Patient-treatment matching for alcoholic men in communication skills versus cognitive-behavioral mood management training

Bringing alcohol treatment to driving under the influence programs: Perceptions from first-time offenders

Alcohol use disorders (AUDs) are common among first-time driving under the influence (DUI) offenders. Individuals with a DUI arrest may attend a DUI alcohol education program for license reinstatement. We evaluated the acceptability of cognitive behavioral treatment (CBT) for AUDs adapted for DUI programs. Participants (N=35) were enrolled in one of two DUI programs in Los Angeles and were an average of 34.5 (SD=11.9) years old; 66% male; 37.1% African American, 34.2% Hispanic/Latino(a), and 20% non-Hispanic White. We analyzed data from ten focus groups and 35 self-report surveys that evaluated the nine-session CBT group protocol. Overall, participants stated that the CBT philosophy was acceptable and helpful in thinking about how to prevent future DUIs. They also found the coping skills in the sessions relevant to other life events and decisions. Participants valued the personal disclosure and interactive role-play and group exercises embedded within each session stating that these exercises helped with group cohesion and self-disclosure. Data from satisfaction surveys showed that participants reported high satisfaction ratings on the overall session, session content, and session facilitator. Future studies are needed to evaluate whether evidence-based treatment within DUI programs may increase access to evidence-base care among at-risk individuals who may not otherwise seek treatment for their AUDs.

Study design to evaluate cognitive behavioral therapy among a diverse sample of adults with a first-time DUI offense

BACKGROUND

Driving under the influence (DUI) of alcohol is a major public health concern, and many individuals continue to drink and drive even after being convicted of a DUI offense. Latinos, in particular, are disproportionately likely to be arrested for a DUI, have higher rates of recidivism, and are more likely to die in alcohol-related accidents than non-Latino Whites. Latinos also experience significant disparities in accessing alcohol-related treatment.

METHODS/DESIGN

This study protocol paper describes a randomized trial of cognitive behavioral therapy (CBT) compared to usual care in DUI programs for individuals with a first-time offense and at-risk drinking. We will utilize a two-group randomized design where individuals enrolled in a DUI program with a first-time conviction will be randomized to CBT (n = 150) or usual care (n = 150). Participants will be assessed at baseline, immediately post-treatment, and 6-months post-treatment. Recidivism data will be collected using administrative data within 2 years post-treatment.

DISCUSSION

This project has the potential to benefit a large population of vulnerable individuals who are at risk of DUI recidivism. It also develops a new model of care by providing treatment in DUI programs to reduce disparities associated with poor treatment access. Trial registration NCT02588703.

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.

Cognitive-behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials

OBJECTIVE

This meta-analysis examined 53 controlled trials of cognitive-behavioral treatment (CBT) for adults diagnosed with alcohol- or illicit-drug-use disorders. The aims were to provide an overall picture of CBT treatment efficacy and to identify client or treatment factors predictive of CBT effect magnitude.

METHOD

The inverse variance weighted effect size (Hedges' g) was calculated for each study and pooled using fixed and random effects methods. Potential study-level moderators were assessed in subgroup analyses by primary drug, type of CBT, and type of comparison condition. In addition, seven client and treatment variables were examined in meta-regression analyses.

RESULTS

Across studies, CBT produced a small but statistically significant treatment effect (g = 0.154, p < .005). The pooled effect was somewhat lower at 6-9 months (g = 0.1 15, p < .005) and continued to diminish at 12-month follow-up (g = 0.096, p < .05). The effect of CBT was largest in marijuana studies (g = 0.513, p < .005) and in studies with a no-treatment control as the comparison condition (g = 0.796, p < .005). Meta-regression analyses indicated that the percentage of female participants was positively associated and the number of treatment sessions was negatively associated with effect size.

CONCLUSIONS

The findings demonstrate the utility of CBT across a large and diverse sample of studies and under rigorous conditions for establishing efficacy. CBT effects were strongest with marijuana users, when CBT was compared with no treatment, and may be larger with women than with men and when delivered in a brief format.

Urge-specific and lifestyle coping strategies of cocaine abusers: relationships to treatment outcomes

This study investigated specific coping techniques for effectiveness in reducing cocaine use after treatment. The urge-specific strategies questionnaire-cocaine (USS-C) assessed frequency of use of 21 strategies for coping with urges. The general change strategies questionnaire-cocaine (GCS-C) assessed frequency of use of 21 lifestyle change strategies designed to maintain abstinence. Cocaine-dependent patients were assessed at follow-up after residential treatment for USS-C (n=59 at 3 months, 84 at 6 months), GCS-C (n=89 at 3 months, 120 at 6 months) and substance use. Less cocaine use was associated with urge coping by thinking about negative or positive consequences, alternative behaviors, distraction, relaxation/meditation, escape, offer refusal, spiritual methods, behavior chains, mastery messages, problem-solving, meeting or sponsor, or seeking social support. The lifestyle change strategies of thinking about consequences, working toward goals, thinking of oneself as sober, clean recreation, regular relaxation, avoiding temptations, not carrying much money, living with clean people, seeking social support, spiritual involvement, keeping busy, and health activities were also associated with less cocaine use. Results suggest focusing coping skills training on these potentially effective strategies.

Facial affect perception in alcoholics

Satisfactory interpersonal interaction involves understanding others' facial expressions. Alcoholic individuals often have severe interpersonal difficulties that may relate to poor and distorted perception of facial expressions. The importance of attention direction has been highlighted by the finding, in recent primate studies, of neurons responsible for the detection of attention direction. Studies on humans suggest that expression perception is modulated by attention direction (whether the expression is directed towards or away from the observer). Here, for the first time, the relationship between attention direction and perception of expression (anger, sadness, happiness and disgust) in alcoholic and control subjects is investigated. We used animated facial stimuli depicting different emotions to give measures of recognition accuracy and of perceptual sensitivity. Our study demonstrated that alcoholics made more errors than control subjects in recognising expressions generally and had a tendency to mis-label sad expressions directed towards them as being hostile (angry/disgusted). When asked to select the point when they started to see the expression, alcoholics, especially female alcoholics, chose higher expression intensities. This study highlights the importance of investigating the modulating effects of attention direction when studying the perception of expressions and provides an indication of how alcoholics' inappropriate social reactions may be triggered.

Interactions between psychotherapy procedures and patient attributes that predict alcohol treatment effectiveness: a preliminary report

This study examined interactions between patient attributes and therapist interventions on alcoholism treatment outcome. Process analyses of an early psychotherapy session from either cognitive-behavioral (CBT) or family systems (FST) therapy and baseline patient information (N=47) were used to measure theory-based therapy and patient variables. Hierarchical linear regression was used to test the effect of each patient-therapy interaction on changes in drinking behavior. Two disordinal interactions were predictors of alcohol use during the maintenance phase of treatment. Patients high in emotional distress did best when their therapy addressed emotional experiences, and the converse was observed for patients low in distress. Patients high in reactance had better drinking outcomes when their therapy was nondirective, and patients low in reactance improved more with directive therapy. In contrast to the interactions between patient attributes and the therapy process, the interactions between patient attributes and treatment model (CBT versus FST) were not reliable predictors of alcohol use.

Out-patient behaviour therapy in alcoholism: treatment outcome after 2 years

OBJECTIVE

The main aim of the study was the evaluation of out-patient behavioural approaches in alcohol dependence. Additionally, the persistence of treatment effects and the impact of psychiatric comorbidity in long-term follow-up was examined.

METHOD

A total of 120 patients were randomly assigned to non-specific supportive therapy or to two different behavioural therapy programmes (coping skills training and cognitive therapy) each comprising 26 weekly sessions; the follow-up period lasted 2 years.

RESULTS

Patients undergoing behavioural therapy showed a consistent trend towards higher abstinence rates; significant differences between the two behavioural strategies could not be established. Moreover, the results indicate a reduced ability of cognitive impaired patients to cope with short-time abstinence violations and at a reduced benefit from behavioural techniques for patients with severe personality disorders.

CONCLUSION

Behavioural treatment yielded long-lasting effects and met high acceptance; yet, still in need of improvement is the development of specific programmes for high-risk patients.

Brief coping skills treatment for cocaine abuse: 12-month substance use outcomes

Patients (N = 108) in a study of cocaine-specific coping skills training (CST), which was found to reduce cocaine use during a 3-month follow-up, were followed for an additional 9 months. CST involved coping skills training in the context of high-risk situations. Control treatment used meditation-relaxation. Both were added to comprehensive private substance abuse treatment. Patients in CST who relapsed had significantly fewer cocaine use days than did the control group during the first 6 months, then both conditions did equally well. Patients in CST also drank alcohol more frequently in the last 6 months than did contrast patients but did not differ in heavy drinking days. For cocaine use outcomes, no interaction of treatment was found with gender, education, route of administration, drug use severity, sociopathy, or depression. Implications include the need to investigate different lengths and combinations of treatment.

Coping and social skills training for alcohol and cocaine dependence

Coping and Social Skills Training (CSST) has been in the forefront of the addictions literature for over two decades. In this review, we provide an outline of empirically validated CSST assessment measures and treatment protocols for alcohol dependence and cocaine dependence. Key elements covered in CSST include communication skills training, cue exposure treatment with urge coping skills, and cocaine-specific coping skills training. We conclude with a summary of the research to date in support of CSSt and future directions for the treatment of addictive behaviors.

Exploring the diversity of dual diagnosis: utility of cluster analysis for program planning

This study demonstrates the utility of using cluster analysis to explore the heterogeneity of dual diagnosis populations so as to facilitate planning and implementation of individualized treatment programs. A sample of 467 persons admitted to a state psychiatric hospital with DSM-III-R psychiatric diagnoses and substance abuse problems were interviewed on the Addiction Severity Index (ASI) and other measures to assess psychological, social, and community functioning. Scores on seven ASI severity ratings (medical, employment, alcohol, drug, legal, family, and psychiatric functioning) were used to group patients into seven homogeneous subgroups using cluster analysis: best functioning, unhealthy alcohol abuse, functioning alcohol abuse, drug abuse, functioning polyabuse, criminal polyabuse, and unhealthy polyabuse. Cluster reliability and validity were demonstrated using split-half tests as well as cross-sectional and longitudinal analyses. Results illustrate the extreme heterogeneity of dual diagnosis and are suggestive of how individualized treatment programs can be matched to the particular needs of patients with dual diagnoses.

Preliminary study of effect of the Iraqi invasion on addictive behaviour in Kuwait

During the Iraqi invasion, Kuwait was flooded with alcoholic substances and drugs which, if used, could induce harmful radical changes in the personality and behaviour of Kuwait citizens (not Islam prohibits alcohol). After liberation aggressive behaviour prevailed among some Kuwait citizen groups, including addicts, as the government of Kuwait had not yet reestablished discipline and control over the citizens. Forensic cases of addicts referred to Kuwait Psychiatric Hospital before and after the invasion were examined. Marked differences were observed concerning age, education, occupation, marital status, addictive behaviour, crime committed, and place of referral and discharge.

Explaining abstinence rates following treatment for alcohol abuse: a quantitative synthesis of patient, research design and treatment effects

We examined the relationships of treatment, patient and research design characteristics to treatment outcome (i.e. abstinence rates) in a sample of 150 treatment conditions drawn from 100 alcohol treatment outcome studies published between 1980 and 1992. Treatment characteristics were related to abstinence rates: more intensive treatments had higher abstinence rates than less intensive treatments, whereas treatments with an expressed goal other than abstinence had lower abstinence rates than treatments with an abstinence goal. When the public vs. private ownership status of the treatment facility was taken into account, the presence of behavioral elements in the treatment condition also was related to higher abstinence rates. Because of inconsistent reporting in primary studies, we assessed the effects of only one patient pre-treatment characteristic; treatment conditions with a higher proportion of socially stable patients had better outcomes. Research design characteristics were also related to abstinence rates. Treatment conditions with shorter follow-ups and treatments drawn from studies that did not use criteria to exclude more impaired subjects had better outcomes. We discuss possible reasons why our findings regarding the effects of treatment intensity and the use of exclusionary criteria differ from those in previous reviews.

Relationship between role-play measures of coping skills and alcoholism treatment outcome

Alcoholic clients were given role-play tests, involving various social and drinking-related scenarios, before and after two types of aftercare treatment. The assessments were used both to evaluate the effects of treatment and to determine whether any dimensions of pretreatment role-play performance interact with treatment type to predict treatment outcome. Eighty-nine patients were randomly assigned to aftercare group treatment involving either interactional therapy or coping skills training. Clients in both treatments experienced declines in their urge to drink during the role-play scenes from pre- to posttreatment, and these declines were related to reductions in heavy drinking. Three pretreatment role-play variables interacted with type of treatment to predict outcome: observer-rated skill, observer-rated anxiety, and self-reported urge to drink. In general, those patients who did better in the role plays had better drinking outcomes following interactional therapy. Those who experienced more difficulty in the role plays fared best with coping skills training. The results suggest that role-play measures could be used for patient-treatment matching, although it remains to be determined whether they will be superior to more easily assessed patient characteristics.