Psychology of Addictive Behaviors

Potential consequences of the Dobbs v. Jackson Women’s Health Organization decision.
Objective: In June 2022, the U.S. Supreme Court released a landmark decision in which they held that the right to abortion is not protected by the U.S. Constitution, ending almost 50 years of federally legal abortion in the United States. Because prior research demonstrates linkages between reproductive health and substance use at multiple socioecological levels, in this special section, we present studies that take a broad scope to understanding how addictive behaviors and reproduction-related behaviors, options, and access to care interrelate across a variety of contexts. Method: In this introduction, the guest editors detail the impetus for this special section, provide a brief overview of the present studies, discuss policy and intervention implications, and suggest future research directions. Results: The five studies presented in this special section span a wide range of populations, methods, and substance use and reproduction-related issues, including reasons for past abortions among women with opioid use disorder, alcohol effects on men’s condom use resistance, considerations regarding alcohol-involved rape on implementation of “rape exceptions” to abortion bans, the role of early exposure to substance use and sexual abuse on reproductive health outcomes, and the effects of exposure to abortion-related media coverage on alcohol use intentions following the Supreme Court decision. Conclusions: The studies in this special section highlight the ways in which substance use and reproductive health are inextricably intertwined. Recent and future changes in reproductive health legislation and policy underscore the critical need for continued empirical inquiry into these intersecting public health concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Alcohol-involved rape: Limitations of the “rape exception” for abortion access.
Objective: In June 2022, the U.S. Supreme Court removed federal abortion protections, giving individual states the authority to enact abortion regulations. Since that ruling, many states have enacted abortion bans; however, several of these states allow “rape exceptions,” theoretically providing rape victims who become pregnant access to abortion services. Notably, alcohol use by the rape victim and perpetrator is common. In this brief report, we describe findings from research on alcohol-involved rape that have the potential to impact the utility of rape exceptions. Method: In this synthesis of the research literature pertaining to alcohol-involved rape victimization and perpetration, we focus on key concepts detailed in extant research likely relevant to accessing abortion services through rape exceptions. Results: Victim alcohol intoxication may limit the use of rape exceptions to abortion bans by delaying rape acknowledgment, increasing victim blame, undermining victim credibility, and deterring rape reporting. Commensurately, perpetrator alcohol intoxication may increase the need for victims to access abortion services by reducing perpetrator condom use during rape and increasing other sexually aggressive acts such as nonconsensual condom removal. Conclusions: Research evidence suggests that alcohol-involved rape incidents present critical obstacles to utilizing statutory rape exceptions to banned abortion services beyond challenges that non-alcohol-involved rape survivors are also likely to experience. Rape survivors from oppressed communities (e.g., people of color, gender minorities, and/or sexual minorities) may be disproportionately impacted. Empirical investigations specifically examining how substance use during rape impacts reproductive health care accessibility are paramount for informing health care providers, law enforcement, legal practitioners, and policymakers. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Alcohol intoxication, condom use rationale, and men’s coercive condom use resistance: The role of past unintended partner pregnancy.
Objective: Cisgender men’s condom use resistance (CUR), deliberate attempts to avoid using a condom with a partner who wishes to use one, may include coercive strategies, such as deception and force, and places their partners at risk for unintended pregnancy and sexually transitted infections (STIs). This investigation used an alcohol administration design to examine one distal (history of unintended partner pregnancy) and two proximal (acute alcohol intoxication, condom use rationale) contributors to men’s intentions to engage in coercive CUR. Method: Nonproblem drinking, cisgender men (N = 313) completed questionnaires, then were randomized to a beverage condition (control, placebo, low dose [.04%gm], and high dose [.08%gm]). Participants completed a sexual risk analog and reported their coercive CUR intentions after a hypothetical, female partner provided a condom use rationale (STI avoidance or pregnancy avoidance). Results: Men who received the pregnancy condom use rationale reported higher intentions to engage in coercive CUR when they received a high alcohol dose relative to sober men. For men who had a history of unintended partner pregnancy, receiving a pregnancy condom use rationale was associated with greater intentions to have forced, condomless sex if they received a high alcohol dose relative to sober men. Conclusions: Intoxicated men may be more likely to engage in coercive CUR; this may indicate that when intoxicated, pregnancy risks are less salient relative to STI-related outcomes. As reproductive rights are being decimated, effective interventions targeting CUR, particularly when intoxicated, are needed in tandem with policies that affirm one’s ability to prevent and terminate pregnancy. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Sexual and reproductive health behaviors of women with criminal legal involvement and substance use disorders: A life course perspective.
Objective: Early exposure to drug use and sexual abuse may contribute to later substance use, causing downstream effects on sexual and pregnancy-related behaviors. We applied the life course perspective to qualitative interview findings conducted with women with criminal legal involvement to explore connections between participants’ early exposure to drugs and childhood sexual abuse with subsequent engagement with substance use and sexual and reproductive behaviors. Method: We analyzed semistructured interviews with 33 racially diverse women with criminal legal involvement, Ages 18–65, who were recruited from a community organization in the Midwestern United States to explore their experiences and perspectives on factors that influenced their substance use and reproductive health behaviors. We used a modified grounded theory approach and retroactively applied the life course perspective model to inform and organize our data. Results: Fifteen participants described exposure to substances and/or sexual abuse at a young age which played a role in influencing later life behaviors involving substance use and sexual and reproductive health. For some participants, the accumulation of experiences further contributed to shared pregnancy behaviors and outcomes including unexpected and rapid repeat pregnancies and difficulty abstaining from drug use while pregnant. Conclusions: Early life experiences may influence later life sexual and reproductive health behaviors. These experiences must be considered when engaging with women in patient-centered and trauma-informed ways in settings where they seek care including carceral facilities, obstetrics and gynecology and primary care clinics, and substance use disorder treatment programs. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Reasons for past abortions among women in treatment for opioid use disorder.
Objective: The main reasons women in the general population seek abortion are financial, timing, and partner-related reasons. While women with opioid use disorder (OUD) appear to use abortion services more than women in the general population, reasons for abortion in this group have not been examined to our knowledge. Method: Female patients aged 18–50 years in OUD treatment at 22 randomly selected facilities in Michigan were surveyed. The survey included items assessing reproductive health history. Women who reported having one or more abortions were asked to think back to that time and their reasons for choosing abortion. Twenty potential reasons and a write-in option were offered; women could endorse as many as applied. Results: Of 260 women surveyed, 84 reported having an abortion. Of these, most (77.4%) reported multiple reasons for having an abortion. The most common reasons for having an abortion were not having money to take care of a baby (54.8%), feeling too young to have a child and not feeling ready to be a mother (both 42.9%), not loving the father and other partner-related concerns (25.0%–32.1%), and having concerns about the effects of their drug use (28.6%). No combination of reasons for abortion emerged as more prevalent than any other. Conclusions: Like women in the general population, women in treatment for OUD had not only abortions because of financial, timing, and partner-related reasons but also concerns about the effects of their drug use. These results underscore the multiple and often interrelated reasons that lead women to seek abortion. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Watching the fall of Roe v. Wade: Media exposure relates to U.S. women’s alcohol use intentions.
Objective: The Supreme Court of the United States’ decision in Dobbs v. Jackson Women’s Health Organization in June 2022 overturned Roe v. Wade and ended federal protection of abortion rights. Given the drastic policy changes as a result of the ruling and high exposure to media related to abortion, women opposed to the decision may have experienced distress, which could trigger maladaptive coping strategies, such as alcohol use. The present research examined how consuming abortion-related media in the weeks following the Dobbs decision impacted alcohol use intentions among women of reproductive age residing in the 13 “trigger law” states that immediately restricted abortion access. Method: A sample of 196 women (Mage = 30.52, SD = 6.9) residing in trigger law states answered questions about abortion-related media consumption, views toward the Dobbs ruling, negative affect, and alcohol use intentions. Results: Consuming more abortion-related media predicted higher alcohol use intentions for women who opposed the ruling, but not those who were in favor of abortion restrictions. Conclusions: This timely study provides evidence of how the Dobbs ruling is associated with health ramifications beyond reproduction, yielding insights about how high media exposure to large-scale, distressing events may put those most affected—women of reproductive age in states that enacted new policies restricting abortion access—at risk for alcohol use. Findings highlight an imperative direction for future research as abortion restrictions continue to be spotlighted in U.S. media and state legislatures. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Prevalence of psychosocial issues among pregnant women who do and do not use illicit substances.
Objective: The American College of Obstetricians and Gynecologists (ACOG) recommends providers screen their prenatal patients for 11 psychosocial issues because they affect patient mental and physical well-being. The prevalence and co-occurrence of these issues have rarely been compared among pregnant women who do and do not report recent illicit substance use. Method: Seven psychosocial issues identified by ACOG were operationalized using National Survey on Drug Use and Health variables. We report weighted prevalence and adjusted risk ratios (ARR) for these issues in pregnant women who did versus did not report past-month illicit substance use. Results: Pregnant women (n = 3,657) who reported past-month illicit substance use (6.3%; 95% CI [5.4–7.3]) had significantly higher prevalence of almost all psychosocial issues examined, including past-month cigarette smoking (44.9% versus 9.5%; ARR = 2.84, 95% CI [2.21–3.65]); past-month alcohol use, 36.1% versus 7.9%; ARR = 4.71 (3.59–6.18); serious past-month distress, 23.0% versus 5.0%; ARR = 3.51 (2.39–5.15); no health insurance, 11.7% versus 6.2%; ARR = 1.71 (1.07–2.74); and receipt of food stamps, 45.0% versus 24.0%; ARR = 1.40 (1.18–1.67). Moving 3 + times in the past year followed a similar pattern, but results were compatible with there being no difference, 10.6% versus 5.5%; ARR = 1.39 (0.86–2.25). The majority of pregnant women reporting illicit substance use endorsed experiencing ≥ 2 psychosocial issues while the majority of those who did not report illicit substance use did not endorse any. Conclusions: Pregnant women who use illicit substances experience higher prevalence and greater co-occurrence of psychosocial issues compared to those who do not, reinforcing recommendations for multidisciplinary approaches to care. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Social associations and alcohol consumption in an Australian community sample: An egocentric social network analysis.
Objective: This study examined how social associations from a person’s social network may be associated with their own alcohol consumption. Method: Alcohol consumption behavior was examined among the social networks of 784 survey respondents (54% female, Mage = 35.3 years), using egocentric social network analysis. Participants (egos) were recruited via a panel aggregator and completed an online survey about the frequency of their alcohol consumption and that of the 20 most influential people in their lives (alters). The survey also explored who these alters were (family, friends, work colleagues) and the interrelationships among these alters. Results: Egos who consumed alcohol, or consumed alcohol more frequently, were surrounded by more alters who also drank alcohol and felt closer (had stronger ties) to these alters. These relationships remained statistically significant when controlling for demographic and other variables. The social networks of those who consumed alcohol more frequently were more densely intertwined. Conclusions: Alcohol may serve to initiate social connections and be a “social glue” that reinforces relationships. These strong social associations present a potential barrier to individuals who wish to reduce their alcohol consumption because they have few close social connections who do not drink alcohol (or who do so infrequently), and their highly interconnected social networks make it difficult to socialize only with those who do not drink frequently. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
The role of social connection in opioid use disorder treatment engagement.
Objective: Medications for opioid use disorder (OUD or MOUD) treatment combining pharmacotherapy with psychosocial support are effective for managing OUD. However, treatment engagement remains a challenge, with retention rates ∼30%–50%. Although social connection has been identified as important to recovery, it remains unclear whether and how social factors can bolster participation in treatment. Method: Individuals receiving MOUD at three outpatient treatment programs (N = 82) and healthy community controls (N = 62) completed validated measures assessing social connection including (a) size, diversity, and embeddedness of social networks; (b) perceived social support and criticism within familial relationships; and (c) subjective social status. For those receiving MOUD, we also examined how aspects of social connection related to opioid (re)use and treatment engagement (medication adherence, group, and individual meeting attendance) assessed over ∼8 weeks/person. Results: Compared to controls, individuals receiving MOUD had smaller and less diverse and embedded social networks (Cohen’s d > 0.4), and despite similar levels of perceived social support (d = 0.02), reported higher levels of social criticism (d = 0.6) and lower subjective social status (d = 0.5). Within the MOUD group, higher social network indices correlated specifically with higher therapeutic group attendance (Rs > 0.30), but not medication adherence, while higher levels of perceived criticism correlated with more frequent opioid use (R = 0.23). Results were mostly robust to control for sociodemographic variables, psychological distress/COVID-19, and treatment duration, but differed by MOUD type/program. Conclusions: These findings highlight the potential importance of assessing an individual’s social capital, promoting positive social connection, and continuing to assess the implementation and value of psychosocial support in MOUD treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved)

Psychology of Addictive Behaviors - Vol 38, Iss 2