Dispositional Mindfulness, Shame, and Compulsive Sexual Behaviors among Men in Residential Treatment for Substance Use Disorders

The mindful resiliency in recovery model: empowering the transcendence of stigma

Introduction

Mindfulness-based interventions show unique promise in treating substance use disorders among marginalized populations who face heightened stigma. The Mindful Resiliency in Recovery Model is introduced as a novel theoretical framework articulating how mindfulness training can mitigate the adverse effects of stigma, enhance psychological resilience, and facilitate sustained recovery from addiction.

Methods

The current manuscript synthesizes various models of mindfulness processes, stigma, and substance use disorder recovery to propose an integrated theoretical framework on the promise of mindfulness-based interventions in supporting recovery. Further, the current manuscript draws upon empirical literature to establish preliminary support for the premises and hypotheses of the Mindful Resiliency in Recovery Model concerning the mechanisms influencing the efficacy of mindfulness-based interventions among marginalized individuals.

Results

Preliminary evidence supports the premises of the proposed model. There is evidence to suggest that specific processes like increased present-moment awareness, acceptance, decentering, reappraisal, and savoring may be especially salient in mitigating internalized stigma and fostering resiliency in recovery. There is a need for additional research on these processes, and contextual factors that may moderate their efficacy.

Discussion

The Mindful Resiliency in Recovery Model has significant implications for optimizing mindfulness-based interventions to empower marginalized individuals to transcend stigma and actualize their capacity for wellbeing in substance use disorder recovery. It provides a roadmap for future research on the mechanisms and contextual factors affecting the efficacy of mindfulness-based interventions for marginalized and stigmatized communities. It further offers guidance to clinicians utilizing mindfulness-based interventions to support individuals experiencing stigma.

Internalized Shame Among Justice-Involved Women in Substance Use Disorder Treatment: Measurement Invariance and Changes During Treatment

Shame is one of the leading barriers to successful recovery in substance use treatment settings. This secondary analysis study examined measurement invariance of the Internalized Shame Scale (ISS) and explored changes in shame during treatment. Participants (N=105) in the parent study were recruited from a nonprofit residential treatment center for justice-involved women and were randomized to receive mindfulness-based relapse prevention or relapse prevention treatment. A series of confirmatory factor analyses were used to assess measurement invariance in a one-factor measurement model of the ISS. Latent growth curve modeling was used to examine change in shame over time. Our findings support the assumption of measurement invariance across multiple time points and across treatment conditions, supporting comparisons of stigma scores across groups and over time. Although we observed significant reductions in shame from pre- to post-treatment, there were no differences across treatment conditions. Additional research is needed to determine how distinct treatment components relate to reductions in shame among individuals receiving treatment for a substance use disorder.

Compulsive sexual behavior disorder in an inpatient sample with substance use disorder

Background

Several studies indicate that compulsive sexual behavior disorder (CSBD) shares core elements with substance use disorder (SUD). These findings support the assumption of common mechanisms in addiction, which may lead to a higher tendency in patients with SUD to have comorbid CSBD. Nevertheless, this relationship between CSBD and SUD is poorly understood to date.

Aim

This study aimed to compare the prevalence of CSBD and its subtype pornography use disorder (PUD) between a SUD group and a matched control group. Herein, we aimed to test whether patients with SUD are more likely to have a comorbid CSBD/PUD. We further hypothesized that a higher CSBD/PUD prevalence in patients with SUD is accompanied by more pronounced CSBD- and PUD-related personal characteristics.

Methods

We assessed CSBD, PUD, and related personal characteristics in an inpatient SUD sample (N = 92) and a healthy control sample matched by age, gender, and educational level.

Outcomes

Primary outcomes were the diagnoses of CSBD/PUD as assessed by questionnaires. CSBD/PUD-related personal characteristics were the early onset of problematic pornography consumption, relationship status as a single person, a high sexual motivation, a high level of time spent watching pornography, and a high degree of problematic pornography consumption (Problematic Pornography Consumption Scale, short version).

Results

There was no significant difference between groups regarding CSBD prevalence (SUD sample, 3.3%; control sample, 7.6%) and PUD prevalence (SUD sample, 2.2%; control sample, 6.5%). We found relationship status as a single person and the sexual motivation dimension of importance of sex to be the only CSBD-related personal characteristics that were more pronounced in the SUD sample than the matched control group.

Clinical Implications

Results indicate no higher tendency for patients with SUD to develop comorbid CSBD/PUD, yet important vulnerabilities (eg, emotional dysregulation) should be considered when treating addictive disorder to prevent possible symptom displacement.

Strengths and Limitations

A strength of the study is that we compared a sample of patients with SUD with a matched control sample and used an instrument based on ICD-11 criteria for CSBD. Possible limitations are significant differences between the groups because of the restrictions in an inpatient clinic that may have influenced responses (eg, roommates) and that the control group was not screened for SUD. Therefore, the results should be interpreted with some caution.

Conclusion

We found no evidence of an overcomorbidity of SUD and CSBD/PUD. However, a higher rate of vulnerability factors for CSBD/PUD in the SUD sample might suggest some similarities between SUD and CSBD/PUD.

A Mediation Moderation Model between Self-Evaluative Emotions and Relapse Rate among Polysubstance Users: A Comparative Cross-Sectional Study

A substantial portion of drug abuse research has concentrated on people with a single-substance-use disorder (SSUD), but many people abuse more than one drug. Studies have yet to examine how those with polysubstance-use disorder (PSUD) differ from those with an SSUD on the risk of relapse, self-evaluative emotions (e.g., shame and guilt), and personality factors (e.g., self-efficacy). Eleven rehab facilities in Lahore city, Pakistan were randomly chosen to provide a sample of 402 males with PSUD. For comparison, 410 age-matched males with SSUD were enlisted using a demographic form with eight questions, the State Shame and Guilt Scale, and the General Self-Efficacy Scale. Mediated moderation analysis was performed using Hayes' process macro. The results demonstrate that shame-proneness is positively associated with relapse rate. Guilt-proneness mediates the relationship between shame-proneness and relapse rate. Self-efficacy buffers the influence of shame-proneness on relapse rate. Although the mediation and moderation effects were found in both study groups, these effects were significantly stronger among people with PSUD than those with SSUD. To be more specific, people with PSUD reported a higher overall score on shame, guilt, and relapse rate. Additionally, people with SSUD indicated a higher score on self-efficacy than those with PSUD. The findings of this study suggest that drug rehab facilities should implement a variety of strategies to raise drug users' levels of self-efficacy, which will help to reduce their risk of relapse.

Practical Considerations for Treating Comorbid Posttraumatic Stress Disorder in the Addictions Clinic: Approaches to Clinical Care, Leadership, and Alleviating Shame

A practical, common-sense framework for recognizing and addressing comorbid posttraumatic stress disorder (PTSD) in the substance use disorder (SUD) clinic is outlined. The article focuses on strategies that can help establish trauma-informed care or augment an existing approach. Interventions are organized around the task of ameliorating shame (or shame sensitivity), which represents a transdiagnostic mediator of psychopathology and, potentially, capacity for change. Countershaming strategies can guide a trauma-responsive leadership approach. Considering the striking rate of underdiagnosis of PTSD among patients with SUD, implementing routine systematic PTSD screening likely represents the single most consequential trauma-informed intervention that SUD clinics can adopt.

Prevalence of Suicidal Behavior and Associated Clinical Correlates in Patients with Behavioral Addictions

Addictive disorders are characterized by severe consequences, including suicidal events, but most studies investigating the association between addiction and suicidal risk have focused on substance use disorders and gambling disorder at the expense of the rest of behavioral addictions. This study examined the prevalence and the associated clinical correlates of suicidal ideation and suicide attempts in a sample of patients with a diagnosis of behavioral addiction. The total sample consisted of 4404 individuals: 4103 of these patients with gambling disorder, 99 with gaming disorder, 44 with sex addiction, and 158 with buying–shopping disorder. All of them were assessed consecutively at a specialized hospital unit for the treatment of behavioral addictions. Participants attended two clinical interviews and completed self-reported questionnaires to explore clinical features of behavioral addictions, personality traits, psychopathological symptomatology, suicidal behavior, and sociodemographic variables. The highest prevalence of suicidal ideation was found in patients with gambling disorder (22.9%), followed by buying–shopping disorder (18.4%), sex addiction (18.2%), and gaming disorder (6.1%). The highest prevalence of suicide attempts was registered for sex addiction (9.1%), followed by buying–shopping disorder (7.6%), gambling disorder (6.7%), and gaming disorder (3.0%). Female gender and unemployment constituted two relevant sociodemographic factors associated with suicidal risk in gambling disorder, gaming disorder, and buying–shopping disorder. Lack of family support appeared as a relevant risk factor, except for gaming disorder. These results pointed out that suicide is a prevalent behavior in behavioral addictions, and clinicians and researchers need to pay particular attention to the specificities of each behavioral addiction when assessing suicidal risk.

Is Compulsive Sexual Behavior Different in Women Compared to Men?

The inclusion of Compulsive Sexual Behavior Disorder (CSBD) in the ICD-11 has sparked research interest on this topic in recent years. This review aims to investigate gender differences in Compulsive Sexual Behavior (CBD) and persons with CSBD. While impulsivity and psychiatric comorbidity play a role in persons with CSBD regardless of gender, some gender differences can be identified. CSBD is more prevalent in men, with a higher rate of reported sexual behaviors and higher scores on questionnaires measuring CSBD related symptoms. Neuroticism and stress vulnerability seem to play a more important role in the symptomatology of CSBD in women. While it seems plausible that childhood adversities play a role in the development of CSB, the manner with respect to how these adversities affect men and women differently is still to be explored. More clinical studies including the female CSBD population are required to infer clinical implications.

Online Narratives of Methamphetamine Use and Risky Sexual Behavior: Can Shame-Free Guilt Aid in Recovery?

Methamphetamine (meth) use is a recurring public health challenge in the U.S. In 2016, approximately 1.6 million Americans reported using meth. Meth use is associated with a number of adverse outcomes, including those associated with users' sexual health. In particular, meth use is linked to an increased risk for sexually transmitted infections and unplanned pregnancies. While studies have examined associations between substance use of various types-including meth use, and shame and guilt-few studies have examined relationships among substance use, sexual risk behaviors, and shame and guilt. No qualitative studies, to our knowledge, have studied all three of these phenomena in a sample of meth users. The present qualitative study explored the sexual risk behaviors and associated feelings of shame and guilt in relation to meth use. It draws from anonymous letters and stories (N = 202) posted to an online discussion forum by meth users and their family members. A grounded theory analysis of these narratives identified four primary themes pertaining to meth use and sexual behaviors: (1) feeling heightened sexual arousal and stimulation on meth, (2) experiencing sexual dissatisfaction on meth, (3) responding to sexual arousal and dissatisfaction, and (4) feeling ashamed and/or guilty. Ultimately, the present findings indicate that feelings of shame and guilt may arise more from the consequences of sexual risk behaviors stemming from meth use rather than meth use itself. The emotional toll of meth-induced sexual risk behaviors, particularly shame and guilt over the loss of meaningful relationships and self-respect due to multiple sexual partners, may provide an important opportunity for interventionists.

Mindful self-regulation of attention is a key protective factor for emotional dysregulation and addictive behaviors among individuals with alcohol use disorder

Individuals with alcohol use disorder (AUD) and other substance use disorders (SUDs) frequently show co-occurrent behavioral addictions (BAs) (i.e., gambling and compulsive sex) and other inflexible behaviors (IBs) (i.e., compulsive buying and dysfunctional eating behaviors). The covariation of these conditions might be explained by a role of emotion dysregulation (ED) and executive dysfunctions. This study aims at investigating whether ED and self-regulation of attention (SRA) could be common processes that underpin BAs and other IBs among individuals with AUD. The study hypothesized that SRA should represent a key protective factor for the relationships between ED and BAs/IBs. The research included 319 treatment-seeking individuals with a primary diagnosis of AUD. Five independent multiple parallel mediational models were tested. Self-report instruments were administered in order to assess ED, BAs and other IBs, which represented independent and dependent variables respectively. SRA was self-report assessed and, it was considered the key mediator variable. The analyses highlighted significant total effects of ED on the severity of BAs and IBs. SRA fully mediated the relationships between ED and BAs/IBs, with exception of gambling. ED and SRA should be considered common dimensions that explain the covariation of BAs and IBs among individuals with AUD. SRA represents an adaptive form of emotion regulation that sustains the engagement in goal-oriented behaviors. Future neuroimaging and longitudinal studies are recommended in order to demonstrate the role of ED and SRA on development, maintenance and treatment of BAs and IBs among individuals with SUDs.

Associations of mindfulness with adolescent outcomes and sexuality

INTRODUCTION

Using an online survey, we evaluated how adolescent trait and state mindfulness was associated with positive adolescent outcomes in non-sexually active and sexually active adolescents. Additionally, we evaluated a newly developed measure, the Sexual Mindfulness Measure (SMM), with adolescents.

METHODS

We asked 2000 U.S. adolescents (half boys/girls; 1/3 low, medium, and high incomes) aged 13-18 (one group 13-15, another 16-18) about trait mindfulness, sexual state mindfulness, and adolescent outcomes. Using Confirmatory Factor Analysis and structured equation modeling, we evaluated the reliability and validity of the SMM and its associations with adolescent outcomes.

RESULTS

Using a trait mindfulness measure, we found that mindful adolescents with no sexual experience, showed positive associations with self-efficacy, body-esteem, and disclosure with both fathers and mothers. Evaluating adolescents who were sexually active, we confirmed that the SMM had a two-factor structure and demonstrated acceptable reliability for both male and female adolescents. We found that the SMM was associated with positive sexual attitudes, body image, self-efficacy, and disclosure to parents above and beyond trait mindfulness.

CONCLUSIONS

Trait mindfulness was associated with positive self-assessments and parental disclosure. The SMM provided an important assessment of how sexually active adolescents' ability to remain aware and non-judgmental during sexual experiences may be positively associated with outcomes such as sexual consent, positive body image, self-efficacy, disclosure to parents, and negatively associated with sexual shame and sexual anxiety above and beyond trait mindfulness.

Dialectical behaviour therapy skills training for the treatment of addictive behaviours among individuals with alcohol use disorder: the effect of emotion regulation and experiential avoidance

BACKGROUNDS

Dialectical behavior therapy skills training (DBT-ST) is an effective treatment for alcohol use disorder (AUD). AUD frequently co-occurs with other addictive behaviors.

OBJECTIVE

s: These secondary analyses of prior studies on the effectiveness of a 3-month DBT-ST program for AUD investigated pre- post-treatment changes in the severity of concurrent addictive behaviors. The study hypothesized that emotion regulation and experiential avoidance should be the key therapeutic mechanisms involved in the treatment of addictive behaviors.

METHODS

The research included 186 individuals (110 males; 76 females) with a primary diagnosis of AUD. Mediational models were performed considering shorter PROMIS questionnaire subscales (i.e., gambling, sex, shopping, food binging, and starvation) as dependent variables. The difficulties in emotion regulation scale and acceptance and action questionnaire-II total scores were independent and mediator variables, respectively.

RESULTS

Clinical variables significantly improved during the treatment, independent of baseline levels. Changes in emotion regulation showed significant total effects on improvements in addictive behaviors. Significant indirect effects of changes in experiential avoidance were detected considering compulsive buying and dysfunctional eating behaviors.

CONCLUSION

The DBT-ST was a feasible treatment for several addictive behaviors frequently reported by individuals with AUD. The improvements in emotion regulation and experiential avoidance were relevant therapeutic mechanisms involved in the treatment of these conditions. Future controlled trials and follow-up studies are recommended to support the efficacy of DBT-ST as a stand-alone intervention for the treatment of different classes of addictive behaviors.

Exploring Gender Differences in the Relationship between Dispositional Mindfulness and Compulsive Sexual Behavior among Adults in Residential Substance Use Treatment

Objectives

Compulsive sexual behavior (CSB) is overrepresented among adults with substance use disorders (SUD), yet there is no empirically supported CSB treatment for this population. Cross-sectional and single case designs supported dispositional mindfulness as a potential CSB intervention target. However, the relations between CSB and each of the five dispositional mindfulness facets remain unknown.

Methods

Extending prior research to inform intervention efforts, we reviewed medical records for 1993 adults (77.6% male) in residential treatment for SUD to examine gender differences in the relations between dispositional mindfulness facets (acting with awareness, observation of experience, describing with words, non-judging of inner experience, and non-reactivity to inner experience) and five CSB indicators (loss of control, relationship disturbance, preoccupation, affect disturbance, and internet problems).

Results

For men, path analyses revealed that acting with awareness, nonjudging of inner experience, describing with words, non-reactivity to inner experience, alcohol/drug use and problems, and depression and anxiety symptoms related to CSB (p range: .00-.04). For women, acting with awareness, non-judging of inner experience, alcohol/drug use and problems, and depression symptoms related to several CSB indicators (p range: .00-.04).

Conclusions

Mindfulness-based CSB interventions should evaluate the benefit of increasing intentional responses towards present-moment experiences among adults with SUD. Targeting alcohol/drug misuse, negative affect, and judgement towards thoughts and emotions may be beneficial.

Experiential Avoidance as a Mediator of the Relationship between Dispositional Mindfulness and Compulsive Sexual Behaviors among Men in Residential Substance Use Treatment

The present study sought to extend compulsive sexual behavior (CSB) and mindfulness research by testing whether dispositional mindfulness negatively related to CSB among men with substance use disorders (SUD) through experiential avoidance. Dispositional mindfulness is believed to decrease experiential avoidance, a correlate of CSB. We therefore hypothesized that dispositional mindfulness would relate to CSB indirectly through experiential avoidance. We reviewed medical records from 175 men in residential treatment for SUD. Results revealed significant indirect effects of dispositional mindfulness on CSB through experiential avoidance. Results provided preliminary support for developing mindfulness-based CSB interventions that target experiential avoidance.