When should clinicians switch treatments? An application of signal detection theory to two treatments for women with alcohol use disorders.
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.
Hildebrandt
Tom
T
Mount Sinai School of Medicine, Department of Psychiatry, One Gustave L. Levy Place, New York, NY 10029, USA. tom.hildebrandt@mssm.edu
McCrady
Barbara
B
Epstein
Elizabeth
E
Cook
Sharon
S
Jensen
Noelle
N
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