Search

Purpose of Review: Polysubstance use is common, particularly amongst some age groups and subcultures. It is also associated with elevated risk of psychiatric and physical health problems. We review the recent research findings, comment on changes to polysubstance diagnoses, report on contemporary clinical and epidemiological polysubstance trends, and examine the efficacy of preventive and treatment approaches. Recent Findings: Approaches to describing polysubstance use profiles are becoming more sophisticated. Models over the last 18 months that employ latent class analysis typically report a no use or limited-range cluster (alcohol, tobacco and marijuana), a moderate-range cluster (limited range and amphetamine derivatives), and an extended-range cluster (moderate range, and nonmedical use of prescription drugs and other illicit drugs). Prevalence rates vary as a function of the population surveyed. Wide-ranging polysubstance users carry higher risk of comorbid psychopathology, health problems, and deficits in cognitive functioning. Summary: Wide-ranging polysubstance use is more prevalent in subcultures such as 'ravers' (dance club attendees) and those already dependent on substances. Health risks are elevated in these groups. Research into the prevention and treatment of polysubstance use is underdeveloped. There may be benefit in targeting specific polysubstance use and risk profiles in prevention and clinical research.

Background: A significant minority of Australians engage in concurrent drug use (using more than one drug in a given period). We examined clusters and correlates of concurrent drug use using the latest available nationally representative survey data on Australian young adults. Sample: 3836 participants aged 18-29. years (mean age 24. years) from the 2010 National Drug Strategy Household Survey (NDSHS). Method: Clusters were distilled using latent class analysis of past year use of alcohol, tobacco, cannabis, cocaine, hallucinogens, ecstasy, ketamine, GHB, inhalants, steroids, barbiturates, meth/amphetamines, heroin, methadone/buprenorphine, other opiates, painkillers and tranquillisers/sleeping pills. Results: Concurrent drug use in this sample was best described using a 4-class solution. The majority (87.5%) of young adults predominantly used alcohol only (50.9%) or alcohol and tobacco (36.6%). 10.2% reported using alcohol, tobacco, marijuana, and ecstasy, and 2.3% reported using an extensive range of drugs. Conclusion: Most drug use clusters were robust in their profile and stable in their prevalence, indicating little meaningful change at the population level from 2007. The targeting of alcohol and tobacco use remains a priority, but openness to experiencing diverse drug-related effects remains a significant concern for 12.5% of young people in this age group.

Heavy alcohol use increases dramatically at age 14, and there is emerging cross-sectional evidence that when girls experience family conflict at younger ages (11–13 years) the risk of alcohol use and misuse is high. This study evaluated the role of family conflict and subsequent depressed mood in predicting heavy alcohol use among adolescent girls. Method: This was a three-wave longitudinal study with annual assessments (modal ages 12, 13, and 14 years). The participants (N = 886, 57% female) were from 12 metropolitan schools in Victoria, Australia, and participants completed questionnaires during school class time. The key measures were based on the Communities That Care Youth Survey and included family conflict (Wave 1), depressed mood (Wave 2), and heavy alcohol use (Wave 3). Control variables included school commitment, number of peers who consumed alcohol, whether parents were living together, and ethnic background. Results: With all controls in the model, depressed mood at Wave 2 was predicted by family conflict at Wave 1. The interaction of family conflict with gender was significant, with girls showing a stronger association of family conflict and depressed mood. Depressed mood at Wave 2 predicted heavy alcohol use at Wave 3. Conclusions: Girls may be especially vulnerable to family conflict, and subsequent depressed mood increases the risk of heavy alcohol use. The results support the need for gender-sensitive family-oriented prevention programs delivered in late childhood and early adolescence.

Introduction Throughout the world, alcohol consumption is common among adolescents. Adolescent alcohol use and misuse have prognostic significance for several adverse long-term outcomes, including alcohol problems, alcohol dependence, school disengagement and illicit drug use. The aim of this study was to evaluate whether randomisation to a community mobilisation and social marketing intervention reduces the proportion of adolescents who initiate alcohol use before the Australian legal age of 18, and the frequency and amount of underage adolescent alcohol consumption. Method and analysis The study comprises 14 communities matched with 14 non-contiguous communities on socioeconomic status (SES), location and size. One of each pair was randomly allocated to the intervention. Baseline levels of adolescent alcohol use were estimated through school surveys initiated in 2006 (N=8500). Community mobilisation and social marketing interventions were initiated in 2011 to reduce underage alcohol supply and demand. The setting is communities in three Australian states (Victoria, Queensland and Western Australia). Students (N=2576) will complete school surveys in year 8 in 2013 (average age 12). Primary outcomes: (1) lifetime initiation and (2) monthly frequency of alcohol use. Reports of social marketing and family and community alcohol supply sources will also be assessed. Point estimates with 95% CIs will be compared for student alcohol use in intervention and control communities. Changes from 2006 to 2013 will be examined; multilevel modelling will assess whether random assignment of communities to the intervention reduced 2013 alcohol use, after accounting for community level differences. Analyses will also assess whether exposure to social marketing activities increased the intervention target of reducing alcohol supply by parents and community members.

Current research ethical guidelines are unclear about the extent to which adolescents can be considered competent to provide informed consent to participate in psychological research. Researchers and human research ethics committees (HRECs) need clearer guidance on when various types of parental consent are required. Some important psychological research on critical public health issues affecting young people is delayed, its methodology compromised, or even does not proceed, because the vagueness in current guidelines lead HRECs to take unduly conservative decisions about the level of risk from research participation, and the competency of mature minors to consent. This paper includes recommendations for researchers and the Australian Psychological Society that could enhance the ethical conduct of research with adolescents.

The first part of this research assessed the longitudinal relationships between alcohol-related associative strength and alcohol use measured at two time-points, 6 months apart. Cross-lagged results support the utility of alcohol-related associative strength to predict drinking behaviours prospectively and vice versa. These results remained after competing explanations of previous use, autocorrelations between memory measures, sensation seeking and background variables of age and gender were accounted for. Findings offer further evidence for an implicit cognitions approach to drinking processes. In the second part of our study, cross-sectional analysis investigated potential mediating mechanisms in the relation of associative strength to quantity and frequency dimensions of drinking. Mediational models provide preliminary evidence that implicit memory processes may have differential effects on quantity and frequency dimensions of drinking behaviours. The results point to the possibility that increasing awareness of implicit alcohol-related associations may have utility in interventions for young adults.

This chapter presents a review and critique of empirical research on communication skills in marriage or married-like relationships. Such a chapter is warranted on several counts. First, marriage remains a popular social institution with about 80% of the population professing an intention to marry at some point in their lives (McDonald, 1995). Although most couple relationships start out happy, satisfaction erodes for a substantial proportion of marriages. At any given time, 20% of all married couples report marital dissatisfaction (Reynolds, Rizzo, Gallagher, & Speedy, 1979), and in Western countries, between 40% and 55% of marriages end in divorce (De Guilbert-Lantoine & Monnier, 1992; McDonald, 1995). Second, marital communication is a more valued resource for married individuals than communication with others; amongst married people, the spouse is the person most often turned to for support (Beach, Martin, Blum, & Roman, 1993; Cutrona, 1996; Sarason, Sarason, & Pierce, 1994). Third, escalation of conflict into violence is common in married couples; physical aggression occurs in about 30% of married couples in the United States (Straus, Gelles, & Steinmetz, 1980) and newly wed couples in the United Kingdom (Kelly & Fincham, 1999), leads to significant physical injury in about 10% of couples (Straus & Gelles, 1986; Straus et al., 1980), and is the most common interpersonal context in which homicide occurs (National Committee on Violence, 1990). Fourth, marital conflict is associated with child problems, particularly when children are exposed to it, when it is frequent, intense, involves physical aggression, and remains unresolved (Cummings & Davies, 1994; Grych & Fincham, 1990, 1992; Fantuzzo, et al., 1991). Finally, conflictual couple communication is associated with stress-related disease indicators, such as poor immune response (Kiecolt-Glaser, et al., 1987), and sustained elevations in stress-related hormones (Malarkey, Kiec

While a large proportion of Aboriginal Australians do not consume alcohol, those who do frequently show severe alcohol problems, and alcohol problems are associated with family conflict and violence. The aims were to examine the internal coherence and reliability of measures of family and alcohol measures for indigenous Australians in remote communities. This study involved 99 indigenous people from a remote North Queensland community. Questions were drawn from established questionnaires and administered verbally. Principle components factor analysis revealed three coherent and reliable measures of family conflict, independence, and cohesion. Expectancies of affective change had sound internal reliability for drinkers, and covaried with alcohol problems in the expected direction. The Alcohol Use Disorders Identification Test had two distinct factors relating to consumption and problems, but quantity/frequency measures may have limited reliability due to the common practice among drinkers of sharing alcohol. These measures should facilitate the detection and initial assessment of alcohol and family problems, and may be useful for evaluating change in future interventions that target family and alcohol problems.

Background: In the alcohol literature, most cognition research has focused on alcohol expectancies. Overall scores on alcohol expectancy questionnaires predict longitudinal changes in drinking behavior. However, the association between expectancy subscale scores and drinking behavior is inconsistent and modest. Attitudinal information may vary in accessibility (i.e., the ease or speed with which attitudinal information is evaluated), and more accessible (i.e., faster) attitudinal evaluations may predict heavier alcohol consumption. An alternative hypothesis arising from response competition theory is that heavy drinkers will show slow attitudinal evaluations, given that heavy drinkers frequently show mixed, inconsistent, or opposing alcohol‐related beliefs. In this study we examined the degree to which speed of processing of alcohol‐related evaluative judgments longitudinally predicted alcohol consumption in university students. Methods: Response latencies for alcohol‐ and non‐alcohol‐related attitudinal inquiries and measures of alcohol use were administered at two intervals 4 months apart. Results: The key findings were that response times for tension reduction and cognitive impairment items at time 1 positively predicted alcohol consumption at time 2. These results held after we accounted for autocorrelation in drinking and individual variability in reactivity. Conclusion: For items relating to tension reduction, response times fit a response competition hypothesis better than the attitude accessibility hypothesis.

Aim: To evaluate the efficacy of a short‐term alcohol‐focused intervention for maritally distressed women, and to explore changes in relationship functioning. Design: Participants were assigned randomly to an alcohol‐focused treatment or to a waiting‐list control group. The waiting‐list control group began the intervention at 1‐month follow‐up. Setting: The intervention took place at a research and training centre offering outpatient psychology services to the community. Participants: A sample of 32 women with alcohol and marital problems were recruited through the media. Participants reported protracted alcohol problems, moderate to severe impact of alcohol on social and occupational functioning, and moderate to severe marital distress. Measurements: Measures of average alcohol consumption, marital distress, relational efficacy and depression were administered at pre‐ and post‐therapy, and at 1, 6 and 12‐month follow‐up. Intervention: The intervention involved six 1‐hour sessions, consisting of clinical assessment, motivational interviewing, cognitive‐behavioural strategies and relapse prevention. Results: At 1‐month follow‐up, the intervention was associated with statistically significant improvements in alcohol consumption, marital satisfaction, relational efficacy and depression, and these effects were sustained at 12‐month follow‐up. Conclusions: At 1‐month follow‐up the intervention was associated with decreased alcohol consumption and depression, and increased marital satisfaction and relational efficacy, with evidence of maintained effects at 12‐month follow‐up. However, it is unlikely that reduced problem drinking and improved confidence in resolving problems were the only factors producing low marital quality in these couples. Further research is needed to identify those individuals who might benefit from marital interventions.

Divorce rates in Western countries have focused attention on the need to support couples experiencing marital problems. Unfortunately, only about half the couples who receive marital therapy benefit from it and few experience long-term improvement in their relationship. But even if success rates improved dramatically, the ubiquity of marital discord makes it unlikely that marital therapy will ever be able to meet the need for services . Largely in response to these problems, a variety of marital prevention and enrichment programs have been developed. The goal of such programs is to prepare couples for future problems and resolve any existing marital problems before they become significant

This article is a review of the association of individual and marital problems. The focus is on depression, alcohol abuse, anxiety disorders, and the functional psychoses, each of which interact with marital distress in important ways. Although the causal connections between these disorders and marital distress are complex and only particularly understood, the available evidence shows that individuals’ and couples’ problems often exacerbate each other. Consequently, regardless of whether the initial presentation is individual or couple focused, there is routinely a need to assess both individual and relationship functioning. Couples therapy, and in particular behavioral couples therapy (BCT), is an important element of effective treatment of depression, alcohol abuse, anxiety disorders, and the functional psychoses. The integration of couple and individual therapy presents a number of clinical challenges, and in concluding this article the authors provide guidelines for managing these challenges.

Emotion is the essence of committed adult relationships. Poets, painters, film makers, novelists and others, in trying to capture the human experience of relationships, attempt to portray the love, passion, anger, hurt and rage which occur within the emotional crucible that is intimacy. Yet much psychological research on couple relationships focuses primarily on behavioural and cognitive processes. This seems to miss the full experience of relationships. For example, when one studies the interactions of happy couples, it is often not the positive statements, caring behaviours and relationship-enhancing thoughts that stand out as primary features. Instead...

The limited effectiveness of cognitive behavioural marital therapy (CBMT) for some couples may be due to a failure to achieve generalized changes in behavioural, cognitive or physiological responses during marital interaction. In the present study an intra-subject replication design across five maritally distressed couples assessed changes associated with CMBT in behaviour, cognitions, and physiological arousal during marital communication. These response domains were assessed weekly in both clinic and home settings. Introduction of CBMT was associated with clear reductions in behavioural negativity in both settings for all couples, some variable cognitive changes across couples and settings, but no consistent change in physiological arousal across couples or settings. Physiological responding was asynchronous with behaviour and cognition. Further research is needed on the significance of physiological arousal in marital distress, and the importance of changes in physiological responding during marital interaction to marital therapy outcome.