Alcohol affects video lottery terminal (VLT) gambling behaviors and cognitions differently

People frequently combine alcohol use and gambling. However, our understanding of the effects of alcohol on gambling behavior is limited, both in terms of what the effects are and how they occur. The effects of a moderately intoxicating dose of alcohol (i.e., a blood alcohol concentration of .06 g%) on the video lottery terminal (VLT) gambling behaviors and cognitions of community-recruited nonpathological (n = 30) and probable pathological gamblers (n = 30) were compared. Alcohol increased the rate of double up betting (i.e., choosing to play a bonus game, after a winning video poker hand, which involves trying to pick a higher ranked card than the dealer's card from among 5 face down cards) of probable pathological gamblers, but did not influence their irrational beliefs about VLT play. Alcohol maintained the irrational beliefs about VLT play of nonpathological gamblers, but did not influence their gambling behaviors. Results are consistent with a growing body of research finding that gambling cognitions have an equivocal role in explaining actual gambling behaviors. Potential mechanisms for the observed effects are discussed. Applied implications discussed include: educating regular VLT players about the effects of alcohol on irrational gambling cognitions; reconsidering policies and practices that make alcohol available where machine gambling takes place; and targeting even moderate alcohol use in the treatment of gambling problems.

CBT for high anxiety sensitivity: alcohol outcomes

INTRODUCTION

High anxiety sensitivity (AS) has been associated with greater alcohol consumption and alcohol-related problems as well as greater sensitivity to the anxiety-reducing effects of alcohol and greater risky negative reinforcement motives for drinking. The present study reported on the alcohol-related outcomes of a telephone-delivered cognitive behavioral treatment (CBT) designed to reduce high AS.

METHODS

Eighty individuals with high AS (M age=36 years; 79% women; 76% Caucasian) seeking treatment for their AS-related concerns participated in the study and were randomly assigned to an eight week telephone CBT program or a waiting list control. Participants completed measures of drinking motives and problem drinking at pre- and post-treatment.

RESULTS

Multilevel modeling showed that the treatment was successful in reducing AS. The treatment also resulted in specific reductions in drinking to cope with anxiety motives as well as physical alcohol-related problems. Mediated moderation analyses showed treatment-related changes in AS mediated changes in drinking to cope with anxiety motives. Changes in drinking to cope with anxiety motives mediated changes in physical alcohol-related problems.

CONCLUSIONS

Results of the present study suggest that an AS-targeted intervention may have implications for reducing risky alcohol use cognitions and behaviors. Further research is needed in a sample of problem drinkers.

Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults

BACKGROUND

Cognitive behavioural therapy (CBT) is an evidence-based treatment for anxiety disorders. Many people have difficulty accessing treatment, due to a variety of obstacles. Researchers have therefore explored the possibility of using the Internet to deliver CBT; it is important to ensure the decision to promote such treatment is grounded in high quality evidence.

OBJECTIVES

To assess the effects of therapist-supported Internet CBT on remission of anxiety disorder diagnosis and reduction of anxiety symptoms in adults as compared to waiting list control, unguided CBT, or face-to-face CBT. Effects of treatment on quality of life and patient satisfaction with the intervention were also assessed.

SEARCH METHODS

We searched the Cochrane Depression, Anxiety and Neurosis Review Group Specialized Register (CCDANCTR) to 12 April 2013. The CCDANCTR includes relevant randomised controlled trials from EMBASE (1974 -), MEDLINE (1950 -) and PsycINFO (1967 -). We also searched online clinical trial registries and reference lists of included studies. We contacted authors to locate further trials. An update of an initial search (April 2013), conducted in September 2014, identified seven new completed studies, seven previously ongoing studies now completed, and four new ongoing studies. This is a fast-moving area; we plan to update this review shortly, incorporating these new studies.

SELECTION CRITERIA

Each identified study was independently assessed for inclusion by two authors. To be included, studies had to be randomised controlled trials of therapist-supported ICBT compared to a waiting list, attention, information, or online discussion group; unguided CBT (that is, self-help); or face-to-face CBT. We included studies that treated adults with an anxiety disorder (panic disorder, agoraphobia, social phobia, post-traumatic stress disorder, acute stress disorder, generalized anxiety disorder, obsessive compulsive disorder, and specific phobia) defined according to the Diagnostic and Statistical Manual of Mental Disorders III, III-R, IV, IV-TR or the International Classification of Disesases 9 or 10.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed the risk of bias of included studies and judged overall study quality. We used data from intention-to-treat analyses wherever possible. We assessed treatment effect for the dichotomous outcome of clinically important improvement in anxiety using a risk ratio (RR) with 95% confidence interval (CI). For disorder-specific and general anxiety symptom measures and quality of life we assessed continuous scores using standardized mean differences (SMD). We examined statistical heterogeneity using the I(2) statistic.

MAIN RESULTS

We screened 1000 citations and selected 30 studies (2181 participants) for inclusion. The studies examined social phobia (11 trials), panic disorder with or without agoraphobia (8 trials), generalized anxiety disorder (4 trials), post-traumatic stress disorder (1 trial), and specific phobia (1 trial). Five remaining studies included a range of anxiety disorder diagnoses. Studies were conducted in Sweden (15 trials), Australia (12 trials), Switzerland (2 trials), and the Netherlands (1 trial) and investigated a variety of ICBT protocols. Three primary comparisons were identified, experimental versus waiting list control, experimental versus unguided ICBT, and experimental versus face-to-face CBT.Moderate quality evidence from 9 studies (644 participants) contributed to a pooled RR of 4.18 (95% CI 2.42 to 7.22) for clinically important improvement in anxiety at post-treatment, favouring therapist-supported ICBT over a waiting list, attention, information, or online discussion group only. Similarly, the SMD for disorder-specific symptoms at post-treatment (22 studies, 1573 participants; SMD -1.12, 95% CI -1.39 to -0.85) and general anxiety symptoms at post-treatment (14 studies, 1004 participants; SMD -0.79, 95% CI -1.10 to -0.48) favoured therapist-supported ICBT. The quality of the evidence for both outcomes was low.One study compared unguided CBT to therapist-supported ICBT for clinically important improvement in anxiety at post-treatment, showing no difference in outcome between treatments (54 participants; very low quality evidence). At post-treatment there were no clear differences between unguided CBT and therapist-supported ICBT for disorder-specific anxiety symptoms (4 studies, 253 participants; SMD -0.24, 95% CI -0.69 to 0.21; low quality evidence) or general anxiety symptoms (two studies, 138 participants; SMD 0.28, 95% CI -2.21 to 2.78; low quality evidence).Compared to face-to-face CBT, therapist-supported ICBT showed no significant differences in clinically important improvement in anxiety at post-treatment (4 studies, 365 participants; RR 1.09, 95% CI 0.89 to 1.34; moderate quality evidence). There were also no clear differences between face-to-face and therapist supported ICBT for disorder-specific anxiety symptoms at post-treatment (6 studies, 424 participants; SMD 0.09, 95% CI -0.26 to 0.43; low quality evidence) or general anxiety symptoms at post-treatment (5 studies, 317 participants; SMD 0.17, 95% CI -0.35 to 0.69; low quality evidence).Overall, risk of bias in included studies was low or unclear for most domains. However, due to the nature of psychosocial intervention trials, blinding of participants and personnel, and outcome assessment tended to have a high risk of bias. Heterogeneity across a number of the meta-analyses was substantial, some was explained by type of anxiety disorder or may be meta-analytic measurement artefact due to combining many assessment measures. Adverse events were rarely reported.

AUTHORS' CONCLUSIONS

Therapist-supported ICBT appears to be an efficacious treatment for anxiety in adults. The evidence comparing therapist-supported ICBT to waiting list, attention, information, or online discussion group only control was low to moderate quality, the evidence comparing therapist-supported ICBT to unguided ICBT was low to very low quality, and comparisons of therapist-supported ICBT to face-to-face CBT was low to moderate quality. Further research is needed to better define and measure any potential harms resulting from treatment. These findings suggest that therapist-supported ICBT is more efficacious than a waiting list, attention, information, or online discussion group only control, and that there may not be a significant difference in outcome between unguided CBT and therapist-supported ICBT; however, this latter finding must be interpreted with caution due to imprecision. The evidence suggests that therapist-supported ICBT may not be significantly different from face-to-face CBT in reducing anxiety. Future research should involve equivalence trials comparing ICBT and face-to-face CBT, examine the importance of the role of the therapist in ICBT, and include effectiveness trials of ICBT in real-world settings. A timely update to this review is needed given the fast pace of this area of research.

Drinking motives and attentional bias to affective stimuli in problem and non-problem drinkers

Problem drinking may reflect a maladaptive means of coping with negative emotions or enhancing positive emotions. Disorders with affective symptoms are often characterized by attentional biases for symptom-congruent emotionally valenced stimuli. Regarding addictions, coping motivated (CM) problem gamblers exhibit an attentional bias for negative stimuli, whereas enhancement motivated (EM) problem gamblers exhibit this bias for positive stimuli (Hudson, Jacques, & Stewart, 2013). We predicted that problem drinkers would show similar motive-congruent attentional biases. Problem and non-problem drinkers (n = 48 per group) completed an emotional orienting task measuring attentional biases to positive, negative, and neutral stimuli. As predicted, EM problem drinkers showed an attentional bias for positive information (i.e., reduced accuracy for positively cued trials). However, CM problem drinkers displayed a general distractibility (i.e., reduced accuracy, regardless of cue valence). The results add further support for Cooper et al.'s (1992) motivational model of alcohol use, and indicate potential motivation-matched intervention targets. (PsycINFO Database Record

Testing the four-factor model of personality vulnerability to alcohol misuse: a three-wave, one-year longitudinal study

The 4-factor model of personality vulnerability identifies 4 personality risk factors for alcohol misuse: hopelessness, anxiety sensitivity, impulsivity, and sensation seeking. These personality traits are associated with distinct mechanisms and motivations for alcohol misuse. Individuals high in hopelessness drink to regulate dysphoric affect, while those high in anxiety sensitivity drink to reduce anxiety and to conform to peer expectations. Individuals high in sensation seeking are highly sensitive to the rewarding properties of alcohol, and misuse alcohol to maximize enjoyment. Impulsivity is a broad risk factor contributing to all drinking motives. We hypothesized that personality vulnerabilities would indirectly predict alcohol quantity and problems through specific drinking motives theorized by the 4-factor model. The present study tested hypotheses using a 3-wave, 1-year longitudinal study of undergraduate drinkers (N = 302). Data were analyzed using multilevel path analysis. Hopelessness and impulsivity were positively related to drinking motives in the expected fashion. Anxiety sensitivity was related to coping-anxiety and conformity motives only in the between-subjects model (partially supporting hypotheses), while sensation seeking was generally unrelated to all drinking motives and alcohol outcomes (failing to support hypotheses). Enhancement motives predicted alcohol quantity and problems at both levels, coping-depression motives predicted alcohol problems at the between-subjects level only, and coping-anxiety, conformity, and social motives failed to predict alcohol outcomes beyond other motives. Overall, this study partially supports the 4-factor model, with the strongest support emerging for impulsivity and hopelessness. This study suggests that personality traits such as impulsivity and hopelessness may be important targets in prevention and treatment with undergraduate drinkers.

Telephone-delivered cognitive behavioral therapy for high anxiety sensitivity: a randomized controlled trial

OBJECTIVE

High anxiety sensitivity (AS) is associated with the development and maintenance of anxiety and depressive symptoms and is theorized to be a mediator of treatment outcomes for anxiety and depression. The present study tested the efficacy of a telephone-delivered cognitive behavioral therapy (CBT) intervention in reducing high AS and its associated anxiety and depressive symptoms.

METHOD

Treatment-seeking participants with high AS were recruited from the community (N = 80; M age = 36 years; 79% women; 76% Caucasian) and were randomly assigned to an 8-week telephone-delivered CBT program or a waiting list control. Participants completed anxiety and depression symptom and diagnostic measures at pre- and posttreatment, after a subsequent 4 weeks of continued interoceptive exposure, and 8 weeks later.

RESULTS

Multilevel modeling showed the treatment was successful in reducing AS, as well as panic, social phobia, posttraumatic stress symptoms, and number of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnoses per participant when compared to a waiting list control. These gains were maintained at follow-up. Generalized anxiety and depressive symptoms, however, did not improve as a result of treatment. Mediated moderation analyses suggested that treatment-related changes in AS may mediate anxiety symptom changes.

CONCLUSION

RESULTS of the present study provide promising evidence for this transdiagnostic treatment approach. Reductions in anxiety symptoms across diagnostic categories stemming from this AS-targeted intervention may have implications for helping a broad array of clients with various anxiety disorders that share AS as a common risk or maintenance factor.

Cannabis use motives and personality risk factors

According to the model of substance abuse of Conrod, Pihl, Stewart, and Dongier (2000), four personality factors (i.e., anxiety sensitivity [AS], introversion/hopelessness [I/H], sensation seeking [SS], and impulsivity [IMP]) are associated with elevated risk for substance use/misuse, with each personality factor being related to preference for particular drugs of abuse (e.g., AS with anxiolytics). However, cannabis use has not been consistently linked to any one of these personality factors. This may be due to the heterogeneity in cannabis use motives. The present study explored the association between these four personality risk factors and different cannabis use motives. Cannabis users completed an interview about their motives for cannabis use as well as the self-report Substance Use Risk Profile Scale (SURPS; Woicik, Conrod, Stewart, & Pihl, 2009), which measures the four personality risk factors. Results showed that AS was associated with conformity motives and I/H was associated with coping motives for cannabis use. SS was positively associated with expansion motives and IMP was associated with drug availability motives. Thus, personality risk factors in the model of Conrod et al. (2000) are associated with distinct cannabis use motives in a pattern consistent with theory.

The effect of snus on alcohol-related cigarette administration in dependent and non-dependent smokers

INTRODUCTION

Alcohol has been found to increase tobacco smoking in both dependent daily smokers (DDS) and nondependent nondaily smokers (NNS), yet little attention has been directed toward examining how different treatments/products modify drinking-related smoking behavior.

METHODS

This study examined the acute effects of snus (4mg of nicotine) on alcohol-related smoking responses in 18 DDS and 17 NNS. During each double-blind session, participants were randomly assigned to receive one of the following combinations: alcohol and snus, alcohol and placebo snus, placebo alcohol and snus, or placebo alcohol and placebo snus. Participants consumed their assigned beverage before absorbing their session's product, and after 30min participants could self-administer puffs of their preferred brand of cigarette over a 60-minute period using a progressive ratio task.

RESULTS

Alcohol significantly increased tobacco craving (p<.001) and tended to decrease latency to start smoking (p=.021) but only among NNS. In contrast, snus tended to decrease the number of puffs earned and how hard DDS worked for puffs in both beverage conditions (ps≤.019) but it did not alter the smoking behavior of NNS. Craving was not significantly impacted by snus in either type of smoker.

DISCUSSION

These findings raise the possibility that different processes mediate alcohol and cigarette co-use in NNS and DDS and suggest that snus may be effective in reducing alcohol-related cigarette use in DDS specifically.