Factors Associated With Marijuana Use Among Treatment-seeking Adult Cigarette Smokers in the Criminal Justice Population.

OBJECTIVES: Due to the elevated rates of cigarette use and marijuana use within the criminal justice system, it is critical to develop a stronger understanding of tobacco and marijuana co-use among this population to inform future interventions. METHODS: This study is a secondary analysis of baseline data from a smoking cessation randomized clinical trial of adults (n = 500) in a community correction program. Participants were classified as using cigarettes only or both cigarettes and marijuana through either self-report or positive urine drug screening. Demographics and measures regarding legal, drug use, smoking, mental health, and interpersonal histories were assessed. Logistic regression analyses were conducted to assess factors associated with co-use. RESULTS: Among adults who smoked cigarettes, 25% reported current marijuana use. Individuals who used both cigarettes and marijuana were more likely than those who only used cigarettes to be African American (80%), male (73.6%), and younger (M = 32.4 [SD = 11.0]). Increasing difficulties with last quit attempt was associated with a reduction in the likelihood of co-use (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.60-0.94, P < 0.05), and benzodiazepine (OR 9.09, 95% CI 1.25-65.94, P < 0.05) and opioid (OR 8.17, 95% CI 2.03-32.93, P < 0.01) use was significantly associated with an increased likelihood of co-use. CONCLUSIONS: This study identified several factors that are associated with an increased risk of cigarette and marijuana co-use among a community correction population. These findings will be valuable for informing targeted prevention and treatment interventions.

Correcting delayed circadian phase with bright light therapy predicts improvement in ADHD symptoms: A pilot study.

Attention-deficit/hyperactivity disorder (ADHD) is a common condition with comorbid insomnia reported in >70% of children and adults. These patients demonstrate delays in sleep-wake rhythms, nocturnal rise in melatonin, and early morning rise in cortisol. Given that standard psychopharmacologic treatments for ADHD often do not completely control symptoms in participants with circadian rhythm delay, we sought to test whether bright light therapy (BLT) advances circadian rhythms and further reduces ADHD symptoms over standard treatments. In addition to standard of care, participants with ADHD diagnosis underwent 1 week of baseline assessment followed by 2-weeks of 30-min morning 10,000-lux BLT beginning 3 h after mid-sleep time. Participants minimized overhead light after 4 p.m., wore an actigraphy watch, and recorded BLT time on daily sleep logs. Dim Light Melatonin Onset (DLMO) was assessed at baseline and after 2-week treatment. ADHD symptoms were measured by the ADHD-Rating Scales (ADHD-RS). BLT significantly advanced the phase of DLMO by 31 min [mean time (SEM), 20:36 (0:21) advanced to 20:05 (0:20)] and mid-sleep time by 57 min [4:37 (0:22) advanced to 3:40 (0:16); paired t-tests, p = 0.002 and 0.004, respectively). Phase advances (in DLMO or mid-sleep time) were significantly correlated with decreased ADHD-RS total scores (p = 0.027 and 0.044) and Hyperactive-Impulsive sub-scores (p = 0.014 and 0.013, respectively). Actigraphy analysis for a subset of 8 participants with significant DLMO phase advance revealed no significant changes in total sleep time, sleep efficiency, wake after sleep onset, or percent wake during sleep interval. This is the first successful use of BLT for advancing melatonin phase and improving ADHD symptoms in adults. BLT may be a complementary treatment for both delayed sleep timing and ADHD symptoms in adults.

Prevalence and Factors Associated with Hazardous Alcohol Use Among Persons Living with HIV Across the US in the Current Era of Antiretroviral Treatment.

Hazardous alcohol use is associated with detrimental health outcomes among persons living with HIV (PLWH). We examined the prevalence and factors associated with hazardous alcohol use in the current era using several hazardous drinking definitions and binge drinking defined as ≥5 drinks for men versus ≥4 for women. We included 8567 PLWH from 7 U.S. sites from 2013 to 2015. Current hazardous alcohol use was reported by 27% and 34% reported binge drinking. In adjusted analyses, current and past cocaine/crack (odd ratio [OR] 4.1:3.3-5.1, p < 0.001 and OR 1.3:1.1-1.5, p < 0.001 respectively), marijuana (OR 2.5:2.2-2.9, p < 0.001 and OR 1.4:1.2-1.6, p < 0.001), and cigarette use (OR 1.4:1.2-1.6, p < 0.001 and OR 1.3:1.2-1.5, p < 0.001) were associated with increased hazardous alcohol use. The prevalence of hazardous alcohol use remains high in the current era, particularly among younger men. Routine screening and targeted interventions for hazardous alcohol use, potentially bundled with interventions for other drugs, remain a key aspect of HIV care.

Withdrawal exposure with withdrawal regulation training for smoking cessation: a randomized controlled pilot trial.

INTRODUCTION: Although withdrawal processes form a key motivational basis for cigarette use, smoking cessation treatments appear to exert only modest effects on withdrawal. One treatment option for further reducing withdrawal severity would be to provide smokers with withdrawal regulation training. The objective of this study was to pilot a smoking cessation intervention comprising withdrawal exposure with withdrawal regulation training. METHODS: Adult smokers (N=80) were randomized to one of two conditions: 1) Withdrawal Exposure with Withdrawal Regulation Training (WT), which included the development and application of individualized withdrawal regulation strategies over four separate sessions that spanned the first four hours of abstinence; 2) or Relaxation Control (RC) training, which controlled for the therapeutic contact of WT. All sessions occurred before the quit date, after which differential treatment was discontinued and all participants received brief counseling, nicotine replacement therapy, and self-help literature. Biochemically-confirmed (CO≤3) seven-day point-prevalence abstinence was assessed at Months 2 and 3 after end-of-treatment. RESULTS: Treatment completion and ratings of credibility and efficacy were high and equivalent across conditions. 22.2% of participants in the WT condition were abstinent at both time points, whereas 0% and 4.2% of participants in the RC condition were abstinent at Months 2 and 3 (Month 3 OR=6.5 [0.73, 59.19]). In-session withdrawal ratings suggested WT improved regulation of withdrawal symptoms, which were in turn associated with abstinence. CONCLUSIONS: This small pilot study suggests that WT promotes abstinence by enhancing withdrawal regulation. Results warrant further investigation of this innovative treatment approach.

The Adverse Effects of Motherhood on Substance Use Treatment Program Outcomes Among Adolescent Women.

OBJECTIVES: Adolescent mothers have differing risks and responsibilities compared to adolescent women without children that may impact substance use treatment. This study sought to describe characteristics of adolescent women in a substance use treatment program and determine the effect of adolescent motherhood on treatment program outcomes. METHODS: Data were collected from standardized interviews of female adolescents in a case management criminal justice diversion program for substance-using adolescents and adults. Variables included sociodemographic factors (ie, race/ethnicity, age, financial support, education, insurance, marital status, sexual abuse), Diagnostic and Statistical Manual-IV (DSM-IV) substance use disorder diagnoses, and motherhood (ie, childbirth and residence with a child). Treatment program outcome was documented by case workers at the end of the participants' time in the program. Chi-square analyses and analysis of variances determined associations between variables. Logistic regression was used to assess characteristics associated with negative treatment program outcome. RESULTS: Data from 1080 adolescent women aged 16-21 years (mean 19.7 years, SD = 1.16) were analyzed; 403 (37%) were mothers. After controlling for sociodemographic factors and substance use disorder diagnoses, adolescent mothers were less likely to successfully complete the treatment program than nonmothers. Adolescent women with reliance on family or friends for financial support, lower education status, and cannabis and cocaine use disorders had worse treatment program outcomes. CONCLUSIONS: Childbirth and parenting adversely affect substance use treatment outcomes for adolescent women in the criminal justice system. Future research should explore tailored substance use treatments for adolescents with children. Job training and educational support may improve outcomes.

Association of race and age with treatment attendance and completion among adult marijuana users in community-based substance abuse treatment.

OBJECTIVES: African American youth who use marijuana are less likely to attend and complete treatment than white youth. Limited information is available on racial and age variation in treatment attendance and completion among adults who use marijuana. METHODS: The current research examined differences in community-based substance abuse treatment attendance and completion between adult African American and white marijuana users in 2 independent samples from the US southeastern (N = 160; 70.6% African American) and mid-Atlantic (N = 450; 34.7% African American) regions. OUTCOMES: Attended at least 3 treatment sessions, successful treatment completion, number of days in treatment, and percentage of positive urine drug screens. Adjusted regression models examined the association of race, age, and the interaction of race and age with treatment attendance and completion. RESULTS: In the southeastern sample, successful treatment completion was significantly associated with the interaction of race and age (adjusted odds ratio = 1.35, 95% confidence interval = 1.08-1.69); whereas younger African Americans were less likely to complete treatment than older African Americans, age was unrelated to treatment completion among whites. In the mid-Atlantic sample, African Americans were significantly less likely to attend at least 3 treatment sessions (adjusted odds ratio = 0.37, 95% confidence interval = 0.23-0.58), and younger adult marijuana users were retained for fewer days in treatment (adjusted ß = 0.13, 95% confidence interval = 0.27-2.48). Among African Americans, 37.9% (SD = 38.0) of urine drug screens tested positive for at least 1 illicit drug, and among whites, 34.2% (SD = 37.8%) tested positive; the percentage of positive urine drug screens was not associated with race or age. CONCLUSIONS: Among marijuana-using adults, treatment attendance and completion differ by race and age, and improvements in treatment completion may occur as some African Americans mature out of young adulthood.