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1.
Addict Behav ; 124: 107106, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34530206

RESUMO

BACKGROUND AND AIMS: Negative affect and alcohol craving are common features of Alcohol Use Disorder (AUD). Both independently contribute to AUD severity and poorer treatment outcomes, but their relationship is poorly understood. Multidimensional alcohol craving measures now allow for examination of key dimensions of craving. This study explored the relationship between depression, anxiety, stress, and the alcohol craving dimensions of intensity, imagery and intrusiveness. METHOD: Five-hundred and twenty-five treatment seeking AUD patients (mean age of 39.79 years, SD = 11.57 years, 67% male) completed the Depression Anxiety Stress Scales (DASS), Alcohol Use Disorder Identification Test-Consumption items (AUDIT-C), and Alcohol Craving Experience (ACE-F) questionnaire, which measured the frequency of craving intensity, imagery and intrusiveness. Regression models predicted main effects of predictors and moderation by alcohol consumption. RESULTS: Higher levels of stress were independently associated with increased craving intensity, imagery and intrusiveness. Significant positive associations were also found between anxiety and craving imagery. The association between depression and craving was not significant after controlling for other predictors. CONCLUSIONS: AUD patients experienced higher cravings when stressed and greater imagery when anxious. These results support the need to consider the relationships between stress and craving when managing alcohol dependence.


Assuntos
Alcoolismo , Fissura , Adulto , Consumo de Bebidas Alcoólicas , Alcoolismo/epidemiologia , Ansiedade/epidemiologia , Feminino , Humanos , Masculino , Saúde Mental
2.
Front Psychiatry ; 12: 643107, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34262487

RESUMO

Globally, cannabis is the most frequently used controlled substance after alcohol and tobacco. Rates of cannabis use are steadily increasing in many countries and there is emerging evidence that there is likely to be greater risk due to increased concentrations of delta-9-tetrahydrocannabinol (THC). Cannabis use and Cannabis Use Disorder (CUD) has been linked to a wide range of adverse health outcomes. Several biological, psychological, and social risk factors are potential targets for effective evidence-based treatments for CUD. There are no effective medications for CUD and psychological interventions are the main form of treatment. Psychological treatments based on Social Cognitive Theory (SCT) emphasize the importance of targeting 2 keys psychological mechanisms: drug outcome expectancies and low drug refusal self-efficacy. This mini-review summarizes the evidence on the role of these mechanisms in the initiation, maintenance, and cessation of cannabis use. It also reviews recent evidence showing how these psychological mechanisms are affected by social and biologically-based risk factors. A new bioSocial Cognitive Theory (bSCT) is outlined that integrates these findings and implications for psychological cannabis interventions are discussed. Preliminary evidence supports the application of bSCT to improve intervention outcomes through better targeted treatment.

3.
Drug Alcohol Depend ; 194: 216-224, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30453107

RESUMO

BACKGROUND: The bioSocial Cognitive Theory (bSCT) hypothesizes two pathways linking dimensions of impulsivity to substance use. The first predicts that the association between reward sensitivity and substance use is mediated by positive outcome expectancies. The second predicts that the relationship between rash impulsiveness and substance use is mediated by refusal self-efficacy. This model has received empirical support in studies of alcohol use. The present research provides the first application of bSCT to a cannabis treatment population and aims to extend its utility to understanding cannabis use and severity of dependence. DESIGN: 273 patients referred for cannabis treatment completed a clinical assessment that contained measures of interest. SETTING: A public hospital alcohol and drug clinic. MEASUREMENTS: The Sensitivity to Reward Scale, Dysfunctional Impulsivity Scale, Cannabis Expectancy Questionnaire, Cannabis Refusal Self-Efficacy Questionnaire and Severity of Dependence Scale-Cannabis were completed, along with measures of cannabis consumption. FINDINGS: The bSCT model provided a good fit to the data for cannabis use and severity of dependence outcomes. The association between reward sensitivity and each cannabis outcome was fully mediated by positive cannabis expectancies and cannabis refusal self-efficacy. The relationship between rash impulsiveness and each cannabis outcome was fully mediated by cannabis refusal self-efficacy. CONCLUSIONS: Findings support the application of the bSCT model to cannabis use and dependence severity and highlight the important role of social cognitive mechanisms in understanding the association between impulsivity traits and these outcomes. The differential association of impulsivity traits to social cognition may assist targeted treatment efforts.


Assuntos
Cognição , Abuso de Maconha/psicologia , Abuso de Maconha/terapia , Modelos Psicológicos , Encaminhamento e Consulta , Comportamento Social , Adulto , Cognição/fisiologia , Estudos Transversais , Feminino , Humanos , Comportamento Impulsivo/fisiologia , Masculino , Encaminhamento e Consulta/tendências , Recompensa , Autoeficácia , Inquéritos e Questionários , Resultado do Tratamento
4.
Drug Alcohol Depend ; 170: 142-146, 2017 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-27894043

RESUMO

BACKGROUND AND AIMS: Relatively few cannabis dependent individuals seek treatment and little is known about the determinants of treatment seeking. Social Cognitive Theory (SCT) provides a useful framework for examining human behaviour and motivation which may be helpful in explaining treatment seeking. This study examined the differences in cannabis outcome expectancies and cannabis refusal self-efficacy between treatment seekers and non-treatment seekers with cannabis dependence. DESIGN: Non-treatment seekers were referred to an illicit drug diversion program. Treatment seekers commenced an outpatient cannabis treatment program and completed a comprehensive assessment that included measures of cannabis outcome expectancies and refusal self-efficacy. SETTING: A public hospital alcohol and drug outpatient clinic. PARTICIPANTS: 269 non-treatment seekers and 195 individuals commencing cannabis dependence treatment. MEASUREMENTS: The Cannabis Expectancy Questionnaire (CEQ), Cannabis Refusal Self-Efficacy Questionnaire (CRSEQ), Severity of Dependence Scale - Cannabis (SDS-C), General Health Questionnaire (GHQ-28) and Readiness to Change Questionnaire (RTC) were completed. FINDINGS: Treatment seekers had significantly higher levels of negative cannabis outcome expectancies and significantly lower levels of emotional relief refusal self-efficacy (belief in ability to resist using cannabis when experiencing negative affect) (ps<0.001). Treatment seekers had significantly higher levels of psychological distress and self-perceived cannabis dependence compared to non-treatment seekers (ps<0.001). CONCLUSIONS: High negative cannabis outcome expectancies and low emotional relief refusal self-efficacy may play a key role in motivation to seek treatment.


Assuntos
Cognição , Abuso de Maconha/psicologia , Abuso de Maconha/terapia , Motivação , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Autoeficácia , Comportamento Social , Adulto , Feminino , Humanos , Masculino , Inquéritos e Questionários
5.
Drug Alcohol Depend ; 170: 74-81, 2017 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-27883947

RESUMO

BACKGROUND: Drug-related outcomes expectancies and refusal self-efficacy are core components of Social Cognitive Theory. Both predict treatment outcome in alcohol use disorders. Few studies have reported expectancies and refusal self-efficacy in cannabis dependence. None have examined both, although both constructs are key targets in Cognitive-Behavioural Therapy (CBT). This study tests the predictive role of expectancies and refusal self-efficacy in treatment outcome for cannabis dependence. DESIGN: Outpatients completed a comprehensive assessment when commencing cannabis treatment and predictors of treatment outcome were tested. SETTING: A university hospital alcohol and drug outpatient clinic. PARTICIPANTS: 221 cannabis-dependent patients participated in a 6-week CBT program where the goal was abstinence. MEASUREMENTS: Cannabis Expectancy Questionnaire and Cannabis Refusal Self-Efficacy Questionnaire, cannabis dependence severity [Severity of Dependence Scale], psychological distress [General Health Questionnaire] at baseline; the timeline follow-back procedure at baseline and each session. FINDINGS: Patients reporting lower confidence in their ability to resist cannabis during high negative affect (emotional relief refusal self-efficacy) had a lower likelihood of abstinence (p=0.004), more days of use (p<0.001), and larger amount used (p<0.001). Negative cannabis expectancies predicted greater likelihood of abstinence (p=0.024). Higher positive expectancies were associated with lower emotional relief self-efficacy, mediating its association with outcome (p<0.001). CONCLUSIONS: Emotional relief refusal self-efficacy and negative expectancies are predictive of better treatment outcomes for cannabis dependence. Positive expectancies may indirectly predict poorer outcome because of a negative association with self-efficacy, but this conclusion remains tentative as directionality could not be established.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Abuso de Maconha/terapia , Autoeficácia , Estresse Psicológico/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Abuso de Maconha/diagnóstico , Abuso de Maconha/psicologia , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
6.
Addiction ; 109(5): 728-35, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24400950

RESUMO

BACKGROUND AND AIMS: Research into craving is hampered by lack of theoretical specification and a plethora of substance-specific measures. This study aimed to develop a generic measure of craving based on elaborated intrusion (EI) theory. Confirmatory factor analysis (CFA) examined whether a generic measure replicated the three-factor structure of the Alcohol Craving Experience (ACE) scale over different consummatory targets and time-frames. DESIGN: Twelve studies were pooled for CFA. Targets included alcohol, cigarettes, chocolate and food. Focal periods varied from the present moment to the previous week. Separate analyses were conducted for strength and frequency forms. SETTING: Nine studies included university students, with single studies drawn from an internet survey, a community sample of smokers and alcohol-dependent out-patients. PARTICIPANTS: A heterogeneous sample of 1230 participants. MEASUREMENTS: Adaptations of the ACE questionnaire. FINDINGS: Both craving strength [comparative fit indices (CFI = 0.974; root mean square error of approximation (RMSEA) = 0.039, 95% confidence interval (CI) = 0.035-0.044] and frequency (CFI = 0.971, RMSEA = 0.049, 95% CI = 0.044-0.055) gave an acceptable three-factor solution across desired targets that mapped onto the structure of the original ACE (intensity, imagery, intrusiveness), after removing an item, re-allocating another and taking intercorrelated error terms into account. Similar structures were obtained across time-frames and targets. Preliminary validity data on the resulting 10-item Craving Experience Questionnaire (CEQ) for cigarettes and alcohol were strong. CONCLUSIONS: The Craving Experience Questionnaire (CEQ) is a brief, conceptually grounded and psychometrically sound measure of desires. It demonstrates a consistent factor structure across a range of consummatory targets in both laboratory and clinical contexts.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Comportamento Aditivo/psicologia , Fissura , Fumar/psicologia , Adolescente , Adulto , Idoso , Cacau , Etanol , Análise Fatorial , Feminino , Alimentos , Humanos , Masculino , Pessoa de Meia-Idade , Teoria Psicológica , Inquéritos e Questionários , Produtos do Tabaco , Adulto Jovem
7.
Addiction ; 109(1): 111-9, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24112822

RESUMO

BACKGROUND AND AIMS: Self-efficacy beliefs and outcome expectancies are central to Social Cognitive Theory (SCT). Alcohol studies demonstrate the theoretical and clinical utility of applying both SCT constructs. This study examined the relationship between refusal self-efficacy and outcome expectancies in a sample of cannabis users, and tested formal mediational models. DESIGN: Patients referred for cannabis treatment completed a comprehensive clinical assessment, including recently validated cannabis expectancy and refusal self-efficacy scales. SETTING: A hospital alcohol and drug out-patient clinic. PARTICIPANTS: Patients referred for a cannabis treatment [n = 1115, mean age 26.29, standard deviation (SD) 9.39]. MEASUREMENTS: The Cannabis Expectancy Questionnaire (CEQ) and Cannabis Refusal Self-Efficacy Questionnaire (CRSEQ) were completed, along with measures of cannabis severity [Severity of Dependence Scale (SDS)] and cannabis consumption. FINDINGS: Positive (ß = -0.29, P < 0.001) and negative (ß = -0.19, P < 0.001) cannabis outcome expectancies were associated significantly with refusal self-efficacy. Refusal self-efficacy, in turn, fully mediated the association between negative expectancy and weekly consumption [95% confidence interval (CI) = 0.03, 0.17] and partially mediated the effect of positive expectancy on weekly consumption (95% CI = 0.06, 0.17). CONCLUSIONS: Consistent with Social Cognitive Theory, refusal self-efficacy (a person's belief that he or she can abstain from cannabis use) mediates part of the association between cannabis outcome expectancies (perceived consequences of cannabis use) and cannabis use.


Assuntos
Atitude , Abuso de Maconha/reabilitação , Autoeficácia , Adolescente , Adulto , Feminino , Humanos , Masculino , Abuso de Maconha/psicologia , Teoria Psicológica , Resultado do Tratamento , Adulto Jovem
8.
Front Psychiatry ; 4: 79, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23966956

RESUMO

BACKGROUND: Population-based surveys demonstrate cannabis users are more likely to use both illicit and licit substances, compared with non-cannabis users. Few studies have examined the substance use profiles of cannabis users referred for treatment. Co-existing mental health symptoms and underlying cannabis-related beliefs associated with these profiles remains unexplored. METHODS: Comprehensive drug use and dependence severity (Severity of Dependence Scale-Cannabis) data were collected on a sample of 826 cannabis users referred for treatment. Patients completed the General Health Questionnaire, Cannabis Expectancy Questionnaire, Cannabis Refusal Self-Efficacy Questionnaire, and Positive Symptoms and Manic-Excitement subscales of the Brief Psychiatric Rating Scale. Latent class analysis was performed on last month use of drugs to identify patterns of multiple drug use. Mental health comorbidity and cannabis beliefs were examined by identified drug use pattern. RESULTS: A three-class solution provided the best fit to the data: (1) cannabis and tobacco users (n = 176), (2) cannabis, tobacco, and alcohol users (n = 498), and (3) wide-ranging substance users (n = 132). Wide-ranging substance users (3) reported higher levels of cannabis dependence severity, negative cannabis expectancies, lower opportunistic, and emotional relief self-efficacy, higher levels of depression and anxiety and higher manic-excitement and positive psychotic symptoms. CONCLUSION: In a sample of cannabis users referred for treatment, wide-ranging substance use was associated with elevated risk on measures of cannabis dependence, co-morbid psychopathology, and dysfunctional cannabis cognitions. These findings have implications for cognitive-behavioral assessment and treatment.

9.
Drug Alcohol Depend ; 125(3): 244-51, 2012 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-22445623

RESUMO

BACKGROUND: There are few valid clinical assessment instruments for cannabis. Self-efficacy, or the ability of users to resist temptation, is a central feature of social cognitive theory. This study outlines the development and validation of the cannabis refusal self-efficacy questionnaire (CRSEQ), which measures the situational confidence to refuse cannabis. METHOD: One thousand two hundred and forty-six patients referred for cannabis assessment completed the CRSEQ including measures of cannabis consumption and dependence severity (severity of dependence scale-cannabis, SDS-C). The CRSEQ was subject to independent exploratory (n=621, mean age 26.88, 78.6% male) and confirmatory (n=625, mean age 27.51, 76.8% male) factor analysis. RESULTS: Three factors: Emotional Relief, Opportunistic and Social Facilitation were identified. They provided a good statistical and conceptual fit for the data. Emotional relief cannabis refusal self-efficacy was identified as most predictive of cannabis dependence, after controlling for cannabis consumption. CONCLUSIONS: The CRSEQ is recommended as a psychometrically sound and clinically useful measure for cannabis misuse treatment planning and assessment.


Assuntos
Abuso de Maconha/psicologia , Abuso de Maconha/reabilitação , Testes Neuropsicológicos , Autoeficácia , Adulto , Sinais (Psicologia) , Demografia , Emoções/fisiologia , Análise Fatorial , Feminino , Nível de Saúde , Humanos , Masculino , Valor Preditivo dos Testes , Análise de Componente Principal , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes , Fatores Sexuais , Meio Social , Inquéritos e Questionários
10.
Drug Alcohol Depend ; 115(3): 167-74, 2011 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-21163593

RESUMO

BACKGROUND: Outcome expectancies are a key cognitive construct in the etiology, assessment and treatment of Substance Use Disorders. There is a research and clinical need for a cannabis expectancy measure validated in a clinical sample of cannabis users. METHOD: The Cannabis Expectancy Questionnaire (CEQ) was subjected to exploratory (n=501, mean age 27.45, 78% male) and confirmatory (n=505, mean age 27.69, 78% male) factor analysis in two separate samples of cannabis users attending an outpatient cannabis treatment program. Weekly cannabis consumption was clinically assessed and patients completed the Severity of Dependence Scale-Cannabis (SDS-C) and the General Health Questionnaire (GHQ-28). RESULTS: Two factors representing Negative Cannabis Expectancies and Positive Cannabis Expectancies were identified. These provided a robust statistical and conceptual fit for the data. Internal reliabilities were high. Negative expectancies were associated with greater dependence severity (as measured by the SDS) and positive expectancies with higher consumption. The interaction of positive and negative expectancies was consistently significantly associated with self-reported functioning across all four GHQ-28 scales (Somatic Concerns, Anxiety, Social Dysfunction and Depression). Specifically, within the context of high positive cannabis expectancy, higher negative expectancy was predictive of more impaired functioning. By contrast, within the context of low positive cannabis expectancy, higher negative expectancy was predictive of better functioning. CONCLUSIONS: The CEQ is the first cannabis expectancy measure to be validated in a sample of cannabis users in treatment. Negative and positive cannabis expectancy domains were uniquely associated with consumption, dependence severity and self-reported mental health functioning.


Assuntos
Abuso de Maconha/diagnóstico , Abuso de Maconha/reabilitação , Inquéritos e Questionários , Adulto , Cannabis/efeitos adversos , Cannabis/metabolismo , Análise Fatorial , Feminino , Humanos , Masculino , Abuso de Maconha/epidemiologia , Abuso de Maconha/psicologia , Fumar Maconha/epidemiologia , Modelos Teóricos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
11.
J Inherit Metab Dis ; 33 Suppl 3: S417-20, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20882350

RESUMO

Investigations into the biochemical markers associated with executive function (EF) impairment in children with early and continuously treated phenylketonuria (ECT-PKU) remain largely phenylalanine-only focused, despite experimental data showing that a high phenylalanine:tyrosine (phe:tyr) ratio is more strongly associated with EF deficit than phe alone. A high phe:tyr ratio is hypothesized to lead to a reduction in dopamine synthesis within the brain, which in turn results in the development of EF impairment. This paper provides a snapshot of current practice in the monitoring and/or treatment of tyrosine levels in children with PKU, across 12 countries from Australasia, North America and Europe. Tyrosine monitoring in this population has increased over the last 5 years, with over 80% of clinics surveyed reporting routine monitoring of tyrosine levels in infancy alongside phe levels. Twenty-five percent of clinics surveyed reported actively treating/managing tyrosine levels (with supplemental tyrosine above that contained in PKU formulas) to ensure tyrosine levels remain within normal ranges. Anecdotally, supplemental tyrosine has been reported to ameliorate symptoms of both attention deficit hyperactivity disorder and depression in this population. EF assessment of children with ECT-PKU was likewise highly variable, with 50% of clinics surveyed reporting routine assessments of intellectual function. However when function was assessed, test instruments chosen tended towards global measures of IQ prior to school entry, rather than specific assessment of EF development. Further investigation of the role of tyrosine and its relationship with phe and EF development is needed to establish whether routine tyrosine monitoring and increased supplementation is recommended.


Assuntos
Suplementos Nutricionais , Fenilcetonúrias/sangue , Fenilcetonúrias/terapia , Padrões de Prática Médica , Tirosina/sangue , Tirosina/uso terapêutico , Adolescente , Australásia , Biomarcadores/metabolismo , Criança , Pré-Escolar , Cognição , Suplementos Nutricionais/efeitos adversos , Europa (Continente) , Função Executiva , Pesquisas sobre Atenção à Saúde , Humanos , Lactente , Recém-Nascido , Testes de Inteligência , Testes Neuropsicológicos , América do Norte , Fenilalanina/sangue , Fenilcetonúrias/diagnóstico , Fenilcetonúrias/metabolismo , Fenilcetonúrias/psicologia , Valor Preditivo dos Testes , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Tirosina/efeitos adversos
12.
Br J Health Psychol ; 13(Pt 3): 435-48, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17535506

RESUMO

OBJECTIVES: The present research examined the sun protection intentions and behaviours of young people in a high risk skin cancer area using an extended theory of planned behaviour (TPB) incorporating additional social influences of group and image norms. DESIGN: The study employed a prospective design to examine young people's sun protection intentions and behaviour. METHOD: Participants (N=1,134), aged 12-20 years, were students (school, university, TAFE) and young employees living in Queensland, Australia. Participants completed a questionnaire assessing the TPB predictors (attitude, subjective norm, perceived behavioural control) and additional social influences (group norm, image norm) of sun protection intentions. Two weeks later, participants (N=734) reported their sun protection behaviour for the previous fortnight. RESULTS: Results revealed that the TPB variables of attitude, subjective norm and perceived behavioural control and the additional social influence variable of group norms, but not image norms, emerged as significant predictors of intentions to engage in sun protection. The extended TPB variables accounted for 36% of the variance in intentions. For behaviour, the extended TPB variables accounted for 27% of the variance with both intention and, unexpectedly, group norm as the significant direct predictors of sun protective behaviours. CONCLUSIONS: Results of this study provide support for the application of the TPB in the sun safety context and highlight the importance of considering the influence of group norms in the development of future interventions to increase young people's sun protection intentions and behaviour.


Assuntos
Clima , Helioterapia , Teoria Psicológica , Assunção de Riscos , Segurança , Comportamento Social , Queimadura Solar/prevenção & controle , Adolescente , Adulto , Austrália , Criança , Feminino , Humanos , Masculino , Estudos Prospectivos , Identificação Social
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