Functioning, life context, and help-seeking among late-onset problem drinkers: comparisons with nonproblem and early-onset problem drinkers

We compared the functioning and life contexts of late-middle-aged adults classified as late-onset problem drinkers (n=229), early-onset problem drinkers (n=475), and nonproblem drinkers (n=609). Compared with nonproblem drinkers, late-onset problem drinkers consumed more alcohol and functioned more poorly; they also reported more negative life events and chronic stressors, fewer social resources, and more use of avoidance coping. However, late-onset problem drinkers consumed less alcohol, had fewer drinking problems, functioned better, and had more benign life contexts than did early-onset problem drinkers. We found no evidence of an association between age-related loss events and the onset of late-life drinking problems. Very few problem drinkers sought help specifically for their alcohol abuse, but about 25% did seek treatment from mental health practitioners. Problem drinkers who were functioning more poorly and who reported more life stressors and fewer social resources were more likely to seek help.     

Short-term processes of remission and nonremission among late-life problem drinkers.

This prospective study compares alcohol use, functioning, life stressors, social resources, and help-seeking among three groups of older adults: remitted problem drinkers, nonremitted problem drinkers, and nonproblem drinkers. At initial assessment, to-be-remitted problem drinkers had several advantages compared with individuals who would continue to have drinking problems. Specifically, they consumed less alcohol, reported fewer drinking problems, had friends who approved less of drinking, and were more likely to seek help from mental health practitioners. Problem drinkers who remitted improved somewhat over time, but they did not attain the level of functioning or type of life contexts shown by nonproblem drinkers. Time of onset of drinking problems influenced the short-term process of remission: Compared with early-onset individuals, late-onset problem drinkers were more likely to remit over the 1-year interval. The predictors of short-term remission suggested that late-onset problem drinkers may be more reactive to physical health stressors and to social influences than are individuals with more long-standing problems with alcohol.     

Remission of Late-Life Drinking Problems: A 4- Year Follow-up

This 4-year follow-up study compared stably remitted late-life problem drinkers to nonremitted problem drinkers and nonproblem drinkers. At time 1, to-be-remitted drinkers reported less alcohol consumption and fewer drinking problems, more depression and less self-confidence, less spousal support and approval of drinking from friends, and more help-seeking than did to-be-nonremitted drinkers. Remitted drinkers showed improvement in functioning and life context at the 4-year follow-up, but compared with nonproblem drinkers some deficits persisted. Stable remission and abstinence among late-onset drinkers were closely tied to receiving less spousal support and approval from friends for drinking at time 1, whereas helpseeking was a strong predictor of stable remission and abstinence among early-onset problem drinkers. For both late- and early-onset drinkers, abstinence was predicted by initially having more drinking problems, depression, and health stressors.     

Pain and use of alcohol to manage pain: prevalence and 3-year outcomes among older problem and non-problem drinkers

AIMS: Most older adults report having recently experienced pain, and many older adults have late-life drinking problems. However, to our knowledge, the intersection of pain and alcohol misuse by older adults has not been studied. This research focuses on the implications of pain for older individuals who have problems with alcohol. DESIGN: Longitudinal survey. SETTING, PARTICIPANTS AND MEASUREMENT: Older community-residing adults (n = 401) were classified as problem and non-problem drinkers. At baseline and 3 years later they were asked to provide information about their pain, use of alcohol to manage pain, drinking behavior, chronic health problems and recent serious injury. FINDINGS: At baseline, older problem drinkers reported more severe pain, more disruption of daily activities due to pain and more frequent use of alcohol to manage pain than did older non-problem drinkers. More pain was associated with more use of alcohol to manage pain; this relationship was stronger among older adults with drinking problems than among those without drinking problems. Among older men, more baseline drinking problems interacted with use of alcohol to manage pain to predict more health problems and serious injury 3 years later. Among older women, more baseline drinking problems interacted with use of alcohol to manage pain to predict more drinking problems 3 years later. CONCLUSIONS: The results highlight the importance of monitoring the drinking behavior of older patients who present with pain complaints, especially patients who have pre-existing problems with alcohol.     

Gender differences in the individual characteristics and life contexts of late-middle-aged and older problem drinkers

This study focuses on gender differences in the individual characteristics and life contexts of late-life problem drinkers. Late-middle-aged women with drinking problems (n = 183) consumed less alcohol, had fewer drinking problems, and reported more recent onset of drinking problems than did their male counterparts (n = 476). They also used more psychoactive medications, were more depressed, and were less likely to seek alcohol treatment. Consistent with a gender role perspective on alcohol abuse, problem-drinking women had more family-related and fewer financial stressors than did problem-drinking men. Contrary to expectation, however, problem-drinking women reported more support from children, extended family members, and friends than did problem-drinking men. Moreover, women who continued to have drinking problems over a 1-year interval reported some unexpected short-term benefits at follow-up, including reduced spouse stressors. Women who had remitted at follow-up experienced less spouse support, and more family-related stressors and depression than did remitted men. They also lost support from extended family members over the 1-year interval. The results suggest a need for screening and treatment efforts tailored more closely to the life circumstances of women with late-life drinking problems.     

Drinking patterns and problems: a comparison of two black primary care samples in two regions

This paper explores the effect of regional ("wet" vs. "dry") variation in drinking patterns and problems on the prevalence of alcohol-related problems among those seeking care in primary care settings. A sample of black primary care patients interviewed in Hinds County, MS (n = 740) and in Contra Costa County, CA (n = 93) are compared on quantity and frequency of usual drinking, drunkenness, consequences of drinking, and alcohol dependence. Controlling for demographic differences in logistic regression analysis, drinkers in Contra Costa, while no more likely to report heavy drinking, were four times more likely to report alcohol-related consequences, more than five times more likely to report alcohol dependence experiences, and more than nine and a half times more likely to report ever having had treatment for an alcohol problem than those in Hinds County. Data suggest that regional variations in drinking patterns may be reflected in alcohol involvement in primary care caseloads, and that the large variation in the prevalence of alcohol-related problems found in primary care settings may, in part, be attributable to this. All primary care settings do not appear to hold equal promise for screening for and intervening with problem drinking, and further research is needed in determining those settings that provide the greatest potential for targeting prevention efforts.     

Relationship Between Age and Drinking Patterns and Drinking Problems Among Japanese, Japanese-Americans, and Caucasians

Comparing alcohol consumption patterns by age and gender among Japanese in Japan and Japanese-Americans and Caucasians in the United States, this study examined the associations between age and both heavy drinking and social problems using logistic regression for each ethnic group of male current drinkers. As reported in previous studies of Caucasians, men drink more alcohol than women, older respondents are more likely than younger ones to be abstainers, and the percentages of heavier drinkers and problem drinkers are higher among the young than among older people. Although Japanese-Americans reported consuming less alcohol than Caucasians, their drinking patterns by age were similar:among both United States populations, younger respondents are at higher risk for drinking problems than older respondents, even when alcohol consumption and sociodemographic variables are controlled by logistic regression. However, this association of age and drinking patterns and drinking problems is not universal. Japanese men consumed more alcohol and had a higher proportion of heavier drinkers in the middle age groups; the association between age and drinking problems also varied in this group. In addition to aging, sociocultural factors such as drinking norms probably account for the differences in drinking behavior among different age groups. This study may stimulate further cross-cultural comparison of drinking patterns and problems.     

Missed opportunities in addressing drinking behavior in medical and mental health services

BACKGROUND: Epidemiological and clinical literature point to the importance of screening for alcohol problems in medical and psychiatric settings. However, little is known about which problem drinkers seek help from those services or about the characteristics of those who have their drinking addressed. METHODS: We interviewed a probability sample of adult dependent and problem drinkers in the general population (n = 672) and consecutive admissions to chemical dependency programs in a northern California county (n = 926). We reinterviewed them 1 year later and measured medical and mental health visits and whether their drinking was addressed during the visit. RESULTS: Almost two-thirds of problem drinkers had a medical visit, and approximately one-third had a mental health visit, yet drinking was not often discussed, especially during medical visits. Many of those more likely to have a visit were not more likely to have their drinking addressed. Women and individuals older than 40 years had more medical and mental health visits [odds ratio (OR), 1.71; p < 0.001 and OR, 1.55; p < 0.001, respectively, for women; OR, 1.57; p < 0.05 and OR, 1.64; p < 0.05, respectively, for age >/=40 years], but were not more likely to have their drinking addressed in either setting, and women were less likely than men to have their drinking addressed in mental health settings (OR, 0.62; p < 0.05). Those with higher alcohol severity and those who had attended chemical dependency treatment during the previous year were more likely to have their drinking addressed in each setting. Insurance status predicted medical, but not mental health, visits and was not related to having drinking addressed in either setting. CONCLUSIONS: Drinking behavior was not routinely addressed by medical and mental health practitioners for dependent and problem-drinking men and women who presented in public and private medical and mental health settings.     

Late‐Life Alcohol Consumption and 20‐Year Mortality

Background: Growing epidemiological evidence indicates that moderate alcohol consumption is associated with reduced total mortality among middle‐aged and older adults. However, the salutary effect of moderate drinking may be overestimated owing to confounding factors. Abstainers may include former problem drinkers with existing health problems and may be atypical compared to drinkers in terms of sociodemographic and social‐behavioral factors. The purpose of this study was to examine the association between alcohol consumption and all‐cause mortality over 20 years among 1,824 older adults, controlling for a wide range of potential confounding factors associated with abstention. Methods: The sample at baseline included 1,824 individuals between the ages of 55 and 65. The database at baseline included information on daily alcohol consumption, sociodemographic factors, former problem drinking status, health factors, and social‐behavioral factors. Abstention was defined as abstaining from alcohol at baseline. Death across a 20‐year follow‐up period was confirmed primarily by death certificate. Results: Controlling only for age and gender, compared to moderate drinkers, abstainers had a more than 2 times increased mortality risk, heavy drinkers had 70% increased risk, and light drinkers had 23% increased risk. A model controlling for former problem drinking status, existing health problems, and key sociodemographic and social‐behavioral factors, as well as for age and gender, substantially reduced the mortality effect for abstainers compared to moderate drinkers. However, even after adjusting for all covariates, abstainers and heavy drinkers continued to show increased mortality risks of 51 and 45%, respectively, compared to moderate drinkers. Conclusions: Findings are consistent with an interpretation that the survival effect for moderate drinking compared to abstention among older adults reflects 2 processes. First, the effect of confounding factors associated with alcohol abstention is considerable. However, even after taking account of traditional and nontraditional covariates, moderate alcohol consumption continued to show a beneficial effect in predicting mortality risk.     

Adult transition from at-risk drinking to alcohol dependence: the relationship of family history and drinking motives

Background:  Prospective studies have not previously examined whether a family history of alcoholism and drinking motives conjointly predict a diagnosed DSM-IV alcohol abuse or dependence in adults, despite a large literature that each is associated with alcohol consumption. The focus of this study is the conjoint, prospective examination of these risk factors in a 10-year longitudinal study of adults who were at-risk drinkers at baseline.
Methods:  Prospective, population-based cohort of drinkers aged 18 or older from a Northeastern U.S. area initially evaluated for history of alcohol use disorders and drinking motives in 1991 to 1992. New onset dependence was studied in those who never met the criteria for alcohol dependence at baseline ( n  = 423), and new onset abuse was studied in those who never met the criteria for alcohol abuse at baseline ( n  = 301) and who did not develop dependence during the follow-up.
Results:  Family history significantly interacted with 2 baseline drinking motives in predicting new onsets of DSM-IV alcohol dependence: drinking to reduce negative affect (OR 3.38; 95% CI 1.05, 10.9) and drinking for social facilitation (OR 3.88; CI 1.21, 12.5). Effects were stronger after conditioning the drinking motives on having a positive family history of alcoholism. In contrast, in predicting new onsets of alcohol abuse, drinking motives did not have direct effects or interact with family history.
Conclusions:  Those who drank to reduce negative affect or for social facilitation at baseline were at greater risk of alcohol dependence 10 years later if they also had a family history of alcoholism. These results suggest an at-risk group that can be identified prior to the development of alcohol dependence. Further, the findings suggest utility in investigating the interaction of drinking motives with measured genetic polymorphisms in predicting alcohol dependence.     

The association between alcohol consumption patterns and adherence to food consumption guidelines

Objective: To examine the association between alcohol consumption patterns and adherence to major food consumption guidelines in adults in Spain. Methods: Telephone survey of 12,037 persons, representative of the population age 18 to 64 years in the region of Madrid, conducted from 2000 to 2005. The threshold between average moderate and excessive drinking was 40 g alcohol/d in men and 24 g/d in women. Binge drinking was defined as intake of ≥80 g alcohol in men and ≥60 g in women during 1 drinking session in the last 30 days. Food consumption was measured with a 24‐hour recall. Statistical analyses were performed using logistic regression and adjusted for the main confounders. Results: In total, 4.3% of study participants were excessive drinkers and 10.3% binge drinkers; 6.5% preferred spirits and 24.2% drank with meals. In comparison with never drinking, average moderate drinking with binge drinking was associated with excessive meat consumption (>1 serving/d). Excessive alcohol consumption without binge drinking was associated with insufficient intake of milk products (<2 servings/d) and excessive consumption of meat, fish, and eggs (>2 servings/d). Excessive drinkers with binge drinking more often did not meet the guidelines on consumption of fruit and vegetables (<3 servings/d), milk products, and meat. Excessive drinkers, with and without binge drinking, were more likely to skip a meal, especially breakfast. Consumption mainly of spirits was associated with insufficient fruit and vegetable consumption, and with skipping a meal. Finally, drinking at mealtimes was associated with poor adherence to most of the food consumption guidelines. No dietary differences between men and women were found in relation to alcohol consumption. Conclusions: Average excessive alcohol consumption, binge drinking, preference for spirits, and drinking alcohol at mealtimes are associated with poor adherence to major food consumption guidelines.     

Prevalence of alcohol dependence among excessive drinkers in New Mexico

BACKGROUND: Excessive alcohol consumption claims more than 75,000 lives in the United States each year. The prevalence of alcohol dependence among excessive drinkers is not well known. METHODS: Data from the 2002 Behavioral Risk Factor Surveillance System (BRFSS) in New Mexico were used to assess the prevalence of excessive drinking, including binge drinking, heavy drinking, alcohol-impaired driving, and alcohol dependence. RESULTS: Of 4,761 respondents, 16.5% were excessive drinkers; 14.4% binge drank and 1.8% were alcohol dependent. While the rates of alcohol dependence were higher among the youngest age group, males, those with some college education, and those of race/ethnicity other than White, non-Hispanic, only differences by age were statistically significant. The prevalence of alcohol dependence was the highest among those who reported alcohol-impaired driving in the past 30 days (15.9%), and was lower among those who reported heavy drinking (13.4%) and binge drinking (8.1%). CONCLUSIONS: Although 16.5% of New Mexico adults had at least 1 type of excessive drinking, only 1.8% of all adults met the criteria for alcohol dependence. Furthermore, only a minority of those who reported binge drinking, heavy drinking, or alcohol-impaired driving met the criteria for alcohol dependence. This suggests that most alcohol problems in New Mexico are likely due to excessive drinking among persons who are not alcohol dependent. The adverse health and social consequences associated with excessive drinking are not limited to those who are alcohol dependent, but extend to a broader range of problem drinkers across the population.     

Rates and predictors of relapse after natural and treated remission from alcohol use disorders

AIMS: This study examined the rates and predictors of 3-year remission, and subsequent 16-year relapse, among initially untreated individuals with alcohol use disorders who did not obtain help or who participated in treatment and/or Alcoholics Anonymous in the first year after recognizing their need for help. DESIGN AND MEASURES: A sample of individuals (n = 461) who initiated help-seeking was surveyed at baseline and 1 year, 3 years, 8 years and 16 years later. Participants provided information on their life history of drinking, alcohol-related functioning and life context and coping. FINDINGS: Compared to individuals who obtained help, those who did not were less likely to achieve 3-year remission and subsequently were more likely to relapse. Less alcohol consumption and fewer drinking problems, more self-efficacy and less reliance on avoidance coping at baseline predicted 3-year remission; this was especially true of individuals who remitted without help. Among individuals who were remitted at 3 years, those who consumed more alcohol but were less likely to see their drinking as a significant problem, had less self-efficacy, and relied more on avoidance coping, were more likely to relapse by 16 years. These findings held for individuals who initially obtained help and for those who did not. CONCLUSIONS: Natural remission may be followed by a high likelihood of relapse; thus, preventive interventions may be indicated to forestall future alcohol problems among individuals who cut down temporarily on drinking on their own.     

A Comparison of General Self-Efficacy and Drinking Refusal Self-Efficacy in Predicting Drinking Behavior

A number of studies have suggested that task specific self-efficacy has more influence over behavior than general self-efficacy. However, little research has compared the impact of task-specific self-efficacy beliefs to the impact of general self-efficacy in predicting alcohol consumption. This study aimed to compare the contribution of general self-efficacy and drinking refusal self-efficacy (a form of task-specific self-efficacy) to volume and frequency of alcohol consumption. Regression analyses were performed in samples of community (n = 298) and clinical (n = 296) drinkers. Overall, drinking refusal self-efficacy was found to be a significant predictor of alcohol consumption in the community sample, while general self-efficacy was found to be a significant predictor of drinking in the clinical sample. These differences highlight the differential roles of general and task specific self-efficacy in governing drinking behavior and suggest future directions for prevention and treatment of alcohol problems.     

Evaluation of the Yale-Brown Obsessive Compulsive Scale (YBOCS-hd) for Heavy Drinking With Mild to Moderately Dependent Alcohol Abusers

BACKGROUND: Many similarities have been noted between urges and desires to drink heavily and obsessive-compulsive disorders (OCD). Based on such similarities, Modell et al. (1992) developed the Yale-Brown Obsessive Compulsive Scale for heavy drinking (YBOCS-hd), a modified version of YBOCS, to assess obsessions and compulsions related to heavy drinking. Evaluation of the YBOCS-hd has been limited to more severely dependent alcohol abusers. METHODS: The present study used a self-administered version of the YBOCS-hd to evaluate (1) the severity of drinking-related obsessive compulsive symptoms with mild to moderately dependent alcohol abusers (problem drinkers), and (2) whether end-of-treatment changes in YBOCS-hd scores would be related to within-treatment functioning. RESULTS: Results indicated that problem drinkers have lower alcohol-related Obsessive and Compulsive subscale scores than did more severely dependent drinkers, but higher scores than did non-problem drinkers, supporting the construct validity of the YBOCS-hd. In addition, at the end of treatment, the YBOCS-hd scores of alcohol abusers who drank at low-risk levels during treatment were significantly lower than the scores of those who drank at high-risk levels. Lastly, exploratory factor analysis did not provide support for the two purported YBOCS-hd subscales (Obsessive, Compulsive). Instead, the analysis yielded a single general factor and a second factor that contained two questions measuring heavy drinking. CONCLUSIONS: Despite the fact that total YBOCS-hd scores covaried with drinking, neither the total YBOCS-hd pretreatment score nor the two subscale scores predicted functioning at the end of treatment. The present results call into question the utility of the YBOCS-hd, because a single item measuring the heaviness of drinking was as useful as the total YBOCS-hd and its two subscales in relating changes during treatment to end-of-treatment functioning for problem drinkers. However, although the YBOCS-hd does not predict changes in drinking, it may have value as an indirect measure of drinking in situations where direct measurement of alcohol consumption is undesirable (i.e., direct measurement might be reactive). Because the present findings are derived from problem drinkers, further research is needed to confirm the factor structure of the YBOCS-hd with clients who represent a broader range of alcohol problem severity.     

Controlled study of brief personalized assessment-feedback for drinkers interested in self-help

AIMS: Brief alcohol interventions typically have been directed to heavy-drinking patients seeking primary health care and college students. This study examined the efficacy of mailing brief personalized assessment-feedback to interested drinkers recruited from the general public. We hypothesized that problem drinkers would benefit more from the intervention than individuals who were not problem drinkers. DESIGN: A two-arm, double-blinded, community-based randomized controlled trial with 6-month follow-up. SETTING AND PARTICIPANTS: A screening interview was administered to a stratified random sample of 10 014 Canadians 18 years of age and older (5621 women and 4393 men; M age = 43.3 years, SD = 15.99; response rate = 65.4%). INTERVENTION: Current drinkers interested in receiving alcohol self-help materials (n = 1727) were assigned randomly to receive brief personalized assessment-feedback on male and female population drinking norms by mail, or to a delayed-treatment control group, and were contacted 6 months later (76% retention rate). MEASUREMENTS: Problem drinking status at baseline [using sex-specific Alcohol Use Disorders Identification Test (AUDIT) cut scores], and frequency and quantity of alcohol use at follow-up. FINDINGS: Analysis of covariance identified the hypothesized interaction of baseline problem drinking status and treatment condition (P < 0.01). Among problem drinkers identified at baseline the intervention caused a 10.1% reduction in per-occasion binge drinking compared to controls, whereas there was no difference in binge drinking across conditions for non-problem drinkers. CONCLUSIONS: The continuum of care for alcohol problems can be broadened by providing brief interventions to interested drinkers in the general population.     

Age at first drink relates to behavioral measures of impulsivity: the immediate and delayed memory tasks

BACKGROUND: This study examined the relationship between laboratory-measured impulsivity and age at first drink. METHODS: Using a laboratory behavioral measure of impulsivity [Immediate (IMT) and Delayed Memory Tasks (DMT)], we compared two groups of women differing in their self-reported age at first drink (early-onset drinking, age <18 years, n = 40; late-onset drinking, age > or =21 years, n = 23). It was expected that those who first consumed alcohol before the legal drinking age (i.e., early onset) would perform in a more impulsive manner on the laboratory behavioral measure than the late-onset drinkers. RESULTS: The main finding was that the early-onset group (IMT: mean, 28.7%; DMT: mean, 30.4%) had increased commission error rates compared with the late-onset group (IMT: mean, 21.2%; DMT: mean, 15.5%) during both the IMT [ANOVA:F (1,61) = 4.30; p = 0.042; f = 0.27] and DMT [F (1,61) = 10.76; p = 0.002; f = 0.42]. Age at first drink was significantly correlated with DMT commission errors (r = -0.23; p = 0.037), although this was only at the trend level for IMT commission errors (r = -0.20; p = 0.062); these correlations are likely to be underestimates because of range restriction of the age variable. CONCLUSIONS: These results demonstrate that differences in impulsive behavioral responding are distinguishable even between groups of alcohol drinkers who are not experiencing clinically significant problems with alcohol.     

Alcohol consumption, alcohol dependence, and all-cause mortality

BACKGROUND: This study examined the effects of alcohol consumption and DSM-IV alcohol dependence on the risk of mortality. METHODS: Data from the 1988 National Health Interview Survey Alcohol Supplement were matched to the National Death Index for the years 1988 to 1995 (baseline n = 37,682 U.S. adults age > or =25 linked to 3,586 deaths). All mortality analyses were based on proportional hazards models that adjusted for age, sex, race/ethnicity, marital status, education, income, labor force status, body mass index, smoking status, and poor health indicators at baseline. RESULTS: When dependence was not considered and all past-year abstainers were used as the reference group, both light and moderate drinkers exhibited a reduced risk of mortality, with hazards ratios of 0.76 (0.68-0.84) and 0.84 (0.74-0.96). Heavy drinkers had about the same risk of dying as did past-year abstainers, and very heavy drinkers had an increased risk that was not significant (OR = 1.17, CI = 0.93-1.47). When lifetime abstainers were used as the reference category, the protective effect of moderate drinking fell short of significance, and there were nearly significant increased risks among former drinkers and very heavy drinkers. When dependence was considered, light and moderate drinkers without dependence had a reduced mortality risk regardless of reference group, and there was no significant effect among heavy or very heavy drinkers without dependence. Among dependent drinkers, there was no protective effect of light or moderate drinking, and very heavy drinkers had a significantly increased risk (OR = 1.56 relative to past-year abstainers and 1.65 relative to lifetime abstainers). CONCLUSIONS: Because alcohol dependence nullifies the protective effect of light and moderate drinking, it is important to understand its role as an independent risk factor for mortality. Differences between dependent and nondependent drinkers who drank comparable amounts suggest that this risk may result from longer and heavier drinking histories before baseline, more severe health problems at baseline, more heavy episodic drinking, and, possibly, differences in beverage preference.     

The roles of alcohol-related self-statements in social drinking

Recent literature showed that expectancies or cognitions have been proposed as a major factor in influencing the amount of alcohol an individual consumes and the behavioral consequences following consumption. However, how alcohol expectancies influence alcohol consumption is unclear; this paper reports two studies of the relationship. Study I examined the relationship between alcohol consumption and alcohol-related positive and negative self-statements in 110 social drinkers. The results showed that, in a nondrinking situation, the alcohol expectancies and variables measuring consumption and alcohol-related problems were correlated. Also, subjects who perceived their "alcoholic sets" as negative consumed more than those who perceived theirs as positive. Study II investigated changes in self-statement responding in 8 light and 8 heavy drinkers in a "normal" pub drinking situation. The results showed that alcohol-dependent self-statements in the light drinkers were relatively stable across time and between drinking and nondrinking environments. However, the alcohol-dependent self-statements of heavy drinkers became more negative during the drinking session. Furthermore, the degree and nature of such changes appeared to be related to alcohol-associated problems and consumption.