Marijuana's acute effects on cognitive bias for affective and marijuana cues

Marijuana produces acute increases in positive subjective effects and decreased reactivity to negative affective stimuli, though may also acutely induce anxiety. Implicit attentional and evaluative processes may explicate marijuana's ability to acutely increase positive and negative emotions. This within-subjects study examined whether smoked marijuana with 2.7-3.0% delta-9-tetrahydrocannabinol (THC), relative to placebo, acutely changed attentional processing of rewarding and negative affective stimuli as well as marijuana-specific stimuli. On 2 separate days, regular marijuana users (N = 89) smoked placebo or active THC cigarette and completed subjective ratings of mood, intoxication, urge to smoke marijuana, and 2 experimental tasks: pleasantness rating (response latency and perceived pleasantness of affective and marijuana-related stimuli) and emotional Stroop (attentional bias to affective stimuli). On the pleasantness rating task, active marijuana increased response latency to negatively valenced and marijuana-related (vs. neutral) visual stimuli, beyond a general slowing of response. Active marijuana also increased pleasantness ratings of marijuana images, although to a lesser extent than placebo due to reduced marijuana urge after smoking. Overall, active marijuana did not acutely change processing of positive emotional stimuli. There was no evidence of attentional bias to affective word stimuli on the emotional Stroop task with the exception of attentional bias to positive word stimuli in the subgroup of marijuana users with cannabis dependence. Marijuana may increase allocation of attentional resources toward marijuana-specific and negatively valenced visual stimuli without altering processing of positively valenced stimuli. Marijuana-specific cues may be more attractive with higher levels of marijuana craving and less wanted with low craving levels.

An event-level investigation of hangovers' relationship to age and drinking

Animal and human data suggest that adolescents experience hangover effects that are distinct from adults. The present study used ecological momentary assessment (EMA) methods to examine the temporal relationships between drinking and hangovers, and how this varied by age and sex. We hypothesized that alcohol's dose-dependent effects on hangover severity are more pronounced among adolescents and young adults than older drinkers. We also explored whether greater hangover severity would lead to a lower likelihood and volume of alcohol use later the same day. Data were pooled from 4 studies of drinkers (N = 274; ages 15 to 66 years) who completed a 4- to 14-day (M = 7.46, SD = 1.13) EMA monitoring period. Each morning, participants recorded how much alcohol they consumed the day before and rated their hangover severity. Participants who consumed a greater quantity of alcohol the prior day reported more severe hangover symptoms; however, there was an interaction between drinking volume and age, such that hangover was more severe among younger drinkers, especially at higher drinking levels. More severe hangover symptoms did not predict the likelihood of drinking later that day; however, on drinking days, more severe hangover symptoms predicted lower quantities of alcohol use later that day. This event-level effect did not vary as a function of age. Study outcomes did not vary by sex. Our findings suggest that younger drinkers experience more severe hangovers, and that greater hangover results in lighter drinking later that same day regardless of age.

Contingent vouchers and motivational interviewing for cigarette smokers in residential substance abuse treatment

Residential drug treatment provides an opportunity to intervene with smokers with substance use disorders (SUD). A randomized controlled clinical trial compared: (1) contingent vouchers (CV) for smoking abstinence to noncontingent vouchers (NCV), crossed with (2) motivational interviewing (MI) or brief advice (BA), for 184 smokers in SUD treatment. During the voucher period, 36% of carbon monoxide readings indicated smoking abstinence for those receiving CV versus 13% with NCV (p < .001). Post-treatment (3-9 months) point-prevalence abstinence rates were low (3-4% at each follow up), with more abstinence when CV was combined with MI (6.6% on average) than with BA (0% on average). No differential effects on drug use or motivation to quit smoking occurred. Thus, CV had limited effects on long-term smoking abstinence in this population but effects were improved when CV was combined with MI. More effective methods are needed to increase motivation to quit smoking and quit rates in this high-risk population.

Adolescent Substance Treatment Engagement Questionnaire for Incarcerated Teens

BACKGROUND

Treatment engagement is often measured in terms of treatment retention and drop out, resource utilization, and missed appointments. Since persons may regularly attend treatment sessions but not pay close attention, actively participate, or comply with the program, attendance may not reflect the level of effort put into treatment. Teens in correctional settings may feel coerced to attend treatment, making it necessary to develop measures of treatment involvement beyond attendance. This study describes the development and validation of the Adolescent Substance Treatment Engagement Questionnaire (ASTEQ), Teen and Counselor versions.

METHODS

The psychometric properties of the ASTEQ were examined in a sample of incarcerated teens (N = 205) and their counselors. Principal component analysis was conducted on teen and counselor versions of the questionnaire.

RESULTS

Scales of positive and negative treatment engagement were found, reflecting both overt behaviors (joking around, talking to others) and attitudes (interest in change). Significant correlations with constructs related to treatment attitudes and behaviors, and misbehaviors (including substance use) demonstrate good concurrent and predictive validity. Teen and counselor ratings of engagement produced validity correlations in the medium effect size range.

CONCLUSIONS

These measures comprise a valid and reliable method for measuring treatment engagement for incarcerated teens.

Intolerance for withdrawal discomfort and motivation predict voucher-based smoking treatment outcomes for smokers with substance use disorders

Identifying predictors of abstinence with voucher-based treatment is important for improving its efficacy. Smokers with substance use disorders have very low smoking cessation rates so identifying predictors of smoking treatment response is particularly important for these difficult-to-treat smokers. Intolerance for Smoking Abstinence Discomfort (IDQ-S), motivation to quit smoking, nicotine dependence severity (FTND), and cigarettes per day were examined as predictors of smoking abstinence during and after voucher-based smoking treatment with motivational counseling. We also investigated the relationship between IDQ-S and motivation to quit smoking. Smokers in residential substance treatment (n=184) were provided 14days of vouchers for complete smoking abstinence (CV) after a 5-day smoking reduction lead-in period or vouchers not contingent on abstinence. Carbon monoxide readings indicated about 25% of days abstinent during the 14days of vouchers for abstinence in the CV group; only 3-4% of all participants were abstinent at follow-ups. The IDQ-S Withdrawal Intolerance scale and FTND each significantly predicted fewer abstinent days during voucher treatment; FTND was nonsignificant when controlling for variance shared with withdrawal intolerance. The one significant predictor of 1-month abstinence was pretreatment motivation to quit smoking, becoming marginal (p<.06) when controlling for FTND. Lower withdrawal intolerance significantly predicted 3month abstinence when controlling for FTND. Higher withdrawal intolerance pretreatment correlated with less motivation to quit smoking. Implications for voucher-based treatment include the importance of focusing on reducing these expectancies of anticipated smoking withdrawal discomfort, increasing tolerance for abstinence discomfort, and increasing motivation.

General and religious coping predict drinking outcomes for alcohol dependent adults in treatment

BACKGROUND

Religiosity is associated with improved treatment outcomes among adults with alcohol dependence; however, it is unknown whether religious coping predicts drinking outcomes above and beyond the effects of coping in general, and whether gender differences exist.

METHODS

We assessed 116 alcohol-dependent adults (53% women; mean age = 37, SD = 8.6) for use of religious coping, general coping, and alcohol use within 2 weeks of entering outpatient treatment, and again 6 months after treatment.

RESULTS

Religious coping at 6 months predicted fewer heavy alcohol use days and fewer drinks per day. This relationship was no longer significant after controlling for general coping at 6 months.

CONCLUSIONS

The relationship between the use of religious coping strategies and drinking outcomes is not independent of general coping. Coping skills training that includes religious coping skills, as one of several coping methods, may be useful for a subset of adults early in recovery.

SCIENTIFIC SIGNIFICANCE

This novel, prospective study assessed the relationship between religious coping strategies, general coping, and treatment outcomes for alcohol-dependent adults in treatment with results suggesting that the use of religious coping as one of several coping methods may be useful for a subset of adults early in recovery.

Working Memory Moderates the Association Between Smoking Urge and Smoking Lapse Behavior After Alcohol Administration in a Laboratory Analogue Task

INTRODUCTION

Lapses after smoking cessation often occur in the context of alcohol use, possibly because alcohol increases urge to smoke. Poor working memory, or alcohol-induced decrements in working memory, may influence this relationship by making it more difficult for an individual to resist smoking in the face of smoking urges.

METHODS

Participants (n = 41) completed measures of working memory and urge to smoke before and after alcohol administration (placebo, 0.4 g/kg, and 0.8 g/kg, within subjects) and then participated in a laboratory analogue task in which smoking abstinence was monetarily incentivized.

RESULTS

Working memory moderated the relationship between smoking urge and latency to smoke: for those with relatively poorer working memory, urge to smoke was more strongly and negatively associated with latency to smoke (i.e., higher urges were associated with shorter latency).

CONCLUSIONS

Those with weak working memory may need additional forms of treatment to help them withstand smoking urges.

Acute effects of low and high dose alcohol on smoking lapse behavior in a laboratory analogue task

RATIONALE

Smoking lapses (i.e., returns to smoking after quitting) often occur following alcohol consumption with observational data suggesting greater quantities of alcohol lead to greater risk. However, a causal dose-dependent effect of alcohol consumption on smoking lapse behavior has not been established, and the mechanisms that might account for such an effect have not been tested.

OBJECTIVES

In a within-subjects design, we examined the effects of low- (0.4 g/kg) and high-dose (0.8 g/kg) alcohol, relative to placebo, on smokers' ability to resist initiating smoking after acute smoking abstinence.

METHODS

Participants were 100 heavy alcohol drinkers, smoking 10-30 cigarettes per day. Across three separate days, participants consumed placebo, low-dose, or high-dose alcohol following 3 h of smoking abstinence and, 35 min later, were offered the opportunity to smoke while resisting smoking was monetarily reinforced proportional to the amount of time delayed.

RESULTS

Consistent with a dose-response effect, participants smoked 3.35 min (95 % confidence intervals (CI) [-7.09, 0.40], p = .08) earlier following low-dose alcohol and 6.36 min (95 % CI [-9.99, -2.73], p = .0006) earlier following high-dose alcohol compared to drinking a placebo beverage. Effects of dose on smoking behavior were partially mediated by increases in urge to smoke. There was no evidence that alcohol's effects on urge to smoke or ability to resist smoking were mediated through its stimulating or sedating effects.

CONCLUSIONS

Alcohol can reduce the ability to resist smoking in a dose-dependent fashion, in part, due to its effect on increasing the intensity of smoking urges.

Measuring behaviors of individual adolescents during group-based substance abuse intervention

BACKGROUND

Group treatment is delivered in youth correctional facilities, yet groups may be iatrogenic. Few measures with demonstrated psychometric properties exist to track behaviors of individuals during groups. The authors assessed psychometrics for the Group Process-Individual Level measure (GP-IL) of group treatment.

METHODS

N = 152 teens were randomized to 1 of 2 groups (10 sessions each). Adolescents, counselors, and observers rated teen behaviors at sessions 3 and 10. GP-IL assesses reinforcement for deviancy and positive behaviors, member rejection, and counselor connection and praise.

RESULTS

Internal consistency and 1-month stability were demonstrated. Concurrent validity is supported by correlations with measures expected to be associated with group behavior (e.g., coping skills). Counselors and observers rated more deviancy during interactive skills-building groups versus didactic psychoeducational groups (P ≤ .005). Scales evidenced incremental validity.

CONCLUSIONS

GP-IL offers a sound method of tracking adolescent behaviors for professionals working with groups. Counselors ratings were most reliable and valid overall.

Individual versus significant-other-enhanced brief motivational intervention for alcohol in emergency care

OBJECTIVE

Effects of brief motivational interventions (BMIs) for heavy drinkers identified by alcohol-related emergency department (ED) visits are mixed. The successes of including significant others (SOs) in behavioral treatment suggest that involving SOs in ED-delivered BMI might prove beneficial. This study investigated the relative efficacy of an SO-enhanced motivational intervention (SOMI) compared with an individual motivational intervention (IMI) to address heavy drinking in emergency care settings.

METHOD

ED (n = 317) or trauma unit (n = 89) patients were randomly assigned to receive either an IMI or an SOMI and were reassessed at 6 and 12 months for alcohol consumption, alcohol-related consequences, and perceived alcohol-specific SO support.

RESULTS

Generalized estimating equation analyses showed consistent reductions over time for both alcohol consumption and consequences. At 1-year follow-up, the average reduction in total drinks consumed per week was greater for patients in the SOMI condition than the IMI condition. In SOMI, 9.4% more patients moved to within the national guidelines for weekly drinking than did IMI patients. Frequency of heavy drinking and negative alcohol consequences showed no differential effects of intervention.

CONCLUSIONS

Emergence of a modest treatment effect at 12 months suggests that SO involvement in the SOMI condition may have led to more sustained positive influence on patient drinking than in the IMI condition. Implications and limitations regarding SO involvement in brief treatment are discussed.

Acculturation stress and drinking problems among urban heavy drinking Latinos in the Northeast

This study investigates the relationship between the level of acculturation and acculturation stress and the extent to which each predicts problems related to drinking. Hispanics who met criteria for hazardous drinking completed measures of acculturation, acculturation stress, and drinking problems. Sequential multiple regression was used to determine whether the levels of self-reported acculturation stress predicted concurrent alcohol problems after controlling for the predictive value of the acculturation level. Acculturation stress accounted for a significant variance in drinking problems, while adjusting for acculturation, income, and education. Choosing to drink in response to acculturation stress should be an intervention target with Hispanic heavy drinkers.

Length of smoking deprivation moderates the effects of alcohol administration on urge to smoke

Although smoking deprivation is often used in laboratory studies to induce urges to smoke cigarettes, the optimal length of deprivation has not been established. Previous research showed that overnight abstinence from cigarettes led to high baseline urge to smoke that potentially masked alcohol's acute effects on urge to smoke (Kahler et al., 2012). The current study examined whether alcohol's effects on smoking urge were more pronounced when a shorter length of smoking deprivation was used (i.e., 3h instead of overnight abstinence). Using a balanced placebo design for alcohol administration, we found that participants experienced a significant increase in self-reported urge to smoke when administered alcohol after a 3-h smoking deprivation (n=32), whereas this effect was smaller and nonsignificant when smokers were required to be abstinent overnight (n=96). Research on factors that heighten smoking urges may find stronger effects if a 3-h deprivation is used compared to using overnight abstinence.

Motivational interviewing versus brief advice for cigarette smokers in residential alcohol treatment

Residential treatment for substance use disorders (SUD) provides opportunity for smoking intervention. A randomized controlled trial compared: (1) motivational interviewing (MI) to brief advice (BA), (2) in one session or with two booster sessions, for 165 alcoholics in SUD treatment. All received nicotine replacement (NRT). MI and BA produced equivalent confirmed abstinence, averaging 10% at 1 month, and 2% at 3, 6 and 12 months. However, patients with more drug use pretreatment (>22 days in 6 months) given BA had more abstinence at 12 months (7%) than patients in MI or with less drug use (all 0%). Boosters produced 16-31% fewer cigarettes per day after BA than MI. Substance use was unaffected by treatment condition or smoking cessation. Motivation to quit was higher after BA than MI. Thus, BA plus NRT may be a cost-effective way to reduce smoking for alcoholics with comorbid substance use who are not seeking smoking cessation.

Effects of caffeinated vs. non-caffeinated alcoholic beverage on next-day hangover incidence and severity, perceived sleep quality, and alertness

AIMS

Beliefs about the effects of mixing caffeine and alcohol on hangover or sleep may play a role in motivation to consume these mixtures; therefore, information is needed about actual effects. We investigated whether intoxication with caffeinated vs. non-caffeinated beer differentially affected perceived sleep quality, sleepiness, and hangover incidence and severity the next morning.

METHODS

University students (89%) and recent graduate drinkers were randomized to receive: (1) beer with the equivalent of 69mg caffeine/12oz glass of regular beer (n=28) or (2) beer without caffeine (n=36), in sufficient quantity to attain a BrAC of 0.12g%. After an 8-h supervised sleep period, participants completed measures of hangover, sleep quality, sleep latency and time asleep, and sleepiness.

RESULTS

While caffeinated beer improved perceived sleep quality, effect sizes were greater for morning alertness than for quality while sleeping, with no effect on sleep latency or total sleep time. No effects were seen on hangover incidence or severity.

CONCLUSIONS

Mixing caffeine and alcohol does not significantly impair amount of sleep or sleep latency, hangover, or sleepiness the morning after drinking to intoxication in this population.

Impulsivity and alcohol demand in relation to combined alcohol and caffeine use

Problematic alcohol use among college students continues to be a prominent concern in the United States, including the growing trend of consuming caffeinated alcoholic beverages (CABs). Epidemiologically, CAB use is associated with incremental risks from drinking, although these relationships could be due to common predisposing factors rather than specifically due to CABs. This study investigated the relationship between CAB use, alcohol misuse, and person-level characteristics, including impulsive personality traits, delayed reward discounting, and behavioral economic demand for alcohol use. Participants were 273 regularly drinking undergraduate students. Frequency of CAB use was assessed over the past month. A multidimensional assessment of impulsivity included the UPPS-P questionnaire, which measures positive and negative urgency, premeditation (lack thereof), perseverance (lack thereof), and sensation seeking (Lynam, Smith, Whiteside, & Cyders, 2007), and a validated questionnaire-based measure of delayed reward discounting. Demand was assessed via a hypothetical alcohol purchase task. Frequency of CAB consumption was significantly higher in men than in women and was also associated with higher impulsivity on the majority of the UPPS-P subscales, steeper delayed reward discounting, and greater demand for alcohol. Significant correlations between CAB use and both alcohol demand and lack of premeditation remained present after including level of alcohol misuse in partial correlations. In a hierarchical linear regression incorporating demographic, demand, and impulsivity variables, CAB frequency continued to be a significant predictor of hazardous alcohol use. These results suggest that although there are significant associations between CAB consumption and gender, impulsivity, and alcohol demand, CAB use continues to be associated with alcohol misuse after controlling for these variables.

Comparison of the cigarette dependence scale with four other measures of nicotine involvement: correlations with smoking history and smoking treatment outcome in smokers with substance use disorders

The cigarette dependence scale (CDS) was developed to assess principal aspects of smoking dependence. In a French longitudinal survey, CDS showed stronger relationships to urge and change in smoking rate than the Fagerström test for nicotine dependence (FTND). Neither measure predicted abstinence at follow-up in that survey but there was no treatment or cessation induction. The present study investigated concurrent and predictive validity of the CDS in a treatment population by comparing the CDS to the FTND and other measures of tobacco involvement as (1) a correlate of smoking and cessation history and (2) a predictor of short-term smoking abstinence among smokers with substance use disorders (SUD) receiving smoking treatment.

METHODS

Smokers (10+ cigarettes per day) in substance treatment received brief advice and nicotine patch for 8 weeks; half also received contingent vouchers for smoking cessation. Assessments were conducted pretreatment and 7, 14 and 30 days after treatment initiation, with abstinence verified biochemically.

RESULTS

At baseline (n=305), the 12-item and 5-item CDS versions showed excellent and marginal reliability, respectively. FTND shared 43 and 61% of variance with CDS-12 and CDS-5, respectively. FTND and CDS scales correlated positively with cigarettes per day, and negatively with time to first cigarette, motivation to quit and age at first daily smoking. Only CDS correlated with the number of past quit attempts. Neither CDS nor FTND predicted abstinence within treatment, unlike the motivation measure and time to first cigarette.

CONCLUSION

In moderate-heavy smokers with SUD in smoking treatment in the U.S., the CDS is largely equivalent to the FTND as an indicator of tobacco dependence but the CDS-5 is less reliable. Motivation was the most consistent predictor of outcome, and time to first cigarette was the only tobacco dependence measure that predicted smoking abstinence during treatment.

Role of tobacco smoking in hangover symptoms among university students

OBJECTIVE

Although hangover results from excessive alcohol consumption, the specific pathways through which hangover symptoms arise have not been elucidated. Research on predictors of hangover sensitivity may provide clues about such mechanisms. The present study investigated whether tobacco smoking on days of heavy drinking affects next-day hangover incidence and severity.

METHOD

The study drew on diary data from a study on smoking and drinking among 113 students at a midwestern university in the United States. Participants completed a daily, web-based, 26-item survey for 8 weeks to assess prior-day alcohol and tobacco use as well as current-day hangover symptoms. Hierarchical linear modeling was used to test the hypothesis that amount of smoking is related to hangover, controlling for amount of alcohol consumed, sex, and other individual characteristics. Analyses were conducted after selecting only days with alcohol consumption levels that typically elicit hangover, then repeated on lighter drinking days for comparison. Validity of the hangover items was checked by comparing reports after such heavy drinking days with days of lighter drinking.

RESULTS

Across all possible person-days, 92% of daily reports were obtained. When selecting only events where an estimated blood alcohol concentration of 110 mg/dl was attained, smoking significantly increased the odds of hangover incidence and hangover severity while controlling for number of drinks consumed and sex. Additional analyses controlling for age first smoked regularly, frequency of drug use, type of drug involvement, or smoking status resulted in findings that were unchanged.

CONCLUSIONS

Smoking more on heavy drinking days affects hangover sensitivity and severity, possibly because of acute pharmacological effects.

Intolerance for discomfort among smokers: comparison of smoking-specific and non-specific measures to smoking history and patterns

INTRODUCTION

Intolerance of discomfort associated with recent smoking cessation has been studied with only one smoking-specific questionnaire. The present study investigates the extent to which the previously validated Intolerance for Smoking Abstinence Discomfort Questionnaire (IDQ-S) scales share variance with (a) laboratory measures of distress tolerance (Paced Serial Addition Task and a breath-holding task) that have themselves been validated against smoking history, (b) the cold pressor task (not previously validated for smoking), and (c) an anxiety sensitivity questionnaire previously used for a similar purpose. The study then tests the hypothesis that the IDQ-S scales will have a higher correlation with smoking rate and dependence and with number and length of past smoking cessation attempts than with anxiety sensitivity or behavioral distress tolerance tasks do, since those measures are not smoking-specific.

METHODS

Sixty daily smokers recruited from the community completed the measures.

RESULTS

The behavioral tasks and anxiety sensitivity shared little common variance. Anxiety sensitivity correlated more highly with IDQ-S than did the behavioral tasks but only 27% of variance was shared with the IDQ-S Withdrawal Intolerance; no distress tolerance measure correlated significantly with the IDQ-S Lack of Cognitive Coping scale. Only the IDQ-S scales correlated significantly with nicotine dependence, rate and past cessation: Withdrawal Intolerance with nicotine dependence and rate, and Lack of Cognitive Coping with fewer quit attempts.

CONCLUSIONS

The smoking-specific measure of intolerance for discomfort may be more useful in smoking research than the less specific measures of distress tolerance.

Urge-specific and lifestyle coping strategies of alcoholics: relationships of specific strategies to treatment outcome

BACKGROUND

The present study examined the efficacy of various specific lifestyle and situation-specific coping skills by determining the relationship of each of these strategies to drinking outcomes.

METHODS

Patients with alcohol dependence in intensive day treatment (n=165) were participating in a randomized trial of naltrexone versus placebo and adjunctive communication and coping skills training or a control treatment. The alcohol version of the Urge-Specific Strategies (USS) questionnaire and the General Strategies for Alcoholics (GSA) were administered early in treatment. The USS assesses 16 situation-specific strategies taught in cue exposure treatment, communication skills training, or relaxation/meditation training to cope with experiencing an urge to drink (e.g., think of positive and negative consequences of drinking, use mastery messages, engage in an alternative behavior); the 21-item GSA assesses lifestyle change strategies taught in communication skills training and in the general treatment program (e.g., keep busy, exercise regularly, attend 12-Step meetings, avoid high-risk situations). Alcohol use and frequency of use of the skills were assessed 6 and 12 months following treatment.

RESULTS

Many specific behavioral and cognitive coping strategies were significantly related to drinking outcomes, including 13 urge-specific and 18 general lifestyle strategies, while other strategies were unrelated.

CONCLUSIONS

Since some strategies taught in treatment are more effective in preventing relapse than others; treatment may be improved by focusing on these specific strategies. Since results may be limited to this population, replication is needed in more diverse settings and without medication.

Initial development of a measure of expectancies for combinations of alcohol and caffeine: the Caffeine + Alcohol Combined Effects Questionnaire (CACEQ)

Caffeinated alcoholic beverage (CAB) consumption is widespread among young adults in the United States and is associated with increased negative consequences from alcohol. In addition to the direct pharmacological effects of adding caffeine to alcohol, another possible risk mechanism is via socially learned expectancies, which has received very little consideration. The current study conducted an initial psychometric validation of a measure of CAB expectancies to facilitate research in this area. Participants were 409 undergraduate regular drinkers (71% female) who were assessed for alcohol and CAB use, alcohol use/misuse, and expectancies about CABs. The majority (62%) of participants reported CAB experience and 48% reported CAB use in the past month. Participants primarily consumed spontaneously-prepared as opposed to premixed-CABs. More frequent CAB use was significantly positively correlated with levels of alcohol use and misuse. For the expectancy items, exploratory factor analysis revealed two factors that were labeled "Intoxication Enhancement" and "Avoid Negative Consequences." The patterns of expectancies reflected beliefs that CABs enhanced intoxication, but did not protect against negative consequences. The measure was titled the Caffeine + Alcohol Combined Effects Questionnaire (CACEQ). Intoxication enhancement scores were significantly associated with frequency of CAB use, even after adjusting for the role of weekly drinking and alcohol misuse, supporting the convergent validity of the CACEQ. These data provide initial support for the CACEQ and suggest it may be useful for clarifying the role of expectancies in CAB use. Applications for studying the risks associated with CAB use and methodological considerations are discussed.

Breath holding duration and self-reported smoking abstinence intolerance as predictors of smoking lapse behavior in a laboratory analog task

INTRODUCTION

Distress intolerance (DI) is elevated in smokers and confers increased risk for relapse following a quit attempt. Intolerance of respiratory distress and of nicotine withdrawal may be particularly relevant predictors of smoking cessation outcomes. However, no studies to date have examined the association between smoking relevant DI and smoking lapse behavior in a laboratory setting. The current study examined whether DI was associated with the risk of initiating smoking in a laboratory-based lapse analog task.

METHODS

This study is a secondary data analysis from a study of the impact of alcohol administration on smoking behavior. Ninety-six cigarette smokers completed measures of DI and a smoking lapse analog task. Breath holding (BH) duration and self-reported intolerance of smoking abstinence were analyzed as predictors of smoking initiation in a survival analysis model.

RESULTS

Shorter BH duration was associated with greater risk of smoking initiation, controlling for nicotine dependence, nicotine withdrawal symptoms, and demographics. Self-report measures of smoking abstinence DI were not associated with BH duration or time to smoking initiation when controlling for nicotine dependence severity.

CONCLUSIONS

BH captures a domain of DI that is specifically associated with a higher risk of initiating smoking in this analog of smoking lapse. The prediction of smoking in an analog lapse task adds to the extant literature identifying an association between DI and smoking lapse and may enable further research to understand and address the mechanism through which BH affects smoking lapse risk.

Trajectories of adolescent alcohol use after brief treatment in an Emergency Department

OBJECTIVE

The primary aim of this study was to identify distinct classes of trajectories of adolescent substance use following a brief motivational interviewing (MI) intervention in an Emergency Department (ED). The secondary aim was to identify predictors of class membership.

METHODS

Latent growth mixture modeling was used with 177 adolescents who participated in two randomized clinical trials evaluating MI for an alcohol-related event.

RESULTS

Three classes were identified: (1) moderate use, decreasers consisting of 56.8% of participants; (2) heavy use, decreasers, consisting of 10.5% of participants, and (3) heavy use sustainers, consisting of 32.7% of participants. Hispanic ethnicity, parental monitoring, and days of high-volume drinking were significant predictors of class membership. Hispanic ethnic status and high levels of parental monitoring were associated with decreased likelihood of belonging to either of the two heavy use classes. More frequent high-volume drinking at baseline was associated with increased likelihood of belonging to the heavy use, sustainer class, and decreased likelihood of belonging to the heavy use, decreaser class. Across all three classes, being female and having frequent high-volume drinking at baseline were associated with worse response to the intervention.

CONCLUSIONS

These findings have important implications for identifying adolescents who may benefit from different or additional intervention, and for anticipating and informing families of adolescents' potential drinking course following treatment.

Sex differences in stimulus expectancy and pharmacologic effects of a moderate dose of alcohol on smoking lapse risk in a laboratory analogue study

RATIONALE

Alcohol use is often implicated in initial lapses to smoking during quit smoking attempts. Mechanisms explaining this association are unknown but could include (a) learned associations between drinking and smoking or (b) direct pharmacologic effects of alcohol.

OBJECTIVES

In a 2 (told alcohol vs. told placebo) × 2 (0.4 g/kg vs. 0.0 g/kg ethanol) between-subjects balanced placebo design, we examined instruction and beverage condition effects on smokers' ability to resist initiating smoking and whether these effects differed by sex.

METHODS

Participants were 96 heavy alcohol drinkers, smoking 10-30 cigarettes per day. After 15 h of smoking abstinence, participants consumed either an alcoholic or a nonalcoholic beverage and 35 min later completed a smoking lapse task.

RESULTS

Overall, neither instructions nor beverage contents influenced behavior on the smoking lapse task. However, the instruction condition had different effects in men and women. Women, but not men, were more likely to smoke and reported expecting greater satisfaction from smoking when they were told alcohol compared to told placebo. The effects of instruction condition on smoking behavior were not mediated by self-reported expected satisfaction from smoking.

CONCLUSIONS

Women may be more likely to choose to smoke after drinking moderate amounts of alcohol because of their expectations rather than the pharmacological effects of the alcohol.

Enhanced motivational interviewing versus brief advice for adolescent smoking cessation: results from a randomized clinical trial

BACKGROUND

Motivational interviewing (MI) is widely used for adolescent smoking cessation but empirical support for this approach is mixed.

METHODS

Adolescent cigarette smokers 14-18 years old (N=162) were recruited from medical, school, and community settings and randomly assigned to enhanced MI or brief advice (BA) for smoking cessation. MI comprised an in-person individual session, a telephone booster session one week later, and a brief telephone-based parent intervention. BA consisted of standardized brief advice to quit smoking. Assessments occurred at baseline, post-treatment and at 1-, 3-, and 6-month follow ups.

RESULTS

Biochemically-confirmed 7-day point prevalence abstinence rates were low (e.g., 4.5% for MI; 1.4% for BA at 1 month) and did not differ significantly by group at any follow up. Only those in MI reported significant decreases in cigarettes smoked per day (CPD) from baseline to 1 month. At 3 and 6 months, smokers in both groups reported significantly reduced CPD with no differences between groups. MI reduced perceived norms regarding peer and adult smoking rates, while BA had no effect on normative perceptions. No group differences emerged for self-reported motivation or self-efficacy to quit smoking.

CONCLUSIONS

Findings support the efficacy of MI for addressing normative misperceptions regarding peer and adult smoking and for modestly reducing CPD in the short-term; however, these effects did not translate to greater smoking abstinence. MI may have more promise as a prelude to more intensive smoking intervention with adolescents than as a stand-alone intervention.