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INTRODUCTION Historically, women with alcohol use disorder (AUD) have been an underserved population. In the United States, more than 5 million adult women, or 4.2% of the adult female population, [...]

Although alcohol use disorders (AUDs) adversely affect women, research on efficacious treatments for women is limited. In this randomized efficacy trial of 102 heterosexual women with AUDs, the authors compared alcohol behavioral couple therapy (ABCT) and alcohol behavioral individual therapy (ABIT) on percentage of days abstinent (PDA) and percentage of days of heavy drinking (PDH) over 6 months of treatment and 12 months of posttreatment follow-up. Baseline relationship functioning and comorbid disorders were tested as moderators of outcome. Piecewise linear growth models were used to model outcomes. During treatment, women increased their PDA and decreased their PDH, with significantly greater improvements in ABCT than in ABIT (d = 0.59 for PDA; d = 0.79 for PDH). Differences favoring ABCT were maintained during follow-up. Women with poorer baseline relationship functioning improved more on PDA during treatment with ABCT than with ABIT. For PDH, results during treatment and follow-up favored ABCT for women with better baseline relationship functioning. ABCT resulted in better outcomes than ABIT for women with Axis I disorders at the end of follow-up (PDA), and for women with Axis II disorders at the end of treatment (PDA) and at the end of follow-up (PDH). (Contains 3 footnotes, 5 tables, and 5 figures.)

Ninety men with alcohol problems and their female partners were randomly assigned to 1 of 3 outpatient conjoint treatments: alcohol behavioral couples therapy (ABCT), ABCT with relapse prevention techniques (RP/ABCT), or ABCT with interventions encouraging Alcoholics Anonymous (AA) involvement (AA/ABCT). Couples were followed for 18 months after treatment. Across the 3 treatments, drinkers who provided follow-up data maintained abstinence on almost 80% of days during follow-up, with no differences in drinking or marital happiness outcomes between groups. AA/ABCT participants attended AA meetings more often than ABCT or RP/ABCT participants, and their drinking outcomes were more strongly related to concurrent AA attendance. For the entire sample, AA attendance was positively related to abstinence during follow-up in both concurrent and time-lagged analyses. In the RP/ABCT treatment, attendance at posttreatment booster sessions was related to posttreatment abstinence. Across treatment conditions, marital happiness was related positively to abstinence in concurrent but not time-lagged analyses.

Alcoholics Anonymous (AA) and behavior therapy have been characterized as having opposing views of alcoholism. This article describes theoretical foundations, view of the change process, and treatment practices of AA and behavior therapy. Theoretical and practice perspectives on integration of the two models are examined, and advantages and disadvantages of integration are discussed. (Author)

Topics of the nature and treatment of alcoholism have been investigated for years, only recently have they begun to interface and complement one another. This and following articles address interface from both perspectives and cover content areas that touch on current issues, research and treatment trends, and controversies in the alcohol field. (BF)

Objective: The current study examined the distinction between primary and secondary depression among substance use patients to test whether the primary depressed subgroup presents to treatment with a unique profile of clinical and vulnerability characteristics. Method: The heterogeneous sample comprised 286 individuals (76% male) with alcohol and/or drug abuse or dependence (according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised) across four treatment outcome studies conducted at the alcohol research center at the Rutgers University Center of Alcohol Studies. Participants were classified as having comorbid lifetime history of primary depression (21%), secondary depression (24%), or no depression (55%). Results: Participants in the primary depression and secondary depression groups were comparable in severity of substance use, and both of these groups had more severe substance use problems than the no-depression group. The primary depression group presented with more severe depression histories, higher levels of current depressive symptoms, and higher rates of additional Axis I comorbidity at treatment entry. In terms of vulnerability indices, the primary depression subgroup had a uniquely high family history risk for major depressive disorder; underlying personality vulnerability to depression was also evident in the primary depression group, with higher neuroticism and lower extraversion relative to secondary depression patients. Conclusions: The findings suggest that careful assessment of lifetime depression symptoms vis-a-vis substance use history and severity yields important information identifying the primary depression subtype of substance use patients as a group with a unique and more severely affected clinical presentation of depression and other Axis I psychopathology relative to secondary depression patients. Effectiveness of substance use interventions may be augmented with depression treatment for primary depression patients, given their more severe clinical presentation and vulnerability characteristics. (J. Stud. Alcohol Drugs, 72, 151-157, 2011), DEPRESSIVE DISORDERS ARE HIGHLY comorbid with drug and alcohol use disorders (i.e., substance use disorders [SUDs]; Grant, 1995; Grant and Hartford, 1995; Grant et al., 1996; Substance Abuse and Mental [...]

Objective: This study tested an integrated relapse model drawing hypotheses from both interpersonal and intra-individual relapse models. It was hypothesized that the relationships between alcohol-specific social support (support for drinking and support for not drinking) and drinking outcomes would be partially mediated by motivation. Method: Participants were 158 women with alcohol use disorders participating in two linked randomized controlled trials. One trial compared standard individual cognitive behavioral therapy (CBT) for alcohol use disorders with female-specific CBT for alcohol use disorders; the other compared alcohol behavioral couple therapy with blended individual CBT and alcohol behavioral couple therapy. Measures included the Important People Interview to measure social-support variables, the Timeline Followback to measure drinking variables, and the Stages of Change Readiness and Treatment Eagerness Scale to measure motivation. Results: Results of structural equation modeling suggested a mediational role of motivation in the relationship between support for drinking and drinking frequency. Individuals with more network support for drinking at baseline had less motivation for abstinence at the end of treatment, which predicted drinking frequency over the 6 months after treatment. The indirect effect of baseline support for drinking on 6-month follow-up drinking frequency was statistically significant. A similar, although only marginally significant, pattern was found for the relationship between support for not drinking and drinking frequency. Individuals with more social network for not drinking at baseline had more motivation at the end of treatment at the trend level, which in turn predicted 6-month follow-up drinking frequency. The indirect effect of baseline support for not drinking on 6-month follow-up drinking frequency trended toward significance. Conclusions: This study offers preliminary evidence that motivation is one mechanism by which abstinence-specific social support affects treatment outcome. (J Stud. Alcohol Drugs, 71, 930-937, 2010), FOR PEOPLE WITH ALCOHOL USE DISORDERS, social support has been found to predict positive drinking outcomes (Hunter-Reel et al., 2009). Lower levels of drinking are correlated with the degree of [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2008.04.001 Byline: David P. Menges (a), Barbara S. McCrady (b), Elizabeth E. Epstein (a), Charles Beem (c) Keywords: Alcohol; Psychometric; Assessment; Relapse; High-risk situations Abstract: The Drinking Patterns Questionnaire (DPQ) is a self-report instrument designed to identify high-risk (HR) drinking situations. While prior investigation has established the preliminary psychometric properties of the DPQ, additional research is needed. The current study evaluated the construct validity of the Work-Related, Financial, Parents, and Children subscales of the DPQ as well as the internal consistency of all subscales. Author Affiliation: (a) Center of Alcohol Studies, Rutgers, The State University of New Jersey, 607 Allison Rd., Piscataway, NJ 08854, USA (b) Center on Alcoholism, Substance Abuse, and Addictions, The University of New Mexico, MSC11-6280, 2650 Yale Blvd. SE, Albuquerque, NM 87106, USA (c) Caron Treatment Services, PO Box 150, Wernersville, PA, 19565, USA

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2007.12.004 Byline: Blaise L. Worden, Barbara S. McCrady, Elizabeth E. Epstein Keywords: Assessment; Alcoholism; Posttreatment follow-up; Interview Abstract: Little research has been conducted on symptom reductions in response to assessments in clinical trials, despite the impact such reactivity may have on interpretation of outcomes. Reactivity to data collection procedures during post-treatment follow-up may obscure treatment effects. The current study examined whether female participants (n =102) in a trial of cognitive-behavioral treatment for alcohol dependence had lower drinking quantity and frequency immediately after participating in follow-up assessments. Repeated measures ANOVAs were used to compare each participant's drinking among two-week time periods immediately before the follow-up, directly after the follow-up, and between follow-ups. No assessment reactivity was found for 9 or 15 month follow-up interviews, but was suggested at a 12 month in-person interview. Author Affiliation: Rutgers University, Center of Alcohol Studies, 607 Allison Road, Piscataway, NJ 08854, United States of America

Objective: Research indicates that the social networks of women differ from those of men. Although studies indicate that social support greatly affects alcohol use, little attention has been paid to gender differences in this area. The objective of the current study is to examine the pretreatment social networks of women seeking conjoint treatment for an alcohol-use disorder. Method: As part of a larger randomized clinical trial, 102 women in committed heterosexual relationships who were seeking treatment for an alcohol-use disorder at an outpatient clinic were interviewed before treatment entry. Participants completed the Important People and Activities Instrument to assess the size and composition of the women's social networks. Pretreatment drinking was assessed using the Timeline Followback interview. Results: Participants in this study reported fairly large supportive networks. Drinking quantity and frequency in the 3 months before treatment were examined in light of social network connection. Women with moderate/heavy drinking partners reported more drinking days but drank fewer drinks per drinking day than women with light drinking/abstaining partners. In addition, we found a positive association between the number of drinkers in the social network and the participant percentage of drinking days. Conclusions: The main findings of this study were the significant interrelationships between moderate or heavy drinking among social network members and the drinking patterns of women with alcohol-use disorders. (J Stud. Alcohol Drugs 68: 871-878, 2007), SUBSTANTIAL EVIDENCE HAS ACCUMULATED to suggest that women and men drink differently and that consequences associated with drinking differ by gender (Bischof et al., 2005; Pettinati et al., 2000). Likewise, [...]

Objective. We tested the effectiveness of a long-term coordinated care strategy--intensive case management (ICM)--compared with usual care (UC) among a group of substance-dependent women receiving Temporary Assistance for Needy Families (TANF). Methods. Substance-dependent women on TANF (N = 302) were recruited from welfare offices. They were assessed and randomly assigned to ICM or UC; follow-up was at 3, 9, and 15 months. UC consisted of a health assessment at the welfare office and a referral to substance abuse treatment and TANF services. ICM clients received ICM services in addition to UC services. Results. ICM clients had significantly higher levels of substance abuse treatment initiation, engagement, and retention compared with UC clients. In some cases, ICM treatment attendance rates were double those of UC rates. Additionally, almost twice as many ICM clients were abstinent at the 15 month follow-up compared with UC clients (P Conclusions. ICM is a promising intervention for managing the chronic nature of substance dependence among women receiving TANF. Future research should refine long-term care strategies--such as ICM--that address the chronic nature of substance dependence among low-income populations.

Objective: Participants in alcohol treatment outcome studies typically undergo extensive assessment protocols to determine eligibility and provide descriptive and predictive data before beginning therapy. Changes in alcohol consumption as a result of reactivity to assessment have generally not been studied; most researchers collapse data across the pretreatment period and compare them with within-treatment and posttreatment periods. Previously we found a reduction in drinking days from 90 days prebaseline to 3 months postbaseline, with no significant additional reduction during the second 3 months of treatment, in a clinical trial of cognitive-behavioral therapy (CBT) for alcohol-dependent women. The current study examined the points at which these participants stopped or reduced their drinking during the pretreatment assessment period. Method: As part of a randomized clinical trial of 6 months of individual or couples CBT for 102 alcoholic women, study participants were assessed briefly via a telephone screen, a 90-minute clinical intake session with their spouses, and then a 3- to 4-hour baseline research interview. Results: Changes in drinking frequency occurred at all four points in the pretreatment assessment process, resulting in 44% of the participants becoming abstinent before the first session of treatment. A decrease in drinking quantity across the assessment period also was found. Participants who significantly reduced drinking prior to Session 1 demonstrated better drinking outcomes during and 12 months after treatment. Conclusions: Changes in alcohol consumption during the assessment process in treatment outcome studies should be examined in future studies, as implications abound for interpretation of results from clinical trials. Also, implications regarding the active ingredients in brief interventions and mechanisms of the therapeutic impact of alcohol assessment should be further addressed., PARTICIPANTS IN TREATMENT OUTCOME studies on alcohol problems typically undergo extensive assessment protocols to assess eligibility and to provide descriptive and predictive data before beginning therapy sessions. Changes in alcohol [...]

Objective: Research suggests that high levels of dissatisfaction, conflict and aggression characterize the relationships of alcoholics. The present study addressed aspects of bidirectional violence that occur in the relationships of female alcoholics. Method: Participants were 109 women (and their partners) in a randomized clinical trial comparing individual and couple treatment for female alcoholics. Participants completed the Modified Conflicts Tactics Scale (CTS); four CTS subscales were calculated: Verbal Aggression, Psychological Coercion, Minor Violence and Severe Violence. Results: Sixty-one percent of the couples reported at least some violence (27% severe) between them in the prior year. In 23% of the couples, the woman was more severely violent than the man; in 11% of the couples, the man was more severely violent. Conclusions: Overall, results suggest that verbal aggression, psychological coercion and physical violence occur in the context of a distressed relationship., RESEARCH INTO THE INTIMATE couple relationships of alcoholics suggests that these relationships tend to be burdened with dissatisfaction and conflict (McCrady et al., 1998; O'Farrell and Fals-Stewart, 1999). Alcoholic couples [...]

Forty-eight patients undergoing inpatient detoxification for alcohol dependence were assigned to either brief advice (BA) to attend Alcoholics Anonymous or a motivational enhancement for 12-step involvement (ME-12) intervention that focused on increasing involvement in 12-step self-help groups. Attendance at 12-step groups did not differ significantly by treatment condition over 6 months of follow-up, nor did drinking outcomes. There was a significant interaction between 12-step experience and treatment condition, indicating that ME-12 was associated with relatively better alcohol outcomes at the low ends of 12-step experience, whereas BA was associated with relatively better outcomes at the high ends of 12-step experience. Results indicate that among patients undergoing alcohol detoxification, ME-12 may be beneficial only for those who have little experience with 12-step groups.

This expert consensus statement reviews evidence on the effectiveness of drug and alcohol self-help groups and presents potential implications for clinicians, treatment program managers and policymakers. Because longitudinal studies associate self-help group involvement with reduced substance use, improved psychosocial functioning, and lessened health care costs, there are humane and practical reasons to develop self-help group supportive policies. Policies described here that could be implemented by clinicians and program managers include making greater use of empirically-validated self-help group referral methods in both specialty and non-specialty treatment settings and developing a menu of locally available self-help group options that are responsive to client's needs, preferences, and cultural background. The workgroup also offered possible self-help supportive policy options (e.g., supporting self-help clearinghouses) for state and federal decision makers. Implementing such policies could strengthen alcohol and drug self-help organizations, and thereby enhance the national response to the serious public health problem of substance abuse. Keywords: Self-help groups; Mutual help organizations; Twelve steps; Effectiveness research; Policy

This study tracked pretreatment attrition of 120 callers, 84 of whom were potentially eligible for outpatient couple treatment for male drug abuse. Demographic, significant other, substance use, and access related variables were examined as predictors of intake and treatment entry. Results were similar to other findings regarding variables associated with initiation of individual substance use treatment, and 29% of eligible callers entered treatment. Men whose partners did not use substances or who used in moderation were more likely to attend the intake session, and couples who received referrals were more likely to enter treatment than those who responded to a newspaper advertisement. Key Words: Pretreatment attrition; Couple therapy; Drug abuser., Outpatient settings that treat substance abuse in the United States suffer from high pretreatment dropout rates and low treatment retention rates (1), especially compared to rates for treatment of other [...]