Quality of Research
Review Date: November 2010
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Hester, R. K., Delaney, H. D., & Campbell, W. (2010). ModerateDrinking.com and Moderation Management: Outcomes of a randomized clinical trial with non-dependent problem drinkers. Manuscript submitted for publication.
Supplementary Materials Carroll, K. M., Ball, S. A., Martino, S., Nich, C., Babuscio, T. A., Nuro, K. F., et al. (2008). Computer-assisted delivery of cognitive-behavioral therapy for addiction: A randomized trial of CBT4CBT. American Journal of Psychiatry, 165(7), 881-888. 
Carroll, K. M., Ball, S. A., Martino, S., Nich, C., Babuscio, T. A., & Rounsaville, B. J. (2009). Enduring effects of a computer-assisted training program for cognitive behavioral therapy: A 6-month follow-up of CBT4CBT. Drug and Alcohol Dependence, 100(1-2), 178-181.
Hester, R. K., Delaney, H. D., Campbell, W., & Handmaker, N. (2009). A Web application for moderation training: Initial results of a randomized clinical trial. Journal of Substance Abuse Treatment, 37(3), 266-276.
Humphreys, K., & Klaw, E. (2001). Can targeting nondependent problem drinkers and providing Internet-based services expand access to assistance for alcohol problems? A study of the Moderation Management self-help/mutual aid organization. Journal of Studies on Alcohol, 62(4), 528-532.
Miller, W. R., & Marlatt, G. A. (1984). Comprehensive Drinker Profile (CDP) manual supplement for use with Brief Drinker Profile, Follow-Up Drinker Profile, Collateral Interview Form. Retrieved from http://casaa.unm.edu/inst/CDPmana.pdf
Miller, W. R., Tonigan, J. S., & Longabaugh, R. (1995). Scale construction and item analysis. In The Drinker Inventory of Consequences (DrInC): An instrument for assessing adverse consequences of alcohol abuse. Project MATCH Monograph Series, Vol. 4 (DHHS Publication No. 95-3911, pp. 5-16). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism.
Squires, D. D., & Hester, R. K. (2002). Computer-based brief intervention for drinkers: The increasing role for computers in the assessment and treatment of addictive behaviors. Behavior Therapist, 25(3), 59-65.
Outcomes
| Outcome 1: Alcohol abstinence |
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Description of Measures
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Alcohol abstinence was measured as the percentage of days abstinent (PDA) in the past 90 days. It was assessed using a self-administered, online version of the Brief Drinker Profile (BDP) and independently verified by collateral report from a significant other on the Collateral Interview Form (CIF). The BDP, derived from the Comprehensive Drinker Profile, is a 50-minute structured interview that measures the quantity and frequency of current drinking and the severity of risk factors across eight life domains: demographics, family and employment status, history of problem development, alcohol-related problems, severity of dependence, other drug use, additional life problems, and motivation for treatment. Participants completed the BDP in the clinic where the study was conducted using a Web application separate from ModerateDrinking.com. The CIF, with items that parallel those in the BDP, is administered to a significant other for verification of self-reported drinking behavior. Assessments occurred at baseline and at 3-, 6-, and 12-month follow-ups. Study participants received phone calls reminding them to return to the clinic to complete the BDP follow-up assessments (to ensure sobriety), and a research assistant administered the CIF by telephone to the identified significant other a few days after completion of the BDP.
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Key Findings
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Individuals concerned about their drinking were recruited for a 12-month randomized clinical trial. After phone and in-person screening to exclude individuals with alcohol dependence or comorbid conditions, participants were randomly assigned to one of two intervention conditions: MD plus MM or MM only. For both groups, PDA averaged across the three follow-ups was higher than PDA at baseline (p < .001); however, the increase in PDA was greater for MD plus MM participants than for MM-only participants (28.6% vs. 7.8%; p = .004). This group difference was associated with a medium effect size (Cohen's d = 0.65).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.0
(0.0-4.0 scale)
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| Outcome 2: Alcohol-related problems |
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Description of Measures
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Alcohol-related problems were measured using an online version of the Drinker Inventory of Consequences (DrInC), a 50-item self-report questionnaire that measures the consequences of both lifetime and recent (past 90 days) drinking behavior across five life domains: interpersonal, physical, social, impulsive, and intrapersonal. Participants completed the DrInC in the clinic where the study was conducted using a Web application separate from ModerateDrinking.com. Assessments occurred at baseline and at 3-, 6-, and 12-month follow-ups. Study participants received phone calls reminding them to return to the clinic to complete the DrInC follow-up assessments (to ensure sobriety).
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Key Findings
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Individuals concerned about their drinking were recruited for a 12-month randomized clinical trial. After phone and in-person screening to exclude individuals with alcohol dependence or comorbid conditions, participants were randomly assigned to one of two intervention conditions: MD plus MM or MM only. For both groups, the number of alcohol-related problems averaged across the three follow-ups was fewer than the number of alcohol-related problems at baseline (p < .001); however, the decrease in alcohol-related problems was greater for MD plus MM participants than for MM-only participants from baseline to the 3-month follow-up (p = .011). This group difference was no longer significant at the 6- and 12-month follow-ups.
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.0
(0.0-4.0 scale)
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| Outcome 3: Peak alcohol use on drinking days |
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Description of Measures
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Peak alcohol use on drinking days was measured as the median peak blood alcohol content (BAC) per drinking day during the past 90 days. Median peak BAC per drinking day was estimated using a self-administered, online version of the BDP and independently verified by collateral report from a significant other on the CIF. The BDP, derived from the Comprehensive Drinker Profile, is a 50-minute structured interview that measures the quantity and frequency of current drinking and the severity of risk factors across eight life domains: demographics, family and employment status, history of problem development, alcohol-related problems, severity of dependence, other drug use, additional life problems, and motivation for treatment. Participants completed the BDP in the clinic where the study was conducted using a Web application separate from ModerateDrinking.com. The CIF, with items that parallel those in the BDP, is administered to a significant other for verification of self-reported drinking behavior. Assessments occurred at baseline and at 3-, 6-, and 12-month follow-ups. Study participants received phone calls reminding them to return to the clinic to complete the BDP follow-up assessments (to ensure sobriety), and a research assistant administered the CIF by telephone to the identified significant other a few days after completion of the BDP.
Study participants were dichotomized as "binge" or "nonbinge" drinkers on the basis of NIAAA's binge drinking definition: more than five drinks per drinking occasion for men or more than four drinks per drinking occasion for women.
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Key Findings
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Individuals concerned about their drinking were recruited for a 12-month randomized clinical trial. After phone and in-person screening to exclude individuals with alcohol dependence or comorbid conditions, participants were randomly assigned to one of two intervention conditions: MD plus MM or MM only. Among the findings from this study were the following:
- From baseline to the 12-month follow-up, MD plus MM participants had a greater decrease in median peak BAC per drinking day than MM-only participants (p = .018). This group difference was associated with a medium effect size (Cohen's d = 0.62).
- Among nonbinge drinkers, the decrease in median peak BAC per drinking day from baseline to the average across the three follow-ups was greater for MD plus MM participants than for MM-only participants (85 mg% to 46 mg% vs. 51 mg% to 42 mg%; p = .008). This group difference was associated with a large effect size (Cohen's d = 1.0).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.0
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
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56.3% Female
43.8% Male
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78.8% White
18.8% Hispanic or Latino
2.5% Race/ethnicity unspecified
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Alcohol abstinence
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2.3
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3.0
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3.5
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2.5
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3.0
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3.5
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3.0
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2: Alcohol-related problems
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2.8
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3.0
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3.5
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2.5
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3.0
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3.5
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3.0
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3: Peak alcohol use on drinking days
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2.3
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3.0
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3.5
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2.5
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3.0
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3.5
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3.0
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Study Strengths The BDP and the DrInC are well-known assessment instruments in the field and have excellent psychometric properties. The study used collateral reports from significant others to establish convergent validity of self-reported drinking behavior on the BDP. The Web-based format of the intervention strengthened intervention fidelity in that the content delivered to each participant was identical; additionally, participants were queried by email on how much they accessed the Web sites. Attrition and missing follow-up data were handled by imputation and a sophisticated mixed-model analysis approach. Separate analyses were performed for study completers and noncompleters to rule out significant between-group differences. Potential confounds were limited by the use of randomization and a comparison condition that provided a good attention control to the target intervention. The analysis used an intent-to-treat approach with an adequate sample size based on a prospective power analysis, and it included effect sizes for condition contrasts in addition to traditional tests of significance.
Study Weaknesses The conversion of the BDP, a structured interview, to an online, self-administered questionnaire was of concern because no sample reliability data were provided to show comparability to the original interview instrument. Convergent validity of the BDP self-reports with collateral reports was weak (correlations of .41-.48) for the baseline and 3- and 6-month follow-up assessments. The study had an overall attrition rate of 25% and differential attrition across conditions (21% for the intervention group and 31% for the comparison group). A potential confound and design limitation was the absence of an assessment-only control group. The investigators did not fully justify the decision to average outcome-specific measures across the three follow-up assessments rather than use a more customary growth-curve modeling approach, which would have examined change over time across multiple follow-ups.
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