5-HTTLPR moderates naltrexone and psychosocial treatment responses in heavy drinking men who have sex with men.

BACKGROUND: A functional polymorphism (5-HTTLPR) in the promoter region of the serotonin transporter gene has been widely studied as a risk factor and moderator of treatment for a variety of psychopathologic conditions. To evaluate whether 5-HTTLPR moderates the effects of treatment to reduce heavy drinking, we studied 112 high-functioning European-American men who have sex with men (MSM). Subjects participated in a randomized clinical trial of naltrexone (NTX) and cognitive behavioral therapy (CBT) for problem drinking. METHODS: Subjects were treated for 12 weeks with 100 mg/d of oral NTX or placebo (PBO). All participants received medical management with adjusted brief behavioral compliance enhancement treatment (BBCET) alone or in combination with modified behavioral self-control therapy (MBSCT; an amalgam of motivational interviewing and CBT). Participants were genotyped for the tri-allelic 5-HTTLPR polymorphism (i.e., low-activity S' or high-activity L' alleles). RESULTS: During treatment, the number of weekly heavy drinking days (HDD; defined as 5 or more standard drinks per day) was significantly lower in subjects with the L'L' (N = 26, p = 0.015) or L'S' (N = 52, p = 0.016) genotype than those with the S'S' (N = 34) genotype regardless of treatment type. There was a significant interaction of genotype with treatment: For subjects with the S'S' genotype, the effects of MBSCT or NTX on HDD were significantly greater than the minimal intervention (i.e., BBCET or PBO, p = 0.007 and p = 0.049, respectively). In contrast, for subjects with 1 or 2 L' alleles, the effects of the more intensive psychosocial treatment (MBSCT) or NTX did not significantly differ from BBCET or PBO. CONCLUSIONS: These preliminary findings support the utility of the 5-HTTLPR polymorphism for personalizing treatment selection in problem drinkers.

Understanding messaging preferences to inform development of mobile goal-directed behavioral interventions.

BACKGROUND: Mobile messaging interventions have been shown to improve outcomes across a number of mental health and health-related conditions, but there are still significant gaps in our knowledge of how to construct and deliver the most effective brief messaging interventions. Little is known about the ways in which subtle linguistic variations in message content can affect user receptivity and preferences. OBJECTIVE: The aim of this study was to determine whether any global messaging preferences existed for different types of language content, and how certain characteristics moderate those preferences, in an effort to inform the development of mobile messaging interventions. METHODS: This study examined user preferences for messages within 22 content groupings. Groupings were presented online in dyads of short messages that were identical in their subject matter, but structurally or linguistically varied. Participants were 277 individuals residing in the United States who were recruited and compensated through Amazon's Mechanical Turk (MTurk) system. Participants were instructed to select the message in each dyad that they would prefer to receive to help them achieve a personal goal of their choosing. RESULTS: Results indicate global preferences of more than 75% of subjects for certain types of messages, such as those that were grammatically correct, free of textese, benefit-oriented, polite, nonaggressive, and directive as opposed to passive, among others. For several classes of messages, few or no clear global preferences were found. There were few personality- and trait-based moderators of message preferences, but subtle manipulations of message structure, such as changing "Try to…" to "You might want to try to…" affected message choice. CONCLUSIONS: The results indicate that individuals are sensitive to variations in the linguistic content of text messages designed to help them achieve a personal goal and, in some cases, have clear preferences for one type of message over another. Global preferences were indicated for messages that contained accurate spelling and grammar, as well as messages that emphasize the positive over the negative. Research implications and a guide for developing short messages for goal-directed behaviors are presented in this paper.

Alcohol use disorders among substance dependent women on Temporary Assistance with Needy Families: more information for diagnostic modifications for DSM-5.

PURPOSE: While modifications to alcohol use disorder (AUD) criteria are proposed for DSM-5, examination of the criteria's performance among highly vulnerable populations is lacking. This study determined the dimensionality and rank order severity of the DSM-IV AUD criteria among Temporary Assistance for Needy Families (TANF) recipients with high rates of chemical dependency and co-morbid mental health disorders. METHOD: Secondary analysis was performed on data from 461 TANF eligible women screened for AUD criteria using the Structured Clinical Interview for DSM-IV-TR. Exploratory (EFA) and confirmatory factor analyses (CFA) were performed on the AUD criteria. Two-parameter Item Response Theory (IRT) analysis was performed to determine item location and discrimination of criteria for both abuse and dependence. Differential item functioning for those with an additional substance use disorder or with high levels of depressive symptoms was explored. RESULTS: 41.2% met criteria for dependence, and 4.4% for abuse. EFA and CFA revealed a two-factor model provided adequate fit to criteria, and IRT indicated a potential hierarchical order between the criteria-abuse being more severe but dependence having greater reliability. CONCLUSION: Contrary to existing literature, findings suggest that a two-factor solution may be appropriate. Implications are discussed.

Functioning of alcohol use disorders criteria among middle-aged and older adults: implications for DSM-5.

This study explored dimensionality and rank-order severity of the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) alcohol use disorder (AUD) criteria among adults 50+ years old. Secondary analysis was performed on data from individuals 50+ (N = 3,412) from the 2009 National Survey of Drug Use and Health. Confirmatory factor analyses (CFA) and item response theory (IRT) analyses were performed on the 11 AUD criteria. DSM-IV and DSM fifth edition (DSM-5) classifications were compared. CFA revealed a one-factor model. IRT analyses revealed that AUD criteria identify only severe cases of AUD. Overall, 5.8% met criteria for a DSM-IV AUD; 7.5% met criteria for DSM-5 AUD.

Drink goal difficulty effect on outcomes in moderation-based alcohol treatment for sexual minority men.

Sexual minority men (SMM) who drink heavily are at a greater risk for developing alcohol use disorders (AUD) and associated negative consequences. Barriers to treatment prevent SMM from accessing traditional care, and moderation-based alcohol treatment is a more desirable alternative. As such, investigating effective goal setting in moderation-based alcohol treatment, particularly, which goals yield the most effective outcomes, is warranted. Applying the tenets of Goal Setting Theory, this study explored the relationship between goal difficulty and goal achievement. In a secondary data analysis of a randomized controlled trial that delivered a combination of medication (i.e., naltrexone) and behavioral (i.e., Modified Behavioral Self-Control Training) treatment for SMM with AUD (N = 178), generalized estimating equations tested the effect of goal difficulty (defined as the proposed magnitude of change from current drinking in number of drinking days and number of heavy drinking days) on goal achievement at Months 0, 3, 6, and 9. Goal importance, self-efficacy, and AUD severity were tested as moderators. Findings yielded a significant positive relationship between goal difficulty and goal achievement for number of drinking days but a negative relationship for the number of heavy drinking days. Moderators of these relationships were not found. In order to increase the likelihood of achieving their goals in moderation-based alcohol treatment, SMM should initially consider setting more difficult goals for reducing drinking days. Additionally, goals of more conservative difficulty should be set for reducing heavy drinking days.

Context and craving among individuals with alcohol use disorder attempting to moderate their drinking.

Many individuals with alcohol use disorder (AUD) prefer a goal of moderation, because they do not see their drinking as causing severe enough consequences to merit abstinence. Given that individuals attempting to moderate will continue to put themselves in contexts where drinking occurs, understanding how distinct external alcohol cues prompt craving is important for implementing the optimal treatments for individuals with AUD. Using data from a randomized controlled trial of stepped care brief interventions for AUD, this study explored the relationship between drinking contexts and craving in individuals attempting to moderate their drinking using ecological momentary assessment (EMA). At baseline, participants were asked to prospectively identify drinking contexts that were particularly likely to elicit intense craving and heavy drinking, called highly valued drinking contexts (HVCs). During EMA, participants were asked to report three times a day (morning, afternoon, evening) on their non-mutually exclusive contexts and their level of craving. Using multilevel modeling, all drinking contexts were tested as concurrent predictors of craving across the 84 days of the study. Next, AUD severity was tested as a moderator of HVC on craving. Results demonstrated that being in an HVC corresponded to greater reports of any craving and intensity of craving, over and above the influences of several other contextual factors (e.g., negative affect and already drinking). AUD severity significantly moderated HVC's impact on any craving, such that greater AUD severity potentiated HVC's already high odds of any craving. Implications for treatments for individuals with AUD are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A pilot study of online feedback for adult drinkers 50 and older: Feasibility, efficacy, and preferences for intervention.

Normative (NF) and personalized feedback (PF) are moderately effective brief interventions for at-risk drinking middle-aged and older adults. This study tested the feasibility of online feedback for drinkers 50 and older. This study's aims were to identify whether there is differential effectiveness of PF over NF in prompting drinkers 50years old and older to plan for change and to determine potential preferences for intervention among adult drinkers 50 and older with practical knowledge about computers. METHOD: Using Amazon's Mechanical Turk, 138 male and female drinkers aged 50 to 75+ were recruited to complete an online survey that asked about their: perceptions of their drinking, quantity and frequency of drinking, and any comorbid health and/or mental health disorders/medications. They were then provided either NF or PF. NF provided information about how participants' drinking compared to their same age and gendered peers. PF provided information about level of risk to health and provided recommendations for safe levels of drinking. After feedback, participants were evaluated for their reactions (e.g., "How much does this worry you?") and their plan to change their drinking. Participants were asked about preferences for interventions. RESULTS: 80% of participants rated themselves a no or low-risk drinker, yet 52.2% were found to be at-risk drinkers. Overall, participants reported feedback was helpful, and 43.9% made some kind of plan to change. Participants in NF were significantly more likely to make a plan for change than those in PF. Participants reported that they most preferred an online (40.9%) or a brief in-person (31.8%) intervention. CONCLUSION: Findings revealed that brief online feedback was feasible, though limited to those who are computer knowledgeable. Unexpectedly, NF outperformed PF, suggesting that peer comparisons may be more motivating for adults 50 and older than previously thought. Finally, an online intervention appears to be a preferred intervention for alcohol use among this particular group of drinkers.

The effects of therapeutic bond within a brief intervention for alcohol moderation for problem drinkers.

The quality of the relationship between a therapist and his or her client can make a significant contribution to recovery from substance use disorders. Treatments often harness aspects of therapeutic relationships (e.g., therapeutic bond) to positively affect therapeutic outcomes. Within motivational interviewing (MI), for example, authors theorize that a relational component is 1 active component that affects change. The present study aims to examine the effects of relationships within a treatment setting on drinking. A secondary data analysis was performed on data collected from problem drinkers in a randomized controlled trial. Participants were assigned to MI or relational MI without directive elements (spirit-only MI). Participants answered questions about alcohol use and therapeutic bond before, during, and at the end of an 8-week treatment period. High levels of therapeutic bond and empathic resonance predicted decreased alcohol use at the end of treatment for participants in both conditions. This study highlights the importance of relational components in treatments for substance abuse. (PsycINFO Database Record

Testing the initial efficacy of a mailed screening and brief feedback intervention to reduce at-risk drinking in middle-aged and older adults: the comorbidity alcohol risk evaluation study.

OBJECTIVES: To determine the initial efficacy of a mailed screening and brief intervention to reduce at-risk drinking in persons aged 50 and older. DESIGN: Pilot randomized controlled trial. SETTING: University of California at Los Angeles Department of Medicine Community Offices and Primary Care Network. PARTICIPANTS: Individuals aged 50 and older who were identified as at-risk drinkers according to the Comorbidity Alcohol Risk Evaluation Tool (CARET) (N = 86). INTERVENTION: Participants were assigned randomly to receive personalized mailed feedback outlining their specific risks associated with alcohol use, an educational booklet on alcohol and aging, and the National Institutes of Health Rethinking Drinking: Alcohol and Your Health booklet (intervention group) or nothing (control group). MEASUREMENTS: Alcohol-related assessments at baseline and 3 months; CARET-assessed at-risk drinking, number of risks, and types of risks. RESULTS: At 3 months, fewer intervention group participants than controls were at-risk drinkers (66% vs 88%), binge drinking (45% vs 68%), using alcohol with a medical or psychiatric condition (3% vs 17%), or having symptoms of such a condition (29% vs 49%). CONCLUSION: A brief mailed intervention may be an effective approach to intervening with at-risk drinkers aged 50 and older.

Variation in Mu-Opioid Receptor Gene (OPRM1) as a Moderator of Naltrexone Treatment to Reduce Heavy Drinking in a High Functioning Cohort.

BACKGROUND: It is well known that naltrexone, an FDA-approved medication for treatment of alcohol dependence, is effective for only a subset of individuals. Recent studies have examined the utility of a functional A118G single nucleotide polymorphism (SNP) of the mu-opioid receptor gene (OPRM1) as a predictor of naltrexone treatment response. Although the findings to date have generally been consistent with a moderating effect of the SNP, further evaluation of this hypothesis is warranted. OBJECTIVE: To evaluate whether problem drinkers with one or two copies of the 118G allele respond better to naltrexone treatment. The treatment goal in this cohort of high functioning men who have sex with men (MSM) was to reduce heavy drinking, rather than to promote abstinence. METHOD: 112 subjects of European ancestry from a randomized clinical trial of naltrexone and behavioral therapy for problem drinking MSM were included in the analysis. Subjects were treated for 12 weeks with 100 mg/day of oral naltrexone hydrochloride. All participants received medical management with a modified version of the Brief Behavioral Compliance Enhancement Treatment (BBCET), alone or in combination with Modified Behavioral Self-control Therapy (MBSCT). RESULTS: Naltrexone-treated subjects with one or two 118G alleles had a significantly greater percentage of non-hazardous drinking (NoH) (p < 0.01) than those treated with placebo or A118 homozygotes in either medication group. CONCLUSIONS: These results are consistent with a modest moderating effect of the OPRM1 118G allele on the reduction of heavy drinking by naltrexone treatment.

A randomized clinical trial of naltrexone and behavioral therapy for problem drinking men who have sex with men.

OBJECTIVE: This study tested the comparative effectiveness of modified behavioral self-control therapy (MBSCT) and naltrexone (NTX), as well as the added benefit of combining the 2, in problem drinking men who have sex with men (MSM) seeking to reduce but not quit drinking. METHOD: Participants (N = 200) were recruited and urn randomized to 1 of 2 medication conditions, NTX or placebo (PBO), and either MSBCT or no behavioral intervention, yielding 4 conditions: PBO, NTX, MSBCT, and NTX + MSBCT. In addition, all participants received a brief medication compliance intervention. Participants were treated for 12 weeks and assessed 1 week after treatment completion. Two primary outcomes-sum of standard drinks and number of heavy drinking days-and 1 secondary outcome-percentage of those drinking in a nonhazardous manner (NoH)-were selected a priori. RESULTS: There was a significant main effect for MBSCT (all ps < .01) but not NTX on all 3 outcomes. In addition, the combination of NTX and MBSCT was not more effective than either MSCBT or PBO. There was a significant interaction effect on NoH, such that NTX significantly increased the likelihood (odds ratio = 3.3) of achieving a nonhazardous drinking outcome relative to PBO. In addition, NTX was significantly more effective than PBO on a descriptive outcome: negative consequences of drinking. CONCLUSIONS: There was no advantage to adding NTX to MBSCT. In addition, MBSCT showed stronger evidence of efficacy than NTX. At the same time, NTX delivered in the context of a minimal medication compliance intervention was significantly more effective than PBO on an important clinical indicator. Results provide new information to guide the treatment of problem drinking, including in primary care settings.

Depression's moderation of the effectiveness of intensive case management with substance-dependent women on temporary assistance for needy families: outpatient substance use disorder treatment utilization and outcomes.

OBJECTIVE: Intensive case management (ICM) is effective for facilitating entry into and retention in outpatient substance use disorder treatment (OSUDT) for low-income substance-dependent women; however, no studies have specifically examined the moderating impact of depressive symptoms on ICM. The purpose of this study was to investigate whether depressive symptoms moderated ICM's effect on OSUDT engagement, attendance, and outcomes for substance-dependent women on Temporary Assistance for Needy Families (TANF). It was hypothesized that highly depressed women would demonstrate worse outcomes on all indicators. METHOD: Logistic regression and generalized estimating equations were used to determine depression's moderating impact on ICM in a secondary analysis of data from a randomized controlled trial comparing the effectiveness of ICM to usual care provided by local public assistance offices in Essex County, NJ. Substance-dependent women (N = 294) were recruited while being screened for TANF eligibility and were followed for 24 months. RESULTS: Findings revealed that high levels of depressive symptoms moderated the effectiveness of ICM in unexpected directions for two outcome variables. Subjects with high levels of depressive symptoms in ICM were (a) significantly more likely to engage in at least one treatment program than those in usual care and (b) associated with the fewest mean drinks per drinking day across the 24-month follow-up period. Independent effects for high levels of depressive symptoms and ICM were also found to positively influence engagement, attendance, and percentage days abstinent. CONCLUSIONS: ICM is effective for substance-dependent women with a broad spectrum of depressive symptoms in enhancing OSUDT utilization and outcomes.

Doctoral education in social work: what we know and what we need to know.

Little is known about social work doctoral students and graduates: why they chose doctoral study, the kind of work they do, and the nature of their unique contributions to the profession. This article reviews past studies of doctoral education in social work in the context of general trends in doctoral education in the United States, underscoring the need for more social workers with doctoral degrees. Using data from the Survey of Earned Doctorates, social work doctoral graduates from two recent years are described, including their employment plans at graduation and their indebtedness. Implications of the findings for the profession are discussed.

An Item Response Theory (IRT) analysis of the Short Inventory of Problems-Alcohol and Drugs (SIP-AD) among non-treatment seeking men-who-have-sex-with-men: evidence for a shortened 10-item SIP-AD.

The Short Inventory of Problems-Alcohol and Drugs (SIP-AD) is a 15-item measure that assesses concurrently negative consequences associated with alcohol and illicit drug use. Current psychometric evaluation has been limited to classical test theory (CTT) statistics, and it has not been validated among non-treatment seeking men-who-have-sex-with-men (MSM). Methods from Item Response Theory (IRT) can improve upon CTT by providing an in-depth analysis of how each item performs across the underlying latent trait that it is purported to measure. The present study examined the psychometric properties of the SIP-AD using methods from both IRT and CTT among a non-treatment seeking MSM sample (N=469). Participants were recruited from the New York City area and were asked to participate in a series of studies examining club drug use. Results indicated that five items on the SIP-AD demonstrated poor item misfit or significant differential item functioning (DIF) across race/ethnicity and HIV status. These five items were dropped and two-parameter IRT analyses were conducted on the remaining 10 items, which indicated a restricted range of item location parameters (-.15 to -.99) plotted at the lower end of the latent negative consequences severity continuum, and reasonably high discrimination parameters (1.30 to 2.22). Additional CTT statistics were compared between the original 15-item SIP-AD and the refined 10-item SIP-AD and suggest that the differences were negligible with the refined 10-item SIP-AD indicating a high degree of reliability and validity. Findings suggest the SIP-AD can be shortened to 10 items and appears to be a non-biased reliable and valid measure among non-treatment seeking MSM.

When the caregiver needs care: the plight of vulnerable caregivers.

OBJECTIVES: This study examined the characteristics, activities, and challenges of high-risk informal caregivers. METHODS: Telephone interviews were conducted with a nationally representative cross-section of 1002 informal caregivers. Vulnerable caregivers with poor health or a serious health condition were compared with nonvulnerable caregivers. RESULTS: Thirty-six percent of caregivers were vulnerable. Compared with nonvulnerable caregivers, vulnerable caregivers were more likely to have difficulty providing care, to provide higher-intensity care, to report that their physical health had suffered since becoming a caregiver, to be aged 65 years or older, to be married, and to have less than 12 years of education. CONCLUSIONS: Reliance on informal caregivers without considering the caregiver's ability to provide care can create a stressful and potentially unsafe environment for the caregiver and the care recipient.