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Introduction: Mindfulness-based treatments have received increasing interest and empirical support in the clinical psychology literature. There are, however, no studies to date that have systematically examined treatment enactment, which is the amount and type of home practice participants incorporate into their daily lives. Because treatment enactment has been cited as a key aspect of treatment fidelity, this study examined the relationships between treatment enactment (i.e., home mindfulness practice) and alcohol and other drug (AOD) use and craving in the context of a larger study of mindfulness-based relapse prevention (MBRP)., Methods: Participants (N=93) in this secondary analysis had been randomized in the parent study to receive MBRP. AOD use, craving, and home mindfulness practice were assessed at baseline, post-treatment, 2-month and 4-month follow-up time points., Results: MBRP participants significantly increased the amount of time spent in home mindfulness practice over the course of the study. Further, greater time spent in home practice was associated with less AOD use and craving at the 2- and 4-month follow-ups. Of note, the significant treatment gains in home practice faded somewhat at the 2- and 4-month follow-ups as participants returned to standard aftercare, which did not involve mindfulness-based practice., Conclusions: Participation in MBRP was associated with a significant increase in home mindfulness practice, and increased involvement in home practice was associated with significantly lower AOD use and craving over the course of the study. This suggests that treatment enactment, which entails building mindfulness practice into one's daily life, plays a key role in ongoing recovery following MBRP treatment. Teaching mindfulness skills for daily use versus for only in high-risk situations has the potential to boost the longevity of MBRP treatment effects. These findings also suggest that MBRP clinicians should target the post-intervention decline in home practice (e.g., with ongoing mindfulness practice groups) to maximize the benefits of mindfulness meditation in decreasing AOD use and craving., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Distress tolerance refers to the degree to which an individual is able to withstand negative psychological and/or physical states. Empirical literature has indicated that lower distress tolerance is associated with a number of negative alcohol and other drug (AOD) use outcomes and psychopathology. Mindfulness meditation focuses on enhancing affect regulation, and may be particularly beneficial for individuals with lower distress tolerance. This secondary analysis evaluated the basic psychometric properties of the Distress Tolerance Scale (DTS) in a clinical sample of individuals with AOD-use disorders and tested whether distress tolerance for negative psychological states moderated treatment effects on AOD outcomes in an initial efficacy trial of mindfulness-based relapse prevention (MBRP). It was hypothesized that participants with lower distress tolerance would report fewer AOD use days over the 4-month follow-up if they received MBRP versus treatment as usual (TAU). Participants (N=168) in the parent RCT were recruited from a private, nonprofit agency providing inpatient and outpatient care for individuals with AOD-use disorders. Assessments of 60-day frequency of AOD use, as measured by the Timeline Followback, were conducted at baseline, immediately postintervention, and 2months and 4months following the intervention. Distress tolerance, as measured by the DTS, was assessed at baseline. Results indicated a one-factor solution, which is consistent with how the DTS has been implemented in other studies. As predicted, DTS was positively associated with all mindfulness subscales, suggesting its convergent validity in this clinical sample. Findings showed the hypothesized time×treatment×distress tolerance interaction, and thereby indicated that participants with lower distress tolerance who received MBRP treatment experienced a greater curvilinear decrease in AOD use days over time than those with lower distress tolerance who received TAU. However, the observed plateau effect suggests that these effects were not maintained at the 4-month follow-up. Findings suggest that distress tolerance is a clinically relevant client characteristic to consider in matching participants to aftercare treatment and that MBRP may be particularly helpful for individuals with lower distress tolerance., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The current investigation evaluated (1) the incremental predictive validity of non-judgmental acceptance in terms of alcohol use coping motives and (2) the mediating role of non-judgmental acceptance in the association between posttraumatic stress symptom severity and alcohol use coping motives. Participants included 153 (79 women) adults who reported exposure to at least one DSM-IV PTSD Criterion A traumatic life event and alcohol use in the past month. Non-judgmental acceptance emerged as a significant incremental predictor of alcohol use coping motives. Furthermore, non-judgmental acceptance partially mediated the association between posttraumatic stress symptom severity and alcohol use coping motives. Theoretical and clinical implications of the findings are discussed with regard to better understanding the co-occurrence of posttraumatic stress and alcohol use disorders., (Published by Elsevier Ltd.)

Substance use disorders often co-occur with eating disorders in female populations. This review addresses the prevalence and etiology of this comorbidity in women. Thirteen peer-reviewed journal articles are reviewed. Conclusions are drawn concerning prevalence rates, theory, and implications for treatment. Current research supports distinct etiologies and growth trajectories for both disorders. Thus, comorbidity presents with unique challenges, and often, worse outcomes. Though comorbidity rates are high, little research has been done concerning treatment. Given the high prevalence rates of these comorbid disorders, a specific treatment needs to be developed that targets both disorders simultaneously., (Copyright (c) 2009 Elsevier Ltd. All rights reserved.)

Brief intervention (BI) research has traditionally examined alcohol and drug use outcomes; however it is unknown whether BIs can also impact on-the-job productivity. This exploratory study examines changes in workplace productivity and related costs for clients receiving a BI for at-risk drinking in the employee assistance program (EAP). Participants were 44 clients attending the EAP for behavioral health concerns, screened for at-risk drinking, assigned to BI+Usual Care (n=25) or UC alone (n=19), and who completed 3-month follow-up. Absenteeism, presenteeism, and productivity costs were derived as outcomes. At follow-up, participants in the BI+UC group had improved productivity when at work (presenteeism) compared to the UC group. The estimated cost savings from improved productivity for the BI+UC group was $1200 per client over the UC group. Groups did not differ by absenteeism (missed days of work). Preliminary evidence suggests the broad impact BIs may have. Implications for future BI research are discussed., (Copyright 2009 Elsevier Ltd. All rights reserved.)

Tobacco use is prevalent in adolescents and understanding factors that contribute to smoking uptake remains a critical public health priority. While there is now good support for the role of implicit (preconscious) cognitive processing in accounting for changes in drug use, these models have not been applied to tobacco use. Longitudinal analysis of smoking data presents unique problems, because these data are usually highly positively skewed (with excess zeros) and render conventional statistical tools (e.g., OLS regression) largely inappropriate. This study advanced the application of implicit memory theory to adolescent smoking by adopting statistical methods that do not rely on assumptions of normality, and produce robust estimates from data with correlated observations. The study examined the longitudinal association of implicit tobacco-related memory associations (TMAs) and smoking in 114 Australian high school students. Participants completed TMA tasks and behavioural checklists designed to obscure the tobacco-related focus of the study. Results showed that the TMA-smoking association remained significant when accounting for within-subject variability, and TMAs at Time 1 were modestly associated with smoking at Time 2 after accounting for within subject variability. Students with stronger preconscious smoking-related associations appear to be at greater risk of smoking. Strategies that target implicit TMAs may be an effective early intervention or prevention tool. The statistical method will be of use in future research on adolescent smoking, and for research on other behavioural distributions that are highly positively skewed.

Previous studies have demonstrated that attempts to suppress thoughts about using substances may actually lead to increases in substance use. Vipassana, a mindfulness meditation practice, emphasizes acceptance, rather than suppression, of unwanted thoughts. A study by Bowen and colleagues examining the effects of a Vipassana course on substance use in an incarcerated population showed significant reductions in substance use among the Vipassana group as compared to a treatment - usual control condition [Bowen S., Witkiewitz K., Dillworth T.M., Chawla N., Simpson T.L., Ostafin B.D., et al. (2006). Mindfulness Meditation and Substance Use in an Incarcerated Population. Psychology of Addictive Behaviors.]. The current study further examines the mediating effects of thought suppression in the relationship between participation in the course and subsequent alcohol use. Those who participated in the course reported significant decreases in avoidance of thoughts when compared to controls. The decrease in avoidance partially mediated effects of the course on post-release alcohol use and consequences.

Little is known about what type of drinking related consequences may enhance motivation to change or may hinder behavior change over time. In order to examine this research question, 120 adult participants abusing alcohol were administered the Drinker Inventory of Consequences-Recent (DrInC-R), the Brief Readiness to Change Questionnaire (BRTC), and the Steady Pattern Chart (SP). Subscale scores from the DrInC-R and the BRTC; and alcohol consumption as assessed by the SP at baseline and three month follow-up were retained for data analyses. Greater intrapersonal DrInC-R consequences scores significantly predicted greater contemplation stage scores (R2=.37, p<.001), and lower precontemplation stage scores (R2=.32, p<.001), and DrInC-R impulse control and interpersonal consequences scores significantly predicted alcohol consumption at three month follow-up after controlling for baseline consumption (R2=.50, p<.001). Increased awareness of intrapersonal drinking related consequences may motivate change, whereas numbers of impulse control and interpersonal consequences may predict changes in drinking behavior over the short-term.

A growing body of research suggests that mindfulness-based therapies may be effective in treating a variety of disorders including stress, chronic pain, depression and anxiety. However, there are few valid and reliable measures of mindfulness. Furthermore, mindfulness is often thought to be related to spirituality, given its roots in Buddhist tradition, but empirical studies on this relationship are difficult to find. The present study: (1) tested the reliability and validity of a new mindfulness measure, the Freiburg Mindfulness Inventory (FMI), (2) explored the relationship between mindfulness and spirituality, and (3) investigated the relationship between mindfulness and/or spirituality and alcohol and tobacco use in an undergraduate college population (N=196). Results support the reliability of the FMI and suggest that spirituality and mindfulness may be separate constructs. In addition, smoking and frequent binge-drinking were negatively correlated with spirituality scores; as spirituality scores increased the use of alcohol and tobacco decreased. Thus, spirituality may be related to decreased substance use. In contrast, a positive relationship between mindfulness and smoking/frequent binge-drinking behavior was uncovered, and warrants further investigation.

The transtheoretical model of Prochaska and DiClemente [Psychother. Theory Res. Prac. 19 (1982) 276] postulates that cognitive skills are critical for drinking behavior change. Memory and executive cognitive function likely influence the execution of skills that are implicated for both motivating and sustaining drinking behavior change. Participants who met criteria for alcohol abuse or dependence (N=117) were administered a battery of standardized memory and executive cognitive function tests that included the Wechsler Memory Scale-Revised (WMS-R), Controlled Oral Word Association Test (COWAT), Ruff Figural Fluency Test (RFFT), and Wisconsin Card Sort Test (WCST). Lower verbal and higher delayed recall memory score at baseline significantly predicted precontemplation, higher verbal memory scores predicted contemplation, and better attention-concentration at baseline significantly predicted reduced drinking at 3-month follow-up, after controlling for baseline alcohol consumption. The study findings indicate that explicit memory processes may have utility for predicting readiness to change drinking behavior.

Employee assistance programs (EAPs) are widely available to assist employees with a variety of problems. This research examined factors related to utilization and outcome by individuals with addictive behaviors (ABs) versus other problem areas. The specific aims of this study were to evaluate referral source and treatment outcome by gender and presenting problem. The sample included 3890 men and women who attended the EAP for a variety of concerns. Men were less likely than women to self-refer and more likely to be mandated to the EAP. Men were also much more likely to present with ABs. Relative to clients presenting with other issues, individuals with ABs were less likely to self-refer, have their problems resolved in the EAP, and were seen for fewer sessions. These results suggest that EAPs may be well suited for implementation of brief interventions (BIs) that have been empirically supported in other contexts.

Harm reduction approaches to alcohol problems have endured a controversial history in both the research literature and the popular media. Although several studies have demonstrated that controlled drinking is possible and that moderation-based treatments may be preferred over abstinence-only approaches, the public and institutional views of alcohol treatment still support zero-tolerance. After describing the problems with zero-tolerance and the benefits of moderate drinking, the research literature describing prevention and intervention approaches consistent with a harm reduction philosophy are presented. Literature is reviewed on universal prevention programs for young adolescents, selective and indicated prevention for college students, moderation-based self-help approaches, prevention and interventions in primary care settings, pharmacological treatments, and psychosocial approaches with moderation goals. Overall, empirical studies have demonstrated that harm reduction approaches to alcohol problems are at least as effective as abstinence-oriented approaches at reducing alcohol consumption and alcohol-related consequences. Based on these findings, we discuss the importance of individualizing alcohol prevention and intervention to accommodate the preferences and needs of the targeted person or population. In recognizing the multifaceted nature of behavior change, harm reduction efforts seek to meet the individual where he or she is at and assist that person in the direction of positive behavior change, whether that change involves abstinence, moderate drinking, or the reduction of alcohol-related harm. The limitations of harm reduction and recommendations for future research are discussed.

The transtheoretical model posits that contemplating change in substance abuse involves weighing the costs of substance use against the benefits. One of the common aversive consequences of substance misuse is personal loss. Indeed, higher total number of losses of unspecified recency and importance have predicted greater motivation to change substance use patterns. A sample of 110 participants with co-occurring Axis I psychiatric and substance use disorders completed a questionnaire measuring recent important substance-related losses (LOSS-QR) and the Brief Readiness to Change questionnaire (RTC). The LOSS-QR yielded scores for frequency, importance, and association of substance misuse with recent losses. Total recent important substance-related loss scores were positively and significantly correlated with total RTC. Hierarchical regression analyses found that identifying losses as substance related and important accounted for significant amounts of variance in total RTC, and identifying losses as substance related predicted precontemplation and contemplation scores. As hypothesized by the transtheoretical model, awareness of substance-related losses seems to be important for people with comorbid psychiatric disorders contemplating behavior change.

Research using the balanced placebo design seeks to differentiate the physiological and psychological effects of drinking alcohol. Questions regarding the validity of the design center about experimenter instructions, particularly in the antiplacebo cell at higher blood alcohol content (BAC) levels. This study tested the plausibility of two misattribution strategies designed to reduce the conflict between experimenter instructions and internal cues of drunkenness. Forty-two participants (BAC = .055) were told that they received no alcohol, with internal cues of drunkenness said to be produced by a (sham) second drug, a (placebo) tachistoscopic display, or no misattribution given. The placebo drug group reported less alcohol intoxication without reporting less physical impairment than the control or tachistoscopic groups. Doubt of instructions was expressed more frequently in the control group than in the placebo drug group. Mean time to first reported doubt of experimenter instructions was longer for the placebo drug group. A manipulation check designed to account for demand effects indicated that instituting the pharmacologic misattribution increased the success of the manipulation over the control group. Providing a credible attribution for internal symptoms of drunkenness makes experimenter's instructions more credible, improving the validity of the antiplacebo cell of the balanced placebo design.

The purpose of this paper is to describe what harm reduction is, how it developed, how it works, and why it is becoming a major approach in the addictive behaviors field. Based on principles of public health, harm reduction offers a pragmatic yet compassionate set of strategies designed to reduce the harmful consequences of addictive behavior for both drug consumers and the communities in which they liver. To illustrate how harm reduction has been applied to both the prevention and treatment of addiction problems, highlights of a national conference on harm reduction are presented. The historical roots of harm reduction programs in Europe (Netherlands and the United Kingdom) are described. The paper concludes with a discussion of four basic assumptions central to harm reduction: (a) harm reduction is a public health alternative to the moral/criminal and disease models of drug use and addiction; (b) it recognizes abstinence as an ideal outcome but accepts alternatives that reduce harm; (c) it has emerged primarily as a "bottom-up" approach based on addict advocacy, rather than a "top-down" policy established by addiction professionals; and (d) it promotes low threshold access to services as an alternative to traditional high threshold approaches.

Cue exposure techniques have been increasingly applied in the treatment of addictive behaviors. The role of cue exposure in a comprehensive approach to relapse prevention is considered from several theoretical perspectives. Issues discussed include the optimal definition of both cue and response variables in cue exposure, the relation between exposure to drug-taking cues and elicitation of outcome expectancies, and the combination of extinction-based cue exposure methods and skill training in relapse prevention programs. Whether cue exposure effects are mediated by extinction of appetitive craving responses and/or by the modification of efficacy and outcome expectancies is discussed.

Expectations of the effects of alcohol have been related to drinking behaviors for both problem and nonproblem drinkers. The present investigation expanded on previous research by considering age, sex, and alcohol expectancies as differential predictors of frequency and quantity of drinking. Subjects, 157 males and 168 females, completed alcohol expectancy, drinking habits, and demographic questionnaires. Results showed significant sex differences in predictors of drinking frequency. Males who reported most frequent drinking tended to have stronger expectations of increased Social and Physical Pleasure, Global Positive Changes, and Sexual Enhancement. On the other hand, frequent consumption among females was best predicted by stronger expectations that alcohol would reduce tension. The amount consumed per drinking occasion was predicted by the same two expectancy factors for males and females: Social and Physical Pleasure and Social Assertion. Age was an important contributing predictor of quantity and frequency for females only. Results indicated the importance of investigating the mediating role of expectancies (a) within sex and (b) with respect to frequency versus quantity of drinking behavior.

To assess the effects of exercise and meditation on alcohol consumption in social drinkers, 60 male students, between the ages of 21 and 30, all classified as heavy social drinkers, were randomly assigned to one of three conditions: exercise (running), meditation, and a no-treatment control group. The study consisted of three distinct phases: pretreatment baseline (2 weeks), treatment intervention (8 weeks), and a follow-up period (6 weeks). Subjects in the running and meditation conditions met as a group during the treatment intervention phase, and all subjects self-monitored their daily consumption of alcohol throughout the study. The results showed that subjects in the exercise condition significantly reduced their alcohol consumption compared to the no-treatment control condition. The implications of these findings for treatment intervention, and the importance of subject compliance are discussed.

The present study investigated the reasons given for drinking episodes that led to arrests for driving while intoxicated (DWI). DWI arrestees completed a self-report checklist of the psychological and situational factors associated with their drinking-related arrest. Three general categories of reasons for drinking were factor analytically derived. These included (a) drinking in response to negative feelings primarily of an interpersonal nature, (b) drinking in response to negative feelings primarily of an intrapersonal nature, and (c) social factors involved in drinking.