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Bipolar disorders and substance use disorders (SUDs) show high co-occurrence. One explanation for this co-occurrence may be common personality vulnerabilities involved in both. The authors tested whether high behavioral approach system (BAS) sensitivity and impulsiveness are shared personality vulnerabilities in bipolar spectrum disorders and substance use problems and their co-occurrence in a longitudinal study of 132 individuals on the bipolar spectrum and 153 control participants. At Time 1, participants completed the Behavioral Inhibition System/BAS Scales and the Impulsive Nonconformity Scale. Substance use problems were assessed via the Michigan Alcoholism Screening Test and the Drug Abuse Screening Test at 4-month intervals for 1 year. Participants with bipolar disorder had higher rates of lifetime SUDs and substance use problems during the follow-up, relative to control participants. In line with hypotheses, higher BAS sensitivity and impulsiveness predicted bipolar status and increased substance use problems prospectively. BAS total, BAS Fun Seeking, and impulsiveness mediated the association between bipolar spectrum status and prospective substance use problems, with impulsiveness as the most important mediator. High BAS sensitivity and impulsiveness may represent shared personality vulnerabilities for both disorders and may partially account for their co-occurrence. Keywords: bipolar spectrum, substance use, behavioral approach system (BAS) sensitivity, impulsiveness

Despite evidence showing that readiness to change substance use predicts reductions in substance use among treated adolescents, there is little research on changes in thoughts about abstinence and marijuana use during and after treatment. The current study tested whether time-varying changes in adolescents' motivation to abstain and perceived difficulty to abstain from marijuana use hinder the return of regular marijuana use during and after treatment. Monthly data on thoughts about abstinence, marijuana use, and treatment utilization were collected over 6 months from 142 adolescents recruited from intensive outpatient substance use treatment. Results indicated that higher motivation to abstain (but not perceived difficulty) predicted fewer days of marijuana use, over and above the individual's average trajectory of marijuana use, the initial severity of marijuana involvement, and the effects of treatment utilization. Moreover, past-month marijuana use influenced both motivation to abstain and perceived difficulty to abstain. Findings highlight the importance of abstinence-related cognitions as a target of intervention during and after treatment and underscore the importance of considering recovery from substance use disorders as a dynamic process of change over time. Keywords: adolescent, treatment outcome, substance use, motivation to abstain

The highly addictive drug methamphetamine has been associated with impairments in social cognitions as evidenced by changes in users' behaviors. Physiological changes in brain structure and functioning, particularly in the frontal lobe, have also been identified. The authors propose a biopsychosocial approach to understanding the effects of methamphetamine addiction by relating the physiological effects of the drug to the behaviors and social cognitions of its users, through the application of the theory of mind paradigm. Although onset of methamphetamine use has been linked to the desire for socialization, chronic use has been associated with an increase in depression, aggressiveness, and social isolation, behaviors that also implicate involvement of the frontal lobe. The reviewed literature provides strong circumstantial evidence that social-cognitive functioning is significantly impacted by methamphetamine use and that the social isolation, depression, and aggressiveness associated with chronic use is due to more than just the social withdrawal associated with addiction. Treatment considerations for methamphetamine must therefore consider the role of social cognition, and pharmacological responses must address the documented impact of the drug on frontal lobe functioning. Keywords: methamphetamine, addiction, social cognition, brain function, theory of mind

Human drug seeking may be goal directed in the sense that it is mediated by a mental representation of the drug or habitual in the sense that it is elicited by drug-paired cues directly. To test these 2 accounts, the authors assessed whether a drug-paired stimulus (S+) would transfer control to an independently trained drug-seeking response. Smokers were trained on an instrumental discrimination that established a tobacco S + in Experiment 1 and a tobacco and a money S + in Experiment 2 that elicited an expectancy of their respective outcomes. Participants then learned 2 new instrumental responses, 1 for each outcome, in the absence of these stimuli. Finally, in the transfer test, each S+ was found to augment performance of the new instrumental response that was trained with the same outcome. This outcome-specific transfer effect indicates that drug-paired stimuli controlled human drug seeking via a representation or expectation of the drug rather than through a direct stimulus-response association. Keywords: expectancy, human, attention, transfer, learning

A manual-guided, spirituality-focused intervention--spiritual self-schema (3-S) therapy--for the treatment of addiction and HIV-risk behavior was developed as part of a Stage I behavioral therapies development project. It is theoretically grounded in cognitive and Buddhist psychologies and may be suitable for individuals of diverse faiths. The therapy development process began with focus groups to assess addicted clients' perceived need for a spirituality-focused intervention. The therapy was then codified in manual format, and a controlled clinical trial was conducted. Here the authors report on inner-city, methadone-maintained clients' personal experiences that were recorded in semistructured interviews following completion of the therapy. Findings from this qualitative study support the value of integrating spirituality-focused interventions into addiction treatment for the purpose of increasing motivation for drug abstinence and HIV prevention. Keywords: spirituality, addiction, HIV prevention, Buddhism, meditation

Some ways that family role and psychiatric disorder influence family stigma are examined, using a vignette design describing a person with a health condition and a family member. Family stigma related to drug dependence is worse than for other health conditions, with family members being blamed for both the onset and offset of a relative's disorder and likely to be socially shunned.

The purpose of this study was to identify factors associated with 4 clusters of obstacles (self-reliance, privacy issues, quality of care, and communication and trust) to mental health and substance abuse treatment in 3 treatment sectors for residents of 3 reservations in the United States. Participants (N = 3,084) disclosed whether they had sought treatment for emotional, drug, or alcohol problems in the past year and, if so, whether they had faced obstacles in obtaining care from Indian Health Services, tribal services, and other public or private systems. Correlates of these obstacles included negative social support, instrumental social support, utility of counselors, utility of family doctors, treatment sector, treatment type, diagnosis of an anxiety disorder, and tribe. Keywords: American Indians, obstacles to care, mental health services

The authors tested predictions, derived from a self-regulation model, about variables moderating the relationship between level of substance use (tobacco, alcohol, and marijuana) and problems associated with use. Data were from two independent studies of adolescents, with mean ages of 15.4 and 15.5 years (Ns = 1,699 and 1,225). Factor analysis indicated correlated dimensions of control problems and conduct problems. Protective moderation was found for variables indexing good self-control; risk-enhancing moderation was found for variables indexing poor self-control. These effects were generally independent of deviance-prone attitudes and externalizing symptomatology. Multiple-group structural modeling indicated moderation occurred for paths from life stress and coping motives and for paths from level to control and conduct problems. Moderation effects were also found for parental variables, peer variables, and academic competence.

A study was conducted to build a computer-administered Addiction Severity Index (ASI) using regression equations. A stable regression equation for each ASI problem area was determined using a dataset administered by trained, reliable interviewers. Principal substance-abuse diagnoses were considered, including cocaine, primary alcohol and opiate addiction. Results indicated that Interviewer Severity Rating hinders the appropriation application of ASIs in clinical settings.

A study was conducted to analyze psychometric characteristics of the drug abuse screening test in psychiatric outpatients. Additional psychometric indexes were added in a sample of seriously and persistently mentally ill outpatients. Data on psychiatric status was determined using a self-report questionnaire and structured interview. Results indicated items that may be confusing to individuals in treatment for mental illness.

Changes in the parental subsystem have a significant affect on the improvement of problematic behaviour in adolescents. Most parents and adolescents improve together, supporting the family theory that change in family environment correlates with adolescent's behavior change. In one study, 59% of the families experienced decreases in teenager drug use with parental subsystem change. Only 21% of adolescents showed improvement without their families making any change.

Peer influence is among the leading reasons why some adolescents use drugs. Empirical evidence reveals that people with friends who used drugs have a greater probability of falling into the habit themselves. Other studies on the role of peer pressure show that adolescents often begin to use drugs to win friends or to be able to attribute their drug behavior to the behavior of their peers. These behavior are better known as selection and projection. Social network analysis affords psychologists an effective method for studying drug use by adolescents within the framework of peer groups.

The prospective relationships between drug problems and work adjustment (e.g., job instability, job satisfaction) were examined in a community sample of 470 adults. Polydrug problems (alcohol, marijuana, and cocaine problem drug use) were both predictors and consequences of work adjustment. In partial support of the impaired functioning theory, polydrug problems predicted reduced job satisfaction 4 years later. Supporting the work-related strain theory, early job instability predicted polydrug problems 4 years later. In support of the theory of general deviance, low social conformity predicted later job instability. Finally, supporting social support theory, early support for drug problems reduced polydrug problems and increased job satisfaction 4 years later.

Patients (N = 108) in a study of cocaine-specific coping skills training (CST), which was found to reduce cocaine use during a 3-month follow-up, were followed for an additional 9 months. CST involved coping skills training in the context of high-risk situations. Control treatment used meditation--relaxation. Both were added to comprehensive private substance abuse treatment. Patients in CST who relapsed had significantly fewer cocaine use days than did the control group during the first 6 months, then both conditions did equally well. Patients in CST also drank alcohol more frequently in the last 6 months than did contrast patients but did not differ in heavy drinking days. For cocaine use outcomes, no interaction of treatment was found with gender, education, route of administration, drug use severity, sociopathy, or depression. Implications include the need to investigate different lengths and combinations of treatment.

Recent developments in harm reduction analysis are discussed in response to comments by D.A. Cadogan and by K. Resnicow and E. Drucker. Topics include the distinction between harm reduction and prohibition, public antipathy to intoxication, and the need to reduce total harm rather than average harm.

This article discusses 3 different strategies for dealing with the harmful consequences of drug use and other risky behaviors: We can discourage people from engaging in the behavior (prevalence reduction), we can encourage people to reduce the frequency or extent of the behavior (quantity reduction), or we can try to reduce the harmful consequences of the behavior when it occurs (harm reduction). These strategies are not mutually exclusive; this article offers a framework for integrating them. The framework is useful for examining frequent claims that harm reduction 'sends the wrong message.' Opposition to harm reduction is based in part on a recognition of potential trade-offs among the strategies, but it is also fueled by several more symbolic psychological factors. Strategies for successfully integrating prevalence reduction, quantity reduction, and harm reduction are explored.