Willpower versus "skillpower": Examining how self-efficacy works in treatment for marijuana dependence

FRAMES Elements Associated With Alcohol Treatment Research Assessments and Related Behavior Change

OBJECTIVE

Assessment reactivity research has contributed substantially to our understanding of alcohol treatment research protocols influencing clinical outcomes. The state of the science is such that relatively little is known about how alcohol treatment research participation influences behavior. The purpose of this study was twofold: (a) to determine the distribution of FRAMES elements (i.e., Feedback, personal Responsibility, Advice, a Menu of options, Empathic style of interaction, and support for Self-efficacy) contained in alcohol treatment research assessment interviews; and (b) to examine their association with subsequent alcohol use among a sample of clients presenting for alcohol use disorder treatment.

METHOD

Audiotaped recordings of participant (n = 189) research assessment interviews were converted to digital recordings and reviewed for FRAMES elements using the FRAMES Checklist Instrument.

RESULTS

Feedback, personal responsibility, empathic style of interaction, and support for self-efficacy were the more frequently occurring elements across follow-up periods. Alternatively, menu of options and advice occurred infrequently. Feedback and support for self-efficacy predicted subsequent alcohol use, although the association between feedback and alcohol use was unexpectedly positive.

CONCLUSIONS

As part of the assessment interview process, alcohol treatment research participants receive multiple instances of feedback and support for self-efficacy specific to their alcohol use that are predictive of changes in alcohol use.

Preliminary Effects of a Guided Self-Change Intervention on Perceived Risk and Self-Efficacy in University Students Engaging in Cannabis or Alcohol Misuse

Guided Self-Change (GSC) is a Motivational Interviewing (MI)-based early intervention program, infused with Cognitive Behavioral Therapy (CBT), for individuals with substance use problems. In this study, we implemented a 4-session GSC program with the innovative addition of mindfulness-based techniques at a minority-serving institution to reduce substance use and negative consequences among self-referred university students. We investigated processes that may be associated with behavior change, including perceived risk of use and self-efficacy ratings among university students who reported their primary substance of choice was cannabis (n = 18) or alcohol (n = 18). The sample of 36 participants (Mage = 24.4, SDage = 5, range 18-37) mostly identified as female (58.3%), then male (41.7%); 52.8% identified as Hispanic/Latine, 22.2% as Black or African American, and 19.5% as a sexual minority. Among cannabis primary using students, results indicated that the perceived risk of weekly cannabis use, confidence to change, and readiness to change showed statistically significant increases from pre- to post-assessment. Among alcohol primary using students, confidence to change and readiness to change showed statistically significant increases from pre- to post-assessments. All results yielded large effect sizes, which may be inflated due to the small sample size. Findings suggest that over the course of participation in a brief, 4-session targeted GSC program, there were significant increases in perceived risk and self-efficacy among minority university students who engage in primary cannabis or primary alcohol use.

What Client Demographic, Substance Use, Mental Health, Treatment, and Psychological Variables Predict Residential Treatment Completion for Substance Use Disorders?

Residential treatment is a common option for individuals with moderate to severe substance use disorders. In a cohort of individuals who accessed residential treatment, we investigated client demographic, substance use, mental health, treatment, and psychological predictors of treatment completion. Participants were a retrospective cohort of 1056 (15–69 years) individuals admitted to residential treatment facilities across Queensland, Australia, from January 2014 to December 2016. Participant characteristic information was obtained at admission, including the Depression Anxiety Stress Scale 21 (DASS-21). A multiple logistic regression model was conducted with treatment completion as the outcome. The overall rate of treatment completion was 14.3%. Mild to moderate (aOR = 0.48 [0.28–0.84], p = .010) and severe to extremely severe (aOR = 0.35 [0.17–0.74], p = .006) stress on the DASS-21 at service entry was significantly associated with a lower likelihood of treatment completion. Participants with higher levels of stress at service entry were less likely to complete treatment, representing a missed opportunity to provide targeted support during high-risk periods for individuals with substance use disorders. Further research investigating the nature and causes of stress in-between, during, and following presentations to residential treatment is needed.

The Associations Between Loneliness, Hopelessness, and Self-control and Internet Gaming Disorder Among University Students Who Were Men Who Have Sex With Men: Cross-sectional Mediation Study

BACKGROUND

The minority stress model postulates that men who have sex with men (MSM) often encounter multiple stressors because of their sexual minority status, which may lead to psychological problems and maladaptive coping such as addictive behaviors (eg, internet gaming disorder [IGD]). It was hypothesized that hopelessness and loneliness would be associated with IGD via self-control among MSM.

OBJECTIVE

This study investigated the prevalence of IGD and its associations with variables related to minority stress (loneliness and hopelessness) among MSM who were university students. Mediation involving such associations via self-control was also explored.

METHODS

With informed consent, 305 MSM attending universities in Sichuan, China participated in the study. The validated Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) checklist was used to assess IGD. Multivariable logistic regression adjusted for background factors and structural equation modeling were conducted.

RESULTS

The prevalence of IGD was 12.8% (n=39). Logistic regression found that IGD was positively associated with hopelessness and loneliness, and negatively associated with self-control. The structural equation modeling identified three significant paths between hopelessness/loneliness and IGD: (1) hopelessness → lower self-control → higher IGD (full mediation), (2) loneliness → lower self-control → higher IGD (partial mediation: effect size of 28%), and (3) a direct effect from loneliness to IGD.

CONCLUSIONS

IGD was prevalent among young MSM and warrants interventions that may try to reduce the level of psychosocial problems such as loneliness and hopelessness and improve self-control. According to the socioecological model, the promotion of social acceptance and reduction in stigma toward MSM are important in reducing loneliness and hopefulness among MSM. Self-control links up the relationships between psychosocial problems and IGD and should be given special attention. Longitudinal studies are warranted to confirm the findings and test new mediations between loneliness/hopelessness and MSM with IGD.

Maladaptive cognitions, loneliness, and social anxiety as potential moderators of the association between Internet gaming time and Internet gaming disorder among adolescent Internet gamers in China

The significance of Internet gaming time's dosage effect on Internet gaming disorder (IGD) may depend on gamers' characteristics. Majority of the gamers with extensive gaming time do not develop IGD. This study investigated moderation effects of cognitive/psychosocial factors on the association between Internet gaming time and probable IGD among adolescent Internet gamers in China. The cross-sectional, self-administered, and anonymous survey was conducted from October to December of 2018 among seven conveniently selected secondary school students in Chengdu and Guangzhou, China. Probable IGD was measured by using the DSM-5 checklist. The cognitive/psychosocial moderators were assessed by using validated instruments. Of the 2,503 students who had played Internet games (past 12 months), the prevalence of probable IGD was 17.7%. Internet gaming time [adjusted odds ratio (ORa) = 1.06], the three maladaptive cognitions specific to Internet gaming (perceived overvaluation of rewards, perceived urges, and perceived unwillingness to stop playing) (ORa = 1.17 to 1.44), and the two types of psychosocial factors (loneliness and social anxiety) (ORa = 1.09 to 1.13) were independent risk factors of probable IGD. Moderation analyses showed that overall maladaptive cognitions, perceived urges, and loneliness (but not the other two types of cognitions and social anxiety) were significant moderators of the association between Internet gaming time and probable IGD. The dose-effect relationship of Internet gaming time on probable IGD was significantly and slightly stronger among those with higher levels of perceived urges and loneliness. Interventions to reduce the levels of such moderators may reduce probable IGD directly and buffer the dosage effect among adolescents.

Impulsivity, Self-control, Interpersonal Influences, and Maladaptive Cognitions as Factors of Internet Gaming Disorder Among Adolescents in China: Cross-sectional Mediation Study

Background

Gaming disorder, including internet gaming disorder (IGD), was recently defined by the World Health Organization as a mental disease in the 11th Revision of the International Classification of Diseases (ICD-11). Thus, reducing IGD is warranted. Maladaptive cognitions related to internet gaming (MCIG) have been associated with IGD, while impulsivity, self-control, parental influences, and peer influences are key risk factors of IGD. Previous literature suggests that MCIG is associated with the aforementioned 4 risk factors and IGD, and may thus mediate between these risk factors and IGD. These potential mediations, if significant, imply that modification of MCIG may possibly alleviate these risk factors’ harmful impacts on increasing IGD. These mediation hypotheses were tested in this study for the first time.

Objective

This study tested the mediation effects of MCIG between intrapersonal factors (impulsivity and self-control) and IGD, and between interpersonal factors (parental influences and peer influences) and IGD among adolescents in China.

Methods

An anonymous, cross-sectional, and self-administered survey was conducted among secondary school students in classroom settings in Guangzhou and Chengdu, China. All grade 7 to 9 students (7 to 9 years of formal education) of 7 secondary schools were invited to join the study, and 3087 completed the survey. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) checklist was used to assess IGD. MCIG was assessed by using the Chinese version of the Revised Internet Gaming Cognition Scale. Impulsivity, self-control, and parental or peer influences were measured by using the motor subscale of the Barratt Impulsiveness Scale, the Brief Self-Control Scale, and the modified interpersonal influence scale, respectively. Structural equation modeling was conducted to examine the mediation effects of MCIG between these risk factors and IGD.

Results

The prevalence of IGD was 13.57% (418/3081) and 17.67% (366/2071) among all participants and adolescent internet gamers, respectively. The 3 types of MCIG (perceived rewards of internet gaming, perceived urges for playing internet games, and perceived unwillingness to stop playing without completion of gaming tasks) were positively associated with IGD. Impulsivity, self-control, parental influences, and peer influences were all significantly associated with the 3 types of MCIG and IGD. The 3 types of MCIG partially mediated the associations between the studied factors and IGD (effect size of 30.0% to 37.8%).

Conclusions

Impulsivity, self-control, and interpersonal influences had both direct and indirect effects via MCIG on IGD. Modifications of the 3 types of MCIG can potentially reduce the harmful impacts of impulsivity and interpersonal influences on IGD and enhance the protective effect of self-control against IGD. Future longitudinal studies are warranted.

Momentary coping and marijuana use in treated adults: Exploring mechanisms of treatment

OBJECTIVE

This study was designed to test the hypothesis that an Individualized Assessment and Treatment Program (IATP) for cannabis use disorder (CUD) that utilized experience sampling (ES) data to individualize treatment would be more effective at eliciting adaptive coping responses in high-risk situations than a more conventional cognitive-behavioral treatment. It was further expected that increases in momentary adaptive coping, positive affect, and self-efficacy expectancies would mediate the effects of treatment on momentary drug use in the hours following a temptation-to-use episode.

METHOD

The participants were 198 adults seeking treatment for CUD, randomized to receive either a conventional motivational enhancement + cognitive-behavioral treatment (MET-CBT) with or without contingency management (CM) or an IATP with or without CM. Treatment took place over nine individual sessions, and follow-ups were conducted out to 14 months post-intake. ES data were recorded in all treatments at pretreatment, and at various points during and after treatment.

RESULTS

Analyses of ES data indicated that the IATP conditions yielded greater increases in use of adaptive coping skills during temptation episodes than did the MET-CBT conditions. Mediation analyses supported the hypothesis that momentary use of coping skills mediates the effects of IATP on use or non-use of marijuana in the hours following a temptation episode.

CONCLUSIONS

Use of an individualized coping treatment approach results in lower use of marijuana in high-risk situations, and actual utilization of adaptive coping appears to be a mechanism of that effect. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Precision Mental Health Care for Cannabis Use Disorder: Utility of a bioSocial Cognitive Theory to Inform Treatment

Globally, cannabis is the most frequently used controlled substance after alcohol and tobacco. Rates of cannabis use are steadily increasing in many countries and there is emerging evidence that there is likely to be greater risk due to increased concentrations of delta-9-tetrahydrocannabinol (THC). Cannabis use and Cannabis Use Disorder (CUD) has been linked to a wide range of adverse health outcomes. Several biological, psychological, and social risk factors are potential targets for effective evidence-based treatments for CUD. There are no effective medications for CUD and psychological interventions are the main form of treatment. Psychological treatments based on Social Cognitive Theory (SCT) emphasize the importance of targeting 2 keys psychological mechanisms: drug outcome expectancies and low drug refusal self-efficacy. This mini-review summarizes the evidence on the role of these mechanisms in the initiation, maintenance, and cessation of cannabis use. It also reviews recent evidence showing how these psychological mechanisms are affected by social and biologically-based risk factors. A new bioSocial Cognitive Theory (bSCT) is outlined that integrates these findings and implications for psychological cannabis interventions are discussed. Preliminary evidence supports the application of bSCT to improve intervention outcomes through better targeted treatment.

Effects of self-control, drug-use peers and family attachment on drug use among Chinese users: A gender-specific analysis

INTRODUCTION

The increasing trend of synthetic drug use has been a significant concern in China. The current research adopted a gendered perspective to examine the effects of self-control, drug-use peers and family attachment on drug use frequency in China.

METHODS

This cross-sectional survey research recruited 785 people who used drugs from four compulsory drug rehabilitation institutions in Guangdong and Shandong Province of China in 2018. Ordinary least squares regression analyses were conducted to examine the gendered effects of self-control (Grasmick et al.'s cognitive scale), drug-use peers and family attachment on drug use frequency.

RESULTS

Low self-control was neither a significant nor gendered predictor of drug use frequency when controlling for effects of drug-use peers and family attachment. Drug-use peers strongly increased participants' drug use frequency, regardless of gender. However, an important finding is that for males, support from families reduced drug use frequency but conversely meeting and contact with families increased drug use frequency. For females, only trust in families prevented their further involvement in drug use.

DISCUSSION AND CONCLUSIONS

Low self-control may not be a core explanatory factor for drug use behaviours in China. Thus, treatment programs should focus more on skills building than self-control. Future programs could focus more on reducing association with their drug-use peers and further explore the complex relationships with their families. Gender should be considered in treatment options.

Individualized assessment and treatment program (IATP) for cannabis use disorder: Randomized controlled trial with and without contingency management

This study tested a new approach to the treatment of cannabis use disorder (CUD). CUD is difficult to treat, and achieving abstinence is particularly difficult. The individualized assessment and treatment program (IATP) was intended to address this problem by providing a highly individualized approach to the training of coping skills most relevant for each individual. To do this, an experience sampling procedure was used prior to treatment to record patients' marijuana use behavior and associated thoughts, feelings, coping behaviors, and situations. This information was used by therapists to plan treatment that would address the specific strengths and weaknesses of each patient in drug-use situations. The present study tested IATP against a conventional combined motivational enhancement cognitive-behavioral treatment (MET-CBT), with or without the addition of contingency management (CM) for abstinence. The patients were 198 men and women randomly assigned to 1 of 4 nine-session treatment conditions: MET-CBT, MET-CBT-CM, IATP, or IATP-CM. Patients were assessed out to 14 months. Planned contrasts indicated that the IATP conditions yielded greater levels of abstinence than did the MET-CBT conditions. The addition of CM did not bolster the performance of IATP but did do so for MET-CBT. As expected, IATP lead to greater use of coping skills than did the MET-CBT conditions. However, coping skills use was not a significant predictor of outcome when other variables were in the same analyses. Self-efficacy was a robust predictor and mediator of outcome. We suggest that the IATP may act by enhancing self-efficacy. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Testing the biosocial cognitive model of substance use in cannabis users referred to treatment

BACKGROUND

The bioSocial Cognitive Theory (bSCT) hypothesizes two pathways linking dimensions of impulsivity to substance use. The first predicts that the association between reward sensitivity and substance use is mediated by positive outcome expectancies. The second predicts that the relationship between rash impulsiveness and substance use is mediated by refusal self-efficacy. This model has received empirical support in studies of alcohol use. The present research provides the first application of bSCT to a cannabis treatment population and aims to extend its utility to understanding cannabis use and severity of dependence.

DESIGN

273 patients referred for cannabis treatment completed a clinical assessment that contained measures of interest.

SETTING

A public hospital alcohol and drug clinic.

MEASUREMENTS

The Sensitivity to Reward Scale, Dysfunctional Impulsivity Scale, Cannabis Expectancy Questionnaire, Cannabis Refusal Self-Efficacy Questionnaire and Severity of Dependence Scale-Cannabis were completed, along with measures of cannabis consumption.

FINDINGS

The bSCT model provided a good fit to the data for cannabis use and severity of dependence outcomes. The association between reward sensitivity and each cannabis outcome was fully mediated by positive cannabis expectancies and cannabis refusal self-efficacy. The relationship between rash impulsiveness and each cannabis outcome was fully mediated by cannabis refusal self-efficacy.

CONCLUSIONS

Findings support the application of the bSCT model to cannabis use and dependence severity and highlight the important role of social cognitive mechanisms in understanding the association between impulsivity traits and these outcomes. The differential association of impulsivity traits to social cognition may assist targeted treatment efforts.

Momentary factors during marijuana use as predictors of lapse during attempted abstinence in young adults

INTRODUCTION

Young adults using marijuana heavily often try multiple times to quit on their own. We sought to identify momentary experiences during marijuana use that could aid in predicting lapse when young adults subsequently attempt abstinence.

METHODS

Young adults (N=34) age 18-25 using marijuana ≥5days/week and planning to quit completed a survey of sociodemographic characteristics, substance use, marijuana expectancies, use motives, perceived social support, and confidence to abstain. They completed ecological momentary assessment (EMA) smartphone reports several times/day for two weeks prior to, then during two weeks of attempted abstinence. Use period EMA reports assessed affect, craving, accessibility, situational permissibility, use, and motivation to abstain. Baseline survey and EMA data were examined in relation to subsequent lapse during attempted abstinence.

RESULTS

Nearly 3 in 4 participants (73.5%) reported lapsing during attempted abstinence from marijuana. On bivariate analyses, lower baseline dependence severity score, negative effect expectancies, perceived family support, and confidence to abstain were each associated with lapse. Of the use period EMA variables, greater percent of days with marijuana use, reports of easy accessibility, and reports of situational permissibility were each associated with lapse. Modeled together, negative effect expectancies, perceived family support, confidence to abstain, and situational permissibility during use were highly accurate in predicting lapse during attempted abstinence.

CONCLUSIONS

Momentary factors may add to conventionally-surveyed characteristics to enhance prediction of lapse during attempted abstinence among young adults with heavy marijuana use. Momentary assessment prior to a quit attempt may thus enable more effective personalized approaches to preventing lapse.

Treatment response and non-response in CBT and Network Support for alcohol disorders: targeted mechanisms and common factors

AIMS

To determine whether mechanisms of drinking behavior change that are targeted by specific treatments mediate the effects of Packaged Cognitive Behavior Therapy (PCBT) and Network Support (NS) on abstinence rates throughout 27 months.

DESIGN

Secondary analysis of data from two Network Support Project randomized clinical trials, in which participants were assigned to either a case management control treatment (control) or NS treatment in trial 1, or to PCBT or NS treatment in trial 2.

SETTING

An out-patient substance abuse treatment site at a university medical center in the United States.

PARTICIPANTS

A total of 249 men and 154 women (n = 403) with alcohol use disorder.

MEASUREMENTS

The primary outcome was membership in a treatment responder class determined by growth mixture modeling (GMM) of monthly proportion days abstinent (PDA) to 27 months. Key predictors of responder class membership included network change variables, and changes in coping scores and self-efficacy.

FINDINGS

GMM analyses indicated that a three-class solution provided the best fit to the data: a treatment responder class comprising almost 55% of patients, a late relapsing class that showed post-treatment gains followed by a return to baseline drinking (12.7% of patients) and a non-responder class (32% of patients). Analyses indicated that treatment effects on responder class membership were moderated by baseline drinking (P < 0.001). PCBT effects were mediated by changes in coping scores (P < 0.05). NS treatment effects were also mediated by coping change, as well as by increases in self-efficacy and in number of abstinent friends (P < 0.05).

CONCLUSIONS

Long-term success in Packaged Cognitive Behavior Therapy and Network Support treatments for alcohol use disorder appears to be mediated by both general mechanisms (developing coping skills and self-efficacy) and treatment-targeted mechanisms (developing network strategies that emphasize social support and avoiding friends who drink).

The Indirect Effects of Self-Efficacy on Cannabis Use via Cannabis Protective Strategies: A Preliminary Study

Cannabis use has more than doubled in the past decade and nearly three of 10 users develop a cannabis use disorder. The increase in users, combined with the ongoing changes in the medical, legal and social status of cannabis, has contributed to interest in the antecedents of cannabis use. In the current preliminary study, we gathered information from a community sample (N = 54) of regular cannabis using young adults. Assessments included perceived self-efficacy for reducing intake or abstaining (SE-R/A), use of cannabis protective strategies (CPS), and average quantity of cannabis use per day. We systematically explored which specific CPS were most strongly associated with self-efficacy and cannabis use. Three clinically relevant subgroups of CPS emerged from this analysis: strategies strongly associated with only self-efficacy, only cannabis use, and both variables. We hypothesized that self-efficacy would be associated with less cannabis use via use of CPS. Among specific CPS examined, "Use a little and then wait to see how you feel before using more" had the strongest association with self-efficacy while "Avoid methods of using cannabis that can make you more intoxicated than you would like" had the strongest negative association with cannabis use. We observed a significant indirect relationship from self-efficacy to cannabis use through use of CPS. Our findings suggest that use of CPS is a potential mechanism by which cannabis users reduce use, and a more proximal antecedent of cannabis use than personal confidence in one's ability to stop using. These preliminary findings highlight the value of studying individual strategies. They also may have implications for promoting use of cannabis protective strategies when treating those with cannabis use problems.

Heroin refusal self-efficacy and preference for medication-assisted treatment after inpatient detoxification

OBJECTIVE

An individual's self-efficacy to refuse using heroin in high-risk situations is believed to minimize the likelihood for relapse. However, among individuals completing inpatient heroin detoxification, perceived refusal self-efficacy may also reduce one's perceived need for medication-assisted treatment (MAT), an effective and recommended treatment for opioid use disorder. In the current study, we examined the relationship between heroin refusal self-efficacy and preference for MAT following inpatient detoxification.

METHOD

Participants (N=397) were interviewed at the start of brief inpatient opioid detoxification. Multiple logistic regression was used to estimate the adjusted association of background characteristics, depressed mood, and perceived heroin refusal self-efficacy with preference for MAT.

RESULTS

Controlling for other covariates, depressed mood and lower perceived refusal self-efficacy were associated with a significantly greater likelihood of expressing preference for MAT (versus no MAT).

CONCLUSIONS

Perceived ability to refuse heroin after leaving detox is inversely associated with a heroin user's desire for MAT. An effective continuum of care model may benefit from greater attention to patient's perceived refusal self-efficacy during detoxification which may impact preference for MAT and long-term recovery.

Gender differences in cannabis use disorder treatment: Change readiness and taking steps predict worse cannabis outcomes for women

INTRODUCTION

Gender differences in cannabis use and cannabis use disorder have been established. Regarding treatment, some evidence suggests that women are less responsive, though the mechanisms are not well understood. Motivation to change and self-efficacy are associated with better outcomes overall, and may help explain gender differences in cannabis use outcomes.

METHODS

A secondary data analysis of a double-blind placebo controlled trial of buspirone treatment for cannabis dependence (N=175) was conducted. Self-report assessments of motivation to change, self-efficacy, and other clinical correlates were completed at baseline, and cannabis use was measured throughout the study.

RESULTS

There was a significant interaction between gender and taking steps on abstinence. Counter to hypothesis, higher taking steps reduced likelihood of achieving abstinence among women; there was no association among men. Subsequently, taking steps was associated with self-efficacy and quantity of use among men, and cannabis related problems among women. There was a significant interaction between gender and readiness to change on creatinine adjusted cannabinoid levels. Change readiness was positively associated with cannabinoid levels among women, but not men.

CONCLUSIONS

Motivation to change and initiation of change behavior predict worse cannabis outcomes in women. Men and women differ in what motivates change behavior. Social desirability, neurobiology, and treatment type may impact these effects. Gender differences in cannabis use and treatment responsiveness must be considered in future studies.

The Impact of the Project K Youth Development Program on Self-Efficacy: A Randomized Controlled Trial

A key issue for youth development programs is whether the learning they provide is transferred to participants' daily lives. It is also important that they are effective for the diverse range of participants they attract. This study used a randomized controlled trial design to measure the impact of Project K, a New Zealand-based youth development program, on academic and social self-efficacy. Project K combines a 3-week wilderness adventure, a 10 day community service component, and 1 year of mentoring to promote positive growth in 14-15 year olds with low self-efficacy. At baseline, the evaluation included 600 Project K (46 % female) and 577 Control participants (48 % female) and revealed that Project K was effective in improving both social and academic self-efficacy from pre- to post-program with effects being sustained 1 year later. Parents' perceptions of changes in the participants' interpersonal skills supported these findings. Differential program effects were found across participant subgroups, particularly 1 year after program completion. The implications of these differences are discussed.

Abstinence Self-Efficacy and Substance Use at 2 Years: The Moderating Effects of Residential Treatment Conditions

The relationship between abstinence self-efficacy and substance use at 2 years was examined among a sample (N = 470) of persons with substance use disorders and recent incarceration histories. Participants were assigned to residential (therapeutic community/TC or Oxford House) or nonresidential (usual care) conditions. The authors hypothesized abstinence self-efficacy would predict decreased substance use, and residential treatments would moderate this relationship. A conditional effect was observed, with low levels of abstinence self-efficacy predicting significant increases in substance use in the TC and usual care conditions. Supplemental analyses revealed significant decreases in substance use over time among participants in the Oxford House condition, and a significant conditional effect (gender x treatment condition) in relation to substance use. Findings point to the need for researchers to examine factors that mitigate the relationship between abstinence self-efficacy and substance use outcomes, and for treatment providers to consider the Oxford House model for this population.