Do Varying Levels of Exposure to Pornography and Violence Have an Effect on Non-Conscious Emotion in Men?

As we are often inundated with images of violence and pornography in modern times with the aid of mobile devices and unrestricted online access and content, the non-conscious effect of such exposure is an area of concern. To date, many clinicians and researchers in behavioral sciences rely on conscious responses from their clients to determine affective content. In doing so, they overlook the effect the non-conscious has on an individual's emotions. The present study aimed to examine variations in conscious and non-conscious responses to emotion-inducing images following varying amounts of exposure to violent and pornographic images. Eighteen participants who self-reported as being low pornography users were presented with emotion-inducing images after no exposure (Session 1), after one round of exposure to 50 pornographic and 50 violent images (Session 2) and after a further nine rounds of exposure to 50 pornographic and 50 violent images (Session 3). Sessions were temporally separated by at least 2 days while startle reflex modulation (SRM) and scalp-recorded event-related potentials (ERPs) were used to determine non-conscious emotion-related responses to pre-evaluated emotion pictures. Explicit valence and arousal ratings were assessed for each of those emotion pictures to determine conscious emotion effects potentially changing as a function of increasing controlled exposure to pornographic and violent visual material. Conscious explicit ratings and SRM amplitudes revealed no significant difference between the sessions. However, frontal ERP analysis revealed significant changes between processing of "violent" and "unpleasant" images at later ERP time windows, further supporting the growing body of research which shows that relying on self-report data does not result in a full understanding of emotional responses.

Characteristics of Suicide Attempters and Ideators in a Clinical Sample of Substance Users.

There is little research to distinguish those who attempt suicide and those who only consider suicide, and the role that substance use plays in this progression. We aim to describe clinical correlates of suicide attempters versus ideators in substance users. We examined characteristics of substance users (N = 185) that had either a suicide attempt within the last 6 months (n = 94) or were suicide ideators (n = 91). Suicide attempters displayed significant different clinical profiles to that of non-attemptors. Relative to ideators, attempters had greater scores on impulsivity, the brief psychiatric scale and more likely to be female and a recent psychostimulant user. Logistic regression revealed that male gender was associated with a decreased odds of a previous suicide attempt (OR = 0.37, p < 0.05) and greater impulsivity scores were associated with increased odds of an attempt (OR = 1.15, p < 0.05), although entering interaction terms diminished the role of impulsivity and revealed a significant interaction of alcohol use x depression. While impulsivity was a significant predictor of suicide attempt relative to depression or alcohol use alone, this reduced when considering interactions between psychological characteristics and substance use, whereby the effect of alcohol use on the likelihood of a recent suicide attempt varied at different levels of depression.

Psychosocial interventions for people with both severe mental illness and substance misuse.

BACKGROUND: Even low levels of substance misuse by people with a severe mental illness can have detrimental effects. OBJECTIVES: To assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care. SEARCH METHODS: For this update (2013), the Trials Search Co-ordinator of the Cochrane Schizophrenia Group (CSG) searched the CSG Trials Register (July 2012), which is based on regular searches of major medical and scientific databases. The principal authors conducted two further searches (8 October 2012 and 15 January 2013) of the Cochrane Database of Systematic Reviews, MEDLINE and PsycINFO. A separate search for trials of contingency management was completed as this was an additional intervention category for this update. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) comparing psychosocial interventions for substance misuse with standard care in people with serious mental illness. DATA COLLECTION AND ANALYSIS: We independently selected studies, extracted data and appraised study quality. For binary outcomes, we calculated standard estimates of relative risk (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis. For continuous outcomes, we calculated the mean difference (MD) between groups. For all meta-analyses we pooled data using a random-effects model. Using the GRADE approach, we identified seven patient-centred outcomes and assessed the quality of evidence for these within each comparison. MAIN RESULTS: We included 32 trials with a total of 3165 participants. Evaluation of long-term integrated care included four RCTs (n = 735). We found no significant differences on loss to treatment (n = 603, 3 RCTs, RR 1.09 CI 0.82 to 1.45, low quality of evidence), death by 3 years (n = 421, 2 RCTs, RR 1.18 CI 0.39 to 3.57, low quality of evidence), alcohol use (not in remission at 36 months) (n = 143, 1 RCT, RR 1.15 CI 0.84 to 1.56,low quality of evidence), substance use (n = 85, 1 RCT, RR 0.89 CI 0.63 to 1.25, low quality of evidence), global assessment of functioning (n = 171, 1 RCT, MD 0.7 CI 2.07 to 3.47, low quality of evidence), or general life satisfaction (n = 372, 2 RCTs, MD 0.02 higher CI 0.28 to 0.32, moderate quality of evidence).For evaluation of non-integrated intensive case management with usual treatment (4 RCTs, n = 163) we found no statistically significant difference for loss to treatment at 12 months (n = 134, 3 RCTs, RR 1.21 CI 0.73 to 1.99, very low quality of evidence).Motivational interviewing plus cognitive behavioural therapy compared to usual treatment (7 RCTs, total n = 878) did not reveal any advantage for retaining participants at 12 months (n = 327, 1 RCT, RR 0.99 CI 0.62 to 1.59, low quality of evidence) or for death (n = 493, 3 RCTs, RR 0.72 CI 0.22 to 2.41, low quality of evidence), and no benefit for reducing substance use (n = 119, 1 RCT, MD 0.19 CI -0.22 to 0.6, low quality of evidence), relapse (n = 36, 1 RCT, RR 0.5 CI 0.24 to 1.04, very low quality of evidence) or global functioning (n = 445, 4 RCTs, MD 1.24 CI 1.86 to 4.34, very low quality of evidence).Cognitive behavioural therapy alone compared with usual treatment (2 RCTs, n = 152) showed no significant difference for losses from treatment at 3 months (n = 152, 2 RCTs, RR 1.12 CI 0.44 to 2.86, low quality of evidence). No benefits were observed on measures of lessening cannabis use at 6 months (n = 47, 1 RCT, RR 1.30 CI 0.79 to 2.15, very low quality of evidence) or mental state (n = 105, 1 RCT, Brief Psychiatric Rating Scale MD 0.52 CI -0.78 to 1.82, low quality of evidence).We found no advantage for motivational interviewing alone compared with usual treatment (8 RCTs, n = 509) in reducing losses to treatment at 6 months (n = 62, 1 RCT, RR 1.71 CI 0.63 to 4.64, very low quality of evidence), although significantly more participants in the motivational interviewing group reported for their first aftercare appointment (n = 93, 1 RCT, RR 0.69 CI 0.53 to 0.9). Some differences, favouring treatment, were observed in abstaining from alcohol (n = 28, 1 RCT, RR 0.36 CI 0.17 to 0.75, very low quality of evidence) but not other substances (n = 89, 1 RCT, RR -0.07 CI -0.56 to 0.42, very low quality of evidence), and no differences were observed in mental state (n = 30, 1 RCT, MD 0.19 CI -0.59 to 0.21, very low quality of evidence).We found no significant differences for skills training in the numbers lost to treatment by 12 months (n = 94, 2 RCTs, RR 0.70 CI 0.44 to 1.1, very low quality of evidence).We found no differences for contingency management compared with usual treatment (2 RCTs, n = 206) in numbers lost to treatment at 3 months (n = 176, 1 RCT, RR 1.65 CI 1.18 to 2.31, low quality of evidence), number of stimulant positive urine tests at 6 months (n = 176, 1 RCT, RR 0.83 CI 0.65 to 1.06, low quality of evidence) or hospitalisations (n = 176, 1 RCT, RR 0.21 CI 0.05 to 0.93, low quality of evidence).We were unable to summarise all findings due to skewed data or because trials did not measure the outcome of interest. In general, evidence was rated as low or very low due to high or unclear risks of bias because of poor trial methods, or poorly reported methods, and imprecision due to small sample sizes, low event rates and wide confidence intervals. AUTHORS' CONCLUSIONS: We included 32 RCTs and found no compelling evidence to support any one psychosocial treatment over another for people to remain in treatment or to reduce substance use or improve mental state in people with serious mental illnesses. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high quality trials are required which address these concerns and improve the evidence in this important area.

Exploration of the comorbidity of cannabis use disorders and mental health disorders among inpatients presenting to all hospitals in New South Wales, Australia.

BACKGROUND: Cannabis is one of the most commonly used illegal psychoactive substances and its use often coexists with mental health disorders. OBJECTIVES: This study explores the relationships between cannabis use disorders and some common mental health disorders. METHODS: Admissions to all New South Wales (NSW) hospitals were analyzed. The data were extracted from the NSW Department of Health Inpatient Statistics Data Collection for the period 1 July 2006 to 30 June 2007. Readmissions within 28 days were excluded. Data extraction and analyses were performed by using the SAS program. Chi-square tests and odds ratio were used to examine the association between cannabis use disorder and mental health disorders. RESULTS: Of the 1.8 million admissions, associations between cannabis use disorders and mental health disorders were strong (odds ratio = 7.8-10.7, p < .001). Inpatients (53.8%) who used cannabis had at least one identifiable mental disorder. Higher comorbidity rates were observed for females (39.6%) and for those aged between 30 and 49 years. Cannabis use disorder comorbid with the most common mental disorders were: anxiety disorder (3.4%), bipolar affective disorder (5.7%), major depressive disorder (10.9%), personality disorder (9.2%), schizophrenia (15.0%), and severe stress disorder (8.7%). Cannabis use disorder has strong associations with these mental health disorders (odds ratio 4.8-34.8). The average length of stay (ALOS) for cannabis use disorders was 9.0 days and the ALOS for the most common mental health disorders was 11.0 days. CONCLUSIONS AND IMPLICATIONS: This study provides detailed information about the association between cannabis use disorders and mental health disorders and extends our understanding of comorbidity presentations in inpatient admissions.

Exploration of the comorbidity of alcohol use disorders and mental health disorders among inpatients presenting to all hospitals in New South Wales, Australia.

Alcohol is one of the most commonly used legal psychoactive substances, and its use often coexists with mental health disorders. This study explores the relationships between alcohol use and some common mental health disorders. Admissions to all New South Wales (NSW) hospitals were analyzed. The data were extracted from the NSW Department of Health Inpatient Statistics Data Collection for the period 1 July 2006 to 30 June 2007. Readmissions within 28 days were excluded. Data extraction and analyses were performed by using the SAS program. Chi-square tests and odds ratio were used to measure the association. Of the 1.8 million admissions, associations between alcohol use disorders and mental health disorders were strong (odds ratio 7.8 to 10.7, P < .001). A 33.8% of patients who used alcohol had at least 1 identifiable mental disorder. Higher comorbidity rates were observed for females (39.6%) and for those aged between 30 and 49 years. The most common mental disorders were anxiety disorders, bipolar affective disorders, major depressive disorders, personality disorders, schizophrenia, and severe stress disorders. Comorbidity with one of these mental disorders ranged from 1% to 17.6%, with significant associations (odds ratio 5.6 to 14.1). The average length of stay (ALOS) for alcohol use disorders were 6.4 days and the ALOS for the most common mental health admissions was 11.2 days. This study provides detailed information about the association between alcohol use and mental health disorders and extends our understanding of comorbidity presentations in inpatient admissions.

Do EEG and Startle Reflex Modulation Vary with Self-Reported Aggression in Response to Violent Images?

Increased violence and aggressive tendencies are a problem in much of the world and are often symptomatic of many other neurological and psychiatric conditions. Among clinicians, current methods of diagnosis of problem aggressive behaviour rely heavily on the use of self-report measures as described by the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) and International Classification of Diseases 10th revision (ICD-10). This approach does not place adequate emphasis on objective measures that are potentially sensitive to processes not feeding into subjective self-report. Numerous studies provide evidence that attitudes and affective content can be processed without leading to verbalised output. This exploratory study aimed to determine whether individuals in the normal population, grouped by self-reported aggression, differed in subjective versus objective affective processing. Participants (N = 52) were grouped based on their responses to the Buss-Durkee Hostility Inventory. They were then presented with affect-inducing images while brain event-related potentials (ERPs) and startle reflex modulation (SRM) were recorded to determine non-language-based processes. Explicit valence and arousal ratings for each image were taken to determine subjective affective effects. Results indicated no significant group differences for explicit ratings and SRM. However, ERP results demonstrated significant group differences between the 'pleasant' and 'violent' emotion condition in the frontal, central and parietal areas across both hemispheres. These findings suggest that parts of the brain process affective stimuli different to what conscious appraisal comes up with in participants varying in self-reported aggression.

Stop Using Stuff: trial of a drug and alcohol intervention for young people with comorbid mental illness and drug and alcohol problems.

OBJECTIVE: Substance abuse is a significant problem in the treatment of young people with their first psychosis. This study reports a randomized trial of a brief manualized cognitive behavioural therapy for substance abuse in young people with psychosis. METHOD: Subjects were randomized between the study treatment and a group treated as usual. Treatment was a four to six session brief cognitive behavioural therapy (CBT) intervention developed specifically for this patient group - Stop Using Stuff (SUS). RESULTS: Both groups improved across the trial. However, those exposed to the active treatment improved significantly on measures of the frequency of cannabis and alcohol abuse. CONCLUSIONS: Brief interventions in substance abuse in young people with psychosis can help moderate substance use in this difficult to treat group.

Addition of cue exposure to cognitive-behaviour therapy for alcohol misuse: a randomized trial with dysphoric drinkers.

AIM: To test whether addition of moderation-orientated cue exposure (CE) or CE after dysphoric mood induction (emotional CE, ECE) improved outcomes above those from cognitive-behaviour therapy alone (CBT) in people who drank when dysphoric. DESIGN: Multi-site randomized controlled trial comparing CBT with CBT + CE and CBT + ECE. SETTING: Out-patient rooms in academic treatment units in Brisbane and Sydney, Australia. PARTICIPANTS: People with alcohol misuse and problems controlling consumption when dysphoric (n = 163). Those with current major depressive episode were excluded. INTERVENTION: Eight weekly 75-minute sessions of individual treatment for alcohol problems were given to all participants, with CBT elements held constant across conditions. From session 2, CBT + CE participants resisted drinking while exposed to alcohol cues, with two priming doses of their preferred beverage being given in some sessions. After an initial CE session, CBT + ECE participants recalled negative experiences before undertaking CE, to provide exposure to emotional cues of personal relevance. MEASUREMENTS: Alcohol consumption, related problems, alcohol expectancies, self-efficacy and depression. RESULTS: Average improvements were highly significant across conditions, with acceptable maintenance of effects over 12 months. Both treatment retention and effects on alcohol consumption were progressively weaker in CBT + CE and CBT + ECE than in CBT alone. Changes in alcohol dependence and depression did not differ across conditions. CONCLUSIONS: These data do not indicate that addition of clinic-based CE to standard CBT improves outcomes. A different approach to the management of craving may be required.

Comorbidity of bipolar and substance use disorders in national surveys of general populations, 1990-2015: Systematic review and meta-analysis.

BACKGROUND: Substance use disorders (SUDs) are common in people with a bipolar disorder (BD). This systematic review and meta-analysis aimed to estimate the prevalence rates of SUDs in persons with BD based on national or international surveys of household populations. METHODS: Studies published from 1990 to Dec 31, 2015 were identified from MEDLINE, EMBASE. psychINFO, and CINAHL databases and reference lists. We calculated prevalence rates and conducted meta-analysis with random-effects model. RESULTS: We identified 9 unique surveys of which two surveys were repeated 10 years later using independent samples. The total sample size was 218,397 subjects. The mean prevalence for any illicit drug use disorder was 17%, for alcohol use disorder (AUD) it was 24% and SUD it was 33%. The strongest associations were found between BD and illicit drug use (pooled odds ratio (OR) 4.96, 95% CI 3.98-6.17) followed closely by BD and AUD (OR 4.09, 95% CI 3.37-4.96). The association was higher for BD respondents using illicit drugs compared to bipolar II respondents (ORs 7.48 vs. 3.30). LIMITATIONS: Some of the meta-analysis grouped illicit substances together without taking into consideration types of substance use which may differ widely between countries and over time. All included studies were cross-sectional so onset and causality can not be determined. CONCLUSIONS: The meta-analysis revealed that people with an alcohol use disorder were 4.1 times of greater risk of having a BD compared to those without an AUD. The risks were even higher for illicit drug users where they were 5.0 times of greater risk of having BD compared to non-users. These data confirm strong associations between co-occurring SUDs and BD, indicating a need for more informative studies to help develop better interventions in treating persons with BD and comorbid SUDs.

Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990-2015: Systematic review and meta-analysis.

BACKGROUND: Comorbidity between substance use disorders (SUDs) and bipolar disorder (BD) is highly prevalent to the extent it may almost be regarded the norm. This systematic review and meta-analysis aimed to estimate the prevalence rates of SUDs in treatment seeking patients diagnosed with BD in both inpatient and outpatient settings. METHODS: A comprehensive literature search of Medline, EMBASE, psychINFO and CINAHL databases was conducted from 1990 to 2015. Prevalence of co-morbid SUDs and BD were extracted and odds ratios (ORs) were calculated using random effects meta-analysis. RESULTS: There were 151 articles identified by electronic searches that yielded 22 large, multi-site studies and 56 individual studies describing comorbid rates of SUDs amongst community dwelling, BD inpatients or outpatients. The SUDs with the highest prevalence in BD were alcohol use (42%) followed by cannabis use (20%) and other illicit drug use (17%). Meta-analysis showed males had higher lifetime risks of SUDs compared to females. BD and comorbid SUDS were associated with earlier age of onset and slightly more hospitalisations than non-users. LIMITATIONS: The results do not take into account the possibility that individuals may have more than one comorbid disorder, such as having more than one SUD, anxiety disorder, or other combination. Some of the meta-analyses were based on relatively few studies with high rates of heterogeneity. Most included studies were cross-sectional and therefore causality cannot be inferred. CONCLUSIONS: This systematic review shows comorbidity between SUDs and bipolar illness is highly prevalent in hospital and community-based samples. The prevalence of SUDs was similar in patients with bipolar I and bipolar II disorders. This study adds to the literature demonstrating that SUDs are common in BD and reinforces the need to provide better interventions and properly conducted treatment trials to reduce the burden conferred by comorbid SUD and BD.

Innovative approaches to intervention for problem drinking.

PURPOSE OF REVIEW: To critique the recent literature on telephone, correspondence-based, and computerized interventions for alcohol problems, which enhance or substitute for practitioner-delivered treatments. RECENT FINDINGS: There is an unmet need for screening, assessment and intervention for alcohol problems, in part because of the difficulty in accessing such treatment within the current health care system. Research on the efficacy of correspondence or electronic (for example Internet-based) interventions is beginning to emerge. In the period 2003-2004 we identified nine acceptability or feasibility studies of these approaches and seven efficacy trials covering a wide range of settings. These modes of intervention are acceptable to patients and the public, and with careful planning, can be implemented in a variety of settings. Treatment trials demonstrate the efficacy of these interventions in reducing hazardous drinking by university students, in delaying initiation of heavy drinking in children and adolescents, and, intriguingly, in addressing insomnia among recovering alcoholics. SUMMARY: There is strong support among potential users for alcohol interventions that employ telephone assistance, written correspondence, and the Internet. These new technologies offer the prospect of increasing the reach of interventions for problem drinking and being cost-effective alternatives or supplements to face-to-face health service delivery.

Prevalence of comorbid substance use, anxiety and mood disorders in epidemiological surveys, 1990-2014: A systematic review and meta-analysis.

BACKGROUND: Comorbidity is highly prevalent between substance use disorders (SUDs), mood and anxiety disorders. We conducted a systematic review and meta-analysis to determine the strength of association between SUDs, mood and anxiety disorders in population-based epidemiological surveys. METHODS: A comprehensive literature search of Medline, EMBASE, CINAHL, PsychINFO, Web of Science, and Scopus was conducted from 1990 to 2014. Sources were chosen on the basis that they contained original research in non-clinical populations conducted in randomly selected adults living within defined boundaries. Prevalence of comorbid SUDs, mood and anxiety disorders and odds ratios (ORs) were extracted. RESULTS: There were 115 articles identified by electronic searches that were reviewed in full text which yielded 22 unique epidemiological surveys to extract lifetime and 12-month prevalence data for psychiatric illness in respondents with an SUD. Meta-analysis indicated the strongest associations were between illicit drug use disorder and major depression (pooled OR 3.80, 95% CI 3.02-4.78), followed by illicit drug use and any anxiety disorder (OR 2.91, 95% CI 2.58-3.28), alcohol use disorders and major depression (OR 2.42, 95% CI 2.22-2.64) and alcohol use disorders and any anxiety disorder (OR 2.11, 95% CI 2.03-2.19). ORs for dependence were higher than those for abuse irrespective to diagnoses based on lifetime or 12-month prevalence. CONCLUSIONS: This review confirms the strong association between SUDs, mood and anxiety disorders. The issue has now been recognised worldwide as a factor that affects the profile, course, patterns, severity and outcomes of these disorders.

Efficacy of moderation-oriented cue exposure for problem drinkers: a randomized controlled trial.

The effectiveness of cue exposure following a priming dose was compared with cognitive-behavioral intervention in a community sample of problem drinkers. Participants were randomly allocated to 1 of the 2 conditions and received a mean of 5.84 (SD = 2.69) sessions. A psychologist blind to treatment condition conducted an 8-month follow-up. Compared with pretreatment levels, significant decreases in alcohol consumption were evident posttreatment and maintained at follow-up for both groups. Reductions in severity of dependence, impaired control, and alcohol-related problems were also evident for both groups at follow-up. No differences in outcome associated with initial severity of alcohol dependence were apparent. The results raise the issue of the appropriateness of reserving a goal of controlled drinking for those with relatively mild alcohol problems and low alcohol dependence.

Psychosocial interventions for people with both severe mental illness and substance misuse.

Over 50% of people with a severe mental illness also use illicit drugs and/or alcohol at hazardous levels. This review is based on the findings of 32 randomized controlled trials which assessed the effectiveness of psychosocial interventions, offered either as one-off treatments or as an integrated or nonintegrated program, to reduce substance use by people with a severe mental illness. The findings showed that there was no consistent evidence to support any one psychosocial treatment over another. Differences across trials with regard to outcome measures, sample characteristics, type of mental illness and substance used, settings, levels of adherence to treatment guidelines, and standard care all made pooling results difficult. More quality trials are required that adhere to proper randomization methods; use clinically valuable, reliable, and validated measurement scales; and clearly report data, including retention in treatment, relapse, and abstinence rates. Future trials of this quality will allow a more thorough assessment of the efficacy of psychosocial interventions for reducing substance use in this challenging population.

The efficacy of an opportunistic cognitive behavioral intervention package (OCB) on substance use and comorbid suicide risk: a multisite randomized controlled trial.

OBJECTIVE: People with substance use disorders who present with suicidal behavior are at high risk of subsequent suicide. There are few effective treatments specifically tailored for this population that diminish this risk. We aimed to assess the impact of an opportunistic cognitive behavioral intervention package (OCB) among adult outpatients with a substance use and comorbid suicide risk. METHOD: A randomized controlled trial was conducted across 2 sites in which 185 patients presenting with suicide risk and concurrent substance use received either OCB (8 sessions plus group therapy) or treatment as usual (TAU) over a 6-month period. Primary outcomes were suicidal behavior (suicide attempts, suicidal intent and presence of suicide ideation) and level of drug and alcohol consumption. Secondary outcomes were changes in psychological measures of suicide ideation, depression, anxiety, and self-efficacy. RESULTS: There were no completed suicides, and only 2 participants reported suicide attempts at follow-up. Suicide ideation, alcohol consumption, and cannabis use fell over time but no significant Treatment × Time differences were found. There were also no differences between OCB and TAU over time on psychological measures of depression, anxiety, or self-efficacy. Suicide ideation at 6-month follow-up was predicted by cannabis use and higher scores on the Brief Psychiatric Rating Scale at baseline. CONCLUSIONS: The opportunistic cognitive behavioral intervention package did not appear to be beneficial in reducing suicide ideation, drug and alcohol consumption, or depression relative to treatment as usual.

Randomized controlled trial of cognitive behaviour therapy for comorbid post-traumatic stress disorder and alcohol use disorders.

Aims This study aimed to test the efficacy of integrated cognitive behaviour therapy (CBT) for coexisting post traumatic stress disorder (PTSD) and alcohol use disorders (AUD). Setting Clinics across Sydney, Australia.Design Randomized controlled trial of 12 once-weekly individual sessions of either integrated CBT for PTSD and AUD(integrated therapy, IT; n = 33) or CBT for AUD plus supportive counselling (alcohol-support, AS; n = 29). Blind assessments were conducted at baseline and post-treatment and at 5 [standard deviation (SD) = 2.25] and 9.16(SD = 3.45) months post-treatment. Participants Sixty-two adults with concurrent PTSD and AUD. Measurements Outcomes included changes in alcohol consumption (time-line follow-back), PTSD severity [clinician-administered PTSD scale (CAPS)], alcohol dependence and problems, and depression and anxiety. Findings Reductions in PTSD severity were evident in both groups. IT participants who had received one or more sessions of exposure therapy exhibited a twofold greater rate of clinically significant change in CAPS severity at follow-up than AS participants [IT60%, AS 39%, odds ratio (OR): 2.31, 95% confidence interval (CI): 1.06, 5.01]. AS participants exhibited larger reductions than IT participants in alcohol consumption, dependence and problems within the context of greater treatment from other services during follow-up. Results lend support to a mutually maintaining effect between AUD and PTSD. Conclusions Individuals with severe and complex presentations of coexisting post-traumatic stress disorder(PTSD) and alcohol use disorders (AUD) can derive substantial benefit from cognitive behaviour therapy targeting AUD, with greater benefits associated with exposure for PTSD. Among individuals with dual disorders, these therapies can generate significant, well-maintained treatment effects on PTSD, AUD and psychopathology.

Development of a Controlled Drinking Self-Efficacy Scale and appraising its relation to alcohol dependence.

There is no specific self-efficacy measure that has been developed primarily for problem drinkers seeking a moderation drinking goal. In this article, we report the factor structure of a 20-item Controlled Drinking Self-Efficacy Scale (CDSES; Sitharthan et al., 1996; Sitharthan et al., 1997). The results indicate that the CDSES is highly reliable, and the factor analysis using the full sample identified four factors: negative affect, positive mood/social context, frequency of drinking, and consumption quantity. A similar factor structure was obtained for the subsample of men. In contrast, only three factors emerged in the analysis of data on female participants. Compared to women, men had low self-efficacy to control their drinking in situations relating to positive mood/social context, and subjects with high alcohol dependence had low self-efficacy for situations relating to negative affect, social situations, and drinking less frequently. The CDSES can be a useful measure in treatment programs providing a moderation drinking goal.