An interest in reducing relapse among alcoholics has led to a consideration of stimulus control factors in drinking. Research suggests that through classical conditioning alcoholics may develop reactions to cues previously associated with drinking and that these reactions might be an important determinant of relapse. Although this model indicates the potential for cue exposure treatment methods to alter conditioned reactions, data on reactivity to alcohol cues by alcoholics and nonalcoholics are scarce. Two studies are presented that address this issue and provide evidence for the validity of salivation as a measure of cue reactivity. Alcoholics and nonalcoholics were presented with the sight and smell of their preferred brand of alcohol and a control beverage. Self-report, behavioral, and psychophysiological data were collected. Alcoholics salivated more than nonalcoholics to alcohol cues and more to alcohol than to the control beverage. Alcoholics salivated differentially to cues, whereas nonalcoholics did not. Patterns of reactivity were consistent with a conditioning model. Both groups reported greater urges to drink alcohol in the presence of alcohol, but neither group reported more thoughts about alcohol in the presence of alcohol as compared with the control beverage. Implications of salivary reactivity for theory and treatment are discussed.Relapse prevention among individuals treated for problem drinking continues to challenge clinicians and researchers.Prompted in part by clinical observation, theoretical discussions have suggested that setting cues or stimulus control factors may be relevant to this complex problem. Several reports have indicated that strong reactions may be conditioned to stimuli that are repeatedly paired with substance use and, in turn, that these reactions may contribute to craving, tolerance, and nonpharmacological aspects of withdrawal symptoms (Cooney,
This regimen is safe, with the best 2-year OS and PFS achieved in any Radiation Therapy Oncology Group primary CNS lymphoma trial. Randomized trials that incorporate this regimen are needed to determine its efficacy compared with other strategies.
This study of 632 drug injectors enrolled in eight residential detoxification centers within the National Drug Abuse Treatment Clinical Trials Network tested three interventions to reduce drug and sex risk behaviors. Participants were randomized to: (a) a two-session, HIV/HCV counseling and education (C&E) model added to treatment as usual (TAU), (b) a one-session, therapeutic alliance (TA) intervention conducted by outpatient counselors to facilitate treatment entry plus TAU, or (c) TAU. Significant reductions in drug and sex risk behaviors occurred for all three conditions over a 6-month follow-up period. C&E participants reported significantly greater rates of attending an HIV testing appointment, but this was not associated with better risk reduction outcomes. Reporting treatment participation within 2 months after detoxification and self-efficacy to practice safer injection behavior predicted reductions in injection risk behaviors. Findings indicate that participation in detoxification was followed by significant decreases in drug injection and risk behaviors for up to 6-months; interventions added to standard treatment offered no improvement in risk behavior outcomes.
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