This study evaluated the use of a brief motivational interview (MI) to reduce alcohol-related consequences and use among adolescents treated in an emergency room (ER) following an alcohol-related event. Patients aged 18 to 19 years (N = 94) were randomly assigned to receive either MI or standard care (SC). Assessment and intervention were conducted in the ER during or after the patient's treatment. Follow-up assessments showed that patients who received the MI had a significantly lower incidence of drinking and driving, traffic violations, alcohol-related injuries, and alcohol-related problems than patients who received SC. Both conditions showed reduced alcohol consumption. The harm-reduction focus of the MI was evident in that MI reduced negative outcomes related to drinking, beyond what was produced by the precipitating event plus SC alone.

Several learning-based theories have been forwarded to account for the problem of drug relapse, including conditioned withdrawal, conditioned compensatory responding, appetitive motivational models, and social learning models. The various models are compared and evaluated against available evidence from studies with humans pertaining to alcohol and tobacco addiction. Studies that are reviewed focus primarily on the antecedents and consequences of alcohol and smoking relapse, as well as on reactions to cues that have been associated with prior drug ingestion, in an attempt to understand their motivational relevance. Problems in evaluating the various relapse models in humans are discussed. It is concluded that the appetitive model is better supported than the withdrawal model, and the compensatory model is least supported. Reactions to substance use stimuli may play an important role in alcohol and smoking relapse. Concepts drawn from the various theoretical models are linked tentatively in a schematic diagram of a hypothesized sequence of cognitive/affective, physiological, and behavioral events that lead to initial drug use after a period of abstinence (slip) and then to continued use (a relapse). The treatment implications of some of the cue reactivity models are discussed.

A behavioral economic approach to alcohol use disorders (AUDs) emphasizes both individual and environmental determinants of alcohol use. The current study examined individual differences in alcohol demand (i.e., motivation for alcohol under escalating conditions of price) and delayed reward discounting (i.e., preference for immediate small rewards compared to delayed larger rewards) in 61Correspondence regarding this study should be addressed to James MacKillop, PhD, Department of Psychology, University of Georgia, Athens, GA 30602; or via at jmackill@uga.edu. Lara Ray is now at the University of California, Los Angeles. Publisher's Disclaimer:The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/abn. NIH Public AccessAuthor Manuscript J Abnorm Psychol. Author manuscript; available in PMC 2011 February 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript heavy drinkers (62% with an AUD). In addition, based on theoretical accounts that emphasize the role of craving in reward valuation and preferences for immediate rewards, craving for alcohol was also examined in relation to these behavioral economic variables and the alcohol-related variables. Intensity of alcohol demand and delayed reward discounting were significantly associated with AUD symptoms, but not with quantitative measures of alcohol use, and were also moderately correlated with each other. Likewise, craving was significantly associated with AUD symptoms, but not with alcohol use, and was also significantly correlated with both intensity of demand and delayed reward discounting. These findings further emphasize the relevance of behavioral economic indices of motivation to alcohol use disorders and the potential importance of craving for alcohol in this relationship. KeywordsAlcohol; Behavioral Economics; Discounting; Demand; CravingBehavioral economics integrates the principles of psychology and economics to understand how individuals make transactions with the world Camerer, 1999). The approach has been extensively applied to both normal and abnormal behavior, particularly in the area of alcohol use disorders (AUDs) and other substance use disorders (Vuchinch & Heather, 2003). As it is applied to substance use, behavioral economics has made major contributions to characterizing how environmental factors, such as increases in cost or the presence of alternative reinforcers, affect alcohol and other substance use (Bigelow, Cohen, Liebson, & Faillace, 1972;Higgins, Bickel, & Hughes, 1994;Winger, Galuska, & Hursh, 2007). Behavioral economics also recog...

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The purpose of this study was to evaluate the efficacy of two brief interventions and the inclusion of a 1-month booster session with college students who were referred to attend alcohol education following an alcohol-related incident. Participants (N=225; 48.9% male) were randomly assigned to receive one session of a Brief Motivational Interview (BMI) or computer-delivered intervention (CDI) with the Alcohol 101 CD-ROM. Participants were also randomly assigned to booster/no booster. At 3-month follow up, participants in BMI reported greater help seeking and use of behavioral strategies to moderate drinking. At 12-month follow up, BMI participants were drinking more frequently and CDI participants were consuming a greater number of drinks per occasion than at baseline. Mediation analyses showed that the use of specific behavioral strategies mediated the effect of the BMI condition on drinking volume. There was no intervention effect on alcohol problems, and the booster condition did not significantly affect outcomes. Promoting specific behaviors in the context of in-person brief interventions may be a promising approach to reducing drinking volume among identified at-risk students.

Aim To establish the efficacy of a brief motivational intervention compared to feedback only when delivered in an emergency department for reducing alcohol use and problems among young adults. Design Two-group randomized controlled trial with follow-up assessments at 6 and 12 months. Setting Level I Trauma Center. Participants A total of 198 18-24-year-old patients who were either alcohol positive upon hospital admission or met screening criteria for alcohol problems. Intervention Participants were assigned randomly to receive a one-session motivational intervention (MI) that included personalized feedback, or the personalized feedback report only (FO). All participants received additional telephone contact 1 month and 3 months after baseline. Measurements Demographic information, alcohol use, alcohol problems and treatment seeking. Findings Six months after the intervention MI participants drank on fewer days, had fewer heavy drinking days and drank fewer drinks per week in the past month than did FO patients. These effects were maintained at 12 months. Clinical significance evaluation indicated that twice as many MI participants as FO participants reliably reduced their volume of alcohol consumption from baseline to 12 months. Reductions in alcohol-related injuries and moving violations, and increases in alcohol treatment-seeking were observed across both conditions at both follow-ups with no differences between conditions. Conclusions This study provides new data supporting the potential of the motivational intervention tested to reduce alcohol consumption among high-risk youth.

An interest in reducing relapse among alcoholics has led to a consideration of stimulus control factors in drinking. Research suggests that through classical conditioning alcoholics may develop reactions to cues previously associated with drinking and that these reactions might be an important determinant of relapse. Although this model indicates the potential for cue exposure treatment methods to alter conditioned reactions, data on reactivity to alcohol cues by alcoholics and nonalcoholics are scarce. Two studies are presented that address this issue and provide evidence for the validity of salivation as a measure of cue reactivity. Alcoholics and nonalcoholics were presented with the sight and smell of their preferred brand of alcohol and a control beverage. Self-report, behavioral, and psychophysiological data were collected. Alcoholics salivated more than nonalcoholics to alcohol cues and more to alcohol than to the control beverage. Alcoholics salivated differentially to cues, whereas nonalcoholics did not. Patterns of reactivity were consistent with a conditioning model. Both groups reported greater urges to drink alcohol in the presence of alcohol, but neither group reported more thoughts about alcohol in the presence of alcohol as compared with the control beverage. Implications of salivary reactivity for theory and treatment are discussed.Relapse prevention among individuals treated for problem drinking continues to challenge clinicians and researchers.Prompted in part by clinical observation, theoretical discussions have suggested that setting cues or stimulus control factors may be relevant to this complex problem. Several reports have indicated that strong reactions may be conditioned to stimuli that are repeatedly paired with substance use and, in turn, that these reactions may contribute to craving, tolerance, and nonpharmacological aspects of withdrawal symptoms (Cooney,

This study tested the feasibility and efficacy of a brief smoking intervention for adolescents in a hospital setting. Forty adolescent patients were randomized to receive either brief advice or a motivational interview, a nonconfrontational therapeutic intervention. Feasibility of brief smoking interventions with teen patients was supported by high rates of recruitment, retention, and quit attempts, and long periods of continuous abstinence. Although between-groups differences on smoking measures were not significant at 3-month follow-up, an effect size of h = .28 was noted. The sample showed significant decreases in smoking dependence and number of days smoked. Baseline stage of change, smoking rate, and depression were significant prospective predictors of smoking outcome. Implications for smoking intervention research with adolescents are discussed.