A sample of 253 children of alcoholics (COAs) and 237 children of nonalcoholics (non-COAs) were compared on alcohol and drug use, psychopathology, cognitive ability, and personality. COAs reported more alcohol and drug problems, stronger alcohol expectancies, higher levels of behavioral undercontrol and neuroticism, and more psychiatric distress in relation to non-COAs. They also evidenced lower academic achievement and less verbal ability than non-COAs. COAs were given Diagnostic Interview Schedule alcohol diagnoses more frequently than non-COAs. The relation between paternal alcoholism and offspring alcohol involvement was mediated by behavioral undercontrol and alcohol expectancies. Although gender differences were found, there were few Gender X Family History interactions; the effects of family history of alcoholism were similar for men and women. When gender effects were found, they showed greater family history effects for women.

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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.

Recent evidence suggests that alcohol consumption can lead to attenuated stress response, but parameters such as dose and personality traits appear to influence the magnitude of alcohol's effects. To better characterize these relations, male social drinkers were asigned to either a placebo, a moderate, or a high dose of alcohol and then had heart rate and a self-report measure of anxiety taken during a stressful social interaction. Consistent with previous research, alcohol dampened both heart rate and, to a lesser extent, anxiety responses to the stressor. Because the reduced heart rate responsivity was obtained in the absence of increased basal heart rate, cardiovascular stress response dampening (SRD) does not appear to be an artifact of an initial values effect. Although there was some evidence that individuals with prealcoholic personality traits were especially sensitive to the SRD effect of alcohol, this effect did not appear to be strong or robust across alternative measures of prealcoholic traits. There was no evidence that self-consciousness or expectancies for tension-reducing alcohol effects were associated with stress responsivity in subjects consuming alcohol.Alcohol is generally considered to be effective in reducing psychological stress. However, despite much empirical investigation, the effect of alcohol on stress is neither well characterized nor well understood (Pihl & Smith, 1983). A number of both correlational and experimental studies indicate that alcohol can reduce stress and is consumed for its stress-reducing properties (predictions generated from the tension reduction hypothesis; Pihl & Smith, 1983), but other studies yield results that contradict these findings. Although the general literature on alcohol and stress appears quite muddled, scrutiny of the literature reveals several areas of consistency (Sher, in press).One of these areas of consistency concerns the attenuating effect of a relatively large (i.e., around 1 g ethanol/kg body weight) dose of ethanol on the cardiovascular responses to a discrete

This investigation explored the relationship of client engagement variables (client expectations, therapeutic/working alliance, and session attendance) with treatment satisfaction and posttreatment drinking-related outcomes using data from 2 outpatient alcohol treatment studies (N=208). Path analysis was used to test a model in which engagement variables jointly influence client satisfaction with treatment and subsequent drinking-related outcomes. The proposed model fit well with the data and accounted for 14-23% of the variance in posttreatment outcomes. The relationships in the model suggest that the link between treatment satisfaction and outcome is clarified by examining client engagement variables, which relate indirectly to outcome by means of client satisfaction.