Background Alcohol use is frequently implicated as a factor in nonadherence to highly active antiretroviral therapy (HAART). There have not been efforts to systematically evaluate findings across studies. This meta-analysis provides a quantitative evaluation of the alcohol-adherence association by aggregating findings across studies and examining potential moderators. Methods Literature searches identified 40 qualifying studies totaling over 25,000 participants. Studies were coded on several methodological variables. Results In the combined analysis, alcohol drinkers were approximately 50–60% as likely to be classified as adherent [OR = 0.548, 95% CI: 0.490–0.612] compared to abstainers (or those who drank relatively less). Effect sizes for problem drinking, defined as meeting the National Institute on Alcohol Abuse and Alcoholism (NIAAA) criteria for at-risk drinking or criteria for an alcohol use disorder, were greater [OR = 0.474, 95% CI = 0.408–0.550] than those reflecting any or global drinking [OR = 0.604, 95% CI = 0.531–0.687]. Several variables moderated the alcohol-adherence association. Conclusions Results support a significant and reliable association of alcohol use and medication nonadherence. Methodological variables appear to moderate this association and could contribute to inconsistencies across studies. Future research would benefit from efforts to characterize theoretical mechanisms as well as mediators and moderators of the alcohol-adherence association.

Background: The COVID-19 pandemic has resulted in massive disruptions to society, to the economy, and to daily life. Some people may turn to alcohol to cope with stress during the pandemic, which may put them at risk for heavy drinking and alcohol-related harms. Research is needed to identify factors that are relevant for coping-motivated drinking during these extraordinary circumstances to inform interventions. This study provides an empirical examination of coping motive pathways to alcohol problems during the early stages of the COVID-19 pandemic. Methods: Participants (N = 320; 54.7% male; mean age of 32 years) were Canadian adult drinkers who completed an online survey assessing work-and home-related factors, psychological factors, and alcohol-related outcomes over the past 30 days, covering a time period beginning within 1 month of the initiation of the COVID-19 emergency response. Results: The results of a theory-informed path model showed that having at least 1 child under the age of 18, greater depression, and lower social connectedness each predicted unique variance in past 30day coping motives, which in turn predicted increased past 30-day alcohol use (controlling for pre-COVID-19 alcohol use reported retrospectively). Income loss was associated with increased alcohol use, and living alone was associated with increased solitary drinking (controlling for pre-COVID-19 levels), but these associations were not mediated by coping motives. Increased alcohol use, increased solitary drinking, and greater coping motives for drinking were all independently associated with past 30-day alcohol problems, and indirect paths to alcohol problems from having children at home, depression, social connectedness, income loss, and living alone were all supported. Conclusions: Findings provide insight into coping-motivated drinking early in the COVID-19 pandemic and highlight the need for longitudinal research to establish longer term outcomes of drinking to cope during the pandemic.

The Relapse Prevention (RP) model has been a mainstay of addictions theory and treatment since its introduction three decades ago. This paper provides an overview and update of RP for addictive behaviors with a focus on developments over the last decade (2000-2010). Major treatment outcome studies and meta-analyses are summarized, as are selected empirical findings relevant to the tenets of the RP model. Notable advances in RP in the last decade include the introduction of a reformulated cognitive-behavioral model of relapse, the application of advanced statistical methods to model relapse in large randomized trials, and the development of mindfulness-based relapse prevention. We also review the emergent literature on genetic correlates of relapse following pharmacological and behavioral treatments. The continued influence of RP is evidenced by its integration in most cognitive-behavioral substance use interventions. However, the tendency to subsume RP within other treatment modalities has posed a barrier to systematic evaluation of the RP model. Overall, RP remains an influential cognitive-behavioral framework that can inform both theoretical and clinical approaches to understanding and facilitating behavior change.