Biomedical subjects

G J Connors

Publications and source records attributed to G J Connors.

At least 37 records · Page 2Linked to original sources

PubMed1996

Relapse research and the Reasons for Drinking Questionnaire: a factor analysis of Marlatt's relapse taxonomy.

A factor analysis (n = 183) of Marlatt's relapse taxonomy as assessed by the Reasons for Drinking Questionnaire (RFDQ) (see Appendix I, this article) was conducted using a heterogeneous alcohol treatment sample. Results indicated that the predominant factor was negative emotions. The second factor consisted of social pressure and positive emotions, and a third factor consisted of physical withdrawal, wanting to get high, testing control, substance cues and urges to drink. Each of the 13 categories in the Marlatt taxonomy loaded on one of the three factors. Scores on the first factor for the first and second lapses were correlated. The same held true for the other two factors. The negative emotions factor was positively related to blood alcohol level on the first day of the lapse, the lapse duration (in days), and occurrence of a second lapse (even when controlling for alcohol dependence). The negative emotions factor in turn was related to client reports of alcohol dependence, trait anger, and depression (all positively). Women scored higher on the first factor, and men scored higher on the second factor. The third factor was inversely related to the number of days of abstinence preceding the lapse. Taken together, these analyses, illustrate that different precipitants occur together, suggesting that clients might productively be trained in the use of specific relevant coping skills to address potential relapse precipitants. Focusing on the third RFDQ factor may be particularly important in the early stages of abstinence. The importance of anger and depression management during alcohol treatment is also highlighted by these results.

Adult↗

PubMed1996

Understanding relapse in the broader context of post-treatment functioning.

There exists much interest in developing more sophisticated conceptual and data analytic frameworks for evaluating and understanding the post-treatment functioning of alcoholics. Much of this interest has been fostered by the systematic research endeavors of Moos and his colleagues, whose "systems model" of treatment outcome closely parallels multivariate models of illness and health. This article focuses on an extrapolation of the systems model to the study of relapse, viewing relapse as one outcome of a set of independent variables that include person and environmental factors. The subjects were 142 clients entering either inpatient or outpatient treatment for alcoholism. Preliminary assessments, using path analyses and multiple regression models, are presented on the interrelationships between background characteristics, pretreatment alcohol involvement/ symptomatology, treatment, coping skills/responses, stressors and relapse/outcome following treatment entry. The results overall showed a considerable amount of convergence in the sense that the composite "blocks" representing background characteristics, alcohol involvement/symptomatology and coping skills/responses generally were significant predictors of various relapse and other posttreatment functioning variables. However, the variables contributing to the predictive power of a particular composite varied as a function of the dependent variable being assessed. The conceptual model and associated analytic strategies guiding this research would appear to hold much potential for advancing knowledge in this area.

Adaptation, Psychological↗

PubMed1996

Looking forward and back to relapse: implications for research and practice.

In this commentary, the three principal investigators of the Relapse Replication and Extension Project (RREP) reflect on clinical and research implications of study findings from the three collaborating sites. A primary purpose of RREP was to study the reliability and validity of a taxonomy of relapse antecedents originally proposed by Marlatt two decades ago. Under the best of research conditions, with extensive training and practice, it was difficult to achieve reliability of coding with the original three-level system, although with only two levels of classification more reasonable albeit variable reliability was found. Modifications may improve the taxonomy's reliability, but RREP data indicate that a more appropriate strategy is to measure possible antecedents of relapse by continuous scales such as those provided by Annis, Heather and Litman. There is reasonably consistent evidence for two common antecedents of relapse: negative emotional states, and positive emotional states in a social context. Antecedents of relapse show only modest consistency within individuals from one occasion to the next. The causes to which clients attribute relapses may exert a significant effect on future drinking episodes. Stable and internal attributions, such as are commonly associated with a dispositional disease model, may serve to perpetuate relapse. From the RREP studies, the availability of coping skills appears to be a potent protective factor, and ineffective coping a consistent predictor of relapse. Implications for clinical research and practice are considered.

Adaptation, Psychological↗

PubMed1995

Self-report screening tests for alcohol problems in primary care.

Considering the prevalence of excessive alcohol use, its adverse consequences on physical and emotional well-being, and the high degree of responsivity of early-stage drinking problems to brief intervention, screening for alcohol abuse is warranted in medical practice. We describe several practical self-report tests that can help primary care physicians screen their patients for alcohol abuse. Two of the more popular tests, the Michigan Alcoholism Screening Test and the CAGE (an acronym for questions about cutting down on drinking, annoyance at others' concern about drinking, feeling guilty about drinking, and using alcohol as an eye-opener in the morning), are comparable in sensitivity and specificity. Either test is appropriate, but the brevity of CAGE generally gives it an advantage in a busy medical office. Three new tests, the Alcohol Use Disorders Identification Test, the Adolescent Drinking Index, and the TWEAK also are promising. We offer guidelines for selection of screening tests for primary care practice.

Alcoholism↗

PubMed1995

Contrasting self-report screens for alcohol problems: a review.

Current trends in conceptions of alcohol problems and provision of health care put increased emphasis on identifying individuals whose alcohol use and problems cover a range of severity. The purpose of this study is to begin to provide information on the relative utility of self-report measures designed to identify (screen for) individuals with alcohol problems. To achieve this goal, the empirical literature on contrasts of self-report screening measures was reviewed, and 13 relevant studies across diverse settings and subject populations were identified. The review showed that the CAGE, the Michigan Alcoholism Screening Test (MAST), and the short MAST (sMAST) have been the most widely studied self-report instruments to screen for alcohol problems. Direct comparisons show the MAST to be more sensitive than the CAGE, but with elderly patients the CAGE may perform better than the MAST. Furthermore, available data suggest that the CAGE and the sMAST perform comparably. Finally, the CAGE, MAST, and sMAST all perform best when predicting criteria most similar to those the instruments were designed to reflect. The study concludes with a discussion of priorities for research on screening instruments.

Adult↗

PubMed1994

Quality of life as an outcome variable in alcoholism treatment research.

Although a number of approaches to measuring alcohol consumption are available, these alone do not reflect the full range of changes that may be associated with response to treatment for alcohol abuse and dependence. What constitutes a sufficient index of response to alcohol treatment? At the very least, research should measure negative consequences of alcohol consumption, although they may be difficult to specify beyond the client's own perception. Associations between alcohol consumption and dimensions of life quality may be negative or positive in value and may be broadly or narrowly conceptualized, depending upon the aims of the study. Although models exist for the conceptualization and measurement of many aspects of quality of life in alcoholism and other fields, much remains to be specified. Still to be accomplished is a careful examination of the interrelationships between alcohol consumption and specific dimensions of life quality, particularly as these interrelationships are affected by time since treatment and client characteristics among other potential mediators and moderators. Project MATCH has attempted a broad assessment of dimensions of life quality beyond alcohol consumption. These variables are viewed as secondary, rather than primary, measures of treatment outcome. The extent to which Project MATCH's strategy was effective is a question that will be answered when we examine the interrelationships among the various dimensions of outcome and the differential effects of treatments on these outcome dimensions.

Activities of Daily Living↗

PubMed1994

Process assessment in treatment matching research.

A complete understanding of the effects of treatment requires an examination of the process by which the treatment produces the outcome as well as a thorough assessment of the outcomes. Process assessment assumes even greater importance in matching research than in other types of treatment research, since client-treatment interactions are hypothesized to be moderated or mediated by specific treatment components. The role of process assessment in treatment matching research is examined using Project MATCH as an illustrative example. Four process domains, including dose of treatment, within-session treatment activities, the therapeutic alliance and extra-session activities, are described in terms of their role as mediators or moderators of treatment outcome and the perspectives by which they are assessed in Project MATCH.

Alcoholism↗

PubMed1994

A chronological review of empirical studies matching alcoholic clients to treatment.

During the past 20 years researchers have become increasingly interested in exploring the benefits of differential assignment of alcoholics to treatments based on client-specific characteristics, rather than searching for a single "most effective" intervention for all clients. Thirty-one empirical studies on "client-treatment matching" are reviewed, particularly from the perspective of how research methodology in this area has evolved. In addition, general observations are provided on how research methodology on this topic can be further enhanced. Finally, several promising interactions between client characteristics and particular interventions are noted, based on empirical studies to date.

Alcoholism↗

PubMed1994

Classical analytical methods for detecting matching effects on treatment outcome.

This article presents a classical approach for analyzing repeated measures designs with specific application to treatment matching studies. The generic treatment matching hypothesis is formulated under the multivariate general linear model, transforming the dependent variables to account for the repeated measures structure of the data. Issues of primary importance in the use of this approach (such as correcting for inflated Type I error and robustness of statistical tests to parametric assumptions) are discussed. The article concludes with an assessment of the strengths and weaknesses of this approach compared with alternative approaches.

Alcoholism↗

PubMed1994

Assessment issues and strategies in alcoholism treatment matching research.

Sensitive and comprehensive client assessment entails complex conceptual and methodological considerations. Such activity is at the heart of matching clients to appropriate treatments. This article begins by specifying the goals and functions of assessment to support matching. This is followed by a discussion of the strategies employed in Project MATCH to identify matching and outcome variables. The assessment battery used in Project MATCH is next described. Finally, an overview of issues surrounding administration of assessment measures is provided. Particular attention is given to the topics of sequencing and timing of measures.

Alcoholism↗

PubMed1993

Changes in alcohol expectancies and drinking behavior among treated problem drinkers.

Research on alcohol expectancies among clinical populations has not focused on the extent to which changes in alcohol expectancies correspond to changes in drinking. In this investigation, male and female problem drinkers participating in an outpatient treatment focused on drinking reduction techniques provided data on drinking behavior and alcohol expectancies at pretreatment, posttreatment and at an 18-month follow-up. Results showed a significant relationship between decreases in alcohol expectancies and decreased drinking. Decreases in alcohol expectancies were not found over the course of the 8-week treatment, but instead at the 18-month follow-up. Implications and future research needs are discussed.

Adult↗

PubMed1991

School adjustment of children of alcoholic fathers: comparison to normal controls.

The present study used objective indices of academic performance to test the hypothesis that children of alcoholic fathers (COA's) have poorer school adjustment than children of nonalcoholic parents (non-COA's). Subjects were 39 children of male alcoholics treated for alcoholism in a VA program and 33 control children whose nonalcoholic parents (matched on demographic indices) reported low marital conflict. The results showed that daughters of alcoholics, but not the sons, showed more variability than controls in their school attendance. There was suggestive evidence that they also missed more school days than controls, with a reversed pattern for the sons of alcoholics. Generally, however, the COA group was not compromised academically and did not show more conduct problems compared to controls. Within the COA group, long-term paternal drinking adjustment (years of problem drinking and total number of hospitalizations for drinking) appeared to be related to poorer GPA, while short-term adjustment (alcohol-related days in jail and number of days drinking in year previous to treatment) were more related to poorer attendance. The results are discussed in terms of the mechanism of the effect of paternal drinking on children's school adjustment and the difficulty in making generalizations about the consequences of being the child of an alcoholic.

Achievement↗

PubMed1991

Drinking experiences in three populations of male drinkers.

The first drinking experience has been suggested as an important point in etiological processes associated with alcohol use and abuse. In this study, initial drinking experiences were assessed among populations of alcoholics, problem drinkers, and non-problem drinkers. Results showed that the alcoholics and problem drinkers more frequently consumed 5 or more drinks during their initial drinking occasion than the nonproblem drinkers. Alcoholics were most likely to experience their second drinking event within several days. In addition, there was a tendency for alcoholics and problem drinkers to describe more negative effects associated with their initial drinking experience. No effects were found for age of first drink or its location. Such differences in first drinking may have implications for understanding the etiology of drinking problems.

Adult↗

PubMed1990

Using a drinking motivation scale to predict degrees of problematic drinking.

Much of the recent interest in the role of cognitive factors in decisions to drink has focused on alcohol beliefs and drinking motivations. In this study, male alcoholics in treatment, untreated problem drinkers and non-problem drinkers were studied using a variation of the Mulford and Miller Definitions of Alcohol Scale, which assesses personal-deficiency and social/celebratory reasons for drinking. The three groups of drinkers differed significantly on their mean level of endorsement of items comprising each drinking motivation subscale. The alcoholics scored highest on both personal-deficiency and social/celebratory reasons for drinking, followed by the problem drinkers and then non-problem drinkers. The problem drinkers and non-problem drinkers, relative to the alcoholics, rated their social/celebratory reasons for drinking stronger than their personal-deficiency reasons. A multiple discriminant analysis yielded a function which was moderately successful in classifying the alcoholics (70% correctly classified) and non-problem drinkers (67%). The problem drinkers were much more difficult to correctly classify (32% were classified as alcoholic, 49% as non-problem drinkers). The findings suggest that potentially important differences exist in drinkers' motivations to consume alcohol, motivations that vary as a function of problem drinking severity. These are results which might productively be used in assessment and treatment endeavors.

Adult↗

PubMed1989

Biases in relapse attributions made by alcoholics and their wives.

Although numerous studies have investigated the relapse attributions of alcoholics, few have considered the biases inherent in such attributions. Two sources of bias were investigated in the relapse attributions of 26 alcoholic men and their wives: the passage of time and actor-observer perspective. As predicted: (a) Wives made more dispositional attributions than their husbands (an actor-observer difference); (b) the attributions of the husbands showed a dispositional shift over time, while their wives' attributions showed no temporal effects; and (c) attributional concordance within couples increased over time. Several explanations for these results were considered and implications for couples therapy with recovering alcoholics and their spouses were discussed.

Adult↗

PubMed1989

Alcohol themes within country-western songs.

Cultural norms regarding alcohol use and drinking behavior can be communicated through the lyrics of songs. An analysis of alcohol themes in country-western lyrics was undertaken. Seven categories emerged from a rational clustering procedure used with 58 alcohol-related lyrics. Almost two-thirds of the lyrics were placed in three of the categories, labeled Existential Dilemmas and Lessons Learned, Loneliness and Lost Love, and Negative Consequences. There were few references to drinking for positive, celebratory reasons. Implications for prevention efforts and for further research on drinkers' perceptions and the relationship between popular culture and drinking behavior are discussed.

Alcohol Drinking↗

PubMed1989

Initial drinking experiences among black and white male and female student drinkers.

Survey studies have revealed significant gender and racial differences in alcohol use patterns. One variable which may be related to some of these differences is initial drinking experiences. In this study, such experiences were assessed among 96 Black and White male and female college students. Consistent with past research, differences in initial drinking experiences were associated with gender. Predominant was the finding that men drank more during their initial drinking experience than did women. Further, males tended to report a shorter latency before the second drinking occurrence than did females, and females were more likely to first drink with family while males more often first drank with friends. No racial differences were found. Differences in later drinking patterns, especially those correlated with race, may depend more on subsequent rather than initial drinking experience.

Adult↗

PubMed1988

Alcoholics' attributions of factors affecting their relapse to drinking and reasons for terminating relapse episodes.

This study was designed to examine alcoholics' attributions about their relapses. The subjects were 36 male alcoholic participants in a study of the effectiveness of group behavioral marital therapy (BMT) for alcoholism. Subjects' treatment condition had been determined by random assignment to either the BMT, interactional marital therapy, or control group. At a two year posttreatment follow-up interview, subjects were asked what they thought the main reasons were for starting and stopping drinking in their two most recent relapses. Subjects' responses showed that both interpersonal and psychological factors were perceived to affect relapses, with some treatment group differences in how relapses were viewed. Subjects reported a variety of factors in their stopping drinking, with anticipation of negative consequences the most frequently reported reason. The treatment groups did not differ on their attributions for relapse termination. The results were interpreted as replicating and extending previous studies of relapse among alcoholics by showing the importance of spouse and other family members in subjects' attributions of relapse and their termination.

Adult↗