Using self-help materials to motivate change at assessment for alcohol treatment.

The utility of a brief self-help booklet provided at assessment for alcohol treatment was evaluated using a quasi-experimental design (booklet provided to all clients for one month at a time, interspersed by one month of no booklets, for a 6-month period). While the booklet did not result in any significant reduction in client attrition, clients who received the booklet at their assessment were drinking less by the 6-month follow-up than those who did not receive the booklet. Limitations of this study, including the quasi-experimental design and the impact of the low baseline attrition rates, are discussed.

Problem drinkers: evaluation of a stepped-care approach.

The present study evaluated a stepped-care model for the treatment of problem drinkers; those not severely dependent on alcohol. The initial treatment consisted of a motivationally based, four-session outpatient treatment. Based on previous research, treatment nonresponders were defined as having consumed more than 12 drinks per week between the assessment and third session. Six-month follow-up interviews were conducted on three groups of problem drinkers: (1) those who responded to the initial intervention (n = 67); (2) those who did not respond to the initial treatment (n = 36); and (3) those who did not respond to the initial treatment and received a supplemental intervention (n = 33). The last two groups were used to evaluate whether providing treatment nonresponders with an additional "step" would improve treatment outcomes. The primary dependent measures were posttreatment percent days abstinent and posttreatment drinks per drinking day. Results suggested that (1) within treatment drinking can help identify treatment nonresponse in stepped-care models; (2) the supplemental intervention did not influence posttreatment drinking; (3) treatment responders and nonresponders sought additional help at the same rate. The present study is the first study on stepped-care for alcohol treatment and provides a methodology for evaluating stepped interventions. Recommendations for future research in this area include more attention to assessing the needs of treatment nonresponders and help seeking behavior of both responders and nonresponders after an initial intervention.

Relationship between posttreatment drinking and alternative responses to high-risk situations proposed during treatment by problem drinkers.

Problem drinkers' alternatives to high-risk situations were evaluated and related to treatment outcome. participants were 80 problem drinkers (64% males, 36% females) who completed a brief outpatient Guided Self-Change treatment. Treatment included a homework exercise where clients identified two to three high-risk situations and generated alternative responses for each situation. Based on a coding scheme developed by Moser and Annis (1996), responses were coded as (a) cognitive or behavioral, and (b) active or avoidant. Results indicated that the proportion of cognitive coping responses (e.g., thinking through the consequences) was positively related to posttreatment improvement. This prospective study suggests that intention to use active cognitive coping responses influences the relapse process.

A model for answering the substance abuse educational needs of health professionals: the North Carolina Governor's Institute on Alcohol and Substance Abuse.

Physicians can play an increased role in recognizing, intervening, and moderating their patients' misuse of alcohol and other drugs. This article explores the need for educational changes to permit physicians to develop skills in prevention, screening, and office-based treatment. It includes a personal account by one of the authors of his experience in recognizing deficiencies in substance abuse education both in his own medical school training and in today's health science curricula in the United States. It reviews prior initiatives by NIAAA/NIDA to address curriculum needs and describes an innovative collaborative model in North Carolina called the Governor's Institute on Alcohol and Substance Abuse. The Institute was created in 1990 as a nonprofit corporation to promote education, research, and communication among health professionals. Some of the Institute's programs are described, including its curriculum integration project in the state's four medical schools. The article concludes that the time is right to introduce substance abuse concepts into basic and continuing education for all health professionals.

Learning alcohol tolerance by mental or physical practice.

Five groups of six male social drinkers learned a psychomotor task (Tracometer) and subsequently attended five sessions to perform the task after drinking. On each of the first four sessions, subjects received 0.62 g/kg alcohol. On session 5, a placebo was administered when alcohol was expected. During treatment sessions 1-3, two groups performed the task with a valuable consequence for drug-compensatory performance: either information (IO) or information plus money (MI). This MI experience was mentally rehearsed by a third group (MR). Two control groups performed the task, either with no outcome (N), or with money for compensatory performance but no information about earnings until the study concluded (MO). Sessions 4 and 5 assessed the effect of the prior treatments when all groups performed the task with money and information. Groups MI, IO and MR displayed comparable and significantly more tolerance and a stronger compensatory response to placebo than control groups MO and N. The evidence indicates that mental or physical practice associating drug-compensatory performance with some valuable outcome enhances tolerance to moderate doses of alcohol.

Response expectancies affect the acquisition and display of behavioral tolerance to alcohol.

Two experiments demonstrated that a learned expectation of a favourable consequence for drug-compensatory performance enhanced behavioral tolerance to alcohol, and when the expectancy was trained, the subsequent display of tolerance depended upon its consequence. Both experiments involved each of four groups of six male social drinkers each, who drank 0.62 g/kg alcohol on four sessions, and a placebo on a fifth session. Experiment 1 provided two groups with the opportunity to learn the response expectancy by performing a motor task under alcohol with either an informative consequence (IO) or information plus money contingent upon drug-compensatory performance (MI). Two control groups performed with either no outcome (N), or with money for compensatory performance but no information about earnings until the experiment concluded (MO). The effects of learning history were evident on sessions 4 and 5 when the same consequence was contingent upon the performance of all groups. Compared to controls, the groups that had received response expectancy training (MI and IO) displayed significantly more alcohol tolerance and greater compensatory facilitation of performance under placebo. In Experiment 2, all groups received the same response expectancy training, and the effect of the consequence of compensatory performance was demonstrated during subsequent test sessions 4 and 5. An informative consequence (MI or IO) enhanced tolerance and the compensatory response to placebo, whereas performance with no response contingent information (N or MO), revealed little tolerance or compensatory response to placebo. Theoretical and practical implications of the findings were discussed.

Learning alcohol tolerance: the contribution of response expectancies.

This paper reviews research on tolerance developed by task practice under alcohol, and concludes that tolerance in such a situation is influenced by the environmental consequence of drug-compensatory performance. Analysis of the evidence proposes that a learned association between the response and its consequence results in a response expectancy. When the consequence of drug-compensatory performance is more valuable, more tolerance is displayed. Support for this learning analysis is provided by some recent alcohol research indicating that response expectancies affecting tolerance can also be acquired by mental rehearsal of performance and its outcome under drug. Further, these response expectancies may be acquired during the course of a single drug dose, and may alter the display of acute tolerance to alcohol. Additional theoretical predictions are discussed, and the possible social and clinical relevance of the evidence is considered.

Mental rehearsal of a task before or after ethanol: tolerance facilitating effects.

Two groups of six male social drinkers learned a psychomotor skill task and then drank the same dose of ethanol (0.62 g/kg) on each of five sessions. Sessions 1 and 5 provided pre-treatment and post-treatment measures of task performance under ethanol. During treatment sessions 2, 3 and 4, one group (MRBD) mentally rehearsed the task before drinking and the other group (MRAD) mentally rehearsed the task after drinking. On the post-treatment session, the MRAD group was significantly less impaired (i.e. more tolerant) than the MRBD group. Thus, mental rehearsal of a task under ethanol facilitates the development of tolerance to the behavioral effects of the drug.

Attenuation of ethanol tolerance by a novel stimulus.

A Pavlovian conditioning model of tolerance emphasizes that an association between predrug cues and the systemic effects of the drug contributes to tolerance. On the basis of this model, established tolerance should be attenuated by "external inhibition," i.e., by presentation of a novel, extraneous stimulus. This prediction was evaluated in the present experiment. Rats that were so tolerant to the hypothermic effect of ethanol that they evidenced no drug-induced decrease in temperature were presented with a bright strobe light following ethanol administration. The light precipitated a large decrease in temperature in these rats. These results provide further evidence that tolerance to the hypothermic effect of ethanol is, in part, mediated by learning.