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ALCOHOL DEPENDENCE IS A POTENT risk factor for suicidal ideation and behavior. A meta-analysis of international studies estimated that individuals with alcohol dependence are at 9.8 (95% confidence interval [CI]: [...], Objective: Using a heuristic model of suicidal ideation and behavior, the two objectives were to identify correlates of(l) unique suicide-related outcomes (ideation, planning, planned attempt, unplanned attempt) and (2) specific transitions from one suicide-related category to the next. Method: Analyses were conducted with data from the Collaborative Study on the Genetics of Alcoholism (COGA), a six-site family pedigree study of individuals in treatment for alcoholism, their relatives, and control families. There were 3,729 subjects in the analysis; all were age 18 years or older with a diagnosis of current alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Lifetime suicidal ideation, planning, and attempts were analyzed retrospectively. Correlates of each lifetime transition were analyzed using a series of multivariate logistic regressions. Multivariate multinomial regression analysis was used to examine correlates of each lifetime outcome. Results: Female gender is uniquely associated with transitions to unplanned and planned attempts. Independent depression and substance-induced depression are associated with transitions to ideation and planning, whereas alcohol-related aggression is correlated with transitions to unplanned attempts. Analyses of suicide-related outcomes show that women are at higher risk for unplanned and planned attempts. Substance use and impairment are related to suicidal plans and attempts but not ideation. Independent and substance-induced depressions are associated with each suicide-related outcome, whereas alcohol-related aggression is uniquely related to unplanned attempts. Conclusions: Data underscore the heterogeneity of suicidal ideation and behavior among alcoholics and indicate the need to make clear distinctions between types of suicidal ideation and behavior in research and prevention efforts.

THE CONSTRUCT OF DIRECTIVENESS historically has been given multiple meanings in the psychotherapy and counseling fields. Early psychotherapy research characterized directiveness as leading the client (Ashby et al., 1957) or [...], Objective: This study examined the interactions of therapist directiveness with patient anger and patient reactance among an alcohol-treatment-seeking sample. Method: Participants in the study consisted of 139 individuals with alcohol abuse or dependence who received treatment at a single clinical research unit of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity). Analyses tested for the independence of the two interactions, identified components within the directiveness construct and examined the relationship between those components and the patient attributes. Results: Results showed that the interactions between directiveness and anger and between directiveness and reactance each accounted for unique variance in predicting posttreatment alcohol use as measured by percentage of days abstinent (PDA) and percentage of heavy drinking days (PHDD). Principal components analysis of the directiveness construct generated two underlying components that were interpreted to be confrontation and structure. Significant interactions were observed between patient reactance and both the confrontation and structure components. Confrontation also interacted with patient anger; however, no interaction was found between anger and structure. Conclusions: The interactions of therapist directiveness with patient anger and reactance demonstrated both shared and unique qualities. These results highlight the importance of focusing on specific aspects of directiveness to better understand the effect of patient-treatment interactions on alcohol use. This study has implications for theory and research as well as for the delivery of treatment services.