Analytic methods for modeling longitudinal data from rolling therapy groups with membership turnover.

Interventions for a variety of emotional and behavioral problems are commonly delivered in the context of treatment groups, with many using rolling admission to sustain membership (i.e., admission, dropout, and discharge from group are perpetual and ongoing). The authors present an overview of the analytic challenges inherent in rolling group data and outline commonly used (but flawed) analytic and design approaches to addressing (or sidestepping) these issues. Moreover, the authors propose use of latent class pattern mixture models (LCPMMs) as a statistically and conceptually defensible approach for modeling treatment data from rolling groups. The LCPMM approach is illustrated with rolling group data from a group-based alcoholism pilot treatment trial (N = 128). Different inferences were made with regard to treatment efficacy under LCPMM vs. the commonly used standard group-clustered latent growth model (LGM); coupled with other preliminary findings in this area, inferences from LGMs may be overly liberal when applied to data from rolling groups. Continued work on data analytic difficulties in groups with membership turnover is critical for furthering the ecological validity of research on behavioral treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Partner violence before and after individually based alcoholism treatment for male alcoholic patients.

This study examined partner violence in the year before and the year after individually based, outpatient alcoholism treatment for 301 married or cohabiting male alcoholic patients and used a demographically matched nonalcoholic comparison sample. In the year before treatment, 56% of the alcoholic patients had been violent toward their female partner, 4 times the rate of 14% in the comparison sample. In the year after treatment, violence decreased significantly to 25% of the alcoholic sample but remained higher than in the comparison group. Among remitted alcoholics after treatment, violence prevalence of 15% was nearly identical to the comparison sample and half the rate among relapsed patients (32%). Thus, partner violence decreased after alcoholism treatment, and clinically significant violence reductions occurred for patients whose alcoholism was remitted after treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of cognitive rehabilitation on the neuropsychological status of patients in drug abuse treatment who display neurocognitive impairment.

72 patients engaged in residential drug abuse treatment who also had cognitive impairment were randomly assigned to 1 of 4 groups. One group of patients received 2 hrs of computer-assisted cognitive rehabilitation per week over a 6-mo period; a 2nd group received 2 hrs of progressive muscle relaxation per week over a 6-mo period; a 3rd group was taught typing on a computer; and a 4th group received no treatment beyond that provided by the program. All patients were tested with a neuropsychological test battery at admission and at monthly intervals thereafter for 6 mo. Results show that Ss in the cognitive rehabilitation group demonstrated a faster rate of cognitive recovery during the first 2 mo of treatment and had more efficient cognitive functioning over the first 4 mo of residence. These patients were also rated as more "appropriately participatory" in the treatment program by the clinical staff. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Occurrence of Male-to-Female Intimate Partner Violence on Days of Men's Drinking: The Moderating Effects of Antisocial Personality Disorder.

In this study, the moderating effects of antisocial personality disorder (ASPD) on the day-to-day relationship between male partner alcohol consumption and male-to-female intimate partner violence (IPV) for men entering a domestic violence treatment program (n = 170) or an alcoholism treatment program (n = 169) were examined. For both samples, alcohol consumption was associated with an increased likelihood of nonsevere IPV among men without a diagnosis of ASPD but not among men with ASPD (who tended to engage in nonsevere IPV whether they did or did not drink). Drinking was more strongly associated with a likelihood of severe IPV among men with ASPD compared with those without ASPD who also drank. These results provide partial support for a multiple threshold model of intoxication and aggression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating intimate partner violence among substance-abusing dyads: The effect of couples therapy.

This study examined whether participation in couples therapy, compared with individual therapy, had a differential effect on the day-to-day relationship between substance use and occurrences of intimate partner violence (IPV) among married or cohabiting substance-abusing men. Patients (N = 207) were randomly assigned to either partner-involved behavioral couples therapy (BCT; included non-substance-abusing female partners in conjoint sessions) or individual-based treatment (IBT; male partners only). Couples in BCT reported lower levels of IPV and substance use at a 12-month posttreatment follow-up compared with couples with male partners in IBT. Moreover, treatment assignment was a significant moderator of the day-to-day relationship between substance use and IPV. Likelihood of nonsevere and severe male-to-female partner violence on days of male partners’ substance use was lower among couples who received BCT compared with IBT. These findings indicate couples therapy may play an important role in the treatment of IPV among substance-abusing couples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Learning sobriety together: A randomized clinical trial examining behavioral couples therapy with alcoholic female patients.

Married or cohabiting female alcoholic patients (n = 138) and their non-substance-abusing male partners were randomly assigned to 1 of 3 equally intensive interventions: (a) behavioral couples therapy plus individual-based treatment (BCT; n = 46), (b) individual-based treatment only (IBT; n = 46), or (c) psychoeducational attention control treatment (PACT; n = 46). During treatment, participants in BCT showed significantly greater improvement in dyadic adjustment than those in IBT or PACT; drinking frequency was not significantly different among participants in the different conditions. During the 1-year posttreatment follow-up, compared with participants who received IBT or PACT, participants who received BCT reported (a) fewer days of drinking, (b) fewer drinking-related negative consequences, (c) higher dyadic adjustment, and (d) reduced partner violence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analytic complexities associated with group therapy in substance abuse treatment research: Problems, recommendations, and future directions.

In community-based alcoholism and drug abuse treatment programs, the vast majority of interventions are delivered in a group therapy context. In turn, treatment providers and funding agencies have called for more research on interventions delivered in groups in an effort to make the emerging empirical literature on the treatment of substance abuse more ecologically valid. Unfortunately, the complexity of data structures derived from therapy groups (because of member interdependence and changing membership over time) and the present lack of statistically valid and generally accepted approaches to analyzing these data have had a significant stifling effect on group therapy research. This article (a) describes the analytic challenges inherent in data generated from therapy groups, (b) outlines common (but flawed) analytic and design approaches investigators often use to address these issues (e.g., ignoring group-level nesting, treating data from therapy groups with changing membership as fully hierarchical), and (c) provides recommendations for handling data from therapy groups using presently available methods. In addition, promising data-analytic frameworks that may eventually serve as foundations for the development of more appropriate analytic methods for data from group therapy research (i.e., nonhierarchical data modeling, pattern-mixture approaches) are also briefly described. Although there are other substantial obstacles that impede rigorous research on therapy groups (e.g., evaluation and measurement of group process, limited control over treatment delivery ingredients), addressing data-analytic problems is critical for improving the accuracy of statistical inferences made from research on ecologically valid group-based substance abuse interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Computer-assisted cognitive rehabilitation for the treatment of patients with substance use disorders: A randomized clinical trial.

The purpose of this study was to examine the comparative efficacy of cognitive rehabilitation as an intervention for substance misuse. Patients with substance use disorders entering long-term residential care (N = 160) were randomly assigned to one of two conditions: (a) standard treatment plus computer-assisted cognitive rehabilitation (CACR), which was designed to improve cognitive performance in areas such as problem solving, attention, memory, and information processing speed; and (b) an equally intensive attention control condition consisting of standard treatment plus a computer-assisted typing tutorial (CATT). Participants were assessed at baseline, during treatment, at treatment completion, and 3-, 6-, 9-, and 12-month follow-up. Intent-to-treat analyses showed that, compared with those randomized to CATT, patients who received CACR were significantly more engaged in treatment (e.g., higher ratings of positive participation by treatment staff, higher ratings of therapeutic alliance), more committed to treatment (e.g., longer stays in residence) and reported better long-term outcomes (e.g., higher percentage of days abstinent after treatment). Mediational analyses revealed the positive comparative effect of CACR on abstinence during the year after treatment was mediated by treatment engagement and length of stay in residence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)