Daniel M. Purnine

Decisional balance regarding substance use among persons with schizophrenia.

State-of-the-science treatment of substanceabuse relies on decisional balance activities (weighingpros and cons of continued substance use) to enhancemotivation for change. Few data are available regarding the feasibility of these activities amongpersons dually diagnosed with schizophrenia andsubstance use disorder. To address this lacuna in theliterature, we completed focus groups with 21participants, all of whom had a schizophrenia-spectrumdiagnosis and lifetime substance abuse or dependence.These key informants discussed the pros and cons ofsubstance use as well as the pros and cons of quitting in response to a structured group interview.Our qualitative data indicate that persons living withschizophrenia can generate rich and diverse decisionalbalance information. We describe salient themes, contrast complementary perspectives (i.e., thepros of using and cons of quitting), and suggesttreatment implications based on thesefindings.

Enhancing Readiness-to-Change Substance Abuse in Persons with Schizophrenia A Four-Session Motivation-Based Intervention

This article describes a four-session intervention designed for persons with co-occurring substance abuse and schizophrenia-spectrum disorders, to be administered as an add-on module to supplement ongoing mental health treatment in an outpatient setting. The intervention targets those dually diagnosed individuals with low readiness-to-change as indicated by current use, and/or lowlevel of engagement in treatment for substance abuse. The intervention is designed to increase problem recognition, to enhance motivation to change maladaptive patterns of substance use, and to facilitate engagement in substance abuse treatment. To achieve these goals, the authors have adopted constructs from the Transtheoretical Model of Change, the authors used principles of motivational and harm reduction interventions, and tailored them to the target population.

Assessing positive and negative symptoms in outpatients with schizophrenia and mood disorders

The Positive and Negative Syndrome Scale (PANSS) was developed to assess symptomatology in inpatients with schizophrenia. We examined its reliability and validity among outpatients with schizophrenia (N = 75) and mood disorders (N = 61). Because the hypothesized three-scale structure of the PANSS has not been supported by existing research, we also examined its factor structure. Interrater reliability for individual items and the positive and negative scales was demonstrated. Evidence supported the internal consistency of each scale in the overall sample and the schizophrenia group but was mixed among those with mood disorders. PANSS scores were higher in the schizophrenia group. These scores, in turn, were lower than those generally reported among inpatients with schizophrenia, providing known-groups validity evidence. Four of five factors were similar to those reported among inpatients with schizophrenia. Together, these results support the use of the PANSS among outpatients and reinforce existing support for assessing positive and negative symptoms in mood disorders.

Methods of changing patterns of substance use among individuals with co-occurring schizophrenia and substance use disorder.

Individuals with a severe mental illness and substance use disorder tend to have medical and social problems and to make slower progress in treatment than those who have either disorder alone. Nevertheless, little attention has been paid to the discovery of effective methods of modifying substance use in the severely mentally ill (SMI). The purpose of this study was to collect qualitative data as a way to help identify techniques that might help to change patterns of substance use in the SMI. The participants were 21 men and women who were psychiatric clinic outpatients and who had a current schizophrenia spectrum diagnosis. A total of 18 participants had a lifetime diagnosis of alcohol abuse or dependence, and 21 lifetime other drug diagnoses were recorded for the sample. These individuals participated in focus group discussions about topics related to substance use and peoples experiences with trying to quit. The results showed that participants identified several therapeutic and extratherapeutic factors that helped them to initiate and maintain changes in their substance use, as well as factors that hindered change. The findings are related to knowledge about the effectiveness of substance use disorder treatment techniques in general, and implications of the data are discussed for the conduct of integrated treatment of individuals with severe mental illness and a substance use disorder.

The Inventory of Dyadic Heterosexual Preferences: Development and psychometric evaluation

This article describes the development and evaluation of an instrument that measures preferences for specific sexual behaviors of heterosexual men and women in a dyadic context. In Study 1, 74 statements of preference were reduced to 46 on the basis of reliability and range of responses. Factor analysis revealed that 27 of the 46 items loaded on 6 factors: Erotophilia, Use of Contraception, Conventionality, Use of Erotica, Use of Drugs/Alcohol, and Romanticism. In Study 2, factor analysis of fresh data from a second sample cross-validated these results. To establish construct validity of the revised 27-item Inventory of Dyadic Heterosexual Preferences (IDHP), relationships between each of its 6 scales and 6 criterion measures were examined. These analyses suggested that the last scale is more accurately characterized by the term Romantic Foreplay. We conclude that the IDHP measures 6 distinct domains of sexual preference with a brief, psychometrically sound instrument. Potential applications of the IDHP, suggestions for future research, and strengths and limitations of the current investigation are discussed.

Age and gender differences in sexual behavior preferences: A follow-up report

This study extends prior research on gender differences in sexual behavior preferences. The authors administered the 6-factors Inventory of Dyadic Heterosexual Preferences (IDHP)1 to 76 married or cohabiting couples (mean age = 35 years). Their preference patterns were compared to similar data obtained previously from younger (mean age = 21 years), single respondents. Gender differences that were replicated included womens stronger preferences for romantic foreplay and mens greater erotophilia and preferences for using erotica and combining alcohol and drug use with sex. Womens stronger conventionality was not replicated among older partners, both of whom were less conventional than their younger counterparts. Older men and women were also more inclined toward the use of erotica. Unlike younger men, older men were more negative toward the use of contraception. Implications for sexual safety, adjustment, communication, and therapy are discussed.