Adverse childhood experiences, posttraumatic stress disorder symptoms, and compulsive behaviors among adults in substance use treatment: A latent class analysis.

Adverse childhood experiences (ACEs) are prevalent and associated with common problems among adults with substance use disorders (SUDs), including posttraumatic stress disorder (PTSD) symptoms and compulsive behaviors. Most studies consider cumulative ACEs when examining their associations with health and behavioral outcomes. We tested whether patterns of ACEs related to SUD symptoms, PTSD symptoms, and compulsive behaviors among adults receiving treatment for substance use. We identified latent classes of ACEs using medical record data from 721 patients in residential SUD treatment and conducted Wald chi-square tests to assess whether these latent classes differed in alcohol and drug use disorder symptoms, PTSD symptoms, compulsive sexual behavior, and compulsive gambling. We identified four latent classes: high ACEs (15.1%), maltreatment (12.4%), household problems (22.3%), and low ACEs (49.1%). There were significant differences across latent classes in drug use disorder symptoms, PTSD symptoms, and compulsive sexual behavior, χ2(1, N = 721) = 37.42-107.07, ps < .001. Participants in the high ACEs and household problems classes had more drug use disorder symptoms than those in the low ACEs class. Relative to all other classes, individuals in the low ACEs class had the lowest PTSD symptoms and those in the high ACEs class had the highest PTSD symptoms. Findings indicate that adults with SUDs who have more ACEs have the highest risk for PTSD symptoms and compulsive sexual behavior. Screening for ACEs while considering ACE patterns and frequency may benefit treatment planning for SUD patients with comorbid concerns such as PTSD symptoms and compulsive sexual behavior.

Examining trauma, anxiety, and depression as predictors of dropout from residential treatment for substance use disorders.

Substance use disorders (SUDs) are highly prevalent and have deleterious effects on one's health and well-being. Inpatient treatment for SUDs reduces patient relapse, which subsequently ameliorates these negative effects on the individual and society. Additionally, those who complete treatment are less likely to relapse compared to those who do not complete treatment. Thus, maintaining patient engagement in treatment and reducing the rates of those leaving against medical advice (AMA) is particularly important. Examining the factors and comorbidities that may contribute to treatment dropout has the potential to identify at-risk patients in need of additional individualized intervention. The current study aimed to examine comorbid anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms as predictors of dropout AMA in a residential substance use treatment population. Results showed that patients with social anxiety were more likely to leave treatment AMA, while those with PTSD were more likely to complete treatment. Findings suggest that PTSD-specific treatment, as offered in this facility, may help with patient retention, while group focused therapy may be distressing to those with social anxiety. Clinical implications of this research may include incorporating evidence-based practice for social anxiety early during inpatient treatment to reduce anxiety such that patients may better engage with SUDs treatment.

Development of the Alcohol and Cannabis Simultaneous Use Scale (ACSUS) in College Students.

Background: Despite the prevalence and negative outcomes associated with simultaneous alcohol and cannabis use (i.e., marijuana [SAM] use; i.e., so that the effects of both alcohol and cannabis overlap) among college students, there is no comprehensive measure of SAM use, with past research relying on single items. The present studies aimed to develop the Alcohol and Cannabis Simultaneous Use Scale (ACSUS), a comprehensive self-report measure of SAM use frequency, quantity, and problems in college students. Methods: College students at two Midwestern universities who used alcohol and cannabis (Study 1: N=534; Mean age=19; 71% female; 88% White; Study 2: N=258; Mean age=21; 81% female; 85% White) completed the newly developed ACSUS. Results: Exploratory factor analysis (Study 1) revealed the ACSUS fit best with 9-items representing two factors: Factor 1 measures frequency and quantity of SAM use, and Factor 2 measures associated problems with SAM use. Confirmatory factor analysis (Study 2) supported the two-factor structure of the ACSUS which was positively associated with measures of alcohol use, cannabis use, simultaneous use motives, and impulsivity. Conclusions: These data provide initial support for the ACSUS, developed to investigate the frequency, quantity, and associated problems with SAM use in college students.

Sexual Narcissism and Hypersexuality Relate to Sexual Coercion in Hookups among U.S. University Students.

Sexual violence remains a prevalent issue on college campuses. Sexual coercion, a form of sexual violence, is frequently employed within casual sexual encounters (i.e., hookups). The present study investigated hypersexuality and sexual narcissism as unique predictors of sexual coercion and examined whether there were gender differences in these associations. Participants (N = 793, ages 18-25) were undergraduate students at a large southeastern university who have: (1) engaged in sexual activity within the past six months and (2) had at least one prior hookup experience. Respondents completed surveys online assessing levels of sexual narcissism, hypersexuality, and sexual coercion perpetration in hookups. Participants primarily identified as female (71.7%), White (84.2%), and heterosexual (86.6%), with an average of 9.77 sexual engagements per month. Bivariate correlations and independent samples t-tests were conducted to examine associations between and gender differences across study variables, respectively. We assessed the factor structure of study variables using confirmatory factor analysis and tested hypotheses using structural equation modeling. Compared to women, men scored higher on sexual exploitation and all hypersexuality subscales. After establishing good-fitting measurement models, we found that both sexual narcissism and hypersexuality predicted increased sexual coercion perpetration and that gender did not moderate these associations. Study findings demonstrated that sexual narcissism and hypersexuality are risk factors for sexual coercion perpetration in hookups across gender. Although associations were consistent across gender, men may report higher levels of sexual coercion perpetration risk factors. Future researchers could focus on gender differences in the etiology of sexual coercion risk factors.

Integrating Mindfulness and Acceptance Into Traditional Cognitive Behavioral Therapy During the COVID-19 Pandemic: A Case Study of an Adult Man With Generalized Anxiety Disorder.

Generalized Anxiety Disorder (GAD) can be chronic and impairing, highlighting the need for effective treatments. Although Cognitive Behavior Therapy (CBT) is an effective treatment for GAD, a number of patients continue to report GAD symptoms treatment. Integrating evidenced-based treatment components into CBT treatments, such as mindfulness- and acceptance-based treatment components found in Acceptance and Commitment Therapy (ACT), may help improve the efficacy of treatment. Emerging interventions and research suggest that the cognitive restructuring aspect of CBT and acceptance stance of ACT (e.g., cognitive defusion) can be implemented into treatment concurrently from a stance of increasing a patient's coping skills repertoire and psychological flexibility. This systemic case analysis examined the efficacy and clinical utility of integrating ACT into a manualized CBT treatment for GAD. Furthermore, this study examined treatment efficacy and therapeutic alliance as the treatment rapidly and unexpectedly transitioned from in-person to telehealth due to the COVID-19 pandemic. Pre- to post-treatment and time-series analyses showed significant decreases in anxiety symptoms, worry, depressive symptoms, and emotion dysregulation. Although there was an initial increase in depressive and anxiety symptoms, worry, and emotion dysregulation following the switch from in-person to telehealth services, these quickly subsided and resumed a downward trend. The therapeutic relationship did not deteriorate during the transition to telehealth. This case study provides evidence of feasibility and efficacy of an integrated CBT/ACT approach in treating GAD. It also suggests that despite some temporary increase in symptoms, therapeutic alliance and treatment efficacy were not impacted by the switch to telehealth.

Emotion dysregulation moderates the relationship between alcohol use and eating pathology among heavy-drinking college men.

OBJECTIVES: There is limited research examining the relationship between alcohol use and eating pathology in men or factors that may moderate this association. The current study investigated the relationship between alcohol use and eating pathology, and examined emotion dysregulation as a moderator of this association, among heavy-drinking college men. METHOD: Men mandated to receive an alcohol intervention (N = 88; average age = 19 years) completed questionnaires related to alcohol use, emotion dysregulation, and eating pathology. RESULTS: Results demonstrated positive relationships between alcohol use and some eating pathology, and a significant interaction between alcohol use and emotion dysregulation. However, results were contrary to hypotheses, such that there was a positive relationship between alcohol use and eating pathology at low levels of emotion dysregulation. CONCLUSION: Future studies should continue to examine the overall presentation of eating pathology in men and investigate factors that may impact the relationship between alcohol use and eating pathology.

The Effects of a Health Care-Based Brief Intervention on Dating Abuse Perpetration: Results of a Randomized Controlled Trial.

Dating abuse (DA) is prevalent and consequential, yet there are no evidence-based interventions for the health care setting that prevent perpetration. The current study's purpose was to test a one-session brief motivational interview-style intervention to decrease DA perpetration. We conducted a two-arm RCT of the Real Talk intervention with follow-up at 3 and 6 months. Participants were 172 youth ages 15-19 years old, recruited from the pediatric emergency department or outpatient care services of an urban hospital in the USA in 2014-2017. The primary outcome was change in self-reported DA perpetration, including subtypes of DA such as physical, sexual, psychological, and cyber DA. Youth in both intervention and control arms reduced DA perpetration over time. GEE models indicated no overall intervention effects for any, physical, sexual, or psychological DA. There were overall effects for cyber DA (RR 0.49, 95% CI 0.27, 0.87). There were also effects at 3 months for psychological DA (RR 0.24, 95% CI 0.06, 0.93) and cyber DA (RR 0.39, 95% CI 0.19, 0.79). Analyses stratified by gender also found overall effects for males for any DA (RR 0.20, 95% CI 0.07, 0.55), physical DA (RR 0.30, 95% CI 0.10, 0.89), and cyber DA (RR 0.04, 95% CI 0.01, 0.27). For males, intervention effects on any DA persisted to 6 months (RR 0.13, 95% CI 0.02, 1.01). This health care-based one-session DA intervention is a potentially promising approach to reduce DA perpetration among adolescents.Clinical trial registration: This study is registered at www.clinicaltrials.gov NCT02080923.

Suicide ideation among Southern U.S. Sexual minority college students.

Sexual minority individuals are at higher risk for suicide ideation compared with heterosexual individuals. We tested whether the interpersonal-psychological theory of suicide explains increased suicide ideation among sexual minority college students living in the southeastern region of the United States. The cross-sectional study assessed correlates of suicide ideation in a convenience sample (n = 82) of sexual minority college students. Perceived burdensomeness and thwarted belongingness correlated with suicide ideation. However, only perceived burdensomeness correlated with suicide ideation while controlling for depressive symptoms. Pending replication, perceived burdensomeness may be a target for suicide prevention and intervention among sexual minority college students.

Dispositional Mindfulness and Aggression Among Adults in Residential Treatment for Opioid Use Disorder: Preliminary Findings From an Applied Setting.

Individuals with opioid use disorder (OUD) evidenced high levels of aggression both before and after the onset of opioid misuse. Continued aggression after abstinence suggested that abstinence alone may be inadequate. The present study investigated dispositional mindfulness in relation to aggressive attitudes, and verbal and physical aggression, by reviewing medical records of 163 adults in residential treatment for OUD. Results of hierarchical regression analyses, controlling for age and alcohol/drug use and problems, revealed a negative relationship between dispositional mindfulness and both aggressive attitudes and verbal aggression. Although dispositional mindfulness negatively related to physical aggression at the bivariate level, only alcohol use and problems related to physical aggression in regression analyses. Mindfulness-based treatments may be a useful avenue for targeting aggression within this population.

Predicting sexual behaviors from mid-adolescence to emerging adulthood: The roles of dating violence victimization and substance use.

The purpose of the present study was to determine whether dating violence victimization (psychological, physical, and sexual) and substance use (alcohol and marijuana) predicted sexual behaviors that increase risk for poor outcomes from ages 15-19. Adolescents (N = 1042; 56% female) were recruited from high schools in Southeast Texas in 2010 and followed annually for six years. The mean age of the sample at baseline was 15.09 (SD = 0.79). Participants primarily identified as Hispanic (31.4%), White (29.4%), and Black/African American (27.9%). Participants completed measures of dating violence victimization, substance use, and sexual behaviors annually. We examined unique and interactive associations between substance use and dating violence victimization with sexual behaviors that increase risk for poor outcomes. Multilevel modeling demonstrated that, when examining predictors simultaneously, marijuana use and psychological victimization predicted sexual behaviors over time for males. For females, marijuana use, and physical and psychological victimization all predicted sexual behaviors over time, with marijuana exerting the strongest effect, particularly among females who also used alcohol. Prevention efforts for adolescent sexual behaviors that increase risk for poor outcomes should include a focus on reducing substance use, particularly marijuana, and the effects of dating violence victimization.

An Examination of Sexting, Sexual Violence, and Alcohol Use Among Men Arrested for Domestic Violence.

Technological advances provide greater opportunity for electronic communication to occur within romantic relationships. Sexting, defined as sending sexually explicit content via electronic mediums, is one such type of communication and its association with alcohol use and partner violence is supported by existing research. We extend this knowledge by examining the prevalence of past-year sexting within a clinical sample of men arrested for domestic violence (N = 312). The associations between sexting, alcohol use, and sexual violence perpetration in the past year were also examined. Findings indicated that sexting was a prevalent behavior among this population, with 60% of the sample having requested a sext from someone, 55% having been asked to send a sext, and 41% having sent a sext within the past year. Logistic regression analyses indicated that sexting was linked to past-year sexual violence perpetration, even after controlling for age and past-year alcohol use. This is the first study to provide evidence that sexting is prevalent among men arrested for domestic violence. Moreover, men who endorsed sexting within the past year were more likely to have perpetrated past-year sexual violence than men who did not engage in sexting. Understanding the relation between sexting and other problematic behaviors, such as alcohol use and sexual violence, will inform intervention efforts across various populations.

Does experiential avoidance explain the relationships between shame, PTSD symptoms, and compulsive sexual behaviour among women in substance use treatment?

OBJECTIVE: Untreated compulsive sexual behaviour (CSB) poses a risk to efficacious substance use disorder (SUD) treatment. Yet the ways in which CSB manifests in women with SUDs remains poorly understood. Shame and trauma exposure are well-documented correlates for women's CSB. Prior theory suggested women with shame and trauma-related symptoms may engage in CSB in an effort to escape aversive internal experiences. Thus, the present study examined experiential avoidance as a mediator of the relationship between defectiveness/shame beliefs, post-traumatic stress disorder symptoms, and CSB in a sample of women with SUDs. METHOD: Cross-sectional, self-report data were collected from 446 women (M age = 37.40) in residential treatment for SUDs. RESULTS: Experiential avoidance partially mediated the relationship between both post-traumatic stress disorder symptoms and defectiveness/shame beliefs and CSB. CONCLUSIONS: These results extend theoretical conceptualizations of women's CSB to a treatment population. CSB intervention efforts may benefit from targeting women's avoidance of painful experiences.

Age of onset for physical and sexual teen dating violence perpetration: A longitudinal investigation.

Teen dating violence (TDV) is a serious and prevalent public health problem. TDV is associated with a number of negative health consequences for victims and predicts violence in adult relationships. Thus, efforts should be devoted to the primary prevention of TDV. However, only a few studies have examined when the risk for the first occurrence of TDV is greatest. Continued research in this area would inform the timing of, as well as developmentally appropriate strategies for, TDV primary prevention efforts. The current study examined at which age(s) the risk for TDV perpetration onset was greatest. Utilizing a panel-based design, a sample of racially/ethnically diverse high school students (N=872; 56% female) from the Southwestern United States completed self-report surveys on physical and sexual TDV perpetration annually for six years (2010 to 2016). Findings suggested that the physical TDV risk of onset was at or before ages 15 to 16 for females and at or before age 18 for males. For sexual TDV perpetration, risk was similar for males and females during adolescence, before uniquely increasing for males, and not females in emerging adulthood. Findings highlight the need for TDV primary prevention programs to be implemented early in high school, and potentially in middle school.

E-cigarette use of young adults motivations and associations with combustible cigarette alcohol, marijuana, and other illicit drugs.

BACKGROUND AND OBJECTIVES: Although the prevalence of e-cigarette use among adolescents and young adults has caught up to or eclipsed that of combustible cigarette use, there is relatively little known about (a) the link between e-cigarettes and other substances and (b) the reasons underlying this increase in e-cigarette use. To address this gap in knowledge, the current study examined associations between e-cigarette use and other substances and identified motives for e-cigarette use among young adults. METHODS: Participants included an ethnically diverse sample of African American, White, and Hispanic young adults (N = 662; 61% female) who were participating in an ongoing survey-based longitudinal study of health and risky behaviors. RESULTS: Hispanic, White, and male young adults reported significantly greater past year e-cigarette use compared to their African American and female counterparts. Bivariate correlations showed that use of e-cigarettes was positively associated with use of combustible cigarettes, alcohol, marijuana, cocaine, amphetamines, inhalants, hallucinogens, ecstasy, and misuse of over-the-counter and prescription medications. Furthermore, e-cigarette users reported a higher prevalence of substance use relative to those who did not use e-cigarettes. The taste of e-cigarettes was identified as an important motive for use. CONCLUSIONS AND SIGNIFICANCE: Although the potential harm associated with e-cigarettes remains largely unknown, e-cigarettes appear to be a risk marker for the use of substances that are known to pose substantial health problems. Health care providers should screen for e-cigarette use, and youth substance use prevention programs should target the reduction of e-cigarette use with particular attention to addressing their taste appeal. (Am J Addict 2017;26:343-348).

A Randomized Controlled Trial of a Mindfulness and Acceptance Group Therapy for Residential Substance Use Patients.

BACKGROUND: Substance use disorders are understood as a chronically relapsing condition that is difficult to treat. However, in recent years there have been promising developments in the treatment of substance use disorders, specifically with interventions based on mindfulness and acceptance and commitment therapy. Little research has examined whether these types of interventions may positively impact residential substance use treatment outcomes. OBJECTIVES: Thus, in the current study we developed and examined, in a randomized controlled trial, a 4-week, eight-session, adjunctive mindfulness and acceptance group therapy for patients in residential substance use treatment. Our primary outcomes were substance use cravings, psychological flexibility, and dispositional mindfulness at treatment discharge. METHODS: Patients (N = 117) from a private residential substance use facility were randomized to receive the adjunctive mindfulness and acceptance group or treatment-as-usual. Patients were assessed at treatment intake and at discharge from a 28-30-day residential program. RESULTS: Although treatment groups did not statistically differ at discharge on any primary outcome, small effect sizes favored the mindfulness and acceptance group on cravings and psychological flexibility. Conclusions/Importance: Continued research is needed to determine whether the addition of mindfulness and acceptance-based interventions improve outcomes long term following residential substance use treatment.

Dating Violence Perpetration: Associations With Early Maladaptive Schemas.

Violence between dating couples is a serious and prevalent problem among college students (Shorey, Cornelius, & Bell, 2008). Social-cognitive theories of aggression (e.g., Berkowitz, 1990) propose that perpetrators may have more maladaptive cognitive schemas that increase risk for aggression than non-perpetrators. Thus, this study examined differences between perpetrators and non-perpetrators of dating violence on early maladaptive schemas, which are rigidly held cognitive and behavioral patterns that guide how individuals encode and respond to stimuli in their environments (Young, Klosko, & Weishaar, 2003). Within a sample of female (n = 242) and male (n = 193) college students, results demonstrated that many early maladaptive schema domains were associated with psychological and physical dating violence perpetration, although mostly for women. In addition, the schema domain of impaired autonomy showed medium-to-large differences between female perpetrators and non-perpetrators, whereas the domain of impaired limits showed a medium-to-large difference for male perpetrators and non-perpetrators of physical aggression. These findings add to a growing body of literature on risk factors for dating violence, suggesting that early maladaptive schemas may be associated with individual differences in aggression risk. The results also further support social-cognitive models of aggressive behavior.

Depression, anxiety, and compulsive sexual behaviour among men in residential treatment for substance use disorders: The role of experiential avoidance.

Nearly one-third of individuals in treatment for substance use disorders endorse at-risk levels of compulsive sexual behaviours (CSBs). Untreated sexual compulsivity may facilitate relapse for treatment-seeking men. Previous research and theory suggest that CSBs are maintained by efforts to escape or alter negative affect (e.g., depression and anxiety). However, this hypothesis has not been examined within a sample of men in treatment for substance use disorders. In an effort to better understand CSBs within a population of men with substance use disorders, the present study is the first to examine experiential avoidance as one potential mechanism underlying the relation between men's symptoms of depression and anxiety and their use of CSBs. The present study reviewed medical records of 150 men in residential treatment for substance use disorders. Structural equation modelling was used to examine pathways from men's depression and anxiety symptoms to CSBs directly and indirectly through experiential avoidance while controlling for alcohol/drug problems and use. Results revealed significant indirect effects of both depression and anxiety symptoms on CSB through experiential avoidance. These results support and extend existing research on CSB in a treatment population. Findings suggest that intervention efforts for CSB may benefit by targeting men's avoidance of painful internal events. KEY PRACTITIONER MESSAGE: Compulsive sexual behaviour is related to symptoms of depression and anxiety amongst men in residential treatment for substance use disorders. Experiential avoidance is positively related to compulsive sexual behaviour amongst men with substance use disorders. For men in treatment for substance use disorders, the relation between symptoms of depression and anxiety and compulsive sexual behaviour is explained, in part, by experiential avoidance. Helping men with substance use disorders develop more adaptive methods of processing aversive experiences, as opposed to escaping them, may reduce their use of compulsive sexual behaviours when faced with aversive affect.

A preliminary investigation of the relationship between dispositional mindfulness and eating disorder symptoms among men in residential substance use treatment.

The comorbidity between eating disorders (EDs) and substance use disorders (SUDs) is of particular concern given the high rates of mortality, relapse and poor treatment outcomes associated with both disorders. As a result, there has been a growing impetus within the field to elucidate factors that might influence and aid treatment for this comorbidity. One such factor is dispositional mindfulness, as past literature has demonstrated a significant relationship between mindfulness and both EDs and SUDs. However, we are unaware of any research that has examined the relationship between dispositional mindfulness and ED symptoms in a sample of men in residential treatment for SUDs. Medical records from 152 men were included in the current study. Alcohol and drug use and problems, ED symptoms, and dispositional mindfulness were assessed with self-report measures. Hierarchical regression analysis indicated that dispositional mindfulness was inversely related to ED symptoms after controlling for alcohol use, drug use, and age. Although results are preliminary and continued research in this area is needed, our findings suggest that there may be potential usefulness in targeting and enhancing mindfulness among patients in residential treatment for SUDs with co-occurring psychiatric symptoms (e.g., EDs).

The Relationship Between Generalized Anxiety Symptoms and Treatment Dropout Among Women in Residential Treatment for Substance Use Disorders.

BACKGROUND: Generalized anxiety disorder (GAD) co-occurs with substance use disorders (SUDs) at an alarmingly high rate, and the presence of anxiety is associated with an increased risk for relapse to substance use following treatment. Furthermore, comorbid SUDs and other forms of psychopathology are associated with an increased risk for leaving treatment against medical advice (AMA). OBJECTIVE AND METHOD: Research has yet to examine whether the presence of GAD symptoms is associated with leaving treatment AMA in SUDs populations. Thus, the current study sought to address this important gap in the literature by examining this relationship among a sample of 122 women in residential treatment for SUDs. RESULTS: Results demonstrated that GAD symptoms were significantly associated with the decision to leave treatment AMA after controlling for age, education, problematic alcohol and drug use, and depression symptoms. CONCLUSIONS/IMPORTANCE: Our finding indicates the potential importance of assessing and targeting GAD in treatment for SUDs, which may increase treatment compliance.

Are Borderline Personality Symptoms Associated With Compulsive Sexual Behaviors Among Women in Treatment for Substance Use Disorders? An Exploratory Study.

OBJECTIVE: Extant literature has documented a significant relationship between borderline symptoms and substance use disorders. As supported in past work, there is a significant theoretical relationship between borderline symptoms and compulsive sexual behaviors because both disorders share common underlying behaviors and traits. There is no known research that has examined the empirical relationship between borderline symptoms and compulsive sexual behaviors in a population with substance use disorders. To fill this important gap in the literature, this relationship was examined in the current study. METHOD: Medical records from 120 women admitted to a private, residential treatment program for substance use disorders were reviewed for the current study. RESULTS: Hierarchical multiple regression analysis demonstrated that borderline symptoms were significantly associated with compulsive sexual behaviors after controlling for alcohol use and problems, drug use and problems, age, and positive impression management. CONCLUSION: Results from this study provide potentially important research and clinical implications, which could ultimately aid treatment and reduce relapse. However, continued research is needed to further examine the relationship between symptoms and compulsive sexual behaviors.