Determinants of physical and global functioning in adult HIV-positive heterosexual men.

Little is known about the psychosocial factors that might impact the functioning ability of heterosexual men living with HIV. We examined positive and negative coping, social support, and HIV stigma as predictors of physical and global functioning in a cross-sectional sample of 317 HIV-infected adult heterosexual male patients recruited from clinical and social service agencies in New York City. Study participants were primarily minority and low income. Sixty-four percent were African-American, 55% were single, and 90% were 40 years of age or older. The majority had long-term HIV (LTHIV), with an average duration of 15 years since diagnosis. After controlling for participant characteristics, structural equation modeling analyses revealed that positive coping and social support had a significant positive direct effect on global functioning, while stigma had a significant negative direct effect on global functioning. The physical functioning model revealed that negative coping and HIV stigma had significant negative direct effects, whereas social support had a significant positive indirect effect. Age and duration of HIV diagnosis were not associated with physical and global functioning. In conclusion, we found that heterosexual men living with LTHIV who have ineffective coping, less social support, and greater stigma have reduced functioning ability. Study findings have implications for developing interventions aimed at increasing and retaining functioning ability with the end goal of improving successful aging in this population.

A systematic review of the psychometric properties of the Sexual Relationship Power Scale in HIV/AIDS research.

The Sexual Relationship Power Scale (SRPS) was developed over a decade ago to address the lack of reliable and valid measures of relationship power in social, behavioral and medical research. The SRPS and its two subscales (relationship control [RC], decision-making dominance [DMD]) have been used extensively in the field of HIV prevention and sexual risk behavior. We performed a systematic review of the psychometric properties of the SRPS and subscales as reported in the HIV/AIDS literature from 2000 to 2012. A total of 54 published articles were identified, which reported reliability or construct validity estimates of the scales. Description of the psychometric properties of the SRPS and subscales is reported according to study population, and several cross-population trends were identified. In general, the SRPS and RC subscale exhibited sound psychometric properties across multiple study populations and research settings. By contrast, the DMD subscale had relatively weak psychometric properties, especially when used with specific populations and research settings. Factors that influenced the psychometric properties of the various scales and subscales included the study population, mean age of the sample, number of items retained in the scale, and modifications to the original scales. We conclude with recommendations for (1) the application and use of the SRPS and subscales, (2) reporting of psychometric properties of the scales in the literature, and (3) areas for future research.

Treating substance abuse: partner and family approaches.

Historically, alcohol and other substance use disorders were viewed as individual-based problems that were most effectively treated by focusing on the diagnosed individual. However, in response to numerous clinical trials demonstrating the efficacy (and often superiority) of couple and family treatments for alcoholism and drug abuse, this emphasis on treating the individual has slowly given way to a greater awareness of family members' crucial roles in the etiology, maintenance, and long-term course of substance use and addictive behavior. As a result, clinicians are increasingly interested in understanding substance misuse from a systemic perspective and exploring how partner- and family-involved interventions may be used to address individuals' substance abuse.

Behavioral couples therapy for substance abusers: where do we go from here?

Behavioral couples therapy (BCT) is an evidence-based family treatment for substance abuse. The results of numerous investigations over the past 30 years indicate that participation in this treatment by married or cohabiting substance-abusing patients, compared with more traditional individual-based interventions, results in greater reductions in substance use, higher levels of relationship satisfaction, greater reductions in partner violence, and more favorable cost outcomes. This review examines the rationale for using BCT, the empirical literature supporting its use, methods used as part of this intervention, and future research directions.

Coping behavior and depressive symptoms in adult children of alcoholics.

This paper examined whether adult children of alcoholics (ACOAs) would report more depressive mood symptoms as compared to non-ACOAs, whether coping behaviors differed as a function of ACOA status, and whether specific coping behaviors were related to depressive mood symptoms in ACOAs. Participants were 136 college students categorized as ACOAs and 436 college students categorized as non-ACOAs as determined by scores on the Children of Alcoholics Screening Test (CAST; J.W.Jones, 1983 The children of alcoholics screening test: test manual. Chicago: Camelot). As compared to non-ACOAs, ACOAs reported significantly more symptoms of depressive mood as measured by the Profile of Mood States (POMS; McNair, Lorr, and Droppleman, 1992 POMS manual: profile of mood states. San Diego, CA: Edits). On the COPE Inventory (Carver, Scheier, and Weintraub, 1989 Assessing coping strategies: a theoretically based approach. Journal of Personality and Social Psychology, 56:267-283), ACOAs reported higher use of the following coping strategies: Behavior Disengagement, Denial, Focus on and Venting of Emotions, Humor, and Substance Use. For both the ACOA and non-ACOA groups, the use of Positive Reinterpretation and Growth and the use of Planning were significantly associated with fewer depressive symptoms, whereas Mental Disengagement, Focus on and Venting of Emotions, Denial, Behavior Disengagement, Substance Use, and Suppression of Competing Activities were associated with higher depressive mood scores.

Maternal and paternal alcoholism and depressive mood in college students: parental relationships as mediators of ACOA-depressive mood link.

The present study examined whether suspecting one's mother versus father of alcohol abuse was associated with parent-offspring relationships, and the degree to which parent-child relationships were associated with depressive symptoms. As compared to non-ACOAs (n=288), ACOAs (n=100) reported more negative parent-child relationships (i.e., greater alienation, poorer communication, less trust, greater emotional longing, and more negative attitudes toward the parent) and increased depressive symptoms on the POMS (McNair, Lorr, & Droppleman, 1992). A closer look revealed that suspected maternal alcohol abuse was associated with more negative mother-child relationships, whereas suspected paternal alcohol abuse was associated with more negative father-child relationships. Both maternal alcohol abuse and paternal alcohol abuse predicted depressive symptoms.

The Case for Examining and Treating the Combined Effects of Parental Drug Use and Interparental Violence on Children in their Homes.

This review examines what have been, to this point, generally two divergent lines of research: (a) effects of parental drug abuse on children, and (b) effects of children's exposure to interparental violence. A small, but growing body of literature has documented the robust relationship between drug use and intimate partner violence. Despite awareness of the interrelationship, little attention has been paid to the combined effect of these deleterious parent behaviors on children in these homes. Thus, we argue for the need to examine the developmental impact of these behaviors (both individually and combined) on children in these homes and for treatment development to reflect how each of these parent behaviors may affect children of substance abusers.

Subtypes of alcohol and intimate partner violence: a latent class analysis.

The investigation explored whether subtypes of relapse to violence exist for different levels of intimate partner violence and drinking behavior among men who relapse to both alcohol and violence after alcoholism treatment. Male clients entering an alcoholism treatment program who reported at least one incident of intimate partner violence and their female partners (N = 294) were recruited for participation. Data were analyzed using a latent class analysis of mixture model. Findings revealed that two classes of violence best described the sample of men that relapsed to violence. Class 1 contained males who had perpetrated more days of violence, relapsed to violence faster, more frequently relapsed to alcohol, and had a higher percentage of males identified as meeting diagnostic criteria for antisocial personality disorder compared to those in class 2.

Alcoholism and intimate partner violence: effects on children's psychosocial adjustment.

It is widely recognized that alcoholism and relationship violence often have serious consequences for adults; however, children living with alcoholic parents are susceptible to the deleterious familial environments these caregivers frequently create. Given the prevalence of IPV among patients entering substance abuse treatment, coupled with the negative familial consequences associated with these types of behavior, this review explores what have been, to this point, two divergent lines of research: (a) the effects of parental alcoholism on children, and (b) the effects of children's exposure to intimate partner violence. In this article, the interrelationship between alcoholism and IPV is examined, with an emphasis on the developmental impact of these behaviors (individually and together) on children living in the home and offers recommendations for future research directions.

Substance abuse and intimate partner violence: treatment considerations.

Given the increased use of marital- and family-based treatments as part of treatment for alcoholism and other drug disorders, providers are increasingly faced with the challenge of addressing intimate partner violence among their patients and their intimate partners. Yet, effective options for clinicians who confront this issue are extremely limited. While the typical response of providers is to refer these cases to some form of batterers' treatment, three fundamental concerns make this strategy problematic: (1) most of the agencies that provide batterers' treatment only accept individuals who are legally mandated to complete their programs; (2) among programs that do accept nonmandated patients, most substance-abusing patients do not accept such referrals or drop out early in the treatment process; and (3) available evidence suggests these programs may not be effective in reducing intimate partner violence. Given these very significant concerns with the current referral approach, coupled with the high incidence of IPV among individuals entering substance abuse treatment, providers need to develop strategies for addressing IPV that can be incorporated and integrated into their base intervention packages.

Brief relationship therapy for alcoholism: a randomized clinical trial examining clinical efficacy and cost-effectiveness.

The purpose of this study was to examine the clinical efficacy and cost effectiveness of brief relationship therapy (BRT), a shortened version of standard behavioral couples therapy (S-BCT), with alcoholic male patients (N = 100) and their nonsubstance-abusing female partners. Participants were randomly assigned to 1 of 4 treatment conditions: (a) BRT, (b) S-BCT, (c) individual-based treatment (IBT), or (d) psychoeducational attention control treatment (PACT). Equivalency testing revealed that, compared with those assigned to S-BCT, participants who were randomly assigned to BRT had equivalent posttreatment and 12-month follow-up heavy drinking outcomes. Moreover, at 12-month follow-up, heavy drinking and dyadic adjustment outcomes for patients who received BRT were superior to those of patients who received IBT or PACT. BRT was significantly more cost effective than the S-BCT, IBT, or PACT.

Assessing the costs, benefits, cost-benefit ratio, and cost-effectiveness of marital and family treatments: why we should and how we can.

The vast majority of outcome studies examining the effects of marital and family treatments focus exclusively on indicators of and changes in familial functioning and individual members' psychosocial adjustment, but fail to measure, report, or analyze treatment costs, benefits, cost-benefit ratio, or cost-effectiveness. Because of growing concerns about spiraling health care costs, clinical and economic outcomes constitute equally important and complementary aspects of any evaluation of marital and family treatments. The twofold purpose of this article is to define different components of cost analyses of health-related interventions, including marital and family treatments, and to describe methods for calculating and integrating clinical and cost outcome information when evaluating marital and family treatments. There are significant opportunities to promote the use of such treatments by conducting and reporting the results of cost analyses.