Table 3 –
Overview of primary abstinence and non-abstinence based treatment outcomes
| Approach | Measurement considerations | Pros | Cons | |
|---|---|---|---|---|
| Biological | Utox | Detection times vary; Quantitative testing needed to reduce carry-over effects | primary method of biological verification; accurate and reliable; low-cost; on-site testing | poor temporal specificity; potential for adulteration |
| Blood | typically used for verification rather than screening; relatively short detection window (~24 hours) | highly accurate; reduced risk of adulteration | invasive; high cost; does not provide immediate results; requires medically trained collectors | |
| Saliva (oral fluid) | short detection time; indicative of more recent drug use/abstinence | non-invasive, rapid, easily-observed collection; on-site collection and screening; lower biohazard risk; ability to collect multiple samples | difficult/unpleasant to obtain sufficient saliva; sensitivity and specificity mixed; drug concentration may be lower than urine | |
| Breathalyzer | verification of alcohol abstinence in short-term (past 6-12 hours) | non-invasive, rapid, easily-observed collection; on-site collection and screening; lower biohazard risk; ability to collect multiple samples | limited to alcohol testing; may be challenging for those with asthma or lung disease | |
| Carbon monoxide (CO) | cutoff may vary for distinguishing smokers from non-smokers depending on whether sensitivity or specificity is prioritized | immediate, non-invasive, and portable assessment of smoking status | may be affected by exposure to environmental tobacco smoke or pollutants; limited sensitivity to detect brief smoking lapses | |
| Self-report | Timeline follow-back (TFLB) | calendar-based method; more reliable when biological specimens also collected | low-cost; ability to calculate multiple outcome measures for flexible intervals (7-day, past-month); retrospective reporting minimizes missing data | potential for under-reporting substance-use; reliability of retrospective self-report has been questioned |
| EMA / Daily diary | recording at specified time intervals, signal-contingent, or event-contingent | high ecological validity; reduces reliance on memory; may be more sensitive to change | participant burden; potentially high rates of missing data | |
| Non-abstinence based outcomes | Days in tx | can be defined in multiple ways depending on the type of tx | can be verified through medical records; tx retention has been linked to better outcomes; | indicator of tx acceptability rather than tx response; challenging to determine when tx drop out occurred |
| Medication adherence | includes strategies for verification (e.g., tracer, MEMS caps) | increases internal validity of ‘tx response’ outcome | no standards for defining compliance cutoff | |
| Reduction in frequency/severity | measure of reduction dependent on baseline timeframe | practical and consistent with chronic nature of addiction; may be more sensitive than abstinence | clinical significance of reduction-based measures not established | |
| Improvement in functioning/quality of life | based on self-report; consideration of whether functioning/quality of life is direct result of drug use | well-established assessment measures for quality of life; clinically meaningful | may not be sensitive to change in drug use; dependent on baseline timeframe | |
| Diagnostic Threshold | may be measured through interview-based assessment or self-report; DSM-5 provides severity indicators | direct measure of substance-use disorder criteria | may not be sensitive to change in short-term |