Drug-abusing patients and their intimate partners: dyadic adjustment, relationship stability, and substance use

The dyadic adjustment and substance use of couples with a drug-abusing husband (n = 94), couples with a drug-abusing wife (n = 36), couples in which both partners abused drugs (n = 87), and non-substance-abusing conflicted couples (n = 70) were examined. For couples with 1 drug-abusing partner, a higher percentage of days abstinent during the year before treatment for drug abuse was associated with a higher level of relationship satisfaction. When both partners abused drugs, the relationship between percentage of days abstinent and relationship satisfaction became stronger and more negative as the time partners spent together using drugs increased. A higher percentage of days abstinent was associated with relationship stability for couples with 1 drug-abusing partner during and 1 year after treatment; for couples in which both partners abused drugs, a higher percentage of days abstinent was associated with relationship instability.     

Couple communication in stepfamilies

Effective communication is assumed to help sustain couple relationships and is a key focus of most relationship education programs. We assessed couple problem-solving communication in 65 stepfamily and 52 first-time-marrying couples, with each group stratified into high risk and low risk for relationship problems based on family-of-origin experiences. Relative to partners in first-time couples, partners in stepfamily couples were less positive, less negative, and more likely to withdraw from discussion. Risk was associated with communication in first-time but not stepfamily couples. Stepfamily couples do not exhibit the negative communication evident in high-risk first-time-marrying couples, and available relationship education programs that focus on reducing negative communication are unlikely to meet the needs of stepfamilies.     

Behavioral Intentions: Which Ones Predict Fertility Behavior in Married Couples?1

The published literature on the relationship between behavioral intentions and fertility behavior exhibits four major problems: inconsistent and confusing use of theoretical constructs, limited use of different types of intentions, use of nonbehavioral outcomes, and failure to explore adequately the couple aspects of the intentions/behavior relationship. The study reported here addresses these problems by using a theoretical framework that characterizes the psychological/behavioral sequence leading to a planned conception, three different types of fertility intentions, a behavioral outcome variable, and data from 196 married couples with no children and 185 married couples with one child. Data analysis results in a simultaneous equation, constrained regression model which indicates that child-timing intentions are the most important predictors of proceptive behavior over a 3-1/2 year period and that childbearing intentions are next in importance; that behavioral intentions are the final common pathway through which fertility motivations, attitudes, beliefs, and desires affect behavior; that the use of proceptive behavior as an outcome variable improves the explanatory power of our models; and that the interaction of couple intentions do not demonstrate greater husband or wife influence over couple proceptive behavior but do demonstrate that disagreement has a delaying effect on the onset of that behavior.     

Implicit Cognition and Addiction

ABSTRACT— Extensive recent research has begun to unravel the more implicit or automatic cognitive mechanisms in addiction. This effort has increased our understanding of some of the perplexing characteristics of addictive behaviors. The problem, often, is not that substance abusers do not understand that the disadvantages of continued use outweigh the advantages; rather, they have difficulty resisting their automatically triggered impulses to use their substance of abuse. Existing interventions may help to moderate these impulses. In addition, new techniques aimed at directly modifying implicit cognitive processes in substance abuse are being developed.     

Dating couples and their relationships: intimacy and contraceptive use

Investigations of ineffective contraceptive use have generally focused on individualistic rather than dyadic factors. The present study used a sample of dating couples to investigate four intimacy dimensions in relation to contraceptive use. Fourteen consistent contraceptive use (CCU) couples and 16 inconsistent contraceptive use (ICU) couples participated. It was found that the two groups' expectations of intimacy did not differ significantly. However, the ICU couples reported experiencing significantly lower levels of emotional, social, and intellectual intimacy than did the CCU couples. Significant differences between realized and expected levels of intimacy were found only among ICU couples. The results indicate that partners with mutually dissatisfying levels of intimacy were more likely to use contraceptives inconsistently.     

The Effectiveness of Therapy with Couples Reporting a History of Childhood Sexual Abuse: An Exploratory Study

The purpose of this pilot study was to explore the impact of childhood sexual abuse (CSA) on couples therapy. Participants were couples seeking therapy who were screened for CSA prior to therapy. Groups were compared using self-report and therapist-rated measures of individual and relational distress. Results indicate that although therapists report significant differences between CSA couples and couples not reporting abuse at the onset of therapy, those differences do not translate into significant differences in the perceived effectiveness of therapy as measured by change scores on therapist rated levels of distress, questions regarding the effectiveness of therapy, dropout, and length of treatment.     

The role of illicit substance use in a conceptual model of intimate partner violence in men undergoing treatment for alcoholism

Illicit substance use (ISU) predicts intimate partner violence (IPV) above and beyond alcohol use and other known IPV correlates. Stuart and colleagues (2008) provided evidence for a theoretical framework by which ISU contributes both directly and indirectly to IPV. We sought to replicate and extend their findings using data from 181 married or cohabiting heterosexual couples in which the male had recently begun a substance abuse treatment program and met criteria for alcohol dependence (97%) or abuse (3%). Using SEM, we found that (a) Stuart et al.'s model provided a good fit to the data; (b) men's cocaine use and women's sedative use emerged as particularly relevant to their respective perpetration of IPV; (c) a positive association between men's antisociality and physical aggression was mediated by increased stimulant use; and (d) the specific pattern of IPV predicted by women's sedative use differed across levels of aggression severity. These findings not only highlight the direct role of ISU in relationship aggression, but also support a larger theory-driven model comprising various proximal and distal precursors of IPV.     

Husbands' and wives' alcohol use disorders and marital interactions as longitudinal predictors of marital adjustment

In this longitudinal study, the relationships among wives' and husbands' lifetime alcoholism status, marital behaviors, and marital adjustment were tested. Participants were 105 couples from the Michigan Longitudinal Study (MLS), an ongoing multimethod investigation of substance use in a community-based sample of alcoholics, nonalcoholics, and their families. At baseline (T1), husbands and wives completed a series of diagnostic measures, and lifetime diagnosis of alcohol use disorder (AUD, as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed.), was assessed. Couples completed a problem-solving marital interaction task 3 years later at T2, which was coded for the ratio of positive to negative behaviors. Couples also completed a measure of marital adjustment at T4 (9 years after T1 and 6 years after T2). Results showed that husbands' lifetime AUD predicted lower levels of their wife's positive marital behaviors 3 years later but was not related to their own or their wife's marital adjustment 9 years from baseline. By contrast, wives' lifetime AUD had direct negative associations with their own and their husband's marital satisfaction 9 years later, and wives' marital behaviors during the problem-solving task predicted their own and their husband's marital satisfaction 6 years later. Findings indicate that marital adjustment in alcoholic couples may be driven more by the wives' than the husbands' AUD and marital behavior. Implications for intervention with alcoholic couples were discussed.     

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.     

Barriers and Supports to Substance Abuse Service Use Among Homeless Adults

Although there is a great need for substance abuse services among the homeless, many homeless individuals do not use those services. This study examined barriers and supports related to service use. Participants recognized a need for treatment and significant barriers to accessing care.     

Behavioral Marriage Therapy: II. Empirical Perspective

Two recent published reviews of research on behavioral marriage therapy stimulated us to supplement these accounts with additional relevant data. First, we place research on behavioral couples therapy in the broader context of outcome research on nonbehavioral marital therapy. We then summarize the results of 23 studies of behavioral couples therapy not included in these previous reviews and conclude that these additional data on controlled and comparative studies do little to enhance the current empirical status of the efficacy of behavioral marriage therapy and in no case do they establish the superiority of social learning approaches. It is concluded that an open mind to all sources of data on the efficacy of marital therapy is needed if the field is to make meaningful advances.     

Perceptions of Family Environment Among Psychiatric Patients and Their Wives

This study compared the perceived family environments of former psychiatric inpatients with thought, affective, and substance abuse disorders to those of normative comparison couples using the Family Environment Scale. Family environment was assessed among patients and wives separately at hospital discharge and at three- and twelve-month follow-ups. Patients and their wives were consistently more incongruent in their perceptions of their shared environment than normative couples. In addition, low-functioning patient couples reported less family cohesion, expressiveness, and recreational emphasis than their higher functioning counterparts; the high-functioning patient couples more closely resembled the norm. The paper discusses possible relationships between positive family contact and better patient functioning.     

The World of Mad Men: Power,Surface and Passion

Mad Men is disturbing to post-millennium viewers, particularly those of a “certain” age, on three counts. First, it invokes a particular historical context of gender oppression; second it captures the prevailing post-War injunction that emotional distress is unseemly and distasteful; and third, it captures the zeitgeist's celebration of surface over substance in relationship. However, just as disturbing as these historically situated interpersonal premises is the niggling question that each relationship pairing and each episode leaves with the viewer. To wit: How much of the disconnection and the unrequited longings are reflective of a particular historical era, and to what degree do they reflect timeless aspects of character and relationship? Thus Mad Men provides an exquisitely rendered sociocultural tableau in which the viewer struggles, however articulated or not, with one of the essential knots of psychoanalytic as well as couples treatment: the complicated interpenetration of culture and character, of time and timelessness.     

Alcohol and substance use in the Arabian Gulf region: a review

Despite cultural, social, religious, and legal constraints on Muslim Arab nationals living in the Arabian Peninsula against the consumption of alcohol or drugs, usage and dependence do exist. The aim of this paper is to provide a systematic review, compiling and critiquing the literature in this interesting yet neglected area. Information about the current status of alcohol and substance abuse research and knowledge in the Arabian Gulf region will be presented, providing an accessible synopsis of available papers. A systematic review of English and Arabic language literature was conducted by searching electronic databases (1975-2007) and conducting hand searches of Arab published journals. Only studies investigating alcohol and/or substance use or abuse issues with participants (1) of Arab nationality, (2) living in an Arabian Gulf country, and (3) of Muslim faith were included. Within this literature, the majority of research has been conducted with clinical male participants. The most commonly abused drugs are alcohol, heroin, and hashish. Literature investigating the substance use domain with people who are not seeking treatment for addiction is extremely limited. Although the research is largely in its infancy, it does however confirm alcohol and substance abuse in Muslim, Gulf Arab nationals. We strongly urge that further research into substance use and abuse in this region is conducted. Community investigations assessing the prevalence, magnitude, and associated problems with alcohol and substance abuse and also research into valid and reliable measurements in these countries are warranted.     

The effects of three methods of observation on couples in interactional research

Abstract

Reactivity to observation can affect both internal and external validity of experimental studies. Although the effects of observation have been well documented in groups and parent-child interaction, there have been few studies of observer effects on couples. This study assessed the effects of three different methods of observation—one-way mirror, audio-recording and video-recording—on 30 volunteer, nonclinical couples. No differences were found among couples in the three observational conditions on measures of interactional behavior on a problem-solving task, participant appraisals of self-consciousness, discomfort and reactivity for themselves and their spouses, or on pre-post observation measures of anxiety and feelings toward spouse. The results suggest that these different types of observation do not produce significantly different effects on nonclinical couples and that studies utilizing these three methods may be compared.     

The Effect of Smiling and of Head Tilting on Person Perception

A survey on alcohol and drug use was completed by 1,291 college students. As predicted from research on self-schemas, greater self-efficacy was associated with lower substance use among respondents who indicated having been treated for substance abuse but not among those who had not received treatment. Also, those who reported receiving treatment were more likely than the others to report having attended campus programs on substance abuse. These findings suggest that substance use and its control are important aspects of the self-definition of those who receive treatment for substance abuse.     

Couple Therapy with Veterans: Early Improvements and Predictors of Early Dropout

Family services within Veterans Affairs Medical Centers fulfill an important role in addressing relationship distress among Veterans, which is highly prevalent and comorbid with psychopathology. However, even for evidence‐based couple therapies, effectiveness is weaker compared to controlled studies, maybe because many Veteran couples drop out early and do not reach the “active” treatment stage after the 3–4 session assessment. In order to improve outcomes, it is critical to identify couples at high risk for early dropout, and understand whether couples may benefit from the assessment as an intervention. The current study examined (a) demographics, treatment delivery mode, relationship satisfaction, and psychological symptoms as predictors of dropout during and immediately following the assessment phase, and (b) changes in relationship satisfaction during assessment. 174 couples completed questionnaires during routine intake procedures. The main analyses focused on 140 male Veterans and their female civilian partners; 36.43% dropped out during the assessment phase and 24.74% of the remaining couples immediately following the first treatment session. More severe depressive symptoms in non‐Veteran partners were associated with dropout during assessment. Relationship satisfaction improved significantly during the assessment phase for couples who did not drop out, with larger gains for non‐Veteran partners. No demographics or treatment delivery mode were associated with dropout. Although more research is needed on engaging couples at risk for early dropout and maximizing early benefits, the findings suggest that clinicians should attend to the civilian partner's and Veteran's depressive symptoms at intake and consider the assessment part of active treatment.     

A Randomized Controlled Trial of Coach Contact During a Brief Online Intervention for Distressed Couples

The negative impacts of relationship distress on the couple, the family, and the individual are well‐known. However, couples are often unable to access effective treatments to combat these effects—including many couples who might be at highest risk for relationship distress. Online self‐help interventions decrease the barriers to treatment and provide couples with high quality, research‐based programs they can do on their own. Using a combined multiple baseline and randomized design, the present study investigated the effectiveness of the Brief OurRelationship.com (Brief‐OR) program with and without staff support in improving relationship distress and individual functioning. Results indicated the program produced significant gains in several areas of relationship functioning; however, these gains were smaller in magnitude than those observed in Full‐OR. Furthermore, effects of Brief‐OR were not sustained over follow‐up. Comparisons between couples randomized to Brief‐OR with and without contact with a staff coach indicated that coach contact significantly reduced program noncompletion and improved program effects. Limitations and future directions are discussed.