Interpersonal styles, peer relationships, and outcomes in residential substance use treatment

Abstract

Interpersonal relationships play a key role in recovery from substance use disorders (SUDs). We examined the associations between problematic interpersonal styles, peer relationships, and treatment outcomes in a sample of U.S. military veterans in residential SUD treatment. Participants were 189 veterans enrolled in a residential SUD treatment program at a Department of Veterans Affairs medical center. Participants were interviewed at the time of treatment entry (baseline), one month into treatment, and 12 months following discharge from treatment. More problematic interpersonal styles at treatment entry, measured by the Inventory of Interpersonal Problems-Circumplex (IIP-C), predicted more SUD symptoms 12 months post-discharge (r=.29, P<.01). Results of a principal components analysis of the IIP-C subscales revealed three main factors of interpersonal styles: Passive, Cruel/Aloof, and Controlling. With the exception of the Passive factor, the relationship between these interpersonal styles and SUD symptoms 12 months after discharge was mediated by relationship quality with peers one month in treatment: i.e., more problematic interpersonal styles at baseline predicted poorer relationship quality with peers at 1 month, which in turn predicted more SUD symptoms at 12 months. Results demonstrate the importance of assessing interpersonal styles among patients in residential SUD treatment, as well as potentially augmenting existing evidence-based psychosocial treatments with a focus on interpersonal styles.

Relevance of psychopathic traits to therapeutic processes and outcomes for veterans with substance use disorders.

“…An increasing body of recent evidence indicates, contrary to previous claims (Harris & Rice, 2006), that individuals with psychopathic traits can benefit from therapeutic interventions (Caldwell, 2011; Caldwell et al 2006; 2007, 2012; Sewall & Olver, 2019). Whereas much of the research on psychopathy and treatment has focused primarily on treatment outcomes (e.g., retention, recidivism), less is known about how psychopathic traits influence pretreatment and in-treatment processes, as described earlier.…”

“…Baseline functioning (e.g., psychiatric distress, coping style), adjustment to treatment (e.g., relationships with peers), and perceptions of treatment (e.g., program alliance, therapeutic factors) have been identified as key process variables that may positively or negatively influence treatment outcomes (Demmel & Rist, 2005; Harrison et al 2017; Ilgen et al 2006). For instance, higher psychiatric distress at baseline (Daughters, et al, 2005) and negative peer relationships within residential substance use treatment programs (Harrison, et al, 2017) have been linked with poorer substance treatment outcomes. Similarly, therapeutic influences such as promotion of feelings of hope and connectedness to the treatment have been implicated in the effectiveness of group-based treatments among populations including high-risk patients (Hauber, et al, 2019), individuals with personality disorders (Friedman & Downey, 2016), and substance use treatment groups (Amram & Benbenishty, 2014).…”

Development and validation of 21-item outcome inventory (OI-21)

“…Convergent and discriminant validity revealed the interpersonal difficulties subscale had higher correlation with unfriendly (hostile) type than friendly type. Likewise, the depression subscale had higher correlation with social inhibition, which is common and related to many psychopathologies such as depression, internet addiction, and substance abuse ( Harrison et al., 2017 ; Husson et al., 2017 ; Monacis et al., 2017 ). The same is true for the relationship between OI subscales and attachment anxiety and avoidance, where the anxiety subscale was significantly related to attachment anxiety but not to avoidance.…”

A re‐introduction of the psychodynamic approach to the standard clinical psychology curriculum

“…Furthermore, the dimensional views of impairment in self and relational functioning are relevant in conceptualizing interpersonal difficulties in almost all mental disorders. For example, disruptions in the ability to maintain fulfilling meaningful relationships are common in patients with depression (e.g., Kupferberg et al, 2016), anxiety (Shin & Newman, 2019), bipolar spectrum disorders (e.g., Bartholomew et al, 2019) traumatic stress (Scoglio et al, 2022), eating disorders (e.g., Luo et al, 2018), schizophrenia spectrum disorders (e.g., Green et al, 2019); and substance use (e.g., Harrison et al, 2017). Thus, the dimensional framework of viewing psychopathology on the self and interpersonal functioning is relevant for therapists to conceptualize and treat interpersonal difficulties.…”