Social cognitive predictors of treatment outcome in cannabis dependence

Validation of the psychoactive substance refusal Self-Efficacy Questionnaire (PSRSEQ) in adolescent case-clients of social workers in Hong Kong

BACKGROUND

Self-efficacy is a key concept in various behavioral theories. Refusal self-efficacy is important in understanding issues related to psychoactive substance use. To facilitate related research, this study translated and validated the Chinese version of the 14-item Psychoactive Substance Refusal Self-efficacy Questionnaire (PSRSEQ) among adolescents. There is a debate about whether such a refusal self-efficacy scale should be unidimensional or multidimensional.

METHODS

A survey was conducted among 601 adolescent case-clients of social workers in Hong Kong from July 2021 to June 2022. Various psychometric properties were examined.

RESULTS

The confirmatory factor analysis (CFA) supported the original 3-factor structure of the PSRSEQ (emotional relief, opportunistic, and social facilitation refusal self-efficacy), which showed satisfactory psychometric properties (internal consistency, convergent validity in terms of significant negative correlations with the intention of psychoactive substance use in the next year and psychoactive substance use behavior in the past six months, and the absence of floor effect) but ceiling effect was obvious. Notably, unacceptable discriminant validity of one subscale and strong correlations among the three subscales were observed. In another set of analyses using two split-half subsamples, the exploratory factor analysis identified a 1-factor 14-item structure, which was confirmed by CFA and showed satisfactory psychometric properties.

CONCLUSIONS

The 1-factor PSRSEQ, instead of the one having a 3-factor structure, was preferred and recommended to assess psychoactive substance refusal self-efficacy among Chinese adolescents. It is warranted to validate the scale in other adolescent and age groups in future studies.

Predictors of effective therapy among individuals with Cannabis Use Disorder: a review of the literature

Treatment demand for Cannabis Use Disorder (CUD) has increased in the past decade in almost all European countries, and CUD is currently the most common reason for first-time drug-related treatment admission in the European Union. Even though several therapeutic approaches have been shown to benefit individuals with CUD, there is a lack of knowledge regarding factors associated with effective therapy and the underlying mechanisms of change among individuals with CUD presenting for treatment. The aim of the present paper was to review current knowledge on factors that have been shown to contribute to positive outcomes in CUD treatment. A scoping methodology was used, focusing on empirically evaluated studies that used defined, cannabis-related outcome measures. In eligible studies, factors of investigation were categorized as either 'mediators', i.e., treatment-related factors associated with the processes or mechanisms through which patients benefit from therapy, or 'moderators' which are patient-related characteristics that predict his/her odds to benefit from treatment or patient-related (i.e., moderators). Factors categorized as mediators were then classified 'specific factors' if they were related to a certain technique or treatment modality or 'common factors' if they were assessed beyond treatment modalities. Findings suggest that in CUD treatment, specific mediators include treatment duration, addressing motivation to change, acquiring coping skills, enhancing self-efficacy, and integrating several therapeutic components. Common mediators include therapeutic alliance, empathy, expectations and cultural adaptation. Moderators in CUD treatment include sex, ethnicity, age-related factors and comorbid disorders.

Impact of a brief distress intolerance intervention on acute stress modulation of response inhibition neurophysiology in cannabis use disorder

BACKGROUND

The prevalence of cannabis use in the US has increased within the past two decades. Moreover, cannabis use disorder (CUD) is associated with significant disability, but the underlying neural mechanisms of CUD are unclear. Distress intolerance (DI), a psychological risk factor for CUD, may confer risk in part via impaired inhibitory control (IC) capacity during acute stress. DI and cannabis use problems have been associated with altered N2 amplitude, an IC-related event-related potential, in prior cross-sectional studies, but whether altered N2 is a state marker of CUD severity, a pathoplastic factor responsive to intervention and predictive of CUD symptom change over time, or an enduring trait-like vulnerability is unclear. In this secondary analysis, we tested the impact of a DI-targeted intervention on acute stress-related modulation of the N2 and whether pre-intervention N2 predicted CUD symptom change through follow-up.

METHOD

Sixty participants were randomly assigned to a DI-targeted or control intervention. Participants completed an IC task before and after a stress induction at pre- and post-intervention lab visits while EEG activity was recorded.

RESULTS

The DI intervention did not alter the N2 compared to a control intervention. Pre-intervention post-stress IC-related N2 was associated with worse CUD severity but did not predict changeover time.

CONCLUSION

Findings are consistent with blunted N2 after acute stress acting as a stable marker of CUD severity rather than a pathoplastic factor predictive of CUD trajectory. Future research should investigate whether stress-related blunting of N2 is a consequence of severe CUD or a pre-existing vulnerability.

Adolescents and youths' opinions about the factors associated with cannabis use: a qualitative study based on the I-Change model

BACKGROUND

To learn about the experiences and opinions of adolescent non-consumers and regular cannabis users about cannabis use and the factors that determine its use, using the I-Change explanatory model as a basis.

METHODS

Qualitative methodology with a content analysis was used. Focus groups were conducted with adolescents who were non-regular cannabis users (those who had not tried cannabis or had only experimented with it before) and semi-structured interviews were conducted with adolescent and young adult in recovery who were in a detoxification program. A deductive analysis of the audio-recorded and transcribed interviews was performed, using the domains of the I-Change Model as a reference.

RESULTS

Personal problems, social problems or family problems can lead to cannabis use. There was a lack of knowledge and low risk perception about consumption of this drug. There are other factors that influence consumption, the perception of advantages, such as the feeling of freedom and the influence of the peer group. The consumption of this substance in girls is changing, becoming more and more equal to that of boys. The family has an important role to play in preventing drug use.

CONCLUSION

Knowledge of these factors is of vital importance as a prior step to the development of efficient intervention measures adjusted to the needs identified and the characteristics of the population.

Development of the motivational thought frequency scale for alcohol abstinence (MTF-A)

BACKGROUND AND AIMS

For most treatment-seeking patients with severe Alcohol Use Disorder (AUD), abstinence is the clinically indicated goal. Existing AUD motivation scales are non-specific about treatment consumption goals, which limit their effectiveness. Desires and mental imagery are relevant in the motivation for AUD treatment engagement. The Motivational Thought Frequency Scale for an abstinence goal (MTF-A) was adapted from the MTF for controlled drinking (MTF-CD). This study psychometrically evaluated the MTF-A in an alcohol-dependent sample engaged in treatment with a goal of abstinence. To enhance the clinical utility of the scale, a secondary aim was to evaluate a psychometrically equivalent short version of the MTF-A.

METHOD

A sample N of 329 treatment-seeking patients with AUD (mean age of 44.44 years, SD = 11.89 years, 72% male) who were undertaking a cognitive behavioral treatment (CBT) program for abstinence completed the Motivational Thought Frequency Scale for Abstinence (MTF-A) and the Severity of Alcohol Dependence Questionnaire (SADQ). The MTF-A measured motivation for abstinence through four factors: intensity, self-efficacy imagery, incentives imagery, and availability. Confirmatory factor analyses (CFAs) were conducted to examine factor structure and model fit. Cronbach's alpha assessed internal consistency. Predictive validity was determined by logistic regression predicting first-session treatment non-attendance and alcohol consumption between baseline assessment and commencement of treatment, controlling for potential confounds.

RESULTS

A four-factor structure provided the best fit for the MTF-A, compared with one- and three-factor models. A shortened 9-item MTF-A scale (S-MTF-A) provided better fit than the 13-item MTF-A scale. Both MTF-A and S-MTF-A displayed good internal consistency. Although both MTF-A and S-MTF-A successfully predicted first-session treatment non-attendance, neither predicted alcohol consumption between the baseline assessment and commencement of treatment.

CONCLUSIONS

The model fit of the four-factor, 9-item S-MTF-A was superior to the original 13-item MTF-A. Both scales were predictive of participation of AUD treatment. Desires and mental imagery play an important role in AUD treatment motivation.

Factors associated with counselling adherence in opioid treatment programs

Federally certified opioid treatment programs (OTPs) provide psychosocial counselling in addition to medications for opioid use disorder (MOUDs) using a patient-centered approach in providing substance use disorder treatment. This study explored factors associated with patients' adherence to counselling while receiving MOUD at an OTP. A retrospective cohort design using data on adult patients (n = 1151, 61% females, 39% males) admitted to an OTP from July 1, 2014, to June 30, 2016, was employed. The data were for single episodes of care up to 52 weeks. Survival analysis (cox proportional hazards regression) assessed the relationship of personal characteristics, socio-economic status, payment for services, type of substance use, comprehensive care and social support with counselling for up to a year. Results indicated that age, having services paid for by public means, was associated with counselling adherence. Primary heroin use patients had a higher risk of counselling adherence failure than patients who primarily used non-medicinal prescription substances. Treatment agencies may benefit from funding and using evidence-based practices for primary heroin use patients and young adults to better engage and retain these populations in treatment.

Risk Factors for Substance Use across the Lifespan

Substance use is a perennial public health concern with associated health risks and economic impacts on society. In this article, we present a selective review of the epidemiological and clinical literatures on alcohol and substance use from a lifespan developmental perspective. We compare and contrast risk factors for the initiation of use and the development of a substance use disorder in adolescence, young adulthood, middle-age and later life. During adolescence, alcohol use experimentation is at its peak. Specific risk factors have been identified including trauma and parenting style that can increase the risk of substance use for teenagers. Emerging adults and college students are likely to experiment with other substances in addition to alcohol such as nicotine, marijuana, cocaine, and prescription medication such as Adderall. Middle-age and older adults with alcohol and substance use in their developmental histories may have an undiagnosed alcohol use disorder. Others will develop a late-onset substance use disorder in older age, possibly due to a dearth of social support, coping with bereavement, and medical complication. Based on Social Cognitive Theory, the roles of expectancies and self-efficacy are hypothesized to impact substance use and the risk of substance use disorder across the lifespan. Implications of the present review for future research on age-specific risk factors in alcohol use in relation to underlying developmental processes are considered.

Correlates of treatment engagement and client outcomes: results of a randomised controlled trial of nabiximols for the treatment of cannabis use disorder

INTRODUCTION AND AIMS

There is increasing interest and evidence for the use of cannabinoid medications in the treatment of cannabis use disorder, but little examination of the correlates of successful treatment. This paper is a secondary analysis of a randomised placebo-controlled trial of nabiximols for the treatment of cannabis use disorder (CUD), aiming to identify which client and treatment characteristics impact treatment engagement and outcomes.

METHOD

Bayesian multiple regression models were used to examine the impact of age, gender, duration of regular cannabis use, daily quantity of cannabis, cannabis use problems, self-efficacy for quitting, sleep, mental health, pain measures, and treatment group upon treatment engagement (retention, medication dose, and counselling participation) and treatment outcomes (achieving end-of-study abstinence, and a 50% or greater reduction in cannabis use days) among the 128 clients participating in the 12-week trial.

RESULTS

Among the treatment factors, greater counselling attendance was associated with greater odds of abstinence and ≥ 50% reduction in cannabis use; nabiximols with greater odds of ≥ 50% reduction and attending counselling, and reduced hazard of treatment dropout; and higher dose with lower odds of ≥ 50% reduction. Among the client factors, longer duration of regular use was associated with higher odds of abstinence and 50% reduction, and lower hazard of treatment dropout; greater quantity of cannabis use with reduced hazard of dropout, greater odds of attending counselling, and higher average dose; greater pain at baseline with greater odds of ≥ 50% reduction and higher average dose; and more severe sleep issues with lower odds of ≥ 50% reduction. Males had lower odds of attending counselling.

DISCUSSIONS AND CONCLUSIONS

These findings suggest that counselling combined with agonist pharmacotherapy may provide the optimal treatment for cannabis use disorder. Younger clients, male clients, and clients with sleep issues could benefit from extra support from treatment services to improve engagement and outcomes.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12616000103460) https://www.anzctr.org.au.

Drug and alcohol practitioners' attitudes toward the use of standardized assessment

Despite their importance to evidence-based assessment, standardized assessments remain underutilized by mental health practitioners in practice. The underutilization has been attributed to a lack of appreciation of the importance of standardized assessments, lack of knowledge of standardized assessments, and practical barriers to implementation. This study sought to gather the first descriptive data on alcohol and other drug (AOD) practitioners' attitudes toward, and knowledge and self-reported use of, standardized assessments. Practical barriers to implementation in initial assessment and progress monitoring were also assessed. Ninety-nine Australian AOD practitioners recruited via newsletters of national representative bodies and practitioner networks completed an online survey. While practitioners' attitudes towards using standardized assessments for initial assessment and progress monitoring were generally positive and consistent with other populations of health practitioners, assessments remained underutilized in practice. Most AOD practitioners did not consider standardized assessments to be feasible to implement. The current findings highlight the importance of practical barriers, particularly organization-level barriers, in the underutilization of standardized assessments in AOD practice. Findings support an extension of dialogue surrounding evidence-based practice beyond treatment selection to include assessment practices at a more general level. The present study offers a starting point from which efforts to improve practitioner compliance with evidence-based best practices can be conceived, designed, and implemented.

Pattern of predictive features of continued cannabis use in patients with recent-onset psychosis and clinical high-risk for psychosis

Continued cannabis use (CCu) is an important predictor for poor long-term outcomes in psychosis and clinically high-risk patients, but no generalizable model has hitherto been tested for its ability to predict CCu in these vulnerable patient groups. In the current study, we investigated how structured clinical and cognitive assessments and structural magnetic resonance imaging (sMRI) contributed to the prediction of CCu in a group of 109 patients with recent-onset psychosis (ROP). We tested the generalizability of our predictors in 73 patients at clinical high-risk for psychosis (CHR). Here, CCu was defined as any cannabis consumption between baseline and 9-month follow-up, as assessed in structured interviews. All patients reported lifetime cannabis use at baseline. Data from clinical assessment alone correctly classified 73% (p < 0.001) of ROP and 59 % of CHR patients. The classifications of CCu based on sMRI and cognition were non-significant (ps > 0.093), and their addition to the interview-based predictor via stacking did not improve prediction significantly, either in the ROP or CHR groups (ps > 0.065). Lower functioning, specific substance use patterns, urbanicity and a lack of other coping strategies contributed reliably to the prediction of CCu and might thus represent important factors for guiding preventative efforts. Our results suggest that it may be possible to identify by clinical measures those psychosis-spectrum patients at high risk for CCu, potentially allowing to improve clinical care through targeted interventions. However, our model needs further testing in larger samples including more diverse clinical populations before being transferred into clinical practice.

Development and validation of the Stimulant Refusal Self-Efficacy Questionnaire (SRSEQ) in stimulant users in treatment

BACKGROUND

Self-efficacy is a core component of Social Cognitive Theory. Refusal self-efficacy is an individual's belief in their ability to refuse a substance in specific high-risk situations. Change in refusal self-efficacy is predictive of positive treatment outcomes. Measurement of refusal self-efficacy is critical as it directs coping skills development techniques though existing behavioural treatments. There is no validated measure of stimulant refusal self-efficacy. This study developed and validated the Stimulant Refusal Self-Efficacy Questionnaire (SRSEQ) to measure confidence in the ability to refuse stimulants in specific high-risk situations.

METHOD

Two hundred and seven stimulant-using patients referred for assessment completed the SRSEQ and measures including stimulant dependence severity (Severity of Dependence Scale-Stimulant, SDS-S). Confirmatory Factor Analysis (CFA) using structural equation modelling (SEM) was conducted to test the theoretically-driven three-factor structure of the SRSEQ. Criterion validity was tested with severity of stimulant dependence.

RESULTS

The CFA supported the three-factor structure. Emotional Relief (β = -0.27, p = .008), Opportunistic (β = -0.24, p = .013) and Social Facilitation (β = -0.32, p < .001) refusal self-efficacy were uniquely associated with stimulant dependence severity, explaining 55.1% variance.

CONCLUSIONS

The SRSEQ is psychometrically sound and may be clinically useful to assist with assessment and treatment planning for stimulant use disorder.

Precision Mental Health Care for Cannabis Use Disorder: Utility of a bioSocial Cognitive Theory to Inform Treatment

Globally, cannabis is the most frequently used controlled substance after alcohol and tobacco. Rates of cannabis use are steadily increasing in many countries and there is emerging evidence that there is likely to be greater risk due to increased concentrations of delta-9-tetrahydrocannabinol (THC). Cannabis use and Cannabis Use Disorder (CUD) has been linked to a wide range of adverse health outcomes. Several biological, psychological, and social risk factors are potential targets for effective evidence-based treatments for CUD. There are no effective medications for CUD and psychological interventions are the main form of treatment. Psychological treatments based on Social Cognitive Theory (SCT) emphasize the importance of targeting 2 keys psychological mechanisms: drug outcome expectancies and low drug refusal self-efficacy. This mini-review summarizes the evidence on the role of these mechanisms in the initiation, maintenance, and cessation of cannabis use. It also reviews recent evidence showing how these psychological mechanisms are affected by social and biologically-based risk factors. A new bioSocial Cognitive Theory (bSCT) is outlined that integrates these findings and implications for psychological cannabis interventions are discussed. Preliminary evidence supports the application of bSCT to improve intervention outcomes through better targeted treatment.

Additive effectiveness and feasibility of a theory-driven instant assessment and feedback system in brief cannabis intervention: A randomised controlled trial

Assessment and personalised feedback are important components of brief interventions (BIs) for cannabis use. A key outcome is to increase motivation to change during this short interaction. The diversity of available assessments and time burden scoring them pose a challenge for routine use in clinical practice. An instant assessment and feedback (iAx) system was developed to administer assessments informed by bioSocial Cognitive Theory, that were instantly scored and benchmarked against clinical norms, to provide patient feedback and guide treatment planning. This study evaluated the feasibility and additive effectiveness of the iAx on motivation to change cannabis use, when compared to treatment as usual (TAU), in a single-session BI. A randomised controlled trial was conducted in a public hospital alcohol and drug outpatient clinic. Eighty-seven cannabis users (M_age = 26.41; 66% male) were assigned to the BI utilising the iAx (iAx; n = 44) or to the standard BI (TAU; n = 43). Patients completed pre- and post-BI assessments of motivation to change and a post-BI measure of treatment satisfaction. Practitioners completed a feedback survey. Patients receiving iAx reported a significantly greater increase in motivation to change from pre- to post-BI compared to patients receiving TAU (d = 0.49, p = .03). Treatment satisfaction was high across both conditions, with no significant difference between groups (p = .57). Practitioners also reported a high level of satisfaction with the iAx system. In summary, findings support the feasibility and additive effectiveness of the iAx to enhance patient motivation during cannabis BI.

Impact of a computerized intervention for high distress intolerance on cannabis use outcomes: A randomized controlled trial

OBJECTIVE

Prevalence of regular cannabis use and cannabis use disorder (CUD) have increased in the past two decades, but treatment-seeking is low and extant brief interventions do not target causal risk factors implicated in etiological models of addiction. Elevated distress intolerance (DI) is one risk factor that has been empirically linked with greater CUD severity and maintenance in regular users, but, to our knowledge, research has never targeted it in a brief intervention among cannabis users with CUD or at high risk. The current RCT evaluated the impact of a DI intervention (i.e., Distress Tolerance Intervention [DTI]) compared to a healthy habits control intervention (i.e., Healthy Video Control [HVC]) on DI and cannabis use outcomes.

METHOD

We randomized cannabis users with high DI (N = 60) to the DTI or HVC condition and they received two computerized intervention sessions. We assessed relief cannabis craving at pre- and post-treatment; and we assessed DI, cannabis use coping motives, use-related problems, and use frequency at pre- and post-treatment as well as one- and four-month follow-ups. We assessed CUD symptoms via interviews at pre-treatment and four-month follow-up.

RESULTS

Significant, durable reductions in DI and all cannabis use outcomes occurred in both conditions. Compared to the HVC condition, the DTI led to greater reductions in use frequency during the treatment period. Reductions in self-reported DI were correlated with reductions in coping motives and CUD symptoms.

CONCLUSION

The DTI's impact on all outcomes was largely comparable to the control condition, though it may have utility as an adjunctive intervention.

Distress Tolerance as a Familial Vulnerability for Distress-Misery Disorders

Low perceived distress tolerance (DT), a trait-like individual difference factor reflecting one's perceived ability to withstand aversive affective states, has been linked with current internalizing and substance use disorders (SUDs). However, perceived DT has not been systematically evaluated as a familial, transdiagnostic vulnerability factor for internalizing and SUDs. The current study tested whether perceived DT runs in families and whether it is reduced among individuals with versus without remitted internalizing/SUD psychopathology. Perceived DT and internalizing/SUDs were measured in 638 individuals (nested within 256 families). Analyses also adjusted for the effects of neuroticism to test whether DT was a specific vulnerability factor independent of temperamental negative affect. Analyses revealed that perceived DT was lower in individuals with remitted distress (i.e., major depression, generalized anxiety disorder, posttraumatic stress disorder) but not fear disorders (i.e., panic disorder, social anxiety disorder, specific phobia, obsessive-compulsive spectrum disorders) relative to healthy controls, and the effect of distress-misery disorder history remained significant when adjusting for neuroticism. Perceived DT was not significantly different among individuals with versus without a remitted SUD. There were no effects for comorbid SUD and distress-misery disorders. Finally, perceived DT was also significantly correlated within families, suggesting that it runs in families. Overall, results suggest that independent of neuroticism, low perceived DT is a familial vulnerability for distress (but not fear or substance use) disorders.

Prevalence of drug use, alcohol consumption, cigarette smoking and measure of socioeconomic-related inequalities of drug use among Iranian people: findings from a national survey

Background

Drug use can lead to several psychological, medical and social complications. The current study aimed to measure and decomposes socioeconomic-related inequalities in drug use among adults in Iran.

Methods

This was a cross-sectional study The PERSIAN Cohort is the largest and most important cohort among 18 distinct areas of Iran. This study was conducted on 130,570 adults 35 years and older. A structured questionnaire was applied to collect data. The concentration index (C) was used to quantify and decompose socioeconomic inequalities in drug use.

Results

The prevalence experience of drug use was 11.9%. The estimated C for drug use was − 0.021. The corresponding value of the C for women and men were − 0.171 and − 0.134, respectively. The negative values of the C suggest that drug use is more concentrated among the population with low socioeconomic status in Iran (p < 0.001). For women, socioeconomic status (SES) (26.37%), province residence (− 22.38%) and age (9.76%) had the most significant contribution to socioeconomic inequality in drug use, respectively. For men, SES (80.04%), smoking (32.04%) and alcohol consumption (− 12.37%) were the main contributors to socioeconomic inequality in drug use.

Conclusions

Our study indicated that drug use prevention programs in Iran should focus on socioeconomically disadvantaged population. Our finding could be useful for health policy maker to design and implement effective preventative programs to protect Iranian population against the drug use.

The Role of Affect in Psychosocial Treatments for Substance Use Disorders

PURPOSE OF REVIEW

This paper provides a narrative review of studies published over the past five years that have examined the role of affect, including both affective symptoms and affective disorders, in psychosocial treatments for substance use disorder.

RECENT FINDINGS

A growing body of literature suggests that affective symptoms and affective disorders may moderate substance use disorder treatment efficacy, mediate the effects of treatment on substance use outcomes, and may be directly changed by substance use disorder treatment.

SUMMARY

Substance use disorders and affective disorders commonly co-occur, and both affect and affective disorders are associated with substance use disorder treatment outcomes. Future research should continue to examine affect as a moderator, mediator, and outcome of substance use disorder treatments. In particular, new studies that are designed to test precision medicine hypotheses would greatly expand our understanding of the role of affective symptoms and disorders in substance use disorder treatment.

Predictive Outcome Validity of General Health Questionnaire (GHQ-28) in Substance Abuse Patients Treated in Therapeutic Communities

Objective: The use of psychoactive substances has been one of the most important global public health problems over the last few decades. Among the problems associated with substance use, dual diagnosis is one of the most relevant. This study aims to investigate the predictive validity of the GHQ-28 (General Health Questionnaire-28; "probable psychiatric cases") in relation to poor treatment outcome measured by (a) "early treatment dropout" and (b) "nonclinically relevant improvement at discharge." Methods: A longitudinal prospective design was used. A sample of 219 substance use disorder patients, who received treatment in a therapeutic community, was selected. Patients were assessed using the GHQ-28 and the outcome variables were registered. A hierarchical logistic regression model was performed to identify factors independently associated with the outcome measure ("early treatment dropout" and "nonclinically relevant improvement at discharge"). Results: Of the total sample, 79 subjects (36%) were considered "early treatment dropouts" and 56.6% (102) presented a "nonclinically relevant improvement at discharge." The two hierarchical logistic regression results show that being classified as a "probable psychiatric case" was significantly and directly associated with "early treatment dropout" and "nonclinically relevant improvement at discharge," as a poor in-treatment outcome indicator. Conclusions: The results of this study support the notion that the probable psychiatric cases identified by the GHQ-28 scale have a greater probability of "early treatment dropout" and have a greater probability of "nonclinically relevant improvement in discharge" of the therapeutic community. These data indicate that GHQ-28 is a suitable clinical instrument for predicting dropout and treatment effect in residential substance use disorder treatment.

Passion for Marijuana Use Mediates the Relations between Refusal Self-Efficacy and Marijuana Use and Associated Consequences

Marijuana (MJ) refusal self-efficacy and obsessive/harmonious passion for MJ use are associated with use and related consequences but have not been examined simultaneously. We examined the relation among obsessive/harmonious passion for MJ use, refusal self-efficacy, frequency of use, and related consequences in an online community sample (n = 524; mean age = 23.78; 87.5% male). A path analysis revealed that, while controlling for the relationship between MJ use and consequences, lower refusal self-efficacy was related to greater obsessive passion and to greater harmonious passion, and was associated with more consequences but not with MJ use. Greater obsessive passion was associated with greater MJ use frequency and consequences, and greater harmonious passion was related to greater MJ use frequency and fewer consequences. Obsessive passion mediated the relation between lower refusal self-efficacy and greater MJ use and more consequences, and harmonious passion mediated the relation between lower refusal self-efficacy and consequences. Passion mediates the relationships between refusal self-efficacy and MJ use and consequences, with obsessive passion being the stronger mediator. Passion could be a relevant target in interventions aimed at changing a person's MJ use.

Distress intolerance moderation of motivated attention to cannabis and negative stimuli after induced stress among cannabis users: an ERP study

Prevalence of cannabis use is increasing, but many regular users do not develop cannabis use disorder (CUD); thus, CUD risk identification among current users is vital for targeted intervention development. Existing data suggest that high distress intolerance (DI), an individual difference reflective of the ability to tolerate negative affect, may be linked to CUD, but no studies have tested possible neurophysiological mechanisms. Increased motivated attentional processing of cannabis and negative emotional stimuli as indexed by neurophysiology [i.e. the late positive potential (LPP)], particularly during acute stress, may contribute to CUD among high DI users. Frequent cannabis users with high (n = 61) and low DI (n = 44) viewed cannabis, negative, and matched neutral images during electroencephalography (EEG) recording before and after a laboratory stressor. Cannabis cue-elicited modulation of the 1000- to 3000-milliseconds LPP was larger in high DI users at post-stressor only, although the effect was only robust in the 1000- to 2000-milliseconds window. Further, modulation magnitude in the high DI group covaried with stress-relief craving and some CUD indices in the 400- to 1000-milliseconds and 1000- to 3000-milliseconds windows, respectively. No significant effects of DI on negative stimuli-elicited LPP modulation were found, although inverse associations with some CUD indices were observed. Finally, exploratory analyses revealed some evidence for DI moderation of the relation between subjective stressor reactivity and negative stimuli-elicited LPP modulation such that greater stressor reactivity was associated with blunted versus enhanced modulation in the high and low DI groups, respectively. Negative and cannabis stimuli-elicited LPP modulation appear to index distinct, CUD-relevant neural processes in high DI cannabis users.

Marijuana protective behavioral strategies and marijuana refusal self-efficacy: Independent and interactive effects on marijuana-related outcomes

Separately, research has identified use of marijuana protective behavioral strategies and marijuana refusal self-efficacy to be protective factors associated with less marijuana use and associated harms. To date, these factors have not been examined together. Using a large sample of college students recruited from 10 U.S. universities (n = 1,123), we examined the extent to which use of marijuana protective behavioral strategies and marijuana refusal self-efficacy have redundant, independent, or interactive effects on a wide range of marijuana-related outcomes using cross-sectional data. Across 9 marijuana-related outcomes, we found 1 significant buffering interaction (length of typical intoxication), 1 significant synergistic interaction (peak subjective intoxication), and 7 nonsignificant interactions (past month frequency, typical frequency, typical quantity, typical subjective intoxication, frequency of peak intoxication, negative consequences, and cannabis use disorder symptoms). Despite variability across distinct outcomes, on 8 of 9 of these outcomes, we found that individuals who reported high use of marijuana protective behavioral strategies and high levels of marijuana refusal self-efficacy demonstrated the lowest rates of marijuana use/harms. Our findings suggest that both of these factors are promising intervention targets, and future studies should examine distinct intervention strategies to modify use of marijuana protective behavioral strategies and marijuana refusal self-efficacy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Testing the biosocial cognitive model of substance use in cannabis users referred to treatment

BACKGROUND

The bioSocial Cognitive Theory (bSCT) hypothesizes two pathways linking dimensions of impulsivity to substance use. The first predicts that the association between reward sensitivity and substance use is mediated by positive outcome expectancies. The second predicts that the relationship between rash impulsiveness and substance use is mediated by refusal self-efficacy. This model has received empirical support in studies of alcohol use. The present research provides the first application of bSCT to a cannabis treatment population and aims to extend its utility to understanding cannabis use and severity of dependence.

DESIGN

273 patients referred for cannabis treatment completed a clinical assessment that contained measures of interest.

SETTING

A public hospital alcohol and drug clinic.

MEASUREMENTS

The Sensitivity to Reward Scale, Dysfunctional Impulsivity Scale, Cannabis Expectancy Questionnaire, Cannabis Refusal Self-Efficacy Questionnaire and Severity of Dependence Scale-Cannabis were completed, along with measures of cannabis consumption.

FINDINGS

The bSCT model provided a good fit to the data for cannabis use and severity of dependence outcomes. The association between reward sensitivity and each cannabis outcome was fully mediated by positive cannabis expectancies and cannabis refusal self-efficacy. The relationship between rash impulsiveness and each cannabis outcome was fully mediated by cannabis refusal self-efficacy.

CONCLUSIONS

Findings support the application of the bSCT model to cannabis use and dependence severity and highlight the important role of social cognitive mechanisms in understanding the association between impulsivity traits and these outcomes. The differential association of impulsivity traits to social cognition may assist targeted treatment efforts.

Distress intolerance moderation of neurophysiological markers of response inhibition after induced stress: Relations with cannabis use disorder

Cannabis use is prevalent but only a minority of regular users develop cannabis use disorder (CUD); thus, CUD risk identification among current cannabis users is vital for targeted intervention development. Existing data suggest that high distress intolerance (DI), an individual difference reflective of the ability to withstand negative affect, is linked to CUD, possibly via stress-elicited impairment of response inhibition but this has never been explicitly tested. Frequent cannabis users with high and low DI completed a go/no-go task during EEG recording before and after a laboratory stressor. Relations between DI, cannabis use-related problems, and behavioral as well as neurophysiological markers of response inhibition functioning were assessed. DI significantly moderated the effect of the stressor on the conflict-monitoring but not evaluative phase of response inhibition as measured by N2 and P3a amplitude, respectively. Unexpectedly, cannabis users with high DI demonstrated stressor-elicited enhancement rather than impairment of conflict-monitoring neural activity, which was related to faster reaction time (RT) and decreased past-month cannabis problems. Enhanced inhibition-related modulation of P3a amplitude was generally associated with increased cannabis problems regardless of acute stress. Results did not provide support for stress-elicited impairment in cognitive control as a mechanism linking high DI and CUD, though some support was found for the relevance of inhibition-related neural activity to CUD. Stress-elicited enhancement of conflict-monitoring neural activity during response inhibition may reflect an adaptive neural response among cannabis users with high DI that protects against CUD in this at-risk group. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Missing Data Techniques and the Statistical Conclusion Validity of Survey-Based Alcohol and Drug Use Research Studies: A Review and Comment on Reproducibility

The goal of the present review was to examine whether or not the use of modern missing data techniques impacts the statistical conclusion validity of research on alcohol and drug use outcomes in survey-based research studies. We identified 28 papers and received complete case data from the authors of 12 studies. Seven studies (25%) reported the missing data pattern (missing not at random [MNAR], missing at random [MAR], missing completely at random [MCAR]), 15 studies (53.6%) indicated the amount of missing observations in the data set, and a significant proportion of studies ( n = 13, 46.4%) did not report any of the conditions or assumptions under which the missing data analysis was performed or implemented. Six of the 12 (50%) studies analyzed reported a different number of statistically significant associations between the complete case and full sample analyses. Efforts should be made to make missing data analysis more accessible, easy to implement and report to improve transparency and reproducibility of findings.

A biosocial cognitive model of cannabis use in emerging adulthood

OBJECTIVES

The aim of this study was to test a new theoretical model of cannabis use incorporating biologically-based personality traits and social cognition. This biosocial cognitive theory (bSCT) has robust support in alcohol studies, but has not been applied to cannabis. The model proposes two pathways linking dimensions of impulsivity to cannabis use. The first predicts that the association between Reward Sensitivity (SR) and cannabis use is mediated by positive outcome expectancies. The second predicts that the relationship between Rash Impulsiveness (RI) and cannabis use is mediated by cannabis refusal self-efficacy. An extended version of this model was also tested and included a third pathway linking Punishment Sensitivity (SP) to cannabis use via higher negative outcome expectancies.

METHOD

Participants were 252 18-to-21-year-olds who completed questionnaires assessing cannabis use, personality and social cognition. Theoretical models were tested using structural equation modeling.

RESULTS

The bSCT model provided a good fit to the data (CFI=0.95; RMSEA=0.07; SRMR=0.06). Positive cannabis expectancies and refusal self-efficacy partially mediated the association between SR and cannabis use (p<0.05). Cannabis refusal self-efficacy fully mediated the relationship between RI and cannabis use (p<0.05). The addition of a third SP pathway did not improve model fit.

CONCLUSIONS

Consistent with alcohol studies, the association between impulsivity and cannabis use is largely mediated by social cognition. The bSCT may provide novel insights to inform prevention and treatment of problematic cannabis use.

Treatment seeking in cannabis dependence: The role of social cognition

BACKGROUND AND AIMS

Relatively few cannabis dependent individuals seek treatment and little is known about the determinants of treatment seeking. Social Cognitive Theory (SCT) provides a useful framework for examining human behaviour and motivation which may be helpful in explaining treatment seeking. This study examined the differences in cannabis outcome expectancies and cannabis refusal self-efficacy between treatment seekers and non-treatment seekers with cannabis dependence.

DESIGN

Non-treatment seekers were referred to an illicit drug diversion program. Treatment seekers commenced an outpatient cannabis treatment program and completed a comprehensive assessment that included measures of cannabis outcome expectancies and refusal self-efficacy.

SETTING

A public hospital alcohol and drug outpatient clinic.

PARTICIPANTS

269 non-treatment seekers and 195 individuals commencing cannabis dependence treatment.

MEASUREMENTS

The Cannabis Expectancy Questionnaire (CEQ), Cannabis Refusal Self-Efficacy Questionnaire (CRSEQ), Severity of Dependence Scale - Cannabis (SDS-C), General Health Questionnaire (GHQ-28) and Readiness to Change Questionnaire (RTC) were completed.

FINDINGS

Treatment seekers had significantly higher levels of negative cannabis outcome expectancies and significantly lower levels of emotional relief refusal self-efficacy (belief in ability to resist using cannabis when experiencing negative affect) (ps<0.001). Treatment seekers had significantly higher levels of psychological distress and self-perceived cannabis dependence compared to non-treatment seekers (ps<0.001).

CONCLUSIONS

High negative cannabis outcome expectancies and low emotional relief refusal self-efficacy may play a key role in motivation to seek treatment.