Transmission from vaccinated individuals in a large SARS-CoV-2 Delta variant outbreak.

An outbreak of over 1,000 COVID-19 cases in Provincetown, Massachusetts (MA), in July 2021-the first large outbreak mostly in vaccinated individuals in the US-prompted a comprehensive public health response, motivating changes to national masking recommendations and raising questions about infection and transmission among vaccinated individuals. To address these questions, we combined viral genomic and epidemiological data from 467 individuals, including 40% of outbreak-associated cases. The Delta variant accounted for 99% of cases in this dataset; it was introduced from at least 40 sources, but 83% of cases derived from a single source, likely through transmission across multiple settings over a short time rather than a single event. Genomic and epidemiological data supported multiple transmissions of Delta from and between fully vaccinated individuals. However, despite its magnitude, the outbreak had limited onward impact in MA and the US overall, likely due to high vaccination rates and a robust public health response.

A preliminary investigation of the relationship between dispositional mindfulness and eating disorder symptoms among men in residential substance use treatment.

The comorbidity between eating disorders (EDs) and substance use disorders (SUDs) is of particular concern given the high rates of mortality, relapse and poor treatment outcomes associated with both disorders. As a result, there has been a growing impetus within the field to elucidate factors that might influence and aid treatment for this comorbidity. One such factor is dispositional mindfulness, as past literature has demonstrated a significant relationship between mindfulness and both EDs and SUDs. However, we are unaware of any research that has examined the relationship between dispositional mindfulness and ED symptoms in a sample of men in residential treatment for SUDs. Medical records from 152 men were included in the current study. Alcohol and drug use and problems, ED symptoms, and dispositional mindfulness were assessed with self-report measures. Hierarchical regression analysis indicated that dispositional mindfulness was inversely related to ED symptoms after controlling for alcohol use, drug use, and age. Although results are preliminary and continued research in this area is needed, our findings suggest that there may be potential usefulness in targeting and enhancing mindfulness among patients in residential treatment for SUDs with co-occurring psychiatric symptoms (e.g., EDs).

The Relationship Between Generalized Anxiety Symptoms and Treatment Dropout Among Women in Residential Treatment for Substance Use Disorders.

BACKGROUND: Generalized anxiety disorder (GAD) co-occurs with substance use disorders (SUDs) at an alarmingly high rate, and the presence of anxiety is associated with an increased risk for relapse to substance use following treatment. Furthermore, comorbid SUDs and other forms of psychopathology are associated with an increased risk for leaving treatment against medical advice (AMA). OBJECTIVE AND METHOD: Research has yet to examine whether the presence of GAD symptoms is associated with leaving treatment AMA in SUDs populations. Thus, the current study sought to address this important gap in the literature by examining this relationship among a sample of 122 women in residential treatment for SUDs. RESULTS: Results demonstrated that GAD symptoms were significantly associated with the decision to leave treatment AMA after controlling for age, education, problematic alcohol and drug use, and depression symptoms. CONCLUSIONS/IMPORTANCE: Our finding indicates the potential importance of assessing and targeting GAD in treatment for SUDs, which may increase treatment compliance.

Dispositional Mindfulness and Aggression Among Women in Residential Substance Use Treatment.

There is a large literature on substance misuse and interpersonal aggression, including aggression perpetrated by women in treatment for substance misuse. There is also a growing body of literature on mindfulness and substance use, as well as mindfulness and aggression. However, to date, there has been little research on whether dispositional mindfulness is associated with increased aggression among women in treatment for substance misuse. The current study, therefore, examined whether dispositional mindfulness was associated with aggression, above and beyond substance use and demographic characteristics, in women in residential substance misuse treatment (N = 137). Results showed that lower dispositional mindfulness was associated with increased aggression (physical, verbal, and aggressive attitude). Moreover, this relationship between dispositional mindfulness and aggression remained even after controlling for alcohol problems, drug problems, and age, all known predictors of aggression. Our results provide the first empirical evidence that dispositional mindfulness is negatively associated with aggression in women in treatment for substance misuse. Pending replication, this could have important implications for treatment. Specifically, mindfulness-based interventions may prove helpful for the concurrent treatment of substance misuse and aggression.

The relationship between early maladaptive schemas and eating-disorder symptomatology among individuals seeking treatment for substance dependence.

Numerous studies have examined early maladaptive schemas (EMS) and their relationship to psychological disorders, including eating disorders (EDs) and substance use disorders (SUDs). However, to date, there are no empirical investigations that have examined the relationship between EMS and EDs among individuals seeking treatment for substance use. In an attempt to further elucidate this relationship, the purpose of the current, exploratory study was to examine the relationship between EMS, ED symptomatology (i.e., bulimia and binge-eating but not anorexia), and substance use and to directly compare EMS among individuals with and without a probable ED diagnosis. Participants were 387 men and 132 women seeking residential treatment for substance use. Results demonstrated that 11 of the 18 EMS were significantly associated with ED. Moreover, patients with a probable ED scored significantly higher than patients without a probable ED on 8 of the 18 EMS. Results suggest that EMS are prevalent among individuals with ED pathology seeking treatment for substance use. Thus treatment programs could potentially benefit from the assessment and treatment of EMS among dually-diagnosed patients. Given the exploratory and preliminary nature of the study, continued research is needed to further examine the relationship between EMS, EDs, and substance use.

Gender differences in early maladaptive schemas in a treatment-seeking sample of alcohol-dependent adults.

The current study examined early maladaptive schemas among alcohol-dependent men and women and sought to determine whether men and women differed in their early maladaptive schemas. Using preexisting patient records of adults diagnosed with alcohol dependence from a residential treatment center in the Southeastern United States, from 2005 to 2010 (N = 854), results showed that women scored significantly higher than men on 14 of the 18 early maladaptive schemas assessed. Both women and men endorsed having a number of early maladaptive schemas, with four schemas being particularly prevalent across gender. Study limitations are noted and implications of these findings for treatment and future research are discussed.

Evidence of transmission from fully vaccinated individuals in a large outbreak of the SARS-CoV-2 Delta variant in Provincetown, Massachusetts.

Multiple summer events, including large indoor gatherings, in Provincetown, Massachusetts (MA), in July 2021 contributed to an outbreak of over one thousand COVID-19 cases among residents and visitors. Most cases were fully vaccinated, many of whom were also symptomatic, prompting a comprehensive public health response, motivating changes to national masking recommendations, and raising questions about infection and transmission among vaccinated individuals. To characterize the outbreak and the viral population underlying it, we combined genomic and epidemiological data from 467 individuals, including 40% of known outbreak-associated cases. The Delta variant accounted for 99% of sequenced outbreak-associated cases. Phylogenetic analysis suggests over 40 sources of Delta in the dataset, with one responsible for a single cluster containing 83% of outbreak-associated genomes. This cluster was likely not the result of extensive spread at a single site, but rather transmission from a common source across multiple settings over a short time. Genomic and epidemiological data combined provide strong support for 25 transmission events from, including many between, fully vaccinated individuals; genomic data alone provides evidence for an additional 64. Together, genomic epidemiology provides a high-resolution picture of the Provincetown outbreak, revealing multiple cases of transmission of Delta from fully vaccinated individuals. However, despite its magnitude, the outbreak was restricted in its onward impact in MA and the US, likely due to high vaccination rates and a robust public health response.

The Relationship Between Eating Disorder Symptoms and Treatment Rejection among Young Adult Men in Residential Substance Use Treatment.

Research has demonstrated that individuals with substance use disorders (SUDs) and comorbid mental health problems evidence heightened negative consequences, including poorer treatment outcomes, a higher risk for relapse, and mortality compared to individuals with a single disorder. In this study, we focus on the comorbidity between SUDs and eating disorder (ED) symptomatology, as EDs are similarly associated with high rates of relapse, morbidity, and mortality. Of particular importance is research examining treatment rejection among individuals in treatment for SUDs with cooccurring ED symptomatology. This study seeks to add to the literature by examining treatment rejection among young adult men in residential treatment for SUDs (N = 68) with cooccurring ED symptomatology. Results from hierarchical regression analyses indicated that ED symptoms were significantly associated with treatment rejection after controlling for alcohol and drug use and problems and depression symptoms. Although this is a preliminary study, the results add to a growing body of research examining the comorbidity between SUDs and ED symptomatology. Future research examining this relationship is needed to further elucidate the treatment patterns among individuals with comorbid ED symptoms and substance use diagnoses.

Research Reactions Following Participation in Intimate Partner Violence Research: An Examination With Men in Substance Use Treatment.

There has been increased attention in recent years related to the research reactions of individuals who participate in intimate partner violence (IPV) research. Existing studies demonstrate that participating in IPV research is not emotionally upsetting for the vast majority of participants and that many participants perceive benefit from their research participation. However, almost all of the existing research has utilized non-clinical samples or battered women, failing to examine the research reactions of a clinical sample of men. Thus, the present study examined the research reactions of men in substance use treatment ( N = 138) who completed a self-report measure of IPV perpetration and victimization. We also examined whether distress tolerance moderated the relationship between reports of IPV and negative emotional research reactions. Consistent with previous research, after accounting for distress tolerance, substance use, and demographic control variables, IPV was unrelated to negative emotional research reactions. Distress tolerance did not moderate the association between IPV and research reactions. Findings add to a growing body of literature suggesting that IPV research meets Institutional Review Board (IRB) requirements for minimal risk research.

Further evidence of self-medication: personality factors influencing drug choice in substance use disorders.

According to Khantzian's (2003) self-medication hypothesis (SMH), substance dependence is a compensatory means to modulate affects and self-soothe in response to distressing psychological states. Khantzian asserts: (1) Drugs become addicting because they have the power to alleviate, remove, or change human psychological suffering, and (2) There is a considerable degree of specificity in a person's choice of drugs because of unique psychological and physiological effects. The SMH has received criticism for its variable empirical support, particularly in terms of the drug-specificity aspect of Khantzian's hypothesis. We posit that previous empirical examinations of the SMH have been compromised by methodological limitations. Also, more recent findings supporting the SMH have yet to be replicated. Addressing previous limitations to the research, this project tested this theory in a treatment sample of treatment-seeking individuals with substance dependence (N = 304), using more heterogeneous, personality-driven measures that are theory-congruent. Using an algorithm based on medical records, individuals were reliably classified as being addicted to a depressant, stimulant, or opiate by two independent raters. Theory-based a priori predictions were that the three groups would exhibit differences in personality characteristics and emotional-regulation strategies. Specifically, our hypotheses entailed that when compared against each other: (1) Individuals with a central nervous system (CNS) depressant as drug of choice (DOC) will exhibit defenses of repression, over-controlling anger, and emotional inhibition to avoid acknowledging their depression; (2) Individuals with an opiate as DOC will exhibit higher levels of aggression, hostility, depression, and trauma, greater deficits in ego functioning, and externalizing/antisocial behavior connected to their use; and (3) Individuals with a stimulant as DOC will experience anhedonia, paranoia, have a propensity to mania, and display lower levels of emotional inhibition. MANOVAs were used to test three hypotheses regarding drug group differences on the personality variables that were in keeping with the SMH. The MANOVAs for Hypothesis I (Depressant group) and Hypothesis II (Opiate group) were statistically significant. Findings partially support the SMH, particularly in its characterization of personality functioning in those addicted to depressants and opiates.