Marital interactions of male versus female alcoholics

The impact of alcohol on affiliative verbal behavior: A systematic review and meta-analysis

BACKGROUND

Language is a fundamental aspect of human social behavior that is linked to many rewarding social experiences, such as social bonding. Potential effects of alcohol on affiliative language may therefore be an essential feature of alcohol reward and may elucidate pathways through which alcohol is linked to social facilitation. Examinations of alcohol's impact on language content, however, are sparse. Accordingly, this investigation represents the first systematic review and meta-analysis of alcohol's effects on affiliative language. We test the hypothesis that alcohol increases affiliative verbal approach behaviors and discuss future research directions.

METHODS

PsycInfo and Web of Science were systematically searched in March 2023 according to our preregistered plan. Eligible studies included social alcohol administration experiments in which affiliative verbal language was assessed. We present a random-effects meta-analysis that examines the effect of alcohol compared to control on measures of affiliative verbal behavior.

RESULTS

Our search identified 16 distinct investigations (comprising 961 participants) that examined the effect of alcohol on affiliative verbal behavior. Studies varied greatly in methods and measures. Meta-analytic results demonstrated that alcohol is modestly associated with increases in affiliative verbal behavior (Hedges' g = 0.164, 95% CI [0.027, 0.301], p = 0.019). Study quality was rated using an adapted version of the Quality Assessment Tool for Quantitative Studies and did not significantly moderate alcohol's effects.

CONCLUSIONS

This study provides preliminary evidence that alcohol can increase affiliative verbal behaviors. This effect may be an important feature of alcohol reward. Given heterogeneity in study features, low study quality ratings, and limited reporting of effect size data, results simultaneously highlight the promise of this research area and the need for more work. Advances in language processing methodologies that could allow future work to systematically expand upon this finding are discussed.

Pathology in Relationships

Committed, long-term romantic relationships are ubiquitous among modern society. They are one of the most important contexts for the development, maintenance, and treatment of psychopathology. In this review, I first place psychopathology within the most commonly cited theoretical model of marital satisfaction and stability and then discuss how relationship satisfaction is conceptualized and assessed in this literature. In the second half of the review, I describe the theories regarding how romantic relationships may be connected to psychopathology. Relationship distress is easily incorporated into a diathesis-stress model as an important trigger for psychopathology. Next, I review cross-sectional research, longitudinal research, and treatment efficacy research linking relationship quality and psychopathology. I provide evidence for the robustness of these effects and areas where research must expand. I finish with a summary section that synthesizes what is known about the mechanisms linking relationship distress and psychopathology.

The Three-Item Thinking about Your Partner's Drinking Scale (TPD-3): Item Response Theory, Reliability, and Validity

Interdependence is a defining feature of close relationships, and alcohol use is one domain where one person's motivations and behaviors can affect a partner's well-being. Concern about partner drinking is a gauge that determines whether a partner's alcohol use has the potential to be problematic to the relationship, and brief and efficient measurement of this construct can be used to serve clinicians, scientists, and practitioners. Across four studies (N = 1,807), we use item response theory analysis to present a 3-item brief screening tool assessing concern about partner drinking: Thinking about your Partner's Drinking-3 (TPD-3). The TPD-3 revealed strong test-retest reliability and expected patterns of convergent, concurrent, and incremental validity with perceived partner drinking and alcohol-related consequences, behavioral responses to partner drinking, and relationship well-being. We present the TPD-3 as a useful screening tool and for measurement of concern about partner drinking when efficient assessment is desired.

Alcohol, conflict, and aggression in intimate relationships: A dyadic approach

Intimate partner aggression (IPA) is a critical public health problem that requires clear and testable etiological models that may translate into effective interventions. While alcohol intoxication and a pattern of heavy alcohol consumption are robust correlates of IPA perpetration, there has been limited research that examines this association from a dyadic perspective. In the present review, we discuss compelling reasons for understanding dyadic factors that assist our understanding of alcohol-facilitated IPA, review the relatively small number of studies that have investigated such factors, and provide a theoretical and methodological framework for researchers to conceptualize how to model alcohol-facilitated IPA from a dyadic framework.

Partner Conflict and Support as Moderators of Alcohol Use on Alcohol Problems and Marital Satisfaction in Young Adult Marital Dyads

BACKGROUND

This cross-sectional study used data from 483 young adult marital dyads to evaluate conflict-with-partner and support-from-partner as moderators of alcohol use on 2 outcomes: alcohol problems and marital satisfaction. A path analytic modeling approach was used to test stress-exacerbating and stress-buffering hypotheses, and to accommodate the interdependent nature of the dyadic data.

METHODS

This cross-sectional sample was selected from an adolescent-to-young adult longitudinal study in which spouses were recruited into the study during a later young adult assessment when the sample was, on average, 32.5 years old. Individual interviews using computerized technology were conducted with participants.

RESULTS

Findings for the outcome of alcohol problems indicated stress exacerbation in that higher conflict by each partner in interaction with higher alcohol use was associated with more alcohol problems for wives. Husbands' and wives' alcohol problems were lower when higher partner support buffered the association between alcohol use and alcohol problems. For the outcome of marital satisfaction, higher support-from-partner buffered the association between alcohol use and marital satisfaction. Finally, the combination of alcohol use and conflict-with-partner had more adverse implications for women's alcohol problems relative to men's alcohol problems.

CONCLUSIONS

These findings highlight that interactions between interpersonal dimensions of romantic relationships and alcohol use by both partners contribute to our understanding of their associations with alcohol problems and marital satisfaction within the marital relationship. Furthermore, there was some sex specificity in that some interactions were more prominently associated with alcohol problems for wives than husbands.

A meta-analysis of longitudinal associations between substance use and interpersonal attachment security

Substance use has long been associated with close relationship distress. Although the direction of influence for this association has not been established, it has often been assumed that substance use is the causal agent and that close relationship distress is the effect. But research seeking to establish temporal precedence in this link has produced mixed findings. Further, theoretical models of substance use and close relationship processes present the plausibility of the inverse pathway-that insecure close relationships may serve as a vulnerability factor for the development of later substance problems. The current review applies an attachment-theoretical framework to the association between close social bonds and substance use and substance-related problems. Targeting longitudinal studies of attachment and substance use, we examined 665 effect sizes drawn from 34 samples (total N = 56,721) spanning time frames ranging from 1 month to 20 years (M = 3.8 years). Results revealed a significant prospective correlation between earlier attachment and later substance use (r = -.11, 95% CI [-.14, -0.08]). Further, cross-lagged coefficients were calculated which parsed auto-regressive effects, indicating that lower attachment security temporally preceded increases in substance use (r = -.05, 95% CI [-.06, -.04]). Analyses further indicated that the pathway from earlier attachment to later substance use was significantly stronger than that from earlier substance use to later attachment. Results also revealed several moderators of the attachment-substance use link. These findings suggest that insecure attachment may be a vulnerability factor for substance use, and indicate close relationship quality as a promising line of inquiry in research on substance use disorder risk. (PsycINFO Database Record

Alcohol's Effects on Pair-Bond Maintenance in Male Prairie Voles

Alcohol abuse can have devastating effects on social relationships. In particular, discrepant patterns of heavy alcohol consumption are associated with increased rates of separation and divorce. Previous studies have attempted to model these effects of alcohol using socially monogamous prairie voles. These studies showed that alcohol consumption can inhibit the formation of pair bonds in this species. While these findings indicated that alcohol's effects on social attachments can involve biological mechanisms, the formation of pair bonds does not properly model long-term human attachments. To overcome this caveat, this study explored whether discordant or concordant alcohol consumption between individuals within established pairs affects maintenance of pair bonds in male prairie voles. Male and female prairie voles were allowed to form a pair bond for 1 week. Following this 1-week cohabitation period, males received access to 10% continuous ethanol; meanwhile, their female partners had access to either alcohol and water or just water. When there was a discrepancy in alcohol consumption, male prairie voles showed a decrease in partner preference (PP). Conversely, when concordant drinking occurred, males showed no inhibition in PP. Further analysis revealed a decrease in oxytocin immunoreactivity in the paraventricular nucleus of alcohol-exposed males that was independent of the drinking status of their female partners. On the other hand, only discordant alcohol consumption resulted in an increase of FosB immunoreactivity in the periaqueductal gray of male voles, a finding suggesting a potential involvement of this brain region in the effects of alcohol on maintenance of pair bonds. Our studies provide the first evidence that alcohol has effects on established pair bonds and that partner drinking status plays a large role in these effects.

The Proximal Effects of Acute Alcohol Consumption on Male-to-Female Aggression: A Meta-Analytic Review of the Experimental Literature

The current meta-analytic review examined the experimental literature to quantify the causal effect of acute alcohol consumption on self-reported and observed indicators of male-to-female general, sexual, and intimate partner aggression. Database and reference list searches yielded 22 studies conducted between 1981 and 2014 that met all criteria for inclusion and that were subjected to full text coding for analysis. Results detected a significant overall effect (d = .36), indicating that male participants who consumed alcohol evidenced greater aggressive behavior toward females while completing a subsequent laboratory aggression paradigm than male participants who received no alcohol. We found homogeneity across all categories of potential moderator variables. Results further indicated that alcohol resulted in comparable increases of male-to-female sexual (d = .32) and intimate partner (d = .45) aggression. Further research is required to draw meaningful conclusions about individual and situational factors that may interact with acute alcohol consumption to produce the highest levels of risk.

Gender and HIV infection in the context of alcoholism in Kenya

Women in sub-Saharan Africa account for more than half (58%) of people living with the HIV and it is the only continent where HIV prevalence is higher for women than for men. Studies have attributed alcoholism with the high rates of HIV infection due to its impact on sexual behaviour and arousal. African countries with high rates of alcoholism also reportedly have higher rates of HIV infection. This study explores rural communities' perspectives on the risk factors for HIV infection among women who are in alcohol discordant relationships where the man drinks alcohol excessively. Data were gathered through focus group discussions in rural central Kenya where alcoholism has reached epidemic levels. Key findings indicate the perceived severity of alcoholism, the perceived impact of alcoholism on men's reproductive health and the unmet sexual and reproductive needs of women in alcohol discordant relationships. Women engage in risky sexual behaviours in an attempt to meet these needs. Such risky behaviour in addition to alcohol-related sexual violence and low response-efficacy for safer sexual practices make them vulnerable to HIV infection and enhances the spread of HIV within communities. The study concludes that in preventing HIV infection among women in alcohol communities affected by alcohol, it is important to focus on their response efficacy. Intervention programmes that focus on HIV prevention among older married women and that integrate alcohol and HIV prevention are long overdue.

An interdependent look at perceptions of spousal drinking problems and marital outcomes

Research supports a bidirectional association between heavy alcohol use and marital quality among couples. The current research extends previous research on the role of interpersonal perception by examining how partner drinking and perceiving one's partner's drinking as problematic are associated with subsequent marital outcomes. Specifically, we evaluated how perceiving one's partner to have a drinking problem was associated with marital functioning, and whether that association differed based on the partner's actual drinking. Married couples (N = 123 dyads) with at least one spouse who consumed alcohol regularly completed measures of alcohol use and consequences, the perception that their spouse's drinking was problematic, and marital adjustment (i.e., relationship satisfaction, commitment, and trust). Results from actor-partner interdependence models using structural equations modeling indicated that for husbands, partner heavy drinking was associated with lower adjustment. Additionally, for husbands, perceiving their spouse had a drinking problem was associated with lower adjustment for both themselves and their wives. Moreover, significant interactions between partner drinking and the perception of partner drinking problem on marital adjustment emerged. Specifically, perceiving one's partner's drinking as a problem was only negatively associated with relationship adjustment if the partner reported higher levels of heavy drinking. This pattern was stronger for husbands. Results illustrate the importance of interpersonal perception, gender differences, and the use of dyadic data to model the complex dynamic between spouses with regard to alcohol use and how it affects relationship outcomes.

Mechanisms of Alcohol-Facilitated Intimate Partner Violence

Intimate partner violence (IPV) is a critical public health problem that requires clear and testable etiological models that may translate into effective interventions. While alcohol intoxication and a pattern of heavy alcohol consumption are robust correlates of IPV perpetration, there has been limited research that examines the mediating mechanisms of how alcohol potentiates IPV. We provide a theoretical and methodological framework for researchers to conceptualize how alcohol intoxication causes IPV, and propose innovative laboratory methods that directly test mediational mechanisms. We conclude by discussing how these innovations may lead to the development of interventions to prevent or reduce alcohol-related IPV.

Using multiple methods to examine gender differences in alcohol involvement and marital interactions in alcoholic probands

BACKGROUND

This study examined gender differences in alcohol involvement and marital interactions among probands with a past 1-year alcohol use disorder (AUD).

METHODS

Adults with alcohol dependence (37 males and 17 females) and their spouses were recruited from a local substance abuse treatment center and from the local community. Couples completed a series of self-report measures and a 15-min videotaped marital interaction task that was coded for negative and positive behaviors and sequential interactions. Couples also separately called in to an interactive voice response (IVR) system every night for 14 consecutive nights and reported on their spouse's negative and positive marital behaviors.

RESULTS

Compared to male probands, female probands reported a) more negative marital interactions in the previous month; b) higher levels of negative reciprocity and a lower positive-to-negative ratio in the marital interaction task; and c) more daily and nightly marital conflict over the 14-day diary period. Negative marital behaviors in the evening by female spouses were associated with higher odds of intoxication among male probands on the following day. In contrast, a) negative marital behaviors by male spouses were cross-sectionally associated with higher odds of intoxication among female probands within the same day; and b) positive marital behaviors by male spouses during the day were associated with lower odds of intoxication among female probands that night.

CONCLUSIONS

Marital conflict, assessed via multiple methods over multiple time scales, appears to be more frequent among female compared to male alcoholics. Marital conflict predicts daily intoxication among male and female probands.

Men and women who attend Al-Anon: gender differences in reasons for attendance, health status and personal functioning, and drinker characteristics

Although Al-Anon Family Groups (Al-Anon) is the most common source of help for people concerned about someone else's drinking, only 16% of members are men. To identify gender differences, we compared demographics, reasons for attendance, health status, and personal functioning, and drinker characteristics of 174 men and women attending Al-Anon. Men and women were similar in most areas; however, some key differences emerged. Men reported better overall mental health than women, and described some differing concerns and drinker characteristics. With this information, healthcare providers may facilitate men's participation in Al-Anon by addressing their unique concerns and possible barriers to attendance.

DSM-IV alcohol dependence and marital dissolution: evidence from the National Epidemiologic Survey on Alcohol and Related Conditions

OBJECTIVE

The purpose of this study was to examine the cross-sectional and longitudinal associations among alcohol use disorder (AUD), stressful life events, and marital dissolution in a probability sample of adults.

METHOD

The National Epidemiologic Survey on Alcohol and Related Conditions is a prospective, longitudinal study of a probability sample of 43,083 adults 18 years of age and older living in the United States. The interval between Wave 1 (W1) and Wave 2 (W2) was approximately 3 years. Cross-sectional analyses included 32,359 adults ages 18 and older who were ever married at W1, and longitudinal analyses included 17,192 adults who were currently married at W1 and who completed relevant W2 measures. Participants completed inhome surveys conducted with computer-assisted personal interviewing.

RESULTS

Rates of lifetime marital dissolution were significantly higher among those with lifetime AUD (48.3%) than in those with no lifetime AUD (30.1%). The incidence of marital dissolution from W1 to W2 was 15.5% for those with a past-12-month AUD at W1, compared to 4.8% among those with no AUD. Proportional hazards regression analyses showed that past-12-month AUD, tobacco use disorder, other substance use disorder, stressful life events, older age at marriage, being married more than once, and being married to an alcoholic at W1 predicted greater hazards of marital dissolution at W2. These associations were not moderated by gender.

CONCLUSIONS

AUD and stressful life events predict subsequent marital dissolution independently of other substance use disorders, mood and anxiety disorders, and personality disorders. Results were discussed within the framework of the Vulnerability-Stress-Adaptation model of marriage.

Effects of administered alcohol on intimate partner interactions in a conflict resolution paradigm

OBJECTIVE

Although couples' alcohol use has been associated with intimate partner aggression and poorer marital functioning, few studies have examined the proximal effects of alcohol on couple interactions. The current experimental study examined the effects of alcohol, administered independently to male and female intimate partners, on positive and negative interaction behaviors within a naturalistic conflict resolution paradigm.

METHOD

Married and cohabiting couples (n = 152) were recruited from the community and each partner randomly assigned to receive either alcohol (target dose: .08 mg/kg) or no alcohol. They engaged in two 15-minute interactions regarding current disagreements in their relationship, one before and one after beverage administration. Videotaped interactions were coded by trained observers using the Rapid Marital Interaction Coding System, and positive and negative interaction behaviors were analyzed using the Actor-Partner Interdependence Model.

RESULTS

Participants displayed decreased negativity and increased positivity following alcohol consumption when their partners were sober but no differences in negativity or positivity when their partners also consumed alcohol. There were no gender differences. Although participants with a history of perpetrating intimate partner aggression displayed more negativity, prior aggression did not interact with beverage condition.

CONCLUSIONS

The immediate effects of alcohol consumption on couple interaction behaviors appeared more positive than negative. Contrary to hypotheses, congruent partner drinking had neither particularly positive nor particularly negative effects. These unique findings represent a rare glimpse into the immediate consequences of alcohol consumption on couple interaction and stand in contrast to its delayed or long-term effects.

Perceptions of partners' problematic alcohol use affect relationship outcomes beyond partner self-reported drinking: alcohol use in committed romantic relationships

Alcohol use is prevalent among college students, including those who are in committed romantic relationships. Individuals' perceptions of their partner's alcohol use may have significant effects on how they view both their partner and their relationship. The current study examines the effect of one's perception of one's romantic partner's drinking as problematic on one's relationship satisfaction and commitment, and whether this varies as a function of one's partner's drinking. Both partners in romantic heterosexual relationships (N = 78 dyads) completed an online survey assessing alcohol use and problems, relationship satisfaction and commitment, and the perception that their partner's drinking was problematic. Analyses using Actor-Partner Interdependence Models (APIMs) revealed a partner-moderated actor interaction, such that partner self-reported drinking significantly moderated the association between the actor's perception of their partner's drinking as problematic and actor relationship outcomes. Results indicated that when partners drank at higher levels, perceiving their drinking as problematic did not have an effect. These individuals were less satisfied regardless of their perceptions. However, when partners drank at lower levels, perceiving their drinking as problematic was negatively associated with relationship outcomes. Furthermore, for alcohol consumption, three-way interactions with gender emerged, indicating that this effect was stronger for males. Results extend the literature on drinking in relationships and on interpersonal perception. Implications and future directions are discussed.

Psychometric assessment of a self-administered version of the Significant Other Survey

While there are a number of general measures that assess interpersonal and psychological distress experienced by individuals who are in a close relationship with a substance abusing adult, until recently the field has lacked a psychometrically sound, self-administered multidimensional measure explicitly designed to measure the problems of non-substance-abusing adults who are concerned about a substance using loved one. This study examined the psychometric properties of a 54-item, self-administered (SA) version of the Significant Other Survey (SOS), a measure designed to address this gap. The SOS-SA assesses problems across seven problem domains (emotional, relationship, family, financial, physical violence, legal, health). Coefficient alpha estimates (N = 168) were good to excellent for five of the domains, the test-retest reliability (N = 83) across a 7-day time frame was fair to excellent for all seven domains. Similar reliability coefficients were identified regardless of whether the item queried about the problem frequency or perceived severity. There was preliminary support for the construct and discriminant validity of the SOS-SA. The SOS-SA appears to be a promising instrument given that it is brief, requires no specialized training to administer, and has good psychometric properties.

Relationship-specific alcohol expectancies in couples with concordant and discrepant drinking patterns

OBJECTIVE

Despite growing evidence that the marital problems typically attributed to heavy drinking are stronger for couples in which only one partner is a heavy drinker than in couples in which both partners are heavy drinkers, relatively little research has examined factors that may serve to maintain particular drinking configurations. The current research examines the association between the configuration of partners' drinking and relationship-specific alcohol expectancies.

METHOD

Data are from an ongoing prospective study examining the effect of alcohol on executive cognitive functioning. Participant couples (n = 251) represented one of four drinking groups: concordant heavy drinkers (n = 68), heavy drinking husband (n = 79), heavy drinking wife (n = 35), and concordant abstainers/light drinkers (n = 69). As part of the study, participant couples completed a measure of relationship-specific alcohol expectancies through the mail.

RESULTS

Analyses reveal that wives demonstrate greater intimacy/openness expectancies in the concordant heavy drinking group than in the other three groups, as predicted. Unexpectedly, husbands demonstrate greater intimacy/openness expectancies if either member of the couple is a heavy drinker. Additionally, couples reported stronger sexual enhancement, power/assertion, and social pleasure/fun expectancies when the wife was a heavy drinker and stronger power/assertion expectancies when the husband was a heavy drinker.

CONCLUSIONS

Relationship-specific alcohol expectancies are differentially associated with the configuration of partners' drinking patterns. Wives' drinking status appears to influence relationship-specific alcohol expectancies to a greater extent than husbands' drinking status. Additional research is needed to determine the long-term effect of these associations.

Daily alcohol use and romantic relationship functioning: evidence of bidirectional, gender-, and context-specific effects

Whether beneficial or harmful, cause or effect, the nature of associations between drinking and close relationship processes remains unclear. The present study examined these issues by using daily reports of alcohol use and relationship functioning from 69 heterosexual couples over 3 weeks. Multilevel modeling indicated that alcohol had both positive and negative effects on relationship processes and that effects were more positive for women, and when small amounts were consumed, partners drank together, or they consumed similar amounts. Interestingly, however, positive effects on intimacy and partner behaviors were not mediated by sexual contact. In the reverse direction, women were found to drink more than men in response to relationship difficulties and feeling disconnected from their partner (i.e., low intimacy). Overall findings indicate that associations between drinking and relationship processes are complex and bidirectional and that they may be more important for women than men.

Prevalence and frequency of problems of concerned family members with a substance-using loved one

BACKGROUND

Limited research has examined the prevalence and frequency of specific problems of concerned family members and significant others (CSOs) of alcohol- or substance-using individuals (SUIs).

OBJECTIVES

We surveyed CSOs of SUIs to determine the prevalence and frequency of their problems and explored whether relationship to the SUI, gender of the CSO, or living arrangements altered problem prevalence and frequency.

METHODS

Non-substance-using CSOs (n=110) completed the Significant Other Survey, which asks about problems in seven domains (emotional; family; relationship; financial; health; violence; legal). Problem outcomes were compared based on the CSO's relationship to the SUI (partner or spouse vs. parent), gender of the CSO (male vs. female), and living arrangements of the CSO and the SUI (residing together vs. residing apart).

RESULTS

Problems were prevalent with at least two-thirds of the participants endorsing one or more problems in all but the legal domain. They also occurred frequently, with CSOs reporting problems on one-third to one-half of the past 30 days, in all but the violence and legal domains. Problems tended to be greater for CSOs who were partners, females, or living with the SUI.

CONCLUSION

CSOs experience frequent problems in a wide range of life domains and the types of difficulties they experience appear to differ based on type of relationship, gender, and their living arrangement relative to the SUI.

SCIENTIFIC SIGNIFICANCE

This investigation expands our understanding of the specific problems that CSOs face. The findings have important implications for treatment and health policy regarding these individuals.

Anxiety, mood, and substance use disorders in parents of children with anxiety disorders

Examined the prevalence of anxiety, mood, and substance use disorders in the parents of anxiety disordered (AD) children relative to children with no psychological disorder (NPD). The specificity of relationships between child and parent anxiety disorders was also investigated. Results revealed higher prevalence rates of anxiety disorders in parents of AD children relative to NPD children. Specific child-mother relationships were found between child separation anxiety and panic disorder and maternal panic disorder, as were child and maternal social phobia, obsessive compulsive disorder, and specific phobias. Findings are discussed with reference to theory, clinical implications, and future research needs.

Unique Aspects of Female-primary Alcoholic Relationships

OBJECTIVE

This descriptive paper assesses the applicability of knowledge about alcoholic relationships to treatment-seeking alcoholic women.

METHODS

One hundred and nine heterosexual couples were recruited between 1997 and 2000 for a randomized clinical trial of treatments for female alcoholics. Measures included the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV, Timeline Followback Interview, Areas of Change Questionnaire, Dyadic Adjustment Scale-Revised, Spouse Behavior Questionnaire, and Drinking Patterns Questionnaire.

RESULTS

Couples reported moderate levels of relationship distress the women claimed that relationship issues were important antecedents to their alcohol consumption. Male partners reported frequent use of active and passive strategies for coping with their wives drinking.

CONLCUSIONS

Results suggest that findings on marital distress are applicable to both populations, but that findings on reasons for drinking from male-primary alcoholic couples may not be fully applicable to female-primary alcoholic couples.

Spousal concordance for substance use and anxiety disorders

Assortative mating -- the tendency for mate selection to occur on the basis of similar traits -- plays an essential role in understanding the genetic contribution to psychiatric illness. It also carries significant impact on clinical prognosis and is an important mechanism explaining spousal concordance. This study uses a family study design ascertaining 225 probands with substance abuse/dependence, anxiety disorders, and controls to address: (1) Is there spousal concordance or cross-concordance for substance use and/or anxiety disorders? (2) Is the spousal concordance or cross-concordance associated with worse clinical outcomes? (3) What is the mechanism of the concordance or cross-concordance? Results show a high magnitude of spousal concordance for substance use disorders with a third of the substance probands' spouses also substance dependent. In contrast, there was no spousal concordance for anxiety disorders. Couples were also concordant for having "no disorders." Both substance use and anxiety disorder concordance were associated with poorer global functioning and persistent illness. Assortative mating is a likely mechanism for spousal concordance given the elevated rate of substance use disorders among the relatives of spouses' of substance probands. Implications for family/genetic studies and the transmission of substance use disorders and "no disorders" include: (1) at the individual level, spousal concordance influences probands' course of illness, couples' marital functioning, and offspring's genetic and environmental context; and (2) at the population level, it shifts the general distribution of substance use disorders and "no disorders" by reducing the "average" couple concordance and increasing the number concordant and discordant couples at extremes of the distribution.

Marital and family processes in the context of alcohol use and alcohol disorders

Alcohol use is often part of the fabric of marriage and family life, and although it is associated with certain positive effects, excessive drinking and alcohol disorders can exert a negative effect on the marital development and on the development of children in the context of the family. This review considers evidence that alcohol influences and is influenced by marital/family processes, including transitions into marriage and parenthood, marital satisfaction, marital violence, parenting, and child development. The review discusses the importance of antisocial behavior and the need to examine women's drinking, and the joint impact of men's and women's drinking on marital/family processes. The review highlights the lack of studies in certain key areas, including the link between discordant drinking and violence and marital satisfaction, the role of alcohol in child neglect, and the potential role of marital conflict as a mediator or moderator of the relationship between alcohol and child functioning.

Possible contributors to the gender differences in alcohol use and problems

Research on alcohol use and problems has demonstrated a much higher rate of alcohol use disorders (AUDs) among men compared with women. The authors review the most frequently researched biological and psychosocial factors that may play a role in the gender differences in alcohol use and problems. Among the biological factors, women might carry a lower genetic risk for AUDs and tend to suffer more negative biological consequences from drinking as compared with men. Regarding psychosocial factors, men appear to be more likely than women to manifest certain risk factors for alcohol use and problems (e.g., fewer perceived social sanctions for drinking, positive expectancies for alcohol use, personality traits such as impulsivity) and have fewer protective factors. Although these findings have helped to explain some of the gender differences in alcohol use and problems, there are inconsistencies in the literature. Additionally, many studie may not have enough statistical power to detect gender differences. The authors suggest that the biological and social consequences of alcohol abuse for women may be especially potent protective factors against AUDs and discuss the possibility of public health campaigns developed on the basis of this idea.

Depressive symptoms over time in women partners of men with and without alcohol problems

In a sample of 202 adult women and their families, the authors examined the effects of their male partners' alcohol problems and antisociality, the women's alcohol problems and antisociality, family conflict, and offspring behavioral problems on the women's depressive symptoms over a 3-year period. The women's antisociality and alcohol problems were more strongly related to family conflict, offspring behavioral problems, and the women's depressive symptoms than were the men's antisociality and alcohol problems. The women's antisociality and family conflict most strongly predicted increases in the women's depressive symptoms over time. In addition, family conflict mediated the effects of maternal antisociality on the women's depressive symptoms.

Marital interaction in alcoholic and nonalcoholic couples: alcoholic subtype variations and wives' alcoholism status

The authors examined problem-solving marital interactions of alcoholic and nonalcoholic couples (N = 132). Four alcoholic groups (husband alcoholic with antisocial personality disorder or not, paired with alcoholic or nonalcoholic wives) were compared with each other and with a both-spouses-nonalcoholic group. Consistent with the alcoholic subtypes hypothesis, couples with an antisocial alcoholic husband had higher levels of hostile behavior regardless of wives' alcoholism status. In contrast, rates of positive behaviors and the ratio of positive to negative behaviors were greatest among couples in which either both or neither of the spouses had alcoholic diagnoses and were lowest among alcoholic husbands with nonalcoholic wives. Discussion focuses on possible mechanisms linking antisocial alcoholism and discrepant alcoholic diagnoses to poorer marital outcomes.

Gender differences in risk factors and consequences for alcohol use and problems

Women drink less alcohol and have fewer alcohol-related problems than men. Women appear to be less likely than men to manifest certain risk factors for alcohol use and problems and are more likely to have certain protective factors against these problems: women perceive greater social sanctions for drinking; women are less likely to have characteristics associated with excessive drinking including aggressiveness, drinking to reduce distress, behavioral undercontrol, sensation-seeking and antisociality; and women are more likely to have desirable feminine traits (e.g., nurturance) protective against excessive drinking. In addition, consequences of heavy alcohol use, or alcohol use disorders, appear to be more negative for women than men, at least in some domains: women suffer alcohol-related physical illnesses at lower levels of exposure to alcohol than men, and some studies suggest women suffer more cognitive and motor impairment due to alcohol than men; women may be more likely than men to suffer physical harm and sexual assault when they are using alcohol; heavy alcohol use in women is associated with a range of reproductive problems. Implications of these findings for future research and public health education campaigns are discussed.

You, me...and drugs--a love triangle: important considerations when both members of a couple are abusing substances

Concordant couples can be defined as couples in which both partners have issues with "substance abuse." Studies demonstrate that couples display similar patterns of "substance abuse" that cannot be explained by sociodemographic factors alone. Unfortunately, few studies have focused on the unique relationship dynamics and needs of concordant couples. "Substance abuse" by a client's partner can profoundly affect their recovery and treatment. It is therefore important to understand how clients are influenced by their partners' use. This article attempts to define the needs and issues of concordant couples within a broader psychosocial context. In addition, an overview on the concordant couple literature is provided, along with a discussion of effective treatment and potential barriers to treatment.

For better or for worse? The effects of alcohol use on marital functioning

Two competing hypotheses propose opposite effects for the relation between alcohol use and marital functioning. One hypothesis conceptualizes alcohol use as maladaptive and proposes that it serves as a chronic stressor that causes marital dysfunction and subsequent dissolution. An opposing hypothesis proposes that alcohol use is adaptive and serves to temporarily relieve stressors that cause marital dysfunction, stabilizing the marital relationship, and perhaps preventing dissolution. Sixty studies were reviewed that tested the relation between alcohol use and one of three marital functioning domains (satisfaction, interaction, and violence). Results provide overwhelming support for the notion that alcohol use is maladaptive, and that it is associated with dissatisfaction, negative marital interaction patterns, and higher levels of marital violence. A small subset of studies found that light drinking patterns are associated with adaptive marital functioning; however, more research is necessary to replicate these effects and identify specific conditions under which they occur.

Social adjustment of family members and significant others (FSOs) of drug users

This study investigated the social adjustment of female family members and significant others (FSOs) of illicit drug users in order to gain insight into the impact of drug use upon those close to the user. Using the Social Adjustment Scale-Self Report (SAS-SR), we examined the social adjustment self-ratings (overall and in seven specific role areas) of 41 female partners and 24 mothers of drug users. We compared these ratings to the ratings they reported for their drug-using partners or children, to each other, and to self-ratings drawn from community comparison samples. As expected, results showed that the female FSOs reported significantly better social adjustment than the drug users in most role areas. However, their social adjustment was compromised relative to the community samples. Partners of drug users reported poorer adjustment than parents of drug users overall and in the specific areas of marital and economic functioning. Further inquiry is needed to improve our understanding of the impact of drug use on the users' family members.

Observation of couple conflicts: clinical assessment applications, stubborn truths, and shaky foundations

The purpose of this review is to provide a balanced examination of the published research involving the observation of couples, with special attention toward the use of observation for clinical assessment. All published articles that (a) used an observational coding system and (b) relate to the validity of the coding system are summarized in a table. The psychometric properties of observational systems and the use of observation in clinical practice are discussed. Although advances have been made in understanding couple conflict through the use of observation, the review concludes with an appeal to the field to develop constructs in a psychometrically and theoretically sound manner.

Observation of couple conflicts: clinical assessment applications, stubborn truths, and shaky foundations

The purpose of this review is to provide a balanced examination of the published research involving the observation of couples, with special attention toward the use of observation for clinical assessment. All published articles that (a) used an observational coding system and (b) relate to the validity of the coding system are summarized in a table. The psychometric properties of observational systems and the use of observation in clinical practice are discussed. Although advances have been made in understanding couple conflict through the use of observation, the review concludes with an appeal to the field to develop constructs in a psychometrically and theoretically sound manner.

Interpersonal processes and psychopathology among expectant and nonexpectant adolescent couples

This study examined the interpersonal and psychological functioning of expectant and nonexpectant adolescent couples. Interpersonal processes were assessed using the Structural Analysis of Social Behavior (L. S. Benjamin, 1974) and psychological functioning was assessed using the Diagnostic Interview for Children and Adolescents--Revised (W. Reich, 1991). Compared with their nonexpectant peers, expectant couples exhibited higher rates of negative interpersonal processes, including demand-withdraw behaviors and lower rates of positive interpersonal processes. Expectant males reported higher rates of behavior disorders, substance use disorders, and internalizing disorders than nonexpectant males. Higher rates of substance-use disorders mediated the effect of expectancy status on demand-withdraw behavior. Results help clarify the links between the psychological risks associated with adolescent pregnancy and the interpersonal functioning of young expectant couples.