Comparative Study of Three Levels of Care in a Substance Use Disorder Inpatient Facility on Risk for Sexual Addiction

Little research has focused on the risk of sexual addiction within an inpatient drug and alcohol treatment facility. The present study compared the rate and severity of sexual addiction in three chemical dependency units (30-day primary, 30-day relapse, and 90-day extended). A total of 485 participants completed the Sexual Addiction Screening Test-Revised (SAST-R). Demographic variables and substance and psychiatric diagnoses were gathered through patient chart review. Prevalence rates by unit were Primary Care 18%, Relapse 18.6%, and Extended Care 29.0%. Participants in Extended Care had a significantly higher prevalence of being identified as at risk for sexual addiction than either Relapse or Primary Care. Results showed significant differences in scores on the SAST-R in individuals in Extended Care as compared to individuals in either the Primary or Relapse units. Significant gender differences also emerged overall and by unit. Higher rates of diagnoses of certain chemical substances and psychiatric disorders emerged between the individuals at risk for sexual addiction versus those not at risk. This study is the first to explore risk for sexual addiction in inpatient substance use disorder treatment at different levels of care, and it demonstrates the need for further research that can differentiate between substance use disorders and sexual addiction in order to provide early intervention to improve treatment outcomes and prevent relapse

Ecological momentary assessment of affect and craving in patients in treatment for prescription opioid dependence

•Ecological momentary assessment used to assess mood in prescription opiate patients.•Sub-group of opiate patients display reduced positive affect early in recovery.•Correlation found between low positive affect and higher drug craving.•Rationale for use of ecological momentary assessment in substance abuse research. Low positive affect (PA) is likely to contribute to risk of relapse; however, it has received relatively little attention in clinical research. This study examined the associations among positive affect, negative affect (NA), and craving in medically withdrawn patients using ecological momentary assessment (EMA). Participants (n=73) provided reports of their PA, NA, and craving 4 times a day for an average of 10.47 (SD=3.80) days. Person- and day-level associations between PA, NA, and craving were examined using multilevel models. A significant interaction emerged between person- and day-level PA such that PA on the day level was negatively associated with craving for individuals experiencing low mean PA throughout the study. No significant interaction emerged between person- and day-level NA. The main effects for both person- and day-level NA were significant. Individuals experiencing high NA throughout the study experienced higher craving overall and on days when NA was higher than usual, craving was also higher. Results suggest that high person- and day-level NA may directly contribute to the risk for relapse via increased craving, whereas low day- level PA may contribute to risk for relapse among individuals exhibiting low person-level PA via increased craving on days with lower than average levels of PA for those individuals. Given that there is a paucity of research relating low PA to craving, continued investigation into how and when low PA creates risk for relapse is warranted

Daily sleep quality affects drug craving, partially through indirect associations with positive affect, in patients in treatment for nonmedical use of prescription drugs

Sleep disturbance has been identified as a risk factor for relapse in addiction to a range of substances. The relationship between sleep quality and treatment outcome has received relatively little attention in research on nonmedical use of prescription drugs (NMUPD). This study examined the within-person association between sleep quality and craving in medically detoxified patients in residence for the treatment of NMUPD. Participants (n=68) provided daily reports of their sleep quality, negative affect (NA), positive affect (PA), and craving for an average of 9.36 (SD=2.99) days. Within-person associations of sleep quality and craving were examined using multilevel modeling. Within-person mediation analyses were used to evaluate the mediating roles of NA and PA in the relationship between sleep quality and craving. Greater cravings were observed on days of lower than usual sleep quality (γ10=−0.10, p=0.003). Thirty-one percent of the overall association between sleep quality and craving was explained by PA, such that poorer sleep quality was associated with lower PA and, in turn, lower PA was associated with greater craving. No evidence emerged for an indirect association between sleep quality and craving through NA. Daily fluctuations in sleep quality were associated with fluctuations in craving, an association partially explained by the association between sleep quality and daily PA. These data encourage further research on the relationship between sleep, affect, and craving in NMUPD patients, as well as in patients with other substance use disorders. •Better than usual sleep quality was associated with lower than usual drug craving.•Higher than usual positive affect was associated with lower than usual drug craving.•The association between sleep quality and drug craving was partly mediated through positive affect

The role of civility and cultural humility in navigating controversial areas in psychology

We are living in the most culturally diverse but perhaps least interculturally civil time in modern history, and the field of psychology is not immune. Over recent decades, our field has often engaged in divisive and uncivil dialogue, as people with diverse perspectives have criticized, derogated, or even demonized one another. This article explores how civility and cultural humility can help remedy such situations. We focus on the controversial intersection of religion/spirituality and sexuality/gender. Bringing together a diverse group of coauthors, we discuss how cultural humility and civility can help navigate controversy within the arenas of public policy, multicultural training, clinical practice, and scientific research. First, we summarize current policies about civility and theories about cultural humility. Second, drawing on case examples, we discuss how civility and cultural humility can guide effective multicultural training and clinical practice at this intersection. Third, we review the team science literature on diversity and use a case example to illustrate how civility and cultural humility can help diverse teams advance research on religion/spirituality and sexuality/gender (e.g., by helping harness collective wisdom, honor cultural differences, build group cohesion, and resolve team conflict). Fourth, we highlight possible problems with civility (e.g., perceptions of civility can differ) and promises of incivility (e.g., protest can catalyze progress). Finally, we present an integrative model for guiding policymaking, clinical practice, and research in controversial areas, as dialogue partners adopt empathy as their affective stance, civility as their behavioral stance, and humility as their cognitive stance

The Role of Civility and Cultural Humility in Navigating Controversial Areas in Psychology

We are living in the most culturally diverse but perhaps least interculturally civil time in modern history, and the field of psychology is not immune. Over recent decades, our field has often engaged in divisive and uncivil dialogue, as people with diverse perspectives have criticized, derogated, or even demonized one another. This article explores how civility and cultural humility can help remedy such situations. We focus on the controversial intersection of religion/spirituality and sexuality/gender. Bringing together a diverse group of coauthors, we discuss how cultural humility and civility can help navigate controversy within the arenas of public policy, multicultural training, clinical practice, and scientific research. First, we summarize current policies about civility and theories about cultural humility. Second, drawing on case examples, we discuss how civility and cultural humility can guide effective multicultural training and clinical practice at this intersection. Third, we review the team science literature on diversity and use a case example to illustrate how civility and cultural humility can help diverse teams advance research on religion/spirituality and sexuality/gender (e.g., by helping harness collective wisdom, honor cultural differences, build group cohesion, and resolve team conflict). Fourth, we highlight possible problems with civility (e.g., perceptions of civility can differ) and promises of incivility (e.g., protest can catalyze progress). Finally, we present an integrative model for guiding policymaking, clinical practice, and research in controversial areas, as dialogue partners adopt empathy as their affective stance, civility as their behavioral stance, and humility as their cognitive stanc

Daily sleep quality affects drug craving, partially through indirect associations with positive affect, in patients in treatment for nonmedical use of prescription drugs

OBJECTIVE: Sleep disturbance has been identified as a risk factor for relapse in addiction to a range of substances. The relationship between sleep quality and treatment outcome has received relatively little attention in research on nonmedical use of prescription drugs (NMUPD). This study examined the within-person association between sleep quality and craving in medically detoxified patients in residence for the treatment of NMUPD. METHOD: Participants (n= 68) provided daily reports of their sleep quality, negative affect (NA), positive affect (PA), and craving for an average of 9.36 (SD= 2.99) days. Within-person associations of sleep quality and craving were examined using multilevel modeling. Within-person mediation analyses were used to evaluate the mediating roles of NA and PA in the relationship between sleep quality and craving. RESULTS: Greater cravings were observed on days of lower than usual sleep quality (γ(10) = −0.10, p = .003). Thirty-one percent of the overall association between sleep quality and craving was explained by PA, such that poorer sleep quality was associated with lower PA and, in turn, lower PA was associated with greater craving. No evidence emerged for an indirect association between sleep quality and craving through NA. CONCLUSIONS: Daily fluctuations in sleep quality were associated with fluctuations in craving, an association partially explained by the association between sleep quality and daily PA. These data encourage further research on the relationship between sleep, affect, and craving in NMUPD patients, as well as in patients with other substance use disorders