Addiction Book

8/4/2019 Addiction Book

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A d d i c t i v eB e i i a v i o r sN E W R E A D I N G S O N E T I O L O G Y , P R E V E N T I O N ,A N D T R E A T M E N T

E D I T E D B YG. A lan M a r la t t and Ka tie W i tkiew i tz

A M E R I C A N P S Y C H O L O G I C A L A S S O C I A T I O NW A S H I N G T O N , D C


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Copyright 2009 by the American Psychological Association. All rights reserved. Except aspermitted under the United States Copyright Act of 1976, no part of this publication maybe reproduced or distributed in any form o r by any means, including, but n ot limited to, th eprocess of scanning and digitization, or stored in a database or retrieval system, witho ut theprior written permission of the publisher.Chapters 1 and 21 were authored or coauthored by an employee ofthe United States govem m en t as part of official duty and are considered to be in the pu blic dom ain.Published by T o orderAm erican Psychological Association AP A Order Department750 First Street, NE P.O . Box 92984Wash ington, DC 20002 Wash ington, DC 20090-2984www.apa.org Tel: (800) 374- 2721 ; Direct: (202) 336-5510Fax: (202) 336-5502; TDD /TTY: (202) 336-6123Online: www.apa.org/books/

E-mail: [email protected] the U.K., Europe, Africa, a nd th e M iddle East, copies may be ordered fromAmerican Psychological Association3 Henrietta StreetCovent Garden, LondonWC2E8LU EnglandTypeset in Goudy by Circle Graphics, Columbia, MDPrinter: Edwards Brothers, Inc., Ann Arbor, MICover Designer: Berg Design, Albany , NYTechnical/Produ ction Editor: Harriet KaplanTlie opinions and statements published are the responsibility of the authors, and suchopinions and statements do not necessarily represent the policies of the AmericanPsychological Association.Library of Congress Cataloging-in-Publication DataAddictive be haviors: new readings on etiology, prevention, and trea tmen t / edited by G. A lanMarlatt and Katie Witkiewitz. 1st ed.p . ; cm ."Reprinted from American Psychological Association joumals."Includes bibliographical references an d ind ex.ISBN-13:978-1-4338-0402-1ISBN-10:1-4338-0402-61. Substanc e abuse. 2. Com pulsive behav ior. I. M arlatt, G. Alan. II. Witkiew itz, Katie.III. American Psychological Association.[DNLM: 1. Substance-R elated Disordersetiology Collected Works . 2. Behavior,Addictive Collected W orks. 3. Substance-Related Disordersprevention & controlCollected Wo rks. 4- Substance-Related DisorderstherapyCollected W orks. WM 270A22473 2009]

RC564.A314 20093 6 2 . 2 9 ^ I c 2 2 2 0 0 8 0 1 4 3 9 4

British Library Cataloguing-in-Publication DataA CIP record is available from the British Library.Printed in the United States of AmericaFirst Edition


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CONTENTS

Contributors xiIntroduction 3G. Alan Marlatt and Katie WitkiewitzI. Role of Psychology and Behavioral Science

in Add iction Research and Tre atm ent 17Ch apter 1. Co ntributio ns of Behavioral Scienceto Alcohol Research: Understanding

W ho Is at Risk and W hy 19Enoch Gordis

Ch apter 2. W hy Psychologists Should Treat Alcoh oland Drug Problems 33William R. Miller and Sandra A. Brown


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I I . Epidemiological Ov erview and Etiology 57Chapter 3. Etiologic Connections Am ong Substance

Dep enden ce, Antisocial Behavior, and Personality:Mo deling the Extemalizing Spectrum 59Robert F. Krueger, Brian M. Hicks,Christopher]. Patrick, Scott R. Carlson,William G . lacono, and Matt M cGue

Ch apter 4. Etiological Co ntribu tions to Heavy DrinkingFrom Late Ado lescence to Young Ad ulthoo d 89Serena M. King, S. Alexandra Burt,Stephen M. Malone, Matt McG ue,and William G . lacono

Ch apter 5. Trend s in Ecstasy Use in the Un ited StatesFrom 1995 to 2001: Comparison With MarijuanaUsers and Association W ith O the r Drug Use 117Silvia S. Martins, GuidoMazzotti,arui Howard D. Ch ikoat

I I I . Prevention and Harm Reduction 135Ch apter 6. Toward a Psychology of Harm Red uction 137Robert]. MacCounCh apter 7. Ado lescent Substance Use Outcom es in the Raising

Healthy Children Project: A Two-Part LatentGrow th Curve Analysis 159Eric C. Broum, Richard F. Catalano,Charles B. Fleming, Kevin P. Haggerty,and Robert D.Abbott

Ch ap ter 8. Project DA RE : N o Effects at lO-Year Follow-Up 187Donald R. Lynam, Richard Milich, Rick Zimmerman,Scott P. N ovak, TK Logan, Catherine Martin,Carl Leukefeld, and Richard Clayton

IV . Initiation and Progression in Adolescence 197Ch apter 9. A Long itudinal Analysis of Friendships

and Substance Use: Bidirectional InfluenceFrom Ado lescence to Ad ultho od 199Thomas]. Dishion and Lee D. Ow en

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Ch apter 10. Co njoint Develop mental Trajectoriesof Young Ad ult Alcoho l and Tobacco Use 225Kristirw, M . ]ackson, Kenne th] . Sher,andjohnE. Schulenberg

V . Family Dyn amics and Family Impact 25 7Chapter 1 1 . The Roles of Familial Alcoholism

and A dolescent Family Harmo ny in YoungAd ults' Substance Depen dence D isorders:Mediated and Mo derated Relations 259Qing Zhou, Kevin M. King, and Laurie Chassin

Ch ap ter 12. Family Risk Factors and Ado lescent Substance Use:Moderation Effects for Tem peram ent Dimensions 287Thomas Ashby W ills, ]ames M . Sandy, Alison Yaeger,and Ori Shinar

V I . Screening and Assessment 3 21Ch apter 13. Te st-R etest Reliability of Alco hol Measures:

Is There a Difference Between Intemet-BasedAssessment and Tradition al Methods? 323Elizabeth T. Miller, D a n ] . Neal, Lisa]. Roberts,]ohn S. Boer, Sally O. Cresskr, ]ane Metrik,arui G . Alan M arlatt

Ch apter 14. T h e Neuropsychological Test Performanceof Dmg-Abusing Patients: An Examinationof Latent Cog nitive Abilities and AssociatedRisk Factors 343William Fals-Stewart and Marsha E. Bates

Ch apter 15. Immediate An teced ents of Cigarette Smo king:A n An alysis From Ecological M omen taryAssessment 367SaulShiffman, Chad]. Gwaltney, MarkH. Balabanis,Kenneth S. Liu, jean A . P aty ,]on D . Kassel,Mary Hickcox, and Maryann Gnys

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V II. Trea tmen t Approaches and Models 40 1Ch ap ter 16. Relapse Prevention for Alco hol and Dmg Problems:

Th at W as Zen, This Is Tao 403Katie Witkiewitz and G . Alan Marlatt

Ch apter 17. Brief Trea tmen ts for Can nabis Dep endence :Findings From a Randomized M ultisite Trial 429The Marijuana Treatment Project Research G roup

C ha pte r 18. Sm oking Cessa tion: Progress, Priorities,and Prospectus 459Raymond Niaura and David B. Abrams

Ch apter 19. Risk Factors and Neuropsychological Recoveryin Clients W ith A lcohol Use Disorders W hoW ere Exposed to Different Treatm ents 497Marsha E. Bates, DanieUe Barry, Erich W. Labouvie,William Fals-Stewart, Gerald Voelbel,and Jennifer F. Buckman

Chap ter 20. Alcoho l and Tobacco Cessationin Alcohol-Dependent Smokers:Analysis of Real-Time Reports 515Ned L. Cooney, Mark D . Litt, ]udith L. C ooney,David T . Pilkey, Howard R. Steinberg,and Cheryl A. Onclcen

Chapter 21. Ad dictive Disorders in Con tex t: Principlesand Puzzles of Effective Tr eatm en t and Recovery 537RiuiolfH. Moos

Chap ter 22. Abstinence-Based Incentives in M ethadoneMaintenance: Interaction With Intake StimulantTes t Results 559Maxine L. Stitzer, fesska Peirce, Nancy M. Petry,Kimberly Kirby, John Roll, Joseph Krasrmnsky,AUan Cohen , jack Blaine, Ryan V andrey,Ken Kolodner, and Rui Li

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V III . Issues in Specific Pop ulations 57 3Chapter 23. Preventing Substance Abuse in American Indian

and A laska Native Youth: Promising Strategiesfor Hea lthier Com mu nities 575Elizabeth H . Hawkins, LiRian H . Cummins,and G. Alan Marlatt

Chap ter 24. Examination of Ethnicity in Controlled Treatm entOutcome Studies Involving Adolescent SubstanceAbusers: A Com prehensive Literature Review 623Marilyn J. Strada, BradDonohue,and Noe lk L. Leffcrrge

Chapter 25 . Measuring Adolescent Dmg Abuseand Psychosocial Factors in Four Ethnic Groupsof Dm g-Abusing Boys 657Ken C. Winters, William W . Latimer,Randy D. Stinchfield, and Elizabeth Egan

Chap ter 26. Meta-Analyses of ALDH 2 and ADH J BW ith Alcohol Dependence in Asians 677Susan E. Luczak, S tephen ]. Glatt,and T amara L . WaR

Au thor Index 713Subject Index 751Ab out the Editors 777

CONTENTS IX


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CONTRIBUTORS

Robert D. AbbottDavid B. AbramsJoh n S. BaerM ark H. BalabanisDanielle BarryMarsha E. BatesJack BlaineEric C. BrownSandra A . BrownJennifer F. BuckmanS. Alexan dra BurtScott R. C arlsonRichard F. CatalanoLaurie ChassinHoward D. ChilcoatRichard ClaytonAllan CohenJudith L. CooneyNed L. Cooney

Sally O . C resslerLillian H. CumminsTho mas J. DishionBrad Donohu eElizabeth EganWilliam Fals-StewartCharles B. FlemingStephen J. Glat tMaryann GnysEnoch G ordisCh ad J. GwaltneyKevin P. HaggertyElizabeth H. HawkinsMary HickcoxBrian M . HicksW illiam G. laconoKristina M . JacksonJon D. KasselKevin M . King

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Serena M . KingKimberly KirbyKen KolodnerJoseph KrasnanskyRobert F. KruegerErich W. L abouvieWilliam W. LatimerNoe lle L. LefforgeCarl LeukefeldRui LiMark D . LittKenneth S. LiuTK LoganSusan E. LuczakDonald R. LynamRobert J. MacC ounStephen M. MaloneThe Marijuana Treatment Project

Research GroupG. Alan MarlattCatherine MartinSilvia S. M artinsGuido MazzottiMatt McGueJane MetrikRichard MilichElizabeth T. MillerW illiam R . MillerRudolf H. MoosDan J. Neal

Raymond N iauraScott P. NovakCheryl A. O nckenLee D. Ow enChristopher J. PatrickJean A . PatyJessica PeirceNancy M. PetryDavid T. PilkeyLisa J. RobertsJohn RollJames M. SandyJohn E. SchulenbergKenneth J. SherSaul ShiffmanOri ShinarHoward R. SteinbergRandy D. StinchfieldMaxine L. StitzerMarilyn J. StradaRyan VandreyGerald VoelbelTamara L. WallThom as Ashby WillsKen C. WintersKatie W itkiewitzAlison YaegerQing ZhouRick Zimmerman

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A d d i c t i v e B e h a v i o r s


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INTRODUCTIONG. ALAN MARLATT AND KATIE WITKIEWITZ

Since the publication ofthe Addictive Behaviors Reader in 1997, therehave been major advances in the research, prevention, and treatment ofaddictive behaviors, many of which are docum ented by chapters in th e current volume of readings. Gary VandenBos, coeditor of the earlier volume,contacted us in 2007 to see if we would be interested in putting together anew collection of readings from over the past decade. We thank Gary for hisdevo tion to this topic and support of this edited collection.O ne major developm ent over the past decade has been th e current definitio n of addiction as a "brain disease" as promo ted by the Nation al In stituteon Drug Abuse and other autho rities. Giv en th at th e neuroscience of addiction has made great strides in recent years, including analyses of how drugtaking impacts various pleasure centers in the brain (many mediated bydopamine release that often enhances the rewarding consequences of drug

use), it is no surprise tha t considerable research activity has bee n devo ted tothe developm ent of new pharmaco therapies th at are designed to reduce dmgcraving or block th e rewarding effects of various substances on brain fiinctioning. Research findings show that although pharmacotherapy (e.g., naltrexone, acamprosate, buprenorphrine, methadone, etc.) can have beneficialtherapeutic effects (e.g., reducing craving and urges to use), the effects are


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often enhanced if the treatment program combines pharmacotherapy with abehavioral intervention (e.g., relapse prevention, cognitive-behavior therapy, motivational interviewing).

Behavioral research on ad dictive behaviors has also grown expo nentiallyover the past 10 years. Many o fth e findings and controversies identified in the1990s hav e now been replicated, expanded , and extended t o different popu lations or different types of addictive behavio r. As will be ev ident in this collection of readings, the field has greatly benefited from advances in computertechnology and increases in the National Institutes of Health budget from1995 to 2002. Clinical trials are larger, more powerful, and have p roduced better data. Methodology, particularly statistical and assessment techn iques , haschanged the face of conducting research on addictive behaviors. Statisticalmethods and software that were previously unused by many psychologicalresearchers are recently being introduced into the mainstream. This factbecomes blatantly evident when one browses through the more recent issueso fthe jou m al Psychology of Addictive Behaviors, where nearly every a rticle h asat least onefigureof a complicated stmctural equation model or latent growthcurve mod el. Assessment techn iques have largely benefited from advances incomputing technology. The growth of the Intemet has made way for manyW eb-based psychological assessment tools and in terven tions delivered on line.In this volume, E. T. Miller et al. (chap. 13) provide an introd uction to W eb-based assessment and test its reliability com pared w ith trad itiona l meth ods. Invivo methods for data collection, such as ecological momentary assessment(EMA) via handheld computers and interactive voice response systems, haveprovided real-time assessment of addictive behav ior as it is happening in a person's daily life. Shiffman et al . (chap. 15) and Cooney et al . (chap. 20) provideexamples of applications using EMA .

The intensity of treatment for addictive behaviors has also shifted overthe past decade. In the traditional approach, anyone diagnosed w ith an addiction p roblem was referred to an intensive residential treatm ent program . Mostsuch programs lasted for a month (28 days or longer) and combined medicaldetoxification and intensive treatment based on the disease model of addiction. More recently, there has been a shift in emphasis to embrace the"stepped-care" model. In this approach, initial intervention is usually briefand may consist of a single session or professional advice, often in settingssuch as primary care, medical emergency rooms, and trauma cen ters. Th e aimof the brief in terven tion is to engage the client or patient to participate in aself-help group or structured ou tpatien t trea tme nt to get him or her startedin taking action. If the brief intervention is successful, no more treatment isnecessary. If it is no t successful, the clien t cou ld be encou raged to "step up "to a more intensive treatm ent (e.g., attend ing a 12-step group or signing upfor inp atien t tre atm en t). Intensive rehab is more often reserved as a last resortif less intensive therapy is unsuccessful.

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Th e expansion of available treatm ent goals is also a notewo rthy development of the past decade. Traditional abstinence-only or "high-threshold"intervention programs are typically based on the disease model of addictionand a 12-step program for recovery. More recently, clients who are unw illingor unable to make a com mitm ent to abstinence hav e been offered altem ativetreatm ent goals (an approach known as h irm reduction). Orig inally associatedwith interventio ns for IV dm g users such as needle exchang e (to reduce th epotential harm of HIV infection) or methadone maintenance (to reduce therisk of overdose or other problems associated with illegal drug use), harmreduction strategies have b een applied to o ther high-risk addictive behaviorssuch as problem drinking (e.g., moderation management, brief alcoholscreening and in terven tion for college students). Harm reduction therapy isa low-threshold approach tha t is willing to "meet people where they are at"instead of a confrontational top-down approach that mandates treatmentgoals that require to tal a bstinen ce for successful recovery.

Th e addictive behaviors treatm ent field is also working to develop anintegrated treatm ent approach for working with clients who are experiencingco-occurring substance abuse and m ental he alth problems. Many clients tha twe see in our clinical programs are using alcohol and/or other dmgs to self-medicate other personal problems such as anxiety, depression, or personalitydisorders. Typically, such clients are referred back and forth betw een m enta lhe alth professionals ("You are drinking excessively because you are trying t oreduce the in tensity of your depression symptoms") and substance abuse treatment professionals ("Your depression is caused by your alcoholism"). Suchclients often fall between the cracks of these frequently opposing professionalperspectives and may give up and drop out of treatment altogether. As aresult, the re is a strong need to provide an integrated treatm ent approach, onethat ties together both sides of the presenting problem, and offers a flexibleapproach to choosing treatment goals (including both harm reduction andabstinence).

AN OVERVIEW OF THE CHAPT ERSThe articles reprinted in this collection of readings were all selectedfrom American Psychological Association (APA) journals published since1997. The selection of representative articles was determined by impact onthe field, quality of research m ethodology, a nd topic coverage. Key articles ineight to pic areas were selected (eac h represented in a different section of thebook ): (a) the role of behavioral science in add iction research and the treatme nt of addiction (P art I) ; (b) epidemiology and etiology of addictive beha v

iors (Part II); (c) prevention and reducing the harm associated with addictivebehaviors (Part III); (d) the initiation and progression of addictive behaviors

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in adolescence (Part IV); (e) the role of familial factors, including familyhistory of addiction (Part V); (f) the screening and assessment of addictivebehaviors (Part VI); (g) treatment approaches and models of addiction(Part VII); and (h ) add ictive behaviors in specific po pulations (Part V lll ).

We started with abstracts from every article published in APA journals since 1997 that were related to the topic of addictive behaviors. Thisvoluminous list was then reduced to 86 articles that were deemed "exceptional" by the editors, three advanced graduate students (Sharon Hsu,Diane Logan, and Joel Grow), and one postdoctoral fellow (Susan Collins)at the University of Washington, Seattle. A final selection of 26 articleswas chosen for this collection. Because of space limitations and to avoidoverlap of topic areas, many excellent and ground-breaking articles wereleft out of the final selection.Role of Psychology and Behavioral Sciencein Addiction Research and Treatment

Part I of the book contains two chapters written by top researchers inthe field of addictive behaviors. Enoch Gordis (chap. 1), former director ofthe N ationa l Institute of Alcoho l Abuse and A lcoholism, provides a thorough overview of the role of behavioral science in the p reven tion and treatment of alcohol use disorders. He highlights genetics research, gainingknowledge of neural systems, and medications dev elopmen t as imp ortant forelucidating the relationship between biology and behavior as well as howadvances in these areas will improve the efficacy and effectiveness of alcoholpreven tion and interven tion metho ds. Gordis also describes fiiture challengesfor behav ioral scientists, all of which are still relevan t today: diagnos tic issues,adolescent drink ing, the role of stress horm one s, and increasing biobehavio ral(including neural systems) and etiology research.

T he chapter by W . R. Miller and Brown (cha p. 2) makes a compellingcase for how and why psychologists, who may or may no t hav e formal ad dictions training, can and should provide assessment and treatment of addictivebehaviors. The chapter focuses on the qualities and special expertise ofpsychologists tha t m ake them suited for working with individuals who h avealcohol and/o r drug problem s. Substance use disorders are the most p revale ntform of mental health problem and frequently co-occur with other mentalhealth disorders. Thus, psychologists who treat other psychological problemswill likely have several clients who are also struggling with an addictivebehavior. Fortunately, many studies have shown that basic clinical skills(e.g., emp athy, reflection) are predictors of favorable tr eatm ent outcom es.W . R. M iller and Brown also address some of the barriers for psychologists inthe routine treatment of substance use disorders and provide several recommendations for future training and research.



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Epidemiological Overview and EtiologyPart 11 ofth e book includes three chap ters that address etiology and epi

demiology. The first two chapters tackle some of the main challenges tobehavioral scientists described by Gordis in Part I: genetics, biobeh avioralresearch, and substance use in adolescence. Kmeger et al. (chap. 3) proposea biometric model of the "extemalizing spectm m" tha t encompasses comorbid substance use, antisocial behavio r, and personality style. Th e chapter provides a thorough review of genetic research to d ate and examines the geneticand environmental influences on the extemalizing spectrum in 626 twinpairs. The results support a hierarchical model in which the co-occurrenceamong alcohol dependence, drug dependence, conduct disorder, adolescentantisocial behavior, and disinhibitory personal style could all be partiallyexplained by a heritab le ex temalizing factor. Because all of the varian ce wasnot explained by heritability the authors concluded that both general environmental and specific etiologic factors play a role in predicting extemalizing behaviors and substance depen dence diagnoses.

Using the same data from the Mirmesota Tw in Family Study as Kmegeret al., King, Burt, Malone, McG ue, and lacono (chap. 4) exam ine genetic andenvironmen tal predictors of heavy drinking from late adolescence to adulthood.The chapter explores whether heavy drinking and onset of heavy drinkingamong 1,252 tw in pairs from ages 17 to 20 can be partially explained by genetic,environm ental, or neurological predictors. T he results show th at biological predictors of heavy drinking are more influential among male twins compared withfemale twin pairs and that changes in heavy drink ing are largely attributab le t ononshared environmen tal factors for both males and females. Th e authors recomm end future research to exam ine specific genetic and environm ental factors.

The final chapter in this section addresses trends in ecstasy and otherdmg use from 1995 to 2001, a time when the increase in ecstasy use in theUn ited States was considered a n "epidemic." M artins, Mazzotti, and C hilc oat(chap. 5) look at data from the N ationa l Household Survey on Dm g Abuse,which provides a nationally representative sample across the United States.Th e results show tha t lifetime ecstasy use prevalence more th an doubled from1995 (1.6%) t o 2001 (3.6%) and t ha t this increase was particularly no table foryounger age groups (18- to 25-year-olds). In addition, users of ecstasy werelikely to report using many oth er dmgs, including alcoho l, marijuana, cocaine,crack, hero in, LSD, and stimulants. The authors suggest prev entio n and harmreduction strategies for educating adolescents and young adults about ecstasy.

Prevention and Harm ReductionThe issue of harm reduction was a hotly debated topic throughoutthe 1990s and into the new millennium. In the first chapter of Part III,

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M acCo un (chap . 6) addresses the Am erican d mg policy and a framework forintegrating strategies to reduce harmful consequences of substance use andother behaviors. The strategies described in the articleprevalence reduction, quantity reduction, and harm reductionhave been evaluated quitedifferently in the domain of drug control, where the primary strategy hastraditionally be en "use reduction " via strict proh ibition and enforcemen t. A sof 2006, the Dep artment of Justice had reported th at 53 % of federal prisoninmates were drug offenders, and the trend of increased prison populationsdue to dmg-related co nvictions co ntinue s. M acCo un takes a "frank look" atopposition to harm reduction and provides hypotheses for making harmreduction more successful and palatable.

The most effective and cost-saving way to reduce harm from substance use is through prevention. In the 1990s there was a flurry of large-scale preven tive interve ntions targeting youth develop men t and substanceuse. One such intervention, the Raising Healthy Children project , wasdesigned to target developmentally appropriate risk and protective factorsby implementing, school-, student-, and family-level intervention strategies that were targeted to the developmental stage of the child. Brown,Catalano, Fleming, Haggerty, and Abbott (chap. 7) examined the developmental trajectories of substance use from Grades 6 through 10 in 959participants in this project. Using an innovative growth modeling strategy,the authors report that the intervention was effective in reducing thefrequency of both alcohol and marijuana use during these years but noteliminating use entirely. Returning to the idea of harm reduction. Brownet al. conclude that although the intervention did not prevent use, it didpotentially reduce the harm that has been associated with frequent substance use in adolescence.

In the final chapter of this section, Lynam et al. (chap. 8) examine10-year outcomes of the most widely disseminated and ineffective drug-prevention program in the United States, Project Drug Abuse ResistanceEducation (DARE). DARE is a federally funded, school-based educationprogram , wh ich is delivered by uniformed police officers over 17 weekly sessions. Despite the widespread popularity oft he program and th e federal costof implementing it, several outcomes studies have concluded that DAREhas no short-term effects on actual drug use. Lynam et al. examine theaffects of DARE (compared with a standard drug-education curriculum) ondrug use in 1,002 individuals 10 years after they received the DAREcurriculum. As in nearly all studies to date, the chapter concludes thatDARE is not effective at reducing drug use or changing attitudes towarddrug use. T he authors provide some poten tial reasons why DAR E advocatespersist in promoting th e program despite the overwhelming evidence tha tthe program is not efficacious.



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Initiation and Progression in AdolescenceAs described by Gordis in cha pter 1, the ch allenge of preven ting an d

treating substance use in adolescence is a major target for addictive behaviorsresearchers. T h e two chapters in Part IV provide a longitudinal analysis ofthe development of substance use from adolescence into young adulthood.Dishion and Ow en (ch ap. 9) examine the bidirectional relationship betw eendev iant friendships and substance use from age 13 to age 23 in a sample of 206boys. T he results are consistent w ith previous research in showing th at thestrongest predictor of adolescent substance use is belonging to a peer groupthat also uses substances. One unexpected finding described in the article isthe identification of a subgroup of adolescents who used substances duringadolescence and escalated to dangerous dmg use in young adulthood but didnot have a deviant peer group. The authors conclude that aside from thissmall subgroup, most adolescents might benefit from p reven tive intervention stha t target peer group behavior and school- or comm unity-wide preve ntioninterventions.

In the next chapter, Jackson, Sher, and Schulenberg (chap. 10) examine trajectories of alcohol and tobacco use during young adulthood using datafrom the Monitoring the Future study. Using growth mixture modeling, theauthors extracted seven classes of drinking/smok ing, w ith individuals expectedto be in th e largest class (56% ) reporting n o drinking or smoking. In addition ,the authors examine predictors of alcohol and tobacco trajectories and conclude that parent education, gender, race, and religiosity predicted specificdevelopmental courses for both alcohol and tobacco use across time. Themethodology used in the chapter has the potential to greatly increase ourunderstanding of addictive behavior over time.

Family Dynamics and Family ImpactFamily history of alcoho l problems has been consistently show n to predict increased risk for drinking problem. In addition, family-level variables(e.g., family harmo ny, family conflict) hav e been shown to be strong predictors of substance use. The two chapters in Part V provide an investigationinto t he role of family in the de velopm ent of substance use and abuse duringadolescence and young adulthood. In the first chapter, Zhou, King, andChassin (chap. 11) examine the interaction between family history of alcoholism and family harmon y during adolescence in t he p rediction of alcoholand drug dependence during young adulthood. In their study, the authorsassessed 732 pa rticip ants from 393 families overfive ime points spanning th ecourse of roughly 13 years (from average ages 13 to 2 6). Th e results are con

sistent w ith p revious findings regarding the direct effects of family history of

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alcoho l on offspring substance use depend enc e and family h armo ny as a protective factor related to decreased dmg dep enden ce du ring young adulthoo d.In addition, the authors show that family harmony during adolescence partially mediated th e direct effect of family history o n young adu lt develo pm entof substance use depen den ce.In the second chapter. W ills, Sandy, Yaeger, and Shin ar (chap . 12) provide a slightly different slant by examining potential moderators of adolescentsubstance use, including family risk factors and a variety of tem perament characteristics. The application of latent growth modeling to test moderationeffects, a large sample size (N = 1,810), and obtaining information from multiple reporters (adolescents and teachers) are particular strengths of the study.The chapter reports that family relationships and family stress are significantand unique predictors of adolescent and peer substance use. In ad dition, severaltemp eramen t factors were found to m oderate this association. For adolescentswith positive emotionality and task attention, the relationship was weakened,whereas for those adolescents with high negative em otionality and h igh activity level the impact of family risk factors was heightened. The chapter concludes by examining these opposing resiliency and vulnerability effects withina broad theoretical context.Screening and Assessment

As described above, one of the m ost notable chang es since the publication of the Addictive Behaviors Reader in 1997 is the advances in computingtechnology and an exponential increase in the number of Internet users.Since th e early 1990s, researchers have been incorporating W eb-based computer technology and handheld computers as useful research tools, and theapplications of computing to research questions have greatly expanded ourability t o gather large amounts of data from a wide variety of peop le. T he firstand th ird chap ters in Part VI describe two such applications. E. T. M iller et al.(chap. 13) conducted the first test-retest reliability study comparing Intern et-based assessment and traditional paper-based methods of assessment. Theauthors cond ucted two assessments with in 1 week in which 255 participantswere randomized to complete either Intemet or paper-based assessments.T he results strongly support the tes t-rete st reliability of Internet-bas ed assessm en t and show no differences be tween assessment techn iques, suggesting t ha tInternet-based methods are a suitable and cost-efficient altemative to traditional paper-based measures.

Advances in statistical software are evident in the second study in PartVI. Fals-Stewart and Bates (chap. 14) examine th e neuropsychological functioning of 587 participants recruited from substance use treatment programsusing a multimethod approach and latent variable modeling. The authorsdescribe four cognitive factors (executive, verbal, speed, and memory) that

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sufficiently represent 15 different neuropsychological test scores. In addition,the authors identify several risk factors that have predicted neuropsychological functioning, including premorbid fiinctioning, years of education,alcohol career length and recent drinking quantity, polydmg dependence,family history of alcoholism, an d several biological measures.T he final chap ter in Part VI revisits the issue of expanding research questions by incorporating com puting technolog y. In 1994, Stone and Shiffmanpublished their seminal work on EM A, which is an assessment approach tha tattempts to take th e laboratory to the person by providing an assessment instmment that is delivered in real-time in real-world contexts. Using handheldcomputers, participants complete electronic diaries of their daily life based onscheduled, random and self-initiated assessments. EMA greatly reduces problems of recall and enh ance s ecological validity. Shiffman and h is colleagueshave conducted several studies to date (Shiffman et al, 1997, 2000; Shiffrnan,Paty, Gnys, Kassel, &. Hickcox , 1996), and their research has provided volumesof knowledge about th e im mediate anteced ents and consequences of engagingin a variety of addictive behaviors. T he work that we selected for this volum e(Shiffman et al., chap . 15) examines the situational cues that precede smokingin real time. The authors recmited 304 smokers who recorded smoking andnonsm oking situations over the course of 1 week. In total, the authors collected10,084 and 11,155 reports from smoking and nonsm oking situations, respectively. Using generalized estimating equations th e autho rs show th at smokingurges, consum ption of coffee and food, and the presence of othe r smokers werethe strongest predictors of ad lib smoking. Negative or positive affect andarousal were no t related to smoking, which is contrary to prior studies tha t h aveconsistently shown a strong relationship betw een self-reported affect and smoking behavior. It is importan t to n ote tha t these prior studies relied heavily onself-report via retrospective recall and were therefore not sensitive to themomentary experiences of the smoker. EMA and other in vivo methods ofassessment (e.g., interac tive voice response, tex t messaging) hav e the po ten tialto greatly expand our understanding of addictive behavior.

Treatm ent A pproaches and ModelsSeven articles were selected for Part VII, each describing a differenttreatment approach for a variety of addictive behaviors. It is important tono te th at n o single approach appears to be more effective tha n o thers in th etreatment of addictive behavior problems and a wide variety of treatmentalternatives are currently available. The chapters in this section describeseveral different trea tm ent models, as well as some outcom e da ta from studies th at hav e implem ented various treatme nts. Relapse, or the retum to prob

lematic substance use after a period of abstention or moderate drinking,remains one of the most common outcomes following treatment and is

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possibly one of the most fmstrating aspects of the treatment of addictivebehavior. In the first article (Witkiewitz & M arlatt, chap. 16), we provide areview and synthesis of relapse prevention for alcohol and dmg problems.We included this chapter because it offers a comprehensive review of themultitude of risk factors for relapse as well as methods for assessment andtreatment. The chapter also provides an extensive description of futureresearch strategies that may help elucidate the relapse process and enhancerelapse prevention interventions.

The second chapter, authored by The Marijuana Treatment ProjectResearch Group (chap. 17), examines the efficacy of two brief interventionsfor cannabis dependence. The multisite randomized control trial recruited450 participants and randomly assigned them to either two sessions of motivation enh ancem ent treatment (ME T), nine sessions of a m ulticomp onenttreatm ent including M ET and cog nitive-behavio ral techniqu es, or a delayed-treatment control condition. Both active treatment conditions were significantly more effective in reducing marijuana use relative to the controlcondition, and individuals in the nine-session treatment experienced significantly greater reductions in cannabis use and related consequences comparedwith the two-session treatment.

Niaura and A brams (chap. 18) review th e state of the a rt for smokingcessation treatment in the third chapter in this section. Tobacco use is theleading cause of preventable death in the United States, and nicotine hasbeen described as one of the m ost addicting substances. Several treatm entshave been developed for smoking cessation, from behavioral in terven tion tonicotine patches to hypnotherapy. Interventions have been implementedacross a variety of con texts includ ing individual treatm ent, com mun ity-basedinterventions, health-care-delivered intervention, and public healthapproaches. Niaura a nd Abrams provide a thoroug h overview of the field ofsmoking cessation interventions as well as offer recommendations for smoking cessation gu idelines and future research for behaviora l research related tosmoking cessation.

Using similar methods as described by Fals-Stewart and Bates (chap.14) in the p revious section. Bates et al. (chap. 19) examine neuropsychological fiinctioning among 1,726 participants who received alcohol treatment inthe Project MATCH study. Project MATCH was a multisite study that wasconducted to examine potential patient-treatment matching effects following three active treatments: cognitive-behavioral treatment, MET, and12-step facilitation. T he results suggest tha t initial neuropsycho logical abilities as well as a variety of risk factors pred icted neuropsychological recoveryat 15 months following treatment initiation.

Cooney et al. (chap . 20) also used electronic diaries for EM A in a studyexam ining relapse precip itants in th e first 2 weeks following discharge fromtreatm ent in a sample of 102 alcohol-depen dent smokers. Overall, 90.2% of

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participants did not lapse to alcohol use during the monitoring period, butth e abstinence rates for smoking were 5.8% an d 24 .0% for brief and intensiv etreatmen ts, respectively. Mom entary predictors of thefirstdrink andfirstcigarette included urges to smoke and d rink, self-efficacy, and m ood. T he dataalso provided evidence that alcohol urges increased following smokingepisodes, supporting a cross-substance cue reactivity m odel. The se are exciting data and future research needs to be conducted to extend the EMAfollow-up period fiirther.

In the ne xt chap ter in this section. Moos (chap. 21) ponders the sevenprinciples and unresolved puzzles of effective addictive behavior treatmentand recovery processes. H e provides a detailed review of research studies th athave either provided support or refuted the prevailing wisdom in addictiontreatment. In conclusion. Moos provides a brief discussion of the concemscom monly voiced by clinical providers who are often least familiar and mostsuspicious of "evidence-based" treatments. In many ways, this chapter isessential reading for all psychologists who are practitioners treating orresearchers researching addictive behavior.

In the final treatm ent ap proach chapter, Stitzer et al . (chap . 22) describean in novative an d evidence-based treatme nt for stimulant abuse and dependence. Th e in trodu ction of incentives as part of addiction treatm ent was basedon a basic behavioral p rinciple: If a behavio r is reinforced, it is more likely tooccur in th e fiiture. Star ting in th e early 1990s, researchers began to systematically evaluate whether providing incentives, a treatment called contingencymanagement, would result in lasting changes beyond the period when incentives for behavior were stopped. According to behav ioral theory, there will bedecay of the behavior after reinforcement ceases, and this has commonlybeen found to be the case in addiction treatment. Stitzer et al. look at a specific aspect of contingency management within a sample of 386 methadonemain tenance patients. The question they address is wheth er intake stimulanttest results (i.e., providing stimulant negative or positive urine tests at theinitiation of treatment) would mediate the relationship between incentivesand treatment outcomes. Analyses reveal that both groups of individuals(stimulan t positive and stimulant negative at intake) reported reduced during-treatme nt dmg use relative to a non-incentive-based control cond ition. T heresults from this particular study m n co ntrary to a comm only he ld belief th atincen tives should only be offered for ind ividuals with less severe dmg abuse.

Issues in Specific PopulationsIn Part VIII, the final section of the book, four chapters examine issues forspecific populations with substance abuse problems. As identified by Gordis in

the first chapter of this collection, understanding and preventing adolescentsubstance use is an enormous challenge for addictive behaviors researchers and

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clinicians. Thus, for the first three chapters in this section, we included articlesthat focused o n adolescent populations. In th efirstchapter of Part VIII, Hawkins,Cum mins, and M arlatt (chap . 23) provide a thorough literature review on preventing substance use in Am erican Ind ian and Alaskan Na tive adolescents. Inth efirstsection o fthe chapter, the authors provide an introduction to substanceuse prevalence rates as well as risk and protective factors for abusing specificsubstances among Native populations. In the last two sections Hawkins et al. provide a review of prevention efforts and offer recom mendations for fiiture researchand preven tive strategies that are most promising for substance abuse preven tionamong Native adolescents. The chapter concludes with a description of aprogram that was codeveloped by researchers at the University of Washingtonand N ative eldersfi-om he Seattle Indian Health Board. The "Canoe Joumey"is a culturally congm ent preven tion program th at is unique t o the cultural experiences of tribes in the Pacific Northwest. Drawing on the Northwest Nativetradition of the canoe joumey, a metaphor was constmcted in which the canoejoumey, as well as other Na tive symbols, served as a metaphor to teach skills suchas com munication , decision making, and goal setting as well as providing informa tion abou t alcohol and dmg use and its consequences.

The Hawkins et al. chapter provides a convincing example of howethnicity and cultural values should be incorporated into treatment of substance use as well as how an existing prevention program can be successfiillymodified to accom modate culturally relevant variables. In coun terpo int to theHawkins chapter, Strada, Donohue, and Lefforge (chap. 24) provide a comprehensive review of how poorly the field has responded to this need. Theauthors reviewed 18 adolescent dm g treatm ent outcome studies to exam inewhether ethnicity was systematically incorporated into the analysis or interpreta tion of findings across all studies. In tota l, 94% o fth e studies m ention edethnicity to some extent and 28% incorporated eth nicity in to their design, butonly 6% of studies included specific analyses to exam ine eth nicity as a po tential moderator of treatmen t responding. Th e authors conclude th at the addictive behaviors research community n eeds to invest energy in th e exam inationof ethnicity in existing controlled outcome studies and the development oradaptation of treatments to accomm odate culture-relevant variables.

Winters, Latimer, Stinchfield, and Egan (chap. 25) focus specifically onthe v alida tion of a multiscale assessment tool for ado lescent dm g abusers calledthe Personal Experience Inventory, which was primarily developed in Whitesamples. T he au thors sampled 3,191 adolescen t boys (13 to 18 years old) fi'om30 different adolescent dm g abuse programs, representing four groups: W hit e,African American, Native American, and Hispanic. Although the resultsdo provide strong support for the validity and commonality of the PersonalExperience Inventory across ethnic groups, there were discrepancies across allethnic groups on test-retest reliability in which some scales had inadequate reliability and some had discrepancies o n response probabilities and distortions.

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In the final cha pter of this collection , Luczak et al. (chap. 26) providean up date and meta-analysis of two genes, ALD H2 (aldehyde dehydrogenase) and AD H IB (alcohol dehydrog enase), which have been shown tooffer protection from alcohol dependence, particularly among NortheastAsian populations. The chapter reviews the genetic influence and thepotential mediators and moderators for the effects of these genes on alcoho l depend ence. In general, the authors conclude th at an additive model ofgenetic influence (in which one gene allele is good and possession of twogene alleles is even better) provides an appropriate means for modelingthe relationship between ALDH2 and alcohol dependence, whereas a partial dominant or dominant model explains the influence of ADHIB. Thearticle also describes several moderators of these effects, including beingJapanese, recruiting samples from t reatm ent settings, and gender (with me nshowing greater protection from ADHIB). It is interesting that this findingis con sistent w ith th e results from King et al. (chap. 4) presented in Part IIof this volume.

CONCLUDING REMARKS AND ACKNOWLEDGMENTSTh is collection of readings from articles published by the A PA providesa small sampling of psychological research on addictive behaviors. As men

tioned earlier, because of space constraints, the collection excludes severalarticles of equal importance to th e ones that were chosen. In add ition, becausethe focus of the book is on APA-published works, several ground-breakingarticles from Joumal of Studies on Akohol arui Drugs, Addictive Behavicns,Addiction, and other non-APA publications were not included. Also, severallarge-scale studies, most notably the COMBINE study, have recently beenpublished in medical joumals, including the foumal of the American MedkalAssociation and the N ew England fourrud of Medicine. Th e interested reader isreferred to the references at th e end of each chapter in this collection, w hichprovide a fiirther wealth of studies.In closing, we thank Gary VandenBos for initiating the process for thisnew volume. We are also indebted to the great work conducted by SusanCollins, Joel Grow, Sharon Hsu, and Diane Logan in the identification ofarticles to be included in this collection.

REFERENCESShiffman, S., Balabanis, M. H., Paty, J. A., Engberg, J., Gwaltney, C . J., Liu, K. S.,

et al. (2000). Dynamic effects of self-efficacy on smoking lapse and relapse.Health Psychology, 19, 315-323.

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Shiffman, S., Engberg, J., Paty, J. A ., Perz, W ., Gn ys, M ., Kassel, J. D., & H ickco x,M. (1997). A day at a time: Predicting smoking lapse from daily urge. Joumal ofAbnormal Psychology, 106, 104-116.

Shiffman, S., Paty, J. A ., Gn ys, M., Kassel, J. D., & Hickco x, M . (19 96) . First lapsesto smoking: Within-subjects analyses of real-time reports. Joumal of Consultingand CUnical Psychology, 64, 366-379.

Stone, A. A., & Shiffman, S. (1994). Ecological momentary assessment in behavioral medicine . Annals of Behavioral Medicine, 16, 19 9-2 02 .

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IROLE OF PSYCHOLOGYAND BEHAVIORAL SCIENCEIN ADDICTION RESEARCHAND TREATMENT

Addiction Book

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