Dawn E. Sugarman

The relationship between drinking control strategies and college student alcohol use.

Interventions designed to reduce heavy drinking among college students often contain suggestions for drinking control strategies. However, little is known about the relationship between the use of these strategies and alcohol consumption. The authors developed a measure of drinking control strategies and investigated its psychometric properties in a sample of 250 college drinkers. Strategies clustered into three factors: selective avoidance of heavy drinking activities and situations, strategies used while drinking, and alternatives to drinking. These three types of strategies were independently associated with alcohol use; however, the first and last types were negatively associated with alcohol consumption, whereas the second type was positively associated with alcohol use. The findings from this study suggest that the type of strategy recommended may be important when the goal is alcohol reduction.

A Methodological Analysis of Randomized Clinical Trials of Computer-Assisted Therapies for Psychiatric Disorders: Toward Improved Standards for an Emerging Field

OBJECTIVE Computer-assisted therapies offer a novel, cost-effective strategy for providing evidence-based therapies to a broad range of individuals with psychiatric disorders. However, the extent to which the growing body of randomized trials evaluating computer-assisted therapies meets current standards of methodological rigor for evidence-based interventions is not clear. METHOD A methodological analysis of randomized clinical trials of computer-assisted therapies for adult psychiatric disorders, published between January 1990 and January 2010, was conducted. Seventy-five studies that examined computer-assisted therapies for a range of axis I disorders were evaluated using a 14-item methodological quality index. RESULTS Results indicated marked heterogeneity in study quality. No study met all 14 basic quality standards, and three met 13 criteria. Consistent weaknesses were noted in evaluation of treatment exposure and adherence, rates of follow-up assessment, and conformity to intention-to-treat principles. Studies utilizing weaker comparison conditions (e.g., wait-list controls) had poorer methodological quality scores and were more likely to report effects favoring the computer-assisted condition. CONCLUSIONS While several well-conducted studies have indicated promising results for computer-assisted therapies, this emerging field has not yet achieved a level of methodological quality equivalent to those required for other evidence-based behavioral therapies or pharmacotherapies. Adoption of more consistent standards for methodological quality in this field, with greater attention to potential adverse events, is needed before computer-assisted therapies are widely disseminated or marketed as evidence based.

Cognitive Function as an Emerging Treatment Target for Marijuana Addiction

Cannabis is the most widely used illicit substance in the world, and demand for effective treatment is increasing. However, abstinence rates following behavioral therapies have been modest, and there are no effective pharmacotherapies for the treatment of cannabis addiction. We propose a novel research agenda and a potential treatment strategy, based on observations that both acute and chronic exposure to cannabis are associated with dose-related cognitive impairments, most consistently in attention, working memory, verbal learning, and memory functions. These impairments are not completely reversible upon cessation of marijuana use, and moreover may interfere with the treatment of marijuana addiction. Therefore, targeting cognitive impairment associated with chronic marijuana use may be a promising novel strategy for the treatment of marijuana addiction. Preclinical studies suggest that medications enhancing the cholinergic transmission may attenuate cannabis-induced cognitive impairments, but these cognitive enhancing medications have not been examined in controlled human studies. Preliminary evidence from individuals addicted to other drugs suggests that computerized cognitive rehabilitation may also have utility to improve cognitive function in marijuana users. Future clinical studies optimally designed to measure cognitive function as well as drug use behavior would be needed to test the efficacy of these treatments for marijuana addiction.

Are women at greater risk? An examination of alcohol-related consequences and gender.

Men typically drink more than women; however, women achieve higher BACs (blood alcohol concentration) than men at equivalent consumption levels. This study investigated the unique effect of gender on individual alcohol problems by controlling both consumption and intoxication in a sample of 1,331 undergraduate drinkers. Gender independently influenced the risk of experiencing seven of nine negative consequences: (a) being female increased risk for tolerance, blacking out, passing out, drinking after promising not to, and getting injured; (b) being male increased risk for damaging property and going to school drunk. Gender patterns should be explored in a wider set of alcohol-related problems.

The description and evaluation of the implementation of an integrated healthcare model.

Two studies were conducted to examine the practical implementation of an integrated health care model in five primary care clinics in the Upstate New York Veterans Affairs (VA) system. The aims of the studies were: (a) to describe the basic clinical elements of the integrated health care service offered by behavioral health providers (BHPs) in the primary care setting, and (b) to evaluate the perceptions of providers and patients regarding integrated health care practices in their primary care clinics. In Study 1, we reviewed 180 electronic medical records of patients who met with a BHP in primary care. In Study 2, we used semistructured interviews and self-report questionnaires to collect information from 46 primary care providers, 12 BHPs, and 140 patients regarding their perceptions of integrated health care in their primary care clinics. Both studies illustrate a useful method for evaluating the practical implementation of integrated health care models.

Drink less or drink slower: The effects of instruction on alcohol consumption and drinking control strategy use

Brief alcohol interventions often involve recommendations to use drinking control strategies. However, little is known about the functional effect of these strategies on alcohol use. This prospective study employed an experimental design to evaluate the relationship between strategy use and alcohol consumption. The differential effects of instructions to increase the use of strategies or to reduce alcohol consumption were compared to self-monitoring (SM) only. Undergraduate drinkers were randomized into 3 conditions: SM plus strategy increase (SI; n = 61), SM plus alcohol reduction (AR; n = 60), and SM control (SM; n = 56). Participants in the AR group reduced their alcohol use over 2 weeks, while those in the SI group did not drink less. Participants in the SI group increased strategy use over time, whereas the AR group increased use of some strategies but not others. These results indicate that increasing use of drinking control strategies does not necessarily result in reduced drinking. Furthermore, all strategies are not equal in their association with alcohol consumption; if the goal is alcohol reduction, type of strategy recommended may be important.

The Relationship Between Educational Attainment and Relapse Among Alcohol-Dependent Men and Women: A Prospective Study

BACKGROUND We investigated the relationship between educational attainment and drinking outcomes after discharge from inpatient treatment for alcohol dependence. METHODS Between 1993 and 1996, we consecutively recruited 41 women and 60 men hospitalized for alcohol dependence and followed them up monthly for 1 year. We conducted structured interviews during hospitalization and at monthly intervals after discharge for 1 year. We examined the relationship between educational attainment before treatment and postdischarge drinking outcomes, including time to relapse. RESULTS After covariate adjustment, educational level was a significant predictor of drinking outcomes. CONCLUSIONS Lower levels of educational attainment before entry into treatment predicted shorter times to first drink and relapse in both women and men. The association of educational attainment and treatment outcome for alcohol dependence warrants further investigation.

A Pilot Study of Posttraumatic Stress and Associated Functioning of Army National Guard Following Exposure to Iraq Warzone Trauma

This study examines the experiences of a convenience sample of Army National Guard soldiers who were combat exposed during the Iraq War. Thirty-one men volunteered to complete an interview and ques...

Coping strategy use following computerized cognitive-behavioral therapy for substance use disorders.

Coping strategies are emerging as a predictor of treatment outcome for substance users and may be particularly important among computerized and self-change approaches. We used data from a randomized clinical trial of a computer-based version of cognitive-behavioral therapy (CBT4CBT) to: (1) examine the association between observer ratings of coping skills and self-reported coping strategies; (2) evaluate whether participants assigned to the CBT4CBT program reported greater use of coping strategies compared with those not exposed to the program; and (3) examine the differential effect of coping strategies by treatment group on drug-related outcomes. Individuals (N = 77) seeking treatment for substance dependence at a community-based outpatient substance abuse treatment facility were recruited and randomized to receive treatment-as-usual (TAU), or TAU plus CBT4CBT, with the Coping Strategies Scale administered at baseline and posttreatment. Self-reported coping strategy use was strongly correlated with observer ratings on a role-play assessment of coping skills. Although no significant group differences were found across time for coping strategy use, results suggested that as coping strategy use increased, drug use decreased, and this relationship was stronger for participants who received CBT4CBT.

Group therapy for women with substance use disorders: Results from the Women's Recovery Group Study

BACKGROUND This Stage II trial builds on a Stage I trial comparing the single-gender Womens Recovery Group (WRG) to mixed-gender Group Drug Counseling (GDC) that demonstrated preliminary support for the WRG in treating women with substance use disorders. The Stage II trial aims were to (1) investigate effectiveness of the WRG relative to GDC in a sample of women heterogeneous with respect to substance of abuse and co-occurring psychiatric disorders, and (2) demonstrate the feasibility of implementing WRG in an open-enrollment group format at two sites. METHOD In this randomized clinical trial, participants were included if they were substance dependent and had used substances within the past 60 days (n=158). Women were randomized to WRG (n=52) or GDC (n=48); men were assigned to GDC (n=58). Substance use outcomes were assessed at months 1-6 and 9. RESULTS Women in both the WRG and GDC had reductions in mean number of substance use days during treatment (12.7 vs 13.7 day reductions for WRG and GDC, respectively) and 6 months post-treatment (10.3 vs 12.7 day reductions); however, there were no significant differences between groups. CONCLUSIONS The WRG demonstrated comparable effectiveness to standard mixed-gender treatment (i.e., GDC) and is feasibly delivered in an open-group format typical of community treatment. It provides a manual-based group therapy with women-focused content that can be implemented in a variety of clinical settings for women who are heterogeneous with respect to their substance of abuse, other co-occurring psychiatric disorders, and life-stage.