How Is Success Judged

In one sense, judging the outcome of treatment would seem simple: Either the person is or is not still drinking in a problematic manner. A closer examination of treatment-outcome research quickly reveals a number of complexities.

First is the question of the standard against which a treatment is to be judged. Is a "success" rate of 60 percent spectacularly good or shameful? This is decided relative to the expected outcome without the same treatment. This is why the usual standard for judging effectiveness in medical research is the controlled trial in which clients are randomly assigned to different treatment methods. In the absence of proper controls, one cannot judge adequately whether the outcome of a treatment is better or worse than it would have been without the special treatment. Evidence from properly controlled trials is more consistent than the results of uncontrolled trials, presenting a clearer picture of effectiveness.

A second complexity is: What constitutes success? When success is defined very conservatively, as total abstinence from alcohol (not even one drink) since the end of treatment, low success rates can be expected. Yet if some drinking is permitted among "successes," it is necessary to define the acceptable limits for how much, how often, and with what consequences. Some studies have reported only a category of "improved" cases without adequate definition.

Once successful outcome is clearly defined, there is the problem of how to measure it. Should a researcher accept the client's self-report? Should friends and family members be interviewed? Should blood, breath, or urine samples be required? If multiple outcome measures are used, how does one decide which is the truth?

Still another example is the issue of length of follow-up. Success rates are typically highest within a few weeks or months from the time of treatment. A large percentage of relapses occur between three and twelve months after treatment. Short follow-up periods, then, overestimate success rates. Longer follow-ups raise the additional problem of how to deal with lost cases. If one studies only those who can be easily found two years later, success rates may be inflated.

For these reasons, the effectiveness of treatment approaches is best judged by accumulating evidence from several properly controlled studies. Conclusions presented above, regarding the efficacy of different psychological treatment approaches, were drawn on this basis.

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