Biomedical subjects

B S McCrady

Publications and source records attributed to B S McCrady.

At least 19 recordsLinked to original sources

PubMed2001

Manual-guided cognitive-behavioral therapy training: a promising method for disseminating empirically supported substance abuse treatments to the practice community.

A gap exists between empirically supported substance abuse treatments and those used in community settings. This study examined the feasibility of training substance abuse counselors to deliver cognitive-behavioral treatment (CBT) using treatment manuals. Participants were 29 counselors. Counselors were randomly assigned to receive CBT training or to a control group. Counselor attitudes were assessed pre- and posttraining. In addition, CBT therapy sessions were videotaped and rated for adherence and skillfulness. CBT counselors reported high levels of satisfaction with the training, intention to use CBT interventions, and confidence in their ability to do so. Ratings indicated that 90% of counselors were judged as having attained at least adequate levels of CBT skillfulness. Findings demonstrate the feasibility of using psychotherapy technology tools as a means of disseminating science-based treatments to the substance abuse practice community.

Adult↗

PubMed2000

Alcohol use disorders and the Division 12 Task Force of the American Psychological Association.

The Division 12 Task Force on Promotion and Dissemination of Psychological Procedures promulgated guidelines to identify treatments with empirical support for effectiveness. No treatment for alcohol abuse or dependence was rated as efficacious; 4 treatments for other drug use disorders were rated "probably efficacious." The alcohol treatment research community has questioned why alcohol treatments with strong empirical support are not in the task force's list. This article presents results of the application of task force standards to 13 major psychosocial alcohol treatments viewed as having strong empirical support. Brief intervention and relapse prevention met task force criteria for "efficacious" treatments. However, in 1996, when the task force last published a list of empirically supported treatments (D. L. Chambless et al., 1996), there were insufficient published studies meeting task force criteria for these 2 treatments. Motivational enhancement met criteria to be rated "probably efficacious."

Alcoholism↗

PubMed1999

Ethical issues in informed consent with substance abusers.

Alcohol and drug abusers present issues that complicate the informed consent process. The present study examined the practices of federally funded clinical investigators in obtaining informed consent from alcohol and drug abusers. Ninety-one (51%) researchers completed a 27-item survey on informed consent issues. The majority of investigators (57%) recruited participants susceptible to coercion; most used procedures to minimize coercion. Two thirds of researchers used objective means to determine competence to give consent and comprehension of consent forms. Virtually all investigators had policies to deal with suicidality, homicidality, or reports of child abuse; less than 1/2 informed participants of these limits to confidentiality. Almost 50% of investigators had dealt with intoxicated or suicidal participants; 12% had encountered homicidal participants; and 23% had encountered child abuse or neglect. Half of the sample used collateral data sources; about 1/2 of these obtained written informed consent from collaterals. Guidelines for informed consent with substance abusers are suggested.

Coercion↗

PubMed1999

Maintaining change after conjoint behavioral alcohol treatment for men: outcomes at 6 months.

AIM: To compare the effectiveness of standard behavioral couples therapy for alcohol problems to two maintenance enhanced therapies. DESIGN: Randomized clinical trial. SETTING: Outpatient substance abuse treatment clinic. PARTICIPANTS: Ninety males with alcohol abuse or dependence and their female partners. INTERVENTIONS: Weekly, outpatient therapy in one of three randomly assigned conditions: Alcohol Behavioral Couples Therapy (ABCT), Alcoholics Anonymous plus ABCT (AA/ABCT) or Relapse Prevention plus ABCT (RP/ABCT). FINDINGS: The men significantly reduced the frequency of drinking and heavy drinking during treatment. During the first 6 months post-treatment, 65.7% of male subjects were classified as improved on a composite measure of drinking and drinking-related consequences. Compared to baseline levels, the percentage of abstinent days increased and heavy drinking days decreased, but the three conditions did not differ. Two outcome variables favored the purely behavioral treatment conditions (ABCT and RP/ABCT) over the AA/ABCT condition: time to the first heavy drinking day was longer for subjects in the ABCT condition than subjects in the AA/ABCT condition, and subjects in the RP/ABCT condition tended to have shorter drinking episodes than subjects in the AA/ABCT condition. Subjects who complied with post-treatment maintenance plans were more likely to be abstinent than subjects who did not. CONCLUSIONS: Results favored the two behavioral conditions and did not suggest additional benefit from combining AA with behavioral couples therapy, but those who did attend AA showed a positive impact.

Adult↗

PubMed1999

Problem drinking from young adulthood to adulthood: patterns, predictors and outcomes.

OBJECTIVE: Many young adults engage in heavy or problem drinking, but it is unclear who will continue problem drinking into adulthood. This study followed a general population sample in order to study patterns of problem drinking over time, to identify differences among drinking groups, to test a model differentiating youth-limited from developmentally-persistent problem drinkers, and to examine adult outcomes. METHOD: Data were from the Health and Human Development Project; subjects (N = 1,073) were in three age cohorts (age 18-25; age 21-28; age 24-31). Based on use and consequences data from two assessment intervals, cluster analyses were performed. RESULTS: Cluster analyses yielded four drinking groups: youth-limited problem drinkers, stable moderate drinkers, stable low drinkers and developmentally-persistent problem drinkers. Rates of youth-limited problem drinking peaked in the middle cohort and rates of developmentally-persistent problem drinking decreased in the oldest cohort. Discriminant analysis revealed that developmentally-persistent problem drinkers in each age cohort are more likely to be male, to show high disinhibition, and to experience a high level of problem behaviors. Youth-limited problem drinkers were similar to developmentally-persistent problem drinkers on many young adult characteristics and adult outcomes. Developmentally-persistent problem drinkers in each age cohort continued to show higher levels of problem behaviors in adulthood than youth-limited problem drinkers. CONCLUSIONS: Most young adults show continuity of drinking patterns. Although developmentally-persistent problem drinkers did not differ from youth-limited problem drinkers in adopting adult roles, their continued experience of many problem behaviors suggests that they fail to adopt the role of greater conventionality in adulthood.

Adolescent↗

PubMed1998

Behavioral couples treatment of alcohol and drug use disorders: current status and innovations.

Research suggests that Behavioral Couples Therapy (BCT), tailored to treat alcohol problems, produces significant reduction in alcohol consumption and improvement in marital functioning. Having established basic clinical protocols for Alcohol Behavioral Couples Therapy (ABCT) and provided support for their efficacy, clinical researchers around the country continue to develop and study new applications of the basic ABCT treatment models, such as adding relapse prevention or Alcoholics Anonymous components. Recent research supporting the heterogeneity in the population of individuals with alcohol problems has prompted some researchers on ABCT to consider additional adaptations of the treatment models for specific subgroups of alcoholics, and for particular individual and couples characteristics. Adaptation of ABCT to treat new populations such as drug abusers, female alcoholics, and problem drinkers is under investigation. The current article provides an overview of theoretical and clinical aspects of ABCT, and research on efficacy of the basic model and on areas of innovation and adaptation to new populations. Directions for future research on ABCT are suggested.

Adaptation, Psychological↗

PubMed1997

Affiliation with Alcoholics Anonymous after treatment: a study of its therapeutic effects and mechanisms of action.

Relatively little is known about how substance abuse treatment facilitates positive outcomes. This study examined the therapeutic effects and mechanisms of action of affiliation with Alcoholics Anonymous (AA) after treatment. Patients (N = 100) in intensive 12-step substance abuse treatment were assessed during treatment and at 1- and 6-month follow-ups. Results indicated that increased affiliation with AA predicted better outcomes. The effects of AA affiliation were mediated by a set of common change factors. Affiliation with AA after treatment was related to maintenance of self-efficacy and motivation, as well as to increased active coping efforts. These processes, in turn, were significant predictors of outcome. Findings help to illustrate the value of embedding a test of explanatory models in an evaluation study.

Adaptation, Psychological↗

PubMed1997

Marital functioning in early versus late-onset alcoholic couples.

Current knowledge about alcohol and marital functioning is limited by restrictive sample selection, inattention to the literature on individual-based alcoholic subtypes, and lack of research linking individual differences among alcoholics to marital functioning. The present study was designed to study marital functioning of alcoholics in light of current alcohol typologies. Subjects were part of a larger study on conjoint treatment of alcoholic males and their female partners. Four typologies-including Type 1/2, In-Home/Out-of-home, Steady/Episodic, and Early/Late Onset-were tested for replicability and discriminant validity before linking them to marital functioning. Discriminant validity was found only for the Early (59%)-versus Late (41%)-Onset typology;thus, further analyses linked only this typology with marital functioning. At baseline, Early-Onset couples reported more marital instability, and the females in these couples were more distressed. During treatment, Early-Onset couples reported higher daily marital satisfaction than Late-Onset couples. Regardless of age of onset, males reported higher marital satisfaction than their spouses during treatment, but their satisfaction did not increase during treatment. Female partners' marital satisfaction increased during treatment. Female partners of Late-Onset males reported particularly low marital satisfaction during treatment. Parsing the sample according to the early-/late-onset typology yielded different predictors of marital satisfaction for males and females within each subtype. For female partners of Early-Onset alcoholics, psychological distress unrelated to her partner's drinking severity was most associated with her own marital satisfaction, whereas marital adjustment of female partners of Late-Onset alcoholics was most associated with the male's level of perceptual accuracy regarding her needs. This pattern was reversed for the males; marital adjustment of Early-Onset alcoholics was most associated with his partner's perceptual accuracy of his needs, whereas marital functioning of Late-Onset alcoholics was best accounted for by his own psychological distress.

Adult↗

PubMed1997

The Drinking-Related Locus of Control Scale: the factor structure with treatment-seeking outpatients.

OBJECTIVE: The psychometric properties of the Drinking-Related Locus of Control Scale (DRIE) were investigated when the distribution of DRIE scores taken from a sample of outpatient men was found to be skewed toward an internal locus of control, and numerous items on the scale showed little or no variability. METHOD: The DRIE was administered to 93 treatment-seeking, male alcoholics meeting DSM-II-R criteria for alcohol abuse or dependence who attended a clinical screen and baseline assessment for a larger study designed to examine the efficacy of conjoint marital therapy in the treatment of alcoholism. Subjects were recruited through newspaper, radio and television announcements, letters to physicians, employee assistance programs, outpatient treatment programs and detoxification centers. Subjects were either married or in a cohabitating relationship with a nonalcoholic, female partner. RESULTS: A factor analysis with a Procrustes rotation failed to replicate the three factor structure identified by previous researchers and consequently the reliability coefficients of the corresponding subscales were found to be low. Several items were endorsed as internal by more than 95% of the sample, showing little or no variability among subjects. An independent factor analysis, which excluded the items endorsed predominantly as internal, identified a single factor structure comprised of first person statements about helplessness and an inability to abstain from drinking. CONCLUSIONS: One possible explanation for the difference in the factor structure is that the current investigation employed outpatient subjects rather than inpatient subjects, who have been the focus of most research on the control orientation of alcoholics to date. A second possible explanation may be found in the sociodemographic makeup of the current sample which is younger, better educated and has less severe drinkers than the sample of veterans in the study that established the original factor structure of the DRIE.

Adult↗

PubMed1997

Sources of motivation in a couples outpatient alcoholism treatment program.

This study examines sources of motivation to seek treatment. Participants were 105 male alcoholics and their non-alcoholic female partners who participated in a study of three different approaches to the conjoint treatment of alcoholism. Participants' sources of motivation were coded from responses to questions at the initial clinical screening interview. Sources of motivation were classified as "internal" or "external." More participants had internal sources of motivation (74%) than external sources. Participants with internal sources of motivation scored higher on the Michigan Alcoholism Screening Test than participants with external sources of motivation, but did not differ on other measures of pretreatment severity of alcohol problems. About half of the participants (53%) cited their partner as a primary source of motivation to seek treatment. Other sources of motivation cited were: increasing problems with alcohol, mental health problems, and physical health problems. There was greater variability among internal sources of motivation than among external sources of motivation. Participants' partners but not the male participants themselves, experienced an increase in marital satisfaction from pre- to within-treatment when the participant was motivated to come to treatment by his partner.

Adult↗

PubMed1996

Alcohol treatment and health care system reform.

After reviewing the empirical literature, we suggest that advances in the assessment and treatment of alcohol problems have the following important implications for health care system reform: (1) alcohol use disorders and problems associated with alcohol use are prevalent and are complicated by various comorbid conditions, and they result in large costs to the health care system and to society; (2) alcohol treatment generally results in reduced drinking and more efficient use of health care resources; (3) specific treatments have demonstrated effectiveness; (4) screening and assessment instruments with excellent sensitivity to the heterogeneity of alcohol problems have been developed; (5) evidence that specific treatments have differential effectiveness with different patients groups is accumulating; and (6) good evidence exists for the effectiveness of brief interventions, particularly with less severe and chronic alcohol problems. These findings suggest that alcohol treatment services in a reformed health care system should include (1) universal coverage for alcohol treatment, including full benefits for outpatient care; (2) a rational system of assessment and triage for treatment, including an increased emphasis on screening and brief interventions in primary medical care settings; (3) a full range of treatment services that vary in intensity; and (4) addictions treatment provider incentives and contingencies to provide treatments of proven effectiveness. When fully implemented, an efficient approach to the treatment of alcohol-related problems will result in one of the largest pools of cost savings in a reformed American health care system.

Alcoholism↗

PubMed1996

Involving health care workers in screening for alcohol problems.

OBJECTIVES: (1) Examine physician and nursing staff compliance with conducting an alcohol screening interview; (2) Compare compliance with the interview with usual physician and nurse assessment of drinking; (3) Examine reasons why drinking information might not be collected. DESIGN: Residents and nurses were taught how to use an alcohol screening interview and were told by the director of residency training or by the Vice-President for Nursing to administer it to all admitted patients. Data on interviewed patients were compared with medical record data on a randomly selected series of 80 patients who were not interviewed. SETTING: Teaching hospital in an urban/suburban community. PATIENTS/PARTICIPANTS: Residents on internal medicine and family practice services; surgical nurses. MEASUREMENTS AND MAIN RESULTS: Compliance with conducting the interview was low (14.7% of residents' admissions; 13.53% of nurses' admissions). Review of the medical records indicated that some alcohol-related information was recorded in most patients' medical records (physicians recorded information on 94% of patients on the teaching services, nurses on the surgical unit recorded alcohol-related information on 71% of patients). Surgeons and surgical residents recorded alcohol-related information on 30% of their patients. Residents were more likely to interview male than female patients, and residents and nurses tended to interview patients with higher GGTP values. CONCLUSIONS: (1) Compliance with administering a standardized alcohol screening interview was low. (2) Nurses, and residents in family practice and internal medicine made some assessment of drinking for most patients. Surgeons assessed drinking in a minority of patients. (3) Expressed reasons for not administering the standardized interview included discomfort with the interview, viewing the interview as too time-consuming, or not part of the usual responsibilities of the nurses or residents. Other possible reasons for the low levels of compliance are discussed.

Admitting Department, Hospital↗

PubMed1996

Examining mediators of change in traditional chemical dependency treatment.

OBJECTIVE: Few studies have examined processes that mediate positive outcomes in the treatment of substance use disorders. The present study used a theory-driven approach to assess mechanisms hypothesized as curative by the traditional chemical dependency treatment approach. Several specific disease model processes such as accepting powerlessness over alcohol and two processes common to both the disease model and other treatment approaches (commitment to abstinence and intention to avoid high-risk situations) were studied. It was hypothesized that patients entering treatment would manifest high levels of denial, that there would be significant reduction of denial and increased endorsement of disease model and common processes as a result of treatment and that processes would mediate outcome. METHOD: Patients (N = 79; 54 men) in intensive traditional alcohol/drug treatment were assessed at entry into treatment, at the end of treatment and 1 month following treatment. Both self-report and clinician ratings of processes were assessed. RESULTS: Overall, results provided little support for study hypothesis. Subjects showed low levels of denial at treatment entry. Specific disease model, but not common processes, increased during treatment. Common processes, but not disease model processes, predicted relapse. Patients with higher levels of commitment to abstinence and greater intentions to avoid high-risk situations were at lower risk for relapse. However, greater commitment to Alcoholics Anonymous and belief in a Higher Power predicted reduced severity of relapse among those who did relapse. CONCLUSIONS: Findings do not support prevailing practitioner views regarding how traditional treatment works and suggest that interventions in these treatments may be mismatched to patient needs.

Adult↗

PubMed1996

Issues in the implementation of a randomized clinical trial that includes Alcoholics Anonymous: studying AA-related behaviors during treatment.

OBJECTIVE: The purpose of this study is to examine implementation of a randomized clinical trial and within treatment behavior when AA is included as an element of treatment. Special attention is given to the measurement of compliance, use of treatment skills, and the nature and extent of involvement with AA during the active phase of treatment. METHOD: Subjects, 90 male alcoholics and their female partners seeking conjoint, outpatient behavioral alcoholism treatment, were randomly assigned to one of three treatments: alcohol-focused behavioral marital therapy (ABMT), ABMT plus AA/Alanon (AA/ABMT), or ABMT plus relapse prevention (RP/ABMT). Within treatment data are reported for the 68 couples who completed at least five treatment sessions. Measures included: treatment attrition, number of treatment sessions, attendance at AA and Alanon, use of AA and Alanon skills, compliance with homework assignments and drinking during treatment. RESULTS: Several aspects of within treatment behavior were examined: (1) Attrition: There was no differential attrition across treatment conditions, with 24.4% of couples discontinuing treatment prior to the fifth session. (2) AA and Alanon attendance: Subjects in the AA/ABMT treatment were more likely to attend AA (91.7% attended at least one AA meeting; 58.3% attended at least one Alanon meeting) than were subjects in the other treatment conditions (18% attended at least one AA meeting and 14% at least one Alanon meeting). Subjects in the AA/ABMT condition attended significantly more AA and Alanon meetings than did subjects in the other treatment conditions. (3) Homework compliance: Subjects generally showed no differences in compliance with homework assignments, but spouses in the AA/ABMT condition completed less condition-specific homework (37.2%, versus 67.8% for the RP/ABMT spouses) because of low utilization of Alanon. (4) Use of AA-related skills: Subjects reported using AA-related skills more frequently in the AA/ABMT condition than in the other treatment conditions. (5) Patterns of attendance: Analyses of AA attendance during treatment revealed three patterns: positive attendance, characterized by regular AA attendance or increasing use of AA across treatment; negative attendance, characterized by decreased AA attendance over time; and nonattendance, characterized by none or infrequent and erratic attendance. CONCLUSIONS: Randomized clinical trials can be used to study AA. Use of multiple measures of treatment compliance and examination of patterns of AA utilization use over time provide more complex views of the patterns of involvement with AA than do simple descriptive reports of attendance.

Adult↗

PubMed1995

Loss of control and inability to abstain: the measurement of and the relationship between two constructs in male alcoholics.

The constructs "loss of control" and "inability to abstain" have been used extensively in alcohol research. Examination of the literature, however, reveals inconsistencies in the ways researchers have operationalized and measured these constructs and a dearth of empirical investigation of the validity of the constructs. The current study examines a number of methods of operationalizing loss of control and inability to abstain and investigates the relationship of the two constructs with each other. Ninety-seven male alcoholics who participated in an outpatient conjoint alcoholism treatment study provided data on pre-treatment alcohol consumption and self-report measures of lifetime drinking behavior. Nine interview or questionnaire items that best approximated items used in the literature to measure inability to abstain and loss of control were chosen for analysis. Items measuring both constructs were highly intercorrelated and were associated more strongly with quantity rather than frequency of alcohol consumption, suggesting significant overlap between the constructs. None of the items were associated with a particular drinking pattern. The results provide support for a unitary dimension of impaired control, as used in the alcohol dependence syndrome, and suggest that the value of loss of control and inability to abstain as distinct and meaningful constructs should be reconsidered.

Adult↗

PubMed1994

Attrition from conjoint alcoholism treatment: do dropouts differ from completers?

This study addresses patient attrition in order to identify variables associated with retention in conjoint treatment for alcohol abuse and dependence. Subjects were 105 male alcoholics and their partners who participated in a randomized clinical trial of three approaches to conjoint treatment of alcoholism: (a) alcohol and behavioral marital therapy (ABMT); (b) ABMT plus Alcoholics Anonymous and Alanon (AA/ABMT); and (c) ABMT plus relapse prevention (RP/ABMT). Completers (n = 45) attended two assessment and 15-17 treatment sessions. Partial completers (n = 23) left treatment between the 5th and 15th treatment session. Thirty-seven dropouts left treatment between the first assessment session and the 5th treatment session; of these, 22 dropouts completed at least one treatment session (called early treatment dropouts). Of subjects who entered treatment, dropouts from early treatment were least compliant with treatment requirements in the first few sessions, less educated, and less committed to their relationship. Data indicate that therapists with more clinical experience were more likely to retain clients in treatment, regardless of treatment condition. The data do not reflect a linear relationship between most variables studied and a continuum of attrition status from assessment to completion of the program.

Adult↗

PubMed1994

Alcoholics Anonymous and behavior therapy: can habits be treated as diseases? Can diseases be treated as habits?

Alcoholics Anonymous (AA) and behavior therapy have often been characterized as having opposing views of the nature and treatment of alcohol problems. This article describes the theoretical foundations, view of the change process, and treatment practices of AA and behavior therapy. Theoretical and practice perspectives on integration of the two models are examined, and advantages and disadvantages of integration are discussed.

Adult↗

PubMed1994

Introduction to the special section: research on the nature and treatment of alcoholism--does one inform the other?

Although the 2 topics of the nature and treatment of alcoholism have both been investigated for years, they are just recently beginning to interface with and complement one another. This special section addresses the interface from both perspectives and covers content areas that touch on current issues, research and treatment trends, and controversies in the alcohol field. The first 2 articles focus on the nature of alcoholism with commentary on implications for treatment, and the second 4 articles shift to examine research on treatment of alcohol problems, with implications for understanding the nature of alcoholism. This introductory article describes the special section, summarizes the articles in the section and integrates the information to discuss areas of increasing interface between research on the nature and treatment of heterogeneous substance abuse problems.

Alcoholism↗