Alcoholics Anonymous (AA) attendance is predictive of increased abstinence for many problem drinkers and treatment referral to AA is common. Strong encouragement to acquire an AA sponsor is likewise typical, and findings about the benefits associated with social support for abstinence in AA support this practice, at least indirectly. In spite of this widespread practice, however, prospective tests of the unique contribution of having an AA sponsor are lacking. This prospective study investigated the contribution of acquiring an AA sponsor using a methodologically-rigorous design that isolated the specific effects of AA sponsorship. Participants were recruited from AA and outpatient treatment. Intake and follow-up assessments included questionnaires, semi-structured interviews, and urine toxicology screens. Eligibility criteria limited prior treatment and AA histories to clarify the relationship of interest while, for generalizability purposes, broad substance abuse criteria were used. Of the 253 participants, 182 (72%) provided complete data on measures central to the aims of this study. Overall reductions in alcohol, marijuana and cocaine use were found over 12-months and lagged analyses indicated that AA attendance significantly predicted increased abstinence. During early AA affiliation but not later logistic regressions showed that having an AA sponsor predicted increased alcohol-abstinence and abstinence from marijuana and cocaine after first controlling for a host of AA-related, treatment, and motivational measures that are associated with AA exposure or which are generally prognostic of outcome.

Background The prevalence of alcohol, tobacco, and other drug (ATOD) use among emergency department (ED) patients is high and many of these patients have unrecognized and unmet substance use treatment needs. Identification of patients in the ED with problem substance use is not routine at this time. Methods We examined screening data, including standardized measures of ATOD use (HSI, AUDIT-C, DAST-10), from 14,866 ED patients in six hospitals across the United States. We expected younger age, male gender, higher triage acuity, and other substance use severity (ATOD) to be associated both with use versus abstinence and with severity of each substance use type. We used negative binomial hurdle models to examine the association between covariates and (1) substance use versus abstinence (logistic submodel) and with (2) severity among those who used substances (count submodel). Results Rates of use and problem use in our sample were similar to or higher than other ED samples. Younger patients and males were more likely to use ATOD, but the association of age and gender with severity varied across substances. Triage level was a poor predictor of substance use severity. Alcohol, tobacco, and drug use were significantly associated with using other substances and severity of other substance use. Conclusion Better understanding of the demographic correlates of ATOD use and severity and the patterns of comorbidity among classes of substance can inform the design of optimal screening and brief intervention procedures addressing ATOD use among ED patients. Tobacco may be an especially useful predictor.

Objective Common factors such as therapist empathy play an important role in treatment for addictive behaviors. The present study was a secondary analysis designed to evaluate the relationship between therapist empathy and alcohol treatment outcomes in data from a large, multi-site randomized controlled trial. Method Audio-recorded psychotherapy sessions for 38 therapists and 700 clients had been randomly selected for fidelity coding from the Combined Behavioral Intervention condition of Project COMBINE. Sessions were evaluated by objective raters for both specific content (coping with craving, building social skills and managing negative mood) and relational components (empathy level of the therapist). Multilevel modeling with clients nested within therapists evaluated drinks per week at the end of treatment. Results Approximately 11% of the variance in drinking was accounted for by therapists. A within-therapist effect of empathy was detected (B = −0.381, se = 0.103, p < .001); more empathy than usual was associated with subsequent decreased drinking. The Social and Recreational Counseling module (B = −0.412, se = 0.124, p < .001), Coping with Cravings and Urges (B = −0.362, se = 0.134, p < .01) and the Mood Management module (B = −0.403, se = 0.138, p < .01) were also associated with decreased drinking. No between-therapist effect was detected, and the interactions between empathy and module content were not significant. Conclusions The results of the study appear consistent with the hypothesis that skills-building and therapist empathy are independent contributions to the overall benefit derived from the Combined Behavioral Intervention. Public Health Significance This study suggests that the interpersonal skills of the therapist influence the effectiveness of a behavioral treatment for problem drinking.

ABSTRACT. Objective: Craving has been defined as intense desires or urges to consume alcohol and is considered predictive of future drinking and relapse. Despite this assumption, research on the craving-drinking relationship has been mixed, calling into question how researchers define and measure craving. The primary aim of the current study was to examine a promising, but understudied, model of craving (Ambivalence Model of Craving [AMC]) that calls for the concurrent assessment of both approach (desires to use) and avoidance (desires to not use) inclinations. Method: Participants (N = 175) were recruited from an acute detoxification facility. Alcohol craving was evaluated with a cue-reactivity paradigm in which participants viewed substance cue slides and separately rated their desire to consume and not consume the substance after each image. Latent profile analysis examined distinct motivational profiles for alcohol predicted by the AMC: ambivalence (high approach, high avoidance), indifference (low approach, low avoidance), approach (high approach, low avoidance), and avoidance (low approach, high avoidance). Results: Latent classes corresponded to the AMC, but a fifth class differentiated moderate versus high ambivalence. Classes were associated with auxiliary variables in predicted directions; high ambivalence and approach classes were associated with greater drinking and negative consequences, whereas voluntary admittance to treatment was more likely with ambivalence and avoidance classes. Conclusions:The AMC provides a promising framework for evaluating cue-elicited craving and alcohol use in clinical samples and may be a useful model of craving for clinicians during treatment. (J. Stud. Alcohol Drugs, 76, 764-772, 2015)