We‐Language and Sustained Reductions in Drinking in Couple‐Based Treatment for Alcohol Use Disorders

Couple‐based treatments for alcohol use disorders (AUDs) produce higher rates of abstinence than individual‐based treatments and posit that active involvement of both identified patients (IPs) and significant others (SOs) is partly responsible for these improvements. Separate research on couples’ communication has suggested that pronoun usage can indicate a communal approach to coping with health‐related problems. The present study tested whether communal coping, indicated by use of more first‐person plural pronouns (“we” language), fewer second‐person pronouns (“you” language), and fewer first‐person singular pronouns (“I” language), predicted improvements in abstinence in couple‐based AUD treatment. Pronoun use was measured in first‐ and mid‐treatment sessions for 188 heterosexual couples in four clinical trials of alcohol behavioral couple therapy (ABCT). Percentages of days abstinent were assessed during treatment and over a 6‐month follow‐up period. Greater IP and SO “we” language during both sessions was correlated with greater improvement in abstinent days during treatment. Greater SO “we” language during first‐ and mid‐treatment sessions was correlated with greater improvement in abstinence at follow‐up. Greater use of IP and SO “you” and “I” language had mixed correlations with abstinence, typically being unrelated to or predicting less improvement in abstinence. When all pronoun variables were entered into regression models, only greater IP “we” langue and lower IP “you” language predicted improvements in abstinence during treatment, and only SO “we” language predicted improvements during follow‐up. Most pronoun categories had little or no association with baseline relationship distress. Results suggest that communal coping predicts better abstinence outcomes in couple‐based AUD treatment.     

Reflecting Resiliency: Openness About Sexual Orientation and/or Gender Identity and Its Relationship to Well-Being and Educational Outcomes for LGBT Students

For lesbian, gay, bisexual, and transgender (LGBT) youth, coming out (i.e., disclosure of LGBT identity to others) can be a key developmental milestone, one that is associated with better psychological well‐being. However, this greater visibility may come with increased risk of peer victimization. Being out, therefore, may reflect resilience and may unfold differently depending on ecological context as some spaces may be more or less supportive of LGBT youth than others. This article explores a model of risk and resilience for outness among LGBT youth, including whether it varies by community context. We tested our hypothesized model with a national dataset of 7,816 LGBT secondary school students using multi‐group structural equation modeling. Consistent with our hypotheses, outness was related to higher victimization but also to higher self‐esteem and lower depression. Greater victimization was related to negative academic outcomes directly and indirectly via diminished well‐being. The increases in victimization associated with outness were larger for rural youth, and benefits to well‐being partly compensated for their lower well‐being overall. This article suggests that being out reflects resilience in the face of higher risk of victimization, in addition to promoting well‐being in other ways. Nonetheless, contextual factors influence how this model operates among LGBT youth.     

Effects of biochemical validation of self-reported cigarette smoking on treatment success and on misreporting abstinence

Many investigators have reported that cigarette smokers who are trying to quit often falsely report being abstinent at the end of treatment. Unfortunately, much of the previous research designed to investigate this problem has been flawed, making the results difficult to interpret. We attempted to avoid these flaws and to investigate the measurement of alveolar carbon monoxide (CO) levels to validate self-reported smoking rates at the end of treatment. Participants in behavioral cessation clinics were randomly assigned to one of three conditions that varied in timing of exposure to information regarding CO measurement: at the beginning of treatment (demonstration of CO measurement, discussion of smoking effects on CO levels, and notification that individual CO levels would be measured at the conclusion of the clinic), at the end of treatment (demonstration, discussion, and notification of CO measurement prior to self-reports of smoking levels), or at the end of treatment (demonstration and discussion of CO measurement subsequent to self-reports of smoking levels). CO levels of all participants were measured at the end of treatment after they reported their current smoking levels. Only 16% of self-reports of abstinence were not verified by CO measurement. Smokers who observed the CO demonstration at the beginning of treatment were significantly more likely than the other two groups to achieve abstinence at the end of treatment and significantly less likely to misreport abstinence. Clinical and research implications of these results are discussed.     

“It Just Always Seemed Like it Wasn't a Big Deal,Yet I Know for Some People They Really Struggle with It”: LGBT Religious Identities in Context

Scholarly examinations of lesbian, gay, bisexual, and transgender (LGBT) religious identities have typically focused on “identity reconciliation,” which assumes that being both LGBT and religious is a “contradiction,” and posits a “coherent” identity as a desired end goal. The present research draws on a qualitative study of three LGBT‐identified congregations to demonstrate that there are a variety of ways in which LGBT religious people approach the connection between their LGBT identity and their religion. While some participants of the study did feel a need to reconcile these aspects of their self, others report never feeling a strong conflict between their LGBT identity and faith. The differences in these understandings of LGBT identity emerge out of the sociotemporal contexts the interviewees exist in, suggesting that different contexts provide divergent resources for identity performances. Through these findings, I contribute to our understanding of the intersection of religious agency, religious identities, and religion as a quality of social spaces.     

Concurrent brief versus intensive smoking intervention during alcohol dependence treatment.

Alcohol dependent smokers (N=118) enrolled in an intensive outpatient substance abuse treatment program were randomized to a concurrent brief or intensive smoking cessation intervention. Brief treatment consisted of a 15-min counseling session with 5 min of follow-up. Intensive intervention consisted of three 1-hr counseling sessions plus 8 weeks of nicotine patch therapy. The cigarette abstinence rate, verified by breath carbon monoxide, was significantly higher for the intensive treatment group (27.5%) versus the rate for the brief treatment group (6.6%) at 1 month after the quit date but not at 6 months, when abstinence rates fell to 9.1% for the intensive treatment group and 2.1% for the brief treatment group. Smoking treatment assignment did not significantly impact alcohol outcomes. Although intensive smoking treatment was associated with higher rates of short-term tobacco abstinence, other, perhaps more intensive, smoking interventions are needed to produce lasting smoking cessation in alcohol dependent smokers.     

A receiver operator characteristics analysis of treatment outcome in binge eating disorder to identify patterns of rapid response

The purpose of this study was to perform a receiver operator characteristics (ROC) analysis on a treatment sample from a randomized controlled treatment trial of participants with binge eating disorder (BED). An ROC analysis was completed with 179 adults in a 20-week treatment trial for BED to predict abstinence from binge eating at end of treatment. Percent reductions in binge eating episodes were examined following weeks 1 through 10 of treatment. The rate of percent decrease in binge eating episodes during treatment for BED was a significant predictor of clinical outcome at end of treatment. Participants who demonstrated a 15% reduction in binge eating episodes at week one were more likely to respond positively to treatment and achieve clinical remission. Findings from the current study suggest that a significant reduction in binge eating during the first week of treatment may be predictive of end of treatment remission in those with BED.     

Is control a viable goal in the treatment of pathological gambling?

According to a report of National Gambling Impact Study Commission (National Gambling Impact Study Commission (1999). Final report. Washington, DC: Government Printing Office.), 97% of problem gamblers in the United States do not seek treatment. Within the small proportion of problem gamblers who enter into treatment, a high percentage drops out. Despite the fact that some researchers argue against abstinence as the only acceptable treatment goal and that regaining control over gambling behaviour appears to be possible for some pathological gamblers (PG), abstinence has been the only gambling intervention treatment goal. The primary goal of this study was to verify whether controlled gambling is a viable goal for pathological gamblers. The second goal was to identify the characteristics that predicted a successful outcome for treatment with a controlled gambling goal. Eighty-nine PGs were enrolled in cognitive-behavioural treatment aimed at controlled gambling. Six and twelve month follow-ups were conducted in order to evaluate the maintenance of therapeutic gains and to identify significant predictors of successful controlled gambling. Results showed that using the intent-to-treat procedure, 63% had a score of 4 or less on the DSM-IV at the end of treatment. That proportion was 56% and 51% at the 6- and 12-month follow-ups. If we retain only those who completed the treatment, these proportions increased to 92%, 80% and 71% at post-treatment, 6- and 12-month follow-ups, respectively. On the majority of the measures, significant improvements were found at post-treatment and the therapeutic gains were maintained at the 6- and 12-month follow-ups. However, few variables were identified to predict who would benefit from control rather than abstinence. The clinical and philosophical implications of these results are discussed in this paper.     

A National Evaluation of Community-Based Youth Cessation Programs: End of Program and Twelve-Month Outcomes

Most youth cessation treatment research consists of efficacy studies in which treatments are evaluated under optimal conditions of delivery. Less is known about the effectiveness of youth cessation treatments delivered in real-world, community based settings. A national sample of 41 community-based youth cessation programs participated in a longitudinal evaluation to identify site, program, and participant characteristics associated with successful cessation. Validated quit rates were comparable to those in randomized controlled trials; 7-day abstinence at the end of program averaged 14% and 30-day abstinence at 12 months averaged 12%. Multivariate GEE models explored predictors of smoking cessation at the end of the programs and at 12 months. Results showed correlates of both short- and long-term cessation. Findings point to the importance of both individual and community-level variables, including motivation, opportunities for and encouragement to engage in activities outside of academics, having youth participate in treatment before they become highly dependent smokers, and community norms and ordinances that discourage youth purchase, use and possession of tobacco. Providing evidence-based treatment to youth in community-based settings results in successful cessation.     

The Meanings and Manifestations of Religion and Spirituality among Lesbian, Gay, Bisexual, and Transgender Adults

The present study employed a mixed method approach in the effort to explore religious and spiritual practices among lesbian, gay, bisexual, and transgender (LGBT) individuals, as well as the meanings ascribed to the terms religiosity and spirituality by LGBT adults. Data were collected via a cross-sectional survey consisting of open- and close-ended items among 498 LGBT (lesbian, gay, bisexual, transgender) identified individuals attending an annual Pride event in a large northeastern city. Both quantitative and qualitative findings suggested that consistent with other studies, spirituality was defined largely in relational terms (e.g., in terms of one’s relationship with God and with self). Religion, in contrast, was defined largely in terms of communal worship and in terms of its negative influences in the lives of individuals and communities. For this sample of LGBT persons, spiritual identities were more pronounced than religious ones, and this pattern may be explained by their understanding of the spiritual self in relation to prosocial engagement and interconnectedness with others, the world around them, and the universe. Further, religious affiliation and practices were explained, in part, by the religion in which the individual was raised, level of educational attainment, as well as the developmental stage in which the person is currently situated. The findings highlight the reality that a substantial number of LGBT individuals may remain committed to religious and spiritual life, which may be related to a motivation to make sense of one’s place in the world especially in light of societal misunderstandings and intolerance to LGBT individuals.     

Addressing disparities: The impact of a lesbian,gay, bisexual,and transgender graduate counselling course

Background: Lesbian, gay, bisexual and transgender (LGBT) individuals experience serious mental health disparities and treatment inequities. Counsellor education has been identified as both a contributing factor to these problems as well as an ameliorating mechanism to address these inequalities. Aim: The purpose of the current study was to evaluate the impact of an LGBT‐affirmative counselling course. Method: A total of 23 students enrolled in a graduate LGBT counselling course were administered the Sexual Orientation Counselor Competency Scale (SOCCS, Bidell, 2005) and the Lesbian, Gay, and Bisexual Affirmative Counseling Self‐Efficacy Inventory (LGB‐CSI, Dillon & Worthington, 2003) pre‐ and post‐course. In addition, a comparison group of 23 matched counselling students was obtained from an existing data source in order to make further assessments of the course's effectiveness. Those in the comparison group were not enrolled in the LGBT course, but were administered the SOCCS at analogous time intervals. Results: After completing the LGBT course, enrolled students demonstrated significant improvements regarding their sexual orientation counsellor competency and self‐efficacy. In addition, these students showed significant gains in SOCCS scores versus those in the comparison group. Implications: Results from this study show the positive effect a full‐credit LGBT psychotherapy course can have on graduate counselling students' sexual orientation counsellor competency and self‐efficacy. The findings also indicate that such a course can significantly impact counselling skills, a facet of LGBT cultural competency found to be the most attenuated. Findings are discussed in conjunction with LGBT‐affirmative counsellor training and clinical practice.     

An exposure approach to alcohol abuse

The drinking behaviour of alcoholics was firstly analysed in terms of antecedents, behaviour and consequences. Thereafter, treatment consisted of exposure to the antecedents of drinking, whilst patients were prevented from drinking. Five out of the six patients attained abstinence from drinking by the end of therapy, this abstinence being maintained over follow-ups of up to 9 months, and also noted an absence of desire to drink at the end of therapy. The possible mechanisms in operation during treatment are discussed, including operant or classical conditioning, teaching of self control and cognitive invalidation.     

Changes in Hypothesized Mechanisms of Change Before and After Initiating Abstinence in Cognitive-Behavioral Therapy for Women With Alcohol Use Disorder

Abstinence self-efficacy, coping skills, and therapeutic alliance are hypothesized mechanisms of behavioral change (MOBCs) in cognitive-behavioral therapy (CBT) for alcohol use disorder (AUD). However, little is known about when these hypothesized MOBCs change during treatment or in relation to the initiation of abstinence from alcohol, which the current study investigated. Patient-reported abstinence self-efficacy, drinking-related coping skills, and therapeutic alliance were measured at every session throughout a 12-session clinical trial that previously showed equivalent drinking reductions in female-specific individual- and group-based CBT for AUD. Participants (N = 121 women) were classified into subgroups based on whether and when they first initiated 14 days of continuous abstinence from alcohol during treatment. Interrupted time-series analyses evaluated the magnitude and timing of change in MOBC variables in relation to the initiation of abstinence. All three MOBC measures showed gradual improvements throughout treatment (within-subjects d = 0.03 to 0.09 change per week). Participants who initiated abstinence during treatment experienced additional sudden improvements in abstinence self-efficacy (d = 0.47) and coping skills (d = 0.27), but not therapeutic alliance (d = -0.02), the same week they initiated abstinence. Participants who were already abstinent when treatment started maintained higher abstinence self-efficacy and coping skills, but not therapeutic alliance, throughout treatment compared to participants who never initiated abstinence. Initiating abstinence may help facilitate improvements in abstinence self-efficacy and drinking-related coping skills. Clinicians may help patients anticipate when and how much these variables are expected to improve during treatment and encourage initiation of abstinence to potentially help facilitate improvements in abstinence self-efficacy and coping skills.     

A randomized controlled trial of contingency management for smoking cessation in substance use treatment patients

Background/ObjectiveContingency management (CM) is one of the most effective interventions for smokers with substance use disorder (SUD), and no empirical assessment of its long-term efficacy has been conducted so far in a real-world context. The objectives were: (1) examine the additive effectiveness of CM on cognitive-behavioral treatment (CBT) for smoking cessation, and (2) examine the relationship between smoking cessation and substance use abstinence.MethodA total of 80 participants (75.8% males; M_age = 45.31; SD = 9.64) were assigned to two smoking cessation treatments: CBT or CBT+CM. A set of generalized estimating equations were conducted to examine the effect of treatment condition on smoking outcomes, as well as the effect of smoking status on substance abstinence.ResultsAdding CM to CBT for smoking cessation improved tobacco abstinence rates at the end-of-treatment (p = .049). Tobacco abstinence rates declined over time (p = .012), but no significant effects of treatment condition were observed across follow-ups (p = .260). Smoking cessation was not significantly related to substance abstinence (p ≥ .488).ConclusionsCM facilitates early abstinence in smokers with SUD, although effects subside after treatment termination. The lack of association between smoking abstinence and substance use suggests no jeopardizing effects as a result of quitting smoking.     

Accounting for self-selected drinking goals in the assessment of treatment outcome

Many treatment outcome studies are abstinence-based and rely on achieved abstinence as an indicator of success, making the implicit assumption that participants have an abstinence goal. However, it is often the case that participants self-select controlled drinking goals, even in the context of an abstinence-based treatment. The current study explored the use of an outcome variable, percent weeks meeting goal (PWMG), which takes into account individual goal choice at baseline. The sample consisted of 57 women who participated in a cognitive-behavioral therapy treatment for alcohol dependence and were followed for 18 months after baseline. Twenty-two (39%) women self-selected controlled drinking goals, and 35 (61%) self-selected an abstinence goal at baseline. A repeated measures analysis of variance with PWMG as the dependent variable revealed that both goal groups were equally successful in meeting their goals during the 6-month treatment period. After treatment, participants with a goal of abstinence had more PWMG than did participants with a self-selected controlled drinking goal, but the difference was significant at a trend level. The two goal groups did not differ in outcome when the authors compared them using more traditional measures of outcome, percent days abstinent and percent heavy drinking days.     

Is negative the new positive? Secondary transfer effect of exposure to LGBT portrayals in TV entertainment programs

This study investigates the primary effect of positive, neutral, and negative exposure to Lesbian, Gay, Bisexual, and Transgender (LGBT) TV portrayals in entertainment programs on attitudes toward the LGBT community and the Secondary Transfer Effect (STE) of such exposure on attitudes toward people with Asperger's Disorder (the secondary out-group), controlling for face-to-face and online contacts with both out-groups. Research was conducted using a mixed methods approach. Quantitative Study 1 used an online survey of 716 Israeli Jews, to investigate primary and secondary effects of TV exposure to LGBT portrayals. The positive primary effect of TV exposure was shown—regardless of LGBT portrayals perceived as positive, neutral, or negative. STE of TV exposure to neutral and negative LGBT portrayals is likely to diminish social distance to people with Asperger's Disorder, while no STE was found with positive LGBT portrayals. Full mediation effect of attitudes toward the LGBT community was found. Qualitative Study 2, based on 52 in-depth interviews, was conducted in order to reveal the hidden mechanisms of these effects, examining the parasocial experience and its interpretations by the viewers. According to qualitative findings, the positive primary and secondary effects of negative exposure may be explained by varied interpretations of gay portrayals on TV by different people depending on social background and life experience, opposite reaction on stereotypical gay portrayals on TV, and asymmetrical negative-positive heuristic. Given the important role of TV in fostering more positive intergroup relations, this research revealed sources of prejudice reduction and increase in tolerance toward “others” for society at large.     

Challenging the opposition of LGBT identities and Muslim cultures: initial research on the experiences of LGBT Muslims in Canada

ABSTRACT

Many have described the cultural and political opposition between LGBT rights and identities and Muslim cultures. Rahman (2014) has argued that one important way to challenge this perceived enmity is to produce further knowledge about the experiences and identities of LGBT Muslims because they exist at the intersections of this political opposition and disrupt the assumptions underlying it. Drawing on Rahman’s framework of Muslim LGBT as “LGBT Intersectional Identities”, we provide initial evidence from on-going research into the experiences of LGBT Muslims in Canada, based on six in-depth qualitative interviews. Focusing on the tensions between living an LGBT life and being Muslim, we demonstrate that there are strategies for reconciling the two that undermine assumptions about the mutual exclusivity of Muslim cultures and homosexualities. These strategies both confirm the extant evidence of identity processes for LGBT Muslims and provide some new evidence of the awareness of negotiating Islamophobia, racialization and Muslim homophobia as part of the development of an LGBT Muslim identity, and the need to understand Muslim identity in a broader frame than simply religious. In this sense, the experiences of LGBT Muslims present an LGBT intersectional challenge, both to western assumptions about the coherence of LGBT identity and the coming out process, and to assumptions in Muslim culture that tend to position individuals who identify as LGBT outside of their traditions.     

Rapid smoking,cue exposure and support in the modification of smoking

Forty-nine dependent smokers were assigned to one of three treatment conditions: rapid smoking, cue exposure or simple support. There were no differences between treatments in the proportion who stopped smoking or the average reduction in smoking at the end of treatment or at 1 yr follow-up. The overall proportion who stopped was 22% at the end of treatment and 14% at 1 yr follow-up. Time of the first cigarette of the day (before tea or coffee) and percentage reduction in consumption whilst trying to cut down unaided, predicted abstinence at 1 yr follow-up. These results do not support claims made for the effectiveness of rapid smoking.     

Effects of internet-based voucher reinforcement and a transdermal nicotine patch on cigarette smoking

Nicotine replacement products are commonly used to promote smoking cessation, but alternative and complementary methods may increase cessation rates. The current experiment compared the short-term effects of a transdermal nicotine patch to voucher-based reinforcement of smoking abstinence on cigarette smoking. Fourteen heavy smokers (7 men and 7 women) completed the four 5-day phases of the study: baseline, patch treatment, voucher treatment, and return to baseline. The order of the two treatment phases was counterbalanced across participants. In the patch treatment condition, participants wore a 14-mg transdermal nicotine patch every day. In the voucher treatment condition, participants received vouchers contingent on abstinence from smoking, defined as producing carbon monoxide (CO) readings of < or =4 parts per million. Participants e-mailed two video clips per day showing them breathing into a CO monitor and the resulting CO reading to clinic staff. In the voucher treatment, 24% of samples were negative, and 5% of samples were negative in the patch treatment. Results suggest that contingent vouchers were more effective than transdermal nicotine patches in promoting abstinence.     

A randomized wait-list controlled pilot study of dialectical behaviour therapy guided self-help for binge eating disorder

This study examined the efficacy of guided self-help based on dialectical behaviour therapy (DBTgsh) for binge eating disorder (BED). Individuals (88.3% female; mean 42.8 years) were randomized to DBTgsh (n = 30) or wait-list (WL; n = 30). DBTgsh participants received an orientation, DBT manual, and six 20-min support calls over 13 weeks. All participants were assessed pre- and post-treatment using interview and self-report; also, DBTgsh participants were re-assessed six months post-treatment. At treatment end, DBTgsh participants reported significantly fewer past-month binge eating episodes than WL participants (6.0 versus 14.4) and significantly greater rates of abstinence from binge eating (40.0% versus 3.3%). At six-month follow-up, DBTgsh participants reported significantly improved quality of life and reduced ED psychopathology compared to baseline scores. In addition, most improvements in the DBTgsh group were maintained, although binge eating abstinence rates decreased to 30%. These preliminary positive findings indicate that DBTgsh may offer an effective, low-intensity treatment option for BED.     

Effects of dopamine transporter and receptor polymorphisms on smoking cessation in a bupropion clinical trial.

This study examined the role of dopaminergic genes in prospective smoking cessation and response to bupropion treatment in a placebo-controlled clinical trial. Smokers of European ancestry (N=418) provided blood samples for genetic analysis and received either bupropion or placebo (10 weeks) plus counseling. Assessments included the dopamine D2 receptor (DRD2) genotype, dopamine transporter (SLC6A3) genotype, demographic factors, and nicotine dependence. Smoking status was verified at the end of treatment (EOT) and at 6-month follow-up. The results provided evidence for a significant DRD2 * SLC6A3 interaction effect on prolonged smoking abstinence and time to relapse at EOT, independent of treatment condition. Such effects were no longer significant at 6-month follow-up, however. These results provide the first evidence from a prospective clinical trial that genes that alter dopamine function may influence smoking cessation and relapse during the treatment phase.