Drug use and suicidal ideation in the daily lives of individuals in a dialectical behavior therapy program

OBJECTIVES

Substance use disorders and borderline personality disorders (BPD) often co-occur and may be concurrently treated by Dialectical Behavior Therapy (DBT). However, there is limited information on how drug use and suicidal ideation may interact in the daily lives of individuals receiving DBT treatment.

METHODS

This study examined the DBT diary cards of 47 individuals in a community mental health center's partial hospital and intensive outpatient program. Multilevel modeling techniques were used to examine the moderating effects of BPD symptom severity on the relationship between same day, 1-, 2-, and 3-day lagged drug use and suicidal ideation.

RESULTS

Results indicated a significant relationship between same-day, 1-day lagged, 2-day lagged drug use and suicidal ideation. BPD was a moderator for the relationship between 1-day lagged drug use and suicidal ideation.

CONCLUSION

Limitations of the study include the measure for BPD symptom severity was only collected pretreatment and the results are likely limited to the effects of cannabis use on suicidal ideation. Clinicians may need to consider the prolonged effects of drug use on suicidal ideation when conducting chain analyses on suicidal behaviors.

Dialectical Behavior Therapy Skills and Urges to Use Alcohol and Substances: An Examination of Diary Cards

Background: Skills learned in Dialectical Behavior Therapy (DBT) are a proposed mechanism that prompts behavior change. Few studies have examined the effects of DBT skills on treatment outcomes. No published studies have examined the effects of DBT skills on alcohol and substance use outcomes. Objectives: This study examined 48 individuals in a community mental health facility that delivers DBT-adherent treatment. Utilizing intake data and diary cards, multilevel model analyses were conducted to examine the effects each DBT skills domain had on urges for participants that entered treatment with varying frequencies of alcohol and substance use. Results: Emotion regulation and mindfulness skills domains were related to decreased urges for individuals that entered treatment with high frequencies of alcohol and substance use. Previous-day distress tolerance skills were associated with decreased urges and previous-day interpersonal effectiveness skills were associated with decreased urges for individuals that entered treatment with high frequencies of substance use. Conclusions: DBT skills may be a helpful mechanism to decrease urges for individuals that use alcohol and other substances. However, more research on why certain skills domains may be more effective is needed.

When does modifying the protocol go too far? Considerations for implementing evidence-based treatment in practice

The majority of evidence-based psychological treatments (EBTs) are packaged as manuals that provide guidance regarding when and how to deliver specific interventions (e.g., cognitive restructuring, exposure). However, clinical practice regularly necessitates flexibility in the timing and delivery of treatment strategies. Indeed, research on the dissemination and implementation of EBTs has highlighted the need to adapt these treatments to fit the needs of specific settings or patient populations. Adapting a treatment also means changing it from its original, evidence-based format, raising questions about how much or in which ways a treatment can be altered before it is no longer reflective of the original EBT. The purpose of this article is to discuss factors that contribute to the challenge of adapting EBTs, highlight considerations for clinicians with regard to modifying EBTs, and propose directions for future research that can provide guidelines for adapting EBTs in the future. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Applying adherent DBT Principles to treatment in a partial hospital setting: An analysis over 5-years of outcomes from intake to discharge

OBJECTIVES

A small number of studies to date have examined Partial Hospital (PH) that utilize a Dialectical Behavior Therapy (DBT) model. Preliminary findings suggest DBT PH programs can be effective in various symptom reduction.

METHODS

This study examined clinically relevant outcomes and included a heterogeneous clinical sample over a five-year period. Specifically, the present study assessed pre-post data to examine changes in symptoms of depression, anxiety, hopelessness, and overall degree of suffering from intake to discharge in a DBT PH.

RESULTS

Findings showed symptom reduction from intake to discharge for depression, anxiety, hopelessness, and suffering for all 5 years. This DBT PH program was successful at reducing various symptoms in a sample of psychiatric patients.

CONCLUSION

Clinicians might consider the advantages of placing patients in PH programs versus an inpatient stay or consider utilizing DBT-informed PH programs after an inpatient hospitalization as a form of step-down care.

DBT-informed treatment in a partial hospital and intensive outpatient program: the role of step-down care

Few studies to date have examined Partial Hospital (PH) and Intensive Outpatient (IOP) programs that utilize a Dialectical Behavior Therapy (DBT)-informed model. Preliminary findings suggest that DBT-informed PH programs are effective in reducing clinical symptoms; however, less is known about IOP programs as well as step-down care models. The present study utilized clinically relevant outcome indices and included a heterogeneous clinical sample. Specifically, the present study assessed pre-post data to examine changes in symptoms of depression, anxiety, hopelessness, and overall degree of suffering from intake to discharge in DBT-informed PH and IOP programs as well as a step-down condition (PH to IOP). Participants included 205 adults (ages M = 35.28, SD = 12.49). The sample was predominantly female (N = 139, 67.8%) and Caucasian (N = 181, 88.3%). The sample was divided into three distinct groups: PH program patients, PH to IOP program step-down patients, and IOP patients. Findings indicated significant symptom reduction from intake to discharge for all three conditions. There were no significant differences in mean change scores in symptom reduction between the three groups. Severity of depression symptoms at intake predicted program placement. However, type of program did not predict significant changes in symptoms from intake to discharge. This DBT-informed PH and IOP program was successful at reducing various psychiatric symptoms in the sample. Clinicians might consider the advantages of placing patients with higher symptoms of depression into PH programs with the intention of transitioning to step-down care through IOP programs that utilize DBT.

ADHD, depression, and substance abuse risk among beginning college students

Objective: This study examined differences in substance use, depression, and academic functioning among ADHD and non-ADHD college students. Participants: Included 1,748 students (ages 18-25; women 68.4%; Caucasian 71.3%) with and without history of ADHD. Methods: We assessed the relationship of ADHD to substance use variables, controlling for depressive symptoms and examined relationships with GPA. Results: ADHD students were more likely to have engaged in frequent alcohol use, binge drinking, regular marijuana use and to have used other drugs in the last year. They reported higher depression symptoms than non-ADHD students, although substance abuse risk remained high even when controlling for depressive symptoms. ADHD students had lower overall GPA than those without ADHD. However, this difference was no longer significant when controlling for depression and marijuana use. Conclusions: College campuses should consider programing aimed at identifying ADHD students at risk for developing substance abuse problems and emotional difficulties.

Does it Matter What We Drink? Beverage Type Preference Predicts Specific Alcohol-Related Negative Consequences Among College Students

BACKGROUND

College student substance use has been a problem for many years. In particular, heavy alcohol consumption can create issues with academics, social relationships, and overall functioning. Unitary measures of generic alcohol consumption (e.g., drinking frequency) are important predictors of alcohol-related negative consequences, but the small amount of specific-beverage research available suggests that assessing beverage type consumed may enhance prediction.

OBJECTIVES

The purpose of the present study was to expand knowledge of alcoholic beverage preference in relation to negative consequences and confirm the factor structure of the RAPI proposed by Martens et al. ( 2007 ) in a college student sample.

METHODS

In addition, the present study expanded current knowledge by assessing beverage preference type in relation to specific negative consequences on the RAPI.

RESULTS

Results replicated the three-factor structure originally found by Martens et al. ( 2007 ). Moreover, results found that individuals consuming shots of liquor or alcohol mixed with caffeine reported higher overall RAPI scores and higher scores on the Abuse/Dependence and Personal Consequences factors but not the Social Consequences factor than those consuming mixed drinks, beer, or wine. Conclusions/Importance: This research might inform discussions with incoming college freshman about not only alcohol consumption and negative consequences but the dangers of drinking specific types of alcohol beverages such as shots and/or alcohol mixed with caffeine.

Evaluation of a dialectical behavior therapy-informed partial hospital program: outcome data and exploratory analyses

The use of dialectical behavioral therapy (DBT) among a variety of programs and patients has recently exploded. Of particular interest is the use of DBT in partial hospital (PH) programs due to the high number of severely ill and suicidal patients who participate in these programs. Recently, Lothes, Mochrie and St. John (2014) examined data from a local DBT-informed PH program and found significant reductions in depression, anxiety, hopelessness, and degree of suffering from intake to discharge. The present study examined these same four symptom constructs by assessing intake and discharge data for additional individuals enrolled in this DBT-informed PH program. In addition, lengths of stay and acuity ratings were analyzed to explore the relationship between these variables and symptom constructs. Significant symptom reduction in depression, anxiety, hopelessness, and degree of suffering from intake to discharge was found among high and medium acuity patients, replicating the results of Lothes et al. (2014). Further, individuals with the highest acuity saw the largest reduction in hopelessness symptoms the longer they participated in the program (i.e., a significant interaction effect between acuity and length of stay). This is meaningful given the connection between hopelessness and suicidal ideation/action, which is of particular concern for those charged with treating clinical populations. DBT-informed PH programs may be a cost-effective and useful way to treat high-risk patients who come from inpatient facilities. Future studies may wish to create follow-up periods (i.e., 3 months, 6 months) post-discharge to assess if symptom reduction remains.