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Objective: The effects of an evening of heavy drinking on next-day occupational performance are mixed across studies and have not been investigated for ship-handling performance. Furthermore, it is not known whether the residual effects of alcohol on next-day performance are due to its effects on sleep., Method: Merchant marine cadets (N=61) who had been trained on a diesel power plant simulator and who drank heavily at least episodically were given placebo beer one evening and were randomized on a second evening to placebo or real beer that resulted in a mean breath alcohol concentration (BrAC) of .115 g%. After an 8-hour sleep period, a meal, and a return to < or = .02 g% BrAC, cadets were assessed with self-report measures and the power plant simulator., Results: No effects of beverage condition were seen on actual performance, although cadets who consumed alcohol rated their performance as impaired compared with the placebo conditions. Alcohol consumption also increased the Acute Hangover Scale score, improved perceived sleep quality, and decreased perceived latency to sleep onset while not affecting perceived sleep duration., Conclusions: While residual alcohol effects are found on some complex performance tasks, residual effects of .11 to .12 g% BrAC were not seen on ship engine simulator performance despite increased hangover symptoms and perceived impairment from the hangover. Therefore, this level of heavy drinking might not be deleterious to next-day routine occupational performance by young ship engineers despite the subjective ill effects. The perception that alcohol improves sleep onset might be a motivation for some to drink heavily. The effects on older engineers, at higher alcohol levels, and on other ship-handling tasks still need to be studied.

Objective: There were two specific goals for the current study: (1) to demonstrate that adolescents display drug-specific cue reactivity to alcohol and cigarette visual cues that varies based on drug-use history and (2) to test the unique contribution of adolescents' avoidance reactions to alcohol and cigarette cues, independent of approach/craving reaction., Method: Adolescents (N = 143; age 13-20 years; 58 males) with varied substance-use histories were recruited from school and community sites. Adolescents were presented with a series of alcohol, cigarette, and nondrug comparison visual cues and reported their approach/craving and avoidance reactions. They also completed individual difference measures related to their alcohol and cigarette use and experiences., Results: When adolescents were grouped according to their current alcohol or cigarette use (no use, low use, high use), increased use of alcohol or cigarettes was associated with stronger reactions (increased approach, decreased avoidance) to cues for that substance but not to nondrug control cues. Simultaneous regression analyses demonstrated that after controlling for approach/craving reactions, avoidance cue reactions predicted unique and/or incremental variance in measures of alcohol and cigarette usage, recent change in patterns of use, alcohol expectancies, alcohol restraint and parental alcohol problems., Conclusions: Adolescents displayed robust alcohol and cigarette cue-specific reactions that varied systematically with their current use of these drugs. Across numerous clinically relevant individual difference variables, predictive power was greatly enhanced through the inclusion of both avoidance and approach reactions.

Objective: Patients treated in an urban emergency department were studied to determine if college status, gender and having alcohol as a reason for medical treatment were related to alcohol use and related problem behaviors., Method: Patients ages 18-19 years (N = 250; 55% men) who had or had not been drinking alcohol prior to the event that precipitated their medical treatment were assessed on their alcohol use, alcohol-related problems and drug use., Results: There were high levels of alcohol use, tobacco use and other drug use in the sample, regardless of the reason for medical treatment. Analyses consistently showed that patients treated for alcohol-related reasons had more severe drinking patterns and problems than patients who were alcohol negative. Patients not enrolled in college showed similar patterns of alcohol consumption as their college-attending peers, but bad more severe alcohol-related behaviors and problems. Few gender differences were found and no interactions were found between gender, alcohol status and college status., Conclusions: Findings indicate that older adolescents who receive medical treatment for alcohol use are not inexperienced drinkers. Furthermore, in this convenience sample, college students did not appear to be at greater risk for substance use or problems. Findings underscore the potential usefulness of alcohol intervention programs for alcohol-involved medical patients, and the need to attend to the alcohol and drug use of nonstudent populations.

Objective: The performance of three brief screens, the CAGE, TWEAK and Alcohol Use Disorders Identification Test (AUDIT), was evaluated against a DSM-IV diagnosis of alcohol abuse or dependence in an adolescent sample., Method: Adolescents (13-19 years old) who presented to an emergency department for treatment of an injury, and who tested negative for blood alcohol concentration at time of admission, were administered a structured diagnostic interview and modified versions of the CAGE, TWEAK and AUDIT., Results: Of the 415 adolescents for whom complete data were available, 18% met criteria for a DSM-IV alcohol use disorder according to the Diagnostic Interview Schedule for Children (version 2.3). Teens who reported alcohol use in the last year (n = 261, 58% male, 71% white) were included in analyses that compared the performance of the three screening instruments. Receiver Operating Characteristic analysis indicated that the AUDIT demonstrated the best performance across the range of its cut-scores, with optimal performance at a cut-score of 4. The TWEAK performed optimally at a cut-score of 2 and the CAGE at a cut-score of 1., Conclusions: Routine alcohol screening among adolescents seen in a hospital setting is indicated. Two important directions for future research include the identification of adolescent-specific alcohol screening items, and the validation of an adolescent-specific definition of problem drinking that addresses limitations of DSM-IV alcohol diagnoses when applied to adolescents.

Objective: The relationship between tobacco dependence and alcohol dependence has received considerable scrutiny in the past few years. The present study of alcoholics in treatment for alcoholism extended previous work by investigating the cross-sectional and longitudinal relationships between drinking and smoking variables., Method: Male and female alcoholics (N = 116) completed a standard assessment of smoking and drinking pretreatment followed by a laboratory assessment of reactivity to alcohol cues. Participants' drinking and smoking were evaluated again 6 months following treatment., Results: (1) Pretreatment tobacco dependence, pretreatment alcohol dependence, urge to smoke and urge to drink were positively correlated; (2) smoking rates and drinking rates were not correlated either before or following treatment; (3) pretreatment smoking history did not predict posttreatment drinking; (4) the rate of smoking declined following treatment for alcoholism for 45% of the smoking patients who completed a 6-month follow-up, independent of relapse status; and (5) relapsers who smoked more heavily also drank less frequently during follow up., Conclusions: Consistent but modest cross-sectional relationships between drinking and smoking variables before alcohol treatment decrease after treatment for alcohol dependence. A spontaneous improvement in smoking rate occurs in many (45%), particularly among those who smoked more heavily pretreatment and thus benefit most by the reduction. Directions for future research are discussed.

Objective: The relationship between tobacco dependence and alcohol dependence has received little empirical scrutiny. The present study of alcoholics in treatment for alcoholism investigated pretreatment tobacco and alcohol history and dependence, as well as subjective responsivity to alcohol cues., Method: Eighty-three male alcoholics underwent a questionnaire assessment of smoking and drinking pretreatment followed by a laboratory assessment of reactivity to alcohol cues., Results: The analyses demonstrate that (1) pretreatment tobacco dependence and pretreatment alcohol dependence are related, (2) alcohol dependence predicts urges to smoke during alcohol treatment, (3) exposure to alcohol cues results in increased urge to smoke, (4) smoking when ill predicts urge to drink during alcohol cue exposure and (5) urge to smoke is positively correlated with urge to drink., Conclusions: These data, collected in a population of alcoholics not currently receiving smoking interventions, indicate that smoking may be a factor to address during alcohol treatment. The clinical importance of these data is discussed.

The present study investigates reaction time (RT) as a measure of attentional deficits produced during alcohol cue exposure. Twenty-four male alcoholic patients responded to a series of computer-generated tones as rapidly as possible during baseline and again during either an alcohol cue exposure period or exposure to a control beverage (water). Patients required increased time to respond to the tones when exposed to alcohol cues. No such increase in RT was found during exposure to a control beverage. In addition, RT was significantly correlated with self-reported urge to drink. These data provide initial validation for the use of RT as an objective measure of cue reactivity. Both theoretical and clinical implications for the use of RT as a measure of the effects of cue exposure are discussed.

The purpose of this study was twofold: to investigate gender differences in alcohol cue reactivity, and to study the effect of individualized mood induction on cue reactivity. Male (n = 38) and female (n = 19) alcoholics were exposed to an alcoholic beverage before and after mood induction to assess their reactivity to the beverage cues. The mood induction was based on a situation the subject had identified as being high risk for relapse. Subjects showed urge and salivary reactivity in response to alcohol beverage cues prior to mood induction, and the induction of mood enhanced urge reactivity in both men and women. Analyses with alcohol urge reactors (subjects that demonstrate an increased urge to drink alcohol in response to an alcoholic beverage cue) suggested that women show more urge reactivity in response to negative moods than do men. No gender differences were seen in reactivity to beverage cues alone. These results identify an important gender difference in the effect of negative moods on cue reactivity and suggest that negative mood situations may place women at a higher risk for relapse than men.

Social learning theory postulates that chronic alcohol abusers may have deficits in ability to cope with stressful situations, and these deficits may be associated with relapse after treatment. Attempts to study the hypothesized deficits have been hampered by methodological problems. Therefore, a behavior analytic procedure was used to develop 10 categories of situations based on over 600 drinking situations elicited from alcoholics. Role plays were developed for each of these categories, and samples of alcoholics in treatment were asked to respond as if they were trying not to drink. Videotaped responses were behaviorally rated by trained judges for skill and anxiety, and subjects completed self-report ratings of urge to drink, anxiety, difficulty and skill after each role play. Good interrater reliabilities and internal consistency were found across three samples of alcoholics, with virtually no gender differences. Previous and current investigations show the validity and utility of this instrument. The Alcohol Specific Role Play Test therefore shows promise as a means of assessing alcoholics' reactions to high-risk situations.

Alcoholics' reactions to drinking-related stimuli (cue reactivity) have been well documented and alcohol cue exposure treatment has been conducted recently in several clinical trials. Prior to conducting large-scale clinical trials it is important to know what effects detoxification may have on cue reactivity. However, no information is available about the effects of stage of detoxification or of detoxification medication on alcohol cue reactivity. In this study, 45 male alcoholics, detoxified without medication, were assessed during either their second, fourth or sixth day of withdrawal. Further, their reactivity was compared to that of alcoholics detoxified with chlordiazepoxide (n = 15), and to that of alcoholics in their fourth week after drinking (n = 28). Cue reactivity assessment investigated salivation and urge to drink after 3 minutes of water cue exposure and then after 3 minutes of alcohol cue exposure. Urges to drink were assessed during an additional 15 minutes of alcohol exposure to explore latency to maximum reactivity and habituation. Reactivity did not differ as a function of group membership, although salivation was elevated to both beverages during the first week of detoxification. Of the sample, 70% reacted to alcohol with increased urge and 65% with increased salivation, with no difference between groups in proportions of reactors. The maximum urge to drink occurred in the first 6 minutes of alcohol exposure, followed by a gradual and significant decrease. There were no differences on these measures between alcoholics in their first or fourth week after their last drink. Implications for theory and clinical applications are discussed.

To evaluate three promising social learning approaches to the treatment of alcoholism, 69 male alcoholics in standard inpatient treatment participated in either a communication skills training group (CST), a communication skills training group with family participation (CSTF) or a cognitive behavioral mood management training group (CBMMT). Alcoholics who received CST or CSTF drank significantly less alcohol per drinking day during 6-month follow-up than those in CBMMT. The groups did not differ in abstinence rates or latency to relapse. All groups improved in skill and anxiety on the extensive battery of process measures, including role-play tests of general and alcohol-specific coping skills, but those in CST improved most in skill in alcohol-specific high-risk role plays and in ability to relax after the role plays. Alcoholics' skill, response latency, anxiety and urge to drink during alcohol-specific role plays were highly correlated with treatment outcome, demonstrating the importance of including comprehensive process measures in treatment outcome research. Implications for patient-treatment matching and future research are discussed.

After testing with the Controlled Repression-Sensitization Scale, 38 alcoholics were found to place greater reliance on sensitizing defenses than nonalcoholics. A test of the Defense Mechanism Inventory found no differences between alcoholics and controls.

In a follow-up study of alcoholic patients, those with higher levels of denial had lower rates of rehospitalization and higher rates of treatment completion than those who relied on other defense mechanisms.

The relationship of various irrational beliefs to alcohol dependence, urges to drink, anxiety and drinking after treatment was investigated for 63 male alcoholics, using Jones' Irrational Beliefs Test (IBT). Alcohol dependence was most strongly associated with problem avoidance. Urges to drink, anxiety and difficulty during alcohol-related role-plays were strongly correlated with problem avoidance and dwelling on negative events. The IBT was unrelated to pretreatment drinking measures but did predict 6-month posttreatment drinking (n = 48) which suggests these beliefs can mediate treatment response. Feeling doomed by the past was the best predictor of both frequency of drinking and average quantity consumed during follow-up. Treatment implications include targeting specific beliefs for intervention.