A randomized trial of two behavioral interventions to improve outcomes following inpatient detoxification for alcohol dependence

Participants (n=150), undergoing inpatient alcohol detoxification, were randomized into 3 groups: treatment as usual (TAU), motivation enhancement therapy (MET), or peer-delivered 12-step facilitation (P-TSF). The main outcome was the initiation of any type of subsequent rehabilitation service (i.e., professional treatment or self-help) within 30 and 90 days of discharge. At the 30-day follow-up interview, there was no significant difference among the groups in the rate of initiation of any type of subsequent care (82%, 74%, and 82%, respectively, p=0.617); however, the MET group had significantly more patients initiate subsequent inpatient treatment by the 90-day follow-up interview compared to the P-TSF group (31% and 61%, respectively, p=0.007) and a greater proportion of MET participants completed subsequent inpatient treatment compared to both the TAU and P-TSF groups. There were no differences in drinking-related outcomes. MET during inpatient detoxification may help patients initiate subsequent inpatient rehabilitation treatment.

Intimate partner violence and specific substance use disorders: findings from the National Epidemiologic Survey on Alcohol and Related Conditions

The association between substance use and intimate partner violence (IPV) is robust. It is less clear how the use of specific substances relates to relationship violence. This study examined IPV perpetration and victimization related to the following specific substance use disorders: alcohol, cannabis, cocaine, and opioid. The poly substance use of alcohol and cocaine, as well as alcohol and marijuana, were also examined. Data were analyzed from wave two of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005). Associations between substance use disorders and IPV were tested using logistic regression models while controlling for important covariates and accounting for the complex survey design. Alcohol use disorders and cocaine use disorders were most strongly associated with IPV perpetration, while cannabis use disorders and opioid use disorders were most strongly associated with IPV victimization. A diagnosis of both an alcohol use disorder and cannabis use disorder decreased the likelihood of IPV perpetration compared to each individual substance use disorder. A diagnosis of both an alcohol use disorder and cocaine use disorder increased likelihood of reporting IPV perpetration compared with alcohol use disorders alone but decreased likelihood of perpetration compared with a cocaine use disorder diagnosis alone. Overall, substance use disorders were consistently related to intimate partner violence after controlling for important covariates. These results provide further evidence for the important link between substance use disorders and IPV and add to our knowledge of which specific substances may be related to relationship violence.

Sources and frequency of secondhand smoke exposure during pregnancy

INTRODUCTION

This study examined sources of exposure to secondhand smoke (SHS) during pregnancy and misclassification of women as having no SHS exposure if partner smoking was used as the only measure of SHS exposure. We also examined changes in SHS exposure across the three trimesters of pregnancy.

METHODS

The sample consisted of 245 pregnant women who were in a serious relationship with a partner and 106 for examination of change over time. Women's smoking status was determined by a combination of self-reports and oral fluid assays. Women's reports of partner smoking, smoking by other social network members, and frequency of exposure to SHS were obtained.

RESULTS

The most common source of SHS exposure during pregnancy was the partner (n = 245). However, reliance on the partner smoking measure alone would have misclassified a substantial number of women as having no SHS exposure during pregnancy. The importance of exposure from the general social network was also evident in the finding that among nonsmoking women with nonsmoking partners, 50% reported some level of SHS exposure in the preceding week. Contrary to expectations, there were no changes in SHS exposure across the three trimesters of pregnancy (n = 106).

CONCLUSIONS

Results highlight the need for treatment plans to target sources of exposure from other members of women's social networks in addition to partners. It may be unrealistic to expect women's cessation efforts to be successful in the face of consistent and continued SHS exposure through pregnancy.

Using touch-screen technology to assess smoking in a low-income primary care clinic: a pilot study

This pilot study examined the use of a touch-screen tablet personal computer to assess smoking and alcohol use among low-income primary care patients (N = 100) and tested cross-method consistency with a paper assessment. Data were collected in 2009. A touch-screen survey assessed smoking, alcohol use, partner smoking, and acceptability. A separate paper survey assessed smoking, partner smoking, and acceptability. The touch-screen assessment was highly acceptable and reliable. Implications and limitations are noted. Future research should explore the use of touch-screen technology for clinical endeavors requiring a quick assessment of substance use. There was no outside funding for this study.

Readiness to change and training expectations prior to a training workshop for substance abuse clinicians

Understanding clinicians' readiness to change their clinical practice, as well as their training expectations prior to a clinical workshop, may be helpful for improving technology transfer in the substance user treatment field. This study aimed to explore both these areas prior to a workshop designed to offer a new clinical intervention for their practice. Fifty-four clinicians volunteered to participate in a Behavioral Couples Therapy (BCT) workshop. Using negative binomial regression models, significant associations were found between clinicians' readiness to change and training expectations. Participants were found to be highly motivated to learn new technologies and highly endorsed notions of adopting elements of BCT into their practice. There was greater caution with regard to committing to adopt the full protocol. Exploring some of the obstacles in adopting new treatment approaches by even the most motivated of clinicians could be a fruitful area for future research.

Individual, partner and relationship factors associated with non-medical use of prescription drugs

AIMS

The objective of the current report was to examine individual, partner and relationship factors (e.g. relationship satisfaction) associated with the non-medical use of prescription drugs (NMUPD) in a community sample of married adults.

DESIGN

The current report used two waves of data from an ongoing study of couples who were recruited at the time they applied for their marriage license and are now in the 10th year of follow-up. Logistic regression models examined the relation between individual, partner and relationship factors and NMUPD.

PARTICIPANTS

This report is based on 273 couples. Measurements Participants completed questionnaires that assessed prescription drug use, alcohol use, other substance use, depression, marital satisfaction and socio-demographic factors.

FINDINGS

Among wives, there was evidence that a partner's prescription drug use and relationship factors were associated with increased risk for NMUPD. There was some evidence suggesting that it was the increased access or availability, and not the partner's use per se, that was related to the NMUPD. These results persisted after controlling for other illicit drug use, heavy drinking, depressive symptomatology and socio-demographic factors. Among men, neither partner use nor relationship factors were associated with NMUPD after considering the impact of individual-level risk factors.

CONCLUSION

Prevention and intervention efforts directed at reducing the risk for NMUPD should consider the influence of partner and relationship factors in addition to individual-level risk factors.

A randomized trial: are care navigators effective in connecting patients to primary care after psychiatric crisis?

Persons with serious mental illnesses suffer excess medical morbidity compared to the general population. This RCT aimed to determine whether navigators are effective in helping patients connect to primary care after psychiatric crisis. Adults presenting for emergency care were randomly assigned to a navigator versus usual care. Navigators facilitated access to primary care. Outcomes were connection rates to medical care and the impact of health insurance, hospitalization and mental health care on primary care attendance. After 1 year, the intervention group was statistically more likely to access care, versus controls (62.4 vs. 37.6%, P < .001). Navigators were effective in helping patients connect to primary care after a psychiatric crisis. Improved access to primary care is important given the complex chronic health problems of this vulnerable cohort.

Analyzing family data: A GEE approach for substance use researchers

INTRODUCTION

Analyzing data that arises from correlated observations such as husband-wife pairs, siblings, or repeated assessments of the same individuals over time requires more specialized analytic tools. Additionally, outcomes that are not normally distributed such as count data, (e.g., number of symptoms or number of problems endorsed) also require specialized analytic tools. Generalized estimating equations (GEE) are a very flexible tool for dealing with correlated data (such as data derived from related individuals such as families). The objective of this report was to compare traditional ordinary least squares regression (OLS) to a GEE approach for analyzing family data.

METHODS

Using data from an ongoing five-wave longitudinal study of newlywed couples, we examined a subset of 173 families with children between the ages of 4 and 11 at two data collection points. The relation between parental risk factors (e.g., heavy drinking, aggression, marital quality) and child internalizing symptoms was examined within the context of two regression-based models: traditional OLS regression and a GEE approach.

RESULTS

Overall, the GEE approach allowed a more complete use of the available data, provided more robust findings, and produced more reliable parameter estimates.

CONCLUSION

GEE models are a flexible regression-based approach for dealing with related data that arises from correlated data such as family data. Further, given the availability of the models in common statistical programs, family researchers should consider these models for their work.

The longitudinal association between multiple substance use discrepancies and marital satisfaction

AIMS

The objective of this work was to examine the relation between patterns of substance use among newly married couples and marital satisfaction over time. In particular, this work examined if differences between husbands' and wives' heavy alcohol use and cigarette smoking, rather than simply use per se, predicted decreases in marital satisfaction over the first 7 years of marriage.

METHODS

Married couples (n = 634 couples) were assessed on a variety of substance use and relationship variables at the time of marriage and again at the first, second, fourth and seventh years of marriage.

RESULTS

After controlling for key socio-demographic variables, discrepancies in husband and wife cigarette smoking and heavy alcohol use were related to significant reductions in marital satisfaction. Importantly, couples who were discrepant on both substances experienced the greatest declines in marital satisfaction over time.

CONCLUSIONS

Patterns of substance use among newly married couples are important predictors of changes in marital functioning over time. It was not simply the heavy alcohol use or cigarette smoking that predicted dissatisfaction but, rather, differences between husbands' and wives' substance use that impacted the relationship.

The social network and alcohol use

OBJECTIVE

Previous research has found that a drinking-supportive social network has a strong influence on heavy drinking and alcohol-related problems over time. The objective of this work was to understand the individual difference and interpersonal factors that predict changes in the social network relevant to alcohol use.

METHOD

Data are from a large, ongoing prospective sample of 634 newly married couples in the United States. The current study examined the association between individual, relationship, and partner factors as they relate to changes in the number of drinking buddies in the social network during the first 7 years of marriage.

RESULTS

After controlling for the number of drinking buddies before marriage, as well as the frequency of heavy drinking, several individual, relationship, and partner factors were associated with changes in the social network over time. For both husbands and wives, alcohol expectancies and a partner's social network related to changes in the number of drinking buddies over time. Additionally, husbands with higher levels of extroversion and agreeableness had a greater number of drinking buddies over time. Among wives, personality factors were not related to changes in the number of drinking buddies over time.

CONCLUSIONS

This work extends previous research by examining factors that predict changes in the social network that are most influential in alcohol use. Identifying these factors is important for informing prevention and treatment efforts.

Longitudinal prediction of early childhood discipline styles among heavy drinking parents

This study sought to examine predictors of parenting trajectories in a sample of heavy drinking and abstaining/light drinking parents. Mixture modeling was used to estimate trajectories of parental discipline styles over time. Two dimensions of parenting were examined: laxness and overreactivity. Changes in these dimensions were examined for each parent. Trajectories for mothers and fathers were very similar and were generally stable from 18 months to 5-6 years child age. Fathers' binge drinking was associated with high levels of both paternal and maternal overreactivity. Mothers with depressed affect had the highest levels of overreactivity, whereas fathers reporting depressed affect were more likely to have moderate levels of laxness. Mothers with high levels of marital satisfaction were more likely to have partners in the stable low overreactivity group. Findings begin to elucidate the nature of early family processes that may contribute to maladaptive child outcomes in heavy drinking families.

Testing methodologies to recruit adult drug-using couples

Given the increased reliance on caller id, caller blocking, and answering machines, random digit dialing has become a less successful recruiting technique, especially among younger individuals. This pilot study tested the feasibility of using multi-step mailed survey methodology to obtain a random sample of adult, substance-using couples. Feasibility was assessed in terms of response rates and generalizability of the sample. A sample of 1000 names and addresses was purchased from a professional survey company. Half of the sample received a $1 incentive and the rest did not receive the incentive. There were no other differences between the other procedures used. The response rate for the incentive group was significantly higher compared to the non-incentive group (66% vs. 47%, p<.001). Past month marijuana use was 4.6% compared to estimates from the US National Survey on Drug Use and Health for this region of 5.0%. Similarly, rates of heavy drinking and attitudes about drug use were also similar to other estimates. There were no differences on substance use for the incentive group compared to the non-incentive group. This pilot study demonstrated the feasibility of using a multi-step mailed survey to recruit a representative sample of adult, substance-using couples.

Spousal and alcohol-related predictors of smoking cessation: a longitudinal study in a community sample of married couples

We investigated the longitudinal influence of spousal and individual heavy drinking and heavy smoking on smoking cessation among married couples. Couples' (N = 634) past-year smoking, alcohol problems, and heavy drinking were assessed. We used an event history analysis and found that spousal and one's own heavy smoking and one's own heavy drinking decreased the likelihood of smoking cessation. Heavy drinking and spousal behavior should be considered when developing public health interventions and policies for smoking cessation.

Longitudinal moderators of the relationship between excessive drinking and intimate partner violence in the early years of marriage

Alcohol problems are one of the most well-established risk factors for physical intimate partner violence. Nonetheless, most individuals who drink heavily do so without ever aggressing against a partner. Laboratory research identifies hostility as an important moderator of the association between alcohol and general aggression, and correlational research suggests that stress and coping may also be important moderators of the alcohol-aggression link. Building on this research, the authors examined hostility, coping, and daily hassles as moderators of the associations between excessive drinking and intimate partner violence across the first 4 years of marriage in a sample of 634 newly married couples. Excessive drinking was a significant cross-sectional correlate, but it did not emerge as a unique longitudinal predictor of intimate partner violence perpetration in this sample. However, alcohol was longitudinally predictive of husband violence among hostile men with high levels of avoidance coping. Findings generally supported the moderation model, particularly for men. These findings implicate hostility, coping, and daily hassles, as well as alcohol, as potentially important targets for partner violence prevention strategies for young married couples.

Husbands' SUD is associated with higher levels of co-occurring but not non-co-occurring psychiatric disorders among their wives

OBJECTIVE

Substance use among husbands has been shown to be associated with higher rates of substance use and of psychiatric symptoms among their wives. However, substance use disorders (SUD) and psychiatric disorders (as opposed to substance use or psychiatric symptoms) are rarely rigorously assessed among large samples of couples, so it is unclear whether SUD among husbands are associated with SUD among their wives, and whether the wives also display a higher prevalence of co-occurring or non-co-occurring psychiatric disorders. We compared the level of SUD, of co-occurring (with SUD) psychiatric disorders, and of non-co-occurring psychiatric diagnoses among the wives of males with SUDs vs among the wives of males without SUDs. We hypothesized that the presence of SUDs among males would be associated with a higher level of SUDs, of co-occurring psychiatric disorders, and of non-co-occurring psychiatric disorders in their wives.

METHOD

The subjects in this study were the spouses of adult men with a lifetime history of an SUD (SUD+ husbands, N=342) vs those with no lifetime history of an SUD (SUD- husbands, N=350). These subjects were recruited for participation in a longitudinal project designed to elucidate the etiology of substance use disorders.

RESULTS

Co-occurring SUDs were five times more common among the spouses of SUD+ husbands than among the spouses of SUD- husbands (10.2% vs 2.0%, chi-square=19.7, p=0.000). SUD/depressive disorder and SUD/anxiety disorder were both seven times more common among the spouses of SUD+ husbands than among the spouses of SUD- husbands (19.4% vs 4.7%, chi-square=45.8, p=0.000; 14.3% vs 2.0%, chi-square=34.5, p=0.000). In contrast, non-co-occurring depressive disorders and non-co-occurring anxiety disorders were not more common among the wives of the SUD+ husbands than among the SUD- husbands.

CONCLUSIONS

These findings demonstrate that SUD and co-occurring psychiatric disorders (with SUD) are more common among the spouses of SUD+ husbands than among the spouses of SUD- husbands, but non-co-occurring ("pure") psychiatric disorders are not more common among the spouses of the SUD+ husbands.

Predictors of heavy drinking and drinking problems over the first 4 years of marriage

This study investigated the factors predictive of heavy drinking and drinking problems over the early years of marriage, focusing on premarital drinking and the relatively stable individual risk and protective factors that were present prior to marriage and on social-interpersonal factors that may change or emerge over marriage. Newlywed couples were assessed at the time of marriage and at the 1st, 2nd, and 4th anniversaries with respect to frequency of heavy drinking and the extent of drinking problems and a variety of factors that have been found to be predictive of adult alcohol problems. The results indicated that antisocial characteristics, family history of alcoholism, negative affect, and alcohol expectancies were related to heavy drinking and alcohol problems at the time of marriage. Changes after marriage were predicted by the drinking of one's partner and of one's peers and by alcohol expectancies for social/physical pleasure for both men and women. In addition, the quality of the marriage was longitudinally protective from the experience of alcohol problems for both men and women, although it was not related to changes in heavy drinking.

Predictors of marijuana use among married couples: the influence of one's spouse

With the transition into marriage, marijuana and other substance use tends to decline; however, this is not true for all individuals. The objective of this work was to examine the impact of premarital individual and partner psychological health and substance use behaviors on the likelihood of using marijuana over the first four years of marriage. Couples' (N=634) marijuana use, other substance use, and psychological variables were assessed at the time they applied for their marriage license and then again at the first, second and fourth anniversaries. Generalized estimating equation models were used to estimate the risk for using marijuana over the first four years of marriage after controlling for the natural decrease in risk associated with time and other relevant sociodemographic variables. Smoking prior to marriage and heavy alcohol use was associated with an increased risk for using marijuana over the first four years of marriage for both husbands and wives. After considering the impact of time and individual risk factors, a spouse's use of marijuana prior to marriage was a strong predictor of increased risk for marijuana use during the first four years of marriage.

The drinking partnership and marital satisfaction: The longitudinal influence of discrepant drinking

The objective was to determine whether discrepancies between husbands' and wives' past-year heavy drinking predicted decreased marital satisfaction over time. Participants (N = 634) were recruited at the time they applied for their marriage licenses. Couples completed questionnaires about their alcohol use and marital satisfaction at the time of marriage and again at their 1st and 2nd anniversaries. Generalized estimating equation models were used to evaluate the association between discrepancies in husbands' and wives' heavy drinking in the year prior to marriage and marital satisfaction at the 1st wedding anniversary and the association between discrepancies in heavy alcohol use in the 1st year of marriage and marital satisfaction at the 2nd wedding anniversary. In these prospective time-lagged analyses, discrepancies in husbands' and wives' heavy drinking predicted decreased marital satisfaction over time while controlling for heavy drinking. Over time, these couples may be at greater risk for decreased marital functioning that may lead to relationship dissolution.

Alcohol use and partner expectations among newly married couples

The objective of this work was to determine if a spouse's expectations about a married person's drinking patterns affected his/her partner's alcohol use and alcohol use-related problems. Alcohol use and problems were assessed in a U.S. urban sample of 634 couples at the time they applied for their marriage license (1996-1999) and at their first and second anniversaries. Husbands' expectations about married women's alcohol use, as well as wives' expectations about married men's alcohol use, were assessed at each wave using a three-item scale. Linear regression models were used to identify the longitudinal association between a person's expectations of married individuals' drinking patterns and his/her spouse's alcohol use the following year. Evidence was found to support the relation between one spouse's expectations and his/her partner's alcohol use. However, wives' expectations appeared more influential compared to husbands and this influence is not present at the start of marriage, but rather develops slightly later. The study's limitations are noted.

Alcohol use, alcohol problems, and depressive symptomatology among newly married couples

BACKGROUND

Individuals married to heavy drinking spouses often have poorer health compared to those whose spouses are not heavy drinkers. This work examined how one spouse's alcohol involvement and alcohol-related problems affect his/her spouse's depressive symptomatology over time.

METHODS

Couples (N=634) were assessed for past year alcohol involvement and alcohol-related problems (marital and non-marital) and depressive symptomatology when they applied for a marriage license. They were reassessed at their first and second anniversaries. Multilevel models were used to analyze the association between one spouse's alcohol involvement and alcohol problems and his/her partner's depressive symptomatology over time.

RESULTS

Both husbands' and wives' marital alcohol problems were associated with wives' depressive symptoms. Neither spouses' alcohol consumption was associated with wives' depressive symptoms. Husbands' marriage-related alcohol problems and frequency of heavy drinking were related to husbands' depressive symptoms; however, wives' alcohol problems and alcohol use were unrelated to husbands' depression.

CONCLUSIONS

In a community sample of married couples, we found that husbands' and wives' marital alcohol problems affect wives' depressive symptoms, but only husbands' marital alcohol problems affect husbands' depressive symptoms. Future work should consider other subgroups of alcohol-related problems in one spouse and their relation to depression in his/her partner.

Predicting risky drinking outcomes longitudinally: what kind of advance notice can we get?

This paper summarizes the proceedings of a symposium presented at the 2005 Research Society on Alcoholism meeting in Santa Barbara, California, that spans the interval from toddlerhood to early middle adulthood and addresses questions about how far ahead developmentally we can anticipate alcohol problems and related substance use disorder and how such work informs our understanding of the causes and course of alcohol problems and alcohol use disorder. The context of these questions both historically and developmentally is set by Robert Zucker in an introductory section. Next, Maria Wong and colleagues describe the developmental trajectories of behavioral and affective control from preschool to early adolescence in a high risk for alcoholism longitudinal study and demonstrate their ability to predict alcohol and drug outcomes in adolescence. Duncan Clark and Jack Cornelius follow with a report on the predictive utility of parental disruptive behavior disorders in predicting onset of alcohol problems in their adolescent offspring in late adolescence. Next, Kenneth Leonard and Gregory Homish report on adult development study findings relating baseline individual, spouse, and peer network drinking indicators at marriage onset that distinguish different patterns of stability and change in alcohol problems over the first 2 years of marriage. In the final paper, John Schulenberg and colleagues, utilizing national panel data from the Monitoring the Future Study, which cover the 18- to 35-year age span, show how trajectories of alcohol use in early adulthood predict differential alcohol abuse and dependence outcomes at age 35. Finally, Robert Zucker examines the degree to which the core symposium questions are answered and comments on next step research and clinical practice changes that are called for by these findings.

Spousal influence on smoking behaviors in a US community sample of newly married couples

Among married couples, partners often have similar characteristics and behaviors. Among individuals who smoke cigarettes, it is not uncommon for them to have a partner who also smokes. In fact, having a partner who smokes can influence the spouse's initiation of smoking, or return to smoking after a previous quit attempt. Additionally, it is possible that a nonsmoking partner can influence his/her spouse to stop smoking. Participants for this research are from a community sample of couples in the United States. They were recruited at the time they applied for their marriage license and followed through to their second wedding anniversary. Logistic regression models, controlling for demographics, were utilized to determine if a partner's smoking status predicted smoking initiation or relapse over the early years of marriage. Overall, there was some support that a partner's smoking status did influence the other's smoking, although more support was found for spousal influence on relapse than cessation. There was more support for husband's influence compared to wife's influence, nonsmoking wives were more likely to resume smoking in the early years of their marriage if their partners were smokers. Wives' smoking, however, did not predict husband initiation of smoking. These findings suggest that during the transition into marriage, spouses do influence their partners' behaviors. In particular, women are more likely to resume smoking, or return to smoking if their partners smoke.

Antenatal Risk Factors Associated With Postpartum Comorbid Alcohol Use and Depressive Symptomatology

BACKGROUND

High rates of comorbid depression and alcohol use disorders have been reported in epidemiological studies; little work has considered comorbidity in women during the perinatal period. The goal of this work was to identify prenatal factors (at each trimester) that predicted postpartum comorbid depressive symptoms and alcohol use in women.

METHODS

The data are from an ongoing longitudinal study of pregnancy outcome that is now in its 16th year of follow-up. The first four assessments were used in this study (fourth and seventh prenatal months, delivery, and 8 months after delivery; n = 595). Prenatal variables in five domains (psychological, substance use, social, obstetrical, and demographic) were considered in analyses to predict postpartum comorbid depressive symptoms and alcohol use in women.

RESULTS

At each trimester, higher rates of depressive symptoms, binge drinking (four or more drinks per occasion), and tobacco use were significantly associated with comorbidity at the eighth postpartum month. Third-trimester anxiety was also significantly associated with postpartum comorbidity. Prenatal social support, obstetrical complications, and demographic factors were not related to an increased risk for postpartum comorbidity.

CONCLUSIONS

Women with more depressive symptoms, who binge-drink, or who smoke cigarettes at any time during their pregnancies are at risk for postpartum comorbidity. Women should be screened for depressive symptoms and substance use, and treatment should be initiated when women exhibit the risk factors described.