Two studies were conducted to assess variables related to the social determinants of alcohol consumption. In Study 1, moderate-and heavy-drinking male undergraduates were paired with confederates who behaved in a sociable or unsociable manner while modeling either light or heavy consumption. Modeling occurred in the sociable conditions but not in the unsociable conditions, where subjects tended to drink heavily. In Study 2, a similar group of subjects was exposed to one of three social status conditions crossed with light versus heavy consumption. The results indicated a modeling effect in all social status conditions. These studies provide further support for the existence of a modeling effect that can be disrupted by a lack of rapport between drinking partners. This latter finding has implications for the etiology of problem drinking because it suggests that increased alcohol consumption may serve as a strategy for coping with aversive social interactions.

This randomized controlled trial evaluated the efficacy of a brief intervention designed to reduce the harmful consequences of heavy drinking among high-risk college students. Students screened for risk while in their senior year of high school (188 women and 160 men) were randomly assigned to receive an individualized motivational brief intervention in their freshman year of college or to a no-treatment control condition. A normative group selected from the entire screening pool provided a natural history comparison. Follow-up assessments over a 2-year period showed significant reductions in both drinking rates and harmful consequences, favoring students receiving the intervention. Although high-risk students continued to experience more alcohol problems than the natural history comparison group over the 2-year period, most showed a decline in problems over time, suggesting a developmental maturational effect.

Relapse prevention, based on the cognitive-behavioral model of relapse, has become an adjunct to the treatment of numerous psychological problems, including (but not limited to) substance abuse, depression, sexual offending, and schizophrenia. This article provides an overview of the efficacy and effectiveness of relapse prevention in the treatment of addictive disorders, an update on recent empirical support for the elements of the cognitive-behavioral model of relapse, and a review of the criticisms of relapse prevention. In response to the criticisms, a reconceptualized cognitive-behavioral model of relapse that focuses on the dynamic interactions between multiple risk factors and situational determinants is proposed. Empirical support for this reconceptualization of relapse, the future of relapse prevention, and the limitations of the new model are discussed.

ONCERNS ABOUT HIGH PUBLIC system costs incurred by chronically homeless individuals have inspired nationwide efforts to eliminate chronic homelessness. 1,2 Homeless people have high barriers to health care access generally but use acute care services at high rates. [3][4][5] Mortality rates among homeless adults are 3 or more times that of the general population. 6,7 Chronically homeless people with severe alcohol problems, sometimes referred to as chronic public inebriates, are highly visible on the streets and are costly to the public through high use of publicly funded health and criminal justice systems resources. [8][9][10][11][12] Typical interventions such as shelters, abstinence-based housing, and treatment programs fail to reverse these patterns for this population. 10,13 Health conditions and mortality rates within this population are similar to those found in developing countries. 14,15 Average age at death is estimated to be 42 to 52 years, with 30% to 70% of deaths related to alcohol. 7,16,17 The provision of housing reduces hospital visits, admissions, and duration of hospital stays among homeless individuals, 5,18,19 and overall public system spending is reduced by nearly as much as is spent on housing. 19 One type

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