Relapsed alcoholic individuals frequently report that negative emotional states trigger their return to drinking. A parametric laboratory study was conducted to assess the separate and combined effects of exposure to alcohol-related stimuli and induced negative moods in abstinent alcoholic persons. The authors also sought to determine if reactivity to alcohol cues or reactivity to negative mood induction predicted relapse soon after treatment. Men with alcoholism (N = 50) undergoing inpatient treatment participated in a guided imagery procedure designed to induce negative moods and were then exposed to either their favorite alcoholic beverage or to spring water. Results indicated that both alcoholic beverage presentation and negative affect imagery led to increased subjective reporting of desire to drink. These effects were additive but not multiplicative (i.e., the interaction of mood state with beverage type was not significant). Reported urge to drink during the trial that combined negative mood imagery with alcoholic beverage exposure predicted time to relapse after inpatient discharge.

Self-efficacy is the belief that one has the ability to implement the behaviors needed to produce a desired effect. There has been growing interest in the role of self-efficacy as a predictor and/or mediator of treatment outcome in a number of domains. The present paper reviews the recent literature on self-efficacy in the substance abuse field. In numerous studies of substance abuse treatment, self-efficacy has emerged as an important predictor of outcome, or as a mediator of treatment effects. Despite these repeated positive findings, the self-efficacy concept has had little impact on the design of treatments. Since the concept was first introduced, there have been numerous suggestions regarding the means by which self-efficacy may be enhanced in clinical settings, but very little by way of empirical tests of those suggestions. This review concludes with a number of recommendations for further research to improve understanding of this potentially valuable concept and its interactions with other variables, and to develop effective strategies for enhancing self-efficacy.

The cold-pressor task was used with 102 female undergraduates in 2 experiments to determine (a) whether self-efficacy has validity as a true causal determinant of behavior change or is a correlate of change that has already occurred and (b) how perceptions of control and self-efficacy interact to determine choice behavior, persistence, and the impact of an aversive stimulus. Results of Experiment 1 indicate that self-efficacy expectations affected performance beyond what would have been expected from past performance alone. Changes in self-efficacy expectations predicted changes in cold-pressor tolerance. These findings suggest that self-efficacy expectations can be causal determinants of behavior in an aversive situation. Results of Experiment 2 indicate that self-efficacy was separable from control and that performance was best if both high levels of perceived control and self-efficacy were present. These findings support the notion that self-efficacy expectations can mediate the desirability of providing control, in that those who benefit most from control are those who are most confident they can exercise it.

Previous studies have noted particular difficulty in achieving abstinence among those who are marijuana dependent. The present study employed a dismantling design to determine whether adding contingency management (ContM) to motivational enhancement therapy plus cognitive behavioral therapy (MET+CBT), an intervention used in prior studies of treatment for marijuana dependence, would enhance abstinence outcomes. 240 marijuana dependent participants were recruited via advertisements and assigned to either MET+CBT, ContM only, MET+CBT+ContM, or to a casemanagement control condition. All interventions involved 9 weekly 1-hour sessions, except for the ContM-only condition whose sessions lasted about 15 minutes. ContM provided reinforcement for marijuana-free urine specimens, in the form of vouchers redeemable for goods or services. Followup data were collected at posttreatment and at 3-month intervals for 1 year. The two ContM conditions had superior abstinence outcomes: ContM-only had the highest abstinence rates at posttreatment, and the MET+CBT+ContM combination had the highest rates at later follow-ups. The roles of contingency management and coping skills training in the treatment of marijuana dependence are discussed.

The Network Support Project was designed to determine if a treatment could lead patients to change their social network from one that supports drinking to one that supports sobriety. This study reports two-year posttreatment outcomes. Alcohol dependent men and women (N=210) were randomly assigned to one of three outpatient treatment conditions: Network Support (NS), Network Support + Contingency Management (NS+CM), or Case Management (CaseM, a control condition). Analysis of drinking rates indicated that the NS condition yielded up to 20% more days abstinent than the other conditions at two years posttreatment. NS treatment also resulted in greater increases at 15 months in social network support for abstinence, as well as AA attendance, and AA involvement, than did the other conditions. Latent growth modeling suggested that social network changes were accompanied by increases in self-efficacy and coping that were strongly predictive of long-term drinking outcomes. The findings indicate that a network support treatment can effect long-term adaptive changes in drinkers' social networks, and that these changes contribute to improved drinking outcomes in the long-term. KeywordsAlcoholism; Social Support; AA; Cognitive-behavioral treatment; Network Support It has often been noted that the most significant problem related to treatment of alcohol dependence is not the attainment of initial abstinence, but relapse following treatment. Marlatt (1985) estimated that fully one-third of treated individuals relapse in the first 90 days after completion of treatment. In a review of treatment effectiveness, Nathan (1986) reported that one to two years after treatment less than half of patients maintain sobriety. In a review of multisite studies, Miller, Walters and Bennett (2001) noted that approximately 65% of patients continued to drink one year after alcoholism treatment. Despite increased attention to the problem of relapse, few interventions have been able to effectively counter this phenomenon.One approach to this problem has been the development of treatments intended to change drinkers' social networks so that they are more supportive of abstinence and less supportive of drinking. The social network has long been regarded as an important locus of reinforcement for drinking behavior (e.g., Steinglass & Wolin, 1974). Longabaugh and Beattie (Beattie & Longabaugh, 1999;Longabaugh & Beattie, 1986) coined the term "network support for drinking," referring to the degree to which people in one's environment encourage drinking. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptNetwork support for drinking has been found to be predictive of poor treatment outcome (Havassy, Hall & Wasserman, 1991, Longabaugh et al., 1993Project MATCH Research Group, 1997).Alternatively, networks that promote sobriety can also affect drinking rates. The most obvious example of such a network is the fellowship of Alcoholics Anonymous (AA). Several studies support the efficacy of AA or similar groups in reducing alc...