Christine M. Davis

Alcohol treatment research assessment exposure: a critical review of the literature.

Alcohol treatment researchers have speculated about the benefits of research participation (e.g., research follow-up interviews functioning as aftercare) for more than 4 decades (Gallen, 1974). Alternatively, research participation can decrease study design sensitivity and hamper the interpretability of research findings. To the extent that the typical alcohol treatment trial is characterized by frequent and comprehensive data collection, accounting for potential research assessment-related effects is essential for proper interpretation of study findings. Given this background, the purpose of this article is to review the alcohol treatment research literature on assessment exposure resulting in subject reactivity. In addition, interventions that use data collection activities to inform clinical practice are receiving increased attention, and such interventions share common characteristics with research assessment-related clinical improvements. Therefore, a second purpose of this article is to compare and contrast these 2 influences of behavior change. Study findings indicate that during and posttreatment data collection activities (i.e., both research and clinical data) positively influence clinical outcomes, although there appears to be important differences in regard to the mechanisms by which these 2 data collection activities exert their influence. Understanding of mechanisms of behavior change, effect boundaries, and the conditions under which clinical improvement is most likely to occur is only at a rudimentary level.

Alcohol Use Post AUD Treatment Initiation as a Predictor of Later Functioning

Objective: To replicate and extend the earlier work of Maisto and colleagues showing an association between early post-treatment alcohol use and later functioning (123). Methods: The present study classified adults presenting for alcohol use disorders (AUD) treatment (n = 114) into one of three drinker groups (i.e., abstainer, moderate drinker, or heavy drinker) based upon alcohol use during the first 6-months following outpatient AUD treatment initiation, and examined the associations between drinker group classification and later alcohol use and psychosocial functioning. Results: Study results showed that individuals classified within the heavy drinker group tended to have the poorest outcomes (i.e., greater alcohol use and poorer psychosocial functioning) relative to individuals classified within the abstainer or moderate drinker groups. Conclusions: Study findings are consistent with the prior work of Maisto and colleagues. In addition, it appears that alcohol use, particularly heavy alcohol consumption, during the early post-treatment initiation period may serve as a marker for later alcohol related problems and poorer overall psychosocial functioning.

Variation in Mu-Opioid Receptor Gene (OPRM1) as a Moderator of Naltrexone Treatment to Reduce Heavy Drinking in a High Functioning Cohort

BACKGROUND It is well known that naltrexone, an FDA-approved medication for treatment of alcohol dependence, is effective for only a subset of individuals. Recent studies have examined the utility of a functional A118G single nucleotide polymorphism (SNP) of the mu-opioid receptor gene (OPRM1) as a predictor of naltrexone treatment response. Although the findings to date have generally been consistent with a moderating effect of the SNP, further evaluation of this hypothesis is warranted. OBJECTIVE To evaluate whether problem drinkers with one or two copies of the 118G allele respond better to naltrexone treatment. The treatment goal in this cohort of high functioning men who have sex with men (MSM) was to reduce heavy drinking, rather than to promote abstinence. METHOD 112 subjects of European ancestry from a randomized clinical trial of naltrexone and behavioral therapy for problem drinking MSM were included in the analysis. Subjects were treated for 12 weeks with 100 mg/day of oral naltrexone hydrochloride. All participants received medical management with a modified version of the Brief Behavioral Compliance Enhancement Treatment (BBCET), alone or in combination with Modified Behavioral Self-control Therapy (MBSCT). RESULTS Naltrexone-treated subjects with one or two 118G alleles had a significantly greater percentage of non-hazardous drinking (NoH) (p < 0.01) than those treated with placebo or A118 homozygotes in either medication group. CONCLUSIONS These results are consistent with a modest moderating effect of the OPRM1 118G allele on the reduction of heavy drinking by naltrexone treatment.

Dynamic modeling of behavior change

We consider a conceptual and quantitative modeling approach for investigating dynamic behavior change. While the approach is applicable to behavior change in eating disorders, smoking, substance abuse and other behavioral disorders, here we present our novel dynamical systems modeling approach to understand the processes governing an individual’s behavior in the context of problem drinking. Recent advances in technology have resulted in large intensive longitudinal data sets which are particularly well suited for study within such frameworks. However, the lack of previous work in this area (specifically, on the interand intra-personal factors governing drinking behavior of individuals) renders this a daunting and unique challenge. As a result, issues which are typically routine in mathematical modeling require considerable effort such as the determination of key quantities of interest, and the timescale on which to represent them. We discuss the construction of an initial mathematical model for two starkly distinct individuals and make a case for the potential for such efforts to help in understanding the underlying mechanisms responsible for behavior change in problem drinkers. AMS Subject Classification: 91E10, 34K29, 62G10.

Ascertaining the relationships between the trajectories of specific categories of alcohol-related negative consequences and subsequent drinking behavior.

The first year following alcohol use disorder (AUD) treatment has been identified as a period of high risk for relapse and an important timeframe for enquiry regarding alcohol-related behavior change and its maintenance. In addition, at least among individuals with AUD, alcohol use and negative consequences have been shown to be reciprocally related. A commonly used measure of alcohol-related negative consequences is the Drinker Inventory of Consequences (DrInC). Investigations of specific categories of alcohol-related negative consequences and their trajectories, however, have been lacking. Given this background, the purpose of this study was to: follow the course of the 5 DrInC categories of alcohol-related negative consequences over the first year post-AUD treatment initiation; investigate whether these trajectories varied by gender, age, and/or treatment condition; examine the relationships between these trajectories and subsequent drinking behavior; and investigate whether these relationships varied by gender, age, and/or treatment condition, via secondary data analyses. Data from the outpatient arm of Project MATCH (n = 952) were utilized. Study results revealed that the trajectory of each DrInC category was indicative of improved alcohol-related problems across the first year posttreatment initiation. Specific DrInC categories varied as a function of gender, age, and treatment condition, and the trajectories were predictive of subsequent drinking behavior. Specifically, higher intercepts during the treatment period were associated with poorer drinking behavior 1 year later. Alternatively, steeper negative slopes were associated with improved drinking behavior. Some of these relationships were modified by gender, age, and treatment condition. It was concluded that assessing alcohol-related negative consequences during the first year posttreatment initiation period has clinical utility. (PsycINFO Database Record