Use of MMPI subtypes in predicting completion of a residential alcoholism treatment program.

To obtain data on patient characteristics relevant to treatment outcome, the Minnesota Multiphasic Personality Inventory (MMPI) was administered to 86 men 3–5 days following their admission to a 30-day residential alcoholism treatment program. Cluster analyses yielded three subtypes whose mean MMPI code types were as follows: Type I comprised a 4-2-8 code type, with marked additional pathology; Type II comprised a 4-9/9-4 code type; and Type III comprised a 2-4/4-2 code type. The subtypes differed significantly in their rates of treatment completion, with Type II yielding a greater proportion of program dropouts. To investigate the effect of time of MMPI administration on subtype results, 68 subjects who remained in treatment were readministered the MMPI 14–26 days following admission. A comparison of Time 1 and Time 2 typologies highlights the importance of test administration time and provides some explanation for previous discrepant findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Locus of control and patient attrition from an alcoholism treatment program.

Investigated the relationship of male alcoholics' locus of control scores to dropping out of treatment at various stages. No differences were found among Ss who left at 2 wks, dropped out between 2 wks and 60 days, or completed the 60 dys, or among patients who completed or left the 1-yr aftercare program in total, personal, sociopolitical control scores. Ss who dropped out of aftercare had significantly lower total and personal control scores, and a significantly greater change in personal control in the internal direction, at the end of the intensive treatment than those who completed the aftercare, contrary to prediction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral treatment for smokers with a history of alcoholism: Predictors of successful outcome.

This study examined baseline predictors associated with smoking abstinence among 205 smokers (113 men, 92 women) with a past history of alcoholism. Their mean age was 41.8 years, and 93% were Caucasian. Participants were randomly assigned to standard treatment (ST), behavioral counseling plus exercise (BEX), or behavioral counseling plus nicotine gum (BNIC). Factors multivariately associated with point-prevalence smoking abstinence at posttreatment (1 week after target quit date) were a longer duration of prior smoking abstinence and an interaction between treatment group and having an active 12-step sponsor. ST was more effective for those with an active sponsor, whereas both BEX and BNIC were more effective for those without an active sponsor. At 1-year follow-up, independent predictors of point-prevalence smoking abstinence were a lower Fagerstr6m Tolerance Questionnaire score (K. O. Fagerstrom, 1978) and fewer years of smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of physical exercise in alcoholism treatment and recovery.

A growing body of literature has demonstrated that physical exercise is associated with favorable mental health outcomes. Exercise has the potential to be an accessible and affordable adjunct treatment option for persons with alcohol use disorders (AUD); however, exercise-based interventions have rarely been applied to this population. The authors examine the potential role of physical exercise in the process of recovery from AUD. Possible physiological, psychological, and social mechanisms whereby exercise may exert influence on alcohol use outcomes are outlined. Studies examining the effects of physical exercise on alcohol and other addictive behaviors are reviewed, and the viability of structured, exercise-based adjunct interventions for AUD populations is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Theoretical and practical foundations of an inpatient post-traumatic stress disorder and alcoholism treatment program.

Describes the structure and process of an inpatient program for the treatment of posttraumatic stress disorder (PTSD) and alcoholism. The therapeutic community setting uses lifespan developmental and social learning models to provide patients with (1) a framework for understanding what has happened to them, (2) tools for more effective coping, (3) an arena to experience the discomfort of previous coping mechanisms, and (4) the anxiety/pleasure of creating and practicing a new and more effective repertoire of skills. The program is divided into 3 phases. Phase 1 focuses on solidifying motivation for change through assessment, education, and interpersonal work. Phase 2 represents the action stage, and incorporates exposure-based therapy in a developmental framework to address trauma issues. Phase 3 emphasizes maintenance and generalization of patients' learning via modified relapse prevention training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting response to depression treatment: The role of negative cognition.

Repeated experiences with major depressive disorder (MDD) may strengthen associations between negative thinking and dysphoria, rendering negative cognition more accessible and pronounced with each episode. According to cognitive theory, greater negative cognition should lead to a more protracted episode of depression. In this study of 121 adults with MDD, number of previous episodes was associated with slower change in depression across inpatient and outpatient treatment. Further, although pretreatment negative cognition and pretreatment family impairment both uniquely predicted slower change in depressive symptoms, only negative cognition mediated the association between depression history and depression change. Findings suggest that repeated MDD episodes are specifically associated with increased negative cognition, which in turn contributes to a more pernicious course of symptom change during treatment for depression. (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)     

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)     

Predicting rapid relapse following treatment for chemical dependence: A matched-subjects design.

Explored the prognostic significance of treatment and posttreatment variables on rapid relapse following residential treatment for chemical dependence. 54 persons were identified as 3-month treatment failures by the criteria of 1–3 months of alcohol/drug use in combination with alcohol/drug-related consequences and poor life adjustment. To limit heterogeneity, these persons were matched on MMPI scores with persons who were 3-month outcome successes. Additionally, these MMPI patterns were classified as near normal or indicative of psychiatric symptoms. Multivariate statistics revealed a high level of outcome predictability; continued emotional turmoil (depression, anxiety, and sleep problems) posttreatment was strongly related to failure among the psychiatric MMPI group. Failure to engage in a continuing posttreatment aftercare plan was associated with failure among persons in the near-normal MMPI group. Research approaches that attempt to limit heterogeneity among alcoholics appear to have promise in uncovering powerful prognostic indicators. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The federal role in research, treatment, and prevention of alcoholism.

Outlines the dimensions of the alcohol abuse problem in the US, federal legislation related to the treatment and prevention of alcohol and drug abuse, and priorities for future government involvement in research and treatment. It is argued that the government should play a greater role in the dissemination of research results; fund demonstration projects targeted at improving the effectiveness of alcoholism treatment; coordinate employee assistance programs in the workplace; and ensure that services are extended to currently underserved populations such as the elderly, minorities, and women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol abuse and alcoholism: The psychologist's role in prevention, research, and treatment.

Outlines the extent of the problem of alcohol abuse in the US, factors involved in the diagnosis of alcohol dependence, the value of psychologically oriented treatment, and the use of clinical and physiological screening measures. The need for primary prevention efforts directed at adolescents, the children of alcoholic parents, and those in military service is stressed, and the value of intervention programs based in the workplace is noted. It is argued that psychologists can play an important role in establishing the sociobehavioral basis of alcohol abuse, developing techniques for identifying alcoholics, and devising prevention and intervention strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting length of stay, functional outcome, and aftercare in the rehabilitation of stroke patients. The dominant role of higher-order cognition

BACKGROUND AND PURPOSE: Research in recent years has revealed factors that are important predictors of physical and functional rehabilitation: demographic variables, visual and perceptual impairments, and psychological and cognitive factors. However, there is a remaining uncertainty about prediction of outcome and a need to clinically apply research findings. This study was designed to identify the relative importance of medical, functional, demographic, and cognitive factors in predicting length of stay in rehabilitation, functional outcome, and recommendations for postdischarge continuation of services. METHODS: The influence of these factors was determined by comparing diagnostic, medical, demographic, functional, and neuropsychological information that was retrospectively obtained by reviewing the records of 86 patients admitted for comprehensive rehabilitation due to stroke (n = 36) or orthopedic injury (n = 50). Multiple linear regression with statistical adjustment to control for overprediction of variance was used to predict outcomes. RESULTS: The study revealed the primary importance of higher-order cognitive impairments (comprehension, judgment, short-term verbal memory, and abstract thinking) in extending length of stay and increasing referrals for outpatient therapies and home services after discharge for the cerebrovascular accident patients in comparison with orthopedic cohorts. CONCLUSIONS: The need is discussed for early, comprehensive assessment of deficits in cognition that affect a stroke survivor's ability to participate in a rehabilitation program and remediation that facilitates functional improvement by building on residuals of impaired abilities or teaching compensatory behaviors.     

Age differences in temporal discounting: The role of dispositional affect and anticipated emotions.

We examined age differences in temporal discounting, the tendency to devalue delayed outcomes relative to immediate ones, with particular emphasis on the role of affective responses. A life-span sample completed an incentive-compatible temporal discounting task involving both monetary gains and losses. Covariates included demographic characteristics, cognitive functioning, personality traits, affective responses, and subjective health. Advanced age was associated with a lower tendency to discount the future, but this effect reached statistical significance only for the discounting of delayed gains. An examination of covariates suggested that age effects were associated with age differences in mental health and affective responses rather than demographic or cognitive variables. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

From optimism and pessimism to coping: The mediating role of academic motivation.

The main goal of this study was to examine an integrative model in which academic motivation was hypothesized to mediate the relationships between dispositional optimism and pessimism and coping utilization during the preparation for midterm exams. A sample of 299 undergraduate students completed measures of optimism and academic motivation two weeks prior to midterm exams and measures of academic motivation and coping two weeks after midterm exams. Results of structural equation modeling indicated that self-determined motivation mediated the relationship between dispositional optimism and task-oriented coping, whereas non-self-determined motivation mediated the relationship between dispositional pessimism and disengagement-oriented coping. Furthermore, task-oriented coping was associated with an increase in self-determined motivation from Time 1 to Time 2, whereas disengagement-oriented coping related to an increase in non-self-determined motivation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The expanding scope of alcoholism treatment evaluation.

Researchers are beginning to examine the degree of implementation of alcoholism treatments, treatment processes, and the role of life context or extratreatment factors (such as stressful life events) in the recovery–relapse process. Examples of these trends from alcoholism treatment evaluations are presented within the context of an integrative, process-oriented evaluation framework. Implications for research and practice are discussed with respect to matching patients with treatments and the instrumental and conceptual value of the results of alcoholism treatment evaluations. (61 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of genetics in the pathogenesis of alcoholism.

This article reviews behavior genetic methods and critiques some of the major studies that converge on a genetic basis for alcohol abuse. In particular, it critically examines the adoption studies from Scandinavia and the United States. Serious flaws with respect to a number of important methodological considerations, such as problematic diagnostic criteria and high rates of foster parent psychopathology, suggest that the conclusions drawn by the authors of these studies should be tempered. An evaluation of high-risk research underscores the contradictory findings from different studies and the lack of a coherent conceptual framework to assess results. More sophisticated assessments of environmental factors are suggested to take into account Gene?×?Environment interactions and gene–environment correlation effects that may lead to more precise specifications of the etiology of alcohol disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of an outpatient treatment program for insomnia: A preliminary report.

Evaluated 20 patients who suffered from chronic insomnia and who completed all phases of a 1-yr treatment program. The treatment, which consisted of 5 weekly, 1-hr group sessions and a follow-up 1 mo later, provided education about sleep, instruction in relaxation techniques, stimulus control instructions, and training in sleep hygiene. Self-monitoring data collected by the Ss showed general improvement across a variety of sleep parameters. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preparing clients for alcoholism treatment: Effects on treatment participation and outcomes.

In this study, 126 clients (87 men, 39 women) entering outpatient alcoholism treatment were assigned randomly to 1 of 3 preparatory conditions: a role induction (RI) session, a motivational interview (MI) session, or a no-preparatory session control group (CG). Clients assigned to the MI preparatory condition attended more treatment sessions and had fewer heavy drinking days during and 12 months after treatment relative to CG clients. Clients assigned to MI, relative to CG clients, also had more abstinent days during treatment and during the first 3 months posttreatment, although this difference was not maintained through the remainder of the 12-month follow-up period. Clients assigned to the RI condition showed no significant advantage over those in the CG condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)