Marital Functioning in Early Versus Late-Onset Alcoholic Couples

Current knowledge about alcohol and marital functioning is limited by restrictive sample selection, inattention to the literature on individual-based alcoholic subtypes, and lack of research linking individual differences among alcoholics to marital functioning. The present study was designed to study marital functioning of alcoholics in light of current alcohol typologies. Subjects were part of a larger study on conjoint treatment of alcoholic males and their female partners. Four typologies—including Type 1/2, In-Home/Out-of-home, SteadyIEpisodic, and EarlyILate Onset—were tested for replicability and discriminant validity before linking them to marital functioning. Discriminant validity was found only for the Early (59%)-versus Late (41 %)-Onset typology; thus, further analyses linked only this typology with marital functioning. At baseline, Early-Onset couples reported more marital instability, and the females in these couples were more distressed. During treatment, Early-Onset couples reported higher daily marital satisfaction than Late-Onset couples. Regardless of age of onset, males reported higher marital satisfaction than their spouses during treatment, but their satisfaction did not increase during treatment. Female partners' marital satisfaction increased during treatment. Female partners of Late-Onset males reported particularly low marital satisfaction during treatment. Parsing the sample according to the early-/late-onset typology yielded different predictors of marital satisfaction for males and females within each subtype. For female partners of Early-Onset alcoholics, psychological distress unrelated to her pattner's drinking severity was most associated with her own marital satisfaction, whereas marital adjustment of female partners of Late-Onset alcoholics was most associated with the male's level of perceptual accuracy regarding her needs. This pattern was reversed for the males; marital adjustment of Early-Onset alcoholics was most associated with his partner's perceptual accuracy of his needs, whereas marital functioning of Late-Onset alcoholics was best accounted for by his own psychological distress.     

Sudden gains among women receiving treatment for alcohol use disorders

Understanding the timing and types of change during treatment for mental health disorders is an important step toward elucidating possible mechanisms of behaviour change in response to therapeutic interventions, yet these issues have not been adequately addressed in the alcohol dependence treatment literature. The current study applied sudden gains (SGs) methodology, an approach originally developed in depression treatment studies, to a sample of women receiving treatment for alcohol use disorders. SGs are drastic improvements in symptoms that occur between two psychotherapy sessions and are hypothesised to be the result of what occurred in the first of those two sessions. SGs can happen at any time during the course of treatment, can happen more than once, and are individualised, as opposed to aggregated for a sample. For the current study, SGs were examined across three variables: percent drinking days (PDD), urge frequency (UF), and urge intensity (UI) in a sample of 102 women receiving either individual or couple cognitive-behavioural therapy for alcohol use disorders. Results indicated the presence of SGs; one-third of the sample experienced at least one SG in either alcohol use or urges to drink; the most common SGs were in frequency of urges to drink. SGs in urge frequency during treatment predicted better post-treatment drinking outcome.     

Exploring bidirectional couple violence in a clinical sample of female alcoholics

OBJECTIVE: Research suggests that high levels of dissatisfaction, conflict and aggression characterize the relationships of alcoholics. The present study addressed aspects of bidirectional violence that occur in the relationships of female alcoholics. METHOD: Participants were109 women (and their partners) in a randomized clinical trial comparing individual and couple treatment for female alcoholics. Participants completed the Modified Conflicts Tactics Scale (CTS); four CTS subscales were calculated: Verbal Aggression, Psychological Coercion, Minor Violence and Severe Violence. RESULTS: Sixty-one percent of the couples reported at least some violence (27% severe) between them in the prior year. In 23% of the couples, the woman was more severely violent than the man; in 11% of the couples, the man was more severely violent. CONCLUSIONS: Overall, results suggest that verbal aggression, psychological coercion and physical violence occur in the context of a distressed relationship.     

Precision and accuracy of an ankle-worn accelerometer-based pedometer in step counting and energy expenditure

BACKGROUND: Walking is a widely used approach to increase physical activity levels in obese patients. In this paper, we investigate the precision and accuracy of an ankle-worn dual-axis accelerometer (Stepwatch) and investigate its potential application as a predictor of energy expenditure. METHODS: Twenty healthy subjects (10 lean, 10 obese) wore spring-levered (Accusplit), piezoelectric (Omron HF-100), and Stepwatch pedometers. Subjects walked on a treadmill at 1, 2, and 3 mph and in a hallway at 1 and 1.85 mph, during which energy expenditure was measured. RESULTS: The Stepwatch counted 99.7 +/- 0.67% (mean +/- SEM) of the manual counts. In comparison, the Omron pedometer counted 61 +/- 3.3% and the Accusplit counted 26 +/- 2.8% of the manual counts at 1 mph although all pedometers were accurate (> 98% of counts) at 3 mph. In repeated measures, the Stepwatch produced negligible variance (SD = 0.36) over all speed whereas the other pedometers showed a large amount of variance at all speed (SD = 4-13). Stepwatch counts were predictive of walking energy expenditure corrected by weight (r2 > 0.8). CONCLUSION: The counts from the Stepwatch were virtually identical to the manual counts from a trained investigator and provided a reliable predictor of walking energy expenditure.     

Active ingredients: how and why evidence-based alcohol behavioral treatment interventions work

This article summarizes the proceedings of a symposium that was organized and chaired by Richard Longabaugh and presented at the 2004 Research Society on Alcoholism meeting in Vancouver, British Columbia, Canada. The aim of the presentation was to focus on evidence for the active ingredients of behavioral therapies for patients with alcohol use disorders. Dennis M. Donovan, PhD, reviewed evidence for the active ingredients of cognitive behavioral therapy. Barbara S. McCrady, PhD, presented a conceptual model for mechanisms of change in alcohol behavior couples therapy and reviewed evidence for this model. J. Scott Tonigan, PhD, presented data testing three hypothesized mechanisms of change in twelve-step facilitation treatment. Mitchell P. Karno, PhD, presented therapy process data that tested whether matching therapist behaviors to client attribute across three therapies affected drinking outcomes. Jon Morgenstern served as discussant.     

Stage of change and decisional balance for women seeking alcohol treatment

Stage of change and decisional balance have been used to understand motivation for changes in health behavior. This study examined relationships between these constructs in a sample of 119 alcohol-dependent women presenting for alcohol treatment. Before treatment, participants completed measures of readiness to change and perceived benefits and costs of changing drinking behavior. Results showed that individuals who exhibited greater readiness to change perceived more advantages and fewer disadvantages of changing their drinking behavior. This was true for the scale scores of Precontemplation and Action on the Readiness to Change Questionnaire (RCQ), but Contemplation scale scores were unrelated to decisional balance variables. When analyzed by stage, individuals in Action reported more benefits relative to costs than individuals in Contemplation. Thus, the constructs of stage of change and decisional balance appear to be related and may prove to be useful in enhancing motivation in alcohol-dependent women.     

Gait and balance of transfemoral amputees using passive mechanical and microprocessor-controlled prosthetic knees

BACKGROUND: Microprocessor-controlled knee joints appeared on the market a decade ago. These joints are more sophisticated and more expensive than mechanical ones. The literature is contradictory regarding changes in gait and balance when using these sophisticated devices. METHODS: This study employed a crossover design to assess the comparative performance of a passive mechanical knee prosthesis compared to a microprocessor-controlled knee joint in 15 subjects with an above-knee amputation. Objective measurements of gait and balance were obtained. RESULTS: Subjects demonstrated significantly improved gait characteristics after receiving the microprocessor-controlled prosthetic knee joint (p<0.01). Improvements in gait were a transition from a hyperextended knee to a flexed knee during loading response which resulted in a change from an internal knee flexor moment to a knee extensor moment. The participants' balance also improved (p<0.01). All conditions of the Sensory Organization Test (SOT) demonstrated improvements in equilibrium score. The composite score also increased. CONCLUSIONS: Transfemoral amputees using a microprocessor-controlled knee have significant improvements in gait and balance.     

Improving 24-Month Abstinence and Employment Outcomes for Substance-Dependent Women Receiving Temporary Assistance for Needy Families With Intensive Case Management

Objective. We examined abstinence rates among substance-dependent women receiving Temporary Assistance for Needy Families (TANF) in intensive case management (ICM) over 24 months and whether ICM yielded significantly better employment outcomes compared with a screen-and-refer program (i.e., usual care).Methods. Substance-dependent (n = 302) and non–substance dependent (n = 150) TANF applicants in Essex County, New Jersey, were recruited. We randomly assigned substance-dependent women to ICM or usual care. We interviewed all women at 3, 9, 15, and 24 months.Results. Abstinence rates were higher for the ICM group than for the usual care group through 24 months of follow-up (odds ratio [OR] = 2.11; 95% confidence interval [CI] = 1.36, 3.29). A statistically significant interaction between time and group on number of days employed indicated that the rate of improvement over time in employment was greater for the ICM group than for the usual care group (incidence rate ratio = 1.03; 95% CI = 1.02, 1.04). Additionally, there were greater odds of being employed full time for those in the ICM group (OR = 1.68; 95% CI = 1.12, 2.51).Conclusions. ICM is a promising intervention for managing substance dependence among women receiving TANF and for improving employment rates among this vulnerable population.Substance use disorders are among the most prevalent and costly national health problems. Addressing substance use disorders among low-income mothers has special importance because of the vulnerable nature of the population and the higher prevalence rates of substance use disorders than for other women.^1–4 The passage of welfare reform legislation heightened concerns about the well-being of low-income mothers with substance use disorders and opened new opportunities for system change. Under Temporary Assistance for Needy Families (TANF) regulations, women who fail to participate in mandated work activities face sanction and loss of benefits. At the same time, welfare reform granted much greater latitude to states to develop comprehensive support services, including funding substance use disorders treatment.⁵Recent reviews note that women with substance use disorders represent a minority of TANF populations but experience more severe and persistent barriers to employment and are less likely to become employed than are their counterparts without substance use disorders.^6,7 There is a consensus that women with substance use disorders who receive TANF need services that are more intensive than the rapid labor force attachment approach typically found in welfare settings.⁸ However, there is an absence of research to guide states in evaluating policy and program options.In an earlier study, we reported on substance use outcomes comparing 2 policy-relevant options for women receiving TANF who were diagnosed with substance dependence: (1) a substance use disorders screen-and-refer program, and (2) a substance use disorders screen-and-refer program augmented by intensive case management (ICM) and vouchers.⁹ Substance use disorders screen-and-refer models screen applicants in welfare offices for substance use disorders with paper and pencil screening measures. Applicants screening positive are assessed for substance use disorders, and if treatment is deemed necessary, clients are mandated to a substance use disorders treatment program. This screen-and-refer approach for women with substance use disorders who apply for benefits is the most common strategy that states employ.¹⁰Although screen-and-refer programs focus on case identification and triage to substance use disorders treatment, evidence strongly supports the consideration of more-intensive interventions. Studies of women with substance use disorders who receive TANF indicate high rates of co-occurring mental health and social problems that are not likely to be addressed in substance use disorders treatment.^11,12 In addition, newer conceptualizations of substance use disorders as a chronic illness suggest that interventions should provide extended monitoring over time; coordination of services may improve outcomes when added to standard substance use disorders treatment.^13,14In our earlier study, we found that substance-dependent women receiving TANF in ICM had significantly higher levels of access and retention in substance use disorders treatment and were almost twice as likely to be abstinent 15 months following study entry than were those assigned solely to a screen-and-refer option. In our current study, we had 2 primary aims: to examine whether early group main effects for abstinence were sustained over longer-term follow-up (16–24 months) and to test whether ICM yielded significantly better employment outcomes when compared with screen and refer.To the best of our knowledge, no previous study has reported employment outcomes among women who formerly received TANF either in substance use disorders screen-and-refer programs or in ICM. Testing the effectiveness of policy-relevant interventions for low-income mothers with substance use disorders is vitally connected to health issues post–welfare reform. Women who fail to achieve employment are subject to sanction and loss of social safety net benefits, including Medicaid coverage. Also, programs with demonstrated effectiveness in helping women with substance use disorders gain employment, rather than simply become abstinent, are more likely to receive additional resources from welfare agencies.¹⁵In addition, we had 1 secondary aim. We examined whether previous abstinence predicts later employment outcomes. A guiding supposition among welfare and substance use disorders treatment professionals is that abstinence from mood-altering substances is a necessary first step toward gaining employment.¹⁶ Surprisingly, previous studies have not reported a strong relationship between abstinence and employment outcomes.¹⁷ However, no study has examined this hypothesis in a post–welfare reform context.     

Comparative effectiveness of three types of spouse involvement in outpatient behavioral alcoholism treatment

Treatment was provided to 53 alcoholics and their spouses in one of three outpatient behavioral treatment conditions: minimal spouse involvement (MSI) (N = 21), alcohol-focused spouse involvement (AFSI) (N = 13) or alcohol-focused spouse involvement plus behavioral marital therapy (ABMT) (N = 19). Subjects were followed for 6 months after treatment. All subjects markedly decreased their drinking and reported increased life satisfaction. ABMT subjects were more compliant than AFSI subjects with conjoint homework assignments, decreased their drinking more quickly during treatment, relapsed more slowly after treatment and maintained marital satisfaction better. ABMT subjects were more likely than MSI subjects to stay in treatment and maintained their marital satisfaction better after treatment. Clinical and theoretical significance of the findings are discussed.