Stepped Care for Patients to Optimize Whole Recovery (SC-POWR): An Effectiveness Trial Evaluating a Stepped Care Model for Individuals With Opioid Use Disorder and Chronic Pain

Many patients who receive treatment for opioid use disorder (OUD) report experiencing chronic pain (CP), which is associated with high levels of ongoing nonmedical opioid use and low retention in OUD treatment. In pilot studies of patients with OUD receiving buprenorphine or methadone who had CP, cognitive behavioral therapy (CBT) attenuated nonmedical opioid use compared with treatment-as-usual (TAU), but patients in both treatment arms exhibited similar pain improvements. Adding exercise and stress reduction to this model may augment pain-related outcomes. With funding from National Institutes of Health, we plan to conduct a randomized clinical trial of 316 patients with OUD and CP to test the effectiveness of TAU compared with Stepped Care for Patients to Optimize Whole Recovery (SC-POWR) to reduce nonmedical opioid use and pain (primary outcomes) (Aim 1) and decrease pain intensity and interference, alcohol use, anxiety, depression and stress, and improve sleep (secondary outcomes) (Aim 2). Eligible participants will be randomized to receive TAU (buprenorphine or methadone and at least once a month individual or group counseling) or SC-POWR (ie, TAU and up to 12 CBT sessions) for 24 weeks. Based on prespecified nonresponse criteria, SC-POWR may be stepped up at week 6 to receive onsite weekly group sessions of exercise (Wii Fit, Tai Chi) and "stepped up" again at week 15 to receive weekly group sessions of stress reduction (relaxation training, auricular acupuncture). They will be followed for another 24 weeks to evaluate durability of treatment response for illicit opioid use, alcohol use, pain, anxiety, depression, stress, sleep, and retention in medications for OUD (Aim 3).

A Quantitative Examination of Illness Models Among People With Opioid Use Disorder Receiving Methadone Treatment

BACKGROUND

Few studies have examined illness models among people with addiction. We investigated illness models and their associations with demographics and treatment beliefs among patients receiving methadone treatment for opioid use disorder.

METHODS

From January 2019 to February 2020, patients receiving methadone treatment at outpatient opioid treatment programs provided demographics and rated using 1 to 7 Likert-type scales agreement with addiction illness models (brain disease model, chronic medical condition model [CMCM], and no explanation [NEM]) and treatment beliefs. Pairwise comparisons and multivariate regressions were used to examine associations between illness models, demographics, and treatment beliefs. Statistical significance was set at P < 0.05.

RESULTS

A total of 450 patients participated in the study. Forty percent self-identified as female, 13% as Hispanic, and 78% as White; mean age was 38.5 years. Brain disease model was the most frequently endorsed illness model (46.2%), followed by CMCM (41.7%) and NEM (21.9%). In multivariate analyses, agreement with brain disease model was significantly positively associated with beliefs that methadone treatment would be effective, counseling is important, and methadone is lifesaving, whereas agreement with CMCM was significantly positively associated with beliefs that methadone treatment would be effective, counseling is important, 12-step is the best treatment, taking methadone daily is important, and methadone is lifesaving. In multivariate analyses, agreement with NEM was negatively significantly associated with beliefs that methadone would be effective, counseling is important, taking methadone daily is important, and methadone is lifesaving.

DISCUSSION

Many patients in methadone treatment endorsed medicalized addiction models. Agreement with addiction illness models appear to be related to treatment beliefs.

The impact of body image dissatisfaction on psychological distress and health-related quality of life among patients in methadone treatment

BACKGROUND AND OBJECTIVES

Minimal research has examined body image dissatisfaction (BID) among patients receiving methadone maintenance treatment (MMT). We tested associations between BID and MMT quality indicators (psychological distress, mental and physical health-related quality of life [HRQoL]) and whether these associations varied by gender.

METHODS

One hundred and sixty-four participants (n = 164) in MMT completed self-report measures of body mass index (BMI), BID, and MMT quality indicators. General linear models tested if BID was associated with MMT quality indicators.

RESULTS

Patients were primarily non-Hispanic White (56%) men (59%) with an average BMI in the overweight range. Approximately 30% of the sample had moderate or marked BID. Women and patients with a BMI in the obese range reported higher BID than men and patients with normal weight, respectively. BID was associated with higher psychological distress, lower physical HRQoL, and was unrelated to mental HRQoL. However, there was a significant interaction in which the association between BID and lower mental HRQoL was stronger for men than women.

DISCUSSION AND CONCLUSIONS

Moderate or marked BID is present for about three in 10 patients. These data also suggest that BID is tied to important MMT quality indicators, and that these associations can vary by gender. The long-term course of MMT may allow for assessing and addressing novel factors influencing MMT outcomes, including BID.

SCIENTIFIC SIGNIFICANCE

This is one of the first studies to examine BID among MMT patients, and it highlights MMT subgroups most at risk for BID and reduced MMT quality indicators due to BID.

Correlates of Perceived Discrimination Related to Substance Use Disorders Among Patients in Methadone Maintenance Treatment

This study sought to examine demographic, treatment-related, and diagnosis-related correlates of substance use disorder (SUD)-related perceived discrimination among patients receiving methadone maintenance treatment (MMT). Participants were 164 patients at nonprofit, low-barrier-to-treatment-access MMT programs. Participants completed measures of demographics, diagnosis-related characteristics (Brief Symptom Inventory (BSI-18) and Depressive Experiences Questionnaire (DEQ)), and treatment-related characteristics. Perceived discrimination was measured on a seven-point Likert-type scale ranging from 1 ("Not at all") to 7 ("Extremely") in response to the item: "I often feel discriminated against because of my substance abuse." Given the variable's distribution, a median split was used to categorize participants into "high" and "low" discrimination groups. Correlates of high and low discrimination were analyzed with bivariate and logistic regression models. Ninety-four participants (57%) reported high SUD-related perceived discrimination. Bivariate analyses identified six statistically significant correlates of SUD-related perceived discrimination (P < .05): age, race, age of onset of opioid use disorder, BSI-18 Depression, DEQ Dependency, and DEQ Self-Criticism. In the final logistic regression model, those with high (versus low) SUD-related perceived discrimination were more likely to report depressive symptoms and be self-critical. Patients in MMT with high compared to low SUD-related perceived discrimination may be more likely to report being depressed and self-critical.

"Just fighting for my life to stay alive": a qualitative investigation of barriers and facilitators to community re-entry among people with opioid use disorder and incarceration histories

BACKGROUND

During the period of community re-entry immediately following release from jail or prison, individuals with opioid use disorder (OUD) face structural barriers to successful re-entry and high risk of overdose. Few published studies investigate experiences in the immediate period (i.e., first 24 h) of re-entry among people with OUD.

AIM

To understand the barriers and facilitators to treatment and reintegration of people with OUD during the initial transition from carceral settings back into the community.

METHODS

From January-December 2017, we conducted 42 semi-structured qualitative interviews with patients with a history of incarceration who were receiving methadone at a not-for-profit, low-barrier opioid treatment program. Interviews probed participants' community re-entry experiences immediately following incarceration. Interviews were transcribed and analyzed using a Thematic Analysis approach.

RESULTS

The main themes described the experiences during the 24 h following release, reacclimating and navigating re-entry barriers, and re-entry preparedness and planning. Participants noted the initial 24 h to be a period of risk for returning to substance use or an opportunity to engage with OUD treatment as well as a tenuous period where many lacked basic resources such as shelter or money. When discussing the subsequent re-entry period, participants noted social challenges and persistent barriers to stable housing and employment. Participants overall described feeling unprepared for release and suggested improvements including formal transition programs, improved education, and support to combat the risk of overdose and return to substance use after incarceration.

CONCLUSIONS

In this study that qualitatively examines the experiences of people with incarceration histories and OUD enrolled in methadone treatment, we found that participants faced many barriers to community re-entry, particularly surrounding basic resources and treatment engagement. Participants reported feeling unprepared for release but made concrete suggestions for interventions that might improve the barriers they encountered. Future work should examine the incorporation of these perspectives of people with lived experience into the development of transition programs or re-entry classes.

What's in a Name? Terminology Preferences Among Patients Receiving Methadone Treatment

BACKGROUND

Despite recognition of the importance of substance use disorder (SUD) terminology, few studies examine terminology preferences among patients with SUDs.

OBJECTIVE

To examine preferences of patients with opioid use disorder (OUD) concerning the terminology used by addiction counselors.

DESIGN

From January 1, 2019, to February 28, 2020, participants were recruited consecutively from 30-day treatment review sessions at outpatient methadone treatment programs in the Northeastern United States to complete a cross-sectional survey.

PARTICIPANTS

Participants were English-speaking adult patients with OUD enrolled in methadone treatment.

MAIN MEASURES

Participants completed 7-point Likert-type scales from 1 ("Strongly Disagree") to 7 ("Strongly Agree") to rate their preferences for (a) the presenting problem, (b) collective nouns referring to those with the presenting problem, and (c) personal descriptors. We used univariate analysis of covariance (ANCOVA) to examine the associations between demographics (i.e., age, sex, and race) and terminology preferences and ordinal logit regression to explore the association between 12-step program partiality and preference for the term "addict."

KEY RESULTS

We surveyed 450 patients with mean age of 38.5 (SD = 11.1) years; 59.6% self-identified as male, 77.6% as White, and 12.7% as Hispanic. The highest-rated preferences for presenting problem were "addiction," "substance use," and "substance abuse." The highest-rated collective noun terms were "client," "patient," and "guest." "Person with an addiction," "person with substance use disorder," and "substance-dependent person" were the highest-rated personal descriptors. There were significant differences in terminological preference based on race and age. Twelve-step program partiality was associated with greater preference for the term "addict" (F = 21.22, p < .001).

CONCLUSIONS

Terminology preferences among people receiving methadone treatment aligned with existing guidelines recommending that clinicians use medically accurate and destigmatizing terminology when referring to substance use disorders and the persons who have them. Demographic differences emerged in terminological preferences, warranting further examination.

Session quality and impact in psychotherapy with American Indian clients

The quality and impact of psychotherapy sessions are primary concerns in service delivery. However, no published investigations of quality or impact of psychotherapy sessions with American Indian (AI) patients could be found in the scientific literature. We sought to demonstrate that collecting such data is feasible as well as to inform the development of evidence-based practices and cultural adaptations. To this end, we asked psychotherapists treating AIs in outpatient psychotherapy within an urban community clinic to rate the quality and impact of sessions delivered to their clients. Eight psychotherapists self-reported session quality and impact with the Session Evaluation Questionnaire, Form 5 (SEQ-5; Stiles, 1980, 1984) immediately following service delivery to 112 separate, consecutive clients. Session quality was assessed with measures of depth and smoothness. Post-session impact was assessed with measures of positivity and emotional arousal. Overall, sessions were rated as equally deep, but smoother, more positive, and less emotionally arousing in comparison to a sample of experienced university-based psychotherapists (Cummings et al., 1993). However, sessions provided by AI psychotherapists were rated as deeper, less positive, and more emotionally arousing than sessions provided by White psychotherapists. Replicating this study in a larger sample and including client as well as observer ratings will help to move this nascent line of research forward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Pilot Investigation of Nonpharmacological Pain Management Intervention Groups in Methadone Maintenance Treatment

OBJECTIVES

We examined the feasibility (i.e., single-session attendance) of conducting 3 counselor-delivered nonpharmacological pain management intervention (NPMI) groups in methadone maintenance treatment (MMT): (1) Coping with Pain, an intervention based on cognitive-behavioral therapy, (2) Wii-Covery, an exergame intervention to facilitate exercise, and (3) Juggling Group, an intervention to promote social inclusion and reduce stress. We examined pre-post session changes in pain and mood associated with group attendance.

METHODS

Over 1 month at an MMT clinic with 1800 patients, each NPMI group was offered daily Monday-Friday and 1 was offered on Saturdays. A standardized but unvalidated measure was administered before and after sessions to assess acute changes in current pain intensity and mood states. Paired t-tests with Bonferroni corrections were performed for each NPMI group (P < 0.0007 [.05/7]).

RESULTS

About 452 patients (67% male, 84% White, mean age, 40) attended at least 1 NPMI group. About 57% reported current chronic pain. Attendance at any NPMI group (for the whole sample and the subset with chronic pain) was significantly associated with acute reductions in current pain intensity, anxiety, depression, and stress, and acute increases in current energy and happiness. Attendance at Coping with Pain and Juggling Group was also associated with acute increases in compassion.

CONCLUSIONS

Coping with Pain, Wii-Covery, and Juggling Group are feasible to conduct in MMT, and acute improvements in current pain intensity and specific mood states associated with a single session attendance point to the importance of examining systematically the efficacy of these and other NPMIs in MMT.

A Student Walks into Class … Vignettes to Identify Substance Use Disorder Models of Illness among College Students

INTRODUCTION

Illness models, including illness recognition, perceived severity, and perceived nature can affect treatment-seeking behaviors. Vignettes are a leading approach to examine models of illness but are understudied for substance use disorders (SUDs). We created vignettes for multiple common DSM-5 SUDs and assessed SUD illness models among college students.

METHODS

Seven vignettes in which the protagonist meets DSM-5 diagnostic criteria for SUDs involving tobacco, alcohol, cannabis, Adderall, cocaine, Vicodin, and heroin were pilot tested and randomly assigned to 216 college students who completed measures related to illness recognition, perceived severity, and perceived nature. MANOVAs with Scheffe post-hoc tests were conducted to examine vignette group differences on models of illness.

RESULTS

Vignettes met acceptable levels of clarity and plausibility. Participants characterized the protagonist's substance use as a problem, a SUD, or an addiction most frequently with Vicodin, heroin, and cocaine and least frequently with tobacco and cannabis. Participants assigned to the Vicodin, heroin, and cocaine vignettes were the most likely to view the protagonist's situation as serious and life-threatening, whereas those assigned to the cannabis vignette were the least likely. Numerically more participants characterized the pattern of substance use as a problem (91%) or an addiction (90%) than a SUD (76%), while only 15% characterized it as a chronic medical condition.

CONCLUSIONS

Illness recognition and perceived severity varied across substances and were lowest for cannabis. Few participants conceptualized SUDs as chronic medical conditions. College students may benefit from psychoeducation regarding cannabis use disorder and the chronic medical condition model of SUDs.

Psychiatric comorbidity and order of condition onset among patients seeking treatment for chronic pain and opioid use disorder

BACKGROUND

The study objective was to compare psychiatric comorbidity among patients seeking treatment for chronic pain and opioid use disorder (OUD) by order of condition onset (i.e., "Pain First," "OUD First," "Same Time").

METHODS

Data from 170 patients entering two clinical trials of treatments for current comorbid chronic pain and OUD conducted between March 2009 and July 2013 were compared by order of condition onset. The Structured Clinical Interview for DSM-IV-TR Axis I Disorders and the Diagnostic Interview for DSM-IV Personality Disorders (Axis II) were performed by doctoral-level providers using a standardized training protocol. Age of onset group differences on specific diagnostic variables were examined using multinomial logistic regression.

RESULTS

Fifty-two percent were in the "Pain First" group (n = 89), 35 % in the "OUD First" group (n = 59), and 13 % in the "Same Time" group (n = 22). Compared with the Pain First group, the Same Time group was less likely to report heroin (vs. prescription opioids) as the primary drug used (OR = 0.20, 95 % CI = 0.06-0.72) or meet criteria for an Axis II disorder (OR = 0.24, 95 % CI = 0.07-0.83). Compared with the Pain First group, the OUD First group was more likely to meet criteria for a current nonopioid substance use disorder (OR = 3.20, 95 % CI = 1.22-8.40).

CONCLUSIONS

Our findings regarding differences in psychiatric comorbidity associated with order of condition onset indicate that varying pathways may exist for the emergence of chronic pain and OUD; further research should investigate potential treatment implications.

Alexithymia and pain experience among patients using methadone-maintenance therapy

BACKGROUND

Alexithymia, difficulty identifying and describing one's emotions coupled with a tendency to externalize, is a potentially important yet understudied treatment target for patients with opioid use disorder. The aim of this study was to examine the role of alexithymia in pain experience among individuals with opioid use disorder.

METHODS

One-hundred-and-sixty-four patients receiving methadone maintenance treatment completed a battery of self-report measures related to alexithymia, drug use, and pain experiences. Comparisons were performed on the full sample between those with or without clinically significant levels of alexithymia. For a subsample reporting pain (n = 138), intercorrelations were performed to test whether drug use history, pain catastrophizing, pain acceptance, and alexithymia were related to pain severity and pain interference. Regression analyses were performed to test for serial mediation of pain catastrophizing and pain acceptance on the relationship between alexithymia and pain interference in this subsample.

RESULTS

Individuals with alexithymia showed increased pain catastrophizing and interference, and intercorrelations indicated that increased alexithymia was associated with increased pain interference, more pain catastrophizing, and reduced pain acceptance. A serial regression model among a subset of patients with pain indicated that pain catastrophizing and pain acceptance mediated the effect of alexithymia on pain interference.

CONCLUSIONS

These findings suggest that alexithymia, as well as both pain catastrophizing and pain acceptance, contribute to interference associated with pain and are potentially important intervention targets among methadone-treated patients with pain.

A qualitative investigation of addiction counselors' perceptions and experiences implementing an open-access model for treating opioid use disorder

OBJECTIVE

To examine addiction counselors' perceptions and experiences of implementing an open-access model for methadone maintenance treatment (MMT), in which the program rapidly enrolled prospective patients, irrespective of ability to pay, and provided real-time access to multiple voluntary treatment options. Between 2006, when the treatment program initially implemented this model, and 2020, the census of clients receiving methadone maintenance at the study site grew from 1431 to 4500.

METHODS

Participants were 31 addiction counselors employed at a treatment organization that implemented an open-access model to scale up MMT. We examined counselors' perceptions and experiences of working in programs that employed this model, using individual semi-structured interviews, which an interdisciplinary team audiotaped, transcribed, and systematically coded using grounded theory. The team reviewed themes and reconciled disagreements (rater agreement was 98%). We describe themes that more than 10% of participants reported.

RESULTS

Counselors described perceived advantages of the open-access model for clients (e.g., "individualized to client needs"), clinicians (e.g., "fewer demands"), and the community (e.g., "crime reduced"). Counselors also described perceived disadvantages of the open-access model for clinicians (e.g., "uneven workload") and clients (e.g., "need for more intensive services for some clients"), as well as program-level concerns (e.g., "perceived lack of structure").

CONCLUSIONS

Counselors who work in opioid treatment programs that use an open-access framework described multiple benefits to themselves, their clients, and the public; they also outlined disadvantages for themselves and clients, which research should further explore and address to facilitate MMT scale up.

A first look at the working alliance in psychotherapy with American Indians

We could find no published studies measuring the working alliance in outpatient psychotherapy with American Indians. Given that the working alliance has been shown to be one of the most reliable and robust predictors of outcome across psychotherapeutic modalities, we sought to understand the working alliance in this population. Eight psychotherapists in an urban outpatient clinic rated their working alliance with American Indian patients (n = 112) immediately after treatment delivery using the Working Alliance Inventory, 12-item short form (Tracey & Kokotovic, 1989). Working alliance data from 112 sessions were collected and compared with data from the Working Alliance Inventory, 12-item short form, normative sample (Busseri & Tyler, 2003). Therapist-rated working alliance in psychotherapy with American Indian patients was higher than a comparison sample. Alliance was unaffected by patient, therapist, or therapy-related variables in this sample. The working alliance is likely to be an important construct in psychotherapy with American Indian patients. Replication with a larger, representative group of therapists as well as the collection of patient and observer ratings are important next steps. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Experiences of burnout among drug counselors in a large opioid treatment program: A qualitative investigation

BACKGROUND

Little is known about possible experiences of burnout among drug counselors in opioid treatment programs that are scaling up capacity to address the current opioid treatment gap.

METHODS

Participants in this quality improvement study were 31 drug counselors employed by large opioid treatment programs whose treatment capacities were expanding. Experiences of burnout and approaches for managing and/or preventing burnout were examined using individual semi-structured interviews, which were audiotaped, transcribed, and systematically coded by a multidisciplinary team using grounded theory.

RESULTS

Rates of reported burnout (in response to an open-ended question) were lower than expected, with approximately 26% of participants reporting burnout. Counselor descriptions of burnout included cognitive, affective, behavioral, and physiological symptoms; and job-related demands were identified as a frequent cause. Participants described both self-initiated (e.g., engaging in pleasurable activities, exercising, taking breaks during workday) and system-supported strategies for managing or preventing burnout (e.g., availing of supervision and paid time off). Counselors provided recommendations for system-level changes to attenuate counselor risk of burnout (e.g., increased staff-wide encounters, improved communication, accessible paid time off, and increased clinical supervision).

CONCLUSIONS

Findings suggest that drug counselor burnout is not inevitable, even in opioid treatment program settings whose treatment capacities are expanding. Organizations might benefit from routinely assessing counselor feedback about burnout and implementing feasible recommendations to attenuate burnout and promote work engagement.

"Day-to-day, it's a roller coaster. It's frustrating. It's rewarding. It's maddening and it's enjoyable": A qualitative investigation of the lived experiences of addiction counselors

Psychologists in medication for addiction treatment (MAT) settings routinely oversee the work of addiction counselors as supervisors, administrators, and human resource specialists. Limited research has explored the lived experiences of counselors who work in programs that have scaled-up MAT in response to the opioid crisis in the U.S. Thirty-one addiction counselors who worked in MAT programs that had scaled-up treatment capacity were interviewed about 3 facets of their lived experiences: work roles, work motivation, and perceived responses of others to their work. Interviews were taped and transcribed. An interdisciplinary team reviewed and coded the transcripts using grounded theory analysis. The main work roles that emerged were counselor, educator, and advocate. Counselors described multiple factors related to intrinsic motivation for their work: family and personal history, altruism, enjoyment of challenges and client complexity, and witnessing and facilitating change. Factors related to extrinsic motivation were workplace opportunities and positive feedback. The main themes concerning responses of nonclients were positive feedback; others' narratives; negative feedback focused on the stigma associated with the treatment, the clients who receive it, and the counselors who provide it; and responses to anticipated negative feedback. Responses from clients were largely positive and focused on appreciation and respect. Psychologists in MAT settings can enhance the lived experiences of addiction counselors by helping them to savor positive feedback from clients and others, to recognize and appreciate their unique skillsets, and to recognize and address (not internalize) the multiple sources of stigma they encounter as addiction counselors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Pain catastrophizing and pain acceptance are associated with pain severity and interference among methadone-maintained patients

OBJECTIVE

The present study examined whether pain catastrophizing and pain acceptance, two important targets of psychosocial interventions for chronic pain, are uniquely associated with pain severity and pain interference among patients on methadone maintenance treatment (MMT).

METHOD

A total of 133 MMT patients who reported experiencing some pain during the previous week completed a battery of self-report measures. Multiple regression was used to test whether pain catastrophizing and pain acceptance are related to pain severity and pain interference above and beyond covariates including demographics, emotional distress, and current methadone dose.

RESULTS

Both pain acceptance and catastrophizing were significantly associated with pain severity and pain interference while controlling for covariates.

CONCLUSIONS

Consistent with previous literature on patients with chronic pain but without opioid use disorder, our findings suggest that both pain catastrophizing and pain acceptance are potentially important intervention targets among MMT patients with co-occurring opioid use disorder and chronic pain.

Electronic cigarette and tobacco use in individuals entering methadone or buprenorphine treatment

BACKGROUND

Although smoking is prevalent among populations with opioid use disorder (OUD), few studies have examined electronic cigarette (EC) use in individuals seeking opioid agonist therapy (OAT). The aim of this study was to evaluate the prevalence and correlates of EC use among individuals seeking OAT.

METHODS

782 patients seeking OAT for OUD completed surveys assessing current and past EC use, reasons for use, current and past cigarette smoking, nicotine dependence, psychiatric distress, trauma, and pain. Bivariate and multivariate models evaluated correlates of daily EC use, past-30-day EC use, and current cigarette smoking.

RESULTS

6% of patients reported daily EC use, 18% reported past-30-day use, 62% reported EC use history, and 85% reported current cigarette smoking. 46% reported using ECs to quit or cut down smoking. In multivariate analyses, daily EC use was associated with higher odds of being a former smoker (OR 21; CI 1.7-273) and lower odds of ever smoking more than 100 cigarettes (OR 0.07; CI 0.01-0.32), while EC use in the past 30 days was associated with lower odds of being Caucasian (OR 0.55; CI 0.34-0.89), ever smoking more than 100 cigarettes (OR 0.13; CI 0.02-0.67), and history of chronic pain (OR 0.59; CI 0.38-0.90), and higher odds of reporting psychiatric distress (OR 1.5; CI 1.1-2.2).

CONCLUSIONS

EC use is common among people with OUD who smoke cigarettes. Those with daily use had higher odds of being former smokers than current smokers. Interventions using ECs may be effective to help reduce harms and mortality in OUD.

An evaluation of the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy for opioid use disorder and chronic pain

AIMS

The primary study aim was to evaluate the feasibility and acceptability of cognitive-behavioral therapy (CBT) for opioid use disorder and chronic pain. The secondary aim was to examine its preliminary efficacy.

METHODS

In a 12-week pilot randomized clinical trial, 40 methadone-maintained patients were assigned to receive weekly manualized CBT (n = 21) or Methadone Drug Counseling (MDC) to approximate usual drug counseling (n = 19).

RESULTS

Twenty of 21 patients assigned to CBT and 18 of 19 assigned to MDC completed the pilot study. Mean (SD) sessions attended were 8.4 (2.9) for CBT (out of 12 possible) and 3.8 (1.1) for MDC (out of 4 possible); mean (SD) patient satisfaction ratings (scored on 1-7 Likert-type scales) were 6.6 (0.5) for CBT and 6.0 (0.4) for MDC (p < .001). The proportion of patients abstinent during the baseline and each successive 4-week interval was higher for patients assigned to CBT than for those assigned to MDC [Wald χ2 (1) = 5.47, p = .02]; time effects (p = .69) and interaction effects between treatment condition and time (p = .10) were not significant. Rates of clinically significant change from baseline to end of treatment on pain interference (42.9% vs. 42.1%, [χ2 (1, N = 40) = 0.002, p = 0.96]) did not differ significantly for patients assigned to CBT or MDC.

CONCLUSIONS

We found support for the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy relative to standard drug counseling in promoting abstinence from nonmedical opioid use among patients with opioid use disorder and chronic pain. Overall, patients exhibited improved pain outcomes, but these improvements did not differ significantly by treatment condition.

Psychotherapy with American Indians: An exploration of therapist-rated techniques in three urban clinics

The aim of the project was to conduct psychotherapy research in American Indian mental health clinics. To date, very little psychotherapy research has been conducted in this area. We report the findings from a multisite investigation of psychotherapy techniques used with American Indians. Psychotherapists, working in three American Indian clinics, were asked to self-report the therapeutic interventions that they used in sessions with 93 separate adult American Indian outpatients. Each therapist rated each client exactly once, and thus data on 93 sessions were collected. Therapists' self-reported technique use with the Multitheoretical List of Therapist Interventions (McCarthy & Barber, 2009). Ratings were made immediately following the delivery of a session. The common factors approach was the most reported approach, followed by person-centered and interpersonal approaches. However, the therapists reported using techniques from all of the main therapeutic approaches. Technique use was affected by client- (demographic and diagnostic), therapist-, and therapy-related variables. This project represents a promising start to systematic psychotherapy research in busy, urban American Indian clinics. Many psychotherapeutic techniques are utilized, and there are many avenues for future research. A replication with client and observer ratings will be an important next step. (PsycINFO Database Record

Psychiatric Disorders Among Patients Seeking Treatment for Co-Occurring Chronic Pain and Opioid Use Disorder

OBJECTIVE

Psychiatric comorbidities complicate treatment of patients with chronic pain and opioid use disorder, but the prevalence of specific comorbid psychiatric disorders in this population has not been systematically investigated.

METHODS

170 consecutive participants entering a treatment research program for co-occurring chronic pain and opioid use disorder between March 2009 and July 2013 were evaluated with the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I/P) and the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV).

RESULTS

The prevalence of any lifetime (and current) comorbid Axis I disorder was 91% (75%); 52% met criteria for lifetime anxiety disorder (48% current), 57% for lifetime mood disorder (48% current), and 78% for lifetime nonopioid substance use disorder (34% current). Common current anxiety diagnoses were posttraumatic stress disorder (21%), generalized anxiety disorder (16%), and panic disorder without agoraphobia (16%). Common current mood diagnoses were major depressive disorder (40%) and dysthymia (11%). A majority of patients had a personality disorder (52%).

CONCLUSIONS

High rates and persistence of co-occurring psychiatric disorders, including anxiety or mood disorders, may explain in part the difficulty providers have treating patients with co-occurring opioid use disorder and chronic pain and suggest possible targets for improving treatment.

TRIAL REGISTRATION

ClinicalTrials.gov identifiers: buprenorphine/naloxone treatment (NCT00634803), opioid treatment program-based methadone maintenance treatment (NCT00727675).

Physical activity, psychiatric distress, and interest in exercise group participation among individuals seeking methadone maintenance treatment with and without chronic pain

BACKGROUND AND OBJECTIVES

Physical activity may improve chronic pain, anxiety, and depression, which are prevalent among patients in methadone maintenance treatment (MMT), but relatively little is known about the physical activity levels or interest in exercise of patients in MMT.

METHODS

We used a brief self-report instrument to assess physical activity levels, chronic pain, psychiatric distress, and interest in exercise group participation among 303 adults seeking MMT.

RESULTS

Most (73%) reported no moderate or vigorous intensity physical activity in the past week; 27% met recommended physical activity levels, and 24% reported interest in exercise group participation. Participants with (compared to those without) chronic pain had higher levels of psychiatric distress and were less likely to meet recommended levels of physical activity (p < .05), but did not differ significantly in their interest in participating in an exercise group. Participants who met recommended levels of physical activity in the past week were more likely to be men and had lower levels of depression than others (p < .05).

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Low levels of physical activity and low interest in exercise group participation among patients entering MMT point to the need for and likely challenges of implementing exercise interventions in MMT.

The psychometric properties of the iowa personality disorder screen in methadone-maintained patients: an initial investigation

The psychometric properties of the Iowa Personality Disorder Screen (IPDS) were examined in 150 methadone-maintained patients who completed measures of demographic, psychopathology, substance use, pain, and methadone maintenance treatment (MMT) characteristics. An exploratory factor analysis revealed a two-factor solution that explained 45% of the scale variance. The first factor captured internalizing tendencies, such as inhibition and hypersensitivity to others. The second factor comprised externalizing tendencies, such as impulsivity and insensitivity to others. The IPDS item subsets, derived factors, and the total score were significantly related to race/ethnicity but not sex. The effects of race/ethnicity were controlled statistically when the IPDS was compared to other measures of psychopathology, self-reported substance use, pain variables, and MMT characteristics. In general, the IPDS appears to be reliable and valid for use with methadone-maintained patients. The two-factor structure found in this study may have clinical utility and merits further investigation in other MMT samples.

Pain and associated substance use among opioid dependent individuals seeking office-based treatment with buprenorphine-naloxone: a needs assessment study

BACKGROUND AND OBJECTIVES

A paucity of studies has examined the pain experiences of opioid dependent individuals seeking office-based buprenorphine-naloxone treatment (BNT). We set out to examine, among those seeking BNT: (a) the prevalence of pain types (i.e., recent pain, chronic pain), (b) the characteristics of pain (intensity, frequency, duration, interference, location, and genesis), and (c) substance use to alleviate pain.

METHOD

We surveyed 244 consecutive individuals seeking office-based BNT for opioid dependence about physical pain and associated substance use.

RESULTS

Thirty-six percent of respondents reported chronic pain (CP) (i.e., pain lasting at least 3 months) and 36% reported "some pain" (SP) (i.e., past week pain not meeting the threshold for CP). In comparison to SP respondents, those with CP were, on average, older; reported greater current pain intensity, pain frequency, typical pain duration, typical pain intensity, and typical pain interference; were more likely to report shoulder or pelvis and less likely to report stomach or arms as their most bothersome pain location; and were more likely to report accident or nerve damage and less likely to report opioid withdrawal as the genesis of their pain. Both pain subgroups reported similarly high rates of past-week substance use to alleviate pain.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

The high rates of pain and self-reported substance use to manage pain suggest the importance of assessing and addressing pain in BNT patients.

Psychopathology and pain correlates of dispositional optimism in methadone-maintained patients

BACKGROUND AND OBJECTIVES

Although higher levels of dispositional optimism are associated with decreased levels of psychopathology and pain, and higher levels of mental health functioning-important outcomes in opioid treatment programs-a paucity of studies has examined dispositional optimism among individuals with opioid use disorders. The aim of this study was to examine the clinical correlates (i.e., psychopathology, pain status) of dispositional optimism in opioid dependent patients enrolled in methadone maintenance treatment (MMT).

METHODS

A survey targeting demographics, pain, psychopathology, and dispositional optimism was administered to 150 MMT patients.

RESULTS

In multivariable analyses, higher levels of dispositional optimism were significantly associated with lower levels of: depression, screened personality disorder criteria, screened symptoms of posttraumatic stress disorder, and pain-related emotional strain. In comparison to those without a history of chronic pain (ie, noncancer related physical pain lasting at least 3 months), MMT patients who reported either lifetime or current chronic pain exhibited significantly lower levels of dispositional optimism.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

The associations among higher levels of dispositional optimism, lower levels of psychopathology, and lower pain-related emotional strain suggest that research focusing on the efficacy of specific interventions to promote dispositional optimism in MMT patients is warranted.

Use of conventional, complementary, and alternative treatments for pain among individuals seeking primary care treatment with buprenorphine-naloxone

Previous studies have not examined patterns of pain treatment use among patients seeking office-based buprenorphine-naloxone treatment (BNT) for opioid dependence.

OBJECTIVES

To examine, among individuals with pain seeking BNT for opioid dependence, the use of pain treatment modalities, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment while in BNT.

METHODS

A total of 244 patients seeking office-based BNT for opioid dependence completed measures of demographics, pain status (ie, "chronic pain (CP)" [pain lasting at least 3 months] vs "some pain (SP)" [pain in the past week not meeting the duration criteria for chronic pain]), pain treatment use, perceived efficacy of prior pain treatment, and interest in receiving pain treatment while in BNT.

RESULTS

In comparison with the SP group (N = 87), the CP group (N = 88) was more likely to report past-week medical use of opioid medication (adjusted odds ratio [AOR] = 3.2; 95% CI, 1.2-8.4), lifetime medical use of nonopioid prescribed medication (AOR = 2.2; 95% CI, 1.1-4.7), and lifetime use of prayer (AOR = 2.8; 95% CI, 1.2-6.5) and was less likely to report lifetime use of yoga (AOR = 0.2; 95% CI, 0.1-0.7) to treat pain. Although the 2 pain groups did not differ on levels of perceived efficacy of prior lifetime pain treatments, in comparison with the SP group, the CP group was more likely to report interest in receiving pain treatment while in BNT (P < 0.001).

CONCLUSIONS

Individuals with pain seeking BNT for opioid dependence report a wide range of conventional, complementary, and alternative pain-related treatments and are interested (especially those with CP) in receiving pain management services along with BNT.

Group-based strategies for stress reduction in methadone maintenance treatment: what do patients want?

OBJECTIVES

To assess methadone maintenance treatment (MMT) patients' willingness to use, and perceived efficacy of, conventional and unconventional group stress reduction treatments.

METHODS

A survey, developed by the authors, was administered to 150 MMT patients.

RESULTS

Levels of treatment willingness and perceived efficacy for both conventional and unconventional treatments were relatively high; however, ratings for conventional interventions were, on average, significantly higher than those for unconventional ones. The highest rated conventional and unconventional treatments in terms of willingness and perceived efficacy were nutrition and spiritual counseling, respectively, whereas the lowest rated conventional and unconventional group treatments were anger management and visualization training, respectively. White race was a significant predictor of lower willingness to try conventional and unconventional group therapies and lower perceived efficacy of unconventional group treatment, whereas female sex and older age were significant predictors of higher levels of willingness to try unconventional group treatment. Higher levels of substance use problems were associated with increased willingness to try conventional group treatment. Higher levels of anxiety emerged as a significant independent predictor of treatment willingness and perceived efficacy for both conventional and unconventional group treatments.

CONCLUSIONS

The relatively high levels of treatment willingness and perceived efficacy of conventional and unconventional group stress reduction treatments point to the feasibility of offering these interventions in MMT and suggest that, in particular, high levels of anxiety are associated with greater treatment willingness and perceived treatment efficacy.

Conventional and unconventional treatments for stress among methadone-maintained patients: treatment willingness and perceived efficacy

We surveyed 150 methadone maintenance treatment (MMT) program patients about willingness to use, and perceived efficacy of, conventional and unconventional nonpharmacological stress-related treatments. Although levels of treatment willingness and perceived efficacy for both conventional and unconventional treatments were high, ratings for conventional interventions were, on average, significantly higher than those for unconventional ones. Dimensions of psychiatric distress-but not demographic or MMT characteristics-predicted treatment willingness for conventional therapies and treatment willingness and perceived efficacy for unconventional therapies. These findings are likely to have implications for resource and program planning in MMT programs. 

Pain catastrophizing and pain coping among methadone-maintained patients

OBJECTIVE

The aim of this study was to examine the association of pain catastrophizing and pain coping strategies with characteristic pain intensity (an average of worst, least, and typical pain intensity in the past week) and recent pain-related disability (an average of three measures of past week pain interference) in opioid-dependent patients enrolled in a methadone maintenance treatment program (MMTP) who reported recent pain.

DESIGN

Cross-sectional survey.

PATIENTS

One hundred and eight MMTP patients who reported recent pain.

MEASURES

Participants completed measures of demographics, pain status (i.e., "chronic severe pain" [pain lasting at least 6 months with at least moderate pain intensity or significant pain interference in the past week] vs "some pain" [pain in the past week not meeting the threshold of chronic severe pain]), characteristic pain intensity, recent pain-related disability, somatization, depression, catastrophizing, and pain coping strategies.

RESULTS

  Catastrophizing explained a significant proportion of the variance in characteristic pain intensity (14%) and recent pain-related disability (11%) after controlling for demographics, pain status, somatization, and depression. Mirroring the findings of studies of non-opioid-dependent chronic pain patients, greater catastrophizing was associated with greater pain intensity and increases in recent pain-related disability. On average, the "chronic severe pain" group reported higher levels of catastrophizing than the "some pain" group.

CONCLUSION

Consistent with studies of patients with chronic pain who are not opioid dependent, our findings emphasize the importance of assessing and addressing catastrophizing in MMTP patients with pain.

Exploring relations among traumatic, posttraumatic, and physical pain experiences in methadone-maintained patients

Differences in lifetime trauma exposure and screened symptoms of posttraumatic stress disorder (PTSD) were examined in methadone maintenance treatment (MMT) patients with a variety of pain experiences. Parametric and nonparametric statistical tests were performed on data obtained from 150 patients currently enrolled in MMT. In comparison to MMT patients reporting no pain in the previous week, those with chronic severe pain (CSP) (ie, pain lasting at least 6 months with moderate to severe pain intensity or significant pain interference) exhibited comparable levels of trauma involving sexual assault but reported significantly higher levels of trauma involving physical assault, number of traumatic events, and screened symptoms of PTSD. A third group, non-CSP MMT patients reporting some pain in the past week, differed significantly from the CSP group on number of traumatic events but reported comparable levels of sexual assault and physical assault. In comparison to men, women reported higher levels of sexual assault and were more likely to score above the cutoff on the PTSD screener but reported comparable levels of physical assault and number of traumatic events. Pain-related differences in trauma and screened symptoms of PTSD exist in MMT patients and may have implications for program planning and outreach efforts.

PERSPECTIVE

This article demonstrates that trauma and screened symptoms of PTSD vary as a function of sex and pain status in methadone-maintained patients. Future studies may benefit from developing and assessing interventions that address chronic pain, PTSD, and opioid dependence in MMT.

Conventional and nonconventional pain treatment utilization among opioid dependent individuals with pain seeking methadone maintenance treatment: a needs assessment study

OBJECTIVE AND METHODS

We surveyed 293 individuals seeking methadone maintenance treatment (MMT) for opioid dependence about pain, pain treatment utilization, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment while in MMT.

RESULTS

Among the 213 respondents reporting recent pain of at least moderate typical pain intensity, those with and those without a lifetime history of chronic pain endorsed similar rates of conventional (with the exception of past-week medical use of nonopiate medication), complementary, and alternative medicine utilization for pain reduction and a numerically smaller proportion endorsed last-week utilization of complementary and alternative medicine when compared with conventional medicine. The most frequently endorsed lifetime conventional pain treatments included opiate and over-the-counter medications, whereas the most frequently endorsed lifetime complementary and alternative medicine pain treatments included stretching, physical exercise, physical therapy, heat therapy, and prayer. Perceived efficacy of prior pain treatment but not interest in pain treatment was associated with chronic pain history status.

CONCLUSION

These findings may have implications for resource and program planning in MMT programs.

Do psychologically-minded clients expect more from counselling?

OBJECTIVES

The aim of this study was to explore the relationship between psychological mindedness and clients' expectations about counselling.

DESIGN

A cross-sectional design was employed to assess correlations among study variables.

METHODS

Participants were 104 counselling-centre clients at a mid-size, Southwestern US university. Participant volunteers filled out the Psychological Mindedness Scale, life orientation test-revised (LOT-R), and the expectations-about-counselling questionnaire.

RESULTS

Clients who reported higher levels of psychological mindedness (PM) reported greater expectations of self-involvement in counselling and greater expectations of positive outcome. In contrast, PM was not significantly related to clients' expectations about their counsellors' in-session behaviour or to expectations about their counsellors' general personality style. Dispositional optimism (LOT-R) did not play a major role in the relationship between PM and expectations about counselling.

CONCLUSIONS

High PM clients do seem to expect more from counselling than low PM clients, particularly in terms of self-involvement in the process and with respect to positive outcome. Consequently, therapists should consider assessing clients' PM, expectations, and the relationship between PM and expectations.

East Asian child-rearing attitudes: an exploration of cultural, demographic and self-disclosure factors among US immigrants

Child-rearing attitudes among East Asian groups have been emphasized in the developmental psychology literature in the context of their association with academic achievement. Although child-rearing attitudes play an important role in the transmission of cultural values, much of the research on East Asian child-rearing attitudes has ignored cultural variables and has instead focused on authoritarian parenting style. The current study examined the association between three classes of variables-culture (i.e., ethnic identity, self-construal, acculturation), demographics (sex, years in the US, English fluency), and self-disclosure-and traditional child-rearing attitudes (TCRA) among East Asian immigrants in the United States. It was hypothesized that higher levels of TCRA would be associated with higher levels of ethnic identity, interdependent self-construal, separation, and guarded self-disclosure, and fewer years spent in the United States. The participants included 170 East Asian (Chinese, Japanese, and Korean) immigrants (88 men, 82 women) who were administered a battery of psychometrically established measures. Our hypotheses were largely supported. We found that, while there was no significant sex by ethnicity effect for TCRA, men were significantly more likely than women to endorse TCRA and the Korean group had significantly higher TCRA than the Japanese group. Ethnic identity, interdependent self-construal, separation, years in the US, and guarded self-disclosure were significant independent predictors of TCRA. The findings suggest the need for broadening the content of assessment tools of child-rearing attitudes and measuring associated cultural and noncultural variables among East Asian ethnic groups. Future research on child-rearing attitudes among Asian ethnic groups may benefit from (1) measuring multiple dimensions of TCRA, (2) assessing associated cultural variables directly rather than inferring them in an ad hoc fashion based on observed ethnicity differences, (3) measurement of demography (including sex and years spent in the host country) and (4) examining the potential influence of guarded self-disclosure.

Allopathic, complementary, and alternative medical treatment utilization for pain among methadone-maintained patients

We surveyed 150 methadone maintenance treatment program (MMTP) patients about pain, pain treatment utilization, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment at the MMTP. Respondents with chronic severe pain (CSP) (ie, pain lasting at least six months with moderate to severe pain intensity or significant pain interference) and "some pain" (ie, pain reported in the previous week but not CSP) endorsed similar rates of past-week and lifetime allopathic or standard medical (with the exception of lifetime medical use of non-opiate medication) and complementary and alternative medicine (CAM) utilization for pain reduction. Prior pain treatments were perceived to be less effective by CSP than SP patients but both groups had equivalent high rates of interest in pain treatment associated with the MMTP. These findings may have implications for resource and program planning in MMTPs.

Relations among psychopathology, substance use, and physical pain experiences in methadone-maintained patients

OBJECTIVE

Differences in psychiatric distress and substance use (licit and illicit) were examined in methadone maintenance treatment (MMT) patients with a variety of pain experiences.

METHOD

Parametric and nonparametric statistical tests were performed on data obtained from 150 patients currently enrolled in MMT. Assessments were carried out at the 3 opioid agonist treatment programs operated by the APT Foundation, New Haven, Connecticut. Participants were recruited between March 2007 and March 2008.

RESULTS

In comparison to MMT patients reporting no pain in the previous week, those with chronic severe pain (CSP) (ie, pain lasting at least 6 months with moderate to severe pain intensity or significant pain interference) exhibited significantly higher (P < .01) levels of depression, anxiety, somatization, overall psychiatric distress, and personality disorder criteria but reported comparable rates of substance use. A third group, ie, non-CSP MMT patients reporting some pain in the past week, differed significantly (P < .05) from the other 2 pain groups on somatization and global psychiatric distress but reported comparable rates of substance use.

CONCLUSIONS

Pain-related differences in psychiatric problems exist in MMT patients and may have implications for program planning and outreach efforts.

Pain and substance-related pain-reduction behaviors among opioid dependent individuals seeking methadone maintenance treatment

We surveyed 293 opioid dependent individuals seeking methadone maintenance treatment about their pain experiences and their substance-related pain reduction behaviors. Among the 213 respondents reporting recent pain of at least moderate typical pain intensity, two-thirds had a lifetime history of chronic pain. In comparison to those without a lifetime history of chronic pain, those with a lifetime history were older, reported higher pain frequency, were more likely to endorse accident or surgery and less likely to endorse "don't know" as the genesis of their recent pain, and endorsed comparable levels of substance-related pain reduction behaviors. These findings may have implications for resource and program planning in MMT programs.

Exploring the relationships among early maladaptive schemas, psychological mindedness and self-reported college adjustment

OBJECTIVES

The primary aim of this research was to study the statistical effects of psychological mindedness (PM) upon the relationship between early maladaptive schemas (EMS) and self-reported college adjustment.

DESIGN

A cross-sectional design was employed to assess correlations among study variables and to assess the role of PM as moderator or mediator in the relationship between EMS and adjustment.

METHODS

Into this study, 264 undergraduate students were recruited in partial fulfilment of research requirements in introductory psychology class. Participants completed the Young Schema Questionnaire, the Psychological Mindedness Scale and the Student Adaptation to College Questionnaire.

RESULTS

At the level of bivariate correlations, EMS were inversely associated with college adjustment and with PM, and PM was positively associated with adjustment. In a multiple regression equation with PM and EMS entered separately and then as an interaction term as predictors of adjustment, PM was not a significant moderator. However, in a path analysis, the indirect effect of EMS on adjustment through PM was significant, suggesting that PM is a significant mediator.

CONCLUSIONS

These findings suggest that the assessment of EMS and PM may enhance an understanding of problems with college adjustment and that interventions to reduce the negative effects of EMS may indeed benefit from efforts to improve PM and its correlates.

Reflections by inner-city drug users on a Buddhist-based spirituality-focused therapy: a qualitative study

A manual-guided, spirituality-focused intervention--spiritual self-schema (3-S) therapy--for the treatment of addiction and HIV-risk behavior was developed as part of a Stage I behavioral therapies development project. It is theoretically grounded in cognitive and Buddhist psychologies and may be suitable for individuals of diverse faiths. The therapy development process began with focus groups to assess addicted clients' perceived need for a spirituality-focused intervention. The therapy was then codified in manual format, and a controlled clinical trial was conducted. Here the authors report on inner-city, methadone-maintained clients' personal experiences that were recorded in semistructured interviews following completion of the therapy. Findings from this qualitative study support the value of integrating spirituality-focused interventions into addiction treatment for the purpose of increasing motivation for drug abstinence and HIV prevention.

A preliminary study of spiritual self-schema (3-S+) therapy for reducing impulsivity in HIV-positive drug users

The purpose of this study was twofold. First, pretreatment correlations are presented among impulsivity, intoxicant use, HIV risk behavior, spirituality, and motivation in a sample of 38 HIV-positive drug users. Second, treatment outcomes are presented from a preliminary study of spiritual self-schema (3-S(+)) therapy - a manual-guided psychotherapy integrating cognitive and Buddhist psychologies - for increasing motivation for abstinence, HIV prevention, and medication adherence. Impulsivity was negatively correlated with spiritual practices and motivation for recovery, and was positively related to intoxicant use and HIV risk behavior. Relative to a standard care comparison condition, patients completing 3-S(+) therapy reported greater decreases in impulsivity and intoxicant use, and greater increases in spiritual practices and motivation for abstinence, HIV prevention, and medication adherence.

Sex role ideology among East Asian immigrants in the United States

Although sex role ideology (i.e., beliefs about the proper roles for men and women) is linked with self-definition and male-female interactions, researchers have rarely examined such beliefs among U.S. immigrants. This study examined the cultural (ethnic identity, self-construal) and demographic (gender, age, years in United States) correlates of sex role ideology among 170 (88 male, 82 female) East Asian immigrants using psychometrically established measures. Male participants who endorsed ethnic identity and interdependent self-construal were more likely to report traditional sex roles; female participants who lived for a longer period of time in the United States and who endorsed independent self-construal were more likely to report sex role equality. Clinicians should consider assessing sex role ideology to reduce the likelihood of stereotyping their immigrant clients.

Gender, sex role ideology, and self-esteem among East Asian immigrants in the United States

This study examined the relationship between gender, sex role ideology, and self-esteem among 170 (88 male, 82 female) East Asian immigrants in the United States. Participants were administered a battery of psychometrically established measures. Men and women did not differ on personal or collective self-esteem (CSE). Women who endorsed traditional sex roles were significantly more likely to report higher private, identity, and total CSE. Personal self-esteem was a significant independent predictor of traditional sex role for women. Participants who endorsed sex role equality were significantly more likely to report public, membership, and total CSE. Sex role equality was associated with enhanced private CSE for men and attenuated personal self-esteem for women. These findings point to the importance of assessing multiple facets of self-esteem, which appear to be differentially associated with sex role ideology for men and women.

A controlled study of a spirituality-focused intervention for increasing motivation for HIV prevention among drug users

Spiritual Self-Schema (3-S) therapy is a manual-guided intervention for increasing motivation for HIV prevention that integrates a cognitive model of self within a Buddhist framework suitable for people of all faiths. In this controlled study, 72 methadone-maintained clients received either standard care and 8 weeks of 3-S therapy, or standard care alone. At treatment completion, 3-S clients reported significantly greater increases in spiritual practices, expression of spiritual qualities, and motivation for HIV prevention. They were also less likely to have engaged in HIV risk behavior. Correlational analyses showed that attendance at 3-S therapy sessions was significantly positively related to spiritual practice at treatment completion and to motivation for HIV prevention, and that both attendance at 3-S sessions and motivation for HIV preventive behavior were significantly negatively related to HIV risk behavior. Completion of 3-S therapy predicted posttreatment HIV preventive behavior, controlling for pretreatment behavior, demographics, and addiction severity measures (odds ratio = 8.89; 95% confidence interval = 1.62-48.93).

Psychological mindedness and awareness of self and others

The major goal of this study was to explore the relationship among psychological mindedness (PM) and several facets of awareness, including a general sense of mindfulness (Mindful Attention Awareness Scale; Brown & Ryan, 2003), as well as more specific awareness of self (self-consciousness scale; Fenigstein, Scheier, & Buss, 1975) and others (Interpersonal Reactivity Index; Davis, 1980). Participants were 103 undergraduate students at an urban liberal arts college. Results indicated that PM (PM Scale; Conte, Plutchik, Jung, Picard, Karasu, & Lotterman, 1990) is related to mindfulness (r = .41, p < .01), private self-consciousness (r = .27, p < .05), as well as cognitive (r = .30, p < .01) and affective (r = .35, p < .01) indices of empathy. Self-consciousness and empathy explained a significant amount of variance in PM in a simultaneous-entry multiple regression. These findings support theoretical claims that PM involves awareness of self and others.

Psychological mindedness and cognitive style

Psychological mindedness (PM) is theorized to be a cognitively toned personality variable, yet, there is a paucity of research addressing the cognitive components of PM. This study was intended to redress this issue by testing the empirical associations between PM and Ambiguity Tolerance, as measured by the Revised Scale for Ambiguity Tolerance (MacDonald, 1970); Locus of Control, as measured by the Locus of Control Scale (Rotter, 1966); and Magical Thinking, as measured by the Magical Ideation Scale (Eckblad & Chapman, 1983). The results indicated that PM is positively associated with ambiguity tolerance, whereas it is inversely related to external locus of control and magical thinking. These findings suggest a cognitive style profile for PM that includes flexibility, a sense of personal agency, and a propensity for realistic thinking. High-PM individuals are likely to bring these cognitive resources to bear in psychotherapy, a tendency that might explain why high PM patients make better use of treatment.