Abstract Having covered the two earliest forms in the last chapter, we now ascend the phylogenetic scale and tum to higher forms of learning. The relationship between the various forms of learning is complex and inadequately understood. What we can be certain of is that there is no contradiction in using both conditioning and higher forms of learning to explain alcohol problems; indeed, we need both to come anywhere near a proper understanding.
The idea that addiction is a disease of the brain first came to prominence in the 1990s, a time characterized appropriately enough by the US President George H. W. Bush as 'the decade of the brain'. Since then, attempts to promote and popularize this idea must be reckoned a great success, particularly in the USA but to varying extents in other countries of the world as well. Certainly, in terms of endorsement by expert institutions in the USA, the idea has been formally recognized by the US National Institute on Drug Abuse (NIDA) and supported by other medical and professional bodies, such as the American Society on Addiction Medicine and the American Psychiatric Association. It is NIDA that has been the main mover and shaker of what has become known as the brain disease model of addiction (BDMA), formally defining addiction as "a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain" (National Institute on Drug Abuse, 2019).
A sample of 34 incarcerated male delinquents aged 16-17 and a matched group of controls were compared on self-report measures of delinquency, on Rest's (1975) Defining Issues Test (DIT) of moral reasoning, and on measures of logical operational ability. The mean levels of self-reported delinquency of the incarcerated group were substantially higher than those of the controls. There was no significant difference between the groups in logical operational ability but the mean P score (index of mature moral reasoning) was significantly higher in the control group. However, no relationship was found between moral reasoning and levels of self-reported delinquency. It was concluded that degree and seriousness of involvement of delinquency is unrelated to immaturity of moral reasoning and that the utility of the cognitive developmental approach to moral socialization may therefore be more restricted than has previously been claimed.
Little research has been done on the role of the therapeutic working alliance in treatment for alcohol problems. This longitudinal study's objectives were (a) to identify predictors of working alliance and (b) to investigate whether client and/or therapist reports of the working alliance predicted posttreatment motivation and then later treatment outcome. Client and therapist perceptions of the working alliance were assessed after the first treatment session using a short form of the Working Alliance Inventory (WAI) among 173 clients taking part in the United Kingdom Alcohol Treatment Trial (UKATT) and randomized to motivational enhancement therapy (MET) or social behavior and network therapy (SBNT) with complete data on all measures of interest. Structural equation models were fitted to identify predictors of WAI scores and investigate the relationships between WAI and measures of drinking during treatment, posttreatment motivation, and successful treatment outcome (abstinent or nonproblem drinker), and measures of drinks per drinking day and nondrinking days, assessed 9 months after the conclusion of treatment. Motivation to change drinking when treatment began was a strong predictor of client-adjusted coefficient = 2.21 (95% confidence interval [CI] [0.36, 4.06]-but not therapist WAI. Client WAI predicted successful treatment outcome-adjusted odds ratios (OR) = 1.09 (95% CI [1.02, 1.17])-and had effects on drinking during treatment, and on posttreatment motivation to change. There was evidence for effect modification by treatment, with strong associations between WAI and posttreatment motivation, and evidence of WAI prediction of treatment outcomes in the MET group, but no evidence of associations for SBNT. Therapist WAI was not strongly associated with treatment outcome (adjusted OR = 1.05; 95% CI [0.99, 1.10]). The working alliance is important to treatment outcomes for alcohol problems, with client evaluation of the alliance strongly related to motivation to change drinking throughout treatment for MET. It was also much more important than therapist-rated alliance in this study. (PsycINFO Database Record
The initiation and maintenance of substantial behaviour change is required to reduce the spread of HIV infection among the intravenous drug-using population. In order to ascertain the efficacy of interventions aimed at reducing HIV-related risk-taking behaviour among this population, valid and reliable (yet preferably short) instruments for measuring such behaviour are required. The HIV risk-taking behaviour scale (HRBS) is a brief 11-item interviewer-administered scale which examines the behaviour of intravenous drug users in relation to both injecting and sexual behaviour. This paper describes the construction of the scale, in addition to data evaluating its reliability and validity. Initial analyses indicate that the scale has satisfactory psychometric properties.
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