Treatment outcome and patient characteristics in an aversion therapy program for alcoholism.

Conducted 1- and 3-yr follow-ups of 685 alcoholic patients treated with aversive conditioning during a 2-wk inpatient program followed by periodic single-day reinforcement sessions. 63% of the Ss reported continuous abstinence for 1 yr, and 31% were still abstinent after 3 yrs. Results indicate that Ss were at highest risk for relapse 3–4 mo after treatment and that continued aftercare was an important component of successful treatment. Outcomes were better for older than younger males and for married than unmarried males. Few significant differences in outcomes for males and females were apparent, and outcome was also unrelated to prior treatment history, education, or occupation. Findings support the use of aversive techniques in the treatment of alcoholism. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking cessation and weight gain.

Investigated determinants of weight gain after quitting smoking in 2 smoking treatment outcome studies in which 255 Ss (mean age 37 yrs) participated. It was hypothesized that (a) abstinence would result in weight gain; (b) postquitting weight gain would be predicted by pretreatment tobacco use, a history of weight problems, and eating patterns; and (c) relapse to smoking would follow weight gain. The 1st 2 hypotheses were confirmed. Year-long abstainers gained more weight than relapsers. Most of the weight gain occurred during the 1st 6 mo following quitting. Number of cigarettes smoked at pretreatment and past maximum body weight correlated positively with weight gain. Scores on a measure of eating control in specific situations, especially emotional ones, explained 27% of the variance in weight gain among abstinent Ss at a 1-yr follow-up. A measure of persistent hunger also predicted weight gain at a 1-yr follow-up. Eating disinhibition scores, number of cigarettes smoked at pretreatment, and maximum body weight were not correlated among Ss abstinent for the year. Disinhibition score and maximum body weight, however, correlated positively in the entire sample of Ss. Contrary to the 3rd hypothesis, greater weight gain during the 1st mo predicted continued abstinence, not relapse. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcoholics Anonymous and Relapse Prevention as Maintenance Strategies After Conjoint Behavioral Alcohol Treatment for Men: 18-Month Outcomes.

Ninety men with alcohol problems and their female partners were randomly assigned to 1 of 3 outpatient conjoint treatments: alcohol behavioral couples therapy (ABCT), ABCT with relapse prevention techniques (RP/ABCT), or ABCT with interventions encouraging Alcoholics Anonymous (AA) involvement (AA/ABCT). Couples were followed for 18 months after treatment. Across the 3 treatments, drinkers who provided follow-up data maintained abstinence on almost 80% of days during follow-up, with no differences in drinking or marital happiness outcomes between groups. AA/ABCT participants attended AA meetings more often than ABCT or RP/ABCT participants, and their drinking outcomes were more strongly related to concurrent AA attendance. For the entire sample, AA attendance was positively related to abstinence during follow-up in both concurrent and time-lagged analyses. In the RP/ABCT treatment, attendance at posttreatment booster sessions was related to posttreatment abstinence. Across treatment conditions, marital happiness was related positively to abstinence in concurrent but not time-lagged analyses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An experimental test of three methods of alcohol risk reduction with young adults.

Tested 3 forms of alcohol risk reduction programming for young adults. Volunteers were randomly assigned to receive a 6-wk class and discussion group, a 6-unit self-help manual, or a single 1-hr feedback and advice session with professional staff. Results reveal significant reductions in self-reported drinking at the end of the intervention phase and maintenance of drinking changes throughout a 2-yr follow-up period. Comparable drinking reductions were rated across treatments; however, noncompliance with the self-help reading program suggested limited utility. Treatment response was related to S age, as Ss showed increased drinking during the year they reached legal drinking status. The efficacy of brief motivational interventions and client matching in prevention programs is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

MMPI evaluation of 5-year methadone treatment status.

Evaluated treatment outcome over a 5-yr period for 148 1st admissions (mean age, 27.14 yrs) to a methadone treatment program. Eleven Ss (7%) were successful treatment completions, 16 Ss (11%) transferred to other methadone programs, 38 Ss (26%) remained in continuous treatment, and 83 Ss (56%) were unsuccessful treatment terminations. Discriminant analysis using the MMPI suggested that the more stable Ss at admission had the best treatment outcome. For the patients in continuous treatment, MMPIs administered at 6-wk, 6-mo, and 5-yr intervals indicated that this group of Ss did not change on the personality dimension. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhancing the efficacy of behavior therapy for obesity: Effects of aerobic exercise and a multicomponent maintenance program.

Tested whether the efficacy of behavior therapy for obesity might be improved by the programmatic additions of an aerobic exercise regimen during treatment and a multicomponent maintenance program following treatment. 14 male and 76 female obese 22–60 yr olds were randomly assigned to 2 treatment conditions (behavior therapy or behavior therapy plus aerobic exercise) and 2 posttreatment conditions (no further contact or a multicomponent maintenance program). The exercise regimen consisted of 80 min/week of brisk walking or stationary cycling. The maintenance program included therapist contact by telephone and mail and peer self-help group meetings. At posttreatment, Ss in the behavior therapy plus aerobic exercise condition lost significantly more weight than those who received behavior therapy only. Over an 18-mo follow-up period, maintenance program participants demonstrated significantly better weight-loss progress than Ss in the no-further-contact condition. (29 ref) (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)     

Broad-spectrum behavioral approach to smoking cessation: Effects of social support and paraprofessional training on the maintenance of treatment effects.

Conducted 2 treatment programs to determine the efficacy of a multi-component smoking intervention and various maintenance procedures. Prior to Program 1, 60 smokers were randomly assigned to 1 of 3 experimental conditions—a smoking abstinence program (SAP), a smoking abstinence program plus social support (SAP-SS), a smoking abstinence program plus social support and paraprofessional training (SAP-SS-PT)—or to 1 of 2-control conditions—effort control (EC) or a waiting list (WL). Individuals assigned to EC and WL conditions became treatment participants (EC-SAP-SS, WL-SAP-SS) during Program 2 and received training from SAP-SS-PT Ss. Results indicate that social support and paraprofessional training tended to facilitate maintenance, although 6-mo follow-up data revealed considerable relapse across treatment conditions. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of a preventive self-management programme for problem drinkers.

31 Ss (average age 39 yrs) participated in either of 2 variations of a self-management, controlled drinking program: Type R used regular techniques; Type E used those methods and taught Ss additional strategies for coping with life stresses related to drinking. Results show that a significant reduction occurred for all Ss over the 1-yr treatment period. Type E Ss were significantly more likely to be drinking in a nonhazardous fashion than Type R Ss. (French summary) (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Secondary prevention with college drinkers: Evaluation of an alcohol skills training program.

This study evaluated secondary prevention approaches for young adults (N?=?36, mean age 23 yrs) at risk for alcohol problems. Ss were randomly assigned to cognitive-behavioral alcohol skills training, a didactic alcohol information program, or assessment only. The skills program included training in blood alcohol level estimation, limit setting, and relapse prevention skills. All Ss maintained daily drinking records during the 8-wk intervention and for 1 wk at each follow-up. Repeated measures multivariate analysis of variance (MANOVA) found a significant reduction over 1-yr follow-up in self-reported alcohol consumption for the total sample. For all drinking measures, the directional findings consistently favored skills training. Despite overall reductions, most Ss continued to report occasional heavy drinking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contingent take-home incentive: Effects on drug use of methadone maintenance patients.

Examined contingent methadone take-home privileges for effectiveness in reducing on-going supplemental drug use of methadone maintenance patients. 53 new intakes were randomly assigned to begin receiving take-home privileges after 2 consecutive weeks of drug-free urines or to a noncontingent procedure in which take-homes were delivered independently of urine test results. The contingent procedure produced more individuals with at least 4 consecutive weeks of abstinence (32 vs 8%); 28% of noncontingent Ss also achieved abstinence after shifting to the contingent procedure. Lower baseline rate of drug-free urines was strongly associated with successful outcome, whereas the type of drug abused (cocaine vs benzodiazepines) did not influence outcomes. Findings support a recommendation for using contingent take-home incentives to motivate abstinence during methadone maintenance treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group counseling versus individualized relapse prevention aftercare following intensive outpatient treatment for cocaine dependence: Initial results.

Ninety-eight male cocaine-dependent patients who completed an intensive outpatient program (IOP) were randomly assigned to either standard group counseling (STND) or individualized relapse prevention (RP) aftercare. Heavier cocaine and alcohol use during IOP and low self-efficacy predicted more cocaine use during the treatment phase of the study, whereas lifetime diagnoses of alcohol dependence, major depression, and any anxiety disorder predicted less cocaine use. Rates of complete abstinence during the 6-month study period were higher in STND than RP, whereas RP was more effective in limiting the extent of cocaine use in those who used during Months 1-3. Matching analyses indicated patients who failed to achieve remission from cocaine dependence during IOP and those with a commitment to absolute abstinence did better in RP than in STND, whereas patients with other abstinence goals did better in STND than RP. Several differences in experiences before cocaine use and "near-miss" episodes were also identified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior modification for obesity: The evaluation of exercise, contingency management, and program adherence.

Investigated crucial aspects of behavioral programs for obesity including (a) the assumption that Ss actually engage in requested behaviors and that these behaviors mediate weight loss, (b) the effect of exercise on weight loss, and (c) the problem of long-term maintenance and generalization to the clinically obese. Exercise and self-managed contingency components were compared in a 2?×?2 factorial design on 44 obese Ss and were evaluated after 10 wks of treatment and 3-mo and 1-yr follow-ups. Significant weight loss was observed for all groups at program termination and the 3-mo follow-up, with only those exposed to exercise and/or contingency management maintaining weight loss after 1 yr. There were no main effects or interactions at program termination or at the 3-mo follow-up. However, the influence of exercise at the 1-yr follow-up was noticeable. Assessment of program adherence indicated that Ss engaged in program behaviors, yet only 1 of 10 such behaviors was related to weight loss. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive rehabilitation of memory functioning in amnesiac alcoholics.

Compared a multicomponent program of intensive memory skill practice for amnesiac alcoholics with a control program in which patients received only nonspecific cognitive activation to assess the extent to which improvement would generalize to memory tasks dissimilar to those used during training and to determine how long treatment gains would be maintained. 12 amnesiac patients (mean age 57.1 yrs) were randomly assigned to either the experimental memory training or the control program. DSM-III diagnoses showed that Ss included 7 with alcohol amnesiac disorder, 2 with dementia associated with alcoholism, 2 with alcohol dependence, and 1 with amnestic syndrome. Five of the experimental Ss and all of the controls completed their respective therapy programs and progress monitor assessment; 4 of the experimental Ss and 5 of the controls completed the entire outcome assessment. Results indicate that the control group showed improvement on most measures, and both groups improved significantly on several of the outcome measures that assessed generalization of memory skills. It is concluded that memory training designed to achieve specific learning goals is likely to be more effective with chronic amnesiacs than is a program of general memory skill rehearsal. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of major depressive disorder in older adult outpatients with brief psychotherapies.

Examined (a) whether older adults in a current major depressive episode would improve systematically when treated with short-term psychotherapies and (b) if they would respond differentially to treatment approaches emphasizing the importance of either cognitive, behavioral, or relational/insight factors in the therapy process. 30 elderly outpatients (aged 59–80 yrs) were assigned to 1 of the 3 individual treatment conditions for 16 sessions over a 12-wk period. Evaluation (Hamilton Rating Scale for Depression, Beck Depression Inventory, and Self-Rating Depression Scale) occurred before and after therapy and at 4 times during a 1-yr follow-up. Comparable improvement in depressive symptoms was seen from pre- to posttest for Ss in all 3 treatment conditions. However, improvement during the 1-yr follow-up was maintained more effectively by Ss treated with behavioral or cognitive therapy than with relational/insight therapy. Results indicate that brief psychotherapies can be effective in the treatment of elderly depressives and that structured therapies may be more beneficial than nonstructured relationally oriented therapy during a treatment-free follow-up period. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral intervention increases abstinence rates for depressive-history smokers.

Describes the test of the hypothesis that a cognitive-behavioral mood management intervention would be effective for smokers with a history of major depressive disorder (MDD). The method was randomized trial; the assessments occurred at Weeks 0, 8, 12, 26, and 52. Ss were 149 smokers (aged 18–65 yrs); 31% had a history of MDD. All received 2 mg of nicotine gum. Mood management was provided in 10 group sessions over 8 wks. Standard treatment was provided in 5 group sessions over 8 wks. Outcome was continuous abstinence. History-positive Ss were more likely to be abstinent when treated with mood management. Treatment condition differences were not significant for history-negative Ss. For history-positive Ss, less anger at baseline predicted abstinence. For history-negative Ss, more years smoked and higher baseline carbon monoxide predicted abstinence. Cognitive-behavioral therapy did not affect mood after quitting. Abstinence predictors differed as a function of baseline diagnosis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Length of stay, neuropsychological performance, and aftercare: Influences on alcohol-treatment outcome.

Hypothesized that 245 alcohol-abusing male veterans, grouped according to levels of neuropsychological functioning, would have differential outcome following random assignment to 2- or 7-wk hospitalization in a milieu-oriented treatment program. Over the 9 mo of posthospitalization follow-up, there was significant improvement for the sample as a whole. However, outcome following 2- and 7-wk programs did not differ significantly. Neuropsychological performance was significantly but modestly related to some outcome criteria (e.g., abstinence rates and employment status), but no consistent interaction with length of stay was found. The most salient finding was the strong relationship of aftercare involvement (which was analyzed as a covariate) to most outcome criteria. Ss who attended weekly aftercare groups for 9 mo following hospitalization were 3 times more likely to remain abstinent than Ss who dropped out of aftercare (70.2 vs 23.4% abstinence, respectively). Implications for individualizing alcohol treatment and conducting future research on patient–treatment matching are discussed. (59 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributional processes in behavior change and maintenance: Smoking cessation and continued abstinence.

If individuals attribute smoking cessation to external factors, they may be less able to maintain abstinence over time. To examine the role of attributions in initial and long-term behavior change, we manipulated the externality of treatment by comparing self-help manuals with and without a drug component and by comparing the motivational orientation of three programs (intrinsic self-help, intrinsic gum, extrinsic gum). We examined attributions for success or failure with treatment, the effects of treatment on initial cessation and on long-term maintenance of nonsmoking, and the effects of attributions on maintenance. Subjects receiving nicotine gum were superior to the intrinsic self-help group in initial cessation but were inferior in maintaining abstinence. Subjects in the intrinsic self-help group made fewer external attributions for success and remained abstinent longer, thus providing support for the attributional mediation of treatment effects on maintenance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of obesity by behavior therapy and very low calorie diet: A pilot investigation.

Treated 17 obese females (mean age 37.5 yrs) who averaged 87% overweight for 6 mo on a program of diet and behavior modification designed for weight loss maintenance. Ss, who were paid to participate, received a balanced diet of 1,000–2,200 kilocalories/day for Month 1, a low calorie protein liquid (400–500 kilocalories/day) for Month 2, low calorie protein (fish, fowl) for Month 3, and a balanced diet for Months 4–6. Results show that Ss lost an average 20.5 kg during treatment and showed significant reductions in anxiety and depression even while consuming the low calorie diet. At 1-yr follow-up, Ss had regained an average of 2.1 kg. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Matching alcoholics to coping skills or interactional therapies: Posttreatment results.

This study tested the hypothesis that patients could be matched to effective treatments on the basis of certain pretreatment characteristics. Specifically, it was hypothesized that those Ss who showed more sociopathy, more psychopathology, and greater neuropsychological impairment would have better outcomes when treated with coping skills training and, conversely, that those with less impairment in these areas would have better outcomes with interactional treatment. Ninety-six male and female Ss were recruited from an inpatient alcoholism treatment program and randomly assigned to 1 of these 2 types of aftercare group treatment. Linear and logistic regression analyses partially confirmed the hypotheses. Coping skills training was more effective for Ss higher in sociopathy or psychopathology, and interactional therapy was more effective for Ss lower in sociopathy. Generally, both treatments appeared equally effective for Ss lower in psychopathology. Contrary to expectations, those more neuropsychologically impaired appeared to have better outcomes after interactional therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)