Predicting relapse in patients with severe alcohol use disorder: The role of alcohol insight and implicit alcohol associations.

Low insight is reported as a risk factor for relapse among patients treated for alcohol use disorders. However, to date, little is known on why patients with low insight are at higher risk for relapse. In this study, we tested the hypothesis that an implicit preference for alcohol over abstinence predicts relapse in patients with low, but not high, alcohol insight. Participants consisted of 77 patients who had received treatment for severe alcohol use disorder in a hospital in France. During hospitalization, they completed a self-report measure of insight and an implicit association test to assess implicit preference for alcohol over abstinence. The primary outcome was relapse assessed one month after discharge. Control variables were gender, age, cognitive deficit, anxiety, depression, craving, and impulsivity. Data were analysed using logistic regression analysis. After adjusting for demographic and clinical variables, relapse was predicted by the interaction between insight and implicit preference for alcohol but not by their main effects alone. Implicit preference for alcohol predicted relapse among patients with relatively low insight, but not among those with relatively high insight. These findings suggest that patients with low insight and strong implicit preference for alcohol are at a higher risk of relapse. Clinicians may therefore focus on and tailor specific interventions to prevent relapse in this vulnerable and at-risk population.

Forecasting a Fatal Decision: Direct Replication of the Predictive Validity of the Suicide-Implicit Association Test.

A previous study by Nock et al. (2010) suggested that people's implicit identification with "death" or "suicide" can accurately predict whether they will attempt suicide several months in advance. We report the first direct and independent replication of this promising finding. Participants were 165 patients seeking treatment at a psychiatric unit in France. At baseline, patients completed the Suicide-Implicit Association Test (S-IAT), a semistructured interview, and a self-report measure of suicide ideation. Six months later, we contacted participants by phone and examined their hospital medical records to determine whether they had made a new suicide attempt. Results showed that the S-IAT did not distinguish between patients who were admitted to the hospital following suicide attempts and those who were admitted for other reasons. As in the original study, however, the S-IAT predicted suicide attempts within the 6-month follow-up period beyond well-known predictors. The test correctly classified 85% of patients (95% confidence interval = [76.91, 91.53]), supporting its diagnostic value for identifying who will make a suicide attempt.

Mummy, daddy, and addiction: Implicit insecure attachment is associated with substance use in college students.

Indirect measures of cognition have become an important tool in research on addiction. To date, however, no research has examined whether indirect measures of parent attachment relate to substance use. To examine this issue, a sample of college students (N = 121) was asked to complete two measures of explicit attachment (the Relationship Questionnaire; Bartholomew & Horowitz, 1991, and the Adult Attachment Styles; Collins & Read, 1990), and a measure of implicit attachment (the Single Category Implicit Association Test, Karpinski & Steinman, 2006). The indirect attachment measure assessed the strength of automatic mental association between the concepts parents and secure. Participants also completed different measures of tobacco, cannabis, and alcohol use. Results showed that, for most of the participants, the parents were considered a source of security at both the explicit and implicit levels. Direct and indirect attachment measures were not related to each other. Overall, explicit attachment was not related to substance use. However, implicit attachment was significantly associated with the use of licit (tobacco) and illicit (cannabis) drugs. We also found some evidence that polydrug use is especially common among students with an insecure implicit attachment. This is the first study to examine how implicit attachment processes relate to addictive behaviors. The results suggest that implicit attachment, thought to reflect unconscious traces of past experiences, is a better predictor of substance use in college students than direct, self-reported measures of attachment. Further studies should examine whether implicit attachment is associated with severe substance use disorders in clinical populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Evaluation of the Cozart DDSV test for cannabis in oral fluid.

Saliva or "oral fluid" has been presented as an alternative matrix to establish drug exposure. The noninvasive collection of an oral fluid sample, which is relatively easy to perform and can be achieved under close supervision, is one of the most important benefits when testing for driving under the influence of drugs. Moreover, the detection of Delta9-tetrahydrocannabinol (THC) in oral fluid is a better indication of recent use than a positive urine test, so there is a higher probability that the subject is experiencing pharmacological effects at the time of sampling. Twenty-five subjects (5 free and 20 addicts from a heroin detoxification center) were included in a study to evaluate the potential application of a new device, the Cozart DDSV (drug detection system visual), to detect cannabis in oral fluid. The time cannabis was last smoked was recorded by the medical staff after interview with each subject. Samples were collected with the Cozart DDS Oral Swab and diluted with the Cozart DDS buffer as proposed by the manufacturer. The Cozart DDSV test was conducted on site at the time of collection, and the remainder of the sample retained for confirmation analysis by gas chromatography with mass spectrometry (GC/MS) after methylation of THC (limit of quantitation 0.5 ng/mL). All 25 samples were analyzed by GC/MS. On-site results were obtained within 10 minutes. The 5 drug-free subjects were negative for cannabis, irrespective of the method. From the 20 subjects declaring that they had smoked cannabis between 30 minutes and 24 hours previously, the DDSV device identified 8 positive subjects (with THC concentrations in the buffer in the range 15-219 ng/mL), whereas 18 subjects tested positive using GC/MS. THC concentrations in the Cozart buffer using GC/MS analysis ranged from 0.7 to 219 ng/mL. These concentrations represent about one third the authentic THC concentrations in oral fluid due to the dilution by the liquid of the device. Given the results, the DDSV device was considered as an acceptable tool to detect cannabis abuse in oral fluid within a period of 2-3 hours after smoking.