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Manera E, Mosti A, Passini S, Ambrosini F, Biolcati R. MANEMOS. The Trigger Situations Inventory. Validation of a Measure Helping Relapse Prevention in the Treatment of Alcohol Use Disorders. Subst Use Misuse 2023; 58:1574-1579. [PMID: 37475478 DOI: 10.1080/10826084.2023.2236204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Background: Relapse Prevention (RP) is a cognitive-behavioral approach that aims to identify situations at high risk of relapse and to support patients with alcohol use disorders (AUDs) in developing coping strategies for the maintenance of desired behavioral changes. Based on this framework, the present study aims to assess and validate the psychometric properties of the MANEMOS, a 24-item inventory of alcohol relapse triggering situations. Methods: The internal consistency and factor structure of the MANEMOS were analyzed in a sample of 313 (27.7% women) in-patients and out-patients, attending alcohol treatment programs in Italian addiction treatment facilities. Results: The results support the internal reliability and validity of the measure. A confirmative factor analysis has revealed the existence of eight distinct dimensions measuring relapse risk situations: namely, Pleasant emotions, Unpleasant emotions, Craving, Conflicts with others, Occasions, Social Pressure, Personal Control, and Physical Discomfort. The patients' assessment of the riskiness of the situation showed some significant differences depending on gender and on type of treatment received. Conclusions: The findings indicate that MANEMOS is a valid measure for identifying and reflecting on patients' high relapse-risk situations. This easy and flexible assessment measure may have important implications for prevention and clinical intervention.
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Affiliation(s)
- Ester Manera
- Servizio Multidisciplinare Integrato (SMI) Mago di Oz, Pisogne, BS, Italy
| | - Antonio Mosti
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Stefano Passini
- Department of Education Studies "G. M. Bertin", University of Bologna, Bologna, Italy
| | - Federica Ambrosini
- Department of Education Studies "G. M. Bertin", University of Bologna, Bologna, Italy
| | - Roberta Biolcati
- Department of Education Studies "G. M. Bertin", University of Bologna, Bologna, Italy
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Gratz KL, Myntti W, Mann AJD, Vidaña AG, Tull MT. Fear of compassion from others explains the relation between borderline personality disorder symptoms and ineffective conflict resolution strategies among patients with substance use disorders. Borderline Personal Disord Emot Dysregul 2022; 9:36. [PMID: 36567316 PMCID: PMC9791734 DOI: 10.1186/s40479-022-00207-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 12/08/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) pathology is common among patients with substance use disorders (SUDs) and associated with a variety of negative outcomes, including worse SUD outcomes. One particularly relevant outcome with links to substance use problems that is likely to be elevated among SUD patients with BPD symptoms is ineffective conflict resolution strategies in romantic relationships. However, no research to date has examined the relation of BPD pathology to strategies for managing conflict in romantic relationships among patients with SUDs, or the factors that may increase the use of ineffective strategies within this population. Thus, this study examined the relations of BPD symptoms to ineffective responses to romantic relationship conflict surrounding substance use among residential patients with SUDs, as well as the explanatory roles of fear of compassion from and for others in these relations. METHODS Patients in a community-based correctional SUD residential treatment facility (N = 93) completed questionnaires, including a measure of BPD symptoms, fear of compassion from and for others, and strategies for responding to conflict surrounding substance use in romantic relationships. RESULTS Fear of compassion from others accounted for significant variance in the relations of BPD symptoms to the ineffective conflict resolution strategies of reactivity, domination, and submission, whereas fear of compassion for others only accounted for significant variance in the relation between BPD symptoms and the strategy of separation (which is not always ineffective). CONCLUSIONS Together, findings suggest that it is fear of compassion from others (vs. fear of compassion for others) that explains the relation between BPD symptoms and ineffective responses to romantic relationship conflict surrounding substance use among SUD patients. Findings highlight the potential utility of interventions aimed at reducing fears of compassion and increasing comfort with and tolerance of compassion from both others and oneself among SUD patients with BPD symptoms in order to strengthen relationships and reduce risk for relapse.
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Affiliation(s)
- Kim L Gratz
- Department of Psychology, University of Toledo, 2801 West Bancroft Street, Toledo, OH, 43606, USA.
| | - Warner Myntti
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | - Adam J D Mann
- Department of Psychology, University of Toledo, 2801 West Bancroft Street, Toledo, OH, 43606, USA
| | - Ariana G Vidaña
- Department of Psychology, University of Toledo, 2801 West Bancroft Street, Toledo, OH, 43606, USA
| | - Matthew T Tull
- Department of Psychology, University of Toledo, 2801 West Bancroft Street, Toledo, OH, 43606, USA
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Salvatore JE, Larsson Lönn S, Sundquist J, Kendler KS, Sundquist K. Social genetic effects for drug use disorder among spouses. Addiction 2022; 118:880-889. [PMID: 36494088 DOI: 10.1111/add.16108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022]
Abstract
AIMS Preclinical and human studies suggest that a social partner's genotype may be associated with addiction-related outcomes. This study measured whether spousal genetic makeup is associated with risk of developing drug use disorder (DUD) during marriage and whether the risk associated with a spouse's genotype could be disentangled from potentially confounding rearing environmental effects. DESIGN Univariable and multivariable logistic regression analyses. SETTING Sweden. PARTICIPANTS Men and women born between 1960 and 1990 and in opposite-sex first marriages before age 35 (n = 294 748 couples). MEASUREMENTS Outcome was DUD diagnosis (inclusive of opioids, sedatives/hypnotics/anxiolytics, cocaine, cannabis, amphetamine and other psychostimulants, hallucinogens, other drugs of abuse and combinations thereof) obtained from legal, medical and pharmacy registries. The focal predictor was family genetic risk scores for DUD (FGRS-DUD), which were inferred from diagnoses in first- through fifth-degree relatives and weighted by degree of genetic sharing. FGRS-DUD were calculated separately for each partner in a couple. FINDINGS Marriage to a spouse with a high FGRS-DUD was associated with increased risk of developing DUD during marriage, ORmales = 1.68 (95% CI = 1.50, 1.88) and ORfemales = 1.35 (1.16, 1.56), above and beyond the risk associated with one's own FGRS-DUD. The risk associated with a spouse's FGRS-DUD remained statistically significant after covarying for parental education. As indicated by a series of null interaction effects, there was no evidence that the risk associated with a spouse's FGRS-DUD differed depending on whether the spouse was DUD-affected, probands' probable contact with in-laws and whether the spouse was raised by his/her biological parents or in another home. CONCLUSIONS There is relatively robust evidence that a person's risk for developing drug use disorder is associated with the genetic makeup of the person's spouse.
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Affiliation(s)
- Jessica E Salvatore
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Sara Larsson Lönn
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Kenneth S Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA.,Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA.,Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
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Hernandez M, Barrio C, Helu-Brown P, Lim C, Gaona L. Substance Use in Relation to Mental Illness: A Study of Mexican-Origin Latinos with Schizophrenia and Their Family Members. HEALTH & SOCIAL WORK 2022; 47:175-183. [PMID: 35708649 PMCID: PMC9280320 DOI: 10.1093/hsw/hlac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/21/2021] [Accepted: 06/02/2021] [Indexed: 06/15/2023]
Abstract
Little is known about family context and substance use behaviors among Latinos with schizophrenia. Learning about patient and family caregiver perceptions of use is critical to our understanding of how best to support these vulnerable patients and family caregivers. This study explored perceptions of substance use in relation to mental illness among Latinos primarily of Mexican origin with schizophrenia and their family caregivers. Semistructured interviews were conducted with 34 participants (20 family caregivers; 14 patients) with direct and indirect substance use experience, in their preferred language. Data were analyzed using thematic analysis, which consisted of comparing codes across and within patient and family caregiver transcripts. Findings revealed that substance use affected well-being, particularly patient recovery and caregiver burden. Strategies to address well-being included limiting substance use, being vigilant about patient use, and communicating the negative impact of use. The environmental impact and stigma of substance use were major contextual challenges. Patients addressed these by limiting their socialization. Family social context was important to how substance use was perceived and managed by patients and caregivers. As such, treatment models should consider a holistic perspective that incorporates family context when addressing substance use among Latinos with schizophrenia.
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Ashrafioun L, Allan NP, Stecker TA. Opioid use disorder and its association with self-reported difficulties participating in social activities. Am J Addict 2021; 31:46-52. [PMID: 34472669 DOI: 10.1111/ajad.13220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Difficulties participating in social activities are associated with increased mortality and are underemphasized in addressing the opioid epidemic. This study assessed the association of difficulties participating in social activities and opioid use disorder (OUD) and suicidal ideation and suicide attempts and difficulties participating in social activities among individuals with OUD. METHODS Data on OUD, difficulties participating in social activities, suicidal ideation, suicide attempts, and other characteristics were assessed in 398,962 respondents from the 2008-2017 National Survey of Drug Use and Health. Logistic regressions examined the association of difficulties participating in social activities and OUD, and then among only respondents with OUD, difficulties participating in social activities and suicidal ideation and suicide attempts. RESULTS Respondents with OUD reported higher levels of difficulties participating in social activities compared with respondents without OUD (severe difficulties: odds ratio [OR] = 4.10, 95% confidence interval [CI] = 3.40-4.93). Among those with OUD, difficulties participating in social activities were associated with suicidal ideation (severe difficulties: OR = 2.45, 95% CI = 1.77-3.38), but not attempts. CONCLUSION AND SCIENTIFIC SIGNIFICANCE The findings indicate that people with OUD experience difficulties participating in social activities and these difficulties are associated with suicidal ideation. It may be important to address difficulties participating in social activities within the context of OUD treatment, potentially as it relates to suicide prevention. This is the first study utilizing 10 years of nationally representative data to assess difficulties participating in social activities, OUD, and suicidal ideation and suicide attempts. Difficulties participating in social activities represent an under-addressed, potentially important therapeutic target to address OUD.
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Affiliation(s)
- Lisham Ashrafioun
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry, Rochester, New York, USA.,VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York, USA
| | - Nicholas P Allan
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York, USA.,Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Tracy A Stecker
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York, USA.,Office of Research, School of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
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Soto-Nevarez A, Reilly A, Stevens E, Bobak TJ, Jason LA. Individuals in sober living: Effects of contact with substance using family members. J Prev Interv Community 2021; 50:124-136. [PMID: 34096471 DOI: 10.1080/10852352.2021.1934943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examines the effects that substance-using family members have on those working to maintain recovery from substance use disorder. Participants (N = 229) were recruited from Oxford Houses (OH) across North Carolina, Texas, and Oregon. A stepwise linear regression with variables including abstinence self-efficacy, gender, substance use, attendance of Alcoholics Anonymous, and conflict with family and non-family was run to examine associations between the amount of substance using family members in the participant's social network. The abstinence self-efficacy mean score, gender, and days of serious conflict with non-family members were significantly associated with total number of substance-using family members in a participant's social network. These results may indicate that OH's serve as a buffer between substance using family members and one's abstinence self-efficacy. It remains unclear if individuals are at an increased risk of relapse from this familial influence when perceived abstinence self-efficacy drops. If so, OH residents could benefit from interventions that help them maintain their perceived abstinence self-efficacy.
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Affiliation(s)
| | - Angela Reilly
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Ed Stevens
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Ted J Bobak
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Leonard A Jason
- Center for Community Research, DePaul University, Chicago, Illinois, USA
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Schwaninger P, Lüscher J, Berli C, Scholz U. Daily support seeking as coping strategy in dual-smoker couples attempting to quit. Psychol Health 2021; 37:811-827. [PMID: 34019454 PMCID: PMC9344997 DOI: 10.1080/08870446.2021.1913157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Smoking cessation is a stressful event and lapses are frequent. The dynamic model of relapse has been criticized for not integrating interpersonal factors as phasic influences. Seeking social support, as a coping strategy to deal with cravings, may help to refrain from smoking. DESIGN Overall, 83 heterosexual dual-smoker couples reported on their craving, the extent of seeking social support from one's partner regarding smoking cessation, and their number of cigarettes smoked in smartphone-based end-of-day diaries, from a joint self-set quit date on across 22 consecutive days. MAIN OUTCOME MEASURE Number of cigarettes smoked. RESULTS Multilevel analyses indicated that on days with higher-than-average levels of craving, male and female smokers reported more cigarettes smoked. Higher-than-usual support seeking was related to fewer cigarettes smoked that same day. For women only, we found a within-person interaction between craving and support seeking on smoking. On days with higher-than-average support-seeking, the effect of craving on smoking was attenuated. CONCLUSION Findings confirm the relevance of interpersonal processes in the relapse process, such as support seeking as coping behavior. Further, as a 'first act' in initiating supportive interactions, support seeking is an important piece in the social support process and a promising target for interventions.
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Affiliation(s)
| | - Janina Lüscher
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Corina Berli
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Urte Scholz
- Department of Psychology, University of Zurich, Zurich, Switzerland
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Effects of family functioning on relapse among individuals with drug addiction in compulsory isolation: a chained mediation model. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01561-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Maurage P, Pabst A, Lannoy S, D'Hondt F, de Timary P, Gaudelus B, Peyroux E. Tackling heterogeneity: Individual variability of emotion decoding deficits in severe alcohol use disorder. J Affect Disord 2021; 279:299-307. [PMID: 33096328 PMCID: PMC7738413 DOI: 10.1016/j.jad.2020.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/02/2020] [Accepted: 10/11/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Severe alcohol use disorder (SAUD) is associated with social cognition deficits. Patients with SAUD are impaired for the recognition of emotional facial expressions, particularly at early stages of abstinence. These deficits damage interpersonal relations and increase relapse risk. However, uncertainties still abound on their variation across emotions and on the heterogeneity of emotional impairments across patients. We addressed these questions by exploring how the deficit varies according to emotions' type/intensity and patients' heterogeneity. METHODS Sixty-five recently detoxified patients with SAUD and 65 matched healthy controls performed the Facial Emotion Recognition Test, assessing the ability to identify six emotions (anger, contempt, disgust, fear, happiness, sadness) displayed by morphed faces with various intensities. Accuracy scores and detection thresholds were collected for each emotion. Beyond group comparisons, multiple single-case analyses determined the percentage of patients presenting decoding deficits for each emotion. RESULTS When current depression and anxiety symptoms were controlled for, patients did not present a general emotion decoding deficit, but were rather characterized by specific deficits for disgust/contempt in accuracy, and for disgust in detection threshold scores. Single-case analyses showed that only a third of patients presented a clinically significant emotional deficit. CONCLUSIONS Patients with SAUD only present emotional decoding deficits for specific interpersonal emotions (disgust/contempt) when subclinical psychopathological states are controlled for, and show no general emotional impairment. This goes against the proposal of a generalized social cognition deficit in this population. This group effect moreover masks a massive heterogeneity across patients, which has implications at experimental and clinical levels.
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Affiliation(s)
- Pierre Maurage
- Louvain Experimental Psychopathology research group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium.
| | - Arthur Pabst
- Louvain Experimental Psychopathology research group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Séverine Lannoy
- Louvain Experimental Psychopathology research group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium; Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA
| | - Fabien D'Hondt
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France; CHU Lille, Clinique de Psychiatrie, CURE, Lille, France; Centre National de Ressources et de Résilience Lille-Paris (CN2R), Lille, France
| | - Philippe de Timary
- Louvain Experimental Psychopathology research group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium; Department of Adult Psychiatry, Saint-Luc Academic Hospital & Institute of Neuroscience, UCLouvain, Brussels, Belgium
| | - Baptiste Gaudelus
- Centre de Neurosciences Cognitives, UMR 5229, CNRS, Bron, France; Service Universitaire de Réhabilitation, SUR-CL3R, Centre Hospitalier Le Vinatier, Lyon, France
| | - Elodie Peyroux
- Centre de Neurosciences Cognitives, UMR 5229, CNRS, Bron, France; Service Universitaire de Réhabilitation, SUR-CL3R, Centre Hospitalier Le Vinatier, Lyon, France
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Knapp KS, Bunce SC, Brick TR, Deneke E, Cleveland HH. Daily associations among craving, affect, and social interactions in the lives of patients during residential opioid use disorder treatment. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 35:609-620. [PMID: 33090811 DOI: 10.1037/adb0000612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study captured the interrelationships among craving, negative affect, and positive and negative social exchanges in the daily lives of patients in residential treatment for opioid use disorders (OUDs). METHOD Participants were 73 patients (77% male), age 19 to 61 (Mage = 30.10, SDage = 10.13) in residential treatment for OUD. Participants completed a smartphone-based survey 4 times per day for 12 consecutive days that measured positive and negative social exchanges (Test of Negative Social Exchange), negative affect (PA-NA scales), and craving (frequency and intensity). Within-person, day-level associations among daily positive and negative social exchanges, negative affect, and craving were examined using multilevel modeling. RESULTS Daily negative social exchanges (M = 1.44, SD = 2.27) were much less frequent than positive social exchanges (M = 6.59, SD = 4.00) during residential treatment. Whereas negative social exchanges had a direct association with same-day craving (β = 0.08; 95% CI = 0.01, 0.16, ΔR2 = 0.01), positive social exchanges related to craving indirectly via moderation of the within-person negative affect-craving link (β = -0.01; 95% CI = -0.01, -0.001, ΔR2 = 0.002). Positive social exchanges decoupled the same-day linkage between negative affect and craving on days when individuals had at least four more positive social exchanges than usual. CONCLUSIONS These results indicate that both negative affect and negative social exchanges are uniquely related to craving on a daily basis, and that extra positive social interactions can reduce the intraindividual coupling of negative affect and craving during residential treatment for OUD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Hernandez M, von Sternberg K, Velasquez MM. Alcohol use and problems among Latinas at risk of an alcohol-exposed pregnancy: The role of acculturation and interpersonal factors. J Ethn Subst Abuse 2020; 21:425-438. [PMID: 32538710 DOI: 10.1080/15332640.2020.1777609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Path analysis was used to examine the role of acculturation, helping relationships, partner status, age, and education on heavy drinking and alcohol problems among 119 Latina adults at risk of an alcohol-exposed pregnancy (AEP). Greater acculturation was positively related to more helping relationships and heavy drinking, and there was an indirect positive relationship between acculturation and alcohol problems. There was also a positive relationship between helping relationships and alcohol problems, and a negative relationship between helping relationships and being partnered. Knowledge of the mechanisms by which acculturation and interpersonal factors influence behavior change can inform potential targets for intervention among Latinas with AEP risk.
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Affiliation(s)
- Mercedes Hernandez
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Kirk von Sternberg
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Mary M Velasquez
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
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Liu Y, Kornfield R, Shaw BR, Shah DV, McTavish F, Gustafson DH. Giving and receiving social support in online substance use disorder forums: How self-efficacy moderates effects on relapse. PATIENT EDUCATION AND COUNSELING 2020; 103:1125-1133. [PMID: 31901364 PMCID: PMC7253337 DOI: 10.1016/j.pec.2019.12.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/18/2019] [Accepted: 12/21/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Individuals in recovery for substance use disorders (SUDs) increasingly use online social support forums, necessitating research on how communicating through these forums can affect recovery. This study examines how giving and receiving support within an SUDs recovery forum predict substance use, and considers whether effects vary according to participants' self-efficacy. METHODS We applied content analysis to 3440 messages that were posted by 231 participants in an online SUDs forum. Surveys assessed social support reception and substance use at three timepoints. We assessed relationships between giving and receiving support and substance use (risky drinking days, illicit drug use days), and the interactions between self-efficacy and social support in predicting substance use outcomes. RESULTS Receiving more emotional support was associated with reduced illicit drug use at 6 and 12 months. For those with low self-efficacy, giving more emotional support predicted less risky drinking at month 12, whereas giving more informational support predicted more risky drinking at month 12. CONCLUSION These results suggest conditional benefits of exchanging support in an online SUDs forum, depending upon type of support (informational versus emotional), the participants' role (giver or receiver), and their self-efficacy. PRACTICE IMPLICATIONS We discuss implications for designing and using peer-to-peer support platforms.
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Affiliation(s)
- Yan Liu
- School of Journalism & Communication, Shanghai University, Shanghai, 200072, China.
| | - Rachel Kornfield
- Department of Communication Studies, Northwestern University, Evanston, IL, 60208, USA
| | - Bret R Shaw
- Department of Life Sciences Communication, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Dhavan V Shah
- School of Journalism & Mass Communication, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Fiona McTavish
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - David H Gustafson
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA
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Villalba K, Cook C, Dévieux JG, Ibanez GE, Oghogho E, Neira C, Cook RL. Facilitators and barriers to a contingency management alcohol intervention involving a transdermal alcohol sensor. Heliyon 2020; 6:e03612. [PMID: 32258468 PMCID: PMC7103775 DOI: 10.1016/j.heliyon.2020.e03612] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/20/2019] [Accepted: 02/10/2020] [Indexed: 11/03/2022] Open
Abstract
Research on contingency management is limited due to feasibility issues with monitoring adherence. Incentives usually depend on objective measures to verify compliance; therefore, biological markers for identifying alcohol use are not as dependable for the use of financial contingency studies. The Secure Continuous Remote Alcohol Monitor (SCRAM) is an objective alcohol biosensor that can be locked onto a person's ankle to address these limitations. In preparation for a large, contingency management study for HIV-positive and HIV-negative persons with heavy drinking, the aims for the study were to (1) explore barriers and facilitators to participating in a contingency management intervention using the SCRAM ankle monitor as the potential alcohol measure for the intervention; (2) explore levels of appropriate compensation for using the SCRAM and for study assessments as part of a contingency management intervention study; and (3) attitudes and beliefs on lifestyle changes as a consequence of wearing the SCRAM among HIV-positive and HIV-negative heavy drinkers in Florida. Five focus groups were conducted and we collected qualitative data from thirty-seven individuals (18 men; 19 women). During the analysis, six themes were identified as barriers and facilitators for participation in a contingency management intervention using the SCRAM sensor to measure alcohol use: (1) health assessment, (2) monetary incentives including payment structure and levels of compensation, (3) stigma associated with wearing the SCRAM sensor, (4) aesthetics and other related concerns with wearing the SCRAM sensor, (5) motivation to stop drinking, and (6) social support. Stigma was a major barrier for wearing the SCRAM sensor; however, if participants were motivated to change their behavior then the monetary incentives became a facilitator to wearing the sensor. In addition to the financial contingency method, social support may further increase the odds for participants to change their behaviors.
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Affiliation(s)
- Karina Villalba
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Christa Cook
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Jessy G Dévieux
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Gladys E Ibanez
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Etinosa Oghogho
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Camila Neira
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
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Cavicchioli M, Ramella P, Vassena G, Simone G, Prudenziati F, Sirtori F, Movalli M, Maffei C. Dialectical behaviour therapy skills training for the treatment of addictive behaviours among individuals with alcohol use disorder: the effect of emotion regulation and experiential avoidance. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:368-384. [PMID: 31990583 DOI: 10.1080/00952990.2020.1712411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUNDS Dialectical behavior therapy skills training (DBT-ST) is an effective treatment for alcohol use disorder (AUD). AUD frequently co-occurs with other addictive behaviors. OBJECTIVE s: These secondary analyses of prior studies on the effectiveness of a 3-month DBT-ST program for AUD investigated pre- post-treatment changes in the severity of concurrent addictive behaviors. The study hypothesized that emotion regulation and experiential avoidance should be the key therapeutic mechanisms involved in the treatment of addictive behaviors. METHODS The research included 186 individuals (110 males; 76 females) with a primary diagnosis of AUD. Mediational models were performed considering shorter PROMIS questionnaire subscales (i.e., gambling, sex, shopping, food binging, and starvation) as dependent variables. The difficulties in emotion regulation scale and acceptance and action questionnaire-II total scores were independent and mediator variables, respectively. RESULTS Clinical variables significantly improved during the treatment, independent of baseline levels. Changes in emotion regulation showed significant total effects on improvements in addictive behaviors. Significant indirect effects of changes in experiential avoidance were detected considering compulsive buying and dysfunctional eating behaviors. CONCLUSION The DBT-ST was a feasible treatment for several addictive behaviors frequently reported by individuals with AUD. The improvements in emotion regulation and experiential avoidance were relevant therapeutic mechanisms involved in the treatment of these conditions. Future controlled trials and follow-up studies are recommended to support the efficacy of DBT-ST as a stand-alone intervention for the treatment of different classes of addictive behaviors.
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Affiliation(s)
- Marco Cavicchioli
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Pietro Ramella
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Giulia Vassena
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Giulia Simone
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Francesca Prudenziati
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Federica Sirtori
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Mariagrazia Movalli
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Cesare Maffei
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
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Sliedrecht W, de Waart R, Witkiewitz K, Roozen HG. Alcohol use disorder relapse factors: A systematic review. Psychiatry Res 2019; 278:97-115. [PMID: 31174033 DOI: 10.1016/j.psychres.2019.05.038] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022]
Abstract
A relapsing-remitting course is very common in patients with an Alcohol Use Disorder (AUD). Understanding the determinants associated with alcohol resumption remains a formidable task. This paper examines relapse determinants based on a systematic review of recent alcohol literature (2000-2019). Relevant databases were consulted for articles that contained information about specific relapse determinants and reported statistical significance of each relapse determinant in predicting relapse. Relapse was broadly defined based on the characterization in the included articles. From the initial identified 4613 papers, a total of 321 articles were included. Results encompass multiple relapse determinants, which were ordered according to biopsychosocial and spiritual categories, and presented, using a descriptive methodology. Psychiatric co-morbidity, AUD severity, craving, use of other substances, health and social factors were consistently significantly associated with AUD relapse. Conversely, supportive social network factors, self efficacy, and factors related to purpose and meaning in life, were protective against AUD relapse. Despite heterogeneity in different methods, measures, and sample characteristics, these findings may contribute to a better therapeutic understanding in which specific factors are associated with relapse and those that prevent relapse. Such factors may have a role in a personalized medicine framework to improve patient outcomes.
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Affiliation(s)
- Wilco Sliedrecht
- De Hoop GGZ, Provincialeweg 70, 3329 KP Dordrecht, the Netherlands.
| | - Ranne de Waart
- Mentrum/Arkin, Wisselwerking 46-48, 1112 XR Diemen, the Netherlands.
| | - Katie Witkiewitz
- The University of New Mexico (UNM), MSC 03-2220, Univ of New Mexico, Albuquerque, NM 87131, USA.
| | - Hendrik G Roozen
- The University of New Mexico (UNM), Center on Alcoholism, Substance Abuse, and Addictions (CASAA), MSC 11 6280, 1 Univ of New Mexico, Albuquerque, NM 87106, USA.
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Permut M, Greene P, Stevens E, Jason L. Gender Differences in the Association Between Romantic Relationships and Relapse Among Individuals in Early Recovery in Oxford House. ALCOHOLISM TREATMENT QUARTERLY 2019. [DOI: 10.1080/07347324.2018.1544057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Magda Permut
- Department of Psychology, University of Maryland Baltimore County, Baltimore, Maryland, USA
| | | | - Ed Stevens
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Leonard Jason
- Center for Community Research, DePaul University, Chicago, Illinois, USA
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17
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Alcohol Abstinence Prediction on the Basis of Conservation of Resources Theory by Stevan E. Hobfoll a Study of Polish Alcohol-Dependent Persons in the Early Phase of Recovery. PSYCH 2019. [DOI: 10.3390/psych1010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Striving for permanent alcohol abstinence can be difficult to achieve or even impossible, which in turn often results in discontinuation of treatment. The main area of interest among researchers dealing with the problem of alcohol dependence is the ability to maintain abstinence. Despite numerous studies in this area, there is still no unambiguous data on the factors affecting the recovery process of alcohol-dependent persons. The main goal of this publication is to present the Conservation of Resources Theory (COR) by S. Hobfoll as an alternative concept to understanding alcohol dependence and to answer whether maintaining abstinence can be predicted, and what kind of resources play a key role in alcohol dependence recovery. A series of two comparisons of independent variables (level, gain and loss of resources) were made in the first and sixth month after the beginning of therapy. Questionnaire longitudinal studies of 350 alcohol-dependent persons were used. Research results show that distribution of resources is of great significance in maintaining abstinence. It is important for the alcohol-dependent person’s recovery process to have the opportunity to gain resources. Experiencing loss of resources in the beginning of treatment often determines their return to drinking. The project provides empirical support for research on the role of supportive factors in an alcohol-dependent person’s recovery process.
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Hsiao YY, Tofighi D, Kruger ES, Lee Van Horn M, MacKinnon DP, Witkiewitz K. The (Lack of) Replication of Self-Reported Mindfulness as a Mechanism of Change in Mindfulness-Based Relapse Prevention for Substance Use Disorders. Mindfulness (N Y) 2019; 10:724-736. [PMID: 30931014 PMCID: PMC6435335 DOI: 10.1007/s12671-018-1023-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The development and evaluation of mindfulness-based interventions for a variety of psychological and medical disorders has grown exponentially over the past 20 years. Yet, calls for increasing the rigor of mindfulness research and recognition of the difficulties of conducting research on the topic of mindfulness have also increased. One of the major difficulties is the measurement of mindfulness, with varying definitions across studies and ambiguity with respect to the meaning of mindfulness. There is also concern about the reproducibility of findings given few attempts at replication. The current secondary analysis addressed the issue of reproducibility and robustness of the construct of self-reported mindfulness across two separate randomized clinical trials of mindfulness-based relapse prevention (MBRP), as an aftercare treatment for substance use disorder. Specifically, we tested the robustness of our previously published findings, which identified a latent construct of mindfulness as a significant mediator of the effect of MBRP on reducing craving following treatment. First, we attempted to replicate the findings in a separate randomized clinical trial of MBRP. Second, we conducted sensitivity analyses to test the assumption of the no-omitted confounder bias in a mediation model. The effect of MBRP on self-reported mindfulness and overall mediation effect failed to replicate in a new sample. The effect of self-reported mindfulness in predicting craving following treatment did replicate and was robust to the no-omitted confounder bias. The results of this work shine a light on the difficulties in the measurement of mindfulness and the importance of examining the robustness of findings.
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Byrne SP, Haber P, Baillie A, Giannopolous V, Morley K. Cue Exposure Therapy for Alcohol Use Disorders: What Can Be Learned from Exposure Therapy for Anxiety Disorders? Subst Use Misuse 2019; 54:2053-2063. [PMID: 31259660 DOI: 10.1080/10826084.2019.1618328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Cue Exposure Therapy (CET) has shown efficacy for treating alcohol use disorders (AUDs). Exposure therapy is highly effective for treating anxiety. Both techniques involve repeated, controlled exposures to alcohol or fear-related stimuli. Objectives: We considered the mechanisms of CET for AUDs by comparing it to exposure therapy for anxiety. Method: We conducted a narrative review contrasting theoretical literature examining the mechanisms of CET versus exposure therapy for anxiety. We reviewed RCTs and acute laboratory paradigms examining CET for AUDs. We considered common areas of emerging research, including the use of d-Cycloserine (DCS) and virtual reality (VR). Results: We found evidence that exposure therapy and CET at least partially achieve their effects through extinction learning. We found evidence that CET for AUDs is effective, with comparable benefits to other effective psychosocial treatments. DCS and VR have shown some limited success for augmenting CET for AUDs, so further research is needed to determine their value. Conclusions: There are theoretical and practical similarities between exposure to fear cues and cues of addiction, especially regarding extinction learning. However, these processes are also unique, particularly regarding the differing motivational properties of fear versus reward-related stimuli. We propose that unlike exposure for anxiety, CET takes effect by increasing self-control with each unreinforced exposure. We consider reasons for CET's limited use for AUDs, including its lower acceptability to clients and clinicians. We also note the limited evidence for CET for other substance use disorders, highlighting the need for continued investigation into its mechanisms and efficacy.
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Affiliation(s)
- Simon P Byrne
- Discipline of Addiction Medicine, National Health and Medical Research Centre of Research Excellence in Mental Health and Substance Use, University of Sydney , New South Wales , Australia
| | - Paul Haber
- Discipline of Addiction Medicine, National Health and Medical Research Centre of Research Excellence in Mental Health and Substance Use, University of Sydney , New South Wales , Australia.,Drug Health Services, Royal Prince Alfred Hospital , Sydney , New South Wales , Australia
| | - Andrew Baillie
- Discipline of Addiction Medicine, National Health and Medical Research Centre of Research Excellence in Mental Health and Substance Use, University of Sydney , New South Wales , Australia.,Faculty of Health Sciences, National Health and Medical Research Centre of Excellence, University of Sydney , New South Wales , Australia
| | - Vickie Giannopolous
- Discipline of Addiction Medicine, National Health and Medical Research Centre of Research Excellence in Mental Health and Substance Use, University of Sydney , New South Wales , Australia
| | - Kirsten Morley
- Discipline of Addiction Medicine, National Health and Medical Research Centre of Research Excellence in Mental Health and Substance Use, University of Sydney , New South Wales , Australia
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20
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Kornfield R, Toma CL, Shah DV, Moon TJ, Gustafson DH. What Do You Say Before You Relapse? How Language Use in a Peer-to-peer Online Discussion Forum Predicts Risky Drinking among Those in Recovery. HEALTH COMMUNICATION 2018; 33:1184-1193. [PMID: 28792228 PMCID: PMC6059378 DOI: 10.1080/10410236.2017.1350906] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Increasingly, individuals with alcohol use disorder (AUD) seek and provide support for relapse prevention in text-based online environments such as discussion forums. This paper investigates whether language use within a peer-to-peer discussion forum can predict future relapse among individuals treated for AUD. A total of 104 AUD sufferers who had completed residential treatment participated in a mobile phone-based relapse-prevention program, where they communicated via an online forum over the course of a year. We extracted patterns of language use on the forum within the first four months on study using Linguistic Inquiry and Word Count (LIWC), a dictionary-based text analysis program. Participants reported their incidence of risky drinking via a survey at 4, 8, and 12 months. A logistic regression model was built to predict the likelihood that individuals would engage in risky drinking within a year based on their language use, while controlling for baseline characteristics and rates of utilizing the mobile system. Results show that all baseline characteristics and system use factors explained just 13% of the variance in relapse, whereas a small number of linguistic cues, including swearing and cognitive mechanism words, accounted for an additional 32% of the total 45% of variance in relapse explained by the model. Effective models for predicting relapse are needed. Messages exchanged on AUD forums could provide an unobtrusive and cost-effective window into the future health outcomes of AUD sufferers, and their psychological underpinnings. As online communication expands, models that leverage user-submitted text toward predicting relapse will be increasingly scalable and actionable.
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Affiliation(s)
- Rachel Kornfield
- a School of Journalism and Mass Communication , University of Wisconsin-Madison
| | - Catalina L Toma
- b Department of Communication Arts , University of Wisconsin-Madison
| | - Dhavan V Shah
- a School of Journalism and Mass Communication , University of Wisconsin-Madison
| | - Tae Joon Moon
- a School of Journalism and Mass Communication , University of Wisconsin-Madison
| | - David H Gustafson
- c Department of Industrial and Systems Engineering , University of Wisconsin-Madison
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21
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Cox S, Bertoux M, Turner JJD, Moss A, Locker K, Riggs K. Aspects of alcohol use disorder affecting social cognition as assessed using the Mini Social and Emotional Assessment (mini-SEA). Drug Alcohol Depend 2018; 187:165-170. [PMID: 29674250 DOI: 10.1016/j.drugalcdep.2018.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Alcohol Use Disorder (AUD) is associated with problems with processing complex social scenarios. Little is known about the relationship between distinct AUD-related factors (e.g., years of problematic drinking), aspects of cognitive function and dysfunction in individuals diagnosed with AUD, and the relative impact these may have on social cognition. AIMS To explore differences in social cognition between a group of participants diagnosed with AUD and controls, using a clinical measure, the Mini Social and Emotional Assessment (mini-SEA). The mini-SEA was used to evaluate social and emotional understanding through a facial emotional recognition task and by utilising a series of social scenes some of which contain a faux pas (social error). METHODS Eighty-five participants (individuals with AUD and controls) completed demographic questions and a general cognitive and social cognitive test battery over three consecutive days. RESULTS Between group analyses revealed that the participants with AUD performed less well on the faux pas test, and differences were also revealed in the emotional facial recognition task. Years of problematic alcohol consumption was the strongest predictor of poor ToM reasoning. CONCLUSION These results suggest a strong link between AUD chronicity and social cognition, though the direction of this relationship needs further elucidation. This may be of clinical relevance to abstinence and relapse management, as basic social cognition skills and ability to maintain interpersonal relationships are likely to be crucial to recovery.
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Affiliation(s)
- Sharon Cox
- London South Bank University, Centre for Addictive Behaviours Research, Division of Psychology, 103 Borough Road, London, SE1 0AA, UK
| | - Maxime Bertoux
- Lille University Hospital, Memory Research and Resources centre & INSERM, U1171, France
| | - John J D Turner
- University of East London, School of Psychology, Water Lane, London, E15 4LZ, UK.
| | - Antony Moss
- London South Bank University, Centre for Addictive Behaviours Research, Division of Psychology, 103 Borough Road, London, SE1 0AA, UK
| | - Kirsty Locker
- Oxleas NHS Foundation Trust, Pinewood Place, Dartford, Kent, DA2 7WG, UK
| | - Kevin Riggs
- University of Hull, Department of Psychology, Cottingham Road, Hull, HU6 7RX, UK
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22
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Young LB, Grant KM, Pulido RD, Simpson JL, Tyler KA, Timko C. Intensive Referral of Veterans to Mutual-Help Groups: A Mixed-Methods Implementation Evaluation. ALCOHOLISM TREATMENT QUARTERLY 2018; 36:179-201. [DOI: 10.1080/07347324.2017.1407224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lance Brendan Young
- Communication Department, Western Illinois University-Quad Cities, Moline, Illinois, USA
| | - Kathleen M. Grant
- VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Jamie L. Simpson
- Psychology Department, Midland University, Fremont, Nebraska, USA
| | - Kimberly A. Tyler
- Sociology Department, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA
- Stanford University School of Medicine, Stanford, California, USA
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Abstract
Addiction and related disorders are chronic lapsing and relapsing disorders where the combination of long term pharmacological and psychosocial managements are the mainstay approaches of management. Among the psychosocial interventions, the Relapse Prevention (RP), cognitive-behavioural approach, is a strategy for reducing the likelihood and severity of relapse following the cessation or reduction of problematic behaviours. Here the assessment and management of both the intrapersonal and interpersonal determinants of relapse are undertaken. This article discusses the concepts of relapse prevention, relapse determinants and the specific interventional strategies.
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Affiliation(s)
- Jayakrishnan Menon
- Centre for Addiction Medicine, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Arun Kandasamy
- Centre for Addiction Medicine, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
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24
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Hallgren KA, McCrady BS, Caudell TP, Witkiewitz K, Tonigan JS. Simulating drinking in social networks to inform alcohol prevention and treatment efforts. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:763-774. [PMID: 28921997 DOI: 10.1037/adb0000308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adolescent drinking influences, and is influenced by, peer alcohol use. Several efficacious adolescent alcohol interventions include elements aimed at reducing susceptibility to peer influence. Modeling these interventions within dynamically changing social networks may improve our understanding of how such interventions work and for whom they work best. We used stochastic actor-based models to simulate longitudinal drinking and friendship formation within social networks using parameters obtained from a meta-analysis of real-world 10th grade adolescent social networks. Levels of social influence (i.e., friends affecting changes in one's drinking) and social selection (i.e., drinking affecting changes in one's friendships) were manipulated at several levels, which directly impacted the degree of clustering in friendships based on similarity in drinking behavior. Midway through each simulation, one randomly selected heavy-drinking actor from each network received an "intervention" that either (a) reduced their susceptibility to social influence, (b) reduced their susceptibility to social selection, (c) eliminated a friendship with a heavy drinker, or (d) initiated a friendship with a nondrinker. Only the intervention that eliminated targeted actors' susceptibility to social influence consistently reduced that actor's drinking. Moreover, this was only effective in networks with social influence and social selection that were at higher levels than what was found in the real-world reference study. Social influence and social selection are dynamic processes that can lead to complex systems that may moderate the effectiveness of network-based interventions. Interventions that reduce susceptibility to social influence may be most effective among adolescents with high susceptibility to social influence and heavier-drinking friends. (PsycINFO Database Record
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Affiliation(s)
- Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Barbara S McCrady
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
| | - Thomas P Caudell
- Department of Electrical and Computer Engineering, University of New Mexico
| | - Katie Witkiewitz
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
| | - J Scott Tonigan
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
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Appiah R, Boakye KE, Ndaa P, Aziato L. “Tougher than ever”: An exploration of relapse prevention strategies among patients recovering from poly-substance use disorders in Ghana. DRUGS: EDUCATION, PREVENTION AND POLICY 2017. [DOI: 10.1080/09687637.2017.1337080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Richard Appiah
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa,
- Department of Occupational Therapy, University of Ghana, Accra, Ghana, and
| | - Kofi E. Boakye
- Institute of Criminology, University of Cambridge, Cambridge, United Kingdom of Great Britain and Northern Ireland,
| | - Peter Ndaa
- Department of Occupational Therapy, University of Ghana, Accra, Ghana, and
| | - Lydia Aziato
- Department of Adult Health, School of Nursing, University of Ghana, Accra, Ghana
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Sarpavaara H. The Causes of Change and No-Change in Substance Users' Talk During Motivational Interviewing in the Probation Service in Finland. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2017; 61:430-444. [PMID: 26188344 DOI: 10.1177/0306624x15596031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article explores the beliefs regarding the causes of change and no-change of substance-using clients during motivational interviewing (MI) sessions in probation service context. The analyses are based on videotaped and transcribed data consisting of 98 MI sessions in 12 probation service offices in Finland from 2007 to 2009. The analysis relies on coding of client's change-related talk utterances and qualitative semiotic framework. The results show that the clients attributed various causes to change and no-change. It seems that the sociocultural, psychological, biological, and contextual causes play an important role in substance users' change talk and motivation to change. It is suggested that aspects of the social and contextual factors should not be overlooked in MI and other substance use treatment.
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Sarpavaara H. Significant others in substance abusers' change talk during motivational interviewing sessions in the Finnish Probation Service. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.1515/nsad-2015-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AimsThis article explores the meanings substance-abusing clients attach to family and friendships during motivational interviewing (MI) sessions in Probation Service.DataThe analyses are based on videotaped and transcribed data consisting of 82 MI sessions. This database involves the first two counseling sessions of 41 client-counselor pairs. Sessions were videotaped in 12 Probation Service offices in Finland between 2007 and 2009.MethodsThe analysis relies on coding of client's change talk utterances and qualitative semiotic framework.ResultsThe meanings of the significant others were diverse from the point of view of the client's motivation: family appeared as a support for change, an aspiration, a sufferer, or an obstacle to change; and friendship appeared as an obstacle to change, a surmounted obstacle, a cause to change, or a support to change.ConclusionsSignificant others and their quality are important and diverse factors that promote or hinder change in substance abuser' change talk. Thus, it is suggested that the meaning of significant others should not be overlooked in MI and other substance abuse treatment.
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Hallgren KA, Barnett NP. Briefer assessment of social network drinking: A test of the Important People Instrument-5 (IP-5). PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2016; 30:955-964. [PMID: 27669094 DOI: 10.1037/adb0000218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Important People instrument (IP; Longabaugh et al., 2010) is one of the most commonly used measures of social network drinking. Although its reliability and validity are well-supported, the length of the instrument may limit its use in many settings. The present study evaluated whether a briefer, 5-person version of the IP (IP-5) adequately reproduces scores from the full IP. College freshmen (N = 1,053) reported their own past-month drinking, alcohol-related consequences, and information about drinking in their close social networks at baseline and 1 year later. From this we derived network members' drinking frequency, percentage of drinkers, and percentage of heavy drinkers, assessed for up to 10 (full IP) or 5 (IP-5) network members. We first modeled the expected concordance between full-IP scores and scores from simulated shorter IP instruments by sampling smaller subsets of network members from full IP data. Then, using quasi-experimental methods, we administered the full IP and IP-5 and compared the 2 instruments' score distributions and concurrent and year-lagged associations with participants' alcohol consumption and consequences. Most of the full-IP variance was reproduced from simulated shorter versions of the IP (ICCs ≥ 0.80). The full IP and IP-5 yielded similar score distributions, concurrent associations with drinking (r = 0.22 to 0.52), and year-lagged associations with drinking. The IP-5 retains most of the information about social network drinking from the full IP. The shorter instrument may be useful in clinical and research settings that require frequent measure administration, yielding greater temporal resolution for monitoring social network drinking. (PsycINFO Database Record
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McCrady BS, Wilson AD, Muñoz RE, Fink BC, Fokas K, Borders A. Alcohol-Focused Behavioral Couple Therapy. FAMILY PROCESS 2016; 55:443-59. [PMID: 27369809 PMCID: PMC5021563 DOI: 10.1111/famp.12231] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Alcohol Behavioral Couple Therapy (ABCT) has emerged over the last 30 years as a highly efficacious treatment for those with alcohol use disorders. This review highlights the historical and conceptual underpinnings of ABCT, as well as the specific treatment elements and structure. Proposed active ingredients, moderators, and mediators of treatment outcome are discussed. Efficacy is evaluated for reductions in identified patient drinking, improved relationship functioning, and reductions in intimate partner violence. Adaptations of ABCT for substances other than alcohol are described. Other adaptations, including brief interventions, interventions addressing PTSD and TBI along with alcohol use, and interventions deliverable via technology platforms are described. Additional cost-benefit and cost-effectiveness findings supporting the economic value of ABCT are noted. Future directions for research in this area include possible adaptations for female identified patients, nontraditional couples, LGBT partners and dyads involving nonintimate partner relationships. The development of more flexible models and enhanced dissemination strategies may improve clinical uptake and utility as well as increasing the feasibility of this treatment for integrated healthcare settings.
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Affiliation(s)
- Barbara S McCrady
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM.
| | - Adam D Wilson
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM
| | - Rosa E Muñoz
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM
| | - Brandi C Fink
- University of New Mexico School of Medicine, Albuquerque, NM
| | - Kathryn Fokas
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM
| | - Adrienne Borders
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM
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Bolin BL, Alcorn JL, Reynolds AR, Lile JA, Rush CR. Human drug discrimination: A primer and methodological review. Exp Clin Psychopharmacol 2016; 24:214-28. [PMID: 27454673 PMCID: PMC4965187 DOI: 10.1037/pha0000077] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Drug-discrimination procedures empirically evaluate the control that internal drug states exert over behavior. They provide a highly selective method to investigate the neuropharmacological underpinnings of the interoceptive effects of drugs. Historically, drug discrimination has been one of the most widely used assays in the field of behavioral pharmacology. Drug-discrimination procedures have also been adapted for use with humans and are conceptually similar to preclinical drug-discrimination techniques in that a behavior is differentially reinforced contingent on the presence or absence of a specific interoceptive drug stimulus. This review gives some general history and background concerning the major theoretical concepts and principles of drug-discrimination research as well as its relevance to substance-use disorders. This article also provides a procedural overview and discusses key methodological issues that must be considered when designing and conducting a human drug-discrimination study. Although drug discrimination is unequivocally one of the most sophisticated and useful behavioral assays to investigate the underlying neuropharmacology of drugs in vivo, enthusiasm for its use has steadily declined in the last decade and a half. We conclude by commenting on the current state of drug-discrimination research and suggest potential avenues for future drug-discrimination research. (PsycINFO Database Record
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Affiliation(s)
- B. Levi Bolin
- Department of Behavioral Science, University of Kentucky College of Medicine, 140 Medical Behavioral Science Building, Lexington, KY, 40536-0086, U.S.A
| | - Joseph L. Alcorn
- Department of Behavioral Science, University of Kentucky College of Medicine, 140 Medical Behavioral Science Building, Lexington, KY, 40536-0086, U.S.A
| | - Anna R. Reynolds
- Department of Behavioral Science, University of Kentucky College of Medicine, 140 Medical Behavioral Science Building, Lexington, KY, 40536-0086, U.S.A
| | - Joshua A. Lile
- Department of Behavioral Science, University of Kentucky College of Medicine, 140 Medical Behavioral Science Building, Lexington, KY, 40536-0086, U.S.A,Department of Psychology, University of Kentucky College of Arts and Sciences, 110 Kastle Hall, Lexington, KY 40506-0044, U.S.A,Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Parkway, Lexington, KY 40509, U.S.A
| | - Craig R. Rush
- Department of Behavioral Science, University of Kentucky College of Medicine, 140 Medical Behavioral Science Building, Lexington, KY, 40536-0086, U.S.A,Department of Psychology, University of Kentucky College of Arts and Sciences, 110 Kastle Hall, Lexington, KY 40506-0044, U.S.A,Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Parkway, Lexington, KY 40509, U.S.A
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Korcha RA, Polcin DL, Bond JC. Interaction of Motivation and Social Support on Abstinence among Recovery Home Residents. JOURNAL OF DRUG ISSUES 2016; 46:164-177. [PMID: 27330222 DOI: 10.1177/0022042616629514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS The impetus to abstain from alcohol and drugs is especially robust when individuals seek help. However, motivation to continue abstinence during ongoing recovery is less understood. The present study assessed how social support interacted with motivation to affect abstinence over an 18-monthe time period. METHODS A sample of 289 residents entering residential recovery homes were recruited and followed at 6-, 12-, and 18-months. Motivation was measured as the perceived costs and benefits of abstinence. Five social influence measures were used to assess interactive effects with costs and benefits on abstinence. RESULTS Perceived costs and benefits of abstinence were robust predictors of abstinence over the 18 month assessment period. Two social support factors interacted with perceived benefits to influence abstinence: 12-step involvement and number of persons in the social network. CONCLUSION Suggestions are made for recovery services to influence perceived costs, benefits, and social network characteristics.
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Affiliation(s)
- Rachael A Korcha
- Public Health Institute, Alcohol Research Group, 6475 Christie Ave. #400, Emeryville, CA 94608
| | - Douglas L Polcin
- Public Health Institute, Alcohol Research Group, 6475 Christie Ave. #400, Emeryville, CA 94608
| | - Jason C Bond
- Public Health Institute, Alcohol Research Group, 6475 Christie Ave. #400, Emeryville, CA 94608
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Worley MJ, Witkiewitz K, Brown SA, Kivlahan DR, Longabaugh R. Social network moderators of naltrexone and behavioral treatment effects on heavy drinking in the COMBINE study. Alcohol Clin Exp Res 2016; 39:93-100. [PMID: 25623409 DOI: 10.1111/acer.12605] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 10/14/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Oral naltrexone is an efficacious medication for treatment of alcohol dependence, but small effect sizes and variability in outcomes suggest the presence of person-level moderators of naltrexone response. Identification of contextual or psychosocial moderators may assist in guiding clinical recommendations. Given the established importance of social networks in drinking outcomes, as well as the potential effects of naltrexone in reducing cue reactivity which may be especially important among those with more heavy drinkers and more alcohol cues in their networks, we examined pretreatment social network variables as potential moderators of naltrexone treatment effects in the COMBINE study. METHODS The sample included all COMBINE study participants in medication conditions with full data on the Important People Inventory (IPI) and covariates at intake (N = 1,197). The intake IPI assessed whether participants had any frequent drinkers in their network and the average frequency of contact with these drinkers. The effects of treatment condition, pretreatment network variables, and their interactions on percent heavy drinking days were tested in hierarchical linear models, controlling for demographics and baseline clinical covariates. RESULTS In treatment conditions involving medical management and combined behavioral intervention (CBI), the effects of active naltrexone on heavy drinking were significantly greater for individuals with frequent drinkers in their network (z = -2.66, p < 0.01) and greater frequency of contact with those drinkers (z = -3.19, p < 0.01). These network variables did not moderate the effects of active naltrexone without CBI. CONCLUSIONS When delivered in conjunction with behavioral interventions, naltrexone can be more potent for alcohol-dependent adults who have greater contact with frequent drinkers prior to treatment, which may indicate patterns of environmental exposure to alcohol. Contextual, social risk factors are a potential avenue to guide personalized treatment of alcohol dependence.
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Affiliation(s)
- Matthew J Worley
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, California
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Van den Berg JF, Van den Brink W, Kist N, Hermes JSJ, Kok RM. Social factors and readmission after inpatient detoxification in older alcohol-dependent patients. Am J Addict 2015; 24:661-6. [PMID: 26300471 DOI: 10.1111/ajad.12287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 08/04/2015] [Accepted: 08/11/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Alcohol dependence is often a chronic relapsing disorder with frequent admissions to inpatient facilities. This study in older alcohol-dependent inpatients investigates the role of social factors in readmissions after inpatient detoxification. METHODS In a prospective study, 132 older alcohol-dependent patients admitted to inpatient detoxification (mean age 63.4, SD = 6.6, 39.4% women) were interviewed with the European version of the Addiction Severity Index (Europ-ASI). Readmission to inpatient treatment was monitored up to 1 year after discharge. The effect of social factors on readmission, the number of readmissions and the time to first readmission was established using group comparisons, Poisson regression analysis, and Cox' proportional hazards regression analysis, respectively. RESULTS Sixty-seven (50.8%) of the 132 patients were readmitted within 1 year. In this group, the median number of readmissions was 2 (IQR = 2, range 1-6) and the median time to first readmission was 88 days (IQR = 116, range 3-356). In a multivariate analysis, spending most leisure time alone predicted fewer readmissions. None of the other social factors predicted readmission, number of readmissions or time to first readmission. DISCUSSION AND CONCLUSIONS Rehospitalization of older alcohol-dependent patients after detoxification is very common, and generally not predicted by social factors. Only spending most leisure time alone may play a role. SCIENTIFIC SIGNIFICANCE This study shows that most social factors are-unexpectedly-not associated with rehospitalization of older alcohol-dependent patients after detoxification. "Spending leisure time alone" warrants further study as a potentially modifiable predictor.
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Affiliation(s)
- Julia F Van den Berg
- Parnassia Psychiatric Institute, The Hague, the Netherlands.,Department of Clinical Psychology, Leiden University, Leiden, the Netherlands
| | | | - Nicolien Kist
- Parnassia Psychiatric Institute, The Hague, the Netherlands
| | | | - Rob M Kok
- Parnassia Psychiatric Institute, The Hague, the Netherlands
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The Role of the Social Environment in Alcohol or Drug Relapse of Probationers Recently Released from Jail. ADDICTIVE DISORDERS & THEIR TREATMENT 2014; 13:179-189. [PMID: 25598744 DOI: 10.1097/adt.0000000000000039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Many individuals involved with the criminal justice system also meet criteria for a substance use disorder. Social support has been identified as an important factor in alcohol and drug relapse, and also for individuals who are incarcerated. The purposes of this study were to describe personal characteristics and the social networks of adult male probationers with substance use disorders and test how changes in social networks related to alcohol or drug use after release from jail. METHODS Fifty adult male probationers who were recently incarcerated (60 to 210 days prior to screening) were recruited from a large Southwest Probation and Parole Division office, and were administered a single assessment that assessed demographic information, social networks, and quantity and frequency of alcohol and drug use before and after incarceration. RESULTS In this sample there was an over-representation of ethnic minorities, higher rates of unemployment, lower educational levels, and lower median income than national averages. Results showed that there were significant changes in social networks from pre- to post-incarceration. Additionally, changes in social networks significantly predicted substance use after release from jail, even after controlling for substance use prior to incarceration, and the percentage of social network members who were heavy drug users mediated percent days abstinent from alcohol and drugs from pre- to post-incarceration. CONCLUSIONS Social networks and social support may operate as dynamic factors in relapse, and may be a target for intervention for adult males with substance use disorders being released from jail.
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Worley MJ, Trim RS, Tate SR, Roesch SC, Myers MG, Brown SA. Self-efficacy and social networks after treatment for alcohol or drug dependence and major depression: disentangling person and time-level effects. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 28:1220-9. [PMID: 25347018 DOI: 10.1037/a0037901] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Proximal personal and environmental factors typically predict outcomes of treatment for alcohol or drug dependence (AODD), but longitudinal treatment studies have rarely examined these factors in adults with co-occurring psychiatric disorders. In adults with AODD and major depression, the aims of this study were to: (a) disaggregate person-and time-level components of network substance use and self-efficacy, (b) examine their prospective effects on posttreatment alcohol/drug use, and (c) examine whether residential environment moderated relations between these proximal factors and substance use outcomes. Veterans (N = 201) enrolled in a trial of group psychotherapy for AODD and independent MDD completed assessments every 3 months during 1 year of posttreatment follow-up. Outcome variables were percent days drinking (PDD) and using drugs (PDDRG). Proximal variables included abstinence self-efficacy and social network drinking and drug use. Self-efficacy and network substance use at the person-level prospectively predicted PDD (ps < .05) and PDDRG (ps < .05). Within-person, time-level effects of social networks predicted future PDD (ps < .05) but not PDDRG. Controlled environments moderated person-level social network effects (ps < .05), such that greater time in controlled settings attenuated the association between a heavier drinking/using network and posttreatment drinking and drug use. Both individual differences and time-specific fluctuations in proximal targets of psychosocial interventions are related to posttreatment substance use in adults with co-occurring AODD and MDD. More structured environmental settings appear to alleviate risk associated with social network substance use, and may be especially advised for those who have greater difficulty altering social networks during outpatient treatment.
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Affiliation(s)
- Matthew J Worley
- Department of Family Medicine, University of California, Los Angeles
| | - Ryan S Trim
- Veterans Affairs San Diego Health Care System
| | | | | | | | - Sandra A Brown
- Department of Psychiatry, University of California, San Diego
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Oser CB, Harp KLH. Treatment outcomes for prescription drug misusers: the negative effect of geographic discordance. J Subst Abuse Treat 2014; 48:77-84. [PMID: 25200740 DOI: 10.1016/j.jsat.2014.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 08/04/2014] [Accepted: 08/06/2014] [Indexed: 11/29/2022]
Abstract
This is the first known study to examine geographic discordance (traveling from one's home residence to a county with a different socio-cultural context to receive substance abuse treatment) as a predictor of clinical and social functioning treatment outcomes (i.e., relapse, self-help attendance, anxiety, and incarceration) among a sample of prescription drug misusers. Treatment entry and 12-month follow-up client-level survey data were collected from 187 clients who misused prescription drugs, and center-level survey data were collected from the supervisors at treatment centers attended by the clients. Multivariate models reveal that geographic discordance significantly increased the odds that prescription drug misusers would report relapse to prescription opioid misuse, anxiety, and any incarceration at follow-up. Moreover, geographically discordant clients were significantly less likely to have attended a self-help group, net of the effect of other individual- and center-level factors. Implications for clinical practice and substance abuse treatment policy are provided.
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Affiliation(s)
- Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY 40506, USA.
| | - Kathi L H Harp
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY 40506, USA
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Situational and psycho-social factors associated with relapse following residential detoxification in a population of Irish opioid dependent patients. Ir J Psychol Med 2014; 29:72-79. [PMID: 30199951 DOI: 10.1017/s079096670001733x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIMS To identify and describe the context and factors involved in the opioid lapse process following discharge from an Irish inpatient opioid detoxification treatment programme. Design, participants, setting: Prospective follow-up study of consecutive detoxified opioid dependent patients treated in a specialist inpatient drug dependency unit. MEASUREMENTS The Maudsley Addiction Profile and a structured interview were administered to 109 patients, 18-36 months after discharge. FINDINGS Of 109 people interviewed at follow-up, 102 (94%) reported at least one episode of opioid use after leaving the residential treatment programme. Eighty eight patients (86% of the lapsers) identified more than one major factor contributing to their recidivism. The median number of factors identified as having a major role in the lapse was four. The most frequently reported major contributors to lapse were low mood (62%), difficulties with craving (62%), ease of access to heroin (48%) and missing the support of the treatment centre (43%). CONCLUSIONS Early lapse was common following inpatient treatment of opioid dependence. Lapse tended to result from a number of common, identifiable, high-risk situations, feelings and cognitions which may assist clinicians and patients develop lapse prevention strategies to anticipate and interrupt this process.
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Sarpavaara H. Talking about friends, drugs, and change: meanings of friendship in substance abusers' change talk. Subst Use Misuse 2014; 49:645-53. [PMID: 24579984 DOI: 10.3109/10826084.2013.841245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This article explores the meanings of substance-abusing clients attach to friendships during motivational treatment sessions in Probation Service. Sessions (98) were videotaped in 12 probation service offices in Finland in 2007 to 2009. By using semiotic framework, this qualitative study examines client's change talk utterance about friendships as a symbolic sign. The findings indicate that the friendships play an important role in the substance-abusing clients' motivation to change and in their treatment outcome. The study suggests that the personal meanings of clients' utterances in motivational treatment sessions could be seen as potential predictors of their future behavior.
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Affiliation(s)
- Harri Sarpavaara
- School of Social Sciences and Humanities, University of Tampere , Tampere , Finland
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Hostetler CM, Ryabinin AE. Social partners prevent alcohol relapse behavior in prairie voles. Psychoneuroendocrinology 2014; 39:152-157. [PMID: 24275014 PMCID: PMC3867132 DOI: 10.1016/j.psyneuen.2013.10.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 10/08/2013] [Accepted: 10/08/2013] [Indexed: 10/26/2022]
Abstract
There is robust evidence for a protective role of interpersonal factors such as social support on alcohol relapse, but research on the mechanisms that social factors may be acting on to effectively protect individuals against relapse is lacking. Prairie voles are highly social, monogamous rodents that freely self-administer ethanol in high amounts, and are a useful model for understanding social influences on alcohol drinking. Here we investigated whether prairie voles can be used to model social influences on relapse using the alcohol deprivation effect, in which animals show a transient increase in ethanol drinking following deprivation. In Experiment I, subjects were housed alone during four weeks of 24-h access to 10% ethanol in a two-bottle choice test. Ethanol was then removed from the cage for 72 h. Animals remained in isolation or were then housed with a familiar same-sex social partner, and ethanol access was resumed. Animals that remained isolated showed an increase in ethanol intake relative to pre-deprivation baseline, indicative of relapse-like behavior. However, animals that were socially housed did not show an increase in ethanol intake, and this was independent of whether the social partner also had access to ethanol. Experiment II replicated the alcohol deprivation effect in a separate cohort of isolated animals. These findings demonstrate that prairie voles display an alcohol deprivation effect and suggest a 'social buffering' effect of relapse-like behavior in the prairie vole. This behavioral paradigm provides a novel approach for investigating the behavioral and neurobiological underpinnings of social influences on alcohol relapse.
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Affiliation(s)
| | - Andrey E. Ryabinin
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon 97239
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Expectancies for smoking cessation among drug-involved smokers: implications for clinical practice. J Subst Abuse Treat 2013; 46:320-4. [PMID: 24314605 DOI: 10.1016/j.jsat.2013.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 10/08/2013] [Accepted: 10/09/2013] [Indexed: 11/22/2022]
Abstract
Drug-involved smokers may be less motivated to quit smoking because they expect smoking cessation to occasion adverse outcomes (e.g., exacerbation of drug use). Non-treatment-seeking adult smokers from the community (N=507) reported drug involvement, expectancies for smoking abstinence via the Smoking Abstinence Questionnaire (SAQ), and motivation to quit smoking (desire to quit and abstinence goal). Mediation analyses evaluated the indirect effects of binge drinking, marijuana, cocaine, other stimulant, opiate, and barbiturate/other sedative involvement on motivation to quit smoking through the SAQ Adverse Outcomes scale. Adverse outcomes expectancies accounted for a reduced desire to quit smoking and a lower likelihood of endorsing a goal of complete smoking abstinence among those involved with binge drinking, marijuana, cocaine, other stimulants, opiates, and barbiturates/other sedatives. Drug-involved smokers' greater expectancies for adverse outcomes upon quitting smoking may deter smoking quit attempts. Interventions are encouraged to counteract the notion that smoking cessation jeopardizes sobriety.
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Chih MY, Patton T, McTavish FM, Isham AJ, Judkins-Fisher CL, Atwood AK, Gustafson DH. Predictive modeling of addiction lapses in a mobile health application. J Subst Abuse Treat 2013; 46:29-35. [PMID: 24035143 DOI: 10.1016/j.jsat.2013.08.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 07/30/2013] [Accepted: 08/02/2013] [Indexed: 11/16/2022]
Abstract
The chronically relapsing nature of alcoholism leads to substantial personal, family, and societal costs. Addiction-comprehensive health enhancement support system (A-CHESS) is a smartphone application that aims to reduce relapse. To offer targeted support to patients who are at risk of lapses within the coming week, a Bayesian network model to predict such events was constructed using responses on 2,934 weekly surveys (called the Weekly Check-in) from 152 alcohol-dependent individuals who recently completed residential treatment. The Weekly Check-in is a self-monitoring service, provided in A-CHESS, to track patients' recovery progress. The model showed good predictability, with the area under receiver operating characteristic curve of 0.829 in the 10-fold cross-validation and 0.912 in the external validation. The sensitivity/specificity table assists the tradeoff decisions necessary to apply the model in practice. This study moves us closer to the goal of providing lapse prediction so that patients might receive more targeted and timely support.
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Affiliation(s)
- Ming-Yuan Chih
- Center for Health Enhancement Systems Studies, College of Engineering, University of Wisconsin - Madison, 1513 University Ave., Madison, WI 53706, USA.
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Mental state decoding and mental state reasoning in recently detoxified alcohol-dependent individuals. Psychiatry Res 2013; 205:232-40. [PMID: 22995039 DOI: 10.1016/j.psychres.2012.08.042] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 07/12/2012] [Accepted: 08/10/2012] [Indexed: 12/30/2022]
Abstract
Impaired social cognition has been associated with interpersonal problems and with the development of and relapse into alcohol abuse. In the present study, self-reported trait empathy, decoding of complex mental states and cognitive and affective mental state reasoning were assessed in alcohol-dependent participants, and the association with executive function and psychopathological characteristics was investigated. Twenty recently detoxified alcohol-dependent patients and 20 matched healthy controls were assessed with an abbreviated German version of the interpersonal reactivity index, the revised reading the mind in the eyes test, the faux pas story test, the trail making test and the letter-number-sequencing test. Patients were impaired relative to controls with regard to mental state decoding on the eyes test and showed reduced faux pas detection and impaired mental state reasoning reflected by lower faux pas understanding and faux pas empathy scores. There were no group differences regarding self-reported trait empathy. Performance on the sociocognitive measures was related to executive functioning and the severity of depressive symptoms. Although self-report measures might not always reliably detect impairments of social cognition, behavioural measures suggest pronounced impairments of mental state decoding and mental state reasoning in association with alcohol dependence. Findings ought to be incorporated into current treatment strategies.
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Love and addiction: the devil is in the differences: a commentary on "the behavioral, anatomical and pharmacological parallels between social attachment, love and addiction". Psychopharmacology (Berl) 2012; 224:27-9; discussion 31-2. [PMID: 22948669 DOI: 10.1007/s00213-012-2858-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 08/23/2012] [Indexed: 10/27/2022]
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Hunter-Reel D, Witkiewitz K, Zweben A. Does session attendance by a supportive significant other predict outcomes in individual treatment for alcohol use disorders? Alcohol Clin Exp Res 2012; 36:1237-43. [PMID: 22324565 DOI: 10.1111/j.1530-0277.2011.01719.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 11/02/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND A significant amount of research has supported the efficacy of couple versus individual treatment for alcohol use disorders, yet little is known about whether involving a significant other during the course of individual treatment can improve outcomes. Likewise, several barriers to couple treatment exist and a more flexible approach to significant other involvement may be warranted. METHODS This study constituted secondary analyses of the COMBINE data, a randomized clinical trial that combined pharmacotherapy and behavioral intervention for alcohol dependence. Data were drawn from the 16-week individual combined behavioral intervention (CBI), which had 776 participants, 31% of which were female, and 23% were non-white. The current study examined whether attendance by a supportive significant other (SSO) during CBI sessions would predict better outcomes. It was further hypothesized that active SSO involvement, defined by attendance during drink refusal or communication skills training sessions, would predict better outcomes. RESULTS SSOs attended at least 1 session for 26.9% of clients. Clients with SSOs who attended at least 1 session had significantly fewer drinking days and fewer drinking-related problems at the end of treatment. The presence of an SSO during a drink refusal training session predicted significantly better outcomes, as compared to SSO attendance at other sessions and drink refusal training without an SSO present. SSO attendance at a communication training session did not predict better outcomes. CONCLUSIONS These results suggest that specific types of active involvement may be important for SSO-involved treatment to have greater efficacy than individual treatment.
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Affiliation(s)
- Dorian Hunter-Reel
- Department of Psychology, University of Washington, Seattle, WA 98102, USA.
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Abstract
Alcohol dependence has been described as a relapsing condition and it has been proposed that alcohol lapses could potentially be explained by dynamic associations between contextual, interpersonal, and intrapersonal risk factors. Yet, few studies have tested the associations between risk factors in the prediction of lapse dynamics. The current study was a secondary analysis of data from the COMBINE study (n = 1,383; COMBINE Study Research Group, 2003). The goal of the current study was to examine static (alcohol dependence severity, treatment history, marital status, psychiatric symptoms) and dynamic (negative affect, craving, stress) predictors of heavy drinking during the course of treatment and up to one year following treatment. Results from dynamic latent difference score models indicated that higher levels of static and dynamic risk and increased dynamic risk over time were significantly associated with greater increases in heavy drinking. Likewise, more frequent heavy drinking and higher static risk predicted higher levels of dynamic risk. In addition, changes in dynamic risk factors significantly mediated the association between changes in heavy drinking and both psychiatric symptoms and treatment history. It is important to note that while the effects of static and dynamic risk factors in the prediction of heavy drinking were statistically significant, the magnitude of the effects were small. The current study provided partial support for a dynamic model of relapse; however future research using intensive longitudinal data collection and more advanced statistical techniques could further elucidate lapse dynamics and potentially improve relapse prevention planning.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, Washington State University–Vancouver, 14204 NE Salmon Creek Avenue Vancouver, WA 98686, USA.
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Hunter-Reel D, McCrady BS, Hildebrandt T, Epstein EE. Indirect effect of social support for drinking on drinking outcomes: the role of motivation. J Stud Alcohol Drugs 2011; 71:930-7. [PMID: 20946752 DOI: 10.15288/jsad.2010.71.930] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study tested an integrated relapse model drawing hypotheses from both interpersonal and intra-individual relapse models. It was hypothesized that the relationships between alcohol-specific social support (support for drinking and support for not drinking) and drinking outcomes would be partially mediated by motivation. METHOD Participants were 158 women with alcohol use disorders participating in two linked randomized controlled trials. One trial compared standard individual cognitive behavioral therapy (CBT) for alcohol use disorders with female-specific CBT for alcohol use disorders; the other compared alcohol behavioral couple therapy with blended individual CBT and alcohol behavioral couple therapy. Measures included the Important People Interview to measure social-support variables, the Timeline Followback to measure drinking variables, and the Stages of Change Readiness and Treatment Eagerness Scale to measure motivation. RESULTS Results of structural equation modeling suggested a mediational role of motivation in the relationship between support for drinking and drinking frequency. Individuals with more network support for drinking at baseline had less motivation for abstinence at the end of treatment, which predicted drinking frequency over the 6 months after treatment. The indirect effect of baseline support for drinking on 6-month follow-up drinking frequency was statistically significant. A similar, although only marginally significant, pattern was found for the relationship between support for not drinking and drinking frequency. Individuals with more social network for not drinking at baseline had more motivation at the end of treatment at the trend level, which in turn predicted 6-month follow-up drinking frequency. The indirect effect of baseline support for not drinking on 6-month follow-up drinking frequency trended toward significance. CONCLUSIONS This study offers preliminary evidence that motivation is one mechanism by which abstinence-specific social support affects treatment outcome.
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Affiliation(s)
- Dorian Hunter-Reel
- Center of Alcohol Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, USA.
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Hendershot CS, Witkiewitz K, George WH, Marlatt GA. Relapse prevention for addictive behaviors. Subst Abuse Treat Prev Policy 2011; 6:17. [PMID: 21771314 PMCID: PMC3163190 DOI: 10.1186/1747-597x-6-17] [Citation(s) in RCA: 176] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 07/19/2011] [Indexed: 11/10/2022] Open
Abstract
The Relapse Prevention (RP) model has been a mainstay of addictions theory and treatment since its introduction three decades ago. This paper provides an overview and update of RP for addictive behaviors with a focus on developments over the last decade (2000-2010). Major treatment outcome studies and meta-analyses are summarized, as are selected empirical findings relevant to the tenets of the RP model. Notable advances in RP in the last decade include the introduction of a reformulated cognitive-behavioral model of relapse, the application of advanced statistical methods to model relapse in large randomized trials, and the development of mindfulness-based relapse prevention. We also review the emergent literature on genetic correlates of relapse following pharmacological and behavioral treatments. The continued influence of RP is evidenced by its integration in most cognitive-behavioral substance use interventions. However, the tendency to subsume RP within other treatment modalities has posed a barrier to systematic evaluation of the RP model. Overall, RP remains an influential cognitive-behavioral framework that can inform both theoretical and clinical approaches to understanding and facilitating behavior change.
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Affiliation(s)
- Christian S Hendershot
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, ON, M5S 2S1, Canada
- Department of Psychiatry, University of Toronto, 250 College St., Toronto, ON M5T 1R8, Canada
| | - Katie Witkiewitz
- Department of Psychology, Washington State University, 14204 NE Salmon Creek Ave, Vancouver, WA, 98686, USA
| | - William H George
- Department of Psychology, University of Washington, Box 351525, Seattle, WA 98195, USA
| | - G Alan Marlatt
- Department of Psychology, University of Washington, Box 351525, Seattle, WA 98195, USA
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Kelly JF, Stout RL, Magill M, Tonigan JS. The role of Alcoholics Anonymous in mobilizing adaptive social network changes: a prospective lagged mediational analysis. Drug Alcohol Depend 2011; 114:119-26. [PMID: 21035276 PMCID: PMC3062700 DOI: 10.1016/j.drugalcdep.2010.09.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 09/01/2010] [Accepted: 09/04/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Many individuals entering treatment are involved in social networks and activities that heighten relapse risk. Consequently, treatment programs facilitate engagement in social recovery resources, such as Alcoholics Anonymous (AA), to provide a low risk network. While it is assumed that AA works partially through this social mechanism, research has been limited in rigor and scope. This study used lagged mediational methods to examine changes in pro-abstinent and pro-drinking network ties and activities. METHOD Adults (N=1726) participating in a randomized controlled trial of alcohol use disorder treatment were assessed at intake, and 3, 9, and 15 months. Generalized linear modeling (Generalized linear modeling) tested whether changes in pro-abstinent and pro-drinking network ties and drinking and abstinent activities helped to explain AA's effects. RESULTS Greater AA attendance facilitated substantial decreases in pro-drinking social ties and significant, but less substantial increases in pro-abstinent ties. Also, AA attendance reduced engagement in drinking-related activities and increased engagement in abstinent activities. Lagged mediational analyses revealed that it was through reductions in pro-drinking network ties and, to a lesser degree, increases in pro-abstinent ties that AA exerted its salutary effect on abstinence, and to a lesser extent, on drinking intensity. CONCLUSIONS AA appears to facilitate recovery by mobilizing adaptive changes in the social networks of individuals exhibiting a broad range of impairment. Specifically by reducing involvement with pro-drinking ties and increasing involvement with pro-abstinent ties. These changes may aid recovery by decreasing exposure to alcohol-related cues thereby reducing craving, while simultaneously increasing rewarding social relationships.
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Affiliation(s)
- John F. Kelly
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 60 Staniford St., Suite 120, Boston, MA 02114
| | - Robert L. Stout
- Decision Sciences Institute/PIRE, 1005 Main St., Pawtucket, RI 02860-7802
| | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University, Providence RI 02912
| | - J. Scott Tonigan
- Center on Alcoholism, Substance Abuse and Addiction (CASAA), 2650 Yale SE., Suite 243, Albuquerque, NM 87106
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Longabaugh R, Wirtz PW, Zywiak WH, O'malley SS. Network support as a prognostic indicator of drinking outcomes: the COMBINE Study. J Stud Alcohol Drugs 2010; 71:837-46. [PMID: 20946740 PMCID: PMC2965482 DOI: 10.15288/jsad.2010.71.837] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 04/28/2010] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To increase understanding of the interrelationship between a patient's social network and patient drinking, the Important People and Activities (IPA) instrument was developed. To meet the aims of the COMBINE (Combining Medications and Behavioral Interventions) Study, the IPA was modified to create the Important People Inventory (IPI), which was used to measure the contextual influence of the patient's social network on patient outcomes and treatment effects. The aims of the present article were to describe the IPI and its differences from the IPA and to test the relationship of network support as measured by the IPI in predicting drinking during and following treatment. METHOD Alcohol-dependent patients (N = 1,373) seeking outpatient treatment in the COMBINE randomized clinical trial were administered the IPI before treatment. Six network constructs were tested for predicting patient drinking. RESULTS As unique effects, alcohol-specific support, as measured by network drinking and opposition to patient drinking, is predictive of patient abstinent days during and following treatment and heavy drinking days following treatment. Other measures of network support have variable relationships to patient drinking at different phases: Some are predictive of patient drinking during treatment but diminish, whereas others are unrelated to drinking during treatment but become increasingly predictive of drinking as time from treatment increases. CONCLUSIONS The IPI is a useful instrument for describing network support of alcohol-use disorder patients entering treatment. Measures of alcohol-specific support are prognostic of drinking outcomes. The patient's network support should be systematically assessed prior to tailored treatment planning.
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Affiliation(s)
- Richard Longabaugh
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Philip W. Wirtz
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - William H. Zywiak
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
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