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Although Latino immigrant men experience many health disparities, they are underrepresented in research to understand and address disparities. Community Based Participatory Research (CBPR) has been identified to encourage participant engagement and increase representation in health disparities research. The CBPR conceptual model describes how partnership processes and study design impact participant engagement in research. Using this model, we sought to describe how these domains influenced participant engagement in a pilot randomized controlled trial of brief intervention for unhealthy alcohol use (n = 121) among Latino immigrant men. We conducted interviews with a sample of study participants (n = 25) and reviewed logs maintained by 'promotores'. We identified facilitators of participant engagement, including the relevance of the study topic, alignment with participants' goals to improve their lives, partnerships with study staff that treated participants respectfully and offered access to resources. Further, men reported that the study time and location were convenient and that they appreciated being compensated for their time. Barriers to participant engagement included survey questions that were difficult to understand and competing demands of work responsibilities. Findings suggest that engaging underserved communities requires culturally responsive and community engagement strategies that promote trust. Future studies should further investigate how CBPR partnership processes can inform intervention research.

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]

Objective: Many trials have demonstrated the effectiveness of cognitive behavioral interventions for alcohol dependence, yet few studies have examined why particular treatments are effective. This study was designed to evaluate whether drink refusal training was an effective component of a combined behavioral intervention (CBI) and whether change in self-efficacy was a mechanism of change following drink refusal training for individuals with alcohol dependence. Method: The present study is a secondary analysis of data from the COMBINE study (COMBINE Study Research Group, 2003), a randomized clinical trial that combined pharmacotherapy with behavioral intervention in the treatment of alcohol dependence. The goal of the present study was to examine whether a drink refusal skills training module, administered as part of a 16-week CBI (n = 776; 31% female, 23% non-White, average age = 44) predicted changes in drinking frequency and self-efficacy during and following the CBI, and whether changes in self-efficacy following drink refusal training predicted changes in drinking frequency up to 1 year following treatment. Results: Participants (n = 302) who received drink refusal skills training had significantly fewer drinking days during treatment (d = 0.50) and up to 1 year following treatment (d = 0.23). In addition, the effect of the drink refusal skills training module on drinking outcomes following treatment was significantly mediated by changes in self-efficacy, even after controlling for changes in drinking outcomes during treatment (proportion mediated = 0.47). Conclusions: Drink refusal training is an effective component of CBI, and some of the effectiveness may be attributed to changes in client self-efficacy. (Contains 1 table, 2 footnotes, and 3 figures.)

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 (f[superscript 2] = 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 (f[superscript 2] = 0.92) and 1 year posttreatment (f[superscript 2] = 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. (Contains 3 tables, 1 footnote, and 4 figures.)

Indigenous communities have engaged in needs and resources assessments for thousands of years. By blending CBPR/TPR approaches with community-driven assets and needs assessments, academic and community based researchers can work together to better understand and identify community strengths as well as issues of concern in Native communities. This best practice approach can set research agendas that are relevant to Native communities and result in interventions and health promotion programs that are respectful of Tribal sovereignty and that incorporate unique traditions and strengths of Native communities. A successful research partnership to develop and implement a needs and resources assessment using CBPR/TPR approaches is presented using a case study that can be used as a model for other research partnerships.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2010.05.008 Byline: Bryan Hartzler (a), Dennis M. Donovan (a)(b), Zhen Huang (c) Keywords: Opiate treatment; Alcohol misuse; Psychosocial functioning Abstract: Many persons seeking opiate treatment present with complex clinical challenges, which may be exacerbated by alcohol misuse. This report details secondary data analyses aggregating treatment-seeking samples across 10 National Institute on Drug Abuse (NIDA) Clinical Trials Network treatment trials to examine alcohol-related characteristics of opiate-primary (OP) clients and compare broad pretreatment characteristics of those with and without an alcohol use disorder (AUD). Analysis of this aggregate OP client sample (n = 1,396) indicated that 38% had comorbid AUD and that a history of alcohol treatment episodes and recent alcohol problems were common. Further, comparisons of OP clients with and without AUD revealed the former were more likely to have had a history of pervasive difficulties in psychosocial functioning. Findings suggest the need for detection of and intervention for alcohol misuse at the outset of opiate treatment and support for the practice of availing medical, psychological, case management, and other support services. Author Affiliation: (a) Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105-4631, USA (b) Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98105, USA (c) Duke Clinical Research Institute, Duke University, Durham, NC 27708, USA Article History: Received 27 January 2010; Revised 19 April 2010; Accepted 5 May 2010

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 [...]

Objective: The aim of this study was to examine the efficacy of pharmacological and behavioral interventions across 1 year posttreatment in the COMBINE (Combining Medications and Behavioral Interventions) Study. Method: Alcohol-dependent individuals (N = 1,383; 428 women) recruited at 11 outpatient academic alcoholism-treatment clinics across the United States participated in a randomized, double-blind, placebo-controlled trial. They received 16 weeks of naltrexone (Revia) or acamprosate (Campral) or both medications and/ or placebos in combination with medical management (MM), with or without combined behavioral intervention (CBI); one group received CBI without pills or MM. Drinking behavior and clinical status were assessed at the end of treatment (Week 16) and at Weeks 26, 52, and 68. Results: Prior treatment with active naltrexone, without active acamprosate or CBI or with active acamprosate plus CBI, and CBI with double placebo resulted in a significantly higher percentage of days abstinent than double placebos with no CBI (p < .05). Having received CBI was associated with positive clinical response posttreatment, compared with not having received CBI. Prior treatment with naltrexone increased the time to the first heavy-drinking day posttreatment (p = .03). No differences were found between patients who had received CBI without MM or pills and those having received MM and double placebo with or without CBI. No significant main effects for acamprosate were found on any of the outcome measures. Conclusions: Previous treatment with MM and either CBI or naltrexone, or both, but not acamprosate, was associated with sustained efficacy beyond discontinuation. Reasons for the maintained treatment gains with naltrexone and/or CBI and potential methods to extend them are discussed., THE AVAILABILITY OF PHARMACOTHERAPIES aimed at achieving abstinence and minimizing relapse provides promise for improving the effectiveness of alcoholism treatment. Naltrexone (Revia, Vivitrol) and acamprosate (Campral), both approved by the [...]

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., THE ALCOHOL USE DISORDERS Identification Test (AUDIT; Babor et al., 2001; Saunders et al., 1993) was developed as a simple method to screen for hazardous and harmful patterns of alcohol [...]

This study examines relationships between both family structure and living with extended family, and substance use among 97 American Indian/Alaska Native (AI/AN) adolescents. Findings demonstrate an increased likelihood of alcohol [...]

Objective: The Alcohol Dependence Scale (ADS) yields continuous scores purported to reflect the severity of the dependence syndrome. We evaluated the concurrent validity of the ADS as a general measure of severity and the screening accuracy of the total score and subscales to detect Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), physiological dependence. Method: Treatment-seeking, alcohol-dependent individuals entering the Combining Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) Study (N = 1,372; 69% men) completed the ADS, diagnostic interviews, and other measures before randomization. Analyses of variance tested differences between ADS quartiles on alcohol-related measures. Areas under the receiver operating characteristic (AUROC) curve assessed screening accuracy for DSM-IV physiological dependence (tolerance or withdrawal) or withdrawal alone. Results: ADS quartiles differed on age, other demographics, and prior treatment episodes. Linear correlation showed moderate to large magnitude associations with alcohol-related self-report measures and most indices of consumption. ADS quartiles differed significantly on proportion with DSM-IV physiological dependence, but AUROC curves indicated that the ADS had limited accuracy as a continuous measure to detect DSMIV physiological dependence (AUROC = .75 [95% confidence interval {CI}: .70-.79] and .67 [95% CI: .60-.74] for men and women, respectively; p = .08) or withdrawal alone (AUROC = .77 [95% CI: .74-.80] and .74 [95% CI: .69-.79] for men and women, respectively; p = .30). Screening accuracy was comparably limited based on ADS subscales reflecting psychoperceptual or psychophysical withdrawal. Conclusions: The ADS reflected variation in symptom severity but did not adequately identify physiological dependence or withdrawal in treatment-seeking individuals with DSM-IV alcohol dependence. (J. Stud. Alcohol Drugs 68: 149-156, 2007), FOLLOWING THE RECOGNITION of alcoholism as a medical illness (Jellinek, 1952) and before the advent of Diagnostic and Statistical Manual (DSM-IV; American Psychiatric Association, 1994) criteria for alcohol dependence, researchers [...]

A study to evaluate the efficacy of medication, behavioral therapies, and their combinations for treatment of alcohol dependence and to evaluate placebo effect on overall outcome is presented. A positive effect of receiving placebo medication and medical management over and above that seen with specialist-delivered behavioral therapy alone is observed and so medical management of alcohol dependence with naltrexone appears to be feasible.

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 follow-up (3-6 months after leaving the treatment waitlist) were nonsignificant. The genders did not differ significantly in rates of psychosocial improvement between referral and follow-up. 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. Keywords: Gender; Substance abuse treatment; Treatment entry; Treatment completion; Abstinence

This study evaluated the relative effectiveness of two forms of publicly funded substance abuse treatment provided in Washington State: The full continuum (FC), in which clients receive approximately three weeks of inpatient treatment prior to outpatient care, and the partial continuum (PC), in which clients are admitted directly to outpatient treatment. Data on treatment process/proximal outcomes, such as psychological distress and readiness to change, were assessed at 8 weeks post intake, and data on treatment services received were obtained at 2, 4, 8, and 12 weeks. Multidimensional outcomes, including alcohol and drug use as well as a number of psychosocial functioning outcomes, were assessed at 3 and 9 months post intake. Results indicated that clients in the FC had greater alcohol, drug, and legal problem severity at intake than those in the PC, whereas medical and employment problem severity was greater in the PC. Clients in the FC received more treatment services in the first 2 weeks than those in the PC, but there were no differences at subsequent points. Outcome analyses at 3 and 9 months indicated that clients in the FC had greater improvements in alcohol, drug, and psychiatric severity than those in the PC. Matching analyses indicated that clients with greater substance-use severity at baseline improved to a greater degree in the FC as compared to the PC. Matching effects were not obtained with medical or psychiatric severity, or readiness to change., INTRODUCTION Current public policy in many states, including Washington, is based on the assumption that the multi-problem public patient needs a full continuum of care (FC) starting with an inpatient [...]