Assessment of the Short Grit Scale in patients with substance use disorder: Psychometric properties and patient characteristics.

Background: Recovery from substance use disorder requires sustained effort and perseverance. Hence, the resilience factor of grit may be important for people in recovery. Little research has been conducted on grit in patients with substance use disorder (SUD), especially in a large and varied sample.Objectives: To analyze the psychometric properties of the Short Grit Scale (Grit-S) in patients with SUD and to use demographic and clinical characteristics to predict variance in Grit-S scores.Methods: Participants completed the Grit-S and other self-report measures. Psychometric properties of the Grit-S were assessed in outpatients (N = 94, 77.7% male) and a hierarchical regression predicted Grit-S variance in inpatients (N = 1238, 65.0% male).Results: The Grit-S demonstrated good internal consistency (α=.75) and strong test-retest reliability (adjusted r = .79, p < .001). Mean Grit-S score was 3.15, lower than other clinical samples reported in the literature. Regression modeling indicated a moderate, statistically significant association between demographic and clinical characteristics and Grit-S scores (R2 = 15.5%, p < .001). Of particular interest, the positive factor of recovery protection showed the strongest association with Grit-S of all variables assessed (ß=.185 vs. ß = .052-.175 for the remaining significant independent variables).Conclusion: The psychometric properties of the Grit-S in patients with SUD support its use in this population. Moreover, the particularly low grit scores among inpatients with SUDs and the association of grit scores with substance use risk and recovery factors suggest that grit could be useful as a treatment target in this population.

Correlates of optimism among patients in substance use disorder inpatient treatment.

BACKGROUND AND OBJECTIVES: Early recovery from substance use disorder (SUD) is often characterized by hopelessness and despair about the future. Optimism, or the expectation that good things will happen, may provide a buffer against despair, and motivate adaptive goal engagement and coping. Study objectives were to (1) compare levels of optimism among individuals in substance use disorder inpatient treatment to other populations and (2) examine correlates of optimism. METHODS: This exploratory study utilized a cross-sectional survey design. Participants (n = 355) completed self-report measures assessing sociodemographic and clinical characteristics. The main variable of interest, optimism, was assessed by Life Orientation Test-Revised scores. Multivariate regression was used to examine the association among sociodemographic and clinical variables and optimism. RESULTS: Our sample (n = 342) scored lower on optimism (mean = 11.7) than general population and SUD patients reported in the literature (range = 13.0-18.5). Optimism was higher for SUD inpatients who were college-educated and those with higher scores on the recovery protection factor, while greater anxiety severity was associated with lower optimism scores. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: This study contributes to emerging research on the association between optimism and SUDs. Optimism has not been previously studied among patients in acute, short-term inpatient SUD treatment and doing so may be clinically useful in addressing low optimism as an obstacle to motivation for treatment. Bolstering optimism may be a promising target for intervention and future research.

Suicidal motivations among opioid overdose survivors: Replication and extension.

BACKGROUND: Several studies suggest suicidal motivation may contribute to opioid overdose fatalities in people with opioid use disorder. In this study, we sought to replicate and extend prior findings suggesting that a desire to die is common prior to nonfatal opioid overdose in people with opioid use disorder. METHODS: Adults receiving inpatient detoxification and stabilization who reported a history of opioid overdose (N = 60) completed questions about suicidal cognition prior to their most recent overdose. RESULTS: Approximately 45% reported some desire to die prior to their most recent overdose, with 20% reporting they had some intention to die. The correlation between these ratings was of a moderate magnitude (ρ = 0.58). Almost 40% of the sample perceived no risk of overdose prior to their most recent overdose event, suggesting a significant underestimation of risk in this population. CONCLUSIONS: Desire to die was common in adults with opioid use disorder prior to nonfatal opioid overdose events, and 1 in 5 people with a history of opioid overdose reported intention to die prior to their most recent opioid overdose. Careful assessment of suicidal cognition in this population may improve prevention of opioid overdose deaths.

Psychometric properties of the Anxiety Sensitivity Index-3 in adults with substance use disorders.

Anxiety sensitivity, or the fear of anxiety-related sensations, has demonstrated relevance to a broad range of psychiatric conditions, including substance use disorders (SUDs). Anxiety sensitivity is typically measured through self-report instruments, most commonly the Anxiety Sensitivity Index-3 (ASI-3). Despite the widespread use of the ASI-3 in studies of SUDs, little is known about its psychometric properties within this population. Patients on an inpatient detoxification unit seeking treatment for SUDs (N = 1248) completed a battery of self-report measures, including the ASI-3. Psychometric properties of the ASI-3 were examined. An exploratory factor analysis with half of the sample (n = 624) supported a 3-factor structure corresponding to the ASI-3 subscales (Social Concerns, Cognitive Concerns, Physical Concerns). Confirmatory factor analysis was used to validate this 3-dimensional structure in a separate subsample (n = 624), resulting in adequate fit when testing a second-order hierarchical model. Internal consistency and convergent and discriminant validity results also supported the use of the ASI-3 in people with SUDs. Despite its widespread use in SUD research, this is the first psychometric investigation of the ASI-3 among individuals seeking treatment for SUDs.

Do people with opioid use disorder and posttraumatic stress disorder benefit from dding Individual opioid Drug Counseling to buprenorphine?

BACKGROUND AND PURPOSE: Large randomized trials have found that behavioral therapy for opioid use disorder (e.g., Individual Drug Counseling, Cognitive Behavioral Therapy for Opioid Use Disorder) does not improve buprenorphine maintenance outcomes, on average, for individuals with opioid use disorder. However, recent studies indicate that certain subgroups of patients may benefit from the addition of behavioral therapy to buprenorphine. In particular, people with more complex and severe psychosocial needs may benefit from the addition of behavioral therapy for opioid use disorder. METHODS: In this study, we conducted a secondary analysis of a large, multi-site randomized trial (N = 357) of buprenorphine maintenance with and without individual Opioid Drug Counseling (ODC) for the treatment of opioid use disorder. We hypothesized that participants with posttraumatic stress disorder (PTSD) would benefit from the addition of ODC. RESULTS: Logistic regression models indicated a significant PTSD by treatment condition interaction. Specifically, 67% of those with PTSD had a successful opioid use disorder treatment outcome when they were assigned to receive both ODC and buprenorphine, compared to a 36% response rate among those who received buprenorphine alone. CONCLUSIONS: Although these results require replication, our findings provide initial indication that ODC is an important complement to buprenorphine maintenance treatment for people with co-occurring PTSD and opioid use disorder.

Sex differences in benzodiazepine misuse among adults with substance use disorders.

Women are more likely than men to be diagnosed with anxiety disorders and to be prescribed benzodiazepines. People with substance use disorders are at a heightened risk for the misuse of benzodiazepines, yet little is known about sex differences in the prevalence, correlates or patterns of benzodiazepine misuse in this population. The aim of this study was to characterize sex differences in benzodiazepine misuse in a sample of adults receiving substance use disorder treatment (N = 352). Almost half of the sample had been prescribed a benzodiazepine and more than 40% had misused a benzodiazepine. Women were more likely to have a lifetime prescription than men, but were not more likely to report misuse or regular misuse. Consistent with data for other substances, women were more likely to report misusing benzodiazepines to cope and reported greater anxiety sensitivity. The vast majority (97%) of participants reported co-use of benzodiazepines with other substances and 65% of women reporting misusing benzodiazepines via a non-oral route of administration (e.g., intranasal). Although benzodiazepine misuse prevalence was not substantively different between men and women, several sex differences in clinical characteristics and patterns of use were identified. Further research on the nature of sex differences in benzodiazepine misuse is needed to inform targeted treatment for both men and women with substance use disorders.

Validation of the craving scale in a large sample of adults with substance use disorders.

Valid and reliable measures of craving are essential for both clinical practice and research. Brief measures are particularly valuable for clinical and research settings in which assessment burden needs to be minimized. The Craving Scale is a 3-item measure of craving that has been previously validated in cocaine-dependent samples. This brief measure has also demonstrated predictive validity in both alcohol and opioid use disorder; however, its psychometric properties in these disorders are not well characterized. The aim of this paper was to extend prior psychometric analyses of the Craving Scale to a large sample of adults seeking treatment for substance use disorders (N = 1,283). Analyses of readability indicated that the Craving Scale was written between a 7-8th grade reading level and had minimal grammatical complexity. The Craving Scale demonstrated strong internal consistency reliability (omega = 0.81), a single-factor latent structure, and adequate concurrent and discriminant validity. Importantly, results were similar when analyses were run separately for alcohol and opioid craving and in men and women, supporting measure invariance across these key groups. Our results provide further support for the reliability and validity of the Craving Scale for use in people with substance use disorders.

Associations between Childhood Abuse and Chronic Pain in Adults with Substance Use Disorders.

BACKGROUND: Both childhood abuse and chronic pain are common in people with substance use disorders (SUDs). Studies have found that exposure to childhood abuse is associated with chronic pain in adulthood; however, few studies have examined this association in people with SUDs. Objectives: This study aimed to characterize the association between childhood abuse and chronic pain presence and severity in adults with SUDs. Methods: Data were obtained from 672 treatment-seeking participants with SUDs on an inpatient detoxification unit. Regression models evaluated whether childhood physical or sexual abuse was associated with the likelihood of chronic pain and severity of several pain-related characteristics: pain catastrophizing, pain severity, and pain interference. Results: Childhood physical and sexual abuse were significantly associated with a greater likelihood of chronic pain in adulthood. In the adjusted analyses, childhood physical abuse was associated with worse pain severity, whereas childhood sexual abuse was associated with greater pain catastrophizing and worse pain interference. Conclusions: Childhood physical and sexual abuse were associated with a greater likelihood of chronic pain in adults with SUDs. Among those with chronic pain, exposure to childhood abuse was associated with a more severe symptom profile, characterized by greater pain severity, more catastrophic interpretations of pain, and more pain-related interference with daily life. People with SUDs and a history of childhood abuse may benefit from screening for pain and interventions to reduce pain catastrophizing. These findings highlight the importance of longitudinal research to understand mechanisms linking childhood abuse exposure to later pain and substance misuse.

Benzodiazepine misuse in adults with alcohol use disorder: Prevalence, motives and patterns of use.

OBJECTIVE: Benzodiazepines are among the most commonly misused drugs. Despite the known risks of combining benzodiazepines and alcohol, little is known about misuse among people with alcohol use disorder (AUD). Our aim was to characterize the prevalence, correlates, and patterns of misuse of benzodiazepines in adults with AUD. METHOD: Adults receiving treatment for AUD (N = 258) completed a battery of questionnaires. We used descriptive statistics to characterize the prevalence and patterns of misuse and we used logistic regression models to identify correlates of misuse. RESULTS: Almost half of the sample reported a history of benzodiazepine prescription and 30% reported a history of misuse. Younger age, female sex, anxiety, and other substance use were associated with misuse. Coping was the most commonly reported reason for misuse. All participants who had misused a benzodiazepine in the past year used concurrently with another substance. CONCLUSIONS: Benzodiazepine misuse was common in this study, and risky patterns of use, such a co-use with other substances, were prevalent. Coping was the most common reason for misusing benzodiazepines, suggesting that un- or under-treated psychiatric symptoms may contribute to misuse.

Pain interference and catastrophizing are not associated with polysubstance use among treatment-seeking patients with substance use disorders and chronic pain.

Background: People with substance use disorders (SUD) and co-occurring chronic pain report the use of myriad substances, which is concerning due to the heightened risk of overdose associated with polysubstance use. Identifying malleable factors associated with polysubstance use in this population can inform interventions. In this study, we examined whether two pain processes - pain interference and pain catastrophizing - were associated with polysubstance use. Objectives: We examined the cross-sectional associations among self-reported pain interference and catastrophizing and polysubstance use. We also determined if sex and primary SUD moderated these associations. Methods: Participants were 236 (36% female) adults receiving inpatient treatment for SUD (58% alcohol use disorder, 42% opioid use disorder) who met criteria for chronic pain. We utilized negative binomial regression to examine associations between pain interference and catastrophizing (focal independent variables) and the number of substances used in the month before treatment (i.e., polysubstance use; outcome). Results: Participants used three substances, on average, in the month prior to treatment. Neither pain interference (IRR = 1.05, p = .06) nor pain catastrophizing (IRR = 1.00, p = .37) were associated with polysubstance use. The association between pain interference and polysubstance use was moderated by sex and primary SUD (ps<0.01), such that these variables were positively related in men and those with alcohol use disorder. Conclusion: Pain interference and catastrophizing were not uniformly associated with polysubstance use, underscoring the need to examine other factors associated with polysubstance use in this population. However, men and those with alcohol use disorder might benefit from interventions targeting pain interference to reduce polysubstance use.

Anxiety sensitivity and grit as mediators between childhood abuse and relapse risk for substance use.

BACKGROUND: Childhood abuse is prevalent in those with substance use disorders (SUDs), and can lead to adverse consequences, including relapse to substance use following treatment. OBJECTIVE: To determine whether anxiety sensitivity (AS) and grit mediate associations between childhood abuse and substance use relapse risk. PARTICIPANTS AND SETTING: Patients on an inpatient detoxification and stabilization unit seeking treatment for SUDs (N = 702). METHODS: Participants were administered self-report measures assessing childhood physical and sexual abuse (CPA/CSA), AS, grit, and relapse risk. A parallel mediation model was used to investigate the association between childhood abuse and relapse risk as mediated by AS and grit. RESULTS: Anxiety sensitivity was associated with greater relapse risk (ß = 0.29, t = 8.24, p < 0.001). Indirect effects of CPA and CSA on relapse risk through AS were statistically significant (CPA: ß = 0.05, 95 % C.I. = 0.02-0.08; CSA: ß = 0.04, 95 % C.I. = 0.01-0.07), indicating AS significantly mediated effects of both CPA and CSA on relapse risk. Grit was not a mediator, however, higher grit score was significantly associated with decreased relapse risk (ß = -0.17, t = -4.90, p < 0.001). CONCLUSIONS: Anxiety sensitivity may be an important construct linking child abuse to relapse risk. Although grit may not mediate the effect of child abuse on relapse risk, it may be clinically relevant to relapse risk. As this sample consisted of treatment-seeking adults, the generalizability of results to other populations is uncertain. Future studies should investigate interventions targeting these constructs in this population.

Depression history as a predictor of outcomes during buprenorphine-naloxone treatment of prescription opioid use disorder.

BACKGROUND: In the multi-site Prescription Opioid Addiction Treatment Study (POATS), the best predictor of successful opioid use outcome was lifetime diagnosis of major depressive disorder. The primary aim of this secondary analysis of data from POATS was to empirically assess two explanations for this counterintuitive finding. METHODS: The POATS study was a national, 10-site randomized controlled trial (N = 360 enrolled in the 12-week buprenorphine-naloxone maintenance treatment phase) sponsored by the NIDA Clinical Trials Network. We evaluated how the presence of a history of depression influences opioid use outcome (negative urine drug assays). Using adjusted logistic regression models, we tested the hypotheses that 1) a reduction in depressive symptoms and 2) greater motivation and engagement in treatment account for the association between depression history and good treatment outcome. RESULTS: Although depressive symptoms decreased significantly throughout treatment (p <.001), this improvement was not associated with opioid outcomes (aOR = 0.98, ns). Reporting a goal of opioid abstinence at treatment entry was also not associated with outcomes (aOR = 1.39, ns); however, mutual-help group participation was associated with good treatment outcomes (aOR = 1.67, p <.05). In each of these models, lifetime major depressive disorder remained associated with good outcomes (aORs = 1.63-1.82, ps = .01-.055). CONCLUSIONS: Findings are consistent with the premise that greater engagement in treatment is associated with good opioid outcomes. Nevertheless, depression history continues to be associated with good opioid outcomes in adjusted models. More research is needed to understand how these factors could improve treatment outcomes for those with opioid use disorder.

Clinical Correlates of Smoking Status in Men and Women with Opioid Use Disorder.

Background: Smoking is highly prevalent in people with opioid use disorder (OUD) and is a significant contributor to morbidity and mortality in this population. However, little is known about the differences between those with OUD who do and do not smoke cigarettes. Objectives: Our aim was to investigate differences between treatment-seeking adults with OUD who did and did not smoke. Methods: Participants (N = 568; 30% female) completed a battery of self-report questionnaires including measures of current smoking status and number of cigarettes smoked per day as well as measures of clinical characteristics (e.g. craving, anxiety). Results: Of the total sample, 77% were current smokers. Multivariable logistic regression identified heroin use (OR = 2.20, 95% CI = 1.38, 3.53) and younger age (OR = 0.97, 95% CI = 0.95, 0.997) as strong correlates of smoking status; other characteristics were not significant. Older age and opioid craving were associated with more cigarettes smoked per day. Notably, these patterns differed for males and females; opioid craving (B = 0.62, SEB = 0.24) was associated with the number of cigarettes smoked among men, and anxiety (B = 0.39, SEB = 0.19) was associated with the number of cigarettes smoked among women. Conclusion: Adults with OUD who used heroin in the past month were more likely to be current smokers. No sex differences were observed in likelihood of smoking; however, the predictors of smoking status and severity differed between men and women.

Associations among interpretation bias, craving, and abstinence self-efficacy in adults with substance use disorders.

OBJECTIVE: Interpretation bias is a crucial therapeutic target in emotional disorders. However, few studies have examined the role of interpretation bias in substance use disorders (SUDs). Our specific aims were: (1) to examine whether interpretation bias was associated with craving and abstinence self-efficacy, and (2) explore potential moderators of these associations, including anxiety severity, sex, and substance type. METHODS: Adults attending an inpatient SUD treatment program (N = 224; mean age = 38.95; 67% male/33% female; 68% primary alcohol use disorder/29% primary opioid use disorder) completed the Word-Sentence Association Paradigm (WSAP) with ambiguous situations related to general anxiety domains (e.g., daily stress, health, relationships), as well as measures of craving (Craving Scale), abstinence self-efficacy (Brief Situational Confidence Scale), and anxiety symptoms (Overall Anxiety Severity and Impairment Scale [OASIS] and Anxiety Sensitivity Index-3). RESULTS: Negative interpretation bias was modestly associated with more craving (r = .23, p = .001) and less confidence to resist using substances (r = -0.23, p = .001). In multiple linear regression models that included the anxiety measures, interpretation bias was the most robust predictor of craving and abstinence self-efficacy. Sex (N = 224) and substance type (opioid vs. alcohol; n = 219) did not moderate these relationships. CONCLUSIONS: These findings suggest that interpretation bias might be an important individual difference within SUD populations.

Long-term naturalistic follow-up of chronic pain in adults with prescription opioid use disorder.

BACKGROUND: Chronic pain is common in patients with prescription opioid use disorder (OUD), and pain severity has been shown to predict opioid use for those with chronic pain. However, recent research suggests that focusing on pain status (i.e., the presence or absence of chronic pain) at treatment initiation may not reflect the clinical significance of pain over the long-term course of OUD. Reports of variability in chronic pain and its clinical significance over time have yet to be investigated in patients with prescription OUD. The present study examined variability in chronic pain status from entry into prescription OUD treatment through 3.5-year follow-up. Additionally, we examined the association between concurrent chronic pain and opioid use at three follow-up time points. METHODS: This secondary analysis (N = 309) of a national, randomized, controlled trial of prescription OUD treatment used generalized estimating equations to assess variability in the prevalence of chronic pain from study entry to 3.5-year follow-up, and the association between chronic pain status and concurrent opioid use. RESULTS: Fifty-three percent of participants reported variability in chronic pain status over time. The prevalence of chronic pain decreased from study entry through follow-up (aOR = 0.47, p < 0.001). Chronic pain was associated with increased opioid use at each follow-up assessment (aOR = 3.56, p < 0.001). CONCLUSIONS: Chronic pain status may vary over time in those with prescription OUD, and chronic pain appears to be associated with concurrent opioid use. The present findings highlight the importance of assessing chronic pain throughout the course of prescription OUD.

Associations between pain catastrophizing and clinical characteristics in adults with substance use disorders and co-occurring chronic pain.

Background: Pain catastrophizing refers to the tendency to interpret pain as harmful, intolerable, or uncontrollable. Greater pain catastrophizing is associated with more pain-related negative phenomena, such as pain reactivity, pain disability, and emotional distress related to pain. Several studies of patients seeking chronic pain treatment have identified an association between pain catastrophizing and misuse of opioids and alcohol; however, it is unknown whether this association would be similarly present in patients with chronic pain seeking substance use disorder treatment. Objectives: The current study examined whether pain catastrophizing is associated with worse pain-related outcomes and psychological functioning in individuals receiving inpatient substance use disorder treatment who endorsed current chronic pain. Methods: In a series of regression models, we tested the associations between pain catastrophizing and functioning, specifically pain interference, craving, anxiety, and days of mood difficulties in a cross-sectional sample of patients seeking substance use disorder treatment with co-occurring chronic pain (N = 244, 67.6% female). Results: Greater pain catastrophizing was associated with more pain interference, higher levels of craving, more anxiety symptoms and more days of mood difficulties, adjusted for demographic characteristics and pain severity. Conclusion: In patients with comorbid substance use disorder and chronic pain, pain catastrophizing may offer a potential therapeutic target to improve substance use treatment outcomes.

Correlates of Opioid Abstinence in a 42-Month Posttreatment Naturalistic Follow-Up Study of Prescription Opioid Dependence.

OBJECTIVE: The natural course of prescription opioid use disorder has not been examined in longitudinal studies. The current study examined correlates of opioid abstinence over time after completion of a treatment trial for prescription opioid dependence. METHODS: The multisite Prescription Opioid Addiction Treatment Study examined different durations of buprenorphine-naloxone treatment and different intensities of counseling to treat prescription opioid dependence, as assessed by DSM-IV; following the clinical trial, a longitudinal study was conducted from March 2009-January 2013. At 18, 30, and 42 months after treatment entry, telephone interviews were conducted (N = 375). In this exploratory, naturalistic study, logistic regression analyses examined the association between treatment modality (including formal treatment and mutual help) and opioid abstinence rates at the follow-up assessments. RESULTS: At the 3 follow-up assessments, approximately half of the participants reported engaging in current substance use disorder treatment (47%-50%). The most common treatments were buprenorphine maintenance (27%-35%) and mutual-help group attendance (27%-30%), followed by outpatient counseling (18%-23%) and methadone maintenance (4%). In adjusted analyses, current opioid agonist treatment showed the strongest association with current opioid abstinence (odds ratios [ORs] = 5.4, 4.6, and 2.8 at the 3 assessments), followed by current mutual-help attendance (ORs = 2.2, 2.7, and 1.9); current outpatient counseling was not significantly associated with abstinence in the adjusted models. CONCLUSIONS: While opioid agonist treatment was most strongly associated with opioid abstinence among patients with prescription opioid dependence over time, mutual-help group attendance was independently associated with opioid abstinence. Clinicians should consider recommending both of these interventions to patients with opioid use disorder. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00316277​.

Nonmedical benzodiazepine use in adults with alcohol use disorder: The role of anxiety sensitivity and polysubstance use.

BACKGROUND AND OBJECTIVES: The nonmedical use of benzodiazepines-defined as use without a prescription or at a dose or frequency higher than prescribed-is increasing among adults in substance use disorder treatment and is associated with risk for overdose. The aim of the current study was to characterize the prevalence of nonmedical benzodiazepine use among adults seeking treatment for alcohol use disorder and to examine whether nonmedical benzodiazepine use was associated with: (1) polysubstance use and (2) greater anxiety sensitivity. METHODS: A sample of 461 treatment-seeking adults with alcohol use disorder who were recruited for a cross-sectional study were included in this analysis. RESULTS: A total of 89 participants (19%) reported nonmedical benzodiazepine use in the previous 30 days. Results of a logistic regression indicated that polysubstance use (number of substances used in the past month) was associated with nonmedical benzodiazepine use. The association between anxiety sensitivity and nonmedical benzodiazepine misuse was moderated by gender; anxiety sensitivity was associated with benzodiazepine use among women, but not men. DISCUSSION AND CONCLUSIONS: These results replicate findings from research on opioid use disorder suggesting that anxiety sensitivity is associated with nonmedical benzodiazepine use in women and not men. SCIENTIFIC SIGNIFICANCE: Targeted intervention to those with polysubstance use-including education on overdose risk when benzodiazepines are combined with other substances-is indicated in men and women with alcohol use disorder. Anxiety sensitivity may be a potential therapeutic target to reduce nonmedical benzodiazepine use among women with alcohol use disorder. (Am J Addict 2018;27:485-490).

Religious coping in patients with severe substance use disorders receiving acute inpatient detoxification.

BACKGROUND AND OBJECTIVES: Religious coping, one of the most widely studied components of spirituality among psychiatric populations, has rarely been addressed in patients with severe substance use disorders (SUD). The aim of our study was to elucidate whether religious coping is related to symptom expression and mutual-help participation. METHODS: Self-reported religious coping was assessed in individuals sequentially admitted to a private psychiatric hospital for inpatient detoxification. Target symptoms of SUD included severity of substance use prior to admission and craving during detoxification. Three hundred thirty-one patients (68.6% male) participated in the survey; mean age was 38.0 years, and primary presenting diagnosis was most commonly alcohol use disorder (n = 202; 61%), followed by opioid use disorder (n = 119; 36%). RESULTS: Positive religious coping was associated with significantly greater mutual-help participation, fewer days of drug use prior to admission, and was modestly, yet significantly associated with lower drug craving. Negative religious coping was associated with lower confidence in the ability to remain abstinent post-discharge and higher drug craving. CONCLUSIONS: Consistent with hypotheses, greater positive religious coping was associated with greater mutual-help participation, lower severity of pre-admission drug use, and lower substance craving during detoxification. Use of positive religious coping may modify the course of SUD recovery by promoting engagement in mutual-help activities. SCIENTIFIC SIGNIFICANCE: The findings of this study suggest that positive and negative religious coping are linked with several key SUD recovery variables. Further research to replicate this finding and to assess mechanisms within this potential association is warranted. (Am J Addict 2017;26:744-750).

Perceived barriers to smoking cessation among adults with substance use disorders.

The majority of adults seeking substance use disorder treatment also smoke. Smoking is associated with greater substance use disorder severity, poorer treatment outcome, and increased mortality among those with substance use disorders. Yet, engaging this population in smoking cessation treatment is a significant challenge. The aim of this study was to examine perceived barriers to smoking cessation among treatment-seeking adults with alcohol or opioid use disorder. Additionally, we examined whether anxiety sensitivity - a known risk factor for barriers to smoking cessation in the general population - was associated with more barriers to smoking cessation in this sample. A sample of 208 adults was recruited for a one-time study and completed self-report measures of anxiety sensitivity and perceived barriers to smoking cessation. Results indicated that the most common barriers were anxiety (82% of the sample), tension/irritability (76%), and concerns about the ability to maintain sobriety from their primary substance of abuse (64%). Those who reported more barriers also reported lower confidence in the ability to change their smoking behavior. Higher anxiety sensitivity was associated with more perceived barriers to smoking cessation, even when controlling for cigarette dependence severity. These results suggest that there are several perceived barriers to smoking cessation among treatment-seeking adults with substance use disorders. In addition to psychoeducational interventions aimed to modify negative beliefs about smoking cessation, anxiety sensitivity may be a promising therapeutic target in this population.