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Shorter and Proximal Timeline Followback Windows Are Representative of Longer Posttreatment Functioning

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Abstract

Very little research has been conducted on what time window provides a representative picture of daily drinking. With respect to pretreatment drinking, one study that used the Timeline Followback (TLFB) with problem drinkers found that a 3-month window is generally representative of annual pretreatment drinking. The objective of the present study was to determine the shortest representative time window for reports of annual posttreatment drinking. A second objective was to determine which of two time windows, 90 days from the end of treatment or 90 days prior to the end of follow-up, was the most representative proxy for annual posttreatment drinking. TLFB reports from 467 problem drinkers who participated in a randomized controlled trial of a mail-based intervention were used in the present analysis. The results show that a 3-month posttreatment window (i.e., first 90 days after the intervention) is sufficiently representative (r = .94) of annual posttreatment drinking for problem drinkers (i.e., less severely dependent alcohol abusers). In addition, although there were no clinically significant differences in drinking behavior between the two 90-day posttreatment windows, the use of proximal windows (i.e., closer to the end of treatment) would minimize participant attrition. In addition, a 3-month versus 12-month TLFB follow-up time frame resulted in a much higher percentage of participants completing the full TLFB (89% vs. 71%). Further research is needed to determine if these findings will generalize to more severely dependent alcohol abusers. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Shorter and Proximal Timeline Followback Windows Are Representative
of Longer Posttreatment Functioning
Christopher J. Gioia, Linda Carter Sobell, Mark B. Sobell, and Edward R. Simco
Nova Southeastern University
Very little research has been conducted on what time window provides a representative picture of daily
drinking. With respect to pretreatment drinking, one study that used the Timeline Followback (TLFB)
with problem drinkers found that a 3-month window is generally representative of annual pretreatment
drinking. The objective of the present study was to determine the shortest representative time window for
reports of annual posttreatment drinking. A second objective was to determine which of two time
windows, 90 days from the end of treatment or 90 days prior to the end of follow-up, was the most
representative proxy for annual posttreatment drinking. TLFB reports from 467 problem drinkers who
participated in a randomized controlled trial of a mail-based intervention were used in the present
analysis. The results show that a 3-month posttreatment window (i.e., first 90 days after the intervention)
is sufficiently representative (r.94) of annual posttreatment drinking for problem drinkers (i.e., less
severely dependent alcohol abusers). In addition, although there were no clinically significant differences
in drinking behavior between the two 90-day posttreatment windows, the use of proximal windows (i.e.,
closer to the end of treatment) would minimize participant attrition. In addition, a 3-month versus
12-month TLFB follow-up time frame resulted in a much higher percentage of participants completing
the full TLFB (89% vs. 71%). Further research is needed to determine if these findings will generalize
to more severely dependent alcohol abusers.
Keywords: alcohol, drinking, Timeline Followback, short follow-up windows, alcohol treatment out-
comes, problem drinkers
The percentage of participants found for follow-up in random-
ized clinical trials is important because several studies have shown
that participants who are difficult to locate or lost to follow-up
generally have poorer outcomes and a worse premorbid status
prior to treatment (Edwards & Rollnick, 1997; Sobell, Sobell, &
Maisto, 1984). Clearly, in such cases, loss of participant data
would positively bias outcome results and limit the external va-
lidity of a study’s findings.
Although investigators have used varying time intervals (e.g., 3
to 24 months) to collect posttreatment drinking data, there is no
optimal or agreed on interval length over which posttreatment data
should be collected or about what percentage of a sample needs to
be interviewed in order for meaningful data analyses to occur
(reviewed in Hansten, Downey, Rosengren, & Donovan, 2000).
The frequency of follow-up and the length of the follow-up inter-
val are important because both could affect attrition rates, partic-
ularly with more labor-intensive outcome measures such as the
Timeline Followback (TLFB). Although there are many advan-
tages to collecting daily drinking data using the TLFB (e.g., a
variety of descriptive variables can be generated, detailed data
about the pattern of and variability in drinking is obtained) com-
pared to aggregate measures (e.g., quantity-frequency measures),
some participants at follow-up have initially refused to complete
lengthy follow-up interviews (Cunningham, Ansara, Wild, Tone-
atto, & Koski-Ja¨nnes, 1999; Miller & Del Boca, 1994; Sobell et al.,
2002). It is interesting that many of these participants, when
offered the alternative of answering a short set of questions in lieu
of a lengthy interview, provided limited information about their
drinking (Sobell et al., 2003). Clearly, based on these studies, there
is a tradeoff between the percentage of participants from whom
data are collected and the quality of data collected (TLFB vs.
aggregate measures). In this regard, using treatment outcome in-
terviews that are as short as possible, without compromising data
quality, is an important objective. Shorter versus longer time
windows also would have the advantage of decreasing memory
errors (Lemmens, Knibbe, & Tan, 1988).
One study recently compared 825 problem drinkers’ self-
reported annual drinking data using the TLFB with annual drink-
ing extrapolated from shorter drinking windows using the same
dataset (Vakili, Sobell, Sobell, Simco, & Agrawal, 2008). Results
indicated that. with aggregated data and large samples, a 3-month
time window provides a reasonable estimate of drinking during the
year preceding treatment, with little to no loss in data accuracy.
Because the Vakili et al. study only examined pretreatment data,
their conclusion cannot be extended to posttreatment time win-
dows.
This article was published Online First January 30, 2012.
Christopher J. Gioia, Linda Carter Sobell, Mark B. Sobell, and Edward
R. Simco, Center for Psychological Studies, Nova Southeastern University.
Supported, in part, by National Institute on Alcohol Abuse and Alco-
holism (Grant AA08593). The secondary data analysis described in this
article was conducted as part of Christopher Gioia’s doctoral dissertation.
Correspondence concerning this article should be addressed to Christo-
pher J. Gioia, Center for Psychological Studies, Nova Southeastern Uni-
versity, 3301 College Avenue, Fort Lauderdale, FL 33314. E-mail:
cgioia@nova.edu
Psychology of Addictive Behaviors © 2012 American Psychological Association
2012, Vol. 26, No. 4, 880– 887 0893-164X/12/$12.00 DOI: 10.1037/a0027027
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... This tool required participants to retrospectively indicate, for each day in the last three months, the approximate amount and type of different substances used. This method possesses several advantages compared to more commonly used measures, because the TLFB provides a detailed overview of substance use patterns and variability in use (Gioia, Sobell, Sobell & Simco, 2012). Furthermore, a retrospective three-month window has been found to be representative of subsequent annual problematic substance use (Gioia et al., 2012). ...
... This method possesses several advantages compared to more commonly used measures, because the TLFB provides a detailed overview of substance use patterns and variability in use (Gioia, Sobell, Sobell & Simco, 2012). Furthermore, a retrospective three-month window has been found to be representative of subsequent annual problematic substance use (Gioia et al., 2012). The TLFB method has been found to possess high test re-test reliability when employed to assess alcohol use (r = .85; ...
... The TLFB method has been found to possess high test re-test reliability when employed to assess alcohol use (r = .85; Gioia et al., 2012). Large correlations between self-report (TLFB) and collateral (i.e., hospital and jail records) reports have also been reported (r = .85; ...
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... Collecting contextual information may require more time-intensive data collection approaches such as structured interviews, timeline followback, daily diaries, or experience sampling. These more time-intensive measures can be integrated with traditional longitudinal designs to add contextual information that will enhance the accuracy and interpretability of the data (Gioia et al., 2012;Sliwinski, 2008). Care is needed, however, when using daily measures as the relatively low frequency of sexual behavior during adolescence might result in high investment of resources and participants' time for limited yield. ...
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... Validation studies of the timeline follow-back method used here for alcohol have consistently indicated reliable and valid reports of alcohol use. [62][63][64] The generalizability of the study may be limited by the 46.7% consent rate. The time commitment required of study participants was the most frequent reason given for declining participation, making it difficult to separate interest in participating in the intervention from the study and multiple follow-up sessions. ...
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... Follow-up intervals for CHOICES-like RCTs have ranged from 4 (Ceperich and Ingersoll, 2011) to 12 months (Rendall-Mkosi et al, 2013). The current study used a 6-month follow-up interval because it has been shown that for reports of drinking follow-up windows as short as 3 months produce aggregate data consistent with those found for a 12-month post-treatment interval (Gioia et al., 2012). Also, the data collected in this study represent the entire 6-month interval (i.e., 180 days), whereas the other CHOICES studies collected data for the 90 days prior to the follow-up date (e.g., days 91-180 for a 6-month follow-up). ...
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... On the other hand, DDE measures take longer as they ask for daily amounts of drinking for intervals spanning several months. While two studies with problem drinkers have found that data from shorter and proximal TLFB windows (i.e., 1 to 3 months) are representative of longer preand post-treatment functioning (e.g., 12 months; Gioia et al., 2012;Vakili et al., 2008), even short TLFB windows can be time consuming (i.e., 10 to 15 minutes). ...
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... The Timeline Followback (TLFB), a psychometrically sound measure, assesses daily drinking for intervals ranging from 1 to 12 months Sobell & Sobell, 1992). Previous studies have shown that shorter preintervention (i.e., 1-3 months; Vakili, Sobell, Sobell, Simco, & Agrawal, 2008) and postintervention intervals (i.e., 1-3 months; Gioia, Sobell, Sobell, & Simco, 2012) are sufficiently representative of problem drinkers' annualized drinking to warrant their use. For this study, a 90-day preintervention interval was selected. ...
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... The Timeline Followback (TLFB), a psychometrically sound measure, assesses daily drinking for intervals ranging from 1 to 12 months Sobell & Sobell, 1992). Previous studies have shown that shorter preintervention (i.e., 1-3 months; Vakili, Sobell, Sobell, Simco, & Agrawal, 2008) and postintervention intervals (i.e., 1-3 months; Gioia, Sobell, Sobell, & Simco, 2012) are sufficiently representative of problem drinkers' annualized drinking to warrant their use. For this study, a 90-day preintervention interval was selected. ...
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... The TLFB is a psychometrically sound measure for assessing daily drinking for intervals ranging from 1-to 12-months Sobell and Sobell, 1992). Examining alcohol consumption over shorter TLFB intervals (e.g., 1 to 3 months) has been shown to sufficiently capture problem drinkers' annual use when compared to longer TLFB intervals for both pre- (Vakili, Sobell, Sobell, Simco, and Agrawal, 2008) and post-intervention (Gioia, Sobell, Sobell, and Simco, 2012). The present study used 90 days for both the pre-(prior to seeing the ad) and postintervention (after receiving the materials by courier) intervals. ...
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Chapter
To obtain valid and reliable data in survey interviews, it is generally acknowledged that the interviewer's behavior should be standardized in order to provide each respondent with the same stimulus and prevent the interviewer affecting the answers of the respondent (Fowler & Mangione, 1990). Conducting an interview using an event history calendar (EHC), however, usually requires the interviewer to be much more flexible. Although completely structured interviews with an EHC have been done (Furstenberg, Brooks-Gunn, & Morgan, 1987), the more common approach is to use a semistructured format with an initial prescribed question for each (sub)domain (Freedman, Thornton, Camburn, Alwin, & Young-DeMarco, 1988). In such an approach, the interviewer is required to react to the respondent's answers, which in turn may produce unwanted interviewer variance and thus may endanger the quality of the data. Thus, interviewers on the one hand have to pose the questions as worded in the questionnaire