Tibor P Palfai

Boston University, Boston, Massachusetts, United States

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Publications (96)276.34 Total impact

  • Tibor Palfai · Richard Saitz · Michael R. Winter ·

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    ABSTRACT: Background: The use of brief intervention for decreasing frequent marijuana use holds potential, but its efficacy in primary care is not known. Methods: Objective: To assess the impact of two brief interventions on marijuana use among daily/ or almost daily marijuana users. Design: Subgroup analysis of a 3-arm randomized clinical trial of two brief counseling interventions compared to no brief intervention on daily marijuana use in a primary care setting (ASPIRE). Participants: ASPIRE study participants who both reported 21-30 days of marijuana use during the past month and identified marijuana as their drug of most concern. Interventions: 1) Brief Negotiated Interview (BNI), a 10-15 minute structured interview, and 2) an Adaptation of Motivational Interviewing (MOTIV), a 30-45 minute intervention. Control group participants received only a list of substance use treatment resources. Main measures: The primary outcome was number of days of marijuana use in the past 30 days at the 6-month follow-up. Secondary outcomes were 1) number of days of marijuana use at 6-week follow-up and 2) drug problems (Short Inventory of Problems, SIP-D) at 6-week and 6-month. Differences between intervention groups were analyzed using negative binomial regression models. Results: Among the 167 eligible participants, we did not find any significant impact of either of the two interventions on past 30 days of marijuana use at 6-months [adjusted incidence rate ratio (aIRR): 0.95 (95% confidence interval (CI)):0.75-1.15, p = 0.82 for BNI vs. control; aIRR:1.02, 95%CI:0.85-1.23, p = 0.82 for MOTIV vs. control]. There was no significant impact on drug-related problems at 6-month follow-up [aIRR:1.12 (95%CI:0.69-1.82) p = 0.66 and aIRR:1.46 (95%CI:0.89-2.38) p = 0.27 for BNI vs. control and MOTIV vs. control, respectively]. Results were similar at 6 weeks. Conclusions: Brief intervention has no apparent impact on marijuana use or drug-related problems among primary care patients with frequent marijuana use identified by screening.
    Substance Abuse 10/2015; DOI:10.1080/08897077.2015.1075932 · 1.62 Impact Factor

  • Addiction science & clinical practice 09/2015; 10(Suppl 2):O45. DOI:10.1186/1940-0640-10-S2-O45

  • Addiction science & clinical practice 09/2015; 10(Suppl 2):O46. DOI:10.1186/1940-0640-10-S2-O46
  • Rebecca M Shingleton · Tibor P Palfai ·
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    ABSTRACT: The aims of this paper were to describe and evaluate the methods and efficacy of technology-delivered motivational interviewing interventions (TAMIs), discuss the challenges and opportunities of TAMIs, and provide a framework for future research. We reviewed studies that reported using motivational interviewing (MI) based components delivered via technology and conducted ratings on technology description, comprehensiveness of MI, and study methods. The majority of studies were fully-automated and included at least one form of media rich technology to deliver the TAMI. Few studies provided complete descriptions of how MI components were delivered via technology. Of the studies that isolated the TAMI effects, positive changes were reported. Researchers have used a range of technologies to deliver TAMIs suggesting feasibility of these methods. However, there are limited data regarding their efficacy, and strategies to deliver relational components remain a challenge. Future research should better characterize the components of TAMIs, empirically test the efficacy of TAMIs with randomized controlled trials, and incorporate fidelity measures. TAMIs are feasible to implement and well accepted. These approaches offer considerable potential to reduce costs, minimize therapist and training burden, and expand the range of clients that may benefit from adaptations of MI. Published by Elsevier Ireland Ltd.
    Patient Education and Counseling 08/2015; DOI:10.1016/j.pec.2015.08.005 · 2.20 Impact Factor
  • Tibor P Palfai · Carl K Kantner · Kelli D Tahaney ·
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    ABSTRACT: Previous work has shown that automatic alcohol-action associations, assessed by the Implicit Association Test (IAT), may play a role in hazardous drinking patterns. The majority of alcohol-related IATs have been constructed using verbal stimuli, and even those who have used pictorial stimuli have only represented beverage categories with pictures. To assess implicit appetitive responses among a broader population of alcohol users, such as those who experience limitations reading and understanding English, there may be utility in the development of an IAT that utilizes only non-verbal stimuli. The current study presents an initial effort to develop such a task and examine its association with drinking. One hundred and fifty-three university students participated individually in a laboratory study in which they first completed a pictorial alcohol-specific approach/avoid IAT, followed by self-report measures of drinking. As hypothesized, negative binomial regression analyses showed that IAT scores predicted the number of heavy drinking episodes and typical number of drinks per occasion. The use of a university student sample for this initial study represents an important limitation of this work, which should be addressed in future research. These findings provide initial evidence for the potential use of non-verbal IATs to assess alcohol-related implicit cognition among adults. Implications for the assessment of hazardous drinking behavior across populations are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of Behavior Therapy and Experimental Psychiatry 07/2015; 50:135-138. DOI:10.1016/j.jbtep.2015.07.002 · 2.23 Impact Factor
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    ABSTRACT: To test 1) whether abstinence and reduction in illicit psychoactive drug use were associated with changes in health outcomes in primary care patients and 2) whether these associations varied by drug type. Secondary analysis of data from a randomized controlled trial that tested a brief intervention for drug use in primary care patients (589 enrolled, 574 completed 6-month assessment). Analyses were conducted overall and stratified by the most commonly self-identified main drugs (marijuana, cocaine, and opioids). Patients who screened positive for illicit drug use at an urban primary care clinic in Boston, Massachusetts, USA. Differences in past-month main drug use at baseline and 6-month outcome were categorized as continued or increased use, decreased use without abstinence, and abstinence. Primary outcomes were 6-month changes in drug use consequences (Short Inventory of Problems scores [range 0-45]), depressive symptoms, and health-related quality of life (HRQOL). Abstinence was associated with a greater decrease in adverse drug use consequences than continued or increased use among the full sample and cocaine and opioids subgroups (adjusted means, full sample: -8.11 vs. -0.05, p < 0.001; cocaine: -13.33 vs. +1.09, p < 0.001, opioids; -16.84 vs. -2.10, p < 0.001). Differences were not significant between those who decreased use compared with those who continued or increased use. There were no significant associations between drug use and depressive symptoms or HRQOL. Neither abstinence nor decreased use was significantly associated with consequences in the marijuana subgroup. Among primary care patients in the US who use illicit psychoactive drugs, abstinence but not reduction in use without abstinence appears to be associated with decreased adverse drug use consequences. This article is protected by copyright. All rights reserved.
    Addiction 06/2015; 110(9). DOI:10.1111/add.13020 · 4.74 Impact Factor
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    Drug and Alcohol Dependence 01/2015; 146:e198-e199. DOI:10.1016/j.drugalcdep.2014.09.455 · 3.42 Impact Factor
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    ABSTRACT: Importance The United States has invested substantially in screening and brief intervention for illicit drug use and prescription drug misuse, based in part on evidence of efficacy for unhealthy alcohol use. However, it is not a recommended universal preventive service in primary care because of lack of evidence of efficacy.Objective To test the efficacy of 2 brief counseling interventions for unhealthy drug use (any illicit drug use or prescription drug misuse)—a brief negotiated interview (BNI) and an adaptation of motivational interviewing (MOTIV)—compared with no brief intervention.Design, Setting, and Participants This 3-group randomized trial took place at an urban hospital-based primary care internal medicine practice; 528 adult primary care patients with drug use (Alcohol, Smoking, and Substance Involvement Screening Test [ASSIST] substance-specific scores of ≥4) were identified by screening between June 2009 and January 2012 in Boston, Massachusetts.Interventions Two interventions were tested: the BNI is a 10- to 15-minute structured interview conducted by health educators; the MOTIV is a 30- to 45-minute intervention based on motivational interviewing with a 20- to 30-minute booster conducted by master’s-level counselors. All study participants received a written list of substance use disorder treatment and mutual help resources.Main Outcomes and Measures Primary outcome was number of days of use in the past 30 days of the self-identified main drug as determined by a validated calendar method at 6 months. Secondary outcomes included other self-reported measures of drug use, drug use according to hair testing, ASSIST scores (severity), drug use consequences, unsafe sex, mutual help meeting attendance, and health care utilization.Results At baseline, 63% of participants reported their main drug was marijuana, 19% cocaine, and 17% opioids. At 6 months, 98% completed follow-up. Mean adjusted number of days using the main drug at 6 months was 12 for no brief intervention vs 11 for the BNI group (incidence rate ratio [IRR], 0.97; 95% CI, 0.77-1.22) and 12 for the MOTIV group (IRR, 1.05; 95% CI, 0.84-1.32; P = .81 for both comparisons vs no brief intervention). There were also no significant effects of BNI or MOTIV on any other outcome or in analyses stratified by main drug or drug use severity.Conclusions and Relevance Brief intervention did not have efficacy for decreasing unhealthy drug use in primary care patients identified by screening. These results do not support widespread implementation of illicit drug use and prescription drug misuse screening and brief intervention.Trial Registration clinicaltrials.gov Identifier: NCT00876941
    JAMA The Journal of the American Medical Association 08/2014; 312(5):502-13. DOI:10.1001/jama.2014.7862 · 35.29 Impact Factor
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    ABSTRACT: AimsThis study assessed the effectiveness of HERMITAGE (HIV's Evolution in Russia - Mitigating Infection Transmission and Alcoholism in a Growing Epidemic), an adapted secondary HIV prevention intervention, compared with an attention control condition in decreasing sexually transmitted infections (STIs) and sex and drug risk behaviors among Russian HIV-infected heavy drinkers.DesignWe conducted a single-blinded, two-armed, randomized controlled trial with 12-month follow-up.SettingThe study was conducted in St. Petersburg, Russia. Participants were recruited from four HIV and addiction clinical sites. The intervention was conducted at Botkin Infectious Disease Hospital.ParticipantsHIV-infected persons with past 6-month risky sex and heavy alcohol consumption (n=700) were randomized to the HERMITAGE intervention (n=350) or an attention control condition (n=350).InterventionA Healthy Relationships Intervention stressing disclosure of HIV serostatus and condom use, adapted for a Russian clinical setting with two individual sessions and three small group sessions.MeasurementsThe primary outcome was incident STI by laboratory test at 12-month follow-up. Secondary outcomes included change in unprotected sex and several alcohol and injection drug use (IDU) variables.FindingsParticipants had the following baseline characteristics: 59% male, mean age 30, 60% past year IDU, 15.4% prevalent STI and mean CD4 cell count 413/μl. Assessment occurred among 75% and 71% of participants at 6 and 12-months, respectively. STIs occurred in 20 subjects (8%) in the intervention group and 28 subjects (12%) in the control group at 12-month follow-up; logistic regression analyses found no significant difference between groups (adjusted odds ratio 0.69; 95% CI: 0.36-1.30; P=0.25). Both groups decreased unsafe behaviors, although no significant differences between groups were found.Conclusions The HERMITAGE HIV risk reduction intervention does not appear to reduce sexually transmitted infections and HIV risk behaviors in Russian HIV-infected heavy drinkers compared with attention controls.
    Addiction 08/2014; 110(1). DOI:10.1111/add.12716 · 4.74 Impact Factor
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    ABSTRACT: This pilot study sought to test the feasibility of procedures to screen students for marijuana use in Student Health Services (SHS) and test the efficacy of a web-based intervention designed to reduce marijuana use and consequences. Students were asked to participate in voluntary screening of health behaviors upon arrival at SHS. One hundred and twenty-three students who used marijuana at least monthly completed assessments and were randomized to one of four intervention conditions in a 2 (intervention: Marijuana eCHECKUP TO GO vs. control)×2 (site of intervention: on-site vs. off-site) between-groups design. Follow-up assessments were conducted online at 3 and 6months. Latent growth modeling was used to provide effect size estimates for the influence of intervention on outcomes. One thousand and eighty undergraduate students completed screening. The intervention did not influence marijuana use frequency. However, there was evidence of a small overall intervention effect on marijuana-related consequences and a medium effect in stratified analyses in the on-site condition. Analyses of psychological variables showed that the intervention significantly reduced perceived norms regarding peer marijuana use. These findings demonstrate that it is feasible to identify marijuana users in SHS and deliver an automated web-based intervention to these students in different contexts. Effect size estimates suggest that the intervention has some promise as a means of correcting misperceptions of marijuana use norms and reducing marijuana-related consequences. Future work should test the efficacy of this intervention in a full scale randomized controlled trial.
    Addictive Behaviors 05/2014; 39(9):1346-1352. DOI:10.1016/j.addbeh.2014.04.025 · 2.76 Impact Factor
  • Kelli D Tahaney · Carl W Kantner · Tibor P Palfai ·
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    ABSTRACT: Dual process models characterize hazardous drinking as a function of appetitive processes and executive processes that enable self-control. Although central to a number of models (e.g., Hofmann et al., 2009a,b), little empirical research has examined how drinking restraint may influence the effects of these processes on alcohol use. The current study examined whether drinking restraint influenced the predictive value of appetitive responses to alcohol cues and executive functioning on typical drinking behavior. It was hypothesized that the interaction between appetitive responses and executive functioning would only be observed among those who had stronger drinking restraint goals. Sixty-nine hazardous drinking young adults (ages 21-30) completed the Trail Making Test and then were exposed to the sight and smell of an alcoholic beverage that they anticipated they would consume. Urge and anticipated stimulant effects of alcohol (A-BAES) were measured following the exposure. The interaction between Trails B and each of the appetitive response ratings (i.e., urge rating and A-BAES) was predictive of drinking behavior (TLFB) only among those high in drinking restraint. These findings highlight the importance of incorporating the role of motivational constructs such as restraint goals in current dual process models of alcohol-related self-control.
    Drug and alcohol dependence 03/2014; 138(1). DOI:10.1016/j.drugalcdep.2014.02.703 · 3.42 Impact Factor
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    Tibor P Palfai · Michael Winter · John Lu · David Rosenbloom · Richard Saitz ·
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    ABSTRACT: Alcohol use among first-year university students continues to be a central health concern. Efforts to address drinking in this population have increasingly relied on web-based interventions, which have the capacity to reach large numbers of students through a convenient and highly utilized medium. Despite evidence for the utility of this approach for reducing hazardous drinking, recent studies that have examined the effectiveness of this approach as a universal prevention strategy in campus-wide studies have produced mixed results. We sought to test the effectiveness of a web-based alcohol intervention as a universal prevention strategy for first-year students. An e-mail invitation linked to a brief, web-based survey on health behaviors was sent to all first-year students during the fall semester. Those who completed the baseline assessment were randomized to receive either a feedback-based alcohol intervention (intervention condition) or feedback about other health-related behaviors such as sleep and nutrition (control condition). A second web-based survey was used to collect follow-up drinking data 5 months later. The number of heavy drinking episodes in the previous month and alcohol-related consequences in the previous 3 months served as the primary dependent variables. Negative binomial regression analyses did not indicate a significant effect of the intervention at follow-up on either heavy drinking episodes or alcohol-related consequences. Analyses of additional drinking outcomes among the subsample of students who reported that they did not drink at baseline showed that those who received the alcohol intervention were subsequently less likely to drink alcohol. These results suggest that web-based alcohol interventions may be a potentially useful method of maintaining abstinence among underage, non-drinking students. Overall, however, results indicate that an e-mail-linked, campus-wide, web-intervention approach to address alcohol use among first-year students may have limited effectiveness as an approach to minimize hazardous drinking over the course of the year.
    The Journal of Prevention 01/2014; 35(2). DOI:10.1007/s10935-013-0337-9
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    ABSTRACT: The impact of depressive symptoms on ART initiation among Russian HIV-infected heavy drinkers enrolled in a secondary HIV prevention trial (HERMITAGE) was examined. We assessed 133 participants eligible for ART initiation (i.e., CD4 count <350 cells/μl) who were not on ART at baseline. Depressive symptom severity and ART use were measured at baseline, 6- and 12-months. Association between depressive symptoms and subsequent ART initiation was evaluated using GEE logistic regression adjusting for gender, past ART use, injection drug use and heavy drinking. Depressive symptom severity was not significantly associated with lower odds of initiating ART. Cognitive depression symptoms were not statistically significant (global p = 0.05); however, those with the highest level of severity had an AOR of 0.25 (95 % CI 0.09-0.71) for delayed ART initiation. Although the effect of depression severity was not significant, findings suggest a potential role of cognitive depression symptoms in decisions to initiate ART in this population.
    AIDS and Behavior 12/2013; 18(6). DOI:10.1007/s10461-013-0674-y · 3.49 Impact Factor
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    ABSTRACT: Questions remain about how brief motivational interventions (BMIs) for unhealthy alcohol use work, and addressing these questions may be important for improving their efficacy. Therefore, we assessed the effects of various characteristics of BMIs on drinking outcomes across 3 randomized controlled trials (RCTs). Audio recordings of 314 BMIs were coded. We used the global rating scales of the Motivational Interviewing Skills Code (MISC) 2.1: counselor's acceptance, empathy, and motivational interviewing (MI) spirit, and patient's self-exploration were rated. MI proficiency was defined as counselor's rating scale scores ≥5. We also used the structure, confrontation, and advice subscale scores of the Therapy Process Rating Scale and the Working Alliance Inventory. We examined these process characteristics in interventions across 1 U.S. RCT of middle-aged medical inpatients with unhealthy alcohol use (n = 124) and 2 Swiss RCTs of young men with binge drinking in a nonclinical setting: Swiss-one (n = 62) and Swiss-two (n = 128). We assessed the associations between these characteristics and drinks/d reported by participants 3 to 6 months after study entry. In all 3 RCTs, mean MISC counselor's rating scales scores were consistent with MI proficiency. In overdispersed Poisson regression models, most BMI characteristics were not significantly associated with drinks/d in follow-up. In the U.S. RCT, confrontation and self-exploration were associated with more drinking. Giving advice was significantly associated with less drinking in the Swiss-one RCT. Contrary to expectations, MI spirit was not consistently associated with drinking across studies. Across different populations and settings, intervention characteristics viewed as central to efficacious BMIs were neither robust nor consistent predictors of drinking outcome. Although there may be alternative reasons why the level of MI processes was not predictive of outcomes in these studies (limited variability in scores), efforts to understand what makes BMIs efficacious may require attention to factors beyond intervention process characteristics typically examined.
    Alcoholism Clinical and Experimental Research 10/2013; 38(3). DOI:10.1111/acer.12274 · 3.21 Impact Factor
  • T P Palfai · D M Cheng · S M Coleman · C Bridden · E Krupitsky · J H Samet ·
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    ABSTRACT: Depressive symptoms have been linked to HIV progression through a number of biobehavioral mechanisms including increased alcohol use. Although research supports an association between alcohol use and depressive symptoms among HIV patients, there have been few studies that have examined whether depressive symptoms predict subsequent drinking, especially among heavy drinking HIV-infected patients. Heavy drinking Russian HIV-infected patients (n=700) were recruited from addiction and HIV care settings for a randomized controlled trial of a risk reduction intervention [HERMITAGE]. GEE overdispersed Poisson regression analyses were conducted to assess the association between depressive symptoms and alcohol consumption 6-months later. In adjusted analyses, depressive symptom severity was significantly associated with drinks per day (global p=.02). Compared to the non-depressed category, mild depressive symptoms were significantly associated with more drinks per day [IRR=1.55, (95% CI: 1.14, 2.09)], while moderate [IRR=1.14, (95% CI: 0.83, 1.56)] and severe [IRR=1.48, (95% CI: 0.93, 2.34)] depressive symptoms were not. Associations between depressive symptom severity and heavy drinking days were not statistically significant (global p=.19). Secondary analyses using the BDI-II screening threshold (BDI-II>14) and the BDI-II cognitive subscale suggested an association between depressive symptoms and drinks per day over time but not heavy episodic drinking. Among heavy drinking HIV-infected patients, elevated depressive symptoms were associated with greater subsequent alcohol use. These findings suggest that depressive symptoms may be important to address in efforts to reduce alcohol-related risks among HIV-infected populations.
    Drug and alcohol dependence 09/2013; 134(1). DOI:10.1016/j.drugalcdep.2013.09.014 · 3.42 Impact Factor
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    ABSTRACT: Marijuana is the most commonly used illicit drug, yet its impact on health and healthcare utilization has not been studied extensively. To assess the cross-sectional association between frequency of marijuana use and healthcare utilization (emergency department and hospitalization) and health (comorbidity, health status), we studied patients in an urban primary care clinic who reported any recent (past 3-month) drug use (marijuana, opioids, cocaine, others) on screening. Frequency of marijuana use in the past 3 months was the main independent variable [daily/ almost daily, less than daily and no use (reference group)]. Outcomes assessed were past 3-month emergency department or hospital utilization, the presence of medical comorbidity (Charlson index ≥ 1), and health status with the EuroQol. We used separate multivariable regression models adjusting for age, sex, tobacco and other substance use. All 589 participants reported recent drug use: marijuana 84 % (29 % daily, 55 % less than daily), cocaine 25 %, opioid 23 %, other drugs 8 %; 58 % reported exclusive marijuana use. Frequency of marijuana use was not significantly associated with emergency department use {adjusted odds ratio [AOR] 0.67, [95 % confidence interval (CI) 0.36, 1.24] for daily; AOR 0.69 [95 % CI 0.40,1.18] for less than daily versus no use}, hospitalization [AOR 0.79 (95 % CI 0.35, 1.81) for daily; AOR 1.23 (95 % CI 0.63, 2.40) for less than daily versus no use], any comorbidity [AOR 0.62, (95 % CI 0.33, 1.18) for daily; AOR 0.67 (95 % CI 0.38, 1.17) for less than daily versus no use] or health status (adjusted mean EuroQol 69.1, 67.8 and 68.0 for daily, less than daily and none, respectively, global p = 0.78). Among adults in primary care who screen positive for any recent illicit or non-medical prescription drug use, we were unable to detect an association between frequency of marijuana use and health, emergency department use, or hospital utilization.
    Journal of General Internal Medicine 09/2013; 29(1). DOI:10.1007/s11606-013-2605-z · 3.42 Impact Factor
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    09/2013; 8(Suppl 1):A61-A61. DOI:10.1186/1940-0640-8-S1-A61
  • Timothy E Ralston · Tibor P Palfai · Mike Rinck ·
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    ABSTRACT: Research suggests that depressed mood is associated with alcohol-related problems, though its relation with drinking behavior has been inconsistent across studies. Efforts to better understand the link between depressed mood and alcohol use have examined drinking motives as a potentially important moderating variable. The current study sought to examine whether drinking motives moderate the influence of depressed mood on alcohol-related action tendencies. Based on Baker, Morse, and Sherman's (1986) positive and negative reinforcement schema model, two competing moderational hypotheses regarding the influence of depressed mood on appetitive responses for alcohol were tested. One hundred and sixty-nine college student drinkers completed assessments of drinking motives and alcohol use. Subjects were exposed to a neutral or depressed mood induction followed by a computerized measure of action tendencies toward alcohol stimuli. Hierarchical regression analyses were conducted to examine whether the influence of depressed mood on action tendencies toward alcohol was moderated by drinking motives. Results showed that there was a significant interaction between mood induction condition and enhancement motives, such that depressed mood appeared to suppress appetitive responding toward alcohol among those with higher enhancement motives. In contrast, there was no evidence that coping motives moderated the association between mood and appetitive response to alcohol. These results suggest that inhibiting affect states associated with one's motivational disposition for drinking may result in the devaluation of alcohol. Limitations and implications are discussed.
    Addictive behaviors 07/2013; 38(12):2810-2816. DOI:10.1016/j.addbeh.2013.07.013 · 2.76 Impact Factor
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    ABSTRACT: Although alcohol and drug use have been identified as HIV-risk factors for men who have sex with men (MSM), little is known about how they interact. An alcohol administration paradigm was used to examine alcohol's cue and pharmacological effects on perceived drug use benefits and consequences in 117 MSM. Planned contrasts indicated that those in the alcohol cue (i.e., placebo) condition reported lower perceived drug consequences compared to controls. No cue effects were found for drug benefits. There was no pharmacological effect of alcohol as compared to alcohol cue on either outcome. Findings suggest that alcohol cues may influence the perception of consequences related to drug use, which has implications for health interventions targeting substance use and HIV risk.
    Addictive behaviors 03/2013; 38(7):2317-2320. DOI:10.1016/j.addbeh.2013.02.014 · 2.76 Impact Factor

Publication Stats

3k Citations
276.34 Total Impact Points


  • 1999-2015
    • Boston University
      • Department of Psychology
      Boston, Massachusetts, United States
  • 1997-2013
    • University of Massachusetts Boston
      • Department of Psychology
      Boston, Massachusetts, United States
  • 2012
    • Beverly Hospital, Boston MA
      Beverly, Massachusetts, United States
  • 2007
    • Boston Medical Center
      Boston, Massachusetts, United States
  • 2004
    • Florida International University
      Miami, Florida, United States
  • 1997-2003
    • Brown University
      • Center for Alcohol and Addiction Studies
      Providence, RI, United States
  • 2001
    • University of Rhode Island
      • Department of Psychology
      Кингстон, Rhode Island, United States
  • 1995
    • University of Toronto
      • Department of Psychology
      Toronto, Ontario, Canada