Inhibition conflict and alcohol expectancy as moderators of alcohol's relationship to condom use.

Inhibition conflict theory predicts that alcohol will decrease condom use only among individuals who are highly conflicted about using a condom, whereas expectancy theory predicts such an effect only among individuals who hold strong beliefs about alcohol's effects on sexual risk taking. In Study 1, the first of these two theories was tested using a newly developed measure of conflict. Data from 308 college students who reported on the first time they had sexual intercourse with their most recent partner (FMRP) supported the utility of this measure and showed that quantity of alcohol consumed was negatively associated with condom use only among high-conflict individuals. In Study 2, 17- to 25-year-old respondents reported on their first sexual intercourse, FMRP, and last intercourse (ns = 465, 1136, and 984, respectively). In a simultaneous test of both inhibition conflict theory and expectancy theory, amount of alcohol consumed was found to be negatively associated with condom use at first intercourse among individuals high in both conflict and expectancy, at FMRP among high-expectancy individuals, and at last intercourse among high-conflict individuals. These results lend partial support to both theories of alcohol's effects and suggest that an integration of these two perspectives will ultimately be required if researchers are to model adequately alcohol's effects on human social behavior.

Alcoholics Anonymous and the use of medications to prevent relapse: an anonymous survey of member attitudes.

OBJECTIVE: The purpose of this study was to systematically assess the attitudes of Alcoholics Anonymous (AA) members toward the newer medications used to prevent relapse (e.g., naltrexone) and to assess their experiences with medication use, of any type, in AA. METHOD: Using media solicitations and snowball sampling techniques, 277 AA members were surveyed anonymously about their attitudes toward use of medication for preventing relapse and their experiences with medication use of any type in AA. RESULTS: Over half the sample believed the use of relapse-preventing medication either was a good idea or might be a good idea. Only 17% believed an individual should not take it and only 12% would tell another member to stop taking it. Members attending relatively more meetings in the past 3 months had less favorable attitudes toward the medication. Almost a third (29%) reported personally experiencing some pressure to stop a medication (of any type). However, 69% of these continued taking the medication. CONCLUSIONS: The study did not find strong, widespread negative attitudes toward medication for preventing relapse among AA members. Nevertheless, some discouragement of medication use does occur in AA. Though most AA members apparently resist pressure to stop a medication, when medication is prescribed a need exists to integrate it within the philosophy of 12-step treatment programs.

Predicting the therapeutic alliance in alcoholism treatment.

OBJECTIVE: Prediction of the therapeutic alliance in alcoholism treatment (as rated by the client and by the therapist) was examined in light of a range of potentially relevant factors, including client demographics, drinking history, current drinking, current psychosocial functioning and therapist demographics. METHOD: The data were gathered in Project MATCH. The present analyses were based on data from 707 outpatients and 480 aftercare clients assigned to one of the three Project MATCH treatments. Potential predictor variables were evaluated by first examining bivariate linear relationships between the variables and ratings of the alliance, and then entering blocks of these predictors into multiple linear regression equations with alliance ratings as the dependent variables. All analysis incorporated adjustments for the nonindependence of ratings pertaining to clients seen by the same therapist. RESULTS: In simple regressions evaluating bivariate relationships, outpatients' ratings of the alliance were positively predicted by client age, motivational readiness to change, socialization, level of perceived social support and therapist age, and were negatively predicted by client educational level, level of depression, and meaning seeking. Therapist ratings in the outpatient sample were positively predicted by the client being female and by level of overall alcohol involvement, severity of alcohol dependence, negative consequences of alcohol use, and readiness to change. Among aftercare clients, ratings of the alliance were positively predicted by readiness to change, socialization and social support, and were negatively predicted by level of depression. Therapist ratings of the alliance in the aftercare sample were positively predicted by the client being female and therapist educational level, and were negatively predicted by pretreatment drinks per drinking day. Of the variables having significant bivariate relationships with alliance scores, only a few were identified as significant predictors in multiple regression equations. Among outpatients, client age and motivational readiness to change remained positive predictors and client education a negative predictor of client ratings of the alliance, while client gender remained a significant predictor of therapist ratings. Among aftercare clients, readiness to change and level of depression remained significant predictors of client ratings, while none of the variables remained a significant predictor of therapist ratings. CONCLUSIONS: While the data indicate that several client variables predict the nature of both the client's and therapist's perception of the therapeutic alliance, the significant relationships are of modest magnitude, and few variables remain predictive after controlling for causally prior variables. The strongest relationship identified in both the outpatient and aftercare samples is that between clients' motivational readiness to change and their ratings of the alliance.

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.

Sex-related alcohol expectancies as moderators of the relationship between alcohol use and risky sex in adolescents.

OBJECTIVE: Alcohol is frequently identified as a potential contributor to HIV-related sexual risk taking. Drawing on alcohol expectancy explanations for postdrinking behavior, the present study tested the hypothesis that adolescents who drink alcohol on a given occasion will be more likely to engage in sexual risk-taking behavior to the extent that they believe that alcohol disinhibits sexual behavior or promotes sexual risk taking. METHOD: The combined effects of sex-related alcohol expectancies and alcohol use in sexual situations were investigated using interview data from a representative sample of 907 (476 male) sexually experienced adolescents (13 to 19 years) who had ever consumed alcohol. RESULTS: Regression analyses on a composite measure of risk taking revealed that for two of three intercourse occasions examined alcohol use was associated with greater risk taking primarily among respondents who expected alcohol to increase risky sexual behavior. CONCLUSIONS: The results lend support to expectancy theories of alcohol's effects on sexual risk taking and raise the possibility that providing overly simplistic warnings that "alcohol leads to risky sex" may paradoxically increase the likelihood that individuals will fail to act prudently when intoxicated. Preventive interventions might beneficially focus on weakening, rather than strengthening, individuals' expectancies with regard to the impact of alcohol on sexual behavior, so that self-protective behavior will be more likely to occur even during intoxication.

PIP: This study tested the hypothesis that adolescents who drink alcohol on a given occasion will be more likely to engage in sexual risk-taking behavior to the extent that they believe that alcohol disinhibits sexual behavior or promotes sexual risk-taking. The sample consisted of 907 (476 male, 431 female) adolescents, ranging in age from 13 to 19 years, who had had sexual intercourse but had never drunk alcohol. Data were collected through face-to-face interviews lasting about 2 hours and conducted by professionally trained interviewers. Regression analyses on a composite measure of risk-taking showed that for 2 or 3 intercourse occasions, alcohol use was positively associated with greater risk-taking, particularly among respondents who also expected alcohol to increase risky sexual behavior. Results of this study was consistent with the hypothesis that alcohol increases sexual risk-taking in part by activating individually held beliefs about the effects of alcohol. Self-reported expectancies are the likely predictors of intoxicated behaviors. Therefore, an individual who perceives that alcohol increases sexual risk-taking needs stronger skills and motivation for maintaining safer sexual behavior. Preventive interventions should also focus on weakening, rather than strengthening, the expectancies of an individual concerning the impact of alcohol on sexual behavior.

Characteristics of participants in secular organizations for sobriety (SOS).

Self-help groups have assisted many in their recovery from alcohol use disorders. Although Alcoholics Anonymous (AA) is the largest self-help organization for addressing alcohol problems, no single organization can be suited to the needs of all alcohol abusers. For example, some alcoholics have chosen not to affiliate with AA because of objections to religious or spiritual references in the 12 steps of AA. It was largely for this reason that a secular self-help organization-Secular Organizations for Sobriety (SOS)-was established. This article provides an overview of SOS. Also described are the results of a survey of SOS participants. These data provide a preliminary picture of SOS members and will, we hope, stimulate further research on this organization and its effectiveness.

Expectancy set, self-reported expectancies and predispositional traits: predicting interest in violence and erotica.

To investigate the role of alcohol expectancies in predicting postdrinking behavior, two studies were conducted. In Study 1, an instrument assessing alcohol expectancies was devised for later use in prediction. Factor analyses with split-sample validation confirmed 3 factors (11 total items): disinhibition, aggression and sexuality. In Study 2, expectancies, Buss-Durkee hostility and Mosher sex-guilt were assessed in a preexperimental questionnaire session. In a subsequent drink administration session, an expectancy set manipulation led subjects to expect alcohol or to expect tonic. To assess postdrinking behavior, interest in violent, erotic and violent-erotic materials was measured unobtrusively using an ad lib slide-viewing task. Consistent with the hypotheses, expectancies in conjunction with trait hostility significantly predicted violence viewing and violent-erotica viewing for expect alcohol, but not expect tonic controls. Moreover, after variance due to hostility was accounted for, expectancies predicted violence viewing significantly and violent-erotica viewing marginally. These findings provide modest support for the proposition that preexisting alcohol expectancies mediate between the effects of expectancy set and postdrinking behaviors. Once activated by perceived alcohol ingestion, these expectancies can shape postdrinking behaviors. The findings also underscore the need for further experimentation aimed at clarifying the interrelationships between alcohol expectancies and expectancy set.

Alcohol expectancy and the relationship between drinking and physical aggression.

This study investigated the role of alcohol expectancy as a moderator of the relationship between drinking habits and self-reported frequency of physical aggression. Questionnaires were administered to a sample of 114 American male college students. After controlling for the subjects' ages, hostility, and attitude toward aggression, the relationship between drinking habits and frequency of physical aggression was significantly stronger for those expecting alcohol to increase aggression than for those expecting either a decrease or no effect on aggression. This finding lends support to expectancy-based explanations of alcohol's effects.

Self-reported alcohol expectancies for self and other as a function of behavior type and dosage set.

The hypothesis that expectancies about alcohol's effects on behavior vary as a function of behavior type and dosage set was tested in two self-report studies. In Study 1, 85 male and 88 female college students estimated how a moderate versus high dosage of alcohol would affect three social and three nonsocial behaviors selected from Southwick, Steele, Marlatt, and Lindell's (1981) alcohol expectancy questionnaire. In Study 2, 61 male and 113 female college students estimated how alcohol would affect the same behaviors, but they estimated the effects on another person (male or female) rather than on themselves. Results from both studies indicated that subjects expected a moderate dose of alcohol to have greater effects on social than nonsocial behavior, and they expected a high dose to have greater effects on nonsocial than social behavior. Gender also influenced the expected strength of alcohol effects.