Development and psychometric evaluation of a rapid intimate partner violence perpetration screening tool.

Current methods of identifying intimate partner violence (IPV) perpetration rely upon lengthy screening instruments, partner injury, and legal involvement. There exist no viable, brief screening tools to facilitate the rapid and early identification of IPV perpetration. The development of a brief IPV screening tool would reduce participant burden and compensation in research as well as aid in self-identification and appropriate consultation for treatment. Three samples were recruited and administered an IPV assessment measure. Receiver Operating Characteristic (ROC) curve analyses were used to determine a critical subset of items that could be rapidly administered and used to accurately detect physical IPV perpetrators. A set of four items emerged that were capable of differentiating between partner violent and nonviolent participants in Samples 1 (the Area Under the ROC Curve (AUC) = .95, SE = .02), 2 (AUC = .98, SE =.01), and 3 (AUC = .94, SE = .04). Internal consistency of the screening items was acceptable across samples and the scores on the screening tool were significantly associated in the expected direction with all assessed risk factors for IPV. Initial evaluation of the rapid IPV perpetration screening tool suggests that it may help satisfy the growing need to quickly determine research eligibility and to help college students self-identify risk, offering objective data upon which to base the decision for follow-up consultation.

Therapist empathy, combined behavioral intervention, and alcohol outcomes in the COMBINE research project.

OBJECTIVE: Common factors such as therapist empathy play an important role in treatment for addictive behaviors. The present study was a secondary analysis designed to evaluate the relation between therapist empathy and alcohol treatment outcomes in data from a large, multisite, randomized controlled trial. METHOD: Audio-recorded psychotherapy sessions for 38 therapists and 700 clients had been randomly selected for fidelity coding from the combined behavioral intervention condition of Project COMBINE. Sessions were evaluated by objective raters for both specific content (coping with craving, building social skills, and managing negative mood) and relational components (empathy level of the therapist). Multilevel modeling with clients nested within therapists evaluated drinks per week at the end of treatment. RESULTS: Approximately 11% of the variance in drinking was accounted for by therapists. A within-therapist effect of empathy was detected (B = -0.381, SE = 0.103, p < .001); more empathy than usual was associated with subsequent decreased drinking. The Social and Recreational Counseling module (B = -0.412, SE = 0.124, p < .001), Coping with Cravings and Urges module (B = -0.362, SE = 0.134, p < .01), and the Mood Management module (B = -0.403, SE = 0.138, p < .01) were also associated with decreased drinking. No between-therapist effect was detected, and the Empathy × Module Content interactions were not significant. CONCLUSIONS: The results of the study appear consistent with the hypothesis that skills building and therapist empathy are independent contributions to the overall benefit derived from the combined behavioral intervention.

Development of a face-to-face injunctive norms brief motivational intervention for college drinkers and preliminary outcomes.

Findings are presented from the first randomized clinical trial that compared changes in alcohol consumption and alcohol-related consequences among college student drinkers from baseline to follow-up across 4 conditions: (a) a new single component injunctive norms brief motivational intervention (IN-BMI) condition; (b) a single component descriptive norms brief motivational intervention (DN-BMI); (c) a combined IN and DN brief motivational intervention (Combined-BMI); and (d) assessment-only control. DN-BMI focused on the juxtaposition of personal, perceived, and actual alcohol use by typical same-sex students at your university. IN-BMI focused on the juxtaposition of personal, perceived, and actual attitudes about alcohol-related consequences by the typical same-sex student at your university. Exploratory analyses assessed the effect of IN-BMI and DN-BMI on matched (e.g., the effect of DN-BMI on perceived DN) and mismatched norms (e.g., the effect of DN-BMI on perceived IN). IN-BMI resulted in greater decreases in alcohol use and consequences when delivered alone and in conjunction with DN-BMI compared with the control condition. Further, the Combined-BMI condition reported greater reductions in alcohol use but not consequences compared to the DN condition. Receiving IN-BMI either alone or in combination with DN-BMI produced greater changes in IN perceptions than were produced in the control group. Grounded in norms theory, this study examined how college student problem drinking is affected by both IN-BMI and DN-BMI alone and in combination. We conclude that IN-BMI alone or in combination with DN-BMI is able to modify alcohol use and reduce alcohol-related consequences. (PsycINFO Database Record

"It Might Actually Work This Time": Benefits and Barriers to Adapted 12-Step Facilitation Therapy and Mutual-Help Group Attendance From the Perspective of Dually Diagnosed Individuals.

Most U.S. healthcare professionals encourage mutual-help group involvement as an adjunct to treatment or aftercare for individuals with substance use disorders, yet there are multiple challenges in engaging in these community groups. Dually diagnosed individuals (DDIs) may face additional challenges in affiliating with mutual-help groups. Twelve-step facilitation for DDIs (TSF-DD), a manualized treatment to facilitate mutual-help group involvement, was developed to help patients engage in Double Trouble in Recovery (DTR), a mutual-help group tailored to DDIs. Given the promising role that TSF-DD and DTR may have for increasing abstinence while managing psychiatric symptoms, the aim of the current study was to systematically examine reasons for TSF-DD and DTR attendance from the perspective of DDIs using focus group data. Participants were a subset (n = 15) of individuals diagnosed with an alcohol use disorder as well as a major depressive, bipolar, or psychotic disorder who participated in a parent study testing the efficacy of TSF-DD for increasing mutual-help group involvement and reducing alcohol use. Analyses of focus group data revealed that participants construed DTR and TSF-DD as helpful tools in the understanding and management of their disorders. Relative to other mutual-help groups in which participants reported feeling ostracized because of their dual diagnoses, participants reported that it was beneficial to learn about dual disorders in a safe and accepting environment. Participants also expressed aspects that they disliked. Results from this study yield helpful empirical recommendations to healthcare professionals seeking to increase DDIs' participation in DTR or other mutual-help groups.

Ambivalence Model of Craving: A Latent Profile Analysis of Cue-Elicited Alcohol Craving in an Inpatient Clinical Sample.

OBJECTIVE: Craving has been defined as intense desires or urges to consume alcohol and is considered predictive of future drinking and relapse. Despite this assumption, research on the craving-drinking relationship has been mixed, calling into question how researchers define and measure craving. The primary aim of the current study was to examine a promising, but understudied, model of craving (Ambivalence Model of Craving [AMC]) that calls for the concurrent assessment of both approach (desires to use) and avoidance (desires to not use) inclinations. METHOD: Participants (N = 175) were recruited from an acute detoxification facility. Alcohol craving was evaluated with a cue-reactivity paradigm in which participants viewed substance cue slides and separately rated their desire to consume and not consume the substance after each image. Latent profile analysis examined distinct motivational profiles for alcohol predicted by the AMC: ambivalence (high approach, high avoidance), indifference (low approach, low avoidance), approach (high approach, low avoidance), and avoidance (low approach, high avoidance). RESULTS: Latent classes corresponded to the AMC, but a fifth class differentiated moderate versus high ambivalence. Classes were associated with auxiliary variables in predicted directions; high ambivalence and approach classes were associated with greater drinking and negative consequences, whereas voluntary admittance to treatment was more likely with ambivalence and avoidance classes. CONCLUSIONS: The AMC provides a promising framework for evaluating cue-elicited craving and alcohol use in clinical samples and may be a useful model of craving for clinicians during treatment.

Longitudinal trajectories of readiness to change: alcohol use and help-seeking behavior.

OBJECTIVE: Pre-post changes in readiness for change (RC) are commonly assessed in treatment outcome studies, often with contradictory results. Little is known about 12-month RC trajectories among those initiating change or about the association between RC and either within- or between-person alcohol use or time-lagged help-seeking behavior. METHOD: This observational longitudinal study measured RC as ambivalence, problem recognition, and taking steps. Participants (N = 253; 66.4% male) diagnosed with alcohol use disorders were recruited from treatment sites, Alcoholics Anonymous (AA) groups, and other community sources when first initiating change and assessed at baseline and 3, 6, 9, and 12 months. RESULTS: Support for significant participant heterogeneity as well as linear and quadratic change in RC trajectories was found, although results differed across the three aspects of RC. Independent associations of both within- and between-person percentage of days abstinent were found for ambivalence and taking steps. Lagged, time-specific fluctuations in prior help-seeking behaviors within an individual predicting subsequent RC showed that both AA (B = -1.650, p < .05) and treatment attendance (B = 2.914, p < .01) were associated with subsequent ambivalence. Prior increases in taking steps within individuals were predictive of subsequent AA but not treatment attendance. CONCLUSIONS: Results inform treatment providers about how RC trajectories vary depending on alcohol use, both within and between individuals, and how individuals may mobilize change attitudes and behaviors, especially in relation to AA attendance. Future research should investigate additional predictors of RC trajectories and the causal direction between RC and help seeking.

Alcohol, tobacco, and drug use among emergency department patients.

BACKGROUND: The prevalence of alcohol, tobacco, and other drug (ATOD) use among emergency department (ED) patients is high and many of these patients have unrecognized and unmet substance use treatment needs. Identification of patients in the ED with problem substance use is not routine at this time. METHODS: We examined screening data, including standardized measures of ATOD use (HSI, AUDIT-C, DAST-10), from 14,866 ED patients in six hospitals across the United States. We expected younger age, male gender, higher triage acuity, and other substance use severity (ATOD) to be associated both with use versus abstinence and with severity of each substance use type. We used negative binomial hurdle models to examine the association between covariates and (1) substance use versus abstinence (logistic submodel) and with (2) severity among those who used substances (count submodel). RESULTS: Rates of use and problem use in our sample were similar to or higher than other ED samples. Younger patients and males were more likely to use ATOD, but the association of age and gender with severity varied across substances. Triage level was a poor predictor of substance use severity. Alcohol, tobacco, and drug use were significantly associated with using other substances and severity of other substance use. CONCLUSION: Better understanding of the demographic correlates of ATOD use and severity and the patterns of comorbidity among classes of substance can inform the design of optimal screening and brief intervention procedures addressing ATOD use among ED patients. Tobacco may be an especially useful predictor.

12-step facilitation for the dually diagnosed: a randomized clinical trial.

There are few clinical trials of 12-step treatments for individuals with serious mental illness and alcohol or drug dependence. This randomized trial assessed the effects of adding a 12-session 12-step facilitation therapy (TSF), adapted from that used in Project MATCH, to treatment as usual in an outpatient dual diagnosis program. Participants were 121 individuals dually diagnosed with alcohol dependence and a serious mental disorder, followed during 12 weeks of treatment and 36 weeks post-treatment. Participants receiving TSF had greater participation in 12-step programs, but did not demonstrate greater improvement in alcohol and drug use. However, considered dimensionally, greater participation in TSF was associated with greater improvement in substance use, and greater 12-step participation predicted decreases in frequency and intensity of drinking. Findings suggest that future work with TSF in this population should focus on maximizing exposure to TSF, and maximizing the effect of TSF on 12-step participation.

Interpersonal Climate of 12-step Groups Predicts Reductions in Alcohol Use.

Research has shown that increases in the size of abstinence-based social networks helps explain the association between 12-step attendance and increased abstinence. This study investigated whether the quality of social interaction in 12-step groups also predicts reduced substance use. Participants reported their perceptions of engagedness, avoidance, and conflict in their 12-step groups and their substance use in four assessments. Results showed that perceptions of group engagedness, but not avoidance or conflict, decreased over time. Despite this, engagedness predicted increased 12-step-related behavior and decreased alcohol use. Findings suggest that positive group interaction plays an important role in 12-step affiliates' recovery efforts.

Is it beneficial to have an alcoholics anonymous sponsor?

Alcoholics Anonymous (AA) attendance is predictive of increased abstinence for many problem drinkers and treatment referral to AA is common. Strong encouragement to acquire an AA sponsor is likewise typical, and findings about the benefits associated with social support for abstinence in AA support this practice, at least indirectly. Despite this widespread practice, however, prospective tests of the unique contribution of having an AA sponsor are lacking. This prospective study investigated the contribution of acquiring an AA sponsor using a methodologically rigorous design that isolated the specific effects of AA sponsorship. Participants were recruited from AA and outpatient treatment. Intake and follow-up assessments included questionnaires, semi-structured interviews, and urine toxicology screens. Eligibility criteria limited prior treatment and AA histories to clarify the relationship of interest while, for generalizability purposes, broad substance abuse criteria were used. Of the 253 participants, 182 (72%) provided complete data on measures central to the aims of this study. Overall reductions in alcohol, marijuana, and cocaine use were found over 12-months and lagged analyses indicated that AA attendance significantly predicted increased abstinence. During early AA affiliation but not later logistic regressions showed that having an AA sponsor predicted increased alcohol-abstinence and abstinence from marijuana and cocaine after first controlling for a host of AA-related, treatment, and motivational measures that are associated with AA exposure or are generally prognostic of outcome.