An opt-out tobacco treatment group intervention within an intensive substance use disorders treatment program: Initial outcomes in the Veterans Health Administration.

INTRODUCTION: Despite steadily declining rates of tobacco use in the United States, individuals suffering from substance use disorders (SUD) and other mental illnesses continue to use tobacco at alarmingly high rates, resulting in increased mortality. Given the synergistic consequences to those who suffer from both tobacco use disorders (TUD) and other SUD, embedding tobacco treatment into structured SUD programs using an opt-out approach may yield a greater impact. The current study compares clinical outcomes (i.e., quit attempts and prescription of tobacco cessation medications) for an opt-out versus opt-in approach to tobacco treatment. METHODS: Tobacco use information was collected prior to and after implementation of an opt-out, eight-session, tobacco group treatment intervention. Patient self-report and medical chart review were utilized to identify individuals who began a tobacco cessation medication during treatment as well as those who reported quitting tobacco, defined as sustained tobacco abstinence for at least seven days. The analysis includes a total of N = 332 Veterans who enrolled in the Intensive Outpatient Program (IOP). RESULTS: Those enrolled in the opt-out tobacco treatment group reported a significantly higher rate of quitting tobacco (24.57%) than those in the opt-in group (2.55%; p <.001). Likewise, the opt-out group was prescribed tobacco cessation medications at a significantly higher rate than the opt-in group (55.00% compared to 14.65%; p <.001). CONCLUSIONS: An opt-out treatment approach to TUD in SUD treatment settings produced improved outcomes, including significantly more patients engaged in TUD treatment and a higher overall rate of SUD treatment completion. IMPLICATIONS: Given the disproportionately high rate of tobacco use among those seeking treatment for SUD, enhanced tobacco cessation interventions could result in both improved tobacco as well as other substance use outcomes. The implementation of an opt-out tobacco treatment intervention embedded into SUD programming is supported by our findings of reduced tobacco use among patients.

The impact of substance use on posttraumatic stress disorder symptoms and treatment discontinuation.

This study examined the impact of ongoing substance use during posttraumatic stress disorder (PTSD) and substance use disorder (SUD) treatment on PTSD symptoms and treatment discontinuation. The study represents a secondary analysis of U.S. military veterans (N = 183) who participated in a randomized clinical trial for the treatment of both PTSD and SUD. Veterans mostly identified as Black (53.8%) or White (41.9%) and male (92.4%). Substance use, PTSD symptoms, and treatment discontinuation were measured at 4-week intervals throughout treatment. Predictors were the percentage of days with alcohol, cannabis, and other substance use (primarily cocaine and opioids) and the average number of alcoholic drinks per drinking day. Outcomes were PTSD symptoms and treatment discontinuation at concurrent and prospective assessments. Multilevel models accounted for the nested structure of the longitudinal data. Alcohol, cannabis, and other substance use did not predict PTSD symptoms or treatment discontinuation prospectively. Concurrently, we observed that as a participant's percentage of drinking days increased by 34.7% (i.e., 1 standard deviation), PTSD symptoms during the same period were 0.07 standard deviations higher (i.e., 1 point on the PCL), B = 0.03, p = .033. No other substances were related to PTSD symptoms concurrently. The findings demonstrate that PTSD symptoms improved regardless of substance use during exposure-based PTSD and SUD treatment, and treatment discontinuation was not associated with substance use. This study suggests that substance use during treatment cannot directly explain the poorer treatment outcomes observed in the literature on comorbid PTSD/SUD compared to PTSD-only populations.

An example of implementing a safety protocol in remote intervention and survey research with college students.

INTRODUCTION: This article draws attention to the need for open evaluation and reporting on safety protocols in survey and intervention research. We describe a protocol for responding to those who indicate increased risk of self-harm (i.e. suicidality or potentially lethal alcohol use) as an example and report on the outcome of our procedures. METHODS: Participants were first-year college students (n = 891) participating in an intervention trial for binge drinking. We describe the protocol, provide descriptive outcomes, and examine whether participant sex, attrition, or study intervention condition were related to endorsing items that indicated risk for suicidality or potentially lethal alcohol use. RESULTS: Of the 891 participants, 167 (18.7%) were identified as being at risk in one or more study wave. Of those, we were able to successfully contact 100 (59.9%), 76 (45.5%) by phone, and 24 (14.4%) by email. Of those 100, 78 accepted mental health resources as a result of outreach. Participant sex, attrition, and intervention condition were not related to risk. DISCUSSION: This article may aid other research teams in developing similar protocols. Strategies to reach an even greater proportion of high-risk participants are needed. A body of literature documenting published safety protocols in research and the associated outcomes would help to identify opportunities for improvement.

Daily associations between affect, drinking motives, and drinking intensity among U.S. young adults.

OBJECTIVE: We investigated the relationships between daily affect, drinking motives, likelihood of drinking, and intensity of drinking, particularly high-intensity drinking (HID), in a sample of young adults. We also explored differences in our outcomes before versus during the early coronavirus disease (COVID-19) pandemic. METHOD: In the springs of 2019 and 2020, young adult drinkers (N = 633) completed 14 consecutive morning surveys (each year) characterizing the prior day's affect, motives, and alcohol use. We examined between-person and within-person associations of affect and motives with two outcomes: any drinking and drinking intensity on drinking days (1 = moderate drinking [1-3 drinks for women, 1-4 drinks for men], 2 = binge drinking [4-7 for women, 5-9 for men], and 3 = HID [8 + for women, 10 + for men]). RESULTS: Young adults reported higher positive affect on drinking days and higher negative affect on nondrinking days. On days when young adults reported greater enhancement motives, positive affect was strongly related to HID. During the early COVID-19 pandemic, young adults were more likely to report drinking, but did not drink more heavily unless they also reported drinking for social motives. CONCLUSIONS: These results suggest that heightened social, coping, and enhancement motives are risk factors for drinking in young adults. They also suggest that young adults perceive their mood to be better on drinking days, particularly when they were drinking to enhance positive affect. Results are consistent with a positive affect regulation model (i.e., drinking to increase positive affect), but not a negative affect regulation model (i.e., drinking to cope with negative affect). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

World Health Organization (WHO) risk level reductions in inpatients with alcohol use disorder and comorbid anxiety disorders.

OBJECTIVE: Studies have demonstrated that reduced drinking without total abstinence is associated with improved outcomes in outpatients with alcohol use disorder (AUD). We sought to examine this question in AUD inpatients who have comorbid anxiety disorders, a common presentation in AUD. METHOD: This is a secondary analysis of data from a randomized controlled trial for N = 241 inpatients with AUD and comorbid anxiety disorders. Change from baseline drinking level was measured at 1-, 4-, and 12-months postdischarge, and psychological and functional outcomes were measured at 4- and 12-months postdischarge. Three groups were compared: abstinent, reduced (reduced drinking by 1-3 World Health Organization drinking risk levels without abstinence), or nonreduced (maintained or increased drinking risk level). RESULTS: At 1-, 4-, and 12-months posttreatment, most patients reported abstinence (83, 63, and 60%), and 11, 25, and 26% reported drinking at a reduced level. Drinking reductions achieved at 1-month posttreatment were maintained at 12-month posttreatment by 74% of participants. Overall, the abstinent group reported the best psychological and functional outcomes at follow-ups, followed by the reduced group. Few differences were observed between reducers and nonreducers, but reducers reported significantly better alcohol dependence severity and alcohol-related problems than nonreducers. CONCLUSIONS: Though abstinence was associated with the best outcomes in this abstinence-based treatment sample, we conclude that reduced drinking is also associated with significant improvements in alcohol-related outcomes in inpatients with AUD and comorbid anxiety disorders.At 1-, 4-, and 12-months posttreatment, most patients reported abstinence (83, 63, and 60%), and 11, 25, and 26% reported drinking at a reduced level. Drinking reductions achieved at 1-month posttreatment were maintained at 12-month posttreatment by 74% of participants. Overall, the abstinent group reported the best psychological and functional outcomes at follow-ups, followed by the reduced group. Few differences were observed between reducers and nonreducers, but reducers reported significantly (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Quantifying heterogeneity in mood-alcohol relationships with idiographic causal models.

BACKGROUND: Ecological momentary assessment (EMA) studies have provided conflicting evidence for the mood regulation tenet that people drink in response to positive and negative moods. The current study examined mood-to-alcohol relationships idiographically to quantify the prevalence and intensity of relationships between positive and negative moods and drinking across individuals. METHOD: We used two EMA samples: 96 heavy drinking college students (sample 1) and 19 young adults completing an ecological momentary intervention (EMI) for drinking to cope (sample 2). Mood and alcohol use were measured multiple times per day for 4-6 weeks. Mood-alcohol relationships were examined using three different analytic approaches: standard multilevel modeling, group causal modeling, and idiographic causal modeling. RESULTS: Both multilevel modeling and group causal modeling showed that participants in both samples drank in response to positive moods only. However, idiographic causal analyses revealed that only 63% and 21% of subjects (in samples 1 and 2, respectively) drank following any positive mood. Many subjects (24% and 58%) did not drink in response to either positive or negative mood in their daily lives, and very few (5% and 16%) drank in response to negative moods throughout the EMA protocol, despite sample 2 being selected specifically because they endorse drinking to cope with negative mood. CONCLUSION: Traditional group-level analyses and corresponding population-wide theories assume relative homogeneity within populations in mood-alcohol relationships, but this nomothetic approach failed to characterize accurately the relationship between mood and alcohol use in approximately half of the subjects in two samples that were demographically and clinically homogeneous. Given inconsistent findings in the mood-alcohol relationships to date, we conclude that idiographic causal analyses can provide a foundation for more accurate theories of mood and alcohol use. In addition, idiographic causal models may also help improve psychosocial treatments through direct use in clinical settings.

Daily-level analysis of drinking intensity and acute physical consequences.

OBJECTIVE: We examined associations of drinking intensity on a given drinking day with acute physical consequences in a sample of U.S. young adult drinkers. METHODS: Participants were past 30-day drinkers at modal age 18 in the 2018 12th-grade Monitoring the Future study who were followed up as part of a daily study in 2019 (n = 911). Of these participants, n = 489 reported at least one drinking day. At age 19, they reported their alcohol use and consequences for 14 consecutive days (n = 1051 drinking days). Daily data were used to examine within- and between-person associations of drinking intensity (moderate [1-3 drinks for women, 1-4 drinks for men], binge [4-7/5-9], or high-intensity [8+/10+]) with four acute physical consequences: hangover, nausea, blackout, and passing out. RESULTS: At least one acute physical consequence was reported on more than half (59.3%) of high-intensity drinking days compared to 40.7% of binge and 4.9% of moderate drinking days. Blackouts and passing out were reported on 17.1% and 9.2% of high-intensity drinking days, respectively. Compared to binge drinking days, high-intensity drinking days were associated with a greater likelihood of any physical consequences (adjusted odds ratio [aOR] = 4.64; 95% confidence interval [CI] = 2.00,10.75), a greater number of consequences (adjusted incident rate ratio [aIRR = 1.99; 95% CI = 1.16,3.42), and a greater likelihood of hangover (aOR = 3.72; 95% CI = 1.58,8.74). Acute physical consequences were also more likely on high-intensity and binge drinking days versus moderate drinking days. CONCLUSIONS: High-intensity drinking days were associated with a distinctly greater risk for acute physical consequences than binge or moderate drinking days.

Using Ecological Momentary Assessments and Fitbit Data to Examine Daily Associations Between Physical Activity, Affect and Alcohol Cravings in Patients with Alcohol Use Disorder.

BACKGROUND: Preliminary studies show that structured physical activity (PA) interventions can reduce negative affect and alcohol use in patients recovering from alcohol use disorder (AUD). The current study tested whether the association between PA, affect, and alcohol cravings can be observed in patients' natural environments (i.e., without a structured intervention) as well. METHOD: Twenty-five participants with AUD completed 3 weeks of ecological momentary assessment (EMA) monitoring and wore Fitbit devices to measure physical activity directly after discharge from partial hospitalization treatment for AUD. PA was operationalized as total steps and consecutive 10-min bouts of moderate-intensity exercise (100 steps/minute). RESULTS: Only 56% of participants engaged in any bouts of moderate-intensity physical activity throughout the 3-week study period (mode = 1 bout), and participants logged an average of 8183 steps/day (SD = 5560). Daily steps were associated with a higher positive affect and lower alcohol cravings, and with higher positive affect the next day, but the effects were very small. No relationships were observed between PA and affect or alcohol cravings at the hourly level except a random effect signifying that bouts of PA were either positively associated or not associated with negative affect in the next hour for different participants. CONCLUSIONS: Overall, results suggest that naturalistic PA may be beneficial for a small subset of patients in recovery from AUD, but the majority did not engage in regular exercise or experience improvements in affect and cravings as a result of PA.

Ability to tolerate distress moderates the indirect relationship between emotion regulation difficulties and loss-of-control over eating via affective lability.

INTRODUCTION: Loss-of-control eating (LOCE), inability to refrain from or cease eating, may contribute to significant distress and dysfunction, yet research is lacking specificity on vulnerabilities contributing to LOCE as an independent construct. Preliminary evidence indicates potential roles of distress tolerance, emotion regulation, and affective lability, but the relationship between these variables and LOCE has been under-assessed. MATERIAL AND METHODS: A sample (N = 3968) consisting of university students completed an assessment of pathological eating and affiliated affective vulnerabilities. A latent variable structural equation model (SEM) was generated to predict LOCE by way of affective lability and indirectly, emotion regulation difficulties and low distress tolerance, controlling for general eating pathology. RESULTS: Findings indicated a significant direct effect of affective lability on LOCE, as well as significant indirect effects of emotion regulation difficulties and distress tolerance on LOCE, via affect lability. Additionally, distress tolerance moderated the relationship between emotion regulation difficulties and affective lability, such that lower ability to tolerate distress strengthened the relationship and higher distress tolerance capability attenuated it. DISCUSSION: Findings suggest an influence of distress tolerance on the relationship between poor emotion regulation and affective lability, which in turn may affect LOCE. Clinical implications and suggestions for future research are discussed.

Idiopathic inflammatory myopathies: a review.

Idiopathic inflammatory myopathy (IIM) is the umbrella term including dermatomyositis (DM), polymyositis (PM), overlap myositis (OM), sporadic inclusion body myositis (IBM) and necrotising autoimmune myopathy (NAM), also known as immune-mediated necrotising myopathy. There is some debate as to whether PM exists as a discrete entity, or perhaps is an overly generalising term encompassing connective tissue disease associated myositis, or OM, and the previously poorly recognised NAM. As such, PM will not be covered in detail in this review. DM, OM and NAM all present similarly, with proximal weakness and elevated creatine kinase (CK) level. By contrast, IBM preferentially involves the long finger flexors and quadriceps, and presents with a normal or only mildly elevated CK. Developments in serological testing and imaging are shifting the diagnostic paradigm away from a reliance on histopathology. The therapeutic armamentarium for IIM continues to evolve, with intravenous immunoglobulin and rituximab proving to be successful for refractory disease. This review will provide a diagnostic algorithm for the clinician to help distinguish between IIM subtypes - with emphasis on clinical assessment, serology and imaging, as well as discussion of therapeutic options and escalation of immunotherapy.

Real-time changes in emotion regulation and loss of control eating.

Difficulties in emotion regulation are an important theoretical construct implicated in the maintenance of loss of control eating. In this study, 45 community and college participants who reported loss of control eating at least once per week carried tablets for 2 weeks, responding to random assessments throughout each day. We compared trajectories of emotion regulation abilities before and after loss of control eating episodes (using average loss of control eating episode time to divide non-loss-of-control eating days). Emotion regulation abilities remained stable on non-loss-of-control eating days, but there was a significant increase in emotion regulation difficulties after loss of control eating episodes. These results suggest that increases in emotion regulation difficulties are not responsible for initiation of loss of control eating.

An ecological momentary assessment of mood, coping and alcohol use among emerging adults in psychiatric treatment.

Background: Emerging adulthood is a critical period for the onset of both mental health disorders and problematic alcohol use. Coping strategies can play an important role in mitigating the onset and progression of these conditions in emerging adulthood. The current study examined daily mood, coping strategy use, and alcohol use during an individualized, ecological momentary intervention (EMI).Objectives: To examine the within-person relationship between mood, coping strategy use, and alcohol use.Methods: Emerging adults (N = 20, 55% female) in a partial hospital program for anxiety or mood disorders who endorsed drinking to cope completed a 6-week EMI to increase non-substance coping skills. The study also measured mood, coping strategy use, and alcohol use over the course of the intervention.Results: Mood and coping variables did not predict the likelihood of drinking on a given day. On drinking days, the number of pre-consumption coping strategies were related to reduced alcohol use (p =.02) and there was a significant interaction between negative mood and coping in predicting alcohol use (p <.01). When pre-consumption negative mood was high, coping strategies predicted decreased alcohol use (p =.02), but when negative mood was low, this relationship was nonsignificant.Conclusions: Using coping skills was associated with reduced alcohol use on days when negative mood was high. Increasing non-substance coping skills may help emerging adults reduce their alcohol use in response to negative mood.

What about this time? Within- and between-person associations between drinking motives and alcohol outcomes.

Alcohol use in college populations is highly prevalent. College students who consume alcohol can experience a variety of different alcohol-related consequences. Drinking motives, or reasons that individuals choose to consume alcohol, are proximal factors that affect alcohol use. Previous research has generally found that internal drinking motives (i.e., coping and enhancement motives) are particularly relevant in predicting alcohol-related consequences. However, most of this research has examined drinking motives as traits, rather than state (i.e., daily) motives. The present study sought to examine enhancement and coping motives as both distinct and combined predictors of alcohol-related consequences at the daily level, directly and via alcohol consumption. Multilevel analyses of a 30-day retrospective report of drinking behaviors showed that within-person enhancement motives increased alcohol-related consequences via increased alcohol use. In contrast, coping motives were directly associated with alcohol-related consequences at the between-person level. Implications of the findings are that clinicians should assess and discuss daily motives for alcohol use with patients presenting with problems related to alcohol use, as well as typical motives. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Multicenter Australian Study to Determine Criteria for Low- and High-Risk Penicillin Testing in Outpatients.

BACKGROUND: Recent single-center studies promote oral penicillin challenges, without skin testing, in patients with low risk/likelihood of true allergy. However, how best to define a low-risk penicillin allergy history is uncertain. OBJECTIVE: To statistically determine an optimal low-risk definition, to select patients for safe outpatient penicillin challenges, without skin testing. METHODS: In a multicenter Australian study (February 2016 to May 2018), testing strategy (skin test and/or oral penicillin challenge) and outcomes were retrospectively collected for all penicillin-allergic patients. Statistical modeling was performed with 8 low-risk definitions, to determine an optimal low-risk definition. RESULTS: A total of 447 subjects (mean age, 45.3 years; 63.8% females) were analyzed. A history of benign, immediate, or delayed rash, more than 1 year before review, was the optimal low-risk definition. A total of 244 of 447 (54.6%) patients met this definition, of which 97.1% tolerated a 1- or 2-dose penicillin challenge, with no anaphylaxis in those who reacted. Of 203 patients designated higher risk, 54 (26.6%) had their allergy confirmed by skin test (n = 45) or challenge (n = 9). CONCLUSIONS: History of penicillin-associated rash (without angioedema, mucosal ulceration, or systemic involvement), more than 1 year ago, is sufficient to select a patient for a direct oral penicillin challenge. This large multicenter study demonstrates that this approach appears safe, and risk is comparable to that in other procedures being performed in primary care in Australia. The higher risk patients are more likely to benefit from skin testing. This simple risk-based delabeling strategy could potentially be used by nonallergists, leading to more efficient penicillin allergy delabeling service provision.

Protective behavioral strategies and alcohol-related regretted sex among college students.

Regretted sexual experiences are reported at higher rates among sexually active female college students than by their male counterparts. Moreover, alcohol is involved in approximately one third of regretted sex experienced by college students. Previous research has shown that students who implement protective behavioral strategies (PBS) while drinking are able to reduce alcohol-related negative consequences, including regretted sex. In order to compare differences in associations among alcohol use, PBS, and regretted sex, the current study examined these associations as a function of gender. Results were analyzed for each of the 3 subtypes of PBS: Manner of Drinking (MD); Stopping/Limiting Drinking (SLD) and Serious Harm Reduction (SHR). The current study included 371 college students (64.15% female) from a moderate-sized Midwest university. Participants completed a series of online surveys that assessed drinking habits, alcohol-related consequences (i.e., regretted sex), and PBS use. A multigroup path analysis found that alcohol use was positively associated with regretted sex, however, 2 of the 3 PBS subtypes (MD and SLD) were negatively associated with alcohol use. The third PBS subtype (SHR) yielded a direct negative relationship with regretted sex for women, but not for men. Lastly, the interaction of SHR and alcohol use was significantly associated with regretted sex, which was moderated by gender. These results suggest an among PBS use, decreased alcohol use, and fewer instances of regretted sex. Further examination of the differences in relationships among PBS subtypes, alcohol use, and regretted sex for men and women is warranted. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Antimicrobial anaphylaxis: the changing face of severe antimicrobial allergy.

OBJECTIVES: The epidemiology, clinical characteristics and outcomes of antimicrobial-associated anaphylaxis remain ill-defined. We sought to examine antimicrobial anaphylaxis with regard to: (i) the frequency of implicated antimicrobials; (ii) attributable mortality; and (iii) referral for definitive allergy assessment. METHODS: This was conducted through a national retrospective multicentre cohort study at five Australian tertiary hospitals (January 2010 to December 2015). Cases of antimicrobial anaphylaxis were identified from ICD-10 coding and adverse drug reaction committee databases. RESULTS: There were 293 participants meeting the case definition of antimicrobial anaphylaxis and 310 antimicrobial anaphylaxis episodes. Of 336 implicated antimicrobials, aminopenicillins (62/336, 18.5%) and aminocephalosporins (57/336, 17%) were implicated most frequently. ICU admission occurred in 43/310 (13.9%) episodes; however, attributable mortality was low (3/310, 1%). The rate of anaphylaxis to IV antibiotics was 3.5 (95% CI=2.9-4.3) per 100 000 DDDs and the rate of hospital-acquired anaphylaxis was 1.9 (95% CI=2.1-3.3) per 100 000 occupied bed-days. We observed overall low rates of hospital discharge documentation (222/310, 71.6%) and follow-up by specialist allergy services (73/310, 23.5%), which may compromise medication safety and antimicrobial prescribing in future. CONCLUSIONS: This study demonstrated that a high proportion of severe immediate hypersensitivity reactions presenting or acquired in Australian hospitals are secondary to aminopenicillins and aminocephalosporins. Overall rates of hospital-acquired anaphylaxis, predominantly secondary to cephalosporins, are low, and also associated with low inpatient mortality.

The significance of anti-granulocyte-macrophage colony-stimulating factor antibodies in cryptococcal infection: case series and review of antibody testing.

We report two cases of cryptococcosis, associated with anti-granulocyte-macrophage colony-stimulating factor antibodies. We review this recently identified acquired form of autoimmune immune deficiency and discuss the potential applications of granulocyte-macrophage colony-stimulating factor antibody testing by enzyme-linked immunosorbent assay.

Within- and between-person associations from mood to alcohol consequences: The mediating role of enhancement and coping drinking motives.

Between-subjects literature has established that trait-like negative mood predicts coping motives, which predict alcohol-related problems and that trait-like positive mood predicts mood enhancement motives, which then predict alcohol consumption. However, there is considerable within-person variation in drinking motives, and the relationship between mood, motives, and alcohol outcomes must be more closely examined at a daily level. The current study used ecological momentary assessment (EMA) to measure mood, motives, alcohol use, and alcohol consequences in 101 college drinkers over a 15-day period. At the between-subjects level, positive mood predicted enhancement motives, which in turn predicted alcohol consumption and consequences. Negative mood predicted coping motives, which were associated with only alcohol-related consequences. At the within-subjects level, daily anxious and depressed mood were associated with endorsing coping motives, but coping motives were not associated with alcohol consumption or problems. Positive mood was associated with enhancement motives, which was associated with both daily alcohol consumption and problems. These results corroborate previous findings that enhancement motives are most predictive of outcomes in the college population and highlight the importance of considering within-subject variance in drinking motives. The relationships between mood, motives, and alcohol outcomes differ when examined as between-subjects versus within-subject constructs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).