title: When should clinicians switch treatments? An application of signal detection theory to two treatments for women with alcohol use disorders.
abstract: Statistical application of signal detection theory has been used to study the clinical utility of early treatment response in a range of treatments and psychiatric disorders. The current study sought to examine the predictive value of weekly within-treatment drinking using receiver operator curves (ROCs) and zero-inflated Poisson (ZIP) regression in 102 women with alcohol use disorders (AUDs) randomized to either alcohol behavioral individual treatment (ABIT; n = 52) or alcohol behavioral couples treatment (ABCT; n = 50). ROC analyses indicated that failure to achieve or sustain abstinence by the end-of-treatment and one-year follow-up was predicted with reasonable accuracy by week 4 percent days abstinent (PDA) in ABIT. ZIP models yielded similar results with evidence for within-treatment PDA with week 6 PDA predicting both the abstinence as well as percent days drinking at the end-of-treatment and one-year follow-up. Within-treatment PDA was a significantly better predictor of outcomes for ABIT than ABCT, despite a better overall treatment response for ABCT. Implications for stepped care models of alcohol treatment are discussed and recommendations for future research made.
authors.affiliation: Mount Sinai School of Medicine, Department of Psychiatry, One Gustave L. Levy Place, New York, NY 10029, USA. tom.hildebrandt@mssm.edu
authors.forename: Tom
authors.initials: T
authors.lastname: Hildebrandt
authors.forename: Barbara
authors.initials: B
authors.lastname: McCrady
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Epstein
authors.forename: Sharon
authors.initials: S
authors.lastname: Cook
authors.forename: Noelle
authors.initials: N
authors.lastname: Jensen
mesh_terms: D000328:Adult; D000368:Aged; D019973:Alcohol-Related Disorders / Q000523:psychology / Q000628:therapy*; D019540:Area Under Curve; D001521:Behavior Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D008962:Models, Theoretical; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010347:Patient Care Planning; D016012:Poisson Distribution; D011237:Predictive Value of Tests; D012372:ROC Curve; D055502:Secondary Prevention; D017603:Signal Detection, Psychological; D017211:Treatment Failure; D016896:Treatment Outcome