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

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

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

Introduction: This study assessed differences in individual tobacco product use between past month marijuana users and nonusers, and trends in overall tobacco use and use of specific tobacco products among marijuana users.Methods: Data were obtained from 378 459 adults participating in the 2003-2012 National Survey on Drug Use and Health, a cross-sectional, household interview survey conducted annually. Data from the most recent 2 years (2011-2012) were used to assess differences in the prevalence of various tobacco products by past month marijuana status. Data from all years were used to assess historical trends in overall tobacco use, and use of cigarettes, cigars, and blunts among marijuana users; trend significance was assessed using orthogonal polynomials.Results: From 2011-2012, the prevalence of any past month tobacco use among the 9727 past month marijuana users was 68.6% excluding blunts, and 78.3% including blunts (vs. 25.3% for nonusers, P < .0001); 77.3% of past month marijuana users reported past month combusted tobacco use (vs. 23.4% of non-MJ users, P < .0001). By product, 60.1% of past month marijuana users reported past month cigarette use, 42.0% reported past month blunt use, and 20.6% reported past month cigar use. Overall, adjusted trends in past month cigarette use decreased, while trends in past month blunt use increased; cigar use did not change.Discussion: Tobacco use is highly prevalent among adult marijuana users and represents an important potential comorbidity of marijuana use. In light of increasing policies legalizing marijuana, it is critical to monitor changes in overall and specific tobacco product use. [ABSTRACT FROM AUTHOR]

Background: Decision-making processes have been posited to affect treatment outcome in addicted patients.Objective: The present multi-site study assessed whether two measures of decision-making predicted relapse and subsequent use in stimulant-dependent patients.Methods: A total of 160 methamphetamine- or cocaine-dependent patients participating in a multi-site clinical trial evaluating a modified 12-step facilitation intervention for stimulant-dependent patients (STAGE-12) were assessed. Decision-making processes of risk and delay (Iowa Gambling Task [IGT]) and response reversal (Wisconsin Card Sorting Task [WCST]) were obtained shortly after treatment admission followed by assessment of stimulant use over the next six months. The relationships of the IGT and WCST (Perseverative Errors) with relapse (yes/no) and days of stimulant use during the 6-month period following post-randomization were evaluated.Results: Performance on the IGT and WCST did not significantly predict relapse status or time to relapse. Unexpectedly, worse performance on the IGT was associated with a fewer number of stimulant use days (p = 0.001). In contrast, worse performance on the WCST (more perseverative errors) was associated with a greater number of stimulant use days (p = 0.0003). The predictive effects of perseverative errors on subsequent use were confined to methamphetamine-dependent and Minority participants.Conclusions: Decision-making processes, as measured in the current study, do not uniformly predict relapse or subsequent use. A decrease in the salience attribution of non-drug reinforcers may explain the positive relationship between IGT performance and post-relapse use. More comprehensive and global measures of impulsiveness may better assess relapse risk and use. [ABSTRACT FROM AUTHOR]

Background: Bidirectional, collaborative partnerships between academic researchers and practitioners have been a fundamental vehicle to achieve the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) goal of improving outcomes of community-based drug treatment. These partnerships blend clinical perspectives of practitioners and methodological expertise of researchers working together to address clinically meaningful issues through randomized clinical trials conducted in community treatment settings. Objectives: Bidirectionality is a guiding principle of the CTN, but its operationlization at the practical level in protocol development and implementation has not been articulated. This descriptive article presents the development of one protocol as an example and model of this bidirectional, collaborative, iterative partnership between researchers and practitioners. Methods: This article illuminates several specific issues encountered while developing STAGE-12, a behavioral intervention to facilitate 12-step mutual support group involvement, as well as the rationale for decisions taken to resolve each. Results: The STAGE-12 protocol was successfully developed through a series of decisions taking into account both design factors and clinical practice needs and realities, thus maintaining a balance between methodological rigor and generalizability. Conclusion: The review demonstrates the process by which research and practice have been blended in protocol development, exemplifying the underlying principle of bidirectionality, a key element in the success of the NIDA CTN. Scientific Significance: Bidirectional partnerships as derived in the CTN, employing a hybrid model of efficacy-effectiveness research, are capable of designing and implementing protocols that are both methodologically rigorous and clinically meaningful, thus increasing likelihood of adoption and eventual improvement in public health. [ABSTRACT FROM AUTHOR]

Background: Community Based and Tribally Based Participatory Research (CBPR/TPR) are approaches that can be successful for developing ethical and effective research partnerships between academic institutions and Tribes and Native organizations. Objectives: The NIDA Clinical Trials Network funded a multi-site, exploratory study using CBPR/TPR to begin to better understand substance abuse issues of concern to some Tribes and Native organizations as well as strengths and resources that exist in these communities to address these concerns. Attention was paid to the development and maintenance of research partnerships in each of the sites. Methods: Each of the five partnerships is briefly described and common as well as unique challenges and successes are identified. Results: A summary of the common themes for developing these collaborative research efforts is provided. Conclusion: True, collaborative research partnerships require a great deal of time and effort in order to develop mutual trust, understanding, knowledge, and collaboration that will guide research that is rigorous as well as ethical, effective, and culturally appropriate. Scientific Significance: As AIAN communities become increasingly sophisticated partners in, and consumers of, research, CBPR and TPR are emerging as effective, ethical, culturally appropriate, and acceptable approaches. This can serve to improve the science we engage in with AIAN communities, add to the scarce literature regarding AIAN communities, and better serve AIAN communities in addressing health disparities and improving health. [ABSTRACT FROM AUTHOR]

Aims. To examine the effects of different follow-up rates on estimates of treatment outcome and predictive models thereof, and to specify participant characteristics associated with tracking difficulty. Design. An observational study using data collected for a randomized, experimental design. Setting. The King County Assessment Center in Seattle, Washington, an organization responsible for referral to publicly funded substance abuse treatment. Participants. Substance-addicted individuals referred to publicly funded inpatient or outpatient treatment. Measurements. Standardized self-report instruments measuring substance use, substance use consequences and general functioning. Chart review was used to measure treatment entry and completion. Findings. There was a significant association between follow-up difficulty and outcomes related to addiction treatment and later substance use. However, outcome estimates based on 60% of the sample who were easiest to locate were only minimally different from those based on the 90-100% ultimately captured, and predictive models of outcome based on the 60% group were reasonably similar to those based on the final sample. Of baseline characteristics examined, only age was associated with later tracking difficulty. Conclusions. Studies reporting follow-up rates below 70% may produce valid findings and study attrition may be largely unpredictable from participant characteristics at baseline. However, a number of factors such as type of population studied, geographical location of the sample, reasons for loss to follow-up and sample size must be considered when attempting to generalize the findings of this study. [ABSTRACT FROM AUTHOR]

Brief Interventions (BIs) for problematic drug use in general medical settings, including in Emergency Departments (EDs), have shown disappointing results compared to those that target problematic alcohol use. Telephone booster calls may augment the impact of a BI delivered in the ED. The current study uses data from the National Drug Abuse Treatment Clinical Trials Network (CTN) Protocol 0047, "Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED)", a multisite randomized clinical trial conducted in six EDs in the U.S. We examine dose effects of telephone boosters (0, 1, or 2 calls completed) with non-treatment seeking patients who we randomized to the BI-Booster condition and who endorsed problematic drug use during their ED visit (N = 427). We assessed primary outcomes at 3-, 6-, and 12-month follow-ups, which included past month use of the primary drug of choice, use of any drug, and heavy drinking. There were no significant differences among those completing 0, 1, or 2 booster calls on any of the three main outcomes at 3-, 6-, and 12-months post-BI in the ED. Patients who were older were significantly more likely to complete booster calls. Taken together, these findings raise questions about the clinical utility of booster phone calls following screening and BIs targeting heterogeneous drug use in the ED. [ABSTRACT FROM AUTHOR]

This article discusses the perceived locus of control as a function of level of depression. This contention has direct relevance in comparative studies of control orientation between alcoholics and nonalcoholics because the former group is characterized by a high incidence of clinical depression. The purpose of the present investigation was to confirm previous findings that have related depression to the I-E scale and to cross-validate evidence of the effects of a mood-response bias on a sample of alcoholics and nonalcoholic.

The discusses the existence of more mice or a better mouse trap that reflects on primary outcome of drug abuse treatment in clinical trials. He is critical of the measures undertaken by A. Uchtenhagen to evaluate substance abuse treatment involving the psychosocial function, quality of life, and patient satisfaction. Also investigated the possibility that the use secondary outcome measures the broader complexities of clinical outcomes as well as clinical trials.

Practitioners and researchers across disciplines have been interested in identifying variables that act as indicators of treatment success or failure and one straightforward approach to measuring treatment success is to assess client satisfaction with treatment. Existing measures of treatment satisfaction do not address the specific aspects relevant to alcohol use disorder (AUD) treatment. Researchers in the COMBINE Study developed a new measure of treatment satisfaction to assess satisfaction in AUD treatment: The Evaluation of Treatment (EOT) measure. The aims of the present study were to examine the factor structure of items from the EOT measure and to examine the association between the EOT measure and other measures of client engagement, as well as AUD treatment outcomes. We also extended the model to test for possible mediation effects of treatment evaluation on the relationship between client treatment engagement components and AUD treatment outcomes. Confirmatory factor analyses indicated a 6-factor model with a higher order treatment satisfaction factor provided an excellent fit to the data (χ2 (246)=499.44, p<0.001, CFI=0.99, TLI=0.98, RMSEA =0.040 (90% CI: 0.035, 0.045). Overall, the latent factor of treatment satisfaction was significantly associated with client engagement predictors and treatment evaluation significantly mediated the associations between both working alliance and treatment expectations in the prediction of alcohol-related problems and global severity. Findings suggest that client evaluations of treatment play a substantial role in predicting AUD treatment outcomes and should be considered in future treatment and research. [ABSTRACT FROM AUTHOR]

Objective: This secondary data analysis explored predictors and outcomes of having a 12-step sponsor among individuals receiving treatment for stimulant use disorders, inclusive of four types of 12-step groups (Narcotics Anonymous, Alcoholics Anonymous, Cocaine Anonymous, and Crystal Meth Anonymous).Method: For a multisite randomized clinical trial, participants (N = 471; 59% women) were recruited among adult patients in 10 U.S. community treatment programs. Participants were randomized into treatment as usual (TAU) or a 12-step facilitation (TSF) intervention: Stimulant Abuser Groups to Engage in 12-Step (STAGE-12). Logistic regression analyses explored the extent to which participants obtained sponsors, including the extent to which treatment condition and other predictors (12-step experiences, expectations, and beliefs) were associated with having a sponsor. The relationship between end-of-treatment sponsorship and follow-up substance use outcomes was also tested.Results: Participants were more likely to have a sponsor at the end of treatment and 3-month follow-up, with the STAGE-12 condition having higher sponsorship rates. Twelve-step meeting attendance and literature reading during the treatment period predicted having a sponsor at the end of treatment. Sponsorship at the end of treatment predicted a higher likelihood of abstinence from stimulant use and having no drug-related problems at follow-up.Conclusions: This study extends previous research on sponsorship, which has mostly focused on alcohol use disorders, by indicating that sponsorship is associated with positive outcomes for those seeking treatment from stimulant use disorders. It also suggests that sponsorship rates can be improved for those seeking treatment from stimulant use disorders through a short-term TSF intervention. [ABSTRACT FROM AUTHOR]

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