| Study summary: |
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Alcohol dependence (AD) afflicts nearly 14% of the population (Kessler et al., 1994; Kessler
et al., 1997; Regier et al., 1990), and has a chronic and relapsing course (Brownell,
Marlatt, Litchenstein, & Wilson, 1986). Negative emotional states have consistently been
found to maintain alcohol use disorders (AUDs; Cooney, Litt, Morse, Bauer, & Gaupp, 1997;
Litt, Cooney, Kadden, & Gaupp, 1990; Rubonis et al., 1994) and increase the risk of relapse
following AUD treatment (Cooney et al., 1997). This relationship is particularly robust
among individuals with co-morbid psychiatric disorders, such as posttraumatic stress
disorder (PTSD; Coffey et al., 2002; Sharkansy, Brief, Peirce, Meehan, & Mannix, 1999; Tate,
Brown, Unrod, & Ramo, 2004; Waldrop, Back, Verduin, & Brady, in press). Likewise, alcohol
use may be maintained by a desire to facilitate or prolong positive emotional states
(Cooper, Frone, Russell, & Mudar, 1992; Simpson, 2003).
Many psychological interventions for AUDs, most notably the majority of cognitive-behavioral
treatment (CBT) packages, have thus focused on the development of coping skills to prevent
relapse in response to such triggers, and have been demonstrated to be at least moderately
effective in promoting abstinence (Miller & Wilbourne, 2002). However, attempts to specify
the active ingredients of CBT for AD have been disappointing and most studies examining
potential mechanisms of change have failed to find the expected relationships (Longabaugh et
al., 2005; Morgenstern & Longabaugh, 2000). The lack of empirical evidence substantiating
coping skills as a mechanism of change for CBT (Morgenstern & Longabaugh, 2000) may be due,
in part, to the lack of specificity in coping skill interventions. Broadly speaking, two
primary foci of coping skill interventions for AUD are 1) increasing cognitive techniques
focused on challenging and changing thought patterns, or 2) increasing experiential
acceptance by fostering an accepting stance towards internal states, such as through "urge
surfing" (Kadden et al., 1992). These two coping skill approaches (cognitive restructuring
and experiential acceptance) likely lead to reduced alcohol use through different pathways.
Theoretically, experiential acceptance approaches suggest that the mechanism of change in
decreasing alcohol use is increased willingness toward internal experience (e.g., emotions,
thoughts, sensations), whereas cognitive restructuring approaches suggest that decreased
alcohol use results from decreases in negative appraisals brought about by challenging and
changing thought patterns. However, this has yet to be systematically evaluated. |