Evaluation of the Controlling Alcohol and Relationship Enhancement (CARE) Program With Hazardous Drinkers

Apathy is associated with poorer abstinence self-efficacy in individuals with methamphetamine dependence

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Used an apathy composite T-score approach validated in methamphetamine-dependence.

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Apathy, above other factors, associated with poorer drug abstinence self-efficacy.

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Methamphetamine use characteristics unrelated to drug abstinence self-efficacy.

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Social peer pressure was riskiest situation for potential methamphetamine relapse.

Background

Confidence in one’s ability to achieve and maintain drug abstinence (i.e., abstinence self-efficacy) is a strong predictor of substance use treatment outcomes. Neurobehavioral factors that may interfere with abstinence self-efficacy are less well established, particularly in methamphetamine (METH). This study investigated whether apathy, which is highly prevalent during active METH use and periods of abstinence, influences abstinence self-efficacy among METH dependent individuals.

Methods

Sixty-six participants with lifetime METH dependence and METH abuse/METH dependence diagnoses within the last 18 months (mean age [SD] = 39.5 years [10.7]), and no severe psychiatric or neurological diseases, completed the Methamphetamine Self-Efficacy Scale (MSES), alongside a comprehensive neurobehavioral evaluation. The MSES presents six situations that may lead to relapse and collects self-report ratings for two subscales: “Confidence” (i.e., confidence in one’s ability to abstain from using METH, or METH abstinence self-efficacy) and “Temptation” (i.e., how tempted one is to use METH) with regard to each situation. Apathy was measured using a composite T-score comprised of items and scales from three well-validated, self-report assessments.

Results

Multivariable linear regression found that higher Apathy T-scores were significantly associated with lower Confidence ratings (i.e., poorer METH abstinence self-efficacy; p < .05), independent of potentially relevant factors (e.g., Temptation to use METH, comorbid HIV disease, and neurocognitive impairment).

Conclusions

Elevated apathy may adversely impact one’s confidence to abstain from METH use. Findings highlight the importance of addressing apathy in order to improve METH abstinence self-efficacy, which may subsequently increase the likelihood of successful METH treatment outcomes.

An ecological model of mediators of change in Couple Relationship Education

Couple Relationship Education (RE) seeks to enrich couples' relationships, and assist them to manage stressful life events [1]. In the current paper we present an ecological model of couple relationships intended to guide the practice of RE, analyze the mediators of RE effects, and suggest future research needs to assess moderators and mediators of RE effects in order to enhance the impact of RE.

Relationship education research: current status and future directions

The overarching aim of this article is to review the research on relationship education programs and approaches that has been published or accepted for publication since the last review article in 2003. This article provides a critical overview of the relationship education field and sets an agenda for research and practice for the next decade. A theme weaved throughout the article is the ways in which relationship education is similar and different from couples therapy, and we conclude that there can be a synergistic, healthy marriage between the two. We then provide recommendations for future directions for research in the relationship education field. Finally, the coauthors comment on our experiences in both the relationship education field and the couples therapy field as both researchers and interventionists.

Couple relationship education in Australia

In Australia, the strengthening of marriage through relationship education has received strong governmental policy support and some modest financial support. Couple relationship education services are offered by a variety of community-based, church-affiliated, and church-based providers. There is a strong emphasis on providing programs that are developed locally in response to perceived couple needs and government policies. Available evaluations show that most couples who attend education value the service, but relationship education providers need to do a better job reaching out to couples at high risk for future relationship problems, and more research is needed on the effects of education on long-term marital outcomes. There is significant scope for building on current initiatives to incorporate evidence-based approaches and to expand the program reach to more couples.