Addiction motivation reformulated: an affective processing model of negative reinforcement

This article offers a reformulation of the negative reinforcement model of drug addiction and proposes that the escape and avoidance of negative affect is the prepotent motive for addictive drug use. The authors posit that negative affect is the motivational core of the withdrawal syndrome and argue that, through repeated cycles of drug use and withdrawal, addicted organisms learn to detect interoceptive cues of negative affect preconsciously. Thus, the motivational basis of much drug use is opaque and tends not to reflect cognitive control. When either stressors or abstinence causes negative affect to grow and enter consciousness, increasing negative affect biases information processing in ways that promote renewed drug administration. After explicating their model, the authors address previous critiques of negative reinforcement models in light of their reformulation and review predictions generated by their model.     

Family secrecy: a comparative study of juvenile sex offenders and youth with conduct disorders

The reported research was designed to compare adjudicated male juvenile sexual offenders and youth with conduct disorders on five aspects of family secrecy and deception. Twenty-nine male juvenile sex offenders and 32 comparison youth from three child welfare agencies in New York State participated in the study. Research assistants, blind to the hypotheses of the study and status of the youth, coded agency records for five variables identified a priori as a basis of comparison. Analyses revealed that the two groups were different on three of the five and on the total number of items scored. Families of juvenile sex offenders told more lies, had more family myths, and were more likely to be involved in taboo behavior. Logistic regression revealed that this factor of family deception significantly increased the odds of sexual offending over and above other measures of family pathology. These data support the hypotheses of the study and have implications for both clinical practice and future research in this area.     

Smoking withdrawal dynamics: I. Abstinence distress in lapsers and abstainers

Smoking withdrawal reports from a clinical trial (n = 893) were submitted to hierarchical linear modeling as a cross-method replication of a heterogeneity approach to withdrawal measurement and to clarify the influence of postcessation smoking on symptom reports. Five individual difference parameters tapping distinct facets of withdrawal were derived: intercepts (mean severity), linear slope (direction and rate of change), quadratic trend (curvature), volatility (scatter) and, among lapsers, a cigarette coefficent (smoking-related deflections of symptoms). All parameters were highly variable across persons. Lapsers had more aversive symptom patterns than abstainers, and symptoms tended to be higherthan otherwise predicted on lapse days. These results reinforce the conclusion that withdrawal symptoms are highly variable and argue against discarding withdrawal data from participants who lapse.     

Family caregivers and indicators of cancer-related distress

Increases in the cost of medical care coupled with shorter hospital stays and an aging population are but a few of the reasons why home care for patients has become so important. This study examines variables that contribute to distress among lay-caregivers who provide home care to cancer survivors. Participants consisted of 135 survivor-caregiver dyads in which the caregiver was a member of the survivor's family or a close friend. Measures of caregiver distress were selected from the Ferrell et al. (1995) quality of life tool; predictor variables included cancer survivor and caregiver demographics, physical and emotional health status and behavioural characteristics. Hierarchical regression analysis indicated that, jointly, the three sets of indicators accounted for 35% of caregiver distress. Standardized regression coefficients indicated that relational deprivation (feelings of loss of togetherness, planned activities and contact with other individuals) was the most important predictor of caregiver distress (p<0.01). Female sex, less practice of healthy behaviours, greater number of patient care needs and pessimistic expectations (all ps<0.05) also were significant predictors in the final trimmed model. Results suggest that cancer support services that address the needs of the care receiver with the protection of the family caregiver in mind should be considered.     

Eating disordered adolescent males

The purpose of this study was to describe a sample of 40 eating disordered adolescent males in order to complete a series of follow-up studies on adolescent females who were seen for evaluation and treatment at Boston Children's Hospital Outpatient Eating Disorders Clinic between 1981 and 1991. The sample was drawn from all males seen at the clinic (between 1981 and 1995) who were eligible for inclusion because of a diagnosis of anorexia nervosa, bulimia nervosa, or eating disorder-not otherwise specified. Data were collected via retrospective chart review and three self-administered quantitative scales. Although the response rate to the mailed follow-up questionnaires was low, comparisons with the three studies on females were consistent with those of other investigations, suggesting that the course and outcome of these illnesses are remarkably similar for males and females. The findings support the idea that clinicians, coaches, peers, and family members should encourage young men to share concerns about body image and weight at an earlier, less severe juncture, with assurance that these issues are common to both sexes.     

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