Biomedical subjects

G J Connors

Publications and source records attributed to G J Connors.

At least 19 recordsLinked to original sources

PubMed2001

Reducing alcohol consumption among heavily drinking women: evaluating the contributions of life-skills training and booster sessions.

Problem-drinking women (N = 144) without histories of severe physical dependence on alcohol received drinking-reduction training and were assigned to receive (or not receive) 2 treatment enhancements: life-skills training and booster sessions. The design resulted in 4 treatment conditions: drinking-reduction treatment (DRT) plus life-skills training, DRT plus booster sessions, DRT plus life-skills training and booster sessions, or DRT only. The interventions entailed 13 hr of DRT, 7 hr devoted to the life-skills training or to a no-life-skills training educational module, plus 8 hr of booster sessions for those receiving them. Participants evidenced significant reductions in alcohol use during the 18 months after treatment. Those with greater pretreatment drinking evidenced differential response to the experimental manipulations: The treatment enhancements (life skills and booster sessions) led to significantly improved drinking outcomes among women who were heavier drinkers at pretreatment. There were no significant effects of the treatment enhancements among lighter drinkers at pretreatment. The results provide support for use of treatment enhancements in interventions designed to moderate women problem drinkers' alcohol use.

Adult↗

PubMed2000

Treatment settings for persons with alcoholism: evidence for matching clients to inpatient versus outpatient care.

This study compared inpatient, intensive outpatient, and standard outpatient treatment settings for persons with alcoholism and tested a priori hypotheses about the interaction of setting with client alcohol involvement and social network support for drinking. Participants (N = 192) were assigned randomly in cohorts to 1 of the 3 settings. The settings did not differ in posttreatment primary drinking outcomes, although inpatients had significantly fewer jail and residential treatment days combined than outpatients. Clients high in alcohol involvement benefited more from inpatient than outpatient care; the opposite was true at low alcohol involvement levels. Network drinking support did not moderate setting effects. Clients low in cognitive functioning also appeared to benefit more from inpatient than outpatient care. Improved outcomes might be achieved by matching degree of alcohol involvement and cognitive functioning to level of care.

Adult↗

PubMed2000

Alcohol treatment, changes in coping skills, self-efficacy, and levels of alcohol use and related problems 1 year following treatment initiation.

The relationships among alcohol treatment, coping skills, and self-efficacy in predicting alcohol use and related consequences following treatment initiation were investigated. The participants were 77 men and 65 women who were entering either inpatient or outpatient alcohol treatment. The analyses confirmed predictions that treatment, coping skills, and self-efficacy each contributed significantly to the prediction of 12-month alcohol consumption beyond the variance accounted for by participant control variables. Only self-efficacy explained significant additional variance in the consequences outcome. Mediation analyses of the alcohol consumption variables suggested that treatment effects were not mediated by either coping skills or self-efficacy and that the effects of coping skills were not mediated by self-efficacy. The findings are interpreted as providing partial support for social learning theory approaches. Suggestions for future research are discussed.

Adaptation, Psychological↗

PubMed2000

Alcoholics Anonymous and the use of medications to prevent relapse: an anonymous survey of member attitudes.

OBJECTIVE: The purpose of this study was to systematically assess the attitudes of Alcoholics Anonymous (AA) members toward the newer medications used to prevent relapse (e.g., naltrexone) and to assess their experiences with medication use, of any type, in AA. METHOD: Using media solicitations and snowball sampling techniques, 277 AA members were surveyed anonymously about their attitudes toward use of medication for preventing relapse and their experiences with medication use of any type in AA. RESULTS: Over half the sample believed the use of relapse-preventing medication either was a good idea or might be a good idea. Only 17% believed an individual should not take it and only 12% would tell another member to stop taking it. Members attending relatively more meetings in the past 3 months had less favorable attitudes toward the medication. Almost a third (29%) reported personally experiencing some pressure to stop a medication (of any type). However, 69% of these continued taking the medication. CONCLUSIONS: The study did not find strong, widespread negative attitudes toward medication for preventing relapse among AA members. Nevertheless, some discouragement of medication use does occur in AA. Though most AA members apparently resist pressure to stop a medication, when medication is prescribed a need exists to integrate it within the philosophy of 12-step treatment programs.

Adult↗

PubMed2000

Predicting the therapeutic alliance in alcoholism treatment.

OBJECTIVE: Prediction of the therapeutic alliance in alcoholism treatment (as rated by the client and by the therapist) was examined in light of a range of potentially relevant factors, including client demographics, drinking history, current drinking, current psychosocial functioning and therapist demographics. METHOD: The data were gathered in Project MATCH. The present analyses were based on data from 707 outpatients and 480 aftercare clients assigned to one of the three Project MATCH treatments. Potential predictor variables were evaluated by first examining bivariate linear relationships between the variables and ratings of the alliance, and then entering blocks of these predictors into multiple linear regression equations with alliance ratings as the dependent variables. All analysis incorporated adjustments for the nonindependence of ratings pertaining to clients seen by the same therapist. RESULTS: In simple regressions evaluating bivariate relationships, outpatients' ratings of the alliance were positively predicted by client age, motivational readiness to change, socialization, level of perceived social support and therapist age, and were negatively predicted by client educational level, level of depression, and meaning seeking. Therapist ratings in the outpatient sample were positively predicted by the client being female and by level of overall alcohol involvement, severity of alcohol dependence, negative consequences of alcohol use, and readiness to change. Among aftercare clients, ratings of the alliance were positively predicted by readiness to change, socialization and social support, and were negatively predicted by level of depression. Therapist ratings of the alliance in the aftercare sample were positively predicted by the client being female and therapist educational level, and were negatively predicted by pretreatment drinks per drinking day. Of the variables having significant bivariate relationships with alliance scores, only a few were identified as significant predictors in multiple regression equations. Among outpatients, client age and motivational readiness to change remained positive predictors and client education a negative predictor of client ratings of the alliance, while client gender remained a significant predictor of therapist ratings. Among aftercare clients, readiness to change and level of depression remained significant predictors of client ratings, while none of the variables remained a significant predictor of therapist ratings. CONCLUSIONS: While the data indicate that several client variables predict the nature of both the client's and therapist's perception of the therapeutic alliance, the significant relationships are of modest magnitude, and few variables remain predictive after controlling for causally prior variables. The strongest relationship identified in both the outpatient and aftercare samples is that between clients' motivational readiness to change and their ratings of the alliance.

Adult↗

PubMed1999

Strategies for preparing clients for treatment. A review.

Substantial numbers of mental health clients do not return following their initial therapy visits or drop out of treatment prematurely. Two general classes of strategies designed to reduce premature attrition and enhance treatment participation are reviewed. Research on psychotherapy preparatory techniques (role induction, vicarious therapy pretraining, and experiential pretraining) indicates that these educational techniques are effective in reducing early treatment attrition and may be especially effective with populations at high risk for dropout (e.g., lower socioeconomic groups, chronically mentally ill clients, and institutionalized juvenile delinquents). Motivational interviewing, a technique originally developed for clients with alcohol problems, is designed to reduce client ambivalence toward therapy and change and enhance commitment to and motivation for treatment. Research in the alcohol field suggests that a session of pretreatment motivational interviewing enhances treatment outcome. Both motivational interviewing and psychotherapy preparatory techniques are relatively brief and easy to incorporate into existing mental health care.

Behavior Therapy↗

PubMed1999

Telescoping of landmark events associated with drinking: a gender comparison.

OBJECTIVE: The literature suggests that women exhibit "telescoped" development of (i.e., faster progression to) alcoholism, with fewer years drinking than men. The purpose of this study was to use data gathered in the course of a large clinical trial to further examine this issue. METHOD: Subjects in this retrospective study were from a pool of 1,307 men and 419 women enrolled in Project MATCH, a multisite alcohol treatment matching study. MATCH subjects were recruited from both outpatient and aftercare settings over a 2-year period. Age-of-onset for landmark events in the development of alcoholism were determined from self-report and clinical interviews given at baseline entry into the study. Gender differences in age-of-onset variables were assessed within both outpatient and aftercare settings. Gender differences in progression times between successive landmarks were also examined. Differences were tested with both multivariate and univariate ANOVA techniques. RESULTS: Women generally began getting drunk regularly at a later average age than men (26.6 versus 22.7 years, p< or =.001), began experiencing their first drinking problems at a later average age than men (27.5 versus 25.0 years, p< or =.001) and exhibited loss of control over their drinking at a later average age than men (29.8 versus 27.2 years, p< or =.001). However, these gender differences were most pronounced for older individuals and attenuated for younger subjects. Women also progressed faster than men, on average, between first getting drunk regularly and first encountering drinking problems (0.9 versus 2.3 years, p< or =.001) and between first loss of drinking control and onset of worst drinking problems (5.5 versus 7.8 years, p< or =.001). Women also exhibited shorter average progression times between first getting drunk regularly and first seeking treatment (11.6 versus 15.8 years, p< or =.001), although this effect was negligible for younger subjects. CONCLUSIONS: Telescoping is a relatively robust phenomenon in treatment-seeking alcoholics and indicates that women are more likely to progress faster through the landmark events in the development of alcoholism than are men.

Adult↗

PubMed1999

Treating problem drinking.

Recent data suggest that most people experiencing alcohol problems have problems of mild to moderate severity. Relative to alcoholics, these drinkers have a shorter problem-drinking history, greater social and economic stability, and greater personal resources. This article describes a cognitive-behavioral treatment approach designed specifically for problem drinkers with low levels of physical dependence on alcohol who choose to reduce their drinking. After describing various drinking-reduction techniques, the article reviews empirical evidence for drinking-reduction training. The increasing availability of drinking-reduction interventions holds considerable promise for reducing alcohol-related dysfunction among problem drinkers.

Alcohol Drinking↗

PubMed1998

Male and female alcoholics' attributions regarding the onset and termination of relapses and the maintenance of abstinence.

This study was designed to examine male and female alcoholics' attributions of factors associated with the onset and termination of specific relapse events. In addition, data were gathered on factors associated with the achievement and maintenance of abstinent periods. The participants were 77 men and 65 women alcoholics entering alcoholism treatment who were followed for a 12-month period. The two relapse precipitants reported most often by the men were a desire to drink and feeling good. The women most often reported a desire to drink, psychological cravings, letting down one's guard, feeling down, and spouse/partner factors. The women more often reported letting down one's guard and spouse/partner factors as precipitants, relative to the men. Among the factors identified as associated with termination of a relapse, the influences most often endorsed were "just decided to stop" and, among women, feeling bad emotionally. The most frequently identified methods for achieving and maintaining abstinence were avoiding risky people and places, recalling drinking problems (especially among men), treatment, and use of self-help groups.

Adult↗

PubMed1998

Internal validity of Project MATCH treatments: discriminability and integrity.

Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) is a multisite collaborative project designed to evaluate patient-treatment interactions in alcoholism treatment. To evaluate whether major threats to the internal validity of the independent (treatment) variable in Project MATCH could be ruled out, we investigated several aspects of treatment integrity and discriminability. In this study, 1,726 alcohol-dependent participants at 10 sites were randomized to 3 treatments: cognitive-behavioral treatment (CBT), motivational enhancement therapy (MET), and 12-step facilitation (TSF). Participants received treatment either as outpatients or as aftercare following a more intensive inpatient or day hospital treatment. For both the outpatient and aftercare arms of the study, treatments were discriminable in that therapists implemented each of the treatments according to manual guidelines and rarely used techniques associated with comparison approaches. Participants received a high level of exposure to their study treatments, and the intended contrast in treatment dose between MET and the 2 more intensive treatments (CBT and TSF) was obtained. Alcoholics Anonymous involvement was significantly higher for participants assigned to TSF versus MET or CBT, whereas the treatments did not differ in utilization of other nonstudy treatments. Nonspecific aspects of treatment such as therapist skillfulness and level of the therapeutic alliance were comparable across treatment conditions.

Adult↗

PubMed1998

Participant selection biases in a randomized clinical trial of alcoholism treatment settings and intensities.

Eligible participants and decliners in a randomized study of inpatient, intense outpatient, and standard outpatient treatments for alcoholics were compared and contrasted on a series of demographic, social stability, psychological, legal, drug use, problem severity, and treatment history variables. Among 302 individuals meeting eligibility requirements, those agreeing to participate, compared with decliners, were more likely to be unemployed, be residentially less stable, have legal problems, use other drugs, have a more severe alcohol problem, have a recent treatment history, and were less likely to have problems with violence. Participants also were more likely to be male and non-white, although gender and racial effects were not significant when other variables were controlled for. The implications of these findings for generalizing the results of inpatient-outpatient studies are discussed, and the need for routine reporting of decliner characteristics in research reports is stressed.

Adult↗

PubMed1997

The therapeutic alliance and its relationship to alcoholism treatment participation and outcome.

The relationship between the therapeutic alliance and treatment participation and drinking outcomes during and after treatment was evaluated among alcoholic outpatient and aftercare clients. In the outpatient sample, ratings of the working alliance, whether provided by the client or therapist, were significant predictors of treatment participation and drinking behavior during the treatment and 12-month posttreatment periods, after a variety of other sources of variance were controlled. Ratings of the alliance by the aftercare clients did not predict treatment participation or drinking outcomes. Therapists ratings of the alliance in the aftercare sample predicted only percentage of days abstinent during treatment and follow-up. The results document the independent contribution of the therapeutic alliance to treatment participation and outcomes among alcoholic outpatients.

Adult↗

PubMed1997

Subject-collateral reports of drinking in inpatient alcoholics with comorbid mental disorders.

Verbal self-report continues to be the primary method by which clinicians and researchers obtain measurements of a person's past drinking. In addition, collateral reports are an important second measure of an individual's drinking behavior. Although there is considerable confidence in the use of collateral reports as a measure of drinking in individuals with only a diagnosis of alcohol abuse or dependence, information about subject-collateral reports for alcoholics with a comorbid mental disorder is lacking. given both that symptoms of mental illness can negatively impact cognitive processes relevant to the recall of information, and that such symptoms can be influenced by alcohol consumption, it is important to be confident in the reports of alcohol use in dually diagnosed individuals. This study examined subject-collateral reports of alcohol use in two groups of inpatient alcoholics: those meeting DSM-III-R criteria for an alcohol use disorder and a current mental disorder (n = 91) and those meeting criteria for an alcohol use disorder only (n = 93). Overall, the results show that the self-reports of alcoholics with comorbid mental disorders are generally valid. In addition, subject-collateral agreement was found to be similar for both groups, with no consistent tendency to overreport or underreport alcohol or drug use in either group. Importantly, psychological symptom severity and cognitive functioning were not related to subject-collateral agreement. However, less frequent contact between subject and collateral had a more negative impact on subject-collateral agreement for the dual diagnosis group, compared with the alcohol-only group. Recommendations for enhancing the accuracy of self-reports of drinking in a dual diagnosis population are discussed.

Adult↗

PubMed1996

Characteristics of participants in secular organizations for sobriety (SOS).

Self-help groups have assisted many in their recovery from alcohol use disorders. Although Alcoholics Anonymous (AA) is the largest self-help organization for addressing alcohol problems, no single organization can be suited to the needs of all alcohol abusers. For example, some alcoholics have chosen not to affiliate with AA because of objections to religious or spiritual references in the 12 steps of AA. It was largely for this reason that a secular self-help organization-Secular Organizations for Sobriety (SOS)-was established. This article provides an overview of SOS. Also described are the results of a survey of SOS participants. These data provide a preliminary picture of SOS members and will, we hope, stimulate further research on this organization and its effectiveness.

Adult↗

PubMed1996

Conceptualizations of relapse: a summary of psychological and psychobiological models.

While substance use disorders have long been recognized as chronic relapsing conditions, it has mainly been in the last two decades that clinical researchers have been systematically attending to the nature and processes of relapse. These efforts have led to the development of a variety of psychological and psychobiological models of relapse. These models are summarized in the present article, with particular attention placed on each model's basic principles and on the precipitants of relapse predicted by the respective models. The delineation of these models may help facilitate subsequent cross-referencing and cross-fertilization of thinking in this important area.

Alcoholism↗

PubMed1996

Construct validation analyses on the Marlatt typology of relapse precipitants.

Marlatt's typology of relapse precipitants has had a major influence on clinical research and practice in the substance use disorders. The purpose of this study was to evaluate the construct validity of the typology, which was done in several ways. First, precipitants of the relapse coded at the baseline assessment and for the first drink post-treatment admission were compared. In addition, baseline relapse precipitants were compared with the highest factor scores recorded in the baseline Inventory of Drinking Situations data. A third set of analyses concerned the relationship among Marlatt precipitant codes, psychiatric diagnoses, and Alcohol Dependence Scale scores. The subjects were 142 men and women who were recruited for this study upon their admission to inpatient or outpatient alcohol treatment programs. Participants completed a baseline assessment covering substance use, including information on the precipitants of a pretreatment "relapse", and other areas of functioning. Subjects then completed bimonthly follow-up assessments during the course of 1 year. The results showed support for only one of the predictions regarding the construct validity of the Marlatt typology. Possible explanations for these findings and their implications for clinical research and practice are discussed.

Adult↗

PubMed1996

Relapse research and the Reasons for Drinking Questionnaire: a factor analysis of Marlatt's relapse taxonomy.

A factor analysis (n = 183) of Marlatt's relapse taxonomy as assessed by the Reasons for Drinking Questionnaire (RFDQ) (see Appendix I, this article) was conducted using a heterogeneous alcohol treatment sample. Results indicated that the predominant factor was negative emotions. The second factor consisted of social pressure and positive emotions, and a third factor consisted of physical withdrawal, wanting to get high, testing control, substance cues and urges to drink. Each of the 13 categories in the Marlatt taxonomy loaded on one of the three factors. Scores on the first factor for the first and second lapses were correlated. The same held true for the other two factors. The negative emotions factor was positively related to blood alcohol level on the first day of the lapse, the lapse duration (in days), and occurrence of a second lapse (even when controlling for alcohol dependence). The negative emotions factor in turn was related to client reports of alcohol dependence, trait anger, and depression (all positively). Women scored higher on the first factor, and men scored higher on the second factor. The third factor was inversely related to the number of days of abstinence preceding the lapse. Taken together, these analyses, illustrate that different precipitants occur together, suggesting that clients might productively be trained in the use of specific relevant coping skills to address potential relapse precipitants. Focusing on the third RFDQ factor may be particularly important in the early stages of abstinence. The importance of anger and depression management during alcohol treatment is also highlighted by these results.

Adult↗

PubMed1996

Understanding relapse in the broader context of post-treatment functioning.

There exists much interest in developing more sophisticated conceptual and data analytic frameworks for evaluating and understanding the post-treatment functioning of alcoholics. Much of this interest has been fostered by the systematic research endeavors of Moos and his colleagues, whose "systems model" of treatment outcome closely parallels multivariate models of illness and health. This article focuses on an extrapolation of the systems model to the study of relapse, viewing relapse as one outcome of a set of independent variables that include person and environmental factors. The subjects were 142 clients entering either inpatient or outpatient treatment for alcoholism. Preliminary assessments, using path analyses and multiple regression models, are presented on the interrelationships between background characteristics, pretreatment alcohol involvement/ symptomatology, treatment, coping skills/responses, stressors and relapse/outcome following treatment entry. The results overall showed a considerable amount of convergence in the sense that the composite "blocks" representing background characteristics, alcohol involvement/symptomatology and coping skills/responses generally were significant predictors of various relapse and other posttreatment functioning variables. However, the variables contributing to the predictive power of a particular composite varied as a function of the dependent variable being assessed. The conceptual model and associated analytic strategies guiding this research would appear to hold much potential for advancing knowledge in this area.

Adaptation, Psychological↗