Comorbidity and Risk Behaviors Among Drug Users Not in Treatment

In a sample of 700 drug users, 64% evidenced comorbidity (i.e., coexisting substance use and psychiatric disorders). Robust relationships between the presence of comorbidity and increased levels of risk behavior, such as needle sharing and trading sex for money, were revealed.     

The AIDS Risk Reduction Model: Examining Intentions to Use Condoms Among Injection Drug Users1

This paper uses the AIDS Risk Reduction Model (ARRM) to examine psychosocial factors involved in adopting safer sex practices in a sample of Los Angeles injection drug users (IDUs; n= 161) who reported having more than one sex partner in the year preceding the interview. The ARRM hypothesizes that behavior change is a process occurring in three stages: (a) labeling one's behavior as problematic, (b) making a commitment to behavior change, and (c) taking action to accomplish that change. We test the first two stages of the model using a measure of perceived risk of HIV infection (Stage I), and intentions to use condoms always during vaginal or anal sex in the next year (Stage 2). We examine differences in the predictive value of the ARM between IDUs who reported using condoms in the year prior to the interview and those who reported not using them. We identify leverage points in the model-factors which appear to have a major influence on intentions to use condoms and which may be amenable to change through educational or other types of intervention. For both condom users and non-users, susceptibility to AIDS predicted perceived infection risk (Stage I). For condom users, knowledge about AIDS also predicted perceived risk. For both groups, self efficacy, peer norms concerning condom use, and the perceived pleasure of using condoms predicted intentions to use condoms (Stage 2). Our findings do not support either direct or indirect relationships between the Stage 1 and Stage 2 outcome variables for either group.     

Religiosity and HIV-Related Drug Risk Behavior: A Multidimensional Assessment of Individuals from Communities with High Rates of Drug Use

We examined the relationship between religiosity and HIV-related drug risk behavior among individuals from communities with high rates of drug use who participated in the SHIELD (Self-Help in Eliminating Life-Threatening Disease) study. This analysis examined the dimensions of religious ideation, religious participation, and religious support separately to further understand the relationship with risk taking. Results indicate that greater religious participation appeared to be the dimension most closely associated with drug behaviors. Specifically, we found that those with greater religious participation are significantly less likely to report recent opiates or cocaine use; injection drug use; crack use; and needle, cotton or cooker sharing. Future work to understand the nature of these associations will assist in the development of interventions in communities with high rates of drug use.     

Developing a Feminist Model for Clinical Consultation:

Feminist therapists have often felt outside the mainstream of clinical practice. The on-going process of developing our theoretical base has both strengthened our effectiveness and decreased our sense of professional isolation. Few mentors, colleagues or supervisors share this feminist philosophical base. One response to this dilemma has been the development of feminist organizations, such as the Feminist Therapy Institute and the Association for Women in Psychology. A complementary response is the creation of local feminist consultation groups for ongoing clinical consultation and for personal support. This paper discusses the process of developing one such group and the role that the interaction that commonality and diversity has played in its creation and evolution. The dialectical relationship between commonality and diversity is also explored in a broader sense. Finally, the beginning of a developmental view of this group's evolution is offered, emphasizing the links for women between connectedness and learning.     

Regulatory Focus and Anxiety: A Self-Regulatory Model of GAD-Depression Comorbidity

The etiology of generalized anxiety disorder (GAD), including its high degree of comorbidity with major depressive disorder (MDD), remains a conceptual and clinical challenge. In this article, we discuss the relevance of regulatory focus theory, an influential theory of self-regulation, for understanding vulnerability to GAD as well as GAD/MDD comorbidity. The theory postulates two systems for pursuing desired end states: the promotion and prevention systems. Drawing upon studies documenting the affective and motivational consequences of failing to attain promotion versus prevention goals, as well as the literature linking promotion failure with depression, we propose how dysfunction within the prevention system could lead to GAD - with, as well as without, MDD.     

Comorbidity in compulsive hoarding: a case report

A 56-year-old male presented with compulsive hoarding along with attention-deficit/hyperactivity disorder and schizotypal personality disorder. Hoarding has been described as difficult to treat both pharmacologically and behaviorally, and this patient's comorbid conditions also contributed to his overall impairment. The patient's treatment regimen of fluvoxamine, amphetamine salts, and risperidone, along with behavioral therapy, has helped with hoarding behaviors, motivation, procrastination, and increased socialization. Hoarding may be a unique subtype of obsessive-compulsive disorder with poorer prognosis and distinct neuroanatomic dysfunction. Augmentation with stimulants may provide benefits in aspects of hoarding such as procrastination, especially in patients with comorbid attention-deficit hyperactivity disorder.     

Decreasing Adolescent Drug Use and School Failure:

Behavioral analyses of 3 adolescents show that 3 months of targeted family problem-solving training can decrease drug use and school failure by the end of a 1 1/4 year follow-up while control behaviors remain stable. Some findings, however, reflected incomplete understanding of the controlling variables: (a) lengthy delays before behavioral improvement, (b) recurrences of the problem behavior and subsequent recoveries during follow-up, and (c) correlated changes in the home and school environments. It is suggested that systematic study of relevant variables in the intervention could reduce behavioral variability and further increase understanding of adolescent drug use.     

Developing a Capped Model for Combining Ideals

Philosophia - This work motivates the Combined Model for Combining Ideals, which Larry Temkin introduces in “sketch” form in Rethinking the Good, and goes on to begin filling in the...     

Comorbidity of Conduct and Depressive Problems at Sixth Grade: Substance Use Outcomes Across Adolescence

The comorbidity of conduct and depressive problems and substance use outcomes were examined in a community-based sample of 340 African American males and females. Alcohol, tobacco, and marijuana use were examined at Grades 6, 8, and 10 based on the following group membership at sixth grade: (a) comorbid conduct and depressive problems; (b) conduct problems only; (c) depressive problems only; (d) neither conduct nor depressive problems. Overall, the two conduct problem groups displayed the highest levels of substance use, although at some time points, comorbid youth displayed significant higher substance use levels. Subjects with depressive problems only displayed levels of substance use that were equivalent to subjects in the nonproblem group. Results highlight the importance of controlling for comorbid symptoms, possible interactive effects between conduct and depressive problems, and implications for treatment and prevention of substance use.     

Developing Support for Alcohol and Drug Education: A Case Study of a Counselor's Role

A small group of individuals successfully helped a rural community deal with its adolescent drug problems and illustrated important roles for counselors and community leaders.     

The Association of Group Self-Identification and Adolescent Drug Use in Three Samples Varying in Risk1

This study provides a cross-sectional analysis of the relations between group self-identification and adolescent drug use in 3 samples of youth: comprehensive high-school, continuation high-school, and runaway/street youth. Youth identified with discrete groups in all 3 samples, and similar general groups were formed. In most comparisons, a high-risk group showed greater levels of drug use than did other groups. This is the first study to demonstrate that group self-identification (a) is a generalizable construct across different types of adolescent samples, (b) is related to use of drugs other than tobacco, and (c) remains a significant correlate of drug use controlling for its relations with demographic variables and several other psychosocial variables.     

Comorbidity of Hyperactivity-Impulsivity-Inattention and Conduct Problems: Risk Factors in Social, Affective, and Academic Domains

Children showing a comorbid behavior pattern of hyperactivity-impulsivity-inattention and conduct problems (HIA + CP) were contrasted to children having only an internalizing and externalizing behavior pattern (I + E) and matched controls. Children displaying the HIA + CP behavior pattern were at greater risk on a number of outcome measures in social and academic domains beginning in Grade 3 and continuing into Grade 4. The most marked differences among the three groups were found on peer measures of rejection and friendship and teacher ratings of social skills. On average, almost two-thirds of the HIA + CP group were rejected by their peers compared to one-third of the I + E group and only 12.5% controls. Over 70% of the HIA + CP group had no reciprocated friendships from Grade 3 to Grade 4 compared to less than half of the I + E group and approximately one-fourth of controls. Contrary to much theorizing in the literature, the HIA + CP and I + E groups showed average levels of academic self-concept and did not differ from controls in on measures of social self-concept and academic self-concept and general self-esteem. These findings were interpreted in light of positive illusory biases and the established link between aggressive behavior and egotism. The current article offers partial support for Lynam's (1996) notion of the fledgling psychopath.     

Drug Use and Self-Organization: A Personal Construct Study of Religious Conversion in Drug Rehabilitation

This study investigates the changes in self-identity in 86 participants of a religious drug rehabilitation program in Hong Kong. Conversion to Christianity is found to bring a shedding of a negative drug self-identity and a progressive identification with the Jesus ideal in the participants. From an image of a person with low morality, low confidence, little compassion, and tender feelings, a person isolated and dependent, identification with Jesus brings about a moral, tender, compassionate, and self-reliant person. The grid method is found to be an appropriate medium for the investigation of the relationship between substance use and patterns of self-organization. The research data support the formulation of a personal construct theory of drug abuse, focusing on the implications of acquiring a drug self-subsystem by the drug user. A parallel is drawn between Kelly's (1955) fixed-role therapy and the rehabilitative process, suggesting that, with its focus on the reconstruction of self, fixed-role therapy holds promise for drug rehabilitation work.     

Comorbidity Between Depression and Anxiety in Adolescents: Bridge Symptoms and Relevance of Risk and Protective Factors

Depression and anxiety are highly prevalent and comorbid in adolescents, and this co-occurrence leads to worse prognosis and additional difficulties. The relationship between depression and anxiety must be delineated to, in turn, reduce and prevent the comorbidity, however our knowledge is still limited. We used network analysis to investigate bridge symptoms; symptoms that connect individual depression and anxiety symptoms and thus can help explain the comorbidity. We also examined the role of relevant risk and protective factors in explaining these symptom-level associations between these disorders. We analyzed data from the Avon Longitudinal Study of Children and Parents (n?=?3670). Depression and anxiety symptoms, peer victimization, bullying, peer relational problems, prosocial behavior, and parental monitoring were assessed at a single time point around age 13 years. Stressful life events (SLEs) were assessed at age 11 years. We identified the most prominent bridge symptoms among depression (“feeling unhappy”, “feeling lonely”) and anxiety symptoms (“worrying about past”, “worrying about future”). Peer relational difficulties and SLEs were strongly associated with several depression and anxiety symptoms, such that these two risk factors created a link between individual depression and anxiety symptoms. Prosocial behavior had several negative associations with symptoms of both disorders, suggesting it can be an important protective factor.