Does patient involvement in treatment planning improve adherence, enrollment and other treatment outcome in alcohol addiction treatment? A systematic review

Figures & data

Figure 1. PRISMA 2009 flow diagram.

Table 1. Characteristics of included studies.

Population		Design		Intervention and outcome measures
Study (first author)	N	Study design	Setting and sex	Options	Option characteristic	Outcome measure	Follow up	Results
Thornton (1977)	123	Quasi-RCT.	Male wartime veteran inpatients.	3 options. Voluntary Abstaining, involuntary abstaining or voluntary controlled drinking. Intervention is considered informed choice	Choose from treatment goals.	Alcohol use.	6 months post treatment	Voluntary abstainers had better drinking outcome than both involuntary abstainers and voluntary controlled drinkers. Enrollment, adherence and quality of life were not measured.
Joosten (2008)	227	Multi-site randomized controlled study.	Male and female inpatients. Both alcohol and substance use patients were enrolled.	5 shared decision-making sessions were held before treatment start.	Choose from treatment goals.	Alcohol use, and quality of life.	End of treatment and 3 months post treatment	Better outcome for SDM group on quality of life. No difference on drinking outcome. Enrollment and adherence were not measured.
Ojehagen and Berglund (1986)	58	Quasi-RCT.	Male and female outpatients.	2 options. Collaborating on treatment methods and goal or treatment as usual. Intervention is considered informed choice.	Choose both from treatment methods and treatment goals.	Treatment engagement.	Immediately after treatment completion. Treatment duration was 2 years. No post treatment follow-up.	Improved adherence. Drinking outcome, enrollment and quality of life were not measured.
McKay et al. (1995)	144	Randomized controlled study.	Male veterans with both alcohol and substance use. Both inpatients and outpatients.	2 options. Inpatient or outpatient treatment. Intervention is considered informed choice	Choose from treatment setting.	Treatment engagement, and alcohol use.	3-, 6- and 12-months post treatment.	No difference in drinking outcome or adherence. Enrollment, and quality of life were not measured.
McCrady et al. (2011)	122	Quasi-RCT.	Female outpatients.	2 options. Individual or couple therapy. Intervention is considered informed choice.	Choose from treatment methods.	Treatment engagement and retention.	End of treatment. No post treatment follow-up.	Increased enrollment when self-selecting treatment method. Drinking outcome, adherence and quality of life were not measured.
McKay et al. (2015)	428	Multi-site-randomized controlled study	Male and female alcohol and/or cocaine dependent outpatients who failed to start treatment as usual.	4 outpatient treatment options. Intervention is considered informed choice.	Choose from treatment methods.	Alcohol use and treatment engagement.	1-, 2-, 3-, 4-, 5-, 6-month follow up during treatment. No post treatment follow-up.	Decreased drop-out rate when choosing treatment method. Improved drinking outcome in control group for those not engaged in treatment at week 2. Enrollment and quality of life were not measured.

Table 2. Methodological quality of included studies.

Study (first author)	Criteria validity												Effect assessment
	1	2	3	4	5	6	7	8	9	10	11	12	A	B
Thornton (1977)	–	–	–	–	–	+	–	–	+	+	+	+	?	?
Joosten (2008)	+	–	–	–	?	+	+	+	+	+	+	+	+	+
Ojehagen and Berglund (1986)	–	–	–	–	–	+	?	?	?	+	+	+	?	?
McKay et al. (1995)	+	–	–	–	?	+	+	+	+	+	+	+	+	+
McCrady et al. (2011)	–	–	–	–	?	+	?	+	+	?	+	+	+	?
McKay et al. (2015)	+	–	–	–	?	+	+	+	+	+	+	+	+	+

1: adequate randomization; 2: Concealment of treatment allocation; 3: Blinding of patients; 4: Blinding of care provider; 5: Blinding of outcome assessor; 6: Dropout rate described; 7: Patient analyzed in allocation group; 8: Study free of suggestion; 9: Similar baseline characteristics; 10: avoidance of co-intervention; 11: acceptable compliance in all groups; 12: similarity of timing outcome assessment: A: Report of treatment effect size; B: Report of estimation of treatment effect.

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Ojehagen A, Berglund M. 1986. To keep the alcoholic in out-patient treatment. A differentiated approach through treatment contracts. Acta Psychiatr Scand. 73(1):68–75.

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McKay J R, Alterman A I, McLellan A. T, Snider E C, O’Brien C P. 1995. Effect of random versus nonrandom assignment in a comparison of inpatient and day hospital rehabilitation for male alcoholics. J Consult Clin Psychol. 63(1):70–78.

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McCrady B. S, Epstein E. E, Cook S, Jensen N. K, Ladd B. O. 2011. What do women want? Alcohol treatment choices, treatment entry and retention. Psychol Addict Behav. 25(3):521–529.

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McKay J R, Drapkin M L, Van Horn D H. A, Lynch K G, Oslin D W, DePhilippis D, Ivey M, Cacciola J S. 2015. Effect of patient choice in an adaptive sequential randomization trial of treatment for alcohol and cocaine dependence. J Consult Clin Psychol. 83(6):1021–1032.

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