Project MATCH Research Articles

Fast Projection Matching for X-ray Tomography

X-ray 3D tomographic techniques are powerful tools for investigating the morphology and internal structures of specimens. A common strategy for obtaining 3D tomography is to capture a series of 2D projections from different X-ray illumination angles of specimens mounted on a finely calibrated rotational stage. However, the reconstruction quality of 3D tomography relies on the precision and stability of the rotational stage, i.e. the accurate alignment of the 2D projections in the correct three-dimensional positions. This is a crucial problem for nano-tomographic techniques due to the non-negligible mechanical imperfection of the rotational stages at the nanometer level which significantly degrades the spatial resolution of reconstructed 3-D tomography. Even when using an X-ray micro-CT with a highly stabilized rotational stage, thermal effects caused by the CT system are not negligible and may cause sample drift. Here, we propose a markerless image auto-alignment algorithm based on an iterative method. This algorithm reduces the traditional projection matching method into two simplified matching problems and it is much faster and more reliable than traditional methods. This algorithm can greatly decrease hardware requirements for both nano-tomography and data processing and can be easily applied to other tomographic techniques, such as X-ray micro-CT and electron tomography.

Projective biomechanical depth matching for soft tissue registration in laparoscopic surgery.

A key component of computer- assisted surgery systems is the accurate and robust registration of preoperative planning data with intraoperative sensor data. In laparoscopic surgery, this image-based registration remains challenging due to soft tissue deformations. This paper presents a novel approach for biomechanical soft tissue registration of preoperative CT data with stereo endoscopic image data. The proposed method consists of two registrations steps. First, we use a 3D surface mosaic from partial surfaces reconstructed from stereo endoscopic images to initially align the biomechanical model with the intraoperative position and shape of the organ. After this initialization, the biomechanical model is projected onto newly captured surfaces, resulting in displacement boundary conditions, which in turn are used to update the biomechanical model. The method is evaluated in silico, using a human liver model, and in vivo, using porcine data. The quantitative in silico data shows a stable behaviour of the biomechanical model and root-mean-square deviation of volume vertices of under 3mm with adjusted biomechanical parameters. This work contributes a fully automatic featureless non-rigid registration approach. The results of the in silico and in vivo experiments suggest that our method is able to handle dynamic deformations during surgery. Additional experiments, especially regarding human tissue behaviour, are an important next step towards clinical applications.

Coping mediates the effects of cognitive-behavioral therapy for alcohol use disorder among out-patient clients in Project MATCH when dependence severity is high.

There is inconsistent evidence that alcohol-specific coping is a mechanism of change in cognitive-behavioral therapy (CBT) for alcohol use disorder (AUD). Our primary aim was to test whether baseline dependence severity moderates the mediational effect of CBT on drinking outcomes via coping. Secondary data analysis of Project MATCH , a multi-site alcohol treatment trial in which participants, recruited in out-patient and aftercare arms, were randomized to three treatments: CBT, motivational enhancement therapy (MET) and Twelve-Step facilitation (TSF). Nine research sites in the United States. A total of 1063 adults with AUD. The primary outcomes were percentage days abstinent and percentage heavy drinking days at the 1-year follow-up. Coping was assessed with the Processes of Change Questionnaire . Dependence severity was measured with the Alcohol Dependence Scale . Among the full available sample (across treatment arms), there were no significant moderated mediation effects. Double moderated mediation analyses indicated that several moderated mediation effects were moderated by treatment arm (all P<0.05). In the out-patient arm, there were several significant moderated mediation effects (all P<0.05), but no significant moderated mediation effects in the aftercare arm. For out-patient clients with high baseline dependence severity, end-of-treatment coping mediated the positive treatment effects of CBT, compared with both MET and TSF, on 1-year drinking outcomes (all P<0.05). Coping did not mediate treatment effects of CBT among those with low or moderate dependence severity. In the Project MATCH out-patient sample, whether or not coping mediated the effects of cognitive-behavioral therapy for alcohol use disorder was conditional on dependence severity. End-of-treatment coping mediated the positive treatment effects of cognitive-behavioral therapy on 1-year drinking outcomes among out-patient clients when dependence severity was high, but not when dependence severity was low or moderate.

Detail‐Preserving Explicit Mesh Projection and Topology Matching for Particle‐Based Fluids

AbstractWe propose a new explicit surface tracking approach for particle‐based fluid simulations. Our goal is to advect and update a highly detailed surface, while only computing a coarse simulation. Current explicit surface methods lose surface details when projecting on the isosurface of an implicit function built from particles. Our approach uses a detail‐preserving projection, based on a signed distance field, to prevent the divergence of the explicit surface without losing its initial details. Furthermore, we introduce a novel topology matching stage that corrects the topology of the explicit surface based on the topology of an implicit function. To that end, we introduce an optimization approach to update our explicit mesh signed distance field before remeshing. Our approach is successfully used to preserve the surface details of melting and highly viscous objects, and shown to be stable by handling complex cases involving multiple topological changes. Compared to the computation of a high‐resolution simulation, using our approach with a coarse fluid simulation significantly reduces the computation time and improves the quality of the resulting surface.

An assembly method for micro parts jointing with given space angle based on projection matching

It is difficult to assemble micro parts jointing with given space angle as the parts assembled are not on the same flat and the visual depth of microscopic vision is small, which can cause the images gathered by the microscopic vision unintelligible and feature extraction difficult. For the problem, this paper presents an assembly method of micro parts based on projection matching. It can assemble micro parts jointing with given space angle accurately. Firstly, an ideal assembly model is established as the size of the micro parts through the drawing software. Secondly, a graphics algorithm based on the primitive information from CAD is designed. Thirdly, according to the pixel value calibration and the graphics algorithm, the projection pictures are shown on the control interface. Lastly, the control method of micro parts is proposed to assemble them with given space angle. And we accomplished an assembly experiment of micro-tube and micro-column in this way, whose assembly deviation is 0.12[Formula: see text]. Experiment results indicate that the angle between two micro parts assembled can be controlled within the given deviation.

How Much Is Too Much? Patterns of Drinking During Alcohol Treatment and Associations With Post-Treatment Outcomes Across Three Alcohol Clinical Trials.

This secondary data analysis examined patterns of drinking during alcohol treatment and associated drinking outcomes during the first year following treatment. The goal was to provide clinicians with guidance on which patients may be most at risk for negative long-term outcomes based on drinking patterns during treatment. This study was an analysis of existing data (N = 3,851) from three randomized clinical trials for alcohol use disorder: the COMBINE Study (n = 1,383), Project MATCH (n = 1,726), and the United Kingdom Alcohol Treatment Trial (n = 742). Indicators of abstinence, non-heavy drinking, and heavy drinking (defined as 4/5 or more drinks per day for women/men) were examined during each week of treatment using repeated-measures latent class analysis. Associations between drinking patterns during treatment and drinking intensity, drinking consequences, and physical and mental health 12 months following intake were examined. Seven drinking patterns were identified. Patients who engaged in persistent heavy drinking throughout treatment and those who returned to persistent heavy drinking during treatment had the worst long-term outcomes. Patients who engaged in some heavy drinking during treatment had better long-term outcomes than persistent heavy drinkers. Patients who reported low-risk drinking or abstinence had the best long-term outcomes. There were no differences in outcomes between low-risk drinkers and abstainers. Abstinence, low-risk drinking, or even some heavy drinking during treatment are associated with the best long-term outcomes. Patients who are engaging in persistent heavy drinking are likely to have the worst outcomes and may require a higher level of care.

The search for an elusive cutoff remains: Problems of binary classification of heavy drinking as an endpoint for alcohol clinical trials

BackgroundTo examine whether a clinically meaningful alcohol consumption cutoff can be created for clinical samples, we used receiver operator characteristic (ROC) curves to derive gender-specific consumption cutoffs that maximized sensitivity and specificity in the prediction of a wide range of negative consequences from drinking. MethodsWe conducted secondary data analyses using data from two large clinical trials targeting alcohol use disorders: Project MATCH (n=1726) and COMBINE (n=1383). ResultsIn both studies, we found that the ideal cutoff for men and women that maximized sensitivity/specificity varied substantially both across different alcohol consumption variables and alcohol consequence outcomes. Further, the levels of sensitivity/specificity were poor across all consequences. ConclusionsThese results fail to provide support for a clinically meaningful alcohol consumption cutoff and suggest that binary classification of levels of alcohol consumption is a poor proxy for maximizing sensitivity/specificity in the prediction of negative consequences from drinking. Future research examining consumption-consequence associations should take advantage of continuous measures of alcohol consumption and alternative approaches for assessing the link between levels of consumption and consequences (e.g., ecological momentary assessment). Clinical researchers should consider focusing more directly on the consequences they aim to reduce instead of relying on consumption as a proxy for more clinically meaningful outcomes.

Oblique Projection Matching Pursuit

Recent theory of compressed sensing (CS) tells us that sparse signals can be reconstructed from a small number of random samples. In reconstruction of sparse signals, greedy algorithms, such as the orthogonal matching pursuit (OMP), have been shown to be computationally efficient. In this paper, the performance of OMP is shown to be dependent on how well information of the underlying signals is preserved in the residual vector. Further, to improve the information preservation, we present a modification of OMP, called oblique projection matching pursuit (ObMP), which updates the residual in a oblique projection manor. Using the restricted isometric property (RIP), we build a solid yet very intuitive grasp of the more accurate phenomenon of ObMP. We also show from empirical experiments that the ObMP achieves improved reconstruction performance over the conventional OMP algorithm in terms of support detection ratio and mean squared error (MSE).

Do Alcohol Relapse Episodes During Treatment Predict Long-Term Outcomes? Investigating the Validity of Existing Definitions of Alcohol Use Disorder Relapse.

The construct of relapse is used widely in clinical research and practice of alcohol use disorder (AUD) treatment. The purpose of this study was to test the predictive validity of commonly appearing definitions of AUD relapse in the empirical literature. Secondary analyses of data from Project MATCH and COMBINE were conducted using 7 definitions of "relapse" based on drinking quantity within a single drinking episode: any drinking; at least 4/5 drinks for women/men; at least 4.3/7.1 drinks for women/men; at least 6/7 drinks for women/men; at least 6 drinks; at least 7/9 drinks for women/men; and at least 8/10 drinks for women/men. Relapse was used to predict alcohol consumption, related consequences, and nonconsumption outcomes (quality of life, psychosocial functioning) at the end of treatment and up to 1year posttreatment. Regression analyses indicated within-treatment relapse definitions significantly predicted end-of-treatment alcohol consumption and alcohol-related consequences. Heavy drinking definitions were generally more predictive than the any drinking definition, but no single heavy drinking definition was consistently a better predictor of outcomes. Relapse definitions were less predictive of longer-term alcohol-related outcomes and both shorter- and longer-term nonconsumption outcomes, including health and psychosocial functioning. One particular definition of relapse did not consistently stand out as the best predictor. Advances in AUD research may require reconceptualization of relapse as a multifaceted dynamic process and may consider a wider range of relevant behaviors (e.g., health and psychosocial functioning) when examining the change process in individuals with AUD.

Ascertaining the relationships between the trajectories of specific categories of alcohol-related negative consequences and subsequent drinking behavior.

The first year following alcohol use disorder (AUD) treatment has been identified as a period of high risk for relapse and an important timeframe for enquiry regarding alcohol-related behavior change and its maintenance. In addition, at least among individuals with AUD, alcohol use and negative consequences have been shown to be reciprocally related. A commonly used measure of alcohol-related negative consequences is the Drinker Inventory of Consequences (DrInC). Investigations of specific categories of alcohol-related negative consequences and their trajectories, however, have been lacking. Given this background, the purpose of this study was to: follow the course of the 5 DrInC categories of alcohol-related negative consequences over the first year post-AUD treatment initiation; investigate whether these trajectories varied by gender, age, and/or treatment condition; examine the relationships between these trajectories and subsequent drinking behavior; and investigate whether these relationships varied by gender, age, and/or treatment condition, via secondary data analyses. Data from the outpatient arm of Project MATCH (n = 952) were utilized. Study results revealed that the trajectory of each DrInC category was indicative of improved alcohol-related problems across the first year posttreatment initiation. Specific DrInC categories varied as a function of gender, age, and treatment condition, and the trajectories were predictive of subsequent drinking behavior. Specifically, higher intercepts during the treatment period were associated with poorer drinking behavior 1 year later. Alternatively, steeper negative slopes were associated with improved drinking behavior. Some of these relationships were modified by gender, age, and treatment condition. It was concluded that assessing alcohol-related negative consequences during the first year posttreatment initiation period has clinical utility. (PsycINFO Database Record

Reward and relief dimensions of temptation to drink: construct validity and role in predicting differential benefit from acamprosate and naltrexone.

Researchers have sought to distinguish between individuals whose alcohol use disorder (AUD) is maintained by drinking to relieve negative affect ('relief drinkers') and those whose AUD is maintained by the rewarding effects of alcohol ('reward drinkers'). As an opioid receptor antagonist, naltrexone may be particularly effective for reward drinkers. Acamprosate, which has been shown to down-regulate the glutamatergic system, may be particularly effective for relief drinkers. This study sought to replicate and extend prior work (PREDICT study; Glöckner-Rist et al. ) by examining dimensions of reward and relief temptation to drink and subtypes of individuals with distinct patterns of reward/relief temptation. We utilized data from two randomized clinical trials for AUD (Project MATCH, n = 1726 and COMBINE study, n = 1383). We also tested whether classes of reward/relief temptation would predict differential response to naltrexone and acamprosate in COMBINE. Results replicated prior work by identifying reward and relief temptation factors, which had excellent reliability and construct validity. Using factor mixture modeling, we identified five distinct classes of reward/relief temptation that replicated across studies. In COMBINE, we found a significant class-by-acamprosate interaction effect. Among those most likely classified in the high relief/moderate reward temptation class, individuals had better drinking outcomes if assigned to acamprosate versus placebo. We did not find a significant class-by-naltrexone interaction effect. Our study questions the orthogonal classification of drinkers into only two types (reward or relief drinkers) and adds to the body of research on moderators of acamprosate, which may inform clinical decision making in the treatment of AUD.

The Alcohol Intervention Mechanisms Scale (AIMS): Preliminary Reliability and Validity of a Common Factor Observational Rating Measure

The present work provides an overview, and pilot reliability and validity for the Alcohol Intervention Mechanisms Scale (AIMS). The AIMS measures therapist interventions that occur broadly across modalities of behavioral treatment for alcohol use disorder. It was developed based on identified commonalities in the function rather than content of therapist interventions in observed therapy sessions, as well as from existing observer rating systems. In the AIMS, the primary function areas are: explore (four behavior count codes), teach (five behavior count codes), and connect (three behavior count codes). Therapist behavior counts provide a frequency rating of occurrence (i.e., adherence). The three functions (explore, teach, connect) are then rated on global skillfulness, which provides a quality valence (i.e., competence) to the entire session. In the present study, three independent raters received roughly 30 hours of training on the use of the AIMS by the first author. Data were a sample of therapy session audio files from a Project MATCH clinical research site. Reliability results showed generally good performance for the measure. Specifically, 2-way mixed intraclass coefficients were ‘excellent’, ranging from .94 to .99 for function summary scores, while prevalence-adjusted, bias-adjusted kappa for global skillfulness measures were in the ‘fair’ to ‘moderate’ range (k=.36 to.40). Internal consistency reliability was acceptable, as were preliminary factor models by behavioral treatment function (i.e., explore, teach, connect). However, confirmatory fit for the subsequent three factor model was poor. In concurrent validity analyses, AIMS summary and skillfulness scores showed associations with relevant Project MATCH criterion measures (i.e., MATCH Tape Rating Scale) that were consistent with expectations. The AIMS is a promising and reliable observational measure of three proposed common functions of behavioral alcohol treatment.

The exact complexity of projective image matching

Projective image matching is an important image processing task. Given digital images A and B, the challenge is to find a projective transformation f for A such that it most closely resembles B. Previous research led to a polynomial time algorithm that elaborately searches the so-called dictionary D(A) of all projective transformations of A using a preprocessed data structure. This paper shows that projective image matching is even TCO-complete by applying a much simpler parallel way of browsing D(A). This reveals further insight into the problem's structural properties and relates it to fundamental computer operations like integer multiplication and division.

Adding tools to the toolbox: The role of coping repertoire in alcohol treatment.

Few studies have examined distinct patterns (i.e., repertoires) of coping skills among alcohol use disorder (AUD) populations. We examined patterns of coping among individuals following AUD treatment and were particularly interested in whether the broadness of one's repertoire, or the degree of utilizing a broad range of different coping skills, was related to alcohol treatment outcomes. We conducted secondary analyses of data from the COMBINE Study (N = 1,101; mean age = 45.14, SD = 10.19, 68.8% male; 21.3% non-White) and Project MATCH (N = 1,587; mean age = 40.25, SD = 11.07, 75.7% male; 19.7% non-White). Finite mixture models were conducted to examine patterns of alcohol-specific coping, as measured by the Processes of Change Questionnaire (Prochaska, Velicer, DiClemente, & Fava, 1988). Three latent coping repertoire classes provided the best fit to the data in both studies: (a) a broad class that had a broad range of different skills that were consistently used, (b) a moderate class that had a moderate range of different skills that were consistently used, and (c) a narrow class that had a limited range of different skills that were consistently used. In both studies the broad repertoire class generally had the best treatment outcomes. Receiving the combined behavioral intervention in COMBINE predicted a greater likelihood of expected classification in the broad class. Having a broad coping repertoire was associated with better alcohol treatment outcomes and may be an important target in AUD treatment. Further research examining distinct patterns or repertoires of coping among AUD populations is warranted. (PsycINFO Database Record

Temptation Minus Self-Efficacy in Alcohol Relapse: A Project MATCH Follow-Up.

Relapse is a crucial event that occurs for many individuals during recovery from alcohol use disorder. This article examines the impact of temptation to drink and self-efficacy to abstain on two distinct aspects of relapse. Causal chain analyses from Project MATCH, a multisite alcoholism treatment trial, provided initial support for the difference between temptation and self-efficacy as a predictor of alcohol use outcomes. In the current study, the Temptation minus Self-Efficacy (T-S) score from the Alcohol Abstinence Self-Efficacy Scale (AASE) is investigated as a predictor of two alcohol use outcomes that were not analyzed in previous Project MATCH reports. This study evaluated the ability of end-of-treatment T-S (calculated as Temptation minus Self-Efficacy scores on AASE) to predict time to first drink and number of drinks on first drinking day. Data were analyzed on 627 participants from Project MATCH who relapsed after completing treatment and achieving a period of abstinence. T-S at end of treatment was a significant predictor of two alcohol use outcomes during the 1-year follow-up period. In addition, situation-specific subscale scores of T-S predicted alcohol use outcomes. T-S in social/positive situations predicted time to first drink. T-S in negative affect situations predicted number of drinks on first drinking day. Results support end-of-treatment measurement discrepancy between AASE scales of Temptation and Abstinence Self-Efficacy as a predictor of time to first drink and number of drinks on first drinking day among individuals who relapse after treatment.

The In-Session and Long-Term Role of a Significant Other in Motivational Enhancement Therapy for Alcohol Use Disorders

ObjectiveTo examine how significant other (SO) language in support of or against client abstinence from alcohol influences clients’ in-session speech and drinking behavior over the 9months post-Motivational Enhancement Therapy (MET). MethodSequential analyses were used to examine the language of Project MATCH clients who invited an SO to participate in an MET session. Hierarchical regressions investigated the predictive relationship between SO language and clients’ post-treatment drinking behavior. A cohort analytic design compared the change language of these SO-involved participants against a matched group who chose client-only therapy. Results'SO Support Change' language increased the odds of client Change Talk in the next utterance (p<.01). SO Support Change did not significantly predict reduced post-treatment drinking, whereas 'SO Against Change' significantly predicted an increase in average drinks per drinking day (DDD) across months 7-9 post-MET (p=.04). In the matched comparison, the proportion of change-related client language was comparable across the SO-involved and client-only groups. ConclusionsMotivational interviewing theory was supported by the sequential association between SO and client language as well as the predictive link between SO Against Change and client drinking intensity. Given the centrality of pro-sobriety language in the literature, it was surprising that SO Support Change did not predict alcohol use outcomes. Findings are discussed in relation to contemporary treatment process research and clinical practice.

National Dissemination of Motivation Enhancement Therapy in the Veterans Health Administration: Training Program Design and Initial Outcomes

Motivational enhancement therapy (MET) can be defined most simply as the “….combination of Motivational Interviewing (MI) with assessment feedback….” (Miller & Rollnick, 2013, p. 250). MET has a clear evidence-base promoting its use especially for treatment of substance use disorders (SUDs). Despite its efficacy and utility, MET is not widely used in clinical settings. In 2012, to facilitate the dissemination of MET, the Veterans Health Administration [VHA; the health care component of the U.S. Department of Veterans Affairs (VA)] launched a national training program that provided competency-based training in MET to VA staff working in SUD specialty care clinics. All VA facilities are required to implement EBPs for SUDs, such as MET, and ensure that they are available to veterans. This paper describes the VA MET training program and examines the impact of the MET training program on participants' knowledge of MET and self-reported MET skills. We review the components of the training and consultation and discuss adaptations made from the Project MATCH MET model to a real-world clinical setting. Of the 264 training participants we trained 2012–2013, 213 (81%) successfully completed all requirements of the training program, including requirements for demonstrating competency and attending at least 75% of scheduled consultation calls. After completion of the training program, approximately 85% of the clinicians reported implementing MET often (either 1–3 times per week or daily). Furthermore, we saw significant increases in MI knowledge from pretraining assessment to post-workshop and from pretraining to post-consultations. Additional training program details and revisions are discussed.

Reproducibility and differential item functioning of the alcohol dependence syndrome construct across four alcohol treatment studies: An integrative data analysis

BackgroundThe validity of the alcohol dependence syndrome has been supported. The question of whether different measures of the construct are comparable across studies and patient subgroups has not been examined. This study examined the alcohol dependence construct across four diverse large-scale treatment samples using integrative data analysis (IDA). MethodWe utilized existing data (n=4393) from the COMBINE Study, Project MATCH, the Relapse Replication and Extension Project (RREP), and the United Kingdom Alcohol Treatment Trial (UKATT). We focused on four measures of alcohol dependence: the Alcohol Dependence Scale (COMBINE and RREP), Alcohol Use Inventory (MATCH), the Leeds Dependence Questionnaire (UKATT), and the Diagnostic and Statistical Manual of Mental Disorders (COMBINE and MATCH). Moderated nonlinear factor analysis was used to create a measure of alcohol dependence severity that was moderated by study membership, gender, age, and marital status. ResultsA commensurate measure of alcohol dependence severity was successfully created using 20 items available in four studies. We identified differential item functioning by study membership, age, gender, and/or marital status for 12 of the 20 items, indicating specific patient subgroups who responded differently to items based on their underlying dependence severity. ConclusionsAlcohol dependence severity is a single unidimensional construct that is comparable across studies. The use of IDA provided a strong test of the validity of the alcohol dependence syndrome and clues as to how some items used to measure dependence severity may be more or less central to the construct for some patients.

Within-session communication patterns predict alcohol treatment outcomes

BackgroundWithin-session client speech is theorized to be a key mechanism of behavior change in motivational interviewing (MI), a directional, client-centered approach to behavior change. Client change talk (CT: speech indicating movement toward changing a problematic health behavior) and sustain talk (ST: speech supporting continuing a problematic health behavior) have each shown relationships with outcomes. However, it may be the case that patterns of within-session client speech, rather than counts of client speech, are important for producing change. MethodsRecorded initial MI/MET psychotherapy sessions from Project MATCH had been previously rated using the Motivational Interviewing Sequential Code for Observing Process Exchange (MI-SCOPE), a mutually exclusive and exhaustive sequential coding system. From these existing data, session conditional probabilities for transitions of interest (the transition from CT to more CT, and the transition from reflections of CT to CT) were analyzed as empirical Bayes estimates of log-normalized odds ratios. ResultsCT frequencies and these log-normalized odds ratios were entered as independent variables into longitudinal generalized estimating equation (GEE) models predicting within-treatment and post-treatment drinking. While all variables were significant predictors of within-treatment drinking, only the CT–CT transition emerged as a significant predictor of decreased drinking after treatment. ConclusionsThe momentum of a client's speech about change during an MI session may be a better predictor of outcome than is a simple frequency count of it. Attending not only to the mere occurrence of CT, but also recognizing the importance of consecutive client statements of CT, may improve treatment outcomes.

Examining temptation to drink from an existential perspective: Associations among temptation, purpose in life, and drinking outcomes.

Temptation to drink (TTD), defined as the degree to which one feels compelled to drink in the presence of internal or external alcohol-related cues, has been shown to predict alcohol-treatment outcomes among individuals with alcohol-use disorders (AUDs). Research examining TTD from an existential perspective is lacking and little is known about how existential issues such as purpose in life (PIL) relate to TTD, which is surprising given the role of existential issues in many treatments and mutual help approaches for AUDs. In the current study, we examined the longitudinal associations in a sample of 1726 among TTD, PIL, and drinking outcomes using data from Project MATCH (1997, 1998). Parallel process latent growth curve analyses indicated that PIL and TTD were significantly associated across time, such that higher initial levels of PIL and increases in PIL over time were associated with lower initial levels of TTD and decreases in TTD over time. Higher initial levels of TTD, lower initial levels of PIL, increases in TTD, and decreases in PIL were significantly associated with greater intensity and frequency of drinking and greater drinking-related consequences at the 15-month follow-up. Accordingly, TTD and PIL may be important constructs for clinicians to consider throughout the course of treatment. Future studies should examine if and how various kinds of treatments for AUDs are associated with increases in PIL, and whether these increases are related to decreased TTD and reduced drinking.