Attentional biases in abstinent alcoholics and their association with craving.

Previous investigations of attentional bias for alcohol cues in abstinent alcoholics indicate enhanced processing of alcohol cues on the modified Stroop task, and a more complicated "vigilance-avoidance" pattern of attentional bias on the visual probe task. Given that, in general, subjective craving is positively associated with attentional bias, we predicted that attentional biases in abstinent alcoholics would depend on their level of alcohol craving. In the present study 28 alcoholic patients, who had recently commenced a day treatment program, and 26 social drinking controls completed an alcohol Stroop task, a visual probe task with three stimulus durations (200, 500, and 2,000 ms), and self-report assessments of craving and alcohol dependence. On the alcohol Stroop task, abstinent alcoholics showed a greater interference effect for alcohol-related than neutral words, relative to social drinkers. On the visual probe task, alcoholic patients who reported a high level of craving exhibited a greater attentional bias toward alcohol cues, relative to both patients reporting a low level of craving, and social drinker controls. Alcoholics who reported low levels of craving showed avoidance of alcohol cues at 500 ms, relative to social drinkers. Among alcoholics, early dropout from treatment was associated with the severity of alcohol dependence and the strength of subjective craving, but it was not associated with measures of attentional bias. These results clarify the importance of subjective craving as a correlate of attentional biases in abstinent alcoholics.

Strengthening motivational interviewing skills following initial training: a randomised trial of workplace-based reflective practice.

AIM: The study assesses whether a workplace-based educational intervention helps professionals who had trained in Motivational Interviewing (MI) become more competent in it. DESIGN: Randomised controlled trial. PARTICIPANTS: Professionals in health and social services in Dorset, UK, who had received training in MI (n=54). INTERVENTION: (a) CONTROL: Update day in MI (b) THEME (Twelve Hours to Enhance Motivational Effectiveness): Update day plus 12 weekly worksheets to stimulate reflection on practice of MI, feedback to audiotaped sessions with clients, and three 30 minute sessions of telephone coaching. MEASUREMENTS: Degree of competence in MI, as assessed from videotapes of interviews with simulated patients, carried out at entry to the study and 4 months later. Each videotape was coded independently by two trained coders using the Motivational Interviewing Treatment Integrity (MITI) system. FINDINGS: Of the 44 participants who completed the second assessment, those in THEME showed significantly (p<0.05) greater increases in the Spirit of MI and overall competence in MI. CONCLUSIONS: Workplace based interventions may enhance the effectiveness of brief training in MI and other psychological therapies.

Evaluating a method of assessing competence in Motivational Interviewing: a study using simulated patients in the United Kingdom.

In this evaluation of a method of assessing competence in Motivational Interviewing (MI), participants were asked to interview an actor simulating a substance abuser who was ambivalent about an important issue. The interviews were videotaped and subsequently rated for competence in MI using the Motivational Interviewing Treatment Integrity code (MITI). Ratings of 43 interviews made independently by trained judges found high levels of inter-rater agreement. Ratings of 11 pairs of interviews carried out by the same interviewer with different simulated patients, a mean of 26days apart, resembled each other closely. Participants who had been trained in MI were significantly more competent than others. There was a significant association between researchers' and patients' ratings of the extent to which the interviewer demonstrated the spirit of MI. These findings imply that the assessment method produces reasonably reliable and valid ratings of competence in MI and can be used for both clinical and research purposes.

A randomised trial of early warning signs relapse prevention training in the treatment of alcohol dependence.

A pragmatic randomised trial examined the effects of Early Warning Signs Relapse Prevention Training (EWSRPT) on drinking in alcohol dependent persons with history of relapse. Participants were 124 abstinent alcohol dependent patients with a history of relapse (median five relapses) who entered the trial as they completed a 6-week day treatment programme. They were randomly allocated to receive either (1) Aftercare as Usual (AU) or (2) AU plus 15 individual sessions of EWSRPT using Gorski's protocol. Assessment carried out at entry to the trial, and 4, 8, and 12 months later, included self-report of drinking, blood tests (gamma glutamyl transferase, GGT; serum alanine aminotransferase, ALT) and measures of functioning (Alcohol Problems Questionnaire, APQ; SF36, Brief Symptom Inventory, BSI; Assessment of Warning-signs of Relapse, AWARE). Intention to treat analysis found no significant differences in continuous abstinence during the follow-up year (17% of 58 AU, 31% of 58 EWSRPT, p=0.08). The EWSRPT participants had a significantly lower probability of drinking heavily (74% of AU, 55% of EWSRPT, p=0.04), and significantly fewer days drinking (p=0.05) and heavy drinking (p=0.04). These clinically worthwhile effects for a relapse-prone group justify further research into EWSRPT.

Is oral fluid analysis as accurate as urinalysis in detecting drug use in a treatment setting?

BACKGROUND: Technology for testing oral fluid (OF) for the presence of drugs is available for treatment services and is more attractive than urinalysis: its validity is not well established. AIMS: Compare the accuracy of methods of on-site testing of OF and urine. DESIGN: Comparison of the sensitivity and specificity of on-site testing of samples of OF and urine collected on the same occasion, using subsequent blind laboratory analysis of the same urine samples as the standard. SETTING: British addiction treatment service. PARTICIPANTS: 157 drug dependent persons, 89% with evidence of opiates, 73% male, and 85% aged between 20 and 35 years. MEASUREMENTS: Assessment of presence of four drugs using SYVA ETS urinalysis and Cozart Rapiscan OF Drug Test systems. Laboratory urinalysis using microplate enzyme-immunoassay technique. RESULTS: The sensitivity of OF tests and urinalysis were, respectively, for opiates 91 and 91%, methadone 91 and 94%, and benzodiazepines 6 and 72%. The specificity of OF tests and urinalysis were, respectively, for opiates 78 and 67%, methadone 90 and 95%, and benzodiazepines 95 and 96%. Amphetamine usage was rare. CONCLUSIONS: OF testing is as accurate as urinalysis in detecting the presence of opiates and methadone, and the absence of methadone and benzodiazepines.