Improving the retention rate for residential treatment of substance abuse by sequential intervention for social anxiety

BACKGROUND Residential drug rehabilitation is often seen as a treatment of last resort for people with severe substance abuse issues. These clients present with more severe symptoms, and frequent psychiatric comorbidities relative to outpatients. Given the complex nature of this client group, a high proportion of clients seeking treatment often do not enter treatment, and of those who do, many exit prematurely. Given the highly social nature of residential drug rehabilitation services, it has been argued that social anxieties might decrease the likelihood of an individual entering treatment, or increase the likelihood of them prematurely exiting treatment. The current paper reports on the protocol of a Randomised Control Trial which examined whether treatment of social anxiety prior to entry to treatment improves entry rates and retention in residential drug rehabilitation. METHOD/DESIGN A Randomised Control Trial comparing a social skills treatment with a treatment as usual control group was employed. The social skills training program was based on the principles of Cognitive Behaviour Therapy, and was adapted from Ron Rapee's social skills training program. A permutated block randomisation procedure was utilised. Participants are followed up at the completion of the program (or baseline plus six weeks for controls) and at three months following entry into residential rehabilitation (or six months post-baseline for participants who do not enter treatment). DISCUSSION The current study could potentially have implications for addressing social anxiety within residential drug treatment services in order to improve entry and retention in treatment. The results might suggest that the use of additional screening tools in intake assessments, a focus on coping with social anxieties in support groups for clients waiting to enter treatment, and greater awareness of social anxiety issues is warranted. AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRY Australian New Zealand Clinical Trials Registry (ACTRN) registration number: ACTRN12611000579998.This research was supported under Australian Research Council's Linkage Projects funding scheme (project number: LP0990162)

Motivational drive and alprazolam misuse : a recipe for aggression?

Benzodiazepine-related aggression has received insufficient research attention, in particular little is known about the motivational factors which may contribute to the development of this paradoxical response. The revised Reinforcement Sensitivity Theory provides a theoretical framework from which to understand the relevant underlying motivational processes. The current study aimed to identify the role of approach and avoidance motivational tendencies in the occurrence of benzodiazepine-related aggression. Data regarding benzodiazepine and other substance use, approach and avoidance motivation, and general and physical aggressive behaviour were collected via self-report questionnaires. Participants were a convenience sample (n=204) who reported using benzodiazepines in the previous year. Participants were primarily male (62.7%), aged 18–51 years old. Hierarchical multiple regressions indicated that general and physical aggression were predicted by alprazolam use and Drive, a facet of approach motivation. Overall, lower diazepam use significantly predicted higher levels of general aggression. However, when diazepam-preferring participants were examined in isolation of the larger sample (23.5% of sample), problematic (dependent) diazepam use was associated with greater aggression scores, as was dependence risk for alprazolam-preferring participants (39.7% of sample). The findings highlight the importance of motivational factors and benzodiazepine use patterns in understanding benzodiazepine-related aggression, with implications for violent offender rehabilitation

Improving the retention rate for residential treatment of substance abuse by sequential intervention for social anxiety

Background: Residential drug rehabilitation is often seen as a treatment of last resort for people with severe substance abuse issues. These clients present with more severe symptoms, and frequent psychiatric comorbidities relative to outpatients. Given the complex nature of this client group, a high proportion of clients seeking treatment often do not enter treatment, and of those who do, many exit prematurely. Given the highly social nature of residential drug rehabilitation services, it has been argued that social anxieties might decrease the likelihood of an individual entering treatment, or increase the likelihood of them prematurely exiting treatment. The current paper reports on the protocol of a Randomised Control Trial which examined whether treatment of social anxiety prior to entry to treatment improves entry rates and retention in residential drug rehabilitation. Method/design: A Randomised Control Trial comparing a social skills treatment with a treatment as usual control group was employed. The social skills training program was based on the principles of Cognitive Behaviour Therapy, and was adapted from Ron Rapee's social skills training program. A permutated block randomisation procedure was utilised. Participants are followed up at the completion of the program (or baseline plus six weeks for controls) and at three months following entry into residential rehabilitation (or six months post-baseline for participants who do not enter treatment). Discussion: The current study could potentially have implications for addressing social anxiety within residential drug treatment services in order to improve entry and retention in treatment. The results might suggest that the use of additional screening tools in intake assessments, a focus on coping with social anxieties in support groups for clients waiting to enter treatment, and greater awareness of social anxiety issues is warranted

Altered experience mediates the relationship between schizotypy and mood disturbance during shamanic-like journeying

Studies have found that shamanic practices are associated with statistically significant reductions in mood disturbance relative to baseline. However, contrary results were obtained for non-shamanic practitioners exposed to shamanic-like techniques. These inconsistent results may be partially due to a personality trait referred to as schizotypy, which has been demonstrated to influence susceptibility to shamanic-like techniques. Furthermore, given that an integral feature of shamanism is the production of altered states of awareness and altered experiences, and that shamanism is associated with health benefits, perhaps the production of such alterations affects health benefits. Consequently, the present study aimed to investigate whether altered state of awareness and altered experience mediated the association between schizotypy and mood disturbance during exposure to a shamanic-like condition. Sixty-nine non-shamans were randomly assigned to one of two conditions: shamanic-like journeying with drumming or sitting quietly with eyes open. Total mood disturbance-change was significantly negatively correlated with schizotypy and altered experience -- but not altered state of awareness -- and these correlations were significantly stronger for the shamanic-like journeying condition relative to the control condition. Furthermore, altered experience significantly mediated the association between schizotypy and total mood disturbance-change during exposure to shamanic-like journeying.<br /

Reinforcement sensitivity theory : a paradigm for understanding the motivational processes underlying alcohol use

Provides an examination of the processes which motivate individuals to drink alcohol. It was found that heavier drinkers are highly sensitive to reward yet more likely to experience negative affect, both generally, and in response to alcohol-related cues. Based on these findings a model focusing on the links between personality, mood and craving for alcohol was developed

The validity of the tension-reduction hypothesis in alcohol cue-reactivity research

Abstract not available

A predictive model of drinkers' responses to alcohol-related cues : a proposal

Abstract not available

Extraversion and Altered State of Awareness Predict Alcohol Cue-Reactivity

Studies have shown that regular drinkers respond to alcohol-related stimuli with increases in urge to drink and changes in affect. Evidence indicates that there is individual variability in responses to alcohol-related cues. The current study aimed to examine (1) the role of extraversion in understanding variability in responses to alcohol cues and (2) whether cue-elicited altered states of awareness are related to urge to drink and affective responses. Forty-one participants were exposed first to a neutral and then to an alcohol cue; urge and affective responses were then measured. Extraversion was a significant positive predictor of urge to drink, while altered state of awareness was a significant positive predictor of urge to drink and positive affect. Interestingly, altered state of awareness significantly improved prediction of both urge to drink and positive affect after controlling for levels of extraversion. These findings suggest that changes in states of awareness following presentation of alcohol cues may facilitate the observed increases in urge to drink and positive affect