Internalized Stigma Measurement in Substance Use Treatment Settings: A Narrative Review.

Stigma relating to substance use disorders is one of the many barriers to enrolling in substance use treatment. Stigma is also related to poorer substance use treatment outcomes, yet few studies of substance use and substance use treatment outcomes include measures of stigma. Stigma is a multi-level experience occurring as a result of discrimination within a systematic power structure promoting inequities among marginalized populations. Several domains of stigma are manifested among individuals seeking treatment for a substance use disorder, with internalized stigma being the most commonly measured. The current paper is a narrative review of measures that have been developed to measure internalized stigma related to substance use in treatment settings. Measures of stigma (n=8) in substance use treatment settings were identified using PubMed and PsycINFO databases. The review identified various strengths of existing measures, including a broad range of measures with mostly excellent internal consistency. The review also identified limitations including the general lack of consideration for multiple domains and intersecting forms of stigma, samples with limited racial and ethnic diversity, and the lack of assessments of polysubstance use. The development of measures of stigma that assess multiple domains of stigma and that are tested in a wide range of substance use treatment settings with racially and ethnically diverse participants is needed. This is of particular importance because stigma remains a crucial barrier to successful initiation and completion of substance use treatment.

Measuring Readiness to Change Substance Use, Alcohol Use, and Cannabis Use: An Experimental Manipulation of Cognitive Effort.

Background: The Transtheoretical Model supports that readiness to change should predict actual substance-related behavior change. This relationship is surprisingly modest. Across several behavioral domains, individuals tend to have unrealistic expectations regarding the amount of effort and time required to successfully change one's behaviors, dubbed the False Hope Syndrome. Objectives: Based on False Hope Syndrome, we expect the standard method of measuring self-reported readiness to change is overestimated. To test this hypothesis, we experimentally manipulated level of cognitive effort prior to completing readiness to change measures. College students from a large southwestern university who reported using substances in the past 30 days (n = 345) were recruited from a psychology department participant pool and randomized to one of three conditions: 1) standard, low effort condition, 2) medium effort condition (selected likes/dislikes of substance use and negative consequences of changing one's use), and 3) high effort condition (also provided written responses to how they would handle difficult situations related to changing their substance use). We conducted one-way ANOVAs with Tukey post-hoc comparisons to examine differences on three measures of readiness to change: the University of Rhode Island Change Assessment (URICA) scale as well as readiness and motivation rulers. Results: Contrary to our hypothesis, all significant statistical tests supported higher cognitive effort conditions reporting higher readiness to change. Although effect sizes were modest, higher cognitive effort appeared to increase self-reported readiness to change substance use. Conclusions: Additional work is needed to test how self-reported readiness to change relates to actual behavior change when assessed under the different effort conditions.

Utility of the Brief Young Adult Alcohol Consequences Questionnaire to Identify College Students At-Risk for Alcohol Related Problems: Relative Operating Characteristics across Seven Countries.

Background: It is important to identify students who would benefit from early interventions to reduce harmful drinking patterns and associated consequences. the Brief Young Adult Alcohol Consequences Questionnaire (B-YAACQ) could be particularly useful as a screening tool in university settings. Objectives. The present study examined the utility of the B-YAACQ to distinguish among students at-risk for problematic alcohol use as measured by the AUDIT. Objectives: The present study examined the utility of the B-YAACQ to distinguish among students at-risk for problematic alcohol use as measured by the AUDIT. Methods: A sample of 6382 students (mean age=20.28, SD=3.75, 72.2% females) from seven countries (i.e., U.S., Canada, South-Africa, Spain, Argentina, Uruguay, England) completed the B-YAACQ, the AUDIT and different measures of alcohol use. Results: ROC analyses suggested that a cutoff score of 5 maximized the YAACQ's discrimination utility to differentiate between students at low versus moderate/high risk in the total sample and across countries (except in Canada, where the cutoff was 4). In addition, a cutoff of 7 differentiated between students at low/moderate versus high risk in the total sample, while cutoffs of 10, 9, 8 and 7 differentiate between students at low/moderate versus high risk in Uruguay, U.S and Spain (10), Argentina (9), England (8), and Canada and South-Africa (7), respectively. Students classified at the three risk levels (i.e., low, moderate and high) differed in age (i.e., a younger age was associated with higher risk) and drinking patters (i.e., higher drinking frequency, quantity, binge drinking and AUDIT and B-YAACQ scores in the higher risk groups). Conclusions: This study suggest that the B-YAACQ is a useful tool to identify college students at-risk for experiencing problematic patterns of alcohol use.

Measurement invariance of the University of Rhode Island Change Assessment Scale in Project MATCH: An exploratory structural equation modeling approach.

BACKGROUND: Progression through the stages of change is a proposed mechanism underlying the effects of treatment for alcohol use disorder (AUD). However, examining stages of change as a mechanism of treatment effects requires that the measure be invariant across patient subgroups, treatment conditions, and time. In this study, we examined measurement invariance of the University of Rhode Island Change Assessment Scale (URICA) in Project MATCH using an exploratory structural equation modeling (ESEM) approach. METHODS: We conducted a secondary analysis of data from Project MATCH (N = 1726; Mage  = 40.2, SD = 10.9; 75.7% male; 80% non-Hispanic white), a multisite randomized clinical trial that tested three AUD treatments: Motivational Enhancement Therapy, Cognitive-Behavioral Therapy, or Twelve-Step Facilitation. Participants completed the 24-item URICA for assessing the stages of change in relation to drinking at baseline and post-treatment (3 months after baseline). RESULTS: A 4-factor ESEM provided a good fit to the data and a better fit to the data than a conventional 4-factor confirmatory factor analysis model. Further, the URICA demonstrated scalar invariance across each patient subgroup at baseline (sex, ethnicity, marital status, education, and parental history of AUD) and treatment condition at follow-up. However, the URICA was not longitudinally invariant as the metric model resulted in a significant decrement in model fit. CONCLUSIONS: Measurement invariance of the URICA over time was not supported. Longitudinally invariant measures of the stages of change are needed to test the proposal that progression through the stages explains treatment effects.

A ß-NMR study of the depth, temperature, and molecular-weight dependence of secondary dynamics in polystyrene: Entropy-enthalpy compensation and dynamic gradients near the free surface.

We investigated the depth, temperature, and molecular-weight (MW) dependence of the γ-relaxation in polystyrene glasses using implanted 8Li+ and ß-detected nuclear magnetic resonance. Measurements were performed on thin films with MW ranging from 1.1 to 641 kg/mol. The temperature dependence of the average 8Li spin-lattice relaxation time (T1 avg) was measured near the free surface and in the bulk. Spin-lattice relaxation is caused by phenyl ring flips, which involve transitions between local minima over free-energy barriers with enthalpic and entropic contributions. We used transition state theory to model the temperature dependence of the γ-relaxation, and hence T1 avg. There is no clear correlation of the average entropy of activation (Δ‡S̄) and enthalpy of activation (Δ‡H̄) with MW, but there is a clear correlation between Δ‡S̄ and Δ‡H̄, i.e., entropy-enthalpy compensation. This results in the average Gibbs energy of activation, Δ‡G, being approximately independent of MW. Measurements of the temperature dependence of T1 avg as a function of depth below the free surface indicate the inherent entropic barrier, i.e., the entropy of activation corresponding to Δ‡H̄ = 0, has an exponential dependence on the distance from the free surface before reaching the bulk value. This results in Δ‡G near the free surface being lower than the bulk. Combining these observations results in a model where the average fluctuation rate of the γ-relaxation has a "double-exponential" depth dependence. This model can explain the depth dependence of 1/T1 avg in polystyrene films. The characteristic length of enhanced dynamics is ∼6 nm and approximately independent of MW near room temperature.

Examining Cross-Country and Sex Differences on a Comprehensive Assessment of Protective Behavioral Strategies for Alcohol.

OBJECTIVE: Use of protective behavioral strategies (PBS) has been associated with reduced alcohol-related harms among college students. However, most of this research has been conducted among U.S. samples. The present study examines the use of PBS in an international context. METHOD: Participants (n = 1512) were recruited from universities in Spain (n = 298), Argentina (n = 439), and the U.S. (n = 775) to determine if there are differences in PBS use across countries and/or across sex. Further, we examined whether the association between PBS use and negative consequences differ across country and sex. RESULTS: We found that U.S. students reported the most frequent use of Stopping/Limiting Drinking PBS (M = 3.32, SD = 1.23) compared to Argentine (M = 2.89, SD = 0.97) and Spanish (M = 2.83, SD = 0.94) students. Argentine students reported the least frequent use of Serious Harm Reduction PBS (M = 4.57, SD = 0.99) compared to U.S. (M = 5.09, SD = 0.98) and Spanish (M = 5.03, SD = 0.78) students. Elastic net regression analyses stratified by country indicated most individual PBS predicted decreased negative alcohol-related consequences, although two items consistently predicted increased consequences and we observed some variability in the most predictive specific strategies in each country. Across each subscale and for 32 of 40 individual items, females reported more frequent use of PBS than males (ps<.05). CONCLUSIONS: From the perspective of developing and adapting interventions, we recommend the cultural context in which PBS are used is taken into account. Although future work is needed to delineate cultural factors underlying the country-level differences we found, these findings have implications for the most promising PBS to target for college students in each country.

Magnesium(II)-ATP Complexes in 1-Ethyl-3-Methylimidazolium Acetate Solutions Characterized by 31 Mg ß-Radiation-Detected NMR Spectroscopy.

The complexation of MgII with adenosine 5'-triphosphate (ATP) is omnipresent in biochemical energy conversion, but is difficult to interrogate directly. Here we use the spin- 1/2 ß-emitter 31 Mg to study MgII -ATP complexation in 1-ethyl-3-methylimidazolium acetate (EMIM-Ac) solutions using ß-radiation-detected nuclear magnetic resonance (ß-NMR). We demonstrate that (nuclear) spin-polarized 31 Mg, following ion-implantation from an accelerator beamline into EMIM-Ac, binds to ATP within its radioactive lifetime before depolarizing. The evolution of the spectra with solute concentration indicates that the implanted 31 Mg initially bind to the solvent acetate anions, whereafter they undergo dynamic exchange and form either a mono- (31 Mg-ATP) or di-nuclear (31 MgMg-ATP) complex. The chemical shift of 31 Mg-ATP is observed up-field of 31 MgMg-ATP, in accord with quantum chemical calculations. These observations constitute a crucial advance towards using ß-NMR to probe chemistry and biochemistry in solution.

Understanding alcohol harm reduction behaviors from the perspective of self-determination theory: A research agenda.

The evidence for the efficacy of harm reduction approaches to harmful alcohol use has accumulated over the past 30 years. Self-determination theory (SDT; Ryan and Deci 2017) offers a useful framework for understanding why people engage in alcohol harm reduction behaviors, as well as for delineating active ingredients of harm reduction interventions and individual characteristics that influence response to intervention. In the current paper, we sought to advance a research agenda for applying SDT to alcohol harm reduction behaviors. Specifically, we provide specific examples of the utility of SDT in advancing research on alcohol harm reduction behaviors and provide recommendations for future studies to address issues related to measurement, generalizability, temporal directionality, and causal relationships in examining the constructs of SDT and alcohol harm reduction behaviors. We also suggest that future research apply SDT to advance the understanding of how, why, and for whom harm reduction interventions are most effective. Finally, we provide recommendations for how SDT could potentially be applied to develop novel alcohol interventions.

The Addictions Neuroclinical Assessment Negative Emotionality Domain Among Treatment-Seekers with Alcohol Use Disorder: Construct Validity and Measurement Invariance.

BACKGROUND: The Addictions Neuroclinical Assessment (ANA), a framework for measuring heterogeneity in alcohol use disorder (AUD), focuses on 3 domains that reflect neurobiological dysfunction in addiction and correspond to the cycles of addiction: executive function, incentive salience, and negative emotionality. Kwako and colleagues (Am J Psychiatry 176:744, 2019) validated a 3-factor model of the ANA with neuropsychological and self-report indicators among treatment-seekers and non-treatment-seekers with and without AUD. The present analysis replicated and extended these findings in a treatment-seeking sample, focusing on the negative emotionality domain. METHODS: Participants (n = 563; 58.8% male; mean age = 34.3) were part of a multisite prospective study of individuals entering AUD treatment. We examined the factor structure of the negative emotionality domain at the baseline, 6-month follow-up, and 12-month follow-up assessments. The Beck Depression Inventory, Beck Anxiety Inventory, State-Trait Anger Expression Inventory-Trait Anger Subscale, and 3 Drinker Inventory of Consequences items assessing negative affective consequences were indicators in the model. RESULTS: Results indicated that a 1-factor model was an excellent fit at all assessments and that the negative emotionality domain was time and gender invariant. Furthermore, negative emotionality was associated with drinking patterns and reasons for alcohol use (i.e., drinking because of negative emotions and urges/withdrawal) at all assessments. CONCLUSIONS: This analysis provides evidence for the construct validity and measurement invariance of the ANA negative emotionality domain among AUD treatment-seekers. Future studies are needed to evaluate prospective associations between negative emotionality and specific treatment modalities, and whether individuals with greater negative emotionality are more likely to respond to treatment that targets drinking to relieve negative affective states.

Can Alcohol Use Disorder Recovery Include Some Heavy Drinking? A Replication and Extension up to 9 Years Following Treatment.

BACKGROUND: Recent research indicates some individuals who engage in heavy drinking following treatment for alcohol use disorder fare as well as those who abstain with respect to psychosocial functioning, employment, life satisfaction, and mental health. The current study evaluated whether these findings replicated in an independent sample and examined associations between recovery profiles and functioning up to 6 years later. METHODS: Data were from the 3-year and 7- to 9-year follow-ups of subsamples initially recruited for the COMBINE study (3-year follow-up: n = 694; 30.1% female, 21.0% non-White; 7- to 9-year follow-up: n = 127; 38.9% female, 27.8% non-White). Recovery at 3 years was defined by latent profile analyses including measures of health functioning, quality of life, employment, alcohol consumption, and cannabis and other drug use. Functioning at the 7- to 9-year follow-up was assessed using single items of self-rated general health, hospitalizations, and alcohol consumption. RESULTS: We identified 4 profiles at the 3-year follow-up: (i) low-functioning frequent heavy drinkers (13.9%), (ii) low-functioning infrequent heavy drinkers (15.8%), (iii) high-functioning heavy drinkers (19.4%), and (iv) high-functioning infrequent drinkers (50.9%). At the 7- to 9-year follow-up, the 2 high-functioning profiles had the best self-rated health, and the high-functioning heavy drinking profile had significantly fewer hospitalizations than the low-functioning frequent heavy drinking profile. CONCLUSIONS: Previous findings showing heterogeneity in recovery outcomes were replicated. Most treatment recipients functioned well for years after treatment, and a subset who achieved stable recovery engaged in heavy drinking and reported good health outcomes up to 9 years after treatment. Results question the long-standing emphasis on drinking practices as a primary outcome, as well as abstinence as a recovery criterion in epidemiologic and treatment outcome research and among stakeholder groups and funding/regulatory agencies. Findings support an expanded recovery research agenda that considers drinking patterns, health, life satisfaction, and functioning.

The Relationship between Negative Affect and Alcohol and Marijuana Use Outcomes among Dual Users.

Background: Past research with college students has found that substance use motives, particularly coping motives, mediate the relationship between negative affect and alcohol- and marijuana-related outcomes. Objectives: This study aimed to investigate substance use motives of dual users of both substances (past 30-day use; not necessarily simultaneous use) and identify any mediation effects that are either common to both substances or substance-specific. Methods: The majority of dual users (n = 2,034) identified as being White, non-Hispanic (63.8%), female (69.08%), and reported a mean age of 20.24 (SD = 3.16) years. To test study aims, path models were conducted such that negative affect (stress, depressive and anxiety symptoms) were independently modeled as predictors of substance use outcomes (i.e. quantity and consequences) via substance use motives. Results: All three negative affect symptoms were indirectly related to both alcohol and marijuana consequences via coping motives, such that higher negative affect was associated with higher coping motives; which in turn were positively associated with consequences. Substance-specific effects were also found: (a) stress was indirectly related to both alcohol and marijuana use quantity via enhancement motives, (b) depressive/anxiety symptoms were indirectly related to alcohol use quantity via enhancement motives, and (c) all three negative affect symptoms were indirectly related to both marijuana use quantity and negative consequences via expansion motives. Conclusions: Findings suggests that dual users of alcohol and marijuana with negative affect symptoms engage in substance use for similar reasons as single substance users with negative affect symptoms. Intervention efforts should examine ways to replace substance-related coping and expansion methods with non-substance-related methods.

Post-traumatic stress and marijuana outcomes: The mediating role of marijuana protective behavioral strategies.

Background: The present study investigated the mediating role of protective behavioral strategies for marijuana (PBSM) on the relationship between posttraumatic stress disorder (PTSD) and marijuana outcomes (i.e. marijuana use frequency, marijuana use quantity, cannabis use disorder (CUD) symptoms, and marijuana-related problems). Methods: Participants were 1,107 traditional age college students (Mage = 20.26, SD = 3.32; 66.5% White, non-Hispanic; 68.8% female), who reported consuming marijuana at least once in the last 30 days and completed measures of PTSD symptoms, PBSM, and marijuana-related outcomes. Results: PBSM significantly mediated the positive relationships between PTSD symptoms and both CUD symptoms and marijuana-related problems. More specifically, PTSD symptoms were negatively associated with PBSM, which in turn was negatively associated with marijuana use frequency and marijuana use quantity, which were in turn positively associated with CUD symptoms and marijuana-related problems. Conclusion: Taken together, the associations between higher PTSD symptoms and greater experience of CUD symptoms and marijuana-related problems may occur because students use fewer PBSM and thus engage in larger quantity and frequency of marijuana use. These findings lend support to the utility of targeting PBSM as a harm reduction effort for students with PTSD symptoms who use marijuana.

The Relationship Between Social Anxiety and Alcohol and Marijuana Use Outcomes Among Concurrent Users: A Motivational Model of Substance Use.

BACKGROUND: College students with more social anxiety symptoms are particularly vulnerable to problematic alcohol and marijuana use given their susceptibility for elevated anxiety symptoms in social settings combined with the normative nature of substance use. Existing research has established substance use as coping motivated for these students when examining alcohol and marijuana use problems separately. The next step is to determine whether students with more social anxiety who use both substances do so for similar or different reasons. The current study tested a comprehensive (i.e., all variables in the same model) motivational model of alcohol/marijuana use in a sample of college students from 10 universities across the United States who endorsed both past-month alcohol and marijuana use. METHODS: College students were recruited through psychology department participant pools and completed an online survey assessing mental health symptoms, substance use motives, and substances use behaviors. Current sample comprised concurrent alcohol/marijuana users (n = 2,034), 29.6% of whom endorsed clinically indicated levels of social anxiety and nearly one-fourth exceeded the cutoff for hazardous drinking (23.2%) and hazardous marijuana use (21.9%). RESULTS: Across both substances, coping motives significantly mediated the positive relationship between social anxiety symptoms and substance use problems. Unique to alcohol, conformity motives mediated the association between social anxiety symptoms and alcohol-related problems. CONCLUSIONS: Taken together, students with more social anxiety who are focused on anxiety management may use either alcohol or marijuana; however, these students may experience more alcohol-related problems when drinking to fit in with peers.

Use of Alcohol Protective Behavioral Strategies as a Moderator of the Alcohol Use-Consequences Relationship: Evidence from Multiple Replications.

BACKGROUND: The use of protective behavioral strategies (PBS) has been found to attenuate the relationship between alcohol use and related consequences. OBJECTIVES: The current study examined PBS use as a moderator of the association between alcohol use and consequences in multiple samples (N = 9) of college students with different sample sizes (e.g., ns 125-736). We also examined sex as a moderator of the PBS moderation analyses. Across all samples, we predicted that the use of more PBS would attenuate the use-consequences relation. METHODS: In total, 3,524 college students completed online measures of alcohol use, consequences, and PBS use (i.e., PBSS) across two sites. Conclusions/importance: In the analyses, 3 two-way interactions were consistent with the literature (i.e., use-consequences relation weakest among those with high PBS use), 6 were opposite of what was reported in the literature (i.e., use-consequences relation strongest among those with high PBS use), and 39 were not statistically significant. These results corroborate, contradict, and extend the current body of knowledge in the extant alcohol PBS literature. In the examination of three-way interactions in the combined sample, serious harm reduction (SHR) PBS was found to moderate the use-consequences relation among female, but not among male students. Specifically, the use-consequences relation was weakest among female students who used more SHR PBS indicating that SHR PBS may be an important intervention target for female college students. Additional experimental and longitudinal studies are needed to examine the effects of PBS use on the use-consequences relation.

Direct measurements of the temperature, depth and processing dependence of phenyl ring dynamics in polystyrene thin films by ß-detected NMR.

There is indirect evidence that the dynamics of a polymer near a free surface are enhanced compared with the bulk but there are few studies of how dynamics varies with depth. ß-Detected nuclear spin relaxation of implanted 8Li+ has been used to directly probe the temperature and depth dependence of the γ-relaxation mode, which is due to phenyl rings undergoing restricted rotation, in thin films of atactic deuterated polystyrene (PS-d8) and determine how the depth dependence of dynamics is affected by sample processing, such as annealing, floating on water and the inclusion of a surfactant, and by the presence of a buried interface. The activation energy for the γ-relaxation process is lower near the free surface. Annealing the PS-d8 films and then immersing in water to mimic the floating procedure used to transfer films had negligible effects on the thickness of the region near the free surface with enhanced mobility. Measurements on a bilayer film indicate enhanced phenyl ring dynamics near the buried interface compared with a single film at the same depth. PS-d8 films annealed with the surfactant sodium dodecyl sulfate (SDS) deposited on the surface show enhanced dynamics in the bulk compared with a pure PS-d8 film and a PS-d8 film where the SDS was washed away. There is less contrast between the surface and bulk in the SDS-treated sample, which could account for the elimination of the Tg confinement effect observed in films containing SDS [Chen and Torkelson, Polymer, 2016, 87, 226].

A quantification of the alcohol use-consequences association in college student and clinical populations: A large, multi-sample study.

BACKGROUND: The present study sought to quantify the relationship between alcohol use and alcohol-related consequences in both college student and clinical samples. METHODS: We gathered 33 college student datasets comprising of 15,618 participants and nine clinical sample datasets comprising of 4,527 participants to determine the effect size of the relationship between alcohol use and alcohol-related consequences. We used random-effects meta-analytic techniques, separately in college and clinical samples, to account for a distribution of true effects and to assess for heterogeneity in effect sizes. RESULTS: Results demonstrated that the clear majority of the variability in alcohol-related consequences is not explained by alcohol use (ie, >77% in college samples; >86% in clinical samples), and that there was significant heterogeneity in all effect sizes. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Experiencing alcohol-related consequences results from factors that extend beyond frequency and quantity of alcohol consumed suggesting a need to examine other predictors of alcohol-related consequences beyond alcohol use. (Am J Addict 2018;27:116-123).

Weighing the Pros and Cons of Using Alcohol Protective Behavioral Strategies: A Qualitative Examination among College Students.

BACKGROUND: Alcohol protective behavioral strategies (PBS) are behaviors engaged in immediately prior to, during, after, or instead of drinking with the explicit goal of reducing alcohol use, intoxication, and/or alcohol-related harms. Despite the quantitative support for alcohol PBS as a protective factor among college student drinkers, we know of no qualitative research aimed at determining college student drinkers' perceptions regarding the advantages and disadvantages of using PBS. OBJECTIVES: In the style of a decisional balance exercise, we asked college student drinkers (analytic n = 113) to identify 5 reasons they would not use PBS (cons) and 5 reasons they would use PBS (pros). METHOD: Participants (majority female, 77.0%) were recruited from a psychology department participant pool at a large, southeastern university in the United States. Within our analytic sample, participants on average consumed 6.38 (SD = 8.16) drinks per typical week of drinking and reported consuming alcohol on average 7.5 days (SD = 5.83) in the last 30 days. RESULTS: Using a descriptive phenomenological approach, we identified 2 themes for pros (prevention of specific negative alcohol-related consequences and general safety) and 4 themes for cons (goal conflict, ineffectiveness, difficulty of implementation, and negative peer/social repercussions). Overall, participants reported more pros than cons and this discrepancy (i.e., number of PBS pros minus number of PBS cons) was positively related to self-reported frequency of PBS use. Conclusions/Importance: Taken together, we hope that clinicians/researchers will probe individual's reasons for choosing to use (or not use) PBS in order to tailor or improve existing PBS-based interventions.

A Burning Problem: Cannabis Lessons Learned from Colorado.

With recent increases in cannabis' popularity, including being legalized in several states, new issues have emerged related to use. Increases in the number of users, new products, and home growing all present distinct concerns. In the present review, we explored various cannabis-related concerns (i.e. use, acquiring, growing, and public health/policy) that have arisen in Colorado in order to provide information on emerging issues and future directions to mitigate negative outcomes that could occur in states considering, or that already have implemented, a legalized cannabis market. Specific to Colorado, issues have arisen related to edibles, vaporizers/'e-cannabis', concentrates, growing, quantifying use, intoxicated driving, and arrests. Understanding cannabis dosing (including dose-dependent effects and related consequences), standardizing quantities, evaluating the safety of new products, and developing harm reduction interventions are important next steps for informing public policy and promoting health and well-being. Overall, increasing our knowledge of emerging issues related to cannabis is key to promoting the benefits and combating the potential harms of cannabis, especially for states legalizing medical or recreational cannabis.

Temporal Stability of Heavy Drinking Days and Drinking Reductions Among Heavy Drinkers in the COMBINE Study.

BACKGROUND: Recently, the Food and Drug Administration (FDA) proposed to expand the options for primary end points in the development of medications for alcohol use disorder to include either abstinence from alcohol or a nonabstinent outcome: no heavy drinking days (with a heavy drinking day defined as more than 3 drinks per day for women and more than 4 drinks per day for men [>3/>4 cutoff]). The FDA also suggested that 6 months would be the most appropriate length for a clinical trial to demonstrate the stability of this nonabstinent drinking outcome. However, few alcohol clinical trials have examined the stability of nonheavy drinking during and after treatment. METHODS: In a secondary analysis of the COMBINE study data (n = 1,383), we examined transitions in heavy drinking days during the course of treatment (months 1 through 4), during the transition out of treatment (months 4 through 7), and up to 12 months afterward (months 13 through 16) using latent variable mixture models. RESULTS: Heavy drinking and nonheavy drinking were relatively stable in consecutive months (minimum agreement [kappa] = 0.64 for months 1 to 2). Most individuals were stable low-risk drinkers/abstainers or heavy drinkers by the end of treatment, as characterized by a 10% probability (or less) of transitioning out of either a no heavy drinking state or a heavy drinking state. More than two-thirds of the heavy drinkers who exceeded the heavy drinking threshold during treatment reported, on average, a 64% reduction in drinking frequency and a 38% reduction in drinking intensity from pretreatment drinking levels. CONCLUSIONS: The results show stability of no heavy drinking as an outcome within the first 4 months of treatment and that the >3/>4 drink cutoff may mask substantial reductions in alcohol consumption among some patients. Future studies should explore the clinical utility of reduction end points.

Viability of the World Health Organization quality of life measure to assess changes in quality of life following treatment for alcohol use disorder.

PURPOSE: Quality of life is an outcome often examined in treatment research contexts such as biomedical trials, but has been studied less often in alcohol use disorder (AUD) treatment. The importance of considering QoL in substance use treatment research has recently been voiced, and measures of QoL have been administered in large AUD treatment trials. Yet, the viability of popular QoL measures has never been evaluated in AUD treatment samples. Accordingly, the present manuscript describes a psychometric examination of and prospective changes in the World Health Organization Quality of Life measure (WHOQOL-BREF) in a large sample (N = 1383) of patients with AUD recruited for the COMBINE Study. METHODS: Specifically, we examined the construct validity (via confirmatory factor analyses), measurement invariance across time, internal consistency reliability, convergent validity, and effect sizes of post-treatment changes in the WHOQOL-BREF. RESULTS: Confirmatory factor analyses of the WHOQOL-BREF provided acceptable fit to the current data and this model was invariant across time. Internal consistency reliability was excellent (α > .9) for the full WHOQOL-BREF for each timepoint; the WHOQOL-BREF had good convergent validity, and medium effect size improvements were found in the full COMBINE sample across time. CONCLUSIONS: These findings suggest that the WHOQOL-BREF is an appropriate measure to use in samples with AUD, that the WHOQOL-BREF scores may be examined over time (e.g., from pre- to post-treatment), and the WHOQOL-BREF may be used to assess improvements in quality of life in AUD research.