Drinking Outcomes Research Articles

Predictors of drinking and functional outcomes for men and women following inpatient alcohol treatment.

This prospective study uses path analytic models to examine baseline characteristics associated with both functioning and drinking outcomes 12 months after inpatient alcohol treatment. Alcohol-dependent participants (N = 101) were recruited during inpatient alcohol treatment and assessed monthly 1 year after discharge. Alcohol severity was negatively associated with education and self-efficacy; marital status was positively associated with self-efficacy; and education and self-efficacy were negatively associated with drinking outcomes. Low alcohol severity, not having a depression diagnosis, and being married were associated with less social support impairment, which was in turn associated with better drinking outcomes. Having a history of sexual abuse did not influence drinking outcomes. However, having a history of sexual abuse was negatively associated with global functioning. Drinking outcomes were associated with education, self-efficacy, social support, and diagnosis of depression at baseline; however, global functioning 1 year following treatment was primarily and negatively associated with sexual abuse history. Future treatment research should include measures of both functioning and drinking behavior outcomes.

Cumulative Proportion of Responders Analysis (CPRA) as a Tool to Assess Treatment Outcome in Alcohol Clinical Trials

Several definitions of treatment response have been proposed for alcohol clinical trials (e.g., abstinence and no heavy drinking). However, each of these outcomes allows only one definition of successful response. In contrast, the cumulative proportion of responders analysis (CPRA) includes all of the possible drinking response cutoff points, providing a more complete picture of the therapeutic effects of a treatment. CPRA has been used to examine the efficacy of analgesics but not alcohol pharmacotherapy. To demonstrate its potential utility, we conducted CPRA in two large alcohol treatment trials: the COMBINE (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence) trial (naltrexone) and a multisite topiramate trial. CPRA was used to demonstrate the efficacy of naltrexone and topiramate on continuous measures of in-treatment drinking-heavy drinking days and drinks per day-and their reductions from pretreatment. All possible cutoff points were portrayed for each measure. We provide graphs to illustrate the effects of the active medications compared with placebo and examined them statistically over a number of salient drinking outcomes to evaluate their efficacy. Treatment group responder curves were not parallel across the entire range of cutoff points; rather, they separated only at lower levels of drinking. In general, effect sizes increased by 0.10-0.15 when going from the lowest drinking level cutoff (i.e., abstinence and no heavy drinking) to the cutoff associated with the maximal treatment effect. CPRA may be useful in designing subsequent trials and helping to illustrate for treatment providers the likelihood of treatment success given various definitions of a positive response.

A 5‐Year Follow‐Up of Depressed and Bipolar Patients with Alcohol Use Disorder in an Irish Population

Alcohol use disorders (AUDs) and affective disorders commonly co-occur, and this co-occurrence is mutually detrimental. To date, few long-term outcome studies exist involving patients with these comorbid disorders. We wished to determine treatment outcomes 5 years after inpatient integrated treatment in patients with these co-occurring disorders, and identify prognostic factors associated with long-term outcome. Two hundred and five depressed and bipolar patients with AUD who completed an inpatient integrated treatment program for dual diagnosis were assessed at baseline, posttreatment discharge, and at 3 months, 6 months, 2 years, and 5 years after treatment. The retention rate at 3 months postdischarge was 95.6%, 75.6% at 6 months, 70.2% at 2 years, and 55.6% at 5 years. Depression, elation, anxiety, and craving scores all fell over the 5-year period, as did the drinking outcome measures in both the depressed and bipolar alcoholics. Each of the primary drinking outcome measures had independent prognostic factors: abstinence at 2 years predicted abstinence at 5 years; number of drinking days at 6 months and 2 years predicted number of drinking days at 5 years; number of drinks per drinking day at 6 months and 2 years predicted number of drinks per drinking day at 5 years. Moreover, the majority of nonabstinent light drinkers at 3 months, who had significantly reduced their mean weekly alcohol consumption since baseline, remained light drinkers at 5 years and very few went on to be heavy drinkers. Indeed, if they did alter category by 5 years, they tended to become abstinent. Dual diagnosis of AUD and depression or bipolar disorder may be treated successfully together with intensive intervention and follow-up, and various prognostic factors emerge. Early abstinence predicts later abstinence, and the vast majority of those who achieve light drinking early in recovery remain light drinkers or become abstinent at 5 years.

Sustain talk predicts poorer outcomes among mandated college student drinkers receiving a brief motivational intervention.

Within-session client language that represents a movement toward behavior change (change talk) has been linked to better treatment outcomes in the literature on motivational interviewing (MI). There has been somewhat less study of the impact of client language against change (sustain talk) on outcomes following an MI session. This study examined the role of both client change talk and sustain talk, as well as therapist language, occurring during a brief motivational intervention (BMI) session with college students who had violated college alcohol policy (N = 92). Audiotapes of these sessions were coded using a therapy process coding system. A series of hierarchical regressions were used to examine the relationships among therapist MI-consistent and MI-inconsistent language, client change talk and sustain talk, as well as global measures of relational variables, and drinking outcomes. Contrary to prior research, sustain talk, but not change talk, predicted poorer alcohol use outcomes following the BMI at 3- and 12-month follow-up assessments. Higher levels of client self-exploration during the session also predicted improved drinking outcomes. Therapist measures of MI-consistent and MI-inconsistent language, and global measures of therapist acceptance and MI spirit were unrelated to client drinking outcomes. Results suggest that client sustain talk and self-exploration during the session play an important role in determining drinking outcomes among mandated college students receiving a BMI addressing alcohol use.

The great recession and drinking outcomes: protective effects of politically oriented coping.

Research derived from the stress paradigm suggests that certain types of coping (e.g., problem-focused coping instead of behavioral disengagement) are protective against problem-related drinking to deal with social stressors. Going beyond the typical focus in the coping literature, we hypothesize that stressors engendered by macrolevel social forces may require coping actions within the political realm in contrast to modes of coping focused outside of the political realm. A United States sample of 663 respondents completed a mail survey in 2010, including measures of stressful consequences of the Great Recession, drinking patterns and problems, modes of coping encompassed in the Brief COPE instrument, and politically oriented coping. Structural equation modeling examined whether modes of coping mediated the links between stressors and drinking outcomes. A substantial portion of the associations between stressors and drinking was explained by modes of coping. Politically oriented coping was protective against problem drinking for both genders. Future studies should further explore politically oriented coping in addition to modes of coping outside of the political realm when studying the relationships between macrolevel social stressors and deleterious drinking outcomes.

Psychometrically improved, abbreviated versions of three classic measures of impulsivity and self-control.

Self-reported impulsivity confers risk factor for substance abuse. However, the psychometric properties of many self-report impulsivity measures have been questioned, thereby undermining the interpretability of study findings using these measures. To better understand these measurement limitations and to suggest a path to assessing self-reported impulsivity with greater psychometric stability, we conducted a comprehensive psychometric evaluation of the Barratt Impulsiveness Scale-11 (BIS-11), the Behavioral Inhibition and Activation Scales (BIS/BAS), and the Brief Self-Control Scale (BSCS) using data from 1,449 individuals who participated in substance use research. For each measure, we evaluated (a) latent factor structure, (b) measurement invariance, (c) test-criterion relationships between the measures, and (d) test-criterion relations with drinking and smoking outcomes. Notably, we could not replicate the originally published latent structure for the BIS, BIS/BAS, or BSCS or any previously published alternative factor structure (English language). Using exploratory and confirmatory factor analysis, we identified psychometrically improved, abbreviated versions of each measure: 8-item, 2-factor BIS-11 (root-mean-square error of approximation [RMSEA] = .06, comparative fit index [CFI] = .95); 13-item, 4-factor BIS/BAS (RMSEA = .04, CFI = .96); and 7-item, 2-factor BSCS (RMSEA = .05, CFI = .96). These versions evidenced (a) stable, replicable factor structures, (b) scalar measurement invariance, ensuring our ability to make statistically interpretable comparisons across subgroups of interest (e.g., sex, race, drinking/smoking status), and (c) test-criterion relationships with each other and with drinking/smoking. This study provides strong support for using these psychometrically improved impulsivity measures, which improve data quality directly through better scale properties and indirectly through reducing response burden.

Motivation and self-efficacy in the context of moderated drinking: global self-report and ecological momentary assessment.

Despite ample research demonstrating the role of motivation and self-efficacy in predicting drinking in the context of abstinence, little research explicitly explores their role in the context of moderation, and none have utilized daily diary methods. The purpose of this study was to (a) explore the concordance between global self-report and daily diary composite measures of motivation and self-efficacy and (b) compare the ability of each in predicting drinking outcomes in the context of a study of brief AUD treatments focused on controlled drinking. Problem drinkers (N = 89) were assessed, provided feedback about their drinking, and randomly assigned to one of three conditions: two brief AUD treatments or a third group asked to change on their own. Global self-report (GSR) measures were administered at baseline and Week 8 (end of treatment). Daily diary composites (DDC) were created from data collected via an Interactive Voice Recording system during the week prior to baseline and the week prior to Week 8. Findings revealed some concordance between GSR and DDC at both baseline and Week 8, indicating the two methods capture some of the same construct; however, their respective relationships to drinking differed. DDC for both baseline and Week 8 significantly predicted Week 8 drinking outcomes, whereas only change in GSR significantly predicted drinking outcomes. Findings suggest that motivation and self-efficacy are important to moderated drinking, and that both GSR and daily diary methods are useful in understanding mechanisms of change in the context of moderation. Daily diary methods may provide significant advantages. Limitations and arenas for future research are discussed.

Alcohol craving in patients diagnosed with a severe mental illness and alcohol use disorder: Bidirectional relationships between approach and avoidance inclinations and drinking.

The current study was undertaken to better understand the craving-drinking relationship among individuals dually diagnosed with a severe mental illness (SMI) and an alcohol use disorder (AUD). Using an ambivalence conceptualization of craving (Breiner, Stritzke, & Lang, 1999), we investigated the bidirectional relationships between desires and behavioral intentions to use (approach inclinations) and not use (avoidance inclinations) alcohol and drinking outcomes in patients diagnosed with an SMI-AUD. Patients (N = 278) seeking outpatient dual diagnosis treatment from a community mental health center were followed longitudinally over the course of 6 months. Assessments at baseline, 2-month, 4-month, and 6-month intervals included approach and avoidance inclinations, alcohol urges, readiness to change, and drinking outcomes. Time-lagged multilevel growth curve modeling found that avoidance inclinations moderated the effect of approach inclinations on subsequent drinking outcomes differentially over time. Specifically, avoidance inclinations attenuated the effect of approach on subsequent heavier drinking levels, and high avoidance/low approach demonstrated significant decreases on levels of drinking over time. Results also indicated that number of drinks consumed and heavy drinking days predicted subsequent approach inclinations differentially over time, such that lower levels of drinking predicted decreases in approach inclinations. Decreases in drinking also predicted higher subsequent avoidance inclinations, which were maintained over time. These findings highlight the complexity of subjective craving responses and the importance of measuring both approach and avoidance inclinations. Among those diagnosed with SMI-AUDs, treatment strategies that increase avoidance inclinations may increase abstinence rates in this difficult-to-treat population.

Associations of descriptive and reflective injunctive norms with risky college drinking.

The current study describes the relative predictive power of descriptive norms (i.e., how much the target student believes referents "drink until they get drunk") and reflective injunctive norms (i.e., target student's perception of referents' approval of the target student drinking until drunk) across various reference groups. The aim of this study was to gain further insight into which types of norms and reference groups are most highly concurrently correlated with risky drinking. It was hypothesized that both reflective injunctive and descriptive norms would be significantly positively correlated with risky drinking outcomes, and that more proximal reference group norms would be more highly predictive than more distal reference group norms. Participants (N = 837) were college students on the U.S. west coast who completed questionnaires in the context of a longitudinal parent study. Cross-sectional, zero-inflated negative binomial regressions were used to test the relative strengths of correlations between descriptive and reflective injunctive norms (i.e., for typical college students, closest friend, person whose opinion they value most, and closest family member) and risky drinking (i.e., peak alcohol quantity, frequency of heavy drinking episodes, and alcohol-related problems). Findings showed that descriptive and reflective injunctive norms were most consistently, strongly and positively correlated with risky drinking when they involved referents who were closer to the target college drinkers (i.e., closest friend and person whose opinion you value the most). Norms for typical college students were less consistent correlates of risky drinking. These findings may contribute to the knowledge base for enhancing normative reeducation and personalized normative feedback interventions to include more personally salient and powerful normative information.

Mecamylamine for Treatment of People With Dual Diagnoses of Depression and Alcohol Dependence

Objective: Currently there is no consensus on the best treatment for individuals with dual diagnoses of alcohol dependence and depression. The aim of this study was to assess the efficacy of mecamylamine augmentation of an antidepressant in reducing drinking, smoking, and depressive symptoms. Methods: This was a double-blind, randomized 12-week treatment trial comparing mecamylamine to placebo. Twenty-one participants with diagnosed alcohol dependence and comorbid depression were included in this study. Eleven participants were assigned to mecamylamine and ten were assigned to placebo. The main outcome variables included drinking measures and depressive symptoms. Analyses included all participants. Results: Mecamylamine augmentation was effective in reducing drinking outcomes particularly in nonsmokers. Symptoms of depression decreased for all participants and there was a trend indicating that this was more pronounced again for nonsmokers receiving mecamylamine. The rates of smoking decreased for all smokers. There were no significant differences in the rates of side effect reporting between those receiving mecamylamine and those receiving placebo or smokers versus nonsmokers. Conclusions: Mecamylamine was more effective than placebo in reducing drinking in nonsmokers. The data regarding depressive symptoms and smoking need further study. This study is registered on www.clinicaltrials.gov under number NCT00563797.

Spiritual awakening predicts improved drinking outcomes in a Polish treatment sample.

This study examined concurrent and longitudinal associations between two dimensions of affiliation in Alcoholics Anonymous (AA)-attendance and spiritual awakening-and drinking outcomes among adult patients who were in treatment for alcohol dependence in Warsaw, Poland. In a study conducted at four addiction treatment centers, male and female patients (n = 118) with a DSM-IV diagnosis of alcohol dependence were assessed at baseline (Time 1 or T1), 1 month (T2), and 6-12 months postbaseline (T3) for AA meeting attendance, various aspects of AA affiliation, and alcohol use. Alcoholics Anonymous meeting attendance and alcohol consumption were measured using the Timeline Followback interview. Self-report of having had a spiritual awakening was measured using a modified version of the Alcoholics Anonymous Involvement Scale. There were no cross-sectional or longitudinal associations between AA meeting attendance and improved drinking outcomes. In contrast, self-report of a spiritual awakening between T2 and T3 was significantly associated with abstinence (OR = 2.4, p < .05) and the absence of any heavy drinking (OR = 3.0, p < .05) at T3, even when demographic and clinical characteristics were statistically controlled. Self-reports of spiritual awakening predicted improved drinking outcomes in a Polish treatment sample.

The impact of patient- and SBI process-level variables on six-month drinking outcomes in a level I trauma center

Researchers have decried the lack of investigation regarding the “how and why” of brief intervention effects. Additional research is needed to explicate the processes at work during motivational interviewing brief interventions, as well as the most salient factors influencing these processes. The overall aim of the current study was to better understand the nature and possible active ingredients of the screening and brief intervention encounter. Specifically, this inquiry focused upon the effect of patient-level variables and two distinct brief motivational interviewing-based counseling interventions on six-month drinking outcomes. Three hundred and thirty-three adult participants were recruited from a Level I trauma center. Participants were randomized to one of two brief counseling intervention arms. All interventions were conducted by professional mental health counselors or graduate student counselors-in-training. Follow-up data regarding participants’ drinking patterns and well-being were collected via telephone approximately 6 months subsequent to the intervention. Data were analyzed using MANOVA and hierarchical regression. There were two primary significant findings of this study: one, that a new standardized brief counseling intervention appeared to be as efficacious as a widely-used brief intervention focusing upon quantity and frequency of drinking; and two, that patient pre-intervention AUDIT scores were a major predictor of changes in patient AUDIT scores at 6 months post-intervention in a way that was theoretically counter-intuitive: namely, that high scores (indicating possible alcohol dependence) were associated with the greatest changes at follow-up. Limitations and implications of findings are discussed. Future investigation of the construct of patient engagement is recommended.

Interactive effects of drinking history and impulsivity on college drinking

The transition from adolescence into emerging adulthood is a critical developmental period for changes in alcohol use and drinking related problems. Prior research has identified a number of distinct developmental alcohol use trajectories, which appear to be differentially related to young adult drinking outcomes. Another correlate of alcohol use in early adulthood is impulsivity. The primary aim of this study was to examine the moderating role of impulsivity in the relation between patterns of past alcohol use and hazardous drinking during the first year of college. Participants (N=452; 49% male; mean age 18.5years; 82% Caucasian) completed self-report measures during the first year of college, including retrospective alcohol use calendars, current alcohol use and drinking problems, and personality. Group-based trajectory modeling was used to identify groups with similar adolescent drinking history from retrospective, self-report. Four groups were identified: abstainers/very light users, late/moderate users, early/moderate users, and steep increase/heavy users. The abstainer/very light user group reported the lowest levels of alcohol use and problematic drinking in college; the steep increase/heavy use group reported the highest levels of alcohol use and problematic drinking. As predicted, the role of personality—specifically urgency, or emotion-based rash action—was strongest among moderate use groups. These findings may be helpful in guiding targeted prevention and intervention programs for alcohol use and abuse.

S24 * NEW DEVELOPMENTS IN THE TREATMENT OF ALCOHOL USE DISORDERS

S24 * NEW DEVELOPMENTS IN THE TREATMENT OF ALCOHOL USE DISORDERS

The efficacy of single-component brief motivational interventions among at-risk college drinkers.

College students are an at-risk population for heavy drinking and negative alcohol-related outcomes. Research has established that brief, multicomponent motivational interviewing-based interventions can be effective at reducing alcohol use or related problems, but less is known about the efficacy of individual components within these interventions. The purpose of this study was to test the efficacy of 2 single-component, in-person, brief (15-20 min) alcohol interventions: personalized normative feedback (PNF) and protective behavioral strategies feedback (PBSF). Data were collected on 365 undergraduate students from a large Midwestern university (65% women; 89% White) who were randomly assigned to 1 of 3 conditions: PNF, PBSF, or alcohol education (AE). Participants completed measures of alcohol use, alcohol-related problems, social norms, and protective behavioral strategies. Results indicated that the PNF intervention was efficacious relative to the other conditions at reducing alcohol use and that its effects at 6-month follow-up were mediated by changes in perceived norms at the 1-month follow-up. The PBSF intervention was not efficacious at reducing alcohol use or alcohol-related problems. These findings provide support for the efficacy of an in-person PNF intervention and theoretical support for the hypothesized mechanisms of change in the intervention. Implications for researchers and clinicians are discussed.

Predictors of drinking and functional outcomes for men and women following inpatient alcohol treatment

Predictors of drinking and functional outcomes for men and women following inpatient alcohol treatment

Topiramate treatment for alcoholic outpatients recently receiving residential treatment programs: A 12-week, randomized, placebo-controlled trial

BackgroundInitiation of a relapse prevention medication is crucial at the end of alcohol detoxification. This study aimed to examine the efficacy and safety of topiramate for alcoholism in patients receiving a residential treatment program of alcohol detoxification and post-acute treatment. MethodsThis was a 12-week, randomized, double-blind, placebo-controlled trial of topiramate for alcoholism in patients receiving a residential treatment program. Individuals with DSM-IV alcohol dependence with minimal withdrawal were enrolled. Participants were randomly assigned to receive either 100–300mg/day of topiramate or placebo. Primary outcomes were given as percentages of heavy drinking days and time to first day of heavy drinking. Other drinking outcomes, craving, and health-related quality of life were evaluated. ResultsA total of 106 participants were randomized to receive topiramate (n=53) or placebo (n=53). Twenty-eight participants of the topiramate group (52.8%) and 25 participants of the placebo group (47.2%) completed the study. Averaged over the trial period, there was no significant difference between groups on the mean percentages of heavy drinking days [1.96 (−1.62 to 5.54), p=.28]. Log rank survival analysis found no difference of time to first day of heavy drinking between topiramate and placebo groups (61.8 vs. 57.5 days, respectively; χ2=0.61, d.f.=1, p=.81). Other secondary outcomes were not significantly different between groups. ConclusionsBy using a conservative model for data analysis, we could not detect the effectiveness of topiramate in this particular population. As the sensitivity analysis showed a trend of its benefit, further studies in larger sample sizes are still warranted.

The role of behavioral inhibition and behavioral approach systems in the associations between mood and alcohol consequences in college: A longitudinal multilevel analysis

The behavioral inhibition system (BIS) and behavioral approach system (BAS) are thought to influence sensitivity to reinforcement and punishment, making them useful for predicting mood-related drinking outcomes. This study provided the first examination of BIS and BAS as moderators of longitudinal within-person associations between mood and alcohol-related consequences in college student drinkers. Participants (N=637) at two public U.S. universities completed up to 14 online surveys over the first three years of college assessing past-month general positive and negative moods, as well as past-month alcohol use and consequences. BIS and BAS were assessed at baseline. Using multilevel regression, we found that BIS and BAS moderated the within-person associations between negative mood and alcohol consequences. For students high on BIS only, high on BAS only, or high on both BIS and BAS, within-person increases in negative mood were associated with greater alcohol consequences in the first year of college. However, these negative mood–alcohol consequence associations diminished over time for students high on BIS and low on BAS, but remained strong for students high on both BIS and BAS. Within-person associations between positive mood and alcohol consequences changed from slightly positive to slightly negative over time, but were not moderated by BIS or BAS. Findings suggest that BIS and BAS impact the within-person association between general changes in negative mood and negative alcohol consequences, working jointly to maintain this relationship over time.

The association between binge drinking and birth outcomes: results from the Born in Bradford cohort study

BackgroundVarious human and animal studies suggest that peak alcohol exposure during a binge episode, rather than total alcohol exposure, may determine fetal development. Research about the impact of binge drinking...

Alcohol, still the forgotten drug

Alcohol, still the forgotten drug