Situations involving negative affect account for nearly half of all relapses to alcohol use among men and women engaged in alcohol treatment. Despite the key role of negative affect, there are (a) no well-developed, empirically-tested, efficacious treatments that specifically attempt to reduce the impact of negative affect on relapse to alcohol use, and (b) few studies that have directly assessed whether interventions that target negative affect positively impact emotional states and/or drinking outcomes among alcohol dependent men and women. In the present study (submitted in response to the Request for Application [RFA-AA-07-005] Mechanisms of Behavior Change in the Treatment of Alcohol Use Disorders ), we propose to examine whether a reduction of negative emotional responses to drinking trigger situations, via prolonged imaginal exposure, will produce a concomitant reduction in alcohol craving produced by those same cues. Further, we will examine whether a reduction in negative emotional responses and negative affect-elicited alcohol craving is associated with positive treatment outcomes among alcohol dependent men and women. In the proposed study, alcohol dependent men and women will receive six sessions of prolonged imaginal exposure to negative affect drinking situations delivered concurrent with a standard 12-session Treatment as Usual (TAU) for alcohol dependence. The prolonged exposure intervention will incorporate two laboratory sessions (pre-and post-treatment) intended to assess change in cue-elicited negative emotions and alcohol craving. In addition, the study will assess if reductions in negative affect lead to improved alcohol treatment outcomes at 1 and 3-month follow up. Across many disorders, including substance use disorders, emotional experiencing and emotional processing have been identified as a common principle of therapeutic change. Success in demonstrating how treatments for alcohol dependence work can serve as a basis for maximizing treatment effects and ensure that critical features, such as prolonged direct experiencing of emotions, are generalized to clinical practice. Situations involving negative affect account for nearly half of all relapses to alcohol use among men and women engaged in alcohol treatment. Success in demonstrating that a reduction in emotional reactivity to negative affect drinking situations results in better alcohol treatment outcomes can serve as a basis for maximizing treatment effects and ensure that critical features, such as emotional experiencing, are generalized to clinical practice. ? ? ?
