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Objective: This study tested an integrated relapse model drawing hypotheses from both interpersonal and intra-individual relapse models. It was hypothesized that the relationships between alcohol-specific social support (support for drinking and support for not drinking) and drinking outcomes would be partially mediated by motivation.Method: Participants were 158 women with alcohol use disorders participating in two linked randomized controlled trials. One trial compared standard individual cognitive behavioral therapy (CBT) for alcohol use disorders with female-specific CBT for alcohol use disorders; the other compared alcohol behavioral couple therapy with blended individual CBT and alcohol behavioral couple therapy. Measures included the Important People Interview to measure social-support variables, the Timeline Followback to measure drinking variables, and the Stages of Change Readiness and Treatment Eagerness Scale to measure motivation.Results: Results of structural equation modeling suggested a mediational role of motivation in the relationship between support for drinking and drinking frequency. Individuals with more network support for drinking at baseline had less motivation for abstinence at the end of treatment, which predicted drinking frequency over the 6 months after treatment. The indirect effect of baseline support for drinking on 6-month follow-up drinking frequency was statistically significant. A similar, although only marginally significant, pattern was found for the relationship between support for not drinking and drinking frequency. Individuals with more social network for not drinking at baseline had more motivation at the end of treatment at the trend level, which in turn predicted 6-month follow-up drinking frequency. The indirect effect of baseline support for not drinking on 6-month follow-up drinking frequency trended toward significance.Conclusions: This study offers preliminary evidence that motivation is one mechanism by which abstinence-specific social support affects treatment outcome. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We tested the effectiveness of a long-term coordinated care strategy--intensive case management (ICM)--compared with usual care (UC) among a group of substance-dependent women receiving Temporary Assistance for Needy Families (TANF). METHODS: Substance-dependent women on TANF (N=302) were recruited from welfare offices. They were assessed and randomly assigned to ICM or UC; follow-up was at 3, 9, and 15 months. UC consisted of a health assessment at the welfare office and a referral to substance abuse treatment and TANF services. ICM clients received ICM services in addition to UC services. RESULTS: ICM clients had significantly higher levels of substance abuse treatment initiation, engagement, and retention compared with UC clients. In some cases, ICM treatment attendance rates were double those of UC rates. Additionally, almost twice as many ICM clients were abstinent at the 15 month follow-up compared with UC clients (P<.0025). CONCLUSIONS: ICM is a promising intervention for managing the chronic nature of substance dependence among women receiving TANF. Future research should refine long-term care strategies-such as ICM-that address the chronic nature of substance dependence among low-income populations. [ABSTRACT FROM AUTHOR]

The present study sought to characterize well-being indicators for a sample of children of substance dependent TANF women. Participants were 372 mothers meeting DSM-IV criteria for substance dependence and 156 non-substance abusing women from two urban counties in New Jersey. Children of substance dependent TANF mothers experienced significant vulnerabilities, as demonstrated by higher levels of contextual risk factors and negative behavioral and emotional and school outcomes. Overall, these rates were about double those found in children of non-substance abusing mothers. Results highlight the need for multi-systemic services to address the problems experienced by substance abusing TANF women and their children. [ABSTRACT FROM AUTHOR]

This article summarizes the proceedings of a symposium that was organized and chaired by Richard Longabaugh and presented at the 2004 Research Society on Alcoholism meeting in Vancouver, British Columbia, Canada. The aim of the presentation was to focus on evidence for the active ingredients of behavioral therapies for patients with alcohol use disorders. Dennis M. Donovan, PhD, reviewed evidence for the active ingredients of cognitive behavioral therapy. Barbara S. McCrady, PhD, presented a conceptual model for mechanisms of change in alcohol behavior couples therapy and reviewed evidence for this model. J. Scott Tonigan, PhD, presented data testing three hypothesized mechanisms of change in twelve-step facilitation treatment. Mitchell P. Karno, PhD, presented therapy process data that tested whether matching therapist behaviors to client attribute across three therapies affected drinking outcomes. Jon Morgenstern served as discussant. [ABSTRACT FROM AUTHOR]

This article is a compilation of the information presented at a symposium at the 2001 RSA Meeting in Montreal, Canada. The presentations were: (1) Maintaining change after conjoint behavioral alcohol treatment for men: the role of involvement with Alcoholics Anonymous, by Barbara S. McCrady and Elizabeth E. Epstein; (2) Changing AA practices and outcomes: Project MATCH 3-year follow-up, by J. Scott Tonigan; (3) Life events and patterns of recovery of AA-exposed adults and adolescents, by Patricia L. Owen and Valerie Slaymaker; (4) Social networks and AA involvement as mediators of change, by Lee Ann Kaskutas and Keith Humphreys; and (5) What do we know about Alcoholics Anonymous? by William R. Miller, discussant. [ABSTRACT FROM AUTHOR]

Women's experiences as professionals and behavior therapists have changed considerably in the past 40 years. The author describes early challenges and experiences of discrimination as a young female professional. Although women's opportunities have improved considerably, women still experience unique career challenges and choices. The author provides some suggestions for women's career development. [ABSTRACT FROM AUTHOR]

Introduction: Driving while intoxicated (DWI) results in significant morbidity and mortality. Ignition interlock devices (IID) decrease the risk of drinking and driving while installed, but DWI rates increase after the IID is removed. Efforts are needed to maintain change after the IID is removed; engaging concerned family members (CFMs) is an untested strategy. Smartphones may provide a promising platform to support DWI offenders with IIDs and their CFMs; the purpose of the present study was to develop such a smartphone-web app., Methods: Formative work occurred in two sequential phases. Phase 1 included key informant interviews with DWI offenders and CFMs, development of one app module, and usability testing. Phase 2 included focus groups with DWI offenders and CFMs, development of three more app modules, and usability testing. The Bangor System Usability Scale was used to rate app usability and navigability., Results: Results of key informants and focus groups indicated that offenders and CFMs lacked information and were frustrated by the IID, experienced financial burden from the DWI and IID, viewed supportive communication and positive shared activities as important, and were positive about the app. Four modules were developed, Life with Interlock, Supporting Changes in Drinking, Doing Things Together, and Effective Communication. Usability testing indicated that the B-SMART modules were easy to use and informative., Conclusions: Careful formative work resulted in an app responsive to the concerns of DWI offenders with IIDs and their CFMs. Controlled research is needed to evaluate the efficacy of the app., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Although modestly effective treatments exist for alcohol use disorder (AUD), many individuals return to heavy drinking after treatment, suggesting the need for better understanding of factors that contribute to maintaining abstinence or drinking reductions. Whereas past studies identified what treatments work for AUD, recent studies focus more on why particular treatments work, and the mechanisms by which treatment leads to change. This focus on mechanisms of behavior change (MOBC) may inform the process by which treatment leads to better outcomes, and also may lead to new treatments or modifications of existing treatments that target empirically supported mechanisms known to lead to change. There is a paucity of studies examining MOBC from a neurocognitive perspective., Method: To address this gap in knowledge, the study described here is examining emotional reactivity, alcohol cue reactivity, and cognitive control as potential MOBC at three levels of analysis - self-report, behavior, and neural., Results: One hundred ten treatment-seeking individuals with an AUD are being randomized to receive 8 sessions of either Cognitive Behavioral Treatment (CBT) or Mindfulness Based Treatment (MBT) after up to 4 sessions of a platform treatment focused on enhancing motivation to change. To establish the temporal relationship between changes in drinking and changes in MOBC, patients are assessed at baseline, during and immediately after treatment, and 9- and 15-months post-baseline. Relationships between changes in drinking and changes in the proposed MOBC will be examined using advanced mixed modeling techniques., Conclusions: Results should advance AUD treatment by targeting treatments to neurocognitive MOBC., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

A standard component of service delivery in alcohol treatment clinics is evidence-based assessment (EBA). Although EBA is essential for selecting appropriate treatment modalities for alcohol use and associated problems, there are limitations in existing EBAs concerning evidence of cultural equivalence and utility among individuals seeking alcohol treatment. However, training in EBA, addictions, and clinical applications with diverse populations all are gaps in clinical training in doctoral programs in clinical psychology. The present work used the clinical science model to review the psychometric properties, cross-cultural utility, and measurement invariance of measures in an assessment battery used in an alcohol treatment training clinic. This article describes the results of that review, recommendations for retaining or replacing common assessment measures used in alcohol treatment clinics, and recommendations for alcohol treatment clinics interested in engaging in similar processes. Findings suggested that more research is needed to evaluate the psychometric properties of EBAs utilized in an alcohol treatment assessment battery, particularly among American Indian and Alaska Native people, and to test measurement invariance across race/ethnicity and other identity groups in alcohol treatment-seeking populations. Overall, routine reviews of cultural relevance are needed in clinical settings to stay current with the emerging literature. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Involving family members in a patient's treatment for alcohol use disorder (AUD) leads to more positive outcomes, but evidence-based family-involved treatments have not been adopted widely in AUD treatment programs. Study aims the following: (a) modify an empirically supported 12-session AUD treatment, alcohol behavioral couple therapy (ABCT) to make it shorter and appropriate for any concerned family member and (b) conduct a small clinical trial to obtain feasibility data and effect size estimates of treatment efficacy., Method: ABCT content was adapted to three-sessions following input from clinicians, patients, and family members. Patient and family member dyads were recruited from an inpatient treatment program and randomized to the new treatment, brief family-involved treatment (B-FIT), or treatment-as-usual (TAU). Drinking was assessed using the Form-90; family support and family functioning were assessed using the Family Environment Scale Conflict and Cohesion subscales and the Family Adaptability and Cohesion Evaluation Scale-IV, Communication scale. Dyads ( n = 35) were assessed at baseline and 4-month follow-up., Results: On average, dyads received one of three B-FIT sessions with 6 dyads receiving no sessions due to scheduling conflicts or patient discharge. At follow-up, there was a large-to-medium effect size estimate favoring B-FIT for proportion drinking days (patient report, n = 22; Hedges' g = 1.01; patient or family report, n = 28; Hedges' g = .48). Results for family support or family functioning measures favored TAU., Conclusions: Implementation of brief family-involved treatment in inpatient AUD treatment was challenging, but preliminary data suggest the potential value of B-FIT in impacting drinking outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Alcohol use disorder (AUD) and family functioning are inextricably bound, and families are impacted negatively by AUD, but families show substantial improvements with AUD recovery. Family members can successfully motivate a person with AUD to initiate changes in drinking or to seek AUD treatment. During recovery, family members can provide active support for recovery. Several couple- or family-involved treatments for AUD have been developed and tested in rigorous efficacy trials. Efficacious treatments based in family systems theory or cognitive behavioral approaches focus on the concerned family member alone, or they engage the couple or family as a unit in the treatment. However, most treatments have been studied in fairly homogeneous, heterosexual, White, non-Hispanic populations, limiting the potential generalizability of these treatments. Substantial gaps remain in our understanding of family processes associated with the initiation and maintenance of AUD recovery among adults. This review outlines the existing literature and describes opportunities for future research to address knowledge gaps in understanding the mechanisms by which these treatments are efficacious, use of family-based treatments with diverse populations, integration of pharmacotherapies with family-involved treatment, role of families in recovery-oriented systems of care, and how to improve treatment development and dissemination., Competing Interests: Disclosures Dr. McCrady is the author of a therapist manual and a client workbook on Alcohol Behavioral Couple Therapy, a treatment that is discussed briefly in this paper. She receives royalties from the sale of these publications and also receives payments for workshops to train practitioners in the use of Alcohol Behavioral Couple Therapy. Dr. McCrady’s research on Alcohol Behavioral Couple Therapy and the B-FIT treatment discussed in this paper has been supported by grants from NIAAA. Dr. Flanagan is Principal Investigator of an NIAAA-sponsored grant using the Alcohol Behavioral Couple Therapy treatment manual. There are no other competing financial interests or other conflicts of interest to declare.

Objective: Adolescents' drinking is influenced by their friends' drinking. However, it is unclear whether individually-targeted alcohol interventions reduce drinking in the friends of individuals who receive the intervention. This study used simulations of drinking in simulated longitudinal social networks to test whether individually-targeted alcohol interventions may be expected to spread to non-targeted individuals., Method: Stochastic actor-based models simulated longitudinal social networks where changes in drinking and friendships were modeled using parameters from a meta-analysis of high school 10th grade social networks. Social influence (i.e., how much one's friends' drinking affects their own drinking) and social selection (i.e., how much one's drinking affects who they select as friends) were manipulated at several levels. At the midpoint of each simulation, a randomly-selected heavy-drinking individual was experimentally assigned to an intervention (changing their drinking status to non-drinking) or a control condition (no change in drinking status) and the drinking statuses of that individual's friends were recorded at the end of the simulation., Results: Friends of individuals who received the intervention significantly reduced their drinking, with higher reductions occurring in networks with greater social influence. However, all effect sizes were small (e.g., average per-friend reduction of .07 on a 5-point drinking scale)., Conclusions: Individually-targeted alcohol interventions may have small effects on reducing the drinking of non-targeted adolescents, with social influence being a mechanism that drives such effects. Due to small effect sizes, many adolescents may need to receive alcohol interventions to produce measurable effects on drinking outcomes for non-targeted individuals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: Clients who receive alcohol use disorder (AUD) treatment experience variable outcomes. Measuring clinical progress during treatment using standardized measures (i.e., measurement-based care) can help indicate whether clinical improvements are occurring. Measures of mechanisms of behavioral change (MOBCs) may be particularly well-suited for measurement-based care; however, measuring MOBCs would be more feasible and informative if measures were briefer and if their ability to detect reliable change with individual clients was better articulated., Method: Three abbreviated measures of hypothesized MOBCs (abstinence self-efficacy, coping strategies, anxiety) and a fourth full-length measure (depression) were administered weekly during a 12-week randomized trial of cognitive-behavioral therapy (CBT) for women with AUD. Psychometric analyses estimated how reliably each measure distinguished within-person change from between-person differences and measurement error. Reliability coefficients were estimated for simulated briefer versions of each instrument (i.e., instruments with fewer items than the already-abbreviated instruments) and rates of reliable improvement and reliable worsening were estimated for each measure., Results: All four measures had good reliability (.86-.90) for detecting within-person change. Many participants (41.4%-62.5%) reliably improved on MOBCs from first to last treatment session. Reliable improvement on MOBCs was associated with reductions in percentage of drinking days (PDD) at 3, 9, and 15-month follow-ups. Simulated briefer versions of each instrument retained good reliability for detecting change with only 3 (self-efficacy), 11 (coping strategies), 5 (anxiety), or 10 items (depression)., Conclusions: Brief MOBC measures can detect reliable change for individuals in AUD treatment. Routinely measuring MOBCs may help with monitoring clinical progress. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The alcohol treatment literature has established in-session client speech as a mechanism of change that therapist behavior can influence and that can predict drinking outcomes. This study aimed to explore temporal patterns of in-session speech in Alcohol Behavioral Couple Therapy (ABCT), including the unique interplay between client and partner speech and the role of speech trajectories in predicting client drinking outcomes. Participants were 165 heterosexual couples receiving ABCT in one of four clinical trials. We coded client speech on an utterance-by-utterance basis using the System for Coding Couples' Interactions in Therapy-Alcohol. We focused on individual-level speech codes of change talk and sustain talk and couple-level variables of positive and negative interactions. We segmented the initial and midtreatment sessions into quartiles to conduct path analyses and latent growth curve models. Path analyses suggested that clients and partners may not have been aligned in terms of treatment goals at the start of the therapy. This misalignment within couples was pronounced during the initial session and decreased by the midtreatment session, reflecting progression toward treatment goals. Of the latent growth curve models, only client sustain talk during the midtreatment session predicted greater client drinking at the end of treatment. Results provide insight into the inner workings of ABCT and suggest recommendations for ABCT therapists. This study also supports a growing consensus that sustain talk may be a stronger mechanism of change than change talk in various alcohol treatment interventions., Competing Interests: Declaration of competing interest Dr. McCrady is the author of a therapist manual and client workbook on Alcohol Behavioral Couple Therapy. She receives royalties from the sale of these publications. The authors have no other conflicts of interest to report., (Published by Elsevier Inc.)

Research shows fluctuations in drinking across the menstrual cycle among women with alcohol use disorder (AUD), but little work has investigated moderators of these fluctuations. This study examined drinking and craving intensity across the menstrual cycle, and the moderating effect of baseline depression and emotional distress during the midlate luteal phase and/or menses, among women receiving AUD treatment. Fifty-nine regularly cycling women reported menstrual history and baseline depression. Over 3 months of treatment, they kept daily logs of drinks, alcohol cravings, and menstruation (yes/no). Emotional distress during the midlate luteal phase and/or menses of their most recent menstrual cycle was also assessed during treatment. Menstrual cycle phase was estimated for each within-treatment day. Mixed model analyses tested main and interactive effects of menstrual cycle phase, baseline depression, and emotional distress during the midlate luteal phase and/or menses on daily drinks and craving intensity. Women drank most during the midlate luteal phase and menses compared with other phases. Among women with lower baseline depression, those with lower distress during the midlate luteal phase and/or menses reported more intense cravings during the midlate luteal phase (ΔM = .77, p = .000) and menses (ΔM = .51, p = .012); those with higher distress reported more intense cravings during menses, compared with all other phases ( p < .01). Among women with higher baseline depression, craving intensity remained consistently high. Results document more drinking during the midlate luteal phase and menses and suggest that cycle-related distress and depression moderate the alcohol-menstrual association among women in AUD treatment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Women with alcohol use disorder (AUD) experience more barriers to AUD treatment and are less likely to access treatment than men with AUD. A literature review identified several barriers to women seeking help: low perception of a need for treatment; guilt and shame; co-occurring disorders; employment, economic, and health insurance disparities; childcare responsibilities; and fear of child protective services. Women entering treatment present with more severe AUD and more complex psychological, social, and service needs than men. Treatment program elements that may reduce barriers to AUD treatment include provision of childcare, prenatal care, treatment for co-occurring psychological problems, and supplemental social services. Research has suggested that outcomes for women are best when treatment is provided in women-only programs that include female-specific content. To date, research on treatments tailored to the individual needs of women is limited, but research on mechanisms of change has suggested the importance of targeting anxiety and depression, affiliative statements in treatment, abstinence self-efficacy, coping skills, autonomy, and social support for abstinence. Future research should focus on early interventions, linkages between primary care or mental health clinics and AUD treatment settings, and integrated treatments for co-occurring AUD and other disorders. Further research should also explore novel treatment delivery approaches such as digital platforms and peer support groups., Competing Interests: Financial Disclosure The authors declare that they have no competing financial interests.

Background: Understanding the association between smoking and alcohol use among women may help inform the delivery of targeted interventions to address both of these health behaviors., Methods: This study analyzed data from N = 138 women enrolled in a randomized clinical trial comparing female-specific individual versus group cognitive-behavior therapy for alcohol use disorder (AUD). We assessed cigarette use patterns, participants' interest in quitting smoking and motivation to quit smoking during treatment for AUD, and examined the relationship between smoking and alcohol use before and during alcohol treatment., Results: Over a third of the sample reported smoking cigarettes at baseline (N = 47, 34.1%), with the majority of smokers reporting daily cigarette use. At baseline, those who smoked reported a high interest in quitting smoking M = 7.8 out of 10 (SD = 2.7), although most believed they should quit smoking only after achieving some success in quitting drinking (50.0%). However, participants who smoked cigarettes (compared to non-smokers) reported more alcohol abuse and dependence symptoms (p = .001), lower rates of completing the alcohol treatment (p = .03), attended significantly fewer treatment sessions (p = .008), and consumed significantly more drinks per day on average both at baseline (p = .002) and during the treatment period (p = .04)., Conclusions: Findings suggest that women with AUD who also smoke cigarettes have greater difficulty engaging in or responding to treatment for their alcohol use. However, these participants reported high interest in quitting smoking but low perceived readiness during AUD treatment, suggesting that motivational interventions should be considered that could take advantage of the opportunity to treat women for both of these co-occurring behaviors while in treatment., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

This paper describes SUD/addictions training at the University of New Mexico. Coordinated and integrated academic, research, and clinical training resources are described, with an emphasis on the integration of resources across multiple training domains. Academic training resources in the Psychology Department include core clinical courses, basic science courses, and opportunities for students to develop expertise in health or quantitative psychology. Other academic resources come from affiliated departments and colleges such as Sociology, the College of Population Health, the College of Education, and Health Sciences. Research training resources are available within the Psychology Department, affiliated Departments and Colleges, and specialized research centers including the Center on Alcoholism, Substance Abuse, and Addictions, and the Mind Research Network. A network of community partners provides additional research sites. Clinical training resources are provided through a specialized alcohol treatment clinic and a diversity clinic within the Department, opportunities for students to serve as research clinicians, and community practicum sites supervised by on-site doctoral level psychologists or Departmental faculty. The UNM training program provides one model for graduate training in SUD/addictions. Keys to the program are the presence of multiple SUD/addictions clinical faculty member with active research programs, willingness to mentor students in research and clinical work, and basic science faculty whose research is relevant to addictive behaviors. Other critical elements include systematic development of clinical training opportunities, effective collaborations with community agencies for research and clinical training, meaningful research partnerships with other academic departments and specialized research centers, and external funding for training activities.

Although interpersonal trauma history (ITH) is frequently associated with alcohol use disorder (AUD), little is known about specific psychological constructs that may indirectly link these phenomena. This study hypothesized that one such construct may be negative cognitive schemas that often emerge in the aftermath of trauma. Secondary latent variable modeling was conducted using the Project MATCH sample of adults receiving treatment for AUD ( N = 1726; 24.3% women; 38.63% ITH). The negative cognitions latent variable provided an excellent fit to the data and showed evidence of strong measurement invariance. As hypothesized, negative cognitions mediated the inverse association between ITH at baseline and percent days abstinent from alcohol 12 weeks later. Findings suggest that negative cognitions may be a specific underlying mechanism and potential treatment target for individuals with ITH and AUD., Competing Interests: The authors of this article have no conflicts of interest.

Abstinence self-efficacy, coping skills, and therapeutic alliance are hypothesized mechanisms of behavioral change (MOBCs) in cognitive-behavioral therapy (CBT) for alcohol use disorder (AUD). However, little is known about when these hypothesized MOBCs change during treatment or in relation to the initiation of abstinence from alcohol, which the current study investigated. Patient-reported abstinence self-efficacy, drinking-related coping skills, and therapeutic alliance were measured at every session throughout a 12-session clinical trial that previously showed equivalent drinking reductions in female-specific individual- and group-based CBT for AUD. Participants (N = 121 women) were classified into subgroups based on whether and when they first initiated 14 days of continuous abstinence from alcohol during treatment. Interrupted time-series analyses evaluated the magnitude and timing of change in MOBC variables in relation to the initiation of abstinence. All three MOBC measures showed gradual improvements throughout treatment (within-subjects d = 0.03 to 0.09 change per week). Participants who initiated abstinence during treatment experienced additional sudden improvements in abstinence self-efficacy (d = 0.47) and coping skills (d = 0.27), but not therapeutic alliance (d = -0.02), the same week they initiated abstinence. Participants who were already abstinent when treatment started maintained higher abstinence self-efficacy and coping skills, but not therapeutic alliance, throughout treatment compared to participants who never initiated abstinence. Initiating abstinence may help facilitate improvements in abstinence self-efficacy and drinking-related coping skills. Clinicians may help patients anticipate when and how much these variables are expected to improve during treatment and encourage initiation of abstinence to potentially help facilitate improvements in abstinence self-efficacy and coping skills., (Copyright © 2019. Published by Elsevier Ltd.)

Combining pharmacological interventions with evidence-based behavioral interventions may help optimize treatment outcomes for alcohol use disorder (AUD). While several effective behavioral interventions for AUD have been developed, the vast majority target individual patients, despite evidence that behavioral interventions for couples have the ability to outperform individual treatments for AUD. Alcohol Behavioral Couples Therapy (ABCT) is an evidence-based behavioral intervention for couples that has been shown to significantly reduce AUD severity as well as improve relationship functioning. Accumulating evidence suggests that the neuropeptide oxytocin has the ability to reduce alcohol craving and consumption, symptoms of tolerance and withdrawal, and ameliorate neurobiological deficits associated with AUD. Furthermore, oxytocin has demonstrated the ability to increase prosocial behavior and cognition, and restore sensitivity to natural rewards such as interpersonal relationships. No study to date has examined the ability of oxytocin to enhance ABCT. Thus, the primary objective of this Phase II study is to examine the effects of oxytocin versus placebo in combination with ABCT in reducing AUD severity and improving relationship functioning. We also will utilize neuroimaging techniques before and after treatment to investigate the underlying pathophysiology of AUD among couples and identify prognostic indicators of treatment outcome. The findings from this study might provide critical new information to help inform clinical practice and accelerate research on the pharmacological treatment of AUD., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To determine the relative cost-effectiveness of individual female-specific cognitive behavioral therapy (I-FS-CBT) versus group female-specific cognitive behavioral therapy (G-FS-CBT)., Methods: This cost-effectiveness study is based on a randomized controlled trial in which 155 women seeking treatment for alcohol use disorder at an academic outpatient clinic were randomized to 12 manual-guided sessions of I-FS-CBT (n = 75) or G-FS-CBT (n = 80). The primary patient outcomes were the number of drinking days and the number of heavy drinking days during the 12-week treatment and 1-year follow-up periods. All cost data (including resource utilizations) were collected prospectively alongside the trial. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were used to determine the cost-effectiveness of I-FS-CBT relative to G-FS-CBT. Results are presented from the provider perspective., Results: During the 12-week treatment period, G-FS-CBT is likely to be cost-effective when the threshold value to decision-makers of one fewer drinking day (or one fewer day of heavy drinking) is less than $141 (or $258), and I-FS-CBT is likely to be cost-effective if the threshold is greater than $141 (or $258). During the 1-year follow-up period, G-FS-CBT is likely to be cost-effective when the threshold value to decision-makers of one fewer drinking day (or one fewer day of heavy drinking) is less than $54 (or $169), and I-FS-CBT is likely to be cost-effective if the threshold is greater than $54 (or $169). The results are robust to sensitivity analyses on several key cost parameters., Conclusions: Compared to I-FS-CBT, G-FS-CBT holds promise as a cost-effective approach, in both the short run and the long run, for improving drinking outcomes of women with alcohol use disorder., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Alcohol Behavioral Couple Therapy (ABCT) is an efficacious alcohol treatment. The purpose of the study was to describe patient and partner language and therapist behavior during therapy sessions and test a proposed causal model linking active ingredients of ABCT as measured by therapist behaviors, hypothesized mechanisms of behavior change as measured by in-session patient and partner language, and alcohol use outcomes., Method: Data came from couples in four ABCT clinical trials (N = 188; 86 males, 102 females, and their partners). Patient and partner verbal behaviors in session one and a mid-treatment session were coded using the System for Coding Couples' Interactions in Therapy-Alcohol. Therapist behavior was coded using the Couples Treatment Integrity Rating System. Percent days abstinent was calculated from daily drinking data for the first and second half of treatment and six months post-treatment., Results: Therapists delivered an adequate level of the ABCT interventions during treatment. During treatment, couples increased positive behaviors, talked less about drinking, and decreased their amount of motivational language. Therapist behaviors did not predict patient or partner behaviors during treatment or drinking outcomes. Partner advice in the first session predicted poorer drinking outcomes. At mid-treatment, patient behaviors as a block, and specific behaviors of contemptuousness toward their partner and sustain talk, predicted poorer drinking outcomes., Conclusions: During ABCT, patients decrease their drinking, and patient and partner behaviors change in predicted ways. Partner advice, patient contemptuousness, and patient sustain talk predicted poorer outcomes. Analyses of within-session verbal behavior did not support the hypothesized mechanisms for change for ABCT., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: To test group-based Female-Specific Cognitive Behavioral Therapy (G-FS-CBT) for women with Alcohol Use Disorder (AUD) against an individual Female-Specific Cognitive Behavioral Therapy (I-FS-CBT). This aims of this paper are to describe G-FS-CBT development, content, feasibility, acceptability, group process, engagement in treatment, and within- and post-treatment outcomes., Methods: Women with AUD (n=155) were randomly assigned to 12 manual-guided sessions of G-FS-CBT or I-FS-CBT; 138 women attended at least one treatment session., Results: Women in G-FS-CBT attended fewer sessions (M=7.6) than women in I-FS-CBT (M=9.7; p<.001). Women in both conditions reported high satisfaction with the treatments. Independent coders rated high fidelity of delivery of both G-FS-CBT and I-FS-CBT. Therapeutic alliance with the therapist was high in both conditions, with I-FS-CBT being slightly but significantly higher than G-FS-CBT. In the first six weeks of treatment, women in both treatment conditions significantly reduced their percent drinking days (PDD) and percent heavy days drinking (PHD) by equivalent amounts, maintained through the rest of treatment and the 12month follow up with no treatment condition effects. Women reported significant improvement in all but one of the secondary outcomes during treatment; gains made during treatment in depression, anxiety, autonomy, and interpersonal problems were maintained during the follow-up period, while gains made during treatment in use of coping skills, self-efficacy for abstinence, self-care, and sociotropy deteriorated over follow up but remained improved compared to baseline., Conclusions: Findings support the feasibility, acceptability, and efficacy of a group format for female-specific CBT for AUD, a new 12-session, single gender, community friendly, group therapy with programming specifically for women. Similar, positive outcomes for individual and group treatment formats were found for drinking, mood, coping skills, self-confidence, interpersonal functioning, and self-care., (Copyright © 2018. Published by Elsevier Inc.)

This study compared Female-Specific Cognitive Behavioral Therapy (FS-CBT) to evidence-based, gender-neutral CBT (GN-CBT; Epstein & McCrady, 2009) for women with alcohol use disorder (AUD). Women (N = 99) with AUD, mean age 48, were randomly assigned to 12 outpatient manual-guided sessions of FS-CBT (n = 44) or GN-CBT (n = 55). Women were assessed at baseline and 3, 9 and 15 months after baseline for drinking and for specific issues common among women with AUD. A FS-CBT protocol was developed that was discriminable on treatment integrity ratings from GN-CBT. No treatment condition differences were found in treatment engagement, changes in drinking, alcohol-related coping, abstinence self-efficacy, motivation to change, or constructs directly targeted in FS-CBT (sociotropy, autonomy, depression, anxiety). Women in both conditions were highly engaged and satisfied with treatment, and reported significant reductions in drinking and changes in desired directions for all other variables except social support for abstinence. In the year following treatment, women in the FS-CBT but not in the CBT condition reported an increase in percentage of abstainers in their social networks (0.69% per month, SE = 0.21, p = .002). The value and appeal of female-specific programming in AUD treatment has been established in the wider literature (Epstein & Menges, 2013), and the current study provides support for the use of the Female-Specific Cognitive Behavioral Therapy (FS-CBT) manual as an option that may yield outcomes similar to standard gender-neutral CBT for women with AUD. Future research should examine whether FS-CBT enhances treatment utilization for women. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Sudden gains (SGs) are defined as abrupt and significant improvements in mental health symptoms that occur between two psychotherapy sessions. Preliminary evidence suggests that SGs may be an important pattern of symptom reduction in the treatment of alcohol use disorder (AUD) (i.e., a steep between-session reduction in drinking or alcohol craving frequency or intensity) (Drapkin, Epstein, McCrady, & Eddie, 2015). The current study examined SGs within two randomized clinical trials (RCTs) testing female-specific cognitive behavior therapy (CBT) protocol for AUD (n=146). We tested a priori hypotheses about whether women's baseline depression, anxiety, and confidence to be abstinent while in a negative emotional state would predict attainment of SGs after attending sessions that addressed depression, anxiety, and emotion regulation (i.e., sessions five and six of the 12-session protocol). Data were collected at baseline, within treatment, and 15months after baseline. Results showed that women with high levels of depression and/or anxiety and low confidence to be abstinent in a negative emotional state at baseline were more likely to experience a SG (steep decrease in drinking) after sessions five and six (p=0.02). Further, among women with high levels of depression and/or anxiety at baseline, those who experienced both a SG in drinking after session five/six and had higher confidence to remain abstinent in a negative emotional state at the end of treatment reported lower drinking frequency at 9- but not 15-month follow-up [95% CI=(-2.65, -0.86)]. Findings support the value of providing interventions targeting mood and emotion regulation in AUD treatment for women., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Adolescent drinking influences, and is influenced by, peer alcohol use. Several efficacious adolescent alcohol interventions include elements aimed at reducing susceptibility to peer influence. Modeling these interventions within dynamically changing social networks may improve our understanding of how such interventions work and for whom they work best. We used stochastic actor-based models to simulate longitudinal drinking and friendship formation within social networks using parameters obtained from a meta-analysis of real-world 10th grade adolescent social networks. Levels of social influence (i.e., friends affecting changes in one's drinking) and social selection (i.e., drinking affecting changes in one's friendships) were manipulated at several levels, which directly impacted the degree of clustering in friendships based on similarity in drinking behavior. Midway through each simulation, one randomly selected heavy-drinking actor from each network received an "intervention" that either (a) reduced their susceptibility to social influence, (b) reduced their susceptibility to social selection, (c) eliminated a friendship with a heavy drinker, or (d) initiated a friendship with a nondrinker. Only the intervention that eliminated targeted actors' susceptibility to social influence consistently reduced that actor's drinking. Moreover, this was only effective in networks with social influence and social selection that were at higher levels than what was found in the real-world reference study. Social influence and social selection are dynamic processes that can lead to complex systems that may moderate the effectiveness of network-based interventions. Interventions that reduce susceptibility to social influence may be most effective among adolescents with high susceptibility to social influence and heavier-drinking friends. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Background: Although many providers recommend alcohol abstinence as an initial step in the treatment of alcohol use disorders (AUD), there is a scarcity of research on specific behavioral strategies to achieve this step. The current study examined efficacy of a unique abstinence planning intervention for alcohol in a cognitive behavioral therapy (CBT) outpatient protocol., Design: 128 women enrolled in a randomized controlled trial of CBT for AUD at a university-based clinic comprised the sample., Measurements: Session 1 manual-guided interventions included an abstinence planning discussion in which each woman chose a specific plan for achieving initial abstinence in collaboration with her therapist. Drinking data were collected via participant logs during the 16week within-treatment period and via Timeline Follow-Back interview at 12month follow-up., Findings: For 32.8% (n=42) of women who stopped drinking during the pre-treatment assessment period, their abstinence plan was to maintain abstinence (MA). 18.0% (n=23) of women chose a "cold turkey" approach (CT, abrupt cessation without medical assistance), and 46.1% (n=59) chose a "winding down" approach (WD, systematic reduction of drinking toward a specified quit date). Generalized Estimating Equations (GEE) analyses showed that type of abstinence plan chosen was differentially associated with percent days drinking (PDD) in later treatment (weeks 7-16) (p<0.01) and during 12month follow-up (p<0.01). Women in the WD group had the highest PDD for both time frames and women in the CT group drank more frequently during later treatment compared to those in the MA group. The association between plan and PDD during follow-up was moderated by early treatment PDD (weeks 1-7; p<0.01), such that women in the MA and WD groups had lower follow-up PDD if they were able to decrease their drinking during early treatment., Conclusions: Women who were maintaining abstinence at treatment entry or had planned to stop using alcohol abruptly (i.e., "cold turkey") after starting treatment had better overall drinking outcomes than those who chose to wind down. A plan to wind-down drinking appeared to be the most appealing option to women in the study and, among those who were able to successfully execute this winding down approach, was related to positive long-term drinking outcomes., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Research suggests that women with alcohol use disorders (AUDs) experience more severe medical and social consequences from alcohol use compared to men, but little is known about health improvements following alcohol treatment., Methods: This study sought to characterize the pre-treatment health status of 138 alcohol dependent women enrolled in 12 sessions of female-specific group or individual outpatient treatment and examine the degree to which alcohol treatment might promote positive quality of life changes. Quality of life was assessed using the World Health Organization Quality of Life measure at baseline and 3months later at the end of treatment., Results: The most common health problems at baseline were: smoking cigarettes (34.1%), hypertension (31.2%), obesity (27.5%), arthritis (21.0%), high cholesterol (17.4%), heart problems (8.7%), and a history of cancer (7.2%). Significant improvements across physical, t(117)=4.67, p<0.001, d=0.42; psychological, t(117)=7.31, p<0.001, d=0.62; social, t(117)=3.18, p=0.002, d=0.28; and environmental, t(117)=2.39, p=0.018, d=0.17; quality of life domains were seen after treatment. Percent days abstinent during treatment was positively associated with overall health satisfaction and psychological health at the end of treatment., Conclusions: Women presenting for outpatient treatment for alcohol use disorders report many comorbid negative health problems. Thus, it is important for both substance use and health care providers to consider the overlap of alcohol use problems and health domains. Furthermore, female-specific cognitive behavioral treatment for alcohol use disorders positively impacted multiple health domains for women, suggesting a potential transdiagnostic intervention to target co-occurring health and substance use problems., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Because it is not common in the U.S. for jails to allow inmates to continue opioid medications that have been started in the community, we aimed to assess whether inmates maintained on methadone showed different rates of recidivism, lengths of incarceration, and types of offenses than other incarcerated groups. We also analyzed rates of return to home clinics after release. In order to answer these questions this study used extant data from 960 adult inmates in a large metropolitan detention center who were in 1 of 4 groups: general population with no known substance use disorders, alcohol detoxification, methadone maintenance (MMT), and opioid detoxification. Recidivism was assessed for 1 year after release. Data were collected from medical screening forms and jail databases and included demographic variables, dates of admission and release, number of doses and total dosage of methadone if applicable, reason for incarceration, and the date of rebooking and nature of offense, if it occurred. There was a significant difference in time to rebooking, F (3956)=13.32, p=.00, with the MMT group taking longer to be rebooked (275.6 days) than the opioid (236.3 days) and alcohol detoxification groups (229.3 days), but not the general population group (286.2 days). Survival analysis indicated significantly better survival without rebooking in the MMT and general population groups than the alcohol and opioid detoxification groups. There also were differences in length of incarceration, F (3, 954)=9.02, p=.00, with the MMT group being incarcerated longer than other substance using groups; and in misdemeanor vs. felony rebooking offenses, χ 2 [3]=31.29, p<.01, with the opioid detoxification group being more likely to have a felony rebooking than the general or alcohol groups. In a separate analysis, data from 137 MMT clients, who were not precisely the same clients who were involved in other analyses reported in this article, indicated that over 97% returned to their home methadone clinics after incarceration. In summary, inmates who had been allowed to be maintained on methadone started in the community displayed a significantly longer time to be rearrested than inmates undergoing opioid or alcohol detoxification, but not inmates without substance use disorders. When they were rebooked, they were as likely as the opioid detoxification group to be rearrested for felony offenses., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Alcohol Behavioral Couple Therapy (ABCT) has emerged over the last 30 years as a highly efficacious treatment for those with alcohol use disorders. This review highlights the historical and conceptual underpinnings of ABCT, as well as the specific treatment elements and structure. Proposed active ingredients, moderators, and mediators of treatment outcome are discussed. Efficacy is evaluated for reductions in identified patient drinking, improved relationship functioning, and reductions in intimate partner violence. Adaptations of ABCT for substances other than alcohol are described. Other adaptations, including brief interventions, interventions addressing PTSD and TBI along with alcohol use, and interventions deliverable via technology platforms are described. Additional cost-benefit and cost-effectiveness findings supporting the economic value of ABCT are noted. Future directions for research in this area include possible adaptations for female identified patients, nontraditional couples, LGBT partners and dyads involving nonintimate partner relationships. The development of more flexible models and enhanced dissemination strategies may improve clinical uptake and utility as well as increasing the feasibility of this treatment for integrated healthcare settings., (© 2016 Family Process Institute.)

Almost half of convicted jail inmates have an alcohol use disorder and many are released to environments that put them in contact with network members and cues that make them more likely to relapse on alcohol or drugs. Given the high-risk period immediately following release, the purpose of this study was to examine the efficacy of a brief motivational intervention administered just prior to release to increase substance use treatment entry and attendance, decrease alcohol and drug use, and change social networks for inmates with alcohol use disorders. Forty adult male inmates with AUDs were consented into the study and randomized to a motivational intervention or the control condition (an educational intervention), and then were contacted to do a 1-month follow-up interview (62.5% completed this interview). Results indicated that conducting these interventions was feasible and considered extremely helpful by participants. Although there were no significant group differences, medium to large effect sizes suggest possible benefits from the motivational intervention in decreasing days of alcohol and drug use and increasing abstinence, and reducing the proportion of heavy drug users or users of any kind in the social network. Future studies should replicate these findings in larger sample sizes and over longer follow-up time periods. Results may have implications for the use of brief intervention strategies at jails for inmates with AUDs., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objectives: Alcohol Behavioral Couple Therapy (ABCT) is an efficacious treatment for alcohol use disorders. Coding treatment integrity can shed light on the active ingredients of ABCT, but there are no published studies of treatment integrity instruments for ABCT. The present study describes the development and initial reliability of the Treatment Integrity Rating System - Couples Version (C-TIRS) for ABCT., Methods: The C-TIRS was used to rate 284 first- and mid-treatment ABCT sessions of 188 couples in four randomized clinical trials., Results: Average inter-rater reliability for distinguishing ratings between C-TIRS items was fair-to-good for quantity items (intraclass correlation [ICC] = 0.64) and poor-to-fair for quality items (ICC = 0.41). Five C-TIRS subscales were defined a priori to measure treatment components involving cognitive-behavioral therapy, spouse involvement, couple therapy, common therapeutic factors, and overall adherence to the treatment protocol and had adequate internal reliability ( α = 0.74-0.89). Inter-rater reliability was fair to good on seven of ten scales but poor on three scales (ICC range = 0.17-0.72)., Conclusions: The C-TIRS was designed to provide information about quantity and quality of the delivery of ABCT components; however, further refinement of the C-TIRS is warranted before it should be used in frontline practice. Clinical implications and recommendations for future research are discussed.

Couple therapy for women with alcohol use disorders (AUDs) yields positive drinking outcomes, but many women prefer individual to conjoint treatment. The present study compared conjoint cognitive-behavioral therapy (CBT) for women with AUDs to a blend of individual and conjoint therapy. Participants were 59 women with AUDs (95% Caucasian, mean age = 46 years) and their male partners randomly assigned to 12 sessions of Alcohol Behavioral Couple Therapy (ABCT) or to a blend of 5 individual CBT sessions and 7 sessions of ABCT (Blended-ABCT). Drinking and relationship satisfaction were assessed during and for 1-year posttreatment. Treatment conditions did not differ significantly on number of treatment sessions attended, percentage of drinking days (PDD), or percentage of heavy drinking days (PDH), during or in the 12 months following treatment. However, effect size estimates suggested a small to moderate effect of Blended-ABCT over ABCT in number of treatment sessions attended (d = -.41), and first- and second-half within treatment PDD (d = -.41, d = -.28), and PDH (d = -.46, d = -.38). Moderator analyses found that women lower in baseline sociotropy had lower PDH across treatment weeks 1-8 than in Blended-ABCT than ABCT and that women lower in self-efficacy had lower PDH during follow-up in Blended-ABCT than in ABCT. The 2 treatment groups did not differ significantly in within-treatment or posttreatment relationship satisfaction. Results suggest that blending individual and conjoint treatment yields similar or slightly better outcomes than ABCT, is responsive to women's expressed desire for individual sessions as part of their treatment, and decreases the challenges of scheduling conjoint sessions. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Background and Aims: Drinking urges during treatment for alcohol use disorders (AUDs) are common, can cause distress and predict relapse. Clients may have little awareness of how their drinking urges might be expected to change during AUD treatment in general and in response to initiating abstinence. The aim of the present study was to test whether drinking urges change on a daily level during treatment and after initiating abstinence., Design: Secondary data analysis was performed using daily drinking urge ratings from two randomized clinical trials., Setting and Participants: Women (n = 98) and men (n = 79) with AUDs in separate clinical trials of out-patient AUD-focused cognitive-behavioral therapy., Measurements: Daily dichotomous indicators of any drinking urges or acute escalations in urges (i.e. at least two more urges compared with the previous day) were examined using generalized linear mixed growth-curve modeling., Findings: Participants who initiated abstinence reported reductions in urges immediately thereafter (log odds ratios: women B = -0.701, P < 0.001; men B = -0.628, P = 0.018), followed by additional, gradual reductions over time (women B = -0.118, P < 0.001; men B = -0.141, P < 0.001). Participants who entered treatment abstaining from alcohol also reported significant reductions in urges over time (women B = -0.147, P < 0.001; men B = -0.142, P < 0.001). Participants who drank throughout treatment had smaller (women B = -0.042, P = 0.012) or no reductions in urges (men B = 0.015, P = 0.545). There was no evidence that urges increased systematically in response to initiating abstinence., Conclusions: Drinking urges during out-patient behavioral treatment for alcohol use disorders may be maintained in part by alcohol consumption. Initiating abstinence is associated with reductions in drinking urges immediately and then more gradually over time., (© 2015 Society for the Study of Addiction.)

Couple-based treatments for alcohol use disorders (AUDs) produce higher rates of abstinence than individual-based treatments and posit that active involvement of both identified patients (IPs) and significant others (SOs) is partly responsible for these improvements. Separate research on couples' communication has suggested that pronoun usage can indicate a communal approach to coping with health-related problems. The present study tested whether communal coping, indicated by use of more first-person plural pronouns ("we" language), fewer second-person pronouns ("you" language), and fewer first-person singular pronouns ("I" language), predicted improvements in abstinence in couple-based AUD treatment. Pronoun use was measured in first- and mid-treatment sessions for 188 heterosexual couples in four clinical trials of alcohol behavioral couple therapy (ABCT). Percentages of days abstinent were assessed during treatment and over a 6-month follow-up period. Greater IP and SO "we" language during both sessions was correlated with greater improvement in abstinent days during treatment. Greater SO "we" language during first- and mid-treatment sessions was correlated with greater improvement in abstinence at follow-up. Greater use of IP and SO "you" and "I" language had mixed correlations with abstinence, typically being unrelated to or predicting less improvement in abstinence. When all pronoun variables were entered into regression models, only greater IP "we" langue and lower IP "you" language predicted improvements in abstinence during treatment, and only SO "we" language predicted improvements during follow-up. Most pronoun categories had little or no association with baseline relationship distress. Results suggest that communal coping predicts better abstinence outcomes in couple-based AUD treatment., (© 2015 Family Process Institute.)

This study aimed to examine whether classification of couples in which one partner has an alcohol problem is similar to that reported in the general couples literature. Typologies of couples seeking alcohol behavioral couple therapy (ABCT) were developed via hierarchical cluster analysis using behavioral codes of couple interactions during their first ABCT session. Four couples types based on in-session behavior were established reliably, labeled avoider, validator, hostile, and ambivalent-detached. These couple types resembled couples types found in previous research. Couple type was associated with baseline relationship satisfaction, but not alcohol use. Results suggest heterogeneity in couples with alcohol problems presenting to treatment; further study is needed to investigate the function of alcohol within these different types., (© 2015 American Association for Marriage and Family Therapy.)

Damage to the brain's white matter is a signature injury of alcohol use disorders (AUDs), yet understanding of risks associated with clinical and demographic characteristics is incomplete. This study investigated alcohol problem severity, recent drinking behavior, and demographic factors in relation to white matter microstructure in heavy drinkers. Magnetic resonance imaging (MRI) scans, including diffusion tensor imaging (DTI), were collected from 324 participants (mean age = 30.9 ± 9.1 years; 30% female) who reported five or more heavy drinking episodes in the past 30 days. Drinking history and alcohol problem severity were assessed. A common white matter factor was created from fractional anisotropy (FA) values of five white matter tracts: body of corpus callosum, fornix, external capsule, superior longitudinal fasciculus, and cingulate gyrus. Previous research has implicated these tracts in heavy drinking. Structural equation modeling (SEM) analyses tested the hypothesis that, after controlling for duration of alcohol exposure, clinical and behavioral measures of alcohol use severity would be associated with lower white matter factor scores. Potential interactions with smoking status, gender, age, treatment-seeking status, and depression or anxiety symptoms also were tested. Controlling for number of years drinking, greater alcohol problem severity and recent drinking frequency were significantly associated with lower white matter factor scores. The effect of drinking frequency differed significantly for men and women, such that higher drinking frequency was linked to lower white matter factor scores in women but not in men. In conclusion, alcohol problem severity was a significant predictor of lower white matter FA in heavy drinkers, after controlling for duration of alcohol exposure. In addition, more frequent drinking contributed to lower FA in women but not men, suggesting gender-specific vulnerability to alcohol neurotoxicity.

Background: The current review revisits the article entitled: "Active Ingredients: How and Why Evidence-Based Alcohol Behavioral Treatment Interventions Work" published in Alcoholism: Clinical and Experimental Research. This work summarized proceedings from a 2004 Symposium of the same name that was held at the Annual Meeting of the Research Society on Alcoholism (RSA). A decade has passed, which provides occasion for an evaluation of progress. In 2014, an RSA symposium titled Active Treatment Ingredients and Client Mechanisms of Change in Behavioral Treatments for Alcohol Use Disorders: Progress 10 Years Later did just that., Methods: The current review revisits state-of-the-art research on the 3 treatments examined 10 years ago: cognitive behavioral therapy, alcohol behavior couples therapy, and 12-step facilitation. Because of its empirically validated effectiveness and robust research agenda on the study of process outcome, motivational interviewing has been selected as the fourth treatment modality to be discussed. For each of these 4 treatments, the reviewers provide a critical assessment of current theory and research with a special emphasis on key recommendations for the future., Results: Noteworthy progress has been made in identifying active ingredients of treatments and mechanisms of behavior change in these 4 behavioral interventions for alcohol and other drug use disorders. Not only have we established some of the mechanisms through which these evidence-based treatments work, but we have also uncovered some of the limitations in our existing frameworks and methods., Conclusions: Further progress in this area will require a broader view with respect to conceptual frameworks, analytic methods, and measurement instrumentation., (Copyright © 2015 by the Research Society on Alcoholism.)

Parental alcohol use disorders (AUDs) have been conceptualized as a chronic stressor that can lead to deleterious long-term outcomes in children of individuals with AUDs. Yet, while many individuals are detrimentally affected by their parents' problematic alcohol use, and go on to manifest psychological problems, others do not. How individuals cope with the stress of having a parent with an AUD is believed to be an important moderator of this differential outcome. This study assessed whether individuals' alcohol-specific coping styles predicted alcohol use, positive or negative life events, and depression, using a sample of 465 college students, of whom 20% were adult children of individuals with alcohol use disorders, colloquially known as adult children of alcoholics (ACOAs), and a battery of well-validated, self-report measures. Participant ACOAs reported less 'engaged' and 'total' alcohol-specific coping strategies and more 'withdrawal' alcohol-specific coping strategies than their non adult children of alcoholics (NACOAs) counterparts. Across participants, women reported more 'engaged', 'tolerant/inactive', and 'total' coping than men. Although ACOAs reported significantly more negative life events, which predicted more passive coping styles, they did not differ significantly from NACOAs on measures of problematic alcohol use or depression, supporting theories of resilience in ACOAs regardless of their alcohol-specific coping styles. For NACOAs, 'tolerant' coping predicted greater depression and alcohol-related problems; 'engaged' coping predicted fewer alcohol problems. Results suggest that ACOAs cope differently with problematic alcohol use among relatives and friends compared with NACOAs and are more likely to experience negative life events. Additionally, alcohol-related coping strategies have more predictive utility in NACOAs than ACOAs., (© The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Individuals receiving treatment for alcohol use disorders (AUDs) often experience urges to drink, and reductions in drinking urges during cognitive-behavioral therapy (CBT) predict better treatment outcomes. However, little previous work has examined patterns of daily drinking urges during treatment. The present study examined patterns of change in daily drinking urges among participants in two randomized clinical trials of males ( N = 80 with 4401 daily recordings) and females ( N = 101 with 8011 daily recordings) receiving individual- or couples-based CBT. Drinking urges were common during treatment, occurring on 45.1% percent of days for men and 44.8% for women. Drinking urges and alcohol use for both genders decreased substantially during the course of treatment. Both genders had increases in drinking urges as more time elapsed since attending a treatment session. For men, this increase was most pronounced at the beginning of treatment, but for women it was most pronounced near the end of treatment. Alcohol use and drinking urges were both more likely to occur on weekends. The results suggest that these times may lead to higher risk for drinking, and clients may benefit from high-risk planning that is focused on these times.

Background: Preliminary studies have suggested that patients entering research trials for alcohol use disorders (AUDs) may show substantial reductions in drinking prior to beginning treatment., Objectives: Determine whether significant pretreatment reductions in drinking are present in a sample of alcohol-dependent women entering a psychotherapy trial for AUDs, and whether such pretreatment drinking reductions predict lower levels of drinking during and posttreatment., Method: The study included 136 women with DSM-IV alcohol dependence who participated in a trial of individual or couples-based cognitive behavioral therapy for AUDs. Repeated-measures ANOVAs were used to examine changes in drinking across the pretreatment assessment period, and hierarchical multiple regression was used to test whether pretreatment reductions in drinking predicted continued reduced drinking during treatment and follow-up at 12 months posttreatment., Results: Patients had significant reductions in drinking quantity and frequency throughout the pretreatment period, with one-third of the sample becoming abstinent prior to treatment. Controlling for baseline quantity and frequency of drinking, reductions in pretreatment drinking were predictive of reduced frequency of drinking within- and posttreatment, and lower quantity of drinking per drinking occasion in the within-treatment period but not the posttreatment period. Motivational level and treatment arm did not predict the level of change in drinking across the pretreatment period., Conclusions: The overall reductions in drinking are consistent with previous findings suggesting that female participants in AUD treatment trials can show a substantial amount of reduction in drinking during the pretreatment assessment phase, before therapy skills are imparted.