Disaggregating within- and between-person effects of affect on drinking behavior in a clinical sample with alcohol use disorder.

OBJECTIVE: The goal of the current study was to better understand affect-drinking relations among those diagnosed with an alcohol use disorder (AUD), as recent meta-analytic work suggests that daily negative affect may not universally predict subsequent alcohol consumption in those nondependent on alcohol. Specifically, we investigated the between- and within-person effects of positive and negative affects on drinking. METHOD: Participants (n = 92) who met AUD diagnostic criteria completed a 90-day daily assessment of drinking behavior and positive and negative affects. RESULTS: Time-lagged multilevel modeling revealed that within-person elevations in negative affect predicted increased odds and quantity of drinking later in the day. Relations between positive affect and drinking were nonsignificant. CONCLUSIONS: These findings are in contrast to recent meta-analytic findings and highlight the complexity of affect-drinking relations among those diagnosed with AUD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Pretreatment changes in drinking: Theoretical and methodological implications for alcohol use disorder treatment outcome research.

BACKGROUND: There is a growing recognition of the importance of changes in drinking prior to the first treatment session (i.e., pretreatment change). A major limitation of past studies of pretreatment change is the reliance on retrospective reporting on drinking rates between the baseline assessment and the first treatment session collected at the end of treatment. The present study sought to extend previous findings by examining 12-month treatment outcomes and correlates of pretreatment changes in drinking measured weekly during treatment. METHODS: Data from a randomized behavioral clinical trial examining the effect of therapeutic alliance feedback on drinking outcomes were analyzed (n = 165). All participants received cognitive behavioral therapy for alcohol dependence, completed pre and posttreatment assessments, and provided weekly measures of drinking during treatment. RESULTS: Results indicated that approximately half of the sample reduced their heavy drinking days by 70% or more and number of drinking days by 50% or more prior to beginning treatment. Further, individuals who reported greater consideration of how their problematic drinking affected their social environment displayed greater changes in drinking days prior to treatment. Changes in heavy drinking days were also related to relationship status, such that individuals who were single/never married were less likely to change prior to treatment than those who were married/cohabitating or separated/divorced. CONCLUSION: These confirm the importance of pretreatment change in the study of treatment outcomes, and suggest that interpersonal processes, including the appraisal of drinking behavior in a social context, may play an important role in pretreatment changes in drinking.

Associations Between Sociodemographic, Mental Health, and Mild Traumatic Brain Injury Characteristics With Lifetime History of Criminal Justice Involvement in Combat Veterans and Service Members.

INTRODUCTION: Veterans and service members (V/SM) may have more risk factors for arrest and felony incarceration (e.g., posttraumatic stress disorder and at-risk substance use) but also more protective factors (e.g., access to health care) to mitigate behaviors that may lead to arrest. As such, understanding which factors are associated with criminal justice involvement among V/SM could inform prevention and treatment efforts. The current study examined relationships between lifetime history of arrests and felony incarceration and sociodemographic, psychological, and brain injury characteristics factors among combat V/SM. MATERIALS AND METHODS: The current study was a secondary data analysis from the Chronic Effects of Neurotrauma Consortium multicenter cohort study, approved by local institutional review boards at each study site. Participants were V/SM (N = 1,540) with combat exposure (19% active duty at time of enrollment) who were recruited from eight Department of Veterans Affairs and DoD medical centers and completed a baseline assessment. Participants were predominantly male (87%) and white (72%), with a mean age of 40 years (SD = 9.7). Most (81%) reported a history of at least one mild traumatic brain injury, with one-third of those experiencing three or more mild traumatic brain injuries (33%). Participants completed a self-report measure of lifetime arrest and felony incarceration history, a structured interview for all potential concussive events, the post-traumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and the Alcohol Use Disorders Identification Test-Consumption. Three groups were compared on self-reported level of lifetime history of criminal justice system involvement: (1) no history of arrest or incarceration (65%); (2) history of arrest but no felony incarceration (32%); and (3) history of felony incarceration (3%). RESULTS: Ordinal regression analyses revealed that hazardous alcohol consumption (ß = .44, P < .001; odds ratio = 1.56) was positively associated with increased criminal justice involvement after adjusting for all other variables. Being married or partnered (ß = -.44, P < .001; odds ratio = 0.64) was negatively associated with decreased criminal justice involvement. CONCLUSIONS: The rate of lifetime arrest (35%) in this V/SM sample was consistent with rates of arrests in the U.S. general population. One modifiable characteristic associated with lifetime arrest and felony incarceration was hazardous alcohol consumption. Alcohol use should be a top treatment target for V/SM at risk for arrest and those with history of criminal justice involvement.

The transdiagnostic role of food craving: An application of substance use models.

Food craving is a transdiagnostic process underlying clinically significant disordered eating behaviors and eating disorder diagnoses. However, the lack of literature examining the role of food craving as it relates to the full spectrum of disordered eating behaviors, including restrictive eating and compensatory behaviors, may be due to the traditional definition of food craving as the desire to consume particular foods. Applying motivational models of substance use craving to food craving may help to explain inconsistencies within existing literature. Three motivational models of craving from the substance use literature may be particularly applicable to (1) provide a clear definition of food craving as a motivational process, (2) understand the role of that motivational process as it underlies the full spectrum of disordered eating behavioral patterns, (3) provide insight for the most appropriate ways in which to accurately assess food craving, and (4) establish ways in which food craving may represent a useful motivational process to target in eating disorder treatments. This narrative review describes three models of substance use craving and provides suggestions for utilizing motivational models to understand the transdiagnostic role of food craving as it relates to the full spectrum of disordered eating behaviors in both research and clinical work.

Youths' and Young Adults' Experiences of Police Involvement During Initiation of Involuntary Psychiatric Holds and Transport.

Over the past decade, police involvement in behavioral health crisis response has generated concern and controversy. Despite the salience and timeliness of this topic, the literature on service user experiences of interactions with officers is small and studies of youths and young adults are nonexistent. The authors aimed to investigate youths' and young adults' experiences of police involvement in involuntary psychiatric hold initiation and transport. In-depth interviews were conducted with 40 participants (ages 16-27) who had experienced an involuntary hold; the 28 participants who reported police involvement are the focus of this analysis. Data were inductively coded, and codes were grouped into larger themes. A majority of participants reported negative experiences; major themes characterizing negative encounters were the framing of distress as criminal or of intervention as disciplinary rather than therapeutic, perceived aggression and callousness from police officers, and poor communication. The authors also characterized the positive experiences of officer involvement reported by a minority of participants and youths' perspectives on the degree of control officers could exert over initiation and transport decisions. Findings help center the voices of youths and young adults with mental health challenges and raise important questions about contemporary policies regarding police involvement in crisis response and, more broadly, about coercive responses to distress or emotional crisis.

Approach and avoidance alcohol inclinations in heavy drinking college students: An ecological momentary assessment study.

BACKGROUND: Understanding the motivational determinants of drinking among college students is necessary to improve the identification of those at greatest risk and to inform prevention and treatment interventions. Alcohol craving, or the desire to use alcohol, is considered one important factor in the development and maintenance of drinking behaviors. Recent evidence suggests that the link between alcohol craving (approach inclinations) and alcohol use is moderated by desires not to use alcohol (avoidance inclinations). Using ecological momentary assessment, the present study investigated the influence of motivational conflict (high desires to use and high desires to not use alcohol) on alcohol consumption among college students. METHODS: Undergraduate students (n = 80; 88.8% female) completed assessments of alcohol-related behaviors and alcohol motivation five times daily for fourteen days. RESULTS: Although between-person effects were nonsignificant, significant within-person effects indicated that avoidance inclinations attenuated the effect of approach inclinations in the prediction of drinking (controlling for age, gender, drinking history, affect, day of week, and time of day). CONCLUSIONS: Findings highlight the need for consideration of the unique effects of both approach and avoidance inclinations in the prediction of alcohol consumption and draw attention to the need for further investigation into the complex interplay of these processes in daily life.

Investigating the impact of involuntary psychiatric hospitalization on youth and young adult trust and help-seeking in pathways to care.

PURPOSE: Few studies have focused on the experience of involuntary psychiatric hospitalization among youth, especially the impact of these experiences on engagement with mental health services post-discharge. In this study, we contribute to a deeper understanding of youth experiences of involuntary hospitalization (IH) and its subsequent impacts on trust, help-seeking, and engagement with clinicians. METHODS: The study utilized a grounded theory approach, conducting in-depth interviews with 40 youth and young adults (ages 16-27) who had experienced at least one prior involuntary hospitalization. RESULTS: Three quarters of the youth reported negative impacts of IH on trust, including unwillingness to disclose suicidal feelings or intentions. Selective non-disclosure of suicidal feelings was reported even in instances in which the participant continued to meet with providers following discharge. Factors identified as contributing to distrust included perceptions of inpatient treatment as more punitive than therapeutic, staff as more judgmental than empathetic, and hospitalization overall failing to meet therapeutic needs. Conversely, participants reporting more mixed experiences of hospitalization and simultaneously strong indirect benefits, including greater family support, diminished family judgement members and greater access to care. CONCLUSION: Findings draw attention to the ways in which coercive experiences may impact youth pathways to and through care. Additional research is needed to understand the impact of these experiences across larger samples, and their influence on downstream outcomes including engagement and long-term wellbeing. Finally, these data may inform the development and testing of inpatient and post-discharge interventions designed to mitigate potential harm.

Reductions in Drinking Predict Increased Distress: Between- and Within-Person Associations between Alcohol Use and Psychological Distress During and Following Treatment.

BACKGROUND: As the nature of the association between alcohol use disorder (AUD) and other disorders is not well understood, the ways in which psychological distress changes during the course of treatment for AUD are relatively unknown. Existing literatures posit 2 competing hypotheses such that treatment for AUD concurrently decreases alcohol use and psychological distress or treatment for AUD decreases alcohol use and increases psychological distress. The current study examined the ways in which psychological distress changed as a function of treatment for AUD, including the relationship between psychological distress and drinking behaviors. METHODS: Secondary data analysis was conducted on an existing clinical trial dataset that investigated the effect of cognitive-behavioral therapy and therapeutic alliance feedback on AUDs. Specifically, data collected at baseline, posttreatment, 3-month, 6-month, 9-month, and 12-month follow-up assessments were examined. RESULTS: Results indicated decreases in heavy drinking days, increases in percentage of days abstinent, and decreases in overall psychological distress. Findings also revealed that changes in psychological distress did not predict changes in drinking at the next time interval; however, decreases in drinking predicted higher psychological distress at the next assessment. Further, average levels of psychological distress were positively associated with rates of drinking. CONCLUSIONS: The current study provides some insight into how psychological distress changes during the course of treatment for AUD, including the relationship between changes in drinking and such symptoms. Future research should continue to explore these relationships, including the ways in which treatment efforts can address what may be seen as paradoxical effects.

Coordinated Specialty Care Discharge, Transition, and Step-Down Policies, Practices, and Concerns: Staff and Client Perspectives.

OBJECTIVE: In recent years, optimizing the process of transition and discharge from coordinated specialty care (CSC), a program that provides early intervention in psychosis, has emerged as an important focus area for program administrators, clinicians, and policy makers. To explore existing CSC policies and practices and to understand frontline provider and client views on discharge, the authors conducted a comprehensive analysis of staff and client interview data from the Mental Health Block Grant 10% Set-Aside Study. METHODS: Data from 66 interviews with groups of CSC providers and administrators representing 36 sites and 22 states were analyzed, as well as data from interviews with 82 CSC clients at 34 sites. Transcripts were coded by using systematic content analyses. RESULTS: Analyses of data from providers and administrators showed the heterogeneity of CSC program practices and strategies regarding discharge and highlighted a range of concerns related to postdischarge service accessibility and quality. Analysis of data from client interviews reflected the heterogeneity of transition challenges that clients confront. A significant number of participants reported concerns about their readiness for discharge. CONCLUSIONS: CSC discharge policies and practices vary across CSC programs and states. Frequent clinician and client concerns about optimal program length, transition, and postdischarge services highlight the importance of sustained policy and research efforts to develop evidence-informed practice guidelines and possible modifications to the time-limited CSC model that currently dominates the field.

A dyadic approach to attachment anxiety and avoidance, marital conflict, and drinking.

In this research, we integrate attachment theory and dyadic methodology to examine how attachment anxiety and avoidance might interact with marital conflict to influence alcohol consumption, drinking motives, and alcohol-related problems in a sample of 280 married and cohabiting couples over 3 years. Both husband and wife attachment anxiety were related to higher levels of own drinking to cope and alcohol-related problems. Additionally, both husband and wife reports of marital conflict were associated with own alcohol-related problems. For wives, significant interactions between anxiety and marital conflict suggested that anxiety was more strongly associated with alcohol consumption, coping, and problems at higher levels of conflict. For husbands, significant interactions between avoidance and conflict indicated that avoidance was more strongly associated with coping and problems at lower levels of conflict. This research suggests two main patterns of attachment and alcohol use, both exacerbated by marital conflict and different for husbands and wives.

Investigating the mobility of the peer specialist workforce in the United States: Findings from a national survey.

OBJECTIVE: The objectives of the current study were to characterize (a) peer specialist interest in enrolling in/returning to higher education and perceived barriers, (b) perceptions of the local availability of higher education/continuing education programming, and (c) perceived barriers to the advancement of the peer workforce. METHOD: We utilized both close-ended and open-ended items from a large, collaboratively developed national survey of peer specialists. Analytic methods included both descriptive and basic inferential statistics (N = 801) and qualitative coding and analysis (subsample N = 451). RESULTS: High levels of interest in higher education were found, with nearly 80% of participants reporting that they would enroll/return to college were it feasible. Analysis of open-ended responses regarding perceived barriers to career advancement revealed 5 major themes: financing and administrative policies; perceived public discrimination and devaluation of the peer specialist role by coworkers and agency leadership; lack of opportunities and mechanisms for advancement; the simultaneous need for advanced education and the inaccessibility of college or graduate degrees; and individual level barriers, including internalized stigma and derailed work histories due to disability. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: As the peer workforce continues to grow, it is critical that the field grapple with fundamental questions as to how to best support the development and advancement of the peer workforce. Our findings underscore persistent workplace challenges and perceived barriers to advancement, insights which may help the field develop strategies for improving development supports. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Development and Psychometric Evaluation of a Brief Approach and Avoidance of Alcohol Questionnaire.

BACKGROUND: The Approach and Avoidance of Alcohol Questionnaire (AAAQ) was developed as a measure of craving to assess both desires to consume and desires to avoid consuming alcohol. Although the measure has been used in a variety of populations to predict future alcohol use behavior, the factor structures observed vary based on sample type (e.g., clinical vs. college samples) and may be overly long for use in repeated measures designs. The current article describes the development of a brief version of the AAAQ for use in clinical populations. METHODS: Using existing data sets of individuals in treatment for alcohol use disorder, exploratory analyses (e.g., exploratory factor analysis and item response theory) were conducted using an inpatient sample (N = 298) at a substance abuse treatment facility. Confirmatory analyses (e.g., confirmatory factor analysis and multiple regression) were conducted using an inpatient detoxification sample (N = 175) and a longitudinal outpatient treatment sample (N = 53). RESULTS: The brief AAAQ had comparable internal consistency, explained a similar amount of variance in alcohol consumption and related problems, and exhibited superior model fit as compared to the original measure. CONCLUSIONS: These findings indicate that the brief AAAQ is an effective tool to assess alcohol craving in clinical populations in treatment settings.

Assessing Treatment Integrity in Alcohol Behavioral Couple Therapy.

OBJECTIVES: Alcohol Behavioral Couple Therapy (ABCT) is an efficacious treatment for alcohol use disorders. Coding treatment integrity can shed light on the active ingredients of ABCT, but there are no published studies of treatment integrity instruments for ABCT. The present study describes the development and initial reliability of the Treatment Integrity Rating System - Couples Version (C-TIRS) for ABCT. METHODS: The C-TIRS was used to rate 284 first- and mid-treatment ABCT sessions of 188 couples in four randomized clinical trials. RESULTS: Average inter-rater reliability for distinguishing ratings between C-TIRS items was fair-to-good for quantity items (intraclass correlation [ICC] = 0.64) and poor-to-fair for quality items (ICC = 0.41). Five C-TIRS subscales were defined a priori to measure treatment components involving cognitive-behavioral therapy, spouse involvement, couple therapy, common therapeutic factors, and overall adherence to the treatment protocol and had adequate internal reliability (α = 0.74-0.89). Inter-rater reliability was fair to good on seven of ten scales but poor on three scales (ICC range = 0.17-0.72). CONCLUSIONS: The C-TIRS was designed to provide information about quantity and quality of the delivery of ABCT components; however, further refinement of the C-TIRS is warranted before it should be used in frontline practice. Clinical implications and recommendations for future research are discussed.