Reductions in Drinking Predict Increased Distress: Between- and Within-Person Associations between Alcohol Use and Psychological Distress During and Following Treatment.

BACKGROUND: As the nature of the association between alcohol use disorder (AUD) and other disorders is not well understood, the ways in which psychological distress changes during the course of treatment for AUD are relatively unknown. Existing literatures posit 2 competing hypotheses such that treatment for AUD concurrently decreases alcohol use and psychological distress or treatment for AUD decreases alcohol use and increases psychological distress. The current study examined the ways in which psychological distress changed as a function of treatment for AUD, including the relationship between psychological distress and drinking behaviors. METHODS: Secondary data analysis was conducted on an existing clinical trial dataset that investigated the effect of cognitive-behavioral therapy and therapeutic alliance feedback on AUDs. Specifically, data collected at baseline, posttreatment, 3-month, 6-month, 9-month, and 12-month follow-up assessments were examined. RESULTS: Results indicated decreases in heavy drinking days, increases in percentage of days abstinent, and decreases in overall psychological distress. Findings also revealed that changes in psychological distress did not predict changes in drinking at the next time interval; however, decreases in drinking predicted higher psychological distress at the next assessment. Further, average levels of psychological distress were positively associated with rates of drinking. CONCLUSIONS: The current study provides some insight into how psychological distress changes during the course of treatment for AUD, including the relationship between changes in drinking and such symptoms. Future research should continue to explore these relationships, including the ways in which treatment efforts can address what may be seen as paradoxical effects.

Development and Psychometric Evaluation of a Brief Approach and Avoidance of Alcohol Questionnaire.

BACKGROUND: The Approach and Avoidance of Alcohol Questionnaire (AAAQ) was developed as a measure of craving to assess both desires to consume and desires to avoid consuming alcohol. Although the measure has been used in a variety of populations to predict future alcohol use behavior, the factor structures observed vary based on sample type (e.g., clinical vs. college samples) and may be overly long for use in repeated measures designs. The current article describes the development of a brief version of the AAAQ for use in clinical populations. METHODS: Using existing data sets of individuals in treatment for alcohol use disorder, exploratory analyses (e.g., exploratory factor analysis and item response theory) were conducted using an inpatient sample (N = 298) at a substance abuse treatment facility. Confirmatory analyses (e.g., confirmatory factor analysis and multiple regression) were conducted using an inpatient detoxification sample (N = 175) and a longitudinal outpatient treatment sample (N = 53). RESULTS: The brief AAAQ had comparable internal consistency, explained a similar amount of variance in alcohol consumption and related problems, and exhibited superior model fit as compared to the original measure. CONCLUSIONS: These findings indicate that the brief AAAQ is an effective tool to assess alcohol craving in clinical populations in treatment settings.

Disaggregating within- and between-person effects of affect on drinking behavior in a clinical sample with alcohol use disorder.

OBJECTIVE: The goal of the current study was to better understand affect-drinking relations among those diagnosed with an alcohol use disorder (AUD), as recent meta-analytic work suggests that daily negative affect may not universally predict subsequent alcohol consumption in those nondependent on alcohol. Specifically, we investigated the between- and within-person effects of positive and negative affects on drinking. METHOD: Participants (n = 92) who met AUD diagnostic criteria completed a 90-day daily assessment of drinking behavior and positive and negative affects. RESULTS: Time-lagged multilevel modeling revealed that within-person elevations in negative affect predicted increased odds and quantity of drinking later in the day. Relations between positive affect and drinking were nonsignificant. CONCLUSIONS: These findings are in contrast to recent meta-analytic findings and highlight the complexity of affect-drinking relations among those diagnosed with AUD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychometric Evaluation of the Approach and Avoidance of Alcohol Questionnaire in a Community Sample.

Contrary to most theories of alcohol craving, which only consider desires to use, the Ambivalence Model of Craving (AMC) conceptualizes craving bi-dimensionally as the concurrent desires to consume (approach) and desires not to consume (avoid) alcohol. Consistent with the AMC, the Approach and Avoidance of Alcohol Questionnaire (AAAQ) is a 14-item self-reported measure designed to assess alcohol approach and avoidance inclinations. Scores on the AAAQ have been shown to have high reliability and validity in clinical and college student populations, with a two-factor solution emerging in clinical samples of patients with Alcohol Use Disorders (AUDs) and a three-factor solution in samples of college students. However, despite a number of studies examining the use of the AAAQ in clinical and college student samples, to the best of our knowledge there have not been any psychometric evaluations of the AAAQ in community samples. The current study examined the psychometric properties of the AAAQ by examining the factor structure in a community sample (N = 537). Consistent with the results of previous studies utilizing non-clinical samples, a three-factor solution fit the data best and was invariant across gender. Additionally, all three factors were significantly associated with variables of drinking behavior. These results suggest that the AAAQ provides valid and reliable scores that measure approach and avoidance inclinations in community populations.

Applying a multidimensional model of craving to disordered eating behaviors: Development of the Food Approach and Avoidance Questionnaire.

Despite revisions to the DSM-5, current diagnostic criteria poorly capture the phenomena of eating disorders. The construct of food craving may help to explain the range of disordered eating and compensatory behaviors, but current measures do not fully capture the construct. Borrowing from the substance use literature and emphasizing both approach and avoidance craving inclinations, the ambivalence model of craving (AMC) provides a useful framework for predicting broad patterns of disordered eating behaviors. This study sought to develop and preliminarily validate a multidimensional AMC-based measure of food craving. Items for the Food Approach and Avoidance Questionnaire were generated and development and validation data were collected via online survey from community-based adults and university students (N = 1,070). Exploratory factor and item response theory analyses were used for measure development. Linear regressions were used to examine convergent and discriminant validity. Exploratory sensitivity analyses included logistic regressions and receiver operating characteristic curves. As hypothesized, a 2-factor measure was supported. No sex differences emerged in item functioning. The approach factor was associated with greater trait food craving, more uncontrolled eating, and greater likelihood of meeting self-reported diagnostic criteria for bulimia nervosa and binge eating disorder. The avoidance factor was associated with higher levels of restrained eating, drive for thinness, and an increased likelihood of meeting self-reported diagnostic criteria for anorexia nervosa and bulimia nervosa. Preliminary data support a new multidimensional measure of approach and avoidance food craving with potential for a transdiagnostic conceptualization of disordered eating and compensatory behaviors. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Health-related internet use among opioid treatment patients.

The Internet and smartphones have become commonplace and can be effective in overcoming traditional barriers to accessing health information about substance use disorders (SUD), and their prevention or treatment. Little is known, however, about specific factors that may influence the use of these technologies among socioeconomically disadvantaged populations with SUDs. This study characterized the use of digital technologies and the Internet among individuals receiving treatment for opioid use disorder, focusing on identifying predictors of Internet use for health-related purposes. Participants came from an urban opioid replacement therapy program and completed a face-to-face survey on Internet and technology use. We examined the association between online health information seeking and technology acceptance variables, including perceived usefulness, effort expectancy, social influence, and facilitating conditions (e.g., availability of devices/services and technical support). Participants (N = 178, ages 18-64) endorsed high rates of current smartphone ownership (94%) and everyday Internet use (67%). 88% of participants reported searching online for information about health or medical topics in the past 3 months. Predictors of Internet use for health-related purposes were higher technology acceptance for mobile Internet use, younger age, current employment, and less bodily pain. Our results demonstrate high acceptance and use of mobile technology and the Internet among this sample of socioeconomically disadvantaged individuals with SUDs. However, these findings also highlight the importance of identifying barriers that disadvantaged groups face in using mobile technologies when designing technology-based interventions for this population.

Impact of Pretreatment Change on Mechanism of Behavior Change Research: An Applied Example Using Alcohol Abstinence Self-Efficacy.

OBJECTIVE: With the growing recognition that, for some, significant changes in drinking occur before the first treatment session (i.e., pretreatment change), researchers have called for the careful assessment of when change occurs and its potential impact on mechanism of behavior change (MOBC) research. Using a commonly hypothesized MOBC variable, alcohol abstinence self-efficacy, the primary aim of this study was to examine the effect of pretreatment change on the study of MOBCs. METHOD: Sixty-three individuals diagnosed with alcohol dependence were recruited to participate in a 12-week cognitive-behavioral treatment. Participants completed weekly assessments of self-efficacy and drinking behaviors. RESULTS: Multilevel time-lagged regression models indicated that pretreatment change significantly moderated the effect of self-efficacy on the number of drinking days, such that among those higher on pretreatment change, higher self-efficacy ratings predicted lower rates of drinking days in the week until the next treatment session. In contrast, pretreatment change did not moderate the effect of self-efficacy on the rate of heavy drinking days. CONCLUSIONS: Results from the current study add to a small but growing body of research highlighting the importance of pretreatment change when studying MOBCs. Further, these results provide important insights into the conditions in which self-efficacy may play an important role in treatment outcomes.