Applications of the self-awareness model of alcohol consumption: Predicting patterns of use and abuse

Women and shame: narratives of recovery from alcohol dependence

OBJECTIVE

Existing literature indicates distinct pathways and the key role of shame and stigma into alcohol dependence (AD) and recovery for women. Internationally, there is a paucity of research exploring these factors from women's perspectives.

METHODS AND MEASURES

Taking a critical realist epistemological position, unstructured life story interviews were analysed via narrative analysis to explore how seven women from the UK, storied shame in their recovery from AD.

RESULTS

Shame followed a common trajectory across participants' stories, appearing as a reoccurring factor throughout AD and recovery. Participants narrated shame as gendered, contributing to a loss of personal control in defining a valued personal identity. Drinking began as a shame-management strategy but evolved into a source of shame, compounded by fears of being labelled an 'alcoholic woman'. Recovery involved reclaiming the self through de-shaming a shame-based identity and developing a positive, non-drinking identity. By evaluating 'shaming' recovery frameworks, sharing stories and reconstructing their own, participants were able to work through shame, resist pathologising identity labels and internalise esteemed 'sober' identities.

CONCLUSION

This research provides important insights into the intersection between shame, identity, gender and culture in women's recovery from AD. Implications for clinical practice, future research and policy are considered.

Psychometric properties of persian version of escapism scale among Iranian adolescents

The aim of this study was to assess the psychometric properties of the Persian version of the Escapism Scale among Iranian adolescents aged 14-18. Between January 2021 and August 2021, cross-sectional study was conducted using a convenience sampling method to select 566 participants (340 girls and 226 boys) to investigate the relationship between physical activity and mental health in adolescents. The participants completed several questionnaires, including the Escapism Scale, Erikson Psychosocial Stage Inventory (EPSI), Satisfaction with Life Scale (SWLS), Hope Scale (AHS), Smartphone Addiction Scale-Short Version (SAS-SV), and General Self-efficacy (GSE). Construct validity, reliability using Cronbach's alpha, and concurrent validity were used to evaluate the Escapism Scale's validity and reliability. Results of the Confirmatory Factor Analysis (CFA) indicated that a two-factor model provided a good fit for the data: sbX2 = 179.99 (p < 0.01); SRMR = 0.07; RMR = 0.56, CFI = 0.91; NFI = 0.89; IFI = 0.91; NFI = 0.89; GFI = 0.93; AGFI = 0.90, RMSEA = 0.076). The Cronbach's alpha coefficient for escapism was 0.73. The study found a significant positive relationship between escapism and smartphone addiction (r = 0.19). Additionally, a significant negative relationship was observed between escapism and hope (r=-0.31), satisfaction with life (r=-0.34), and general self-efficacy (r=-0.33). Furthermore, a significant relationship was found between escapism and gender. Lastly, the study found a significant relationship between escapism and identity confusion (r = 0.164, P < 0.01) and identity coherence (P < 0.01, r = 29). In conclusion, the Escapism Scale is a valid and reliable tool for assessing escapism and psychological evaluations in Iranian adolescents. These results may inform future research and suggest re-testing in clinical populations.

Self-Escapism among Iranian Girl Adolescents: Validity and Reliability of Persian Translation Scale.. [DOI: 10.21203/rs.3.rs-2037372/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

This research was conducted to determine the validity and reliability of the Persian version of the self-escapism scale among Iranian girl adolescents aged 14–18. A cross-sectional study was conducted between January 2021 and August 2021 among Iranian girl adolescents. Five hundred sixty-six adolescents (340 girls and 226 boys) were selected using a convenience sampling method. The participants completed The Escapism Scale, Erikson Psychosocial Stage Inventory (EPSI), Satisfaction with Life Scale (SWLS), Hope Scale (AHS), Smartphone Addiction Scale-Short Version (SASSV), and General Self-efficacy (GSE). The Escapism Scale's validity and reliability were examined as construct validity based on the confirmatory factor analysis (CFA), reliability using Cronbach’s alpha, and divergent and convergent validity. Results of the CFA indicated that a two-factor model provides a good fit for the data: sbX2 = 179.99 (p < 0.01); SRMR = 0.07; RMR = 0.56, CFI = 0.91; NFI = 0.89; IFI = 0.91; NFI = 0.89; GFI = 0.93; AGFI = 0.90, RMSEA = 0.076). Cronbach’s alpha coefficient for the self-escapism was 0.73. There was a significant relationship between self-escapism with identity confusion (r = 0.164, P < 0.01) and identity coherence (P < 0.01, r = 29). The finding showed a significant negative relationship between self-escapism with AHS (r=-0.31), SWLS (r=-0.34), and GHS (r=-0.33). There was a significant positive relationship between self-escapism and SAS-SV (r = 0.19). Also, the findings have shown a relationship between self-escapism and gender. This scale has been recommended to assess self-escapism in Iranian adolescents and psychological evaluations.

Repetitive negative thinking, metacognitive beliefs, and their interaction as possible predictors for problematic cannabis use

The metacognitive formulation of addictive behaviours considers repetitive negative thinking (RNT) and metacognitive beliefs as two important processes involved in the development and maintenance of addictive behaviours. To date, very limited research has investigated the implication of these processes in problematic cannabis use. The present study was aimed at exploring the association between RNT, metacognitive beliefs, and cannabis use in a sample of 157 problematic cannabis users. Participants were administered measures of cannabis use severity, RNT, metacognitive beliefs, anxiety, and depression. Multiple regression analysis showed that metacognitive beliefs (cognitive confidence, beliefs about the need to control thought, and cognitive self-consciousness) were independent predictors of problematic cannabis use and related problem severity when controlling for RNT and negative affect (anxiety and depression). Furthermore, RNT predicted problematic cannabis use severity only for users with low levels of negative beliefs about thoughts concerning uncontrollability and danger. These data suggest that metacognitive beliefs and RNT may be two relevant cognitive processes for understanding problematic cannabis use. More generally, it enables the consideration of cannabis use from the perspective of self-regulation theories, and more specifically cognitive regulation, thus offering several theoretical and clinical implications.

The acute effects of alcohol on state rumination in the laboratory

RATIONALE

Rumination is a repetitive, negative, self-focused thinking style associated with various forms of psychopathology. Recent studies suggest that rumination increases craving for alcohol and predicts harmful drinking and alcohol-related problems. However, the acute effects of alcohol on rumination have not been previously studied. It is proposed that alcohol may reduce ruminative thinking through decreasing negative mood.

OBJECTIVES

In the present study, we aimed to test the previously unexplored effects of acute alcohol consumption on rumination in a hazardous drinking population.

METHODS

We conducted a randomised placebo-controlled laboratory study to examine the effect of low (0.4 g kg^-1) and high doses (0.8 g kg^-1) of alcohol on state rumination compared to placebo. Participants completed a rumination induction task prior to receiving drinks. We then measured state rumination and mood at repeated time points; 30 min, 60 min and 90 min post-drinks consumption.

RESULTS

We found a significant decrease in state rumination in the low-dose alcohol group compared to placebo at 30 min post-alcohol consumption, but no difference was observed between the high-dose alcohol and placebo groups. Mediation analysis provided evidence for an indirect effect of alcohol on state rumination through concurrent changes in negative mood.

CONCLUSIONS

These findings suggest that acute alcohol consumption can regulate negative mood and concurrently rumination, providing preliminary evidence for the role of rumination in alcohol use disorders. Rumination may be a treatment target in alcohol use disorders.

Using Placebo Beverages in Group Alcohol Studies

BACKGROUND

Placebo beverage conditions remain a key element in the methodological toolkit for alcohol researchers interested in evaluating pharmacological and nonpharmacological factors influencing the effects of alcohol consumption. While interest in experimentally examining alcohol in social context is on the rise, there has been little research examining the effectiveness of placebo manipulations in group settings, when just 1 suspicious participant could potentially jeopardize the effect of the placebo on group members. Moreover, research has rarely considered the association between individual difference factors (e.g., gender) and placebo manipulation effectiveness. The present study, using an uncommonly large sample of placebo-consuming participants, was well suited to investigate fundamental questions regarding placebo efficacy that have not been assessed previously. Specifically, we aimed to examine placebo efficacy and general processes of placebo functioning in a group context. We also assessed potential associations between a variety of individual difference factors and placebo response.

METHODS

A total of 240 participants (50% male) consumed placebo beverages during a triadic drinking period (across 80 three-person groups). Participants reported their subjective intoxication, stimulation, and sedation 8 minutes following drink consumption and estimated the alcohol content of their drink at the end of the study.

RESULTS

Participants consuming placebo beverages in groups were nearly universal in reporting that they had consumed alcohol (>99%) and had experienced an increase in feelings of intoxication [t(239) = 22.03, p < 0.001] and stimulation [t(239) = 5.53, p < 0.001], levels that were similar to those observed in prior studies conducted with participants drinking placebos in isolation. Further, participants' placebo responses were independent of their 2 group members and were largely unaffected by a variety of individual difference factors.

CONCLUSIONS

Placebo response generally operated independently of group-member influences, suggesting that researchers can successfully conduct placebo beverage studies utilizing group drinking designs.

Distress Response to the Failure to an Insoluble Anagrams Task: Maladaptive Emotion Regulation Strategies in Binge Drinking Students

Background: Emotion regulation refers to the attempt to influence the latency, magnitude, and duration of an emotion, and to modify the experiential, behavioral, or physiological components of the emotional response. In situations of personal failure, individuals, and in particular those who present a tendency to self-focus, may experience intense emotional distress. Individuals who lack proper adaptive emotion regulation strategies may engage in activities leading to immediate pleasure, such as alcohol drinking, in order to escape the self-relevance of emotional experiences. This self-awareness theory of drinking has been shown explain relapses in self-focused alcohol-dependent individuals in situations of personal failure, after detoxification. Such relapses support the existence of maladaptive emotion regulation strategies in alcohol dependence. As binge drinking may be considered as an early stage of alcohol-use-disorder, the aim of this study was to explore the relationship between emotional distress, self-regulation and self-consciousness in binge drinkers (BD). Methods: Fifty-five students (32 BD and 23 controls) completed different questionnaires related to the self (self-consciousness and self-regulation questionnaires) and were exposed to a situation of self-failure (insoluble anagrams). Results: The distress induced by the anagrams task was more related to self-blame, ruminations and maladaptive emotion regulation strategies in BD than in controls. Emotional distress was related to less positive refocusing, refocusing on planning, and adaptive emotion regulation strategies among the control group with less public self-consciousness. Emotional distress was related to more positive refocusing, positive reappraisal, refocusing on planning, and adaptive emotion regulation strategies among control participants with higher public self-consciousness. Low self-conscious BD who experienced anagram distress used less acceptance and less refocusing on planning strategies. Conversely, high self-conscious BD used more refocusing on planning strategies when experiencing anagram distress. Conclusion: This study suggests a relationship between emotional distress and self-regulation, in BD only. Moreover, public self-consciousness appears to be a disposition that motivates non-BD to improve actions and attitudes to meet self-standards. Finally, this study suggests a minor role of self-consciousness in the relationship between self-regulation and emotional distress in BD. Finally, low private/public self-consciousness in the binge drinking group may also be related to more maladaptive emotion regulation strategies.

The effects of alcohol on emotion in social drinkers

Understanding why people drink alcohol and in some cases develop drinking problems has long puzzled researchers, clinicians, and patients alike. In the mid-1940s and early 1950s, experimental research began to systematically investigate alcohol's hedonic properties. Presumably, alcohol consumption would prove reinforcing as a consequence of its capacity either to relieve stress or to brighten positive emotional experiences. This article reviews experimental research through the years examining the impact of alcohol on both the relief of negative affect and the enhancement of positive affect. It covers initial accounts that emphasized direct pharmacological effects of ethanol on the central nervous system. These early studies offered surprisingly tepid support for the premise that alcohol improved emotional states. Next, studies conducted in the 1970s are considered. Informed by social learning theory and employing advances derived from experimental psychology, this research sought to better understand the complex effects of alcohol on emotion. Coverage of this work is followed by discussion of current formulations, which integrate biological and behavioral approaches with the study of cognitive, affective, and social processes. These current perspectives provide insight into the particular conditions under which alcohol can boost emotional experiences. Finally, future research directions and clinical implications are considered.

Dimensions of Adult Attachment, Affect Regulation, and Romantic Relationship Functioning

Recent research has suggested that adult attachment style, an orientation to relationships thought to be determined by child-hood relationships with parents and subsequent experiences with important attachment figures, affects the experience of romantic love. Several hypotheses were generated regarding attachment-style differences in affect-regulation strategies (nonintimate sexual behavior, alcohol use, and eating disorders) and attachment experiences and dynamics in couples (e.g., relationship satisfaction, partner-matching on attachment style). These hypotheses were tested using seven theoretically derived attachment scales, which reveal the specific attributes of a person's attachment style. Results indicate substantial associations between attachment dimensions and relationship satisfaction, nonintimate sexuality, eating disorders, and motives for drinking, and replicate previous research showing nonrandom but weak pairing of attachment styles in dating couples.

The hyper-sentient addict: an exteroception model of addiction

BACKGROUND

Exteroception involves processes related to the perception of environmental stimuli important for an organism's ability to adapt to its environment. As such, exteroception plays a critical role in conditioned response. In addiction, behavioral and neuroimaging studies show that the conditioned response to drug-related cues is often associated with alterations in brain regions including the precuneus/posterior cingulate cortex, an important node within the default mode network dedicated to processes such as self-monitoring.

OBJECTIVE

This review aimed to summarize the growing, but largely fragmented, literature that supports a central role of exteroceptive processes in addiction.

METHODS

We performed a systematic review of empirical research via PubMed and Google Scholar with keywords including 'addiction', 'exteroception', 'precuneus', and 'self-awareness', to identify human behavioral and neuroimaging studies that report mechanisms of self-awareness in healthy populations, and altered self-awareness processes, specifically exteroception, in addicted populations.

RESULTS

Results demonstrate that exteroceptive processes play a critical role in conditioned cue response in addiction and serve as targets for interventions such as mindfulness training. Further, a hub of the default mode network, namely, the precuneus, is (i) consistently implicated in exteroceptive processes, and (ii) widely demonstrated to have increased activation and connectivity in addicted populations.

CONCLUSION

Heightened exteroceptive processes may underlie cue-elicited craving, which in turn may lead to the maintenance and worsening of substance use disorders. An exteroception model of addiction provides a testable framework from which novel targets for interventions can be identified.

The association between depression and craving in alcohol dependency is moderated by gender and by alexithymia factors

Alexithymia is a multifaceted personality trait that involves difficulties in identifying and describing feelings to others, a poor fantasy life and an externally oriented cognitive style. Alexithymia has been described as a vulnerability factor for mental and physical diseases. We investigated in a group of 158 alcohol-dependent patients (103 men, 55 women) the association between depression and craving for alcohol when these patients were starting a detoxification program, and the moderating impact of gender and alexithymia on this relation. We first found an interaction between depression and gender in the prediction of craving in the sense that only for women an increase in depressive mood was related to an increase in total craving. When examining gender separately, we found that alexithymia factors acted as moderators. For women, the link between depression and craving was strengthened for the ones scoring higher on "difficulties describing feelings". But for men, the link between depression and craving was reduced for the ones scoring higher on "externally-oriented thinking". These findings suggest that in some cases that need to be identified more systematically in the future, the "externally-oriented thinking" alexithymia factor can exert - at least in the short term - some protective effects.

Booze, Bars, and Bystander Behavior: People Who Consumed Alcohol Help Faster in the Presence of Others

People help each other less often and less quickly when bystanders are present. In this paper, we propose that alcohol consumption could attenuate or reverse this so-called bystander effect. Alcohol impairs people cognitively and perceptually, leading them to think less about the presence of others and behave less inhibited. Moreover, alcohol makes people more prone to see the benefits of helping and not the costs. To provide an initial test of these lines of reasoning, we invited visitors of bars in Amsterdam to join our study at a secluded spot at the bar. We manipulated bystander presence, and at the end of the study, we measured alcohol consumption. When participants took their seats, the experimenter dropped some items. We measured how many items were picked up and how quickly participants engaged in helping. Results revealed that alcohol did not influence the bystander effect in terms of the amount of help given. But importantly, it did influence the bystander effect in terms of response times: people who consumed alcohol actually came to aid faster in the presence of others.

Impaired self-awareness in human addiction: deficient attribution of personal relevance

Compromised self-awareness of illness-related deficits and behaviors in psychopathology (e.g., schizophrenia) has been associated with deficient functioning of cortical midline regions including the ventromedial prefrontal cortex (vmPFC), implicated in personal relevance. Here, we review and critically analyze recent evidence to suggest that vmPFC abnormalities could similarly underlie deficient tagging of personal relevance in drug addiction, evidenced by a constellation of behaviors encompassing drug-biased attention, negative outcome insensitivity, self-report/behavior dissociation, and social inappropriateness. This novel framework might clarify, for example, why drug-addicted individuals often ruin long-standing relationships or forego important job opportunities while continuing to engage in uncontrolled drug-taking. Therapeutic interventions targeting personal relevance and associated vmPFC functioning could enhance self-awareness and facilitate more adaptive behavior in this chronically relapsing psychopathology.

A social-attributional analysis of alcohol response

Conventional wisdom and survey data indicate that alcohol is a social lubricant and is consumed for its social effects. In contrast, the experimental literature examining alcohol's effects within a social context reveals that alcohol does not consistently enhance social-emotional experience. We identify a methodological factor that might explain inconsistent alcohol-administration findings, distinguishing between studies featuring unscripted interactions among naïve participants (k = 18) and those featuring scripted social interactions with individuals identified as study confederates (k = 18). While 89% of naïve-participant studies find positive effects of alcohol on mood (d = 0.5), only 11% of confederate studies find evidence of significant alcohol-related mood enhancement (d = -0.01). The naïve-participant versus confederate distinction remains robust after controlling for various moderators including stress manipulations, gender, group size, anxiety outcome measure, and within-group consistency of beverage assignment. Based on the findings of our review, we propose a multidimensional, social-attributional framework for understanding alcohol-related reward. Borrowing organizing principles from attribution theory, the social-attributional approach predicts that alcohol will enhance mood when negative outcomes are perceived to be unstable and/or self-relevant. Our framework proposes that alcohol's effects within a social context are largely explained by its tendency to free individuals from preoccupation with social rejection, allowing them to access social rewards. The social-attributional approach represents a novel framework for integrating distinct, well-validated concepts derived from several theories of alcohol's effects. It further presents promising lines of inquiry for future research examining the role of social factors in alcohol reward and addiction susceptibility.

The associations between self-consciousness, depressive state and craving to drink among alcohol dependent patients undergoing protracted withdrawal

Context

In order to understand how certain personality traits influence the relation between depression symptoms and craving for alcohol, trait self-consciousness (trait SC) was examined during a withdrawal and detoxification program.

Methods

Craving (Obsessive and Compulsive Drinking Scale), depressive state (Beck Depression Inventory) and trait SC (Revised Self-Consciousness Scale) were assessed in alcohol-dependent inpatients (DSM-IV, N = 30) both at the beginning (T1: day 1 or 2) and at the end (T2: day 14 to18) of protracted withdrawal during rehabilitation.

Results

A significant decrease in craving and depressive symptoms was observed from T1 to T2, while SC scores remained stable. At both times, strong positive correlations were observed between craving and depression. Moreover, regression analyses indicated that trait SC significantly moderated the impact of depression on cravings for alcohol.

Limitations

This study was performed on a relatively small sample size. Administration of medications during detoxification treatment can also be a confounding factor. Finally, craving could have been evaluated through other types of measurements.

Conclusions

During protracted withdrawal, alcohol craving decreased with the same magnitude as depressive mood. Depressive symptoms were related to alcohol craving but only among patients with high trait SC scores. Our results suggest that metacognitive approaches targeting SC could decrease craving and, in turn, prevent future relapses.

Health risk behaviors and physical symptom reporting among Jordanian youths: personality and sociodemographic correlates

Sociodemographic (gender and socioeconomic status) and personality (dispositional self-consciousness) correlates of risk behavior (smoking, seatbelt nonuse, vehicular speeding) and physical symptom reporting were assessed in a sample of Jordanian college students. Statistically significant correlations were found between gender and both risk behavior and physical symptom reporting. Female participants were more likely to complain of physical symptoms, but less likely to engage in risk behavior than males. Socioeconomic status was negatively related to physical symptom reporting, but variably related to risk behavior. Private self-consciousness was not related to risk behavior or to complaints of physical symptoms. Public self-consciousness was negatively associated with seatbelt use. Multiple regression analyses showed that, overall, socioeconomic status and gender were better predictors of risk behaviors and physical symptom reporting than any aspect of dispositional self-consciousness. The implications of these findings are discussed.

Sex differences in mediating and moderating processes linking economic stressors, psychological distress, and drinking

OBJECTIVE

Given the recent downturn in the U.S. economy, we considered in this study the processes linking economic stressors, psychological distress, and two alcohol-related outcomes (past-month drinking and problematic drinking).

METHOD

Data were drawn from a mail survey of a national sample of 663 respondents. Structural equation modeling was used to assess whether psychological distress mediates the associations between economic stressors and the alcohol-related outcomes considered and whether these associations varied by gender.

RESULTS

Controlling for correlations among the outcomes and the effects of the sociodemographic control variables, psychological distress was found to partly explain the association between economic stressors and problematic drinking. The mediating effects on problematic drinking were significantly greater for men than women.

CONCLUSIONS

The findings demonstrate the utility of considering interrelationships among alcohol-related outcomes and, in this context, reveal the circumstances in which gender matters most for understanding the associations among economy-related stressors, psychological distress, and drinking.

Self-consciousness as a moderator of the effect of social drinking motives on alcohol use

This study evaluated self-consciousness as a moderator of the relationship between social drinking motives and alcohol use. Participants included 243 undergraduate students who reported alcohol use, alcohol-related problems, self-consciousness, and social motives. We expected that social drinking motives, private self-consciousness, and public self-consciousness would be positively associated with drinking and that this relationship would be moderated by self-consciousness. Specifically, we expected this relationship to be stronger for people lower in private self-consciousness, based on decreased awareness about their internal states. In addition, we expected that the relationship between social motives and drinking would be stronger among those who were higher in public self-consciousness, given their focus on the self as a social object. Consistent with expectations, the associations between social motives and peak drinking and drinks per week were more strongly associated among those lower in private self-consciousness. However, inconsistent with expectations, the relationship between social motives and drinking was stronger among those who were lower, rather than higher, in public self-consciousness. Overall implications of these research findings extend previous research emphasizing the importance of considering social influences in etiology and prevention of drinking. Moreover, while social motives are a consistent predictor of drinking among young adults, this is not universally true. This study contributes to social cognitive literature seeking to understand and identify individual factors related to drinking and their application to the adaptation of existing intervention approaches.

Neuroimaging for drug addiction and related behaviors

In this review, we highlight the role of neuroimaging techniques in studying the emotional and cognitive-behavioral components of the addiction syndrome by focusing on the neural substrates subserving them. The phenomenology of drug addiction can be characterized by a recurrent pattern of subjective experiences that includes drug intoxication, craving, bingeing, and withdrawal with the cycle culminating in a persistent preoccupation with obtaining, consuming, and recovering from the drug. In the past two decades, imaging studies of drug addiction have demonstrated deficits in brain circuits related to reward and impulsivity. The current review focuses on studies employing positron emission tomography (PET), functional magnetic resonance imaging (fMRI), and electroencephalography (EEG) to investigate these behaviors in drug-addicted human populations. We begin with a brief account of drug addiction followed by a technical account of each of these imaging modalities. We then discuss how these techniques have uniquely contributed to a deeper understanding of addictive behaviors.

Reliability, validity, and psychometric development of the pornography consumption inventory in a sample of hypersexual men

This article reports the psychometric evaluation of the Pornography Consumption Inventory (PCI), which was developed to assess motivations for pornography use among hypersexual men. Initial factor structure and item analysis were conducted in a sample of men (N = 105) seeking to reduce their pornography consumption (Study 1), yielding a 4-factor solution. In a second sample of treatment-seeking hypersexual men (N = 107), the authors further investigated the properties of the PCI using confirmatory factor analytic procedures, reliability indices, and explored PCI associations with several other constructs to establish convergent and discriminant validity. These studies demonstrate psychometric evidence for the PCI items that measure tendencies of hypersexual men to use pornography (a) for sexual pleasure; (b) to escape, cope, or avoid uncomfortable emotional experiences or stress; (c) to satisfy sexual curiosity; and (d) to satisfy desires for excitement, novelty, and variety.

The neurocircuitry of impaired insight in drug addiction

More than 80% of addicted individuals fail to seek treatment, which might reflect impairments in recognition of severity of disorder. Considered by some as intentional deception, such 'denial' might instead reflect dysfunction of brain networks subserving insight and self-awareness. Here we review the scant literature on insight in addiction and integrate this perspective with the role of: (i) the insula in interoception, self-awareness and drug craving; (ii) the anterior cingulate in behavioral monitoring and response selection (relevant to disadvantageous choices in addiction); (iii) the dorsal striatum in automatic habit formation; and (iv) drug-related stimuli that predict emotional behavior in addicted individuals, even without conscious awareness. We discuss implications for clinical treatment including the design of interventions to improve insight into illness severity in addiction.

How emotion shapes behavior: feedback, anticipation, and reflection, rather than direct causation

Fear causes fleeing and thereby saves lives: this exemplifies a popular and common sense but increasingly untenable view that the direct causation of behavior is the primary function of emotion. Instead, the authors develop a theory of emotion as a feedback system whose influence on behavior is typically indirect. By providing feedback and stimulating retrospective appraisal of actions, conscious emotional states can promote learning and alter guidelines for future behavior. Behavior may also be chosen to pursue (or avoid) anticipated emotional outcomes. Rapid, automatic affective responses, in contrast to the full-blown conscious emotions, may inform cognition and behavioral choice and thereby help guide current behavior. The automatic affective responses may also remind the person of past emotional outcomes and provide useful guides as to what emotional outcomes may be anticipated in the present. To justify replacing the direct causation model with the feedback model, the authors review a large body of empirical findings.

The effect of psychotherapy on self-awareness in incarcerated and nonincarcerated alcoholics: a pilot study

Changes in self-awareness in incarcerated and nonincarcerated male alcoholics are measured before and after disaccustoming therapy based on Alcoholics Anonymous principles. The four-mode conception of self-awareness of Zaborowski is employed. The results show significant and expected changes in incarcerated participants (in defensive, individual, and reflective modes of self-awareness) and almost no changes in nonincarcerated individuals. An effect of motivation on therapy is also identified. Incarceration appears to be more conducive to recovery than to conditions outside the prison.

Anxiety sensitivity, controllability, and experiential avoidance and their relation to drug of choice and addiction severity in a residential sample of substance-abusing veterans

The aim of the present study was to evaluate anxiety-related psychological risk factors (e.g., anxiety sensitivity, perceived uncontrollability, emotional avoidance) and their relation to drug of choice and addiction severity in an inpatient residential substance abuse population. Fully detoxified veterans (N=94) meeting criteria for Axis I substance abuse disorders were enrolled in a 28-day residential substance abuse treatment program and completed the following measures at intake and discharge: Anxiety Sensitivity Index, Body Sensations Questionnaire (BSQ), Acceptance and Action Questionnaire (AAQ), Beck Depression Inventory (BDI; intake only), and the Anxiety Control Questionnaire (ACQ). Consistent with the expectation, veterans who reported more distress over bodily sensations (anxiety sensitivity, BSQ) and depressive symptoms (BDI) were more likely to avoid experiencing negative affect (AAQ) and perceived themselves as lacking in control (ACQ). Further, extent of avoidance, and to a lesser extent, controllability, discriminated between participants as a function of primary and comorbid diagnostic status, whereas anxiety sensitivity did not. No relation was found between anxiety sensitivity and drug of choice, and relations between assessed psychological factors and domains of addiction severity were mixed. Findings suggest that heightened bodily sensitivity, emotional avoidance, and perceived uncontrollability are common sequelae of patients seeking residential substance abuse treatment, but they do not contribute uniquely to drug of choice and measures of addiction severity. Theoretical and treatment implications are discussed with particular emphasis on approaches that may increase coping with untoward bodily cues, decrease avoidance of negative affect, and improve patient's sense of personal control over their responses and the environment.

A Daily Process Examination of the Stress-Response Dampening Effects of Alcohol Consumption

The authors used a daily process design to assess alcohol's stress-response dampening (SRD) effects. Moderate to heavy social drinkers (N=100) reported on palmtop computers their alcohol consumption and social context in vivo for 30 days. Participants also reported on their mood states in the late morning and early evening and completed a paper-and-pencil daily diary in which they recorded their negative events. The association between negative events and mood was weaker on days when individuals consumed alcohol prior to the final mood assessment. However, the moderating effect of alcohol on the negative event-mood association was limited to drinking in social situations. Alcohol's SRD effects varied as a function of several between-person risk factors.

Aspects of guilt and self-reported substance use in adolescence

The use of addictive substances is undergoing moralization in American society-behaviors once viewed as personal preferences now carry moral significance. Research has shown that sociomoral emotions like guilt, thought to be reflective of one's internalized standards and societal mores, can be an important influence on behavior. The present study explored the relationship between college students' self-reports of adolescent substance use (cigarettes, alcohol, and marijuana) and scores on indices tapping different aspects of guilt (Standards, Situational, and Chronic Guilt). Participants were 230 undergraduate students (mean age = 19; 55 percent female; 69 percent White). Substance users had lower scores on Standards and Situational Guilt than non-users, but no difference was observed in Chronic Guilt. The present results suggest that a stronger internalization of societal standards, as reflected by higher scores on Standards and Situational Guilt, may prove a useful tool in the prevention of substance use.

Guilty pleasures and grim necessities: affective attitudes in dilemmas of self-control

Do self-control situations pit controlled reason against impulsive emotion, or do some emotions support the controlled choice? A pilot study of self-control attitudes found ambivalence between hedonic affect associated with short-term perspectives and self-conscious affect associated with the long term. In Study 1, negative self-conscious affect accompanied higher self-control among delayed-cost dilemmas ("guilty pleasures") but not delayed-benefit dilemmas ("grim necessities"). Study 2 showed that hedonic affect was more accessible than was self-conscious affect, but this difference was less among high self-control dilemmas. In Study 3, unobtrusively primed self-conscious emotion words caused dieters to eat less if the emotions were negative, more if positive. Hedonic positive and negative emotion words had the opposite effect. Self-conscious emotional associations, then, can support self-control if brought to mind before the chance to act.

Prediction of single episodes of drinking during the treatment of alcohol-dependent patients

Drinking episodes during the treatment (relapses or lapses) of alcohol-dependent patients is predicted from clinical ratings of patients and individual background data such as alcohol drinking history and social status. The probability of these relapses (or lapses) is determined up to three days in advance using a logistic regression procedure. The study group consisted of 33 male alcohol-dependent persons, who participated in a treatment program. Clinical ratings were performed three times a week by a trained person during a visit to the clinic. The questionnaire contained 23 different items about irritation, craving for alcohol. sleep disturbances, etc. The relapses were either self-reported or detected by a biochemical marker in a urine sample that was taken daily. The most important factor for a relapse in alcohol drinking was shown to be if the patient already had had one relapse during the treatment. Other important clinical factors were the levels of irritation and autonomic disturbances. None of the variables measuring mood shifts was significant. Family conditions during childhood were the most important background variables. The predictions turned out to have a rather high specificity, but the sensitivity was lower. Half of the relapses were not predicted by an increased probability for relapse. Self-reported relapses were predictable from preceding interviews and were also less frequent compared to those detected objectively by the biochemical markers.

Effects of negative outcome on food consumption in college women with and without troubled eating patterns

This study looked at the effects that failure experiences have on food consumption and their effect on college women. Part I of the study (N = 169) was used to screen subjects for Part II (N = 55) based on scores on the Bulimia Test-Revised. In part II, eating-disordered and control participants completed one of two types of tasks-a negative outcome and a neutral outcome control task. Following the task, a bogus cookie rating task provided the opportunity for participants to eat chocolate chip cookies. Mood was assessed throughout Part II. Results indicate that mood was more negative following the negative outcome task. Eating-disordered participants ate more than did controls in this same condition; these participants also reported improved mood after eating.

Esteem Threat, Self-Regulatory Breakdown, and Emotional Distress as Factors in Self-Defeating Behavior

Patterns of human self-defeating or self-destructive behavior are examined in relation to several hypothesized causes. Threatened egotism appears to be a major, pervasive cause: Self-defeating responses are especially common when people feel that others may perceive them less favorably than the people desire. Self-regulation failure is also a common element in most self-defeating behavior. Emotional distress is often a precipitating factor. Several causal processes, including foolish risk taking and escapist responses, link emotional distress to self-defeat.

Smoking and attention: a review and reformulation of the stimulus-filter hypothesis

An accumulation of evidence suggests that smoking may be reinforcing, in part, due to nicotine's capacity to enhance attentional processing. Correspondingly, the stimulus-filter model of nicotine reinforcement asserts that nicotine facilitates cognitive performance by acting as a stimulus-barrier, thereby screening irrelevant and annoying stimuli from the smoker's awareness. A review of the available data suggests that while nicotine does appear to reliably enhance sustained, divided, and focused attention, the stimulus-filter model falls short of adequately explaining the findings. An alternative, attention, allocation model of nicotine reinforcement is reviewed, the tenets of which suggest that nicotine differentially augments attentional processing via its propensity to: (a) induce attentional narrowing, and (b) increase perceptual processing capacity. The motivational implications of the model, including smokers' use of nicotine to dampen stress, are discussed.

Self-examination therapy as an adjunct treatment for depressive symptoms in substance abusing patients

To determine the efficacy of Self-Examination Therapy as an adjunct treatment for depressive symptoms in substance abusing patients, 28 adult male volunteers from a substance abuse unit at a VA Medical Center were randomly assigned to either Self-Examination Therapy or a Current Events comparison group. Analyses indicated that participants in Self-Examination Therapy showed significantly greater improvement in depressive symptoms and overall psychopathology than participants in the Current Events comparison group. These results suggest that Self-Examination Therapy is a viable adjunct treatment for substance abusers, particularly those with depressive symptoms.

Dimensions of Adolescent Self-Concept Associated with Substance Use

Self-concept has been often examined in relation to adolescent substance use and research results have shown consistently strong association between the two. Yet, the authors maintain that the global construct is amorphous and lacking in defined boundaries that allow for planning and implementation of educational and treatment interventions that effectively impact self-concept. The purpose of the study was to examine the underlying dimensions of self-concept that relate to adolescent alcohol and drug use. Four constitutive dimensions of self-concept were identified through factor analysis. These four factors are negative image, self- confidence, bonding and effectiveness. All four self-concept measures were found to significantly correlate with both drug experimentation and frequency of drug use. Three of the self- concept factors (negative image, self-confidence, and effectiveness) are considered to be internally referenced. These dimensions of self-concept may be the cumulative effect of genetic, psychological and environmental forces. The intractable nature of internal self-concept dimensions may require intensive services and ongoing support services for effective treatment of deficits. However, the fourth self-concept factor, bonding, is primarily viewed as an externally-referenced factor. Remediation of bonding deficits calls for inclusion of significant others in the overall strategy of self-concept enhancement.

The role of psychobiological states in chemical dependency: who becomes addicted?

This paper argues that recent developments in the understanding of psychobiological states may help to explain individual differences in susceptibility to addiction. It points out that the construct of arousal is deficient for this purpose and that a more fruitful approach views humans as bundles of state-dependent selves, strongly affected by self-efficacy and response expectancies. Coping skills, enhancement behaviors, and other state-regulating techniques are seen as crucial to liability to chemical dependency and the social learning underlying their genesis is explored. Under this view drug experiences are held to be analogous to hypnotic inductions and psychological approaches to therapy could usefully focus on helping addicts develop a metaperspective on the succession of psychobiological states.

The change process in alcoholics: client motivation and denial in the treatment of alcoholism within the context of contemporary nursing

Despite being constantly cited as a critical intervening variable in the recovery from alcohol problems, there is a paucity of literature on client motivation. This paper reviews the current literature which impacts on motivation and its importance in treatment and develops in a stepwise manner the revised expectancy/motivation hypothesis, tentatively explaining both motivation and denial as a natural process in behavioural change. Because of the revised expectancy/motivation hypothesis' distinctly defined stages which closely relate to the process of nursing and the qualitative and quantitative measurement it entails which the nursing process demands, it offers a particularly appropriate model for treatment within nurse practice.

Abstinence expectancy and abstinence among men undergoing inpatient treatment for alcoholism

Several personal and situational variables were examined as possible predictors of renewed drinking before completion of an inpatient alcoholism treatment program: either drinking surreptitiously while remaining in the program or leaving the program to return to alcohol. Male alcoholics were interviewed shortly after entering the program and again as they finished treatment. The first interview assessed predictor variables, the second interview assessed drinking during treatment. Treatment dropouts were pursued to determine their drinking status. Discriminant analyses revealed that renewed drinking was inversely related to subjects' reported expectancies of remaining abstinent during the next 6 months, positively related to employment instability, and also related to racial group. Analysis of premature termination of treatment as an alternative outcome variable suggested that these effects were specific to renewed drinking per se. Discussion centers on the potential relevance of expectancy-based theories of self-regulation to behavior during the period of treatment.

Identification of nonalcoholic and alcoholic beers: effects of consumption practices and beer brand

Because nonalcoholic beer provides sensory cues that simulate alcoholic beer, this beverage may be more effective than other placebos in contributing to a credible manipulation of expectancy to receive alcohol. The present experiment assessed the sensory identification of nonalcoholic and alcoholic beers. Subjects with higher beer consumption practices were more accurate than subjects with lower beer consumption practices in the identification of nonalcoholic beers. Brand of nonalcoholic beer affected the identification performance of subjects with lower beer consumption practices.