Clara M. Bradizza

Factors Influencing the Temporal Relationship between Alcohol Consumption and Experiences with Aggression among College Women

The authors assessed temporal relationships among alcohol use, aggression, and mood using daily data from 179 college women. Participants called an interactive voice response system over an 8-week period. The odds of experiencing verbal, sexual, and physical aggression (odd ratios = 2.25, 19.44, and 11.84, respectively) were significantly higher on heavy drinking days (M = 7.46 drinks) compared to nondrinking days. Both a history of victimization and greater psychological symptom severity influenced the odds of involvement in verbal aggression. The odds of alcohol consumption were 3 times higher during the 24 hr following verbal aggression compared with days in which verbal aggression did not occur. On the day immediately following involvement in either verbal or physical aggression, positive mood decreased and negative mood increased. During the week (2-7 days) following sexual aggression, womens positive mood was decreased. These findings reinforce the need for interventions aimed at reducing heavy episodic drinking on college campuses.

The relationship of alexithymia to emotional dysregulation within an alcohol dependent treatment sample.

Difficulties regulating emotions have implications for the development, maintenance, and recovery from alcohol problems. One construct thought to impede the regulation of emotion is alexithymia. Alexithymia is characterized by difficulties identifying, differentiating and expressing feelings, a limited imagination and fantasy life, and an externally-oriented thinking style (e.g., prefer talking about daily activities rather than feelings). Given that poor emotion regulation skills have been found to predict posttreatment levels of alcohol use, and that several defining characteristics of alexithymia bear similarity to deficits in emotion regulation skills, it is possible that alexithymia may predict poorer alcohol treatment outcomes. Thus, the present study first examined the relationship of alexithymia to several other emotion regulation measures and then investigated the impact of alexithymia on attrition and alcohol treatment outcomes in men and women (N=77) enrolled in a 12-week cognitive-behavioral intervention for alcohol dependence. At baseline, higher scores on alexithymia were associated poorer emotion regulation skills, fewer percent days abstinent, greater alcohol dependence severity, and several high-risk drinking situations. Alexithymia was unrelated to attrition and to level of alcohol consumption at posttreatment. Overall, the construct of alexithymia is shown to be related to several theoretically-related constructs (e.g., emotion regulation, mindfulness) but demonstrated a limited relationship to drinking outcomes in those seeking treatment for alcohol dependence.

Solitary and social heavy drinking, suicidal ideation, and drinking motives in underage college drinkers

In college students, solitary heavy drinking (i.e., while alone) is associated with depression and with higher rates of drinking problems than heavy drinking in social contexts. This study explored the relationship among heavy episodic drinking context, suicidal ideation, and drinking motives among underage college drinkers (n=91) with a history of passive suicidal ideation. Participants completed measures of depression, suicidal ideation, alcohol consumption and problems, and drinking motives. Multiple regression analyses revealed that suicidal ideation, but not depression, was significantly related to solitary heavy drinking. Neither was related to social heavy drinking. Enhancement motives for drinking, but not other drinking motives (i.e., social, conformity, drinking to cope), were significantly associated with social heavy drinking. In contrast, only drinking to cope was associated with solitary heavy drinking. These findings suggest that greater suicidal ideation is associated with greater frequency of becoming intoxicated while alone, and that this drinking is motivated by attempts to cope. Solitary heavy drinking is a potentially dangerous coping strategy for an individual experiencing suicidal ideation.

Drinking to cope as a statistical mediator in the relationship between suicidal ideation and alcohol outcomes among underage college drinkers

Etiological models of alcohol use that highlight the role of negative affect and depression have not been applied to the association of suicidality and alcohol use. The authors examined whether a motivational model of alcohol use could be applied to understand the relationship between suicidal ideation and alcohol outcomes in a sample of underage college drinkers who had a history of passive suicidal ideation (n = 91). In this cross-sectional study, regression analyses were conducted to examine whether drinking to cope with negative affect statistically mediated or was an intervening variable in the association between suicidal ideation and alcohol outcomes. Results revealed that drinking to cope was a significant intervening variable in the relationships between suicidal ideation and alcohol consumption, heavy episodic drinking, and alcohol problems, even while controlling for depression. These results suggest that the relationship between suicidal ideation and alcohol outcomes may be due to individuals using alcohol to regulate or escape the distress associated with suicidal ideation. Consideration of alcohol-related models can improve the conceptualization of research on suicidality and alcohol use.

Affect regulation training (ART) for alcohol use disorders: Development of a novel intervention for negative affect drinkers

Although negative affect is a common precipitant of alcohol relapse, there are few interventions for alcohol dependence that specifically target negative affect. In this stage 1a/1b treatment development study, several affect regulation strategies (e.g., mindfulness, prolonged exposure, distress tolerance) were combined to create a new treatment supplement called affect regulation training (ART), which could be added to enhance cognitive-behavioral therapy (CBT) for alcohol dependence. A draft therapy manual was given to therapists and treatment experts before being administered to several patients who also provided input. After two rounds of manual development (stage 1a), a pilot randomized clinical trial (N=77) of alcohol-dependent outpatients who reported drinking often in negative affect situations was conducted (stage 1b). Participants received 12-weekly, 90-minute sessions of either CBT for alcohol dependence plus ART (CBT+ART) or CBT plus a healthy lifestyles control condition (CBT+HLS). Baseline, end-of-treatment, and 3- and 6-month posttreatment interviews were conducted. For both treatment conditions, participant ratings of treatment satisfaction were high, with CBT+ART rated significantly higher. Drinking outcome results indicated greater reductions in alcohol use for CBT+ART when compared to CBT+HLS, with moderate effect sizes for percent days abstinent, drinks per day, drinks per drinking day, and percent heavy drinking days. Overall, findings support further research on affect regulation interventions for negative affect drinkers.

Effects of extinction context and retrieval cues on renewal of alcohol-cue reactivity among alcohol-dependent outpatients

Pavlovian conditioning models have led to cue-exposure treatments for drug abuse. However, conditioned responding to drug stimuli can return (be renewed) following treatment. Animal research and a previous study of social drinkers indicated that extinction is highly context dependent but that renewal could be reduced by the inclusion of a cue from the extinction context. This study extends this research to a clinical sample. Alcohol-dependent outpatients (N = 143) completed an extinction trial to reduce craving and salivation responses to alcohol cues. They were then randomized to renewal tests in either the same context as extinction, a different context, the different context containing an extinction cue, or the different context with cue plus a manipulation to increase the salience of the cue. Contrary to predictions, the different context did not produce the expected renewal effect. Although the generalization of extinction effects beyond the cue-exposure context is a positive clinical finding, it is inconsistent with basic research findings on the context dependence of extinction. Possible explanations for this inconsistency are discussed.

Qualitative analysis of high-risk drug and alcohol use situations among severely mentally ill substance abusers

Situational factors have been found to influence relapse to alcohol and drug use in general samples of substance abusers. However, little research exists examining the influence of interpersonal and intrapersonal determinants in samples of individuals dually diagnosed with a severe mental illness (SMI) and a substance use disorder (SUD). This study assessed high-risk alcohol and drug use situations in dually diagnosed individuals using focus group methodology. Qualitative data analysis yielded 10 themes that encompassed 33 high-risk situations: Psychological symptoms, positive and negative affect, reminders of substance use, being around people who use drugs and alcohol, interpersonal conflict, offers of drugs or alcohol, experiencing loss, receiving money, loss of appetite, and being abstinent. These results suggest that individuals with an SMI and SUD experience a number of unique high-risk situations that differ from those reported by non-SMI substance abusers. This study provides the basis for future quantitative studies assessing the prevalence of these situations in representative samples of SMI alcohol and drug abusers. This information allows for the development of relapse assessment instruments and treatment strategies appropriate for this population.

Pretreatment changes in drinking: relationship to treatment outcomes.

Pretreatment changes in alcohol use challenges the assumption that the major portion of the change process occurs after treatment entry. Greater understanding of the behavior change process prior to treatment has the potential to improve our understanding of behavioral changes during treatment. In this study, participants (N = 45) were recruited for a clinical trial examining multiple mechanisms of change in cognitive-behavioral treatment for alcohol dependence. Using data from both baseline and end of treatment assessments, several pretreatment intervals were created (e.g., a 2-week pre-phone call interval, phone call to baseline assessment, baseline assessment to first treatment). To examine pretreatment changes in drinking, percent days abstinent and drinks per drinking day were analyzed using multilevel growth curve modeling and repeated-measures ANOVAs. Initial examination of the data revealed significant increases in percent days abstinent and decreases in drinks per drinking day during the pretreatment intervals. Follow-up analyses also suggested that the majority of change in drinking occurs between the phone call and baseline assessment. Further examination of the data revealed two distinct patterns of pretreatment change: (a) rapid changers who maintained changes during the course of treatment and (b) gradual changers who changed more gradually during the course of treatment. Analyses revealed that rapid changers had significantly higher rates of abstinence and lower drinks per drinking day at 90 days posttreatment compared with gradual changers. Overall, the data suggest that a more systematic investigation of pretreatment changes in alcohol use is warranted. Future studies may yield insights resulting in more efficient treatment delivery and adaptations to treatment based on an individuals pretreatment change status.

Relationship Between Approach and Avoidance Inclinations to Use Alcohol and Treatment Outcomes

BACKGROUND Despite growing recognition of the importance of multidimensional assessments of craving, little is known about how both approach and avoidance of alcohol inclinations change during the course of treatment, or relate to treatment outcomes. The current study examined the relationship between approach inclinations, avoidance inclinations, and treatment outcomes in individuals seeking treatment for alcohol dependence, and investigated whether changes in approach and avoidance ratings were associated with changes in drinking. METHODS Individuals (n=81) seeking treatment for alcohol dependence were randomized to receive either 12-sessions of cognitive-behavioral therapy plus healthy living skills or 12-sessions of cognitive-behavioral therapy plus affect regulation training. Participants provided pre- and post- treatment scores on various measures including drinking behaviors and approach and avoidance inclinations to use alcohol. RESULTS Results indicated that both approach and avoidance inclinations were uniquely and significantly associated with problem recognition, and that avoidance inclinations were uniquely related to taking steps to make a change in alcohol use at baseline. In addition, avoidance inclinations were positively associated with number of sessions attended with no association found for approach ratings. Finally, results suggested that changes observed in drinking outcomes (drinks/day and% days abstinent) were significantly associated with changes in approach, but not avoidance inclinations. CONCLUSIONS These findings highlight the importance of measuring both desire to consume and desire to avoid consuming alcohol simultaneously and suggest that avoidance inclinations are associated with treatment initiation and retention, and approach inclinations with positive treatment outcomes.

Young-Adult Malt Liquor Drinkers: Prediction of Alcohol Problems and Marijuana Use

Malt liquor (ML) is a cheap, high alcohol content beverage that is marketed to appeal to young adults. Findings from the few published studies of ML use suggest that it may be associated with excessive drinking, alcohol problems, and the use of illicit drugs. The authors conducted separate hierarchical multiple regressions to examine the role of ML use and psychosocial variables (e.g., personality, ML motives) in alcohol-related problems and marijuana use. Demographic characteristics served as controls. The sample consisted of 639 (456 men, 183 women) young adults (M = 22.9 years, SD = 4.2) who regularly (> or =40 oz/week) consumed ML. ML use significantly and positively predicted alcohol problems, ML-specific problems, and marijuana use, above and beyond their associations with typical alcohol use. Marijuana was the illicit drug of choice, and 46% reported concurrent use of marijuana and ML. Those who concurrently used ML and marijuana began drinking at a younger age and reported more substance use (particularly marijuana) and more alcohol-related problems than did non-concurrent users. These results suggest that ML use may represent a risk for alcohol problems and marijuana use.