Toward Empirically Based Standards for Abuser Intervention

Summary

This article describes the development of operational guidelines for Abuser Intervention Programs in Maryland. Unlike in many states which have adopted quite specific standards regarding program format, duration, etc., the Maryland guidelines address a fairly narrow range of issues. These include outreach to victims, communication with the courts, and the need for intervention programs to address domestic abuse directly in their program content. Maryland has also established a research task force on Abuser Intervention Programs, whose goal is to use empirical data to inform the use of best practices in the state, to facilitate empirical research at abuser intervention programs in Maryland, and to develop more detailed program standards in the future.     

Intimate partner physical abuse perpetration and victimization risk factors: A meta-analytic review

Evidence from 85 studies was examined to identify risk factors most strongly related to intimate partner physical abuse perpetration and victimization. The studies produced 308 distinct effect sizes. These effect sizes were then used to calculate composite effect sizes for 16 perpetration and 9 victimization risk factors. Large effect sizes were found between perpetration of physical abuse and five risk factors (emotional abuse, forced sex, illicit drug use, attitudes condoning marital violence, and marital satisfaction). Moderate effect sizes were calculated between perpetration of physical abuse and six risk factors (traditional sex-role ideology, anger/hostility, history of partner abuse, alcohol use, depression, and career/life stress). A large effect size was calculated between physical violence victimization and the victim using violence toward her partner. Moderate effect sizes were calculated between female physical violence victimization and depression and fear of future abuse.     

Attribution of control and teenage pregnancy

In rural Appalachia in Tennessee, data on 13 female adolescents who had experienced a pregnancy (mean age=16 years, 7 months) were compared with those on 38 female adolescents who had not experienced a pregnancy (mean age-16 years, 4 months) to test the hypothesis that teenagers who experience a pregnancy have external attributions of control over their life events. The Nowicki-Strickland Locus of Control Scale for Children was administered to determine their beliefs about causes of events in their lives. All the girls were white and matched for socioeconomic status, housing, and cultural background. The mean attribution of control to external agents score stood at 14.5 for girls who had experienced a pregnancy compared with 12.7 for those who had not experienced a pregnancy, but the difference was not significant (p=.08).54% of the cases exhibited external attributional orientation compared with 16% of the controls (p.02). This finding concurred with that of earlier studies. The fact that not all the girls who had experienced a pregnancy had external attributional orientation suggested that it is not the only factor linked to adolescent pregnancy. Studies have not identified whether external attributional orientation is a causal factor or consequence of adolescent pregnancy. A 1980 study found that women who had shown more external locus of control scores during pregnancy and tended to castigate themselves had a high probability of postpartum depression. Another study indicated that rises in depression among adolescents were linked to prechange orientations toward external attributions of control. Practitioners should selectively pay attention to teenagers who have extreme attributional orientations since many teenagers carry their pregnancies to term and choose to rear their infants. These orientations appear to pose risks for the adolescent mother and her children.     

Abuser and abused: Perverse solutions following childhood abuse

This paper addresses the relationship between severe childhood physical abuse and both perverse states of mind and frank perversion in women. The psychic necessity for the perversion in these circumstances is discussed, together with the wide range of forms it may take. Psychoanalytic psychotherapy may pose great technical difficulties in such cases. This is because of both the strains the therapist must bear in the countertransference, and also the constant pressure on the therapist to enact with the patient her perverse internal object relationships.     

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.     

意义治疗的团体辅导对于戒毒者复吸倾向的影响

摘 要: 考察意义治疗的团体辅导对于戒毒者复吸倾向的干预效果。选择生命意义感较低的被试18名进入实验组,并选择与其分数匹配的18名被试组成对照组。后测结果表明,与控制组相比,实验组被试的价值感、效能感、成就感和生命意义感均有显著提升,复吸倾向显著降低。结论: 意义治疗的团体辅导能够显著提高戒毒人员的创造性价值类生命意义源和生命意义感,显著降低其复吸倾向。提升创造价值与对苦难的理解是提高生命意义感的有效途径。     

Child abuse: Prognostic factors in therapy effectiveness

We have attempted to define the problem of child abuse by separating the abusers into two categories. Pattern abusers seem to be primarily a social issue in that the abuse is an outgrowth of the parental charge to control her/his child. However, another abuser is seen as a borderline or psychotic individual when the abuse is an outgrowth of a transferential distortion on the part of the parent. It was suggested that family therapy for the latter may be the preferential mode of intervention.     

Female suicide and wife abuse: a cross-cultural perspective

Data from a number of societies, including North America, indicate that wife abuse may be one of the most significant precipitants of female suicide. Anthropological analysis indicates that in some societies female suicide is a culturally recognized behavior that enables the weak to influence the strong and/or take revenge on those who oppress them. Case studies from West New Britain Province in Papua New Guinea and comparisons with data from other societies suggest that if a woman's support group does not defend her when she is the victim of violence that passes the bounds of normative behavior, her suicide may be revenge suicide, intended to force others to take vengeance on the abusive husband. Research focused on the relationship between domestic violence and female suicide should be a priority of anthropologists as well as suicidologists.     

Exploring the Relationship Between Gender,Mental Health Needs,and Treatment Orders in a Metropolitan Juvenile Court

We explored personal, social, and legal factors associated with different types of mental health treatment orders in one Missouri metropolitan court where the majority of system-involved youth are African-American. The research question under investigation is: with objective assessment information at their disposal, do judges order mental health treatment based on indicators of need or do they follow the pattern found in other studies where demographic and legal variables are key indicators? The bivariate results indicate that while males and females do not differ in mental health status, they do differ in psychosocial needs and offense patterns. In the multivariate analysis, the mental health treatment specific model indicates that commonly used indicators of need, prior mental health status and being female are related to receiving treatment orders. In the substance abuse treatment specific model, the significant factors are closely aligned with need: drug offenses, substance abuse problems, and negative influence of peers.     

Ethical Issues in HIV/STD Prevention Research With High Risk Youth: Providing Help,Preserving Validity

Many preventive intervention studies with adolescents address high-risk behaviors such as drug and alcohol use, and unprotected sex. Randomized controlled trials (RCT) are the gold standard methodology used to test the effectiveness of these behavioral interventions. Interventions outside the rigidly described protocol are prohibited. However, there are ethical challenges to implementing inflexible intervention protocols, especially when the target population is young, experiences many stressful events, and lives in a resource-poor environment. Teens who are at high risk for substance use or sexual risk behaviors tend to be at risk for other problems such as exposure to violence, sexual and physical abuse, depression, and homelessness. How should investigators deal with the psychological and social needs of teenagers in prevention programs in an ethically appropriate way and at the same time preserve the validity of RCT results? We have identified program characteristics, participant characteristics, interaction with parents, and problems with adolescents not in the study as sources of ethical dilemmas in RCT with at-risk adolescents. As a result of our experience, we recommend that every behavioral intervention study develop an ethics protocol, which should include rules for providing help to participants, has contact information for experts to provide guidance, and an emergency procedure for dealing with life threatening situations. In addition, studies should have a resource manual, train research staff in these ethical issues, and work with a data safety and monitoring board or ethics committee.     

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.     

Rehabilitation of executive disorders after brain injury: Are interventions effective?

In this paper, the effectiveness of interventions for executive disorders was reviewed. The objective was to evaluate the internal and external validity of intervention studies. A total of 46 papers, describing 54 studies, conducted in the last two decades meeting several preset inclusion criteria, was included in this review. The studies were categorized into three treatment approaches in order to enhance comparability. The overall results show that many interventions yield positive outcomes and seem to be effective in reducing executive problems in brain‐injured subjects. However, several studies have only an explorative intent and are based on less sophisticated experimental designs. The verification of their results is generally more tenuous. The internal validity, or the set‐up of experimental conditions necessary to draw valid conclusions about treatment effectiveness, including the choice of well‐matched control groups, or the randomization of patients over treatment and control conditions, is not always strong. The same conclusion can be drawn for the external validity of a number of the intervention studies; often evidence of generalization to real‐life situations, long‐term follow‐up, and transfer to non‐trained situations, were (partially) lacking in the studies under review. The authors are aware that the design of proper randomized controlled trials for the investigation of the treatment effectiveness of executive disorders is cumbersome and time consuming. Nonetheless, the provisional results of several well‐designed studies described in this review make the effort worthwhile.     

Criminal justice and the drug-abusing offender: policy issues of coerced treatment

Criminal justice populations, including arrestees, probationers, inmates and parolees, have become increasingly involved with drugs of abuse. These numbers have seriously impacted the criminal justice system from enforcement to the courts, corrections, and subsequent legal supervision agencies. Prevalence of substance abuse in these populations is reported, as well as the effectiveness of community-based and corrections-based treatment in effecting behavioral changes to reduce drug demand. The characteristics of successful intervention programs are described and an ideal model proposed for better integrating community treatment and criminal justice intervention efforts.     

DRUG ABUSE AND THE FAMILY

The Family and Drug Abuse Symposium held on July 10–12, 1975, brought together individuals who possess clinical and/or research expertise in the area of family research and substance abuse. The purpose of the symposium was directed toward assessing the current state of knowledge in the field and delineating directions for future work. The role of family interaction in causing or maintaining a drug abuse problem has only recently become the focus of research and innovative treatment efforts. This special section is intended to acquaint therapists and researchers with recent work in the field; the papers are revised versions of materials originally prepared for the symposium. This first paper offers a brief overview of the symposium and summarizes issues that arose from each of the four workshops: I. Psychosocial Research; II. Clinical Observations; III. Clinical Programs; and IV. Recommendations Made to the National Institute on Drug Abuse. The next paper is a review of recent studies in research and treatment that have approached substance abuse from a family viewpoint. Other research methods that appear relevant to the study of families with a drug-abusing member are discussed. Three commentaries on this review follow. The last paper describes an extensive effort to implement and evaluate family therapy within an existing drug treatment facility.     

冰毒使用者抑制控制的损伤、可逆性及干预策略

冰毒使用的危害日益凸显,受到社会的普遍关注。行为、认知和脑功能的研究结果一致表明:长期的冰毒使用会导致使用者的抑制控制受损,包含一般抑制控制损伤以及药物相关线索条件下的损伤。这些损伤与前额脑区的异常密切相关,对冰毒使用者的行为和认知能力产生不良影响。目前,这些损伤只能部分恢复,因此,改善冰毒使用者抑制控制的干预策略成为热点。未来研究可以从不同药物成瘾者的差异性、多药物使用模式以及有区别的运动干预等方面对冰毒使用者的抑制控制损伤进行深入研究。     

Case Studies in the Family Treatment of Drug Abuse

This article, with case illustrations, attempts to demonstrate that drug-abuse behavior can be understood more clearly in the light of family loyalties and unresolved family crises than from the perspective that drug abusers are social deviates.1 Drug abuse is viewed as symptomatic, as a signal that both drug abuser and his or her family are having difficulty in getting past a particular stage in the natural unfolding life cycle of a family. Treatment of drug abuse is seen primarily as helping the family to become "unstuck," thereby freeing the individual's and family's energy for the task of self-development and growth rather than expending it to maintain rigid patterns of interaction in an attempt to prevent change.     

Chronic sildenafil (Viagra) administration reduces anxiety in intact and castrated male rats

Epidemiological research indicates that sildenafil (Viagra) abuse is associated with increased risk behaviors. The present study employs the open field, a standard animal model used in the field of anxiety research, to examine whether chronic exposure to sildenafil affects anxiety and risk-taking behaviors in gonadally intact and castrated male Wistar rats. Sildenafil (10 mg/kg) or saline were administered three times a week for three weeks. Animals were tested once a week in the open field during and after drug treatment. Sildenafil treatment increased the number of center entries and time spent in the center in intact and castrated animals during and after treatment, suggesting that repeated drug use decreases anxiety. Sildenafil also restored the deficits in exploration and locomotion produced by castration, indicating that sildenafil effects on open field behaviors are independent of endogenous androgens. We caution against generalizing from this study to human behaviors, but propose that the behavioral effects produced by a chronic high dose of sildenafil warrant further studies into its abuse potential.     

Development and Implementation of a Function-Based Clinical Interview to Evaluate Childhood Behavior Problems

The most common reason that children are referred to mental health providers relates to behavior and emotional problems. Without intervention, children with maladaptive behaviors are at risk for poor school performance, interpersonal difficulties, and significant conduct problems later in life. Previous research on the assessment of these problems has focused primarily on caregiver self-report questionnaires, observational coding, and/or diagnostic classification. The behavior literature has far fewer examples of best-practice interview strategies to solicit meaningful clinical information from primary stakeholders. Since caregiver report is essential during initial interviews to better understand his or her child’s presenting issues and given the primary role of assessment is to integrate information into the design of an evidence-based intervention (Barlow et al., 2005), additional published guidance on the content of these clinical interactions is warranted. The following paper outlines an approach to gathering pertinent information from caregivers about their children’s behavior in a way that is germane to treatment planning. In addition, the authors include validity and reliability data to substantiate the interview’s continued use in the clinical setting.     

Medicalizing the drug war

Recent findings in the field of psychopharmacology pertain to the abuse of drugs and alcohol among criminal offenders and have implications for new management techniques. Drugs of abuse exert their effects on areas of the brain responsible for pleasure, providing a powerful reinforcement for drug usage. Furthermore, there is a prevalence of psychological, psychiatric and social dysfunctions that antedate drug use which are identifiable at an early age. It is suggested that drugs of abuse differentially influence users via these biological, psychological and social mechanisms, reinforcing the development of serious and chronic abuse in a vulnerable subgroup. Studies of drug abuse specially indicate that within this subgroup, antisocial behavior precedes and exacerbates drug abuse, and multiple risk factors contribute to the concomitant development of criminality and drug abuse. Early detection and comprehensive treatment of underlying disorders that may both precipitate and result from drug abuse promise to improve possibilities for prevention and reducing relapse rates. Furthermore, the inclusion of pharmacologic treatments may further enhance the success of conventional drug treatments. This article proposes that incorporating scientific data and medicalizing our approach to drug abuse is essential to win the war against drugs.     

Counselling a Taiwanese woman with infertility problems

The purpose of this case report is to describe, analyse and discuss the process and outcome of counselling a 38-year-old Taiwanese woman with infertility problems by a female Taiwanese counsellor who employed the relationship-centred counselling (RCC) approach. The client's long-standing fertility has been deeply connected to her symptoms of depression, anxiety, psychological and physiological pain, and social stress. During a 10-month counselling intervention, the client gradually minimized her physiological symptoms, reduced her negative emotions, improved her interpersonal relationships, built up her social support network, and enhanced her sense of internal control, self-esteem and satisfaction with life.