Impact of implementing a tobacco and recreational nicotine-free policy and enhanced treatments on programmatic and patient-level outcomes within a residential substance use disorder treatment program.

BACKGROUND: Recent estimates are that 30% of military veterans use tobacco or recreational nicotine products, and rates significantly increase for veterans with co-occurring substance use disorder (SUD). Despite emerging literature that indicate better outcomes when SUD and tobacco use disorder (TUD) are treated simultaneously (in parallel), most SUD programs fail to address tobacco use. This can prove catastrophic, as perhaps the most likely cause of death lifetime for patients admitted to a SUD treatment program is tobacco/nicotine-related. Studies suggest that residential SUD treatment programs can improve the screening, diagnosis, documentation, and treatment of TUD. Perceived barriers among staff include fear of causing patients to leave early. There are few studies evaluating the accuracy of these perceived barriers to programmatic and patient-level outcomes in the residential SUD treatment setting when TUD services are provided along with a nicotine/tobacco-free therapeutic milieu. OBJECTIVE: In the fall of 2015, a SUD treatment program at a large midwestern Veteran. Affairs Medical Center fully implemented a tobacco-free residential unit. The current study investigates the programmatic and patient-level outcomes among cohorts treated before versus after the tobacco-free policy was implemented. PARTICIPANTS & PROCEDURES: This study utilized archival data and all participants were enrolled in the residential program with 117 veterans enrolled pre and 92 post tobacco-free policy. The final sample consisted of 194 males (92.8%), 14 females (6.7%), and 1 transgendered (0.5%) with a mean age of 47.80 (SD = 12.65). Most of the participants were Caucasian (69.4%) and divorced (43.1%). The majority (167, 79.9%) reported current tobacco use, with cigarettes (118, 56.5%) being the most frequently reported type. In addition, 17.59 (SD = 6.51) years old is the average start age of tobacco use. RESULTS: Veterans in the pre-policy cohort did not differ from post-policy cohort on age, gender, ethnicity, and marital status. Preliminary results related to programmatic outcomes indicate improved rates of TUD diagnosis during intake (28.4% to 75.0%). Similar rates were observed in veterans who reported tobacco quit goal during treatment planning (37.4% to 56.8%). However, while there were no significant differences in the total rates of infractions; tobacco-related infractions significantly increased from one to eight. Finally, there were no significant differences in the number of against medical advice discharges or irregular discharges. Examination of patient-level outcomes revealed similar rates of veterans enrolling in the program as it relates to rates of current tobacco use, admission expired breath carbon monoxide (CO) measured in parts per million (ppm), longest period of tobacco abstinence, and self-reported primary preferred substance/drug. Of note, there were also no differences in reported importance and confidence of quitting tobacco. Rates of veterans prescribed nicotine replacement therapy during residential stay more than doubled. CONCLUSIONS: Our data suggest that implementing a tobacco-free policy within a residential SUD treatment program would not deter veterans from staying engaged in the program as evident by similar rates of irregular and AMA discharges. In addition, the prevalence of Veterans wishing to quit tobacco was higher in the post-policy cohort, as was NRT utilization, and without the addition of staff. Specific treatment recommendations will be discussed along with other implications.

Substance use consequences, mental health problems, and readiness to change among Veterans seeking substance use treatment.

Individuals seeking substance use treatment who have one or more co-occurring mental health problems tend to have lower treatment engagement, higher rates of attrition, and poorer treatment outcomes. Readiness to change (RTC) is an integral construct in the recovery process, with higher RTC associated with improved treatment outcomes. However, the impact of psychiatric symptoms on RTC is not fully understood, especially among specialty subpopulations, such as military Veterans. Therefore, the aim of the present study was to examine the associations of mental health problems with RTC in a sample of Veterans initiating outpatient substance use treatment. The present sample was comprised of 278 Veterans (12% women, Mage = 48.22, SD = 14.06) who completed self-report intake measures assessing past month substance use frequency, substance-related consequences, symptoms of insomnia, depression, and anxiety, and importance and confidence to change one's substance use. Four separate canonical correlation analyses focusing on RTC alcohol, opioid, cannabis, and nicotine use were conducted. Veterans' inclusion in each analysis was not mutually exclusive. Results indicated that greater depression, anxiety, consequences, and frequency of alcohol use corresponded with greater importance to change alcohol use. Likewise, greater depression, anxiety, and insomnia symptoms along with frequency of use and consequences related to greater importance and confidence to change one's opioid use. In contrast, greater anxiety, depression, insomnia, and frequency of use were associated with less confidence in one's ability to change cannabis use. None of these variables were related to one's RTC nicotine use. Findings highlight the importance of assessing mental health problems at outset of substance use treatment, as they may be an indication of RTC and could be used as a catalyst to advance Veterans forward in the process of behavior change.

Diversion of prescription stimulants among college students: An initial investigation of injunctive norms.

Nonmedical use of prescription stimulants (NMUPS) is an increasing problem among the college student population. Despite recent increases in stimulant prescriptions, little research has examined diversion of prescription stimulants among college students. The purpose of the current exploratory study was to compare normative beliefs about the frequency and motives of NMUPS among a college student sample. Participants were 121 college students who reported having a current prescription for a prescription stimulant. Participants completed online surveys and reported occasions of diversion behavior along with ratings of perceived approval for NMUPS and associated motives. Participants with a history of diversion were more likely to rate their close friends as more approving of more frequent NMUPS, and more approving of various motives for NMUPS. Perceived approval of NMUPS and NMUPS motives among parents and typical university students was similar across diversion groups, with parents and university students being rated as more approving of NMUPS for educational purposes. These findings extend the use of social norms theory to a new behavior while adding to our understanding how those who divert their medication differ from those who do not. Future studies should seek to establish a causal relationship between perceived approval for NMUPS and diversion behaviors. These findings also suggest that future research should focus on the feasibility and impact of social norms intervention for NMUPS and medication diversion.

Normative influences on the nonmedical use of prescription stimulants among college students.

Recent epidemiological data indicate an increasing trend in the nonmedical use of prescription drugs among college students. The nonmedical use of prescription drugs involves using a prescription medication without a prescription, or using the medication in a manner inconsistent with a health care provider's instructions. Among college students, prescription stimulants have the highest ratio of nonmedical to medical use and the highest rate of illicit selling and trading on college campuses. The increased prevalence is accompanied by increased risk, as 18-25-year-olds have the highest rate of emergency department visits for nonmedical use of prescription stimulants (NMUPS). To date, no study has examined the impact of social norms on NMUPS. The social norm theory has accounted for other health related behaviors (e.g., alcohol and marijuana use) and has been utilized in brief interventions targeting risky health behaviors. The current study examined the prevalence of self-reported NMUPS among college students and the impact of perceived social norms on NMUPS. The current study included 959 participants who completed an online survey that assessed for NMUPS, self-approval for NMUPS, and perceived descriptive and injunctive norms for NMUPS. Similar to previous research on alcohol and marijuana use, students overestimated the prevalence of NMUPS and this overestimation was related to past-year NMUPS. Perceived close friend and parental approval of NMUPS was positively related to self-approval and past-year NMUPS. Overall, the study broadens the existing literature on NMUPS and provides a platform for developing brief interventions that target this risky behavior. (PsycINFO Database Record

Modeling motivations for non-medical use of prescription drugs.

INTRODUCTION: Non-medical use of prescription drugs (NMUPD) is a growing problem among college-aged individuals. Motivations for use of a substance have been shown to predict consumption behavior across a variety of substances, but research on motivations for engaging in NMUPD is limited. We hypothesize that Confirmatory Factor Analysis (CFA) would support a two-factor latent structure for motivations (self-treatment and recreational) for NMUPD across three classes of drugs (stimulants, tranquilizers and sedatives, and pain relievers). METHODS: Data were collected from 1016 undergraduates attending a large southeastern university via an online survey. Motivations for use were subjected to a CFA for those participants who reported past-year use of each drug class (tranquilizer and sedative use n=138, pain reliever use n=189, and stimulant use n=258). RESULTS: Model fit varied across drug class. A two-factor model emerged for both pain relievers and stimulants, and each factor was positively correlated with one another and with frequency of use for both drug classes. A two-factor model was not a good fit for tranquilizers and sedatives. CONCLUSIONS: Motives for NMUPD are a relatively understudied construct. Although our initial results suggest that a proposed framework consisting of self-treatment and recreational motives might have some utility in explaining the use of stimulants and pain relievers, more research is needed to characterize motives for tranquilizers and sedatives. Additional research is also needed to develop assessment measures that capture the full range of motives for all three classes of NMUPD.

Beyond risky alcohol use: screening non-medical use of prescription drugs at National Alcohol Screening Day.

INTRODCUTION: Recent epidemiological data has indicated an increasing trend in the non-medical use of prescription drugs (NMUPD) among college students. NMUPD has shown a strong relationship with heavy alcohol use and associated negative consequences. Despite the trends and association with other risky behavior, there remain large gaps in the literature regarding this hazardous behavior. To date, no study has examined the prevalence of NMUPD among student attending National Alcohol Screening Day (NASD), and few studies have explored motives contributing to NMUPD, as well as the relationship between motives, NMUPD, and alcohol use. METHODS: The current study examined the prevalence and motives for NMUPD among undergraduate students (N=128) attending NASD. RESULTS: Overall, 42% of the sample reported NMUPD at least once in their lifetime, 29.7% at least once in the past year, and 18.0% reported simultaneously engaging in alcohol consumption and NMUPD. Pain relievers were the most frequently used drug class for lifetime use, and stimulants were the most frequently reported for past year use. Most students reported NMUPD for functional reasons. Students that engaged in binge drinking were three times more likely to report NMUPD. CONCLUSIONS: The findings from the current study suggest that events like NASD may provide a platform for screening and discussing NMUPD, and its associated risk with heavy alcohol use.

Towards the development of laboratory methods for studying drinking games: initial findings, methodological considerations, and future directions.

BACKGROUND: Drinking games are prevalent among college students and are associated with increased alcohol use and negative alcohol-related consequences. There has been substantial growth in research on drinking games. However, the majority of published studies rely on retrospective self-reports of behavior and very few studies have made use of laboratory procedures to systematically observe drinking game behavior. OBJECTIVES: The current paper draws on the authors' experiences designing and implementing methods for the study of drinking games in the laboratory. RESULTS: The paper addressed the following key design features: (a) drinking game selection; (b) beverage selection; (c) standardizing game play; (d) selection of dependent and independent variables; and (e) creating a realistic drinking game environment. CONCLUSIONS: The goal of this methodological review paper is to encourage other researchers to pursue laboratory research on drinking game behavior. Use of laboratory-based methodologies will facilitate a better understanding of the dynamics of risky drinking and inform prevention and intervention efforts.

Alcohol use, impulsivity, and the non-medical use of prescription stimulants among college students.

The non-medical use of prescription drugs (NMUPD) is a growing public health concern. College students have been identified as a particularly at risk population for engagement in NMUPD. Across all prescription drug classes, stimulants show the highest ratio of illicit to medical use and are thus important to examine within this population. Emerging research has suggested a relationship between the non-medical use of prescription stimulants (NMUPS) and alcohol use within the college student population. Finally, the construct of impulsivity may serve as an additional indicator for students who engage in NMUPS as well as those who engage in NMUPS/alcohol co-ingestion. The purpose of this paper is to expand on previous prevalence data collected for the past year NMUPS and NMUPS/alcohol co-ingestion. Additionally, this paper examines whether those who engage in NMUPS or NMUPS/alcohol co-ingestion differ significantly from their non-using counterparts on measures of alcohol use, alcohol related negative consequences, binge drinking, and impulsivity. Finally, binary logistic regression models indicated that increased alcohol use, alcohol related negative consequences, and impulsivity all significantly increase the odds of an individual engaging in NMUPS or NMUPS/alcohol co-ingestion.

Student perceptions of specific components within a personalized feedback intervention.

Previous research suggests that personalized feedback interventions (PFI) can be an effective tool in reducing risky alcohol use among college students; however, little is known about how students perceive the individual components that are typically used during PFIs. In the current study, participants (N = 219, 63.5% female, 84% Caucasian, undergraduates enrolled in introductory psychology courses) reported their drinking behavior in the past month, and then immediately received a computerized PFI based on their self-reported alcohol use. The PFI was modeled from the Brief Alcohol Screening and Intervention for College Students (BASICS) approach and included 10 separate feedback components presented in random order. Participants provided acceptability ratings on each of the 10 components. Overall, participants found the PFI generally acceptable, with females rating the PFI as more acceptable than males, and binge drinkers (defined as 5 or more drinks on an occasion for males and 4 or more drinks for females) rating the PFI more acceptable than nonbinge drinkers. Differences in acceptability emerged across the 10 components, as participants rated the practical cost components (e.g., money spent on alcohol, calories consumed) as more acceptable than didactic information (e.g., impact of blood alcohol levels) and personal negative consequences. The results are similar to a previous study that examines student reactions to PFIs (Miller & Leffingwell, 2013). Overall, the findings suggest that college students prefer certain feedback components to others. Moreover, the findings indicate that future research is needed to examine the relationship between preferred components and treatment outcomes to determine which components are most effective for reducing risky drinking.

The role of personality variables in drinking game participation.

Drinking games are prevalent among college student and associated with increased risk of experiencing negative alcohol-related consequences. Personality variables, and specifically impulsivity and sensation seeking, have been linked to increased alcohol consumption and related negative consequences, but research on the relationship between personality and drinking game participation is limited. The current study used path analysis to assess the impact of sensation seeking and impulsivity on frequency of drinking game participation and related consequences in a sample of undergraduate college students. Findings suggest that sensation seeking and impulsivity are positively associated with frequency of drinking game participation. Both impulsivity and sensation seeking had a direct effect on negative consequences associated with drinking games, and both had an indirect relationship when controlling for the frequency of drinking game participation. The results are largely consistent with previous studies in suggesting that impulsivity and sensation seeking play a role in predicting risky alcohol use and related negative consequences. Understanding the relationship between personality variables and negative drinking game consequences may better inform the treatment of hazardous drinking among college students.

Examining alcohol and alcohol-free versions of a Simulated Drinking Game Procedure.

OBJECTIVE: Drinking games contribute to heavy drinking on college campuses because the rules often result in rapid alcohol consumption and increased risk of negative consequences. The current study used the Simulated Drinking Game Procedure (SDGP) to observe and describe drinking game behavior under controlled laboratory conditions. METHOD: Participants (N = 40) age of 21 and older played a laboratory version of beer pong. Participants were randomly assigned to play with either beer or water, and the study examined the differences in consumption, blood alcohol concentration (BAC) estimates, and subjective experiences within and across the beverage conditions. RESULTS: Participants in both beverage conditions viewed the sessions as realistic simulations of actual drinking games. Participants who played with beer consumed more drinks and refused fewer drinks than those served water. Two measures of BAC (calculated formula and breath alcohol device) were correlated with one another and with the amount of alcohol consumed. BAC estimates based on the formula tended to be higher than readings obtained from the breath alcohol device, and the discrepancies between the two measures were higher among female participants. CONCLUSIONS: The findings suggest that both the alcohol and alcohol-free versions of the SDGP are safe and ecologically valid research tools for examining drinking game behavior. The study highlights the features and limitations of both versions of the SDGP and provides a platform for continued development of the methodology, allowing researchers to address a range of clinically relevant research questions.