Adolescent and Parent Alliance and Treatment Outcome in Multidimensional Family Therapy.

In this study, the authors examined the relation between adolescent and parent therapeutic alliances and treatment outcome among 65 substance-abusing adolescents receiving multidimensional family therapy. Observer ratings of parent alliance predicted premature termination from treatment. Observer ratings, but not self-report, of adolescent alliance predicted adolescents' substance abuse and dependency symptoms at posttreatment, as well as days of cannabis use at 3-month follow-up. The association between adolescent alliance and substance abuse and dependency symptoms at posttreatment was moderated by the strength of the parent alliance. Results reveal the unique and interactive effects of the 2 alliances on treatment outcome and emphasize the need for a systemic and well-articulated approach to developing and maintaining the multiple alliances inherent to family therapy. (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)     

Increasing Substance Abuse Treatment Compliance for Persons With Traumatic Brain Injury.

This study compared 3 methods of increasing participation in substance abuse treatment for clients with traumatic brain injury. Participants (N = 195) were randomly assigned to 4 conditions: (a) motivational interview, (b) reduction of logistical barriers to attendance, (c) financial incentive, and (d) attention control. Four interviewers conducted structured, brief telephone interventions targeting the timeliness of signing an individualized service plan. Participants assigned to the barrier reduction (74%) and financial incentive (83%) groups were more likely to sign within 30 days compared with the motivational interview (45%) and attention control (45%) groups. Similar results were observed for time to signing, perfect attendance at appointments, and premature termination during the following 6 months. Extent of psychiatric symptoms was the only significant covariate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Controlled Study of a Cigarette Smoking Cessation Intervention for Adolescents in Substance Abuse Treatment.

Tobacco use is prevalent among youth with alcohol and other drug problems, yet this issue has received limited research and clinical attention. This study reports on a controlled evaluation of a cigarette smoking intervention with 54 adolescents in treatment for substance abuse, ages 13-18 (22% female). Participants were assessed at 4 time points. A greater proportion of participants in the treatment condition (n = 26) reported cessation attempts and point abstinence than did control participants (n = 28) at all time points. However, significant differences were found only for point abstinence at a 3-month follow-up. These findings provide initial support for the efficacy of a smoking cessation intervention delivered in the context of adolescent substance abuse treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distress Tolerance as a Predictor of Early Treatment Dropout in a Residential Substance Abuse Treatment Facility.

A large percentage of individuals who enter residential substance abuse treatment drop out before completing treatment. Given that early treatment dropout places individuals at an increased risk for relapse, identifying the mechanisms underlying treatment dropout would have several important theoretical and clinical implications. In the current study, the authors examined levels of psychological and physical distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility. In a sample of 122 individuals entering a residential substance abuse treatment facility, level of psychological distress tolerance was predictive of early treatment dropout above and beyond relevant self-report variables. There was no relationship between physical distress tolerance and early treatment dropout. Implications for future studies and treatment development or modification are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Alcohol and Other Drugs: Perspectives on Use, Abuse, Treatment and Prevention.

Reviews the book, Alcohol and Other Drugs: Perspectives on Use, Abuse, Treatment and Prevention by Whitehead, Grindstaff and Boydell (Eds.) (1973). According to the editors, the purpose of this collection of twenty three articles is "to provide readers with a somewhat advanced view of some of the major findings and issues in the use of alcohol and other drugs". Eleven of the articles (approximately one third of the book) are directed to alcohol topics and the remainder to other drugs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Abstinence Self-Efficacy and Abstinence 1 Year After Substance Use Disorder Treatment.

To better understand the relationship between abstinence self-efficacy and treatment outcomes in substance use disorder patients, experts in the field need more information about the levels of abstinence self-efficacy most predictive of treatment outcomes. Participants (N = 2,967) from 15 residential substance use disorder treatment programs were assessed at treatment entry, discharge, and 1-year follow-up. A signal detection analysis compared the ability of different measures of self-efficacy to predict 1-year abstinence and identified the optimal cutoffs for significant predictors. The maximal level of abstinence self-efficacy (i.e., 100% confident) measured at discharge was the strongest predictor of 1-year abstinence. Treatment providers should focus on obtaining high levels of abstinence self-efficacy during treatment with the goal of achieving 100% confidence in abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Indicators of Client Engagement: Influences on Alcohol Treatment Satisfaction and Outcomes.

This investigation explored the relationship of client engagement variables (client expectations, therapeutic/working alliance, and session attendance) with treatment satisfaction and posttreatment drinking-related outcomes using data from 2 outpatient alcohol treatment studies (N = 208). Path analysis was used to test a model in which engagement variables jointly influence client satisfaction with treatment and subsequent drinking-related outcomes. The proposed model fit well with the data and accounted for 14-23% of the variance in posttreatment outcomes. The relationships in the model suggest that the link between treatment satisfaction and outcome is clarified by examining client engagement variables, which relate indirectly to outcome by means of client satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric Comorbidity and Substance Use Treatment Outcomes of Adolescents.

Treatment outcomes of 126 adolescents (13-18 years old) with comorbid substance use disorders (SUDs) and Axis I psychiatric disorders (mood, anxiety, conduct, and attention-deficit/hyperactivity disorders) were compared to 81 SUD adolescents with no additional Axis I disorder. Participants completed structured interviews and symptom measures while participating in an adolescent treatment program and at 6 months following treatment. Results indicated that comorbid youth received more treatment during the outcome period; despite this, more comorbid SUD-Axis I disordered adolescents used substances following treatment than SUD-only youth, even after controlling for socioeconomic status and ethnicity. Among comorbid youth, internalizing disordered adolescents were less likely to use substances during the follow-up period, and externalizing disordered youth returned to substance use most rapidly after discharge from treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent and parent therapeutic alliances as predictors of dropout in multidimensional family therapy.

The authors examined the relations between adolescent-therapist and mother-therapist therapeutic alliances and dropout in multidimensional family therapy for adolescents who abuse drugs. The authors rated videotapes of family therapy sessions using observational methods to identify therapist-adolescent and therapist-mother alliances in the first 2 therapy sessions. Differences in adolescent and mother alliances in families that dropped out of therapy and families that completed therapy were compared. Results indicate that both adolescent and mother alliances with the therapist discriminated between dropout and completer families. Although no differences were observed between the 2 groups in Session 1, adolescents and mothers in the dropout group demonstrated statistically significantly lower alliance scores in Session 2 than adolescents and parents in the completer group. These findings are consistent with other research that has established a relationship between therapeutic alliance and treatment response. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Association Among Parental Substance Use Disorder, P300 Amplitude, and Neurobehavioral Disinhibition in Preteen Boys at High Risk for Substance Use Disorder.

The P300 amplitude of the event-related potential as a mediator of the association between parental substance use disorder (SUD) and child's neurobehavioral disinhibition was assessed. The P300 amplitude was recorded using an oddball task in sons of fathers having either lifetime SUD (n = 105) or no psychiatric disorder (n = 160). Neurobehavioral disinhibition was assessed using measures of affect regulation, behavior control, and executive cognitive function. Parental SUD and child's P300 amplitude accounted for, respectively, 16.6% and 16.8% of neurobehavioral disinhibition variance. Controlling for parental and child psychopathology, an association between parental SUD and child's P300 amplitude was not observed. It was concluded that the P300 amplitude does not mediate the association between parental SUD and child's neurobehavioral disinhibition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Illicit Substance Use and Intimate Partner Violence Among Men in Batterers' Intervention.

This study investigated the effects of illicit substance use and alcohol on the occurrence of violence among men in batterers' intervention and their female partners. Results showed that over half of the batterers reported using illicit substances in the past year, and over one third of partners were reported to have used 1 or more illicit substances in the past year. Relative to the non-substance users, substance users scored significantly higher on all measures of perpetration and receipt of intimate partner violence after controlling for alcohol use. Results also showed that illicit substance use uniquely predicted specific forms of violence perpetration and victimization. The results highlight the need for interventions tailored to address substance use and violence concurrently. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance use diagnosis within a community sample of adults: Distinction, comorbidity, and progression over time.

Practicing psychologists conceptualize, assess, and treat clients who use substances in different ways. Using longitudinal data from a multiethnic community sample of 470 adults, the authors examine patterns of abuse and dependence on alcohol, marijuana, and cocaine. Men were significantly more abusive, dependent, and polysubstance dependent on all drugs than women. A large percentage of drug abusers, and over 1/3 with drug dependence, remitted without formal treatment. However, early severe problems with cocaine increased later alcohol problems. Traditional disease progression and drug use acquisition models are not supported. Psychologists should incorporate the natural course of substance use into treatment and prevention efforts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic Alliance, Negative Mood Regulation, and Treatment Outcome in Child Abuse-Related Posttraumatic Stress Disorder.

This study examined the related contributions of the therapeutic alliance and negative mood regulation to the outcome of a 2-phase treatment for childhood abuse-related posttraumatic stress disorder (PTSD). Phase 1 focused on stabilization and preparatory skills building, whereas Phase 2 was comprised primarily of imaginal exposure to traumatic memories. Hierarchical regression analyses indicated the strength of the therapeutic alliance established early in treatment reliably predicted improvement in PTSD symptoms at posttreatment. Furthermore, this relationship was mediated by participants' improved capacity to regulate negative mood states in the context of Phase 2 exposure therapy. In the treatment of childhood abuse-related PTSD, the therapeutic alliance and the mediating influence of emotion regulation capacity appear to have significant roles in successful outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking Among Psychiatric Outpatients: Relationship to Substance Use, Diagnosis, and Illness Severity.

To understand the elevated smoking rates among psychiatric patients, the authors investigated whether psychiatric diagnosis, illness severity, and other substance use predicted smoking status in a diverse sample (N=2,774) of psychiatric outpatients. Results indicated that 61% smoked daily and that 18% smoked heavily. Smoking was related to psychiatric diagnosis and illness severity as well as caffeine consumption and substance abuse. Diagnoses of bipolar disorder, schizoaffective disorder, and schizophrenia were independently related to smoking status, an association that was most pronounced among persons treated at clinics serving more impaired patients. Thus, diagnosis and illness severity contribute to elevated smoking rates, even after controlling for other substance use. Cessation programs are needed to reduce tobacco use in this vulnerable population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of Forgiveness Therapy on Anger, Mood, and Vulnerability to Substance Use Among Inpatient Substance-Dependent Clients.

Anger and related emotions have been identified as triggers in substance use. Forgiveness therapy (FT) targets anger, anxiety, and depression as foci of treatment. Fourteen patients with substance dependence from a local residential treatment facility were randomly assigned to and completed either 12 approximately twice-weekly sessions of individual FT or 12 approximately twice-weekly sessions of an alternative individual treatment based on routine drug and alcohol therapy topics. Participants who completed FT had significantly more improvement in total and trait anger, depression, total and trait anxiety, self-esteem, forgiveness, and vulnerability to drug use than did the alternative treatment group. Most benefits of FT remained significant at 4-month follow-up. These results support FT as an efficacious newly developed model for residential drug rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective Relations Between Bulimic Pathology, Depression, and Substance Abuse: Unpacking Comorbidity in Adolescent Girls.

[Correction Notice: An erratum for this article was reported in Vol 72(4) of Journal of Consulting and Clinical Psychology (see record 2007-16893-001). The findings of Leon, Fulkerson, Perry, Keel, and Klump ("Three to four year prospective evaluation of personality and behavioral risk factors for later disordered eating in adolescent girls and boys," Journal of Youth and Adolescence, 1999, Vol. 28, No. 2, pp. 181-196), cited on page 62, were incorrectly reported. Leon et al. (1999) found that the latent variable of negative affect/attitudes determined at study entrance significantly correlated with final year eating disorder risk score when conducted with the full sample and when removing Time 1 high eating disorder risk subjects. This latent variable consisted of the GBI Depression, MPQ Negative Emotionality, EDI Ineffectiveness, EDI Interoceptive Awareness, and EDI Body Dissatisfaction scales. A subsequent univariate analysis of Time 1 Negative Emotionality scale score on Time 3 eating disorder risk, adjusting for initial eating disorder risk score, showed a nonsignificant effect size (Stice, E. [2002]. Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128, 825-848).] To elucidate the processes that contribute to the comorbidity between bulimic pathology, depression, and substance abuse, the authors tested the temporal relations between these disturbances with prospective data from adolescent girls (N = 496). Multivariate analyses indicated that depressive symptoms predicted onset of bulimic pathology but not of substance abuse, bulimic symptoms predicted onset of depression but not of substance abuse, and substance abuse symptoms predicted onset of depression but not of bulimic pathology. Results suggest that the comorbidity arises because certain disorders are risk factors for the other disorders. Findings also provide support for select etiologic theories and further establish the clinical significance of these conditions by showing that they increase risk for onset of other psychiatric disturbances. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in tobacco use among adolescent smokers in substance abuse treatment.

Adolescents with substance use disorders (SUDs) smoke cigarettes more than youth in the general population. Little is known about changes in smoking patterns during and after outpatient SUD treatment. We examined whether receiving SUD treatment had a differential impact on cigarette smoking behaviors of mild (     

Validity and reliability of the Lesbian, Gay, Bisexual Working Alliance Self-Efficacy Scales.

In this paper, the authors report on the development and initial psychometric evaluation of the Lesbian, Gay, and Bisexual Working Alliance Self-Efficacy Scales (LGB-WASES) with data collected from two studies and 534 counseling trainees. Exploratory factor analysis results yielded a 32-item scale with a three-factor model (a) Emotional Bond, (b) Establishing Tasks, and (c) Setting Goals. LGB-WASES scores were internally consistent and remained stable over a 3-week period. Construct validity evidence suggests the LGB-WASES scores were (a) positively related to general perceptions of counseling self-efficacy and multicultural counseling competency, (b) negatively related to attitudes toward lesbians and gay men, and (d) unrelated to social desirability. Recommendations for future research are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse assessment and treatment: The current training and practice of APA Division 22 members.

Objective: To determine the preparedness of rehabilitation psychologists to work with people with disabilities with primary or secondary substance-related problems by examining their education, training, and current practice. Design: Mail survey. Participants: 76 (47 men, 29 women) Division 22 members of the American Psychological Association. Results: Although 79% of respondents reported treating individuals with alcohol and other drug issues, over half rated their training in substance abuse treatment as inadequate. Referring to self-help groups and instilling cognitive-behavioral coping skills were common treatments. Participants reported a lack of preparation in substance abuse training in their graduate program coursework, practicum, and internship. Conclusion: Continuing education and changes to curriculum requirements, with linkage to existing certification bodies, should be considered to close the gap between training and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)