Substance Misuse

Self-efficacy, outcome expectations, and fantasies as predictors of alcoholics' postreatment drinking

The usefulness of distinguishing between alcoholic patients' expectations and their fantasies about treatment outcome was examined. Results at 6 and 12 months follow-up did not support the results of research with nonalcoholic participants which related better outcomes to a combination of positive expectations and negative fantasies about future drink-related situations. Higher self-efficacy expectancy at intake, however, was associated with better clinical outcome. Findings supported Bandura's (1986) contention that outcome expectations add little information on prediction beyond that explained by self-efficacy expectancy. The clinical implications of these results are discussed.

Social influences: effects of the social environment on the use of alcohol and other drugs

The research aimed to measure social influences produced by the differential effects of "high use" and "low use" environments on students' vulnerability to substance misuse. Each environment was represented by 3,000 students sampled from high and low use colleges. The social influences were measured by comparing vulnerability/resistance scores derived through a cognitive mapping strategy of the Associative Group Analysis method. Using an advanced system of software, empirical measures of students' propensities to use or not to use harmful substances were obtained by comparing hundreds of spontaneous responses elicited from individual respondents to the response distributions of reference groups of frequent alcohol/drug users and nonusers. In all comparisons, students with higher levels of reported use also showed higher vulnerability. In all comparisons, students in the high use environment showed significantly higher levels of vulnerability than students in the low use environment. ANOVA results indicated the vulnerability of students was significantly related to (high vs low use) campus environment as well as to marijuana use, alcohol use, and gender. Measuring vulnerability as a function of social influences opens numerous applications in proactive prevention.

Cue-exposure vs self-control in the treatment of binge eating: a pilot study

From a recent theory on the learned nature of craving responses and binge eating, it follows that craving will extinguish when the CS-US bond is broken by prolonged exposure to the cues predicting excessive food intake with response prevention. The present authors treated six obese bulimics with cue exposure and response prevention. Six other patients learned to avoid or escape the binge-related cues with the aid of self control techniques. Although both treatments appeared to be effective in reducing the binge frequency, a most remarkable finding of the present study is that all patients treated by cue exposure were abstinent, directly after treatment and during the 1 yr follow-up. In contrast to the 100% binge-free subjects treated by cue exposure, self control techniques and relapse prevention led to abstinence in merely 33% of the subjects.