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Aims - To estimate the magnitude of cannabis cue–reactivity responses in people who regularly use cannabis. Methods - EMBASE, PUBMED, PsycINFO, PsycEXTRA and Project CORK were searched for within-subject comparison studies published between January 2000 and December 2014. Eligible studies compared regular cannabis users' subjective craving or psychophysiological responding when exposed to cannabis cues to their responses to neutral cues and/or to their responses during a baseline assessment. Eligible studies presented original data and were written in English. Fourteen studies met inclusion criteria, but data were not available for two. The 12 included studies contained 393 participants (12–97 participants per study; mean age range: 16.4–32.6 years). Standardized effects sizes were computed for heart rate, skin conductance, skin temperature, blood pressure, event-related potentials (Pz P300) and self-reported craving (Visual Analogue Scales and Marijuana Craving Questionnaire) and synthesized using a multivariate meta-regression model. Results - On average, cannabis users experienced moderate cue–reactivity, as determined by comparisons with baseline conditions [d = 0.59, 95% confidence interval (CI) = 0.43, 0.74, P < 0.001] and with neutral cue comparisons (d = 0.47, 95% CI = 0.32, 0.62, P < 0.001). This model, which excluded studies at a greater than low risk of bias and included PzP300 studies as a moderator (due to having larger effect sizes), had a moderately low level of heterogeneity of effect size (I2 = 45.6%, Q = 56.97, P = 0.003) and showed no evidence of publication bias. Cue–reactivity was most noticeable (large effect size) when assessed by Pz P300 waves (d = 1.71, 95% CI = 0.77, 2.64, P = 0.0003; I2 = 86%, Q = 36.30, P < 0.001) and least noticeable (trivial effect size) when examining heart rate (d = 0.14, 95% CI = −0.34, 0.62, P = 0.58; I2 = 80%, Q = 20.0, P < 0.001). These subgroup models demonstrated high heterogeneity of effect size. Conclusions - Regular cannabis users experience moderate to extremely intense cue–reactivity, such that their attentional biases towards cannabis cues are much stronger than their perceptions of craving for the drug.

Background and Aims Research into craving is hampered by lack of theoretical specification and a plethora of substance-specific measures. This study aimed to develop a generic measure of craving based on elaborated intrusion (EI) theory. Confirmatory factor analysis (CFA) examined whether a generic measure replicated the three-factor structure of the Alcohol Craving Experience (ACE) scale over different consummatory targets and time-frames. Design Twelve studies were pooled for CFA. Targets included alcohol, cigarettes, chocolate and food. Focal periods varied from the present moment to the previous week. Separate analyses were conducted for strength and frequency forms. Setting Nine studies included university students, with single studies drawn from an internet survey, a community sample of smokers and alcohol-dependent out-patients. Participants A heterogeneous sample of 1230 participants. Measurements Adaptations of the ACE questionnaire. Findings Both craving strength [comparative fit indices (CFI = 0.974; root mean square error of approximation (RMSEA) = 0.039, 95% confidence interval (CI) = 0.035–0.044] and frequency (CFI = 0.971, RMSEA = 0.049, 95% CI = 0.044–0.055) gave an acceptable three-factor solution across desired targets that mapped onto the structure of the original ACE (intensity, imagery, intrusiveness), after removing an item, re-allocating another and taking intercorrelated error terms into account. Similar structures were obtained across time-frames and targets. Preliminary validity data on the resulting 10-item Craving Experience Questionnaire (CEQ) for cigarettes and alcohol were strong. Conclusions The Craving Experience Questionnaire (CEQ) is a brief, conceptually grounded and psychometrically sound measure of desires. It demonstrates a consistent factor structure across a range of consummatory targets in both laboratory and clinical contexts.

Aims Alcohol use disorders and depression co-occur frequently and are associated with poorer outcomes than when either condition occurs alone. The present study (Depression and Alcohol Integrated and Single-focused Interventions; DAISI) aimed to compare the effectiveness of brief intervention, single-focused and integrated psychological interventions for treatment of coexisting depression and alcohol use problems. Methods Participants (n = 284) with current depressive symptoms and hazardous alcohol use were assessed and randomly allocated to one of four individually delivered interventions: (i) a brief intervention only (single 90-minute session) with an integrated focus on depression and alcohol, or followed by a further nine 1-hour sessions with (ii) an alcohol focus; (iii) a depression focus; or (iv) an integrated focus. Follow-up assessments occurred 18 weeks after baseline. Results Compared with the brief intervention, 10 sessions were associated with greater reductions in average drinks per week, average drinking days per week and maximum consumption on 1 day. No difference in duration of treatment was found for depression outcomes. Compared with single-focused interventions, integrated treatment was associated with a greater reduction in drinking days and level of depression. For men, the alcohol-focused rather than depression-focused intervention was associated with a greater reduction in average drinks per day and drinks per week and an increased level of general functioning. Women showed greater improvements on each of these variables when they received depression-focused rather than alcohol-focused treatment. Conclusions Integrated treatment may be superior to single-focused treatment for coexisting depression and alcohol problems, at least in the short term. Gender differences between single-focused depression and alcohol treatments warrant further study. Language: en

Aims To assess the effectiveness of current treatment approaches to assist benzodiazepine discontinuation. Methods A systematic review of approaches to benzodiazepine discontinuation in general practice and out-patient settings was undertaken. Routine care was compared with three treatment approaches: brief interventions, gradual dose reduction (GDR) and psychological interventions. GDR was compared with GDR plus psychological interventions or substitutive pharmacotherapies. Results Inclusion criteria were met by 24 studies, and a further eight were identified by future search. GDR [odds ratio (OR) = 5.96, confidence interval (CI) = 2.08–17.11] and brief interventions (OR = 4.37, CI = 2.28–8.40) provided superior cessation rates at post-treatment to routine care. Psychological treatment plus GDR were superior to both routine care (OR = 3.38, CI = 1.86–6.12) and GDR alone (OR = 1.82, CI = 1.25–2.67). However, substitutive pharmacotherapies did not add to the impact of GDR (OR = 1.30, CI = 0.97–1.73), and abrupt substitution of benzodiazepines by other pharmacotherapy was less effective than GDR alone (OR = 0.30, CI = 0.14–0.64). Few studies on any technique had significantly greater benzodiazepine discontinuation than controls at follow-up. Conclusions Providing an intervention is more effective than routine care. Psychological interventions may improve discontinuation above GDR alone. While some substitutive pharmacotherapies may have promise, current evidence is insufficient to support their use.

Objective: To determine the reliability and validity of the Severityof Dependence Scale (SDS) for detecting cannabis dependencerelative to other predictor variables in a large sample of inpatientswith a psychotic disorder.Methodology: Participants were 153 inpatients with a currentpsychotic disorder in Brisbane, Australia. They were administeredthe SDS for a cannabis use in the past 12 months. Presence ofcurrent cannabis dependence in the past 12 months was assessedusing the Comprehensive International Diagnostic Interview(CIDI).Results: Approximately 54.2% of inpatients met criteria for DSMIVcannabis dependence in the past 12 months. The SDS had highlevels of internal consistency, construct validity and concurrentvalidity with a current DSM-IV cannabis dependence. Individualswith a positive screen on the SDS were nearly 30 times more likelyto have current cannabis dependence, and remained the strongestpredictor of cannabis dependence after controlling for otherpredictor variables.Conclusions: The SDS is a valid and reliable screen for cannabisdependence amongst inpatients with a psychotic disorder and isrecommended as a brief, easy to administer screening tool in thispopulation.

Aim To test whether addition of moderation-orientated cue exposure (CE) or CE after dysphoric mood induction ( emotional CE, ECE) improved outcomes above those from cognitive-behaviour therapy alone (CBT) in people who drank when dysphoric. Design Multi-site randomized controlled trial comparing CBT with CBT + CE and CBT + ECE. Setting Out-patient rooms in academic treatment units in Brisbane and Sydney, Australia. Participants People with alcohol misuse and problems controlling consumption when dysphoric (n = 163). Those with current major depressive episode were excluded. Intervention Eight weekly 75-minute sessions of individual treatment for alcohol problems were given to all participants, with CBT elements held constant across conditions. From session 2, CBT + CE participants resisted drinking while exposed to alcohol cues, with two priming doses of their preferred beverage being given in some sessions. After an initial CE session, CBT + ECE participants recalled negative experiences before undertaking CE, to provide exposure to emotional cues of personal relevance. Measurements Alcohol consumption, related problems, alcohol expectancies, self-efficacy and depression. Results Average improvements were highly significant across conditions, with acceptable maintenance of effects over 12 months. Both treatment retention and effects on alcohol consumption were progressively weaker in CBT + CE and CBT + ECE than in CBT alone. Changes in alcohol dependence and depression did not differ across conditions. Conclusions These data do not indicate that addition of clinic-based CE to standard CBT improves outcomes. A different approach to the management of craving may be required.

Identification of people who will benefit most from brief interventions is an important research challenge in the study of addictive disorders. The current study investigated predictors of response to correspondence interventions for alcohol abuse. We examined both subject retention and alcohol intake over a 12-month period. The primary focus was on the predictive utility of self-efficacy, stages of change and alcohol dependence. Self-efficacy performed relatively well in the study, predicting both retention and later consumption. When predicting 12-month consumption from pretest assessments or examining subject retention over the last 6 months, self-efficacy offered a significant contribution to multivariate analyses. However, in some other predictions a significant effect of self-efficacy was eliminated after the entry of other variables. Stages of change significantly predicted mid-way through treatment, but did not provide an independent prediction of overall retention or treatment response. Neither the degree of alcohol dependence nor level of alcohol problems figured in any of the predictions. Older subjects stayed longer in the study, and those with lower intake and higher pretest self-efficacy had the lowest consumption at 12 months. Results are compared with previous research on prediction of outcomes in addictive disorders.

Recognizing the need to offer alternative methods of brief interventions, this study developed correspondence treatments for low-dependent problem drinkers and evaluated their impact. One hundred and twenty-one problem drinkers were recruited by media advertisements and were randomly allocated to a full cognitive-behavioural treatment programme (CBT) or to a minimal intervention condition (MI) that gave information regarding alcohol misuse and instructions to record drinking++. As predicted, CBT was more effective than MI in reducing alcohol consumption over the 4-month controlled trial period. CBT produced a 50% fall in consumption, bringing the average intake of subjects within recommended maximum levels. Treatment gains at 6 months were well maintained to 12 months. High levels of consumer satisfaction, a high representation of women and a substantial participation from isolated rural areas attested to the feasibility of the correspondence programme as an alternative treatment. However, some drinking occasions still involved high intake for a significant subgroup of subjects, and this issue will be addressed in future programmes. The results supported the use of correspondence delivery as a means of promoting early engagement and equity of access between city and country areas.

McCambridge & Rollnick [1] argue that increased benefits from brief motivational interventions (MIs) for alcohol abuse may be obtained if they addressed patients’ con- cerns more directly, especially in severe dependence and primary care. We agree, but take the idea a step further. Recent research on comorbidity has illustrated the power of simultaneously addressing multiple issues in an integrated manner, especially when these changes have synergistic effects (as typically occurs with psycho- sis and substance use [2]). Integrated MI for comorbidity can even be used productively in a single-session format [3]. This idea may have wider application. Recent work in remote Indigenous Australian communities has highlighted the benefits of a broad-ranging discussion of key relationships, activities and resources that confer strength, as well as aspects that worry them or cause dissatisfaction [4]. If excessive drinking is present, its impact on other life areas is reviewed, as in standard MI. However, it is considered alongside other highly valued goals. While the approach has demonstrated effects on both alcohol use and mental health [5], its impact is restricted only by the range of goals that are selected...