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McCrady BS, Claus E, Witkiewitz K, Shiver A, Swartz M, Chávez R. Neurocognitive and neurobehavioral mechanisms of change following psychological treatment for alcohol use disorder. Contemp Clin Trials 2024; 142:107538. [PMID: 38615751 DOI: 10.1016/j.cct.2024.107538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Although modestly effective treatments exist for alcohol use disorder (AUD), many individuals return to heavy drinking after treatment, suggesting the need for better understanding of factors that contribute to maintaining abstinence or drinking reductions. Whereas past studies identified what treatments work for AUD, recent studies focus more on why particular treatments work, and the mechanisms by which treatment leads to change. This focus on mechanisms of behavior change (MOBC) may inform the process by which treatment leads to better outcomes, and also may lead to new treatments or modifications of existing treatments that target empirically supported mechanisms known to lead to change. There is a paucity of studies examining MOBC from a neurocognitive perspective. METHOD To address this gap in knowledge, the study described here is examining emotional reactivity, alcohol cue reactivity, and cognitive control as potential MOBC at three levels of analysis - self-report, behavior, and neural. RESULTS One hundred ten treatment-seeking individuals with an AUD are being randomized to receive 8 sessions of either Cognitive Behavioral Treatment (CBT) or Mindfulness Based Treatment (MBT) after up to 4 sessions of a platform treatment focused on enhancing motivation to change. To establish the temporal relationship between changes in drinking and changes in MOBC, patients are assessed at baseline, during and immediately after treatment, and 9- and 15-months post-baseline. Relationships between changes in drinking and changes in the proposed MOBC will be examined using advanced mixed modeling techniques. CONCLUSIONS Results should advance AUD treatment by targeting treatments to neurocognitive MOBC.
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Affiliation(s)
- Barbara S McCrady
- Center on Alcohol, Substance use, And Addictions; Department of Psychology, University of New Mexico, United States.
| | - Eric Claus
- Mind Research Network, 1101 Yale Blvd NE, Albuquerque, NM 87106, United States; The Pennsylvania State University, United States
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions; Department of Psychology, University of New Mexico, United States
| | - Alicia Shiver
- Center on Alcohol, Substance use, And Addictions; Department of Psychology, University of New Mexico, United States
| | - Megan Swartz
- Mind Research Network, 1101 Yale Blvd NE, Albuquerque, NM 87106, United States
| | - Roberta Chávez
- Center on Alcohol, Substance use, And Addictions; Department of Psychology, University of New Mexico, United States
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McCrady BS, Tonigan JS, Fink BC, Chávez R, Martinez AD, Borders A, Fokas K, Epstein EE. A randomized pilot trial of brief family-involved treatment for alcohol use disorder: Treatment engagement and outcomes. Psychol Addict Behav 2023; 37:853-862. [PMID: 36931829 PMCID: PMC10504405 DOI: 10.1037/adb0000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Involving family members in a patient's treatment for alcohol use disorder (AUD) leads to more positive outcomes, but evidence-based family-involved treatments have not been adopted widely in AUD treatment programs. Study aims the following: (a) modify an empirically supported 12-session AUD treatment, alcohol behavioral couple therapy (ABCT) to make it shorter and appropriate for any concerned family member and (b) conduct a small clinical trial to obtain feasibility data and effect size estimates of treatment efficacy. METHOD ABCT content was adapted to three-sessions following input from clinicians, patients, and family members. Patient and family member dyads were recruited from an inpatient treatment program and randomized to the new treatment, brief family-involved treatment (B-FIT), or treatment-as-usual (TAU). Drinking was assessed using the Form-90; family support and family functioning were assessed using the Family Environment Scale Conflict and Cohesion subscales and the Family Adaptability and Cohesion Evaluation Scale-IV, Communication scale. Dyads (n = 35) were assessed at baseline and 4-month follow-up. RESULTS On average, dyads received one of three B-FIT sessions with 6 dyads receiving no sessions due to scheduling conflicts or patient discharge. At follow-up, there was a large-to-medium effect size estimate favoring B-FIT for proportion drinking days (patient report, n = 22; Hedges' g = 1.01; patient or family report, n = 28; Hedges' g = .48). Results for family support or family functioning measures favored TAU. CONCLUSIONS Implementation of brief family-involved treatment in inpatient AUD treatment was challenging, but preliminary data suggest the potential value of B-FIT in impacting drinking outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | - Brandi C. Fink
- University of New Mexico
- University of Oklahoma Health Sciences Center, Department of Psychiatry and Behavioral Sciences, 920 Stanton L. Young Boulevard, G. Rainey Williams Pavilion, Third Floor, Oklahoma City, OK 73104
| | | | | | | | - Kathryn Fokas
- University of New Mexico
- Independent practice, Los Angeles
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Hernandez-Vallant A, Votaw VR, Herron JL, Stein ER, Swan JE, Ulrich DM, Blackwell MA, McCrady BS. A clinical science guide for reviewing the cross-cultural rigor of assessments in an alcohol training clinic. Psychol Serv 2023:2023-38946-001. [PMID: 36689373 PMCID: PMC10363250 DOI: 10.1037/ser0000738] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A standard component of service delivery in alcohol treatment clinics is evidence-based assessment (EBA). Although EBA is essential for selecting appropriate treatment modalities for alcohol use and associated problems, there are limitations in existing EBAs concerning evidence of cultural equivalence and utility among individuals seeking alcohol treatment. However, training in EBA, addictions, and clinical applications with diverse populations all are gaps in clinical training in doctoral programs in clinical psychology. The present work used the clinical science model to review the psychometric properties, cross-cultural utility, and measurement invariance of measures in an assessment battery used in an alcohol treatment training clinic. This article describes the results of that review, recommendations for retaining or replacing common assessment measures used in alcohol treatment clinics, and recommendations for alcohol treatment clinics interested in engaging in similar processes. Findings suggested that more research is needed to evaluate the psychometric properties of EBAs utilized in an alcohol treatment assessment battery, particularly among American Indian and Alaska Native people, and to test measurement invariance across race/ethnicity and other identity groups in alcohol treatment-seeking populations. Overall, routine reviews of cultural relevance are needed in clinical settings to stay current with the emerging literature. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Alexandra Hernandez-Vallant
- Department of Psychology, University of New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
| | - Victoria R. Votaw
- Department of Psychology, University of New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
| | - Jalene L. Herron
- Department of Psychology, University of New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
| | - Elena R. Stein
- Department of Psychology, University of New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
| | - Julia E. Swan
- Department of Psychology, University of New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
| | | | | | - Barbara S. McCrady
- Department of Psychology, University of New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
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Hallgren KA, Holzhauer CG, Epstein EE, McCrady BS, Cook S. Optimizing the length and reliability of measures of mechanisms of change to support measurement-based care in alcohol use disorder treatment. J Consult Clin Psychol 2021; 89:277-287. [PMID: 34014690 DOI: 10.1037/ccp0000643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Clients who receive alcohol use disorder (AUD) treatment experience variable outcomes. Measuring clinical progress during treatment using standardized measures (i.e., measurement-based care) can help indicate whether clinical improvements are occurring. Measures of mechanisms of behavioral change (MOBCs) may be particularly well-suited for measurement-based care; however, measuring MOBCs would be more feasible and informative if measures were briefer and if their ability to detect reliable change with individual clients was better articulated. METHOD Three abbreviated measures of hypothesized MOBCs (abstinence self-efficacy, coping strategies, anxiety) and a fourth full-length measure (depression) were administered weekly during a 12-week randomized trial of cognitive-behavioral therapy (CBT) for women with AUD. Psychometric analyses estimated how reliably each measure distinguished within-person change from between-person differences and measurement error. Reliability coefficients were estimated for simulated briefer versions of each instrument (i.e., instruments with fewer items than the already-abbreviated instruments) and rates of reliable improvement and reliable worsening were estimated for each measure. RESULTS All four measures had good reliability (.86-.90) for detecting within-person change. Many participants (41.4%-62.5%) reliably improved on MOBCs from first to last treatment session. Reliable improvement on MOBCs was associated with reductions in percentage of drinking days (PDD) at 3, 9, and 15-month follow-ups. Simulated briefer versions of each instrument retained good reliability for detecting change with only 3 (self-efficacy), 11 (coping strategies), 5 (anxiety), or 10 items (depression). CONCLUSIONS Brief MOBC measures can detect reliable change for individuals in AUD treatment. Routinely measuring MOBCs may help with monitoring clinical progress. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Kevin A Hallgren
- Behavioral Research in Technology and Engineering (BRiTE) Center
| | | | | | - Barbara S McCrady
- Department of Psychology, Center on Alcohol, Substance use, And Addictions
| | - Sharon Cook
- Institute for Health, Health Care Policy and Aging Research
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Abstract
Alcohol use disorder (AUD) and family functioning are inextricably bound, and families are impacted negatively by AUD, but families show substantial improvements with AUD recovery. Family members can successfully motivate a person with AUD to initiate changes in drinking or to seek AUD treatment. During recovery, family members can provide active support for recovery. Several couple- or family-involved treatments for AUD have been developed and tested in rigorous efficacy trials. Efficacious treatments based in family systems theory or cognitive behavioral approaches focus on the concerned family member alone, or they engage the couple or family as a unit in the treatment. However, most treatments have been studied in fairly homogeneous, heterosexual, White, non-Hispanic populations, limiting the potential generalizability of these treatments. Substantial gaps remain in our understanding of family processes associated with the initiation and maintenance of AUD recovery among adults. This review outlines the existing literature and describes opportunities for future research to address knowledge gaps in understanding the mechanisms by which these treatments are efficacious, use of family-based treatments with diverse populations, integration of pharmacotherapies with family-involved treatment, role of families in recovery-oriented systems of care, and how to improve treatment development and dissemination.
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Affiliation(s)
- Barbara S. McCrady
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Julianne C. Flanagan
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
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Hallgren KA, McCrady BS, Witkiewitz K, Caudell TP. Do alcohol interventions affect peers who do not receive the intervention? Modeling treatment contagion effects via simulations of adolescent social networks. Psychol Addict Behav 2021; 35:326-336. [PMID: 33793279 DOI: 10.1037/adb0000656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Adolescents' drinking is influenced by their friends' drinking. However, it is unclear whether individually-targeted alcohol interventions reduce drinking in the friends of individuals who receive the intervention. This study used simulations of drinking in simulated longitudinal social networks to test whether individually-targeted alcohol interventions may be expected to spread to non-targeted individuals. METHOD Stochastic actor-based models simulated longitudinal social networks where changes in drinking and friendships were modeled using parameters from a meta-analysis of high school 10th grade social networks. Social influence (i.e., how much one's friends' drinking affects their own drinking) and social selection (i.e., how much one's drinking affects who they select as friends) were manipulated at several levels. At the midpoint of each simulation, a randomly-selected heavy-drinking individual was experimentally assigned to an intervention (changing their drinking status to non-drinking) or a control condition (no change in drinking status) and the drinking statuses of that individual's friends were recorded at the end of the simulation. RESULTS Friends of individuals who received the intervention significantly reduced their drinking, with higher reductions occurring in networks with greater social influence. However, all effect sizes were small (e.g., average per-friend reduction of .07 on a 5-point drinking scale). CONCLUSIONS Individually-targeted alcohol interventions may have small effects on reducing the drinking of non-targeted adolescents, with social influence being a mechanism that drives such effects. Due to small effect sizes, many adolescents may need to receive alcohol interventions to produce measurable effects on drinking outcomes for non-targeted individuals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Kevin A Hallgren
- Behavioral Research in Technology and Engineering (BRiTE) Center
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Fokas K, Robinson CSH, Witkiewitz K, McCrady BS, Yeater EA. The Indirect Relationship Between Interpersonal Trauma History and Alcohol Use via Negative Cognitions in a Multisite Alcohol Treatment Sample. Alcohol Treat Q 2020; 38:290-305. [PMID: 33012968 DOI: 10.1080/07347324.2019.1669513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although interpersonal trauma history (ITH) is frequently associated with alcohol use disorder (AUD), little is known about specific psychological constructs that may indirectly link these phenomena. This study hypothesized that one such construct may be negative cognitive schemas that often emerge in the aftermath of trauma. Secondary latent variable modeling was conducted using the Project MATCH sample of adults receiving treatment for AUD (N = 1726; 24.3% women; 38.63% ITH). The negative cognitions latent variable provided an excellent fit to the data and showed evidence of strong measurement invariance. As hypothesized, negative cognitions mediated the inverse association between ITH at baseline and percent days abstinent from alcohol 12 weeks later. Findings suggest that negative cognitions may be a specific underlying mechanism and potential treatment target for individuals with ITH and AUD.
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Affiliation(s)
- Kathryn Fokas
- University of New Mexico, Department of Psychology, Center on Alcoholism, Substance Abuse, and Addictions
| | - Charles S H Robinson
- University of Florida, Department of Clinical and Health Psychology, Center for Pain Research and Behavioral Health
| | - Katie Witkiewitz
- University of New Mexico, Department of Psychology, Center on Alcoholism, Substance Abuse, and Addictions
| | - Barbara S McCrady
- University of New Mexico, Department of Psychology, Center on Alcoholism, Substance Abuse, and Addictions
| | - Elizabeth A Yeater
- University of New Mexico, Department of Psychology, Center on Alcoholism, Substance Abuse, and Addictions
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Abstract
Women with alcohol use disorder (AUD) experience more barriers to AUD treatment and are less likely to access treatment than men with AUD. A literature review identified several barriers to women seeking help: low perception of a need for treatment; guilt and shame; co-occurring disorders; employment, economic, and health insurance disparities; childcare responsibilities; and fear of child protective services. Women entering treatment present with more severe AUD and more complex psychological, social, and service needs than men. Treatment program elements that may reduce barriers to AUD treatment include provision of childcare, prenatal care, treatment for co-occurring psychological problems, and supplemental social services. Research has suggested that outcomes for women are best when treatment is provided in women-only programs that include female-specific content. To date, research on treatments tailored to the individual needs of women is limited, but research on mechanisms of change has suggested the importance of targeting anxiety and depression, affiliative statements in treatment, abstinence self-efficacy, coping skills, autonomy, and social support for abstinence. Future research should focus on early interventions, linkages between primary care or mental health clinics and AUD treatment settings, and integrated treatments for co-occurring AUD and other disorders. Further research should also explore novel treatment delivery approaches such as digital platforms and peer support groups.
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Affiliation(s)
- Barbara S McCrady
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Elizabeth E Epstein
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kathryn F Fokas
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
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Hayaki J, Holzhauer CG, Epstein EE, Cook S, Gaba A, Lorenzo AC, McCrady BS. Menstrual cycle phase, alcohol consumption, alcohol cravings, and mood among women in outpatient treatment for alcohol use disorder. Psychol Addict Behav 2020; 34:680-689. [PMID: 32250129 DOI: 10.1037/adb0000576] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research shows fluctuations in drinking across the menstrual cycle among women with alcohol use disorder (AUD), but little work has investigated moderators of these fluctuations. This study examined drinking and craving intensity across the menstrual cycle, and the moderating effect of baseline depression and emotional distress during the midlate luteal phase and/or menses, among women receiving AUD treatment. Fifty-nine regularly cycling women reported menstrual history and baseline depression. Over 3 months of treatment, they kept daily logs of drinks, alcohol cravings, and menstruation (yes/no). Emotional distress during the midlate luteal phase and/or menses of their most recent menstrual cycle was also assessed during treatment. Menstrual cycle phase was estimated for each within-treatment day. Mixed model analyses tested main and interactive effects of menstrual cycle phase, baseline depression, and emotional distress during the midlate luteal phase and/or menses on daily drinks and craving intensity. Women drank most during the midlate luteal phase and menses compared with other phases. Among women with lower baseline depression, those with lower distress during the midlate luteal phase and/or menses reported more intense cravings during the midlate luteal phase (ΔM = .77, p = .000) and menses (ΔM = .51, p = .012); those with higher distress reported more intense cravings during menses, compared with all other phases (p < .01). Among women with higher baseline depression, craving intensity remained consistently high. Results document more drinking during the midlate luteal phase and menses and suggest that cycle-related distress and depression moderate the alcohol-menstrual association among women in AUD treatment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Jumi Hayaki
- Department of Psychology, College of the Holy Cross
| | | | | | - Sharon Cook
- Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey
| | - Ayorkor Gaba
- Department of Psychiatry, University of Massachusetts Medical School
| | - Ava C Lorenzo
- Graduate School for Applied and Professional Psychology, Rutgers, The State University of New Jersey
| | - Barbara S McCrady
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
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McCrady BS, Witkiewitz K, Venner KL, Fokas K. Education and Training in Substance Use Disorders and Addictions: The University of New Mexico Integrated Training Model. Train Educ Prof Psychol 2020; 14:60-69. [PMID: 33767800 PMCID: PMC7989818 DOI: 10.1037/tep0000287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper describes SUD/addictions training at the University of New Mexico. Coordinated and integrated academic, research, and clinical training resources are described, with an emphasis on the integration of resources across multiple training domains. Academic training resources in the Psychology Department include core clinical courses, basic science courses, and opportunities for students to develop expertise in health or quantitative psychology. Other academic resources come from affiliated departments and colleges such as Sociology, the College of Population Health, the College of Education, and Health Sciences. Research training resources are available within the Psychology Department, affiliated Departments and Colleges, and specialized research centers including the Center on Alcoholism, Substance Abuse, and Addictions, and the Mind Research Network. A network of community partners provides additional research sites. Clinical training resources are provided through a specialized alcohol treatment clinic and a diversity clinic within the Department, opportunities for students to serve as research clinicians, and community practicum sites supervised by on-site doctoral level psychologists or Departmental faculty. The UNM training program provides one model for graduate training in SUD/addictions. Keys to the program are the presence of multiple SUD/addictions clinical faculty member with active research programs, willingness to mentor students in research and clinical work, and basic science faculty whose research is relevant to addictive behaviors. Other critical elements include systematic development of clinical training opportunities, effective collaborations with community agencies for research and clinical training, meaningful research partnerships with other academic departments and specialized research centers, and external funding for training activities.
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Affiliation(s)
- Barbara S McCrady
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico
| | - Katie Witkiewitz
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico
| | - Kamilla L Venner
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico
| | - Kathryn Fokas
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico
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Bold KW, Rosen RL, Steinberg ML, Epstein EE, McCrady BS, Williams JM. Smoking characteristics and alcohol use among women in treatment for alcohol use disorder. Addict Behav 2020; 101:106137. [PMID: 31648138 PMCID: PMC7096210 DOI: 10.1016/j.addbeh.2019.106137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/16/2019] [Accepted: 09/16/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Understanding the association between smoking and alcohol use among women may help inform the delivery of targeted interventions to address both of these health behaviors. METHODS This study analyzed data from N = 138 women enrolled in a randomized clinical trial comparing female-specific individual versus group cognitive-behavior therapy for alcohol use disorder (AUD). We assessed cigarette use patterns, participants' interest in quitting smoking and motivation to quit smoking during treatment for AUD, and examined the relationship between smoking and alcohol use before and during alcohol treatment. RESULTS Over a third of the sample reported smoking cigarettes at baseline (N = 47, 34.1%), with the majority of smokers reporting daily cigarette use. At baseline, those who smoked reported a high interest in quitting smoking M = 7.8 out of 10 (SD = 2.7), although most believed they should quit smoking only after achieving some success in quitting drinking (50.0%). However, participants who smoked cigarettes (compared to non-smokers) reported more alcohol abuse and dependence symptoms (p = .001), lower rates of completing the alcohol treatment (p = .03), attended significantly fewer treatment sessions (p = .008), and consumed significantly more drinks per day on average both at baseline (p = .002) and during the treatment period (p = .04). CONCLUSIONS Findings suggest that women with AUD who also smoke cigarettes have greater difficulty engaging in or responding to treatment for their alcohol use. However, these participants reported high interest in quitting smoking but low perceived readiness during AUD treatment, suggesting that motivational interventions should be considered that could take advantage of the opportunity to treat women for both of these co-occurring behaviors while in treatment.
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Affiliation(s)
- Krysten W Bold
- Department of Psychiatry, Yale University School of Medicine, 34 Park Street CMHC, New Haven, CT 06519, United States.
| | - Rachel L Rosen
- Department of Psychology, Rutgers, The State University of New Jersey, 152 Frelinghuysen Rd, New Brunswick, NJ 08854, United States
| | - Marc L Steinberg
- Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, 317 George Street, New Brunswick, NJ 08901, United States
| | - Elizabeth E Epstein
- Center of Alcohol Studies, Rutgers, the State University of New Jersey, 607 Allison Rd, Piscataway, NJ 08854, United States; Department of Psychiatry, University of Massachusetts Medical School, 365 Plantation Street, Worcester, MA 01605, United States
| | - Barbara S McCrady
- Center of Alcohol Studies, Rutgers, the State University of New Jersey, 607 Allison Rd, Piscataway, NJ 08854, United States; Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd. SE, Albuquerque, NM 87106, United States
| | - Jill M Williams
- Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, 317 George Street, New Brunswick, NJ 08901, United States
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Hallgren KA, Epstein EE, McCrady BS. Changes in Hypothesized Mechanisms of Change Before and After Initiating Abstinence in Cognitive-Behavioral Therapy for Women With Alcohol Use Disorder. Behav Ther 2019; 50:1030-1041. [PMID: 31735239 PMCID: PMC6866668 DOI: 10.1016/j.beth.2019.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/11/2019] [Accepted: 01/30/2019] [Indexed: 12/01/2022]
Abstract
Abstinence self-efficacy, coping skills, and therapeutic alliance are hypothesized mechanisms of behavioral change (MOBCs) in cognitive-behavioral therapy (CBT) for alcohol use disorder (AUD). However, little is known about when these hypothesized MOBCs change during treatment or in relation to the initiation of abstinence from alcohol, which the current study investigated. Patient-reported abstinence self-efficacy, drinking-related coping skills, and therapeutic alliance were measured at every session throughout a 12-session clinical trial that previously showed equivalent drinking reductions in female-specific individual- and group-based CBT for AUD. Participants (N = 121 women) were classified into subgroups based on whether and when they first initiated 14 days of continuous abstinence from alcohol during treatment. Interrupted time-series analyses evaluated the magnitude and timing of change in MOBC variables in relation to the initiation of abstinence. All three MOBC measures showed gradual improvements throughout treatment (within-subjects d = 0.03 to 0.09 change per week). Participants who initiated abstinence during treatment experienced additional sudden improvements in abstinence self-efficacy (d = 0.47) and coping skills (d = 0.27), but not therapeutic alliance (d = -0.02), the same week they initiated abstinence. Participants who were already abstinent when treatment started maintained higher abstinence self-efficacy and coping skills, but not therapeutic alliance, throughout treatment compared to participants who never initiated abstinence. Initiating abstinence may help facilitate improvements in abstinence self-efficacy and drinking-related coping skills. Clinicians may help patients anticipate when and how much these variables are expected to improve during treatment and encourage initiation of abstinence to potentially help facilitate improvements in abstinence self-efficacy and coping skills.
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Affiliation(s)
- Kevin A. Hallgren
- Behavioral Research in Technology and Engineering (BRiTE Center) and Department of Psychiatry and Behavioral Sciences, University of Washington. 1959 NE Pacific Street, Box 356560, Seattle, WA 98195, United States,
| | - Elizabeth E. Epstein
- Department of Psychiatry, Addiction Division, University of Massachusetts Medical School. Biotech One, 365 Plantation Street, Worcester, Massachusetts 01605, United States,
| | - Barbara S. McCrady
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico. UNM CASAA, 2650 Yale Blvd. SE, Albuquerque, NM 87106, United States,
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Epstein EE, McCrady BS, Hallgren KA, Gaba A, Cook S, Jensen N, Hildebrandt T, Holzhauer CG, Litt MD. Individual versus group female-specific cognitive behavior therapy for alcohol use disorder. J Subst Abuse Treat 2018; 88:27-43. [PMID: 29606224 DOI: 10.1016/j.jsat.2018.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/28/2017] [Accepted: 02/13/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To test group-based Female-Specific Cognitive Behavioral Therapy (G-FS-CBT) for women with Alcohol Use Disorder (AUD) against an individual Female-Specific Cognitive Behavioral Therapy (I-FS-CBT). This aims of this paper are to describe G-FS-CBT development, content, feasibility, acceptability, group process, engagement in treatment, and within- and post-treatment outcomes. METHODS Women with AUD (n=155) were randomly assigned to 12 manual-guided sessions of G-FS-CBT or I-FS-CBT; 138 women attended at least one treatment session. RESULTS Women in G-FS-CBT attended fewer sessions (M=7.6) than women in I-FS-CBT (M=9.7; p<.001). Women in both conditions reported high satisfaction with the treatments. Independent coders rated high fidelity of delivery of both G-FS-CBT and I-FS-CBT. Therapeutic alliance with the therapist was high in both conditions, with I-FS-CBT being slightly but significantly higher than G-FS-CBT. In the first six weeks of treatment, women in both treatment conditions significantly reduced their percent drinking days (PDD) and percent heavy days drinking (PHD) by equivalent amounts, maintained through the rest of treatment and the 12month follow up with no treatment condition effects. Women reported significant improvement in all but one of the secondary outcomes during treatment; gains made during treatment in depression, anxiety, autonomy, and interpersonal problems were maintained during the follow-up period, while gains made during treatment in use of coping skills, self-efficacy for abstinence, self-care, and sociotropy deteriorated over follow up but remained improved compared to baseline. CONCLUSIONS Findings support the feasibility, acceptability, and efficacy of a group format for female-specific CBT for AUD, a new 12-session, single gender, community friendly, group therapy with programming specifically for women. Similar, positive outcomes for individual and group treatment formats were found for drinking, mood, coping skills, self-confidence, interpersonal functioning, and self-care.
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Affiliation(s)
- Elizabeth E Epstein
- Center of Alcohol Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, United States; Department of Psychiatry, University of Massachusetts Medical School, 365 Plantation Street, Worcester, MA, 01605, United States.
| | - Barbara S McCrady
- Center of Alcohol Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, United States; Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd. SE, Albuquerque, NM 87106, United States.
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St., Box 356560, Seattle, WA 98195, United States
| | - Ayorkor Gaba
- Center of Alcohol Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, United States; Department of Psychiatry, University of Massachusetts Medical School, 365 Plantation Street, Worcester, MA, 01605, United States.
| | - Sharon Cook
- Center of Alcohol Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, United States.
| | - Noelle Jensen
- Center of Alcohol Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, United States.
| | - Thomas Hildebrandt
- Department of Psychiatry, Mt. Sinai School of Medicine, 1425 Madison Ave, Floor 6, Room 30, New York, NY 10029, United States.
| | - Cathryn Glanton Holzhauer
- Department of Psychiatry, University of Massachusetts Medical School, 365 Plantation Street, Worcester, MA, 01605, United States; Veterans Affairs VISN 1 Central Western Massachusetts, 421 North Main St Leeds MA 01053, United States.
| | - Mark D Litt
- University of Connecticut Health Center, Division of Behavioral Sciences and Community Health, 263 Farmington Avenue, MC 3910, Farmington, CT 06030-3910, United States.
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Holzhauer CG, Epstein EE, Hayaki J, Marinchak JS, McCrady BS, Cook SM. Moderators of sudden gains after sessions addressing emotion regulation among women in treatment for alcohol use. J Subst Abuse Treat 2017; 83:1-9. [PMID: 29129190 PMCID: PMC5728387 DOI: 10.1016/j.jsat.2017.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
Sudden gains (SGs) are defined as abrupt and significant improvements in mental health symptoms that occur between two psychotherapy sessions. Preliminary evidence suggests that SGs may be an important pattern of symptom reduction in the treatment of alcohol use disorder (AUD) (i.e., a steep between-session reduction in drinking or alcohol craving frequency or intensity) (Drapkin, Epstein, McCrady, & Eddie, 2015). The current study examined SGs within two randomized clinical trials (RCTs) testing female-specific cognitive behavior therapy (CBT) protocol for AUD (n=146). We tested a priori hypotheses about whether women's baseline depression, anxiety, and confidence to be abstinent while in a negative emotional state would predict attainment of SGs after attending sessions that addressed depression, anxiety, and emotion regulation (i.e., sessions five and six of the 12-session protocol). Data were collected at baseline, within treatment, and 15months after baseline. Results showed that women with high levels of depression and/or anxiety and low confidence to be abstinent in a negative emotional state at baseline were more likely to experience a SG (steep decrease in drinking) after sessions five and six (p=0.02). Further, among women with high levels of depression and/or anxiety at baseline, those who experienced both a SG in drinking after session five/six and had higher confidence to remain abstinent in a negative emotional state at the end of treatment reported lower drinking frequency at 9- but not 15-month follow-up [95% CI=(-2.65, -0.86)]. Findings support the value of providing interventions targeting mood and emotion regulation in AUD treatment for women.
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Affiliation(s)
| | - Elizabeth E Epstein
- University of Massachusetts Medical School, 365 Plantation Street, Worcester, MA 01605, USA; Center of Alcohol Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, USA
| | - Jumi Hayaki
- College of the Holy Cross, 1 College Street, Worcester, MA 01610, USA
| | - James S Marinchak
- VA Connecticut Healthcare System, Newington Campus, 555 Willard Ave, Newington, CT 06111, USA
| | - Barbara S McCrady
- Center of Alcohol Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, USA; Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd. SE, Albuquerque, NM 87106, USA
| | - Sharon M Cook
- Center of Alcohol Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, USA
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Epstein EE, McCrady BS, Hallgren KA, Cook S, Jensen NK, Hildebrandt T. A randomized trial of female-specific cognitive behavior therapy for alcohol dependent women. Psychol Addict Behav 2017; 32:1-15. [PMID: 29154553 DOI: 10.1037/adb0000330] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This study compared Female-Specific Cognitive Behavioral Therapy (FS-CBT) to evidence-based, gender-neutral CBT (GN-CBT; Epstein & McCrady, 2009) for women with alcohol use disorder (AUD). Women (N = 99) with AUD, mean age 48, were randomly assigned to 12 outpatient manual-guided sessions of FS-CBT (n = 44) or GN-CBT (n = 55). Women were assessed at baseline and 3, 9 and 15 months after baseline for drinking and for specific issues common among women with AUD. A FS-CBT protocol was developed that was discriminable on treatment integrity ratings from GN-CBT. No treatment condition differences were found in treatment engagement, changes in drinking, alcohol-related coping, abstinence self-efficacy, motivation to change, or constructs directly targeted in FS-CBT (sociotropy, autonomy, depression, anxiety). Women in both conditions were highly engaged and satisfied with treatment, and reported significant reductions in drinking and changes in desired directions for all other variables except social support for abstinence. In the year following treatment, women in the FS-CBT but not in the CBT condition reported an increase in percentage of abstainers in their social networks (0.69% per month, SE = 0.21, p = .002). The value and appeal of female-specific programming in AUD treatment has been established in the wider literature (Epstein & Menges, 2013), and the current study provides support for the use of the Female-Specific Cognitive Behavioral Therapy (FS-CBT) manual as an option that may yield outcomes similar to standard gender-neutral CBT for women with AUD. Future research should examine whether FS-CBT enhances treatment utilization for women. (PsycINFO Database Record
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Affiliation(s)
| | - Barbara S McCrady
- Center of Alcohol Studies, Rutgers, The State University of New Jersey
| | - Kevin A Hallgren
- Center of Alcohol Studies, Rutgers, The State University of New Jersey
| | - Sharon Cook
- Center of Alcohol Studies, Rutgers, The State University of New Jersey
| | - Noelle K Jensen
- Center of Alcohol Studies, Rutgers, The State University of New Jersey
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Hallgren KA, McCrady BS, Caudell TP, Witkiewitz K, Tonigan JS. Simulating drinking in social networks to inform alcohol prevention and treatment efforts. Psychol Addict Behav 2017; 31:763-774. [PMID: 28921997 DOI: 10.1037/adb0000308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adolescent drinking influences, and is influenced by, peer alcohol use. Several efficacious adolescent alcohol interventions include elements aimed at reducing susceptibility to peer influence. Modeling these interventions within dynamically changing social networks may improve our understanding of how such interventions work and for whom they work best. We used stochastic actor-based models to simulate longitudinal drinking and friendship formation within social networks using parameters obtained from a meta-analysis of real-world 10th grade adolescent social networks. Levels of social influence (i.e., friends affecting changes in one's drinking) and social selection (i.e., drinking affecting changes in one's friendships) were manipulated at several levels, which directly impacted the degree of clustering in friendships based on similarity in drinking behavior. Midway through each simulation, one randomly selected heavy-drinking actor from each network received an "intervention" that either (a) reduced their susceptibility to social influence, (b) reduced their susceptibility to social selection, (c) eliminated a friendship with a heavy drinker, or (d) initiated a friendship with a nondrinker. Only the intervention that eliminated targeted actors' susceptibility to social influence consistently reduced that actor's drinking. Moreover, this was only effective in networks with social influence and social selection that were at higher levels than what was found in the real-world reference study. Social influence and social selection are dynamic processes that can lead to complex systems that may moderate the effectiveness of network-based interventions. Interventions that reduce susceptibility to social influence may be most effective among adolescents with high susceptibility to social influence and heavier-drinking friends. (PsycINFO Database Record
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Affiliation(s)
- Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Barbara S McCrady
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
| | - Thomas P Caudell
- Department of Electrical and Computer Engineering, University of New Mexico
| | - Katie Witkiewitz
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
| | - J Scott Tonigan
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
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Holzhauer CG, Epstein EE, Cohn AM, McCrady BS, Graff FS, Cook S. Erratum to "Heterogeneity in pathways to abstinence among women in treatment for alcohol use disorder" [Journal of Substance Abuse Treatment 75 (2017) 1-9]. J Subst Abuse Treat 2017; 76:18-19. [PMID: 28340903 DOI: 10.1016/j.jsat.2017.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Elizabeth E Epstein
- University of Massachusetts Medical School, 365 Plantation Street, Worcester, MA 01605, USA; Center of Alcohol Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, USA
| | - Amy M Cohn
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Department of Oncology, Georgetown University Medical Center, Cancer Prevention and Control Program, 900 G Street, NW, Fourth Floor, Washington, DC 20001, USA
| | - Barbara S McCrady
- Center of Alcohol Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, USA; Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico MSC11 6280, 2650 Yale Blvd. SE, Albuquerque, NM 87106, USA
| | - Fiona S Graff
- War-Related Illness and Injury Study Center, VA NJ Health Care System, 385 Tremont Ave., East Orange, NJ 07018, USA
| | - Sharon Cook
- Center of Alcohol Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, USA
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McCrady BS, Epstein EE, Hallgren KA, Cook S, Jensen NK. Women with alcohol dependence: A randomized trial of couple versus individual plus couple therapy. Psychol Addict Behav 2017; 30:287-99. [PMID: 27214168 DOI: 10.1037/adb0000158] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Couple therapy for women with alcohol use disorders (AUDs) yields positive drinking outcomes, but many women prefer individual to conjoint treatment. The present study compared conjoint cognitive-behavioral therapy (CBT) for women with AUDs to a blend of individual and conjoint therapy. Participants were 59 women with AUDs (95% Caucasian, mean age = 46 years) and their male partners randomly assigned to 12 sessions of Alcohol Behavioral Couple Therapy (ABCT) or to a blend of 5 individual CBT sessions and 7 sessions of ABCT (Blended-ABCT). Drinking and relationship satisfaction were assessed during and for 1-year posttreatment. Treatment conditions did not differ significantly on number of treatment sessions attended, percentage of drinking days (PDD), or percentage of heavy drinking days (PDH), during or in the 12 months following treatment. However, effect size estimates suggested a small to moderate effect of Blended-ABCT over ABCT in number of treatment sessions attended (d = -.41), and first- and second-half within treatment PDD (d = -.41, d = -.28), and PDH (d = -.46, d = -.38). Moderator analyses found that women lower in baseline sociotropy had lower PDH across treatment weeks 1-8 than in Blended-ABCT than ABCT and that women lower in self-efficacy had lower PDH during follow-up in Blended-ABCT than in ABCT. The 2 treatment groups did not differ significantly in within-treatment or posttreatment relationship satisfaction. Results suggest that blending individual and conjoint treatment yields similar or slightly better outcomes than ABCT, is responsive to women's expressed desire for individual sessions as part of their treatment, and decreases the challenges of scheduling conjoint sessions. (PsycINFO Database Record
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Affiliation(s)
| | | | - Kevin A Hallgren
- Department of Psychiatry, University of Washington School of Medicine
| | - Sharon Cook
- Center of Alcohol Studies, Rutgers University
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Bold KW, Epstein EE, McCrady BS. Baseline health status and quality of life after alcohol treatment for women with alcohol dependence. Addict Behav 2017; 64:35-41. [PMID: 27543832 PMCID: PMC5143167 DOI: 10.1016/j.addbeh.2016.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/13/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Research suggests that women with alcohol use disorders (AUDs) experience more severe medical and social consequences from alcohol use compared to men, but little is known about health improvements following alcohol treatment. METHODS This study sought to characterize the pre-treatment health status of 138 alcohol dependent women enrolled in 12 sessions of female-specific group or individual outpatient treatment and examine the degree to which alcohol treatment might promote positive quality of life changes. Quality of life was assessed using the World Health Organization Quality of Life measure at baseline and 3months later at the end of treatment. RESULTS The most common health problems at baseline were: smoking cigarettes (34.1%), hypertension (31.2%), obesity (27.5%), arthritis (21.0%), high cholesterol (17.4%), heart problems (8.7%), and a history of cancer (7.2%). Significant improvements across physical, t(117)=4.67, p<0.001, d=0.42; psychological, t(117)=7.31, p<0.001, d=0.62; social, t(117)=3.18, p=0.002, d=0.28; and environmental, t(117)=2.39, p=0.018, d=0.17; quality of life domains were seen after treatment. Percent days abstinent during treatment was positively associated with overall health satisfaction and psychological health at the end of treatment. CONCLUSIONS Women presenting for outpatient treatment for alcohol use disorders report many comorbid negative health problems. Thus, it is important for both substance use and health care providers to consider the overlap of alcohol use problems and health domains. Furthermore, female-specific cognitive behavioral treatment for alcohol use disorders positively impacted multiple health domains for women, suggesting a potential transdiagnostic intervention to target co-occurring health and substance use problems.
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Affiliation(s)
- Krysten W Bold
- Rutgers, the State University of New Jersey, Center of Alcohol Studies, 607 Allison Road, Piscataway, NJ 08854, United States; Yale School of Medicine, Department of Psychiatry, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519, United States.
| | - Elizabeth E Epstein
- Rutgers, the State University of New Jersey, Center of Alcohol Studies, 607 Allison Road, Piscataway, NJ 08854, United States; University of Massachusetts School of Medicine, Department of Psychiatry, Biotech One, 365 Plantation Street, Worcester, MA 01605, United States
| | - Barbara S McCrady
- University of New Mexico, Department of Psychology, Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale SE, Albuquerque, NM 87106, United States
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Owens MD, McCrady BS. A Pilot Study of a Brief Motivational Intervention for Incarcerated Drinkers. J Subst Abuse Treat 2016; 68:1-10. [PMID: 27431041 PMCID: PMC4955738 DOI: 10.1016/j.jsat.2016.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/01/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
Almost half of convicted jail inmates have an alcohol use disorder and many are released to environments that put them in contact with network members and cues that make them more likely to relapse on alcohol or drugs. Given the high-risk period immediately following release, the purpose of this study was to examine the efficacy of a brief motivational intervention administered just prior to release to increase substance use treatment entry and attendance, decrease alcohol and drug use, and change social networks for inmates with alcohol use disorders. Forty adult male inmates with AUDs were consented into the study and randomized to a motivational intervention or the control condition (an educational intervention), and then were contacted to do a 1-month follow-up interview (62.5% completed this interview). Results indicated that conducting these interventions was feasible and considered extremely helpful by participants. Although there were no significant group differences, medium to large effect sizes suggest possible benefits from the motivational intervention in decreasing days of alcohol and drug use and increasing abstinence, and reducing the proportion of heavy drug users or users of any kind in the social network. Future studies should replicate these findings in larger sample sizes and over longer follow-up time periods. Results may have implications for the use of brief intervention strategies at jails for inmates with AUDs.
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Affiliation(s)
- Mandy D Owens
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA; University of Washington School of Medicine, Seattle, WA, USA.
| | - Barbara S McCrady
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
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Abstract
Alcohol Behavioral Couple Therapy (ABCT) has emerged over the last 30 years as a highly efficacious treatment for those with alcohol use disorders. This review highlights the historical and conceptual underpinnings of ABCT, as well as the specific treatment elements and structure. Proposed active ingredients, moderators, and mediators of treatment outcome are discussed. Efficacy is evaluated for reductions in identified patient drinking, improved relationship functioning, and reductions in intimate partner violence. Adaptations of ABCT for substances other than alcohol are described. Other adaptations, including brief interventions, interventions addressing PTSD and TBI along with alcohol use, and interventions deliverable via technology platforms are described. Additional cost-benefit and cost-effectiveness findings supporting the economic value of ABCT are noted. Future directions for research in this area include possible adaptations for female identified patients, nontraditional couples, LGBT partners and dyads involving nonintimate partner relationships. The development of more flexible models and enhanced dissemination strategies may improve clinical uptake and utility as well as increasing the feasibility of this treatment for integrated healthcare settings.
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Affiliation(s)
- Barbara S McCrady
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM.
| | - Adam D Wilson
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM
| | - Rosa E Muñoz
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM
| | - Brandi C Fink
- University of New Mexico School of Medicine, Albuquerque, NM
| | - Kathryn Fokas
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM
| | - Adrienne Borders
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM
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Owens MD, McCrady BS, Borders AZ, Brovko JM, Pearson MR. Psychometric properties of the system for coding couples' interactions in therapy--alcohol. Psychol Addict Behav 2016; 28:1077-88. [PMID: 25528049 DOI: 10.1037/a0038332] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Few systems are available for coding in-session behaviors for couples in therapy. Alcohol Behavioral Couple Therapy (ABCT) is an empirically supported treatment, but little is known about its mechanisms of behavior change. In the current study, an adapted version of the Motivational Interviewing for Significant Others coding system was developed into the System for Coding Couples' Interactions in Therapy-Alcohol (SCCIT-A), which was used to code couples' interactions and behaviors during ABCT. Results showed good interrater reliability of the SCCIT-A and provided evidence that the SCCIT-A may be a promising measure for understanding couples in therapy. A 3-factor model of the SCCIT-A (Positive, Negative, and Change Talk/Counter-Change Talk) was examined using a confirmatory factor analysis, but model fit was poor. Because model fit was poor, ratios were computed for Positive/Negative ratings and for Change Talk/Counter-Change Talk codes based on previous research in the couples and Motivational Interviewing literature. Post hoc analyses examined correlations between specific SCCIT-A codes and baseline characteristics, and indicated some concurrent validity. Correlations were run between ratios and baseline characteristics; ratios may be an alternative to using the factors from the SCCIT-A. Reliability and validity analyses suggest that the SCCIT-A has the potential to be a useful measure for coding in-session behaviors of both partners in couples therapy and could be used to identify mechanisms of behavior change for ABCT. Additional research is needed to improve the reliability of some codes and to further develop the SCCIT-A and other measures of couples' interactions in therapy.
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Affiliation(s)
- Mandy D Owens
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
| | - Barbara S McCrady
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
| | - Adrienne Z Borders
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
| | - Julie M Brovko
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
| | - Matthew R Pearson
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
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Hallgren KA, McCrady BS, Epstein EE. Trajectories of drinking urges and the initiation of abstinence during cognitive-behavioral alcohol treatment. Addiction 2016; 111:854-65. [PMID: 26709608 PMCID: PMC4826789 DOI: 10.1111/add.13291] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 09/08/2015] [Accepted: 12/22/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Drinking urges during treatment for alcohol use disorders (AUDs) are common, can cause distress and predict relapse. Clients may have little awareness of how their drinking urges might be expected to change during AUD treatment in general and in response to initiating abstinence. The aim of the present study was to test whether drinking urges change on a daily level during treatment and after initiating abstinence. DESIGN Secondary data analysis was performed using daily drinking urge ratings from two randomized clinical trials. SETTING AND PARTICIPANTS Women (n = 98) and men (n = 79) with AUDs in separate clinical trials of out-patient AUD-focused cognitive-behavioral therapy. MEASUREMENTS Daily dichotomous indicators of any drinking urges or acute escalations in urges (i.e. at least two more urges compared with the previous day) were examined using generalized linear mixed growth-curve modeling. FINDINGS Participants who initiated abstinence reported reductions in urges immediately thereafter (log odds ratios: women B = -0.701, P < 0.001; men B = -0.628, P = 0.018), followed by additional, gradual reductions over time (women B = -0.118, P < 0.001; men B = -0.141, P < 0.001). Participants who entered treatment abstaining from alcohol also reported significant reductions in urges over time (women B = -0.147, P < 0.001; men B = -0.142, P < 0.001). Participants who drank throughout treatment had smaller (women B = -0.042, P = 0.012) or no reductions in urges (men B = 0.015, P = 0.545). There was no evidence that urges increased systematically in response to initiating abstinence. CONCLUSIONS Drinking urges during out-patient behavioral treatment for alcohol use disorders may be maintained in part by alcohol consumption. Initiating abstinence is associated with reductions in drinking urges immediately and then more gradually over time.
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Affiliation(s)
- Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Barbara S McCrady
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - Elizabeth E Epstein
- Department of Psychiatry, University of Massachusetts School of Medicine, Worcester, MA, USA
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Abstract
Couple-based treatments for alcohol use disorders (AUDs) produce higher rates of abstinence than individual-based treatments and posit that active involvement of both identified patients (IPs) and significant others (SOs) is partly responsible for these improvements. Separate research on couples' communication has suggested that pronoun usage can indicate a communal approach to coping with health-related problems. The present study tested whether communal coping, indicated by use of more first-person plural pronouns ("we" language), fewer second-person pronouns ("you" language), and fewer first-person singular pronouns ("I" language), predicted improvements in abstinence in couple-based AUD treatment. Pronoun use was measured in first- and mid-treatment sessions for 188 heterosexual couples in four clinical trials of alcohol behavioral couple therapy (ABCT). Percentages of days abstinent were assessed during treatment and over a 6-month follow-up period. Greater IP and SO "we" language during both sessions was correlated with greater improvement in abstinent days during treatment. Greater SO "we" language during first- and mid-treatment sessions was correlated with greater improvement in abstinence at follow-up. Greater use of IP and SO "you" and "I" language had mixed correlations with abstinence, typically being unrelated to or predicting less improvement in abstinence. When all pronoun variables were entered into regression models, only greater IP "we" langue and lower IP "you" language predicted improvements in abstinence during treatment, and only SO "we" language predicted improvements during follow-up. Most pronoun categories had little or no association with baseline relationship distress. Results suggest that communal coping predicts better abstinence outcomes in couple-based AUD treatment.
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Affiliation(s)
- Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Barbara S McCrady
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
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Ladd BO, McCrady BS. Typology of Couples Entering Alcohol Behavioral Couple Therapy: An Empirical Approach and Test of Predictive Validity on Treatment Response. J Marital Fam Ther 2016; 42:62-75. [PMID: 25808432 PMCID: PMC5282940 DOI: 10.1111/jmft.12121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study aimed to examine whether classification of couples in which one partner has an alcohol problem is similar to that reported in the general couples literature. Typologies of couples seeking alcohol behavioral couple therapy (ABCT) were developed via hierarchical cluster analysis using behavioral codes of couple interactions during their first ABCT session. Four couples types based on in-session behavior were established reliably, labeled avoider, validator, hostile, and ambivalent-detached. These couple types resembled couples types found in previous research. Couple type was associated with baseline relationship satisfaction, but not alcohol use. Results suggest heterogeneity in couples with alcohol problems presenting to treatment; further study is needed to investigate the function of alcohol within these different types.
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Monnig MA, Yeo RA, Tonigan JS, McCrady BS, Thoma RJ, Sabbineni A, Hutchison KE. Associations of White Matter Microstructure with Clinical and Demographic Characteristics in Heavy Drinkers. PLoS One 2015; 10:e0142042. [PMID: 26529515 PMCID: PMC4631485 DOI: 10.1371/journal.pone.0142042] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 09/11/2015] [Indexed: 11/18/2022] Open
Abstract
Damage to the brain’s white matter is a signature injury of alcohol use disorders (AUDs), yet understanding of risks associated with clinical and demographic characteristics is incomplete. This study investigated alcohol problem severity, recent drinking behavior, and demographic factors in relation to white matter microstructure in heavy drinkers. Magnetic resonance imaging (MRI) scans, including diffusion tensor imaging (DTI), were collected from 324 participants (mean age = 30.9 ± 9.1 years; 30% female) who reported five or more heavy drinking episodes in the past 30 days. Drinking history and alcohol problem severity were assessed. A common white matter factor was created from fractional anisotropy (FA) values of five white matter tracts: body of corpus callosum, fornix, external capsule, superior longitudinal fasciculus, and cingulate gyrus. Previous research has implicated these tracts in heavy drinking. Structural equation modeling (SEM) analyses tested the hypothesis that, after controlling for duration of alcohol exposure, clinical and behavioral measures of alcohol use severity would be associated with lower white matter factor scores. Potential interactions with smoking status, gender, age, treatment-seeking status, and depression or anxiety symptoms also were tested. Controlling for number of years drinking, greater alcohol problem severity and recent drinking frequency were significantly associated with lower white matter factor scores. The effect of drinking frequency differed significantly for men and women, such that higher drinking frequency was linked to lower white matter factor scores in women but not in men. In conclusion, alcohol problem severity was a significant predictor of lower white matter FA in heavy drinkers, after controlling for duration of alcohol exposure. In addition, more frequent drinking contributed to lower FA in women but not men, suggesting gender-specific vulnerability to alcohol neurotoxicity.
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Affiliation(s)
- Mollie A. Monnig
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, United States of America
- * E-mail:
| | - Ronald A. Yeo
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - J. Scott Tonigan
- Center on Alcoholism, Substance Abuse, and Addictions, Albuquerque, New Mexico, United States of America
| | - Barbara S. McCrady
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, United States of America
- Center on Alcoholism, Substance Abuse, and Addictions, Albuquerque, New Mexico, United States of America
| | - Robert J. Thoma
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Amithrupa Sabbineni
- Department of Psychology and Neuroscience, University of Colorado at Boulder, Boulder, Colorado, United States of America
| | - Kent E. Hutchison
- Department of Psychology and Neuroscience, University of Colorado at Boulder, Boulder, Colorado, United States of America
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Magill M, Kiluk BD, McCrady BS, Tonigan JS, Longabaugh R. Active Ingredients of Treatment and Client Mechanisms of Change in Behavioral Treatments for Alcohol Use Disorders: Progress 10 Years Later. Alcohol Clin Exp Res 2015; 39:1852-62. [PMID: 26344200 PMCID: PMC4592447 DOI: 10.1111/acer.12848] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/20/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The current review revisits the article entitled: "Active Ingredients: How and Why Evidence-Based Alcohol Behavioral Treatment Interventions Work" published in Alcoholism: Clinical and Experimental Research. This work summarized proceedings from a 2004 Symposium of the same name that was held at the Annual Meeting of the Research Society on Alcoholism (RSA). A decade has passed, which provides occasion for an evaluation of progress. In 2014, an RSA symposium titled Active Treatment Ingredients and Client Mechanisms of Change in Behavioral Treatments for Alcohol Use Disorders: Progress 10 Years Later did just that. METHODS The current review revisits state-of-the-art research on the 3 treatments examined 10 years ago: cognitive behavioral therapy, alcohol behavior couples therapy, and 12-step facilitation. Because of its empirically validated effectiveness and robust research agenda on the study of process outcome, motivational interviewing has been selected as the fourth treatment modality to be discussed. For each of these 4 treatments, the reviewers provide a critical assessment of current theory and research with a special emphasis on key recommendations for the future. RESULTS Noteworthy progress has been made in identifying active ingredients of treatments and mechanisms of behavior change in these 4 behavioral interventions for alcohol and other drug use disorders. Not only have we established some of the mechanisms through which these evidence-based treatments work, but we have also uncovered some of the limitations in our existing frameworks and methods. CONCLUSIONS Further progress in this area will require a broader view with respect to conceptual frameworks, analytic methods, and measurement instrumentation.
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Affiliation(s)
- Molly Magill
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Brian D Kiluk
- Yale University School of Medicine, New Haven, Connecticut
| | - Barbara S McCrady
- Center on Substance Abuse, Alcoholism, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - J Scott Tonigan
- Center on Substance Abuse, Alcoholism, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Richard Longabaugh
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
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Hallgren KA, Owens MD, Brovko JM, Ladd BO, McCrady BS, Epstein EE. Trajectories of Drinking Urges During Individual- and Couple-based Cognitive-Behavioral Treatment for Alcohol Use Disorders. Alcohol Treat Q 2015; 33:161-184. [PMID: 27453630 DOI: 10.1080/07347324.2015.1018778] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Individuals receiving treatment for alcohol use disorders (AUDs) often experience urges to drink, and reductions in drinking urges during cognitive-behavioral therapy (CBT) predict better treatment outcomes. However, little previous work has examined patterns of daily drinking urges during treatment. The present study examined patterns of change in daily drinking urges among participants in two randomized clinical trials of males (N = 80 with 4401 daily recordings) and females (N = 101 with 8011 daily recordings) receiving individual- or couples-based CBT. Drinking urges were common during treatment, occurring on 45.1% percent of days for men and 44.8% for women. Drinking urges and alcohol use for both genders decreased substantially during the course of treatment. Both genders had increases in drinking urges as more time elapsed since attending a treatment session. For men, this increase was most pronounced at the beginning of treatment, but for women it was most pronounced near the end of treatment. Alcohol use and drinking urges were both more likely to occur on weekends. The results suggest that these times may lead to higher risk for drinking, and clients may benefit from high-risk planning that is focused on these times.
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Affiliation(s)
- Kevin A Hallgren
- University of Washington, Center for the Study of Health and Risk Behaviors, Seattle, WA USA
| | - Mandy D Owens
- University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, Albuquerque, NM USA
| | - Julie M Brovko
- University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, Albuquerque, NM USA
| | - Benjamin O Ladd
- Reed College, Adolescent Health Research Program, Portland, OR USA
| | - Barbara S McCrady
- University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, Albuquerque, NM USA
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Drapkin ML, Eddie D, Buffington AJ, McCrady BS. Alcohol-Specific Coping Styles of Adult Children of Individuals with Alcohol Use Disorders and Associations with Psychosocial Functioning. Alcohol Alcohol 2015; 50:463-9. [PMID: 25802055 DOI: 10.1093/alcalc/agv023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/24/2015] [Indexed: 11/12/2022] Open
Abstract
Parental alcohol use disorders (AUDs) have been conceptualized as a chronic stressor that can lead to deleterious long-term outcomes in children of individuals with AUDs. Yet, while many individuals are detrimentally affected by their parents' problematic alcohol use, and go on to manifest psychological problems, others do not. How individuals cope with the stress of having a parent with an AUD is believed to be an important moderator of this differential outcome. This study assessed whether individuals' alcohol-specific coping styles predicted alcohol use, positive or negative life events, and depression, using a sample of 465 college students, of whom 20% were adult children of individuals with alcohol use disorders, colloquially known as adult children of alcoholics (ACOAs), and a battery of well-validated, self-report measures. Participant ACOAs reported less 'engaged' and 'total' alcohol-specific coping strategies and more 'withdrawal' alcohol-specific coping strategies than their non adult children of alcoholics (NACOAs) counterparts. Across participants, women reported more 'engaged', 'tolerant/inactive', and 'total' coping than men. Although ACOAs reported significantly more negative life events, which predicted more passive coping styles, they did not differ significantly from NACOAs on measures of problematic alcohol use or depression, supporting theories of resilience in ACOAs regardless of their alcohol-specific coping styles. For NACOAs, 'tolerant' coping predicted greater depression and alcohol-related problems; 'engaged' coping predicted fewer alcohol problems. Results suggest that ACOAs cope differently with problematic alcohol use among relatives and friends compared with NACOAs and are more likely to experience negative life events. Additionally, alcohol-related coping strategies have more predictive utility in NACOAs than ACOAs.
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Affiliation(s)
- Michelle L Drapkin
- Philadelphia VA Medical Center, Philadelphia, PA, USA Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David Eddie
- Center of Alcohol Studies, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | | | - Barbara S McCrady
- The Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
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Abstract
BACKGROUND Preliminary studies have suggested that patients entering research trials for alcohol use disorders (AUDs) may show substantial reductions in drinking prior to beginning treatment. OBJECTIVES Determine whether significant pretreatment reductions in drinking are present in a sample of alcohol-dependent women entering a psychotherapy trial for AUDs, and whether such pretreatment drinking reductions predict lower levels of drinking during and posttreatment. METHOD The study included 136 women with DSM-IV alcohol dependence who participated in a trial of individual or couples-based cognitive behavioral therapy for AUDs. Repeated-measures ANOVAs were used to examine changes in drinking across the pretreatment assessment period, and hierarchical multiple regression was used to test whether pretreatment reductions in drinking predicted continued reduced drinking during treatment and follow-up at 12 months posttreatment. RESULTS Patients had significant reductions in drinking quantity and frequency throughout the pretreatment period, with one-third of the sample becoming abstinent prior to treatment. Controlling for baseline quantity and frequency of drinking, reductions in pretreatment drinking were predictive of reduced frequency of drinking within- and posttreatment, and lower quantity of drinking per drinking occasion in the within-treatment period but not the posttreatment period. Motivational level and treatment arm did not predict the level of change in drinking across the pretreatment period. CONCLUSIONS The overall reductions in drinking are consistent with previous findings suggesting that female participants in AUD treatment trials can show a substantial amount of reduction in drinking during the pretreatment assessment phase, before therapy skills are imparted.
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Affiliation(s)
- Blaise L Worden
- 1Institute of Living, Department of Psychiatry , Hartford, Connecticut , USA
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Hunter-Reel D, Epstein EE, McCrady BS, Eddie D. PERSONALITY DISORDERS AND THE PREDICTION OF ALCOHOL USE OUTCOMES FOR WOMEN: DIMENSIONAL VERSUS CATEGORICAL CLASSIFICATION. Addict Res Theory 2014; 22:176-180. [PMID: 26120291 PMCID: PMC4479299 DOI: 10.3109/16066359.2013.793314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The impending shift in DSM-5 from categorical to a hybrid categorical-dimensional diagnosis scheme has generated considerable interest in the relative merits of these respective approaches. This is particularly true for the diagnostically complex category of personality disorders (PDs). The present study assessed whether categorical or dimensional measures better predicted alcohol consumption in a sample of 102 women enrolled in a clinical trial comparing individual Cognitive Behavioral Therapy (CBT) to conjoint CBT for alcohol use disorders (AUD). Linear regression was used to evaluate whether each PD diagnosis (categorical), or the number of PD symptoms endorsed per PD (dimensional) better predicted percent days drinking over the course of six months of treatment. PD criteria (dimensional) better predicted drinking for Paranoid, Borderline, and Obsessive-Compulsive PDs, while diagnosis (categorical) was a better predictor only for Passive-Aggressive PD. Both schemes predicted drinking outcomes for Avoidant, Dependent, and Depressive PDs, and neither was predictive for Narcissistic PD. These findings suggest that the addition of a dimensional approach for PDs potentially enhances the prediction of alcohol use outcomes.
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Affiliation(s)
- Dorian Hunter-Reel
- Department of Psychology, Behavioral Research and Therapy Clinics, University of Washington, Seattle, WA 98195
| | | | - Barbara S McCrady
- Center on Alcoholism, Substance Abuse and Addictions and Department of Psychology, University of New Mexico, Albuquerque, NM 87106
| | - David Eddie
- Department of Psychology, Center of Alcohol Studies, Rutgers University, Piscataway, NJ 08854
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McCrady BS, Owens MD, Borders AZ, Brovko JM. Psychosocial Approaches to Alcohol Use Disorders Since 1940: A Review. J Stud Alcohol Drugs Suppl 2014. [DOI: 10.15288/jsads.2014.75.68] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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McCrady BS, Owens MD, Borders AZ, Brovko JM. Psychosocial Approaches to Alcohol Use Disorders Since 1940: A Review. J Stud Alcohol Drugs Suppl 2014. [DOI: 10.15288/jsads.2014.s17.68] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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McCrady BS, Owens MD, Borders AZ, Brovko JM. Psychosocial approaches to alcohol use disorders since 1940: a review. J Stud Alcohol Drugs Suppl 2014; 75 Suppl 17:68-78. [PMID: 24565313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE A review of psychosocial approaches to alcohol use disorders (AUDs) was performed to identify and contextualize trends in major treatment approaches and special populations and provide possible future directions for alcohol research. METHOD The PsycINFO database was searched for peer-reviewed articles relevant to psychosocial approaches to AUDs for each decade since the 1940s, resulting in approximately 4,246 articles for review. Topics were included if they made up at least 4% of the relevant articles for any one decade. Nine treatment and seven special population topics were identified for the current review. RESULTS Psychoanalytic/psychodynamic and aversion therapies were major topics in the 1940s and 1950s, but few articles have been published recently. Other topics have shown consistent representation in the literature, including criminal justice and military populations, self-help groups, group therapies, couples and family therapies, behavioral treatments and cognitive-behavioral therapy, and complementary/ alternative treatments. The majority of the specific population topics and two newer treatment approaches have appeared more recently in significant proportions, including adolescents, college students, women, ethnic minorities, and dually diagnosed populations; newer treatments include brief interventions and motivational interviewing approaches. CONCLUSIONS The number of articles on psychosocial approaches to AUDs has been increasing since the 1940s. There have been recent surges in alcohol research on specific populations, an increase in the integration of alcohol treatment with primary care, and a continued emphasis on empirically supported and cost-effective treatments for AUDs; these trends likely will continue into the future.
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Affiliation(s)
- Barbara S McCrady
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Mandy D Owens
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Adrienne Z Borders
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Julie M Brovko
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
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Abstract
This National Institutes of Health funded study investigated spiritual growth as a change mechanism in 12-step programs. A total of 130 people, early 12-step affiliates with limited Alcoholics Anonymous (AA) histories, were recruited from 2007 to 2008 from AA, treatment, and community centers in a Southwestern city in the United States. A majority of the sample was alcohol dependent. Participants were interviewed at baseline and at 3, 6, and 9 months. Lagged General Linear Modeling analyses indicated that spiritual change as measured by the Religious Background and Behavior (RBB) self-report questionnaire were predictive of increased abstinence and decreased drinking intensity, and that the magnitude of this effect varied across different RBB scoring algorithms. Future research should address study limitations by recruiting participants with more extensive AA histories and by including assessments of commitment to, and practice of, AA prescribed activities. The study's limitations are noted.
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Affiliation(s)
- J Scott Tonigan
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico , Albuquerque, New Mexico , USA
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Grosso JA, Epstein EE, McCrady BS, Gaba A, Cook S, Backer-Fulghum LM, Graff FS. Women's motivators for seeking treatment for alcohol use disorders. Addict Behav 2013; 38:2236-45. [PMID: 23501141 DOI: 10.1016/j.addbeh.2013.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 02/09/2013] [Accepted: 02/11/2013] [Indexed: 10/27/2022]
Abstract
This study examined types of internal and external motivations for seeking treatment and the predictive utility of different types of motivation among 180 women with an alcohol use disorder (AUD) participating in a two-armed trial testing different individual and couple therapies for AUDs. Reasons for seeking treatment were coded for type of internal or external motivation. Most women (97%) cited internal reasons for seeking help, including: concern about progression of AUD (61.1%), health (43.3%), mental health (38.9%), and family (38.3%). Occupational concerns, an internal motivator cited by 6% of women, were associated with better drinking outcomes; interpersonal-family concerns were associated with poorer outcomes. Some motivators for seeking treatment may not be related to sustained changes in drinking, suggesting that understanding motivators for treatment may be inadequate to maintain change. Reasons for help-seeking may need to be addressed in treatment to produce long-lasting change.
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Abstract
Atrophy of brain white matter (WM) often is considered a signature injury of alcohol use disorders (AUDs). However, investigations into AUD-related changes in WM volume have yielded complex findings that are difficult to synthesize in a narrative review. The objective of this study was to obtain an averaged effect size (ES) for WM volume reduction associated with AUD diagnosis and to test potential moderators of ES. Study inclusion criteria were: (1) English language; (2) peer reviewed; (3) published before December 2011; (4) use of magnetic resonance imaging (MRI); (5) human participants; (6) inclusion of AUD group; (7) inclusion of non-AUD comparison group; and (8) reporting or testing of total or cerebral WM volume. Moderators included study design, MRI methodology and AUD characteristics. Nineteen studies with a total of 1302 participants (70% male) were included, and calculated ESs were confirmed by the corresponding author for 12 studies. The magnitude of the averaged ES adjusted for small sample bias (Hedges' g) for WM reduction in AUDs was 0.304 (standard error = 0.134, range = -0.57-1.21). Hierarchical linear modeling indicated that the overall ES differed significantly from 0, t(18) = 2.257, P = 0.037, and that the distribution of the 19 ESs showed significant heterogeneity beyond sampling error, χ(2) (18) = 52.400, P < 0.001. Treatment-seeking status and length of abstinence were significant moderators of ES distribution. These results are suggestive of WM recovery with sustained abstinence and point to the need for further investigation of factors related to treatment-seeking status.
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Affiliation(s)
- Mollie A Monnig
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Boulevard SE, Albuquerque, NM 87106, USA.
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Abstract
Feedback brief interventions for alcohol use problems have been highly effective with undergraduate populations. However, there has been little research on the effectiveness of administering feedback alone to community treatment populations. The goal of the current study was to assess the effectiveness of a feedback brief intervention in a community treatment setting with patients characterized largely by dependence on alcohol and drugs, ethnic diversity, and low socioeconomic status. It was hypothesized that pre-treatment brief individualized feedback would reduce alcohol consumption and increase participation in subsequent treatment for a substance use disorder (SUD). Participants were recruited from a public hospital's SUD clinic. After the intake but prior to entry into the treatment as usual, 121 participants were randomized to receive personalized feedback or a condition without feedback. Eighty-seven participants completed post-intervention follow-up interviews and were included in the final analyses. Repeated measures ANOVAs and MANCOVAs were used to examine variables obtained from the Addiction Severity Index (ASI; McLellan et al., 1992) of drinking quantity and frequency, and motivation for treatment. Results indicated that personalized feedback delivered no benefit beyond that of pre-treatment assessment procedures (phone screening and intake interview) alone. Intervention conditions did not differ on other outcomes at follow-up, including days of heavy drinking, motivation for treatment, or drug use frequency. Therefore, feedback-based brief interventions may be not helpful in reducing the drinking frequency and intensity of individuals presenting to community-based substance use treatment.
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Affiliation(s)
- Blaise L Worden
- Hartford Hospital/Institute of Living, Center for Cognitive Behavioral Therapy, Hartford, Connecticut 06106
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Ladd BO, Glynn LH, Fischer DJ, Owens M, Hallgren KA, McLouth CJ, Monnig MA, Campbell W, McCrady BS. A Guide for Starting a Specialty Training Clinic: An Alcohol Treatment Program as an Example. Prof Psychol Res Pr 2013; 44:65-72. [PMID: 23704805 PMCID: PMC3657837 DOI: 10.1037/a0030699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since the Boulder conference more than 50 years ago, clinical psychology has been moving towards empirically based techniques and methods. Considerable research has been conducted and a multitude of studies have documented support for empirically supported treatments (ESTs). However, the literature on implementing ESTs in real-world settings is relatively limited. The absence of practical guidance poses a particular problem for students in clinical psychology training programs that emphasize training and competency in ESTs. This article describes the development of an alcohol specialty clinic within a clinical psychology training program from the first conceptualizations to establishment of a referral base and provision of services. At each step, integration of science and clinical practice is discussed. Future directions and suggestions for developing training clinics are provided.
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Abstract
Heavy drinking among college students is associated with social, health, and legal problems. One factor that may contribute to heavy drinking is an attentional bias for alcohol-related cues, which can influence drinking automatically and without an individual's awareness. Using tests of alcohol-related attentional bias, such as the alcohol Stroop task, previous research has shown that alcohol dependent drinkers have greater attentional biases than non-dependent drinkers, but results for college student drinkers have been mixed. The present study examined alcohol Stroop task performance and its relationship to drinking levels and drinking-related problems among 84 college students during the 2009-2010 academic year with at least one binge drinking episode in the previous month. As hypothesized, results indicated that participants had greater attentional interference when alcohol words were presented compared to when neutral words were presented during the Stroop task, suggesting that the students in the sample displayed greater attentional biases for alcohol words compared to neutral words. Results showed that Stroop task responding did not vary by drinking frequency or drinking-related problems, but did vary by drinking intensity. Presentation of alcohol-related cues may cause heavier drinking college students to attend to these stimuli, which may increase the saliency of these cues and influence their likelihood of drinking. Implications for prevention and treatment efforts are discussed.
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Owens MD, Hallgren KA, Ladd BO, Rynes K, McCrady BS, Epstein E. Associations between Relationship Satisfaction and Drinking Urges for Women in Alcohol Behavioral Couples and Individual Therapy. Alcohol Treat Q 2013; 31:10.1080/07347324.2013.831668. [PMID: 24187430 PMCID: PMC3810990 DOI: 10.1080/07347324.2013.831668] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined the association between relationship satisfaction and drinking urges among women who participated in alcohol behavioral individual therapy (ABIT) and Alcohol Behavioral Couples Therapy (ABCT). Relationship satisfaction and drinking urges were not related on a daily level, but urges were related to mean levels of relationship satisfaction and this association was moderated by treatment condition and time in treatment. Women with higher relationship satisfaction had fewer drinking urges, and women in ABCT with higher relationship satisfaction experienced greater reductions in urges during treatment. These findings suggest that ABCT may target the association between relationship satisfaction and drinking urges.
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Affiliation(s)
- Mandy D Owens
- University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, Albuquerque, NM 87106, USA
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Abstract
Couple therapy for treating alcohol use disorders (AUDs) results in less drinking and greater relationship stability and satisfaction in both men and women with AUDs. The theoretical tenets, treatment methods, and research evidence for Alcohol Behavioral Couple Therapy (ABCT) are summarized. The application of ABCT is illustrated through the treatment of a 42-year-old woman with an AUD and her 56-year-old husband. During 12 sessions over a 6-month period, the woman attained abstinence from alcohol and learned cognitive and behavioral coping skills to deal with drinking antecedents. Her husband learned to support her abstinence by stopping drinking himself, helping her cope with drinking urges, and reinforcing her successes. The couple increased positive pleasurable activities that did not involve alcohol and improved their communication skills. Challenges in the treatment included her ambivalence about abstaining, their complicated work and travel schedules, and other life stressors.
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Affiliation(s)
- Barbara S McCrady
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM 87122, USA.
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Manuel JK, Austin JL, Miller WR, McCrady BS, Tonigan JS, Meyers RJ, Smith JE, Bogenschutz MP. Community Reinforcement and Family Training: a pilot comparison of group and self-directed delivery. J Subst Abuse Treat 2012; 43:129-36. [PMID: 22154038 PMCID: PMC3331969 DOI: 10.1016/j.jsat.2011.10.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 10/06/2011] [Accepted: 10/19/2011] [Indexed: 11/24/2022]
Abstract
In a randomized clinical pilot study, 40 concerned significant others (CSOs) of treatment-refusing alcohol- and drug-using individuals were randomized to either Community Reinforcement and Family Training (CRAFT) conducted in a group format (Group CRAFT) or a Self-Directed CRAFT condition. Although results indicated no significant between-group difference in engaging treatment-refusing substance-using individuals (referred to as identified patients or IPs) into treatment, the engagement rate in Group CRAFT was similar to rates previously reported with individual CRAFT. For the intent-to-treat analysis, 60% of Group CRAFT CSOs engaged their loved one into treatment, as compared with 40% in Self-Directed CRAFT. Of CSOs in the Group condition who received at least one session of group therapy, 71% engaged their IP into treatment. CSOs in both conditions reported improvements in family cohesion and conflict at the 3- and 6-month follow-up, replicating prior CRAFT findings.
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Affiliation(s)
- Jennifer K Manuel
- Department of Psychiatry, University of California, San Francisco, CA 94110, USA.
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McCrady BS, Epstein EE, Cook S, Jensen NK, Ladd BO. What do women want? Alcohol treatment choices, treatment entry and retention. Psychol Addict Behav 2012; 25:521-9. [PMID: 21644804 DOI: 10.1037/a0024037] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Study aims were to assess preferences for individual or conjoint treatment, differences between women with alcohol use disorders (AUDs) selecting each modality, and the impact on treatment entry and retention of providing a choice of treatments. During initial screening, women with AUDs in an intimate relationship with a male partner were given the choice of individual or conjoint treatment. After choosing a treatment modality and completing all assessments they entered one of two randomized trials testing different approaches to each treatment modality. Standardized measures were used to assess drinking quantity, frequency, and problems; motivation to change; and relationship satisfaction. Women's reasons for choice of treatment modality were coded using an iterative coding process. Results showed that women were more likely to select and follow through with individual than conjoint treatment. Women cited a desire to work on individual problems, lack of perceived support from their partner, and logistical issues as reasons for preferring individual treatment. Women in the two choice groups did not differ significantly on individual, partner, or relationship characteristics, but small to medium effect sizes suggested that women choosing individual treatment were more educated and less satisfied with their relationship, had fewer pretreatment heavy drinking days, and heavier drinking partners. Offering women a choice of treatment modality increased the probability of entering treatment, but not treatment attendance. Results suggest that barriers to couple therapy for women with AUDs need to be addressed to facilitate more widespread dissemination. Given women's preferences, it also is important to offer a range of treatments.
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Affiliation(s)
- Barbara S McCrady
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, MSC11 6280, 2650 Yale Boulevard SE, Albuquerque, NM 87106, USA.
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Farris SG, Epstein EE, McCrady BS, Hunter-Reel D. Do co-morbid anxiety disorders predict drinking outcomes in women with alcohol use disorders? Alcohol Alcohol 2012; 47:143-8. [PMID: 22215000 DOI: 10.1093/alcalc/agr155] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS It is unclear whether co-morbid anxiety disorders predict worse drinking outcomes during attempts to change drinking behavior. Studies have yielded mixed results, and have rarely examined drinking outcomes based on a specific type of anxiety disorder. Women with alcohol use disorders (AUDs) are of particular interest as they are at risk for co-morbid anxiety [Kessler et al. (1997) Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the national co-morbidity survey. Arch Gen Psychiat 54:313-21]. METHODS Participants were 260 women with AUDs participating in an alcohol-treatment outcome studies. The Timeline Follow-Back was used to assess drinking frequency (percent days drinking) prior, within and 6 months post-treatment. The current study tested the hypothesis that having at least one lifetime anxiety disorder diagnosed at baseline using the Structured Clinical Interview for DSM Disorders would be associated with more drinking at all study time points. Exploratory analyses examined patterns of drinking outcomes by specific anxiety diagnoses. RESULTS Lifetime anxiety diagnosis was linked to poorer drinking outcomes post-treatment (β = 0.15, P = 0.020), despite less frequent drinking prior to treatment. Analyses by specific anxiety diagnosis indicated that generalized anxiety disorder predicted poorer drinking outcomes within treatment (β = 0.14, P = 0.018) and during follow-up (β = 0.16, P = 0.014). CONCLUSION Co-morbid anxiety problems complicate treatment for AUDs among women. Further, specific anxiety disorders should be evaluated as distinct constructs as evidenced by the differential outcomes related to generalized anxiety disorder. Implications for treatment development for women with AUDs are discussed.
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Affiliation(s)
- Samantha G Farris
- Center of Alcohol Studies, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
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Hussaarts P, Roozen HG, Meyers RJ, van de Wetering BJ, McCrady BS. Problem Areas Reported by Substance Abusing Individuals and Their Concerned Significant Others. Am J Addict 2011; 21:38-46. [DOI: 10.1111/j.1521-0391.2011.00187.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Hunter-Reel D, McCrady BS, Hildebrandt T, Epstein EE. Indirect effect of social support for drinking on drinking outcomes: the role of motivation. J Stud Alcohol Drugs 2011; 71:930-7. [PMID: 20946752 DOI: 10.15288/jsad.2010.71.930] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study tested an integrated relapse model drawing hypotheses from both interpersonal and intra-individual relapse models. It was hypothesized that the relationships between alcohol-specific social support (support for drinking and support for not drinking) and drinking outcomes would be partially mediated by motivation. METHOD Participants were 158 women with alcohol use disorders participating in two linked randomized controlled trials. One trial compared standard individual cognitive behavioral therapy (CBT) for alcohol use disorders with female-specific CBT for alcohol use disorders; the other compared alcohol behavioral couple therapy with blended individual CBT and alcohol behavioral couple therapy. Measures included the Important People Interview to measure social-support variables, the Timeline Followback to measure drinking variables, and the Stages of Change Readiness and Treatment Eagerness Scale to measure motivation. RESULTS Results of structural equation modeling suggested a mediational role of motivation in the relationship between support for drinking and drinking frequency. Individuals with more network support for drinking at baseline had less motivation for abstinence at the end of treatment, which predicted drinking frequency over the 6 months after treatment. The indirect effect of baseline support for drinking on 6-month follow-up drinking frequency was statistically significant. A similar, although only marginally significant, pattern was found for the relationship between support for not drinking and drinking frequency. Individuals with more social network for not drinking at baseline had more motivation at the end of treatment at the trend level, which in turn predicted 6-month follow-up drinking frequency. The indirect effect of baseline support for not drinking on 6-month follow-up drinking frequency trended toward significance. CONCLUSIONS This study offers preliminary evidence that motivation is one mechanism by which abstinence-specific social support affects treatment outcome.
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Affiliation(s)
- Dorian Hunter-Reel
- Center of Alcohol Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, USA.
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Cohn AM, Epstein EE, McCrady BS, Jensen N, Hunter-Reel D, Green KE, Drapkin ML. Pretreatment clinical and risk correlates of substance use disorder patients with primary depression. J Stud Alcohol Drugs 2011; 72:151-7. [PMID: 21138705 DOI: 10.15288/jsad.2011.72.151] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The current study examined the distinction between primary and secondary depression among substance use patients to test whether the primary depressed subgroup presents to treatment with a unique profile of clinical and vulnerability characteristics. METHOD The heterogeneous sample comprised 286 individuals (76% male) with alcohol and/or drug abuse or dependence (according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised) across four treatment outcome studies conducted at the alcohol research center at the Rutgers University Center of Alcohol Studies. Participants were classified as having comorbid lifetime history of primary depression (21%), secondary depression (24%), or no depression (55%). RESULTS Participants in the primary depression and secondary depression groups were comparable in severity of substance use, and both of these groups had more severe substance use problems than the no-depression group. The primary depression group presented with more severe depression histories, higher levels of current depressive symptoms, and higher rates of additional Axis I comorbidity at treatment entry. In terms of vulnerability indices, the primary depression subgroup had a uniquely high family history risk for major depressive disorder; underlying personality vulnerability to depression was also evident in the primary depression group, with higher neuroticism and lower extraversion relative to secondary depression patients. CONCLUSIONS The findings suggest that careful assessment of lifetime depression symptoms vis-à-vis substance use history and severity yields important information identifying the primary depression subtype of substance use patients as a group with a unique and more severely affected clinical presentation of depression and other Axis I psychopathology relative to secondary depression patients. Effectiveness of substance use interventions may be augmented with depression treatment for primary depression patients, given their more severe clinical presentation and vulnerability characteristics.
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Affiliation(s)
- Amy M Cohn
- Center of Alcohol Studies, Rutgers, The State University of New Jersey, 607 Allison Road, Piscataway, New Jersey 08854-8001, USA.
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