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Blow FC, Walton M, Ilgen M, Ignacio RV, Walters H, Massey L, Barry KL, McCormick R, Coughlin LN. Peer- and web-based interventions for risky drinking among US National Guard members: Mission Strong randomized controlled trial. Addiction 2023; 118:1246-1257. [PMID: 37041669 DOI: 10.1111/add.16172] [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: 03/21/2022] [Accepted: 02/07/2023] [Indexed: 04/13/2023]
Abstract
AIMS To test separatel the efficacy of a web-based and a peer-based brief intervention (BI), compared with an expanded usual care control (EUC) group, among military reserve component members using alcohoI in a hazardous and harmful manner. DESIGN In the randomized controlled trial, participants were assigned to: [1] web-based BI with web-based boosters (BI + web), [2] web-based BI with peer-based boosters (BI + peer) or [3] enhanced usual care (EUC). SETTING Michigan, USA. PARTICIPANTS A total of 739 Michigan Army National Guard members who reported recent hazardous alcohol use; 84% were male, the mean age was 28 years. INTERVENTION The BI consisted of an interactive program guided by a personally selected avatar. Boosters were delivered either on the web or personally by a trained veteran peer. A pamphlet, given to all participants, included information on hazardous alcohol use and military-specific community resources and served as the EUC condition. MEASUREMENTS The primary outcome measure was binge drinking episodes in the past 30 days, measured at 12 months after the BI. FINDINGS All randomized participants were included in the outcome analyses. In adjusted analyses, BI + peer [beta = -0.43, 95% confidence interval (CI) = -0.56 to -0.31, P < 0.001] and BI + web (beta = -0.34, 95% CI = -0.46 to -0.23, P < 0.001) reduced binge drinking compared with EUC. CONCLUSION This satudy was a web-based brief intervention for hazardous alcohol use, with either web- or peer-based boosters, reduced binge alcohol use among Army National Guard members.
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Affiliation(s)
- Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
| | - Maureen Walton
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Mark Ilgen
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
- Department of Veteran Affairs Healthcare, System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA
| | - Rosalinda V Ignacio
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Heather Walters
- Department of Veteran Affairs Healthcare, System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA
| | - Lynn Massey
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Kristen L Barry
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
| | - Richard McCormick
- Center for Healthcare Research and Policy, MetroHealth/Case Western Reserve University, Cleveland, OH, USA
| | - Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
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O'Grady MA, Tross S, Cohall A, Wilson P, Cohall R, Campos S, Lee S, Dolezal C, Elkington KS. Readiness to change among justice-involved young adults in an alternative sentencing program who screened positive for alcohol or drug risk. Addict Behav Rep 2022; 16:100456. [PMID: 36147454 PMCID: PMC9485898 DOI: 10.1016/j.abrep.2022.100456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/05/2022] [Accepted: 08/28/2022] [Indexed: 11/26/2022] Open
Abstract
Justice-involved young adults are in need of tailored substance use interventions. Readiness to change is a key component of substance use behavioral change. Many justice-involved young adults were ready to change their substance use. Personal reasons to quit using drugs are a potential intervention target.
Introduction Readiness to change is a key component of substance use behavioral change; yet little is known about readiness to change among justice-involved young adults. This study 1) describes readiness to change alcohol and drug use and 2) examines predictors of readiness to change alcohol and drug use among justice-involved young adults. Method Justice-involved young adults (18–24 years; n = 137) who were positive on a validated alcohol and/or drug screening tool completed an interview assessing substance use, readiness to change, and reasons to quit. A multivariable linear regression model examined whether reasons to change and substance use severity, and interactions between these, predicted readiness. Results More than half of participants were contemplating or had decided to quit/cut down substance use. Personal reasons to quit were positively related to readiness to change; interpersonal reasons were negatively associated. Conclusions This study contributes information needed to design motivational interventions for substance use among justice-involved young adults. Personal reasons to quit using drugs are a potential intervention target.
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Affiliation(s)
- Megan A O'Grady
- Department of Public Health Sciences, University of Connecticut, School of Medicine, USA
| | - Susan Tross
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, USA
| | - Alwyn Cohall
- Mailman School of Public Health, Columbia University, USA.,New York Presbyterian Hospital, USA
| | - Patrick Wilson
- Mailman School of Public Health, Columbia University, USA
| | - Renee Cohall
- Mailman School of Public Health, Columbia University, USA.,New York Presbyterian Hospital, USA
| | - Stephanie Campos
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, USA
| | - Sin Lee
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, USA
| | - Curtis Dolezal
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, USA.,HIV Center of Clinical and Behavioral Studies, USA
| | - Katherine S Elkington
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, USA.,HIV Center of Clinical and Behavioral Studies, USA
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Carter PM, Cranford JA, Buu A, Walton MA, Zimmerman MA, Goldstick J, Ngo Q, Cunningham RM. Daily patterns of substance use and violence among a high-risk urban emerging adult sample: Results from the Flint Youth Injury Study. Addict Behav 2020; 101:106127. [PMID: 31645000 PMCID: PMC6999833 DOI: 10.1016/j.addbeh.2019.106127] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/04/2019] [Accepted: 09/09/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Interpersonal violence is a significant public health problem, with substance use a key risk factor. Intensive longitudinal methods (ILMs) provide data on daily patterns/relationships between substance use and violence, informing prevention. Prior daily research has not focused on these relationships among urban minority samples. METHODS Within an RCT comparing ILM assessment/schedule methods, 162-participants completed daily IVR (n = 81) or SMS (n = 81) assessments measuring 19 substance use and violence (partner/non-partner) behaviors daily for 90-days. GLMMs characterized between- and within-person predictors of daily violence. RESULTS Participants [48.7%-female; age = 24.4; 62.3%-African-American; 66.7%-public assistance] completed an average of 46.5 daily reports [SD = 26.7]. Across 90-days, alcohol was characterized by episodic weekend use (average = 10 days-of-use, 34.4% drinking-days involved binge-drinking), while marijuana use was continuous (average = 27 days-of-use; 1.7 times/day), with no weekend differences. Among 118-violent conflicts, 52.5% occurred on weekends; 57.6% were with non-partners/peers; 61.0% involved perpetration/57.6% victimization; and 52.5% involved severe violence. For violence conflicts, 27.1% were preceded by alcohol/22.9% preceded by drug use. Between-person predictors of daily violence included retaliatory attitudes (AOR = 3.2) and anxiety (AOR = 1.1). Within-person predictors included weekends (AOR = 1.6), binge drinking (AOR = 1.9), non-medical prescription opioid use (AOR = 3.5) and illicit drug use (AOR = 8.1). CONCLUSION Among a high-risk urban minority sample, we found that higher baseline retaliatory attitudes and anxiety, as well as same-day binge drinking, non-medical prescription opioid use, and illicit drug use were associated with daily violence, likely reflecting both pharmacological and socio-contextual factors. Addressing substance use and retaliatory violence with tailored prevention efforts may aid in decreasing negative interpersonal violence outcomes.
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Affiliation(s)
- Patrick M. Carter
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America,Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America,Corresponding author at: Department of Emergency Medicine, University of Michigan, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan 48109, United States of America. (P.M. Carter)
| | - James A. Cranford
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America,University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Rd., Ann Arbor, MI 48109, United States of America,Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, MI 48503, United States of America
| | - Anne Buu
- Department of Health Behavior & Biological Sciences, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI 48109-5482, United States of America
| | - Maureen A. Walton
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Rd., Ann Arbor, MI 48109, United States of America
| | - Marc A. Zimmerman
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America,Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, United States of America
| | - Jason Goldstick
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America
| | - Quyen Ngo
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America
| | - Rebecca M. Cunningham
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, MI 48109, United States of America,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, United States of America,Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America,Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, MI 48503, United States of America
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Goldstick JE, Walton MA, Bohnert ASB, Heinze JE, Cunningham RM. Predictors of alcohol use transitions among drug-using youth presenting to an urban emergency department. PLoS One 2019; 14:e0227140. [PMID: 31891632 PMCID: PMC6938309 DOI: 10.1371/journal.pone.0227140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/12/2019] [Indexed: 11/19/2022] Open
Abstract
Background Precipitants of alcohol use transitions can differ from generalized risk factors. We extend prior research by predicting transitions in alcohol use disorder (AUD) during adolescence and emerging adulthood. Methods From 12/2009-9/2011, research assistants recruited 599 drug-using youth age 14–24 from Level-1 Emergency Department in Flint, Michigan. Youth were assessed at baseline and four biannual follow-ups, including a MINI Neuropsychiatric interview to diagnose AUD (abuse/dependence). We modeled AUD transitions using continuous time Markov Chains with transition probabilities modulated by validated measures of demographics, anxiety/depression symptoms, cannabis use, peer drinking, parental drinking, and violence exposure. Separate models were fit for underage (<21) and those of legal drinking age. Results We observed 2,024 pairs of consecutive AUD states, including 264 transitions (119 No-AUD→AUD; 145 AUD→No-AUD); 194 (32.4%) individuals were diagnosed with AUD at ≥1 assessment. Among age 14–20, peer drinking increased AUD onset (No-AUD→AUD transition) rates (Hazard ratio—HR = 1.70; 95%CI: [1.13,2.54]), parental drinking lowered AUD remission (AUD→No-AUD transition) rates (HR = 0.53; 95%CI: [0.29,0.97]), and cannabis use severity both hastened AUD onset (HR = 1.18; 95%CI: [1.06,1.32]) and slowed AUD remission (HR = 0.85; 95%CI: [0.76,0.95]). Among age 21–24, anxiety/depression symptoms both increased AUD onset rates (HR = 1.35; 95%CI: [1.13,1.60]) and decreased AUD remission rates (HR = 0.74; 95%CI: [0.63,0.88]). Friend drinking hastened AUD onset (HR = 1.18, 95%CI: [1.05,1.33]), and slowed AUD remission (HR = 0.84; 95%CI: [0.75,0.95]). Community violence exposure slowed AUD remission (HR = 0.69, 95%CI: [0.48,0.99]). In both age groups, males had >2x the AUD onset rate of females, but there were no sex differences in AUD remission rates. Limitations, most notably that this study occurred at a single site, are discussed. Conclusions Social influences broadly predicted AUD transitions in both age groups. Transitions among younger youth were predicted by cannabis use, while those among older youth were predicted more by internalizing symptoms and stress exposure (e.g., community violence). Our results suggest age-specific AUD etiology, and contrasts between prevention and treatment strategies.
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Affiliation(s)
- Jason E. Goldstick
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- * E-mail:
| | - Maureen A. Walton
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, United States of America
| | - Amy S. B. Bohnert
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, United States of America
| | - Justin E. Heinze
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Hurley Medical Center, Department of Emergency Medicine, Flint, MI, United States of America
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Goldstick JE, Carter PM, Heinze JE, Walton MA, Zimmerman M, Cunningham RM. Predictors of transitions in firearm assault behavior among drug-using youth presenting to an urban emergency department. J Behav Med 2019; 42:635-645. [PMID: 31367929 PMCID: PMC6999855 DOI: 10.1007/s10865-019-00021-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 02/14/2019] [Indexed: 12/14/2022]
Abstract
Risk and protective factors for firearm assault (FA) have been established, but little is known about factor preceding transitions in FA behavior. We modeled covariate effects on individuals' transitions in FA behavior (Yes/No) using inhomogeneous, continuous-time, Markov Chains. 3287 assessments were made across five initial biannual follow-ups, and two additional biannual follow-ups (an average of 2.2 years later) from a follow-on study; 2687 pairs of transitions were observed (2414 No-FA → No-FA; 89 No-FA → FA; 121 FA → No-FA; 63 FA → FA). Non-firearm peer violence (HR = 2.31, 95% CI [1.28,4.21]), firearm victimization (HR = 2.57, 95% CI [1.31,5.04]), and marijuana ASSIST sum (HR = 1.27, 95% CI [1.05,1.54]) all preceded transitions into FA, but not transitions out of FA. Delinquent peer associations both hastened transitions into FA (HR = 1.19, 95% CI [1.00,1.40]) and slowed transitions out of FA (HR = 0.84, 95% CI:[0.72,1.00]), with analogous findings regarding attitudes favoring retaliation. Efforts to prevent FA initiation should focus on those currently reporting firearm violence victimization, and on factors indicating an escalating delinquency trajectory (e.g. non-firearm violence, substance use), while programs focusing on peer influences and social norms may be effective at preventing FA regardless of current FA status.
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Affiliation(s)
- Jason E Goldstick
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, USA.
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA.
| | - Patrick M Carter
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, USA
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Justin E Heinze
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, USA
| | - Maureen A Walton
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
- University of Michigan Addiction Center, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Marc Zimmerman
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, USA
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, USA
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, USA
- Department of Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI, 48503, USA
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Davis AK, Arterberry BJ, Schneeberger D, Bonar EE, Bauermeister JA, Young SD, Cunningham RM, Walton MA. Evaluation of the Dualistic Model of Passion for Alcohol Consumption among Emerging Adults Engaged in Risky Drinking. ADDICTION RESEARCH & THEORY 2019; 28:21-28. [PMID: 33041737 PMCID: PMC7539847 DOI: 10.1080/16066359.2019.1571192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 06/11/2023]
Abstract
Understanding factors influencing risky drinking among emerging adults could enhance interventions to reduce adverse outcomes. As a motivational construct, the dualistic model of passion (i.e., obsessive passion: drinking is compelling and conflicts with other life activities/values; harmonious passion: drinking is an important, but not overwhelming, part of life) offers a novel explanation for persistent alcohol use. Yet, the dualistic model of passion has not yet been evaluated in this at-risk population. Therefore, we examined whether the variables proposed by the dualistic model of passion were associated with sex, binge-drinking, and alcohol-related consequences among young risky drinkers. We analyzed cross-sectional baseline data collected as part of an ongoing randomized controlled trial of emerging adults (n=327; M age=22.6, SD=1.1, range 21-24; 61% female; 76% White non-Hispanic) engaged in risky drinking (AUDIT-C score ≥ 4 females, ≥ 5 males) recruited nationally via social media advertisements. A path analysis revealed significant positive direct effects between obsessive passion and binge drinking and alcohol-related consequences, and significant negative direct effects between male sex and harmonious passion and binge drinking. There was also a positive direct effect between binge drinking and alcohol-related consequences. Male sex and obsessive passion were both indirectly related to alcohol-related consequences via binge drinking. Type of passion and male sex differentiates risky drinkers who binge drink and who experienced alcohol-related consequences. Future research should examine whether targeting obsessive passion reduces binge drinking and negative outcomes.
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Affiliation(s)
- Alan K Davis
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD
- Department of Psychology, University of Iowa, 901 Stange Road, Ames, IA
| | | | - Diane Schneeberger
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI
| | - Erin E Bonar
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI
| | - José A Bauermeister
- University of Pennsylvania, Department of Family and Community Health, School of Nursing, 418 Curie Blvd., Philadelphia, PA
| | - Sean D Young
- University of California Institute for Prediction Technology, Department of Family Medicine, School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024
| | - Rebecca M Cunningham
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI
| | - Maureen A Walton
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI
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Burrow-Sánchez JJ, Corrales C, Totsky J. Predictive validity of the SOCRATES in a clinical sample of Latina/o adolescents. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2018; 33:171-177. [PMID: 30589309 DOI: 10.1037/adb0000432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) is a widely used measure of a client's motivation to change their substance use behavior. It is comprised of 3 subscales, recognition, ambivalence, and taking steps, which correspond to one's awareness, uncertainty, and behavior relative to their substance use. Typically the measure has been examined in adult treatment samples, whereas less attention has been paid to its use with adolescents, especially racial/ethnic minority youth. The purpose of the current study was to test the predictive validity of the SOCRATES subscales on posttreatment substance use levels with a clinical sample of Latina/o adolescents (N = 105) in substance use treatment. Hypotheses were tested via generalized linear models for each of the 3 subscales. Results indicated that higher scores on the Taking Steps subscale of the SOCRATES at pretreatment were predictive of lower days of substance use after treatment for adolescents in the sample. Implications of the results and suggestions for future research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Carter PM, Dora-Laskey AD, Goldstick JE, Heinze JE, Walton MA, Zimmerman MA, Roche JS, Cunningham RM. Arrests Among High-Risk Youth Following Emergency Department Treatment for an Assault Injury. Am J Prev Med 2018; 55:812-821. [PMID: 30344036 PMCID: PMC6246796 DOI: 10.1016/j.amepre.2018.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/20/2018] [Accepted: 07/03/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Violence is a leading cause of morbidity and mortality for youth, with more than 600,000 emergency department visits annually for assault-related injuries. Risk for criminal justice involvement among this population is poorly understood. The objective of this study was to characterize arrests among high-risk, assault-injured, drug-using youth following emergency department treatment. METHODS Youth (aged 18-24 years) with past 6-month drug use who were seeking emergency department treatment for either an assault or for non-violence reasons were enrolled (December 2009-September 2011) in a 2-year longitudinal study. Arrests in the 24 months following the emergency department visit were analyzed in 2016-2017 using survival analysis of objective Law Enforcement Information Network data. Hazard ratios quantifying the association between risk factors for arrest were estimated using Cox regression. RESULTS In the longitudinal cohort, 511 youth seeking emergency department care (assault injury group n=299, comparison group n=212) were aged ≥18 years and were included for analysis. Youth in the assault injury group cohort had a 47% higher risk of arrest than the comparison group (38.1% vs 25.9%, RR=1.47, p<0.05). In unadjusted analyses, male sex, assault injury, binge drinking, drug use disorder, and community violence exposure were all associated with increased risk of arrest during the follow-up period. Cox regression identified that male sex (hazard ratio=2.57), drug use disorder diagnosis (hazard ratio=1.42), assault injury at baseline (hazard ratio=1.63), and community violence exposure (hazard ratio=1.35) increased risk for arrest. CONCLUSIONS Drug-using assault-injured youth have high rates of arrest. Emergency department and community interventions addressing substance use and violence involvement may aid in decreasing negative violence and criminal justice outcomes among high-risk youth. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01152970.
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Affiliation(s)
- Patrick M Carter
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan.
| | - Aaron D Dora-Laskey
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Hurley Medical Center, Department of Emergency Medicine, Flint, Michigan
| | - Jason E Goldstick
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Justin E Heinze
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Maureen A Walton
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Marc A Zimmerman
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jessica S Roche
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Rebecca M Cunningham
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; Hurley Medical Center, Department of Emergency Medicine, Flint, Michigan; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
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Roche JS, Clery MJ, Carter PM, Dora-Laskey A, Walton MA, Ngo QM, Cunningham RM. Tracking Assault-injured, Drug-using Youth in Longitudinal Research: Follow-up Methods. Acad Emerg Med 2018; 25:1204-1215. [PMID: 30381864 PMCID: PMC6494734 DOI: 10.1111/acem.13495] [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: 02/20/2018] [Revised: 05/14/2018] [Accepted: 05/31/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Violence is one of the leading causes of death among youth ages 14 to 24. Hospital- and emergency department (ED)-based violence prevention programs are increasingly becoming a critical part of public health efforts; however, evaluation of prevention efforts is needed to create evidence-based best practices. Retention of study participants is key to evaluations, although little literature exists regarding optimizing follow-up methods for violently injured youth. This study aims to describe the methods for retention in youth violence studies and the characteristics of hard-to-reach participants. METHODS The Flint Youth Injury (FYI) Study is a prospective study following a cohort of assault-injured, drug-using youth recruited in an urban ED, and a comparison population of drug-using youth seeking medical or non-violence-related injury care. Validated survey instruments were administered at baseline and four follow-up time points (6, 12, 18, and 24 months). Follow-up contacts used a variety of strategies and all attempts were coded by type and level of success. Regression analysis was used to predict contact difficulty and follow-up interview completion at 24 months. RESULTS A total of 599 patients (ages 14-24) were recruited from the ED (mean ± SD age = 20.1 ± 2.4 years, 41.2% female, 58.2% African American), with follow-up rates at 6, 12, 18, and 24 months of 85.3%, 83.7% 84.2%, and 85.3%, respectively. Participant contact efforts ranged from two to 53 times per follow-up time frame to complete a follow-up appointment, and more than 20% of appointments were completed off site at community locations (e.g., participants' homes, jail/prison). Participants who were younger (p < 0.05) and female (p < 0.01) were more likely to complete their 24-month follow-up interview. Participants who sought care in the ED for assault injury (p < 0.05) and had a substance use disorder (p < 0.01) at baseline required fewer contact attempts to complete their 24-month follow-up, while participants reporting a fight within the immediate 3 months before their 24-month follow-up (p < 0.01) required more intensive contact efforts. CONCLUSIONS The FYI study demonstrated that achieving high follow-up rates for a difficult-to-track, violently-injured ED population is feasible through the use of established contact strategies and a variety of interview locations. Results have implications for follow-up strategies planned as part of other violence prevention studies.
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Affiliation(s)
- Jessica S. Roche
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109
| | - Michael J. Clery
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105
| | - Patrick M. Carter
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109
| | - Aaron Dora-Laskey
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, Michigan, 48503
| | - Maureen A. Walton
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109,University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Rd, Ann Arbor, Michigan 48109
| | - Quyen M. Ngo
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Institute for Research on Women and Gender, University of Michigan, 1136 Lane Hall, 204 S. State Street, Ann Arbor, MI 48109-1290
| | - Rebecca M. Cunningham
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC 10-G080, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48105,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, 48109,Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, Michigan, 48503,Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, Michigan, 48109
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10
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Davis AK, Arterberry BJ, Bonar EE, Chermack ST, Blow FC, Cunningham RM, Walton MA. Predictors of positive drinking outcomes among youth receiving an alcohol brief intervention in the emergency department. Drug Alcohol Depend 2018; 188:102-108. [PMID: 29758380 PMCID: PMC6261455 DOI: 10.1016/j.drugalcdep.2018.03.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/30/2018] [Accepted: 03/31/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Reducing underage drinking is a public health priority given increased risk for injury and other consequences. Emergency department (ED) visits offer a potential "teachable moment" to initiate interventions among youth engaged in risky drinking. Given mixed findings for alcohol brief interventions (BIs), this paper examined baseline markers of BI response in order to inform future interventions. METHOD We conducted secondary analyses of data from a randomized controlled trial of an alcohol BI delivered to youth in an ED. Among 475 participants (Mage = 18.6, SD = 1.4; 48.7% Female, 78.6% White/Caucasian) receiving a computer or therapist BI, we examined baseline characteristics (i.e., demographic, substance use, mood, risk/protective factors, and readiness to change) that predicted positive intervention response (i.e., BI responder) at 3-month follow-up using AUDIT-C scores (cut offs: <3 for ages 14-17; <4 for ages 18-20). RESULTS Mediated logistic regression analysis (controlling for demographics) showed that greater readiness to change at baseline was positively related to BI response and baseline alcohol consumption was negatively related to BI response. Having a mentor was indirectly related to BI response via baseline alcohol consumption. Baseline readiness to change and alcohol consumption mediated the association between positive peer influences and BI response, whereas readiness to change mediated the relation between depression and BI response. CONCLUSION Findings suggest that BI response is influenced by protective social factors, such as positive peers and mentors, and depression, via baseline alcohol severity indicators (i.e., readiness to change, consumption), thus providing clues for enhancing the content and dose of early interventions.
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Affiliation(s)
- Alan K Davis
- Behavioral Pharmacology Research Unit, Department of Psychiatry, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Brooke J Arterberry
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Erin E Bonar
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA; University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI, 48109, USA
| | - Stephen T Chermack
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Frederic C Blow
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA; HSR and D Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Floor 2, Ann Arbor, MI, 48109, USA
| | - Rebecca M Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI, 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI, 48109-2800, USA
| | - Maureen A Walton
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA; HSR and D Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Floor 2, Ann Arbor, MI, 48109, USA
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11
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Walton MA, Ngo QM, Chermack ST, Blow FC, Ehrlich PF, Bonar EE, Cunningham RM. Understanding Mechanisms of Change for Brief Alcohol Interventions Among Youth: Examination of Within-Session Interactions. J Stud Alcohol Drugs 2018; 78:725-734. [PMID: 28930060 DOI: 10.15288/jsad.2017.78.725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Alcohol brief interventions (BIs) for youth are efficacious, but effect sizes found have been modest. This article presents secondary data analyses from a randomized controlled trial of motivational interviewing-based (MI) alcohol BIs among youth in an emergency department, examining within-session predictors of alcohol outcomes at 3 months among those receiving BIs. METHOD Risky drinkers (ages 14-20) received either a computer BI (n = 277) or therapist BI (n = 278). Within-session measures were obtained via computer metrics (therapist and computer BIs) and coding of audiotapes (therapist BI only). Parallel structural equation models examined direct and indirect effects of BI components on 3-month alcohol consumption and consequences, with posttest precursors of behavior change (e.g., importance, readiness, and intentions) as potential mediators. Components examined included reasons to avoid or reduce drinking, strengths, strategies for change, benefits of change, and leisure activities (computer BI only), and MI global ratings and MI-adherent behaviors (therapist BI only). RESULTS For both BIs, greater number of strategies directly predicted greater posttest scores, with posttest scores mediating the relationship between strategies and alcohol consumption at 3 months. Greater number of strengths directly predicted fewer alcohol-related consequences at 3 months for both BIs; however, strengths also indirectly predicted greater consumption, mediated by posttest scores. Greater number of reasons to avoid or reduce drinking directly predicted greater alcohol consumption for the therapist BI only. CONCLUSIONS These findings suggest ways to optimize the content and efficacy of alcohol BIs. Reviews of strategies such as refusal skills, protective behavioral strategies, and coping with negative affect may be particularly salient for reducing alcohol misuse.
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Affiliation(s)
- Maureen A Walton
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Injury Center, University of Michigan, Ann Arbor, Michigan
| | - Quyen M Ngo
- Injury Center, University of Michigan, Ann Arbor, Michigan.,Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.,Institute on Women and Gender Studies, University of Michigan, Ann Arbor, Michigan
| | - Stephen T Chermack
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Mental Health Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.,Mental Health Innovation, Services, and Outcomes Section, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Peter F Ehrlich
- Injury Center, University of Michigan, Ann Arbor, Michigan.,Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, Michigan
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Rebecca M Cunningham
- Injury Center, University of Michigan, Ann Arbor, Michigan.,Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.,School of Public Health, University of Michigan, Ann Arbor, Michigan
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12
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Blow FC, Walton MA, Bohnert ASB, Ignacio RV, Chermack S, Cunningham RM, Booth BM, Ilgen M, Barry KL. A randomized controlled trial of brief interventions to reduce drug use among adults in a low-income urban emergency department: the HealthiER You study. Addiction 2017; 112:1395-1405. [PMID: 28127808 DOI: 10.1111/add.13773] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/20/2016] [Accepted: 01/26/2017] [Indexed: 11/27/2022]
Abstract
AIMS To examine efficacy of drug brief interventions (BIs) among adults presenting to a low-income urban emergency department (ED). DESIGN Randomized controlled trial on drug use outcomes at 3, 6 and 12 months. Participants were assigned to (1) computer-delivered BI (Computer BI), (2) therapist-delivered, computer-guided BI (Therapist BI) or (3) enhanced usual care (EUC-ED) for drug-using adults. Participants were re-randomized after the 3-month assessment to either adapted motivational enhancement therapy (AMET) booster or enhanced usual care booster (EUC-B). SETTING Patients recruited from low-income urban emergency departments (ED) in Flint, Michigan, USA. PARTICIPANTS A total of 780 ED patients reporting recent drug use, 44% males, mean age = 31 years. INTERVENTIONS Computer BI consisted of an interactive program guided by a virtual health counselor. Therapist BI included computer guidance. The EUC-ED conditions included review of community health and HIV prevention resources. The BIs and boosters were based on motivational interviewing, focusing on reduction of drug use and HIV risk behaviors. MEASUREMENTS Primary outcome was past 90 days using drugs at 6 and 12 months and secondary outcomes were weighted drug-days and days of marijuana use. FINDINGS Percentage changes in mean days used any drug from baseline to 12 months were: Computer BI + EUC-B: -10.9%, P = 0.0844; Therapist BI + EUC-B: -26.7%, P = 0.0041, for EUC-ED + EUC-B: -20.9, P = 0.0011. In adjusted analyses, there was no significant interaction between ED intervention and booster AMET for primary and secondary outcomes. Compared with EUC-ED, Therapist BI reduced number of days using any drug [95% confidence interval (CI) = -0.41, -0.07, P = 0.0422] and weighted drug-days (95% CI = -0.41, -0.08, P = 0.0283). Both Therapist and Computer BI had significantly fewer number of days using marijuana compared to EUC-ED (Therapist BI: 95% CI = -0.42, -0.06, P = 0.0104, Computer BI: 95% CI = -0.34, -0.01, P = 0.0406). Booster effects were not significant. CONCLUSIONS An emergency department-based motivational brief intervention, delivered by a therapist and guided by computer, appears to reduce drug use among adults seeking emergency department care compared with enhanced usual care.
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Affiliation(s)
- Frederic C Blow
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Injury Center, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Maureen A Walton
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Injury Center, University of Michigan, Ann Arbor, MI, USA
| | - Amy S B Bohnert
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Injury Center, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Rosalinda V Ignacio
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Stephen Chermack
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, Ann Arbor, MI, USA
| | - Rebecca M Cunningham
- Injury Center, University of Michigan, Ann Arbor, MI, USA.,Department of Emergency Medicine, University of Michigan, Ann Arbor, MI and Hurley Hospital, Flint, MI, USA.,School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Center for Mental Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Mark Ilgen
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Kristen L Barry
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA
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13
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Voloshyna DM, Bonar EE, Cunningham RM, Ilgen MA, Blow FC, Walton MA. Blackouts among male and female youth seeking emergency department care. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 44:129-139. [PMID: 28032801 PMCID: PMC6186526 DOI: 10.1080/00952990.2016.1265975] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/22/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Alcohol-related blackouts are a common consequence of heavy drinking, and these blackouts pose risk for injury and other adverse health outcomes. OBJECTIVE To examine the prevalence and correlates of blackouts among underage drinkers. METHODS Youth (ages 14-20) presenting to a suburban Emergency Department (ED) completed screening surveys. Among those reporting past-year alcohol consumption, we examined past 3-month blackouts in relation to: background characteristics (e.g., demographics, fraternity/sorority involvement), substance use, sexual risk behaviors and incapacitated sexual assault (unaware/unable to consent due to alcohol/drugs), forced sexual assault, positive depression screening, and reason for ED visit (injury vs. medical). RESULTS In total, 2,300 past-year drinkers participated: 58% female, 75% Caucasian, and mean age = 18.4. Regarding past 3-month blackouts, 72.7% reported none, 19.3% reported monthly or less, and 8% reported monthly or more. Multivariate cumulative logit regression indicated that blackout frequency was positively associated with: college involvement in Greek life, alcohol use severity, prescription drug misuse, marijuana, screening positive for depression, incapacitated sexual assault, and a gender by alcohol use severity interaction. CONCLUSION With one-quarter of this clinical sample reporting recent blackouts, as well as the association between blackout frequency and health risk behaviors and other outcomes, findings underscore the need for programs focusing on substance use, depression, and preventing sexual assault. Interventions should also address poly-substance use and drinking motives. Although findings highlight how college students in Greek life may be at high risk for blackouts, many participants not in college also reported blackouts, suggesting that interventions in other settings are also needed.
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Affiliation(s)
- Diana M. Voloshyna
- Department of Psychiatry, Narcology, Neurology and Medical Psychology, V.N. Karazin Kharkiv National University, Svobody Sq. 6 r. №694а, Kharkiv, Ukraine, 61077
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
| | - Erin E. Bonar
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
| | - Rebecca M. Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, Michigan, 48109
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPHI, Ann Arbor, MI 48109
| | - Mark A. Ilgen
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105
| | - Frederic C. Blow
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105
| | - Maureen A. Walton
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, Michigan, 48109
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14
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Goldstick JE, Stoddard SA, Carter PM, Zimmerman MA, Walton MA, Cunningham RM. Characteristic substance misuse profiles among youth entering an urban emergency department: neighborhood correlates and behavioral comorbidities. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:671-681. [PMID: 27315355 PMCID: PMC5123591 DOI: 10.1080/00952990.2016.1174707] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Little is known about characteristic profiles of substance use - and their individual- and neighborhood-level correlates - among high-risk youth. OBJECTIVES To identify characteristic substance misuse profiles among youth entering an urban emergency department (ED) and explore how those profiles relate to individual- and community-level factors. METHODS Individual-level measures came from screening surveys administered to youth aged 14-24 at an ED in Flint, Michigan (n = 878); alcohol outlet and crime data came from public sources. Binary misuse indicators were generated by using previously established cut-points on scores of alcohol and drug use severity. Latent class analysis (LCA) identified classes of substance use; univariate tests and multinomial models identified correlates of class membership. RESULTS Excluding non-misusers (51.5%), LCA identified three classes: marijuana-only (27.9%), alcohol/marijuana (16.1%), and multiple substances (polysubstance) (4.6%). Moving from non-misusers to polysubstance misusers, there was an increasing trend in rates of: unprotected sex, motor vehicle crash, serious violence, weapon aggression, and victimization (all p < .001). Controlling for individual-level variables, polysubstance misusers lived near more on-premises alcohol outlets than non-misusers (RRR = 1.42, p = .01) and marijuana-only misusers (RRR = 1.31, p = .03). Alcohol/marijuana misusers were more likely to live near high violent crime density areas than non-misusers (RRR = 1.83, p = .01), and were also more likely than marijuana-only misusers to live in areas of high drug crime density (RRR = 1.98, p = .03). No other relationships were significant. CONCLUSION Substance-misusing youth seeking ED care have higher risk for other problem behaviors and neighborhood-level features display potential for distinguishing between use classes. Additional research to elucidate at-risk sub-populations/locales has potential to improve interventions for substance misuse by incorporating geographic information.
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Affiliation(s)
- Jason E. Goldstick
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA,Injury Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Sarah A. Stoddard
- Injury Research Center, University of Michigan, Ann Arbor, MI, USA,University of Michigan Youth Violence Prevention Center, Ann Arbor, MI, USA,School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Patrick M. Carter
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA,Injury Research Center, University of Michigan, Ann Arbor, MI, USA,University of Michigan Youth Violence Prevention Center, Ann Arbor, MI, USA,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Marc A. Zimmerman
- Injury Research Center, University of Michigan, Ann Arbor, MI, USA,University of Michigan Youth Violence Prevention Center, Ann Arbor, MI, USA,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Maureen A. Walton
- Injury Research Center, University of Michigan, Ann Arbor, MI, USA,University of Michigan Youth Violence Prevention Center, Ann Arbor, MI, USA,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA,Injury Research Center, University of Michigan, Ann Arbor, MI, USA,University of Michigan Youth Violence Prevention Center, Ann Arbor, MI, USA
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15
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Ehrlich PF, Roche JS, Cunningham RM, Chermack ST, Carter PM, Booth BM, Blow F, Barry K, Walton MA. Underage drinking, brief interventions, and trauma patients: Are they really special? J Trauma Acute Care Surg 2016; 81:149-55. [PMID: 27120317 PMCID: PMC4915985 DOI: 10.1097/ta.0000000000001093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While the relationship between underage drinking and injury has been well established, few studies have examined whether presenting for an acute injury moderates the efficacy of a brief intervention (BI) on alcohol misuse. METHODS Patients (aged 14-20 years) in the emergency department screening positive for risky drinking (Alcohol Use Disorders Identification Test-Consumption score) completed a baseline assessment, were randomized to conditions (a standalone computer-delivered BI [n = 277], a therapist-delivered BI [n = 278], or a control condition [n = 281]), and completed a 3-month follow-up. This secondary analysis of Project U-Connect examined regression models (controlling for baseline values) to examine the main effects of injury and the interaction effects of injury by BI condition on alcohol consumption and consequences. RESULTS Among 836 youth enrolled in the randomized controlled trial (mean age, 18.6 years; 51.6% were male; 79.4% were white), 303 (36.2%) had a primary complaint of intentional or unintentional injury. At baseline, injured patients were more likely to be male (p < 0.001) and have higher alcohol consumption (p < 0.01), but were less likely to misuse prescription drugs (p = 0.02) than those presenting for medical reasons. Regression models (controlling for baseline values) demonstrated that injury presentation predicted greater alcohol consumption prior to a BI. The computer BI was more effective at reducing alcohol consequences among those presenting with injury than those presenting for other reasons. Injury did not affect the efficacy of the computer BI on alcohol consumption, and injury did not affect the efficacy of the therapist BI on alcohol outcomes. CONCLUSIONS A therapist or computer BI reduced alcohol consumption and consequences among risky drinkers regardless of reason for emergency department presentation highlighting the opportunity to reach a broad array of youth. Although the therapist BI was not moderated by injury presentation, the computer BI was particularly effective at reducing alcohol consequences among those presenting with injury at 3-month follow-up. LEVEL OF EVIDENCE Therapeutic/care management study, level III.
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Affiliation(s)
- Peter F Ehrlich
- From the Injury Center (P.F.E., J.S.R., R.M.C., P.M.C., B.M.B., F.B., M.A.W.), University of Michigan Medical School, Ann Arbor, Michigan; Department of Emergency Medicine (J.S.R., R.M.C., P.M.C.), University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Health Behavior and Health Education (R.M.C.), University of Michigan School of Public Health, Ann Arbor, Michigan; Michigan Youth Violence Prevention Center (J.S.R., R.M.C., P.M.C., M.A.W.), University of Michigan School of Public Health, Ann Arbor, Michigan; Addiction Center, Department of Psychiatry (S.T.C., F.B., K.B., M.A.W.), University of Michigan School of Medicine, Ann Arbor, Michigan; Center for Clinical Management Research, Department of Veterans Affairs (S.T.C., F.B., M.A.W.), Ann Arbor VA Healthcare System, Ann Arbor, Michigan; Department of Psychiatry College of Medicine, University of Arkansas for Medical Sciences, (B.M.B.), Little Rock, Arkansas; Section of Pediatric Surgery (P.F.E.), CS Mott Children's Hospital, Department of Surgery, University of Michigan School of Medicine, Ann Arbor Michigan; and Institute for Healthcare Policy and Innovation (R.M.C., F.B.), University of Michigan, Ann Arbor, Michigan
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16
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Readiness to change is a predictor of reduced substance use involvement: findings from a randomized controlled trial of patients attending South African emergency departments. BMC Psychiatry 2016; 16:35. [PMID: 26897614 PMCID: PMC4761196 DOI: 10.1186/s12888-016-0742-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study examines whether readiness to change is a predictor of substance use outcomes and explores factors associated with RTC substance use among patients at South African emergency departments. METHODS We use data from participants enrolled into a randomized controlled trial of a brief substance use intervention conducted in three emergency departments in Cape Town, South Africa. RESULTS In adjusted analyses, the SOCRATES "Recognition" (B = 11.6; 95 % CI = 6.2-17.0) and "Taking Steps" score (B = -9.5; 95 % CI = -15.5- -3.5) as well as alcohol problems (B = 4.4; 95 % CI = 0.9-7.9) predicted change in substance use involvement at 3 month follow-up. Severity of depression (B = 0.2; 95 % CI = 0.1-0.3), methamphetamine use (B = 3.4; 95 % CI = 0.5- 6.3) and substance-related injury (B = 1.9; 95 % CI = 0.6-3.2) were associated with greater recognition of the need for change. Depression (B = 0.1; 95 % CI = 0.04 -0.1) and methamphetamine use (B = 2.3; 95 % CI = 0.1 -4.2) were also associated with more ambivalence about whether to change. Participants who presented with an injury that was preceded by substance use were less likely to be taking steps to reduce their substance use compared to individuals who did not (B = -1.7; 95 % CI = -5.0- -0.6). CONCLUSION Findings suggest that brief interventions for this population should include a strong focus on building readiness to change substance use through motivational enhancement strategies. Findings also suggest that providing additional support to individuals with depression may enhance intervention outcomes. TRIAL REGISTRATION This trial registered with the Pan African Clinical Trial Registry (PACTR201308000591418) on 14/07/2013.
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Patton R, Lau CH(J, Blow FC, Ranney M, Cunningham R, Walton M. Prevalence and Correlates of Depression and Drinking Behaviors Among Adolescents and Emerging Adults in a Suburban Emergency Department. Subst Use Misuse 2016; 51:34-40. [PMID: 26669633 PMCID: PMC5137633 DOI: 10.3109/10826084.2015.1074692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Both alcohol use and depression are concerning health issues among youth. The Emergency Department (ED) is a critical location to access youth with depressive symptoms and alcohol misuse. OBJECTIVES To inform future interventions in the ED, this study examined the relationship between drinking behaviors and depressive symptoms among youth seeking ED care. METHODS Youth ages 14-20 were recruited from a level-1 trauma ED located in the Midwest as part of a larger ongoing study. Participants completed an electronic screening survey, which included assessment of alcohol use, depressive symptoms, and demographic variables. Two logistic regression models were conducted to assess the relationship between depressive symptoms with alcohol consumption and specific alcohol-related consequences. RESULTS Among 3,659 participants, bivariate analysis indicated that individuals screening positive for depression were more likely to be female, nonwhite, receive public assistance, and report higher scores on both alcohol consumption and alcohol-related consequences. Regression analyses indicated alcohol consumption, inability to stop drinking once starting, and feelings of guilt or remorse after drinking were significantly positively related to screening positive for depression. CONCLUSIONS/IMPORTANCE Current findings support use of the ED as a location for identifying youth who are experiencing co-morbid alcohol use and depressive symptoms. Future research should focus on the effectiveness of brief intervention in the ED that focuses on the co-occurrence of alcohol misuse and depressive symptoms among youth.
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Affiliation(s)
- Rikki Patton
- University of Akron, Counseling, 114 Chima, 27 S. Forge St, Akron, 44325 United States
| | | | - Frederic C Blow
- University of Michigan, Department of Psychiatry, 4250 Plymouth Rd., Ann Arbor, 48109 United States
| | - Megan Ranney
- Brown University, Emergency Medicine, Providence, United States
| | | | - Maureen Walton
- University of Michigan, Department of Psychiatry, 4250 Plymouth Rd., Ann Arbor, 48109 United States
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Cunningham RM, Chermack ST, Ehrlich PF, Carter PM, Booth BM, Blow FC, Barry KL, Walton MA. Alcohol Interventions Among Underage Drinkers in the ED: A Randomized Controlled Trial. Pediatrics 2015; 136:e783-93. [PMID: 26347440 PMCID: PMC4586730 DOI: 10.1542/peds.2015-1260] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study examined the efficacy of emergency department (ED)-based brief interventions (BIs), delivered by a computer or therapist, with and without a post-ED session, on alcohol consumption and consequences over 12 months. METHODS Patients (ages 14-20 years) screening positive for risky drinking were randomized to: BI (n = 277), therapist BI (n = 278), or control (n = 281). After the 3-month follow-up, participants were randomized to receive a post-ED BI session or control. Incorporating motivational interviewing, the BIs addressed alcohol consumption and consequences, including driving under the influence (DUI), and alcohol-related injury, as well as other concomitant drug use. The computer BI was an offline, Facebook-styled program. RESULTS Among 4389 patients screened, 1054 patients reported risky drinking and 836 were enrolled in the randomized controlled trial. Regression models examined the main effects of the intervention conditions (versus control) and the interaction effects (ED condition × post-ED condition) on primary outcomes. The therapist and computer BIs significantly reduced consumption at 3 months, consequences at 3 and 12 months, and prescription drug use at 12 months; the computer BI reduced the frequency of DUI at 12 months; and the therapist BI reduced the frequency of alcohol-related injury at 12 months. The post-ED session reduced alcohol consequences at 6 months, benefiting those who had not received a BI in the ED. CONCLUSIONS A single-session BI, delivered by a computer or therapist in the ED, shows promise for underage drinkers. Findings for the fully automated stand-alone computer BI are particularly appealing given the ease of future implementation.
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Affiliation(s)
- Rebecca M. Cunningham
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan;,Department of Health Behavior and Health Education and,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan;,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Stephen T. Chermack
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan;,Center for Clinical Management Research, Ann Arbor, Veterans Affairs Healthcare System, Department of Veterans Affairs, Ann Arbor, Michigan
| | - Peter F. Ehrlich
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Department of Surgery, Section of Pediatric Surgery, CS Mott Children’s Hospital, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Patrick M. Carter
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan;,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Brenda M. Booth
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and
| | - Frederic C. Blow
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan;,University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan;,Center for Clinical Management Research, Ann Arbor, Veterans Affairs Healthcare System, Department of Veterans Affairs, Ann Arbor, Michigan
| | - Kristen L. Barry
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Maureen A. Walton
- University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan;,Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan;,University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
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Burch AE, Rash CJ, Petry NM. Sex effects in cocaine-using methadone patients randomized to contingency management interventions. Exp Clin Psychopharmacol 2015; 23:284-90. [PMID: 26237326 PMCID: PMC4525716 DOI: 10.1037/pha0000034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Contingency management (CM) is an effective treatment for promoting cocaine abstinence in patients receiving methadone maintenance. However, few studies have examined the effect of sex on treatment outcomes in this population. This study evaluated the impact of sex on longest duration of abstinence (LDA) and percent negative urine samples in 323 cocaine-using methadone patients from 4 randomized clinical trials comparing CM to standard methadone care. Overall, women had better treatment outcomes compared with men, demonstrated by an increase in both LDA and percentages of negative samples. Patients receiving CM also had significantly higher LDA and percentages of negative samples compared to patients receiving standard care, but sex by treatment condition effects were not significant. These data suggest that cocaine-using methadone patients who are women have better substance use outcomes than men in interventions that regularly monitor cocaine use, and CM is equally efficacious regardless of sex.
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Affiliation(s)
| | | | - Nancy M. Petry
- University of Connecticut School of Medicine,Corresponding author: Nancy M. Petry, Ph.D., Professor of Medicine, University of Connecticut School of Medicine (MC 3944), 263 Farmington Ave., Farmington, CT 06030-3944, , Phone: 860-679-2593, Fax: 860-679-1312; Ashley E. Burch, Ph.D., University of Connecticut School of Medicine (MC 3944), 263 Farmington Ave., Farmington, CT 06030-3944, , Phone: 860-679-4665; Carla J. Rash, Ph.D., Assistant Professor, University of Connecticut School of Medicine (MC 3944), 263 Farmington Ave., Farmington, CT 06030-3944, , Phone: 860-679-4689, Fax: 860-679-1312
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Carter PM, Walton MA, Roehler DR, Goldstick J, Zimmerman MA, Blow FC, Cunningham RM. Firearm violence among high-risk emergency department youth after an assault injury. Pediatrics 2015; 135:805-15. [PMID: 25847808 PMCID: PMC4411782 DOI: 10.1542/peds.2014-3572] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The risk for firearm violence among high-risk youth after treatment for an assault is unknown. METHODS In this 2-year prospective cohort study, data were analyzed from a consecutive sample of 14- to 24-year-olds with drug use in the past 6 months seeking assault-injury care (AIG) at an urban level 1 emergency department (ED) compared with a proportionally sampled comparison group (CG) of drug-using nonassaulted youth. Validated measures were administered at baseline and follow-up (6, 12, 18, 24 months). RESULTS A total of 349 AIG and 250 CG youth were followed for 24 months. During the follow-up period, 59% of the AIG reported firearm violence, a 40% higher risk than was observed among the CG (59.0% vs. 42.5%; relative risk [RR] = 1.39). Among those reporting firearm violence, 31.7% reported aggression, and 96.4% reported victimization, including 19 firearm injuries requiring medical care and 2 homicides. The majority with firearm violence (63.5%) reported at least 1 event within the first 6 months. Poisson regression identified baseline predictors of firearm violence, including male gender (RR = 1.51), African American race (RR = 1.26), assault-injury (RR = 1.35), firearm possession (RR = 1.23), attitudes favoring retaliation (RR = 1.03), posttraumatic stress disorder (RR = 1.39), and a drug use disorder (RR = 1.22). CONCLUSIONS High-risk youth presenting to urban EDs for assault have elevated rates of subsequent firearm violence. Interventions at an index visit addressing substance use, mental health needs, retaliatory attitudes, and firearm possession may help decrease firearm violence among urban youth.
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Affiliation(s)
- Patrick M Carter
- University of Michigan Injury Center, Department of Emergency Medicine, and Michigan Youth Violence Prevention Center and University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan;
| | - Maureen A Walton
- University of Michigan Injury Center, Michigan Youth Violence Prevention Center and University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Douglas R Roehler
- University of Michigan Injury Center, Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jason Goldstick
- University of Michigan Injury Center, Department of Emergency Medicine, and Michigan Youth Violence Prevention Center and
| | - Marc A Zimmerman
- University of Michigan Injury Center, Michigan Youth Violence Prevention Center and Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Frederic C Blow
- University of Michigan Injury Center, University of Michigan Addiction Research Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan; National Serious Mental Illness Treatment, Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; and
| | - Rebecca M Cunningham
- University of Michigan Injury Center, Department of Emergency Medicine, and Michigan Youth Violence Prevention Center and Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Emergency Medicine, Hurley Medical Center, Flint, Michigan
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Goldstick JE, Lipton RI, Carter P, Stoddard SA, Newton MF, Reischl T, Walton M, Zimmerman MA, Cunningham RM. The Effect of Neighborhood Context on the Relationship Between Substance Misuse and Weapons Aggression in Urban Adolescents Seeking ED Care. Subst Use Misuse 2015; 50:674-84. [PMID: 25607807 PMCID: PMC4646060 DOI: 10.3109/10826084.2014.998235] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Frameworks for studying the ecology of human behavior suggest that multiple levels of the environment influence behavior and that these levels interact. Applied to studies of weapons aggression, this suggests proximal risk factor (e.g., substance use) effects may differ across neighborhoods. OBJECTIVES To estimate how the association between weapons aggression and substance use varies as a function of several community-level variables. METHODS Individual-level measures (demographics, behavioral measures) were obtained from a survey of youth aged 14-24 years old seeking care at a Level-1 ED in Flint, Michigan. Community-level variables were obtained from public sources. Logistic generalized additive models were used to test whether community-level variables (crime rates, alcohol outlets, demographics) modify the link between individual-level substance use variables and the primary outcome measure: self-reported past 6-month weapon (firearm/knife) related aggression. RESULTS The effect of marijuana misuse on weapons aggression varied significantly as a function of five community-level variables: racial composition, vacant housing rates, female headed household rates, density of package alcohol outlets, and nearby drug crime rates. The effect of high-risk alcohol use did not depend on any of the eight community variables tested. CONCLUSIONS The relationship between marijuana misuse and weapons aggression differed across neighborhoods with generally less association in more disadvantaged neighborhoods, while high-risk alcohol use showed a consistently high association with weapons aggression that did not vary across neighborhoods. The results aid in understanding the contributions of alcohol and marijuana use to the etiology of weapon-related aggression among urban youth, but further study in the general population is required.
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Affiliation(s)
- Jason Elliott Goldstick
- Department of Emergency Medicine, University of Michigan, Ann Arbor, USA; Department of Health Sciences, Oakland University
| | - Robert I. Lipton
- Department of Health Behavior and Health Education, University of Michigan school of Public Health, Ann Arbor, USA
| | - Patrick Carter
- Department of Health Behavior and Health Education, University of Michigan school of Public Health, Ann Arbor, USA
| | - Sarah A. Stoddard
- Department of Health Behavior and Health Education, University of Michigan school of Public Health, Ann Arbor, USA
| | - Manya F. Newton
- Department of Health Behavior and Health Education, University of Michigan school of Public Health, Ann Arbor, USA
| | - Thomas Reischl
- Department of Health Behavior and Health Education, University of Michigan school of Public Health, Ann Arbor, USA
| | - Maureen Walton
- Department of Psychiatry, University of Michigan, Ann Arbor, USA
| | - Marc A. Zimmerman
- Department of Health Behavior and Health Education, University of Michigan school of Public Health, Ann Arbor, USA
| | - Rebecca M. Cunningham
- Department of Health Behavior and Health Education, University of Michigan school of Public Health, Ann Arbor, USA
- University of Michigan Injury Center, Ann Arbor, USA
- University of Michigan, Emergency Medicine, Domin’s Farms, SPC, USA
- Hurley Medical Center, Emergency Medicine, Flint, USA
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Bohnert KM, Walton MA, Ranney M, Bonar EE, Blow FC, Zimmerman MA, Booth BM, Cunningham RM. Understanding the service needs of assault-injured, drug-using youth presenting for care in an urban Emergency Department. Addict Behav 2015; 41:97-105. [PMID: 25452051 PMCID: PMC4324457 DOI: 10.1016/j.addbeh.2014.09.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/24/2014] [Accepted: 09/17/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Violence is a leading cause of injury among youth 15-24years and is frequently associated with drug use. To inform optimal violence interventions, it is critical to understand the baseline characteristics and intent to retaliate of drug-using, assault-injured (AI) youth in the Emergency Department (ED) setting, where care for violent injury commonly occurs. METHODS At an urban ED, AI youth ages 14-24 endorsing any past six-month substance use (n=350), and a proportionally-sampled substance-using comparison group (CG) presenting for non-assault-related care (n=250), were recruited and completed a baseline assessment (82% participation). Medical chart review was also conducted. Conditional logistic regression was performed to examine correlates associated with AI. RESULTS Over half (57%) of all youth met the criteria for drug and/or alcohol use disorder, with only 9% receiving prior treatment. Among the AI group, 1 in 4 intended to retaliate, of which 49% had firearm access. From bivariate analyses, AI youth had poorer mental health, greater substance use, and were more likely to report prior ED visits for assault or psychiatric evaluation. Based on multivariable modeling, AI youth had greater odds of being on probation/parole (AOR=2.26; CI=1.28, 3.90) and having PTSD (AOR=1.88; CI=1.01, 3.50) than the CG. CONCLUSIONS AI youth may have unmet needs for substance use and mental health treatment, including PTSD. These characteristics along with the risk of retaliation, increased ED service utilization, low utilization of other health care venues, and firearm access highlight the need for interventions that initiate at the time of ED visit.
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Affiliation(s)
- Kipling M Bohnert
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48105, USA; National Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, MI 48105, USA
| | - Maureen A Walton
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48105, USA; University of Michigan Injury Center, Ann Arbor, MI 48106, USA; Michigan Youth Violence Prevention Center, Flint, MI 48109, USA
| | - Megan Ranney
- Brown University, Department of Emergency Medicine, Providence, RI 02903, USA; Brown University, Injury Prevention Center, Providence, RI 02903, USA
| | - Erin E Bonar
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - Frederic C Blow
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48105, USA; National Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, MI 48105, USA; University of Michigan Injury Center, Ann Arbor, MI 48106, USA
| | - Marc A Zimmerman
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; University of Michigan Injury Center, Ann Arbor, MI 48106, USA; Michigan Youth Violence Prevention Center, Flint, MI 48109, USA
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Rebecca M Cunningham
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI 48106, USA; Hurley Medical Center, Flint, MI, USA; University of Michigan Injury Center, Ann Arbor, MI 48106, USA; Michigan Youth Violence Prevention Center, Flint, MI 48109, USA.
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Yu J, Hussain S, Appel P. Characteristics of veterans in community-based treatment programs for substance use disorders: an analysis of data from a state-wide system. J Addict Dis 2014; 34:101-11. [PMID: 25415232 DOI: 10.1080/10550887.2014.975609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examined records of patients in New York State treatment programs for substance use disorders from 1995 to 2012, which consisted of 81,471 patients with a self-reported veteran status and 1,260,618 without. Results indicated that, compared to other patients in community-based treatment, veterans have distinctive demographic characteristics, primary substance use, and treatment participation. Implications of the findings were discussed. The authors call for more in-depth research to examine veterans' pathways into community-based treatment, their perception of and experience with treatment services, and the likely influence of cultural background and the role of specific military experiences on their treatment outcomes.
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Affiliation(s)
- Jiang Yu
- a School of Social Welfare, University at Albany, State University of New York , Albany , New York , USA
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Yeterian JD, Bursik K, Kelly JF. Religiosity as a Predictor of Adolescents' Substance Use Disorder Treatment Outcomes. Subst Abus 2014; 36:453-61. [PMID: 25222569 DOI: 10.1080/08897077.2014.960550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND A growing body of research on adults with substance use disorders (SUDs) suggests that higher levels of religiosity and/or spirituality are associated with better treatment outcomes. However, investigation into the role of religiosity and spirituality in adolescent SUD treatment response remains scarce. The present study examines religiosity as a predictor of treatment outcomes in an adolescent sample, with alcohol/other drug problem recognition as a hypothesized moderator of this relationship. Problem recognition was selected as a moderator in an attempt to identify a subset of adolescents who would be more likely to use religious resources when attempting to change their substance use. METHODS One hundred twenty-seven outpatient adolescents aged 14 to 19 (Mage=16.7, SD=1.2, 24% female) were followed for 1 year after treatment intake. Growth curve analyses were used to assess the impact of baseline religiosity and problem recognition on subsequent abstinence rates, drug-related consequences, and psychological distress. RESULTS On average, abstinence did not change significantly during the follow-up period, whereas drug-related consequences and psychological distress decreased significantly. Religiosity did not predict changes in abstinence or psychological distress over time. Religiosity did predict reductions in drug-related consequences over time (b=-0.20, t=-2.18, P=.03). However, when problem recognition was added to the model, the impact of religiosity on consequences became nonsignificant, and there was no interaction between religiosity and problem recognition on consequences. CONCLUSIONS The main hypothesis was largely unsupported. Possible explanations include that the sample was low in religiosity and few participants were actively seeking sobriety at treatment intake. Findings suggest adolescent outpatients with SUD may differ from their adult counterparts in the role that religiosity plays in recovery.
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Affiliation(s)
- Julie D Yeterian
- a Department of Psychology, Suffolk University , Boston , Massachusetts , USA.,b Department of Psychiatry, Center for Addiction Medicine Massachusetts General Hospital , Boston , Massachusetts , USA
| | - Krisanne Bursik
- b Department of Psychiatry, Center for Addiction Medicine Massachusetts General Hospital , Boston , Massachusetts , USA
| | - John F Kelly
- b Department of Psychiatry, Center for Addiction Medicine Massachusetts General Hospital , Boston , Massachusetts , USA.,c Department of Psychiatry, Harvard Medical School , Boston , Massachusetts , USA
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Walton MA, Chermack ST, Blow FC, Ehrlich PF, Barry KL, Booth BM, Cunningham RM. Components of Brief Alcohol Interventions for Youth in the Emergency Department. Subst Abus 2014; 36:339-49. [PMID: 25222484 PMCID: PMC4362952 DOI: 10.1080/08897077.2014.958607] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Alcohol brief interventions (BIs) delivered by therapists are promising among underage drinkers in the emergency department (ED); however, integration into routine ED care is lacking. Harnessing technology for identification of at-risk drinkers and delivery of interventions could have tremendous public health impact by addressing practical barriers to implementation. The paper presents baseline, within BI session, and posttest data from an ongoing randomized controlled trial (RCT) of youth in the ED. METHODS Patients (ages 14-20) who screened positive for risky drinking were randomized to computer BI (CBI), therapist BI (TBI), or control. Measures included demographics, alcohol consumption (Alcohol Use Disorders Identification Test--Consumption [AUDIT-C]), process questions, BI components (e.g., strengths, tools), and psychological constructs (i.e., importance of cutting down, likelihood of cutting down, readiness to stop, and wanting help). RESULTS Among 4389 youth surveyed (13.7% refused), 24.0% (n = 1053) screened positive for risky drinking and 80.3% (n = 836) were enrolled in the RCT; 93.7% (n = 783) completed the posttest. Although similar in content, the TBI included a tailored, computerized workbook to structure the session, whereas the CBI was a stand-alone, offline, Facebook-styled program. As compared with controls, significant increases were found at posttest for the TBI in "importance to cut down" and "readiness to stop" and for the CBI in "importance and likelihood to cut down." BI components positively associated with outcomes at posttest included greater identification of personal strengths, protective behavioral strategies, benefits of change, and alternative activities involving sports. In contrast, providing information during the TBI was negatively related to outcomes at posttest. CONCLUSIONS Initial data suggest that therapist and computer BIs are promising, increasing perceived importance of reducing drinking. In addition, findings provide clues to potentially beneficial components of BIs. Future studies are needed to identify BI components that have the greatest influence on reducing risky drinking behaviors among adolescents and emerging adults.
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Affiliation(s)
- Maureen A. Walton
- University of Michigan, Department of Psychiatry, Addiction Research Center, Ann Arbor, MI, USA
- University of Michigan, Injury Center, Ann Arbor, MI, USA
| | - Stephen T. Chermack
- Department of Veterans Affairs National Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
- University of Michigan, Department of Psychiatry, Mental Health Services Outcomes and Translation Section, Ann Arbor, MI, USA
| | - Frederic C. Blow
- Department of Veterans Affairs National Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
- University of Michigan, Department of Psychiatry, Mental Health Services Outcomes and Translation Section, Ann Arbor, MI, USA
| | - Peter F. Ehrlich
- University of Michigan, Injury Center, Ann Arbor, MI, USA
- University of Michigan Health System, C.S. Mott Children’s Hospital, Department of Surgery, Section of Pediatric Surgery, Ann Arbor, MI, USA
| | - Kristen L. Barry
- Department of Veterans Affairs National Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
- University of Michigan, Department of Psychiatry, Mental Health Services Outcomes and Translation Section, Ann Arbor, MI, USA
| | - Brenda M. Booth
- University of Arkansas for Medical Sciences, Department of Psychiatry, Little Rock, AR, USA
| | - Rebecca M. Cunningham
- University of Michigan, Injury Center, Ann Arbor, MI, USA
- University of Michigan, Department of Emergency Medicine, Ann Arbor, MI, USA
- University of Michigan, School of Public Health, Ann Arbor, MI, USA
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Caviness CM, Hagerty CE, Anderson BJ, de Dios MA, Hayaki J, Herman D, Stein MD. Self-efficacy and motivation to quit marijuana use among young women. Am J Addict 2014; 22:373-80. [PMID: 23795877 DOI: 10.1111/j.1521-0391.2013.12030.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 11/17/2011] [Accepted: 12/16/2011] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Assessing motivation to quit substance use is recommended as part of brief interventions. The purpose of this study was to determine correlates of desire to quit marijuana use among young adult women enrolled in a brief motivational intervention trial. METHODS Participants were 332 female marijuana users, aged 18-24, who rated their current desire to quit using a single item change ladder. We hypothesized self-efficacy and prior quit attempts will interact in this population to increase motivation to quit. RESULTS Participants had a mean age of 20.5 years, 67.7% were non-Hispanic Caucasian, and 60% had some desire to quit marijuana use. Using multivariate linear regression, quit desire was significantly lower among Caucasians (b = -.256; 95% CI -.489; -.037) and more frequent marijuana users (b = -.268; 95% CI -.372; -.166), and higher among those with previous quit attempts (b = .454; 95% CI .235; .671), and greater marijuana problem severity (b = .408; 95% CI .302; .514). Greater refusal self-efficacy was associated with greater quit desire among participants with previous quit attempts, but not among those without prior quit attempts (b = .241; 95% CI .050; .440). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Understanding the factors relating to quit desire among marijuana users may allow clinicians to tailor counseling so as to increase readiness to quit and decrease use and its associated consequences.
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Aubuchon-Endsley NL, Callahan JL. Exploring Pretreatment Expectancies in a Campus Mental Health Setting: The Validation of a Novel Expectancies Measure. JOURNAL OF COLLEGE COUNSELING 2014. [DOI: 10.1002/j.2161-1882.2014.00048.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Nicki L. Aubuchon-Endsley
- Department of Psychology; Oklahoma State University; Stillwater
- Now at Alpert Medical School; Brown University
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Abdel-Salam S. Examining the relationship between self-control and adolescent TC treatment completion. JOURNAL OF SUBSTANCE USE 2014. [DOI: 10.3109/14659891.2012.728670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cunningham RM, Ranney M, Newton M, Woodhull W, Zimmerman M, Walton MA. Characteristics of youth seeking emergency care for assault injuries. Pediatrics 2014; 133:e96-105. [PMID: 24323994 PMCID: PMC3876183 DOI: 10.1542/peds.2013-1864] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To characterize youth seeking care for assault injuries, the context of violence, and previous emergency department (ED) service utilization to inform ED-based injury prevention. METHODS A consecutive sample of youth (14-24) presenting to an urban ED with an assault injury completed a survey of partner violence, gun/knife victimization, gang membership, and context of the fight. RESULTS A total of 925 youth entered the ED with an assault injury; 718 completed the survey (15.4% refused); 730 comparison youth were sampled. The fights leading to the ED visit occurred at home (37.6%) or on streets (30.4%), and were commonly with a known person (68.3%). Fights were caused by issues of territory (23.3%) and retaliation (8.9%); 20.8% of youth reported substance use before the fight. The assault-injured group reported more peer/partner violence and more gun experiences. Assault-injured youth reported higher past ED utilization for assault (odds ratio [OR]: 2.16) or mental health reasons (OR: 7.98). Regression analysis found the assault-injured youth had more frequent weapon use (OR: 1.25) and substance misuse (OR: 1.41). CONCLUSIONS Assault-injured youth seeking ED care report higher levels of previous violence, weapon experience, and substance use compared with a comparison group seeking care for other complaints. Almost 10% of assault-injured youth had another fight-related ED visit in the previous year, and ~5% had an ED visit for mental health. Most fights were with people known to them and for well-defined reasons, and were therefore likely preventable. The ED is a critical time to interact with youth to prevent future morbidity.
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Affiliation(s)
- Rebecca M. Cunningham
- School of Public Health,,Departments of Emergency Medicine and,Injury Center, University of Michigan, Ann Arbor, Michigan;,Hurley Medical Center, Flint, Michigan;,Michigan Youth Violence Prevention Center, Flint, Michigan; and
| | - Megan Ranney
- Department of Emergency Medicine and,Injury Prevention Center, Brown University, Providence, Rhode Island
| | - Manya Newton
- Departments of Emergency Medicine and,Injury Center, University of Michigan, Ann Arbor, Michigan;,Hurley Medical Center, Flint, Michigan
| | | | - Marc Zimmerman
- School of Public Health,,Injury Center, University of Michigan, Ann Arbor, Michigan;,Michigan Youth Violence Prevention Center, Flint, Michigan; and
| | - Maureen A. Walton
- Psychiatry, and,Injury Center, University of Michigan, Ann Arbor, Michigan;,Michigan Youth Violence Prevention Center, Flint, Michigan; and
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Labbe AK, Greene C, Bergman BG, Hoeppner B, Kelly JF. The importance of age composition of 12-step meetings as a moderating factor in the relation between young adults' 12-step participation and abstinence. Drug Alcohol Depend 2013; 133:541-7. [PMID: 23938074 PMCID: PMC3818368 DOI: 10.1016/j.drugalcdep.2013.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 07/16/2013] [Accepted: 07/23/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Participation in 12-step mutual help organizations (MHO) is a common continuing care recommendation for adults; however, little is known about the effects of MHO participation among young adults (i.e., ages 18-25 years) for whom the typically older age composition at meetings may serve as a barrier to engagement and benefits. This study examined whether the age composition of 12-step meetings moderated the recovery benefits derived from attending MHOs. METHOD Young adults (n=302; 18-24 years; 26% female; 94% White) enrolled in a naturalistic study of residential treatment effectiveness were assessed at intake, and 3, 6, and 12 months later on 12-step attendance, age composition of attended 12-step groups, and treatment outcome (Percent Days Abstinent [PDA]). Hierarchical linear models (HLM) tested the moderating effect of age composition on PDA concurrently and in lagged models controlling for confounds. RESULTS A significant three-way interaction between attendance, age composition, and time was detected in the concurrent (p=0.002), but not lagged, model (b=0.38, p=0.46). Specifically, a similar age composition was helpful early post-treatment among low 12-step attendees, but became detrimental over time. CONCLUSIONS Treatment and other referral agencies might enhance the likelihood of successful remission and recovery among young adults by locating and initially linking such individuals to age appropriate groups. Once engaged, however, it may be prudent to encourage gradual integration into the broader mixed-age range of 12-step meetings, wherein it is possible that older members may provide the depth and length of sober experience needed to carry young adults forward into long-term recovery.
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Affiliation(s)
- Allison K. Labbe
- MGH Center for Addiction Medicine, 60 Staniford Street, Boston, MA 02114, United States
| | - Claire Greene
- MGH Center for Addiction Medicine, 60 Staniford Street, Boston, MA 02114, United States
| | - Brandon G. Bergman
- MGH Center for Addiction Medicine, 60 Staniford Street, Boston, MA 02114, United States
| | - Bettina Hoeppner
- MGH Center for Addiction Medicine, 60 Staniford Street, Boston, MA 02114, United States
| | - John F. Kelly
- MGH Center for Addiction Medicine, 60 Staniford Street, Boston, MA 02114, United States
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Joe GW, Knight DK, Becan JE, Flynn PM. Recovery among adolescents: models for post-treatment gains in drug abuse treatments. J Subst Abuse Treat 2013; 46:362-73. [PMID: 24238715 DOI: 10.1016/j.jsat.2013.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 09/20/2013] [Accepted: 10/04/2013] [Indexed: 10/26/2022]
Abstract
Recovery among adolescents undergoing substance abuse treatment was modeled in terms of pre-treatment motivation, therapeutic relationships, psychological functioning, treatment retention, legal pressures, DSM diagnoses, and client demographics. To address between program differences, a within-covariance matrix, based on 547 youth, was used. Applicability of the results across treatment modalities was also examined. The data were from the NIDA-sponsored DATOS Adolescent study. Results from structural equation models (estimated using Mplus) indicated that higher pre-treatment motivation predicted stronger counselor and in-treatment peer relationships, better counselor relationships and retention predicted less illegal drug use at follow-up, and DSM diagnosis was important in the treatment process. Overall, illegal drug use at follow-up was associated with post-treatment alcohol consumption, cigarette use, condom nonuse, psychological distress, criminality, and school non-attendance. The results document the importance of motivation and therapeutic relationships on recovery, even when taking into account the relative effects of legal pressures, DSM diagnoses, and demographics.
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Affiliation(s)
- George W Joe
- Texas Christian University, Fort Worth, TX 76129, USA.
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Yeterian JD, Greene MC, Bergman BG, Kelly JF. Does Mandated Treatment Benefit Youth? A Prospective Investigation of Adolescent Justice System Involvement, Treatment Motivation, and Substance Use Outcomes. ALCOHOLISM TREATMENT QUARTERLY 2013; 31:431-449. [PMID: 24159252 DOI: 10.1080/07347324.2013.831671] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The majority of adolescents treated for substance use disorder (SUD) in the United States are now referred by the criminal justice system. Little is known, however, regarding how justice-system involvement relates to adolescent community treatment outcomes. Controversy exists, also, over the extent to which justice system involvement reflects a lack of intrinsic motivation for treatment. This study examined the relation between justice system referral and reported reason for treatment entry and tested the extent to which each predicted treatment response and outcome. METHOD Adolescent outpatients (N = 127; M age = 16.7, 24% female) with varying levels of justice-system involvement (i.e., no justice system involvement [No-JSI; n = 63], justice-system involved [JSI; n = 40], justice system involved-mandated [JSI-M; n = 24]) and motivation levels (i.e., self-motivated [n = 40], externally-motivated [n = 87]) were compared at treatment intake. Multilevel mixed models tested these groups' effects on percent days abstinent (PDA) and odds of heavy drinking (HD) over 12 months. RESULTS JSI-M were less likely to be self-motivated compared to No-JSI or JSI (p = 0.009). JSI-M had higher PDA overall, but with significant declines over time, relative to no-JSI. Self-motivated patients did not differ from externally-motivated patients on PDA or HD. CONCLUSIONS Mandated adolescent outpatients were substantially less likely to report self-motivated treatment entry. Despite the notion that self-motivated treatment entry would be likely to produce better outcomes, a judicial mandate appears to predict an initially stronger treatment response, although this diminishes over time. Ongoing monitoring and/or treatment may be necessary to help maintain treatment gains for justice system-involved adolescents.
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Affiliation(s)
- Julie D Yeterian
- Massachusetts General Hospital, Center for Addiction Medicine, Department of Psychiatry, and Harvard Medical School, Boston, MA 02114
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Carter PM, Walton MA, Newton MF, Clery M, Whiteside LK, Zimmerman MA, Cunningham RM. Firearm possession among adolescents presenting to an urban emergency department for assault. Pediatrics 2013; 132:213-21. [PMID: 23837181 PMCID: PMC3727673 DOI: 10.1542/peds.2013-0163] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Firearm violence is a leading cause of death among youth. The objectives of this study were (1) determine firearm possession rates and associated correlates among youth seeking care for assault in an emergency department (ED); (2) understand differences in risk factors for youth with firearm possession; and (3) identify firearm possession characteristics in this population: type, reason for possession, and source of firearms. METHODS Youth (14 to 24 years old) presenting to a Level 1 ED with assault were administered a computerized screening survey. Validated instruments were administered, measuring demographics, firearm rates and characteristics, attitudes toward aggression, substance use, and previous violence history. RESULTS Among 689 assault-injured youth, 23% reported firearm possession in the past 6 months. Only 17% of those reporting firearm possession obtained the gun from a legal source; 22% reported ownership of highly lethal automatic/semiautomatic weapons and 37.1% reported having a firearm for protection. Logistic regression analysis identified significant correlates of firearm possession, including male gender, higher socioeconomic status, illicit drug use, recent serious fight, and retaliatory attitudes. CONCLUSIONS ED assault-injured youth had high rates of firearm possession (23.1%), most of which were not obtained from legal sources. Youth with firearm possession were more likely to have been in a recent serious fight, and to endorse aggressive attitudes that increase their risk for retaliatory violence. Future prevention efforts should focus on minimizing illegal firearm access among high-risk youth, nonviolent alternatives to retaliatory violence, and substance use prevention.
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Affiliation(s)
- Patrick M. Carter
- Departments of Emergency Medicine, and,University of Michigan Injury Center, and,Hurley Medical Center, Flint, Michigan
| | - Maureen A. Walton
- Psychiatry, School of Medicine,,University of Michigan Injury Center, and
| | - Manya F. Newton
- Departments of Emergency Medicine, and,University of Michigan Injury Center, and,Hurley Medical Center, Flint, Michigan
| | | | - Lauren K. Whiteside
- Division of Emergency Medicine, School of Medicine, University of Washington, Seattle, Washington; and
| | - Marc A. Zimmerman
- University of Michigan Injury Center, and,Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan;,Flint Youth Violence Prevention Center, Flint, Michigan
| | - Rebecca M. Cunningham
- Departments of Emergency Medicine, and,University of Michigan Injury Center, and,Hurley Medical Center, Flint, Michigan;,Flint Youth Violence Prevention Center, Flint, Michigan
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Gunter WD, Abdel-Salam S. Therapeutic Engagement and Posttreatment Substance Use in Adolescent TC Clients. JOURNAL OF DRUG ISSUES 2013. [DOI: 10.1177/0022042613491103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The problem of adolescent drug use places a huge toll on society and a heavy burden on the criminal justice system. Despite the ability of therapeutic communities (TCs) to lower drug relapse, a great deal remains unknown in terms of how the process of treatment actually works for adolescents. Using data collected as part of the Drug Abuse Treatment Outcomes Studies–Adolescents, this study examines the direct and indirect relationship between therapeutic engagement and posttreatment substance use. Though there are few direct effects of therapeutic engagement on substance use, findings suggest that those more engaged in treatment are more likely to complete treatment and, therefore, less likely to use substances. This suggests that instruments that evaluate therapeutic engagement are important in assessing involvement in treatment, and that programming designed to engage the adolescents in TC treatment should be utilized to reduce the risk of posttreatment relapse.
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Rowe CL. Family therapy for drug abuse: review and updates 2003-2010. JOURNAL OF MARITAL AND FAMILY THERAPY 2012; 38:59-81. [PMID: 22283381 DOI: 10.1111/j.1752-0606.2011.00280.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Just 15 years ago, Liddle and Dakof (Journal of Marital and Family Therapy, 1995; 21, 511) concluded, based on the available evidence, that family therapy represented a "promising, but not definitive" approach for the treatment of drug problems among adolescents and adults. Seven years later, Rowe and Liddle (2003) review described considerable progress in this specialty with encouraging findings on adolescent-focused models based on rigorous methodology, as well as advances with adult-focused family-based treatments. The current review brings the field up to date with highlights from research conducted in the intervening 7 years, cross-cutting issues, recommendations for new research, and practice implications of these findings. Adolescent-focused family-based models that attend to the ecology of the teen and family show the most consistent and strongest findings in recent studies. Adult-focused models based on behavioral and systems theories of change also show strong effects with drug abusers and their families. The overarching conclusion is that family-based models are not only a viable treatment alternative for the treatment of drug abuse, but are now consistently recognized among the most effective approaches for treating both adults and adolescents with drug problems.
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Affiliation(s)
- Cynthia L Rowe
- Department of Epidemiology and Public Health, Center for Treatment Research on Adolescent Drug Abuse, University of Miami, Miller School of Medicine, Miami, Florida 33136, USA.
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Tsao JCI, Stein JA, Ostrow D, Stall RD, Plankey MW. The mediating role of pain in substance use and depressive symptoms among Multicenter AIDS Cohort Study (MACS) participants. Pain 2011; 152:2757-2764. [PMID: 21962911 DOI: 10.1016/j.pain.2011.08.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 08/16/2011] [Accepted: 08/26/2011] [Indexed: 10/17/2022]
Abstract
Pain in human immunodeficiency virus (HIV) frequently co-occurs with substance use and depression. The complex associations among patient characteristics, pain, depression, and drug use in HIV suggests a role for testing models that can account for relationships simultaneously, control for HIV status, and also test for mediation. Using structural equation modeling, the current study examined associations among pain, sociodemographics, illicit drug use, and depressive symptoms in 921 HIV-seropositive and 1019 HIV-seronegative men from the Multicenter AIDS Cohort Study, an ongoing prospective study of the natural history of HIV infection among gay/bisexual men. Longitudinal repeated measures data collected over a 6-year period were analyzed using predictive path models in which sociodemographics, HIV status, and CD4+ cell counts predicted pain, which, in turn, predicted depressive symptoms and illicit drug use. The path models did not differ substantially between HIV-seropositive and -seronegative men. Analyses using the total sample indicated that pain served both as a mediator and as a predictor of more use of cannabis, cocaine, and heroin, as well as more depressive symptoms. HIV-seropositive status predicted more use of inhaled nitrites. In this cohort, having lower CD4+ cell counts (predicted by HIV status), being African American, less educated, and older were all associated with more pain, which, in turn, was associated with more illicit drug use and more depressive symptoms. The results underscore the need for adequate pain management, particularly among vulnerable subgroups of HIV-seropositive and HIV-seronegative men to reduce the risk of drug use and depression.
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Affiliation(s)
- Jennie C I Tsao
- Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, USA Department of Psychology, UCLA, Los Angeles, CA, USA The Chicago Multicenter AIDS Cohort Study (MACS) and the Ogburn-Stouffer Center for Social Organization Research at the National Opinion Research Center (NORC), University of Chicago, Chicago, IL, USA Graduate School of Public Health, Department of Behavioral and Community Health Services, University of Pittsburgh, Pittsburgh, PA, USA Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
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37
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Smith DC, Godley SH, Godley MD, Dennis ML. Adolescent Community Reinforcement Approach outcomes differ among emerging adults and adolescents. J Subst Abuse Treat 2011; 41:422-30. [PMID: 21831564 DOI: 10.1016/j.jsat.2011.06.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 05/23/2011] [Accepted: 06/06/2011] [Indexed: 11/27/2022]
Abstract
One fifth of all public treatment admissions are emerging adults, and few studies have considered whether treatments are developmentally appropriate. This study compares outcomes between adolescents and emerging adults with substance use disorders who received the Adolescent Community Reinforcement Approach (A-CRA). Propensity score matching was used to create a weighted comparison group of adolescents (n = 151) who had similar demographic characteristics, clinical severity, and treatment retention as the group of emerging adults (n = 152). We examined age differences in abstinence and other psychosocial outcomes at the last available follow-up. Emerging adults and adolescents both reduced their substance use at follow-up. However, emerging adults were less likely to be abstinent and in remission and had more days of alcohol use when compared with adolescents. This study's findings are consistent with prior work on emerging adults. Additional research should examine features of interventions that are most effective in addressing the developmental needs of emerging adults.
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Affiliation(s)
- Douglas C Smith
- University of Illinois at Urbana-Champaign, School of Social Work, 1010 West Nevada Street, Urbana, IL 61801, USA.
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Smith DC, Cleeland L, Dennis ML. Reasons for quitting among emerging adults and adolescents in substance-use-disorder treatment. J Stud Alcohol Drugs 2010; 71:400-9. [PMID: 20409434 DOI: 10.15288/jsad.2010.71.400] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Understanding developmental differences in reasons for quitting substance use may assist clinicians in tailoring treatments to different clinical populations. This study investigates whether alcohol-disordered and problem-drinking emerging adults (i.e., ages 18-25 years) have different reasons for quitting than younger adolescents (i.e., ages 13-17 years). METHOD Using a large clinical sample of emerging adults and adolescents, we compared endorsement rates for 26 separate reasons for quitting between emerging adults and adolescents who were matched on clinical severity. Then age group was regressed on total, interpersonal, and personal reasons for quitting, and mediation tests were conducted with variables proposed to be developmentally salient to emerging adults. RESULTS Among both age groups, self-control reasons were the most highly endorsed. Emerging adults had significantly fewer interpersonal reasons for quitting (Cohen's d = 0.20), and this association was partially mediated by days of being in trouble with one's family. There were no differences in personal reasons or total number of reasons for quitting. CONCLUSIONS Our findings are consistent with developmental theory suggesting that emerging adults experience less social control, which here leads to less interpersonal motivation to refrain from alcohol and drug use. As emerging adults in clinical samples may indicate few interpersonal reasons for quitting, one challenge to tailoring treatments for them will be identifying innovative ways of leveraging social supports and altering existing social networks.
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Affiliation(s)
- Douglas C Smith
- School of Social Work, University of Illinois at Urbana-Champaign, MC-082, Urbana, Illinois 61801, USA.
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Hadland SE, Kerr T, Li K, Montaner JS, Wood E. Access to drug and alcohol treatment among a cohort of street-involved youth. Drug Alcohol Depend 2009; 101:1-7. [PMID: 19081203 PMCID: PMC2667152 DOI: 10.1016/j.drugalcdep.2008.10.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 10/06/2008] [Accepted: 10/09/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND A number of options for treatment are available to young drug users, but little is known about the youth who actually attempt to access such services. Here we identify characteristics of a cohort of street-involved youth and highlight commonly encountered barriers. METHODS From September 2005 to July 2007, data were collected from the At-Risk Youth Study (ARYS), a prospective cohort of 529 drug users aged 14-26 living in Vancouver, Canada. Participants who attempted to access any addiction services in the 6 months prior to enrollment were compared in univariate analyses and multiple logistic regression modeling of socio-demographic and drug-related factors. RESULTS Factors positively associated with attempting to access services included Aboriginal ethnicity (adjusted odds ratio [AOR]=1.66 [1.05-2.62]), high school education (AOR=1.66 [1.09-2.55]), mental illness (AOR=2.25 [1.50-3.38]), non-injection crack use (AOR=2.93 [1.76-4.89]), and spending >$50 on drugs per day (AOR=2.13 [1.41-3.22]). Among those who experienced difficulty-accessing services, the most commonly identified barrier was excessively long waiting lists. In a subgroup analysis comparing those who tried to access services but were unsuccessful to those who were successful, risk factors positively associated with failure included drug bingeing (odds ratio [OR]=2.86 [1.22-6.76]) and homelessness (OR=3.86 [1.11-13.4]). CONCLUSIONS In light of accumulating evidence that drug use among street youth is associated with risky health-related behaviors, improving access to treatment and other addiction services should remain an important public health priority.
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Affiliation(s)
- Scott E. Hadland
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA, 21205
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada, V6T 1Z3
| | - Kathy Li
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6
| | - Julio S. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada, V6T 1Z3
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada, V6T 1Z3
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Alvarez J, Jason LA, Davis MI, Olson BD, Ferrari JR. Latinos and Latinas in communal settings: a grounded theory of recovery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:1317-34. [PMID: 19440520 PMCID: PMC2681194 DOI: 10.3390/ijerph6041317] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 03/26/2009] [Indexed: 11/16/2022]
Abstract
Semi-structured interviews were conducted with 12 Latino/a residents of a mutual help residential recovery program (Oxford House) in order to elicit their experiences of the program's therapeutic elements. A model of recovery emerged from the analysis including several themes supported by existing literature: personal motivation and readiness to change, mutual help, sober environment, social support, and accountability. Consistent with a broad conceptualization of recovery, outcomes included abstinence, new life skills, and increased self-esteem/sense of purpose. Most participants were the only Latino/a in their Houses; however, cultural differences did not emerge as salient issues. The study's findings highlight potential therapeutic aspects of mutual-help communal recovery programs and suggest that English-speaking, bicultural Latinos/as have positive experiences and may benefit from participating in these programs.
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Affiliation(s)
- Josefina Alvarez
- Adler School of Professional Psychology, 65 E. Wacker Place, Suite 2100, Chicago, IL 60601, USA
| | - Leonard A. Jason
- DePaul University, Center for Community Research, 990 Fullerton Avenue, Suite 3100, Chicago, Illinois 60614, USA
- Author to whom correspondence should be addressed; E-Mail:
; Tel.: +1-773-325-2018
| | - Margaret I. Davis
- DePaul University, Center for Community Research, 990 Fullerton Avenue, Suite 3100, Chicago, Illinois 60614, USA
| | - Bradley D. Olson
- Northwestern University, School of Education and Social Policy 2120 Campus Drive Evanston, IL 60208, USA
| | - Joseph R. Ferrari
- DePaul University, Department of Psychology, 2219 N. Kenmore Ave., Chicago, Il. 60614, USA
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Jones HE, Martin PR, Heil SH, Kaltenbach K, Selby P, Coyle MG, Stine SM, O'Grady KE, Arria AM, Fischer G. Treatment of opioid-dependent pregnant women: clinical and research issues. J Subst Abuse Treat 2008; 35:245-59. [PMID: 18248941 PMCID: PMC2633026 DOI: 10.1016/j.jsat.2007.10.007] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Revised: 10/11/2007] [Accepted: 10/28/2007] [Indexed: 12/22/2022]
Abstract
This article addresses common questions that clinicians face when treating pregnant women with opioid dependence. Guidance, based on both research evidence and the collective clinical experience of the authors, which include investigators in the Maternal Opioid Treatment: Human Experimental Research (MOTHER) project, is provided to aid clinical decision making. The MOTHER project is a double-blind, double-dummy, flexible-dosing, parallel-group clinical trial examining the comparative safety and efficacy of methadone and buprenorphine for the treatment of opioid dependence in pregnant women and their neonates. The article begins with a discussion of appropriate assessment during pregnancy and then addresses clinical management stages including maintenance medication selection, induction, and stabilization; opioid agonist medication management before, during, and after delivery; pain management; breast-feeding; and transfer to aftercare. Lastly, other important clinical issues including managing co-occurring psychiatric disorders and medication interactions are discussed.
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Affiliation(s)
- Hendree E Jones
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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Paddock SM, Edelen MO, Wenzel SL, Ebener P, Mandell W, Dahl J. Measuring changes in client-level treatment process in the therapeutic community (TC) with the Dimensions of Change Instrument (DCI). THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2007; 33:537-46. [PMID: 17668339 DOI: 10.1080/00952990701407439] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The Dimensions of Change Instrument (DCI) measures treatment process in residential therapeutic community (TC) settings. It summarizes eight factors of treatment process from a client perspective. We present evidence of the reliability of the DCI for assessing both adult (N = 519) and adolescent (N = 474) client perceptions of treatment process. The DCI factors significantly increase over time, with increases consistently seen across all DCI factors for adults. We highlight areas for future DCI modifications to broaden its applicability to adolescents. Our findings show that clinicians can use the DCI to evaluate adult client progress and target areas for improving quality of care.
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Tsao JCI, Stein JA, Dobalian A. Pain, problem drug use history, and aberrant analgesic use behaviors in persons living with HIV. Pain 2007; 133:128-37. [PMID: 17449182 PMCID: PMC2173909 DOI: 10.1016/j.pain.2007.03.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 03/01/2007] [Accepted: 03/13/2007] [Indexed: 11/28/2022]
Abstract
Little is known about the relationship between pain and aberrant use of prescription analgesics in persons living with HIV. We examined the predictive and concurrent associations among pain, aberrant use of opioids, and problem drug use history in a nationally representative longitudinal sample of 2267 HIV+ persons. Covariance structure analyses tested a conceptual model wherein HIV+ patients with a history of problematic drug use (n=870), compared to those without such history (n=1397), were hypothesized to report more pain and aberrant opioid use, as well as use of opioids specifically for pain at baseline and 6- and 12-month follow-ups, after controlling for key sociodemographic characteristics. In support of the hypothesized model, patients with a history of problematic drug use reported more pain, and were more likely to report aberrant use of prescription analgesics, as well as use of such medications specifically for pain, compared to patients without such history. We also found a trend toward greater stability of aberrant opioid use over time in problem drug users compared with non-problem users suggesting a persistent pattern of inappropriate medication use in the former group. Our findings suggest that even though HIV+ persons with a history of problematic drug use report on-going patterns of using prescription analgesics specifically for pain, these patients continued to experience persistently higher levels of pain, relative to non-problem users. Among non-problem users, pain was not linked to aberrant use of opioids, but was linked to the use of such medications specifically for pain.
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Affiliation(s)
- Jennie C I Tsao
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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