Georgia Stathopoulou

OBJECTIVE: Despite significant advances in psychosocial treatments for substance use disorders, the relative success of these approaches has not been well documented. In this meta-analysis, the authors provide effect sizes for various types of psychosocial treatments, as well as abstinence and treatment-retention rates for cannabis, cocaine, opiate, and polysubstance abuse and dependence treatment trials. METHOD: With a comprehensive series of literature searches, the authors identified a total of 34 well-controlled treatment conditions-five for cannabis, nine for cocaine, seven for opiate, and 13 for polysubstance users-representing the treatment of 2,340 patients. Psychosocial treatments evaluated included contingency management, relapse prevention, general cognitive behavior therapy, and treatments combining cognitive behavior therapy and contingency management. RESULTS: Overall, controlled trial data suggest that psychosocial treatments provide benefits reflecting a moderate effect size according to Cohen's standards. These interventions were most efficacious for cannabis use and least efficacious for polysubstance use. The strongest effect was found for contingency management interventions. Approximately one-third of participants across all psychosocial treatments dropped out before treatment completion compared to 44.6% for the control conditions. CONCLUSIONS: Effect sizes for psychosocial treatments for illicit drugs ranged from the low-moderate to high-moderate range, depending on the substance disorder and treatment under study. Given the long-term social, emotional, and cognitive impairments associated with substance use disorders, these effect sizes are noteworthy and comparable to those for other efficacious treatments in psychiatry.

Associations between exercise and mental well-being have been documented repeatedly over the last two decades. More recently, there has been application of exercise interventions to clinical populations diagnosed with depression, anxiety, and eating disorders with evidence of substantial benefit. Nonetheless, attention to the efficacy of exercise interventions in clinical settings has been notably absent in the psychosocial treatment literature, as have been calls for the integration of these methods within the clinical practice of psychologists. In this article, we provide a quantitative and qualitative review of these efficacy studies in clinical samples and discuss the potential mechanism of action of exercise interventions, with attention to both biological and psychosocial processes. The meta-analysis of 11 treatment outcome studies of individuals with depression yielded a very large combined effect size for the advantage of exercise over control conditions: g = 1.39 (95% CI: .89-1.88), corresponding to a d = 1.42 (95% CI: .92-1.93). Based on these findings, we encourage clinicians to consider the role of adjunctive exercise interventions in their clinical practice and we discuss issues concerning this integration.

Refining the mechanisms behind illicit drug use is an important factor for improving the quality of clinical care. Research in alcohol, marijuana, and nicotine use disorders have linked coping motives (e.g. using substances to ameliorate negative emotional states) to problematic substance use. We evaluated the link between emotion regulation difficulties (as assessed via the difficulties in emotion regulation scale [DERS]) and motives for drug use (as assessed via the Drug Use Motives Questionnaire) among individuals (n = 68) with opioid use disorders who were in methadone maintenance treatment. We found that the DERS total score was significantly associated with coping motives for use. Nonacceptance of emotional responses was the only DERS domain that offered nonredundant prediction of coping motives. These findings highlight the relevance of specific emotion regulation deficits in motives for illicit drug use among individuals with opioid use disorders and may help inform targeted cognitive-behavioral treatments in this population.

The sample for this exploratory qualitative study of Greek perceptions of elder abuse consisted of 43 Greek participants from urban centers and 28 Greeks from a small island village. Participants were asked to provide examples of extreme, moderate, and mild abuse from an adult child toward his/her aging parent. Half of the examples of extreme abuse were various forms of physical aggression. Predominant examples of moderate abuse were psychological abuse and neglect, and at the mild level neglect was the most highly cited category. The most frequently mentioned specific types of elder mistreatment were verbal abuse, psychological neglect, physical neglect, and hitting. There were no gender differences in the kinds of examples that participants gave or the severity they attributed to their examples. Females were more often presented as victims of abuse than males. A negative correlation was found between age and the number of physical abuse examples given overall, and as types of severe abuse.