The alcohol expectancy construct: Overview and clinical applications

Recently there has been much research on cognitive factors in decisions to drink and responses to alcohol. Most of this research has concerned expectancies regarding alcohol effects, but much less attention has been paid to applying these data to clinical practice. In this paper, the potential clinical applications of current knowledge regarding expectancies, with emphases on assessment and intervention, are discussed. Problems of assessment are determining the nature and strength of alcohol expectancies, including their domains, situation specificity, and dose-related influences. Along these lines, representative scales are described. Three aspects of intervention, each pertaining to a phase of drinking behavior, are presented. The first area is initiation of drinking, when drinking decisions are presumed to be motivated by alcohol expectancies. Strategies for (a) attempting to change expectancies and (b) engaging in alternative behaviors to achieve desired, or expected, outcomes are described. The second area concerns the assessment and labeling of drinking effects, with a focus on tracking the relationship between alcohol use and expectancies over the course of a drinking event. The third area deals with subsequent drinking and clinically revolves around the application of altered expectancies to subsequent drinking in that episode or in future drinking situations. The relevance of alcohol expectancies to the maintenance of treatment gains and to the prevention of relapse also is discussed. Finally, throughout this paper there is an emphasis on identifying strategies for investigating clinically relevant questions about alcohol-related expectancies and drinking patterns.