Desire thinking as a predictor of drinking status following treatment for alcohol use disorder: A prospective study.

Research has indicated that craving is one of the strongest predictors of treatment outcome and relapse in Alcohol Use Disorders (AUD) but there is little consensus on the factors that may influence its activation and escalation. Research has also shown that desire thinking is an important cognitive process which may exacerbate craving in problem drinkers. The aim of present study was to explore, for the first time, the role of desire thinking in prospectively predicting relapse, craving and binge drinking in patients receiving treatment for AUD. One hundred and thirty-five patients admitted to two rehabilitation centres and two outpatient services for addiction and mental health problems were administered baseline, treatment completion and three months follow-up measures of anxiety and depression, AUD severity, binge drinking frequency, craving and desire thinking. Results indicated that the verbal perseveration component of desire thinking at treatment completion was the only significant predictor of relapse at follow-up over and above baseline AUD severity and binge drinking frequency. Furthermore, the imaginal prefiguration component of desire thinking and craving levels at treatment completion were found to predict craving levels at follow-up independently of AUD severity and binge drinking frequency at baseline. Finally, both the imaginal prefiguration and verbal perseveration components of desire thinking at treatment completion were found to be the only predictors of binge drinking frequency at follow-up independently of AUD severity and binge drinking frequency at baseline. Treatments for AUD should aim to reduce desire thinking in people to enhance clinical outcomes and reduce relapse risk.

Stages and Processes of Change Utilized by Female Sex Workers Participating in an Alcohol-Reduction Intervention in Mombasa, Kenya.

BACKGROUND: According to the transtheoretical model (TTM) behavior change occurs through a series of steps when an individual becomes aware of a behavior, prepares to change, and executes those changes using certain processes. This model has not yet been used to describe alcohol-reduction behavior change processes in resource-limited settings. OBJECTIVE: This qualitative analysis aimed to describe and characterize the stages and processes of change employed by female sex workers in Mombasa, Kenya during the course of their participation in a 6-month alcohol reduction intervention. METHODS: In 2011-2012, clinical interviews were conducted with 45 female sex workers. One interview was conducted each month during the intervention period, resulting in a total of six transcripts per participant. During each interview, the counselor noted the participant's stage of change and recent alcohol use. The clinical notes were analyzed via qualitative coding techniques and organized into matrices to classify alcohol reduction strategies discussed by participants. RESULTS: Participants discussed using the stage-specific processes of change described by the TTM to reduce their alcohol use and maintain the behavior change. Participants who were HIV-positive at the start of the intervention seemed to progress to the action/maintenance stage more quickly than HIV-negative participants. CONCLUSIONS/IMPORTANCE: Results suggest that the TTM constructs may be relevant in understanding the alcohol reduction behavior change process of an at-risk population in a resource-limited setting. Future quantitative research should seek to validate the TTM's application internationally. Alcohol interventions should consider tailoring content to participants' stages of change and HIV-status for increased effectiveness.

Exploring Elements of Fun to Motivate Youth to Do Cognitive Bias Modification.

OBJECTIVE: Heavy drinking among young adults poses severe health risks, including development of later addiction problems. Cognitive retraining of automatic appetitive processes related to alcohol (so-called cognitive bias modification [CBM]) may help to prevent escalation of use. Although effective as a treatment in clinical patients, the use of CBM in youth proves more difficult, as motivation in this group is typically low, and the paradigms used are often viewed as boring and tedious. This article presents two separate studies that focused on three approaches that may enhance user experience and motivation to train: a serious game, a serious game in a social networking context, and a mobile application. MATERIALS AND METHODS: In the Game Study, 77 participants performed a regular CBM training, aimed at response matching, a gamified version, or a placebo version of that training. The gamified version was presented as a stand-alone game or in the context of a social network. In the Mobile Study, 64 participants completed a different CBM training, aimed at approach bias, either on a computer or on their mobile device. RESULTS: Although no training effects were found in the Game Study, adding (social) game elements did increase aspects of the user experience and motivation to train. The mobile training appeared to increase motivation to train in terms how often participants trained, but this effect disappeared after controlling for baseline motivation to train. CONCLUSIONS: Adding (social) game elements can increase motivation to train, and mobile training did not underperform compared with the regular training in this sample, which warrants more research into motivational elements for CBM training in younger audiences.

People with alcohol use disorders in specialized care in eight different European countries.

AIM: To provide a description of patients receiving alcohol treatment in eight different European countries, including the level of comorbidities and functional limitations. METHODS: Drinking behaviours, DSM-IV alcohol use disorder (AUD), mental and somatic comorbidities, disability and health services utilization of 1767 patients from various specialized treatment settings were assessed as representative for regions of eight European countries. Severity of alcohol dependence (AD) in terms of drinking level was compared with a large representative US sample. RESULTS: Patients in specialized care for AUDs showed high levels of consumption [average level of daily ethanol intake: 141.1 g, standard deviation (SD): 116.0 g], comorbidity [e.g. liver problems: 19.6%, 95% confidence interval (CI): 17.5-21.6%; depression: 43.2%, 95% CI: 40.7-45.8%; anxiety: 50.3%, 95% CI: 47.8-52.9%], disability and health services utilization (average number of nights spent in hospital(s) during the last 6 months: 8.8, SD: 19.5 nights). Severity of AD was similar to the US sample, but European men consumed on average more alcohol daily. CONCLUSIONS: High levels of consumption, somatic and mental comorbidities, disability and functional losses were found in this representative treatment sample, indicating that treatment was initiated only at severe stages of AUDs. Earlier initiation of treatment could help avoid some of the health and social burden.

Cigarette smoking and drug use among a nationally representative sample of HIV-positive individuals.

BACKGROUND AND OBJECTIVES: Among HIV-positive populations, the prevalence of cigarette smoking remains disproportionately high and is associated with significant morbidity and mortality. Little is known about this topic among HIV-positive persons in the general population. METHODS: Data came from the 2005 to 2011 National Survey on Drug Use and Health (NSDUH) public use data files. Unadjusted and adjusted multinomial logistic regression analyses explored the associations between socio-demographic, drug and alcohol use, and drug and/or alcohol treatment characteristics with smoking status among HIV-positive individuals (n = 349). RESULTS: More than 40% of the sample was current smokers. In adjusted analyses, females (aRRR = .11, 95% CI = .03-.41) and participants who had never been married (aRRR = .19, 95% CI = .05-.58), were more likely to be former smokers than never smokers. Females (aRRR = .37, 95% CI = .14-.96) and individuals older than age 35 (aRRR = .37, 95% CI = .16-.89) were less likely to be current smokers than never smokers. Conversely, previously married persons (aRRR = 5.72, 95% CI = 1.40-23.31), participants reporting binge drinking (aRRR = 5.96, 95% CI = 2.27-15.64), and lifetime drug or alcohol treatment (aRRR = 5.12, 95% CI = 2.09-12.55) were more likely to be current smokers than never smokers. CONCLUSIONS: Findings help confirm the high prevalence of smoking among HIV-positive persons suggesting the need for integrated substance use and smoking cessation treatment among HIV-positives. SCIENTIFIC SIGNIFICANCE: The present findings have implications for the development and implementation of targeted smoking cessation programs for HIV-positive smokers.

Student perceptions of specific components within a personalized feedback intervention.

Previous research suggests that personalized feedback interventions (PFI) can be an effective tool in reducing risky alcohol use among college students; however, little is known about how students perceive the individual components that are typically used during PFIs. In the current study, participants (N = 219, 63.5% female, 84% Caucasian, undergraduates enrolled in introductory psychology courses) reported their drinking behavior in the past month, and then immediately received a computerized PFI based on their self-reported alcohol use. The PFI was modeled from the Brief Alcohol Screening and Intervention for College Students (BASICS) approach and included 10 separate feedback components presented in random order. Participants provided acceptability ratings on each of the 10 components. Overall, participants found the PFI generally acceptable, with females rating the PFI as more acceptable than males, and binge drinkers (defined as 5 or more drinks on an occasion for males and 4 or more drinks for females) rating the PFI more acceptable than nonbinge drinkers. Differences in acceptability emerged across the 10 components, as participants rated the practical cost components (e.g., money spent on alcohol, calories consumed) as more acceptable than didactic information (e.g., impact of blood alcohol levels) and personal negative consequences. The results are similar to a previous study that examines student reactions to PFIs (Miller & Leffingwell, 2013). Overall, the findings suggest that college students prefer certain feedback components to others. Moreover, the findings indicate that future research is needed to examine the relationship between preferred components and treatment outcomes to determine which components are most effective for reducing risky drinking.

Exercise enhances hippocampal recovery following binge ethanol exposure.

Binge drinking damages the brain, and although a significant amount of recovery occurs with abstinence, there is a need for effective strategies to maximize neurorestoration. In contrast to binge drinking, exercise promotes brain health, so the present study assessed whether it could counteract ethanol-induced damage by augmenting natural self-repair processes following one or more binge exposures. Adult female rats were exposed to 0 (control), 1 or 2 binges, using an established 4-day model of binge-induced neurodegeneration. Half of the animals in each group remained sedentary, or had running wheel access beginning 7 days after the final binge, and were sacrificed 28 days later. To assess binge-induced hippocampal damage and exercise restoration, we quantified volume of the dentate gyrus and number of granule neurons. We found that a single binge exposure significantly decreased the volume of the dentate gyrus and number of granule neurons. A second binge did not exacerbate the damage. Exercise completely restored baseline volume and granule neuron numbers. To investigate a potential mechanism of this restoration, we administered IdU (a thymidine analog) in order to label cells generated after the first binge. Previous studies have shown that neurogenesis in the dentate gyrus is decreased by binge alcohol exposure, and that the hippocampus responds to this insult by increasing cell genesis during abstinence. We found increased IdU labeling in binge-exposed animals, and a further increase in binged animals that exercised. Our results indicate that exercise reverses long-lasting hippocampal damage by augmenting natural self-repair processes.

Alcohol misuse among older adult public housing residents.

Low-income older adults living in public housing are at heightened risk for substance misuse. This study identified the prevalence of alcohol misuse among older public housing residents (n = 187) and explored predictors of problem drinking. Including weekly drinking levels and binge drinking, 23% of the sample engaged in problem drinking behaviors. Logistic regression analysis revealed that race, gender, employment status, years smoking, and illegal drug use were significant predictors of problem drinking. No residents were receiving substance abuse treatment. As the number of older adults increase, training social workers to assess and treat alcohol misuse in older adults is critical.

Rehabilitation training using complex motor learning rescues deficits in eyeblink classical conditioning in female rats induced by binge-like neonatal alcohol exposure.

BACKGROUND: Effective treatments for the behavioral and cognitive deficits in children with fetal alcohol spectrum disorders (FASD) are lacking, and translational approaches using animal models can help develop rational interventions. One such model, binge-like alcohol exposure in neonatal rats during the period of brain development comparable with that of the human third trimester, causes structural and functional damage to the cerebellum and disrupts cerebellar-dependent eyeblink classical conditioning. The eyeblink conditioning deficits first demonstrated in this rat model predicted the similar deficits subsequently demonstrated in children with FASD. METHODS: The current study extends this translational approach by testing the hypothesis that rehabilitation training involving 20 days of training on traversal of an obstacle course (complex motor learning) would ameliorate the deficits on classical conditioning of eyeblink responses produced by the neonatal alcohol exposure. We have previously shown that this training stimulates cerebellar synaptic plasticity and improves alcohol-induced deficits on motor coordination tasks. RESULTS: The current studies found that rehabilitation training significantly attenuated alcohol-induced deficits in acquisition of eyeblink conditioning in females but not in males. These results are consistent with normalization of cerebellar-dependent learning, at least in alcohol-exposed females. CONCLUSIONS: These findings extend previous studies in this model suggesting that rehabilitation of adolescents with FASD using training with complex motor learning tasks could be effective in ameliorating functional impairments associated with cerebellar damage. Eyeblink classical conditioning deficits are now well documented in children with FASD and could serve as an evaluation measure to continue to develop therapeutic interventions such as complex motor learning.

Project reduce: reducing alcohol and marijuana misuse: effects of a brief intervention in the emergency department.

STUDY OBJECTIVE: Brief interventions (BI) for alcohol misuse and recently for marijuana use for emergency department patients have demonstrated effectiveness. We report a 12-month outcome data of a randomized controlled trial of emergency department (ED) patients using a novel model of BI that addresses both alcohol and marijuana use. METHODS: ED research assistants recruited adult patients who admitted alcohol use in the last month, and marijuana use in the last year. In the ED, patients received an assessment of alcohol and marijuana use and were randomized to treatment (n=249) or standard care (n=266). Treatment consisted of two sessions of BI. At 3 and 12months, both groups had an assessment of alcohol and marijuana use and negative consequences of use. RESULTS: 515 patients were randomized. We completed a 12-month follow-up assessments on 83% of those randomized. Measures of binge drinking and conjoint marijuana and alcohol use significantly decreased for the treatment group compared to the standard care group. At 12-month binge alcohol use days per month in the treatment group were (M=0.72:95% CI=0.36-1.12) compared to standard care group (M=1.77:95% CI=1.19-1.57) Conjoint use days in the treatment group (M=1.25.1:95% CI=0.81-1.54) compared to standard care group (M=2.16:95% CI=1.56-2.86). No differences in negative consequences or injuries were seen between the treatment and standard care groups. CONCLUSIONS: BI for alcohol and marijuana decreased binge drinking and conjoint use in our treatment group. BI appears to offer a mechanism to reduce risky alcohol and marijuana use among ED patients but expected reductions in consequences of use such as injury were not found 12months after the ED visit.

Alcohol use and treatment among Former Soviet Union immigrants in Israel: review of publications July 2009-December 2011.

This article examines the current state of alcohol use among immigrants from the Former Soviet Union (FSU) in Israel, as an update to the 2 previous publications that reviewed studies published in the professional literature (mainly in Hebrew) and referred to earlier periods (from the early 1990s until 2006 and from 2007 through June 2009). This article reviews studies published primarily in Hebrew from mid-2009 throughout December 2011 and describes alcohol use patterns and treatment among FSU immigrants. As the third in the sequence of reviews aimed at English readers, it confirms the findings of the previous 2 reviews. Alcohol use among FSU immigrants continues to be more prevalent than among Israeli-born residents, and FSU immigrants continue to be overrepresented in treatment programs. Moreover, the review describes a severe worsening in alcohol use among FSU detached youth and no differences in alcohol use among early and recent immigrants between the ages of 18 and 40 years.

Integration of behavioral medicine in primary care.

The health care system in the United States is inefficient and there are many incentives for sustainable changes in the delivery of care. Incorporating behavioral medicine offers a wide range of opportunities. Within primary care settings, pain disorders, addiction, depression, and anxiety disorders are highly prevalent. Numerous chronic health conditions also require behavioral support for lifestyle change. These disorders are optimally managed through interdisciplinary collaborations that include a behavioral medicine component. This article discusses the effective integration of behavioral medicine within a primary care patient-centered medical home and describes the organizational planning and structure required for success.