Examining the reliability of alcohol/drug use and HIV-risk behaviors using Timeline Follow-Back in a pilot sample.

Research on the course of substance use disorders (SUDs) faces challenges in assessing behavior over lengthy time periods. Calendar-based methods, like the Timeline Followback (TLFB), may overcome these challenges. This study assessed the reliability of self-reported weekly alcohol use, drug use, and HIV-risk behaviors over the past 90 days using an interview TLFB. Individuals with SUD in outpatient treatment (N = 26) completed the TLFB at baseline and then a week later with separate interviewers. Weekly ratings were aggregated across 4 week intervals for each administration. Intra-class correlations were used to compare agreement between the two administrations. Reliabilities for alcohol and drug use ratings ranged from good to excellent for most drug categories (ICCs = 0.76 - 1.00), except opioid use (other than heroin) and sedative use produced sub-standard reliabilities (ICCs = 0.29 - 0.74). HIV-risk behavior reliabilities also ranged from good to excellent (ICCs = 0.70 - 0.97), but were substandard for the number of casual sex partners for some intervals (ICCs = 0.29, 0.63). Findings extend support for the use of TLFB to produce reliable assessments of many drugs and HIV-risk behaviors across longitudinal intervals.

Construct validation analyses on the Marlatt typology of relapse precipitants.

Marlatt's typology of relapse precipitants has had a major influence on clinical research and practice in the substance use disorders. The purpose of this study was to evaluate the construct validity of the typology, which was done in several ways. First, precipitants of the relapse coded at the baseline assessment and for the first drink post-treatment admission were compared. In addition, baseline relapse precipitants were compared with the highest factor scores recorded in the baseline Inventory of Drinking Situations data. A third set of analyses concerned the relationship among Marlatt precipitant codes, psychiatric diagnoses, and Alcohol Dependence Scale scores. The subjects were 142 men and women who were recruited for this study upon their admission to inpatient or outpatient alcohol treatment programs. Participants completed a baseline assessment covering substance use, including information on the precipitants of a pretreatment "relapse", and other areas of functioning. Subjects then completed bimonthly follow-up assessments during the course of 1 year. The results showed support for only one of the predictions regarding the construct validity of the Marlatt typology. Possible explanations for these findings and their implications for clinical research and practice are discussed.

Understanding relapse in the broader context of post-treatment functioning.

There exists much interest in developing more sophisticated conceptual and data analytic frameworks for evaluating and understanding the post-treatment functioning of alcoholics. Much of this interest has been fostered by the systematic research endeavors of Moos and his colleagues, whose "systems model" of treatment outcome closely parallels multivariate models of illness and health. This article focuses on an extrapolation of the systems model to the study of relapse, viewing relapse as one outcome of a set of independent variables that include person and environmental factors. The subjects were 142 clients entering either inpatient or outpatient treatment for alcoholism. Preliminary assessments, using path analyses and multiple regression models, are presented on the interrelationships between background characteristics, pretreatment alcohol involvement/ symptomatology, treatment, coping skills/responses, stressors and relapse/outcome following treatment entry. The results overall showed a considerable amount of convergence in the sense that the composite "blocks" representing background characteristics, alcohol involvement/symptomatology and coping skills/responses generally were significant predictors of various relapse and other posttreatment functioning variables. However, the variables contributing to the predictive power of a particular composite varied as a function of the dependent variable being assessed. The conceptual model and associated analytic strategies guiding this research would appear to hold much potential for advancing knowledge in this area.

The reliability of Marlatt's taxonomy for classifying relapses.

Marlatt's focus on the relapse situation has had a major impact upon research and clinical practice in treating addictions. One component of his work was the development of a taxonomy for classifying precipitants of relapse. This taxonomy has been incorporated into the nomenclature of clinicians and clinical researchers as part of an explanatory framework for understanding relapses. Despite the taxonomy's influence it has never been examined for the reliability of its use across research studies. The present study compared the reliability of independent classifications of 149 relapse episodes by trained raters at three research laboratories. Despite considerable across-laboratory training, reliability was found to be inconsistent for research purposes. It is concluded that comparability of results based on Marlatt's relapse taxonomy across independent studies must be subject to question, and assumptions necessary for the aggregation of a knowledge base are not supported. Recommendations are offered for improving the reliability of the taxonomy and the methods used to collect taxonomy data. More generally, questions regarding the value of the specific relapse categories, as well as the overall taxonomy, are raised.

Relapse research and the Reasons for Drinking Questionnaire: a factor analysis of Marlatt's relapse taxonomy.

A factor analysis (n = 183) of Marlatt's relapse taxonomy as assessed by the Reasons for Drinking Questionnaire (RFDQ) (see Appendix I, this article) was conducted using a heterogeneous alcohol treatment sample. Results indicated that the predominant factor was negative emotions. The second factor consisted of social pressure and positive emotions, and a third factor consisted of physical withdrawal, wanting to get high, testing control, substance cues and urges to drink. Each of the 13 categories in the Marlatt taxonomy loaded on one of the three factors. Scores on the first factor for the first and second lapses were correlated. The same held true for the other two factors. The negative emotions factor was positively related to blood alcohol level on the first day of the lapse, the lapse duration (in days), and occurrence of a second lapse (even when controlling for alcohol dependence). The negative emotions factor in turn was related to client reports of alcohol dependence, trait anger, and depression (all positively). Women scored higher on the first factor, and men scored higher on the second factor. The third factor was inversely related to the number of days of abstinence preceding the lapse. Taken together, these analyses, illustrate that different precipitants occur together, suggesting that clients might productively be trained in the use of specific relevant coping skills to address potential relapse precipitants. Focusing on the third RFDQ factor may be particularly important in the early stages of abstinence. The importance of anger and depression management during alcohol treatment is also highlighted by these results.

Alcohol treatment, changes in coping skills, self-efficacy, and levels of alcohol use and related problems 1 year following treatment initiation.

The relationships among alcohol treatment, coping skills, and self-efficacy in predicting alcohol use and related consequences following treatment initiation were investigated. The participants were 77 men and 65 women who were entering either inpatient or outpatient alcohol treatment. The analyses confirmed predictions that treatment, coping skills, and self-efficacy each contributed significantly to the prediction of 12-month alcohol consumption beyond the variance accounted for by participant control variables. Only self-efficacy explained significant additional variance in the consequences outcome. Mediation analyses of the alcohol consumption variables suggested that treatment effects were not mediated by either coping skills or self-efficacy and that the effects of coping skills were not mediated by self-efficacy. The findings are interpreted as providing partial support for social learning theory approaches. Suggestions for future research are discussed.

Psychopharmacological effects of alcohol on time perception: the extended balanced placebo design.

Time perception is affected by the pharmacological action of many drugs, but the contribution of expected effects of drugs has not been considered. A new design, the extended balanced placebo design (EBPD), is presented to study both the pharmacological and expected effects of alcohol on time perception. The EBPD makes it possible to examine the effects of alcohol across a broad range of expected and pharmacological doses. By contrast, the domain of inquiry was limited to low doses of alcohol in the original balanced placebo design. The design was later modified to study higher doses, but the control and the pure drug and expectancy conditions were sacrificed in the transformation. In the EBPD, however, any realistic combination of the expected and actual dose of alcohol can be studied, while retaining pure drug and expectancy conditions. The EBPD was tested in the present study with respect to its psychopharmacological effectiveness and the effects of alcohol on time perception. The design was effective in terms of three manipulation checks: blood alcohol concentration, subjective intoxication and postexperimental beliefs about the alcohol content of the beverage consumed. In addition, the expected and actual doses of alcohol interacted over time to evidence active compensation for the pharmacological effects of alcohol on time perception. Finally, a covariance structure model was confirmed in which the expected and actual doses of alcohol increased the perceived rate of time passage, which in turn lengthened objective estimation of a one-second interval.

Methodological note: corroboration of self-reported smoking status using significant other reports.

Significant other reports (SORs) are commonly used in smoking cessation studies to verify self-reports of smoking status. This report focuses on factors related to the smoker and significant other, which can affect self-reported classification of smoking status when using SORs. Data used in this analysis were collected from a cohort of 107 smokers who participated in a smoking cessation program. Participants were contacted at 1, 3, and 6 months after quitting to obtain self-reports of smoking status. SORs also were obtained at each assessment period. The highest discrepancy rate between self-report and SOR was observed among slippers, followed by relapsers, and abstainers, respectively. In addition, corroboration of smoking status was influenced by the social context in which the significant other was likely to see the smoker.

Substance abuse treatment cost offsets vary with gender, age, and abstinence likelihood.

The cost-offset effect has been promoted as a way for substance abuse treatment to pay for itself by generating reductions in health care utilization in other areas. Clients (n = 5,434) that were abstinent for 24 months following substance abuse treatment had lower posttreatment utilization than clients that had relapsed. An examination of cost offsets revealed a complex interplay between gender, age, and type of utilization (medical versus psychiatric). Cost offsets were especially pronounced for women over 40 years old.

Male and female alcoholics' attributions regarding the onset and termination of relapses and the maintenance of abstinence.

This study was designed to examine male and female alcoholics' attributions of factors associated with the onset and termination of specific relapse events. In addition, data were gathered on factors associated with the achievement and maintenance of abstinent periods. The participants were 77 men and 65 women alcoholics entering alcoholism treatment who were followed for a 12-month period. The two relapse precipitants reported most often by the men were a desire to drink and feeling good. The women most often reported a desire to drink, psychological cravings, letting down one's guard, feeling down, and spouse/partner factors. The women more often reported letting down one's guard and spouse/partner factors as precipitants, relative to the men. Among the factors identified as associated with termination of a relapse, the influences most often endorsed were "just decided to stop" and, among women, feeling bad emotionally. The most frequently identified methods for achieving and maintaining abstinence were avoiding risky people and places, recalling drinking problems (especially among men), treatment, and use of self-help groups.

Social influence processes in smoking cessation: postquitting predictors of long-term outcome.

Participants in a smoking cessation program completed measures of positive and negative social influence processes related to maintaining abstinence, along with measures previously associated with success in smoking cessation (e.g., motivation, stress, nicotine dependence). The relationship of these variables to smoking status at three assessments (postquitting, 3-, and 6-month follow-ups) was evaluated in a hierarchical multiple regression analysis. The results indicated that while variables such as nicotine dependence, motivation, and stress predicted postquitting status, social influence processes were the most important predictors of longer term outcome. Both increased support and hindrances from friends/coworkers were related to returning to smoking at 3- and 6-month follow-ups. Support and hindrance from partners/spouses was not related to smoking status at any time. The need for a broadened, multidimensional conceptualization of social influence processes in smoking cessation is discussed.