Key reading from Thomas F. Babor’s body of work, annotated by the author.
Babor TF, Mendelson JH, Greenberg I, Kuehnle JC. Experimental analysis of the “happy hour:” Effects of purchase price on alcohol consumption. Psychopharmacology, 1978; 58:35-41.
This paper describes a lab experiment like no other. Heavy and moderate drinkers lived on a hospital ward for 30 days, working on an operant task to earn money that could be used to purchase alcohol. We lowered the price by half during an afternoon “happy hour” and observed a doubling of consumption. This is one of the first studies showing a causal effect of discount drink promotions.
Babor TF, Mendelson JH, Uhly B, Souza E. Drinking patterns in experimental and barroom settings. Journal of Studies on Alcohol, 1980; 41:635-651.
We subsequently replicated the happy hour findings in a study conducted in a barroom setting, and also described the lognormal distribution of drinking episodes in heavy and moderate drinkers. The findings indicated that heavy drinkers drink in moderation in proportion to the frequency they drink excessively, a finding that has been totally ignored in the literature on “moderate” drinking.
Babor TF, Berglas S, Mendelson JH, Ellingboe J. Alcohol, affect and the disinhibition of verbal behavior. Psychopharmacology, 1983; 80:53-60.
This lab study monitored the verbal behavior and feeling states of young adult drinkers during the BAC intoxication, demonstrating that at the exact same BAC levels, feeling states are quite different depending on whether the BAC is ascending or descending. Going up, people feel stimulated and euphoric; coming down, they report fatigue, depression and hostility.
Babor TF, Cooney NL, Lauerman RJ. The drug dependence syndrome concept as a psychological theory of relapse behaviour: An empirical evaluation. British Journal of Addiction, 1987; 82:393-405.
This paper describes how the severity of the alcohol dependence syndrome predicts the reinstatement of alcohol dependence following relapse to drinking in treated alcoholics. It was one of the few empirical evaluations of the dependence syndrome concept.
Babor, T.F., Higgins-Biddle, J., Saunders, JB, Monteiro, MG (2001) AUDIT The Alcohol Use Disorders Identification Test: Guidelines for use in Primary Care, 2nd edition. World Health Organization: Geneva, Switzerland.
The AUDIT Manual was published by WHO in 2001. Along with the validation study published by Saunders et al. in 1993; the AUDIT has emerged as the most widely used alcohol screening tests in the world. The process of developing the AUDIT was a true collaboration among investigators in six countries, something that was done with a palpable sense of excitement about the potential of applied research to change clinical practice for the better on an international level.
Babor, T.F. & Del Boca, F.K. (Eds) (2003) Treatment Matching in Alcoholism. Cambridge University Press: Cambridge, UK.
This book tells the story of Project MATCH, the largest treatment matching study ever conducted with alcoholics. There are some interesting findings here: that treatment with talk therapy “works,” particularly if combined with AA, and that the Technology Model of treatment matching does not work, at least when patient characteristics are theoretically matched with different psychotherapies.
Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, Farmer A, Jablenski A, Pickens R, Regier D, Sartorius N, Towle L. The composite international diagnostic interview: An epidemiological instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry, l988; 45:1069-1077.
I worked with Lee Robins to develop the alcohol section of the CIDI, which subsequently became one of the main tools used internationally in psychiatric epidemiology. Although it provided basis for the standardization of psychiatric diagnoses in international studies, the limitations of the alcohol section have never been corrected to my satisfaction.
Babor TF, Hofmann M, Del Boca F, Hesselbrock V, Meyer R, Dolinsky Z, Rounsaville B. Types of alcoholics, I: Evidence for an empirically-derived typology based on indicators of vulnerability and severity. Archives of General Psychiatry, 49:599-608, 1992.
This paper provided the empirical basis for the Type A/Type B distinction in the manifestation of alcohol dependence. The findings were consistent with many prior theories and studies, but we also provided a better theoretical rationale for the need to consider different types of alcoholics for treatment and an understanding of etiology.
WHO Brief Intervention Study Group. A cross-national trial of brief interventions with heavy drinkers. American Journal of Public Health, 86(7): 948-955, 1996. (T.F. Babor responsible author)
After the development of the AUDIT, a ten-nation trial was initiated by WHO to evaluate the effectiveness of brief interventions. NIAAA funded the participation of a US site and the US Coordinating Center although our grant was initially rejected because the reviewers did not believe that we could obtain accurate information from drinkers in different countries. The trial demonstrated the ability of brief interventions to reduce hazardous drinking, a finding the generalized across a diverse group of countries, cultures and language groups.
WHO ASSIST Working Group. The alcohol, smoking and substance involvement screening test (ASSIST): development, reliability and feasibility. Addiction 97:1183-1194, 2002.
With the success of the AUDIT, the World Health Organization, under the leadership of Maristela Monteiro, convened a planning group to develop the prototype for a screening test that would identify at-risk substance use across ten substance classes, providing severity metrics allow clinicians to prioritize the substances most in need of an intervention. The ASSIST has proven to be a useful screener and now we have developed a short version that is much more efficient in terms of time and training.
Babor, T., Caetano, R., Casswell, S., Edwards, G., Giesbrecht, N., Graham, K., Grube, J., Gruenewald, P., Hill, L., Holder, H., Homel, R., Österberg, E., Rehm, J., Room, R., Rossow, I. (2003) Alcohol: No Ordinary Commodity – Research and Public Policy. Oxford: Oxford University Press.
Griffith Edwards, then Editor of ADDICTION, and Case Coos at WHO EURO organized a meeting in Copenhagen to plan a new policy review of the world literature on alcohol. A group of co-authors was chosen and a collaborative process was initiated to produce a scholarly review of the science base for alcohol policy. After several meetings to review chapter drafts the authors concluded that the emerging theme that captured the epidemiology as well as the policy issues was that alcohol was no ordinary commodity. The book won the first prize in 2004 in the British Medical Association’s book awards in the public health category, and was again ranked in the top three when the second edition was published in 2010.
Babor, T.F., Stenius, K. and Savva, S. (Eds) (2003) Publishing Addiction Science: A Guide for the Perplexed. Social and Health Services Ltd., Rockville, MD.
Publishing Addiction Science came out of my collaboration with a group affiliated with the International Society of Addiction Journal Editors. We wanted to develop a guide for people interested in publishing and expose them at the same time to the ethical challenges of bringing good scientific research to fruition in a journal article. The book has since been rewritten and expanded in two subsequent editions, the latest in 2017 that was published by Ubiquity Press.
The Marijuana Treatment Project Research Group (2004) Brief treatments for cannabis dependence: Findings from a randomized multi-site trial. Journal of Consulting and Clinical Psychology 72(3) 455-466. (T.F. Babor, responsible author)
MTP was one of the most interesting multisite studies I participated in because we were dealing with chronic marihuana smokers who were desperately trying to stop using cannabis. The results were about as good as you can get from a clinical trial, and they provide interesting insights into how treatment works. The findings suggest that the anticipation of treatment is as important as the treatment itself in motivating chronic users to cut down or stop.
Dennis M, Godley SH, Diamond G, Tims FM, Babor T, Donaldson J, Liddle H, Titus JC, Kaminer Y, Webb C, Hamilton N, Funk R. (2004) The Cannabis Youth Treatment (CYT) Study: main findings from two randomized trials. J Subst Abuse Treat. Oct;27(3):197-213.
The CYT study showed that all the fancy therapeutic techniques developed to treat young people’s marihuana smoking work no better than a few sessions of cognitive behavioral therapy, probably because once kids are busted by their school or their parents they respond equally well to just about any therapeutic intervention. It seems like the main value of different psychosocial treatments is to motivate therapists to appear competent, regardless of the effectiveness of their therapy.
Babor, T.F., Higgins-Biddle, J., Dauser, D., Higgins, P., & Burleson, J. (2005). Alcohol screening and brief intervention in primary care settings: Implementation models and predictors. Journal of Studies on Alcohol 66(3):361-369.
This study showed that screening rates depend on a variety of practical considerations in the clinic, including whether clinicians are happy with their jobs and have a minimum of competing priorities so they can set up and manage a screening program.
Babor, T., Caulkins, J., Edwards, G., Fischer, B., Foxcroft, D.R., Humphreys, K., Obot, I., E., Rehm, J., Reuter, P., Room, R., Rossow, I., Strang, J. Drug Policy and the Public Good, Oxford: Oxford University Press, 2010.
With the success of Alcohol: No Ordinary Commodity as a policy brief, Griffith Edwards convened a group of career scientists to summarize the science base relevant to national and international drug policy. The book found mixed evidence for current policy options in the areas of demand reduction and supply control, but the most remarkable finding was the failure of the international drug control system and government funding agenciesto invest in drug policy research.
Humeniuk R., Ali R., Babor T., Formigoni ML., de Lacerda R., Ling W., McRee B., Newcombe D., Pal H, Poznyak V., Simon S., & Vendetti J. (2012) A randomized controlled trial of a brief intervention for illicit drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in clients recruited from primary health-care settings in four countries. Addiction 107:957-966.
This study was organized by the World Health Organization in order to test the value of screening for drug use in primary care settings. The results were very encouraging, especially in the context of a trial that was conducted simultaneously in India, Australia, the USA and Brazil.
Babor TF, Xuan Z, Damon D, Noel J. An empirical evaluation of the US Beer Institute’s self-regulation code governing the content of beer advertising. Am J Public Health. 2013 103(10):e45-51.
We collected ads broadcast a 10-year period during the US college basketball national tournament. The study allowed us to apply a new technique to the documentation of code violations, and it demonstrated the hollowness of the beer industry’s claims about “corporate social responsibility.”
Noel J, Babor T, Robaina K. (2017) Industry self-regulation of alcohol marketing: A systematic review of content and exposure research. Addiction DOI: 10.1111/add.13410
There was a need to pull together a rather disparate literature dealing with alcohol marketing and the alcohol industry’s self-regulation schemes. The literature proved to be a severe indictment of the alcohol industry’s claim that they were capable of regulating their own commercial activities in the interests of public health.
Heidari S, Babor T F, De Castro P, Tort S, Curno M. (2016) Sex and Gender Equity in Research: Rationale for the SAGER Reporting Guideline and recommended use. Research Integrity and Peer Review 1:2. DOI: 10.1186/ s41073-016-0007-6. (Corresponding Author)
I was asked to join the Gender Policy Committee at a chance meeting with a small group at the bi-annual meeting of the European Association of Science Editors. We reviewed the literature on gender issues, did a survey of journal editors, and developed the guideline published in this article. I subsequently worked to get addiction journals to adopt the guideline.
Noel J., Babor T. F., Robaina K., Feulner M., Vendrame A., Monteiro M. Alcohol marketing in the Americas and Spain during the 2014 FIFA World Cup Tournament. Addiction 2016; 112 (Suppl. 1): 109–16.
We suspected that the FIFA World Cup would be a mega-marketing event for the alcohol industry, and were not disappointed. With no encouragement or funding from government, private or philanthropic organizations, we enlisted collaborators in 10 countries to record the Round of 16 games and then evaluated the marketing contents for code violations. The results were revealing.
The opinions expressed in this commentary reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the Society for the Study of Addiction.