The Role of Shame in the Relationship between Alcohol Use Severity and Relational Intimacy among Sexual Minority Women.

Background: Sexual Minority Women (SMW) are disproportionately likely to struggle with substance use and shame, two factors that are associated with poorer relationship quality and decreased relational intimacy (Doyle & Molix, 2015). However, there is a dearth of research examining shame and substance use concurrently among SMW. Objectives: The current study elucidated the role of shame-based cognitions (SBCs) and shame-based behaviors (SBBs) in explaining the relationship between alcohol use severity and relational intimacy. We recruited adult cisgender women (N = 105) in a romantic relationship who self-identified as a sexual minority and reported alcohol use during the past three months through Amazon Mechanical Turk. Participants completed an online survey assessing alcohol use, SBCs, SBBs, and relational intimacy. Results: There was a significant positive relationship between alcohol use severity with SBCs (r = .29, p = .003) and with SBBs (r = .62, p <.001). SBBs were shown to be negatively correlated with relational intimacy (r = -.48, p < .001). Parallel mediation analysis demonstrated that SBCs and SBBs accounted for approximately 34.4% of the variance in intimacy. The indirect effects of SBCs were significant (ß = .10, 95% CI [.02, .18] while SBBs (ß = -.14, 95% CI [-.29, .01]) did not show effects. Discussions: Given the disproportionate rates of alcohol use among SMW, this study offers a nuanced picture of the relationships between constructs known to impact alcohol use. The findings underscore the importance of SBCs and point to a potential treatment target among SMW presenting with alcohol use and diminished relational intimacy.

Substance Use Disorders in Women.

Substance use disorder (SUD) is among the leading causes of premature morbidity and mortality and imposes significant health, economic, and social burdens. Gender differences have been found in the development, course, and treatment of SUD, with women at increased risk for physiologic and psychosocial consequences compared with men. Reasons for these differences are multifold and include biological, genetic, environmental, and behavioral factors. This article discusses SUD among women, emphasizing clinical considerations for care. Specific topics include epidemiology, sex and gender differences, common comorbidities, screening, diagnosis, treatment, pregnancy, and sociocultural factors.

Psychologists' and psychotherapists' knowledge, attitudes, and clinical practices regarding the therapeutic use of psychedelics.

INTRODUCTION: This study explored the current knowledge, attitudes, and clinical practices regarding psychedelics among mental health professionals in California, where state legislation to decriminalize psychedelics has been proposed. METHOD: Two hundred thirty-seven mental health providers (74% female; mean age 54; 83% White; 46% psychologists) completed a 37-item online survey between November 2021 and February 2022, disseminated through local and state-wide professional organizations in California. RESULTS: Providers endorsed limited knowledge about the risks and benefits of psychedelic use (M = 4.7 and 5.4, respectively, with 10 = high knowledge) and inadequate knowledge to counsel patients on use (45%). Gaps in knowledge related to psychedelic drug scheduling and current use in clinical research were identified. Providers expressed support for additional psychedelic research (97%), approval of recreational (66%) and medical (91%) psychedelic use, belief in the potential therapeutic benefits of psychedelics (89%), and concerns about safety (33%) and potential psychiatric risks (27%). Results indicated that most providers discuss psychedelic use with patients (73%), yet many do not feel comfortable addressing the effects of use (49%). There were significant correlations between knowledge and attitudes towards psychedelics (r = 0.2, p = .006; r = 0.31, p < .001) and attitudes and clinical practices (r = 0.34, p < .001). CONCLUSIONS: Findings suggest that providers are interested in psychedelic-assisted treatments and hold favourable attitudes towards the therapeutic use of psychedelics yet lack the knowledge to appropriately counsel patients, highlighting the need for additional provider education about psychedelics.

Risk for Ecstasy Use Disorder and Other Substance Use Among International Users of Recreational Ecstasy/Molly/MDMA.

Ecstasy/Molly/MDMA is a widely used substance often taken in combination with other drugs in different contexts. The current study assessed ecstasy use patterns, concurrent substance use and the context of ecstasy use among an international sample of adults (N = 1,732). Participants were 87% white, 81% male, 42% college educated, 72% employed, with a mean age of 25.7 (SD = 8.3). Using the modified UNCOPE, risk for ecstasy use disorder was 22% overall, and significantly higher among younger individuals and those with greater frequency and quantity of use. Participants reporting risky ecstasy use endorsed significantly higher use of alcohol, nicotine/tobacco, cannabis, cocaine, amphetamine, benzodiazepines, and ketamine compared to those at lower risk. Great Britain (aOR = 1.86; 95% CI [1.24, 2.81]) and Nordic countries (aOR = 1.97; 95% CI [1.11, 3.47]) were approximately 2 times more likely to exhibit risk for ecstasy use disorder than the United States, Canada, Germany, and Australia/New Zealand. Taking ecstasy at home emerged as a common setting followed by electronic dance music events and music festivals. The UNCOPE may be a useful clinical tool for detecting problematic ecstasy use. Harm reduction interventions for ecstasy should target young people, substance co-administration, and context of use.

Development and initial validation of an MDMA/Ecstasy motives assessment.

OBJECTIVE: MDMA/Ecstasy motives differ from those of other substances such as alcohol, cannabis, and methamphetamine. Previous literature on alcohol and cannabis use identified social, expansion, enhancement, coping, and conformism as primary motives for use. MDMA/Ecstasy users also report using the drug for increases in self-awareness and energy. The development of an MDMA/Ecstasy use motives assessment has potential to inform treatment interventions and public policy on harm reduction. METHOD: An MDMA/Ecstasy use motives assessment was developed from alcohol and cannabis motives measures and qualitative feedback from MDMA/Ecstasy users. Participants included an international sample of adults (N = 1754) who completed an online questionnaire regarding their motives for using recreational MDMA/Ecstasy. RESULTS: Exploratory and confirmatory factor analysis supported a 4-factor MDMA/Ecstasy motives scale. The four motive scales showed good internal consistency reliabilitySocial (α = 0.88) Expansion (α = 0.81), Coping (α = 0.82), and Energy (α = 0.75). Conformity and Enhancement did not emerge as significant factors. Analyses demonstrated convergent and discriminant validity with relevant constructs including quantity/frequency of use, MDMA use disorder, sensation seeking personality, and positive and negative consequences of use. CONCLUSIONS: MDMA/Ecstasy use motives differ from those of other substances due to the distinctly stimulating, emotional, and empathic effects sought by users. By identifying salient MDMA/Ecstasy motives, this study highlights the unique aspects of recreational MDMA/Ecstasy use. This research has utility for informing clinical practice and contributing to public health harm reduction efforts.

Qualitative exploration of the psychological dimensions of telehealth shared medical appointments (SMAs) for buprenorphine prescribing.

Background: Shared medical appointments (SMAs) for buprenorphine prescribing are clinical encounters in which multiple patients with opioid problems receive treatment from providers in a group setting. Telehealth, the provision of clinical services remotely using telecommunications technology, is an essential modality for improving access to healthcare when combined with SMAs, especially since the COVID pandemic. Objectives: The current study specifically examined psychological components of telehealth SMAs for buprenorphine prescribing to learn about the benefits and drawbacks of this treatment model. Methods: Data was collected through qualitative interviews with patients (N=10) in a psychiatry addiction medicine clinic. Narrative synthesis using grounded theory was conducted to identify salient themes from the interviews. Results: Findings highlighted the advantages and downsides of telehealth SMA to treat addictive disorders in a digital age: (1) Shared group identity; (2) Decreased stigma around buprenorphine; (3) Benefits of telehealth; (4) Discomfort with group SMA format; (5) Strategies for managing medication side effects; and (6) Enhanced empathy for providers. Several themes corresponded to therapeutic factors identified in group therapy (i.e., installation of hope, universality, imparting information, altruism) and mechanisms theorized in previous SMA research (e.g., combating isolation, disease self-management, feeling inspired by others). Conclusion: Telehealth SMAs for buprenorphine prescribing may be a unique opportunity for patients to receive both ongoing medication management and psychosocial benefits that promote recovery and reduce stigma. The SMA group had shortcomings for some patients, including privacy concerns, fear of judgment from other patients and limited time to discuss individual concerns with providers.

A systematic review of stigma interventions for providers who treat patients with substance use disorders.

BACKGROUND: Stigma surrounding substance use disorders (SUDs) is a frequently cited barrier to treatment engagement. Research consistently demonstrates that healthcare professionals' attitudes towards patients with addiction problems are often negative and may adversely impact service delivery. The current study presents a systematic review of stigma interventions for providers who treat patients with SUDs, in order to evaluate the quality of existing studies and potential for implementation in clinical settings. METHODS: This systematic literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases included PubMed, APA PsycInfo and the Cochrane Database of Systematic Reviews. Of the 1462 records identified between 2011 and 2019, 15 studies were eligible for inclusion. A narrative synthesis of stigma interventions summarized the change in stigmatizing attitudes held by providers. RESULTS: Studies included heterogeneous and culturally diverse samples of providers (N = 1324), who varied by age, location, discipline, and experience, with the exception of primarily female providers (75%). Results delineated six types of provider stigma interventions with components including online education, in-person education, in-person contact with consumers in recovery, or some combination of these elements. The highest quality studies incorporated motivational interviewing or communication training interventions, and many interventions combined either in-person mentorship or contact with individuals in recovery. Positive effects on provider attitudes occurred at several levels of educational and consumer contact interventions. Interventions with consumer contact demonstrated long-term maintenance of attitudinal shifts. Despite significant methodological limitations and low-quality assessment ratings, several studies utilized real-world providers and patients, as well as practical, innovative, brief, and potentially cost-effective interventions, particularly in locations with limited technological resources. CONCLUSIONS: Research on provider stigma interventions increased in recent years, indicating greater worldwide attention to the negative impact of stigma. While educational interventions alone can be helpful in attitudinal change, contact with individuals in recovery from SUDs is a vital component of provider stigma interventions, particularly for lasting effects. This review highlights the importance of including implementation outcomes, such as sustainability and cost-effectiveness, in the study of stigma interventions for providers of addiction treatment.

Mystical-type experiences occasioned by ketamine mediate its impact on at-risk drinking: Results from a randomized, controlled trial.

BACKGROUND: Sub-anesthetic ketamine administration may be helpful for substance use disorders. Converging evidence suggests that the efficacy of ketamine for certain conditions may implicate a subset of its psychoactive effects. AIMS: The aim of this analysis is to evaluate whether the mystical-type effects of ketamine are critical for clinical efficacy in alcohol-dependent individuals. In this secondary analysis, we determine if a subset of the psychoactive effects of ketamine, the so-called mystical-type experience, mediates the effect of ketamine, when combined with motivational enhancement therapy, on at-risk drinking behavior in alcohol-dependent individuals interested in treatment. METHODS: Forty alcohol dependent adults were randomized to either a 52-minute infusion of ketamine or midazolam, which they received on a designated quit-day during the second week of a five-week motivational enhancement therapy regimen. Psychoactive effects were assessed following the infusion, and alcohol use was monitored for the subsequent 3 weeks at each twice-weekly visit. RESULTS: We found that ketamine leads to significantly greater mystical-type effects (by Hood Mysticism Scale) and dissociation (by Clinician Administered Dissociative States Scale) compared to the active control. Ketamine also led to significant reduction in at-risk drinking. The Hood Mysticism Scale, but not Clinician Administered Dissociative States Scale score, was found to mediate the effect of ketamine on drinking behavior. CONCLUSIONS: This trial adds evidence to the literature on the importance of mystical-type experiences in addiction treatment. Future research should continue to investigate the relationship between the psychoactive effects of psychedelic therapeutics and clinical outcomes for other substance use and mental health disorders.

Online mutual-help intervention for reducing heavy alcohol use.

Online interventions have potential to reach a wide range of people, including heavy drinkers unable or unwilling to seek formal treatment or support groups. This study examined a self-guided alcohol Internet intervention that provides access to several different online social networks and is based on principles of harm reduction, cognitive-behavioral therapy (CBT), and relapse prevention. Active participants in the online program (N = 57) completed a survey that retrospectively assessed prior alcohol use, current alcohol use patterns, drinking goals, involvement in online activities, and use of CBT self-help tools. Findings indicated significant reductions in drinks per week (DPW), drinks per day (DPD), and drinking days per week (DDW) from baseline to post-intervention. Longer time in the online program was associated with greater reduction in DDW, rs(57) = .31, p = .02; while use of CBT self-help tools was positively correlated with reduction in DPW, rs(57) = .37, p = .005. Engagement in multiple online activities (i.e., social networking, e-mail groups, chat room, forum discussion) was associated with greater drinking reductions in DPW, (F[1,55]) = 8.55, p < .005; and DDW, (F[1,55]) = 7.12, p < .01). Results suggest that an online program may assist heavy drinkers in decreasing alcohol use through utilization of a cyber community, social networking, and self-help tools. Conversely, 74% of participants were still engaging in high-risk drinking, raising the possibility that an online mutual-help group with personalized goals intended to reduce harm, may inadvertently normalize heavy alcohol use.

Factors associated with treatment retention in pregnant women with opioid use disorders prescribed methadone or electing non-pharmacological treatment.

Opioid use during pregnancy is rising, with an estimated 14-22% of women obtaining an opioid prescription during pregnancy. Methadone maintenance therapy (MMT) has been the gold standard for treatment of opioid use disorders during pregnancy; however, its use is limited in clinical practice due to availability, stigma, and reluctance on the part of clinicians. The present study compared against medical advice (AMA) treatment dropout from seven days of residential care between pregnant women diagnosed with opioid dependence who elected either MMT (n = 119) or non-pharmacological treatment (NPT) (n = 91) within the same treatment program in Baltimore, Maryland from 1996 to 1998. Multiple logistic regression analysis was conducted to compare the rate of AMA drop out between the two modalities. Patients who elected NPT were 2.77 times as likely to leave residential treatment as patients who elected MMT (adjusted odds ratio [OR = 2.77, 95% confidence interval [CI]: 1.23-6.17]. AMA was associated with interviewer-assessed drug severity and patient's rating of the importance of psychiatric treatment. The present findings further support the clinical utility of MMT and suggest that policies that facilitate the implementation of MMT in clinical practice would be beneficial to the engagement and retention of pregnant women with opioid use disorders.

Gender confirming medical interventions and eating disorder symptoms among transgender individuals.

OBJECTIVE: Studies indicate that transgender individuals may be at risk of developing eating disorder symptoms (EDS). Elevated risk may be attributed to body dissatisfaction and/or societal reactions to nonconforming gender expression, such as nonaffirmation of a person's gender identity (e.g., using incorrect pronouns). Limited research suggests that gender-confirming medical interventions (GCMIs) may prevent or reduce EDS among transgender people. METHOD: Participants included 154 transfeminine spectrum (TFS) and 288 transmasculine spectrum (TMS) individuals who completed the Trans Health Survey. Serial multiple mediation analyses controlling for age, education, and income were used to examine whether body satisfaction and nonaffirmation mediate any found relationships between various GCMIs (genital surgery, chest surgery, hormone use, hysterectomy, and hair removal) and EDS. RESULTS: For TFS individuals, the nonaffirmation to body satisfaction path mediated relationships between all GCMIs and EDS, although body satisfaction alone accounted for more of the indirect effects than this path for chest surgery. For TMS individuals, relationships between all GCMIs and EDS were mediated by the nonaffirmation to body satisfaction path. CONCLUSION: Findings support the hypothesis that GCMIs reduce experiences of nonaffirmation, which increases body satisfaction and thus decreases EDS. Among TFS participants, the relationship between chest surgery and lower levels of EDS was mediated most strongly by body satisfaction alone, suggesting that satisfaction with one's body may result in lower EDS even if affirmation from the external world is unchanged. Implications of these findings for intervention, policy, and legal efforts are discussed, and future research recommendations are provided. (PsycINFO Database Record

Cannabis use patterns and motives: A comparison of younger, middle-aged, and older medical cannabis dispensary patients.

INTRODUCTION: Medical cannabis is increasingly being used for a variety of health conditions as more states implement legislation permitting medical use of cannabis. Little is known about medical cannabis use patterns and motives among adults across the lifespan. METHODS: The present study examined data collected at a medical cannabis dispensary in San Francisco, California. Participants included 217 medical cannabis patients who were grouped into age-defined cohorts (younger: 18-30, middle-aged: 31-50, and older: 51-72). The age groups were compared on several measures of cannabis use, motives and medical conditions using one-way ANOVAs, chi-square tests and linear regression analyses. RESULTS: All three age groups had similar frequency of cannabis use over the past month; however, the quantity of cannabis used and rates of problematic cannabis use were higher among younger users relative to middle-aged and older adults. The association between age and problematic cannabis use was moderated by age of regular use initiation such that earlier age of regular cannabis use onset was associated with more problematic use in the younger users, but not among older users. Middle-aged adults were more likely to report using medical cannabis for insomnia, while older adults were more likely to use medical cannabis for chronic medical problems such as cancer, glaucoma and HIV/AIDS. Younger participants reported cannabis use when bored at a greater rate than middle-aged and older adults. CONCLUSIONS: Findings suggest that there is an age-related risk for problematic cannabis use among medical cannabis users, such that younger users should be monitored for cannabis use patterns that may lead to deleterious consequences.

Utilizing a transdiagnostic neuroscience-informed approach to differentiate the components of a complex clinical presentation: A case report.

Background: Recent research recognizes considerable overlap in the clinical presentation of psychiatric disorders such as Autism Spectrum Disorder, Attention Deficit Hyperactivity Disorder and Social Anxiety Disorder. The diagnostic approach collects symptoms to reflect a single underlying psychopathological process. The Research Domain Criteria (RDoC) emphasizes psychopathology as arising from combinations of abnormalities in core underlying constructs that can be measured at many levels of analysis, from biological to behavioral. Patients who present with clinical heterogeneity may benefit from transdiagnostic case conceptualization that integrates detailed symptom information across multiple measurements spanning multiple domains of functioning based in the RDoC framework. Case presentation: We report on one case that was included in a research study focused on advancing knowledge towards a transdiagnostic, brain-based model of anxiety and depression. The 20-year-old male patient presented at a community mental health clinic for inattention, low mood, sleep problems and anxious symptoms. The patient also presented with primary problems in negative valence systems (anxiety, avoidance, and bias towards negative information), cognitive systems (fluctuating cognitive ability over time, poor concentration and ability to focus), and social processing systems (deficits in social communication skills). Conceptualizing this case through a transdiagnostic lens augmented the patient's treatment plan by including a more integrative approach. Treatment included social skills training, progressive relaxation exercises, and basic psychoeducation in emotional expression and independent living skills. Conclusion: This case illustrates the utility of a transdiagnostic approach, particularly when a traditional diagnostic model generates conflicting evidence and/or multiple comorbidities. RDoC provides a framework for integrating abnormalities across multiple dimensions. Furthermore, it lays the foundation for future integration of brain-behavior relationships into case conceptualization and personalized treatment approaches.

Developing a clinical translational neuroscience taxonomy for anxiety and mood disorder: protocol for the baseline-follow up Research domain criteria Anxiety and Depression ("RAD") project.

BACKGROUND: Understanding how brain circuit dysfunctions relate to specific symptoms offers promise for developing a brain-based taxonomy for classifying psychopathology, identifying targets for mechanistic studies and ultimately for guiding treatment choice. The goal of the Research Domain Criteria (RDoC) initiative of the National Institute of Mental Health is to accelerate the development of such neurobiological models of mental disorder independent of traditional diagnostic criteria. In our RDoC Anxiety and Depression ("RAD") project we focus trans-diagnostically on the spectrum of depression and anxiety psychopathology. Our aims are a) to use brain imaging to define cohesive dimensions defined by dysfunction of circuits involved in reactivity to and regulation of negatively valenced emotional stimulation and in cognitive control, b) to assess the relationships between these dimension and specific symptoms, behavioral performance and the real world capacity to function socially and at work and c) to assess the stability of brain-symptom-behavior-function relationships over time. METHODS AND DESIGN: Here we present the protocol for the "RAD" project, one of the first RDoC studies to use brain circuit functioning to define new dimensions of psychopathology. The RAD project follows baseline-follow up design. In line with RDoC principles we use a strategy for recruiting all clients who "walk through the door" of a large community mental health clinic as well as the surrounding community. The clinic attends to a broad spectrum of anxiety and mood-related symptoms. Participants are unmedicated and studied at baseline using a standardized battery of functional brain imaging, structural brain imaging and behavioral probes that assay constructs of threat reactivity, threat regulation and cognitive control. The battery also includes self-report measures of anxiety and mood symptoms, and social and occupational functioning. After baseline assessments, therapists in the clinic apply treatment planning as usual. Follow-up assessments are undertaken at 3 months, to establish the reliability of brain-based subgroups over time and to assess whether these subgroups predict real-world functional capacity over time. First enrollment was August 2013, and is ongoing. DISCUSSION: This project is designed to advance knowledge toward a neural circuit taxonomy for mental disorder. Data will be shared via the RDoC database for dissemination to the scientific community. The clinical translational neuroscience goals of the project are to develop brain-behavior profile reports for each individual participant and to refine these reports with therapist feedback. Reporting of results is expected from December 2016 onward. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02220309 . Registered: August 13, 2014.

Assessment of provider attitudes toward #naloxone on Twitter.

BACKGROUND: As opioid overdose rates continue to pose a major public health crisis, the need for naloxone treatment by emergency first responders is critical. Little is known about the views of those who administer naloxone. The current study examines attitudes of health professionals on the social media platform Twitter to better understand their perceptions of opioid users, the role of naloxone, and potential training needs. METHODS: Public comments on Twitter regarding naloxone were collected for a period of 3 consecutive months. The occupations of individuals who posted tweets were identified through Twitter profiles or hashtags. Categories of emergency service first responders and medical personnel were created. Qualitative analysis using a grounded theory approach was used to produce thematic content. The relationships between occupation and each theme were analyzed using Pearson chi-square statistics and post hoc analyses. RESULTS: A total of 368 individuals posted 467 naloxone-related tweets. Occupations consisted of professional first responders such as emergency medical technicians (EMTs), firefighters, and paramedics (n = 122); law enforcement officers (n = 70); nurses (n = 62); physicians (n = 48); other health professionals including pharmacists, pharmacy technicians, counselors, and social workers (n = 31); naloxone-trained individuals (n = 12); and students (n = 23). Primary themes included burnout, education and training, information seeking, news updates, optimism, policy and economics, stigma, and treatment. The highest levels of burnout, fatigue, and stigma regarding naloxone and opioid overdose were among nurses, EMTs, other health care providers, and physicians. In contrast, individuals who self-identified as "naloxone-trained" had the highest optimism and the lowest amount of burnout and stigma. CONCLUSIONS: Provider training and refinement of naloxone administration procedures are needed to improve treatment outcomes and reduce provider stigma. Social networking sites such as Twitter may have potential for offering psychoeducation to health care providers.

Training and Practices of Cannabis Dispensary Staff.

Introduction: The proliferation of cannabis dispensaries within the United States has emerged from patient demand for the legalization of cannabis as an alternative treatment for a number of conditions and symptoms. Unfortunately, nothing is known about the practices of dispensary staff with respect to recommendation of cannabis strains/concentrations for specific patient ailments. To address this limitation, the present study assessed the training and practices of cannabis dispensary staff. Materials and Methods: Medical and nonmedical dispensary staff (n=55) were recruited via e-mail and social media to complete an online survey assessing their demographic characteristics, dispensary features, patient characteristics, formal training, and cannabis recommendation practices. Results: Fifty-five percent of dispensary staff reported some formal training for their position, with 20% reporting medical/scientific training. A majority (94%) indicated that they provide specific cannabis advice to patients. In terms of strains, dispensary staff trended toward recommendations of Indica for anxiety, chronic pain, insomnia, nightmares, and Tourette's syndrome. They were more likely to recommend Indica and hybrid plants for post-traumatic stress disorder (PTSD)/trauma and muscle spasms. In contrast, staff were less likely to recommend Indica for depression; hybrid strains were most often recommended for amyotrophic lateral sclerosis (ALS). In terms of cannabinoid concentrations, dispensary staff were most likely to recommend a 1:1 ratio of delta-9-tetrahydrocannabinol (THC):cannabidiol (CBD) for patients suffering from anxiety, Crohn's disease, hepatitis C, and PTSD/trauma, while patients seeking appetite stimulation were most likely to be recommended THC. Staff recommended high CBD for arthritis and Alzheimer's disease and a high CBD or 1:1 ratio for ALS, epilepsy, and muscle spasms. Conclusions: Although many dispensary staff are making recommendations consistent with current evidence, some are recommending cannabis that has either not been shown effective for, or could exacerbate, a patient's condition. Findings underscore the importance of consistent, evidence-based, training of dispensary staff who provide specific recommendations for patient medical conditions.

Evidence-based supervision: Tracking outcome and teaching principles of change in clinical supervision to bring science to integrative practice.

Supervision is the primary way in which psychotherapy trainees develop the skills of applying interventions, conceptualizing cases, and practicing self-reflection. Although critical to professional development, the nature and objectives of supervision can vary widely among supervisors, depending on idiosyncratic differences and the orientation used. As clinical psychology moves toward integrating science and practice, the need to teach students evidence-based principles of therapeutic change and how to use outcome measures to enhance progress is paramount. Furthermore, with hundreds of "evidence-based" interventions and widely diverse supervisors, the fact that cross-cutting interventions and common factors carry the burden of most therapeutic change is frequently lost. In this article, we outline an experimental training system that is being tested as a means to teach student-therapists to use empirically established moderators (treatment factors) and mediators of change to tailor their interventions to client differences. This experimental approach is derived from Systematic Treatment Selection (Beutler, Clarkin, & Bongar, 2000), a cross-cutting system that can be used to aid individualized treatment planning as well as to track and use client outcomes in clinical supervision within a graduate-level training clinic.

Substance abuse treatment services for pregnant women: psychosocial and behavioral approaches.

Women who use tobacco, alcohol and drugs during pregnancy are at increased risk of maternal and fetal morbidity. Universal screening using empirically validated approaches can improve identification of substance-using pregnant women and facilitate comprehensive assessment of treatment needs. There is strong evidence for effectiveness of psychosocial and behavioral substance abuse treatments across a range of intensities and levels of care. In addition to addressing substance use, services for co-occurring psychiatric disorders, trauma exposure, and prenatal care are important components of coordinated systems of care. More research on and greater access to evidence-based interventions is needed for this underserved population.

Directly administered antiretroviral therapy: pilot study of a structural intervention in methadone maintenance.

Devising interventions to provide integrated treatment for addiction and medical problems is an urgent issue. This study piloted a structural intervention, Directly Administered Antiretroviral Therapy (DAART), to assist methadone-maintenance patients in HIV medication adherence. Twenty-four participants received: (1) antiretroviral medications at the methadone clinic daily before receiving their methadone; (2) take-home antiretroviral medication for days they were not scheduled to attend the methadone clinic, and (3) brief adherence counseling to address adherence barriers. DAART lasted 24 weeks, with a planned step-down to twice-weekly administration in weeks 25-36, followed by self-administration in weeks 37-48. Retention rates at weeks 24, 36, and 48 were 83, 92, and 75% respectively. DAART was associated with improvement in the proportion of participants achieving viral suppression as well as with high medication adherence rates (clinic-verified; 85% and self-reported 97%) during the active intervention phase. DAART was effective as an intervention but did not promote transition to self-administration. This study demonstrates that DAART is adaptable and simple enough to be implemented into methadone treatment programs interested in providing HIV adherence services.