Clinical research has found a strong association between negative affect and returning to alcohol use after a period of abstinence. Yet little is known about the probability of a lapse given a particular level of negative affect or whether there is a reciprocal relationship between negative affect and alcohol use across time. The goal of the current study was to examine the association between negative affect and drinking behavior in the 1st year following alcohol treatment. The authors applied an associative latent transition analysis to the Project MATCH outpatient data (n = 952) and then replicated the model in the Project MATCH aftercare data (n = 774). Changes in drinking following treatment were significantly associated with current and prior changes in negative affect, and changes in negative affect were related to prior changes in drinking (effect size range = 0.13-0.33). The results supported the hypothesis that negative affect and alcohol lapses are dynamically linked and suggest that targeting the relationship between negative affect and alcohol use could greatly decrease the probability of lapses and improve alcohol treatment outcomes.Keywords negative affect; alcohol relapse; depression; anger; associative latent transition analysisThe earliest theories of alcohol and drug dependence included descriptions of negative affect, avoidance of aversive states, and pleasure seeking as primary motives for substance use (Solomon & Corbit, 1974;Wikler, 1948). Experiencing negative affect has been linked to reinitiation of drug use (i.e., a lapse) following periods of abstinence. Several studies have shown that self-reported negative mood predicts substance use treatment outcomes (e.g., Cooney, Litt, Morse, Bauer, & Gaupp, 1997;Hodgins, el-Guebaly, & Armstrong, 1995;Kessler et al., 1997;Zywiak, Connors, Maisto, & Westerberg, 1996), and higher rates of relapse (i.e., a return to heavy drinking) have been observed among individuals with comorbid affective disorders (Conner, Sorensen, & Leonard, 2005;Curran, Flynn, Kirchner, & Booth, 2000;Hasin et al., 2002;Hodgins, el-Guebaly, Armstrong, & Dufour, 1999;Kodl et al., 2008). Cognitive-behavioral or pharmacological treatment of depression and/or anxiety in conjunction with alcohol treatment has been shown to decrease negative affective symptoms and improve drinking outcomes (e.g., Kushner et al., 2005;Nunes & Levin, 2004;Turner & Wehl, 1984).Several theories have been put forward to explain the relationship between negative affect and alcohol use. The self-medication hypothesis (Khantzian, 1997) Armeli et al., 2003;Kushner et al., 1996). Baker, Piper, McCarthy, Majeskie, and Fiore (2004) proposed that the avoidance of negative affect during withdrawal produces the primary motive for resumption of drug use. Several brain systems and neurotransmitters have been implicated as playing key roles in the reinforcing effects of drugs, acute withdrawal symptoms, and negative reinforcement associated with drug addiction. The prefrontal cortex, hypothalamic-pituitary-a...

Empirically-supported treatments for alcohol dependence exist, yet understanding of influences contributing to the intended behavior change is limited. The current study, a secondary analysis of the recent multi-site COMBINE trial (The COMBINE Study Research Group, 2003), tested a mediational model wherein change in client self-efficacy for abstinence was examined as a potential mediator of associations between client-report of the therapeutic bond and one-year outcomes of drinking frequency, drinking consequences, and psychiatric functioning. For analyses, the 1383 COMBINE trial participants were grouped as follows: 1) those receiving study medications (Naltrexone, Acamprosate, Naltrexone + Acamprosate, Placebo) and enrolled in medication management (MM) only (n=607), 2) those receiving study medications/MM and also enrolled in a combination behavioral intervention (CBI) as well (n=619), and 3) those enrolled in CBI only (n=157). Mediation analyses using the product-of-coefficients approach indicated self-efficacy change during treatment significantly mediated associations between the therapeutic bond with the CBI therapist and each of the three one-year outcomes among those exclusively receiving CBI, but failed to do so among those receiving pills/MM (with or without CBI). Effect sizes were small, but indicated that variance in bond-outcome associations was partially mediated by self-efficacy change for trial participants. Findings advance understanding of proximal client change processes during delivery of treatments for alcohol dependence.

Determining whether a particular treatment works for specific groups of people can help tailor dissemination of evidence-based alcohol treatments. It has been proposed that individuals from different racial groups might have better outcomes in treatments that are sensitive to sociocultural issues that impact alcohol use among these groups. The current study was a secondary analysis of data from the combined behavioral intervention (CBI) condition of the COMBINE study. Those randomly assigned to CBI (n = 776) had the opportunity to receive up to 9 skills training modules, which were chosen by the therapist. The goal of the current study was to determine whether receiving 1 of the CBI modules, drink refusal and social pressure skills training, predicted differential outcomes among African American clients. Results indicated that African American clients who received the drink refusal skills training module (n = 25) had significantly fewer heavy drinking days (d = 0.79) 1 year following treatment than African Americans clients who did not receive the module (n = 35). African American clients who received the module also had significantly fewer heavy drinking days (d = 0.86) than non-Hispanic White clients who received the module (n = 241). Good clinical outcomes at 1 year post treatment were observed among 80% of African Americans who received the module, compared with 54% of African Americans who did not receive the module and 52% of non-Hispanic White clients who did receive the module. Although small sample size limits interpretation, findings provide preliminary evidence supporting the inclusion of drink refusal skills training as part of alcohol interventions for African American clients.

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