Elsevier

Addictive Behaviors

Volume 37, Issue 3, March 2012, Pages 225-233
Addictive Behaviors

Validity of Timeline Follow-Back for self-reported use of cannabis and other illicit substances — Systematic review and meta-analysis

https://doi.org/10.1016/j.addbeh.2011.11.025Get rights and content

Abstract

Background

Timeline Follow-Back (TLFB) is a widely used, calendar-based measure of self-reported use of (among other things) illicit substances. We examined agreement between TLFB and biological measures for illicit substances.

Methods

PubMed, PsycINFO, Cochrane CENTRAL, and EMBASE were searched in December 2010. 16,633 papers screened to identify those that measured illicit substance use by both TLFB and biological measures. We extracted data on agreement between TLFB and biological measures, sample size, study type, inclusion criteria of participants, and length of recall of TLFB.

Results

Twenty-nine papers were included, almost exclusively in substance-use-disorder populations. Some studies reported several overall agreement rates, e.g. over time. Lowest and highest weighted average agreement rates were: for cannabis, 87.3% (95% confidence interval 86.9% to 87.7%) and 90.9% (90.5% to 91.4%); for cocaine, 79.3% (79.1% to 79.6%) and 84.1% (83.9% to 84.2%); for opiates 94.0% (93.5% to 94.5%) for both weighted averages; and for studies not distinguishing between substances, 88.5% (88.4 to 88.7%) and 91.0% (90.7% to 91.2%). Higher agreement was found in populations without psychiatric comorbidity, and lower agreement in randomized controlled trials. Publication bias or selective outcome reporting bias was not detected.

Conclusions

TLFB validly detects use of illicit substances in populations with substance use disorders. Using TLFB may limit the need for biological samples, making information on illicit substance use easier and less costly to obtain and analyze.

Highlights

► Timeline Follow-Back (TLFB) validly detects use of illicit substances. ► TLFB provides an inexpensive alternative to biological samples. ► TLFB may be superior to biological samples for quantification of substance use.

Introduction

Many studies involving use, abuse, and dependence of substances such as alcohol or illicit drugs rely on self-reported measures of consumed amounts. The Timeline Follow-Back (TLFB) instrument is a commonly used self-report instrument used for assessing frequency and quantity of substance use (Sobell & Sobell, 1992). The instrument is interviewer-administered, using a visual calendar in which the respondent charts life events in order to enhance recall of substance use.

The TLFB instrument was originally developed with the intent of measuring alcohol consumption, and a number of studies have explored its validity in this context. Most studies find the instrument to be a highly valid measure of alcohol consumption (Carney et al., 1998, Grant et al., 1995, Sobell et al., 1996, Sobell et al., 1988, Toll et al., 2006), whereas a few find the validity to be modest (Searles et al., 2002, Searles et al., 2000). Using TLFB to estimate frequency and amount of tobacco smoking also produces valid results (Collins et al., 2009, Lewis-Esquerre et al., 2005, Toll et al., 2005). These findings on legal substances do not necessarily, however, extrapolate to detection of illicit substances. The validity of TLFB in measuring use of illicit substances has never been explored in a systematic review. Such validation will be useful in the context of randomized clinical trials (RCTs), cohort studies, case–control studies, etc. In particular, establishing the validity of TLFB in clinical populations such as patients with substance use disorders may be of importance both for research and treatment purposes. If TLFB is a valid description of patterns and amounts of illicit substance use, it holds practical advantages over the use of biological measures such as samples of urine, blood, or hair. For instance, it is less costly as it does not involve the use of laboratory and storage equipment, and may also be more acceptable to patients and research subjects than having to deliver a biological sample. Additionally, detection of substances in biological samples is limited to the length of time the substance or its metabolites are detectable in the sample. The TLFB is not, however, intended to enhance truthfulness of self-report, only to enhance recall.

In this article, we attempt to answer the following question through a systematic review and meta-analysis of existing literature: How well does TLFB measure consumption of cannabis and other illicit substances in comparison to biological measures such as blood, hair, or urine?

Section snippets

Methods

The protocol for this systematic review was made publically available on www.currentprotocols.com prior to initiation of the literature search (Hjorthøj, Hjorthøj, & Nordentoft, 2009).

Results

Fig. 1 details the literature retrieval process as a QUOROM flow chart (Moher et al., 1999). Of 58 retrieved papers that applied both TLFB and biological measures, we excluded four as applying positive or negative reinforcement (Feucht et al., 1994, Moore and Budney, 2002, Yacoubian, 2003, Zlotnick et al., 2009), one where agreement data was reported elsewhere (Baer et al., 2008), and 28 due to them not reporting on agreement, and authors either replying that they could provide no such data or

Discussion

The included papers were almost exclusively on subjects with a diagnosis of alcohol or illicit substance use disorder. Consequently, all conclusions relate only to this group of people, and results of this systematic review cannot necessarily be generalized to e.g. general populations. Generally, TLFB for detection of illicit substances had high levels of overall agreement with biological measures. There was some variation, however, with some studies reporting what might be considered medium

Role of funding source

Funding for this study came from funds and grants supporting the CapOpus trial, specifically supplied by: The Lundbeck Foundation, The Municipality of Copenhagen, The Egmont Foundation, The Health Insurance Foundation, The Ministry of Social Welfare, Aase and Ejnar Danielsen's Foundation, and the Wørzner Foundation. The foundations etc. providing funds and grants were not involved in any manner in design and conduct of the study; collection, management, analysis, and interpretation of the data;

Contributors

All authors wrote and approved the protocol. CRH extracted references from data sources. CRH and ARH selected papers for inclusion in the review. CRH extracted and synthesized data from individual studies. All authors actively drafted the manuscript and have approved the final manuscript.

Conflict of interest

The authors have no conflicting interests and have no financial or other relationship relevant to the subject of this article.

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