The use and impact of self-monitoring on substance use outcomes: A descriptive systematic review

Abstract

Background: Self-Monitoring (SM), the act of observing ones’ own behavior, has been used in substance use treatment because SM may bring conscious awareness to automatized substance use behaviors. Empirical findings regarding SM’s effectiveness are mixed. The aim of this study was to synthesize the literature for the efficacy of SM on substance use. Method: A literature search was conducted using MEDLINE/PubMed. Results: Out of 2,659 citations, 41 studies with 126 analyses were included. Among analyses from studies rated Moderate (n = 24) or Strong (n = 3) quality, SM was shown to have a helpful effect (e.g., reducing substance use) 29% of the time; to have no effect 63.0% of the time; and to be detrimental in 8.0% of analyses. SM’s helpful effects were associated with methodological characteristics including longer monitoring and Phone/IVR and EMA/Computer methodologies compared to Paper/Pencil. SM was more helpful in non-treatment-seekers (35.0% of analyses showed SM to be helpful compared to 25.0% of analyses with treatment-seekers). Conclusions: Results of this study suggest that SM, under certain circumstances, as the potential to be a low-cost, low-risk research and early intervention strategy for substance users.

Keywords:

• Self-monitoring
• assessment effects
• systematic review
• low-intensity intervention

Acknowledgments

The authors would like to thank the Center for Integrated Healthcare SERVICE Lab Support Staff, especially Jacob Scharer, Yvette Rother, Lee Bernstein, Jennie Tapio, Taylor Larobardiere, Jillian Avery, and Michael Paladino, for their help with this research.

Disclosure statement

The views expressed in this article are those of the authors alone and do not represent the US Federal Government or the Department of Veterans’ Affairs. The authors have no financial conflicts of interest to disclose.

Notes

1 This study compared 4 conditions: self-directed behavioral self-control training, therapist-directed behavioral control training, an SM-waitlist control, and a non-SM waitlist control. For the current review, only analyses examining the difference between the SM-waitlist control and the non-SM waitlist control were extracted.

2 This study included a manipulation of High Expectancy (i.e., that SM would change behavior) vs. Low Expectancy, and compared SM of cigarettes smoked to craving. Analyses included in this review are based on analyses collapsed across groups; i.e., overall changes to SM in all groups.

3 Although this study also compared SM to acupuncture groups, the analysis from this review is regarding the within-persons reduction in cigarettes in the SM group.

4 Alcohol SM group was the control group in this study; the experimental group monitored snack-eating behavior. For this review, only data from the alcohol SM group are presented.

5 This study had three SM groups (Group 1: time opening a new pack; Group 2: same as Group 1 + time each cigarette smoked; Group 3: same as Group 2 + brand of cigarette smoked, how much they smoked, who they were with, and how much each cigarette was enjoyed). For the purposes of this review, analyses comparing these groups to non-SM controls were extracted.

6 This study used four groups: low follow-up + SM, intensive follow-up + SM, low follow-up w/o SM, and intensive follow-up w/o SM. Analyses collapsed across the follow-up conditions that compared SM to non-SM were extracted.

7 This study also had a SM + dashboard + counseling group; only analyses focused on the comparison between the SM + dashboard group vs. the non-treatment control were extracted.

8 This study had three groups: 1 week SM before quitting; 1 week SM after quitting, and no SM. Analyses reported in this review were only those comparing the two SM conditions (combined) to the no-SM group.

9 This study also had a weekly monitoring condition. All results reported in this review were between daily SM and no SM.

10 Study also had a SM + Feedback condition; not reported in this review.

11 SM group was considered the control condition for a study looking at SM vs. SM + Increased Strategies for Control. Analyses reported in this review are based on omnibus tests collapsed across groups and follow-up contrast tests looking at SM group alone vs. the null hypothesis.

12 Quality raters for this article initially discrepant on variable assessing participant withdrawal from the study. Withdrawals increased over the course of the study and by end of study only 18 of 31 participants remained, which would have rendered this a Weak rated article. However, most analyses reported in the manuscript those reported in this review are from the first 60 days of the study, which included 24 of 31 participants, moving this into the Moderate quality category.

13 This study compared three SM groups to a brief alcohol intervention control; only one SM group used compensation.

14 Participants were not compensated for SM directly, they were compensated for returning their diaries at the end of the study period.

15 Same as Footnote c.

16 This study had two JC conditions and one C + condition.

17 Subscales in analyses 78–84 came from the WSWS⁷⁷; 85–86 from the Positive and Negative Affect Scale;⁷⁸ 87–91 from the Self-Efficacy Scale,⁷⁹ 92–93 from the Decisional Balance Inventory—Short Form;⁸⁰ 94–96 from the Situational Temptation Inventory.⁸¹

Additional information

Funding

Writing of this manuscript was supported in part by the Department of Veterans Affairs Office of Research and Development, Health Services Research & Development Career Development Award Program; the Department of Veterans Affairs Office of Academic Affiliations, Advanced Fellowship Program in Mental Illness Research and Treatment, the Department of Veterans Affairs Center for Integrated Healthcare, VA Western New York Healthcare System at Buffalo, and the Department of Veterans Affairs Office of Research and Development.