Benjamin O. Ladd

What Do Women Want? Alcohol Treatment Choices, Treatment Entry and Retention

Study aims were to assess preferences for individual or conjoint treatment, differences between women with alcohol use disorders (AUDs) selecting each modality, and the impact on treatment entry and retention of providing a choice of treatments. During initial screening, women with AUDs in an intimate relationship with a male partner were given the choice of individual or conjoint treatment. After choosing a treatment modality and completing all assessments they entered one of two randomized trials testing different approaches to each treatment modality. Standardized measures were used to assess drinking quantity, frequency, and problems; motivation to change; and relationship satisfaction. Womens reasons for choice of treatment modality were coded using an iterative coding process. Results showed that women were more likely to select and follow through with individual than conjoint treatment. Women cited a desire to work on individual problems, lack of perceived support from their partner, and logistical issues as reasons for preferring individual treatment. Women in the two choice groups did not differ significantly on individual, partner, or relationship characteristics, but small to medium effect sizes suggested that women choosing individual treatment were more educated and less satisfied with their relationship, had fewer pretreatment heavy drinking days, and heavier drinking partners. Offering women a choice of treatment modality increased the probability of entering treatment, but not treatment attendance. Results suggest that barriers to couple therapy for women with AUDs need to be addressed to facilitate more widespread dissemination. Given womens preferences, it also is important to offer a range of treatments.

When you see it, let it be: Urgency, mindfulness and adolescent substance use

The emotion-based domains of impulsivity, positive and negative urgency, are facets that have garnered attention due to their associations with substance use, and mindfulness based strategies have shown promise in reducing substance use in adults. The aim of the current study was to examine relations among urgency, mindfulness, and substance use in adolescence. Cross-sectional data were collected from students (N=1,051) at a large, private high school in the Pacific Northwest. Both positive and negative urgency were uniquely associated with greater likelihood of lifetime and current alcohol use; only positive urgency predicted lifetime marijuana use. Mindfulness was associated with a lower likelihood of lifetime alcohol or marijuana use. Interactions between urgency and mindfulness were not supported. Our findings highlight the need to explore relations among baseline mindfulness, skills based mindfulness, and personality in adolescent alcohol and other drug use.

Evaluating an Integrative Theoretical Framework for HIV Sexual Risk among Juvenile Justice involved Adolescents

Juvenile justice involved youth are at great risk for negative outcomes of risky sexual behavior including HIV/AIDS. Given the strong connection between alcohol use and risky sex in this population, it is important to consider alcohol use in interventions designed to decrease risky sexual behavior. This paper provides support for an integrative translational model that incorporates psychosocial, neurobiological, and genetic factors to better predict alcohol-related sexual risk behavior. Specifically, we present the design, methods, and baseline data from a complex randomized control trial, Project SHARP (Sexual Health and Adolescent Risk Prevention) in order to illustrate how this broad array of factors can best predict alcohol-related sexual risk behavior. Participants were justice-involved adolescents (n=284) who completed an fMRI and self-report assessments prior to randomization to either a sexual risk plus alcohol risk reduction group intervention or to an information-only contact control group intervention. Structural equation modeling was utilized and findings supported the hypothesized relationships in the translational model. Preliminary data suggest that interventions among justice-involved adolescents targeting alcohol-related sexual risk behavior may be more effective if a biopsychosocial approach is considered.

Trajectories of Drinking Urges During Individual- and Couple-Based Cognitive-Behavioral Treatment for Alcohol Use Disorders

Individuals receiving treatment for alcohol use disorders (AUDs) often experience urges to drink, and reductions in drinking urges during cognitive-behavioral therapy (CBT) predict better treatment outcomes. However, little previous work has examined patterns of daily drinking urges during treatment. This study examined patterns of change in daily drinking urges among participants in two randomized clinical trials of males (N = 80 with 4,401 daily recordings) and females ( N = 101 with 8,011 daily recordings) receiving individual- or couples-based CBT. Drinking urges were common during treatment, occurring on 45.1% of days for men and 44.8% for women. Drinking urges and alcohol use for both genders decreased substantially during the course of treatment. Both genders had increases in drinking urges as more time elapsed since attending a treatment session. For men, this increase was most pronounced at the beginning of treatment, but for women it was most pronounced near the end of treatment. Alcohol use and drinking urges were both more likely to occur on weekends. The results suggest that these times may lead to higher risk for drinking, and clients may benefit from high-risk planning that is focused on these times.

Feasibility and Reliability of a Coding System to Capture In-Session Group Behavior in Adolescents

Limited research has explored the role of in-session behavior during motivational enhancement (ME) in group formats. The current study presents initial feasibility of assessing behavior of high school students (N = 425) attending Project Options, a voluntary secondary drug and alcohol prevention program utilizing ME techniques. Building on previous research exploring client language supporting/opposing health behavior, student group behavior was coded live at the specific utterance and global level; group leader behavior was also coded globally. Interrater reliability of the coding system was assessed, and preliminary validity of the coding system was examined by exploring associations between characteristics of group members and in-session group behavior. Initial reliability estimates were excellent for the specific behavior codes. Reliability of the global codes was mixed, with raters demonstrating good reliability on support for unhealthy behavior, opposition to unhealthy behavior, and support for healthy behavior. Reliability of the group leader codes was fair to poor. Greater percent healthy talk was associated with a lower percentage of group members reporting lifetime alcohol use. The results of the current study suggest that some in-session behavior at the group level can be coded reliably via live observation and that in-session behavior at the group level is associated with alcohol use prior to attending the program. Future research is needed to explore the utility of in-session behavior in terms of predicting future behavior at the group and individual level.

Associations between Relationship Satisfaction and Drinking Urges for Women in Alcohol Behavioral Couples and Individual Therapy.

This study examined the association between relationship satisfaction and drinking urges among women who participated in alcohol behavioral individual therapy (ABIT) and Alcohol Behavioral Couples Therapy (ABCT). Relationship satisfaction and drinking urges were not related on a daily level, but urges were related to mean levels of relationship satisfaction, and this association was moderated by treatment condition and time in treatment. Women with higher relationship satisfaction had fewer drinking urges, and women in ABCT with higher relationship satisfaction experienced greater reductions in urges during treatment. These findings suggest that ABCT may target the association between relationship satisfaction and drinking urges.

Assessing Treatment Integrity in Alcohol Behavioral Couple Therapy.

Objectives:Alcohol Behavioral Couple Therapy (ABCT) is an efficacious treatment for alcohol-use disorders. Coding treatment integrity can shed light on the active ingredients of ABCT, but there are no published studies of treatment integrity instruments for ABCT. The present study describes the development and initial reliability of the Treatment Integrity Rating System-Couples Version (C-TIRS) for ABCT. Materials and Methods:The C-TIRS was used to rate 284 first and mid-treatment ABCT sessions of 188 couples in 4 randomized clinical trials. Results:Average interrater reliability for distinguishing ratings between C-TIRS items was fair to good for quantity items [intraclass correlation (ICC)=0.64] and poor to fair for quality items (ICC=0.41). Five C-TIRS subscales were defined a priori to measure treatment components involving cognitive-behavioral therapy, spouse involvement, couple therapy, common therapeutic factors, and overall adherence to the treatment protocol and had adequate internal reliability (&agr;=0.74 to 0.89). Interrater reliability was fair to good on 7 of 10 scales, but poor on 3 scales (ICC range=0.17 to 0.72). Conclusions:The C-TIRS was designed to provide information about quantity and quality of the delivery of ABCT components; however, further refinement of the C-TIRS is warranted before it should be used in frontline practice. Clinical implications and recommendations for future research are discussed.

Drinking, abstinence, and academic motives: relationships among multiple motivational domains and alcohol use in college students

BACKGROUND Drinking, abstinence, and academic motives have been previously linked with alcohol consumption in high school and college students; however, little research has examined the impact of such sources of motivations concurrently. OBJECTIVE Drawing from self-determination theory (SDT; Ryan & Deci, 2000), the current study tested the hypothesis that alcohol-related and academic motives would be associated with one another along internal vs. external focused dimensions. We also examined the relative influence of these motives on alcohol consumption. METHODS College students (N=226) completed self-report measures assessing drinking motives, abstinence motives, academic motives, and alcohol-related outcomes. RESULTS Findings suggest that drinking motives are related to abstinence motives but not academic motives. Both forms of alcohol-related motives were related to alcohol use and consequences; no associations between academic motives and alcohol variables were observed. CONCLUSIONS/IMPORTANCE The lack of associations among academic motives, alcohol-related motives, and alcohol variables departs from previous findings suggesting that academic motives impact alcohol use. The current findings indicate a greater understanding of the interplay of motivational sets related to salient issues for youth, such as academics, is needed in order to expand intervention models for alcohol use in such populations.

Effects of sex composition on group processes in alcohol prevention groups for teens.

Although most alcohol and other drug prevention programs for adolescents are offered in group settings, little is known about the possible effects of sex composition on group processes and mechanisms of change. Using the Group Actor-Partner Interdependence Model framework, we examined how the sex constellation of adolescent prevention group members influenced youth satisfaction, engagement, and endorsement of healthy behavior during group. Participants in Project Options (N = 379; 61.8% girls; Mage = 16.1; SD = 1.4), a voluntary school-based alcohol prevention program, completed measures of satisfaction at each prevention session and observers rated engagement and change talk for each group. When analyses were oriented toward girls, their personal satisfaction, group-rated satisfaction, and group-level engagement were positively related to having more girls in the group. Similarly, in boys, personal satisfaction, satisfaction of the group as a whole, and engagement in groups improved when groups were composed of more girls. Statements supportive of healthy alcohol/drug-related decision making were unrelated to group composition. The findings suggest that the composition of girls and boys in groups has differential effects on some group processes. This avenue of research has merit for understanding the mechanisms associated with satisfaction and engagement in adolescent substance use prevention programs.

Psychometric Properties of the Adolescent Reinforcement Survey Schedule-Alcohol Use Version with College Student Drinkers.

ABSTRACT Background: Behavioral economic theories of drinking posit that the reinforcing value of engaging in activities with versus without alcohol influences drinking behavior. Measures of the reinforcement value of drugs and alcohol have been used in previous research, but little work has examined the psychometric properties of these measures. Objectives: The present study aims to evaluate the factor structure, test–retest reliability, and concurrent validity of an alcohol-only version of the Adolescent Reinforcement Survey Schedule (ARSS-AUV). Methods: A sample of 157 college student drinkers completed the ARSS-AUV at two time points 2–3 days apart. Test–retest reliability, hierarchical factor analysis, and correlations with other drinking measures were examined. Results: Single, unidimensional general factors accounted for a majority of the variance in alcohol and alcohol-free reinforcement items. Residual factors emerged that typically represented alcohol or alcohol-free reinforcement while doing activities with friends, romantic or sexual partners, and family members. Individual ARSS-AUV items had fair-to-good test–retest reliability, while general and residual factors had excellent test–retest reliability. General alcohol reinforcement and alcohol reinforcement from friends and romantic partners were positively correlated with past-year alcohol consumption, heaviest drinking episode, and alcohol-related negative consequences. Alcohol-free reinforcement indices were unrelated to alcohol use or consequences. Conclusions/Importance: The ARSS-AUV appears to demonstrate good reliability and mixed concurrent validity among college student drinkers. The instrument may provide useful information about alcohol reinforcement from various activities and people and could provide clinically-relevant information for prevention and treatment programs.