Measuring the discrepancy between current and ideal spiritual and religious functioning in problem drinkers.

The idea that spiritual and religious functioning (SRF) is associated with alcohol misuse is generally supported, but problems with typical research methods limit the utility of findings. Problems in SRF were conceptualized as discrepancies between current and ideal SRF. Two separate studies were conducted to develop and evaluate a scale to measure the subjective importance and adequacy of aspects of SRF that seem to be associated with alcohol problems. The 1st study suggested that a questionnaire developed to evaluate self-reported ratings of current and ideal SRF is both internally consistent and temporally stable. In the 2nd study, the questionnaire was administered to persons seeking treatment for alcohol problems and persons who indicated that they had never sought treatment for an alcohol problem. Results indicate that those with a drinking problem were more likely to report substantial discrepancies between current and ideal SRF, supporting the validity of the measure as an indicator of problems in SRF. The usefulness of this method for treatment and research is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A test of religious commitment and spiritual transcendence as independent predictors of underage alcohol use and alcohol-related problems.

Religiousness exerts a protective effect against underage alcohol use, but it is largely unknown whether its protective quality extends equally to alcohol-related problems. It is also unclear to what extent spirituality, which is related to religiousness, exerts a similar protective effect. The current study examined whether facets of religiousness and spirituality—religious commitment and spiritual transcendence—were differentially related to alcohol use and alcohol-related problems among an underage sample of young adults. Despite being underage, most participants (n = 344; 61% female) reported having an alcoholic drink at least once a month and having at least two to three drinks per occasion. Results of hierarchical linear regression analyses that controlled for demographics, positive alcohol expectancies, and impulsivity found unique associations between religious commitment and spiritual transcendence and alcohol use. Specifically, religious commitment operated as a protective factor, while spiritual transcendence operated as a risk factor for alcohol use. Neither religious commitment nor spiritual transcendence predicted alcohol-related problems. Results of this study inform future research by highlighting the importance of studying religiousness and spirituality as unique constructs with the potential for differential predictive utility. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cocaine abusers with and without alcohol dependence respond equally well to contingency management treatments.

Contingency management (CM) treatments are efficacious in treating cocaine abuse. Despite high prevalence rates of alcohol dependence (AD) among individuals with cocaine use disorders, relatively little data are available regarding whether comorbid AD is associated with poorer treatment outcomes in general, or in response to CM in particular. Using data from 3 randomized trials of CM for cocaine abuse, we compared cocaine abusers (N = 393) with and without AD in terms of abstinence and psychosocial problems during treatment and follow-up. Alcohol dependent participants had more lifetime years of cocaine and alcohol use and greater severity of alcohol and psychiatric problems. CM was positively and significantly associated with longer durations of abstinence, regardless of AD status. Although not significantly associated with abstinence, the presence of AD was related to improvement in medical and alcohol-related problems during treatment, and these gains were maintained posttreatment. The results suggest that cocaine abusers benefit equally well from CM treatments, regardless of AD status. Further, alcohol dependent participants are able to offset greater baseline severity in psychosocial functioning and maintain these improvements with CM. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived Uncertainty, Spiritual Well-Being, and Psychosocial Adaptation in Individuals With Multiple Sclerosis.

Objective: To examine the role of spiritual well-being as a mediator and moderator between perceived uncertainty and psychosocial adaptation to multiple sclerosis (MS). Participants and Design: Fifty individuals (40 women, 10 men) diagnosed with multiple sclerosis. Main Outcome Measures: Self-report measures on illness uncertainty, spiritual (religious and existential) well-being, and psychosocial adjustment to illness were analyzed by a series of hierarchical multiple regression analyses. Results: Both uncertainty and spiritual well-being independently predicted psychosocial adjustment to MS after the influence of demographic and disability-related variables were considered. Spiritual well-being demonstrated a mediator effect but, mostly, failed to show a moderator effect. Conclusion: Spiritual well-being exerts an appreciable influence on adaptation to MS and also acts to mitigate the impact of uncertainly on adaptation. Rehabilitation psychologists may wish to consider its beneficial role as part of their clinical work. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Mindfulness meditation and substance use in an incarcerated population.

Despite the availability of various substance abuse treatments, alcohol and drug misuse and related negative consequences remain prevalent. Vipassana meditation (VM), a Buddhist mindfulness-based practice, provides an alternative for individuals who do not wish to attend or have not succeeded with traditional addiction treatments. In this study, the authors evaluated the effectiveness of a VM course on substance use and psychosocial outcomes in an incarcerated population. Results indicate that after release from jail, participants in the VM course, as compared with those in a treatment-as-usual control condition, showed significant reductions in alcohol, marijuana, and crack cocaine use. VM participants showed decreases in alcohol-related problems and psychiatric symptoms as well as increases in positive psychosocial outcomes. The utility of mindfulness-based treatments for substance use is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-reported effects of alcohol use on symptoms of schizophrenia

Forty-two acute inpatients with schizophrenia, 23 of whom had a past or current alcohol use disorder, were given a structured interview that focused on reasons for alcohol use and changes in perceived effects of alcohol on psychiatric symptoms from the first episode of illness to the current episode. Drinking for sociability or celebration decreased over time, while drinking to relieve depression or problems increased. Subjects who experienced hallucinations, paranoia, or both significantly more often reported an increase in these symptoms after drinking. Subjects with an alcohol-related diagnosis were significantly more likely than those without such a diagnosis to cite relief of depression and problems or worries as a reason for alcohol use.     

Efficacy of moderation-oriented cue exposure for problem drinkers: A randomized controlled trial.

The effectiveness of cue exposure following a priming dose was compared with cognitive-behavioral intervention in a community sample of problem drinkers. Participants were randomly associated to 1 of the 2 conditions and received a mean of 5.84 (SD=2.69) sessions. A psychologist blind to treatment condition conducted an 8-month follow-up. Compared with pretreatment levels, significant decreased in alcohol consumption were evidence posttreatment and maintained at follow-up for both groups. Reductions in severity of dependence, impaired control, and alcohol-related problems were also evidence for both groups at follow-up. No differences in outcome associated with initial severity of alcohol dependence were apparent. The results raise the issue of the appropriateness of reserving a goal of controlled drinking for those with relatively mild alcohol problems and low alcohol dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric CNS consultation model in a medical setting

This prospective follow-up study reports the outcome of children and adolescents discharged from short-term inpatient treatment based on teacher evaluations with Rutter's Questionnaire. There was a significant reduction in deviant behaviour between pretreatment and 5-month follow-up assessment but not between 5-month and 1-year follow-up. However, relatively few children fell within the normal range of non-clinically referred children. The child's more impaired general functioning, more frequent individual behaviour symptoms, antisociality and disengaged family interaction were associated with less favourable outcome. Pure affective or anxiety disorder predicted functioning within normal range and improvement in behaviour problems at follow-up. Treatment variables were not found to be associated with the outcome.     

Religion and spirituality in rehabilitation outcomes among individuals with traumatic brain injury.

Objective: The long-term consequences of traumatic brain injury affect millions of Americans, many of whom report using religion and spirituality to cope. Little research, however, has investigated how various elements of the religious and spiritual belief systems affect rehabilitation outcomes. The present study sought to assess the use of specifically defined elements of religion and spirituality as psychosocial resources in a sample of traumatically brain injured adults. Participants: The sample included 88 adults with brain injury from 1 to 20 years post injury and their knowledgeable significant others (SOs). The majority of the participants with brain injury were male (76%), African American (75%) and Christian (76%). Measures: Participants subjectively reported on their religious/spiritual beliefs and psychosocial resources as well as their current physical and psychological status. Significant others reported objective rehabilitation outcomes. Analyses: Hierarchical multiple regression analyses were used to determine the proportion of variance in outcomes accounted for by demographic, injury related, psychosocial and religious/spiritual variables. Results: The results indicate that religious well-being (a sense of connection to a higher power) was a unique predictor for life satisfaction, distress and functional ability whereas public religious practice and existential well-being were not. Conclusions: The findings of this project indicate that specific facets of religious and spiritual belief systems do play direct and unique roles in predicting rehabilitation outcomes whereas religious activity does not. Notably, a self-reported individual connection to a higher power was an extremely robust predictor of both subjective and objective outcome. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Researching the spiritual dimensions of alcohol and other drug problems

Although religions have been far from silent on the use of psychoactive drugs, and spirituality has long been emphasized as an important factor in recovery from addiction, surprisingly little research has explored the relationships between these two phenomena. Current findings indicate that spiritual/religious involvement may be an important protective factor against alcohol/drug abuse. Individuals currently suffering from these problems are found to have a low level of religious involvement, and spiritual (re)engagement appears to be correlated with recovery. Reasons are explored for the lack of studies testing spiritual hypotheses, and promising avenues for future research are discussed. Comprehensive addictions research should include not only biomedical, psychological and socio-cultural factors but spiritual aspects of the individual as well.     

Management of unstable coronary syndromes in patients with previous coronary artery bypass grafts following coronary angiography

A recent survey of psychiatric research indicates religion has been given little attention, and when it has been considered, the measures have been simplistic. The present study was designed to describe the religious needs and resources of psychiatric inpatients. With the use of a multidimensional conception of religion and two established instruments, 51 adult psychiatric inpatients were surveyed about their religious needs and resources. For comparison, 50 general medical/surgical patients, matched for age and gender, were also surveyed. Eighty-eight percent of the psychiatric patients reported three or more current religious needs. Although there were no differences in religious needs between the two patient groups, there were significant differences in religious resources. Psychiatric patients had lower spiritual well-being scores and were less likely to have talked with their clergy. Religion is important for the psychiatric patients, but they may need assistance to find resources to address their religious needs.     

A randomized trial comparing day and residential drug abuse treatment: 18-month outcomes.

Extending an earlier report of 6-month outcomes, this study reports 12- and 18-month follow-up data for clients (N?=?188) entering a therapeutic community drug treatment program who were randomly assigned to day or residential treatment conditions. Outcomes included Addiction Severity Index composite scores and measures of depression, psychiatric symptoms, and social support. Both groups showed significant change over time. The pattern of change indicated decreased problem severity in the 1st 6 months and then maintenance of lowered problem severity. Comparisons between groups indicated greater improvement for residential treatment clients on social problems and psychiatric symptoms but no differences on the remaining outcomes. Although residential treatment may offer some specific advantages, the conclusion here is that improvement among day treatment clients was not significantly different from that of residential treatment clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pharmacologic enhancement of atrial electrical defibrillation efficacy: role of ibutilide

This paper reviews a number of studies relating to religion and coping with chronic illness, emphasizing those aspects relevant to palliative care. After pointing out that religious and existential needs are common in chronic illness, a critical examination is made of those studies which purport to demonstrate associations between spiritual beliefs, religious practices and psychological prognosis. Recommendations are made as to how religious issues can be dealt with in clinical practice, with particular relevance to the multidisciplinary palliative care team.     

Educational lectures and films in the clinical treatment of alcoholism: a critique

A recent meta-analysis of alcohol treatment outcome research concluded that educational lectures and films are an ineffective treatment modality in the treatment of persons with alcohol-related problems. This paper suggests several reasons why educational lectures and films are likely to be ineffective with alcohol misusers. Possible explanations include (a) the inability of alcoholics to appreciate and utilize (presented) information because of the cognitive deficits associated with chronic alcohol misuse, (b) the presentation of inaccurate or misleading information about alcoholism through lectures and films (i.e., unitary disease concept, faulty conceptualizations of denial), and (c) conventional alcoholism education which may undermine an individual's belief in her/his ability to make a complete and successful recovery from chemical dependence. Treatment implications and suggestions for further research are briefly discussed.     

Mental health, not social support, mediates the forgiveness-alcohol outcome relationship.

Religiousness and spirituality are important to most Americans, and evidence suggests that they may contribute to both addiction and recovery. Forgiveness is a specific dimension of religiousness and spirituality that may enhance recovery, but the mechanism(s) through which it operates is unknown. We hypothesized that higher levels of forgiveness would be associated with higher levels of mental health and social support, which, in turn, would be associated with improved alcohol-related outcomes. Baseline and 6-month longitudinal data from a sample of 149 individuals with alcohol use disorders seeking outpatient substance abuse treatment were analyzed through multiple-mediation statistical techniques. While previous research has shown direct associations among forgiveness, alcohol-related outcomes, mental health, and social support, this study found that the direct associations between forgiveness and alcohol-related outcomes were no longer significant when mental health and social support were analyzed as mediator variables. At baseline, for each alcohol-related outcome measured (alcohol-related problems, percent heavy drinking days, percent days abstinent, and drinks per drinking day), mental health individually played a role in the relationship with both forgiveness of self and forgiveness of others, fully mediating or operating through an indirect-only pathway. For alcohol-related problems only, mental health fully mediated the relationship with forgiveness of self at follow-up and operated through an indirect-only pathway with forgiveness of others longitudinally. Social support and feeling forgiven by God were nonsignificant variables at baseline, follow-up, and longitudinally. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Aviation suicide: a review of general aviation accidents in the UK, 1970-96

A review was undertaken of 415 general aviation accidents. Three were definite cases of suicide and in another seven it seemed possible that the deceased had taken their own lives. Therefore, in the United Kingdom, suicide definitely accounts for 0.72% of general aviation accidents and possibly for more than 2.4%. The latter accords more closely with the findings from Germany than from the United States. Previous psychiatric or domestic problems and alcohol misuse are features of these cases. Aerobatics before the final impact is another frequent finding. The investigation of fatal accidents involving "pilot error" is incomplete without an examination of the victim's social and psychological history. An assessment of a pilot's mental well-being is an essential part of aviation medical examinations.     

The quest for meaning: Religious affiliation differences in the correlates of religious quest and search for meaning in life.

Religious traditions are considered to provide their members with a way to integrate their experiences into a coherent, comprehensible whole; functioning as a meaning system. Given that religious traditions vary in certain ways, the meaning systems they provide to their members might also differ from one another. The present study was concerned with whether seeking existential meaning in religion and life is compatible with other expressions of religiousness across denominations. Using a multigroups application of path analysis, we investigated whether the relations of two forms of existential seeking, secular (search for meaning in life) and sacred (religious quest), with several religious and psychological well-being measures differed as a function of denomination in a sample of Catholic and Protestant young adults (Study 1; N = 284) and a sample of Catholic, Evangelical, and Non-Evangelical Protestant young adults (Study 2; N = 454). Although comparisons across studies are difficult because the “Protestant” category in Study 1 could have included both Evangelical and non-Evangelical Protestants, one consistent pattern did emerge: there were no denomination-based differences in any of the relations of search for meaning with any of the religiousness variables in either study. Also, in both studies, Catholics demonstrated a positive relation of search for meaning with religious quest and negative relations of search for meaning with presence of meaning in life and overall religiousness. Results for religious quest appeared unstable across studies, raising possible questions about its measurement qualities. Implications for the study of cultural and existential factors and religion are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual abuse and the subsequent development of alcohol problems

The literature on sexual abuse and alcohol problems has been reviewed. Various methodological issues are relevant in determining whether there is merely an association or also a causal relationship. These include the definition of sexual abuse, the degree and timing of abuse, the methods of data collection, sample selection, the presence or absence of control groups, possible recall bias, difficulties with prospective studies for this subject, and the definition of alcohol misuse or dependence. Results with community and victim samples are conflicting, but studies on samples of problem drinkers suggest an association between severe alcohol problems and previous sexual abuse, at least in women. The association may be especially strong for earlier and more severe forms of sexual abuse. Possible mechanisms for an association were examined and are: (1) sexual abuse as a cause of alcohol misuse; (2) alcohol misuse predisposing people to sexual assault; (3) sexual assault and alcohol misuse both resulting from another factor; (4) sexual abuse predisposing to other conditions associated with alcohol misuse; and (5) an artefactual association. Regardless of the role of sexual abuse in causing alcohol problems, the available evidence suggests that victims of sexual abuse may present to services with more problematical patterns of drinking and more concurrent psychiatric disorder.