Moratorium on Maltzman: an Appeal to Reason

Maltzman\u27s comment on Cook (1985), which appears elsewhere in this issue, is an unveiled attempt to resurrect the same allegations about our research that he made 7 years ago. None of the allegations are new! Over the past 7 years, those allegations have been the topic of 5 separate inquiries, in each of which we were vindicated. In this response, we review the multiple inquiries and we show how Maltzman continues to (1) cite our work out of context, (2) make false assumptions about the inquiries and our procedures and (3) disregard evidence contradicting his assertions. He relies on data that, to use his characterization, are a tempest in a teapot. Having answered the same fundamental attack time and again over the past 7 years, we declare a unilateral moratorium on responding to Maltzman. Moreover, our repeated vindications, and research published over the last 20 years corroborating moderation outcomes, illustrate that, indeed, science is self-correcting

Imagine Being Accused of Scientific Fraud!

Our careers have been characterized by wonderfully serendipitous opportunities; being accused of scientific fraud was not one of them. The study involved a randomized controlled trial we conducted in 1970-1971 with alcohol abusers using a low-risk drinking goal rather than an abstinence goal, and the low-risk drinking goal group had better outcomes over 3 years of follow-up. In 1982 it was alleged that we had committed scientific fraud. The attack received national and international attention, including on 60 Minutes. Fortunately, we had maintained meticulous records from the study for 12 years and were vindicated in four major investigations and a $95 million lawsuit. In retrospect, that experience had an upside. It taught us that science is a social process that can be very rough and tumble, that colleagues with integrity are invaluable, and that investigative news shows are primarily entertainment and are forgotten very quickly. Our careers also had other highlights. Our early research involved conducting experimental intoxication studies with individuals who had serious alcohol problems. We learned much from those studies, because alcohol problems are among the few disorders almost always studied in the absence of symptoms. To evaluate our first controlled trial with low-risk drinking, we developed an assessment instrument now known as the Timeline Followback for collecting retrospective reports of behaviors. Over our careers we focused on the large population of persons who have alcohol problems that are not severe, we did research on natural recovery (also referred to as self-change), and we developed and validated a treatment called Guided Self-Change (GSC) in individual and group formats. The GSC treatment has now been validated in 12 studies and 4 languages. Finally, we were involved in community dissemination of evidence-based practice, preventing alcohol-exposed pregnancies, and we developed and evaluated a computer and smartphone intervention called iSelfChange. At the end of this session, the learner will be able to: Describe the upside, downside, and aftermath of a scientific controversy that derived from research successfully challenging conventional wisdom. Describe evolution of a program of motivational behavioral-cognitive treatment research on alcohol problems to pioneer research on self-change and innovative treatments. Describe how studying persons with alcohol use disorders when they were intoxicated provided valuable insights into the nature of alcohol problems. Recommended Readings: Marlatt, G. A. (1983). The controlled-drinking controversy: A commentary. American Psychologist, 38(10), 1097-1110. doi:10.1037/0003-066x.38.10 .1097Sobell, M. B., & Sobell, L. C. (2005). Guided Self-Change treatment for substance abusers. Journal of Cognitive Psychotherapy, 19, 199-210.Sobell, L.C., Sobell, M. B., & Agrawal, S. (2009). Randomized controlled trial of a cognitive-behavioral motivational intervention in a group versus individual format for substance use disorders. Psychology of Addictive Behaviors, 23, 4, 672-683. doi: 10.1037/a00116636.Sobell, L. C., Sobell, M. B., Leo, G. I., Agrawal, S., Johnson-Young, L., & Cunningham, J. A. (2002). Promoting self-change with alcohol abusers: A community-level mail intervention based on natural recovery studies. Alcoholism: Clinical and Experimental Research, 26, 936-948

Factors Affecting Agreement between Alcohol Abusers\u27 and Their Collaterals\u27 Reports

Objective: Because of their low cost and ease of use, collaterals\u27 reports are the most frequent source of independent corroboration with alcohol abusers\u27 self-reports of drinking and related events. Although several reviews have shown that we can have confidence in the accuracy of alcohol abusers\u27 reports of their drinking and in the use of collateral reports as an independent validity criterion, neither data source is error free. This study examined factors that influence the level of agreement between collaterals\u27 and alcohol abusers\u27 reports. Method: Using data from a study of natural recoveries from alcohol-related problems, this study examined how agreement between 120 alcohol abusers\u27 (79.2% male) and their collaterals\u27 reports varied as a function of collateral type and of the collaterals\u27 ratings of their confidence in the accuracy of their reports of the subjects\u27 drinking and related behaviors. Collaterals\u27 awareness of nonalcohol-related levels was also examined. Results: The best agreement occurred for reports from alcohol abusers\u27 spouses who were fairly confident about the information provided. For all variables, some proportion of collaterals respond to demand characteristics of the interview by providing very specific information about subjects\u27 behavior yet admit to being unsure of this information. Conclusions: Collaterals who are fairly sure of the information they provide are the preferred informants to corroborate alcohol abusers\u27 reports of drinking and related behaviors. In some cases the best collaterals are spouses who are fairly sue of the information they reported. It is also recommended that treatment outcome studies should accept reports only from collaterals who are confident about the information they report

Alcohol Breath Tests: Criterion Times for Avoiding Contamination by “Mouth Alcohol”

Using either a gas chromatography or an infrared absorption technique, series of blood alcohol concentrations (BACs) determined by breath tests were obtained from human subjects immediately subsequent to their having only oral contact with beverages ranging in ethyl alcohol concentration from 4% to 95% +. Times for total dissipation of mouth alcohol residuals to a level of practical nonsignificance ranged from 10 to 19 min. Dissipation rates were an inverse and approximately exponential function of the ethyl alcohol concentration of the beverage and were greatly shortened by rinsing the mouth with warm (34°C) water prior to testing. The results are discussed in terms of their relevance to the methodology of a number of research studies employing BAC breath-testing equipment

Severely Dependent Alcohol Abusers May Be Vulnerable To Alcohol Cues in Television Programs

The self-reported ability of 96 alcohol abusers to resist the urge to drink heavily was assessed after they viewed a videotape of a popular prime time television program complete with advertisements. Different versions of the videotape were used to evaluate the effects of a television program with and without alcohol scenes as crossed with the effects of three different types of commercials (i.e., beer, nonalcoholic beverages, food). Before and after viewing the videotape, subjects, who were led to believe that they were participating in two separate and unrelated sets of experimental procedures, completed several drinking questionnaires. Responses to one of the questionnaires provided an unobtrusive measure of self-reported ability to resist the urge to drink heavily. Results indicated that alcohol cues in a television program affected some alcohol abusers\u27 perceived ability to resist the urge to drink heavily. In particular, those with higher alcohol dependence scores showed a decrease in confidence after viewing a television program with alcohol cues compared to subjects who watched the same program but without the alcohol scenes. The clinical implications of these findings are discussed. Until further research is forthcoming, given the artificial nature of the study setting, the results of this study must be viewed with some caution

Criterion Intervals for Pretreatment Drinking Measures in Treatment Evaluation

Drinking during a 30-day pretreatment period was found not to be representative of longer pretreatment intervals, especially in a population of seriously impaired inpatient alcoholic

Effect of Television Programming and Advertising on Alcohol Consumption in Normal Drinkers

The drinking behavior of 96 male normal drinking college students was assessed after they viewed a videotape of a popular prime-time television program complete with advertisements. Different versions of the videotape were used to evaluate the effects of a television program with and without alcohol scenes as crossed with the effects of three different types of advertisements (i.e., beer, nonalcoholic beverages and food). After viewing the videotape, the subjects, who were led to believe that they were participating in two separate and unrelated sets of experimental procedures, were asked to perform a taste rating of light beers, which actually provided an unobtrusive measure of their alcohol consumption. The results provided no support for the widely held assumption that drinking scenes in television programs or televised advertisements for alcoholic beverages precipitate increased drinking by viewers. This finding, however, must be considered in the context of the laboratory setting of the study, and thus may not generalize to real-life television viewing. Further research in this area is clearly needed, including an evaluation of the effects of television program content and advertisements on other populations (e.g., alcohol abusers)

The Reliability of Alcohol Abusers’ Self-Reports Of Drinking and Life Events That Occurred In the Distant Past

This study investigated the test-retest reliability of 69 alcohol abusers\u27 current reports about their past (approximately 8 years prior to interview) drinking behavior and life events. Drinking behavior was assessed by the Lifetime Drinking History (LDH) questionnaire and life events were assessed using the Recent Life Changes Questionnaire (RLCQ). Reliability coefficients for LDH variables were generally moderate to high (r = .52 to .81). Using empirical criteria, the diagnostic power of the two LDH interviews to classify correctly subjects as either having had or not having had a drinking problem was quite high. The reliability coefficient for the RLCQ was r = .85 and 91.7% of the identified events were reported in both interviews. Similarly high test-retest reliabilities and individual event agreement rates were obtained for the six homogeneous subscales of the RLCQ. Subjects were also asked why they had given inconsistent answers to life events questions in the two interviews. Inconsistencies often resulted from errors in the temporal placement of events or from misunderstanding items, rather than from failure to recall an event; this suggests that some sources of error in recalling life events can be reduced. It is concluded that alcohol abusers\u27 reports of drinking and life events occurring many years prior to the date of interview are generally reliable. This finding is consistent with previous studies showing high test-retest reliabilities for reports of recent drinking and related events

Comparison of a Quick Drinking Screen with the Timeline Followback for Individuals with Alcohol Problems

Objective: Two major strategies have typically been used to assess recent drinking: (1) Daily Estimation (DE) measures such as the Timeline Followback (TLFB) and (2) Quantity-Frequency (QF) summary measures. Although QF measures provide a quick and easy measure of consumption, they have been criticized as not being able to capture sporadic and unpatterned drinking (e.g., days that reflect important social and/or health risks). The TLFB, a psychometrically sound drinking assessment method, is able to capture all drinking, including sporadic heavy days and unpatterned drinking. In some situations, however, recall of daily drinking may not be possible or practical (e.g., limited time; no resources). This article compares results obtained by using a QF measure and a DE measure to assess problem drinkers’ pretreatment drinking. Method: The current study, part of a large community mail intervention with 825 alcohol abusers, compared results from two drinking measures covering the same time interval that were administered on two different occasions approximately 2.5 weeks apart. Both measures, the Quick Drinking Screen (QDS; a QF summary measure that collected data by telephone) and the TLFB (a self-administered daily estimation measure), collected drinking data for the year prior to the interview. Results: Although the QDS and the TLFB are very different drinking measures, remarkably similar aggregate drinking data were obtained for five drinking variables. Conclusions: When it is not necessary or possible to gather detailed drinking data, the QDS produces reliable brief summary measures of drinking, at least for not severely alcohol dependent individuals. Also, respondents do not appear to use a repetitive response pattern when completing the TLFB

Guided Self-Change Treatment for alcohol abuse in Spain: a single-case study

Aunque existe evidencia de la efectividad de intervenciones breves para disminuir el consumo problemático de alcohol, son escasos los datos en población española. El objetivo de este estudio es analizar, por primera vez en España, la efectividad del Programa de Auto-Cambio Dirigido (Guided Self-Change Treatment; GSCT). Método: Se aplicaron 4 sesiones individuales con frecuencia semanal del programa a una consumidora de alto riesgo de alcohol. Resultados: Los resultados indican una disminución del consumo de alcohol de 42 a 0 unidades de bebida estándar por semana y un aumento de la autoeficacia percibida, manteniéndose en el seguimiento a 6 meses. Conclusiones: Como ya señalaron estudios anteriores en población latinoamericana, el GSCT parece ser efectivo en la reducción del consumo de alcohol y las consecuencias negativas asociadas al mismoAlthough there is evidence of the effectiveness of brief interventions at reducing problem drinking, there is a lack of studies in Spanish population. This study aims to analyze, for the first time in Spain, the effectiveness of the Guided Self-Change Treatment (GSCT).Methods: One-day a week, the 4-sesion program was individually applied to a woman with a pattern of high-risk alcohol consumption. Results: After treatment, thefrequency of drinking decreased from 42 to 0 standard drinks per week and self-efficacywas clinically significantimproved. Changes were maintained at 6-months follow up. Conclusions: To conclude, the GSCT seems to be effective at reducing problem drinking and the negative consequences associated with it, which is consistent with the results of previous studies in Latin American population