Self-efficacy Mediates the Relationship Between Depression and Length of Abstinence After Treatment Among Youth but Not Among Adults

Abstract

We present two studies testing whether self-efficacy mediates the relationship between depression symptoms and initial abstinence duration after substance use treatment in adolescents and adults. Study 1: Adolescents (N = 208) were recruited from substance use treatment in an urban/suburban area in the United States between 1999 and 2005 and were followed monthly after discharge. Measures used were affective state (depression symptoms), drug-taking coping self-efficacy, and length of abstinence after treatment. Self-efficacy fully mediated the relationship between depression and time to use. Study 2: In a similar study design, adult veterans (N = 160) in outpatient substance user treatment were interviewed during treatment and monthly following treatment. Depression was negatively associated with self-efficacy, and self-efficacy predicted time to first substance use, but there was no mediation. Study implications and limitations are noted.

RÉSUMÉ

Titre

“Self-efficacy” s’interpose dans la relation entre dépression et durée d’abstinence post-traitement chez des jeunes, mais pas chez des adultes.

Nous présentons deux études qui évaluent si “self-efficacy” s’interpose dans la relation entre symptômes dépressifs et la durée de l’abstinence initiale d’abus de drogues et d’alcool à la suite d’un traitement en consultation hôsptalière extèrne chez des adolescents et des adultes. Première étude: Adolescents (N = 208) ont été recrutés dans des centres de traitement pour abus de drogues et d’alcool entre 1999 et 2005 dans un espace urbain aux États-Unis. Ils ont ensuite été suivis mensuellement à partir de leurs dates de décharge du centre de traitement. Les mesures qui ont été employées sont: état affectif (symptômes dépressifs), “self-efficacy” par rapport à la capacité de gêrer l’usage de drogue et d’alcool, et durée d’abstinence post-traitement. La mesure de “self-efficacy” a entièrement prédit la corrélation entre dépression et lapse de temps avant usage. Deuxième étude: Dans une étude similaire, des vétérans adultes (N = 160) en consultation hôsptalière extèrne pour abus de drogue et d’alcool ont été interrogés durant leurs traitements, et mensuellement à partir de leurs dates de décharge du centre de traitement. La mesure de depression s’est avèrée négativement correlée à la mesure de “self-efficacy”, et la mesure de “self-efficacy” s’est révèlée prédictive de la durée du lapse de temps avant le premier usage de drogue et d’alcool, mais “self-efficacy” ne s’est pas interposé dans la relation entre symptômes dépressifs et la durée de l’abstinence initiale d’abus de drogues et d’alcool. Les implications et les limitations de ces resultats sont prises en compte.

RESUMEN

Titolo

Eficacia personal media la relación entre la depresión y la duración de la abstinencia inicial después del tratamiento en los adolescentes pero no en los adultos

Presentamos dos estudios para estudiar si es que la eficacia personal media la relación entre los síntomas de depresión y la duración de la abstinencia inicial después del tratamiento del abuso de sustancias en adolescentes y adultos. Estudio 1: (N = 208) adolescentes fueron reclutados de un tratamiento de abuso de sustancias de un área urbana/suburbana de los Estados Unidos entre 1999–2005, y se les dio seguimiento mensualmente después de darlos de alta. Las medidas que se usaron fueron el estado afectivo (síntomas de depresión), la eficacia personal para lidiar con la toma de drogas, y la extensión de la abstinencia después del tratamiento. La eficacia personal medió plenamente en la relación entre la depresión y el tiempo de uso. Estudio 2: En un diseño de estudio similar, se entrevistaron (N = 160) Veteranos adultos de un tratamiento de pacientes externos de abuso de sustancias durante su tratamiento y mensualmente después del tratamiento. La depresión se asoció negativamente con la eficacia personal, y la eficacia personal predijo el tiempo de la primera vez de abuso de sustancias, pero no hubo mediación. Las implicaciones y limitaciones del estudio se indicaron.

Keywords :

• relapse
• comorbidity
• self-efficacy
• depression
• developmental psychopathology

THE AUTHORS

Dr. Danielle Ramo is a postdoctoral scholar in the Substance Abuse Treatment and Services Training Program funded by the National Institute on Drug Abuse in the Department of Psychiatry at the University of California at San Francisco. Her research focuses on understanding the role of lifespan development in the etiology, expression, and treatment of addictive disorders. The study presented here is a portion of Dr. Ramo's doctoral dissertation research, funded by a Kirschstein National Research Service Award from the National Institute on Drug Abuse, which examined developmental models of substance misuse relapse. Currently, Dr. Ramo has a postdoctoral fellowship funded by the California Tobacco-Related Diseases Research Program to study patterns of tobacco and marijuana use among young adults recruited through the Internet.

Dr. Mark Myers is a professor in the Department of Psychiatry at the University of California at San Diego and a staff psychologist at the San Diego Veterans Affairs Healthcare System. His research focuses primarily on the course of addictive behaviors in youth. Most recently, Dr. Myers has engaged in the study of youth tobacco use, investigating adolescent and young adult smoking cessation efforts and examining initiation and progression of smoking among college students. His currently funded research examines factors that influence smoking cessation efforts among college students.

Dr. Sandra A. Brown is a professor of psychology and psychiatry at the University of California at San Diego and the Chief of Psychology Service at the Veterans Affairs San Diego Healthcare System. Dr. Brown is internationally recognized for her developmentally focused alcohol and drug intervention research. She is the past President of Division 50 (Addictions) of the American Psychological Association, is on the executive board of numerous scientific organizations, and has over 250 publications. She is involved in addiction prevention and intervention at the regional, state, and national levels and is currently involved in the effort of the National Institute on Alcohol Abuse and Alcoholism to establish national screening guidelines for youth. Dr. Brown's research yielded some of the pioneering information on the relapse process for youth as well as long-term outcomes for clinical samples of youth who have experienced alcohol and drug problems. Her current research funded by the National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, and National Institute of Mental Health investigates neurocognitive impact of early alcohol and drug exposure, processes whereby youth escalate or diminish their substance use with and without treatment, the role of psychiatric comorbidity in the treatment of alcohol and drug problems, and novel early intervention strategies to diminish substance problems among youth.

Notes

1 Treatment can be briefly and usefully defined as a planned, goal-directed, and temporally structured change process, which is of necessary quality, appropriateness, and conditions (endogenous and exogenous) and is bounded (by culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help-based (AA, NA, etc.), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—which aren't also used with nonsubstance users. In the West, with the relatively new ideology of “harm reduction” and the even newer “quality of life” treatment-driven model, there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Editor's note

2 The reader is reminded that the concepts and processes of risk and protective factors are often noted in the literature, without adequately noting their dimensions (linear, non linear), their “demands,” and the critical necessary conditions (endogenously as well as exogenously; from a micro to a macro level), which are necessary for either of them to operate (begin, continue, become anchored and integrate, change as de facto realities change, cease, etc.) or not to, and whether their underpinnings are theory driven, empirically based, individual, and/or systemic stakeholder-bound, based upon “principles of faith stake,” historical observation, and the like. This is necessary to clarify if these terms are not to remain as yet additional shibboleths in a field of many stereotypes. Editor's note.