Impact of motivational changes on drinking outcomes in pharmacobehavioral treatment for alcohol dependence

Background: Psychological factors such as motivation to change and self‐efficacy influence drinking outcomes in alcohol‐dependent individuals who are enrolled in pharmacobehavioral studies. Previous results from our research clinic indicated that initial stage of change of heavy drinkers enrolled in a pharmacobehavioral trial was significantly associated with alcohol consumption. However, overall empirical findings regarding the consistency and extent of the connection between motivational factors and behavior are mixed. This may be in part because of the impact of changes in motivation over the course of treatment and/or characteristics of the individuals receiving the intervention. Our goal in the present study was to examine the extent to which levels of motivation and self‐efficacy changed during the treatment phase of a pharmacobehavioral treatment trial, and the extent to which these variables affected drinking behavior in subsets of alcohol‐dependent individuals. Methods: We conducted an exploratory evaluation of changes in motivation, temptation to drink, confidence to abstain, and drinking behavior over time during the treatment phase of a pharmacobehavioral study involving 321 alcohol‐dependent individuals. We also examined the extent to which individual variables such as initial drinking severity, onset of alcohol dependence, and medication status influenced changes in motivation, self‐efficacy, and drinking behavior. Results: Participants reported improvements in motivation to change, self‐efficacy for change, and drinking behaviors over the course of treatment. As hypothesized, motivation to change and self‐efficacy for change were related to specific dimensions of posttreatment drinking. Heavy drinkers reported more improvement in drinking behaviors than did nonheavy drinkers. Early‐onset drinkers who were on medication reduced their drinking more than those on placebo, and these drinking changes appear to be partially mediated by reductions in temptation. Conclusions: Reductions in drinking occur and are predicted by increased motivation to change, reduced temptation to drink, and increased confidence to abstain in this population of alcoholic‐dependent individuals. Early and late onset and heavy drinkers and those taking medications displayed differential changes in drinking behavior, some of which were explained by the mediating effects of self‐efficacy. This is a first step in understanding more about which alcoholic individuals respond best to treatment and what mechanisms may be involved in the changes in drinking and drinking‐specific changes in frequency and intensity of drinking.     

A Metric of Maternal Prenatal Risk Drinking Predicts Neurobehavioral Outcomes in Preschool Children

Background: Fetal Alcohol Spectrum Disorders (FASDs), including Fetal Alcohol Syndrome, continue to be high‐incidence developmental disorders. Detection of patterns of maternal drinking that place fetuses at risk for these disorders is critical to diagnosis, treatment, and prevention, but is challenging and often insufficient during pregnancy. Various screens and measures have been used to identify maternal risk drinking but their ability to predict child outcome has been inconsistent. This study hypothesized that a metric of fetal “at‐risk” alcohol exposure (ARAE) derived from several indicators of maternal self‐reported drinking would predict alcohol‐related neurobehavioral dysfunctions in children better than individual measures of maternal alcohol consumption alone. Methods: Self‐reported peri‐conceptional and repeated maternal drinking during pregnancy were assessed with semi‐structured interviews and standard screens, i.e., the CAGE, T‐ACE, and MAST, in a prospective sample of 75 African‐American mothers. Drinking volumes per beverage type were converted to standard quantity and frequency measures. From these individual measures and screening instruments, a simple dichotomous index of prenatal ARAE was defined and used to predict neurobehavioral outcomes in the 4‐ to 5‐year‐old offspring of these women. Study outcomes included IQ, attention, memory, visual‐motor integration, fine motor skill, and behavior. Statistical analyses controlled for demographic and other potential confounders. Results: The current “at‐risk” drinking metric identified over 62% of the mothers as drinking at risk levels—23% more than the selection criterion identified—and outperformed all individual quantity and frequency consumption measures, including averages of weekly alcohol use and “binge” alcohol exposures (assessed as intake per drinking occasion), as well as an estimate of the Maternal Substance Abuse Checklist ( Coles et al., 2000 ), in predicting prenatal alcohol‐related cognitive and behavioral dysfunction in 4‐ to 5‐year‐old children. Conclusions: A metric reflecting multiple indices of “at‐risk” maternal alcohol drinking in pregnancy had greater utility in predicting various prenatal alcohol‐related neurobehavioral dysfunction and deficits in children compared to individual measures of maternal self‐reported alcohol consumption or a previous maternal substance abuse index. Assessing fetal risk drinking in pregnant women was improved by including multiple indicators of both alcohol consumption and alcohol‐related consequences and, if appropriate practical applications are devised, may facilitate intervention by health care workers during pregnancy and potentially reduce the incidence or severity of FASDs.     

The long-term effectiveness of brief interventions for unsafe alcohol consumption: a 10-year follow-up

Aims To examine the long‐term impact of brief and early interventions for hazardous and harmful alcohol consumption. Design A 9‐month and 10‐year follow‐up of subjects recruited into a randomized controlled trial of a range of alcohol‐related brief interventions. Setting General practices, the outpatient or acute care services of a major city hospital, and a privately run health screening programmeme. Participants The cohort of 554 (non‐dependent) hazardous and harmful drinkers recruited into the Australian arm of the Phase II World Health Organization collaborative project on identification and treatment of persons with harmful alcohol consumption. Intervention The effectiveness of three forms of intervention, ranging from 5 to 60 minutes in duration, were compared with a no‐treatment control condition. Measurements Included drinking behaviour and biological markers of alcohol use. In addition, at 10 years subjects were asked about symptoms of diagnosable alcohol use disorders and their experience of alcohol‐related psychological, social and physical harm. Mortality was also assessed. Findings Results provide further evidence for the short‐term effectiveness of alcohol‐related brief interventions. In comparison to controls, subjects offered intervention: (1) report significantly lower consumption; and (2) less unsafe drinking at 9‐month follow‐up. The intensity of intervention was not related to the amount of change in drinking behaviour. Analysis at 10 years failed to find any differences in outcomes between intervention and control groups in median consumption, mean reduction in consumption from baseline to follow‐up, mortality and ICD‐10 diagnoses of alcohol dependence or harmful alcohol use. Conclusions This study failed to find evidence that brief advice and counselling without regular follow‐up and reinforcement can sustain significant long‐term reductions in drinking behaviour at 10‐year follow‐up.     

Is Talk “Cheap”? An Initial Investigation of the Equivalence of Alcohol Purchase Task Performance for Hypothetical and Actual Rewards

Background: Behavioral economic alcohol purchase tasks (APTs) are self‐report measures of alcohol demand that assess estimated consumption at escalating levels of price. However, the relationship between estimated performance for hypothetical outcomes and choices for actual outcomes has not been determined. The present study examined both the correspondence between choices for hypothetical and actual outcomes, and the correspondence between estimated alcohol consumption and actual drinking behavior. A collateral goal of the study was to examine the effects of alcohol cues on APT performance. Methods: Forty‐one heavy‐drinking adults (56% men) participated in a human laboratory protocol comprising APTs for hypothetical and actual alcohol and money, an alcohol cue reactivity paradigm, an alcohol self‐administration period, and a recovery period. Results: Pearson correlations revealed very high correspondence between APT performance for hypothetical and actual alcohol (ps < 0.001). Estimated consumption on the APT was similarly strongly associated with actual consumption during the self‐administration period (r = 0.87, p < 0.001). Exposure to alcohol cues significantly increased subjective craving and arousal and had a trend‐level effect on intensity of demand, in spite of notable ceiling effects. Associations among motivational indices were highly variable, suggesting multidimensionality. Conclusions: These results suggest there may be close correspondence both between value preferences for hypothetical alcohol and actual alcohol, and between estimated consumption and actual consumption. Methodological considerations and priorities for future studies are discussed.     

Randomized controlled trial of a brief intervention for unhealthy alcohol use in hospitalized Taiwanese men

Aims To evaluate the effectiveness of a brief intervention in hospitalized Taiwanese men to reduce unhealthy alcohol consumption. Design Randomized controlled trial. Setting Medical/surgical wards of a medical centre in Taipei, Taiwan. Participants Of 3669 consecutive adult male in‐patients, 616 were identified as unhealthy alcohol users (>14 drinks/week) and assigned randomly to either usual care (n = 308) or a brief intervention (n = 308). Measurements Primary outcomes were changes in alcohol consumption at 4, 9 and 12 months, including self‐reported weekly alcohol consumption, drinking days and heavy drinking episodes assessed by 7‐day time‐line follow‐back. Secondary outcomes were (i) self‐reported alcohol problems, (ii) health‐care utilization (hospital days and emergency department visits), (iii) self‐reported seeking of speciality treatment for alcohol problems and (iv) 3‐month Quick Drinking Screen. Findings Based on intention‐to‐treat analyses, the intervention group consumed significantly less alcohol than the control group among both unhealthy drinkers and the subgroup of alcohol‐dependent participants over 12 months, on both 7‐day and 3‐month assessments. Adjunctive analyses of only those who completed all assessments found that total drinks consumed did not remain significant. Significantly more participants with alcohol use disorders in the intervention than in the control group (8.3%, 19 of 230 versus 2.1%, four of 189) consulted specialists by 12 months (P = 0.01). However, alcohol‐related problems and health‐care utilization did not differ significantly in the two groups during follow‐up. Conclusions Data from Taiwan confirm that brief in‐hospital intervention can result in a reduction in alcohol intake by men who drink heavily or are diagnosed with an alcohol use disorder.     

Mechanisms, Determinants and Processes of Change in the Modification of Drinking Behavior

Background:  This article explores the conceptual foundations of the search for mechanisms of change in psychotherapy and behavior change approaches.
Method:  We examine historical and recent attempts to identify mechanisms and discuss results of research studies that examine the modification of drinking and other behaviors. Finally, we describe potential mechanisms of change and offer direction for the future of research.
Results:  A series of key questions is addressed. The first critical question is, Where are the appropriate places to look for mechanisms of change in the modification of drinking behavior: person, provider, intervention, or environment? The second questions what we know about change mechanisms from recent research. The third addresses the appropriate methods and designs to isolate and understand these mechanisms. The final question is, How should we proceed to advance our understanding of the critical mechanisms that drive the process of the modifying drinking and recovery from alcoholism?
Conclusions:  We propose a dynamic, life course and an interactive, multidimensional perspective that focuses on personal mechanisms of change and how they interact with interventions, providers, policies, and other life context factors that facilitate or act as barriers to engaging these mechanisms of change.     

A Quantitative Analysis of Latino Acculturation and Alcohol Use: Myth Versus Reality

Research on health among Latinos often focuses on acculturation processes and the associated stressors that influence drinking behavior. Given the common use of acculturation measures and the state of the knowledge on alcohol‐related health among Latino populations, the current analyses tested the efficacy of acculturation measures to predict various indicators of alcohol consumption. Specifically, this quantitative review assessed the predictive utility of acculturation on alcohol consumption behaviors (frequency, volume, and quantity). Two main analyses were conducted—a p‐curve analysis and a meta‐analysis of the observed associations between acculturation and drinking behavior. Results demonstrated that current measures of acculturation are a statistically significant predictor of alcohol use (Z = ?20.75, p < 0.0001). The meta‐analysis included a cumulative sample size of 29,589 Latino participants across 31 studies. A random‐effects model yielded a weighted average correlation of 0.16 (95% confidence interval = 0.12, 0.19). Additional subgroup analyses examined the effects of gender and using different scales to measure acculturation. Altogether, results demonstrated that acculturation is a useful predictor of alcohol use. In addition, the meta‐analysis revealed that a small positive correlation exists between acculturation and alcohol use in Latinos with a between‐study variance of only 1.5% (τ² = 0.015). Our analyses reveal that the association between current measures of acculturation and alcohol use is relatively small.     

Changes in Sensation Seeking and Risk‐Taking Propensity Predict Increases in Alcohol Use Among Early Adolescents

Background: Conceptual models implicating disinhibitory traits often are applied to understanding emergent alcohol use, but, little is known of how inter‐individual changes in these constructs relate to increases in alcohol use in early adolescence. The current study utilized behavioral and self‐report instruments to capture the disinhibitory‐based constructs of sensation seeking and risk‐taking propensity to examine if increases in these constructs over time related to increases in early adolescent alcohol use. Methods: Participants included a community sample of 257 early adolescents (aged 9 to 12) who completed a self‐report measure of sensation seeking, a behavioral task assessing risk‐taking propensity, and a self‐report of past year alcohol use, at 3 annual assessment waves. Results: Both sensation seeking and risk‐taking propensity demonstrated significant increases over time, with additional evidence that change in the behavioral measure of risk‐taking propensity was not because of practice effects. Greater sensation seeking and greater risk‐taking propensity demonstrated concurrent relationships with past year alcohol use at each assessment wave. Prospective analyses indicated that after accounting for initial levels of alcohol use, sensation seeking, and risk‐taking propensity at the first assessment wave, larger increases in both constructs predicted greater odds of alcohol use at subsequent assessment waves. Conclusions: Results indicate the role of individual changes in disinhibitory traits in initial alcohol use in early adolescents. Specifically, findings suggest it is not simply initial levels of sensation seeking and risk‐taking propensity that contribute to subsequent alcohol use but in particular increases in each of these constructs that predict greater odds of use. Future work should continue to assess the development of sensation seeking and risk‐taking propensity in early adolescence and target these constructs in interventions as a potential means to reduce adolescent alcohol use.     

Development of a Smartphone-Based,Self-Administered Intervention System for Alcohol Use Disorders

Advances in mobile technology provide an opportunity to deliver in-the-moment interventions to individuals with alcohol use disorders, yet availability of effective “apps” that deliver evidence-based interventions is scarce. The authors developed an immediately available, portable, smartphone-based intervention system whose purpose is to provide stand-alone, self-administered assessment and intervention. In this article, the authors describe how theory and empirical evidence, combined with smartphone functionality, contributed to the construction of a user-friendly, engaging alcohol intervention. With translation in mind, the authors discuss how they selected appropriate intervention components including assessments, feedback and tools, that work together to produce the hypothesized outcomes.     

Phosphatidylethanol and Alcohol Consumption in Reproductive Age Women

Background: Fetal alcohol disorders are preventable, but self‐reported alcohol consumption can be misleading and impede effective treatment. Biomarkers represent an alternative method for assessing alcohol use, and this study evaluated the relationship between blood phosphatidylethanol (PEth) and alcohol use in a sample of reproductive age women. Methods: Alcohol use was estimated by validated self‐report methods in 80 nonpregnant women ages 18 to 35. PEth was measured by a contracted laboratory using a liquid chromatography‐tandem mass spectrometry assay. Regression methods appropriate for the distribution of PEth were used to define its relationship to alcohol consumption during the prior 2 weeks and explore the effects of drinking patterns on this association. Receiver operating characteristic analysis was used to estimate the sensitivity of PEth for various drinking levels at 95% specific cutoffs. Results: PEth had a positive linear association with grams of alcohol consumed (p < 0.001), and was detectable in 93% of subjects consuming an average of 2 or more drinks per day. The relationship between total alcohol consumption and PEth may be stronger in women with recent heavy drinking days. The relationship between drinking and PEth varied considerably between individuals, and sensitivity for a certain amount of drinking was low at a highly specific cutoff concentration. Conclusions: PEth is a highly sensitive indicator of moderate and heavy alcohol consumption in reproductive age women and may complement the use of self‐report alcohol screens when additional objective markers of alcohol use are desirable. However, choosing a highly valid cutoff concentration for PEth to differentiate various levels of alcohol consumption may not be feasible.     

Identification of behaviour change techniques to reduce excessive alcohol consumption

Background Interventions to reduce excessive alcohol consumption have a small but important effect, but a better understanding is needed of their ‘active ingredients’. Aims This study aimed to (i) develop a reliable taxonomy of behaviour change techniques (BCTs) used in interventions to reduce excessive alcohol consumption (not to treat alcohol dependence) and (ii) to assess whether use of specific BCTs in brief interventions might be associated with improved effectiveness. Methods A selection of guidance documents and treatment manuals, identified via expert consultation, were analysed into BCTs by two coders. The resulting taxonomy of BCTs was applied to the Cochrane Review of brief alcohol interventions, and the associations between the BCTs and effectiveness were investigated using meta‐regression. Findings Forty‐two BCTs were identified, 34 from guidance documents and an additional eight from treatment manuals, with average inter‐rater agreement of 80%. Analyses revealed that brief interventions that included the BCT ‘prompt self‐recording’ (P = 0.002) were associated with larger effect sizes. Conclusions It is possible to identify specific behaviour change techniques reliably in manuals and guidelines for interventions to reduce excessive alcohol consumption. In brief interventions, promoting self‐monitoring is associated with improved outcomes. More research is needed to identify other behaviour change techniques or groupings of behaviour change techniques that can produce optimal results in brief interventions and to extend the method to more intensive interventions and treatment of alcohol dependence.     

The neighborhood alcohol environment and at-risk drinking among African-Americans

Background: Our objective was to examine whether components of the neighborhood alcohol environment—liquor store, on‐premise outlet, convenience store, and supermarket densities—are positively associated with at‐risk alcohol consumption among African‐American drinkers. Methods: A multilevel cross‐sectional sample of 321 African‐American women and men ages 21 to 65 years recruited from April 2002 to May 2003 from three community‐based healthcare clinics in New Orleans, Louisiana, was studied. Results: The alcohol environment had a significant impact on at‐risk alcohol consumption among African‐American drinkers, specifically liquor store density (adjusted OR = 3.11, 95% CI = 1.87, 11.07). Furthermore, the influence of the alcohol environment was much stronger for African‐American female drinkers (adjusted OR = 6.96, 95% CI = 1.38, 35.08). Conclusions: Treatment and prevention programs should take into account the physical environment, and the concentration of outlets in minority neighborhoods must be addressed as it poses potential health risks to the residents of these neighborhoods.     

School-based alcohol education: results of a cluster-randomized controlled trial

Objective   This study aimed to examine the effects of a school-based alcohol education intervention.
Design   Two-arm three-wave cluster-randomized controlled trial, with schools as the unit for randomization. Surveys were conducted prior to intervention implementation, then 4 and 12 months after baseline.
Setting   A total of 30 public schools in Schleswig-Holstein, Germany.
Participants   Baseline data were obtained from 1686 7th graders. The retention rate was 85% over 12 months.
Intervention   The intervention consisted of four interactive lessons conducted by teachers, booklets for students and booklets for parents.
Measures   Knowledge, attitudes, life-time alcohol consumption (ever use alcohol without parental knowledge, ever been drunk and ever binge drinking) and past-month alcohol use.
Results   Intention-to-treat analyses revealed that intervention status was associated with more general knowledge about alcohol and lower levels of life-time binge drinking. No effects were found with respect to students' self-reported attitudes, intentions to drink, life-time alcohol use and past-month alcohol use.
Conclusions   The results indicate that this brief school-based intervention had a small short-term preventive effect on alcohol misuse.     

Web-based assessment and brief intervention for alcohol use in women of childbearing potential: a report of the primary findings

Background: There is a need for more effective assessment and primary prevention programs aimed at accurately measuring and reducing alcohol consumption among women before conception in underserved, high‐risk populations. Health information technology may serve this purpose; however, the effectiveness of such tools within this population is not known. Methods: We conducted a small‐scale randomized controlled trial to test the effectiveness of an adapted web‐based alcohol assessment and intervention tool among low‐income, nonpregnant women of reproductive age who were receiving Women Infant and Children (WIC) services in San Diego County and who reported currently drinking at a moderate risk level. A total of 150 risky drinking participants completed a web‐based assessment and were randomly assigned to either receive a personalized feedback intervention or general health information about alcohol consumption and fetal alcohol syndrome. Follow‐up assessments on reported alcohol consumption were conducted via telephone at 1‐ and 2‐months postbaseline. Participants ranged in age from 18 to 44 and were predominately Hispanic/Latina (44%). Results: At baseline, all respondents reported consuming ≥3 standard drinks on ≥1 occasion in the previous month. Outcome data were available for 131 participants. The main outcome measure was reduction in the number of risky drinking occasions, which did not differ significantly between treatment conditions (odds ratio 1.200, 95% CI 0.567 to 2.539, p = 0.634). Over 70% of the participants, however, reported a reduction in risky drinking occasions regardless of treatment condition (control 43/63, 68%; experimental 49/68, 72%). Conclusions: The results of this study demonstrate that web‐based assessment of alcohol consumption among low‐income women of reproductive age, as represented by WIC clients, is feasible and acceptable. The findings also suggest that detailed and interactive assessments of alcohol consumption may be sufficient for the reduction of risky drinking within this population without personalized feedback.     

A placebo-controlled randomized clinical trial of naltrexone in the context of different levels of psychosocial intervention

Background:  Naltrexone is approved for the treatment of alcohol dependence when used in conjunction with a psychosocial intervention. This study was undertaken to examine the impact of 3 types of psychosocial treatment combined with either naltrexone or placebo treatment on alcohol dependency over 24 weeks of treatment: (1) Cognitive-Behavioral Therapy (CBT) + medication clinic, (2) BRENDA (an intervention promoting pharmacotherapy) + medication clinic, and (3) a medication clinic model with limited therapeutic content.
Methods:  Two hundred and forty alcohol-dependent subjects were enrolled in a 24-week double-blind placebo-controlled study of naltrexone (100 mg/d). Subjects were also randomly assigned to 1 of 3 psychosocial interventions. All patients were assessed for alcohol use, medication adherence, and adverse events at regularly scheduled research visits.
Results:  There was a modest main treatment effect for the psychosocial condition favoring those subjects randomized to CBT. Intent-to-treat analyses suggested that there was no overall efficacy of naltrexone and no medication by psychosocial intervention interaction. There was a relatively low level of medication adherence (50% adhered) across conditions, and this was associated with poor outcome.
Conclusions:  Results from this 24-week treatment study demonstrate the importance of the psychosocial component in the treatment of alcohol dependence. Moreover, results demonstrate a substantial association between medication adherence and treatment outcomes. The findings suggest that further research is needed to determine the appropriate use of pharmacotherapy in maximizing treatment response.     

Meta‐Analysis of the Association of Alcohol‐Related Social Media Use with Alcohol Consumption and Alcohol‐Related Problems in Adolescents and Young Adults

Despite the pervasive use of social media by young adults, there is comparatively little known about whether, and how, engagement in social media influences this group's drinking patterns and risk of alcohol‐related problems. We examined the relations between young adults’ alcohol‐related social media engagement (defined as the posting, liking, commenting, and viewing of alcohol‐related social media content) and their drinking behavior and problems. We conducted a systematic review and meta‐analysis of studies evaluating the association of alcohol consumption and alcohol‐related problems with alcohol‐related social media engagement. Summary baseline variables regarding the social media platform used (e.g., Facebook and Twitter), social media measures assessed (e.g., number of alcohol photographs posted), alcohol measures (e.g., Alcohol Use Disorders Identification Test and Timeline Follow back Interview), and the number of time points at which data were collected were extracted from each published study. We used the Q statistic to examine heterogeneity in the correlations between alcohol‐related social media engagement and both drinking behavior and alcohol‐related problems. Because there was significant heterogeneity, we used a random‐effects model to evaluate the difference from zero of the weighted aggregate correlations. We used metaregression with study characteristics as moderators to test for moderators of the observed heterogeneity. Following screening, 19 articles met inclusion criteria for the meta‐analysis. The primary findings indicated a statistically significant relationship and moderate effect sizes between alcohol‐related social media engagement and both alcohol consumption (r = 0.36, 95% CI: 0.29 to 0.44, p < 0.001) and alcohol‐related problems (r = 0.37, 95% CI: 0.21 to 0.51, p < 0.001). There was significant heterogeneity among studies. Two significant predictors of heterogeneity were (i) whether there was joint measurement of alcohol‐related social media engagement and drinking behavior or these were measured on different occasions and (ii) whether measurements were taken by self‐report or observation of social media engagement. We found moderate‐sized effects across the 19 studies: Greater alcohol‐related social media engagement was correlated with both greater self‐reported drinking and alcohol‐related problems. Further research to determine the causal direction of these associations could provide opportunities for social media‐based interventions with young drinkers aimed at reducing alcohol consumption and alcohol‐related adverse consequences.     

Effects of ethanol exposure on subsequent acquisition and extinction of ethanol self-administration and expression of alcohol-seeking behavior in adult alcohol-preferring (P) rats: II. Adult exposure

Background In a preceding study, we reported that ethanol (EtOH) consumption during periadolescence in alcohol‐preferring (P) rats produced significant effects on the acquisition, extinction, Pavlovian spontaneous recovery (PSR), and reacquisition of operant self‐administration of EtOH. The objective of the present study was to determine if EtOH consumption during adulthood produced similar effects on subsequent operant behaviors. Methods Adult female P rats (>135 days of age) were given 24 hr free‐choice access to 15% EtOH for 30 days or were similarly housed and received water only. After a 15 day period of no EtOH access and without any prior training, adult alcohol drinking and adult alcohol‐naïve rats were placed in standard two‐lever (15% EtOH and water) chambers to examine acquisition of EtOH self‐administration. After stable responding was established on a concurrent fixed ratio (FR) 5 FR1 schedule for EtOH versus water, the P rats underwent extinction training for nine sessions. After extinction and a 2 week home cage period (with no operant sessions or access to EtOH), rats were returned to the operant chambers in the absence of reward for seven consecutive sessions to test for PSR. After PSR testing, animals were maintained in their home cage for a week, before being reintroduced to the operant chambers and allowed to respond for EtOH and water. Results Both the adult alcohol‐drinking and adult alcohol‐naïve groups rapidly acquired EtOH self‐administration, expressed a pronounced PSR, which was augmented by EtOH priming and the presence of a discriminative stimulus (odor cue), and increased responding when EtOH was reinstated. Adult pre‐exposure to EtOH did not alter any of the operant measures. Conclusions The results of this study suggest that, unlike the results with EtOH pre‐exposure during periadolescence, chronic alcohol drinking by P rats in adulthood did not produce sufficient long‐lasting changes in neuronal function to alter subsequent operant acquisition of alcohol self‐administration, alcohol relapse, or alcohol‐seeking behavior.     

Brief Intervention for Problem Drinkers in a Chinese Population: A Randomized Controlled Trial in a Hospital Setting

Background:  Alcohol is a legal and accessible substance in Taiwan. As excessive alcohol has been linked to health and social problems, it is necessary to develop a brief, rapid, and low-cost tool to help health care providers deal with persons in Taiwan whose alcohol consumption has become hazardous or harmful to their health.
Methods:  A randomized controlled clinical trial with 6- and 12-month follow-ups was designed. Eighteen medical/surgical units at a medical center in northern Taiwan were randomly assigned to 2 groups: experimental ( n  = 9) and control ( n  = 9). Inpatients on the units were enrolled if they met the following criteria: were older than 18 years, had no severe psychiatric illness, and were not pregnant. The experimental group ( n  = 138) received the intervention, a 15-minute counseling visit in which nurses screened participants using the Alcohol Use Disorders Identification Test (AUDIT), provided a health promotion booklet for adults, and individually discussed the booklet contents with patients based on their drinking level (AUDIT score). The control group ( n  = 137) received no treatment. Patterns of alcohol consumption were determined by AUDIT scores at baseline, 6, and 12 months later.
Results:  Alcohol use disorders identification test scores decreased significantly in both groups at 6 months after the intervention, but did not differ significantly between the 2 groups. However, 12 months after the brief alcohol intervention, experimental subjects' AUDIT scores were significantly better than those of the control group.
Conclusions:  Our brief alcohol intervention provided a 12-month benefit for problem drinkers in Taiwan.     

A brief alcohol intervention for hazardously drinking incarcerated women

Objective To test the hypothesis that among hazardously drinking incarcerated women who are returning to the community, a brief alcohol intervention will result in less alcohol use at follow‐up relative to standard of care. Methods Eligible participants endorsed hazardous alcohol consumption—four or more drinks at a time on at least 3 separate days in the previous 3 months or a score of 8 or above on the Alcohol Use Disorders Identification Test. Participants were randomized to either an assessment‐only condition or to two brief motivationally focused sessions, the first delivered during incarceration, the second 1 month later after community re‐entry. Participants recalled drinking behaviors at 3 and 6 months after the baseline interview using a 90‐day time‐line follow‐back method. Results The 245 female participants averaged 34 years of age, and were 71% Caucasian. The mean percentage of alcohol use days in the 3 months prior to incarceration was 51.7% and heavy alcohol use days was 43.9%. Intervention effects on abstinent days were statistically significant at 3 months (odds ratio = 1.96, 95% confidence interval 1.17, 3.30); the percentage of days abstinent was 68% for those randomized to intervention and 57% for controls. At 6 months the effect of the intervention was attenuated and no longer statistically significant. Conclusions Among incarcerated women who reported hazardous drinking, a two‐session brief alcohol intervention increased abstinent days at 3 months, but this effect decayed by 6 months. Study participants continued to drink heavily after return to the community. More intensive intervention pre‐release and after re‐entry may benefit hazardously drinking incarcerated women.     

Randomized controlled trial of cognitive–behavioural therapy for coexisting depression and alcohol problems: short-term outcome

Aims   Alcohol use disorders and depression co-occur frequently and are associated with poorer outcomes than when either condition occurs alone. The present study (Depression and Alcohol Integrated and Single-focused Interventions; DAISI) aimed to compare the effectiveness of brief intervention, single-focused and integrated psychological interventions for treatment of coexisting depression and alcohol use problems.
Methods   Participants ( n  = 284) with current depressive symptoms and hazardous alcohol use were assessed and randomly allocated to one of four individually delivered interventions: (i) a brief intervention only (single 90-minute session) with an integrated focus on depression and alcohol, or followed by a further nine 1-hour sessions with (ii) an alcohol focus; (iii) a depression focus; or (iv) an integrated focus. Follow-up assessments occurred 18 weeks after baseline.
Results   Compared with the brief intervention, 10 sessions were associated with greater reductions in average drinks per week, average drinking days per week and maximum consumption on 1 day. No difference in duration of treatment was found for depression outcomes. Compared with single-focused interventions, integrated treatment was associated with a greater reduction in drinking days and level of depression. For men, the alcohol-focused rather than depression-focused intervention was associated with a greater reduction in average drinks per day and drinks per week and an increased level of general functioning. Women showed greater improvements on each of these variables when they received depression-focused rather than alcohol-focused treatment.
Conclusions   Integrated treatment may be superior to single-focused treatment for coexisting depression and alcohol problems, at least in the short term. Gender differences between single-focused depression and alcohol treatments warrant further study.