Alan A. Cavaiola

Behavioral Sequelae of Physical and/or Sexual Abuse in Adolescents.

In a survey of 500 admissions to a short-term residential chemical dependency treatment center for adolescents (ages 12 to 18), 150 adolescents (30%) had been identified as victims of physical and/or sexual abuse. While the abused group had a higher incidence of prior social service and mental health intervention, extraordinarily 68% of these abuse cases had not been reported by children, family, or interviewers prior to the adolescents having entered the chemical dependency residential treatment facility. This chemically dependent, previously abused group was differentiated from a comparison group of nonabused, chemically dependent adolescents, and a second comparison group of nonabused, nonchemically dependent adolescents. Results indicated a higher incidence of acting out behavior, runaways, legal involvement and sexual promiscuity within the abused group.

Self-Esteem in Abused Chemically Dependent Adolescents.

In a random sample of 500 admissions to a residential treatment center for chemically dependent adolescents. 150 cases of physical and sexual abuse had been identified. These adolescents were matched for age, race, and socioeconomic status, with two comparison groups: a group of nonabused chemically dependent adolescents and a group of nonabused, nonchemically dependent adolescents. Self-esteem was measured, utilizing the Tennessee Self-Concept Scale (TSCS), which was administered to all subjects. The abused, chemically dependent adolescents were found to demonstrate significantly lower self-esteem on all subscales when analyzed against these two comparison groups. There were negligible differences within the abused group when the TSCS scores were analyzed according to type of abuse. Aggressive/physically abused adolescents scored higher on the Physical Self subscale and the incest group scored significantly lower on the Identity subscales. These results suggest that abuse is equally devastating, regardless of the type of abuse, e.g., physical, sexual, incest, and has a long-lasting impact on self-esteem.

Comparison of DWI offenders with non-DWI individuals on the MMPI-2 and the Michigan Alcoholism Screening Test.

Two groups of driving-while-intoxicated (DWI) offenders with either one DWI offense or with repeat offenses were compared to a group of nonoffenders using the Minnesota Multiphasic Personality Inventory (MMPI-2) and the Michigan Alcoholism Screening Test (MAST). Demographic information was also collected regarding their prior legal history, family history, and blood alcohol level at the time of the DWI arrest. The results indicated both DWI groups had scored significantly higher than the comparison group on the K, Psychopathic Deviate (Pd) Scale, Over-Controlled Hostility (O-H) Scale, and MacAndrews Alcoholism Scale-Revised (MAC-R). The first offenders and multiple offenders did not differ significantly from one another. On the MAST, both DWI offender groups scored significantly higher than the nonoffenders. This time, however, the multiple offenders scored significantly higher than the first-offender group. Unexpectedly, the first offenders and multiple offenders did not differ with regards to blood alcohol level at the time of arrest. There were no significant differences noted with regard to prior legal history or family history of alcoholism for all three groups. These results are discussed with regard to assessment implications.

Psychological Distress in Abused, Chemically Dependent Adolescents

ABSTRACT Prior research has identified physical and sexual abuse as prevalent in both adult and adolescent substance use disorder populations. The purpose of this study was to assess whether differences exist in the levels of psychological distress in abused, chemically dependent adolescents when compared to their non-abused counterparts, and to a second comparison group of non-abused, non-chemically dependent adolescents, for the purposes of determining if this might provide a means of differentiating abused adolescents earlier in treatment. Results of the SCL-90-R indicated that abused adolescents demonstrated more severe levels of psychological distress, as well as earlier onset of alcohol and drug use. There were also significant distress profiles that distinguished the abused group from their non-abused counterparts. These findings are discussed with regard to early identification and treatment implications.

Locus of Control in Drinking Driving Offenders and Non-Offenders

Abstract This study assesses the differences in locus of control among drinking driving offenders (DWI) when compared to non-drinking drivers (non-DWI) using Rotters Internal External Locus of Control Scale (I-E) and the Drinking Related Locus of Control Scale (DRIE). DWI offenders demonstrated higher external scores than non-DWI group on both measures, however, on the DRIE, more internality was found for both groups.

The Impact of Social Support and Attachment Style on Quality of Life and Readiness to Change in a Sample of Individuals Receiving Medication-Assisted Treatment for Opioid Dependence

BACKGROUND A basic principle within the addictions treatment field is that social support is a vital ingredient in the recovery process. This study examines the nature of social support in a sample of opioid-dependent men and women who are currently being treated in a medication-assisted treatment program (methadone). This research examines the types of social support behaviors that the opioid-dependent individuals consider helpful and explores whether attachment style (i.e., secure, ambivalent, or anxious attachment) was a determining factor in whether social support was perceived as helpful. The dependent variables included readiness to change addictive behaviors and abstinence from other mood-altering drugs. METHODS Participants (N = 159) completed a demographic questionnaire, the Significant Others Scale, the Experiences in Close Relationships Scale, the Multidimensional Scale of Perceived Social Support Assessment, the Readiness to Change Scale, and an Attachment Style Questionnaire. The demographic questionnaire included subjective ratings of self-improvement. RESULTS Social support predicted perceived improvement in all of the areas examined (e.g., health, family/social relationships) and abstinence; however, attachment style did not predict improvement or with readiness to change. CONCLUSIONS Social support is an important factor in ones recovery from substance use disorders. Yet attachment style (i.e., anxious, avoidant, or secure) did not predict abstinence or overall improvement in functioning.

Perception of Risk for Subsequent Drinking and Driving Related Offenses and Locus of Control among First-Time DUI Offenders

It is estimated that approximately one third of first-time driving-under-the-influence (DUI) offenders are at risk for committing a subsequent offense. To reduce the risk of recidivism, most states require mandatory screening and counseling of convicted DUI offenders. Unfortunately, the majority of offenders are not receptive to either screening or recommendations for further interventions designed to reduce their level of risk. The current study examines the relationship between locus of control and receptivity to risk status. To test this hypothesis, both the Rotter Internal-External Locus of Control Scale (I-E) and the Drinking Related Internal-External Locus of Control Scale (DRIE) were administered to a group of convicted first DUI offenders. The results indicate that the offenders manifesting a more internal locus of control were more receptive to risk information compared to their external locus of control counterparts. Important clinical implications of these findings are discussed.

The Presentation of Dual Diagnosis in an Adolescent Chemical Dependence Unit

Clinical observation of several hundred admissions to a short-term, residential, adolescent chemical dependency unit reveal a number of dual diagnoses cases. This paper discusses the most often occurring dual diagnoses cases, i.e., chemical dependency coexistent with Attention Deficit Disorder, Affective Disorder, Physical Abuse and Sexual Abuse. Diagnostic and treatment issues are presented and discussed.

Considerations in civil commitment of individuals with substance use disorders

Several states currently have enacted laws that allow for civil commitment for individuals diagnosed with severe substance use disorders. Civil commitment or involuntary commitment refers to the legal process by which individuals with mental illness are court-ordered into inpatient and/or outpatient treatment programs. Although initially civil commitment laws were intended for individuals with severe mental illness, these statutes have been extended to cover individuals with severe substance use disorders. Much of the recent legislation allowing for civil commitment of individuals with substance use disorders has come about in response to the heroin epidemic and is designed to provide an alternative to the unrelenting progression of opioid use disorders. Civil commitment also provides an opportunity for individuals with opioid use disorders to make informed decisions regarding ongoing or continued treatment. However, civil commitment also raises concerns regarding the potential violation of 14th Amendment rights, specifically pertaining to abuses of deprivation of liberty or freedom, which are guaranteed under the 14th Amendment to the United States Constitution. This commentary examines these issues while supporting the need for effective brief civil commitment legislation in all states.

The Effects of Equine Assisted Activities Therapy on Plasma Cortisol and Oxytocin Concentrations and Heart Rate Variability in Horses and Measures of Symptoms of Post-Traumatic Stress Disorder in Veterans

&NA; With the increase in the number of horses being used in Equine‐Assisted Activities and Therapies (EAAT) programs and with the increasing concern for animal welfare, it is important to understand the impact of such interventions on the stress level and quality of life for the horses involved. The purpose of the present pilot study was to test the hypothesis that participation in EAAT would acutely alter physiological markers of stress and well‐being, including plasma cortisol, plasma oxytocin, and heart rate variability (HRV), in horses and that symptoms of posttraumatic stress disorder (PTSD) would be reduced after five sessions of EAAT in veterans who had previously been diagnosed with PTSD. Nine healthy geldings, of various breeds, ages 10–23 years, conditioned and experienced as therapeutic riding horses, were selected to participate in the study. Of these, seven were selected at random to wear electrocardiogram units, and all nine were used for blood sampling to measure plasma cortisol and oxytocin. Each horse was randomly assigned to partner with a veteran for five EAAT sessions, 1 hour in duration. A standing control was conducted on a later date on which horses did not participate in EAAT. Measurement after 5 days of EAAT was conducted immediately after the end of the last session on day 5 using the Brief Symptom Inventory and the PCL‐5 (a 20 item self‐report measure of the Diagnostic and Statistical Manual of Mental Disorders ‐ 5 for symptoms of PTSD). Two way repeated measure analysis of variance showed no significant day by time interactions for plasma cortisol (P = .821) or oxytocin (P = .861). There was a significant day by time interaction (P = .006) for heart rate (HR); where on day 1, HR (bpm) was significantly lower during the interaction with the veterans. There were no significant differences in HRV variables. Posttherapy measures in PTSD symptoms in veterans were significantly reduced except for interpersonal sensitivity (P = .08) and phobic anxiety (P = .17). There was an effect of EAAT on HR which was significantly reduced on day 2 during the actual EAAT session. Equine‐Assisted Activities and Therapies had no effect on respiration rate and systolic or diastolic blood pressure in veterans involved in five sessions of EAAT, lasting 60 minutes in duration over the course of 5 days. Stress levels, as demonstrated by plasma cortisol concentrations and HRV, did not change in horses involved in EAAT sessions with veterans who had been previously diagnosed with PTSD. Furthermore, the horses used in this study did not demonstrate increased levels of well‐being as demonstrated by the lack of change in plasma oxytocin concentrations after EAAT sessions. Symptoms of PTSD did change significantly in the veterans who participated in this study.