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Background: Post hoc analyses of 2 randomized controlled trials suggest naltrexone may reduce alcohol use and improve smoking cessation outcomes among heavy drinkers receiving smoking cessation treatment. However, no studies have been conducted specifically to examine naltrexone for this purpose or to test whether naltrexone has benefit when added to smoking cessation counseling that explicitly addresses heavy drinking., Methods: We recruited heavy-drinking smokers from the community and randomized them to receive 10 weeks of either (i) 50 mg naltrexone (n = 75) or (ii) placebo (n = 75) daily. Participants received 6 weeks of transdermal nicotine patch and 6 sessions of counseling that addressed both heavy drinking and smoking. Participants were followed for 26 weeks after their target quit smoking date., Results: Across medication conditions, there were substantial reductions at follow-up in percent heavy drinking days (primary outcome) and average drinks per week (secondary outcome). However, participants receiving naltrexone did not differ significantly from those receiving placebo on percent heavy drinking days (effect size d = -0.04, 95% CI [-0.30, 0.22], p = 0.76) or average drinks per week (d = -0.09, 95% CI [-0.35, 0.18], p = 0.54) during follow-up. Naltrexone compared to placebo was not associated with a significant increase in smoking abstinence rates during follow-up, odds ratio = 0.93, 95% CI [0.46, 1.86], p = 0.83. The effect of naltrexone on these outcomes was not significantly moderated by current alcohol dependence or gender., Conclusions: Results indicate that heavy-drinking smokers, including those with current alcohol dependence, can make substantial reductions in drinking in the context of smoking cessation treatment. However, this study provided no evidence that naltrexone is efficacious for enhancing reductions in drinking or improving smoking cessation in this population. Limitations of this study included lower-than-desired sample size and modest adherence to study medication., (Copyright © 2017 by the Research Society on Alcoholism.)

Objective: Worldwide, alcohol is the most commonly used psychoactive substance. However, heterogeneity among alcohol users has been widely recognized. This paper presents a typology of alcohol users based on an implementation of idiographic methodology to examine longitudinal daily and cyclic (weekly) patterns of alcohol use at the individual level., Method: A secondary data analysis was performed on the pre-intervention data from a large randomized control trial. A time series analysis was performed at the individual level, and a dynamic cluster analysis was employed to identify homogenous longitudinal patterns of drinking behavior at the group level. The analysis employed 180 daily observations of alcohol use in a sample of 177 alcohol users., Results: The first order autocorrelations ranged from -.76 to .72, and seventh order autocorrelations ranged from -.27 to .79. Eight distinct profiles of alcohol users were identified, each characterized by a unique configuration of first and seventh autoregressive terms and longitudinal trajectories of alcohol use. External validity of the profiles confirmed the theoretical relevance of different patterns of alcohol use. Significant differences among the eight subtypes were found on gender, marital status, frequency of drug use, lifetime alcohol dependence, family history of alcohol use and the Short Index of Problems., Conclusions: Our findings demonstrate that individuals can have very different temporal patterns of drinking behavior. The daily and cyclic patterns of alcohol use may be important for designing tailored interventions for problem drinkers., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Aims: The efficacy of batterer intervention programs to reduce intimate partner violence (IPV) is questionable, with individuals with alcohol problems particularly unlikely to benefit. We examined whether adding adjunctive alcohol intervention to batterer intervention reduced the likelihood of substance use and violence relative to batterer intervention alone., Design: Randomized clinical trial., Setting: Batterer intervention programs in Rhode Island, USA., Participants: A total of 252 hazardous drinking men in batterer intervention programs. Participants were randomized to receive 40 hours of standard batterer program (SBP) or the SBP plus a 90-minute alcohol intervention (SBP + BAI). None withdrew due to adverse effects. Data were collected at baseline, 3-, 6- and 12-month follow-up, with follow-up rates of 95, 89 and 82%, respectively., Measurements: Substance use was measured with a well-validated calendar-assisted interview. Violence was measured with a validated questionnaire. Arrest records were obtained for all participants. The primary substance use outcome was drinks per drinking day (DPDD) and the primary violence outcome was frequency of any physical IPV., Findings: Relative to SBP alone, men receiving SBP + BAI reported consuming fewer DPDD at 3-month follow-up [B = -1.36, 95% confidence interval (CI): -2.65, -0.04, P = 0.04] but not 6- or 12-month follow-up. In secondary analyses, men receiving SBP + BAI reported significantly greater abstinence at 3- (B = 0.09, 95% CI: 0.03, 0.14, P = 0.002) and 6-month (B = 0.06, 95% CI: 0.01, 0.11, P = 0.01) follow-up but not 12-month follow-up. There were no significant differences in physical IPV between men receiving SBP and men receiving SBP + BAI. In secondary analyses, men receiving SBP + BAI reported less severe physical aggression at 3-month (IRR = 0.18, 95% CI: 0.05, 0.65, P = 0.009) but not 6- or 12-month follow-up. Men receiving SBP + BAI reported less severe psychological aggression (B = -1.24, 95% CI: -2.47, -0.02, P = 0.04) and fewer injuries to partners at 3- and 6-month follow-up (IRR = 0.33, 95% CI: 0.12, 0.92, P = 0.03), with differences fading by 12 months., Conclusions: Men with a history of intimate partner violence and hazardous drinking who received a batterer intervention plus an alcohol intervention showed improved alcohol and violence outcomes initially, but improvements faded by 12 months., (© 2013 The Authors, Addiction © 2013 Society for the Study of Addiction.)

It is well known that diabetes self-care behaviors are critical to disease progression. Unfortunately, many patients do not adhere to diabetes self-care recommendations despite their importance. Alcohol use has been identified as a barrier to diabetes self-care adherence. Excessive alcohol consumption not only negatively impacts diabetes self-care adherence but also affects the course of diabetes. Diabetes patients who are at-risk drinkers are likely to have poor diabetes treatment adherence, leading to increased morbidity and mortality. Alcohol consumption by diabetes patients is often inadequately assessed and addressed in their medical care. Brief interventions to reduce at-risk drinking have been well validated in a variety of patient populations and offer the potential to improve diabetes treatment adherence and outcome. Assessment and treatment of at-risk drinking could be readily incorporated into routine diabetes care. Strategies for brief assessment of and intervention for at-risk drinking are offered.

We tested the psychometric properties and predictive validity of a newly developed 8-item measure of commitment to quitting smoking, conceptualized as the state of being personally bound or obligated to persist in quitting smoking despite potential difficulties, craving and discomfort. Participants were 157 heavy drinking smokers enrolled in a clinical trial of smoking cessation treatments. The measure showed strong unidimensionality, good internal consistency, and moderate stability from baseline to quit date. Commitment significantly increased from baseline to quit date. Higher commitment to quitting at baseline predicted greater odds of abstinence at post-treatment and 16 and 26 weeks after quit date. Commitment predicted smoking outcome over and above level of tobacco dependence, self-reported importance of quitting smoking, and self-efficacy for remaining abstinent. Results suggest that commitment is a highly relevant construct for smoking cessation, which can be reliably assessed with the Commitment to Quitting Smoking Scale and which may be an excellent target for smoking cessation treatments.

Objective: Research has shown that women who perpetrate partner violence or are victims of partner violence are more likely than comparison groups to have alcohol problems. The present study represents the largest sample collected to date of women arrested for domestic violence and court referred to batterer intervention programs. The aim of this study is to compare hazardous and nonhazardous drinking women on violence perpetration and victimization and to examine whether group differences in these variables are attributable to women's drinking, their general propensity for violence, their partners' drinking, or a combination of these factors., Methods: We recruited 103 women who were arrested for domestic violence and divided the sample into groups of hazardous drinkers (HD) and nonhazardous drinkers (NHD). We administered multiple measures of substance use and problems and assessed the women's relationship aggression, use of general violence and their relationship partners' substance use., Results: Relative to the NHD group, the HD group scored higher on violence perpetration (physical assault, psychological abuse, sexual abuse, injuries) and violence victimization (physical assault). In addition, the HD group scored higher than the NHD group on general violence perpetration and partner alcohol and drug problems. Results from regression analyses indicated that women's drinking, women's general violence, and partner drinking all contributed to some form of violence perpetration or victimization; women's hazardous drinking group status was particularly important in the prediction of physical assault perpetration and victimization., Conclusions: The results of the study suggest that substance use and problems should be assessed routinely as part of violence intervention programs for women and that intervention programs would be improved by offering adjunct or integrated alcohol treatment.

Interventions targeting physical activity may be valuable as an adjunct to alcohol treatment, but have been relatively untested. In the current study, alcohol dependent, physically sedentary patients were randomized to: a 12-week moderate-intensity, group aerobic exercise intervention (AE; n=25) or a brief advice to exercise intervention (BA-E; n=23). Results showed that individuals in AE reported significantly fewer drinking and heavy drinking days, relative to BA-E during treatment. Furthermore adherence to AE strengthened the beneficial effect of intervention on alcohol use outcomes. While high levels of moderate-intensity exercise appeared to facilitate alcohol recovery regardless of intervention arm, attending the group-based AE intervention seemed to further enhance the positive effects of exercise on alcohol use. Study findings indicate that a moderate intensity, group aerobic exercise intervention is an efficacious adjunct to alcohol treatment. Improving adherence to the intervention may enhance its beneficial effects on alcohol use.

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Objective: There is a paucity of research on the temporal association between substance use and intimate partner violence (IPV) perpetration and victimization, especially among women arrested for domestic violence. The current study examined whether the probability of IPV perpetration and victimization increases following alcohol or drug use relative to days of no use among women arrested for domestic violence. Method: Women arrested for domestic violence and court referred to batterer intervention programs who met criteria for hazardous drinking participated in the current study (N = 105). Women who reported drinking 4 or more drinks on 1 occasion at least once per month for the past 6 months were considered hazardous drinkers. Violence and substance use were assessed with the Timeline Followback Interviews for substance use and IPV. Results: Women were more likely to perpetrate physical violence on a drinking day (OR = 10.58; 95% CI [5.38, 20.79]) and on a heavy drinking day (OR = 12.81; 95% CI [8.10, 33.57]), relative to a nondrinking day. Women were more likely to be victimized by physical violence on a drinking day (OR = 5.22; 95% CI [2.79, 9.77]) and on a heavy drinking day (OR = 6.16; 95% CI [3.25, 11.68]), relative to a nondrinking day. They were more likely to be victims of sexual coercion (OR = 6.06; 95% CI [1.19, 30.80]) on a cocaine use day relative to a nonuse day. Conclusions: Alcohol use was temporally associated with physical violence perpetration and victimization, and cocaine use was temporally associated with sexual coercion victimization, suggesting that substance use should be targeted in batterer intervention programs for women. [ABSTRACT FROM AUTHOR]

Diabetes Mellitus is a serious chronic disease, affecting an increasing number of individuals worldwide. Adherence to diabetes self-care behaviors is key to the successful management of the disease. At-risk drinking is common among diabetic patients and is associated with inferior diabetes treatment adherence and outcomes, resulting in increased mortality and morbidity. Furthermore, individuals with diabetes who engage in at-risk drinking are also in danger of incurring the negative consequences of at-risk drinking found in the general population. Research suggests that alcohol use screening and intervention do not commonly occur during the course of primary care treatment for diabetes. While methods for reducing alcohol use in this population have been largely unexplored to date, brief interventions to reduce at-risk drinking have been well-validated in other patient populations and offer the promise to reduce at-risk drinking among diabetic patients, resulting in improved diabetes treatment adherence and outcomes. [ABSTRACT FROM AUTHOR]

Heavy alcohol use frequently co-occurs with cigarette smoking and may impede smoking cessation. This clinical trial examined whether smoking cessation treatment that incorporates brief alcohol intervention can improve smoking cessation outcomes (7-day verified point prevalence abstinence) and reduce drinks consumed per week. Heavy drinkers seeking smoking cessation treatment were assigned by urn randomization to receive, along with 8 weeks of nicotine replacement therapy, either a 4-session standard smoking cessation treatment (ST, n = 119) or standard treatment of equal intensity that incorporated brief alcohol intervention (ST-BI, n = 117). Across follow-ups over 26 weeks, participants in ST-BI reported approximately 20% fewer drinks per week (p < .027) and greater smoking abstinence (adjusted odds ratio = 1.56; 95% confidence interval = 1.01, 2.43) than did those in ST; however, effects on smoking were primarily evident at 2 weeks after quit date and were essentially absent by 16 weeks. The effect of ST-BI on smoking outcome was most robust among moderately heavy drinkers compared with that on very heavy drinkers. Integrating brief alcohol intervention into smoking cessation treatment appears feasible, but further development is needed to yield lasting effects on smoking. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether training primary care clinicians in maintenance care for patients who have changed their drinking influences practice behavior.Design: We randomized 15 physician and 3 mid-level clinicians in 2 primary care offices in a 2:1 design. The 12 intervention clinicians received a total of 2 (1/4) hours of training in the maintenance care of alcohol problems in remission, a booster session, study materials and chart-based prompts at eligible patients' visits. Six controls provided usual care. Screening forms in the waiting rooms identified eligible patients, defined as those who endorsed: 1 or more items on the CAGE questionnaire or that they had an alcohol problem in the past; that they have "made a change in their drinking and are trying to keep it that way"; and that they drank <15 (men) or <10 (women) drinks per week in the past month. Exit interviews with patients evaluated the clinician's actions during the visit.Results: Of the 164 patients, 62% saw intervention clinicians. Compared with patients of control clinicians, intervention patients were more likely to report that their clinician asked about their alcohol history (odds ratio, 2.8; 95% confidence interval, 1.3, 5.8). Intervention clinicians who asked about the alcohol history were more likely to assess prior and planned alcohol treatment, assist through offers for prescriptions and treatment referral, and receive higher satisfaction ratings for the visit.Conclusions: Systemic prompts and training in the maintenance care of alcohol use disorders in remission might increase primary care clinicians' inquiries about the alcohol history as well as appropriate assessment and intervention after an initial inquiry. [ABSTRACT FROM AUTHOR]

Presents a study that assessed the impact of an intensive, individually based, partial hospitalization treatment for alcohol dependence on alcohol use, marital violence, psychological abuse and marital satisfaction among male patients and their partners in the U.S. Background on the efforts of the U.S. Department of Health and Human Services to reduce domestic violence; Chronic and acute health problems caused by marital violence; Limitations of the study.

Presents information on the treatment of comorbid alcoholism and depression in a patient in the United States. Impact of depression on alcohol treatment outcome; Efficacy of antidepressants in the treatment of depressed alcoholics; Use of cognitive-behavioral treatment; Discussion on a case study.

Objective: Research has shown that women who perpetrate partner violence or are victims of partner violence are more likely than comparison groups to have alcohol problems. The present study represents the largest sample collected to date of women arrested for domestic violence and court referred to batterer intervention programs. The aim of this study is to compare hazardous and nonhazardous drinking women on violence perpetration and victimization and to examine whether group differences in these variables are attributable to women's drinking, their general propensity for violence, their partners' drinking, or a combination of these factors. Method: We recruited 103 women who were arrested for domestic violence and divided the sample into groups of hazardous drinkers (HD) and nonhazardous drinkers (NHD). We administered multiple measures of substance use and problems and assessed the women's relationship aggression, use of general violence and their relationship partners' substance use. Results: Relative to the NHD group, the HD group scored higher on violence perpetration (physical assault, psychological abuse, sexual abuse, injuries) and violence victimization (physical assault). In addition, the HD group scored higher than the NHD group on general violence perpetration and partner alcohol and drug problems. Results from regression analyses indicated that women's drinking, women's general violence, and partner drinking all contributed to some form of violence perpetration or victimization; women's hazardous drinking group status was particularly important in the prediction of physical assault perpetration and victimization. Conclusions: The results of the study suggest that substance use and problems should be assessed routinely as part of violence intervention programs for women and that intervention programs would be improved by offering adjunct or integrated alcohol treatment. [ABSTRACT FROM AUTHOR]

Objective: In this study we use methods based on Item Response Theory to examine in depth the psychometric properties of the Alcohol Dependence Scale (ADS). In particular, we examine the ability of each ADS item to discriminate among individuals across the continuum of alcohol dependence severity and also examine the extent to which item-response options provide useful and reliable information about the level of alcohol dependence. Method: Participants were 166 alcohol-dependent patients with elevated depressive symptoms. We conducted a maximum likelihood common factors analysis on the ADS, and then used a nonparametric kernel smoothing method to create Item Characteristic Curves (ICC) and Option Characteristic Curves (OCC) for each ADS item. On the basis of these curves, we identified items showing at least fair discrimination and modified the scoring of response options where indicated. We then created an empirically derived ADS score and correlated it with the original ADS and with other measures of alcohol involvement. Results: Replicating previous studies, our results indicated a primarily unidimensional factor structure. A total of 12 of the 25 ADS items showed good discrimination, and examination of the OCC indicated that dichotomous scoring was most appropriate for these items. This 12-item abbreviation of the ADS was highly correlated with the original scale (r = 0.91), and showed similar patterns of correlations with other measures of alcohol involvement. Conclusions: Results suggest potential gains in measurement efficiency using methods based on Item Response Theory and indicate potential ordering of dependence symptoms based on item severities. [ABSTRACT FROM AUTHOR]