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Zvolensky MJ, Kauffman BY, Garey L, Buckner JD. Abstinence phobia among adult African American/Black cannabis users. Addict Behav 2022; 132:107344. [PMID: 35569320 PMCID: PMC10029065 DOI: 10.1016/j.addbeh.2022.107344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE African American/Black individuals experience significant health disparities, particularly as it relates to cannabis use. As such, there is a need to identify intrapersonal factors related to more severe patterns of use among this subpopulation. Worry about quitting or reducing cannabis as a result of the anticipated anxiety-related states during deprivation (i.e., abstinence phobia) is one factor that is theoretically important in the context of cannabis-related disparities. METHOD The current study sought to examine the cross-sectional association between abstinence phobia and cannabis use problems, perceived barriers for cannabis cessation, and cannabis withdrawal symptoms. Participants included 83 African American/Black cannabis users (31.3% female, Mage = 38.12, SD = 10.42). RESULTS Cannabis abstinence phobia was associated with greater severity of cannabis use problems, more perceived barriers for quitting cannabis use, and more severe cannabis withdrawal symptoms. CONCLUSIONS Abstinence phobia may represent an underrecognized intervention target for addressing cannabis use problems and quit success.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | | | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA; HEALTH Institute, University of Houston, Houston, TX, USA
| | - Julia D Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
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2
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Dunn K, Bergeria C, Huhn AS, Strain EC. Differences in patient-reported and observer-rated opioid withdrawal symptom etiology, time course, and relationship to clinical outcome. Drug Alcohol Depend 2020; 215:108212. [PMID: 32781310 DOI: 10.1016/j.drugalcdep.2020.108212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 07/18/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
Although opioid withdrawal ratings are frequently used as primary outcomes for therapeutic trials, there has been limited empirical examination of opioid withdrawal symptom onset or etiology as an outcome, and also little examination of differences in outcomes between patient-reported and observer-ratings of withdrawal. Patient-reported (Subjective Opiate Withdrawal Scale, SOWS) and observer ratings (Clinical Opiate Withdrawal Scale, COWS) of opioid withdrawal collected as part of a randomized controlled residential clonidine, tramadol-extended release, and buprenorphine/naloxone 7-day taper for opioid withdrawal management were analyzed. Withdrawal ratings were collected seven times daily and primary outcomes were percent of participants (N = 103) endorsing symptoms, time of symptom onset, and relationship of scales to taper completion. Participants had variable endorsement of specific symptoms, ranging from 37 % ("feel like vomiting") to 97 % ("change in resting pulse"). Symptoms were more likely to be reported on the SOWS than COWS. Most symptoms began around 8 h after last dose, though comparison of like symptoms across the scales revealed patients reported symptoms on the SOWS > 10 h before they were observed on the COWS. SOWS peak severity score was more closely associated with taper completion than the COWS. Data suggest the patient-reported SOWS demonstrated a higher level of symptom endorsement, earlier detection of symptom onset, and better association with taper completion relative to the observer rated COWS. These data provide insight into the etiology of opioid withdrawal symptom expression and time course that can be used to inform treatment intervention timing and provide a baseline for other withdrawal evaluations.
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Affiliation(s)
- Kelly Dunn
- 5510 Nathan Shock Dr, Baltimore, MD, 21224, United States.
| | | | - Andrew S Huhn
- 5510 Nathan Shock Dr, Baltimore, MD, 21224, United States
| | - Eric C Strain
- 5510 Nathan Shock Dr, Baltimore, MD, 21224, United States
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Stein MD, Conti MT, Herman DS, Anderson BJ, Bailey GL, Noppen DV, Abrantes AM. Worries About Discontinuing Buprenorphine Treatment: Scale Development and Clinical Correlates. Am J Addict 2019; 28:270-276. [PMID: 30993833 DOI: 10.1111/ajad.12884] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/06/2019] [Accepted: 03/09/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the benefits of maintenance buprenorphine treatment for opioid use disorder (OUD), many individuals report an interest in discontinuing the medication, while also expressing worries about tapering. The purpose of this study was to develop a measure of worries about buprenorphine discontinuation ("Off Bupe") and determine the demographic and clinical characteristics associated with these worries. METHODS Between May 2017 and May 2018, we surveyed adults in an outpatient primary care buprenorphine program (n = 138). Reliability and validity of the Off Bupe measure were examined. RESULTS Participants averaged 39 years of age, 54% were male, average duration of buprenorphine was 189 weeks and 85.5% reported eventually wanting to discontinue buprenorphine, although fewer than 10% were actively tapering. We derived two scales, withdrawal symptom worry (10 items, ɑ = 0.94) and relapse worry (7 items, ɑ = 0.88). Worry about symptoms was positively associated with current buprenorphine dose (P = 0.016), physical discomfort avoidance (P < 0.001), and inversely associated with self-efficacy to quit buprenorphine (P < 0.001) and distress tolerance (P < 0.001). Worry about opioid relapse was associated positively with age (P = 0.019), current buprenorphine dose (P = 0.004), physical discomfort avoidance (P < 0.001), and impulsivity (P = 0.002), and inversely associated with self-efficacy to quit buprenorphine (P < 0.001). DISCUSSION AND CONCLUSIONS Psychometric evaluation of the "Off Bupe" scale demonstrated its content and construct validity and internal reliability. SCIENTIFIC SIGNIFICANCE The scale might help individuals with OUD and their providers identify concerns about discontinuing buprenorphine. (Am J Addict 2019;28:270-276).
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Affiliation(s)
- Michael D Stein
- Department of Behavioral Medicine and Addictions Resaerch, Butler Hospital, Providence, Rhode Island.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Micah T Conti
- Department of Behavioral Medicine and Addictions Resaerch, Butler Hospital, Providence, Rhode Island
| | - Debra S Herman
- Department of Behavioral Medicine and Addictions Resaerch, Butler Hospital, Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Bradley J Anderson
- Department of Behavioral Medicine and Addictions Resaerch, Butler Hospital, Providence, Rhode Island
| | - Genie L Bailey
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Stanley Street Treatment and Resources, Inc, Fall River, Massachusetts
| | - Donnell Van Noppen
- Department of Behavioral Medicine and Addictions Resaerch, Butler Hospital, Providence, Rhode Island
| | - Ana M Abrantes
- Department of Behavioral Medicine and Addictions Resaerch, Butler Hospital, Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Zvolensky MJ, Rogers AH, Manning K, Hogan JBD, Paulus DJ, Buckner JD, Mayorga NA, Hallford G, Schmidt NB. Anxiety sensitivity and cannabis use problems, perceived barriers for quitting, and fear of quitting. Psychiatry Res 2018; 263:115-120. [PMID: 29544142 DOI: 10.1016/j.psychres.2018.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/02/2018] [Accepted: 03/03/2018] [Indexed: 11/25/2022]
Abstract
Cannabis is among the most widely used psychoactive substances in the United States, and rates of cannabis use and cannabis-related problems are increasing. Anxiety sensitivity, or the fear of aversive interoceptive sensations, may be relevant to better understanding cannabis use problems and other significant cannabis use processes (e.g., beliefs about quitting). Previous research has primarily focused on the global anxiety sensitivity construct; however, anxiety sensitivity lower-order facets (Cognitive Concerns, Physical Concerns, and Social Concerns) tend to be differentially related to substance use processes in non-cannabis specific studies. The current study therefore explored anxiety sensitivity lower-order facets in relation to cannabis use problems, perceived barriers for cannabis cessation, and abstinence phobia (fear of not using cannabis) among a community sample of 203 cannabis-using adults. Results indicated that anxiety sensitivity Cognitive Concerns were significantly associated with each of the dependent measures and these effects were not explained by shared variance with the other lower-order factors or a range of other covariates (e.g., tobacco use). The present findings suggest future work may benefit from focusing on the role of anxiety sensitivity Cognitive Concerns in the maintenance of cannabis use.
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Affiliation(s)
- Michael J Zvolensky
- University of Houston, Department of Psychology, Houston, TX, USA; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX, USA.
| | - Andrew H Rogers
- University of Houston, Department of Psychology, Houston, TX, USA
| | - Kara Manning
- University of Houston, Department of Psychology, Houston, TX, USA
| | - Julianna B D Hogan
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Daniel J Paulus
- University of Houston, Department of Psychology, Houston, TX, USA
| | - Julia D Buckner
- Louisiana State University, Department of Psychology, Baton Rouge, LA, USA
| | - Nubia A Mayorga
- University of Houston, Department of Psychology, Houston, TX, USA
| | - Gerald Hallford
- University of Houston, Department of Psychology, Houston, TX, USA
| | - Norman B Schmidt
- Florida State University, Department of Psychology, Tallahassee, FL, USA
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What stops people on long-term opioid substitution from completing treatment? DRUGS AND ALCOHOL TODAY 2017. [DOI: 10.1108/dat-09-2017-0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Opioid substitution treatment is effective in reducing harm for the person and society. However, the introduction of the recovery agenda has changed treatment philosophy. Associated targets such as successful treatment completions have introduced new expectations from treatment providers and service users. The purpose of this paper is to provide a service user-centred evaluation of underlying reasons that might prevent them from considering completion of treatment.
Design/methodology/approach
Ten service users who were stable on opioid substitution treatment for more than five years were interviewed face-to-face using a semi-structured format. Detailed inductive coding and thematic analysis of all transcripts was conducted.
Findings
Most participants expressed fear of change to their treatment and in particular reduction of the prescribed medication, due to past traumatic withdrawal experience, fear of relapse, fear of negative impact on their mental and physical health. Nevertheless all were optimistic about their future lives and were hoping to be able to complete their treatment at some point. A three-month follow-up revealed little change, with most participants not considering changing their medication dose in the future.
Practical implications
It could be argued that treatment providers, instead of focussing their efforts on stable service users in promoting treatment exit, should focus on new service users, avoiding coercion to treatment aims and rushed detoxifications.
Originality/value
This small qualitative study confirms results of other recent studies on the same theme and argues for the importance of the quality of the treatment experience of new people accessing treatment.
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Dunn KE, Saulsgiver KA, Miller ME, Nuzzo PA, Sigmon SC. Characterizing opioid withdrawal during double-blind buprenorphine detoxification. Drug Alcohol Depend 2015; 151:47-55. [PMID: 25823907 PMCID: PMC4447545 DOI: 10.1016/j.drugalcdep.2015.02.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/23/2015] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Prescription opioid (PO) abuse has become an urgent public health issue in the United States. Detoxification is one important treatment option, yet relatively little is known about the time course and severity of opioid withdrawal during buprenorphine detoxification. METHODS This is a secondary analysis of data from a randomized, placebo-controlled, double-blind evaluation of 1, 2, and 4-week outpatient buprenorphine tapers among primary prescription opioid (PO) abusers. The aim is to characterize the time course and severity of buprenorphine withdrawal under rigorous, double-blind conditions, across multiple taper durations, and using multiple withdrawal-related measures (i.e., self-report and observer ratings, pupil diameter, ancillary medication utilization). Participants were PO-dependent adults undergoing buprenorphine detoxification and biochemically-verified to be continuously abstinent from opioids during their taper (N = 28). RESULTS Participants randomly assigned to the 4-week taper regimen experienced a relatively mild and stable course of withdrawal, with few peaks in severity. In contrast, the 1- and 2-week taper groups experienced stark increases in withdrawal severity during the week following the last buprenorphine dose, followed by declines in withdrawal severity thereafter. The 4-week taper group also reported significantly fewer disruptions in sleep compared to the other experimental groups. When predictors of withdrawal were examined, baseline ratings of "Expected Withdrawal Severity" was the most robust predictor of withdrawal experienced during the taper. CONCLUSION Data from this trial may inform clinicians about the expected time course, magnitude, and pattern of buprenorphine withdrawal and aid efforts to identify patients who may need additional clinical support during outpatient buprenorphine detoxification.
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Affiliation(s)
- Kelly E Dunn
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, United States.
| | | | - Mollie E Miller
- Brown University Center for Alcohol and Addiction Studies, Providence, RI, United States
| | - Paul A Nuzzo
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Stacey C Sigmon
- University of Vermont Departments of Psychiatry, Burlington, VT, United States; University of Vermont Departments of Psychology, Burlington, VT, United States
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Stotts AL, Masuda A, Wilson K. Using Acceptance and Commitment Therapy during Methadone Dose Reduction: Rationale, Treatment Description, and a Case Report. COGNITIVE AND BEHAVIORAL PRACTICE 2009; 16:205-213. [PMID: 20628479 PMCID: PMC2902188 DOI: 10.1016/j.cbpra.2008.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Many clients who undergo methadone maintenance (MM) treatment for heroin and other opiate dependence prefer abstinence from methadone. Attempts at methadone detoxification are often unsuccessful, however, due to distressing physical as well as psychological symptoms. Outcomes from a MM client who voluntarily participated in an Acceptance and Commitment Therapy (ACT) - based methadone detoxification program are presented. The program consisted of a 1-month stabilization and 5-month gradual methadone dose reduction period, combined with weekly individual ACT sessions. Urine samples were collected twice weekly to assess for use of illicit drugs. The participant successfully completed the program and had favorable drug use outcomes during the course of treatment, and at the one-month and one-year follow-ups. Innovative behavior therapies, such as ACT, that focus on acceptance of the inevitable distress associated with opiate withdrawal may improve methadone detoxification outcomes.
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Robles E, Gilmore-Thomas KK, Miller FB, McMillan DE. Sensitivity to acute methadone dose changes in maintenance patients. J Subst Abuse Treat 2002; 23:409-13. [PMID: 12495803 DOI: 10.1016/s0740-5472(02)00274-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study assessed whether methadone patients can identify acute dose changes in their maintenance dose, and explored the relationships between self-reported drug effects and real or perceived dose changes. Four times each week patients (N = 10) unpredictably received either 80%, 90%, 100%, 110% or 120% of their usual daily dose (50-100 mg). Approximately 24 hr later they indicated which dose they had received on the previous day, and rated the previous day's dose in terms of good effects, bad effects, and change in medication taste. Correct estimation of the doses received was always at the levels expected by chance alone. Furthermore, this sample of patients could not detect dose-related changes in medication taste. However, self-reports of good effects were significantly higher when patients believed that they had received a dose increment, and ratings of bad effects were higher when patients believed that they had received a dose decrement.
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Affiliation(s)
- Elias Robles
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 611-1, Little Rock, AR 72205, USA.
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Eklund C, Hiltunen AJ, Melin L, Borg S. Abstinence fear in methadone maintenance withdrawal: a possible obstacle for getting off methadone. Subst Use Misuse 1997; 32:779-92. [PMID: 9178443 DOI: 10.3109/10826089709039377] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The present study attempts to shed light on methadone maintenance patients expectations regarding withdrawal symptoms during voluntary methadone detoxification. The study includes two groups of subjects; one group who have tried on their own initiative to terminate their methadone maintenance treatment (Group 1) and one group that contains rehabilitated patients who have not tried to quit using methadone (Group 2). Two main results have emerged. Group 1 has negative expectations beforehand about the intensity of withdrawal which significantly exceed the later, actual experience. Group 2 has negative expectations about the intensity of withdrawal that significantly exceed the negative expectations of Group 1. The clinical implications of these results are discussed.
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Affiliation(s)
- C Eklund
- Department of Clinical Psychology, University of Uppsala, Sweden
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