Cherry Lowman

A Developmental Perspective on Alcohol and Youths 16 to 20 Years of Age

Late adolescence (ie, 16–20 years of age) is a period characterized by escalation of drinking and alcohol use problems for many and by the onset of an alcohol use disorder for some. This heightened period of vulnerability is a joint consequence of the continuity of risk from earlier developmental stages and the unique neurologic, cognitive, and social changes that occur in late adolescence. We review the normative neurologic, cognitive, and social changes that typically occur in late adolescence, and we discuss the evidence for the impact of these transitions on individual drinking trajectories. We also describe evidence linking alcohol abuse in late adolescence with neurologic damage and social impairments, and we discuss whether these are the bases for the association of adolescent drinking with increased risks of mental health, substance abuse, and social problems in adulthood. Finally, we discuss both the challenges and successes in the treatment and prevention of adolescent drinking problems.

Craving research: future directions

Many prospective clinical studies have concluded that craving does not reliably predict relapse and that the concept is of little or no clinical utility. Contrary to earlier more simplistic clinical models of addiction, more recent models do not require that craving be present for relapse to occur. New approaches to study human craving may enhance its predictive validity and yield more knowledge of its nature, course, behavioural sequelae and regulatory function in alcohol/drug consumption. These approaches include empirical research that focuses on: (1) the elucidation of the domains of craving (i.e. subjective experience, physiological responses, behavioural sequelae and their inter-relationships); (2) the temporal dynamics of craving (i.e. its course over minutes or days, as well as its natural history over the course of a drinking career); (3) the factors that may mediate/moderate/determine the development and resolution of craving; (4) studies of the predictive validity of craving measures; and (5) the development of valid methods of measuring the different domains of craving. The conclusions are that future craving research should: (1) incorporate more sophisticated general theories of behaviour (conditioning, cognitive social learning, neurobiological, and genetic); (2) apply more sophisticated and standardized measurement methods and experimental paradigms, including studies in which alcohol is made available to human subjects; and (3) effective development of new pharmacological and behavioural therapies for relapse prevention depend on greater understanding of the nature and measurement of craving.

Promising Themes in Alcoholism Treatment Research

The past 10 years have witnessed dramatic growth in alcoholism research. In particular, attention has been focused intensely on techniques that diagnose and treat alcoholism more effectively. The evolution and expansion of this important area is reflected by the fact that in 1990, the National Institute on Alcohol Abuse and Alcoholism, the major funding source for alcoholism research in the world, expended over

Substance abuse treatment services: An introduction

22 million on investigations primarily oriented toward treatment issues, whereas the comparable figure a decade earlier was below

Replication and extension of Marlatt's taxonomy of relapse precipitants: Overview of procedures and results

2 million. In light of the magnitude as well as the economic and personal cost of alcoholism, public support for research on treatment is likely to be sustained and, in fact, strengthened in the future.

Research perspectives on alcohol craving: an overview

Health services for the treatment of alcohol and drug abuse, never static, today are in a new phase of formative flux. Evidenced by the papers in this Special Issue of the Journal of Mental Health Administration, innovation is the watchword as treatment services respond to pressures for both greater treatment effectiveness and greater cost-effectiveness. Providers, researchers, and administrators alike are looking for new answers to the question of what works, for whom, and at what cost. Three major trends can be seen emerging: (1) more application of automated management information systems (MIS), (2) more emphasis on improving the fit between treatment and the treated, and (3) more pressure for cost-effective approaches.