Individual psychotherapy for addicted clients: an application of control mastery theory

Interpersonal guilt and substance use in college students

BACKGROUND

The college years are a time for developing independence and separating from one's family, and they are also a time in which substance use often escalates. This study examined the relationships between use of substances and interpersonal guilt, an emotion that can arise from feelings about separation among college students.

METHODS

In total, 1865 college students completed a survey evaluating substance use and interpersonal guilt. Regular users of alcohol, cigarettes, cannabis, and other illicit drugs were compared with nonregular users of each substance. Sequential linear regression, controlling for confounding variables, examined relationships between regular use of each substance and scores on a guilt index.

RESULTS

Risky drinkers and daily smokers had significantly more interpersonal guilt than their peers who did not regularly use these substances. In contrast, regular cannabis users had significantly less guilt than nonregular cannabis users.

CONCLUSIONS

These data suggest that substance use among college students may be related to interpersonal guilt and family separation issues, and this relationship may vary across substances.

Reported alcohol use and behavior in long-distance runners

Because alcohol may impair sports performance, we hypothesized there would be less drinking in serious recreational runners. We used mailed questionnaires to examine drinking patterns (2-wk quantity/frequency), scores on modified versions of the Michigan Alcoholism Screening Test (brief MAST [BMAST], short MAST [SMAST]), and parental history of problem drinking in 397 men and 144 women runners participating in a 20-mile race, compared with a nonexercising control population of 138 men and 119 women. A subset of 188 pairs (104 men, 84 women) were matched for gender, age, educational level, and marital status. We used chi-square analysis, paired t-test, and ANOVA. Male gender, running, and a family history for problem drinking predicted increased total alcohol consumption. We found that male runners (vs male controls) drank more 14.2 +/- 19.6 vs 5.4 +/- 7.6 drinks.wk-2, P = 0.004) and felt guilty about their drinking (26.6% vs 13.8%, P < 0.01). Men and women runners reported more occasions of drinking than matched controls (2.8 +/- 2.7 vs 2.0 +/- 2.3.wk-2, P = 0.004). Runners with scores on the BMAST (> or = 6) or SMAST (> or = 3) suggestive of a history of problem drinking drank less than controls with a similar score. Contrary to our hypothesis, running is associated with increased alcohol consumption, except in those who report a history of problem alcohol behavior.

Gender differences in social and psychological problems of substance abusers: a comparison to nonsubstance abusers

This study examines gender differences in 16 social and psychological problems among substance abusers and nonsubstance abusers in a community population to determine whether such differences are simply a reflection of differences between men and women in the general population. Data were gathered from 119 respondents using the Addiction Severity Index. Loglinear analysis suggests that problems typically attributed to "being a female substance abuser" may be due to the effect of gender or substance abuse alone. Only two problems significantly distinguish female substance abusers from the other comparison groups: psychiatric hospitalizations and relatives with substance abuse. However, women in the overall sample were more troubled by family problems, had more parents with psychiatric problems, and received more outpatient psychiatric treatment. Problems associated with substance abuse, not gender, include divorce, problems controlling violence, and parents with substance abuse problems. These findings suggest that substance-abusing women experience a "double whammy" because they incur both the problems of women and the problems of substance abusers. Disaggregating gender and substance abuse effects has implications for treatment-matching and relapse prevention, specifically for suggesting strategies that address the special vulnerabilities of substance-abusing women.

Guilt, shame, and depression in clients in recovery from addiction

Men and women in recovery from addiction were compared on levels of depression, guilt, and shame. The measurement of guilt included subscales of Survivor Guilt, Separation Guilt, Omnipotent Responsibility Guilt, Trait Guilt, State Guilt, and Adaptive Guilt. The sample included 75 men and 33 women in treatment in a residential treatment community. It was found that women were significantly higher than men in depression. The recovering subjects were compared to nonaddicted subjects and established norms, and it was found that the recovering people were higher on depression, shame, and the subscales of maladaptive guilt. Both men and women in recovery were significantly lower than norms in adaptive guilt.

Shame, guilt, and depression in men and women in recovery from addiction

Men and women in recovery from addiction were compared on levels of depression and self-conscious affect including proneness to shame, guilt, externalization, detachment, and pride. The sample consisted of 130 subjects (88 men and 42 women; mean age 33.04), 90 of whom were active participants in a 12-step recovery program, and 40 of whom were in a residential treatment community. Subjects completed The Beck Depression Inventory and The Test of Self-Conscious Affect. Significant differences between the sexes were found for proneness to shame, detachment, and depression. Women were significantly higher on shame and depression; men were significantly higher on detachment. The subjects were compared to subjects who were not chemically dependent. It was found that these recovering drug-addicted subjects scored significantly higher in proneness to shame and externalization and significantly lower on proneness to guilt. Treatment implications of proneness to shame in the drug-addicted population, and particularly in women, are discussed. The use of confrontational drug treatment strategies may be contraindicated.