A mindfulness-based, stress and coping model of craving in methamphetamine users

Narratives of Disconnection: A Life Course Perspective of Methamphetamine Use Among Sexual Minority Men Living with HIV

BACKGROUND

Sexual minority men (SMM) are exposed to societal and structural stressors that translate into poor health outcomes. One such outcome is substance use, which research has long documented as a prominent disparity among SMM. Methamphetamine is a particularly deleterious substance for SMM because its use is often framed as a coping response to social and structural stressors.

METHOD

Guided by stress and coping theory and a life course perspective, the purpose of this qualitative study is to assess the development of coping strategies in the context of prominent social and structural determinants among SMM living with HIV who use methamphetamine.

RESULTS

Data were collected from 2016 to 2018 via in-depth interviews with 24 SMM living with HIV who use methamphetamine in San Francisco, CA. Mean age of participants was 47 and over half self-identified as ethnoracial minorities. Narrative analysis surfaced a sequential pattern of disconnection at foundational, relational, and recovery levels. This analysis revealed that multi-level stressors were present across the life course that amplified engagement in methamphetamine use.

CONCLUSION

Findings highlight the benefits of holistic, integrated, and trauma-informed approaches to address the function of methamphetamine use as a response to societal, cultural, and institutional processes of stigmatization and discrimination. Peer-based approaches may also be beneficial to reframe the ways in which SMM living with HIV who use methamphetamine form and sustain relationships.

In the Interest of Time: Assessing the Role of Resilience Across an Intergenerational Sample of People Living with HIV

BACKGROUND

Biomedical advances have improved the quality of life of people living with HIV (PLWH); however, barriers to optimal well-being remain. A key feature in understanding the lived experiences of PLWH is resilience. The concept of resilience is quite complex in terms of its antecedents and expressions, suggesting the need for more nuanced understandings of how it could be harnessed to better support this population.

METHOD

The concept of resilience was explored in a qualitative study involving 22 PLWH, selectively sampled by era of diagnosis. Through interviews focused on context and experiences of living with HIV, the sample highlighted resilience processes corresponding to Positive reappraisal of life events, Positive reappraisal of self, and Community as resilience.

RESULTS

Participants who have lived with HIV longer more commonly described engaging in psychological processes of resilience, whereas those who were more recently diagnosed reported engaging in more social processes. However, these processes were not mutually exclusive and the ability to perform resilience through community seems to be key to optimizing outcomes, irrespective of era of diagnosis.

CONCLUSION

PLWH are a heterogeneous population where engagement in distinct processes of resilience may have important implications for optimal social and health outcomes. Better understanding of the distinct and diverse pathways through which PLWH engage in resilience may inform interventions promoting optimal well-being.

Mindfulness and clinical correlates in methamphetamine use disorder

BACKGROUND

Mindfulness-based interventions are increasingly used for the treatment of substance use disorders, including methamphetamine use disorder (MUD). Literature indicates that trait mindfulness may play a key role in the effectiveness of these treatments on therapeutic outcome, yet no prior studies have tested for differences in trait mindfulness between individuals with MUD and healthy control participants. Such differences are important for treatment implementation.

OBJECTIVES

The goals of this study were to evaluate trait mindfulness and to determine its clinical correlates in individuals with MUD.

METHODS

A group of participants with MUD at varying lengths of abstinence from methamphetamine (< 1h to 90 days; mean 5.4 ± 12.5 days; N=95, 53 female, 42 male) and a healthy control group (N=65, 30 female, 35 male) completed the Mindfulness Attention Awareness Scale (MAAS). Group differences and relationships between trait mindfulness and several measures of drug use and psychiatric symptoms were evaluated.

RESULTS

In participants with MUD, trait mindfulness was 10% lower than in healthy controls (p < 0.001), but it was not significantly correlated with measures of drug use or craving. Across both groups, trait mindfulness was negatively correlated with state anxiety, depression, emotional dysregulation, impulsivity, and a history of childhood trauma, while it was positively correlated with self-compassion (ps < 0.001).

CONCLUSION

The deficit in trait mindfulness in MUD presents a capacity that can be targeted for improved treatment outcome with mindfulness-based therapies. Trait mindfulness is inversely related to mood dysregulation.

Mindfulness Intervention Improves Coping and Perceptions of Children's Behavior among Families with Elevated Risk

Mindfulness-informed interventions (MIIs) are increasingly common but have not been extensively studied among families with elevated levels of risk (e.g., those involved in child protective services and/or receiving financial assistance). These families often experience high rates of stressors that can impact coping strategies, interpersonal dynamics, and relationships. Given that mindfulness has been shown to promote health and wellbeing, this study used a sample from two pilot randomized controlled trials to test the extent to which a mindfulness-informed intervention improved coping strategies and perceptions of children's behavior among 53 families with elevated risk. A principal components analysis with a direct oblimin rotation revealed that cognitive-emotion coping strategies could be characterized by three factors: positive adaptation, negative adaptation, and positive refocusing. Intention-to-treat analysis indicated significant group by time differences, with intervention participants demonstrating improvements in positive refocusing coping, positive adaptation coping, and perceptions of children's behavior problems compared to participants in the waitlist control group. No significant differences were found for negative adaptation coping strategies. Findings provide preliminary support for the benefits of mindfulness training in a sample generally underrepresented in the mindfulness intervention literature.

What Client Demographic, Substance Use, Mental Health, Treatment, and Psychological Variables Predict Residential Treatment Completion for Substance Use Disorders?

Residential treatment is a common option for individuals with moderate to severe substance use disorders. In a cohort of individuals who accessed residential treatment, we investigated client demographic, substance use, mental health, treatment, and psychological predictors of treatment completion. Participants were a retrospective cohort of 1056 (15–69 years) individuals admitted to residential treatment facilities across Queensland, Australia, from January 2014 to December 2016. Participant characteristic information was obtained at admission, including the Depression Anxiety Stress Scale 21 (DASS-21). A multiple logistic regression model was conducted with treatment completion as the outcome. The overall rate of treatment completion was 14.3%. Mild to moderate (aOR = 0.48 [0.28–0.84], p = .010) and severe to extremely severe (aOR = 0.35 [0.17–0.74], p = .006) stress on the DASS-21 at service entry was significantly associated with a lower likelihood of treatment completion. Participants with higher levels of stress at service entry were less likely to complete treatment, representing a missed opportunity to provide targeted support during high-risk periods for individuals with substance use disorders. Further research investigating the nature and causes of stress in-between, during, and following presentations to residential treatment is needed.

Examining the Relationships between Mindfulness and Tobacco Craving Factors

BACKGROUND

Relationships between mindfulness and general craving have been documented. However, there is still no data regarding relationships between mindfulness and the different craving factors.

METHODS

Using data from an online survey among hospital workers smoking tobacco in France (n = 127), we performed linear regression models with the four craving factors as outcomes, and dispositional mindfulness as explanatory variable.

RESULTS

After adjusting for nicotine dependence, mindfulness was negatively associated with general craving and three out of four craving factors (emotionality, compulsivity and purposefulness, but not expectancy).

CONCLUSIONS

These results support the implementation of mindfulness-based interventions in the context of tobacco cessation attempt.

Optimizing outpatient treatment outcomes among methamphetamine-using gay and bisexual men through a computerized depression intervention

INTRODUCTION

Depression is a common sequelae of frequent methamphetamine use, and may influence rates of engagement in sexual risk-taking among methamphetamine-using cisgender gay, bisexual, and other men who have sex with men (GBMSM). The study team hypothesized that layering a brief, computerized depression intervention (i.e., MoodGym; based on Cognitive Behavioral Therapy [CBT] and Interpersonal Therapy) on top of a long-running outpatient methamphetamine treatment program (based on CBT and Contingency Management) for GBMSM could optimize reductions in methamphetamine use and sexual risk-taking among program participants.

METHODS

This pilot study, which also included analysis of historical data, employed nearest-neighbor matching algorithms to match current pilot study participants (N = 39) to prior participants of an outpatient methamphetamine treatment program (N = 703) and employed treatment effects analyses to determine the observed effects of adding depression intervention content to GBMSM-specific methamphetamine treatment.

RESULTS

Pilot study participants who received the MoodGym intervention were significantly less likely to submit methamphetamine-metabolite positive urine samples (Adjusted Treatment Effect [ATE] = -0.72; p < 0.01), and evidenced significantly greater reductions in receptive condomless anal intercourse with non-primary partners in the past 30 days (ATE = -1.39; p < 0.05), relative to prior participants of the outpatient methamphetamine treatment program who did not receive depression intervention content.

CONCLUSION

Preliminary results suggest layering a brief computerized depression intervention onto outpatient methamphetamine treatment for GBMSM may optimize reductions in methamphetamine use and/or sexual risk-taking.