Pretreatment changes in drinking: Theoretical and methodological implications for alcohol use disorder treatment outcome research.

BACKGROUND: There is a growing recognition of the importance of changes in drinking prior to the first treatment session (i.e., pretreatment change). A major limitation of past studies of pretreatment change is the reliance on retrospective reporting on drinking rates between the baseline assessment and the first treatment session collected at the end of treatment. The present study sought to extend previous findings by examining 12-month treatment outcomes and correlates of pretreatment changes in drinking measured weekly during treatment. METHODS: Data from a randomized behavioral clinical trial examining the effect of therapeutic alliance feedback on drinking outcomes were analyzed (n = 165). All participants received cognitive behavioral therapy for alcohol dependence, completed pre and posttreatment assessments, and provided weekly measures of drinking during treatment. RESULTS: Results indicated that approximately half of the sample reduced their heavy drinking days by 70% or more and number of drinking days by 50% or more prior to beginning treatment. Further, individuals who reported greater consideration of how their problematic drinking affected their social environment displayed greater changes in drinking days prior to treatment. Changes in heavy drinking days were also related to relationship status, such that individuals who were single/never married were less likely to change prior to treatment than those who were married/cohabitating or separated/divorced. CONCLUSION: These confirm the importance of pretreatment change in the study of treatment outcomes, and suggest that interpersonal processes, including the appraisal of drinking behavior in a social context, may play an important role in pretreatment changes in drinking.

Leveraging Integrated Primary Care to Enhance the Health System Response to IPV: Moving toward Primary Prevention Primary Care.

Intimate partner violence (IPV) is a prominent public health problem in the United States, with significant health impacts that are often severe and persistent. Healthcare systems have been called upon to improve both the systematic identification and treatment of IPV largely by adopting secondary and tertiary prevention efforts. Research to date demonstrates both benefits and challenges with the current strategies employed. In this paper, we summarize current knowledge about the healthcare system's response to IPV and evaluate the strengths, limitations, and opportunities. We offer recommendations to broaden the continuum of healthcare resources to address IPV, which include a population health approach to primary prevention.

Applying a bifactor model to the functions of relational aggression: Associations with hostile attribution biases and difficulties with emotion regulation.

Previous research suggests that reactive and proactive aggression likely have distinct underlying mechanisms that uniquely contribute to the perpetration of each as a result of faulty cognitive and emotional processes. Still, very little work has examined the association of the functions of relational aggression with emotion dysregulation and hostile attribution biases. In addition, it is important to examine relational aggression in its pure and co-occurring functions given that past work finds reactive and proactive aggression to occur both jointly and distinctly. Thus, the current study employed a bifactor model to distinguish between pure reactive, pure proactive, and co-occurring relational aggression in emerging adulthood (N = 647, Mage = 19.92, SD = 2.83), a developmental time period for which relational aggression is particularly prominent. To further address gaps in the relational aggression literature, indirect pathway models revealed that relational hostile attribution biases emerged as a concurrent indirect path in the relationship between emotion dysregulation and pure reactive relational aggression. Furthermore, emotion dysregulation was directly positively associated with both pure functions as well as co-occurring relational aggression, and hostile attribution biases for relational provocations were directly associated with both pure functions of relational aggression, though the association was negative for pure proactive and positive for pure reactive relational aggression. Findings highlight the potential influence of emotion dysregulation and attributing hostile intent to social situations on engaging in the different functions of relational aggression.

Relationship Health and Intimate Partner Violence in Integrated Primary Care: Individual Characteristics and Preferences for Relationship Support across Risk Levels.

This study explores differences in characteristics and relationship treatment preferences across different levels of intimate partner violence (IPV) among Veterans Affairs (VA) primary care patients. In Fall 2019, we sent a mail-in survey assessing relationship healthcare needs to N = 299 Veterans randomly sampled from 20 northeastern VA primary care clinics (oversampling female and younger Veterans). We compared those reporting past year use or experience of physical/sexual aggression, threats/coercion, or injury (Severe IPV; 21%), to those only reporting yelling and screaming (Verbal Conflict; 51%), and denying any IPV (No IPV; 28%). Participants across groups desired 2-6 sessions of face-to-face support for couples' health and communication. No IPV participants were older and had preferred treatment in primary care. The Verbal Conflict and Severe IPV groups were both flagged by IPV screens and had similar interest in couple treatment and relationship evaluation. The Severe IPV group had higher rates of harms (e.g., depression, alcohol use disorder, relationship dissatisfaction, fear of partner) and higher interest in addressing safety outside of VA. Exploratory analyses suggested differences based on use vs. experience of Severe IPV. Findings highlight ways integrated primary care teams can differentiate services to address dissatisfaction and conflict while facilitating referrals for Severe IPV.

Online Crowdsourcing as a Quasi-Experimental Method for Collecting Data on the Perpetration of Alcohol-Related Partner Aggression.

Cross-sectional survey, prospective, and experimental data have been evaluated to better understand the role of alcohol as a contributing cause of intimate partner aggression. Laboratory-based alcohol administration studies provide controlled data regarding causality, but the use of this methodology lacks ecological validity and has been hampered by rigorous procedural and financial demands. Online crowdsourcing is an emerging pseudoexperimental methodology with low costs, rapid data collection, access to diverse populations, greater ecological validity, and the potential to facilitate prolific research to supplement the chronic scarcity of experimental data. The current rapid review first summarizes prior methodological approaches to investigating the proximal influence of alcohol on partner aggression, then reviews prior crowdsourcing research in the disparate areas of alcohol and partner aggression, then describes aggression paradigms that may be readily adapted to online administration. We conclude by introducing recommendations for future quasi-experimental research investigating alcohol-related partner aggression research using the online crowdsourcing methodology. Initial evidence suggests that online crowdsourcing may yield appropriate samples and that existing paradigms may be adapted to rapidly, efficiently, and ethically supplement experimental alcohol-related partner aggression research.

How Moderate Alcohol Consumption Impacts Married or Cohabiting Couples in Expressing Disagreements: An Automatic Computation Model and Analysis.

Alcohol consumption is common in married/cohabiting couples, and many studies have attempted to understand its effects on their behavior patterns. Traditionally, those evaluations have been done through questionnaires and self-reports. While these approaches have unique contributions, they cannot track instantaneous behavioral changes, such as when a person shows disagreement, and are subjective to personal bias. Hence, we developed a computation model to automatically and objectively quantify instantaneous non-verbal disagreement expressed by head shakings and the corresponding following behavior. We conducted a preliminary analysis based on data from a randomized controlled experiment, where married/cohabiting couples discussed conflicts in different alcohol consumption conditions. Results showed that participants demonstrated different behavioral patterns in expressing moderate and strong disagreement. In addition, alcohol influenced males' head-shaking magnitude and females' following behavior more than their partners'. The proposed method is general and can be extended to investigate other behavioral cues.

The Impact of Depressive Symptoms on Response to Integrated Cognitive Behavioral Therapy for Substance Use Disorders and Intimate Partner Violence.

PURPOSE: Past studies demonstrated the efficacy of integrated cognitive-behavioral therapy (CBT) for substance use disorder (SUD) and intimate partner violence (IPV) as well as high rates of depressive symptoms in this population. However, little is known about how depressive symptoms impact treatment outcomes. We hypothesized that integrated CBT, but not standard drug counseling (DC), would buffer the negative effects of depressive symptoms on treatment response. DESIGN/METHODOLOGY/APPROACH: A secondary analysis of a randomized trial compared men assigned to 12 weeks of integrated CBT for SUD and IPV (n=29) to those in DC (n=34). FINDINGS: Most (60%) of the sample reported any depressive symptoms. Controlling for baseline IPV, reporting any depressive symptoms was associated with more positive cocaine screens during treatment. Among men with depressive symptoms, integrated CBT but not DC was associated with fewer positive cocaine screens. Controlling for baseline alcohol variables, integrated CBT and depressive symptoms were each associated with less aggression outside of intimate relationships (e.g., family, strangers) during treatment. For men without depressive symptoms, integrated CBT was associated with less non-IPV aggression compared to DC. Effects were not significant for other substances, IPV, or at follow-up. ORIGINALITY: Although integrated CBT's efficacy for improving SUD and IPV has been established, moderators of treatment response have not been investigated. PRACTICAL IMPLICATIONS: Integrated CBT buffered depressive symptoms' impact on cocaine use, yet only improved non-IPV aggression in men without depressive symptoms. RESEARCH LIMITATIONS/IMPLICATIONS: This study found some evidence for differential response to CBT by depressive symptoms on cocaine and aggression at end of treatment, which did not persist three months later. Future studies should explore mechanisms of integrated CBT for SUD and IPV, including mood regulation, on depressive symptoms in real-world samples.

Sexual Dysfunction and Preferences for Discussing Sexual Health Concerns Among Veteran Primary Care Patients.

BACKGROUND: Sexual health is an important, yet often overlooked, aspect of overall health. Veterans may be particularly at risk for sexual dysfunction. The objectives of this study were to assess the prevalence and correlates of sexual dysfunction and examine preferences among veterans for discussing sexual problems. METHODS: In this cross-sectional study, we mailed 1500 surveys to a random sample of primary care patients from 3 Veterans Affairs medical centers; 313 were returned (21% response rate) and 248 had complete data. Veterans (M age = 49.4 years) were mostly White (86.7%), women (60.9%), and married (79.0%). The Arizona Sexual Experience Scale was used to screen for sexual dysfunction. RESULTS: Half of veterans, 62.3% of women and 32.0% of men, screened positive for sexual dysfunction. More than 60% of veterans agreed that the primary care team should provide information, proactively ask, and inquire on medical history forms about sexual problems; 59.3% were open to meeting with behavioral health providers. CONCLUSIONS: Primary care providers should ask veterans about sexual health, as sexual dysfunction was prevalent, especially among women and among men over age 65. Most veterans were receptive to being asked about sexual problems in primary care and preferred to be asked rather than bring it up.

A meta-analytic review of the relationship between cyber aggression and substance use.

BACKGROUND: Prior research has demonstrated that various substances of abuse play a contributing role to acts of physical and verbal aggression. It is less clear if and to what extent substance use is associated with an increased risk in perpetrating cyber aggression, an emerging form of aggressive behavior that occurs through digital communication. METHODS: A comprehensive review of the literature resulted in 15 studies and 18 unique samples from which effect size estimates were calculated. RESULTS: Analyses resulted in a moderate, significant mean observed correlation indicating that individuals who engaged in substance use were more likely than those who did not to perpetrate cyber aggression (r = 0.24, k = 18, 95% CI = 0.20, 0.28). Comparing data across types of substances revealed that alcohol use represents a stronger risk factor for cyber aggression than nicotine, cannabis, or other illicit drugs. Results also suggest a stronger relationship between substance use and cyber aggression among older than younger samples and in the context of intimate partner rather than peer aggression. Comparable estimates of substance-related cyber aggression emerged across types of cyber aggression and perpetrator gender. CONCLUSIONS: Further research is required to increase confidence in estimates used in moderation analyses. As with traditional aggression, alcohol use appears to represent a risk factor for cyber aggression, though it is unclear if the disinhibitory properties of alcohol are the mechanism of action for substance-related cyber aggression.

A Qualitative Analysis of Physically Aggressive Conflict Episodes Among a Community Sample.

Intimate partner aggression among community couples has been conceptualized as representing an occasional, situationally provoked response to a conflict. Yet, relatively few studies have considered the situational factors that contribute to the occurrence of an aggressive episode. The present study used thematic analysis to understand how episodes of physical aggression come about from the participant's perspective. We examined narrative descriptions of relationship conflicts that included physical aggression to gain insight into the types of aggressive incidents experienced, the reasons and motives behind the aggression, and the meaning of these events. Married and cohabiting couples (ages 18-45 at baseline) were recruited from the community to participate in a longitudinal study of relationships. Heavy drinking couples were oversampled. At Wave 3, participants were asked to describe the most severe conflict they had experienced over the past year and to answer questions about severity and impact. Narratives that described use of partner physical aggression by one or both partners were subject to thematic analysis. Using narratives provided by 27 male and 29 female respondents (representing 51 different couples), we identified three primary motives or reasons for aggression: Expressive, Instrumental, and Punishment. Narratives suggested as a primary theme that participants view partner violence as unusual, undesirable, and hence, meaningful. This was particularly true for male-to-female violence, which appeared objectively and subjectively different from female-to-male violence. Findings provide unique insight into the function and meaning of partner violence, including its gendered nature, within a community sample. Implications for measurement of partner aggression are also discussed.

Caffeinated Alcoholic Beverages and Intimate Partner Violence Victimization.

Background: Caffeinated alcoholic beverage (CAB) use is associated with general victimization beyond the use of alcohol alone. Materials and Methods: No prior research has evaluated the association between CAB use and intimate partner violence (IPV) victimization. This study evaluated the CAB-IPV victimization relationship using the responses of 100 (40 female) respondents to an online survey. Results: Results of logistic regression analyses indicated that CAB use was associated with IPV physical and sexual victimization after adjusting for demographics and heavy alcohol use. Exploratory analyses detected little evidence of sex differences in the strength of the relationship between CAB use and IPV victimization. Conclusions: The current results provide initial evidence that CAB use may place males and females at greater risk of IPV victimization.

The association between caffeinated alcoholic beverages and the perpetration of intimate partner violence.

Background: Problematic alcohol use is a recognized risk factor for intimate partner violence (IPV) perpetration.Objective: The use of caffeinated alcoholic beverages (CAB) appears to be associated with high-risk drinking behavior but the relationship between CAB use and IPV has yet to be explored.Methods: Sixty male and 40 female married or dating participants responded to an online survey including measures of past-year alcohol use and partner violence.Results: Logistic regression analyses revealed that CAB users were significantly more likely to perpetrate physical assault and partner injury after controlling for age, sex, ethnicity, income, and heavy alcohol use. The relationship between CAB use and perpetration of sexual coercion was better accounted for by heavy alcohol use.Conclusion: Results from the current study suggest that there exists an independent link between CAB use and partner violence perpetration.

The role of craving in the treatment of alcohol use disorders: The importance of competing desires and pretreatment changes in drinking.

BACKGROUND: The current study aimed to contribute to the understanding of the session to session relationship between craving and drinking during the course of treatment via the incorporation into the analysis of both a) motivation to avoid alcohol and 2) pretreatment change, given that half of all individuals entering treatment change their drinking prior to the first session. METHODS: Sixty-three treatment-seeking participants received 12 weeks of CBT for alcohol dependence and completed assessments of approach inclinations, avoidance inclinations and drinking behaviors at the end of each session. RESULTS: Consistent with our hypothesis, motivations to avoid alcohol and pretreatment change significantly interacted with craving to predict both number of drinking days and heavy drinking days during the interval between sessions. Specifically, among lower pretreatment changers, motivation to avoid alcohol moderated the effect of craving on number of drinking days and number of heavy drinking days, such that craving positively predicted drinking among those lower on motivations to avoid only. In contrast, among higher pretreatment changers, cravings positively predicted drinking among those higher on motivations to avoid alcohol. CONCLUSIONS: These findings highlight the importance of measuring both desire to consume and desire to avoid consuming alcohol simultaneously, and suggest that ambivalence may function differently depending on whether one is initiating (low pretreatment change) versus maintaining change (high pretreatment change).

Provocation and target gender as moderators of the relationship between acute alcohol use and female perpetrated aggression.

Acute alcohol use appears to exert a small but significant effect on female perpetrated aggression in the laboratory but there has been no effort to evaluate comprehensively the situational moderators of this relationship. This preliminary review was intended to explore the moderating effects of provocation and target gender on alcohol-related aggression among females in this understudied area of research. Moderator analyses were conducted on 14 studies. Despite limitations imposed by the sparsity of laboratory based research on alcohol-related aggression among females, initial results suggest that alcohol may exert stronger effects over female aggression following high (d = 0.25, k = 8, p < .01, 95% CI = 0.10-0.40) rather than low (d = -0.07, k = 6, p = .52, 95% CI = -0.29-0.15) provocation and when targets of aggression are female (d = 0.19, k = 9, p = .01, 95% CI = 0.04-0.34) rather than male (d = -0.06, k = 4, p = .61, 95% CI = -0.30-0.18). Results offer initial insight into situational risk factors pertinent to research and treatment of alcohol-related aggression among females while serving as an impetus for future research in this critical, neglected area of study.

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.

Problematic alcohol use as a risk factor for cyber aggression within romantic relationships.

BACKGROUND AND OBJECTIVES: Cyber aggression has emerged as a modern form of intimate partner violence which has yet to undergo sufficient research necessary to identify risk factors that may increase the likelihood or severity of cyber aggressive behavior toward a relationship partner. Prior research offers contradictory findings pertaining to the relationship between problematic alcohol use and cyber aggression. METHODS: We recruited 100 (40 female) adult participants through online crowdsourcing to complete a series of questionnaires assessing traditional partner violence, cyber aggression, and problematic alcohol use. RESULTS: Forty-two percent of the sample reported perpetrating cyber relational aggression and 35% reported perpetrating cyber privacy invasion during the year prior to study participation. Traditional partner violence was associated with both forms of cyber aggression. Problematic alcohol use was only associated with privacy invasion after accounting for demographic factors and traditional partner violence. DISCUSSION AND CONCLUSIONS: Cyber aggression was prevalent among the current adult sample. Results suggest that problematic alcohol use is a risk factor for cyber privacy invasion but not cyber relational aggression. SCIENTIFIC SIGNIFICANCE: Findings add to and clarify the nascent, conflicting results that have emerged from prior research on alcohol-related cyber aggression. (Am J Addict 2018;XX:1-7).

Impact of Pretreatment Change on Mechanism of Behavior Change Research: An Applied Example Using Alcohol Abstinence Self-Efficacy.

OBJECTIVE: With the growing recognition that, for some, significant changes in drinking occur before the first treatment session (i.e., pretreatment change), researchers have called for the careful assessment of when change occurs and its potential impact on mechanism of behavior change (MOBC) research. Using a commonly hypothesized MOBC variable, alcohol abstinence self-efficacy, the primary aim of this study was to examine the effect of pretreatment change on the study of MOBCs. METHOD: Sixty-three individuals diagnosed with alcohol dependence were recruited to participate in a 12-week cognitive-behavioral treatment. Participants completed weekly assessments of self-efficacy and drinking behaviors. RESULTS: Multilevel time-lagged regression models indicated that pretreatment change significantly moderated the effect of self-efficacy on the number of drinking days, such that among those higher on pretreatment change, higher self-efficacy ratings predicted lower rates of drinking days in the week until the next treatment session. In contrast, pretreatment change did not moderate the effect of self-efficacy on the rate of heavy drinking days. CONCLUSIONS: Results from the current study add to a small but growing body of research highlighting the importance of pretreatment change when studying MOBCs. Further, these results provide important insights into the conditions in which self-efficacy may play an important role in treatment outcomes.

Crowdsourcing as a method for collecting data pertaining to the effects of alcohol on perceptions of partner aggression.

BACKGROUND: Efforts designed to investigate the effects of recent alcohol use on the perception of intimate partner aggression have been stultified by significant financial and logistical barriers that warrant the development of supplemental research methods that may result in more prolific investigation of the phenomenon. OBJECTIVES: The current study explored the viability of using online crowdsourcing to assess the effects of recent alcohol use on the perception of partner aggression. METHOD: Mechanical Turk was used to recruit a convenience sample of 60 males who were asked to provide information on their own use of partner aggression, their most recent episode of alcohol use, and their perception of the behaviors and characters depicted in a written partner aggression vignette. Data were evaluated using five separate hierarchical multiple regression models predicting participant perception. RESULTS: Analyses revealed that 35% of the sample had used partner aggression in the past year and that 22% of the sample had consumed alcohol in the past day. Nonviolent participants perceived the aggressor and the behavior more negatively than partner violent participants. Some indicators revealed that recent alcohol use was associated with more positive perceptions of partner aggression. CONCLUSION: Expected associations among prior partner aggression, recent alcohol use, and perception of partner aggression vignettes were observed. Crowdsourcing may represent a source for data evaluating the effects of recent alcohol use on perceptions of aggression. Methodological refinement will benefit research and, ultimately, clinical prevention and intervention.

Parents' concordant and discordant alcohol use and subsequent child behavioral outcomes.

Alcohol problems have variable outcomes for marital relationships depending on whether drinking patterns are concordant or discordant among the members of the dyad; however, it is unclear what impact these variations in drinking patterns have on children. The current study was designed to explore several gaps and limitations in the parent heavy drinking literature. In particular, the prospective associations over 3years between parent heavy drinking, parenting, and child externalizing behavior were investigated in an integrated model to examine the influence of concordant and discordant drinking within couples on subsequent outcomes for their children. The study consisted of 180 couples recruited by mailings with children primarily between the ages of 4 and 11years old (52% male children). Parent-report of marital conflict, parenting, alcohol use, and child externalizing behavior were measured in a longitudinal study. Actor-Partner Interdependence Model analyses were conducted. Higher levels of maladaptive parenting were associated with higher externalizing for children of concordant drinking couples as opposed to discordant drinking couples. Implications for research and practice are discussed, including investigating mediators and moderators of the current findings such as quality of the parent-child relationship.

A Randomized Controlled Trial Assessing the Efficacy of Cognitive Behavioral Therapy for Substance-Dependent Domestic Violence Offenders: An Integrated Substance Abuse-Domestic Violence Treatment Approach (SADV).

The current study evaluates a therapy for substance-dependent perpetrators of partner violence. Sixty-three males arrested for partner violence within the past year were randomized to a cognitive behavioral substance abuse-domestic violence (SADV; n = 29) or a drug counseling (DC; n = 34) condition. Seventy percent of offenders completed eight core sessions with no differences between SADV and DC conditions in the amount of substance or aggression at pretreatment. SADV participants had fewer cocaine-positive toxicology screens and breathalyzer results during treatment, were less likely to engage in aggressive behavior proximal to a drinking episode, and reported fewer episodes of violence than DC participants at posttreatment follow-up. SADV shows promise in decreasing addiction and partner violence among substance-dependent male offenders.