Amelia Roberts-Lewis

Differential roles of thought suppression and dispositional mindfulness in posttraumatic stress symptoms and craving

Exposure to traumatic events often results in severe distress which may elicit self-medication behaviors. Yet, some individuals exposed to trauma do not develop post-traumatic stress symptoms and comorbid addictive impulses. In the wake of traumatic events, psychological processes like thought suppression and mindfulness may modulate post-traumatic stress and craving for substances. We examined the differential roles of mindfulness and suppression in comorbid post-traumatic stress and craving among a sample of 125 persons with extensive trauma histories and psychiatric symptoms in residential treatment for substance dependence. Results indicated that thought suppression, rather than extent of trauma history, significantly predicted post-traumatic stress symptom severity while dispositional mindfulness significantly predicted both post-traumatic stress symptoms and craving. In multiple regression models, mindfulness and thought suppression combined explained nearly half of the variance in post-traumatic stress symptoms and one-quarter of the variance in substance craving. Moreover, multivariate path analysis indicated that prior traumatic experience was associated with greater thought suppression, which in turn was correlated with increased post-traumatic stress symptoms and drug craving, whereas dispositional mindfulness was associated with decreased suppression, post-traumatic stress, and craving. The maladaptive strategy of thought suppression appears to be linked with adverse psychological consequences of traumatic life events. In contrast, dispositional mindfulness appears to be a protective factor that buffers individuals from experiencing more severe post-traumatic stress symptoms and craving.

Cognitive and affective mechanisms linking trait mindfulness to craving among individuals in addiction recovery

The present study aimed to identify affective, cognitive, and conative mediators of the relation between trait mindfulness and craving in data culled from an urban sample of 165 persons (in abstinence verified by urinalysis) entering into residential treatment for substance use disorders between 2010 and 2012. Multivariate path analysis adjusting for age, gender, education level, employment status, and substance use frequency indicated that the association between the total trait mindfulness score on the Five Facet Mindfulness Questionnaire and alcohol/drug craving was statistically mediated by negative affect (measured by the PANAS, beta = −.13) and cognitive reappraisal (measured by the CERQ, beta = −.08), but not by readiness to change (measured by the URICA, beta = −.001). Implications for mindfulness-oriented treatment of persons with substance use disorders are discussed. The studys limitations are noted.

Incorporating Gender Specific Approaches for Incarcerated Female Adolescents: Multilevel Risk Model for Practice

The rise in female delinquency has resulted in large numbers of girls being incarcerated in Youth Development Centers (YDC). However, there are few gender specific treatment programs for incarcerated female adolescent offenders, particularly for those with a history of substance dependency. In this article, we present a Multi-level Risk Model (MRM) for the assessment of adolescent female offenders and illustrate how components of effective gender-specific programming are germane for incarcerated teen girls with substance abuse and co-morbid mental health disorders. Application of this model to the HEART (Holistic Enrichment for At-Risk Teens) is presented. Implications for clinical, organizational, and research issues are discussed.

Acceptability of a Social Support Intervention for Re-entering Prisoners

A relatively unexplored area of prisoner reentry programs involves actively engaging the prisoner’s naturally occurring social support in the reentry interventions. Most reentering prisoners rely on loved ones for social support, but that support is often fragile. Interventions that strengthen the sustainability of social support are crucial to a successful reentry. This study evaluates the acceptability of a social support intervention for male prisoners with substance-use disorders who are reentering the community. The manualized, community-based Support Matters intervention is delivered to dyads comprised of a reentering prisoner and a support partner through 10 weekly group sessions. Support Matters teaches cognitive and relational skills that reduce the likelihood of relapse to substance abuse and crime. This acceptability evaluation pilot tested Support Matters with a sample of 30 prisoner-support person dyads and 7 program facilitators to assess the recipients’ and intervention deliverers’ perceptions of the suitability and satisfaction with the program and to gather recommendations for refining Support Matters. Quantitative and qualitative data were collected through semi-structured assessments, individual interviews, and focus groups. Intervention deliverers and recipients indicated the model was satisfactory and appraised Support Matters as highly suitable for this audience. Recipients expressed appreciation for the skills training and the group format. Recommendations for improvements included extending the program length, expanding the content, and incorporating engagement strategies before release from prison. Findings regarding this promising intervention approach will help guide the growing number of scholars and practitioners seeking to improve reentering prisoners’ engagement with positive social supports.

Assessing Change in Psychosocial Functioning of Incarcerated Girls with a Substance Use Disorder: Gender Sensitive Substance Abuse Intervention

The objective of this preliminary study was to determine the effectiveness of a female gender-specific substance abuse treatment intervention (Holistic Enrichment for At-Risk Teens, or HEART) in improving problems related to personal and social functioning. A quasi-experimental, 2-group pretest and posttest repeated measures design was used to evaluate the effectiveness of a treatment intervention with 101 incarcerated girls who met DSM-IV criteria for substance dependence. A repeated measures MANCOVA revealed that the HEART program appeared to be more effective in reducing problems related to social functioning than the standard treatment substance abuse intervention. At posttest, significant differences were found between the treatment and comparison groups on three of the four measures of social functioning: problems with family, problems with friends, and problems with school. No significant differences were found between the 2 groups on 3 posttest measures of personal functioning. A critical need exists for gender-sensitive substance abuse interventions in female juvenile correctional facilities. Implications for policy, practice, and research are discussed.

Using Randomized Controlled Trials to Evaluate Interventions for Releasing Prisoners.

Randomized controlled trials (RCTs) are rarely used to evaluate social and behavioral interventions designed for releasing prisoners. Objective: We use a pilot RCT of a social support intervention (Support Matters) as a case example to discuss obstacles and strategies for conducting RCT intervention evaluations that span prison and community contexts. Method: First, we summarize existing studies with current and former prisoner samples that highlight RCT methodological techniques. Then, we introduce the trial of Support Matters and discuss obstacles and efforts to overcome those obstacles. Results and Conclusions: We focus on factors related to sampling frame, participant eligibility, sample size, engagement, and attrition. We conclude with general recommendations related to project delays, compromised research sites, and retention. This article provides guidance based on lessons learned from an RCT of a social support intervention with releasing prisoners and their loved ones. Barriers discussed and recommendations presented here will help interventionists develop and implement RCTs in prison to community contexts.

Evaluating the Cognitive and Behavioral Outcomes of Incarcerated Adolescent Females Receiving Substance Abuse Treatment: A Pilot Study

The purpose of this pilot study was to evaluate the effectiveness of a cognitive-behavioral approach in changing the behavioral and cognitive skills of incarcerated girls participating in a substance abuse treatment program. A repeated measures design was used. The findings of this study revealed that the behaviors (i.e., self-monitoring, self-control, etc.) and cognitive skills (i.e., cognitive concentration, consequential thinking, etc.) of participants improved significantly. Research and practice implications are discussed.

Female Juvenile Offenders with HEART: Preliminary Findings of an Intervention Model for Female Juvenile Offenders with Substance Use Problems:

This pilot study examined the effectiveness of an intensive, gender specific substance abuse treatment program, Holistic Enrichment for At-Risk Teens (HEART), on the psychosocial functioning of 30 incarcerated girls. A single-group multiple repeated measures design method was used to determine the effectiveness of the HEART program in reducing psychosocial problems associated with the behaviors of problem substance use and delinquency. The results showed that participants in the HEART program displayed significant improvement in eight of ten areas of psychosocial functioning: mental health, family relation, peer relations, educational status, vocational, leisure and recreational skills, and decreases in aggressive behaviors. The conclusion is that it is critical for juvenile correctional facilities to become sites where effective, empirically based treatment is provided.

Enhancing Social Support Postincarceration: Results From a Pilot Randomized Controlled Trial

OBJECTIVE Over 50% of released prisoners are reincarcerated within 3 years. Social support from loved ones postincarceration significantly reduces the likelihood of reincarceration. Increasingly, intervention developers aim to implement interventions that will enhance the stability of support available. This study responds to gaps in knowledge. METHOD The current efficacy study reports findings from a randomized controlled trial (n = 57) of a social support intervention. A priori power analysis indicated moderate effect sizes could be detected. Participants were men, average age was 25 years, and over 90% were African American. Preliminary effects on social support, cognitions, substance use, and rearrest were assessed. Recruitment and consent occurred in prison; the intervention and 4 follow-ups occurred postrelease. RESULTS Findings converge with research indicating declines in social support (b = -.70, p < .05) and perceived quality of support (b = .05, p < .01) over time. Age showed inverse relationships with support (b = -1.77, p < .05). There were no statistically significant group effects for social support, cognitions, substance use (with the exception of marijuana), or recidivism. Clinical implications are discussed. CONCLUSION This study advances research on intervention dosage, potency, and measurement considerations.