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)     

Significance of a behavioral economic index of reward value in predicting drinking problem resolution.

This study investigated whether a behavioral economic index of the value of rewards available over different time horizons improved prediction of drinking outcomes beyond established biopsychosocial predictors. Preferences for immediate drinking versus more delayed rewards made possible by saving money were determined from expenditures prior to resolution attempts by problem drinkers with different help-seeking experiences (N = 144). As hypothesized, stable resolutions over a 2-year follow-up were associated with proportionally more preresolution discretionary expenditures on savings and less on alcohol compared with unstable resolutions. The relationship held regardless of help-seeking history, and preresolution drinking practices, problems, and income were similar across outcomes. The findings extend experimental work on behavioral economics and indicate that measuring monetary allocation improves prediction of outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Moderating effects of a craving intervention on the relation between negative mood and heavy drinking following treatment for alcohol dependence.

Objective: Negative affect is a significant predictor of alcohol relapse, and the relation between negative affect and drinking has been shown to be strongly mediated by alcohol craving. Thus, targeting craving during treatment could potentially attenuate the relation between negative affect and drinking. Method: The current study is a secondary analysis of data from the COMBINE study, a randomized clinical trial that combined pharmacotherapy with behavioral intervention in the treatment of alcohol dependence. Our goal in the current study was to examine whether a treatment module that targeted craving would predict changes in negative mood during the 16-week combined behavioral intervention (n = 776) and the relation among changes in mood, craving, and changes in heavy drinking during treatment and 1 year posttreatment. Results: Changes in negative mood were significantly associated with changes in heavy drinking during treatment (f2 = 0.78). Participants (n = 432) who received the craving module had significantly fewer heavy drinking days during treatment (d = 0.31), and receiving the module moderated the relation between negative mood and heavy drinking during treatment (f2 = 0.92) and 1 year posttreatment (f2 = 0.03). Moderating effects of the craving module were mediated by changes in craving during treatment. Within-subject analyses indicated significant pre- to postmodule reductions in negative mood. Additionally, postmodule craving significantly mediated the association between negative mood and heavy drinking during treatment and at posttreatment. Conclusions: The craving module of the combined behavioral intervention may weaken the relation between negative affect and heavy drinking by fostering greater decreases in craving during treatment. (PsycINFO Database Record (c) 2010 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)     

Reliability and validity of a demand curve measure of alcohol reinforcement.

Recent clinical research suggests that several self-report behavioral economic measures of relative reinforcing efficacy (RRE) may show utility as indices of substance abuse problem severity. The goal of the present study was to evaluate the reliability and validity of the Alcohol Purchase Task (APT), a RRE measure that uses hypothetical choices regarding alcohol purchases at varying prices (demand curves) to generate several indices of alcohol-related reinforcement. Participants were 38 college students who reported recent alcohol consumption. Both the raw alcohol purchase/consumption values and several of the computed reinforcement parameters (intensity & Omax) showed good to excellent 2-week test–retest reliability. Reinforcement parameters derived from both a linear-elasticity (Hursh, Raslear, Bauman, & Black, 1989) and an exponential (Hursh & Silberberg, 2008) demand curve equation were generally less reliable, despite the fact that both equations provided a good fit to participants’ reported consumption data. The APT measures of demand intensity (number of drinks consumed when price = 0), Omax (maximum expenditure), and elasticity (α) were correlated with weekly drinking, alcohol-related problems, and other self-report RRE measures (relative discretionary monetary expenditures toward alcohol and/or relative substance-related activity participation and enjoyment). Demand intensity was uniquely associated with problem drinking in a regression model that controlled for weekly consumption. These results provide support for the reliability and validity of the RRE indices generated with the APT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender moderates the relationship between substance-free activity enjoyment and alcohol use.

Laboratory research suggests that there is an inverse relationship between substance use and substance-free reinforcement, but the relevance of this relationship to the prevention of human substance abuse remains somewhat unclear. The present study evaluated the relationship between alcohol use and enjoyment from substance-free activities in a sample of college students who had previously completed an alcohol intervention (N = 107; 55% women; 45% men). The authors used a modified 30-day timeline follow-back interview to collect data on enjoyment from specific substance-free activities that occurred in the evening. Regression analyses revealed that there was a negative association between alcohol consumption and substance-free activity enjoyment for women but not for men. Women who reported greater enjoyment on abstinent evenings reported lower past-month alcohol consumption. Greater average enjoyment from substance-free activities was associated with greater motivation to change drinking among men and women. Although further research is required to determine procedures for increasing participation in substance-free activities and to explicate possible gender differences, these results suggest that increasing enjoyable substance-free activities may be an important prevention component. (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)     

A theory of reservation-dwelling American Indian alcohol use risk.

The authors present a theory for understanding risk for problem drinking among reservation-dwelling American Indians. The theory offers an overall framework for understanding the risk process for this group. It considers the distinction between factors that influence mean levels of American Indian problem drinking and factors that influence individual differences in American Indian drinking. It proposes important contextual differences between reservation-dwelling American Indians and Caucasians that may help explain the higher mean levels of American Indian problem drinking. The theory further holds that, within the high mean level of problem drinking characteristic of many American Indian reservations, individual differences in problem drinking can be explained by very similar personality and learning factors as those that influence problem-drinking levels for other ethnic groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Thinking about drinking: Need for cognition and readiness to change moderate the effects of brief alcohol interventions.

Research has demonstrated the efficacy of brief motivational interventions (BMI) and alcohol expectancy challenge (AEC) in reducing alcohol use and/or problems among college students. However, little is known about variables that may qualify the effectiveness of these approaches. The present analyses tested the hypothesis that need for cognition (NFC), impulsivity/sensation seeking (IMPSS) and readiness to change (RTC) would moderate the effects of BMI and AEC. Participants (N = 335) were heavy drinking college students enrolled in a randomized 2 × 2 factorial study of BMI and AEC. Latent growth curve analyses indicated significant interactions for BMI × NFC and AEC × RTC on alcohol use but not problems. Simple slopes analyses were used to probe these relationships and revealed that higher levels of NFC at baseline were associated with a stronger BMI effect on drinking outcomes over time. Similarly, higher levels of baseline RTC were associated with stronger AEC effects on alcohol use. Future preventive interventions with this population may profit by considering individual differences and targeting approaches accordingly. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Methamphetamine use in a rural college population: Associations with marijuana use, sensitivity to punishment, and sensitivity to reward.

This study examined predictors of methamphetamine use in a 6-month prospective study of 2,270 rural young adults. Sensitivity to punishment (SP), sensitivity to reward (SR), and gender were exogenous variables in an observed variable path analysis with 3 endogenous criteria: Time 1 (T1) marijuana use and methamphetamine use at T1 and Time 2 (T2). SP was negatively associated with marijuana use at T1, and this association was attenuated by SR. Male gender was positively associated with marijuana use. T1 marijuana use and SR were positively, and male gender negatively, associated with T1 methamphetamine use. T1 methamphetamine use, T1 marijuana use, and SP were positively associated with T2 methamphetamine use. Methamphetamine use prevalence and the role of distal predictors and proximal indicators of drug involvement are discussed. (PsycINFO Database Record (c) 2010 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)     

Impulsivity and rapid discounting of delayed hypothetical rewards in cocaine-dependent individuals.

In this study, crack/cocaine-dependent (CD) and non-drug-using matched control (MC) participants were presented with hypothetical immediate and delayed rewards, with 16 delay conditions ranging from 5 min to 25 years. All participants were presented with hypothetical monetary rewards; however, the CD group was also presented with hypothetical crack/ cocaine rewards. The objective value of the rewards ranged from $1 to $1,000. Hyperbolic discounting functions provided a good fit of the data. The CD group discounted monetary rewards at a higher rate than the MC group did, and the CD group discounted crack/cocaine rewards at a higher rate than it did monetary rewards. Moreover, scores on self-report measures indicated greater impulsivity in the CD group when compared with the MC group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive alcohol expectancies partially mediate the relation between delinquent behavior and alcohol use: Generalizability across age, sex, and race in a cohort of 85,000 Iowa schoolchildren.

The extent to which positive alcohol expectancies mediated the association between delinquency and alcohol use, as well as whether age, sex, or race moderated this mediational relation, was examined in a population-based sample of Iowa schoolchildren (N = 85,301) from the 6th, 8th, and 11th grades. Positive alcohol expectancies were found to partially mediate the association between delinquency and alcohol use (alcohol use initiation, past-month drinking, and past-month binge drinking) across the full sample and in each age, sex, and racial subgroup. Evidence for moderated mediation was found for age and race but not for sex, which suggests that the magnitude of the relations among delinquency, positive alcohol expectancies, and alcohol involvement is different in younger versus older children and White, African American, Native American, Asian, and Hispanic youths but is similar in boys versus girls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of alcohol on cigarette craving in heavy smokers and tobacco chippers.

The authors examined the effects of alcohol consumption on cigarette craving in heavy smokers and tobacco chippers (n = 138) who were instructed not to smoke for 12 hr. Participants were exposed to both smoking cues (a lit cigarette) and control cues. Half received a moderate dose of alcohol, adjusted for gender, and half received a placebo. Results indicated that alcohol consumption produced an increase in urge-to-smoke ratings before smoking cue exposure. Moreover, during cue exposure, alcohol consumption produced a sharper increase in urge ratings than did the placebo. In addition, during smoking cue exposure, alcohol increased the likelihood of displaying facial expressions associated with positive affect. These findings suggest that alcohol consumption influences both the magnitude and the emotional valence of cigarette cravings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Moderating effects of sensitivity to punishment and sensitivity to reward on associations between marijuana effect expectancies and use.

The study examined associations between sensitivity to reward (SR), sensitivity to punishment (SP), positive and negative expectancies, and marijuana use in a college sample (N = 809). Marijuana users (n = 227) reported lower SP and greater SR than nonusers. SR attenuated the association between SP and the probability of marijuana use. SP attenuated the association between positive expectancies and the probability of marijuana use as well as the frequency of use among users. SP potentiated the association between negative expectancies and use. The results indicate that SP and SR have interactive effects and that SP moderates the strength of positive and negative cues for risk behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distinctions without a difference: Direct comparisons of psychotherapies for alcohol use disorders.

To estimate the relative efficacy of alcohol use disorder treatments, the authors meta-analyzed studies that directly compared 2 bona fide psychological treatments. The authors accommodated problems with the inclusion of multiple treatment comparisons by randomly assigning a positive/negative sign to the effect size derived from each comparison and then estimating the extent to which effect sizes were heterogeneous. The authors' primary hypothesis was that the variability in effect sizes of bona fide psychological treatments for alcohol use disorders that were directly compared would be zero. For both alcohol measures and measures of abstinence, analyses indicate that effects were homogenously distributed about zero (I2 = 10.61, 0.00, respectively), indicating that different treatment comparisons yielded a common effect size that was not significantly different from zero. Analyses also indicate that allegiance accounted for a significant portion of variability in differences between treatments. Implications for the treatment of alcohol use disorders as well as research on the mechanisms responsible for the benefit of treatment are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Individuation, peers, and adolescent alcohol use: A latent growth analysis.

The study used latent growth modeling to investigate longitudinal relationships between individuation, peer alcohol use, and adolescent alcohol use among African American, Mexican American, and non-Hispanic White adolescents (N=6,048) from 7th, 8th, and 9th grades over a 3-year period. Initial levels of peer alcohol use were significantly related to changes in adolescents' alcohol use, whereas initial adolescent alcohol use also significantly related to changes in peers' alcohol use, suggesting a bidirectional relationship. Higher levels of intergenerational individuation were related to smaller increases in adolescent alcohol use and higher levels of separation were related to larger increases in youth drinking. The findings were similar across ethnic groups. Implications for development of prevention and intervention programs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

What is the latent structure of alcohol use disorders? A taxometric analysis of the Personality Assessment Inventory Alcohol Problems Scale in male and female prison inmates.

Three indicators derived from the Personality Assessment Inventory (PAI) Alcohol Problems scale (ALC)—tolerance/high consumption, loss of control, and negative social and psychological consequences—were subjected to taxometric analysis—mean above minus below a cut (MAMBAC), maximum covariance (MAXCOV), and latent mode factor analysis (L-Mode)—in 1,374 federal prison inmates (905 males, 469 females). Whereas the total sample yielded ambiguous results, the male subsample produced dimensional results, and the female subsample produced taxonic results. Interpreting these findings in light of previous taxometric research on alcohol abuse and dependence it is speculated that while alcohol use disorders may be taxonic in female offenders, they are probably both taxonic and dimensional in male offenders. Two models of male alcohol use disorder in males are considered, one in which the diagnostic features are categorical and the severity of symptomatology is dimensional, and one in which some diagnostic features (e.g., withdrawal) are taxonic and other features (e.g., social problems) are dimensional. (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)