Psychological factors predicting patients' risk of relapse after enrollment in drug use treatment: A systematic review.

BACKGROUND AND AIMS: Despite high rates of relapse after treatment for drug use, to our knowledge there is no systematic literature identifying psychological factors that predict risk of relapse to drug use (excluding alcohol or tobacco). Our aim was to identify psychological factors that predict risk of relapse to drug use after enrollment in drug use treatment. The identification of such factors can support treatment planning and relapse prevention. METHODS: We searched for peer-reviewed articles published between 2000 and 2023 in PsycINFO, PsycArticles, Web of Science, and PubMed. The inclusion criteria were: peer-reviewed publications, quantitative studies, in English, adult samples, with a prospective design, and analyses of minimum one psychological factor as predictor of relapse to drug use. All authors were involved in abstract and full-text screening, and in assessing risk of bias. The findings are presented in a narrative synthesis and tables are organized by type of drug. RESULTS: Of 2226 publications initially identified, 45 were eligible. Twenty-three focused on predicting relapse to stimulants, 15 to opioids, and 7 to unspecified drugs. Substance use at baseline was an important factor predicting risk of relapse to opioids, and possibly stimulants. There was an indication that craving and attention problems potentially predict relapse to use of some drugs. Mental health factors (e.g., psychiatric diagnosis) did not predict relapse. Several psychological factors (e.g., cognition, emotion, personality, motivation) were scarcely examined. Over half of the studies had moderate to high risk of bias. CONCLUSIONS: Based on the 45 studies, few psychological factors predicted risk of relapse to drug use. Higher comparability between studies and more rigorous methodology are necessary in order to derive more precise recommendations that inform and improve clinical practice. PRE-REGISTRATION: PROSPERO, CRD42020182839.

Do adverse experiences predict unemployment and need of psychiatric help after treatment for drug use disorders?

Background: This study prospectively examined the association between adverse experiences (physical abuse, sexual abuse and parental substance use problems [SUPs]), not being employed, in education or training (NEET) and being in need of acute psychiatric help among patients receiving treatment for substance use disorders. Methods: A total of 580 adolescents and early adults aged 15-25 years enrolled in treatment for drug use disorders were included in the analyses. Treatment data were linked to participants' register data on employment, education and acute contact to psychiatric services for the following two years. Multivariable logistic regression models were used to examine associations between the three adverse experiences, NEET and need of acute psychiatric help, adjusting for confounders such as age, gender, ethnicity, treatment response and treatment condition. Results: More than half of the participants were NEET two years after treatment enrolment. After controlling for demographics and treatment conditions, NEET was predicted by parental substance use problems (odds ratio [OR] = 1.89, 95% confidence interval [CI] 1.31- 2.70), exposure to physical abuse (OR = 1.48, 95% CI 1.03-2.13) and non-abstinence (abstinence was negatively associated with NEET, OR = 0.53, 95% CI 0.37-0.76). Being exposed to two (OR = 3.17, 95% CI 1.93-5.21) and three types of adverse experiences (OR = 3.14, 95% CI = 1.47-6.70) predicted NEET more strongly than exposure to one type. One out of 10 participants sought acute care from psychiatric services at least once within two years after treatment. Only sex and ethnic minority status were associated with contacting psychiatric services acutely. Conclusion: The present study suggests that adverse experiences, such as being exposed to parental problematic substance use and physical abuse, may be important predictors for NEET after treatment for SUDs.

Transdiagnostic factors in symptoms of depression and post-traumatic stress: a systematic review.

The current systematic review sought to identify quantitative empirical studies that focused on the transdiagnostic factors of intolerance of uncertainty, emotional dysregulation and rumination, and their relation with depression and post-traumatic stress disorder (PTSD). The overall research aim was to examine the relationship between these transdiagnostic factors and their relation with depression and PTSD symptoms. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Out of the 768 articles initially identified, 55 met the inclusion criteria for the current review. The results determined that intolerance of uncertainty is indirectly related to depression and PTSD symptoms, mainly through other factors including emotion dysregulation and rumination. Additionally, emotional dysregulation is a significant predictor of both depression and PTSD symptoms. Rumination is a robust factor related to depression and PTSD symptoms, this relationship was significant in cross-sectional and longitudinal studies. This review provides evidence on the transdiagnostic factors of intolerance of uncertainty, emotional dysregulation and rumination in the relationship with depression and PTSD symptoms.

The impact of the COVID-19 lockdown on services for substance use in Denmark: Implications for meeting users' needs and recommendations for the future.

Background: The aim of this study was to document employees' experiences of changes in service provision for substance use disorders (SUDs) during the first COVID-19 lockdown in Denmark (spring 2020), as well as to examine their relation to challenges in meeting the service users' needs. Methods: Employees (N = 373) working in SUD treatment and harm reduction services completed an online survey soon after the first national lockdown. The survey included questions about changes in service provision during the lockdown, perceived concerns of the service users, and challenges in meeting the users' emerging needs. Results: Employees reported some positive changes in service provisions, such as increased flexibility in appointments, administering medication-assisted treatment (MAT), and use of telehealth. Negative changes were related to reduced contact with practitioners and harm reduction facilities. Approximately one third of employees reported significant challenges in meeting the users' emerging needs. This was particularly so when users' concerns were about physical and mental well-being, and substance use. In regression models, negative changes in the access to practitioners and MAT administration (but not other changes) predicted difficulties meeting the users' needs. Conclusion: Employees in SUD treatment and harm reduction services in Denmark experienced both positive and negative changes as a result of the first lockdown. However, not all the provision changes were linked to challenges in meeting the users' needs. We discuss practical and research implications of our findings with a focus on the users' physical and mental health, use of telehealth, MAT, and overall service reorganisation.

Youth's personal relationships, psychological symptoms, and the use of different substances: A population-based study.

Background: Externalising symptoms and peer influence are well-established predictors of youth's substance use in general. However, there is little integrative research that compares the relative contribution of psychological and social relationship characteristics as predictors of the use of specific substances among youth in different developmental stages. Methods: A representative sample of Danish adolescents (n = 1,168) and emerging adults (EA; n = 1,878) reported last-month prevalence use of cigarettes, cannabis, and other illicit drugs (OID), and four indices of alcohol use. Predictor variables included internalising and externalising symptoms, and major characteristics of the youth's relationships (e.g., parental drug use, number of close friends). Results: Having a close friend who used illicit drugs, and high externalising symptoms, predicted the risk for using all substances across both age groups. Alcohol use was more consistently related to peer-related variables than to symptoms. Smoking cigarettes, cannabis use, and OIDs use were related to peer and symptom variables. Age group moderated some associations. Parental separation was related more strongly to alcohol use among adolescents than among EA, and higher internalising symptoms were more strongly related to smoking and using OIDs among adolescents than among EA. Male EAs had higher risk for using alcohol than female EAs. Conclusion: Beyond having a close friend who used illicit drugs, and externalising problems, the use of each substance was better explained by a different group of variables. There were few but important moderations by age group. The findings highlight the need for research on risk factors for substance use that is developmentally sensitive, particularly for adolescents, and for specific substances. Thus, interventions and policies should address social, developmental, and psychological factors.

Impulsive Lifestyle Counselling versus treatment as usual to reduce offending in people with co-occurring antisocial personality disorder and substance use disorder: a post hoc analysis.

OBJECTIVES: To assess the impact of a short psychoeducation intervention for antisocial personality disorder on offending after randomization to treatment. DESIGN: Multicentre, superiority, non-blinded randomized controlled trial. Random assignment was conducted in blocks of varying sizes at a central randomization centre. Participants were followed using national register data until 365 days after randomization, migration, or death, whichever occurred first. SETTING: Thirteen outpatient uptake areas in Denmark. PARTICIPANTS: Patients with antisocial personality disorder in treatment for substance use disorders were randomized to treatment as usual (TAU, n = 80) or Impulsive Lifestyle Counselling (ILC, n = 96). A total of 165 patients could be linked to criminal records (TAU, n = 74; ILC, n = 91). INTERVENTION: ILC is a brief psychoeducational program targeting antisocial behavior. The trial was conducted between January 2012 and June 2014. OUTCOMES: Number of criminal offences leading to convictions based on national registers. RESULTS: The mean number of offences was 2.76 in the TAU group (95% Poisson confidence interval [CI] = 2.39, 3.16) and 1.87 in the ILC group (95% CI = 0.97, 1.43). Negative binomial regression was used to assess total number of convictions, as well as convictions for violent, property, driving under the influence, and drug-related crimes. In both adjusted and unadjusted analyses, random assignment to ILC was associated with a lower number of total offences (incidence rate risk ratio [IRR] = 0.43, p = .013; adjusted IRR = 0.45, p < .001) and convictions related to violence (IRR = 0.19, p = .001 adjusted IRR = 0.19, p = .007) and property offences (unadjusted IRR = 0.30, p = 0.003, adjusted IRR = 0.42, p = 0.010). Differences between conditions were not significant for driving under the influence (unadjusted IRR = 0.49, p = .370; adjusted IRR = 0.53, p = .417) or drug offences (unadjusted IRR = 1.06, p = .907; adjusted IRR = 0.55, p = .223). CONCLUSIONS: The ILC program shows promise in reducing offending behavior in people with comorbid substance use and antisocial personality disorder. TRIAL REGISTRATION: ISRCTN registry, ISRCTN67266318 , 15/10/2012.

Effects of contingency management and use of reminders for drug use treatment on readmission and criminality among young people: A linkage study of a randomized trial.

INTRODUCTION: An increasing number of adolescents and emerging adults are entering treatment for drug use disorders in high-income countries. This fact points not only to a need to evaluate treatment outcomes related to drug use reduction, but also to evaluate other indicators of treatment success. The aim of this study was to examine treatment effects on predicting readmission to drug use treatment and being convicted for a criminal offence among youth. A second aim was to examine whether a psychiatric history had an impact on these outcomes. METHODS: Participants were 460 youth aged 15-25 who took part in the YouthDAT, a randomized pragmatic clinical trial for outpatient drug use treatment. The trial compared four treatment conditions consisting of 12 sessions of a manualized treatment based on cognitive behavioral therapy and motivational interviewing. Condition one was the standard (only the manual); condition two consisted of standard treatment and contingency management (CM) (Vouchers); condition three included standard treatment, text reminders, and low-intensity aftercare (Reminders+LIA); and condition four combined the standard treatment, CM, text reminders, and low-intensity aftercare (Combined+LIA). The study linked participants to register data on psychiatric history, drug use treatment history, and criminal convictions. RESULTS: Treatment conditions Reminders+LIA (aB = 0.42, p = .026) and Combined+LIA (aB = 0.69, p = .000) predicted longer time to readmission compared to standard treatment. The Vouchers condition predicted a lower risk for criminal convictions (aIRR = 0.26, p = .001). Half of the participants had a psychiatric history. The treatments with additional strategies were useful in delaying readmission and reducing convictions for these youth. The results remained significant in the adjusted models accounting for relevant participant characteristics. CONCLUSIONS: Additional treatment strategies in outpatient drug use treatment, such as CM, text reminders, and low-intensity aftercare, predicted delayed readmission to treatment and fewer legal problems. Mental health problems were common among youth. However, the treatments with additional strategies were effective with youth with a psychiatric history. Overall, while the additional strategies may be resource demanding for clinical settings, they support treatment success and may also help to decrease other public costs. TRIAL REGISTRATION: ISRCTN registry ISRCTN27473213.

Emotion regulation in context: A naturalistic study of emotion regulation in response to everyday happy and sad memories during dysphoria.

BACKGROUND AND OBJECTIVES: Effective emotion regulation is an important marker of mental health. However, only a sparse number of studies have examined emotion regulation within the context of different emotion type and intensity levels among individuals with elevated depressive symptoms. METHOD: We investigated emotion regulation in response to happiness and sadness experienced in the context of everyday memories of 23 dysphoric and 20 non-depressed participants. Participants completed a diary indicating the intensity of these emotions when thinking about a personal memory, as well as their employment of five emotion regulation strategies at that moment. RESULTS: Multilevel models indicated that dysphoric and non-depressed individuals differed in how they employed three emotion regulation strategies depending on the intensity of the emotions. Relative to non-depressed individuals, dysphoric individuals employed greater brooding, expressive suppression, and memory suppression when experiencing less intense happiness, and employed more brooding for more intense sadness. These effects were maintained after controlling for habitual emotion regulation, and controlling for the opposite concurrent emotion. The findings suggest that dysphoric individuals adjust the use of emotion regulation strategies differently from non-depressed individuals depending on the intensity level of happiness and sadness experienced. These patterns may be indicative of reduced emotion regulation flexibility or fear of emotional shifts. LIMITATIONS: The sample consisted of mostly young women. CONCLUSIONS: Clinical implications, particularly concerning emotion-focused interventions, are discussed.

The Partners for Change Outcome Management System in the psychotherapeutic treatment of cannabis use: a pilot effectiveness randomized clinical trial.

PURPOSE: The aim of the study was to investigate the effectiveness of the Partners for Change Outcome Management System (PCOMS) in improving the retention rate and reducing drug use in a clinic for drug use treatment. MATERIAL AND METHODS: One-hundred outpatients with cannabis use as the primary presenting problem were randomized to either the PCOMS (n = 51) or treatment as usual (TAU; n = 49). Eight weekly psychotherapy sessions were planned in both conditions. The primary outcome was treatment retention measured as the rate of attendance to planned treatment sessions and dropout. The secondary outcomes were current cannabis and other drug use assessed with the European Addiction Severity Index (EuropASI). Several explorative outcomes were analyzed. Blind assessments of drug use were conducted three and six months after baseline. Outcome analyses were conducted on both the treated sample with at least one psychotherapy session (n = 82) and the intention-to-treat sample (n = 100). RESULTS: The results showed no incremental effect of the PCOMS compared to the TAU condition, for neither treatment retention, drug use, or therapeutic alliance. CONCLUSION: The main findings align with previous studies that have found no effect of the PCOMS when employing outcome measures independent from the PCOMS intervention. The results are interpreted with caution due to implementation difficulties, which at the same time suggest challenges when employing the PCOMS in large outpatient clinics for drug use treatment.

Involuntary autobiographical memories and future projections in social anxiety.

Intrusive involuntary memories and images are a cardinal phenomenon in a range of psychological disorders, but not systematically examined in social anxiety. We examined potential biases upon generating involuntary versus voluntary memories and future projections in individuals with high and low levels of social anxiety. Participants recorded involuntary and voluntary autobiographical events, and their associated emotional response in a structured mental time travel diary. High social anxiety was associated with more intense anxiety and embarrassment and greater use of a range of emotion regulation strategies upon generating all types of autobiographical events. Involuntary (versus voluntary) memories and future events were associated with a heightened emotional response independent of social anxiety, and memories were associated with more embarrassment than imagined future events. The effects of high versus low social anxiety and involuntary versus voluntary generation process were independent from each other. The findings have implications for affective and cognitive models of involuntary memories and future projections in emotional disorders.

The tendency for experiencing involuntary future and past mental time travel is robustly related to thought suppression: an exploratory study.

Involuntary mental time travel (MTT) refers to projecting oneself into the past or into the future without prior conscious effort. The previous studies have shown high inter-individual variability in the frequency of involuntary MTT, but a few systematic studies exist. In three exploratory studies, we investigated the relation between individual differences in experiencing involuntary past and future MTT, and selected emotional and cognitive processes, with a special focus on thought suppression. Across all three studies, thought suppression emerged as a robust predictor of involuntary MTT above and beyond emotion-related variables, mind-wandering, daydreaming styles, and demographic variables. Findings from Studies 1 and 2 showed that higher thought suppression consistently predicted both more frequent involuntary past and future MTT across an American and a Danish sample, whereas rumination and emotion regulation were less consistently related to involuntary MTT. In Study 3, thought suppression reliably predicted more frequent involuntary MTT, even when controlling for mind-wandering, as well as for positive and negative daydreaming styles, which were all related to greater involuntary MTT. Overall, the individual differences assessed showed similar relationships to the tendency for having past and future involuntary MTT, with the possible exception of daydreaming styles, which appeared more strongly related to future-directed involuntary MTT.

Emotion Regulation of Events Central to Identity and Their Relationship With Concurrent and Prospective Depressive Symptoms.

Dispositional emotion regulation is related to the severity and maintenance of depressive symptoms. However, whether emotion regulation specific to an event highly central for an individual's identity is predictive of depressive symptoms has not been examined. Nonclinical participants (N = 220) reported the extent to which they employed a selection of emotion regulation strategies when recalling low- and high-centrality events. Dispositional emotion regulation and depressive symptoms were also assessed. A 7-week follow-up was conducted. High-centrality events were associated with more emotion regulation efforts. Greater brooding and expressive suppression in relation to high-centrality memories predicted concurrent depressive symptoms after controlling for event valence and dispostional emotion regulation. Effects were absent for low-centrality memories. Emotion regulation in response to high-centrality memories did not predict depressive symptoms at follow-up beyond baseline depressive symptoms. Overall, the findings showed that maladaptive emotion regulation in response to memories of high-centrality events is important for explaining depressive symptomatology.

Autobiographical memory functions and posttraumatic stress symptoms across adulthood.

Previous research has documented robust individual differences in the functions served by autobiographical memories, and shown that different autobiographical memory functions are related to both positive and negative indicators of psychological well-being, and that their frequency varies with age. In this study, we examined the unique relationship between autobiographical memory functions and posttraumatic stress symptoms (PTSS) and whether such relationships varied with age across adulthood. A representative sample of 1040 adult Danes (20-70 years old) reported the frequency with which they recall autobiographical memories for different purposes as well as their level of posttraumatic stress disorder (PTSD) symptoms. Higher reflective and ruminative functions, as well as lower social function, predicted higher levels of PTSS. There were no moderating effects of age. The results suggest that although the frequency of various autobiographical functions varies throughout the adult years, their association with PTSS is similar across adulthood.

The Looming Maladaptive Style Questionnaire: Measurement invariance and relations to anxiety and depression across 10 countries.

The Looming Maladaptive Style Questionnaire (LMSQ) is a self-report measure designed to assess the looming cognitive style, a tendency to interpret threats as rapidly approaching and increasing in magnitude. To date, no systematic evaluation on the psychometric properties of the LMSQ across diverse cultural contexts has been done. In the present research, the measurement invariance of the LMSQ test scores was examined in 10 countries (N=4000). Confirmatory factor analysis suggested that a two-factor model (i.e., physical looming and social looming) fitted the data well across countries. Partial measurement invariance was established for the LMSQ scores across the countries whereas full measurement invariance was achieved across gender. Meta-analytic structural equation modeling was applied to examine the unique contributions of the two looming factors to anxiety and depression symptoms. Results indicated that the test scores underlying two looming factors were crucial and valid predictors of symptoms. The LMSQ shows promise as a measure with cross-cultural generalizability and opens new avenues for its use in diverse cultural settings.

Cognitive processing in the aftermath of relationship dissolution: Associations with concurrent and prospective distress and posttraumatic growth.

Non-marital romantic relationship dissolution is amongst the most stressful life events experienced by young adults. Yet, some individuals experience posttraumatic growth following relationship dissolution. Little is known about the specific and differential contribution of trait-like and event-specific cognitive processing styles to each of these outcomes. A longitudinal design was employed in which trait-like (brooding and reflection) and dissolution-specific (intrusive and deliberate) cognitive processing was examined as predictors of growth (Posttraumatic Growth Inventory) and distress (Breakup Distress Scale) following a recent relationship dissolution. Initially, 148 participants completed measures of trait-like and dissolution-specific cognitive processing, growth, and distress (T1). A subsample completed a seven-month follow-up (T2). Higher frequency of relationship-dissolution intrusive thoughts predicted concurrent distress after accounting for brooding and relationship characteristics. Further, higher brooding and lower reflection predicted higher distress prospectively. Concurrent growth was predicted by both higher brooding and more deliberate relationship-dissolution thoughts. Prospectively, T1 dissolution intrusive thoughts predicted higher T2 deliberate thoughts, and the interaction between these two constructs predicted higher T2 growth. Therefore, deliberately thinking of the dissolution was related to positive psychological outcomes. In contrast, intrusive dissolution cognitions and a tendency for brooding had a mixed (paradoxical) association with psychological adjustment.