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This study investigated whether a behavioral economic index of the value of rewards available over different time horizons improved prediction of drinking outcomes beyond established biopsychosocial predictors. Preferences for immediate drinking versus more delayed rewards made possible by saving money were determined from expenditures prior to resolution attempts by problem drinkers with different help-seeking experiences (N = 144). As hypothesized, stable resolutions over a 2-year follow-up were associated with proportionally more pre-resolution discretionary expenditures on savings and less on alcohol compared with unstable resolutions. The relationship held regardless of help-seeking history, and pre-resolution drinking practices, problems, and income were similar across outcomes. The findings extend experimental work on behavioral economics and indicate that measuring monetary allocation improves prediction of outcomes.

Introduction There is a substantial and important unmet need to prevent thrombus formation without lysing preexisting hemostatic clots, especially in settings in which the risks of both thrombosis and bleeding [...], The use of fibrinolytic agents to prevent new thrombus formation is limited by an increased risk of bleeding due to lysis of hemostatic clots that prevent hemorrhage in damaged blood vessels. We sought to develop an agent that provides Thrombo prophylaxis without carrying a significant risk of causing systemic fibrinolysis or disrupting hemostatic clots. We previously showed that platelet (PLT) α granule-delivered urokinase plasminogen activator (uPA) is highly effective in preventing thrombosis, while being associated with little systemic fibrinolysis or bleeding. Here, we generated a chimeric prodrug composed of a single-chain version of the variable region of an anti-αIIbβ3 mAb fused to a thrombin-activatable, low-molecular-weight pro-uPA (PLT/uPA-T). PLT/uPA-T recognizes human αIIbβ3 on both quiescent and activated platelets and is enzymatically activated specifically by thrombin. We found that this prodrug binds tightly to human platelets even after gel filtration, has a prolonged half-life in mice transgenic for human aIIb compared with that of uPA-T, and prevents clot formation in a microfluidic system. Importantly, in two murine injury models, PLT/uPA-T did not lyse preexisting clots, even when administration was delayed by as little as 10 minutes, while it concurrently prevented the development of nascent thrombi. Thus, PLT/uPA-T represents the prototype of a platelet-targeted thromboprophylactic agent that selectively targets nascent over preexisting thrombi.

Howard Rachlin and his contemporaries pioneered basic behavioral science innovations that have been usefully applied to advance understanding of human substance use disorder and related health behaviors. We briefly summarize the innovations of molar behaviorism (the matching law), behavioral economics, and teleological behaviorism. Behavioral economics and teleological behaviorism's focus on final causes are especially illuminating for these applied fields. Translational and applied research are summarized for laboratory studies of temporal discounting and economic demand, cohort studies of alcohol and other drug use in the natural environment, and experimental behavioral economic modeling of health behavior‐related public health policies. We argue that the teleological behavioral perspective on health behavior is conducive to and merges seamlessly with the contemporary socioecological model of health behavior, which broadens the contextual influences (e.g., community, economic, infrastructure, health care access and policy) of individuals' substance use and other health risk behaviors. Basic‐to‐applied translations to date have been successful and bode well for continued applications of basic science areas pioneered by Howard Rachlin and his contemporaries. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2007.03.003 Byline: Jesse B. Milby (a), Joseph E. Schumacher (a), Rudy E. Vuchinich (a), Michelle J. Freedman (a), Stefan Kertesz (a), Dennis Wallace (b) Keywords: Homeless; Substance abuse; Contingency management; Cost-effectiveness; Outcomes Abstract: In a randomized controlled trial, behavioral day treatment, including contingency management (CM.sup.+), was compared to contingency management components alone (CM). All 206 cocaine-dependent homeless participants received a furnished apartment with food and work training/employment contingent on drug-negative urine tests. CM.sup.+ also received cognitive-behavioral therapy, therapeutic goal management, and other intervention components. Results revealed that CM.sup.+ treatment attendance and abstinence were not significantly different from CM during 24 weeks of treatment. After treatment and contingencies ended, however, CM.sup.+ showed more abstinence than CM, indicating a delayed effect of treatment from 6 to 18 months. CM.sup.+ had more consecutive weeks abstinent across 52 weeks, but not during active treatment. We conclude that CM alone may be viable as initial care for cocaine-dependent homeless persons. That CM.sup.+ yields more durable abstinence indicates that it may be appropriate as stepped-up care for clients not responding to CM (Clinical Trials.gov, no. NCT00368524). Author Affiliation: (a) University of Alabama at Birmingham, Birmingham, AL, USA (b) Rho Inc. Federal Systems Division, Chapel Hill, NC, USA Article History: Received 22 November 2006; Revised 28 February 2007; Accepted 4 March 2007

Objectives. Housing typically is not provided to homeless persons during drug abuse treatment. We examined how treatment outcomes were affected under 3 different housing provision conditions. Methods. We studied 196 cocaine-dependent participants who received day treatment and no housing (NH), housing contingent on drug abstinence (ACH), or housing not contingent on abstinence (NACH). Drug use was monitored with urine testing. Results. The ACH group had a higher prevalence of drug abstinence than the NACH group (after control for treatment attendance), which in turn had a higher prevalence than the NH group. All 3 groups showed significant improvement in maintaining employment and housing. Conclusions. The results of this and previous trials indicate that providing abstinence-contingent housing to homeless substance abusers in treatment is an efficacious, effective, and practical intervention. Programs to provide such housing should be considered in policy initiatives. doi:10.2105/AJPH.2004.039743)

Influences on seeking help from professional alcohol treatment and from Alcoholics Anonymous (AA) were investigated using problem drinkers (N = 167) with different help-seeking experiences (no assistance, AA only, or treatment plus AA) and current drinking statuses (sustained abstinence for > 2 years or active problem drinking). Depending on their help-seeking experiences, participants rated barriers to or reasons for seeking help from treatment and AA, which were factor analyzed. Common impediments to help-seeking included privacy concerns and participants' beliefs that they could solve their problem on their own and that it was not serious enough to seek help. Common reasons for help-seeking included social and other functional problems related to drinking. There were also influences unique to treatment (e.g., cost) and to AA (e.g., group format). Help-seeking factors did not vary by drinking status. The implications for increasing help-seeking among problem drinkers are discussed.

NATIONAL SURVEYS indicate that approximately 40% of U.S. college students report at least one heavy-drinking episode in the past 2 weeks (O'Malley and Johnston, 2002) and that large numbers of [...], Objective: This study evaluated the relative efficacy of personalized drinking feedback (PDF) delivered with and without a motivational interview (MI) for college student drinkers. Method: Heavy-drinking college students (N=54; 69% female) were identified from a large screening sample and randomly assigned either to receive PDF during a single MI session or to receive PDF without an MI. Of these participants, 51 (94%) completed a 6-month follow-up assessment that included measures of alcohol consumption and alcohol-related problems. Results: At 6-months postintervention, participants in both groups showed significant, small to moderate reductions in alcohol consumption, but the groups did not differ. Women showed larger reductions than men. Rates of alcohol-related problems remained relatively unchanged. Conclusions: The hypothesis that an Mi would enhance the efficacy of PDF was not supported. (J Stud. Alcohol 65: 200-203, 2004)

FEWER THAN 25% of individuals with drinking problems utilize intervention services, but some untreated persons nevertheless resolve their problems (Tucker, 2001). Resolutions clearly can occur in the absence of interventions, [...], Objective: This study investigated whether similar environmental contexts surround abstinent resolutions associated with different intervention experiences, including no assistance. Method: Participants were selected in a 3 x 2 design (25-30 per group, N = 167) according to their help-seeking experiences (no assistance, Alcoholics Anonymous [AA] only, treatment plus AA) and current drinking status (resolved abstinent [RA] for >2 years or nonresolved [NR] controls). Life events were assessed retrospectively over a 4-year period that spanned the 2 years before and 2 years after the initiation of stable abstinence by RA participants or over a matched interval for NR participants. Collateral or reliability interviews were conducted for 84% of the sample as checks on participant reports. Results: Across help-seeking groups, RA participants reported decreased negative events and increased positive events from the pre- through the post-resolution period. Interventions, especially treatment, enhanced the postresolution improvements in RA participants' life circumstances. This pattern was absent among NR participants. Conclusions: The findings suggest that a similar molar environmental context surrounds resolutions achieved with and without interventions and that interventions are associated with enhanced improvements during maintenance.

The natural recovery from alcoholism which is more effective than alcohol treatments depends on long-term environmental factors and on the willpower and self-control of the subjects. Increased health concerns and stable good health characterize the lives of recovered subjects while alcoholics show a tendency toward negative events. Interpersonal factors such as family and friends do not seem to influence the progress of recovery although the subjects consider them important.

An analysis of the impact of chronic stress on physiological sensitivity to an acute physiological stressor in male high-school teachers confirms the link between problems of daily life and immunological sensitivity to an acute physiological stressor. It also reveals that the sensitivity of biological systems to wild acute stressors is differentially altered by chronic stress. Endocrine variables are affected by the stressor which effects increases in heart rate and blood pressure.