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Objective: The primary purpose of this study was to provide a comprehensive assessment of the underlying factor structure of the Alcohol Dependence Scale (ADS). Secondary goals included assessing concurrent validity of the total ADS and subscales derived from the factor analyses with variables related to alcohol dependence and further evaluating the validity of two proposed dichotomously scored, reduced-item ADS measures. Method: Responses to the ADS were obtained from participants who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for alcohol dependence in two large randomized clinical trials: COMBINE (Combining Medications and Behavioral Interventions Study; n = 1,335; 69% male) and Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity; n = 1,666; 75% male). Both exploratory and confirmatory factor analyses were conducted, and validity coefficients were obtained. Results: Across samples, analyses supported a correlated, three-factor solution representing loss of behavioral control and heavy drinking, obsessive-compulsive drinking style, and psychoperceptual and psychophysical withdrawal. The ADS was significantly related to other measures of severity of dependence, craving for and preoccupation with drinking, temptation to drink and confidence in the ability to not drink in high-risk relapse situations, heavy and sustained drinking patterns, concerns about negative alcohol-related consequences, and awareness of problematic drinking. Conclusions: These findings support a three-factor solution for the ADS and its ability to assess the construct of alcohol dependence in a reliable and valid manner. The 12-item reduced ADS measure (reflecting mostly dependence-related items), as opposed to the 9-item reduced ADS measure (generally excessive drinking items), provided validity coefficients comparable to the total, 25-item ADS., THE ALCOHOL DEPENDENCE SCALE (ADS; Horn et al., 1984; Skinner and Horn, 1984) was originally a 29-item, self-report instrument designed to evaluate the degree of severity of the alcohol dependence [...]

Objective: To evaluate the full range of alcohol treatment effectiveness, it is important to assess secondary nondrinking outcome dimensions in addition to primary alcohol consumption outcomes. Method: We used a large sample (n = 1,226) of alcohol-dependent participants entering the National Institute on Alcohol Abuse and Alcoholism-sponsored COMBINE (Combining Medications and Behavioral Interventions) Study, a multisite clinical trial of pharmacological (naltrexone [ReVia] and acamprosate [Campral]) and behavioral interventions, to examine the effects of specific treatment combinations on nondrinking functional outcomes. We assessed the outcomes at baseline and at the end of 16 weeks of alcohol treatment and again at the 26-week and/or 52-week postrandomization follow-ups. Results: (1) Drinking and secondary outcomes were significantly related, especially at the follow-up periods. A higher percentage of heavy drinking days, more drinks per drinking day, and lower percentage of days abstinent were associated with lower quality-of-life measures. (2) All nondrinking outcomes showed improvement at the end of 16 weeks of treatment and most maintained improvement over the 26-week and 52-week follow-ups. Only two measures returned to pretreatment levels at 52 weeks: percentage of days paid for work and physical health. Improvements of nondrinking outcomes remained even after adjusting for posttreatment heavy drinking status. (3) Although nondrinking outcomes showed overall improvement, specific pharmacological and behavioral treatment combinations were not differentially effective on specific secondary outcomes. Conclusions: In the current study, changes that resulted from treatment were multidimensional, and improvements in nondrinking outcomes reflected the overall significant improvement in drinking but they were not differentiated between treatment combination groups. Findings from this study support the importance of including secondary nondrinking outcomes in clinical alcohol-treatment trials., THE EFFECTIVENESS OF ALCOHOL TREATMENT is typically measured by examining the differences and/or changes in alcohol consumption as the primary outcome dimension (Babor et al., 1994; Finney et al., 2003; [...]

Objective: The current study compared alcoholics who entered treatment for the first time with those who had reported one or more prior treatment experiences using a large sample (N = 1,362) of alcoholics who entered the National Institute on Alcohol Abuse and Alcoholism-sponsored COMBINE (Combining Medications and Behavioral Interventions) Study of pharmacological and behavioral treatment efficacy. Method: Participants were categorized into three prior-treatment groups: (1) treatment naive (n = 691, 50.73%), (2) one to two prior treatments (n = 380, 27.90%), or (3) three or more prior treatments (n = 291, 21.37%). Groups were compared at baseline on multiple drinking and psychosocial variables. Results: The treatment-naive group was more likely to be female, educated, married, and employed. They reported the lowest levels of drinks per drinking day, average drinks per day, alcohol dependence, craving, and alcohol-related consequences; but, they had the oldest age at onset of alcohol problems. Both the treatment-naive group and the one-to-two prior-treatment group had lower percentage days abstinent within the prior 30 days, compared with the three-or-more group (22% and 25% vs 32%, respectively). The treatment-naive group reported the least commitment to an abstinence goal (43% vs 70% and 80%, respectively) and the lowest mean number of Alcoholics Anonymous meetings attended (0.86 vs 3.10 vs 6.91, respectively). They also reported fewer psychological symptoms, less distress, and higher levels of quality of life on physical, emotional, and environmental domains, as well as social relationships. Conclusions: Results suggest that a greater understanding of treatment-naive versus treatment-experienced clients may provide a better profile of help-seeking behavior and may suggest different approaches to treatment., A SMALL BODY OF RECENT STUDIES has found that treatment-naive clients who are entering substance-use treatment for the first time differ significantly from treatment-experienced clients in various pretreatment characteristics and [...]

Objective: The aim of this study was to examine the efficacy of pharmacological and behavioral interventions across 1 year posttreatment in the COMBINE (Combining Medications and Behavioral Interventions) Study. Method: Alcohol-dependent individuals (N = 1,383; 428 women) recruited at 11 outpatient academic alcoholism-treatment clinics across the United States participated in a randomized, double-blind, placebo-controlled trial. They received 16 weeks of naltrexone (Revia) or acamprosate (Campral) or both medications and/ or placebos in combination with medical management (MM), with or without combined behavioral intervention (CBI); one group received CBI without pills or MM. Drinking behavior and clinical status were assessed at the end of treatment (Week 16) and at Weeks 26, 52, and 68. Results: Prior treatment with active naltrexone, without active acamprosate or CBI or with active acamprosate plus CBI, and CBI with double placebo resulted in a significantly higher percentage of days abstinent than double placebos with no CBI (p < .05). Having received CBI was associated with positive clinical response posttreatment, compared with not having received CBI. Prior treatment with naltrexone increased the time to the first heavy-drinking day posttreatment (p = .03). No differences were found between patients who had received CBI without MM or pills and those having received MM and double placebo with or without CBI. No significant main effects for acamprosate were found on any of the outcome measures. Conclusions: Previous treatment with MM and either CBI or naltrexone, or both, but not acamprosate, was associated with sustained efficacy beyond discontinuation. Reasons for the maintained treatment gains with naltrexone and/or CBI and potential methods to extend them are discussed., THE AVAILABILITY OF PHARMACOTHERAPIES aimed at achieving abstinence and minimizing relapse provides promise for improving the effectiveness of alcoholism treatment. Naltrexone (Revia, Vivitrol) and acamprosate (Campral), both approved by the [...]

Objective: Past research assessing the factor structure of the Alcohol Use Disorders Identification Test (AUDIT) with various exploratory and confirmatory factor analytic techniques has identified one-, two-, and three-factor solutions. Because different factor analytic procedures may result in dissimilar findings, we examined the factor structure of the AUDIT using the same factor analytic technique on two new large clinical samples and on archival data from six samples studied in previous reports. Method: Responses to the AUDIT were obtained from participants who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria for alcohol dependence in two large randomized clinical trials: the COMBINE (Combining Medications and Behavioral Interventions) Study (N = 1,337; 69% men) and Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity; N = 1,711; 76% men). Supplementary analyses involved six correlation matrices of AUDIT data obtained from five previously published articles. Confirmatory factor analyses based on one-, two-, and three-factor models were conducted on the eight correlation matrices to assess the factor structure of the AUDIT. Results: Across samples, analyses supported a correlated, two-factor solution representing alcohol consumption and alcohol-related consequences. The three-factor solution fit the data equally well, but two factors (alcohol dependence and harmful alcohol use) were highly correlated. The one-factor solution did not provide a good fit to the data. Conclusions: These findings support a two-factor solution for the AUDIT (alcohol consumption and alcohol-related consequences). The results contradict the original three-factor design of the AUDIT and the prevalent use of the AUDIT as a one-factor screening instrument with a single cutoff score., THE ALCOHOL USE DISORDERS Identification Test (AUDIT; Babor et al., 2001; Saunders et al., 1993) was developed as a simple method to screen for hazardous and harmful patterns of alcohol [...]

Objective: The Alcohol Dependence Scale (ADS) yields continuous scores purported to reflect the severity of the dependence syndrome. We evaluated the concurrent validity of the ADS as a general measure of severity and the screening accuracy of the total score and subscales to detect Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), physiological dependence. Method: Treatment-seeking, alcohol-dependent individuals entering the Combining Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) Study (N = 1,372; 69% men) completed the ADS, diagnostic interviews, and other measures before randomization. Analyses of variance tested differences between ADS quartiles on alcohol-related measures. Areas under the receiver operating characteristic (AUROC) curve assessed screening accuracy for DSM-IV physiological dependence (tolerance or withdrawal) or withdrawal alone. Results: ADS quartiles differed on age, other demographics, and prior treatment episodes. Linear correlation showed moderate to large magnitude associations with alcohol-related self-report measures and most indices of consumption. ADS quartiles differed significantly on proportion with DSM-IV physiological dependence, but AUROC curves indicated that the ADS had limited accuracy as a continuous measure to detect DSMIV physiological dependence (AUROC = .75 [95% confidence interval {CI}: .70-.79] and .67 [95% CI: .60-.74] for men and women, respectively; p = .08) or withdrawal alone (AUROC = .77 [95% CI: .74-.80] and .74 [95% CI: .69-.79] for men and women, respectively; p = .30). Screening accuracy was comparably limited based on ADS subscales reflecting psychoperceptual or psychophysical withdrawal. Conclusions: The ADS reflected variation in symptom severity but did not adequately identify physiological dependence or withdrawal in treatment-seeking individuals with DSM-IV alcohol dependence. (J. Stud. Alcohol Drugs 68: 149-156, 2007), FOLLOWING THE RECOGNITION of alcoholism as a medical illness (Jellinek, 1952) and before the advent of Diagnostic and Statistical Manual (DSM-IV; American Psychiatric Association, 1994) criteria for alcohol dependence, researchers [...]

A study using a 129-item questionnaire concerning driving behavior, drinking habits and personal and family history submitted to 1,722 Washington State drivers who had had four or more bad driving experiences during 1986 and 1987, determined the risk factors that partially identify intoxicated drivers. This information will be helpful in screening potential drunk drivers and in accident prevention, but additional research is needed to identify more risk factors.

The emergence of validated and enhanced methods of alcoholism treatment necessitates dedicated and systematic efforts to include these new methods in the existing ones to monitor their success and make necessary changes if required. The challenges faced by researchers and practitioners in accomplishing this includes debunking myths, evaluation of the feasibility of making changes and effective communication between people involved in the research. Effective communication between the researchers and the providers is very essential to the success of a research study.

Treatment matching research is influenced by the heterogeneity of the patients and their responses to the various methods of treatment. The preservation of the integrity of treatment and the differentiation between the treatments is dependent on restrictions on study treatment. The Project MATCH, a national multisite study of matching clients to alcohol treatment, is used as a platform to analyze the various methods used to protect treatment integrity during the treatment of a heterogeneous sample of alcoholics. The issues focussed on include development of clinical care guidelines, selection criteria for therapists and strategies for treating a variety of alcoholics within a particular approach.

Several approaches for the treatment of alcohol abuse and dependence exist but it is impossible to include all the approaches in the research studies of treatment matching. The present study focuses on the various issues to be taken into consideration such as the methods of treatment, of therapy and treatment setting when framing a research study. The Project MATCH, a natural multisite study on matching clients to alcohol treatment, provides a platform for analyzing the methodological and practical issues raised and the approaches used in the treatment matching research.

An analysis of the problems involved in making decisions about the selection and recruitment of subjects for treatment matching research reveals that it is a complicated method which requires conceptual, methodological and practical considerations. The project MATCH, a multisite client-treatment matching trial, highlights the various issues involved in decision-making. The success of a multisite trial depends on the selection of proper recruitment strategies and eligibility criteria, contingency planning and effective implementation of the treatment methods.

A review of the methodological issues associated with client-treatment matching confirms the importance of matching in clinical practice relative to alcoholism. Matching individuals to alcoholism treatments improves the outcome of the treatment. The potential benefits of matching such as treatment resource optimization, increased cost and effectiveness and prevention of therapeutic mismatches are forcing clinicians and researchers to promote studies in this domain.

An experiment was carried out on a population sample of Vietnam war veterans to determine the effects of war-zone duty and combat related posttraumatic stress disorder (PTSD) on the severity of substance abuse difficulties. The subjects were categorized in two groups, one for veterans with actual combat experience and another for those without war-zone duty. The results indicate that veterans who served in the war zones experienced more severe drug and alcohol dependence problems than did veterans without PTSD.