Description of a Dialectical Behavior Therapy program in a Veterans Affairs Health Care System

A comprehensive Dialectical Behavior Therapy (DBT) program was created within a VA Health Care System for patients with recent psychiatric hospitalization, suicidality and/or significant emotion dysregulation. The program was notable for being one of a relatively small number of comprehensive DBT programs in the VA system, and for including patients with psychosis and psychotic disorder, with a majority of patients (58%) having a documented history of psychosis or endorsing psychotic symptoms in assessments. We describe the process of creating this program at a VA medical center and present preliminary program evaluation data. All patients completed assessments of suicidality (C-SSRS), emotion dysregulation (DERS), skills use and dysfunctional coping (DBT-WCCL), borderline symptomatology (BSL-23), and depression (PHQ-9) at program entry and subsequently every 6-8 weeks through program completion. Suicide attempts and hospitalizations were also tracked. Twelve patients completed multiple (up to six) assessment timepoints, allowing for evaluation of change during treatment. Patients demonstrated improvements on most measures and no hospitalizations or suicide attempts during active treatment, and the subsample with psychosis showed average improvements on every outcome measure. Eleven of 12 patients completed a full six-month rotation.

Self-control and jail inmates' substance misuse post-release: mediation by friends' substance use and moderation by age

OBJECTIVE

This study examined the relationship between two risk factors for substance misuse (self-control, substance using friends) and changes in jail inmates' substance misuse from pre-incarceration to post-release.

METHOD

Participants were 485 adult jail inmates held on a felony conviction, recruited from a metropolitan county-jail situated in the mid-Atlantic region of the U.S. During incarceration, participants completed self-report assessments of pre-incarceration substance misuse and self-control. At one-year post-release, participants reported their substance misuse and proportion of substance-using friends (n=322 at follow-up).

RESULTS

The relationship between self-control and changes in inmates' substance misuse was fully mediated by association with substance-using friends. Age moderated the relationship between friends' substance use and changes in inmates' own misuse of marijuana and cocaine. Friends' use was more strongly related to marijuana misuse for younger adults than for older adults. However, for cocaine misuse, this relationship was stronger for older adults than for younger adults. Self-control's relationships with other variables were not moderated by age.

CONCLUSIONS

This study underscores importance of self-control's indirect relationship (through substance-using friends) with changes in substance misuse: inmates with lower self-control were more likely to associate with substance-using friends and, in turn, had more symptoms of substance misuse 1-year post release. Results emphasize the importance of considering adult substance-users' friend-relationships. However, age and type of substance appear important when considering the relative importance of friends' influence.