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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2009.04.014 Byline: Jannette M. Parr (a), David J. Kavanagh (b), Ross McD. Young (b), Jason P. Connor (c) Keywords: Benzodiazepines; Expectancy; Factor analysis; Questionnaire; Self-efficacy; Self-report Abstract: This study aimed to develop and assess the reliability and validity of a pair of self-report questionnaires to measure self-efficacy and expectancy associated with benzodiazepine use, the Benzodiazepine Refusal Self-Efficacy Questionnaire (BRSEQ) and the Benzodiazepine Expectancy Questionnaire (BEQ). Internal structure of the questionnaires was established by principal component analysis (PCA) in a sample of 155 respondents, and verified by confirmatory factor analyses (CFA) in a second independent sample (n =139) using structural equation modeling. The PCA of the BRSEQ resulted in a 16-item, 4-factor scale, and the BEQ formed an 18-item, 2-factor scale. Both scales were internally reliable. CFA confirmed these internal structures and reduced the questionnaires to a 14-item self-efficacy scale and a 12-item expectancy scale. Lower self-efficacy and higher expectancy were moderately associated with higher scores on the SDS-B. The scales provide reliable measures for assessing benzodiazepine self-efficacy and expectancies. Future research will examine the utility of the scales in prospective prediction of benzodiazepine cessation. Author Affiliation: (a) The University of Queensland, School of Medicine, Australia (b) Institute of Health & Biomedical Innovation and School of Psychology & Counselling, Queensland University of Technology, Australia (c) The University of Queensland, Centre for Youth Substance Abuse Research, Australia

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2008.10.016 Byline: Fred Arne Thorberg (a)(b), Ross McD. Young (a), Karen A. Sullivan (a)(b), Michael Lyvers (c) Keywords: Alexithymia; Alcohol use disorder; Alcoholism; Affect regulation deficit; Critical review Abstract: All human beings experience emotion. However a number of individuals have difficulties recognising, processing and regulating their emotions. This set of emotional 'deficits' is classified as alexithymia. The prevalence rate of alexithymia in alcohol use disorders is between 45 and 67%. The objective of this paper is to review the published research on alexithymia and alcohol use, assess the methodological quality of this evidence, and draw the findings together to present a critical update on the relationship between alexithymia and alcohol use disorders. Yet, few research studies have comprehensively investigated alexithymia in alcohol use disorders, and a number of key issues still remain to be addressed in exploring the veracity of the link between alexithymia and alcohol use. For example, limited evidence exists regarding the association between alexithymia, alcohol consumption and severity of alcohol dependence. Furthermore, there is no current knowledge about the predictive utility of alexithymia in relation to more well researched and established psychological drinking constructs. Although alexithymia is often considered a risk factor for the development of alcohol use disorders, there is little evidence to support this notion. Given that alexithymia may have the potential to interfere with treatment outcomes, a better understanding of the role of alexithymia in alcohol use is needed. Author Affiliation: (a) Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia (b) School of Psychology and Counselling, Queensland University of Technology, Carseldine, Queensland 4034, Australia (c) Department of Psychology, Bond University, Gold Coast, Queensland 4229, Australia

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2006.07.001 Byline: Ross McD. Young (a), Penelope A. Hasking (b), Tian P.S. Oei (c), William Loveday (c) Keywords: Adolescent; Refusal selfaefficacy; Alcohol Abstract: Adolescent drinking is a significant issue yet valid psychometric tools designed for this group are scarce. The Drinking Refusal SelfaEfficacy Questionnaire -- Revised Adolescent Version (DRSEQaRA) is designed to assess an individual's belief in their ability to resist drinking alcohol. The original DRSEQaR consists of three factors reflecting social pressure refusal selfaefficacy, opportunistic refusal selfaefficacy and emotional relief refusal selfaefficacy. A large sample of 2020 adolescents aged between 12 and 19 years completed the DRSEQ and measures of alcohol consumption in small groups. Using confirmatory factor analysis, the three factor structure was confirmed. All three factors were negatively correlated with both frequency and volume of alcohol consumption. Drinkers reported lower drinking refusal selfaefficacy than nonadrinkers. Taken together, these results suggest that the adolescent version of the Drinking Refusal SelfaEfficacy Questionnaire (DRSEQaRA) is a reliable and valid measure of drinking refusal selfaefficacy. Author Affiliation: (a) Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD 4001, Australia (b) School of Psychology, Psychiatry & Psychological Medicine, Monash University, Caulfield East, VIC 3145, Australia (c) School of Psychology, University of Queensland, St. Lucia, QLD 4072, Australia

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2006.04.006 Byline: Jason P. Connor (a), Ross McD. Young (b), Bruce R. Lawford (c), John B. Saunders (d), Terry L. Ritchie (e), Ernest P. Noble (e) Keywords: DRD2 gene; Comorbidity; Alcohol and nicotine dependence Abstract: Cigarette smoking in those who are alcohol dependent is associated with higher morbidity and mortality. The A1 allele of the D.sub.2 dopamine receptor (DRD2) gene has been independently associated with alcohol and nicotine dependence. Whether this polymorphism is associated with nicotine dependence in those who are also alcohol dependent has not been investigated. Subjects were 84 (61 males; 23 females) Caucasian DSM IV diagnosed nicotine- and alcohol-dependent subjects sampled from consecutive admissions to a hospital alcohol detoxification ward. Data were obtained through standardised measures of nicotine and alcohol consumption and dependence severity. A1.sup.+ allelic (A1/A1 or A1/A2 genotype) compared to A1.sup.- allelic (A2/A2 genotype only) patients were characterised by higher levels of alcohol and cigarette consumption. A1.sup.+ allelic patients reported greater alcohol dependence severity, but not nicotine dependence severity. When the combined nicotine and alcohol dose was examined, A1.sup.+ allelic patients consumed significantly more of these drugs than their A1.sup.- allelic counterparts. Author Affiliation: (a) Department of Psychiatry, The University of Queensland, Princess Alexandra Hospital, Brisbane 4102, Australia (b) Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove Carseldine, Brisbane 4034, Australia (c) Hospital Alcohol and Drug Service, Royal Brisbane and Women's Hospital, Brisbane 4029, Australia (d) Department of Psychiatry, The University of Queensland, Royal Brisbane and Women's Hospital, Herston, Brisbane 4029, Australia (e) Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024-1759, USA

This article examines the relationship between alcohol consumption, relationship satisfaction, and expectation in women. Topics include intimacy, relational efficacy, and depression.

Background Posttraumatic stress disorder (PTSD) is associated with increased inflammation and comorbid medical conditions. However, study findings for individual inflammatory marker levels have been inconsistent. Some research suggests that resilience may play a role in decreased inflammation. A polymorphism in the promoter region of the tumor necrosis factor α gene ( TNFα ), TNFA −308 (rs1800629) is associated with psychiatric illness but its role in PTSD is yet to be elucidated. Objective This study investigates a key inflammatory marker, TNFα, for its role in PTSD severity. Method In a cohort of trauma-exposed Vietnam War veterans ( n = 299; 159 cases, 140 controls) TNF α serum levels and TNFα polymorphism rs1800629 were correlated with PTSD severity and resilience scores. Results The polymorphism was associated with PTSD severity ( p = 0.045). There were significant group differences between cases and controls with regards to serum TNFα levels ( p = 0.036). Significant correlations were found between PTSD severity and elevated TNFα levels ( r = 0.153; p = 0.009), and between resilience and decreased TNFα levels at a trend level ( p = 0.08) across the entire cohort. These relationships were non-significant after controlling for covariates. In the PTSD diagnostic group, a correlation of TNFα and PTSD severity was observed on a trend level ( p = 0.06), the relationship between TNFα and resilience remained non-significant. Conclusions To our knowledge, this is the first time rs1800629 has been investigated in PTSD contributing to a growing body of literature that identifies the GG as a risk genotype for psychiatric disorders in Caucasian cohorts. However, more research is needed to replicate our results in larger, equally well-characterized cohorts. The relationship between serum TNFα levels and PTSD severity and resilience requires further investigation. [ABSTRACT FROM AUTHOR]

Background Schizophrenia is a clinically heterogeneous disorder and may be explained by its complex genetic architecture. Many schizophrenia susceptibility genes were identified but the picture remains unclear due to inconsistent or contradictory genetic association studies. This confusion may, in part, be because symptoms result from the combined interaction of many genes and these interacting genes are associated with specific sub-phenotypes of schizophrenia rather than schizophrenia as a whole. This study investigates the relationship between schizophrenia susceptibility genes and schizophrenia sub-phenotypes by identifying multiple gene variant interactions. Materials and methods Fifty SNPs from 21 genes were genotyped in 235 Australian participants with schizophrenia screened for various phenotypes. Schizophrenia participants were grouped into relevant phenotype clusters using cluster analysis and normalized phenotype cluster scores were calculated for each patient. The relationship between genotypes and normalized phenotype cluster scores were analyzed by linear regression analysis. Results Three phenotype clusters were identified. There was some overlap in symptoms between phenotype clusters, particularly for depression. However, cluster 1 appears to be characterized by speech disorder and affective behavior symptoms, cluster 2 has predominantly hallucination symptoms and cluster 3 has mainly delusion symptoms. Interaction of five SNPs was found to have an effect on cluster 1 symptoms; ten SNPs on cluster 2 symptoms; and eight SNPs on cluster 3 symptoms. Conclusion The interaction of specific susceptibility genes is likely to lead to specific clinical sub-phenotypes of schizophrenia. Larger patient cohorts with more extensive clinical data will improve the detection of gene interactions and the resultant schizophrenia clinical phenotypes. [ABSTRACT FROM AUTHOR]

Abstract: Background: There are few valid clinical assessment instruments for cannabis. Self-efficacy, or the ability of users to resist temptation, is a central feature of social cognitive theory. This study outlines the development and validation of the Cannabis Refusal Self-Efficacy Questionnaire (CRSEQ), which measures the situational confidence to refuse cannabis. Method: One thousand two hundred and forty-six patients referred for cannabis assessment completed the CRSEQ including measures of cannabis consumption and dependence severity (Severity of Dependence Scale-Cannabis, SDS-C). The CRSEQ was subject to independent exploratory (n =621, mean age 26.88, 78.6% male) and confirmatory (n =625, mean age 27.51, 76.8% male) factor analysis. Results: Three factors: Emotional Relief, Opportunistic and Social Facilitation were identified. They provided a good statistical and conceptual fit for the data. Emotional Relief cannabis refusal self-efficacy was identified as most predictive of cannabis dependence, after controlling for cannabis consumption. Conclusions: The CRSEQ is recommended as a psychometrically sound and clinically useful measure for cannabis misuse treatment planning and assessment. [Copyright &y& Elsevier]

Abstract: Background: Up to fifty percent of alcohol dependent individuals have alexithymia, a personality trait characterised by difficulties identifying and describing feelings, a lack of imagination and an externalised cognitive style. Although studies have examined alexithymia in relation to alcohol dependence, no research exists on mechanisms underlying this relationship. The present study examined the mediational effect of alcohol expectancies on alexithymia and alcohol dependence. Methods: 230 outpatients completed the Toronto Alexithymia Scale (TAS-20), the Drinking Expectancy Questionnaire (DEQ) and the Alcohol Use Disorder Identification Test (AUDIT). Results: Regression analysis showed that alexithymia and alcohol dependence was, in two of three cases, partially mediated through alcohol expectancy. Conclusions: Alcohol expectancies of assertion and affective change show promise as mediators of alcohol dependence in individuals with alexithymia. [Copyright &y& Elsevier]

Abstract: Up to fifty per cent of individuals with Alcohol use disorders (AUD) also have alexithymia a personality construct hypothesized to be related to attachment difficulties. The relationship between alexithymia, craving, anxious attachment and alcohol-dependence severity was examined in 254 patients participating in a Cognitive-Behavioral Therapy (CBT) program for alcohol-dependence. Participants completed the Toronto Alexithymia Scale (TAS-20), the Obsessive Compulsive Drinking Scale (OCDS), the Revised Adult Attachment Anxiety Subscale (RAAS-Anxiety) and the Alcohol Use Disorder Identification Test (AUDIT). MANOVA indicated that individuals with alexithymia reported significantly higher levels of total OCDS, obsessive thoughts about alcohol, and compulsive drinking urges and behavior, compared to the non-alexithymic group. Regression analyses found that anxious attachment partially mediated the relationship between alexithymia and craving. Anxious attachment may be a potential treatment target to reduce alcohol consumption in those with alcohol-dependence and alexithymia. [Copyright &y& Elsevier]

Abstract: Background: The C allele of a common polymorphism of the serotonin 2A receptor (HTR2A) gene, T102C, results in reduced synthesis of 5-HT2A receptors and has been associated with current smoking status in adults. The -1438A/G polymorphism, located in the regulatory region of this gene, is in linkage disequilibrium with T102C, and the A allele is associated with increased promoter activity and with smoking in adult males. We investigated the contributions of the HTR2A gene, chronic psychological stress, and impulsivity to the prediction of cigarette smoking status and dependence in young adults. Methods: T102C and -1438A/G genotyping was conducted on 132 healthy Caucasian young adults (47 smokers) who completed self-report measures of chronic stress, depressive symptoms, impulsive personality and cigarette use. Results: A logistic regression analysis of current cigarette smoker user status, after adjusting for gender, depressive symptom severity and chronic stress, indicated that the T102C TT genotype relative to the CC genotype (OR=7.53), and lower punishment sensitivity (OR=0.91) were each significant predictive risk factors. However, for number of cigarettes smoked, only lower punishment sensitivity was a significant predictor (OR=0.81). Conclusions: These data indicate the importance of the T102C polymorphism to tobacco use but not number of cigarettes smoked for Caucasian young adults. Future studies should examine whether this is explained by effects of nicotine on the serotonin system. Lower punishment sensitivity increased risk of both smoking and of greater consumption, perhaps via a reduced sensitivity to cigarette health warnings and negative physiological effects. [Copyright &y& Elsevier]

Abstract: Alexithymia is characterised by deficits in emotional insight and self-reflection that impact on the efficacy of psychological treatments. Given the high prevalence of alexithymia in Alcohol Use Disorders, valid assessment tools are critical. The majority of research on the relationship between alexithymia and alcohol-dependence has employed the self-administered Toronto Alexithymia Scale (TAS-20). The Observer Alexithymia Scale (OAS) has also been recommended. The aim of the present study was to assess the validity and reliability of the OAS and the TAS-20 in an alcohol-dependent sample. Two hundred and ten alcohol-dependent participants in an outpatient Cognitive Behavioral Treatment program were administered the TAS-20 at assessment and upon treatment completion at 12weeks. Clinical psychologists provided observer assessment data for a subsample of 159 patients. The findings confirmed acceptable internal consistency, test–retest reliability and scale homogeneity for both the OAS and TAS-20, except for the low internal consistency of the TAS-20 EOT scale. The TAS-20 was more strongly associated with alcohol problems than the OAS. [Copyright &y& Elsevier]

Abstract: Psychological risk and genetic risk for alcohol dependence are rarely examined in concert. The current study used path analysis (via structural equation modelling) to explore the relationship between the A1 allele of the D2 dopamine receptor DRD2 gene region, age of problem drinking onset, alcohol expectancy and drinking refusal self-efficacy towards alcohol consumption and dependence severity. One hundred and forty-three (93 male, 50 female) alcohol dependent inpatients provided an extensive clinical history, including age of onset of problem drinking and quantity and frequency of alcohol consumption. The Drinking Expectancy Profile and the Alcohol Dependence Scale were completed, and 10 milliliters of blood were obtained for genetic analysis. The results showed that the posited model fitted the data set well and support the pattern of direct (allele status to drinking) and indirect (allele status influenced by psychosocial variables) relationships hypothesised for the model. A formal test of mediation showed some support for a psychosocial mediational model. The results are discussed in terms of a possible developmental trajectory that involves both genetic risk that influences brain dopamine activity and reinforcement expectancies that both operate via diminished drinking refusal self-efficacy. The prevention and treatment possibilities that arise from understanding this trajectory are examined. [Copyright &y& Elsevier]

Abstract: Adolescent drinking is a significant issue yet valid psychometric tools designed for this group are scarce. The Drinking Refusal Self‐Efficacy Questionnaire—Revised Adolescent Version (DRSEQ‐RA) is designed to assess an individual''s belief in their ability to resist drinking alcohol. The original DRSEQ‐R consists of three factors reflecting social pressure refusal self‐efficacy, opportunistic refusal self‐efficacy and emotional relief refusal self‐efficacy. A large sample of 2020 adolescents aged between 12 and 19 years completed the DRSEQ and measures of alcohol consumption in small groups. Using confirmatory factor analysis, the three factor structure was confirmed. All three factors were negatively correlated with both frequency and volume of alcohol consumption. Drinkers reported lower drinking refusal self‐efficacy than non‐drinkers. Taken together, these results suggest that the adolescent version of the Drinking Refusal Self‐Efficacy Questionnaire (DRSEQ‐RA) is a reliable and valid measure of drinking refusal self‐efficacy. [Copyright &y& Elsevier]

Molecular genetic research has identified promising markers of alcohol dependence, including alleles of the D2 dopamine receptor (DRD2) and the GABAA receptor β3 subunit (GABRB3) genes. Whether such genetic risk manifests itself in stronger alcohol-related outcome expectancies, or in difficulty resisting alcohol, is unknown. In the present study, A1+ (A1A1 and A1A2 genotypes) and A1- (A2A2 genotype) alleles of the DRD2 and G1+ (G1G1 and G1 non-G1 genotypes) and G1- (non-G1 non-G1 genotype) alleles of the GABRB3 gene were determined in a group of 56 medically ill patients diagnosed with alcohol dependence. Mood-related alcohol expectancy (AE) and drinking refusal self-efficacy (DRSE) were assessed using the Drinking Expectancy Profile (Manual for the Drinking Expectancy Profile, Behaviour Research and Therapy Centre, Brisbane, 1996). Patients with the DRD2 A1+ allele, compared with those with the DRD2 A1- allele, reported significantly lower DRSE in situations of social pressure. Similarly, lower DRSE was reported under social pressure by patients with the GABRB3 G1+ allele when compared to those with the GABRB3 G1- alleles. Patients with the GABRB3 G1+ allele also revealed reduced DRSE in situations characterized by negative affect than those with the GABRB3 G1- alleles. Patients carrying the GABRB3 G1+ allele showed stronger AE relating to negative affective change (for example, increased depression) than their GABRB3 G1- counterparts. Biological influence in the development of some classes of cognitions is hypothesized. The clinical implications, particularly with regard to patient-treatment matching and the development of an integrated psychological and pharmacogenetic approach, are discussed. [Copyright &y& Elsevier]

Abstract: Confirmatory factor analyses were conducted to evaluate the factorial validity of the Toronto Alexithymia Scale in an alcohol-dependent sample. Several factor models were examined, but all models were rejected given their poor fit. A revision of the TAS-20 in alcohol-dependent populations may be needed. [ABSTRACT FROM AUTHOR]

Emotional and role functioning difficulties are associated with chronic alcohol use and liver disease. Little is known about prospective changes in psychological and psychosocial functioning following orthotopic liver transplantation (OLT) amongst patients with alcoholic liver disease (ALD). We aimed to assess the functioning of this patient group post liver transplantation. Comprehensive psychosocial assessment of depression (Beck Depression Inventory [BDI]), anxiety (State-Trait Anxiety Inventory—Form X [STAI]) and psychosocial adjustment (Psychosocial Adjustment to Illness Scale—Self-Report version [PAIS-SR]) was conducted with 42 ALD patients available for pre and post OLT testing. Dependence severity was assessed by the Brief Michigan Alcoholism Screening Test (bMAST). Significant reductions in average anxiety and depression symptoms were observed 12-months post-OLT. Significant improvements in psychosocial adjustment to illness were also reported. Patients with higher levels of alcohol dependence severity pre transplant assessment improved comparably to those with lower levels of dependence. In summary, the study found that OLT contributed to reducing overall levels of mood and anxiety symptoms in ALD patients, approximating general (non-clinical) population norms. Psychosocial adjustment also improved significantly post liver transplantation. [ABSTRACT FROM AUTHOR]

Abstract: Background: Previous research has suggested an increased risk for individuals with phenylketonuria (PKU) of developing depression and other mood disorders. As PKU can disrupt neurotransmitter synthesis via biochemical mechanisms, depressive symptoms are hypothesised to result from neurotransmitter dysregulation. Whilst adherence (or return) to the phenylalanine-restricted diet may resolve or improve symptoms of depression, data to demonstrate a direct relationship between biochemistry and mood in this population are lacking. Methods: Thirteen adolescents with early and continuously treated PKU and eight sibling controls were compared in their total reported depressive symptoms. A general executive function assessment was also undertaken in the PKU group. Correlations between depressive symptoms and biochemical markers were examined within the PKU group only. Results: Correlational analyses within the PKU group demonstrated strong and significant associations between depressive symptoms and long term exposure to either a high phenylalanine:tyrosine ratio, or low tyrosine. Increasing symptoms of depression were also found to be associated with poorer executive function in the PKU sample. However, both groups of adolescents scored within the normal range in symptoms of depression (p >0.05). Conclusions: Significant associations were observed between biochemical markers indicating poorer dietary control and increasing depressive symptoms in a sample of adolescents with early and continuously treated PKU, although symptoms of depression remained within the normal range. An association between depressive symptoms and poorer EF was also demonstrated. Further research is needed to establish whether the depressive symptoms observed in this young population represent an emerging (subclinical) risk for major depressive disorder as they age. [Copyright &y& Elsevier]

Abstract: Objective: Alcohol-related implicit (preconscious) cognitive processes are established and unique predictors of alcohol use, but most research in this area has focused on alcohol-related implicit cognition and anxiety. This study extends this work into the area of depressed mood by testing a cognitive model that combines traditional explicit (conscious and considered) beliefs, implicit alcohol-related memory associations (AMAs), and self-reported drinking behavior. Method: Using a sample of 106 university students, depressed mood was manipulated using a musical mood induction procedure immediately prior to completion of implicit then explicit alcohol-related cognition measures. A bootstrapped two-group (weak/strong expectancies of negative affect and tension reduction) structural equation model was used to examine how mood changes and alcohol-related memory associations varied across groups. Results: Expectancies of negative affect moderated the association of depressed mood and AMAs, but there was no such association for tension reduction expectancy. Conclusion: Subtle mood changes may unconsciously trigger alcohol-related memories in vulnerable individuals. Results have implications for addressing subtle fluctuations in depressed mood among young adults at risk of alcohol problems. [ABSTRACT FROM AUTHOR]

Abstract: This naturalistic study investigated the mechanisms of change in measures of negative thinking and in 24-h urinary metabolites of noradrenaline (norepinephrine), dopamine and serotonin in a sample of 43 depressed hospital patients attending an eight-session group cognitive behavior therapy program. Most participants (91%) were taking antidepressant medication throughout the therapy period according to their treating Psychiatrists'' prescriptions. The sample was divided into outcome categories (19 Responders and 24 Non-responders) on the basis of a clinically reliable change index [Jacobson, N.S., & Truax, P., 1991. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.] applied to the Beck Depression Inventory scores at the end of the therapy. Results of repeated measures analysis of variance [ANOVA] analyses of variance indicated that all measures of negative thinking improved significantly during therapy, and significantly more so in the Responders as expected. The treatment had a significant impact on urinary adrenaline and metadrenaline excretion however, these changes occurred in both Responders and Non-responders. Acute treatment did not significantly influence the six other monoamine metabolites. In summary, changes in urinary monoamine levels during combined treatment for depression were not associated with self-reported changes in mood symptoms. [Copyright &y& Elsevier]

Abstract: Objective: There is currently little research examining what individuals who are at risk of a stroke want from an invention program. In order to increase the usefulness of such programs, qualitative research methods were used explore invention design issues such as factors affecting accessibility of programs and preferred health information sources. Methods: Thirty people, each with at least one stroke risk factor, participated in one of eight focus groups. Results: Broad support was indicated for our proposed intervention. Participants perceived the value and likely success of such a program enhanced if it: (a) was integrated with, and supported by, other respected health services; (b) included social components (particularly important to women); (c) produced long-term benefits; and (d) included information that was personally relevant and practical in terms of implementing change. Three reasons emerged for continuing stroke education campaigns as a component of intervention programs; these were: (a) a lack of awareness among some participants of gaps in their stroke knowledge; (b) participants’ explicit requests for specific rather than general information; and (c) the apparent failure of some participants to self-identify as at risk. Conclusion: This study yielded a number of important design considerations that should be taken into account when developing stroke intervention programs. Practice implications: We discuss ways of maximising the personal relevance of stroke prevention information along theoretically important dimensions, and consumers’ recommendations for the design and delivery of stroke intervention programs. [Copyright &y& Elsevier]

Abstract: Background: Factors associated with cannabis use among people with psychosis are not well understood. Aims: To examine whether people with psychosis and age-matched controls modified cannabis use in response to recent experiences. Method: This study predicted 4 weeks of cannabis use prospectively, using expectancies derived from recent occasions of use. Results: People with psychosis used cannabis less frequently than controls, but had more cannabis-related problems. More negative cannabis expectancies resulted in less frequent cannabis use over Follow-up. The psychosis group was more likely to moderate cannabis use after negative effects than controls. Conclusions: Results offer optimism about abilities of people with psychosis to moderate cannabis use in the short term. [Copyright &y& Elsevier]

Abstract: The allied psychological drinking constructs of alcohol expectancy and drinking restraint have shown considerable promise, both independently and in combination, in understanding problematic drinking. However, previous research examining the relationship between these two constructs has only occurred in pre-dependent, convenience samples. This study examined the role of both alcohol expectancies and drinking restraint in an alcohol dependent sample. 143 DSM-IV alcohol dependent participants (93 males, 50 females) completed measures of drinking restraint (Temptation and Restraint Inventory, TRI) and alcohol expectancy (Drinking Expectancy Profile, DEP), along with quantity and frequency of consumption and dependence severity (Alcohol Dependence Scale, ADS). The results showed that although alcohol expectancy and drinking restraint do share common underlying properties, there was unique variance attributed to the prediction of dependence severity and consumption. The results also failed to replicate the drinking restraint model observed in non-clinical samples. It was concluded that alcohol expectancy and drinking restraint models appear to show superior utility in pre-dependent populations. The implications of these findings in refining social cognitive models of alcohol misuse are discussed, with a particular focus on prevention. [Copyright &y& Elsevier]

Abstract: Effectively assisting benzodiazepine users to cease use requires a greater understanding of general practitioners’ (GPs) and benzodiazepine users’ views on using and ceasing benzodiazepines. This paper reports the findings from a qualitative study that examined the views of 28 GPs and 23 benzodiazepine users (BUs) in Cairns, Australia. A semi-structured interview was conducted with all participants and the information gained was analysed using the Consensual Qualitative Research Approach, which allowed comparisons to be made between the views of the two groups of interviewees. There was commonality between GPs and BUs on reasons for commencing benzodiazepines, the role of dependence in continued use, and the importance of lifestyle change in its cessation. However, several differences emerged regarding commencement of use and processes of cessation. In particular, users felt there was greater need for GPs to routinely advise patients about non-pharmacological management of their problems and potential adverse consequences of long-term use before commencing benzodiazepines. Cessation could be discussed with all patients who use benzodiazepines for longer than 3 months, strategies offered to assist in management of withdrawal and anxiety, and referral to other health service providers for additional support. Lifestyle change could receive greater focus at all stages of treatment. [Copyright &y& Elsevier]

Abstract: Consistent relationships have been demonstrated between problem drinking and certain personality characteristics. A contemporary cognitive model of alcohol misuse, drinking restraint, has recently shown promise in furthering our understanding of problematic drinking. This study examined the potential association between drinking restraint and personality characteristics in 168 alcohol dependent inpatients. Subjects completed the short-scale Revised Eysenck Personality Scales (EPS-R; Eysenck, Eysenck, & Barrett, 1985), Temptation and Restraint Inventory (TRI; Collins & Lapp, 1992), Alcohol Dependence Scale (ADS; Skinner & Allen, 1982) and drinking measures including quantity, frequency and weekly drinking total. Results indicated that although there was some conceptual overlap between drinking restraint and personality factors, the TRI had a unique relationship with indices of problem drinking once personality factors were taken into account. This indicates that restrained drinking and personality, although related, are discrete constructs. While restrained drinking may aid in the understanding of current drinking behavior, personality characteristics appear to contribute to the etiology and maintenance of drinking problems. [Copyright &y& Elsevier]

Abstract: The drinking refusal self-efficacy questionnaire (DRSEQ: Young, R.M., Oei, T.P.S., 1996. Drinking expectancy profile: test manual. Behaviour Research and Therapy Centre, University of Queensland, Australia; Young, R.M., Oei, T.P.S., Crook, G.M., 1991. Development of a drinking refusal self-efficacy questionnaire. J. Psychopathol. Behav. Assess., 13, 1–15) assesses a person''s belief in their ability to resist alcohol. The DRSEQ is a sound psychometric instrument based on exploratory factor analyses, but has not been subjected to confirmatory factor analysis. In total 2773 participants were used to confirm the factor structure of the DRSEQ. Initial analyses revealed that the original structure was not confirmed in the current study. Subsequent analyses resulted in a revised factor structure (DRSEQ-R) being confirmed in community, student and clinical samples. The DRSEQ-R was also found to have good construct and concurrent validity. The factor structure of the DRSEQ-R is more stable than the original structure of the DRSEQ and the revised scale has considerable potential in future alcohol-related research. [Copyright &y& Elsevier]

Cloninger''s psychobiological model of personality as applied to substance misuse has received mixed support. Contrary to the model, recent data suggest that a combination of high novelty seeking (NS) and high harm avoidance (HA) represents a significant risk for the development of severe substance misuse. A genetic polymorphism previously implicated in severe substance dependence, the Al allele of the D2 dopamine receptor (DRD2) gene, was examined in relation to NS and HA amongst 203 adolescent boys. Specifically, we hypothesized that subjects with the Al+ allele (Al/Al and A1/A2 genotypes) would report stronger NS and would exhibit a more positive relationship between NS and HA than those with the A1− allele (A2/A2 genotypes). These predictions were supported. The correlation between NS and HA in 81 A1+ allelic boys (r=0.27, P=0.02), and that in the 122 Al− allelic boys (r=−0.15, P=0.09), indicated that this relationship differed according to allelic status (F=8.52, P<0.004). Among those with the A1− allele, the present results are consistent with the traditional view that novelty seeking provides positive reinforcement, or the fulfillment of appetitive drives. In contrast, novelty seeking in those with the A1+ allele appears to include a negative reinforcement or self-medicating function. [Copyright &y& Elsevier]

Adolescent alcohol use can result in adverse health and social outcomes, including elevated risk of future substance use disorders. Insecure attachment and heavy peer use are both linked to early problematic drinking, but the precise relationship between these variables is poorly understood. Further, mixed findings in prior literature highlight the importance of distinguishing between both dimensions of insecure attachment – anxiety and avoidance. This laboratory-based study investigated whether peer use moderates the association between attachment and laboratory alcohol consumption in a sample of 120 adolescents of legal drinking age (18–21 years). The relationship between attachment and self-reported alcohol use was also investigated. It was hypothesized that both dimensions of insecure attachment would predict greater self-report and laboratory alcohol use, and that the presence of a heavy drinking peer would strengthen this relationship. Results indicated that attachment anxiety, but not avoidance, predicted self-report and laboratory alcohol use. Peer drinking did not moderate this effect. Findings emphasize the importance of investigating both attachment anxiety and avoidance, and suggest that future research should focus on mediating mechanisms between attachment anxiety and alcohol use. • Insecure attachment dimensions have been implicated in alcohol use. • Peer drinking is a robust predictor of alcohol use. • We examined interactions of these predictors in an adolescent sample. • Attachment anxiety predicted self-reported and actual alcohol use. • Peer drinking did not moderate this effect. [ABSTRACT FROM AUTHOR]

In this study we investigated genome-wide sperm DNA methylation patterns in trauma-exposed Vietnam veterans. At the genome-wide level, we identified 3 CpG sites associated with PTSD in sperm including two intergenic and one CpG within the CCDC88C gene. Of those associated with PTSD in sperm at a nominal level, 1868 CpGs were also associated with PTSD in peripheral blood (5.6% overlap) including the RORA, CRHR1 and DOCK2 genes that have been previously implicated in PTSD. A total of 10 CpG sites were significantly associated with a reported history of a diagnosed mental health condition in children and reached genome-wide significance. CpGs associated with a history of a reported mental health condition in children were also enriched (90% of tested genes) for genes previously reported to be resistant to demethylation, making them strong candidates for transgenerational inheritance. In conclusion, our findings identify a unique sperm-specific DNA methylation pattern that is associated with PTSD. [ABSTRACT FROM AUTHOR]

Abstract Brain-derived neurotrophic factor (BDNF) gene is associated with increased risk of posttraumatic stress disorder (PTSD) and plays a role in neuroplasticity, cognition and memory. BDNF has strong potential as a therapeutic target as studies have shown that antidepressants, electroconvulsive treatment and exercise modulate BDNF expression and methylation. In this study we examined the role of BDNF methylation and expression in PTSD and the implications of exercise in mediating these effects. BDNF DNA methylation and gene expression analysis was performed in a sample of 96 male Vietnam veterans. Cases were combat-exposed veterans with current PTSD (n = 48) and controls were combat exposed veterans with no past or current PTSD diagnosis (n = 48). No association between BDNF mRNA and PTSD was identified. PTSD was associated with decreased methylation at three BDNF CpG sites (cg01546433 P = 0.004835; cg24650785 P = 0.000259 and cg002298481 P = 0.000672). Differential BDNF methylation was associated with exercise, with active exercise associated with lower methylation levels at three CpG sites (cg04481212 P = 0.005; cg01546433 P = 0.025 and cg00298481 P = 0.035). Given that exercise mediates BDNF action on cognitive plasticity, exercise may be a non-invasive, drug free option in the treatment of PTSD. Highlights • Three BDNF CpGs associated with PTSD in combat exposed Vietnam veterans. • Differential BDNF methylation associated with exercise. • No association between BDNF mRNA and PTSD [ABSTRACT FROM AUTHOR]

Background and Objectives: Clinical staff providing addiction treatment predict patient outcome poorly. Prognoses based on linear statistics are rarely replicated. Addiction is a complex non-linear behavior. Incorporating non-linear models, Machine Learning (ML) has successfully predicted treatment outcome when applied in other areas of medicine. Using identical assessment data across the two groups, this study compares the accuracy of ML models versus clinical staff to predict alcohol dependence treatment outcome in behavior therapy using patient data only.Methods: Machine learning models (n = 28) were constructed ('trained') using demographic and psychometric assessment data from 780 previously treated patients who had undertaken a 12 week, abstinence-based Cognitive Behavioral Therapy program for alcohol dependence. Independent predictions applying assessment data for an additional 50 consecutive patients were obtained from 10 experienced addiction therapists and the 28 trained ML models. The predictive accuracy of the ML models and the addiction therapists was then compared with further investigation of the 10 best models selected by cross-validated accuracy on the training-set. Variables selected as important for prediction by staff and the most accurate ML model were examined.Results: The most accurate ML model (Fuzzy Unordered Rule Induction Algorithm, 74%) was significantly more accurate than the four least accurate clinical staff (51%-40%). However, the robustness of this finding may be limited by the moderate area under the receiver operator curve (AUC = 0.49). There was no significant difference in mean aggregate predictive accuracy between 10 clinical staff (56.1%) and the 28 best models (58.57%). Addiction therapists favoured demographic and consumption variables compared with the ML model using more questionnaire subscales.Conclusions: The majority of staff and ML models were not more accurate than suggested by chance. However, the best performing prediction models may provide useful adjunctive information to standard clinically available prognostic data to more effectively target treatment approaches in clinical settings. [ABSTRACT FROM AUTHOR]

Background: This study aimed to develop and validate a shortened version of the Drinking Refusal Self-Efficacy Questionnaire-Revised Adolescent version (DRSEQ-RA) using a large sample of adolescents.Methods: Secondary school students (N = 2609, M = 14.52 years, SD = 0.94) completed the DRSEQ-RA (consisting of subscales: Social Pressure; Opportunistic; Emotional Relief) and the Alcohol Use Disorders Identification Test (AUDIT). These data were analysed using non-parametric item response theory (NIRT) including Mokken scalability coefficients, and confirmatory factor analysis.Results: Social Pressure subscale items were better able to distinguish between adolescents with lower or higher levels of drinking refusal self-efficacy, while the Opportunistic and Emotional Relief subscale items were able to distinguish adolescents with low drinking-refusal self-efficacy. The DRSEQ-RA was reduced from 19-items to a 9-item scale and retained the original three-factor structure. The reduced scale was named the Drinking Refusal Self-Efficacy Questionnaire-Shortened Revised Adolescent version (DRSEQ-SRA). The DRSEQ-RA and the DRSEQ-SRA have almost identical psychometric properties. They both demonstrated good fit to the data, each explained 18% of the variance in alcohol consumption, Adj. R2 = 0.18, p < .001 respectively. The DRSEQ-RA and the DRSEQ-SRA also have excellent scale and subscale internal reliability (αs = 0.92-0.99).Conclusions: The DRSEQ-SRA is a short, 9-item, measure of adolescent drinking-refusal self-efficacy which demonstrates both reliability and validity. A significant advantage is brevity. The DRSEQ-SRA may be a valuable tool for identifying risk of adolescent drinking and prevention/treatment planning in settings where survey administration time is critical. [ABSTRACT FROM AUTHOR]

Background and Aims: Modification of elevated positive expectations of alcohol consumption (alcohol outcome expectancies; AOEs) is a key feature of Cognitive Behaviour Therapy (CBT) approaches to Alcohol Use Disorders (AUDs). Despite extensive research supporting the efficacy of CBT for AUD, few studies have examined AOE change. This study aimed to assess AOE change following completion of CBT for AUD and its association with drinking behaviour.Method: One-hundred and seventy-five patients who completed a 12-week CBT program for AUD were administered the Drinking Expectancy Questionnaire (DEQ) at pre-treatment assessment and upon completion of treatment. Abstinence was achieved by 108 (61.7%) of completing patients. For patients who lapsed, the mean proportion of abstinent days was 93%.Results: DEQ scales assessing expectations of positive alcohol effects on tension reduction, assertiveness, and cognitive enhancement were significantly lower post-treatment (p<0.001). Expectations of negative effects on mood were higher post-treatment (p<0.001). The largest AOE change occurred on the tension reduction scale. Greater percentage of abstinent days over treatment was associated with lower pre-and post-treatment tension reduction expectancy scores (p<0.05). Drinking during treatment was associated with smaller changes in expectations of negative effects of alcohol on mood (p<0.05).Conclusions: Individuals who completed CBT treatment for AUD showed significant AOE change. Tension reduction and affective change expectancies may be particularly important for abstinence and useful markers of lapse risk. [ABSTRACT FROM AUTHOR]

Impulsivity is a core characteristic of externalizing problems and a robust predictor of alcohol use in adolescence. There is little evidence on the causal mechanisms through which impulsivity influences drinking or how they are affected by key social factors (peer influence). This study reports the development of the first comprehensive laboratory model of adolescent impulsivity and alcohol use. One-hundred and twenty adolescents (50% female) of legal drinking age ( M = 19.47 years, SD = 1.12) in Australia (18+ years) were subjected to 1 of 3 experimental manipulations to increase impulsive behavior (reward cue exposure, negative mood induction, ego depletion). Changes in disinhibition (stop-signal task) and reward-seeking (BAS-Fun Seeking) were measured before completing a laboratory drinking task alone or with a heavy-drinking confederate. Reward cue exposure increased alcohol consumption, with the effect mediated by increased reward-seeking. Negative mood induction increased disinhibition, but not drinking. The presence of a heavy-drinking peer directly increased alcohol consumption in an additive fashion. Findings provide causal evidence that extends survey-based research by highlighting the role of reward-related impulsivity in adolescent alcohol use. The new laboratory model can provide novel insights into the psychological processes underlying adolescent impulsivity and impulsivity-related drinking. [ABSTRACT FROM AUTHOR]

The nitric oxide pathway in the hippocampus is involved in the biological stress response with detrimental consequences to cells and HPA axis feedback. Hippocampal atrophy and HPA axis feedback dysfunction are associated with posttraumatic stress disorder (PTSD). This study systematically investigates two genes of the nitric oxide pathway NOS1AP and NOS1 for a potential involvement in PTSD, comorbidities and resilience. A cohort of age and gender matched Vietnam veterans including trauma-exposed cases and controls was recruited and comprehensively assessed ( n = 299). A total of 49 NOS1AP and 16 NOS1 polymorphisms were analysed and genotypes correlated with gold standard clinical measures to assess PTSD severity and related phenotypes (depression, anxiety, stress, resilience) based on diagnostic status. Multiple NOS1AP polymorphisms were associated across all measures, and NOS1 polymorphisms were associated with PTSD severity, stress and resilience. The GG genotype of NOS1 polymorphism rs10744891 was associated with PTSD severity (surviving multiple correction) while the combined TT-TG genotypes were associated with resilience ( p = 0.005; p = 0.033, respectively). This study indicates that NOS1AP and NOS1 from the nitric oxide pathway are likely to play a key role in PTSD, its comorbidities and resilience. Given the essential role of NOS1AP and NOS1 in stress response they may be reliable targets for screening and intervention strategies. [ABSTRACT FROM AUTHOR]

Impulsivity predicts alcohol misuse and risk for alcohol use disorder. Cognition mediates much of this association. Genes also account for a large amount of variance in alcohol misuse, with dopamine and serotonin receptor genes of particular interest, because of their role in motivated behavior. The precise psychological mechanisms through which such genes confer risk is unclear. Trait impulsivity conveys risk for alcohol misuse by influencing two distinct domains of cognition: beliefs about the reinforcing effects of alcohol consumption (positive alcohol expectancy) and the perceived ability to resist it (drinking refusal self-efficacy). This study investigated the effect of the dopamine-related polymorphism in the DRD2/ANKK1 gene (rs1800497) and a serotonin-related polymorphism in the HTR2A gene (rs6313) on associations between impulsivity, cognition, and alcohol misuse in 120 emerging adults (18-21years). HTR2A predicted lower positive alcohol expectancy, higher refusal self-efficacy, and lower alcohol misuse. However, neither polymorphism moderated the linkages between impulsivity, cognition, and alcohol misuse. This is the first report of an association between HTR2A and alcohol-related cognition. Theoretically-driven biopsychosocial models have potential to elucidate the specific cognitive mechanisms through which distal risk factors like genes and temperament affect alcohol misuse in emerging adulthood. [ABSTRACT FROM AUTHOR]

This study investigates the rates of primary psychotic disorders (PPD) and substance-induced psychotic disorders (SIPDs) in methamphetamine (MA) users accessing needle and syringe programs (NSPs). The aim was to determine if there are systematic differences in the characteristics of MA users with PPDs and SIPDs compared to those with no psychotic disorder. Participants were 198 MA users reporting use in the previous month. Diagnosis was determined using the Psychiatric Research Interview for DSM-IV Substance and Mental Disorders (PRISM-IV). Current psychiatric symptoms and substance use were also measured. Just over half ( n =101) of participants met DSM-IV criteria for a lifetime psychotic disorder, including 81 (80%) with a SIPD and 20 (20%) with a PPD. Those with a younger age of onset of weekly MA use were at increased risk of a lifetime SIPD. A current psychotic disorder was found in 62 (39%), comprising 49 SIPDs (79%) and 13 PPDs (21%). MA users with a current PPD were more likely to have received psychiatric treatment in the past month than those with a current SIPD, despite a similar level of psychotic symptom severity. A high proportion of MA users accessing NSPs have psychotic disorders, the majority of which are substance-induced. [ABSTRACT FROM AUTHOR]

Highlights: [•] We investigated whether schizotypy can be considered within a dimensional framework. [•] The participants were injecting amphetamine users. [•] This population have elevated rates of subclinical psychotic symptoms. [•] Brief Psychiatric Rating Scale and O-LIFE was used. [•] A dimensional four-factor model was obtained. [ABSTRACT FROM AUTHOR]

Abstract: Despite considerable research activity and application in treatment, the construct of craving remains poorly understood. We propose that cravings and urges are cognitive–emotional events in time, characterised by frequency, duration, intensity and salience. Commonly used measures of alcohol craving are reviewed, and their strengths and weaknesses identified. Most measures confound craving with behaviours, or with separable cognitive phenomena such as expectancies, intentions, or perceived behavioural control. These confounds have limited our advances in understanding the determinants and consequences of craving. Based on the criteria applied in this review, among the better performing multi-item measures are the Penn Alcohol Craving Scale and Obsessive subscale of the Obsessive–Compulsive Drinking Scale. Optimal assessment strategies are likely to involve daily assessments of peak intensity of cravings, desires or urges and of the frequency and duration of craving episodes. Of particular interest are measures of intensity at times when individuals are at risk of drinking or of other functional impacts from craving. [Copyright &y& Elsevier]

Abstract: Despite considerable recent interest in the issue of comorbid substance use disorders in people with serious mental illness, there remains a need to refine approaches to screening. This paper describes the development and testing of a new screen for substance-related comorbidity, the 12-item DrugCheck Problem List (PL). Exploratory factor analysis with inpatient samples suggested a single-factor structure, although confirmatory factor analysis in a further sample found similar fit from a two-factor model. Sensitivity and specificity in detecting DSM-IV substance use disorders were both high and comparable to performances of the Severity of Dependence Scale and Alcohol Use Disorders Identification Test (Australian version). The list of problem areas provided by the PL has utility in driving further assessment and treatment planning, and offers suggested foci for motivational interviewing. While further testing is indicated, these data provide strong initial support for its use. [Copyright &y& Elsevier]