Prevalence and Factor Structure of PTSD in DSM-5 Versus DSM-IV in a National Sample of Sexual Minority Women.

The impact of changes to posttraumatic stress disorder (PTSD) diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) to Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) within diverse communities is unclear. Young adult sexual minority women are at high risk for interpersonal violence and other forms of trauma exposure compared with heterosexual populations and sexual minority men. They are also at heightened risk of PTSD. As a result, young adult sexual minority women are a key population of interest when examining the impact of diagnostic criteria changes. The goal of the current study was to evaluate the impact of changes to PTSD diagnostic criteria in sexual minority women. Using an online survey, we administered both the original PTSD Symptom Checklist-S (based on DSM-IV criteria) and a version adapted to assess DSM-5 criteria to a national, nonclinical sample of young adult sexual minority women (N = 767). The DSM-5 symptom criteria fit the data well in confirmatory factor analysis. Current PTSD prevalence was higher under the DSM-5 diagnostic algorithm compared with DSM-IV (18.6% vs. 22.9%; d = 0.15). Compared with DSM-IV, associations between PTSD and depression were stronger using DSM-5 criteria, whereas associations between PTSD and high-risk drinking were reduced. Findings suggest that changes to PTSD diagnostic criteria do not have a major impact on prevalence of PTSD among sexual minority women but may have some impact on observed comorbidities.

A Marijuana Consequences Checklist for Young Adults with Implications for Brief Motivational Intervention Research.

Measures assessing marijuana-related consequences or problems experienced by young adults have typically been adapted from measures assessing alcohol consequences. These measures may not fully reflect the specific unwanted or perceived "not so good" effects of marijuana that are experienced by young adults. Thus, using these measures may present a gap, which needs to be addressed, given that reports of consequences are often utilized in brief motivational personalized feedback interventions. Data from three different studies of young adults were used to (1) examine self-reported "not so good" effects or consequences of marijuana use among frequent marijuana-using college students (Study 1), (2) create a new version of a marijuana consequences list and compare it to an existing marijuana consequences measure (Study 2), and (3) assess convergent and divergent validity between a finalized Marijuana Consequences Checklist (MCC, 26-items) and marijuana use and risk for cannabis use disorder (Study 3). The most frequently endorsed self-reported effects of marijuana included the impact on eating (the "munchies"), dry mouth, trouble concentrating, and acting foolish or goofy. Higher scores on the MCC were associated with more frequent use and a higher probability of meeting criteria for cannabis use disorder. The MCC represents a range of negative consequences of marijuana use derived from frequent users' own accounts and includes consequences not assessed by other measures. The MCC captures marijuana-specific negative consequences relevant for young adults, which can be incorporated in brief motivational personalized feedback interventions.

Integrating addiction medicine into rural primary care: Strategies and initial outcomes.

OBJECTIVE: This retrospective study describes the role of behavioral health in an addiction medicine program integrated in a primary care clinic, and evaluates retention, substance use, and mental health symptoms for patients in a rural underserved community. METHOD: Data were abstracted from records of patients referred for buprenorphine treatment of opioid use disorder (N = 101; 45% female, 23% Native Hawaiian or Pacific Islander, Mage = 42.5, SD = 12.75). Among patients prescribed buprenorphine (n = 61), most had comorbid substance-related diagnoses (72% with tobacco use, 75% with at least one other substance use disorder) and non-substance-related mental health diagnoses (77%), most commonly depression and anxiety. Integrated sessions with a behavioral health provider and a buprenorphine-waivered prescriber occurred weekly to monthly. Participants completed depression and anxiety questionnaires (Patient Health Questionnaire-9 and Generalized Anxiety Disorder Scale-7) and provided urine samples at each visit. RESULTS: Most patients (72%) were retained for at least 3 months, with early dropout associated with higher initial depression and anxiety scores. Inconsistent urine drug tests (i.e., those positive for illicit/nonprescribed substances) were significantly more common at treatment initiation (74%) than during the most recent visit (43%, p < .001), and were associated with baseline substance and other mental health factors, as well as shorter treatment duration. Generalized estimating equations models suggested time-based improvements in depression and anxiety symptoms, especially for patients retained for at least 3 months. CONCLUSIONS: Integrating wraparound addiction treatment within a rural primary care setting is feasible and associated with improved mental health and retention outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Do As I Say, Not As I Do.

Little is known about the drinking behaviors and perceptions of the peers facilitating campus alcohol interventions. The current study examined these trajectories in peer counselors ( N = 12) providing personalized normative feedback interventions to undergraduates mandated to clinical services. Peer counselors completed four monthly self-assessments. In spite of facilitating interventions to reduce drinking and associated harms, peer drinking behaviors and expectancies did not change, although significant between subjects effects suggest various trajectories. Peer counselors did correct overestimates of binge drinking but progressively underestimated abstinence norms. Despite the lack of change in the peer counselor behaviors, the mandated clients significantly reduced their drinking, suggesting it may be more important to "Do as I Say" rather than as the facilitator does.

Current intimate relationship status, depression, and alcohol use among bisexual women: The mediating roles of bisexual-specific minority stressors.

Current intimate relationship characteristics, including gender and number of partner(s), may affect one's visibility as a bisexual individual and the minority stressors they experience, which may in turn influence their health. The current study tested four hypotheses: 1) minority stressors vary by current intimate relationship status; 2) higher minority stressors are associated with higher depressive symptoms and alcohol-related outcomes; 3) depressive symptoms and alcohol-related outcomes vary by current intimate relationship status; and 4) minority stressors will mediate differences in these outcomes. Participants included 470 self-identified bisexual women (65% Caucasian, mean age: 21) from a sample of sexual minority women recruited from different geographic regions in the United States through advertisements on social networking sites and Craigslist. Participants completed a 45 minute survey. Respondents with single partners were first grouped by partner gender (male partner: n=282; female partner: n=56). Second, women were grouped by partner gender/number (single female/male partner: n = 338; women with multiple female and male partners: n=132). Women with single male partners and women with multiple male and female partners exhibited elevated experienced bi-negativity and differences in outness (H1). Experienced and internalized bi-negativity were associated with health outcomes, but not outness (H2). Differences in outcomes emerged by partner number and partner number/gender (H3); these differences were mediated by experienced bi-negativity (H4). These results suggest that experiences of discrimination may underlie differences in health related to bisexual women's relationship structure and highlight the importance of evaluating women's relational context as well as sexual identification in understanding health risk behaviors.

The impact of defensiveness and incident reactions on post-sanction drinking behaviors among mandated students.

INTRODUCTION: Prior studies with mandated students (students referred for an intervention following violation of a campus alcohol policy) have suggested that decreases in drinking behaviors may occur before clinical intervention. Others studies have suggested that greater reductions were associated with lower defensiveness and stronger incident reactions, such as responsibility and aversiveness. The current study sought to integrate these findings and examine the influence of pre-sanction drinking and perceptions on mandated students' post-sanction drinking levels prior to attending a brief intervention. METHODS: Data were collected as part of a longitudinal study of brief interventions in a mandated student sample (N=61, 43% female, 97% White). Participants completed demographic measures, scales measuring incident reactions and defensiveness, and a Time Line Follow Back assessing drinking quantity and frequency both pre- and post-sanction. RESULTS: Analyses revealed significant post-sanction decreases in quantity (average total drinks per month) and frequency (number of monthly drinking days). Pre-sanction drinking quantity and frequency significantly predicted post-sanction quantity and frequency, respectively. Interaction effects suggest higher post-sanction quantities among moderate and heavier drinkers with higher defensiveness and lower aversiveness perceptions, while perceptions did not influence outcomes among light drinkers. None of the interactions involving blame or responsibility, or predicting post-sanction frequency, were significant. CONCLUSIONS: These findings suggest a complex relationship between pre-sanction drinking and student reactions. Implications for mandated student interactions and future research directions are discussed.

Use of drinking protective behavioral strategies and sexual perceptions and behaviors in U.S. college students.

Alcohol use among college students is linked to an increased likelihood of engaging in risky sexual behaviors, including casual sex and unprotected sex. These behaviors increase college students' risks for negative social and health-related consequences. This study examined the relationship between drinking behaviors and protective behavioral strategies (PBS), expectancies and perceptions of sexual risk, and actual alcohol-related sexual behaviors and consequences. Sexually active college students completed Web-based self-report measures of drinking behaviors and use of PBS, alcohol expectancies and perceptions of risk, and sexual behaviors and related consequences (n = 524; 57.1% women). Findings indicated that PBS were related to lower expectancies of sexual risk and sexual disinhibition, and among lighter drinkers, lower expectancies of sexual enhancement from alcohol. PBS were also related to decreased perceptions of sexual-related risks, some alcohol-related sexual behaviors, including number of drinks before/during sex, and number of sexual consequences, but were not related to abstaining during sex, frequency of alcohol-related sexual behaviors, or general condom use. These findings demonstrate a disconnect between perceived and actual risks among college students, such that decreased perceptions of risk may not be associated with protective behaviors. Prevention and intervention implications are discussed.

Alcohol interventions for mandated students: behavioral outcomes from a randomized controlled pilot study.

OBJECTIVE: This study investigated the effectiveness of three single-session interventions with high-risk mandated students while considering the influence of motivational interviewing (MI) microskills. METHOD: This randomized, controlled pilot trial evaluated single-session interventions: Alcohol Skills Training Program (ASTP), Brief Alcohol Screening and Intervention for College Students (BASICS) feedback sessions, and treatment-as-usual Alcohol Diversion Program (ADP) educational groups. Participants were 61 full-time undergraduates at a southern U.S. campus sanctioned to a clinical program following violation of an on-campus alcohol policy (Mage = 19.16 years; 42.6% female). RESULTS: RESULTS revealed a significant effect of time for reductions in estimated blood alcohol concentration (eBAC) and number of weekly drinks but not in alcohol-related consequences. Although ASTP and BASICS participants reported significant decreases in eBAC over time, ADP participant levels did not change (with no intervention effects on quantity or consequences). MI microskills were not related to outcomes. CONCLUSIONS: RESULTS from this study suggest equivalent behavioral impacts for the MI-based interventions, although individual differences in outcome trajectories suggest that research is needed to further customize mandated interventions. Given the overall decrease in eBAC following the sanction, the lack of reduction in the ADP condition warrants caution when using education-only interventions.

Response of colleges to risky drinking college students.

Heavy drinking and related consequences continue to affect college campuses due to fatalities, assaults, serious injuries, and arrests that occur among students. Several approaches aimed at reducing the harm incurred by students and the college communities as a result of heavy drinking are being used with varying success. A review of interventions including educational, individual, and environmental approaches are described, as well as new, promising, strategies. Despite some success, elevated and risky drinking patterns continue. As such, concerns over implementation of evidence-based treatments and areas in need of further study are discussed. [Full text available at http://rimed.org/rimedicaljournal-2014-10.asp, free with no login].

"Seems I'm not alone at being alone:" contributing factors and interventions for drinking games in the college setting.

Alcohol use among college students is prevalent and sometimes takes the form of drinking games, in which players are required to drink in accordance with a set of pre-defined rules. Drinking games are typically associated with elevated alcohol consumption and risk to the individual. This perspective piece considers the potential role of social anxiety in motivating participation in drinking games, perceived norms surrounding drinking games (including ways they are portrayed and discussed in popular media), and the role of competitiveness. Implications for skills training-based prevention and intervention efforts are discussed.

Rose-colored beer goggles: the relation between experiencing alcohol consequences and perceived likelihood and valence.

Although experiencing alcohol-related consequences has some influence on future drinking, this effect may be stronger based on the degree to which the consequence is viewed as positive versus negative, either by the individual or predefined by researchers. This study explored the relationship between experiencing positive and negative alcohol-related consequences and college students' perceptions of how likely those consequences were to occur in the future (i.e., likelihood), and their view of how positive or negative experiencing those consequences would be if they did experience them as a result of drinking (i.e., valence). Data were collected from 491 college students (mean age = 19.26; 56.4% female; 55.0% Caucasian; 33.2% Asian/Pacific Islander) through a computerized survey. Results indicated that experiencing more positive consequences in the past year was associated with viewing those consequences as both more likely to occur and more positive, while experiencing more negative consequences was associated with viewing them as less negative and no more likely to occur, except for those who had experienced the highest levels of negative consequences. These findings suggest that finding ways to reduce both perceptions as well as consequences themselves may be effective intervention tools.

Reducing the Harms of College Student Drinking: How Alan Marlatt Changed Approaches, Outcomes, and the Field.

In this article, we discuss Alan Marlatt's contributions to the prevention and reduction of alcohol-related harms among college students. We consider Alan's early research that later led to the development and evaluation of college student drinking programs, and examine Alan's impact, both directly and indirectly through those he mentored and trained, as a scientist-practitioner. We review the recognition of the efficacy of Alan's programs, including the Alcohol Skills Training Program (ASTP) and Brief Alcohol Screening and Intervention for College Students (BASICS), in addition to extensions of these interventions in more recent studies. Finally, we discuss how Alan's work influences interventions with college student drinkers today, and how future directions will continue to be informed by his vision and values.

Which came first: the readiness or the change? Longitudinal relationships between readiness to change and drinking among college drinkers.

AIMS: Although readiness to change (RTC) is cited as a key mechanism underlying drinking behavior change, empirical evidence supporting RTC as a predictor of college drinking has been mixed. Considering methodological limitations of previous studies, the current aim was to conduct a more comprehensive test of longitudinal relationships between readiness to change and college drinking. DESIGN: In this correlational, longitudinal study, we used a series of cross-lagged path analyses to test associations between RTC and college drinking outcomes over a 2-year period. SETTING: Data collection was conducted via online surveys on a university campus in the US Pacific Northwest. PARTICIPANTS: Participants (n = 818; 58% women) were college students who reported at least one heavy-drinking episode in the past month and participated in a randomized controlled trial of personalized normative feedback interventions. MEASUREMENTS: Drinking quantity-frequency items and the Rutgers Alcohol Problem Index assessed drinking outcomes. The Readiness to Change Questionnaire assessed RTC. FINDINGS: For drinking-related problems, the best-fitting model included cross-lagged paths between RTC and subsequent drinking-related problems. For drinking quantity-frequency, best-fitting models also included the cross-lagged paths between drinking quantity-frequency and subsequent RTC. Higher RTC almost uniformly predicted higher subsequent levels of drinking and greater experience of drinking-related problems, and drinking quantity-frequency variables were primarily positive predictors of subsequent RTC. CONCLUSIONS: Contrary to previous assumptions, 'the Readiness to Change Questionnaire' does not appear to be predictive of lower levels of subsequent drinking.

Use of drinking protective behavioral strategies in association to sex-related alcohol negative consequences: the mediating role of alcohol consumption.

Alcohol use has been implicated as a risk factor for sexual negative consequences, such as unprotected sexual intercourse. The present research was conducted to examine the relationship between drinking protective behavioral strategies and consensual sex-related alcohol negative consequences, and whether this relationship varied by gender. Additionally, typical number of drinks during sexual behavior was evaluated as a potential mediator of this association. Heavy drinking, sexually active college students (N = 297, 50.2% women) completed self-report measures of drinking protective behavioral strategies, alcohol consumption, and sex-related alcohol negative consequences. Findings indicated that women who used drinking protective behavioral strategies more frequently were less likely to experience sex-related alcohol negative consequences whereas this relationship was not significant for men. For women, this relationship was mediated by the typical number of drinks consumed during sexual behavior. The current research demonstrates that use of drinking protective behavioral strategies is related to a reduction in women's sex-related risks when drinking. Findings are discussed in terms of alcohol myopia theory. Implications for interventions aimed to reduce higher risk sexual behavior among college students are discussed.

The virtuous drinker: character virtues as correlates and moderators of college student drinking and consequences.

OBJECTIVE: The present study examined the relationship between alcohol use and positive psychology's character virtues1 in a college student sample. Each of the virtues of wisdom, courage, humanity, justice, temperance, and transcendence were examined as protective factors and moderators of drinking consequences. PARTICIPANTS: This sample included 425 undergraduate students at a large Northwest University (69% female; 52% Caucasian, 34% Asian). METHODS: Participants completed paper and pencil questionnaires during October and November 2006 in exchange for extra credit in psychology classes. RESULTS: Higher temperance scores were associated with abstinence, lower risk drinking, and fewer consequences among heavy drinkers; both increased justice and transcendence were independently associated with abstinence only; and wisdom, courage, and humanity were not associated with any outcomes. CONCLUSIONS: The associations between virtues and college student drinking support a collaboration between addictive behaviors and positive psychology to address college student drinking and minimize consequences.

Harm reduction therapy: a practice-friendly review of research.

Harm reduction is an umbrella term for interventions aiming to reduce the problematic effects of behaviors. Although harm reduction was originally and most frequently associated with substance use, it is increasingly being applied to a multitude of other behavioral disorders. This article reviews the state of empirical research on harm reduction practices including alcohol interventions for youth, college students, and a variety of other adult interventions. We also review nicotine replacement and opioid substitution, as well as needle exchanges and safe injection sites for intravenous drug users. Dozens of peer-reviewed controlled trial publications provide support for the effectiveness of harm reduction for a multitude of clients and disorders without indications of iatrogenic effects. Harm reduction interventions provide additional tools for clinicians working with clients who, for whatever reason, may not be ready, willing, or able to pursue full abstinence as a goal.

Examining the Role of Gender in the Relationship Between Use of Condom-Related Protective Behavioral Strategies when Drinking and Alcohol-Related Sexual Behavior.

The present research aimed to examine the relationships among gender, condom-related protective behavior strategies (PBS), and condom use during alcohol-related sexual behavior. Heavy drinking, sexually active U.S. undergraduate college students from a large northwest university (N=454; 61.7% female) completed a web-survey that included measures of drinking, sexual behavior, and condom-related PBS. MANOVA findings suggested that males were more likely to use condom-related PBS than females. Negative binomial regression results suggested that use of condom-related PBS by both genders was positively associated with condom use during alcohol-related sexual behavior, but especially for women. These results suggest that condom-related PBS may be useful to incorporate in interventions targeting alcohol-related sexual behavior among heavy drinking college students.