Publications by authors named "Caroline Easton"

54 Publications

ADVANCE integrated group intervention to address both substance use and intimate partner abuse perpetration by men in substance use treatment: a feasibility randomised controlled trial.

BMC Public Health 2021 05 25;21(1):980. Epub 2021 May 25.

Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.

Background: Substance use is a risk factor for intimate partner abuse (IPA) perpetration. Delivering perpetrator interventions concurrently with substance use treatment shows promise.

Methods: The feasibility of conducting an efficacy and cost-effectiveness trial of the ADVANCE 16-week intervention to reduce IPA by men in substance use treatment was explored. A multicentre, parallel group individually randomised controlled feasibility trial and formative evaluation was conducted. Over three temporal cycles, 104 men who had perpetrated IPA towards a female (ex) partner in the past year were randomly allocated to receive the ADVANCE intervention + substance use treatment as usual (TAU) (n = 54) or TAU only (n = 50) and assessed 16-weeks post-randomisation. Participants' (ex) partners were offered support and 27 provided outcome data. Thirty-one staff and 12 men who attended the intervention participated in focus groups or interviews that were analysed using the framework approach. Pre-specified criteria assessed the feasibility of progression to a definitive trial: 1) ≥ 60% of eligible male participants recruited; 2) intervention acceptable to staff and male participants; 3) ≥ 70% of participants followed-up and 4) levels of substance use and 5) IPA perpetrated by men in the intervention arm did not increase from average baseline level at 16-weeks post-randomisation.

Results: 70.7% (104/147) of eligible men were recruited. The formative evaluation confirmed the intervention's acceptability. Therapeutic alliance and session satisfaction were rated highly. The overall median rate of intervention session attendance (of 14 compulsory sessions) was 28.6% (range 14.3-64.3% by the third cycle). 49.0% (51/104) of men and 63.0% (17/27) of their (ex) partners were followed-up 16-weeks post-randomisation. This increased to 100% of men and women by cycle three. At follow-up, neither substance use nor IPA perpetration had worsened for men in the intervention arm.

Conclusions: It was feasible to deliver the ADVANCE intervention in substance use treatment services, although it proved difficult to collect data from female (ex)partners. While some progression criteria were met, others were not, although improvements were demonstrated by the third cycle. Lessons learned will be implemented into the study design for a definitive trial of the ADVANCE intervention.

Trial Registration: ISRCTN79435190 prospectively registered 22nd May 2018.
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http://dx.doi.org/10.1186/s12889-021-11012-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8147906PMC
May 2021

A meta-analytic review of the relationship between cyber aggression and substance use.

Drug Alcohol Depend 2021 04 9;221:108510. Epub 2021 Feb 9.

Department of Biomedical Sciences, Rochester Institute of Technology, Rochester, NY, United States.

Background: Prior research has demonstrated that various substances of abuse play a contributing role to acts of physical and verbal aggression. It is less clear if and to what extent substance use is associated with an increased risk in perpetrating cyber aggression, an emerging form of aggressive behavior that occurs through digital communication.

Methods: A comprehensive review of the literature resulted in 15 studies and 18 unique samples from which effect size estimates were calculated.

Results: Analyses resulted in a moderate, significant mean observed correlation indicating that individuals who engaged in substance use were more likely than those who did not to perpetrate cyber aggression (r = 0.24, k = 18, 95% CI = 0.20, 0.28). Comparing data across types of substances revealed that alcohol use represents a stronger risk factor for cyber aggression than nicotine, cannabis, or other illicit drugs. Results also suggest a stronger relationship between substance use and cyber aggression among older than younger samples and in the context of intimate partner rather than peer aggression. Comparable estimates of substance-related cyber aggression emerged across types of cyber aggression and perpetrator gender.

Conclusions: Further research is required to increase confidence in estimates used in moderation analyses. As with traditional aggression, alcohol use appears to represent a risk factor for cyber aggression, though it is unclear if the disinhibitory properties of alcohol are the mechanism of action for substance-related cyber aggression.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108510DOI Listing
April 2021

Online Crowdsourcing as a Quasi-Experimental Method for Collecting Data on the Perpetration of Alcohol-Related Partner Aggression.

Trauma Violence Abuse 2020 Aug 10:1524838020946807. Epub 2020 Aug 10.

Rochester Institute of Technology, Rochester, NY, USA.

Cross-sectional survey, prospective, and experimental data have been evaluated to better understand the role of alcohol as a contributing cause of intimate partner aggression. Laboratory-based alcohol administration studies provide controlled data regarding causality, but the use of this methodology lacks ecological validity and has been hampered by rigorous procedural and financial demands. Online crowdsourcing is an emerging pseudoexperimental methodology with low costs, rapid data collection, access to diverse populations, greater ecological validity, and the potential to facilitate prolific research to supplement the chronic scarcity of experimental data. The current rapid review first summarizes prior methodological approaches to investigating the proximal influence of alcohol on partner aggression, then reviews prior crowdsourcing research in the disparate areas of alcohol and partner aggression, then describes aggression paradigms that may be readily adapted to online administration. We conclude by introducing recommendations for future quasi-experimental research investigating alcohol-related partner aggression research using the online crowdsourcing methodology. Initial evidence suggests that online crowdsourcing may yield appropriate samples and that existing paradigms may be adapted to rapidly, efficiently, and ethically supplement experimental alcohol-related partner aggression research.
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http://dx.doi.org/10.1177/1524838020946807DOI Listing
August 2020

A study protocol to assess the feasibility of conducting an evaluation trial of the ADVANCE integrated intervention to address both substance use and intimate partner abuse perpetration to men in substance use treatment.

Pilot Feasibility Stud 2020 11;6:62. Epub 2020 May 11.

9School of Health in Social Science, University of Edinburgh, 8-9 Hope Park Square, Edinburgh, 8HQ 9NW UK.

Background: Strong evidence exists that substance use is a contributory risk factor for intimate partner abuse (IPA) perpetration. Men in substance use treatment are more likely to perpetrate IPA than men from the general population. Despite this, referral pathways are lacking for this group. This trial will assess the feasibility of conducting an evaluation trial of a tailored integrated intervention to address substance use and IPA perpetration to men in substance use treatment.

Methods/design: ADVANCE is a multicentre, parallel-group individually randomised controlled feasibility trial, with a nested formative evaluation, comparing an integrated intervention to reduce IPA + substance use treatment as usual (TAU) to TAU only. One hundred and eight men who have perpetrated IPA in the past 12 months from community substance use treatment in London, the West Midlands, and the South West will be recruited. ADVANCE is a manualised intervention comprising 2-4 individual sessions (2 compulsory) with a keyworker to set goals, develop a personal safety plan and increase motivation and readiness, followed by a 12-session weekly group intervention delivered in substance use services. Men will be randomly allocated (ratio 1:1) to receive the ADVANCE intervention + TAU or TAU only. Men's female (ex) partners will be invited to provide outcome data and offered support from integrated safety services (ISS). Regular case management meetings between substance use and ISS will manage risk. Outcome measures will be obtained at the end of the intervention (approximately 4 months post-randomisation) for all male and female participants. The main objective of this feasibility trial is to estimate parameters required for planning a definitive trial including rates of consent, recruitment, and follow-up by site and group allocation. Nested formative evaluation including focus groups and in-depth interviews will explore the intervention's acceptability to participants, group facilitators, keyworkers and ISS workers. Secondary outcomes include substance use, IPA, mental health, self-management, health and social care service use, criminal justice contacts, and quality of life.

Discussion: Findings from this feasibility trial will inform the design of a multicentre randomised controlled trial evaluating the efficacy and cost-effectiveness of the ADVANCE intervention for reducing IPA and improving the well-being of female (ex)partners.

Trial Registration: ISRCTN79435190.
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http://dx.doi.org/10.1186/s40814-020-00580-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212681PMC
May 2020

Provocation and target gender as moderators of the relationship between acute alcohol use and female perpetrated aggression.

Aggress Violent Behav 2019 May-Jun;40:39-43. Epub 2018 Mar 6.

Rochester Institute of Technology, Department of Biomedical Sciences, 180 Lomb Memorial Dr, Rochester, NY 14623, United States.

Acute alcohol use appears to exert a small but significant effect on female perpetrated aggression in the laboratory but there has been no effort to evaluate comprehensively the situational moderators of this relationship. This preliminary review was intended to explore the moderating effects of provocation and target gender on alcohol-related aggression among females in this understudied area of research. Moderator analyses were conducted on 14 studies. Despite limitations imposed by the sparsity of laboratory based research on alcohol-related aggression among females, initial results suggest that alcohol may exert stronger effects over female aggression following high ( = 0.25, = 8, < .01, 95% CI = 0.10-0.40) rather than low ( = -0.07, = 6, = .52, 95% CI = -0.29-0.15) provocation and when targets of aggression are female ( = 0.19, = 9, = .01, 95% CI = 0.04-0.34) rather than male ( = -0.06, = 4, = .61, 95% CI = -0.30-0.18). Results offer initial insight into situational risk factors pertinent to research and treatment of alcohol-related aggression among females while serving as an impetus for future research in this critical, neglected area of study.
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http://dx.doi.org/10.1016/j.avb.2018.03.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8153192PMC
March 2018

Problematic alcohol use as a risk factor for cyber aggression within romantic relationships.

Am J Addict 2018 Jun 6. Epub 2018 Jun 6.

Rochester Institute of Technology, Department of Biomedical Sciences, Rochester, New York.

Background And Objectives: Cyber aggression has emerged as a modern form of intimate partner violence which has yet to undergo sufficient research necessary to identify risk factors that may increase the likelihood or severity of cyber aggressive behavior toward a relationship partner. Prior research offers contradictory findings pertaining to the relationship between problematic alcohol use and cyber aggression.

Methods: We recruited 100 (40 female) adult participants through online crowdsourcing to complete a series of questionnaires assessing traditional partner violence, cyber aggression, and problematic alcohol use.

Results: Forty-two percent of the sample reported perpetrating cyber relational aggression and 35% reported perpetrating cyber privacy invasion during the year prior to study participation. Traditional partner violence was associated with both forms of cyber aggression. Problematic alcohol use was only associated with privacy invasion after accounting for demographic factors and traditional partner violence.

Discussion And Conclusions: Cyber aggression was prevalent among the current adult sample. Results suggest that problematic alcohol use is a risk factor for cyber privacy invasion but not cyber relational aggression.

Scientific Significance: Findings add to and clarify the nascent, conflicting results that have emerged from prior research on alcohol-related cyber aggression. (Am J Addict 2018;XX:1-7).
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http://dx.doi.org/10.1111/ajad.12736DOI Listing
June 2018

A Randomized Controlled Trial Assessing the Efficacy of Cognitive Behavioral Therapy for Substance-Dependent Domestic Violence Offenders: An Integrated Substance Abuse-Domestic Violence Treatment Approach (SADV).

J Marital Fam Ther 2018 Jul 6;44(3):483-498. Epub 2017 Nov 6.

Yale University School of Medicine SATU.

The current study evaluates a therapy for substance-dependent perpetrators of partner violence. Sixty-three males arrested for partner violence within the past year were randomized to a cognitive behavioral substance abuse-domestic violence (SADV; n = 29) or a drug counseling (DC; n = 34) condition. Seventy percent of offenders completed eight core sessions with no differences between SADV and DC conditions in the amount of substance or aggression at pretreatment. SADV participants had fewer cocaine-positive toxicology screens and breathalyzer results during treatment, were less likely to engage in aggressive behavior proximal to a drinking episode, and reported fewer episodes of violence than DC participants at posttreatment follow-up. SADV shows promise in decreasing addiction and partner violence among substance-dependent male offenders.
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http://dx.doi.org/10.1111/jmft.12260DOI Listing
July 2018

Integrated treatment options for male perpetrators of intimate partner violence.

Drug Alcohol Rev 2017 01 21;36(1):24-33. Epub 2017 Jan 21.

Department of Biomedical Sciences, Rochester Institute of Technology, Rochester, USA.

Issues: Male-to-female intimate partner violence remains a worldwide public health issue with adverse physical and psychological consequences for victims, perpetrators and children. Personality disorders, addiction, trauma and mood symptoms are established risk factors for intimate partner violence perpetration and factor prominently into a recovery-oriented treatment approach.

Approach: We reviewed the partner violence literature for detailed reports of traditional as well as innovative, integrated treatment approaches. Empirically based recommendations for intervention programs and the policies that guide intervention efforts are offered.

Key Findings: Nascent research suggests that integrated treatment models utilising a holistic approach to account for psychological comorbidity and interventions that involve a motivational interviewing component appear promising in terms of significantly improving intimate partner violence treatment compliance and reducing subsequent acts of physical partner violence. Further, methodologically rigorous research is required to fully assess the benefits of traditional and integrated treatment options.

Implications: We have advanced several recommendations, including the development of and exclusive reliance upon empirically supported treatments, conducting a thorough risk and needs assessment of the offender and the immediate family to facilitate appropriate treatment referrals, integrating content to foster the offender's internal motivation to change maladaptive behaviours, and attempting to minimise offender treatment burdens through the strategic use of integrated treatment models.

Conclusions: Intimate partner violence is a complicated and nuanced problem that is perpetrated by a heterogeneous population and requires greater variability in integrated treatment options. [Crane CA, Easton CJ. Integrated treatment options for male perpetrators of intimate partner violence. Drug Alcohol Rev 2017;36:24-33].
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http://dx.doi.org/10.1111/dar.12496DOI Listing
January 2017

The proximal effects of acute alcohol use on female aggression: A meta-analytic review of the experimental literature.

Psychol Addict Behav 2017 Feb 12;31(1):21-26. Epub 2017 Jan 12.

Department of Biomedical Sciences, Rochester Institute of Technology.

Experimental research on alcohol-related aggression has focused largely upon male participants, providing only a limited understanding of the proximal effects of acute alcohol use on aggression among females extrapolated from the male literature. The current meta-analysis was undertaken to summarize the effects of alcohol, compared to placebo or no alcohol, on female aggression as observed across experimental investigations. A review of the literature yielded 11 articles and 12 effect sizes for further analysis. The overall effect size of alcohol on female aggression was small and reached statistical significance (d = .17, p = .02, 95% confidence interval [.03, .30]). Meta-analytic examination of the experimental literature indicated that alcohol is a significant factor in female aggression. The overall alcohol-aggression effect was smaller than has been observed among male samples. Additional research is required to evaluate the influence of other factors on alcohol-related aggressive responding among female participants. (PsycINFO Database Record
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http://dx.doi.org/10.1037/adb0000244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5514292PMC
February 2017

Interventions to reduce intimate partner violence perpetration among people with substance use disorders.

Int Rev Psychiatry 2016 10;28(5):533-543

a Department of Biomedical Sciences , Rochester Institute of Technology , Rochester , NY , USA.

The social and economic cost of intimate partner violence (IPV) is exorbitant and highlights the need for policy reform as it pertains to IPV interventions at a global level. There are multiple variables associated with the aetiology of IPV and, hence, multiple treatment needs must be considered. Substance use is one of several factors likely to influence the occurrence of IPV, but often goes unaddressed in standard treatment approaches. This review will discuss several treatment models for substance using offenders of IPV, including Psycho-educational Models, Cognitive Behavioural Therapy, Couples' Treatments, Parenting Programmes, Integration of Care Models, and Pharmacotherapies. Clinical recommendations will be discussed. Treatment outcomes among substance using offenders of IPV may be improved by implementing changes in protocol that increase diagnostic evaluations, integrate care with evidence-based models, require limits to the number of offenders in a group, and require qualifications for clinicians who treat offenders (licensed and trained psychologists, social workers, and/or psychiatrists).
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http://dx.doi.org/10.1080/09540261.2016.1227307DOI Listing
October 2016

Comorbid substance use diagnoses and partner violence among offenders receiving pharmacotherapy for opioid dependence.

J Addict Dis 2016 Jul-Sep;35(3):205-11. Epub 2016 Feb 22.

a Biomedical Sciences Department , Rochester Institute of Technology , Rochester , New York , USA.

While previous studies find mixed evidence of an association between opioid use and intimate partner violence perpetration among community samples, initial evidence has detected increased rates of partner violence among individuals receiving pharmacological intervention for opioid dependence. The current study evaluated the role of current comorbid substance use diagnoses, a robust risk factor for violent behavior, on the likelihood of perpetrating partner violence among a high risk sample of offenders receiving pharmacological intervention for opioid dependence. The authors analyzed self-report data provided by 81 (55 male) opioid dependent offenders during a court-ordered substance use interview. Approximately one-third of the sample evidenced the recent use of intimate partner violence. Findings indicated that cocaine and benzodiazepine use were independently associated with an increased likelihood of reporting physical partner violence. Alcohol and cannabis use were not associated with partner violence. The current results offer further support for the ongoing need to conduct routine partner violence screenings among substance involved offenders and highlight the importance of developing individualized treatment plans that address comorbid substance use and partner-violent behaviors among individuals in treatment for opioid dependence.
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http://dx.doi.org/10.1080/10550887.2016.1154400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940215PMC
March 2017

Modafinil and sleep architecture in an inpatient-outpatient treatment study of cocaine dependence.

Drug Alcohol Depend 2016 Mar 8;160:49-56. Epub 2016 Jan 8.

Connecticut Mental Health Center, Yale University Department of Psychiatry, 34 Park Street, New Haven, CT 06519, United States.

Objective: To determine whether the increase in slow-wave sleep associated with modafinil treatment in chronic cocaine users mediates improved clinical outcomes.

Method: 57 cocaine dependent participants were randomized to receive modafinil 400mg or placebo daily during a period of inpatient treatment followed by six weeks of outpatient treatment. Participants underwent polysomnographic sleep recording during inpatient treatment prior to and after starting modafinil. Outpatient treatment consisted of weekly cognitive behavioral therapy. Contingency management was used to promote participation in treatment and research demands, including thrice weekly visits during the outpatient phase for urine toxicology screens and other assessments. The primary clinical outcome was the percent of urine toxicology screens that were negative for cocaine.

Results: Modafinil treatment was associated with a higher mean percentage (52% vs. 26%) of cocaine-free urine screens (p=0.02) and an increase in N3 sleep time (p=0.002). The change in N3 sleep time mediated the higher rate of cocaine-free urine screens. Modafinil treatment was also associated with more consecutive days abstinent during outpatient treatment, greater survival of abstinence, higher daily rates of abstinence, and less sleep degradation typically associated with abstinence from chronic cocaine use.

Conclusions: Morning-dosed modafinil improves slow-wave sleep in abstinent cocaine users in the inpatient setting, and this effect is a statistical mediator of improved clinical outcomes associated with continued modafinil treatment. The high rates of abstinence achieved in this trial suggest that promoting healthy sleep physiology in an inpatient setting may be important in the effective treatment of cocaine dependence.
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http://dx.doi.org/10.1016/j.drugalcdep.2015.12.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4767553PMC
March 2016

Physical Health Conditions and Intimate Partner Violence Perpetration Among Offenders With Alcohol Use Diagnoses.

J Interpers Violence 2017 06 9;32(11):1678-1691. Epub 2015 Jun 9.

2 Rochester Institute of Technology, NY, USA.

Intimate partner violence (IPV) is prevalent among samples with diagnosed alcohol use disorders (AUDs), but few studies have evaluated the factors that account for this increased risk, and none have systematically evaluated the risk posed by comorbid physical health conditions. The present study evaluated the likelihood of perpetrating IPV among alcohol diagnosed offenders with medical health problems relative to healthy counterparts. Physical health and partner violence data provided by 655 criminal offenders with AUDs diagnosed during a court-ordered substance abuse evaluation were examined. One third of participants (35.3%) endorsed a physical health condition, and 46.4% reported perpetrating physical IPV. The odds of perpetrating IPV among participants with a physical health condition were 2.29 times larger than among healthy participants. Specific conditions emerged as risk factors for IPV, including brain injury, cardiac issues, chronic pain, liver issues, gastrointestinal symptoms, hepatitis, and recent injury. Findings highlight the importance of identifying and managing physical health conditions that may complicate IPV treatment efforts. Integrated behavioral and medical health treatment approaches may increase treatment compliance and reduce the risk of future partner violence among offenders with co-occurring issues, such as mental illness, addiction, and physical health conditions.
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http://dx.doi.org/10.1177/0886260515590124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4798908PMC
June 2017

The occurrence of female-to-male partner violence among male intimate partner violence offenders mandated to treatment: a brief research report.

Violence Vict 2014 ;29(6):940-51

Little is known about the perceived perpetration of female-to-male intimate partner violence by victims of male offenders mandated to treatment. Sixty-eight male perpetrators of partner violence completed measures of dyadic violent and aggressive responding at intake and at a 12-week follow-up. Approximately 20% of male offenders reported partner violence perpetration and 30% reported victimization with bidirectional violence as the most common configuration of couple violence. Maladaptive responses to conflict were prevalent across partners. Significant and highly correlated reductions in aversive behaviors were detected across the assessment period for both males and their female partners. Results are interpreted within the context of motivational models of female-to-male partner violence and current treatment approaches.
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http://dx.doi.org/10.1891/0886-6708.VV-D-12-00136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4349198PMC
May 2015

Substance Use Disorders and Intimate Partner Violence Perpetration among Male and Female Offenders.

Psychol Violence 2014 Jul;4(3):322-333

Department of Psychiatry, Yale University School of Medicine.

Objective: The current investigation sought to examine the direct associations and interactions among individual and concurrent alcohol, cocaine, cannabis, and opioid use diagnoses with the perpetration of intimate partner violence as well as to assess gender differences across these associations within a large forensic sample of male and female offenders.

Method: Participants (1,290 male and 294 female) completed a court-mandated substance abuse evaluation during which they completed a clinical interview, either endorsing or denying recent physical partner violence perpetration. Specific substance use disorders were diagnosed based primarily upon responses to the clinical interview and were used to predict partner violence perpetration using logistic regression.

Results: Alcohol and cocaine use disorders were significantly associated with IPV perpetration over the past year. Cannabis and opioid use disorders were not directly associated with IPV. A comorbid alcohol use diagnosis increased the likelihood of IPV perpetration among participants with either a cannabis or a cocaine use disorder while participants with an alcohol use disorder were less likely to be violent if they had also met criteria for a cannabis use disorder. These relationships held across males and females.

Conclusions: The current findings emphasize the importance of assessing associations between specific substances of abuse in researching and predicting partner violence and suggest that future efforts focus on the development of integrated treatments for co-occurring partner violence and substance use disorders.
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http://dx.doi.org/10.1037/a0034338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4801342PMC
July 2014

Legal factors associated with change in alcohol use and partner violence among offenders.

J Subst Abuse Treat 2014 Aug 13;47(2):151-9. Epub 2014 Apr 13.

College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY.

Intimate partner violence (IPV) is a pervasive social concern that may be exacerbated by high rates of alcohol dependence among perpetrators. Society has attempted to combat IPV through various legal interventions, but the effects of specific legal factors on behavioral change and treatment compliance remain largely unexamined. The primary focus of the current study was to comprehensively evaluate the impact of various legal factors (i.e., judicial mandate, judicial monitoring, stage of change, and stake in conformity) on mandatory treatment compliance and behavioral change over a 12 week post-adjudication period among a high-risk sample of alcohol dependent IPV offenders (N = 60). Growth curve analyses revealed effects of judicial monitoring and stage of change such that participants reporting low perceived judicial monitoring and early stages of change reported higher initial levels and a more rapid reduction in IPV than those reporting high perceived judicial monitoring and late stages of change, who reported consistently low IPV. Although we found that legal factors were poor predictors of treatment compliance and alcohol use during treatment, the association between alcohol and IPV was moderated by the legal factors. Stake in conformity was negatively associated with IPV among low alcohol users and positively associated among high alcohol users whereas stage of change was negatively associated with IPV among high alcohol users. The current results suggest that pretreatment legal factors may represent an important consideration in reducing IPV among alcohol dependent offenders. Further research is required to determine the efficacy of legal factors in isolation of treatment as well as methods of manipulating these factors to optimally compliment a prescribed course of treatment.
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http://dx.doi.org/10.1016/j.jsat.2014.03.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264836PMC
August 2014

Risk factors of violence during a 4-week period in a psychiatric outpatient population.

J Nerv Ment Dis 2013 Dec;201(12):1021-6

*Department of Psychiatry, Yale University School of Medicine, New Haven, CT; †Department of Psychology, Simon Fraser University Burnaby, BC, Canada; and ‡Mid-Sweden University, Sundsvall, Sweden.

The clinical impact of structured risk assessment instruments has been limited by a lack of information regarding a) their short-term accuracy and b) the relationship between change as measured by the instrument and a change in the risk for harm. Data were collected every 4 weeks on a) variables designed to resemble the items of a structured risk assessment instrument, b) substance use, c) social circumstances and mental state, and d) violent behavior. Scores on the variables designed to resemble the items of a risk assessment instrument were associated with violence during the ensuing 4 weeks. However, an increase in a subject's score on these variables was not associated with violence. Instead, increasing cocaine use and increasing social conflict as described by the subject at interview were associated with violence during those weeks.
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http://dx.doi.org/10.1097/NMD.0000000000000061DOI Listing
December 2013

Treatment of co-occurring alcohol dependence and perpetration of intimate partner violence: the role of anger expression.

J Subst Abuse Treat 2013 Sep 9;45(3):313-8. Epub 2013 Apr 9.

Division of Substance Abuse, Yale University School of Medicine, New Haven, CT 06511 USA.

The purpose of the current study was to examine the role of high self-reported anger on violence and substance use across treatment. Seventy-three, alcohol-dependent males, with a domestic violence arrest within the past year, completed baseline anger measures and engaged in a 12 week cognitive behavioral therapy or 12 step facilitation group. Monthly assessments of substance use and violence were completed. At baseline, participants high on anger expression reported more physical violence in the prior month and more violent arrests. Participants high on anger expression had a greater proportion of positive breathalyzers across treatment, higher frequency of reported drug use across treatment, and higher reported frequency of verbal violence at discharge. These findings suggests that participants who are high on anger expression may need longer-term or more intensive treatments to maintain gains made during treatment because of the increased risk of relapse to both substance use and violence.
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http://dx.doi.org/10.1016/j.jsat.2013.03.001DOI Listing
September 2013

Axis I psychopathology and the perpetration of intimate partner violence.

J Clin Psychol 2014 Mar 3;70(3):238-47. Epub 2013 Jul 3.

University at Buffalo, SUNY.

Objectives: Initial evidence suggests that individuals with specific psychiatric conditions may perpetrate intimate partner violence (IPV) at greater frequency than nondiagnosed comparison samples. The present investigation examined the relationship between IPV and specific clinical diagnoses.

Method: The current investigation utilized data provided by 190 (34% female) adult offenders during court-mandated substance use evaluations to investigate the incidence of past-year IPV among samples of dually diagnosed (bipolar, posttraumatic stress disorder [PTSD], and attention deficit-hyperactivity disorder [ADHD]) clients relative to 3 comparison samples matched on substance use and sociodemographic variables.

Results: Bipolar and PTSD diagnosed participants were more likely to perpetrate IPV than matched comparison and ADHD participants. Bipolar and PTSD diagnosed participants were equally likely to perpetrate IPV, as were ADHD and matched comparison samples.

Conclusions: The frequency of IPV perpetration among bipolar and PTSD diagnosed clients may complicate interpersonal and relationship functioning. The development of integrated treatments for IPV and underlying psychopathology is recommended.
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http://dx.doi.org/10.1002/jclp.22013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189814PMC
March 2014

The association between phencyclidine use and partner violence: an initial examination.

J Addict Dis 2013 ;32(2):150-7

Research Institute on Addictions, University at Buffalo, SUNY, Buffalo, NY 14203, USA.

The association between phencyclidine (PCP) use and violent behavior is unclear. The current investigation evaluated the association between PCP addiction and intimate partner violence, a specific violent behavior, using the substance abuse evaluations of 109 PCP, 81 cannabis, and 97 polysubstance (alcohol and cannabis) abusing offenders. Relative to both comparison groups, PCP users were more likely to receive inpatient referrals, have a significant legal history, and have perpetrated past-year general and intimate partner violence. Data suggest that PCP use may be associated with greater violence perpetration than cannabis use alone or in conjunction with problematic alcohol use.
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http://dx.doi.org/10.1080/10550887.2013.797279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189809PMC
October 2013

Relationship status acceptance, alcohol use, and the perpetration of verbal aggression among males mandated to treatment for intimate partner violence.

J Interpers Violence 2013 Sep 16;28(13):2731-48. Epub 2013 May 16.

University at Buffalo, SUNY, Buffalo, NY 14203, USA.

Forty substance using, male offenders of intimate partner violence completed measures of alcohol use and relationship status acceptance during a pretreatment screening session. They also completed a measure of verbal aggression after each month of a 12-week intervention program. Treatment length, heavy episodic drinking, and relationship status acceptance were used to assess the frequency of verbal aggression at each of the four assessment periods in a repeated measures ANCOVA. Main effects were detected for both alcohol and acceptance variables such that greater verbal aggression was observed among participants with a recent history of heavy episodic drinking and failure to accept the status of the relationship with their female victim. The interaction between time in treatment and relationship status acceptance was significant and showed that participants who accepted their relationship status reported low verbal aggression across measurement occasions while those who did not accept their relationship status reported high initial verbal aggression that decreased over treatment.
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http://dx.doi.org/10.1177/0886260513487991DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264832PMC
September 2013

Parenting of men with co-occurring intimate partner violence and substance abuse.

J Interpers Violence 2013 Jul 19;28(11):2290-314. Epub 2013 Feb 19.

Yale University School of Medicine, New Haven, CT 06520, USA.

No studies to date have compared parenting behaviors of men with co-occurring intimate partner violence (IPV) and substance abuse (SA) with community controls. This study was designed to document mediators of differences in parenting behavior of fathers and the emotional-behavioral problems of their children for men with co-occurring SA and IPV. The self-reported parenting (negative, positive and coparenting behaviors) and the child emotional-behavioral problems of 43 fathers with children aged 2 to 6 years with a recent history of SA + IPV were compared to a sample of 43 community control fathers with the same socioeconomic and cultural backgrounds. Fathers completed measures on their parenting behavior with a target child, coparenting behavior with the child's mother, emotion regulation, romantic attachment, psychiatric symptoms, and the behavior of the target child. Men with co-occurring SA + IPV had significantly less positive coparenting and more negative parenting behaviors than community control fathers. Negative parenting and coparenting were mediated by the fathers' avoidant attachment problems. SA + IPV fathers also reported more emotional and behavioral problems in their children. These poor child outcome differences between groups were mediated by the negative parenting behaviors of the fathers. These results suggest areas of potential focus in interventions with fathers who have co-occurring SA + IPV issues. Focus on attachment difficulties with his coparent, which may include affect regulation, coping with emotions, and communication skills training related to coparenting, may yield significant changes in parenting behaviors and ultimately child functioning.
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http://dx.doi.org/10.1177/0886260512475312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691327PMC
July 2013

Sub-Clinical Trauma in the Treatment of Partner Violent Offenders with Substance Dependence.

Adv Dual Diagn 2013;6(1):5-13

Rochester Institute of Technology.

Purpose: With an established association between PTSD and the perpetration of intimate partner violence, evaluating the effectiveness of emerging integrated treatments for dual substance use and partner violent behavior on individuals with a significant trauma history may serve to improve treatment outcomes for clients with axis I psychopathology. This paper examined the association between sub-clinical trauma, treatment compliance, and recidivism in a sample of male, substance dependent intimate partner violence offenders.

Design/methodology/approach: The described investigation utilized violence perpetration, substance use, and trauma data collected during a larger, randomized control treatment evaluation study. Data was collected from 56 participants at 4 time points throughout treatment.

Findings: Participants with a significant trauma history comprised 33.9% of the sample and demonstrated poorer treatment attendance, as well as heightened partner violence recidivism throughout treatment, as compared to participants who denied experiencing a significant trauma. This finding held across participants receiving substance treatment only and combined treatment addressing substance use and violence.

Practical Implications: IPV perpetrators often have a trauma history themselves. The association between sub-clinical trauma symptomatology and poor treatment outcomes calls for the adaptation of current partner violence intervention models to accommodate the large subset of clients who suffer from either sub-clinical or clinically significant trauma.

Originality/value: This paper is the first to address the potential influence of sub-clinical trauma on the integrated treatment of substance use and partner violence within a forensic sample. Suggestions are offered to adapt existing treatment models to accommodate dual diagnosed clients.
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http://dx.doi.org/10.1108/17570971311308980DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399647PMC
January 2013

Informed Consent: An Ethical Issue in Conducting Research with Male Partner Violent Offenders.

Ethics Behav 2013;23(6):477-488

Department of Psychiatry, Yale University School of Medicine.

Ethical codes help guide the methods of research that involve samples gathered from "at-risk" populations. The current paper reviews general as well as specific ethical principles related to gathering informed consent from partner violent offenders mandated to outpatient treatment, a group that may be at increased risk of unintentional coercion in behavioral sciences research due to court-mandates that require outpatient treatment without the ethical protections imbued upon prison populations. Recommendations are advanced to improve the process of informed consent within this special population and data supporting the utility of the recommendations in a sample 70 partner violent offenders are provided. Data demonstrate that participants were capable of comprehending all essential elements of consent.
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http://dx.doi.org/10.1080/10508422.2013.804795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399711PMC
January 2013

Combining cognitive behavioral therapy and contingency management to enhance their effects in treating cannabis dependence: less can be more, more or less.

Addiction 2012 Sep 8;107(9):1650-9. Epub 2012 May 8.

Division of Substance Abuse, Yale University School of Medicine, New Haven, CT 06516, USA.

Aims: To evaluate reciprocal enhancement (combining treatments to offset their relative weaknesses) as a strategy to improve cannabis treatment outcomes. Contingency management (CM) with reinforcement for homework completion and session attendance was used as a strategy to enhance cognitive-behavioral therapy (CBT) via greater exposure to skills training; CBT was used as a strategy to enhance durability of CM with rewards for abstinence.

Setting: Community-based out-patient treatment program in New Haven, Connecticut, USA.

Design: Twelve-week randomized clinical trial of four treatment conditions: CM for abstinence alone or combined with CBT, CBT alone or combined with CM with rewards for CBT session attendance and homework completion.

Participants: A total of 127 treatment-seeking young adults (84.3% male, 81.1% minority, 93.7% referred by criminal justice system, average age 25.7 years).

Measurements: Weekly urine specimens testing positive for cannabis, days of cannabis use via the time-line follow-back method.

Findings: Within treatment, reinforcing homework and attendance did not significantly improve CBT outcomes, and the addition of CBT worsened outcomes when added to CM for abstinence (75.5 versus 57.1% cannabis-free urine specimens, F = 2.25, P = 0.02). The CM for abstinence condition had the lowest percentage of cannabis-negative urine specimens and the highest mean number of consecutive cannabis-free urine specimens (3.3, F = 2.33, P = 0.02). Attrition was higher in the CBT alone condition, but random effect regression analyses indicated this condition was associated with the greatest rate of change overall. Cannabis use during the 1-year follow-up increased most rapidly for the two enhanced groups.

Conclusions: Combining contingency management and cognitive-behavioural therapy does not appear to improve success rates of treatment for cannabis dependence in clients involved with the criminal justice system.
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http://dx.doi.org/10.1111/j.1360-0443.2012.03877.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509418PMC
September 2012

Fathers entering substance abuse treatment: An examination of substance abuse, trauma symptoms and parenting behaviors.

J Subst Abuse Treat 2012 Oct 2;43(3):335-43. Epub 2012 Feb 2.

Yale University School of Medicine Child Study Center, New Haven, CT 06520, USA.

Objective: The relationship between fatherhood and both psychiatric distress and severity of substance abuse (SA) among men entering SA treatment has not been well explored. This study was designed to (a) examine differences in symptoms of men presenting for SA assessment based on fatherhood status and (b) determine how posttraumatic stress disorder (PTSD) symptoms and severity of SA were associated with parenting for men who were fathers.

Methods: PTSD symptoms, severity of SA, and parenting data reported on structured questionnaires were collected from 126 men presenting for an SA evaluation at a forensic drug diversion clinic.

Results: There were no differences in severity of alcohol or drug use between fathers and nonfathers; however, fathers with more PTSD symptoms reported greater severity of alcohol and drug use. Among the fathers, PTSD symptoms correlated significantly and positively with negative parenting behaviors, whereas SA did not. Fathers with more significant PTSD symptoms were more likely to want help with parenting.

Conclusions: Further exploration of the impact of trauma-related symptoms on the parenting behaviors of substance-abusing men is warranted.
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http://dx.doi.org/10.1016/j.jsat.2011.12.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3346880PMC
October 2012

Depression as a mediator of the association between substance abuse and negative parenting of fathers.

Am J Drug Alcohol Abuse 2012 Jul 13;38(4):344-9. Epub 2012 Jan 13.

Yale University School of Medicine, Department of Psychiatry and Child Study Center, New Haven, CT 06520, USA.

Objective: The role of substance abuse (SA) and depression on paternal parenting has recently gained attention in the research literature. Both SA and depression have been associated with negative parenting in fathers, but studies to date have not examined the mediating role that depression may play in the association of SA and fathering.

Methods: SA, depression, and parenting data were reported by 87 fathers presenting for SA evaluation. Bootstrap mediation modeling was conducted to determine the role of depression on the association between SA and negative parenting.

Results: Depression is a significant mediator of the relationship between the severity of fathers' drug use and hostile-aggressive parenting behaviors. Fathers who had concerns about parenting or wanted help to improve the parent-child relationship had significantly higher symptoms of depression.

Conclusions: Depressive symptoms in fathers entering SA treatment have implications for both the severity of drug abuse and negative parenting behaviors.
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http://dx.doi.org/10.3109/00952990.2011.649221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3640321PMC
July 2012

Differences in treatment outcome among marijuana-dependent young adults with and without antisocial personality disorder.

Am J Drug Alcohol Abuse 2012 Jul 13;38(4):305-13. Epub 2012 Jan 13.

Division of Substance Abuse, Yale University School of Medicine, New Haven, CT 06511, USA.

Background: Few studies have addressed comorbid antisocial personality disorder (ASPD) and marijuana dependence in young adults, and results from previous studies are inconsistent.

Objectives: This study evaluated differences in pretreatment characteristics and treatment outcomes between marijuana-dependent young adults with and without ASPD.

Methods: Data for this study were derived from a randomized trial, in which marijuana-dependent young adults (n = 136) between 18 and 25 years of age were randomized to four behavioral conditions: (1) MET/CBT with CM, (2) MET/CBT without CM, (3) DC with CM, and (4) DC without CM.

Results: Forty-four percent of the participants met DSM-IV-TR criteria for ASPD. ASPD clients had significantly more lifetime alcohol dependence disorders, marijuana use in the 28 days pretreatment, arrests, and assault and weapon charges compared to those without ASPD. ASPD clients did not differ in retention or substance use outcomes at 8 weeks posttreatment or the 6-month follow-up. In general, both groups had more attendance in the voucher condition, but there were no significant ASPD by treatment interactions.

Conclusions: These data suggest that marijuana-dependent young adults with comorbid ASPD do not necessarily have poorer retention or substance use outcomes compared with marijuana-dependent young adults who do not have ASPD when treated in a well-defined behavioral therapy protocol.

Scientific Significance: Previous research has shown increased risks for clients with comorbid ASPD and marijuana dependence; however, our findings suggest that specialized programs for clients with ASPD may not be necessary if they are provided with empirically supported, structured treatments.
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http://dx.doi.org/10.3109/00952990.2011.643989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633215PMC
July 2012

Mindfulness and modification therapy for behavioral dysregulation: results from a pilot study targeting alcohol use and aggression in women.

J Clin Psychol 2012 Jan 19;68(1):50-66. Epub 2011 Sep 19.

John Jay College/City University of New York, New York, NY 10024, USA.

Objectives: Increasing evidence suggests that deficits in mindfulness (awareness, attentiveness, and acceptance of the present moment) play a role in a range of disorders involving behavioral dysregulation. This paper adds to that literature by describing a transdiagnostic psychotherapy (Mindfulness & Modification Therapy; MMT) developed to target behavioral dysregulation.

Design: An open-treatment pilot-trial investigated the feasibility, acceptability, and pre-post effects of MMT targeting women (N = 14) court-referred for alcohol abuse/dependence and aggression.

Results: Pre-post comparisons revealed significant decreases in alcohol use, drug use, and aggression. In addition, the retention rate was 93%.

Conclusion: Preliminary evidence suggests that MMT is a feasible and acceptable treatment that decreases dysregulated behaviors such as substance use and aggression, while also potentially increasing retention.
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http://dx.doi.org/10.1002/jclp.20830DOI Listing
January 2012

Contingency management treatment in substance abusers with and without legal problems.

J Am Acad Psychiatry Law 2011 ;39(3):370-8

Calhoun Cardiology Center, Department of Medicine, University of Connecticut Health Center, Farmington, CT 06030-3944, USA.

Drug and alcohol abusers frequently have legal difficulties, and the legal system often provides negative reinforcement for substance abuse treatment. In contrast, contingency management (CM) treatments utilize positive reinforcement procedures to improve patient outcomes. This study evaluated whether substance-abusing patients with legal problems at treatment entry had differential outcomes, in general and in response to CM, compared with those without legal problems. Data from three randomized CM trials (n = 393) were used in an evaluation of main and interactive effects of legal status and treatment condition, with respect to retention and abstinence. Compared with patients without legal difficulties, those with legal problems remained in treatment for shorter durations and achieved shorter periods of abstinence. CM was positively and significantly associated with longer durations of abstinence, regardless of legal status. Results suggest that substance abusers with legal problems have generally poor outcomes, but that CM is effective regardless of the patient's legal status.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616315PMC
January 2012
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