Faculty Bibliography

Ataques de nervios are an idiom of distress used by Puerto Ricans and other Latinos to express dislocations in the social world of the family. This paper contributes to the growing study of the "anthropology of the emotions". Through detailed interviews with 121 people in Puerto Rico, 78 of whom had had an ataque de nervios, we are developing a thick description of both the prototypical models for ataques de nervios and the varied individual experiences of ataques. The interview used in this study is a version of the Explanatory Model Interview Catalogue specifically adapted for use in a community study of ataques de nervios in Puerto Rico. Responses to questions on the experience of ataque de nervios were analyzed using a team of reviewers who represented differing knowledge and experience with Puerto Rican culture and mental health practice. The experience of ataques de nervios involves a loss of control in several important domains of experience: emotional expressions, bodily sensations, action dimensions and alterations in consciousness. That loss of control is closely linked to important social contexts relating to major life problems and the experience of suffering.

OBJECTIVE:Few studies have examined processes that mediate positive outcomes in the treatment of substance use disorders. The present study used a theory-driven approach to assess mechanisms hypothesized as curative by the traditional chemical dependency treatment approach. Several specific disease model processes such as accepting powerlessness over alcohol and two processes common to both the disease model and other treatment approaches (commitment to abstinence and intention to avoid high-risk situations) were studied. It was hypothesized that patients entering treatment would manifest high levels of denial, that there would be significant reduction of denial and increased endorsement of disease model and common processes as a result of treatment and that processes would mediate outcome. METHOD/METHODS:Patients (N = 79; 54 men) in intensive traditional alcohol/drug treatment were assessed at entry into treatment, at the end of treatment and 1 month following treatment. Both self-report and clinician ratings of processes were assessed. RESULTS:Overall, results provided little support for study hypothesis. Subjects showed low levels of denial at treatment entry. Specific disease model, but not common processes, increased during treatment. Common processes, but not disease model processes, predicted relapse. Patients with higher levels of commitment to abstinence and greater intentions to avoid high-risk situations were at lower risk for relapse. However, greater commitment to Alcoholics Anonymous and belief in a Higher Power predicted reduced severity of relapse among those who did relapse. CONCLUSIONS:Findings do not support prevailing practitioner views regarding how traditional treatment works and suggest that interventions in these treatments may be mismatched to patient needs.