Comparative feasibility and preliminary efficacy of CBT for insomnia among adults seeking and not seeking addiction treatment.

Two out of three adults seeking treatment for alcohol or other substance use disorders report co-occurring symptoms of insomnia. This study compared the feasibility, acceptability, and preliminary efficacy of cognitive behavioural therapy for insomnia (CBT-I) among adults seeking and not seeking treatment for substance use. Adults with alcohol or other substance use disorders (n = 22, 32% female, 82% White; Mage = 39.5) completed assessments at baseline, post-treatment, and at 6 week follow-up. Of those, 11 were and 11 were not enrolled in substance use treatment. All received CBT-I. Multiple imputation was used for missing data. Data were analysed using repeated measures analyses of variance. In the substance use treatment group, 6/11 completed post and 5/11 completed follow-up. In the non-treatment group, 9/11 completed post and 7/11 completed follow-up. Participants in both groups reported improvements in insomnia severity, sleep onset latency, and dysfunctional beliefs about sleep, with most effects evident at post and follow-up. There was a marginal group-by-time interaction in the change in frequency of substance use, with only participants not in substance use treatment reporting decreases at follow-up. Participants in substance use treatment reported significant reductions in substance-related problems and symptoms of post-traumatic stress disorder over time; however, they also reported more symptoms at baseline. CBT-I produces similar reductions in insomnia but is relatively less feasible among individuals in (versus not in) treatment for substance use disorder. This may be due to the more complex logistics of accessing CBT-I among those in treatment. We speculate that integrating CBT-I into treatment for addictions may improve feasibility in this population. clinicaltrials.gov NCT04198311.

Implementing an EMA burst design in community-engaged research: participant and researcher perspectives and recommendations.

Background: Implementing ecological momentary assessment (EMA) methodology to evaluate the substance use disorder (SUD) treatment pipeline has clear advantages, including learning about participants' day-to-day experiences to aid in the improvement of services and accessibility for those seeking treatment. Given that the SUD treatment pipeline spans long periods of time, EMA burst designs (deployment of multiple short EMA periods spread over time) can be advantageous for evaluating the treatment pipeline over time while keeping participant burden low.Objectives: This feasibility study describes (1) the process and study design of implementing EMA burst methodology to evaluate the SUD treatment pipeline experience; (2) study implementation from the perspective of researchers, including discussion of collaboration with community partners; and (3) participant feedback on the experience of engaging with this type of research.Method: EMA metrics, feasibility ratings, and general experience ratings in the study are presented from 22 participants (64% women) who participated in a parent EMA study evaluating the SUD treatment pipeline and 8 who provided feedback in a follow-up survey.Results: Participants found the EMA burst design to be acceptable and not burdensome, although technology issues were present for some participants. Steps to partnering with community treatment programs and implementation of a burst design are outlined.Conclusions: Strategies and recommendations for implementation of an EMA burst study with community partners are provided, including aspects of study design, technology issues, retention, and funding.

Virtual training and technical assistance: a shift in behavioral health workforce access and perceptions of services during emergency restrictions.

BACKGROUND: To respond to the COVID-19 pandemic, the Substance Abuse and Mental Health Services Administration-funded Technology Transfer Centers had to rapidly adapt to ensure that the behavioral health workforce had continuous access to remote training and technical assistance (TTA). Although the Technology Transfer Centers have historically relied partially upon virtual methods for delivering TTA, the shift to a strictly virtual approach necessitated by COVID-19 restrictions has raised new questions for how to best proceed with services when social distancing guidelines are relaxed. The objective of this exploratory paper was to compare TTA provision in the six-month period prior to (9/1/19 thru 2/28/20) and during (4/1/20 thru 9/30/20) early COVID-19 restrictions to determine the extent to which the shift to virtual service provision impacted the behavioral health and medical workforce. Specifically, we examined participants' access to TTA, geographic reach of TTA, and workforce perceptions of satisfaction and utility with TTA provision. METHOD: Participant and event-level data were analyzed to compare the following metrics before and during the COVID pandemic: number of events and attendees; participant demographics; zip codes reached; coverage of rural, suburban, and urban areas; and perceptions of satisfaction with and utility of training. RESULTS: Findings showed a 40% increase in the number of events delivered (p < .001) and a 270% increase in the number of attendees (p < .001) during the COVID period when TTCs relied exclusively on virtual delivery. Geospatial analyses linking zip codes to a schematic of rural, suburban, and urban classifications throughout the United States revealed significant increases in the number of zip codes reached during the COVID time period. Satisfaction levels were comparable before and during the pandemic. CONCLUSIONS: Findings show that expanded access to TTA services via virtual formats resulted in reach to more diverse attendees and regions, and did not come at the expense of satisfaction. Results suggest that virtual TTA should continue to be an important component of TTA offerings post-pandemic.

Psychiatric Comorbidity as a Function of Severity: DSM-5 Alcohol Use Disorder and HiTOP Classification of Mental Disorders.

BACKGROUND: Understanding the comorbidity of alcohol use disorder (AUD) and other psychiatric diagnoses has been a long-standing interest of researchers and mental health professionals. Comorbidity is often examined via the diagnostic co-occurrence of discrete, categorical diagnoses, which is incongruent with increasingly supported dimensional approaches of psychiatric classification and diagnosis, and for AUD more specifically. The present study examined associations between DSM-5 AUD and psychiatric symptoms of other DSM-IV and DSM-5 disorders categorically, and dimensionally organized according to the Hierarchical Taxonomy of Psychopathology (HiTOP) spectra (e.g., Internalizing, Disinhibited Externalizing). METHODS: The comorbidity of AUD with other psychological disorders was examined in 2 independent nationally representative samples of past-year drinkers via an initial examination in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) Wave 2 and replicated in NESARC-III. RESULTS: Analyses focusing on psychopathology symptom counts organized by spectra demonstrated that greater AUD severity was associated with a higher number of symptoms across HiTOP spectra. Traditional categorical analyses also demonstrated increasing prevalence as a monotonic function of DSM-5 AUD severity gradients. CONCLUSIONS: This study indicates that AUD and other psychiatric disorder comorbidity implies increased presence of multiple forms of psychopathology with a corresponding increased number of symptoms across hierarchical spectra. Greater AUD severity increases the likelihood of other psychopathology and, when present, "more severe" presentations. That is, on average, a given disorder (e.g., depression) is more severe when copresenting with an AUD, and increases in severity along with the AUD.

Foundations of Arrogance: A Broad Survey and Framework for Research.

We consider the topic of arrogance from a cross-disciplinary viewpoint. To stimulate further research, we suggest three types of arrogance (individual, comparative, and antagonistic) and six components contributing to them, each logically related to the next. The components progress from imperfect knowledge and abilities to an unrealistic assessment of them, an unwarranted attitude of superiority over other people, and related derisive behavior. Although each component presumably is present to some degree when the next one operates, causality might flow between components in either direction. The classification of components of arrogance should reduce miscommunication among researchers, as the relevant concepts and mechanisms span cognitive, motivational, social, and clinical domains and literatures. Arrogance is an important concept warranting further study for both theoretical and practical reasons, in both psychopathology and normal social interaction. Everyone seems to have qualities of arrogance to some degree, and we consider the importance of arrogance on a spectrum. We contend that humankind can benefit from a better understanding of the cognitive limitations and motivational biases that, operating together, appear to contribute to arrogance. We bring together information and questions that might lead to an invigorating increase in the rate and quality of cross-disciplinary research on arrogance.

Alcohol and cannabis co-use: Receptiveness to treatments and application to intervention planning.

Given the prevalence of alcohol and cannabis co-use among college students, prevention for co-use is crucial. We examined hypothetical receptiveness to substance-specific interventions among students who reported co-use. Students who use alcohol and cannabis were more receptive to alcohol interventions than cannabis interventions. Campus prevention experts should consider offering evidence-based alcohol-focused interventions as a potential pathway for decreasing substance use among college students who engage in co-use.

The Brief Emotion Dysregulation Scale: Development, Preliminary Validation, and Recommendations for Use.

Emotion dysregulation is a multi-faceted, transdiagnostic construct, and its assessment is crucial for characterizing its role in the development, maintenance, and treatment of psychiatric problems. We developed the Brief Emotion Dysregulation Scale (BEDS) to capture four components of emotion dysregulation: sensitivity, lability, reactivity, and consequences. We examined factor structure and construct validity in four independent samples of college students (N = 1,485). We elected to treat consequences as a separate index of problems associated with emotion dysregulation. Exploratory and confirmatory factor analyses did not support the reactivity subscale and instead supported a well-fitting two-factor solution for sensitivity and lability. Multi-group analyses demonstrated strong factorial invariance by gender. The resulting 12-item BEDS includes sensitivity and lability subscales and a separate consequences scale to indicate associated problems. Convergent correlations suggested good construct validity. This provides preliminary support for the BEDS as a brief transdiagnostic screening tool for emotion dysregulation and associated consequences.

College students' receptiveness to intervention approaches for alcohol and cannabis use.

OBJECTIVE: Addressing high-risk alcohol and cannabis use represent major challenges to institutions of higher education. A range of evidence-based treatment approaches are available, but little is known concerning students' receptiveness to such approaches. Prior work identified that students were most open to individual therapy and self-help options for reducing alcohol use, but less open to medication. The current study examines student receptiveness to intervention approaches across a wider range of intervention approaches (e.g., remote/telehealth), and extends to evaluate cannabis intervention receptiveness. METHOD: Undergraduate students reported on alcohol and cannabis use, motives for and reasons against use, and openness to an array of interventions for reducing alcohol and cannabis use. RESULTS: Informal options (self-help, talking with family/friends), individual therapy, and appointments with a primary care provider (PCP) were endorsed most frequently. Group therapy and medication were less commonly endorsed, though medication was endorsed at a higher prevalence than in prior studies. Women generally expressed higher receptiveness than men. Lower alcohol consumption was associated with increased receptiveness to some approaches. Students at high risk for alcohol and/or cannabis dependence were less receptive to many treatment options. CONCLUSIONS: College students were open to a wide variety of approaches for reducing their alcohol and cannabis use. These results can inform selection, implementation, and availability of campus-wide services, especially as low-cost technological-based approaches are expanding. Further attention to existing services (e.g., PCP) for addressing alcohol and cannabis use may be considered, given students' receptiveness to such approaches. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Who Opts In to Alcohol Feedback and How Does That Impact Behavior? A Pilot Trial.

OBJECTIVE: Personalized feedback interventions are effective in reducing alcohol consumption and related problems. However, little is known about the role of choice in outcomes. The current study sought to (a) characterize individuals who opt in for brief alcohol-related feedback, (b) assess participants' consistency in that choice over two time points, and (c) evaluate changes in peak alcohol consumption among those who did and did not receive feedback. METHOD: Participants reporting past-12-month alcohol consumption were recruited through Prolific. At the outset of the survey, participants were asked if they would like to receive feedback on their drinking at the end of the survey ("opt in"). Participants at Time 1 (T1; N = 732) were 41% female, 91% White, and 8% Hispanic (mean age = 36, SD = 12.25, range: 18-80). A subset was invited back for a 30-day retest (Time 2 [T2]; n = 234). RESULTS: Those reporting higher maximum drinks and more drug use were more likely to opt in to feedback than those with lower use. Further, 85% of participants were consistent in their choice of whether to receive feedback across T1 and T2 (κ = .65). Among heavy drinking participants with T1 and T2 data (n = 163), there was an effect of feedback on intensity of consumption at T2. CONCLUSIONS: Individuals who engage in heavy alcohol use are more likely to opt in to personalized alcohol feedback, and most do so consistently. Among heavy drinkers, feedback at T1 reduced intensity of consumption at T2, but the effect was small and requires future replication in more diverse samples.

Simultaneous use of alcohol and cigarettes in a mixed psychiatric sample: Daily-life associations with smoking motives, craving, stimulation, sedation, and affect.

Co-use of alcohol and cigarettes is common and associated with greater negative consequences compared to use of either substance alone. Furthermore, alcohol and cigarettes are often used at the same time, and these "simultaneous" use events are associated with greater consumption of each substance. Given the prevalence and negative consequences associated with this pattern, we sought to identify proximal predictors and reinforcers of simultaneous use in individuals with a range of emotional and behavioral dysregulation who may be at greater risk of experiencing substance-related problems. Specifically, 41 adults who drank alcohol and smoked cigarettes (28 with borderline personality disorder and 13 community individuals) completed 21 days of ecological momentary assessment (EMA). First, we used multilevel models on cigarette-use moments to examine whether momentary cigarette motive endorsement differed based on whether participants were also drinking alcohol in that moment. Second, we used multilevel models on all EMA moments to examine whether simultaneous use was associated with greater craving and reinforcing effects compared to use of either substance alone. Participants reported greater enhancement and social motives for smoking cigarettes when also drinking alcohol compared to when they were only smoking. Participants also reported greater alcohol craving, greater sedation, attenuated positive affect, and greater fear following simultaneous use compared to use of either substance alone. Our results add to a growing body of research characterizing proximal influences on simultaneous substance use. Findings highlight potential treatment targets for individuals seeking to better understand or cut down on their use of alcohol, cigarettes, or both. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Co-use of medication and alcohol: The influence on subjective effects of intoxication and affect.

Co-use of alcohol and medication can have serious negative health effects (e.g., overdose risk, liver damage). Research has primarily focused on older adults or the pharmacokinetics of specific medication-alcohol combinations. Little work has focused on the subjective experience of persons who take alcohol-interactive (AI) medications and also drink alcohol, particularly in psychiatric samples at high risk for problematic alcohol use and high rates of prescription medication use, such as individuals with borderline personality disorder (BPD). Data from a larger ecological momentary assessment study of alcohol use in 52 persons diagnosed with BPD (83% women; Mage = 26 years) were used to examine the influence of alcohol intoxication (i.e., estimated blood alcohol concentration [eBAC]) and medication co-use on momentary subjective experience while drinking. Participants reported AI medication use at baseline and completed multiple ecological momentary assessment reports per day over 21 days, which included reports of alcohol use, subjective effects of alcohol (e.g., pleasure, feeling worse), and negative and positive affect. AI medications significantly moderated the association between eBAC and pleasurable effects of alcohol, such that at higher levels of eBAC, those taking AI medications experienced blunted subjective pleasure compared with those not taking AI medications. AI medications did not moderate the associations between eBAC and subjective relief, feeling worse, positive affect, or negative affect. Attenuated pleasure during drinking could lead to increased drinking in an attempt to achieve a desirable state among individuals who co-use psychiatric medications and alcohol, and therefore may represent a useful target for prevention and intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Crisis line services: A 12-month descriptive analysis of callers, call content, and referrals.

Crisis lines are a valuable community resource that anonymously and freely serve those in acute crisis. As a result of anonymity, it has been difficult to fully characterise crisis line services. However, appraising and improving crisis line services for the communities they serve is essential, even with the additional difficulty anonymity poses. This study seeks to increase our understanding of current crisis services and utilisation via a characterisation of various aspects of a United States crisis line service centre over 12-months including features of calls (e.g. call length), callers (e.g. victimisation history), and information provided to the caller (e.g. referrals). We examine five crisis lines totalling 5,001 calls from October 2018 to September 2019. Descriptive information is provided on call volume, patterns across time, caller characteristics, victimisation types, and referrals. Although we were unable to assess prospective outcomes due to anonymity, 99.5% of callers that were asked (61.35% of all calls; n = 3,068) reported the call as helpful. This provides an important overview of crisis line services and suggests they are a valuable community health resource serving a range of callers. Given the findings of the present study, we conclude with a discussion of recommendations and implications for community crisis line centres and future research.

Individual symptoms or categorical diagnoses? An epidemiological examination of the association between alcohol use, personality disorders, and psychological symptoms.

Given the high comorbidity among psychological disorders, and in particular, personality disorders (PDs) and alcohol use disorder, screening and intervention efforts may benefit from the inclusion of transdiagnostic symptoms. Extant symptoms can improve the ability to efficiently gather important information about an individual that relates to a number of conditions, behaviors, and potential problems. Further, less time is needed to assess these symptoms, as compared with full diagnostic criteria sets, which have limitations of their own. This study examined the utility of two PD symptoms, affective instability and impulsivity, as compared with relevant categorical diagnoses (antisocial and borderline PDs), to provide useful information about alcohol use disorder and heaviness of alcohol consumption. Individual symptoms were comparable to the categorical diagnoses in predicting important treatment targets. In an effort to identify and treat comorbidities in a more efficient way, future research should investigate the applicability of these individual symptoms, and other transdiagnostic targets, to screening and brief intervention protocols. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A mixed-method evaluation of the adoption and implementation of the College Alcohol Intervention Matrix among prevention experts: a study protocol.

BACKGROUND: Risky drinking among college campuses has been a long-standing concern and there have been dedicated efforts to develop evidence-based prevention and treatment strategies (EBSs) to decrease alcohol use and increase healthy behaviors among college students. Further, the College Alcohol Intervention Matrix (CollegeAIM) was developed as a tool with accompanying resources, to assist institutions of higher education in selecting EBSs that are appropriate and a good fit for their campuses. However, the CollegeAIM tool and selection of prevention strategies from stakeholders' perspectives has yet to be evaluated. This study protocol describes the methodology for a research project evaluating CollegeAIM from an implementation science perspective using the Exploration, Preparation, Implementation, and Sustainment framework. METHODS: The aims of this study will be accomplished with a mixed-method design comprised of reviews of strategic planning documents, quantitative surveys and interviews with prevention experts, and focus groups to identify key components of a decision-support program for prevention experts to support the use of CollegeAIM. Participants are members of the multi-site Missouri Partners in Prevention coalition to reduce risky substance use on college campuses across the state. DISCUSSION: The results of this study will provide key information to support the development of additional supportive tools for campuses that can improve their selection and implementation of EBSs that fit the needs of their respective campuses. This work is important to further advance the implementation and sustainment of extant EBSs for risky college alcohol use.

A daily-life study of interpersonal stressors and alcohol use in individuals with borderline personality disorder and community controls.

BACKGROUND: Interpersonal stressors (ISs) are major factors in relapse in alcohol use disorder (AUD) and are theorized to play a role in drinking behaviors. Past work has examined this association using ecological momentary assessment (EMA), but the unique effects of rejections and disagreements on alcohol use are unknown. Research suggests the two ISs functionally differ and may display distinct associations with drinking. Further, these associations may differ in people with borderline personality disorder (BPD), a population reporting frequent IS and co-occurring AUD. METHODS: 113 drinkers (community: n = 59; BPD: n = 54) reported alcohol use and ISs using EMA for 21 days. Using generalized estimating equations, we expected that rejection and disagreement would predict increased likelihood of drinking each day. We examined both cumulative (throughout each day) and immediate momentary effects of ISs predicting subsequent drinking on that same day. Further, we predicted that these associations would be stronger in individuals with BPD. RESULTS: Greater rejections throughout the day were associated with a reduced likelihood of drinking that day (OR = 0.56, 95 % CI:[0.32, 0.97], p < .040). In contrast, disagreements immediately prior to drinking were associated with an increased likelihood of drinking that day (OR = 0.60, 95 % CI:[1.02, 2.50], p = .039). However, the effect of disagreement on drinking was moderated by BPD diagnosis (OR = 2.56, 95 % CI:[1.13, 5.80], p = .025), such that the effect was only present for individuals with BPD. CONCLUSIONS: Assessing ISs as an aggregate predictor may mask potentially opposite effects on alcohol use. Additionally, disagreements may be a risk factor for subsequent alcohol use in BPD.

Treatment of personality pathology through the lens of the hierarchical taxonomy of psychopathology: Developing a research agenda.

Despite the emphasis on evidence-based treatment for psychological disorders, to date, there has been limited research examining treatment for nine of the 10 categorical personality disorders in DSM-5 Section 2. This is perhaps not surprising given the complex heterogeneity and co-morbidity within personality pathology. The hierarchical taxonomy of psychopathology (HiTOP) was proposed to address limitations within the traditional categorical model of the diagnostic system. Within this system are five spectra: detachment, antagonistic externalizing, disinhibited externalizing, thought disorder and internalizing. These foundational personality traits potentially have direct and specific treatment implications. The purpose of this paper is to highlight potential psychotherapeutic and pharmacological treatment recommendations within the personality spectra. Additionally, we outline the advantages of considering the personality science found within dimensional models of psychopathology in clinical assessment and intervention to aid in treatment planning. © 2019 John Wiley & Sons, Ltd.

Maladaptive Personality Trait Models: Validating the Five-Factor Model Maladaptive Trait Measures With the Personality Inventory for DSM-5 and NEO Personality Inventory.

Eight measures have been developed to assess maladaptive variants of the five-factor model (FFM) facets specific to personality disorders (e.g., Five-Factor Borderline Inventory [FFBI]). These measures can be used in their entirety or as facet-based scales (e.g., FFBI Affective Dysregulation) to improve the comprehensiveness of assessment of pathological personality. There are a limited number of studies examining these scales with other measures of similar traits (e.g., DSM-5 alternative model). The current study examined the FFM maladaptive scales in relation to the respective general personality traits of the NEO Personality Inventory-Revised and the pathological personality traits of the DSM-5 alternative model using the Personality Inventory for DSM-5. The results indicated the FFM maladaptive trait scales predominantly converged with corresponding NEO Personality Inventory-Revised, and Personality Inventory for DSM-5 traits, providing further validity for these measures as extensions of general personality traits and evidence for their relation to the pathological trait model. Benefits and applications of the FFM maladaptive scales in clinical and research settings are discussed.

Alcohol Use Disorder and Antisocial and Borderline Personality Disorders.

Alcohol use disorder (AUD) frequently co-occurs with other psychiatric disorders, including personality disorders, which are pervasive, persistent, and impairing. Personality disorders are associated with myriad serious outcomes, have a high degree of co-occurrence with substance use disorders, including AUD, and incur significant health care costs. This literature review focuses on co-occurring AUD and personality disorders characterized by impulsivity and affective dysregulation, specifically antisocial personality disorders and borderline personality disorders. Prevalence rates, potential explanations and causal models of co-occurrence, prognoses, and the status of existing treatment research are summarized. Several important future research considerations are relevant to these complex, co-occurring conditions. Research assessing mechanisms responsible for co-occurring AUD and antisocial personality disorder or borderline personality disorder will further delineate the underlying developmental processes and improve understanding of onset and courses. In addition, increased focus on the efficacy and effectiveness of treatments targeting underlying traits or common factors in these disorders will inform future prevention and treatment efforts, as interventions targeting these co-occurring conditions have relatively little empirical support.

Disinhibition as a unifying construct in understanding how personality dispositions undergird psychopathology.

Disinhibition has been a construct of interest for decades, as evidenced by its inclusion in most prominent models of general personality functioning and its link to personality pathology, other psychopathology, health behaviors, and public health concerns. Disinhibition is manifest in behavioral, task based, and physiological measures, and common etiologies are a major reason for the coherence of the domain across a variety of assessment modalities. The current review will provide a summary of the conceptualization of the construct across prominent models, its link to psychopathology and maladaptive behaviors, and its etiology. Finally, we provide discussion on its clinical application utilizing disinhibition to aid in understanding comorbid psychopathology and through a description of its potential use in treatment.

The Five Factor Borderline Inventory: Behavioral outcomes across time.

The Five-Factor Borderline Inventory Short Form (FFBI-SF) is a 48-item dimensional measure of borderline personality disorder (BPD) that was developed from the Five-factor model (FFM). Previous research has examined the relationships of the FFBI-SF to the FFM and BPD. The purpose of the current study was to investigate the relationship of FFBI-SF scales with behavioral outcomes, such as self-injury, physical fights, panic symptoms, promiscuous sex, theft, attempted suicide, reckless driving, and binge eating. A potential advantage of the FFBI-SF, relative to other measures of BPD, is the provision of subscales, which provides a more precise and differentiated assessment. In the current study, the predictive validity of the FFBI-SF in relation to various impulsive behaviors was investigated across a 2-month time period. Additional comparisons were also made with respect to a more traditional measure of borderline personality disorder and an assessment of the normal range of the FFM. Undergraduate students in psychology courses (T1 = 938, T2 = 284, T3 = 163) and workers from Amazon Mechanical Turk (T1 = 215, T2 = 167, T3 = 157) were administered personality measures and a measure of impulsive behaviors across 3 time points. The results are discussed with respect to the comparative validity of the FFBI-SF, relative to traditional measures of borderline personality disorder and the FFM. Overall, the study provided evidence that the FFBI-SF is able to predict specific maladaptive behaviors over time and therefore may be useful in clinical and research settings. (PsycINFO Database Record