Patient reported goals for medications for opioid use disorder: A theory of proximal goal attainment.

Background: There exist substantial patient barriers to accessing medications for opioid use disorder (MOUD), including travel distance, stigma, and availability of MOUD providers. Yet, despite these barriers, there exists a subset of patients who possess the requisite motivation to seek and remain adherent to treatment. Objective: To explore patient-derived goals in MOUD treatment-adherent patients. Methods: This study used in-depth interviews with patients receiving methadone who were enrolled in opioid treatment programs (OTPs) across Tennessee. Participants were recruited from 12 different OTPs to participate in telephonic semi-structured interviews to a point of saturation. Participants had to be adherent to treatment, in treatment for 6 months or greater, and English speaking. Analysis occurred inductively using a constructivist approach to Grounded Theory. Results: In total, 17 patient interviews were conducted in the spring of 2021. Participants described goal setting across three general stages of treatment: (1) addressing acute physical and emotional needs upon treatment entry, (2) development of supportive structure and routine to develop healthy skills facilitated by treatment team, and (3) identifying and pursuing future-focused goals not directly linked to treatment. A Proximal Goals in MOUD Framework is introduced. Conclusion: In this qualitative study on patient reported goals in MOUD it was found that goals are transitory and relative to the stage of treatment. Further research is needed to better understand goal evolution over the course of treatment and its impact on treatment retention.

Community-Centered Patient Journey Map in Opioid Use Disorder: A Tool to Address Compassion Fatigue among Community Pharmacists.

Community pharmacists have become increasingly exposed to opioid use disorders in recent decades. However, both pharmacist training and traditional practice environments have not been adequate to prepare the pharmacist for both the patient care needs and regulatory barriers of patients experiencing opioid use disorders (OUD). As a result, there is a need to increase pharmacists' awareness of both the overall patient experience as they navigate their OUD and the role of the community pharmacy as a touchpoint within that experience. To this end, a Community-Centered Patient Journey in Drug Addiction Treatment journey map was developed with expert insights, clinical experience, and in-depth interviews (conducted in spring of 2021) with 16 participants enrolled in licensed opioid treatment programs in Tennessee. Patients, policymakers, clinicians, and academic researchers were involved in the map development. Lived experiences of key informants were captured via in-depth interviews. A consensus decision-making approach was used throughout the patient journey map development process. The final patient journey map illustrates a non-linear pathway, describes the central role of the patient's community, and emphasizes three major "pain points" within the system (access, adherence, and affordability). Future research should investigate the impact of such a journey map on pharmacy personnel's knowledge, attitudes, and behaviors.

Preliminary validation of the Diversion Risk Scale (DRS): Using environmental and individual factors to predict opioid-related diversion events.

The standard of care calls for the assessment of patients with chronic pain prior to the initiation of opioids, with one part of this assessment including assessment of the risk of misuse of medications. However, traditional opioid risk assessment tools focus almost entirely on individual factors and on the risk of misuse and addiction to opioids. Diversion of opioid medications has been found to be not uncommon, but to date, there have been no assessment tools specifically designed to assess the risk of diversion. In this study, we developed a measure designed specifically to assess the risk of an opioid medication ending up in the hands of someone other than the chronic pain patient to whom they were prescribed. A 15-item measure, the Diversion Risk Scale, was created and administered to 85 patients at a chronic pain practice. Results found that the measure had acceptable predictive validity. It was moderately correlated with traditional opioid risk assessment tools and showed improved ability to predict specific indicators of diversion. Diversion has been an understudied phenomenon, and the clinical value of an assessment tool that can help predict diversion in the chronic pain population is discussed.

The Role of Impulsivity and Stress Mind-Set in Understanding the Mindfulness-Intimate Partner Aggression Relationship.

Perpetration of relational aggression, which is estimated to occur in 60% to 90% of relationships, has been demonstrated to have lasting negative effects both systemically and for its victims. Relational aggression has also been demonstrated to be impacted, in part by impulsivity, stress mind-set, and mindfulness. The present study examined a path analysis model of the relation between mindfulness and relational aggression, utilizing impulsivity as the mediating variable. Furthermore, the present study incorporated an examination of the potential moderating effects of stress mind-set on the relation between impulsivity and relational aggression. Three hundred eighty-three participants were recruited from across the United States, using Facebook ads. Participants completed online questionnaires assessing key study variables. We hypothesized that the negative urgency aspect of impulsivity would mediate the relation between the five facets of mindfulness and relational aggression, and further that this relationship would be moderated by stress mind-set, such that a stress mind-set which conceptualizes stress as negative would make the relation between impulsivity and relational aggression stronger. We hypothesized that the negative urgency aspect of impulsivity would mediate the relation between mindfulness and relational aggression. Furthermore, we hypothesized that the relation between impulsivity and aggression would be moderated by stress mind-set. Results indicated that the negative urgency component of impulsivity mediated the relation between all five facets of mindfulness and perpetration of relational aggression. Furthermore, stress mind-set moderated the relation between negative urgency and relational aggression, such that a lower stress mind-set was related to a stronger association between negative urgency and aggression. Implications for clinical intervention and future research efforts are discussed.

Exploring Changes in Gang Involvement and Associated Risk Factors for American Indian Adolescents in Reservation Communities.

Reservation communities are among emerging communities for gang activity, in which reports of a rise in youth and/or criminal gangs began occurring after the 1980s. Gang membership has been found to pose a public health risk, strain community resources, and risk a number of individual negative life outcomes. Perceived increases in reservation gang activity have been observed by law-enforcement and community stakeholders, but comparatively little empirical research has focused specifically on these communities. Utilizing data from an existing public dataset, analysis of variance and regression analysis were utilized to examine cross sectional trends in gang involvement among 14,457 American Indian adolescents in reservation communities between 1993-2013. Results of this study failed to establish a consistent pattern of either growth or decline in gang membership across time when examining all reservations communities, with data suggesting that consistent trends may exist only within specific communities. Gang members were found to endorse significantly more alcohol and marijuana use, anger, depressed mood, and victimization as a whole. Only alcohol and marijuana use, violent behavior, and depressed mood demonstrated a significant interaction with time and gang membership. Finally, self-reported substance use, criminal behavior/delinquency, and violence perpetration significantly increased as gang affiliation increased.

A Longitudinal Investigation on the Relation between Self-Compassion and Alcohol Use in a Treatment Sample: A Brief Report.

Alcohol misuse is often a chronic problem such that relapses following treatment are common. One potential protective factor for alcohol misuse is self-compassion, which includes self-kindness, feelings of common humanity, and mindfulness when faced with personal suffering and hardships. This study tested the hypothesis that self-compassion, and specifically self-compassion promoting facets including self-kindness, common humanity, and mindfulness, were longitudinally associated with reduced alcohol use among a sample of men and women in substance use disorder treatment (N = 62). Results partially supported the hypothesis, in that only the mindfulness facet of self-compassion was associated with decreased alcohol use over time. Sex and age differences as they related to the positive facets of self-compassion and alcohol use emerged. These findings suggest that positive facets of self-compassion may be beneficial factors to cultivate in alcohol treatment programs.

A 20-year study of the bidirectional relationship between anxious and depressive symptomology and pain medication usage.

Aim: To investigate the 20-year relationship between anxiety, depression and pain medication use. Patients: A total of 521 individuals reporting chronic pain from the National Survey of Midlife Development in the USA (MIDUS) study. Methods: Structural equation modeling of 20-year longitudinal survey data. Results: Over 20 years, a bidirectional relationship between depression and anxiety in individuals with chronic pain was indicated. Pain medication utilization predicted later use at 10 years. Pain medication use was not strongly related to later anxiety; however, heightened anxiety was associated with later use. Conclusion: Depression and anxiety show an extensive long-term bidirectional relationship. While there was little indication of a relationship between pain medication use and later negative mood, anxiety was associated with subsequent pain medication use.

The Impact of History of Aggression and Alcohol Use on Aggressive: Responding in the Laboratory.

The current study examines how different levels of past aggression combined with self-reported levels of alcohol use impacted lab-based aggressive responding. Data were collected from 160 male undergraduate college students. Participants completed online measures of drinking (Alcohol Use Disorders Identification Test) and past aggression (Buss Perry Aggression Questionnaire) prior to a lab session assessing aggressive responding [Point Subtraction Aggression Paradigm (PSAP)]. Regression analyses revealed participants with "high" levels of past alcohol use and a history of "high" aggression were more likely to respond aggressively on the PSAP, a trend primarily driven by those with a history of physical aggression. For proactively aggressive participants, the risk for aggressive responding is greater in individuals with a history of physically aggressive behavior as they report higher alcohol use, relative to those "low" in past aggression. The interaction of alcohol use and past aggression was associated with continued aggressive behavior.

Neuropsychological Effects of Placebo Stimulants in College Students.

Many college students underestimate or ignore the side-effects associated with nonmedical use of prescription stimulants (NMUPS) and are motivated by hopes of academic enhancement. The present study measured the effect a placebo stimulant and personal expectancies have on subjective physiological changes and cognitive enhancement. Undergraduate college students participated in a two-phase study. Phase 1 (n = 305) involved completing an online survey to gather distal study variables and individual stimulant expectancy data. Phase 2 (n = 166) required students to attend an in-person session where they completed physiological and neuropsychological measures (e.g., Physical Symptom Checklist, Digit Span, Passage Comprehension). Students were randomized to receive a placebo stimulant medication (experimental) or no medication (control). Following a 30-minute absorption period, participants completed another set of physiological and neuropsychological measures. Experimental participants reported significant increases in positive symptoms resulting from the placebo stimulant. Expectancies moderated the impact of the placebo stimulant on Passage Comprehension performance; no other neuropsychological task performance was impacted. Despite subjective reports of feeling the effects of stimulants, task performance was unaffected. Moreover, expectancies may play a small role in perceptions of the effects of stimulants.

Trait Anger and Partner-Specific Anger Management Moderate the Temporal Association Between Alcohol Use and Dating Violence.

OBJECTIVE: Research demonstrates alcohol temporally precedes and increases the odds of violence between intimate partners. However, despite an extensive theoretical literature on factors that likely moderate the relationship between alcohol and dating violence, minimal empirical research has examined such moderators. METHOD: The purpose of the present study was to examine two potential moderators of this association: trait anger and partner-specific anger management. Undergraduate men (N = 67) who had consumed alcohol within the past month and were in current dating relationships completed a baseline assessment of their trait anger and partner-specific anger management skills and subsequently completed daily assessments of their alcohol use and violence perpetration (psychological, physical, and sexual) for up to 90 consecutive days. RESULTS: Alcohol was significantly associated with increased odds of physical aggression among men with relatively high but not low trait anger and partner-specific anger management deficits. In contrast, alcohol was significantly associated with increased odds of sexual aggression among men with relatively low trait anger and partner-specific anger management deficits. CONCLUSIONS: Our findings demonstrate important differences in the roles of acute intoxication and anger management in the risk of physical aggression and sexual dating violence. Interventions for dating violence may benefit from targeting both alcohol and adaptive anger management skills.

Do Alcohol and Marijuana Increase the Risk for Female Dating Violence Victimization? A Prospective Daily Diary Investigation.

OBJECTIVE: Dating violence is a serious and prevalent problem, with females being victimized by partners at high rates with numerous negative health consequences. Previous research has been equivocal on whether substance use on the part of the victim temporally precedes and, thus, increases the odds of victimization. While the sole responsibility for violence is always with the perpetrator, knowing this information could provide useful information for theory as well as interventions designed to keep women safe. METHOD: Participants were female college students in a current dating relationship who had consumed alcohol in the previous month (N = 173). Students completed daily surveys on their violence victimization, alcohol use, and marijuana use for up to 90 consecutive days. RESULTS: On any drinking days, heavy drinking days, and as the number of alcoholic drinks consumed increased, women were more likely to be victimized by psychological, physical, and sexual dating violence. Marijuana use also preceded and increased the odds of sexual victimization. Relationship length moderated some of these temporal associations, such that the odds of victimization on a drinking day, or marijuana use day, were increased for participants in longer relationships. CONCLUSIONS: Findings underscore the importance of considering the role that alcohol and marijuana use play in increasing the risk for dating violence victimization among women. Intervention programs for dating violence may benefit by attempting to decrease substance use in order to reduce risk for female victims.

Being the victim of violence during a date predicts next-day cannabis use among female college students.

AIMS: To determine whether being the victim of violence during a date among female college students on any given day predicted cannabis and alcohol use the following day. DESIGN, SETTING AND PARTICIPANTS: Between August 2010 and January 2013, we conducted a 90-day daily diary study with 174 females who were in current dating relationships from a large university in the Southeastern United States. The mean age of the sample was 18.70 years [standard deviation (SD) = 1.27]; participants were primarily non-Hispanic Caucasian (86.2%). Participants answered questions about contact with their dating partner, being the victim of violence (physical and sexual) during a date, physical perpetration, alcohol use and cannabis use for up to 90 days. The mean number of diaries completed was 54.90 (SD = 27.66). MEASUREMENTS: The primary outcomes were self-reported daily cannabis and alcohol use. Being the victim of violence during a date was assessed each day using self-report items from the Revised Conflict Tactics Scales and Sexual Experiences Survey. FINDINGS: Being the victim of violence during a date predicted cannabis use the following day (odds ratio = 2.25), and this effect held when controlling for contact with a partner, cannabis and alcohol use the previous day, physical perpetration the previous day, alcohol use the same day and the overall likelihood of being the victim of violence during a date, substance use and physical perpetration. Being the victim of violence during a date did not predict next-day alcohol use. Being the victim of sexual and physical violence during a date did not differentially predict next-day substance use. CONCLUSIONS: Among female college students in the United States, being the victim of violence during a date appears to increase the risk for cannabis use the following day.

Alcohol Use, Alcohol-Related Outcome Expectancies, and Partner Aggression Among Males Court-Mandated to Batterer Intervention Programs: A Brief Report.

Additional work is needed to determine how and/or why the relationship between alcohol use and increased risk of partner aggression (PA) exists. Researchers have begun to examine whether alcohol-related outcome expectancies (i.e., beliefs about the cognitive and behavioral effects of alcohol) are associated with PA irrespective of alcohol use. We examined the relationship between alcohol use, alcohol expectancies, and PA among 360 males arrested for a domestic violence offense and court-mandated to treatment. Results indicate that certain alcohol expectancies do play a role in the relationship between alcohol use and some forms of PA.

Emotion Regulation Moderates the Association Between Proximal Negative Affect and Intimate Partner Violence Perpetration.

Negative affect is a central component of many theories of aggressive behavior. Though understudied, it is likely that proximal negative affect increases the odds of aggression perpetration when individuals have poor emotion regulation, but not when individuals have more adaptive emotion regulation. Thus, the current study examined (1) the proximal effect of various indicators of negative affect (e.g., anger, hostility, depression) on intimate partner violence (IPV) perpetration and (2) whether poor emotion regulation moderated these associations. For up to 90 consecutive days, male college students (N = 67) in a current dating relationship completed daily surveys on their negative affect and IPV perpetration. Results demonstrated that emotion regulation moderated many of the associations between proximal negative affect and physical aggression perpetration, such that negative affect was associated with increased odds of violence when poor emotion regulation was high but not low. This is the first study to demonstrate the moderating role of emotion regulation in the link between proximal negative affect and IPV perpetration. As such, these findings have important implications for existing theories of IPV and emotion regulation and suggest that interventions may effectively reduce IPV by targeting emotion regulation.

Women's Stress, Depression, and Relationship Adjustment Profiles as They Relate to Intimate Partner Violence and Mental Health During Pregnancy and Postpartum.

OBJECTIVE: This study applied latent class analysis to examine whether homogeneous subgroups of women emerged based on their self-reported stress, depression, and relationship adjustment during pregnancy. We also examined whether women in different groups experienced different intimate partner violence (IPV) and mental health symptoms during pregnancy and postpartum. METHOD: 180 women completed assessments during the first 18 weeks of pregnancy and 122 completed follow-up assessments six weeks postpartum. RESULTS: A two-class solution best fit the data. One group reported higher mean stress and depression and poorer relationship adjustment compared to the other group. The high severity class reported more psychological IPV victimization and perpetration and more physical IPV victimization during pregnancy compared to the low severity class. Membership in the high severity class was associated with higher postpartum depression. CONCLUSIONS: Findings highlight the associations between different profiles of mental and relational health during pregnancy and postpartum. Future studies should explore the utility of dyadic interventions aimed at reducing stress, depression, and IPV, and improving relationship adjustment as a means to improve women's health during pregnancy and postpartum. These findings also highlight the potential utility of applying person-centered analytic approaches to the study of women's and couples' health during this time period.

The Relation Between Moment-to-Moment Mindful Attention and Anxiety Among Young Adults in Substance Use Treatment.

BACKGROUND: A growing body of research has examined the intersection of mindfulness and substance use, and a large body of research has examined the relation between mindfulness and anxiety. Unfortunately, no research has been conducted on the relation between mindfulness and anxiety symptoms among young adults (i.e., 18-25 years old) in treatment for substance use. The purpose of the current study was to examine the relation between one facet of mindfulness, moment-to-moment attention, and anxiety (panic and generalized anxiety) among young adults in treatment for substance use. METHODS: Preexisting patient records from a residential substance use treatment center for young adults were reviewed (N = 148). Patient records were examined from May 2012 to August 2013, which represented all young adult patients admitted to the residential treatment facility during this time. RESULTS: Findings demonstrated that moment-to-moment mindful attention was associated with symptoms of panic disorder and generalized anxiety disorder even after controlling for gender, age, education, alcohol use, drug use, and the shared variance in generalized and panic symptoms. There were no gender differences in moment-to-moment mindful attention. CONCLUSIONS: These findings provide preliminary evidence that moment-to-moment mindful attention is associated with panic and generalized anxiety in young adults in substance use treatment. Combined with previous research on mindfulness-based interventions among adults in substance use treatment, research should examine the efficacy of mindfulness-based interventions for young adults in substance use treatment.

The moderating effect of women's alcohol misuse on the relationship between intimate partner violence victimization and postpartum depression.

BACKGROUND AND OBJECTIVES: We examined the moderating effect of women's alcohol misuse on the relationship between intimate partner violence (IPV) victimization and postpartum depression. METHODS: Self-report data were collected from 122 women. Analyses controlled for women's baseline depression severity and partner alcohol misuse. RESULTS: Women's alcohol misuse moderated the relationship between psychological IPV victimization and postpartum depression only at high levels of the moderator. DISCUSSION AND CONCLUSIONS: Findings highlight the mental health risk posed by the combination of psychological IPV and alcohol misuse postpartum. SCIENTIFIC SIGNIFICANCE: Findings emphasize the need to investigate the understudied topic of women's postpartum alcohol misuse.

Bidirectional effects of parenting and youth substance use during the transition to middle and high school.

The current study assessed bidirectional relationships between supportive parenting behaviors (i.e., involvement, positive parenting), parental control strategies (i.e., parental monitoring, effective discipline), and youth substance use in a sample of aggressive youth during the transitions to middle and high school. Participants were drawn from the control group of a larger longitudinal study and were followed from 4th through 9th grade. Cross-lagged developmental models were evaluated using structural equation modeling. Youth substance use at 6th, 7th, and 8th grade influenced positive parenting at 7th, 8th, and 9th grade, but did not influence parental involvement or monitoring at any grade. Parental involvement, monitoring, and positive parenting at earlier grades did not influence youth substance use at later grades. Reciprocal relationships were observed between effective discipline and youth substance use at all grades. Results are consistent with models of bidirectionality that suggest that parents and children adjust their behavior based on the response of the other. Findings may impact our understanding of the development of youth substance use across time and improve interventions designed to reduce this behavior during periods of transition.

Bidirectional associations between parenting behavior and child callous-unemotional traits: does parental depression moderate this link?

The current study longitudinally examined bidirectional associations between callous-unemotional (CU) traits and parenting dimensions. This study extended the literature by examining whether parental depression moderated these relations in a pre-adolescent sample. Proposed relations were examined using a longitudinal sample of 120 aggressive children (59.6 % male) who were in the 4th grade (M = 10.56 years, SD = 0.56) at baseline and were followed annually over 4 years. A series of generalized estimating equation (GEE) models were used to examine proposed relations. At the first order level, corporal punishment (p < . 001) and poor supervision/monitoring predicted increases in CU traits (p = 0.03) however, the inverse relations were not found. Importantly, parental depression moderated the link between corporal punishment and CU traits. Specifically, at high levels of depression, corporal punishment was predictive of increases in CU traits, but was unrelated to CU traits at low levels of depression. These findings aid in our understanding of the link between corporal punishment and CU traits by highlighting conditions under which certain parenting behaviors have an impact on CU traits, which in turn, may have important intervention implications. Further clinical implications, limitations and future directions are discussed.

Effects of gender and motivations on perceptions of nonmedical use of prescription stimulants.

OBJECTIVE: This study examined the impact on college students' perceptions of nonmedical use of prescription stimulants (NMUPS) of motivation for use and gender. PARTICIPANTS: Participants were college students (N=695) from 2 universities in different regions of the United States. METHODS: Participants read a vignette describing a college student who used a prescription stimulant for a nonmedical purpose and rated their perception of that individual using a semantic differential. A 2 (participant gender) by 2 (gender of the individual described in the vignette) by 3 (motive for use: get high, study, lose weight) design was used. RESULTS: The male who used a stimulant to study was rated significantly less negatively than if he used the stimulant to get high. NMUPS as a study aid was viewed the least negatively overall. CONCLUSIONS: Findings suggest that gender does not, whereas motivation for use does, impact students' perceptions of NMUPS.