Comparative feasibility and preliminary efficacy of CBT for insomnia among adults seeking and not seeking addiction treatment.

Two out of three adults seeking treatment for alcohol or other substance use disorders report co-occurring symptoms of insomnia. This study compared the feasibility, acceptability, and preliminary efficacy of cognitive behavioural therapy for insomnia (CBT-I) among adults seeking and not seeking treatment for substance use. Adults with alcohol or other substance use disorders (n = 22, 32% female, 82% White; Mage = 39.5) completed assessments at baseline, post-treatment, and at 6 week follow-up. Of those, 11 were and 11 were not enrolled in substance use treatment. All received CBT-I. Multiple imputation was used for missing data. Data were analysed using repeated measures analyses of variance. In the substance use treatment group, 6/11 completed post and 5/11 completed follow-up. In the non-treatment group, 9/11 completed post and 7/11 completed follow-up. Participants in both groups reported improvements in insomnia severity, sleep onset latency, and dysfunctional beliefs about sleep, with most effects evident at post and follow-up. There was a marginal group-by-time interaction in the change in frequency of substance use, with only participants not in substance use treatment reporting decreases at follow-up. Participants in substance use treatment reported significant reductions in substance-related problems and symptoms of post-traumatic stress disorder over time; however, they also reported more symptoms at baseline. CBT-I produces similar reductions in insomnia but is relatively less feasible among individuals in (versus not in) treatment for substance use disorder. This may be due to the more complex logistics of accessing CBT-I among those in treatment. We speculate that integrating CBT-I into treatment for addictions may improve feasibility in this population. clinicaltrials.gov NCT04198311.

Effect of Cognitive Behavioral Therapy for Insomnia on Alcohol Treatment Outcomes Among US Veterans: A Randomized Clinical Trial.

Importance: Three of 4 adults in treatment for alcohol use disorder (AUD) report symptoms of insomnia. Yet the first-line treatment for insomnia (cognitive behavioral therapy for insomnia, CBT-I) is often delayed until abstinence is established. Objective: To test the feasibility, acceptability, and preliminary efficacy of CBT-I among veterans early in their AUD treatment and to examine improvement in insomnia as a mechanism for improvement in alcohol use outcomes. Design, Setting, and Participants: For this randomized clinical trial, participants were recruited through the Addictions Treatment Program at a Veterans Health Administration hospital between 2019 and 2022. Patients in treatment for AUD were eligible if they met criteria for insomnia disorder and reported alcohol use in the past 2 months at baseline. Follow-up visits occurred posttreatment and at 6 weeks. Interventions: Participants were randomly assigned to receive 5 weekly sessions of CBT-I or a single session about sleep hygiene (control). Participants were asked to complete sleep diaries for 7 days at each assessment. Main Outcomes and Measures: Primary outcomes included posttreatment insomnia severity (assessed using the Insomnia Severity Index) and follow-up frequency of any drinking and heavy drinking (4 drinks for women, ≥5 drinks for men; number of days via Timeline Followback) and alcohol-related problems (Short Inventory of Problems). Posttreatment insomnia severity was tested as a mediator of CBT-I effects on alcohol use outcomes at the 6-week follow-up. Results: The study cohort included 67 veterans with a mean (SD) age of 46.3 years (11.8); 61 (91%) were male and 6 (9%) female. The CBT-I group included 32 participants, and the sleep hygiene control group 35 participants. Of those randomized, 59 (88%) provided posttreatment or follow-up data (31 CBT-I, 28 sleep hygiene). Relative to sleep hygiene, CBT-I participants reported greater decreases in insomnia severity at posttreatment (group × time interaction: -3.70; 95% CI, -6.79 to -0.61) and follow-up (-3.34; 95% CI, -6.46 to -0.23) and greater improvements in sleep efficiency (posttreatment, 8.31; 95% CI, 1.35 to 15.26; follow-up, 18.03; 95% CI, 10.46 to 25.60). They also reported greater decreases in alcohol problems at follow-up (group × time interaction: -0.84; 95% CI, -1.66 to -0.02), and this effect was mediated by posttreatment change in insomnia severity. No group differences emerged for abstinence or heavy-drinking frequency. Conclusions and Relevance: In this randomized clinical trial, CBT-I outperformed sleep hygiene in reducing insomnia symptoms and alcohol-related problems over time but had no effect on frequency of heavy drinking. CBT-I should be considered a first-line treatment for insomnia, regardless of abstinence. Trial Registration: ClinicalTrials.gov Identifier: NCT03806491.

Implementing an EMA burst design in community-engaged research: participant and researcher perspectives and recommendations.

Background: Implementing ecological momentary assessment (EMA) methodology to evaluate the substance use disorder (SUD) treatment pipeline has clear advantages, including learning about participants' day-to-day experiences to aid in the improvement of services and accessibility for those seeking treatment. Given that the SUD treatment pipeline spans long periods of time, EMA burst designs (deployment of multiple short EMA periods spread over time) can be advantageous for evaluating the treatment pipeline over time while keeping participant burden low.Objectives: This feasibility study describes (1) the process and study design of implementing EMA burst methodology to evaluate the SUD treatment pipeline experience; (2) study implementation from the perspective of researchers, including discussion of collaboration with community partners; and (3) participant feedback on the experience of engaging with this type of research.Method: EMA metrics, feasibility ratings, and general experience ratings in the study are presented from 22 participants (64% women) who participated in a parent EMA study evaluating the SUD treatment pipeline and 8 who provided feedback in a follow-up survey.Results: Participants found the EMA burst design to be acceptable and not burdensome, although technology issues were present for some participants. Steps to partnering with community treatment programs and implementation of a burst design are outlined.Conclusions: Strategies and recommendations for implementation of an EMA burst study with community partners are provided, including aspects of study design, technology issues, retention, and funding.

Agreement between momentary and retrospective reports of cannabis use and alcohol use: Comparison of ecological momentary assessment and timeline followback indices.

OBJECTIVE: This study compares three methods of cannabis and of alcohol use assessment in a sample of regular cannabis users: (a) ecological momentary assessment (EMA) repeated momentary surveys aggregated to the daily level, (b) EMA morning reports (MR) where participants reported on their total use from the previous day, and (c) retrospective timeline followback (TLFB) interviews covering the same period of time as the EMA portion of the study. We assessed the overall correspondence between these methods in terms of cannabis and alcohol use occasions and also investigated predictors of agreement between methods. METHOD: Forty-nine individuals aged 18-50 (Mage = 24.49, 49% female, 84% White) who reported regular cannabis use completed a 14-day EMA study. At the end of the EMA period, participants returned to the laboratory to complete a TLFB (administered via computer) corresponding to the same dates of the EMA period. RESULTS: Daily aggregated EMA and TLFB reports showed a low to modest agreement for both alcohol and cannabis use. Overall, agreement between EMA and MR was better than agreement between EMA and TLFB, likely because less retrospection is required when only reporting on behavior from the previous day. Quantity and frequency of use differentially predicted agreement across reporting methods when assessing alcohol compared to cannabis. When reporting cannabis use, but not alcohol use, individuals who used more demonstrated higher agreement between EMA and TLFB. CONCLUSIONS: Results suggest that retrospective reporting methods assessing alcohol and cannabis should not be considered a direct "substitute" for momentary or daily assessments. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Prevalence and correlates of alcohol-induced blackout in a diverse sample of veterans.

BACKGROUND: Alcohol-induced blackouts have been associated concurrently and prospectively with alcohol-related harm. Although rates of heavy drinking among military samples tend to be comparable or higher than rates among civilian samples, the prevalence and correlates of blackout in the military population are understudied. METHODS: Veterans (N = 241, 29% female, 39% Black) reported on their alcohol consumption and mental health as part of a larger health-related study among veterans. In this secondary analysis, we tested theoretically and empirically informed predictors (gender, drinking quantity, and other drug use) and consequences [depression, posttraumatic stress disorder (PTSD)] of alcohol-induced blackout. Given the diversity of the sample, potential roles of racial/ethnic discrimination and drinking to cope in alcohol-induced blackout were also tested. RESULTS: Past-year prevalence of alcohol-induced blackout was 53% among veterans who drank alcohol and 68% among those who screened positive for hazardous drinking. Everyday experience of racial discrimination was the strongest concurrent predictor of alcohol-induced blackout. Drinking quantity and use of other drugs were significant correlates only in bivariate models. Controlling for gender, race, drinking quantity, other drug use, and discrimination, blackout frequency was significantly associated with symptoms of depression, but not symptoms of PTSD. Both blackout and racial discrimination were associated with drinking to cope. CONCLUSIONS: The prevalence and correlates of alcohol-induced blackout among veterans are largely consistent with those documented in civilian and young adult populations. Among racially diverse groups, racial discrimination may be more strongly associated with mental health symptoms than alcohol consumption or acute alcohol consequences such as blackout.

Gender, acculturation, and alcohol-related consequences among college students of color.

OBJECTIVE: The present study examined if identification with mainstream American culture (acculturation) and heritage culture (enculturation) are differentially associated with blackouts and other drinking consequences among male and female college students of color. PARTICIPANTS: Participants were college students (N = 150) who self-identified as a racial/ethnic minority and endorsed blackouts in the past year. METHODS: Regression models were used to examine gender-by-acculturation/enculturation interaction effects on alcohol-induced blackout and other alcohol-related consequences. RESULTS: While acculturation was not significantly associated with either drinking outcome, enculturation showed a significant relationship with blackout frequency. Gender moderated this relationship; greater enculturation was associated with increased blackout frequency among male but not female students. CONCLUSIONS: The present findings suggest the importance of considering the interplay between enculturation and gender in understanding alcohol use among college students of color. Men who endorse high levels of enculturation may be at an increased risk of experiencing negative drinking-related consequences.

Momentary subjective responses to alcohol as predictors of continuing to drink during daily-life drinking episodes.

PURPOSE: Subjective response to alcohol's stimulating and sedating effects is a person-level risk factor for heavy drinking and alcohol use disorder. Longitudinal and laboratory studies have demonstrated that at-risk individuals experience greater stimulation and lower sedation while drinking. While between-person subjective responses inform risk and etiology, in-the-moment assessments during daily-life drinking may elucidate the within-person processes by which stimulation and sedation may lead to heavier drinking. We aimed to characterize these momentary processes by testing momentary stimulation and sedation during drinking as predictors of subsequently continuing to drink during densely sampled, daily-life drinking episodes. PROCEDURES: 113 adults (54 with borderline personality disorder and 59 community participants; 77.9% female) completed ecological momentary assessment for 21 days, reporting momentary subjective stimulation and sedation throughout drinking episodes and momentary alcohol use after drink initiation (i.e., continued drinking). FINDINGS: GLMMs demonstrated that greater day-level stimulation (OR=1.48, 95% CI=[1.20, 1.82], p<.001), greater person-level stimulation (OR=1.63, 95% CI=[1.05, 2.53], p=.031), and lower momentary sedation (OR=0.54, 95% CI=[0.41, 0.71], p<.001) predicted continued drinking. CONCLUSIONS: Although greater stimulation and lower sedation have been conceptualized as individual-level risk factors for heavy drinking, our findings suggest that these associations are accompanied by processes that operate within person. Our results suggest that greater stimulation may confer risk for heavy drinking at the level of the drinking episode, possibly acting as positive reinforcement that may contribute to heavier drinking during future episodes. In contrast, lower sedation may primarily confer in-the-moment risk by contributing to momentary decisions to keep drinking within an episode.

Sex differences in associations between alcohol use and sleep in mid-to-late life.

OBJECTIVES: To examine associations between alcohol use and sleep in middled-aged/older adults and to test sex as a moderator of this relationship. METHODS: Participants were 183 adults (46% female) ages 50 and above who consumed alcohol in the past year. Linear regressions tested sex as a moderator of associations between alcohol use and sleep parameters. Alcohol use was measured using the Alcohol Use Disorders Identification Test (AUDIT). Overall sleep health and sleep quality were assessed using the Pittsburgh Sleep Quality Index (PSQI), and pre-sleep arousal was assessed using the Pre-Sleep Arousal Scale. RESULTS: Overall, 11% of participants screened positive for hazardous drinking (AUDIT scores of 7+/8+ for women/men), and 59% reported poor overall sleep health (scores >5 on the PSQI). Alcohol use was not associated with overall sleep health (B = -0.25, p = .08) or pre-sleep arousal (B = 0.15, p = .64). However, contrary to hypotheses, more hazardous drinking was associated with better subjective sleep quality, only among women (B = -0.08, p = .009). Alcohol use was not associated with sleep quality among men (B = 0.01, p = .58). Associations remained significant when controlling for age, symptoms of anxiety and depression, body mass index, use of sleep medication, number of medical conditions, and chronic pain. CONCLUSIONS: Among middle-aged and older adults, alcohol use is more strongly associated with sleep patterns among women than men, when assessed concurrently (i.e., at the same time point). Findings support the need for further consideration of sex differences in associations between alcohol use and sleep.

Motives for and Barriers to Research Participation Among Racially and Ethnically Diverse Veterans.

INTRODUCTION: Veterans in general-and especially those who identify as Veterans of color-are underrepresented in health-related treatment research. This contributes to health inequity by hindering the development of evidence-based treatment recommendations for people of color. This project utilized culturally centered research procedures to identify health-related research priorities and examine motives for and barriers to research participation in a diverse sample of Veterans. MATERIALS AND METHODS: Veterans (N = 330, 32% female; 36% Black, 28% White, 15% Latinx, 12% Asian, 4% Multiracial) reported their experiences with and perspectives on health-related research online from remote locations. Linear regression was used to test associations between discrimination and motives/barriers for research. All procedures were approved by the Institutional Review Board (#2033562). RESULTS: Participants identified psychological concerns, particularly PTSD, as research priorities for Veterans in their communities, but also prioritized physical problems (e.g., brain injury) and social concerns (e.g., homelessness, access to care). Perceptions of, motives for, and barriers to research were similar across racial/ethnic groups. The most common motive was contributing to research that seems important, and the most common barrier was not knowing about research opportunities. Every-day experiences with discrimination (e.g., people acting as if they are afraid of you because of your race/ethnicity) were associated with more barriers to research among Black participants. CONCLUSIONS: Experiences of racial/ethnic discrimination are associated with different research-related outcomes across racial/ethnic groups. Efforts to engage diverse populations should prioritize access to (not willingness to participate in) health-related research.

Using ecological momentary assessment and a portable device to quantify standard tetrahydrocannabinol units for cannabis flower smoking.

AIMS: To evaluate the feasibility and validity of a new method of quantifying cannabis flower use, integrating the amount of cannabis flower smoked, and the potency of the cannabis flower. DESIGN: Ecological momentary assessment (EMA) for 14 days. SETTING: Participants' daily lives in Columbia, Missouri, USA. PARTICIPANTS: A total of 50 community participants, who were regular cannabis flower smokers (48% female). MEASUREMENTS: Momentary subjective intoxication ratings following cannabis flower smoking; momentary quantity of cannabis flower smoked; potency of cannabis flower smoked in terms of percentage of tetrahydrocannabinol (THC) concentration assessed with a portable device, the Purpl Pro; and time since finished smoking. FINDINGS: Participants completed our field testing of their cannabis flower (96.2%) and were compliant with our 2-week EMA protocol (73% for random prompts and 91% for morning reports). Momentary subjective intoxication ratings trended down as a function of time since smoking (r = -0.10, P = 0.004, 95% CI, [-0.17, -0.03]). Multi-level model (MLM) results indicated the momentary standard THC units (mg THC) were positively associated with momentary subjective intoxication ratings (b = 0.01, P = 0.03, 95% CI, [0.01, 0.012]). CONCLUSIONS: There is evidence to support the feasibility and initial validity of a new method of quantifying cannabis flower use into standard tetrahydrocannabinol units. Researchers investigating the effects of cannabis flower use on a range of outcomes (e.g. neurobehavioral effects, emotional sequelae, and driving impairment) as well as in clinical treatment trials might adopt this method to provide estimates of cannabis flower use.

Daily associations between modifiable sleep behaviors and nighttime sleep among young adult drinkers with insomnia.

STUDY OBJECTIVES: Empirical evidence linking individual sleep hygiene practices to subsequent sleep parameters is limited, particularly at the daily level. This study compared the strength of daily, within-person associations between these modifiable sleep behaviors and nighttime sleep in young adult drinkers with insomnia. METHODS: Young adults (ages 18-30 years; n = 56) who met diagnostic criteria for insomnia and reported past-month binge drinking wore wrist actigraphy and completed online sleep diaries for 8.5 days (standard deviation = 2.3; 477 reports). Diaries assessed engagement in 11 sleep hygiene recommendations. Multilevel models tested daily associations between sleep behaviors and 3 outcomes: sleep quality, self-reported sleep efficiency, and actigraphy-measured sleep efficiency. RESULTS: Participants self-reported better sleep quality/efficiency on days that they slept in a comfortable environment, limited naps to 30 minutes, and maintained a consistent wake time. They self-reported worse sleep quality and efficiency on nights that they avoided alcohol use before bedtime. No sleep behaviors were significantly associated with actigraphy-measured sleep efficiency after correcting for inflation in type I error. CONCLUSIONS: The sleep hygiene recommendations most strongly associated with sleep at the daily level were consistent with stimulus control. Creating a comfortable sleep environment also emerged as an important correlate of daily sleep. Heavy drinkers with insomnia may perceive better sleep if they drink before bedtime; however, this finding may be unique to this population. CITATION: Miller MB, Curtis AF, Hall NA, et al. Daily associations between modifiable sleep behaviors and nighttime sleep among young adult drinkers with insomnia. J Clin Sleep Med. 2022;18(3):703-712.

Co-use of medication and alcohol: The influence on subjective effects of intoxication and affect.

Co-use of alcohol and medication can have serious negative health effects (e.g., overdose risk, liver damage). Research has primarily focused on older adults or the pharmacokinetics of specific medication-alcohol combinations. Little work has focused on the subjective experience of persons who take alcohol-interactive (AI) medications and also drink alcohol, particularly in psychiatric samples at high risk for problematic alcohol use and high rates of prescription medication use, such as individuals with borderline personality disorder (BPD). Data from a larger ecological momentary assessment study of alcohol use in 52 persons diagnosed with BPD (83% women; Mage = 26 years) were used to examine the influence of alcohol intoxication (i.e., estimated blood alcohol concentration [eBAC]) and medication co-use on momentary subjective experience while drinking. Participants reported AI medication use at baseline and completed multiple ecological momentary assessment reports per day over 21 days, which included reports of alcohol use, subjective effects of alcohol (e.g., pleasure, feeling worse), and negative and positive affect. AI medications significantly moderated the association between eBAC and pleasurable effects of alcohol, such that at higher levels of eBAC, those taking AI medications experienced blunted subjective pleasure compared with those not taking AI medications. AI medications did not moderate the associations between eBAC and subjective relief, feeling worse, positive affect, or negative affect. Attenuated pleasure during drinking could lead to increased drinking in an attempt to achieve a desirable state among individuals who co-use psychiatric medications and alcohol, and therefore may represent a useful target for prevention and intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cannabis use as a moderator of cognitive behavioral therapy for insomnia.

STUDY OBJECTIVES: Cannabis use is common among young adults and has been proposed as a potential treatment for insomnia. However, controlled studies examining the impact of cannabis use on insomnia symptoms are rare. This secondary analysis of published trial data tested cannabis use during cognitive behavioral treatment for insomnia (CBT-I) as a moderator of treatment efficacy. METHODS: Young adults (ages 18-30 years) who reported past-month binge drinking (4/5+ drinks for women/men) and met diagnostic criteria for insomnia disorder were randomized to CBT-I (n = 28) or sleep hygiene (n = 28) groups. Interaction effects were tested using multilevel models. Outcomes included insomnia severity, actigraphy-assessed sleep efficiency, diary-assessed sleep quality, drinking quantity, and alcohol-related consequences. RESULTS: Twenty-six participants (46%; 12 in the sleep hygiene group and 14 in the CBT-I group) reported using cannabis during the treatment phase of the study, on an average of 23% of treatment days (range, 3%-100%). Relative to those who did not use cannabis, participants who used cannabis during treatment reported heavier drinking and more frequent cigarette use. Approximately 1 in 4 cannabis users (27%) reported using cannabis to help with sleep; however, cannabis users and nonusers did not differ in the use of alcohol as a sleep aid. Controlling for sex, race, drinking quantity, cigarette use, symptoms of depression, and symptoms of anxiety, use of cannabis during treatment did not moderate CBT-I effects on insomnia severity (b, -.002; p = .99) or other outcomes (all p > .20). CONCLUSIONS: CBT-I is effective in reducing insomnia symptoms among young adult drinkers with insomnia, regardless of cannabis use. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: The Insomnia Treatment and Problems (iTAP) Study; URL: https://clinicaltrials.gov/ct2/show/NCT03627832; Identifier: NCT03627832. CITATION: Miller MB, Carpenter RW, Freeman LK, Curtis AF, Yurasek AM, McCrae CS. Cannabis use as a moderator of cognitive behavioral therapy for insomnia. J Clin Sleep Med. 2022;18(4):1047-1054.

A daily-life study of interpersonal stressors and alcohol use in individuals with borderline personality disorder and community controls.

BACKGROUND: Interpersonal stressors (ISs) are major factors in relapse in alcohol use disorder (AUD) and are theorized to play a role in drinking behaviors. Past work has examined this association using ecological momentary assessment (EMA), but the unique effects of rejections and disagreements on alcohol use are unknown. Research suggests the two ISs functionally differ and may display distinct associations with drinking. Further, these associations may differ in people with borderline personality disorder (BPD), a population reporting frequent IS and co-occurring AUD. METHODS: 113 drinkers (community: n = 59; BPD: n = 54) reported alcohol use and ISs using EMA for 21 days. Using generalized estimating equations, we expected that rejection and disagreement would predict increased likelihood of drinking each day. We examined both cumulative (throughout each day) and immediate momentary effects of ISs predicting subsequent drinking on that same day. Further, we predicted that these associations would be stronger in individuals with BPD. RESULTS: Greater rejections throughout the day were associated with a reduced likelihood of drinking that day (OR = 0.56, 95 % CI:[0.32, 0.97], p < .040). In contrast, disagreements immediately prior to drinking were associated with an increased likelihood of drinking that day (OR = 0.60, 95 % CI:[1.02, 2.50], p = .039). However, the effect of disagreement on drinking was moderated by BPD diagnosis (OR = 2.56, 95 % CI:[1.13, 5.80], p = .025), such that the effect was only present for individuals with BPD. CONCLUSIONS: Assessing ISs as an aggregate predictor may mask potentially opposite effects on alcohol use. Additionally, disagreements may be a risk factor for subsequent alcohol use in BPD.

A test of the interpersonal function of non-suicidal self-injury in daily life.

Theoretical models of non-suicidal self-injury (NSSI) posit that individuals use NSSI to influence others, but this remains largely untested. We used ambulatory assessment to test the interpersonal function of NSSI in the daily lives of 51 women with DSM-5 NSSI disorder. Participants reported NSSI events, urges, motives, and positive/negative interpersonal events (IPEs) for 14 days, providing five semi-random daily assessments and event-related NSSI reports. We analyzed 3,498 data-points, including 155 NSSI events, using multilevel models. We observed a positive concurrent association between the number of negative IPEs and NSSI engagement. Additionally, perceived distress of negative IPEs was positively associated with concurrent NSSI events and urges, and predicted later events. We saw no reduction in negative or increase in positive IPEs following NSSI. In a trait-level interview, participants endorsed interpersonal motives only minimally, but indicated that others often trigger NSSI. In daily life, participants rarely endorsed the motive 'get help/attention'. The results suggest that negative IPEs trigger NSSI, but that individuals in this sample rarely used NSSI for interpersonal motives and did not experience interpersonal reinforcement of NSSI. We discuss limitations of and possible solutions for under-reporting of interpersonal motives and benefits of studying interpersonal triggers (rather than outcomes) in future studies.

Predictors of unplanned drinking in daily life: The influence of context, impulsivity, and craving in those with emotion dysregulation.

OBJECTIVE: Unplanned drinking, or drinking that violates intentions, has been linked to significant alcohol-related consequences; however, little is known about what factors within individuals' daily lives predict whether unplanned drinking occurs. This study examines the influence of daily-life impulsivity, alcohol craving, and interpersonal contexts on unplanned drinking. METHOD: Ecological Momentary Assessment (EMA) data were collected from 32 moderate drinkers. Participants were prompted six times per day for up to 21 days. Each morning participants reported whether they planned to drink that day. Multilevel and GEE models predicted drinking behaviors on days without intent to drink from daily-life interpersonal contexts, and pre-drinking ratings of impulsivity and craving. RESULTS: Spending time in a bar and spending relatively more time with other people on days with no intention to drink was associated with drinking. Individuals who experienced higher craving prior to drinking were relatively more likely to engage in unplanned drinking. When participants reported relatively greater difficulties with premeditation, they were more likely to subsequently report initiating an unplanned drinking episode. Results also suggest that individuals generally higher on negative urgency may be less likely to engage in unplanned drinking but drink more when they do. CONCLUSION: These results indicate the influence of daily-life contexts, craving, and impulsivity on unplanned drinking behavior. We highlight several possible avenues for intervention and prevention efforts including modifying social and interpersonal environments, screening for craving patterns, and targeting cognitive deficits in planning.

Sleep and alcohol use among young adult drinkers with Insomnia: A daily process model.

BACKGROUND: Previous studies examining associations between sleep and alcohol use have done so primarily at the aggregate (between-person) level and primarily among healthy young adults. This study aimed to examine reciprocal, within-person associations between sleep and alcohol use among young adult drinkers with insomnia. METHODS: Young adults who engaged in past-month binge drinking and met diagnostic criteria for insomnia (N = 56) wore wrist actigraphy and completed online daily diaries assessing sleep and drinking for an average of 8.52 days (SD = 2.31), resulting in 477 reports. Multilevel models were used to examine within- and between-person effects of sleep quality and efficiency on alcohol use and vice versa. Bedtime and waketime were included as secondary sleep parameters. RESULTS: Participants reported drinking on 231 days (48%). Participants did not report significantly different sleep quality on heavier-drinking days, nor did they demonstrate significant changes in actigraphy-measured sleep efficiency. However, they self-reported better sleep efficiency on heavier-drinking days (driven primarily by improvements in sleep onset latency), and they reported heavier drinking following days of better sleep efficiency (driven by improvements in total sleep time). Drinking was also associated with later bedtimes and waketimes. CONCLUSIONS: Young adult drinkers with insomnia report reciprocal associations between subjective sleep efficiency and alcohol use, but these results were not replicated using objective measures. Providers may need to challenge the belief that there is a positive association between alcohol use and sleep among young adults who drink and have insomnia.

Cognitive behavioral therapy for insomnia among young adults who are actively drinking: a randomized pilot trial.

STUDY OBJECTIVES: More than half of young adults at risk for alcohol-related harm report symptoms of insomnia. Insomnia symptoms, in turn, have been associated with alcohol-related problems. Yet one of the first-line treatments for insomnia (Cognitive Behavioral Therapy for Insomnia or CBT-I) has not been tested among individuals who are actively drinking. This study tested (1) the feasibility and short-term efficacy of CBT-I among binge-drinking young adults with insomnia and (2) improvement in insomnia as a predictor of improvement in alcohol use outcomes. METHODS: Young adults (ages 18-30 years, 75% female, 73% college students) who met criteria for Insomnia Disorder and reported 1+ binge drinking episode (4/5+ drinks for women/men) in the past month were randomly assigned to 5 weekly sessions of CBT-I (n = 28) or single-session sleep hygiene (SH, n = 28). All participants wore wrist actigraphy and completed daily sleep surveys for 7+ days at baseline, posttreatment, and 1-month follow-up. RESULTS: Of those randomized, 43 (77%) completed posttreatment (19 CBT-I, 24 SH) and 48 (86%) completed 1-month follow-up (23 CBT-I, 25 SH). CBT-I participants reported greater posttreatment decreases in insomnia severity than those in SH (56% vs. 32% reduction in symptoms). CBT-I did not have a direct effect on alcohol use outcomes; however, mediation models indicated that CBT-I influenced change in alcohol-related consequences indirectly through its influence on posttreatment insomnia severity. CONCLUSIONS: CBT-I is a viable intervention among individuals who are actively drinking. Research examining improvement in insomnia as a mechanism for improvement in alcohol-related consequences is warranted. TRIAL REGISTRATION: U.S. National Library of Medicine, https://clinicaltrials.gov/ct2/show/NCT03627832, registration #NCT03627832.

The environmental, interpersonal, and affective context of nonsuicidal self-injury urges in daily life.

Urges for nonsuicidal self-injury (NSSI) are important precursors to NSSI acts and may serve as a point of intervention. A close understanding of the phenomenology of NSSI urges and the contexts in which they occur is therefore warranted. We used ambulatory assessment to examine the environmental, interpersonal, and affective contexts of NSSI urges. We recruited 56 participants with borderline personality disorder who reported on urges and contexts for 21 days with six random daily prompts, resulting in 5,750 completed assessments. Twenty-two participants reported 160 NSSI urges. We provide extensive descriptive results characterizing the interaction partners, activities, and events participants reported in association with NSSI urges. Results from a logistic multilevel model using the full sample (testing associations between all contexts and urges simultaneously) revealed that urges were more likely to occur at higher levels of negative affect, when rejection was experienced, and later in the day. Urges were not associated with disagreements or feeling let down, being at home versus away, being alone versus in company, socializing versus doing another activity, and it being a weekday versus weekend. Additional growth curve analysis for negative affect using the subsample of 22 participants who reported urges showed that, over the course of urge days compared with nonurge days, negative affect increased before urges, peaked during the urge, and then decreased, approximating a quadratic curve. We conclude that urges occurred primarily in the context of negative affect and rejection, which is consistent with theories on intra- and interpersonal functions of NSSI. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Diagnostic Accuracy of the CASI-4R Psychosis Subscale for Children Evaluated in Pediatric Outpatient Clinics.

Diagnostic accuracy of the Diagnostic and Statistical Manual of Mental Disorders-oriented Child and Adolescent Symptom Inventory (CASI-4R) Psychotic Symptoms scale was tested using receiver operating characteristic analyses to identify clinically significant psychotic symptoms. Participants were new outpatients (N = 700), ages 6.0 to 12.9 years (M = 9.7, SD = 1.8) at 9 child outpatient mental health clinics, who participated in the Longitudinal Assessment of Manic Symptoms (LAMS) Study baseline assessment. Because LAMS undersampled participants with low mania scores by design, present analyses weighted low scorers to produce unbiased estimates. Psychotic symptoms, operationally defined as a score of 3 or more for hallucinations or 4 or more for delusions based on the Schedule for Affective Disorders and Schizophrenia (K-SADS) psychosis items, occurred in 7% of youth. K-SADS diagnoses for those identified with psychotic symptoms above threshold included major depressive disorder, bipolar spectrum disorder, attention deficit/hyperactivity disorder, posttraumatic stress disorder, psychotic disorders, and autism spectrum disorder. The optimal psychosis screening cut score (maximizing sensitivity and specificity) was 2.75+ (corresponding diagnostic likelihood ratio [DiLR] = 4.29) for the parent version and 3.50+ (DiLR = 5.67) for the teacher version. The Area under the Curve for parent and teacher report was .83 and .74 (both p < .001). Parent report performed significantly better than teacher report for identifying psychotic symptoms above threshold (p = .03). The CASI-4R Psychosis subscale (J) appears clinically useful for identifying psychotic symptoms in children because of its brevity and accuracy.