Alcohol cue reactivity, negative-mood reactivity, and relapse in treated alcoholic men.

Relapsed alcoholic individuals frequently report that negative emotional states trigger their return to drinking. A parametric laboratory study was conducted to assess the separate and combined effects of exposure to alcohol-related stimuli and induced negative moods in abstinent alcoholic persons. The authors also sought to determine if reactivity to alcohol cues or reactivity to negative mood induction predicted relapse soon after treatment. Men with alcoholism (N?=?50) undergoing inpatient treatment participated in a guided imagery procedure designed to induce negative moods and were then exposed to either their favorite alcoholic beverage or to spring water. Results indicated that both alcoholic beverage presentation and negative affect imagery led to increased subjective reporting of desire to drink. These effects were additive but not multiplicative (i.e., the interaction of mood state with beverage type was not significant). Reported urge to drink during the trial that combined negative mood imagery with alcoholic beverage exposure predicted time to relapse after inpatient discharge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of extinction context and retrieval cues on alcohol cue reactivity among nonalcoholic drinkers.

Pavlovian conditioning models have influenced the development of cue exposure treatments for drug abuse. However, poor maintenance of extinction performance (renewal) after treatment is a common problem. A treatment-analogue experiment tested the role of context in renewal, as well as a potential strategy for reducing renewal. Seventy-eight social drinkers completed extinction trials to reduce saliva and urge reactivity to alcohol cues and were randomly assigned to a renewal test in either the same context as extinction, a different context, or the different context containing a cue from the extinction context (E-cue). As predicted, the different context produced greater renewal than the same context and renewal was attenuated when the E-cue was present. These results offer preliminary evidence for the context dependence of extinction to alcohol cues and for the use of an extinction cue to improve the generalizability of exposure therapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The human startle reflex and alcohol cue reactivity: Effects of early versus late abstinence.

This study investigated the human eyeblink startle reflex as a measure of alcohol cue reactivity. Alcohol-dependent participants early (n?=?36) and late (n?=?34) in abstinence received presentations of alcohol and water cues. Consistent with previous research, greater salivation and higher ratings of urge to drink occurred in response to the alcohol cues. Differential salivary and urge responding to alcohol versus water cues did not vary as a function of abstinence duration. Of special interest was the finding that startle response magnitudes were relatively elevated to alcohol cues, but only in individuals early in abstinence. Affective ratings of alcohol cues suggested that alcohol cues were perceived as aversive. Methodological and theoretical implications of the findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children's understanding of retrieval cue utilization.

To understand the logic of effective cue utilization, one must know not only that cues are useful but that a specific cue is useful only if it is located where one will be when it is time to remember, and placed so one will encounter it automatically. This experiment investigated 16 1st, 16 2nd, and 16 5th graders' knowledge of the use of retrieval cues to aid memory. Stories representing effective and ineffective cue locations were constructed. Many 1st graders believed that all cue locations were effective; the discrimination of ineffective locations showed a clear order of acquisition by age. Those 1st graders had little understanding of external retrieval cues as mnemonic means. As soon as Ss achieved this understanding, it was coordinated with temporal requirements for using cues effectively. However, full understanding of the temporal criteria required a series of developments. Ss at first knew only that a cue encountered after the time to do the task would be ineffective. Next, Ss understood that a cue would be ineffective if it were encountered after the time one had to remember to do the task. Most 5th graders knew that even a cue encountered before the task would be ineffective if the cue appeared greatly in advance of the time one had to remember. Results are discussed in terms of the importance of investigating children's integrated knowledge, or theories, about memory. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived stress, quitting smoking, and smoking relapse.

Assessed perceptions of stress prior to quitting smoking and at 1, 3, and 6 mo after quitting in 211 Ss. Analyses provide evidence for a relation between changes in stress levels and changes in smoking status. Ss who failed to quit smoking for more than 24 hrs maintained a relatively high and consistent level of stress over the 6-mo period. For continuously abstinent Ss, stress decreased as duration of abstinence increased. Increased stress with relapse was found across all time periods, and decreased stress after quitting was observed at 2 time periods. The relationship between smoking and stress may be bidirectional. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Taste reactivity to alcohol in rats.

Rats were infused intraorally with 4 concentrations of ethanol (3%, 6%, 9%, and 12%), and their subsequent oral, facial, and bodily responses were videotaped and analyzed. Naive rats did not display significant changes in ingestive-type responding over the concentrations tested. A significant increase in aversive responses was noted, with the largest number of aversive responses found with the 12% solution. Initial reactivity failed to predict subsequent consumption when rats were given free access to the same alcohol concentrations during 2-bottle tests. Reactivity testing after the period of alcohol access indicated that only the aversive responding changed significantly from the initial reactivity, with rats showing fewer aversive responses. The results indicated how the taste of alcohol is perceived by naive rats and how this perception is changed after consummatory experience with alcohol. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive changes after alcohol cue exposure.

A study was conducted to examine cognitive changes in alcoholics and nonalcoholics after alcohol cue exposure. Forty-nine alcoholics in treatment and 26 nonalcoholics recruited from the community were exposed to a neutral stimulus and to their favorite alcoholic beverage. They held and sniffed the beverage but were not allowed to consume it. Results indicated that both alcoholic and nonalcoholic subjects showed the following changes after alcohol cue exposure: increased desire to drink, increased expectations of pleasant alcohol effects, decreased expectations of arousal, and decreased expectations of behavioral impairment from drinking. Alcoholic subjects responded to alcohol cues with reports of increased physical symptoms, decreased confidence about coping with future temptation, and increased guilt. These results are consistent with Marlatt's hypothesis that an alcoholic in a high-risk relapse situation experiences an increase in positive outcome expectations and a decrease in self-efficacy. The results are also consistent with a respondent conditioning model of craving. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trans-situational consistency in smoking relapse.

Explored the consistency of experiences of temptation to smoke in 57 ex-smokers who called a relapse-prevention hotline on 2 occasions. Ss had smoked at least 10 cigarettes per day for 1 yr and had been abstinent for at least 2 days prior to calling. Only modest transsituational consistency was observed. Social aspects of relapse situations showed the most consistency. Behavioral coping showed modest transsituational consistency, whereas cognitive coping showed no stability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing relapse to cigarette smoking by behavioral skill training.

Two relapse prevention conditions (skills training vs discussion control) were crossed with 2 levels of aversive smoking (6- vs 30-sec inhalations). 135 smokers were recruited, and 123 of them completed treatment. Ss completed an assessment battery that included the Profile of Mood States and the State–Trait Anxiety Inventory. Differences in abstinence rates and in number of cigarettes smoked favoring the skills training condition were found at 6 and 52 wks from study start. Analyses indicated that at 52 wks, lighter smokers (20 cigarettes/day or fewer at pretreatment) were more likely to be favorably affected by the skills training condition than heavier smokers. Ss assigned to the skills training condition were more likely to report use of coping skills, but they did not differ from the discussion condition in perceived costs and benefits of change or of smoking, or in mood dysphoria or physical complaints. Abstinent Ss reported less mood disturbance than nonabstinent Ss at Weeks 3, 6, and 26 and fewer physical complaints at Week 52. The relation of these findings to a model of maintenance of therapeutic change is discussed. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of alternative theoretical approaches to smoking cessation and relapse.

139 smokers (mean age 40.6 yrs) were randomly assigned either to (a) a traditional treatment program that used contingency contracting and emphasized the necessity for absolute abstinence (AA) or (b) a relapse-prevention (RP) treatment that focused on gradual acquisition of nonsmoking skills. It was hypothesized that the RP treatment would be less successful initially but would result in better maintenance skills and show a lesser relapse rate during a 1-yr follow-up. Each program was evaluated in 2 formats: group-based treatment and self-help materials. Results indicate comparable 1-yr abstinence rates for all treatments, although more Ss dropped out of the self-help formats. Ss in the RP intervention were more likely to lapse sooner after quitting and were more likely to quit again during the 1-yr maintenance period. Women were more successful in the RP program, and men had greater success with the AA approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma-focused imaginal exposure for individuals with comorbid posttraumatic stress disorder and alcohol dependence: Revealing mechanisms of alcohol craving in a cue reactivity paradigm.

With a sample (N = 43) of participants meeting current diagnostic criteria for both alcohol dependence and posttraumatic stress disorder (PTSD), the authors tested the hypothesis that alcohol craving elicited by a trauma cue might be attenuated if trauma-elicited negative emotion were reduced following trauma-focused imaginal exposure. In a laboratory-based experiment, participants were randomly assigned to either trauma-focused imaginal exposure or imagery-based relaxation. A cue reactivity paradigm was used to assess alcohol craving prior to, and after completion of, the 6 clinical sessions. Attrition was high but did not differ between experimental conditions. For study completers, PTSD symptoms decreased in the exposure condition but not in the relaxation condition. Alcohol craving and distress elicited by trauma images decreased in the exposure condition but did not change in the relaxation condition. Results support the hypothesis that negative emotion is a mechanism of alcohol craving. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term psychological sequelae of smoking cessation and relapse.

The authors examined whether smoking cessation and relapse were associated with changes in stress, negative affect, and smoking-related beliefs. Quitters showed decreasing stress, increasing negative health beliefs about smoking, and decreasing beliefs in smoking's psychological benefits. Quitters became indistinguishable from stable nonsmokers in stress and personalized health beliefs, but quitters maintained stronger beliefs in the psychological benefits of smoking than stable nonsmokers. Relapse was not associated with increases in stress or negative affect. However, relapsers increased their positive beliefs about smoking and became indistinguishable from smokers in their beliefs. For quitters, decreased stress and negative beliefs about smoking may help maintain successful cessation. However, for relapsers, declining health risk perceptions may undermine future quit attempts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of posttreatment decentering and cognitive reactivity to relapse in major depression.

Z. V. Segal et al. (2006) demonstrated that depressed patients treated to remission through either antidepressant medication (ADM) or cognitive-behavioral therapy (CBT), but who evidenced mood-linked increases in dysfunctional thinking, showed elevated rates of relapse over 18 months. The current study sought to evaluate whether treatment response was associated with gains in decentering-the ability to observe one's thoughts and feelings as temporary, objective events in the mind-and whether these gains moderated the relationship between mood-linked cognitive reactivity and relapse of major depression. Findings revealed that CBT responders exhibited significantly greater gains in decentering compared with ADM responders. In addition, high post acute treatment levels of decentering and low cognitive reactivity were associated with the lowest rates of relapse in the 18-month follow-up period. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating reactivity to ecological momentary assessment during smoking cessation.

Ecological momentary assessment (EMA) consists of assessing phenomena in real time in the natural environment. EMA allows for more fine-grained analyses of addictive behavior and minimizes threats to internal validity, such as recall biases and errors. However, because of the intensive monitoring involved in EMA, measurement reactivity is a concern. To test whether EMA with palmtop personal computers induces reactivity, the authors compared smoking-related outcomes between smokers using EMA and those not using EMA during a quit attempt. The use of no-EMA control groups has been rare in reactivity investigations to date. The EMA protocol included event-contingent assessments (smoking episodes, urge episodes) and random assessments. Outcomes included biologically confirmed abstinence and self-report measures of withdrawal, self-efficacy, motivation, affect, and temptations. Participants were smokers motivated to quit (N = 96). They were randomized to 1 of 3 groups: EMA for the week preceding a planned quit date, EMA for the week following the quit date, and no EMA. Abstinence rates did not differ between the groups at Day 7 or at Day 28 postcessation. For the 20 subscales assessed at each of 3 assessment times, there were significant differences between participants with and without EMA experience for 3 subscales at the 1st of 3 assessment times, and significant differences for 3 different subscales at the 3rd assessment time. These differences suggest some reactivity to EMA, although the inconsistent pattern across time indicates that further research is needed to definitively conclude that EMA induces reactivity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nicotine dependence: Psychosocial approaches to the prevention of smoking relapse.

Describes smoking relapse within the context of nicotine dependence and reviews psychosocial relapse prevention methods. Two-thirds of smokers who quit either on their own or with the help of an intervention relapse within the first 3 mo after quitting. Even after several months of abstinence, relapse often occurs. Efforts to reduce or prevent smoking relapse need to address the addictive and reinforcing properties of nicotine and the multiple biopsychosocial relationships among nicotine, affect regulation, cognitive functioning, and body weight. More work is needed in developing more effective smoking cessation and relapse prevention interventions for hard-core smokers, many of whom suffer from psychiatric conditions and come from lower socioeconomic backgrounds. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynamic effects of self-efficacy on smoking lapse and relapse.

Self-efficacy (SE) is thought to be critical to success in smoking cessation both as an individual difference and as a dynamic process after a quit attempt. In this study, 214 smokers used palm-top computers to record day-to-day variations in SE during 4 weeks after quitting. SE remained at high and stable levels prior to a 1st lapse but decreased and became more variable thereafter. The authors used event history models with time-varying covariates to assess the effect of daily SE on lapse and relapse risk. Daily SE measures predicted an initial lapse on the subsequent day. However, this relationship was accounted for by stable baseline differences in SE (assessed by questionnaire), rather than by day-to-day dynamics in SE. Progression from 1st lapse to relapse was also examined. In this instance, daily SE predicted subsequent relapse risk, even when baseline SE and concurrent smoking were accounted for, suggesting the importance of SE dynamics for this stage of the relapse process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of alcohol sensitivity on P3 event-related potential reactivity to alcohol cues.

Although alcoholics and individuals at risk for alcoholism often show smaller amplitude of the P3 event-related brain potential (ERP), recent data (K. Namkoong, E. Lee, C. H. Lee, B. O. Lee, & S. K. An, 2004) indicate that alcohol-related cues elicit larger P3 amplitude in alcoholics than in controls. Little is known concerning the ERP profiles or alcohol cue reactivity of social drinkers at risk for alcoholism due to low sensitivity to alcohol's effects. Participants differing in alcohol sensitivity viewed images of alcoholic and nonalcoholic beverages while ERPs were recorded and provided information about their alcohol use patterns at baseline and 4 months later. Compared to high-sensitivity participants, those low in sensitivity showed larger P3s to alcohol cues, even when recent alcohol use was statistically controlled for. Moreover, the P3 elicited by alcohol cues predicted alcohol use at follow-up, a finding supporting the idea that P3 amplitude reflects the motivational significance of substance-related cues. These findings point to risk status, not consumption history, as an important predictor of cue reactivity effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)