Randomized clinical trial of matching client alcohol use disorder severity and level of cognitive functioning to treatment setting: A partial replication and extension.

In a tightly controlled, clinical research environment, Rychtarik et al. (2000) found that individuals with an alcohol use disorder (AUD) benefited more from inpatient (IP) than outpatient care, if they presented with high alcohol problem severity and/or low cognitive functioning. This study sought to (a) validate and extend these findings within the uncontrolled environment of a community-based treatment center and (b) test whether inpatients had fewer days of involuntary abstinence (e.g., incarcerations), controlling for differences in treatment expectancy across care settings. Clients (N = 176) with an AUD were deterministically assigned to inpatient-need group (needs IP = high severity and/or low cognitive functioning; no need for IP = neither high severity nor low cognitive functioning). Within need group, participants were randomly assigned to 21 days of routine inpatient or outpatient care, plus 6 months of continuing care. Primary outcomes of percentage of days abstinent (PDA), monthly point prevalence abstinence (PPA), and drinks per drinking day (DDD), and the secondary outcome of involuntary abstinence were assessed over 18 months. Among high-severity participants, inpatients significantly reduced DDD, and outpatients did not. Neither problem severity nor cognitive functioning moderated other setting effects. Treatment expectancy, assessed after being informed of scheduled setting, was higher among inpatients than outpatients. High-expectancy inpatients maintained the highest PDA throughout follow-up, had the highest PPA for most of follow-up, and delayed peak prevalence of involuntary abstinence by 6 months. In sum, the Alcohol Problem Severity × Setting interaction on DDD appears robust. The potential moderating role of expectancy will warrant further study. (PsycINFO Database Record

Skill training versus 12-step facilitation for parents of substance-abusing teens.

Distressed parents (N=85) with a substance-abusing adolescent not receiving treatment were randomized to 12 weeks of coping skill training (CST), 12-step facilitation (TSF), or delayed treatment control (DTC). At the end of treatment/delay, CST showed greater coping skillfulness than TSF, and both CST and TSF were more skillful than DTC. The percentage of parent problem days (PPD)-days when the adolescent's substance use caused a problem-also was reduced in CST and TSF, relative to DTC. Both CST and TSF reported significantly reduced monthly PPD by the end of a 12-month follow-up. Skill training and TSF interventions appear equally effective for this underserved parent population.

Web-based coping skills training for women whose partner has a drinking problem.

Spouses whose partner has an alcohol use disorder can experience considerable psychological distress. Yet, because of social, financial, relationship, and psychological barriers they often remain hidden and underserved. To partially reduce treatment barriers for this population, this study evaluated the short-term efficacy of a self-paced, web-delivered coping skills training program for women experiencing distress as a result of living with a partner with an alcohol use disorder. Participants (N = 89) were randomly assigned to either 8 weeks of an Internet-administered coping skills training program (iCST), or an 8-week delayed treatment control (DTC). Participation in, and satisfaction with iCST was high. At the end of the 8-week access/delay period, iCST participants exhibited a significantly higher level of coping skills relative to DTC, d = 1.02, 95% confidence interval [CI; .64, 1.51], and reported significantly fewer depressive symptoms, d = -.65, 95% CI [-1.21, -.35], and situational anger, d = -.70, 95% CI [-1.62, -.64]. Moreover, iCST appeared to prevent an increase in symptoms among those with low baseline symptom levels; DTC did not. Skill acquisition appeared to partially mediate changes observed. Online coping skills training may be an effective way of reaching and helping a large number of this frequently underserved population.

Parent-adolescent report correspondence on adolescent substance abuse among teens in residential rehabilitation.

Research on the correspondence between adolescent and parent reports of adolescent substance abuse has typically been conducted on adolescent outpatient treatment samples, or on non-treatment samples. In the current study, fifty adolescents receiving residential substance abuse treatment, and their parents were assessed separately regarding the teen's substance use (e.g., cigarettes, alcohol, marijuana, other illicit drugs) during the 90 days preceding adolescent treatment entry. Correspondence between reporters was for the most part fair to excellent, with observed discrepancies generally due to parents providing lower estimates of use than did adolescents. Multiple regression analysis revealed that higher discrepancy between reporters occurred when the parent was younger, when the parent encountered fewer problems due to the teen's substance use, when the adolescent attended more probation or parole meetings, the fewer the number of days the adolescent was incarcerated, and the fewer days the adolescent lived at home prior to treatment. Results from exploratory analyses suggest that parents and adolescents are more discrepant when the assessment occurs later in the adolescent's treatment program. Overall, results suggest that in the absence of a cooperative teen, parental report of the adolescent's previous substance use could serve as a good proxy among families in which the adolescent is entering residential substance abuse treatment.

Agreement between Parent and Adolescent Reports of Adolescent Substance Use.

This study examined the correspondence between parent and adolescent reports of the adolescent's substance use in a population of parents concerned about, and experiencing problems resulting from, their teen's substance use. Seventy-five parents and their adolescent (76% not in treatment; 24% in treatment) were interviewed separately regarding the teen's recent use of cigarettes, alcohol, marijuana, and other illicit drugs. Irrespective of adolescent treatment status, fair-to-good congruence was found on cigarette and marijuana use, alcohol use frequency, and overall substance use frequency. Poor congruence was found on the incidence of alcohol and other illicit drug use, and the quantity of alcohol consumed per drinking day. Multiple regression analysis revealed that poorer congruence on substance use frequency occurred when the teen was younger, when the parent scored low on monitoring and high on psychological distress, and when the parent used alcohol more frequently. Results indicate that parental awareness of teen substance use varies with the substance used and its measurement. In the absence of a cooperative teen, however, parental report of the frequency of adolescent substance use appears to serve as a fair-to-good proxy.

Preliminary evaluation of a coping skills training program for those with a pathological-gambling partner.

Individuals living with a pathological-gambling partner can experience significant psychological distress. In this report, we conduct a preliminary evaluation of a coping skills training program (CST) for this population. Twenty-three individuals experiencing stress from living with a pathological-gambling partner who was not in treatment were randomly assigned to either CST or a delayed treatment control (DTC) condition. CST consisted of ten, weekly individual sessions to teach more effective coping skills. At the end of the treatment/delay period, CST participants, relative to those in DTC, showed a large improvement in coping skillfulness that appeared to mediate a corresponding large significant reduction in depression and anxiety relative to DTC. Partner gambling during the period decreased in both conditions but did not differ between them, nor did partner help-seeking differ. CST shows promise as an effective treatment for individuals distressed as a result of a partner's gambling problem. Larger, longer-term evaluations of the intervention, and comparison with alternate treatment models are needed.

A review of substance use research among those with mental retardation.

This article reviews research conducted on the cigarette, alcohol, and illicit drug use of adolescents and adults with mental retardation (MR). The majority of the research related to substance use conducted on this population has been limited to surveys. Overall, results of these studies suggest that, although substance use is slightly lower among those with MR than among nondisabled comparison groups, it is nonetheless a problem for many individuals. This research is reviewed and a discussion of both the general and specific flaws of these studies follows. Further, the examination of education, prevention, and treatment programs for this population has been overlooked, indicating that individuals with MR are likely not receiving the services most appropriate for them. The article concludes with a discussion of several topics that need to be addressed in future studies, including research on potential best practices in the overlooked areas of substance abuse interventions.

Coping skills training and 12-step facilitation for women whose partner has alcoholism: effects on depression, the partner's drinking, and partner physical violence.

Women (N=171), distressed from their partners' untreated alcoholism, received either coping skills training (CST), 12-step facilitation (TSF), or delayed treatment (DTC). CST and TSF resulted in lower depression levels than DTC but did not differ from one another. Skill acquisition mediated the treatment effects of CST; Al-Anon attendance did not mediate the TSF effect. Lower depression levels were maintained at 12 months with no differences between groups. Partner drinking decreased from pretreatment to follow-up in the CST and TSF conditions. However, for partners with a history of relationship violence, drinking improved across follow-up in the CST condition but worsened in the TSF condition. Partner relationship violence was less in the CST condition. CST may be particularly useful for women experiencing physical violence from a partner with alcoholism.

Psychometric evaluation of the parent situation inventory: a role-play measure of coping in parents of substance-using adolescents.

This article reports on the generalizability, reliability, and construct validity of the Parent Situation Inventory (PSI), a role-play measure of coping skills in parents experiencing problems from an adolescent's drug and alcohol use. Generalizability was robust (.80) and alternate form and test-retest reliability were satisfactory. PSI skillfulness was negatively related to the parent's own substance use and to the adolescent's alcohol use. The PSI shows promise as a reliable and potentially valid measure of coping in this population and has direct implications for developing and evaluating skill-based parent training programs.