Controlling for selection bias in the evaluation of Alcoholics Anonymous as aftercare treatment. 1998

J Fortney, and B Booth, and M Zhang, and J Humphrey, and E Wiseman
Veterans Affairs Medical Center, Centers for Mental Healthcare Research, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock 72114, USA.

OBJECTIVE The purpose of this research was to control for self-selection bias in the evaluation of Alcoholics Anonymous (AA) as aftercare treatment. Observational studies of alcoholism aftercare treatment are subject to selection bias whenever the self-selection process results in important differences in unobserved casemix dimensions between treatment groups. METHODS The sample included 118 male veterans discharged from inpatient alcohol treatment, 85% of whom were followed-up at 3 months. Drinking outcomes were measured by self-reported abstinence in the third month after discharge. The aftercare treatment effect of AA was estimated using standard logistic regression analysis and instrumental variables analysis. Instruments included the subject's ability to drive oneself to AA meetings and the presence/absence of an AA meeting in the subject's town of residence. A Hausman exogeniety test was used to determine whether the standard logistic regression results were subject to self-selection bias. RESULTS Estimates from the standard logistic regression yielded a positive (OR = 3.7) and significant (p = .018) treatment effect for AA attendance. However, the instrumental variables analysis yielded a smaller (OR* = 1.7) and insignificant treatment effect estimate (p = .782). The Hausman exogeniety test indicated that the treatment effect estimate from the standard logistic regression was subject to significant self-selection bias (chi2 = 83.9, 1 df, p <.01). CONCLUSIONS The AA aftercare treatment effect observed in this sample was due to differences in unobserved casemix factors between the treatment groups. Results suggest that previous AA aftercare research may have also been subject to self-selection bias. Researchers of substance abuse outcomes should consider analyzing nonexperimental data using instrumental variables methodologies.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010358 Patient Participation Patient involvement in the decision-making process in matters pertaining to health. Patient Activation,Patient Empowerment,Patient Engagement,Patient Involvement,Patient Participation Rates,Activation, Patient,Empowerment, Patient,Engagement, Patient,Involvement, Patient,Participation Rate, Patient,Participation Rates, Patient,Participation, Patient,Patient Participation Rate
D012107 Research Design A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. Experimental Design,Data Adjustment,Data Reporting,Design, Experimental,Designs, Experimental,Error Sources,Experimental Designs,Matched Groups,Methodology, Research,Problem Formulation,Research Methodology,Research Proposal,Research Strategy,Research Technics,Research Techniques,Scoring Methods,Adjustment, Data,Adjustments, Data,Data Adjustments,Design, Research,Designs, Research,Error Source,Formulation, Problem,Formulations, Problem,Group, Matched,Groups, Matched,Matched Group,Method, Scoring,Methods, Scoring,Problem Formulations,Proposal, Research,Proposals, Research,Reporting, Data,Research Designs,Research Proposals,Research Strategies,Research Technic,Research Technique,Scoring Method,Source, Error,Sources, Error,Strategies, Research,Strategy, Research,Technic, Research,Technics, Research,Technique, Research,Techniques, Research
D005500 Follow-Up Studies Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. Followup Studies,Follow Up Studies,Follow-Up Study,Followup Study,Studies, Follow-Up,Studies, Followup,Study, Follow-Up,Study, Followup
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000359 Aftercare The care and treatment of a convalescent patient, especially that of a patient after surgery. After Care,After-Treatment,Follow-Up Care,Postabortal Programs,Postabortion,After Treatment,After-Treatments,Care, Follow-Up,Cares, Follow-Up,Follow Up Care,Follow-Up Cares,Postabortal Program,Program, Postabortal,Programs, Postabortal
D000436 Alcoholics Anonymous An organization of self-proclaimed alcoholics who meet frequently to reinforce their practice of abstinence. Anonymous, Alcoholics
D000437 Alcoholism A primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic. (Morse & Flavin for the Joint Commission of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism: in JAMA 1992;268:1012-4) Alcohol Abuse,Alcoholic Intoxication, Chronic,Ethanol Abuse,Alcohol Addiction,Alcohol Dependence,Alcohol Use Disorder,Abuse, Alcohol,Abuse, Ethanol,Addiction, Alcohol,Alcohol Use Disorders,Chronic Alcoholic Intoxication,Dependence, Alcohol,Intoxication, Chronic Alcoholic,Use Disorders, Alcohol

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