Finding the Middle Path Between Dependence and Autonomy: Recent Trainee Experiences in Dialectical Behavior Therapy Supervision

Originally published in DBT Bulletin Volume 3, Issue 1 pages 28-32 (2020). The DBT Bulletin is published by DBT California

Addressing substance abuse and violence in substance use disorder treatment and batterer intervention programs

Background Substance use disorders and perpetration of intimate partner violence (IPV) are interrelated, major public health problems. Methods We surveyed directors of a sample of substance use disorder treatment programs (SUDPs; N=241) and batterer intervention programs (BIPs; N=235) in California (70% response rate) to examine the extent to which SUDPs address IPV, and BIPs address substance abuse. Results Generally, SUDPs were not addressing co-occurring IPV perpetration in a formal and comprehensive way. Few had a policy requiring assessment of potential clients, or monitoring of admitted clients, for violence perpetration; almost one-quarter did not admit potential clients who had perpetrated IPV, and only 20% had a component or track to address violence. About one-third suspended or terminated clients engaging in violence. The most common barriers to SUDPs providing IPV services were that violence prevention was not part of the program’s mission, staff lacked training in violence, and the lack of reimbursement mechanisms for such services. In contrast, BIPs tended to address substance abuse in a more formal and comprehensive way; e.g., one-half had a policy requiring potential clients to be assessed, two-thirds required monitoring of substance abuse among admitted clients, and almost one-half had a component or track to address substance abuse. SUDPs had clients with fewer resources (marriage, employment, income, housing), and more severe problems (both alcohol and drug use disorders, dual substance use and other mental health disorders, HIV + status). We found little evidence that services are centralized for individuals with both substance abuse and violence problems, even though most SUDP and BIP directors agreed that help for both problems should be obtained simultaneously in separate programs. Conclusions SUDPs may have difficulty addressing violence because they have a clientele with relatively few resources and more complex psychological and medical needs. However, policy change can modify barriers to treatment integration and service linkage, such as reimbursement restrictions and lack of staff training

Effect of Race and Sex on Primary Care Physicians' Diagnosis and Treatment of Late-Life Depression

To examine primary care physician (PCP) contributions toward racial and sex differences in the diagnosis and treatment of late-life depression. Design : Survey using a computerized instrument incorporating video interviews and text, with volunteer PCPs randomly assigned to one of four standardized video vignettes of an elderly patient depicting late-life depression. Vignettes differed only in the patient/actor's race (white/African-American) or sex. Setting : American Academy of Family Physicians meeting, San Diego, California, 2002. Participants : One hundred seventy-eight U.S.-practicing postresidency PCPs who were asked to participate in a clinical decision-making study. Measurements : The computerized survey instrument assessed PCPs' diagnoses, first-line treatment and management recommendations, and judgment of personal characteristics/behaviors for the patients in the vignettes. Results : Eighty-five percent of all PCPs correctly diagnosed the elderly patient(s) with major depression. There were no significant differences in the diagnosis of depression, treatment recommendations, or PCP assessment of most patient characteristics by the race or sex of the patient/actor in the vignette, but PCP characteristics, most notably the location of medical school training (U.S. vs international), affected the likelihood of a depression diagnosis and treatment recommendations. Conclusion : Given standardized symptom-pictures, PCPs are just as likely to diagnose and treat depression in African-American as in white older people, suggesting that bias based simply on apparent patient race is not a likely explanation for the lower rates of depression diagnosis and treatment in older African Americans. PCPs who have trained at international medical schools may benefit from targeted training initiatives on the diagnosis and treatment of late-life depression.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65962/1/j.1532-5415.2005.53255.x.pd

Do drinking consequences predict sexual revictimization in a college sample of binge-drinking women?

Thesis (Master's)--University of Washington, 2014Sexual victimization is prevalent on college campuses in the US. A proportion of women experience multiple sexual assaults, and sexual assault risk in college is heightened among those with prior victimization histories. One risk factor for sexual revictimization is victims' alcohol use. Most research has focused on associations between alcohol consumption per se and revictimization. The current study's objective was to understand some potential mechanisms by which drinking confers risk for revictimization. We hypothesized specific drinking consequences would predict risk for revictimization above and beyond the quantity of alcohol consumed. A randomly selected sample of binge drinking female college students was assessed for baseline victimization (categorized as childhood versus adolescent victimization), quantity of alcohol consumed, and drinking consequences experienced. A subset of 162 women was assessed 30 days later for revictimization. Of the subset, 40 (24.6%) women were revictimized in the following 30 days. Blackout drinking at baseline predicted incapacitated sexual revictimization among women previously victimized as adolescents, after accounting for quantity of alcohol consumed. Other drinking consequences examined were not predictive of revictimization. Results support previous findings that adolescent sexual assault is an important predictor of sexual revictimization in college and blackout drinking may confer unique risk for revictimization

Feasibility, acceptability, and outcomes of a brief mindfulness intervention for college students with posttraumatic stress symptoms and problem drinking

Thesis (Ph.D.)--University of Washington, 2017-08The majority of college students will experience a traumatic event either before or during college, and a significant subset of those students experience PTSD symptoms. Additionally, many college students engage in problematic alcohol use. There is evidence that individuals with co-occurring PTSD symptoms and alcohol and other substance use disorders often use substances in an attempt to reduce their PTSD symptoms, and college students with PTSD symptoms experience more negative alcohol and drug consequences than those without PTSD. The relationship between PTSD and alcohol and other substance use disorders is often cyclical: individuals use substances to cope with PTSD symptoms, which in turn exacerbate symptoms and make them vulnerable to further traumatic experiences. Mindfulness interventions have been successfully utilized for individuals with PTSD or substance use disorders. However, to date, no previous studies have evaluated treatments for college students with co-occurring PTSD symptoms and problem drinking. This study evaluated the feasibility, acceptability, and efficacy of a 4-week group loving-kindness meditation (LKM) compared to referral to treatment as usual (RTAU) for college students with PTSD symptoms and problem drinking. Seventy-six college students participated in the current study. Overall, the LKM group was feasible and acceptable to college students, although recruitment of eligible students into the study was lower than expected and attendance at LKM groups was modest. Participants’ PTSD symptoms, drinking quantity, and negative drinking consequences decreased over the course of the study, although there was no significant differences between the LKM and RTAU conditions on these outcomes. Additionally, higher coping drinking motives predicted greater PTSD symptoms and more drinking consequences, highlighting the need for early effective intervention for individuals who drink to cope with their PTSD symptoms

Predictors of suicide in patients with dementia

BackgroundAssessing predictors of suicide and means of completion in patients with dementia may aid the development of interventions to reduce risk of suicide among the growing population of individuals with dementia.MethodsThis national, retrospective, cohort study used data from the Department of Veterans Affairs (fiscal years 2001–2005). The sample included patients ≥60 years old diagnosed with dementia (N = 294,952), of which 241 committed suicide. Potential predictors of suicide were identified using logistic regression. Suicide methods are also reported.ResultsIncreased risk of suicide was associated with white race (OR: 2.4, 95% CI: 1.2, 4.8), depression (OR: 2.0, 95% CI: 1.5, 2.9), a history of inpatient psychiatric hospitalizations (OR: 2.3, 95% CI: 1.5, 3.5), and prescription fills of antidepressants (OR: 2.1, 95% CI: 1.6, 2.8) or anxiolytics (OR: 2.0, 95% CI: 1.5, 2.7). Nursing home admission was associated with lower suicide risk (OR: 0.3, 95% CI: 0.1, 0.8). Severity of medical comorbidity did not affect risk of suicide. Sensitivity analysis indicated that the majority of suicides occurred in those who were newly diagnosed with dementia. Firearms were the most common method of suicide (73%) used.ConclusionsGiven the higher rate of suicide in those receiving treatment for psychiatric symptoms and the high proportion that died using firearms, closer monitoring and assessment of gun access may be an important part of initial treatment planning for older male patients with dementia, particularly those with symptoms of depression or anxiety.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153111/1/alzjjalz201101006.pd

Psychiatric Diagnosis and Intervention in Older and Younger Patients in a Primary Care Clinic: Effect of a Screening and Diagnostic Instrument

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111161/1/j.1532-5415.1998.tb01533.x.pd

Does mindfulness moderate the relationship between protective behavioral strategies and alcohol use in high school seniors?

Decreases in alcohol consumptions have been linked to the use of protective behavioral strategies (PBS) a number of times (Arterberry et al., 2014; Kenny et al., 2014; & Braitman et al., 2014). Trait mindfulness has been researched looking for a link in substance use treatment. Promising results have been found (Grow et al., 2015; Vinci et al., 2014) that have led to the creation of treatment modalities such as Mindfulness-Based Relapse Prevention (Bowen, Charla, Marlatt, 2010). The present study investigates the relation between PBS, mindfulness, and negative outcomes due to alcohol consumption. The participants are part of a larger study (N = 3,352) investigating a brief online alcohol use intervention amongWashington state (n = 1,181) and Swedish high school seniors (n = 2,171). Data was collected at a six-month follow-up via an online survey. Participants completed the 15-item Protective Behavioral Strategies Scale that measures PBS with responses ranging from 1-Never to 6-Always (PBSS; Martens et al., 2007); a 12-item trait mindfulness measure with responses ranging from1-Rarely/Not at all to 4-Almost always (Cognitive and AffectiveMindfulness Scale Revised; Feldman et al., 2007); and the Young Adult Alcohol Problem Screening Test (Hurlbut & Sher, 1992), which measures social and personal problems related to drinking. A regression analysis was performed to assess the relationship between the measures. Significant main effects were found for PBS (p < 0.001) and mindfulness (p < 0.01) on negative consequences of alcohol use. However, there was no moderating effect of mindfulness on the relation between PBS and negative effects of alcohol (p = 0.10). Results support past research on the impact of mindfulness on negative effects of alcohol. Results regarding PBS were not consistent with past literature regarding their impact on decreasing negative effects of alcohol. This may be attributed to a relationship between those individuals using PBS and the amount of negative drinking consequences they already experience. There was not enough evidence to suggest amoderating effect ofmindfulness as a factor that would further decrease negative alcohol effects. Future research could investigate whether a treatment designed to increase the effectiveness of PBS through increased mindfulness is a suitable intervention. This research was supported by NIAAA # 5R01AA018276 awarded to Drs. Larimer & Berglund

Facets of mindfulness predict drinking consequences in a sample of American and Swedish adolescents

Mindfulness-based interventions have become increasingly utilized with individuals with alcohol and substance use disorders (e.g., Bowen et al., 2014); however, the relationship between mindfulness and substance use is complex (Karyadi et al., 2014). Mindfulness is a multifaceted construct and includes factors related to attentional control, present moment focus, and an attitude of non-judgment and acceptance. Thus, the relationship between different mindfulness factors and substance use, and negative consequences related to its use, may differ. In the present study, we examined which specific elements of mindfulness would best predict drinking consequences 6 months later in a sample of American and Swedish adolescents. Additionally, we examined whether adolescents’ nationality would moderate the relationship between mindfulness and drinking consequences. Our sample included Washington St, USA and Swedish adolescents participating in a larger study investigating a brief online intervention for alcohol use (N = 3,352). Participants completed an online survey at 6- and 12-month follow up. At the 6-month follow up, trait-mindfulness wasmeasured using the Cognitive and AffectiveMindfulness Scale-Revised (Feldman et al., 2007). At 12-month follow up, alcohol related negative consequences were measured using the Rutgers Alcohol Problem Index (White & Lobouvie, 1989). Linear regression analysis revealed that mindfulness factors did explain a significant proportion of variance in drinking consequences scores, R2 = 0.02, F(4, 620) = 2.67, p = 0.03. Specifically, the mindfulness factor of attention predicted drinking consequences, such that lower levels of attention predictedmore drinking consequences, b = 0.23, p = 0.02. None of the other mindfulness factors significantly predicted drinking consequences. Adolescents’ nationality did notmoderate the relationship between the mindfulness factors and drinking consequences 6 month later. The present study findings differ from previous findings, which found a relationship between awareness and drinking consequences (Fernandez et al., 2010), although this may be due to differences in how mindfulness factors were conceptualized and assessed. Nationality was not shown to moderate the relationship between mindfulness factors and drinking consequences, suggesting that mindfulness factors may not be culturally bound and may operate consistently across cultures, although examination of additional cultures is needed