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Preview: Psychology of Addictive Behaviors - Vol 23, Iss 4

Psychology of Addictive Behaviors - Vol 31, Iss 3

The Psychology of Addictive Behaviors publishes peer-reviewed original articles related to the psychological aspects of addictive behaviors. Articles on the following topics are included: (a) alcohol and alcoholism, (b) drug use and abuse, (c) eating diso

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Copyright: Copyright 2017 American Psychological Association

Providing intensive addiction/housing case management to homeless veterans enrolled in addictions treatment: A randomized controlled trial.


This study sought to determine whether homeless veterans entering Veterans Affairs (VA) substance use treatment randomized to intensive addiction/housing case management (AHCM) had improved housing, substance use, mental health, and functional outcomes and lower acute health care utilization, compared to a housing support group (HSG) control. Homeless veterans (n = 181) entering outpatient VA substance use treatment were randomized to AHCM and HSG and received treatment for 12 months. AHCM provided individualized housing, substance use and mental health case management, life skills training, and community outreach. The control condition was a weekly drop-in housing support group. Adjusted longitudinal analyses compared groups on baseline to month 12 change in percentage of days housed and functional status, substance use, and mental health outcomes (36-Item Short-Form Health Survey; Addiction Severity Index [ASI]). Negative binomial regression models compared groups on health care utilization. Both conditions significantly increased percentage of days housed, with no differences detected between conditions. In total, 74 (81.3%) AHCM and 64 (71.1%) HSG participants entered long-term housing (odds ratio = 1.9, 95% confidence interval [0.9, 4.0], p = .088). HSG participants experienced a greater decrease in emergency department visits than AHCM (p = .037), whereas AHCM participants remained in substance use treatment 52.7 days longer (p = .005) and had greater study treatment participation (p < .001) than HSG. ASI alcohol composite scores improved more for HSG than AHCM (p = .006), and both conditions improved on ASI drug and psychiatric scores and alcohol/drug abstinence. AHCM did not demonstrate overarching benefits beyond standard VA housing and substance use care. For those veterans not entering or losing long-term housing, different approaches to outreach and ongoing intervention are required. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Substance use prevention and treatment outcomes for emerging adults in non-college settings: A meta-analysis.


Emerging adults have the highest prevalence rate of alcohol and drug use and represent a large proportion of treatment admissions in the United States. Those who do not attend college experience higher rates of use and may not have similar advantages as those attending college. A systematic review included studies investigating prevention and treatment outcomes among emerging adults in non-college settings. We included studies reporting an average age between 18 and 25 conducted outside of college settings. We extracted data for experimental effects (experimental group compared to control), and contrasted treatments with active and no intervention controls. We also examined several moderators. Fifty studies were meta-analyzed, including 32 prevention and 18 treatment studies. Overall, our experimental weighted mean effect size was d = .17 for both prevention and treatment studies. Comparisons across treatment types typically yielded nonsignificant results. Across prevention and treatment studies, smaller effects existed for studies delivering personalized feedback interventions. For treatment studies only, the percent of students included in the sample was a significant moderator. Overall effects were similar to current meta-analyses on college drinking. However, personalized feedback may be a less effective prevention strategy in non-college settings, and the field should prioritize increasing the effectiveness of treatments targeting non-college students. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Drinking among strangers: A meta-analysis examining familiarity as a moderator of alcohol’s rewarding effects.


Drinking in unfamiliar social settings has long been linked to alcohol problems. A large body of indirect evidence has accumulated to suggest that alcohol’s rewarding subjective effects—both tension relieving and positive-mood enhancing—will be magnified when it is consumed among strangers versus among familiar individuals. But the link between social familiarity and alcohol reward has never been examined. I conducted a meta-analysis of 21 alcohol-administration studies featuring social context (total N = 2,046), examining the effects of alcohol on self-reports of mood and social outcomes and on behaviors in the context of social interactions. Studies were classified according to whether participants involved in the social interaction were previously acquainted prior to study participation (familiarity condition) and also according to other characteristics of the social interaction and alcohol-dosing procedure. Results of random effects metaregression models revealed a significant effect of familiarity in moderating alcohol response, Q(1) = 9.80, p = .0002. Alcohol-related social–emotional enhancement was significantly larger when studies examined interactions among strangers (d = .48, 95% confidence interval [CI: .34, .61]) versus when they examined interactions among familiar individuals (d = .09, 95% CI [−.12, .29]). Of note, in analyses examining self-reports and behaviors separately, findings indicated that alcohol consumption leads to similar behavioral disinhibition across familiar and unfamiliar contexts but that the consequences of this disinhibition for internal subjective experience may differ depending on familiarity. Overall, results suggest that individuals may gain more subjective reward from alcohol in unfamiliar social contexts, pointing to familiarity as a potentially promising line of inquiry for research examining mechanisms of risk for alcohol problems. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

A computer adaptive testing version of the Addiction Severity Index—Multimedia Version (ASI–MV): The Addiction Severity CAT.


The purpose of this study was to develop and validate a computer adaptive testing (CAT) version of the Addiction Severity Index—Multimedia Version (ASI–MV), the Addiction Severity CAT. This goal was accomplished in 4 steps. First, new candidate items for Addiction Severity CAT domains were evaluated after brainstorming sessions with experts in substance abuse treatment. Next, this new item bank was psychometrically evaluated on a large nonclinical (n = 4,419) and substance abuse treatment (n = 845) sample. Based on these results, final items were selected and calibrated for the creation of the Addiction Severity CAT algorithms. Once the algorithms were developed for the entire assessment, a fully functioning prototype of an Addiction Severity CAT was created. CAT simulations were conducted, and optimal termination criteria were selected for the Addiction Severity CAT algorithms. Finally, construct validity of the CAT algorithms was evaluated by examining convergent and discriminant validity and sensitivity to change. The Addiction Severity CAT was determined to be valid, sensitive to change, and reliable. Further, the Addiction Severity CAT’s time of completion was found to be significantly less than the average time of completion for the ASI–MV composite scores. This study represents the initial validation of an Addiction Severity CAT based on item response theory, and further exploration of the Addiction Severity CAT is needed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Craving and tobacco use: Development of the choice behavior under cued conditions (CBUCC) procedure.


Many addiction theories propose that craving modulates smoking. Research on this relationship has yielded mixed results, which might be explained, in part, by a consideration of the various behaviors representing tobacco use. Tobacco use can be divided into seeking (attempts to access cigarettes) and consumption (ingestion of tobacco). Seeking can be further divided into behaviors that reflect the operation of automatic or nonautomatic cognitive processes. We developed a procedure (Choice Behavior Under Cued Conditions) to systematically examine the relationships between craving and these behaviors. Over multiple trials, thirty dependent smokers were exposed to a lit cigarette or a cup of water located behind a locked glass door. On each trial, participants rated craving and indicated the amount of money ($.01–$.25) they would spend to gain access to the cue. The amount spent, which determined the probability that the door would be unlocked and participants could sample the cue, indexed nonautomatic seeking. Latency to access the cue indexed automatic seeking behavior, and puff duration indexed consumption. Participants on average reported mild to moderate craving levels and had significantly higher craving and spent significantly more money on cigarette trials than water trials, though they did not access the cigarette more quickly than the water. Craving was significantly associated with money spent on cigarette trials (r = 0.54, p < .001) and puff duration (r = 0.38, p < .05), but not with latency (r = 0.35, p = .06). Overall, the data support the utility of this new procedure for examining the relationships between craving and various manifestations of tobacco use. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Depressive symptoms mediate the relationship between changes in emotion regulation during treatment and abstinence among women with alcohol use disorders.


Women with alcohol use disorders (AUD) experience high rates of co-occurring conditions, such as depression and posttraumatic stress disorder (PTSD), which can complicate treatment engagement and response. Therefore, identifying factors that underlie alcohol use, depression, and PTSD symptoms in women with AUD has important treatment implications. The current study investigated emotion regulation as one such underlying factor. We tested a model that examined the extent to which changes in emotion regulation during treatment predicted women’s depression and PTSD symptom severity at treatment completion and subsequent alcohol use following treatment. The study included 48 participants enrolled in a randomized controlled trial of interpersonal psychotherapy versus usual care for women with co-occurring alcohol dependence and major depression. Assessments were conducted at baseline, posttreatment (16 weeks), and follow-up (24 weeks). Descriptive statistics of baseline data revealed heightened levels of emotion dysregulation in this sample, which were related to fewer days abstinent from alcohol, more negative consequences from alcohol, and greater PTSD symptom severity. Women’s lower depressive symptoms at the end of treatment were found to mediate the relationship between improved emotion regulation during the treatment period and greater abstinence following treatment. Posttreatment PTSD symptoms, however, were not found to mediate that relationship. These results suggest that improvements in depressive symptoms during treatment are associated with emotion regulation at the end of treatment, which may contribute to greater abstinence from alcohol following treatment. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

An application of deviance regulation theory to reduce alcohol-related problems among college women during spring break.


Spring break (SB) can lead to heavy episodic drinking and increased alcohol-related risks. This may be especially relevant for women. The current study utilized deviance regulation theory to increase the use of protective behavioral strategies (PBSs) among female college students on SB. Female college students going on SB (n = 62) completed a screening, a pre-SB intervention (where they were randomly assigned to receive either a positively or negatively framed message about individuals who do or do not use PBS), and a post-SB assessment that provided alcohol and PBS use data for each day of SB (n = 620 person-days). Data were analyzed using a multilevel structural equation model. In the negative frame, SB PBS use was higher among those who perceived SB PBS norms to be more common on SB relative to non-SB. In the positive frame, SB PBS use was higher among those who perceived SB PBS norms to be less common on SB relative to non-SB. These associations did not result in lower alcohol consumption, but did result in a lower likelihood of experiencing alcohol-related problems during SB. These results suggest that a brief online intervention, that utilizes targeted messages based on normative perceptions of SB PBS use, could be an effective strategy for reducing alcohol-related consequences among college student women during SB. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

When alcohol is only part of the problem: An event-level analysis of negative consequences related to alcohol and other substance use.


While alcohol remains the drug of choice for most college students, national data show that 40% of college students also use other substances (e.g., marijuana, cocaine, etc.). Longitudinal studies indicate that students who report use of both alcohol and other substances experience more consequences (e.g., blackout, arrests). The current study expands upon this research by using a multilevel approach to examine average and event-level alcohol combined with other substance use (ALC+) and its role on consequences experienced. In addition, the research examined which substance combined with alcohol posed the most risk. A total of 461 students reported on alcohol use, substance use, and consequences experienced (e.g., Young Adult Alcohol Consequences Questionnaire [YAACQ]) on 12 weekend nights (Thursday, Friday, Saturday) across 4 weekends in an academic year. Multilevel model analyses revealed a positive association between both average and event-level ALC+ use and the number of consequences experienced. A significant cross-level interaction was also revealed indicating students who typically combine alcohol and other substances experienced more consequences on occasions when they use more substances relative to students who typically use alcohol only. Finally, alcohol plus nicotine, or marijuana, or attention-deficit/hyperactivity disorder (ADHD) medications, or cocaine were all significantly positively related to increased consequences. These findings provide consistent evidence that ALC+ use is a highly prevalent behavior among college students that increases risk of problematic consequences. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Daily stressors as antecedents, correlates, and consequences of alcohol and drug use and cravings in community-based offenders.


Justice-involved individuals with alcohol and drug use problems reoffend at higher rates than their nonusing counterparts, with alcohol and drug use serving as an important vector to recidivism. At the daily level, exposure to stressors may exacerbate problematic alcohol and drug use; at the individual level, prior treatment experiences may mitigate substance use as individuals adapt to and learn new coping mechanisms. We conducted a daily diary study using Interactive Voice Response technology over 14 consecutive days with 117 men on probation or parole participating in a community-based treatment program (n = 860 calls) and referred to medication-assisted treatment. Participants reported daily stressors, craving for alcohol and illegal drugs, and use of alcohol and illegal drugs 1 time each day. Results of multilevel models showed significant day-to-day fluctuation in alcohol and drug craving and use. In concurrent models, increases in daily stressors were associated with increases in cravings and use of illegal drugs. Prior treatment experience modified many of these relationships, and additional lagged models revealed that those with less treatment experience reported an increase in next-day alcohol craving when they experienced increases in stressors on the previous day compared to those with more treatment experience. Collectively, these findings highlight the importance of tailoring treatment as a function of individual differences, including prior treatment experiences, and targeting daily stressors and subsequent cravings among justice-involved adults with alcohol and drug use problems. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

The association between daily PTSD symptom severity and alcohol-related outcomes in recent traumatic injury victims.


The self-medication hypothesis proposes that individuals experiencing posttraumatic stress disorder (PTSD) symptoms may use alcohol (or other substances) to self-medicate distress, while the mutual maintenance hypothesis proposes that alcohol use also exacerbates or maintains distress. Existing research largely supports the self-medication hypothesis. However, findings are often based upon retrospective reporting of problems and assessment of symptoms anchored to a trauma occurring in the remote past. To improve on these retrospective designs, the current study examined the relationship between daily PTSD symptom severity and alcohol-related outcomes during the early phase of recovery following a traumatic physical injury. Specifically, 36 injury victims reported on PTSD symptom severity, alcohol craving, alcohol consumption, and negative drinking consequences thrice daily (morning, afternoon, night) over 7 days beginning 6 weeks postinjury. Results indicated relationships between PTSD symptom severity and alcohol craving/negative consequences when these experiences were assessed concurrently within the same signal (particularly during the nighttime assessments). Prospective models found that nighttime PTSD symptom severity was related to negative drinking consequences occurring the following morning, even after controlling for consumption level, suggesting a more general behavioral regulation problem. Results were less supportive of the mutual maintenance hypothesis. Collectively, these results suggest that health interventions targeting PTSD symptom severity in recent injury victims—particularly when delivered at night—may be able to prevent problematic alcohol use. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

E-cigarette use, perceptions, and cigarette smoking intentions in a community sample of young adult nondaily cigarette smokers.


E-cigarettes have been suggested as a strategy for reducing harm from cigarettes. Although e-cigarettes could be a less-harmful alternative to cigarettes for those trying to quit, there may also be costs that outweigh any benefits of reduction. The purpose of the present study was to prospectively investigate perceptions of e-cigarettes, cigarette smoking intentions, and their associations with e-cigarette use over time. Community participants (N = 348, 57% male) aged 18 to 24 years were recruited for a longitudinal study of tobacco use. Inclusion criteria included nondaily cigarette smoking for ≥ 6 months with no history of daily smoking. Participants reported e-cigarette use over the past 14 days at baseline, and for the past 9 days at 3, 6, and 9 months. Assessments were completed online or via mobile phone. Across the 4 assessments, 22% to 33% of participants reported recent e-cigarette use. Intent to quit smoking cigarettes and intent to maintain smoking were unrelated to e-cigarette frequency. E-cigarette frequency was positively associated with perceiving e-cigarettes as less harmful than cigarettes and more positive e-cigarette expectancies (ps < .05). E-cigarette use was also more frequent among those who smoked cigarettes frequently and who used e-cigarettes to circumvent cigarette bans more often (ps < .05). The combination of these findings suggests that, at least among nondaily smoking young adults, other factors may influence frequency of e-cigarette use more than harm reduction. Findings instead seem consistent with the hypothesis that e-cigarettes are more often used to complement ongoing cigarette smoking. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

User identified positive outcome expectancies of electronic cigarette use: A concept mapping study.


Electronic cigarette (ECIG) use is growing in popularity, but little is known about the perceived positive outcomes of ECIG use. This study used concept mapping (CM) to examine positive ECIG outcome expectancies. Sixty-three past 30-day ECIG users (38.1% female) between the ages of 18 and 64 (M = 37.8, SD = 13.3) completed a CM module. In an online program, participants provided statements that completed a prompt: “A specific positive, enjoyable, or exciting effect (i.e., physical or psychological) that I have experienced WHILE USING or IMMEDIATELY AFTER USING an electronic cigarette/electronic vaping device is. . . .” Participants (n = 35) sorted 123 statements into “piles” of similar content and rated (n = 43) each statement on a 7-point scale (1 = Definitely NOT a positive effect to 7 = Definitely a positive effect). A cluster map was created using data from the sorting task, and analysis indicated a 7 cluster model of positive ECIG use outcome expectancies: Therapeutic/Affect Regulation, High/Euphoria, Sensation Enjoyment, Perceived Health Effects, Benefits of Decreased Cigarette Use, Convenience, and Social Impacts. The Perceived Health Effects cluster was rated highest, although all mean ratings were greater than 4.69. Mean cluster ratings were compared, and females, younger adults, past 30-day cigarette smokers, users of more “advanced” ECIG devices, and nonlifetime (less than 100 lifetime cigarettes) participants rated certain clusters higher than comparison groups (ps < 0.05). ECIG users associate positive outcomes with ECIG use. ECIG outcome expectancies may affect product appeal and tobacco use behaviors and should be examined further to inform regulatory policies. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Genetic variation in the exome: Associations with alcohol and tobacco co-use.


Shared genetic factors represent one underlying mechanism thought to contribute to high rates of alcohol and tobacco co-use and dependence. Common variants identified by molecular genetic studies tend to confer only small disease risk, and rare protein-coding variants are posited to contribute to disease risk, as well. However, given that genotyping technologies allowing for their inclusion in association studies have only recently become available, the magnitude of their contribution is poorly understood. The current study examined genetic variation in protein-coding regions (i.e., the exome) for associations with measures of lifetime alcohol and tobacco co-use. Participants from the UCSF Family Alcoholism Study (N = 1,862) were genotyped using an exome-focused genotyping array, and assessed for DSM–IV diagnoses of alcohol and tobacco dependence and quantitative consumption measures using a modified version of the Semi-Structured Assessment for the Genetics of Alcoholism. Analyses included single variant, gene-based, and pathway-based tests of association. One EMR3 variant and a pathway related to genes upregulated in mesenchymal stem cells during the late phase of adipogenesis met criteria for statistical significance. Suggestive associations were consistent with previous findings from studies of substance use and dependence, including variants in the CHRNA5–CHRNA3–CHRNB4 gene cluster with cigarettes smoked per day. Further, several variants and genes demonstrated suggestive association across phenotypes, suggesting that shared genetic factors may underlie risk for increased levels of alcohol and tobacco use, as well as psychopathology more broadly, providing insight into our understanding of the genetic architecture underlying these traits. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Genetic and environmental origins of gambling behaviors from ages 18 to 25: A longitudinal twin family study.


Gambling behaviors tend to increase in prevalence from late adolescence to young adulthood, and the underlying genetic and environmental influences during this period remain largely understudied. We examined the genetic and environmental influences on gambling behaviors contributing to stability and change from ages 18 to 25 in a longitudinal, behavioral genetic mixed-sex twin study design. Participants were enrolled in the Minnesota Twin Family Study. A range of gambling behaviors (maximum frequency, average frequency, money lost, and gambling problems) were assessed at ages 18 and 25. The results of our study support the following conclusions: (a) the genetic and environmental factors impacting a range of gambling behaviors are largely similar in men and women, (b) genetic factors increase in influence from 18 to 25 (21% at age 18 to 57% at age 25), (c) shared environmental factors are influential at age 18, but tend to decrease from ages 18 to 25 (55% at age 18 to 10% at age 25), and (d) nonshared environmental influences are similarly significant and are small to moderate in magnitude at both ages. The findings add to a small yet important research area regarding determinants of youth gambling behaviors and have the potential to inform prevention and intervention efforts. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Measuring the slot machine zone with attentional dual tasks and respiratory sinus arrhythmia.


Recent accounts of problematic electronic gaming machine (EGM) gambling have suggested attentional pathology among at-risk players. A putative slot machine zone is characterized by an intense immersion during game play, causing a neglect of outside events and competing goals. Prior studies of EGM immersion have relied heavily upon retrospective self-report scales. Here, the authors attempt to identify behavioral and psychophysiological correlates of the immersion experience. In samples of undergraduate students and experienced EGM users from the community, they tested 2 potential behavioral measures of immersion during EGM use: peripheral target detection and probe-caught mind wandering. During the EGM play sessions, electrocardiogram data were collected for analysis of respiratory sinus arrhythmia (RSA), a measure of calming self-regulation governed by the parasympathetic nervous system. Subjective measures of immersion during the EGM play session were consistently related to risk of problem gambling. Problem gambling score, in turn, significantly predicted decrements in peripheral target detection among experienced EGM users. Both samples showed robust RSA decreases during EGM play, indicating parasympathetic withdrawal, but neither immersion nor gambling risk were related to this change. This study identifies peripheral attention as a candidate for quantifying game immersion and its links with risk of problem gambling, with implications for responsible gambling interventions at both the game and venue levels. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)