Resistance to temptation: the interaction of external and internal control on alcohol use during residential treatment for alcohol use disorder.

BACKGROUND: There is evidence that drinking during residential treatment is related to various factors, such as patients' general control beliefs and self-efficacy, as well as to external control of alcohol use by program's staff and situations where there is temptation to drink. As alcohol use during treatment has been shown to be associated with the resumption of alcohol use after discharge from residential treatment, we aimed to investigate how these variables are related to alcohol use during abstinence-oriented residential treatment programs for alcohol use disorders (AUD). METHODS: In total, 509 patients who entered 1 of 2 residential abstinence-oriented treatment programs for AUD were included in the study. After detoxification, patients completed a standardized diagnostic procedure including interviews and questionnaires. Drinking was assessed by patients' self-report of at least 1 standard drink or by positive breathalyzer testing. The 2 residential programs were categorized as high or low control according to the average number of tests per patient. RESULTS: Regression analysis revealed a significant interaction effect between internal and external control suggesting that patients with high internal locus of control and high frequency of control by staff demonstrated the least alcohol use during treatment (16.7%) while patients with low internal locus of control in programs with low external control were more likely to use alcohol during treatment (45.9%). No effects were found for self-efficacy and temptation. CONCLUSIONS: As alcohol use during treatment is most likely associated with poor treatment outcomes, external control may improve treatment outcomes and particularly support patients with low internal locus of control, who show the highest risk for alcohol use during treatment. High external control may complement high internal control to improve alcohol use prevention while in treatment.

"What do you mean by spirituality? Please draw me a picture!" Complementary faith-based addiction treatment in Switzerland from the client's perspective.

This article reviews: (1) the relative importance of spirituality and religion in Switzerland and the United States, (2) the rationale for faith-based addiction intervention programs and the drawbacks of measurement approaches, and (3) results from a pilot study exploring the meaning of spirituality and religiosity from the consumer's perspective. Twenty-three patients entering the Swiss Südhang clinic in-patient alcohol user treatment program during the first five months in 2012 participated upon their admission in a video-taped drawing task, designed to provide their personal visualized definitions of the terms "spirituality" and "religiosity." Nine dimensions emerged pointing to a high complexity of the concepts.

Association between craving and attention deficit/hyperactivity disorder symptoms among patients with alcohol use disorders.

BACKGROUND/AIM: Adult Alcohol Use Disorders (AUD) patients with Attention Deficit/Hyperactivity Disorder (ADHD) symptoms may suffer more from craving than patients who only have AUD. However, craving may be even more strongly related to withdrawal and psychiatric symptoms; therefore, the association between craving and ADHD may be misinterpreted. The purpose of this study is to examine the association between craving and ADHD symptoms among AUD patients in more detail. METHODS: In a multisite study, 385 patients with and without ADHD symptoms who were attending treatment for alcohol dependence were compared in terms of craving, withdrawal, and psychiatric symptoms. The contribution of ADHD symptoms to craving was estimated in a hierarchical regression analysis by controlling for psychiatric and withdrawal symptoms. RESULTS: Patients with probable adult ADHD showed higher craving, more withdrawal and psychiatric symptoms, and rated withdrawal symptoms as more severe than did patients without ADHD symptoms. In the regression model, only about 3% of variance in alcohol craving was explained by ADHD symptomatology, whereas 23% of the variance was explained when withdrawal and psychiatric symptoms were added to the model. CONCLUSIONS: Alcohol craving is likely related to withdrawal and psychiatric symptoms more strongly than to ADHD symptoms.

Drinking episodes during abstinence-oriented inpatient treatment: dual perspectives of patients and therapists--a qualitative analysis.

AIMS: Treatment programs are frequently confronted with the consumption of alcohol by patients during therapy. This is in conflict with the abstinence agreement upon admission, which is considered to be instrumental for positive treatment outcomes. This qualitative analysis aims, first, to identify the range of patients' causal attributions, addiction concepts and control strategies detected in the narratives of off-site consumption episodes and, secondly, to compare this inventory with the response of the therapists. METHODS: A total of 42 semi-structured face-to face interviews were conducted with patients and their therapists (n = 22) from two major Swiss inpatient alcohol clinics in 2010/2011. Interviews were conducted shortly after the detection of a patient's off-premises alcohol consumption. Textual exploration and systematic coding used ATLAS.ti to identify themes, interpretative categories and prevention strategies shared by the therapists. RESULTS: Elements of outpatient-controlled drinking programs are mirrored in the patients' lay strategies, and similarities with self-change mechanisms can be observed. The dimensionality of therapists' views of the consumption incidents-illustrated by their prevention recommendations-proves to be less differentiated than the control strategies and situational framing of the patients. CONCLUSIONS: The focus on abstinence only and the adoption of the loss-of-control concept limits therapists' ability to feed patients' reports of their drinking episodes and coping efforts into a strength-based approach including a wider range of treatment outcomes.

The role of working memory in dichotic-listening studies of auditory laterality.

We present data related to the role of working memory in dichotic-listening studies of speech lateralization using consonant-vowel syllable stimuli. A working-memory procedure was actually used in the pioneering dichotic-listening studies by Doreen Kimura in 1960, a fact that was forgotten in later dichotic-listening studies, exclusively focusing on the perceptual aspects of speech sound lateralization. Capitalizing on the original Kimura (1961a, 1961b) studies, we hypothesized that an increase in working-memory load leads to an amplified right-ear advantage (REA) in the dichotic-listening task. A total of 30 participants completed a dichotic-listening task including three working-memory load conditions, each consisting of trials of 3, 4, and 5 dichotically presented letter pairs. Results confirmed an enhanced REA as working-memory load increased. This right-ear effect increased significantly from 3 to 4 stimulus pairs and leveled off with the 5th pair. In addition, the assumption was tested that, within a single load condition, the REA appears mainly in late serial input positions. A detailed analysis of the results revealed that only late positions contributed to the overall REA. However, the highest load condition (5 letter pairs) also produced significant ear differences in the early part of the input position curve. The mechanisms likely to be responsible for these results are discussed in terms of top-down and bottom-up processes in hemispheric asymmetry.