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Medical debt has grown dramatically over the past few decades. While cancer and diabetes are known to be associated with medical debt, little is known about the impact of other medical conditions and health behaviors on medical debt. We analyzed cross-sectional data on 9174 households - spanning lower-income, middle-income, and higher-income based on the Census poverty threshold - participating in the 2019 wave of the nationally representative United States Panel Study of Income Dynamics (PSID). The outcomes were presence of any medical debt and presence of medical debt≥ $2000. Respondents reported on medical conditions (diabetes, cancer, heart disease, chronic lung disease, asthma, arthritis, anxiety disorders, mood disorders) and on health behaviors (smoking, heavy drinking). Medical debt was observed in lower-income households with heart disease (OR = 2.64, p-value = 0.006) and anxiety disorders (OR = 2.16, p-value = 0.02); middle-income households with chronic lung disease (OR = 1.73, p-value = 0.03) and mood disorders (OR = 1.53, p-value = 0.04); and higher-income households with a current smoker (OR = 2.99, p-value0.001). Additionally, medical debt ≥$2000 was observed in lower-income households with asthma (OR = 2.16, p-value = 0.009) and a current smoker (OR = 1.62, p-value = 0.04); middle income households with hypertension (OR = 1.65, p-value = 0.05). These novel findings suggest that the harms of medical debt extend beyond cancer, diabetes and beyond lower-income households. There is an urgent need for policy and health services interventions to address medical debt in a wider range of disease contexts than heretofore envisioned. Intervention development would benefit from novel conceptual frameworks on the causal relationships between health behaviors, health conditions, and medical debt that center social-ecological influences on all three of these domains.

OBJECTIVE: The purpose of this study was to investigate the extent to which two of the more salient characteristics of a treatment research assessment protocol (i.e., the comprehensiveness of the assessment battery and the frequency of its administration) for alcohol use disorder contribute to reductions in substance use and related negative consequences. METHOD: Study participants were recruited from two hospital-administered substance use disorder outpatient clinics. Two hundred thirty-five individuals presenting for outpatient alcohol treatment screened study eligible and provided informed consent. Study participants were randomized to one of four research assessment conditions (i.e., frequent-comprehensive, frequent-brief, infrequent-comprehensive, and infrequent-brief) based on the crossing of a 2 (i.e., assessment comprehensiveness: comprehensive vs. brief) by 2 (i.e., assessment frequency: frequent vs. infrequent) factorial design. RESULTS: Individuals assigned to the frequent assessment conditions reported greater reductions in substance use and substance use–related negative consequences relative to their counterparts assigned to the infrequent assessment conditions. In addition, a greater proportion of individuals assigned to the frequent assessment conditions reported abstinence from both alcohol and other substances. CONCLUSIONS: The improvements in substance use and related negative consequences associated with more frequent research assessments were statistically significant and clinically meaningful.

The first year following alcohol use disorder (AUD) treatment has been identified as a period of high risk for relapse and an important timeframe for enquiry regarding alcohol-related behavior change and its maintenance. In addition, at least among individuals with AUD, alcohol use and negative consequences have been shown to be reciprocally related. A commonly used measure of alcohol-related negative consequences is the Drinker Inventory of Consequences (DrInC). Investigations of specific categories of alcohol-related negative consequences and their trajectories, however, have been lacking. Given this background, the purpose of this study was to: follow the course of the 5 DrInC categories of alcohol-related negative consequences over the first year post-AUD treatment initiation; investigate whether these trajectories varied by gender, age, and/or treatment condition; examine the relationships between these trajectories and subsequent drinking behavior; and investigate whether these relationships varied by gender, age, and/or treatment condition, via secondary data analyses. Data from the outpatient arm of Project MATCH (n = 952) were utilized. Study results revealed that the trajectory of each DrInC category was indicative of improved alcohol-related problems across the first year posttreatment initiation. Specific DrInC categories varied as a function of gender, age, and treatment condition, and the trajectories were predictive of subsequent drinking behavior. Specifically, higher intercepts during the treatment period were associated with poorer drinking behavior 1 year later. Alternatively, steeper negative slopes were associated with improved drinking behavior. Some of these relationships were modified by gender, age, and treatment condition. It was concluded that assessing alcohol-related negative consequences during the first year posttreatment initiation period has clinical utility. (PsycINFO Database Record

Self-regulation theory (SRT) posits that individuals make decisions regarding behavior change based on a comparison of their actual (e.g., excessive alcohol use) and desired (e.g., abstinence) behaviors. This comparison must result in a discrepancy of sufficient magnitude to motivate an individual toward behavior change. It appears that this purported mechanism of behavior change (MOBC) has not been tested with regards to alcohol use disorder (AUD) treatment. Furthermore, there seems to be no psychometrically sound instrument for assessing such discrepancies in a clinical sample. The purpose of this study was to establish the psychometric properties of an instrument developed to assess actual versus desired alcohol use discrepancies that could be used to test this purported MOBC underlying SRT. The Alcohol Use Discrepancy Instrument (AUDI) was administered to 235 individuals participating in the Clifford et al. (2007) alcohol treatment outcome study that centered on research assessment exposure reactivity effects. Principal axis factor analysis yielded a unidimensional construct (Cronbach’s α = 0.80). Baseline and six-month AUDI scores were correlated with concurrent alcohol use (proportion days abstinent, drinks per drinking day, and proportion heavy days, p < .01) in expected directions. Parallel process models provided further evidence of the AUDI’s construct validity, as well as its potential as a measure of discrepancy as a MOBC. The AUDI has good psychometric properties and is likely to prove useful for assessing discrepancies between actual and desired alcohol use behavior, which, according to the principles of SRT, is essential for behavior change and maintenance.

Alcohol treatment researchers have speculated about the benefits of research participation (e.g., research follow-up interviews functioning as aftercare) for more than four decades (Gallen, 1974). Alternatively, research participation can decrease study design sensitivity and hamper the interpretability of research findings. To the extent that the typical alcohol treatment trial is characterized by frequent and comprehensive data collection, accounting for potential research assessment related effects is essential for proper interpretation of study findings. Given this background, the purpose of this article is to review the alcohol treatment research literature on assessment exposure resulting in subject reactivity. In addition, interventions that use data collection activities to inform clinical practice are receiving increased attention and such interventions share common characteristics with research assessment related clinical improvements. Therefore, a second purpose of this paper is to compare and contrast these two influences of behavior change. Study findings indicate that during- and post-treatment data collection activities (i.e., both research and clinical data) positively influence clinical outcomes, although there appears to be important differences regarding the mechanisms by which these two data collection activities exert their influence. Understanding of mechanisms of behavior change, effect boundaries, and the conditions under which clinical improvement is most likely to occur is only at a rudimentary level.

To replicate and extend the earlier work of Maisto and colleagues showing an association between early post-treatment alcohol use and later functioning (1, 2, 3).The present study classified adults presenting for alcohol use disorders (AUD) treatment (n = 114) into one of three drinker groups (i.e., abstainer, moderate drinker, or heavy drinker) based upon alcohol use during the first 6-months following outpatient AUD treatment initiation, and examined the associations between drinker group classification and later alcohol use and psychosocial functioning.Study results showed that individuals classified within the heavy drinker group tended to have the poorest outcomes (i.e., greater alcohol use and poorer psychosocial functioning) relative to individuals classified within the abstainer or moderate drinker groups.Study findings are consistent with the prior work of Maisto and colleagues. In addition, it appears that alcohol use, particularly heavy alcohol consumption, during the early post-treatment initiation period may serve as a marker for later alcohol related problems and poorer overall psychosocial functioning.

There has been increasing recognition among alcohol treatment researchers that research assessment exposure subject reactivity effects can contribute to clinical outcomes, decrease study design sensitivity, and confound research findings. The present study is an experimental investigation of two of the more salient components of the research assessment interview (i.e., frequency and comprehensiveness) and their effects on clinical outcomes (Part I: Alcohol Use and Related Consequences) and treatment participation (Part II: Treatment Engagement and Involvement).The study design was a 2 (Frequency of Assessment) x 2 (Comprehensiveness of Assessment) completely randomized factorial, and study participants were randomly assigned, using an urn randomization procedure, to one of the resulting four experimental research assessment exposure conditions: (1) frequent-comprehensive, (2) frequent-brief, (3) infrequent-comprehensive, and (4) infrequent-brief. Study participants were recruited from one of two hospital-based outpatient alcohol- and other substance-abuse clinics. Two hundred thirty-five subjects were randomly assigned to one of the four research assessment exposure conditions.Research assessment exposure subject reactivity effects were related significantly to alcohol use and related negative consequences, such that subjects assigned to the infrequent-brief research assessment exposure condition reported the poorest outcomes.The research protocols used to study alcohol treatments have clinical efficacy and can alter the outcomes (e.g., alcohol use) under investigation. It is important for researchers to control/account for subject reactivity effects when conducting alcohol treatment outcome trials. Accurate interpretation of data derived from clinical trials of alcohol treatments necessitates taking research assessment exposure subject reactivity effects into consideration.

This article summarizes the proceedings of a symposium that was organized and chaired by Patrick R. Clifford and presented at the 2005 Research Society on Alcoholism meeting in Santa Barbara, California. The aims of the presentation were to focus on the prediction and explanation of longer-term functioning following alcohol use disorders (AUD) treatment. Along these lines, Stephen A. Maisto, PhD, presented data (i.e., Project MATCH outpatient sample) on the relationship between drinking behavior in the first year following AUD outpatient treatment initiation and functioning at 3-year follow-up. Robert L. Stout, PhD, using data from the Extended Case Monitoring Study, analyzed long-term drinking patterns using shorter-term information. James R. McKay, PhD, examined the relationship between treatment services received and problem severities across a 2-year follow-up period. J. Scott Tonigan, PhD, served as the panel discussant.

This study examined the extent to which alcohol-related expectancies were associated with assaults among 278 injured drinkers in the emergency department setting. Results of logistic regression analyses indicated that patients who were male, had high blood alcohol levels and who expected alcohol to make them more careless were more likely to report being assaulted. Conversely, among males, patients who expected to become more powerful and aggressive when drinking were less likely to be assaulted. These findings suggest that helping patients understand how expectancies surrounding alcohol use shape drinking and its behavioral concomitants may circumvent their risk for future assaults.

Many published clinical trials have less than adequate follow-up. When conducting a clinical trial, researchers attempt to minimize data loss; however, some data may not be collected, particularly when subjects are lost to follow-up. Careful planning of research protocols, including comprehensive initial data collection, identification of locators, flexible scheduling, systematic subject tracking, monitoring subject loss, and systematically approaching problem cases can ensure high follow-up rates. This article presents a compendium of techniques and procedures that researchers can use to enhance follow-up and address attrition in their studies. Finally, this article outlines statistical techniques that can be used to address the effects of missing data, particularly when patients are lost to follow-up.

Objectives: The purpose of this paper is to better understand marijuana use among injured problem drinkers in the emergency department (ED). The specific objectives are: 1) to assess the prevalence of marijuana use; 2) to identify factors associated with marijuana use; 3) to determine whether prior injury is associated with marijuana use; and 4) to determine whether marijuana-using problem drinkers want to change behaviors. Methods: The authors conducted a post-hoc analysis on data obtained prospectively. Subjects had injury and problem drinking: either measurable alcohol level (blood alcohol concentration, BAC), report of drinking, or an Alcohol Use Disorders Identification Test (AUDIT) score of $8. The study was conducted on weekend nights; 3,776 injured ED patients were screened, 383 refused, 578 were enrolled, and 433 had complete data. Results: Of the 433 subjects, 48.3% reported using marijuana in the three months prior. Marijuana-using problem drinkers had more hazardous drinking, higher AUDIT scores (14.0 vs. 11.4, p < 0.001), and higher risk-taking scores (12.4 vs. 10.1, p < 0.001). More used other drugs (69.7% vs. 30.3%, p < 0.001). In regression analyses, marijuana use remained an independent predictor of prior injury (OR = 2.16, 95% CI = 1.25 to 3.75), particularly prior alcoholrelated (OR = 2.26, 95% CI = 1.45 to 3.53) and motorvehicle-related (OR = 1.69, 95% CI = 1.03 to 2.79) injury. Readiness-to-change scores were similar (4.14 vs. 4.22, p = 0.21) between users and nonusers. Conclusions: Marijuana use among injured problem drinkers is prevalent. Their risk of prior injury is increased. Counseling for alcohol and injury should address marijuana use. Key words: alcohol use; marijuana use; substance abuse; injury prevention; emergency medicine; brief intervention. ACADEMIC EMERGENCY MEDICINE 2003; 10:43‐51.

Attributions regarding alcohol treatment research protocols influencing clinical outcomes have persisted for more than 25 years. Although well-designed alcohol treatment outcome studies typically involve frequent, and often comprehensive, research assessment protocols, procedures are seldom in place to control or account for possible subject reactivity to the research protocol. This article presents a theoretical basis for a relationship between research protocols and treatment outcomes.The article reviews the relevant alcohol treatment outcome literature and presents a "weight of evidence" regarding subject reactivity effects and alcohol treatment outcome research assessment protocols. Also, the FRAMES (feedback, responsibility, advice, menu, empathy and self-efficacy) model was coupled with self-regulation theory to provide a theoretical explanation of how research assessment protocols might contribute to clinically relevant behavioral change.Researcher attributions, empirical investigations and theoretical considerations all provide evidence that is consistent with the existence of subject reactivity to research assessment protocols.Recommendations are made regarding interpretation of data collected as part of an alcohol treatment outcome study, control of potential subject reactivity confounding variables and directions for future research.

The purpose of the present study was to investigate whether sociopathic alcoholics respond differentially to different types of treatment. An earlier study found that alcoholics with antisocial personality disorder had somewhat better outcomes if treated in individually focused versus relationship-focused cognitive-behavioral treatment. The present study was designed to attempt to replicate these findings. One hundred and forty-nine alcoholics (42 of whom scored high on a measure of sociopathy) were randomly assigned to receive either individually focused cognitive-behavioral treatment or a relationship-focused community reinforcement approach. Follow-up evaluations were conducted every 4 months for 2 years. Results failed to support the study hypothesis. Drinking outcomes were similar for sociopathic alcoholics in both treatment conditions. Directions for future research are identified.

Aim. To determine the effectiveness of the Health Care Intervention Service (HIS), an early intervention program for general hospital patients with alcohol dependence or at risk for alcohol dependence . Design, setting and participants. HIS consists of screening, assessment and assignment to either full or risk-reduction intervention. Full intervention includes a referral to treatment. Outcomes were compared across three groups: those who received a full intervention, those who received a risk-reduction intervention, and a comparison group of similar patients from hospitals with no HIS program. Patients were screened for alcohol involvement and interviewed during their hospitalization (prior to the intervention in HIS hospitals) and again 6 months following the intervention . Findings. Full intervention was effective in increasing the probability of abstinence, reducing the number of heavy drinking days, and encouraging patients to accept the referral to treatment. Risk-reduction intervention was effective in reducing alcohol consumption and consequences, but only for those patients who had some signs of dependence at the first interview . Conclusions. HIS has demonstrated its effectiveness in a "real world" bureaucratic and clinical environment.

Drug policy advocates must move beyond simplistic concepts of supply reduction and demand reduction. A realistic drug policy must differentiate between drug use and abuse and must avoid contributing to the harm done by drug use. A harm reduction approach requires a more refined model representing the interactions of the complex system of variables which influences the outcomes of the drug experience. This paper examines some of the elements that should go into such a model.

Efforts to measure the effectiveness of drug policy have proven arduous. The barriers encountered when attempting to measure the relevant constructs of concern are numerous and complex. Furthermore, the conclusions drawn from a specific analysis are contingent upon the measures utilized. The difficulties are further complicated by problems of conceptualization, definition, legal status, attribution, sampling bias and response bias. The focus of the present paper is to identify some of these potential barriers and offer some practical solutions.

The major purposes of the study were: a) to examine the relationship between attitudes and self-reported levels of drinking; and b) to develop a stable prediction equation that included attitudes as a predictor of drinking behavior. A Likert-type survey was developed to measure college student's attitudes toward alcohol. The survey was administered to a sample of college students (n=1049). The coefficient alpha reliability estimate was found to be .91. Stepwise multiple regression procedures were used to ascertain the relationships between attitudes and other psychosocial constructs of drinking. The dependent variable was an alcohol consumption index. The analysis revealed that the seven variable model was the most parsimonious (R 2 =.46), and attitudes toward drinking was the strongest predictor of self-reported drinking behavior. A double cross-validation of the regression model indicated that the model was very stable, and therefore could be generalized to similar samples. The substantive findings related to students' self-reported drinking practices are also reported.

Drug problems, including alcohol and tobacco abuse, present major public health concerns for the American people. Drug abuse and its related difficulties have been associated with both increased morbidity and premature mortality. In the United States, ethnic minorities have experienced the overall negative impact of drug abuse much more severely than the general population. The impact of drug prohibition in the United States has not been to eliminate or minimize the use of illicit drugs. Indeed, in recent times, the use of some illegal substances (e.g., cocaine) has increased among certain segments of our population; while the use of licit substances (e.g., alcohol) has decreased among specific groups. Unfortunately, drug prohibition and related policies have contributed to the differential impact of the negative consequences of drug abuse on ethnic and racial minorities. The passage and enforcement of repressive drug laws, to curb what is essentially a public health problem, has not been demonstrated to be a productive mechanism for the amelioration of drug related problems within our minority communities.

Over the past 30 years in the United States, there have been marked secular increases in polydrug use. Alcohol and other substance use disorders are highly comorbid. Yet, little research has characterized patterns of polydrug use in persons with alcohol dependence. In particular, little is known about this population's use of alcohol and other drugs in combination or on the same day, which is termed simultaneous polydrug use (SPU). This research assessed patterns of SPU in 212 problem drinkers who participated in an alcohol treatment outcome study. Subjects were given a Time-Line Follow-Back interview that assessed the use of alcohol and nine other drug classes for each day of the 120 days before treatment entry. A majority of subjects (61%) reported SPU during this assessment interval. Subjects who reported SPU were disproportionately younger, male, and unmarried, compared with those who did not report SPU. The most common alcohol/drug combinations were alcohol with cocaine (60% of subjects who reported SPU), alcohol with marijuana (51% of SPU subjects), and alcohol with sedatives (31% of SPU subjects). The most common three-drug combination was alcohol, cocaine, and marijuana (23% of SPU subjects). Alcohol use and drug use were associated at the event level, significantly more than association predicted by the base rates of the individual behaviors. Time-Line Follow-Back data correlated highly with a questionnaire measure of SPU. Results indicate that polydrug use is an important focus for assessment and intervention in alcohol treatment programs.

Objectives: To examine the relationship between a saliva alcohol test (SAT) and hazardous/harmful drinking, as measured by the Alcohol Use Disorders Identification Test (AUDIT), among a sample of subcritically injured patients. Methods: Patients (n = 78) seeking treatment for a subcritical injury were saliva-tested for alcohol and interviewed regarding their drinking behaviors and related difficulties. Associations of SAT values with AUDIT results were determined. Results: SAT results and hazardous/harmful drinking were not independent events (p < 0. 001). Estimates of sensitivity and specificity (using a dichotomous SAT result [≥ 4 mmol/L] to identify positive AUDIT patients) were 65. 2% and 83. 6%, respectively. SAT-positive people had significantly higher AUDIT scores than did SAT-negative individuals (p < 0. 0001). Patients experiencing assault-type injuries were much more likely to be SAT-positive than were patients incurring other types of injury. Discriminant function analysis suggests that AUDIT scores can successfully identify SAT-positive and SAT-negative patients; the analysis accounted for 42. 5% of the variance and correctly classified 84. 6% of the sample. Conclusions: The use of an easy-to-administer, noninvasive, routine SAT, among patients presenting for a subcritical injury in a hospital ED, provides a mechanism for the identification of individuals with a history of hazardous/harmful drinking. However, since discrimination of hazardous/harmful drinking is imperfect, some caution is warranted when conducting such screening activities.

Objectives: To determine the incidence of alcohol use in subcritically injured patients presenting to the ED, by using a saliva alcohol test (SAT) at ED triage during the ED initial assessment; to compare the incidence of alcohol use revealed by the SAT with documentation of alcohol use by ED nurses and emergency physicians (EPs) blinded to the SAT results; and to describe the demographics of the SAT-positive, subcritically injured population. Methods: A blinded, prospective, observational evaluation of ED patients presenting with subcritical injuries was performed. The patients were tested for alcohol use with an SAT, and a subsequent record review was conducted for extraction of demographic data and evidence of documentation of alcohol use by ED nurses and EPs blinded to the SAT results. Results: During the study. 791 subcritically injured patients had SATs performed. Twenty-one percent of these patients were found to be alcohol-positive by SAT. Either the ED nurse or the EP documented a clinical impression of alcohol use for 52% of the SAT-positive patients. There were higher SAT-positive rates among men (24%), victims of assault (47%), and patients arriving at night (41%). Conclusions: While the SAT identified 21% of the subcritically injured patient population as alcohol-positive, ED nurse and EP documentation did not identify half of these alcohol-positive patients. Many of these patients may be at risk for additional injuries related to their drinking behavior.

The purpose of the study was to identify a stable model of psychosocial variables related to cocaine use among college students. Development and validation of this model could contribute to a useful cocaine abuse risk profile for college students. Of the 683 students who participated in the study, 179 reported using cocaine at least once in their life on an anonymous survey. The relationship between an index of cocaine use (coef. alpha = .79) and eight psychosocial variables was examined using a multiple regression procedure. The results indicated that two variables, perceived academic ability and interest in school, were significantly associated with scores on the cocaine index. Cross-validation procedures, including Tukey's Jackknife method, were conducted to ascertain the stability of the multiple regression model based on changes in the R-Squared value. The implications for future research and prevention programming efforts are discussed.

Clinical research and wisdom suggest that alcoholics with antisocial personality (ASPs) disorders have poorer drinking outcomes after treatment than alcoholics without this disorder. The present study challenges this wisdom, suggesting that poor prognosis and response to treatment have been confounded by not covarying on pretreatment drinking measures. Thirty-one ASPs are compared with 118 non-ASPs randomly assigned to extended cognitive behavioral and relationship enhancement treatments. Thirteen to 18 months after treatment initiation, ASPs average more abstinent days than do non-ASPs. Drinking intensity is a function of a patient-treatment matching effect: ASPs treated with cognitive behavioral treatment (CB) drink less/drinking day than do either non-ASPs treated in CB or ASPs treated in relationship enhancement. This finding is supportive of a comparable matching effect for CB and ASP found by Kadden et al. (1989). Examination of the process indicates that, irrespective of drinking index, ASPs respond poorly when they experience high posttreatment support for abstinence, whereas non-ASPs respond better with support. We conclude that early pessimism for successful treatment of ASP alcoholic drinking outcome may be unwarranted.

The psychometric properties of the Significant-other Behavior Questionnaire (SBQ), an instrument measuring the specific social support in terms of the patient's drinking. Assessments of the significant other's behavior in the presence of the patient drinking is provided by both the patient and significant other. Data from the two SBQ forms were analyzed with a principal axis factor analytic procedure with varimax rotation. The scales were similar for the two forms with four behavioral reactions, withdraw from the patient, support drinking, support sobriety, and punish drinking. Correlations between the two forms on the same four scales were higher than correlations within groups on three of four scales and differed from measures of general social support. Applications of the SBQ are discussed.

This study examined the associations between college students' self-reported alcohol use and corresponding collateral reports and identified factors that influence agreement between both sets of reports.Subject-collateral pairs (N = 300) were recruited from undergraduate psychology courses.Data yielded moderate correlations between subject-collateral pairs for all alcohol use measures, whereas discrepancy analyses revealed a tendency for subjects to report greater alcohol use relative to collateral reports. Greater subject-collateral agreement regarding frequency of subject alcohol use was predicted by a greater frequency of shared drinking occasions between the dyads, lower subject self-reported drug use, and lower levels of collateral guessing, whereas greater correspondence for quantity of alcohol consumed was predicted by fewer subject self-reported alcohol-related negative consequences, lower levels of subject self-reported drug use, and lower levels of alcohol ingestion among collaterals.College students appear to provide reasonably accurate self-reports of their alcohol use.

Polydrug use produces important health and safety risks. Little research has examined whether multiple drugs are used simultaneously (at the same time or in close temporal sequence). Instead, researchers have assessed concurrent polydrug use (the use of multiple drugs within a given time period such as years or months). The research here examined patterns and predictors of both simultaneous and concurrent polydrug use in 575 first-year college students. Both concurrent and simultaneous polydrug use were common for alcohol, tobacco, and marijuana. The percentage of concurrent polydrug users who were also simultaneous polydrug users ranged from 82% to 93% across subgroups defined by gender and the use of a single drug. Male gender, high levels of sensation seeking, and frequent alcohol use predicted single-drug versus polydrug use status as well as simultaneous polydrug use. Patterns and predictors of simultaneous and concurrent polydrug use should be addressed in prevention research and preventative interventions.

Individuals use a variety of drugs for a host of reasons and college students are no exception. Reasons provided for specific types of "recreational" drug use have included, but have not been limited to, medicinal, social, mood enhancement, and experimentation. In an attempt to discern the relationship between drug use and life satisfaction among college students, a slightly modified version of the National Institute on Drug Abuse (NIDA) Monitoring the Future Survey was administered to 683 students attending a major research university located in the southwestern United States. Based on the obtained study results a life satisfaction composite variable was created via factor analysis. Additionally, a polynomial multiple regression analysis was conducted to discern the association between the derived life satisfaction composite variable and drug use indices.

Objective: Previous research has shown a signifi cant rela- tionship between alcohol consumption in the fi rst year following alcohol treatment admission and longer term functioning. This fi nding is clinical- ly important and pertains to the clinical course of alcohol-use disorders (AUDs). This study investigated mediators of these relationships, focus- ing on the fi rst year after treatment admission and alcohol consumption 3 years later. Method: Analyses were conducted on the outpatient Project MATCH (Matching Alcohol Treatment to Client Heterogeneity) sample at baseline (N = 952) and at Months 37-39 after treatment admission (n = 802; hereafter referred to as 3 years). Participants were classifi ed as fi rst-year "abstainer," "moderate drinker," or "heavy drinker." A model featuring three latent variables (psychosocial functioning, self-effi cacy, and treatment experiences) whose indicators were collected at 15 months after treatment admission was initially tested for its fi t to the data. The 3- year outcomes were percentage of days abstinent and drinks per drinking day. Each model was run on randomly split subsamples and then cross- validated on the remaining participants. Results: Model tests by use of structural equation modeling methods showed poor model fi t, owing primarily to problems involving the psychosocial-functioning variable. Consequently, a reduced model was tested that dropped the psychosocial factor. Initial tests of this model showed an excellent fi t to the data that replicated across subsamples and 3-year drinking variables at the over- all model and individual path levels. There was strong support for the hypothesis that the total effects of fialcohol use on 3-year drink- ing is mediated in part (31% and 23% for the two drinking outcomes) through self-effi cacy to abstain from alcohol at 15 months. Conclusions: First-year posttreatment admission alcohol use predicts longer term (3- year) alcohol use, and a substantial portion of this relationship seems to be mediated through self-effi cacy at 15 months to abstain from alcohol use. The apparent benefi t of sustained abstinence in the fi rst year may be in part the result of facilitation in the rate or strength of the acquisition of self-effi cacy. Discussed are the clinical implications of these fi ndings as well as directions for future research involving longitudinal studies of alcohol use, treatment experiences, psychosocial factors, and their interaction both within the fi rst year and afterward in the determination of the clinical course of alcohol-use disorders. (J. Stud. Alcohol Drugs 69: 728-737, 2008)

Social norms-based interventions targeting college student drinking behaviors have become increasingly popular. Such interventions purportedly modify student misperceptions of fellow student drinking behaviors, which leads to changes in individual drinking behavior. Despite claims of successful interventions, research demonstrating that social norms-based interventions modify student perceptions is lacking.The authors conducted a laboratory experiment examining the feasibility of this mechanism of action and aimed to determine the validity of the campus-specific drinking norms hypothesis.The authors randomly assigned 60 students to 1 of 3 research conditions: Alcohol 101 (national drinking norms), a didactic presentation of campus specific drinking norms, or a control condition.Both intervention groups modified student misperceptions regarding peer alcohol use, and these changes were sustained 1 week later.Social norms-based interventions can contribute to more accurate drinking perceptions among college students.

A substantial number of the injured patients who go to the emergency department (ED) for treatment will have alcohol use issues and may be intoxicated at the time of treatment (Becker et al., 1995; Cherpitel, 1999; Freedland et al., 1993), and they are at risk from continuing to experience adverse health and psychosocial consequences (D’Onofrio et al., 2005; Dinh-Zarr et al., 2000; McDonald et al., 2004). As ED treatment presents a brief opportunity for the health-care professional to screen for and to address patients’ hazardous alcohol use, it is important that emergency-care professionals determine the most efficacious way to help individuals who may be amenable to changing their alcohol-related behaviors and reduce the likelihood of future negative consequences (Crawford et al., 2004; D’Onofrio et al., 2005). Brief motivational interviewing (BMI) is a therapeutic approach that has been employed to change patient behavior in a variety of clinical settings. This brief client-centered intervention focuses on helping patients identify behaviors that need to be changed, increased patient ambivalence, motivation, and planning for changing identified behaviors (Field et al., 2005;Miller and Rollnick, 2002). A meta-analysis on the use of BMI in randomized clinical trials in primary care settings has demonstrated effectiveness in reducing alcohol consumption in patients when compared with standard care (Burke et al., 2003; Moyer et al., 2002; Rounsaville et al., 2001). A more recent review of the literature suggests that BMI is generally more effective than standard care in the ED for reducing hazardous alcohol use, such as binge drinking, and in reducing alcohol-related injuries and negative consequences (P. Nilsen et al., unpublished data). However, treatment regimes such as BMI should not only demonstrate efficacy but also should provide an explanation of the mechanisms by which the treatment facilitates change in the patient (Rounsaville et al., 2001). In reviewing research on the treatment components for alcohol use, Miller (1985) concluded that therapist characteristics were seldom investigated as a predictor of patient motivation and treatment compliance (Miller, 1985). In explaining how treatments such as BMI work, it is important to understand what works by also looking at therapists’ behaviors, rather than only focusing on the patient characteristics that moderate treatment. This current investigation was conducted as a secondary analysis of data from a large-scale randomized clinical trial which demonstrated that injured ED patients, randomized into BMI with a booster BMI session, experienced better long-term outcomes than ED patients receiving standard care (SC), including reduced alcohol-related injuries and negative consequences (Longabaugh et al., 2001). Using an intention-to-treat model, the original study compared treatment effectiveness of injured ED patients (n = 539) randomization to: (1) SC (n = 188), (2) 1 session of BMI delivered in the ED setting (BI; n = 182), and (3) 2 sessions of BMI (BIB; n = 169) (one delivered in the ED and a later booster session delivered outside of the ED). In the original study, all recruited participants were at-risk drinkers by virtue of having a score of 8 or greater in the AUDIT, and/or having alcohol in their system at the time of injury or ED visit. The Institutional Review Board of the hospital and university approved the original research protocol. The outcome data analyzed in the present paper were provided by those participants recruited into the study who were interviewed 12 months after their initial injury-related ED visit (84%). These follow-up interviews were conducted by research assistants who were blinded to participant group assignment. The original study demonstrated that those participants assigned to the BIB condition as compared with those assigned to the SC, had fewer alcohol-related injuries and negative consequences during the 12 months after treatment (Longabaugh et al., 2001). However, because only 68% of the participants assigned to the BIB condition actually received the second BMI session, it is important to examine why some participants did not complete the second BMI session and to determine if completion of the second BMI was important in predicting treatment outcomes. As participants were demonstrating a selection bias in deciding whether or not to return to complete the treatment assignment, it was important (1) to determine what effect that this lack of treatment completion had on participant outcomes and (2) to examine what therapists behaviors may have influenced the decisions of the participants to complete treatment, after we have ruled out competing theories of participant characteristics that were associated with treatment completion.

This is the second of two articles in this issue on participant reactivity to alcohol treatment research assessment protocols. In the first article, Clifford et al. presented experimental evidence that the combination of less frequent and less comprehensive assessment results in the least assessment reactivity, as measured by alcohol use and related consequences at 1 year after admission for adult outpatient treatment for alcohol problems. In addition, Part I revealed that the presence of either frequent or comprehensive research assessment tends to result in a greater degree of reactivity. This article extends the analyses by Clifford et al. to treatment for substance use-disorders engagement and involvement across a 1-year follow-up.The design, participants, and procedures were identical to those described in Clifford et al. Treatment data were obtained from hospital records and participants' self-reports as part of the Timeline Followback interview.Analyses revealed several effects of frequency of assessment and comprehensiveness of assessment on treatment engagement or involvement. The reactivity effect observed varied with the dependent variable, which included if a participant presented for outpatient treatment (more likely in the comprehensive groups), the number of days of outpatient substance use-disorders treatment during follow-up (no reactivity effects), if a participant engaged in intensive treatment for substance-use disorders during follow-up (more likely for the frequent groups in Months 1-6, but the reverse in Months 7-12, and overall more likely in the brief conditions), and the number of days of intensive treatment for substance-use disorders during follow-up (more days in the frequent groups in Months 1-6, no frequency differences in Months 7-12, and overall more days in the brief groups), respectively. Additional analyses showed that treatment participation did not mediate the reactivity effects on alcohol use and related consequences reported by Clifford et al.Data provide experimental evidence for a causal relationship between frequency of assessment and comprehensiveness of assessment on substance abuse-treatment engagement and involvement. Future research should be directed at understanding the factors in the assessment process that determine reactivity effects.

The relationship between moderate alcohol consumption in the first year following alcohol treatment admission and longer-term functioning is clinically important and pertains to the clinical course of alcohol-use disorders. This study investigated these relationships, focusing on the first year posttreatment admission and 3 years later.Analyses were conducted on the outpatient Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) sample (n = 952 at baseline, and n = 802 at Months 37-39). Participants were classified as first-year "abstainer," "moderate drinker," or "heavy drinker."Drinker classification predicted percentage of days abstinent from alcohol, drinks per drinking day, and alcohol-related negative consequences at 3 years. The abstainers had better drinking outcomes than either of the other two groups, and the moderate drinkers' outcomes were better than those of the heavy drinkers. The heavy drinkers had a higher rate of negative consequences at 3 years than did the abstainers and the moderate drinkers, who did not differ from each other. Analyses of change in drinker status between 1 and 3 years explored variability in clinical course.First-year posttreatment alcohol use on the group level predicts longer-term alcohol use and related functioning, and moderate drinking may be considered a treatment goal option for some individuals. The data also reaffirm the variability among individuals in clinical course following alcohol treatment. Future research should aim to understand the factors that determine the maintenance of patterns of alcohol use that are not associated with the occurrence of alcohol-related negative consequences.

Little is known about treatment process for behavior change for brief interventions. Patient ratings of treatment process during a patient-centered brief intervention for alcohol were used to predict post-treatment alcohol use and consequences. We use data from a randomized clinical trial that compared the effects of BI (1 session) to BI and booster (BIB, 2 sessions) to reduce harmful drinking and alcohol consequences. Subjects were n=167 (BI) and n=82 (BIB). Five of the 12 ratings were rated significantly higher by those in the BIB condition compared to BI. The only predictor of reduced alcohol consequences at 12-months was higher ratings of, “I have obtained some new understanding,” for BIB participants (t=−2.50, p < .05). Patient perspectives on treatment may have a role in patient outcomes and should be explored as a dimension of treatment process.

Previous research suggests that abstinence from alcohol during the first year posttreatment for alcohol-use disorders (AUDs) is an important, independent predictor of longer-term alcohol consumption and related functioning. The purpose of this study was to test the hypothesis that abstinence during the first year posttreatment initiation predicts alcohol use at Months 37-39. A second aim of this study was to explore the relationship between "moderate" drinking in the first year and drinking at Months 37-39.Secondary data analyses were conducted on the outpatient Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) sample (N = 952 at baseline and 802 at Months 37-39). For these analyses, participants were classified first as abstainers, moderate drinkers, or heavy drinkers based on their alcohol use in the first year posttreatment initiation.Analyses of covariance showed that the first-year drinker classification predicted both percentage of days abstinent and drinks per drinking day at Months 37-39. Subsequent analyses showed that the abstainers functioned significantly better than (1) both of the other drinker groups combined and (2) either of the other two groups, which did not differ from each other on either measure of alcohol use. A third set of exploratory analyses evaluated first-year abstinence and heavy drinking as continuous variables and showed an essentially linear relationship between them and drinking at 3 years.This study confirmed the strong relationship between first-year abstinence and later drinking but did not show that participants who engaged in moderate drinking during the first year had positive alcohol-use outcomes at 3 years. The clinical implications of the findings, their generalizability to different populations of individuals presenting for specialty alcohol treatment, and future research directions are discussed.

Collateral informants have been routinely included in substance abuse treatment research to corroborate subject self-reported alcohol and other drug use. However, only a few studies to date have examined subject-collateral correspondence with respect to non-clinical populations (e.g., college students). The purpose of the present study was to examine the associations between college students self-reported substance use and corresponding collateral (i.e., friends') reports. A total of 100 subject-collateral pairs were recruited from psychology courses at a large public university located in the Southeastern, United States. Subjects and collaterals provided information specific to their own, as well as their friend's, recent (i.e., last 90-days) substance use. Study data yielded moderate to good, statistically significant, correlations between subject-friend pairs for each type of substance use. Discrepancy analyses revealed that the majority of subjects reported greater substance use relative to their collateral reports. This pattern of response (i.e., subject reporting greater use) is consistent with the extant literature. In addition, the friend's personal substance use appeared to influence his/her report of the subject's alcohol and other drug use. It appears that college student self-reports regarding alcohol and other drug use are reasonably accurate.

Although the Short Index of Problems (SIP) is often used, little is known about the psychometric properties of the SIP in special populations. The present study seeks to determine the following: (1) whether it is possible to substitute items to enhance the psychometric properties of the SIP and (2) whether the SIP, or improved scale, is as sensitive as the Drinker Inventory of Consequences (DrInC) to assess intervention effectiveness.The sample consisted of 404 injured patients who were treated in the Emergency Department (ED) of a major teaching hospital that serves southern New England. Three approaches were used to guide development of the 3-month SIP-R, the potential alternative to the SIP. Cronbach's alpha assessed intrascale reliability; hierarchical multiple regression assessed construct validity; performance of the scales assessing intervention change were compared to the total 3-month DrInC as a function of intervention using analysis of covariance (ANCOVA).There was no evidence that changing the current SIP items will significantly improve performance. The 3-month SIP performed as well as the 3-month DrInC-2R in predicting 12-month DrInC scores and in determining intervention change at 12 months. Of the 45 DrInC items, 31 also predicted a difference across intervention groups.These results suggest there is no advantage to changing the current SIP items. The 3-month SIP is a psychometrically sound measure for assessing consequences of alcohol consumption in an ED sample and is almost as sensitive to intervention change as the full DrInC.

Many published clinical trials have less than adequate follow-up. When conducting a clinical trial, researchers attempt to minimize data loss; however, some data may not be collected, particularly when subjects are lost to follow-up. Careful planning of research protocols, including comprehensive initial data collection, identification of locators, flexible scheduling, systematic subject tracking, monitoring subject loss, and systematically approaching problem cases can ensure high follow-up rates. This article presents a compendium of techniques and procedures that researchers can use to enhance follow-up and address attrition in their studies. Finally, this article outlines statistical techniques that can be used to address the effects of missing data, particularly when patients are lost to follow-up.

The purpose of this paper is to better understand marijuana use among injured problem drinkers in the emergency department (ED). The specific objectives are: 1) to assess the prevalence of marijuana use; 2) to identify factors associated with marijuana use; 3) to determine whether prior injury is associated with marijuana use; and 4) to determine whether marijuana-using problem drinkers want to change behaviors.The authors conducted a post-hoc analysis on data obtained prospectively. Subjects had injury and problem drinking: either measurable alcohol level (blood alcohol concentration, BAC), report of drinking, or an Alcohol Use Disorders Identification Test (AUDIT) score ofor =8. The study was conducted on weekend nights; 3,776 injured ED patients were screened, 383 refused, 578 were enrolled, and 433 had complete data.Of the 433 subjects, 48.3% reported using marijuana in the three months prior. Marijuana-using problem drinkers had more hazardous drinking, higher AUDIT scores (14.0 vs. 11.4, p0.001), and higher risk-taking scores (12.4 vs. 10.1, p0.001). More used other drugs (69.7% vs. 30.3%, p0.001). In regression analyses, marijuana use remained an independent predictor of prior injury (OR = 2.16, 95% CI = 1.25 to 3.75), particularly prior alcohol-related (OR = 2.26, 95% CI = 1.45 to 3.53) and motor-vehicle-related (OR = 1.69, 95% CI = 1.03 to 2.79) injury. Readiness-to-change scores were similar (4.14 vs. 4.22, p = 0.21) between users and nonusers.Marijuana use among injured problem drinkers is prevalent. Their risk of prior injury is increased. Counseling for alcohol and injury should address marijuana use.

The purpose of this study was to replicate and extend research that shows abstinence from alcohol during the first year following treatment predicts better longer term functioning in alcohol use and other areas.The subjects were 187 men and women who had participated in a clinical trial of the differential effectiveness of two behavioral treatments for alcohol problems as a function of subject characteristics. All subjects who participated in this phase of the study were classified as either abstinent from alcohol or not based on their drinking behavior during the first 12 months following treatment initiation. Subjects' alcohol use and other behaviors were evaluated for Months 13-24. The primary dependent variables of interest were alcohol use, self-efficacy, and psychological functioning.A comparison of the two abstinence groups showed that abstainers, compared to drinkers, had less alcohol use, higher self-efficacy, and better psychological functioning. CONCLUSIONS The results suggest the association is robust between abstinence during the first year following treatment initiation or cessation and later functioning, and extend this finding to include psychological functioning. Future research should focus on possible mediators of the abstinence correlations with later behavior that are of theoretical and practical importance, and on specifying gradients of duration of abstinence or other drinking patterns reflecting improvement and their relationship to longer term functioning.

Objective: The study aim was to test whether a brief mo- tivational intervention, with or without a booster session, would improve drinking-related outcomes more than standard Emergency Department (ED) treatment. Method: The study population consisted of 539 (78% male) injured patients treated in the ED and discharged to the commu- nity following their treatment. Injured patients met inclusion criteria if they were assessed as hazardous or harmful drinkers by scoring eight or more on the AUDIT and/or having alcohol in their system at the time of their injury or ED visit. Patients were randomly assigned to either standard care (SC), brief intervention (BI) or brief intervention plus a booster session (BIB). At 1-year follow-up, 447 patients (83% of the sample) were re-interviewed to measure alcohol-related negative con- sequences, injuries and drinking. Results: Patients receiving BIB, but not BI patients, reduced alcohol-related negative consequences and alcohol-related injuries more than did those in the SC group. All three groups reduced their days of heavy drinking. Patients with histories of hazardous drinking responded to BIB, whether or not they had consumed alcohol prior to their injury. Conclusions: Together, these results indi- cate that the effects of a booster session that is added to a brief inter- vention in the ED can be helpful to injured patients with a history of hazardous or harmful drinking, irrespective of whether they have con- sumed alcohol prior to their injury. (J. Stud. Alcohol 62: 806-816, 2001)

This study, drawing upon data collected as part of a randomized clinical trial of alcohol treatment matching effects, investigates the relationship between research follow-up assessment interviews and subsequent drinking behaviors.Subjects (N = 188; 143 men) participated in a day hospital substance-use disorder treatment program at either a private psychiatric hospital (n = 151) or a community hospital (n = 37) and were classified into one of three research groups: regularly scheduled follow-up interviews, missed scheduled follow-up interviews, and delayed Year-2 follow-up interviews. Complete data relevant to the present study were collected on 157 subjects.Study results provided support for a subject reactivity effect related to the research follow-up interview; that is, those subjects classified within the regularly scheduled follow-up interviews condition had the better drinking outcomes. Furthermore, by the end of the second follow-up year, subjects classified within the delayed Year-2 follow-up interviews condition had the poorest drinking outcomes.There may be considerable potential for subject reactivity effects, specific to the research assessment interview, to confound study results. Therefore, the interpretation of data from alcohol treatment outcome studies that fail to control for such potential confounding effects must be viewed with caution. Researchers are advised to control for these potentially confounding effects via methodological and/or statistical mechanisms.

.. .. . ....... .... .. Objectives: 1 ) To cluster patients according to self-reported drinking patterns using cluster analysis; 2) to externally validate clustered groups on variables related to drinking but not used in the cluster analysis; and 3) to use the clustered patients’ responses to alcohol consumption questions to develop a brief screening tool emergency physicians can use to identify patients in need of referral or intervention related to potentially hazardous alcohol consumption. Methods: A self-report battery was administered to 95 subcritically injured patients. Patients also were saliva alcohol-tested upon arrival to the ED. Using the patients’ self-reported quantity, frequency of alcohol consumption, and frequency of having 26 drinks on a drinking occasion, patients were categorized into 3 groups using cluster analysis. The 3 clusters were externally validated using injury-related variables, alcohol-related consequences, and the patients’ reported readiness to change drinking. A screening tool was developed using cutoff values reported by the patients’ answers to drinking pattern questions. Results: Fifty-nine patients were alcohol-negative, and 36 tested alcohol-positive (i.e., >4 mmol/L [>20 mgl dL]) or had elevated scores on an alcohol problem screening instrument. Three distinct drinking pattern clusters were found. Clusters were validated using discriminant function analysis and multivariate analyses of variance to confirm cluster classifications. Steady and high-intensity drinkers reported more alcohol-related negative consequences, and high-intensity drinkers indicated they would consider changing their drinking. The screening tool correctly classified 97% of the patient sample into their respective clusters. Conclusions: Using the drinking pattern questions in the clustering procedure was effective for grouping injured patients into clusters that could be differentiated on other drinking-related variables. The resulting screening tool can be used in the ED setting to screen patients for further assessment and intervention. The readiness-to-change results support the assertion that the injury event provides a “teachable moment” for subcritically injured patients whose injury may be related to their alcohol consumption.

Personality, as measured by subscales of the Sensation Seeking Scale (Zuckerman, 1979), social environmental exposure to alcohol use measured by parental and peer alcohol use, and past alcohol use were examined as predictors of late adolescent alcohol use in a sample of 575 1st-year college students. Efficacious predictors, in order of importance, include peer alcohol use, disinhibition, and age of first intoxication. The results support the relative importance of peer networks over parental models in determining late adolescent alcohol use. Our combinatorial model of personality, social environment, and past behavior is one such model in a growing trend toward the use of interactional models for predicting behavior.

Alcohol abuse and its related difficulties present major concerns for public health professionals. It has been associated with both increased morbidity and premature mortality. Although alcohol abuse is a problem of great magnitude for society in general, minority communities experience its overall negative impact more severely than do other groups. Furthermore, the rate ofproblematic drinking among members of the lower socioeconomic status group has been estimated to be almost three times higher than that of the general adult U.S. population. This is particularly disturbing given thefact that a disproportionate number of minority people are classified within lower SES groupings. The lack of an adequate conceptualization of a public health strategy contributes significantly to the problems of alcohol abuse prevention in the Black community. Priority must be given to national policies that foster the development and delivery of primary prevention services targeted for minority populations.

Although estimates concerning the prevalence of various forms of substance abuse vary considerably, it is critical to note that even the more conservative estimates indicate a major public health problem. Furthermore, increased drug experimentation has been frequently associated with the college experience. Utilizing a slightly modified version of the National Institute on Drug Abuse (NIDA) Monitoring the Future Survey, the present study examined the epidemiology of self-reported drug taking behaviors (e.g., alcohol, marijuana, tranquilizers, stimulants, psychedelics, etc.) among a sample ( n = 683) of students attending a major public university. Data analyses focused on the specific settings and social groupings in which drug use occurred as well as on the frequency and type(s) of drug taking behaviors. Based on the results yielded from a disjoint cluster analysis, four distinct groups of drug users were identified. These four groups then served as categories of the dependent variable in a discriminant function analysis. A general linear models procedure was employed to identify the more efficacious discriminating (i.e., independent) variables.