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APA Journal: Psychology of Addictive Behaviors

A brief mindfulness intervention for college student binge drinkers: A pilot study.Open in a New Window

The current study sought to evaluate the feasibility and efficacy of a brief mindfulness intervention aimed to reduce rates and consequences of binge drinking among college students. Participants were 76 undergraduate students assigned to a mindfulness/cue exposure group (MG) or a control/cue exposure only group (CG). Assessments were administered at the beginning of the initial session (i.e., baseline), the end of the initial session (i.e., posttreatment) and weekly for the subsequent 4 weeks. During the initial session, participants engaged in a cue exposure protocol that differed by group. The MG participated in a 60-min individual mindfulness intervention composed of didactic and experiential activities during the initial session. They participated in a mindfulness practice during the Week 2 follow-up assessment and were asked to engage in 1 hr of out-of-session mindfulness meditation each week during the 4-week assessment period. Treatment outcome examined changes in frequency of binge episodes, consequences of alcohol use, readiness to change alcohol use, alcohol refusal self-efficacy, and dispositional mindfulness between groups over time. Group differences in readiness to change, self-efficacy, and dispositional mindfulness were not found from baseline to posttreatment. Four weeks after the initial intervention, the MG reported significantly less binge episodes, fewer consequences of alcohol use, higherself-efficacy and higher dispositional mindfulness than the CG. Feasibility and participant acceptability of the intervention was demonstrated by consistent attendance, low attrition and high satisfaction ratings by the MG. Results provide initial support for the efficacy of a brief, mindfulness-based intervention among college students who report binge drinking. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Employment-based reinforcement of adherence to oral naltrexone in unemployed injection drug users: 12-month outcomes.Open in a New Window

Oral naltrexone could be a promising relapse-prevention pharmacotherapy for recently detoxified opioid-dependent patients; however, interventions are often needed to promote adherence with this treatment approach. We recently conducted a study to evaluate a 26-week employment-based reinforcement intervention of oral naltrexone in unemployed injection drug users (Dunn et al., 2013). Participants were randomly assigned into a contingency (n = 35) group required to ingest naltrexone under staff observation to gain entry into a therapeutic workplace or a prescription (n = 32) group given a take-home supply of oral naltrexone and access to the workplace without observed ingestion. Monthly urine samples were collected and analyzed for evidence for naltrexone adherence, opioid use, and cocaine use. As previously reported, contingency participants provided significantly more naltrexone-positive urine samples than prescription participants during the 26-week intervention period. The goal of this current study is to report the 12-month outcomes, which occurred 6 months after the intervention ended. Results at the 12-month visit showed no between-groups differences in naltrexone-positive, opioid-negative, or cocaine-negative urine samples and no participant self-reported using naltrexone at the follow-up visit. These results show that even after a period of successfully reinforced oral naltrexone adherence, longer-term naltrexone use is unlikely to be maintained after reinforcement contingencies are discontinued. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Pilot trial of an expressive writing intervention with HIV-positive methamphetamine-using men who have sex with men.Open in a New Window

Among men who have sex with men (MSM), the co-occurrence of trauma and stimulant use has negative implications for HIV/AIDS prevention. HIV-positive, methamphetamine-using MSM were recruited to pilot test a 7-session, multicomponent resilient affective processing (RAP) intervention that included expressive writing exercises targeting HIV-related traumatic stress. An open-phase pilot with 10 participants provided support for feasibility of intervention delivery such that 99% of the RAP sessions were completed in a 1-month period. Subsequently, 23 additional participants were enrolled in a pilot randomized controlled trial of the RAP intervention (n = 12) versus an attention-control condition that included writing exercises about neutral topics (n = 11). Acceptability was evidenced by participants randomized to RAP expressing significantly more negative emotions in their writing and reporting greater likelihood of recommending expressive writing exercises to a friend living with HIV. Over the 3-month follow-up period, attention-control participants reported significant decreases in HIV-related traumatic stress while RAP intervention participants reported no significant changes. Compared to attention-control participants, those in the RAP intervention reported significant reductions in the frequency of methamphetamine use immediately following the 1-month RAP intervention period. Thematic analyses of RAP expressive writing exercises revealed that multiple negative life events characterized by social stigma or loss contribute to the complex nature of HIV-related traumatic stress. Findings support the feasibility and acceptability of an exposure-based intervention targeting HIV-related traumatic stress. However, more intensive intervention approaches that simultaneously target trauma and stimulant use will likely be needed to optimize HIV/AIDS prevention efforts with this population. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Culturally specific versus standard smoking cessation messages targeting Hispanics: An experiment.Open in a New Window

Few smoking cessation trials have focused on U.S. Hispanics. Consequently, little is known about culturally specific considerations for intervention delivery. The purpose of this study was to test the efficacy of a written smoking cessation intervention varying in cultural specificity and language. Participants (N = 222) were English-Spanish bilingual Hispanic smokers recruited from the community. A 2 (cultural specificity—culturally specific or standard) × 2 (receipt of preferred language materials—preferred or less preferred) between-subjects experiment was conducted. Participants were assessed at baseline and at a 2-week post intervention follow-up. Dependent variables measured intervention evaluations (intended utilization and content evaluation), cigarettes smoked per day, and smoking cessation (secondary outcome). We hypothesized independent effects of cultural specificity, receipt of preferred language materials, and an interaction effect. Results demonstrated that intended utilization was greater among participants who received the intervention in their preferred language, F(1, 213) = 9.772, p = .002, η² = .044. No differences in content evaluations were observed. However, number of cigarettes smoked per day was lower, and self-reported cessation was significantly greater among participants who received a culturally specific intervention, F(1, 152) = 4.939, p = .028, partial η² = .031, and materials in their preferred language, OR = 5.356, p = .037, 95% CI [1.106, 25.948], respectively. In conclusion, this study contributes to our understanding of dimensions influencing responses to smoking cessation interventions among Hispanics. Both cultural specificity and preferred language delivery appear to be causally related to the intended utilization of interventions and smoking behavior. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Alcohol-related cues potentiate alcohol impairment of behavioral control in drinkers.Open in a New Window

The acute impairing effects of alcohol on inhibitory control are well-established, and these disinhibiting effects are thought to play a role in its abuse potential. Alcohol impairment of inhibitory control is typically assessed in the context of arbitrary cues, yet drinking environments are comprised of an array of alcohol-related cues that are thought to influence drinking behavior. Recent evidence suggests that alcohol-related stimuli reduce behavioral control in sober drinkers, suggesting that alcohol impairment of inhibitory control might be potentiated in the context of alcohol cues. The current study tested this hypothesis by examining performance on the attentional-bias behavioral activation (ABBA) task that measures the degree to which alcohol-related stimuli can reduce inhibition of inappropriate responses in a between-subjects design. Social drinkers (N = 40) performed the task in a sober condition, and then again following placebo (0.0 g/kg) and a moderate dose of alcohol (0.65 g/kg) in counterbalanced order. Inhibitory failures were greater following alcohol images compared to neutral images in sober drinkers, replicating previous findings with the ABBA task. Moreover, alcohol-related cues exacerbated alcohol impairment of inhibitory control as evidenced by more pronounced alcohol-induced disinhibition following alcohol cues compared to neutral cues. Finally, regression analyses showed that greater alcohol-induced disinhibition following alcohol cues predicted greater self-reported alcohol consumption. These findings have important implications regarding factors contributing to binge or “loss of control” drinking. That is, the additive effect of disrupted control mechanisms via both alcohol cues and the pharmacological effects of the drug could compromise an individual’s control over ongoing alcohol consumption. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Reinforcement sensitivity underlying treatment-seeking smokers’ affect, smoking reinforcement motives, and affective responses.Open in a New Window

Nicotine dependence has been suggested to be related to reinforcement sensitivity, which encompasses behavioral predispositions either to avoid aversive (behavioral inhibition) or to approach appetitive (behavioral activation) stimuli. Reinforcement sensitivity may shape motives for nicotine use and offer potential targets for personalized smoking cessation therapy. However, little is known regarding how reinforcement sensitivity is related to motivational processes implicated in the maintenance of smoking. Additionally, women and men differ in reinforcement sensitivity, and such difference may cause distinct relationships between reinforcement sensitivity and motivational processes for female and male smokers. In this study, the authors characterized reinforcement sensitivity in relation to affect, smoking-related reinforcement motives, and affective responses, using self-report and psychophysiological measures, in over 200 smokers before treating them. The Behavioral Inhibition/Activation Scales (BIS/BAS; Carver & White, 1994) was used to measure reinforcement sensitivity. In female and male smokers, BIS was similarly associated with negative affect and negative reinforcement of smoking. However, positive affect was positively associated with BAS Drive scores in male smokers, and this association was reversed in female smokers. BIS was positively associated with corrugator electromyographic reactivity toward negative stimuli and left frontal electroencephalogram alpha asymmetry. Female and male smokers showed similar relationships for these physiological measures. These findings suggest that reinforcement sensitivity underpins important motivational processes (e.g., affect), and gender is a moderating factor for these relationships. Future personalized smoking intervention, particularly among more dependent treatment-seeking smokers, may experiment to target individual differences in reinforcement sensitivity. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Drinking motives and attentional bias to affective stimuli in problem and non-problem drinkers.Open in a New Window

Problem drinking may reflect a maladaptive means of coping with negative emotions or enhancing positive emotions. Disorders with affective symptoms are often characterized by attentional biases for symptom-congruent emotionally valenced stimuli. Regarding addictions, coping motivated (CM) problem gamblers exhibit an attentional bias for negative stimuli, whereas enhancement motivated (EM) problem gamblers exhibit this bias for positive stimuli (Hudson, Jacques, & Stewart, 2013). We predicted that problem drinkers would show similar motive-congruent attentional biases. Problem and non-problem drinkers (n = 48 per group) completed an emotional orienting task measuring attentional biases to positive, negative, and neutral stimuli. As predicted, EM problem drinkers showed an attentional bias for positive information (i.e., reduced accuracy for positively cued trials). However, CM problem drinkers displayed a general distractibility (i.e., reduced accuracy, regardless of cue valence). The results add further support for Cooper et al.’s (1992) motivational model of alcohol use, and indicate potential motivation-matched intervention targets. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Alcohol-cue exposure effects on craving and attentional bias in underage college-student drinkers.Open in a New Window

The effect of alcohol-cue exposure on eliciting craving has been well documented, and numerous theoretical models assert that craving is a clinically significant construct central to the motivation and maintenance of alcohol-seeking behavior. Furthermore, some theories propose a relationship between craving and attention, such that cue-induced increases in craving bias attention toward alcohol cues, which, in turn, perpetuates craving. This study examined the extent to which alcohol cues induce craving and bias attention toward alcohol cues among underage college-student drinkers. We designed within-subject cue-reactivity and visual-probe tasks to assess in vivo alcohol-cue exposure effects on craving and attentional bias on 39 undergraduate college drinkers (ages 18–20). Participants expressed greater subjective craving to drink alcohol following in vivo cue exposure to a commonly consumed beer compared with water exposure. Furthermore, following alcohol-cue exposure, participants exhibited greater attentional biases toward alcohol cues as measured by a visual-probe task. In addition to the cue-exposure effects on craving and attentional bias, within-subject differences in craving across sessions marginally predicted within-subject differences in attentional bias. Implications for both theory and practice are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Cognitive control moderates the association between emotional instability and alcohol dependence symptoms.Open in a New Window

Previous research has linked emotional instability with problematic alcohol use. This may be a function of increased “hot” information processing (which is relatively automatic in nature and highly influenced by emotional states) for individuals with more emotional instability. According to dual-process models, cognitive control may attenuate the impact of emotional instability by preventing an overreliance on hot information processing. It was hypothesized that emotional instability would be positively associated with alcohol-related consequences, but that cognitive control would moderate this association. Participants were undergraduate students (n = 80) who endorsed drinking at moderate levels. Participants completed laboratory assessments of emotional instability, alcohol use and its consequences, and cognitive control. An observed variable path model examined the association between emotional instability and alcohol problems. Consistent with hypotheses, emotional instability was positively associated with alcohol consequences, and this relationship was moderated by cognitive control, at least for dependence symptoms. At low levels of cognitive control, there was a positive association between emotional instability and dependence symptoms (β = 0.514, p < .001), however, this association was attenuated and no longer significant at high levels of cognitive control (β = 0.095, p = .302). Emotional instability may promote alcohol dependence via an overreliance on hot information processing. Consistent with dual-process theory, this relationship is diminished among individuals with more cognitive control. Interventions focusing on increasing cognitive control may be effective in reducing alcohol pathology associated with emotional instability. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Prenatal substance exposure: What predicts behavioral resilience by early adolescence?Open in a New Window

Understanding behavioral resilience among at-risk adolescents may guide public policy decisions and future programs. We examined factors predicting behavioral resilience following intrauterine substance exposure in a prospective longitudinal birth-cohort study of 136 early adolescents (ages 12.4–15.9 years) at risk for poor behavioral outcomes. We defined behavioral resilience as a composite measure of lack of early substance use initiation (before age 14), lack of risky sexual behavior, or lack of delinquency. Intrauterine substance exposures included in this analysis were cocaine, tobacco, alcohol, and marijuana. We recruited participants from Boston Medical Center as mother–infant dyads between 1990 and 1993. The majority of the sample was African American/Caribbean (88%) and 49% female. In bivariate analyses, none and lower intrauterine cocaine exposure level predicted resilience compared with higher cocaine exposure, but this effect was not found in an adjusted model. Instead, strict caregiver supervision (adjusted odds ratio [AOR] = 6.02, 95% confidence interval (CI) [1.90, 19.00], p = .002), lower violence exposure (AOR = 4.07, 95% CI [1.77, 9.38], p < .001), and absence of intrauterine tobacco exposure (AOR = 3.71, 95% CI [1.28, 10.74], p = .02) predicted behavioral resilience. In conclusion, caregiver supervision in early adolescence, lower violence exposure in childhood, and lack of intrauterine tobacco exposure predicted behavioral resilience among a cohort of early adolescents with significant social and environmental risk. Future interventions should work to enhance parental supervision as a way to mitigate the effects of adversity on high-risk groups of adolescents. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Correction to Field et al. (2015).Open in a New Window

Reports an error in "The validity of different measures of automatic alcohol action tendencies" by Inge Kersbergen, Marcella L. Woud and Matt Field (Psychology of Addictive Behaviors, 2015[Mar], Vol 29[1], 225-230). In the Online First August 18, 2014, version of this report, there was an error in the byline for Inge Kersbergen and Matt Field. Both authors are affiliated with the University of Liverpool and United Kingdom Centre for Tobacco and Alcohol Studies, Liverpool, United Kingdom. All versions of this article have been corrected. (The following abstract of the original article appeared in record 2014-33794-001.) Previous studies have demonstrated that automatic alcohol action tendencies are related to alcohol consumption and hazardous drinking. These action tendencies are measured with reaction time tasks in which the latency to make an approach response to alcohol pictures is compared with the latency to make an avoidance response. In the literature, 4 different tasks have been used, and these tasks differ on whether alcohol is a relevant (R) or irrelevant (IR) feature for categorization and on whether participants must make a symbolic approach response (stimulus-response compatibility [SRC] tasks) or an overt behavioral response (approach avoidance tasks [AAT]) to the pictures. Previous studies have shown positive correlations between measures of action tendencies and hazardous drinking and weekly alcohol consumption. However, results have been inconsistent and the different measures have not been directly compared with each other. Therefore, it is unclear which task is the best predictor of hazardous drinking and alcohol consumption. In the present study, 80 participants completed all 4 measures of action tendencies (i.e., R-SRC, IR-SRC, R-AAT, and IR-AAT) and measures of alcohol consumption and hazardous drinking. Stepwise regressions showed that the R-SRC and R-AAT were the only significant predictors of hazardous drinking, whereas the R-AAT was the only reliable predictor of alcohol consumption. Our results confirm that drinking behavior is positively correlated with automatic alcohol approach tendencies, but only if alcohol-relatedness is the relevant feature for categorization. Theoretical implications and methodological issues are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


The relationship between childhood physical and emotional abuse and smoking cessation among U.S. women and men.Open in a New Window

Childhood maltreatment is associated with increased likelihood of smoking. The purpose of the current investigation was to compare quitting motives, quit attempts, and quit success between U.S. adult smokers with or without childhood maltreatment (physical or emotional abuse), and those with or without serious psychological distress (SPD). We also examined whether SPD mediated associations between childhood maltreatment and all outcomes. We analyzed data from a 2-wave cohort telephone survey of a national U.S. sample of current cigarette smokers (n = 751). We used generalized path modeling to examine associations between maltreatment/SPD and concerns about smoking, motivation to quit, quit attempts, and smoking cessation (among the overall sample and selecting for those who made at least 1 quit attempt between waves; n = 368). Among women, maltreatment and SPD were associated with lower likelihood of quitting as well as making a successful quit attempt. SPD mediated the association between maltreatment and likelihood of successfully quitting. Women with maltreatment also had stronger concerns about smoking and motivation to quit than those without maltreatment, although there were no differences in actual quit attempts made. Neither childhood maltreatment nor SPD was associated with smoking outcomes among men. Findings suggest that female smokers with a history of childhood maltreatment are motivated to quit smoking; however, they may have more difficulty quitting smoking as a result of SPD. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Affective behavior and temperament predict the onset of smoking in adolescence.Open in a New Window

Earlier use of tobacco in adolescence is associated with numerous adverse outcomes later in life. Although a number of studies have linked individual differences in affective functioning to adolescent smoking, these have relied primarily on self-report measures, and the contribution of different dimensions of affect to the onset of tobacco use during this period remains unclear. The current study examined these issues in a sample of 180 adolescents recruited from an ongoing prospective, longitudinal study examining emotional development. At approximately age 12, participants completed a questionnaire measure of affective temperament and took part in a family interaction task that was coded observationally to provide measures of dysphoric, aggressive, and positive behaviors. At 2 subsequent assessments, which took place approximately 2.5 years and 4 years after the initial assessment, participants completed a questionnaire measure of substance use. In total, 70 participants initiated smoking between the ages of 12 and 17. An earlier onset of smoking was predicted by more aggressive and less positive observed behavior during the interaction task, as well as lower levels of self-reported temperamental Effortful Control. There were no associations between dysphoric behaviors, or temperamental measures of negative affectivity or surgency and the onset of smoking. The findings add to a small body of literature demonstrating that behavioral components of affect can prospectively predict substance use in adolescence and suggest that different dimensions of affect show unique relationships with early substance use. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Protective behavioral strategies and future drinking behaviors: Effect of drinking intentions.Open in a New Window

Alcohol use is common among United States and Swedish high school students and is related to negative consequences. Whereas drinking intentions are associated with future drinking behaviors, the use of protective behavioral strategies (PBS) is associated with decreased alcohol-related harm among young adults. The interactive effect of PBS and drinking intentions in predicting alcohol outcomes has not been examined. Further, because most PBS studies have been conducted among U.S. college students, PBS research among other populations is needed. The aims of this study were to evaluate longitudinally (a) the relationships between drinking intentions, PBS and alcohol outcomes, and (b) the moderating roles of drinking intentions and country in these relationships among United States and Swedish high school drinkers. Data were collected at baseline, 6- and 12-month follow-ups on 901 Swedish and 288 U.S. high school drinkers. Drinking intentions were associated with more alcohol use and consequences, and use of certain PBS was related to fewer alcohol-related consequences over time. Additionally, the negative prospective relationship between use of PBS and alcohol use, but not alcohol-related consequences, was moderated by intentions, such that the relationship was stronger among participants endorsing high drinking intentions. Country did not moderate these relationships. These results provide initial support for the generalizability of PBS college research to United States and Swedish high school students and suggest that interventions targeting the use of PBS may be most effective among high school drinkers endorsing high drinking intentions. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Childhood cognitive measures as predictors of alcohol use and problems by mid-adulthood in a non-Western cohort.Open in a New Window

This study examined the relationship between childhood cognitive functioning and academic achievement and subsequent alcohol use and problems in a non-Western setting. We examined longitudinal data from a birth cohort sample (N = 1,795) who were assessed at age 11 years on cognitive measures and then approximately 25 years later on lifetime alcohol use and alcohol use disorder symptom count. The sample was from Mauritius (eastern Africa), which allowed us to examine these relationships in a non-Western society with a different social structure than is typical of prior cognitive studies on primarily White samples in Western societies. Poorer performance on the Trail Making Test B-A in childhood predicted being a lifetime drinker, even after covarying for gender, childhood psychosocial adversity, and Muslim religion. Lower academic achievement and verbal IQ, but not performance IQ, were predictive of subsequent alcohol problems after including demographic covariates; the relationship between verbal IQ and alcohol problems was stronger in females than males. A nonlinear relationship emerged for Trails, suggesting that only more extreme impairment on this measure was indicative of later alcohol problems. Results of this study provide evidence that verbal deficits and poor academic performance exist in a general cohort sample by age 11 years (when 99% were nondrinkers) for those who go on to develop alcohol problems. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


The role of the working alliance in treatment for alcohol problems.Open in a New Window

Little research has been done on the role of the therapeutic working alliance in treatment for alcohol problems. This longitudinal study’s objectives were (a) to identify predictors of working alliance and (b) to investigate whether client and/or therapist reports of the working alliance predicted posttreatment motivation and then later treatment outcome. Client and therapist perceptions of the working alliance were assessed after the first treatment session using a short form of the Working Alliance Inventory (WAI) among 173 clients taking part in the United Kingdom Alcohol Treatment Trial (UKATT) and randomized to motivational enhancement therapy (MET) or social behavior and network therapy (SBNT) with complete data on all measures of interest. Structural equation models were fitted to identify predictors of WAI scores and investigate the relationships between WAI and measures of drinking during treatment, posttreatment motivation, and successful treatment outcome (abstinent or nonproblem drinker), and measures of drinks per drinking day and nondrinking days, assessed 9 months after the conclusion of treatment. Motivation to change drinking when treatment began was a strong predictor of client—adjusted coefficient = 2.21 (95% confidence interval [CI] [0.36, 4.06]—but not therapist WAI. Client WAI predicted successful treatment outcome—adjusted odds ratios (OR) = 1.09 (95% CI [1.02, 1.17])—and had effects on drinking during treatment, and on posttreatment motivation to change. There was evidence for effect modification by treatment, with strong associations between WAI and posttreatment motivation, and evidence of WAI prediction of treatment outcomes in the MET group, but no evidence of associations for SBNT. Therapist WAI was not strongly associated with treatment outcome (adjusted OR = 1.05; 95% CI [0.99, 1.10]). The working alliance is important to treatment outcomes for alcohol problems, with client evaluation of the alliance strongly related to motivation to change drinking throughout treatment for MET. It was also much more important than therapist-rated alliance in this study. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Effects of long-term AA attendance and spirituality on the course of depressive symptoms in individuals with alcohol use disorder.Open in a New Window

Alcohol use disorder (AUD) is associated with depression. Although attendance at Alcoholics Anonymous (AA) meetings predicts reductions in drinking, results have been mixed about the salutary effects of AA on reducing depressive symptoms. In this single-group study, early AA affiliates (n = 253) were recruited, consented, and assessed at baseline, 3, 6, 9, 12, 18, and 24 months. Lagged growth models were used to investigate the predictive effect of AA attendance on depression, controlling for concurrent drinking and treatment attendance. Depression was measured using the Beck Depression Inventory (BDI) and was administered at baseline 3, 6, 12, 18, and 24 months. Additional predictors of depression tested included spiritual gains (Religious Background and Behavior questionnaire [RBB]) and completion of 12-step work (Alcoholics Anonymous Inventory [AAI]). Eighty-five percent of the original sample provided follow-up data at 24 months. Overall, depression decreased over the 24 month follow-up period. AA attendance predicted later reductions in depression (slope = −3.40, p = .01) even after controlling for concurrent drinking and formal treatment attendance. Finally, increased spiritual gains (RBB) also predicted later reductions in depression (slope = −0.10, p = .02) after controlling for concurrent drinking, treatment, and AA attendance. In summary, reductions in alcohol consumption partially explained decreases in depression in this sample of early AA affiliates, and other factors such as AA attendance and increased spiritual practices also accounted for reductions in depression beyond that explained by drinking. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


A mechanistic test of nicotine replacement therapy sampling for smoking cessation induction.Open in a New Window

Studies that explore the mechanisms of treatment effect are needed in the area of smoking cessation induction, the primary goal of which is to promote the occurrence of a quit attempt among individuals who report little interest in smoking cessation. This study tested the mediational effect of 5 psychological variables (motivation to quit, abstinence self-efficacy, knowledge of nicotine replacement therapy (NRT), and both positive and negative attitudes toward NRT) on the relationship between NRT sampling and smoking outcomes. Adults who reported low levels of intention to quit in the next month (n = 593) were recruited for a nationwide randomized clinical trial of NRT sampling. Participants provided self-report data via telephone interview on multiple occasions, with the final follow-up at 6 months. Motivation to quit, and to a lesser degree, abstinence self-efficacy at the end of the 6-week intervention best accounted for the effect of NRT sampling as a promoter of quit attempts, smoking reduction, and 7-day point prevalence abstinence. Providing smokers with free NRT samples, in addition to encouraging them to engage in temporary abstinence, results in meaningful change in motivation and self-efficacy, which in turn influence smoking outcomes. Cessation induction interventions should aim to increase motivation to quit and abstinence self-efficacy, above and beyond any efforts to increase knowledge or prompt attitudinal shifts. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


The moderating role of experiential avoidance in the relationships between internal distress and smoking behavior during a quit attempt.Open in a New Window

Recent smoking cessation studies have shown that decreasing experiential avoidance (EA; i.e., tendency to reduce or avoid internal distress) improves success, but to date none have examined the moderating effect of EA on the role of specific internal distress in smoking cessation. This study examined whether prequit general EA (Acceptance and Action Questionnaire) and smoking-specific EA (Avoidance and Inflexibility Scale) moderated the relations between 4 measures of postquit internal distress (depressive symptoms, negative affect, physical withdrawal symptoms, craving) and smoking. Forty adult smokers participated in a randomized controlled trial of distress tolerance treatment for smokers with a history of early lapse. Multilevel models showed that prequit smoking-specific EA, but not general EA, significantly moderated the relationship between all measures of internal distress, except craving, and smoking over 13 weeks postquit. When examined over 26 weeks, these relations remained unchanged for all, but the moderating effect became trend-level for depressive symptoms. Significant associations between postquit internal distress and smoking were found only in those with high prequit smoking-specific EA. Moreover, prequit smoking-specific EA did not predict postquit levels or changes in internal distress, suggesting that decreasing smoking-specific EA prequit may not reduce internal distress, but may instead reduce smoking risk in response to such distress during a quit attempt. Results mainly supported hypothesized relations, but only for smoking-specific EA. Smoking cessation interventions focusing on EA reduction may especially benefit those vulnerable to greater postquit depressive and withdrawal symptoms, and those who smoke to regulate aversive internal states. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


The role of avoidance and inflexibility in characterizing response to contingency management for cocaine use disorders: A secondary profile analysis.Open in a New Window

Contingency management (CM) is a reinforcement-based approach that provides tangible rewards for objectively verified drug abstinence. CM is the most effective available behavioral intervention for cocaine use disorders; however, response to CM is variable, with significant rates of nonresponse. In the present investigation, we conducted a secondary profile analysis to identify potentially modifiable cognitive–affective characteristics associated with CM response (abstinence vs. continued use) preceding a pharmacotherapy trial for cocaine dependence. Ninety-nine cocaine-dependent, treatment-seeking adults participated in a 4-week baseline CM procedure using high-value vouchers for submission of cocaine-negative urines. Separate profiles for responders and the nonresponders were established using standardized mean scores on relevant pretreatment measures of negative affect, experiential avoidance, cocaine withdrawal/craving, and impulsivity. Results indicated no differences between responder subgroups on baseline levels of negative affect, withdrawal/craving, or impulsivity; however, CM nonresponders, relative to responders, reported significantly higher levels of avoidance and behavioral inflexibility (p < .01) in the context of distressing cocaine-related thoughts, feelings, and bodily sensations. These data suggest that emotion regulation skills may serve as a therapeutic strategy for enhancing response to CM for cocaine use disorders. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


The role of personality in predicting drug and alcohol use among sexual minorities.Open in a New Window

Research consistently demonstrates that sexual minority status is associated with increased risk of problematic substance use. Existing literature in this area has focused on group-specific minority stress factors (e.g., victimization and internalized heterosexism). However, no known research has tested the incremental validity of personality traits as predictors of substance use beyond identified group-specific risk factors. A sample of 704 sexual minority adults was recruited nationally from lesbian, gay, bisexual, transgender, queer, and questioning community organizations and social networking Web sites and asked to complete an online survey containing measures of personality, sexual minority stress, and substance use. Hierarchical regression models were constructed to test the incremental predictive validity of five-factor model personality traits over and above known sexual minority risk factors. Consistent with hypotheses, extraversion and conscientiousness were associated with drug and alcohol use after accounting for minority stress factors, and all factors except agreeableness were associated with substance use at the bivariate level of analysis. Future research should seek to better understand the role of normal personality structures and processes conferring risk for substance use among sexual minorities. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


College students’ drinking motives and social-contextual factors: Comparing associations across levels of analysis.Open in a New Window

Prior investigations have established between-person associations between drinking motives and both levels of alcohol use and social-contextual factors surrounding that use, but these relations have yet to be examined at the within-person level of analysis. Moreover, exploring previously posited subtypes of coping motives (i.e., coping with depression, anxiety, and anger) may shed light on the within-person processes underlying drinking to cope. In this daily diary study of college student drinking (N = 722; 54% female), students reported each day how many drinks they consumed the previous evening in both social and nonsocial settings along with their motives for each drinking episode. Additionally, they reported whether they attended a party the evening before, the number of people they were with, the gender makeup of that group, and their perceptions of their companions’ drinking prevalence and quantity. External reasons for drinking—social and conformity motives—showed patterns largely consistent across levels of analysis and in agreement with motivational models. However, internal reasons for drinking—enhancement and coping motives—demonstrated divergent associations that suggest different processes across levels of analysis. Finally, coping subtypes showed differing associations with drinking levels and social-contextual factors dependent on the predisposing emotion and the level of analysis. These results suggest that internal drinking motives have unique state and trait components, which could have important implications for the application of motivational models to prevention and treatment efforts. We recommend including drinking motives (including coping subtypes) as within-person measures in future microlongitudinal studies. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


College student affect and heavy drinking: Variable associations across days, semesters, and people.Open in a New Window

This study tested associations between positive and negative affect and heavy drinking in 734 college students who completed daily diaries in 14-day bursts once per semester over 7 semesters (≤98 days per person). Three-level multilevel models tested whether affect and heavy drinking were linked across days, semesters, and persons. Higher daily, between-semester, and between-person positive affect were each associated with greater odds of heavy drinking on weekdays and on weekend days. A significant interaction with semester in college showed that the association between daily positive affect and heavy drinking on weekend days became stronger over time. That is, heavy drinking on a weekend day with higher positive affect was more likely in later years of college (OR = 2.93, Fall of 4th year), compared to earlier in college (OR = 1.80, Fall of 1st year). A similar interaction was found for between-semester positive affect and heavy drinking on weekdays. Higher daily negative affect was associated with a greater odds of heavy drinking on weekdays only for students who first began drinking in 7th grade or earlier (OR = 2.36). Results of this study highlight the importance of varied time spans in studying the etiology, consequences, and prevention of heavy drinking. Harm-reduction strategies that target positive affect-related drinking by encouraging protective behaviors during celebratory events may become increasingly important as students transition to later years of college. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Alcohol use longitudinally predicts adjustment and impairment in college students with ADHD: The role of executive functions.Open in a New Window

The primary aim of this study was to evaluate whether alcohol consumption longitudinally predicts the adjustment, overall functioning, and grade point average (GPA) of college students with ADHD and to determine whether self-report of executive functioning (EF) mediates these relationships. Sixty-two college students comprehensively diagnosed with ADHD completed ratings at the beginning and end of the school year. Regression analyses revealed that alcohol consumption rated at the beginning of the year significantly predicted self-report of adjustment and overall impairment at the end of the year, above and beyond ADHD symptoms and baseline levels of adjustment/impairment but did not predict GPA. Exploratory multiple mediator analyses suggest that alcohol use impacts impairment primarily through EF deficits in self-motivation. EF deficits in the motivation to refrain from pursuing immediately rewarding behaviors in order to work toward long-term goals appear to be particularly important in understanding why college students with ADHD who consume alcohol have a higher likelihood of experiencing significant negative outcomes. The implications of these findings for the prevention of the negative functional outcomes often experienced by college students with ADHD are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Clarifying observed relationships between protective behavioral strategies and alcohol outcomes: The importance of response options.Open in a New Window

Protective behavioral strategies (PBS), or harm-reduction behaviors that can potentially reduce alcohol consumption or associated problems, have been assessed in varied ways throughout the literature. Existing scales vary in focus (i.e., broad vs. narrow), and importantly, in response options (i.e., absolute frequency vs. contingent frequency). Absolute frequency conflates PBS use with number of drinking occasions, resulting in inconsistencies in the relationship between PBS use and alcohol outcomes, whereas contingent frequency is less precise, which could reduce power. The current study proposes the use of absolute frequencies to maximize precision, with an adjustment for number of drinking days to extricate PBS use from drinking occasions, resulting in a contingent score. Study 1 examined the associations between PBS subscales using the Strategy Questionnaire (Sugarman & Carey, 2007) and alcohol outcomes, finding that in raw score form the association between PBS and typical alcohol outcomes varied greatly from significantly positive to significantly negative, but adjusted score relationships were all consistent with harm reduction perspectives. In addition, curvilinear relationships with typical alcohol use were eliminated using the score adjustment, resulting in linear associations. Study 2 confirmed the findings from Study 1 with a more precise timeframe, additional alcohol assessments, and heavier college drinkers. The relationships between alcohol outcomes and PBS in raw score form were again varied, but became consistently negative using the score adjustment. Researchers examining PBS and related constructs should consider modifying current scales to include a precise frequency response scale that is adjusted to account for number of drinking occasions. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Examining the role of abstainer prototype favorability as a mediator of the abstainer-norms–drinking-behavior relationship.Open in a New Window

Past research has indicated that peer influence is associated with risky health behaviors, such as alcohol and other substance use (e.g., Maxwell, 2002; Santor, Messervey, & Kusumakar, 2000). Specifically, research has indicated that believing that more of one’s peers use alcohol predicts more favorable prototypes (risk images) of the typical alcohol user (Litt & Stock, 2011; Teunissen et al., 2014). However, it is unclear if this same relationship would hold when considering abstainer (i.e., people who do not use alcohol) cognitions. The primary goal of the present study was to determine whether normative perceptions of peer abstinence from alcohol predict alcohol consumption and whether this relationship is mediated by abstainer prototypes. Results from 2,095 college students (42% male) indicated that the relation between abstainer norms and drinking behavior was mediated by abstainer prototypes such that believing that more peers abstained from alcohol use predicted more favorable prototypes of the typical alcohol abstainer, which in turn predicted lower alcohol use. Results from this study provide important first steps to delineating the relationship between abstainer cognitions and alcohol use. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Online gaming in the context of social anxiety.Open in a New Window

In 2014, over 23 million individuals were playing massive multiplayer online role-playing games (MMORPGs). In light of the framework provided by Davis’s (2001) cognitive–behavioral model of pathological Internet use, social anxiety, expressions of true self, and perceived in-game and face-to-face social support were examined as predictors of Generalized Problematic Internet Use Scale (GPIUS) scores and hours spent playing MMORPGs per week. Data were collected from adult MMORPG players via an online survey (N = 626). Using structural equation modeling, the hypothesized model was tested on 1 half of the sample (N = 313) and then retested on the other half of the sample. The results indicated that the hypothesized model fit the data well in both samples. Specifically, expressing true self in game, higher levels of social anxiety, larger numbers of in-game social supports, and fewer supportive face-to-face relationships were significant predictors of higher GPIUS scores, and the number of in-game supports was significantly associated with time spent playing. The current study provides clinicians and researchers with a deeper understanding of MMORPG use by being the first to apply, test, and replicate a theory-driven model across 2 samples of MMORPG players. In addition, the present findings suggest that a psychometric measure of MMORPG usage is more indicative of players’ psychological and social well-being than is time spent playing these games. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


The impact of gambling advertising: Problem gamblers report stronger impacts on involvement, knowledge, and awareness than recreational gamblers.Open in a New Window

Although there is a general lack of empirical evidence that advertising influences gambling participation, the regulation of gambling advertising is hotly debated among academic researchers, treatment specialists, lobby groups, regulators, and policymakers. This study contributes to the ongoing debate by investigating perceived impacts of gambling advertising in a sample of gamblers drawn from the general population in Norway (n = 6,034). Three dimensions of advertising impacts were identified, representing perceived impacts on (a) gambling-related attitudes, interest, and behavior (“involvement”); (b) knowledge about gambling options and providers (“knowledge”); and (c) the degree to which people are aware of gambling advertising (“awareness”). Overall, impacts were strongest for the knowledge dimension, and, for all 3 dimensions, the impact increased with level of advertising exposure. Those identified as problem gamblers in the sample (n = 57) reported advertising impacts concerning involvement more than recreational gamblers, and this finding was not attributable to differences in advertising exposure. Additionally, younger gamblers reported stronger impacts on involvement and knowledge but were less likely to agree that they were aware of gambling advertising than older gamblers. Male gamblers were more likely than female gamblers to report stronger impacts on both involvement and knowledge. These findings are discussed with regard to existing research on gambling advertising as well as their implications for future research and policy-making. (PsycINFO Database Record (c) 2015 APA, all rights reserved)


Predicting attitudes toward a restrictive alcohol policy: Using a model of distal and proximal predictors.Open in a New Window

Previous research on attitudes toward a restrictive alcohol policy has mainly focused on variables such as demographics and own drinking as possible predictors. The present article adds to the existing literature by examining the impact of a set of beliefs and personal experiences with the harm caused by other peoples’ drinking. We suggest and test an analytic model in which the predictors are ranked according to their conceptual proximity to attitudes. The data stem from a Web survey in the Norwegian adult population (N = 1,951), mapping the respondents’ attitudes toward pricing policy and availability restrictions, belief in the harm-limiting effect of such measures, belief in the harm caused by drinking, and personal experiences with harm from others’ drinking. In line with the suggested model, belief in the effectiveness of restrictive measures and belief in the harm caused by drinking appeared as the strongest predictors. Attitudes were less strongly related to own drinking, and particularly to demographics. Altogether, 41% of the variance in attitudes was explained. Negative experience with other peoples’ drinking was a statistically significant predictor only among young respondents. The strong relationships between proximal predictors, such as belief in the harm caused by drinking and belief in the harm-limiting effect of restrictive measures and attitudes, indicate that support for a restrictive policy may be increased by focusing on awareness of such issues rather than on more distal predictors. However, further research is needed to acquire more knowledge about the mechanisms behind these associations. (PsycINFO Database Record (c) 2015 APA, all rights reserved)
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