Jody A. Binkoff

Smoking and treatment outcome for alcoholics: Effects on coping skills, urge to drink, and drinking rates

The interrelationship between alcohol and tobacco addiction is beginning to receive more attention because it has conceptual and practical significance for understanding and treating addictive disorders. This investigation focuses on the effects of smoking on risk for relapse after alcoholism treatment. The relationships between smoking and: (1) alcohol consumption rate and dependence at pretreatment, (2) reactions to coping with alcohol high-risk-for-relapse role plays, and (3) alcohol treatment outcome were investigated. These relationships were studied first in a sample of male VA alcoholics (n=45) and then replicated and extended in a different sample from a private hospital (n=53 females, 110 males). Smoking and drinking rate, and smoking and alcohol dependence, were significantly correlated at pretreatment. Smokers with greater dependence on cigarettes (i.e., higher Fagerstrom Tolerance Questionnaire scores; shorter latency to smoking first cigarette of the day) experienced significantly greater urge to drink, urge to smoke, difficulty, and anxiety in role plays of alcohol high-risk situations, independent of their pretreatment drinking rate or alcohol dependence. Smoking dependence did not predict mean number of drinks per day or frequency of drinking days during 6-month follow-up. In the private hospital sample, among alcoholics who drank at all during follow-up, the more dependent smokers drank more alcohol on drinking days than did the less dependent smokers. Implications for theory and treatment of addictive disorders are discussed.

Patient-treatment matching for alcoholic men in communication skills versus cognitive-behavioral mood management training

It would be helpful to be able to predict which alcoholics will be more likely to benefit from specific forms of treatment in order to optimize treatment resources. Certain hypothesized patient-treatment matching predictions were investigated with 52 alcoholics who received either communication skills training or cognitive behavioral mood management training in addition to a standard Veterans Administration inpatient alcoholism treatment program. Significant interaction effects showed that alcoholics had worse treatment outcomes in mood management training if they had higher initial anxiety or urge to drink in high-risk role plays or lower had higher initial anxiety or urge to drink in high-risk role plays or lower education. No significant interaction of treatment with irrational beliefs or marital status was found. Communication skills training seemed to be equally effective for alcoholics at any educational level, irrespective of initial coping skill, anxiety, urge to drink, alcohol dependence, or marital status. Thus, although mood management training seems to be as effective as communication skills training for alcoholics with higher education, less anxiety, and less urge to drink, communication skills training benefits a broader spectrum of patients, regardless of initial level of education, alcohol dependence, skill, anxiety, or beliefs.

Children as independent variables: Some clinical implications of child-effects

The influence that childrens behavior has on changing the behavior, cognitions, or affect of adults is an important but often overlooked factor in clinical interventions with children. Childrens behavior often plays a prominent role in maintaining patterns of adult-child interactions that are detrimental to the childs healthy psychological adjustment. Recognition of such child-effects holds important implications for improving assessment and follow-through in adult-mediated behavior change programs. This recognition also suggests that children can act as the primary change agent in certain interventions, a strategy that may serve to empower children while enhancing their perceptions of control. In general, the concept of reciprocal influence in adult-child interactions underscores the importance of the emerging concept of behavioral family therapy.