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Walsh BE, Manzler CA, Noyes ET, Schlauch RC. Examining the daily reciprocal relations between alcohol abstinence self-efficacy and drinking among non-treatment seeking individuals with alcohol use disorder (AUD). Addict Behav 2024; 156:108068. [PMID: 38772225 DOI: 10.1016/j.addbeh.2024.108068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/01/2024] [Accepted: 05/17/2024] [Indexed: 05/23/2024]
Abstract
Theoretical and empirical models of alcohol use and misuse indicate that abstinence self-efficacy (ASE) predicts improvements in treatment outcomes among individuals with alcohol use disorder (AUD). More recently, studies have begun examining daily fluctuations in ASE to better understand in-the-moment determinants of drinking behaviors. With the goal of assessing how ASE is implicated in maintenance (rather than changing) of hazardous drinking patterns, the current study examined daily reciprocal relations between ASE and drinking among individuals with AUD. Non-treatment seeking adults (n = 63) with AUD were recruited and completed daily surveys assessing ASE and drinking behaviors for 14 days. Data were analyzed using time-lagged multilevel modeling. Results indicated that both within- and between-person elevations in ASE predicted decreased likelihood of drinking, but only within-person ASE predicted fewer drinks consumed on drinking days. Previous-day drinking behavior was unrelated to next-day ASE; however, higher percentage of drinking days during the monitoring period (between-person) was associated with lower daily ASE. These results demonstrate that confidence in one's ability to abstain from drinking varies considerably across days, and that fluctuations may be implicated in daily drinking decisions. The lack of effect of previous-day drinking on ASE (combined with the significant effect of average drinking frequency) may suggest that sustained periods of reduced drinking or abstinence are necessary to impact ASE. This study points to ASE's role in the maintenance of daily drinking behavior among non-treatment-seeking individuals with AUD and reiterates the importance of self-efficacy in behavioral control and decision-making at the daily level.
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Affiliation(s)
- Brendan E Walsh
- Department of Psychology, University of South Florida, 3711 USF Citrus Drive, Tampa, FL 33620, USA.
| | - Charles A Manzler
- Department of Psychology, University of South Florida, 3711 USF Citrus Drive, Tampa, FL 33620, USA.
| | - Emily T Noyes
- Department of Psychology, University of South Florida, 3711 USF Citrus Drive, Tampa, FL 33620, USA.
| | - Robert C Schlauch
- Department of Psychology, University of South Florida, 3711 USF Citrus Drive, Tampa, FL 33620, USA.
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2
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Meisel SN, Boness CL, Miranda R, Witkiewitz K. Beyond mediators: A critical review and methodological path forward for studying mechanisms in alcohol use treatment research. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:215-229. [PMID: 38099412 PMCID: PMC10922633 DOI: 10.1111/acer.15242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
Understanding how treatments for alcohol use disorder (AUD) facilitate behavior change has long been recognized as an important area of research for advancing clinical care. However, despite decades of research, the specific mechanisms of change for most AUD treatments remain largely unknown because most prior work in the field has focused only on statistical mediation. Statistical mediation is a necessary but not sufficient condition to establish evidence for a mechanism of change. Mediators are intermediate variables that account statistically for the relationship between independent and dependent variables, whereas mechanisms provide more detailed explanations of how an intervention leads to a desired outcome. Thus, mediators and mechanisms are not equivalent. To advance mechanisms of behavior change research, in this critical review we provide an overview of methodological shortfalls of existing AUD treatment mechanism research and introduce an etiologically informed precision medicine approach that facilitates the testing of mechanisms of behavior change rather than treatment mediators. We propose a framework for studying mechanisms in alcohol treatment research that promises to facilitate our understanding of behavior change and precision medicine (i.e., for whom a given mechanism of behavior change operates and under what conditions). The framework presented in this review has several overarching goals, one of which is to provide a methodological roadmap for testing AUD recovery mechanisms. We provide two examples of our framework, one pharmacological and one behavioral, to facilitate future efforts to implement this methodological approach to mechanism research. The framework proposed in this critical review facilitates the alignment of AUD treatment mechanism research with current theories of etiologic mechanisms, precision medicine efforts, and cross-disciplinary approaches to testing mechanisms. Although no framework can address all the challenges related to mechanisms research, our goal is to help facilitate a shift toward more rigorous and falsifiable behavior change research.
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Affiliation(s)
| | | | - Robert Miranda
- E. P. Bradley Hospital, Riverside, RI USA
- Department of Psychiatry & Human Behavior, Brown University, Providence, RI USA
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico
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3
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Davis JA, Gius BK, Crane CA, Maisto SA, Schlauch RC. Pretreatment changes in drinking: Theoretical and methodological implications for alcohol use disorder treatment outcome research. Alcohol Clin Exp Res 2023; 47:1406-1420. [PMID: 37455388 DOI: 10.1111/acer.15120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND There is a growing recognition of the importance of changes in drinking prior to the first treatment session (i.e., pretreatment change). A major limitation of past studies of pretreatment change is the reliance on retrospective reporting on drinking rates between the baseline assessment and the first treatment session collected at the end of treatment. The present study sought to extend previous findings by examining 12-month treatment outcomes and correlates of pretreatment changes in drinking measured weekly during treatment. METHODS Data from a randomized behavioral clinical trial examining the effect of therapeutic alliance feedback on drinking outcomes were analyzed (n = 165). All participants received cognitive behavioral therapy for alcohol dependence, completed pre and posttreatment assessments, and provided weekly measures of drinking during treatment. RESULTS Results indicated that approximately half of the sample reduced their heavy drinking days by 70% or more and number of drinking days by 50% or more prior to beginning treatment. Further, individuals who reported greater consideration of how their problematic drinking affected their social environment displayed greater changes in drinking days prior to treatment. Changes in heavy drinking days were also related to relationship status, such that individuals who were single/never married were less likely to change prior to treatment than those who were married/cohabitating or separated/divorced. CONCLUSION These confirm the importance of pretreatment change in the study of treatment outcomes, and suggest that interpersonal processes, including the appraisal of drinking behavior in a social context, may play an important role in pretreatment changes in drinking.
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Affiliation(s)
- Jared A Davis
- Department of Psychology, University of South Florida, Tampa, Florida, USA
| | - Becky K Gius
- Department of Psychology, University of South Florida, Tampa, Florida, USA
| | - Cory A Crane
- Department of Biomedical Sciences, Rochester Institute of Technology, Rochester, New York, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Robert C Schlauch
- Department of Psychology, University of South Florida, Tampa, Florida, USA
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4
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Stasiewicz PR, Bradizza CM, Lucke JF, Zhao J, Dermen KH, Linn BK, Slosman KS, LaBarre C. Pretreatment changes in drinking: A test of a tailored treatment approach. Alcohol Clin Exp Res 2023; 47:549-565. [PMID: 36799772 DOI: 10.1111/acer.15022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/26/2022] [Accepted: 01/17/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Pretreatment reductions in drinking are well documented and have been demonstrated to predict posttreatment drinking outcomes. Making use of the predictive value of pretreatment change has great appeal in settings that place a premium on efficient clinical decisions regarding appropriate type and intensity of treatment. METHODS This study investigates whether different types and intensities of treatment are appropriate and beneficial for individuals entering treatment for an alcohol use disorder (AUD; N = 201) who make more vs. less pretreatment change in their drinking during a 2-month pretreatment period. Based on an algorithm derived from pilot research, we derived two independent pretreatment change arms that we called Substantial Change and Minimal Change. Each arm was a parallel, sequentially randomized design consisting of a treatment group and an active control. The Substantial Change arm compared six sessions of relapse prevention treatment (RPT) with 12 sessions of cognitive behavioral therapy for AUD (CBT) as an active control. Both CBT and RPT occurred over a 12-week period. The Minimal Change arm compared 12 sessions of an integrated motivational intervention combined with CBT (MI/CBT) with 12 sessions of CBT as an active control. The outcome variables were changes in number of days abstinent (NDA) and number of days heavy drinking (NDH) per week. RESULTS For the Substantial Change arm, a noninferiority analysis revealed that six sessions of RPT were noninferior to 12 sessions of CBT at each posttreatment assessment for both NDA and NDH. For the Minimal Change arm, a superiority analysis failed to detect that MI/CBT was superior to CBT at any posttreatment assessment for both NDA and NDH. CONCLUSIONS In the substantial change arm, results suggest that offering a less intensive initial treatment, like RPT, may lower costs and conserve clinical resources. In the Minimal Change arm, results indicate the need to continue searching for a treatment or treatment enhancements to improve alcohol outcomes.
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Affiliation(s)
- Paul R Stasiewicz
- School of Social Work, University at Buffalo, Buffalo, New York, USA
| | - Clara M Bradizza
- School of Social Work, University at Buffalo, Buffalo, New York, USA
| | - Joseph F Lucke
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Junru Zhao
- School of Social Work, University at Buffalo, Buffalo, New York, USA
| | - Kurt H Dermen
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Braden K Linn
- School of Social Work, University at Buffalo, Buffalo, New York, USA
| | - Kim S Slosman
- School of Social Work, University at Buffalo, Buffalo, New York, USA
| | - Charles LaBarre
- School of Social Work, University at Buffalo, Buffalo, New York, USA
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5
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Revill AS, Anderson LE, Kidd C, Gullo MJ. Drug and alcohol practitioners' attitudes toward the use of standardized assessment. Addict Behav 2022; 128:107231. [PMID: 35032854 DOI: 10.1016/j.addbeh.2021.107231] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/21/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
Despite their importance to evidence-based assessment, standardized assessments remain underutilized by mental health practitioners in practice. The underutilization has been attributed to a lack of appreciation of the importance of standardized assessments, lack of knowledge of standardized assessments, and practical barriers to implementation. This study sought to gather the first descriptive data on alcohol and other drug (AOD) practitioners' attitudes toward, and knowledge and self-reported use of, standardized assessments. Practical barriers to implementation in initial assessment and progress monitoring were also assessed. Ninety-nine Australian AOD practitioners recruited via newsletters of national representative bodies and practitioner networks completed an online survey. While practitioners' attitudes towards using standardized assessments for initial assessment and progress monitoring were generally positive and consistent with other populations of health practitioners, assessments remained underutilized in practice. Most AOD practitioners did not consider standardized assessments to be feasible to implement. The current findings highlight the importance of practical barriers, particularly organization-level barriers, in the underutilization of standardized assessments in AOD practice. Findings support an extension of dialogue surrounding evidence-based practice beyond treatment selection to include assessment practices at a more general level. The present study offers a starting point from which efforts to improve practitioner compliance with evidence-based best practices can be conceived, designed, and implemented.
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Constant HMRM, Ferigolo M, Barros HMT, Moret-Tatay C. A clinical trial on a brief motivational intervention in reducing alcohol consumption under a telehealth supportive counseling. Psychiatry Res 2021; 303:114068. [PMID: 34217102 DOI: 10.1016/j.psychres.2021.114068] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/15/2021] [Indexed: 02/04/2023]
Abstract
It is known that among those seeking to cease consumption of alcohol, there can be as high as a 50% relapse rate in the first 12 months. Different tools for treatments have been developed, such as telehealth, with the aim of helping this population. As a result of this demand, technology has gained strength in recent years. A new point of view about the treatment will broaden our knowledge far beyond just efficacy. It seems that understanding the mechanisms that lead to treatment success is as important as knowing its effectiveness. Therefore, the present study examined the relationships between Brief Motivational Intervention by telephone (BMI), motivational stage, outcome, and coping strategies using path analysis. In the post-evaluation, variables such as BMI (randomized individuals), motivational stage and decreased consumption of alcohol reached statistical significance (p<.001), suggesting that BMI might improve motivational stage and reduced consumption of alcohol. In terms of coping, the results also indicate that positive thinking might be a variable of interest when planning to decrease alcohol consumption. More research is needed to recognize the potential of new technology in the health area and to uncover the innumerable possibilities of using these tools as a strategy to help alcohol users.
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Affiliation(s)
- Hilda Maria Rodrigues Moleda Constant
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Ligue 132- Serviço Nacional de Orientações e Informações sobre Prevenção do Uso de Drogas (VIVAVOZ), Rua Sarmento Leite, 245 - Porto Alegre, Rio Grande do Sul, Brasil CEP 90050-170; Departamento de Neuropsicobiología, Metodología y Psicología Social Facultad de Psicología Universidad Católica de Valencia "San Vicente Mártir" Sede de San Juan Bautista.
| | - Maristela Ferigolo
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Ligue 132- Serviço Nacional de Orientações e Informações sobre Prevenção do Uso de Drogas (VIVAVOZ), Porto Alegre, Rio Grande do Sul, Brasil
| | - Helena Maria Tannhauser Barros
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Departamento de Farmacociências- Ligue 132- Serviço Nacional de Orientações e Informações sobre Prevenção do Uso de Drogas (VIVAVOZ), Porto Alegre, Rio Grande do Sul, Brasil
| | - Carmen Moret-Tatay
- Departamento de Neuropsicobiología, Metodología y Psicología Social Facultad de Psicología Universidad Católica de Valencia "San Vicente Mártir" Sede Padre Jofré, Valencia, Spain; Dipartimento di Neuroscienze Salute Mentale e Organi di Senso, NESMOS Università La Sapienza, Rome, Italy
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Chang C, Wang TJ, Chen MJ, Liang SY, Wu SF, Bai MJ. Factors influencing readiness to change in patients with alcoholic liver disease: A cross-sectional study. J Psychiatr Ment Health Nurs 2021; 28:344-355. [PMID: 32667735 DOI: 10.1111/jpm.12677] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 06/19/2020] [Accepted: 07/08/2020] [Indexed: 12/20/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Readiness to change has been documented as a factor affecting alcohol treatment attendance, engagement and outcome. Knowledge regarding readiness to change and its influencing factors in patients with alcoholic liver diseases will inform the development of relevant interventions to help these patients to successfully stop drinking. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The scores in all three dimensions of readiness, recognition, ambivalence and taking steps, were low. For the recognition stage, age, drinking severity and stigma are important factors to be considered. For the ambivalence stage, age and drinking severity are important influencing factors. For the taking steps stage, drinking refusal self-efficacy and depression should be the focus. Instead of negative associations, we found that age and drinking severity, self-stigma and depression were positively associated with readiness to change. Patients who are younger and have higher drinking severity, higher self-stigma, higher self-efficacy and severe depression are more likely to change alcohol use. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Age, drinking severity, self-stigma, drinking refusal self-efficacy and depression are important factors to be considered when mental health nurses try to increase psychological preparedness for changing alcohol use in patients with alcoholic liver diseases. Different factors must be considered for patients in different stages of readiness to change. Different alcohol treatments are needed for different patient populations. ABSTRACT: Introduction Readiness to change (RC) refers to the willingness or psychological preparedness for changing alcohol use. Knowledge regarding factors influencing RC is crucial for developing alcohol treatment plans. Aims The study's purpose was to investigate RC and its influencing factors in patients with alcoholic liver disease (ALD). The factors explored include demographics, disease characteristics, drinking severity, self-stigma, depression, social support and self-efficacy. Method This is a cross-sectional study using self-reported questionnaires. Results Eighty-seven patients with ALD were recruited. Their scores in all three dimensions of readiness, recognition, ambivalence and taking steps, were low. Self-stigma, age and drinking severity explained 32.3% variation in recognition. Drinking severity and age explained 21.5% variation in ambivalence. Self-efficacy, depression and age explained 19.3% variation in taking steps. Discussion Instead of negative associations, we found that age, drinking severity, self-stigma and depression were positively associated with RC. Younger patients with higher drinking severity, higher self-stigma, higher self-efficacy and severe depression are more likely to change alcohol use. Implications for practice Mental health nurses should consider factors such as age, drinking severity, self-stigma, self-efficacy and depression, while trying to increase patients' RC. More specifically, strategies to increase self-efficacy and interventions to support coping are needed. Relevance statement Many ALD patients needing treatment for problematic alcohol use can be effectively managed in primary care with appropriate specialist support. An experienced specialist mental health nurse can play this role. Mental health nurses are important members of alcohol addiction treatment teams. Traditionally, most nurses working in alcohol therapy services have been mental health specialists and work in a partnership model with physicians and other healthcare professionals. The influencing factors found in this study can further inform mental health nurses to recognize and work more effectively with ALD patients' alcohol problems.
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Affiliation(s)
- Chi Chang
- Department of Nursing, Mackay Memorial Hospital, Taipei, Taiwan.,School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Tsae-Jyy Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Ming-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shu-Yuan Liang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shu-Fang Wu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Ming-Jong Bai
- Division of Gastroenterology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, Taitung, Taiwan
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Hussain MA, Iudicello JE, Morgan EE, Kamat R, Heaton RK, Grant I. Apathy is associated with poorer abstinence self-efficacy in individuals with methamphetamine dependence. Addict Behav Rep 2021; 13:100331. [PMID: 33521229 PMCID: PMC7820030 DOI: 10.1016/j.abrep.2020.100331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/14/2020] [Accepted: 12/20/2020] [Indexed: 12/13/2022] Open
Abstract
Used an apathy composite T-score approach validated in methamphetamine-dependence. Apathy, above other factors, associated with poorer drug abstinence self-efficacy. Methamphetamine use characteristics unrelated to drug abstinence self-efficacy. Social peer pressure was riskiest situation for potential methamphetamine relapse.
Background Confidence in one’s ability to achieve and maintain drug abstinence (i.e., abstinence self-efficacy) is a strong predictor of substance use treatment outcomes. Neurobehavioral factors that may interfere with abstinence self-efficacy are less well established, particularly in methamphetamine (METH). This study investigated whether apathy, which is highly prevalent during active METH use and periods of abstinence, influences abstinence self-efficacy among METH dependent individuals. Methods Sixty-six participants with lifetime METH dependence and METH abuse/METH dependence diagnoses within the last 18 months (mean age [SD] = 39.5 years [10.7]), and no severe psychiatric or neurological diseases, completed the Methamphetamine Self-Efficacy Scale (MSES), alongside a comprehensive neurobehavioral evaluation. The MSES presents six situations that may lead to relapse and collects self-report ratings for two subscales: “Confidence” (i.e., confidence in one’s ability to abstain from using METH, or METH abstinence self-efficacy) and “Temptation” (i.e., how tempted one is to use METH) with regard to each situation. Apathy was measured using a composite T-score comprised of items and scales from three well-validated, self-report assessments. Results Multivariable linear regression found that higher Apathy T-scores were significantly associated with lower Confidence ratings (i.e., poorer METH abstinence self-efficacy; p < .05), independent of potentially relevant factors (e.g., Temptation to use METH, comorbid HIV disease, and neurocognitive impairment). Conclusions Elevated apathy may adversely impact one’s confidence to abstain from METH use. Findings highlight the importance of addressing apathy in order to improve METH abstinence self-efficacy, which may subsequently increase the likelihood of successful METH treatment outcomes.
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Affiliation(s)
- Mariam A Hussain
- University of California San Diego, School of Medicine, Department of Psychiatry, 220 Dickinson Street # B, San Diego, CA 92103, USA.,San Diego State University/University of California San Diego Joint Doctoral Program, Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Jennifer E Iudicello
- University of California San Diego, School of Medicine, Department of Psychiatry, 220 Dickinson Street # B, San Diego, CA 92103, USA
| | - Erin E Morgan
- University of California San Diego, School of Medicine, Department of Psychiatry, 220 Dickinson Street # B, San Diego, CA 92103, USA
| | - Rujvi Kamat
- University of California San Diego, School of Medicine, Department of Psychiatry, 220 Dickinson Street # B, San Diego, CA 92103, USA
| | - Robert K Heaton
- University of California San Diego, School of Medicine, Department of Psychiatry, 220 Dickinson Street # B, San Diego, CA 92103, USA
| | - Igor Grant
- University of California San Diego, School of Medicine, Department of Psychiatry, 220 Dickinson Street # B, San Diego, CA 92103, USA
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Stasiewicz PR, Bradizza CM, Ruszczyk MU, Lucke JF, Zhao J, Linn B, Slosman KS, Dermen KH. The Identification of Pretreatment Trajectories of Alcohol Use and Their Relationship to Treatment Outcome in Men and Women With Alcohol Use Disorder. Alcohol Clin Exp Res 2019; 43:2637-2648. [PMID: 31688963 PMCID: PMC6904501 DOI: 10.1111/acer.14216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/08/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Few studies have focused on behavioral changes that occur prior to entering treatment for an alcohol use disorder (AUD). In 2 studies (Psychol Addict Behav, 27, 2013, 1159; J Stud Alcohol, 66, 2005, 369), pretreatment reductions in alcohol use were associated with better treatment outcomes. Identifying patterns of pretreatment change has the potential to inform clinical decision making. METHODS This study sought to identify pretreatment change trajectories in individuals seeking outpatient treatment for AUD (N = 205) using finite mixture modeling based on changes in number of days abstinent per week (NDA). RESULTS The analysis identified 3 pretreatment trajectory classes. Class 1 (High Abstinence-Minimal Increase; HA-MI) (n = 64; 31.2%) reported a high level of pretreatment NDA with minimal change during an 8-week pretreatment interval. Class 2 (Low Abstinence-Steady Increase; LA-SI) (n = 73; 35.6%) reported a low level of pretreatment NDA followed by a steady increase beginning 2 weeks prior to the phone screen. Class 3 (Nonabstinent-Accelerated Increase; NA-AI) (n = 68; 33.2%) reported no or very low levels of pretreatment NDA but demonstrated an increase following the phone screen. With regard to within-treatment change, Class 1 demonstrated the least and Class 3 demonstrated the most change in NDA. From baseline to 6-month follow-up, Class 3 added 2.31 abstinent days per week, Class 2 added 0.69 days, and Class 1 added 0.63 days. The increase in NDA for Class 3 was significantly different from the other 2 classes; however, Class 3 reported fewer overall days abstinent at 6-month follow-up. CONCLUSIONS Study results have clinical and research implications including recommended changes to treatment protocols and research designs. Understanding the impact of pretreatment trajectories of alcohol use on within-treatment and posttreatment outcomes may provide important information about adapting treatment to increase efficiency and effectiveness.
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Affiliation(s)
| | | | | | | | - Junru Zhao
- School of Social Work, University at Buffalo
| | - Braden Linn
- Clinical and Research Institute on Addictions, University at Buffalo
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10
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Neighbors C, Tomkins MM, Lembo Riggs J, Angosta J, Weinstein AP. Cognitive factors and addiction. Curr Opin Psychol 2019; 30:128-133. [PMID: 31310894 DOI: 10.1016/j.copsyc.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/11/2019] [Accepted: 05/30/2019] [Indexed: 12/14/2022]
Abstract
The present paper provides a brief review of cognitive factors related to addiction. Five representative cognitive constructs were selected from the current literature. These include the distinction between implicit and explicit cognitions; metacognitions; expectancies; motives; and social norms. For each of these a general overview is provided along with specific findings from selected recent studies. The intention is to provide the reader with a succinct but reasonable view of how each construct is currently studied in relation to the use of alcohol and other substances and to become aware of some of the strengths and limitations corresponding to the study of these constructs.
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11
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Schlauch RC, Crane CA, Connors GJ, Dearing RL, Maisto SA. The role of craving in the treatment of alcohol use disorders: The importance of competing desires and pretreatment changes in drinking. Drug Alcohol Depend 2019; 199:144-150. [PMID: 31054421 PMCID: PMC6561501 DOI: 10.1016/j.drugalcdep.2019.02.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/08/2019] [Accepted: 02/21/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The current study aimed to contribute to the understanding of the session to session relationship between craving and drinking during the course of treatment via the incorporation into the analysis of both a) motivation to avoid alcohol and 2) pretreatment change, given that half of all individuals entering treatment change their drinking prior to the first session. METHODS Sixty-three treatment-seeking participants received 12 weeks of CBT for alcohol dependence and completed assessments of approach inclinations, avoidance inclinations and drinking behaviors at the end of each session. RESULTS Consistent with our hypothesis, motivations to avoid alcohol and pretreatment change significantly interacted with craving to predict both number of drinking days and heavy drinking days during the interval between sessions. Specifically, among lower pretreatment changers, motivation to avoid alcohol moderated the effect of craving on number of drinking days and number of heavy drinking days, such that craving positively predicted drinking among those lower on motivations to avoid only. In contrast, among higher pretreatment changers, cravings positively predicted drinking among those higher on motivations to avoid alcohol. CONCLUSIONS These findings highlight the importance of measuring both desire to consume and desire to avoid consuming alcohol simultaneously, and suggest that ambivalence may function differently depending on whether one is initiating (low pretreatment change) versus maintaining change (high pretreatment change).
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Affiliation(s)
- Robert C Schlauch
- Department of Psychology, University of South Florida, 4202 East Fowler Ave, Tampa, FL 33620, USA.
| | - Cory A Crane
- Rochester Institute of Technology, Department of Biomedical Sciences, 180 Lomb Memorial Drive, Rochester, NY 14623, USA
| | - Gerard J Connors
- Research Institute on Addictions, University at Buffalo, 1021 Main St., Buffalo, NY 14203, USA
| | | | - Stephen A Maisto
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244, USA
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12
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Novel Approaches to the Study of Mechanisms of Behavior Change in Alcohol and Other Drug Use Disorders. J Stud Alcohol Drugs 2018; 79:159-162. [PMID: 29553341 PMCID: PMC9798475 DOI: 10.15288/jsad.2018.79.159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Indexed: 02/25/2024] Open
Affiliation(s)
- Mechanisms of Behavior Change Satellite Committee
- Members of the Mechanisms of Behavior Change Satellite Committee contributing to the manuscript are (in alphabetical order) Marsha E. Bates, Brian Borsari, Brett Hagman, Jon M. Houck, Mitchell Karno, Alexis Kuerbis, Kenneth Leonard, Molly Magill, J. Scott Tonigan, Jalie A. Tucker, and Katie Witkiewitz. Molly Magill, Mitchell Karno, and Katie Witkiewitz served as Special Section Editors and drafted this introduction to the Special Section. All authors provided edits and contributed to the final version. Correspondence may be sent to Katie Witkiewitz at the Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM 87131, or via email at:
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Novel Approaches to the Study of Mechanisms of Behavior Change in Alcohol and Other Drug Use Disorders. J Stud Alcohol Drugs 2018; 79:159-162. [PMID: 29553341 PMCID: PMC9798475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Mechanisms of Behavior Change Satellite Committee
- Members of the Mechanisms of Behavior Change Satellite Committee contributing to the manuscript are (in alphabetical order) Marsha E. Bates, Brian Borsari, Brett Hagman, Jon M. Houck, Mitchell Karno, Alexis Kuerbis, Kenneth Leonard, Molly Magill, J. Scott Tonigan, Jalie A. Tucker, and Katie Witkiewitz. Molly Magill, Mitchell Karno, and Katie Witkiewitz served as Special Section Editors and drafted this introduction to the Special Section. All authors provided edits and contributed to the final version. Correspondence may be sent to Katie Witkiewitz at the Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM 87131, or via email at:
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