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Bizier A, Jones A, Businelle M, Kezbers K, Hoeppner BB, Giordano TP, Thai JM, Charles J, Montgomery A, Gallagher MW, Cheney MK, Zvolensky M, Garey L. An Integrated mHealth App for Smoking Cessation in Black Smokers With HIV: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e52090. [PMID: 38657227 DOI: 10.2196/52090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Black adults who smoke and have HIV experience immense stressors (eg, racial discrimination and HIV stigma) that impede smoking cessation success and perpetuate smoking-related health disparities. These stressors also place Black adults who smoke and have HIV at an increased risk of elevated interoceptive stress (eg, anxiety and uncomfortable bodily sensations) and smoking to manage symptoms. In turn, this population is more likely to smoke to manage interoceptive stress, which contributes to worse HIV-related outcomes in this group. However, no specialized treatment exists to address smoking cessation, interoceptive stress, and HIV management for Black smokers with HIV. OBJECTIVE This study aims to test a culturally adapted and novel mobile intervention that targets combustible cigarette smoking, HIV treatment engagement and adherence, and anxiety sensitivity (a proxy for difficulty and responsivity to interoceptive stress) among Black smokers with HIV (ie, Mobile Anxiety Sensitivity Program for Smoking and HIV [MASP+]). Various culturally tailored components of the app are being evaluated for their ability to help users quit smoking, manage physiological stress, and improve health care management. METHODS This study is a pilot randomized controlled trial in which Black combustible cigarette smokers with HIV (N=72) are being recruited and randomly assigned to use either (1) the National Cancer Institute's QuitGuide app or (2) MASP+. Study procedures include a web-based prescreener; active intervention period for 6 weeks; smartphone-based assessments, including daily app-based ecological momentary assessments for 6 weeks (4 ecological momentary assessments each day); a video-based qualitative interview using Zoom Video Communications software at week 6 for participants in all study conditions; and smartphone-based follow-up assessments at 0, 1, 2 (quit date), 3, 4, 5, 6, and 28 weeks postbaseline (26 weeks postquitting date). RESULTS Primary outcomes include biochemically verified 7-day point prevalence of abstinence, HIV-related quality of life, use of antiretroviral therapy, and HIV care appointment adherence at 26 weeks postquitting date. Qualitative data are also being collected and assessed to obtain feedback that will guide further tailoring of app content and evaluation of efficacy. CONCLUSIONS The results of this study will determine whether the MASP+ app serves as a successful aid for combustible cigarette smoking cessation, HIV treatment engagement, and physiological stress outcomes among Black people with HIV infection. If successful, this study will provide evidence for the efficacy of a new means of addressing major mental and physical health difficulties for this high-risk population. If the results are promising, the data from this study will be used to update and tailor the MASP+ app for testing in a fully powered randomized controlled trial that will evaluate its efficacy in real-world behavioral health and social service settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05709002; https://clinicaltrials.gov/study/NCT05709002. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52090.
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Affiliation(s)
- Andre Bizier
- University of Houston, Houston, TX, United States
| | | | - Michael Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Krista Kezbers
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Bettina B Hoeppner
- Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | | | | | | | - Audrey Montgomery
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Matthew W Gallagher
- University of Houston, Houston, TX, United States
- HEALTH Institute, Houston, TX, United States
- Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX, United States
| | - Marshall K Cheney
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
| | - Michael Zvolensky
- University of Houston, Houston, TX, United States
- HEALTH Institute, Houston, TX, United States
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lorra Garey
- University of Houston, Houston, TX, United States
- HEALTH Institute, Houston, TX, United States
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Hoeppner BB, Simpson HV, Weerts C, Riggs MJ, Williamson AC, Finley-Abboud D, Hoffman LA, Rutherford PX, McCarthy P, Ojeda J, Mericle AA, Rao V, Bergman BG, Dankwah AB, Kelly JF. A Nationwide Survey Study of Recovery Community Centers Supporting People in Recovery From Substance Use Disorder. J Addict Med 2024:01271255-990000000-00290. [PMID: 38426533 DOI: 10.1097/adm.0000000000001285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The medical community has become aware of its role in contributing to the opioid epidemic and must be part of its resolution. Recovery community centers (RCCs) represent a new underused component of recovery support. METHODS This study performed an online national survey of all RCCs identified in the United States, and used US Census ZIP code tabulation area data to describe the communities they serve. RESULTS Residents of areas with RCCs were more likely to be Black (16.5% vs 12.6% nationally, P = 0.005) and less likely to be Asian (4.7% vs 5.7%, P = 0.005), American Indian, or Alaskan Native (0.6% vs 0.8%, P = 0.03), or live rurally (8.5% vs 14.0%, P < 0.0001). More than half of RCCs began operations within the past 5 years. Recovery community centers were operated, on average, by 8.8 paid and 10.2 volunteer staff; each RCC served a median of 125 individuals per month (4-1,500). Recovery community centers successfully engaged racial/ethnic minority groups (20.8% Hispanic, 22.5% Black) and young adults (23.5% younger than 25 years). Recovery community centers provide addiction-specific support (eg, mutual help, recovery coaching) and assistance with basic needs, social services, technology access, and health behaviors. Regarding medications for opioid use disorder (MOUDs), RCC staff engaged members in conversations about MOUDs (85.2%) and provided direct support for taking MOUD (77.0%). One third (36.1%) of RCCs reported seeking closer collaboration with prescribers. CONCLUSIONS Recovery community centers are welcoming environments for people who take MOUDs. Closer collaboration between the medical community and community-based peer-led RCCs may lead to significantly improved reach of efforts to end the opioid epidemic.
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Affiliation(s)
- Bettina B Hoeppner
- From the Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA (BBH, CW, ACW, DF-A, LAH, BGB, ABD, JFK); Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom (HVS); Department of Neurology, Harvard Medical School, Boston, MA (MJR); Faces & Voices of Recovery, Washington, DC (PXR, PM); Massachusetts Bureau of Substance Addiction Services, Executive Office of Health and Human Services, Department of Public Health, Boston, MA (JO); Alcohol Research Group/Public Health Institute, Emeryville, CA (AAM); and West End Clinic, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA (VR)
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Schiff DM, Muftu S, MacMillan KDL, Work EC, Hoeppner BB, Greenfield SF, Schwartz L, Chaiyachati B, Wilens TE, Bernstein JA. Mutual Mistrust: The Multilayered Experiences at the Intersection of Healthcare and Early Parenting Among Mothers With Opioid Use Disorder. J Addict Med 2024; 18:55-61. [PMID: 37994464 PMCID: PMC10872799 DOI: 10.1097/adm.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
OBJECTIVE The aim of the study is to explore the early parenting experiences among a cohort of postpartum individuals with opioid use disorder (OUD) both during and after the delivery hospitalization to identify areas of intervention to strengthen bonding and attachment. METHODS Semistructured qualitative interviews with recently pregnant people with OUD assessed parenting needs, supports, and goals in the context of the demands of addiction treatment and early motherhood. Probes explored the relationship between early parenting experiences, addiction, and recovery, as well as enabling factors and barriers to mother-infant bonding. Interviews were completed between 2019 to 2020. A constant comparative methods approach was used for codebook development and analysis. RESULTS Twenty-six women completed interviews a mean of 10.1 months postpartum. Twenty-four women were receiving methadone or buprenorphine treatment at delivery for OUD. Four interrelated themes emerged. Women experienced the following: (1) increased surveillance from healthcare workers who doubted their parenting ability; (2) a desire for a "normal" early parenting experience that was not disrupted by increased medical monitoring and surveillance; (3) complex and intersecting identities of being both a mother and a person in recovery; and (4) the importance of support from and advocacy by clinicians and peers to developing maternal confidence and connection. CONCLUSIONS Interventions are needed to improve the early parenting experiences of opioid-exposed mother-infant dyads, to address the mutual mistrust between health care providers and parents, and to provide additional supports to families. Promotion of positive attachment and parental self-efficacy should be prioritized over increased surveillance and scrutiny to sustain maternal recovery trajectories into early childhood and foster family well-being.
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Affiliation(s)
- Davida M. Schiff
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, Massachusetts, 02114
| | - Serra Muftu
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, Massachusetts, 02114
| | | | - Erin C. Work
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, Massachusetts, 02114
| | - Bettina B. Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, Massachusetts, 02114
| | - Shelly F. Greenfield
- Division of Women’s Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, 115 Mill St, Belmont, MA 02478
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Leah Schwartz
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Barbara Chaiyachati
- Department of Pediatrics, Perelman School of Medicine, and Leonard Davis Institute, University of Pennsylvania
- Division of General Pediatrics, PolicyLab and Clinical Futures, Children’s Hospital of Philadelphia
| | - Timothy E. Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, Massachusetts, 02114
| | - Judith A. Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
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Winkelman JW, Wipper B, Zackon J, Hoeppner BB. Lack of Efficacy of Suvorexant in People with Insomnia and Poorly Controlled Type 2 Diabetes. Nat Sci Sleep 2023; 15:1117-1128. [PMID: 38152441 PMCID: PMC10752032 DOI: 10.2147/nss.s434058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023] Open
Abstract
Objective/Background Sleep disturbance is a common and underappreciated feature of diabetes and sleep may contribute to glycemic control in people with type 2 diabetes (T2D). We conducted a 3-month trial to examine the efficacy of suvorexant in improving sleep and health outcomes in people with suboptimally controlled T2D and insomnia. Participants/Methods This parallel, double-blind, randomized placebo-controlled trial was conducted using the sequential parallel comparison design (SPCD). Sixty-nine people with poorly controlled T2D (HbA1c ≥ 6.5) were randomized to placebo and/or suvorexant (10-20 mg). The primary outcome was subjective total sleep time (sTST), and secondary outcomes were Insomnia Severity Index (ISI) score and wake time after sleep onset (WASO). Exploratory outcomes included sleep efficiency, hemoglobin A1c (HbA1c), and C-reactive protein (CRP). Exploratory analyses were conducted on relationships between sleep and diabetes outcomes. Results There were no significant improvements in sTST (p = 0.27), ISI (p = 0.86), or WASO (p = 0.94) among participants taking suvorexant compared to placebo. There were also no significant changes in any of the exploratory endpoints. Improvements in sleep were associated with improvements in both objective (ie, HbA1c) and subjective (ie, Diabetes Distress Scale) measures of diabetes, as well as reductions in depressive symptoms, independent of treatment assignment. Conclusion The study did not find evidence that suvorexant is efficacious for insomnia in people with poorly controlled T2D. The associations of improved sleep with improvements in both diabetes-related metrics and depressive symptoms across groups highlight the importance of identifying and treating sleeping difficulties in this population. CT Registration # Nct03818581.
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Grants
- research grant from Investigator-Initiated Studies Program of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA
- this paper are those of the authors and do not necessarily represent those of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA
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Affiliation(s)
- John W Winkelman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Jordana Zackon
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Nyer MB, Hopkins LB, Nagaswami M, Norton R, Streeter CC, Hoeppner BB, Sorensen CEC, Uebelacker L, Koontz J, Foster S, Dording C, Giollabhui NM, Yeung A, Fisher LB, Cusin C, Jain FA, Pedrelli P, Ding GA, Mason AE, Cassano P, Mehta DH, Sauder C, Raison CL, Miller KK, Fava M, Mischoulon D. A Randomized Controlled Trial of Community-Delivered Heated Hatha Yoga for Moderate-to-Severe Depression. J Clin Psychiatry 2023; 84:22m14621. [PMID: 37883245 DOI: 10.4088/jcp.22m14621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Objective: To evaluate feasibility, acceptability, and preliminary efficacy of heated yoga to treat moderate-to-severe depression. Design: An 8-week randomized controlled trial (RCT) of heated yoga versus waitlist control was conducted from March 2017 to August 2019. Methods: Participants in the yoga condition were asked to attend heated yoga classes at 2 community heated yoga studios at least twice weekly. We assessed acceptability and feasibility using exit interview and attendance data, respectively. The primary intervention efficacy outcome variable was change in the Inventory of Depressive Symptomatology-Clinician Rated (IDS-CR) score from baseline to post-intervention (week 8). Results: We randomized 80 participants and included 65 (mean [± SD] age 32.7 [± 11.7] years; 81.5% female) in the analyses (yoga n = 33, waitlist n = 32). The mean IDS-CR score at baseline was 35.6 (± 7.9) for the full sample, 36.9 (± 8.8) for yoga participants, and 34.4 (± 6.7) for waitlist participants. Participants attended an average of 10.3 (± 7.1) total classes over the 8-week intervention period. Yoga participants had a significantly greater pre- to post-intervention reduction in IDS-CR scores than waitlist participants (Cohen d = 1.04, P < .001). More yoga participants (59.3%; n = 16) than waitlist participants (6.3%; n = 2) evidenced larger treatment responses (IDS-CR ≥ 50% decrease in symptoms). Participants rated the heated yoga and its aftereffects positively in exit interviews. Conclusions: Approximately 1 heated yoga session per week (mean of 10.3 classes over 8 weeks) was associated with significantly greater reduction in depression symptoms than a waitlist control. Participants rated heated yoga positively. Taken together, results suggest feasibility, acceptability, and preliminary efficacy for patients with depression and warrant further research using active control conditions. Trial Registration: ClinicalTrials.gov identifier: NCT02607514.
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Affiliation(s)
- Maren B Nyer
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Corresponding Author: Maren Nyer, PhD, Depression Clinical & Research Program, Massachusetts General Hospital, One Bowdoin Square, 6th Floor, Boston, MA 02139
| | | | - Megha Nagaswami
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard Norton
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Chris C Streeter
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry and Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Chloe E C Sorensen
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Lisa Uebelacker
- Alpert Medical School, Brown University, Providence, Rhode Island
- Butler Hospital, Providence, Rhode Island
| | - Jill Koontz
- Blueprint Wellness, LLC, Wakefield, Massachusetts
| | - Simmie Foster
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Christina Dording
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Naoise Mac Giollabhui
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Albert Yeung
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Lauren B Fisher
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Cristina Cusin
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Felipe A Jain
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Paola Pedrelli
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Grace A Ding
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Ashley E Mason
- Osher Center for Integrative Health, University of California, San Francisco (UCSF), San Francisco, California
- Department of Psychiatry, University of California, San Francisco (UCSF), San Francisco, California
| | - Paolo Cassano
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Darshan H Mehta
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Osher Center for Integrative Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Christina Sauder
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Human Development and Family Studies, School of Human Ecology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Charles L Raison
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Human Development and Family Studies, School of Human Ecology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Karen K Miller
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Alpert Medical School, Brown University, Providence, Rhode Island
| | - Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Kelly JF, Levy S, Matlack M, Hoeppner BB. Who affiliates with SMART recovery? A comparison of individuals attending SMART recovery, alcoholics anonymous, both, or neither. Alcohol Clin Exp Res (Hoboken) 2023; 47:1926-1942. [PMID: 37864536 PMCID: PMC10605873 DOI: 10.1111/acer.15164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/21/2023] [Accepted: 08/01/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Mutual-help organizations (MHOs) play a crucial role for many individuals with alcohol use disorder (AUD) or other substance use disorders in achieving stable remission. While there is now substantial research characterizing who uses 12-step MHOs, very little is known about who becomes affiliated with newer and rapidly growing MHOs, such as Self-Management and Recovery Training ("SMART" Recovery). More research could inform knowledge regarding who may be best engaged by these differing pathways. METHODS We conducted a cross-sectional analysis of participants (N = 361) with AUD recruited mostly from the community who were starting a new recovery attempt and self-selected into one of four different recovery paths: (1) SMART Recovery ("SMART-only"; n = 75); (2) Alcoholics Anonymous ("AA-only"; n = 73); (3) Both SMART and AA ("Both"; n = 53); and (4) Neither SMART nor AA ("Neither"; n = 160). We compared the groups on demographics, clinical history, treatment and recovery support service use, and indices of functioning and well-being. We computed descriptives and conducted inferential analyses according to the data structure. RESULTS Compared to study participants choosing AA-only or Both, SMART-only participants were more likely to be White, married, have higher income and more education, be full-time employed, and evince a pattern of lower clinical severity characterized by less lifetime and recent treatment and recovery support services usage, lower alcohol use intensity and fewer consequences, and less legal involvement. AUD symptom levels, lifetime psychiatric diagnoses, psychiatric distress, and functioning were similar across MHO-engaged groups. CONCLUSION SMART Recovery appears to attract individuals with greater psychosocial stability and economic advantage and less severe histories of alcohol-related impairment and legal involvement. Findings suggest that certain aspects specific to the SMART Recovery group approach, format, and/or contents may appeal to individuals exhibiting this type of profile. As such, SMART appears to provide an additional resource that expands the repertoire of options for individuals with AUD who seek recovery.
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Affiliation(s)
- John F. Kelly
- Massachusetts General Hospital, Psychiatry Department
- Harvard Medical School, Department of Psychiatry
| | - Samuel Levy
- Massachusetts General Hospital, Psychiatry Department
| | - Maya Matlack
- Massachusetts General Hospital, Psychiatry Department
| | - Bettina B. Hoeppner
- Massachusetts General Hospital, Psychiatry Department
- Harvard Medical School, Department of Psychiatry
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Cioe PA, Schnoll R, Hoeppner BB, Gross R, Hitsman BL, Leone FT, Ashare R, Vilardaga R, Tashima K, Pinkston M, Kahler CW. The Impact of the COVID-19 Pandemic on Stress, Isolation, Smoking Behaviors, and Motivation to Quit in People with HIV Who Smoke. AIDS Behav 2023; 27:1862-1869. [PMID: 36357808 PMCID: PMC9649403 DOI: 10.1007/s10461-022-03917-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/12/2022]
Abstract
People with HIV (PWH) smoke at higher rates compared with the general population and have lower cessation rates. The primary aim of this study was to examine the impact of the COVID-19 pandemic on smoking in PWH. A survey was administered to participants in two smoking cessation trials in the United States. Mean cigarettes per day was 13.9 (SD 8.6), and participants reported they had smoked on average for 30.93 years (SD 10.4). More than half (55.7%) of participants (N = 140) reported not changing their smoking during the pandemic, while 15% reported decreasing, and 25% reported increasing their smoking. In bivariate analyses, worrying about food due to lack of money (χ2 = 9.13, df 2, p = 0.01) and greater Covid-related worry (rs = 0.19, p = 0.02) were significantly associated with increased smoking. Qualitative research may be needed to more clearly elucidate factors related to smoking behaviors among PWH.
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Affiliation(s)
- Patricia A Cioe
- Center for Alcohol & Addiction Studies, Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, USA.
| | - Robert Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Bettina B Hoeppner
- Department of Psychiatry, Recovery Research Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Robert Gross
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Brian L Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Frank T Leone
- Pulmonary, Allergy, & Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Ashare
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Karen Tashima
- Division of Infectious Diseases, Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Megan Pinkston
- Division of Infectious Diseases, Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Christopher W Kahler
- Center for Alcohol & Addiction Studies, Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, USA
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Gilman JM, Potter K, Schuster RM, Hoeppner BB, Eden Evins A. Cannabis use for medical symptoms: Patterns over the first year of use. Addict Behav 2023; 144:107719. [PMID: 37068366 DOI: 10.1016/j.addbeh.2023.107719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND As greater numbers of states in the United States and countries in the world continue to legalize cannabis for medical use, it has become increasingly important to assess patterns of cannabis use in individuals using cannabis for medical symptoms over time. A public health concern is that, like recreational cannabis, some individuals using cannabis for medical reasons may develop detrimental patterns of use, leading to the development of a cannabis use disorder (CUD). METHODS In a 9-month longitudinal cohort study following a 12-week randomized, waitlist-controlled trial in 149 adults who used cannabis to alleviate insomnia, pain, depressed mood, or anxiety (RCT: NCT03224468), we assessed whether patterns of cannabis use for the 9 months following the RCT were associated with the development of CUD. RESULTS We identified five unique trajectories of use; 31 participants (21%) had low stable or no use, 50 (34%) had medium stable use, 19 (13%) had high stable use, 26 (17%) showed de-escalating and 23 (15%) showed escalating use over 9 months following the RCT. Of 149 participants enrolled, 19 (13%) met diagnostic criteria for CUD at 12 months. Only the escalating cannabis use pattern predicted significantly higher rates of CUD compared to the low or no use category (OR = 4.29, 95% CI = 1.21 to 10.87, p = 0.02). CONCLUSIONS These data indicate that most individuals using cannabis for medical symptoms have a stable pattern of use over the first year. Escalation of use may be a detrimental pattern that warrants further concern.
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Affiliation(s)
- Jodi M Gilman
- Massachusetts General Hospital (MGH) Department of Psychiatry, Center for Addiction Medicine, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Kevin Potter
- Massachusetts General Hospital (MGH) Department of Psychiatry, Center for Addiction Medicine, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Randi M Schuster
- Massachusetts General Hospital (MGH) Department of Psychiatry, Center for Addiction Medicine, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Bettina B Hoeppner
- Massachusetts General Hospital (MGH) Department of Psychiatry, Center for Addiction Medicine, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - A Eden Evins
- Massachusetts General Hospital (MGH) Department of Psychiatry, Center for Addiction Medicine, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Cooke ME, Potter KW, Jashinski J, Pascale M, Schuster RM, Tervo-Clemmens B, Hoeppner BB, Pachas GN, Evins AE, Gilman JM. Development of cannabis use disorder in medical cannabis users: A 9-month follow-up of a randomized clinical trial testing effects of medical cannabis card ownership. Front Psychiatry 2023; 14:1083334. [PMID: 36960460 PMCID: PMC10027723 DOI: 10.3389/fpsyt.2023.1083334] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/13/2023] [Indexed: 03/09/2023] Open
Abstract
Background Evidence for long-term effectiveness of commercial cannabis products used to treat medical symptoms is inconsistent, despite increasingly widespread use. Objective To prospectively evaluate the effects of using cannabis on self-reported symptoms of pain, insomnia, anxiety, depression, and cannabis use disorder (CUD) after 12 months of use. Methods This observational cohort study describes outcomes over 9 months following a 12-week randomized, waitlist-controlled trial (RCT: NCT03224468) in which adults (N = 163) who wished to use cannabis to alleviate insomnia, pain, depression, or anxiety symptoms were randomly assigned to obtain a medical marijuana card immediately (immediate card acquisition group) or to delay obtaining a card for 12 weeks delay (delayed card acquisition group). During the 9-month post-randomization period, all participants could use cannabis as they wished and choose their cannabis products, doses, and frequency of use. Insomnia, pain, depression, anxiety, and CUD symptoms were assessed over the 9-month post-randomization period. Results After 12 months of using cannabis for medical symptoms, 11.7% of all participants (n = 19), and 17.1% of those using cannabis daily or near-daily (n = 6) developed CUD. Frequency of cannabis use was positively correlated with pain severity and number of CUD symptoms, but not significantly associated with severity of self-reported insomnia, depression, or anxiety symptoms. Depression scores improved throughout the 9 months in all participants, regardless of cannabis use frequency. Conclusions Frequency of cannabis use was not associated with improved pain, anxiety, or depression symptoms but was associated with new-onset cannabis use disorder in a significant minority of participants. Daily or near-daily cannabis use appears to have little benefit for these symptoms after 12 months of use.
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Affiliation(s)
- Megan E. Cooke
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States
| | - Kevin W. Potter
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Julia Jashinski
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
| | - Michael Pascale
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
| | - Randi M. Schuster
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Brenden Tervo-Clemmens
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States
| | - Bettina B. Hoeppner
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Gladys N. Pachas
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - A. Eden Evins
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Jodi M. Gilman
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States
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10
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Kelly JF, Levy SA, Hoeppner BB. An investigation of SMART Recovery: protocol for a longitudinal cohort study of individuals making a new recovery attempt from alcohol use disorder. BMJ Open 2023; 13:e066898. [PMID: 36737095 PMCID: PMC9900056 DOI: 10.1136/bmjopen-2022-066898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Alcohol use disorder (AUD) remains one of the most pervasive of all psychiatric illnesses conferring a massive health and economic burden. In addition to professional treatments to address AUD, mutual-help organisations such as Alcoholics Anonymous (AA) and newer entities like Self-Management and Recovery Training (SMART Recovery) play increasingly important roles in many societies. While much is known about the positive effects of AA, very little is known about SMART. Hence, this study seeks to estimate real-world patterns of utilisation and benefit from SMART Recovery as well as explore for whom (moderators) and how (mechanisms) SMART confers recovery benefits. METHODS AND ANALYSIS Naturalistic, longitudinal, cohort study (n=368) of individuals with AUD recruited between February 2019 and February 2022, initiating a new recovery attempt who self-select into one of four groups at study entry: (1) SMART Recovery; (2) AA; (3) SMART+AA; (4) Neither SMART nor AA; (stratified by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) severity markers), with assessments conducted at intake, and 3 months, 6 months, 9 months, 12 months, 18 months and 24 months. Primary outcomes are: frequency of SMART and AA meetings attendance; per cent days abstinent and per cent days heavy drinking. Secondary outcomes include psychiatric distress; quality of life and functioning. Moderator variables include sex/gender; race/ethnicity; spirituality. Mediational variables include social networks; coping skills; self-efficacy; impulsivity. Multivariable regression with propensity score matching will test for patterns of attendance and effects of participation over time on outcomes and test for mechanisms and moderators. ETHICS AND DISSEMINATION This study involves human participants and was approved by the Massachusetts General Hospital Institutional Review Board (Protocol #: 2017P002029/PHS). Results will be published in peer-reviewed journals and presented at conferences. REGISTRATION This is a non-randomised, naturalistic, longitudinal, cohort study, and thus was not registered in advance. Results, therefore, should be considered exploratory.
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Affiliation(s)
- John F Kelly
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Samuel A Levy
- Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bettina B Hoeppner
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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11
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Feeney A, Hoeppner BB, Freeman MP, Flynn M, Iosifescu DV, Trivedi MH, Sanacora G, Mathew SJ, DeBattista C, Ionescu DF, Cusin C, Papakostas GI, Jha MK, Fava M. Effect of Concomitant Benzodiazepines on the Antidepressant Effects of Ketamine: Findings From the RAPID Intravenous Ketamine Study. J Clin Psychiatry 2022; 84. [PMID: 36383742 DOI: 10.4088/jcp.22m14491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Ketamine is a novel and rapidly acting treatment for major depressive disorder (MDD). Benzodiazepines are commonly coprescribed with antidepressants in MDD. This study sought to examine data from a randomized clinical trial that compared a single infusion of intravenous (IV) ketamine to midazolam placebo in treatment-resistant depression (DSM-IV-TR MDD) and to assess whether the use of concomitant oral benzodiazepines differentially affected treatment response to ketamine versus midazolam. Methods: This trial ran from December 2015 to December 2016. Subjects who were taking oral benzodiazepines (n = 44) were compared to those who were not (n = 55). A significant treatment-by-benzodiazepine effect could be interpreted as a possible moderator of differential treatment response to ketamine versus midazolam. Benzodiazepine use was examined as both a binary and a continuous predictor, to assess the impact of dosage. Results: Benzodiazepine users did not differ from non-users on the original study's primary outcome measure, score on the 6-item Hamilton Depression Rating Scale (HDRS-6), at baseline, but the former had more severe anxiety. When oral benzodiazepine use was modeled as a binary predictor, benzodiazepine use did not impact differential treatment response. However, when benzodiazepine dosage was considered, there was a significant impact of benzodiazepine use on differential treatment response. Oral benzodiazepines significantly impacted HDRS-6 (P = .018) and Clinical Global Impressions-Severity of Illness scale (CGI-S; P = .008) scores at day 1 (24 hours post treatment); effects were nonsignificant for all day 3 outcomes. Among ketamine subjects, higher doses of benzodiazepines were associated with less improvement in depression scores at day 1. Conclusions: Concomitant oral benzodiazepines at higher doses may attenuate the antidepressant effects of IV ketamine at day 1 but not day 3 post-infusion. Trial Registration: ClinicalTrials.gov identifier: NCT01920555.
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Affiliation(s)
- Anna Feeney
- Clinical Trials Network and Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Corresponding author: Anna Feeney, MD, Clinical Trials Network and Institute, Massachusetts General Hospital, One Bowdoin Sq, 9th Floor, Boston, MA 02114
| | - Bettina B Hoeppner
- Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Marlene P Freeman
- Clinical Trials Network and Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Center for Women's Mental Health, Massachusetts General Hospital, Boston, Massachusetts
| | - Martina Flynn
- Clinical Trials Network and Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Dan V Iosifescu
- Clinical Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York.,Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, Texas
| | | | - Sanjay J Mathew
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,Michael E. Debakey VA Medical Center Mental Health Care Line, Houston, Texas
| | | | | | - Cristina Cusin
- Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - George I Papakostas
- Clinical Trials Network and Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Manish K Jha
- Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, Texas
| | - Maurizio Fava
- Clinical Trials Network and Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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12
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Hoeppner SS, Millstein RA, Siegel KR, Carlon HA, Harnedy LE, Chung WJ, Huffman JC, Hoeppner BB. A secondary analysis examining the performance of the State Optimism Measure (SOM) compared to the Life Orientation Test-Revised (LOT-R) in measuring optimism over time. Psychol Health 2022:1-16. [PMID: 36154764 PMCID: PMC10039955 DOI: 10.1080/08870446.2022.2126472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 06/20/2022] [Accepted: 09/15/2022] [Indexed: 10/14/2022]
Abstract
Objective: Optimism is an important factor impacting health and human functioning. Originally conceptualized as a trait, increasing evidence indicates that optimism can change over time and could be an intervention target. Measures are needed that can capture changes in optimism.Design: In this secondary analysis, we compared the performance of a newly developed state measure, the State Optimism Measure (SOM), to the widely used trait measure, the Life Orientation Test-Revised (LOT-R), in detecting changes over time during a disruptive life event: the onset of the COVID-19 pandemic in the United States.Main Outcome Measures: Participants (n = 81) were nondaily smokers participating in a smoking cessation intervention, who completed the SOM and LOT-R before and after the initial COVID-19 outbreak.Results: Optimism declined from pre- to post-COVID-19 outbreak, as assessed by both scales (LOT-R: p=.0147,gav=0.23; SOM: p<.0001,gav=0.56). The change detected was greater when measured by the SOM (p<.0001). Changes in optimism were correlated with concurrent changes in perceived stress, positive affect, and negative affect.Conclusion: Our results suggest that the SOM has a greater sensitivity to detect within-person changes in optimism than the LOT-R and highlight the SOM's utility for longitudinal studies assessing changes in optimism.
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Affiliation(s)
| | | | - Kaitlyn R. Siegel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
| | | | - Lauren E. Harnedy
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
| | - Wei-Jean Chung
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
| | - Jeff C. Huffman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
| | - Bettina B. Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
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13
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Schiff DM, Work EC, Muftu S, Partridge S, MacMillan KDL, Gray JR, Hoeppner BB, Kelly JF, Greenfield SF, Jones HE, Wilens TE, Terplan M, Bernstein J. "You have to take this medication, but then you get punished for taking it:" lack of agency, choice, and fear of medications to treat opioid use disorder across the perinatal period. J Subst Abuse Treat 2022; 139:108765. [PMID: 35341614 PMCID: PMC9187596 DOI: 10.1016/j.jsat.2022.108765] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/28/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Medications to treat opioid use disorder (MOUD) during pregnancy and in the postpartum period remain underutilized. A need exists to enhance our understanding of modifiable factors, facilitators, and barriers to MOUD utilization and adherence in the perinatal period to improve maternal and child outcomes. METHODS The study conducted semi-structured qualitative interviews with recently pregnant people with opioid use disorder (OUD) to explore experiences as a pregnant and/or parenting person with OUD, perceptions of enabling factors and barriers to treatment utilization, incentivizing factors for maintaining adherence, and acceptability of ongoing supports to sustain treatment adherence. The study team used constant comparative methods to analyze transcripts and develop the codebook. The team double coded the transcripts, with an overall kappa coefficient of 0.88. RESULTS The study team interviewed twenty-six women on average 10.1 months after delivery. All women had some prior experience using MOUD. Four unique themes emerged as barriers to medication utilization and adherence in the perinatal period: 1) Lack of agency and autonomy surrounding medication decisions because pregnancy or parenting status affected treatment adherence; 2) Hesitancy to use MOUD to minimize risk of newborn withdrawal; 3) Concern about increased scrutiny and potential loss of custody due to mandated child protective services reporting for opioid-exposure at delivery in Massachusetts; and 4) Perception that treatment environments, particularly methadone clinics, did not provide gender-responsive or equitable care, and standardized, inflexible visit regulations were particularly difficult to comply with in the early postpartum period. CONCLUSIONS Women with OUD experienced a double bind when making perinatal treatment decisions, describing pressure to use MOUD with negative consequences after delivery. Key areas for possible intervention emerged from interviews. These areas include improving uptake of shared decision-making to increase patient autonomy and agency, particularly among those in the earliest stages of recovery during pregnancy; ongoing education around perinatal MOUD safety and efficacy; detangling MOUD and neonatal withdrawal signs from mandated child protective services reporting; and improving gender-responsive and equitable care in substance use disorder treatment programs, including incorporating the utilization of home visiting services for dosing assessments and administration in the early postpartum period.
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Affiliation(s)
- Davida M Schiff
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, MA, 02114, United States of America.
| | - Erin C Work
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, MA, 02114, United States of America
| | - Serra Muftu
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, MA, 02114, United States of America
| | - Shayla Partridge
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, MA, 02114, United States of America
| | - Kathryn Dee L MacMillan
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, 02115, United States of America
| | - Jessica R Gray
- Division General of Internal Medicine, MassGeneral Hospital for Children, Boston, MA, 02114, United States of America; Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, 02114, United States of America
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, United States of America
| | - John F Kelly
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, United States of America
| | - Shelly F Greenfield
- Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, 115 Mill St, Belmont, MA 02478, United States of America; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States of America
| | - Hendrée E Jones
- UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, 410 North Greensboro St., Carrboro, NC, United States of America
| | - Timothy E Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States of America
| | - Mishka Terplan
- Friends Research Institute, 1040 Park Ave, Suite 103, Baltimore, MD 21202, United States of America
| | - Judith Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States of America
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14
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Schiff DM, Work EC, Foley B, Applewhite R, Diop H, Goullaud L, Gupta M, Hoeppner BB, Peacock-Chambers E, Vilsaint CL, Bernstein JA, Bryant AS. Perinatal Opioid Use Disorder Research, Race, and Racism: A Scoping Review. Pediatrics 2022; 149:184771. [PMID: 35156121 PMCID: PMC9044279 DOI: 10.1542/peds.2021-052368] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Racial/ethnic inequities are well documented in both maternal-infant health and substance use disorder treatment outcomes. OBJECTIVE To systematically review research on maternal-infant dyads affected by opioid use disorder (OUD) to evaluate for racial/ethnic disparities in health utilization or outcomes and critically assess the reporting and inclusion of race/ethnicity data. DATA SOURCES Peer-reviewed literature in MEDLINE, Embase, and Web of Science from 2000 to 2020. STUDY SELECTION Research reporting health utilization and outcomes data on dyads affected by OUD during pregnancy through the infant's first birthday. DATA EXTRACTION We extracted data on race/ethnicity, study exposures/outcomes, how race/ethnicity data were analyzed, how authors discussed findings associated with race/ethnicity, and whether racism was mentioned as an explanation for findings. RESULTS Of 2023 articles reviewed, 152 quantitative and 17 qualitative studies were included. Among quantitative studies, 66% examined infant outcomes (n = 101). Three articles explicitly focused on evaluating racial/ethnic differences among dyads. Among quantitative studies, 112 mentioned race/ethnicity, 63 performed analyses assessing for differences between exposure groups, 27 identified racial/ethnic differences, 22 adjusted outcomes for race/ethnicity in multivariable analyses, and 11 presented adjusted models stratified by race/ethnicity. None of the qualitative studies addressed the role that race, ethnicity, or racism may have had on the presented themes. CONCLUSIONS Few studies were designed to evaluate racial/ethnic inequities among maternal-infant dyads affected by OUD. Data on race/ethnicity have been poorly reported in this literature. To achieve health equity across perinatal OUD, researchers should prioritize the inclusion of marginalized groups to better address the role that structural racism plays.
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Affiliation(s)
- Davida M. Schiff
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts,Address correspondence to Davida M. Schiff, MD, MSc, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA 02114. E-mail:
| | - Erin C. Work
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Bridget Foley
- Substance Use Disorder Initiative, Department of Psychiatry
| | | | - Hafsatou Diop
- Massachusetts Department of Public Health, Boston, Massachusetts
| | | | - Munish Gupta
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | - Judith A. Bernstein
- Division of Community Health Sciences, Boston University School of Public Health, Boston Massachusetts
| | - Allison S. Bryant
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
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15
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Hoeppner BB, Siegel KR, Carlon HA, Kahler CW, Park ER, Hoeppner SS. A Smoking Cessation App for Nondaily Smokers (Version 2 of the Smiling Instead of Smoking App): Acceptability and Feasibility Study. JMIR Form Res 2021; 5:e29760. [PMID: 34787577 PMCID: PMC8663587 DOI: 10.2196/29760] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/12/2021] [Accepted: 08/24/2021] [Indexed: 12/18/2022] Open
Abstract
Background Recent evidence highlights the significant detrimental impact of nondaily smoking on health and its disproportionate prevalence in underserved populations; however, little work has been done to develop treatments specifically geared toward quitting nondaily smoking. Objective This study aims to test the feasibility, acceptability, and conceptual underpinnings of version 2 of the Smiling Instead of Smoking (SiS2) smartphone app, which was developed specifically for nondaily smokers and uses a positive psychology approach. Methods In a prospective, single-group study, nondaily smokers (N=100) were prescribed use of the SiS2 app for 7 weeks while undergoing a quit attempt. The app assigned daily positive psychology exercises and behavioral tasks every 2 to 3 days, which guided smokers through using the smoking cessation tools offered in the app. Participants answered surveys at baseline and at 2, 6, 12, and 24 weeks postquit. Feasibility was evaluated based on app use and acceptability based on survey responses. The underlying conceptual framework was tested by examining whether theorized within-person changes occurred from baseline to end of treatment on scales measuring self-efficacy, desire to smoke, and processing of self-relevant health information (ie, pros and cons of smoking, importance of the pros and cons of quitting, and motivation). Results Participants used the SiS2 app on an average of 24.7 (SD 13.8) days out of the 49 prescribed days. At the end of treatment, most participants rated the functions of the app as very easy to use (eg, 70/95, 74% regarding cigarette log and 59/95, 62% regarding happiness exercises). The average score on the System Usability Scale was 79.8 (SD 17.3; A grade; A+ ≥84.1, B+ <78.8). Most participants reported that the app helped them in their quit attempt (83/95, 87%), and helped them stay positive while quitting (78/95, 82%). Large effects were found for within-person decreases in the desire to smoke (b=−1.5, 95% CI −1.9 to −1.1; P<.001; gav=1.01), the importance of the pros of smoking (b=-20.7, 95% CI −27.2 to −14.3; P<.001; gav=0.83), and perceived psychoactive benefits of smoking (b=−0.8, 95% CI −1.0 to −0.5; P<.001; gav=0.80). Medium effects were found for increases in self-efficacy for remaining abstinent when encountering internal (b=13.1, 95% CI 7.6 to 18.7; P<.001; gav=0.53) and external (b=11.2, 95% CI 6.1 to 16.1; P<.001; gav=0.49) smoking cues. Smaller effects, contrary to expectations, were found for decreases in motivation to quit smoking (P=.005) and the perceived importance of the pros of quitting (P=.009). Self-reported 30-day point prevalence abstinence rates were 40%, 56%, and 56% at 6, 12, and 24 weeks after the quit day, respectively. Conclusions The SiS2 app was feasible and acceptable, showed promising changes in constructs relevant to smoking cessation, and had high self-reported quit rates by nondaily smokers. The SiS2 app warrants testing in a randomized controlled trial.
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Affiliation(s)
- Bettina B Hoeppner
- Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Kaitlyn R Siegel
- Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Hannah A Carlon
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Elyse R Park
- Health Promotion and Resiliency Research Intervention Program, Psychiatry & Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Susanne S Hoeppner
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
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16
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Schiff DM, Nielsen TC, Hoeppner BB, Terplan M, Hadland SE, Bernson D, Greenfield SF, Bernstein J, Bharel M, Reddy J, Taveras EM, Kelly JF, Wilens TE. Methadone and buprenorphine discontinuation among postpartum women with opioid use disorder. Am J Obstet Gynecol 2021; 225:424.e1-424.e12. [PMID: 33845029 DOI: 10.1016/j.ajog.2021.04.210] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/12/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The postpartum year is a vulnerable period for women with opioid use disorder, with increased rates of fatal and nonfatal overdose; however, data on the continuation of medications for opioid use disorder on a population level are limited. OBJECTIVE This study aimed to examine the effect of discontinuing methadone and buprenorphine in women with opioid use disorder in the year following delivery and determine the extent to which maternal and infant characteristics are associated with time to discontinuation of medications for opioid use disorder. STUDY DESIGN This population-based retrospective cohort study used linked administrative data of 211,096 deliveries in Massachusetts between 2011 and 2014 to examine the adherence to medications for opioid use disorder. Individuals receiving medications for opioid use disorder after delivery were included in the study. Here, demographic, psychosocial, prenatal, and delivery characteristics are described. Kaplan-Meier survival analysis and Cox regression modeling were used to examine factors associated with medication discontinuation. RESULTS A total of 2314 women who received medications for opioid use disorder at delivery were included in our study. Overall, 1484 women (64.1%) continued receiving medications for opioid use disorder for a full 12 months following delivery. The rate of continued medication use varied from 34% if women started on medications for opioid use disorder the month before delivery to 80% if the medications were used throughout pregnancy. Kaplan-Meier survival curves differed by maternal race and ethnicity (the 12-month continuation probability was .65 for White non-Hispanic women and .51 for non-White women; P<.001) and duration of use of prenatal medications for opioid use disorder (12-month continuation probability was .78 for women with full prenatal engagement and .60 and .44 for those receiving medications for opioid use disorder ≥5 months [but not throughout pregnancy] and ≤4 months prenatally, respectively; P<.001). In all multivariable models, duration of receipt of prenatal medications for opioid use disorder (≤4 months vs throughout pregnancy: adjusted hazard ratio, 3.26; 95% confidence interval, 2.72-3.91) and incarceration (incarceration during pregnancy or after delivery vs none: adjusted hazard ratio, 1.79; 95% confidence interval, 1.52-2.12) were most strongly associated with the discontinuation of medications for opioid use disorder. CONCLUSION Almost two-thirds of women with opioid use disorder continued using medications for opioid use disorder for a full year after delivery; however, the rates of medication continuation varied significantly by race and ethnicity, degree of use of prenatal medications for opioid use disorder, and incarceration status. Prioritizing medication continuation across the perinatal continuum, enhancing sex-specific and family-friendly recovery supports, and expanding access to medications for opioid use disorder despite being incarcerated can help improve postpartum medication adherence.
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Affiliation(s)
- Davida M Schiff
- Division of General Academic Pediatrics, MassGeneral Hospital for Children and Harvard Medical School, Boston, MA.
| | - Timothy C Nielsen
- Faculty of Medicine and Health, Children's Hospital Westmead Clinical School, University of Sydney, Camperdown, Australia
| | | | | | - Scott E Hadland
- Department of Pediatrics, Boston University School of Medicine, Boston, MA; Grayken Center for Addiction, Boston Medical Center, Boston, MA
| | - Dana Bernson
- Massachusetts Department of Public Health, Boston, MA
| | - Shelly F Greenfield
- Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA; Harvard Medical School, Boston, MA, Division of Community Health Sciences, Boston University School of Public Health, Boston, MA
| | - Judith Bernstein
- Harvard Medical School, Boston, MA, Division of Community Health Sciences, Boston University School of Public Health, Boston, MA
| | - Monica Bharel
- Massachusetts Department of Public Health, Boston, MA
| | - Julia Reddy
- Massachusetts Department of Public Health, Boston, MA
| | - Elsie M Taveras
- Division of General Academic Pediatrics, MassGeneral Hospital for Children and Harvard Medical School, Boston, MA
| | - John F Kelly
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Timothy E Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, MA
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17
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Hoeppner BB, Hoeppner SS, Carlon HA, Abry A, Darville A, Rohsenow DJ. Preparing for the Quit Day: Comparing Beliefs of Nondaily Versus Daily Young Adult Smokers as They Prepare for a Quit Attempt. Nicotine Tob Res 2021; 23:1038-1046. [PMID: 32882037 DOI: 10.1093/ntr/ntaa166] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 09/01/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Most smoking cessation approaches are modeled on heavy daily smoking. With increasing prevalence of nondaily smoking, it may be necessary to modify these approaches for nondaily smokers. AIMS To provide information about beliefs and attitudes relevant to smoking cessation for nondaily smokers. METHODS Secondary analysis of two prospective studies on young adult smokers (18-24 years of age) provided brief advice to quit smoking. Measures include baseline levels of constructs relevant to smoking cessation counseling and perceived benefits of and barriers to smoking cessation. RESULTS Participants (n = 40 nondaily, 122 daily smokers) were predominantly White (70% and 84%, respectively), gender-balanced (50% and 43% female), full-time college students (89% and 95%). At baseline, nondaily smokers reported lower levels of nicotine dependence (p < .001; nondaily: Fagerström Test for Nicotine Dependence (FTND) = 0.8 ± 1.5, daily: FTND = 3.1 ± 1.9), lower urge to smoke (p < .001), greater self-efficacy when facing external smoking stimuli (p = .03), expecting to experience fewer positive effects (reduced negative affect, p = <.001, stimulation, p = .02), and valuing the importance of smoking effects less (ps < .01) than daily smokers. During counseling, nondaily smokers generated both fewer benefits of cessation (Wald X2(df = 1) = 4.91, p = .027) and fewer barriers (Wald X2(df = 1) = 5.99, p =.014) than daily smokers. Withdrawal was not listed by nondaily smokers as a barrier (p < .01). CONCLUSIONS Constructs relevant to smoking cessation for daily smokers were less salient to young nondaily smokers, compared with moderately addicted young daily smokers, as indicated by responses to standardized scales and by the generation of fewer benefits and barriers in counseling. Interventions may need to find novel ways to engage nondaily smokers, particularly young adult, in smoking cessation efforts. IMPLICATIONS This study is unique in eliciting benefits and barriers from nondaily smokers as they are about to make a quit attempt. This is a critically important point in time, as this is the point in time in which an action plan is formed and can be informed and enhanced by smoking cessation support. Our study further allowed direct comparison to daily smokers undergoing the same procedures, which allowed the identification of unique factors that may impact nondaily smokers in their quit attempt, which may guide intervention efforts. Use of a mixed method design further strengthen the rigor of this study.
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Affiliation(s)
- Bettina B Hoeppner
- Department of Psychiatry, Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Susanne S Hoeppner
- Department of Psychiatry, Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, MA
| | - Hannah A Carlon
- Department of Psychiatry, Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Alexandra Abry
- Department of Psychiatry, Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Damaris J Rohsenow
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
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18
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Harlow LL, Aiken L, Blankson AN, Boodoo GM, Brick LAD, Collins LM, Cumming G, Fava JL, Goodwin MS, Hoeppner BB, Mackinnon DP, Molenaar PCM, Rodgers JL, Rossi JS, Scott A, Steiger JH, West SG. A Tribute to the Mind, Methodology and Mentoring of Wayne Velicer. Multivariate Behav Res 2021; 56:377-389. [PMID: 32077317 PMCID: PMC7438240 DOI: 10.1080/00273171.2020.1729083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Wayne Velicer is remembered for a mind where mathematical concepts and calculations intrigued him, behavioral science beckoned him, and people fascinated him. Born in Green Bay, Wisconsin on March 4, 1944, he was raised on a farm, although early influences extended far beyond that beginning. His Mathematics BS and Psychology minor at Wisconsin State University in Oshkosh, and his PhD in Quantitative Psychology from Purdue led him to a fruitful and far-reaching career. He was honored several times as a high-impact author, was a renowned scholar in quantitative and health psychology, and had more than 300 scholarly publications and 54,000+ citations of his work, advancing the arenas of quantitative methodology and behavioral health. In his methodological work, Velicer sought out ways to measure, synthesize, categorize, and assess people and constructs across behaviors and time, largely through principal components analysis, time series, and cluster analysis. Further, he and several colleagues developed a method called Testing Theory-based Quantitative Predictions, successfully applied to predicting outcomes and effect sizes in smoking cessation, diet behavior, and sun protection, with the potential for wider applications. With $60,000,000 in external funding, Velicer also helped engage a large cadre of students and other colleagues to study methodological models for a myriad of health behaviors in a widely applied Transtheoretical Model of Change. Unwittingly, he has engendered indelible memories and gratitude to all who crossed his path. Although Wayne Velicer left this world on October 15, 2017 after battling an aggressive cancer, he is still very present among us.
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Kelly JF, Fallah-Sohy N, Cristello J, Stout RL, Jason LA, Hoeppner BB. Recovery community centers: Characteristics of new attendees and longitudinal investigation of the predictors and effects of participation. J Subst Abuse Treat 2021; 124:108287. [PMID: 33771284 DOI: 10.1016/j.jsat.2021.108287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/02/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Recovery community centers (RCCs) have expanded across the U.S., serving as social "recovery hubs" that increase recovery capital (e.g., employment, housing) by providing resources that clinical care does not provide. While research supports RCCs' general utility, little is known about new participants' characteristics, predictors of engagement, services used, and benefits derived. Greater knowledge would inform the field about RCCs' clinical and public health potential. METHOD Prospective, single-group study of individuals (N = 275) starting at RCCs (k = 7) in the northeastern U.S. and reassessed 3 months later regarding the services these individuals used and the benefits they derived (e.g., reduced substance problems, enhanced quality of life [QOL]). Regression and longitudinal models tested theorized relationships. RESULTS Participants were mostly young to middle-aged, racially diverse, single, unemployed, men and women, with low education and income, suffering from opioid or alcohol use disorder, with a history of psychiatric problems, low QOL, and prior treatment/mutual-help participation. Attendance varied greatly, but on average, was 1-2 times/week, with greater RCC engagement predicted by Hispanic ethnicity, shorter travel time, prior treatment, lower initial social support, and relatively greater baseline QOL (QOL was low overall). Commonly used and highly valued services included social support infrastructures (e.g., recovery coaching/meetings), and technological and employment assistance. In longitudinal analyses (n = 138), the study observed improvements in duration of abstinence, substance problems, psychological well-being, and QOL, but not in recovery assets. CONCLUSION Findings generally are consistent with prior observations that RCCs engage and provide benefits for individuals facing the greatest challenges in terms of clinical pathology and low QOL and resources.
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Affiliation(s)
- John F Kelly
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, United States of America.
| | | | | | | | - Leonard A Jason
- Decision Sciences Institute, Providence, RI, United States of America
| | - Bettina B Hoeppner
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, United States of America
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20
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Hoeppner SS, Carlon HA, Kahler CW, Park ER, Darville A, Rohsenow DJ, Hoeppner BB. COVID-19 Impact on Smokers Participating in Smoking Cessation Trials: The Experience of Nondaily Smokers Participating in a Smartphone App Study. Telemed Rep 2021; 2:179-187. [PMID: 35720753 PMCID: PMC8812286 DOI: 10.1089/tmr.2021.0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 05/09/2023]
Abstract
Objectives: To provide initial insight into how the COVID-19 pandemic could affect smoking behaviors and cessation efforts that were underway at its onset. Methods: An additional survey was added to follow-up assessments in an ongoing smoking cessation study for nondaily smokers: a measure of impact of COVID-19 and a subset of previously administered scales measuring smoking, emotional well-being, and alcohol use. Pre-post tests were conducted (84 ± 28 days apart). Results: Participants (81/100 of enrolled; 67% female, 75% white, 10% Hispanic, 37 ± 11 years old) reported experiencing changes regarding work (35% income reduction/loss; 35% remote work) and living situation (15% consolidated residences). Participants reported their motivation to quit smoking "slightly" increased after COVID-19 (p < 0.001), more so in those having achieved 30-day abstinence (p = 0.0045). Worry, fear, and a desire to support the greater good increased (ps < 0.05). Increases in motivation to quit correlated positively with prosocial and wellness changes. Data from pre- to post-COVID-19 onset showed decreases in emotional well-being (increased stress, negative affect, decreased coping, positive affect, all ps < 0.01), but not changes in smoking abstinence (p = 0.65), readiness to quit (p = 0.16), smoking frequency (p = 0.96), or cigarettes per day (p = 0.96). Heavy drinking decreased (p < 0.01). Trying e-cigarettes increased (p = 0.04). Conclusions: Nondaily smokers participating in a smoking cessation study during the COVID-19 pandemic reported worsened emotional well-being without effects on smoking outcomes and said their motivation to quit was slightly increased. Correlations of motivation to quit with prosocial and wellness changes suggest that targeting these constructs may be particularly helpful during a pandemic.
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Affiliation(s)
- Susanne S. Hoeppner
- OCD and Related Disorders Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hannah A. Carlon
- Department of Psychiatry, Recovery Research Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher W. Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Elyse R. Park
- Department of Psychiatry, MGH Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Audrey Darville
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Damaris J. Rohsenow
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Bettina B. Hoeppner
- Department of Psychiatry, Recovery Research Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- *Address correspondence to: Bettina Hoeppner, PhD, Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, USA,
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21
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Eddie D, Vilsaint CL, Hoffman LA, Bergman BG, Kelly JF, Hoeppner BB. From working on recovery to working in recovery: Employment status among a nationally representative U.S. sample of individuals who have resolved a significant alcohol or other drug problem. J Subst Abuse Treat 2020; 113:108000. [PMID: 32359673 PMCID: PMC7450389 DOI: 10.1016/j.jsat.2020.108000] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/02/2020] [Accepted: 03/08/2020] [Indexed: 12/15/2022]
Abstract
Alcohol and other drug (AOD) use disorders exact a prodigious annual economic toll in the United States (U.S.), driven largely by lost productivity due to illness-related absenteeism, underemployment, and unemployment. While recovery from AOD disorders is associated with improved health and functioning, little is known specifically about increases in productivity due to new or resumed employment and who may continue to struggle. Also, because employment can buffer relapse risk by providing structure, meaning, purpose, and income, greater knowledge in this regard would inform relapse prevention efforts as well as employment-related policy. We conducted a cross-sectional, nationally representative survey of the U.S. adult population assessing persons who reported having resolved an AOD problem (n = 2002). Weighted employment, unemployment, retirement, and disability statistics were compared to the general U.S. population. Logistic and linear regression models tested for differences in employment and unemployment among demographic categories and measures of well-being. Compared to the general U.S. population, individuals who had resolved an AOD problem were less likely to be employed or retired, and more likely to be unemployed and disabled. Certain recovering subgroups, including those identifying as black and those with histories of multiple arrests, were further disadvantaged. Conversely, certain factors, such as a higher level of education and less prior criminal justice involvement were associated with lower unemployment risk. Despite being in recovery from an AOD problem, individuals continue to struggle with obtaining employment, particularly black Americans and those with prior criminal histories. Given the importance of employment in addiction recovery and relapse prevention, more research is needed to identify employment barriers so that they can be effectively addressed.
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Affiliation(s)
- David Eddie
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, 151 Merrimac St. 6(th) Floor, Boston, MA 02114 617-643-9194, United States of America.
| | - Corrie L Vilsaint
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, 151 Merrimac St. 6(th) Floor, Boston, MA 02114 617-643-9194, United States of America
| | - Lauren A Hoffman
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, 151 Merrimac St. 6(th) Floor, Boston, MA 02114 617-643-9194, United States of America
| | - Brandon G Bergman
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, 151 Merrimac St. 6(th) Floor, Boston, MA 02114 617-643-9194, United States of America
| | - John F Kelly
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, 151 Merrimac St. 6(th) Floor, Boston, MA 02114 617-643-9194, United States of America
| | - Bettina B Hoeppner
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, 151 Merrimac St. 6(th) Floor, Boston, MA 02114 617-643-9194, United States of America
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22
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Schiff DM, Nielsen T, Hoeppner BB, Terplan M, Hansen H, Bernson D, Diop H, Bharel M, Krans EE, Selk S, Kelly JF, Wilens TE, Taveras EM. Assessment of Racial and Ethnic Disparities in the Use of Medication to Treat Opioid Use Disorder Among Pregnant Women in Massachusetts. JAMA Netw Open 2020; 3:e205734. [PMID: 32453384 PMCID: PMC7251447 DOI: 10.1001/jamanetworkopen.2020.5734] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Racial and ethnic disparities persist across key health and substance use treatment outcomes for mothers and infants. The use of medications, such as methadone or buprenorphine, for the treatment of opioid use disorder (OUD) has been associated with improvements in the outcomes of mothers and infants; however, only half of all pregnant women with OUD receive these medications. The extent to which maternal race or ethnicity is associated with the use of medication to treat OUD, the duration of the use of medication to treat OUD, and the type of medication used to treat OUD during pregnancy are unknown. OBJECTIVE To examine the extent to which maternal race and ethnicity is associated with the use of medications for the treatment of OUD in the year before delivery among pregnant women with OUD. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used a linked population-level statewide data set of pregnant women with OUD who delivered a live infant in Massachusetts between October 1, 2011, and December 31, 2015. Of 274 234 total deliveries identified, 5247 deliveries among women with indicators of having OUD were included in the analysis. Maternal race and ethnicity were defined as white non-Hispanic, black non-Hispanic, or Hispanic based on self-reported data on birth certificates. MAIN OUTCOMES AND MEASURES Main outcomes were the receipt of any medication for OUD, the consistency of the use of medication (at least 6 continuous months of use before delivery, inconsistent use, or no use) for the treatment of OUD, and the type of medication (methadone or buprenorphine) used to treat OUD. Multivariable models were adjusted for maternal sociodemographic characteristics, comorbidities, and any significant interactions between the covariates and race and ethnicity. RESULTS The sample included 5247 pregnant women with OUD who delivered a live infant in Massachusetts during the study period. The mean (SD) maternal age at delivery was 28.7 (5.0) years; 4551 women (86.7%) were white non-Hispanic, 462 women (8.8%) were Hispanic, and 234 women (4.5%) were black non-Hispanic. A total of 3181 white non-Hispanic women (69.9%) received any type of medication for the treatment of OUD in the year before delivery compared with 228 Hispanic women (49.4%) and 108 black non-Hispanic women (46.2%). Compared with white non-Hispanic women, black non-Hispanic and Hispanic women had a substantially lower likelihood (adjusted odds ratio [aOR], 0.37; 95% CI, 0.28-0.49 and aOR, 0.42; 95% CI, 0.35-0.52, respectively) of receiving any medication for the treatment of OUD. Stratification by maternal age identified greater disparities among younger women. Black non-Hispanic and Hispanic women also had a lower likelihood (aOR, 0.24; 95% CI, 0.17-0.35 and aOR, 0.34; 95% CI, 0.27-0.44, respectively) of consistent use of medication for the treatment of OUD compared with white non-Hispanic women. With respect to the type of medication used to treat OUD, black non-Hispanic and Hispanic women had a lower likelihood (aOR, 0.60; 95% CI, 0.40-0.90 and aOR, 0.77; 95% CI, 0.58-1.01, respectively) than white non-Hispanic women of receiving buprenorphine treatment compared with methadone treatment. CONCLUSIONS AND RELEVANCE This study found racial and ethnic disparities in the use of medications to treat OUD during pregnancy, with black non-Hispanic and Hispanic women significantly less likely to use medications consistently or at all compared with white non-Hispanic women. Further investigation of patient, clinician, treatment program, and system-level factors associated with these findings is warranted.
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Affiliation(s)
- Davida M. Schiff
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Timothy Nielsen
- Child Population and Translational Health Research, University of Sydney, Randwick, New South Wales, Australia
| | | | | | - Helena Hansen
- Department of Psychiatry, New York University, New York, New York
| | - Dana Bernson
- Massachusetts Department of Public Health, Boston
| | | | | | - Elizabeth E. Krans
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Women’s Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sabrina Selk
- Massachusetts Department of Public Health, Boston
| | - John F. Kelly
- Department of Psychiatry, New York University, New York, New York
| | - Timothy E. Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
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23
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Kelly JF, Fallah-Sohy N, Vilsaint C, Hoffman LA, Jason LA, Stout RL, Cristello JV, Hoeppner BB. New kid on the block: An investigation of the physical, operational, personnel, and service characteristics of recovery community centers in the United States. J Subst Abuse Treat 2020; 111:1-10. [PMID: 32087832 PMCID: PMC7039941 DOI: 10.1016/j.jsat.2019.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/09/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Professional treatment and non-professional mutual-help organizations (MHOs) play important roles in mitigating addiction relapse risk. More recently, a third tier of recovery support services has emerged that are neither treatment nor MHO that encompass an all-inclusive flexible approach combining professionals and volunteers. The most prominent of these is Recovery Community Centers (RCCs). RCC's goal is to provide an attractive central recovery hub facilitating the accrual of recovery capital by providing a variety of services (e.g., recovery coaching; medication assisted treatment [MAT] support, employment/educational linkages). Despite their growth, little is known formally about their structure and function. Greater knowledge would inform the field about their potential clinical and public health utility. METHOD On-site visits (2015-2016) to RCCs across the northeastern U.S. (K = 32) with semi-structured interviews conducted with RCC directors and online surveys with staff assessing RCCs': physicality and locality; operations and budgets; leadership and staffing; membership; and services. RESULTS Physicality and locality: RCCs were mostly in urban/suburban locations (90%) with very good to excellent Walk Scores reflecting easy accessibility. Ratings of environmental quality indicated neighborhood/grounds/buildings were moderate-good attractiveness and quality. Operations: RCCs had been operating for an average of 8.5 years (SD = 6.2; range 1-33 years) with budgets (mostly state-funded) ranging from $17,000-$760,000/year, serving anywhere from a dozen to more than two thousand visitors/month. Leadership and staffing: Center directors were mostly female (55%) with primary drug histories of alcohol (62%), cocaine (19%), or opioids (19%). Most, but not all, directors (90%) and staff (84%) were in recovery. Membership: A large proportion of RCC visitors were male (61%), White (72%), unemployed (50%), criminal-justice system-involved (43%) and reported opioids (35%) or alcohol (33%) as their primary substance. Roughly half were in their first year of recovery (49%), but about 20% had five or more years. Services: RCCs reported a range of services including social/recreational (100%), mutual-help (91%), recovery coaching (77%), and employment (83%) and education (63%) assistance. Medication-assisted treatment (MAT) support (43%) and overdose reversal training (57%) were less frequently offered, despite being rated as highly important by staff. CONCLUSIONS RCCs are easily accessible, attractive, mostly state-funded, recovery support hubs providing an array of services to individuals in various recovery stages. They appear to play a valued role in facilitating the accrual of social, employment, housing, and other recovery capital. Research is needed to understand the relative lack of opioid-specific support and to determine their broader impact in initiating and sustaining remission and cost-effectiveness.
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Affiliation(s)
- John F Kelly
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, United States of America.
| | - Nilofar Fallah-Sohy
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, United States of America
| | - Corrie Vilsaint
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, United States of America
| | - Lauren A Hoffman
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, United States of America
| | - Leonard A Jason
- Decision Sciences Institute, Providence, RI, United States of America
| | | | - Julie V Cristello
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, United States of America
| | - Bettina B Hoeppner
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, United States of America
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24
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Kelly JF, Stout RL, Jason LA, Fallah-Sohy N, Hoffman LA, Hoeppner BB. One-Stop Shopping for Recovery: An Investigation of Participant Characteristics and Benefits Derived From U.S. Recovery Community Centers. Alcohol Clin Exp Res 2020; 44:711-721. [PMID: 32012306 DOI: 10.1111/acer.14281] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recovery community centers (RCCs) are the "new kid on the block" in providing addiction recovery services, adding a third tier to the 2 existing tiers of formal treatment and mutual-help organizations (MHOs). RCCs are intended to be recovery hubs facilitating "one-stop shopping" in the accrual of recovery capital (e.g., recovery coaching; employment/educational linkages). Despite their growth, little is known about who uses RCCs, what they use, and how use relates to improvements in functioning and quality of life. Greater knowledge would inform the field about RCC's potential clinical and public health utility. METHODS Online survey conducted with participants (N = 336) attending RCCs (k = 31) in the northeastern United States. Substance use history, services used, and derived benefits (e.g., quality of life) were assessed. Systematic regression modeling tested a priori theorized relationships among variables. RESULTS RCC members (n = 336) were on average 41.1 ± 12.4 years of age, 50% female, predominantly White (78.6%), with high school or lower education (48.8%), and limited income (45.2% <$10,000 past-year household income). Most had either a primary opioid (32.7%) or alcohol (26.8%) problem. Just under half (48.5%) reported a lifetime psychiatric diagnosis. Participants had been attending RCCs for 2.6 ± 3.4 years, with many attending <1 year (35.4%). Most commonly used aspects were the socially oriented mutual-help/peer groups and volunteering, but technological assistance and employment assistance were also common. Conceptual model testing found RCCs associated with increased recovery capital, but not social support; both of these theorized proximal outcomes, however, were related to improvements in psychological distress, self-esteem, and quality of life. CONCLUSIONS RCCs are utilized by an array of individuals with few resources and primary opioid or alcohol histories. Whereas strong social supportive elements were common and highly rated, RCCs appear to play a more unique role not provided either by formal treatment or by MHOs in facilitating the acquisition of recovery capital and thereby enhancing functioning and quality of life.
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Affiliation(s)
- John F Kelly
- From the, Recovery Research Institute, (JFK, NF-S, LAH, BBH), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Leonard A Jason
- Decision Sciences Institute, (LAJ), Providence, Rhode Island
| | - Nilofar Fallah-Sohy
- From the, Recovery Research Institute, (JFK, NF-S, LAH, BBH), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lauren A Hoffman
- From the, Recovery Research Institute, (JFK, NF-S, LAH, BBH), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bettina B Hoeppner
- From the, Recovery Research Institute, (JFK, NF-S, LAH, BBH), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Fava M, Freeman MP, Flynn M, Judge H, Hoeppner BB, Cusin C, Ionescu DF, Mathew SJ, Chang LC, Iosifescu DV, Murrough J, Debattista C, Schatzberg AF, Trivedi MH, Jha MK, Sanacora G, Wilkinson ST, Papakostas GI. Correction: Double-blind, placebo-controlled, dose-ranging trial of intravenous ketamine as adjunctive therapy in treatment-resistant depression (TRD). Mol Psychiatry 2020; 25:1604. [PMID: 30617276 PMCID: PMC8329695 DOI: 10.1038/s41380-018-0311-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Supplementary Figure 1 and Supplementary Tables 1-4 have been re-uploaded so as to reflect the versions supplied during proofs stage. The publisher apologizes for the error in versioning. The HTML version of the paper has been updated.
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Affiliation(s)
| | - Marlene P. Freeman
- 0000 0004 0386 9924grid.32224.35Massachusetts General Hospital, Boston, MA USA
| | - Martina Flynn
- 0000 0004 0386 9924grid.32224.35Massachusetts General Hospital, Boston, MA USA
| | - Heidi Judge
- 0000 0004 0386 9924grid.32224.35Massachusetts General Hospital, Boston, MA USA
| | - Bettina B. Hoeppner
- 0000 0004 0386 9924grid.32224.35Massachusetts General Hospital, Boston, MA USA
| | - Cristina Cusin
- 0000 0004 0386 9924grid.32224.35Massachusetts General Hospital, Boston, MA USA
| | - Dawn F. Ionescu
- 0000 0004 0386 9924grid.32224.35Massachusetts General Hospital, Boston, MA USA
| | - Sanjay J. Mathew
- 0000 0001 2160 926Xgrid.39382.33Baylor College of Medicine/Michael E. Debakey VA Medical Center, Houston, TX USA
| | - Lee C. Chang
- 0000 0001 2160 926Xgrid.39382.33Baylor College of Medicine/Michael E. Debakey VA Medical Center, Houston, TX USA
| | - Dan V. Iosifescu
- 0000 0001 0670 2351grid.59734.3cIcahn School of Medicine at Mount Sinai, New York, NY USA
| | - James Murrough
- 0000 0001 0670 2351grid.59734.3cIcahn School of Medicine at Mount Sinai, New York, NY USA
| | - Charles Debattista
- 0000000419368956grid.168010.eStanford University School of Medicine, Stanford, CA USA
| | - Alan F. Schatzberg
- 0000000419368956grid.168010.eStanford University School of Medicine, Stanford, CA USA
| | - Madhukar H. Trivedi
- 0000 0000 9482 7121grid.267313.2University of Texas Southwestern, Dallas, TX USA
| | - Manish K. Jha
- 0000 0000 9482 7121grid.267313.2University of Texas Southwestern, Dallas, TX USA
| | - Gerard Sanacora
- 0000000419368710grid.47100.32Yale University, New Haven, CT USA
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Hoeppner SS, Carlon HA, Lambert AF, Hoeppner BB. Is the thought-action repertoire a viable intervention target in substance use populations? Gen Hosp Psychiatry 2019; 61:130-135. [PMID: 31753694 DOI: 10.1016/j.genhosppsych.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study examined if general population findings of positive correlations between happiness and breadth of thought-action repertoire (TAR) hold in substance use populations, and tests if the TAR is a modifiable intervention target. METHODS Using data from a randomized online survey on 468 adults in recovery from problematic substance use, we compared 5 happiness exercises to two control exercises on participants' post-exercise TAR, as measured by Frederickson's Modified Open-Ended Twenty Statements Test (MOETST) and coded specifically for action tendencies. RESULTS A negative binomial regression model indicated that momentary happiness reported before exercise completion was significantly and positively related to the breadth of action tendency repertoires (exp(b) = 1.05, exp(95% CI) [1.01, 1.09], p = 0.012). Two of five happiness exercises were associated with higher action tendency scores compared to the "Three Hard Things" control condition ("Savoring": exp(b) [95% CI]: 1.51 [1.10, 2.09], X2(df = 1) = 6.36, adj. p = 0.038; "Rose, Thorn, Bud": 1.50 [1.09, 2.06], X2(df = 1) = 6.19, adj. p = 0.038). None were significantly different from a neutral control. Effects were not significant for MOETST raw scores. CONCLUSIONS Results indicate that momentary happiness is associated with broadened action tendencies among individuals in recovery. Brief, self-administered happiness exercises can successfully broaden this aspect of the thought-action repertoire in this population.
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Affiliation(s)
- Susanne S Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Hannah A Carlon
- Department of Psychiatry, Massachusetts General Hospital, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA
| | - Adrian F Lambert
- Department of Psychiatry, Massachusetts General Hospital, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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Hoeppner BB, Hoeppner SS, Carlon HA, Perez GK, Helmuth E, Kahler CW, Kelly JF. Leveraging Positive Psychology to Support Smoking Cessation in Nondaily Smokers Using a Smartphone App: Feasibility and Acceptability Study. JMIR Mhealth Uhealth 2019; 7:e13436. [PMID: 31271147 PMCID: PMC6636238 DOI: 10.2196/13436] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/01/2019] [Accepted: 05/18/2019] [Indexed: 01/07/2023] Open
Abstract
Background Nondaily smoking is an increasingly prevalent smoking pattern that poses substantial health risks. Objective We tested the feasibility of using a smartphone app with positive psychology exercises to support smoking cessation in nondaily smokers. Methods In this prospective, single-group pilot study, nondaily smokers (n=30) used version 1 of the Smiling Instead of Smoking (SiS) app for 3 weeks while undergoing a quit attempt. The app assigned daily happiness exercises, provided smoking cessation tools, and made smoking cessation information available. Participants answered surveys at baseline and 2, 6, 12, and 24 weeks after their chosen quit day and participated in structured user feedback sessions 2 weeks after their chosen quit day. Results App usage during the prescribed 3 weeks of use was high, with an average 84% (25.2/30) of participants using the app on any given day. App use was largely driven by completing happiness exercises (73%, 22/30) of participants per day), which participants continued to complete even after the end of the prescribed period. At the end of prescribed use, 90% (27/30) of participants reported that the app had helped them during their quit attempt, primarily by reminding them to stay on track (83%, 25/30) and boosting their confidence to quit (80%, 24/30) and belief that quitting was worthwhile (80%, 24/30). Happiness exercises were rated more favorably than user-initiated smoking cessation tools, and 80% (24/30) of participants proactively expressed in interviews that they liked them. App functionality to engage social support was not well received. Functionality to deal with risky times was rated useful but was rarely used. Within-person changes from baseline to the end of prescribed use were observed for several theorized mechanisms of behavior change, all in the expected direction: confidence increased (on a 0-100 scale, internal cues: b=16.7, 95% CI 7.2 to 26.3, P=.001; external cues: b=15.8, 95% CI 5.4 to 26.1, P=.004), urge to smoke decreased (on a 1-7 scale, b=−0.8, 95% CI −1.3 to −0.3, P=.002), and perceptions of smoking became less positive (on a 1-5 scale, psychoactive benefits: b=−0.5, 95% CI −0.9 to −0.2, P=.006; pleasure: b=−0.4, 95% CI −0.7 to −0.01, P=.03; on a 0-100 scale, importance of pros of smoking: b=−11.3, 95% CI −18.9 to −3.8, P=.004). Self-reported abstinence rates were 40% (12/30) and 53% (16/30) of participants 2 and 24 weeks post quit, respectively, with 30% (9/30) biochemically validated as abstinent 2 weeks post quit. Conclusions A smartphone app using happiness exercises to aid smoking cessation was well received by nondaily smokers. Given the high nonadherence and dropout rates for technology-delivered interventions reported in the literature, the high engagement with positive psychology exercises is noteworthy. Observed within-person changes and abstinence rates are promising and warrant further development of this app.
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Affiliation(s)
- Bettina B Hoeppner
- Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Susanne S Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, MA, United States
| | - Hannah A Carlon
- Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Giselle K Perez
- Behavioral Medicine Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Eric Helmuth
- School of Public Health, Boston University, Boston, MA, United States
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - John F Kelly
- Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Kelly JF, Greene MC, Bergman BG, White WL, Hoeppner BB. How Many Recovery Attempts Does it Take to Successfully Resolve an Alcohol or Drug Problem? Estimates and Correlates From a National Study of Recovering U.S. Adults. Alcohol Clin Exp Res 2019; 43:1533-1544. [PMID: 31090945 PMCID: PMC6602820 DOI: 10.1111/acer.14067] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/16/2019] [Indexed: 11/27/2022]
Abstract
Background Alcohol and other drug (AOD) problems are commonly depicted as chronically relapsing, implying multiple recovery attempts are needed prior to remission. Yet, although a robust literature exists on quit attempts in the tobacco field, little is known regarding patterns of cessation attempts related to alcohol, opioid, stimulant, or cannabis problems. Greater knowledge of such estimates and the factors associated with needing fewer or greater attempts may have utility for health policy and clinical communication efforts and approaches. Methods Cross‐sectional, nationally representative survey of U.S. adults (N = 39,809) who reported resolving a significant AOD problem (n = 2,002) and assessed on number of prior serious recovery attempts, demographic variables, primary substance, clinical histories, and indices of psychological distress and well‐being. Results The statistical distribution of serious recovery attempts was highly skewed with a mean of 5.35 (SD = 13.41) and median of 2 (interquartile range [IQR] = 1 to 4). Black race, prior use of treatment and mutual‐help groups, and history of psychiatric comorbidity were associated with higher number of attempts, and more attempts were associated independently with greater current distress. Number of recovery attempts did not differ by primary substance (e.g., opioids vs. alcohol). Conclusions Estimates of recovery attempts differed substantially depending on whether the mean (5.35 recovery attempts) or median (2 recovery attempts) was used as the estimator. Implications of this are that the average may be substantially lower than anticipated because cultural expectations are often based on AOD problems being “chronically relapsing” disorders implicating seemingly endless tries. Depending on which one of these estimates is reported in policy documents or communicated in public health announcements or clinical settings, each may elicit varying degrees of help‐seeking, hope, motivation, and the use of more assertive clinical approaches. The more fitting, median estimate of attempts should be used in clinical and policy communications given the distribution.
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Affiliation(s)
- John F Kelly
- From the, Recovery Research Institute (JFK, BGB, BBH), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Brandon G Bergman
- From the, Recovery Research Institute (JFK, BGB, BBH), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Bettina B Hoeppner
- From the, Recovery Research Institute (JFK, BGB, BBH), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Millstein RA, Chung WJ, Hoeppner BB, Boehm JK, Legler SR, Mastromauro CA, Huffman JC. Development of the State Optimism Measure. Gen Hosp Psychiatry 2019; 58:83-93. [PMID: 31026732 PMCID: PMC6501845 DOI: 10.1016/j.genhosppsych.2019.04.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Optimism, or positive expectations about the future, is associated with better health. It is commonly assessed as a trait, but it may change over time and circumstance. Accordingly, we developed a measure of state optimism. METHODS An initial 29-item pool was generated based on literature reviews and expert consultations. It was administered to three samples: sample 1 was a general healthy population (n = 136), sample 2 was people with cardiac disease (n = 96), and sample 3 was persons recovering from problematic substance use (n = 265). Exploratory factor analysis and item-level descriptive statistics were used to select items to form a unidimensional State Optimism Measure (SOM). Confirmatory factor analysis (CFA) was performed to test fit. RESULTS The selected seven SOM items demonstrated acceptable to high factor loadings on a single dominant factor (loadings: 0.64-0.93). There was high internal reliability across samples (Cronbach's alphas: 0.92-0.96), and strong convergent validity correlations in hypothesized directions. The SOM's correlations with other optimism measures indicate preliminary construct validity. CFA statistics indicated acceptable fit of the SOM model. CONCLUSIONS We developed a psychometrically-sound measure of state optimism that can be used in various settings. Predictive and criterion validity will be tested in future studies.
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Affiliation(s)
- Rachel A Millstein
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Wei-Jean Chung
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Julia K Boehm
- Department of Psychology, Chapman University, Orange, CA, USA
| | - Sean R Legler
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Hoeppner BB, Schick MR, Carlon H, Hoeppner SS. Do self-administered positive psychology exercises work in persons in recovery from problematic substance use? An online randomized survey. J Subst Abuse Treat 2019; 99:16-23. [DOI: 10.1016/j.jsat.2019.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 01/05/2019] [Accepted: 01/07/2019] [Indexed: 01/07/2023]
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Hoeppner BB, Hoeppner SS, Schick MR, Milligan CM, Helmuth E, Bergman BG, Abroms LC, Kelly JF. Using the text-messaging program SmokefreeTXT to support smoking cessation for nondaily smokers. Subst Use Misuse 2019; 54:1260-1271. [PMID: 30999794 DOI: 10.1080/10826084.2018.1552300] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Smoking cessation interventions for nondaily smokers are needed. The current study explores the fit of the text-messaging intervention SmokefreeTXT for nondaily smokers. METHODS Adult nondaily smokers (N = 32; mean age = 35 ± 12, 64% female, 53% non-Hispanic White) were enrolled in SmokefreeTXT. SmokefreeTXT usage data were recorded passively, theorized mechanisms of change were assessed at baseline and 2, 6, and 12 weeks after the chosen quit day, and EMA protocols captured real-time cigarette reports at baseline, and during the first two weeks after the quit day. RESULTS Most participants completed the SmokefreeTXT program and responded to system-initiated inquiries, but just-in-time interaction with the program was limited. In retrospective recall at treatment end, content of the text-messages was rated as "neutral" to "helpful." Within-person change was observed in theorized mechanisms, with less craving (p < 0.01), increased abstinence self-efficacy (external: p < 0.01; internal: p < 0.01), and poorer perceptions of pros of smoking (psychoactive benefits: p < 0.01, pleasure p < 0.01; and pros: p < 0.01) reported after SmokefreeTXT initiation compared to baseline. Exploratory analyses of real-time reports of smoking (225 cigarette reports in N = 17 who relapsed) indicated that cigarettes smoked in the first two weeks after quitting were more likely to occur to reduce craving (OR = 2.21[1.21-3.72]), and less likely to occur to socialize (OR = 0.06[0.01-0.24]), between 19:00 and 23:00 (OR = 0.34[0.17-0.66]), and on Saturdays (OR = 0.59[0.35-0.99]) than prior to quitting. CONCLUSIONS While well accepted by nondaily smokers, SmokefreeTXT could potentially be improved by targeting cons of smoking, enhancing engagement with the just-in-time component of SmokefreeTXT, and tweaking the timing of text-messages.
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Affiliation(s)
- Bettina B Hoeppner
- a Recovery Research Institute, Massachusetts General Hospital , Harvard Medical School , Boston , Massachusetts, USA.,b Department of Psychiatry , Massachusetts General Hospital, Harvard Medical School , Boston , Massachusetts, USA
| | - Susanne S Hoeppner
- b Department of Psychiatry , Massachusetts General Hospital, Harvard Medical School , Boston , Massachusetts, USA.,c Massachusetts General Hospital , Center for Anxiety and Traumatic Stress Disorders , Boston , Massachusetts, USA
| | - Melissa R Schick
- a Recovery Research Institute, Massachusetts General Hospital , Harvard Medical School , Boston , Massachusetts, USA
| | - Connor M Milligan
- a Recovery Research Institute, Massachusetts General Hospital , Harvard Medical School , Boston , Massachusetts, USA
| | - Eric Helmuth
- d Boston University School of Public Health , Boston , Massachusetts, USA
| | - Brandon G Bergman
- a Recovery Research Institute, Massachusetts General Hospital , Harvard Medical School , Boston , Massachusetts, USA
| | - Lorien C Abroms
- e Department of Prevention and Community Health, Milken Institute School of Public Health , George Washington University , Washington , DC , USA
| | - John F Kelly
- a Recovery Research Institute, Massachusetts General Hospital , Harvard Medical School , Boston , Massachusetts, USA.,b Department of Psychiatry , Massachusetts General Hospital, Harvard Medical School , Boston , Massachusetts, USA
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Bergman BG, Claire Greene M, Hoeppner BB, Kelly JF. Expanding the reach of alcohol and other drug services: Prevalence and correlates of US adult engagement with online technology to address substance problems. Addict Behav 2018; 87:74-81. [PMID: 29960132 DOI: 10.1016/j.addbeh.2018.06.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/15/2018] [Accepted: 06/15/2018] [Indexed: 12/26/2022]
Abstract
Online technologies are well integrated into the day-to-day lives of individuals with alcohol and other drug (i.e., substance use) problems. Interventions that leverage online technologies have been shown to enhance outcomes for these individuals. To date, however, little is known about how those with substance use problems naturally engage with such platforms. In addition, the scientific literatures on health behavior change facilitated by technology and harms driven by technology engagement have developed largely independent of one another. In this secondary analysis of the National Recovery Study (NRS), which provides a geo-demographically representative sample of US adults who resolved a substance use problem, we examined a) the weighted prevalence estimate of individuals who engaged with online technologies to "cut down on substance use, abstain from substances, or strengthen one's recovery" (i.e., recovery-related use of online technology, or ROOT), b) clinical/recovery correlates of ROOT, controlling for demographic covariates, and c) the unique association between ROOT and self-reported history of internet addiction. Results showed one in ten (11%) NRS participants reported ROOT. Significant correlates included greater current psychological distress, younger age of first substance use, as well as history of anti-craving/anti-relapse medication, recovery support services, and drug court participation. Odds of lifetime internet addiction were 4 times greater for those with ROOT (vs. no ROOT). These data build on studies of technology-based interventions, highlighting the reach of ROOT, and therefore, the potential for a large, positive impact on substance-related harms in the US.
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Affiliation(s)
- Brandon G Bergman
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, United States..
| | - M Claire Greene
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, United States
| | - Bettina B Hoeppner
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, United States
| | - John F Kelly
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, 151 Merrimac Street, Boston, MA 02114, United States
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Kelly JF, Abry AW, Milligan CM, Bergman BG, Hoeppner BB. On being "in recovery": A national study of prevalence and correlates of adopting or not adopting a recovery identity among individuals resolving drug and alcohol problems. Psychol Addict Behav 2018; 32:595-604. [PMID: 30070538 DOI: 10.1037/adb0000386] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The concept of recovery has become an organizing paradigm in the addiction field globally. Although a convenient label to describe the broad phenomena of change when individuals resolve significant alcohol or other drug (AOD) problems, little is known regarding the prevalence and correlates of adopting such an identity. Greater knowledge would inform clinical, public health, and policy communication efforts. We conducted a cross-sectional nationally representative survey (N = 39,809) of individuals resolving a significant AOD problem (n = 1,995). Weighted analyses estimated prevalence and tested correlates of label adoption. Qualitative analyses summarized reasons for prior recovery identity adoption/nonadoption. The proportion of individuals currently identifying as being in recovery was 45.1%, never in recovery 39.5%, and no longer in recovery 15.4%. Predictors of identifying as being in recovery included formal treatment and mutual-help participation, and history of being diagnosed with AOD or other psychiatric disorders. Qualitative analyses regarding reasons for no/prior recovery identity found themes related to low AOD problem severity, viewing the problem as resolved, or having little difficulty of stopping. Despite increasing use of the recovery label and concept, many resolving AOD problems do not identify in this manner. These appear to be individuals who have not engaged with the formal or informal treatment systems. To attract, engage, and accommodate this large number of individuals who add considerably to the AOD-related global burden of disease, AOD public health communication efforts may need to consider additional concepts and terminology beyond recovery (e.g., "problem resolution") to meet a broader range of preferences, perspectives and experiences. (PsycINFO Database Record
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Affiliation(s)
- John F Kelly
- Recovery Research Institute, Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital
| | - Alexandra W Abry
- Recovery Research Institute, Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital
| | - Connor M Milligan
- Recovery Research Institute, Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital
| | - Brandon G Bergman
- Recovery Research Institute, Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital
| | - Bettina B Hoeppner
- Recovery Research Institute, Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital
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Villegas AC, DuBois CM, Celano CM, Beale EE, Mastromauro CA, Stewart JG, Auerbach RP, Huffman JC, Hoeppner BB. A longitudinal investigation of the Concise Health Risk Tracking Self-Report (CHRT-SR) in suicidal patients during and after hospitalization. Psychiatry Res 2018; 262:558-565. [PMID: 28954699 DOI: 10.1016/j.psychres.2017.09.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 07/31/2017] [Accepted: 09/17/2017] [Indexed: 01/25/2023]
Abstract
The Concise Health Risk Tracking Self-Report (CHRT-SR) scale is a brief self-report instrument to assess suicide risk. Initial investigations have indicated good psychometric properties in psychiatric outpatients. The aims of this paper were to examine the construct validity and factor structure of the twelve- (CHRT-SR12) and seven-item (CHRT-SR7) versions and to test if clinically expected within-person changes in suicide risk over time were measurable using the CHRT-SR in two study cohorts hospitalized for suicidal ideation or behavior: (1) patients with major depressive disorder (MDD) who participated in a psychological intervention trial, n = 65, and (2) participants with bipolar disorder or MDD in an observational study, n = 44. The CHRT-SR12 and self-report measures of hopelessness, depression, and positive psychological states were administered during admission and several times post-discharge. Both versions showed good internal consistency in inpatients and confirmed the three-factor structure (i.e., hopelessness, perceived lack of social support and active suicidal ideation and plans) found in outpatients. CHRT-SR scores had strong correlations with negative and positive affective constructs in the expected directions, and indicated decreases in suicide risk following discharge, in line with clinical expectations. The CHRT-SR12 and CHRT-SR7 are promising self-report measures for assessing suicide risk in very high-risk patient populations.
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Affiliation(s)
- Ana C Villegas
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Christina M DuBois
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher M Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Eleanor E Beale
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Jeremy G Stewart
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Randy P Auerbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Kelly JF, Bergman B, Hoeppner BB, Vilsaint C, White WL. Prevalence and pathways of recovery from drug and alcohol problems in the United States population: Implications for practice, research, and policy. Drug Alcohol Depend 2017; 181:162-169. [PMID: 29055821 PMCID: PMC6076174 DOI: 10.1016/j.drugalcdep.2017.09.028] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/23/2017] [Accepted: 09/26/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Alcohol and other drug (AOD) problems confer a global, prodigious burden of disease, disability, and premature mortality. Even so, little is known regarding how, and by what means, individuals successfully resolve AOD problems. Greater knowledge would inform policy and guide service provision. METHOD Probability-based survey of US adult population estimating: 1) AOD problem resolution prevalence; 2) lifetime use of "assisted" (i.e., treatment/medication, recovery services/mutual help) vs. "unassisted" resolution pathways; 3) correlates of assisted pathway use. Participants (response=63.4% of 39,809) responding "yes" to, "Did you use to have a problem with alcohol or drugs but no longer do?" assessed on substance use, clinical histories, problem resolution. RESULTS Weighted prevalence of problem resolution was 9.1%, with 46% self-identifying as "in recovery"; 53.9% reported "assisted" pathway use. Most utilized support was mutual-help (45.1%,SE=1.6), followed by treatment (27.6%,SE=1.4), and emerging recovery support services (21.8%,SE=1.4), including recovery community centers (6.2%,SE=0.9). Strongest correlates of "assisted" pathway use were lifetime AOD diagnosis (AOR=10.8[7.42-15.74], model R2=0.13), drug court involvement (AOR=8.1[5.2-12.6], model R2=0.10), and, inversely, absence of lifetime psychiatric diagnosis (AOR=0.3[0.2-0.3], model R2=0.10). Compared to those with primary alcohol problems, those with primary cannabis problems were less likely (AOR=0.7[0.5-0.9]) and those with opioid problems were more likely (AOR=2.2[1.4-3.4]) to use assisted pathways. Indices related to severity were related to assisted pathways (R2<0.03). CONCLUSIONS Tens of millions of Americans have successfully resolved an AOD problem using a variety of traditional and non-traditional means. Findings suggest a need for a broadening of the menu of self-change and community-based options that can facilitate and support long-term AOD problem resolution.
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Affiliation(s)
- John F. Kelly
- Recovery Research Institute, Massachusetts General Hospital, 151 Merrimac Street, and Harvard Medical School, Boston, MA, 02114, United States,Corresponding author at: Recovery Research Institute, Massachusetts General Hospital, 151 Merrimac Street, Boston, MA, 02114, United States. (J.F. Kelly)
| | - Brandon Bergman
- Recovery Research Institute, Massachusetts General Hospital, 151 Merrimac Street, and Harvard Medical School, Boston, MA, 02114, United States
| | - Bettina B. Hoeppner
- Recovery Research Institute, Massachusetts General Hospital, 151 Merrimac Street, and Harvard Medical School, Boston, MA, 02114, United States
| | - Corrie Vilsaint
- Recovery Research Institute, Massachusetts General Hospital, 151 Merrimac Street, and Harvard Medical School, Boston, MA, 02114, United States
| | - William L. White
- Chestnut Health Systems, W Chestnut St, Bloomington, IL, 61701, United States
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Hoeppner BB, Schick MR, Kelly LM, Hoeppner SS, Bergman B, Kelly JF. There is an app for that - Or is there? A content analysis of publicly available smartphone apps for managing alcohol use. J Subst Abuse Treat 2017; 82:67-73. [PMID: 29021117 DOI: 10.1016/j.jsat.2017.09.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Smartphone apps are emerging as a promising tool to support recovery from and prevention of problematic alcohol use, yet it is unclear what type of apps are currently available in the public domain, and to what degree these apps use interactive tailoring or other dynamic features to meet users' specific needs. METHODS We conducted a content analysis of Android apps for managing drinking available on Google Play (n=266), downloaded between November 21, 2014 and June 25, 2015. We recorded app popularity (>10,000 downloads) and user-rated quality (number of stars) from Google Play, and coded the apps on three domains (basic descriptors, functionality, use of dynamic features). RESULTS In total, the reviewed 266 apps were downloaded at least 2,793,567 times altogether. The most common types of app were BAC calculators (37%), information provision apps (37%), tracking calendars (24%), and motivational tools (21%). Most apps were free (65%) or low in cost (mean=$3.76; SD=$5.80). Many apps provided at least some level of tailored feedback (60%), but the extent of tailoring was limited. Use of other dynamic features (i.e., push notifications, passive data collection) was largely absent. Univariate models predicting app popularity (i.e., >10,000 downloads vs. not) and user-rated quality (i.e., star rating) indicated that tailoring was positively related to popularity (OR=2.41 [1.30-4.46]), and the existence of time-based tailoring (e.g., tracking) was related to quality (b=0.48 [0.19-0.77]). CONCLUSIONS These apps have a wide public health reach with >2.7 million total combined downloads to date. A wide variety of apps exist, allowing persons interested in using apps to help them manage their drinking to choose from numerous types of supports. Tailoring, while related favorably to an app's popularity and user-rated quality, is limited in publicly available apps.
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Affiliation(s)
- Bettina B Hoeppner
- Recovery Research Institute and Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, United States; Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, United States.
| | - Melissa R Schick
- Recovery Research Institute and Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, United States
| | - Lourah M Kelly
- Recovery Research Institute and Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, United States; Suffolk University, Psychology Department, 73 Tremont Street, 8th Floor, MA 02114, United States
| | - Susanne S Hoeppner
- Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, United States
| | - Brandon Bergman
- Recovery Research Institute and Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, United States; Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, United States
| | - John F Kelly
- Recovery Research Institute and Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, United States; Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, United States
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Evins AE, Hoeppner SS, Schoenfeld DA, Hoeppner BB, Cather C, Pachas GN, Cieslak KM, Maravic MC. Maintenance pharmacotherapy normalizes the relapse curve in recently abstinent tobacco smokers with schizophrenia and bipolar disorder. Schizophr Res 2017; 183:124-129. [PMID: 27956009 PMCID: PMC5432398 DOI: 10.1016/j.schres.2016.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/11/2016] [Accepted: 11/12/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the effect of maintenance pharmacotherapy on sustained abstinence rates between recently abstinent smokers with schizophrenia and bipolar disorder (SBD) and general population smokers without psychiatric illness. METHOD We performed a person-level, pooled analysis of two randomized controlled trials of maintenance varenicline, conducted in adult smokers with SBD and general population smokers, controlling for severity of dependence. Smokers abstinent after 12-weeks of open varenicline treatment were randomly assigned to ≥12-weeks maintenance varenicline or identical placebo. RESULTS In those assigned to maintenance placebo, the abstinence rate at week-24 was lower in those with SBD than for those without psychiatric illness (29.4±1.1% vs. 61.8±0.4%, OR:0.26, 95% CI: 0.13, 0.52, p<0.001). In smokers assigned to maintenance pharmacotherapy, however, there was no effect of diagnosis on abstinence rates at week-24 (87.2±0.8% vs. 81.9±0.2%, OR: 1.68, 95% CI: 0.53, 5.32, p=0.38). Time to first lapse was shortest in those with SBD assigned to maintenance placebo (Q1=12days, 95%CI: 4, 16), longer in those without psychiatric illness assigned to maintenance placebo (Q1=17days, 95%CI: 17, 29), still longer in general-population smokers assigned to maintenance varenicline (Q1=88, 95% CI:58,91, and longest in those with SBD who received maintenance varenicline (Q1>95days, 95%CI:non-est), (Χ23df=96.99, p<0.0001; all pairwise comparisons p<0.001). CONCLUSIONS Following a standard 12-week course of pharmacotherapy, people with schizophrenia and bipolar disorder were more likely to relapse to smoking without maintenance varenicline treatment. Maintenance pharmacotherapy could improve longer-term tobacco abstinence rates and reduce known smoking-related health disparities in those with SMI.
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Affiliation(s)
- A. Eden Evins
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Susanne S. Hoeppner
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - David A. Schoenfeld
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Bettina B. Hoeppner
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Corinne Cather
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Gladys N. Pachas
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Kristina M. Cieslak
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Melissa Culhane Maravic
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Hoeppner BB, Hoeppner SS, Abroms LC. How do text-messaging smoking cessation interventions confer benefit? A multiple mediation analysis of Text2Quit. Addiction 2017; 112:673-682. [PMID: 27943511 PMCID: PMC6067921 DOI: 10.1111/add.13685] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/13/2016] [Accepted: 11/03/2016] [Indexed: 11/30/2022]
Abstract
AIMS To determine the degree to which the observed benefit of Text2Quit was accounted for by psychosocial mechanisms derived from its quit smoking messaging versus from the use of extra-programmatic smoking cessation treatments and services. DESIGN Prospective, multiple mediation model of a randomized controlled trial (RCT). SETTING United States nation-wide. PARTICIPANTS A total of 409 adult daily smokers participated. Participants were, on average, 35 years of age, predominantly female (68%), white (79%), lacked a college degree (70%), had medium nicotine dependence (average Fagerström Nicotine Dependence Score score of 5.2) and more than half (62%) had made a previous quit attempt. INTERVENTION Adult daily smokers browsing the web for smoking cessation support (n = 409; recruited 19 May2011-10 July 2012) were randomized to receive smoking cessation support via Text2Quit versus a smoking cessation material. MEASUREMENTS Mediators (i.e. changes in psychosocial constructs of health behavior change, use of extra-programmatic treatment) were assessed at 1 month using single-item measures and outcome (i.e. self-reported 7-day point prevalence abstinence) at 6-month follow-up. FINDINGS Mediators accounted for 35% of the effect of Text2Quit on smoking cessation. Only psychosocial mechanisms had complete mediational paths, with increases in self-efficacy [b = 0.10 (0.06-0.15)], quitting know-how [b = 0.07 (0.03-0.11)] and the sense that someone cared [b = 0.06 (0.01-0.11)], partially explaining the conferred benefit of Text2Quit. Use of outside resources, including treatments promoted explicitly by Text2Quit, i.e. medication [b = 0.001 (-0.01 to 0.01), quitline [b = -0.002 (-0.01 to 0.04)], treatments and resources not promoted by Text2Quit, i.e. online forums [b = 0.01 (-0.01 to 0.04)] and self-help materials [b = -0.01 (-0.04 to 0.02)], did not have complete mediational paths. An interaction effect existed for medication use that suggested that for participants not using medication, Text2Quit conferred substantial benefit, but not for participants using medication. CONCLUSIONS Text-messaging programs for smoking cessation appear primarily to confer benefit by promoting improvements in the psychosocial processes related to quitting rather than through the use of extra-programmatic smoking cessation treatments and services.
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Affiliation(s)
- Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Susanne S Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Bergman BG, Kelly NW, Hoeppner BB, Vilsaint CL, Kelly JF. Digital recovery management: Characterizing recovery-specific social network site participation and perceived benefit. Psychol Addict Behav 2017; 31:506-512. [PMID: 28206780 DOI: 10.1037/adb0000255] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research shows that digital social network sites (SNSs) may be valuable platforms to effect health behavior change. Little is known specifically about their ability to help address alcohol and other drug problems. This gap is noteworthy, given that individuals are already participating in existing, recovery-specific SNSs (hereafter referred to as recovery SNSs): online communities with the functionality of conventional SNSs (e.g., Facebook) that focus on substance use disorder (SUD) recovery. For example, InTheRooms.com (ITR) is a large, well-known recovery SNS that is available for free 24 hr/day via website and mobile smartphone applications. It offers recovery tools within a digital social milieu for over 430,000 registered users. To augment the knowledge base on recovery SNS platforms, we conducted an online survey of 123 ITR participants (M = 50.8 years old; 56.9% female; 93.5% White; M = 7.3 years of abstinence, range of 0-30 years; 65% cited alcohol as their primary substance). Respondents engaged with ITR, on average, for about 30 min/day several times each week. Daily meditation prompts and live online video meetings were the most commonly utilized resources. Participants generally endorsed ITR as a helpful platform, particularly with respect to increased abstinence/recovery motivation and self-efficacy. Compared to individuals abstinent for 1 or more years, those abstinent less than 1 year (including nonabstinent individuals) showed similar rates of engagement with ITR activities and similar levels of perceived benefit. Our findings suggest that longitudinal studies are warranted to examine the clinical utility of ITR and other recovery SNSs as SUD treatment adjuncts and/or recovery self-management tools. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | - John F Kelly
- Recovery Research Institute, Massachusetts General Hospital
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Fava M, Johe K, Ereshefsky L, Gertsik LG, English BA, Bilello JA, Thurmond LM, Johnstone J, Dickerson BC, Makris N, Hoeppner BB, Flynn M, Mischoulon D, Kinrys G, Freeman MP. A Phase 1B, randomized, double blind, placebo controlled, multiple-dose escalation study of NSI-189 phosphate, a neurogenic compound, in depressed patients. Mol Psychiatry 2016; 21:1372-80. [PMID: 26643541 PMCID: PMC5030464 DOI: 10.1038/mp.2015.178] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/25/2015] [Accepted: 10/05/2015] [Indexed: 12/02/2022]
Abstract
We wanted to examine tolerability and efficacy of NSI-189, a benzylpiperizine-aminiopyridine neurogenic compound for treating major depressive disorder (MDD). This was a Phase 1B, double blind, randomized, placebo controlled, multiple-dose study with three cohorts. The first cohort received 40 mg q.d. (n=6) or placebo (n=2), the second cohort 40 mg b.i.d. (n=6) or placebo (n=2), and the third cohort 40 mg t.i.d. (n=6) or placebo (n=2). Twenty-four patients with MDD were recruited, with the diagnosis and severity confirmed through remote interviews. Eligible patients received NSI-189 or placebo for 28 days in an inpatient setting with assessments for safety, pharmacokinetics (PK) and efficacy. Outpatient follow-up visits were conducted until day 84 (±3). NSI-189 was relatively well tolerated at all doses, with no serious adverse effects. NSI-189 area under the curve increased in a dose-related and nearly proportional manner across the three cohorts, with a half-life of 17.4-20.5 h. The exploratory efficacy measurements, including Symptoms Of Depression Questionnaire (SDQ), Montgomery-Asberg Depression Scale (MADRS), Clinical Global Impressions-Improvement (CGI-I), and The Massachusetts General Hospital (MGH) Cognitive and Physical Functioning Questionnaire (CPFQ) showed a promising reduction in depressive and cognitive symptoms across all measures for NSI-189, with significant improvement in the SDQ and CPFQ, and a medium to large effect size for all measures. These improvements persisted during the follow-up phase. In summary, NSI-189 shows potential as a treatment for MDD in an early phase study. The main limitation of this preliminary study was the small sample size of each cohort.
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Affiliation(s)
- M Fava
- Massachusetts General Hospital, Clinical Trials and Network Institute, Boston, MA, USA,Harvard Medical School, Department of Psychiatry, Boston, MA, USA,Department of Psychiatry, Clinical Trials Network and Institute, Massachusetts General Hospital, Slater Family Professor of Psychiatry, Harvard Medical School, 55 Fruit Street, Bulfinch 351, Boston, MA 02114, USA. E-mail:
| | - K Johe
- Neuralstem Inc., Germantown, MD, USA
| | - L Ereshefsky
- PAREXEL International, Los Angeles Early Phase Unit, Los Angeles, CA, USA
| | - L G Gertsik
- California Clinical Trials Medical Group, Glendale, CA, USA
| | - B A English
- PAREXEL International, Los Angeles Early Phase Unit, Los Angeles, CA, USA
| | - J A Bilello
- Ridge Diagnostics, Research Triangle Park, NC, USA
| | - L M Thurmond
- Ridge Diagnostics, Research Triangle Park, NC, USA
| | | | - B C Dickerson
- Center for Morphometric Analysis, Massachusetts General Hospital, Boston, MA, USA
| | - N Makris
- Center for Morphometric Analysis, Massachusetts General Hospital, Boston, MA, USA
| | - B B Hoeppner
- Massachusetts General Hospital, Clinical Trials and Network Institute, Boston, MA, USA,Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - M Flynn
- Massachusetts General Hospital, Clinical Trials and Network Institute, Boston, MA, USA
| | - D Mischoulon
- Massachusetts General Hospital, Clinical Trials and Network Institute, Boston, MA, USA,Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - G Kinrys
- Massachusetts General Hospital, Clinical Trials and Network Institute, Boston, MA, USA,Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - M P Freeman
- Massachusetts General Hospital, Clinical Trials and Network Institute, Boston, MA, USA,Harvard Medical School, Department of Psychiatry, Boston, MA, USA
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Bergman BG, Hoeppner BB, Nelson LM, Slaymaker V, Kelly JF. The effects of continuing care on emerging adult outcomes following residential addiction treatment. Drug Alcohol Depend 2015; 153:207-14. [PMID: 26116368 PMCID: PMC4510025 DOI: 10.1016/j.drugalcdep.2015.05.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/13/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Professional continuing care services enhance recovery rates among adults and adolescents, though less is known about emerging adults (18-25 years old). Despite benefit shown from emerging adults' participation in 12-step mutual-help organizations (MHOs), it is unclear whether participation offers benefit independent of professional continuing care services. Greater knowledge in this area would inform clinical referral and linkage efforts. METHODS Emerging adults (N=284; 74% male; 95% Caucasian) were assessed during the year after residential treatment on outpatient sessions per week, percent days in residential treatment and residing in a sober living environment, substance use disorder (SUD) medication use, active 12-step MHO involvement (e.g., having a sponsor, completing step work, contact with members outside meetings), and continuous abstinence (dichotomized yes/no). One generalized estimating equation (GEE) model tested the unique effect of each professional service on abstinence, and, in a separate GEE model, the unique effect of 12-step MHO involvement on abstinence over and above professional services, independent of individual covariates. RESULTS Apart from SUD medication, all professional continuing care services were significantly associated with abstinence over and above individual factors. In the more comprehensive model, relative to zero 12-step MHO activities, odds of abstinence were 1.3 times greater if patients were involved in one activity, and 3.2 times greater if involved in five activities (lowest mean number of activities in the sample across all follow-ups). CONCLUSIONS Both active involvement in 12-step MHOs and recovery-supportive, professional services that link patients with these community-based resources may enhance outcomes for emerging adults after residential treatment.
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Affiliation(s)
- Brandon G. Bergman
- Massachusetts General Hospital (Boston, MA)
,Harvard Medical School (Boston, MA)
| | - Bettina B. Hoeppner
- Massachusetts General Hospital (Boston, MA)
,Harvard Medical School (Boston, MA)
| | - Lindsay M. Nelson
- Hazelden Betty Ford Foundation’s Butler Center for Research (Center City, MN)
| | - Valerie Slaymaker
- Hazelden Betty Ford Foundation’s Butler Center for Research (Center City, MN)
| | - John F. Kelly
- Massachusetts General Hospital (Boston, MA)
,Harvard Medical School (Boston, MA)
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Kelly JF, Greene MC, Bergman B, Hoeppner BB, Slaymaker V. The Sponsor Alliance Inventory: Assessing the Therapeutic Bond Between 12-Step Attendees and Their Sponsors. Alcohol Alcohol 2015; 51:32-9. [PMID: 26113488 DOI: 10.1093/alcalc/agv071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/30/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS Within 12-step mutual-help organizations (MHOs), a sponsor plays a key recovery-specific role analogous to a 'lay therapist', serving as a role model, support and mentor. Research shows that attendees who have a sponsor have higher rates of abstinence and remission from substance use disorder (SUD), yet, while myriad formal psychotherapy studies demonstrate the therapeutic significance of the alliance between patients and professional clinicians on treatment outcomes, very little is known about the influence of the 'therapeutic alliance' between 12-step members and their sponsor. Greater knowledge about this key 12-step relationship could help explain greater degrees of 12-step effects. To bridge this gap, this study sought to develop and test a measure assessing the 12-step sponsee-sponsor therapeutic alliance--the Sponsor Alliance Inventory (SAI). METHOD Young adults (N = 302) enrolled in a prospective effectiveness study who reported having a 12-step sponsor during the study (N = 157) were assessed at treatment entry, and 3, 6 and 12 months later on the SAI, their 12-step MHO attendance, involvement and percent days abstinent (PDA). RESULTS Principal axis extraction revealed a single, 10-item, internally consistent (α's ≥ 0.95) scale that explained the majority of variance and was largely invariant to primary substance, gender and time. Criterion validity was also supported with higher SAI scores predicting greater proximal 12-step attendance, involvement and PDA. CONCLUSION The SAI may serve as a brief, valid measure to assess the degree of sponsee-sponsor 'therapeutic alliance' within 12-step communities and may help augment explanatory models estimating the effects of MHOs on recovery outcomes.
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Affiliation(s)
- John F Kelly
- MGH Psychiatry, Center for Addiction Medicine, Recovery Research Institute, 60 Staniford Street, Boston, MA 02114, USA
| | - M Claire Greene
- MGH Psychiatry, Center for Addiction Medicine, Recovery Research Institute, 60 Staniford Street, Boston, MA 02114, USA
| | - Brandon Bergman
- MGH Psychiatry, Center for Addiction Medicine, Recovery Research Institute, 60 Staniford Street, Boston, MA 02114, USA
| | - Bettina B Hoeppner
- MGH Psychiatry, Center for Addiction Medicine, Recovery Research Institute, 60 Staniford Street, Boston, MA 02114, USA
| | - Valerie Slaymaker
- MGH Psychiatry, Center for Addiction Medicine, Recovery Research Institute, 60 Staniford Street, Boston, MA 02114, USA
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Hoeppner BB, Hoeppner SS, Seaboyer L, Schick MR, Wu GWY, Bergman BG, Kelly JF. How Smart are Smartphone Apps for Smoking Cessation? A Content Analysis. Nicotine Tob Res 2015; 18:1025-31. [PMID: 26045249 DOI: 10.1093/ntr/ntv117] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/23/2015] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Smartphone technology is ideally suited to provide tailored smoking cessation support, yet it is unclear to what extent currently existing smartphone "apps" use tailoring, and if tailoring is related to app popularity and user-rated quality. METHODS We conducted a content analysis of Android smoking cessation apps (n = 225), downloaded between October 1, 2013 to May 31, 2014. We recorded app popularity (>10,000 downloads) and user-rated quality (number of stars) from Google Play, and coded the existence of tailoring features in the apps within the context of using the 5As ("ask," "advise," "assess," "assist," and "arrange follow-up"), as recommended by national clinical practice guidelines. RESULTS Apps largely provided simplistic tools (eg, calculators, trackers), and used tailoring sparingly: on average, apps addressed 2.1 ± 0.9 of the 5As and used tailoring for 0.7 ± 0.9 of the 5As. Tailoring was positively related to app popularity and user-rated quality: apps that used two-way interactions (odds ratio [OR] = 5.56 [2.45-12.62]), proactive alerts (OR = 3.80 [1.54-9.38]), responsiveness to quit status (OR = 5.28 [2.18-12.79]), addressed more of the 5As (OR = 1.53 [1.10-2.14]), used tailoring for more As (OR = 1.67 [1.21-2.30]), and/or used more ways of tailoring 5As content (OR = 1.35 [1.13-1.62]) were more likely to be frequently downloaded. Higher star ratings were associated with a higher number of 5As addressed (b = 0.16 [0.03-0.30]), a higher number of 5As with any level of tailoring (b = 0.14 [0.01-0.27]), and a higher number of ways of tailoring 5As content (b = 0.08 [0.002-0.15]). CONCLUSIONS Publically available smartphone smoking cessation apps are not particularly "smart": they commonly fall short of providing tailored feedback, despite users' preference for these features.
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Affiliation(s)
- Bettina B Hoeppner
- Center for Addiction Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA;
| | - Susanne S Hoeppner
- Center for Addiction Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Lourah Seaboyer
- Center for Addiction Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA; Department of Psychology, Suffolk University, Boston, MA
| | - Melissa R Schick
- Center for Addiction Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Gwyneth W Y Wu
- Center for Addiction Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA; School of Education, Johns Hopkins University, Baltimore, MD
| | - Brandon G Bergman
- Center for Addiction Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - John F Kelly
- Center for Addiction Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA
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Redding CA, Prochaska JO, Armstrong K, Rossi JS, Hoeppner BB, Sun X, Kobayashi H, Yin HQ, Coviello D, Evers K, Velicer WF. Randomized trial outcomes of a TTM-tailored condom use and smoking intervention in urban adolescent females. Health Educ Res 2015; 30:162-78. [PMID: 24794584 PMCID: PMC4296884 DOI: 10.1093/her/cyu015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 03/18/2014] [Indexed: 06/03/2023]
Abstract
Smoking and sexual risk behaviors in urban adolescent females are prevalent and problematic. Family planning clinics reach those who are at most risk. This randomized effectiveness trial evaluated a transtheoretical model (TTM)-tailored intervention to increase condom use and decrease smoking. At baseline, a total of 828 14- to 17-year-old females were recruited and randomized within four urban family planning clinics. Participants received TTM or standard care (SC) computerized feedback and stage-targeted or SC counseling at baseline, 3, 6 and 9 months. Blinded follow-up telephone surveys were conducted at 12 and 18 months. Analyses revealed significantly more consistent condom use in the TTM compared with the SC group at 6 and 12, but not at 18 months. In baseline consistent condom users (40%), significantly less relapse was found in the TTM compared with the SC group at 6 and 12, but not at 18 months. No significant effects for smoking prevention or cessation were found, although cessation rates matched those found previously. This TTM-tailored intervention demonstrated effectiveness for increasing consistent condom use at 6 and 12 months, but not at 18 months, in urban adolescent females. This intervention, if replicated, could be disseminated to promote consistent condom use and additional health behaviors in youth at risk.
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Affiliation(s)
- Colleen A Redding
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - James O Prochaska
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - Kay Armstrong
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - Joseph S Rossi
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - Bettina B Hoeppner
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - Xiaowu Sun
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - Hisanori Kobayashi
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - Hui-Qing Yin
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - Donna Coviello
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - Kerry Evers
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - Wayne F Velicer
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
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Abstract
OBJECTIVE Relapse to smoking after making a quit attempt is both common and rapid in adolescent smokers. Momentary self-efficacy (SE)-that is, momentary shifts in one's confidence in the ability to abstain from smoking-predicts the occurrence and timing of relapse among adolescent smokers. Therefore, it is important to identify factors that are associated with changes in momentary SE early in a quit attempt. This study examined the relationship between affect states (including positive, negative, and nicotine withdrawal states) and momentary SE at various stages of a quit attempt. METHOD Adolescent daily smokers interested in making a quit attempt (n = 202) completed ecological momentary assessments (EMA) each day for 1 week leading up to and 2 weeks after a quit attempt. In each assessment, they reported current SE and affect state. RESULTS RESULTS of linear mixed models indicated that most of the examined affect states were related to momentary SE. Contrary to expectation, they were related to momentary SE both immediately before and after the quit attempt. Moderation effects were observed for select affect states, where higher baseline SE was related to lower momentary SE in the presence of increasing negative high activation, boredom, and difficulty concentrating. CONCLUSIONS Our findings suggest that both positive and negative affect states are related to SE, and that thereby positive affect enhancement may be a promising, underutilized treatment target.
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Affiliation(s)
- Bettina B. Hoeppner
- Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA 02114, USA
| | - Christopher W. Kahler
- Department of Behavioral and Social Sciences and the Center for Alcohol and Addiction Studies, Box GS121-4, Brown School of Public Health, Providence, RI 02912, USA
| | - Chad J. Gwaltney
- Department of Behavioral and Social Sciences and the Center for Alcohol and Addiction Studies, Box GS121-4, Brown School of Public Health, Providence, RI 02912, USA
- ERT, Inc., Philadelphia, PA, 19103
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Hoeppner BB, Hoeppner SS, Kelly JF. Do young people benefit from AA as much, and in the same ways, as adult aged 30+? A moderated multiple mediation analysis. Drug Alcohol Depend 2014; 143:181-8. [PMID: 25150401 PMCID: PMC10071823 DOI: 10.1016/j.drugalcdep.2014.07.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/14/2014] [Accepted: 07/18/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Research has shown that participation in Alcoholics Anonymous (AA) confers significant recovery benefit to adults suffering from alcohol use disorder (AUD). Concerns persist, however, that AA may not work as well for younger adults, who tend to have shorter addiction histories, different social circumstances, and less spiritual/religious interest than adults. METHODS Secondary data analysis of Project MATCH, using a prospective, moderated multiple mediation analysis to test and compare six previously identified mechanisms of change in younger adults (n=266) vs. adults aged 30+ (n=1460). Nine clinical sites within the United States. Treatment-seeking adults (n=1726) suffering from AUD who participated in 12 weeks of outpatient treatment and completed follow-ups at 3-, 9- and 15-months. AA attendance during treatment; mediators at 9 months; and outcomes [percentage of days abstinent (PDA) and drinks per drinking day (DDD)] at 15 months. RESULTS AA attendance was associated with improved drinking outcomes in both younger adults (PDA: F(1, 247)=8.55, p<0.01; DDD: F(1, 247)=15.93, p<0.01) and adults aged 30+ (PDA: F(1, 1311)=86.58, p<0.01; DDD: F(1, 1311)=11.96, p<0.01). Only two of the six hypothesized pathways (i.e., decreases in pro-drinking social networks, self-efficacy in social situations) appeared to work in younger adults. CONCLUSION Unidentified mechanisms of behavior change that are mobilized by AA participation appear to be at work in young people. Once identified, these mechanisms may shed new light on how exactly AA confers similar benefits for young people and, more broadly, may enhance our understanding of recovery-related change for young adults that could yield novel intervention targets.
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Affiliation(s)
- Bettina B Hoeppner
- Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, 60 Staniford Street, Boston, MA 02114, United States.
| | - Susanne S Hoeppner
- Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, 60 Staniford Street, Boston, MA 02114, United States
| | - John F Kelly
- Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, 60 Staniford Street, Boston, MA 02114, United States
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Hoeppner BB, Bidwell LC, Colby SM, Barnett NP. Smoking patterns and their relationship to drinking among first-year college students. Nicotine Tob Res 2014; 16:743-52. [PMID: 24415586 PMCID: PMC4015088 DOI: 10.1093/ntr/ntt205] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 11/16/2013] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Unlike older smokers, young adult smokers frequently engage in light and intermittent smoking. It remains unclear how stable such smoking patterns are over time, as substantial variability exists between these smokers. This study identified subgroups of college student smokers based on the trajectory of their smoking frequency during the first year of college, thereby examining stability versus instability over time. We then tested if the interplay between drinking and smoking differed in the identified groups to determine the relative role drinking may play in intermittent versus more regular smoking. METHODS Incoming college students at 3 institutions completed online biweekly surveys of their daily substance use throughout the first year of college. Students who reported smoking at least 1 cigarette during this year (n = 266) were included in analyses (70% female, 74% White). RESULTS Group-based trajectory modeling identified 5 groups of smokers, 3 of which maintained their smoking frequency throughout the year (77%), and 2 groups of infrequent smokers showed significant trends (11% increasing, 12% decreasing). Notably, nondaily smoking was maintained at different specific frequencies (e.g., 1 vs. 3 days per week). Identified groups differed in the relationship between drinking and smoking, where cooccurrence was particularly strong among infrequent smokers, and trends in smoking quantity differed between groups. CONCLUSIONS While there was a diversity of smoking patterns in the sample, patterns of intermittent smoking remain relatively stable for a majority of students throughout the year. Intervention messages targeting drinking and smoking should be tailored on the basis of smoking frequency.
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Affiliation(s)
- Bettina B. Hoeppner
- Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Suzanne M. Colby
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
| | - Nancy P. Barnett
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
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Schuman-Olivier Z, Hoeppner BB, Evins AE, Brewer JA. Finding the right match: mindfulness training may potentiate the therapeutic effect of nonjudgment of inner experience on smoking cessation. Subst Use Misuse 2014; 49:586-94. [PMID: 24611853 PMCID: PMC4096689 DOI: 10.3109/10826084.2014.850254] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mindfulness training (MT) is an emerging therapeutic modality for addictive disorders. Nonjudgment of inner experience, a component of mindfulness, may influence addiction treatment response. To test whether this component influences smoking cessation, tobacco smokers (n = 85) in a randomized control trial of MT vs. Freedom from Smoking (FFS), a standard cognitive-behaviorally-oriented treatment, were divided into split-half subgroups based on baseline Five Facet Mindfulness Questionnaire nonjudgment subscale. Smokers who rarely judge inner experience (nonjudgment > 30.5) smoked less during follow-up when randomized to MT (3.9 cigs/d) vs. FFS (11.1 cigs/d), p < .01. Measuring trait nonjudgment may help personalize treatment assignments, improving outcomes.
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Affiliation(s)
- Zev Schuman-Olivier
- 1Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
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Bergman BG, Greene MC, Hoeppner BB, Slaymaker V, Kelly JF. Psychiatric comorbidity and 12-step participation: a longitudinal investigation of treated young adults. Alcohol Clin Exp Res 2014; 38:501-10. [PMID: 24033550 PMCID: PMC3946781 DOI: 10.1111/acer.12249] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 05/28/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence indicates that 12-step mutual-help organizations (MHOs), such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), can play an important role in extending and potentiating the recovery benefits of professionally delivered addiction treatment among young adults with substance use disorders (SUD). However, concerns have lingered regarding the suitability of 12-step organizations for certain clinical subgroups, such as those with dual diagnosis (DD). This study examined the influence of diagnostic status (DD vs. SUD-only) on both attendance and active involvement (e.g., having a sponsor, verbal participation during meetings) in, and derived benefits from, 12-step MHOs following residential treatment. METHODS Young adults (N = 296; 18 to 24 years old; 26% female; 95% Caucasian; 47% DD [based on structured diagnostic interview]), enrolled in a prospective naturalistic study of SUD treatment effectiveness, were assessed at intake and 3, 6, and 12 months posttreatment on 12-step attendance/active involvement and percent days abstinent (PDA). t-Tests and lagged, hierarchical linear models (HLM) examined the extent to which diagnostic status influenced 12-step participation and any derived benefits, respectively. RESULTS For DD and SUD-only patients, posttreatment attendance and active involvement in 12-step organizations were similarly high. Overall, DD patients had significantly lower PDA relative to SUD-only patients. All patients appeared to benefit significantly from attendance and active involvement on a combined 8-item index. Regarding the primary effects of interest, significant differences did not emerge in derived benefit between DD and SUD-only patients for either attendance (p = 0.436) or active involvement (p = 0.062). Subsidiary analyses showed, however, that DD patients experienced significantly greater abstinence-related benefit from having a 12-step sponsor. CONCLUSIONS Despite concerns regarding the clinical utility of 12-step MHOs for DD patients, findings indicate that DD young adults participate and benefit as much as SUD-only patients, and may benefit more from high levels of active involvement, particularly having a 12-step sponsor. Future work is needed to clarify how active 12-step involvement might offset the additional recovery burden of a comorbid mental illness on substance use outcomes.
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Affiliation(s)
- Brandon G Bergman
- Center for Addiction Medicine , Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Gorrindo T, Chevalier L, Goldfarb E, Hoeppner BB, Birnbaum RJ. Autonomic arousal and learning in Web-based simulation: a feasibility study. J Contin Educ Health Prof 2014; 34 Suppl 1:S17-S22. [PMID: 24935879 DOI: 10.1002/chp.21234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Autonomic arousal is an important component of understanding learning as it is related to cognitive effort, attention, and emotional arousal. Currently, however, little is known about its relationship to online education. We conducted a study to determine the feasibility of measuring autonomic arousal and engagement in online continuing medical education (CME). METHOD Using the Computer Simulation Assessment Tool (CSAT) platform, health care providers were randomly assigned to either high- or low-valence versions of a Web-based simulation on risk assessment for a returning veteran. Data were collected on participants' actions within the simulation, self-reported cognitive engagement, knowledge retention, and autonomic arousal measured using galvanic skin response (GSR). RESULTS Participants in the high-valence condition (n = 7) chose a lower percentage of critical actions (M = 79.2, SD = 4.2) than participants in the low valence (n = 8) condition (M = 83.9, SD = 3.6, t(1,14) = 2.44, p = .03). While not statistically significant, high-valence participants reported higher cognitive engagement. Participants in the high-valence condition showed a larger increase in physiologic arousal when comparing mean tonic GSR during the orientation simulation to the study simulation (high-valence mean difference = 4.21 μS, SD = 1.23 vs low-valence mean difference = 1.64 μS, SD = 2.32, t(1,13) = -2.62, p = .01). DISCUSSION In addition to being consistent with previous engagement research, this experiment functioned as a feasibility study for measuring autonomic arousal in online CME. The current study provides a framework for future studies, which may use neurophysiology to identify the critical autonomic and engagement components associated with effective online learning.
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