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PubMed2006

Clinical features associated to refractory obsessive-compulsive disorder.

UNLABELLED: Some patients with obsessive-compulsive disorder (OCD) exhibit an unsatisfactory reduction in symptom severity despite being treated with all the available therapeutic alternatives. The clinical variables associated with treatment-refractoriness in OCD are inconsistently described in the literature. METHODS: To investigate factors associated with treatment-refractoriness of patients with OCD, we conducted a case-control study, comparing 23 patients with treatment-refractory OCD to 26 patients with treatment-responding OCD. RESULTS: The factors associated with refractoriness of OCD were higher severity of symptoms since the onset of OCD (p<0.001), chronic course (p=0.003), lack of a partner (p=0.037), unemployment (p=0.025), low economic status (p=0.015), presence of obsessive-compulsive symptoms of sexual/religious content (p=0.043), and higher scores on family accommodation (p<0.001). Only the three latter variables remained significantly associated with treatment-refractoriness after regression analyses. LIMITATIONS: small sample size, the biases and drawbacks inherent to a case-control study, and the inclusion criteria used to define the study groups may have limited the generalisation of the results. CONCLUSION: A major strength of this study is the systematic and structured evaluation of a vast array of variables related to the clinical expression of OCD, including epigenetic factors and ratings derived from instruments evaluating family accommodation. The presence of sexual/religious symptoms, low economic status and high modification on family function due to OCD were independently associated with treatment-refractoriness. Future longitudinal studies are warranted to verify if these variables represent predictive factors of treatment non-response.

Adult↗
PubMed2004

Enabling behavior in a clinical sample of alcohol-dependent clients and their partners.

Substance use disorders affect not only the identified client but significant others as well. Clinical work and some research suggest that partner responses to drinking may either facilitate or hinder treatment acceptance and recovery efforts. Female partners of male alcoholics have received much of this attention, and have been labeled as codependents or enablers. We administered a clinically derived assessment tool, the Behavioral Enabling Scale, to 42 alcoholic clients and their partners enrolled in a couples counseling program to determine the extent of specific partner behaviors that might reasonably be thought to reinforce drinking or hinder recovery. Results indicated that, among other findings, the majority of both clients and partners reported the partner took over chores or duties from the alcoholic client at some point during the relationship, drank or used other drugs with the client, and lied or made excuses to others to cover for the drinker. Moreover, particular relationship beliefs were associated with higher behavioral enabling scores, providing clear direction for cognitive and behavioral interventions. It is argued that efforts to understand and treat alcohol dependence will be more productive if partner behaviors are incorporated into assessment and intervention procedures.

Adult↗
PubMedDate not supplied

Family relationships of adults with borderline personality disorder.

Current, ongoing interactions between adults exhibiting borderline personality disorder (BPD) traits and their families of origin may influence and maintain self-destructive behavior. Family interactions in such patients are often characterized by coexisting extremes of overinvolvement and underinvolvement by parental figures. Such parental behavior may trigger preexisting role relationship schemata in vulnerable individuals. Negative family reactions to new behavior patterns may make change difficult. A model for how present-day interpersonal patterns lead to self-destructive behavior, based on clinical observations, is proposed and case examples are presented.

Adult↗
PubMedDate not supplied

Therapeutic alliance and the retention of couples in conjoint alcoholism treatment.

Differences were investigated in the degree to which less versus more experienced therapists formed a therapeutic alliance with their clients and how these differences were related to retaining couples in treatment. Two raters, using the Vanderbilt Therapeutic Alliance Scale (VTAS) and the Vanderbilt Negative Indicators Scale (VNIS), coded 15-minute audiotaped segments of the first treatment session for 66 couples participating in a randomized clinical trial of three types of couple therapy for alcoholism. Ten therapists, whose experience ranged from 15 years of postdoctoral practice to a 1 year predoctoral practicum, administered the treatment. Results indicated that the more experienced therapists scored significantly higher on the VTAS and lower on the VNIS than did the less experienced therapists. Therapists' scores on these scales were significantly related to number of treatment sessions attended and number of couples completing treatment, but not to treatment outcomes.

Adult↗
PubMedDate not supplied

The social construction of co-dependency in the treatment of substance abuse.

Co-dependency has become an important concept in the treatment of substance abuse, yet there is still disagreement about what it means. The meaning of co-dependency is important because it shapes public perceptions of helping behavior and affects the treatment that persons with addictions receive. However, some observers have criticized co-dependency, arguing that the concept is gender-biased, denigrates women, and blames innocent victims of substance abuse. This investigation examined the social construction of co-dependency in the treatment of substance abuse by asking substance-abuse counselors three questions: (a) what do they mean by co-dependency, (b) to what extent does co-dependency mean women, and (c) to what extent do they agree. The findings suggest that co-dependency is a reliable social construction that substance-abuse counselors use to describe persons of both genders.

Attitude of Health Personnel↗
PubMed1998

Development and testing of the codependency assessment tool.

Codependency constitutes a significant health risk, particularly for women, because codependent women are often involved in abusive and potentially harmful relationships. Individuals who are identified as codependent can engage in therapy and gain knowledge and freedom from such relationships. However, there is no reliable and valid measure of codependency that is consistently used to identify these individuals. This article describes the development and testing of the Codependency Assessment Tool, a multivariate tool that conceptualizes codependency as a construct comprising five factors: (1) Other Focus/Self-Neglect, (2) Low Self-Worth, (3) Hiding Self, (4) Medical Problems, and (5) Family of Origin Issues. The instrument has excellent reliability and validity. Its test-retest reliabilities = .78 to .94; Cronbach's alpha = .78 to .91. Criterion validity was determined to be established by using known groups; construct validity was established by comparing the codependency dimensions with depression.

Adult↗
PubMed1998

Depression and codependency in women.

Seven million American women are depressed, and 40 million Americans, primarily women, have been labeled as codependent. This study aimed to identify the prevalence of codependency in women undergoing treatment for depression, examine the relationship between codependency and depression, and determine which of the symptoms of codependency are most highly predictive of depression scores. Depression and codependency were measured in a sample of 105 depressed women by using the Beck Depression Inventory and the Codependency Assessment Tool. Descriptive statistics, Pearson's Product Moment Correlation, and multiple regression were used for analysis. Of these depressed women, 36% were moderately to severely codependent. Depression and codependency were strongly related, with the significant gamma = .92 (P < .001). Of the codependency subscales, Low Self-Worth and Hiding Self correlate most strongly with depression; Other Focus/Self-Neglect added the least-independent--explanatory power. Thus, future research should be directed toward the relationship of codependency to power, alienation of self, and personality disorders.

Adult↗
PubMed1999

Codependency in male and female helping professionals.

The purpose of this study is to determine and compare the prevalence of codependency in a group of 77 female and a group of 72 male helping professionals. Relatively low rates of codependency were observed in this sample, and the five-factor structure of the Codependency Assessment Tool (CODAT) was replicated. Males showed slightly higher codependency than females on the total CODAT and on the Hiding Self and Family of Origin Issues subscales. The CODAT was shown to be relevant to both males and females. Further research is needed to determine if a general population of male and female subjects would yield similar results.

Adult↗
PubMed1990

Male heroin addicts and their female mates: impact on disorder and recovery.

A pilot investigation was undertaken to determine whether the social relationships between men who currently used heroin with their female mates differed from those of men who formerly used heroin, but were currently abstinent, with their female mates. Six couples were selected for study via the representative case method. Men currently abstinent from heroin had begun drug use later, had a family history of affective disorders, and had initiated their conjugal relationship after cessation of heroin use. Female mates of males currently abstinent from heroin had never used heroin with their mates in conjunction with sexual activity, had significantly positive ratings of their mates' performance of social roles, and were striving to obtain formal training to improve their employment skills. In contrast, the couples including actively using heroin addicts used opiates together, especially to enhance their sexual activity. The relationships of these couples were not as mutually supportive, and the male's role was less responsible and attracted less respect than that of the abstinent male. The females were depressed and had little positive aspects to their lives. Partners in all couples experienced a large number of stressful events, but current heroin use increased stress and hampered coping efforts. Interaction analysis of dynamics in relationships of men currently abstinent from heroin revealed that participation in mates' family life served to reshape their behaviors into more socially acceptable roles.

Adult↗
PubMed1990

Measuring codependents' close relationships: a preliminary study.

A survey of clinical literature and input from addiction counselors yielded eight commonly assumed characteristics of codependents' relationships. These were defined in a manner amenable to measurement by the Acquaintance Description Form (Wright, 1985), and added to the standard form to provide a codependent version (ADF-C2). Forty-one women and 19 men awaiting or beginning codependent counseling responded to the ADF-C2, and to Friel's Codependency Assessment Inventory and forms soliciting background information. Thirty-nine women and 30 men from the general population provided a comparison group. Although tentative, results were encouraging concerning progress toward measuring codependents' relationships. Broad profiles for both women and men supported the foundational observation that codependents maintain strong commitments to their partners notwithstanding stress and unrewardingness. Specifically, codependent women showed five expected characteristics: Control, Exaggerated Responsibility, Worth Dependency, Rescue Orientation, and Change Orientation. Codependent men showed two: Control and Exaggerated Responsibility.

Alcoholism↗
PubMed1996

Spouse enabling of alcohol abuse: conception, assessment, and modification.

This article presents a conception of spouse enabling of partner alcohol abuse, a review of its dysfunctions, and an approach to assessment and modification to reduce spouse enabling behavior. Based on experience with its use in unilateral family therapy with many spouses of treatment-refusing alcohol abusers, procedural guidelines, treatment methods, two case examples from a crossover experimental dyad, and clinical results for the two cases in the dyad are described. Also presented are practice issues, characteristics of spouse enabling as they relate to disenabling intervention, and areas of possible application of the disenabling program.

Adult↗
PubMed1997

Recovering from alcoholism in communal-living settings: exploring the characteristics of African American men and women.

African American men (n = 33) and women (n = 32) residing in a self-governed, communal-living aftercare program known as Oxford House were surveyed on socio-demographic, personality, recovery, and setting attribute variables. Women, compared to men, were more likely to report sexual abuse as an adult, be diagnosed with an eating disorder, engage in writing bad checks prior to recovery, and claim a stronger perception that Oxford House provided a structured and safe setting. Men, in contrast to women, were more likely to have engaged in drug sales and residential theft prior to recovery, claim less self-doubt about controlling their future life, and report greater attempts at rebuilding interpersonal relations and working 12-step programs. Men and women did not differ significantly in self-reports of co-dependency. Results indicate that gender specific and culturally sensitive characteristics upon both entry and in the course of recovery should be considered in communal facilities such as Oxford House.

Adult↗
PubMed2002

Criterion validity of the interpersonal dependency inventory: a preliminary study on 621 addictive subjects.

The interpersonal dependency inventory comprised three subscales called Emotional reliance of another person (ER), lack of social self confidence (LSS) and Assertion of autonomy (AUT). Several formula have been developed for deriving whole-scale scores. The aim of the study on 621 addictive subjects was to determine the best formula using the DSM-IV dependent personality disorder as gold standard. The formula 3 ER + LSS - AUT yielded the best values of sensitivity and specificity.

Adult↗
PubMed2003

Cigarette smoking, snuff use and alcohol drinking: coexisting risk behaviours for oral health in young males.

OBJECTIVES: The use of oral moist snuff (snus) is widespread among Swedish men, but little is known about the use in adolescents. The aim of this study was to describe patterns of snuff dipping, smoking and alcohol drinking in a sample (n = 6287) of 9th grade male students participating in a census survey in the Stockholm region. RESULTS: About 20% of the sample reported use of snus, and more than two-thirds of snus users were also cigarette smokers. Among current nonusers of tobacco (66% of the sample), 14% reported frequent binge drinking, in contrast to 49% among current exclusive cigarette smokers, 60% among exclusive snus users and 69% among users of both cigarettes and snus. The estimated mean annual consumption of alcohol was 5-10 times higher among tobacco users than among nonusers, with users of snus consuming more alcohol than smokers. Compared to non- or minimal drinkers, heavy alcohol drinkers had a disproportionately higher risk to report snus use, after adjustment for smoking behaviour (OR = 16.7, 95% CI 12.9-21.7). When the analysis was restricted to users of only one type of tobacco, heavy drinkers were twice as likely to report snus, rather than cigarette, use. CONCLUSIONS: Both tobacco use and alcohol drinking have been independently associated with a variety of pathological oral conditions in adults. These behaviours coexist in early adolescence. Their effect on oral health need to be investigated in prospective studies and should be of concern to the dental professionals.

Adolescent↗
PubMed1999

Drug-abusing patients and their intimate partners: dyadic adjustment, relationship stability, and substance use.

The dyadic adjustment and substance use of couples with a drug-abusing husband (n = 94), couples with a drug-abusing wife (n = 36), couples in which both partners abused drugs (n = 87), and non-substance-abusing conflicted couples (n = 70) were examined. For couples with 1 drug-abusing partner, a higher percentage of days abstinent during the year before treatment for drug abuse was associated with a higher level of relationship satisfaction. When both partners abused drugs, the relationship between percentage of days abstinent and relationship satisfaction became stronger and more negative as the time partners spent together using drugs increased. A higher percentage of days abstinent was associated with relationship stability for couples with 1 drug-abusing partner during and 1 year after treatment; for couples in which both partners abused drugs, a higher percentage of days abstinent was associated with relationship instability.

Adult↗
PubMed2002

A meta-analysis of team-efficacy, potency, and performance: interdependence and level of analysis as moderators of observed relationships.

Meta-analytic techniques were used to examine level of analysis and interdependence as moderators of observed relationships between task-specific team-efficacy, generalized potency, and performance. Sixty-seven empirical studies yielding 256 effect sizes were identified and meta-analyzed. Results demonstrated that relationships are moderated by level of analysis. Effect sizes were stronger at the team level (p = .39) than at the individual level (p = .20). At the team level, both team-efficacy and potency had positive relationships with performance (ps = .41 and .37, respectively). Interdependence significantly moderated the relationship between team-efficacy and performance, but not between potency and performance. The relationship between team-efficacy and performance was stronger when interdependence was high (p = .45) than when it was low (p = .34).

Codependency, Psychological↗
PubMed2004

Alcoholics anonymous and relapse prevention as maintenance strategies after conjoint behavioral alcohol treatment for men: 18-month outcomes.

Ninety men with alcohol problems and their female partners were randomly assigned to 1 of 3 outpatient conjoint treatments: alcohol behavioral couples therapy (ABCT), ABCT with relapse prevention techniques (RP/ABCT), or ABCT with interventions encouraging Alcoholics Anonymous (AA) involvement (AA/ABCT). Couples were followed for 18 months after treatment. Across the 3 treatments, drinkers who provided follow-up data maintained abstinence on almost 80% of days during follow-up, with no differences in drinking or marital happiness outcomes between groups. AA/ABCT participants attended AA meetings more often than ABCT or RP/ABCT participants, and their drinking outcomes were more strongly related to concurrent AA attendance. For the entire sample, AA attendance was positively related to abstinence during follow-up in both concurrent and time-lagged analyses. In the RP/ABCT treatment, attendance at posttreatment booster sessions was related to posttreatment abstinence. Across treatment conditions, marital happiness was related positively to abstinence in concurrent but not time-lagged analyses.

Adult↗