Varenicline OTC Trial on Efficacy and Safety.

INTRODUCTION: Varenicline helps people who smoke quit at rates 2-3 times greater than placebo. Currently in the U.S., varenicline is not available over the counter (OTC). In this study, we assessed the safety and efficacy of 1mg and 0.5mg varenicline as an OTC medication for smoking cessation in comparison to placebo. METHODS: This randomized, double-blind, placebo-controlled study was performed at two clinical sites in the United States of n=313 people. The treatment period was 12 weeks. During the COVID pandemic, the protocol was modified to allow remote participation; verification of smoking status was via breath carbon monoxide levels for in-person visits and mailed urine cotinine kits for the remote participants. RESULTS: There was no difference in biologically confirmed continuous abstinence by condition between Weeks 8-12; however, the odds of biologically confirmed point prevalence abstinence were higher for those in the 1mg b.i.d. condition than for those in the placebo condition at Week 12 (OR 3.39; 95% CI 1.49, 7.71), and were higher for those assigned to the 1.0mg b.i.d. condition than the 0.5mg b.i.d. condition at Week 12 (OR 2.37; 95% CI 1.11, 5.05). Adverse events were modest, and as expected (vivid dreams and nausea in the medication conditions). CONCLUSIONS: The results are suggestive that varenicline is safe and effective as an OTC medication.

The Social Determinants of Suicide among Female Service Members and Veterans : Running Title: Social Determinants of Suicide.

AIMS: Evaluate the social determinants of health (SDOH) associated with suicidality among female Service Members and Veterans (SMV) in Arizona. METHODS: Used data from a statewide Arizona Veteran Survey (n = 1,134) to analyze SDOH associated with suicidality (any self-report of suicidal ideation, suicide attempt, or calling a crisis line). Response data were cross-tabulated and analyzed for statistical significance using a chi-square test with a p-value of p < 0.05. RESULTS: Depression, disability, barriers to treatment, housing instability, feelings of loneliness, and more were associated with increased suicidality among respondents. Substance use within the last 30 days, social support, and Veteran social support were not found to be significantly associated with suicidality. CONCLUSIONS: Female SMV populations experiencing social, economic, and health disparities appear to be at higher risk for suicide. These findings suggest that future suicide prevention efforts may be more effective if tailored towards populations in need of additional support and social services.

Do Coping Motives and Perceived Impaired Control Mediate the Indirect Links from Childhood Trauma Facets to Alcohol-Related Problems?

INTRODUCTION: The Self-Medication Hypothesis suggests that individuals drink to alleviate undesirable affective states. Behavioral Economics Theory states that individuals deprived of resources (i.e., physically neglected) consume more reinforcing substances when they are available than others. Childhood trauma may indirectly increase impaired control over alcohol (IC; drinking beyond one's own intentions) and thereby increase alcohol use and problems through the employment of coping-motives. METHOD: A structural equation model that included sex as a covariate examined mediated paths with 612 university students. RESULTS: Men were less likely to be emotionally abused and were more likely to use greater amounts of alcohol than women did. Physical neglect was directly linked to both more IC and alcohol use. Emotional and sexual abuse were directly linked to more coping motives. Both emotional and sexual abuse were indirectly linked to more alcohol use and its related problems through increased coping motives and IC. CONCLUSIONS: Consistent with Behavioral Economics Theory, there was a direct link between physical neglect and IC. We also found partial support for the Self-Medication Hypothesis regarding the emotional and sexual abuse trauma dimensions; they indirectly contributed to alcohol use and its related problems via the mediating mechanisms of more coping motives and IC. Our findings suggest coping motives could be a therapeutic target for intervention among those sexually or emotionally abused.

Does Relationship-Contingent Self-Esteem Play a Role in the Stress to Impaired Control Pathway to Alcohol-Related Problems in a College Student Sample?

The Appraisal-Disruption Model (ADM) suggests that individuals use alcohol as a means of dampening negative self-talk. Relationship-contingent self-esteem (RCSE) emerges from validating one's self-esteem depending on one's romantic relationship(s) and is known to predict alcohol-related problems. We hypothesized that RCSE indirectly predicts drinking outcomes through the mediating mechanism(s) of stress and impaired control over alcohol (IC; drinking to excess beyond one's own intentions). We fit a multiple-group structural equation model with self-report survey data from 479 college students. We used a 20,000 bootstrap technique to examine possible mediated pathways. Consistent with evolutionary theory, our model was moderated by sex: more variance in alcohol-related problems was explained for women (R2 = 0.479) than for men (R2 = 0.280). RCSE was directly linked to more stress. Furthermore, higher levels of RCSE were indirectly linked to more IC through increased stress, and in turn, more heavy episodic drinking and alcohol-related problems for both men and women. Consistent with the ADM, those with higher levels of RCSE experienced more stress and, in turn, more IC and subsequent adverse alcohol outcomes. Thus, therapists targeting alcohol use disorders (AUDs) may wish to determine if their client's self-esteem changes dramatically based on their moment-to-moment appraisal of their intimate relationships.

Winning at all costs: The etiology of hypercompetitiveness through the indirect influences of parental bonds on anger and verbal/physical aggression.

Hypercompetitiveness reflects the need to compete and win at all costs as a means of maintaining or enhancing one's own self-worth (Horney, 1937; Ryckman, Hammer, Kaczor, & Gold, 1990). This need to win at any cost is linked to expressions of verbal and physical aggression, which may take a toll on important relationships (Hibbard & Buhrmester, 2010). We sought to explore whether parental bonds with mothers and fathers (i.e., care, rejection, autonomy, and overprotection) were indirectly linked to aggression via the mediating mechanisms of hypercompetitiveness and feelings of anger. A sample of 581 university students (316 females; 265 males) were used to examine a multiple-group structural equation model. Tests of structural invariance revealed clear moderation by gender. For instance, the pathway from verbal to physical aggression was stronger for males compared to females. For females only, higher levels of father care were indirectly linked to fewer acts of physical aggression. For both genders, higher levels of mother overprotection were indirectly linked to more acts of physical aggression through increased hypercompetitiveness and, in turn, more feelings of anger. Findings regarding maternal overprotection are consistent with both Evolutionary and Social Learning theories of behavior.