Prospective analysis of early lapse to drinking and smoking among individuals in concurrent alcohol and tobacco treatment

The aims of the current study were to examine, prospectively, (a) dynamic changes in affective state, self-efficacy, and urge in the hours before initial smoking and drinking lapses among individuals in concurrent alcohol and smoking treatment, and (b) the extent to which self-efficacy, urge to use, and/or the use of one substance predicted lapse to the other substance. Ninety-six men and women recruited for a clinical trial of concurrent alcohol and tobacco treatment were eligible for inclusion. Only data from those who experienced an initial lapse to drinking (n=29) or smoking (n=32) were included. Two outpatient substance abuse clinics provided concurrent alcohol and smoking treatment on a weekly basis for three months. Ecological Momentary Assessment (EMA) methods were employed over a 28-day monitoring period to assess antecedents to first drink, and a 14-day monitoring period was examined for initial smoking lapses. Baseline and EMA measures of positive and negative affect, alcohol/smoking urge, alcohol/smoking abstinence self-efficacy, nicotine withdrawal, and quantity/frequency of alcohol and tobacco use were examined as lapse predictors. Analyses of EMA ratings controlled for the corresponding baseline measure. Smoking lapse among individuals in concurrent alcohol and tobacco treatment was foreshadowed by higher urges to smoke, lower positive mood, and lower confidence to resist smoking. Drinking lapse was preceded by lower confidence to resist smoking, but only among individuals who reported recent smoking. Concurrent alcohol and smoking treatment should focus on the enhancement of abstinence self-efficacy, positive mood, and the curbing of urges in order to offset lapse risk.     

Trajectories of alcohol and drug use and dependence from adolescence to adulthood: the effects of familial alcoholism and personality

This study describes trajectories of substance use and dependence from adolescence to adulthood. Identified consumption groups include heavy drinking/heavy drug use, moderate drinking/experimental drug use, and light drinking/rare drug use. Dependence groups include alcohol only, drug only, and comorbid groups. The heavy drinking/heavy drug use group was at risk for alcohol and drug dependence and persistent dependence and showed more familial alcoholism, negative emotionality, and low constraint. The moderate drinking/experimental drug use group was at risk for alcohol dependence but not comorbid or persistent dependence and showed less negative emotionality and higher constraint. Familial alcoholism raised risk for alcohol and drug use and dependence in part because children from alcoholic families were more impulsive and lower in agreeableness.     

A Preliminary Investigation of the Relationship Between Emotion Dysregulation and Partner Violence Perpetration Among Individuals with PTSD and Alcohol Dependence

This study examines the link between emotion dysregulation and intimate partner violence (IPV) among 77 individuals with posttraumatic stress disorder (PTSD) and alcohol dependence. Participants were recruited from a residential substance abuse treatment program as part of the eligibility screening for an institutional review board approved clinical trial examining the efficacy of an exposure-based intervention in individuals dually diagnosed with alcohol dependence and PTSD. Participants reported on PTSD symptoms, alcohol use disorder symptoms, emotion dysregulation, and physical and verbal aggression in their intimate relationships during the past year. Findings demonstrated that difficulties with emotion regulation are associated with physical and verbal IPV perpetration in a clinical sample. Although facets of emotion regulation emerged as significant predictors of IPV in the models, alcohol and PTSD symptom severity did not emerge as predictors of IPV. These findings suggest targeted emotion regulation skills training could benefit substance abusers who engage in IPV and that emotion dysregulation might be an important target for future research aimed at understanding elevated rates of IPV perpetration in mental health samples.     

Comorbidity of substance dependence and depression: role of life stress and self-efficacy in sustaining abstinence.

The authors examined life stress and self-efficacy as predictors of time to relapse for 113 adults with comorbid major depressive disorder and alcohol and/or substance dependence in a randomized clinical trial comparing 2 psychotherapy interventions (integrated cognitive- behavioral therapy and 12-step facilitation therapy). Life stress, self-efficacy, and substance use were assessed at treatment entry, 12 weeks (mid-treatment), and 24 weeks (end of treatment). Time to relapse was defined as the number of days from treatment initiation until first alcohol and/or drug use. Half of the sample relapsed within the study period of 24 weeks. There was no significant difference between treatment groups. Individuals experiencing life stressors were more likely to relapse early than those not experiencing life stressors. Lower self-efficacy also predicted earlier relapse. Chronic stress levels and self-efficacy were stable across time for most individuals. In contrast, acute stress events occurred at differing times, and survival analyses provided evidence of heightened relapse risk in the month following acute stressors. The interaction of self-efficacy and life stress was not significant. The results highlight the significance of life stress and self-efficacy as predictors of early relapse.     

Examining the Relationship of Substance Use and Sexual Orientation

In this article we examine the effects of self-reported sexual orientation on substance abuse. Using data on a random sample of 6,713 individuals in Washington State, this study examines causes and correlates of substance use by sexual minorities, an at-risk and treatment underserved population. Logistic regression results indicate homosexual orientation is a significant positive predictor of past year marijuana use, past year hard drug use, past year binge drinking, and lifetime alcohol addiction. Bisexual orientation is a significant predictor of past year marijuana use, past year hard drug use, and past year binge drinking. Potential causal mechanisms for these elevated patterns of substance use are discussed.     

Statistical Effects of Religious Participation and Marriage on Substance Use and Abuse in Racial and Ethnic Minorities

Substance use and abuse, which includes alcohol use, alcohol dependence, drug use, and drug dependence, inflicts a substantial toll on Americans. Although studies have demonstrated the protective effect of social support, such as religious participation and via marriage, understanding their influence on racial and ethnic minorities is limited. Thus, the aim of this study is to assess the impact of social support on substance use and abuse in racial and ethnic minorities. The Collaborative Psychiatric Epidemiology Surveys, sponsored by the National Institute of Mental Health, a repository of race, ethnicity, and mental health data, was leveraged to develop four models using multivariate analysis, specifically logistic regression to estimate the probability of meeting the criteria for substance use and abuse. Racial and ethnic minorities were found to have lower rates of substance use and abuse compared to Whites, and foreign-born individuals were consistently less likely to use or abuse substances compared to American-born minorities. Mental health conditions were highly associated with substance use and abuse, and social support by way of religious participation and marriage was protective against substance use and abuse. In racial and ethnic minorities, nativity and social support were protective against substance use and abuse; however, these protective factors did not completely eliminate risk. Thus, although race and ethnicity are important to understanding health outcomes and health behaviors, such as substance use and abuse, it is the intersection of multiple factors, representing internal and external forces, which may be more informative and offer a more comprehensive picture of the landscape influencing drug and alcohol use and dependence. Targeted interventions should consider leveraging religious spaces and bilingual materials when attempting to reach racial and ethnic minorities.     

Assessment of Panic Frequency: Reliability and Validity of a Time-Line Follow-Back Method

The purpose of this study was to investigate the reliability and validity of a Panic Attack Frequency Calendar (PAFC), modeled after a time-line follow-back (TLFB) procedure (e.g., Sobell & Sobell, 1979). The latter has been used for years to reliably and validly assess daily alcohol use through self-report over extended periods of time. Seventy-four adult individuals (ages 18–57) who had experienced a panic attack within the past 2 weeks completed a battery of self-report questionnaires, including retrospective frequency measures, and were administered an 8-week PAFC initially and a 10-week PAFC 2 weeks later. Half the participants self-monitored their panic attacks in a diary. The PAFC showed high stability over 2 weeks across several panic behavior variables. The PAFC was also shown to be a valid instrument in assessing panic frequency when compared with panic data obtained from the diary and the retrospective frequency measure.     

The Relationship Between Parental Alcoholism and Adolescent Psychopathology: A Systematic Examination of Parental Comorbid Psychopathology

The relationship between parental alcohol dependence (with and without comorbid psychopathology) and adolescent psychopathology was examined in a sample of 665 13-17 year-old adolescents and their parents. Results indicated that adolescents who had parents diagnosed with alcohol dependence only did not significantly differ from adolescents who had parents with no psychopathology in regard to any of the measures of psychological symptomatology (substance use, conduct disorder, and depression) or clinical diagnoses (alcohol dependence, marijuana dependence, conduct disorder, or depression) assessed. In contrast, adolescents who had parents diagnosed with alcohol dependence and either comorbid drug dependence or depression were more likely to exhibit higher levels of psychological symptomatology. In addition, adolescents who had parents diagnosed with alcohol dependence, depression, and drug dependence were most likely to exhibit psychological problems. These findings underscore the importance of considering parental comorbid psychopathology when examining the relationship between parental alcoholism and offspring adjustment.     

Attitudes held by members of the clergy about alcohol

Alcohol, tobacco and other drug abuse continue to cause major threats to the physiological, psychological, sociological and spiritual health of the nation. According to recent statistics, over 80% of the illegal drugs used by youth, both male and female, is marijuana, with cocaine, opium and their derivatives comprising at least 15% of the drugs used by youth. When considering the ill effects of drug abuse, it is the legal one, alcohol that is responsible for the greatest impact on society. While it remains imperative that allied health professionals understand the many ramifications of substance abuse, it is also critical that leaders of faith communities have the knowledge and skills to meet this challenge competently. Due to the relevance of ministries as a possible resource, the focus of this exploratory study is to assess the knowledge, skills and attitudes of clergy about substance use and abuse and to determine their confidence of clergy in assisting their congregation with need related to this area.     

Church youth alcohol and drug education programs

This study indicates that pastors believe that their churches should have a role in influencing the alcohol and drug use of their members; that about half of the churches in this study actually had youth alcohol and drug education programs; and that the content of these education programs and church attitudes toward substance use are affected by the degree of fundamentalism-liberalism of the church.     

Validity of self-reports of alcohol and other drug use: a multitrait-multimethod assessment

Four methods (self-reported rating, self-reported intake, peer-reported rating, peer-reported intake) and multiple analytical criteria were employed to assess the construct validity of reports of three types of substance use (alcohol, marijuana, and cigarettes) in a study of 194 college students who were members of friendship pairs. The resulting multitrait-multimethod matrix was analyzed in the traditional fashion as well as with confirmatory factor analysis. Convergent and discriminant validity for the three substance use traits were quite adequate, although the validity of one measure (the peer-reported intake measure of alcohol use) may be considered inadequate according to some criteria. This study demonstrates the usefulness of multimethod assessment and confirmatory factor analysis for research on construct validity and for derivation of more accurate measures of drug use.     

The influence of self-efficacy on alcohol use among American Indians

The influence of self-efficacy (general and substance use) on alcohol use among 114 American Indian and Native Alaskan adults was examined. Analysis of variance was performed to assess differences between alcohol use groups (nonuse, low use, and medium-high use). Low general self-efficacy (GSE) was associated with higher alcohol use. High substance use self-efficacy (SSE) was associated with higher alcohol use. Moreover, low GSE was associated with higher SSE. Results indicate that alcohol use may be in response to feelings of powerlessness within one's life and may be sustained by perceived feelings of control over use. The study suggests that the concept of self-efficacy appears to relate to empowerment issues and, as such, would have important applications for use with minority individuals.     

Violent offenses associated with co‐occurring substance use and mental health problems: Evidence from CJDATS

The present study examines the relationship between substance use, mental health problems, and violence in a sample of offenders released from prison and referred to substance abuse treatment programs. Data from 34 sites (n = 1,349) in a federally funded cooperative, the Criminal Justice Drug Abuse Treatment Studies (CJDATS), were analyzed. Among parolees referred to substance abuse treatment, self‐reports for the six‐month period before the arrest resulting in their incarceration revealed frequent problems with both substance use and mental health. For most offenders with substance use problems, the quantity of alcohol consumed and the frequency of drug use were associated with a greater probability of self‐reported violence. Mental health problems were not indicative of increases in violent behavior, with the exception of antisocial personality problems, which were associated with violence. The paper emphasizes the importance of providing substance abuse treatment in relation to violent behavior among offenders with mental health problems being discharged to the community. Copyright © 2009 John Wiley & Sons, Ltd.     

Substance use in lesbian, gay, and bisexual populations: an update on empirical research and implications for treatment

Historically, substance use problems were thought to be more prevalent in lesbian, gay, and bisexual (LGB) populations, and correcting skewed perceptions about substance abuse among LGB individuals is critically important. This review provides an update on empirical evidence on LGB substance use patterns and treatment outcome, with specific focus on clinical implications of findings. Compared to earlier studies, the recent research included in this review has used more sophisticated methodologies and more representative samples, and also has investigated multiple dimensions of sexual orientation in relation to substance use patterns. Findings from recent research suggest that lesbians and bisexual women are at greater risk for alcohol and drug use disorders and related problems, and that gay and bisexual men are at greater risk for illicit drug use and related problems. Several sociocultural factors have emerged as correlates of substance use patterns in LGB populations (e.g., affiliation with gay culture, HIV status), and several demographic characteristics (e.g., female, older age) do not appear to be as robust of protective factors against substance abuse for LGB individuals compared to heterosexual populations. Bisexual identity and/or behavior in particular seem to be related to increased risk for substance abuse. In terms of treatment outcome, limitations of extant research prevent conclusions about the relative impact of LGB-specific interventions, and further research that includes women and uses more equivalent comparison interventions is needed. Clinical implications of research findings are discussed for case identification, selection of treatment goals (e.g., moderation vs. abstinence), targets for intervention, and specific treatment modalities.     

Depression as measured by the Beck Depression Inventory-II among injecting drug users

This study conducts a confirmatory factor analysis of the Beck Depression Inventory-II (BDI-II) with a sample of 598 individuals who reported recent injecting drug use. Findings indicate that out of four models tested, the best model for this sample is a three-factor solution (somatic, affective, and cognitive) previously reported by Buckley, Parker, and Heggie. The findings that nearly 50% of participants provided BDI-II scores indicating significant depressive symptomatology reveals that these individuals are in need of treatment for their psychiatric symptoms as well as substance use. Somatic symptoms are endorsed more strongly than affective or cognitive symptoms of depression, suggesting a possible, but yet poorly defined, relationship between depressive symptomatology and drug use that centers on shared somatic symptomatology.     

The Validity of the “Mother” and “Father” Cards of the Rorschach

This article presents analyses on psychometric properties of a recent revision of the Substance Abuse Subtle Screening Inventory (SASSI-3). Participants were 772 individuals from a range of clinical settings who were independently diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association [APA], 1987) or DSM-IV (APA, 1994) criteria regarding the presence or absence of a substance-dependence disorder. A development sample (n = 391) was used to formulate SASSI-3 decision rules that yielded 95% agreement with clinical diagnoses of substance dependence. Correspondence with the criterion variable was shown to be 97% in a cross-validation sample (n = 381) from the same clinical settings. Convergent relations were demonstrated with a variety of other indexes of substance misuse, including clinical assessments of substance abuse history, alcohol and drug-related arrests, self-reported use of illicit drugs, and other instruments designed to screen for substance misuse. Further, logistic regression analyses indicated no significant differences in the overall accuracy of the SASSI-3 as a function of respondents' demographic characteristics or clinical ratings of respondents' level of adjustment and functioning (Global Assessment of Functioning ratings; APA, 1987, 1994).     

A test of the relations between avoidance of panic-related situations and substance use, substance dependence, and depression among subclinical panickers

The hypotheses that among subclinical panickers, avoidance of panic-related situations would be associated with elevated substance use levels and increased likelihood of lifetime diagnoses of substance dependence and major depressive disorder (MDD) were tested. Findings confirmed that panic-related avoidance was associated with an elevated likelihood of lifetime diagnoses of nicotine and alcohol dependence as well as MDD, but not drug dependence. Panic avoidance was also related to relatively greater daily levels of cigarette and alcohol use.     

Stuttering,alcohol consumption and smoking

PurposeLimited research has been published regarding the association between stuttering and substance use. An earlier study provided no evidence for such an association, but the authors called for further research to be conducted using a community sample. The present study used data from a community sample to investigate whether an association between stuttering and alcohol consumption or regular smoking exists in late adolescence and adulthood.MethodsRegression analyses were carried out on data from a birth cohort study, the National Child Development Study (NCDS), whose initial cohort included 18,558 participants who have since been followed up until age 55. In the analyses, the main predictor variable was parent-reported stuttering at age 16. Parental socio-economic group, cohort member's sex and childhood behavioural problems were also included. The outcome variables related to alcohol consumption and smoking habits at ages 16, 23, 33, 41, 46, 50 and 55.ResultsNo significant association was found between stuttering and alcohol consumption or stuttering and smoking at any of the ages. It was speculated that the absence of significant associations might be due to avoidance of social situations on the part of many of the participants who stutter, or adoption of alternative coping strategies.ConclusionBecause of the association between anxiety and substance use, individuals who stutter and are anxious might be found to drink or smoke excessively, but as a group, people who stutter are not more likely than those who do not to have high levels of consumption of alcohol or nicotine.     

Factors related to young people's attitudes to the consumption of alcohol and other psychoactive substances

In this study we analyzed variables related to the consumption of alcohol and other psychoactive substances among young people, and to their attitudes towards experimentation. The sample was made up of 775 pupils aged 12 to 16 from four secondary schools in the Principality of Asturias (northern Spain). The results obtained confirm the multi-causal nature of these phenomena. The attitudes of young people towards substance use was found to be more favourable the lower the perception of risk, the more mistaken their beliefs and the more permissive their disposition to the use of alcohol and other illegal drug. Other determining factors are their relationship with peer groups that use drugs, antisocial behaviours and attention-seeking indications.     

Pro-drug-use myths and competing constructs in the prediction of substance use among youth at continuation high schools: a one-year prospective study

Experimentation with drugs among adolescents often is preceded by faulty beliefs (myths) regarding drug effects. The present study provides empirical demonstration of the utility of a drug use myths index in the prediction of subsequent drug use in a prospective study of substance use among high-risk adolescents. Drug use was measured as an index of recent cigarette, alcohol and marijuana use. A belief-type drug use myths index was compared as a predictor of drug use with four other frequently researched correlates of drug use. The other measures were of social influence, outcome expectancies, attitudes toward wrongness of drug use and sensation seeking. The belief-type drug use myths, attitudes toward wrongness and sensation seeking indices were found to be significant predictors of drug use among our sample of 1074 youth when controlling for gender, ethnicity and prior drug use. These findings have implications for understanding factors contributing to individual differences in drug use behaviors and could benefit the development of drug education programs for high-risk individuals.