Systematic, methodologically rigorous research reviews are the primary foundation for efforts to identify evidence-based treatments for alcohol misuse and alcohol use disorders. To appropriately inform alcohol treatment practice guidelines, reviews should be conducted periodically, given the proliferation of relevant research, including more rigorous studies of new treatment approaches (e.g., new medications) as applied to more diverse participant samples (e.g., individuals with co-occurring psychiatric disorders). Over the past two decades, two major projects have provided comprehensive, systematic reviews of alcohol treatment outcome research. One has been work at the VA Palo Alto Health Care System (VAPAHCS) funded by two grants from NIAAA. The other has been that by Dr. William Miller and colleagues at the University of New Mexico (UNM). We propose to build upon and extend these two projects to provide updated, comprehensive, largely quantitative reviews of the alcohol treatment outcome research literature. The project's primary aim is to determine the relative efficacy/effectiveness of psychosocial and pharmacological alcohol treatments, treatment settings, and continuing care via research syntheses. To accomplish this aim, a set of reviews will be conducted. One will be a comprehensive """"""""adjusted box-score"""""""" review of alcohol treatment approaches or modalities that takes into account variation in study characteristics related to the probability of finding significant treatment effects and the strength of the alternatives against which treatments have been compared. In addition, updated effect size-based meta-analyses will compare (a) pharmacological treatments versus placebo conditions (the first such comprehensive review), (b) inpatient/residential treatment versus outpatient treatment, (c) brief interventions versus usual medical/more extensive specialty alcohol care, (d) relapse prevention versus other forms of treatment or control conditions, and (e) continuing care versus treatment as usual or no treatment. Another analysis will model treatment outcomes (abstinence and """"""""success"""""""" rates) across studies based on patient, treatment, and study characteristics. Secondary aims are to: (1) describe the nature and the methodology of recent alcohol treatment studies in comparison with earlier studies;(2) investigate the use of eligibility criteria in alcohol treatment trials and their impact on the generalizability of findings;and (3) review studies of the implementation of evidence-based substance use disorder treatments, guided by a conceptual model of innovation implementation.
The proposed project will provide important new syntheses of findings on the efficacy/effectiveness of different forms and settings of alcohol treatment that will inform recommendations regarding evidence-based alcohol treatments. As such, it will provide a """"""""big picture"""""""" view of alcohol treatment research findings that is impossible to achieve from reading scattered reports of individual research projects, and will help maximize the societal return on investment in alcohol treatment research. In addition, the proposed work will provide valuable information to researchers on treatment effect magnitudes, research attrition (i.e., follow-up rates), assessment reactivity, and the use of eligibility criteria and their impact on research generalizability that will be useful in planning future research projects.
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