Combination pharmacotherapy in alcoholism: a novel treatment approach

Combination pharmacotherapy has proven effective in a number of psychiatric disorders, including depression and schizophrenia. However, compared with other affective disorders, few studies have explored the use of combination therapy in alcoholism, and the majority have been limited to animal models. There is evidence to support a role for combination therapy in alcoholism. For example, several neurochemical systems, including the dopaminergic, serotonergic, and opioidergic, appear to affect alcohol intake. Studies in several different types of alcohol-preferring rats have suggested that coadministration of agents to target more than one of these systems simultaneously may produce beneficial effects on alcohol intake, while avoiding problematic effects, such as alterations in food or water intake. Data from preliminary clinical studies have shown trends toward combination therapy reducing alcohol intake in humans. While such findings are encouraging, they must be explored further in larger, randomized, double-blind trials.     

Activity group guidance: a developmental approach

Activity Group Guidance can be a useful tool for counselors who wish to include developmental guidance in their repertoire. The authors illustrate the content, process, and group dynamics of Activity Group Guidance, and they describe and evaluate a comprehensive Activity Group Guidance program. Finally, the authors give specific suggestions to counselors who wish to start Activity Groups.     

Adolescent sex and mass media: a developmental approach

Media critics point to adolescents' exposure to "sexy" television and popular music. Developmental transitions lead to increased information seeking, and developmental tasks force adolescents to find information sources other than their parents, implying a link between sexy media and adolescent development. Media research informed by knowledge of adolescent development may be able to clarify this connection, and model development is discussed here.     

A community-reinforcement approach to alcoholism

Several theoretical approaches to alcoholism exist. An opérant reinforcement approach was used in the present study to develop a new procedure that rearranged community reinforcers such as the job, family and social relations of the alcoholic such that drinking produced a time-out from a high density of reinforcement. The results showed that the alcoholics who received this Community-Reinforcement counseling drank less, worked more, spent more time with their families and out of institutions than did a matched control group of alcoholics who did not receive these procedures. This new approach appears to be an effective method of reducing alcoholism. An analysis in reinforcement terms is presented of the etiology, epidemiology, and treatment of alcoholism.     

Improvements in the community-reinforcement approach to alcoholism

This study evaluated a modified Community-Reinforcement program for treating alcoholics. The previously tested Community-Reinforcement program included special job. family, social and recreational procedures and was shown to reduce alcoholism. To increase the effectiveness of the program further, the present study incorporated a Buddy system, a daily report procedure, group counseling, and a special social motivation program to ensure the self-administration of Disulfiram (Antabuse). The alcoholics who received the improved Community-Reinforcement program drank less. worked more, spent more time at home and less time institutionalized than did their matched controls who received the standard hospital treatment including Antabuse in the usual manner. These results were stable over a 2-year period. The program appeared even more effective and less time-consuming than the previous program. The present results replicate the effectiveness of the Community-Reinforcement program for reducing alcoholism and indicate the usefulness of the additions to the program.     

Skid-row rescue missions: A religious approach to alcoholism

The focus of this study is on the religious service at which many skid-row rescue missions require attendance to receive benefits. Data were obtained from an observation study of thirty-seven skid-row rescue missions in Los Angeles and Seattle, interviews with ten mission directors, and mission newsletters. The missions use material benefits to attract potential converts. The theme of spiritual conversion is predominant in the mission service (sermons, songs, testimonies). Mission personnel feel they have been called by God, often have backgrounds similar to the people they serve, and view the skid rowers' problems as primarily personal and spiritual. Skid rowers resent the use of religion as bait, view their problems as primarily structural, and use the missions only as a last resort. The missions need to be compared to other alcoholism rehabilitation and religious institutions. A key component to their continued existence is outside Christian supporters.     

Selective attention and attention switching: towards a unified developmental approach

We review and relate two literatures on the development of attention in children: one concerning flexible attention switching and the other concerning selective attention. The first is a growing literature on preschool children’s performances in an attention‐switching task indicating that children become more flexible in their attentional control during the preschool years. The second literature encompasses a large and robust set of phenomena for the same developmental period that indicates a protracted course of development for selective attention in children. We ask whether developmental changes in processes of selective attention may contribute to more flexible attention switching. We consider the two sets of phenomena with respect to this question and propose an empirical agenda for their joint study that may lead ultimately to a unified account of the development of selective attention and attention switching.     

The operant-respondent distinction: Future directions

The operant-respondent distinction has provided a major organizing framework for the data generated through the experimental analysis of behavior. Problems have been encountered, however, in using it as an explanatory concept for such phenomena as avoidance and conditioned suppression. Data now exist that do not fit neatly into the framework. Moreover, the discovery of autoshaping has highlighted difficulties in isolating the two types of behavior and conditioning. Despite these problems, the operant-respondent framework remains the most successful paradigm currently available for organizing behavioral data. Research and theoretical efforts should therefore probably be directed to modifying the framework to account for disparate data.     

Long-term family therapy: A developmental approach

The emphasis in family therapy literature on brief therapy has given a false sense of what family therapy can accomplish. While it has helped to develop different theories of change and refine techniques to deal with resistance, it has caused many clinicians to mistake technique for treatment. A long term developmental approach is advocated in which the family therapist is the general practitioner rather than the specialist. This paper is the result of a 30-year caseload in which there was a group of multi-therapy families.     

Model building in developmental psychopathology: a pragmatic approach to understanding and intervention

Proposes model building as a pragmatic and integrative approach to developmental psychopathology. The model-building process is iterative within a program of research, cycling through the following phases of research: theory, field observation, construct definition, measurement development, construct analysis, model testing, experimental field trials, and model revision. Research on the development of and interventions for antisocial behavior is discussed as a tool for reflecting on the model-building process. The ecological framework is offered as a science-based heuristic that integrates various levels of analysis and theoretical perspectives.     

Recognizing the role of parents in developmental outcomes: a systems approach to evaluating the child with developmental disabilities

When developmental concerns arise in children, a clinical assessment focuses on the child's developmental profile to achieve three goals (1) determine diagnosis, (2) develop interventions, and (3) evaluate progress. Parents often have needs during this time that are not addressed by professionals because of the exclusive focus on the child during the evaluation. In this article, we suggest that clinicians take a "systems" approach to the assessment process by recognizing how the well being of family members can impact a child with a developmental disability. We review systems theory and its conceptualization of individual functioning and discuss how parental well-being differs according to child diagnosis. Finally we suggest a systems-based model to use during the assessment process.