Neurocognitive impairment associated with alcohol use disorders: Implications for treatment.

Between 50% and 80% of individuals with alcohol use disorders experience mild to severe neurocognitive impairment. There is a strong clinical rationale that neurocognitive impairment is an important source of individual difference affecting many aspects of addiction treatment, but empirical tests of the direct influence of impairment on treatment outcome have yielded weak and inconsistent results. The authors address the schism between applied-theoretical perspectives and research evidence by suggesting alternative conceptual models of the relationship between neurocognitive impairment and addiction treatment outcome. Methods to promote neurocognitive recovery and ways in which addiction treatments may be modified to improve psychosocial adaptation are suggested. Specific suggestions for future research that may help clarify the complex relations between neurocognitive impairment and addiction treatment are outlined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonproblem drinking outcomes in adolescents treated for alcohol use disorders.

Change to nonproblem drinking was studied in 159 adolescents (70% male) presenting for alcohol use disorders (AUDs) treatment. A community sample (n=148, 47% male) also was assessed. Clinical participants had a current AUD at baseline; 1 year later, 17% remained abstinent, 60% had at least 1 AUD symptom (problem drinkers), and 23% were drinking but had no AUD symptoms (nonproblem drinkers). Drinking among the nonproblem drinkers decreased and was lower than in the problem drinkers. Nonproblem drinkers increased in psychosocial functioning and decreased in the number of illicit drugs used relative to problem drinkers and generally did not differ from the abstainers. The results suggest alternative views of treatment goals, relapse, and treatment outcome in adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interactions between self-reported alcohol outcome expectancies and cognitive functioning in the prediction of alcohol use and associated problems: A further examination.

A recent debate regarding the theoretical distinction between explicit and implicit cognitive processes relevant to alcohol-related behaviors was strongly shaped by empirical findings from dual-process models (Moss & Albery, 2009; Wiers & Stacy, 2010; Moss & Albery, 2010). Specifically, as part of a broader discussion, Wiers & Stacy (2010) contended that alcohol-related behaviors are better predicted by self-reported alcohol expectancies for individuals with good executive control and verbal abilities relative to those without such abilities. The purpose of the current paper is to further test whether self-reported alcohol outcome expectancies are moderated by measures of cognitive functioning. Using multiple indices of alcohol use, alcohol-related consequences, self-reported alcohol outcome expectancies, and cognitive functioning, both cross-sectional and longitudinal analyses were conducted in a prospective sample of 489 individuals at varying risk for alcohol use disorders. Results from a series of regression analyses testing interactions between self-reported alcohol expectancies and cognitive functioning showed minimal support for the hypothesized pattern discussed by Wiers and Stacy, 2010 regarding self-reported alcohol outcome expectancies. The overall rates of significance were consistent with Type I error rates and a substantial proportion of the significant interactions were inconsistent with previous findings. Thus, the conclusion that cognitive measures consistently moderate the relation between self-reported alcohol expectancies and alcohol use and outcomes should be tempered. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Longitudinal association between marital dissatisfaction and alcohol use disorders in a community sample.

The prospective association between marital dissatisfaction and alcohol use disorders (abuse and/or dependence) was evaluated in a randomly selected community sample. Married individuals (N=1,675) from the New Haven Epidemiologic Catchment Area project who did not have a current alcohol use disorder at baseline were followed prospectively for 12 months. Results indicated that baseline marital dissatisfaction was significantly associated with alcohol use disorder diagnosis during follow-up, with dissatisfied spouses being 3.7 times more likely than satisfied spouses to have a diagnosis of current alcohol use disorder at follow-up. The longitudinal association between baseline marital dissatisfaction and current alcohol use disorder diagnosis at follow-up remained significant when controlling for baseline demographic variables and history of alcohol use disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

From the lab to the clinic: Effectiveness of cognitive-behavioral treatments for anxiety disorders.

A controversy exists over whether results of randomized controlled trials of psychological treatment methods generalize to routine clinical practice. To examine the generalizability of cognitive-behavioral interventions for anxiety disorders, a meta-analysis of 11 effectiveness studies was conducted. Only studies that closely approximated real-world clinical practice were included in the present meta-analysis (e.g., studies were conducted in a nonuniversity setting, practitioners had regular caseloads, clients were not excluded if they had comorbid conditions). Cognitive-behavioral interventions were associated with significant improvement in anxiety symptoms at the end of treatment (dw = 1.35) and again at follow-up (dw = 1.14). On the basis of these results, it seems that cognitive-behavioral interventions for anxiety disorders generalize to real-world clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relapse as a nonlinear dynamic system: Application to patients with alcohol use disorders.

Understanding the relapse process is one of the most important issues in addictive behaviors research. To date, most studies have taken a linear approach toward predicting relapse based on risk factors. Nonlinear dynamical systems theory can be used to describe processes that are not adequately modeled using a linear approach. In particular, the authors propose that catastrophe theory, a subset of nonlinear dynamical systems theory, can be used to describe the relapse process in addictive behaviors. Two small prospective studies using 6-month follow-ups of patients with alcohol use disorders (inpatient, n=51; outpatient, n=43) illustrate how cusp catastrophe theory may be used to predict relapse. Results from these preliminary studies indicate that a cusp catastrophe model has more predictive utility than traditional linear models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The development of children's intentions to use alcohol: Direct and indirect effects of parent alcohol use and parenting behaviors.

The purpose of this study was to explore the effect of parent alcohol use and parenting behavior on the development of children's intentions to use alcohol in Grades 1 through 8. The authors hypothesized that the effect of parent alcohol use on children's intention to use alcohol would be mediated through parenting behavior, specifically monitoring/supervision, positive parenting, and inconsistent discipline. Using cohort-sequential latent growth modeling (LGM), the authors tested 3 models examining the effect of the development of parent alcohol use on the development of children's intentions to use alcohol, as mediated by the development of each of the 3 parenting behaviors. Multiple group analyses were used to explore gender differences. The effect of growth in parent alcohol use on growth in children's intentions was mediated only by parent monitoring/supervision and was significant only for girls. The effect of inconsistent discipline was directly related to growth in intentions for both boys and girls. Although parent alcohol use was related to less positive parenting, positive parenting was unrelated to children's intentions to use alcohol. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting post-treatment-initiation alcohol use among patients with severe mental illness and alcohol use disorders.

Few investigators studying alcohol abuse among individuals with a severe mental illness (SMI) have examined predictors of posttreatment alcohol outcomes. In the present study, a multivariate approach based on a theoretical model was used to study the relationship between psychosocial factors and post-treatment-initiation alcohol use. Predictors of alcohol use outcomes were examined in 278 individuals diagnosed with a current schizophrenia-spectrum or bipolar disorder and an alcohol use disorder (AUD). At 6-months follow-up, 144 of 228 available participants (63%) had good clinical outcomes. The results of structural equation modeling indicated that type of pretreatment residential setting was directly related to treatment, with participants who lived in supervised settings (41%) reporting significantly more days of treatment (β = .34, p     

Transdiagnostic approaches to the treatment of anxiety disorders: A quantitative review.

Transdiagnostic cognitive-behavioral group treatments for anxiety, treatments that are designed to be applicable to diagnostically mixed groups of anxiety disorder clients, have been garnering interest in recent years. At least 7 independent research teams have developed transdiagnostic anxiety treatment protocols and reported preliminary outcomes data. In this review, we outline the basic theoretical rationale underlying transdiagnostic models of anxiety and review each of the treatment protocols that have been reported to date. Finally, the efficacy of these treatments is examined using meta-analytic methods. Results indicated that overall, transdiagnostic treatments are associated with a very large pre- to posttreatment effect size, and stable maintenance of gains through follow-up. Recommendations for transdiagnostic treatment implementation are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol demand, delayed reward discounting, and craving in relation to drinking and alcohol use disorders.

A behavioral economic approach to alcohol use disorders (AUDs) emphasizes both individual and environmental determinants of alcohol use. The current study examined individual differences in alcohol demand (i.e., motivation for alcohol under escalating conditions of price) and delayed reward discounting (i.e., preference for immediate small rewards compared to delayed larger rewards) in 61 heavy drinkers (62% with an AUD). In addition, based on theoretical accounts that emphasize the role of craving in reward valuation and preferences for immediate rewards, craving for alcohol was also examined in relation to these behavioral economic variables and the alcohol-related variables. Intensity of alcohol demand and delayed reward discounting were significantly associated with AUD symptoms, but not with quantitative measures of alcohol use, and were also moderately correlated with each other. Likewise, craving was significantly associated with AUD symptoms, but not with alcohol use, and was also significantly correlated with both intensity of demand and delayed reward discounting. These findings further emphasize the relevance of behavioral economic indices of motivation to AUDs and the potential importance of craving for alcohol in this relationship. (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)     

Religiosity, alcohol use attitudes, and alcohol use in a national sample of adolescents.

The purpose of this study was to investigate alcohol use attitudes as a mediator of the relationship between religiosity and the frequency of past month alcohol use in a national sample of adolescents. Data were drawn from 18,314 adolescents who participated in the 2006 and 2007 National Survey on Drug Use and Health. Variables included religiosity, alcohol use attitudes, and past month frequency of alcohol use. Structural equation modeling was used to test alcohol use attitudes as a mediator of the relationship between religiosity and frequency of alcohol use and to test model invariance across 4 racial/ethnic groups. Results suggest that alcohol use attitudes partially mediate the relationship between religiosity and frequency of alcohol use. Furthermore, while the pattern of these relationships is similar across racial/ethnic groups, the magnitude of alcohol use attitudes on frequency of alcohol use differed. Implications for prevention programs include targeting alcohol use attitudes in a variety of settings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Workplace absenteeism and alcohol use: A sequential analysis.

This investigation examined the day-to-day relationship between alcohol use and workplace absenteeism among a sample of participants (N = 280) employed in 1 of 3 large companies located in the northeastern U.S. With a semistructured interview, information was collected from employees about specific days of drinking during a 1-month period and marked on a calendar. Data about employees' absences during the same target time period were collected from the companies' human resource departments and were also marked on a calendar. A significant relationship was found between alcohol use and workplace absences; workers were, roughly 2 times more likely to be absent from work the day after alcohol was consumed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of early alliance ruptures and their resolution to process and outcome in three time-limited psychotherapies for personality disorders.

This study examined the relationship of early alliance ruptures and their resolution to process and outcome in a sample of 128 patients randomly assigned to 1 of 3 time-limited psychotherapies for personality disorders: cognitive–behavioral therapy, brief relational therapy, or short-term dynamic psychotherapy. Rupture intensity and resolution were assessed by patient- and therapist-report after each of the first 6 sessions. Results indicated that lower rupture intensity and higher rupture resolution were associated with better ratings of the alliance and session quality. Lower rupture intensity also predicted good outcome on measures of interpersonal functioning, while higher rupture resolution predicted better retention. Patients reported fewer ruptures than did therapists. In addition, fewer ruptures were reported in cognitive–behavioral therapy than in the other treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal risk factors for intimate partner violence among men in treatment for alcohol use disorders.

Objective: This study examined static and time-varying risk factors for perpetration of intimate partner violence (IPV) among men in treatment for alcohol use disorders. Method: Participants were 178 men diagnosed with alcohol abuse or dependence and their partners. Most (85%) of the men were European American; their average age was 41.0 years. Participants completed measures assessing initial alcohol problem severity, baseline beliefs related to alcohol use, antisocial personality characteristics, alcohol and drug use, relationship adjustment, and IPV. Results: According to couples' reconciled reports, 42% of participants perpetrated IPV at baseline. Among this group, the IPV recurrence rate was 43% at 6-month follow-up and 36% at 12-month follow-up. For participants without IPV perpetration at baseline, new incidence of IPV was 15% and 7% at the 6-month and 12-month follow-up points, respectively. Fixed marker predictors of IPV rates included baseline alcohol problem severity variables, baseline beliefs related to alcohol use, and antisocial personality characteristics. Variable risk factor predictors included alcohol and drug use variables, relationship adjustment factors, and anger. Alcohol use variables and anger were associated with new incidents of IPV among those without reported IPV at baseline only. Conclusions: Findings suggest that assessing and monitoring IPV occurrence by both partners is important for men in treatment for alcohol use disorders. Results indicate vulnerability factors that may identify individuals at risk for IPV and provide targets for IPV prevention among those with alcohol use disorders. These findings can aid in the development of more comprehensive models that more precisely predict IPV. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of group psychotherapy for older adult clients: A meta-analysis.

This review examined the effectiveness of group psychotherapy for older (55+) adults. Results from 44 studies with pre-post designs and 27 controlled studies indicated that group psychotherapy benefits older adults, with average rs of .42 and .24 for pre-post and controlled designs, respectively. The type of therapy provided and the age of the clients were associated with pretreatment to posttreatment improvement. Clients in cognitive-behavioral group therapy improved more than those receiving reminiscence therapy. The older the average age of the group members, the less they benefited from therapy. Number of sessions attended, length of therapy sessions, the percentage of women in the group, and client living situation were not significant moderators of outcome. Overall, group interventions for older adults appear to be effective and the average effect size for pre-post studies was quite similar to those yielded by meta-analyses of group therapy with younger adults and adolescents. However, the average effect size for controlled studies of group therapy with older adults appears to be somewhat smaller than the values reported in meta-analyses with younger clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality disorder symptoms, drinking motives, and alcohol use and consequences: Cross-sectional and prospective mediation.

Research shows high comorbidity between Cluster B personality disorders (PDs) and alcohol use disorders (AUDs). Studies on personality traits and alcohol use have identified coping and enhancement drinking motives as mediators in the relations among impulsivity, affective instability, and alcohol use. To the extent that PDs reflect extreme expression of these traits, drinking motives should mediate the relation between PD symptoms and alcohol involvement. This was tested using path models estimating the extent to which coping and enhancement drinking motives mediated the relation between Cluster B symptom counts and alcohol use and problems both concurrently and at a 5-year follow-up. Three hundred fifty-two adults participated in a multiwave study of risk for alcoholism (average age = 29 years at Wave 1). Enhancement motives mediated (a) the cross-sectional relation between Cluster B symptoms and drinking quantity/frequency, heavy drinking, total drinking consequences, dependence features, and AUD diagnosis and (b) the prospective relation to AUDs. Although coping motives mediated the relation between Cluster B symptoms and drinking consequences and dependence features cross-sectionally, prospective effects were limited to indirect effects through Time 1. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of psychotherapy training and intervention use on session outcome.

Objective: This study was an investigation of the relationships among therapist training variables, psychotherapy process, and session outcome in a psychotherapy training clinic. The aims were to assess the relationship between “training as usual” and intervention use in individual psychotherapy, to investigate the relationship between therapist intervention use and session outcome, and to test whether training variables moderate this relationship. Method: Graduate student therapists (n = 19; mean age = 27 years; 79% women; 84% White) provided information about their training and completed a measure of intervention use (Multitheoretical List of Therapeutic Interventions; McCarthy & Barber, 2009) and clients (n = 42; mean age = 33 years; 64% women; 95% White) completed a measure of session outcome (Session Progress Scale; Kolden, 1991) after each session of individual psychotherapy. Results: With regard to intervention use and session outcome, no main effects were found for the training variables. Consequently, tests of moderation were not performed. The final model for intervention use and session outcome yielded main effects for time-varying interpersonal therapy and time-varying common factor use, and a 3-way interaction among time-varying cognitive–behavioral (CBT) intervention use, between-patient common factor use, and between-therapist common factor use. Patients who received more common factor interventions on average rated sessions as less helpful when more CBT interventions were employed; this finding was stronger for patients who were being treated by therapists with higher average levels of common factor use. Conclusions: Implications for training are discussed, with particular attention paid to the importance of clinical decision making and the complex interaction between common and unique technical factors in practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)