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.

Validating a behavioral economic approach to assess food demand: effects of body mass index, dietary restraint, and impulsivity.

Behavioral economic theory is a useful framework for analyzing factors influencing choice, but the majority of human behavioral economic research has focused on drug choice. The behavioral economic choice paradigm may also be valuable for understanding food-maintained behavior. Our primary objective was two-fold: (1) Validate a human laboratory model of food-appetitive behavior, and (2) Assess the contribution of individual level factors that may differentially impact food choice behavior. Two studies were conducted. In Study 1, female subjects (N=17) participated in two consecutive food choice experimental sessions, whereas in Study 2, female subjects (N=21) participated in one concurrent food choice experimental session. During consecutive choice sessions (Study 1), demand for the more palatable food (i.e., high-sugar/high-fat) was more inelastic than the less palatable (i.e., low-sugar/low-fat) option. During concurrent choice sessions, demand for the more palatable food (i.e., high-sugar/high-fat) was more inelastic for restrained vs. unrestrained eaters, and for those who were overweight vs. normal weight. Demand for both palatable and less palatable choices was more elastic for high-impulsive vs. low-impulsive subjects. These findings suggest that the behavioral economic framework can be used successfully to develop a human laboratory model of food-appetitive behavior.

The moderating effects of intolerance of uncertainty and social connectedness on college students' addictive behaviors and mental health symptoms during the COVID-19 pandemic.

Objective: This study aimed to understand COVID-19 pandemic impacts on anxiety, depression, and addictive/excessive behaviors, with exploration of intolerance of uncertainty (IU) and social connectedness as potential moderators. Participants: Adult college students participated. Method: Our online survey assessed symptoms and behaviors prior to COVID-19, during the initial outbreak (Wave 1), and during early 2021 (Wave 2). Results: Significant increases were found in anxiety, depression, binge eating, sexual behaviors, video game playing, internet/social media usage, and compulsive exercise in both waves. IU moderated the relationship between both depression/anxiety and certain excessive behaviors; social connectedness moderated the relationship between anxiety and smoking. Conclusions: This study replicated prior work and highlights new impacts on addictive/excessive behaviors, as well as moderating effects from social connectedness and IU. Future research is warranted to evaluate the efficacy of treatments targeting IU and social connectedness as the pandemic continues to unfold.

Foods and Nutritional Characteristics Associated With Addictive-Like Eating.

Emerging literature is exploring the contribution of specific nutritional characteristics and food additives to the development of addictive-like eating, implicating highly processed foods and those high in fat and sugar in its pathophysiology. To our knowledge, no mixed methods study has yet aimed to investigate the relationship between food characteristics and addictive-like eating. Towards this end, we applied an a priori classification scheme to open-ended answers to enable us to use quantitative methods to analyze qualitative data. A sample of individuals who endorsed self-perceived "food addiction" (N = 182; 50% female; Mage = 34.1) reported the foods to which they believed they were "addicted." We classified these foods according to their levels of fat, carbohydrates, sugar, and sodium, and evaluated their predictive power on addictive-like eating. Pizza, chocolate, hamburgers, and pasta respectively, were the most reported food items to which participants felt they were addicted. Addictive-like eating was significantly predicted by endorsement of "addiction" to high-sodium foods. In contrast, "addiction" to high-sugar foods negatively predicted addictive-like eating symptoms. Findings support an association between highly processed and high-sodium foods with addictive-like eating behavior among humans, consistent in large part with prior human and animal literature. Results also suggest that people are readily able to report on their experiences of addiction to foods; specifically, they can freely endorse the experience of addictive-like eating and offer experiences of addictive foods that are largely consistent with theory and the literature.

Spiritual practices are associated with improved weight management following bariatric surgery.

BACKGROUND: Research shows that spirituality and religiosity may positively impact various health outcomes, but little is known about their role in supporting weight management efforts, particularly in the context of bariatric surgery. OBJECTIVE: This study examined spiritual practices and health-related behaviors of bariatric surgery patients 1-2 years postoperatively. SETTING: Large bariatric center in the Midwest of the United States. METHODS: Patients (n = 152) completed questionnaires 1-2 years postoperatively examining weight, physical activity, eating behaviors, and spiritual practices and experiences related to bariatric surgery. RESULTS: Participants were primarily married (59.2%), Caucasian (81.6%), and female (84.2%) who had undergone Roux-en-Y gastric bypass (64.5%) or sleeve gastrectomy (32.9%) 17.3 months previously. Most participants (71%) believed their spirituality did or could impact weight loss after surgery. Practices including connecting with nature, art and music, meditation, yoga, and attending spiritual or religious-based activities were positively correlated with weight loss, healthy eating, or exercise participation. CONCLUSION: Findings provide preliminary evidence for the benefits of spirituality in bariatric patients making lifestyle changes after surgery.

Practicing what we know: Multicultural counseling competence among clinical psychology trainees and experienced multicultural psychologists.

Multicultural (MC) competence is considered a necessary skill for clinical and counseling psychologists; however, there is little to no research on the assessment of demonstrated multicultural counseling competence (DMCCC) of clinical psychology graduate students. In this study, we developed a MC assessment instrument to assess DMCCC of clinical psychology graduate students compared with MC-experienced psychologists. In addition, we assessed for differences between the endorsement of MC-appropriate strategies and actual use of these strategies in clinical practice, both by MC-experienced psychologists and clinical psychology students. Results revealed significant differences between the DMCCC of clinical psychology graduate students and MC-experienced psychologists. Significant differences also emerged between endorsement of strategies as multiculturally appropriate and likelihood of actual use of these strategies. Findings suggest that future training and competence models should incorporate participants' ability to not only identify multiculturally appropriate strategies but also use these strategies in therapy.

Measurement Invariance of the Modified Yale Food Addiction Scale 2.0 Across Gender and Racial Groups.

Objective: Food addiction reflects a substance use disorder framework, suggesting certain foods (e.g., high-fat, high-sugar foods) may trigger an addictive-like eating response in vulnerable individuals. This study explored whether the Modified Yale Food Addiction Scale 2.0 (mYFAS 2.0), a newly validated and shortened measure of food addiction, is appropriate for use in heterogeneous samples. Assessment of mYFAS 2.0 invariance is essential, as this measure was developed for use as a brief screener in large epidemiological samples that are likely demographically diverse. Method: Multigroup confirmatory factor analysis examined measurement invariance across racial/ethnic (White, Black, and Hispanic) and gender (male, female) groups. Participants were recruited through Qualtrics qBus, which uses demographic quotas to recruit a sample representative of the U.S. census reference population. Individuals were included in analyses if they identified their race/ethnicity as White, Black, or Hispanic (N = 923). Results: Results supported full and partial measurement invariance across racial and gender groups, respectively. Discussion: Results increase confidence in the generalizability of findings using the mYFAS 2.0 and indicate that observed differences in prevalence rates, such as the higher rates of food addiction observed for women and Hispanic individuals, are likely due to true differences in the population rather than due to measurement bias.

The relationship of body image to body mass index and binge eating: the role of cross-situational body image dissatisfaction versus situational reactivity.

Although body image is often conceptualized as a trait, there is growing recognition of situational influences. It was hypothesized that college women whose body image was more reactive to situational influences would be more likely to experience adverse weight-related outcomes, including obesity and binge eating behavior. In a pilot study, vignettes were rated to yield a range of situational body image ratings, and the three vignettes that captured the full range (lowest, median, and highest ratings) were used in the main study. In the main study, 138 female undergraduates (M = 19.5 yr., SD = 1.9; 74.6% "White or Caucasian") completed a survey that included the Questionnaire on Eating and Weight Patterns-Revised. They also provided Body Image State Scale ratings in response to three vignettes drawn from the pilot study. Body image "reactivity" was defined as the range over which body image scores varied for a given participant (standard deviation of the means). Contrary to predictions, overall body dissatisfaction across situations--but not situational reactivity--was related to higher BMI, greater likelihood of binge eating, and higher depression. Results suggest when body image dissatisfaction is relatively impervious to situational influences, it may be a risk factor for disordered eating behavior, whereas body image dissatisfaction that is responsive to situational influences appears to be less pathognomonic.

Body image, body satisfaction, and eating patterns in normal-weight and overweight/obese women current smokers and never-smokers.

To explore differences between women smokers and never-smokers in body image and eating patterns, we analyzed data obtained from 587 women (18-55 years old) recruited to participate in laboratory investigations not focused on weight concerns. The sample consisted of 420 current smokers and 167 never-smokers; 44% of each group were overweight or obese (BMI>or=25). Questionnaires included measures of body image, body dissatisfaction, and restrained and disinhibited eating. Smokers did not differ from never-smokers on perceived body shape but endorsed a thinner preferred body shape and scored lower on body satisfaction than never-smokers. Smokers also scored higher on measures of disinhibited eating. Among smokers, those who were overweight/obese scored higher than normal-weight smokers on concerns about post-cessation weight gain and lower on self-efficacy to avoid relapse if weight increased. Our findings suggest that women smokers may require help in attaining a more realistic body image and attention to dysfunctional eating patterns if they are to achieve and maintain a healthful weight and/or to quit smoking successfully. They also indicate that overweight smokers may be at elevated risk of relapse in the face of post-cessation weight gain.

Actual versus perceived risk of cervical cancer among college women smokers.

UNLABELLED: Cervical cancer is a well-established smoking-related illness, but many at-risk women are unaware of this link. OBJECTIVE: The authors designed this study to (1) investigate the relationship of smoking behavior with the history of abnormal Pap test results, sexual history, and perceived risk of cervical cancer and (2) determine whether self-classified smoking status (and hence perceived risk) corresponds with actual smoking behavior in a college student population. PARTICIPANTS AND METHOD SUMMARY: College women students (N = 135) completed a survey assessing smoking history, health history, sexual risk behavior, and risk awareness. RESULTS: Relative to those who had not smoked in the past month, current smokers (n = 36, or 27% of the total sample) perceived themselves to be at higher risk for developing cervical cancer, but did not demonstrate increased awareness of specific cervical cancer risk factors, including smoking. Twenty-eight percent (10 of 36) of past-month smokers did not define themselves as current smokers. CONCLUSION: The authors conclude that anti-smoking and health-related messages targeting smokers may misfire for individuals who do not define themselves as smokers but are nonetheless at risk for smoking-related consequences and escalating use.

Differences in smoking patterns among women smokers with childhood versus later onset of weight problems.

We hypothesized that among overweight women smokers, those with Childhood Onset weight problems may be more likely to engage in unhealthy eating and dieting behaviors, including smoking to control weight. Data were collapsed from 89 currently overweight (BMI> or =25) women smokers who were recruited to participate in smoking research projects that focused on weight, body image, and food intake. We compared those who reported first becoming overweight before Junior High School (n=22) with those who recalled first experiencing weight problems during Junior High School or later (n=67). Women with Childhood Onset weight problems reported first trying cigarettes at a significantly younger age than those with Later Onset (13 vs. 15 years of age, respectively), and they reported more nicotine withdrawal symptoms during smoking abstinence, with a significantly greater likelihood of endorsing anger/irritability and trouble concentrating. No group differences were evident for cigarettes per day or other indicators of nicotine dependence (e.g., FTND). Although it is unclear whether having weight problems during childhood contributes directly to smoking initiation, our results provide evidence that Childhood Onset weight problems may serve as a marker for earlier smoking experimentation and may also complicate cessation efforts due to their association with elevated withdrawal symptomatology. Future longitudinal studies with prospective measures of weight, dieting, and smoking initiation may be helpful in establishing causal pathways in different subgroups of smokers.