Empirical evidence for the Social Stress Model of Substance Abuse

The Daily Spiritual Experience Scale: Empirical Relationships to Resiliency-Related Outcomes, Addictions, and Interventions

The Daily Spiritual Experience Scale (DSES) is a 16-item self-report measure designed to assess a set of experiences that may occur in the context of daily life for many different kinds of people. These include awe, a merciful attitude, giving other-centered love, deep inner peace, finding strength, guidance, or consolation from a transcendent source, among others. The DSES includes theistic and non-theistic language and alternatives, and has proven useful for those from many religions and for the unaffiliated. Since its original publication, it has been translated into over 40 languages, used in hundreds of published studies, and adopted for use in many practical settings. Empirically, the DSES predicts greater resilience, stress buffering, post-traumatic growth, and a sense of meaning in the face of illness, trauma, and daily stressors, as well as less substance abuse and burnout. Intervention studies using the DSES show that a variety of interventions can increase the frequency of these experiences. In this article, we will provide a brief overview of the scale and review its use in the empirical literature with respect to resilience and related outcomes. Findings suggest that the experiences measured by the DSES may serve as a resource for those experiencing distress of various kinds.

Happiness as a Buffer of the Association Between Dependence and Acute Tobacco Abstinence Effects in African American Smokers

Introduction

African American (AA) smokers are at disproportionate risk of tobacco dependence, utilizing smoking to regulate stress, and poor cessation outcomes. Positive emotional traits may function as coping factors that buffer the extent to which dependence increases vulnerability to adverse responses to acute tobacco abstinence (ie, tobacco withdrawal). This laboratory study examined subjective happiness (SH; dispositional orientation towards frequent and intense positive affect [PA] and life satisfaction) as a moderator of the relation between tobacco dependence and subjective and behavioral abstinence effects among AA smokers.

Methods

AA smokers (N = 420, 39.0% female) completed self-report measures of tobacco dependence and SH followed by two counterbalanced experimental sessions (nonabstinent vs. 16-hour abstinent) involving self-report measures of composite withdrawal, urge to smoke, and mood, and a behavioral smoking task in which participants could: (1) earn money to delay smoking reinstatement, and (2) subsequently purchase cigarettes to smoke.

Results

Tobacco dependence was positively associated with increased abstinence effects in composite withdrawal, urge to smoke, PA, and latency to smoking reinstatement (ps < .04). SH significantly moderated the relation between dependence and abstinence-induced increases in composite withdrawal (β = -.17, p < .001), such that the predictive power of dependence on withdrawal severity grew proportionately weaker as levels of SH increased.

Conclusions

SH may insulate against adverse effects of dependence on withdrawal during acute smoking abstinence, particularly withdrawal symptom clusters that are craving- and mood-based. Consideration of positive emotional traits as stress-coping factors in the dependence-withdrawal link may be warranted in research and practice with AA smokers.

Implications

The current study contributes to a growing body of literature examining the potentially advantageous role of positive emotional traits to smokers. We do so by identifying a relatively understudied psychological construct within tobacco research-subjective happiness-that may suppress the extent to which more severe tobacco dependence increases risk for subjective withdrawal-related distress during acute smoking abstinence in AA smokers. In doing so, the study provides a primer for future targeting of subjective happiness and other positive emotional traits as means to understand and treat acute tobacco abstinence effects among dependent AA smokers.

Concurrent use of alcohol with other drugs and DSM-5 alcohol use disorder comorbid with other drug use disorders: Sociodemographic characteristics, severity, and psychopathology

BACKGROUND

Little is known about the sociodemographic profiles, the intensity of drinking, the severity of alcohol use disorder (AUD), and psychopathology among individuals with specific patterns of concurrent alcohol and drug use and AUD and other drug use disorders (DUDs) comorbidity.

METHODS

Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III. We examined sociodemographic correlates and psychopathology among individuals with specific patterns of concurrent use of alcohol and drug and AUD-DUD comorbidity relative to alcohol use or AUD only, respectively, using multinomial logistic regression. We also examined whether concurrent alcohol and drug use and AUD-DUD comorbidity increased the intensity of drinking and severity of AUD, respectively.

RESULTS

The majority (62.0%) of past-year drinkers used only alcohol. The 12-month prevalence of AUD only was 53.5%. Individuals with concurrent use of alcohol and drugs and AUD-DUD comorbidity were more likely to be men, younger, never/previously married, with lower education and income (odds ratios (ORs) ≥ 1.2). Concurrent use of alcohol and drugs and AUD- DUD comorbidity groups were more likely to experience psychopathology than the alcohol use only and AUD only groups, respectively (ORs ≥ 1.3). The intensity of drinking was greater among the concurrent use groups relative to the alcohol use only group, while the severity of AUD was greater among AUD-DUD comorbidity groups relative to the AUD only group.

CONCLUSIONS

Research on consequences and treatment outcome of concurrent use of alcohol and drugs and AUD-DUD comorbidity is warranted to inform the development of more effective prevention/intervention programs.

Does Parental Monitoring Moderate the Impact of Community Violence Exposure on Probation Youth's Substance Use and Sexual Risk Behavior?

The present study examined whether parental monitoring buffers the negative effects of communtity violence exposure on probation youth's substance use and sexual risk behaviors. Among a sample of 347 Chicago youth on probation, ages 13-17 years, parental monitoring did not moderate the relationship between community violence exposure and probation youth's sexual risk and substance use. However, parental monitoring was independently associated with less engagement in sexual risk and substance use, and community violence exposure was independently associated with more risk behavior among probation youth. The present study contributes to the growing literature on the impact of community violence exposure and parenting on adjudicated youth risk.

Prevalence of Marijuana Use Disorders in the United States Between 2001-2002 and 2012-2013

IMPORTANCE

Laws and attitudes toward marijuana in the United States are becoming more permissive but little is known about whether the prevalence rates of marijuana use and marijuana use disorders have changed in the 21st century.

OBJECTIVE

To present nationally representative information on the past-year prevalence rates of marijuana use, marijuana use disorder, and marijuana use disorder among marijuana users in the US adult general population and whether this has changed between 2001-2002 and 2012-2013.

DESIGN, SETTING, AND PARTICIPANTS

Face-to-face interviews conducted in surveys of 2 nationally representative samples of US adults: the National Epidemiologic Survey on Alcohol and Related Conditions (data collected April 2001-April 2002; N = 43,093) and the National Epidemiologic Survey on Alcohol and Related Conditions-III (data collected April 2012-June 2013; N = 36,309). Data were analyzed March through May 2015.

MAIN OUTCOMES AND MEASURES

Past-year marijuana use and DSM-IV marijuana use disorder (abuse or dependence).

RESULTS

The past-year prevalence of marijuana use was 4.1% (SE, 0.15) in 2001-2002 and 9.5% (SE, 0.27) in 2012-2013, a significant increase (P < .05). Significant increases were also found across demographic subgroups (sex, age, race/ethnicity, education, marital status, income, urban/rural, and region). The past-year prevalence of DSM-IV marijuana use disorder was 1.5% (0.08) in 2001-2002 and 2.9% (SE, 0.13) in 2012-2013 (P < .05). With few exceptions, increases in the prevalence of marijuana use disorder between 2001-2002 and 2012-2013 were also statistically significant (P < .05) across demographic subgroups. However, the prevalence of marijuana use disorder among marijuana users decreased significantly from 2001-2002 (35.6%; SE, 1.37) to 2012-2013 (30.6%; SE, 1.04).

CONCLUSIONS AND RELEVANCE

The prevalence of marijuana use more than doubled between 2001-2002 and 2012-2013, and there was a large increase in marijuana use disorders during that time. While not all marijuana users experience problems, nearly 3 of 10 marijuana users manifested a marijuana use disorder in 2012-2013. Because the risk for marijuana use disorder did not increase among users, the increase in prevalence of marijuana use disorder is owing to an increase in prevalence of users in the US adult population. Given changing laws and attitudes toward marijuana, a balanced presentation of the likelihood of adverse consequences of marijuana use to policy makers, professionals, and the public is needed.

Neighborhood environment and urban African American marijuana use during high school

African American male high school students have the highest rates of marijuana use among all racial, ethnic, and gender groups, yet there is limited research examining contextual factors salient to the African American community. The purpose of this study was to examine how neighborhood environment measured in 8th grade is related to longitudinal transitions in marijuana use during high school (9th to 12th grades) in a sample of urban African Americans. Four hundred and fifty-two African American children were interviewed annually beginning in 1st grade as part of a longitudinal field study in Baltimore city. Latent transition analysis indicated early in high school posed the greatest risk for initiation and progression of marijuana use. Community violence exposure was associated with an increased likelihood of transitioning from no marijuana use to infrequent use (adjusted odds ratios (AOR) = 2.40, p < 0.001). Higher perceived neighborhood disorder (AOR = 3.20, p = 0.004), drug activity and sales in the neighborhood (AOR = 2.28, p = 0.028), and community violence exposure (AOR = 4.54, p < 0.001) were associated with an increased risk of transitioning from no use to frequent/problematic marijuana use. There was evidence for partial mediation of these associations by perceptions of harm and depressed mood. Drug activity and sales was associated with progression from infrequent to frequent and problematic use (AOR = 2.87, p = 0.029). African American youth living in urban environments with exposure to drug activity, violence, and neighborhood disorder are at increased risk for both initiation and progression to more frequent and problematic marijuana use during high school. These findings highlight the need to develop interventions for African American youth that are mindful of the impact of the additional stressors of living in a high-risk urban environment during a critical developmental transition period. Reducing exposure to drug activity and violence in high-risk urban neighborhoods may be the first step to potentially halt increasing rates of marijuana use among African Americans.

Contextual stress and health risk behaviors among African American adolescents

This study examined the longitudinal association between contextual stress and health risk behaviors and the role of protective factors in a community epidemiologically-defined sample of urban African American adolescents (N = 500; 46.4% female). Structural equation modeling was used to create a latent variable measuring contextual stress (community violence, neighborhood disorder, and experiences with racial discrimination). Contextual stress in 8th grade was associated with aggressive behavior and substance use 2 years later for boys. For girls, contextual stress predicted later substance use, but not aggressive behavior. High academic competence and self-worth reduced the impact of contextual stress on substance use for boys. Implications for intervention and directions for future research on health risk behaviors among African American adolescents are discussed.

Contextual stress and health risk behaviors among African American adolescents

This study examined the longitudinal association between contextual stress and health risk behaviors and the role of protective factors in a community epidemiologically-defined sample of urban African American adolescents (N = 500; 46.4% female). Structural equation modeling was used to create a latent variable measuring contextual stress (community violence, neighborhood disorder, and experiences with racial discrimination). Contextual stress in 8th grade was associated with aggressive behavior and substance use 2 years later for boys. For girls, contextual stress predicted later substance use, but not aggressive behavior. High academic competence and self-worth reduced the impact of contextual stress on substance use for boys. Implications for intervention and directions for future research on health risk behaviors among African American adolescents are discussed.

Risking risk: the influence of types of capital and social networks on the injection practices of drug users

Although syringe exchange and other harm reduction interventions have generally been effective in reducing bloodborne pathogen incidence among injection drug users (IDUs), in some cases a minority of IDUs continues to engage in risky injection behavior. Building on emerging perspectives in social epidemiology and research on drug use in anthropology that point to the importance of examining fundamental social causes of risk behavior, or what puts individuals at risk for risk, this study used a multilevel perspective to explore whether forms of capital, social network characteristics, and other contextual factors influence continued risky injection behavior. Quantitative and qualitative data were collected on IDUs in the city of Marseilles, France, where sterile injection equipment has been legal and officially promoted since 1995. In multivariate analysis on data concerning active users, location in the densest part of a large, interconnected network of IDUs greatly increased the likelihood of risky injection practices, while there was a non-significant tendency for low Acquired Cultural and Economic Capital to predict this behavior. Among the strongest individual-level characteristics to predict this outcome were illicit use of prescribed medication, generally high dose buprenorphine, and unprotected sex. Parental abuse of psychoactive drugs during the subject's childhood, on the other hand, greatly decreased the chances of engaging in risky injection behavior. Additionally, qualitative data analysis suggests that risky injection may be linked to lack of resources to procure drugs, and not simply to inadequate sterile injection equipment. Further research, including ecological models, is needed to better understand how fundamental social conditions are related to "risk for risk". However, public health interventions can already address the need for community-level interventions, while rethinking the consequences of inaccessible drugs and unintended "leakage" from the introduction of buprenorphine and other medicalized treatments for opiate dependency.

The effects of endomorphin-1 on conditioned defeat in Syrian hamsters (Mesocricetus auratus)

The present study examined the effect of endomorphin-1 (EM1), an endogenous opioid with a high affinity for the mu opiate receptor, on conditioned defeat. Conditioned defeat is a phenomenon in which hamsters that have been defeated subsequently fail to exhibit normal territorial aggression and instead display submissive/defensive behaviors even when paired with a non-aggressive intruder. In experiment 1, animals were placed in the home cage of a larger resident for 15 min and were defeated. After 24 h, animals received a 3-microl injection of EM1 (0.0, 0.3, 3.0, or 10 nmol) into the left lateral cerebral ventricle 5 min before a smaller non-aggressive intruder was placed in the home cage of the experimental animal. In experiment 2, animals were infused with EM1 immediately after the initial defeat and were paired with a non-aggressive intruder 24 h later as in experiment 1. EM1 reduced the duration of submissive/defensive behavior in experiment 1 (P<0.05) but not in experiment 2 (P>0.05). These data support the hypothesis that the highly selective mu receptor agonist endomorphin-1 modulates the expression of conditioned defeat, but provides no support for the hypothesis that endomorphin-1 modulates the consolidation of conditioned defeat.

Substance Use and Self-Reported Mental Health: The Moderating Effect of Acquaintance Use Behavior among Adults

A considerable body of literature has documented the positive effects that social relationships have for mental health. Similarly, a number of studies have demonstrated the importance of peer and acquaintance networks in attempts to understand substance use. The present study brings together these disparate fields and examines the relationship between individual alcohol and marijuana use and self-reported mental health, and, in particular, whether acquaintance substance use behavior may, under certain conditions, moderate this association by providing a normative context of acceptance. Based on an analysis of a community-based sample of 23,932 adults from 41 mid-sized cities nationwide, the findings indicate that in addition to the detrimental relationship between individual's substance use and mental health, substance use on the part of acquaintances increases the odds of reporting poor mental health, irrespective of the respondent's own use or non-use. However, the relative effect of acquaintance substance use behavior is smaller for those individuals who use than for those who do not: among users of alcohol and marijuana, having acquaintances who also use is associated with a lesser increase in odds as compared to those who do not use but whose acquaintances do. These results suggest that the degree of normative congruity between individual behavior, the “local” context formed by peers and associates, and the broader societal context is a variable factor which is implicated in the relation between substance use and mental health.

Women's perception of provider, social, and program support in an outpatient drug treatment program

The purpose of this study was to explore perceptions of pregnant and parenting substance-abusing women in an outpatient drug treatment program regarding provider and social support. Also identified were aspects of the rehabilitation program perceived by the women as assisting them to maintain abstinence from substance use. Data were collected through a demographic questionnaire and a tool designed by the authors based on the Social Stress Model of Substance Abuse (Lindenberg et al., 1993) and the literature of social support. The majority of the women were satisfied with their social support from family and friends. Sixty-seven percent of the women felt the support received from medical providers were not adequate. Also, the majority of the women received no information on risks of drug use and pregnancy from their medical providers. The women felt the program helped maintain abstinence by providing education, coping mechanisms, resources, 12-step programs, and spiritual guidance.

A study of barriers to the engagement of significant others in adult addiction treatment

Using the focus group methodology, this study identified personal and structural barriers to the engagement of significant others in an outpatient addictions treatment program. Twenty-eight significant others (family members, other kin, and friends) associated with 21 patients participated in one of three focus group sessions. The cut-and-paste technique was used to analyze the narrative data. Improving communication and reconnecting patients with a supportive community were forms of support identified. Patients' willingness to accept support and therapists' invitation to involve significant others in the treatment were identified as necessary precursors to their initial involvement. Providing educational and therapeutic support to significant others were endorsed as important elements in maintaining their involvement. Offering a diversity of therapeutic services beyond standard office hours, providing home visits and child care were viewed as facilitators for their involvement. It became apparent that support providers tended to resent having their own needs ignored. Feelings of isolation, fatalism, loneliness, ignorance, and fear were expressed by significant others. Theoretical and practical implications of the findings are discussed.

A description of precipitants of drug use among dually diagnosed patients with chronic mental illness

In this report, we describe patients' perceptions of the chronological occurrence of their mental illness and substance abuse. The patients were enrolled in a community mental health center and received dual diagnosis treatment from an affiliated psychiatric rehabilitation program. Using a questionnaire designed to address this issue, we assessed patients' perceptions of support currently being received at the treatment program and how beneficial they perceived this support to be. In addition, we assessed why substance use was a coping strategy in times of perceived stress early in life and whether this behavior has changed to date. Assessing the perception of the sequence of co-occurring disorders among patients enables us to better understand the factors that precipitate substance use and exacerbate mental illness. This knowledge may aid in the design of effective treatment strategies for this population of patients.

Effectiveness of Intervention Into SUBSTANCE ABUSE DISORDERS in Women With Comorbid Depression

Victimization was supported by the occurrence of various forms of abuse--sexual, physical, and emotional--and the difficulty in establishing healthy intimate relationships. Because relapse is common, nurses must be alert for faulty negative thinking, behaviors, and feelings that might lead to relapse.

Correlates of alcohol and drug use among low-income Hispanic immigrant childbearing women living in the USA

Alcohol and drug use is a widespread and serious problem with deleterious consequences for the health and well-being of childbearing-age women and their children. Little information exists regarding etiological factors for substance use among Hispanic childbearing-age women immigrating to the United States (USA). This research provides a correlational analysis of factors associated with alcohol and drug use. The Social Stress Model for Substance Use Prevention provided the conceptual framework for this cross-sectional, interview-administered survey of 60 low-income predominantly Mexican-American women. The outcome variable was alcohol and drug use (alcohol, cigarettes, marijuana, cocaine and opiates). Independent variables included the major constructs of the model: stress, social support, social influences, personal competencies and community resource utilization patterns. Findings suggested that the levels of drug use were lower among this study sample than in the general USA population regardless of pregnancy status. Bivariate correlations demonstrate that women with higher drug use indices had more lenient attitudes regarding drug use and were more likely to have family and friends that used alcohol and drugs. Although drug use was relatively low among this sample of women, both women who used alcohol themselves and women whose partners used alcohol and drugs reported significantly higher levels of stress, weaker social support and poorer levels of self esteem. Implications for practice and future research are suggested.

"I'Ve had too much done to my heart": the dilemma of addiction and recovery as seen through seven youngsters' lives

Aware of the dearth of in-depth studies on recovering adolescent addict/alcoholics, we conducted a year-long qualitative study of seven formerly-addicted youth committed to recovery. The research question was: how do addicted youth become and remain sober? Bending to social stress, including racism and ethnic prejudice, three participants relapsed. However, personal commitment augmented by familial, community, spiritual, and educational support encouraged four to remain sober. Learning from both those who failed and succeeded, the theoretical concepts of surrender, social stress, and resiliency helped to interpret the participants' patterns of response and better understand adolescent recovery.

Competence and drug use: theoretical frameworks, empirical evidence and measurement

Statistics show that use of harmful substances (alcohol, cigarettes, marijuana, cocaine) among women of childbearing age is widespread and serious. Numerous theoretical models and empirical studies have attempted to explain the complex factors that lead individuals to use drugs. The Social Stress Model of Substance Abuse [1] is one model developed to explain parameters that influence drug use. According to the model, the likelihood of an individual engaging in drug use is seen as a function of the stress level and the extent to which it is offset by stress modifiers such as social networks, social competencies, and resources. The variables of the denominator are viewed as interacting with each other to buffer the impact of stress [1]. This article focuses on one of the constructs in this model: that of competence. It presents a summary of theoretical and conceptual formulations for the construct of competence, a review of empirical evidence for the association of competence with drug use, and describes the preliminary development of a multi-scale instrument designed to assess drug protective competence among low-income Hispanic childbearing women. Based upon theoretical and empirical studies, eight domains of drug protective competence were identified and conceptually defined. Using subscales from existing instruments with psychometric evidence for their validity and reliability, a multi-scale instrument was developed to assess drug protective competence. Hypothesis testing was used to assess construct validity. Four drug protective competence domains (social influence, sociability, self-worth, and control/responsibility) were found to be statistically associated with drug use behaviors. Although not statistically significant, expected trends were observed between drug use and the other four domains of drug protective competence (intimacy, nurturance, goal directedness, and spiritual directedness). Study limitations and suggestions for further psychometric testing of the instrument are described.

Emerging themes in preclinical research on alcohol and aggression

Animal research into the alcohol-aggression relationship is based on a need to understand this relationship in people, and its success depends on the degree to which animal models can provide appropriate parallels to relevant human phenomena. Comparisons of human and animal literature suggest that parallels may be found for the following: alcohol enhances aggression in some, but not all individuals; consumption increases the probability of victimization (being attacked by a conspecific); alcohol reduces anxiety, and socially stressed individuals show increased voluntary consumption; alcohol reduces avoidance of threatening situations or stimuli and may place individuals at greater risk of being attacked; both anxiety reduction and decreased avoidance of threat may increase the probability of involvement in violent situations. These findings suggest that a variety of mechanisms may be involved in alcohol enhancement of aggression. Differences in effects of alcohol on human, as opposed to animal, aggression may reflect specific human capabilities. Although high doses of alcohol consistently reduce aggression in laboratory animals, this may reflect motoric and sedative effects that are not relevant for human behavior, in which verbal aggression and aggression involving the use of weapons make motor capability less important. Human voluntary alcohol consumption may also reflect response to stressors that also simultaneously promote aggression, a situation not paralleled by animal studies in which the drug is administered rather than voluntarily consumed. Nonetheless, obtained parallels suggest that animal experimentation using ecologically relevant situations can provide highly generalizable analyses of the alcohol-aggression relationship.

A Model of Contributing Risk Factors to Chemical Dependency in Nurses

1. The risk of chemical dependency in women includes a chaotic family of origin, victimization, and low self-esteem. 2. Women with substance abuse disorders often suffer from a co-morbid depression, which is a threat to relapse. 3. Nursing and nursing education must develop strategies to minimize the risks associated with substance abuse disorders.