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Psychology of Addictive Behaviors - Vol 31, Iss 1



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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Systematic review of SMART Recovery: Outcomes, process variables, and implications for research.

2017-02-06

Clinical guidelines recommend Self-Management and Recovery Training (SMART Recovery) and 12-step models of mutual aid as important sources of long-term support for addiction recovery. Methodologically rigorous reviews of the efficacy and potential mechanisms of change are available for the predominant 12-step approach. A similarly rigorous exploration of SMART Recovery has yet to be undertaken. We aim to address this gap by providing a systematic overview of the evidence for SMART Recovery in adults with problematic alcohol, substance, and/or behavioral addiction, including (i) a commentary on outcomes assessed, process variables, feasibility, current understanding of mental health outcomes, and (ii) a critical evaluation of the methodology. We searched six electronic peer-reviewed and four gray literature databases for English-language SMART Recovery literature. Articles were classified, assessed against standardized criteria, and checked by an independent assessor. Twelve studies (including three evaluations of effectiveness) were identified. Alcohol-related outcomes were the primary focus. Standardized assessment of nonalcohol substance use was infrequent. Information about behavioral addiction was restricted to limited prevalence data. Functional outcomes were rarely reported. Feasibility was largely indexed by attendance. Economic analysis has not been undertaken. Little is known about the variables that may influence treatment outcome, but attendance represents a potential candidate. Assessment and reporting of mental health status was poor. Although positive effects were found, the modest sample and diversity of methods prevent us from making conclusive remarks about efficacy. Further research is needed to understand the clinical and public health utility of SMART as a viable recovery support option. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



The proximal effects of acute alcohol use on female aggression: A meta-analytic review of the experimental literature.

2017-01-12

Experimental research on alcohol-related aggression has focused largely upon male participants, providing only a limited understanding of the proximal effects of acute alcohol use on aggression among females extrapolated from the male literature. The current meta-analysis was undertaken to summarize the effects of alcohol, compared to placebo or no alcohol, on female aggression as observed across experimental investigations. A review of the literature yielded 11 articles and 12 effect sizes for further analysis. The overall effect size of alcohol on female aggression was small and reached statistical significance (d = .17, p = .02, 95% confidence interval [.03, .30]). Meta-analytic examination of the experimental literature indicated that alcohol is a significant factor in female aggression. The overall alcohol–aggression effect was smaller than has been observed among male samples. Additional research is required to evaluate the influence of other factors on alcohol-related aggressive responding among female participants. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



Daily associations between PTSD, drinking, and self-appraised alcohol-related problems.

2017-01-09

Alcohol dependence (AD) and posttraumatic stress disorder (PTSD) are highly comorbid, yet limited research has focused on PTSD and daily drinking as they relate to self-appraised alcohol-related problems. In treatment contexts, patients’ appraisals of alcohol-related problems have implications for assessment, intervention strategies, and prognosis. This study investigated the moderating effect of within-person (daily symptoms) and between-person (overall severity) differences in PTSD on the association between daily drinking and same-day alcohol-related problems. Participants with comorbid AD and PTSD (N = 86) completed 1 week of Interactive Voice Recognition data collection, and logistic and γ-adjusted multilevel models were used to estimate odds and magnitude of self-appraised alcohol-related problems. Results revealed that both within-person and between-person PTSD moderated the association between number of drinks and severity of self-appraised problems. As within-person and between-person PTSD symptoms increased, there was a weaker association between number of drinks consumed and perceived alcohol-related problems. Contrasts further revealed that on nondrinking and light-drinking days, PTSD (both daily symptoms and overall severity) was positively associated with ratings of alcohol-related problems. However, PTSD was not associated with alcohol-related problems on heavier drinking days. In conclusion, more severe PTSD is associated with a less directly contingent relationship between drinking quantity and perceived alcohol-related problems. These findings suggest the importance of further investigations of this moderating effect as well as clinical treatment of comorbid AD and severe PTSD with functional analysis of drinking. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



Do brief motivational interventions reduce drinking game frequency in mandated students? An analysis of data from two randomized controlled trials.

2016-12-12

College students frequently engage in drinking games (DGs) and experience a variety of consequences as a result. It is currently unknown whether brief motivational interventions (BMIs) that provide feedback on DG participation can reduce this high risk behavior. This study examined outcome data from 2 randomized clinical trials to examine whether BMIs facilitate change in DG frequency and how these changes may occur. Mandated college students (Trial 1, N = 198, 46% female; Trial 2, N = 412; 32% female) were randomized to BMI or comparison control conditions. Hierarchical linear modeling (HLM) was used to compare the BMI and comparison groups to determine whether the BMI reduced DG participation over time. Percent change talk (PCT) during the discussion of DG during the session was examined as a predictor of change in DG frequency, and gender was examined as a moderator of treatment effects. Controlling for regular drinking frequency, participants who received a BMI did not significantly reduce their DG frequency relative to the comparison group in either sample, and the BMI was equally ineffective at reducing DG behavior for men and women. DG-related PCT during the BMI was associated with lower DG frequency at the second follow-up in both trials. In Trial 1, PCT during the BMI was associated with less steep increases in DG frequency across the course of all follow-ups. Effects of PCT on DG behavior were not moderated by gender. Findings did not support hypothesized reductions in DG participation following a BMI. Future research should explore whether targeted DG-specific interventions could reduce DG participation and the role of in-session client language in facilitating such change. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



Impulsive personality traits and alcohol use: Does sleeping help with thinking?

2017-01-16

Both impulsivity and sleep disturbance have been associated with heavy alcohol use among young adults; yet studies to date have not examined their interactive effects. The current study aimed to determine if adequate sleep moderates the association between impulsive personality traits and alcohol use among young adults. College students (N = 568) who had been mandated to alcohol treatment following violation of campus alcohol policy provided information regarding alcohol use and related consequences, impulsive personality traits (measured using the UPPS Impulsive Behavior Scale), and perception of sleep adequacy as part of a larger intervention trial. Higher urgency, lower premeditation, and higher sensation-seeking predicted greater levels of alcohol consumption, while higher urgency predicted more alcohol-related consequences. As hypothesized, there was a significant interaction between premeditation and sleep adequacy in the prediction of drinks per week; in contrast to hypotheses, however, premeditation was associated with drinking only among those reporting adequate (rather than inadequate) sleep. Specifically, the tendency to premeditate was associated with less drinking among those who reported adequate sleep and was not associated with drinking among those reporting inadequate sleep. Sensation-seeking and urgency are associated with greater alcohol involvement among young adults, regardless of sleep adequacy. Conversely, the ability to plan ahead and anticipate the consequences of one’s behaviors (premeditation) is only protective against heavy drinking among individuals receiving adequate sleep. With replication, these findings may inform alcohol prevention and intervention efforts. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



Lifetime Alcoholics Anonymous attendance as a predictor of spiritual gains in the Relapse Replication and Extension Project (RREP).

2017-01-12

This study investigated the association between extent of lifetime attendance in Alcoholics Anonymous (AA) and spiritual gains among treatment seeking adults for alcohol use disorder. Participants included 246 individuals from 2 of the 3 sites in the Relapse Replication and Extension Project (Lowman, Allen, Stout, & The Relapse Research Group, 1996). Baseline characteristics included 63% male, 39.9% single, and the average age was 34 years (SD = 8.2). The Alcoholics Anonymous Involvement questionnaire (Tonigan, Connors, & Miller, 1996) was used to assess lifetime AA attendance. The Religious Beliefs & Behaviors Questionnaire (Connors, Tonigan, & Miller, 1996) was used to assess spirituality. Percent days abstinent (PDA) and drinks per drinking day (DPDD) were measured using the Form 90. At baseline, adults with more extensive AA histories were more severely alcohol impaired although they were no older relative to adults with less past AA exposure. Clear patterns of AA engagement were found between the high–low AA history groups over follow-up, with adults with less AA experience reporting less AA participation across a swath of AA-specific measures. Gains in spiritual practices significantly mediated AA-related benefit as measured by PDA and DPDD. Tests for moderated-mediation indicated that the magnitude of the mediational effect of spiritual gains did not differ between high–low AA history groups. Having an extensive AA history did not advantage (or disadvantage) adults in mobilizing future spiritual practices that are prescribed in AA. Clinical assessment of client AA history is important, however, because it predicts both the nature and extent that clients may participate in AA. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



P3 event-related potential reactivity to smoking cues: Relations with craving, tobacco dependence, and alcohol sensitivity in young adult smokers.

2016-11-17

The current study tested whether the amplitude of the P3 event-related potential (ERP) elicited by smoking cues is (a) associated with the degree of self-reported craving reactivity, and (b) moderated by degree of tobacco dependence. Because alcohol and cigarettes are frequently used together, and given recent evidence indicating that individual differences in alcohol sensitivity influence reactivity to alcohol cues, we also investigated whether alcohol sensitivity moderated neural responses to smoking cues. ERPs were recorded from young adult smokers (N = 90) while they participated in an evaluative categorization oddball task involving 3 types of targets: neutral images, smoking-related images, and images of drinking straws. Participants showing larger P3 amplitudes to smoking cues and to straw cues (relative to neutral targets) reported greater increases in craving after cue exposure. Neither smoking status (daily vs. occasional use) nor psychometric measures of tobacco dependence consistently or specifically moderated P3 reactivity to smoking cues. Lower alcohol sensitivity was associated with larger P3 to smoking cues but not comparison straw cues (relative to neutral targets). This effect was further moderated by tobacco dependence, with the combination of lower sensitivity and higher dependence associated with especially pronounced P3 reactivity to smoking cues. The findings suggest the smoking-cue elicited P3 ERP component indexes an approach-oriented incentive motivational state accompanied by a subjective sense of cigarette craving. Self-reported low sensitivity to the pharmacologic effects of alcohol may represent a marker of drug cue reactivity and therefore deserves attention as a potential moderator in smoking cue exposure studies. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



Activity enjoyment, not frequency, is associated with alcohol-related problems and heavy episodic drinking.

2016-09-15

Depression and alcohol use disorder (AUD) commonly co-occur, and this comorbidity is associated with greater impairment and higher likelihood of relapse compared to either disorder alone. Identifying shared vulnerability across depression and AUD may aid in developing more parsimonious treatment approaches. Low levels of positive reinforcement for healthy behaviors have been implicated as a shared vulnerability across both depression and AUD. However, prior research in this area has largely been conducted among college students and has rarely examined depression and AUD symptoms together. This study aims to extend prior literature by examining the association between both the frequency and enjoyment of activities and AUD symptoms in a national sample of adults (n = 609) while also accounting for depressive symptoms. Study results indicated that low levels of enjoyment were associated with greater alcohol-related problems and frequency of heavy episodic drinking, above and beyond depressive symptoms. The frequency of potentially pleasurable activities was unrelated to alcohol-related problems or heavy episodic drinking. Findings extend prior literature by providing evidence for the association between enjoyment of activities and alcohol use, above and beyond depressive symptoms, among a national sample of adults. These results suggest that prioritizing enjoyment of activities, rather than frequency, may be important for behavioral intervention efforts to address heavy drinking and associated problems. Future longitudinal research using observational methods of behavior is needed to identify causal relationships between activity enjoyment and AUD symptoms. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



Public perceptions of behavioral and substance addictions.

2016-11-28

Most of the research on public perceptions of people with addictive disorders has focused on alcohol and illicit drugs, rather than addiction to behavioral activities. To expand the range of addictive behaviors and types of perceptions studied, we designed the present study to assess the lay public’s definitions of and willingness to affiliate with people described as addicted to 1 of 2 specific behaviors (i.e., pornography or gambling) or 1 of 3 specific substances (i.e., alcohol, marijuana, or heroin). A nationwide convenience sample (N = 612) of American adults completed online questionnaires during the summer of 2015. Participants rated heroin as more addictive than the other drugs and behaviors and, despite differences among the conditions, were generally unwilling to affiliate with an individual addicted to any of the 2 behaviors or 3 substances. When asked to rate different potential indications of addiction, participants endorsed behavioral signs of impaired control and physiological and psychological dependence as more indicative of all 5 types of addiction than desire to use the substance or engage in the addictive behavior. Despite recent efforts to increase public knowledge about addictive disorders, members of the public continue to endorse some attitudes indicative of stigmatization toward people with selected substance and behavioral addictions. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



Reliability and validity of data obtained from alcohol, cannabis, and gambling populations on Amazon’s Mechanical Turk.

2016-11-28

Researchers recently have begun using Mechanical Turk (MTurk), an online crowdsourcing platform, to recruit addiction populations. However, whether the data obtained from substance users and gamblers on MTurk are reliable and valid is unknown. Herein, we assessed the internal and retest reliability of and concurrent and convergent validity of data obtained from addiction populations on MTurk. Current drinkers (N = 208), cannabis users (N = 200), and gamblers (N = 200) residing in the United States completed measures of alcohol, cannabis, and gambling severity, psychological constructs (e.g., impulsivity) related to addictions, overt and subtle measures of valid responding, and motivations for completing MTurk studies. Of the original sample, 88–92% of participants who provided informed consent for recontact completed a reassessment 1 week later. The internal consistency of the addiction severity measures ranged from α = .75 to .93. The stability over 1 week ranged from κ = .57 to .70 for categorical classification, and intraclass correlation coefficient (ICC) = .71 to .86 for continuous measures. The addiction measures were significantly correlated with each other and with other constructs related to addictive behaviors. Overall, 80–85% of participants provided valid responses. They reported attending and answering questions honestly, with financial motives being the most frequently endorsed motivation. After invalid responses were excluded, results remained the same for alcohol and gambling, but significant differences emerged for the cannabis sample. The results suggest that the self-report data obtained from alcohol and gambling populations are of high quality, however, caution is warranted with cannabis populations. MTurk shows promise as a recruitment tool for some addictive behaviors. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



Development and validation of the Gambling Pathways Questionnaire (GPQ).

2016-12-12

The Pathways Model (Blaszczynski & Nower, 2002) is a theoretical framework that proposes three pathways for identifying etiological subtypes of problem gamblers. The model has been used to assist clinicians in developing individualized treatments that target not only the gambling behavior but also associated risk factors that may undermine recovery and precipitate relapse. The current study sought to develop and validate a new screening instrument, based on the Pathways Model for treatment-seeking gamblers. Participants were gamblers age 18 and over who scored 1+ symptoms on the Problem Gambling Severity Index of the Canadian Problem Gambling Index and presented to one of 22 participating treatment centers in Canada, the United States, and Australia (N = 1,176). Data were collected on 127 items, consisting of 62 core items that reflected variables in the Pathways Model and 65 experimental items derived from recent scholarly literature in gambling etiology. Exploratory and confirmatory factor analyses identified the following six factors: Antisocial Impulsive Risk-Taking, Stress-Coping, Mood Pre-Problem-Gambling Onset, Mood Post-Problem-Gambling Onset, Child Maltreatment, and Meaning Motivation. The Gambling Pathways Questionnaire showed excellent internal consistency (α = .937), with good to high reliability found for each of the six factors, ranging from .851 to .945. Cluster analysis results demonstrated that the three-factor model produced good model fit to the data: Cluster 1 (Behaviorally Conditioned Subtype), Cluster 2 (Emotionally Vulnerable Subtype) and Cluster 3 (Antisocial, Impulsive Risk-Taking Subtype). The present study is the first to present an empirical measure for assigning problem gamblers to etiological subtypes for use as a screening tool in treatment settings. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



Psychometric properties of the Short Inventory of Problems (SIP) with adjudicated DUI intervention participants.

2017-01-12

We used responses of two large samples of court-ordered participants from a statewide alcohol/driving safety program to investigate factor structure, score reliability, and criterion-related validity of the Short Inventory of Problems (SIP). Exploratory and confirmatory factor analyses, using both item-level and subscore-level data, support a one-factor structure for the SIP. Internal consistency score reliability estimates were consistent across samples and high enough to warrant use for making decisions about individuals. Item response theory model calibration of the scale, using a two-parameter logistic model, yielded consistent estimates of location and discrimination (slope) across samples. Estimated scale scores correlated moderately with an independent indicator of alcohol problems and poorly with an indicator of risky driving behavior, lending evidence of convergent and discriminant validity. We judge the SIP as adequately described by a single factor, that the joint person-item scale is coherent, and scores behave consistently across samples. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



The effect of therapists’ adherence and competence in delivering the adolescent community reinforcement approach on client outcomes.

2016-10-13

[Correction Notice: An Erratum for this article was reported in Vol 31(1) of Psychology of Addictive Behaviors (see record 2016-59284-001). In the article, the disclosed interest for Mark D. Godley in the author note is misrepresented. The accurate representation is that the organization employing Mark D. Godley, Chestnut Health Systems, receives fees for A-CRA training. In addition, the disclosed interest statement for Jane Ellen Smith and Robert J. Meyers should read Jane Ellen Smith and Robert J. Meyers each have private consulting businesses that conduct workshops on CRA or A-CRA; they also receive royalties on the CRA book. All versions of this article have been corrected.] Central to the debate over the implementation of empirically supported treatments is whether therapist skill has a measurable, positive relationship with client outcome. The fidelity and skill with which therapists deliver treatments have been studied under the constructs of adherence and competence. Evidence for a relationship between adherence and competence and client outcomes has been mixed, possibly due to small sample sizes, potentially inadequate measures for rating therapists’ skill, and limited statistical methods. The current study used a data set in which 91 therapists provided services to 384 clients from the Assertive Adolescent and Family Treatment project. Therapists trained to deliver the Adolescent Community Reinforcement Approach (A-CRA) submitted audiorecorded sessions to independent raters during their training process. Measures of adherence and competence derived from session ratings were examined in a multilevel model for associations with client substance use outcomes at 3-, 6-, and 12-month follow-ups. Therapist competence was significantly predictive of decreases in clients’ days of substance use. Therapist adherence was not predictive of client substance use outcomes in the full sample; however, when only those clients who completed the 12-month follow-up were included, between-therapists adherence was found to be predictive of a decrease in client substance use. This study adds to the evidence that competence in the delivery of treatment is associated with better client treatment outcomes. Adherence may be associated with better treatment outcomes as it was in follow-up completers. Future research should investigate the nature of the relationship between protocol-specific adherence and competence and client outcomes. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



“The effect of therapists’ adherence and competence in delivering the adolescent community reinforcement approach on client outcomes”: Correction to Campos-Melady et al. (2016).

2016-12-08

Reports an error in "The Effect of Therapists’ Adherence and Competence in Delivering the Adolescent Community Reinforcement Approach on Client Outcomes" by Marita Campos-Melady, Jane Ellen Smith, Robert J. Meyers, Susan H. Godley and Mark D. Godley (Psychology of Addictive Behaviors, Advanced Online Publication, Oct 13, 2016, np). In the article, the disclosed interest for Mark D. Godley in the author note is misrepresented. The accurate representation is that the organization employing Mark D. Godley, Chestnut Health Systems, receives fees for A-CRA training. In addition, the disclosed interest statement for Jane Ellen Smith and Robert J. Meyers should read Jane Ellen Smith and Robert J. Meyers each have private consulting businesses that conduct workshops on CRA or A-CRA; they also receive royalties on the CRA book. All versions of this article have been corrected. (The following abstract of the original article appeared in record 2016-49310-001.) Central to the debate over the implementation of empirically supported treatments is whether therapist skill has a measurable, positive relationship with client outcome. The fidelity and skill with which therapists deliver treatments have been studied under the constructs of adherence and competence. Evidence for a relationship between adherence and competence and client outcomes has been mixed, possibly due to small sample sizes, potentially inadequate measures for rating therapists’ skill, and limited statistical methods. The current study used a data set in which 91 therapists provided services to 384 clients from the Assertive Adolescent and Family Treatment project. Therapists trained to deliver the Adolescent Community Reinforcement Approach (A-CRA) submitted audiorecorded sessions to independent raters during their training process. Measures of adherence and competence derived from session ratings were examined in a multilevel model for associations with client substance use outcomes at 3-, 6-, and 12-month follow-ups. Therapist competence was significantly predictive of decreases in clients’ days of substance use. Therapist adherence was not predictive of client substance use outcomes in the full sample; however, when only those clients who completed the 12-month follow-up were included, between-therapists adherence was found to be predictive of a decrease in client substance use. This study adds to the evidence that competence in the delivery of treatment is associated with better client treatment outcomes. Adherence may be associated with better treatment outcomes as it was in follow-up completers. Future research should investigate the nature of the relationship between protocol-specific adherence and competence and client outcomes. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



Working alliance and empathy as mediators of brief telephone counseling for cigarette smokers who are not ready to quit.

2017-02-06

Working alliance and empathy are believed to be important components of counseling, although few studies have empirically tested this. We recently conducted a randomized controlled trial in which brief motivational and reduction counseling failed to increase the number of participants who made a quit attempt (QA) in comparison to usual care (i.e., brief advice to quit). Our negative findings could have been due to nonspecific factors. This secondary analysis used a subset of participants (n = 347) to test (a) whether, in comparison to usual care, brief telephone-based motivational or reduction counseling predicted greater working alliance or empathy; (b) whether changes in these nonspecific factors predicted an increased probability of a QA at a 6-month follow-up; and (c) whether counseling affected the probability of a QA via working alliance or empathy (i.e., mediation). Findings were similar for both active counseling conditions (motivational and reduction) versus usual care. In comparison to usual care, active counseling predicted greater working alliance (p < .001) and empathy (p < .05). Greater working alliance predicted a greater probability of a QA (p < .001) but, surprisingly, greater empathy predicted a decreased probability of a QA (p < .05) at the 6-month follow-up. Working alliance (p < .001) and empathy (p < .05) mediated the active counseling’s effects on the probability of a QA. One explanation for our motivational and reduction interventions’ failure to influence QAs in comparison to usual care is that working alliance and empathy had opposing effects on quitting. Our analyses illustrate how testing nonspecific factors as mediators can help explain why a treatment failed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)