Amber M. Jarnecke

Relationships and social support have direct effects on opioid misuse, which is highly prevalent and associated with morbidity and mortality. However, there is a dearth of research focusing on the characteristics and quality of intimate relationships in the context of opioid misuse, which is important for informing interventions with the dual target of improving intimate relationships and reducing opioid use. The current study surveyed individuals with opioid misuse who are in intimate relationships to characterize how they perceive (1) their relationship functioning and (2) how their intimate partners impact their opioid use. Individual participants (N=93) were recruited from Amazon's Mechanical Turk (mTurk) and answered quantitative survey questions related to their opioid and other substance use, intimate relationship quality and functioning, and intimate partners' behaviors in relation to their opioid use. Opioid misuse severity significantly differed by sexuality and rates of polysubstance use were high in this sample. Many participants reported low relationship quality and intimate partner violence in their relationship. Some participants reported using opioids with their intimate partners (33.3%) and having an intimate partner who had overdosed on opioids (15.1%). Many participants also reported that arguments with intimate partners impacted their opioid cravings (52.7%) and that they have an interest in couples treatment for opioid use (80.7%). Findings highlight links between intimate relationships and opioid misuse and identify areas in which behavioral treatments may be adapted to address the needs of couples with OUD. Future research should replicate the current findings in larger and more diverse samples.

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) often co-occur and present significant treatment challenges. Cognitive Processing Therapy (CPT) is a widely used, efficacious treatment for PTSD, but the application of CPT among individuals with co-occurring PTSD/AUD has been limited. To address this gap, we developed a novel, 12-session trauma-focused treatment that combines CPT with Relapse Prevention (RP) for AUD (CPT+RP). This paper describes CPT+RP and presents preliminary outcomes from the first six participants enrolled in a larger, ongoing multisite clinical trial of CPT+RP. PTSD symptoms were assessed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and PTSD Checklist for DSM-5 (PCL-5). The Timeline Follow-Back (TLFB) assessed frequency (percent days drinking; PDD) and quantity (drinks per drinking day; DDD) of alcohol use, and craving was measured using the Penn Alcohol Craving Scale (PACS). The Client Satisfaction Questionnaire measured acceptability. Pre- to post-treatment reductions were observed in PTSD symptoms (ΔMCAPS-5 = 14.00; ΔMPCL-5 = 20.50), frequency and quantity of alcohol use (ΔMPDD = 38.65; ΔMDDD = 6.24), and craving (ΔPACS = 6.17). Most participants achieved clinically significant improvement in their PTSD symptoms and acceptability was high. Although preliminary, the findings suggest the new CPT+RP intervention is feasible, acceptable, and a promising treatment innovation for co-occurring PTSD and AUD.

Since the inception of the criterion A framework into the posttraumatic stress disorder (PTSD) diagnosis in DSM-III, what qualifies as traumatic has been a fieldwide debate. Historically, social movements coinciding with advances in research have spurred improvements in the definition of criterion A, often by expanding the breadth of experiences that are considered trauma exposure. Contemporary issues of ongoing racial discrimination, ethno-violence, public health pandemics, warfare, oppression, and climate change warrant a re-examination of the criterion A definition. This critical review builds on prior critiques of criterion A for PTSD and addresses (1) the limitations to the current criterion A definition in DSM-5 in capturing the experience of minoritized individuals; (2) three categories of trauma that are under-recognized in the current criterion A definition; and (3) the implications of expanding criterion A on clinical and research practice. We critically review three trauma categories that disproportionately affect minoritized individuals—invisible traumas, identity-based traumas, and systemic traumas. Evidence to date suggests that several traumatic experiences in these categories are traumatic and are more prevalent among individuals with minoritized identities or marginalized in society. We discuss the implications of these traumas being omitted from criterion A and call for future work to critically examine trauma and the definition of criterion A in the PTSD diagnostic framework. Overall, this critical review captures traumas which remain undertreated, underdiagnosed, and under-represented by our current psychiatric nosology.

Introduction: Substance use is strongly associated with intimate partner violence (IPV) and is a modifiable risk factor for IPV. However, lack of comprehensive screening and referral for co-occurring IPV and substance use, along with their psychiatric sequalae, limits the identification and implementation of effective interventions for substance-related IPV. This narrative review (1) investigates the literature on screening and referral practices for IPV, and if these include screening for substance use or other psychiatric comorbidities, (2) provides recommendations for current best practices, and (3) suggests future directions for research and practice aimed at identifying and reducing substance-related IPV.Methods: A narrative literature review examined studies investigating IPV screening and referral programs in clinics. Selected studies were reviewed for: (1) effectiveness, (2) barriers to implementation and sustainability, and (3) responsivity to psychiatric comorbidity, including substance use and substance use disorders (SUD).Results: Findings suggest that effective IPV screening and referral programs have been developed, but disparities in IPV screening exist and many programs only screen for IPV victimization. Barriers to the implementation and sustainability of IPV screening programs include lack of ongoing provider training, funding or institutional support, and direct connection to referral services. Further, many IPV screening programs lack assessment of and referral for comorbid psychiatric conditions, including substance use, and tend not to be routinely implemented in SUD clinics.Discussion: Additional systematic work is needed to develop universal and comprehensive screening and referral programs for substance-related IPV and address issues of long-term sustainability, particularly within SUD treatment settings.

Purpose: Intimate partner violence (IPV) is a serious public health concern that is highly prevalent among couples with alcohol misuse. It is well-established that alcohol can exacerbate negative IPV outcomes; however, less is known about how hazardous alcohol consumption, combined with family composition, such as the presence of children in the home, may impact IPV in a dyadic context. The current study examined the separate and interactive roles of the couple’s caretaking status and alcohol use disorder (AUD) severity on psychological and physical IPV victimization. Methods: Secondary data were analyzed from 100 couples considered high risk due to reporting physical IPV and at least one partner meeting criteria for AUD. Multilevel mixture models were used to dyadically test how caretaking status and each partner’s AUD severity, separately and interactively, related to the couple’s psychological and physical IPV severity. Results: Caretaking status and one’s own AUD severity, when examined separately, were positively related to psychological and physical IPV victimization. One’s partner’s AUD severity was also related to severity of physical IPV victimization. There was no evidence of an interaction in this sample. Conclusions: Caretaking status played an important role in IPV victimization even when accounting for AUD in high-risk couples. Caretaking status and AUD did not interact; however, the significant main effects suggest an additive association, such that the combination of AUD severity and caretaking is more risky for IPV victimization than either factor alone. Findings highlight the importance of considering family composition and alcohol use behaviors on IPV risk.

PTSD and substance use disorders (SUD) frequently co-occur among veterans. Integrated exposure-based treatments, such as Concurrent Treatment of PTSD and SUD Using Prolonged Exposure (COPE), are efficacious in reducing PTSD and SUD symptoms and posttraumatic emotions. This study examines whether guilt and anger (a) decreased in a randomized clinical trial comparing COPE with Relapse Prevention (RP) therapy for SUD and (b) mediated PTSD and SUD symptom reductions or vice versa. Veterans (90.1% men) diagnosed with PTSD and SUD were randomized to 12 sessions of COPE (n = 54) or RP (n = 27). Guilt and anger were assessed at 10 time points during treatment. Multilevel linear models assessed changes in guilt and anger across treatments and lagged multilevel mediation analyses assessed within-subject change in guilt and anger predicting PTSD and percent days of substance use, and vice versa. Guilt (B = -.12, SE = .02, p < .001) and anger (B = -.13, SE = .02, p < .001) improved in both treatments, however guilt was significantly lower in Sessions 7 through 11 among veterans receiving COPE. Improvement in guilt mediated PTSD symptom improvement in both treatment groups (B = -.08, SE = .04, 95% CI [-.16, -.01]), and PTSD symptom improvement mediated anger reduction in COPE (B = -.03, SE = .01, 95% CI [-.06, -.01]). The substance use models were insignificant. Among veterans, integrated, trauma-focused treatments may be associated with greater guilt (directly) and anger (indirectly) reductions due to processing trauma. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objective: Social anhedonia is associated with disinterest in social interactions and poor relationship functioning, yet little is known about the specific mechanisms underlying associations between social anhedonia and romantic relationship behaviors and satisfaction. We examined the links between social anhedonia, perceptions of conflict communication patterns, and marital satisfaction.Method: The current research examined the role of social anhedonia on marital quality and functioning longitudinally across a year in a sample of 100 newlywed couples using an actor‐partner interdependence framework.Results: Social anhedonia was negatively associated with own and partner's marital satisfaction. It was also negatively associated with constructive communication and positively associated with destructive communication. Furthermore, cross‐sectional mediation analyses showed that communication patterns mediated the social anhedonia‐satisfaction link.Conclusions: Taken together, these findings suggest that social anhedonia is likely to lead to lower marital satisfaction, partly through its effect on communication between partners.

Alcohol use can operate as a chronic relationship stressor with adverse influences on individual and relationship functioning, including negative conflict behaviors; however, it remains unclear what modifiable individual-level factors may moderate this association. The current study examined the effects of maladaptive cognitive emotion regulation strategies on the relation between alcohol use problems and negative relationship conflict behaviors. Participants were 30 couples (N=60) wherein at least one partner engaged in recent hazardous drinking or illicit drug use. Participants completed a measure of maladaptive cognitive emotion regulation strategies (i.e., catastrophizing, self-blame, blaming others, rumination) and engaged in a 10-minute dyadic conflict task in the laboratory. Couple conflict behaviors were video-recorded and assessed using a validated coding system. Actor partner interdependence models indicated that (1) men with more maladaptive cognitive emotion regulation strategies displayed more negative relationship conflict behaviors and (2) among women who use fewer maladaptive cognitive emotion regulation strategies, those who report alcohol use problems display more negative relationship behaviors than women who report fewer alcohol use problems. These findings suggest that the tendency to engage in fewer maladaptive cognitive emotion regulation strategies buffers the effect of conflict among women without alcohol use problems. Results also suggest that women with alcohol use problems engaged in more negative conflict behaviors regardless of their tendency to use maladaptive cognitive emotion regulation strategies. This research has important implications for integrating emotion regulation skills into alcohol use treatment for women, particularly later in the course of treatment.