Reducing alcohol consumption among heavily drinking women: evaluating the contributions of life-skills training and booster sessions.

Problem-drinking women (N = 144) without histories of severe physical dependence on alcohol received drinking-reduction training and were assigned to receive (or not receive) 2 treatment enhancements: life-skills training and booster sessions. The design resulted in 4 treatment conditions: drinking-reduction treatment (DRT) plus life-skills training, DRT plus booster sessions, DRT plus life-skills training and booster sessions, or DRT only. The interventions entailed 13 hr of DRT, 7 hr devoted to the life-skills training or to a no-life-skills training educational module, plus 8 hr of booster sessions for those receiving them. Participants evidenced significant reductions in alcohol use during the 18 months after treatment. Those with greater pretreatment drinking evidenced differential response to the experimental manipulations: The treatment enhancements (life skills and booster sessions) led to significantly improved drinking outcomes among women who were heavier drinkers at pretreatment. There were no significant effects of the treatment enhancements among lighter drinkers at pretreatment. The results provide support for use of treatment enhancements in interventions designed to moderate women problem drinkers' alcohol use.

Strategies for preparing clients for treatment. A review.

Substantial numbers of mental health clients do not return following their initial therapy visits or drop out of treatment prematurely. Two general classes of strategies designed to reduce premature attrition and enhance treatment participation are reviewed. Research on psychotherapy preparatory techniques (role induction, vicarious therapy pretraining, and experiential pretraining) indicates that these educational techniques are effective in reducing early treatment attrition and may be especially effective with populations at high risk for dropout (e.g., lower socioeconomic groups, chronically mentally ill clients, and institutionalized juvenile delinquents). Motivational interviewing, a technique originally developed for clients with alcohol problems, is designed to reduce client ambivalence toward therapy and change and enhance commitment to and motivation for treatment. Research in the alcohol field suggests that a session of pretreatment motivational interviewing enhances treatment outcome. Both motivational interviewing and psychotherapy preparatory techniques are relatively brief and easy to incorporate into existing mental health care.

Treating problem drinking.

Recent data suggest that most people experiencing alcohol problems have problems of mild to moderate severity. Relative to alcoholics, these drinkers have a shorter problem-drinking history, greater social and economic stability, and greater personal resources. This article describes a cognitive-behavioral treatment approach designed specifically for problem drinkers with low levels of physical dependence on alcohol who choose to reduce their drinking. After describing various drinking-reduction techniques, the article reviews empirical evidence for drinking-reduction training. The increasing availability of drinking-reduction interventions holds considerable promise for reducing alcohol-related dysfunction among problem drinkers.

A prospective study of self-esteem and alcohol use disorders in early adulthood: evidence for gender differences.

The relations among gender, self-esteem, and DSM-III alcohol use disorder diagnoses were examined in a sample of 217 men and 240 women evaluated at four annual assessments over the college years. The results support clinical observations that low self-esteem plays a particularly important etiological role in alcohol problems in women relative to men. Women who had an alcohol use disorder during years 3 and/or 4 showed relatively low levels of self-esteem throughout the study period. Furthermore, the study provides clear evidence for prospective prediction from year 1 self-esteem to year 4 alcohol use disorder diagnosis for women, but not for men. There was minimal evidence to suggest that alcohol use predicts later self-esteem.

Characteristics of children of alcoholics: putative risk factors, substance use and abuse, and psychopathology.

A sample of 253 children of alcoholics (COAs) and 237 children of nonalcoholics (non-COAs) were compared on alcohol and drug use, psychopathology, cognitive ability, and personality. COAs reported more alcohol and drug problems, stronger alcohol expectancies, higher levels of behavioral undercontrol and neuroticism, and more psychiatric distress in relation to non-COAs. They also evidenced lower academic achievement and less verbal ability than non-COAs. COAs were given Diagnostic Interview Schedule alcohol diagnoses more frequently than non-COAs. The relation between paternal alcoholism and offspring alcohol involvement was mediated by behavioral undercontrol and alcohol expectancies. Although gender differences were found, there were few Gender X Family History interactions; the effects of family history of alcoholism were similar for men and women. When gender effects were found, they showed greater family history effects for women.

The effects of smoking cessation on food craving.

Weight gain is considered a frequent consequence of smoking cessation. Several psychological mechanisms may play an important role in weight gain following smoking cessation. The present investigation examined changes in food craving associated with smoking cessation using psychophysiologic (i.e., salivation), self-report, and behavioral (i.e., ad lib consumption) measures of reactivity to food cues in a prospective design. Although quitters (n = 16) evidenced weight gain (approximately 5 lbs.) at 1 week and 5 weeks post quit date and while control groups of smokers (n = 11) and nonsmokers (n = 16) did not, no support was found for increased craving assessed via self-report or salivation. The quitters did show evidence of increased craving as measured by ad lib consumption, while smokers and nonsmokers did not. However, the failure to find a significant Group by Session interaction limits our ability to make a strong statement concerning between-group differences on ad lib consumption.

Alcohol cue reactivity and ad lib drinking in young men at risk for alcoholism.

Individuals at high risk for alcoholism have been hypothesized to acquire alcoholic characteristics more rapidly than those at low risk. Two studies examined reactivity to alcohol cues, a phenomenon linked to craving for alcohol in clinical alcoholics, and ad lib drinking behavior in young men at varying risk for alcoholism. In Study 1, subjects exhibited increased autonomic and subjective responses during exposure to an alcohol beverage relative to a control beverage, suggesting that alcohol cue reactivity is not merely a clinical alcoholic phenomenon but also present in more moderate drinkers. This alcohol cue reactivity, however, was unrelated to risk status. Also, high-risk subjects exhibited greater nonspecific electromyographic and skin temperature reactivity, and higher baseline salivation volume than low-risk subjects. Of special note, ad lib alcohol consumption in Study 1 was correlated with subjects' self-report of craving during exposure to the alcoholic beverage. Study 2 attempted to replicate the baseline salivation finding but results were equivocal concerning the robustness of this effect. Also in Study 2, subjects exhibited decreased salivation volume following a placebo beverage and increased salivation volume following alcohol consumption. Studies 1 and 2 compared ad lib drinking behavior in high-risk and low-risk samples, but no group differences were found.