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.

Impulsivity Dimensions Predict Treatment Dropout Among Women in Residential Treatment for Substance Use Disorders.

Residential treatment for substance use disorders (SUDs) is effective at reducing substance use, dependence, and other related problems. However, dropout from treatment against medical advice (AMA) is common in residential treatment settings. Studies have shown that impulsivity is associated with substance misuse and treatment dropout in predominately male samples, but less is known regarding whether impulsivity dimensions predict treatment dropout among women. This study examined impulsivity dimensions (ie, negative urgency, positive urgency, lack of perseverance, lack of premeditation, and sensation seeking) as predictors of dropout AMA among women in a residential substance use treatment facility (N = 229). Logistic regression results demonstrated that elevations in lack of perseverance and sensation seeking were associated with an increased odds of treatment dropout AMA and that lack of premeditation was associated with a decreased odds of treatment dropout AMA. Study findings suggest that early evidence-based interventions for sensation seeking and lack of perseverance may improve retention of women in residential treatment.

Alcohol Use, Discrimination, and Psychological Partner Abuse Among LGBQ+ College Students: Results From a Daily Diary Study.

Alcohol use correlates with psychological partner abuse (PA) perpetration among lesbian, gay, bisexual, queer, and other nonheterosexual (LGBQ+) young adults. However, less is known about the proximal association between alcohol use and psychological PA within this population, which would provide valuable information for intervention development. Informed by minority stress and alcohol-related PA theories, we evaluated whether (a) psychological PA perpetration odds increased as the number of drinks consumed prior to psychological PA on a given day increased, (b) psychological PA perpetration odds were greater following heavy episodic drinking (HED) relative to non-HED, and (c) experiencing LGBQ+-specific discrimination (i.e., heterosexist harassment, incivility, and hostility) strengthened the association between daily alcohol use (number of drinks, HED) and subsequent psychological PA perpetration. LGBQ+ college students (N = 41; 75.6% women, 22.0% men, and 2.4% transgender/non-binary) completed a baseline survey of past-year discrimination before completing daily reports of their alcohol use and psychological PA for 60 consecutive days. Multilevel modeling revealed that drinking more than one usually does on a given day is positively associated with subsequent psychological PA odds (OR = 1.31, p < .001). Psychological PA was more likely following HED relative to non-HED (OR = 3.23, p < .001). Unexpectedly, experiencing discrimination was negatively associated with psychological PA odds across models (OR = .26 p = .01). No alcohol × discrimination interactions emerged. Results support alcohol use as a proximal risk factor for psychological PA among LGBQ+ college students and underscore the need for more nuanced examination of discrimination and other contextual variables in alcohol-related PA.

Intimate Partner Violence Perpetration Among Sexual Minority Young Adults: Associations With Alcohol Use, PTSD Symptoms, Internalized Homophobia, and Heterosexist Discrimination.

Lesbian, gay, bisexual, queer, and other sexual minority (LGBQ+) young adults report similar or higher rates of intimate partner violence (IPV) perpetration than their heterosexual peers. Elevated IPV risk among LGBQ+ young adults may be attributable to experiencing heterosexist discrimination and internalized homophobia. In addition, LGBQ+ people report disproportionate posttraumatic stress disorder (PTSD) symptoms, alcohol use, and IPV perpetration in dating relationships. Thus, this study explored which combinations of IPV risk factors (i.e., experiencing heterosexist discrimination, internalized homophobia, PTSD symptoms, alcohol use) related to forms of IPV perpetration, inclusive of psychological, physical, and sexual forms, in a sample of 342 LGBQ+ young adults. Internalized homophobia was related to psychological IPV perpetration at high and medium levels of PTSD symptoms and only high levels of alcohol use. PTSD symptoms and alcohol use interacted to predict psychological IPV perpetration; and PTSD symptoms related to increased psychological IPV perpetration at high and medium, but not low, alcohol use levels. Alcohol use was positively related to physical IPV perpetration. No other risk factors or interactions were significantly related to physical or sexual IPV perpetration. Results were consistent with prior findings that linked internalized homophobia, alcohol use, and PTSD symptoms to IPV perpetration and highlight the interacting nature of these IPV perpetration risk factors. Comprehensive IPV interventions with LGBQ+ young adults should evaluate the impact of simultaneously targeting these multiple IPV risk factors considering their interacting contributions to IPV perpetration risk. More research is needed to examine the temporal relations between minority stress, PTSD symptoms, alcohol use, and IPV perpetration.

Applying the interpersonal-psychological theory of suicide to inform the association between bullying victimization and suicidal ideation in college students.

Objective: Victims of bullying are at increased risk for suicidal ideation. The purpose of the current study is to examine the impact of bullying victimization in childhood on college student's current report of suicidal ideation through two mechanisms derived from the interpersonal-psychological theory of suicide. Participants: Our sample consists of 304 undergraduate college students from a large, southeastern university. Methods: We employed a cross-sectional design with self-report surveys to examine the indirect effects of childhood bullying victimization frequency on suicidal ideation through thwarted belongingness and perceived burdensomeness. Results: The association between bullying victimization and suicidal ideation was explained by perceived burdensomeness, but not thwarted belongingness. Conclusions: Bullying victimization in childhood may have distal effects on suicidal ideation through influencing perceptions of worthlessness and self-hatred. Interventions in college settings that address the impact of bullying victimization on perceived burdensomeness may reduce potential for suicidal ideation among college students.

Alcohol Use and Compulsive Sexual Behaviors in College Students: The Moderating Effect of Alcohol-Related Sexual Expectancies.

Compulsive sexual behaviors (CSB) and alcohol use are prevalent among college students. Alcohol use frequently co-occurs with CSB; however, further examination of risk factors of co-occurring alcohol use and CSB is needed. We examined the moderating effect of alcohol-related sexual expectancies, specifically sexual drive and affect expectancies, on the association between alcohol use/problems and CSB among 308 college students from a large university in the southeastern United States. Alcohol use/problems and CSB had a positive significant relationship among college students high in sexual drive expectancies and high and average in sexual affect expectancies. These findings suggest that alcohol-related sexual expectancies may be a risk factor for alcohol-related CSB.

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.

Applying the DSM-5 Alternative Model of Personality Disorders and the Shedler-Westen Assessment Procedure to the Classic Case of "Madeline G.": Novice and Expert Rater Convergences and Divergence.

Prior research supports the learnability of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Alternative Model of Personality Disorders (AMPD). However, researchers have yet to compare novice ratings on the AMPD's Level of Personality Functioning Scale and the 25 pathological personality traits with expert ratings. Furthermore, the AMPD has yet to be examined with the idiographic Shedler-Westen Assessment Procedure (SWAP). We compared the aggregated AMPD clinical profile of a group of psychology doctoral students who learned the AMPD to high levels of reliability to that of an expert rater using the crucible of the classical case of "Madeline G." Examination of AMPD and SWAP ratings of "Madeline G." revealed excellent overall concordance but suggests that novice raters tend to perceive lower levels of personality impairment.

Alcohol Use and Aggression among Men in Residential Treatment for Substance Use Disorders: The Moderating Role of Mindfulness Facets.

Objective: Aggressive behaviors are consistently linked to alcohol use and are over-represented among individuals in substance misuse treatment compared to the general population. Trait mindfulness (i.e., a multifaceted construct including attending to and accepting experiences) had an inverse relationship with aggression such that greater trait mindfulness may attenuate the risk alcohol use poses for aggression. Method: We examined the moderating effect of the five facets of trait mindfulness on the relationship between alcohol use/problems and aggressive attitudes, physical aggression, and verbal aggression among 516 men in residential treatment for substance use disorders. Results: Explication of the significant interactions utilizing the Johnson-Neyman technique revealed alcohol use/problems positively related to aggressive attitudes for men with below average and average Nonreactivity and Acting mindfulness facets. The positive relationship between alcohol use/problems and verbal aggression was present among men below average in Nonreactivity and Acting. Alcohol use/problems positively related to physical aggression among men below average and average in the mindfulness facets of Describe and Acting. Furthermore, alcohol use/problems positively related to aggressive attitudes and physical aggression among men average or above average in the mindfulness facet of Observe. Conclusions: Findings suggest that among men who misuse substances, the relation between alcohol use and aggression may be conditional and influenced by deficits in trait mindfulness.

Alcohol Problems, Jealousy, and Cyber Dating Abuse Perpetration Among Men and Women: Toward a Conceptual Model.

Investigations of alcohol use in relation to cyber dating abuse (CDA) remain underdeveloped relative to alcohol-related face-to-face dating abuse research. A critical step toward advancing this area of research would include examining the applicability of alcohol-related partner abuse models to CDA perpetration. Existing models of alcohol-related partner abuse suggested that alcohol and partner abuse are more likely to co-occur in the presence of aggressogenic distal traits. We propose that this model may extend to CDA perpetration. Toward this end, the present study collected cross-sectional data from college students (N = 258; 56.2% male) to investigate whether trait romantic jealousy moderated the association between alcohol problems and CDA perpetration, controlling for face-to-face dating abuse perpetration. We hypothesized that alcohol problems would positively relate to CDA perpetration among college students with high, but not low, romantic jealousy. We explored whether the interactive effect varied by sex. Results revealed a significant three-way interaction; the moderating role of romantic jealousy in the relation between alcohol problems and CDA perpetration varied by sex. Alcohol problems positively related to CDA perpetration for women with high, but not low, romantic jealousy. Alcohol problems did not relate to CDA perpetration regardless of men's level of romantic jealousy. These preliminary results suggested that alcohol-related partner abuse models may be useful for conceptualizing CDA perpetration and identifying CDA intervention components.

Problematic Pornography Use and Physical and Sexual Intimate Partner Violence Perpetration Among Men in Batterer Intervention Programs.

Recent decades witnessed a surge in pornography use, contributing to what some researchers referred to as problematic pornography use (PPU; excessive, compulsive, and uncontrollable pornography use). Informed by cognitive scripts theory, cross-sectional, longitudinal, and experimental research spanning several decades documented a positive association between men's pornography use and physical and sexual violence perpetration. However, there is a paucity of research investigating pornography use broadly, and PPU specifically, among men who perpetrate intimate partner violence (IPV). The present cross-sectional study investigated the association between self-reported PPU and physical and sexual IPV perpetration among 273 men in batterer intervention programs. After accounting for psychiatric symptomology and substance use and problems, results revealed a positive association between PPU and both physical and sexual IPV perpetration. Findings highlighted the need for continued investigation of the function of pornography use for violent men, particularly as it relates to physical and sexual IPV perpetration.

Risk of Revocation Among Batterers: A Preliminary Analysis of Criminogenic, Intimate Partner Violence, and Mental Health Risks.

This study examined whether criminogenic risk, domestic violence risk, and mental health diagnoses would predict probation revocation among batterers in a felony domestic violence court (FDVC). Review of probation files included baseline assessments and probation disposition for FDVC probationers from January 2014 to March 2018 (n = 64). Results of the binary logistic regression analysis showed that criminogenic risk was a significant predictor of FDVC probation revocation. Interventions to prevent unsuccessful completion of domestic violence courts may benefit from programming that addresses early engagement in treatment, antisocial thinking patterns, and treatment for substance use disorders.

Sexting and Substance Use among Women Arrested for Domestic Violence: A Brief Report.

BACKGROUND: Advances in technology provide opportunities for communication using electronic mediums. Sexting is one form of electronic communication and includes the sending of explicit sexual content (e.g., photos, text) through electronic mediums. Previous research demonstrated a positive association between sexting and behaviors such as substance use. Moreover, substance use increases the risk for intimate partner violence and is also associated with risky behaviors. OBJECTIVES: The aim of the present study was to examine the prevalence of sexting in a sample of 84 women mandated to attend batterer intervention programs following arrest for domestic violence. The associations between sexting, substance use, and intimate partner violence were also examined. METHOD: Participants completed self-report questionnaires that assessed sexting, intimate partner violence, and alcohol and drug use symptoms. RESULTS: Fifty-four percent of participants reported being asked to send a sext, 35.1% reported sending a sext, and 32.0% reported requesting a sext. Drug use symptoms were positively associated with some forms of sexting and intimate partner violence. There was a significant difference in drug use symptoms, such that women who received a request to send a sext had significantly more symptoms relative to women who had not received a request to send a sext. CONCLUSION: This is the first examination of sexting in a sample of women arrested for domestic violence. Findings indicate an association between drug use symptoms, sexting, and intimate partner violence, warranting continued research in this domain.

A Longitudinal Investigation on the Relation between Self-Compassion and Alcohol Use in a Treatment Sample: A Brief Report.

Alcohol misuse is often a chronic problem such that relapses following treatment are common. One potential protective factor for alcohol misuse is self-compassion, which includes self-kindness, feelings of common humanity, and mindfulness when faced with personal suffering and hardships. This study tested the hypothesis that self-compassion, and specifically self-compassion promoting facets including self-kindness, common humanity, and mindfulness, were longitudinally associated with reduced alcohol use among a sample of men and women in substance use disorder treatment (N = 62). Results partially supported the hypothesis, in that only the mindfulness facet of self-compassion was associated with decreased alcohol use over time. Sex and age differences as they related to the positive facets of self-compassion and alcohol use emerged. These findings suggest that positive facets of self-compassion may be beneficial factors to cultivate in alcohol treatment programs.

Sexual Coercion in the College Population: A Form of Risk-Taking Behavior.

The purpose of this study was to examine whether a decision-making model of risk-taking behavior, specifically impulsivity, positive and negative outcome expectation, and sensation seeking, can be extended to motivation for perpetration of sexual coercion. Participants included 276 sexually active college students between the ages of 18 and 25 years old who completed a set of questionnaires: (a) Sexual Experiences Survey, (b) Sensation Seeking Scales, (c) Cognitive Appraisal of Risky Events, (d) Barratt Impulsiveness Scale, and (e) Reckless Behavior Questionnaire. Multiple regression analyses were utilized to examine the relationship between these decision-making models and sexually coercive behaviors. General risk-taking behaviors were positively correlated with acts of sexual coercion, r = .16, p < .01. The predictor variables accounted for a significant amount of the variance in sexual coercion, R2 = .11, F(4, 246) = 7.57, p < .01. Only sensation seeking contributed unique variance to our model of sexual coercion, ß = .27, t = 4.06, p < .01. Interventions to reduce sexual coercion may be more successful if they target those high in risk-taking. Similarly, prevention efforts informed by research on how to engage and hold the attention of sensation seeking youth may be more successful.