How important are positive and negative outcome expectancies in the treatment of addiction: a narrative review of the literature

The affective gradient hypothesis: an affect-centered account of motivated behavior

Everyone agrees that feelings and actions are intertwined, but cannot agree how. According to dominant models, actions are directed by estimates of value and these values shape or are shaped by affect. I propose instead that affect is the only form of value that drives actions. Our mind constantly represents potential future states and how they would make us feel. These states collectively form a gradient reflecting feelings we could experience depending on actions we take. Motivated behavior reflects the process of traversing this affective gradient, towards desirable states and away from undesirable ones. This affective gradient hypothesis solves the puzzle of where values and goals come from, and offers a parsimonious account of apparent conflicts between emotion and cognition.

The effects of sex and outcome expectancies on perceptions of sexual harassment

Using an outcome expectancy framework, this research sought to understand sex differences in the underlying beliefs that influence harassment perception. One hundred and ninety-six participants (52% women) read a series of vignettes depicting common examples of digital male-on-female sexual harassment. They were asked to what extent they thought each scenario constituted sexual harassment, and how likely the perpetrator would experience positive and negative outcomes. Consistent with predictions, women were more likely to consider the behaviours as harassment than men were. Both sexes harassment perceptions had significant relationships with their outcome expectancies, but we also found evidence of a sex specific moderation; the link between men's negative outcome expectancies was moderated by their positive ones. The results suggest that perceptions of harassment may have sexually asymmetrical underpinnings. Measuring the interplay between positive and negative outcome expectancies in relation to sexual harassment perception is a novel approach, that may have implications for the development of anti-sexual harassment interventions. Implications for theory and future research directions are discussed.

Measuring Gambling Outcome Expectancies in Adolescents: Testing the Psychometric Properties of a Modified Version of the Gambling Expectancy Questionnaire

The Gambling Expectancy Questionnaire (GEQ; Gillespie et al. 2007a) is a 23-item scale assessing three positive outcome expectancies (Enjoyment/Arousal, Money, Self-Enhancement) and two negative outcome expectancies (Over-Involvement, Emotional Impact) related to gambling. It is the most used instrument to assess gambling outcome expectancies in adolescents and it has good psychometric properties. To allow a greater and more useful application of the scale, the present study aimed to modify the GEQ to make it usable with all adolescents, regardless of their gambling behaviour and to verify its psychometric properties. To that aim, the items were modified and the response scale was reduced from a seven-point to a five-point Likert scale. To verify the adequacy of the modified scale, two studies were conducted among Italian adolescents. In the first study (n = 501, 75% males, Mage = 16.74, SD = .88), after having removed four items and relocating another through explorative factor analysis, the original five-factor structure of the scale was confirmed by applying a confirmatory factor analysis. Reliability and validity evidence were also provided. The second study (n = 1894, 61% males, Mage = 15.68, SD = .71) attested its invariance across gambling behaviour status and gender. The modified version of the GEQ (GEQ - MOD) can be profitably used for research and preventive purposes with youth.

Positive expectancies mediate the association between sensation seeking and marijuana outcomes in at-risk young adults: A test of the acquired preparedness model

BACKGROUND AND OBJECTIVES

The acquired preparedness model (APM) integrates personality trait research and psychosocial learning, which are theorized to ultimately increase risk for problematic substance use outcomes.

METHODS

The present study uses the APM to examine the potential mediational role of positive and negative expectancies on the relationship between impulsivity and two marijuana outcomes (ie, frequency of use and marijuana use disorder [MUD] symptom count) among an at-risk sample of young adults with history of antisocial behavior and substance use in adolescence and their siblings (n = 312).

RESULTS

Results suggest a significant indirect effect of sensation seeking on recent marijuana use through positive marijuana expectancies. There also was a significant indirect effect of sensation seeking on past-year MUD symptoms through positive expectancies. No significant indirect effects through negative expectancies were found for either outcome.

DISCUSSION AND CONCLUSIONS

Our findings are consistent with the APM and suggest that higher sensation seeking is related to increased positive beliefs about marijuana outcomes, which is related to higher marijuana use and more MUD symptoms.

SCIENTIFIC SIGNIFICANCE

These findings suggest that positive expectancies are an important risk factor for marijuana use and misuse, particularly for at-risk individuals with elevated rates of sensation seeking. Positive marijuana expectancies may be important to address in interventions for at-risk individuals. (Am J Addict 2018;XX:1-6).

Alcohol expectancies pre-and post-alcohol use disorder treatment: Clinical implications

BACKGROUND AND AIMS

Modification of elevated positive expectations of alcohol consumption (alcohol outcome expectancies; AOEs) is a key feature of Cognitive Behaviour Therapy (CBT) approaches to Alcohol Use Disorders (AUDs). Despite extensive research supporting the efficacy of CBT for AUD, few studies have examined AOE change. This study aimed to assess AOE change following completion of CBT for AUD and its association with drinking behaviour.

METHOD

One-hundred and seventy-five patients who completed a 12-week CBT program for AUD were administered the Drinking Expectancy Questionnaire (DEQ) at pre-treatment assessment and upon completion of treatment. Abstinence was achieved by 108 (61.7%) of completing patients. For patients who lapsed, the mean proportion of abstinent days was 93%.

RESULTS

DEQ scales assessing expectations of positive alcohol effects on tension reduction, assertiveness, and cognitive enhancement were significantly lower post-treatment (p<0.001). Expectations of negative effects on mood were higher post-treatment (p<0.001). The largest AOE change occurred on the tension reduction scale. Greater percentage of abstinent days over treatment was associated with lower pre-and post-treatment tension reduction expectancy scores (p<0.05). Drinking during treatment was associated with smaller changes in expectations of negative effects of alcohol on mood (p<0.05).

CONCLUSIONS

Individuals who completed CBT treatment for AUD showed significant AOE change. Tension reduction and affective change expectancies may be particularly important for abstinence and useful markers of lapse risk.

Alcohol expectancies longitudinally predict drinking and the alcohol myopia effects of relief, self-inflation, and excess

INTRODUCTION

Alcohol myopia theory posits that alcohol consumption attenuates information processing capacity, and that expectancy beliefs together with intake level are responsible for experiences in myopic effects (relief, self-inflation, and excess).

METHODS

Adults (N=413) averaging 36.39 (SD=13.02) years of age completed the Comprehensive Effects of Alcohol questionnaire at baseline, followed by alcohol use measures (frequency and quantity) and the Alcohol Myopia Scale one month later. Three structural equation models based on differing construct manifestations of alcohol expectancies served to longitudinally forecast alcohol use and myopia.

RESULTS

In Model 1, overall expectancy predicted greater alcohol use and higher levels of all three myopic effects. In Model 2, specifying separate positive and negative expectancy factors, positive but not negative expectancy predicted greater use. Furthermore, positive expectancy and use explained higher myopic relief and higher self-inflation, whereas positive expectancy, negative expectancy, and use explained higher myopic excess. In Model 3, the seven specific expectancy subscales (sociability, tension reduction, liquid courage, sexuality, cognitive and behavioral impairment, risk and aggression, and self-perception) were simultaneously specified as predictors. Tension reduction expectancy, sexuality expectancy, and use contributed to higher myopic relief; sexuality expectancy and use explained higher myopic self-inflation; and risk and aggression expectancy and use accounted for higher myopic excess. Across all three predictive models, the total variance explained ranged from 12 to 19% for alcohol use, 50 to 51% for relief, 29 to 34% for self-inflation, and 32 to 35% for excess.

CONCLUSIONS

Findings support that the type of alcohol myopia experienced is a concurrent function of self-fulfilling alcohol prophecies and drinking levels. The interpreted measurement manifestation of expectancy yielded different prevention implications.

Negative expectancies measured with the Substance Use Beliefs Questionnaire can differentiate controls from those in treatment for alcohol dependence

Purpose

– The purpose of this paper is to test the discriminative validity of the Substance Use Beliefs Questionnaire (SUBQ) with alcohol dependent users, by assessing if the new tool can successfully differentiate between two extreme groups.

Design/methodology/approach

– The criterion used to select the two extreme groups was participation or not in treatment for alcohol dependence. Score of the Severity of Alcohol Dependence Questionnaire (SADQ) was used as a secondary confirmation criterion of extreme difference.

Findings

– In all, 98 staff and 94 people in treatment for alcohol dependence were recruited. The treatment group scored 30.83 higher than the control on SADQ, 10.76 on positive and 28.98 on negative expectancies. Negative expectancies score had correctly classified 88.5 per cent and positive expectancies score only 66 per cent of the original grouped cases. The area under the Receiver Operating Characteristics (ROC) curve for negative expectancies was 0.94 (very good) with a cut-off point of 43.5 with 89 per cent sensitivity and 92 per cent specificity. The area under the ROC curve for positive expectancies was 0.73 (fair). Due to the shape it was difficult to identify a cut-off point.

Research limitations/implications

– The results support the discriminative validity of the negative expectancies sub scale of the SUBQ between two extreme groups. With only the use of negative expectancies score participants could be classified correctly to those of the control and those of the treatment group.

Originality/value

– SUBQ is the first tool to measure outcome expectancies across substances, facilitating relevant research with poly substance users. Future research needs to explore the discriminative validity of the tool with the other three substance groups (smokers, stimulant and opioids users), involved in the development and validation of the SUBQ.