Leslie C. Morey - US grants

mental disorders; mental disorder diagnosis; data collection methodology /evaluation; human subject;

In recent years increasing research attention has been paid to the classification of individuals with alcohol related disorders. One research program has involved the construction of classifications based upon statistical cluster analytic techniques. The resulting typologies seem to have a number of important implications for differential alcoholism treatment, although thus far little research has specifically addressed this question. The goal of the proposed project is to begin an intensive examination of the treatment implications of a particularly promising alcoholism classification system. This classification is based upon extensive research and contains three types of alcohol abusers: Early Stage Problem Drinkers, Affiliative Alcoholics, and Schizoid Alcoholics. The project will be directed at examining the psychotherapy process in the treatment of these different alcoholic types, and it is hypothesized that the interpersonal differences noted between these three types will be manifest in their treatment. In doing so, the project will adapt stat of the art measures of psychotherapy process to the field of alcoholism treatment. The sample for the study will include 30 alcohol abusing patients (10 of each alcoholic type) treated in an intensive three week treatment program. Data will be obtained concerning (a) their alcohol use patterns; (b) their interpersonal orientation; and (c) their behavior during the process of psychotherapy. The results of the study will yield specific information about implications of client classificatoin for the psychotherapeutic treatment of alcoholism, as well as establish pilot data for future outcome studies which match clients with specific psychotherapeutic strategies.

borderline personality disorder; schizoid personality; obsessive compulsive disorder; longitudinal human study; avoidance behavior; disease /disorder proneness /risk; diagnosis design /evaluation; pathologic process; outcomes research; disease /disorder model; model design /development; comorbidity; cooperative study; disease /disorder classification; health care service utilization; functional ability; behavioral /social science research tag; young adult human (21-34); questionnaires; human subject; interview; clinical research; psychometrics;

DESCRIPTION (provided by applicant): Individuals with alcohol use problems represent a heterogeneous group with respect to variables relevant to classification and treatment. Failure to account for this heterogeneity would be expected to compromise treatment outcome and matching effects. With this in mind, Project MATCH hypothesized several treatment matching relationships based on alcoholic type, alcohol severity, psychiatric severity, and alcohol dependence, but found limited effects of client heterogeneity. However, it is possible that the existing examinations of Project MATCH data have not fully characterized the nature of severity of alcohol dependence, as these analyses have typically examined dependence severity as an additive symptom count similar to the diagnostic strategy represented in the DSM-IV. We propose to examine dependence severity as a latent trait hypothesized to have a characteristic developmental progression, and that this conceptualization may result in a dimension that may represent an important source of variance in treatment response and outcome, both directly and as a moderator of other important typological variables. We seek to identify salient markers of dependence severity on this putative developmental continuum using techniques of Item Response Theory (IRT), and examine the implications of this approach to severity scaling in the Project MATCH data with respect to its effect on treatment and treatment matching outcomes. Specifically, this project seeks to (1) use IRT to establish scaled severity markers that may theoretically reflect milestones in the developmental course of alcoholism; (2) test the generalizability of the scaled continuum across gender and ethnic background; and (3) scale Project MATCH participants based upon their empirical fit with (traitedness) and their placement on (severity) this identified latent severity trait, and then use this information to re-examine the treatment effects and matching hypotheses central to that project.