Self-Monitoring May be an Effective Reduction Strategy Especially Among Individuals Not Seeking Cessation for Substance Abuse

Excessive drinking does not necessarily equal alcohol dependence, according to the CDC.26 In conjunction with the Substance Abuse and Mental Health Services Administration (SAMHSA), data from more than 138,000 adults who responded to the National Survey on Drug Use and Health (NSDUH) in 2009, 2010, or 2011 were analyzed.27 According to the results, 90% of excessive drinkers did not meet Diagnostic and Statistical Manual of Mental Disorders (4th edition, DSM-IV) criteria for alcohol dependence. Robert Brewer, MD, MSPH, Alcohol Program lead at the CDC and one of the study’s investigators noted that while the results may be “contrary to popular opinion,” they “emphasize the importance of taking a comprehensive approach to reducing excessive drinking” through evidence-based strategies, screening, counseling, and treatment. Clinicians who are uncertain how the changes from DSM-IV to DSM-5 may affect the diagnosis of alcohol use disorders should reference the NIAAA comparison fact sheet.28
Excessive drinking does not necessarily equal alcohol dependence, according to the CDC.26 In conjunction with the Substance Abuse and Mental Health Services Administration (SAMHSA), data from more than 138,000 adults who responded to the National Survey on Drug Use and Health (NSDUH) in 2009, 2010, or 2011 were analyzed.27 According to the results, 90% of excessive drinkers did not meet Diagnostic and Statistical Manual of Mental Disorders (4th edition, DSM-IV) criteria for alcohol dependence. Robert Brewer, MD, MSPH, Alcohol Program lead at the CDC and one of the study’s investigators noted that while the results may be “contrary to popular opinion,” they “emphasize the importance of taking a comprehensive approach to reducing excessive drinking” through evidence-based strategies, screening, counseling, and treatment. Clinicians who are uncertain how the changes from DSM-IV to DSM-5 may affect the diagnosis of alcohol use disorders should reference the NIAAA comparison fact sheet.28
While self-monitoring (SM) has been used in substance use treatment, empirical findings regarding the effectiveness of SM are mixed. This study aims to synthesize through literature the efficacy of SM on substance use.

Self-monitoring (SM) may be a viable low-risk, low-cost early intervention strategy among some substance users. These findings, from a systematic review, were published in Substance Abuse.

Researchers from the Veterans Affairs Center for Integrated Healthcare searched publication databases from May 2018 through June of 2020 for studies about intervention strategies for substance use. A total of 41 publications with moderate to strong quality were included.

The studies comprised 6031 (range, 5-1478) participants who were aged mean 34.2±12.8 years, 59% were White, and 57.6% were men. The substances were alcohol only (41.4%), tobacco only (35.7%), and 21.9% of studies focused on a mixture of substances.

The studies found SM was helpful among 29.0% of analyses, had no effect for 63.0%, and a detrimental effect among 8.0%. Stratified by substance type, SM was helpful for 36.6% of analyses with alcohol, 25.0% with tobacco, and 21.1% with other substance analyses. Among patients who were or were not seeking treatment, SM had no effect among 73.3% and 47.5%, a helpful effect for 25.0% and 35.0%, and a detrimental effect for 1.7% and 17.5%, respectively.

Among studies of SM, 12 used ecological momentary assessments (EMAs), 10 interactive voice recording (IVR) or telephone, and 4 used pencil and paper diary assessments. IVR and EMAs were observed to be more helpful than a diary (33.3% vs 28.8% vs 20.0%, respectively). The specific monitoring of additional features other than consumption was more effective (29.9%) than consumption alone (23.1%). Longer intervention durations were most effective (0-3 weeks: 18.2%; 3-6 weeks: 25.9%; >6 weeks: 40.0%).

This study was limited by the varying study methods, making comparisons noncongruent.

These data indicated ~30% of individuals who use substances may benefit from SM. As SM is a low-cost, low-risk strategy, it may be a viable first option, especially among individuals who are not seeking cessation from alcohol use.

Reference

Gass JC, Funderburk JS, Shepardson R, Kosiba JD, Rodiguez L, Maisto SA. The use and impact of self-monitoring on substance use outcomes: A descriptive systematic review. Subst Abus. 2021;1-36. doi:10.1080/08897077.2021.1874595.