Alcoholic drinking: suppression by a brief time-out procedure

A field investigation of the effects of drinking consequences on young adults' readiness to change

In the research on readiness to change (RTC) one's drinking, there has been little assessment of the influence of positive drinking consequences or other potential moderating variables. To address these limitations, we examined how young adults' RTC their alcohol consumption shortly following a drinking episode was associated with self-reported drinking consequences, as well as any potential moderating effects of gender and Breath Alcohol Concentration (BrAC). In street interviews outside bars, 238 young adults were administered questionnaires about their drinking, including a measure examining participants' current readiness to reduce their alcohol consumption. Within 72h of their drinking episode, 67 participants (36 males; entire sample Mage=20.90years, Range=18-26years) completed an online survey, once again measuring RTC as well as positive and negative drinking consequences. Consistent with our hypothesis, positive drinking consequences were negatively associated with participants' changes in RTC. Additionally, a three-way interaction of gender×BrAC×positive drinking consequences on RTC showed that females with low BrACs reported higher RTC scores when they had endorsed fewer positive drinking consequences. Interestingly, negative drinking consequences alone did not impact individuals' RTC. Because positive drinking consequences were a significantly better predictor of RTC than were negative drinking consequences, researchers are advised to examine both types of consequences in future studies. Finally, effective alcohol education programs for those who have never consumed alcohol as well as social drinkers should include consideration of the experience of positive outcomes.

Integrating field methodology and web-based data collection to assess the reliability of the Alcohol Use Disorders Identification Test (AUDIT)

Field methodologies offer a unique opportunity to collect ecologically valid data on alcohol use and its associated problems within natural drinking environments. However, limitations in follow-up data collection methods have left unanswered questions regarding the psychometric properties of field-based measures. The aim of the current study is to evaluate the reliability of self-report data collected in a naturally occurring environment - as indexed by the Alcohol Use Disorders Identification Test (AUDIT) - compared to self-report data obtained through an innovative web-based follow-up procedure. Individuals recruited outside of bars (N=170; mean age=21; range 18-32) provided a BAC sample and completed a self-administered survey packet that included the AUDIT. BAC feedback was provided anonymously through a dedicated web page. Upon sign in, follow-up participants (n=89; 52%) were again asked to complete the AUDIT before receiving their BAC feedback. Reliability analyses demonstrated that AUDIT scores - both continuous and dichotomized at the standard cut-point - were stable across field- and web-based administrations. These results suggest that self-report data obtained from acutely intoxicated individuals in naturally occurring environments are reliable when compared to web-based data obtained after a brief follow-up interval. Furthermore, the results demonstrate the feasibility, utility, and potential of integrating field methods and web-based data collection procedures.

Loss of control and inability to abstain: the measurement of and the relationship between two constructs in male alcoholics

The constructs "loss of control" and "inability to abstain" have been used extensively in alcohol research. Examination of the literature, however, reveals inconsistencies in the ways researchers have operationalized and measured these constructs and a dearth of empirical investigation of the validity of the constructs. The current study examines a number of methods of operationalizing loss of control and inability to abstain and investigates the relationship of the two constructs with each other. Ninety-seven male alcoholics who participated in an outpatient conjoint alcoholism treatment study provided data on pre-treatment alcohol consumption and self-report measures of lifetime drinking behavior. Nine interview or questionnaire items that best approximated items used in the literature to measure inability to abstain and loss of control were chosen for analysis. Items measuring both constructs were highly intercorrelated and were associated more strongly with quantity rather than frequency of alcohol consumption, suggesting significant overlap between the constructs. None of the items were associated with a particular drinking pattern. The results provide support for a unitary dimension of impaired control, as used in the alcohol dependence syndrome, and suggest that the value of loss of control and inability to abstain as distinct and meaningful constructs should be reconsidered.

Alcoholism, politics, and bureaucracy: the consensus against controlled-drinking therapy in America

Controlled drinking has long been rejected as a therapeutic goal in traditional American alcoholism treatment. More striking has been the adoption of this position by behaviorists who once fostered controlled-drinking (CD) therapy, such as Peter Nathan, former director of the Rutgers Center of Alcohol Studies. This shift has occurred even while the evidence for rejecting the value of moderation training is unclear. Rather than being justified empirically, this rejection must instead be understood as a strategy behaviorists have used to jettison a politically explosive element in the behavioral package in order to gain overall acceptance for the behavioral approach to treating alcoholism. However, this strategy entails significant scientific, clinical, social, and ethical costs.

What schedule-induced polydipsia can tell us about alcoholism

An animal model of chronic and excessive voluntary (unforced) alcohol ingestion is presented in which, by drinking, animals produce repeated, substantial elevations in blood ethanol concentration and develop physical dependence. The overindulgence is elective in that ethanol is chosen in preference to certain other fluid-ingestive alternatives. Beside the usual demonstrations of acutely compromised motor performance, tolerance development, cross-tolerance, etc., the model demonstrates that the consequences of even short, but continued, daily drinking episodes results in the disruption of reinforced behavior that occurs later in the day when blood ethanol is absent (impaired general functioning). The conditions which induce the ethanol overindulgence can generate a variety of behavioral excesses which places alcoholism in a context of environmentally determined malfunctions that are subject to therapeutic change by altering situational parameters. Efficacious experiments utilizing therapeutic and preventive strategies are described that may serve as suggestions for corresponding human alcoholism intervention strategies.

Contingency management interventions: effects on treatment outcome during methadone detoxification

We examined the effectiveness of a contingency management program in preventing relapse to illicit opiate use and increasing treatment retention during outpatient methadone detoxification treatment. Twenty male opiate addicts were randomly assigned to an experimental or control group. Following a 3-week methadone stabilization period, men in both groups received identical gradual methadone dose reductions during Weeks 4 through 9 and were maintained on placebo during Weeks 10 through 13. Beginning in Week 4, control patients received $5.00 for providing a specimen twice weekly. Experimental patients received $10.00 and a take home methadone dose for each opiate-free urine specimen but forfeited the incentives and participated in more intensive clinic procedures when specimens were opiate positive. The contingency management procedure slowed the rate of relapse to illicit opiate use. Experimental patients provided significantly more opiate-free urines during the methadone dose reduction in Weeks 4 through 9 than control patients, although the difference between groups was no longer significant during placebo administration in Weeks 10 through 13. In addition, the contingency management program improved treatment retention and reduced symptom complaints during the detoxification. The usefulness and limitations of contingency management procedures for outpatient methadone detoxification are discussed.

Social Interaction and the Distribution of Alcohol Consumption

Both survey data and liver cirrhosis mortality data demonstrate the existence of a relationship between per capita consumption of alcohol and the prevalence of heavy alcohol use. The present paper reviews some of the explanations given for this relationship, and the so-called “contagion between persons” explanation is further developed. The empirical evidence for the basic assumptions of this theory is reviewed, and some predictions are derived and related to empirical facts.

Effects of response-contingent clock stimuli on behavior maintained by intravenous codeine in the rhesus monkey

Response-contingent brief presentations of clock stimuli differentially correlated with food availability altered rates of codeine-maintained lever pressing. Rhesus monkeys performed under a two lever multiple schedule: Multiple fixed interval clock 5 min variable interval 2 min. Different colored lights were presented during successive 75 sec period of the fixed-interval clock component. Lever pressing under the FI Clock schedule was maintained by presentation of 1 g Noyes pellets, and lever pressing under the VI schedule by 0.05 mg/kg infusions of codeine PO4. Characteristic schedule-controlled performance developed in both schedule components. When the clock stimulus from the first or the final period of the FI Clock schedule was presented contingent upon completion of a short fixed ratio of responses during the variable-interval schedule component, the first clock stimulus decreased and the final clock stimulus increased rates of codeine-maintained lever pressing. Neither the first nor the final clock stimulus altered the frequency of codeine injection. The effect of each clock stimulus was accentuated by increasing the duration of stimulus presentation and by decreasing the response requirement for stimulus illumination. These rate-altering effects of the clock stimuli were most pronounced when different reinforcers were presented in the two components of the multiple schedule when either food or intravenous codeine injection was available under both components of the multiple schedule, response-contingent clock stimulus presentation did not alter response rates under the VI schedule.

Positive reactions of alcoholic men to sensory deprivation

Ten male alcoholics who had been abstinent for 2 to 9 weeks volunteered to participate in a study on the effects of sensory deprivation. After 8 hours of lying on a bed in a dark, silent room, they indicated on various measures that they had found the experience to be quite pleasant; in fact, they indicated that they had more frequent positive experiences and less frequent negative experiences than in normal life. This finding indicates that sensory deprivation may be an acceptable treatment modality for alcoholics, as it has been for other clinical population.

Assessing the alcoholic's disposition to drink

Reliable and valid techniques for assessing the alcoholic's disposition to drink would allow researchers to address many issues of clinical significance. This paper reviews some basic issues in behavioral assessment techniques, proposes several criteria for a reasonably general technique for assessing disposition to drink, and presents evidence relevant to the validity of one behavioral measure of disposition to drink. A study is presented which focuses on distinguishing good from poor treatment outcome subjects on the basis of their response patterns for alcohol during a simulated drinking binge. Alcoholic subjects were assigned to one of two treatment outcome groups based on treatment success evaluated at follow-up two months after hospital discharge. An analysis of the alcoholic's response patterns for alcohol during a simulated drinking binge revealed that good outcome subjects showed decreases in disposition to drink as their blood alcohol levels (BAL) rose, while poor outcome subjects showed increases in disposition to drink as their BAL increased. These results indicate that individual differences in behavioral response to alcoholization and withdrawal can index the alcoholic's potential for readdiction and relapse subsequent to hospital treatment and illustrate the role which behavioral assessment techniques can play in developing and refining models of human alcohol abuse.

The validity of self-recording reports made by drug and alcohol abusers in a residential setting

In this study a self-recording procedure was used to clarify the relationship between urges or cravings for drugs (including alcohol) and actual drug (including alcohol) use within a residential setting. There were two purposes of the study: first, to evaluate the predictive validity of the self-recording procedure; and second, to generate empirical data relevant to the concept of craving, which is crucial to many theories of drug and alcohol addiction. The predictive validity of the urge reports was evaluated using a behavioral measure--actual and suspected drug use incidents. These incidents were reported by staff members on all drug and alcohol abusers in residential treatment during a 2-month period. The results indicate that there is no significant tendency for there to be an increased use of drugs on the same days that drug urges are reported, and that drug use incidents are most likely associated with reports of no urges for drugs. Therefore, the predictive validity of the self-recording reports was not established. The data challenge the notion that drug usage is preceeded by or accompanied by (intense, driving) drug cravings at least within this setting.