Principal Investigator: William R. Miller, Ph.D.
Co Investigators: Janice M. Brown, Ph.D.,Reid K. Hester, Ph.D., Paula L. Wilbourne, M.S.
Funding Agency: none
Since 1979, our group has been reviewing the accumulating literature on the efficacy of methods for treating alcoholism. The principal goal has been to provide clinicians with a fair summary and appraisal of this very large scientific literature.
We began with a narrative review of the literature through the 1970s (Miller & Hester, 1980). We updated this review (Miller & Hester, 1986a) and extended it to studies of matching clients with treatment methods (Miller & Hester, 1986c). We also published one of the first reviews of the relative efficacy of inpatient and less intensive treatment settings, concluding that residential programs do not yield better outcomes overall (Miller & Hester, 1986b, 1989). The next step was to review cost-effectiveness implications of the treatment efficacy literature (Holder et al., 1991). A look back at U.S. treatment methods of the 1940s and 1950s suggested that mainstream alcoholism treatment approaches had not really changed all that much by 1990 (Miller, 1992).
Another review arose in response to the common and broad question, "How effective is treatment for alcoholism?" Here we combined findings from several large multisite studies to come up with estimates of the average outcomes of undifferentiated alcoholism treatment (Miller, Walters & Bennett, 2002). We concluded that in the year following a treatment episode, about one in four clients remain continuously abstinent, and an additional one in ten drink moderately and without problems. We found mortality during this period to average less than 2%. Perhaps most informatively, even clients who did drink in the year following treatment showed substantial improvement, abstaining on three out of four days, and reducing their overall alcohol consumption by 87% on average, with a 60% reduction in alcohol-related problems. Clearly a binary classification into "success" (abstinent) and "failure" overlookd a large amount of improvement in patients who do not maintain perfect abstinence.
In response to concerns that we had been giving equal weight to studies with strong methodology and those with weak methodology, we began a new series of reviews in which the evidence contributed by each study was weighted by the quality of its research methods (Miller et al., 1995, 1998, 2003; Miller & Wilbourne, 2002). To our surprise, we found that weighting studies according to methodological quality resulted in very little change in the conclusions that would be drawn from a much simpler "box score" method. We have also published clinical literature reviews in more targeted areas including:
References:
Co Investigators: Janice M. Brown, Ph.D.,Reid K. Hester, Ph.D., Paula L. Wilbourne, M.S.
Funding Agency: none
Since 1979, our group has been reviewing the accumulating literature on the efficacy of methods for treating alcoholism. The principal goal has been to provide clinicians with a fair summary and appraisal of this very large scientific literature.
We began with a narrative review of the literature through the 1970s (Miller & Hester, 1980). We updated this review (Miller & Hester, 1986a) and extended it to studies of matching clients with treatment methods (Miller & Hester, 1986c). We also published one of the first reviews of the relative efficacy of inpatient and less intensive treatment settings, concluding that residential programs do not yield better outcomes overall (Miller & Hester, 1986b, 1989). The next step was to review cost-effectiveness implications of the treatment efficacy literature (Holder et al., 1991). A look back at U.S. treatment methods of the 1940s and 1950s suggested that mainstream alcoholism treatment approaches had not really changed all that much by 1990 (Miller, 1992).
Another review arose in response to the common and broad question, "How effective is treatment for alcoholism?" Here we combined findings from several large multisite studies to come up with estimates of the average outcomes of undifferentiated alcoholism treatment (Miller, Walters & Bennett, 2002). We concluded that in the year following a treatment episode, about one in four clients remain continuously abstinent, and an additional one in ten drink moderately and without problems. We found mortality during this period to average less than 2%. Perhaps most informatively, even clients who did drink in the year following treatment showed substantial improvement, abstaining on three out of four days, and reducing their overall alcohol consumption by 87% on average, with a 60% reduction in alcohol-related problems. Clearly a binary classification into "success" (abstinent) and "failure" overlookd a large amount of improvement in patients who do not maintain perfect abstinence.
In response to concerns that we had been giving equal weight to studies with strong methodology and those with weak methodology, we began a new series of reviews in which the evidence contributed by each study was weighted by the quality of its research methods (Miller et al., 1995, 1998, 2003; Miller & Wilbourne, 2002). To our surprise, we found that weighting studies according to methodological quality resulted in very little change in the conclusions that would be drawn from a much simpler "box score" method. We have also published clinical literature reviews in more targeted areas including:
- Treatment of pathological gambling ( López Viets & Miller, 1997)
- Brief interventions (Apodaca & Miller, in press; Bien et al., 1993)
- Childhood abuse and addiction (Simpson & Miller (2002)
- Neuropsychological assessment of alcohol impairment (Miller & Saucedo, 1983)
- Self-regulation and addictions (Miller & Brown, 1991)
References:
- Apodaca, T. R., & Miller, W. R. (2003). A meta-analysis of the effectiveness of bibliotherapy for alcohol problems. Journal of Clinical Psychology, 59, 289-304
- Bien, T. H., Miller, W. R., & Tonigan, J. S. (1993). Brief interventions for alcohol problems: A review.Addiction, 88, 315-336.
- Holder, H., Longabaugh, R., Miller, W. R., & Rubonis, A. V. (1991). The cost effectiveness of treatment for alcoholism: A first approximation. Journal of Studies on Alcohol, 52, 517-540.
- López Viets, V. C. & Miller, W. R. (1997). Treatment approaches for pathological gamblers. Clinical Psychology Review, 17, 689-702.
- Miller, W. R. (1992). The effectiveness of treatment for substance abuse: Reasons for optimism. Journal of Substance Abuse Treatment, 9, 93-102.
- Miller, W. R. (1992). The evolution of treatment for alcohol problems since 1945. In P. G. Erickson & H. Kalant (Eds.), Windows on Science: 40th anniversary scientific lecture series (pp. 107-124). Toronto: Addiction Research Foundation.
- Miller, W. R., Andrews, N. R., Wilbourne, P., & Bennett, M. E. (1998). A wealth of alternatives: Effective treatments for alcohol problems. In W. R. Miller & N. Heather (Eds.), Treating addictive behaviors: Processes of change (2nd ed., pp. 203-216). New York: Plenum Press.
- Miller, W. R., & Brown, J. M. (1991). Self-regulation as a conceptual basis for the prevention and treatment of addictive behaviours (pp. 3-79). In N. Heather, W. R. Miller, & J. Greeley (Eds.), Self-control and the addictive behaviours. Sydney: Maxwell Macmillan Publishing Australia.
- Miller, W. R., Brown, J. M., Simpson, T. L., Handmaker, N. S., Bien, T. H., Luckie, L. F., Montgomery, H. A., Hester, R. K., & Tonigan, J. S. (1995). What works? A methodological analysis of the alcohol treatment outcome literature. In R. K. Hester & W. R. Miller (Eds.), Handbook of alcoholism treatment approaches: Effective alternatives (2nd ed., pp. 12-44). Boston, MA: Allyn and Bacon.
- Miller, W. R., & Hester, R. K. (1980). Treating the problem drinker: Modern approaches. In W. R. Miller (Ed.), The addictive behaviors: Treatment of alcoholism, drug abuse, smoking and obesity pp. 11-141). Oxford: Pergamon Press.
- Miller, W. R., & Hester, R. K. (1986a). The effectiveness of alcoholism treatment methods: What research reveals. In W. R. Miller & N. Heather (Eds.), Treating addictive behaviors: Processes of change (pp. 121-174). New York: Plenum Press.
- Miller, W. R., & Hester, R. K. (1986b). Inpatient alcoholism treatment: Who benefits? American Psychologist, 41, 794-805.
- Miller, W. R., & Hester, R. K. (1986c). Matching problem drinkers with optimal treatments. In W. R. Miller & N. Heather (Eds.), Treating addictive behaviors: Processes of change (pp. 175-203). New York: Plenum Press.
- Miller, W. R., & Hester, R. K. (1989). Inpatient alcoholism treatment: Rules of evidence and burden of proof. American Psychologist, 44, 1245-1246.
- Miller, W. R., & Saucedo, C. F. (1983). Assessment of neuropsychological impairment and brain damage in problem drinkers. In C. J. Golden, J. A. Moses, Jr., J. A. Coffman, W. R. Miller, & F. D. Strider (Eds.), Clinical neuropsychology: Interface with neurologic and psychiatric disorders (pp. 141-195). New York: Grune & Stratton
- Miller, W. R., Walters, S. T., & Bennett, M. E. (2001). How effective is alcoholism treatment? Journal of Studies on Alcohol, 62, 211-220.
- Miller, W. R., & Wilbourne, P. L. (2002). Mesa Grande: A methodological analysis of clinical trials of treatments for alcohol use disorders. Addiction, 97, 265-277.
- Miller, W. R., Wilbourne, P. L., & Hettema, J. E. (2003). What works? A summary of alcohol treatment outcome research. In R. K. Hester & W. R. Miller (Eds.), Handbook of Alcoholism Treatment Approaches: Effective Alternatives (3 rd ed., pp. 13-63). Boston, MA: Allyn & Bacon.
- Simpson, T. L., & Miller, W. R. (2002). Concomitance between childhood sexual and physical abuse and substance abuse: A review. Clinical Psychology Review, 22, 27-77.
