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

Shame-and-guilt-proneness, interpersonal sensitivity, and alcohol: Results from a moderated mediation

BACKGROUND

Shame-proneness has been consistently associated with more problematic alcohol outcomes, and guilt-proneness has been associated with fewer. The aim of this study was to determine if the associations of shame-and-guilt-proneness with alcohol outcomes vary as a function of interpersonal sensitivity.

METHOD

A longitudinal study examined shame-proneness and guilt-proneness as predictors of alcohol consumption and related problems one month later. This research was conducted at a large public university in the United States.

RESULTS

Participants (N=414) were heavy-drinking college students (51% female) with a mean age of 21.76 (SD=2.02) who consumed an average of 12.13 (SD=8.81) standard drinks per week. Shame-proneness, but not guilt-proneness, was directly associated with increased drinking and indirectly associated with increased problems. The indirect effects of shame on problems through drinking were stronger at higher levels of interpersonal sensitivity.

CONCLUSIONS

Results suggest that shame-proneness may increase alcohol consumption and subsequent problems among those high in interpersonal sensitivity. Alcohol may be used as a means to withdraw from social threats that are amplified by interpersonal sensitivity.

A Mediation Moderation Model between Self-Evaluative Emotions and Relapse Rate among Polysubstance Users: A Comparative Cross-Sectional Study

A substantial portion of drug abuse research has concentrated on people with a single-substance-use disorder (SSUD), but many people abuse more than one drug. Studies have yet to examine how those with polysubstance-use disorder (PSUD) differ from those with an SSUD on the risk of relapse, self-evaluative emotions (e.g., shame and guilt), and personality factors (e.g., self-efficacy). Eleven rehab facilities in Lahore city, Pakistan were randomly chosen to provide a sample of 402 males with PSUD. For comparison, 410 age-matched males with SSUD were enlisted using a demographic form with eight questions, the State Shame and Guilt Scale, and the General Self-Efficacy Scale. Mediated moderation analysis was performed using Hayes' process macro. The results demonstrate that shame-proneness is positively associated with relapse rate. Guilt-proneness mediates the relationship between shame-proneness and relapse rate. Self-efficacy buffers the influence of shame-proneness on relapse rate. Although the mediation and moderation effects were found in both study groups, these effects were significantly stronger among people with PSUD than those with SSUD. To be more specific, people with PSUD reported a higher overall score on shame, guilt, and relapse rate. Additionally, people with SSUD indicated a higher score on self-efficacy than those with PSUD. The findings of this study suggest that drug rehab facilities should implement a variety of strategies to raise drug users' levels of self-efficacy, which will help to reduce their risk of relapse.

Guilt in alcohol use: A systematic review

For decades, alcohol use disorder has been investigated in an attempt to understand its processes and implications. However, among all of the factors involved in alcohol use disorder, the role of guilt in alcohol use remains poorly explained, with many contradictory results. Therefore, the purpose of this review is to conduct a systematic analysis of the literature from 1990 to 2022 to review the studies investigating the link between guilt and alcohol consumption. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, 31 studies were included in this review. The results of this work enable to highlight the plurality of guilt that has been studied in the literature. Grouped in two categories: state guilt and trait guilt, they seem to have diverse implications towards alcohol use or misuse. Guilt proneness seems to act as a protective factor towards alcohol use, except for the few studies conducted on a clinical population. Numerous studies indicated that state guilt is deleterious toward alcohol use, even if some results are contradictory. Furthermore, this work allows us to shed light on the limits of the studies currently carried out, and thus to propose new directions for future studies.

Patient experiences of prescription drug monitoring programs: a qualitative analysis from an Australian pharmaceutical helpline

BACKGROUND

Prescription Drug Monitoring Programs (PDMP) are electronic databases that are used to track and monitor the prescribing and dispensing of controlled substances, such as opioid analgesics and benzodiazepines. PDMP have been used widely throughout North America and have recently been implemented in Australia. Several unintended harms have been associated with PDMP in North America, including increased stigma, discrimination, and dismissal from care for patients prescribed these medications.

AIMS

This study aimed to better understand how people who use prescription medications extramedically and their loved ones give meaning to their consumption and their treatment experiences and concerns in the context of a newly implemented real-time PDMP in Victoria, Australia.

METHOD

Nineteen audio recordings of telephone calls made to the PDMP Pharmaceutical Helpline were transcribed and thematically analysed.

RESULTS

Patients and their families were hopeful that PDMP would stop the extra medical use of medications. However, many were deeply concerned about how they would cope with withdrawal or life stressors without the support these medications afforded. Patients reported experiences of stigma and strained therapeutic relationships associated with PDMP implementation.

CONCLUSION

PDMP have the potential to both assist and harm patients whose prescription medication use has been identified as 'risky' by the PDMP. The findings from this study suggest that clear and open communication, as well as reflection on unconscious bias and stigma may assist healthcare providers to facilitate better patient experiences and outcomes in the context of prescription medication dependence.

Understanding interpersonal guilt: Associations with attachment, altruism, and personality pathology

The aim of this article is to empirically investigate the relationships among interpersonal guilt, as conceived within control-mastery theory (CMT), and attachment, altruism, and personality pathology in an English-speaking sample. An online sample of 393 participants was recruited to complete the Interpersonal Guilt Rating Scale self-report version-15 (IGRS-15s), together with other empirically validated measures for the assessment of attachment, altruism, and personality pathology. On the basis of previous studies conducted in Italian-speaking samples, we hypothesized that survivor guilt, separation/disloyalty guilt, and omnipotent responsibility guilt would be associated with attachment anxiety and avoidance, altruism, and personality pathology; self-hate was hypothesized to be associated only with attachment anxiety and avoidance and personality pathology. Analyses examined bivariate associations as well as the network of partial correlations among variables. The results largely confirmed hypothesized associations, with self-hate evincing the strongest unique association with personality dysfunction. Findings provide a basis for further research regarding interpersonal guilt and personality and relational functioning, with potential implications for clinical conceptualizations of the role of guilt in psychopathology.

Addiction to Social Networking Sites and User Responses

Prior studies have primarily used "variable-centered" perspectives to identify factors underlying user responses to social networking site (SNS) addiction, their predictors and outcomes. This paper extends this perspective by taking a person-centered approach to examine (1) the prototypical subpopulations (profiles) of users' extent of SNS addiction and responses to it, (2) how affiliations with these profiles can explain user behaviors toward SNS use, and (3) how personality traits can predict affiliations with these profiles. To this end, we propose a typological theory of SNS addiction and user responses to it via two empirical, personcentered studies. Study 1 draws on survey data from 188 SNS users to develop a typology of users based on the extent of their SNS addiction and their responses to it. It further examines the relations between affiliation with these profiles and users' SNS discontinuance intention, as a typical behavioral response to SNS addiction. Study 2 uses survey data from 284 SNS users to validate the user typology developed in Study 1 and investigate its relations to users' Big Five personality traits. Our findings shed light on a typology of five prototypical profiles of SNS users-cautious, regular, consonant, dissonant, and hooked-who differ in their extent of SNS addiction and their cognitive, emotional, and behavioral responses to it. Our findings also demonstrate how Big Five personality traits can predict user affiliations with these prototypical profiles.

Managing shame and guilt in addiction: A pathway to recovery

A dominant view of guilt and shame is that they have opposing action tendencies: guilt- prone people are more likely to avoid or overcome dysfunctional patterns of behaviour, making amends for past misdoings, whereas shame-prone people are more likely to persist in dysfunctional patterns of behaviour, avoiding responsibility for past misdoings and/or lashing out in defensive aggression. Some have suggested that addiction treatment should make use of these insights, tailoring therapy according to people's degree of guilt-proneness versus shame-proneness. In this paper, we challenge this dominant view, reviewing empirical findings from others as well as our own to question (1) whether shame and guilt can be so easily disentangled in the experience of people with addiction, and (2) whether shame and guilt have the opposing action tendencies standardly attributed to them. We recommend a shift in theoretical perspective that explains our main finding that both emotions can be either destructive or constructive for recovery, depending on how these emotions are managed. We argue such management depends in turn on a person's quality of self-blame (retributive or 'scaffolding'), impacting upon their attitude towards their own agency as someone with fixed and unchanging dispositions (shame and guilt destructive for recovery) or as someone capable of changing themselves (shame and guilt productive for recovery). With an eye to therapeutic intervention, we then explore how this shift in attitude towards the self can be accomplished. Specifically, we discuss empathy-driven affective and narratively-driven cognitive components of a process that allow individuals to move away from the register of retributive self-blame into a register of scaffolding 'reproach', thereby enabling them to manage their experiences of both shame and guilt in a more generative way.

Online Narratives of Methamphetamine Use and Risky Sexual Behavior: Can Shame-Free Guilt Aid in Recovery?

Methamphetamine (meth) use is a recurring public health challenge in the U.S. In 2016, approximately 1.6 million Americans reported using meth. Meth use is associated with a number of adverse outcomes, including those associated with users' sexual health. In particular, meth use is linked to an increased risk for sexually transmitted infections and unplanned pregnancies. While studies have examined associations between substance use of various types-including meth use, and shame and guilt-few studies have examined relationships among substance use, sexual risk behaviors, and shame and guilt. No qualitative studies, to our knowledge, have studied all three of these phenomena in a sample of meth users. The present qualitative study explored the sexual risk behaviors and associated feelings of shame and guilt in relation to meth use. It draws from anonymous letters and stories (N = 202) posted to an online discussion forum by meth users and their family members. A grounded theory analysis of these narratives identified four primary themes pertaining to meth use and sexual behaviors: (1) feeling heightened sexual arousal and stimulation on meth, (2) experiencing sexual dissatisfaction on meth, (3) responding to sexual arousal and dissatisfaction, and (4) feeling ashamed and/or guilty. Ultimately, the present findings indicate that feelings of shame and guilt may arise more from the consequences of sexual risk behaviors stemming from meth use rather than meth use itself. The emotional toll of meth-induced sexual risk behaviors, particularly shame and guilt over the loss of meaningful relationships and self-respect due to multiple sexual partners, may provide an important opportunity for interventionists.

Guilt, Shame, Empathy, Self-Esteem, and Traumas: New Data for the Validation of the Interpersonal Guilt Rating Scale-15 Self-Report (IGRS-15s)

The aim of this paper is to present further data for the validation of the Interpersonal Guilt Rating Scale-15 self-report (IGRS-15s; Gazzillo et al., 2018). We recruited a sample of 448 subjects, to whom we administered the IGRS-15s together with other empirically validated measures for the assessment of social desirability, shame, self-esteem, empathy, mental health and therapeutic alliance. In line with our hypotheses, the previously established three-factor structure of the IGRS-15s (Survivor guilt, Omnipotence guilt, and Self-hate) was confirmed. Moreover, the internal consistency and test-retest reliability of IGRS-15s were adequate to good. All the IGRS-15s factors were negatively correlated with self-esteem and mental health and positively correlated with shame; Survivor guilt and Omnipotence guilt were positively correlated with empathy; Survivor guilt and Self-hate negatively affected therapeutic alliance; and different traumas had different, theoretically predictable, impacts on the different kinds of guilt. Overall, these data support the reliability and validity of the IGRS-15s.

Measuring Alcohol Use-Related Shame and Guilt: Development and Validation of the Perceptions of Drinking Scale

Background: The dispositional tendency to experience guilt is inversely related to disordered alcohol use, while dispositional shame-proneness appears to share a positive relationship with alcohol problems. Objective: In order to further research in this domain, a new measure of alcohol use-related shame and guilt is described. Methods: Using exploratory and confirmatory factor analysis (CFA), the psychometric properties of the Perceptions of Drinking Scale (PODS) were validated across two independent samples (Sample 1 N = 293, Sample 2 N = 429). Results: A four factor model of the PODS was identified in exploratory factor analysis. The hypothesized four-factor PODS model was validated in an independent sample using CFA (RMSEA = .046; CFI = .99; TLI = .99). Alcohol use-related shame and guilt were reliably differentiated, and test re-test stability, divergent and convergent validity was established. Alcohol use-related shame was not clearly related to taking action to address problematic alcohol use, but was positively related with measures of negative affect and using avoidance-based coping strategies. Conversely, alcohol use-related guilt was generally unrelated to measures of negative affect and was clearly associated with the taking of action to address problematic alcohol use. Conclusions: The Perceptions of Drinking Scale has good psychometric properties and also appears to reliably distinguish between experiences of alcohol use-related shame and guilt. Both alcohol use-related shame and guilt appear to be positively associated with the contemplation of changing one's alcohol use-related behaviors. Only alcohol use-related guilt was clearly linked to the taking of action to address problematic drinking behavior.

Corrections and connection to the community: A diagnostic and service program for incarcerated adult men with FASD

Previous research has demonstrated that impaired social and adaptive behavior due to prenatal alcohol exposure can be associated with severe conduct disorders in adolescence, mental health concerns, school failure, employment difficulties, substance abuse, difficulty with the law, and incarceration. The Corrections and Connections to the Community research and service program was established to examine adult male offenders with frequent contact with the provincial corrections system. Individuals who participated in the program received neuropsychological testing, a functional assessment and a psychiatric interview. Results indicated that 90% of the participants identified within the spectrum of FASD. The functional profile indicated that many participants had impaired social functioning. A natural dichotomy emerged from the data which reflected those who connected early with the criminal justice system (65%) and those who did not connect within the 18 month project period. Significant differences emerged between those individuals who reconnected with the justice system and who also possessed a juvenile record and those who did not. Further analysis also indicated significant differences between scores on the Finger Tapping Test, Trail Making Test A, ILS and California Verbal Learning Test. Findings of this study highlight the importance of appropriate programming and services for incarcerated men with FASD.

Songwriting to Target State Shame, Guilt, and Pride in Adults with Substance Use Disorder on a Detoxification Unit: A Cluster-Randomized Study

BACKGROUND

Resultant of engaging in behaviors outside of their value systems to maintain addiction, many people with substance use disorder (SUD) feel shame and guilt. Although shame, guilt, and pride do not represent traditional dependent measures in SUD research, experimental studies targeting these constructs are warranted.

OBJECTIVE

The purpose of this study was to determine the effects of a single songwriting intervention on state shame, guilt, and pride with adults with SUD on a detoxification unit.

METHOD

Participants (N = 118) were cluster-randomized to songwriting or control conditions. To avoid testing fatigue in this single-session study, experimental participants received a group-based blues songwriting protocol targeting state shame, guilt, and pride and then completed the questionnaire. Control participants completed the questionnaire before receiving an intervention.

RESULTS

While there was no significant between-group difference in state shame or guilt, there tended to be slightly lower mean scores in the experimental condition. There was a significant between-group difference in state pride (p = .012), with experimental participants having higher mean scores than control participants.

CONCLUSION

Although only the state pride measure reached significance, shame, guilt, and pride represent consequential constructs for people with SUD. As addressing shame and guilt can be perceived as confrontational, group-based blues songwriting may represent a positive, engaging, and creative intervention to target these challenging but important topics. Implications for clinical practice, limitations, and suggestions for future research are provided.

Shame mediates the relationship between depression and addictive behaviours

BACKGROUND

Alcohol and gambling problems are common in young adults. Self-medication theory states that young adults with depression drink and/or gamble to escape negative emotions. Research shows that depression is a risk factor for drinking/gambling problems, but more work is needed to examine mediators underlying these associations. One potential mediator is shame. Shame is a self-directed emotion that follows a negative life event and is characterized by intense feelings of inferiority, worthlessness, and embarrassment. Depressed individuals are especially susceptible to shame (and associated emotions). Shame has also been implicated in risk for addiction. Accordingly, we predicted that elevated shame would explain why depression is associated with both alcohol and gambling problems.

METHODS

A longitudinal design was used to examine this hypothesis. Undergraduates (N = 210) completed self-reports of depression at baseline (Time 1) and then completed self-reports of shame, alcohol misuse, gambling problems one month later (Time 2).

RESULTS

Results showed that individuals with elevated depression at Time 1 endorsed high levels of shame at Time 2, which in turn predicted more gambling (β = .038, 95% CI [.010, .087]) and alcohol problems (β = .249, 95% CI [.123, .435]) at Time 2. We found that increased levels of shame explained the effects of depression on problem drinking and gambling.

CONCLUSIONS

Study findings improve our understanding of the depressive pathway to addiction by providing evidence for shame as a potential mechanism of this pathway.

IMPACT

Reducing shame can be a target of clinical interventions for young adults with depression and alcohol/gambling problems.

Is shame a proximal trigger for drinking? A daily process study with a community sample

Between-subjects studies show that people with higher levels of shame tend to experience more negative drinking-related consequences than people with lower levels of shame. However, within-subjects studies of the association between daily fluctuations in shame and subsequent drinking have yielded mixed findings. This study aimed to resolve these inconsistencies by examining the association between daily fluctuations in shame, between-subjects differences in shame, and subsequent evening alcohol consumption in a sample of 70 community-dwelling drinkers. In addition, we examined whether the previous night's drinking predicted shame the next day based on the theory that shame may operate in a cyclical fashion in some people to maintain problematic drinking patterns. Multilevel model analyses showed a cross-level interaction in which individuals' average levels of ashamed mood moderated the effect of daily fluctuations in shame on solitary drinking. In contrast, previous day's drinking was only weakly related to shame the next day. This study contributes to existing literature by refining models of negative mood-related drinking and further elucidating the patterns by which shame serves as a trigger for drinking, particularly among high shame individuals. The authors interpret results in terms of self-control theory and demonstrate the importance of disaggregating between- and within-subjects variance when examining longitudinal data. (PsycINFO Database Record

Preliminary Data about the Validation of a Self-Report for the Assessment of Interpersonal Guilt: The Interpersonal Guilt Rating Scales-15s (IGRS-15s)

The aim of this article is to present validation data about a self-report rating scale for the assessment of interpersonal guilt according to Control-Mastery Theory (CMT; Silbershatz, 2005; Weiss, 1993; Weiss, Sampson, & The Mount Zion Psychotherapy Research Group, 1986), the Interpersonal Guilt Rating Scale-15s (IGRS-15s). In order to perform the validation of this tool in an Italian sample we have collected a sample of 645 nonclinical subjects. They had to complete the IGRS-15s, the Scale for the Measurement of the Impending Punishment (SMIP; Caprara et al., 1990), the Interpersonal Guilt Questionnaire-67 (IGQ-67; O'Connor et al., 1997), the Psychological General Well-Being Index (PGWBI; Dupuy, 1984), and the Affective Neuroscience Personality Scales (ANPS; Davis, Panksepp, & Normansell, 2003), together with an ad-hoc questionnaire for collecting demographic data, the Socio-Demographical Schedule. We have performed a confirmatory factor analysis to verify if the four-factor solution based on CMT and replicated in previous research (Gazzillo et al., 2017) was confirmed. Then, we checked the retest reliability of IGRS-15s after four weeks in a random subsample of 54 subjects. In order to assess its concurrent and discriminant validity, we calculated the correlations between IGRS-15s assessment and SMIP and IGQ-67. Finally, to test its construct validity, we assessed the relationships between the IGRS-15s and the affective systems using the ANPS and the wellbeing assessed with the PGWBI. The data collected support the retest reliability and the concurrent and discriminant validity of the measure, and we have collected preliminary data about its construct validity. Examples of the possible clinical and research applications of this tool are discussed.

Prone to feel guilty: Self-evaluative emotions in alcohol-dependence

BACKGROUND

Prior research has repeatedly shown that alcohol-dependence is associated with interpersonal difficulties. However, guilt and shame, two crucial self-evaluative emotions triggered by the transgression of social norms, have not been explored among alcohol-dependent individuals despite their important role in psychiatric disorders. The present study thus aimed to investigate whether alcohol-dependence is associated with greater proneness to negatively evaluate one's own behaviors (guilt) or the entire self (shame).

METHODS

25 alcohol-dependent individuals (ADI) and 25 matched healthy individuals completed a scenario-based inventory (TOSCA-3), requiring from participants to rate the extent they will react to each scenario in terms of (contextualized) guilt and shame. Participants also completed a list of adjectives related to the frequency at which they generally experience (uncontextualized) guilt and shame (PFQ-2).

RESULTS

When controlling for possible confounds (i.e., depression and anxiety), ADI reported greater proneness to experience guilt at the TOSCA-3 (η²=.22) compared to healthy individuals.

CONCLUSIONS

This study is the first to show that alcohol-dependence is associated with greater contextualized guilt-proneness, i.e., negative evaluation of one's own behaviors that transgress social norms. Therefore, these results reinforce the relevance of social disorders in alcohol-dependence and indicate that ADI may benefit of therapeutic programs to avoid a generalization of guilt towards shame.

Genetic Counseling for Alcohol Addiction: Assessing Perceptions and Potential Utility in Individuals with Lived Experience and Their Family Members

Though addictions to substances including alcohol are highly heritable, there have been no studies regarding the possible applicability of genetic counseling to this set of conditions. Adults (≥18 years old) with a personal and/or family history of alcohol addiction were recruited to participate in an online survey-based study comprising 43 questions about beliefs/concern about recurrence risk and etiology of alcohol addiction and its impact on childbearing decisions, and perceptions of potential utility of genetic counseling for alcohol addiction. We applied primarily descriptive statistics, but also tested the hypotheses that perceiving genetic counseling to be useful would be associated with: 1) increasing importance attributed to genetics in the etiology of alcohol addiction, and 2) greater concern about recurrence of alcohol addiction (in self and/or children). Overall, the 113 participants recognized the multifactorial nature of alcohol addiction but reported a wide range of estimated recurrence risks for first-degree relatives. Overall, 62% perceived genetic counseling for alcohol addiction to be potentially beneficial. Participants were more likely to perceive a benefit from genetic counseling if they were concerned about recurrence for themselves (p = .021) or perceived genetics to be etiologically important in alcohol addiction (p = .024). Future studies are warranted to evaluate the outcomes of genetic counseling for addictions with respect to patient understanding, lifestyle modifications and psychological adaptation.

Reliability and Validity of the Interpersonal Guilt Rating Scale-15: A New Clinician-Reporting Tool for Assessing Interpersonal Guilt According to Control-Mastery Theory

This article introduces the Interpersonal Guilt Rating Scale-15 (IGRS-15), a brief clinician-rated tool for the clinical assessment of interpersonal guilt as conceived in Control-Mastery Theory (CMT; Silberschatz, 2015; Weiss, 1993), and its psychometric proprieties. The items of the IGRS-15 were derived from the CMT clinical and empirical literature about guilt, and from the authors' clinical experiences. Twenty-eight clinicians assessed 154 patients with the IGRS-15, the patient self-reported Interpersonal Guilt Questionnaire-67 (IGQ-67; O'Connor, Berry, Weiss, Bush, & Sampson, 1997), and the Clinical Data Form (CDF; Westen & Shedler, 1999). A semi-exploratory factor analysis pointed to a four-factor solution in line with the kinds of guilt described in CMT: Survivor guilt, Separation/disloyalty guilt, Omnipotent responsibility guilt, and Self-hate. The test-retest reliability of the IGRS-15 was good. Moreover, the IGRS-15 showed good concurrent and discriminant validity with the IGQ-67. IGRS-15 represents a first step in the direction of supporting the clinical judgment about interpersonal guilt with an empirically sound and easy-to-use tool.

The Guilt Inventory

The Guilt Inventory contains subscales measuring trait guilt, state guilt, and moral standards. Previous research has suggested the reliability of these scales and the validity of their interpretations. The items, coding, and scoring procedure for the Guilt Inventory are presented here as well as additional evidence regarding the reliability and measurement characteristics of its subscales.

Intimate partner aggression-related shame and posttraumatic stress disorder symptoms: The moderating role of substance use problems

A dearth of literature has examined the consequences of women's use of aggression in intimate relationships. Women's use of aggression against their intimate partners, regardless of their motivation (e.g., self-defense, retaliation), may elicit shame. Shame, in turn, may contribute to the maintenance and/or exacerbation of posttraumatic stress disorder (PTSD) symptoms, which are commonly experienced in this population. Further, emerging research suggests that emotionally avoidant coping strategies, such as substance use, may strengthen the relation between shame and PTSD symptoms. The goal of the present study was to examine whether women's shame concerning their use of intimate partner aggression is associated with their PTSD symptoms, and whether drug and alcohol use problems moderate this association. Participants were 369 community women who had used and been victimized by physical aggression in an intimate relationship with a male partner in the past six months. The intimate partner aggression-related shame × drug (but not alcohol) use problems interaction on PTSD symptom severity was significant. Analysis of simple slopes revealed that women's intimate partner aggression-related shame was positively associated with their PTSD symptoms when drug use problems were high, but not when drug use problems were low. Findings have implications for the potential utility of PTSD treatments targeting a reduction in shame and maladaptive shame regulation strategies (i.e., drug use) in this population. Aggr. Behav. 42:427-440, 2016. © 2015 Wiley Periodicals, Inc.

Narcissistic Vulnerability and Addiction

The main body of research on addiction and pathological narcissism has focused on the study of their co-occurrence by applying Diagnostic and Statistical Manual of Mental Disorders ( DSM) definitions for these clinical phenomena or by assessing trait narcissism in substance-dependent populations. Clinically informed comprehensive conceptualizations of narcissism which focus on its phenomenological range from vulnerability to grandiosity have not been applied in studying the specific narcissistic disturbances that underlie the relationship between these comorbid conditions. Aiming to examine this relationship, this study compared the presence of pathological narcissism, and more specifically narcissistic grandiosity and vulnerability, in substance-dependent individuals in treatment with individuals from the general population. Comparisons indicate that substance-dependent individuals experience significant narcissistic disturbances more likely related to vulnerability than grandiosity. Shame, rage, and self-esteem contingent upon external validation comprise the intrapsychic and interpersonal vulnerability. Implications for the clinical conceptualization of pathological narcissism as well as for substance dependence treatment interventions are discussed.

Treating PTSD Within the Context of Heightened Suicide Risk

Because posttraumatic stress disorder (PTSD) is one of the few psychological conditions that predict suicidal behavior among those who think about suicide, many patients with PTSD present clinically with elevated suicide risk. Expert consensus and practice guidelines recommend against trauma-focused treatments for patients with elevated suicide risk, however. Research aimed at understanding the common mechanisms that underlie the association of PTSD and suicide risk has led to several advances in the effective care of suicidal patients diagnosed with PTSD. Based on these results, various combinations and sequences of suicide-focused treatments, risk management procedures, and trauma-focused treatments are implicated.

Psychiatric symptoms and mental health court engagement

People with mental illnesses are overrepresented in the criminal justice system. Many interventions have been implemented to treat the underlying causes of criminal justice involvement and prevent people with mental illnesses from recidivating. Mental health courts (MHC) are one of these programs. This analysis examines the relationship between psychiatric symptoms and MHC engagement. Eighty MHC participants from two Midwestern MHCs were interviewed. Symptom severity was assessed at baseline using the Brief Psychiatric Rating Scale. MHC engagement was estimated by treatment adherence, substance use, days spent in jail, probation violations, and MHC retention during a six month follow-up period. Using nonparametric statistical tests and logistic regression, results indicate symptoms of depression, anxiety, and guilt are more severe at baseline for those people who are incarcerated during the follow-up period. Symptoms of anxiety are more severe for people who are terminated or went missing during the follow-up period. Further research is needed to determine the directionality and causality of these relationships. MHCs professionals should be aware of the relationship between symptom severity and MHC engagement and attempt to connect participants with treatment and services as early as possible and individualize treatment plans based on current symptoms and need.

Cultural differences and shame in an expressive writing alcohol intervention

The present study evaluates the relationships between shame, culture, and drinking behavior in predicting drinking intentions in the context of an expressive writing intervention. Theory and empirical findings have generally found that shame is maladaptive and can lead to anxiety, depression, and problematic alcohol use. However, research on cultural differences suggests that shame may be differentially damaging to individuals of collectivist, Asian cultures. Previous research evaluating expressive writing as a brief alcohol intervention has shown promising results such as reduced drinking intentions and increased readiness to change drinking behavior. The present study tested the hypothesis that feelings of shame after writing about a negative heavy drinking event would be associated with greater alcohol use generally and that this effect would differ for Caucasian compared to Asian individuals. We also explored whether this differed for light and heavy drinkers. Two hundred sixty-four undergraduates (74% female) who drank at least one alcoholic beverage in the past month completed measures of demographics, baseline drinking, event-related shame and guilt, pre- and postwriting affect, and drinking intentions. Results revealed that, independent of affect, social desirability, and event-related guilt, shame was generally negatively associated with drinking intentions for Caucasians and light drinking Asians. However, for heavy drinking Asians, shame was associated with increased drinking intentions. Results suggest that interventions that elicit shame are differentially effective and should be targeted accordingly.

Socio-demographic characteristics and consumption patterns of drug users – synthesis of outcome research at a TC for a 10 year range

Purpose

– Therapeutic communities (TCs) are one of the existent social responses in helping drug users overcome addiction and pursue social reintegration. The purpose of this paper is to present and discuss the general characteristics of about 200 drug users and their addiction and those of addicts abroad treated in a TC and clinically discharged. The analysis now presented is the first empirical approach to capture social regularities and singularities that are present in these individuals’ reintegration strategies.

Design/methodology/approach

– The data have a ten-year range – from 1999 to 2009 – and were statically analysed.

Findings

– They show a group of individuals with low qualifications reflected in their professional occupation, from which family is an essential support. These data also show a significant prevalence of heroin, alcohol, cocaine and polydrug uses, highlighting the need to consider new use patterns and new synthetic substances.

Originality/value

– TC have been little studied, mainly in Portugal.

Embodied Deviance, Gender, and Epistemologies of Ignorance: Re-Visioning Drugs Use in a Neurochemical, Unjust World

The paper develops key notions needed for a feminist embodiment approach to drugs, their use and users. First, the term embodied deviance is defined in relationship to women drug users. Second, the bodily tasks of gendered drug use are defined to show how "normal" embodiment is foreclosed to women drug users. Third, disease regimes and epistemologies of ignorance are introduced. Fourth, another piece is inserted into the feminist embodiment puzzle -emotions. Simply, we look at some of the practices that emerge from the affective dimensions of gendered drug use. In the concluding section of my paper, I ask, "Where do we go from here?"

Children's proneness to shame and guilt predict risky and illegal behaviors in young adulthood

Do shame and guilt help people avoid doing wrong? Although some research suggests that guilt-proneness is a protective factor while shame-proneness puts individuals at risk, most research is either cross-sectional or short-term. In this longitudinal study, 380 5th graders (ages 10-12) completed measures of proneness to shame and guilt. We re-interviewed 68 % of participants after they turned 18 years old (range 18-21). Guilt-proneness assessed in childhood predicted fewer sexual partners, less use of illegal drugs and alcohol, and less involvement with the criminal justice system. Shame-proneness, in contrast, was a risk factor for later deviant behavior. Shame-prone children were more likely to have unprotected sex and use illegal drugs in young adulthood. These results held when controlling for childhood SES and teachers' ratings of aggression. Children's moral emotional styles appear to be well established by at least middle childhood, with distinct downstream implications for risky behavior in early adulthood.

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.

Internet pornography use: perceived addiction, psychological distress, and the validation of a brief measure

The authors aimed to validate a brief measure of perceived addiction to Internet pornography refined from the 32-item Cyber Pornography Use Inventory, report its psychometric properties, and examine how the notion of perceived addiction to Internet pornography might be related to other domains of psychological functioning. To accomplish this, 3 studies were conducted using a sample of undergraduate psychology students, a web-based adult sample, and a sample of college students seeking counseling at a university's counseling center. The authors developed and refined a short 9-item measure of perceived addiction to Internet pornography, confirmed its structure in multiple samples, examined its relatedness to hypersexuality more broadly, and demonstrated that the notion of perceived addiction to Internet pornography is very robustly related to various measures of psychological distress. Furthermore, the relation between psychological distress and the new measure persisted, even when other potential contributors (e.g., neuroticism, self-control, amount of time spent viewing pornography) were controlled for statistically, indicating the clinical relevance of assessing perceived addiction to Internet pornography.

Two faces of group-based shame: moral shame and image shame differentially predict positive and negative orientations to ingroup wrongdoing

This article proposes distinctions between guilt and two forms of shame: Guilt arises from a violated norm and is characterized by a focus on specific behavior; shame can be characterized by a threatened social image (Image Shame) or a threatened moral essence (Moral Shame). Applying this analysis to group-based emotions, three correlational studies are reported, set in the context of atrocities committed by (British) ingroup members during the Iraq war (Ns = 147, 256, 399). Results showed that the two forms of shame could be distinguished. Moreover, once the other form of shame was controlled for, they were differentially related to orientations toward the outgroup: Image Shame was associated with negative orientations, whereas Moral Shame had associations with positive outgroup orientations. These associations were distinct from the associations of guilt and rejection. Study 3 used a longitudinal design and provided evidence suggestive of a causal direction from emotions to outgroup orientation.

Trauma Informed Guilt Reduction Therapy With Combat Veterans

Guilt related to combat trauma is highly prevalent among veterans returning from Iraq and Afghanistan. Trauma-related guilt has been associated with increased risk for posttraumatic psychopathology and poorer response to treatment. Trauma Informed Guilt Reduction (TrIGR) therapy is a 4-module cognitive-behavioral psychotherapy designed to reduce guilt related to combat trauma. The goals of this study were to describe the key elements of TrIGR and report results of a pilot study with 10 recently deployed combat veterans. Ten combat veterans referred from a VA Posttraumatic Stress Disorder (PTSD) or mental health clinic completed TrIGR over 4 to 7 sessions. Nine veterans completed the posttreatment assessment. This initial pilot suggests that TrIGR may help to reduce trauma-related guilt severity and associated distress. Changes in trauma-related guilt were highly correlated with reductions in PTSD and depression symptoms over the course of treatment, suggesting a possible mechanistic link with severity of posttraumatic psychopathology. TrIGR warrants further evaluation as an intervention for reducing guilt related to traumatic experiences in combat.

Interpersonal guilt in college student pathological gamblers

BACKGROUND

Interpersonal guilt is associated with psychopathology, but its relationship to pathological gambling has not been studied.

OBJECTIVES

This study examined the relationship between interpersonal guilt and pathological gambling.

METHODS

In total, 1979 college students completed a questionnaire containing the South Oaks Gambling Screen, Interpersonal Guilt Questionnaire, and questions about substance use. Students identified as pathological gamblers (n = 145) were matched to nonproblem gamblers with respect to demographics and substance use.

RESULTS

Pathological gamblers had significantly higher interpersonal guilt than their nonproblem gambling peers.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Pathological gambling college students have excessive interpersonal guilt, and these findings may lead to novel treatment approaches.

Shame, Guilt and Remorse: Implications for Offender Populations

The emotions shame and guilt may represent a critical stepping stone in the rehabilitation process. Often referred to as "moral" emotions owing to their presumed role in promoting altruistic behavior and inhibiting antisocial behaviors, shame and guilt provide potentially exciting points of intervention with offenders. In this article, we describe current psychological theory and research that underscores important differences between shame and guilt. We note parallels between psychologists' conceptions of guilt and shame, and criminologists' conceptions of reintegrative and disintegrative shaming. We summarize recent research investigating the implications of these moral emotions for criminal and risky behavior, with special emphasis on the handful of studies conducted with actual offenders. We conclude with a discussion of implications for treatment in criminal justice settings.

Interpersonelle Schuldgefühle und psychische Beeinträchtigung

Zusammenfassung. Theoretischer Hintergrund: Interpersonelle Schuldgefühle sind klinisch relevant, bisher aber kaum empirisch untersucht. Fragestellung: Es soll zur Validierung des “Fragebogens zu interpersonellen Schuldgefühlen“ (FIS) beigetragen werden. Methode: Zusammenhänge zwischen interpersonellen Schuldgefühlen (FIS) und psychischer Beeinträchtigung (Beck-Depressions-Inventar, SCL-90-R, U-Bogen-24, IIP-D) wurden an 308 PsychotherapiepatientInnen untersucht. Ergebnisse: Auf den Skalen Überlebensschuldgefühl, Schuldgefühl aus Verantwortung und Gesamtwert zeigten PsychotherapiepatientInnen höhere Werte als ProbandInnen einer repräsentativen Bevölkerungsstichprobe. Frauen gaben mehr Schuldgefühle an als Männer. Interpersonelle Schuldgefühle standen in positivem Zusammenhang mit psychischer Beeinträchtigung. PatientInnen gaben zum Therapieende niedrigere Werte für Trennungsschuldgefühl, Schuldgefühl aus Verantwortung und den Gesamtwert an als zu Therapiebeginn. Schlussfolgerungen: Der “Fragebogen zu interpersonellen Schuldgefühlen“ scheint eine klinisch relevante, valide und zeitökonomische Erfassung interpersoneller Schuldgefühle zu erlauben.

Managing depressive symptoms in the context of abstinence: findings from a qualitative study of women

PROBLEM

In both community and clinical studies, higher rates of co-occurring depression and substance use disorder have been found in women. Within the past decade, there has been a plethora of research addressing co-occurring depression and substance abuse. However, comparatively few studies include individuals who suffer with depressive symptoms, which may not meet specific diagnostic criteria despite the significant impairment they may experience.

METHOD

An ethnographic method was used to elicit the experiences of women dependent on alcohol and/or other substances and who have stopped drinking and/or using.

FINDINGS

Findings corroborated those from previous studies in which depressive symptoms preceded substance abuse and continued during sustained abstinence. Separation in services between mental health and substance abuse resulted in fragmented care.

CONCLUSION

Based on these findings, recommendations for screening, assessment, and treatment implications are forwarded.

Moral emotions and moral behavior

Moral emotions represent a key element of our human moral apparatus, influencing the link between moral standards and moral behavior. This chapter reviews current theory and research on moral emotions. We first focus on a triad of negatively valenced "self-conscious" emotions-shame, guilt, and embarrassment. As in previous decades, much research remains focused on shame and guilt. We review current thinking on the distinction between shame and guilt, and the relative advantages and disadvantages of these two moral emotions. Several new areas of research are highlighted: research on the domain-specific phenomenon of body shame, styles of coping with shame, psychobiological aspects of shame, the link between childhood abuse and later proneness to shame, and the phenomena of vicarious or "collective" experiences of shame and guilt. In recent years, the concept of moral emotions has been expanded to include several positive emotions-elevation, gratitude, and the sometimes morally relevant experience of pride. Finally, we discuss briefly a morally relevant emotional process-other-oriented empathy.

On the importance of distinguishing shame from guilt: relations to problematic alcohol and drug use

Previous research has demonstrated that shame-proneness (the tendency to feel bad about the self) relates to a variety of life problems, whereas guilt-proneness (the tendency to feel bad about a specific behavior) is more likely to be adaptive. The current analyses sought to clarify the relations of shame-proneness and guilt-proneness to substance use problems in three samples with differing levels of alcohol and drug problem severity: college undergraduates (Study 1 N=235, Study 2 N=249) and jail inmates (Study 3 N=332). Across samples, shame-proneness was generally positively correlated with substance use problems, whereas guilt-proneness was inversely related (or unrelated) to substance use problems. Results suggest that shame and guilt should be considered separately in the prevention and treatment of substance misuse.

Depressive symptoms, stress, and coping among women recovering from addiction

This article focuses on the variability in well-being of 102 women in continuous recovery from addiction for 1 to 5 years. Univariate and bivariate analyses of cross-sectional data on recent depressive symptomatology, and psychosocial stress and coping strategies before and during recovery yielded the following findings: (a) Nearly a third of the sample reported scores above the 16-point cut-off on the Center for Epidemiologic Studies Depression Scale, indicating risk for depression; (b) over half had a history of diagnosed depression; (c) perceived stress in 16 life domains significantly decreased from prerecovery to recovery; (d) by recovery, participants significantly increase their use of positive strategies, but they continued use some negative ones; and (e) risk for high depressive symptomatology was greatest among those who were married or cohabiting, had a history of clinical of depression, high perceived stress in areas of money and emotional and physical health. Findings are discussed in terms of their implications for treatment and aftercare.

Additional evidence for an association between the dopamine D4 receptor (D4DR) exon III seven-repeat allele and substance abuse in opioid dependent subjects: relationship of treatment retention to genotype and personality

The long form of the dopamine D4 receptor (D4DR) exon III repeat polymorphism has been linked in some but not all studies to impulsive, extravagant and novelty-seeking personality traits that are prominent in affiliated behaviours such as attention deficit disorder and substance abuse. In particular, we have reported previously an increased frequency of the long seven-repeat D4DR exon III allele in a group of 141 opioiddependent subjects compared to 110 control subjects. In order to further substantiate the role of D4DR in contributing to heroin addiction we have genotyped an additional, smaller cohort of opioid-dependent subjects. In this new group of 57 opioid-dependent subjects compared to an expanded group of 143 control subjects a significant difference was observed in overall genotype frequency (p=0.04). An excess of the seven-repeat allele of the D4DR receptor gene was also observed compared to control subjects (p=0.06). The frequency of the seven-repeat allele is 15.8% in the heroin addict population vs. 8.1% in the control group, conferring a relative risk of 2.07 (95% CI: 0.98-4.38). An association between two polymorphisms considered together (D4DR and dopamine D3 receptor) and treatment retention was observed (p=0.02). In a subgroup of 38 opioid-dependent subjects, who were successfully administered the TPQ, higher Harm Avoidance (p< 0.001) and Novelty Seeking (NS3; extravagant vs. reserved, p< 0.001) scores were found. In contrast to some previous reports, no relationship was apparent between TPQ scores and treatment retention in this small group of opioid-dependent subjects.