Structural Equation Analyses of Clinical Subpopulation Differences and Comparative Treatment Outcomes: Characterizing the Daily Lives of Drug Addicts

The use of structural equation modeling (SEM) is illustrated for comparative treatment outcome research conducted with heterogeneous clinical subpopulations within large multimodality treatment settings. All analyses are accomplished with SEM analogs of more familiar classical multivariate techniques. The effect of the early period of treatment on the daily lives of 486 clients in two drug abuse treatment modalities (methadone maintenance and outpatient counseling) is evaluated. Structured means analysis is used to assess initial differences between modalities on the latent means of 6 latent constructs reflecting daily life. The effect of treatment modality and attrition from the program on daily life latent constructs is evaluated while initial selection differences are statistically controlled. Effect sizes are computed on the basis of SEM parameter estimates. The advantage of SEM over classic multivariate approaches for correcting for selection bias when assessing comparative outcomes is explained.