Effects of family therapy for substance abuse: A systematic review of recent research

One of the most serious psychosocial problems worldwide is substance abuse because of its repercussions not only on the physical and psychological health of the abuser but also on their relational functioning. Among the well-established therapeutic approaches for the treatment of substance abuse is family therapy, which, in addition to influencing personal variables, promotes changes in family dynamics. The main objective of this study is to review the scientific literature published from 2010 to the present on the efficacy and effectiveness shown by family-based treatment approaches for substance use problems both in adolescent and adult samples. In addition, the effect on secondary variables such as family functioning and behavioral problems is evaluated. The empirical evidence accumulated in the last decade and reviewed in the present study indicates that the incorporation of family members in the treatment of substance abuse produces benefits by diminishing consumption and improving family functioning. Limitations of this study and of the research reviewed are discussed and directions for future research are provided.     

Reframing caring for parents who struggle with substance-use disorders

Nancy Suchman and the colleagues she influenced have produced ground-breaking and attitude-challenging work in understanding how parenting and substance use come together. Dr Suchman and her colleagues make the claim that there is nothing about a substance-use disorder that precludes effective and sensitive caring for children especially with interventions that focus on the parent–child relationship. Suchman's legacy is to highlight how substance use as an illness pulls individuals away from important, caring relationships and limits their giving themselves to those relationships. Restoring the salience of caring relationships and of the individual's ability to care may be as impactful on their substance use as a strict focus on the reduction of drug use and achieving abstinence.     

Ethnic differences in psychiatric disorders among adolescent substance abusers in treatment

The present study describes the diagnostic profile of over 800 adolescents admitted to residential therapeutic community programs for treatment of drug abuse and related problems. The relationship between race/ethnicity and psychiatric disturbance is examined, and the association among these factors to outcome is investigated. Over 90% of the sample had a DSM-III-R nonsubstance diagnosis. There were significant differences among the race/ethnic groups on attention deficit-hyperactivity and the disruptive behavior and affective disorders. In general, African-American adolescents yielded the lowest rates of disturbance across all categories of disorders. There was no relationship among race/ethnicity, psychiatric disturbance, and 1-year posttreatment outcomes.     

My place,your place,and no place: Behavior settings as a risk factor for HIV-related injection practices of drug users in Baltimore,Maryland

Information is sparse on the social context of illicit drug injection behaviors and their relationship to HIV infection. This study examined relationships between injection settings, injecting with others, and HIV risk behaviors of sharing needles and not cleaning contaminated needles in a sample of 630 inner-city injecting drug users in Baltimore, MD. Through open-ended interviews, five primary settings of injection behavior were identified. These settings included one's own, friends' and mother's residence, shooting galleries, and semipublic areas. Most participants reported injecting in their own residence (92%) and friends' residence (86%) in the prior 6 months. In a multiple regression analysis, injecting at friends' residence, in shooting galleries, and in semipublic areas and frequency of injecting with others were significantly associated with frequency of sharing uncleaned needles, “slipping” (i.e., failure to disinfect shared needles), and not always cleaning used needles before injecting. Results suggest that interventions may benefit from targeting settings as well as behaviors to reduce the spread of HIV. This research was supported by grants DA04334, DA05911, DA06313, and DA08985 from the National Institute on Drug Abuse.     

AN EXPERIMENTAL COMPARISON OF THREE DIFFERENT SCHEDULES OF REINFORCEMENT OF DRUG ABSTINENCE USING CIGARETTE SMOKING AS AN EXEMPLAR

The efficacy of three different schedules of reinforcement for promoting and sustaining drug abstinence was compared in this study. Cigarette smoking was studied as an exemplar of stimulant drug self-administration. Sixty cigarette smokers were assigned to one of three groups (progressive rate of reinforcement, fixed rate of reinforcement, and yoked control). Participants in all three groups were asked to refrain from smoking for 1 week. Participants in the progressive and fixed groups achieved greater mean levels of abstinence than those in the control group. Participants in the progressive group were significantly less likely to resume smoking when they became abstinent than participants in the other groups.     

Physical characteristics of residential psychiatric and substance abuse programs: Organizational determinants and patient outcomes

Described the Physical and Architectural Characteristics Inventory (PACI), which assesses the physical characteristics of hospital- and community-based psychiatric and substance abuse residential treatment programs for adults. Developed using data from 94 representative programs, the PACI has 7 dimensions that assess community accessibility, physical features that add convenience, aid recreation, and provide support for patients, and space for patient and staff functions. In comparison to community-based programs (n=63), hospital programs (n=31) had more social-recreational and prosthetic aids, safety features, staff facilities, and space. The PACI dimensions were also related to other organizational features, such as facility ownership and program size and staffing level. Programs with more physical amenities had patients who were more involved in self-initiated and community activities and were more likely to successfully complete the program and be discharged to independent living situations and paid jobs. Programs with more social-recreational and prosthetic aids, space, and access to community resources also had better patient outcomes. In addition, PACI dimensions were related to observers' ratings of facility attractiveness. Potential applications of the PACI and the full inventory of which it is a part are discussed.     

Diagnosing posttraumatic stress disorder with the MMPI clinical scales: A review of the literature

A review of the literature resulted in 21 published studies that reported mean MMPI profile patterns for PTSD patients. Of these, six (29%) reported that the mean 8-2 profile pattern significantly differentiated PTSD patients from non-PTSD patients. The majority of studies found additional PTSD profile patterns reflecting nearly all of the MMPI clinical scales. The data indicate some common group profile patterns for inpatient veterans, prisoner's of war, and inpatient veteran substance abusers. The results also support the hypothesis that there is a continuum from inpatient to outpatient and veteran to civilian populations that corresponds with both symptom and stressor severity. It is concluded that although there is some typicality in similar populations, clinicians should expect heterogeneous MMPI profiles from PTSD patients representing a diversity of clinical symptoms and styles.     

Violent behavior in adolescents and young adults: A person and environment model

We explore a model that examines how personal and environmental variables explain violent behavior by adolescents. Repeated interviews with youths from 1984–1992 from 10 cities across the United States provided the data. These interviews first occurred with 2,787 youths when they were adolescents (1984–85 and 1986–87) and the interviews were repeated on a subsample of 602 youths when they were young adults (1989–90 and 1991–92). Longitudinal multivariate analyses showed that almost a third of the variance in adolescent violent behaviors was predicted by a combination of personal variables (gender, substance misuse) and environmental variables (history of child abuse, stressful events, traumatic events, and city rates of unemployment). Further, almost a third of the variance in change in violent behaviors from year to year was predicted by prior violent behavior and a combination of personal variables (gender, suicidality, and substance misuse) and environmental variables (stressful events).     

基于网络理论的物质成瘾新视角

物质成瘾是一种涉及生理、心理和环境等多因素的复杂现象, 但是当前基于生物还原论的解释对物质成瘾现象整体性的理解和康复研究造成了阻碍。网络理论聚焦于心理障碍变量之间相互作用形成的反馈环路, 从整体视角为研究物质成瘾提供了新的理论框架。将网络理论应用于物质成瘾的研究中将有利于:(1)理解症状之间的相互关系和影响; (2)理解症状网络的整体性和系统性动态变化过程; 以及(3)将多层次和多水平因素整合到统一的理论框架中。从网络理论视角来理解物质成瘾, 也将对未来的干预和治疗提供了理论支持。目前, 网络理论仍处于言语模型阶段, 未来需要进一步提出更具体、可验证的统计模型, 以完善对于物质成瘾机制的了解, 更加有效地推进物质成瘾的治疗与恢复。