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NEW READINGS AND ON E T I O L O G Y , PREVENTION, TREATMENT
E D I T E D BY
G. Alan Marlatt and Katie Witkiewitz
Copyright © 2009 by the American Psychological Association. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, including, but not limited to, the process of scanning and digitization, or stored in a database or retrieval system, without the prior written permission of the publisher. Chapters 1 and 21 were authored or coauthored by an employee ofthe United States govemment as part of official duty and are considered to be in the public domain. Published by American Psychological Association 750 First Street, NE Washington, DC 20002 www.apa.org To order APA Order Department P.O. Box 92984 Washington, DC 20090-2984 Tel: (800) 374-2721; Direct: (202) 336-5510 Fax: (202) 336-5502; TDD/TTY: (202) 336-6123 Online: www.apa.org/books/ E-mail: firstname.lastname@example.org
In the U.K., Europe, Africa, and the Middle East, copies may be ordered from American Psychological Association 3 Henrietta Street Covent Garden, London WC2E8LU England Typeset in Goudy by Circle Graphics, Columbia, MD Printer: Edwards Brothers, Inc., Ann Arbor, MI Cover Designer: Berg Design, Albany, NY Technical/Production Editor: Harriet Kaplan Tlie opinions and statements published are the responsibility of the authors, and such opinions and statements do not necessarily represent the policies of the American Psychological Association. Library of Congress Cataloging-in-Publication Data Addictive behaviors: new readings on etiology, prevention, and treatment / edited by G. Alan Marlatt and Katie Witkiewitz. — 1st ed. p.; cm. "Reprinted from American Psychological Association joumals." Includes bibliographical references and index. ISBN-13:978-1-4338-0402-1 ISBN-10:1-4338-0402-6 1. Substance abuse. 2. Compulsive behavior. I. Marlatt, G. Alan. II. Witkiewitz, Katie. III. American Psychological Association. [DNLM: 1. Substance-Related Disorders—etiology—Collected Works. 2. Behavior, Addictive—Collected Works. 3. Substance-Related Disorders—prevention & control— Collected Works. 4- Substance-Related Disorders—therapy—Collected Works. WM 270 A22473 2009] RC564.A314 2009 362.29^Ic22
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Contributions of Behavioral Science to Alcohol Research: Understanding Who Is at Risk and Why Enoch Gordis Why Psychologists Should Treat Alcohol and Drug Problems William R. Alan Marlatt and Katie Witkiewitz I. Brown xi 3 17 19 Chapter 2. Role of Psychology and Behavioral Science in Addiction Research and Treatment Chapter 1. Miller and Sandra A.CONTENTS Contributors Introduction G. 33 .
and Matt McGue Etiological Contributions to Heavy Drinking From Late Adolescence to Young Adulthood Serena M. and William G. MacCoun Adolescent Substance Use Outcomes in the Raising Healthy Children Project: A Two-Part Latent Growth Curve Analysis Eric C. Krueger. Brian M. GuidoMazzotti. Chapter 7. Catherine Martin. Richard F. Novak. Initiation and Progression in Adolescence Chapter 9. William G. Catalano. Dishion and Lee D. TK Logan.II. Etiologic Connections Among Substance Dependence. Scott P. Fleming. Kevin P.Abbott Project DARE: No Effects at lO-Year Follow-Up Donald R. Charles B. Richard Milich. Lynam. Malone. Broum. Haggerty. Toward a Psychology of Harm Reduction Robert]. Rick Zimmerman. Owen 197 199 VI CONTENTS . Scott R. Stephen M. Chikoat 57 59 Chapter 4. Hicks. 89 Chapter 5. A Longitudinal Analysis of Friendships and Substance Use: Bidirectional Influence From Adolescence to Adulthood Thomas]. lacono. Epidemiological Overview and Etiology Chapter 3. and Richard Clayton 135 137 159 Chapter 8. and Robert D. Martins. Carlson. Prevention and Harm Reduction Chapter 6. King. Alexandra Burt. lacono Trends in Ecstasy Use in the United States From 1995 to 2001: Comparison With Marijuana Users and Association With Other Drug Use Silvia S. arui Howard D. 117 III. Patrick. 187 IV. Matt McGue. S. and Personality: Modeling the Extemalizing Spectrum Robert F. Christopher]. Carl Leukefeld. Antisocial Behavior.
Sandy. Neal.]on D. Miller. Kenneth S. ]ames M. Roberts. 367 CONTENTS vn . jean A. Kenneth].Chapter 10. Liu. Conjoint Developmental Trajectories of Young Adult Alcohol and Tobacco Use Kristirw. and Ori Shinar 257 259 Chapter 12. Kassel. Mary Hickcox. Lisa]. Kevin M. Bates Immediate Antecedents of Cigarette Smoking: An Analysis From Ecological Momentary Assessment SaulShiffman. Sher. andjohnE. and Maryann Gnys 321 Chapter 13. Cresskr. Schulenberg 225 V. arui G. The Roles of Familial Alcoholism and Adolescent Family Harmony in Young Adults' Substance Dependence Disorders: Mediated and Moderated Relations Qing Zhou. Paty. Dan]. Family Dynamics and Family Impact Chapter 11. Alan Marlatt The Neuropsychological Test Performance of Dmg-Abusing Patients: An Examination of Latent Cognitive Abilities and Associated Risk Factors William Fals-Stewart and Marsha E. Screening and Assessment Test-Retest Reliability of Alcohol Measures: Is There a Difference Between Intemet-Based Assessment and Traditional Methods? Elizabeth T. M. Balabanis. ]ane Metrik. King. and Laurie Chassin Family Risk Factors and Adolescent Substance Use: Moderation Effects for Temperament Dimensions Thomas Ashby Wills. Boer. ]ohn S. Alison Yaeger. 343 Chapter 15. ]ackson. Sally O. Chad]. 323 Chapter 14. MarkH. 287 VI. Gwaltney.
Stitzer. Moos Abstinence-Based Incentives in Methadone Maintenance: Interaction With Intake Stimulant Test Results Maxine L. Kimberly Kirby. Mark D. 459 Chapter 19. AUan Cohen. Howard R. Steinberg. Ken Kolodner. This Is Tao Katie Witkiewitz and G. Litt. Pilkey. Ryan Vandrey. and Rui Li 401 403 Chapter 17. John Roll. 429 Chapter 18. David T. Gerald Voelbel. Nancy M. 537 Chapter 22. and Prospectus Raymond Niaura and David B. Abrams Risk Factors and Neuropsychological Recovery in Clients With Alcohol Use Disorders Who Were Exposed to Different Treatments Marsha E. Erich W. 497 Chapter 20. Buckman Alcohol and Tobacco Cessation in Alcohol-Dependent Smokers: Analysis of Real-Time Reports Ned L. Priorities. ]udith L. Bates. Treatment Approaches and Models Chapter 16. Cooney. fesska Peirce. 515 Chapter 21.VII. jack Blaine. Labouvie. 559 vm CONTENTS . Onclcen Addictive Disorders in Context: Principles and Puzzles of Effective Treatment and Recovery RiuiolfH. DanieUe Barry. Relapse Prevention for Alcohol and Dmg Problems: That Was Zen. Cooney. and Cheryl A. Alan Marlatt Brief Treatments for Cannabis Dependence: Findings From a Randomized Multisite Trial The Marijuana Treatment Project Research Group Smoking Cessation: Progress. Joseph Krasrmnsky. Petry. William Fals-Stewart. and Jennifer F.
657 Chapter 26. Preventing Substance Abuse in American Indian and Alaska Native Youth: Promising Strategies for Healthier Communities Elizabeth H. Luczak. Hawkins.VIII. Leffcrrge Measuring Adolescent Dmg Abuse and Psychosocial Factors in Four Ethnic Groups of Dmg-Abusing Boys Ken C. Latimer. Stinchfield. LiRian H. and Elizabeth Egan Meta-Analyses of ALDH2 and ADHJ B With Alcohol Dependence in Asians Susan E. Cummins. Strada. 677 Author Index Subject Index About the Editors 713 751 777 CONTENTS IX . Winters. and Tamara L. Glatt. William W. and Noelk L. Randy D. WaR 573 575 Chapter 24. and G. Issues in Specific Populations Chapter 23. BradDonohue. 623 Chapter 25. Alan Marlatt Examination of Ethnicity in Controlled Treatment Outcome Studies Involving Adolescent Substance Abusers: A Comprehensive Literature Review Marilyn J. Stephen].
Cummins Thomas J. Haggerty Elizabeth H. Gwaltney Kevin P. Cooney Sally O. Alexandra Burt Scott R. Cressler Lillian H. Buckman S. Dishion Brad Donohue Elizabeth Egan William Fals-Stewart Charles B. Hawkins Mary Hickcox Brian M. Fleming Stephen J. King XI . Bates Jack Blaine Eric C. Jackson Jon D. Chilcoat Richard Clayton Allan Cohen Judith L. Cooney Ned L. Brown Jennifer F. Catalano Laurie Chassin Howard D. lacono Kristina M. Baer Mark H. Carlson Richard F. Abrams John S. Kassel Kevin M. Glatt Maryann Gnys Enoch Gordis Chad J. Hicks William G. Abbott David B. Balabanis Danielle Barry Marsha E. Brown Sandra A.CONTRIBUTORS Robert D.
Winters Katie Witkiewitz Alison Yaeger Qing Zhou Rick Zimmerman XH CONTRIBUTORS . Miller William R. Sandy John E. Oncken Lee D. King Kimberly Kirby Ken Kolodner Joseph Krasnansky Robert F. Lefforge Carl Leukefeld Rui Li Mark D. Miller Rudolf H. Krueger Erich W. Neal Raymond Niaura Scott P. Strada Ryan Vandrey Gerald Voelbel Tamara L. Novak Cheryl A. MacCoun Stephen M. Latimer Noelle L. Owen Christopher J. Alan Marlatt Catherine Martin Silvia S. Stitzer Marilyn J. Steinberg Randy D.Serena M. Roberts John Roll James M. Luczak Donald R. Sher Saul Shiffman Ori Shinar Howard R. Wall Thomas Ashby Wills Ken C. Schulenberg Kenneth J. Malone The Marijuana Treatment Project Research Group G. Lynam Robert J. Pilkey Lisa J. Martins Guido Mazzotti Matt McGue Jane Metrik Richard Milich Elizabeth T. Paty Jessica Peirce Nancy M. Patrick Jean A. Stinchfield Maxine L. Labouvie William W. Moos Dan J. Liu TK Logan Susan E. Petry David T. Litt Kenneth S.
Addictive Behaviors .
Given that the neuroscience of addiction has made great strides in recent years. etc. We thank Gary for his devotion to this topic and support of this edited collection.. reducing craving and urges to use).) can have beneficial therapeutic effects (e. there have been major advances in the research. acamprosate. the effects are . contacted us in 2007 to see if we would be interested in putting together a new collection of readings from over the past decade. methadone. prevention.. many of which are documented by chapters in the current volume of readings.g. coeditor of the earlier volume.g. ALAN MARLATT AND KATIE WITKIEWITZ Since the publication ofthe Addictive Behaviors Reader in 1997. Gary VandenBos. it is no surprise that considerable research activity has been devoted to the development of new pharmacotherapies that are designed to reduce dmg craving or block the rewarding effects of various substances on brain fiinctioning. One major development over the past decade has been the current definition of addiction as a "brain disease" as promoted by the National Institute on Drug Abuse and other authorities. including analyses of how drug taking impacts various pleasure centers in the brain (many mediated by dopamine release that often enhances the rewarding consequences of drug use). buprenorphrine. naltrexone. Research findings show that although pharmacotherapy (e. and treatment of addictive behaviors.INTRODUCTION G.
T. Clinical trials are larger. (chap. In the traditional approach. cognitive-behavior therapy. particularly statistical and assessment techniques. has changed the face of conducting research on addictive behaviors. no more treatment is necessary. and trauma centers.often enhanced if the treatment program combines pharmacotherapy with a behavioral intervention (e. If the brief intervention is successful. expanded. the client could be encouraged to "step up" to a more intensive treatment (e. Miller et al. In vivo methods for data collection. more powerful. have provided real-time assessment of addictive behavior as it is happening in a person's daily life. relapse prevention. Statistical methods and software that were previously unused by many psychological researchers are recently being introduced into the mainstream. MARLATT AND WITKIEWITZ . (chap.. The aim of the brief intervention is to engage the client or patient to participate in a self-help group or structured outpatient treatment—to get him or her started in taking action. and extended to different populations or different types of addictive behavior. attending a 12-step group or signing up for inpatient treatment). Most such programs lasted for a month (28 days or longer) and combined medical detoxification and intensive treatment based on the disease model of addiction. medical emergency rooms. such as ecological momentary assessment (EMA) via handheld computers and interactive voice response systems. 20) provide examples of applications using EMA. Many ofthe findings and controversies identified in the 1990s have now been replicated. where nearly every article has at least onefigureof a complicated stmctural equation model or latent growth curve model. the field has greatly benefited from advances in computer technology and increases in the National Institutes of Health budget from 1995 to 2002.g. Shiffman et al. anyone diagnosed with an addiction problem was referred to an intensive residential treatment program. motivational interviewing). E. If it is not successful. In this volume.g. and have produced better data. initial intervention is usually brief and may consist of a single session or professional advice. As will be evident in this collection of readings. Behavioral research on addictive behaviors has also grown exponentially over the past 10 years. The intensity of treatment for addictive behaviors has also shifted over the past decade. there has been a shift in emphasis to embrace the "stepped-care" model. In this approach. often in settings such as primary care. 15) and Cooney et al.. (chap. Intensive rehab is more often reserved as a last resort if less intensive therapy is unsuccessful. More recently. Methodology. 13) provide an introduction to Webbased assessment and test its reliability compared with traditional methods. The growth of the Intemet has made way for many Web-based psychological assessment tools and interventions delivered online. This fact becomes blatantly evident when one browses through the more recent issues ofthe joumal Psychology of Addictive Behaviors. Assessment techniques have largely benefited from advances in computing technology.
. such clients are referred back and forth between mental health professionals ("You are drinking excessively because you are trying to reduce the intensity of your depression symptoms") and substance abuse treatment professionals ("Your depression is caused by your alcoholism"). (d) the initiation and progression of addictive behaviors INTRODUCTION . Traditional abstinence-only or "high-threshold" intervention programs are typically based on the disease model of addiction and a 12-step program for recovery. Typically. or personality disorders. there is a strong need to provide an integrated treatment approach. The selection of representative articles was determined by impact on the field. As a result.g. harm reduction strategies have been applied to other high-risk addictive behaviors such as problem drinking (e. quality of research methodology. Such clients often fall between the cracks of these frequently opposing professional perspectives and may give up and drop out of treatment altogether. one that ties together both sides of the presenting problem. Originally associated with interventions for IV dmg users such as needle exchange (to reduce the potential harm of HIV infection) or methadone maintenance (to reduce the risk of overdose or other problems associated with illegal drug use). depression. and topic coverage. (b) epidemiology and etiology of addictive behaviors (Part II). moderation management. brief alcohol screening and intervention for college students). The addictive behaviors treatment field is also working to develop an integrated treatment approach for working with clients who are experiencing co-occurring substance abuse and mental health problems. (c) prevention and reducing the harm associated with addictive behaviors (Part III). AN OVERVIEW OF THE CHAPTERS The articles reprinted in this collection of readings were all selected from American Psychological Association (APA) journals published since 1997.The expansion of available treatment goals is also a noteworthy development of the past decade. Key articles in eight topic areas were selected (each represented in a different section of the book): (a) the role of behavioral science in addiction research and the treatment of addiction (Part I). and offers a flexible approach to choosing treatment goals (including both harm reduction and abstinence). More recently. Harm reduction therapy is a low-threshold approach that is willing to "meet people where they are at" instead of a confrontational top-down approach that mandates treatment goals that require total abstinence for successful recovery. Many clients that we see in our clinical programs are using alcohol and/or other dmgs to selfmedicate other personal problems such as anxiety. clients who are unwilling or unable to make a commitment to abstinence have been offered altemative treatment goals (an approach known as h^irm reduction).
. Substance use disorders are the most prevalent form of mental health problem and frequently co-occur with other mental health disorders. (g) treatment approaches and models of addiction (Part VII). all of which are still relevant today: diagnostic issues. Miller and Brown also address some of the barriers for psychologists in the routine treatment of substance use disorders and provide several recommendations for future training and research. and one postdoctoral fellow (Susan Collins) at the University of Washington. reflection) are predictors of favorable treatment outcomes. empathy. and medications development as important for elucidating the relationship between biology and behavior as well as how advances in these areas will improve the efficacy and effectiveness of alcohol prevention and intervention methods. Fortunately. and (h) addictive behaviors in specific populations (Part Vlll). 1). (e) the role of familial factors. Because of space limitations and to avoid overlap of topic areas. and Joel Grow). who may or may not have formal addictions training. can and should provide assessment and treatment of addictive behaviors. many excellent and ground-breaking articles were left out of the final selection. provides a thorough overview of the role of behavioral science in the prevention and treatment of alcohol use disorders. R. Gordis also describes fiiture challenges for behavioral scientists. including family history of addiction (Part V). three advanced graduate students (Sharon Hsu.in adolescence (Part IV). A final selection of 26 articles was chosen for this collection. MARLATT AND WITKIEWITZ . Miller and Brown (chap. the role of stress hormones. gaining knowledge of neural systems. and increasing biobehavioral (including neural systems) and etiology research. R. (f) the screening and assessment of addictive behaviors (Part VI). Seattle. Role of Psychology and Behavioral Science in Addiction Research and Treatment Part I of the book contains two chapters written by top researchers in the field of addictive behaviors. psychologists who treat other psychological problems will likely have several clients who are also struggling with an addictive behavior. 2) makes a compelling case for how and why psychologists. The chapter focuses on the qualities and special expertise of psychologists that make them suited for working with individuals who have alcohol and/or drug problems. former director of the National Institute of Alcohol Abuse and Alcoholism. This voluminous list was then reduced to 86 articles that were deemed "exceptional" by the editors. many studies have shown that basic clinical skills (e. He highlights genetics research. The chapter by W. Enoch Gordis (chap.g. adolescent drinking. W. Thus. We started with abstracts from every article published in APA journals since 1997 that were related to the topic of addictive behaviors. Diane Logan.
LSD. Using the same data from the Mirmesota Twin Family Study as Kmeger et al. and lacono (chap. The results show that lifetime ecstasy use prevalence more than doubled from 1995 (1. The first two chapters tackle some of the main challenges to behavioral scientists described by Gordis in Part I: genetics. The results support a hierarchical model in which the co-occurrence among alcohol dependence. heroin.6%) and that this increase was particularly notable for younger age groups (18. marijuana. In the first chapter of Part III. Because all of the variance was not explained by heritability the authors concluded that both general environmental and specific etiologic factors play a role in predicting extemalizing behaviors and substance dependence diagnoses. including alcohol. and Chilcoat (chap. Malone. and personality style. In addition. Burt. (chap. The chapter explores whether heavy drinking and onset of heavy drinking among 1. biobehavioral research. which provides a nationally representative sample across the United States." Martins.to 25-year-olds). and disinhibitory personal style could all be partially explained by a heritable extemalizing factor.6%) to 2001 (3. The authors recommend future research to examine specific genetic and environmental factors. INTRODUCTION . 3) propose a biometric model of the "extemalizing spectmm" that encompasses comorbid substance use. a time when the increase in ecstasy use in the United States was considered an "epidemic. Kmeger et al. conduct disorder. The final chapter in this section addresses trends in ecstasy and other dmg use from 1995 to 2001. antisocial behavior. McGue.. Prevention and Harm Reduction The issue of harm reduction was a hotly debated topic throughout the 1990s and into the new millennium. environmental. users of ecstasy were likely to report using many other dmgs.Epidemiological Overview and Etiology Part 11 ofthe book includes three chapters that address etiology and epidemiology. King. drug dependence.252 twin pairs from ages 17 to 20 can be partially explained by genetic. and stimulants. Mazzotti. The chapter provides a thorough review of genetic research to date and examines the genetic and environmental influences on the extemalizing spectrum in 626 twin pairs. cocaine. The authors suggest prevention and harm reduction strategies for educating adolescents and young adults about ecstasy. 5) look at data from the National Household Survey on Dmg Abuse. crack. adolescent antisocial behavior. The results show that biological predictors of heavy drinking are more influential among male twins compared with female twin pairs and that changes in heavy drinking are largely attributable to nonshared environmental factors for both males and females. and substance use in adolescence. 4) examine genetic and environmental predictors of heavy drinking from late adolescence to adulthood. or neurological predictors.
Using an innovative growth modeling strategy. One such intervention. MacCoun takes a "frank look" at opposition to harm reduction and provides hypotheses for making harm reduction more successful and palatable. where the primary strategy has traditionally been "use reduction" via strict prohibition and enforcement. school-based education program. and family-level intervention strategies that were targeted to the developmental stage of the child. it did potentially reduce the harm that has been associated with frequent substance use in adolescence. Brown. conclude that although the intervention did not prevent use. which is delivered by uniformed police officers over 17 weekly sessions. quantity reduction.002 individuals 10 years after they received the DARE curriculum. As in nearly all studies to date. 6) addresses the American dmg policy and a framework for integrating strategies to reduce harmful consequences of substance use and other behaviors. Haggerty. 7) examined the developmental trajectories of substance use from Grades 6 through 10 in 959 participants in this project. (chap. several outcomes studies have concluded that DARE has no short-term effects on actual drug use. In the final chapter of this section. Brown et al. the Department of Justice had reported that 53% of federal prison inmates were drug offenders. The most effective and cost-saving way to reduce harm from substance use is through prevention. and the trend of increased prison populations due to dmg-related convictions continues. 8) examine 10-year outcomes of the most widely disseminated and ineffective drugprevention program in the United States. Despite the widespread popularity ofthe program and the federal cost of implementing it.MacCoun (chap. the chapter concludes that DARE is not effective at reducing drug use or changing attitudes toward drug use. Catalano. In the 1990s there was a flurry of largescale preventive interventions targeting youth development and substance use. the authors report that the intervention was effective in reducing the frequency of both alcohol and marijuana use during these years but not eliminating use entirely. Returning to the idea of harm reduction. school-. the Raising Healthy Children project. The strategies described in the article—prevalence reduction. Lynam et al. student-. Fleming. and harm reduction—have been evaluated quite differently in the domain of drug control. Lynam et al. and Abbott (chap. examine the affects of DARE (compared with a standard drug-education curriculum) on drug use in 1. was designed to target developmentally appropriate risk and protective factors by implementing. Project Drug Abuse Resistance Education (DARE). The authors provide some potential reasons why DARE advocates persist in promoting the program despite the overwhelming evidence that the program is not efficacious. As of 2006. MARLATT AND WITKIEWITZ . DARE is a federally funded.
or community-wide prevention interventions. The authors conclude that aside from this small subgroup. and Schulenberg (chap. and Chassin (chap. family conflict) have been shown to be strong predictors of substance use. family harmony. In addition..Initiation and Progression in Adolescence As described by Gordis in chapter 1. The methodology used in the chapter has the potential to greatly increase our understanding of addictive behavior over time. In the first chapter. Sher. One unexpected finding described in the article is the identification of a subgroup of adolescents who used substances during adolescence and escalated to dangerous dmg use in young adulthood but did not have a deviant peer group. In addition. In the next chapter. with individuals expected to be in the largest class (56%) reporting no drinking or smoking. In their study. Using growth mixture modeling. The two chapters in Part V provide an investigation into the role of family in the development of substance use and abuse during adolescence and young adulthood. 9) examine the bidirectional relationship between deviant friendships and substance use from age 13 to age 23 in a sample of 206 boys. and religiosity predicted specific developmental courses for both alcohol and tobacco use across time. family-level variables (e. 11) examine the interaction between family history of alcoholism and family harmony during adolescence in the prediction of alcohol and drug dependence during young adulthood. the authors examine predictors of alcohol and tobacco trajectories and conclude that parent education. the challenge of preventing and treating substance use in adolescence is a major target for addictive behaviors researchers. the authors assessed 732 participants from 393 families overfivetime points spanning the course of roughly 13 years (from average ages 13 to 26). race. Dishion and Owen (chap. most adolescents might benefit from preventive interventions that target peer group behavior and school. King. Jackson.g. gender. The results are consistent with previous findings regarding the direct effects of family history of INTRODUCTION . the authors extracted seven classes of drinking/smoking. Family Dynamics and Family Impact Family history of alcohol problems has been consistently shown to predict increased risk for drinking problem. 10) examine trajectories of alcohol and tobacco use during young adulthood using data from the Monitoring the Future study. The results are consistent with previous research in showing that the strongest predictor of adolescent substance use is belonging to a peer group that also uses substances. Zhou. The two chapters in Part IV provide a longitudinal analysis of the development of substance use from adolescence into young adulthood.
Sandy. The authors conducted two assessments within 1 week in which 255 participants were randomized to complete either Intemet or paper-based assessments. and Shinar (chap. Advances in statistical software are evident in the second study in Part VI. The results strongly support the test-retest reliability of Internet-based assessment and show no differences between assessment techniques. The authors describe four cognitive factors (executive. Since the early 1990s. a large sample size (N = 1. the relationship was weakened. T. The chapter reports that family relationships and family stress are significant and unique predictors of adolescent and peer substance use. and the applications of computing to research questions have greatly expanded our ability to gather large amounts of data from a wide variety of people. In addition. speed. In addition. Miller et al. The first and third chapters in Part VI describe two such applications. one of the most notable changes since the publication of the Addictive Behaviors Reader in 1997 is the advances in computing technology and an exponential increase in the number of Internet users.810). 12) provide a slightly different slant by examining potential moderators of adolescent substance use. The chapter concludes by examining these opposing resiliency and vulnerability effects within a broad theoretical context. Wills. Screening and Assessment As described above. the authors show that family harmony during adolescence partially mediated the direct effect of family history on young adult development of substance use dependence. (chap. 13) conducted the first test-retest reliability study comparing Internetbased assessment and traditional paper-based methods of assessment. suggesting that Internet-based methods are a suitable and cost-efficient altemative to traditional paper-based measures. whereas for those adolescents with high negative emotionality and high activity level the impact of family risk factors was heightened. including family risk factors and a variety of temperament characteristics. In the second chapter. and memory) that J0 MARLATT AND WITKIEWITZ . several temperament factors were found to moderate this association. researchers have been incorporating Web-based computer technology and handheld computers as useful research tools. E. verbal. Fals-Stewart and Bates (chap. For adolescents with positive emotionality and task attention. and obtaining information from multiple reporters (adolescents and teachers) are particular strengths of the study. Yaeger.alcohol on offspring substance use dependence and family harmony as a protective factor related to decreased dmg dependence during young adulthood. The application of latent growth modeling to test moderation effects. 14) examine the neuropsychological functioning of 587 participants recruited from substance use treatment programs using a multimethod approach and latent variable modeling.
including premorbid fiinctioning. The work that we selected for this volume (Shiffman et al. The final chapter in Part VI revisits the issue of expanding research questions by incorporating computing technology. The authors recmited 304 smokers who recorded smoking and nonsmoking situations over the course of 1 week. text messaging) have the potential to greatly expand our understanding of addictive behavior. 2000. Shiffman and his colleagues have conducted several studies to date (Shiffman et al. Treatment Approaches and Models Seven articles were selected for Part VII. interactive voice response. remains one of the most common outcomes following treatment and is INTRODUCTION JI . 15) examines the situational cues that precede smoking in real time.084 and 11. and the presence of other smokers were the strongest predictors of ad lib smoking. 1996). respectively.. Relapse. and their research has provided volumes of knowledge about the immediate antecedents and consequences of engaging in a variety of addictive behaviors. In 1994. EMA and other in vivo methods of assessment (e. alcohol career length and recent drinking quantity. which is an assessment approach that attempts to take the laboratory to the person by providing an assessment instmment that is delivered in real-time in real-world contexts. or the retum to problematic substance use after a period of abstention or moderate drinking. Stone and Shiffman published their seminal work on EMA. as well as some outcome data from studies that have implemented various treatments. Using handheld computers.g. the authors identify several risk factors that have predicted neuropsychological functioning.sufficiently represent 15 different neuropsychological test scores. The chapters in this section describe several different treatment models. &. chap. years of education. EMA greatly reduces problems of recall and enhances ecological validity. random and self-initiated assessments. polydmg dependence. Gnys. Paty.. and several biological measures.155 reports from smoking and nonsmoking situations. Using generalized estimating equations the authors show that smoking urges. 1997. It is important to note that no single approach appears to be more effective than others in the treatment of addictive behavior problems and a wide variety of treatment alternatives are currently available. It is important to note that these prior studies relied heavily on self-report via retrospective recall and were therefore not sensitive to the momentary experiences of the smoker. participants complete electronic diaries of their daily life based on scheduled. which is contrary to prior studies that have consistently shown a strong relationship between self-reported affect and smoking behavior. Negative or positive affect and arousal were not related to smoking. Hickcox. Kassel. family history of alcoholism. Shiffrnan. the authors collected 10. each describing a different treatment approach for a variety of addictive behaviors. consumption of coffee and food. In total. In addition.
Using similar methods as described by Fals-Stewart and Bates (chap. or a delayedtreatment control condition. Niaura and Abrams (chap. and individuals in the nine-session treatment experienced significantly greater reductions in cannabis use and related consequences compared with the two-session treatment. Several treatments have been developed for smoking cessation. Project MATCH was a multisite study that was conducted to examine potential patient-treatment matching effects following three active treatments: cognitive-behavioral treatment. The multisite randomized control trial recruited 450 participants and randomly assigned them to either two sessions of motivation enhancement treatment (MET). 90. Both active treatment conditions were significantly more effective in reducing marijuana use relative to the control condition. Interventions have been implemented across a variety of contexts including individual treatment. Tobacco use is the leading cause of preventable death in the United States. The results suggest that initial neuropsychological abilities as well as a variety of risk factors predicted neuropsychological recovery at 15 months following treatment initiation. The chapter also provides an extensive description of future research strategies that may help elucidate the relapse process and enhance relapse prevention interventions. Cooney et al. we provide a review and synthesis of relapse prevention for alcohol and dmg problems. and nicotine has been described as one of the most addicting substances. Overall. 19) examine neuropsychological fiinctioning among 1. and public health approaches. (chap. 20) also used electronic diaries for EMA in a study examining relapse precipitants in the first 2 weeks following discharge from treatment in a sample of 102 alcohol-dependent smokers.possibly one of the most fmstrating aspects of the treatment of addictive behavior.2% of 12 MARLATT AND WITKIEWITZ . authored by The Marijuana Treatment Project Research Group (chap. The second chapter. We included this chapter because it offers a comprehensive review of the multitude of risk factors for relapse as well as methods for assessment and treatment. health-care-delivered intervention. examines the efficacy of two brief interventions for cannabis dependence. 14) in the previous section. and 12-step facilitation. MET. (chap. Niaura and Abrams provide a thorough overview of the field of smoking cessation interventions as well as offer recommendations for smoking cessation guidelines and future research for behavioral research related to smoking cessation. community-based interventions. Bates et al.726 participants who received alcohol treatment in the Project MATCH study. In the first article (Witkiewitz & Marlatt. 18) review the state of the art for smoking cessation treatment in the third chapter in this section. from behavioral intervention to nicotine patches to hypnotherapy. chap. nine sessions of a multicomponent treatment including MET and cognitive-behavioral techniques. 16). 17).
the final section of the book.participants did not lapse to alcohol use during the monitoring period. providing stimulant negative or positive urine tests at the initiation of treatment) would mediate the relationship between incentives and treatment outcomes. four chapters examine issues for specific populations with substance abuse problems. look at a specific aspect of contingency management within a sample of 386 methadone maintenance patients. and this has commonly been found to be the case in addiction treatment. would result in lasting changes beyond the period when incentives for behavior were stopped. In conclusion.0% for brief and intensive treatments. Moos (chap.e. Stitzer et al. there will be decay of the behavior after reinforcement ceases. According to behavioral theory. self-efficacy. The results from this particular study mn contrary to a commonly held belief that incentives should only be offered for individuals with less severe dmg abuse. supporting a cross-substance cue reactivity model. Starting in the early 1990s. but the abstinence rates for smoking were 5. These are exciting data and future research needs to be conducted to extend the EMA follow-up period fiirther. this chapter is essential reading for all psychologists who are practitioners treating or researchers researching addictive behavior. a treatment called contingency management. As identified by Gordis in the first chapter of this collection. Stitzer et al. understanding and preventing adolescent substance use is an enormous challenge for addictive behaviors researchers and INTRODUCTION 13 . (chap. researchers began to systematically evaluate whether providing incentives. 22) describe an innovative and evidence-based treatment for stimulant abuse and dependence.. The introduction of incentives as part of addiction treatment was based on a basic behavioral principle: If a behavior is reinforced. it is more likely to occur in the fiiture. Analyses reveal that both groups of individuals (stimulant positive and stimulant negative at intake) reported reduced duringtreatment dmg use relative to a non-incentive-based control condition. and mood. In the final treatment approach chapter. The data also provided evidence that alcohol urges increased following smoking episodes. Moos provides a brief discussion of the concems commonly voiced by clinical providers who are often least familiar and most suspicious of "evidence-based" treatments. Momentary predictors of thefirstdrink andfirstcigarette included urges to smoke and drink. In the next chapter in this section. The question they address is whether intake stimulant test results (i. He provides a detailed review of research studies that have either provided support or refuted the prevailing wisdom in addiction treatment. In many ways. respectively. Issues in Specific Populations In Part VIII.8% and 24. 21) ponders the seven principles and unresolved puzzles of effective addictive behavior treatment and recovery processes.
and Hispanic. decision making. African American. there were discrepancies across all ethnic groups on test-retest reliability in which some scales had inadequate reliability and some had discrepancies on response probabilities and distortions. we included articles that focused on adolescent populations. Although the results do provide strong support for the validity and commonality of the Personal Experience Inventory across ethnic groups. Strada. The Hawkins et al. a metaphor was constmcted in which the canoe joumey. for the first three chapters in this section. In the last two sections Hawkins et al. Drawing on the Northwest Native tradition of the canoe joumey. Hawkins. Stinchfield. In counterpoint to the Hawkins chapter. In thefirstsection ofthe chapter. representing four groups: White.clinicians. In thefirstchapter of Part VIII. The "Canoe Joumey" is a culturally congment prevention program that is unique to the cultural experiences of tribes in the Pacific Northwest. Latimer. and goal setting as well as providing information about alcohol and dmg use and its consequences. The chapter concludes with a description of a program that was codeveloped by researchers at the University of Washington and Native eldersfi-omthe Seattle Indian Health Board. and Marlatt (chap. 14 MARLATT AND WITKIEWITZ . 24) provide a comprehensive review of how poorly the field has responded to this need. chapter provides a convincing example of how ethnicity and cultural values should be incorporated into treatment of substance use as well as how an existing prevention program can be successfiilly modified to accommodate culturally relevant variables. which was primarily developed in White samples. 25) focus specifically on the validation of a multiscale assessment tool for adolescent dmg abusers called the Personal Experience Inventory. Cummins. and Lefforge (chap. The authors sampled 3. The authors reviewed 18 adolescent dmg treatment outcome studies to examine whether ethnicity was systematically incorporated into the analysis or interpretation of findings across all studies. and Egan (chap. provide a review of prevention efforts and offer recommendations for fiiture research and preventive strategies that are most promising for substance abuse prevention among Native adolescents. Native American. Winters. The authors conclude that the addictive behaviors research community needs to invest energy in the examination of ethnicity in existing controlled outcome studies and the development or adaptation of treatments to accommodate culture-relevant variables. the authors provide an introduction to substance use prevalence rates as well as risk and protective factors for abusing specific substances among Native populations. 23) provide a thorough literature review on preventing substance use in American Indian and Alaskan Native adolescents. as well as other Native symbols.191 adolescent boys (13 to 18 years old) fi'om 30 different adolescent dmg abuse programs. In total. 94% ofthe studies mentioned ethnicity to some extent and 28% incorporated ethnicity into their design. Donohue. but only 6% of studies included specific analyses to examine ethnicity as a potential moderator of treatment responding. served as a metaphor to teach skills such as communication. Thus.
In closing. C.. which provide a fiirther wealth of studies. K. H. whereas a partial dominant or dominant model explains the influence of ADHIB. Health Psychology. We are also indebted to the great work conducted by Susan Collins.. most notably the COMBINE study. 4) presented in Part II of this volume. In addition. Addiction.. The chapter reviews the genetic influence and the potential mediators and moderators for the effects of these genes on alcohol dependence. several large-scale studies. Sharon Hsu. In general. The interested reader is referred to the references at the end of each chapter in this collection. Luczak et al.In the final chapter of this collection. 315-323. the authors conclude that an additive model of genetic influence (in which one gene allele is good and possession of two gene alleles is even better) provides an appropriate means for modeling the relationship between ALDH2 and alcohol dependence. 26) provide an update and meta-analysis of two genes. including being Japanese. S. Addictive Behavicns. recruiting samples from treatment settings. particularly among Northeast Asian populations. 19. including the foumal of the American Medkal Association and the New England fourrud of Medicine. have recently been published in medical joumals. (2000).. J. Joel Grow.. because the focus of the book is on APA-published works. J. Paty. we thank Gary VandenBos for initiating the process for this new volume. S. M. Engberg.. INTRODUCTION 15 . the collection excludes several articles of equal importance to the ones that were chosen. (chap. Balabanis. A. Liu. REFERENCES Shiffman. because of space constraints. ALDH2 (aldehyde dehydrogenase) and ADH IB (alcohol dehydrogenase). CONCLUDING REMARKS AND ACKNOWLEDGMENTS This collection of readings from articles published by the APA provides a small sampling of psychological research on addictive behaviors. The article also describes several moderators of these effects. As mentioned earlier. J. Dynamic effects of self-efficacy on smoking lapse and relapse. and Diane Logan in the identification of articles to be included in this collection. et al. which have been shown to offer protection from alcohol dependence. several ground-breaking articles from Joumal of Studies on Akohol arui Drugs. (chap. and gender (with men showing greater protection from ADHIB). Also. and other non-APA publications were not included. It is interesting that this finding is consistent with the results from King et al. Gwaltney.
(1994).. Engberg..Shiffman. Shiffman.. & Hickcox. Paty. J. A.. 199-202. Gnys. 366-379. S. A. Stone. First lapses to smoking: Within-subjects analyses of real-time reports. Kassel. S. Perz. Joumal of Abnormal Psychology. Paty. J6 MARLATT AND WITKIEWITZ . & Shiffman. 104-116. & Hickcox.. A. M. Gnys. 106. M.. A. M. Kassel. (1996).. Annals of Behavioral Medicine. J. W. J. D. Ecological momentary assessment in behavioral medicine. M. 64... J. Joumal of Consulting and CUnical Psychology. 16. J. (1997).. S. D.. A day at a time: Predicting smoking lapse from daily urge.
I ROLE OF PSYCHOLOGY AND BEHAVIORAL SCIENCE IN ADDICTION RESEARCH AND TREATMENT .
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