The role of feedback in the process of health behavior change.

OBJECTIVE: To offer a taxonomy of types of feedback and describe potential mechanisms of action particularly in the area of addictive behaviors. METHOD: Reviewed the literature to examine support for types-Generic, Targeted, and Personalized-and for mechanisms of feedback. RESULTS: Although it is not clear how it works, feedback is thought to offer important information, to create a sense of caring and helping relationship, to reach more directly decisional considerations, to increase engagement in the materials, to increase motivation, or to provide social comparison and norms. CONCLUSIONS: Avenues for future research in search of the most effective manner of using feedback to promote health behavior change are discussed.

Optimizing the cost-effectiveness of alcohol treatment: a rationale for extended case monitoring.

There has been much research on and debate about the appropriate length of acute treatment for alcohol problems. In the United States, the lengthy and costly treatment programs of only a few years ago have been supplanted by ever-shorter and less intensive protocols, with little evidence that this trend will end soon. In this paper, we argue that, because of the chronic, recurrent nature of alcohol problems, an optimal system for delivering treatment services to alcoholics needs to focus on long-term engagement with clients. There is evidence from studies on research reactivity and telephone follow-up protocols that a low-intensity long-term protocol for maintaining contact with clients over time spans measured in years may result in better long-term clinical outcomes and reduced long-term health care utilization and costs. We describe a flexible long-term low-intensity follow-up protocol for alcohol abusers we call "case monitoring." This protocol is specifically designed to minimize long-term health-care use. We predict that such an intervention should be especially efficacious for women, persons with comorbid Axis I disorders, and persons lower in sociopathy. The design of a study to determine the clinical and health service effects of this intervention is also described.

Motivation for change and alcoholism treatment.

Motivation plays an important role in alcoholism treatment by influencing patients to seek, complete, and comply with treatment as well as make successful long-term changes in their drinking. Both alcohol-abusing and alcohol-dependent people can be classified into different "stages of change" in terms of their readiness to alter their drinking behavior. Consequently, researchers have had to consider more seriously the role of motivation in the treatment of and recovery from substance abuse and to incorporate motivational enhancement strategies into treatment programs.

Scleroderma is associated with differences in individual routes of drug metabolism: a study with dapsone, debrisoquin, and mephenytoin.

Exposure to certain environmental agents may induce a scleroderma-like syndrome in a small proportion of individuals. Differences in susceptibility could involve metabolic activation of a protoxin, with affected patients having a greater converting ability. This possibility was investigated in 84 patients with scleroderma and 108 control subjects with in vivo probes of specific pathways of metabolism. Scleroderma was associated with reduced hydroxylating activity for dapsone and S-mephenytoin, whereas the ability to hydroxylate debrisoquin and N-acetyl dapsone was similar in both groups. Logistic regression confirmed these associations based on the shift in frequency distribution. Individuals who were poor metabolizers for mephenytoin and only modest N-hydroxylators of dapsone had a tenfold increased risk of scleroderma (p = 0.008). Thus this combined metabolic impairment may be causally involved in the development of scleroderma or, alternatively, the disease may produce inhibition of selected metabolizing enzymes in a subset of patients.