Jane Ellen Smith

A randomized trial of two methods for engaging treatment-refusing drug users through concerned significant others.

In a randomized clinical trial, 90 concerned significant others (CSOs) of treatment-refusing illicit drug users were assigned to either (a) community reinforcement and family training (CRAFT), which teaches behavior change skills, (b) CRAFT with additional group aftercare sessions after the completion of the individual sessions; or (c) Al-Anon and Nar-Anon facilitation therapy (Al-Nar FT). All protocols received 12 hr of manual-guided individual treatment. Follow-up rates for the CSOs were consistently at least 96%. The CRAFT conditions were significantly more effective than Al-Nar FT in engaging initially unmotivated drug users into treatment. CRAFT alone engaged 58.6%, CRAFT + aftercare engaged 76.7%, and Al-Nar FT engaged 29.0%. No CSO engaged a treatment-refusing loved one once individual sessions had been completed.

Paranoid and nonparanoid schizophrenic processing of facially displayed affect

It was proposed that differences between paranoid and nonparanoid schizophrenics in the processing of affective information may reflect underlying differences in their schema for emotion-laden information. Performances of 14 paranoid schizophrenics, 13 nonparanoid schizophrenics, and 15 matched controls were compared on a facial affect judgment task, and a matched control task comprising geometric figures largely devoid of emotional information. Subjects were required to rate friendliness, select an emotion label, and subsequently to remember the stimuli. Nonparanoids were deficient in overall labeling of facial affect, suggesting a weak cognitive schema for emotional information. The paranoids were particularly more accurate than the nonparanoids at labeling the negative facial affects, suggesting well-developed negative emotional aspects in their cognitive schema. Unexpectedly, nonparanoids relative to paranoids displayed a greater memory deficit in the recognition of geometric figures than in the recognition of faces. The nonparanoid deficit suggests these subjects may have poorly organized schema for remembering less structured nonverbal information. The findings support the idea of fundamental cognitive processing differences between paranoid and nonparanoid schizophrenia.

The Community Reinforcement Approach to the Treatment of Substance Use Disorders

Empirical support is presented for the Community Reinforcement Approach (CRA), a broad-spectrum cognitive-behavioral treatment for substance use disorders. At the core of CRA is the belief that an individuals environment can play a powerful role in encouraging or discouraging drinking and drug use. Consequently, it attempts to rearrange contingencies so that sober behavior is more rewarding than substance-abusing behavior. Originally tested in the early 1970s with a small sample of alcohol-dependent inpatients, it has repeatedly proven to be successful over the years with larger, diverse populations. Empirical backing is also presented for a new variant of CRA that works through family members to engage treatment-resistant individuals into substance abuse treatment.

The Community Reinforcement Approach.

The Community Reinforcement Approach (CRA), originally developed for individuals with alcohol use disorders, has been successfully employed to treat a variety of substance use disorders for more than 35 years. Based on operant conditioning, CRA helps people rearrange their lifestyles so that healthy, drug-free living becomes rewarding and thereby competes with alcohol and drug use. Consequently, practitioners encourage clients to become progressively involved in alternative non-substance-related pleasant social activities, and to work on enhancing the enjoyment they receive within the “community” of their family and job. Additionally, in the past 10–15 years, researchers have obtained scientific evidence for two off-shoots of CRA that are based on the same operant mechanism. The first variant is Adolescent Community Reinforcement Approach (A-CRA), which targets adolescents with substance use problems and their caregivers. The second approach, Community Reinforcement and Family Training (CRAFT), works through family members to engage treatment-refusing individuals into treatment. An overview of these treatments and their scientific backing is presented.

Getting off the fence:: Procedures to engage treatment-resistant drinkers☆

Historically there have been few options for individuals seeking help for treatment-resistant loved ones with substance abuse problems. This article describes a program with empirical backing called Community Reinforcement and Family Training (CRAFT). This cognitive-behavioral treatment teaches the concerned significant other how to use behavioral principles to reduce the loved ones drinking and to encourage the drinker to seek treatment. Additionally it assists the concerned significant other in alleviating other types of stress and in introducing meaningful reinforcers into his or her own life.

Thin ideal internalization in Mexican girls: A test of the sociocultural model of eating disorders

OBJECTIVE We examined the influence of thin ideal internalization on body dissatisfaction and disordered eating in Mexican girls. METHOD We sampled 137 public school girls aged 12-15 from a small city in Mexico. Participants were given Spanish versions of the sociocultural attitudes toward appearance scale, two measures of body dissatisfaction, the eating attitudes test, and the attitudinal familism scale. RESULTS Thin ideal internalization mediated the relationship between thin ideal awareness and body dissatisfaction, and the relationship between thin ideal awareness and eating disorder symptoms. Attitudinal familism was negatively correlated with thin ideal internalization for girls outside of the normal weight range. CONCLUSION Mexican girls are at risk of eating disorder symptoms, and there is support for the sociocultural model of disordered eating in this population. Hispanic family values may mark protection from thin ideal internalization in Mexican girls outside of the normal weight range.

Community Reinforcement Training with Concerned Others

It is widely acknowledged that problems related to alcohol misuse can seriously affect the lives of family members, friends, and close associates of the drinker (Collins, Leonard, & Searles, 1990; Orford & Harwin, 1982; Paolino & McCrady, 1977). Very often those individuals closest to the drinker are the first to feel the negative effects of problematic drinking. In the past, self-help programs advised individuals who were concerned about someone else’s drinking to disengage or “detach” from the problems of the user and to concentrate on taking care of themselves. In recent years counseling approaches have been developed that include procedures for training concerned others (COs) in more active strategies for dealing with someone else’s drinking. Furthermore, they help COs address areas of their own lives, such that they are better able to recognize and cope with the problems and stresses associated with being close to a problem drinker.

Mediating and moderating effects of stress perception and situation type on coping responses in women with disordered eating.

Effects of stress perception and situation type on coping behavior were assessed in undergraduate females. Women with high (n=28) and low (n=28) Eating Attitudes Test (EAT) scores listened to audiotaped scenes representing two different situation types and two levels of stress. As predicted, the High EAT group rated scenes as more stressful and endorsed more of the maladaptive emotion-oriented coping, compared to the low EAT condition. Importantly, analyses revealed that stress perception mediated the relationship between group membership and emotion-oriented coping. Scene type appeared to moderate the effect of group on emotion-oriented coping. However, stress perception was shown to mediate, or account for, the moderating effect of situation type; a relationship termed mediated moderation. So although the two groups appeared to differ in the effect of situation type on coping, this apparent interaction effect can be attributed to differences in their perception of stress. Finally, women with High EAT scores did not exhibit a deficit in the more productive task-oriented coping behaviors, nor did they exhibit an avoidant coping style. In sum, the maladaptive coping used by women with disordered eating may represent characteristic emotional responses to exaggerated perceptions of stress and a preoccupation with issues specific to body image and food, rather than deficits in productive coping skills or an avoidant coping style.

The Relationship between Posttraumatic Growth and Substance Use in Homeless Women with Histories of Traumatic Experience

Posttraumatic growth (PTG)--namely, the experience of positive change in oneself or ones life following trauma--is particularly relevant for homeless women because they have greater trauma exposure than the general population, as well as higher rates of substance use. The present study examined PTG and substance use in this population. Fifty homeless women with trauma histories participated. In line with predictions, more current substance use was related to less PTG, more reliance on avoidant coping once approach coping was accounted for, and greater PTSD symptomatology. Levels of growth were comparable to those found in samples with less trauma exposure.

Measurement invariance of the Eating Attitudes Test-26 in Caucasian and Hispanic women

To determine whether the EAT-26 functions similarly in Caucasian and Hispanic samples, the current study investigated the factor structure of the Eating Attitudes Test (EAT-26) in 235 undergraduate Caucasian (53.6%) and Hispanic (46.4%) women, and tested for measurement invariance across the two samples. A Confirmatory Factor Analysis (CFA) of the original 3-factor structure of the EAT resulted in a poor fit in both the Caucasian and Hispanic samples. We then performed a CFA using a previously discovered 4-factor, 16-item structure. This abbreviated measure was a good fit in both the Caucasian and Hispanic samples, and the model was invariant across all dimensions tested. The 16-item EAT is a better-fitting measure in Caucasian and Hispanic women than the commonly used EAT-26. This replicates an earlier finding and generalizes those conclusions to a Hispanic sample.