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Efficacy of Relapse Prevention in Substance Use: A Meta-Analysis Review

This meta-analysis critiques the efficacy of relapse prevention on substance use disorders, specifically alcohol, cocaine, smoking, and polysubstance use, it also examines the effect on psychosocial adjustment.

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Efficacy of Relapse Prevention in Substance Use: A Meta-Analysis Review

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  1. Meta-Analysis Critique The Efficacy of Relapse Prevention on Substance Use Disorders Ashlee Carter 11/7/05

  2. Reference • Irvin, J.E., Bowers, C.A., Dunn, M.E., & Wang, M.C. (1999). Efficacy of Relapse Prevention: A Meta-Analytic Review. Journal of Consulting and Clinical Psychology, 67, 563-570.

  3. Research Domain • Clinical Psychology • Therapeutic Interventions • Substance Use Disorders • Alcohol Use • Cocaine Use • Smoking (Tobacco) • Polysubstance Use

  4. Central Questions • What is the effect of RP on substance use behavior • What is the effect of RP on overall psychosocial adjustment?

  5. Potential Moderating Variables • Class of substance use disorder • Treatment modality • Setting of treatment • Adjunctive use of medication • Outcome measures • Comparative efficacy of RP • Length of posttreatment follow-up

  6. Methods • Study identification: • Computerized databases • Reference lists • Contact prominent researchers to request unpublished data • Inclusion/Exclusion criteria • Result: 26 studies, 70 hypothesis tests, 9,504 participants

  7. Methods • Main effect sizes converted to r • Mini meta-analysis within studies • r transformed to Fisher’s z • Weighted average z score calculated • z converted back to r • Aggregate r across studies • 95% CI calculated • Weighted average r

  8. Results • Overall treatment effect of RP interventions for alcohol use disorders, substance use disorders, and smoking is r = .14 (95% CI = .10 – .17, n = 22). • Overall treatment effect of RP interventions on improving psychosocial adjustment is r = .48 (95% CI = .42 to .53, n = 10).

  9. Results: File drawer bias? • Fail-safe n = 388 (p = 0.05) • Number of undiscovered studies averaging no effect of RP interventions that would be required to reduce the obtained relationship to zero • Conclusion: The main effect is tolerant to future undiscovered null results

  10. Results: Moderator Analysis • Contrast analyses • Z scores • Problems: • Small sample sizes • Differences in effect sizes due to class of substance use disorder • Medication varies

  11. Results: Moderating Variables • 1) More effective in treating alcohol and polysubstance use than smoking or cocaine use. • 2) Equally effective in group and individual formats. • 3) Equally effective in outpatient and inpatient formats. • 4) More effective with adjunctive medication than without. • 5) Reported more effective in studies that used self-report versus biochemically validated self-report measures.

  12. Results: Moderating Variables • 6) Effective when evaluated with pretest-posttest designs and when compared to physician advice; only moderately effective when compared with psychoeducational groups or discussion controls. • 7) Treatment effects were largest when outcomes were assessed immediately following treatment and tended to become smaller as the length of follow-up increased.

  13. Conclusions: Done well • Large sample of studies • Appropriate methods • Weighted averaged r • Mini meta-analysis in z • Methods clearly outlined • Formulas included • Table • Original statistic included • Coding for moderator clearly described

  14. Conclusions: Done well • Dot Plot • General progression of effect size • No gaps Published and unpublished studies • File drawer bias addressed • Statistics consistently presented • Limitations admitted

  15. Conclusions: Questionable? • Study identification method • Publication bias? • Study rigor? • Moderator analyses • Small sample sizes • Adjustment of alpha levels? • Interpretable?

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