Article

Life Stress, Coping and Comorbid Youth: An Examination of the Stress-Vulnerability Model for Substance Relapse

Department of Psychology, University of California, San Diego, USA.
Journal of psychoactive drugs (Impact Factor: 1.1). 10/2006; 38(3):255-62. DOI: 10.1080/02791072.2006.10399851
Source: PubMed

ABSTRACT

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.

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    • "). 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). "
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    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.
    No preview · Article · Jun 2015 · Psychiatry Research
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    • "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; Kelly, Dow, Yeterian, Kahler, 2010; 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, Godley, et al., 2007; Kelly et al, 2010; 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. "
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    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).
    Full-text · Article · Dec 2012 · Psychology of Addictive Behaviors
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    • "This environmental modulation of sensitization is especially interesting because it is well known that environmental cues trigger craving and drug-seeking behavior in humans (Childress et al., 1986; Niaura et al., 1988; Carter and Tiffany, 1999). Several animal studies and some human laboratory studies have suggested that exposure to stress increases drug use and is associated with craving and relapse in addicts (Sinha, 2001; Sinha et al., 2006; Anderson et al., 2006; Grusser et al., 2007). Stress/negative affect and drug cues produce increases in anxiety associated with craving, producing a dissociable psychobiological state involving subjective emotional, cardiovascular, and cortisol responses (Sinha et al., 2006; Fox et al., 2007). "
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    ABSTRACT: Several substances that inhibit the induction or expression of behavioral sensitization have been proposed, but patients who present for treatment often have already an established sensitized drug response. Serotonergic agents, including serotonin-2 (5-HT(2)) antagonists, reverse cocaine sensitization, but there is no evidence for the same effect with ethanol, although serotonin involvement in ethanol sensitization has been well reported. To evaluate a 5-HT(2C) antagonist effect on reversing established ethanol sensitization, three experiments were performed assessing locomotor activity of mice under different treatments. First, mice received daily intraperitoneal saline (S), mianserin 10 (M1) or 20 mg/kg (M2), ethanol 2 g/kg (E), or ethanol+mianserin for 21 days. Then, each treatment was withdrawn for 3 days, and mice were randomly challenged with S, E, M1, or M2. During the next 7 days, S and E groups were subjected to daily treatment with S, E, M1, or M2. On the eighth day, all rats were tested under ethanol challenge. The saline group expressed sensitization under ethanol challenge similarly to the ethanol group. Mianserin+ethanol blocked the development of sensitization, suggesting an involvement of the 5-HT(2C) receptor subtype on ethanol-induced sensitization. Ethanol challenge to the chronic mianserin group did not express sensitization, implicating a role for mianserin in protection against stress. Mianserin did not reverse established ethanol sensitization, suggesting that cocaine- and ethanol-induced sensitization involved different mechanisms.
    Full-text · Article · Mar 2008 · Pharmacology Biochemistry and Behavior
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Questions & Answers about this publication

  • Béatrice Marianne Ewalds-Kvist added an answer in Psychoeducation:
    Is anyone currently studying the Stress-Vulnerability Model in psychiatry?

    I am interested in:

    • synthesis of evidence for the elements that make up the model
    • research on the introduction of S-V as a form of psychoeducation
    • development of multimedia methods of explaining the model
    • patient outcomes as a result of being exposed to S-V psychoeducation 

    I have found the patient acceptability for the model to be very high, but I foresee problems in being able to demonstrate patient outcomes - other than knowledge acquisition.

    Thanks in advance,

    Richard.

    Béatrice Marianne Ewalds-Kvist

    Dear Richard, 

    you can contact the authors to these papers here on RG. They all elaborated the stress-vulnerability model. 

    • [Show abstract] [Hide abstract]
      ABSTRACT: 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.
      No preview · Article · Oct 2006 · Journal of psychoactive drugs

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