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Palfai TP, Morone NE, Kratzer MPL, Murray GE, Otis JD, Maisto SA, Rowland BHP. Mobile health intervention to address chronic pain among those who engage in hazardous drinking: A pilot study. Drug Alcohol Depend 2024; 256:111121. [PMID: 38367537 PMCID: PMC11056789 DOI: 10.1016/j.drugalcdep.2024.111121] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/28/2024] [Accepted: 02/04/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Hazardous drinking has been associated with chronic pain in community and medical samples. The purpose of this study was to develop a novel, integrated mobile health intervention that improves pain management and reduces hazardous drinking that may be implemented in primary care settings. METHODS Forty-eight participants with moderate or greater chronic pain and hazardous drinking were recruited from primary care clinics and through social media sites. Following baseline assessment, participants were randomized to a counselor-supported smartphone app intervention (INTV) or a counselor delivered treatment-as-usual control condition (CTL). RESULTS Results supported the feasibility and acceptability of the smartphone app intervention. Participants found it easy to use, reported high levels of satisfaction, and showed high levels of engagement with the app. Between-group effect size estimates at follow-up showed small effects for the intervention on pain ratings. However, using clinically meaningful change thresholds of 30% and 50% improvement in pain scores, 38% and 25% respectively of those in the INTV condition showed reductions compared to 20% and 12.5% respectively in the CTL condition. Effect size estimates did not indicate intervention superiority on alcohol outcomes as participants in both conditions showed considerable reductions in drinking over the course of the study. CONCLUSIONS Results supported the view that a mobile health intervention delivered via smartphone with electronic coaching is a feasible and acceptable method of addressing chronic pain among those who engage in hazardous drinking. Future work should test the efficacy of this approach in a fully powered trial.
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Affiliation(s)
- Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA 02215, USA.
| | - Natalia E Morone
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, USA
| | - Maya P L Kratzer
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA 02215, USA
| | - Grace E Murray
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA 02215, USA
| | - John D Otis
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA 02215, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, 801 430 Huntington Hall, Syracuse NY 13210, USA
| | - Bonnie H P Rowland
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA 02215, USA
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Luehring-Jones P, Fulford D, Palfai TP, Simons JS, Maisto SA. Alcohol, Sexual Arousal, and Partner Familiarity as Predictors of Condom Negotiation: An Experience Sampling Study. AIDS Behav 2024; 28:854-867. [PMID: 37751109 DOI: 10.1007/s10461-023-04189-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
Numerous contextual factors contribute to risky sexual decision-making among men who have sex with men (MSM), with experimental laboratory-based studies suggesting that alcohol consumption, sexual arousal, and partner familiarity have the potential to impact condom negotiations during sexual encounters. The purpose of the current study was to extend this line of inquiry outside of the laboratory and into the everyday lives of MSM. We collected six weeks of daily data on alcohol consumption and sexual behaviors from 257 moderate- and heavy-drinking MSM to examine the within- and between-subjects effects of alcohol consumption, average daily sexual arousal, and partner familiarity on condom negotiation processes during sexual encounters. We hypothesized that alcohol consumption, higher levels of average daily sexual arousal, and greater partner familiarity would all contribute to a reduced likelihood of condom negotiation prior to sexual activity, and that they would also affect the difficulty of negotiations. Contrary to hypotheses, none of these three predictors had significant within-subjects effects on condom negotiation outcomes. However, partner familiarity and average daily sexual arousal did exert significant between-subjects effects on the incidence of negotiation and negotiation difficulty. These findings have important implications for risk-reduction strategies in this population. They also highlight the challenges of reconciling results from experimental laboratory research and experience sampling conducted outside of the laboratory on sexual risk behavior.
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Affiliation(s)
- Peter Luehring-Jones
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA.
| | - Daniel Fulford
- Department of Occupational Therapy and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Tibor P Palfai
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA
| | - Jeffrey S Simons
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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Clifford PR, Davis CM, Maisto SA, Stout RL. FRAMES Elements Associated With Alcohol Treatment Research Assessments and Related Behavior Change. J Stud Alcohol Drugs 2024; 85:218-226. [PMID: 37917020 PMCID: PMC10941817 DOI: 10.15288/jsad.22-00372] [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] [Received: 04/24/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE Assessment reactivity research has contributed substantially to our understanding of alcohol treatment research protocols influencing clinical outcomes. The state of the science is such that relatively little is known about how alcohol treatment research participation influences behavior. The purpose of this study was twofold: (a) to determine the distribution of FRAMES elements (i.e., Feedback, personal Responsibility, Advice, a Menu of options, Empathic style of interaction, and support for Self-efficacy) contained in alcohol treatment research assessment interviews; and (b) to examine their association with subsequent alcohol use among a sample of clients presenting for alcohol use disorder treatment. METHOD Audiotaped recordings of participant (n = 189) research assessment interviews were converted to digital recordings and reviewed for FRAMES elements using the FRAMES Checklist Instrument. RESULTS Feedback, personal responsibility, empathic style of interaction, and support for self-efficacy were the more frequently occurring elements across follow-up periods. Alternatively, menu of options and advice occurred infrequently. Feedback and support for self-efficacy predicted subsequent alcohol use, although the association between feedback and alcohol use was unexpectedly positive. CONCLUSIONS As part of the assessment interview process, alcohol treatment research participants receive multiple instances of feedback and support for self-efficacy specific to their alcohol use that are predictive of changes in alcohol use.
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Affiliation(s)
- Patrick R. Clifford
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Christine M. Davis
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | | | - Robert L. Stout
- Pacific Institute for Research and Evaluation, Quantitative Capabilities Collaboration, Beltsville, Maryland
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Murray GE, Palfai TP, Kratzer MPL, Maisto SA, Simons JS. Sexual alcohol expectancies moderate the relation between alcohol use and sexual behavior among men who have sex with men. Alcohol 2023:S0741-8329(23)00345-2. [PMID: 38101524 DOI: 10.1016/j.alcohol.2023.12.005] [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: 09/13/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND HIV transmission remains a significant health concern for men who have sex with men (MSM) in the United States. Heavy episodic drinking (HED) is related to increased rates of condomless anal intercourse (CAI) among MSM, though evidence suggests that this association may vary by individual difference factors. The present secondary analysis tested whether sexual alcohol expectancies (SAEs) moderate the associations between frequency of HED and anal intercourse (AI) with and without a condom among moderate-to-heavy drinking HIV- MSM. METHODS Two hundred and forty-eight moderate-to-heavy drinking MSM completed self-report questionnaires including the Sexual Behavior Questionnaire, the Modified Daily Drinking Questionnaire, and the Sexual Alcohol Expectancies Questionnaire. RESULTS Negative binomial regressions indicated that SAEs moderated the association between frequency of HED and AI with a condom, but not between the frequency of HED and condomless AI (CAI). CONCLUSIONS These results suggest that stronger SAEs play a role in alcohol-related sexual behavior among MSM, but do not provide evidence that SAEs are associated with increased risk for HIV transmission through CAI.
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Affiliation(s)
- Grace E Murray
- Boston University, Department of Psychological and Brain Sciences, Boston, MA.
| | - Tibor P Palfai
- Boston University, Department of Psychological and Brain Sciences, Boston, MA
| | - Maya P L Kratzer
- Boston University, Department of Psychological and Brain Sciences, Boston, MA
| | | | - Jeffrey S Simons
- Department of Psychology, University of South Dakota, Vermillion, SD
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Johnson EM, Possemato K, Chinman M, True G, Hedges J, Hampton BN, Edelman EJ, Maisto SA. Integrating stakeholder feedback into the design of a peer-delivered primary care wellness program: A rapid qualitative study. BMC Health Serv Res 2023; 23:1370. [PMID: 38062433 PMCID: PMC10701982 DOI: 10.1186/s12913-023-10324-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Individuals seen in Primary Care with behavioral health concerns who decline behavioral health treatment may benefit from the support of peers (consumers in recovery from behavioral health concerns employed to support other consumers). Whole Health STEPS is a new intervention for Veterans in Primary Care with behavioral health concerns which combines essential elements of peers' role and the Whole Health model using a stepped-care design. We incorporated stakeholder feedback in the Whole Health STEPS design to improve fit with Veterans, peers, and primary care settings. METHODS We conducted semi-structured qualitative interviews with VA staff using questions derived from the Consolidated Framework for Implementation Research (CFIR). Participants were recruited via a maximum variation strategy across a national sample and interviewed between January 2021-April 2021. The analytic design was a rapid qualitative analysis. Interviews addressed design decisions and potential barriers and facilitators to future implementation. Then, we made adaptations to Whole Health STEPS and catalogued changes using the Framework for Adaptations and Modifications-Enhanced (FRAME). A VA peer conducted the interviews, participated in analyses, assisted with design modifications, and co-wrote this paper. RESULTS Sixteen staff members from 9 VA primary care peer programs participated (8 peers and 8 supervisors/administrators). Feedback themes included: capitalizing on peer skills (e.g., navigation), ensuring patient-centered and flexible design, and making it easy and efficient (e.g., reducing session length). Understanding the structure of primary care peers' roles and their interactions with other programs helped us identify role conflicts (e.g., overlap with Whole Health Coaches and Health Behavior Coordinators), which led to design modifications to carve out a unique role for Whole Health STEPS. Staff also made recommendations about marketing materials and training tools to support Whole Health STEPS roll out. CONCLUSIONS Feedback from frontline staff, including peers, in the design process was crucial to identifying essential modifications that would not have been possible after initial trials without re-evaluating efficacy due to the extent of the changes. Whole Health STEPS was adapted to fit within a range of program structures, emphasize peers' unique contributions, and streamline delivery. Lessons learned can be applied to other interventions.
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Affiliation(s)
- Emily M Johnson
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave. (116C), Syracuse, NY, 13210, USA.
| | - Kyle Possemato
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave. (116C), Syracuse, NY, 13210, USA
| | - Matthew Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- RAND Corporation, Pittsburgh, PA, USA
- VISN 4 Mental Illness Research, Education, and Clinical Center, Pittsburgh, PA, USA
| | - Gala True
- South Central Mental Illness Research Education and Clinical Center, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
- Department of Medicine, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jacob Hedges
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave. (116C), Syracuse, NY, 13210, USA
| | - Brittany N Hampton
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave. (116C), Syracuse, NY, 13210, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine and Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Stephen A Maisto
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave. (116C), Syracuse, NY, 13210, USA
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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Scharer JL, Gass JC, Shepardson RL, Maisto SA, Funderburk JS. Factors Influencing Patient Receptivity to Brief Alcohol Interventions in Primary Care: An Application of Conjoint Analysis. Subst Use Misuse 2023; 59:90-96. [PMID: 37791686 DOI: 10.1080/10826084.2023.2262008] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background: Brief alcohol interventions (BAIs) are an evidence-based practice for addressing hazardous alcohol use in primary care settings. However, numerous barriers to implementation of BAIs in routine practice have been identified, including concerns about patient receptivity to BAIs. Despite this being a commonly identified barrier to BAI implementation, little BAI implementation research has focused on patient receptivity. Objectives: This study aimed to identify the treatment preferences of primary care patients who screened positive for hazardous alcohol use and to evaluate factors that may influence patients' receptivity to BAIs delivered in primary care. We conducted a mailed survey of primary care patients (N = 245) who screened positive for hazardous alcohol use on annual screening measures based on electronic medical record data. Patients completed measures assessing treatment preferences and a conjoint analysis questionnaire designed to evaluate the relative importance of three factors (focus of the BAI, tailoring of the BAI, and familiarity with the provider delivering the BAI) for patient receptivity. Results: Conjoint analysis results revealed that familiarity with provider (with patients preferring BAIs delivered by providers they have previously met) was the most important factor in predicting patients' receptivity to BAIs. Additionally, patients preferred to discuss alcohol use in the context of another concern (focus of the BAI) and preferred personalized information tailored based on their specific health concerns (tailoring of the BAI), although these factors were not statistically significant when accounting for familiarity with provider. Conclusions: Findings of the present study have potential to inform future research on implementation of BAIs.
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Affiliation(s)
- Jacob L Scharer
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center (116C), Syracuse, New York, USA
| | - Julie C Gass
- VA Center for Integrated Healthcare, VA Western New York Healthcare System (116N), Buffalo, New York, USA
- Department of Psychology, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Robyn L Shepardson
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center (116C), Syracuse, New York, USA
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Stephen A Maisto
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center (116C), Syracuse, New York, USA
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Jennifer S Funderburk
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center (116C), Syracuse, New York, USA
- Department of Psychology, Syracuse University, Syracuse, New York, USA
- Department of Psychiatry, University of Rochester, Rochester, New York, USA
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Gass JC, Maisto SA, Edelman D, Funderburk JS. Brief conjoint visits between an embedded behavioral health provider and primary care team member: When are they used and what are the barriers and facilitators? Fam Syst Health 2023; 41:488-501. [PMID: 37471048 DOI: 10.1037/fsh0000817] [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] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Conjoint visits utilize the expertise of primary care providers (PCPs) and behavioral health providers (BHPs) to address complex comorbidities in patients. The objectives were to describe the use and features of conjoint visits and identify barriers and facilitators as described by BHPs in integrated settings. METHOD Three hundred and forty-five BHPs who worked in integrated primary care, a majority identifying as female and white, completed an online survey between October 2018 and July 2019. RESULTS Results indicated common reasons for conjoint visits were for mental or behavioral health concerns. Though they reported high comfort using conjoint visits (M = 4.3/5), 56.5% of BHPs participated in them less than monthly or never. Using a constant comparison approach, qualitative data were coded to reveal six categories of barriers and five categories of facilitators to conjoint visits. The most common barriers were a result of a lack of systemic support, such as 73.5% reporting lack of time, while the most common facilitators were coordination (60.7%) and interprofessional communication (39.3%). DISCUSSION Although conjoint visits are used infrequently, findings suggest it is not because they are unhelpful as providers generally found this type of appointment favorable. Rather, they and their teams lack time, training, and support needed for implementation. This research provides an introduction for researchers or clinicians to better understand the use of conjoint visits for patients with high needs and complexities. Future work focused on addressing barriers cited by providers regarding conjoint visits would increase providers' ability to use this form of care when it is needed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Julie C Gass
- VA Center for Integrated Healthcare, Western NY VA Medical Center
| | | | - David Edelman
- ADAPT Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System
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Conner KR, Maisto SA, Abar B, Szafranski S, Chiang A, Hutchison M, Aldalur A, Stecker T. Brief, cognitive-behavioral intervention to promote treatment seeking in adults with severe alcohol use disorder: A randomized controlled trial. Addiction 2023; 118:2342-2351. [PMID: 37488997 PMCID: PMC10805959 DOI: 10.1111/add.16300] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND AND AIMS There is little RCT evidence that brief interventions improve treatment seeking in individuals with severe alcohol use disorder (AUD) or treatment seeking reduces alcohol use. The aim was to test the efficacy of a brief intervention to increase treatment seeking in treatment naïve adults with severe AUD and measure its effects on alcohol use. DESIGN Parallel group, non-pharmacologic RCT with intervention (n = 197) and active control (n = 203) conditions, with blinded assessors conducting follow-ups at 1, 3 and 6 months. SETTING Online recruitment in a 17-county region of upstate New York, USA. PARTICIPANTS Inclusion criteria consisted of ages ≥18 years, Alcohol Use Disorders Identification Test score ≥16, exceeds recommended limits for alcohol use and no history of AUD treatment. n = 400; 50% female; 79% white; mean age, 40.7; mean education, 14.6 years. INTERVENTION AND COMPARATOR One-session telephone-delivered interventions: Cognitive-Behavioral Therapy for Treatment Seeking (CBT-TS; intervention), review of a National Institute on Alcohol Abuse and Alcoholism pamphlet on AUD treatment (control). MEASUREMENTS Self-report of any AUD treatment use over 3 months (primary outcome) and two standard measures of alcohol use over 6 months (secondary outcomes). FINDINGS Intent-to-treat analyses were used. Assessment follow-up rates were ≥93%. Any alcohol-related treatment use over 3-month follow-up was obtained by 38 (19%) intervention participants and 36 (18%) control participants, a non-significant difference, χ2 [1] = 0.16, P = 0.689. Secondary analysis showed a significant interaction term between sex and intervention assignment (β = -1.197, P = 0.027). The interaction suggested CBT-TS was effective in men (22% vs 13%), although the evidence was somewhat weak (P = 0.071), and it was not effective in women (17% vs 24%). CONCLUSIONS A one-session cognitive-behavioral therapy intervention to increase treatment seeking in treatment naïve adults with severe alcohol use disorder did not increase treatment seeking.
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Affiliation(s)
- Kenneth R Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Sarah Szafranski
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrew Chiang
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Morica Hutchison
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Aileen Aldalur
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Tracy Stecker
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
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Shepardson RL, Fletcher TL, Funderburk JS, Weisberg RB, Beehler GP, Maisto SA. Barriers to and facilitators of using evidence-based, cognitive-behavioral anxiety interventions in integrated primary care practice. Psychol Serv 2023; 20:709-722. [PMID: 35951391 PMCID: PMC10166237 DOI: 10.1037/ser0000696] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 11/08/2022]
Abstract
Cognitive-behavioral treatment for anxiety disorders and symptoms remains underutilized in integrated primary care (IPC), in part because the many treatments developed for specialty care are not readily translated to this unique setting. The objective of this study was to identify barriers and facilitators to behavioral health providers (BHPs) delivering evidence-based cognitive--behavioral anxiety interventions within IPC practice. We conducted semistructured interviews with a national sample of 18 BHPs (50% psychologists, 33% social workers, 17% registered nurses) working in IPC in the Veterans Health Administration. We assessed barriers to and facilitators of using psychoeducation, exposure, cognitive therapy, relaxation training, mindfulness/meditation, Acceptance and Commitment Therapy-based interventions, and problem-solving therapy. Qualitative coding and conventional content analysis revealed barriers and facilitators at three levels: IPC, provider, and patient. Themes suggested key barriers of poor fit with the IPC model, BHP training deficits, and lack of patient buy-in, and key facilitators of good perceived fit of the intervention (e.g., scope, duration) with the IPC model, BHPs feeling well equipped, and utility for patients. BHPs select interventions based on fit for the individual patient. Some results were consistent with prior work from specialty care, but the IPC model itself introduces significant implementation challenges. BHPs would benefit from flexible intervention options and training on IPC treatment goals and how to deliver the essence of evidence-based interventions in small doses. Our findings will help to inform adaptation of behavioral anxiety interventions to better fit IPC practice and development of beneficial training and resources for BHPs to reduce implementation challenges. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Robyn L. Shepardson
- Center for Integrated Healthcare, Syracuse VA Medical Center
- Department of Psychology, Syracuse University
| | - Terri L. Fletcher
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
- VA South Central Mental Illness Research, Education, and Clinical Center
| | - Jennifer S. Funderburk
- Center for Integrated Healthcare, Syracuse VA Medical Center
- Department of Psychology, Syracuse University
- Department of Psychiatry, University of Rochester
| | - Risa B. Weisberg
- VA Boston Healthcare System
- Department of Psychiatry, Boston University School of Medicine
- Department of Family Medicine, Alpert Medical School, Brown University
| | - Gregory P. Beehler
- Center for Integrated Healthcare, VA Western New York Healthcare System
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
| | - Stephen A. Maisto
- Center for Integrated Healthcare, Syracuse VA Medical Center
- Department of Psychology, Syracuse University
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White KM, Hess JL, Glatt SJ, Maisto SA, Zvolensky MJ, Ditre JW. Polygenic risk for alcohol consumption and multisite chronic pain: Associations with ad lib drinking behavior. Exp Clin Psychopharmacol 2023; 31:933-941. [PMID: 36480390 PMCID: PMC10247901 DOI: 10.1037/pha0000630] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Interrelations between alcohol use disorder and chronic pain have received increasing empirical attention, and several lines of evidence support the possibility of shared genetic liability. However, research on the genetic contributions to the component processes of these complex and potentially overlapping phenotypes remains scarce. The goal of the present study was to test polygenic risk scores (PRSs) for alcohol consumption and multisite chronic pain as predictors of ad lib drinking behavior during an experimental taste test. PRSs were calculated for 209 pain-free, moderate-to-heavy drinkers (57.9% male; 63.6% White). Among White participants, the alcohol and chronic pain PRSs showed nominally significant (ps < .05) positive associations with the volume of alcohol consumed and peak blood alcohol concentration (BAC), respectively. However, associations did not survive correction for multiple comparisons. When stratifying results by experimental condition (between-subjects design: no-pain vs. pain), the alcohol PRS was significantly and negatively associated with the volume of alcohol poured, consumed, and peak BAC among Black participants randomized to the no-pain condition (all false discovery rate [FDR]p < .05). Conversely, the chronic pain PRS was significantly and positively associated with study outcomes among White participants in both the no-pain (alcohol consumed; FDRp = .037) and pain conditions (peak BAC; FDRp = .017). These findings lend partial support to the assertion that alcohol consumption in the laboratory is reflective of drinking behavior in naturalistic settings. This was also the first study to use a pain-related PRS to predict alcohol outcomes, which may be indicative of shared etiology between base and target traits. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Kyle M. White
- Department of Psychology, Syracuse University, Syracuse, NY 13244, United States
| | - Jonathan L. Hess
- Department of Psychiatry and Behavioral Sciences, The State University of New York (SUNY) Upstate Medical University, Syracuse, NY 13210, United States
| | - Stephen J. Glatt
- Department of Psychiatry and Behavioral Sciences, The State University of New York (SUNY) Upstate Medical University, Syracuse, NY 13210, United States
| | - Stephen A. Maisto
- Department of Psychology, Syracuse University, Syracuse, NY 13244, United States
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX 77004, United States
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
- HEALTH Institute, University of Houston, Houston, TX 77204, United States
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, Syracuse, NY 13244, United States
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Edelman EJ, Dziura J, Deng Y, DePhilippis D, Fucito LM, Ferguson T, Bedimo R, Brown S, Marconi VC, Goetz MB, Rodriguez-Barradas MC, Simberkoff MS, Molina PE, Weintrob AC, Maisto SA, Paris M, Justice AC, Bryant KJ, Fiellin DA. Contingency management with stepped care for unhealthy alcohol use among individuals with HIV: Protocol for a randomized controlled trial. Contemp Clin Trials 2023; 131:107242. [PMID: 37230168 PMCID: PMC10460633 DOI: 10.1016/j.cct.2023.107242] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/01/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Although unhealthy alcohol use is associated with increased morbidity and mortality among people with HIV (PWH), many are ambivalent about engaging in treatment and experience variable responses to treatment. We describe the rationale, aims, and study design for the Financial Incentives, Randomization, with Stepped Treatment (FIRST) Trial, a multi-site randomized controlled efficacy trial. METHODS PWH in care recruited from clinics across the United States who reported unhealthy alcohol use, had a phosphatidylethanol (PEth) >20 ng/mL, and were not engaged in formal alcohol treatment were randomized to integrated contingency management with stepped care versus treatment as usual. The intervention involved two steps; Step 1: Contingency management (n = 5 sessions) with potential rewards based on 1) short-term abstinence; 2) longer-term abstinence; and 3) completion of healthy activities to promote progress in addressing alcohol consumption or conditions potentially impacted by alcohol; Step 2: Addiction physician management (n = 6 sessions) plus motivational enhancement therapy (n = 4 sessions). Participants' treatment was stepped up at week 12 if they lacked evidence of longer-term abstinence. Primary outcome was abstinence at week 24. Secondary outcomes included alcohol consumption (assessed by TLFB and PEth) and the Veterans Aging Cohort Study (VACS) Index 2.0 scores; exploratory outcomes included progress in addressing medical conditions potentially impacted by alcohol. Protocol adaptations due to the COVID-19 pandemic are described. CONCLUSIONS The FIRST Trial is anticipated to yield insights on the feasibility and preliminary efficacy of integrated contingency management with stepped care to address unhealthy alcohol use among PWH. CLINICALTRIALS gov identifier: NCT03089320.
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Affiliation(s)
- E Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Yale Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA.
| | - James Dziura
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, CT, USA; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Dominick DePhilippis
- Veterans Affairs Office of Mental Health and Suicide Prevention, US Department of Veterans Affairs, Washington, DC, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa M Fucito
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Tekeda Ferguson
- Department of Epidemiology, Louisiana State University School of Public Health, New Orleans, LA, USA; Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Roger Bedimo
- Veterans Affairs North Texas Health Care System and UT Southwestern Dallas, TX, USA
| | - Sheldon Brown
- James J. Peters Veterans Affairs Medical Center and Manhattan VA Medical Center and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vincent C Marconi
- Atlanta VAMC, Emory University School of Medicine, Rollins School of Public Health, Atlanta, GA, USA
| | - Matthew Bidwell Goetz
- VA Greater Los Angeles Healthcare System, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | - Michael S Simberkoff
- VA NY Harbor Healthcare System and New York University Grossman School of Medicine, New York, NY, USA
| | - Patricia E Molina
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA; Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Amy C Weintrob
- Washington D.C. Veterans Affairs Medical Center and George Washington University, Washington, DC, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Manuel Paris
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Amy C Justice
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD, USA
| | - David A Fiellin
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Yale Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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12
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Shepardson RL, Funderburk JS, Weisberg RB, Maisto SA. Brief, modular, transdiagnostic, cognitive-behavioral intervention for anxiety in veteran primary care: Development, provider feedback, and open trial. Psychol Serv 2023; 20:622-635. [PMID: 35099230 PMCID: PMC10166236 DOI: 10.1037/ser0000622] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anxiety is undertreated in primary care, and most treatment provided is pharmacological rather than behavioral. Integrating behavioral health providers (BHPs) using the Primary Care Behavioral Health (PCBH) model can help address this treatment gap, but brief interventions suitable for use in PCBH practice are needed. We developed a modular, cognitive-behavioral anxiety intervention, Modular Anxiety Skills Training (MAST), that is evidence-based, transdiagnostic, feasible for PCBH, and patient-centered. MAST comprises up to six 30-min sessions emphasizing skills training. This article describes the rationale for and development of MAST as well as pilot work in the Veterans Health Administration (VA) to tailor and refine MAST for delivery to Veterans in VA primary care (MAST-V) to improve feasibility for VA BHPs and acceptability to Veterans. We used a convergent mixed-methods design with concurrent data collection. In phase one, we interviewed five BHPs to obtain feedback on the treatment manual. BHPs assessed MAST-V to be highly compatible with PCBH and provided suggestions to enhance feasibility. In phase two, we conducted an open trial in which six Veterans experiencing clinically significant anxiety received and provided feedback on all nine possible modules; we also assessed changes in mental health symptoms and functioning as well as treatment satisfaction and credibility. Veterans found MAST-V to be highly acceptable, and pre-post clinical outcomes were very promising with large effect sizes. Findings from this initial pilot provide preliminary support for the feasibility, acceptability, and efficacy of MAST-V and suggest further research with a randomized clinical trial is warranted. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Robyn L. Shepardson
- Center for Integrated Healthcare, Syracuse VA Medical Center
- Department of Psychology, Syracuse University
| | - Jennifer S. Funderburk
- Center for Integrated Healthcare, Syracuse VA Medical Center
- Department of Psychology, Syracuse University
- Department of Psychiatry, University of Rochester
| | - Risa B. Weisberg
- VA Boston Healthcare System
- Department of Psychiatry, Boston University School of Medicine
- Department of Family Medicine, Alpert Medical School, Brown University
| | - Stephen A. Maisto
- Center for Integrated Healthcare, Syracuse VA Medical Center
- Department of Psychology, Syracuse University
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13
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Davis JA, Gius BK, Crane CA, Maisto SA, Schlauch RC. Pretreatment changes in drinking: Theoretical and methodological implications for alcohol use disorder treatment outcome research. Alcohol Clin Exp Res 2023; 47:1406-1420. [PMID: 37455388 DOI: 10.1111/acer.15120] [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: 11/08/2022] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND There is a growing recognition of the importance of changes in drinking prior to the first treatment session (i.e., pretreatment change). A major limitation of past studies of pretreatment change is the reliance on retrospective reporting on drinking rates between the baseline assessment and the first treatment session collected at the end of treatment. The present study sought to extend previous findings by examining 12-month treatment outcomes and correlates of pretreatment changes in drinking measured weekly during treatment. METHODS Data from a randomized behavioral clinical trial examining the effect of therapeutic alliance feedback on drinking outcomes were analyzed (n = 165). All participants received cognitive behavioral therapy for alcohol dependence, completed pre and posttreatment assessments, and provided weekly measures of drinking during treatment. RESULTS Results indicated that approximately half of the sample reduced their heavy drinking days by 70% or more and number of drinking days by 50% or more prior to beginning treatment. Further, individuals who reported greater consideration of how their problematic drinking affected their social environment displayed greater changes in drinking days prior to treatment. Changes in heavy drinking days were also related to relationship status, such that individuals who were single/never married were less likely to change prior to treatment than those who were married/cohabitating or separated/divorced. CONCLUSION These confirm the importance of pretreatment change in the study of treatment outcomes, and suggest that interpersonal processes, including the appraisal of drinking behavior in a social context, may play an important role in pretreatment changes in drinking.
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Affiliation(s)
- Jared A Davis
- Department of Psychology, University of South Florida, Tampa, Florida, USA
| | - Becky K Gius
- Department of Psychology, University of South Florida, Tampa, Florida, USA
| | - Cory A Crane
- Department of Biomedical Sciences, Rochester Institute of Technology, Rochester, New York, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Robert C Schlauch
- Department of Psychology, University of South Florida, Tampa, Florida, USA
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14
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Firkey MK, Tully LK, Bucci VM, Walsh ME, Maisto SA, Hahn JA, Bendinskas KG, Gump BB, Woolf-King SE. Feasibility of remote self-collection of dried blood spots, hair, and nails among people with HIV with hazardous alcohol use. Alcohol Clin Exp Res (Hoboken) 2023; 47:986-995. [PMID: 36949025 PMCID: PMC10360030 DOI: 10.1111/acer.15063] [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: 09/25/2022] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The use of biomarkers in behavioral HIV research can help to address limitations of self-reported data. The COVID-19 pandemic forced many researchers to transition from standard in-person data collection to remote data collection. We present data on the feasibility of remote self-collection of dried blood spots (DBS), hair, and nails for the objective assessment of alcohol use, antiretroviral therapy adherence, and stress in a sample of people with HIV (PWH) who are hazardous drinkers. METHODS Standardized operating procedures for remote self-collection of DBS, hair, and nails were developed for an ongoing pilot study of a transdiagnostic alcohol intervention for PWH. Prior to each study appointment, participants were mailed a kit containing materials for self-collection, instructions, a video link demonstrating the collection process, and a prepaid envelope for returning samples. RESULTS A total of 133 remote study visits were completed. For DBS and nail collection at baseline, 87.5% and 83.3% of samples, respectively, were received by the research laboratory, of which 100% of samples were processed. Although hair samples were intended to be analyzed, most of the samples (77.7%) were insufficient or the scalp end of the hair was not marked. We, therefore, decided that hair collection was not feasible in the framework of this study. CONCLUSION An increase in remote self-collection of biospecimens may significantly advance the field of HIV-related research, permitting the collection of specimens without resource-intensive laboratory personnel and facilities. Further research is needed on the factors that impeded participants' ability to complete remote biospecimen collection.
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Affiliation(s)
| | - Lyric K. Tully
- Syracuse University, Department of Psychology, Syracuse, New York
| | | | - McKenna E. Walsh
- Syracuse University, Department of Psychology, Syracuse, New York
| | | | - Judith A. Hahn
- University of California, San Francisco, Department of Medicine, San Francisco, California
| | | | - Brooks B. Gump
- Syracuse University, Department of Public Health, Syracuse, New York
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15
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Witkiewitz K, Stein ER, Votaw VR, Hallgren KA, Gibson BC, Boness CL, Pearson MR, Maisto SA. Constructs derived from the addiction cycle predict alcohol use disorder treatment outcomes and recovery 3 years following treatment. Psychol Addict Behav 2023; 37:376-389. [PMID: 35951419 PMCID: PMC9918601 DOI: 10.1037/adb0000871] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The addiction cycle has been proposed as a framework for understanding the progression of alcohol use disorder (AUD) in terms of psychological and biological domains, including reward drinking/incentive salience, relief drinking/negative emotionality, and loss of control/executive functioning impairment. To have utility in clinical practice, self-report measures of these domains that are applicable across sociodemographic groups and associated with clinical outcomes are needed. This study sought to validate domains from self-report measures and to test whether domains are measurement invariant across sociodemographic groups and associated with treatment outcomes. METHOD Secondary analysis of individuals with AUD (n = 3,092) who participated in two alcohol clinical trials, Project Matching Alcohol Treatment to Client Heterogeneity (MATCH) and COMBINE. Factor analytic methods were used to derive addiction cycle domains at baseline. These domains were then examined as predictors of outcomes. RESULTS Fifteen self-report items were used as indicators of the addiction cycle domains, with sociodemographic differences in measurement by sex, age, race, education, and AUD symptoms. Relief/negative emotionality and reward/incentive salience were significantly associated with outcomes at 1 and 3 years following treatment, and executive functioning also predicted nonabstinent recovery at 3 years. CONCLUSIONS The results support the utility of domains relevant to the addiction cycle in predicting AUD treatment outcomes and recovery among individuals who sought treatment for AUD. The addiction cycle domains were more strongly associated with outcomes than other measures clinicians might use to predict outcomes (e.g., AUD symptoms). Future research should continue to develop and refine the items and test whether the addiction cycle domains can inform treatment planning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, Center on Alcohol, Substance Use, and Addictions (CASAA), University of New Mexico
| | - Elena R Stein
- Department of Psychology, Center on Alcohol, Substance Use, and Addictions (CASAA), University of New Mexico
| | - Victoria R Votaw
- Department of Psychology, Center on Alcohol, Substance Use, and Addictions (CASAA), University of New Mexico
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Benjamin C Gibson
- Department of Psychology, Center on Alcohol, Substance Use, and Addictions (CASAA), University of New Mexico
| | - Cassandra L Boness
- Department of Psychology, Center on Alcohol, Substance Use, and Addictions (CASAA), University of New Mexico
| | - Matthew R Pearson
- Department of Psychology, Center on Alcohol, Substance Use, and Addictions (CASAA), University of New Mexico
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16
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Rivera AP, Maisto SA, Connors GJ, Schlauch RC. Therapists' first impression of treatment motivation moderates the relationship between the client-rated therapeutic alliance and drinking outcomes during treatment. Alcohol Clin Exp Res 2023; 47:806-821. [PMID: 36863860 DOI: 10.1111/acer.15040] [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: 07/17/2022] [Revised: 01/09/2023] [Accepted: 02/08/2023] [Indexed: 03/04/2023]
Abstract
INTRODUCTION First impressions can influence interpersonal relationships for extended periods, with negative first impressions leading to more negative judgments and behaviors between individuals months after their initial meeting. Although common factors such as therapeutic alliance (TA) are well studied, less is known of the potential influence of a therapist's first impression of their client's motivation on TA and drinking outcomes. Based on data from a prospective study of the perceptions of the TA among clients receiving cognitive-behavioral treatment (CBT), this study examined how therapists' first impressions may moderate the relationship between client-rated TA and drinking outcomes during treatment. METHODS One hundred fifty-four adults participated in a 12-week course of CBT and completed measures of TA and drinking behaviors following each treatment session. Additionally, therapists completed a measure of their first impression of their client's motivation for treatment following the first session. RESULTS Time-lagged multilevel modeling revealed a significant within-person TA by therapists' first impression interaction that predicted percent days abstinent (PDA). Specifically, among participants rated as lower on first impressions of treatment motivation, higher within-person TA predicted greater PDA in the interval prior to the next treatment session. Within-person working alliance was not associated with PDA among individuals rated higher on first impressions of treatment motivation who demonstrated higher PDA throughout treatment. Furthermore, significant between-person TA by first impressions interactions were found for both PDA and drinks per drinking day (DDD), such that among individuals with lower treatment motivation, TA positively predicted PDA and negatively predicted DDD. CONCLUSION Although therapists' first impressions of a client's treatment motivation are positively associated with treatment outcomes, clients' perception of the TA may mitigate the impact of poor first impressions. These findings highlight the need for additional nuanced examinations of the relationship between TA and treatment outcomes, emphasizing the contextual factors that influence this relationship.
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Affiliation(s)
- Alexander P Rivera
- Department of Psychology, University of South Florida, Tampa, Florida, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Gerard J Connors
- Research Institute on Addictions, University at Buffalo, Buffalo, New York, USA
| | - Robert C Schlauch
- Department of Psychology, University of South Florida, Tampa, Florida, USA
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17
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Pfund RA, Richards DK, Boness CL, Schwebel FJ, Tonigan JS, Maisto SA, Witkiewitz K. Relative and Interactive Associations of Psychosocial Intervention and Alcoholics Anonymous Attendance With Alcohol Use Disorder Outcomes. J Stud Alcohol Drugs 2023; 84:281-286. [PMID: 36971717 PMCID: PMC10171249 DOI: 10.15288/jsad.22-00042] [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] [Received: 01/31/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Psychosocial intervention and Alcoholics Anonymous (AA)/mutual help organization attendance are both associated with alcohol use disorder (AUD) outcomes. However, no research has explored the relative or interactive associations of psychosocial intervention and AA attendance with AUD outcomes. METHOD This was a secondary analysis of data from the Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) outpatient arm participants (N = 952), who were randomly assigned to complete 12-session cognitive-behavioral therapy (CBT, n = 301), 12-session 12-step facilitation (TSF, n = 335), or 4-session motivational enhancement therapy (MET, n = 316). Regression analyses tested the association of psychosocial intervention attendance only, AA attendance only (measured as past-90-day attendance immediately after psychosocial intervention, as well as 1 and 3 years after intervention), and their interaction with the percentage of drinking days and percentage of heavy drinking days after intervention, 1 year after intervention, and 3 years after intervention. RESULTS When accounting for AA attendance and other variables, attending more psychosocial intervention sessions was consistently associated with fewer drinking days and heavy drinking days after intervention. AA attendance was consistently associated with a lower percentage of drinking days at 1 and 3 years after intervention, when accounting for psychosocial intervention attendance and other variables. Analyses failed to identify an interaction between psychosocial intervention attendance and AA attendance with AUD outcomes. CONCLUSIONS Psychosocial intervention and AA attendance are robustly associated with better AUD outcomes. Replication studies comprising samples of individuals who attend AA more than once per week are needed to further test the interactive association of psychosocial intervention attendance and AA attendance with AUD outcomes.
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Affiliation(s)
- Rory A. Pfund
- Center on Alcohol, Substance Use, and Addictions, Albuquerque, New Mexico
| | - Dylan K. Richards
- Center on Alcohol, Substance Use, and Addictions, Albuquerque, New Mexico
| | | | - Frank J. Schwebel
- Center on Alcohol, Substance Use, and Addictions, Albuquerque, New Mexico
| | - J. Scott Tonigan
- Center on Alcohol, Substance Use, and Addictions, Albuquerque, New Mexico
| | | | - Katie Witkiewitz
- Center on Alcohol, Substance Use, and Addictions, Albuquerque, New Mexico
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Powers JM, Maisto SA, Zvolensky MJ, Heckman BW, Ditre JW. Longitudinal Associations Between Pain and Use of Cigarettes and E-cigarettes in the Population Assessment of Tobacco and Health (PATH) Study. Nicotine Tob Res 2023; 25:404-411. [PMID: 35965386 PMCID: PMC9910160 DOI: 10.1093/ntr/ntac197] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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] [Received: 03/21/2022] [Revised: 06/22/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Pain has been implicated in the onset and maintenance of nicotine addiction, and there is initial cross-sectional evidence of covariation between pain and the use of cigarettes and e-cigarettes. The goals of the current study were to: (1)test pain severity as a predictor of initiating co-use of cigarettes and e-cigarettes, (2)examine longitudinal associations between pain and use/co-use of cigarettes and e-cigarettes, (3)generate the first prevalence rate data regarding cigarette and e-cigarette use as a function of pain, and (4)examine gender as a moderator of these associations. AIMS AND METHODS Data were drawn from Waves 1-4 of the Population Assessment of Tobacco and Health Study (2013-2018). RESULTS Among exclusive cigarette smokers at Wave 1 (n = 7719), pain severity was associated with a greater likelihood of and faster trajectory to initiating co-use of cigarettes and e-cigarettes (ps < .05). A significant pain × gender interaction (p < .05) revealed this prospective relationship was stronger among women. Among adult respondents who provided at least three waves of data (n = 24 255), greater Wave 1 pain severity was positively associated with e-cigarette use, cigarette smoking, and co-use of cigarettes and e-cigarettes at Waves 2, 3, and 4 (ps < .001). At Wave 4 (n = 33 822), adults with moderate or severe pain endorsed rates of e-cigarette and cigarette use almost two times greater versus no or low pain (ps < .001). CONCLUSIONS Collectively, these findings provide evidence that pain likely serves as an important candidate risk factor for the initiation and maintenance of cigarette and e-cigarette use. IMPLICATIONS This is the first prospective study to show that pain serves as an important risk factor for initiation and maintenance of cigarette and e-cigarette use over time. Weighted prevalence estimates further demonstrated that individuals with moderate or severe pain endorsed rates of cigarette and e-cigarette use and co-use approximately two times greater compared to those with no or low pain. These findings highlight a subpopulation of nicotine users more susceptible to greater healthcare burden, nicotine dependence, and physical impairment. Nicotine users with comorbid pain may benefit from integrated interventions that address pain in the context of cessation.
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Affiliation(s)
- Jessica M Powers
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX 77004, USA
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- HEALTH Institute, University of Houston, Houston, TX 77004, USA
| | - Bryan W Heckman
- The Center for the Study of Social Determinants of Health, Meharry Medical College, Nashville, TN, USA
- Psychiatry and Behavioral Sciences, School of Medicine, Meharry Medical College, Nashville, TN, USA
- Division of Public Health, School of Graduate Studies and Research, Meharry Medical College, Nashville, TN, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
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Abstract
This article presents data on the external validity of an alcohol administration study of sexual decision-making in men who have sex with men (MSM) ages 21-50. Men (N = 135) randomized to alcohol (blood alcohol concentration [BAC] = .075%) or water control conditions reported intentions to engage in condomless anal intercourse (CAI) in response to video vignettes. Following the experiment participants provided 6 weeks of experience sampling method (ESM) data assessing intoxication, sexual arousal, partner relationship, and sexual behavior. Laboratory CAI intentions were hypothesized to predict future CAI behavior, and associations were hypothesized to be conditional upon sexual arousal and intoxication contextual factors as well as laboratory beverage condition. The hypotheses were partially supported. CAI intentions were correlated with subject proportions of days engaging in CAI (r = .29). A multilevel analysis indicated, on average, CAI intention predicted increased probability of CAI versus anal intercourse with a condom (relative risk ratio [RRR] = 1.43). There was mixed evidence of CAI intentions effects being conditional upon laboratory condition as well as arousal and intoxication contextual factors. Graphs of conditional marginal effects identified regions of significance. Effects of CAI intention for men in the alcohol condition on the CAI versus No Sex contrast were significant when sexual arousal was elevated. CAI intentions for men in the water control condition predicted a higher probability of CAI versus anal intercourse with a condom when intoxication was moderately elevated and/or arousal moderately low. The results support the external validity of alcohol administration experiments of sexual decision-making among MSM and, reciprocally, provide support for the validity of ESM assessment of sexual behavior. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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20
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Mastroleo NR, Possemato K, King PR, Balderrama-Durbin C, Crinnin C, Cigrang J, Read JP, Borsari B, Maisto SA, Rauch SA. Development and Initial Testing of a Brief, Integrated Intervention Aimed at Reducing Heavy Alcohol Use and PTSD among Military Veterans in Primary Care. Prof Psychol Res Pr 2023; 54:70-82. [PMID: 38047293 PMCID: PMC10691820 DOI: 10.1037/pro0000489] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 12/05/2023]
Abstract
There is a need for integrated treatment approaches that address heavy alcohol use and posttraumatic stress disorder (PTSD) concurrently among Veterans as interactions between heavy drinking and PTSD are frequent. Veteran engagement in specialty mental health services after referral is limited with poorer outcomes following empirically-supported, exposure-based PTSD treatments that do not explicitly address alcohol use. The current project aimed to incorporate two evidenced-based interventions: Brief Motivational Intervention (BMI) with Prolonged Exposure for Primary Care (PE-PC) for Veterans with heavy drinking and PTSD. Delphi methodology was applied to adapt an intervention protocol using subject matter expert (SME) feedback to guide the refinement of a preliminary treatment manual. The newly developed brief intervention (PC-TIME) was then tested in an open trial (n=9) to gather Veteran participant feedback to modify the treatment manual.Two rounds of SME feedback resulted in 80% agreement that manual content was "acceptable as-is" across all intervention domains. The resulting protocol is a five-session, integrated intervention with session 1 primarily focused on alcohol use reduction and sessions 2-5 consisting of narrative exposure and in-vivo exercises for PTSD symptoms with brief alcohol use check-ins. Open trial results indicated high Veteran acceptance of PC-TIME structure and content, and reductions in heavy drinking and PTSD symptoms. Preliminary data suggest PC-TIME to be a promising approach for treatment of heavy alcohol use and PTSD. A pilot randomized controlled trial is necessary to demonstrate the intervention's efficacy with Veterans in a PC setting.
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Affiliation(s)
- Nadine R. Mastroleo
- Binghamton University (SUNY), Department of Psychology, PO Box 6000 Binghamton, NY 13902
| | - Kyle Possemato
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave, Syracuse, NY 13210
| | - Paul R. King
- VA Center for Integrated Healthcare, VA Western NY Healthcare System, 3495 Bailey Ave, Buffalo, NY 14215
| | | | - Charlotte Crinnin
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave, Syracuse, NY 13210
| | - Jeff Cigrang
- School of Professional Psychology, Wright State University, 3640 Colonel Glenn Hwy, Dayton, OH 45435
| | - Jennifer P. Read
- Department of Psychology, University at Buffalo, 206B Park Hall, Buffalo, NY 14260
| | - Brian Borsari
- San Francisco VA Medical Center, 4150 Clement St, San Francisco, CA 94121
| | - Stephen A. Maisto
- Department of Psychology, Syracuse University, 412 Huntington Hall, Syracuse, NY 13244
| | - Sheila A.M. Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine 12 Executive Park, 3 Floor Atlanta, GA 30329
- Mental Health Service Line, VA Atlanta Healthcare, 1670 Clairmont Rd, Decatur, GA 30033
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21
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Ditre JW, LaRowe LR, Powers JM, White KM, Paladino MB, Zvolensky MJ, Glatt S, Maisto SA. Pain as a causal motivator of alcohol consumption: Associations with gender and race. J Psychopathol Clin Sci 2023; 132:101-109. [PMID: 36480413 PMCID: PMC9870930 DOI: 10.1037/abn0000792] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Despite accumulating evidence indicating reciprocal interrelations between pain and alcohol consumption, no prior work has examined pain as a proximal antecedent of drinking. The goal of the current study was to test the effects of experimental pain induction on ad-lib alcohol consumption among moderate-to-heavy drinkers without chronic pain (N = 237; 42% female; 37% Black; M = 3.26daily drinks). Participants were randomized to either pain-induction (capsaicin + thermal heat paradigm) or no-pain-control conditions. Experimental pain induction lasted for 15 minutes, during which ad-lib alcohol consumption was assessed using an established taste test paradigm. As hypothesized, results indicated that participants randomized to the pain-induction condition poured and consumed more alcohol and reached a higher peak blood alcohol concentration than those randomized to the no-pain condition (ps < 0.05; ηp² range = 0.018-0.021). Exploratory analyses revealed the effects of pain on alcohol consumption to be most pronounced among participants who self-identified as male or Black (relative to female or White, respectively). These findings indicate that the experience of pain serves as a causal, situational motivator for alcohol consumption, and suggest that current drinkers may be susceptible to escalating their consumption of alcohol in the context of pain. Future research is needed to explicate observed differences in the effects of pain on drinking as a function of gender and race, and to extend this work to individuals with chronic pain and varying levels of alcohol use. Collectively, these findings may help inform the development of integrated treatments to address co-occurring pain and alcohol use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Maisto SA, Simons JS, Palfai TP, Moskal D, Sheinfil AZ, Tahaney KD. Effects of Alcohol Intoxication on Sexual Decision-Making among Men Who Have Sex with Men (MSM): Alcohol's Influences on Self-Control Processes. Clin Psychol Sci 2023; 11:40-58. [PMID: 36865995 PMCID: PMC9976705 DOI: 10.1177/21677026221079780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/15/2022]
Abstract
This experiment tested mechanisms linking alcohol intoxication and analogue determinants of condomless anal intercourse (CAI) in a sample of 257 men who have sex with men (MSM). The two mechanisms tested were implicit approach biases toward CAI stimuli and executive working memory. Participants were randomized to 3 conditions (water control, placebo, or alcohol) and following beverage administration completed a working memory task, an Approach Avoidance Task of sexual vs. condom stimuli, and two video role-play vignettes of high-risk sexual scenarios. Sexual arousal and CAI intentions were assessed by self-report, and behavioral skills and risk exposure were derived from participants' role-play behavior. Estimation of four path models showed that the hypothesized mechanisms were supported for the CAI intention outcome, but the findings for the skills and risk exposure outcome were mixed. Implications for development and enhancement of HIV prevention interventions were discussed.
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Affiliation(s)
| | - Jeffrey S. Simons
- Department of Psychology, University of South Dakota, Vermillion, USA
| | - Tibor P. Palfai
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | - Dezarie Moskal
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY, USA,School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Alan Z Sheinfil
- Department of Psychology, Syracuse University, Syracuse, USA
| | - Kelli D. Tahaney
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
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23
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Scharer JL, Funderburk JS, De vita MJ, Rother Y, Maisto SA. Treatment-As-Usual Control Groups in Brief Alcohol Intervention Trials: A Systematic Review and Meta-Analysis. J Stud Alcohol Drugs 2022; 83:934-943. [PMID: 36484591 PMCID: PMC9756399 DOI: 10.15288/jsad.21-00260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 04/15/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Brief alcohol interventions (BAIs) are evidence-based practices that can help reduce hazardous drinking among patients in medical settings. However, descriptions of the treatment-as-usual (TAU) control groups that BAIs are compared to in clinical trials often lack clarity and detail. This systematic review and meta-analysis quantified and compared descriptions of intervention and TAU control arms within reports of randomized controlled trials and examined whether treatment effects were affected by level of detail in narrative descriptions. METHOD A systematic literature search to identify eligible articles was performed. Studies were rated on methodological quality, and the Template for Intervention Description and Replication (TIDieR) checklist was used to rate the level of clarity and detail included in descriptions of the intervention and TAU conditions in eligible articles. Data were extracted from articles for use in meta-analysis and meta-regression. RESULTS Twenty-one studies met inclusion criteria. Across the studies, TIDieR ratings for intervention arms were higher than ratings for control arms. BAIs were linked to reductions in drinks per week, heavy drinking episodes, and alcohol consequences over time when compared with TAU. TIDieR ratings for control groups were significantly associated with larger treatment effects on drinks per week and alcohol consequences but were not significant for heavy drinking episodes. CONCLUSIONS This meta-analysis reiterated the effectiveness of BAIs in medical settings. Yet the lack of clarity in TAU descriptions raises concerns regarding the validity of BAI trials, suggesting need for more detailed reporting and use of the TIDieR guidelines for support.
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Affiliation(s)
- Jacob L. Scharer
- Veterans Affairs (VA) Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York
| | - Jennifer S. Funderburk
- Veterans Affairs (VA) Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York
- Department of Psychology, Syracuse University, Syracuse, New York
- Department of Psychiatry, University of Rochester, Rochester, New York
| | - Martin J. De vita
- Veterans Affairs (VA) Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York
- Department of Psychology, Syracuse University, Syracuse, New York
- Department of Behavioral Health, Brooke Army Medical Center, Joint Base San Antonio, Texas
| | - Yvette Rother
- Veterans Affairs (VA) Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York
| | - Stephen A. Maisto
- Veterans Affairs (VA) Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York
- Department of Psychology, Syracuse University, Syracuse, New York
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24
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De Vita MJ, Maisto SA, Gilmour CE, McGuire L, Tarvin E, Moskal D. The effects of cannabidiol and analgesic expectancies on experimental pain reactivity in healthy adults: A balanced placebo design trial. Exp Clin Psychopharmacol 2022; 30:536-546. [PMID: 34251840 PMCID: PMC8531169 DOI: 10.1037/pha0000465] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite its frequent use for pain relief, no experimental pain research has tested the analgesic effects of cannabidiol (CBD) in humans. The goal of this study was to experimentally test the effects of CBD and expectancies for receiving CBD on human pain reactivity. Using a crossover, 2 × 2 factorial balanced placebo design, drug administration (given inactive substance or given active CBD) and verbal instruction sets (told inactive substance or told active CBD) were experimentally manipulated. Fifteen healthy adults each completed four separate experimental sessions. Participants were randomly assigned to different counterbalanced manipulation conditions at each session: control (told inactive-given inactive); expectancy (told active CBD-given inactive); drug (told inactive-given active CBD); and expectancy + drug (told active CBD-given active CBD). Primary outcomes were pain threshold, tolerance, intensity, unpleasantness, conditioned pain modulation (CPM), and offset analgesia (OA). There was a significant main effect of instructions on OA, such that the OA response was significantly larger when participants were told that they received CBD, regardless of drug content. Pain unpleasantness was significantly reduced in the drug, expectancy, and expectancy + drug conditions, relative to the control condition. The drug and expectancy conditions separately improved CPM, whereas the expectancy + drug and control conditions produced the lowest CPM change scores. We did not detect significant effects for pain threshold, tolerance, or intensity. Our results indicated that separate pain outcomes can be differentially affected by CBD and/or expectancies for receiving CBD. Future investigations of the psychological and pharmacological mechanisms underlying CBD analgesia are warranted. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Martin J. De Vita
- Department of Psychology, Syracuse University
- Department of Behavioral Health, Brooke Army Medical Center
| | | | - Christina E. Gilmour
- Department of Psychology, Syracuse University
- Department of Clinical and Health Psychology, University of Florida
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25
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Sheinfil AZ, Foley JD, Moskal D, Dalton MR, Firkey M, Ramos J, Maisto SA, Woolf-King SE. Daily Associations Between Alcohol Consumption and Antiretroviral Therapy (ART) Adherence Among HIV-Positive Men Who Have Sex With Men. AIDS Behav 2022; 26:3153-3163. [PMID: 35362912 PMCID: PMC9474713 DOI: 10.1007/s10461-022-03657-x] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 01/02/2023]
Abstract
Alcohol consumption is one of the strongest predictors of suboptimal adherence to antiretroviral therapy (ART), however, there is little research that has investigated both within- and between-person associations of alcohol consumption and ART adherence at the event-level. In this secondary data-analysis, (N = 22) HIV-positive MSM prospectively reported daily alcohol consumption and ART adherence for 42-days. Multilevel models demonstrated (1) days in which participants reported consuming any alcohol was associated with 2.48 increased odds of ART non-adherence, compared to days in which participants reported no alcohol consumption, and (2) there was a non-significant trend indicating days in which participants reported consuming greater than their own average levels of alcohol was associated with increased odds of ART non-adherence. Findings highlight the importance of combining intervention efforts that address alcohol consumption and suboptimal ART adherence, and indicate a need for future research to investigate the mechanisms by which alcohol influences ART adherence.
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Affiliation(s)
- Alan Z Sheinfil
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244, Syracuse, NY, USA.
| | - Jacklyn D Foley
- Behavioral Medicine Program, Massachusetts General Hospital, Boston, USA
| | - Dezarie Moskal
- VA Center for Integrated Healthcare, VA WNY Healthcare System, New York, USA
| | - Michelle R Dalton
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244, Syracuse, NY, USA
| | - Madison Firkey
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244, Syracuse, NY, USA
| | - Jeremy Ramos
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244, Syracuse, NY, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244, Syracuse, NY, USA
| | - Sarah E Woolf-King
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244, Syracuse, NY, USA
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26
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Conner KR, Abar B, Aldalur A, Chiang A, Hutchison M, Maisto SA, Stecker T. Alcohol-related consequences and the intention to seek care in treatment naïve women and men with severe alcohol use disorder. Addict Behav 2022; 131:107337. [PMID: 35483181 PMCID: PMC9717617 DOI: 10.1016/j.addbeh.2022.107337] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/18/2022] [Accepted: 04/11/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Research on treatment utilization for alcohol use disorder (AUD) is based primarily on clinical samples and community samples of low AUD severity that may not need formal care. Using a community sample of adults with untreated but severe AUD symptoms, we tested the hypothesis that alcohol-related consequences, but not alcohol consumption levels, are associated with the intention to seek AUD treatment, examined associations of specific types of alcohol-related consequences with intention, and explored sex differences in these associations. METHODS The sample was recruited using social media ads for a randomized controlled trial to test a brief intervention to promote AUD treatment seeking. This report is based on analysis of baseline data collected prior to treatment intervention. Multiple linear regressions examined associations of measures of alcohol consumption, alcohol-related consequences broadly, and specific alcohol-related consequences with the intention to seek treatment. Moderating effects of sex on associations were explored. RESULTS Subjects (n = 349) averaged 41 years of age, 48% were female, 6% were Latinx, 80% were white, 15% were Black, and 92% met criteria for severe AUD. Alcohol consumption measures were not associated with intention to seek treatment whereas interpersonal- and intrapersonal- consequences were associated with intention. Sex served as a moderator, with intrapersonal consequences (e.g., sad mood) showing a stronger association with intention in women and social responsibility consequences (particularly financial) associated with intention in men. CONCLUSION Select alcohol-related consequences may be keys to understanding increased intention to seek AUD treatment including intrapersonal consequences in women and financial consequences in men.
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Affiliation(s)
- Kenneth R Conner
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655C, Rochester, NY 14642, USA.
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655C, Rochester, NY 14642, USA
| | - Aileen Aldalur
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655C, Rochester, NY 14642, USA
| | - Andrew Chiang
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655C, Rochester, NY 14642, USA.
| | - Morica Hutchison
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, USA.
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244, USA.
| | - Tracy Stecker
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Room 431, Charleston, SC 29425, USA.
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27
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Maisto SA, Aldalur A, Abar B, Stecker T, Chiang A, Conner K. Heterogeneity in Alcohol-Related Severity and Interests in Going to Treatment in Community Adults with Alcohol Use Disorder (AUD). Subst Use Misuse 2022; 57:1626-1632. [PMID: 35869665 PMCID: PMC10518904 DOI: 10.1080/10826084.2022.2102192] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
RATIONALE Alcohol use disorder (AUD) is highly prevalent among adults in the US and is associated with substantial personal and societal costs. Yet only a small percentage of adults with AUD initiate treatment, including those with severe AUD symptoms who are most in need of treatment. In this paper we use latent profile analysis (LPA) to describe differences in symptoms of AUD severity and alcohol-related consequences among untreated adults with severe AUD symptoms who were recruited from the community. Identification of such differences will result in better understanding of this population and will improve methods of treatment outreach. METHOD The LPAs were conducted on the baseline data of 403 (50% male, 77% White, M age = 40.74 with severe AUD recruited from the community and enrolled in a trial of an intervention designed to encourage treatment initiation. Participants reported no prior AUD treatment history. The LPAs were based on indicators of AUD severity, alcohol-related negative consequences, and self-reported intention to initiate AUD treatment. RESULTS The LPAs revealed 4 profiles. Profile membership was predicted by baseline participant sex and whether they were living with a partner and was associated with baseline past 30-days alcohol consumption. CONCLUSIONS The findings characterize and describe the variability among adults in the community with untreated severe AUD on variables that tend to motivate such individuals to seek treatment, which could significantly advance treatment outreach efforts.
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Affiliation(s)
- Stephen A. Maisto
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Aileen Aldalur
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Tracy Stecker
- Department of Psychiatry, University of South Carolina, Columbia, South Carolina, USA
| | - Andrew Chiang
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Kenneth Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
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28
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Lauckner C, Walthers J, Stuck J, Bryant K, Edelman EJ, Fiellin DA, Hansen NB, Kahler CW, Magill M, Mastroleo NR, Maisto SA. The Relationship Between Drinking Behavior and Conversational Processes During a Brief Alcohol Reduction Intervention for People with HIV. AIDS Behav 2022; 26:2067-2080. [PMID: 35001249 PMCID: PMC10461530 DOI: 10.1007/s10461-021-03553-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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/26/2022]
Abstract
People with HIV (PWH) frequently engage in unhealthy alcohol use, which can adversely affect antiretroviral adherence and HIV disease progression. Brief interventions based on Motivational Interviewing (MI), including the Brief Negotiated Interview (BNI), can help to reduce drinking. This study examines MI processes observed during a single 15-20 min BNI session delivered by social workers to PWH with unhealthy alcohol use (N = 59) in the context of a stepped care intervention to reduce alcohol consumption. BNI sessions were coded for technical and relational processes encouraged in MI, such as autonomy support, instructive language, and self-exploration. Multiple regression analyses explored the relationship between: (1) Participants' pre-intervention drinking behaviors (weekly drinks and heavy drinking days) and these MI processes, and (2) MI processes and intervention outcomes. Results indicated that PWH who reported more weekly drinks at baseline engaged in less self-exploration, while social workers delivering the BNI used less instructive language for those who reported more heavy drinking days. PWH who engaged in more self-exploration and received more autonomy support had fewer heavy drinking days 6 months after the intervention. These findings suggest the value of providing more opportunities within BNIs to encourage self-exploration, as it may help to enhance intervention efficacy.
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Affiliation(s)
- Carolyn Lauckner
- Department of Behavioral Science, University of Kentucky College of Medicine, 464 Healthy Kentucky Research Bldg, 760 Press Ave, Lexington, KY, 40536, USA.
| | - Justin Walthers
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Jennifer Stuck
- Department of Behavioral Science, University of Kentucky College of Medicine, 464 Healthy Kentucky Research Bldg, 760 Press Ave, Lexington, KY, 40536, USA
| | - Kendall Bryant
- Division of HIV/AIDS Research, National Institute On Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - E Jennifer Edelman
- Program in Addiction Medicine and Center for Interdisciplinary Research on AIDS, Yale School of Medicine, Yale School of Public Health, New Haven, CT, USA
| | - David A Fiellin
- Program in Addiction Medicine and Center for Interdisciplinary Research on AIDS, Yale School of Medicine, Yale School of Public Health, New Haven, CT, USA
| | - Nathan B Hansen
- Department of Health Promotion and Behavior, University of Georgia College of Public Health, Athens, GA, USA
| | - Christopher W Kahler
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Molly Magill
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | | | - Stephen A Maisto
- Department of Psychology, Syracuse University College of Arts & Sciences, Syracuse, NY, USA
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29
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Gordon KS, Becker WC, Bryant KJ, Crystal S, Maisto SA, Marshall BDL, McInnes DK, Satre DD, Williams EC, Edelman EJ, Justice AC. Patient-Reported Bothersome Symptoms Attributed to Alcohol Use Among People With and Without HIV. AIDS Behav 2022; 26:3589-3596. [PMID: 35553287 PMCID: PMC10084471 DOI: 10.1007/s10461-022-03628-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/26/2022]
Abstract
Helping people with HIV (PWH) and without HIV (PWoH) understand the relationship between physical symptoms and alcohol use might help motivate them to decrease use. In surveys collected in the Veterans Aging Cohort Study from 2002 to 2018, PWH and PWoH were asked about 20 common symptoms and whether they thought any were caused by alcohol use. Analyses were restricted to current alcohol users (AUDIT-C > 0). We applied generalized estimating equations. The outcome was having any Symptoms Attributed to Alcohol use (SxAA). Primary independent variables were each of the 20 symptoms and HIV status. Compared to PWoH, PWH had increased odds of SxAA (OR 1.54; 95% CI 1.27, 1.88). Increased AUDIT-C score was also associated with SxAA (OR 1.32; 95% CI 1.28, 1.36), as were trouble remembering, anxiety, and weight loss/wasting. Evidence that specific symptoms are attributed to alcohol use may help motive people with and without HIV decrease their alcohol use.
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Affiliation(s)
- Kirsha S Gordon
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA.
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - William C Becker
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Stephen Crystal
- Rutgers University School of Social Work, New Brunswick, NJ, USA
| | - Stephen A Maisto
- Syracuse University College of Arts and Sciences, Syracuse, NY, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - D Keith McInnes
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Amy C Justice
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
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30
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White KM, LaRowe LR, Powers JM, Paladino MB, Maisto SA, Zvolensky MJ, Glatt SJ, Ditre JW. Family History of Alcohol Use Disorder as a Predictor of Endogenous Pain Modulation Among Moderate to Heavy Drinkers. J Pain 2022; 23:864-875. [PMID: 34974175 PMCID: PMC9086107 DOI: 10.1016/j.jpain.2021.12.005] [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] [Received: 07/07/2021] [Revised: 11/01/2021] [Accepted: 12/13/2021] [Indexed: 05/03/2023]
Abstract
Family history of alcohol use disorder (AUD) is frequently endorsed by persons with chronic pain. Although individuals with a family history of AUD have demonstrated enhanced sensitivity to painful stimulation, previous research has not examined endogenous pain modulation in this population. The goal of this study was to test family history of AUD as a predictor of conditioned pain modulation, offset analgesia, and temporal summation among a sample of moderate and heavy drinkers. Adults with no current pain (N = 235; 58.3% male; Mage = 34.3; 91.9% non-Hispanic; 60% white) were evaluated for family history of AUD at baseline and pain modulatory outcomes were assessed via quantitative sensory testing. Participants with a family history of AUD (relative to those without) evinced a pro-nociceptive pain modulation profile in response to experimental pain. Specifically, family history of AUD was associated with deficits in pain-inhibitory processes. Approximately 4% of the variance in endogenous pain modulation was accounted for by family history, and exploratory analyses suggested these effects may be driven by paternal AUD. PERSPECTIVE: The current findings suggest individuals with a family history of AUD demonstrate pain modulatory function that may predispose them to the development of chronic pain. Clinically, these data may inform pain management approaches for individuals with a family history of AUD.
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Affiliation(s)
- Kyle M White
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Lisa R LaRowe
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Jessica M Powers
- Department of Psychology, Syracuse University, Syracuse, New York
| | | | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, Texas.; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen J Glatt
- Department of Psychiatry and Behavioral Sciences, The State University of New York (SUNY) Upstate Medical University, Syracuse, New York
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, New York..
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31
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Clifford PR, Davis CM, Maisto SA, Stout RL. Alcohol Treatment Research Contributing to Changes in Substance Use Behavior and Related Negative Consequences. J Stud Alcohol Drugs 2022; 83:364-373. [PMID: 35590177 PMCID: PMC9134996] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the extent to which two of the more salient characteristics of a treatment research assessment protocol (i.e., the comprehensiveness of the assessment battery and the frequency of its administration) for alcohol use disorder contribute to reductions in substance use and related negative consequences. METHOD Study participants were recruited from two hospital-administered substance use disorder outpatient clinics. Two hundred thirty-five individuals presenting for outpatient alcohol treatment screened study eligible and provided informed consent. Study participants were randomized to one of four research assessment conditions (i.e., frequent-comprehensive, frequent-brief, infrequent-comprehensive, and infrequent-brief) based on the crossing of a 2 (i.e., assessment comprehensiveness: comprehensive vs. brief) by 2 (i.e., assessment frequency: frequent vs. infrequent) factorial design. RESULTS Individuals assigned to the frequent assessment conditions reported greater reductions in substance use and substance use-related negative consequences relative to their counterparts assigned to the infrequent assessment conditions. In addition, a greater proportion of individuals assigned to the frequent assessment conditions reported abstinence from both alcohol and other substances. CONCLUSIONS The improvements in substance use and related negative consequences associated with more frequent research assessments were statistically significant and clinically meaningful.
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Affiliation(s)
- Patrick R. Clifford
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Correspondence may be sent to Patrick R. Clifford at the School of Public Health, Rutgers, The State University of New Jersey, 683 Hoes Lane West, Room 309, Piscataway, NJ 08854, or via email at:
| | - Christine M. Davis
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | | | - Robert L. Stout
- Pacific Institute for Research and Evaluation, Quantitative Capabilities Collaboration, Pawtucket, Rhode Island
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32
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Clifford PR, Davis CM, Maisto SA, Stout RL. Alcohol Treatment Research Contributing to Changes in Substance Use Behavior and Related Negative Consequences. J Stud Alcohol Drugs 2022. [DOI: 10.15288/jsad.2022.83.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Patrick R. Clifford
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Christine M. Davis
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | | | - Robert L. Stout
- Pacific Institute for Research and Evaluation, Quantitative Capabilities Collaboration, Pawtucket, Rhode Island
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Hutchison M, Aldalur A, Maisto SA, Chiang A, Abar B, Stecker T, Conner KR. Alcohol Use During COVID-19 in Adults with Severe Untreated AUD. Alcoholism Treatment Quarterly 2022; 40:299-310. [PMID: 35937159 PMCID: PMC9355046 DOI: 10.1080/07347324.2022.2060156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Evidence demonstrating increased alcohol use during COVID-19 comes from low- to moderate-alcohol use samples and has yet to use adults with severe but untreated AUD. Using a community sample of adults with severe AUD, this exploratory, cross-sectional study examined associations of COVID-19 alcohol use. Participants were recruited for a phase-II RCT. Only baseline measures, completed prior to randomization, were analyzed in the present study. Key variables were alcohol consumption, COVID-19-related worries and experiences, and qualitative responses of 1) alcohol use and 2) positive changes during COVID-19. 176 pariticpants recruited since COVID-19 were on average 41.4 years old, 49.1% female, and 79% White. Participants drank alcohol nearly 23 of the past 30 days, consumed 7 standard drinks per drinking day, and nearly 90% reported increased alcohol use. More heavy episodic drinking was reported in the first six-months of COVID-19 and more COVID-related concerns in the most recent six-months. Participants reported drinking increased due to "more time on their hands", but the pandemic also "strengthened relationships". Results affirm an increase in alcohol use during COVID-19 in adults with severe, untreated AUD. Findings underscore the need to understand how alcohol use and pandemic-related circumstances may influence one another for adults with severe AUD.
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Affiliation(s)
- Morica Hutchison
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Aileen Aldalur
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Stephen A. Maisto
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Andrew Chiang
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Tracy Stecker
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kenneth R. Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
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Woolf-King SE, Firkey M, Foley JD, Bricker J, Hahn JA, Asiago-Reddy E, Wikier J, Moskal D, Sheinfil AZ, Ramos J, Maisto SA. Development of a Telephone-Delivered Acceptance and Commitment Therapy Intervention for People Living with HIV who are Hazardous Drinkers. AIDS Behav 2022; 26:3029-3044. [PMID: 35303190 PMCID: PMC8931450 DOI: 10.1007/s10461-022-03649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/16/2022]
Abstract
Alcohol use among people living with HIV (PWH) has been increasingly recognized as an important component of HIV care. Transdiagnostic treatments, such as Acceptance and Commitment Therapy (ACT), that target core processes common to multiple mental health and substance-related problems, may be ideal in HIV treatment settings where psychological and behavioral health comorbidities are high. In advance of a randomized clinical trial (RCT), the overall objective of this study was to systematically adapt an ACT-based intervention originally developed for smoking cessation, into an ACT intervention for PWH who drink at hazardous levels. Consistent with the ADAPT-ITT model, the adaptation progressed systematically in several phases, which included structured team meetings, three focus group discussions with PWH (N = 13), and in-depth interviews with HIV providers (N = 10), and development of standardized operating procedures for interventionist training, supervision, and eventual RCT implementation. The procedures described here offer a template for transparent reporting on early phase behavioral RCTs.
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McGinnis KA, Tate JP, Bryant KJ, Justice AC, O'Connor PG, Rodriguez-Barradas MC, Crystal S, Cutter CJ, Hansen NB, Maisto SA, Marconi VC, Williams EC, Cook RL, Gordon AJ, Gordon KS, Eyawo O, Edelman EJ, Fiellin DA. Change in Alcohol Use Based on Self-Report and a Quantitative Biomarker, Phosphatidylethanol, in People With HIV. AIDS Behav 2022; 26:786-794. [PMID: 34542779 DOI: 10.1007/s10461-021-03438-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
The timeline followback (TLFB) takes more resources to collect than the Alcohol Use Disorder Identification Test (AUDIT-C). We assessed agreement of TLFB and AUDIT-C with the biomarker phosphatidylethanol (PEth) and compared changes in TLFB and PEth among persons with HIV (PWH) using secondary data from randomized trials. We calculated operating characteristics and agreement between TLFB (> 1 and > 2 average drinks/day), AUDIT-C ≥ 4 and PEth ≥ 20 among 275 men with HIV. Median age was 57 years, 80% were African-American; and 17% white. Sixty-eight percent had PEth ≥ 20, 46% reported > 2 average drinks/day on TLFB, 61% reported > 1 average drinks/day on TLFB, and 72% had an AUDIT-C ≥ 4. Relative to PEth, sensitivity for AUDIT-C ≥ 4 was 84% (kappa = 0.36), and for TLFB > 1 average drink/day was 76% (kappa = 0.44). Change in alcohol use appeared greater using TLFB measures than PEth. Strategies to robustly assess alcohol use in PWH may require both self-report and biomarkers.
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Affiliation(s)
- Kathleen A McGinnis
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA.
| | - Janet P Tate
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Amy C Justice
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | | | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Stephen Crystal
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | | | - Nathan B Hansen
- College of Public Health, University of Georgia, Athens, GA, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Vincent C Marconi
- School of Medicine and Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health and Seattle-Denver Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Adam J Gordon
- University of Utah and Salt Lake City VA Health Care System, Salt Lake City, UT, USA
| | - Kirsha S Gordon
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | | | - E Jennifer Edelman
- Yale School of Medicine, New Haven, CT, USA
- Center for Interdisciplinary Research On AIDS, Yale School of Public Health, New Haven, CT, USA
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Woolf-King SE, Sheinfil AZ, Ramos J, Foley JD, Moskal D, Firkey M, Kellen D, Maisto SA. A conceptual model of alcohol use and adherence to antiretroviral therapy: systematic review and theoretical implications for mechanisms of action. Health Psychol Rev 2022; 16:104-133. [PMID: 32757813 PMCID: PMC8972079 DOI: 10.1080/17437199.2020.1806722] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Alcohol consumption is one of the most prevalent correlates of antiretroviral therapy (ART) adherence, yet causal processes underlying this association remain largely unexplored. The goal of this systematic review was to develop a conceptual model that describes the causal effect of alcohol consumption on ART nonadherence. We reviewed 230 studies that examined the association between alcohol consumption and ART adherence with three primary aims: (1) to replicate and extend previous reviews of the literature, (2) to summarize and critique study designs capable of answering questions about temporal overlap and (3) to summarize potential mechanisms of action. A model of alcohol-associated ART nonadherence was proposed to guide future work, integrating general theories of ART adherence and theory on the psychological and behavioral effects of alcohol intoxication. The conceptual model describes two mechanistic processes-prospective memory impairment and interactive toxicity beliefs/avoidance behaviors-involved in alcohol-associated intentional and unintentional nonadherence, respectively. This model can be used to guide future research on the causal processes involved in the frequently observed correlation between alcohol consumption and adherence.
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Affiliation(s)
| | - Alan Z. Sheinfil
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jeremy Ramos
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jacklyn D. Foley
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Dezarie Moskal
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Madison Firkey
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - David Kellen
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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Spinola S, De Vita MJ, Gilmour CE, Maisto SA. Effects of acute alcohol administration on working memory: a systematic review and meta-analysis. Psychopharmacology (Berl) 2022; 239:695-708. [PMID: 35075512 DOI: 10.1007/s00213-022-06060-5] [Citation(s) in RCA: 3] [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] [Received: 08/12/2021] [Accepted: 01/03/2022] [Indexed: 01/17/2023]
Abstract
RATIONALE Alcohol-induced executive function deficits may underlie associations between alcohol, self-regulation, and hazardous behaviors. Studies examining the effects of alcohol administration on working memory, an important executive functioning component, have produced mixed findings. Acute alcohol effects on working memory remain unclear. OBJECTIVES We aimed to conduct a systematic review and meta-analysis on the effects of acute alcohol administration on working memory outcomes in studies of healthy adults. METHODS We performed a systematic search of PubMed, MEDLINE, and PsycINFO from inception to June 2021. Studies were included if they met criteria, including healthy participants and administration of quantified alcohol doses against comparative controls. Data extracted included primary working memory outcomes, alcohol doses, and study characteristics. Study quality was assessed using an established validity measure. Working memory task type, alcohol dose, control condition type, and sex/gender composition were explored as moderators using mixed-effects models and meta-regressions. RESULTS Thirty-two studies (1629 participants) provided sufficient data for 54 comparisons between alcohol and control conditions. Random-effects meta-analysis indicated that alcohol administration produced significant, small- to medium-sized working memory decrements (g [95% CI] = - 0.300 [- 0.390 to - 0.211], p < 0.001). Moderation analyses suggested that these effects differed as a function of task type, dose, control condition type, and sex/gender composition. The average quality rating across studies was good. CONCLUSIONS Alcohol administration significantly impaired working memory performance, particularly when executive-related manipulation processes were involved. Future research is needed to investigate how alcohol-induced working memory impairments relate to compromised self-regulation, hazardous behavior, and negative drinking consequences.
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Affiliation(s)
- Suzanne Spinola
- Department of Psychology, Syracuse University, Syracuse, NY, USA. .,VA Connecticut Healthcare System-West Haven, West Haven, CT, USA. .,Department of Psychiatry, Yale University School of Medicine, New Haven, NY, USA.
| | - Martin J De Vita
- Department of Psychology, Syracuse University, Syracuse, NY, USA.,Department of Behavioral Health, Brooke Army Medical Center, San Antonio, TX, USA
| | - Christina E Gilmour
- Department of Psychology, Syracuse University, Syracuse, NY, USA.,Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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Pfund RA, Hallgren KA, Maisto SA, Pearson MR, Witkiewitz K. Dose of psychotherapy and long-term recovery outcomes: An examination of attendance patterns in alcohol use disorder treatment. J Consult Clin Psychol 2022; 89:1026-1034. [PMID: 35025543 DOI: 10.1037/ccp0000703] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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
OBJECTIVES The purpose of this study was to examine associations between psychotherapy session attendance, alcohol treatment outcomes, and Alcoholics Anonymous (AA) attendance. METHOD Using data from Project MATCH, repeated measures latent class analyses of psychotherapy session attendance were conducted among participants in the outpatient arm who were randomly assigned to complete 12-session cognitive-behavioral therapy (CBT; n = 301), 12-session twelve-step facilitation (TSF; n = 335), or 4-session motivational enhancement therapy (MET; n = 316). Associations between psychotherapy attendance classes, heavy drinking, alcohol-related consequences, psychosocial functioning, and AA attendance were examined at posttreatment (97% retention), 1-year posttreatment (92% retention), and 3-years posttreatment (85% retention). RESULTS In general, participants who attended all 12 CBT/TSF sessions had significantly fewer heavy drinking days and alcohol-related consequences at all posttreatment time points than participants who attended 0-2 CBT/TSF sessions. Participants who attended all four MET sessions generally had significantly fewer heavy drinking days and alcohol-related consequences at posttreatment and 1-year posttreatment than participants who attended 0-1 MET sessions. Participants who attended more TSF and MET sessions generally attended more AA meetings, and participants who attended less CBT sessions generally attended fewer AA meetings. CONCLUSIONS With some exceptions, attending all sessions in CBT, TSF, and MET was related to the most favorable heavy drinking and alcohol-related consequences outcomes. Alcoholics' Anonymous and other mutual help groups may be attended differently based on the form and dose of psychotherapy (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Rory A Pfund
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | | | - Matthew R Pearson
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
| | - Katie Witkiewitz
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
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LaRowe LR, Powers JM, Maisto SA, Zvolensky MJ, Glatt SJ, Ditre JW. Brief Report: Expectancies for alcohol analgesia are associated with greater alcohol use among moderate-to-heavy drinkers without chronic pain. Am J Addict 2022; 31:80-84. [PMID: 34873765 PMCID: PMC8849583 DOI: 10.1111/ajad.13245] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/28/2021] [Accepted: 11/24/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Expectancies for alcohol analgesia (i.e., expectations that drinking alcohol will reduce pain) have been associated with greater alcohol consumption among individuals with chronic pain, and there is reason to believe that such expectancies may also contribute to drinking behavior among alcohol users without a current chronic pain condition. Therefore, the objective of these analyses was to test associations between a measure of expectancies for alcohol analgesia (EAA) and alcohol use among drinkers without current pain. METHOD These are secondary analyses of baseline data collected from 200 moderate-to-heavy adult drinkers (39% women). RESULTS EAA scores were positively associated with quantity/frequency of drinking, urge to drink, and other alcohol outcome expectancies (ps < .01). DISCUSSION AND CONCLUSIONS Expectancies that alcohol will reduce pain are associated with heavier drinking among drinkers without pain. Over time, such expectancies may contribute to the development of alcohol use disorder and chronically painful conditions. SCIENTIFIC SIGNIFICANCE This study provides the first evidence that even moderate-to-heavy drinkers without chronic pain may still hold expectancies for alcohol analgesia, and that this may be related to greater quantity/frequency of drinking.
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Affiliation(s)
- Lisa R. LaRowe
- Department of Behavioral and Social Sciences, Brown University School of Public Health
| | | | | | | | - Stephen J. Glatt
- Departments of Psychiatry and Behavioral Sciences, Neuroscience and Physiology, and Public Health and Preventive Medicine at SUNY Upstate Medical University
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Zale EL, Maisto SA, De Vita MJ, Hooten WM, Ditre JW. Increasing cessation motivation and treatment engagement among smokers in pain: A pilot randomized controlled trial. Exp Clin Psychopharmacol 2021; 29:593-604. [PMID: 32757595 PMCID: PMC8499853 DOI: 10.1037/pha0000424] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tobacco smokers with co-occurring pain report greater difficulty quitting, face unique cessation challenges, and may benefit from targeted smoking interventions. We developed and tested a brief motivational intervention aimed at increasing knowledge of pain-smoking interrelations, motivation to quit, and cessation treatment engagement among smokers in pain. Nontreatment seeking daily cigarette smokers with chronic pain (N = 76, 57.9% women, 52.6% White) were randomized to the targeted or ask, advise, refer (AAR) intervention. The targeted intervention included personalized feedback and pain-smoking psychoeducation to help participants develop discrepancy between continued smoking and desired pain outcomes. At postintervention, the targeted intervention (vs. AAR) increased knowledge of pain-smoking interrelations and several indices of motivation to quit smoking (ps < .01). Participants who received the targeted intervention were also more likely to accept information about and report intention to engage evidence-based cessation treatments (ps < .05). Increased knowledge of pain-smoking interrelations mediated postintervention effects on motivation to quit and willingness to learn about treatments. At 1-month follow up, gains in knowledge of pain-smoking interrelations were maintained (p = .009). Participants who received the targeted intervention were more likely to report having subsequently engaged cessation treatment (p = .019), but this was not mediated by increased knowledge of pain-smoking interrelations. Smokers with chronic pain may benefit from targeted interventions that address smoking in the context of pain. Smokers in pain may become increasingly motivated to quit and engage cessation treatment as they become aware of how smoking may exacerbate their pain. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | - W. Michael Hooten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine
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Rowland BHP, Palfai TP, Simons JS, Maisto SA. Working memory moderates the relation between implicit alcohol associations and heavy episodic drinking in moderate-to-heavy drinking men who have sex with men. Addict Behav 2021; 123:107053. [PMID: 34416533 PMCID: PMC8498971 DOI: 10.1016/j.addbeh.2021.107053] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/13/2021] [Accepted: 07/12/2021] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Heavy episodic drinking poses a risk for HIV-infection, particularly among men who have sex with men (MSM). Previous research suggests implicit associations may play a role in heavy episodic drinking and that various executive functions (EF) may moderate the relation between implicit associations and heavy episodic drinking. This study investigated the role of two EF - working memory (maintaining and updating information) and response inhibition (inhibiting prepotent responses) - as moderators of the relation between implicit alcohol approach associations and heavy episodic drinking among moderate-to-heavy drinking MSM. METHODS Two-hundred and fifty-one participants completed measures of implicit alcohol associations (the implicit alcohol approach association test - IAT), working memory, and response inhibition, as well as a self-report questionnaire assessing heavy episodic drinking. Regression analyses were conducted to examine whether the association between the IAT and heavy episodic drinking was moderated by working memory and response inhibition. RESULTS Results showed that working memory moderated the relation between the alcohol IAT and heavy episodic drinking such that IAT alcohol approach scores were positively associated with heavy episodic drinking among those low in working memory but not those high in working memory. Response inhibition did not moderate the association between IAT scores and heavy episodic drinking. CONCLUSIONS Results suggest that the relation between implicit alcohol approach associations and heavy episodic drinking is stronger among moderate-to-heavy drinking MSM with lower working memory capacity compared to those with higher working memory capacity, and these individuals may particularly benefit from alcohol intervention approaches that target automatic alcohol responses.
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Affiliation(s)
- Bonnie H P Rowland
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
| | - Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Jeffrey S Simons
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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Maisto SA, Freeman R, Bryant K. Alcohol-related Behavioral Research and its Integration into Primary and Secondary HIV Preventive Interventions: Introduction. AIDS Behav 2021; 25:233-236. [PMID: 34390434 PMCID: PMC8616853 DOI: 10.1007/s10461-021-03420-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
The purpose of this paper is to provide a brief introduction to and description of the contents of this special issue of AIDS and Behavior. The article begins with a description of the rationale for the special issue and the origin of its compilation. This background information is followed by a brief description of the main articles that are included in the special issue, which is structured by Gaist and Stirrat's [4] definitions of types of behavioral and social science research for HIV-AIDS research. The "bookend" article to this introduction is by Robert Freeman and identifies future directions for research and clinical practice that the special issue articles' content suggests.
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Affiliation(s)
- Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA.
| | - Robert Freeman
- Division of Epidemiology and Prevention Research, NIAAA, Bethesda, MD, USA
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De Vita MJ, Buckheit K, Gilmour CE, Moskal D, Maisto SA. Development of a novel brief quantitative sensory testing protocol that integrates static and dynamic pain assessments: Test-retest performance in healthy adults. Pain Med 2021; 23:347-351. [PMID: 34601615 DOI: 10.1093/pm/pnab290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/06/2021] [Accepted: 09/24/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Quantitative sensory testing is an expanding pain research domain with numerous clinical and research applications. There is a recognized need for brief reliable quantitative sensory testing protocols that enhance assessment feasibility. This study aimed to integrate static (pain threshold, tolerance, suprathreshold) and dynamic (conditioned pain modulation, offset analgesia, temporal summation) pain reactivity measures into a brief 20-minute protocol that uses a single portable device. The test-retest performance of this optimized protocol was evaluated. DESIGN Using a test-retest design, the brief quantitative sensory testing assessment was administered to participants on two occasions separated by exactly 7 days. SETTING A clinical psychology research laboratory at Syracuse University. SUBJECTS Participants were 33 healthy adults recruited from Syracuse University's online research participation pool. METHODS A portable computerized quantitative sensory testing device delivered contact-heat pain to assess static and dynamic pain measures in participants. Dynamic responses were continuously recorded using a computerized visual analog scale. RESULTS Pain threshold, tolerance, and suprathreshold exhibited excellent reliability (intraclass correlations ranged from 0.80 to 0.83). Conditioned pain modulation, offset analgesia, temporal summation yielded reliability in the good to excellent range (intraclass correlations ranged from 0.66 to 0.71). CONCLUSIONS Findings suggested that this brief integrated QST protocol may reliably monitor human pain reactivity over brief periods. This protocol may enhance quantitative sensory testing feasibility in clinical and research settings.
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Affiliation(s)
- Martin J De Vita
- Department of Psychology, Syracuse University.,Department of Behavioral Health, Brooke Army Medical Center
| | - Katherine Buckheit
- Department of Psychology, Syracuse University.,Center for Integrated Healthcare, Syracuse VA Medical Center
| | - Christina E Gilmour
- Department of Psychology, Syracuse University.,Department of Clinical and Health Psychology, University of Florida
| | | | - Stephen A Maisto
- Department of Psychology, Syracuse University.,Center for Integrated Healthcare, Syracuse VA Medical Center
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Maisto SA, Simons JS, Palfai TP, Moskal D, Luehring-Jones P. Daily Associations Among Alcohol Intoxication, Partner Familiarity, Participant Effortful Control, Urgency, and PrEP Uptake on Sexual Behavior in Men Who Have Sex with Men. Arch Sex Behav 2021; 50:2843-2860. [PMID: 33594529 DOI: 10.1007/s10508-020-01852-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Received: 06/01/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to examine the effects of alcohol intoxication and its interaction with contextual or situation (partner familiarity) and individual differences variables (effortful control, urgency, and whether taking pre-exposure prophylaxis (PrEP) medication) on sexual behaviors in men who have sex with men (MSM), a subgroup for whom HIV continues to be a major public health problem in the U.S. The participants were 236 men recruited from two northeastern U.S. cities and aged 21-50 years, M = 27.8). These men participated in a 6-week (two 3-week sampling bursts) experience sampling method (ESM) study. The ESM data were collected via use of software installed on the participant's own or study-provided mobile phone. Individual differences variables were measured by participants' completing questionnaires measuring effortful control and urgency, and the participant's self-report of whether he was currently taking PrEP. The ESM data pertained to sexual behavior as well as situation variables of familiarity of relevant sexual partners and number of standard alcohol drinks consumed. The results generally were consistent with hypotheses, as alcohol intoxication showed a curvilinear relation to the occurrence of condomless anal intercourse. Furthermore, the likelihood of occurrence of condomless anal sex increased with increased familiarity of the sexual partner. Similarly, taking PrEP increased the likelihood of occurrence of condomless anal sex. At the same time, alcohol's effects were moderated by all three individual differences variables as expected, but the prediction that partner familiarity would moderate alcohol's effects on the occurrence of condomless sex was not supported. Clinical implications of the findings center on the application of the data to HIV prevention programs toward inclusion of more empirically supported, nuanced information on the relation between acute alcohol intoxication and sexual behavior. Directions for further research address the need for additional testing and refinement of a person × situation approach to alcohol and sexual behavior. Furthermore, it is argued that it is important to refine further the concept of sexual risk in the context of taking PrEP and to conduct more detailed, multivariate studies of the relation between taking PrEP and patterns of sexual behavior.
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Affiliation(s)
- Stephen A Maisto
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA.
| | - Jeffrey S Simons
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
| | - Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Dezarie Moskal
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA
| | - Peter Luehring-Jones
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Medenblik AM, Calhoun PS, Maisto SA, Kivlahan DR, Moore SD, Beckham JC, Wilson SM, Blalock DV, Dedert EA. Pilot Cohorts for Development of Concurrent Mobile Treatment for Alcohol and Tobacco Use Disorders. Subst Abuse 2021; 15:11782218211030524. [PMID: 34552330 PMCID: PMC8451000 DOI: 10.1177/11782218211030524] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/13/2021] [Indexed: 11/23/2022]
Abstract
Alcohol and tobacco are the 2 most frequently used drugs in the United States and represent the highest co-occurrence of polysubstance use. The objective of this study was to refine an intervention combining mobile contingency management with cognitive-behavioral telephone counseling for concurrent treatment of alcohol and tobacco use disorders. Two cohorts (n = 13 total, n = 5 women) of participants were enrolled, with 10/13 completing treatment and 7/13 completing the 6-month follow-up. At enrollment, participants were drinking a mean of 28.9 drinks per week (SD = 14.1), with a mean of 14.7 heavy drinking days in the past month (SD = 9.9), and a mean of 18.1 cigarettes per day (SD = 11.7). Treatment included a mobile application that participants used to record carbon monoxide and breath alcohol content readings to bioverify abstinence. Participants received up to 4 sessions of phone cognitive-behavioral therapy and monetary reinforcement contingent on abstinence. In cohort 1, 4/6 participants reported abstinent or low-risk drinking post-monitoring. Six weeks post quit-date, 2/6 participants were CO-bioverified abstinent from tobacco use, with 2/6 in dual remission. These results were maintained at 6-months. In cohort 2, 6/7 reported abstinent or low-risk drinking post-monitoring, 5 weeks post quit-date. At the post-monitoring visit, 5/7 were CO-bioverified abstinent from smoking, with 5/7 in dual remission. At 6-months, 3/7 reporting abstinent or low-risk drinking, 1/7 had bioverified abstinence from smoking, with 1/7 in dual remission. Observations suggest that it is possible to develop a concurrent mobile treatment for alcohol and tobacco use disorders.
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Affiliation(s)
- Alyssa M Medenblik
- Psychology Department, University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs Health Care System, Durham, NC, USA.,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Health Care System, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Stephen A Maisto
- Veterans Affairs Center for Integrated Health Care, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Daniel R Kivlahan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Scott D Moore
- Durham Veterans Affairs Health Care System, Durham, NC, USA.,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Jean C Beckham
- Durham Veterans Affairs Health Care System, Durham, NC, USA.,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Sarah M Wilson
- Durham Veterans Affairs Health Care System, Durham, NC, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Health Care System, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Health Care System, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Eric A Dedert
- Durham Veterans Affairs Health Care System, Durham, NC, USA.,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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Gass JC, Funderburk JS, Maisto SA. Barriers and Pathways to Changing Smoking and Risky Drinking in Primary Care Patients With Chronic Conditions Who Failed to Respond to Brief Advice. Prim Care Companion CNS Disord 2021; 23. [PMID: 34416103 DOI: 10.4088/pcc.20m02836] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Objective: Many individuals who smoke tobacco or consume alcohol at hazardous levels have chronic conditions that are caused or exacerbated by these behaviors. The objective of this survey study was to obtain data on the health care concerns, barriers, and readiness to change indicators of smokers/risky drinkers with related health conditions who have not responded to standard primary care interventions. Methods: 167 participants (120 who reported current smoking or risky drinking or both) completed a 1-time mailed survey in 2017/2018. Participants were asked about smoking and drinking habits, physical health and impairments, health-related concerns, and barriers and readiness to change smoking and drinking. Results: For smokers and drinkers, the most common health concern was cardiovascular related (22% and 19%, respectively), though co-users were more concerned about pain. The most common barriers to change were lacking motivation and belief that alcohol/tobacco was not impacting their health. For smokers and drinkers, stronger beliefs that smoking/drinking does not affect their health was associated with lower importance of changing. Conclusions: Data from this study suggest that the main reasons patients report not changing are based on deficits in motivation and likely in information. In a group of patients who all have conditions that contraindicate smoking and risky drinking, their belief that their behaviors do not cause problems and that their health is not affected by their behaviors suggests a need for increased, focused education.
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Affiliation(s)
- Julie C Gass
- VA Center for Integrated Healthcare, Western New York VA Healthcare System, Buffalo, New York.,Department of Psychology, University at Buffalo, State University of New York, Buffalo, New York.,Corresponding author: Julie C. Gass, PhD, 3495 Bailey Ave, 116(N), Buffalo, NY 14215
| | - Jennifer S Funderburk
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York.,Department of Psychology, Syracuse University, Syracuse, New York.,Department of Psychiatry University of Rochester, Rochester, New York *Corresponding author: Julie C. Gass, PhD, 3495 Bailey Ave, 116(N), Buffalo, NY 14215
| | - Stephen A Maisto
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York.,Department of Psychology, Syracuse University, Syracuse, New York
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Witkiewitz K, Wilson AD, Roos CR, Swan JE, Votaw VR, Stein ER, Pearson MR, Edwards KA, Tonigan JS, Hallgren KA, Montes KS, Maisto SA, Tucker JA. Can Individuals With Alcohol Use Disorder Sustain Non-abstinent Recovery? Non-abstinent Outcomes 10 Years After Alcohol Use Disorder Treatment. J Addict Med 2021; 15:303-310. [PMID: 33060466 PMCID: PMC8044251 DOI: 10.1097/adm.0000000000000760] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Four decades ago, the "controlled drinking" controversy roiled the alcohol field. Data have subsequently accumulated indicating that nonabstinent alcohol use disorder (AUD) recovery is achievable, but questions remain whether it is sustainable long-term. This study examined whether nonabstinent recovery at 3 years after AUD treatment is associated with better functioning at 10 years after treatment. METHODS Data were from the 10-year follow-up of Project MATCH (New Mexico site only, n = 146; 30.1% female, 58.6% non-White). Recovery was defined by latent profile analyses based on psychosocial functioning and alcohol consumption 3 years after treatment. Drinking practices and consequences, depression, purpose in life, and anger were assessed 10 years after treatment. Distal outcome analyses examined differences in drinking and functional outcomes at 10 years as a function of the 3-year latent profiles. Analyses were preregistered at https://osf.io/3hbxr. RESULTS Four latent profiles identified at 3 years after treatment (ie, low functioning frequent heavy drinkers, low functioning infrequent heavy drinkers, high functioning heavy drinkers, and high functioning infrequent nonheavy drinkers) were significantly associated with outcomes 10 years after treatment. The 2 high functioning profiles at 3 years had the highest level of psychological functioning at 10 years posttreatment, regardless of alcohol consumption level. Abstinence at 3 years did not predict better psychological functioning at 10 years. CONCLUSIONS Nonabstinent AUD recovery is possible and is sustainable for up to 10 years after treatment. The current findings align with recent proposals to move beyond relying on alcohol consumption as a central defining feature of AUD recovery.
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Affiliation(s)
- Katie Witkiewitz
- University of New Mexico, Albuquerque, NM (KW, ADW, JES, VRV, ERS, MRP, KAE, JST), Yale University, New Haven, CT (CRR), University of Washington, Seattle, WA (KAH), California State University Dominquez Hills, Carson, CA (KSM), Syracuse University, Syracuse, NY (SAM), University of Florida, Gainesville, FL (JAT)
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Witkiewitz K, Wilson AD, Pearson MR, Roos CR, Swan JE, Votaw VR, Stein ER, Edwards KA, Tonigan JS, Hallgren KA, Montes KS, Maisto SA, Tucker JA. A Bridge to Nowhere: Resistance to the Possibility of Some Heavy Drinking During Recovery and the Potential Public Health Implications. J Addict Med 2021; 15:352-353. [PMID: 33577228 PMCID: PMC8352995 DOI: 10.1097/adm.0000000000000796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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LaRowe LR, Maisto SA, Ditre JW. A measure of expectancies for alcohol analgesia: Preliminary factor analysis, reliability, and validity. Addict Behav 2021; 116:106822. [PMID: 33460990 DOI: 10.1016/j.addbeh.2021.106822] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/13/2020] [Accepted: 01/05/2021] [Indexed: 02/08/2023]
Abstract
Rates of alcohol consumption are substantially higher among persons with pain, and recent research has focused on elucidating bidirectional pain-alcohol effects. Expectancies for alcohol analgesia could influence the degree to which alcohol confers acute pain-relieving effects, and may amplify the propensity to respond to pain with drinking behavior. However, no validated measures of expectancies for alcohol analgesia are available. Therefore, we developed a five-item measure of Expectancies for Alcohol Analgesia (EAA), which assesses the perceived likelihood that alcohol will reduce pain. The goal of this project was to examine psychometric properties of the EAA among a sample of 273 current alcohol users with chronic pain (Mage = 32.9; 34% female) who completed an online survey of pain and substance use. Confirmatory factor analysis (CFA) results indicated that the hypothesized single-factor structure of the EAA provided good model fit (Bollen-Stine bootstrap p = .13). The EAA also showed excellent internal consistency (α = 0.97), and scores were positively associated with quantity/frequency of alcohol use, alcohol outcome expectancies, coping-related drinking motives, and pain severity (ps < 0.01). These findings provide initial support regarding the single-factor structure, reliability, and validity of the EAA. Examination of predictive utility and further validation are important next steps.
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Funderburk JS, Pigeon WR, Shepardson RL, Wade M, Acker J, Fivecoat H, Wray LO, Maisto SA. Treating depressive symptoms among veterans in primary care: A multi-site RCT of brief behavioral activation. J Affect Disord 2021; 283:11-19. [PMID: 33516082 DOI: 10.1016/j.jad.2021.01.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/29/2020] [Revised: 12/30/2020] [Accepted: 01/10/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Behavioral activation is ideal for embedded behavioral health providers (BHPs) working in primary care settings treating patients reporting a range of depressive symptoms. The current study tested whether a brief version of Behavioral Activation (two 30-minute appointments, 2 boosters) designed for primary care (BA-PC) was more effective than primary care behavioral health treatment-as-usual (TAU) in reducing depressive symptoms and improving quality of life and functioning. METHODS Parallel-arm, multi-site randomized controlled trial. 140 Veterans were randomized to BA-PC or TAU and completed assessments at baseline, 6 weeks, 12 weeks, and 24 weeks. RESULTS Reductions in depressive symptoms were observed in both groups between baseline and 3-weeks prior to any treatment, with continued reductions among those in the BA-PC condition through 12-weeks. However, there was no significant condition X time interaction at 12-weeks. Quality of life and mental health functioning were significantly improved for those in the BA-PC condition, compared to TAU, at 12 weeks. LIMITATIONS Generalizability to a broader population may be limited as this sample consisted of veterans. Although engagement in TAU matched other prior work, it was lower than engagement in BA-PC, which also may compromise results. CONCLUSIONS Although this study found that both TAU and BA-PC participants showed a decline in depressive symptoms, improvements in functioning and quality of life within those assigned to BA-PC, strong treatment retention and feasibility of BA-PC, and significant reductions in depressive symptoms among those with more severe baseline depressive symptoms are encouraging and support continued research on BA-PC. This trial was registered in clinicaltrials.gov as Improving Mood in Veterans in Primary Care (NCT02276807).
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Affiliation(s)
- Jennifer S Funderburk
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA; Department of Psychology, Syracuse University, Syracuse, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
| | - Wilfred R Pigeon
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA; VA VISN 2 Center of Excellence for Suicide Prevention, Finger Lakes VA Medical Center, Canandaigua, NY, USA
| | - Robyn L Shepardson
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA; Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Michael Wade
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - John Acker
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Hayley Fivecoat
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura O Wray
- VA Center for Integrated Healthcare, Western New York VA Medical Center, Buffalo, NY, USA; Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA
| | - Stephen A Maisto
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA; Department of Psychology, Syracuse University, Syracuse, NY, USA
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