Life Stress, Coping and Comorbid Youth: An Examination of the Stress-Vulnerability Model for Substance Relapse
The stress-vulnerability model of addiction relapse states that the impact of life stress on alcohol and other drug use is influenced by several types of psychosocial risk and protective factors. Coping skills have been shown to be protective against alcohol or other drug use in adolescents and adults. To date, the influence of life stress and coping on addiction relapse has not been investigated among substance use disordered youth with comorbid Axis I psychopathology. In the present study, 80 adolescents, ages 13 to 17, were followed six months after treatment for substance use and Axis I disorders. Participants completed measures of psychopathology, substance use, life stressors and coping during treatment and at three and six months following treatment. Coping ability best predicted youth substance use at six months. Negative life events moderated the relation between coping and frequency of substance use. These results suggest that coping is a protective factor for return to substance involvement post-treatment, particularly for comorbid youth who have experienced high levels of life stress.
[Show abstract] [Hide abstract] ABSTRACT: Coping strategies (CS) are the efforts made by an individual to manage the internal and external demands of stressful situations. Studies showed that in patients with Substance Use Disorder (SUD), adaptive and problem-focused CS are related to fewer relapses and better treatment outcomes. Considering the high rates of comorbidity between SUD and schizophrenia (SZ), and the deficiencies observed in SZ patients in the use of activeproblem-focused CS, this study aims to explore CS used by SUD patients with and without SZ to deal with treatment. 82 males (18-55 yr.) under treatment for a SUD were considered in two groups: SUD without psychiatric comorbidity (SUD; N=43) and SUD with SZ (SZ+; N=39) and assessed through The Coping Strategies Inventory (CSI). Our results indicated that SUD and SZ+ patients only differed in the amount of Engagement strategies they used. Compared to SUD, SZ+ patients showed lesser use of Problem Solving, Social Support and Self-Criticism, and lower Self-Perceived Capacity to engage the Problem. Besides, compared to norms, SUD and SZ+ patients were less likely to use adaptive CS, although this was more remarkable for SZ+ group. Further studies are needed to explore possible benefits of improving CS as part of treatment outcomes.0Comments 0Citations
- "). Moreover, while successful CS are related to fewer relapses preventing the recurrent course of SUD (Anderson et al., 2006; Kiluk et al., 2011), unsuccessful CS can worsen the disorder leading to poor treatment outcomes and increased severity of dependence (Hruska et al., 2011; Bowen and Enkema, 2014). In this line, studies have found that more approaching and fewer avoidance strategies were also predictors of better substance use treatment outcomes, lower alcohol consumption and drug use at 1-year and long-term follow-ups (Chung et al., 2001; Forys et al., 2007; Hasking et al., 2011). "
[Show abstract] [Hide abstract] ABSTRACT: National efforts have focused on improving adolescent substance use disorder (SUD) treatment outcomes, yet improvements remain modest. Because adolescents are noteworthy for heterogeneity in their clinical profiles, treatment might be enhanced by the identification of clinical subgroups for which interventions could be more effectively tailored. Some of these subgroups, such as those based on abstinence motivation, substance involvement, and psychiatric status are promising candidates. This study examined the unique predictive utility of adolescents' primary reason for alcohol and other drug use. Adolescent outpatients (N = 109; 27% female, aged 14-19) were assessed at treatment intake on their reason for substance use, as well as demographic, substance use, and clinical variables, and reassessed at 3, 6, and 12 months. Reason for use fell into two broad domains: using to enhance a positive state (positive reinforcement [PR]; 47% of youth) and using to cope with a negative state (negative reinforcement [NR]; 53% of youth). Compared with PR patients, NR patients were significantly more substance involved, reported more psychological distress, and had a more extensive treatment history. It is important to note that NR patients showed a significant treatment response, whereas PR patients showed no improvement. PR-NR status also uniquely predicted treatment response and outcome independent of a variety of other predictors, including abstinence motivation, self-efficacy, coping, and prior treatment. Adolescents' primary reason for substance use may provide unique clinical information that could inform treatment planning and patient-treatment matching. (PsycINFO Database Record (c) 2012 APA, all rights reserved).0Comments 8Citations
- "Multiple research studies have identified a number of objective and subjective individual factors that predict treatment response and are related to substance use outcomes and relapse (Anderson, Ramo, & Brown, 2006; Ramo and Brown, 2008; Chung & Maisto, 2006; Sussman et al., 2008; Wei, Heckman, Gay, & Weeks, 2011). Some objective predictors have included prior treatment experiences, criminal justice system involvement, and psychiatric comorbidity; subjective factors have included perceived substance involvement and impairment, motivation for abstinence, self-efficacy, and coping skills (Anderson et al., 2006; Dennis, Scott, Funk, & Foss, 2005 Sussman et al., 2008). Importantly, just as adolescents entering treatment have varying levels of motivation for abstinence, coping skills, and abstinence self-efficacy, as well as unique substance use histories, they may also report different reasons for their substance use. "
[Show abstract] [Hide abstract] ABSTRACT: Substance use disorders are chronically relapsing conditions, and there is a need to evaluate whether relapse precursors are consistent across multiple relapses. We identified latent groups of relapse characteristics over time in adolescents with alcohol and substance use disorders following an inpatient treatment episode. Youth (N = 124, mean age = 16 years, 56% male, 60% Caucasian) were interviewed while in treatment and biannually during the first year after treatment to gather contextual information about first and second relapse episodes. We identified two latent classes of relapse precursors labeled aversive-social (41% at initial relapse, 57% at subsequent relapse) and positive-social (59% at initial relapse, 43% at subsequent relapse). Classes were stable in structure over time; however, only 61% of those assigned to aversive-social and 39% assigned to positive-social classes at initial relapse remained there for the subsequent relapse. Findings highlight the dynamic nature of relapse for youth and have important clinical implications.0Comments 3Citations
- "The dominant clusters of relapse precursors found here suggest that for adolescents, social situational precursors dominate regardless of intrapersonal states (either positive, as in the Positive/Social class, or negative, as in the Aversive-Social class). This is consistent with developmentally focused models of substance use of adolescents and young adults, which suggest less discrimination among youth compared to adults and multiple or cumulative relapse determinants such as temptation and stress (Anderson, Ramo, & Brown, 2006; Christiansen, Goldman, & Brown, 1985). Clinicians should highlight social influence as one of the most high risk situations for all youth, and implement cognitive and behavioral strategies to help youth avoid and manage these situations (e.g., emphasize importance of non-using friends, strategies to remove oneself from unexpected situations of temptations, and to increase accuracy of risk assessments;). "