Helen M. Annis

A Relapse Prevention Model for Treatment of Alcoholics

One of the few areas of consensus in the alcoholism treatment field involves the recognition that alcoholism is a chronic condition with a high risk of relapse. Treatment outcome studies have reported rates of 80% or more by 6 months posttreatment discharge (Armor, Polich, & Stambul, 1978; Gottheil, Thornton, Skolada, & Alterman, 1979), and drinking outcomes of individual clients have been found to be highly unstable over time (Annis & Ogborne, 1983; Finney, Moos, & Newborn, 1980, Litman, Eiser, & Taylor, 1979). It is not surprising, therefore, that, increasingly, relapse is being recognized as an important phenomenon for study.

CROSS-CULTURAL EVALUATION OF TWO DRINKING ASSESSMENT INSTRUMENTS: ALCOHOL TIMELINE FOLLOWBACK AND INVENTORY OF DRINKING SITUATIONS

This article describes the psychometric characteristics of two major assessment instruments used in a World Health Organization (WHO) clinical trial: (a) Alcohol Timeline Followback (TLFB, which assesses daily drinking patterns), and (b) Inventory of Drinking Situations (IDS, which assesses antecedents to “heavy” drinking). Clients (N=308) were outpatient alcohol abusers from four countries (Australia, Canada, Mexico, and Sweden). Generally, the Alcohol TLFB and IDS were shown to be reliable and valid with outpatient alcohol abusers in four countries, and in three languages. These results suggest that the Alcohol TLFB and the IDS can be used in clinical and research settings with Swedish-, Spanish-, and English-speaking alcohol abusers.

Gender in relation to relapse crisis situations, coping, and outcome among treated alcoholics

Relapse crisis situations resulting in successful coping (i.e., abstinence) and unsuccessful coping (i.e., relapse) were examined in 90 male and 35 female alcohol clients over the first 12 weeks following treatment discharge. More similarities than differences were observed between the genders in the relapse crisis situations encountered, the number and type of coping strategies used, and the drinking outcome results. A similar proportion of males and females successfully abstained in the first 12 weeks posttreatment; a combination of cognitive and behavioral coping was most frequently used by both genders, and negative emotional states constituted the most commonly reported relapse crisis situation. Survival of a relapse crisis was strongly associated with the number of coping strategies used by both men and women. There was a nonsignificant trend for females to relapse more frequently in negative affect situations (i.e., negative emotions, conflict with others) and males in the presence of other drinkers. Further studies employing larger sample sizes are needed to examine gender differences in the process of relapse.

Development of a Scale to measure outcome expectancy in alcoholics

Self-efficacy theory postulates that altering expectation of personal mastery is the major cognitive process involved in behavior change. Two classes of expectancy are discussed: (a) efficacy expectancy: the belief or confidence one has in being able to successfully perform a specific behavior, and (b) outcome expectancy: the belief one has about the consequences that will follow successful performance. Application of the theory to relapse prevention in alcoholism has addressed the role of efficacy expectancy but not outcome expectancy, the focus of this study. A 34-item scale was developed to measure outcome expectancy in alcoholics, with outcome expectancy defined as the consequences anticipated subsequent to a change in drinking behavior. The scale, consisting of both a strength and a valence component, was administered to 204 male patients admitted to two alcoholism treatment centers. Factor analysis yielded two subscales: the BENEFITS Scale (21 items), a measure of the advantages expected should a change in drinking behavior occur, and the COSTS Scale (13 items), a measure of disadvantages expected should a change in drinking behavior occur. Evidence for reliability and construct validity is presented. Future research and clinical uses of the scale are discussed.

Drinking-Related Assessment Instruments: Cross-Cultural Studies

In recent years a number of drinking-related assessment instruments have undergone extensive developmental work and are in widespread use. These include measures that are designed to assess: 1) patterns of alcohol consumption. Timeline Followback Method (TLFB); and 2) antecedents to alcohol use, Inventory of Drinking Situations (IDS)-two constructs that would be expected to be sensitive to cross-cultural variability in drinking practices. These assessment tools present opportunities for the study of cross-cultural differences in drinking patterns and the circumstances under which drinking occurs. A World Health Organization project utilizing these assessment tools is currently underway in five countries (Australia, Canada, Mexico, Poland, and Sweden). This project focuses on the identification of profile differ.

Further tests of a meta-model of youthful marijuana use

Abstract This paper tests a meta-model of youthful marijuana use on students in Grades 11, 12 and 13. Although the specific models for each grade varied in detail, all followed a meta-model making the following assumptions: (1) that use or nonuse of marijuana depends primarily on attitude towards use; (2) that attitude largely reflects the perceived functional and dysfunctional consequences of use; and (3) that what people perceive as functional or dysfunctional depends on relevant personality characteristics. All three models showed satisfactory goodness-of-fit in terms of nonsignificant overidentification tests (minimum P > 0.25) and small discrepancies between observed correlations and the corresponding theoretically implied correlations. A notable feature of the Grade 13 data in contrast to those for Grade 12 and previously reported findings was the seeming unimportance of the perceived value of marijuana use for gaining acceptance from peers. It was suggested that this might reflect the selective survival into Grade 13 in the sampled community of more independently-oriented students.

Maturational Changes in Canadian Adolescents' Cognitive Attitudinal Structure Concerning Marijuana

Thirty-four items concerning marijuana use were administered three times to a cohort of Canadian high school students between Grades 11 and 13, in 1977 (n = 439), 1978 (n = 419), and 1979 (n = 167). These items were designed to measure four distinct constructs: attitude, perceived peer approval or disapproval, concern about risks, and symbolic protest against conventional society. A cross-sectional factor analysis of the Grade 13 data supported the hypothesized factor structure, as had earlier work with college students. However, analogous analyses on the Grade 11 and Grade 12 data contradicted the hypothesized factor structure. Most notably, separate factors for positive and negative attitude appeared in the Grade 11 and 12 analyses. The data were interpreted primarily in terms of maturational changes, largely through elimination of alternative interpretations by internal analyses and previous findings. Implications were discussed for adolescent cognitive-attitudinal development, attitude theory, and analysis of panel data.