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Biomedical subjects

L C Sobell

Publications and source records attributed to L C Sobell.

At least 19 recordsLinked to original sources
PubMed1998

Evaluation of the readiness to change questionnaire with problem drinkers in treatment.

Prochaska and DiClemente's (1982, 1983) readiness to change model proposes that people resolve health-related concerns by working through a qualitative progression of distinct motivational stages. The present study examined the responses of 66 (44 males, 22 females) mildly dependent outpatient alcohol abusers to the Readiness to Change Questionnaire, a scale developed to classify individuals according to their motivational stage. It has been suggested that the RTCQ may have applicability to problem drinkers in treatment. Reliability analyses conducted on the questionnaire's three subscales resulted in alpha coefficients of .30 for the Precontemplation subscale, .52 for the Contemplation subscale, and .76 for the Action subscale. The low internal reliability for the first two subscales does not support the use of this questionnaire in a treatment context at this time. Further studies are needed to refine the subscales. A psychometrically sound measure, once developed, would provide guidance in treatment matching.

Adult↗
PubMed1997

Factors affecting agreement between alcohol abusers' and their collaterals' reports.

OBJECTIVE: Because of their low cost and ease of use, collaterals' reports are the most frequent source of independent corroboration with alcohol abusers' self-reports of drinking and related events. Although several reviews have shown that we can have confidence in the accuracy of alcohol abusers' reports of their drinking and in the use of collateral reports as an independent validity criterion, neither data source is error free. This study examined factors that influence the level of agreement between collaterals' and alcohol abusers' reports. METHOD: Using data from a study of natural recoveries from alcohol-related problems, this study examined how agreement between 120 alcohol abusers' (79.2% male) and their collaterals' reports varied as a function of collateral type and of the collaterals' ratings of their confidence in the accuracy of their reports of the subjects' drinking and related behaviors. Collaterals' awareness of nonalcohol-related levels was also examined. RESULTS: The best agreement occurred for reports from alcohol abusers' spouses who were fairly confident about the information provided. For all variables, some proportion of collaterals respond to demand characteristics of the interview by providing very specific information about subjects' behavior yet admit to being unsure of this information. CONCLUSIONS: Collaterals who are fairly sure of the information they provide are the preferred informants to corroborate alcohol abusers' reports of drinking and related behaviors. In some cases the best collaterals are spouses who are fairly sue of the information they reported. It is also recommended that treatment outcome studies should accept reports only from collaterals who are confident about the information they report.

Adult↗
PubMed1997

Toward a stepped care approach to treating problem drinkers: the predictive utility of within-treatment variables and therapist prognostic ratings.

AIMS: Cost containment, a central issue in current health planning, encourages the use of brief interventions. Although brief interventions for problem drinkers have proved successful, a portion of such individuals do not change their alcohol use during treatment. DESIGN: Repeated measures design (pre-treatment, within-treatment and 6 months post-treatment). SETTING AND PARTICIPANTS: To identify individuals at risk for continued problem drinking, predictors of post-treatment drinking were examined for 212 problem drinkers who presented for treatment in an outpatient treatment clinic. INTERVENTION: All participants completed a brief cognitive behavioral motivational intervention. MEASUREMENTS: At the pre-treatment assessment demographic, drinking pattern, severity of dependence and other cognitive variables (e.g. self-efficacy, goal choice) were collected. Within-treatment, drinking pattern and cognitive variables such as self-efficacy and goal choice were again measured. FINDINGS: Regression analyses showed that therapist prognosis ratings contributed significantly to the prediction of outcome even when pre-treatment variables were controlled. However, when within-treatment variables were included in the prediction, variables such as within treatment drinking eliminated the predictive utility of therapist prognosis ratings. This pattern held for both percentage of days abstinent and drinks per drinking day at a 6-month follow-up. CONCLUSIONS: It is suggested that a stepped care approach based on prediction models that include clients' within-treatment response can be applied to the treatment of problem drinkers who show little initial response to treatment.

Adult↗
PubMed1996

The reliability of the Alcohol Timeline Followback when administered by telephone and by computer.

The Alcohol Timeline Followback (TLFB) has been shown to be a psychometrically sound assessment instrument for obtaining retrospective daily estimates of alcohol consumption. These evaluations, however, have been limited to face-to-face paper-and-pencil interviews. As use of the TLFB method has increased, investigators have reported using the method to collect follow-up data by telephone. Also, as with many assessment instruments, a computerized version of the TLFB method has been developed. The psychometric characteristics of the TLFB method under these administration conditions have not been evaluated. This paper presents results from two studies showing that the Alcohol TLFB method can obtain reliable drinking data when administered over the telephone and by computer.

Adult↗
PubMed1996

Relationship between posttreatment drinking and alternative responses to high-risk situations proposed during treatment by problem drinkers.

Problem drinkers' alternatives to high-risk situations were evaluated and related to treatment outcome. participants were 80 problem drinkers (64% males, 36% females) who completed a brief outpatient Guided Self-Change treatment. Treatment included a homework exercise where clients identified two to three high-risk situations and generated alternative responses for each situation. Based on a coding scheme developed by Moser and Annis (1996), responses were coded as (a) cognitive or behavioral, and (b) active or avoidant. Results indicated that the proportion of cognitive coping responses (e.g., thinking through the consequences) was positively related to posttreatment improvement. This prospective study suggests that intention to use active cognitive coping responses influences the relapse process.

Adaptation, Psychological↗
PubMed1996

Aftercare telephone contacts with problem drinkers can serve a clinical and research function.

Research staff typically gather treatment outcome data, whereas clinicians perform aftercare contacts. To date no alcohol treatment outcome study has examined the utility of therapists collecting outcome data through aftercare contacts. Using the Alcohol Timeline Followback (TLFB) method modified for clinical aftercare contacts, 154 problem drinkers who were part of a cognitive-behavioral intervention completed the modified TLFB with their primary therapist during aftercare telephone contacts conducted 1 and 3 months after their last treatment session. Clients reported their daily alcohol use over the past 30 days using four consumption categories (i.e. 0 drinks, 1-4 drinks, 5-9 drinks and 10+ drinks). At a 6-month follow-up research interview, a trained research assistant gathered standard TLFB data from the clients that included the time period for aftercare contacts. Correlations between the two TLFB formats showed good alternate form reliability, especially for frequency of alcohol use. Discrepancies between reports were positively associated with heavier pre-treatment and post-treatment drinking, suggesting possible memory biases among heavier drinkers. Subject reports also closely paralleled collateral reports of the subjects' drinking. These results support the utility of a brief TLFB instrument for use by therapists in assessing clients' outcomes by telephone during aftercare contacts.

Adolescent↗
PubMed1996

Recovery from alcohol problems with and without treatment: prevalence in two population surveys.

OBJECTIVES: The purpose of this study was to determine the prevalence of recovery from alcohol problems with and without treatment, including whether such recoveries involved abstinence or moderate drinking. METHODS: Data from two surveys of randomly selected adults in the general population were analyzed. Random-digit dialing was used to conduct telephone interviews with 11,634 and 1034 respondents. Respondents 20 years of age or older were categorized on the basis of drinking status and history. RESULTS: Both surveys found that most individuals (77.5% and 77.7%) who had recovered from an alcohol problem for 1 year or more did so without help or treatment. A sizable percentage (38% and 63%) also reported drinking moderately after resolving their problem. CONCLUSIONS: These two surveys are among the first to report prevalence rates for recovery from alcohol problems for treated and untreated individuals and for moderation and abstinence outcomes.

Adult↗
PubMed1995

Effect of cigarette smoking on alcohol treatment outcome.

Although smoking cigarettes and drinking alcohol are highly correlated, little research has examined the effects of smoking on alcohol abusers' posttreatment functioning. Alcohol abusers (N = 155) were classified on the basis of their pretreatment smoking status as: nonsmoker, ex-smoker, low dependent smoker (first cigarette of the day > 10 minutes after waking), and high dependent smoker (first cigarette of the day < or = 10 minutes after waking). All subjects had received brief cognitive-behavioral outpatient treatment for their alcohol problem. Subjects who were less dependent on nicotine had fewer drinking days and fewer heavy drinking days prior to entering treatment than those who were more dependent on nicotine; the two nonsmoking groups had fewer abstinent days than the low nicotine-dependent subjects and fewer heavy drinking days than the high nicotine-dependent subjects. At the 1-year follow-up, the two smoking groups did not differ from each other on the alcohol variables but reported significantly more abstinent days than the two nonsmoking groups. Treatment implications are discussed.

Adult↗
PubMed1995

Resolution from alcohol problems with and without treatment: reasons for change.

Volunteers at a local science center were asked their reasons for quitting or reducing their alcohol consumption. Of 248 respondents, 64 were classified as having had an alcohol problem from which they had successfully resolved for 1 or more years. Three quarters of all respondents resolved without treatment or self-help groups, and over half (57.8%, 37 of 64) of these respondents' resolutions involved nonabstinence (i.e., moderate drinking). The reason for resolution most often endorsed by respondents was that they had "weighed the pros and cons of drinking and not drinking." The implications of these findings for intervention programs are discussed.

Adult↗
PubMed1994

Beliefs about the causes of substance abuse: a comparison of three drugs.

Respondents were randomly assigned to one of three conditions and completed a questionnaire asking about their beliefs regarding the causes of alcohol abuse, cocaine abuse, or cigarette smoking, and about their humanitarian attitudes toward substance abusers. Three major findings emerged: (a) compared to the other substances of abuse, the disease concept was most strongly endorsed for alcohol abuse, the sin conception for cocaine abuse, and the habit conception for smoking; (b) for alcohol abuse only, endorsement of the disease concept was positively related to humanitarian attitudes; and (c) for all three substance types, the sin conception was negatively related to the expression of humanitarian attitudes. Implications of these findings are discussed.

Adult↗
PubMed1994

Clinical efficacy of the 5-HT3 antagonist ondansetron in alcohol abuse and dependence.

Medications that act on the serotonergic system have been found to be of benefit in the treatment of alcohol-dependent individuals. In a randomized, placebo-controlled study, the efficacy of 6 weeks of ondansetron, a 5-HT3 antagonist (0.25 mg bid or 2.0 mg bid), in the treatment of 71 nonseverely alcohol-dependent males was tested. The results showed reduction of drinking differences were steadily increasing toward the end of the treatment period approached significance at week 7 in the 0.25 mg group (p = 0.06). Twice as many patients in this group showed > or = 2 standard deviations decrease in drinking compared with the other groups. When patients drinking > 10 drinks/drinking day at baseline (n = 11) were excluded from the analysis, significant group differences were found at both treatment and follow-up, with the lower ondansetron dose producing the greatest reduction from baseline (i.e., 2.8 standard drinks; -35% compared with baseline and -21% compared with placebo; p < 0.02-0.001). Within this group, there was an almost 4-fold greater number of patients showing a clinically meaningful decrease in drinking. Lower baseline drinking and higher level of education were significant and strong predictors of drinking reduction during treatment. Ondansetron was very well tolerated; hence, further long-term studies with 5-HT3 antagonists alone or in combination with other treatment components may offer promise for treatment of alcoholism.

Adult↗
PubMed1993

What triggers the resolution of alcohol problems without treatment.

This study investigated natural recoveries (self-change) from alcohol problems, and overcame several methodological problems that affected the few previous studies of this phenomenon. Three groups of individuals who had resolved an alcohol problem without treatment were interviewed about their drinking history, life events that occurred during the year prior to their resolution, and factors that helped maintain their resolution. As a control for prevalence of life events, a control group of nonresolved, nontreated alcohol abusers were interviewed about events in a randomly selected year. Collaterals were interviewed for all subjects. No life event or constellation of events was differentially associated with the resolutions across the three resolved groups or differentiated the resolved and nonresolved groups. Interviews with resolved subjects were qualitatively analyzed-the majority (57%) of recoveries were characterized as involving a "cognitive evaluation" or appraisal of the pros and cons of drinking. Spousal support was reported by the greatest number of resolved subjects as having helped them maintain their resolution. Findings from this study may provide direction for developing new treatment strategies and for accelerating self-change among problem drinkers in the community. The study also demonstrates the importance of using a control group, without which very different conclusions might have been drawn.

Adult↗
PubMed1993

What's in a label? The effects of substance types and labels on treatment considerations and stigma.

Visitors (N = 579) to a science center read selected scenarios and evaluated the most likely outcome for a hypothetical substance abuser. Respondents were randomly assigned to one of six scenario conditions: a person with one of three different substance abuse problems (alcohol, tobacco, or cocaine) was crossed with two labels reflecting high or low substance dependence. Results indicated that: (1) cigarettes were viewed as a less serious substance abuse problem than were alcohol or cocaine (a person who smoked cigarettes was rated as more likely to recover from his problem, self-change was regarded as more appropriate and less stigma was associated with smoking than with the other two drugs); (2) non-abstinent recoveries of all types were greeted with skepticism; and (3) recovery was rated as more likely to occur from treatment than from self-change.

Adaptation, Psychological↗
PubMed1993

Severely dependent alcohol abusers may be vulnerable to alcohol cues in television programs.

The self-reported ability of 96 alcohol abusers to resist the urge to drink heavily was assessed after they viewed a videotape of a popular prime time television program complete with advertisements. Different versions of the videotape were used to evaluate the effects of a television program with and without alcohol scenes as crossed with the effects of three different types of commercials (i.e., beer, nonalcoholic beverages, food). Before and after viewing the videotape, subjects, who were led to believe that they were participating in two separate and unrelated sets of experimental procedures, completed several drinking questionnaires. Responses to one of the questionnaires provided an unobtrusive measure of self-reported ability to resist the urge to drink heavily. Results indicated that alcohol cues in a television program affected some alcohol abusers' perceived ability to resist the urge to drink heavily. In particular, those with higher alcohol dependence scores showed a decrease in confidence after viewing a television program with alcohol cues compared to subjects who watched the same program but without the alcohol scenes. The clinical implications of these findings are discussed. Until further research is forthcoming, given the artificial nature of the study setting, the results of this study must be viewed with some caution.

Adult↗
PubMed1992

Gender issues in the treatment of abusers of alcohol, nicotine, and other drugs.

This review considers gender issues in the recent literature for alcohol, nicotine, and other psychoactive drug abuse and for each of the three drug types reports: (1) the ratio of men to women treated; (2) gender differences in treatment outcome; (3) whether the senior author's gender is related to the gender ratio of subjects in studies; and (4) the percentage of studies reporting methodological variables by gender (e.g., dropouts, outcome). No evidence for sex differences was obtained for any drug class. However, despite the recognized importance of gender as a treatment variable, the majority (72%) of studies failed to address gender differences in treatment outcome.

Adult↗