Eating disorders and alcohol use: group differences in consumption rates and drinking motives.

Alcohol use and drinking motives were investigated among college women divided into four probable eating disorder groups: Bulimia Nervosa, purging subtype (BN n=16) Binge Eating Disorder (BED n=30) Eating Disorder, Not Otherwise Specified (EDNOS n=85) and Non-Eating Disordered Controls (NEDC n=252). Participants completed questionnaires that assessed eating behaviors and attitudes, motives for drinking alcohol, quantity and frequency of alcohol use, and binge drinking. The BED group reported greater weekend alcohol consumption and binge drinking than the EDNOS and NEDC groups. The BN and BED groups were significantly more likely to endorse Coping as a drinking motive than the EDNOS and NEDC groups. The NEDC group was more likely to endorse Mood Enhancement than the EDNOS group. These results offer one explanation for the relationship between eating and alcohol use disorders. Women with eating disorders may use alcohol to cope with negative affect, analogous to findings that women with eating disorders report binge eating to regulate negative affect [Mizes, J. S. (1985). Bulimia: A review of its symptomatology and treatment. Advances in Behavior Research and Therapy, 7, 91-142].

Addressing HIV Risk Behavior Among Pregnant Drug Abusers: An Overview.

Both sex- and drug-related HIV risk behavior are common among pregnant drug abusers. In the absence of intervention, these behaviors are likely to continue throughout pregnancy, placing the women and their unborn children at risk of contracting HIV. Drug treatment programs have been found to have limited impact on these behaviors. Although certain drug risk behaviors have been shown to decrease during drug treatment, sex-related risk behavior remains largely unaffected. Similarly, knowledge- and skill-based HIV risk reduction interventions have demonstrated modest efficacy. Therefore, there is a need to develop new interventions that directly target sex- and drug-related HIV risk behavior among pregnant drug abusers, taking advantage of a period in the women's lives in which the potential negative consequences of risk behavior are more significant given the possible impact on their unborn children and in which there may be a heightened desire to make healthier behavior choices. Recent work suggests that a promising new direction for the field may be incorporating motivational interviewing components into traditional HIV risk reduction interventions, which focus on providing HIV risk information and building sex- and drug-related HIV risk reduction skills.

Predicting eating disorder group membership: an examination and extension of the sociocultural model.

The purpose of this research was to examine and extend portions of the sociocultural model of bulimia nervosa (Stice, E. (1994). Review of the evidence for a sociocultural model of bulimia nervosa and an exploration of the mechanisms of action. Clinical Psychology Review, 14, 633-661; Stice, E., & Agras, W. S. (1998). Predicting onset and cessation of bulimic behaviors during adolescence: A longitudinal grouping analysis. Behavior Therapy, 29, 257-276). Participants were women who reported engaging in binge eating at baseline and the 1-year follow-up (n = 26), women who began binge eating between these 2 points (n = 25), and women who did not report binge eating during the course of the study (n = 199). Results of the first discriminant function analysis provided support for the sociocultural model. However, the results of subsequent analyses suggest that additional variables, including stress, escape-avoidance coping, and interoceptive awareness, emerged as important. Implications of these findings for our understanding of the development and maintenance of binge eating are discussed.

Alcohol Use Among Depressed Patients: The Need for Assessment and Intervention.

For many depressed patients, drinking may interfere with the successful treatment of their depression. Even among patients whose alcohol use does not rise to the level of an alcohol-use disorder, drinking can have a deleterious effect on depression and depressive symptoms and may dampen the impact of treatment for depression. However, subclinical drinking may not be addressed during the course of psychological or psychiatric treatment for depression. The authors advocate for the routine assessment of alcohol use, beyond questioning to diagnose alcohol abuse or dependence, in psychological and psychiatric settings. There is reason to believe that once identified, heavy alcohol use among depressed patients could be addressed effectively through the use of brief motivationally focused interventions.

Alcohol use of diabetes patients: the need for assessment and intervention.

It is well known that diabetes self-care behaviors are critical to disease progression. Unfortunately, many patients do not adhere to diabetes self-care recommendations despite their importance. Alcohol use has been identified as a barrier to diabetes self-care adherence. Excessive alcohol consumption not only negatively impacts diabetes self-care adherence but also affects the course of diabetes. Diabetes patients who are at-risk drinkers are likely to have poor diabetes treatment adherence, leading to increased morbidity and mortality. Alcohol consumption by diabetes patients is often inadequately assessed and addressed in their medical care. Brief interventions to reduce at-risk drinking have been well validated in a variety of patient populations and offer the potential to improve diabetes treatment adherence and outcome. Assessment and treatment of at-risk drinking could be readily incorporated into routine diabetes care. Strategies for brief assessment of and intervention for at-risk drinking are offered.

Effect of CBT on Depressive Symptoms in Methadone Maintenance Patients Undergoing Treatment for Hepatitis C.

To examine the efficacy of a cognitive-behavioral intervention (CBT) to prevent depression among methadone maintenance patients undergoing antiviral treatment for hepatitis C (HCV), 29 patients beginning HCV treatment were randomized to CBT or standard care (SC). Study participants did not meet criteria for major depressive disorder at the time of study recruitment. CBT did not result in less depression-related antiviral treatment failure, better adherence to antiviral treatment, or better HCV RNA outcomes. There were no significant treatment group differences on depressive symptoms over time. The CBT group did display a greater and more consistent decline in both BDI-II and HAM-D scores over time (d=.85 on the BDI-II; d=.72 on the HAM-D).

Human immunodeficiency virus risk behavior among female substance abusers.

HIV is an increasingly critical and costly health problem for American women. Substance use plays a major role in human immunodeficiency virus (HIV) infection in women. There are several plausible explanations for the association between substance use and HIV risk behavior. Pregnant substance abusers are a population deserving special attention given the prevalence of risk behavior in this population and the added risk of perinatal transmission of HIV. Current guidelines for the screening and treatment of HIV among pregnant women and their infants are delineated. Substance abuse treatment has a limited impact on HIV risk behavior in female substance abusers. Similarly, traditional knowledge-based and skill-based HIV risk reduction interventions have modest efficacy in this population. Hence, there is a need to develop new interventions that directly target sex-related and drug-related HIV risk behavior among female substance abusers. Recent work suggests that the incorporation of motivational interviewing components into traditional HIV risk reduction interventions may be a promising new direction for the field.

Brief Alcohol Intervention Among At-Risk Drinkers with Diabetes.

Twenty-eight patients with diabetes who screened positive for at-risk drinking were assigned to brief alcohol intervention (BAI) (n = 14) or standard care (SC) (n = 14) treatment conditions. All participants completed a baseline interview and one-, three, and six-month follow-up interviews. Across the six-month follow-up period, there was a significantly greater reduction in quantity of alcohol consumed in the BAI group. At the six-month follow-up, the BAI group had a greater reduction in quantity of alcohol consumed, percentage of heavy drinking days, and frequency of drinking. Reductions in alcohol use were associated with improved adherence in certain components of diabetes self-care behavior. The results of this study suggest that brief alcohol interventions are efficacious in reducing alcohol use among at-risk drinkers with diabetes and that reductions in alcohol use may result in some improvements in adherence to diabetes self-care behavior.

At-risk drinking among diabetic patients.

Diabetes Mellitus is a serious chronic disease, affecting an increasing number of individuals worldwide. Adherence to diabetes self-care behaviors is key to the successful management of the disease. At-risk drinking is common among diabetic patients and is associated with inferior diabetes treatment adherence and outcomes, resulting in increased mortality and morbidity. Furthermore, individuals with diabetes who engage in at-risk drinking are also in danger of incurring the negative consequences of at-risk drinking found in the general population. Research suggests that alcohol use screening and intervention do not commonly occur during the course of primary care treatment for diabetes. While methods for reducing alcohol use in this population have been largely unexplored to date, brief interventions to reduce at-risk drinking have been well-validated in other patient populations and offer the promise to reduce at-risk drinking among diabetic patients, resulting in improved diabetes treatment adherence and outcomes.