Effects of craving on opioid use are attenuated after pain coping counseling in adults with chronic pain and prescription opioid addiction.

OBJECTIVE: Risk for prescription opioid addiction is an endemic public health concern, especially for adults with chronic pain. This study examined craving as a mediator from pain to opioid use outcomes during prescription opioid addiction treatment and tested whether counseling in pain coping skills moderated the effects of craving on treatment outcomes. METHOD: Secondary analysis on a sample (N = 148) randomized to standard or enhanced counseling for 12 weeks with adjunct opioid maintenance medication. Multilevel analyses examined mediated effects between weekly pain, craving, and opioid use, and tested the interaction between craving and a counseling module on pain coping skills. RESULTS: Greater pain predicted greater craving (ß = 0.25, p < .001), which predicted next-week opioid use (ß = 0.17, p < .001). A statistically significant indirect effect of craving (ß = 0.04, 95% CI [0.02, 0.06]) mediated 95% of the total effect from pain to opioid use. A significant interaction (b = -0.22, p < .01) revealed that after receiving the pain coping module, the association between craving and next-week opioid use was reduced, with greater exposure to the module associated with stronger effects (b = -0.12, p < .01). CONCLUSION: More severe pain predicts greater opioid use due to the association between pain and cravings. Pain coping skills counseling suppressed the association between cravings and opioid use. For adults with chronic pain receiving treatment for prescription opioid addiction, interventions that address cravings through behavioral pain coping skills may be crucial for achieving optimal treatment outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Evaluation of the psychometric properties of the cannabis use disorders identification test - revised among college students.

OBJECTIVE: Cannabis use is common among college students and is associated with a variety of negative consequences. The Cannabis Use Disorders Identification Test Revised (CUDIT-R) is an 8-item screening instrument designed to identify potentially problematic or harmful recent cannabis use. The purpose of the current study was to evaluate the internal consistency and validity of the CUDIT-R in a sample of college students who reported recent cannabis use (past 30 day). METHODS: Participants (n = 229) completed the CUDIT-R and measures of smoking behavior (Daily Smoking Questionnaire; DSQ), cannabis related consequences (Marijuana Problem Index; MPI), and problematic cannabis use (self-reported DSM-5 Cannabis Use Disorder Criteria). RESULTS: The CUDIT-R showed good internal consistency and concurrent validity with cannabis related outcome measures including; frequency of use, cannabis related consequences, and total DSM-5 criteria endorsed. The CUDIT-R also showed evidence of discriminant validity across DSM-5 severity classifications, achieved high levels of sensitivity (0.929) and specificity (0.704), and excellent area under the receiver operating characteristics curve when using a cutoff score of six. All items displayed high levels of discrimination and varied in terms of difficulty and information provided. CONCLUSIONS: Overall, the CUDIT-R appears to be a reliable and valid screening measure when used to identify college students at risk for cannabis related problems. Future research should further evaluate the sensitivity and specificity of the CUDIT-R threshold scores with more rigorously established DSM-5 diagnoses, and across a range of populations. Research on the utility of using the CUDIT-R for measuring treatment outcomes is also warranted.

Differential Role of Cannabis Use Motives in Predicting Impairment Across Three Measures.

OBJECTIVE: Previous research has demonstrated the utility of motivational models of cannabis use to predict the frequency of use and associated negative consequences. However, few existing studies have simultaneously investigated a range of motives across different measures of use-related problems, which limit the ability to assess the differential role various motives play. The purpose of the current study was to examine cannabis use motives as predictors of three measures of cannabis use risk. METHOD: Participants (N = 229) who reported cannabis use within the past 30 days completed the Marijuana Motives Measures, as well as measures of typical smoking behavior and risk: Cannabis Use Disorders Identification Test-R (CUDIT-R; screening measure of hazardous cannabis use), Marijuana Problem Index (MPI; measure of broad psychosocial problems), and cannabis use disorder according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). RESULTS: Cannabis use motives-particularly coping, enhancement, and conformity-contributed to the prediction of cannabis-related impairment beyond gender and the frequency of recent use. Among the motives scales, coping emerged as the most robust predictor across the three impairment measures and was the only motive to add unique variance to predictions of DSM-5 symptoms. Enhancement and conformity motives were predictive of the screening measure (CUDIT-R scores), and enhancement motives was also predictive of a measure of broad psychosocial problems related to cannabis use (MPI scores). CONCLUSIONS: The results highlight the differential role various marijuana use motives play across related but distinct measures of impairment.

A behavioral economic analysis of the nonmedical use of prescription drugs among young adults.

The nonmedical use of prescription drugs is a widely recognized public health issue, and young adults are particularly vulnerable to their use. Behavioral economic drug purchase tasks capture an individual's strength of desire and motivation for a particular drug. We examined young adult prescription drug purchase and consumption patterns using hypothetical behavioral economic purchase tasks for prescription sedatives/tranquilizers, stimulants, and opiate pain relievers. We also examined relations between demand, use frequency, and Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) substance use disorder (SUD) symptoms, and sex differences in these relations. Undergraduate students who endorsed past-year prescription drug use (N = 393) completed an online questionnaire for course credit. Measures assessed substance use frequency and DSM-5 SUD symptoms. Hypothetical purchase tasks for sedatives, stimulants, and pain relievers assessed participants' consumption and expenditure patterns for these substances across 25 prices. Past-year prescription sedative, stimulant, and pain reliever use was endorsed by 138, 258, and 189 participants, respectively. Among these users, consumption for their respective substance decreased as a function of ascending price, as expected. Demand indices for a prescription drug were associated with each other and with use frequency and SUD symptoms, with variability across substances but largely not by sex. In addition, demand for prescription pain relievers differentially predicted symptoms independent of use, with differences for females and males. In conclusion, hypothetical consumption and expenditure patterns for prescription drugs were generally well described by behavioral economic demand curves, and the observed associations with use and SUD symptoms provide support for the utility of prescription drug purchase tasks.

Modeling motivations for non-medical use of prescription drugs.

INTRODUCTION: Non-medical use of prescription drugs (NMUPD) is a growing problem among college-aged individuals. Motivations for use of a substance have been shown to predict consumption behavior across a variety of substances, but research on motivations for engaging in NMUPD is limited. We hypothesize that Confirmatory Factor Analysis (CFA) would support a two-factor latent structure for motivations (self-treatment and recreational) for NMUPD across three classes of drugs (stimulants, tranquilizers and sedatives, and pain relievers). METHODS: Data were collected from 1016 undergraduates attending a large southeastern university via an online survey. Motivations for use were subjected to a CFA for those participants who reported past-year use of each drug class (tranquilizer and sedative use n=138, pain reliever use n=189, and stimulant use n=258). RESULTS: Model fit varied across drug class. A two-factor model emerged for both pain relievers and stimulants, and each factor was positively correlated with one another and with frequency of use for both drug classes. A two-factor model was not a good fit for tranquilizers and sedatives. CONCLUSIONS: Motives for NMUPD are a relatively understudied construct. Although our initial results suggest that a proposed framework consisting of self-treatment and recreational motives might have some utility in explaining the use of stimulants and pain relievers, more research is needed to characterize motives for tranquilizers and sedatives. Additional research is also needed to develop assessment measures that capture the full range of motives for all three classes of NMUPD.

Measuring alcohol-related consequences and motives among students attending Historically Black Colleges and Universities.

INTRODUCTION: College student drinkers have the propensity to engage in heavy alcohol consumption. These consumption patterns can be problematic given the well-established relationship between heavy drinking and negative consequences of alcohol consumption. Though the research on college student drinking is abundant, much of the work conducted has been with Caucasian samples and less so with African American samples or at Historically Black Colleges and Universities (HBCUs). METHODS: The current paper assessed the internal reliability and concurrent validity of two popular measures of alcohol related negative consequences (CAPS-r and YAACQ) and a measure of drinking motives (DMQ-R) within a HBCU sample. RESULTS: Total scores for the CAPS-r and YAACQ and all five subscales of the DMQ-R were internally reliable as determined by Cronbach's alpha. Correlations and regressions established concurrent validity for both measures of negative consequences as well as the subscales for the DMQ-R. CONCLUSIONS: Findings support the use of these measures in the assessment of negative consequences and motivations for alcohol consumption within a HBCU population.

Alcohol use, impulsivity, and the non-medical use of prescription stimulants among college students.

The non-medical use of prescription drugs (NMUPD) is a growing public health concern. College students have been identified as a particularly at risk population for engagement in NMUPD. Across all prescription drug classes, stimulants show the highest ratio of illicit to medical use and are thus important to examine within this population. Emerging research has suggested a relationship between the non-medical use of prescription stimulants (NMUPS) and alcohol use within the college student population. Finally, the construct of impulsivity may serve as an additional indicator for students who engage in NMUPS as well as those who engage in NMUPS/alcohol co-ingestion. The purpose of this paper is to expand on previous prevalence data collected for the past year NMUPS and NMUPS/alcohol co-ingestion. Additionally, this paper examines whether those who engage in NMUPS or NMUPS/alcohol co-ingestion differ significantly from their non-using counterparts on measures of alcohol use, alcohol related negative consequences, binge drinking, and impulsivity. Finally, binary logistic regression models indicated that increased alcohol use, alcohol related negative consequences, and impulsivity all significantly increase the odds of an individual engaging in NMUPS or NMUPS/alcohol co-ingestion.