Suppression of ethanol self-administration in alcoholics by contingent time-out from social interactions

In a residential research ward setting six volunteer chronic alcoholics were given daily access to 17 alcoholic drinks provided that a minimum of 40 min elapsed between receiving successive drinks. Each drink contained 1 oz 95-proof ethanol in orange juice. During baseline phases subjects were free to drink and socialize on the dayroom. However, during social time-out phases subjects were not permitted to socialize for the 40 min period following receipt of each drink. This contingent social time-out manipulation was systematically replicated across three conditions which varied with respect to the number of non-contingent ward privileges available. The results show that contingent social time-out suppressed drinking; and its effectiveness depended directly upon the conditions of available privileges. Within individual subjects, contingent time-out was increasingly effective in suppressing drinking as the available privileges were increasingly restricted.     

Alcoholic drinking: suppression by a brief time-out procedure

Volunteer chronic alcoholics were given daily access to substantial quantities of alcohol within a residential research setting. Drinking was suppressed to an average of approximately one-half of Baseline levels when 10 or 15 min of physical and social isolation was required as an immediate consequence to receiving each one-ounce drink of 95-proof ethanol. This time-out procedure suppressed the drinking of nine out of ten subjects. Drinking returned to high levels when brief contingent time-out was discontinued. The relevance of such reversible controlling relationships to the treatment of alcoholism is discussed.     

The effect of time-out release contingencies on changes in child noncompliance

This project evaluated the effect of time-out release contingencies on changes in child noncompliance to maternal instructions. Twenty-four clinic-referred, noncompliant, preschool children served as subjects. Each child was assessed under baseline conditions and then under one of three experimental conditions: Parent Release, Child Release, or Control. Children in the Parent Release and Child Release conditions experienced time-out contingent upon noncompliance. Temporal and behavioral time-out release contingencies were present in the Parent Release condition but not in the Child Release condition. A spanking procedure was used to inhibit premature escape from time-out for children in the Parent Release group. The results indicated that both time-out groups demonstrated increased compliance ratios. However, improvement associated with the Child Release condition was considered to be clinically insignificant.The authors wish to express their appreciation to Dave DeLawyer, Larry Snapp, and Mike Samac for their assistance in conducting the study.     

Alcohol dependence,beliefs and the priming effect

Twenty hospitalized alcoholics served as their own controls in a study which sought to compare psychophysiological and cognitive factors as mediating influences on the priming effect of alcohol. Ten subjects were independently assessed by a psychiatrist as being severely dependent on alcohol and ten as mildly or moderately alcohol dependent. Physiological, behavioural and subjective indices of the motivation to drink alcohol were employed 15 and 60 min after subjects had consumed beverages on four separate occasions corresponding to four priming conditions. These priming drinks contained either 60 ml vodka in heavy dilution or just tonic water, and in each of these conditions subjects were either led to believe that the beverages contained alcohol or they had no alcohol. The severely-dependent group displayed a degree of concordance between the indices of motivation to drink, and the levels of these tended to be significantly higher than in the less-dependent subjects. The results suggest that severely alcohol-dependent subjects were more disposed to drink 60 min after consuming alcoholic drinks than after soft drinks, regardless of whether they believed that the priming drinks had contained alcohol. Cognitive factors assumed greater importance for the drinking behaviour of less-dependent subjects, although there was evidence of discordance across behavioural, physiological and subjective measures for this group.     

Assessment of attack and drinking in White King pigeons on response-independent food schedules.

Four White King pigeons in Experiment I were exposed to a fixed-time 90-second food schedule with successive access to water and a conspecific target. Drinking per session was sporadic and minimal, while attack per session occurred during most interfood intervals for all animals. Analysis of the temporal distribution of attack showed that the typical postreinforcement pattern of attack developed over the course of the experiment. In Experiment II, the same animals were exposed to a series of fixed-time schedules ranging from 30 to 360 seconds with successive access to water and target. Time engaged in drinking and the number of interfood intervals with drinking were less than that of attack. Food and no-food baselines, which have been typically used to assess schedules-induced drinking and attack, respectively, were used to evaluate the effect of the schedule on attack and water ingestion. Relative to the no-food baseline, both attack and drinking were enhanced by the schedule in all birds. Relative to the food baseline, drinking was slightly suppressed in three birds and attack was enhanced in all. For all animals, the food baseline resulted in more attack and drinking than the no-food baseline.     

Characteristics of the relapse situation of alcoholics treated with aversion conditioning

Recently, there has been considerable interest in applying the principles of learning theory and operant conditioning to the problems of alcoholism. One principle which may be of value is stimulus control. The principle of stimulus control would suggest that there should be some degree of similarity between the environmental circumstances in which alcoholics do their drinking and the situation where they take their first, post-treatment, drink. The principle of stimulus control also suggests that alcoholics treated with aversion therapy would tend to relapse under environmental conditions that were in some way different from their usual drinking environments.Whether we are able to observe a difference in drinking environments before and after treatment depends on whether we have selected the appropriate stimulus dimensions. The present author is in agreement with Lunde and Vogler (1970) who suggest that; types of liquor consumed; drinking associates; whether at home alone, with others or at a bar; are some of the important characteristics of an alcoholic's learning history. These stimulus conditions could be further simplified to location, type of beverage and social or non-social drinking.Since it is physically impossible to turn time backwards or to have observers follow patients everywhere they go, we must rely on self-reports of alcoholics about their drinking history. Although many clinicians have reservations about the veracity of alcoholics. Guze et al. (1963) report that 97 per cent of alcoholics in a prison population could be correctly diagnosed from their own self-report. Thus, it appears that at least when interviewed in the context of a research study where no contingencies are placed on their behavior, verbal or otherwise, self-report by alcoholics can indeed be reliable. The present study examined the relapse situation of alcoholics in terms of the location of the first drink episode, the social environment, and type of beverage consumed and compared this situation to the usual (most frequent) drinking situation prior to treatment.     

The effects of a cooperation contingency on behavior in a continuous three-person environment

Five groups of three subjects resided for 10 or 15 days within a continuously programmed environment. Subjects followed a programmatic arrangement of required and optional private and social activities that determined the individual and group baseline behaviors into which experimental operations were introduced and withdrawn. A cooperation condition was in effect when all three subjects were required to select simultaneous access to a group area before it became available for use. A noncooperation condition was in effect when access to a group area could be selected by individual subjects, without regard to the other subjects' selections. For all groups, the effects of these two conditions on individual and group behaviors were investigated in reversal designs where several successive days occurred under each condition. Groups 1, 4, and 5 had the noncooperation condition interposed between cooperation conditions. Groups 2 and 3 had the cooperation condition interposed between noncooperation conditions. Durations of triadic activities, per cent of time in triadic activities, intercom use, and intersubject program synchronization were greater during cooperation conditions than during noncooperation conditions. These data show that a cooperation contingency within the behavioral program affected both social behavior and the collateral individual behavior necessary to execute the cooperation response.     

The effects of venlafaxine and cognitive behavioral therapy alone and combined in the treatment of co-morbid alcohol use-anxiety disorders

The effects of the antidepressant venlafaxine (VEN-225 mg daily) and transdiagnostic cognitive behavioral treatment (CBT) alone and in combination on alcohol intake in subjects with co-morbid alcohol use disorders (AUDs) and anxiety disorders were compared. Drinking outcomes and anxiety were assessed for 81 subjects treated for 11 weeks with one of 4 conditions: 1) VEN–CBT, 2) VEN-Progressive Muscle Relaxation therapy (PMR), 3) Placebo (PLC)-CBT and 4) a comparison group of PLC-PMR. For subjects who reported taking at least one dose of study medication, the Time × Group interaction was significant for percent days of heavy drinking and drinks consumed per day. For the measure of percent days heavy drinking, the paired comparison of PLC-CBT versus PLC-PMR group indicated that the PLC-CBT group had greater drinking reductions, whereas other groups were not superior to the comparison group. In Week 11, the proportion of subjects in the PLC-CBT group that had a 50% reduction from baseline in percent days heavy drinking was significantly greater than those in the comparison group. Of the 3 “active treatment” groups only the PLC-CBT group had significantly decreased heavy drinking when contrasted to the comparison group. This finding suggests that the transdiagnostic CBT approach of Barlow and colleagues may have value in the management of heavy drinking in individuals with co-morbid alcoholism and anxiety.     

Individualized Behavior Therapy for Alcoholics – Republished Article

A behavior therapy for alcoholism was designed based on the rationale that alcoholic drinking is a discriminated, operant response. Treatment emphasized determining setting events for each subject’s drinking and training equally effective alternative responses to those situations. Seventy male, hospitalized, Gamma alcoholics were assigned to a treatment goal of either nondrinking (N = 30) or controlled drinking (N = 40). Subjects of each group were then randomly assigned to either an experimental group receiving 17 behavioral treatment sessions or a control group receiving only conventional treatment. Treatment of experimental groups differed only in drinking behaviors allowed during sessions and electric shock avoidance schedules. Nondrinker experimental subjects shaped to abstinence, while controlled drinker experimental subjects practiced appropriate drinking behaviors with little shaping, a result attributed to instructions. Follow-up measuring drinking and other behaviors found that experimental subjects functioned significantly better after discharge than control subjects, regardless of treatment goal. Successful experimental subjects could apply treatment principles to setting events not considered during treatment, suggesting the occurrence of rule learning. Results are discussed as evidence that some “alcoholics” can acquire and maintain controlled drinking behaviors. Traditional treatment of alcoholics may be handicapped by unvalidated beliefs concerning the nature of the disorder.     

Effects of two types of response-contingent time-out on compliance and oppositional behavior of children.

The present study examined the effects of two time-out (TO) procedures, within-room and out-of-room, on compliance and oppositional behavior. Subjects were 24 nonclinic 5-year old children and their mothers. Mother-child pairs were assigned to one of three groups (within-room time-out, out-of-room time-out, or control) and observed in a laboratory setting under each of three experimental conditions: pretraining, training, and posttraining. The results indicated that, relative to the control group, both out-of-room and within-room TO reduced oppositional behavior and increased compliance. The two time-out procedures were equally effective in changing the two target behaviors; however, the within-room approach required significantly more administrations of time-out than the out-of-room technique.     

The acquisition of taste aversions in humans with eating and drinking disorders

A written questionnaire or interview concerned with acquisition of illness-induced (taste) aversions to foods and drinks was given to three groups of people with eating and drinking disorders. These groups consisted of 101 male and 1 female hospitalized alcoholics, 8 male and 8 female college-student heavy consumers of alcohol and 18 females with anorexia nervosa and/or bulimia. In most respects taste-aversion acquisition in these three groups was similar to taste-aversion acquisition in a general college-student population previously studied by Logue, Ophir and Strauss (1981), and to taste-aversion acquisition in other species. In all three groups the aversions were more likely to be reported as having been formed through forward rather than simultaneous or backward conditioning, and long-delay learning was frequent. The aversions usually formed to the tastes rather than to the appearance or other aspects of the foods and drinks. Extinction appeared more effective in decreasing the aversions than did forgetting. While the illness responsible for the aversions forming was usually attributed to the subsequently aversive food or drink, in at least one third of the cases subjects reported that something else might have caused their illness. Aversions were more likely to have formed to relatively less familiar and less preferred foods and drinks. However, the hospitalized alcoholics reported fewer aversions, less generalization of aversions, and stronger nausea as the cause of the aversions than did Logue et al.'s (1981) subjects. About 15% of these subjects reported taste aversions to alcoholic beverages. The college-student heavy consumers of alcohol reported no generalization of their taste aversions, but in other respects were similar to Logue et al.'s subjects. Thirty-one percent of these subjects reported taste aversions to alcoholic beverages. The anorexic and bulimic subjects were also similar to Logue et al.'s subjects with the exception that they, like the hospitalized alcoholics, reported stronger nausea as the cause of the aversions. These data may help to understand and treat people with eating and drinking disorders     

Differences in baseline drinking behavior between New Zealand alcoholics and normal drinkers

Details of alcohol drinking by 12 New Zealand hospitalized alcoholics and 12 normal drinkers from the local community were compared in an experimental bar-and-lounge environment. Differences between the drinking behavior of the two groups were found to be statistically significant on measures of total alcohol consumed, sip size and rate of alcohol ingestion (speed of drinking). The drinking pattern exhibited was similar to that reported in baseline studies of North American drinkers, as reported by Schaefer et al. (1971). This similarity was discussed in terms of a behavioral profile of alcoholics as compared with normal drinkers for the diagnosis of problem drinking.     

Schedule constraint on the average drink burst and the regulation of wheel running and drinking in rats

Two experiments compared predictions of a molar-pattern model and a general molar behavior regulation model by requiring rats to wheel run for access to water. In both experiments schedule parameters constrained the baseline average burst length of drinking without constraining total drinking. Five levels of schedule constraint were imposed on time spent per drinking burst (Experiment 1) or the number of drinks per burst (Experiment 2). The results of both experiments supported the general molar behavior regulation view but not the molar-pattern model by showing no increase in total wheel running and no decrease in total drinking under schedule constraint. However, both experiments also showed local effects of drink burst constraint, including a direct relation between the degree of constraint and the local rate of drinking, and an approximation of the temporal distribution of baseline drinking under all degrees of schedule constraint. Most local changes support the view that rats defend the baseline temporal distribution of responding under schedule constraint, though some changes appear related to disruption of local response pattern characteristics.     

Differences in baseline drinking behavior between alcoholics and normal drinkers

Drink preference, sip magnitude, amount of time taken to consume drinks and amount of time between sips were measured for 23 normal drinkers and 26 hospital admitted alcoholics while they consumed up to 16 oz. of 86-proof liquor or its equivalent in an experimental bar-and-lounge environment. The alcoholics as denned in this study ordered more drinks, preferred straight drinks, took larger sips and drank faster, but took a longer time between sips than did the normal drinkers. The utility of baseline drinking measures and the external validity of the results are discussed.     

Effects of relaxation instructions on the electromyographic responses of abstinent alcoholics to drinking-related stimuli

Viewed from a behavioral perspective alcoholism is a behavioral disorder which should be influenced by the same range of environmental and historical variables which affect other operant behaviors. Therefore, environmental stimulus circumstances should play a significant role in influencing alcoholics' disposition to drink. In particular, stimuli which have previously been associated with drinking behavior should come to exert some controlling influence over subsequent disposition to drink. Relapse to substance abuse is often believed to be precipitated by exposure to stimulus circumstances previously associated with the drug or its use. This hypothesis has received its greatest emphasis in the area of narcotics abuse (Wikler, 1965). but presumably it is relevant also to the case of alcohol abuse. Research concerning abusers' reactions to alcohol-related or drinking-related stimuli has been minimal. Ludwig et al. (1974) have presented data suggesting that alcohol-related stimuli interact with priming doses of ethanol to increase alcoholics' disposition to drink. Miller et al. (1974), however, failed to observe a significant effect of drinking-related stimuli upon alcoholics' disposition to drink.

In the field of behavior therapy, relaxation and stimulus-exposure techniques (e.g. systematic desensitization) are often recommended as techniques for reducing the effect of environmental stimuli upon an individual's behavior. However, data are lacking concerning the effect of relaxation training upon alcoholics. The present study uses psychophysiological procedures to investigate three issues concerning the effect of drinking-related stimuli and relaxation instructions upon alcoholics: (1) the effect of a single session of systematic relaxation instructions upon the electromyographic tension levels of abstinent alcoholics; (2) the effect of drinking-related auditory stimuli upon the electromyographic tension levels of abstinent alcoholics; and (3) the influence of prior relaxation instructions upon the EMG responses of abstinent alcoholics exposed to drinking-related stimuli.     

21st birthday drinking and associated physical consequences and behavioral risks

Twenty-first birthday celebrations often involve dangerously high levels of alcohol consumption, yet little is known about risk factors for excessive drinking on this occasion. Participants (N = 150) from a larger prospective study who consumed at least one drink during their celebration completed questionnaires and semistructured interviews about their 21st birthday within four days after the event. Assessments were designed to characterize 21st birthday alcohol use, adjusted for alcohol content, as well as situational/contextual factors (e.g., celebration location, peer influence) that contribute to event-level drinking. Participants reported an average of 10.85 drinks (9.76 adjusted drinks), with experienced drinkers consuming significantly more than relatively na?ve drinkers who had no previous binge or drunken episodes. Men consumed more drinks, whereas age of first drunken episode and heavier drinking during the 3-months preceding the 21st birthday predicted higher estimated blood alcohol concentrations (eBACs) on the 21st birthday. Celebrating in bars and engaging in birthday-specific drinking traditions (free drinks at bars) explained additional variance in 21st birthday eBACs. Both physical consequences (e.g., blacking out or having a hangover) and behavioral risks (e.g., sexually provocative behaviors) were prevalent and were predicted by higher eBACs. Together these findings indicate that 21st birthday celebrations are associated with heavy drinking and a variety of physical consequences and behavioral risks.     

Instructed versus pharmacological effects of alcohol in alcoholics and social drinkers

Twelve alcoholics and 12 social drinkers were studied in an experiment where instructions about alcohol or placebo were orthogonally crossed with administration of alcohol or placebo in a Balanced Placebo Design. Three subjects were simultaneously observed while watching soccer games on the TV together and having free access to a mixed drink, which in the alcohol conditions contained 150ml of 80% proof vodka. The assessment procedure included several aspects of drinking behavior, behavioral observations during the session, psychiatric ratings and nurse observations before and after each session, ratings for craving, self-reported state anxiety and physiological changes (heart rate and blood pressure). In general, the results showed the alcoholic's behavior to be controlled by instruction-induced expectancies rather than by the actual beverage given, whereas the social drinkers showed tendencies in the opposite direction. The implications of these results for the traditional disease conception of alcoholism and for learning theory approaches are discussed.     

THE EFFECT OF MODELLING ON DRINKING RATE

Three male college seniors were asked to drink beer at their normal rate in a simulated tavern setting. Each was paired with a confederate, also a male college senior, in an ABACA single subject design. In the baseline conditions, the confederate matched the drinking rate of the subject. Baseline and all subsequent conditions were continued in 1-hr sessions until a stable drinking rate was achieved. In Condition B, the confederate drank either one third more or one third less than the subject's baseline rate. In Condition C, the direction was reversed. All three subjects closely matched the confederate's drinking rate, whether high or low. All subjects reported they were unaware of the true purpose of the study.     

Alcoholic Subtypes and the MacAndrew Alcoholism Scale

Forty-five alcoholics in treatment (29 males and 16 females) who reported substantial alcohol dependence but scored in the nonalcoholic range on the MacAndrew Alcoholism Scale (MAC) were matched with 45 alcoholics who reported a similar degree of alcohol dependence and obtained alcoholic-range scores on the MAC. Results reveal that high MAC alcoholics were characterized by gregariousness, social drinking, belligerence and aggression while drinking, and a high degree of alcohol-related legal problems. Low MAC alcoholics appeared to be a different or less distinctive type of alcoholic; although they were less outgoing and preferred not to drink with others, they experienced a wide range of serious alcohol-related consequences. Low MAC alcoholics were not more likely to have a history of nonsubstance use psychiatric diagnosis and treatment. Cloninger, Bohman, and Sigvardsson's (1981) alcoholic typology was related to MAC scores: There was a greater likelihood that high-MAC alcoholics were Type II and low MAC alcoholics Type I.     

Alcoholic subtypes and the MacAndrew Alcoholism Scale.

Forty-five alcoholics in treatment (29 males and 16 females) who reported substantial alcohol dependence but scored in the nonalcoholic range on the MacAndrew Alcoholism Scale (MAC) were matched with 45 alcoholics who reported a similar degree of alcohol dependence and obtained alcoholic-range scores on the MAC. Results reveal that high MAC alcoholics were characterized by gregariousness, social drinking, belligerence and aggression while drinking, and a high degree of alcohol-related legal problems. Low MAC alcoholics appeared to be a different or less distinctive type of alcoholic; although they were less outgoing and preferred not to drink with others, they experienced a wide range of serious alcohol-related consequences. Low MAC alcoholics were not more likely to have a history of nonsubstance use psychiatric diagnosis and treatment. Cloninger, Bohman, and Sigvardsson's (1981) alcoholic typology was related to MAC scores: There was a greater likelihood that high-MAC alcoholics were Type II and low MAC alcoholics Type I.