Regression to the mean in substance use disorder treatment research
Abstract
Aims Regression to the mean (RTM) refers to the tendency for a group of cases that differ from the population mean to move (regress) towards the mean, on average, when re‐assessed, if scores at the two points are less than perfectly correlated. This paper considers factors that affect the magnitude of RTM and how RTM may impact findings from primary studies and reviews of substance use disorder (SUD) treatment. Design and methods The paper is guided largely by A Primer on Regression Artifacts by Campbell and Kenny. It reviews potential RTM effects in three areas of SUD treatment research. One is the extent to which within‐group improvement in comparative treatment trials, including ‘placebo effects’, is a function of RTM. The second is the vulnerability of treatment evaluations employing non‐equivalent control group designs to RTM and biased estimates of treatment effects when matching, or statistical equating is used to adjust for pre‐existing group differences. The final issue is the impact of RTM in syntheses of research findings on SUD treatments. In particular, the tendency for later studies of a particular intervention to have smaller treatment effect sizes relative to earlier studies is considered as an RTM phenomenon. Findings RTM is a pervasive, but often unrecognized phenomenon that can bias findings in SUD treatment studies and in systematic reviews of that research. Conclusion SUD treatment researchers should be aware of RTM, take any available steps to reduce it, and try to diagnose whether it is still affecting research findings.
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Reduction of alcohol use regardless of treatment allocation is observed in other alcohol intervention trials, especially in emergency care settings, due to contextual factors such as trauma exposure or the acute care experience.
“This is observed in other alcohol intervention trials, especially those conducted in emergency care settings, due to contextual factors such as trauma exposure or the acute care experience [15,27,37,41–43].”
Cites
Sobell, L. C., & Sobell, M. B. (1992) · Measuring Alcohol Consumption · doi:10.1007/978-1-4612-0357-5_3 · Cited by 4,110 · see citing works
(1997) · Journal of Studies on Alcohol · doi:10.15288/jsa.1997.58.7 · Cited by 1,905 · see citing works
Naltrexone in the Treatment of Alcohol Dependence
Volpicelli, J. R. (1992) · Archives of General Psychiatry · doi:10.1001/archpsyc.1992.01820110040006 · Cited by 1,828 · see citing works
Cumulative Meta-Analysis of Therapeutic Trials for Myocardial Infarction
Lau, J., Antman, E. M., Jimenez-Silva, J., Kupelnick, B., Mosteller, F., & Chalmers, T. C. (1992) · New England Journal of Medicine · doi:10.1056/nejm199207233270406 · Cited by 1,140 · see citing works
Moyer, A., Finney, J. W., Swearingen, C. E., & Vergun, P. (2002) · Addiction · doi:10.1046/j.1360-0443.2002.00018.x · Cited by 1,092 · see citing works
Self-citationInstruments for Causal Inference: An Epidemiologist's Dream?
Hernán, M. A., & Robins, J. M. (2006) · Epidemiology · doi:10.1097/01.ede.0000222409.00878.37 · Cited by 961 · see citing works
. Caution regarding the use of pilot studies to guide power calculations for study proposals.
Kraemer, H. C., Mintz, J., Noda, A., Tinklenberg, J., & Yesavage, J. A. (2006) · Archives of General Psychiatry · doi:10.1001/archpsyc.63.5.484 · Cited by 702 · see citing works
Effect sizes in cumulative meta-analyses of mental health randomized trials evolved over time
Trikalinos, T. A., Churchill, R., Ferri, M., Leucht, S., Tuunainen, A., Wahlbeck, K., & Ioannidis, J. P. A. (2004) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2004.02.018 · Cited by 177 · see citing works
Kraemer, H. C., Gardner, C., Brooks, J. O., & Yesavage, J. A. (1998) · Psychological Methods · doi:10.1037/1082-989x.3.1.23 · Cited by 141 · see citing works
REGRESSION TO THE MEAN: WHAT DOES IT MEAN?
CUNNINGHAM, J. A. (2006) · Alcohol and Alcoholism · doi:10.1093/alcalc/agl039 · Cited by 21 · see citing works
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Madras, B. K., Compton, W. M., Avula, D., Stegbauer, T., Stein, J. B., & Clark, H. W. (2009) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2008.08.003 · Cited by 663 · see citing works
Aubry, T., Goering, P., Veldhuizen, S., Adair, C. E., Bourque, J., Distasio, J., Latimer, E., Stergiopoulos, V., Somers, J., Streiner, D. L., et al. (2016) · Psychiatric Services · doi:10.1176/appi.ps.201400587 · Cited by 220 · see citing works
SBIRT for adolescent drug and alcohol use: Current status and future directions
Mitchell, S. G., Gryczynski, J., O'Grady, K. E., & Schwartz, R. P. (2013) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2012.11.005 · Cited by 185 · see citing works
Schneider, S., Moyer, A., Knapp-Oliver, S., Sohl, S., Cannella, D., & Targhetta, V. (2010) · Journal of Behavioral Medicine · doi:10.1007/s10865-009-9227-2 · Cited by 169 · see citing works
Kohler, S., & Hofmann, A. (2015) · Alcohol and Alcoholism · doi:10.1093/alcalc/agu098 · Cited by 139 · see citing works
Crane, D., Garnett, C., Michie, S., West, R., & Brown, J. (2018) · Scientific Reports · doi:10.1038/s41598-018-22420-8 · Cited by 118 · see citing works
Jenkins, R. J., McAlaney, J., & McCambridge, J. (2009) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2008.09.016 · Cited by 103 · see citing works
Kelly, J. F., Pagano, M. E., Stout, R. L., & Johnson, S. M. (2011) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2011.72.1000 · Cited by 87 · see citing works
Fleming, M. F., Balousek, S. L., Grossberg, P. M., Mundt, M. P., Brown, D., Wiegel, J. R., Zakletskaia, L. I., & Saewyc, E. M. (2010) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2010.71.23 · Cited by 83 · see citing works
Lee, M. R., Chassin, L., & Villalta, I. K. (2013) · Development and Psychopathology · doi:10.1017/s0954579413000424 · Cited by 81 · see citing works
BERNSTEIN, J. A., BERNSTEIN, E., & HEEREN, T. C. (2010) · Drug and Alcohol Review · doi:10.1111/j.1465-3362.2010.00174.x · Cited by 68 · see citing works
McCambridge, J., Kypri, K., & McElduff, P. (2014) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2013.11.017 · Cited by 54 · see citing works
Preusse, M., Neuner, F., & Ertl, V. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00768 · Cited by 38 · see citing works
Kerman, N., Aubry, T., Adair, C. E., Distasio, J., Latimer, E., Somers, J., & Stergiopoulos, V. (2020) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-020-01008-3 · Cited by 30 · see citing works
Chang, G., Fisher, N. D. L., Hornstein, M. D., Jones, J. A., Hauke, S. H., Niamkey, N., Briegleb, C., & Orav, E. J. (2011) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2011.02.011 · Cited by 23 · see citing works
BABOR, T. F. (2008) · Addiction · doi:10.1111/j.1360-0443.2007.02035.x · Cited by 3 · see citing works
Staton, C. A., Minja, L., de Souza, J. V. P., Gallis, J. A., Santos, P. C. P., Buono, M., Sakita, F., Ngowi, K., Boshe, J., Phillips, A. J., et al. (2025) · PLOS Medicine · doi:10.1371/journal.pmed.1004548 · Cited by 3 · see citing works
“This is observed in other alcohol intervention trials, especially those conducted in emergency care settings, due to contextual factors such as trauma exposure or the acute care experience [15,27,37,41–43].”
- Authors
- Finney, J. W.
- Affiliations
- VA Palo Alto Health Care System (US)
- Corresponding author
- Finney, John W.
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2007-12-07
- Volume
- 103
- Issue
- 1
- Pages
- 42-52
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- OpenAlex
- W2122068549
- Cited by
- 78
- References
- 10
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2023: 3 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 4 · 2018: 7 · 2017: 2 · 2016: 2 · 2015: 6 · 2014: 3 · 2013: 7 · 2012: 3
- FWCI
- 1.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
- Keywords
- regression to the mean, addiction treatment, placebo effect, matching, treatment effect size, systematic reviews
- MeSH terms
- Data Interpretation, Statistical, Female, Humans, Male, Regression Analysis, Research Design, Models, Statistical, Substance-Related Disorders
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