Addictive Behaviors, Vol. 22, No. 1, pp. 13Y-144, 1997 Copyright 0 1996 Elsevier Science Ltd Primed-in the USA. All rights reserved 0306-4603197 $17.00 + .oTl Pergamon PII s0306-4603(%)ooo26-3 zyxwvutsrqponmlkjihgfedcbaZYXWV BRIEF REPORT A BI-DIRECTIONAL THEORY OF ADDICTION: EXAMINING COPING AND THE FACTORS RELATED TO SUBSTANCE RELAPSE BRIAN CASTELLANI, RAYMOND WEDGEWORTH, ENOCH WOOTTON. and LOREEN RUGLE VA Medical Center, Veterans Addiction Recovery Center, Brecksville, OH Abstract -The results from this study supported a bi-directional theory of addiction for a sample of Black, inner-city, working-class, male substance abusers. Using structural equations modeling, at 6 months posttreatment we found that (a) the reciprocal effect emotional and psychological distress and substance relapse had on one another existed within the context of their bi-directional relationship with social instability, and (b) effective coping skills and re- sources moderated the negative effects that emotional and psychological distress. social struc- ture, and substance relapse had on one another. These findings led us to three suggestions treatment professionals can use to counteract recidivism. zyxwvutsrqponmlkjihgfedcbaZYXWVUTS Copyright 0 1996 Elsevier Science Ltd In today’s health care climate cost containment is a primary concern for addiction fa- cilities. Perhaps the most difficult factor counteracting cost containment is recidivism (e.g., Peterson, Swindle, Phibbs, Racine, & Moos, 1994). In response to recidivism. analyses have generally focused on either the psychological (e.g., Jacobs. 1989) or so- ciological factors (e.g., Greenberg & Grunberg. 1995). Regardless of which perspec- tive a clinician or researcher holds. one of the key variables affecting both the psycho- logical and sociological is coping (Lazarus & Folkman, 1984). Because coping is associated with both the psychological and sociological factors, our study merged these two perspectives to procure a bi-directional theory of addic- tion. A bi-directional theory of addiction is an extension of Lazarus and Folkman’s (1984) work on coping. They define coping as constantly changing cognitive and be- havioral efforts to manage specific external [sociological] and/or internal [psychologi- cal] demands that are appraised as taxing or exceeding the resources of the person (Lazarus & Folkman, 1984, p. 141). We therefore made the following two hypotheses (a) The relationship between psychological stress, social structure, and substance re- lapse is bi-directional, and (b) coping moderates the effects of psychological distress. social structure, and substance relapse have on one another. To explore these hypotheses we analyzed a sample of working-class, Black, male. in-patient substance abusers to determine the relationship between social structure. coping. psychological distress, and substance relapse 6 months posttreatment. Our hy- potheses were broken down into two models. Model 1 (see Fig. 1.): We hypothesized that substance relapse (SUB), housing. in- come. and employment stability (SOC), and emotional and psychological distress (PSYCH) would all correlate with each other significantly Model 2 (see Fig. 2.): We hypothesized that (a) coping (COPE) would significantly moderate the relationship SOC, PSYCH, and SUB have with each other and that (b) Requests for reprints should be sent to Brian Castellani, M.A., 432 Fairchild Avenue. Kent. OH 44240. 139