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2008 March

Development and Reliability Study of a Daily Alcohol Expectancy Questionnaire

Christine Lee, PhD
Research Assistant Professor

Psychiatry & Behavioral Sciences

Barbara Leigh, Ph.D., MPH, Senior Research Scientist, Alcohol and Drug Abuse Institute (Co-PI)

Description: Alcohol use, misuse, and resulting negative consequences among college students have been extensively documented. Prior research has documented that negative alcohol-related events can promote changes to drinking behavior, motivations for change, and cognitions related to drinking. In this proposal, we will collect pilot data for a larger project "Event-level analysis of expectancies, alcohol use, and consequences," which uses an event-level perspective to examine the interrelationships of expectancies, drinking, and consequences using daily measurements of these constructs. The pilot study has two parts: a) a daily interview assessing these key measures will be pilot-tested on 20 college students, using cognitive interviewing procedures; b) 20 college students will report on their expectancies, drinking, and alcohol-related consequences once a day for two weeks, using automated telephone interviewing (Interactive Voice Response, or IVR). The results of the pilot study will provide documentation that the measures we create are easy to understand and to answer using IVR, and will provide psychometric data on reliability - both of which are crucial for the success of our larger proposal. The factors related to self-change are important for understanding the maintenance and fluctuations of high-risk drinking and may ultimately help inform interventions targeted to drinkers who are at risk for consequences but are not seeking intervention or treatment.

Resulting articles & projects:

  • The pilot data collected from this project directly resulted in the funding of an R01 Research Grant from NIAAA, with funding of $391,432. [1R01AA016979-01A2]

2008 October

Influence of Adolescent Alcohol Exposure on Phasic Dopamine Signaling During Learning

Nicholas A. Nasrallah, Predoctoral Student

Jeremy J. Clark, PhD, Postdoctoral Fellow, Psychiatry & Behavioral Sciences (Co-PI)

Ilene L. Bernstein, PhD, Professor, Psychology (Mentor)

Description: Adolescent alcohol use is a serious public health problem and is associated with an increased risk for development of chronic alcohol use disorders in adulthood. An emerging view on the etiology of addictive disorders is that during their development and progression there is pathological corruption of neural mechanisms involved in reward-related learning and memory (Hyman, 2005). Indeed, drugs of abuse powerfully and directly activate brain circuitry that likely evolved to mediate behaviors related to natural rewards such as food and sex (Kelley & Berridge, 2002). This attribute, along with the ability of repeated drug exposure to persistently modify this circuitry, is thought to be one of many causal factors leading to problem drug use and addiction (Hyman & Malenka, 2001). Support for this "aberrant learning" hypothesis is provided by anatomical, electrophysiological and biochemical evidence for the activation of molecular mechanisms of learning and memory following drug exposure. Early changes following repeated drug exposure include an increase in the incentive value of rewards and associated cues (Robinson & Berridge, 2001). Dopamine is thought to increase the incentive salience of cues by promoting cue-induced approach, binding the conditioned stimulus to the unconditioned stimulus, or by acting as a reinforcement signal in learning. Drug exposure has been shown to enhance the behavioral response to cues that predict natural reward (Wyvell & Berridge, 2001) and is dependent on dopamine transmission (Clark & Bernstein, 2006). This suggests that drug exposure may non-selectively enhance responses to reward and reward related cues.

The goal of this project is to assess the effect of voluntary alcohol intake during adolescence on phasic dopamine activity in the ventral striatum in response to primary reward and during pavlovian incentive learning. This research aims to expand our current understanding of the potential long-term behavioral and neurobiological effects of early-life alcohol exposure.

Resulting articles & projects:

  • Nasrallah NA, Clark JJ, Collins AL, Akers CA, Phillips PE, Bernstein IL. Risk preference following adolescent alcohol use is associated with corrupted encoding of costs but not rewards by mesolimbic dopamine. Proc Natl Acad Sci USA 2011;108(13):5466-71. doi: 10.1073/pnas.1017732108. [PubMed abstract], [Free full text in Pubmed Central]
  • Clark JJ, Nasrallah NA, Hart AS, Collins AL, Bernstein IL, Phillips PE. Altered risk-based decision making following adolescent alcohol use results from an imbalance in reinforcement learning in rats. PLoS One. 2012;7(5):e37357. doi: 10.1371/journal.pone.0037357. [PubMed abstract], [Free full text in Pubmed Central]
  • Findings from this project were used in a successful application by Dr. Clark for a NIDA R01 grant, "Neural Mechanisms of Risk Preference Following Adolescent Alcohol Exposure." [5R01AA021121]
  • In 2013, Jeremy J. Clark received a Presidential Early Career Award for Scientists and Engineers. Clark was recognized for his studies on the neurobiology of motivated behavior. His Presidential Early Career Award will support his continuing investigations of the neural mechanisms of risk preference following adolescent alcohol use. Now on the UW medical school faculty, Clark is part of the Center for Drug Addiction Research.[More...]

Pilot Study of a Group Psychotherapy for Co-occurring Chronic Pain and Addiction

Andrew J. Saxon, MD

Psychiatry & Behavioral Sciences

Description: Little was known about the prevalence and associated outcomes of co-occurring chronic pain among patients in treatment for addictive disorders until relatively recently. Estimates of the prevalence have found that 16-61 % of patients in treatment for addictive disorders (33.2% at Seattle VA) have co-occurring chronic pain, and this co-occurrence is associated with greater functional impairment and greater psychoactive drug use complicating addiction treatment. In our recent study following veterans in addiction treatment over 12 months, we found that veterans with persistent pain, compared to veterans who had low pain, were less engaged in treatment (35 fewer days), were less likely to be abstinent, had worse ASI Alcohol Composite Scores, and greater medical hospitalization and total service costs. Although a number of psychological interventions are available to treat chronic pain of various etiologies, there are no empirically validated psychological treatments developed to treat co-occurring chronic pain in patients with addictive disorders.

The proposed study will develop and provide a preliminary test of a manualized group psychotherapy utilizing a cognitive behavioral approach targeting chronic pain among addiction patients. A version of this psychotherapy has been partially developed and, offered sporadically at Seattle VA but has not been optimized or manualized. After a manual detailing the specific techniques and interventions used in this psychotherapy is created, veterans with a primary diagnosis of non-opioid substance dependence and co-occurring chronic pain who are enrolled in addiction treatment will be randomized to the experimental group therapy or wait-list control and will be assessed at baseline and completion of treatment. Change in physical functioning as measured by the West Haven-Yale Multidimensional Pain Inventory Interference scale will be the primary outcome measure. Secondary outcomes include measures of substance use and other adaptive functioning, as measured with the Timeline Follow-Back for Alcohol and Drugs, AS1 Alcohol and Drug Composite scores, short-form McGill Pain Questionnaire, SF-36, Medication Quantification Scale and Patient Global Impression of Change.

Acceptance and Commitment Therapy for Co-morbid Substance Abuse and PTSD

Alethea A. Varra, PhD
Acting Instructor

Psychiatry & Behavioral Sciences

Tracy L. Simpson, PhD, Assistant Professor, Psychiatry and Behavioral Sciences (Mentor)

Description: A diagnosis of comorbid posttraumatic stress disorder (PTSD) and substance-use disorder (SUD) is frequent in clinical populations with approximately or 25-50% of individuals with either disorder meeting criteria for dual diagnosis in their lifetime and up to 75% of combat veterans meeting criteria for both lifetime SUD and lifetime PTSD. The comorbidity has been shown to severely affect course and outcome of treatment and the call for appropriate and well validated treatment approaches has increased across treatment settings. Although a few treatments have emerged with promising results (e.g. Seeking Safety, Relapse Prevention), between 25-54% of those treated in studies continue to meet criteria for SUD and PTSD. Additional and effective treatment options are clearly needed to address the personal and societal costs associated with this dual diagnosis.

The proposed study will provide a preliminary evaluation of the efficacy of Acceptance and Commitment Therapy (ACT) group treatment for comorbid SUD and PTSD. Thirty six individuals who have been diagnosed with both a SUD and PTSD will be randomized to either an ACT treatment condition or treatment as usual condition. ACT treatment will be delivered in twelve, weekly, one-hour individual sessions. Participants will complete assessments at baseline before entering treatment, after week 6, after week 12 and at 3 month follow-up. Data analyses will examine change in PTSD symptoms and substance use. However, the primary focus of this study is to establish the viability of this treatment in terms of acceptability and successful randomization in order to provide the bases for future and more substantial study.

Note: The start date for this project was significantly delayed pending human subjects approval, but it is now underway.

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