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Biomedical subjects

William Fals-Stewart

Publications and source records attributed to William Fals-Stewart.

At least 19 recordsLinked to original sources

Brief family treatment intervention to promote aftercare among male substance abusing patients in inpatient detoxification: A quasi-experimental pilot study.

We developed a brief family treatment (BFT) intervention for substance abusing patients in inpatient detoxification to promote aftercare treatment post-detox. BFT consisted of meeting with the patient and a family member (spouse or parent) with whom the patient lived to review and recommend potential aftercare plans for the patient. A phone conference was used when logistics prevented an in-person family meeting. Results indicated that male substance abusing patients who received BFT (N=14), as compared with a matched treatment as usual (TAU) comparison group (N=14) that did not, showed a trend toward being more likely to enter an aftercare program and to attend more days of aftercare in the 3 months after detoxification. The magnitude of these differences favoring BFT over TAU was midway between a medium and a large effect size. Days using alcohol or drugs in the 3 months after detox were lower for treatment-exposed BFT patients who had an in-person family meeting than TAU counterparts (trend, medium effect), and for patients who entered aftercare regardless of treatment condition (significant large effect).

Aftercare↗

Parentification and family responsibility in the family of origin of adult children of alcoholics.

The present study examined parentification and family responsibility in the families of origin of 103 female college students who met criteria for being Adult Children of Alcoholics (ACOAs) as compared to 233 women who did not. The gender of the parent with an alcohol problem (mother only, father only, both parents, neither) was also examined in relation to family roles. Participants completed the Parentification Questionnaire-Adult (PQ-A; Sessions, M. W., and Jurkovic, G. J. (1986). Parentification Questionnaire-Adult (PQ-A). Unpublished document. Department of Psychology, Georgia State University, Atlanta, GA), the Filial Responsibility Scale-Adult (FRS-A; Jurkovic, G. J., and Thirkield, A. (1999). Filial Responsibility Scale-Adult (FRS-A). Unpublished document. Department of Psychology, Georgia State University, Atlanta, GA), the Children of Alcoholics Screening Test (CAST; Jones, J. W. (1983). The Children of Alcoholics Screening Test: Test manual. Chicago: Camelot), and indicated whether they suspected their mother/father of a drinking problem. ACOAs reported more parentification, instrumental caregiving, emotional caregiving, and past unfairness in their families of origin as compared to non-ACOAs. However, as compared to ACOAs who indicated that their father was the alcohol-abusing parent or non-ACOAs, respondents who thought their mothers had an alcohol problem reported greater past unfairness. In addition, ACOAs who thought their mothers had a problem with alcohol abuse reported more parentification and emotional caretaking than did non-ACOAs.

Adolescent↗

Does individual treatment for alcoholic fathers benefit their children? A longitudinal assessment.

Psychosocial adjustment in children of alcoholics (COAs; N=125) was examined before and at 3 follow-ups in the 15 months after their fathers entered alcoholism treatment. Before their fathers' treatment, COAs exhibited greater overall and clinical-level symptomatology than children from the demographically matched comparison sample, but they improved significantly following their fathers' treatment. Children of stably remitted fathers were similar to their demographic counterparts from the comparison sample and had fewer adjustment problems than children of relapsed fathers, even after accounting for children's baseline adjustment. Thus, COAs' adjustment improved when their fathers received treatment for alcoholism, and fathers' recovery from alcoholism was associated with clinically significant reductions in child problems.

Adaptation, Psychological↗

Learning sobriety together: A randomized clinical trial examining behavioral couples therapy with alcoholic female patients.

Married or cohabiting female alcoholic patients (n = 138) and their non-substance-abusing male partners were randomly assigned to 1 of 3 equally intensive interventions: (a) behavioral couples therapy plus individual-based treatment (BCT; n = 46), (b) individual-based treatment only (IBT; n = 46), or (c) psychoeducational attention control treatment (PACT; n = 46). During treatment, participants in BCT showed significantly greater improvement in dyadic adjustment than those in IBT or PACT; drinking frequency was not significantly different among participants in the different conditions. During the 1-year posttreatment follow-up, compared with participants who received IBT or PACT, participants who received BCT reported (a) fewer days of drinking, (b) fewer drinking-related negative consequences, (c) higher dyadic adjustment, and (d) reduced partner violence.

Adult↗

Analytic complexities associated with group therapy in substance abuse treatment research: problems, recommendations, and future directions.

In community-based alcoholism and drug abuse treatment programs, the vast majority of interventions are delivered in a group therapy context. In turn, treatment providers and funding agencies have called for more research on interventions delivered in groups in an effort to make the emerging empirical literature on the treatment of substance abuse more ecologically valid. Unfortunately, the complexity of data structures derived from therapy groups (because of member interdependence and changing membership over time) and the present lack of statistically valid and generally accepted approaches to analyzing these data have had a significant stifling effect on group therapy research. This article (a) describes the analytic challenges inherent in data generated from therapy groups, (b) outlines common (but flawed) analytic and design approaches investigators often use to address these issues (e.g., ignoring group-level nesting, treating data from therapy groups with changing membership as fully hierarchical), and (c) provides recommendations for handling data from therapy groups using presently available methods. In addition, promising data-analytic frameworks that may eventually serve as foundations for the development of more appropriate analytic methods for data from group therapy research (i.e., nonhierarchical data modeling, pattern-mixture approaches) are also briefly described. Although there are other substantial obstacles that impede rigorous research on therapy groups (e.g., evaluation and measurement of group process, limited control over treatment delivery ingredients), addressing data-analytic problems is critical for improving the accuracy of statistical inferences made from research on ecologically valid group-based substance abuse interventions.

Humans↗

Retrospective reports of parenting received in their families of origin: relationships to adult attachment in adult children of alcoholics.

The present study examined general and romantic attachment and parenting students received in their families of origin among 401 college students who resided with an alcohol-abusing parent prior to age 16 years as compared to those who did not reside with alcohol-abusing parents. Participants completed the Children's Report of Parent Behavior Instrument [Schludermann, E. and Schludermann, S. (1970). Children's Report of Parent Behavior Inventory (CRPBI). Canada: University of Manitoba], Experiences in Close Relationships--Revised [Fraley, R. C., Waller, N. G., and Brennan, K. G. (2000). An item response theory analysis of self-report measures of adult attachment. Journal of Personality and Social Psychology, 78, 350-365], Relationship Scale Questionnaire [Griffin, D. W. and Bartholomew, K. (1994). Models of the self and other: Fundamental dimensions underlying measures of adult attachment. Journal of Personality and Social Psychology, 67, 430-445], and the Children of Alcoholics Screening Test [Jones, J. W. (1983). The Children of Alcoholics Screening Test: Test manual. Chicago: Camelot]. Young adults who met criteria for ACOAs reported more anxious and avoidant behavior in romantic relationships and a more fearful style of general adult attachment. Parenting behavior in one's family of origin predicted anxious behavior in romantic relationships and a fearful overall style of attachment, whereas being an ACOA and parenting in one's family of origin predicted avoidant behavior in romantic relationships.

Adolescent↗

Addressing intimate partner violence in substance-abuse treatment.

As the use of partner-involved therapies for alcoholism and drug abuse become more common in substance-abuse treatment programs, providers are more frequently encountering one of the most challenging and politically charged public health issues of our time: intimate partner violence (IPV). Recent investigations reveal 40-60% of married or cohabiting substance-abusing patients report episodes of partner aggression in the year preceding entry into treatment. In this article, the interrelationship between substance use and IPV is examined, with an emphasis on clinical implications and options for substance-abuse treatment providers who are often called upon to address IPV during the course of working with their patients. We also describe different intervention options for IPV, offer recommendations for substance-abuse treatment providers who work with partner-violent couples, and outline future research directions.

Adult↗

The occurrence of male-to-female intimate partner violence on days of men's drinking: the moderating effects of antisocial personality disorder.

In this study, the moderating effects of antisocial personality disorder (ASPD) on the day-to-day relationship between male partner alcohol consumption and male-to-female intimate partner violence (IPV) for men entering a domestic violence treatment program (n=170) or an alcoholism treatment program (n=169) were examined. For both samples, alcohol consumption was associated with an increased likelihood of nonsevere IPV among men without a diagnosis of ASPD but not among men with ASPD (who tended to engage in nonsevere IPV whether they did or did not drink). Drinking was more strongly associated with a likelihood of severe IPV among men with ASPD compared with those without ASPD who also drank. These results provide partial support for a multiple threshold model of intoxication and aggression.

Adult↗

Alcohol consumption and intimate partner violence by alcoholic men: comparing violent and nonviolent conflicts.

Alcoholic men and their relationship partners were interviewed about a conflict in which physical assault occurred and 1 in which psychological aggression occurred without physical assault. The interview assessed the quantity of alcohol consumed prior to each conflict, other drug use, and the topics, location, timing, duration, and speed of escalation for each conflict. The number of standard drinks consumed by the husband in the previous 12 hr was significantly higher prior to violent versus nonviolent conflicts for both self- and collateral reports, as was blood alcohol concentration estimated from self-report. Other drug use was not significantly different. Greater drinking by wives prior to violent conflicts was found in some analyses. These within-subject comparisons help to rule out individual difference explanations for the alcohol-violence association and indicate that alcohol consumption is a proximal risk factor for partner violence in alcoholic men.

Adult↗

Brief relationship therapy for alcoholism: a randomized clinical trial examining clinical efficacy and cost-effectiveness.

The purpose of this study was to examine the clinical efficacy and cost effectiveness of brief relationship therapy (BRT), a shortened version of standard behavioral couples therapy (S-BCT), with alcoholic male patients (N = 100) and their nonsubstance-abusing female partners. Participants were randomly assigned to 1 of 4 treatment conditions: (a) BRT, (b) S-BCT, (c) individual-based treatment (IBT), or (d) psychoeducational attention control treatment (PACT). Equivalency testing revealed that, compared with those assigned to S-BCT, participants who were randomly assigned to BRT had equivalent posttreatment and 12-month follow-up heavy drinking outcomes. Moreover, at 12-month follow-up, heavy drinking and dyadic adjustment outcomes for patients who received BRT were superior to those of patients who received IBT or PACT. BRT was significantly more cost effective than the S-BCT, IBT, or PACT.

Adult↗

Assessing the costs, benefits, cost-benefit ratio, and cost-effectiveness of marital and family treatments: why we should and how we can.

The vast majority of outcome studies examining the effects of marital and family treatments focus exclusively on indicators of and changes in familial functioning and individual members' psychosocial adjustment, but fail to measure, report, or analyze treatment costs, benefits, cost-benefit ratio, or cost-effectiveness. Because of growing concerns about spiraling health care costs, clinical and economic outcomes constitute equally important and complementary aspects of any evaluation of marital and family treatments. The twofold purpose of this article is to define different components of cost analyses of health-related interventions, including marital and family treatments, and to describe methods for calculating and integrating clinical and cost outcome information when evaluating marital and family treatments. There are significant opportunities to promote the use of such treatments by conducting and reporting the results of cost analyses.

Cost-Benefit Analysis↗

When family members go to war--a systemic perspective on harm and healing: comment on Dirkzwager, Bramsen, Adèr, and van der Ploeg (2005).

The article by A. J. E. Dirkzwager, I. Bramsen, H. Adèr, and H. M. van der Ploeg (2005; see record 2005-06518-006) provides compelling evidence of trauma transmission of posttraumatic stress symptoms (PTSS) from male peacekeepers to their female partners. Given the rise in troop deployment throughout the globe and increased exposure of soldiers to combat violence, the investigation is highly relevant, important and timely, illustrating the broad systemic emotional toll on couples when partners go to war. The purpose of this comment is to recommend future research directions (a) to reveal the characteristics of those individuals, couples, and family members that may be predictive of vulnerability and resiliency to PTSS and its sequelae; (b) to understand the interrelationship of PTSS and secondary trauma, relationship adjustment, and social support; and (c) to develop and test intervention methods that may be effective in reducing PTSS and other psychosocial problems among peacekeepers, their partners, and other family members.

Family↗

Partner violence before and after couples-based alcoholism treatment for male alcoholic patients: the role of treatment involvement and abstinence.

This study examined partner violence before and after behavioral couples therapy (BCT) for 303 married or cohabiting male alcoholic patients and used a demographically matched nonalcoholic comparison sample. In the year before BCT, 60% of alcoholic patients had been violent toward their female partner, 5 times the comparison sample rate of 12%. In the 1st and 2nd year after BCT, violence decreased significantly from the year before BCT, and clinically significant violence reductions occurred for patients whose alcoholism was remitted after BCT. Structural equation modeling indicated that greater treatment involvement (attending BCT sessions and using BCT-targeted behaviors) was related to lower violence after BCT and that this association was mediated by reduced problem drinking and enhanced relationship functioning.

Adult↗

Risk factors and neuropsychological recovery in clients with alcohol use disorders who were exposed to different treatments.

Risk covariates of neuropsychological ability (NA) at treatment entry and neuropsychological recovery (NR) across 15 months were examined and replicated in 2 samples (Ns = 952 and 774) from Project MATCH, a multisite study of alcoholism treatments. NA at treatment entry was associated with age, education, and other covariates. Statistically significant mean increases in NA over time had small effect sizes, suggesting limited clinical significance of NR in the samples as a whole. However, initial NA and a combination of risk factors in direct and mediated pathways predicted a large proportion of individual differences in NR. Statistically significant but modest differential treatment effects on NR suggest that addiction treatments may need to be modified or developed to facilitate this important aspect of recovery.

Adult↗

Emotional and behavioral problems of children living with drug-abusing fathers: comparisons with children living with alcohol-abusing and non-substance-abusing fathers.

Although the effects of paternal alcoholism on the psychosocial adjustment of children are well documented, the impact of fathers' illicit drug abuse on their children is poorly understood. The purpose of this study was to compare the adjustment of children living in families with drug-abusing fathers (n = 40) with that of children with fathers who abused alcohol (n = 40) and children with non-substance-abusing fathers (n = 40). Children with drug-abusing fathers experienced more internalizing and externalizing symptoms than children with alcoholic or non-substance-abusing fathers. Interparental conflict and parenting behavior mediated the relationship between family type and children's adjustment. Interventions to improve fathers' parenting behavior and reduce partner conflict may lead to better adjustment among custodial children of drug-abusing fathers.

Adult↗

Substance-abusing parents' attitudes toward allowing their custodial children to participate in treatment: a comparison of mothers versus fathers.

Attitudes of substance-abusing fathers (N = 214) and mothers (N = 106) entering outpatient treatment toward allowing their custodial children to participate in individual- or family-based interventions were examined. Only 129 parents (40%) reported they would be willing to allow their children to participate in treatment. A significantly greater proportion of mothers reported they would assent to their children participating (N = 58 [55%]) compared with fathers (N = 71 [33%]). Factors associated with parents' attitudes toward their children participating included parents' (a) referral source into treatment, (b) level of psychiatric distress, and (c) substance use frequency in the previous year. Thus, parental reluctance to allow their children to participate appears to be a significant barrier in efforts to intervene with these at-risk children.

Adolescent↗

The detection of cognitive impairment among substance-abusing patients: the accuracy of the neuropsychological assessment battery-screening module.

In this investigation, the authors examined the classification accuracy of the Neuropsychological Assessment Battery-Screening Module (NAB-SM) in detecting the presence of general cognitive impairment among substance-abusing patients. The NAB-SM and the Neuropsychological Screening Battery (NSB), which has been shown to discriminate reliably between cognitively impaired and unimpaired substance-abusing patients, were each administered to 84 detoxified substance-abusing patients entering residential treatment. Using participants' performance on the NSB as the criterion measure, the authors found that 30 patients (36%) were cognitively impaired; using the NAB-SM, they classified 32 patients (38%) as cognitively impaired. Levels of agreement and diagnostic efficiency between the 2 batteries were excellent, suggesting the NAB-SM can discriminate accurately between cognitively impaired and unimpaired substance-abusing patients.

Adult↗

A comparison of the psychosocial functioning of children with drug-versus alcohol-dependent fathers.

The present study compared the psychosocial functioning of children whose fathers primarily abused illicit drugs other than alcohol (n = 51 ) to children from a demographically matched sample of families whose fathers abused alcohol (n = 51). Children with drug-abusing (DA) fathers exhibited significantly more negative child behaviors on a standardized child-rating scale than did children from homes with alcohol-abusing fathers. In addition, a significantly greater proportion of children with DA fathers met clinical cutoffs indicative of psychosocial impairment (n = 23: 45%) than did children whose fathers abused alcohol (n = 5; 10%). Mediation analyses indicated that severity of drug, legal, medical, employment, and family problems partially mediated the relationship between type of family (i.e., families with fathers who had an alcohol problem versus families with fathers who had a drug problem) and children's psychosocial adjustment.

Adolescent↗