Reliability of a Timeline Followback measure of caffeinated coffee consumption.

BACKGROUND AND AIMS: The Timeline Followback (TLFB) was initially developed to collect retrospective self- reports of alcohol and drug use. Since its development, several peer-reviewed papers have supported it as a sound psychometric measure for substance use and for several other behaviors. Worldwide, coffee is one of the most widely consumed beverages. Although early epidemiological research suggested that drinking coffee is associated with some health problems, several recent studies have found moderate coffee consumption to have an inverse association with mortality. Because of its widespread use, a psychometrically sound measure of coffee consumption would help better inform research and public health policies. DESIGN: This study investigated the test-retest reliability of a version of the TLFB modified to assess coffee consumption. SETTING AND PARTICIPANTS: 98 clinical psychology doctoral students completed a 30-day coffee TLFB on two occasions separated by 14 days. MEASUREMENTS: Participants used a computerized Survey Monkey™ version of the coffee TLFB to report their caffeinated coffee consumption for the same 30-day interval. For the first administration participants reported their consumption for the preceding 30 days, and for the second administration they reported on the preceding 45 days which included the earlier reporting interval. FINDINGS: Reliability coefficients were found to be very high (0.90-0.97). CONCLUSIONS: As with other substance use versions of the TLFB, these results suggest the TLFB is a good method for measuring coffee consumption in research studies and in primary health care settings where such data may be important.

Reducing alcohol consumption to minimize weight gain and facilitate smoking cessation among military beneficiaries.

INTRODUCTION: Smoking cessation-related weight gain can have significant negative health and career consequences for military personnel. Alcohol reduction combined with smoking cessation may decrease weight gain and relapse. METHOD: A randomized clinical trial of military beneficiaries compared a standard smoking cessation (i.e., brief informational) intervention (N=159), with a brief motivational smoking cessation intervention that emphasized reduced drinking to lessen caloric intake and minimize weight gain (N=158). RESULTS: Participants who received the motivational intervention were significantly more likely to quit smoking at the 3-month follow-up (p=0.02), but the differences were not maintained at 6 (p=0.18) or 12months (p=0.16). Neither weight change nor alcohol reduction distinguished the 2 groups. Smoking cessation rates at 12months (motivational group=32.91%, informational group=25.79%) were comparable to previous studies, but successful cessation was not mediated by reduced drinking. CONCLUSIONS: Alcohol reduction combined with smoking cessation did not result in decreased weight gain or improved outcomes.

Preventing Alcohol-Exposed Pregnancies: A Randomized Controlled Trial of a Self-Administered Version of Project CHOICES with College Students and Nonstudents.

BACKGROUND: Alcohol-exposed pregnancies (AEPs) are a preventable cause of birth defects and developmental disabilities for which many women are at risk. The initial 5-session Project CHOICES intervention was found to prevent AEPs. In the ensuing decade, there have been several additional CHOICES-like studies. This study, Project Healthy CHOICES, had 2 objectives: (i) to compare outcomes for students versus nonstudents; and (ii) to test a self-administered mail-based version of the Project CHOICES intervention. METHODS: A randomized controlled trial (RCT) compared 2 interventions for women of childbearing age (18 to 44) who were at risk of an AEP: (i) motivational feedback based on Project CHOICES and (ii) information only. Advertisements recruited 354 women (145 college students; 209 nonstudents) at risk of an AEP. Intervention and study materials were available in English and Spanish. Of the 354 women, 44% were minorities (25% identified as Hispanics). RESULTS: At the 6-month follow-up, the interventions did not differ and there was no Intervention by Student Study interaction. However, over the entire 6-month follow-up, significantly more students (68%) than nonstudents (46%) were not at risk of an AEP (2.1 odds ratio; confidence interval = 1.47 to 2.95). For all groups, risk reduction occurred primarily through effective contraception. CONCLUSIONS: There was no significant difference between the 2 interventions. However, over the entire 6-month follow-up interval, college students were significantly more likely than nonstudents to not be at risk of an AEP and to use effective contraception. While the student groups had significantly higher reduced risk of AEP outcomes, there was also substantial risk reduction for women in the information only condition. These results suggest that the most effective AEP prevention efforts would be to inform women at risk that they could become pregnant. Because about half of all pregnancies are unplanned, identifying women at risk and preventing the risk of AEPs should be a public health priority.

Two Brief Measures of Alcohol Use Produce Different Results: AUDIT-C and Quick Drinking Screen.

BACKGROUND: Several psychometrically sound measures of alcohol use have been developed to assess drinking. The Alcohol Use Disorders Identification Test (AUDIT) and its shorter counterpart the AUDIT-C, which contains the first 3 AUDIT questions, were developed by the World Health Organization and have become the preferred brief measures for screening and evaluating problem severity. This study compared the first 3 questions on the AUDIT with another psychometrically sound brief measure of alcohol use, the Quick Drinking Screen (QDS). METHODS: Data were obtained from a randomized controlled trial of a mail-based intervention promoting self-change with 472 alcohol abusers (n = 280, no prior alcohol treatment; n = 192, prior alcohol treatment). Participants' retrospective self-reports of alcohol consumption were collected using the QDS and the 3 AUDIT-C questions and compared. Although both measures contain similar questions (2 quantity-frequency and 1 binge drinking), they differ in 2 important ways: (i) temporal interval over which data are collected, and (ii) formatting of response options (i.e., a continuous number vs. categorical). RESULTS: Intraclass correlations for drinking variables were moderate to moderately high. A repeated-measures MANOVA using treatment condition and gender as variables revealed significant differences in absolute values between the 2 drinking measures with the QDS showing greater consumption on almost all variables. Participants' numerical answers on the QDS were compared to their categorical answers to the similar alcohol use questions on the AUDIT-C. The comparison revealed that participants' answers on the AUDIT-C were associated with extreme variability compared to their QDS answers. This variability suggests the AUDIT-C would be unreliable as a quantitative measure of alcohol consumption. CONCLUSIONS: The differences between the 3 alcohol use questions on the AUDIT-C and the same questions on the QDS may reflect the imprecision of the AUDIT-C's drinking response categories. Results suggest that the QDS can be used to identify risky drinking and to provide a more informative characterization of a drinker's alcohol consumption than that provided by the AUDIT-C.

Preventing alcohol-exposed pregnancies among Hispanic women.

Project Healthy CHOICES, a self-administered, mail-based prevention intervention, was developed for women at risk of an alcohol-exposed pregnancy (AEP). Participants were sent their assessment and study materials through the United States Postal Service. This article uses data from a larger study (N = 354) and focuses on the 89 women who identified as Hispanic. Potential participants who called in response to English and Spanish ads and who said they could read and write Spanish were given a choice of receiving the intervention materials in English or Spanish. The main objective of the present study was to evaluate differences in outcomes as a function of (a) the language in which the intervention materials were received, and (b) the participants' acculturation levels. Prior to the study, all women were at risk of an AEP. At the 6-month follow-up, two thirds (66%) of all Hispanic women had reduced their overall risk of an AEP, primarily by practicing effective birth control. These outcomes are similar to those reported for previous Project CHOICES studies. Significantly more women who requested the intervention materials in English (75%) compared to Spanish (41%) reduced their overall risk of an AEP. Women with high English cultural domain scores were at significantly less risk of an AEP due to effective contraception and a reduced overall risk of an AEP. Compared to other Project CHOICES studies, Project Healthy CHOICES is less intensive; it is self-administered, freely available, and can be completed without visiting a health care practitioner or clinic.

Individualized Behavior Therapy for Alcoholics - Republished Article.

A behavior therapy for alcoholism was designed based on the rationale that alcoholic drinking is a discriminated, operant response. Treatment emphasized determining setting events for each subject's drinking and training equally effective alternative responses to those situations. Seventy male, hospitalized, Gamma alcoholics were assigned to a treatment goal of either nondrinking (N=30) or controlled drinking (N=40). Subjects of each group were then randomly assigned to either an experimental group receiving 17 behavioral treatment sessions or a control group receiving only conventional treatment. Treatment of experimental groups differed only in drinking behaviors allowed during sessions and electric shock avoidance schedules. Nondrinker experimental subjects shaped to abstinence, while controlled drinker experimental subjects practiced appropriate drinking behaviors with little shaping, a result attributed to instructions. Follow-up measuring drinking and other behaviors found that experimental subjects functioned significantly better after discharge than control subjects, regardless of treatment goal. Successful experimental subjects could apply treatment principles to setting events not considered during treatment, suggesting the occurrence of rule learning. Results are discussed as evidence that some "alcoholics" can acquire and maintain controlled drinking behaviors. Traditional treatment of alcoholics may be handicapped by unvalidated beliefs concerning the nature of the disorder.

Craigslist versus print newspaper advertising for recruiting research participants for alcohol studies: Cost and participant characteristics.

INTRODUCTION: Technology has transformed our lifestyles in dramatic and significant ways, including new and less expensive options for recruiting study participants. This study examines cost and participant differences between two recruitment sources, Craigslist (CL), and print newspapers (PNs). This paper also reviewed and compared studies involving clinical trials published since 2010 that recruited participants using CL alone or in combination with other methods. METHOD: Secondary data analyses from a parent study involving a randomized controlled trial of a mail-based intervention to promote self-change with problem drinkers. RESULTS: Significant differences were found between CL and PN participants on most demographic and pretreatment drinking variables. While all participants had AUDIT scores suggestive of an alcohol problem and reported drinking at high-risk levels, CL participants had less severe drinking problem histories, were considerably younger, and had a higher socioeconomic status than PN participants. The total advertising costs for the 65 CL ads ($275) were significantly less than the 69 PN ads ($33, 311). The recruiting cost per eligible participant was vastly less expensive using CL ($1.46) compared to print newspaper ads ($116.88). CONCLUSIONS: Using CL is a viable recruitment method for soliciting participants, particularly those that are younger, for alcohol intervention studies. It is also less expensive than newspaper ads. When CL participants were recruited, they reported being slightly more confident to change their drinking than PN participants. Limitations of using CL are discussed, including that some initial ad responders gave inconsistent answers to similar questions and a few tried to enter the study more than once.

The Effect of Social Problem Solving Skills in the Relationship between Traumatic Stress and Moral Disengagement among Inner-City African American High School Students.

This study examined the relationship between traumatic stress, social problem solving, and moral disengagement among African American inner-city high school students. Participants consisted of 45 (25 males and 20 females) African American students enrolled in grades 10 through 12. Mediation was assessed by testing for the indirect effect using the confidence interval derived from 10,000 bootstrapped resamples. The results revealed that social problem-solving skills have an indirect effect on the relationship between traumatic stress and moral disengagement. The findings suggest that African American youth that are negatively impacted by trauma evidence deficits in their social problem solving skills and are likely to be at an increased risk to morally disengage. Implications for culturally sensitive and trauma-based intervention programs are also provided.

Self-change among Spanish speakers with alcohol and drug use disorders in Spain and the United States.

OBJECTIVE: Few cross-cultural studies have investigated the self-change process with substance abusers. This study examined commonalities and differences related to the self-change process with Spanish speaking self-changers in Spain and the United States (U.S.) who reported recovering from an alcohol or drug problem on their own (i.e., without formal help or treatment) for ≥1 year. METHOD: Advertisements were primarily used to recruit participants. There were 56 participants in the final sample (Spain, n=29; US; n=27). Participants provided demographic and substance use history information and completed the Drug Use History Questionnaire, Reasons for Change Scale, the Life Events Checklist, and a checklist for maintenance factors after recovery. RESULTS: Significantly more self-changers from the U.S. met DSM IV-TR criteria for alcohol dependence, reported significantly more life events in the year prior to recovery and significantly more maintenance/support events in the year after their recovery than their counterparts in Spain. The majority of participants' recoveries involved abstinence. Some alcohol abusers, however, report successfully engaging in low-risk drinking with no consequences(50% Spain; 22% U.S.), and some drug abusers in Spain (23%) reported a few days per year of very little drug use. CONCLUSIONS: The two groups of Spanish speakers represented very different cultures, and those from the U.S. came from several countries in the Southern hemisphere. The results of this study suggest that even though people speak the same language that does not mitigate against cultural differences. Additional studies of the process of self change with larger participant samples are needed to better inform the development and provision of interventions for Spanish speakers with alcohol and drug use disorders across different cultures and countries.

Reliability of the Timeline Followback for cocaine, cannabis, and cigarette use.

The Timeline Followback (TLFB), a retrospective calendar-based measure of daily substance use, was initially developed to obtain self-reports of alcohol use. Since its inception it has undergone extensive evaluation across diverse populations and is considered the most psychometrically sound self-report measure of drinking. Although the TLFB has been extended to other behaviors, its psychometric evaluation with other addictive behaviors has not been as extensive as for alcohol use. The present study evaluated the test-retest reliability of the TLFB for cocaine, cannabis, and cigarette use for participants recruited from outpatient alcohol and drug treatment programs and the general community across intervals ranging from 30 to 360 days prior to the interview. The dependent measure for cigarette smokers and cannabis users was daily use of cigarettes and joints, respectively, and for cocaine users it was a "Yes" or "No" regarding cocaine use for each day. The TLFB was administered in different formats for different drug types. Different interviewers conducted the two interviews. The TLFB collected highly reliable information about participants' daily use of cocaine, cannabis, and cigarettes from 30, 90, to 360 days prior to the interview. Findings from this study not only suggest that shorter time intervals (e.g., 90 days) can be used with little loss of accuracy, but also add to the growing literature that the TLFB can be used with confidence to collect psychometrically sound information about substance use (i.e., cocaine, cannabis, cigarettes) other than alcohol in treatment- and nontreatment-seeking populations for intervals from ranging up to 12 months prior to the interview.

Alcohol and drug treatment outcome studies: new methodological review (2005-2010) and comparison with past reviews.

OBJECTIVE: Several methodological reviews of alcohol treatment outcome studies and one review of drug studies have been published over the past 40 years. Although past reviews demonstrated methodological improvements in alcohol studies, they also found continued deficiencies. The current review allows for an updated evaluation of the methodological rigor of alcohol and drug studies and, by utilizing inclusion criteria similar to previous reviews, it allows for a comparative review over time. In addition, this is the first review that compares the methodology of alcohol and drug treatment outcome studies published during the same time period. METHOD: The methodology for 25 alcohol and 11 drug treatment outcome studies published from 2005 through 2010 that met the review's inclusion criteria was evaluated. The majority of variables evaluated were used in prior reviews. RESULTS: The current review found that more alcohol and drug treatment outcome studies are now using continuous substance use measures and assessing problem severity. Although there have been methodological improvements over time, the current reviews differed little from their most recent past counterpart. Despite this finding, some areas, particularly the continued low reporting of demographic data, needs strengthening. CONCLUSIONS: Improvement in the methodological rigor of alcohol and drug treatment outcome studies has occurred over time. The current review found few differences between alcohol and drug study methodologies as well as few differences between the current review and the most recent past alcohol and drug reviews.

Shorter and proximal Timeline Followback windows are representative of longer posttreatment functioning.

Very little research has been conducted on what time window provides a representative picture of daily drinking. With respect to pretreatment drinking, one study that used the Timeline Followback (TLFB) with problem drinkers found that a 3-month window is generally representative of annual pretreatment drinking. The objective of the present study was to determine the shortest representative time window for reports of annual posttreatment drinking. A second objective was to determine which of two time windows, 90 days from the end of treatment or 90 days prior to the end of follow-up, was the most representative proxy for annual posttreatment drinking. TLFB reports from 467 problem drinkers who participated in a randomized controlled trial of a mail-based intervention were used in the present analysis. The results show that a 3-month posttreatment window (i.e., first 90 days after the intervention) is sufficiently representative (r = .94) of annual posttreatment drinking for problem drinkers (i.e., less severely dependent alcohol abusers). In addition, although there were no clinically significant differences in drinking behavior between the two 90-day posttreatment windows, the use of proximal windows (i.e., closer to the end of treatment) would minimize participant attrition. In addition, a 3-month versus 12-month TLFB follow-up time frame resulted in a much higher percentage of participants completing the full TLFB (89% vs. 71%). Further research is needed to determine if these findings will generalize to more severely dependent alcohol abusers.

Psychometric properties of the Drug Use Disorders Identification Test (DUDIT) with substance abusers in outpatient and residential treatment.

The psychometric properties of the Drug Use Disorders Identification Test (DUDIT), an 11-item self-report questionnaire developed to screen individuals for drug problems, are evaluated. The measure, developed in Sweden and evaluated there with individuals with severe drug problems, has not been evaluated with less severe substance abusers or with clinical populations in the United States. Participants included 35 drug abusers in an outpatient substance abuse treatment program, 79 drug abusers in a residential substance abuse treatment program, and 39 alcohol abusers from both treatment settings who did not report a drug abuse problem. The DUDIT was found to be a psychometrically sound drug abuse screening measure with high convergent validity (r=.85) when compared with the Drug Abuse Screening Test (DAST-10), and to have a Cronbach's alpha of .94. In addition, a single component accounted for 64.91% of total variance, and the DUDIT had sensitivity and specificity scores of .90 and .85, respectively, when using the optimal cut-off score of 8. Additionally, the DUDIT showed good discriminant validity as it significantly differentiated drug from alcohol abusers. These findings support the DUDIT as a reliable and valid drug abuse screening instrument that measures a unidimensional construct. Further research is warranted with additional clinical populations.

Using one question to identify women at risk for an alcohol-exposed pregnancy.

CONTEXT: Consumption of 8 alcoholic drinks per week or 5 alcoholic drinks on one occasion by a pregnant woman can affect the developing fetus. However, it can be difficult to determine which patients are at risk. OBJECTIVE: To evaluate how well the answer to a single question about binge drinking could help identify women at risk of an alcohol-exposed pregnancy (AEP). METHODS: Using data from a study of methods to prevent AEPs, the authors compared the efficacy of self-reported answers to a screening question about binge drinking (5 or more standard drinks on one occasion) within the past 90 days with answers to a question about drinking quantity (weekly consumption of 8 or more standard drinks) within the past 90 days. RESULTS: The participants were 354 women of childbearing age who met screening criteria for being at risk of an AEP. The binge question was answered positively by 346 women (97.7%) at risk, while only 209 women (59.0%) reported that they drank 8 or more drinks in a week. CONCLUSION: A single question about binge drinking can effectively and quickly identify the majority of women at risk of an AEP.

A Dual-Focus Motivational Intervention to Reduce the Risk of Alcohol-Exposed Pregnancy.

Project CHOICES developed an integrated behavioral intervention for prevention of prenatal alcohol exposure in women at high risk for alcohol-exposed pregnancies. Settings included primary care, university-hospital based obstetrical/gynecology practices, an urban jail, substance abuse treatment settings, and a media-recruited sample in three large cities. The intervention was based on motivational interviewing and targeted both adoption of effective contraception and reduction of alcohol use. Treatment included 4 manual-guided sessions delivered by mental health clinicians and 1 contraceptive counseling session delivered by a family planning clinician. This paper describes the rationale for treatment; the use of motivational interviewing and the transtheoretical model for a dual-focused approach to behavior change; the development of the Project CHOICES intervention; development of the study protocol and treatment manual; and selection, training, supervision, and monitoring of study counselors. Implications for future applications of the intervention are discussed.

Continuities and changes in self-change research.

AIMS: A substantial literature demonstrates that natural recoveries from substance use disorders not only occur but are a common pathway to recovery. This article reviews selectively and comments on the current state-of-the-art in natural recovery research. METHODS: Basic concepts in natural recovery research are presented, and topical and methodological trends and changes in self-change research over time are discussed. CONCLUSIONS: Although considerable progress has occurred in natural recovery research, several topics deserving of further research are identified, and implications for policy practice are discussed.

Randomized controlled trial of a cognitive-behavioral motivational intervention in a group versus individual format for substance use disorders.

Although group therapy is widely used for individuals with substance use disorders (SUDs), randomized clinical trials (RCTs) comparing the same treatment in a group versus individual format are rare. This paper presents the results of a RCT comparing guided self-change (GSC) treatment, a cognitive-behavioral motivational intervention, conducted in a group versus individual format with 212 alcohol abusers and 52 drug abusers who voluntarily sought outpatient treatment. Treatment outcomes demonstrated significant and large reductions in clients' alcohol and drug use during treatment and at the 12-month follow-up, with no significant differences between the group and individual therapy conditions. A therapist time ratio analysis found that it took 41.4% less therapist time to treat clients using the group versus the individual format. Participants' end-of-treatment group cohesion scores characterized the groups as having high engagement, low levels of interpersonal conflict, and low avoidance of group work, all desirable group characteristics. These findings suggest that the GSC treatment model was effectively integrated into a brief group treatment format. Health care cost containment compels further evaluations of the efficacy of group treatments for SUDs.

A Quick Drinking Screen for identifying women at risk for an alcohol-exposed pregnancy.

Two previous studies comparing the Quick Drinking Screen (QDS) with the Timeline Followback (TLFB) found that these two instruments yielded similar reports of alcohol use for clinical and nonclinical populations of problem drinkers. The current study evaluated the correspondence between these two drinking measures with women at risk of an Alcohol-Exposed Pregnancy (AEP). Participants were 355 women who voluntarily participated in a research study during 2005 through 2007 designed to prevent AEPs. All women were screened by phone for eligibility using the QDS and approximately 2 weeks later completed a 3-month TLFB by mail. Results of this study, analyzed in 2008, paralleled previous studies showing that the QDS and the TLFB, two very different drinking measures, collected similar aggregate drinking data for women who drink heavily and are at risk of an AEP. Correspondence between the two drinking measures met acceptable levels of reliability. The present study found that the QDS has demonstrated efficacy for screening women whose level of alcohol use puts them at risk for an AEP. Although the QDS does not yield detailed drinking information, it could be used when it is not possible or necessary to gather daily drinking data.