Preliminary Efficacy of Motivational Interviewing on Problem Drinkers 55 and Older compared to Younger Counterparts

Background: Older adults who drink problematically are the largest group of substance users among those 55 and older. This group often chooses moderation as a goal instead of abstinence, and motivation and self-efficacy are found to have less of an impact on drinking compared to younger adults. No study has examined age effects (specifically 55 and older vs. younger counterparts) on motivational interviewing (MI) compared to brief advice with a sample that includes individuals over 65. Objective: To explore the moderating impact of age on heavy drinkers’ (aged M=50.7 years SD=11.6, range 23-73) response to MI. Methods: Data were from a randomized controlled trial testing stepped care brief interventions for alcohol use disorder. Participants were: 97 aged 22 - 54 years and 66 aged 55-73 years. For this study, generalized estimating equations were used to test drinks per drinking day (DDD) 4 weeks after 2 sessions of MI were implemented compared to brief advice alone. Results: There was no main effect of continuous age on DDD; however, individuals 55 and older demonstrated significantly lower DDD at week 8 than their younger counterparts (on average .20 of standard drink, B=-.17, SE=.07,

A randomized controlled pilot trial of different mobile messaging interventions for problem drinking compared to weekly drink tracking

This study was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) R34AA021502. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Exploration of Treatment Matching to Problem Drinker Characteristics With Motivational Interviewing and Non-directive Client-centered Psychotherapy for Problem Drinkers

Motivational Interviewing (MI) is a known effective intervention for alcohol use disorder (AUD). MI\u27s mechanisms of action remain inconsistently substantiated, and research in this area has been reliant on identifying relationships through strength of association rather than experimental manipulation of active ingredients. In two previous studies, a pilot and a larger replication study, we disaggregated MI into its hypothesized active ingredients by creating three conditions: MI, Spirit Only MI (SOMI, in which evocation of change talk was proscribed), and a non-therapy condition (NTC). Results from both studies yielded equivalent findings across all three conditions. In the current analyses, data from both studies were combined to test five participant characteristics as moderators of MI\u27s component parts: 1) severity of baseline drinking, 2) severe AUD (met 6 or more criteria), 3) baseline self-efficacy to moderate drinking, 4) mean daily confidence to resist heavy drinking in the week prior to treatment initiation, and 5) depression. There were no significant findings related to baseline drinking, severe AUD, or baseline self-efficacy. Confidence yielded a significant interaction effect. When participants had high baseline confidence, drinking for those in MI increased compared to those in SOMI. Depression also yielded a significant moderating effect such that in the context of higher depressive symptoms, receipt of either therapy reduced drinking relative to NTC. Results are discussed in light of existing literature on MOBC with MI and the potential role exploring ambivalence may play for participants with particular characteristics

Dismantling Motivational Interviewing: Effects on Initiation of Behavior Change Among Problem Drinkers Seeking Treatment

Motivational Interviewing (MI) is an efficacious treatment for alcohol use disorders (AUD). MI is thought to enhance motivation via a combination of two therapeutic strategies or active ingredients: one relational and one directional. The primary aim of this study was to examine MI’s hypothesized active ingredients using a dismantling design. Problem drinkers (N=139) seeking treatment were randomized to one of three conditions: MI, relational MI without the directional elements labeled spirit-only MI (SOMI) or a non-therapy control (NTC) condition and followed for eight weeks. Those assigned to MI or SOMI received four sessions of treatment over eight weeks. All participants significantly reduced their drinking by week 8, but reductions were equivalent across conditions. The hypothesis that baseline motivation would significantly moderate condition effects on outcome was generally not supported. Failure to find support for MI s hypothesized active ingredients is discussed in the context of the strengths and limitations of the study design

The Relationship Between In-session Commitment Language and Daily Self-reported Commitment to Reduce or Abstain from Drinking

Background: Motivational interviewing is hypothesized to operate by enhancing a client’s internal motivation to change. Past research operationalizes this process by measuring in-session statements for change (i.e., change talk), yet relationships between change talk and other measures of motivation have yet to be substantiated. This study tested whether in-session change talk predicted subsequent reports of commitment to abstain or moderate drinking assessed via ecological momentary assessment (EMA), and explored each of their contributions to drinking outcomes. Method: Secondary data analysis was performed on data from 48 study participants who received therapy within a randomized controlled trial testing mechanisms of actions of MI. Multilevel models were used to test whether in-session commitment statements (strength, frequency, and slope of strength) made in two therapy sessions predicted subsequent daily reports of commitment to abstain or not drink heavily and drinking (21 days of data) in the weeks following each respective session. Results: A weak, negative relationship between in-session commitment and average daily commitment to abstain emerged. No relationship between in-session statements and average daily commitment to not drink heavily emerged. Only EMA commitment predicted drinking outcome. Post hoc analyses demonstrate a moderating impact of EMA commitment to abstain on in-session commitment strength: low pre-treatment commitment to abstain and increasing commitment strength across a session yielded the greatest drink reduction.Conclusion: In-session change talk and EMA commitment may represent distinct aspects of motivation, yet their interaction appears important to treatment prognoses. Commitment to abstain may be important for treatment selection and successful drink reductio

Testing Cross-sectional and Prospective Mediators of Internalized Heterosexism on Heavy Drinking, Alcohol Problems, and Psychological Distress Among Heavy Drinking Men Who Have Sex with Men

Objective: Minority stress theory is often used as a causal explanation for substance use among lesbian, gay, and bisexual populations. This study tested whether drinking to cope with stress (DTC), loneliness, and gay community participation (GCP) mediated the relationship between one type of minority stress (i.e., internalized heterosexism, IH) and behavioral health outcomes. Method: Utilizing secondary data analysis and the PROCESS procedure, relationships between IH, the mediators (DTC, loneliness, and GCP), and outcomes (heavy drinking, alcohol problems, and psychological distress) were explored, both cross-sectionally and in a lagged manner, among both treatment seeking and non-treatment seeking problem drinking men who have sex with men (MSM). Problem drinkers (N=187) were assessed, provided brief normative feedback about their drinking, given the choice to receive brief alcohol use disorder treatment or change on their own, and then followed for 9 months. Results: Cross-sectional findings revealed that IH was significantly associated with heavy drinking, alcohol problems, and psychological distress. DTC emerged as a significant mediator of IH for all the health outcomes. Loneliness and GCP were significant mediators of IH for alcohol problems and psychological distress. Multiple mediation models reveal that all three mediators significantly contribute to IH’s effect on health outcomes. Lagged analyses did not yield any significant indirect effects. Conclusion: Findings underscore the necessity of addressing IH in psychosocial interventions along with coping skills training that emphasizes culturally relevant social support. Limitations related to generalizability and measurement are reviewed

Within-person Associations Between Daily Motivation and Self-efficacy and Drinking Among Problem Drinkers in Treatment

Gaining a better understanding of the change process holds promise to improve alcohol treatment. Ecological momentary assessment (EMA) coupled with intensive longitudinal data (ILD) approaches have been proposed as promising methods that can advance change process research but have been used infrequently in AUD treatment research. The current study used these approaches to examine the within-person associations of motivation and self-efficacy and drinking among treatment seeking problem drinkers. Participants (N=96) received daily EMA surveys before, during, and after treatment for seven weeks spread over a nine month period. Multi-level modeling was used to test the within-person relationships between the change processes and drinking, controlling for between-person associations and prior drinking. Results indicated that daily fluctuations in motivation and self-efficacy significantly predicted drinking over the next 24 hours; however, several theory-driven hypotheses regarding factors that might moderate that relationship were not supported. Overall, results support the advantages of EMA and ILD as methods that can advance AUD treatment research

Dynamic systems modeling to identify a cohort of problem drinkers with similar mechanisms of behavior change

One challenge to understanding mechanisms of behavior change (MOBC) completely among individuals with alcohol use disorder is that processes of change are theorized to be complex, dynamic (time varying), and at times non-linear, and they interact with each other to influence alcohol consumption. We used dynamical systems modeling to better understand MOBC within a cohort of problem drinkers undergoing treatment. We fit a mathematical model to ecological momentary assessment data from individual patients who successfully reduced their drinking by the end of the treatment. The model solutions agreed with the trend of the data reasonably well, suggesting the cohort patients have similar MOBC. This work demonstrates using a personalized approach to psychological research, which complements standard statistical approaches that are often applied at the population level

A randomized controlled pilot trial of different mobile messaging interventions for problem drinking

IntroductionRecent evidence suggests that text messaging may help to reduce problem drinking as an extension to in-person services, but very little is known about the effectiveness of remote messaging on problem drinking as a stand-alone intervention, or how different types of messages may improve drinking outcomes in those seeking to moderate their alcohol consumption. Methods We conducted an exploratory, single-blind randomized controlled pilot study comparing four different types of alcohol reduction-themed text messages sent daily to weekly drink self-tracking texts in order to determine their impact on drinking outcomes over a 12-week period in 152 participants (≈ 30 per group) seeking to reduce their drinking on the internet. Messaging interventions included: weekly drink self-tracking mobile assessment texts (MA), loss-framed texts (LF), gain-framed texts (GF), static tailored texts (ST), and adaptive tailored texts (TA). Poisson and least squares regressions were used to compare differences between each active messaging group and the MA control. Results When adjusting for baseline drinking, participants in all messaging groups except GF significantly reduced the number of drinks consumed per week and the number of heavy drinking days compared to MA. Only the TA and GF groups were significantly different from MA in reducing the number of drinking days. While the TA group yielded the largest effect sizes on all outcome measures, there were no significant differences between active messaging groups on any outcome measure. 79.6% of individuals enrolled in the study wanted to continue receiving messages for an additional 12 weeks at the end of the study. Discussion Results of this pilot study indicate that remote automated text messages delivered daily can help adult problem drinkers reduce drinking frequency and quantity significantly more than once-a-week self-tracking messages only, and that tailored adaptive texts yield the largest effect sizes across outcomes compared to MA. Larger samples are needed to understand differences between messaging interventions and to target their mechanisms of efficacy

Two-sided bounds on minimum-error quantum measurement, on the reversibility of quantum dynamics, and on the maximum overlap problem using directional iterates

In a unified framework, we obtain two-sided estimates of the following quantities of interest in quantum information theory: 1.The minimum-error distinguishability of arbitrary ensembles of mixed quantum states. 2.The approximate reversibility of quantum dynamics in terms of entanglement fidelity. (This is also referred to as "channel-adapted quantum error recovery" when the reversed channel is the composition of an encoding operation and a noise channel.) 3.The maximum overlap between a bipartite pure quantum state and a bipartite mixed state that may be achieved by applying a local quantum operation to one part of the mixed state. 4. The conditional min-entropy of bipartite quantum states. A refined version of the author's techniques [J. Math. Phys. 50, 032016] for bounding the first quantity is employed to give two-sided estimates of the remaining three quantities. Our primary tool is "small angle" initialization of an abstract generalization of the iterative schemes for computing optimal measurements and quantum error recoveries introduced by Jezek-Rehacek-Fiurasek [Phys. Rev. A 65, 060301], Jezek-Fiurasek-Hradil [Phys. Rev. A 68, 012305], and Reimpell-Werner [Phys. Rev. Lett 94, 080501].Comment: Extensively revised & new content added. Improved min-entropy bounds. Notation made more accessible. Minimax theorem used to clarify relationship between "worst case" bounds and "single instance" bounds. Improved motivation of the choice of "small angle" guess. Eliminated spurious factor appearing when overlap bounds are applied to state distinction. Work connected to that of Beny and Oreshko