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This study examined partner violence before and in the 1st and 2nd year after behavioral couples therapy (BCT) for 103 married or cohabiting women seeking alcohol dependence treatment and their male partners; it used a demographically matched nonalcoholic comparison sample. The treatment sample received M = 16.7 BCT sessions over 5-6 months. Follow-up rates for the treatment sample at Years 1 and 2 were 88% and 83%, respectively. In the year before BCT, 68% of female alcoholic patients had been violent toward their male partner, nearly 5 times the comparison sample rate of 15%. In the year after BCT, violence prevalence decreased significantly to 31% of the treatment sample. Women were classified as remitted after treatment if they demonstrated abstinence or minimal substance use and no serious consequences related to substance use. In Year I following BCT, 45% were classified as remitted, and 49% were classified as remitted in Year 2. Among remitted patients in the year after BCT, violence prevalence of 22% did not differ from the comparison sample and was significantly lower than the rate among relapsed patients (38%). Results for male:perpetrated violence and for the 2nd year after BCT were similar to the 1st year. Results supported predictions that partner violence would decrease after BCT and that clinically significant violence reductions to the level of a nonalcoholic comparison sample would occur for patients whose alcoholism was remitted after BCT. These findings replicate previous research among men with alcoholism. Keywords: female alcoholism, partner violence, couples therapy DOI: 10.1037/a0017389

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2009.03.007 Byline: Douglas C. Smith (a), Shamra Boel-Studt (b), Leah Cleeland (a) Keywords: Parental consent; Drug abuse; Alcohol abuse; Clinical trials; Adolescents Abstract: No systematic review has focused on parental consenting procedures used in adolescent substance abuse treatment outcomes research. To address this gap, we examined parental consenting procedures in adolescent outcome studies (n = 34) published between 1980 and 2007. Although parental consent was required in 89% of adolescent treatment outcome studies we reviewed, consenting procedures were not routinely reported. We argue that parental consenting procedures should be routinely reported as a methodological feature of adolescent treatment outcome studies and, given concerns about sample bias in adolescent risk behavior research when parental consent is required, encourage outcomes researchers in this area to prospectively study the impact of consenting procedures on both the study participation rates and substance use reporting. Author Affiliation: (a) University of Illinois, IL, USA (b) University of Iowa, IA, USA Article History: Received 20 November 2008; Revised 6 February 2009; Accepted 2 March 2009

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2009.03.011 Byline: Matt G. Kushner, Sandra Sletten, Christopher Donahue, Paul Thuras, Eric Maurer, Antonina Schneider, Brenda Frye, Joani Van Demark Keywords: Comorbidity; Alcohol; Panic disorder; Expectancies; CBT treatment Abstract: Anxiety disorders commonly co-occur with alcohol use disorders and reliably mark a poor response to substance abuse treatment. However, treating a co-occurring anxiety disorder does not reliably improve substance abuse treatment outcomes. Failure to account for individual differences in the functional dynamic between anxiety symptoms and drinking behavior might impede the progress and clarity of this research program. For example, while both theory and research point to the moderating role of tension-reduction alcohol outcome expectancies (TR-AOEs) in the association between anxiety symptoms and alcohol use, relevant treatment studies have not typically modeled TR-AOE effects. We examined the impact of a hybrid cognitive-behavioral therapy (H-CBT) treatment for panic disorder (independent variable) on response to a community-based alcohol dependence treatment program (dependent variable) in patients with higher vs. lower TR-AOEs (moderator). The H-CBT treatment was generally effective in relieving participants' panic symptoms relative to controls. However, TR-AOEs interacted with study cohort (H-CBT vs. control) in predicting response to substance abuse treatment. As expected, the H-CBT was most effective in improving alcohol use outcomes among those with the highest TR-AOEs. The study's primary methodological limitations are related to the quasi-experimental design employed. Author Affiliation: University of Minnesota, Department of Psychiatry, United States Article Note: (footnote) [star] This research was supported, in part, by a grant from the National Institute on Alcoholism and Alcohol Abuse (AA12426 and AA015069) awarded to the first author.

IN ADDICTION TREATMENT STUDIES, investigators typically evaluate patients for the presence of addictive disorders, rely on self-reported diagnostic instruments for inclusion and exclusion criteria, and examine differences in treatment outcomes [...], Objective: The aim of this study was to examine psychometric properties of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), diagnostics criteria for alcohol and marijuana dependences among 462 alcohol users and 311 marijuana users enrolled in two multisite trials of the National Drug Abuse Treatment Clinical Trials Network. Method: Diagnostic questions were assessed by the DSM-IV checklist. Data were analyzed by the item response theory and the multiple indicators multiple causes method procedures. Results: Criterion symptoms of alcohol and marijuana dependences exhibited a high level of internal consistency. All individual symptoms showed good discrimination in distinguishing alcohol or marijuana users between high and low severity levels of the continuum. In both groups, 'withdrawal' appeared to measure the most severe symptom of the dependence continuum. There was little evidence of measurement nonequivalence in assessing symptoms of dependence by gender, age, race/ethnicity, and educational level. Conclusions: These findings highlight the clinical utility of the DSM-IV checklist in assessing alcohol- and marijuana-dependence syndromes among treatment-seeking substance users.

Data were pooled from 3 studies of recently resolved community-dwelling problem drinkers to determine whether a behavioral economic index of the value of rewards available over different time horizons distinguished among moderation (n = 30), abstinent (n = 95), and unresolved (n = 77) outcomes. Moderation over 1- to 2-year prospective follow-up intervals was hypothesized to involve longer term behavior regulation processes than abstinence or relapse and to be predicted by more balanced preresolution monetary allocations between short-term and longer terna objectives (i.e., drinking and saving for the future). Standardized odds ratios (ORs) based on changes in standard deviation units from a multinomial logistic regression indicated that increases on this 'Alcohol-Savings Discretionary Expenditure' index predicted higher rates of abstinence (OR = 1.93, p = .004) and relapse (OR = 2.89, p < .0001) compared with moderation outcomes. The index had incremental utility in predicting moderation in complex models that included other established predictors. The study adds to evidence supporting a behavioral economic analysis of drinking resolutions and shows that a systematic analysis of preresolution spending patterns aids in predicting moderation. Keywords: problem drinking, natural resolution, moderation, behavioral economics

Although alcohol use disorders (AUDs) adversely affect women, research on efficacious treatments for women is limited. In this randomized efficacy trial of 102 heterosexual women with AUDs, the authors compared alcohol behavioral couple therapy (ABCT) and alcohol behavioral individual therapy (ABIT) on percentage of days abstinent (PDA) and percentage of days of heavy drinking (PDH) over 6 months of treatment and 12 months of posttreatment follow-up. Baseline relationship functioning and comorbid disorders were tested as moderators of outcome. Piecewise linear growth models were used to model outcomes. During treatment, women increased their PDA and decreased their PDH, with significantly greater improvements in ABCT than in ABIT (d = 0.59 for PDA; d = 0.79 for PDH). Differences favoring ABCT were maintained during follow-up. Women with poorer baseline relationship functioning improved more on PDA during treatment with ABCT than with ABIT. For PDH, results during treatment and follow-up favored ABCT for women with better baseline relationship functioning. ABCT resulted in better outcomes than ABIT for women with Axis I disorders at the end of follow-up (PDA), and for women with Axis II disorders at the end of treatment (PDA) and at the end of follow-up (PDH). Keywords: alcohol use disorders, women, couple therapy, behavior therapy, comorbidity

Background. This investigation aims to determine the 12-month drinking trajectory of older at-risk drinkers in treatment. Furthermore, the drinking trajectory between at-risk drinkers who had met the threshold suggestive of alcohol dependence (problem at-risk drinkers) and those who did not meet this threshold (nonproblematic at-risk drinkers) were compared. Methods. This investigation is a component of the PRISM-E (Primary Care Research in Substance Abuse and Mental Health for the Elderly) Study, a multisite randomized trial comparing service use, outcomes, and cost between Integrated (IC) versus Enhanced Specialty Referral (ESR) care models for older (65+ years) adults with depression, anxiety, and/or at-risk alcohol consumption. This investigation focuses only on at-risk drinkers, generally defined as exceeding recommended drinking limits, which in the case of older adults has been classified as consuming more than one drink per day. Two hundred fifty-eight randomized older at-risk drinkers were examined, of whom 56% were problem drinkers identified through the Short Michigan Alcohol Screening Test-Geriatric version. Results. Over time, all at-risk drinkers showed a significant reduction in drinking. Problem drinkers showed reductions in average weeny consumption and number of occurrences of binge drinking at 3, 6, and 12 months, whereas nonproblematic drinkers showed significant reductions in average weekly consumption at 3, 6, and 12 months and number of occurrences of binge drinking at only 6 months. IC treatment assignment led to higher engagement in treatment, which led to better binge drinking outcomes for problem drinkers. Despite significant reductions in drinking, approximately 29% of participants displayed at-risk drinking at the end of the study. Conclusions. Results suggest that older at-risk drinkers, both problem and nonproblematic, show a considerable decrease in drinking, with slightly greater improvement evidenced in problem drinkers and higher engagement in treatment seen in those assigned to IC. Key Words: Alcohol--At-risk drinking--Problem drinkers.

In the field of clinical alcohol disorders treatment in North America, abstinence continues to be largely viewed as the optimal treatment goal; however, there is a growing awareness of limitations when abstinence is considered the only successful outcome. Although this issue has been discussed in research settings, new studies on the public health significance of heavy drinking (defined as five or more standard drinks per drinking day in men, and four or more standard drinks per drinking day in women) in the past 10 years suggest that clinical providers should consider the value of alternative outcomes besides abstinence. A focus on abstinence as the primary outcome fails to capture the impact of treatment on reduction in the pattern and in the frequency of alcohol consumption. In addition, evaluating reduction in drinking as 'positive' has value for patients as an indicator of clinical progress. Measurement of continuous variables, such as the quantity and the frequency of alcohol consumption, has provided a clearer understanding of the scope of alcohol-related morbidity and mortality at the societal level, and of the relationship between individual patient characteristics and the naturalistic course of alcohol use, abuse, and dependence. A review of these characteristics suggests that there are clinical benefits associated with reducing heavy drinking in alcohol-dependent patients. Given the significant public health consequences associated with heavy drinking and the benefits associated with its reduction, it is proposed that researchers, public health professionals, and clinicians consider using reduction in heavy drinking as a meaningful clinical indicator of treatment response, and that outcomes be individualized to patients' goals and readiness to change. Keywords: Substance abuse; Outcomes; Evaluation; Treatment response; Health effects

College provides a context for experimentation with alcohol and drugs, the consequences of which range from mild to severe. One purpose of this study involved testing the usefulness of the Shortened Inventory of Problems--Alcohol and Drugs (SIP-AD) to assess negative consequences associated with substance use. A random sample of students (n = 421) was drawn from a medium-sized, public university. Subjects reported patterns of use for alcohol, marijuana, and cocaine over both the last 30 days and the past year. Reliability and factor analyses illustrated the internal consistency and validity of the SIP-AD. Multiple linear regression was also used to show how demographic characteristics and substance use behaviors can predict problems associated with using alcohol and/or drugs.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2005.05.003 Byline: Susan R. Tate (a)(b), John R. McQuaid (a)(b), Sandra A. Brown (a)(b)(c) Keywords: Alcohol dependence; Addiction treatment; Life stress; Health Abstract: Most research and treatment focusing on the relationship between life stress and substance use have considered stress as a unitary construct despite the fact that stressors vary in terms of temporal characteristics (short-term vs. long-term) and domains (work, health). In contrast to most stressor domains, increasing evidence suggests that health stressors may reduce the risk of initiating substance use after treatment. We separately evaluated the effect of short-term stress events (discrete date of occurrence), long-term stressors (ongoing stressors lasting 2 weeks or longer), and health stressors on posttreatment alcohol and drug use. Veterans (N = 195) were assessed while receiving addiction treatment and quarterly for 1 year. The odds of initiating posttreatment substance use were 2.5 times greater for participants experiencing severe (nonhealth) long-term stressors. In contrast, participants experiencing short-term health events or severe (nonhealth) short-term events were less likely to initiate posttreatment substance use (odds ratio = .28 and .44, respectively). Author Affiliation: (a) Department of Psychiatry, University of California, San Diego, CA 92161, USA (b) VA San Diego Healthcare System, San Diego, CA 92161, USA (c) Department of Psychology, University of California, San Diego, CA 92161, USA Article History: Received 22 August 2004; Revised 5 March 2005; Accepted 6 May 2005

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2005.01.007 Byline: David W. Oslin (a)(b)(c), Valerie J. Slaymaker (d), Frederic C. Blow (e)(f), Patricia L. Owen (d), Carol Colleran (g) Keywords: Treatment; Alcohol dependence; Aged Abstract: The purpose of this study was to examine differences in the clinical presentation and treatment outcomes of older adults with a diagnosis of alcohol dependence compared to middle-aged adults. Author Affiliation: (a) Section of Geriatric Psychiatry, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States (b) Center for the Study of Addictions, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States (c) Mental Illness Research Education and Clinical Center at the Philadelphia VA Medical Center, United States (d) Butler Center for Research, Hazelden Foundation, Center City, Minnesota, United States (e) Department of Psychiatry, University of Michigan, United States (f) National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC) Health Services Research and Development, Ann Arbor VA Healthcare System, United States (g) Hanley Center, West Palm Beach, FL, United States Article Note: (footnote) [star] Supported, in part, by a grant from the National Institute of Mental Health (#) 1K08 MH01599-01, the Department of Veterans Affairs, and the VISN #4 MIRECC.

Ondansetron is shown to be effective in the treatment of early-onset adult alcohol dependence. Preliminary data from studies conducted suggest that ondansetron is safe and well tolerated in adolescents with alcohol dependence and findings of decreased drinking underscore the need for future double-blind, placebo-controlled studies in this adolescent population.

A pragmatic randomized trial examined the effects of Early Warning Signs Relapse Prevention Training (EWSRPT) on drinking in alcohol dependent persons with history of relapse. The results of this study justify the use of EWSRPT of serving similar patients.

This paper presents the results of the Nationwide Campuses Study that measure the impact of programs supported by the Fund for the Improvement of Postsecondary Education (FIPSE) for collegiate alcohol and other drug (AOD) prevention efforts. Outcomes were measured by using standardized pre- and post-program items on the Core Alcohol and Drug Survey and adjusted prevalences of AOD use. Although student awareness of AOD prevention programs increased during the funding period, there also were increases in the desire for drugs at parties and in the frequencies of arrests for driving while intoxicated or under the influence and of poor academic performance. Adjusted prevalences of alcohol, marijuana, and cocaine use among students increased, while tobacco use decreased. Curriculum infusion, administrative response, and faculty and community activities most clearly were associated with favorable outcomes. Overall, however, FIPSE funding had limited short-term impact on AOD use and its consequences in higher education. Key Words: Alcohol drinking; Cocaine; Drinking behavior; Health promotion; Marijuana; Tobacco., INTRODUCTION Alcohol is the drug of choice at institutions of higher education in the United States. Throughout the 1990s, data from the Monitoring the Future Study (MTF) (1,2), the Core [...]

Regional and demographic characteristics influence the number of alcohol related deaths in significant proportions in the US. Areas with low rates of per capita alcohol consumption may have high rates of alcohol related injuries and fatalities. 'Dry' Hinds County, Mississippi, and 'wet' Contra Costa County, California, reflect variations in the number of alcohol-related deaths on the basis of regional and demographic characteristics.

While alcohol availability, consumption, and abuse were not related to statewide homicide rates in the United States, alcohol consumption, but not availability or abuse, was associated with statewide suicide rates., INTRODUCTION It is well documented that alcohol abuse and misuse are associated with suicide. Both fatal and nonfatal suicidal behaviors are more common in those who abuse alcohol, and alcohol [...]

The morbidity risks for alcoholism in the first-degree relatives of a cohort of male cocaine addicts with or without alcoholism comorbidity were studied. Of the 71 patients who participated in our study, 40 (56.3%) had a history of alcoholism and 37 (59.1%) a history of opioid abuse. Twenty-two patients (30.1%) also met criteria for a lifetime diagnosis of a major psychiatric disorder. Significant increases in morbidity risks for alcoholism were found among male relatives of cocaine addicts with comorbid alcohol dependence when compared with relatives of cocaine addicts with no alcohol comorbidity. Among fathers, risks were .69 vs .32 (z = 2.98, p < .003). Among brothers, risks were .38 vs .15 (z = 2.35, p < .03). Significantly increased risks were also observed in male relatives when probands with a psychiatric diagnosis were excluded from the analyses. Among female relatives, increases in morbidity risks were found but they failed to reach statistical significance. Two interpretations are consistent with these findings. One of these interpretations is that alcoholism is a disorder distinct from other addictions and has its own mode of transmission. The second interpretation is that the transmission of substance use disorders lacks specificity and that the substances selected are influenced by sociocultural or biological factors., INTRODUCTION Alcohol dependence is a common disorder among patients in treatment for drug addiction and among their relatives[1-3]. The heritability of alcoholism is supported by studies of the biological children [...]

Objectives. The purpose of this study was to analyze the prevalence rates of alcohol-related mortality--according to various indicators--in both sexes in Stockholm, Sweden. Methods. A study of alcohol involvement at death was undertaken for all 668 deceased persons aged 15 through 54 years in 1987 in Stockholm. Death certificates, autopsy information, police records, and information about earlier conviction were analyzed. Results. When different measures of estimation were compared, there were great differences in the prevalence rates of alcohol involvement. According to the death certificates, 9.2% of the males and 11.2% of the females had alcoholism, alcohol intoxication, pancreatitis or liver cirrhosis as underlying cause of death. When all accessible information was used, potential alcohol involvement was found in 57.5% of the male and in 32.2% of the female deaths. There was a marked association between earlier drunken driving and alcohol involvement. After reevaluation of the diagnoses with autopsy findings, the number of cases with cardiac enlargement and suspected cardiomyopathy increased from 10 to 62. Conclusion. The results point to the serious underdiagnosis of alcohol involvement in death certificates and the misclassification of important causes of death (i.e., liver cirrhosis and cardiac disease); they also call for increased efforts regarding prevention. (Am J Public Health. 1993;83:838-844), Alcohol as a contributing cause of death is underreported in Stockholm, Sweden. Researchers studied death reports of 668 men and women between the ages of 15 and 54 from the year 1987. Autopsy reports were reviewed for evidence of liver cirrhosis, alcohol hepatitis, fatty liver, pancreatitis, heart enlargement and suspected cardiomyopathy. These conditions may all be related to alcohol abuse. Police records for drunk driving were also reviewed for evidence of alcohol consumption in the deceased. After this information was reevaluated, the estimates of alcohol-related deaths rose from nine percent to 57% for men and from 11% to 32% for women.

Mortality rates in alcoholics who abstain from alcohol for long periods of time are no higher than those in the general population. Of 199 alcoholics enrolled in a treatment program who were followed up to 11 years, 101 relapsed and 98 achieved long-term abstinence. At 11 years, the mortality rate in the abstainers was similar to that in a control group of 92 non-alcoholics, but the rate in the relapsed alcoholics was five times higher than would be expected in the general population. The mortality rate was especially high in relapsed alcoholics between the ages of 20 and 45; there were nine times as many deaths as would be expected in the general population. Smoking did not appear to be associated with increased mortality in relapsed alcoholics, since abstainers smoked as much as relapsers, and both groups smoked more than the non-alcoholics., Objectives.-To determine if alcoholic men who achieved stable abstinence experienced fewer deaths than those who relapsed and to develop a model predictive of premature mortality. Design. -A cohort of alcoholic men recruited into a prospective study of neurocognitive effects of alcoholism was followed up from 1 through 11 years. A demographically equated group of nonalcoholic men was also followed up. Alcoholics were classified as stable abstainers or relapsers. Setting.-Alcoholics were patients or ex-patients from a Department of Veterans Affairs Alcoholism Treatment Program and/or members of local chapters of Alcoholics Anonymous. Participants.-There were 234 alcoholic men who met the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, criteria for alcohol dependence. Follow-up status regarding relapse and mortality was obtained for 199 alcoholic subjects (85%). Of these, 101 had relapsed and 98 had abstained. Ninety-eight nonalcoholic controls equated for age, education, and sex also participated. Mortality status was obtained for 92 subjects in this group (94%). Exclusions.-Major medical and psychiatric illness and history of nonalcoholic drug abuse. Main Outcome Measure. - Death during a follow-up period of 1 through 11 years. Death was ascertained through the National Death Index, the California State Department of Health and Vital Statistics, the State Department of Motor Vehicles, and through personal contact with informants, relatives, and significant others of the subjects. Results.-There were 19 deaths among relapsed alcoholics compared with the expected number of 3.83 (99% confidence interval (CI), 9.64 to 33.38). Among abstinent alcoholics there were four deaths (expected = 3.21; 99% Cl, 0.67 to 12.59). The standardized mortality ratio for relapsed alcoholics was 4.96, which significantly exceeded the expected ratio P Conclusions. Alcoholic men who achieve stable abstinence do not differ from nonalcoholic men in mortality experience; however, alcoholics who relapse die at a rate 4.96 times that of an age-, sex-, and race-matched representative sample from the US Bureau of the Census. JAMA, 1992;267:668-672)

A study that was carried out to replicate many major findings of Connors and others with a larger sample and the use of more reliable statistical methods is described. The importance of coping behaviors in the prediction of drinking outcomes was reaffirmed.

Various alcohol treatment outcome studies reported between 1970 and 1998 are reviewed helping researchers to characterize this field of study, analyze trends over time, and improve work on the same in future. As alcohol treatment research includes societal issues, changes in these also lead to changes in treatment research.