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Norona JC, Borsari B, Yalch MM, Baxley C, Gnys M, DeMarce JM. The Impact of Cognitive Behavioral Therapy for Substance Use Disorders on Veterans' Interpersonal Difficulties. Subst Use Misuse 2024; 59:510-519. [PMID: 38037842 DOI: 10.1080/10826084.2023.2287192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Background: Substance use disorders (SUDs) negatively impact veterans and their relationships with others. Although there are several evidence-based treatments for SUD symptoms, there is less research on whether reduction in SUD symptoms coincides with reduction in interpersonal difficulties. Methods: In this study we examined the relationship between SUD and relationships in a national sample of 458 veterans who received approximately 12 sessions of Cognitive Behavioral Therapy for Substance Use Disorders (CBT-SUD) through the Veterans Health Administration (VHA). Results: Parallel latent growth curve modeling (LGCM) indicated that self-reported alcohol use, drug use, and interpersonal difficulties decreased over the course of treatment. Alcohol and drug use were positively associated with each other and with interpersonal difficulties at each time point, and baseline alcohol and drug use were negatively associated with the reduction of use over time. However, there was little evidence that reductions in substance use led to a reduction in interpersonal difficulties (or vice-versa). Conclusions: Findings highlight promising strategies to further understand how CBT-SUD may enhance reductions in substance use as well as improve relationships with family and friends.
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Affiliation(s)
- Jerika C Norona
- Mental Health Service (116B), San Francisco Virginia Medical Center, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Brian Borsari
- Mental Health Service (116B), San Francisco Virginia Medical Center, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Matthew M Yalch
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Catherine Baxley
- Mental Health Service (116B), San Francisco Virginia Medical Center, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Maryann Gnys
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, District of Columbia, USA
- VISN 6 Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Mental Health Center, Durham, North Carolina, USA
| | - Josephine M DeMarce
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, District of Columbia, USA
- VISN 6 Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Mental Health Center, Durham, North Carolina, USA
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2
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Song Y, Li D, Zhang S, Wang L, Zhen Y, Su Y, Zhang M, Lu L, Xue X, Luo J, Liang M, Li X. The Effect of Behavior Couples Therapy on Alcohol and Drug Use Disorder: a Systematic Review and Meta-Analysis. Alcohol Alcohol 2023; 58:13-22. [PMID: 36208184 DOI: 10.1093/alcalc/agac053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/02/2022] [Accepted: 09/20/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS Behavior couples therapy (BCT) is widely considered to be effective in the treatment of substance use disorders. However, the effect size of BCT in different outcome measures, and at different time points requires further study to prove it. METHODS Systematic searches were performed in various databases. Ultimately, we identified 12 studies, involving 19 randomized controlled trials. We used Hedges' g as the effect size, and all pooled analyses were performed using random-effects models. RESULTS After treatment, BCT was superior to control conditions (either an active or inactive control group) in frequency of substance use (g = 0.17), substance use consequences (g = -0.28) and relationship satisfaction (g = 0.45). After a 12-month follow-up, BCT remained superior to control conditions in frequency of substance use (g = 0.32), substance use consequences (g = -0.34) and relationship satisfaction (g = 0.31). In addition, BCT was more effective in reducing the frequency of substance use than individual-based treatment (IBT) (g = 0.23). There was no significant relationship between the effect size of BCT and publication year (t = 0.92, P = 0.372), percentage of females (t = -0.02, P = 0.987) or the number of treatment sessions (t = -0.52, P = 0.609). CONCLUSIONS BCT was superior to the control conditions in all three outcome measures after treatment and at follow-up, and showed a relatively large effect size for relationship satisfaction. Moreover, BCT was superior to IBT in reducing the frequency of substance use.
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Affiliation(s)
- Yuqi Song
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, China.,Department of Clinical Medical, First Clinical Medical College, Anhui Medical University, Hefei 230032, China
| | - Dongxu Li
- Department of Clinical Medical, First Clinical Medical College, Anhui Medical University, Hefei 230032, China
| | - Shuyu Zhang
- School of Psychology, The Australian National University, Canberra, ACT 2601, Australian
| | - Liping Wang
- Department of Rehabilitation Medicine, First Clinical Medical College, Anhui Medical University, Hefei 230032, China
| | - Yuanyuan Zhen
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, China
| | - Yiyang Su
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, China
| | - Muzi Zhang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, China
| | - Liuyang Lu
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, China
| | - Xiangrui Xue
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, China
| | - Jingyi Luo
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, China
| | - Meng Liang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, China
| | - Xiaoming Li
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei 230032, China
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3
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Mootz JJ, Basaraba CN, Corbeil T, Johnson K, Kubanga KP, Wainberg ML, Khoshnood K. Armed conflict, HIV, and syndemic risk markers of mental distress, alcohol misuse, and intimate partner violence among couples in Uganda. J Trauma Stress 2021; 34:1016-1026. [PMID: 34647647 PMCID: PMC8530966 DOI: 10.1002/jts.22740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022]
Abstract
Northeastern Uganda has suffered from protracted armed conflict and HIV/AIDS and has some of the highest rates of intimate partner violence (IPV) globally. Little is known about how exposure to conflict and HIV influence individuals' syndemic risk markers or those of their partners. We conducted a population-based study using multistage sampling across three districts in Northeastern Uganda. We randomly surveyed 605 women aged 13-49 years and estimated syndemic problems for currently partnered women (N = 561) who reported for their male partners. Syndemic problems were lower in the low-conflict district than the high-conflict district, p = .009. Conflict exposure was associated with couples' syndemic scores, respondent: β = 0.182, p < .001; partner: β = .181, p < .001. Problem scores were significantly higher among women whose partner was either HIV positive, p = .031, or had an unknown HIV status, p = .016, compared with those whose partner was HIV negative. The total effects of women's, β = .15, p = .034, and men's, β = .137, p = .038, armed conflict exposure on male-to-female IPV were significant. For male partners, there were significant total effects of having an unknown, β = .669, p < .001, or positive, β = 1.143, p < .001, HIV status on experiencing female-to-male IPV. These results suggest that syndemic problems and corresponding treatments should consider couple influences. Addressing mediating problems of mental distress and alcohol misuse may reduce the risk of male-to-female IPV. Providing couple-based HIV psychosocial interventions could reduce men's exposure to IPV.
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Affiliation(s)
- Jennifer J. Mootz
- Department of Psychiatry, Columbia University, New York,
New York, USA
- New York State Psychiatric Institute, New York, New York,
USA
| | | | - Thomas Corbeil
- New York State Psychiatric Institute, New York, New York,
USA
| | - Karen Johnson
- School of Social Work, University of Alabama, Birmingham,
Alabama, USA
| | | | - Milton L. Wainberg
- Department of Psychiatry, Columbia University, New York,
New York, USA
- New York State Psychiatric Institute, New York, New York,
USA
| | - Kaveh Khoshnood
- School of Public Health, Yale University, New Haven,
Connecticut, USA
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4
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Nordmyr J, Forsman AK, österman K. Problematic alcohol use and problem gambling: Associations to structural and functional aspects of social ties in a Finnish population sample. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.1515/nsad-2016-0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Aims This study aims to explore associations between structural and functional aspects of social networks and relationships (here labelled social ties) among individuals exhibiting problematic alcohol use and problem gambling, respectively. Material & Methods Data was collected in the 2011 Western Finland Mental Health Survey, a postal questionnaire survey applying a stratified random sampling approach. The survey response rate was 46.2% (n = 4624, age range 15–80 years). Problem behaviours were assessed using the CAGE and Lie/Bet tools. Logistic regression analyses were performed, with problematic alcohol use and problem gambling as dependent variables. Demographic variables, structural social tie factors (marital status, frequency of social contacts, engagement in association activities) and functional social tie factors (experienced loneliness, social support, neighbourhood trust, general trust) constituted explanatory variables. Results In this representative population sample, only one structural social tie variable, marital status, proved to be significantly associated with one of the outcomes (problematic alcohol use). Identical functional social tie variables were associated with both problematic alcohol use and problem gambling: individuals exhibiting the problem behaviours experienced higher levels of experienced loneliness and low levels of neighbourhood trust. Identified interaction effects with demographic factors highlight the complexity of links. Conclusions Functional aspects of individual-level social ties appear to be more relevant when studying problematic alcohol use or problem gambling, similarly to other forms of mental health problems. The role of social ties as preventive or risk factors for problem behaviour development, as a part of problem behaviour maintenance or as a cessation and a recovery resource should be further explored, considering also interactions with demographic variables.
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Affiliation(s)
- Johanna Nordmyr
- Developmental Psychology Åbo Akademi University Vaasa, Finland
| | - Anna K. Forsman
- Developmental Psychology Åbo Akademi University Vaasa, Finland
| | - Karin österman
- Developmental Psychology Åbo Akademi University Vaasa, Finland
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5
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The Involvement of a Concerned Significant Other in Gambling Disorder Treatment Outcome. J Gambl Stud 2016; 33:937-953. [DOI: 10.1007/s10899-016-9657-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Predicting relapses to binge drinking in non-dependent drinkers may now be possible with smartphones. Smartphones have been shown to help individuals reduce their drinking and may help binge drinkers accelerate that process. Predicting the weather has improved greatly over the past 50 years, but predicting a binge drinking episode may be less difficult. It is hypothesized that the number of factors with high predictive value for any particular individual may not be large. Collecting data over time, a smartphone should be able to learn which combination of factors has a high probability of leading to an episode of binge drinking.
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McCrady BS, Wilson AD, Muñoz RE, Fink BC, Fokas K, Borders A. Alcohol-Focused Behavioral Couple Therapy. FAMILY PROCESS 2016; 55:443-59. [PMID: 27369809 PMCID: PMC5021563 DOI: 10.1111/famp.12231] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Alcohol Behavioral Couple Therapy (ABCT) has emerged over the last 30 years as a highly efficacious treatment for those with alcohol use disorders. This review highlights the historical and conceptual underpinnings of ABCT, as well as the specific treatment elements and structure. Proposed active ingredients, moderators, and mediators of treatment outcome are discussed. Efficacy is evaluated for reductions in identified patient drinking, improved relationship functioning, and reductions in intimate partner violence. Adaptations of ABCT for substances other than alcohol are described. Other adaptations, including brief interventions, interventions addressing PTSD and TBI along with alcohol use, and interventions deliverable via technology platforms are described. Additional cost-benefit and cost-effectiveness findings supporting the economic value of ABCT are noted. Future directions for research in this area include possible adaptations for female identified patients, nontraditional couples, LGBT partners and dyads involving nonintimate partner relationships. The development of more flexible models and enhanced dissemination strategies may improve clinical uptake and utility as well as increasing the feasibility of this treatment for integrated healthcare settings.
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Affiliation(s)
- Barbara S McCrady
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM.
| | - Adam D Wilson
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM
| | - Rosa E Muñoz
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM
| | - Brandi C Fink
- University of New Mexico School of Medicine, Albuquerque, NM
| | - Kathryn Fokas
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM
| | - Adrienne Borders
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM
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8
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Bourke E, Magill M, Apodaca TR. The In-Session and Long-Term Role of a Significant Other in Motivational Enhancement Therapy for Alcohol Use Disorders. J Subst Abuse Treat 2016; 64:35-43. [PMID: 26951920 DOI: 10.1016/j.jsat.2016.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 01/14/2016] [Accepted: 01/18/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine how significant other (SO) language in support of or against client abstinence from alcohol influences clients' in-session speech and drinking behavior over the 9 months post-Motivational Enhancement Therapy (MET). METHOD Sequential analyses were used to examine the language of Project MATCH clients who invited an SO to participate in an MET session. Hierarchical regressions investigated the predictive relationship between SO language and clients' post-treatment drinking behavior. A cohort analytic design compared the change language of these SO-involved participants against a matched group who chose client-only therapy. RESULTS 'SO Support Change' language increased the odds of client Change Talk in the next utterance (p<.01). SO Support Change did not significantly predict reduced post-treatment drinking, whereas 'SO Against Change' significantly predicted an increase in average drinks per drinking day (DDD) across months 7-9 post-MET (p=.04). In the matched comparison, the proportion of change-related client language was comparable across the SO-involved and client-only groups. CONCLUSIONS Motivational interviewing theory was supported by the sequential association between SO and client language as well as the predictive link between SO Against Change and client drinking intensity. Given the centrality of pro-sobriety language in the literature, it was surprising that SO Support Change did not predict alcohol use outcomes. Findings are discussed in relation to contemporary treatment process research and clinical practice.
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Affiliation(s)
- Emilie Bourke
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA.
| | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Timothy R Apodaca
- Children's Mercy Hospital Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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9
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Six Month Outcomes of a Peer-Enhanced Community Reinforcement Approach for Emerging Adults with Substance Misuse: A Preliminary Study. J Subst Abuse Treat 2015; 61:66-73. [PMID: 26482135 DOI: 10.1016/j.jsat.2015.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/25/2015] [Accepted: 09/09/2015] [Indexed: 11/21/2022]
Abstract
Little substance use disorder (SUD) treatment research with emerging adults ages 18-25 has been done in community settings, and it is well-known that peers influence emerging adult substance use. The purpose of this study was to develop and test the feasibility of a peer-enhanced behavioral treatment for emerging adults with substance use problems. Emerging adults (n=35) received a peer-enhanced version of the Community Reinforcement Approach (Peer-CRA), in which their peers (n=34) were trained to provide alcohol-specific social support. Both identified clients and peers were interviewed at treatment intake, and again three and six months later. Six month outcomes included days of abstinence adjusted for controlled environment days, social costs due to substance use, and binge drinking days in the past 90 days. Treatments were delivered with high fidelity, and a high proportion of participants were retained in treatment and follow-up assessments. Growth curve analyses revealed that emerging adults and their peers significantly increased their days of abstinence and reduced their binge drinking over time. Larger randomized trials should a) test whether peer-enhanced treatments are efficacious relative to treatment as usual, b) investigate whether secondary benefits exist for non-treatment seeking peers supporting another's treatment, and c) examine whether proposed mechanisms of change (i.e., peer support and peer reductions in substance use) account for any differences in outcomes.
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