A behavioral choice analysis of the role of life events during early nonabstinent natural recovery from alcohol use disorder.

Prior research supported a behavioral choice analysis of the role of life events in posttreatment drinking among abstinence-seeking inpatients with alcohol use disorder (AUD). This study investigated the generality of those relationships among persons attempting "natural" recovery involving moderation drinking. We had two hypotheses: (1) The likelihood of drinking after an event would be related to the degree of alcohol-related disruption in the life-health area of the event.

Matching, behavioral economics, and teleological behaviorism: Final cause analysis of substance use and health behavior.

Howard Rachlin and his contemporaries pioneered basic behavioral science innovations that have been usefully applied to advance understanding of human substance use disorder and related health behaviors. We briefly summarize the innovations of molar behaviorism (the matching law), behavioral economics, and teleological behaviorism. Behavioral economics and teleological behaviorism's focus on final causes are especially illuminating for these applied fields.

Addictive behavior as molar behavioral allocation: Distinguishing efficient and final causes in translational research and practice.

Objective: Translational research on addictive behaviors viewed as molar behavioral allocation is critically reviewed. This work relates rates of behavior to rates of reinforcement over time and has been fruitfully applied to addictive behaviors, which involve excessive allocation to short-term rewards with longer term costs.

Method: Narrative critical review.

Toward cost-effective initial care for substance-abusing homeless.

In a randomized controlled trial, behavioral day treatment, including contingency management (CM+), was compared to contingency management components alone (CM). All 206 cocaine-dependent homeless participants received a furnished apartment with food and work training/employment contingent on drug-negative urine tests. CM+ also received cognitive-behavioral therapy, therapeutic goal management, and other intervention components.

Significance of a behavioral economic index of reward value in predicting drinking problem resolution.

This study investigated whether a behavioral economic index of the value of rewards available over different time horizons improved prediction of drinking outcomes beyond established biopsychosocial predictors. Preferences for immediate drinking versus more delayed rewards made possible by saving money were determined from expenditures prior to resolution attempts by problem drinkers with different help-seeking experiences (N = 144). As hypothesized, stable resolutions over a 2-year follow-up were associated with proportionally more preresolution discretionary expenditures on savings and less on alcohol compared with unstable resolutions.

To house or not to house: the effects of providing housing to homeless substance abusers in treatment.

Objectives: Housing typically is not provided to homeless persons during drug abuse treatment. We examined how treatment outcomes were affected under 3 different housing provision conditions.

Methods: We studied 196 cocaine-dependent participants who received day treatment and no housing (NH), housing contingent on drug abstinence (ACH), or housing not contingent on abstinence (NACH).

Using behavioral theories of choice to predict drinking outcomes following a brief intervention.

Behavioral theories of choice predict that substance use is partly a function of the relative value of drugs in relation to other available reinforcers. This study evaluated this hypothesis in the context of predicting drinking outcomes following an alcohol abuse intervention. Participants (N = 54, 69% female, 31% male) were college student heavy drinkers who completed a single-session motivational intervention.

Transitions during effective treatment for cocaine-abusing homeless persons: establishing abstinence, lapse, and relapse, and reestablishing abstinence.

Data are reported on drug use among cocaine-dependent homeless persons who participated in a clinical trial that compared day treatment only (DT, n = 69) with day treatment plus abstinent-contingent housing and work (DT+, n = 72). Drug use was measured with multiple weekly urine toxicologies. Compared with DT participants, more DT+ participants established abstinence, maintained abstinence for longer durations, were marginally significantly more likely to lapse, and significantly less likely to relapse.

A comparison of personalized feedback for college student drinkers delivered with and without a motivational interview.

Objective: This study evaluated the relative efficacy of personalized drinking feedback (PDF) delivered with and without a motivational interview (MI) for college student drinkers.

Method: Heavy-drinking college students (N = 54; 691% female) were identified from a large screening sample and randomly assigned either to receive PDF during a single MI session or to receive PDF without an MI. Of these participants, 51 (94%) completed a 6-month follow-up assessment that included measures of alcohol consumption and alcohol-related problems.

A factor analytic study of influences on patterns of help-seeking among treated and untreated alcohol dependent persons.

Influences on seeking help from professional alcohol treatment and from Alcoholics Anonymous (AA) were investigated using problem drinkers (N = 167) with different help-seeking experiences (no assistance, AA only, or treatment plus AA) and current drinking statuses (sustained abstinence for > 2 years or active problem drinking). Depending on their help-seeking experiences, participants rated barriers to or reasons for seeking help from treatment and AA, which were factor analyzed. Common impediments to help-seeking included privacy concerns and participants' beliefs that they could solve their problem on their own and that it was not serious enough to seek help.

Different variables are associated with help-seeking patterns and long-term outcomes among problem drinkers.

This study investigated variables associated with help-seeking for drinking problems and with long-term drinking outcomes. In a 3 x 2 design, problem drinkers (N=167) were selected according to their help-seeking history [no assistance (NA), Alcoholics Anonymous (AA) only, or treatment plus AA (TxAA)] and current drinking status [resolved abstinent (RA) for >2 years or non-resolved (NR) active drinkers]. Drinking practices and problems, influences on help-seeking, and life events were assessed retrospectively during structured interviews.

Predicting natural resolution of alcohol-related problems: a prospective behavioral economic analysis.

This study investigated whether the relative allocation of discretionary monetary expenditures to alcoholic beverages versus savings (presumed to reflect relative preferences for immediate vs. delayed rewards) before quitting abusive drinking predicted natural resolution among untreated problem drinkers. Drinking, life events, income, and expenditures were assessed for the year before resolution and again 1 and 2 years later (N = 50).

Environmental contexts surrounding resolution of drinking problems among problem drinkers with different help-seeking experiences.

Objective: This study investigated whether similar environmental contexts surround abstinent resolutions associated with different intervention experiences, including no assistance.

Method: Participants were selected in a 3 x 2 design (25-30 per group, N = 167) according to their help-seeking experiences (no assistance, Alcoholics Anonymous [AA] only, treatment plus AA) and current drinking status (resolved abstinent [RA] for >2 years or nonresolved [NR] controls). Life events were assessed retrospectively over a 4-year period that spanned the 2 years before and 2 years after the initiation of stable abstinence by RA participants or over a matched interval for NR participants.

Still necessary to state the obvious: comment on Alessi, Roll, Reilly, and Johanson (2002).

S. M. Alessi, J.