Urge to gamble in a simulated gambling environment.

Cue reactivity, while increasingly recognized as a central feature of drug and alcohol addiction, is not well studied in gambling. We evaluated the urge to gamble in a simulated casino environment among frequent gamblers who alternated between cycles in which they observed others playing ten hands of Blackjack (first, third and fifth cycle) and cycles in which they played ten hands of Blackjack themselves (second and fourth cycle). The played cycles served as a manipulation for the observed cycles in terms of "priming" (having previously gambled in the environment vs. not) and "anticipation" (expecting more opportunities to gamble in the environment vs. not) and, thus, allowed these conditions: observed cycle 1 = anticipation (+) and prime (-); observed cycle 2 = anticipation (+) and prime (+); and observed cycle 3 = anticipation (-) and prime (+). Subjects' urge to gamble was greater in the gambling environment than in a neutral setting and both positive anticipation and positive priming increased cue reactivity within the gambling environment. The frequency of gambling outside of the study did not affect cue reactivity. However, a preference for Blackjack (vs. other types of gambling) and observing winning (vs. losing) hands were both associated with stronger cue reactivity in the study. These findings contribute to our understanding of pathological gambling.

Cognitive-behavioral therapy for panic disorder in patients being treated for alcohol dependence: Moderating effects of alcohol outcome expectancies.

Anxiety disorders commonly co-occur with alcohol use disorders and reliably mark a poor response to substance abuse treatment. However, treating a co-occurring anxiety disorder does not reliably improve substance abuse treatment outcomes. Failure to account for individual differences in the functional dynamic between anxiety symptoms and drinking behavior might impede the progress and clarity of this research program. For example, while both theory and research point to the moderating role of tension-reduction alcohol outcome expectancies (TR-AOEs) in the association between anxiety symptoms and alcohol use, relevant treatment studies have not typically modeled TR-AOE effects. We examined the impact of a hybrid cognitive-behavioral therapy (H-CBT) treatment for panic disorder (independent variable) on response to a community-based alcohol dependence treatment program (dependent variable) in patients with higher vs. lower TR-AOEs (moderator). The H-CBT treatment was generally effective in relieving participants' panic symptoms relative to controls. However, TR-AOEs interacted with study cohort (H-CBT vs. control) in predicting response to substance abuse treatment. As expected, the H-CBT was most effective in improving alcohol use outcomes among those with the highest TR-AOEs. The study's primary methodological limitations are related to the quasi-experimental design employed.

Follow-up study of anxiety disorder and alcohol dependence in comorbid alcoholism treatment patients.

BACKGROUND: Anxiety disorders are present in a high percentage of alcoholism treatment patients. We tested the prediction that having a comorbid anxiety disorder increases the prospective risk for relapse to drinking after alcoholism treatment. We also explored the prospective associations of specific anxiety syndromes (and depression) with drinking and anxiety outcomes. METHODS: We assessed the diagnostic status and daily drinking patterns of 82 individuals approximately one week after they entered alcoholism treatment (baseline) and again approximately 120 days later (follow-up) (n=53). RESULTS: Consistent with study predictions, those with a baseline anxiety disorder (approximately 55%) were significantly more likely than others to meet various definitions of drinking relapse over the course of the follow-up. Regression models showed that baseline social phobia was the single best predictor of a return to any drinking after treatment, whereas panic disorder was the single best predictor of a relapse to alcohol dependence after treatment. Having multiple anxiety disorders (versus any specific anxiety disorder) at the baseline was the strongest predictor of having at least one active ("persistent") anxiety disorder at the follow-up. Cross-sectional analysis at the follow-up showed that anxiety disorder persisted in the absence of a relapse to alcohol dependence far more often than relapse to alcohol dependence occurred in the absence of a persistent anxiety disorder. CONCLUSIONS: Screening for comorbid anxiety disorder in alcoholism treatment patients is warranted and, where found, should be considered a marker of high relapse risk relative to that of noncomorbid patients. The capacity of specific anxiety treatment to mitigate relapse risk among comorbid patients remains an open question.