Development of a skill training program for parents of substance-abusing adolescents.

This report discusses the development of a coping skill training program for parents of substance-abusing adolescents and presents preliminary data on the effects of the program on parent functioning and adolescent substance use. The behavioral-analytic model of program development was used to sample representative problematic situations experienced by parents of substance-abusing adolescents, obtain an effectiveness-scaling of responses to these situations, and derive alternate forms of a situational role-play measure of parental coping. These situations and scoring guidelines were then used to create the skill training program. Parents of substance-abusing adolescents not in treatment subsequently were randomly assigned in a pilot investigation to either a skill training or delayed treatment condition. Skill training resulted in significant improvement in parental coping skills relative to delayed treatment. Moderate to large improvement in the parent's report of their own functioning, family communication, and the teen's marijuana use also favored the skill training group.

Treatment settings for persons with alcoholism: evidence for matching clients to inpatient versus outpatient care.

This study compared inpatient, intensive outpatient, and standard outpatient treatment settings for persons with alcoholism and tested a priori hypotheses about the interaction of setting with client alcohol involvement and social network support for drinking. Participants (N = 192) were assigned randomly in cohorts to 1 of the 3 settings. The settings did not differ in posttreatment primary drinking outcomes, although inpatients had significantly fewer jail and residential treatment days combined than outpatients. Clients high in alcohol involvement benefited more from inpatient than outpatient care; the opposite was true at low alcohol involvement levels. Network drinking support did not moderate setting effects. Clients low in cognitive functioning also appeared to benefit more from inpatient than outpatient care. Improved outcomes might be achieved by matching degree of alcohol involvement and cognitive functioning to level of care.

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.

Participant selection biases in a randomized clinical trial of alcoholism treatment settings and intensities.

Eligible participants and decliners in a randomized study of inpatient, intense outpatient, and standard outpatient treatments for alcoholics were compared and contrasted on a series of demographic, social stability, psychological, legal, drug use, problem severity, and treatment history variables. Among 302 individuals meeting eligibility requirements, those agreeing to participate, compared with decliners, were more likely to be unemployed, be residentially less stable, have legal problems, use other drugs, have a more severe alcohol problem, have a recent treatment history, and were less likely to have problems with violence. Participants also were more likely to be male and non-white, although gender and racial effects were not significant when other variables were controlled for. The implications of these findings for generalizing the results of inpatient-outpatient studies are discussed, and the need for routine reporting of decliner characteristics in research reports is stressed.

The spouse situation inventory: a role-play measure of coping skills in women with alcoholic partners.

This article reports on the psychometric evaluation of the Spouse Situation Inventory (SSI), a role-play measure of coping skills in women with alcoholic partners. The study examined the generalizability, alternate form reliability, test-retest reliability, and construct validity of the measure in 472 women from both treatment and nontreatment populations. The SSI had acceptable generalizability and reliability. SSI performance also had predicted relationships with measures of general escape coping, alcohol-related coping behaviors, the woman's drinking, the partner's drinking in the treatment group, and the partner's problem recognition in the nontreatment group. The SSI shows promise as a reliable and valid measure of coping skills in this population and has direct implications for development and evaluation of skill training programs.

Self-efficacy, aftercare and relapse in a treatment program for alcoholics.

The role of self-efficacy in the prediction of relapse following alcoholism treatment was examined in a 12-month follow-up evaluation. Self-efficacy was assessed at intake to inpatient treatment and again at discharge. The drinking status of male alcoholics completing treatment then was assessed during six intervals over the course of the posttreatment year. Results indicated a significant increase in self-efficacy from intake to discharge. Additional analyses showed that lower intake self-efficacy ratings were associated with relapse by either 6- or 12-months posttreatment. Discharge self-efficacy, on the other hand, was not related to relapse status at either posttreatment point. A subsequent analysis of the pattern of relapses across the six follow-up intervals was conducted using survival analysis. Results revealed that only intake self-efficacy was predictive of the follow-up interval during which a relapse occurred. Individuals high in self-efficacy at intake showed the greatest resistance to relapse across time. The maintenance of aftercare further reduced the risk of relapse. The results are discussed with respect to self-efficacy theory and the problem of ceiling effects in posttreatment self-efficacy assessments.

Reactivity to alcohol-relevant beverage and imaginal cues in alcoholics.

This study was designed to explore three primary facets of reactivity to alcohol-relevant stimuli among alcoholics: (a) comparison of exposure to an alcohol-containing beverage vs. an appropriate, standardized control beverage; (b) efficacy of imaginally presented cues to elicit reactivity, alone and in combination with beverage cues; and (c) examination of the recovery process. Forty-eight male veterans attending an inpatient alcohol treatment program served as participants and were randomly assigned to one of four groups in a 2 (Alcohol vs. Lemonade Beverage) X 2 (High-Risk vs. Low-Risk Imagery) design. Heart rate reactivity to Beverage cues was consistent with previous research. An interaction of Beverage and Imagery manipulations during recovery revealed both experimental manipulations influenced heart rate, although the Alcohol/High-Risk Imagery exposure group did not demonstrate enhanced effects. Both manipulations also had an impact on ratings of desire to consume alcohol. These findings provide further support for the reliability of cue reactivity effects, and suggest the utility of imaginal exposure procedures as a component of a comprehensive cue reactivity assessment.

Impact of social desirability response sets on the self-report of marital adjustment in alcoholics.

The role of social desirability response sets on self-reported marital satisfaction in 143 male alcoholics and their wives was assessed in a factor analytic study of the combined Locke-Wallace Marital Adjustment Scale (MAS) and Edmonds Marital Conventionalization Scale (MCS). Overall, results indicated that alcoholics rated their marriage as significantly more satisfying than did their wives. There was, however, a large amount of covariation between the MAS and MCS for husbands, and factor analyses revealed considerable redundancy between the two measures as evidenced in one dominant factor on which both MAS and MCS items loaded. Although there was also high covariation between the two scales for wives, there was still enough differential responding to MAS and MCS items to identify both a dominant factor and a second factor, the latter loaded on only by MCS items. Results suggest that the self-reported marital satisfaction of male alcoholics may be highly contaminated by social desirability response sets. The results are discussed with respect to the two-component model of socially desirable responding and caution is urged in the evaluation of self-report marital adjustment measures with this population.

Determinants of disulfiram acceptance among alcohol patients: a test of the theory of reasoned action.

The utility of disulfiram in the treatment of alcohol abuse has been limited by the high frequency with which clients refuse the regimen. The present study identified variables influencing disulfiram acceptance/rejection within the framework of the theory of reasoned action. Eighty male inpatients on an alcohol treatment unit completed a questionnaire operationalizing the components of the model. The theoretical components were then used to predict requests for the drug. Multiple regression analyses revealed significant correlations among components of the model consistent with the assumptions of the theory. In addition, significant differences were found between disulfiram requestors and rejectors in terms of behavioral and normative beliefs about the consequences of being placed on the drug. Implications of these results for the design of effective interventions are discussed.

Ecological relevance of memory tests and the prediction of relapse in alcoholics.

In an inpatient alcoholism rehabilitation program, 56 men were administered two 10-min memory tests: the Product Recall Test (PRT), designed to assess memory for familiar stimuli (assumed to be relatively high in ecological relevance), and the Memory-for-Designs Test (MFD), a test of memory for novel patterns of stimuli (assumed to be relatively low in ecological relevance). Approximately 74% of subjects who recalled less than or equal to half the items of the PRT relapsed at 3 months compared to only 33% of the subjects who recalled more than half the items. Performance on the MFD was not related to relapse rate. PRT performance was almost as predictive of relapse at 3 months as aftercare attendance, and combining both of these variables further improved predictability. The results suggest that the familiarity of the stimuli employed in memory tests may be important in tapping cognitive deficits of alcoholics that place these subjects at increased risk for relapse. The implication of these findings for the time-effective identification of early relapsers from alcoholism treatment programs are discussed.

Behavioral treatment of the geriatric alcohol abuser: a long term follow-up study.

The present study represents a long-term follow-up of elderly persons who completed a behavioral treatment program for alcohol problems. Subjects over the age of 60 at the time they obtained treatment for alcohol abuse were contacted two to four years after discharge. Interviews with the alcohol abuser and a significant other were conducted in an effort to identify the percentage of persons for whom treatment had sustained beneficial effects, differences in outcome for early-versus late-onset alcohol abusers, and demographic and daily activity variables that distinguish abstinent from nonabstinent individuals. Results suggest that beneficial effects of the program maintained for 50% of the patients two or more years following completion of the program. An additional 12% reported significant modification of their drinking. Directions for future research are suggested.

Increasing attendance at alcohol aftercare using calendar prompts and home based contracting.

The effect of an appointment-keeping intervention on attendance at aftercare was examined for 50 male participants in an inpatient alcohol treatment program. Subjects received either a calendar prompt and home-based attendance contract intervention (Experimental group, N = 25) or standard aftercare treatment arrangements (Control group, N = 25). Participants were followed for eight aftercare sessions over a 6-month period. Results showed significant attendance differences between groups for the first seven aftercare sessions, with nearly twice as many experimental subjects as control subjects attending aftercare sessions. Further, significantly fewer experimental than control subjects (24% fewer) were dropped from the alcohol program for three consecutive nonattendances. The present study provides an effective technology for increasing aftercare attendance and thus potentially increasing the probability of long term maintenance of alcohol treatment effects.

Spouse contracting to increase antabuse compliance in alcoholic veterans.

Developed and evaluated a home-based contracting program to determine its effect on the compliance rates of discharged alcohol patients to a disulfiram (antabuse) regimen. The three comparison groups included (a) no contract/no recording; (b) contract/recording; and (c) contract/recording plus instructions for positive reinforcement. Twenty-five patients who had been treated in a behaviorally oriented inpatient alcohol dependence treatment program and who lived with a significant other (i.e., spouse, sibling, parent) participated in the study. At the end of the 3-month period for which the disulfiram was prescribed, those Ss who were involved in contracting and recording reached criterion more frequently than those who were in the minimal treatment group. Furthermore, 84% of this S sample were abstinent at the 3-month follow-up according to collateral reports. The discussion centers on the use of home-based contracting as an inexpensive alternative to other, more costly disulfiram programs. Additional methods for obtaining measures of reliability on self-report of disulfiram usage also are discussed.

Assessing disulfiram compliance: validational study of an abbreviated breath test procedure.

An abbreviated breath test for detecting the disulfiram metabolite carbon disulfide (CS2) was evaluated in an analogue investigation of the sensitivity of the test in identifying disulfiram and non-disulfiram intake in a group of 14 alcoholic inpatients. Disulfiram (250 mg) was administered within an ABAB repeated measures design over a 12-day period with corresponding breath tests administered during morning and afternoon time periods. Dependent measures included spectrophotometric analysis of reacted test samples and visual ratings of sample color. Results indicated that the test was highly sensitive in discriminating disulfiram administration for the group as a whole, as well as for individual subjects. Moreover, visual ratings were more accurate than spectrophotometric cut-off scores in identifying disulfiram administration. The test shows considerable promise as a rapid means of assessing disulfiram compliance.

Alcohol use in television programming: effects on children's behavior.

The impact of televised use of alcoholic beverages on children's behavior was evaluated in this study. Children were randomly assigned to one of three experimental conditions: (a) television with drinking depicted, (b) television without drinking, or (c) a no television control condition. Segments of the syndicated television show M.A.S.H. were used as the viewing stimulus. The impact of the various conditions was evaluated in a choice task requiring subjects to choose either martini or regular glasses of either "whiskey" or "water" to serve pictured adults and children. Results indicated that subjects who viewed television drinking were significantly more likely to choose alcoholic beverages for pictured adults but not children. No effect was found for glass preference. Results and implications of these findings and directions for future research are discussed.

Impact of aftercare arrangements on the maintenance of treatment success in abusive drinkers.

Aftercare to prevent relapse following alcohol treatment has not received adequate experimental investigation. The present study monitored alcohol intake of 50 patients following assignment to either an intensive aftercare recruitment procedure or regular clinic aftercare. The results indicated that those who received the intensive aftercare procedure showed delayed relapse. In addition, regardless of group assignment those who attended aftercare had significantly more success as measured by alcohol intake. The implications of these results for the design of treatment and aftercare programs are discussed.