The Treatment of Substance‐Abusing Clients in Multiservice Mental Health Agencies: A Practice Analysis

This article examines the work behaviors related to counseling substance‐abusing clients by mental health service providers in multiservice mental health agencies. The results support the need for specialized knowledge and skills in working with substance‐abusing clients.     

Alcohol‐aggression expectancies and dispositional aggression moderate the relationship between alcohol consumption and alcohol‐related violence

Alcohol consumption increases aggression, but only in some drinkers. This study examines how expectancies for alcohol‐induced aggression and dispositional aggression moderate the link between alcohol consumption and alcohol‐related violence, building on previous studies that have employed limited measures of alcohol‐related violence and included few women. A sample of 212 men and women reported their alcohol consumption, alcohol‐aggression expectancies, dispositional aggression, and incidents of alcohol‐related aggressive acts. Alcohol‐aggression expectancies and quantity of alcohol consumed interacted to predict alcohol‐related aggression. Alcohol‐aggression expectancies covaried with alcohol‐related aggressive acts, particularly in heavier drinkers. Dispositional aggression also correlated with alcohol‐related aggression among heavier drinkers. These results help identify that alcohol might increase aggression only among heavy drinkers who expect alcohol to increase aggression or who are dispositionally aggressive. Aggr. Behav. 32:517–527, 2006. © 2006 Wiley‐Liss, Inc.     

Sleep Architecture in Infants of Substance‐Abusing Mothers

This longitudinal, year‐long study compared sleep–wake state organization in two groups of infants–infants whose mothers abused substances during their pregnancies and nonexposed, typically developing, age‐matched comparison infants–to determine whether differences in sleep–wake state organization existed between the two groups. Seventeen infants of mothers who were participating in a parent–infant residential treatment program for substance abuse were enrolled. Their sleep–wake state organization over the first year of life was compared to that of 17 age‐matched comparison infants. The intent was to follow each infant on five occasions over the first year of life using established methods of time‐lapse videosomnography to record sleep–wake state organization; however, attrition in the substance‐abusing group was problematic. Some sleep–wake variables (i.e., Active Sleep%, Quiet Sleep%, Awake%, number of nighttime awakenings) were similar for both groups of infants at comparable ages across the first year. Total sleep time and the longest sustained sleep period (sleep continuity variables) differed significantly at some of the ages measured. Although overall sleep architecture appears highly resilient and well organized, some indications of sleep fragmentation and shortened nighttime sleep periods were observed in the substance‐exposed infants. More research is needed to explain why sleep‐continuity variables and not sleep‐state proportion variables differed between the two groups.     

Parental Predictors of Adolescent Alcohol Use and Alcohol‐Related Consequences

This study examined parental predictors of alcohol use and alcohol‐related consequences among 9th‐grade students (N = 296). Parental disapproval of teen drinking and quality of parent–child general communication were significant predictors of drinking behaviors. Implications for counselors are discussed.     

Reducing Alcohol‐Related Consequences Among High School Seniors: Efficacy of a Brief,Web‐Based Intervention

The authors examined the efficacy of a brief, web‐based personalized feedback intervention on reducing alcohol‐related consequences among high school seniors (N = 105) using a group‐randomized controlled design. Results of repeated measures mixed‐models analyses indicated significant intervention effects over time for alcohol‐related consequences at 30‐day and 6‐month follow‐up assessments. Drinking risk status moderated intervention effects such that results were only significant for high‐risk drinkers (i.e., students reporting initiation of heavy episodic drinking at baseline).     

Longitudinal Predictors of Alcohol‐Related Harms During the Transition to Adulthood

While a range of factors have been found to increase the likelihood of alcohol‐related harms among young people, little is known about their relative importance. This article aimed to identify the risks for alcohol‐related harms at an age when alcohol use and problems tend to peak in Australia (19–20 years). A wide range of concurrent and antecedent factors from multiple domains were examined using path analysis, including individual characteristics, family environment, and externalising and internalising problems. The sample comprised of 941 individuals from the Australian Temperament Project, a large longitudinal community‐based study. The path model controlled for current risky drinking and revealed a number of variables that were significant longitudinal predictors of alcohol‐related harms within each of the domains, including adolescent antisocial behaviour and drinking behaviour, low agreeableness, impulsivity, and paternal drinking levels. The potential for developmental prevention approaches to reduce alcohol‐related harms by targeting externalising behaviour problems, interpersonal influences, and individual characteristics is discussed.     

Predicting Desistance or Persistence in the Substance‐Abusing,Mentally Ill,Supervised Offender Population Using Laub and Sampson's (2001) Social Controls and Individual Factors Theory

This study investigated the relationship that social controls and individual factors have on the persistence rate in the substance‐abusing, mentally ill, supervised offender population (N = 886). The data predicted 83% of persistence.     

Suicidal Ideation,Posttraumatic Stress,and Substance Abuse Based on Forcible and Drug‐ or Alcohol‐Facilitated/Incapacitated Rape Histories in a National Sample of Women

Mental health symptoms differ among women with forcible rape (FR ) compared to drug‐ or alcohol‐facilitated/incapacitated rape (DAFR /IR ) histories, but differences in suicidal ideation are unknown. The differences in suicidal ideation based on FR and DAFR /IR history were examined in national samples of college (n  =  2,000) and household‐residing (n  =  3,001) women. For both college women and household‐residing women, FR and DAFR /IR were associated with recent suicidal ideation. Differences emerged when examined indirectly through recent posttraumatic stress disorder, drug abuse, and alcohol abuse. Therefore, it is important to examine both FR and DAFR /IR when assessing suicidal ideation.     

Effects of Self‐Affirmation,Narratives, and Informational Messages in Reducing Unrealistic Optimism About Alcohol‐Related Problems Among College Students

This study examines intervention approaches to improve the accuracy of risk judgments among college students with unrealistic optimism about alcohol‐related problems. We conducted a randomized experiment with 2 self‐affirmation (affirmed, nonaffirmed) and 3 message conditions (narrative, informational, no treatment control). Results indicate that providing risk information to unrealistic optimists, while concomitantly protecting their self‐concept via either self‐affirmation or narratives, may reduce defensive reactions and align their perceived risk more closely with their actual risk. Self‐affirmation reduced unrealistic optimism only among those exposed to an informational message, not those exposed to a narrative. The narrative message appeared to increase perceived risk among unrealistic optimists via transportation and identification with the character. We discuss theoretical and practical implications of this work.     

Alcohol‐Related Consequences Among Intercollegiate Student Athletes: The Role of Drinking Motives

This study examined drinking motives as predictors of alcohol‐related consequences among student athletes and nonathletes. Results indicated that the highest level of alcohol‐related consequences was reported by student athletes with high levels of both coping and conformity motives.     

Maternal representations and emotional availability among drug‐abusing and nonusing mothers and their infants

Both negative and idealized maternal prenatal representations may constitute a risk for mother–infant interaction. This study analyzed the role of maternal prenatal representations and pre‐ to postnatal representational change in predicting mother–infant emotional availability (EA) among 51 drug‐abusing mothers and their infants who participated in either psychodynamic group therapy (PGT) or received psychosocial support (PSS) and among 50 nonusing comparison dyads. Maternal representations of her child, the child's father, her own mother, self‐as‐mother, and self‐as‐woman were measured during pregnancy and at 4 and 12 months' postpartum with the Interview of Maternal Representations (M. Ammaniti et al., 1992 ; M. Ammaniti, R. Tambelli, & P. Perucchini, 1998). EA was measured with the Emotional Availability Scales, fourth edition (Z. Biringen, 2008 ) at 4 and 12 months. The results showed that drug‐abusing mothers had more negative prenatal representations of the self‐as‐woman and of the child's father. Postnatally, PSS mothers tended to first idealize their child, but later to experience disillusionment of idealization. Both negative and idealized prenatal representations of the self‐as‐mother predicted mother–infant EA problems, but only among the PGT mothers. For all mothers, negative representational change was detrimental for the mother–infant EA whereas for drug‐abusing mothers, also increasing idealization from the prenatal period to the postnatal period was harmful. Clinicians working with drug‐abusing mothers should aim at supporting the development of a realistically positive view of motherhood.     

An Exploration of Adlerian Lifestyle Themes and Alcohol‐Related Behaviors Among College Students

The aim of this study was to investigate college student drinking through the lens of Adlerian theory. In a sample of 273 participants, multiple regression analyses confirmed that certain lifestyle themes were associated with alcohol‐related behaviors and that men and women who engage in drinking differ in their convictions and goals as defined by Adlerian theory.     

Acute Alcohol Co‐Ingestion and Hospital‐Treated Deliberate Self‐Poisoning: Is There an Effect on Subsequent Self‐Harm?

The aim of this study was to determine the relationship between alcohol co‐ingestion in an index deliberate self‐poisoning (DSP) episode with repeated DSP and subsequent suicide. A retrospective cohort study was conducted involving 5,669 consecutive index presentations to a toxicology service following DSP between January 1, 1996, and October 31, 2010. Records were probabilistically matched to National Coronial Information System data to identify subsequent suicide. Index DSPs were categorized on co‐ingestion of alcohol, and primary outcomes analyzed were repetition of any DSP, rates of repeated DSP, time to first repeat DSP, and subsequent suicide. Co‐ingestion of alcohol occurred in 35.9% of index admissions. There was no difference between those who co‐ingested alcohol (ALC+) and those who did not co‐ingest alcohol (ALC?) in terms of proportion of repeat DSP, number of DSP events, or time to first repeat DSP event. Forty‐one (1.0%) cases were probabilistically matched to a suicide death; there was no difference in the proportion of suicide between ALC+ and ALC? at 1 or 3 years. There was no significant relationship between the co‐ingestion of alcohol in an index DSP and subsequent repeated DSP or suicide. Clinically, this highlights the importance of mental health assessment of patients that present after DSP, irrespective of alcohol co‐ingestion at the time of event.     

Factors influencing drinking behavior in alcoholic panickers and non-panickers

Male alcoholics who (a) experienced panic attacks prior to abusing alcohol, (b) experienced panic attacks subsequent to abusing alcohol, and (c) had not experienced panic attacks were compared on three sets of measures: the Panic Attack Questionnaire, the Restrained Drinking Scale, and the Inventory of Drinking Situations. The results showed that two groups of Ss who experienced panic attacks were more likely than non-panickers to use drugs other than alcohol, began drinking at an earlier age, had a greater proportion of parents with panic and alcohol related problems, had higher drinking restraint scores, and drank in more situations. The Ss who experienced panic attacks prior to abusing alcohol were more likely than the other groups to drink in situations similar to those related to agoraphobic fears. It was postulated that alcoholics who experience panic attacks, especially those who experienced panic attacks prior to abusing alcohol may be using alcohol to reduce anxiety or fear related to panic attacks.     

Emotionally avoidant language in the parenting interviews of substance‐dependent mothers: Associations with reflective functioning,recent substance use,and parenting behavior

Parenting and emotion regulation are two known, and potentially interrelated, areas of impairment among substance‐abusing mothers. In this study, we examine substance ‐abusing mothers' (positive and negative) emotion language word use during their discussion of negative parenting experiences on the Parent Development Interview for its association with reflective functioning (RF), recent substance‐use history, and sensitivity to child cues. Within a sample of 47 methadone‐maintained mothers, we evaluate the hypothesis that linguistic evidence of emotional avoidance (more frequent positive feeling words and less frequent negative emotion words) will be associated with lower RF, more recent substance use, and more insensitive parenting. Further, we evaluate whether language use mediates the association between self‐focused RF and insensitive parenting. Results of hierarchical regressions suggest that more frequent positive feeling word use, but not negative emotion word use, is associated with lower RF, more recent substance use, and lower sensitivity to child cues. Positive feeling word use partially mediates the association between self‐focused RF and insensitive parenting. Results are discussed in the context of their contribution to the literature on emotion and parenting in substance‐abusing populations.     

Alcohol‐related violence defined by ultimate goals: a qualitative analysis of the features of three different types of violence by intoxicated young male offenders

Based upon a functional approach to understanding aggression, we aimed to identify the occurrence of and to describe the features of three types of alcohol‐related violence defined a priori by ultimate goals: (1) violence in pursuit of nonsocial profit‐based goals, (2) violence in pursuit of social dominance goals, and (3) violence as defence in response to threat. A sample of 149 young men with offences of violence that were alcohol related was interviewed. Cases were classified and detailed information from the first ten cases in each class (N=30) was subjected to thematic analysis. Intoxicated violence in pursuit of nonsocial profit‐based goals was opportunistic and motivated by the desire for more alcohol or drugs. Violence, in these cases, although serious, appeared to be brief. Intoxicated violence in pursuit of social dominance goals was typically precipitated by past or current insult or injury, and was accompanied by strong anger and an adrenaline rush. Attacks were ferocious, and robbing the victim was not uncommon, perhaps to inflict additional humiliation. Feelings of pride and satisfaction were typical and expressions of remorse were uncommon. Regarding intoxicated violence as defence in response to threat, attacks were often expected, and in some cases the respondent made a pre‐emptive strike. Weapon use was common in this group. Fear was experienced, but so too was anger. Feelings of excitement were not reported and remorse was common. Further validation of these types is warranted, and the potential implications of these findings for prevention and treatment are discussed. Aggr. Behav. 36:67–79, 2010. © 2009 Wiley‐Liss, Inc.     

Psychotherapy groups and individual support to enhance mental health and early dyadic interaction among drug‐abusing mothers

The purpose of this controlled study was to examine the outcome of psychodynamic mother–infant group psychotherapy (PGT) outpatient intervention for drug‐abusing perinatal mother–infant dyads. PGT comprised 20 to 24 weekly 3‐hr sessions with 3 to 5 months of follow‐up. A comparison intervention group was formed of mothers participating in individually tailored psychosocial support (PSS) lasting, on average, 12 months and providing mother–infant support and practical counseling. We hypothesized that positive changes would occur in maternal drug abuse, mental health, and mother–infant interaction, especially in the PGT group due to its more intensive therapeutic focus. Participants were 26 drug‐abusing dyads in PGT, 25 in PSS, and 50 dyads in a non‐drug‐abusing comparison group. Assessments were pre‐intervention and at 4 and 12 months' follow‐up, including maternal depressive symptoms and mother–child interaction assessed by the Emotional Availability Scales (EA). As hypothesized, in dyadic interaction maternal hostility decreased significantly in the PGT group, and intrusiveness decreased in both intervention groups, but especially in the PTG group. However, both interventions showed a general improvement in the quality of mother–infant interaction. They also succeeded in sustaining high maternal abstinence, treatment retention, and alleviating depressive symptoms. The findings are discussed in relation to preventing negative transgenerational interaction patterns in the high‐risk dyads.     

Women,alcohol, self‐concept and self‐esteem: A qualitative study of the experience of person‐centred counselling

This study explores the self‐concept and self‐esteem of women with alcohol problems from a client perspective, and relates the findings to person‐centred theory and practice. Eight women with severe and long‐standing alcohol problems, who had received person‐centred counselling, were interviewed in relation to their sense of self over time. The data were analysed using grounded theory methodology, resulting in the emergence of five key categories. Examples from the interviews are used to illustrate the complex relationships between life experience, self‐concept, self‐esteem and drinking. The possible significance of the findings for counsellors working with this client group is discussed.     

The relationship between family‐of‐origin experiences and sexual satisfaction in married couples

This study examined the relationship between perceptions of family‐of‐origin experiences, sexual satisfaction and marital quality. The sample consisted of 3953 married couples who responded to the relationship evaluation. The results showed that more positive overall family‐of‐origin experiences and parent–child relationships were related to higher sexual satisfaction. Overall, family‐of‐origin experiences and parent–child relationships were predictive of higher sexual satisfaction; however, that relationship was significantly mediated by marital quality. There was a strong positive relationship between marital quality and sexual satisfaction. No major gender differences emerged from the findings. The results suggest that family‐of‐origin experiences play a key role in the sexual satisfaction of married couples, especially when mediated by marital quality, and should be considered in treatment, education and research.     

Variables Associated with Therapy Attendance in Runaway Substance Abusing Youth: Preliminary Findings

Service providers and researchers note that youth with substance abuse problems are difficult to engage in treatment and, when engaged, often drop out early. Estimates of the alcohol and drug abuse rate of runaway youth range from 70% to 95%. This study evaluated predictors of therapy attendance in a sample of substance abusing youth recruited through two southwestern runaway shelters. Runaway youth and their families (N = 36) were engaged into a 15-session ecologically-based family therapy (EBFT) intervention. Fewer days between the pretreatment assessment and the first therapy session, as well as less perceived parental care, predicted more therapy sessions attended. No relationship was found between level of substance use and treatment attendance. The findings highlight the importance of engaging families in therapy soon after the youth's arrival to the shelter, as treatment motivation may decrease as the crisis lessens.