Anger is more strongly associated with alcohol and tobacco use and use disorders compared to other substances in American adults

Background: Anger is elevated in substance use disorders (SUDs) and related to problematic use. However, it is unclear whether anger is elevated in individuals who use substances, is only heightened among those with SUDs, and whether anger is more strongly tied to use of certain substances or SUDs.Objectives: We examine the association between anger, general substance use and SUDs.Methods: Data is N = 28,753 (55% female) respondents from the NESARC-III. Participants endorsing anger and indicating negative functional impact were deemed to have experienced significant anger.Results: Logistic regression examining the relative strength of associations between anger, substance use and SUDs (alcohol, opioid, stimulant, tobacco and cannabis) indicated that having a SUD was associated with anger beyond use alone. Alcohol (adjusted odds ratio [AOR] = 1.45; 95% CI 1.32-1.6) and tobacco (AOR = 1.38; 95% CI 1.27-1.51) use displayed the strongest odds of experiencing anger above and beyond other substances in the model. Similarly, alcohol (AOR = 1.45; 95% CI 1.31-1.62) and tobacco (AOR = 1.46; 95% CI 1.3-1.64]) use disorders had the greatest odds of anger relative to other SUDs. These results were significant after controlling for mood, anxiety disorders, and PTSD and no sex differences were observed.Conclusion: These results indicate that SUDs, particularly alcohol and tobacco use and disorders, are positively associated with experiencing anger beyond just substance use. Research must identify the mechanism driving this association to enhance treatments that target anger.

Narratives of holistic mental health recovery in New Zealand Defence Force personnel

Research on military mental health recovery has tended to focus on therapy outcomes while backgrounding the role of diverse healing influences. The New Zealand Defence Force (NZDF) is a bicultural military integrated with Māori customs and cultural perspectives on holistic health and wellbeing. This study used narrative analysis to examine the semi-structured interviews of 21 active duty NZDF personnel who had accessed mental healthcare to understand what factors contributed to their return to wellness. Narratives described an orientation toward recovery as a process, where many interrelated wellbeing and social factors together supported the return to health. Culturally available Māori wellbeing metaphors were adopted as heuristics by service members in their storying of growth and healing. Findings are considered in terms of how wellbeing and recovery are conceptualized and promoted within militaries with diverse cultures. Discussion focuses on how narratives within military institutions can promote resilience and support service member recovery from mental distress.

Development of a Telephone-Delivered Acceptance and Commitment Therapy Intervention for People Living with HIV who are Hazardous Drinkers

Alcohol use among people living with HIV (PWH) has been increasingly recognized as an important component of HIV care. Transdiagnostic treatments, such as Acceptance and Commitment Therapy (ACT), that target core processes common to multiple mental health and substance-related problems, may be ideal in HIV treatment settings where psychological and behavioral health comorbidities are high. In advance of a randomized clinical trial (RCT), the overall objective of this study was to systematically adapt an ACT-based intervention originally developed for smoking cessation, into an ACT intervention for PWH who drink at hazardous levels. Consistent with the ADAPT-ITT model, the adaptation progressed systematically in several phases, which included structured team meetings, three focus group discussions with PWH (N = 13), and in-depth interviews with HIV providers (N = 10), and development of standardized operating procedures for interventionist training, supervision, and eventual RCT implementation. The procedures described here offer a template for transparent reporting on early phase behavioral RCTs.

"Choose change": design and methods of an acceptance and commitment therapy effectiveness trial for transdiagnostic treatment-resistant patients

BACKGROUND

Acceptance and Commitment Therapy (ACT) has been successfully established in hundreds of efficacy trials. It is less understood, however, how ACT works in real-world settings. Furthermore, little is known about how contextual variables such as treatment setting (inpatient vs. outpatient), social network and environment of the patient impact outcome.

METHODS

This paper describes the methods of the Choose Change study that compares transdiagnostic inpatients (n = 85) and outpatients (n = 85) with varying degrees of treatment experience and treatment success (i.e., no previous treatment vs. previous remission vs. treatment-resistant). Patients received ACT during an intensive treatment phase lasting approximately twelve treatment sessions, and were accompanied up to twelve months following intensive treatment. Main outcomes include symptoms, functioning, and well-being. Multiple levels of data are investigated, including treatment context, weekly assessments, a behavioral approach test, multiple follow-up phases, and ambulatory assessment using Event Sampling Methodology, to examine patients' daily context.

DISCUSSION

We aim to investigate antecedents, consequences, and inherent processes that contribute to the maintenance or fluctuations of psychological disorders and the efficacy of ACT treatment. Furthermore, this study intends to increase understanding of how accurately participants can report on their own experiences, in order to expand our knowledge of how to probe for such information in the future. The results of Choose Change will provide basic clinical theory and clinical care with important and meaningful insights into the effectiveness of ACT, trans diagnostically, in in- and outpatients, and in a naturalistic setting.

TRIAL REGISTRATION

This study was retrospectively registered in the ISRCTN Registry (registration number ISRCTN11209732 ) on May 20th 2016.