Alcohol and suicidal behavior.

Alcohol dependence and alcohol intoxication are important risk factors for suicidal behavior. However, the mechanism for the relationship remains unclear. This review presents a conceptual framework relating alcohol to suicidal behavior. Distal risk factors create a statistical potential for suicide. Alcohol dependence, as well as associated comorbid psychopathology and negative life events, act as distal risk factors for suicidal behavior. Proximal risk factors determine the timing of suicidal behavior by translating the statistical potential of distal risk factors into action. The acute effects of alcohol intoxication act as important proximal risk factors for suicidal behavior among the alcoholic and nonalcoholic alike. Mechanisms responsible for alcohol's ability to increase the proximal risk for suicidal behavior include alcohol's ability to: (1) increase psychological distress, (2) increase aggressiveness, (3) propel suicidal ideation into action through suicide-specific alcohol expectancies, and (4) constrict cognition which impairs the generation and implementation of alternative coping strategies. Moreover, the proximal risk factors associated with acute intoxication are consistent with Baumeister's (1990) escape theory of suicide. Suggestions for additional research are discussed, including the possibility that a nonlinear cusp catastrophe model characterizes the relationship between alcohol intoxication and suicidal behavior.

A test of the appraisal-disruption model of alcohol and stress.

OBJECTIVE: Faced with a large body of contradictory findings, investigators have begun to propose cognitive factors that moderate the effects of alcohol on stress. We tested the hypothesis, stemming from the appraisal-disruption model (ADM), that alcohol would be more likely to reduce stress when consumed prior to exposure to a stressor than when consumed following exposure. METHOD: Male and female social drinkers (N = 169, 85 men) with or without a parental history of alcoholism were recruited using separate structured clinical interviews with the participant and with a biological parent. Participants drank a moderate dose of alcohol or a placebo in one of two temporal sequences. Stress was induced by asking participants to present a self-disclosing speech about their physical appearance. Stress responses were assessed using four types of measures: self-reported anxiety, pulse rate, facial expression associated with negative affect and threat-related interference on a color-naming task. RESULTS: Alcohol was generally more likely to attenuate stress responses when initial exposure to a social stressor followed drinking than when it preceded drinking. CONCLUSIONS: Findings were consistent with predictions stemming from the ADM. Alcohol appears to be more likely to reduce stress when initial stress appraisal occurs during intoxication. In contrast, when initial appraisal occurs prior to drinking, alcohol is less effective in attenuating stress.

The relationship of self-efficacy expectancies to relapse among alcohol dependent men and women: a prospective study.

OBJECTIVE: We studied the relationship of self-efficacy expectancies measured during inpatient alcohol treatment and time to first drink and time to relapse following hospitalization. We also examined whether the relationship of in-hospital self-efficacy and posttreatment drinking outcome differed by gender. METHOD: We measured self-efficacy expectancies using the Situational Confidence Questionnaire (SCQ) in 100 subjects (59 men) during inpatient treatment for alcohol dependence. We followed subjects monthly for 1 year and examined the relationship of their in-hospital SCQ scores to posttreatment drinking behavior, as measured by time to first drink, time to relapse and percent abstinent days. RESULTS: Self-efficacy during hospitalization was related to relapse during the 12 months following hospitalization. Survival analysis demonstrated that in-hospital SCQ scores greater than 45 were predictive of better drinking outcomes. The median number of days to relapse after treatment were 30 and 135, respectively, in those with in-hospital SCQ scores less than or equal to 45 compared with those with SCQ scores greater than 45. There were no gender differences in self-efficacy measured during hospitalization, nor were there gender differences in the relationship of self-efficacy to time to relapse. However, men with SCQ scores less than or equal to 45 had fewer abstinent days during follow-up. CONCLUSIONS: Among both men and women being treated for alcohol dependence, a cut-off score of 45 on the SCQ may be especially important in helping clinicians assess patients who are at high risk for more rapid return to drinking after hospitalization.

Development of a brief measure of semantic priming.

Neuropsychologists use a variety of stimuli to investigate semantic memory functioning. Methodological concerns limit interpretation of performance differences between patients and nonpatient controls. The present study describes the development of a brief measure of semantic memory. Results indicate that this measure of semantic priming provides a brief, yet sensitive, measure of semantic memory. It may prove useful for researchers interested in examining semantic memory processes in cognitively impaired individuals.

Effects of cue exposure and deprivation on cognitive resources in smokers.

This research examines the effects of manipulations designed to induce an urge to smoke on cognitive resources. Two cue-exposure experiments were conducted in which current smokers' reported urge to smoke and cognitive resources, as measured by a secondary reaction time (RT) probe, were assessed. In each study, subjects came to the laboratory twice, once while deprived of smoking for 12 hr and once when they were nondeprived. During each session, subjects were exposed to both smoking and control cues. Results indicated that experimental manipulations designed to elicit a strong urge to smoke led to an increase in self-reported urge to smoke and a decrease of available cognitive resources, as measured by RT. In addition, these 2 measures were significantly correlated. These data, in conjunction with previous findings using alcohol-dependent subjects (M. A. Sayette et al., 1994), lend support to the validity of RT as an objective measure of the effects of cue exposure on cognitive resources.