Self-Forgiveness,Shame, and Guilt in Recovery from Drug and Alcohol Problems

ABSTRACT

Background: People with drug and/or alcohol problems often experience feelings of shame and guilt, which have been associated with poorer recovery. Self-forgiveness has the potential to reduce these negative experiences. Methods: The current study tested theorized mediators (acceptance, conciliatory behavior, empathy) of the relationships between shame and guilt with self-forgiveness. A cross-sectional sample of 133 individuals (74.4% male) receiving residential treatment for substance abuse completed self-report measures of shame, guilt, self-forgiveness, and the mediators. Results: Consistent with previous research, guilt had a positive association with self-forgiveness, whereas shame was negatively associated with self-forgiveness. Acceptance mediated the guilt and self-forgiveness relationship and had an indirect effect on the shame and self-forgiveness relationship. Conclusions: These findings emphasize the importance of targeting acceptance when trying to reduce the effects of shame and guilt on self-forgiveness.     

Alcohol Consumption and Alcohol Problems Among Women in European Countries

Traditionally, less research has been conducted on women's drinking as compared to men's. But women's drinking has been shown to differ from men's in terms of consumption patterns and in factors determining heavy and problematic drinking. Thus, special efforts are needed to increase knowledge in this field. This article introduces a set of papers from the recently completed concerted action project Alcohol Consumption and Alcohol Problems among Women in European Countries, supported by the European Commission. The aim of the study was to examine and compare the drinking patterns and problems of women in 9 European countries. This was done by comparing alcohol consumption and alcohol problem rates within and between countries and between men and women and among women. The project also developed recommendations for much needed standardized measures of alcohol consumption and alcohol problems for use in European alcohol epidemiological research.     

Why Do Adolescents Drink? Motivational Patterns Related to Alcohol Consumption and Alcohol-Related Problems

The present study was designed to investigate motivational patterns for drinking alcohol and their relation about alcohol consumption and problems related to alcohol consumption. Data were collected by semistructured interviews and questionnaires, containing questions about reasons for drinking, alcohol consumption, and problems related to alcohol consumption during the years 2001, 2004, and 2005. Three independent population samples from two different counties of central Sweden were included. A total of 11,167 adolescents participated. Data on reasons for drinking were analyzed by factor analysis to extract components explaining drinking motives. Relationships between motivational patterns and alcohol use were examined with correlation analysis. Three drinking motives emerged (social-enhancement, coping, and dominance motives) and related to alcohol consumption and problems related to alcohol consumption. Limitations of the study are noted and discussed.     

Alcohol Consumption Patterns: Gay and Lesbian Urban Ethnic Minority Members

ABSTRACT

The aim of this study was to assess patterns of alcohol consumption and alcohol related problems in a sample of lesbian and gay NYC residents. There were no differences between lesbian (n = 93) and gay (n = 90) subgroups with regard to alcohol use and health related variables. The average number of drinking days reported for the previous 30 day period was 6.87 (SD 7.0) and 16% of the sample reported consuming more than 4 drinks per drinking day. Age, educational level, and feelings of excessive restlessness were associated with alcohol use. Although there have been reports of increased rates of alcohol use and alcohol related problems in the lesbian and gay population, this is not reflected in this sample.     

Workplace Responsibility,Stress, Alcohol Availability and Norms as Predictors of Alcohol Consumption-Related Problems Among Employed Workers

The objectives of this study were to determine the prevalence of alcohol use and problems among employed individuals in Alberta, Canada (N = 1,890), and to conduct a multivariate examination of predictors of alcohol consumption-related problems. General alcohol problems were identified by 10%, although very few workers described any specific work-related alcohol problems (1%). Structural equation modeling revealed that, as hypothesized, workplace alcohol availability predicted general alcohol problems. Job responsibility and workplace norms also predicted alcohol problems but only for men. Perceived work stress did not predict alcohol problems. Results support the development of interventions that focus on re-shaping alcohol use norms.     

Alcohol and Tobacco Consumption among Albanian Immigrants in Florence

The aim of the present study was to obtain information about both drinking and smoking, as well as about alcohol consumption-related problems, among Albanians who have immigrated to Florence, Italy, after the collapse of the Communist regime in 1990. Between October 2001 and January 2002, an opportunistic sample of 141 Albanians living in the city of Florence were interviewed about their alcohol and tobacco use, as well as about their drinking pattern and health problems

Interviewees were mainly (81%) males, of an average age of 28, who had been living in Italy for the last 4 years; 92.9% drank alcoholic beverages, the preferred beverages were wine and liquor, and the average daily consumption was 39.5 grams of pure alcohol—males consumed 48.1 grams per day, which was 3.5 times more than a comparable sample of Florentine males. Also Albanians overtook Florentines in terms of the rate of smokers (49.6% vs. 39.6%) and of contact with the emergency rooms (24.1% vs. 0.37%). Such high amounts of alcohol intake may contribute to the reported high rates of accidents and acts of violence involving Albanians in Florence.

Some hypotheses were discussed to explain such a high level of alcohol consumption, including the sociocultural change due to emigration. The study's limitations are noted.     

Alcohol Use and Partner Expectations Among Newly Married Couples

The objective of this work was to determine if a spouse's expectations about a married person's drinking patterns affected his/her partner's alcohol use and alcohol use–related problems. Alcohol use and problems were assessed in a U.S. urban sample of 634 couples at the time they applied for their marriage license (1996–1999) and at their first and second anniversaries. Husbands' expectations about married women's alcohol use, as well as wives' expectations about married men's alcohol use, were assessed at each wave using a three-item scale. Linear regression models were used to identify the longitudinal association between a person's expectations of married individuals' drinking patterns and his/her spouse's alcohol use the following year. Evidence was found to support the relation between one spouse's expectations and his/her partner's alcohol use. However, wives' expectations appeared more influential compared to husbands and this influence is not present at the start of marriage, but rather develops slightly later. The study's limitations are noted.     

Alcohol Consumption Milestones: Comparing First- Versus Last-Reported Age of Onset

Multiple assessments of age of onset of alcohol use milestones may produce inconsistent reports, yielding potentially different results, depending on the report utilized. Using data from a prospective study of 1,023 middle school students, we modeled risk of onset of four drinking milestones as a function of multiple correlates of alcohol use and compared models using first- versus last-reported age for each milestone. While forward telescoping was evident, no significant differences were obtained for any models examined. Substantive conclusions about associations of correlates of early drinking are not greatly impacted by misreporting age of first use.     

Psychosocial Factors in Alcohol Use-Related Problems of Working Youth

This study investigated the psychosocial correlates of alcohol use related problems in a sample of 581 working adolescents (N = 4405), recruited from five vocational schools in Ankara in June 2004 with the CAGE questionnaire, The Beck Depression Inventory, the Beck Hopelessness Scale, the Spielberger State Anxiety Scale, and the Coopersmith Self-Esteem Inventory. Using a multivariate analysis, the anxiety and hopelessness scores, and the length of stay in Ankara were found to be related to alcohol-use problems of the working youth. The study's limitations were noted and future research was suggested.     

Alcohol Expectancies Mediate the Relationship Between Age of First Intoxication and Drinking Outcomes in College Binge Drinkers

Background: While prior research has shown that age of first intoxication (AI) is associated with negative alcohol outcomes, limited research has examined factors accounting for this relationship. Alcohol expectancies, or beliefs about the effects of alcohol, may explain such associations as both positive and negative expectancies have been shown to be key predictors of drinking outcomes. Objective: The present study examined expectancies as mediators between early AI and alcohol-related outcomes. Method: Data collection occurred in 2012 and 2013. Participants were college students (N = 562, 65.8% women) who completed an online survey including measures of alcohol use history, alcohol expectancies, typical alcohol consumption, and alcohol-related problems. Structural equation modeling was used to test the hypothesized model. Results: Our findings support a model whereby AI is associated with drinking through its influence on both positive and negative expectancies. Specifically, an earlier AI was associated with stronger alcohol expectancies, which in turn, was associated with heavier alcohol use and alcohol-related problems. Conclusions/Importance: These findings are consistent with expectancy theory and previous research suggesting that more experienced drinkers hold stronger drinking-related beliefs, be it positive or negative, and these expectancies ultimately explain variability in alcohol use and problems. Our findings further support that expectancies play an important role in the initiation of drinking behavior.     

Pilot Study: Does the Five Shot Questionnaire Give an Indication of the Severity of Alcohol Use–Related Problems?

This study explores whether the Five Shot Questionnaire reflects the severity of alcoholic inpatients' problems, such as assessed clinically by means of the EuropASI. Data were collected from 101 patients admitted to a psychiatric hospital in Belgium for alcohol use–related problems between September 2003 and December 2004. To investigate the research question, regression analyses—linear, ordinal, and binary logistic regression—have been performed. We conclude that the Five Shot Questionnaire gives an indication of the severity of alcohol use–related problems. As such, it can be recommended in general practice and emergency departments for further evaluation and treatment planning. The article ends with a discussion of its limitations and some suggestions for future research.     

Indicators of Sense of Coherence and Alcohol Consumption-Related Problems: The 2000 U.S. National Alcohol Survey

This paper assesses the relationship of Sense of Coherence (SOC) and alcohol consumption-related problems in the 2000 U.S. National Alcohol Survey (4,630 current drinkers). Measures include a 3-item SOC scale, a 15-item social consequences scale, and DSM-IV alcohol dependence. Using logistic regression, a strong SOC was significantly related to not reporting either consequences or dependence. Results underscore the importance of using theoretically-based approaches to examine nonproblematic drinking. The development of interventions that could strengthen SOC deserves future research attention. The study's limitations are noted. Funded by a National Alcohol Research Center Grant (AA-05595-16) from the U.S. National Institute on Alcohol Abuse and Alcoholism to the Alcohol Research Group.     

Alcohol Prevalence and Attitudes Among Adults and Adolescents: Their Relation to Early Adolescent Alcohol Use in Rural Communities

Although research has identified numerous neighborhood mechanisms influencing urban adolescent risk behaviors, less is known about how community contexts influence rural adolescents. This study explores perceived controls against adolescent drinking (i.e., tolerance of community adolescent alcohol use), adolescent perceptions of community supportiveness, and the prevalence of community alcohol use exhibited by adolescents and adults. Multilevel analyses were applied to 1,424 sixth- through eighth-grade students residing in 22 rural communities in the Northern Plains. Perceptions of tolerance, prevalence, and support from 790 parents, teachers, and community leaders were also collected. Analyses revealed that community supportiveness and controls against drinking reduced both the decision to try alcohol and past-month use among early adolescents. Adolescents were more likely to have ever tried alcohol if they lived in a community with higher peer prevalence than higher levels of adult alcohol prevalence, but in communities where peer drinking was lower; adolescents were more likely to have tried alcohol if they lived in a high adult-prevalence community. Perceived peer drinking was not related to past-month use.     

Changes in Alcohol Use and Drinking Problems in Relation to Role Transitions in Different Stages of the Life Course

Older and younger generations are compared with respect to changes in alcohol use and alcohol-related problems associated with role transitions in the life course, using data from a 9-year follow-up study in the Netherlands. Transitions in several role domains are summarized in an index for structure of everyday life. It was hypothesized that role transitions involving an increase in structure of everyday life would lead to a decrease in drinking and in problems. As expected, the association of the index with alcohol use and alcohol related problems was negative among the younger generation. However, contrary to expectation, the association was positive among the older generation. It is concluded that the role-theoretic framework from which our expectations were derived should be amended when used for research among older people. More specific attention to the content of social roles and associated resources and coping mechanisms available at older age is recommended.     

Stages of Change Assessments in Alcohol Problems: Agreement Across Self- and Clinician-Reports

A number of self-report scales and algorithms have been developed to measure stage of change in alcohol problems. These methods rely on client self-reports, but an alternative approach is to use clinician judgments. The purpose of this investigation was to compare approaches including a newly developed Readiness to Change Questionnaire – Clinician Version (RCQ-CV). Clients being assessed for alcohol treatment (N = 64) completed SOCRATES, the Readiness to Change Questionnaire (RCQ), a social desirability scale, and a stage of change algorithm. Clinicians completed the RCQ-CV and provided a simple assessment of stage of change. The agreement among the alternative methods was generally good with the continuous measures, including agreement between scales, between clients and clinicians, and between experienced clinicians and trainees. Agreement among categorical stage assignments was poor. The RCQ-CV shows promise as a clinical and research tool.     

Songwriting to Target State Shame,Guilt, and Pride in Adults with Substance Use Disorder on a Detoxification Unit: A Cluster-Randomized Study

Background: Resultant of engaging in behaviors outside of their value systems to maintain addiction, many people with substance use disorder (SUD) feel shame and guilt. Although shame, guilt, and pride do not represent traditional dependent measures in SUD research, experimental studies targeting these constructs are warranted. Objective: The purpose of this study was to determine the effects of a single songwriting intervention on state shame, guilt, and pride with adults with SUD on a detoxification unit. Method: Participants (N?=?118) were cluster-randomized to songwriting or control conditions. To avoid testing fatigue in this single-session study, experimental participants received a group-based blues songwriting protocol targeting state shame, guilt, and pride and then completed the questionnaire. Control participants completed the questionnaire before receiving an intervention. Results: While there was no significant between-group difference in state shame or guilt, there tended to be slightly lower mean scores in the experimental condition. There was a significant between-group difference in state pride (p = .012), with experimental participants having higher mean scores than control participants. Conclusion: Although only the state pride measure reached significance, shame, guilt, and pride represent consequential constructs for people with SUD. As addressing shame and guilt can be perceived as confrontational, group-based blues songwriting may represent a positive, engaging, and creative intervention to target these challenging but important topics. Implications for clinical practice, limitations, and suggestions for future research are provided.     

Drinking Reasons and Alcohol Problems by Work Venue Among Female Sex Workers in Guangxi,China

Objective: Alcohol use is a key determinant of sexual risk behaviors, but pathways to alcohol use in the context of commercial sex still remain unclear. The present study explores reasons for drinking and their roles on alcohol use problems among female sex workers (FSWs) in different types of commercial sex venues. Method: In 2009, a sample of 1,022 FSWs from Guangxi, China completed a survey containing a 10-item Alcohol Use Disorders Identification Test (AUDIT) and a 28-item measure of reasons for drinking. Factor analysis revealed five reasons for drinking: suppression, disinhibition, work requirement, sexual enhancement, and confidence booster. Results: All identified reasons except confidence booster appeared to be related to a higher tendency of developing alcohol use problems among FSWs. Types of commercial sex venues moderated the relationship between work requirement and alcohol use problems. Conclusions: Alcohol-risk reduction interventions among this population need to provide them with alternative approaches to regulate emotions and modify their misconceptions about alcohol's sexual enhancing function. More attention is needed to FSWs’ vulnerability to the negative influence of occupational drinking.     

Screening and Brief Intervention for Alcohol Problems in an Underserved Population

Abstract

This case reports the implementation of post-care patient interviews to determine whether or not patients received screening and brief intervention (when needed) for alcohol problems.     

Homelessness and Vulnerability among Adults with and without Alcohol Problems

While many works compare traits of homeless adults across levels of alcohol use, few specifically consider whether drinking status affects determinants of either homelessness or “vulnerability” to homelessness. This paper relies on a 1986 Chicago, Illinois sample (n = 535) to consider the potential contributions of resources, social network characteristics, disaffiliation, and mental health problems. Results suggest that resource problems may determine homelessness regardless of drinking status. But drinking-associated problems may raise the resource threshold for “vulnerability,” reduce the protection afforded by social networks against both homelessness and “vulnerability,7rdquo; increase the deleterious impact of disaffiliation, and spur complicating mental health problems. [Translations are provided in the International Abstracts Section of this issue.]     

Alcohol Consumption in Relation to Work Environment and Key Sociodemographic Characteristics Among Female Sex Workers in China

The study explores the variation in pattern of alcohol use and related risk behaviors by types of sex work environments and sociodemographic characteristics among female sex workers (FSWs) in China. Data were collected from 1,022 FSWs in Guangxi, China, through a self-administered questionnaire. Chi-square and analysis of variance (ANOVA) were used to assess the variations. Results showed that younger FSWs were more susceptible than older FSWs to nearly all the risk drinking behaviors. FSWs of non-Han ethnicity as compared with those of Han ethnicity were more at risk of drinking large amounts of alcohol and having sex under the influence of alcohol. FSWs in entertainment establishments were most likely to have all kinds of risk drinking behaviors. Street-based FSWs were least likely to drink alcohol but more or equally likely to engage in alcohol-related sexual risk behaviors. The study highlights a need to develop tailored alcohol risk reduction intervention that takes into consideration these differences.