RI Gambling Treatment Program
Research Methods
It pays to be skeptical when reading reports of the effectiveness
of treatments, medications or other health-related services. When
we report statistics, such as "76 percent of our patients achieved
significant improvement," we are relying on an accepted scientific
standard of change. Simply speaking, we are referring to clinically
significant change, as opposed to statistically significant change
or absolute change.
What's the difference?
- Absolute change is any
improvement. Say for example, a patient lost $5,000 in the
month before entering our program. Then let's say that we followed
up with that patient after 12 months and found that he lost
$4,900 in the previous 30 days. If we were only looking for
absolute change, then we would count this person as improved.
But most people would agree that that sort of "improvement"
wouldn't be very significant. Worse yet, to report such a person
as having improved would be rather dishonest (in our opinion).
- Statistically significant change
usually relies on group averages in large numbers of
people. For example, consider the following actual statistic
from our program: in 101 patients, the average amount of money
lost gambling in the previous month fell from $2,969 prior to
entering the program, to $522 in the month before the follow-up.
Statistically that's a big enough improvement to say, "the
treatment program was effective in limiting the dollar losses
of those patients." But is $522 (on average) per month
an acceptable amount to spend on gambling every month? And what
about individual patients? Averages can be affected by a few
people who are not doing very well.
- Clinically significant change
refers to individual change. Each person was compared
to himself or herself as a point of reference. Those patients
who improved at least a certain amount (one standard deviation)
on a combination of factors, such as money lost, the frequency
of gambling, loss of control over gambling, distress over one's
gambling, and the desire for treatment, were considered to have
achieved clinically significant change. In other words, each
individual had made a meaningful change in his or her own pattern.
This reflects improvement in several areas, not just one. We
think that this reflects "real" change in real people.
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