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Objective: Depressive and anxiety symptoms co-occur with hazardous drinking among Latinxs. This secondary analysis of a clinical trial to reduce hazardous drinking (motivational interviewing adapted to address social stressors [CAMI] vs. motivational interviewing [MI]) examined effects on anxiety/depressive symptoms. Discrimination and acculturation were examined as moderators., Methods: Latinx (n = 296) hazardous drinkers (2+ occasions/month of heavy drinking; 4/5 drinks/occasion, females/males) were randomized to CAMI/MI. Generalized estimating equations analyzed how treatment conditions and interactions were related to depressive and anxiety symptoms after controlling for covariates., Results: Baseline symptoms (anxiety, depression) exceeded clinical thresholds (Anxiety ≥8, M = 14.62, SD = 13.52; Depression ≥ 12, M = 18.78, SD = 12.57). Cultural adaptation of motivational interviewing (CAMI) showed significantly lower anxiety and depressive symptoms (6/12 months, respectively) than MI. CAMI with high baseline discrimination reported significantly less depression than MI (12 months)., Conclusions: Explicitly addressing social stressors may be a beneficial adjunct to treatment for Latinx drinkers., (© 2020 Wiley Periodicals LLC.)

Background: The NIH Strategic Plan prioritizes health disparities research for socially disadvantaged Hispanics, to reduce the disproportionate burden of alcohol-related negative consequences compared to other racial/ethnic groups. Cultural adaptation of evidence-based treatments, such as motivational interviewing (MI), can improve access and response to alcohol treatment. However, the lack of rigorous clinical trials designed to test the efficacy and theoretical underpinnings of cultural adaptation has made proof of concept difficult., Objective: The CAMI2 (Culturally Adapted Motivational Interviewing) study design and its theoretical model, is described to illustrate how MI adapted to social and cultural factors (CAMI) can be discriminated against non-adapted MI., Methods and Design: CAMI2, a large, 12month randomized prospective trial, examines the efficacy of CAMI and MI among heavy drinking Hispanics recruited from the community (n=257). Outcomes are reductions in heavy drinking days (Time Line Follow-Back) and negative consequences of drinking among Hispanics (Drinkers Inventory of Consequences). A second aim examines perceived acculturation stress as a moderator of treatment outcomes in the CAMI condition., Summary: The CAMI2 study design protocol is presented and the theory of adaptation is presented. Findings from the trial described may yield important recommendations on the science of cultural adaptation and improve MI dissemination to Hispanics with alcohol risk., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: The current study examined whether the presence of the G allele of the A118G polymorphism of the OPRM1 gene (rs1799971) and the long allele of exon 3 VNTR polymorphism of the DRD4 gene moderate the effect of alcohol administration on urge to smoke. These polymorphisms have been associated with greater alcohol induced-urge to drink. Urge to drink and alcohol consumption increase urge to smoke. Therefore, these polymorphisms may also sensitize urge to smoke after alcohol consumption., Methods: Individuals smoking 10-30 cigarettes per day and reporting heavy drinking were recruited from the community. Caucasians (n = 62), 57.3% male, mean age 39.2, took part in a three-session, within-subjects, repeated-measures design study. Participants were administered a placebo, 0.4 g/kg, or 0.8 g/kg dose of alcohol. A118G genotype, exon 3 VNTR genotype, and urge to smoke (baseline and three times after receiving alcohol) were assessed., Results: G allele carriers showed greater urge to smoke across all assessments. Additionally, a significant interaction indicated that G carriers, compared to homozygotes (AA), evinced a significantly greater increase in urge to smoke after high dose alcohol relative to placebo. The interaction between condition, DRD4 polymorphism, and time was not significant., Conclusions: Presence of G allele of the A118G polymorphism of the OPRM1 gene may lead to greater increases in urge to smoke after a high dose of alcohol. Pharmacotherapies targeted to opiate receptors (eg, naltrexone) may be especially helpful in aiding smoking cessation among G carriers who are heavy drinkers., (© The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Animal and human data suggest that adolescents experience hangover effects that are distinct from adults. The present study used ecological momentary assessment (EMA) methods to examine the temporal relationships between drinking and hangovers, and how this varied by age and sex. We hypothesized that alcohol's dose-dependent effects on hangover severity are more pronounced among adolescents and young adults than older drinkers. We also explored whether greater hangover severity would lead to a lower likelihood and volume of alcohol use later the same day. Data were pooled from 4 studies of drinkers (N = 274; ages 15 to 66 years) who completed a 4- to 14-day (M = 7.46, SD = 1.13) EMA monitoring period. Each morning, participants recorded how much alcohol they consumed the day before and rated their hangover severity. Participants who consumed a greater quantity of alcohol the prior day reported more severe hangover symptoms; however, there was an interaction between drinking volume and age, such that hangover was more severe among younger drinkers, especially at higher drinking levels. More severe hangover symptoms did not predict the likelihood of drinking later that day; however, on drinking days, more severe hangover symptoms predicted lower quantities of alcohol use later that day. This event-level effect did not vary as a function of age. Study outcomes did not vary by sex. Our findings suggest that younger drinkers experience more severe hangovers, and that greater hangover results in lighter drinking later that same day regardless of age., ((c) 2015 APA, all rights reserved).)

Introduction: Lapses after smoking cessation often occur in the context of alcohol use, possibly because alcohol increases urge to smoke. Poor working memory, or alcohol-induced decrements in working memory, may influence this relationship by making it more difficult for an individual to resist smoking in the face of smoking urges., Methods: Participants (n = 41) completed measures of working memory and urge to smoke before and after alcohol administration (placebo, 0.4 g/kg, and 0.8 g/kg, within subjects) and then participated in a laboratory analogue task in which smoking abstinence was monetarily incentivized., Results: Working memory moderated the relationship between smoking urge and latency to smoke: for those with relatively poorer working memory, urge to smoke was more strongly and negatively associated with latency to smoke (i.e., higher urges were associated with shorter latency)., Conclusions: Those with weak working memory may need additional forms of treatment to help them withstand smoking urges., (© The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Effects of brief motivational interventions (BMIs) for heavy drinkers identified by alcohol-related emergency department (ED) visits are mixed. The successes of including significant others (SOs) in behavioral treatment suggest that involving SOs in ED-delivered BMI might prove beneficial. This study investigated the relative efficacy of an SO-enhanced motivational intervention (SOMI) compared with an individual motivational intervention (IMI) to address heavy drinking in emergency care settings., Method: ED (n = 317) or trauma unit (n = 89) patients were randomly assigned to receive either an IMI or an SOMI and were reassessed at 6 and 12 months for alcohol consumption, alcohol-related consequences, and perceived alcohol-specific SO support., Results: Generalized estimating equation analyses showed consistent reductions over time for both alcohol consumption and consequences. At 1-year follow-up, the average reduction in total drinks consumed per week was greater for patients in the SOMI condition than the IMI condition. In SOMI, 9.4% more patients moved to within the national guidelines for weekly drinking than did IMI patients. Frequency of heavy drinking and negative alcohol consequences showed no differential effects of intervention., Conclusions: Emergence of a modest treatment effect at 12 months suggests that SO involvement in the SOMI condition may have led to more sustained positive influence on patient drinking than in the IMI condition. Implications and limitations regarding SO involvement in brief treatment are discussed.

Rationale: Smoking lapses (i.e., returns to smoking after quitting) often occur following alcohol consumption with observational data suggesting greater quantities of alcohol lead to greater risk. However, a causal dose-dependent effect of alcohol consumption on smoking lapse behavior has not been established, and the mechanisms that might account for such an effect have not been tested., Objectives: In a within-subjects design, we examined the effects of low- (0.4 g/kg) and high-dose (0.8 g/kg) alcohol, relative to placebo, on smokers' ability to resist initiating smoking after acute smoking abstinence., Methods: Participants were 100 heavy alcohol drinkers, smoking 10-30 cigarettes per day. Across three separate days, participants consumed placebo, low-dose, or high-dose alcohol following 3 h of smoking abstinence and, 35 min later, were offered the opportunity to smoke while resisting smoking was monetarily reinforced proportional to the amount of time delayed., Results: Consistent with a dose-response effect, participants smoked 3.35 min (95 % confidence intervals (CI) [-7.09, 0.40], p = .08) earlier following low-dose alcohol and 6.36 min (95 % CI [-9.99, -2.73], p = .0006) earlier following high-dose alcohol compared to drinking a placebo beverage. Effects of dose on smoking behavior were partially mediated by increases in urge to smoke. There was no evidence that alcohol's effects on urge to smoke or ability to resist smoking were mediated through its stimulating or sedating effects., Conclusions: Alcohol can reduce the ability to resist smoking in a dose-dependent fashion, in part, due to its effect on increasing the intensity of smoking urges.

Although smoking deprivation is often used in laboratory studies to induce urges to smoke cigarettes, the optimal length of deprivation has not been established. Previous research showed that overnight abstinence from cigarettes led to high baseline urge to smoke that potentially masked alcohol's acute effects on urge to smoke (Kahler et al., 2012). The current study examined whether alcohol's effects on smoking urge were more pronounced when a shorter length of smoking deprivation was used (i.e., 3h instead of overnight abstinence). Using a balanced placebo design for alcohol administration, we found that participants experienced a significant increase in self-reported urge to smoke when administered alcohol after a 3-h smoking deprivation (n=32), whereas this effect was smaller and nonsignificant when smokers were required to be abstinent overnight (n=96). Research on factors that heighten smoking urges may find stronger effects if a 3-h deprivation is used compared to using overnight abstinence., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Problematic alcohol use among college students continues to be a prominent concern in the United States, including the growing trend of consuming caffeinated alcoholic beverages (CABs). Epidemiologically, CAB use is associated with incremental risks from drinking, although these relationships could be due to common predisposing factors rather than specifically due to CABs. This study investigated the relationship between CAB use, alcohol misuse, and person-level characteristics, including impulsive personality traits, delayed reward discounting, and behavioral economic demand for alcohol use. Participants were 273 regularly drinking undergraduate students. Frequency of CAB use was assessed over the past month. A multidimensional assessment of impulsivity included the UPPS-P questionnaire, which measures positive and negative urgency, premeditation (lack thereof), perseverance (lack thereof), and sensation seeking (Lynam, Smith, Whiteside, & Cyders, 2007), and a validated questionnaire-based measure of delayed reward discounting. Demand was assessed via a hypothetical alcohol purchase task. Frequency of CAB consumption was significantly higher in men than in women and was also associated with higher impulsivity on the majority of the UPPS-P subscales, steeper delayed reward discounting, and greater demand for alcohol. Significant correlations between CAB use and both alcohol demand and lack of premeditation remained present after including level of alcohol misuse in partial correlations. In a hierarchical linear regression incorporating demographic, demand, and impulsivity variables, CAB frequency continued to be a significant predictor of hazardous alcohol use. These results suggest that although there are significant associations between CAB consumption and gender, impulsivity, and alcohol demand, CAB use continues to be associated with alcohol misuse after controlling for these variables.

Objective: Although hangover results from excessive alcohol consumption, the specific pathways through which hangover symptoms arise have not been elucidated. Research on predictors of hangover sensitivity may provide clues about such mechanisms. The present study investigated whether tobacco smoking on days of heavy drinking affects next-day hangover incidence and severity., Method: The study drew on diary data from a study on smoking and drinking among 113 students at a midwestern university in the United States. Participants completed a daily, web-based, 26-item survey for 8 weeks to assess prior-day alcohol and tobacco use as well as current-day hangover symptoms. Hierarchical linear modeling was used to test the hypothesis that amount of smoking is related to hangover, controlling for amount of alcohol consumed, sex, and other individual characteristics. Analyses were conducted after selecting only days with alcohol consumption levels that typically elicit hangover, then repeated on lighter drinking days for comparison. Validity of the hangover items was checked by comparing reports after such heavy drinking days with days of lighter drinking., Results: Across all possible person-days, 92% of daily reports were obtained. When selecting only events where an estimated blood alcohol concentration of 110 mg/dl was attained, smoking significantly increased the odds of hangover incidence and hangover severity while controlling for number of drinks consumed and sex. Additional analyses controlling for age first smoked regularly, frequency of drug use, type of drug involvement, or smoking status resulted in findings that were unchanged., Conclusions: Smoking more on heavy drinking days affects hangover sensitivity and severity, possibly because of acute pharmacological effects.

Caffeinated alcoholic beverage (CAB) consumption is widespread among young adults in the United States and is associated with increased negative consequences from alcohol. In addition to the direct pharmacological effects of adding caffeine to alcohol, another possible risk mechanism is via socially learned expectancies, which has received very little consideration. The current study conducted an initial psychometric validation of a measure of CAB expectancies to facilitate research in this area. Participants were 409 undergraduate regular drinkers (71% female) who were assessed for alcohol and CAB use, alcohol use/misuse, and expectancies about CABs. The majority (62%) of participants reported CAB experience and 48% reported CAB use in the past month. Participants primarily consumed spontaneously-prepared as opposed to premixed-CABs. More frequent CAB use was significantly positively correlated with levels of alcohol use and misuse. For the expectancy items, exploratory factor analysis revealed two factors that were labeled "Intoxication Enhancement" and "Avoid Negative Consequences." The patterns of expectancies reflected beliefs that CABs enhanced intoxication, but did not protect against negative consequences. The measure was titled the Caffeine + Alcohol Combined Effects Questionnaire (CACEQ). Intoxication enhancement scores were significantly associated with frequency of CAB use, even after adjusting for the role of weekly drinking and alcohol misuse, supporting the convergent validity of the CACEQ. These data provide initial support for the CACEQ and suggest it may be useful for clarifying the role of expectancies in CAB use. Applications for studying the risks associated with CAB use and methodological considerations are discussed.

Rationale: Alcohol use is often implicated in initial lapses to smoking during quit smoking attempts. Mechanisms explaining this association are unknown but could include (a) learned associations between drinking and smoking or (b) direct pharmacologic effects of alcohol., Objectives: In a 2 (told alcohol vs. told placebo) × 2 (0.4 g/kg vs. 0.0 g/kg ethanol) between-subjects balanced placebo design, we examined instruction and beverage condition effects on smokers' ability to resist initiating smoking and whether these effects differed by sex., Methods: Participants were 96 heavy alcohol drinkers, smoking 10-30 cigarettes per day. After 15 h of smoking abstinence, participants consumed either an alcoholic or a nonalcoholic beverage and 35 min later completed a smoking lapse task., Results: Overall, neither instructions nor beverage contents influenced behavior on the smoking lapse task. However, the instruction condition had different effects in men and women. Women, but not men, were more likely to smoke and reported expecting greater satisfaction from smoking when they were told alcohol compared to told placebo. The effects of instruction condition on smoking behavior were not mediated by self-reported expected satisfaction from smoking., Conclusions: Women may be more likely to choose to smoke after drinking moderate amounts of alcohol because of their expectations rather than the pharmacological effects of the alcohol.

Predicting continued problematic levels of drinking after the early 20's could help with early identification of persons at risk. This study investigated whether hangover insensitivity could predict postcollege drinking and problems beyond the variance due to drinking patterns. In a preliminary study, 134 college seniors from a laboratory study of hangover (Time 1) were contacted and assessed 1-4 years (M = 2.3) later (Time 2). Hangover severity was studied after controlled alcohol administration to a specific dose while controlling sleep and environmental influences. Hangover severity at Time 1 was used to predict Time 2 drinking volume and problems while controlling for relevant demographics and Time 1 drinking volume. Hangover insensitivity at Time 1 tended to predict a clinical level of alcohol problems with a large statistical effect size. Hangover sensitivity also correlated positively with sensitivity to alcohol intoxication. Hangover severity did not predict future drinking volume. Hangover insensitivity correlates with insensitivity to intoxication and might predict more serious alcohol problems in the future, suggesting that a future larger study is warranted. Hangover insensitivity could result from physiological factors underlying low sensitivity to alcohol or risk for alcoholism., (PsycINFO Database Record (c) 2012 APA, all rights reserved.)

A sense of purpose in life has been positively associated with mental health and well-being and has been negatively associated with alcohol use in correlational and longitudinal studies but has not been studied as a predictor of cocaine treatment outcome. This study examined pretreatment purpose in life as a predictor of response to a 30-day residential substance use treatment program among 154 participants with cocaine dependence. Purpose in life was unrelated to cocaine or alcohol use during the 6 months pretreatment. After controlling for age, baseline use, and depressive symptoms, purpose in life significantly (p < .01) predicted relapse to any use of cocaine and to alcohol and the number of days cocaine or alcohol was used in the 6 months after treatment. Findings suggest that increasing purpose in life may be an important aspect of treatment among cocaine-dependent patients., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: To determine whether a brief individual motivational interview (IMI) plus a family motivational interview (Family Check-Up [FCU]) would reduce alcohol use in adolescents treated in an emergency department after an alcohol-related event more effectively than would an IMI only., Design: Two-group randomized design with 3 follow-up time points., Setting: An urban regional level I trauma center., Participants: Adolescents aged 13 to 17 years (N = 125) with a positive blood alcohol concentration as tested using blood, breath, or saliva., Interventions: Either IMI or IMI plus FCU., Main Outcome Measures: Drinking frequency (days per month), quantity (drinks per occasion), and frequency of high-volume drinking (≥5 drinks per occasion)., Results: Both conditions resulted in a reduction in all drinking outcomes at all follow-up points (P < .001 for all), with the strongest effects at 3 and 6 months. Adding the FCU to the IMI resulted in a somewhat better outcome than did the IMI only on high-volume drinking days at 3-month follow-up (14.6% vs 32.1%, P = .048; odds ratio, 2.76; 95% confidence interval, 0.99-7.75)., Conclusions: Motivational interventions have a positive effect on drinking outcomes in the short term after an alcohol-related emergency department visit. Adding the FCU to an IMI resulted in somewhat better effects on high-volume drinking at short-term follow-up than did an IMI only. The cost of extra sessions necessary to complete the FCU should be weighed against the potential benefit of reducing high-volume drinking when considering adding the FCU to an IMI for this population.

Objective: Brief interventions in the emergency department targeting risk-taking youth show promise to reduce alcohol-related injury. This study models the cost-effectiveness of a motivational interviewing-based intervention relative to brief advice to stop alcohol-related risk behaviors (standard care). Average cost-effectiveness ratios were compared between conditions. In addition, a cost-utility analysis examined the incremental cost of motivational interviewing per quality-adjusted life year gained., Method: Microcosting methods were used to estimate marginal costs of motivational interviewing and standard care as well as two methods of patient screening: standard emergency-department staff questioning and proactive outreach by counseling staff. Average cost-effectiveness ratios were computed for drinking and driving, injuries, vehicular citations, and negative social consequences. Using estimates of the marginal effect of motivational interviewing in reducing drinking and driving, estimates of traffic fatality risk from drinking-and-driving youth, and national life tables, the societal costs per quality-adjusted life year saved by motivational interviewing relative to standard care were also estimated. Alcohol-attributable traffic fatality risks were estimated using national databases., Results: Intervention costs per participant were $81 for standard care, $170 for motivational interviewing with standard screening, and $173 for motivational interviewing with proactive screening. The cost-effectiveness ratios for motivational interviewing were more favorable than standard care across all study outcomes and better for men than women. The societal cost per quality-adjusted life year of motivational interviewing was $8,795. Sensitivity analyses indicated that results were robust in terms of variability in parameter estimates., Conclusions: This brief intervention represents a good societal investment compared with other commonly adopted medical interventions.

Aim: To assess the effects of binge drinking on students' next-day academic test-taking performance., Design: A placebo-controlled cross-over design with randomly assigned order of conditions. Participants were randomized to either alcoholic beverage [mean = 0.12 g% breath alcohol concentration (BrAC)] or placebo on the first night and then received the other beverage a week later. The next day, participants were assessed on test-taking, neurocognitive performance and mood state., Participants: A total of 196 college students (>or=21 years) recruited from greater Boston., Setting: The trial was conducted at the General Clinical Research Center at the Boston Medical Center., Measurements: The Graduate Record Examinations(c) (GREs) and a quiz on a lecture presented the previous day measured test-taking performance; the Neurobehavioral Evaluation System (NES3) and the Psychomotor Vigilance Test (PVT) measured neurocognitive performance; and the Profile of Mood States (POMS) measured mood., Findings: Test-taking performance was not affected on the morning after alcohol administration, but mood state and attention/reaction-time were affected., Conclusion: Drinking to a level of 0.12 g% BrAC does not affect next-day test-taking performance, but does affect some neurocognitive measures and mood state.

Objective: To evaluate moderators and mediators of brief alcohol interventions conducted in the emergency department., Methods: Patients (18-24 years; n = 172) in an emergency department received a motivational interview with personalized feedback (MI) or feedback only (FO), with 1- and 3-month booster sessions and 6- and 12-month follow-ups. Gender, alcohol status/severity group [ALC+ only, Alcohol Use Disorders Identification Test (AUDIT+) only, ALC+/AUDIT+], attribution of alcohol in the medical event, aversiveness of the event, perceived seriousness of the event and baseline readiness to change alcohol use were evaluated as moderators of intervention efficacy. Readiness to change also was evaluated as a mediator of intervention efficacy, as were perceived risks/benefits of alcohol use, self-efficacy and alcohol treatment seeking., Results: Alcohol status, attribution and readiness moderated intervention effects such that patients who had not been drinking prior to their medical event, those who had low or medium attribution for alcohol in the event and those who had low or medium readiness to change showed lower alcohol use 12 months after receiving MI compared to FO. In the AUDIT+ only group those who received MI showed lower rates of alcohol-related injury at follow-up than those who received FO. Patients who had been drinking prior to their precipitating event did not show different outcomes in the two interventions, regardless of AUDIT status. Gender did not moderate intervention efficacy and no significant mediation was found., Conclusions: Findings may help practitioners target patients for whom brief interventions will be most effective. More research is needed to understand how brief interventions transmit their effects.

Objective: The aim of this research was to study marijuana use, associated risks, and response to brief motivational intervention among young adult drinkers treated in an emergency department., Method: Study participants (N = 215; ages 18-24) were in a randomized controlled trial for alcohol use that compared motivational interviewing with personalized feedback (MI) with personalized feedback only. Past-month marijuana users were compared with nonusers on demographics, readiness, self-efficacy, and behavioral risk variables. Marijuana use was examined as a potential moderator of alcohol outcomes. Whether marijuana use alone or combined marijuana and alcohol use would be reduced as a result of brief intervention for alcohol was examined at 6 and 12 months., Results: Current marijuana users were younger, were more likely to be white, and reported more alcohol use, other illicit drug use, and more alcohol-related consequences than nonmarijuana users. Marijuana use at baseline did not moderate response to brief alcohol treatment. Marijuana use declined from baseline to 6 months for both treatment groups, but only MI participants continued to reduce their use of marijuana from 6- to 12-month follow-up. Reductions in number of days of use of marijuana with alcohol appeared to be primarily a function of decreased alcohol use., Conclusions: Young adult drinkers reporting current marijuana use are at generally higher risk but responded to brief alcohol treatment by reducing alcohol and marijuana use.

Aims: To determine the incidence and covariates of hangover following a night of moderate alcohol consumption at a targeted breath alcohol level., Design: Data were combined from three randomized cross-over trials investigating the effects of heavy drinking on next-day performance. A total of 172 participants received either alcoholic beverage (mean=0.115 g% breath alcohol concentration) or placebo on one night and the other beverage a week later. The next day, participants completed a hangover scale., Participants: Participants were 54 professional merchant mariners attending a recertification course at Kalmar Maritime Academy (Kalmar, Sweden) and 118 university students or recent graduates recruited from greater Boston., Setting: One trial was conducted at Kalmar Maritime Academy (Sweden); the other two were conducted at the General Clinical Research Center at Boston Medical Center., Measurements: A nine-item scale assessed hangover., Findings: Hangover was reported by 76% of participants. Neither alcoholic beverage type nor participant characteristics was associated with incidence of hangover., Conclusions: Our findings on the propensity of hangover suggest that 25-30% of drinkers may be resistant to hangover.

Background: Topiramate was recently reported to be efficacious in reducing drinking rates and craving among individuals with alcohol dependence in a randomized controlled trial, but dose effects could not be determined. This laboratory study systematically examined the dose-dependent effects of topiramate on cue-elicited craving and other putative mechanisms of its pharmacotherapeutic effects on drinking., Methods: Male and female heavy drinkers (n = 61) were randomized to 1 of 3 medication conditions (200 mg/d; 300 mg/d; placebo) in a double-blind study. Participants reached the target dose after a 32-day titration period, then were stabilized for approximately 1 week. All then participated in a laboratory assessment of alcohol cue reactivity and of the subjective effects of a moderate dose of alcohol., Results: Both doses of topiramate reduced the frequency of heavy drinking during the titration period as compared to placebo. However, topiramate did not affect self-reported craving for alcohol during the titration period, during the cue reactivity protocol, or in response to the alcohol challenge procedure. Topiramate reduced the stimulating effects of alcohol ingestion compared to placebo, but only in the 200 mg group., Conclusions: The results of this study support previous findings that topiramate reduces drinking, but the behavioral mechanism underlying this effect does not appear to be attenuation of craving for alcohol as measured using the approaches employed in this study. Rather, the results tentatively suggest that topiramate may exert its beneficial effects by altering the subjective experiences of alcohol consumption. Limitations of the current study are discussed and complementary methods are recommended for future studies, such as the use of behavioral economic paradigms and ecological momentary assessment.

Background: Naltrexone (NTX) has proven to be effective with alcoholics in treatment, with most controlled clinical trials showing beneficial effects on heavy drinking rates. However, little is known about the behavioral mechanisms underlying the effects of NTX on drinking, or about patient characteristics that may moderate NTX's effects on drinking. In this study, ecological momentary assessment (EMA) techniques were used to investigate some of the putative mechanisms of naltrexone's effects on drinking in heavy drinkers who were not seeking treatment for alcohol problems. Polymorphisms in the D4 dopamine receptor (DRD4) gene and the mu-opiate receptor (OPRM1) gene, family history of alcohol problems, age of onset of alcoholism and gender were explored as potential moderators of NTX's effects., Methods: After a 1-week placebo lead-in period, heavy drinkers (n = 180), 63% of whom were alcohol-dependent, were randomized to 3 weeks of daily naltrexone (50 mg) or placebo. Throughout the study, participants used EMA on palm-pilot computers to enter, in real time, drink data, urge levels, and subjective effects of alcohol consumption., Results: Naltrexone reduced percentage drinking days in all participants and reduced percent heavy drinking days in DRD4-L individuals; NTX decreased urge levels in participants with younger age of alcoholism onset; NTX increased time between drinks in participants who had more relatives with alcohol problems; and NTX reduced the stimulating effects of alcohol in women. OPRM1 status did not moderate any of NTX's effects., Conclusions: These results confirm earlier findings of NTX's effects on drinking and related subjective effects, and extend them by describing individual difference variables that moderate these effects in the natural environment, using data collected in real time.

Aim: To establish the efficacy of a brief motivational intervention compared to feedback only when delivered in an emergency department for reducing alcohol use and problems among young adults., Design: Two-group randomized controlled trial with follow-up assessments at 6 and 12 months., Setting: Level I Trauma Center., Participants: A total of 198 18-24-year-old patients who were either alcohol positive upon hospital admission or met screening criteria for alcohol problems., Intervention: Participants were assigned randomly to receive a one-session motivational intervention (MI) that included personalized feedback, or the personalized feedback report only (FO). All participants received additional telephone contact 1 month and 3 months after baseline., Measurements: Demographic information, alcohol use, alcohol problems and treatment seeking., Findings: Six months after the intervention MI participants drank on fewer days, had fewer heavy drinking days and drank fewer drinks per week in the past month than did FO patients. These effects were maintained at 12 months. Clinical significance evaluation indicated that twice as many MI participants as FO participants reliably reduced their volume of alcohol consumption from baseline to 12 months. Reductions in alcohol-related injuries and moving violations, and increases in alcohol treatment-seeking were observed across both conditions at both follow-ups with no differences between conditions., Conclusions: This study provides new data supporting the potential of the motivational intervention tested to reduce alcohol consumption among high-risk youth.

Naltrexone's (NAL) effects on alcohol consumption are generally modest, so identifying patients likely to benefit would improve treatment utility. Several studies indicate that potentially significant moderators of NAL's effects might include family history of alcohol problems (FH), age of onset of alcohol problems, degree of antisocial traits, and comorbid drug use. Data from 128 alcoholic patients enrolled in a 12-week NAL treatment study (50 mg/day) were reanalyzed to determine the role of FH, age of onset, antisocial traits, and comorbid drug use in NAL's treatment effects on heavy drinking days. Dichotomized FH, age of onset of alcohol problems, and comorbid cocaine or marijuana use had no interaction effect with medication. Percentage of relatives with problem drinking (family history percentage [FHP]) moderated the effects of NAL on drinking such that NAL resulted in lower drinking rates only for patients with higher FHP. Antisocial traits also moderated the effects of medication on drinking for patients compliant with =70% of medication. Patients with more antisocial traits had less heavy drinking on NAL than on placebo, whereas patients low on antisocial traits had no benefit from NAL. Covarying antisociality in regressions of drinking outcome on FHP showed that the effects of FHP were not attributable to antisociality. Thus, NAL may selectively benefit alcoholics with antisocial traits or 20% or more relatives with problem drinking., ((c) 2007 APA, all rights reserved)

Purpose: No psychometrically established measure of acute hangover symptoms is published and available to use in experimental investigations. The present investigation combined data across three studies of residual alcohol effects to establish the properties of a new Acute Hangover Scale (AHS) based on symptoms supported in previous lab studies., Methods: Professional mariners from a Swedish maritime academy (n=54) and young adult students/recent graduates of urban U.S. universities (n=135) participated in one of three within-subjects' studies of residual effects of heavy drinking (M=0.114 g% breath alcohol concentration [BrAC]). All drank placebo one evening and alcoholic drinks another evening followed by an 8-h sleep period before completing the AHS 10-20 min after awakening., Results: The AHS showed excellent internal consistency reliability the morning after alcohol. The AHS mean score and each item were significantly affected by beverage but not demographics or typical drinking, supporting validity., Conclusions: The AHS is a reliable and valid instrument for assessing acute hangover symptoms in experimental investigations of residual alcohol effects.

Background: Naltrexone (NTX) reduces drinking and craving in alcoholic individuals in treatment and also in heavy drinkers. Polymorphisms in the D4 dopamine receptor (DRD4) gene and mu-opiate receptor gene (OPRM1) may moderate NTX's effects on craving. This study examined these candidate genes as moderators of the effects of NTX on cue-elicited urge to drink in non-treatment-seeking heavy drinkers., Method: Data from the subset of 93 participants who consented for genetic testing in a larger study of medication effects were used to examine pharmacogenetic hypotheses. The non-treatment-seeking male and female heavy drinkers (62% alcohol dependent) were genotyped for the variable number of tandem repeats polymorphism in the DRD4 gene [L=7 or more (n=34), S=less than 7 (n=56)] and Asn40Asp single-nucleotide polymorphism in the OPRM1 gene [29 aspartate (Asp) carriers and 59 asparagine (Asn) homozygotes]. Ten days after randomization to NTX (50 mg) or placebo, participants completed an alcohol cue reactivity assessment., Results: Any medication effects were all accounted for by interaction with genotype. Naltrexone increased urge for alcohol in Asp carriers across alcohol and neutral beverage cue trials and had no effect on homozygous Asn carriers. Asp40 carriers on either medication had greater decreases (from resting baseline) in mean arterial blood pressure across all beverage cue trials compared with Asn carriers. For DRD4, no differential medication effects by DRD4 polymorphism were found. Alcohol dependence diagnosis did not moderate the effects of gene and medication on cue-elicited measures., Discussion: The differential responses to NTX due to variation in the OPRM1 gene may help explain conflicting results in clinical trials and suggest directions for patient-treatment matching.

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.

We tested whether a brief motivational interview (MI) would reduce alcohol-related consequences and use among adolescents treated in an emergency department (ED) after an alcohol-related event. Patients aged 13 to 17 years (N = 152) with a positive blood alcohol concentration (BAC) by lab test or self-report were recruited in the ED and randomly assigned to receive either MI or standard care (SC). Both conditions resulted in reduced quantity of drinking during the 12-month follow-up, whereas alcohol-related negative consequences were relatively low and stayed low at follow-up. Adolescents who screened positive for problematic alcohol use at baseline reported significantly more improvement on 2 of 3 alcohol use outcomes (average number of drinking days per month and frequency of high-volume drinking) if they received MI compared with SC. We conclude that brief interventions are recommended for adolescents who present to an ED with an alcohol-related event and report preexisting problematic alcohol use.

Nicotine and alcohol may have common neurobiological mechanisms of reinforcement. Therefore, withholding one substance might result in compensatory increases in self-administration of the other. This laboratory study investigated the effects of brief tobacco deprivation on alcohol cue-elicited urges to drink, corresponding psychophysiological reactions, and alcohol consumption. Young adults (N=78) who were moderate to heavy smokers and drinkers were stratified and randomized to a 2 x 2 design. Participants were either deprived of tobacco for 5 h or not deprived and then exposed to in vivo alcohol or control beverage cues. Subsequently, participants engaged in a taste-rating task as an unobtrusive measure of alcohol consumption. Tobacco deprivation resulted in increased urge to smoke and decreased cardiovascular responses but did not increase alcohol urges or alcohol consumption. Results indicate that brief tobacco deprivation does not result in compensatory increases in alcohol consumption among young moderate to heavy drinkers., (Copyright 2004 Elsevier Ltd.)

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.

Characteristics associated with intention to change drinking were examined in 254 adolescents treated in an emergency department for alcohol. Younger age, living at home, lower baseline level of drinking and drinking problems, greater depression, having penalties for breaking family drinking rules, higher injury severity, being frightened, and being admitted to the hospital predicted greater intention to change drinking at the time of the event. Baseline characteristics related to being in the action stage of change 3 months later were younger age; lower drinking; having penalties for breaking family drinking rules; injury severity; and number of anticipated consequences, including being in trouble with parents. This study has implications for brief interventions that capitalize on potential teachable moments with problem-drinking adolescents.

Alcohol use becomes more frequent during adolescence, with the percentage of youth who drink doubling from 8th grade to 12th grade. The escalation in drinking behavior during adolescence is often associated with increased problems and other risk behavior, such as drunk driving. In this study, adolescents (N = 557) were recruited from an emergency department to assess their alcohol use, positive and negative evaluations about alcohol, driving after drinking, and problems experienced from drinking. Analyses explored the mediational role of drinking behavior between adolescents' evaluations and problems from drinking and between evaluations and driving after drinking. The findings indicated that drinking behavior partially mediated the association between positive evaluations and problems experienced from drinking but did not mediate the association between evaluations and drunk driving.

Objective: The purpose of this study was to examine alcohol use, alcohol-related problems, other risk-taking behaviors, and parental monitoring in adolescents who tested positive for alcohol in an emergency department., Study Design: A matched case-control design was implemented for adolescents presenting to a pediatric emergency department who were screened for alcohol use. An alcohol-positive sample (N = 150) was compared with a matched alcohol-negative sample (N = 150) for alcohol use, alcohol problems, depression, smoking, risk-taking behavior, and parental monitoring., Results: The alcohol-positive group reported significantly higher drinking frequency, drinking problems, prior alcohol-related injuries, and episodes of driving after drinking and riding with a drinking driver than the alcohol-negative adolescents. The same pattern was true for depressed mood, reckless behaviors, poor grades in school, and daily smoking. The parents of alcohol-positive teens reported their teens had come home intoxicated more often than parents of alcohol-negative teens. There were no differences between parent groups in monitoring of teens., Conclusion: Adolescents who test positive for alcohol in an emergency department are a high-risk group who meet the criteria for indicated prevention. Screening for alcohol abuse is recommended.

Rationale: Haloperidol, a D2 antagonist, has been shown to moderate the effects of alcohol consumption on craving., Objective: The present study was designed to determine whether a single 5-mg dose of olanzapine (a D2/5-HT2 antagonist) would influence responses to alcohol cues or an alcohol challenge. It was hypothesized that olanzapine would attenuate cue-elicited urge to drink, attenuate the effects of alcohol consumption on urge to drink, and reduce the rewarding effects of alcohol., Methods: To test these hypotheses, 26 heavy social drinkers were randomized to receive either 5 mg olanzapine or placebo approximately 8 h before each of two experimental sessions. Participants consumed a moderate dose of alcohol in one experimental session and a non-alcohol control beverage in another session., Results: Results indicated that mere exposure to alcohol cues and consumption of alcohol increased urge to drink and that olanzapine attenuated these effects. Results also indicated that alcohol increased subjective stimulation and high while olanzapine did not moderate these effects., Conclusions: These results suggest that olanzapine did not influence the rewarding effects of alcohol but did attenuate the effects of alcohol cues and an alcohol challenge on urge to drink.

This article represents the proceedings of a symposium at the 2000 RSA Meeting in Denver, Colorado. The organizer and chair was Barbara A. Flannery, and the co-chairs were Barbara A. Flannery and Helen Pettinati. The presentations were (1) Animal models of alcohol craving and relapse, by Amanda Roberts; (2) Real-time field assessment of alcohol craving, by Ned Cooney; (3) Medications and alcohol craving, by Robert Swift; (4) The assessment of craving: Insights from the clinic and clinical laboratory studies, by Raymond Anton; (5) A comparison of three alcohol craving questionnaires, by Barbara Flannery; (6) and Assessing posttreatment urge to drink, by Damaris Rohsenow.

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.

Aims: Under current US Department of Transportation (DOT) regulations, some commercial vehicle operators are subject to sanctions for having > or = 00.04 g% blood alcohol concentrations (BACs) on the job. This study investigated the effects of alcohol (between 0.04 and 0.05 g% BAC) on the simulated operation of a commercial ship's power plant., Design: A balanced placebo design was used in which alcohol administration was fully crossed with expectancy that alcohol was administrated., Setting: The study was conducted at the Massachusetts Maritime Academy, Buzzards Bay, MA, USA., Participants: Participants were 18 volunteer engineering students in their senior year, at least 21 years of age, with previous experience on the diesel simulator., Intervention: Following a baseline trial on day 1, on day 2 participants were randomized to expectancy (told alcohol or placebo) and beverage (receive alcohol or placebo). The dosage was 0.6 g/kg for males and 0.5 g/kg for females. In both baseline and performance days, participants were randomized to one of four diesel simulator scenarios, each replicating a system failure in a power plant subsystem (e.g. main propulsion, electrical generating)., Measurement: Performance was measured by time required for problem identification and remediation., Findings: A main effect for alcohol administration was found. In the alcohol condition, simulator performance time was almost twice as long (351 sec) as on the placebo condition (186 sec). The expectancy effect was not significant., Conclusion: These findings support the current federal policy on the hazards of this low alcohol level within the context of commercial shipping.

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.

Recent alcohol cue exposure studies have noted that not all alcoholics demonstrate increased reactivity when presented with alcohol-related cues. This study examined the relationship of private self-consciousness (PSC) to subjective, self-report measures of reactivity and measures of negative mood states that involve a focus on internal processes. These subjective measures of reactivity were contrasted with salivary reactivity, an objective measure of reactivity which does not require individual self-report or awareness. A cue reactivity assessment was administered to 47 men meeting DSM-III-R criteria for a diagnosis of alcohol dependence. Our hypothesis, that PSC would predict urge reactivity status and greater levels of negative mood states, was supported. Urge reactors were more likely to be high in PSC, while the proportions of salivary reactors and nonreactors were not significantly different between the high and low PSC groups. Although regression analyses indicated that PSC did not significantly predict urge to drink alcohol, it did predict angry/frustrated mood and sad/depressed mood at the first alcohol trial. These results suggest that individuals high in PSC may benefit more from cue exposure-based treatment, as they are more likely to be urge reactors and to evidence negative mood reactivity. Low PSC individuals may be at higher risk for relapse given they are less able to recognize internal reactions signaling the presence of a high-risk alcohol use situation, and therefore less likely to mobilize coping responses.

Although the prevalence of smoking among alcoholics ranges up to 97%, little is known about mechanisms underlying the co-occurrence of smoking and alcohol use, or the role tobacco may play in alcohol treatment recovery. Adult male alcoholics in treatment (n = 30) were randomly assigned to visual and olfactory exposure either to alcohol cues or to control cues, and then were allowed to smoke while continuing visual exposure to the same cues. Exposure to alcohol cues resulted in significantly greater self-reported urge to drink and urge to smoke but had no significant effect on the topography of smoking behavior. When variance due to urge to smoke was controlled, greater urge to drink correlated negatively with number of cigarette puffs. The results provide some support for a priming hypothesis of tobacco's role on alcoholism recovery. Clinical and theoretical implications are discussed.

Previous work has shown that attempts to deliberately suppress a given thought is associated with heightened accessibility of thought-related information both during and following suppression (Wegner, 1994, Psychological Review, 101, 34-52). This study examined whether attempts to suppress the urge for alcohol would similarly be associated with heightened accessibility of alcohol-related information. Heavy social drinkers were exposed to the sight and smell of their usual alcoholic beverage either under the instructions to suppress their urge to drink alcohol or without such instruction. Following this task, participants were asked to make timed judgements about the applicability of a series of alcohol outcome expectancies. Results supported the view that suppression increases the accessibility of information in memory. Those in the Suppression condition were faster to endorse alcohol outcome expectancies following the exposure to alcohol cues than those in the Control condition. Findings are discussed in terms of cognitive strategies for regulating alcohol use and patterns of restrained drinking.

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 theories suggest that conditioned responses may increase the risk for relapse. Responses to alcohol use cues (cue reactivity) are associated with variables suggestive of risk but little research exists on the relationship of cue reactivity to treatment outcome. Alcoholic men admitted for detoxification to a treatment program (n = 45) underwent a cue reactivity assessment protocol, and 91% received 3-month follow-up interviews. Greater salivary reactivity predicted greater frequency of drinking during follow-up. Attentional factors added independent variance to the prediction of drinking outcome, with greater attention to stimulus or to response predicting less drinking. Cue reactivity did not predict length of hospital stay or latency to first drink. Results are discussed in the context of information processing, social learning theories, and clinical implications for relapse prevention.

Although early investigations were promising, no controlled follow-up studies have investigated the effectiveness of cue exposure treatment for alcoholics. In this study, inpatient alcoholics received either cue exposure integrated with urge coping skills training (CET, n = 22) or a contrast condition (CC) involving daily contact with assessment only (n = 18) in addition to standard treatment. Comprehensive assessment measures were used to investigate change in process and outcome variables. In the second 3 months after treatment, the CET group included more patients who were completely abstinent, had a higher percentage of abstinent days, and tended to report fewer drinks per day than did patients in the contrast condition. The significantly greater use of coping skills during follow-up by the CET group and the significant relationship of these coping skills to decreased drinking suggest that treatment effects were due, at least in part, to the coping skills training, consistent with recent formulations. Theoretical and treatment implications are discussed.

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.

Studies testing the tension reduction hypothesis of alcohol drinking have found contradictory results. Marlatt proposes instead that social drinkers drink to gain control over stressful situations. To test this, 60 male heavy social drinkers were threatened with a social evaluation, then some were given some control over this threat by hearing that they could critique the evaluation and evaluate their evaluator (retaliate). This group was expected to drink less than a threatened group not given control, or a nonthreatened group, and heavy drinkers were expected to be affected more than light drinkers. Then, to determine if people do retaliate after an unfavorable evaluation, subjects received bogus evaluations or no evaluation, and then evaluated "their evaluator." Those receiving favorable or unfavorable evaluations responded in kind, supporting the coping method provided in the evaluation-with-coping condition. However, although the group that was evaluated and given no control reported more anxiety and took fewer sips than the other groups, they did not differ in wine consumption. The results did not support either the tension reduction or the control hypothesis.