study that became available seven months after the study commenced, we wanted to test a reported finding of increased reporting of drinking after a counseling intervention was administered 19 . To do so, participants recruited after that time were queried again about their alcohol use for the 30 days prior to enrollment when contacted by a different RA to complete a post intervention call assessment.…”

Integrating mindfulness with parent training: Effects of the mindfulness-enhanced strengthening families program.

“…Perceptual changes, such as reperceiving, a shift in how one makes sense of thoughts, feelings, or interactions, which has been hypothesized as a central mechanism of mindfulness practices (Shapiro, Carlson, Astin, & Freedman, 2006), may alter how parents evaluate their own parenting after participating in a mindfulness intervention. Similarly, it has been suggested that an increased openness and awareness of experiences following an intervention might yield more candid and accurate reports of behavior such as alcohol use (Nirenberg, Longabaugh, Baird, & Mello, 2013). …”

Listening to the elephant in the room: response-shift effects in clinical trials research

“…Eight of the retained articles addressed drug, medical-device, or surgical interventions [ 11 , 36 , 37 , 39 , 40 , 43 , 44 , 48 ], and nine addressed psychosocial, behavioral, or nursing interventions [ 34 , 35 , 38 , 41 , 45 – 47 , 49 , 50 ]. Ten of the articles were focused on methodological development [ 19 , 34 – 38 , 40 , 41 , 50 , 51 ], and seven on the clinical impact of response shift [ 11 , 39 , 43 – 46 , 49 ].

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“…3 ). Among the 10 retained articles that had adequate power, seven documented a clinically-important response-shift effect that affected trial results [ 11 , 37 , 38 , 43 , 44 , 46 , 49 ], two did not [ 47 , 50 ], and one did not address the clinical impact of response shift [ 41 ]. Among the seven retained articles with inadequate power, two documented a clinically-important response-shift effect (one better [ 39 ], one worse [ 35 ]), and five documented no impact on the estimated intervention impact [ 36 , 40 , 45 , 47 , 48 ].…”