Self-stigma, hope for future, and recovery: An exploratory study of men with early-onset substance use disorder.

Context: The internalizing of experience of stigma among patients with substance use disorders (SUDs) can be debilitating to recovery. Individual factors such as self-regulation and abstinence self-efficacy can impact confidence in recovery and hope for future. Aims: The aim of the study was to explore relationship among self-stigma, self-regulation, self-efficacy, optimism, and confidence in recovery of patients with early-onset SUDs. Settings and Design: The study was carried out on a sample of 40 male patients with SUDs. The study had a single group exploratory design. Materials and Methods: The Self-Regulation Questionnaire, Drug Taking Confidence Questionnaire, Substance Abuse Self Stigma Scale, Revised Generalized Expectancy of Success (GES), and visual analog scale for craving were the measures used in the study. Statistical Analysis: Pearson and spearman's correlation coefficient were used to test associations between the variables. Multiple regression models were drawn to examine predictors of generalized expectancy of success and confidence in recovery. Results: Self-regulation, generalized expectancy of success (optimism), and confidence in recovery were found to be significantly correlated with self-stigma dimensions. The multiple regression model revealed self-regulation and self-devaluation as significant predictors of optimism (GES), whereas abstinence self-efficacy and values disengagement dimension of self-stigma predicted patients' confidence in recovery. Conclusions: Poor regulatory capacities along with internalized feelings of shame, guilt, and devaluation may lead to lower levels of optimism and poorer expectancies of success from future. Patient's self-efficacy in terms of abstaining from use behaviors and disengagement from pursuing life goals can lead to lower levels of confidence in recovery from SUDs and have implications for treatment seeking.

Psychometric properties of Fagerstrom Test of Nicotine Dependence: A systematic review.

The Fagerstrom test for nicotine dependence (FTND) is a widely used test for assessing physical nicotine dependence. However, there is a need to assess the psychometric properties of FTND to assess its role in treatment outcome studies. The aim of the present investigation was to review the psychometric properties of the FTND. A broad systematic literature search was performed from Pubmed and PsycINFO from 2000 to 2019. The publication language was limited to English. Two review authors performed the study selection and extracted the data. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Rayyan software used to screen relevant studies. A total of 1471 articles retrieved from the search, of which 33 studies fulfilled the inclusion criteria. Eleven studies related to testing the reliability of the FTND were analyzed. Twenty-five studies evaluated the Cronbach alpha of the test. Analysis of the studies revealed the questionable psychometric qualities of the adapted versions of the test across different cultures and ethnicity. It also suggested that it may not tap the appropriate constructs that would predict smoking patterns in light smokers, e-cigarette smokers, and smokeless tobacco users. Thus, further research must focus on improving the psychometric properties of FTND to enhance the measurement of nicotine dependence.

Marital and family therapy.

Substance abuse is a family disease that adversely impacts both the user and the user's family. The family can act as a risk factor for the development of substance abuse among children and adults. The family can also be involved in therapy to either help the recovery process or prevent substance abuse. Marital and family therapy have been found to be effective in reducing the severity of substance use, lowering marital and family conflict, improving family communication and cohesion as well as effective parenting practices. Behavioural Couples Therapy has been found to have good empirical support for bringing about the desired changes in both substance abuse and marital relationship. While targeting entire families, the most common evidenced based family interventions are Brief Strategic Family Therapy, Multidimensional Family Therapy, Family Behaviour Therapy, Functional Family Therapy and Community Reinforcement Programme. Marital and family therapy have to be sensitive to gender and culture. Effective use of marital and family therapy requires adequate training to equip practitioners in adequately treating not only substance use disorders and family pathology, but also in treating co-morbid mental health conditions.

Stressful and Traumatic Experiences among Women with Alcohol Use Disorders in India.

AIM: The aim of the present study was to examine lifetime stressful and traumatic experiences among women with alcohol use disorders (AUDs). METHODS: The sample comprised of two groups: a clinical group of 35 women with a diagnosis of AUD and a comparison group of 60 women drawn from the community. After screening out, the participants were administered Life Stressor Checklist-Revised. RESULTS: On an average, clinical group was exposed to 7.57 (standard deviation [SD] = 4.14) stressful events and comparison group was exposed to 4.03 (SD = 2.80) stressful events across the lifespan (t = 4.976; P < 0.001). Clinical group reported a high number of childhood abuse and interpersonal traumas across lifespan than comparison group. The relationship between adverse life experiences and alcohol abuse among women was bidirectional. CONCLUSION: Understanding the nature and experiences of trauma in this group has implications for planning gender-sensitive treatment programs for women seeking help for AUDs in India.

Addiction severity and comorbidity among women with alcohol use disorders: A hospital-based study from India.

AIM: To examine the addiction severity, comorbid psychiatric disorder and their temporal relationship among women seeking treatment for Alcohol Use Disorders (AUDs). MATERIALS AND METHODS: The sample comprised of 35 women with AUDs, with or without psychiatric disorders, recruited from the outpatient and inpatient settings of a tertiary-care hospital. Their mean age was 38.51 years (S.D=7.42). Patients were assessed using Clinical Data Sheet (CDS), Mini-International Neuropsychiatric Interview (MINI), Structured Clinical Interview for DSM-IV Personality disorders (SCIDII), Addiction Severity Index (ASI)-Alcohol subscale and Fagerstrom Test for Nicotine Dependence (FTND). RESULTS: Findings of the study indicated that on average patients initiated alcohol use in their early twenties and developed dependence by the age of 29.66 years (S.D=7.60). The average duration of alcohol dependence was less than a decade before seeking treatment. The mean composite score on ASI was 0.71 (S.D=0.18) and on FTND was 5.16 (S.D=2.59), indicating a high level of alcohol and moderate level of nicotine dependence respectively. On MINI, 57.14% of the patients met the criteria for co-occurring Axis I psychiatric disorders such as major depression disorder and dysthymia. In the majority of the cases, comorbid Axis I disorders were secondary to AUDs. On SCID-II, 17% met the criteria for borderline personality disorder. CONCLUSION: Examining and understanding the substance use and clinical profile of patients with AUDs are crucial for planning intensity, settings and focus of treatment for women with AUDs.

Relationship of Anger with Alcohol use Treatment Outcome: Follow-up Study.

BACKGROUND: Anger is seen as comorbid condition in psychiatric conditions. It has an impact on one's quality of life. It leads to variation in the treatment outcome. The present study is going to explore the relationship of anger with treatment outcome among alcohol users after 1 year of treatment. The data for the present study were taken from the project work on correlates of anger among alcohol users, funded by center for addiction medicine, NIMHANS, Bengaluru, Karnataka, India. MATERIALS AND METHODS: A total of 100 males (50 alcohol-dependent and 50 abstainers) in the age range of 20-45 years with a primary diagnosis of alcohol dependence were taken for the study. They were administered a semi-structured interview schedule to obtain information about sociodemographic details, information about alcohol use, its relationship with anger and its effects on anger control and the State-Trait Anger Expression Inventory. RESULTS: 68% of the dependent and abstainers perceived anger as negative emotion and 76% in control perceived it as negative. The presence of significant difference was seen for relapsers group in relation to trait anger and state anger. The group who remained abstinent from the intake to follow-up differs significantly from the dependent group in relation to state anger and anger control out. Mean score was higher on trait anger for the dependent group. CONCLUSIONS: It has implication for anger management intervention/matching of treatment with users attributes and helping the users to develop the behavioral repertoires to manage anger.

Clinical audit of women with substance use disorders: findings and implications.

AIM: To examine the socio-demographic, clinical and psychosocial profiles of women seeking treatment for substance use disorders (SUDs) in order to understand their treatment needs. MATERIALS AND METHODS: The psychiatric case records of 40 women with SUDs who sought consultation between the year 2012 and 2013 were analysed. RESULTS: The mean age of the sample was 38 years (standard deviation, S.D = ± 7.24). Among these, 52.5% were married and 30% were separated or divorced. Mean age of onset of substance dependence was 28.68 years (S.D. = ± 7.02) with an average of 9.65 years (S.D = ± 7.69) of dependence. Alcohol dependence was present in 80% of the patients, followed by nicotine dependence in 54% of the patients. Co-morbid Axis I and Axis II disorders were present in 62.5% and 10% of the patients respectively. Childhood adverse experiences such as abuse and neglect were reported by 20% of the patients. The factors contributing to initiation and maintenance of substance use were marital discord and interpersonal conflicts (70%), influence of significant others (66%), death of a family members (10%) and other stressful life events (25%). Major consequences of substance use were substance-induced physical problems (62.5%) and interpersonal conflicts (40%). Data analysis indicated poor follow up and relapse rate of 50%. CONCLUSIONS: Adverse life events and interpersonal conflicts are significant contributing factors to substance use among women. The study has implications for planning gender sensitive, multi-dimensional treatment programmes for women seeking treatment for SUDs in India.

Spirituality, religiosity and alcohol related beliefs among college students.

The aim of the present study was to examine spirituality, religiosity, and alcohol-related beliefs among college students. The sample consisted of 236 college students - 120 girls and 116 boys. The age range of the sample was between 18 and 21 years. The tools used in the study were Personal Information Data Sheet, Scale for Assessment of Attitudes toward Drinking and Alcoholism (SAADA), Alcohol Expectancy Questionnaire - Adult Form (AEQ), Beliefs and Values Scale (BVS), and The Religious Background and Behavior Questionnaire (RBBQ). The data were analyzed using t-test and Pearson's product moment correlation. Higher spirituality, religiosity, and both the components of religiosity - God Consciousness and Formal Practices, were all associated with less acceptance of drinking and alcoholism. Positive affect and higher spirituality were both associated with religiosity as well as its components. A positive correlation was found among religiosity and both its components. The results revealed gender differences in that the God Consciousness component of religiosity was found to be higher in girls, but not boys, who did not have exposure to alcohol through prior use or alcohol use in family. The implications for primary prevention for college students are discussed.

Stress and coping behaviors among smokers.

Positive association has been seen between stress and smoking behavior. This relationship has not been explored in relation to one's coping behavior and desire to quit smoking. The present study examined stress, coping and readiness to change among smokers. 50 smokers were selected using a cross sectional design. Assessment Proforma, Fagerstrom test for Nicotine Dependency, General Health Questionnaire, Perceived Stress Scale, Coping Checklist and Readiness to Change Questionnaire were administered on them. Stress was related to smoking behavior as well as initiation and maintenance of smoking. Individuals in the early adulthood stage were using maladaptive coping strategies. Perceived stress was higher among the middle age group. Stress and maladaptive coping behaviors were found to be associated with initiation and maintenance of smoking. It has implications for psychosocial interventions in tobacco cessation.