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Gómez W, Schustack A, Carrico AW, Ramirez-Forcier J, Batchelder A. In the Interest of Time: Assessing the Role of Resilience Across an Intergenerational Sample of People Living with HIV. Int J Behav Med 2024; 31:315-324. [PMID: 37438561 DOI: 10.1007/s12529-023-10198-7] [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] [Accepted: 06/29/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Biomedical advances have improved the quality of life of people living with HIV (PLWH); however, barriers to optimal well-being remain. A key feature in understanding the lived experiences of PLWH is resilience. The concept of resilience is quite complex in terms of its antecedents and expressions, suggesting the need for more nuanced understandings of how it could be harnessed to better support this population. METHOD The concept of resilience was explored in a qualitative study involving 22 PLWH, selectively sampled by era of diagnosis. Through interviews focused on context and experiences of living with HIV, the sample highlighted resilience processes corresponding to Positive reappraisal of life events, Positive reappraisal of self, and Community as resilience. RESULTS Participants who have lived with HIV longer more commonly described engaging in psychological processes of resilience, whereas those who were more recently diagnosed reported engaging in more social processes. However, these processes were not mutually exclusive and the ability to perform resilience through community seems to be key to optimizing outcomes, irrespective of era of diagnosis. CONCLUSION PLWH are a heterogeneous population where engagement in distinct processes of resilience may have important implications for optimal social and health outcomes. Better understanding of the distinct and diverse pathways through which PLWH engage in resilience may inform interventions promoting optimal well-being.
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Affiliation(s)
- Walter Gómez
- Jane Addams College of Social Work, University of Illinois Chicago, 1040 West Harrison Street (MC309), Chicago, IL, 60607-7134, USA.
| | | | - Adam W Carrico
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
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Cherenack EM, Chavez JV, Martinez C, Hirshfield S, Balise R, Horvath KJ, Viamonte M, Jimenez DE, Paul R, Dilworth SE, DeVries B, Pallikkuth S, Stevenson M, Alvarado TC, Pahwa S, Carrico AW. Stimulant use, HIV, and immune dysregulation among sexual minority men. Drug Alcohol Depend 2023; 251:110942. [PMID: 37651812 PMCID: PMC10544798 DOI: 10.1016/j.drugalcdep.2023.110942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/30/2023] [Accepted: 08/12/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Sexual minority men (SMM) report high rates of stimulant use (e.g., crystal methamphetamine, cocaine) and HIV infection. Stimulant use contributes to immune dysfunction, which enhances risk for HIV acquisition and pathogenesis. Research is needed to examine the independent and interactive relationships of stimulant use and HIV infection with systemic immune dysregulation among SMM, especially during the COVID-19 pandemic. METHODS From 2020-2022, 75 SMM in Miami, Florida with and without HIV completed an online survey and provided biospecimens to assess HIV status and viral load (VL), recent stimulant use, and soluble markers of immune activation and inflammation in plasma, including soluble CD14 (sCD14) and elevated high-sensitivity C-reactive protein (hs-CRP > 1.0mg/L). Sociodemographics and prior SARS-CoV-2 infection were compared across HIV status/stimulant use groups. Moderation models examined the independent and interactive associations of stimulant use and HIV status with sCD14 and elevated hs-CRP. RESULTS Thirty participants were persons living with HIV (PWH) (50% with stimulant use), and 45 were HIV-negative (44% with stimulant use). SARS-CoV-2 infection was not associated with stimulant use/HIV groups or immune outcomes. HIV-negative SMM without stimulant use had lower sCD14 compared to other SMM, as well as lower odds of elevated hs-CRP compared to PWH who used stimulants. Stimulant use showed independent associations with immune dysregulation that persisted after controlling for HIV status and VL, whereas HIV status was only independently associated with elevated hs-CRP in one model not controlling for VL. CONCLUSIONS Among SMM, stimulant use was independently associated with elevated immune activation and inflammation.
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Affiliation(s)
- Emily M Cherenack
- Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL 33136, United States.
| | - Jennifer V Chavez
- Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL 33136, United States
| | - Claudia Martinez
- Department of Medicine, Division of Cardiology, University of Miami Miller School of Medicine, 1120 NW 14 ST Suite 1126, Miami, FL 33136, United States
| | - Sabina Hirshfield
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY 11203, United States
| | - Raymond Balise
- Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL 33136, United States
| | - Keith J Horvath
- Department of Psychology, San Diego State University, 6363 Alvarado Court, San Diego, CA 92120, United States
| | - Michael Viamonte
- Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL 33136, United States
| | - Daniel E Jimenez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Suite 1436, Miami , FL 33136, United States
| | - Robert Paul
- Missouri Institute of Mental Health, Department of Psychological Sciences, University of Missouri, St. Louis, One University Blvd, St. Louis, MO 63141, United States
| | - Samantha E Dilworth
- University of California, San Francisco, Center for AIDS Prevention Studies, Department of Medicine, 550 16th St, 3rd Floor, San Francisco, CA 94158, United States
| | - Britt DeVries
- Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL 33136, United States
| | - Suresh Pallikkuth
- Department of Microbiology & Immunology, University of Miami Miller School of Medicine, 1580 NW 10 AVE, Miami, FL 33136, United States
| | - Mario Stevenson
- Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14 ST, Miami, FL 33136, United States
| | - Thaissa Cordeiro Alvarado
- Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14 ST, Miami, FL 33136, United States
| | - Savita Pahwa
- Department of Microbiology & Immunology, University of Miami Miller School of Medicine, 1580 NW 10 AVE, Miami, FL 33136, United States
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL 33136, United States
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Alcohol, tobacco and drug use among adults experiencing homelessness in Accra, Ghana: A cross-sectional study of risk levels and associated factors. PLoS One 2023; 18:e0281107. [PMID: 36877700 PMCID: PMC9987824 DOI: 10.1371/journal.pone.0281107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/16/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Substance use contributes to poor health and increases the risk of mortality in the homeless population. This study assessed the prevalence and risk levels of substance use and associated factors among adults experiencing homelessness in Accra, Ghana. METHODS 305 adults currently experiencing sheltered and unsheltered homelessness in Accra aged ≥ 18 years were recruited. The World Health Organization's (WHO) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to assess substance use risk levels. Association of high-risk substance use with sociodemographic, migration, homelessness, and health characteristics were assessed using logistic regression. RESULTS Nearly three-quarters (71%, n = 216) of the sample had ever used a substance, almost all of whom engaged in ASSIST-defined moderate-risk (55%) or high-risk (40%) use. Survivors of physical or emotional violence (AOR = 3.54; 95% confidence interval [CI] 1.89-6.65, p<.001) and sexual violence (AOR = 3.94; 95%CI 1.85-8.39, p<.001) had significantly higher odds of engaging in high-risk substance use, particularly alcohol, cocaine, and cannabis. The likelihood of engaging in high-risk substance use was higher for men than women (AOR = 4.09; 95%CI 2.06-8.12, p<.001) but lower for those in the middle-income group compared to low-income (AOR = 3.94; 95%CI 1.85-8.39, p<.001). CONCLUSIONS Risky substance use was common among adults experiencing homelessness in Accra, and strongly associated with violent victimisation, gender, and income levels. The findings highlight the urgent need for effective and targeted preventive and health-risk reduction strategies to address risky substance use in the homeless population in Accra and similar cities within Ghana and sub-Sahara Africa with a high burden of homelessness.
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Olem D, Earle M, Gómez W, Coffin L, Cotten P, Jain JP, Moskowitz JT, Carrico AW. Finding Sunshine on a Cloudy Day: A Positive Affect Intervention for Co-Occurring Methamphetamine Use and HIV. COGNITIVE AND BEHAVIORAL PRACTICE 2022; 29:267-279. [PMID: 35812005 PMCID: PMC9269980 DOI: 10.1016/j.cbpra.2020.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Among sexual minority men (i.e., gay, bisexual, and other men who have sex with men) living with HIV, those who use methamphetamine experience profound health disparities. Affect Regulation Treatment to Enhance Methamphetamine Intervention Success (ARTEMIS) is an evidence-based, 5-session, individually delivered positive affect intervention adapted for sexual minority men living with HIV who use methamphetamine. ARTEMIS was designed to amplify the benefits of evidence-based substance use interventions such as contingency management (CM) with this high-priority population. Delivering ARTEMIS during CM has been shown to assist participants in reducing stimulant use, increasing positive affect, and achieving durable reductions in HIV viral load. We describe the theoretical underpinnings of the ARTEMIS intervention, provide details of the training and session protocols with a case example, and discuss implications for future applications in research and clinical settings.
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Hoepper BB, Siegel KR, Carlon HA, Kahler CW, Park ER, Taylor ST, Simpson HV, Hoeppner SS. Feature-level analysis of a smoking cessation smartphone app that uses a positive psychology approach (Preprint). JMIR Form Res 2022; 6:e38234. [PMID: 35900835 PMCID: PMC9377446 DOI: 10.2196/38234] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background Smoking cessation smartphone apps have emerged as highly accessible tools to support smoking cessation efforts. It is unknown how specific app features contribute to user engagement over time and relate to smoking outcomes. Objective To provide a feature-level analysis of the Smiling Instead of Smoking app (version 2) and to link feature use to subsequent smoking cessation. Methods Nondaily smokers (N=100) used the app for a period of 49 days (1 week before quitting and 6 weeks after quitting). Participants self-reported 30-day point-prevalence abstinence at the end of this period and at a 6-month follow up (the survey response rate was 94% and 89% at these points, respectively). Self-reported 30-day point prevalence abstinence rates were 40% at the end of treatment and 56% at the 6-month follow up. The app engaged users in both positive psychology content and traditional behavioral smoking cessation content. The app sent push notifications to prompt participants to complete prescribed content (ie, a “happiness exercise” every day and a “behavioral challenge” to use the app’s smoking cessation tools on 15 out of 49 days). Actions that participants took within the app were timestamped and recorded. Results Participants used the app on 24.7 (SD 13.8) days out of the 49 prescribed days, interacting with the happiness content on more days than the smoking content (23.8, SD 13.8 days vs 17.8, SD 10.3 days; t99=9.28 [2-tailed]; P<.001). The prescribed content was frequently completed (45% of happiness exercises; 57% of behavioral challenges) and ad libitum tools were used on ≤7 days. Most participants used each ad libitum smoking cessation tool at least once, with higher use of personalized content (≥92% used “strategies,” “cigarette log,” “smoke alarms,” and “personal reasons”) than purely didactic content (79% viewed “benefits of quitting smoking”). The number of days participants used the app significantly predicted 30-day point-prevalence abstinence at the end of treatment (odds ratio [OR] 1.05, 95% CI 1.02-1.09; P=.002) and at the 6-month follow up (OR 1.04, 95% CI 1.008-1.07; P=.01). The number of days participants engaged with the happiness content significantly predicted smoking abstinence at the end of treatment (OR 1.05, 95% CI 1.02-1.08; P=.002) and at the 6-month follow up (OR 1.04, 95% CI 1.007-1.07; P=.02). This effect was not significant for the number of days participants engaged with the smoking cessation content of the app, either at the end of treatment (OR 1.04, 95% CI 0.996-1.08, P=.08) or at the 6-month follow up (OR 1.02, 95% CI 0.98-1.06; P=.29). Conclusions Greater app usage predicted greater odds of self-reported 30-day point-prevalence abstinence at both the end of treatment and over the long term, suggesting that the app had a therapeutic benefit. Positive psychology content and prescriptive clarity may promote sustained app engagement over time. Trial Registration ClinicalTrials.gov NCT03951766; https://clinicaltrials.gov/ct2/show/NCT03951766
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Affiliation(s)
- Bettina B Hoepper
- Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Kaitlyn R Siegel
- Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Hannah A Carlon
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Elyse R Park
- Mongan Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Steven Trevor Taylor
- Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Hazel V Simpson
- Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Susanne S Hoeppner
- Obsessive-Compulsive Disorder and Related Disorders Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
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Does Treatment Readiness Shape Service-Design Preferences of Gay, Bisexual, and Other Men Who Have Sex with Men Who Use Crystal Methamphetamine? A Cross Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063458. [PMID: 35329146 PMCID: PMC8951578 DOI: 10.3390/ijerph19063458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 12/17/2022]
Abstract
Crystal methamphetamine (CM) disproportionately impacts gay, bisexual, and other men who have sex with men (gbMSM). However, not all gbMSM are interested in changing their substance use. The present study aimed to examine whether participant-preferred service characteristics were associated with their readiness to change. We surveyed gbMSM who used CM in the past six months, aged 18 plus years, on dating platforms. Participants rated service-design characteristics from “very unimportant” to “very important”. Multivariable regression tested service preference ratings across levels of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES-8D). Among 291 participants, 38.7% reported their CM use was not problematic, 19.5% were not ready to take any action to reduce or stop using CM, and 41.7% were ready to take action. On average, participants rated inclusive, culturally-appropriate, out-patient counselling-based interventions as most important. Participants with greater readiness-to-change scores rated characteristics higher than gbMSM with lesser readiness. Contingency management and non-abstinence programming were identified as characteristics that might engage those with lesser readiness. Services should account for differences in readiness-to-change. Programs that provide incentives and employ harm reduction principles are needed for individuals who may not be seeking to reduce or change their CM use.
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Starks TJ, Adebayo T, Kyre KD, Millar BM, Stratton MJ, Gandhi M, Ingersoll KS. Pilot Randomized Controlled Trial of Motivational Interviewing with Sexual Minority Male Couples to Reduce Drug Use and Sexual Risk: The Couples Health Project. AIDS Behav 2022; 26:310-327. [PMID: 34297275 PMCID: PMC8299442 DOI: 10.1007/s10461-021-03384-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 01/08/2023]
Abstract
A randomized controlled trial evaluated the preliminary efficacy of a dyadically-delivered motivational interviewing (MI) intervention to reduce drug use and sexual risk in a sample of 50 sexual minority (cis)male (SMM) couples. In each couple, at least one partner was aged 18-29; reported drug use and sexual HIV transmission risk; and was HIV-negative. Couples were randomized to either the three-session MI intervention or an attention-matched control, with follow-up surveys completed at 3- and 6-months post-baseline. Between-group differences for all outcomes were non-significant in the overall sample. Subsequent moderation analyses indicated the intervention significantly reduced illicit drug use (excluding marijuana) at 3-month follow-up when either respondents (B = - 1.96; interval rate ratio-IRR 0.02-1.22; p = .001), their partners (B = - 2.60; IRR 0.01-0.64; p = .004), or both (B = - 2.38; IRR 0.01-0.80; p = .001) reported high levels of baseline use. The intervention also reduced condomless anal sex (CAS) with casual partners when both partners reported high frequency baseline CAS (B = - 2.54; IRR 0.01-0.83; p = .047). Findings provide initial evidence of the potential for MI to address drug use and sexual risk-taking among SMM couples at highest risk.Trial Registration ClinicalTrials.gov (NIH U.S. National Library of Medicine) Identifier: #NCT03386110.
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Affiliation(s)
- Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York, CUNY, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA.
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of the City University of New York, New York, NY, USA.
| | - Trinae Adebayo
- Department of Psychology, Hunter College of the City University of New York, CUNY, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
| | - Kory D Kyre
- Department of Psychology, Hunter College of the City University of New York, CUNY, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
| | - Brett M Millar
- Department of Psychology, Hunter College of the City University of New York, CUNY, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
| | - Mark J Stratton
- Mount Sinai Institute for Advanced Medicine HIV Primary Care and Prevention Center of Excellence, New York, NY, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, CA, USA
| | - Karen S Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, VA, USA
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Kidd JD, Paschen-Wolff MM, Mericle AA, Caceres BA, Drabble LA, Hughes TL. A scoping review of alcohol, tobacco, and other drug use treatment interventions for sexual and gender minority populations. J Subst Abuse Treat 2022; 133:108539. [PMID: 34175174 PMCID: PMC8674383 DOI: 10.1016/j.jsat.2021.108539] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/28/2021] [Accepted: 06/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Alcohol, tobacco, and other drug use are among the most prevalent and important health disparities affecting sexual and gender minority (SGM; e.g., lesbian, gay, bisexual, transgender) populations. Although numerous government agencies and health experts have called for substance use intervention studies to address these disparities, such studies continue to be relatively rare. METHOD We conducted a scoping review of prevention and drug treatment intervention studies for alcohol, tobacco, and other drug use that were conducted with SGM adults. We searched three databases to identify pertinent English-language, peer-reviewed articles published between 1985 and 2019. RESULTS Our search yielded 71 articles. The majority focused on sexual minority men and studied individual or group psychotherapies for alcohol, tobacco, or methamphetamine use. CONCLUSION Our findings highlight the need for intervention research focused on sexual minority women and gender minority individuals and on cannabis and opioid use. There is also a need for more research that evaluates dyadic, population-level, and medication interventions.
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Affiliation(s)
- Jeremy D Kidd
- Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Margaret M Paschen-Wolff
- Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Amy A Mericle
- Alcohol Research Group at the Public Health Institute, 6001 Shellmound Street, Suite 450, Emeryville, CA 94608, USA.
| | - Billy A Caceres
- Columbia University School of Nursing, 560 W. 168th Street, New York, NY 10032, USA.
| | - Laurie A Drabble
- San Jose State University, College of Health and Human Sciences, One Washington Square, San Jose, CA 95191, USA.
| | - Tonda L Hughes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Columbia University School of Nursing, 560 W. 168th Street, New York, NY 10032, USA.
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Hoeppner BB, Siegel KR, Carlon HA, Kahler CW, Park ER, Hoeppner SS. A Smoking Cessation App for Nondaily Smokers (Version 2 of the Smiling Instead of Smoking App): Acceptability and Feasibility Study. JMIR Form Res 2021; 5:e29760. [PMID: 34787577 PMCID: PMC8663587 DOI: 10.2196/29760] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/12/2021] [Accepted: 08/24/2021] [Indexed: 12/18/2022] Open
Abstract
Background Recent evidence highlights the significant detrimental impact of nondaily smoking on health and its disproportionate prevalence in underserved populations; however, little work has been done to develop treatments specifically geared toward quitting nondaily smoking. Objective This study aims to test the feasibility, acceptability, and conceptual underpinnings of version 2 of the Smiling Instead of Smoking (SiS2) smartphone app, which was developed specifically for nondaily smokers and uses a positive psychology approach. Methods In a prospective, single-group study, nondaily smokers (N=100) were prescribed use of the SiS2 app for 7 weeks while undergoing a quit attempt. The app assigned daily positive psychology exercises and behavioral tasks every 2 to 3 days, which guided smokers through using the smoking cessation tools offered in the app. Participants answered surveys at baseline and at 2, 6, 12, and 24 weeks postquit. Feasibility was evaluated based on app use and acceptability based on survey responses. The underlying conceptual framework was tested by examining whether theorized within-person changes occurred from baseline to end of treatment on scales measuring self-efficacy, desire to smoke, and processing of self-relevant health information (ie, pros and cons of smoking, importance of the pros and cons of quitting, and motivation). Results Participants used the SiS2 app on an average of 24.7 (SD 13.8) days out of the 49 prescribed days. At the end of treatment, most participants rated the functions of the app as very easy to use (eg, 70/95, 74% regarding cigarette log and 59/95, 62% regarding happiness exercises). The average score on the System Usability Scale was 79.8 (SD 17.3; A grade; A+ ≥84.1, B+ <78.8). Most participants reported that the app helped them in their quit attempt (83/95, 87%), and helped them stay positive while quitting (78/95, 82%). Large effects were found for within-person decreases in the desire to smoke (b=−1.5, 95% CI −1.9 to −1.1; P<.001; gav=1.01), the importance of the pros of smoking (b=-20.7, 95% CI −27.2 to −14.3; P<.001; gav=0.83), and perceived psychoactive benefits of smoking (b=−0.8, 95% CI −1.0 to −0.5; P<.001; gav=0.80). Medium effects were found for increases in self-efficacy for remaining abstinent when encountering internal (b=13.1, 95% CI 7.6 to 18.7; P<.001; gav=0.53) and external (b=11.2, 95% CI 6.1 to 16.1; P<.001; gav=0.49) smoking cues. Smaller effects, contrary to expectations, were found for decreases in motivation to quit smoking (P=.005) and the perceived importance of the pros of quitting (P=.009). Self-reported 30-day point prevalence abstinence rates were 40%, 56%, and 56% at 6, 12, and 24 weeks after the quit day, respectively. Conclusions The SiS2 app was feasible and acceptable, showed promising changes in constructs relevant to smoking cessation, and had high self-reported quit rates by nondaily smokers. The SiS2 app warrants testing in a randomized controlled trial.
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Affiliation(s)
- Bettina B Hoeppner
- Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Kaitlyn R Siegel
- Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Hannah A Carlon
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Elyse R Park
- Health Promotion and Resiliency Research Intervention Program, Psychiatry & Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Susanne S Hoeppner
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
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Tran MTN, Luong QH, Le Minh G, Dunne MP, Baker P. Psychosocial Interventions for Amphetamine Type Stimulant Use Disorder: An Overview of Systematic Reviews. Front Psychiatry 2021; 12:512076. [PMID: 34220557 PMCID: PMC8245759 DOI: 10.3389/fpsyt.2021.512076] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/06/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction: Amphetamine-type stimulants (ATS) use is a global concern due to increased usage and the harm to physical, mental, and social well-being. The objective of this overview of systematic reviews is to summarise trial results of psychosocial interventions and describe their efficacy and safety. Methods: We searched seven bibliographic databases to November 2020 for systematic reviews examining ATS misuse treatment by psychosocial interventions. Given the apparent incompleteness of the included reviews, we undertook a supplemental meta-analysis of all eligible primary studies. Results: We included 11 systematic reviews of moderate to high quality and 39 primary studies which assessed the outcomes of psychosocial interventions on people who use ATS. The key findings include: (1) There were conflicting results about the effectiveness of psychosocial interventions among reviews, which may confuse decision-makers in selecting treatment. (2) In the supplemental meta-analysis, relative to usual care (only counselling or self-help materials), membership of a psychological intervention group was associated with an important reduction in drug usage [risk ratio (RR) 0.80, 95% CI: 0.75 to 0.85]. Patients in psychological interventions used injectables substantially less [odds ratio (OR) 0.35, 95% CI: 0.24 to 0.49]. The risk of unsafe sex in the psychosocial intervention group was lower than in the control group (RR 0.49, 95% CI: 0.34 to 0.71). The combination of therapies reduced 1.51 day using drugs in the preceding 30 days (95% CI: -2.36 to -0.67) compared to cognitive behavioural therapy intervention alone. (3) Compared to usual care, cognitive behavioural therapy was less likely to be retained at follow-up (RR 0.89, 95% CI: 0.82 to 0.97; high-quality evidence). However, the additional of contingency management strategy can make an important improvement upon retention (RR 1.42, 95%CI: 1.25 to 1.62). Authors' Conclusions: Integrated models are more effective than a single-treatment strategy. Comprehensive and sustained psychosocial interventions can help to reduce use of ATS and other drugs, risk behaviours and mental disorders, and significantly improve treatment adherence.
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Affiliation(s)
- Mai Thi Ngoc Tran
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Hanoi, Vietnam
- Nursing and Midwifery Faculty, Hanoi Medical University, Hanoi, Vietnam
| | - Quang Hung Luong
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Giang Le Minh
- Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Michael P. Dunne
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Faculty of Law, Australian Centre of Health Law Research, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Institute for Community Health Research, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Philip Baker
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Bassett SM, Brody LR, Jack DC, Weber KM, Cohen MH, Clark TM, Dale SK, Moskowitz JT. Feasibility and Acceptability of a Program to Promote Positive Affect, Well-Being and Gender Empowerment in Black Women Living with HIV. AIDS Behav 2021; 25:1737-1750. [PMID: 33389322 PMCID: PMC7778488 DOI: 10.1007/s10461-020-03103-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 12/28/2022]
Abstract
While programs and interventions intended to increase positive affect among people living with HIV (PLWH) and other chronic diseases have been associated with improved health outcomes, including decreased depression, programs have not been tailored specifically for Black women. We tailored a program designed to increase positive affect and to decrease depressive symptoms in PLWH to a group format for Black WLWH. We also added skills to increase gender empowerment. We then tested the acceptability and feasibility of this program with 8 Black WLWH. The program was acceptable and relatively feasible, as assessed by women’s participation and feedback about program clarity and helpfulness, which women rated above 9 on a 10-point scale. A few women suggested that optimal delivery point for some skills taught would be shortly after HIV diagnosis. A proof-of-concept program intended to bolster positive emotions and gender empowerment and decrease depression can be tailored for Black WLWH and is relatively feasible and acceptable. A randomized controlled trial is needed to assess the preliminary efficacy of this program on positive affect, depression, and other health outcomes for WLWH.
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Affiliation(s)
- S M Bassett
- Medical Social Sciences, Northwestern University, Chicago, IL, USA.
| | - L R Brody
- Psychological & Brain Sciences, Boston University, Boston, MA, USA
| | - D C Jack
- Fairhaven College of Interdisciplinary Studies, Western Washington University, Bellingham, WA, USA
| | - K M Weber
- Cook County Health and Hektoen Institute of Medicine, Chicago, IL, USA
| | - M H Cohen
- Department of Medicine, Rush University and Stroger Hospital of Cook County, Chicago, IL, USA
| | - T M Clark
- Cook County Health and Hektoen Institute of Medicine, Chicago, IL, USA
| | - S K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - J T Moskowitz
- Medical Social Sciences, Northwestern University, Chicago, IL, USA
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12
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A systematic review and meta-analysis of psychological interventions to improve mental wellbeing. Nat Hum Behav 2021; 5:631-652. [PMID: 33875837 DOI: 10.1038/s41562-021-01093-w] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/05/2021] [Indexed: 12/20/2022]
Abstract
Our current understanding of the efficacy of psychological interventions in improving mental states of wellbeing is incomplete. This study aimed to overcome limitations of previous reviews by examining the efficacy of distinct types of psychological interventions, irrespective of their theoretical underpinning, and the impact of various moderators, in a unified systematic review and meta-analysis. Four-hundred-and-nineteen randomized controlled trials from clinical and non-clinical populations (n = 53,288) were identified for inclusion. Mindfulness-based and multi-component positive psychological interventions demonstrated the greatest efficacy in both clinical and non-clinical populations. Meta-analyses also found that singular positive psychological interventions, cognitive and behavioural therapy-based, acceptance and commitment therapy-based, and reminiscence interventions were impactful. Effect sizes were moderate at best, but differed according to target population and moderator, most notably intervention intensity. The evidence quality was generally low to moderate. While the evidence requires further advancement, the review provides insight into how psychological interventions can be designed to improve mental wellbeing.
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13
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Brown HD, DeFulio A. Contingency management for the treatment of methamphetamine use disorder: A systematic review. Drug Alcohol Depend 2020; 216:108307. [PMID: 33007699 DOI: 10.1016/j.drugalcdep.2020.108307] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 11/17/2022]
Abstract
Methamphetamine use continues to be an important public health problem. Contingency management is among the most effective interventions for reducing methamphetamine use. It has been more than ten years since the last systematic review of contingency management for methamphetamine use disorder. Since then, an additional ten randomized controlled trials and a variety of other studies have been completed. The present systematic review includes 27 studies. Several factors, most notably problem severity, appear to predict treatment outcome. However, the effectiveness of CM has been demonstrated in studies restricted to MSM, studies restricted to implementation in community programs, and in studies of the general population of methamphetamine users conducted in research treatment programs. There appear to be broad benefits of contingency management intervention, including greater drug abstinence, higher utilization of other treatments and medical services, and reductions in risky sexual behavior. Twenty of the twenty-one studies that reported abstinence outcomes showed an effect of contingency management on abstinence, and seven of the nine studies that reported sexual risk behavior outcomes showed an effect of contingency management in reducing risky sexual behavior. Taken together, recent evidence suggests strongly that outpatient programs that offer treatment for methamphetamine use disorder should prioritize adoption and implementation of contingency management intervention.
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Sheridan Rains L, Steare T, Mason O, Johnson S. Improving substance misuse outcomes in contingency management treatment with adjunctive formal psychotherapy: a systematic review and meta-analysis. BMJ Open 2020; 10:e034735. [PMID: 33033080 PMCID: PMC7545634 DOI: 10.1136/bmjopen-2019-034735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Contingency management (CM) is a treatment for substance misuse that involves the provision of incentives. This review examines the hypothesis that adding another formal psychotherapy, such as cognitive-behavioural therapy (CBT) or motivational enhancement therapy (MET), to CM improves substance use outcomes at both treatment end and at post-treatment follow-up compared with CM only. DATA SOURCES Searches were performed in December 2017 and July 2019 of seven electronic bibliographic databases (MEDLINE, PsycINFO, EMBASE, Scopus, Web of Science, CINAHL, PsycEXTRA), as well as online trial registries and EThoS, and were followed by reference list screening. ELIGIBILITY CRITERIA Included studies were randomised controlled trials of adults (18-65) who were using illicit substances, alcohol or tobacco. Studies featured an experimental arm delivering CM combined with a structured evidence-based psychotherapeutic intervention and a CM-only arm. Studies published up to July 2019 were included. DATA EXTRACTION AND SYNTHESIS The primary outcome was biometrically verified point prevalent abstinence (PPA) at treatment end. Secondary outcomes included biometrically verified PPA at post-treatment follow-up and self-reported days of use at treatment end and post-treatment follow-up. Pooled risk ratios for PPA outcomes and standardised mean differences for days of use were calculated using random effects models. Risk of bias was assessed using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS 12 studies (n=1654) were included. The primary analysis found no evidence of a synergistic effect in PPA at treatment end (relative risk (RR) 0.97, 95% CI 0.85 to 1.09; p=0.57). Sensitivity analysis of studies featuring CBT/MET also found no evidence of an effect (RR 0.92; 95% CI 0.79 to 1.08; p=0.32). None of the secondary outcomes showed any evidence of benefit. CONCLUSION The results of the meta-analyses found no evidence that combining CM with another intervention improves the short-term or long-term effects of CM treatment.
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Affiliation(s)
| | - Thomas Steare
- Division of Psychiatry, University College London, London, UK
| | - Oliver Mason
- School of Psychology, University of Surrey, Guildford, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
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15
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Zambrano J, Celano CM, Chung WJ, Massey CN, Feig EH, Millstein RA, Healy BC, Wexler DJ, Park ER, Golden J, Huffman JC. Exploring the feasibility and impact of positive psychology-motivational interviewing interventions to promote positive affect and physical activity in type 2 diabetes: design and methods from the BEHOLD-8 and BEHOLD-16 clinical trials. Health Psychol Behav Med 2020; 8:398-422. [PMID: 33763296 PMCID: PMC7986224 DOI: 10.1080/21642850.2020.1815538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/23/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Physical activity among those with type 2 diabetes (T2D) is independently associated with superior medical outcomes, but existing behavioral interventions have not led to widespread increases in activity in this population. A remotely delivered intervention that targets well-being constructs associated with greater activity and assists in the creation of specific physical activity goals has the potential to improve activity and outcomes in T2D. OBJECTIVE To outline the rationale and methods of two studies designed to assess the impact and optimal duration of a combined positive psychology-motivational interviewing (PP-MI) intervention for inactive persons with T2D. METHODS We conducted trials studying 8-week (BEHOLD-8;) and 16-week (BEHOLD-16;) phone-delivered interventions, compared to attention-matched control conditions. In a two-step randomization design, participants were allocated randomly first to study (BEHOLD-8 or BEHOLD-16), then to study condition within study. The primary aims in both trials were feasibility (rates of session completion) and acceptability (participant session ratings), with additional aims examining intervention effects on accelerometer-measured physical activity, psychological measures, and health-related metrics (e.g. vital signs). Main analyses, currently being conducted, will utilize mixed effects models between study conditions, and secondary analyses will utilize the same models to compare the 8- and 16-week PP-MI interventions on feasibility and impact. RESULTS Enrollment and data collection have been completed for both trials (BEHOLD-8: N = 60; BEHOLD-16: N = 70), and data analysis is ongoing to assess feasibility and acceptability within study, as well as the relative feasibility and acceptability of the PP-MI interventions across the two studies. We will also explore impact on clinical outcomes between groups. CONCLUSIONS This design will address how intervention content (i.e. PP elements vs. no PP elements) and intervention duration (8 weeks vs. 16 weeks) affect feasibility, acceptability, and impact, allowing intervention optimization before a next-step larger clinical trial. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03150199; NCT03001999.
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Affiliation(s)
- Juliana Zambrano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher M. Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Wei-Jean Chung
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christina N. Massey
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Emily H. Feig
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rachel A. Millstein
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Brian C. Healy
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Deborah J. Wexler
- Harvard Medical School, Boston, MA, USA
- Department of Medicine (Endocrinology), Massachusetts General Hospital, Boston, MA, USA
| | - Elyse R. Park
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Julia Golden
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jeff C. Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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16
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Fletcher JB, Clark KA, Reback CJ. Depression and HIV Transmission Risk among Methamphetamine-Using Men who have Sex with Men. ADDICTION RESEARCH & THEORY 2020; 29:263-270. [PMID: 34248451 PMCID: PMC8262401 DOI: 10.1080/16066359.2020.1807960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Methamphetamine use is associated with disproportionate risk of HIV infection and increased risk of depression among sexual minority men. The purpose of the study was to estimate the association between clinical depression diagnoses and sexual risk-taking among cisgender men who have sex with men (MSM) who use methamphetamine. METHOD From March 2014 through January 2016, 286 MSM who use methamphetamine but were not seeking treatment for methamphetamine use disorder were enrolled to participate in a technology-based randomized controlled trial to reduce methamphetamine use and HIV sexual risk behaviors; participants were assessed for major depressive episodes (MDE) and persistent depressive disorder (PDD) at baseline. Multivariate clustered zero-inflated negative binomial regression analyses of condomless anal intercourse (n=282; 1,248 visits) estimated the association between this baseline diagnostic result and engagement in sexual risk-taking over time. RESULTS Participants predominantly identified as non-white (80%), averaged 42 years of age, and reported a HIV prevalence rate of 46%. Engagement in sexual risk-taking consistently demonstrated a positive curvilinear relationship with clinical depression severity, such that, for example, participants without clinical depression (59% of the sample; coef.=1.16) and those with MDE (36% of the sample; coef.=1.45) both demonstrated elevated rates of condomless anal sex with anonymous partners relative to participants with PDD (5% of the sample; analytical reference category; both coef. p<0.05). Data also demonstrated a trend (p = 0.053) of reduced sexual risk-taking with main partners among participants diagnosed with MDE (coef.=-0.94). CONCLUSIONS Methamphetamine use among participants in this study inverted the functional form of the relationship between depression and sexual risk among MSM observed in prior studies. Whereas low-grade depression has been associated with increased sexual risk-taking in prior samples of MSM, methamphetamine upends this relationship, such that the greatest engagement in sexual risk-taking occurred among those diagnosed with MDE at baseline. Additional research is warranted to clarify how methamphetamine influences sexual risk-taking among MSM with/without comorbid depression.
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Affiliation(s)
| | - Kirsty A. Clark
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Cathy J. Reback
- Friends Research Institute, Inc., Los Angeles, CA
- Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles
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17
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Pantalone DW, Nelson KM, Batchelder AW, Chiu C, Gunn HA, Horvath KJ. A Systematic Review and Meta-Analysis of Combination Behavioral Interventions Co-Targeting Psychosocial Syndemics and HIV-Related Health Behaviors for Sexual Minority Men. JOURNAL OF SEX RESEARCH 2020; 57:681-708. [PMID: 32077326 PMCID: PMC7457381 DOI: 10.1080/00224499.2020.1728514] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In the U.S., sexual minority men (SMM) are disproportionately affected by HIV. Interventions are needed to increase HIV prevention and treatment behaviors, especially among syndemically exposed SMM. In recent years, researchers have created and tested combination behavioral interventions co-targeting syndemics and HIV-related health behaviors. We evaluated that literature via systematic review and meta-analysis, identifying 44 trials targeting mental health symptoms, alcohol use, and drug use, as well as sexual risk behavior, antiretroviral adherence, and healthcare engagement. For the randomized controlled trials, we computed between-group, pre-post effect sizes and tested them via random-effects models. Results supported the efficacy of combined interventions with significant, small, positive effects for improving mental health and reducing substance use (d = .20, CIs: 0.12, .29), and reducing sexual risk behavior and improving antiretroviral adherence (d = .16, CIs: .03, .30). Stratification analyses indicate that longer (9+ sessions) and individual (vs. group) interventions resulted in stronger effects on syndemic but not health behavior outcomes. Intervention developers should attend to intervention intensity and format. More evidence is needed about the importance of additional factors, such as novel intervention targets and cultural tailoring, as well as broadening the focus to multi-level interventions to address both interpersonal and structural mechanisms of change.
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Affiliation(s)
- David W Pantalone
- Department of Psychology, University of Massachusetts Boston
- The Fenway Institute, Fenway Health
| | - Kimberly M Nelson
- Department of Community Health Sciences, Boston University School of Public Health
| | - Abigail W Batchelder
- The Fenway Institute, Fenway Health
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School
| | | | - Hamish A Gunn
- Department of Psychology, University of Massachusetts Boston
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18
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Batchelder AW, Moskowitz JT, Jain J, Cohn M, Earle MA, Carrico AW. A novel technology-enhanced internalized stigma and shame intervention for HIV-positive persons with substance use disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2020; 27:55-69. [PMID: 33790528 PMCID: PMC8009529 DOI: 10.1016/j.cbpra.2019.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Internalized stigma, shame, and other negative self-conscious emotions are inadequately addressed barriers to HIV-related self-care, particularly among people actively using substances. Innovative approaches are needed to optimize antiretroviral treatment (ART) adherence as well as engagement in HIV care among people living with HIV and substance use disorders. Based on qualitative feedback from providers and patients, we iteratively developed and conducted a proof-of-concept study of a relatively brief transdiagnostic emotion regulation intervention designed to improve ART adherence care by addressing behavioral and psychological barriers, including internalized stigma and shame, among people living with HIV and active substance use disorders. The final intervention included 5 individual sessions focused on metacognitive awareness of emotions and thoughts, cognitive reframing of dysfunctional thoughts about the self using concepts such as self-compassion, and identifying and reaching the participants' personalized HIV-self-care goal(s). All participants received daily texts querying current emotion and weekly texts querying ART adherence and substance use. To extend the effects of the intervention, we developed a personalized bi-directional text component through which participants received their personalized compassionate self-statements, informed by the intervention content, in response to their answers to emotion queries for 8 weeks after the 5 sessions. The texts modeled using compassionate self-statements as a form of cognitive reframing, consistent with cognitive restructuring of distorted core beliefs. We consented 10 participants living with HIV and problematic substance use in the proof-of-concept pilot. Of the 8 participants who completed all intervention sessions, participants replied to 70% of all text messages sent. All 8 reported strong acceptability of the intervention content. This emotion-focused, technology-enhanced intervention demonstrated proof-of-concept, in that this patient population would participate in this intervention. A larger randomized controlled pilot is needed to determine feasibility and acceptability among people living with HIV and substance use disorders, a hard-to-reach and underserved population.
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Affiliation(s)
- Abigail W Batchelder
- Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts
- University of California, San Francisco, San Francisco, California
| | | | - Jennifer Jain
- University of California, San Francisco, San Francisco, California
| | - Michael Cohn
- University of California, San Francisco, San Francisco, California
| | - Maya A Earle
- University of California, San Francisco, San Francisco, California
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19
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Kang D, Fairbairn CE, Ariss TA. A meta-analysis of the effect of substance use interventions on emotion outcomes. J Consult Clin Psychol 2019; 87:1106-1123. [PMID: 31724427 PMCID: PMC6859954 DOI: 10.1037/ccp0000450] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Emotional distress has been posited as a key underlying mechanism in the development and maintenance of substance use disorder (SUD), and patients seeking SUD treatment are often experiencing high levels of negative emotion and/or low levels of positive emotion. But the extent to which SUD interventions impact emotional outcomes among general SUD populations is yet unquantified. The current meta-analysis aims to fill this gap. METHOD A total of 11,754 records were screened for randomized, controlled trials examining the effect of behavioral SUD interventions on emotion outcomes. Our search yielded a total of 138 effect sizes calculated based on data from 5,146 individuals enrolled in 30 independent clinical trials. Random-effects meta-analysis was used to calculate pooled effect sizes, and metaregression analyses examined study-level moderators (e.g., intervention type). RESULTS Findings indicated a small but significant effect of SUD interventions on emotion outcomes, d = 0.157, 95% CI [0.052, 0.262] (k = 30). The effect size for negative emotion was nominally bigger, d = 0.162, 95% CI [0.056, 0.269] (k = 30), whereas the effect for positive emotion did not reach statistical significance, d = 0.062, 95% CI [-0.089, 0.213] (k = 7). Studies featuring SUD interventions designed to specifically target emotions (i.e., affect-regulation, mindfulness-based treatments) produced larger reductions in negative emotion compared with studies featuring interventions that did not contain specific emotion modules (e.g., contingency management). CONCLUSIONS Findings suggest that SUD interventions-especially mindfulness-based and affect-regulation treatments-indeed significantly reduce negative emotion, although relatively small effect sizes indicate potential room for improvement. Conclusions regarding positive emotion should be considered preliminary because of the limited numbers of samples assessing these outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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20
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Hoeppner SS, Carlon HA, Lambert AF, Hoeppner BB. Is the thought-action repertoire a viable intervention target in substance use populations? Gen Hosp Psychiatry 2019; 61:130-135. [PMID: 31753694 DOI: 10.1016/j.genhosppsych.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study examined if general population findings of positive correlations between happiness and breadth of thought-action repertoire (TAR) hold in substance use populations, and tests if the TAR is a modifiable intervention target. METHODS Using data from a randomized online survey on 468 adults in recovery from problematic substance use, we compared 5 happiness exercises to two control exercises on participants' post-exercise TAR, as measured by Frederickson's Modified Open-Ended Twenty Statements Test (MOETST) and coded specifically for action tendencies. RESULTS A negative binomial regression model indicated that momentary happiness reported before exercise completion was significantly and positively related to the breadth of action tendency repertoires (exp(b) = 1.05, exp(95% CI) [1.01, 1.09], p = 0.012). Two of five happiness exercises were associated with higher action tendency scores compared to the "Three Hard Things" control condition ("Savoring": exp(b) [95% CI]: 1.51 [1.10, 2.09], X2(df = 1) = 6.36, adj. p = 0.038; "Rose, Thorn, Bud": 1.50 [1.09, 2.06], X2(df = 1) = 6.19, adj. p = 0.038). None were significantly different from a neutral control. Effects were not significant for MOETST raw scores. CONCLUSIONS Results indicate that momentary happiness is associated with broadened action tendencies among individuals in recovery. Brief, self-administered happiness exercises can successfully broaden this aspect of the thought-action repertoire in this population.
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Affiliation(s)
- Susanne S Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Hannah A Carlon
- Department of Psychiatry, Massachusetts General Hospital, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA
| | - Adrian F Lambert
- Department of Psychiatry, Massachusetts General Hospital, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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21
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Painter JM, Mote J, Peckham AD, Lee EH, Campellone TR, Pearlstein JG, Morgan S, Kring AM, Johnson SL, Moskowitz JT. A positive emotion regulation intervention for bipolar I disorder: Treatment development and initial outcomes. Gen Hosp Psychiatry 2019; 61:96-103. [PMID: 31439286 PMCID: PMC6861691 DOI: 10.1016/j.genhosppsych.2019.07.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Dysfunction in positive affect is a defining symptom of bipolar I disorder (BD), both during and between mood episodes. We hypothesize that helping people with BD learn skills to create balance in their affective experiences by engaging in strategies that increase low activation positive emotion (LAP; e.g., relaxation) could help to improve well-being during periods of symptom remission. We discuss the development and preliminary outcomes of a positive emotion regulation (PER) group treatment for people with BD, designed as a supplement to pharmacological treatment. METHOD The Learning Affective Understanding for a Rich Emotional Life (LAUREL) intervention is a group-based intervention covering 10 empirically supported skills designed to increase LAP. Sixteen people with BD enrolled in the LAUREL intervention and twelve completed baseline and post-intervention assessments. RESULTS Participants who completed the study (n = 12) attended the majority of groups (87.96%) and reported practicing skills, on average, 16 times a week. We were unable to detect significant differences in mania symptoms following engagement in this PER intervention. Finally, participants reported increases in several areas associated with well-being post-intervention, including mindfulness, reappraisal, and self-compassion. CONCLUSION This study provides a theoretical framework and preliminary support for a PER intervention for BD.
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Affiliation(s)
- Janelle M Painter
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Jasmine Mote
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Andrew D Peckham
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Erica H Lee
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Timothy R Campellone
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Jennifer G Pearlstein
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Stefana Morgan
- University of California, San Francisco, Department of Psychiatry, United States of America.
| | - Ann M Kring
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Sheri L Johnson
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Judith T Moskowitz
- University of California, San Francisco, Department of Psychiatry, United States of America.
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Mimiaga MJ, Pantalone DW, Biello KB, White Hughto JM, Frank J, O’Cleirigh C, Reisner SL, Restar A, Mayer KH, Safren SA. An initial randomized controlled trial of behavioral activation for treatment of concurrent crystal methamphetamine dependence and sexual risk for HIV acquisition among men who have sex with men. AIDS Care 2019; 31:1083-1095. [PMID: 30887824 PMCID: PMC6625920 DOI: 10.1080/09540121.2019.1595518] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
Men who have sex with men (MSM) continue to be the largest risk group for HIV infections in the U.S., where crystal methamphetamine abuse heightens risk for HIV infection through greater engagement in condomless anal sex (CAS). Existing treatments lack attention to replacement activities or the role of depressed mood. Behavioral activation (BA) is an evidence-based approach for depression that involves identifying and participating in pleasurable, goal-directed activities. We hypothesize, for MSM abusing crystal methamphetamine, re-learning how to engage in non-drug-using aspects of life would facilitate their ability to benefit from sexual risk reduction (SRR) counseling. Project IMPACT was a pilot randomized-controlled-trial. Forty-six MSM at sexual risk of acquiring HIV who met DSM-IV criteria for crystal methamphetamine dependence were enrolled. Of those MSM, 41 were randomized: 21 were assigned to the intervention, two sessions of SRR, ten sessions of BA with SRR, and one session of relapse prevention; 20 participants were assigned to a control condition (two sessions of SRR). At the acute post-intervention visit, intervention participants reported an average of 3.2 CAS acts with men who were HIV-infected or whose status they did not know, compared to 4.5 among control participants (β = -0.36; 95% CI: -0.69, -0.02; p = 0.035). At the 6-month post-intervention visit, intervention participants reported 1.1 CAS acts with men who were HIV-infected or whose status they did not know compared to 2.8 among control participants (β = -0.95; 95% CI: -1.44, -0.46; p < 0.0001). Similarly, intervention participants reported 1.0 CAS acts under the influence of crystal methamphetamine with men who were HIV-infected or whose status they did not know compared to 2.5 among control participants (β = -0.87; 95% CI: -1.38, -0.36; p = 0.0005). Lastly, intervention participants reported more continuous days abstaining from crystal methamphetamine compared to control (50.1 vs. 39.0, respectively) (β = 0.25; 95% CI: 0.16, 0.34; p < 0.0001). Findings are encouraging, provide evidence of feasibility and acceptability, and demonstrate initial efficacy for reducing sexual risk for HIV and crystal methamphetamine use.
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Affiliation(s)
- Matthew J. Mimiaga
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - David W. Pantalone
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychology, University of Massachusetts, Boston, MA, USA
| | - Katie B. Biello
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jackie M. White Hughto
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Epidemiology, Yale University School of Public Health, New Haven, CT, USA
| | - John Frank
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Conall O’Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Behavioral Medicine Service, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Arjee Restar
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Steven A. Safren
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Moskowitz JT, Cheung EO, Snowberg KE, Verstaen A, Merrilees J, Salsman JM, Dowling GA. Randomized controlled trial of a facilitated online positive emotion regulation intervention for dementia caregivers. Health Psychol 2019; 38:391-402. [PMID: 31045422 PMCID: PMC6501812 DOI: 10.1037/hea0000680] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To test the effects of Life Enhancing Activities for Family Caregivers (LEAF), a 6-week positive emotion regulation intervention, on outcomes of positive emotion, depression, anxiety, and physical health as measured by the Patient-Reported Outcomes Measurement Information System® (PROMIS®). METHOD A randomized controlled trial (N = 170) comparing LEAF (N = 86) to an emotion reporting/waitlist condition (N = 84) in dementia caregivers. LEAF was individually delivered online by trained facilitators. Participants in the control condition completed daily online emotion reports and then crossed over into the intervention condition after 6 weeks. The study was registered with Clinicaltrials.gov (NCT01825681) and funded by R01NR014435. RESULTS Analyses of difference in change from baseline to 6 weeks demonstrated significantly greater decreases in PROMIS® depression (d = -.25; p = .02) and Quality of Life in Neurological Disorders (NeuroQOL) anxiety (d = -.33; p < .01), as well as improvements in PROMIS® physical health (d = .24; p = .02) in the intervention condition compared to the emotion reporting/waitlist control. The intervention also showed greater improvements in positive emotion (d = .58; p < .01) and positive aspects of caregiving (d = .36; p < .01). Increases in positive emotion significantly mediated the effect of LEAF on depression over time. CONCLUSIONS This randomized controlled trial of the online-facilitated positive emotion regulation intervention in dementia caregivers demonstrated small to medium effect sizes on caregiver well-being and shows promise for remotely delivered programs to improve psychological well-being in caregivers of people with dementia and other chronic illnesses. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Elaine O Cheung
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Karin E Snowberg
- Department of Physiological Nursing, University of California, San Francisco
| | - Alice Verstaen
- Department of Psychology, University of California, Berkeley
| | | | - John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine
| | - Glenna A Dowling
- Department of Physiological Nursing, University of California, San Francisco
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Hoeppner BB, Schick MR, Carlon H, Hoeppner SS. Do self-administered positive psychology exercises work in persons in recovery from problematic substance use? An online randomized survey. J Subst Abuse Treat 2019; 99:16-23. [DOI: 10.1016/j.jsat.2019.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 01/05/2019] [Accepted: 01/07/2019] [Indexed: 01/07/2023]
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Stauffer CS, Moschetto JM, McKernan SM, Hsiang E, Borsari B, Woolley JD. Oxytocin-enhanced motivational interviewing group therapy for methamphetamine use disorder in men who have sex with men: study protocol for a randomized controlled trial. Trials 2019; 20:145. [PMID: 30791944 PMCID: PMC6385415 DOI: 10.1186/s13063-019-3225-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 01/28/2019] [Indexed: 12/17/2022] Open
Abstract
Background The prevalence of methamphetamine use disorder (MUD) in the United States has risen dramatically in the past four decades and is concentrated in populations such as men who have sex with men (MSM). Despite the public health consequences of MUD, there are no FDA-approved psychopharmacological treatments. Psychosocial treatment alone has been shown to reduce methamphetamine use, but high attrition rates limit treatment efficacy. Promising findings from animal models of MUD using exogenous oxytocin, a social neuropeptide, have set the stage for translational work. Along with unique anti-addiction effects, oxytocin holds a primary role in enhancing social salience and modulating stress. In humans, oxytocin administration, combined with evidence-based psychosocial interventions, may act synergistically to improve addiction treatment outcomes and improve retention rates in current MUD treatment. Methods/design We are conducting a randomized, double-blind, placebo-controlled trial of oxytocin-enhanced motivational interviewing group therapy (MIGT). Oxytocin or placebo 40 IU is administered intranasally in conjunction with six, weekly MIGT sessions. We will recruit 50 MSM, initiating treatment for MUD from specialized community health programs in San Francisco, CA, USA. Individuals will be randomized (1:1) to receive six, weekly sessions of MIGT with or without oxytocin. Our primary outcome is session attendance. Other outcomes of interest include: measures of group cohesion, anxiety, psychophysiology, and stimulant craving and use. Discussion This will be the first study of oxytocin’s effects in humans with MUD. Findings from this novel protocol will attempt to bridge existing animal data with the need for innovative clinical treatments for MUD, inform the growing field of pharmacologically-enhanced psychotherapy, and help to elucidate mechanisms behind oxytocin’s potential anti-addiction effects. Trial registration ClinicalTrials.gov, ID: NCT02881177. Registered on 26 August 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3225-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christopher S Stauffer
- University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA, USA.
| | | | | | - Elaine Hsiang
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Brian Borsari
- University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Joshua D Woolley
- University of California, San Francisco, San Francisco VA Medical Center, San Francisco, CA, USA
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Knight R, Karamouzian M, Carson A, Edward J, Carrieri P, Shoveller J, Fairbairn N, Wood E, Fast D. Interventions to address substance use and sexual risk among gay, bisexual and other men who have sex with men who use methamphetamine: A systematic review. Drug Alcohol Depend 2019; 194:410-429. [PMID: 30502543 DOI: 10.1016/j.drugalcdep.2018.09.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Methamphetamine use is common among some populations of gay, bisexual and other men who have sex with men (gbMSM). This study reviewed the status of research on the efficacy of interventions that address harms among gbMSM who use methamphetamine. METHODS We searched MEDLINE, PsycINFO, CINAHL, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar to identify publications from inception to October 23, 2017, that assessed an intervention addressing methamphetamine use among gbMSM. RESULTS Of 1896 potential studies and 935 unique articles screened for inclusion, 28 eligible studies assessed 26 different interventions in the following categories: pharmacological (n = 5); psychosocial (n = 20); harm reduction (n = 1). Given that outcome variables were measured in highly variable ways, we were unable to conduct a meta-analysis of intervention effects. However, 22 studies reported a statistically significant effect on one or more methamphetamine-related outcomes. Among 21 studies that included measures of sexual health-related outcomes, 18 reported a significant effect on one or more sexual health-related outcomes, and 15 of those reported a concurrent effect on both drug- and sexual health-related outcomes. CONCLUSIONS This is the first review to provide compelling evidence that integrating interventions to address both drug- and sexual-related harms for gbMSM who use methamphetamine can be efficacious. Future research should focus on identifying differential effects of various intervention approaches by social positioning, as well as prioritize future evaluations of integrated harm reduction interventions (e.g., the distribution of harm reduction kits within sexual health care settings).
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Affiliation(s)
- Rod Knight
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Canada.
| | - Mohammad Karamouzian
- British Columbia Centre on Substance Use, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Anna Carson
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Joshua Edward
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Patrizia Carrieri
- Institute de la Santé et de la Recherché Médical (INSERM), Marseille, France
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Canada
| | - Danya Fast
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Canada
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Coupland H, Page K, Stein E, Carrico A, Evans J, Dixon T, Sokunny M, Phou M, Maher L. Structural interventions and social suffering: Responding to amphetamine-type stimulant use among female entertainment and sex workers in Cambodia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 64:70-78. [PMID: 30583088 DOI: 10.1016/j.drugpo.2018.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND In Cambodia, HIV infection remains high among female entertainment and sex workers (FESW) and the use of amphetamine-type stimulants (ATS) is an independent risk factor for unprotected sex and sexually transmitted infections among this group. For decades public health approaches to HIV prevention in low and middle income countries (LMIC) have attempted to target the macro-power relations that shape risk behaviour with structural interventions. Recent research has highlighted that interventions that combine ATS risk reduction, in the form of financial incentives for abstinence, with existing HIV prevention programmes, may also play an important role. However, whether this approach goes far enough as a response to structural drivers of risk requires further examination. METHODS Semi-structured in-depth interviews were conducted with 30 FESW (mean age 25 years) from five provinces in Cambodia, as part of formative research for the implementation of the Cambodia Integrated HIV and Drug Prevention (CIPI) trial. The aim was to explore the contexts and drivers of ATS use. Data were analysed using grounded theory. RESULTS In addition to increasing occupational functionality, ATS were used to control pervasive feelings of 'sadness' in relation to the lived experience of poverty, family and relationship problems. Feeling sad could be viewed as an expression of social suffering, in response to competing priorities and seemingly inescapable constraints imposed by a lack of options for income generation, gender inequalities and stigma. Participants expressed interest in microenterprise (ME) opportunities, particularly vocational training, that could create new work opportunities beyond sex work and ATS use. CONCLUSION In addition to reducing ATS use, HIV prevention interventions need to target sources of sadness and social suffering as drivers of risk among FESW in this context. The inclusion of ME opportunities in HIV prevention, to alleviate social suffering, warrants further investigation through qualitative and ethnographic research.
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Affiliation(s)
- Heidi Coupland
- The Kirby Institute for Infection and Immunity, Faculty of Medicine, Level 6, Wallace Wurth Building, UNSW, Sydney, Australia; Drug Health Services, Sydney Local Health District & Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Kimberly Page
- Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Centre, Albuquerque, NM, USA.
| | - Ellen Stein
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
| | - Adam Carrico
- Department of Public Health Sciences, University of Miami, Florida, USA.
| | - Jennifer Evans
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
| | - Thomas Dixon
- Faculty of Law, The University of Sydney, Sydney, Australia.
| | | | - Maly Phou
- FHI360 Cambodia, Phnom Penh, Cambodia.
| | - Lisa Maher
- The Kirby Institute for Infection and Immunity, Faculty of Medicine, Level 6, Wallace Wurth Building, UNSW, Sydney, Australia; The Burnet Institute, Melbourne, Australia.
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28
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Carrico AW, Gόmez W, Jain J, Shoptaw S, Discepola MV, Olem D, Lagana-Jackson J, Andrews R, Neilands TB, Dilworth SE, Evans JL, Woods WJ, Moskowitz JT. Randomized controlled trial of a positive affect intervention for methamphetamine users. Drug Alcohol Depend 2018; 192:8-15. [PMID: 30195243 PMCID: PMC6200638 DOI: 10.1016/j.drugalcdep.2018.07.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/09/2018] [Accepted: 07/14/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Contingency management (CM) is an evidence-based intervention providing rewards in exchange for biomarkers that confirm abstinence from stimulants such as methamphetamine. We tested the efficacy of a positive affect intervention designed to boost the effectiveness of CM with HIV-positive, methamphetamine-using sexual minority men. METHODS This attention-matched, randomized controlled trial of a positive affect intervention delivered during CM was registered on www.clinicaltrials.gov (NCT01926184). In total, 110 HIV-positive sexual minority men with biologically confirmed, recent methamphetamine use were enrolled. Five individual sessions of a positive affect intervention (n = 55) or an attention-control condition (n = 55) were delivered during three months of CM. Secondary outcomes examined over the 3-month intervention period included: 1) psychological processes relevant to affect regulation (i.e., positive affect, negative affect, and mindfulness); 2) methamphetamine craving; 3) self-reported stimulant use (past 3 months); and 4) cumulative number of urine samples that were non-reactive for stimulants (i.e., methamphetamine and cocaine) during CM. RESULTS Those randomized to the positive affect intervention reported significant increases in positive affect during individual sessions and increases in mindfulness over the 3-month intervention period. Intervention-related improvements in these psychological processes relevant to affect regulation were paralleled by concurrent decreases in methamphetamine craving and self-reported stimulant use over the 3-month intervention period. CONCLUSIONS Delivering a positive affect intervention may improve affect regulation as well as reduce methamphetamine craving and stimulant use during CM with HIV-positive, methamphetamine-using sexual minority men.
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Affiliation(s)
- Adam W Carrico
- Department of Public Health Sciences, University of Miami School of Medicine, 1120 NW 14th St., Office 1005, Miami, FL 33136 USA.
| | - Walter Gόmez
- Berkeley School of Social Welfare, University of California, 120 Haviland Hall, #7400, Berkeley, CA 94720 USA
| | - Jennifer Jain
- Department of Medicine, Division of Global Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 902093 USA
| | - Steven Shoptaw
- Departments of Family Medicine and Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, 10080 Wilshire Blvd., Los Angeles, CA 900024 USA
| | - Michael V Discepola
- San Francisco AIDS Foundation, 1035 Market Street, Suite 400, San Francisco, CA 94103 USA
| | - David Olem
- University of California, San Francisco School of Medicine, Box 0886, 550 16th Street, 3469, San Francisco, CA 94158 USA
| | - Justin Lagana-Jackson
- University of California, San Francisco School of Medicine, Box 0886, 550 16th Street, 3469, San Francisco, CA 94158 USA
| | - Rick Andrews
- San Francisco AIDS Foundation, 1035 Market Street, Suite 400, San Francisco, CA 94103 USA
| | - Torsten B Neilands
- University of California, San Francisco School of Medicine, Box 0886, 550 16th Street, 3469, San Francisco, CA 94158 USA
| | - Samantha E Dilworth
- University of California, San Francisco School of Medicine, Box 0886, 550 16th Street, 3469, San Francisco, CA 94158 USA
| | - Jennifer L Evans
- University of California, San Francisco School of Medicine, Box 0886, 550 16th Street, 3469, San Francisco, CA 94158 USA
| | - William J Woods
- University of California, San Francisco School of Medicine, Box 0886, 550 16th Street, 3469, San Francisco, CA 94158 USA
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 633 N. Saint Clair St., 19th Floor, Chicago, IL 60611 USA
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Hart TA, Noor SW, Vernon JRG, Kidwai A, Roberts K, Myers T, Calzavara L. Childhood Maltreatment, Bullying Victimization, and Psychological Distress Among Gay and Bisexual Men. JOURNAL OF SEX RESEARCH 2018; 55:604-616. [PMID: 29190141 DOI: 10.1080/00224499.2017.1401972] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sexual minority men report higher psychological distress than heterosexual men, including depression and anxiety. Research suggests that these health disparities may be due to the heightened stressors that gay, lesbian, and bisexual individuals experience. Some of these stressors occur early on in life, such as childhood abuse and bullying, and may include stressors that are topically related to sexual minority status, such as anti-gay bullying and teasing for gender nonconformity to masculine gender norms. We tested a structural equation model on the association between negative childhood experiences and adult psychological distress among 304 gay and bisexual men. The model fit the data well, and demonstrated an indirect effect of negative childhood experiences on adult psychological distress via dysfunctional thoughts toward oneself. The results integrate the childhood abuse and anti-gay bullying victimization literatures by showing that both forms of adverse childhood experiences are associated with adult psychological distress. The findings suggest the benefit of treatments to reduce negative, dysfunctional thoughts among gay and bisexual men who have experienced adverse childhood events.
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Affiliation(s)
- Trevor A Hart
- a Department of Psychology , Ryerson University and Dalla Lana School of Public Health, University of Toronto
| | - Syed W Noor
- b Department of Psychology, Ryerson University
| | | | | | | | - Ted Myers
- d Dalla Lana School of Public Health, University of Toronto
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Addington EL, Cheung EO, Moskowitz JT. Positive affect skills may improve pain management in people with HIV. J Health Psychol 2018; 25:1784-1795. [PMID: 29649914 DOI: 10.1177/1359105318769355] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Non-opioid pain management strategies are critically needed for people with HIV. We therefore conducted a secondary analysis of pain-related outcomes in a randomized controlled trial of a positive affect skills intervention for adults newly diagnosed with HIV (N = 159). Results suggest that, even if pain prevalence rises, positive affect skills may reduce pain interference and prevent increased use of opioid analgesics by people living with HIV. Future research should replicate and extend these findings by conducting trials that are specifically designed to target pain outcomes.
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Verstaen A, Moskowitz JT, Snowberg KE, Merrilees J, Dowling GA. Life Enhancing Activities for Family Caregivers of people with dementia: protocol for a randomized controlled trial of a positive affect skills intervention. OPEN ACCESS JOURNAL OF CLINICAL TRIALS 2018; 10:1-12. [PMID: 33981167 PMCID: PMC8112203 DOI: 10.2147/oajct.s150597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Given the increasing number of family caregivers of persons with dementia (PWD) and the associated burden and detriments to both physical and mental health, interventions that aim to improve such outcomes are important. Studies are increasingly demonstrating the unique importance of positive emotions in coping with stress, independent from the impact of negative emotions. However, none have examined the benefits of interventions that target positive emotions for caregivers of individuals with a chronic and debilitating disease such as dementia. This paper presents the design and methods for a randomized controlled trial (RCT) of a positive affect skills intervention for family caregivers of PWD. The RCT is of a skills-based intervention that seeks to increase the frequency and intensity of positive affect in order to improve outcomes such as well-being, coping, and physical and mental health. The skills are delivered by trained facilitators via five one-to-one Internet video sessions with family caregivers of persons diagnosed with dementia (eg, Alzheimer's disease, vascular dementia, unspecified). The control group is an emotion reporting/waitlist control. Follow-up assessments are conducted post-intervention and at 1, 3, and 6 months post-completion of the intervention. This study promises to be an important and needed step toward improving the lives of caregivers of PWD.
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Affiliation(s)
- Alice Verstaen
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Karin E Snowberg
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA
| | - Jennifer Merrilees
- UCSF Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Glenna A Dowling
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA
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Rudzinski K, McDonough P, Gartner R, Strike C. Is there room for resilience? A scoping review and critique of substance use literature and its utilization of the concept of resilience. Subst Abuse Treat Prev Policy 2017; 12:41. [PMID: 28915841 PMCID: PMC5603070 DOI: 10.1186/s13011-017-0125-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/28/2017] [Indexed: 12/15/2022] Open
Abstract
Research in the area of illicit substance use remains preoccupied with describing and analyzing the risks of people who use drugs (PWUD), however more recently there has been a drive to use a strengths-based or resilience approach as an alternative to investigating drug use. This leads us to ask: what can be known about PWUD from the point of view of resilience? The objective of this scoping review is to analyze how the concept of resilience is defined, operationalized, and applied in substance use research. Popular health, social science, psychology, and inter-disciplinary databases namely: SCOPUS, PUBMED, PsycINFO, and Sociological Abstracts were searched. Studies were selected if they used the concept of resilience and if substance use was a key variable under investigation. A total of 77 studies were identified which provided a definition of resilience, or attempted to operationalize (e.g., via scales) the concept of resilience in some manner. Data were charted and sorted using key terms and fundamental aspects of resilience. The majority of studies focus on youth and their resistance to, or engagement in, substance use. There is also a small but growing area of research that examines recovery from substance addiction as a form of resilience. Very few studies were found that thoroughly investigated resilience among PWUD. Consistently throughout the literature drug use is presented as a 'risk factor' jeopardizing one's ability to be resilient, or drug use is seen as a 'maladaptive coping strategy', purporting one's lack of resilience. Currently, substance use research provides a substantial amount of information about the internal strengths that can assist in resisting future drug use; however there is less information about the external resources that play a role, especially for adults. Though popular, outcome-based conceptualizations of resilience are often static, concealing the potential for developing resilience over time or as conditions change. Studies of resilience among PWUD predominantly concentrate on health-related behaviours, recovery-related factors or predefined harm reduction strategies. Indeed, overall, current conceptualizations of resilience are too narrow to recognize all the potential manifestations of resilience practices in the daily lives of individuals who actively use drugs.
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Affiliation(s)
- Katherine Rudzinski
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7 Canada
| | - Peggy McDonough
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7 Canada
| | - Rosemary Gartner
- Centre for Criminology & Sociolegal Studies, University of Toronto, 14 Queen’s Park Crescent West, Toronto, ON M5S 3K9 Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7 Canada
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Optimizing Contingency Management with Methamphetamine-Using Men who Have Sex with Men. COGNITIVE AND BEHAVIORAL PRACTICE 2017; 25:286-295. [PMID: 32461714 DOI: 10.1016/j.cbpra.2017.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Among men who have sex with men (MSM), methamphetamine use is associated with multiple, overlapping syndemic conditions including increased risk for HIV seroconversion and onward HIV transmission. Contingency management (CM) is an evidence-based, behavioral intervention implemented to curb methamphetamine use and optimize HIV/AIDS prevention among MSM in San Francisco since 2003. We conducted a program evaluation to document the evolution of this 12-week CM program to include delivery of brief, individual counseling incorporating motivational interviewing and behavioral skills. A drop-in group delivered concurrently with CM urine-screening visits also provides peer support as well as referrals for other social and medical services. From December 2011-October 2013, a total of 131 clients enrolled in the CM program and provided a median of 22 urine samples (Interquartile Range = 10-34) that were non-reactive for methamphetamine. Findings support the feasibility and acceptability of integrating individual and group counseling with community-based CM for methamphetamine-using MSM.
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Critical Review: When the Party is Over: A Systematic Review of Behavioral Interventions for Substance-Using Men Who Have Sex with Men. J Acquir Immune Defic Syndr 2017; 73:299-306. [PMID: 27258233 DOI: 10.1097/qai.0000000000001102] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Because problematic patterns of alcohol and other substance use are prevalent drivers of the HIV/AIDS epidemic, comprehensive interventions are needed for substance-using men who have sex with men (SUMSM). We conducted a systematic review of 12 randomized controlled trials (RCTs) of behavioral interventions for reducing condomless anal intercourse (CAI) in SUMSM. Three RCTs observed that cognitive behavioral or motivational interviewing interventions achieved a 24% to 40% decrease in CAI. Interventions also tended to demonstrate greater efficacy for reducing CAI and substance use among those who had lower severity of substance use disorder symptoms. Although behavioral interventions for SUMSM are one potentially important component of biobehavioral HIV/AIDS prevention, further research is needed to examine whether integrative approaches that cultivate resilience and target co-occurring syndemic conditions demonstrate greater efficacy. Multilevel intervention approaches are also needed to optimize the effectiveness of pre-exposure prophylaxis and HIV treatment as prevention with SUMSM.
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Moskowitz JT, Carrico AW, Duncan LG, Cohn MA, Cheung EO, Batchelder A, Martinez L, Segawa E, Acree M, Folkman S. Randomized controlled trial of a positive affect intervention for people newly diagnosed with HIV. J Consult Clin Psychol 2017; 85:409-423. [PMID: 28333512 DOI: 10.1037/ccp0000188] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We conducted a randomized controlled trial to determine whether IRISS (Intervention for those Recently Informed of their Seropositive Status), a positive affect skills intervention, improved positive emotion, psychological health, physical health, and health behaviors in people newly diagnosed with HIV. METHOD One-hundred and fifty-nine participants who had received an HIV diagnosis in the past 3 months were randomized to a 5-session, in-person, individually delivered positive affect skills intervention or an attention-matched control condition. RESULTS For the primary outcome of past-day positive affect, the group difference in change from baseline over time did not reach statistical significance (p = .12, d = .30). Planned secondary analyses within assessment point showed that the intervention led to higher levels of past-day positive affect at 5, 10, and 15 months postdiagnosis compared with an attention control. For antidepressant use, the between group difference in change from baseline was statistically significant (p = .006, d = -.78 baseline to 15 months) and the difference in change over time for intrusive and avoidant thoughts related to HIV was also statistically significant (p = .048, d = .29). Contrary to findings for most health behavior interventions in which effects wane over the follow up period, effect sizes in IRISS seemed to increase over time for most outcomes. CONCLUSIONS This comparatively brief positive affect skills intervention achieved modest improvements in psychological health, and may have the potential to support adjustment to a new HIV diagnosis. (PsycINFO Database Record
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Affiliation(s)
- Judith T Moskowitz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami
| | - Larissa G Duncan
- Human Development and Family Studies, University of Wisconsin-Madison
| | - Michael A Cohn
- Osher Center for Integrative Medicine, University of California San Francisco
| | - Elaine O Cheung
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Abigail Batchelder
- Osher Center for Integrative Medicine, University of California San Francisco
| | - Lizet Martinez
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Eisuke Segawa
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Michael Acree
- Department of Medicine, University of California San Francisco
| | - Susan Folkman
- Department of Medicine, University of California San Francisco
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Shoptaw S, Landovitz RJ, Reback CJ. Contingent Vs. Non-Contingent Rewards: Time-Based Intervention Response Patterns Among Stimulant-Using Men Who Have Sex With Men. J Subst Abuse Treat 2017; 72:19-24. [PMID: 27938777 PMCID: PMC5922444 DOI: 10.1016/j.jsat.2016.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 09/08/2016] [Accepted: 09/09/2016] [Indexed: 11/17/2022]
Abstract
Stimulant use rates are higher among men who have sex with men (MSM) than the general population. Contingency management (CM) may be an effective intervention for reducing stimulant use in this population. To specify both the mechanism and temporal effects of contingent reward on behavior change, logistic growth trajectory modeling (LGTM) was used to contrast a non-contingent matched rewards condition (i.e., non-contingent yoked controls; NCYC) to a voucher-based CM intervention (maximum=$430) to reduce stimulant use among MSM. Stimulant-using MSM were randomized to either a CM intervention (n=70) or a NCYC condition (n=70). Results from a LGTM (analytical sample n=119; nCM=61; nNCYC=58) indicated four distinct intervention response patterns: responders (i.e., predicted >90% stimulant metabolite-free urinalyses; 64.7% of sample); worsening intervention response (14.3%); non-responders (12.6%); and, single-positive (8.4%); all estimated trajectory coefficients were significant at p<0.03 (2-tailed). Participants receiving CM were significantly overrepresented in the responder (64%) and single-positive (80%) categories (χ2(3)=29.04; p<0.001); all non-responders and 76.5% of the worsening intervention response category were in the NCYC condition. Results demonstrate the utility of trajectory modeling and further support the contingent application of reward as the operative mechanism associated with patterns of stimulant abstinence with CM applied to a sample of stimulant-using MSM outside the context of formal drug treatment.
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Affiliation(s)
- Steven Shoptaw
- Department of Family Medicine, University of California, 10880 Wilshire Blvd Suite 1800, Los Angeles, CA 90024
| | - Raphael J Landovitz
- Center for Clinical AIDS Research & Education, University of California, 11075 Santa Monica Blvd, Suite 100, Los Angeles, CA 90025
| | - Cathy J Reback
- Friends Research Institute, Inc., 1419 La Brea Ave, Los Angeles, CA 90028; Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, 11075 Santa Monica Blvd Suite 200, Los Angeles, CA 90025.
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Carrico AW, Jain J, Discepola MV, Olem D, Andrews R, Woods WJ, Neilands TB, Shoptaw S, Gómez W, Dilworth SE, Moskowitz JT. A community-engaged randomized controlled trial of an integrative intervention with HIV-positive, methamphetamine-using men who have sex with men. BMC Public Health 2016; 16:673. [PMID: 27476110 PMCID: PMC4967339 DOI: 10.1186/s12889-016-3325-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/20/2016] [Indexed: 01/08/2023] Open
Abstract
Background Contingency management (CM) is an evidence-based intervention providing tangible rewards as positive reinforcement for abstinence from stimulants such as methamphetamine. Integrative approaches targeting affect regulation could boost the effectiveness of CM in community-based settings and optimize HIV/AIDS prevention efforts. Methods/Design This randomized controlled trial with HIV-positive, methamphetamine-using men who have sex with men (MSM) is examining the efficacy of a 5-session, individually delivered positive affect regulation intervention – Affect Regulation Treatment to Enhance Methamphetamine Intervention Success (ARTEMIS). ARTEMIS is designed to sensitize individuals to non-drug-related sources of reward as well as assist with managing depression and other symptoms of stimulant withdrawal during CM. HIV-positive, methamphetamine-using MSM who are enrolled in a community-based, 12-week CM program are randomized to receive ARTEMIS or an attention-matched control condition. Follow-up assessments are conducted at 3, 6, 12, and 15 months after enrollment in CM. Four peripheral venous blood samples are collected over the 15-month follow-up with specimen banking for planned biomarker sub-studies. The primary outcome is mean HIV viral load. Secondary outcomes include: sustained HIV viral suppression, T-helper cell count, psychological adjustment, stimulant use, and potentially amplified transmission risk behavior. Discussion Implementation of this randomized controlled trial highlights the importance of delineating boundaries between research activities and community-based service provision. It also provides insights into best practices for integrating the distinct agendas of academic and community partners in clinical research. This trial is currently enrolling and data collection is anticipated to be completed in September of 2018. Trial registration This trial was registered on clinicaltrials.gov (NCT01926184) on August 16, 2013.
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Affiliation(s)
- Adam W Carrico
- Department of Public Health Sciences, University of Miami School of Medicine, 1120 NW 14th St., Office 1005, Miami, FL, 33136, USA.
| | - Jennifer Jain
- University of California, San Francisco School of Nursing, San Francisco, USA
| | | | - David Olem
- University of California, San Francisco School of Nursing, San Francisco, USA
| | - Rick Andrews
- San Francisco AIDS Foundation, San Francisco, USA
| | - William J Woods
- University of California, San Francisco School of Nursing, San Francisco, USA.,University of California, San Francisco Center for AIDS Prevention Studies, San Francisco, USA
| | - Torsten B Neilands
- University of California, San Francisco Center for AIDS Prevention Studies, San Francisco, USA
| | - Steven Shoptaw
- Departments of Family Medicine and Psychiatry, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Walter Gómez
- University of California, San Francisco School of Nursing, San Francisco, USA
| | - Samantha E Dilworth
- University of California, San Francisco Center for AIDS Prevention Studies, San Francisco, USA
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University, San Francisco, USA
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Carrico AW, Nil E, Sophal C, Stein E, Sokunny M, Yuthea N, Evans JL, Ngak S, Maher L, Page K. Behavioral interventions for Cambodian female entertainment and sex workers who use amphetamine-type stimulants. J Behav Med 2016; 39:502-10. [PMID: 26782667 PMCID: PMC4854788 DOI: 10.1007/s10865-016-9713-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 01/07/2016] [Indexed: 11/28/2022]
Abstract
Conditional cash transfer (CCT) and cognitive-behavioral treatments are evidence-based approaches to reduce stimulant use and sexual risk taking. We describe the adaptation and implementation of sequential behavioral interventions for Cambodian female entertainment and sex workers (FESW) who use amphetamine-type stimulants (ATS): (1) a 12-week CCT intervention; and (2) a 4-week cognitive-behavioral aftercare (AC) group. An ongoing cluster randomized stepped wedge trial in 10 Cambodian provinces is enrolling FESW with confirmed recent ATS use to examine the effectiveness of CCT + AC. In the first six provinces, 138 of the 183 eligible FESW (75 %) enrolled in CCT and completed a median of 25 (interquartile range 9-32) of the 36 urine screening visits. Of the 84 participants who were eligible for AC, 79 completed at least one session (94 %) and 57 completed three or more sessions (68 %). Culturally tailored behavioral interventions to reduce ATS use and optimize HIV prevention are feasible in resource-limited settings.
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Affiliation(s)
- Adam W Carrico
- University of California, San Francisco School of Nursing, 2 Koret Way, N511 M, San Francisco, CA, 94143, USA.
- University of California, San Francisco Center for AIDS Prevention Studies, San Francisco, CA, USA.
| | - Ean Nil
- Family Health International 360 (FHI 360), Phnom Penh, Cambodia
| | - Chhit Sophal
- Department of Mental Health and Substance Abuse, Ministry of Health, Phnom Penh, Cambodia
| | - Ellen Stein
- University of California, San Francisco Global Health Sciences, San Francisco, CA, USA
| | - Muth Sokunny
- Family Health International 360 (FHI 360), Phnom Penh, Cambodia
| | - Neak Yuthea
- National Authority for Combatting Drugs, Phnom Penh, Cambodia
| | - Jennifer L Evans
- Department of Mental Health and Substance Abuse, Ministry of Health, Phnom Penh, Cambodia
| | - Song Ngak
- Family Health International 360 (FHI 360), Phnom Penh, Cambodia
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, UNSW Australia, Sydney, Australia
| | - Kimberly Page
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Krentzman AR, Mannella KA, Hassett AL, Barnett NP, Cranford JA, Brower KJ, Higgins MM, Meyer PS. Feasibility, Acceptability, and Impact of a Web-based Gratitude Exercise among Individuals in Outpatient Treatment for Alcohol Use Disorder. THE JOURNAL OF POSITIVE PSYCHOLOGY 2015; 10:477-488. [PMID: 27076837 PMCID: PMC4827271 DOI: 10.1080/17439760.2015.1015158] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 01/30/2015] [Indexed: 01/17/2023]
Abstract
This mixed-methods pilot study examined the feasibility, acceptability, and impact of a web-based gratitude exercise (the 'Three Good Things' exercise (TGT)) among 23 adults in outpatient treatment for alcohol use disorder (AUD). Participants were randomized to TGT or a placebo condition. The intervention was feasible with high rates of completion. Participants found TGT acceptable and welcomed the structure of daily emails; however, they found it difficult at times and discontinued TGT when the study ended. Participants associated TGT with gratitude, although there were no observed changes in grateful disposition over time. TGT had a significant effect on decreasing negative affect and increasing unactivated (e.g., feeling calm, at ease) positive affect, although there were no differences between groups at the 8 week follow up. Qualitative results converged on quantitative findings that TGT was convenient, feasible, and acceptable, and additionally suggested that TGT was beneficial for engendering positive cognitions and reinforcing recovery.
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Affiliation(s)
- Amy R. Krentzman
- University of Minnesota School of Social Work, 1404 Gortner Avenue, St. Paul, MN, USA, 55108
- University of Michigan Addiction Research Center, 4250 Plymouth Rd, Ann Arbor, MI, USA, 48109
| | - Kristin A. Mannella
- University of Michigan Addiction Research Center, 4250 Plymouth Rd, Ann Arbor, MI, USA, 48109
| | - Afton L. Hassett
- University of Michigan, Department of Anesthesiology, Chronic Pain and Fatigue Research Center, 24 Frank Lloyd Wright Drive, Ann Arbor Charter Township, MI, USA, 48105
| | - Nancy P. Barnett
- Center for Alcohol and Addiction Studies and Department of Behavioral and Social Sciences, Brown University, 121 South Main Street, Providence, RI, USA, 02903
| | - James A. Cranford
- University of Michigan Addiction Research Center, 4250 Plymouth Rd, Ann Arbor, MI, USA, 48109
| | - Kirk J. Brower
- University of Michigan Addiction Research Center, 4250 Plymouth Rd, Ann Arbor, MI, USA, 48109
| | - Margaret M. Higgins
- University of Minnesota School of Social Work, 1404 Gortner Avenue, St. Paul, MN, USA, 55108
| | - Piper S. Meyer
- Minnesota Center for Mental Health, University of Minnesota School of Social Work, 1404 Gortner Avenue, St. Paul, MN, USA, 55108
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