Violent substance abusers in domestic violence treatment.

Although substance abuse is frequently encountered in men receiving services in violence treatment settings, systematic study of these 'dual-problem' men has lagged. This study had two main objectives: (1) the characterization of psychoactive substance abuse disorders in a naturalistic sample of men in domestic violence treatment; and (2) clarification of the role of substance abuse on the sociodemographic, personality, psychosocial, and abuse characteristics of dual-problem men. Fifty-three adult men who were attending domestic violence treatment were recruited. They were administered the Addiction Severity Index, the Conflicts Tactics Scale, Structured Clinical Diagnostic Interview, the 16PF and the Symptoms Checklist-90. Partners, when available, were asked to provide corroboration. Sixty-three percent of the men had a current diagnosis of psychoactive substance abuse or dependence, while 92.5% had a lifetime diagnosis. Of the former, the majority was diagnosed as multiply dependent on alcohol and other drugs. As the severity of the substance abuse increased, so too did the dangerousness and frequency of abusive behaviors. Moreover, dual-problem men reported more hostility, apprehension, frustration and suspiciousness and past arrests than did their violence-only cohorts as well as a history of multiple (unsuccessful) treatments for substance abuse. These findings suggest that the trend toward multiple drug complaints seen in other clinical milieus is also being confronted in conjugal violence settings. In addition to the greater therapeutic challenge such dual-problem men present, these findings speak to the need to investigate integrated treatment approaches to improve the outlook of men grappling with both conjugal violence and multiple substance abuse problems.

Subjective appraisal of problem severity and the ASI: secondary data or second opinion? Addiction Severity Index.

The Addiction Severity Index is a popular research and clinical tool for the characterization of individuals grappling with substance abuse problems. For research, use of the seven objectively calculated composite scores of problem severity is recommended. In contrast, clinical use of the instrument relies more upon its subjectively derived interviewer and client severity rating scores. However, little systematic research has looked at the comparability of these two sources of client data. This study compared the objective and subjective scores of the ASI of male (n=141) and female (n=58) clients entering substance abuse treatment. In addition, clients' narratives about their most worrisome problems were recorded and put to content analyses. While significant correlations were found among the various subjective indices, little relationship could be discerned between the objective composite scores and any of the subjective indices derived from either the ASI or the clients' narratives. As the focus of outcome research shifts from objective client and treatment characteristics to a better understanding of the process of intervention, empirical characterization of substance abuse treatment outcome may be enriched by the inclusion of subjective data that taps into the client's own perceptions of problems and treatment efficacy in addition to more objective sources of data.

The incidence and characteristics of violent men in substance abuse treatment.

Linkage between marital violence and substance abuse has been noted in men seeking treatment for substance-use disorders. The present study examined (1) the incidence of family violence in men admitted into substance abuse treatment; (2) the psychosocial characteristics associated with marital violence; and (3) the comparability of violent substance abusers to their treatment cohorts. Fifty-nine men in substance abuse treatment involved in a significant relationship in the past year were assessed for substance abuse, family violence, psychosocial functioning, and personality attributes. Fifty-eight percent of men reported at least one incident of physical familial violence in the past year, while 100% of the men reported having engaged in psychological abuse in the past year. Additionally, greater violence was associated with interpersonal insensitivity, hostile outbursts, and poorer overall functioning independent of substance abuse. Finally, violent male substance abusers reported significantly more hostility, suspiciousness, projection of blame, and interpersonal inadequacy than did the less violent substance abusers. These findings suggest that, in drug-treatment settings, systematic objective screening for family violence is routinely called for.

The effect of vocalization on the heart rate response to mental arithmetic.

The heart rate (HR) responses to verbal and nonverbal mental arithmetic tasks were studied in twenty undergraduate males. The two problem-sets were presented in counterbalanced order to the subjects. Greater HR responses to verbal, in contrast to nonverbal, arithmetic were only observed when the verbal arithmetic task was presented first. The peak (maximal) HR response was also the highest when the verbal arithmetic was presented first to the subjects. It is concluded that physiological or mechanical components of vocalization do not affect the HR response to mental arithmetic. However, certain psychological components, including test-anxiety or motivation, may increase the HR when subjects have to provide verbal answers during a first exposure to a challenge. This effect dissipates during the second exposure to the challenge due to habituation.

The role of spouses of substance abusers in treatment: gender differences.

Studies exploring gender differences among substance abusers in treatment have been fairly consistent in finding that females who enter treatment express more severe psychological and psychosocial disturbances than males, despite presenting with shorter and less intense substance abuse histories. However, strands of evidence suggest that the presence of a spouse, generally perceived as an asset in the treatment of the substance abuser, may have different implications for females than for males. In order to clarify this issue, 67 male and 18 female married substance abusers in treatment and their spouses were questioned on their substance use and psychological and social functioning. Similar to other studies, the female substance abusers reported greater disturbance on dimensions of employment and psychological functioning, but less severity of alcohol abuse. Comparison of male and female spouses, however, revealed that male spouses were likely to present with the following characteristics: (1) more symptoms of substance abuse and depression, (2) less overall physical well-being, and (3) to be less inclined to help others or be involved with their children than the female spouses. These findings are consistent with the view that the process of substance abuse is telescoped in females and is associated with more disturbed functioning in women on admission to treatment than in men. However, contextual differences--specifically in terms of availability of spousal support--may contribute significantly both to the understanding of differences in female versus male substance abusers in treatment as well as to the development of guidelines for adapting treatment based on gender.

Alcoholics also dependent on cocaine in treatment: do they differ from "pure" alcoholics?

Although individuals who exhibit both alcohol and cocaine dependency are seen increasingly in traditional alcoholism rehabilitation settings, their comparability with "pure" alcoholics is unclear. Sociodemographic, psychological, cognitive, and substance abuse status were, therefore, monitored in a group of alcoholics (n = 64) versus a group of cocaine dependent alcoholics (n = 82) on admission and just prior to discharge from 28-day multimodal treatment settings. At admission, cocaine-dependent alcoholics were younger, more likely to be unmarried, have more extensive substance use histories as well as more frequent prior treatments than "pure" alcoholics. Additionally, members of both groups exhibited abnormalities on psychological indices. Both psychological and cognitive indices revealed significant between-group differences which subsequent analyses found to be a confound of the marked age discrepancy between groups. From admission to discharge, scores on both psychological and cognitive indices declined significantly in both groups. Urine assay data revealed a greater tendency for cocaine-dependent alcoholics to relapse during treatment. While the psychological and cognitive data largely argue for the comparability of groups of patients classified as "pure" alcoholics with those who are dependent on both alcohol and cocaine, the latter group may have more difficulty in achieving abstinence during treatment. The interpretability of behavioral indices gathered only at treatment admission is questioned.

Alcohol and cocaine abusers 6 months after traditional treatment: do they fare as well as problem drinkers?

Problem drinkers (N = 49) and individuals presenting with both alcohol and cocaine problems (N = 51) admitted to a traditional 28-day alcoholism treatment milieu were compared on their psychosocial, psychological, neuropsychological functioning and substance abuse at admission as well as at six months posttreatment follow-up. On admission, alcohol and cocaine patients were younger, more likely to live alone or with their family of origin, to report having started using alcohol at an earlier age, to have fewer alcohol-related problems and to have fewer years of but more diversity in their substance abuse than the alcohol-only patients. Otherwise both groups were more similar than different on psychosocial, psychological and neuropsychological dimensions. At six-months posttreatment, both groups showed similar improvement on most dimensions of functioning measured. However, a significantly greater proportion of the alcohol and cocaine abusers admitted to having relapsed in the previous six months, reported significantly fewer average days of abstinence than the alcohol group since terminating treatment, and were more likely to present urine specimens indicative of recent substance abuse at the six-month follow-up interview. Thus, traditional approaches to alcoholism treatment may be less effective in establishing abstinence for individuals with both alcohol and cocaine problems. Adaptations to treatment to reduce the risk for relapse faced by alcohol and cocaine abusers in such milieu are discussed.

Psychophysiological profiles in response to various challenges during recovery from acute aerobic exercise.

Cardiovascular and sympathetic profiles in response to a series of physical and mental challenges were examined during recovery from an acute bout of aerobic exercise performed at 60% VO2,max for 30 min. 9 healthy men were tested on two occasions, once under an experimental (exercise) and once under a control (video watching) condition, in a counter-balanced order, one week apart. Although no differences in blood pressure were found in the two conditions, heart rate and plasma catecholamine concentrations were higher in the exercise than in the control session. These findings were partly attributed to elevated physiological levels 'carried over' from exercise. State anxiety and anger-hostility, however, were lower in the post-experimental period than in the pre-experimental period. The results are discussed in terms of their relevance to exercise and stress psychophysiology.

Aerobic fitness does not influence directly heart rate reactivity to mental stress.

Thirty-seven aerobically high and low fit male and female university students, selected on the basis of estimated aerobic capacity, completed a set of hard as well as a set of easy mental arithmetic tasks for 90 seconds in a counterbalanced order with a 10 min rest period between the tasks. Heart rate (HR) reactivity to either task was independent of aerobic fitness level. Although subjectively rated as more challenging, HR responses to the hard arithmetic task were not greater than that seen to the easy task. These results do not support the conjecture that aerobic fitness level may mediate HR response to acute mental challenge. The overall implications of these results are discussed in relation to the literature concerning aerobic fitness and mental stress.

Failure to alter sympathoadrenal response to psychosocial stress following aerobic training.

This experiment assessed the impact of aerobic training on sympathoadrenal, heart rate and subjective responses to psychosocial stress. Subjects were six previously sedentary males who demonstrated marked improvement in fitness level following 10 weeks of training. Plasma samples, heart rate and subjective arousal ratings were obtained prior to, during, and following exposure to stressful mental tasks within a laboratory session. With the exception of training-related bradycardia which was manifest throughout the session, no changes in plasma epinephrine and norepinephrine concentrations, heart rate or subjective reactivity or recovery were seen. These findings are inconsistent with the hypothesized beneficial effects of aerobic training on stress-response. Methodological factors such as self-selection inherent in previous correlation work or the duration of the training program should be considered in this context. The potential contribution of training-related bradycardia to enhanced coping with challenging situations is explored.

Experimental manipulation of aerobic fitness and the response to psychosocial stress: heart rate and self-report measures.

To determine whether aerobic fitness training alters response to psychosocial stress, 38 males were randomly assigned to either aerobic, anaerobic (weight-lifting), or waiting-list control groups. Experimental groups met three to four times per week in 1-hr sessions aimed at improving either cardiovascular endurance or muscular strength. Aerobic fitness level, heart rate and subjective response to laboratory psychosocial stress, and self-reports of daily stress, coping resources and psychologic symptoms were assessed prior to and following 10 weeks of training. Although posttraining fitness measures confirmed the effectiveness of aerobic training, no group differences were seen on laboratory or self-report measures. However, for aerobic trainers alone, fitness improvement tended to correlate with faster heart rate recovery following psychosocial stress. Fitness improvement was not correlated with any other psychologic changes. This experiment provides only modest support for the hypothesis that aerobic training alters response to psychosocial stress. It is suggested that future work on the psychologic effects of aerobic fitness explore the contribution of training parameters as well as subject characteristics.

The Montreal Type A Intervention Project: major findings.

This article reports a comparison of three short-term treatments (aerobic exercise, cognitive-behavioral stress management, and weight training) in modifying behavioral and cardiovascular reactivity to laboratory psychosocial stressors in healthy Type A men. One hundred seven men completed the treatments and evaluations, 33 in the aerobic exercise group, and 37 each in the cognitive-behavioral stress management and weight-training groups. The stress management group showed significantly greater changes in behavioral reactivity (reductions of 13% to 23% below initial values) than the two physical exercise groups, which did not differ significantly from each other. For physiological reactivity, changes attributable to intervention were trivial for all three treatment groups. The positive finding of reduced behavioral reactivity as a result of the stress management intervention is of potential clinical significance and warrants further exploration. The lack of meaningful reductions in physiological reactivity also requires further exploration in that it raises questions concerning the ability of behavioral treatments in general to modify physiological reactivity, the ability of existing measures to assess accurately changes that are produced and, most fundamental of all, the relevance of physiological reactivity as an outcome measure for treatment efforts with Type As.

Exaggerated psychophysiological reactivity: issues in quantification and reliability.

Marked physiological reactivity to challenging mental tasks has been associated with elevated risk for, as well as the presence of, coronary heart disease. However, little systematic enquiry into the reliability and quantification of such exaggerated reactivity has emerged. Subjects were 32 male, managerial employees, ranging in age from 22 to 56 yr, who satisfied the following criteria: no history or current signs of heart disease, presence of Type A behavior pattern as revealed by the Structured Interview, and an increase during an initial psychosocial stress testing of at least 25% over baseline in at least three out of five psychophysiological indices. Heart rate, systolic blood pressure, diastolic blood pressure, plasma epinephrine and plasma norepinephrine levels were monitored while challenging mental tasks were performed in three sessions (screening, pretraining and posttraining) spaced several weeks apart. Psychophysiological reactivity during the tasks emerged as a consistent trait. For all five measures, change scores from baseline during the screening session were significantly correlated with change scores during the pretraining session. Moreover, the magnitude of the change scores were similar in the screening and pretraining sessions. Analysis of cross correlations within and between indices provided little support for the use of data transformations such as residual scores or analysis of covariance. Finally, on four out of five measures, the challenging tasks were found to be comparable in the degree of reactivity elicited. These findings suggest that, for selected Type A men, exaggerated psychophysiological reactivity occurs reliably when monitored with multiple indices, appears insensitive to mere passage of time, and can be uniformly elicited by a variety of tasks.

Physical fitness level and autonomic reactivity to psychosocial stress.

Two studies explored the influence of aerobic fitness level on autonomic reactivity to psychosocial stress. Experiment 1 employed a correlational, repeated measures design. A total of 45 men who were physically trained, untrained, or training were tested at three-week intervals over nine weeks. The measure of autonomic reactivity was lability in electrodermal activity during two speeded mental tasks designed to induce psychosocial stress. In the initial test session, trained subjects showed faster autonomic recovery from this stress than did untrained or training subjects; in subsequent test sessions involving the repeated administration of the same tasks, the three groups were indistinguishable. Experiment 2 employed 60 subjects who were randomly assigned to 10-week aerobic exercise, meditation, or music appreciation programs. In each session, two psychosocial stressors selected from a battery of six tasks were counterbalanced across treatments and sessions. Over the course of the study, participants in the exercise program improved significantly in physical fitness and also showed faster recovery in the electrodermal response. This quicker autonomic recovery may allow the aerobically fit to cope more effectively with emotional stress.

Aerobic fitness level and reactivity to psychosocial stress: physiological, biochemical, and subjective measures.

Aerobic fitness is associated with numerous physiological adaptations which permit physical stress to be coped with more efficiently. The present experiment examined whether aerobic fitness influences emotional response. Heart rate, biochemical measures (catecholamines, cortisol, prolactin, lactic acid), and self-reported arousal and anxiety were monitored in 15 highly trained and 15 untrained subjects at various points before, during and following exposure to a series of psychosocial stressors. Heart rate and subjective arousal level increased markedly during the stressors in both groups. Trained subjects showed higher levels of norepinephrine and prolactin early in the stress period, more rapid heart rate recovery following the stressors, and lower levels of anxiety at the conclusion of the session. This more rapid heart rate and subjective recovery from psychosocial stress, suggests that aerobically trained individuals may be capable of faster recovery in both physiological and subjective dimensions of emotionality. The differences in reactivity profiles between the aerobically trained and untrained were discussed in light of models that have dealt with the adaptiveness of emotional response.

Cross modal transfer of a conditional flexion response in dogs.

Two experiments investigated cross modal transfer of a conditional flexion response. In the first experiment, two dogs with extensive experimental past histories transferred a discrimination based on the pattern of presentation of auditory stimuli to a comparable pattern of visual stimuli. A second experiment with a naive dog demonstrated that such stimulus patterning also occurred from visual to auditory modalities. Additional tests showed that transfer was based on the relationship between discriminative stimuli and that the negative stimulus in the second modality was actively inhibitory. The data were discussed with reference to general attentiveness and rudimentary concept learning.