Couple Therapy and Addictions

Abstract

Therapies for alcoholism, substance abuse, and other addictions traditionally focus on characteristics of individuals such as behaviors, thoughts, and emotions. These kinds of programs tend to target problems inside the abusing person rather than a relational system. Treatments that are more recent locate the problems within systems of people. Regardless of the locus or cause of the abuse or addiction, seen as arising from disease processes, systemic dynamics, or other mechanisms that lead to unfortunate habits and behaviors, utilizing the individual's partner or family in therapy has become an important part of successful treatment. This article reviews models of couple treatment for alcoholics and substance abusers in terms of initiation into treatment, primary treatment, and relapse prevention.     

Somatic Complaints in Girls: A Longitudinal Perspective

This report presents results from a study of the dimensionality and longitudinal stability of some common self-reported somatic complaints in teenage girls. Data were supplied by the Swedish longitudinal research program “Individual Development and Adaptation”. At four age levels (age 10, 13, 15, and 16 years) a representative sample of approximately 500 girls filled out questionnaires on various adjustment problems, including some typical somatic complaints. A separate dimension of somatic complaints was identified at each age level through factor analysis of the questionnaire data. Correlational stability of somatic complaints was not high until middle adolescence. At this age fairly stable patterns of somatic complaints were also found at the individual level; different somatic complaints were not found to be interchangeable. The results support the interpretation of girls' somatic complaints as a single, meaningful dimension in late childhood and adolescence. This dimension may be hypothesized to constitute a psychological process, somatization, manifesting itself in fairly stable patterns at the individual level in middle adolescence.     

Replication and Extension of a Hierarchical Model of Social Anxiety and Depression: Fear of Positive Evaluation as a Key Unique Factor in Social Anxiety

Wang, Hsu, Chiu, and Liang (2012, Journal of Anxiety Disorders, 26, 215–224) recently proposed a hierarchical model of social interaction anxiety and depression to account for both the commonalities and distinctions between these conditions. In the present paper, this model was extended to more broadly encompass the symptoms of social anxiety disorder, and replicated in a large unselected, undergraduate sample (n = 585). Structural equation modeling (SEM) and hierarchical regression analyses were employed. Negative affect and positive affect were conceptualized as general factors shared by social anxiety and depression; fear of negative evaluation (FNE) and disqualification of positive social outcomes were operationalized as specific factors, and fear of positive evaluation (FPE) was operationalized as a factor unique to social anxiety. This extended hierarchical model explicates structural relationships among these factors, in which the higher-level, general factors (i.e., high negative affect and low positive affect) represent vulnerability markers of both social anxiety and depression, and the lower-level factors (i.e., FNE, disqualification of positive social outcomes, and FPE) are the dimensions of specific cognitive features. Results from SEM and hierarchical regression analyses converged in support of the extended model. FPE is further supported as a key symptom that differentiates social anxiety from depression.     

Home Brewed Alcohol use Among High School Students in a Rural South African Community

This study investigates the use of home brewed alcoholic beverages among adolescents in high schools in a rural community in South Africa. There is much concern about alcohol misuse among young people and very little information exists on alcohol produced by the informal liquor industry in South Africa. A total of 1600 high school students participated in the study. The prevalence rates for past year use of home brewed alcohol was 22.2%. There was association between home brewed alcohol use and correlates such as “lived in city”; “raised by both parents”; “repeating school year”; “poor scholastic progress”; “absenteeism” “getting into trouble”, “arguing with parents/friends”; “neglecting homework”; and “recreation/leisure”. The prevalence rates for home brewed alcoholic beverages use in this rural schools calls for more research that focuses on home brews which could lead to the development of appropriate health promotion intervention in schools.     

Feasibility,acceptability, and impact of a web-based gratitude exercise among individuals in outpatient treatment for alcohol use disorder

This mixed methods pilot study examined the feasibility, acceptability, and impact of a web-based gratitude exercise (the ‘Three Good Things’ exercise (TGT)) among 23 adults in outpatient treatment for alcohol use disorder. Participants were randomized to TGT or a placebo condition. The intervention was feasible with high rates of completion. Participants found TGT acceptable and welcomed the structure of daily e-mails; however, they found it difficult at times and discontinued TGT when the study ended. Participants associated TGT with gratitude, although there were no observed changes in grateful disposition over time. TGT had a significant effect on decreasing negative affect and increasing unactivated (e.g. feeling calm, at ease) positive affect, although there were no differences between groups at the 8 week follow-up. Qualitative results converged on quantitative findings that TGT was convenient, feasible, and acceptable and additionally suggested that TGT was beneficial for engendering positive cognitions and reinforcing recovery.     

Improving conditional discrimination learning and memory in five-year-old children: Differential outcomes effect using different types of reinforcement

Previous studies have demonstrated that discriminative learning is facilitated when a particular outcome is associated with each relation to be learned. When this training procedure is applied (the differential outcomes procedure; DOP), learning is faster and better than when the typical common outcomes procedure or nondifferential outcomes (NDO) is used. Our primary purpose in the two experiments reported here was to assess the potential advantage of DOP in 5-year-old children using three different strategies of reinforcement in which (a) children received a reinforcer following a correct choice (“ + ”), (b) children lost a reinforcer following an incorrect choice (“ ? ”), or (c) children received a reinforcer following a correct choice and lost one following an incorrect choice (“ + / ? ”). In Experiment 1, we evaluated the effects of the presence of DOP and different types of reinforcement on learning and memory of a symbolic delayed matching-to-sample task using secondary and primary reinforcers. Experiment 2 was similar to the previous one except that only primary reinforcers were used. The results from these experiments indicated that, in general, children learned the task faster and showed higher performance and persistence of learning whenever differential outcomes were arranged independent of whether it was differential gain, loss, or combinations. A novel finding was that they performed the task better when they lost a reinforcer following an incorrect choice (type of training “ ? ”) in both experiments. A further novel finding was that the advantage of the DOP over the nondifferential outcomes training increased in a retention test.     

Expand Positive Learning Opportunities and Results

Students with emotional disturbance (ED) experience the worst outcomes of any group of pupils in the public schools. We suggest that at least part of the reason is that the services they receive while in school are inadequate to meet their needs. Although applied research has resulted in a number of effective practices, they are not used in the majority of America's schools. Barriers to the implementation of such practices are described, and recommendations for improving programs and outcomes for these students are offered.     

Perceptions of Liver Transplant Candidates with or Without an Alcohol Use History

Cirrhosis secondary to alcohol use is a primary cause of liver disease and a medical condition for which liver transplantation is a viable treatment option. However, there remains considerable debate within both the lay and the medical communities regarding the distribution of a scarce medical resource to adults with alcoholism. This study examined college students' perceptions toward an adult, presented in a written vignette, for whom liver transplantation was medically indicated. The influence of gender (female and male) and alcohol use history (no alcohol history, alcoholism history with long-term abstinence, alcoholism history with current use) on these ratings was examined. Subjects rated the adult presented with no alcohol history more positively than they did the adults presented with a history of alcoholism. Also, the adult with no alcohol history was more likely to be offered transplantation and was given higher priority ratings for transplantation by subjects. While subjects' own alcohol use history and organ donor registration status were not associated with ratings, having a family member with an alcohol problem and personally knowing a transplant recipient were related to more favorable ratings toward the adult presented in the vignette. Implications of these findings as well as limitations of the study are discussed.     

Long Term Outcomes to Family Caregiver Empowerment

The Vanderbilt Caregiver Empowerment Project evaluated a training program designed to enhance empowerment of caregiver and their subsequent involvement in the mental health treatment of their children. The intervention utilized a multi-component parent training curriculum that was designed to enhance: (a) knowledge of the service system; (b) skills needed to interact with the mental health system; and (c) the caregiver' s mental health services self-efficacy designed to improve caregivers beliefs in their ability to collaborate with service providers. The resulting increased empowerment was hypothesized to increase caretaker involvement, which should affect service use and ultimately the mental health status of the child. A randomized design was used to test the effectiveness of this model with caregivers of children receiving mental health services. The results one-year after the training replicated the intermediate outcomes of the project conducted 3-months after the training. The initial training continued to significantly influence the parent's knowledge and mental health services self-efficacy. However, the intervention had no effect on caregiver involvement in treatment, service use or the mental health status of the children.