Alcohol-Focused Behavioral Couple Therapy.

Alcohol Behavioral Couple Therapy (ABCT) has emerged over the last 30 years as a highly efficacious treatment for those with alcohol use disorders. This review highlights the historical and conceptual underpinnings of ABCT, as well as the specific treatment elements and structure. Proposed active ingredients, moderators, and mediators of treatment outcome are discussed. Efficacy is evaluated for reductions in identified patient drinking, improved relationship functioning, and reductions in intimate partner violence. Adaptations of ABCT for substances other than alcohol are described. Other adaptations, including brief interventions, interventions addressing PTSD and TBI along with alcohol use, and interventions deliverable via technology platforms are described. Additional cost-benefit and cost-effectiveness findings supporting the economic value of ABCT are noted. Future directions for research in this area include possible adaptations for female identified patients, nontraditional couples, LGBT partners and dyads involving nonintimate partner relationships. The development of more flexible models and enhanced dissemination strategies may improve clinical uptake and utility as well as increasing the feasibility of this treatment for integrated healthcare settings.

A preliminary randomized controlled trial of a behavioral exercise intervention for smoking cessation.

INTRODUCTION: Previous exercise intervention studies for smoking cessation have been challenged by a number of methodological limitations that confound the potential efficacy of aerobic exercise for smoking cessation. METHODS: The preliminary efficacy of a behavioral exercise intervention that incorporated features designed to address prior limitations was tested in a randomized controlled trial (RCT). Sixty-one smokers (65.6% female, mean age = 47.3 years, smoked a mean of 19.7 cigarettes/day) were randomized to receive either a 12-week exercise intervention or a 12-week health education contact control. Participants in both conditions received an 8-week telephone-delivered, standard smoking cessation protocol (with the transdermal nicotine patch). Follow-ups were conducted at the end of treatment (EOT), 6- and 12-month timepoints. RESULTS: There were no differences between conditions with respect to the number of weekly exercise or health education sessions attended (9.3±2.8 vs. 9.3±3.0, respectively). While not statistically significant, participants in the exercise condition demonstrated higher verified abstinence rates (EOT: 40% vs. 22.6%, odds ratio [OR] = 2.28; 6- and 12-month follow-ups: 26.7% vs. 12.9%, OR = 2.46). Irrespective of treatment condition, higher levels of moderate-to-vigorous exercise were associated with lower levels of depressive symptoms during the intervention. CONCLUSIONS: The results of this small RCT point toward the benefit of a behavioral exercise intervention designed to address previous methodological limitations for smoking cessation. Given the potential public health impact of the demonstrated efficacy of exercise for smoking cessation, the continued development and optimization of exercise interventions for smokers through larger RCTs merits pursuit.

A randomized pilot trial of brief family-involved treatment for alcohol use disorder: Treatment engagement and outcomes.

OBJECTIVE: Involving family members in a patient's treatment for alcohol use disorder (AUD) leads to more positive outcomes, but evidence-based family-involved treatments have not been adopted widely in AUD treatment programs. Study aims the following: (a) modify an empirically supported 12-session AUD treatment, alcohol behavioral couple therapy (ABCT) to make it shorter and appropriate for any concerned family member and (b) conduct a small clinical trial to obtain feasibility data and effect size estimates of treatment efficacy. METHOD: ABCT content was adapted to three-sessions following input from clinicians, patients, and family members. Patient and family member dyads were recruited from an inpatient treatment program and randomized to the new treatment, brief family-involved treatment (B-FIT), or treatment-as-usual (TAU). Drinking was assessed using the Form-90; family support and family functioning were assessed using the Family Environment Scale Conflict and Cohesion subscales and the Family Adaptability and Cohesion Evaluation Scale-IV, Communication scale. Dyads (n = 35) were assessed at baseline and 4-month follow-up. RESULTS: On average, dyads received one of three B-FIT sessions with 6 dyads receiving no sessions due to scheduling conflicts or patient discharge. At follow-up, there was a large-to-medium effect size estimate favoring B-FIT for proportion drinking days (patient report, n = 22; Hedges' g = 1.01; patient or family report, n = 28; Hedges' g = .48). Results for family support or family functioning measures favored TAU. CONCLUSIONS: Implementation of brief family-involved treatment in inpatient AUD treatment was challenging, but preliminary data suggest the potential value of B-FIT in impacting drinking outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Association between empathy and drinking among a community sample of heavy drinkers: Sex differences and neural correlates.

Alcohol use disorder (AUD) is a major health problem, yet most individuals with AUD do not perceive a need for formal treatment and do not receive treatment. The lack of treatment seeking among individuals with AUD may suggest a lack of self-awareness and insight into the seriousness of AUD related problems, as well as lack of empathy for the impact of one's drinking on others. Recent work has suggested that empathy may be impaired among individuals seeking treatment for AUD. Further these impairments may differ by sex such that males with lower empathy reported more drinking consequences and greater drinking intensity, but there was no association between empathy and drinking among females. The current study used regression analyses (alpha = 0.05) to examine the association between empathy (as measured by the four scales of the Interpersonal Reactivity Index), independent components of gray matter volume in regions associated with empathy, and drinking variables among non-treatment seeking drinkers with AUD (N = 136) and also examined these effects by sex. Results showed greater perspective taking was associated with less temporoparietal and frontotemporal gray matter volume (B(SE) = -0.912 (0.043), p = 0.034). An interaction between perspective taking and sex was associated with craving, such that higher perspective taking was associated with less craving for males only (B(SE) = -0.48 (0.243), p = 0.049; R2 = 0.087). Empathic concern was related to lower percent heavy drinking days for both males and females (B(SE) = -1.57 (0.743), p = 0.035; R2 = 0.11). The current study found empathy may be an important predictor of craving for males and frequency of heavy drinking for males and females. Future work should investigate whether empathy predicts treatment seeking.

Prenatal maternal posttraumatic stress disorder as a risk factor for adverse birth weight and gestational age outcomes: A systematic review and meta-analysis.

BACKGROUND: Although not routinely assessed, prenatal posttraumatic stress disorder (PTSD) is associated with poor maternal mental health and mother-infant bonding. Prenatal PTSD may also be associated with birth weight and gestational age outcomes, but this remains unclear. This systematic review and meta-analysis investigated the association of prenatal PTSD with risk of low birth weight (LBW) or preterm birth (PTB) (dichotomous medically-defined cut-offs) or with birth weight (BW) or gestational age (GA) (continuous variables). METHODS: A comprehensive literature search was conducted in Web of Science, MedLine, PubMed, and PsychInfo. Data were collected and processed according to Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Study quality was assessed with the Newcastle-Ottowa Quality Assessment Scale. Pooled effect sizes were estimated with random-effects models (correlation for continuous and odds ratios for dichotomous outcomes). RESULTS: Sixteen studies with 51,470 participants (prenatal PTSD 8%) were included in 4 meta-analyses. Maternal prenatal PTSD was associated with higher risks of LBW (OR = 1.96; 95% CI, 1.26, 3.03; P = .003), PTB (OR = 1.42; 95% CI, 1.16, 1.73; P = .001), and reduced GA (r = -0.04; 95% CI, -0.06, -0.01; P = .002). LIMITATIONS: Different designs across studies, variety of PTSD assessment practices, and a small pool of studies were noted. CONCLUSIONS: Findings suggest prenatal PTSD presents increased risks of LBW, PTB, and reduced GA. Evidence of physical harm to neonates from prenatal PTSD provides a powerful rationale to increase prenatal PTSD screening and identify effective prenatal interventions to improve maternal and child outcomes.

Inside Alcohol Behavioral Couple Therapy (ABCT): In-session speech trajectories and drinking outcomes.

The alcohol treatment literature has established in-session client speech as a mechanism of change that therapist behavior can influence and that can predict drinking outcomes. This study aimed to explore temporal patterns of in-session speech in Alcohol Behavioral Couple Therapy (ABCT), including the unique interplay between client and partner speech and the role of speech trajectories in predicting client drinking outcomes. Participants were 165 heterosexual couples receiving ABCT in one of four clinical trials. We coded client speech on an utterance-by-utterance basis using the System for Coding Couples' Interactions in Therapy-Alcohol. We focused on individual-level speech codes of change talk and sustain talk and couple-level variables of positive and negative interactions. We segmented the initial and midtreatment sessions into quartiles to conduct path analyses and latent growth curve models. Path analyses suggested that clients and partners may not have been aligned in terms of treatment goals at the start of the therapy. This misalignment within couples was pronounced during the initial session and decreased by the midtreatment session, reflecting progression toward treatment goals. Of the latent growth curve models, only client sustain talk during the midtreatment session predicted greater client drinking at the end of treatment. Results provide insight into the inner workings of ABCT and suggest recommendations for ABCT therapists. This study also supports a growing consensus that sustain talk may be a stronger mechanism of change than change talk in various alcohol treatment interventions.

Treatment Interventions for Women With Alcohol Use Disorder.

Women with alcohol use disorder (AUD) experience more barriers to AUD treatment and are less likely to access treatment than men with AUD. A literature review identified several barriers to women seeking help: low perception of a need for treatment; guilt and shame; co-occurring disorders; employment, economic, and health insurance disparities; childcare responsibilities; and fear of child protective services. Women entering treatment present with more severe AUD and more complex psychological, social, and service needs than men. Treatment program elements that may reduce barriers to AUD treatment include provision of childcare, prenatal care, treatment for co-occurring psychological problems, and supplemental social services. Research has suggested that outcomes for women are best when treatment is provided in women-only programs that include female-specific content. To date, research on treatments tailored to the individual needs of women is limited, but research on mechanisms of change has suggested the importance of targeting anxiety and depression, affiliative statements in treatment, abstinence self-efficacy, coping skills, autonomy, and social support for abstinence. Future research should focus on early interventions, linkages between primary care or mental health clinics and AUD treatment settings, and integrated treatments for co-occurring AUD and other disorders. Further research should also explore novel treatment delivery approaches such as digital platforms and peer support groups.

Education and Training in Substance Use Disorders and Addictions: The University of New Mexico Integrated Training Model.

This paper describes SUD/addictions training at the University of New Mexico. Coordinated and integrated academic, research, and clinical training resources are described, with an emphasis on the integration of resources across multiple training domains. Academic training resources in the Psychology Department include core clinical courses, basic science courses, and opportunities for students to develop expertise in health or quantitative psychology. Other academic resources come from affiliated departments and colleges such as Sociology, the College of Population Health, the College of Education, and Health Sciences. Research training resources are available within the Psychology Department, affiliated Departments and Colleges, and specialized research centers including the Center on Alcoholism, Substance Abuse, and Addictions, and the Mind Research Network. A network of community partners provides additional research sites. Clinical training resources are provided through a specialized alcohol treatment clinic and a diversity clinic within the Department, opportunities for students to serve as research clinicians, and community practicum sites supervised by on-site doctoral level psychologists or Departmental faculty. The UNM training program provides one model for graduate training in SUD/addictions. Keys to the program are the presence of multiple SUD/addictions clinical faculty member with active research programs, willingness to mentor students in research and clinical work, and basic science faculty whose research is relevant to addictive behaviors. Other critical elements include systematic development of clinical training opportunities, effective collaborations with community agencies for research and clinical training, meaningful research partnerships with other academic departments and specialized research centers, and external funding for training activities.

The Indirect Relationship Between Interpersonal Trauma History and Alcohol Use via Negative Cognitions in a Multisite Alcohol Treatment Sample.

Although interpersonal trauma history (ITH) is frequently associated with alcohol use disorder (AUD), little is known about specific psychological constructs that may indirectly link these phenomena. This study hypothesized that one such construct may be negative cognitive schemas that often emerge in the aftermath of trauma. Secondary latent variable modeling was conducted using the Project MATCH sample of adults receiving treatment for AUD (N = 1726; 24.3% women; 38.63% ITH). The negative cognitions latent variable provided an excellent fit to the data and showed evidence of strong measurement invariance. As hypothesized, negative cognitions mediated the inverse association between ITH at baseline and percent days abstinent from alcohol 12 weeks later. Findings suggest that negative cognitions may be a specific underlying mechanism and potential treatment target for individuals with ITH and AUD.

A mother's bond: An ecological momentary assessment study of posttraumatic stress disorder symptoms and substance craving during pregnancy.

Pregnant women with substance use disorder (SUD) comprise an underserved population with complex treatment needs, including complications from trauma histories and comorbid psychological disorders. Using ecological momentary assessment, we examined momentary fluctuations in posttraumatic stress disorder (PTSD) symptoms, prenatal bonding, and substance craving, among pregnant women in SUD treatment who had a history of trauma. We hypothesized that (a) PTSD symptoms and prenatal bonding would each be associated with substance craving and (b) PTSD symptoms would be negatively associated with prenatal bonding, and this would at least partially account for the association between PTSD symptoms and substance craving (i.e., indirect effect). Participants (n = 32) were on average 27.1 weeks pregnant (SD = 5.27), 27.8 years old (SD = 4.54), and predominantly Hispanic/Latina (66%). At the within subjects level, higher momentary ratings of PTSD symptoms were associated with lower quality (but not intensity of preoccupation) of prenatal bonding, which in turn was associated with greater craving. Lower quality of prenatal bonding partially mediated the positive association between PTSD symptoms and craving, which remained strong after accounting for prenatal bonding. Our results provide some preliminary support for considering interventions aimed at stabilizing or decreasing PTSD symptoms and stabilizing or increasing prenatal bonding to reduce substance craving and, thus, the risk of perinatal substance use among women with SUD and trauma histories. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Relationship between empathic processing and drinking behavior in project MATCH.

INTRODUCTION: Family relationships, social connectedness and a greater network of supportive others each predict better drinking outcomes among individuals with alcohol use disorder (AUD). The association between social factors and drinking may be related to the ability of individuals to take the perspectives of others' mental and emotional states, defined as empathic processing (EP). As such, it may be the case that EP is associated with social support (SS) and drinking behavior among individuals with AUD, yet few prior studies have attempted to define EP in an AUD sample. METHODS: The current study was a secondary data analysis of Project MATCH (N=1726) using structural equation modeling to model EP as a latent factor. The study also sought to test the baseline associations between EP, SS, and drinking behavior, as well as sex differences in the associations between EP, SS, and drinking. It was hypothesized that EP would be positively associated with SS and negatively associated with drinking behavior. RESULTS: Results suggested adequate model fit of the EP construct. Structural equation models indicated significant associations between EP, SS, and both drinking consequences and percent drinking days, but only for males. Males reported significantly lower EP and SS from friends, but more SS from family, compared to females. EP was not related to drinking among females. CONCLUSIONS: The current study validated a model of EP in a treatment-seeking sample of individuals with alcohol use disorder. Future work may consider EP as a treatment-modifiable risk factor for drinking frequency and consequences in males.

Utilization of evidence-based smoking cessation treatments by psychiatric inpatient smokers with depression.

OBJECTIVES: Although smoking is a major health issue among depressed psychiatric inpatients and interest in quitting is high, successful quit rates remain low among this population. We sought to understand preferences that depressed inpatient smokers may have for cessation treatments. METHODS: Eighty smokers (60% women, mean age 38.75 ± 11.20) with major depressive disorder and nicotine dependence receiving psychiatric inpatient services provided information on current depressive symptoms, smoking status and nicotine dependence, quit attempts, perceived barriers to quitting, and smoking consequences. RESULTS: Almost half (46%) of participants endorsed a past-year quit attempt. Emotional barriers to quitting were uniquely associated with fewer past-year quit attempts, and depression severity was related to greater emotional barriers to quitting. Nicotine dependence severity was related to a variety of emotional, financial, weight concern, and self-efficacy barriers, but only weight gain concern was associated with decreased odds of making a past-year quit attempt. The number of lifetime quit attempts was positively associated with negative smoking consequences. With regard to interest in smoking cessation treatment, 86% and 92% of smokers reported a willingness to try behavioral counseling and nicotine replacement products, respectively, but fewer smokers reported a willingness to try medication, print or Web-based materials, or an unaided quit attempt. CONCLUSIONS: Although half of our sample reported recent quit attempts, many people did not make an attempt using an evidence-based treatment. On the basis of consumer preferences identified herein, clinical recommendations for reinforcing the use of evidence-based smoking cessation treatments for depressed psychiatric inpatient smokers are provided.

Gender Differences in the Relationship Between Physical Activity and Smoking Among Psychiatrically Hospitalized Adolescents.

Physical activity has been identified as a protective factor with regard to tobacco use, such that physically active adolescents are less likely to initiate smoking, and smokers are less physically active than non-smokers. These findings, along with the well-documented benefits of exercise on mood and well-being in adults, have stimulated interest in exercise-based smoking cessation interventions. However, little research has explored the relationship between physical activity and smoking characteristics within adolescent smokers. Also, gender differences in adolescents' motives for smoking and exercise may have implications for intervention development, especially in clinical populations. The current study explored the relationship between physical activity and smoking in a sample of adolescent smokers (N = 191) and non-smokers (N = 48) receiving inpatient psychiatric treatment (61% female, mean age 15.3 years). Results indicated that smokers were less likely to be physically active than non-smokers. Additionally, there was a consistent pattern of gender differences in the relationship between smoking and physical activity within smokers. Specifically, physically active male smokers were less nicotine dependent and less prone to withdrawal, and had a trend toward greater motivation to quit, than their non-active counterparts. In contrast, physically active female smokers did not differ in dependence or withdrawal and were less motivated to quit than non-active female smokers. Taken together, these results suggest that within clinical populations of adolescent females, smoking and exercise may be used jointly as weight control strategies. Exercise-based interventions for smoking cessation for adolescent females, especially clinical populations, should address weight and body image concerns.