G. Alan Marlatt: 1941-2011

In his extraordinarily productive research career, G. Alan Marlatt contributed to and anticipated by decades a variety of major changes in the treatment of substance use disorders. This article briefly reviews and comments on his contributions to addiction psychology, cognitive-behavior therapy, alcohol expectancies, relapse prevention, moderation goals, harm reduction, and mindfulness meditation research. He departed suddenly and too soon, but left us with a rich heritage for more effective and humane treatment of those who suffer with addiction.     

Seeking the middle way: G. Alan Marlatt and harm reduction

G. Alan Marlatt's research and other professional efforts have profoundly influenced the science and practice of harm reduction. Marlatt's balanced placebo drinking research challenged prevailing attitudes about the loss of control and illustrated the potency of beliefs in predicting drinking behavior. His courageous defense of the Sobells during the controlled drinking controversy was a first step toward legitimizing harm reduction goals. His harm reduction interventions are best practices for college student drinking, and the excellence of those programs has elevated the stature of harm reduction interventions in the US. He developed mindfulness-based harm reduction strategies for those managing relapse or seeking moderation goals in treatment. His interpretation of the science of harm reduction compelled him to speak on behalf of consumers, advocating for alternative forms of treatment rather than a one-size-fits-all model. He collaborated with community stakeholders to extend culturally relevant harm reduction programs into traditionally disempowered communities. Somehow, Marlatt also found time to mentor the next generation of harm reduction scholars and practitioners. The stature of harm reduction today is largely the result of Marlatt's dedication and professionalism. Though he is sorely missed, the field will be continued to be shaped by his ideas for many years to come.     

Pulling for Native communities: Alan Marlatt and the Journeys of the Circle

Rigorous reviews of the science on the effectiveness of Alcoholics Anonymous (AA) indicate that AA and related 12-step treatment are at least as helpful as other intervention approaches. Exactly how AA achieves these beneficial outcomes is less well understood, yet, greater elucidation of AA's mechanisms could inform our understanding of addiction recovery and the timing and content of alcohol-related interventions. Empirical studies examining AA's mechanisms were located from searches in Pubmed, Medline, PsycINFO, Social Service Abstracts and from published reference lists. Thirteen studies completed full mediational tests. A further six were included that had completed partial tests. Mechanisms examined fell into three domains: (1) Common processes; (2) AA-specific practices; and (3) Social and spiritual processes. Results suggest AA helps individuals recover through common process mechanisms associated with enhancing self-efficacy, coping skills, and motivation, and by facilitating adaptive social network changes. Little research or support was found for AA's specific practices or spiritual mechanisms. Conclusions are limited by between-study differences in sampling, measurement, and assessment time-points, and by insufficient theoretical elaboration of recovery-related change. Similar to the common finding that theoretically-distinct professional interventions do not result in differential patient outcomes, AA's effectiveness may not be due to its specific content or process. Rather, its chief strength may lie in its ability to provide free, long-term, easy access and exposure to recovery-related common therapeutic elements, the dose of which, can be adaptively self-regulated according to perceived need.     

Alcohol and drug problems in minority groups

Alcohol is a very recent introduction to the long history of Aboriginal occupation of Australia. The patterns of drinking have arisen as a copy of binge drinking which was and still is a common form of drinking in outback Australia. Grafted onto this is the cultural heritage of sharing as well as the tension release obtained for those at the lowest rung of Australia's socio-economic ladder.

Doctors and nurses are supposed to be the educated members of society and should be expected to go more than half the way in bridging the cultural gap necessary to initiate preventive and curative services to one of the major health problems facing Aborigines and other ethnic groups in Australia.     

Drinking and gambling: a comparison with implications for theories of addiction

There is current concern about the level of excessive gambling in a number of countries, but problem gambling still occupies an uncertain place in the addictions field. The present paper presents results from a pilot study comparing 16 problem gamblers and 16 problem drinkers. Results from a new Attachment Questionnaire suggested that gamblers were just as strongly attached to gambling as drinkers to drinking, although they were significantly less likely to experience withdrawal symptoms. Interviews with the problem gamblers suggested that excessive attachment to gambling was maintained by cyclical processes involving strong, negative feelings associated with gambling losses, shortage of money and the need to keep the extent of gambling secret. It is proposed that these 'secondary' processes, along with primary incentive motivation and the tertiary effects of losses associated with excessive behaviour, are sufficient to explain addiction. It is further suggested that neuroadaptation, tolerance and withdrawal, often thought to be central to the process of addiction, may in fact be of comparatively little importance.     

Harry Potter and the Underage Drinkers: Can We Use This to Talk to Teens About Alcohol?

ABSTRACT

Underage drinking continues to be a major problem in America. Approximately 20% of all alcohol consumed in the United States is consumed by minors with 44% of 8th graders and 77% of 12th graders reporting that they have tried alcohol at least once. The National Highway Traffic Safety Administration reported that, in 2003, as many as 3,657 drivers, 15 to 20 years old, were killed in motor vehicle crashes in the United States. The most recent book in the Harry Potter series, Harry Potter and the Half-Blood Prince, has several references to underage drinking and the provision of alcohol to minors by adults. Given the popularity of the book, clinicians can use this to talk to adolescents about alcohol use.     

In Memoriam: Martin C. Doot,MD

Abstract

The purpose of this study was to use administrative records of admissions to substance abuse treatment to construct episodes of care for publicly funded adolescent clients in Washington State, and then to analyze two important outcomes after an index episode: readmissions to treatment and criminal convictions (including felony convictions and any conviction). The study population was youth, ages 14 to 17, who began and ended an index episode in 1997 and 1998 (n = 5903). The youth were followed for 18 months after the end of their episode, and survival analysis techniques were used to determine the treatment correlates of the outcomes. Clients who completed treatment, compared to those who did not, had significantly lower risks of each outcome, while those with treatment episodes longer than 90 days had lower risks of readmission and felony convictions.     

Depression and heavy drinking occasions: a cross-sectional general population study

The purpose of this study was to assess the association between depression and heavy drinking occasions in the Finnish general population. A subsample (2086/4020, response rate 51.9%) of the National FINRISK 2007 Study was used. Depression was assessed with a modified Beck Depression Inventory (short form) and alcohol problems with the Alcohol Use Disorders Identification Test. Total alcohol intake and number of heavy drinking occasions (≥7 drinks for men, ≥5 drinks for women) were evaluated using the Timeline Followback. Of the sample, 13.0% (123/946) of men and 17.4% (198/1140) of women were classified as being depressed. Further, 7.5% (71/946) of men and 3.5% (40/1140) of women reported having at least four heavy drinking occasions in the previous 28days. In an adjusted logistic regression model, these men had a 2.6-fold risk (95% C.I. 1.2-5.3) of depression, as compared to men with less than four heavy drinking occasions. The association was found irrespective of total alcohol consumption and alcohol problems. This association was not found in women.     

Neurocognitive effects of alcohol hangover

Alcohol hangover is characterized by adverse physical and mental effects that occur the next morning after the intake of toxic doses of alcohol. One of the more relevant functional consequences of hangover is the cognitive and subjective impairment, which could be related to the high socioeconomic costs of alcohol consumption. Nevertheless, few studies have addressed the study of neurocognitive and subjective effects of hangover. The systematic and exhaustive study of neurocognitive and subjective effects has not been done. In the present work we briefly review the hangover impact, not only in the objective execution of attention, psychomotricity and memory tasks, but in the subjective state of the subjects as well. Moreover, we also highlight the methodology difficulties to study neurocognitive effects of hangover and suggest several aspects to take into account in future investigations.     

The problem of binge drinking among Italian university students: a preliminary investigation

Although binge drinking and excessive alcohol consumption are relevant public health problems in Italy, no research has been carried out on those topics for years. In the first months of the year 2005, 1000 undergraduates in a number of Italian universities were administered a survey regarding their attitudes in alcohol consumption. Participants were to complete a questionnaire including demographic and alcohol variables, the Sensation-Seeking Scale (SSSV) and the Positive Drinking Expectancy Scale (PDMS). According to previous research, students were categorized in non-drinkers, social, binge, and heavy drinkers. Results showed that the estimated percentage of binge drinking among university students is 32.9%. The survey revealed-by means of univariate and multivariate analysis-that social, binge, and heavy drinkers differ in terms of some drinking variables, in their expectancies about alcohol and in sensation-seeking dimensions. Implications for the prevention of binge drinking in young adults are currently under discussion even if further investigation into the Italian context is urgently needed.     

Binge drinking behaviour, attitudes and beliefs in a UK community sample: An analysis by gender, age and deprivation

Binge drinking has sparked considerable interest and concern. However, despite this interest little is known about the lay understanding of binge drinking and whether there are differences in understanding by gender, age and level of deprivation.

Aims: This study investigated the beliefs and attitudes to binge drinking of a sample in the Inverclyde area.

Methods: Using both cluster and quota sampling, 586 subjects completed a structured interview, using open questions about their beliefs on binge drinking and whether it was a problem generally and locally.

Findings: Definitions of binge drinking tended to concentrate on intoxication and some described a dependent drinking pattern. Causes and solutions offered were varied but pointed-up levels of deprivation in respect of jobs and entertainment. More subjects regarded binge drinking as a problem in society than locally, which is consistent with research suggesting that misperceptions of others' drinking increases with social distance. Differences in beliefs were found by age and level of deprivation but not gender. It was marked that no subject offered the 'official' definition of bingeing or even an approximation of it.

Conclusions: Further research is required if future mass-media campaigns and interventions are to be relevant to the population.     

Schedule-induced drinking in humans: a potential factor in excessive alcohol use

The timed delivery of monetary reinforcement by a computer-controlled slot machine altered the amount of fluid drunk adjunctively by human subjects. In separate experiments, subjects were allowed access to one of three fluids, water, non-alcoholic beer, or alcoholic beer, while receiving monetary reinforcement from the slot machine on one of two Fixed-Interval schedules (FI30 s or FI90 s). The largest difference in intake between the two schedule conditions occurred when water was the fluid available, but a similar trend in consumption was observed in the other studies. Greater consumption occurred when reinforcement was presented on the FI90-s schedule, which was predicted from previous studies using animals. The possible interaction of schedule-induced drinking with other variables known to influence human alcohol consumption is discussed.     

Sociodemographic correlates of energy drink consumption with and without alcohol: results of a community survey

Objective

We examined the sociodemographic correlates of energy drink use and the differences between those who use them with and without alcohol in a representative community sample.

Methods

A random-digit-dial landline telephone survey of adults in the Milwaukee, Wisconsin area responded to questions about energy drink and alcohol plus energy drink use.

Results

Almost one-third of respondents consumed at least one energy drink in their lifetime, while slightly over 25% used energy drinks in the past year and 6% were past-year alcohol plus energy drink users. There were important racial/ethnic differences in consumption patterns. Compared to non-users, past-year energy drink users were more likely to be non-Black minorities; and past-year alcohol plus energy drink users when compared to energy drink users only were more likely to be White and younger. Alcohol plus energy drink users also were more likely to be hazardous drinkers.

Conclusions

Our results which are among the first from a community sample suggest a bifurcated pattern of energy drink use highlighting important population consumption differences between users of energy drinks only and those who use alcohol and energy drinks together.