Models of relapse and relapse prevention: A commentary.

The author provides a commentary on a series of articles published on relapse to substance abuse. The following points summarize this commentary: animal and human studies of drug priming effects are limited as an analogue for relapse because they fail to address drug self-administration: relapse is following events (contextual initiating conditions) that indicate reduced access to alternative reinforcers; relapse has multiple determinants including internal cognitive processes that may differentiate between urges and substance use: relapse prevention (RP) can be matched with stages of change in treatment; and RP may be associated with emergent effects over time in substance abuse treatment outcome studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of the OCDS-Revised: A Measure of Alcohol and Drug Urges With Outpatient Substance Abuse Clients.

Urges to use substances is an important construct in understanding the maintenance of substance use as well as relapse. There is a need to evaluate single instruments measuring global urges to use substances (including alcohol). The Obsessive Compulsive Drinking Scale (OCDS; R. F. Anton, D. H. Moak, & P. Latham, 1995) was revised and tested as a single measure of urges to use substances. Participants were 252 adults entering outpatient substance abuse treatment. Results suggest that the revised scale (OCDS-R) primarily assesses 1 global factor for urges to use substances. In addition, strong support was found for the reliability and concurrent validity of the OCDS-R, although results for its predictive validity were mixed. The OCDS-R is a brief, psychometrically sound self-report instrument that has applicability within clinical and research settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The co-occurrence of depression and substance abuse in late adolescence

This article examines the role of adolescent social relationships in fostering the occurrence and co-occurrence of depression and substance abuse, using two waves of data from a community sample of adolescents (N = 900). Multinomial logistic response models were estimated to identify the extent to which risk and protective features of youths' family and peer relations were differentially linked with depressive symptoms, substance abuse, and their co-occurrence. Taking a within-person, configurational approach to adolescent adaptation, contrasts involved four subgroups of adolescents: those high on both depressed mood and substance abuse, those who experience neither problem, those evidencing high levels of depressive symptoms only, and those high on substance abuse only. Risk for depressive symptoms was differentiated by its association with conflict and lack of support in the friendship domain. Substance abuse was associated with negative peer pressure, but these youth were otherwise little different from youths with no problems. Whereas co-occurrence of depression and substance use was associated with more difficulties in both the family and peer environments, the most distinctive risk was that of low family support. Discussion centers on the developmental antecedents of co-occurring problems and family relations during adolescence.     

Role of family and peers in the development of prototypes associated with substance use.

Prior research and theory suggest that adolescents often experiment with substances to acquire desired social images. However, little research has addressed the developmental precursors leading to favorable evaluation of substance users. This study tested a model of parental and peer influence on adolescent prototypes using a longitudinal data set of 463 rural adolescents. For both drinking and smoking, positive prototypes of substance users were best predicted by peer affiliations. Adolescents who affiliated with peers who practiced and encouraged substance use developed more positive prototypes of people who drink and smoke. These social images, in turn, predicted subsequent use of alcohol and cigarettes. In contrast to peers, parents had little direct influence on prototypes but did indirectly affect images through the adolescents' choice of peers. Unexpectedly, there was evidence of a negative modeling effect of parental substance use, such that parental smoking predicted more negative prototypes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse patients with posttraumatic stress disorder (PTSD): Identifying specific triggers of substance use and their associations with PTSD symptoms.

Although individuals with comorbid posttraumatic stress disorder (PTSD) and substance use diagnoses are at heightened risk for relapse after substance abuse treatment, little is known about the specific situations in which these individuals are likely to relapse. The present study was designed to test whether a PTSD diagnosis related to substance use in specific situations in which PTSD symptoms were likely to be present. Data were gathered from inpatients (n?=?86) in a substance-abuse treatment program, and relationships between PTSD diagnosis and frequency of substance use in high-risk situations were examined. As predicted, PTSD diagnosis was related to substance use in situations involving unpleasant emotions, physical discomfort, and interpersonal conflict, but not to substance use in other situations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhancing substance abuse treatment engagement in incarcerated adolescents.

The purpose of this study was to determine whether motivational interviewing (MI), compared with an attention control condition (relaxation training [RT]) enhances substance abuse treatment engagement in incarcerated adolescents. At the start of incarceration, adolescents were randomly assigned to individually administered MI or RT. Subsequently, therapists and adolescents (N = 130) rated degree of adolescent participation in the facility's standard care group-based treatments targeting crime and substance use. All adolescents received the facility standard care treatment after their individual MI or RT session. MI statistically significantly mitigated negative substance abuse treatment engagement. Other indicators of treatment engagement were in the expected direction; however, effect sizes were small and nonsignificant. These findings are significant, given concerns regarding the deleterious effects of treating delinquent adolescents in groups and the potential for adolescents to reinforce each other's negative behavior, which in turn may lead to escalated substance use and other delinquent behaviors after release. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression, craving, and substance use following a randomized trial of mindfulness-based relapse prevention.

Objective: A strong relation between negative affect and craving has been demonstrated in laboratory and clinical studies, with depressive symptomatology showing particularly strong links to craving and substance abuse relapse. Mindfulness-based relapse prevention (MBRP), shown to be efficacious for reduction of substance use, uses mindfulness-based practices to teach alternative responses to emotional discomfort and lessen the conditioned response of craving in the presence of depressive symptoms. The goal in the current study was to examine the relation between measures of depressive symptoms, craving, and substance use following MBRP. Method: Individuals with substance use disorders (N = 168; mean age 40.45 years, SD = 10.28; 36.3% female; 46.4% non-White) were recruited after intensive stabilization, then randomly assigned to either 8 weekly sessions of MBRP or a treatment-as-usual control group. Approximately 73% of the sample was retained at the final 4-month follow-up assessment. Results: Results confirmed a moderated-mediation effect, whereby craving mediated the relation between depressive symptoms (Beck Depression Inventory) and substance use (Timeline Follow-Back) among the treatment-as-usual group but not among MBRP participants. MBRP attenuated the relation between postintervention depressive symptoms and craving (Penn Alcohol Craving Scale) 2 months following the intervention (?2 = .21). This moderation effect predicted substance use 4 months following the intervention (?2 = .18). Conclusion: MBRP appears to influence cognitive and behavioral responses to depressive symptoms, partially explaining reductions in postintervention substance use among the MBRP group. Although results are preliminary, the current study provides evidence for the value of incorporating mindfulness practice into substance abuse treatment and identifies a potential mechanism of change following MBRP. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol and tobacco cessation in alcohol-dependent smokers: Analysis of real-time reports.

Alcohol-tobacco interactions and relapse precipitants were examined among alcohol-dependent smokers in a trial of concurrent alcohol and tobacco treatment. After discharge from treatment, participants completed 14 days of electronic diary (ED) assessments of mood, self-efficacy, urges to drink or smoke, and drinking and smoking behavior. ED data revealed an increase in frequency of alcohol urges after smoking episodes. Drinking relapse episodes were predicted by prior ED ratings of low self-efficacy to resist drinking and high urge to smoke. Smoking relapse episodes were predicted by high urge to smoke and high negative, high arousal mood. Results support a cross-substance cue reactivity model of multiple substance use and a limited-strength model, but not a cross-substance coping model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relapse prevention strategies in outpatient substance abuse treatment.

Reviews the use of relapse prevention (RP) strategies in the treatment of substance abuse disorders. The work of G. A. Marlatt and J. R. Gordon (1980, 1985) provided the cognitive-behavioral base of RP models and numerous techniques. Specific protocols for the treatment of alcoholism, cocaine abuse, marijuana abuse, and heroin addiction are described. This body of knowledge has given the drug-free outpatient treatment of substance abuse a clear focus and direction. The techniques used in the RP include 7 groups of strategies: psychoeducation, identification of high-risk situations for relapse, development of coping skills, development of new-life behaviors, increased self-efficacy, dealing with relapse and avoiding the abstinence violation effect, and drug and alcohol monitoring. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective test of the negative affect model of substance abuse: Moderating effects of social support.

The authors tested whether dimensions of negative affect--specifically, trait levels of negative emotionality and state levels of depressive symptoms--increased risk for substance abuse onset and whether perceived social support moderated this relation using data from a 5-year prospective study of 496 school-recruited adolescent girls. Initial negative emotionality, but not depressive symptoms, and deficits in parental, but not peer, support predicted future substance abuse onset in a multivariate hazard model. Tests of the interaction between negative affect dimensions and social support suggested that support did not moderate the relation of negative affect to risk for substance abuse onset. Results provide prospective support for the etiological role in the onset of substance abuse of trait-linked negative affect and of parental support. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of multidimensional family therapy with higher severity substance-abusing adolescents: Report from two randomized controlled trials.

Objective: We used growth mixture modeling to examine heterogeneity in treatment response in a secondary analysis of 2 randomized controlled trials testing multidimensional family therapy (MDFT), an established evidence-based therapy for adolescent drug abuse and delinquency. Method: The first study compared 2 evidence-based adolescent substance abuse treatments: individually focused cognitive–behavioral therapy and MDFT in a sample of 224 urban, low-income, ethnic minority youths (average age = 15 years, 81% male, 72% African American). The second compared a cross-systems version of MDFT (MDFT—detention to community) with enhanced services as usual for 154 youths, also primarily urban and ethnic minority (average age = 15 years, 83% male, 61% African American, 22% Latino), who were incarcerated in detention facilities. Results: In both studies, the analyses supported the distinctiveness of 2 classes of substance use severity, characterized primarily by adolescents with higher and lower initial severity; the higher severity class also had greater psychiatric comorbidity. In each study, the 2 treatments showed similar effects in the classes with lower severity/frequency of substance use and fewer comorbid diagnoses. Further, in both studies, MDFT was more effective for the classes with greater overall substance use severity and frequency and more comorbid diagnoses. Conclusions: Results indicate that for youths with more severe drug use and greater psychiatric comorbidity, MDFT produced superior treatment outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Stability and Impact of Environmental Factors on Substance Use and Problems After Adolescent Outpatient Treatment for Cannabis Abuse or Dependence.

Because alcohol or other drug use following adolescent substance abuse treatment is common, understanding mediators of posttreatment outcome could help improve treatment interventions. The authors conducted path analyses based on data from 552 adolescents (aged 12-18; 82% male) with cannabis abuse or dependence who participated in outpatient treatment. The analysis used the Family Conflict and Cohesion subscales, from the Family Environment Scale, and several scales and indices from the Global Appraisal of Individual Needs. Family conflict, family cohesion, and social support indirectly predicted substance use and substance-related problems as mediated by recovery environment and social risk. This model replicated across 4 follow-up waves (3, 6, 9, and 12 months postintake). These results support the idea of targeting environmental factors during continuing care as a way to improve treatment outcomes for adolescents with cannabis disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Manualized treatment for substance abusers with personality disorders: dual focus schema therapy

The presence of an untreated personality disorder may be associated with worse compliance and outcome in substance abuse treatment. Therapeutic attention to the symptoms of personality disorder may reduce the severity of substance abuse and other Axis I symptoms which potentially contribute to relapse. A 24-week manual-guided individual cognitive-behavioral therapy approach has been developed that integrates relapse prevention with targeted intervention for early maladaptive schemas (enduring negative beliefs about oneself, others, and events) and coping styles. This Dual Focus Schema Therapy is being compared to 12-Step Drug Counseling for opioid-dependent individuals with personality disorders in an ongoing study funded by the National Institute on Drug Abuse. This article reviews Young's (1994) schema-focused theory and approach and summarizes the treatment manual, which integrates relapse prevention for substance abuse.     

Introduction to the special issue on the impact of childhood psychopathology interventions on subsequent substance abuse: Pieces of the puzzle.

Studies of adolescents and adults have reported high levels of co-occurrence of substance abuse with other psychiatric disorders, suggesting influence between the conditions. The comorbidity seems complex and variable, indicating that there may be more than 1 type of association between the comorbid disorders. When occurring in childhood, some of the frequently comorbid psychopathologies typically precede later drug and alcohol abuse and may have implications for substance abuse prevention as early risk indicators and as targets for intervention. Research discussed in this article and in this special issue provides a foundation for investigating the question of whether effective treatment of childhood psychopathologies can prevent or at least mitigate substance abuse for some adolescents. Clinical, research, and policy implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Constructing a short form of the Smoking Consequences Questionnaire with adolescents and young adults.

The goal of the present studies was to construct and validate a short form of the 50-item Smoking Consequences Questionnaire (SCQ; T. H. Brandon & T. B. Baker, 1991), a measure of smoking outcome expectancies. In Study 1, a 21-item short form (S-SCQ) was derived from a sample of 107 young adults previously treated for substance abuse. In Study 2, the measure was cross-validated on 125 adolescents in treatment for substance abuse. Confirmatory factor analyses revealed good model fit and factorial invariance for the 4 S-SCQ subscales across both samples. Validation analyses on each sample found that subscale scores generally correlated significantly with smoking-related variables. The present studies provide initial evidence for the utility of the S-SCQ when used with young adults and adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief coping skills treatment for cocaine abuse: substance use outcomes at three months

AIMS: Coping skills training, a promising treatment approach for alcoholics, was adapted for use with cocaine abusers and effects on outcome were investigated. DESIGN: A cocaine-specific coping skills training (CST) package was compared to an attention placebo control when both were added to a comprehensive treatment program. SETTING: The sites were two private substance abuse treatment facilities, one residential and rural, and one an urban partial hospital. PARTICIPANTS: Substance abusers in treatment with cocaine abuse or dependence were selected. INTERVENTION: The CST intervention was conducted in individual sessions. It involved functional analysis of high risk situations and coping skills training based on the functional analysis. FINDINGS: Clients who received CST had significantly fewer cocaine use days and the length of their longest binge was significantly shorter during the 3-month follow-up period compared to clients in the control condition. CST did not affect relapse rates or use of other substances. CONCLUSIONS: Results support the notion that cocaine-specific CST is a promising adjunct to treatment for cocaine abusers.     

An overview of problem-solving and social skills approaches in substance abuse treatment.

Reviews the research on problem solving (PS) and social skills (SSKs) approaches to treating substance abuse. Populations at high risk for substance abuse have been described as having deficits in these areas. Research shows 2 ways in which poor PS and SSKs can be related to drug use: (1) Deficiencies can lead to failures in interpersonal areas that can precipitate substance use and (2) individuals with deficits may find themselves unable to negotiate their way out of situations that carry a high risk of drug use. PS and SSKs training in substance abuse treatment are designed to give clients new skills that will allow them to maintain their abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relapse in Alcohol- and Drug-Disordered Adolescents With Comorbid Psychopathology: Changes in Psychiatric Symptoms.

This study examined reciprocal relationships between posttreatment substance use and psychiatric symptoms in adolescents with both a substance use disorder and an Axis I mental health disorder. Participants (13-18 years old) were recruited from inpatient treatment centers and interviewed during treatment and monthly for 6 months. Participants who relapsed (N = 103; 48% female) reported the incidence and severity of psychiatric symptoms experienced before and after their 1st posttreatment substance use. The number of symptoms and depression symptoms experienced were related to use of stimulants and other drugs during relapse. There was evidence for both self-medication (symptom reduction) and rebound (symptom exacerbation) effects of substance use on symptom severity. These results demonstrate that, for adolescents with both substance use and mental health disorders, psychiatric symptoms are 1 factor influencing posttreatment substance use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developmental trajectories of co-occurring depressive, eating, antisocial, and substance abuse problems in female adolescents.

Growth trajectories of co-occurring symptomatology were examined in a community sample of 493 female adolescents who were followed annually from early to late adolescence. On average, depression, eating disorder, and substance abuse symptoms increased over time, whereas antisocial behavior decreased. Increases in each symptom domain were associated with relative increases in all other domains. Initial depressive and antisocial behavior symptoms predicted future increases in the other; substance abuse and antisocial behavior symptoms also showed prospective reciprocal relations. Initial depression predicted increases in eating disorder and substance abuse symptoms. Initial eating disorder symptoms predicted increases in substance abuse problems. Finally, the results suggest that the developmental covariation between depressive and eating disorder symptoms and between antisocial behavior and substance abuse symptoms was accounted for by distinct but related 2nd-order growth parameters. (PsycINFO Database Record (c) 2010 APA, all rights reserved)