Nonnormality and divergence in posttreatment alcohol use: reexamining the Project MATCH data "another way."

Alcohol lapses are the modal outcome following treatment for alcohol use disorders, yet many alcohol researchers have encountered limited success in the prediction and prevention of relapse. One hypothesis is that lapses are unpredictable, but another possibility is the complexity of the relapse process is not captured by traditional statistical methods. Data from Project Matching Alcohol Treatments to Client Heterogeneity (Project MATCH), a multisite alcohol treatment study, were reanalyzed with 2 statistical methodologies: catastrophe and 2-part growth mixture modeling. Drawing on previous investigations of self-efficacy as a dynamic predictor of relapse, the current study revisits the self-efficacy matching hypothesis, which was not statistically supported in Project MATCH. Results from both the catastrophe and growth mixture analyses demonstrated a dynamic relationship between self-efficacy and drinking outcomes. The growth mixture analyses provided evidence in support of the original matching hypothesis: Individuals with lower self-efficacy who received cognitive behavior therapy drank far less frequently than did those with low self-efficacy who received motivational therapy. These results highlight the dynamical nature of the relapse process and the importance of the use of methodologies that accommodate this complexity when evaluating treatment outcomes.     

Effects of Smoking Urge on Generation of Smoking-Related Information1

Despite widespread research, the role of smoking urge in relapse remains unclear. The present study examined the effect of a smoking-urge manipulation on the generation of smoking-related information. During each of 2 experimental sessions, smokers were given 90 s to list as many positive characteristics of smoking, and then 90 s to list as many negative characteristics as they could. Results indicated that experimental manipulations designed to elicit an urge to smoke increased the number of positive but not negative aspects of smoking. This selective accessing of positive information related to cigarette use during an urge may increase the likelihood of smoking. Results are interpreted with respect to extant models of drug urge and Kunda's (1990) theory of motivated reasoning.     

Assessing clients in their natural environments with electronic diaries: rationale, benefits, limitations, and barriers

Increasingly, mobile technologies are used to gather diary data in basic research and clinical studies. This article considers issues relevant to the integration of electronic diary (ED) methods in clinical assessment. EDs can be used to gather rich information regarding clients' day-to-day experiences, aiding diagnosis, treatment planning, treatment implementation, and treatment evaluation. The authors review the benefits of using diary methods in addition to retrospective assessments, and they review studies assessing whether EDs yield higher quality data than conventional, less expensive paper-pencil diaries. Practical considerations--including what platforms can be used to implement EDs, what features they should have, and considerations in designing diary protocols for sampling different types of clinical phenomena--are described. The authors briefly illustrate with examples some ways in which ED data could be summarized for clinical use. Finally, the authors consider barriers to clinical adoption of EDs. EDs are likely to become increasingly popular tools in routine clinical assessment as clinicians become more familiar with the logic of diary designs; as software packages evolve to meet the needs of clinicians; and as mobile technologies become ubiquitous, robust, and inexpensive.     

Dissociations and associations of performance in syntactic comprehension in aphasia and their implications for the nature of aphasic deficits

Sixty-one pwa were tested on syntactic comprehension in three tasks: sentence-picture matching, sentence-picture matching with auditory moving window presentation, and object manipulation. There were significant correlations of performances on sentences across tasks. First factors on which all sentence types loaded in unrotated factor analyses accounted for most of the variance in each task. Dissociations in performance between sentence types that differed minimally in their syntactic structures were not consistent across tasks. These results replicate previous results with smaller samples and provide important validation of basic aspects of aphasic performance in this area of language processing. They point to the role of a reduction in processing resources and of the interaction of task demands and parsing and interpretive abilities in the genesis of patient performance.     

Relapse as a nonlinear dynamic system: application to patients with alcohol use disorders

Understanding the relapse process is one of the most important issues in addictive behaviors research. To date, most studies have taken a linear approach toward predicting relapse based on risk factors. Nonlinear dynamical systems theory can be used to describe processes that are not adequately modeled using a linear approach. In particular, the authors propose that catastrophe theory, a subset of nonlinear dynamical systems theory, can be used to describe the relapse process in addictive behaviors. Two small prospective studies using 6-month follow-ups of patients with alcohol use disorders (inpatient, n = 51; outpatient, n = 43) illustrate how cusp catastrophe theory may be used to predict relapse. Results from these preliminary studies indicate that a cusp catastrophe model has more predictive utility than traditional linear models.     

An examination of mood effects on positive alcohol expectancies among undergraduate drinkers

Alcohol expectancies have been found to be related to both alcohol use and abuse. To date, very little research has examined whether state biases known to affect the recall and endorsement of other types of information can influence alcohol expectancies. Mood-congruent memory theory and coping theory are reviewed, and are found to make opposing predictions regarding the relationship between state negative and positive affect and endorsement of positive alcohol expectancies. Study 1 (n = 121 undergraduate drinkers) used a correlational approach to show that negative affect predicted increased endorsement of positive alcohol expectancies. Study 2 (n = 55 undergraduate drinkers) used an experimental approach to show that participants assigned to a negative mood induction endorsed more positive alcohol expectancies than participants assigned to a positive mood induction. Together, these findings suggest that state negative affect can produce transient changes making alcohol use appear to be an attractive coping strategy.