Attentional biases in patients with alcohol dependence: influence of coexisting psychopathology.

OBJECTIVE: The effects of coexisting psychopathology on disorder-specific attentional biases in patients with alcohol dependence are uncertain. We undertook a cross-sectional study assessing attentional biases to alcohol-, depression-, and anxiety- related stimuli using the visual probe task in patients with alcohol dependence, attending a community alcohol service. METHODS: Using the visual probe task, we presented disorder-specific words (relating to alcohol, anxiety, and depression) for 500 ms and measured reaction times. RESULTS: Participants demonstrated a significant attentional bias towards alcohol-related cues (mean 8.5, p = 0.03) but significant avoidance of depression-related cues (mean -8.4, p = 0.01). The subgroup of participants who were recently abstinent (n = 70) showed greatest avoidance of depression-related cues (t(69) = 2.68, p < 0.01) but no significant vigilance towards alcohol or anxiety cues, whereas those still drinking (n = 43) showed attentional biases towards alcohol-related (t(42) = 2.70, p = 0.01) and social anxiety-related cues (t(42) = 2.84, p < 0.01). In the whole sample, the magnitude of attentional bias to alcohol was not correlated with length of drinking history, number of comorbid conditions, or severity of anxiety/depression. CONCLUSIONS: In a clinical sample of alcohol-dependent patients, further investigation is required to explore whether these attentional biases reflect current drinking status or factors indicating prognosis.

The effectiveness of a cognitive-behavioral intervention for pathological gambling: a country-wide study.

BACKGROUND: Clinicians lack adequate data on the effectiveness of treatment for pathological gambling in low- and middle-income countries. METHODS: We evaluated a manualized treatment program that included components of cognitive-behavioral therapy, motivational interviewing, and imaginal exposure in a sample of 128 participants diagnosed with pathological gambling. Our team recruited participants via the helpline of the National Responsible Gambling Program (NRGP) of South Africa between May 2011 and February 2012. Eligible participants, who met the DSM-IV-TR criteria for pathological gambling as assessed by the Structured Clinical Interview for Pathological Gambling (SCI-PG), were referred to practitioners who had been trained in the intervention technique. We then compared pre- and post-treatment scores obtained on the Yale-Brown Obsessive-Compulsive Scale Adapted for Pathological Gambling (PG-YBOCS), the primary outcome measure, and the Sheehan Disability Scale (SDS), the secondary outcome measure. RESULTS: Scores obtained on the PG-YBOCS and the SDS both decreased significantly from the first to the final session (t[127] = 23.74, P < .001, r = .9; t[127] = 19.23, P < .001, r = .86, respectively). CONCLUSIONS: The urges and disability symptoms related to pathological gambling were significantly reduced among participants completing treatment. These preliminary results hold promise for individuals with pathological gambling in South Africa and other low- and middle-income countries.

"Craving": exploring the components of the Desires for Alcohol Questionnaire (DAQ) and the relation to the severity of alcohol problems.

OBJECTIVE: The aims of this study were (a) to explore the components of craving, as measured by the Desires for Alcohol Questionnaire (DAQ), and (b) to examine how craving may relate to the severity of alcohol problems. METHOD: A total of 106 patients seeking treatment for an alcohol use disorder (AUD) completed the DAQ and Alcohol Use Disorders Identification Test (AUDIT). The overall sample was predominantly male (63%) with a mean age of 44 years. Sixty-one percent of the participants were abstinent from alcohol at the time of the study. Principal components analysis was conducted on the DAQ for the overall, abstinent, and currently drinking samples. Correlations were computed between the DAQ and AUDIT scores, and differences in craving between the abstinent and currently drinking samples were investigated. RESULTS: Components of craving, as measured by the DAQ, included the desire to drink, the ability to control drinking, positive reinforcement and negative reinforcement. Drinkers displayed stronger cravings (Mdn = 47.00, interquartile range [IQR] = 32.0-65.0) than those currently abstinent (Mdn = 33.00, IQR = 26.0-43.0; U = 850.0; z = 3.127, p < .01; r = .30). The intensity of craving increased with the severity of the AUD in current drinkers (r = .739, p < .001). CONCLUSIONS: Because of the small sample size, the results of the study should be regarded as preliminary. The components of craving, as measured by the DAQ, support those previously identified in the literature. The study supports the notion that craving is positively associated with the severity of an AUD.

Inequitable access to substance abuse treatment services in Cape Town, South Africa.

BACKGROUND: Despite high levels of substance use disorders in Cape Town, substance abuse treatment utilization is low among people from disadvantaged communities in Cape Town, South Africa. To improve substance abuse treatment utilization, it is important to identify any potential barriers to treatment initiation so that interventions to reduce these barriers can be implemented. To date, substance abuse research has not examined the factors associated with substance abuse treatment utilization within developing countries. Using the Behavioural Model of Health Services Utilization as an analytic framework, this study aimed to redress this gap by examining whether access to substance abuse treatment is equitable and the profile of variables associated with treatment utilization for people from poor communities in Cape Town, South Africa. METHODS: This study used a case-control design to compare 434 individuals with substance use disorders from disadvantaged communities who had accessed treatment with 555 controls who had not accessed treatment on a range of predisposing, treatment need and enabling/restricting variables thought to be associated with treatment utilization. A hierarchical logistic regression was conducted to assess the unique contribution that the need for treatment, predisposing and enabling/restricting variable blocks made on substance abuse treatment utilization. RESULTS: Findings revealed that non-need enabling/restricting variables accounted for almost equal proportions of the variance in service utilization as the need for treatment variables. These enabling/restricting variables also attenuated the influence of the treatment need and predisposing variables domains on chances of treatment utilization. Several enabling/restricting variables emerged as powerful partial predictors of utilization including competing financial priorities, geographic access barriers and awareness of treatment services. Perceived severity of drug use, a need for treatment variable) was also a partial predictor of utilization. CONCLUSIONS: Findings point to inequitable access to substance abuse treatment services among people from poor South African communities, with non-need factors being significant determinants of treatment utilization. In these communities, treatment utilization can be enhanced by (i) expanding the existing repertoire of services to include low threshold services that target individuals with less severe problems; (ii) providing food and transport vouchers as part of contingency management efforts, thereby reducing some of the financial and geographic access barriers; (iii) introducing community-based mobile outpatient treatment services that are geographically accessible; and (iv) employing community-based outreach workers that focus on improving awareness of where, when and how to access existing treatment services.