The effects of naltrexone on alcohol consumption and affect reactivity to daily interpersonal events among heavy drinkers.

The authors examined whether the associations among daily positive and negative interpersonal events, alcohol consumption, and affect varied as a function of naltrexone or placebo administered in a targeted (in anticipation of or in response to high-risk drinking situations) or daily fashion. Heavy drinkers (N = 149) received 4 sessions of brief coping skills counseling in addition to 8 weeks of naltrexone treatment. They recorded for 8 weeks in structured nightly diaries their interpersonal interactions, affect, and alcohol consumption. The authors predicted that participants receiving naltrexone, compared with those taking placebo, would drink less in response to interpersonal encounters and that naltrexone administration would attenuate the link between positive interpersonal events and positive affective states. Results indicated that both positive and negative interpersonal interactions were associated with an increased probability of engaging in any drinking and that positive daily social celebratory events were associated with an increased probability of engaging in heavy drinking. Participants taking naltrexone in a targeted fashion showed the strongest positive association between the number of positive social celebratory events and drinking. Although this finding was inconsistent with the overall reduction in drinking that has been generally reported for those treated with naltrexone, positive social celebratory events occurred on only a minority of days. Participants taking naltrexone, compared with those taking placebo, showed weaker associations between positive social celebratory events and positive and negative affective states. Findings are discussed in terms of naltrexone's dampening effects on the rewarding properties of alcohol use and certain positively valenced stimuli. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief motivational interventions for heavy college drinkers: A randomized controlled trial.

In this randomized controlled trial, the authors evaluated brief motivational interventions (BMIs) for at-risk college drinkers. Heavy drinking students (N = 509; 65% women, 35% men) were randomized into 1 of 6 intervention conditions formed by crossing the baseline Timeline Followback (TLFB) interview (present versus absent) and intervention type (basic BMI, BMI enhanced with a decisional balance module, or none). Assessments completed at baseline, 1, 6, and 12 months measured typical and risky drinking as well as drinking-related problems. Relative to controls, the TLFB interview reduced consumption but not problems at 1 month. The basic BMI improved all drinking outcomes beyond the effects of the TLFB interview at 1 month, whereas the enhanced BMI did not. Risk reduction achieved by brief interventions maintained throughout the follow-up year. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk-taking and alcohol use disorders symptomatology in a sample of problem drinkers.

The relationship between risk-taking behavior and alcohol use disorder (AUD) symptoms is poorly understood. This study employed a modified version of a behavioral measure of risk-taking, the Balloon Analogue Risk Task (BART), to examine its relationship to alcohol use and related symptoms in a community sample of individuals with or at risk for AUD. A total of 158 (71.9% male) participants completed a testing battery that included the BART, a structured diagnostic interview for AUD, and measures of alcohol use and related problems. Estimates of IQ and working memory were assessed as covariates. Results indicated that the relationship between risk-taking propensity, as assessed by the BART, and alcohol problems was significant and negative. Individuals with higher symptom count made fewer pumps per trial on the BART, indicating less risk-taking. It is important to note that this relationship was attenuated when controlling for estimated IQ and working memory span. Further examination demonstrated that IQ and age mediated the relationship between risk-taking propensity and symptom count. The main negative relationship observed between risk-taking on the BART and alcohol use and AUD symptomatology in this sample stands in contrast to the positive relationships observed in adolescent and nonclinical samples. Together, these findings highlight the need to consider development and the course of addiction to fully elucidate the effects of risky-decision making on AUD liability. Furthermore, our results demonstrate the importance of inclusion of neurocognitive covariates (IQ), as well as demographic variables (age) when using this task. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Addressing heavy drinking in smoking cessation treatment: A randomized clinical trial.

Heavy alcohol use frequently co-occurs with cigarette smoking and may impede smoking cessation. This clinical trial examined whether smoking cessation treatment that incorporates brief alcohol intervention can improve smoking cessation outcomes (7-day verified point prevalence abstinence) and reduce drinks consumed per week. Heavy drinkers seeking smoking cessation treatment were assigned by urn randomization to receive, along with 8 weeks of nicotine replacement therapy, either a 4-session standard smoking cessation treatment (ST, n = 119) or standard treatment of equal intensity that incorporated brief alcohol intervention (ST-BI, n = 117). Across follow-ups over 26 weeks, participants in ST-BI reported approximately 20% fewer drinks per week (p     

Self-efficacy change as a mediator of associations between therapeutic bond and one-year outcomes in treatments for alcohol dependence.

Empirically-supported treatments for alcohol dependence exist, yet understanding of influences contributing to the intended behavior change is limited. The current study, a secondary analysis of the recent multisite COMBINE trial (The COMBINE Study Research Group, 2003), tested a mediational model wherein change in client self-efficacy for abstinence was examined as a potential mediator of associations between client report of the therapeutic bond and one-year outcomes of drinking frequency, drinking consequences, and psychiatric functioning. For analyses, the 1383 COMBINE trial participants were grouped as follows: 1) those receiving study medications (naltrexone, acamprosate, naltrexone + acamprosate, placebo) and enrolled in medication management (MM) only (n = 607), 2) those receiving study medications/MM and also enrolled in a combination behavioral intervention (CBI) as well (n = 619), and 3) those enrolled in CBI only (n = 157). Mediation analyses using the product-of-coefficients approach indicated self-efficacy change during treatment significantly mediated associations between the therapeutic bond with the CBI therapist and each of the three one-year outcomes among those exclusively receiving CBI, but failed to do so among those receiving pills/MM (with or without CBI). Effect sizes were small, but indicated that variance in bond-outcome associations was partially mediated by self-efficacy change for trial participants. Findings advance understanding of proximal client change processes during delivery of treatments for alcohol dependence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Efficacy of moderation-oriented cue exposure for problem drinkers: A randomized controlled trial.

The effectiveness of cue exposure following a priming dose was compared with cognitive-behavioral intervention in a community sample of problem drinkers. Participants were randomly associated to 1 of the 2 conditions and received a mean of 5.84 (SD=2.69) sessions. A psychologist blind to treatment condition conducted an 8-month follow-up. Compared with pretreatment levels, significant decreased in alcohol consumption were evidence posttreatment and maintained at follow-up for both groups. Reductions in severity of dependence, impaired control, and alcohol-related problems were also evidence for both groups at follow-up. No differences in outcome associated with initial severity of alcohol dependence were apparent. The results raise the issue of the appropriateness of reserving a goal of controlled drinking for those with relatively mild alcohol problems and low alcohol dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol withdrawal severity in inbred mouse (Mus musculus) strains.

Male mice (Mus musculus) from 15 standard inbred strains were exposed to a nearly constant concentration of ethanol (EtOH) vapor for 72 hr, averaging 1.59 ± 0.03 mg EtOH/mL blood at withdrawal. EtOH- and air-exposed groups were tested hourly for handling-induced convulsions for 10 hr and at Hours 24 and 25. Strains differed markedly in the severity of withdrawal (after subtraction of control values), and by design these differences were independent of strain differences in EtOH metabolism. Correlation of strain mean withdrawal severity with other responses to EtOH supported previously reported genetic relationships of high EtOH withdrawal with low drinking, high conditioned taste aversion, low tolerance to EtOH-induced hypothermia, and high stimulated activity after low-dose EtOH. Also supported were the positive genetic correlations among EtOH, barbiturate, and benzodiazepine withdrawal. Sensitivity of naive mice to several chemical convulsant-induced seizures was also correlated with EtOH withdrawal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical uses of naltrexone: A review of the evidence.

The implication of the opioidergic system in the pathogenesis of various substance use disorders has led to renewed interest in expanding the clinical uses of naltrexone, an opioid antagonist. This article examines the evidence for the efficacy of naltrexone in a variety of substance use and psychiatric disorders. Naltrexone can be an effective treatment for alcohol and opioid dependence if issues of compliance are adequately addressed. Thus far, no definitive role has been found for naltrexone in the treatment of other psychiatric disorders. Further research needs to be done in self-injurious behavior, gambling, cocaine, and nicotine dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An investigation of predictors of nicotine abstinence in a smoking cessation treatment study of smokers with a past history of alcohol dependence.

This study investigated predictors for smoking abstinence at 12-week follow-up among 85 smokers with a past history of alcohol dependence enrolled in a smoking cessation trial. Length of alcohol abstinence at time of enrollment and longest previous period of smoking abstinence were significantly associated with smoking status at follow-up. Multiple logistic regression with these variables entered as predictors suggested that longest previous period of smoking abstinence partially mediated the relationship between length of alcohol abstinence at enrollment and smoking status at follow-up. Additional research is warranted to identify predictors of nicotine abstinence and smoking relapse in this population and to understand the factors that mediate the relationship between length of alcohol abstinence at enrollment and smoking outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contracting, prompting, and reinforcing substance use disorder continuing care: A randomized clinical trial.

Although continuing care is strongly related to positive treatment outcomes for substance use disorder (SUD), participation rates are low and few effective interventions are available. In a randomized clinical trial with 150 participants (97% men), 75 graduates of a residential Veterans Affairs Medical Center SUD program who received an aftercare contract, attendance prompts, and reinforcers (CPR) were compared to 75 graduates who received standard treatment (STX). Among CPR participants, 55% completed at least 3 months of aftercare, compared to 36% in STX. Similarly, CPR participants remained in treatment longer than those in STX (5.5 vs. 4.4 months). Additionally, CPR participants were more likely to be abstinent compared to STX (57% vs. 37%) after 1 year. The CPR intervention offers a practical means to improve adherence among individuals in SUD treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Accounting for self-selected drinking goals in the assessment of treatment outcome.

Many treatment outcome studies are abstinence-based and rely on achieved abstinence as an indicator of success, making the implicit assumption that participants have an abstinence goal. However, it is often the case that participants self-select controlled drinking goals, even in the context of an abstinence-based treatment. The current study explored the use of an outcome variable, percent weeks meeting goal (PWMG), which takes into account individual goal choice at baseline. The sample consisted of 57 women who participated in a cognitive-behavioral therapy treatment for alcohol dependence and were followed for 18 months after baseline. Twenty-two (39%) women self-selected controlled drinking goals, and 35 (61%) self-selected an abstinence goal at baseline. A repeated measures analysis of variance with PWMG as the dependent variable revealed that both goal groups were equally successful in meeting their goals during the 6-month treatment period. After treatment, participants with a goal of abstinence had more PWMG than did participants with a self-selected controlled drinking goal, but the difference was significant at a trend level. The two goal groups did not differ in outcome when the authors compared them using more traditional measures of outcome, percent days abstinent and percent heavy drinking days. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coercion and empowerment in the treatment of individuals with serious mental illness: A preliminary investigation.

Recently, treatment approaches for individuals with serious mental illness (SMI) have sought to increase autonomy to prevent frequent hospitalizations. Two of these strategies are coercive treatment and empowerment. Both coercive treatment and empowerment attempt to increase an individual's freedom from illness as well as rehospitalization. In the literature coercion is viewed as a barrier to empowerment, yet the long-term goals of both approaches are similar. Thus, coercive treatment may not serve as a barrier to empowerment. This study is a preliminary investigation of the empirical relationship between and among coercion, functioning, and empowerment. Participants were recruited from treatment centers in Mississippi and were at varying stages of treatment including inpatient and outpatient (N = 64). Variables of interest were measured with the MacArthur Admissions Experience Survey, Brief Symptom Inventory, Multnomah Community Ability Scale, MacArthur Competence Assessment Tool-Treatment, and Empowerment Scale. In this sample, only functioning was predictive of empowerment, suggesting that empowerment is dependent on an individual's level of functioning. In addition, coercion may not necessarily disempower individuals with SMI. Implications and directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increased sensitivity to the disinhibiting effects of alcohol in binge drinkers.

Heavy episodic alcohol use, or binge drinking, is a serious public health problem. Binge drinking is endemic in college students and has resulted in numerous alcohol-related tragedies, including acute alcohol poisonings, falls, and automobile collisions. Such negative outcomes might occur because binge drinkers are generally more impulsive, and this impulsivity might be exacerbated under alcohol. The purpose of this study was to examine this hypothesis by comparing the acute effects of alcohol on a cognitive measure of behavioral control in binge and nonbinge drinkers. The results indicated that binge drinkers act more impulsively and report feeling more stimulated under an acute 0.65 g/kg dose of alcohol compared to nonbinge drinkers. The present finding of a heightened disinhibitory reaction to alcohol in binge drinkers may help explain the link between impulsivity and problem drinking at a more fundamental level of behavioral control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Deficits in emotion-regulation skills predict alcohol use during and after cognitive–behavioral therapy for alcohol dependence.

Objective: As emotion regulation is widely considered to be a primary motive in the misuse of alcohol, our aim in the study was to investigate whether deficits in adaptive emotion-regulation skills maintain alcohol dependence (AD). Method: A prospective study investigated whether emotion-regulation skills were associated with AD and whether these skills predicted alcohol use during and after treatment for AD. Participants were 116 individuals treated for AD with cognitive–behavioral therapy. Emotion regulation and severity of AD symptoms were assessed by self-report. Alcohol use during treatment was assessed by Breathalyzer and urine analysis for ethyl glucuronide; alcohol use during the 3-month follow-up interval was assessed by self-report. Results: Pretreatment emotion-regulation skills predicted alcohol use during treatment, and posttreatment emotion-regulation skills predicted alcohol use at follow-up, even when controlling for other predictors potentially related to emotion regulation. Among a broad range of specific emotion-regulation skills, the ability to tolerate negative emotions was the only skill that negatively predicted subsequent alcohol consumption when controlling for the other skills. Individuals in the AD sample reported significantly larger deficits in emotion-regulation skills than did those in a nonclinical control sample but significantly less than did those in a sample of individuals exclusively meeting criteria for major depressive disorder. Conclusions: Enhancement of general emotion-regulation skills, especially the ability to tolerate negative emotions, appears to be an important target in the treatment of AD. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Gender differences and developmental change in externalizing disorders from late adolescence to early adulthood: A longitudinal twin study.

Using data from over 1,000 male and female twins participating in the Minnesota Twin Family Study, the authors examined developmental change, gender differences, and genetic and environmental contributions to the symptom levels of four externalizing disorders (adult antisocial behavior, alcohol dependence, nicotine dependence, and drug dependence) from ages 17 to 24. Both men and women increased in symptoms for each externalizing disorder, with men increasing at a greater rate than women, such that a modest gender gap at age 17 widened to a large one at age 24. Additionally, a mean-level gender difference on a latent Externalizing factor could account for the mean-level gender differences for the individual disorders. Biometric analyses revealed increasing genetic variation and heritability for men but a trend toward decreasing genetic variation and increasing environmental effects for women. Results illustrate the importance of gender and developmental context for symptom expression and the utility of structural models to integrate general trends and disorder-specific characteristics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mild stress increases attentional bias in social drinkers who drink to cope: A replication and extension.

The authors investigated the effects of a laboratory stressor task on rapid initial orienting and delayed disengagement aspects of attentional bias for alcohol-related cues in social drinkers (N = 58). Participants were randomly allocated to receive a stress induction or control manipulation before completing a visual probe task in which alcohol cues were presented for either 100 ms or 500 ms. Results indicated that participants who reported drinking alcohol to cope with negative affect had increased attentional bias for alcohol cues after stress induction. This effect of stress induction on attentional bias was evident when cues were presented for 100 ms and 500 ms, which suggests that stress increases both the initial orienting of attention toward and the delayed disengagement of attention from alcohol-related cues. Theoretical implications of this robust finding are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A new decisional balance measure of motivation to change among at-risk college drinkers.

In this study, an open-ended decisional balance worksheet was used to elicit self-generated pros and cons of current drinking and reducing drinking, which were then quantified to create a decisional balance proportion (DBP) reflecting movement toward change (i.e., counts of pros of reducing drinking and cons of current drinking to all decisional balance fields). This study’s goal was to examine the convergent, discriminant, and predictive validity of the DBP as a measure of motivation to change. Participants were college students (N = 143) who reported having engaged in weekly heavy, episodic drinking and who had participated in a larger randomized clinical trial of brief motivational interventions (K. B. Carey, M. P. Carey, S. A. Maisto, & J. M. Henson, 2006). Findings indicated partial support for convergent and discriminant validity of the DBP. Compared with Likert scale measures of decisional balance and readiness to change, DBP scores reflecting greater movement toward change best predicted reductions in heavy drinking quantity and frequency and experience of alcohol-related consequences, although some of these effects decayed by the 12-month follow-up. Findings suggest that the DBP is a valid measure of motivation to change among at-risk college drinkers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of motivation to change after medical treatment for drinking-related events in adolescents.

Characteristics associated with intention to change drinking were examined in 254 adolescents treated in an emergency department for alcohol. Younger age, living at home, lower baseline level of drinking and drinking problems, greater depression, having penalties for breaking family drinking rules, higher injury severity, being frightened, and being admitted to the hospital predicted greater intention to change drinking at the time of the event. Baseline characteristics related to being in the action stage of change 3 months later were younger age; lower drinking; having penalties for breaking family drinking rules; injury severity; and number of anticipated consequences, including being in trouble with parents. This study has implications for brief interventions that capitalize on potential teachable moments with problem-drinking adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The dimensionality of social victimization: A preliminary investigation.

The purpose of the current study was to examine the dimensionality of social victimization and to assess the relation between social victimization and classmate social support in a sample of 260 students. Confirmatory factor analyses yielded four dimensions of peer victimization: overt, verbal social, and nonverbal social victimization and peer exclusion, providing preliminary evidence that social victimization is multidimensional. Boys reported experiencing greater levels of overt victimization than girls and girls were more likely to endorse experiencing peer exclusion. No gender differences were found with respect to children's experience of verbal and nonverbal forms of social victimization. Results suggest that middle school students were more likely to be the target of verbal social victimization than were elementary school students. Verbal social and nonverbal social victimization as well as peer exclusion demonstrated criterion-related validity. Implications for assessment and intervention for social victimization and suggestions for future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)