Relationship of negative emotionality, NIAAA recovery, and 3- and 6-month drinking outcomes among adults in treatment for alcohol use disorder.

BACKGROUND: The National Institute of Alcohol Abuse and Alcoholism (NIAAA) recently released a new definition of recovery from alcohol use disorder (AUD). A patient is considered recovered if they are remitted from DSM-5 AUD and report cessation of heavy drinking. The NIAAA has also recently proposed the Addictions Neuroclinical Assessment (ANA) to guide treatment research. Negative emotionality is one of three domains of the ANA and theory proposes that AUD is maintained by negative reinforcement via the relief of negative affect. The purpose of the current study was to examine: (1) the relationship of end-of-treatment negative emotionality and NIAAA recovery, and (2) the ability of NIAAA recovery at the end of treatment to predict three- and six-month drinking outcomes. METHOD: At baseline and end-of-treatment, women and men (n = 181) in treatment for AUD completed measures of negative emotionality, drinking, and were assessed for DSM-5 AUD diagnostic criteria. At three- and six-months post-treatment, drinking was re-assessed. RESULTS: 22.5% (n = 24) of participants met full criteria for NIAAA recovery at end-of-treatment. Lower levels of end of treatment negative emotionality were associated with increased odds of achieving NIAAA recovery. Meeting NIAAA recovery predicted greater percent days abstinent (PDA) and lower percent heavy drinking days (PHDD) at 3-months, but not at 6-months post-treatment. CONCLUSIONS: This study is among the first to report a relationship between the negative emotionality domain of the ANA and NIAAA recovery. Results underscore the importance of addressing negative emotionality in treatment. Findings also suggest that NIAAA recovery predicts positive short term drinking outcomes.

Exposure to negative emotional cues and alcohol cue reactivity with alcoholics: a preliminary investigation.

Fifty-one male and female inpatient alcoholics received cue exposure treatment involving in vivo exposure to alcohol cues and imaginal exposure to individualized high-risk drinking situations involving negative emotional cues. At post-test, self-report measures of urge to drink alcohol and negative emotional states were obtained during an alcohol cue reactivity assessment. Contrary to our hypothesis, greater exposure to negative emotional cues during treatment was associated with greater urge and negative emotional responses at post-test. In addition, greater duration of exposure to negative emotional cues predicted greater attention to alcohol-related stimuli and thoughts about drinking during the post-test. Implications for future research in this area include extending the duration of exposure to negative emotional cues in order to establish the optimal exposure durations within which a majority of individuals achieve clinically significant reductions in their urge to drink alcohol.

Integrating substance abuse treatment for the seriously mentally ill into inpatient psychiatric treatment.

This paper offers guidelines for the assessment and treatment of substance abuse problems in seriously mentally ill persons who are admitted into inpatient psychiatric treatment. This approach has been used successfully by the authors and may be most useful in settings where a specialized dual-diagnosis treatment program is not feasible. The first step consists of identifying potential substance abusers using several sources of information including the patient's record, a brief patient interview, and an interview with the patient's family and caseworker. Patients who have a confirmed or suspected substance abuse problem undergo a substance abuse assessment designed to evaluate consumption patterns, the negative consequences of substance use, and high-risk situations for alcohol and drug use. Patients are then presented with individualized feedback in a non-coercive manner, which is intended to increase their motivation to change their substance-use behavior. Treatment consists of a structured coping skills group which covers nine specific topics. The topics covered in the group treatment include both general social skills and specific drug and alcohol coping skills intended to assist individuals in coping effectively with high-risk situations. The content of each group session is described along with guidelines for conducting coping skills group treatment with the seriously mentally ill.

Social and coping reasons for drinking: predicting alcohol misuse in adolescents.

OBJECTIVE: Motivational models of alcohol consumption suggest a positive relationship between reasons for drinking and the amount of alcohol consumed. The present study examined race, gender, and age as moderators of the relationship between social and coping motives and alcohol misuse in black and white adolescents. METHOD: A representative population sample (N = 699) of male and female (54%) adolescents between the ages of 13 and 16 was recruited using a random-digit-dial telephone procedure. Six face-to-face interviews with subjects and their families were carried out at approximately yearly intervals. Information gathered assessed alcohol use, social and coping motives for drinking, and psychological distress. RESULTS: Multiple analyses, including both cross-sectional and longitudinal logistic regression analyses and survival analysis were used to examine the relationship of drinking motives to adolescent alcohol misuse. Contrary to our predictions, social motive was a somewhat better predictor of alcohol misuse than was coping motive, particularly during mid- to late adolescence. However, there was some limited evidence of a significant relationship between coping motives and alcohol misuse in the mid-adolescent age group. Some support was found for racial differences such that social motives are better predictors of alcohol misuse among whites than among blacks and coping motives are better predictors among blacks. Few gender differences were found in the relationship of drinking motives and alcohol misuse. CONCLUSIONS: These findings suggest a stronger tendency for social and coping motives to influence alcohol misuse during mid to late than in early adolescence. Research examining the development of motives and the mechanisms by which they influence drinking behavior is needed.

High-risk alcohol and drug use situations among seriously mentally ill inpatients: a preliminary investigation.

Situational factors are important determinants of alcohol and drug use in general samples of substance abusers, with alcohol users and drug users reporting different trigger situations. This study represents an initial attempt to investigate high-risk alcohol and drug use situations in a sample of dually diagnosed individuals. Thirty men and women with both a serious mental illness and an alcohol use or drug use disorder were recruited from an inpatient psychiatric unit and completed questionnaires assessing high-risk alcohol and drug use situations psychiatric symptomatology, and psychological symptoms that trigger substance use. Although the alcohol and drug groups did not differ significantly in the frequency of self-reported high-risk situations for substance use, effect size analyses suggest that six of eight comparisons would demonstrate statistically significant differences with a larger sample size. Both groups reported using substances most frequently when feeling anxiety or depressive symptoms rather than psychotic symptoms. Although preliminary, these results have relevance for the treatment of dually diagnosed persons, particularly for behavioral treatment interventions such as coping skills training and stimulus control techniques.

Alcohol cue reactivity and private self-consciousness among male alcoholics.

Recent alcohol cue exposure studies have noted that not all alcoholics demonstrate increased reactivity when presented with alcohol-related cues. This study examined the relationship of private self-consciousness (PSC) to subjective, self-report measures of reactivity and measures of negative mood states that involve a focus on internal processes. These subjective measures of reactivity were contrasted with salivary reactivity, an objective measure of reactivity which does not require individual self-report or awareness. A cue reactivity assessment was administered to 47 men meeting DSM-III-R criteria for a diagnosis of alcohol dependence. Our hypothesis, that PSC would predict urge reactivity status and greater levels of negative mood states, was supported. Urge reactors were more likely to be high in PSC, while the proportions of salivary reactors and nonreactors were not significantly different between the high and low PSC groups. Although regression analyses indicated that PSC did not significantly predict urge to drink alcohol, it did predict angry/frustrated mood and sad/depressed mood at the first alcohol trial. These results suggest that individuals high in PSC may benefit more from cue exposure-based treatment, as they are more likely to be urge reactors and to evidence negative mood reactivity. Low PSC individuals may be at higher risk for relapse given they are less able to recognize internal reactions signaling the presence of a high-risk alcohol use situation, and therefore less likely to mobilize coping responses.

A conditioning reinterpretation of cognitive events in alcohol and drug cue exposure.

Cue exposure treatments of alcohol and substance abuse disorders are based on a classical conditioning model of drug use and relapse. Recently, social learning theory has been utilized to explain the relationship of cognitive constructs (i.e., self-efficacy, outcome expectations) to measures of cue reactivity. However, social learning theory has not provided clear and testable mechanisms by which cognitions influence behavior. This paper proposes a mechanism, based on principles of classical conditioning, whereby cognitions may influence reactivity to alcohol and drug cues. This view of cognitions within a conditioning framework has several important implications for cue exposure research and treatment.

A test of Tiffany's cognitive model of drug urges and drug-use behavior.

Tiffany's (1990) cognitive model proposes that drug urges and drug use result from distinct (i.e., controlled versus automatic) cognitive processes. This study tested Tiffany's cognitive model utilizing innovative methods derived from the Multiple Resource Theory of cognitive psychology. Forty-two male and 42 female heavy drinking college students were assigned to 1 of 6 groups in two separate 1 (task) x 3 (treatment) factorial experiments in which half the subjects performed a math task while the other half performed a tracking task. Subjects received 1 of 3 treatments: Urge generation, "Drug" (Placebo) Consumption, or a Water control. The predictions were that urges would interfere with performance on the math task, and "drug" consumption would interfere with performance on the tracking task. The main dependent variables were measures of task performance. The results of this study do not clearly support the model; however, several suggestions for future tests of the cognitive model are discussed. Our findings highlight both the difficulty in testing the model, as well as opportunities for further integration of cognitive psychology and behavioral approaches to addictions.

Alcohol problem resolution in the severely mentally ill: a preliminary investigation.

Participants (N = 25) with a severe mental illness who were receiving mental health outpatient treatment at a state psychiatric hospital were interviewed regarding the resolution of their alcohol problem. Resolution was defined as abstinence or non-hazardous, consequence-free drinking for a minimum of 1 year. Participants were interviewed regarding their drinking history, life events, reasons for change and factors maintaining change. The results reveal that negative life events and weighing the pros and cons of drinking are more often associated with entry into treatment than positive life events and advice or warnings from others. In addition, resolution occurs with and without a history of alcohol-specific treatment and includes both abstinent and non-abstinent drinking outcomes. Although preliminary, these results are consistent with previous research investigating the resolution of alcohol problems in individuals with only a diagnosis of alcohol abuse or dependence. Unique to this population is the finding that control of psychological symptoms was identified as an important maintenance factor during the first 12 months following the resolution date. The limitations of the current study, as well as the implications of these findings for future research investigating processes of change in the severely mentally ill are discussed.

Subject-collateral reports of drinking in inpatient alcoholics with comorbid mental disorders.

Verbal self-report continues to be the primary method by which clinicians and researchers obtain measurements of a person's past drinking. In addition, collateral reports are an important second measure of an individual's drinking behavior. Although there is considerable confidence in the use of collateral reports as a measure of drinking in individuals with only a diagnosis of alcohol abuse or dependence, information about subject-collateral reports for alcoholics with a comorbid mental disorder is lacking. given both that symptoms of mental illness can negatively impact cognitive processes relevant to the recall of information, and that such symptoms can be influenced by alcohol consumption, it is important to be confident in the reports of alcohol use in dually diagnosed individuals. This study examined subject-collateral reports of alcohol use in two groups of inpatient alcoholics: those meeting DSM-III-R criteria for an alcohol use disorder and a current mental disorder (n = 91) and those meeting criteria for an alcohol use disorder only (n = 93). Overall, the results show that the self-reports of alcoholics with comorbid mental disorders are generally valid. In addition, subject-collateral agreement was found to be similar for both groups, with no consistent tendency to overreport or underreport alcohol or drug use in either group. Importantly, psychological symptom severity and cognitive functioning were not related to subject-collateral agreement. However, less frequent contact between subject and collateral had a more negative impact on subject-collateral agreement for the dual diagnosis group, compared with the alcohol-only group. Recommendations for enhancing the accuracy of self-reports of drinking in a dual diagnosis population are discussed.