Examining the daily reciprocal relations between alcohol abstinence self-efficacy and drinking among non-treatment seeking individuals with alcohol use disorder (AUD).

Theoretical and empirical models of alcohol use and misuse indicate that abstinence self-efficacy (ASE) predicts improvements in treatment outcomes among individuals with alcohol use disorder (AUD). More recently, studies have begun examining daily fluctuations in ASE to better understand in-the-moment determinants of drinking behaviors. With the goal of assessing how ASE is implicated in maintenance (rather than changing) of hazardous drinking patterns, the current study examined daily reciprocal relations between ASE and drinking among individuals with AUD. Non-treatment seeking adults (n = 63) with AUD were recruited and completed daily surveys assessing ASE and drinking behaviors for 14 days. Data were analyzed using time-lagged multilevel modeling. Results indicated that both within- and between-person elevations in ASE predicted decreased likelihood of drinking, but only within-person ASE predicted fewer drinks consumed on drinking days. Previous-day drinking behavior was unrelated to next-day ASE; however, higher percentage of drinking days during the monitoring period (between-person) was associated with lower daily ASE. These results demonstrate that confidence in one's ability to abstain from drinking varies considerably across days, and that fluctuations may be implicated in daily drinking decisions. The lack of effect of previous-day drinking on ASE (combined with the significant effect of average drinking frequency) may suggest that sustained periods of reduced drinking or abstinence are necessary to impact ASE. This study points to ASE's role in the maintenance of daily drinking behavior among non-treatment-seeking individuals with AUD and reiterates the importance of self-efficacy in behavioral control and decision-making at the daily level.

Establishing Motivational Profiles to Drink among College Students: Converging Patterns Using Multiple Theories of Alcohol use.

Objective: While college student drinking has been studied utilizing many different theories and approaches, it is unclear how these theories may overlap in their explanation of problematic drinking. Rather than relying on one theory, examining overlap between multiple theories of alcohol use may lead to a better understanding of the motivational process underlying drinking behavior. The current study proposes that the Ambivalence Model of Craving, Behavioral Economics, and Alcohol Outcome Expectancy Theory account for the same underlying anticipatory process and sought to demonstrate this by establishing motivational profiles utilizing constructs within each theory. Methods: A total of 318 college student drinkers completed a series of surveys assessing their drinking behavior and the measures pertaining to each theory (i.e., Approach and Avoidance of Alcohol Questionnaire, Alcohol Purchase Task, Alcohol Expectancy Questionnaire). A latent profile analysis was used to establish profiles of motivational tendencies. Results: Results from the latent profile analysis indicated four profiles emerged, three of which were consistent with our hypotheses: approach, avoidance, and indifferent. The fourth motivational profile appeared to represent drinkers with an emerging approach tendency but relatively newer to drinking. The lack of ambivalent profile suggests that avoidant tendencies may develop later in response to an accumulation of experience with drinking. Lastly, these profiles demonstrated expected relationships with drinking behavior. Conclusion: This study is unique in its attempt to highlight similarities between theories. Results provide a useful integration of theories to allow for a more generalized understanding of motivational tendencies that develop in response to drinking experiences.

Outcomes and Management After COVID-19 Critical Illness.

TOPIC IMPORTANCE: COVID-19 has caused > 7 million deaths worldwide since its onset in 2019. Although the severity of illness has varied throughout the pandemic, critical illness related to COVID-19 persists. Survivors of COVID-19 critical illness can be left with sequelae of both the SARS-CoV-2 virus and long-term effects of critical illness included within post-intensive care syndrome. Given the complexity and heterogeneity of COVID-19 critical illness, the biopsychosocial-ecological model can aid in evaluation and treatment of survivors, integrating interactions among physical, cognitive, and psychological domains, as well as social systems and environments. REVIEW FINDINGS: Prolonged illness after COVID-19 critical illness generally can be classified into effects on physical, cognitive, and psychosocial function, with much interaction among the various effects, and includes a wide range of symptoms such as ICU-acquired weakness, prolonged respiratory symptoms, cognitive changes, post-traumatic stress disorder post-traumatic stress disorder, anxiety, and depression. Risk factors for COVID-19 critical illness developing are complex and include preexisting factors, disease course, and specifics of hospitalization in addition to psychological comorbidities and socioenvironmental factors. Recovery trajectories are not well defined, and management requires a comprehensive, interdisciplinary, and individualized approach to care. SUMMARY: The onset of vaccinations, new therapeutics, and new strains of SARS-CoV-2 virus have decreased COVID-19 mortality; however, the number of survivors of COVID-19 critical illness remains high. A biopsychosocial-ecological approach is recommended to guide care of COVID-19 critical illness survivors.

Semantic clustering on common list-learning tasks: a systematic review of the state of the literature and recommendations for future directions.

INTRODUCTION: On some list-learning tasks, such as the California Verbal Learning Test (CVLT) or Hopkins Verbal Learning Test (HVLT), examinees have the opportunity to group words based on semantically related categories (i.e., semantic clustering). Semantic clustering (SC) is often considered the most efficient organizational strategy and adopting SC is presumed to improve learning and memory. In addition, SC is conceptualized as reflecting higher-order executive functioning skills. Although SC measures have intuitive appeal, to date, there are no comprehensive reviews of the SC literature base that summarize its psychometric utility. In this systematic review, we synthesize the literature to judge the validity of SC scores. METHOD: We conducted a systematic literature search for empirical articles reporting SC from the CVLT and HVLT. We qualitatively described the relationship of SC with other list-learning and cognitive test scores and clinical diagnoses, contrasting SC with serial clustering and total learning scores when possible. RESULTS: SC was inversely correlated with serial clustering. Higher SC was strongly associated with better learning and memory performances. When compared with cognitive tests, SC tended to have the strongest relationships with other memory measures and modest relationships with tests of executive functioning. SC had negligible to small relationships with most other cognitive domains. Traditional memory scores yielded stronger relationships to cognitive test performances than did SC. SC across clinical groups varied widely, but clinical groups tended to use SC less often than healthy comparison groups. CONCLUSION: Our comprehensive review of the literature revealed that SC is strongly related to measures of learning and memory on the CVLT and HVLT and is correlated with a wide range of cognitive functions. SC has been understudied in relevant populations and additional research is needed to test the degree to which it adds incremental validity beyond traditional measures of learning and memory.

Reliability and Factor Structure of the Saint Louis University Mental Status (SLUMS) Examination.

OBJECTIVES: Compared to its alternatives (e.g., Mini-Mental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA]), little is known about the psychometric properties and factor structure of the Saint Louis University Mental Status (SLUMS) Examination. The purpose of the current study is to describe the internal consistency, factor structure, and temporal stability of the SLUMS, a widely used cognitive screening measure. METHODS: We examined the SLUMS of 108 mostly White male Veterans seen for home-based primary care services, 101 of whom had complete data and 28 who completed retesting approximately one year later. RESULTS: At time one, Veterans averaged 76.44 (SD = 9.88) years of age and 13.07 (SD = 2.26) years of formal education. Results indicated that the SLUMS had acceptable internal consistency (α = .709) and temporal stability (ρ =.723), with strongest evidence for a one-factor structure. CONCLUSIONS: The SLUMS appears to have adequate reliability and clear one-factor structure in this sample. Additional research with diverse samples is needed to characterize the psychometrics of the SLUMS more comprehensively. CLINICAL IMPLICATIONS: The SLUMS appears to be an efficient method for approximating global cognitive functioning among medically complex older adults.

Systematic Review of the Psychometric Properties of the Saint Louis University Mental Status (SLUMS) Examination.

OBJECTIVES: This systemic review qualitatively synthesizes existing psychometric support for the Saint Louis University Mental Status (SLUMS) Examination, a cognitive screening measure which presents as a free alternative to other widely used dementia screening measures including the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). METHODS: A total of 90 peer-reviewed articles on the SLUMS were identified from PsycINFO and PubMed databases. RESULTS: Sixty-eight records were identified and reviewed by the lead author for eligibility. Studies that included at least one psychometric property of the SLUMS (n = 20) were included in this review. CONCLUSIONS: Support for the SLUMS remains preliminary; however, it appears to have adequate validity, and adequate sensitivity and specificity in detecting cognitive impairment. Numerous shortcomings were identified, including lack of sufficient normative data, information on test-reliability, explored factor structure, and limited application of criterion measures (e.g., imaging studies, biomarkers). Research is needed to establish diverse normative samples and describe the reliability and validity of the SLUMS to strengthen the empirical support for its use. CLINICAL IMPLICATIONS: Until its psychometric properties are better established the SLUMS should be used cautiously when screening for cognitive impairment.

Using supplemental memory measures to refine interpretation of the repeatable battery for the assessment of neuropsychological status.

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is frequently used as a cognitive screening measure or as part of a comprehensive neuropsychological battery. Augmenting the current memory subtests of the RBANS to reflect clinically meaningful distinctions in memory performance may improve its clinical utility, allowing users to generate additional hypotheses and refine clinical interpretations. We pilot four supplementary memory measures to use with the RBANS, adapted from paradigms commonly used by other neuropsychological tests. We also provide several new theoretically derived memory indices to supplement the standard Delayed Memory Index. The new subtests correlated significantly with the standard memory measures, and the new indices demonstrated good reliability and diagnostic accuracy. This study provides preliminary support for supplementing the RBANS to allow for more nuanced interpretations of memory performance.

Relationship of medical comorbidities to psychological health at 2 and 5 years following traumatic brain injury (TBI).

Objective: To examine the relationship between medical comorbidities and psychological health outcomes at 2 and 5 years following traumatic brain injury (TBI). Method: Veterans Affairs (VA) TBI Model System participants who completed a 2-year (n = 225) and/or 5-year (n = 283) follow-up with a comorbidities interview were included in the current study. Psychological health outcomes were assessed using the Patient Global Impression of Change (PGIC), Patient Health Questionnaire-9 (PHQ-9), and Satisfaction with Life Scale (SWLS). While controlling for known predictors of outcome, the relationship of overall comorbidity burden to psychological outcomes was examined cross-sectionally using generalized linear regression at 2 and 5 years post-TBI. Lasso regularization was used to examine relationships of specific comorbid conditions to outcome. Results: Greater comorbidity burden was significantly associated with lower satisfaction with life at 2 and 5 years post-TBI and was associated with greater depressive symptomatology at 5 years post-TBI. Chronic pain was associated with lower satisfaction with life and greater depressive symptoms at both 2- and 5-year follow-up. Sleep apnea was associated with lower satisfaction with life and greater depressive symptoms at 5-year follow-up. Rheumatoid arthritis was associated with lower satisfaction with life and lower levels of perceived improvement in health and well-being at the 5-year follow-up. Implications: Results suggest that medical comorbidities may have a cumulative impact on adverse psychological health outcomes in chronic stages of TBI. This study further highlights the complexity of patients with TBI and the importance of identifying medical comorbidities as they provide potential targets for intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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.

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.

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.

Examination of approach and avoidance inclinations on the reinforcing value of alcohol.

Although behavioral economics tends to focus on environmental factors (i.e., price, availability) that act to influence valuation of alcohol, recent research has begun to address how motivational and cognitive factors influence an individual's demand for alcohol. Motivational states, including craving, are one possible mechanism underlying the value based decision making that demand represents. Using a multidimensional model of craving (Ambivalence Model of Craving), the current study examined the relationships between indices of alcohol demand (i.e., reinforcing value of alcohol) and craving (i.e., approach inclinations), and the ways in which competing desires moderate that relationship (i.e., avoidance inclinations). Individuals who reported consuming alcohol in the past month were recruited for the study using Amazon's Mechanical Turk. A total of 529 participants (mean age=33.03years, SD=8.85) completed a series of surveys assessing their drinking behavior and other alcohol-related measures. Multiple regression analyses indicated that while approach significantly predicted intensity (i.e., consumption at zero cost), Omax (i.e., the maximum alcohol expenditure) and breakpoint (i.e., the first price that seizes consumption), avoidance moderated the relationship between approach and Omax and breakpoint. Specifically, follow up analyses demonstrated that higher avoidance inclinations attenuated the effect of approach inclinations on these demand indices. Finally, despite conceptual overlap between approach, avoidance, and alcohol demand, regression analyses indicated that these constructs account for unique variance in alcohol outcomes. These results illustrate the importance of considering the effects of both approach and avoidance inclinations on an individual's valuation of alcohol.