These data provide a systematic and comprehensive assessment of the association between body weight and psychiatric conditions. Interventions addressing weight loss may benefit from integrating treatment for psychiatric disorders.

Between 50% and 80% of individuals with alcohol use disorders experience mild to severe neurocognitive impairment. There is a strong clinical rationale that neurocognitive impairment is an important source of individual difference affecting many aspects of addiction treatment, but empirical tests of the direct influence of impairment on treatment outcome have yielded weak and inconsistent results. The authors address the schism between applied-theoretical perspectives and research evidence by suggesting alternative conceptual models of the relationship between neurocognitive impairment and addiction treatment outcome. Methods to promote neurocognitive recovery and ways in which addiction treatments may be modified to improve psychosocial adaptation are suggested. Specific suggestions for future research that may help clarify the complex relations between neurocognitive impairment and addiction treatment are outlined.

Objective Contingency management (CM) reduces drug use, but questions remain regarding optimal targets and magnitudes of reinforcement for specific patient subgroups. We evaluated the efficacy of CM reinforcing attendance in patients who initiated treatment with cocaine-negative samples, and of higher magnitude abstinence-based CM in patients who began treatment cocaine positive. Methods Initially cocaine-negative patients (n=333) were randomized to: standard care (SC), SC+CM reinforcing submission of negative samples with $250 in prizes ($250Abs), or SC+CM reinforcing attendance ($250Att). Initially cocaine-positive patients (n=109) were randomized to: SC, $250Abs, or higher magnitude CM ($560Abs). Results For initially cocaine-negative patients, $250Abs and $250Att were equally efficacious to SC in enhancing longest duration of abstinence during treatment (LDA); $250Att patients submitted lower proportions of negative samples when missing samples were considered missing, but these patients also attended more study sessions, provided more samples, and submitted a higher proportion of negative samples than SC patients when expected samples were analyzed, ps<.05. In initially cocaine-positive patients, both CM conditions increased proportions of negative samples relative to SC when missing samples were excluded from analyses, but only $560Abs was efficacious in increasing LDA and proportion of negative samples when expected samples were analyzed, ps<.05. Follow-ups revealed no differences in drug use among groups, but LDA was consistently associated with abstinence during follow-up, p<.05. Conclusions High magnitude abstinence-based reinforcement improved all abstinence outcomes in patients who began treatment while using cocaine. For patients initiating treatment abstinent, both attendance- and abstinence-based CM resulted in improvements on some measures.

PURPOSE-The purpose of this study is to examine gender differences in associations between body mass index (BMI) and affective disorders.METHODS-We used logistic regression to examine the effects of BMI and gender on DSM-IV mood and anxiety disorders in a sample of 40,790 adults.RESULTS-Obesity (BMI ≥ 30.0) was associated with increased risk for any mood disorder, major depressive disorder, and dysthymic disorder, in both men and women (odds ratios [ORs], 1.35-1.88). Risk of bipolar I and II disorders was elevated in obese women (ORs, 1.70-2.41) but not men. Overweight (BMI = 25.0-29.9) predicted increased risk for any mood disorder and bipolar I disorder in women but not men (ORs, 1.16-1.44). Obesity was associated with increased odds of any anxiety disorder and specific phobia in men and women (ORs, 1.35-1.79). Obese women were additionally at increased risk for social phobia. Overweight predicted increased risk of social phobia and specific phobia for women but not men (ORs, 1.27-1.37).CONCLUSIONS-Obese individuals of both genders are at increased risk for a range of mood and anxiety disorders, but women who are even moderately overweight experience increased risks for some disorders as well.

Many older adults do not meet physical activity recommendations and suffer from health-related complications. Reinforcement interventions can have pronounced effects on promoting behavior change; this study evaluated the efficacy of a reinforcement intervention to enhance walking in older adults. Forty-five sedentary adults with mild to moderate hypertension were randomized to 12-week interventions consisting of pedometers and guidelines to walk 10,000 steps/day or that same intervention with chances to win $1-$100 prizes for meeting recommendations. Patients walked an average of about 4,000 steps/day at baseline. Throughout the intervention, participants in the reinforcement intervention met walking goals on 82.5% ± 25.8% of days versus 55.3% ± 37.1% of days in the control condition, p < .01. Even though steps walked increased significantly in both groups relative to baseline, participants in the reinforcement condition walked an average of about 2,000 more steps/day than participants in the control condition, p < .02. Beneficial effects of the reinforcement condition relative to the control condition persisted at a 24-week follow-up evaluation, p < .02, although steps/day were lower than during the intervention period in both groups. Participants in the reinforcement intervention also evidenced greater reductions in blood pressure and weight over time and improvements in fitness indices, ps < .05. This reinforcement-based intervention substantially increased walking and improved clinical parameters, suggesting that larger-scale evaluations of reinforcement-based interventions for enhancing active lifestyles in older adults are warranted. Ultimately, economic analyses may reveal reinforcement interventions to be cost-effective, especially in high-risk populations of older adults.