Cue exposure with coping skills training and communication skills training for alcohol dependence: 6- and 12-month outcomes.

AIMS: Cue exposure treatment (CET) has shown promise in preliminary studies with alcoholics, and Communication Skills Training (CST) has been found beneficial, especially in intensive treatment programs. The aim of the present study was to investigate the effects of CET and CST in a larger controlled study when both were added to intensive treatment programs. DESIGN AND INTERVENTIONS: A 2 x 2 design investigated the effects of CET with urge coping skills training compared to a meditation-relaxation control, and CST compared to an education control when all were added to intensive treatment programs for alcoholics. SETTING: The sites were the inpatient or partial hospital substance abuse treatment programs at a private psychiatric hospital, a state-funded residential facility and a VA medical center. PARTICIPANTS: Patients diagnosed with alcohol dependence without active psychosis were eligible. MEASUREMENTS: Participants were assessed for quantity and frequency of drinking, alcohol cue-reactivity, responses to high risk simulations and urge specific coping skills. FINDINGS: Of 100 treated patients, 86% provided 6-month and 84% provided 12-month follow-up data. Patients who received either CET or CST had fewer heavy drinking days in the first 6 months than control patients. In the second 6 months, CET continued to result in fewer heavy drinking days among lapsers and interacted with CST to decrease quantity of alcohol consumed. CST resulted in fewer alcohol-related problems reported at 12 months. CET resulted in greater reductions in urge to drink in a measure of simulated high-risk situations. CET also resulted in greater reports of use of coping strategies during the follow-up, and many of the urge-specific strategies taught in CET were associated with reduced drinking. CONCLUSIONS: Both CET and CST continue to show promise as elements of comprehensive alcohol treatment programs. Limitations and directions for future research are discussed.

Irrational beliefs, urges to drink and drinking among alcoholics.

The relationship of various irrational beliefs to alcohol dependence, urges to drink, anxiety and drinking after treatment was investigated for 63 male alcoholics, using Jones' Irrational Beliefs Test (IBT). Alcohol dependence was most strongly associated with problem avoidance. Urges to drink, anxiety and difficulty during alcohol-related role-plays were strongly correlated with problem avoidance and dwelling on negative events. The IBT was unrelated to pretreatment drinking measures but did predict 6-month posttreatment drinking (n = 48) which suggests these beliefs can mediate treatment response. Feeling doomed by the past was the best predictor of both frequency of drinking and average quantity consumed during follow-up. Treatment implications include targeting specific beliefs for intervention.

Communication skills training, communication skills training with family and cognitive behavioral mood management training for alcoholics.

To evaluate three promising social learning approaches to the treatment of alcoholism, 69 male alcoholics in standard inpatient treatment participated in either a communication skills training group (CST), a communication skills training group with family participation (CSTF) or a cognitive behavioral mood management training group (CBMMT). Alcoholics who received CST or CSTF drank significantly less alcohol per drinking day during 6-month follow-up than those in CBMMT. The groups did not differ in abstinence rates or latency to relapse. All groups improved in skill and anxiety on the extensive battery of process measures, including role-play tests of general and alcohol-specific coping skills, but those in CST improved most in skill in alcohol-specific high-risk role plays and in ability to relax after the role plays. Alcoholics' skill, response latency, anxiety and urge to drink during alcohol-specific role plays were highly correlated with treatment outcome, demonstrating the importance of including comprehensive process measures in treatment outcome research. Implications for patient-treatment matching and future research are discussed.

Alcohol abusers' and social drinkers' responses to alcohol-relevant and general situations.

Responses of alcohol abusers and social drinkers were compared on general and alcohol-specific problem situations using role-play methodology. Multiple responses were assessed including behavioral observational ratings, self-reports and psychophysiologic measures. There were few differences between groups in responses to the general situations. Alcohol abusers had higher urges to drink than did the social drinkers in both the general and the alcohol-specific situations. However, in response to the alcohol-specific situations, the alcohol abusers, compared to the social drinkers, were rated by judges as significantly less skillful, and they displayed more self-reported anxiety, had a higher frequency of occurrence of problem situations in the natural environment and reported greater perceived realism of the alcohol-specific situations. Psychophysiologic measures did not differentiate between the groups. Results are discussed with respect to the importance of situation specificity in understanding the precipitants of drinking and their treatment implications.

Development of a behavior analytically derived alcohol-specific role-play assessment instrument.

Social learning theory postulates that chronic alcohol abusers may have deficits in ability to cope with stressful situations, and these deficits may be associated with relapse after treatment. Attempts to study the hypothesized deficits have been hampered by methodological problems. Therefore, a behavior analytic procedure was used to develop 10 categories of situations based on over 600 drinking situations elicited from alcoholics. Role plays were developed for each of these categories, and samples of alcoholics in treatment were asked to respond as if they were trying not to drink. Videotaped responses were behaviorally rated by trained judges for skill and anxiety, and subjects completed self-report ratings of urge to drink, anxiety, difficulty and skill after each role play. Good interrater reliabilities and internal consistency were found across three samples of alcoholics, with virtually no gender differences. Previous and current investigations show the validity and utility of this instrument. The Alcohol Specific Role Play Test therefore shows promise as a means of assessing alcoholics' reactions to high-risk situations.

Stimulus control of self-destructive behavior in a psychotic child.

This study attemped to isolate some of the stimulus variables that controlled the self-destructive behavior of a psychotic child. In Experiment 1, the child was exposed to several demand and nondemand situations. In Experiment 2, the situation containing demands was modified so that demands now occurred in the context of a positive, ongoing interaction between the child and the adult therapist. The rates of self-destructive behavior underwent several orderly changes: (1) Rates were high in demand situations and low in nondemand and modifieddemand situations; (2) rates decreased sharply when a stimulus correlated with the termination of demands was introduced; and (3) rates of self-destruction typically showed gradual increases within each of those sessions which contained only demands. These results were interpreted as suggesting that (1) self-destruction, under certain circumstances, may be conceptualized as an escape response which is negatively reinforced by the termination of a demand situation and (2) certain modifications of the social environment may provide discriminative stimuli for behaviors other than self-destruction, thereby decreasing this behavior.

Patient-treatment matching for alcoholic men in communication skills versus cognitive-behavioral mood management training.

It would be helpful to be able to predict which alcoholics will be more likely to benefit from specific forms of treatment in order to optimize treatment resources. Certain hypothesized patient-treatment matching predictions were investigated with 52 alcoholics who received either communication skills training or cognitive behavioral mood management training in addition to a standard Veterans Administration inpatient alcoholism treatment program. Significant interaction effects showed that alcoholics had worse treatment outcomes in mood management training if they had higher initial anxiety or urge to drink in high-risk role plays or lower had higher initial anxiety or urge to drink in high-risk role plays or lower education. No significant interaction of treatment with irrational beliefs or marital status was found. Communication skills training seemed to be equally effective for alcoholics at any educational level, irrespective of initial coping skill, anxiety, urge to drink, alcohol dependence, or marital status. Thus, although mood management training seems to be as effective as communication skills training for alcoholics with higher education, less anxiety, and less urge to drink, communication skills training benefits a broader spectrum of patients, regardless of initial level of education, alcohol dependence, skill, anxiety, or beliefs.

Acquisition of sign language by autistic children. I: Expressive labelling.

There has been growing interest in teaching sign language to autistic children who have failed to develop speech. However, controlled experimentation in this area is nonexistent. In the present study, four nonverbal autistic children were taught expressive sign labels for common objects, using a training procedure that consisted of prompting, fading, and stimulus rotation. The efficacy of the procedure was demonstrated in a multiple-baseline design across objects. The results were reliable, replicable across children, and generalizable across therapists. A stimulus control analysis demonstrated that, for three of the children, correct signing was controlled solely by the visual cues associated with the presentation of a given object and was independent of respect to the known perceptual and linguistic deficits of autistic children.

Escape as a factor in the aggressive behavior of two retarded children.

This study sought to identify some of the variables controlling the severely aggressive behavior of two retarded children. In Experiment 1, each child was presented with several demand and nondemand situations. Aggression was frequent in the demand situations and rare in the nondemand situations. When a stimulus correlated with the termination of demands was introduced, aggression fell to a near zero level. In Experiment 2, for one child, a variety of preferred reinforcers was introduced into the demand situation contingent on correct responding. Aggression abruptly decreased to a low level. Experiments 3 and 4 involved the second child. In Experiment 3, this child was permitted, in one condition, to leave the demand situation if he emitted a nonaggressive response. Aggression decreased to a low level. In Experiment 4, he was prevented, in one condition, from leaving the demand situation in spite of high levels of aggression. Aggression fell to a near zero level. In Experiments 3 and 4, he was permitted, in several conditions, to leave the demand situation following aggressive behavior. Aggression increased to a high level. The results suggested that: (1) aggression can sometimes function as an escape response; and (2) escape-motivated aggression can be controlled by: (a) introducing strongly preferred reinforcers to attenuate the aversiveness of the demand situation; (b) strengthening an alternative, nonaggressive escape response; or (c) using an escape-extinction procedure.