Neurocognitive and neurobehavioral mechanisms of change following psychological treatment for alcohol use disorder.

BACKGROUND: Although modestly effective treatments exist for alcohol use disorder (AUD), many individuals return to heavy drinking after treatment, suggesting the need for better understanding of factors that contribute to maintaining abstinence or drinking reductions. Whereas past studies identified what treatments work for AUD, recent studies focus more on why particular treatments work, and the mechanisms by which treatment leads to change. This focus on mechanisms of behavior change (MOBC) may inform the process by which treatment leads to better outcomes, and also may lead to new treatments or modifications of existing treatments that target empirically supported mechanisms known to lead to change. There is a paucity of studies examining MOBC from a neurocognitive perspective. METHOD: To address this gap in knowledge, the study described here is examining emotional reactivity, alcohol cue reactivity, and cognitive control as potential MOBC at three levels of analysis - self-report, behavior, and neural. RESULTS: One hundred ten treatment-seeking individuals with an AUD are being randomized to receive 8 sessions of either Cognitive Behavioral Treatment (CBT) or Mindfulness Based Treatment (MBT) after up to 4 sessions of a platform treatment focused on enhancing motivation to change. To establish the temporal relationship between changes in drinking and changes in MOBC, patients are assessed at baseline, during and immediately after treatment, and 9- and 15-months post-baseline. Relationships between changes in drinking and changes in the proposed MOBC will be examined using advanced mixed modeling techniques. CONCLUSIONS: Results should advance AUD treatment by targeting treatments to neurocognitive MOBC.

Optimizing Recruitment and Retention in Substance Use Disorder Research in Emergency Departments.

INTRODUCTION: Clinical trial recruitment and retention of individuals who use substances are challenging in any setting and can be particularly difficult in emergency department (ED) settings. This article discusses strategies for optimizing recruitment and retention in substance use research conducted in EDs. METHODS: Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED) was a National Drug Abuse Treatment Clinical Trials Network (CTN) protocol designed to assess the impact of a brief intervention with individuals screening positive for moderate to severe problems related to use of non-alcohol, non-nicotine drugs. We implemented a multisite, randomized clinical trial at six academic EDs in the United States and leveraged a variety of methods to successfully recruit and retain study participants throughout the 12-month study course. Recruitment and retention success is attributed to appropriate site selection, leveraging technology, and gathering adequate contact information from participants at their initial study visit. RESULTS: The SMART-ED recruited 1,285 adult ED patients and attained follow-up rates of 88%, 86%, and 81% at the 3-, 6-, and 12-month follow-up periods, respectively. Participant retention protocols and practices were key tools in this longitudinal study that required continuous monitoring, innovation, and adaptation to ensure strategies remained culturally sensitive and context appropriate through the duration of the study. CONCLUSION: Tailored strategies that consider the demographic characteristics and region of recruitment and retention are necessary for ED-based longitudinal studies involving patients with substance use disorders.

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).

A Randomized Trial of Combined tDCS Over Right Inferior Frontal Cortex and Cognitive Bias Modification: Null Effects on Drinking and Alcohol Approach Bias.

BACKGROUND: Deriving novel treatments for alcohol use disorders (AUDs) is of critical importance, as existing treatments are only modestly effective for reducing drinking. Two promising strategies for treating AUDs include cognitive bias modification (CBM) and transcranial direct current stimulation (tDCS). While each strategy has shown positive results in reducing drinking or alcohol-related constructs (e.g., craving), initial tests of the combination of CBM and tDCS have shown mixed results. The present study investigated the degree to which combining CBM and tDCS (2.0 mA anodal current over F10) could reduce alcohol approach biases and alcohol consumption. METHODS: Seventy-nine at-risk drinkers were randomized to 1 of 4 conditions in a 2 × 2 factorial design: verum CBM/verum tDCS, verum CBM/sham tDCS, sham CBM/verum tDCS, or sham CBM/sham tDCS. Participants completed a baseline assessment of alcohol approach bias and drinking quantity/frequency (i.e., drinks per drinking day [DDD] and percent heavy drinking days [PHDD]), 4 sessions of combined CBM and tDCS, and follow-up assessments of approach bias and alcohol consumption. RESULTS: Results indicated that while participants did demonstrate significant alcohol approach biases at baseline, neither CBM, tDCS, nor the interaction reduced the bias at the follow-up. In addition, there was evidence of a trend toward reducing DDD from baseline to the 1-week/1-month follow-ups, but there was no significant effect of the intervention on either DDD or PHDD. CONCLUSIONS: These results partially replicated null results presented in similar CBM/tDCS trials and suggest that this combination, at least with anodal stimulation over dorsolateral or inferior frontal sites, may have limited utility to reduce drinking.

Increasing ethnic minority participation in substance abuse clinical trials: lessons learned in the National Institute on Drug Abuse's Clinical Trials Network.

Underrepresentation in clinical trials limits the extent to which ethnic minorities benefit from advances in substance abuse treatment. The objective of this article is to share the knowledge gained within the Clinical Trials Network (CTN) of the National Institute on Drug Abuse and other research on recruiting and retaining ethnic minorities into substance abuse clinical trials. The article includes a discussion of two broad areas for improving inclusion-community involvement and cultural adaptation. CTN case studies are included to illustrate three promising strategies for improving ethnic minority inclusion: respondent-driven sampling, community-based participatory research, and the cultural adaptation of the recruitment and retention procedures. The article concludes with two sections describing a number of methodological concerns in the current research base and our proposed research agenda for improving ethnic minority inclusion that builds on the CTN experience.

Strengthening the effectiveness of 'whole of government' interventions to break the cycle of violence in disadvantaged communities.

'Whole of government' interventions are increasingly being used in disadvantaged communities to improve safety and break the cycle of violence. This paper draws on learning from the evaluation of two whole of government interventions in western Sydney that arose in response to community violence and extensive property damage. Methods for strengthening program logic and overcoming differences in perspective are outlined.

Knowledge of sudden infant death syndrome prevention strategies in a multicultural, disadvantaged community.

AIM: This study assessed levels of maternal knowledge of sudden infant death syndrome prevention strategies in a socio-economically disadvantaged, culturally diverse population. METHODS: Pregnant women (n=233) were asked to name three things they could do to reduce the risk of cot death. Answers were marked in accordance with the US National Institute of Child Health and Development guide-lines. RESULTS: Of women 51.5% could correctly name two or more strategies that could reduce the risk of sudden infant death syndrome. There was significant difference by the woman's country of birth: 68.2% of Australian-born women were able to correctly identify two or more strategies, compared with only 37.3% of those born overseas (P<0.001). Most of the small number of Indigenous women included in the study were able to correctly identify two or more strategies. Year of arrival in Australia, number of previous children, age and level of education were not significantly related to women's knowledge. CONCLUSION: Knowledge of sudden infant death syndrome prevention strategies was poorer in overseas-born women. Practitioners working with disadvantaged, overseas-born women should give consideration to women's knowledge of sudden infant death syndrome prevention if current low rates of sudden infant death syndrome deaths are to be maintained.

The social capital:health relationship in two disadvantaged neighbourhoods.

OBJECTIVES: Research into the social determinants of health inequalities is increasingly focusing on macro-level forces affecting individuals and communities. The concept of social capital has been at the centre of this research as a potential explanatory framework for understanding these inequalities. The aim of this study was to identify the components that define social capital and its relationship to self-reported health in two neighbourhoods known to be disadvantaged in south-western Sydney. METHODS: This study uses data from cross-sectional household (door-knock) surveys originally developed as evaluation tools for neighbourhood based interventions. Secondary analyses including factor analysis and multiple regression analysis were used to provide empirical evidence of the components defining social capital and how these, as a concept, were associated with self-reported health. RESULTS: The study revealed six common social capital components in each sample and an additional component in one neighbourhood. These included neighbourhood attachment, support networks, feelings of trust and reciprocity, local engagement, personal attachment to the area, feelings about safety and proactivity in the social context. The social capital model incorporating demographic and socio-economic characteristics explained 23.4% of health variance in one neighbourhood, and 19.3% in the other. Examining the social capital:health relationship revealed that with the exception of feelings of trust and reciprocity, no other social capital component made significant contributions to explaining health variance and that macro-level factors such as housing conditions and employment opportunities emerged as key explanatory factors. CONCLUSION: If interventions are to use social capital as a way of addressing health inequalities, these need to look closely at the role of trust for improving health outcomes of deprived populations as well as ensuring access to resources and infrastructure.