Search

Presents an evaluation of the relationship between the therapeutic alliance and treatment participation and drinking outcomes during and after treatment among alcoholic outpatient and aftercare clients. Study methodology; Predictions of therapists ratings of the alliance in the aftercare sample; What the results of the study concluded.

Aftercare contributes to improved drinking outcome, yet maintenance has been overlooked as a point for intervention. This project evaluated the effect of cognitive-behavioural relapse prevention (RP) and interpersonal process (IP) aftercare groups for recently hospitalized alcoholics, consisting of eight weekly 90 min sessions delivered by three co-therapy teams conducting one group in each condition. Six cohorts of patients were assigned to conditions (N = 39) and assessed at pretreatment, post-treatment, and 6 month follow-up. RP and IP resulted in comparable improvement/outcome on alcohol consumption, alcohol-related impairment, cognitive coping, drinking days, time to first drink, abstinence, and aftercare attendance. In secondary analyses, improvement on temptation was attributed to RP, on behavioural coping to IP, and effects on self-efficacy appeared marginally related to greater short term improvement for RP. The lack of differential outcome is discussed with respect to inadequate power, possible ceiling effects in outcome, the brevity of the follow-up period, and the possibility that treatments may have been more similar in implementation than intended. Suggestions for improving aftercare and relapse prevention research are presented. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to investigate a number of factors that may influence the relationship between neuropsychological impairment and treatment outcome among alcoholics. Cognitive deficit upon admission to treatment was significantly related to the individual's age but independent of the years of problem drinking and the recency of the last drink prior to assessment. Significant improvement was noted on measures of neuropsychological function over the period from treatment admission to 6-month follow-up assessment On the average, improvement in functioning occurred across time despite drinking relapses during the intervening period. The individual's age, but not years of problem drinking, was associated with recovery of function; neither of these variables interacted with subsequent drinking status to affect differentially the changes in cognitive functioning. Finally, selected measures of neuropsychological function assessed both at admission and 6-month follow-up were reliably related to follow-up employment status but unrelated to the average amount of alcohol consumed per day and to the number of heavy drinking days during the 3-month period between the 6- and 9-month foltow-ups. The results are discussed in terms of the need for determining the utility of neuropsychological measures in predicting everyday functioning among alcoholics and for selecting domains of assessment other than cognitive status to predict treatment outcome. [ABSTRACT FROM AUTHOR]

Investigated the potential utility and validity of a measure of subjective helplessness, the H25. Helplessness is defined as the degree to which the individual perceives him/herself to be unable to influence or control the initiation and outcome of a variety of potentially reinforcing activities. Alcoholic subjects were classified into three levels of self-reported helplessness. An initial multivariate analysis of variance indicated that the groups differed with respect to severity level across a number of dimensions of depressive symptomatology, with the High Helplessness group appearing significantly more depressed on each of the measures than Low Helplessness subjects. Subsequent analyses supported the construct validity of the H25. Those measures found to be most descriminating between groups and most predictive of the level of helplessness reflected a dimension of behavioral retardation consistent with the motivational deficits noted in the learned helplessness model. Recommendations for the future validation of individual difference measures of helplessness are discussed. [ABSTRACT FROM AUTHOR]

Cites trauma centers as ideal sites for the implementation of an alcohol screening, intervention, and referral program in the United States. Attitude towards the effectiveness of alcohol treatment in trauma centers; Screening for alcohol problems in a trauma center.

Pilot data have provided tentative evidence that the degree of cognitive impairment may be a meaningful classificatory variable with respect to subsequent outcome. The purpose of the proposed study is to examine the differential effectiveness of short- and long-term intensive therapy for alcoholic subtypes defined by different levels of current problem-solving abilities. Subjects will be male alcoholic veterans participating in an inpatient treatment program at the Seattle Veterans Adminis tration Hospital. Patients volunteering to participate in thepresent study will initially be administered a neuropsychological test battery including the Wechsler Adult Intelligence Scale and tests from the Halstead battery. Scores from these tests will be used to determine the individuals' Brain-Age Quotient (BAQ), a measure of current adaptive abilities developed by Reitan. Measures of personality traits, psychosocial functioning, and drinking-related behavior will be collected on admission and at three-, six, and nine-month follow-up periods. Based on the antici pated findings of the present study, the length of the treatment program may be tailored to meet the specific needs, defined in terms of current adaptive abilities, of the individual client. Such a program would appear to maximize both the probabihty of a successful treatment outcome and mini mize unnecessary expenses. [ABSTRACT FROM PUBLISHER]

Focuses on various literary works related to addictive behavior as of January 1988. Conceptual models of addictive behavior; Discussion on transition and maintenance of addictive behavior; Factors affecting active change process.

The article focuses on a study which investigates the Luria-Nebraska Intellectual Processes Scale as a predictor of Wechsler Adult Intelligence Scale (WAIS) IQs among alcoholic inpatients. Subjects were 28 males who were receiving inpatient alcoholism treatment. Patients were administered the WAIS and the Luria-Nebraska Neuropsychological Battery as part of a more extensive investigation of neuropsychological assessment in alcoholics. Frequency of agreement between obtained IQs and those predicted from the present regression equations was assessed using Wechsler's seven category classification system.

The article focuses on an evaluation of a program based upon congnitive-behavioral techniques as it impacts on the depressed affect and behavior of people with epilepsy. Findings from a controlled, randomized study indicate that recently developed cognitive-behavioral interventions result in significant decreases in depression and increases in related areas of psychosocial functioning that are maintained over time. These preliminary findings suggest the potential usefulness of such psychoeducational skills training programs in the treatment of psychosocial dysfunction among individuals with epilepsy.

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 article discusses the shifts in perceptual differentiation and defense mechanisms in alcoholics. The construct of psychological differentiation allows the prediction of a number of cognitive, behavioral, and personality dimensions from an individual's characteristic, self-consistent style of engaging a perceptual field. Field-dependent persons are those who are unable to make accurate perceptual judgments divorced from contextual cues of the field. The present study investigated the stability of perceptual differentiation and one of its correlates, defense mechanisms, in an alcoholic sample. Defense mechanisms, found to be significantly related to the level of differentiation among alcoholics, have been shown to be relatively stable across time.

The article reports on the shifts in component factors of locus of control as a function of treatment in male alcoholics. The concept of locus of control is related directly to the degree of accountability or responsibility that one perceives oneself to hive for events in one's life. Persons with an internal locus of control perceive life events and their consequences to be directly contingent upon their own behavior. In contrast, persons with an external orientation tend to see events in their lives as beyond personal control and unrelated to their actions.

The primary purpose of the article was to replicate the researcher A. Goss and T.E. Morosko and researcher J. Gozali and J. Sloan studies in an attempt to clarify the ambiguity of their results. A second purpose was to investigate the relationship between MMPI scales and two sets of factor analytically derived subscales of the Locus of Control scale. Psychologist J.B. Rotter's Locus of Control scale and the MMPI were administered to 100 male alcoholic veterans. Significant positive correlations were found betwenn total IE score and the F, D, Pt and Si scales; IE was found to correlate negatively with the L and K scales.

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.

Latino immigrant men are at increased risk for unhealthy alcohol use and related consequences due to social stressors associated with immigration. We assessed the associations of, and examined whether social stressors moderated associations between, alcohol use and alcohol-related consequences in a community-based sample of Latino immigrant men in Washington (N = 187). The mean Alcohol Use Disorders Identification Test Consumption (AUDIT-C) score was 6.3 (scores ≥ 4 indicate unhealthy alcohol use). More than half of the men (61.5%) reported experiencing discrimination in at least one setting and mean acculturative stress score was 18.3 indicating moderate levels of acculturative stress. Linear regression models were fit to assess main effects (associations between both alcohol use and social stressors and alcohol-related consequences) and moderation (whether the association between alcohol use and consequences varied based on experience of social stressors using multiplicative interaction) after adjustment for potential confounders. Alcohol use (β = 0.47, 95% CI = 0.20-0.73; p =.001), discrimination (β = 0.85, 95% CI = 0.27-1.43; p =.004), and acculturative stress (β = 0.13, 95% CI = 0.02-0.24; p =.025) were all associated with increased experience of alcohol-related consequences. The association between alcohol use and alcohol-related consequences was stronger for those with high levels of acculturative stress (p =.025) but not experience of discrimination (p =.587). Findings underscore the importance of social and cultural context in alcohol use and related consequences. Efforts to reduce negative consequences of drinking may include focus on reducing exposure to discrimination and acculturative stress. [ABSTRACT FROM AUTHOR]

The article discusses relationship between locus of control, self-report and non-obstrusive measures of anxiety. The subjects were 52 male alcoholic veteran inpatients who had volunteered to participate in a larger research projects None of the subjects was assessed to have organic brain syndrome or other major psychiatric diagnosis. The significant positive correlation between the Rotter's Locus of Control scale and Activity Preference Questionnaire supports psychologist W.J. Ray and M. Katahn's contention that locus of control and anxiety are conceptually separate, yet correlated, variables.

Objective: Negative affect is a significant predictor of alcohol relapse, and the relation between negative affect and drinking has been shown to be strongly mediated by alcohol craving. Thus, targeting craving during treatment could potentially attenuate the relation between negative affect and drinking. Method: The current study is a secondary analysis of data from the COMBINE study, a randomized clinical trial that combined pharmacotherapy with behavioral intervention in the treatment of alcohol dependence. Our goal in the current study was to examine whether a treatment module that targeted craving would predict changes in negative mood during the 16-week combined behavioral intervention (n = 776) and the relation among changes in mood, craving, and changes in heavy drinking during treatment and 1 year posttreatment. Results: Changes in negative mood were significantly associated with changes in heavy drinking during treatment (f² = 0.78). Participants (n = 432) who received the craving module had significantly fewer heavy drinking days during treatment (d = 0.31), and receiving the module moderated the relation between negative mood and heavy drinking during treatment (f² = 0.92) and 1 year posttreatment (f2 = 0.03). Moderating effects of the craving module were mediated by changes in craving during treatment. Within-subject analyses indicated significant pre- to postmodule reductions in negative mood. Additionally, postmodule craving significantly mediated the association between negative mood and heavy drinking during treatment and at posttreatment. Conclusions: The craving module of the combined behavioral intervention may weaken the relation between negative affect and heavy drinking by fostering greater decreases in craving during treatment. [ABSTRACT FROM AUTHOR]

ABSTRACT. 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: (I) 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. [ABSTRACT FROM AUTHOR]

Abstract: The present study was designed to examine putative risk factors of driving anger, traffic citations, and traffic-related injuries as a function of gender. Participants included 785 (65% men) drivers identified by the Washington State Department of Licensing. Just over half of participants (55%) were identified as high-risk drivers based on multiple traffic violations, whereas 45% were recruited from a random sample of drivers. Participants completed a mailed survey assessing indicators of risky driving and risk factors including sensation seeking, stressful events, negative affect, tobacco use, and drinking behavior. Hierarchical regression analysis was used to evaluate risky driving outcomes as a function of theoretically prioritized risk factors and to evaluate gender as a moderator. Overall, men reported more traffic citations and injuries, but did not differ from women in reported driving anger. All putative risk factors were associated with one or more indicators of risky driving. Moderation results revealed that the positive relationship between drinking frequency and driving anger was stronger for women. In contrast, typical number of drinks consumed was negatively associated with driving anger, which was also more evident for women. In addition, the positive association between sensation seeking and number of traffic citations was stronger among women. [Copyright &y& Elsevier]

This study evaluated gender differences in baseline characteristics and treatment outcomes among 654 treatment seekers referred to state-funded drug treatment. Women were significantly less likely than men to enter treatment following referral, but not significantly less likely to complete treatment, once they entered. After adjustment for treatment dose, gender differences in substance use at followup (3–6 months after leaving the treatment waitlist) were nonsignificant. The genders did not differ significantly in rates of psychosocial improvement between referral and followup. Women waited significantly longer than men before leaving the treatment waitlist (with or without treatment entry), but wait time was associated with entry rates only among men. The authors discuss system-level and personal characteristics that potentially affect wait times and call for additional study of whether abbreviating waits can increase women''s treatment entry rates. [Copyright &y& Elsevier]

Background: Patients with a substance use disorder (SUD) often present with co-occurring chronic conditions in primary care. Despite the high co-occurrence of chronic medical conditions and SUD, little is known about whether chronic condition outcomes or related service utilization in primary care varies between patients with versus without documented SUDs. This study examined whether having a SUD influenced the use of primary care services and common chronic condition outcomes for patients with diabetes, hypertension, and obesity.Methods: A longitudinal cohort observational study examined electronic health record data from 21 primary care clinics in Washington and Idaho to examine differences in service utilization and clinical outcomes for diabetes, hypertension, and obesity in patients with and without a documented SUD diagnosis. Differences between patients with and without documented SUD diagnoses were compared over a three-year window for clinical outcome measures, including hemoglobin A1c, systolic and diastolic blood pressure, and body mass index, as well as service outcome measures, including number of encounters with primary care and co-located behavioral health providers, and orders for prescription opioids. Adult patients (N = 10,175) diagnosed with diabetes, hypertension, or obesity before the end of 2014, and who had ≥2 visits across a three-year window including at least one visit in 2014 (baseline) and at least one visit occurring 12 months or longer after the 2014 visit (follow-up) were examined.Results: Patients with SUD diagnoses and co-occurring chronic conditions were seen by providers more frequently than patients without SUD diagnoses (p's < 0.05), and patients with SUD diagnoses were more likely to be prescribed opioid medications. Chronic condition outcomes were no different for patients with versus without SUD diagnoses.Discussion: Despite the higher visit rates to providers in primary care, a majority of patients with SUD diagnoses and chronic medical conditions in primary care did not get seen by co-located behavioral health providers, who can potentially provide and support evidence informed care for both SUD and chronic conditions. Patients with chronic medical conditions also were more likely to get prescribed opioids if they had an SUD diagnosis. Care pathway innovations for SUDs that include greater utilization of evidence-informed co-treatment of SUDs and chronic conditions within primary care settings may be necessary for improving care overall for patients with comorbid SUDs and chronic conditions. [ABSTRACT FROM AUTHOR]

Highlights: Indigenous Peoples are concerned with previous experience of substance use research as disempowering.Community psychology principles may inform ethical community‐driven substance use research.We explore these principles through seven Indigenous substance use studies across the U.S. and Canada.Indigenous substance use research reflects, expands, and challenges community psychology principles.We discuss implications for Indigenous substance use research and community psychology. Many Indigenous communities are concerned with substance use (SU) problems and eager to advance effective solutions for their prevention and treatment. Yet these communities also are concerned about the perpetuation of colonizing, disorder‐focused, stigmatizing approaches to mental health, and social narratives related to SU problems. Foundational principles of community psychology—ecological perspectives, empowerment, sociocultural competence, community inclusion and partnership, and reflective practice—provide useful frameworks for informing ethical community‐based research pertaining to SU problems conducted with and by Indigenous communities. These principles are explored and extended for Indigenous community contexts through themes generated from seven collaborative studies focused on understanding, preventing, and treating SU problems. These studies are generated from research teams working with Indigenous communities across the United States and Canada—inclusive of urban, rural, and reservation/reserve populations as well as adult and youth participants. Shared themes indicate that Indigenous SU research reflects community psychology principles, as an outgrowth of research agendas and processes that are increasingly guided by Indigenous communities. At the same time, this research challenges these principles in important ways pertaining to Indigenous–settler relations and Indigenous‐specific considerations. We discuss these challenges and recommend greater synergy between community psychology and Indigenous research. [ABSTRACT FROM AUTHOR]