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H Recent Advances in Behavioral Sciences and Treatment GENERAL ISSUES Demonstration of the effectiveness of psychosocial interventions in conjunction with methadone treatment for narcotic addiction and naltrexone treatment for alcoholism. Demonstration of efficacy of contingency voucher system as reinforcer for maintaining participation in drug treatment. Investigations of the substrates of cue-dependent craving and clinical approaches to minimize the likelihood of relapse. Identification of risk factors for using drugs (e.g., psychophathologies, personality disorders, difficulty in regulating emotions and behaviors). Identification of protective factors for prevention and treatment of drug abuse disorders (e.g., high school achievement, peer and family relations, participation in religious or social events, social networks, community reinforcement approaches). Identification of behavioral and social factors that serve as relapse determinants (e.g., psychological factors, drug availability and socializing with other abusers, emotional correlates and sequelae, craving, outcome expectancies). Evaluation of contingency management incentives that promote drug abstinence. Prevention strategies aimed at reducing the risk of needle sharing or unsafe sex to reduce risk of human immunodeficiency virus (HIV) transmission.
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Evaluation of joint pharmacological and behavioral strategies for cocaine and opioid dependence. Latent transition analysis (LTA) allows researchers to estimate and test models of stage-sequential development, such as the predictive effect of early caffeine use on subsequent drug use experience. Prevention strategies for adolescents and older youth have shown the value of delaying early initiation of drug use through school-based education and resistance-skills training and with increased availability of social networks, athletic programs, and neighborhood support activities for older children. NICOTINE Characterization of the reinforcing aspects of nicotine in humans with appreciation of both positive reinforcers (e.g., cognitive effects, mood enhancement, weight control) and negative reinforcers (avoidance of nicotine withdrawal). Establishment of environmental tobacco smoke as a health hazard, with implications for air quality control in the workplace and public places. Successful patient-treatment matching studies (e.g., higher-dose nicotine replacement therapy for heavier smokers, supportive treatments for dysphoric smokers). Demonstration of differential etiology of smoking for men and women and gender differences in smoking cessation. STIMULANTS Prenatal and other developmental exposure to cocaine may be influenced by both direct toxic effects and indirect effects of environment (e.g., parental functioning). Cocaine appears to increase the vulnerability of the exposed child to effects of a poor caretaking environment. ALCOHOL Long-term follow-up study of behavioral effects of alcohol on young men with alcoholic fathers versus nonalcoholic fathers confirmed that a low-intensity response to alcohol at age 20 is associated with 4-times greater likelihood of future alcoholism. Twin studies show that vulnerability to alcoholism is determined by a combination of genetic and environmental factors.
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Mild cognitive impairments resulting from chronic alcohol abuse can affect an individual's ability to learn abstinence. Lowering allowable blood alcohol concentrations for young drivers reduces fatal crashes and arrests for driving while intoxicated. Training of alcohol servers in restaurants and bars reduces alcohol-related problems. Use of patient-treatment matching (Project MATCH) to establish new standards for alcoholism treatment research.
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