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ABSTRACT: Primary prevention efforts aimed at sexual risk behaviors are critical. This experiment was designed to investigate the effects of alcohol intoxication and sexual arousal, as well as person variables of alcohol sex expectancies and attitudes toward condom use, on hypothesized determinants of sexual risk behaviors among men who have sex with men (MSM). The participants were 117 MSM aged 21-50 years who were randomly assigned to one of six separate experimental conditions created by the combination of beverage administration (water control, placebo or alcohol designed to raise blood alcohol level to .07%) and sexual arousal (low or high, manipulated by participants' viewing non-erotic or mildly erotic film clips). Participants attended two experimental sessions. The first session included completing questionnaires about beliefs about alcohol's effects on sex and attitudes toward condoms' effect on sexual pleasure. The second session involved the beverage condition and arousal manipulations. Following these, participants viewed and responded to two interactive videos depicting high sexual risk scenarios. Participants also completed the CARE, a measure of risk perceptions. The dependent variables were behavioral skills, intentions to have unsafe sex, and "risk exposure," derived from responses to the videos. The results of both planned and exploratory analyses showed general support for the hypothesized enhancement of alcohol's effects on sexual risk by both sexual arousal and expectancies. Also as predicted, condom attitudes showed direct relationships to risk exposure and intentions. Implications of the findings for models of alcohol's effects on sexual risk and for the development of HIV prevention interventions were discussed.
Archives of Sexual Behavior 10/2011; 41(4):971-86. · 3.53 Impact Factor
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ABSTRACT: The efficacy of screening and brief intervention (SBI) for drug use in primary care patients is largely unknown. Because of this lack of evidence, US professional organizations do not recommend it. Yet, a strong theoretical case can be made for drug SBI. Drug use is common and associated with numerous health consequences, patients usually do not seek help for drug abuse and dependence, and SBI has proven efficacy for unhealthy alcohol use. On the other hand, the diversity of drugs of abuse and the high prevalence of abuse and dependence among those who use them raise concerns that drug SBI may have limited or no efficacy. Federal efforts to disseminate SBI for drug use are underway, and reimbursement codes to compensate clinicians for these activities have been developed. However, the discrepancies between science and policy developments underscore the need for evidence-based research regarding the efficacy of SBI for drug use. This article discusses the rationale for drug SBI and existing research on its potential to improve drug-use outcomes and makes the argument that randomized controlled trials to determine its efficacy are urgently needed to bridge the gap between research, policy, and clinical practice.
Journal of Addiction Medicine 09/2010; 4(3):123-30. · 1.95 Impact Factor
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Journal of Addiction Medicine 09/2010; 4(3):131-6. · 1.95 Impact Factor
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Journal of Addiction Medicine 08/2010; 4(3):131-136. · 1.95 Impact Factor
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ABSTRACT: Unhealthy alcohol use is common in medical inpatients, and hospitalization has been hypothesized to serve as a "teachable moment" that could motivate patients to decrease drinking, but studies of hospital-based brief interventions have often not found decreases. Evaluating associations between physical health and subsequent drinking among medical inpatients with unhealthy alcohol use could inform refinement of hospital-based brief interventions by identifying an important foundation on which to build them. We tested associations between poor physical health and drinking after hospitalization and whether associations varied by alcohol dependence status and readiness to change.
Participants were medical inpatients who screened positive for unhealthy alcohol use and consented to participate in a randomized trial of brief intervention (n = 341). Five measures of physical health were independent variables. Outcomes were abstinence and the number of heavy drinking days (HDDs) reported in the 30 days prior to interviews 3 months after hospitalization. Separate regression models were fit to evaluate each independent variable controlling for age, gender, randomization group, and baseline alcohol use. Interactions between each independent variable and alcohol dependence and readiness to change were tested. Stratified models were fit when significant interactions were identified.
Among all participants, measures of physical health were not significantly associated with either abstinence or number of HDDs at 3 months. Having an alcohol-attributable principal admitting diagnosis was significantly associated with fewer HDDs in patients who were nondependent [adjusted incidence rate ratio (aIRR) 0.10, 95% CI 0.03-0.32] or who had low alcohol problem perception (aIRR 0.36, 95% CI 0.13-0.99) at hospital admission. No significant association between alcohol-attributable principal admitting diagnosis and number of HDDs was identified for participants with alcohol dependence or high problem perception.
Among medical inpatients with nondependent unhealthy alcohol use and those who do not view their drinking as problematic, alcohol-attributable illness may catalyze decreased drinking. Brief interventions that highlight alcohol-related illness might be more successful.
Alcoholism Clinical and Experimental Research 07/2010; 34(7):1257-65. · 3.34 Impact Factor
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ABSTRACT: The goal of this study was to examine the association between interpersonal violence exposure and utilization of alcohol treatment after medical hospitalizations among adults with alcohol dependence. We analyzed data collected from a prospective cohort of 238 adults with alcohol dependence who were inpatients in a large urban hospital. Participants who reported interpersonal violence victimization had 1.6 times the odds (adjusted odds ratio = 1.64, 95% confidence interval = 0.92-2.91) of receiving alcohol treatment during the year after hospitalization compared to participants with no violence exposure. Recent (past 3 months) exposure to violence was not more strongly related to receipt of treatment than any lifetime violence exposure. Results suggest that a history of interpersonal violence victimization may be associated with an increased odds of alcohol treatment utilization following a medical hospitalization. Therefore, clinicians should be optimistic about identifying and referring patients who have experienced interpersonal violence to alcohol treatment. Moreover, given the potentially high prevalence of interpersonal violence exposure among inpatient populations at large urban hospitals, alcohol treatment providers should develop methods to address both alcohol dependence and violence recovery.
Journal of Substance Abuse Treatment 07/2008; 34(4):464-70. · 3.14 Impact Factor
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ABSTRACT: This study investigated the relationship between age of first drink (AFD) and a broad range of negative alcohol-related outcomes among college students exhibiting unhealthy alcohol use. We conducted an anonymous on-line survey to collect self-report data from first-year college students at a large northeastern university. Among 1,792 respondents who reported ever drinking, 14% reported an AFD before age 14. These early onset drinkers were more likely than later onset drinkers to report frequent drinking, heavy drinking, and other unhealthy alcohol use behaviors. Among the subset of drinkers with unhealthy alcohol use (36%), early drinkers were more likely than later onset drinkers to report experiencing five out of 13 alcohol-related consequences, including driving while intoxicated, missing work or school due to drinking, getting into trouble at work or school due to drinking, receiving lower grades than they should have due to drinking, and developing a tolerance to alcohol.
Substance Abuse 02/2008; 29(1):33-41. · 1.33 Impact Factor
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ABSTRACT: Despite the development of brief efficacious interventions, they are not reaching a large proportion of college students who continue to drink in a manner that puts them at risk for harm. Recent efforts have attempted to address this issue through the development of brief alcohol interventions that may be more broadly disseminated to college students. Researchers have adapted a variety of approaches to print and computer-based modalities that do not require direct real-time contact with an interventionist. The goal of this paper is to review the empirical evidence for the utility of these brief alcohol interventions that are delivered without direct real-time contact. A systematic review of this research suggests that 'no-contact' interventions are feasible and may have efficacy. Further research is needed to understand the duration of these effects, mechanisms of change, moderators of outcome, and how to enhance the effectiveness of these approaches.
Substance Abuse 02/2007; 28(4):119-31. · 1.33 Impact Factor
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ABSTRACT: In four experiments, we examined the effect that presenting a verbal stimulus (viz., an English noun) alongside an abstract visual stimulus (viz., a Chinese character) enhances recognition memory for the abstract visual stimulus. Experiment 1 demonstrated that the character-plus-word combination at both encoding and retrieval results in better recognition than does a character-alone presentation or presenting the combination at encoding only. Experiment 2 demonstrated that presenting the word first and then the character results in better performance than does the opposite order. Experiment 3 showed that the concreteness value of the word, not familiarity, is the critical factor. In Experiment 4, presentation time was varied. More time was needed for liftoff from chance level for the word-character combination than for the character-alone presentation. Together, the results suggest that subjects spontaneously assimilate stimulus and word into a single representation by building asymmetric effortful imagery associations, going from the English word to the Chinese character.
Memory & Cognition 07/2006; 34(4):795-803. · 1.92 Impact Factor
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ABSTRACT: Preference-based utility ratings for health conditions are important components of cost-utility analyses and population burden of disease estimates. However, utility ratings for alcohol problems have not been determined.
The objectives of this study were to directly measure utility ratings for a spectrum of alcohol-related health states and to compare different methods of utility measurement.
The authors conducted a cross-sectional interview of 200 adults from a clinic and community sample.
Subjects completed computerized visual analog scale (VAS), time tradeoff (TTO), and standard gamble (SG) utility measurement exercises for their current health, a blindness scenario, and for 6 alcohol-related health state scenarios presented in random order. The main outcome measures were the utility ratings, scaled from 0 to 1, and anchored by death (0) and perfect health (1).
The 200 subjects were middle-aged (mean, 41 +/- 14 years), 61% women, and racially diverse (48% black, 43% white). Utility ratings decreased as the severity of the alcohol-related health state increased, but differed significantly among the VAS, TTO, and SG methods within each health state. Adjusted mean (95% confidence interval) utility ratings for alcohol dependence (VAS, 0.38 [0.34-0.41]; TTO, 0.54 [0.48-0.60]; SG, 0.68 [0.63-0.73]) and alcohol abuse (VAS, 0.53 [0.49-0.56]; TTO, 0.71 [0.65-77]; SG, 0.76 [0.71-0.81]) were significantly lower than utility ratings for nondrinking, moderate drinking, at-risk drinking, current health, and blindness.
Utility ratings for alcohol-related health states decrease as the severity of alcohol use increases. The low utility ratings for alcohol abuse and alcohol dependence are similar to those reported for other severe chronic medical conditions.
Medical Care 07/2005; 43(6):541-50. · 3.41 Impact Factor
