The burgeoning number of empirically validated therapies has not been met with systematic evaluation of practical, inexpensive means of teaching large numbers of clinicians to use these treatments effectively. An interactive, computer-assisted training program that sought to impart skills associated with the Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) Twelve-Step Facilitation (TSF) manual was developed to address this need.Twenty-five community-based substance use-treatment clinicians were randomized to one of two training conditions: (1) access to the computer- assisted training program plus the TSF manual or (2) access to the manual only. The primary outcome measure was change from preto posttraining in the clinicians' ability to demonstrate key TSF skills.The data suggested that the clinicians' ability to implement TSF, as assessed by independent ratings of adherence and skill for the key TSF interventions, was significantly higher after training for those who had access to the computerized training condition than those who were assigned to the manual-only condition. Those assigned to the computer-assisted training condition also demonstrated greater gains in a knowledge test assessing familiarity with concepts presented in the TSF manual. Conclusions: Computer-based training may be a feasible and effective means of training larger numbers of clinicians in empirically supported, manual-guided therapies.

The objective of this study is to investigate the impact of distilled spirits, wine, and beer taxes on cirrhosis mortality using a large-panel data set and statistical models that control for various other factors that may affect that mortality.The analyses were performed on a panel of 30 U.S. license states during the period 1971-1998 (N = 840 state-by-year observations). Exogenous measures included current and lagged versions of beverage taxes and income, as well as controls for states' age distribution, religion, race, health care availability, urbanity, tourism, and local bans on alcohol sales. Regression analyses were performed using random-effects models with corrections for serial autocorrelation and heteroscedasticity among states.Cirrhosis rates were found to be significantly related to taxes on distilled spirits but not to taxation of wine and beer. Consistent results were found using different statistical models and model specifications.Consistent with prior research, cirrhosis mortality in the United States appears more closely linked to consumption of distilled spirits than to that of other alcoholic beverages.

Despite the importance of action components in information processing models of substance-use motivation, there has been relatively little research that has specifically examined the effects of behavioral cues on motivation to use alcohol. The current study examined the effects of action priming on alcohol-use motivation.One hundred and eighty-eight hazardous drinkers completed a cue-exposure procedure followed by a beer-tasting task. Participants were exposed to their preferred alcohol beverage while they either lifted the beverage (action prime) or leaned toward the beverage (control). Following alcohol-cue exposure, participants completed a taste-test procedure in which they sampled three glasses of beer. Urges to drink following cue exposure and volume of beer consumed during the taste test were the primary dependent variables.Ratings of urge to drink increased in both prime conditions following alcohol-cue exposure and predicted the amount of beer consumed. The priming conditions did not differentially influence urge; however, there was a significant Prime x Gender interaction for volume of beer consumed. Men in the action-prime condition consumed more alcohol in the subsequent taste-test procedure than men who were in the control condition.These results suggest that behavioral sequences associated with drinking may prime alcohol-related motivational states among hazardous-drinking men. Moreover, these action primes may affect subsequent alcohol use independent of changes in subjective indices of alcohol-related motivation. Implications for understanding the distinct effects of alcohol-related cues on controlled and automatic processes underlying alcohol use are discussed.

Longitudinal analyses identified unique multidimensional classes of alcohol use and examined individuals' movement among these classes during emerging adulthood.Latent transition analysis was used to identify a developmental model of alcohol use incorporating four aspects of use: use in the past year, frequency of use, quantity of use, and heavy episodic drinking. Participants were drawn from the Reducing Risk in Young Adult Transitions study (N = 1,143). Participants' alcohol use was assessed at mean ages of 18.5, 20.5, and 22.5 years.Through exploratory analysis, a five-class developmental model was identified as the best description of participants' alcohol use between ages 18.5 and 22.5 years. This model consisted of five multidimensional alcohol-use latent variables: no use, occasional low use, occasional high use, frequent high use, and frequent high use with heavy episodic drinking. Analyses provided information regarding the proportion of participants in each latent class in the model at each measurement occasion and patterns of participants' movement among latent classes during the observed age period.Although alcohol use increased overall for study participants between ages 18.5 and 22.5, participants in lower-level alcohol-use latent classes were more likely to remain in low-level latent classes over time, and participants in moderate- and high-level latent classes were more likely to be in the frequent high use with heavy episodic drinking latent class over time. Implications for the prevention of heavy episodic drinking are discussed.

Many high school and college students are believed to use spring break vacation to travel to destinations with the intent of engaging in extreme party behaviors, including excessive alcohol use. However, the extent to which spring break travelers' behaviors are more risky than their typical behaviors remains unclear.To assess the impact of spring break as a situational risk factor, we analyzed data collected from 176 first-year college students across 10 weeks using weekly telephone interviews.Using multilevel modeling, we found the following: (1) men, participants in fraternity/sorority organizations, students traveling on spring break trips, and those with higher fun-social alcohol expectancies drank more during the regular semester; (2) alcohol use did not increase during spring break week in general; however, (3) spring break travelers increased their alcohol use during spring break.Spring break trips are a risk factor for escalated alcohol use both during the academic semester and during spring break trips, suggesting that some students may seek out opportunities for excessive alcohol use. Results are discussed in terms of niche selection and prevention implications.

The present study seeks to establish the extent to which media coverage acknowledges alcohol's contribution to violent crime as well as to motor vehicle injuries and other injury incidents.The study content-analyzes a unique sample, closely approximating national representativeness, of local and national television news, local newspapers, and national magazines randomly sampled during a 2-year period.Alcohol's role in violent crime and, to a lesser extent, in motor vehicle and other injury incidents is underreported relative to available estimates regarding alcohol-attributable fractions. Relative frequency of various news frames for coverage of alcohol and illegal drugs and differences in coverage of alcohol and illegal drugs as a function of the type of story and news medium are described.The underreporting in the United States of alcohol's contribution to serious and fatal injury from these causes may reduce public perceptions of alcohol-related risks, potentially influencing behavior, including public support of alcohol-control policies. This provides an opportunity for media-advocacy approaches to improve public health content of news coverage.

This study used data gathered from the Diagnostic Interview Schedule, Version Three, Revised (DIS-III-R), which calculated diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R), criteria and rescored the data to be compatible with the criteria of the Fourth Edition of the DSM (DSM-IV) for lifetime alcohol abuse and dependence.A psychologist reassigned questions from the DIS-III-R according to DSM-IV criteria. Another clinician evaluated the rescoring criteria and discrepancies were discussed and resolved. Using these criteria, SAS code was written to automate the rescoring of responses to DIS-III-R questions to DSM-IV diagnoses from a population of DWI offenders.There was a fair-to-good level of agreement between the DSM-III-R and rescored DSM-IV diagnoses (kappa = .65). Three hundred forty-eight subjects classified as alcohol dependent using DSMIII- R were reclassified as alcohol abuse in the DSM-IV rescore. Among subjects who were alcohol dependent based on DIS-III-R criteria, the distribution of DSM-IV diagnoses was similar across gender, age, and ethnic groups. There was no difference in agreement between DSMIII- R and the rescored DSM-IV diagnoses by age category. However, women and Hispanics had significantly higher weighted kappa statistics than men and non-Hispanic whites.Our rescoring results were consistent with earlier studies that compared DSM-III-R and DSM-IV diagnoses. Here, we offer an approach that may be useful to investigators who used the DIS-III-R in earlier studies. The DIS-III-R questions corresponding to DSM-IV criteria for alcohol abuse and alcohol dependence are on our Web site at www.bhrcs.org, along with the scoring algorithm.

Although injured patients in the emergency department (ED) report more frequent use of the ED compared with the general population, and alcohol-related admissions and chronic alcohol misuse have been found to be predictive of future ED admissions, these data are based on only a few U.S. studies. The purpose of this article was to explore the association of alcohol use and ED services use among injured patients cross-nationally.Binary and multinomial logistic regression were used to analyze the association of alcohol consumption with prior ED visits among 9,743 injured patients surveyed in 37 EDs in 14 countries and reported in 23 studies from the combined Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and World Health Organization Collaborative Study of Alcohol and Injuries.Drinking within 6 hours before injury was associated with prior ED visits during the last 12 months (odds ratio = 1.25, p < .05), with a positive dose-response relationship. Heavy drinkers and those drinkers who were alcohol-dependent were also significantly more likely to report multiple prior ED visits, reflecting an elevated burden of services use. At the ED level, stigmatization of alcohol use was the only significant contextual variable that consistently predicted cross-ED variation in the relationship between drinking and ED use, in which the association was weaker in areas where alcohol use is less accepted.This study lends additional support to the potential effectiveness of screening for acute and chronic alcohol use among ED injured patients to reduce ED services use and associated costs.

This study examines the impact of a social norms intervention to reduce alcohol misuse among student-athletes. The intervention was designed to reduce harmful misperceptions of peer norms and, in turn, reduce personal risk.A comprehensive set of interventions communicating accurate local norms regarding alcohol use targeted student-athletes at an undergraduate college. An anonymous survey of all student-athletes was conducted annually for 3 years (2001: n = 414, 86% response; 2002: n = 373, 85% response; and 2003: n = 353, 79% response). A pre/post comparison of student-athletes was conducted separately for new and ongoing athletes at each time point to isolate any general time period effects from intervention effects. A cross-sectional analysis of student-athletes with varying degrees of program exposure was also performed.The intervention substantially reduced misperceptions of frequent alcohol consumption and high-quantity social drinking as the norm among student-athlete peers. During this same time period, frequent personal consumption, high-quantity consumption, high estimated peak blood alcohol concentrations during social drinking, and negative consequences all declined by 30% or more among ongoing student-athletes after program exposure. In contrast, no significant differences across time were seen for new student-athletes each year with low program exposure. Among student-athletes with the highest level of program exposure, indications of personal misuse were at least 50% less likely on each measure when compared with student-athletes with the lowest level of program exposure.This social norms intervention was highly effective in reducing alcohol misuse in this high-risk collegiate subpopulation by intensively delivering data-based messages about actual peer norms through multiple communication venues.

An 18-site randomized trial was conducted to determine the effectiveness of social norms marketing (SNM) campaigns in reducing college student drinking. The SNM campaigns are intended to correct misperceptions of subjective drinking norms and thereby drive down alcohol consumption.Institutions of higher education were randomly assigned to treatment and control groups. At the treatment group institutions, SNM campaigns delivered school-specific, data-driven messages through a mix of campus media venues. Cross-sectional student surveys were conducted by mail at baseline (n = 2,771) and at posttest 3 years later (n = 2,939). Hierarchical linear modeling was applied to examine multiple drinking outcomes, taking intraclass correlation into account.Controlling for other predictors, having an SNM campaign was significantly associated with lower perceptions of student drinking levels and lower alcohol consumption, as measured by a composite drinking scale, recent maximum consumption, blood alcohol concentration for recent maximum consumption, drinks consumed when partying, and drinks consumed per week. A moderate mediating effect of normative perceptions on student drinking was demonstrated by an attenuation of the Experimental Group x Time interaction, ranging from 16.4% to 39.5% across measures. Additional models that took into account the intensity of SNM campaign activity at the treatment institutions suggested that there was a dose-response relationship.This study is the most rigorous evaluation of SNM campaigns conducted to date. Analysis revealed that students attending institutions that implemented an SNM campaign had a lower relative risk of alcohol consumption than students attending control group institutions.