To support the free and open dissemination of research findings and information on alcoholism and alcohol-related problems. To encourage open access to peer-reviewed articles free for all to view.

For full versions of posted research articles readers are encouraged to email requests for "electronic reprints" (text file, PDF files, FAX copies) to the corresponding or lead author, who is highlighted in the posting.


Friday, July 22, 2011

Persuasive Features in Web-Based Alcohol and Smoking Interventions: A Systematic Review of the Literature

In the past decade, the use of technologies to persuade, motivate, and activate individuals’ health behavior change has been a quickly expanding field of research. The use of the Web for delivering interventions has been especially relevant. Current research tends to reveal little about the persuasive features and mechanisms embedded in Web-based interventions targeting health behavior change.

The purpose of this systematic review was to extract and analyze persuasive system features in Web-based interventions for substance use by applying the persuasive systems design (PSD) model. In more detail, the main objective was to provide an overview of the persuasive features within current Web-based interventions for substance use.

We conducted electronic literature searches in various databases to identify randomized controlled trials of Web-based interventions for substance use published January 1, 2004, through December 31, 2009, in English. We extracted and analyzed persuasive system features of the included Web-based interventions using interpretive categorization.

The primary task support components were utilized and reported relatively widely in the reviewed studies. Reduction, self-monitoring, simulation, and personalization seem to be the most used features to support accomplishing user’s primary task. This is an encouraging finding since reduction and self-monitoring can be considered key elements for supporting users to carry out their primary tasks. The utilization of tailoring was at a surprisingly low level. The lack of tailoring may imply that the interventions are targeted for too broad an audience. Leveraging reminders was the most common way to enhance the user-system dialogue. Credibility issues are crucial in website engagement as users will bind with sites they perceive credible and navigate away from those they do not find credible. Based on the textual descriptions of the interventions, we cautiously suggest that most of them were credible. The prevalence of social support in the reviewed interventions was encouraging.

Understanding the persuasive elements of systems supporting behavior change is important. This may help users to engage and keep motivated in their endeavors. Further research is needed to increase our understanding of how and under what conditions specific persuasive features (either in isolation or collectively) lead to positive health outcomes in Web-based health behavior change interventions across diverse health contexts and populations.

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Beneficial Effects of Ethanol Consumption on Insulin Resistance Are Only Applicable to Subjects Without Obesity or Insulin Resistance; Drinking is not

Although moderate drinking has been shown to lower insulin resistance levels, it is still unclear whether alcoholic beverages could be remedies for insulin resistance.

To elucidate this, the correlation between levels of ethanol consumption and insulin resistance were cross-sectionally examined in 371 non-diabetic male Japanese workers.

Multiple regression analysis demonstrated that the ethanol consumption level was inversely correlated with the insulin resistance level assessed by homeostatic model assessment (HOMA-IR, p = 0.0014), the serum insulin level (p = 0.0007), and pancreatic β-cell function, also assessed by HOMA (HOMA-β, p = 0.0002), independently from age, body mass index (BMI), and blood pressure, liver function tests, and lipid profiles status, as well as serum adiponectin.

The correlations were true in subjects with normal BMIs (up to 25.0 kg/m
2, n = 301) or normal HOMA-IR (up to 2.0 µIU·mg/µL·dL n = 337), whereas all of them were non-significant in those with excessive BMIs (n = 70) or in those with HOMA-IR of more than 2.0 (n = 34).

Although it is still unclear whether the reductions of these parameters by ethanol consumption are truly due to the improvement of insulin resistance, at least, these effects are not applicable to subjects with obesity and/or insulin resistance.

Thus, alcoholic beverages could not be remedies for insulin resistance or metabolic syndrome.

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Genetic variability in the NMDA-dependent AMPA trafficking cascade is associated with alcohol dependence

Model studies in mice indicate that the severity of alcohol withdrawal is associated with polymorphic variation and expression of the MPDZ gene. Current knowledge about variation in the human MPDZ gene is limited; however, our data indicate its potential association with alcohol dependence. The multi-PDZ protein is an important part of the N-methyl-D-aspartate (NMDA)-dependent α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptor trafficking cascade that controls glutamate-related excitatory neurotransmission.

To investigate association of variation in the NMDA-dependent AMPA trafficking cascade with alcohol dependence, we performed a gene-set (pathway) analysis using single nucleotide polymorphism (SNP) data from the Study of Addiction: Genetic and Environment.

Rather than testing for association with each SNP individually, which typically has low power to detect small effects of multiple SNPs, gene-set analysis applies a single statistical test to evaluate whether variation in a set of genes is associated with the phenotype of interest.

Gene-set analysis of 988 SNPs in 13 genes in the pathway demonstrated a significant association with alcohol dependence, with P < 0.01 for the global effect of variation in this pathway.

The statistically significant association of alcohol dependence with genetic variation in the NMDA-dependent AMPA receptor trafficking cascade indicates a need for further investigation of the role of this pathway in alcohol dependence.

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Proposed Decision Memo for Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse (CAG-00427N)

The Centers for Medicare and Medicaid Services (CMS) proposes the following:

The evidence is adequate to conclude that screening and behavioral counseling to reduce alcohol misuse, which is recommended with a grade of B by the U.S. Preventive Services Task Force (USPSTF) for adults, including pregnant women, in primary care settings, is reasonable and necessary for the prevention of early illness or disability, and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B.

Therefore CMS proposes to cover annual alcohol screening and for those that screen positive, up to four brief, face-to-face, behavioral counseling interventions per year for Medicare beneficiaries, including pregnant women:

  • Who misuse alcohol, but whose levels or patterns of alcohol consumption do not meet criteria for alcohol dependence (defined as at least three of the following: tolerance; withdrawal symptoms; impaired control; preoccupation with acquisition and/or use; persistent desire or unsuccessful efforts to quit; sustains social, occupational, or recreational disability; use continues despite adverse consequences); and
  • Who are competent and alert at the time that counseling is provided; and
  • Whose counseling is furnished by qualified primary care physicians or other primary care practitioners in a primary care setting.

Each of the behavioral counseling interventions should be consistent with the 5A’s approach that has been adopted by the USPSTF to describe such services:

  1. Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.
  2. Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
  3. Agree: Collaboratively select appropriate treatment goals and methods based on the patient’s interest in and willingness to change the behavior.
  4. Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate.
  5. Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.

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The Reproducibility of the Early Detection of Alcohol Consumption Test Using Split Samples Analyzed in Different Laboratories

This study analyzes the reproducibility of the Early Detection of Alcohol Consumption (EDAC) test by sending blood samples obtained from nine volunteers to four different laboratories. It also describes the reproducibility of the EDAC over time by analyzing the results of testing one subject whose blood sample was sent to seven different laboratories over a 10-year period.

The EDAC is a method of interpreting routine laboratory profiles to identify either binge drinking or heavy drinking; the components of the routine panel were chosen based on a best fit predictions model published previously.

Overall, the results of the cross-sectional analysis showed that the coefficients of variations (CVs) of the routine tests in the panel were mostly below 16%. Only three analytes (total bilirubin, aspartate aminotransferase and monocytes) showed CVs between 20 and 38%. The differences in the EDAC predictions for these volunteers ranged from 0 to 24%. In the long-term analysis, the variation of the EDAC prediction ranged from 0 to 21% probability of heavy drinking for one subject over time. Thus, mild variations of the EDAC are to be expected when the blood samples are analyzed in different laboratories. However, based on this study, these variations in the prediction of heavy drinking should not exceed >24% when using the EDAC test.

This study supports the standard practice established for similar contemporary alcohol biomarkers stipulating that indications of heavy drinking become evident only when subjects experience changes of >30% in the probability of heavy drinking over time.

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Attitudes and behaviour predict women's intention to drink alcohol during pregnancy: the challenge for health professionals.

To explore women's alcohol consumption in pregnancy, and potential predictors of alcohol consumption in pregnancy including: demographic characteristics; and women's knowledge and attitudes regarding alcohol consumption in pregnancy and its effects on the fetus.

We conducted a national cross-sectional survey via computer assisted telephone interview of 1103 Australian women aged 18 to 45 years. Participants were randomly selected from the Electronic White Pages. Pregnant women were not eligible to participate. Quotas were set for age groups and a minimum of 100 participants per state to ensure a national sample reflecting the population. The questionnaire was based on a Health Canada survey with additional questions constructed by the investigators. Descriptive statistics were calculated and logistic regression analyses were used to assess associations of alcohol consumption in pregnancy with participants' characteristics, knowledge and attitudes.

The majority of women (89.4%) had consumed alcohol in the last 12 months. During their last pregnancy (n=700), 34.1% drank alcohol. When asked what they would do if planning a pregnancy (n=1103), 31.6% said they would consume alcohol and 4.8% would smoke. Intention to consume alcohol in a future pregnancy was associated with: alcohol use in the last pregnancy (adjusted OR (aOR) 43.9; 95% Confidence Interval (CI) 27.0 to 71.4); neutral or positive attitudes towards alcohol use in pregnancy (aOR 5.1; 95% CI 3.6 to 7.1); intention to smoke in a future pregnancy (aOR 4.7; 95% CI 2.5 to 9.0); and more frequent and higher current alcohol consumption.

Women's past pregnancy and current drinking behaviour, and attitudes to alcohol use in pregnancy were the strongest predictors of alcohol consumption in pregnancy. Targeted interventions for women at higher risk of alcohol consumption in pregnancy are needed to change women's risk perception and behaviour.

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Implementing alcohol and other drug interventions effectively: How does location matter?

To identify enabler and barrier mechanisms that impact project implementation, from a review of 127 completed projects intended to reduce harms associated with problematic alcohol and licit drug use in Australia.

Data comprised archival material (proposals, reports). A coding framework was developed from the literature and a sample of projects; two researchers developed and refined the framework. Open coding was used to identify factors impacting implementation, followed by pattern coding to identify underlying mechanisms.

Project categories were developed from funding orientation and main activities projects were: enhancing organizational systems and processes (39), training and workforce development (18), community education and prevention (37) and client engagement and treatment (33). Thirty-five projects (28%) were in non-capital city locations.

Nine enabler and ten barrier mechanisms were identified, for example, ‘project planning and design’ and ‘wider service system challenges’. Three enabler mechanisms were more likely to be identified for non-capital city projects; ‘external communication and relationships’ (83% vs 70%), ‘sensitivity to service users and settings’ (49% vs 40%) and ‘funding and resourcing’ (40% vs 35%). Most barrier mechanisms were identified for a higher proportion of non-capital city projects, particularly ‘identifying and retaining personnel’ (54% vs 34%), ‘engaging communities and partners’ (46% vs 26%) and ‘organizational governance and capacity’ (29% vs 5%).

Project implementation in non-capital city locations requires particular attention to project planning and design, staffing and organizational well-being. Policy initiatives and planning.

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Genome-wide association study of conduct disorder symptomatology

Conduct disorder (CD) is one of the most prevalent childhood psychiatric conditions, and is associated with a number of serious concomitant and future problems. CD symptomatology is known to have a considerable genetic component, with heritability estimates in the range of 50%. Despite this, there is a relative paucity of studies aimed at identifying genes involved in the susceptibility to CD.

In this study, we report results from a genome-wide association study of CD symptoms. CD symptoms were retrospectively reported by a psychiatric interview among a sample of cases and controls, in which cases met the criteria for alcohol dependence.

Our primary phenotype was the natural log transformation of the number of CD symptoms that were endorsed, with data available for 3963 individuals who were genotyped on the Illumina Human 1M beadchip array.

Secondary analyses are presented for case versus control status, in which caseness was established as endorsing three or more CD symptoms (
N=872 with CD and N=3091 without CD).

We find four markers that meet the criteria for genome-wide significance (
P<5 × 10−8) with the CD symptom count, two of which are located in the gene C1QTNF7 (C1q and tumor necrosis factor-related protein 7). There were six additional SNPs in the gene that yielded converging evidence of association.

These data provide the first evidence of a specific gene that is associated with CD symptomatology. None of the top signals resided in traditional candidate genes, underscoring the importance of a genome-wide approach for identifying novel variants involved in this serious childhood disorder.

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Global Actions July 22, 2011

Global Actions in Focus: Nigeria

Our landmark road safety event in Abuja on July 18-19 was a success that drew many enthusiastic participants from throughout Nigeria, as well as press coverage. “We achieved the goal of establishing a comprehensive vision through the two-day training course, and were pleased to see so many interested and engaged guests,” said Global Actions Nigeria Country Manager Dr. Lanre Onigbogi.

The training included discussions with Federal Road Safety Commission (FRSC) personnel about methods for reducing crashes, and a conclusion was reached regarding intervention locations. “Many commercial drivers in Nigeria drink very heavily, and pulling people aside can be unsafe for the traffic safety officers,” said ICAP’s Ken Williams, “The decision was made to focus on one access road, Lokoja and Abuja, that is incredibly dangerous. It is the only road that connects Nigeria’s north and south.”

In other workshop discussions, participants focused on commercial drivers at checkpoints and the general driving public. Participants also agreed that a focus on towing could be more constructive than imposing fines, as people are often unwilling to pay fines. In addition, the group brainstormed the idea of engaging owners/operators of the fleets, mostly passenger transport fleets, to increase the legal consequences of drink driving. A challenge will be enabling passengers to contact owners/operators or the FRSC about drink driving or road safety risky behavior. Stakeholders also discussed the need for a complaint process, and reaching out to radio stations along the stretch of highway that will be covered. Ideal would be a billboard at each of those two spots.

A summary of the event will be presented to the Corp Marshall of the FRSC to negotiate what contributions the FRSC can make to the initiative.

What’s Happening Next

· Several workshops are coming up in Da Nang, Vietnam, this month. A Drink Drive Public Awareness Campaigns Development Workshop will take place on July 21 and 22, and a Blood Alcohol Concentration (BAC) testing workshop is scheduled for July 23.

· In Colombia, a PACTOS seminar is planned for the second week of August in Bogotá. We have proposed conducting a training module for PACTOS project managers in the cities of Medellín, Cali, Barranquilla, Bucaramanga, Neiva and Ibagué. We will be gathering PACTOS best practices from the past two years and sharing them in a booklet we will present to the mayors of the cities as they begin their terms in office at the end of this year.

Vested interests in addiction research and policy. Alcohol industry use of social aspect public relations organizations against preventative health me

It has been proposed that alcohol industry ‘social aspects/public relations’ organizations (SAPROs) serve the agenda of lending credibility to industry claims of corporate responsibility while promoting ineffective industry-friendly interventions (such as school-based education or TV advertising campaigns) and creating doubt about interventions which have a strong evidence base (such as higher taxes on alcoholic beverages).

This paper investigated whether submissions to Australia's National Preventative Health Taskforce (NPHT) from alcohol industry bodies regarding the Australian SAPRO, Drinkwise, have used this organization to demonstrate corporate responsibility while promoting industry-friendly interventions.

Submissions to the Australian National Preventative Health Taskforce (NPHT) discussion paper Australia, the healthiest country by 2020 (n = 375) were examined to identify those with primary alcohol content. A thematic analysis of the resulting 33 submissions was conducted to determine which organization, institution or individual discussed Drinkwise.

Nine of the 33 submissions discussed Drinkwise; all were submitted by the alcohol industry or its affiliates. Every industry submission referred to Drinkwise either as providing evidence of social responsibility or by suggesting the industry-friendly actions of Drinkwise as alternatives to those recommended by the NPHT report.

Drinkwise has been used by the alcohol industry to create an impression of social responsibility while promoting interventions that maintain profits and campaigning against effective interventions such as higher taxes on alcohol.

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Grants to Local Law Enforcement Agencies

The Department of Alcoholic Beverage Control (ABC) is anticipating offering grants to law enforcement agencies, subject to funding appropriation.

Effective July 1, 2011, the Department will award grants up to $100,000 to local law enforcement agencies. These grants will enable the selected agencies to expand their present efforts in addressing alcohol-related problems through a comprehensive ABC program that will encompass a wide range of strategies. If your agency is selected, your sworn officers assigned to the project will work closely with ABC investigators and receive training in ABC law, alcohol enforcement strategies, and community resources. > > > > Read More

Modeling Relapse Situations in the Human Laboratory

It is well known that alcoholism is a chronic relapsing illness. While stress significantly impacts alcoholism risk, there is also evidence that increasing levels of alcohol use affect peripheral and central stress and reward pathways thereby setting up a reciprocal relationship among the effects of alcohol consumption of the development, course of and recovery from alcoholism.

This chapter reviews our efforts in assessing the integrity of stress pathways in alcoholism by examining whether altered responses of the stress pathways play a role in relapse risk.

Using validated human laboratory procedures to model two of the most common situations that contribute to relapse risk, we review how such models in the laboratory can predict subsequent alcohol relapse. Empirical findings from human laboratory and brain imaging studies are reviewed to show that specific stress-related dysregulation accompanies the alcohol craving state in alcohol-dependent individuals, and such dysregulation along with increases in alcohol seeking are predictive of increased alcohol relapse risk.

Finally, the significant implications of these findings for the development of novel treatment interventions that target stress processes and alcohol craving to improve alcoholism relapse outcomes are discussed.

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Thursday, July 21, 2011

Screen All Women for Alcohol Use, ACOG Says

Pregnant or not, all women seeing their ob/gyn should be screened for alcohol use to identify at-risk drinking and alcohol dependence, according to the American College of Obstetricians & Gynecologists (ACOG).

The screenings should take place at least every year and within the first trimester of pregnancy, stated an opinion from ACOG's committee on healthcare for underserved women, which was published in the August issue of Obstetrics & Gynecology. > > > > Read More

News Release - New national report shows many differences in the types and levels of substance use and mental illness problems experienced among the

A new report providing state-by-state analyses of a wide range of behavioral health issues reveals that despite some wide variations among the states in the types and levels of problems they confront -- every state must deal with these issues. For example, among those aged 12 and older, Iowa had less than half the current illicit drug use rate of Alaska (5.3-percent versus 13.5-percent) yet Iowa also was among the top 10 states with the highest levels of people age 12 and older currently participating in binge drinking (28.6-percent).
The report developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) provides valuable insight to state public health authorities and service providers on the scope and nature of behavioral health issues affecting their states. The report is part of SAMHSA’s strategic initiative on data, outcomes, and quality -- an effort to provide the best available information to everyone involved in the behavioral health field.
Among the report’s other notable findings:
  • Fewer people in many states perceived that cigarette use can be risky. Between the combined years 2007-2008 and 2008-2009 the perception of great risk from smoking one or more pack of cigarettes a day decreased in 14 states among those aged 12 to 17; in 31 states among those aged 18 to 25 and in 9 states among those 26 and older. No states during this period registered an increase in the perception of risk from heavy cigarette use.
  • Current illicit drug use dropped among adolescents aged 12 to 17 in 17 states between 2002-2003 and 2008-2009 -- no increases in current illicit drug use occurred in any state in this age group over this time period.
  • While the District of Columbia had the nation’s highest rate of past year alcohol dependence or abuse for those 26 or older (8.1-percent), it had the lowest rate among persons aged 12 to 17 (3.0-percent).
  • Utah had the lowest rate of current marijuana use (3.6-percent) while Alaska had the highest rate (11.5-percent). All ten states that had the highest rates of past month illicit drug use among persons age 12 or older were also the top 10 states for past month marijuana use (inalphabetical order -- Alaska, Colorado, District of Columbia, Hawaii, Maine, Massachusetts, New Hampshire, Oregon, Rhode Island and Vermont).
  • Between 2007-2008 and 2008-2009 11 states showed declines in past year cocaine use among persons aged 12 or older (in alphabetical order -- Arizona, Arkansas, Georgia, Indiana, Kentucky, Maryland, Minnesota, Ohio, Oregon, Tennessee and Virginia).
  • Rhode Island had the nation’s highest rate of adults aged 18 or older experiencing serious mental illness in the past year (7.2-percent), while Hawaii and South Dakota shared the lowest rate (3.5-percent).

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State Estimates of Substance Use and Mental Disorders from the 2008-2009 National Survey on Drug Use and Health (NSDUH)

Presents state estimates for 25 measures of substance use or mental disorders based on 2008 and 2009 statistics and estimates of change from previous years' data. Reports on illicit drug, alcohol and tobacco use; treatment need; and mental health factors.

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Putting the Pieces Together for Children and Families

The National Conference on Substance Abuse, Child Welfare and the Courts

September 14 - 16, 2011
National Harbor, MD
Presented by Children & Family Futures
Featuring the National Alliance for Drug Endangered Children 8th Annual Gathering

Safe, stable homes for children and family recovery

The purpose of the conference is to promote multidisciplinary collaborative advances in practice, research and policy that lead to effective, coordinated, and culturally relevant services for children, youth and families affected by substance use disorders and child abuse or neglect.

Conference focus

  • Family based models, the effects of health care reform, ensuring sustainability of effective programs in the midst of a changing fiscal climate and the role of substance use disorders as a central issue in child protection and related child serving agencies.
  • Create national awareness of the key issues facing children and families.
  • Share experience, strength and hope for the hundreds of thousands of children and families affected each year.
  • Bring together a variety of service providers and professionals, including:child welfare providers, substance abuse treatment providers, juvenile and family court judges and attorneys, law enforcement, prosecutors, probation officers, prevention specialists, maternal and child health agencies, physicians, nurses, researchers and evaluators, educators, Tribal communities, community organizations serving youth and children and adult mental health providers.

Conference Overview

Report to Congress on the Prevention and Reduction of Underage Drinking

Underage drinking and associated problems have profound negative consequences for underage drinkers, their families, their communities, and society as a whole. Underage drinking contributes to a wide range of costly health and social problems, including motor vehicle crashes (the greatest single mortality risk for underage drinkers); suicide; interpersonal violence (e.g., homicides, assaults, rapes); unintentional injuries such as burns, falls, and drowning; brain impairment; alcohol dependence; risky sexual activity; academic problems; and alcohol and drug poisoning. On average, alcohol is a factor in the deaths of approximately 4,700 youths in the United States per year, shortening their lives by an average of 60 years (Centers for Disease Control and Prevention [CDC] Alcohol-Related Disease Impact [ARDI] software, 2009b).

Data show modest reductions in underage drinking and some progress toward the goals of the Comprehensive Plan to Prevent and Reduce Underage Drinking (Substance Abuse and Mental Health Services Administration [SAMHSA], 2006), but there is still cause for concern. For example, in 2009, 39 percent of 20-year-olds reported binge drinking (drinking at levels substantially increasing the risk of injury or death) in the past 30 days; about 14 percent of 20-year-olds had, in those 30 days, binged five or more times.

Although drinking levels are lower at younger ages, patterns of consumption across the age spectrum pose significant threats to health and well-being. Particularly troubling is the erosion of the traditional gap between underage males and females in binge drinking. This gap is disappearing as females’ drinking practices converge with those of males. Thus, females are at increasing risk of alcohol-related mortality and morbidity, including sexual violence.

Still, there is reason for optimism. As discussed in Chapters 3 and 4 of this Report, States are increasingly adopting comprehensive policies and practices to alter the individual and environmental factors that contribute to underage drinking and its consequences; these can be expected to reduce alcohol-related death and disability and associated health care costs. These efforts can potentially reduce underage drinking and its consequences and change norms that support underage drinking in American communities.

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The present study addresses the still unresolved issue of the character of alcohol-thiamine metabolic interferences in the developing central nervous system (CNS). Investigations compare developmental neurotoxicity evoked by three patterns of maternal thiamine deficiency (pre, peri and postnatal), with two patterns of maternal chronic alcohol intake (alcohol alone and alcohol + thiamine cotreatment), on seven neurodevelopmental abilities in the offspring.

The three patterns of thiamine deficiency, pair-compared with controls, highlight four sequences of development: 1) embryonic-perinatal sequence; 2) perinatal-postnatal sequence; 3) “ontogeny in ontogeny out” sequence; 4) “off and on” developing sequence.

The results suggest a temporally- and regionally-emergence of structures and centers underlying functional maturation during CNS ontogenesis.

Furthermore, both developmental thiamine deficiencies and ethanol exposure produce two waves of neurofunctional alterations, peaking at P15 (postnatal day 15) and P25, respectively.

The first peak of vulnerability is a prenatal event; it may interfere with the periods of intense cellular proliferation and migration. The second peak represents both perinatal and postnatal events; it may interfere with the periods of cellular differentiation, synaptogenesis, axonogenesis and myelinogenesis.

Alcohol + thiamine cotreatment fails to reduce the first peak, but neutralizes essentially the second peak.

The results suggest that alcohol interferes with thiamine during cellular differentiation and membrane developmental processes mainly. Indeed, among the three conditions of thiamine-deficient diet, only perinatal thiamine deficiency exhibits a closer relationship with developmental alcohol exposure.

Together, these observations suggest that the critical period for alcohol-thiamine antagonism occurs perinatally and affects primarily cellular differentiation.

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What is the association between traumatic life events and alcohol abuse/dependence in people with and without PTSD? Findings from a nationally represe

Approximately 60–90% of the general population will experience a traumatic event during their lifetime. However, relatively few will develop a trauma-related psychological disorder. Possible psychological sequelae of trauma include posttraumatic stress disorder (PTSD) and alcohol-use disorders (AUDs). While AUDs often occur in the context of PTSD, little is known about the degree to which AUDs are attributable to specific traumatic events.

The purpose of the present investigation was to assess the degree to which specific traumatic events are predictive of AUDs in people with and without PTSD.

The current sample was selected from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC; N = 34,160), a nationally representative sample of American adults. Multiple logistic regressions were performed to examine odds ratios of 27 traumatic events among individuals with and without PTSD in the prediction of AUD diagnos

Results indicated significant positive odds ratios among individuals meeting criteria for PTSD and having experienced a childhood trauma (OR = 1.40 [95% CI: 1.08–1.83], P<.01) or assaultive violence (OR = 1.41 [95% CI: 1.13–1.77], P<.01) for predicting AUDs.

Also, among individuals without PTSD, childhood trauma (OR = 1.32 [95% CI: 1.23–1.41], P<.001), assaultive violence (OR = 1.42 [95% CI: 1.13–1.78], P<.001), unexpected death (OR = 1.19 [95% CI: 1.12–1.28], P<.001), and learning of trauma (OR = 1.22 [95% CI: 1.13–1.30], P<.001) positively predicted the presence of AUDs.

Results indicate significant positive relationships between traumatic events and AUDs, particularly among individuals without PTSD. Specific associations and theoretical implications will be discussed.

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Times to drink: cross-cultural variations in drinking in the rhythm of the week

The time of drinking in terms of daytime versus evening and weekday versus weekend is charted for regular drinkers in 14 countries in Europe, Asia, Latin America, Africa and Oceania.

National or regional adult population surveys from the GENACIS project.

The weekly rhythm of drinking varies greatly between societies. Drinking was generally more likely after 5 p.m. and on weekends. To this extent, alcohol consumption is now regulated by a universal clock. The relation of time of day and of the week of drinking to problems from drinking varied between societies. Drinking at specific times was more likely to predict problems among men than women, though for men the particular time varied, while weekday evenings were the most problematic time for women. The relation of drinking at a particular time to problems in part reflected that heavy drinkers were more likely to be drinking at that time.

There are commonalities across cultures in drinking by time of day and day of the week, but the implications of the timing for alcohol-related problems are fairly culture-specific.

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Participation in leisure activities and binge drinking in adults: Findings from a Swedish general population sample

The aim of this cross-sectional study was to estimate the associations between participation in different leisure activities and binge drinking in Swedish adults.

The study was based on a questionnaire in a general population sample (
n = 3567) of individuals aged 19–64 years old. Men and women were defined as binge drinkers if they reported that they had consumed alcohol at least once a month, and stated that at a typical drinking occasion they consumed five or more standard glasses (12 g of alcohol).

Multivariate analyses found associations between binge drinking and socializing with friends among men aged 19–30 years (odds ratio, OR 2.88), in the 31–64 years old age group (OR 1.87). Corresponding results was found in younger women (OR 2.36). A higher OR was also found for younger men who regularly attended sporting events as spectators (OR 1.83), and among respondents in the older age group who regularly played computer or video games (OR 2.11 for women and 1.61 for men). A lower OR for binge drinking was found for men who regularly participated in religious services in both age-groups. Lower prevalence of binge drinking among women was only found in the younger group among those who regularly participated in sports/athletics or other training (OR 0.51).

Our findings suggest that prevention strategies could benefit from an everyday life approach, but also that different interventions should be used in relation to specific leisure activities.

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Recurring alcohol-related care between 1998 and 2007 among people treated for an alcohol-related disorder in 1997: A register study in Stockholm Count

Inpatient care for alcohol intoxication is increasing in Sweden, especially among young women. Since it is well known that alcohol disorder is a chronic relapsing illness, this study examines the extent to which people return for more care.

All inpatients with alcohol-related diagnoses in Stockholm County during 1997 were followed prospectively to 2007 through registers. The proportion reappearing for the same diagnosis, other alcohol-related inpatient, or outpatient care each year after baseline, as well as the number of years the inpatients reappeared were calculated (n=2735). Three diagnoses were examined separately; alcohol dependence, harmful use of alcohol, and alcohol intoxication.

Three out of five inpatients with an alcohol diagnoses reappeared for more alcohol-related inpatient care during the following decade. The proportion returning was largest the year after baseline and then decreased curvilinearly over time. The inclusion of outpatient care increased proportions, but did not change patterns. Of those with an alcohol dependence diagnosis at baseline 42 percent returned for more alcohol-related inpatient care the first, 28 percent the fifth, and 25 percent the tenth year. Corresponding proportions for harmful use and intoxication were smaller. One in five among those with an alcohol dependence returned for more than five of the ten years. Ordered logistic regressions confirmed that besides diagnosis, age and gender were independently related to the number of years returning to care.

While middle-aged males with alcohol dependence were in a revolving door, young female inpatients with intoxication diagnosis returned to a comparably lower degree.

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Wednesday, July 20, 2011

Longitudinal Trajectories of Posttraumatic Stress Disorder Symptoms and Binge Drinking Among Adolescent Girls: The Role of Sexual Victimization

Many studies have documented associations among sexual victimization (SV), posttraumatic stress disorder (PTSD) symptoms, and alcohol use; however, few have examined these associations longitudinally among adolescents. The present study evaluated the effect of SV on the longitudinal trajectory of PTSD symptoms and binge drinking (BD) among adolescent girls, a population known to have high rates of SV and alcohol use.

Participants (N = 1,808 at wave 1) completed interviews regarding PTSD symptoms, BD, and SV experiences over approximately 3 years.

Multilevel modeling revealed decreases in PTSD symptoms over the course of the study; however, compared with nonvictims, adolescents who were sexually victimized reported greater PTSD symptoms at wave 1 and maintained higher levels of PTSD symptoms over the course of the study after controlling for age. SV reported during the study also predicted an acute increase in PTSD symptoms at that occasion. BD increased significantly over the course of the study; however, SV did not predict initial BD or increases over time. SV reported during the study was associated with acute increases in BD at that occasion, although this effect diminished when participants reporting substance-involved rape were excluded.

SV was associated with immediate and long-lasting elevations in PTSD symptoms, but not with initial or lasting elevations in BD over time, suggesting that adolescent victims have yet to develop problematic patterns of alcohol use to cope with SV. However, SV was associated with acute increases in PTSD symptoms and BD, suggesting a need for BD interventions to reduce alcohol-related SV.

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Different chronic ethanol exposure regimens in adolescent and adult male rats: Effects on tolerance to ethanol-induced motor impairment.

Findings are mixed regarding the expression of tolerance after repeated ethanol exposure, perhaps in part due to dose/frequency variations in exposure regimens.

The present study compared age-related differences in tolerance development following 10 days of 1 g/kg twice daily, 2 g/kg once daily, or intermittent 4 g/kg ethanol exposure regimens.

To measure expression of chronic tolerance and acute tolerance, ethanol-induced motor impairment was assessed on day 12, with functionally equivalent ethanol doses administered across age (2 g/kg--adolescents; 1.5 g/kg--adults).

Subsequent challenge doses resulted in lower brain ethanol concentrations in both age groups as a function of the chronic ethanol regimens.

Expected age-related differences emerged in acute tolerance expression in non-manipulated animals, with adolescents, but not adults showing acute tolerance.

Regimens sufficient to induce alterations in ethanol metabolism did not result in chronic functional tolerance at either age, although chronic injections were sufficient to induce acute tolerance in adults.

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Critique 048: A new report on drinking guidelines and the association of alcohol with risk of cancer — 18 July 2011

Alcohol consumption and cancer risk: revisiting guidelines for sensible drinking. CMAJ 2011. DOI:10.1503. /cmaj.110363

Comments on the CMAJ alcohol and cancer report:
Forum members considered that the current report contains many statements not consistent with current scientific research. If the paper was referred to as an “editorial” or “comments,” the authors would obviously be free to advise whatever drinking guidelines they wish. But this paper appears in a reputable journal, and the article is labeled “Analysis,” yet does not reflect current sound scientific data. The report is highly selective in finding a few publications that describe “methodological bias of most studies mentioning an apparent reduction of risk, such as nutritional, lifestyle or social confounders or the inclusion of people who used to consume alcohol, but no longer do, in the reference group.” The authors of this report ignore the considerable data from more scientifically sound research that have largely discredited such studies, as summarized recently by Fuller.
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Alcohol and the Human Brain: A Systematic Review of Different Neuroimaging Methods

Imaging techniques have been in widespread use in the scientific community for more than 3 decades. They facilitate noninvasive, in vivo studies of the human brain in both healthy and diseased persons. These brain-imaging techniques have contributed significantly to our understanding of the effects of alcohol abuse and dependence on structural and functional changes in the human brain. A systematic review summarizing these contributions has not previously been conducted, and this is the goal of the current paper.

The databases PubMed, PsycINFO, and PSYNDEX were searched using central key words. Fulfilling the inclusion criteria were 140 functional and structural imaging studies, together comprising data from more than 7,000 patients and controls. The structural imaging techniques we considered were cranial computerized tomography and various magnetic resonance imaging–based techniques, including voxel-based morphometry, deformation-based morphometry, diffusion tensor magnetic resonance imaging, and diffusion-weighted magnetic resonance imaging. The functional methods considered were magnetic resonance spectroscopy, positron emission tomography, single photon emission computed tomography, and functional magnetic resonance imaging.

Results from studies using structural imaging techniques have revealed that chronic alcohol use is accompanied by volume reductions of gray and white matter, as well as microstructural disruption of various white matter tracts. These changes are partially reversible following abstinence. Results from functional imaging methods have revealed metabolic changes in the brain, lower glucose metabolism, and disruptions of the balance of neurotransmitter systems. Additionally, functional imaging methods have revealed increased brain activity in the mesocorticolimbic system in response to alcohol-themed pictures relative to nondrug-associated stimuli, which might be of predictive value with regard to relapse.

There has been tremendous progress in the development of imaging technologies. Use of these technologies has clearly demonstrated the structural and functional brain abnormalities that can occur with chronic alcohol use. The study of the alcoholic brain provides an heuristic model which furthers our understanding of neurodegenerative changes in general, as well as their partial reversibility with sustained abstinence. Additionally, functional imaging is poised to become an important tool for generating predictions about individual brain functioning, which can then be used as a basis for personalized medicine.

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Subjective Response to Alcohol Challenge: A Quantitative Review

Individual differences in subjective response to alcohol, as measured by laboratory-based alcohol challenge, have been identified as a candidate phenotypic risk factor for the development of alcohol-use disorders (AUDs). Two models have been developed to explain the role of subjective response to alcohol, but predictions from the 2 models are contradictory, and theoretical consensus is lacking.

This investigation used a meta-analytic approach to review the accumulated evidence from alcohol-challenge studies of subjective response as a risk factor. Data from 32 independent samples (total N = 1,314) were aggregated to produce quantitative estimates of the effects of risk-group status (i.e., positive family history of AUDs or heavier alcohol consumption) on subjective response.

As predicted by the Low Level of Response Model (LLRM), family history–positive groups experienced reduced overall subjective response relative to family history–negative groups. This effect was most evident among men, with family history–positive men responding more than half a standard deviation less than family history–negative men. In contrast, consistent with the Differentiator Model (DM), heavier drinkers of both genders responded 0.4 standard deviations less on measures of sedation than did the lighter drinkers but nearly half a standard deviation more on measures of stimulation, with the stimulation difference appearing most prominent on the ascending limb of the blood alcohol concentration curve.

The accumulated results from 3 decades of family history comparisons provide considerable support for the LLRM. In contrast, results from typical consumption comparisons were largely consistent with predictions of the DM. The LLRM and DM may describe 2 distinct sets of phenotypic risk, with importantly different etiologies and predictions for the development of AUDs.

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Is Brief Motivational Intervention Effective in Reducing Alcohol Use Among Young Men Voluntarily Receiving It? A Randomized Controlled Trial

Heavy drinking is one of the leading causes of morbidity and mortality in young men. Brief motivational intervention (BMI) has shown promising results for young people, but has never been tested in young men in the community who volunteered to receive an intervention.

We evaluated the effectiveness of BMI in reducing alcohol use among heavy episodic users and in maintaining low-risk drinking among nonheavy episodic users. Participants were French-speaking young men attending the mandatory Swiss army conscription process. They were offered the opportunity to receive a 20-minute BMI, and those interested were randomized into an intervention group (BMI immediately) or into a control group (BMI after the 6-month follow-up assessment, in a waiting list design). Analyses were conducted separately for heavy and nonheavy episodic users (separated using baseline heavy episodic use frequency) as the hypotheses tested were different between both groups (primary vs. secondary prevention intervention).

From a pool of 6,085 young men invited to receive BMI, 727 (11.9%) showed up and 572 were included in the study (after exclusions related to organizational aspects of the conscription process). Among nonheavy episodic users, there was a protective effect of BMI on weekly alcohol use (p < 0.05). Among heavy episodic users, there were no significant effects of BMI.

About 12% of young men were interested in addressing their drinking within the BMI framework, suggesting that there is some need for easily accessible alcohol intervention. The present intervention did have a preventive effect among low-risk young drinkers in helping them maintain their patterns of alcohol use. An explanation for the lack of effectiveness among heavy episodic users might be that those individuals interested in BMI had patterns of more severe alcohol use, thereby making change more difficult.

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PPARγ Ligands Regulate NADPH Oxidase, eNOS, and Barrier Function in the Lung Following Chronic Alcohol Ingestion

Chronic alcohol ingestion increases the incidence and severity of the acute respiratory distress syndrome (ARDS), where reactive species contribute to alveolar-capillary barrier dysfunction and noncardiogenic pulmonary edema. Previous studies demonstrated that chronic alcohol ingestion increased lung NADPH oxidase and endothelial nitric oxide synthase (eNOS) expression and that ligands for the peroxisome proliferator-activated receptor gamma (PPARγ) reduced NADPH oxidase expression. Therefore, we hypothesized that the PPARγ ligand, rosiglitazone, would attenuate alcohol-induced NADPH oxidase expression and pulmonary barrier dysfunction.

C57Bl/6 mice were treated ± alcohol in drinking water (20% w/v) for 12 weeks. During the final week of alcohol treatment, mice were gavaged with rosiglitazone (10 mg/kg/d) or vehicle. Selected animals were treated twice with lipopolysaccharide (LPS, 2 mg/kg IP) prior to sacrifice. Pulmonary barrier dysfunction was estimated from protein content of bronchoalveolar lavage (BAL) fluid.

LPS treatment increased BAL protein in alcohol-fed but not control mice, and rosiglitazone attenuated LPS and alcohol-induced pulmonary barrier dysfunction. Alcohol- and LPS-induced increases in lung eNOS, Nox1, and Nox4 expression were attenuated by rosiglitazone. In vitro, alcohol (0.10% w/v) increased H2O2 production, barrier dysfunction, eNOS, Nox1, and Nox4 expression in human umbilical vein endothelial cell (HUVEC) monolayers, effects also attenuated by rosiglitazone (10 μM). Alcohol-induced HUVEC barrier dysfunction was attenuated by inhibition of NOS or addition of the eNOS cofactor, tetrahydrobiopterin.

These results indicate that PPARγ activation reduced expression of eNOS, Nox1, Nox4, the production of reactive species, and barrier dysfunction caused by chronic alcohol ingestion and suggest that PPARγ represents a novel therapeutic target for strategies designed to reduce the risk of lung injury in patients with a history of chronic alcohol ingestion.

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Validity of the Hangover Symptoms Scale: Evidence from an Electronic Diary Study

The Hangover Symptoms Scale (HSS) assesses the frequency of 13 symptoms experienced after drinking in the past year. Cross-sectional analyses in college drinkers showed preliminary evidence for the validity of the HSS (Slutske et al., 2003). The current investigation extended this work by examining the construct validity of the HSS in an ecological momentary assessment investigation.

Frequent drinkers (N = 404) carried electronic diaries to track their daily experiences over 3 weeks. Each morning, the diary assessed prior-night drinking behaviors, the presence of current hangover, and intensity of current headache and nausea.

Adjusting for sex and body mass, the HSS significantly predicted diary endorsement of hangover (OR = 2.11, 95% CI = 1.78 to 2.49, p < 0.001). Participants who endorsed the HSS headache and nausea items were especially likely to report the elevations of corresponding symptoms in diary records made the morning after drinking. HSS scores incrementally predicted hangover when the number of drinks consumed in the episode was covaried but did not moderate the relationship between the number of drinks and diary hangover reports.

The HSS appears to be a valid tool for hangover research. Higher HSS scores identify individuals who complain of “real world” hangovers and who may be especially likely to display particular symptoms after a night of drinking. Past hangovers predicted future hangovers, suggesting hangovers do not necessarily discourage or inhibit future drinking, at least across the several-week time interval studied here. There is a need to develop and evaluate complementary measures that can more directly index individual differences in hangover susceptibility in survey designs.

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Nuclear Clusterin Is Associated with Neuronal Apoptosis in the Developing Rat Brain upon Ethanol Exposure

Fetal alcohol spectrum disorder (FASD) is often accompanied by reduced brain volumes, reflecting brain cell death induced by ethanol, but the molecular mechanisms were less elucidated. This study was set up to investigate whether clusterin (Clu) was involved in neuronal cell death in developing rats.

Seven-day-old rats were subcutaneously injected with 20% ethanol in normal saline at 3 g/kg twice. The upregulation of Clu and cell death was detected by immunohistochemistry, immunofluorescence microscopy, and/or Western blotting. Protein–protein interaction was detected by immunoprecipitation and immunoblotting. To identify the isoform interacting with Bcl-XL, HT22 mouse hippocampal cells were transfected with nuclear Clu(nClu)- or secretory Clu-expressing vector, and confocal microscopy was performed. Clu transcripts were knocked down in primary cortical cells using siRNA.

We found that Clu increased in the cerebral cortex following acute ethanol treatment. The Clu upregulation was related to increased cell death, which was assessed by activated caspase-3 and TUNEL staining. The upregulated Clu was a nuclear isoform that was nuclear translocated upon ethanol exposure and interacted with Bcl-XL, mediating apoptosis.

This study shows that nClu plays a pro-apoptotic role in ethanol-induced cell death in the developing brain, providing new insights for development of FASD.

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Neuroadaptations in Adenosine Receptor Signaling Following Long-Term Ethanol Exposure and Withdrawal

Ethanol affects the function of neurotransmitter systems, resulting in neuroadaptations that alter neural excitability. Adenosine is one such receptor system that is changed by ethanol exposure.

The current review is focused on the A1 and the A2A receptor subtypes in the context of ethanol-related neuroadaptations and ethanol withdrawal because these subtypes (i) are activated by basal levels of adenosine, (ii) have been most well-studied for their role in neuroprotection and ethanol-related phenomena, and (iii) are the primary site of action for caffeine in the brain, a substance commonly ingested with ethanol.

It is clear that alterations in adenosinergic signaling mediate many of the effects of acute ethanol administration, particularly with regard to motor function and sedation. Further, prolonged ethanol exposure has been shown to produce adaptations in the cell surface expression or function of both A1 and the A2A receptor subtypes, effects that likely promote neuronal excitability during ethanol withdrawal.

As a whole, these findings demonstrate a significant role for ethanol-induced adaptations in adenosine receptor signaling that likely influence neuronal function, viability, and relapse to ethanol intake following abstinence.

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Remembering Betty Ford

“Have you heard the news?” I received a flurry of emails like this from family members and friends in the hours and days after Betty Ford’s death. They know of my work on the history of alcoholic women, so it was a logical question. Of course, I was saddened to hear of her passing, and in the aftermath I have found myself grappling with questions of periodization and pondering the sense of ownership we sometimes attach to the issues and people we study. On the one hand, Ford was “outside my period” as we say in the trade, since my research has concentrated on the nineteenth and early-to-mid twentieth century era. In fact, I was acutely uncomfortable writing about someone who was still living, and so I had relegated Ford to the epilogue of my book-in-progress. On the other hand, I have found to my surprise that I have cultivated some proprietary feelings about her as well. As a girl growing up in Michigan during the 1970s, I was aware that my mother and her friends—regardless of their formal political affiliations—admired Ford’s down-to-earth character as First Lady, believing it reflected a regional, gendered identity which they shared, that of the capable, unpretentious Midwestern woman. This image, in turn, shaped Ford’s cultural meaning as a female alcoholic and addict.

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Review - Relapse Prevention for Addictive Behaviors

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.

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