Subject reactivity effects and alcohol treatment outcome research

Objective: Attributions regarding alcohol treatment research protocols influencing clinical outcomes have persisted for more than 25 years. Although well-designed alcohol treatment outcome studies typically involve frequent, and often comprehensive, research assessment protocols, procedures are seldom in place to control or account for possible subject reactivity to the research protocol. This article presents a theoretical basis for a relationship between research protocols and treatment outcomes. Method: The article reviews the relevant alcohol treatment outcome literature and presents a 'weight of evidence' regarding subject reactivity effects and alcohol treatment outcome research assessment protocols. Also, the FRAMES (feedback, responsibility, advice, menu, empathy and self-efficacy) model was coupled with self-regulation theory to provide a theoretical explanation of how research assessment protocols might contribute to clinically relevant behavioral change. Results: Researcher attributions, empirical investigations and theoretical considerations all provide evidence that is consistent with the existence of subject reactivity to research assessment protocols. Conclusions: Recommendations are made regarding interpretation of data collected as part of an alcohol treatment outcome study, control of potential subject reactivity confounding variables and directions for future research.