Kurt H. Dermen

The Differential Correlates of Sexual Coercion and Rape

Typically, sexual coercion has been viewed as a less serious form of sexual aggression than attempted rape or rape. However, sexual coercion may be better understood as a qualitatively different type of sexual aggression experience. We examined the correlates of sexual coercion and rape/attempted rape experiences separately among a sample of young women who were at increased risk of sexual victimization as a result of their high levels of sexual activity and alcohol consumption. We hypothesized that personality variables would be associated with sexual coercion but not rape experiences. We found that low self-esteem, low assertiveness, and high sexrelated alcohol expectancies were associated with sexual coercion experiences but not with rape or attempted rape. Higher levels of casual sexual activity and alcohol consumption were associated with both types of experiences. Findings suggest that sexual coercion may be prevented by improving sexual assertiveness and weakening alcohol expectancies to emphasize personal control.

Strategies for Preparing Clients for Treatment: A Review.

Substantial numbers of mental health clients do not return following their initial therapy visits or drop out of treatment prematurely. Two general classes of strategies designed to reduce premature attrition and enhance treatment participation are reviewed. Research on psychotherapy preparatory techniques (role induction, vicarious therapy pretraining, and experiential pretraining) indicates that these educational techniques are effective in reducing early treatment attrition and may be especially effective with populations at high risk for dropout (e.g., lower socioeconomic groups, chronically mentally ill clients, and institutionalized juvenile delinquents). Motivational interviewing, a technique originally developed for clients with alcohol problems, is designed to reduce client ambivalence toward therapy and change and enhance commitment to and motivation for treatment. Research in the alcohol field suggests that a session of pretreatment motivational interviewing enhances treatment outcome. Both motivational interviewing and psychotherapy preparatory techniques are relatively brief and easy to incorporate into existing mental health care.

Indicators of Client Engagement: Influences on Alcohol Treatment Satisfaction and Outcomes

This investigation explored the relationship of client engagement variables (client expectations, therapeutic/working alliance, and session attendance) with treatment satisfaction and posttreatment drinking-related outcomes using data from 2 outpatient alcohol treatment studies (N=208). Path analysis was used to test a model in which engagement variables jointly influence client satisfaction with treatment and subsequent drinking-related outcomes. The proposed model fit well with the data and accounted for 14-23% of the variance in posttreatment outcomes. The relationships in the model suggest that the link between treatment satisfaction and outcome is clarified by examining client engagement variables, which relate indirectly to outcome by means of client satisfaction.

Inhibition conflict and alcohol expectancy as moderators of alcohol's relationship to condom use.

Inhibition conflict theory predicts that alcohol will decrease condom use only among individuals who are highly conflicted about using a condom, whereas expectancy theory predicts such an effect only among individuals who hold strong beliefs about alcohols effects on sexual risk taking. In Study 1, the first of these two theories was tested using a newly developed measure of conflict. Data from 308 college students who reported on the first time they had sexual intercourse with their most recent partner (FMRP) supported the utility of this measure and showed that quantity of alcohol consumed was negatively associated with condom use only among high-conflict individuals. In Study 2, 17- to 25-year-old respondents reported on their first sexual intercourse, FMRP, and last intercourse (ns = 465, 1136, and 984, respectively). In a simultaneous test of both inhibition conflict theory and expectancy theory, amount of alcohol consumed was found to be negatively associated with condom use at first intercourse among individuals high in both conflict and expectancy, at FMRP among high-expectancy individuals, and at last intercourse among high-conflict individuals. These results lend partial support to both theories of alcohols effects and suggest that an integration of these two perspectives will ultimately be required if researchers are to model adequately alcohols effects on human social behavior.

Preparing clients for alcoholism treatment: Effects on treatment participation and outcomes

In this study, 126 clients (87 men, 39 women) entering outpatient alcoholism treatment were assigned randomly to 1 of 3 preparatory conditions: a role induction (RI) session, a motivational interview (MI) session, or a no-preparatory session control group (CG). Clients assigned to the MI preparatory condition attended more treatment sessions and had fewer heavy drinking days during and 12 months after treatment relative to CG clients. Clients assigned to MI, relative to CG clients, also had more abstinent days during treatment and during the first 3 months posttreatment, although this difference was not maintained through the remainder of the 12-month follow-up period. Clients assigned to the RI condition showed no significant advantage over those in the CG condition.

Facilitating involvement in Alcoholics Anonymous during out-patient treatment: a randomized clinical trial.

AIM This study evaluated two strategies to facilitate involvement in Alcoholics Anonymous (AA)--a 12-Step-based directive approach and a motivational enhancement approach--during skills-focused individual treatment. DESIGN Randomized controlled trial with assessments at baseline, end of treatment and 3, 6, 9 and 12 months after treatment. PARTICIPANTS, SETTING AND INTERVENTION: A total of 169 alcoholic out-patients (57 women) assigned randomly to one of three conditions: a directive approach to facilitating AA, a motivational enhancement approach to facilitating AA or treatment as usual, with no special emphasis on AA. MEASUREMENTS Self-report of AA meeting attendance and involvement, alcohol consumption (percentage of days abstinent, percentage of days heavy drinking) and negative alcohol consequences. FINDINGS Participants exposed to the 12-Step directive condition for facilitating AA involvement reported more AA meeting attendance, more evidence of active involvement in AA and a higher percentage of days abstinent relative to participants in the treatment-as-usual comparison group. Evidence also suggested that the effect of the directive strategy on abstinent days was mediated partially through AA involvement. The motivational enhancement approach to facilitating AA had no effect on outcome measures. CONCLUSIONS These results suggest that treatment providers can use a 12-Step-based directive approach to effectively facilitate involvement in AA and thereby improve client outcome.

Alcohol-focused Spouse Involvement and Behavioral Couples Therapy: Evaluation of Enhancements to Drinking Reduction Treatment for Male Problem Drinkers

This study evaluated the effects of alcohol-focused spouse involvement and behavioral couples therapy (BCT) in group drinking reduction treatment for male problem drinkers. Sixty-four male clients and their female partners were randomly assigned to 1 of 3 conditions: treatment for problem drinkers only (PDO), couples alcohol-focused treatment, or the latter combined with BCT. Clients whose partners were included in treatment evidenced fewer heavy drinking days and more abstinent/light drinking days in the year following treatment, relative to PDO clients. The combination of alcohol-focused spouse involvement and BCT yielded no better outcomes than alcohol-focused spouse involvement alone. Drinking consequences, spouse behavioral support for drinking reduction, and relationship satisfaction showed no effects of treatment condition.

Randomized Controlled Trial of Brief Interventions to Reduce College Students’ Drinking and Risky Sex

The present study tested the proposition that an intervention to reduce alcohol use among college students will also reduce their risky sexual behavior. In a randomized controlled trial, 154 heavy-drinking, predominantly White, heterosexual college students at behavioral risk for infection with HIV and other sexually transmitted diseases were assigned to receive no intervention or a two-session, in-person, motivational interviewing-based intervention focused on (a) reducing alcohol risk behavior, (b) reducing HIV risk behavior, or (c) reducing both alcohol and HIV risk behavior. Three-month retrospective assessments of alcohol use and sexual behavior were conducted at intake and at 3-, 6-, 9-, 12-, and 15-month follow-up appointments. During follow-up, participants who received the single-focus alcohol risk-reduction intervention drank less frequently and consumed fewer drinks per drinking day as compared with no-intervention control participants, but did not differ from control participants in their frequency of intercourse without a condom or number of sexual partners. Participants who received the single-focus HIV risk-reduction intervention evidenced fewer unprotected sex events during follow-up, as compared with control participants. The number of sexual partners reported during follow-up did not differ by condition. Effects of the interventions did not vary significantly over time and were not moderated by participant gender. Results suggest that intervening to reduce alcohol use may not reduce risky sexual behavior among nonminority college students, but that a brief motivational intervention targeting HIV risk behavior may have utility for reducing the frequency of unprotected sex in this population.

Characteristics of Participants in Secular Organizations for Sobriety (SOS)

Self-help groups have assisted many in their recovery from alcohol use disorders. Although Alcoholics Anonymous (AA) is the largest self-help organization for addressing alcohol problems, no single organization can be suited to the needs of all alcohol abusers. For example, some alcoholics have chosen not to affiliate with AA because of objections to religious or spiritual references in the 12 steps of AA. It was largely for this reason that a secular self-help organization-Secular Organizations for Sobriety (SOS)-was established. This article provides an overview of SOS. Also described are the results of a survey of SOS participants. These data provide a preliminary picture of SOS members and will, we hope, stimulate further research on this organization and its effectiveness.

Self-reported alcohol expectancies for self and other as a function of behavior type and dosage set.

The hypothesis that expectancies about alcohols effects on behavior vary as a function of behavior type and dosage set was tested in two self-report studies. In Study 1, 85 male and 88 female college students estimated how a moderate versus high dosage of alcohol would affect three social and three nonsocial behaviors selected from Southwick, Steele, Marlatt, and Lindells (1981) alcohol expectancy questionnaire. In Study 2, 61 male and 113 female college students estimated how alcohol would affect the same behaviors, but they estimated the effects on another person (male or female) rather than on themselves. Results from both studies indicated that subjects expected a moderate dose of alcohol to have greater effects on social than nonsocial behavior, and they expected a high dose to have greater effects on nonsocial than social behavior. Gender also influenced the expected strength of alcohol effects.