An operant treatment procedure for alcoholics

For many years total abstinence was regarded as the appropriate criterion for the successful treatment of alcoholism. It is suggested that given societal norms for social consumption of alcohol, plus the social reinforcers which maintain beverage alcohol ingestion, social drinking may serve as a realistic treatment goal. The efficacy of a social drinking criterion was clearly demonstrated by Bigelow et al. (1972). Chronic alcoholic in-patients were placed in a choice situation in which they earned the opportunity to participate in an ‘enriched’ environment contingent upon either moderate drinking or abstinence. Subjects overwhelmingly chose the moderate drinking alternative. Results also suggested that moderate drinking is more reinforcing than abstinence for alcoholics. Further support for the moderate drinking concept was rendered by Mills, Sobel and Schaeffer (1971) in a study which made electric shock contingent on gulping drinks, ordering straight alcoholic drinks and ordering and consuming more than three drinks. Time-out (Cohen et al., 1971), positive reinforcement (Cohen et al., 1971) and social contracting procedures (Miller, 1972) have been effectively employed to reduce drinking behavior from maladaptive to adaptive frequencies.

The present study attempts to extend treatment with a controlled drinking outcome to out-patient alcoholics     

Alkoholabhängigkeit in der psychiatrischen Klinik

In Germany 2.4?% of the population suffer from alcohol dependency and 3.8?% of adults from alcohol abuse. Despite an extensive number of options available for addiction therapy only a minority of affected persons receive addiction-specific therapy. This results in a chronification of the disease and a reduction of approximately 15 years in life expectancy. Background knowledge of the foundations of alcohol addiction leads to a new understanding of the processual course of the disease as well as to new therapy interventions. Individualized treatment includes a combination of outpatient, partial inpatient or inpatient therapeutic measures and range from medical advice for reduction of alcohol consumption, to qualified withdrawal treatment up to pharmacological relapse prophylaxis and long-term weaning treatment. Under current therapeutic conditions abstinence quotas of 50-70?% over 1 year can be achieved. Treating physicians must have sufficient diagnostic certainty and furthermore must be in command of motivating discourse techniques, knowledge on the therapeutic options of outpatient and inpatient withdrawal treatment, pharmaceutical relapse prophylaxis and mediation in rehabilitation measures.     

Quality of life in patients with alcohol dependence disorder with personality disorders: relation to psychological adjustment and craving

The purpose of this study is to determine the self-perceived quality of life of abstinent patients with alcohol dependence disorder during the first month of treatment, and how the presence of personality disorders, psychological adjustment, and the level of craving affect this perception. For this purpose, a sample was used comprising 65 participants with mean age of 43.26 years, of whom 70.8% were male and 29.2% female, with a mean duration of addiction to alcohol consumption of 11.83 years. The results show that quality of life is not related to the duration of abstinence or the course of the addiction. Moreover, the patients who present a personality disorder perceive poorer quality of life in areas such as health status, mood, and social relations. Self-perception of quality of life is affected by psychological adjustment and beliefs about craving. These data should be taken into account when considering quality of life as a measurement of the effectiveness of a treatment for drug addicts with personality disorders.     

Sex Differences in Social Support and Self-Efficacy Within a Recovery Community

This study examined similarities and differences in social support and self-efficacy for abstinence between women and men recovering from substance addiction. The sample consisted of 87 residents of Oxford House (OH) self-run, community-based recovery homes. Analyses revealed similarities between women and men in terms of the composition and utilization of support networks and abstinence self-efficacy. Also, for both sexes, length of residency in OH was significantly related to decreased social support for alcohol and drug use and increased self-efficacy for abstinence. However, multiple-group SEM analyses demonstrated that social support for alcohol/drug use fully mediated the link between length of residency and abstinence self-efficacy for women, but not for men. Findings suggest that the process of gaining self-efficacy to remain abstinent is distinct for women and men, and that social support plays a different role in women's recovery than it does in men's.     

Fitting in and feeling fine: conformity and coping motives as mediators of the relationship between social anxiety and problematic drinking.

The present research was conducted to clarify the relationships among social anxiety, alcohol consumption, alcohol-related problems, and negative-reinforcement drinking motives among college students. Heavy drinking students (N = 316, 53.80% female) completed self-report measures of social anxiety, alcohol consumption, alcohol-related problems, and drinking motives. Findings indicated that students higher in social anxiety consumed less alcohol but experienced more negative consequences. Moreover, the relationship between social anxiety and negative consequences was mediated by coping and conformity drinking motives in addition to alcohol consumption. In the context of social anxiety, the current research demonstrates the importance of examining problematic drinking as distinct constructs: alcohol consumption and negative consequences. Findings are also discussed in terms of implications for interventions with socially anxious students.     

A multiple mediation model of trait worry and hazardous drinking among treatment-seeking smokers: the roles of coping and conformity drinking motives

ABSTRACT

Alcohol use is associated with poorer smoking cessation-related outcomes, and smokers with elevated levels of worry experience greater smoking cessation problems. Yet, little is known about the explanatory mechanisms that may underlie the relationship between trait worry and hazardous drinking among smokers. Therefore, this study explored the explanatory roles of coping and conformity drinking motives in the relationship between trait worry and hazardous drinking outcomes including alcohol consumption, alcohol problems, maximum number of drinks, and the number of prior alcohol quit attempts among treatment-seeking smokers. Participants included 377 treatment-seeking smokers who consumed at least one alcoholic drink in the last year (48% female; 86.2% Caucasian; M _age = 34.83 years, SD = 13.38). Results showed a significant indirect effect of trait worry through coping-related drinking motives in relation to alcohol consumption, alcohol problems, maximum number of drinks, and number of prior drinking quit attempts. These findings were evident after controlling for gender, cigarette dependence, and current psychopathology. These findings suggest that coping drinking motives are one mechanism that may explain the relation between trait worry and hazardous drinking outcomes among treatment-seeking smokers.     

Life Satisfaction and Alcohol Consumption Among Young Adults at Social Gatherings

Although low life satisfaction is related to alcohol abuse among young adults, there is no clear evidence of a specific relationship between wellbeing indexes and alcohol consumption. Several studies have reported different nonlinear relationships. The role of other variables may explain the inconsistent relationships between life satisfaction and alcohol consumption. Concerning individual factors, people’s expectations regarding drinking alcohol (i.e., drinking motives) are considered the most proximal antecedents of alcohol use and may mediate the relationship between life satisfaction and drinking alcohol. Regarding relational factors, social relations are related to both wellbeing and alcohol consumption. The aim of the present study was to examine the relationships among life satisfaction, drinking motives, and alcohol consumption in a sample of young adults. The data were collected by means of a self-report questionnaire from a sample of 536 young adults (median age: 22 years). We tested a structural equation model, assuming the hypothesized relationships, simultaneously on males and females to investigate gender differences. The results showed the influence of social relations on life satisfaction, which in turn influenced participants’ expectations regarding drinking alcohol. Drinking motives were antecedents of alcohol use. Among women, low satisfaction increased coping expectation, which, in turn, increased alcohol consumption. The most dangerous expectation about drinking was that alcohol may enhance a person. Prevention campaigns should aim to deconstruct this idea.     

Second year treatment outcome of alcoholics treated by individualized behavior therapy: Results

Second year treatment outcome results are reported for 69 of 70 male alcoholics who, while hospitalized at Patton State Hospital, served as subjects in an experiment evaluating ‘Individualized Behavior Therapy (IBT)’ techniques. Subjects were initially assigned to either a controlled drinking or non-drinking (abstinence) treatment goal. and were then randomly assigned to either an experimental group receiving IBT or a control group receiving conventional state hospital treatment oriented towards abstinence. Previously reported results found that IBT subjects functioned significantly better than control subjects throughout the first year of follow-up. Second year follow-up results found that IBT subjects treated with a controlled drinking goal functioned significantly better than their respective control subjects on a variety of measures, including drinking behavior. Differences between IBT subjects treated with a non-drinking goal and their control subjects did not retain statistical significance during the second year of follow-up. Individual drinking profiles are presented for all subjects. Only subjects treated by IBT with a goal of controlled drinking engaged in a substantial amount of limited, non-problem drinking during the second year interval, and those subjects also had more abstinent days than subjects in any other group. The nature of adequate follow-up procedures and measures is discussed. Implications of these findings for alcoholism treatment are considered.     

Spielsucht – Alkoholabhängigkeit: „Zwei Süchte,eine Behandlung?“

While alcoholism has been undisputedly classified for decades as an addiction in diagnostic manuals like ICD -10 and DSM -IV, the classification of pathological gambling has not been definitively resolved, although alcohol dependence and pathological gambling have many addiction criteria in common. The course of gambling addiction is typically characterized by an initial phase, a critical habituation phase, and a phase of despair. While a gambling addiction may rapidly progress to chronic dependence within a year, the development of chronic alcohol dependence requires many years of misuse. For gambling addicts, external influence plays a considerable role (trigger situation) on the entry into gambling. For the majority of players, the initial contact comes from third parties, while for problem gamblers the social character of an invitation as a maintaining factor has less influence than for alcoholics. There are differences especially in the expression of comorbidities and the consequences of the addiction. For problem gamblers, these are more psychological than social, while secondary disorders are significant for alcoholics.     

High risk drinking and college students' self-perceptions

The present study examined the relationship between high risk drinking and college students' self-perceptions. High risk drinking was defined as the consumption of four or more drinks in a row for women and five or more drinks in a row for men during a single sitting (within the last year). Historical trends regarding college-age drinking indicate that 44% of college students fit the criteria for high risk drinking at least once over the past year. A survey was administered to 210 college students (52 men and 158 women) between 18 and 22 years of age (M = 20.9, SD = 1.3) to assess their use of alcohol and their self-perceptions. Students' self-perceptions were measured with four subscales from the Neemann-Harter Self-perception Profile for College Students. Students either volunteered to participate in this study outside of class or were solicited during class. It was predicted that students' self-perceptions would differ significantly depending upon their alcohol consumption, i.e., 17.1% were Abstainers, 25.2% were Nonproblem Drinkers, and 57.6% were High Risk Drinkers. Analysis gave significant difference on Global Self-worth between students who abstained and those who were High Risk Drinkers. However, students' perceptions of Scholastic Competence, Intellectual Ability, and Social Acceptance did not differ significantly for the alcohol consumption groups. In addition to high risk drinking, a number of other variables were associated with self-perceptions, such as high school alcohol use, low high school GPA, and students' reported academic involvement. These relations are discussed.     

The Role of Psychological Reactance in Drinking Following Alcohol Prevention Messages1

Two experiments tested whether a dogmatic alcohol prevention message may, by arousing psychological reactance (the motivation to reassert a threatened freedom) result in more subsequent alcohol consumption, compared to a neutral message. In Study 1, 535 college students received either a high-threat (dogmatic) or low-threat (neutral) message recommending either abstinence or controlled drinking. Results indicated that high-threat messages were rated more negatively and resulted in more drinking intentions compared to low threat. The negative effect of high threat on message ratings was most pronounced for habitually heavy drinkers and an abstinence-espousing message. In Study 2, under the guise of a “memory study,” 74 college students received either a high- or low-threat message recommending abstinence from alcohol. Then, under the guise of a “perception study,” all subjects participated in a taste-rating task in which their beer consumption was unobtrusively measured. Results indicated that the effect of high threat was most negative for male heavy drinkers, who drank significantly more beer compared to low-threat controls. These results suggest that the persuasive ability of alcohol prevention efforts depend to a considerable extent on the reactance-arousing properties of the materials and that dogmatic alcohol prevention materials may have counterproductive effects for some college students.     

Sex differences in the alcohol deprivation effect in rats

Few studies have investigated the relationship between early onset of alcohol drinking and relapse in adulthood, which may be larger in females, as revealed by studies using rats as subjects. The present study assesses the alcohol deprivation effect (ADE) in adult rats of both sexes that began alcohol consumption during preadolescence or adolescence. Female and male Wistar rats received free-choice access to water, 5, 10 and 20% (v/v) ethanol solutions during the ethanol exposures. The effects of age and sex on ADE in adult rats were assessed after repeated periods of abstinence. The results showed that female but not male rats increased ethanol intake after the second and third deprivation (showing ADE), irrespective of the onset-age of alcohol drinking.     

Accounting for self-selected drinking goals in the assessment of treatment outcome

Many treatment outcome studies are abstinence-based and rely on achieved abstinence as an indicator of success, making the implicit assumption that participants have an abstinence goal. However, it is often the case that participants self-select controlled drinking goals, even in the context of an abstinence-based treatment. The current study explored the use of an outcome variable, percent weeks meeting goal (PWMG), which takes into account individual goal choice at baseline. The sample consisted of 57 women who participated in a cognitive-behavioral therapy treatment for alcohol dependence and were followed for 18 months after baseline. Twenty-two (39%) women self-selected controlled drinking goals, and 35 (61%) self-selected an abstinence goal at baseline. A repeated measures analysis of variance with PWMG as the dependent variable revealed that both goal groups were equally successful in meeting their goals during the 6-month treatment period. After treatment, participants with a goal of abstinence had more PWMG than did participants with a self-selected controlled drinking goal, but the difference was significant at a trend level. The two goal groups did not differ in outcome when the authors compared them using more traditional measures of outcome, percent days abstinent and percent heavy drinking days.     

Temperament and Problematic Alcohol Use in Adolescence: an Examination of Drinking Motives as Mediators

The present study investigated the associations between temperamental reactivity, drinking motives, alcohol consumption and alcohol-related consequences. Furthermore, it investigated whether drinking motives mediate the relations between temperamental reactivity and the alcohol use variables. The sample consisted of 188 adolescents (64.9% boys) between the ages of 13–20 years (M _age  = 16.9, SD = 1.32). Results revealed that the temperament factors of high BAS fun seeking and high negative affectivity were related to alcohol consumption and alcohol-related consequences respectively. Furthermore, high social and enhancement motives and low conformity motives were associated with alcohol consumption, whereas high coping-depression motives were associated with alcohol-related consequences. Finally, the relation between BAS fun seeking and alcohol consumption was mediated by enhancement and social motives and the association between negative affectivity and alcohol-related consequences was mediated by coping-depression motives. These results highlight the importance of focusing on temperament profiles and their associated drinking motives in the prevention and intervention of alcohol use problems among adolescents.     

Motives and Consequences of Alcohol Use in People With Social Anxiety Disorder: A Daily Diary Study

People with social anxiety disorder (SAD) are at increased risk for alcohol-related problems. Most research exploring social anxiety and alcohol use has examined negative drinking consequences, with less consideration of positive consequences—namely positive social experiences—that may reinforce alcohol use. In this daily diary study, we examined how adults diagnosed with SAD (N = 26) and a psychologically healthy control group (N = 28) experienced positive drinking consequences in naturally occurring drinking episodes during the study period. For 14 consecutive days, participants answered questions about alcohol use, motives for drinking, and positive consequences of drinking. On days when participants drank, those with SAD were more likely than healthy controls to perceive a reduction in anxiety, but the two groups did not differ in their likelihood of experiencing positive social drinking consequences. For both groups, on days when they were more motivated to drink to enhance social experiences (affiliation motives) or cope with distress (coping motives), they were more likely to obtain positive consequences from drinking. Compared to controls, participants with SAD endorsed stronger trait and daily coping motives (anxiety-coping, social anxiety-coping, and depression-coping). Results are discussed in the context of reinforcement mechanisms that may maintain social anxiety and alcohol use.     

Daily interpersonal experiences, context, and alcohol consumption: crying in your beer and toasting good times

The authors explored a multidimensional view of drinking, whereby social and solitary drinking represent distinct behaviors associated with positive and negative experiences, respectively. Using daily diary methodology and multilevel analytic strategy, the authors examined, over 30 days, the within-person association of negative and positive experiences and alcohol consumption in different contexts and focused on interpersonal experiences. On days with more negative interpersonal experiences, participants engaged in more solitary drinking (i.e., drinking at home and alone), whereas on days with more positive interpersonal experiences they drank more in social contexts. The authors also demonstrated that individuals high on neuroticism drank more in solitary contexts on days with more negative interpersonal experiences, relative to those with lower neuroticism. These findings lend support to models linking daily drinking motivation and context-dependent drinking behavior.     

Examining the Relationship of Substance Use and Sexual Orientation

In this article we examine the effects of self-reported sexual orientation on substance abuse. Using data on a random sample of 6,713 individuals in Washington State, this study examines causes and correlates of substance use by sexual minorities, an at-risk and treatment underserved population. Logistic regression results indicate homosexual orientation is a significant positive predictor of past year marijuana use, past year hard drug use, past year binge drinking, and lifetime alcohol addiction. Bisexual orientation is a significant predictor of past year marijuana use, past year hard drug use, and past year binge drinking. Potential causal mechanisms for these elevated patterns of substance use are discussed.     

Individualized behavior therapy for alcoholics: a third year independent double-blind follow-up.

An independently conducted double-blind study providing third year follow-up data for 53 of 70 male alcoholics who served as subjects in an experiment evaluating “Individualized Behavior Therapy (IBT)” techniques is reported. In the original study, subjects were initially assigned to either a controlled drinking or non-drinking (abstinence) treatment goal, and were then randomly assigned to either an experimental group receiving IBT or a control group receiving conventional state hospital treatment oriented towards abstinence. Previously reported results showed that IBT subjects functioned significantly better than control subjects throughout the first year of follow-up. Second year follow-up results found that IBT subjects treated with a controlled drinking goal functioned significantly better than their respective control subjects on a variety of measures, including drinking behavior. Differences between IBT subjects treated with a non-drinking goal and their control subjects did not retain statistical significance during the second year of follow-up. The independently determined follow-up data showed that during the third post-treatment year, subjects in the experimental groups generally functioned better than their respective control subjects. Comparison of the controlled drinking experimental group with its control group showed the significantly better functioning of subjects in the experimental condition on a number of drinking and other life functioning measures. Comparison of the non-drinking groups indicated only one possible difference on the drinking related measures involving a trend for subjects in the experimental condition to abstain more than those in the non-drinker control group. On other life functioning measures, however, subjects in the non-drinking experimental condition showed consistent improvement over their respective control subjects. Both of the controlled drinking groups reported more controlled drinking days than the non-drinking groups throughout the third year follow-up period.     

A cross-cultural investigation of college student alcohol consumption: a classification tree analysis

In this cross-cultural study, the authors attempted to identify high-risk subgroups for alcohol consumption among college students. American and Greek students (N = 132) answered questions about alcohol consumption, religious beliefs, attitudes toward drinking, advertisement influences, parental monitoring, and drinking consequences. Heavy drinkers in the American group were younger and less religious than were infrequent drinkers. In the Greek group, heavy drinkers tended to deny the negative results of drinking alcohol and use a permissive attitude to justify it, whereas infrequent drinkers were more likely to be monitored by their parents. These results suggest that parental monitoring and an emphasis on informing students about the negative effects of alcohol on their health and social and academic lives may be effective methods of reducing alcohol consumption. Classification tree analysis revealed that student attitudes toward drinking were important in the classification of American and Greek drinkers, indicating that this is a powerful predictor of alcohol consumption regardless of ethnic background.