Childhood Adversity, Addiction Severity, and Comorbidity Among Patients Receiving Opioid Use Disorder Treatment: The Role of Emotion Regulation.

ABSTRACT: Patients in opioid use disorder (OUD) treatment report high rates of childhood adversity, and women experience greater exposure to certain types of childhood adversity ( e.g. , sexual abuse). Childhood adversity is associated with clinical severity, but the mechanisms explaining this association are not well understood. Participants ( N = 171) in opioid agonist treatment completed measures of childhood adversity, emotion regulation, and clinical severity ( i.e. , addictive behaviors, depression, and anxiety). Women endorsed greater childhood adversity and higher current psychopathology than men. The association between childhood adversity and clinical severity varied as a function of symptom type, although emotion regulation was a strong predictor in all models. Women reported higher levels of anxiety after controlling for covariates, childhood adversity, and emotion dysregulation. Future research should investigate treatment strategies to address emotion dysregulation among patients in OUD treatment, particularly women who may present with greater childhood adversity exposure and anxiety.

Substance Use, Gambling, Binge-Eating, and Hypersexuality Symptoms Among Patients Receiving Opioid Agonist Therapies.

BACKGROUND AND OBJECTIVES: Patients receiving opioid agonist therapies have high rates of psychiatric comorbidity. Some data suggest that comorbidity is associated with poorer treatment outcomes. The current study assessed predictors of multiple putative addictive behaviors among patients receiving opioid agonist therapies. METHODS: Adults (N = 176) recruited from an outpatient clinic providing opioid agonist therapy completed self-report measures of depression, anxiety, impulsivity, adverse childhood events, and the Recognizing Addictive Disorders (RAD) scale, which includes seven subscales assessing symptoms related to alcohol use, drug use, tobacco use, gambling, binge-eating, hypersexual behavior, and excessive video-gaming. Linear regression and hurdle models identified significant predictors of RAD subscales. Hurdle models included logistic regression estimation for the presence/absence of symptoms and negative binomial regression for estimation of the severity of symptoms. RESULTS: Most patients did not report significant symptoms beyond drug or tobacco use. However, 7% to 47% of participants reported some symptoms of other addictive behaviors (subscale score > 0). Higher impulsivity predicted the presence and/or increased severity of symptoms of drug use, gambling, binge-eating, and hypersexuality. Higher depression significantly predicted increased severity of drug use and binge-eating symptoms. Increased anxiety predicted lower severity of alcohol use and binge-eating and higher severity of smoking symptoms. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: A broader range of potentially addictive symptoms may be present among patients engaged in treatment for opioid use disorder. Few studies have assessed symptoms of binge-eating, hypersexuality, and excessive video-gaming among patients receiving opioid agonist therapy. This study contributes to preliminary findings and highlights important future directions. (Am J Addict 2021;00:00-00).

Psychological Functioning and Health Behaviors Associated with Weight Loss Patterns up to 13.7 Years After Weight Loss Surgery.

Weight loss surgery produces dramatic health improvements immediately after surgery, including rapid declines in diabetes. However, less is known about its long-term effects. 124 St. Vincent Bariatric Center patients completed questionnaires on weight and psychological functioning a mean of 7.7 and 13.7 years post-surgery (T1 and T2, respectively). Because mean weight data may mask differing weight trajectories, participants were categorized based on weight over time. Most participants underwent Roux-En-Y gastric bypass (90.3%) and were Caucasian (96%), female (81.5%), and married (69.1%). Mean age at T2 was 64; mean %EWL was 64.9%. Most patients fit into one of three weight change patterns, reaching weight nadir, and regaining by T1 and then, by T2, experiencing (1) Weight Loss (n = 36), (2) Weight Maintenance (n = 37), or (3) Continued Weight Gain (n = 39). Groups differed significantly on body satisfaction, weighing frequency, and conscientiousness, with Weight Gainers significantly lower than other groups on conscientiousness and body satisfaction, and Weight Losers reporting higher frequency of weighing than Maintainers. Bariatric patients can maintain substantial weight loss and positive psychological functioning for many years post-surgery, although weight regain is associated with less body satisfaction. Conscientiousness may signify medical adherence, whereas frequent weighing may be a behavior that promotes ongoing weight loss.

Development and Validation of the Recognizing Addictive Disorders Scale: A Transdiagnostic Measure of Substance-Related and Other Addictive Disorders.

OBJECTIVE: Substance use disorders and behavioral addictions commonly co-occur. However, few available self-report measures reliably and validly assess the full range of addictive conditions. The development and initial validation of a new measure-Recognizing Addictive Disorders (RADs) scale addresses a significant gap in the literature. Method: After items were generated and evaluated in Study 1, Study 2 (N = 300), applied exploratory factor analysis to the item pool using an online-based community sample. In Study 3 (N = 427), the factor structure was validated using an independent online-based community sample and confirmatory factor analysis. Results: The scale demonstrated good internal consistency (a = .92) and construct validity, including replication of the factor structure (χ2 (553) = 760.83, p < .001, CFI = .997, TLI = .997, RMSEA = .030) and correlation with a related transdiagnostic measure of addiction (r = .72). Discussion: Overall, results support the preliminary validity of a brief transdiagnostic measure of addiction that considers a diverse range of behaviors. For patients presenting to substance abuse treatment, this tool may be useful in identifying symptoms of other types of non-substance problems, which could ultimately aid in treatment planning.

Combined Use of Alcohol and the Internet: Associated Features.

Background: With the potentiality of excessive Internet usage being associated with adverse consequences, the current study assessed adverse outcomes of combined Internet and alcohol misuse. Objective: We hypothesized that participants who simultaneously engage in both alcohol and Internet use would experience adverse outcomes from their actions, compared to those who just misuse the Internet in the absence of alcohol. Methods: The current study deployed an anonymous online survey comprised of scales measuring several domains such as impulsivity, neglect of responsibilities, depression, frequency and quantity of alcohol consumption, as well as Internet usage. From a large (N = 550) sample of college student surveys, we compared the 39 Internet drinkers with a randomly selected sampled of 39 non-drinking counterparts. Results: Relative to their non-drinking counterparts, Internet Drinkers were elevated on measures of alcohol misuse and some features of Internet addiction, but not depression. Conclusion: Of the final sample, 64.7% of those who drank alcohol while using the Internet indicated doing something they later regretted while online. Further exploration is warranted to more fully understand how non-substance compulsive behaviors can be misused and how they interact with substance misuse and co-occurring mental health issues.

A qualitative analysis of men's experiences of binge eating.

Binge eating disorder (BED) is characterized by recurrent overeating episodes, accompanied by loss of control (LOC), in the absence of compensatory behaviors. The literature supports that men overeat as often or more often than do women, but they are less likely to endorse LOC and other BED symptoms. Thus, rates of BED are lower among men. However, differences in prevalence rates may reflect gender bias in current conceptualizations of eating disorders and BED diagnostic criteria, not necessarily truly lower rates of disordered eating among men. The purpose of this study was to gather detailed information about how men experience overeating and related body image concerns, to identify common themes. The grounded theory approach was utilized to examine narratives from 11 overweight/obese male college students about their experiences with overeating, with results suggesting that overeating is consistent with male gender role, but LOC is not. Other overeating themes included mindless eating, emotional antecedents, negative consequences, unintentional dietary restriction, and social encouragement to overeat. Participants also reported dissatisfaction with their bodies, a desire for their bodies to be both muscular and thin, concerns related to their physical functioning and health, and a distinction between body image and self-worth. Collectively, these themes suggest further study to more fully explore the features and consequences of how disordered eating and body image concerns may manifest among men.

Exploratory Factor Analysis of Diagnostic and Statistical Manual, 5th Edition, Criteria for Posttraumatic Stress Disorder.

One change to the posttraumatic stress disorder (PTSD) nomenclature highlighted in the Diagnostic and Statistical Manual, 5th Edition (DSM-5; American Psychiatric Association, 2013) is the conceptualization of PTSD as a diagnostic category with four distinct symptom clusters. This article presents exploratory factor analysis to test the structural validity of the DSM-5 conceptualization of PTSD via an online survey that included the PTSD Checklist-5. The study utilized a sample of 113 college students from a large Midwestern university and 177 Amazon Mechanical Turk users. Participants were primarily female, Caucasian, single, and heterosexual with an average age of 32 years. Approximately 30% to 35% of participants met diagnostic criteria for PTSD based on two different scoring criteria. Results of the exploratory factor analysis revealed five distinct symptom clusters. The implications for the classification of PTSD are discussed.

Substance misuse following Roux-en-Y gastric bypass surgery.

Post-bariatric surgery patients are overrepresented in substance abuse treatment, particularly those who have had the Roux-en-Y gastric bypass (RYGB) procedure. The severity of the substance use disorder (SUD; i.e., warranting inpatient treatment) and related consequences necessitate a better understanding of the variables associated with post-RYGB SUDs. This investigation assessed factors associated with post-RYGB substance misuse. Post-RYGB patients (N = 141; at least 24 months postsurgery) completed an online survey assessing variables hypothesized to contribute to post-RYGB SUDs. Fourteen percent of participants met criteria for postoperative substance misuse. Those with a lower percent total weight loss (%TWL) were more likely to endorse substance misuse. Family history of substance misuse was strongly associated with postoperative substance misuse. Eating-related variables including presurgical food addiction and postsurgical nocturnal eating, subjective hunger, and environmental responsiveness to food cues were also associated with a probable postoperative SUD. These findings have clinical utility in that family history of substance misuse can be easily assessed, and at-risk patients can be advised accordingly. In addition, those who endorse post-RYGB substance misuse appear to have stronger cognitive and behavioral responses to food, providing some support for the theory of behavioral substitution (or "addiction transfer").

Assessing the prevalence of and factors associated with overweight, obesity, and binge eating as a function of ethnicity.

OBJECTIVE: This study aimed to examine the prevalence of and factors associated with overweight, obesity, and binge eating as a function of ethnicity among a national sample of college students. METHODS: Data were drawn from the 2010 Healthy Minds Study sample. Participants were 24,396 college students from 26 colleges and universities. This sample included 62 % females and a broad range of ethnic backgrounds; 30 % were overweight, 10 % were obese, and 7 % met criteria the for binge eating. RESULTS: While African Americans reported the highest prevalence of overweight (49 %) and obesity (24 %), Arab-Americans reported the highest prevalence of binge eating (10 %). The factors associated with weight problems and binge eating differed by ethnicity. CONCLUSIONS: Research is warranted to develop more culturally sensitive interventions to target those ethnic minorities at elevated risk. Further study of binge eating among Arab-Americans is particularly important, as the prevalence of this condition was higher among this group over any other.

Long-term Engagement in Physical Activity Among Bariatric Surgery Patients: Associations with Treatment Outcomes at 5-Year Follow-up.

PURPOSE: Physical activity studies involving bariatric surgery patients tend to be short-term or cross-sectional investigations. Longer-term studies are limited and typically consist of relatively brief objective measurement periods used to generalize activity patterns. Very little research combines objective measurements with structured interviews to determine both the patterns and related factors of long-term physical activity among patients undergoing bariatric surgery. MATERIALS AND METHODS: Previous volunteers in a perioperative physical activity study were invited to participate in a mixed methods study investigating physical activity among bariatric patients over a 5-year postoperative period. Fifty-one patients (Mage = 45.4 years; 76.5% female, 90.2% White; 86.3% Roux-en-Y procedure) provided interview, survey, accelerometer, and anthropometric data. RESULTS: Participants were divided into four exercise quartiles, based on self-report of their length of regular exercise involvement from 1 year before through 5 years after surgery. Those reporting the most periods of regular exercise took the most measured steps per day, had greater moderate-to-vigorous physical activity and more bout-related activity, experienced the largest decrease in BMI, and reported the most adherence to nutritional guidelines. Participants reporting the most and least physical activity found the measurement periods to be most similar to their normal activity patterns. While physical activity increased significantly after surgery, measured physical activity did not reach recommended levels for steps or exercise bout minutes. CONCLUSIONS: Measured physical activity and self-reported physical activity show congruent trends among patients undergoing bariatric surgery. More research is needed to determine optimal long-term monitoring and promotion of physical activity among patients.