Reducing intrusive suicidal mental images in patients with depressive symptoms through a dual-task add-on module: Results of a multicenter randomized clinical trial.

OBJECTIVE: To examine the safety and efficacy of a brief cognitive dual-task (using eye movements) add-on module to treatment as usual (TAU) in reducing the severity and frequency of intrusive suicidal mental images and suicidal ideation. METHOD: We conducted a single-blind, parallel multicenter randomized trial (No. NTR7563) among adult psychiatric outpatients (N = 91; Mage = 34.4, SD = 13.54; 68% female) with elevated depressive symptoms and experiencing distressing suicidal intrusions in the Netherlands. Primary outcome was the severity (Suicidal Intrusions Attributes Scale) and frequency (Clinical Interview for Suicidal Intrusions) of suicidal mental imagery intrusions at 1-week posttreatment and 3-month follow-up. Primary analysis was intention-to-treat. RESULTS: Between November 27, 2018 and September 13, 2021, 91 patients were included and randomly assigned to intervention group (Cognitive Dual Task Add-on + TAU) (n = 46) or TAU-only (n = 45). Cognitive Dual Task Add-on + TAU had greater reductions in severity (mean difference, -15.50, 95% CI [23.81, -7.19]; p < .001, d = 0.60), and frequency (geometric mean difference, 0.47, 95% CI [0.29, 0.79]; p = .004) of suicidal intrusions over time than TAU-alone. Cognitive Dual Task Add-on + TAU patients also showed lower suicidal ideation over time (p = .008, d = 0.42). There were no significant group differences in reductions in depressive symptoms, rumination, or hopelessness. Four serious adverse events occurred (three Cognitive Dual Task Add-on + TAU; one TAU-only); all unlikely attributable to intervention/trial. CONCLUSIONS: Findings provide support for the effectiveness of adding a cognitive dual-task module to the treatment of psychiatric outpatients with elevated depressive symptoms in reducing suicidal intrusions and ideation and can be executed safely. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The comparative effectiveness of Integrated treatment for Substance abuse and Partner violence (I-StoP) and substance abuse treatment alone: a randomized controlled trial.

BACKGROUND: Research has shown that treatments that solely addressed intimate partner violence (IPV) perpetration were not very effective in reducing IPV, possibly due to neglecting individual differences between IPV perpetrators. A large proportion of IPV perpetrators is diagnosed with co-occurring substance use disorders and it has been demonstrated that successful treatment of alcohol dependence among alcohol dependent IPV perpetrators also led to less IPV. The current study investigated the relative effectiveness of Integrated treatment for Substance abuse and Partner violence (I-StoP) to cognitive behavioral treatment addressing substance use disorders including only one session addressing partner violence (CBT-SUD+) among patients in substance abuse treatment who repeatedly committed IPV. Substance use and IPV perpetration were primary outcome measures. METHOD: Patients who entered substance abuse treatment were screened for IPV. Patients who disclosed at least 7 acts of physical IPV in the past year (N = 52) were randomly assigned to either I-StoP or CBT-SUD+. Patients in both conditions received 16 treatment sessions. Substance use and IPV perpetration were assessed at pretreatment, halfway treatment and posttreatment in blocks of 8 weeks. Both completers and intention-to-treat (ITT) analyses were performed. RESULTS: Patients (completers and ITT) in both conditions significantly improved regarding substance use and IPV perpetration at posttreatment compared with pretreatment. There were no differences in outcome between conditions. Completers in both conditions almost fully abstained from IPV in 8 weeks before the end of treatment. CONCLUSIONS: Both I-StoP and CBT-SUD+ were effective in reducing substance use and IPV perpetration among patients in substance abuse treatment who repeatedly committed IPV and self-disclosed IPV perpetration. Since it is more cost and time-effective to implement CBT-SUD+ than I-StoP, it is suggested to treat IPV perpetrators in substance abuse treatment with CBT-SUD+.

Prediction of intimate partner violence by type of substance use disorder.

The present study investigated whether (combinations of) specific substance use disorders predicted any and severe perpetration and victimization in males and females entering substance abuse treatment. All patients (N = 1799) were screened for IPV perpetration and victimization; almost one third of the sample committed or experienced any IPV in the past year. For males, an alcohol use disorder in combination with a cannabis and/or cocaine use disorder significantly predicted any IPV (perpetration and/or victimization) as well as severe IPV perpetration. For females, alcohol and cocaine abuse/dependence predicted both any IPV (perpetration and/or victimization) and severe IPV perpetration. Results from the present study emphasize the importance of routinely assessing IPV in patients in substance abuse treatment and demonstrate that clinicians should be particularly alert for IPV in patients with specific substance use disorder combinations.

Screening on perpetration and victimization of intimate partner violence (IPV): two studies on the validity of an IPV screening instrument in patients in substance abuse treatment.

BACKGROUND: About 50% of patients in substance abuse treatment with a partner perpetrated and/or experienced intimate partner violence in the past year. To date, there are no screeners to identify both perpetrators and victims of partner intimate violence in a substance abusing population. We developed a 4 item screening instrument for this purpose, the Jellinek Inventory for assessing Partner Violence (J-IPV). Important strengths of the J-IPV are that it takes only 2 minutes to administer and is easy to use and to score. METHODS: To investigate the validity of the J-IPV, two independent studies were conducted including 98 and 99 participants, respectively. Aim of the second study was to cross-validate findings from the first study. Psychometric properties of the J-IPV were determined by calculating sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio's by comparing J-IPV outcomes to outcomes on the Revised Conflict Tactics Scales ('gold standard'). Also, receiver operator characteristics (ROC)-curves were determined to weight sensitivity and specificity as a result of different J-IPV cutoffs, and the area under the curve (AUC) was calculated. RESULTS: Results of the first study demonstrated that the J-IPV possesses good psychometric properties to detect perpetrators and victims of any as well as severe intimate partner violence. Results from the second study replicated findings from the first study. CONCLUSIONS: We recommend administering the J-IPV to patients entering substance abuse treatment. If perpetrators and victims of partner violence are identified, action can be taken to stop IPV perpetration and arrange help for victims, for example by offering perpetrators treatment or by providing safety planning or advocacy interventions to victims.

Substance use disorders in forensic psychiatry: differences among different types of offenders.

This is the first study that compared different types of offenders in forensic outpatient treatment (i.e., offenders of general violence [GV], intimate partner violence [IPV], sex crimes, and "other offenses" such as drug smuggling and property crimes) regarding the prevalence of substance use disorders at the time of the offense. In total, 35.8% of participants (n = 187) were diagnosed with any substance use disorder. Specifically, 61.5% of GV perpetrators, 30.9% of IPV perpetrators, 9.1% of sex offenders, and 26.7% of "other offenders" were diagnosed with substance abuse or dependence. More GV offenders and less sex offenders fulfilled diagnostic criteria for a substance use disorder. Furthermore, 29.9% of the offenders were intoxicated by substances at the moment they committed the offense (48.5% of GV perpetrators, 25.0% of IPV perpetrators, 17.4% of sex offenders, and 21.0% of other offenders). More GV perpetrators were intoxicated during the offense. As there is a clear association between substance abuse and criminal behavior, substance abuse in offenders should be assessed and, if present, be treated.

Substance misuse and substance use disorders in sex offenders: a review.

Substance abuse has often been associated with committing sex offenses. In this article, the following will be reviewed: 1) studies that assessed substance abuse in sex offenders; 2) differences in substance abuse among different types of sex offenders; 3) differences in substance abuse between sex offenders and nonsexual offenders and substance abuse in the normal population; 4) sex offenders' intoxication at the time of the offense; and 5) differences in intoxication at the time of the offense among different types of sex offenders. Studies will be discussed according to the method they used to assess substance abuse, i.e., file research, screening instruments or semi-structured interviews. This review shows that about half of the sex offenders has a history of substance abuse, a quarter to half of the sex offenders has a history of alcohol misuse and that about one fifth to a quarter of the sex offenders has a history of drug misuse. Furthermore, about a quarter to half of the sex offenders appeared to be intoxicated at the time of the offense. The review results in recommendations for future research. Because of the high prevalence of substance abuse in sex offenders it is advisable to routinely screen for substance abuse and, if necessary, to treat substance abuse.

Substance use disorders in perpetrators of intimate partner violence in a forensic setting.

This study investigates the point prevalence of substance use disorders in 150 perpetrators of intimate partner violence (IPV) in a forensic setting and compares participants with and without substance use disorders on demographic and offence-related variables. Furthermore, it investigates the frequency of IPV perpetrated under the influence of substances. Half the sample (50.0%) meets diagnostic criteria for at least one substance-related diagnosis. Significantly more IPV perpetrators without substance use disorders compared with IPV perpetrators with substance use disorders have children living at home and have abused their children. Relative to IPV perpetrators without substance use disorders, significantly more IPV perpetrators with substance-related disorders are found to be under the influence of substances at the time of the offence. Results highlight the importance of understanding the prevalence of substance use disorders in IPV perpetrators in forensic settings.