Exploring the Psychometric Properties of the Spiritual Well-Being Scale Among Individuals with Substance Use Disorders

Although spirituality seems to be an important protective factor in the treatment of addiction, a serious limitation within the current literature involves a lack of research examining the psychometric properties of scales that measure spirituality among individuals struggling with substance use disorders (SUDs). The purpose of this study was to investigate the psychometric properties of the Spiritual Well-Being Scale (SWB) among a sample of 305 individuals recruited from a residential substance abuse treatment center. Exploratory factor analyses supported the scale’s original structure. Validity and reliability tests suggested the SWB could be useful in assessing spiritual well-being among individuals with SUDs.     

Inverse correlations between symptom scores and spiritual well-being among African American patients with first-episode schizophrenia spectrum disorders

Spirituality, religiosity, and spiritual/religious well-being are relatively understudied in the context of severe mental illnesses. Nonetheless, individuals dealing with such disorders, including schizophrenia, often make use of spirituality and religious affiliation as coping resources. In this preliminary study, we examined correlations between psychopathology severity and spiritual well-being among first-episode schizophrenia-spectrum disorder patients. The sample consisted of 18 African American patients hospitalized on an inpatient psychiatric unit in a large, urban, public hospital. After confirmation of diagnosis with the Structured Clinical Interview for DSM-IV Axis I Disorders, symptom severity was rated with the Positive and Negative Syndrome Scale, and self-reported spiritual well-being was evaluated with the Spiritual Well-Being Scale. Spearman correlations revealed that negative symptom scores were inversely correlated with religious well-being scores (rho = -.614; p = 0.007), and that general psychopathology symptom scores were inversely correlated with existential well-being scores (rho = -.539; p = 0.021). These preliminary findings indicate that negative symptoms and general psychopathology symptoms may have a detrimental effect on religious and existential well-being in patients with a first episode of a schizophrenia-spectrum disorder, or that religious and existential well-being may have an effect on symptomatology.     

Addiction and personality

Within the field of substance abuse, it is now widely admitted that the addictive personality does not exist. No one personality type is predisposed to addiction. The predisposition to drug dependence involves many different factors: psychological, social, familial, biological. None of these factors can be the sole determinant of drug dependence. Keeping that in mind, it is of interest to review the recent data on the relationship between personality traits or disorders and opiate and cocaine dependence. Using DSM and ICD categorical assessment, no single personality disorder emerged, instead a range of personality disorders has been evaluated in opiate and cocaine dependent subjects. Every type of personality disorders (PD) existed but cluster BPD were the most common (especially antisocial personality disorder in opiate addicts). However, it is noteworthy that a large minority to a majority of subjects did not display any king of PD. The implication of these results is that antisocial PD is probably over-diagnosed in drug dependence clinical settings. The studies reviewed failed to demonstrate that personality disorders were strong predictors of outcome in opiate or cocaine dependence. However, opiate dependent PD subjects entering treatment had more severe problems and lower retention rate than non PD subjects. But the amount of improvement was not significantly different between PD subjects and non PD subjects. This demonstrated that substance dependent PD patients could benefit from treatment whose intensity and duration must be adjusted. There is good support for the idea that Sensation Seeking trait is a vulnerability factor to substance abuse. But after dependence develops, sensation seeking is probably irrelevant to continued use of the drugs. This break between the psychopathology of vulnerability of substance abuse and the psychopathology of dependence raises the question of the existence of dramatically different factors involved in both phases of addiction.     

Relations of Personality to Substance Use Problems and Mental Health Disorder Symptoms in Two Clinical Samples of Adolescents

There is a high overlap between substance misuse and mental health disorders in adolescents. Certain personality traits (i.e., sensation seeking, impulsivity, hopelessness, and anxiety sensitivity) may be related to increased risk for mental health symptoms and/or substance misuse. The current study examined the relationships between personality and both substance use problems and externalizing and internalizing mental health symptoms in two clinical samples of adolescents. One sample consisted of adolescents receiving treatment for a primary mental health disorder, while the other sample included adolescents receiving treatment for a primary substance use disorder. A total of 116 participants (58 for each sample) completed the Substance Use Risk Profile Scale (SURPS), to examine personality factors, the Brief Child and Family Phone Interview- Self-Report, to examine mental health disorder symptoms, and the Personal Experience Screening Questionnaire, to examine substance use problems. After controlling for age, gender, and sample, sensation seeking and impulsivity were positively related to substance use problems, impulsivity was positively related to symptoms of externalizing disorders, and anxiety sensitivity and hopelessness were positively related to symptoms of internalizing disorders. These findings support the utility of the SURPS in predicting theoretically relevant symptoms in clinical samples of adolescents. Moreover, they extend previous research that has focused on using the SURPS as a predictor of substance misuse to its utility in also predicting mental health disorder symptoms. These findings have implications for improving mental health and addictions treatment services for adolescents.     

Tri-ethnic variations of co-morbid substance and alcohol use disorders in schizophrenia

OBJECTIVES: This study examined the differential prevalence of substance and alcohol use disorders among European Americans, African Americans, and Latinos with schizophrenia (n = 6424) who received public mental health services in San Diego County during fiscal year 2002-2003. METHODS: Data were obtained from the public mental health database used by the San Diego County Mental Health System. Chi-Square analyses and stepwise logistic regression analyses were used to examine differences regarding the prevalence of substance and alcohol use among clients with schizophrenia and schizoaffective disorder, and to analyze the sociodemographic variables associated with this co-morbidity. RESULTS: Significant differences in the prevalence of diagnosed co-morbidity were found across the ethnic groups. Rates of co-morbid diagnosis among African Americans (25%) were significantly higher than those among European Americans (22%) and Latinos (19%). Logistic regression results revealed ethnicity was a significant predictor of co-morbid substance and alcohol use, as was being homeless and male. Among Latinos, language preference was also a significant predictor. Latinos who denoted English as their primary language were 1.7 times more likely to be diagnosed with co-morbid substance or alcohol use disorders than Latinos who denoted Spanish. CONCLUSIONS: Among people with schizophrenia, there were significant differences in prevalence rates and predictors of diagnosed co-morbid substance and alcohol use disorders. Future research is needed to examine the relationship among language preference, level of acculturation, and subsequent diagnosing barriers for Latinos. Among African Americans, the reasons behind increased co-morbidity rates need to be examined, and homelessness should be carefully addressed among all three ethnic groups.     

Spiritual well-being, social desirability and reasons for living: is there a connection?

In order to explore the relationship between spirituality, social desirability, and reasons for living, 100 individuals completed the Reasons for Living Inventory (RFL), the Spiritual Well-being Scale (SWBS) and the Marlowe-Crowne Social Desirability Scale (MCSDS). Positive correlations were found between religious well-being and the total RFL score and Moral Objections subscale and between existential well-being and several RFL scales. Results indicate that the RFL Moral Objections subscale taps the same type of beliefs as does the SWBS religious well-being subscale. There also appears to be a strong relationship between the adaptive cognitive beliefs which people report as reasons for not considering suicide and their existential beliefs. This emphasises the need for careful assessment of individual needs and beliefs when dealing with suicidal individuals. Areas of concern to the therapist who is working with a suicidal client were not affected by high SD scores.     

Relationships Between Treatment Expectations and Treatment Outcomes Among Outpatients with Substance Use Problems

Currently, studies exploring the relationship between treatment expectations (TE) and outcome among individuals with substance use problems are significantly lacking. This is important as relapse and attrition rates among this group are greater than those with other psychological problems. Understanding how TE impact treatment outcomes among this group would provide information to clinicians about which TE to intervene in order to positively influence treatment outcomes. Thus, this eight-month follow-up study investigated TE that could predict treatment outcomes (i.e., clients?? substance use, mood states, number of treatment sessions received and clients?? satisfaction with the service they received) among 130 outpatients with substance use problems. Using binary logistic regression, age, gender and TE were entered as predictors of treatment outcomes. Results showed that those that had higher expectations about taking responsibility and being open in counseling were more likely to report improvements in their main substance of concern. Furthermore, those that had higher expectations for a positive outcome from counseling were more likely to improve their mood especially depression levels. Although TE could not predict attrition, younger clients were more likely to leave treatment without notice or against advice, receive less treatment sessions and be less satisfied with the treatment they received. Individuals that had higher expectations of being open in counseling and for clinicians?? to self-disclosure were more likely to be satisfied with the treatment they received. The findings not only have clinical implications but also implications in relation to developing policies for clinicians working with clients with substance use problems as well as conducting further research in this area.     

An abstinence-oriented program for substance use disorders: poorer outcome associated with opiate dependence.

OBJECTIVES: To evaluate the characteristics of patients with various substance-related disorders, and to examine rates of retention in treatment. METHODS: We assessed the demographic characteristics, substance abuse, and psychological distress of 239 men and women at admission. Six-month performance was evaluated, using as criteria length of stay in treatment, abstinence, attendance in therapy sessions, and completion status at discharge. RESULTS: Moderate to severe psychological distress was observed among these individuals. Higher levels of depression were found among women and in individuals with alcohol and sedative use disorders. The primary drug of abuse, frequency of use, and reason for entering treatment were the most significant predictors of retention. CONCLUSIONS: Opiate-addicted clients had the worst prognosis and treatment profiles. Further research is needed to identify factors that would optimize treatment for opiate dependence.     

Gender Patterns in Borderline Personality Disorder

Gender differences in patients with borderline personality disorder are potentially relevant because they may guide clinicians in assessment and treatment. To date, a number of clinical features in borderline personality disorder have been examined for gender differences. As for prevalence, earlier research concluded that a higher proportion of women than men suffer from borderline personality disorder, although more recent research has determined no differences in prevalence by gender. In addition, there may not be gender differences in borderline personality disorder with respect to specific types of self-harm behavior, such as self-cutting or levels of psychological distress at clinical presentation. However, current evidence indicates that there are notable gender differences in borderline personality disorder with regard to personality traits, Axis I and II comorbidity, and treatment utilization. With regard to personality traits, men with borderline personality disorder are more likely to demonstrate an explosive temperament and higher levels of novelty seeking than women with borderline personality disorder. As for Axis I comorbidity, men with borderline personality disorder are more likely to evidence substance use disorders whereas women with borderline personality disorder are more likely to evidence eating, mood, anxiety, and posttraumatic stress disorders. With regard to Axis II comorbidity, men with borderline personality disorder are more likely than women to evidence antisocial personality disorder. Finally, in terms of treatment utilization, men with borderline personality disorder are more likely to have treatment histories relating to substance abuse whereas women are more likely to have treatment histories characterized by more pharmacotherapy and psychotherapy.     

Co-morbidity of personality disorders in individuals with substance use disorders.

This review summarizes the recent literature about personality disorders among substance abusers. First, it will be shown that personality disorders are highly prevalent co-morbid conditions among addicted individuals. Second, it is argued that this co-morbidity is likely to be accounted for by multiple complex etiological relationships. Finally, the clinical relevance of routine assessment of (maladaptive) personality traits in individuals admitting for substance abuse treatment will be discussed.     

Comorbid personality disorder and treatment use in a community sample of youths: a 20-year follow-up

OBJECTIVE: The impact of comorbid personality disorder (PD) on subsequent treatment and psychotropic drug use was examined in a representative sample of over 700 individuals. METHOD: Axis I disorders and PD were assessed by self- and mother-report at mean ages 13 and 22 years, and by self-report at mean age 33. Mothers reported treatment use by participants before mean age 33; participants reported treatment and psychotropic drug use at mean age 33. RESULTS: Individuals with multiple axis I disorders without PD, axis I disorder-PD comorbidity, and single disorders were compared simultaneously to individuals not diagnosed. Overall, odds of subsequent and past year treatment or psychotropic drug use or both were highest when PD co-occurred with a mood, an anxiety, a disruptive, or a substance use disorder. CONCLUSION: Co-occurring personality pathology may contribute to elevated mental health service use, including use of psychotropic drugs, among young adults in the community.     

Dialectical Behavior Therapy for Multiple Treatment Targets: A Case Study of a Male with Comorbid Personality and Substance Use Disorders

Dialectical behavior therapy has accrued substantial evidence as a treatment for individuals with borderline personality disorder. However, there are only two randomized clinical trials with individuals with comorbid substance use disorders. This case study presents Michael, a male client who sought treatment for his alcohol use, difficulties at work, and struggles with making and maintaining relationships. Michael engaged in dialectical behavior therapy that simultaneously addressed his substance use with comorbid borderline personality disorder. With this approach, the client exhibited reductions in substance use, suicidal ideation, self-harm, and increases in skillful behaviors. Results highlight the importance of continuing assessments with clients and using this information to inform therapy as well as provide an example of how trainees, with close supervision, can implement dialectical behavior therapy with a client with comorbid borderline personality and substance use disorders.     

Factors differentiating personality-disordered individuals with and without a history of unipolar mood disorder

The relationship between mood disorders and personality disorders has been of longstanding interest to clinicians. Despite theoretical reasons to do so, virtually no studies have examined factors that discriminate personality-disordered subjects with a history of mood disorder (PD/HMD) from personality-disordered subjects without a history of mood disorder (PD). This study examined demographic variables, patterns of comorbidity, measures of life functioning, personality traits, and early life experiences differentiating PD/HMD (n = 83) from PD (n = 214). Diagnoses were assigned using structured clinical interviews and a best-estimate procedure. The results suggest that subjects with borderline personality disorder are more likely to have a life history of mood disorder than are subjects with other personality disorders. In addition, PD/HMDs are more likely to receive a diagnosis of anxiety disorder or alcoholism, to have lower Global Assessment of Functioning (GAF) scores, and to have sought treatment than PDs. On self-report measures of personality, PD/HMDs endorse higher levels of trait anxiety and affective lability (e.g., Harm Avoidance, Neuroticism) than do PDs. PD/HMDs are also more likely to report childhood physical and emotional abuse than are PDs, and to describe their parents as using affectionless control. No differences were found between Axis II clusters as a function of mood disorder history. The discussion suggests a potential model in which early environmental stress interacts with constitutional vulnerabilities to put individuals at an increased risk for both mood and anxiety disorders as well as personality disorders.     

Self-harm behavior among individuals with intermittent explosive disorder and personality disorders

Self-harm behaviors are a major public health concern across the lifespan, particularly among individuals with psychiatric disorders. Little research, however, has examined these behaviors among individuals with a diagnosis characterized by recurrent acts of impulsive aggression, Intermittent Explosive Disorder (IED). Furthermore, extant research has not examined variables that might mediate the relationship between IED and self-harm. The current study examined the rates of non-suicidal self-injury (NSSI) and suicide attempts among individuals with IED as compared to healthy controls, individuals with personality disorders (PDs; which are highly comorbid with IED), and individuals with comorbid IED and PD. The study also examined the indirect effects of aggression, impulsivity, and affective lability in the relationship between diagnosis and self-harm. Participants were 1079 community individuals and prevalence rates among the total sample were 18% for NSSI and 13.2% for suicide attempts. Scores on measures aggression, impulsivity, and affect lability showed significant indirect effects on the relationships between IED + PD and NSSI; scores on aggression showed a significant indirect effect on the relationship between PD and NSSI; scores on impulsivity showed a significant indirect effect on the relationship between IED + PD and suicide attempt. These results suggest that individuals with PDs, and particularly those with comorbid IED and PD, are at increased risk for engagement in self-harm behaviors. Furthermore, traits of aggression, impulsivity, and affect lability significantly accounted for the relationship between diagnostic status and self-harm, particularly in regards to NSSI.     

Role of substance abuse comorbidity and personality on the outcome of depression in bipolar disorder: harm avoidance influences medium-term treatment outcome

Comorbid conditions are frequent in bipolar disorder (BD) and may complicate the treatment and course of illness. We investigated the role of substance use disorder (SUD), axis II personality disorders (PD) and continuous personality traits on the medium-term outcome (6 months) of treatment for bipolar depression. One hundred and thirty-nine BD patients meeting criteria for a depressive episode were included in the study. SUD and PD were diagnosed according to structured interviews. Personality dimensions were evaluated by the Temperament and Character Inventory. Depressive severity over time was evaluated by the Hamilton Rating Scale for Depression. Neither PD nor SUD influenced the outcome of depression. Variables independently associated with a poor outcome were a high baseline severity and high scores for the temperamental trait of Harm Avoidance. Though several limitations characterize the present study, neurotic personality traits seem to be associated with a slower recovery from depressive symptoms in BD, independently from their initial severity.     

Effects of religiosity and spirituality on the treatment response in patients with depressive disorders

BackgroundFew studies have investigated the roles of religiosity and spirituality in predicting treatment response among psychiatric patients with depressive disorders.MethodsIn total, 232 outpatients with depressive disorders completed measurements of psychological symptoms, religiosity, and spirituality at baseline. A response was defined as Clinical Global Impression—Improvement scale (CGI-I) score of 1 or 2 at the last visit during a 6-month treatment period. Univariate analyses and logistic regression analysis were used to identify predictors of treatment response.ResultsIn univariate analyses, treatment response was associated with marital status, longer treatment duration, less severe baseline symptoms, higher personal importance of religion, and higher spirituality. In logistic regression analysis, subjective important considerations for religion and spirituality were significantly related with treatment response after controlling for marital status, treatment duration, and baseline symptom severity. Of these variables, spirituality remained a significant predictor in the final model.ConclusionsThese findings suggest that higher spirituality may independently contribute to favorable treatment responses among depressed patients in addition to other demographic and clinical factors.     

Multilevel approach to gender differences in adaptation in father-mother dyads parenting individuals with Autism Spectrum Disorder

BackgroundMost studies of gender differences in the ASD literature present methodological limitations regarding the treatment of dyadic data. This work explored gender differences in the psychological adaptation of a sample of Spanish fathers and mothers of individuals with Autism Spectrum Disorder (ASD) using a multilevel modeling approach (MLM) that accounts for nested data.MethodQuestionnaires including different adaptation measures were completed by 120 father-mother dyads raising individuals with ASD. We designed a two-level model (parents nested in dyads) with three predictor variables at level 1 (parent gender, parent age, and perception of child’s behavior problems) and four predictor variables at level 2 (child age, family income, ASD severity, and time since diagnosis) to examine the influence of these variables on negative and positive psychological outcomes (stress, anxiety, depression, and psychological well-being).ResultsMothers experienced higher levels of stress and anxiety than fathers, even after controlling for interdependence and sociodemographic factors. ASD severity was a significant predictor of both progenitors’ stress and well-being, and family income was also related to psychological well-being, although no gender differences were observed in the way these variables are related to parental outcomes.ConclusionsProfessionals should offer parents support to adjust expectations according to their child’s ASD severity given its relationship to parental stress and well-being. Considering that mothers experience higher levels of stress and anxiety than fathers, clinicians should encourage maternal protective factors. Finally, governments should consider new policies aiming to support ASD families’ treatment expenses.     

Predictors of psychiatric hospitalization for adults with co-occurring substance and mental disorders as compared to adults with mental illness only

Predictors of psychiatric hospitalization, predisposing, enabling and need, of adults with co-occurring mental and substance disorders were compared to predictors for adults with a mental illness only. Research participants were 1613 users of crisis intervention services. Findings using Cox regression show that dually-diagnosed individuals were more likely to be hospitalized. Enabling and need factors were important predictors for both groups. Disruptive behavior was a predictor for dually-diagnosed clients but not for clients with mental illness only. Findings suggest that outpatient mental health services are less well equipped to address a psychiatric crisis when it was accompanied by substance use issues.     

Characteristics of Co-Dependence Among Wives of Persons with Substance Use Disorder in Iran

Substance use disorder is known to adversely affect both the user as well as his or her family members. A consequence of chemical dependence on family members is co-dependence. Co-dependence is associated with an excessive focus on the needs and behaviors of the person with substance use disorder. Most studies in the field of drug-related problems in Iran have focused on the substance user, while few studies have been carried out on the family members. A qualitative case study approach was employed to explore characteristics of co-dependence among wives of persons with substance use disorder in Iran where substance use disorder is a notable social harm. Purposive snowball sampling technique was used to identify 11 Iranian wives of individuals with substance use disorder. The data were collected through in-depth, face-to-face interviews, non-participation observation, and document analysis. Data were analyzed using the constant comparative method. The analysis yielded five main characteristics of co-dependence among wives of persons with substance use disorder, namely: Denial, enabling behavior, low self-worth, enmeshed self, and weak spiritual relationship with God. The findings showed that except for a weak spiritual relationship with God, most of the characteristics of co-dependence among the participants were similar to the traits of co-dependents found in previous studies conducted outside Iran.