The impact of a virtual mind-body program on resilience factors among international English-speaking adults with neurofibromatoses: secondary analysis of a randomized clinical trial.

PURPOSE: To test the effects of the Relaxation Response Resiliency Program - Neurofibromatosis (3RP-NF), a mind-body resilience program for people with NF, on resilience factors from baseline to post-treatment and 6- and 12-month follow-up. METHODS: This is a secondary analysis of a fully powered randomized clinical trial (RCT) of 3RP-NF and health education control (HEP-NF). We recruited adults with NF1, NF2, or schwannomatosis who reported stress or difficulty coping with NF symptoms. Both conditions received 8 weekly 90-minute group sessions; 3RP-NF focused on building resilience skills. We measured resilience factors via the Measure of Current Status-A (adaptive coping), Cognitive and Affective Mindfulness Scale-Revised (mindfulness), Gratitude Questionnaire-6 (gratitude), Life Orientation Test Optimism Scale (optimism), and Medical Outcomes Study Social Support Survey (perceived social support) at baseline, post-intervention, and 6- and 12-month follow-up. We used linear mixed models with completely unstructured covariance across up to four repeated measurements (baseline, post-treatment, and 6- and 12-month follow-up) to investigate treatment effects on resilience factors. RESULTS: We enrolled 228 individuals (Mage=42.7, SD = 14.6; 74.5% female; 87.7% White; 72.8% NF1, 14.0% NF2, 13.2% schwannomatosis). Within groups, both 3RP-NF and HEP-NF showed statistically significant improvements in all outcomes across timepoints. 3RP-NF showed significantly greater improvement in adaptive coping compared to HEP-NF from baseline to post-intervention and baseline to 6 months (Mdifference= 0.29; 95% CI 0.13-0.46; p < 0.001; Mdifference= 0.25; 95% CI 0.07-0.33; p = 0.005); there were no other between-group differences amongst the remaining resilience factors. CONCLUSION: 3RP-NF showed promise in sustainably improving coping abilities amongst people with NF. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov Identifier: NCT03406208. Registration submitted December 6, 2017, first patient enrolled October 2017.

The Role of Safety Behaviors in the Relationship between Social Anxiety and Marijuana Use Problems.

Background: Social anxiety has been associated with higher levels of and more problematic marijuana use. Research suggests that safety behaviors may play a role in the development and maintenance of marijuana problems. However, the safety behaviors that are most commonly associated with social anxiety have not been investigated, nor has the potential moderating role of gender on this relationship. Method: A diverse sample of regular marijuana users (N = 279) completed measures of social anxiety, safety behaviors related to social situations, and marijuana use problems. Results: Social anxiety and safety behavior use were both positively correlated with marijuana use problems. These relationships were stronger in men than in women. Among men only, tendencies to use safety behaviors to cope with social situations accounted for the relationship between social anxiety symptoms and marijuana-related problems. Discussion: The avoidant coping style that characterizes safety behaviors in social anxiety may also underlie problematic patterns of marijuana use, particularly for men. The present study is the first to report an association between safety behaviors in social situations and marijuana use problems and suggests the importance of examining the effect of reducing safety behaviors in social situations, in regular marijuana users with comorbid social anxiety.

Development of the Response to Fearful Situations Scale.

BACKGROUND: Most measures of anxious avoidance are limited to disorder-specific mechanisms and ignore the measurement of courage/approach responding in confronting fearful situations. AIMS: The purpose of the present study was to construct and validate a self-report assessment of the tendency towards avoidant or approach responding in fearful situations, the Response to Fearful Situations Scale (RFSS). METHOD AND RESULTS: In Study 1 (n = 241), exploratory factor analysis resulted in two factors, avoidance and approach. Study 2 (n = 423) replicated the two-factor structure and established test-re-test reliability. In Study 3 (n = 44), the RFSS demonstrated predictive validity on a behavioural avoidance task. In Studies 4 (n = 253) and 5 (n = 256), the RFSS was associated with clinical symptoms above existing measures of avoidance. DISCUSSION: These results validate the use of the RFSS as a transdiagnostic measure of avoidance and approach.

"Not just right" experiences account for unique variance in eating pathology.

"Not just right" experiences (NJREs) are uncomfortable sensations of incompleteness linked to obsessive-compulsive disorder; however, NJREs may be transdiagnostic and play a role in eating pathology. The current study examined relations between NJREs and eating pathology in undergraduate students. Participants (n = 248) completed self-report and behavioral assessments. Controlling for obsessive-compulsive symptoms, negative affect, and perfectionism, NJRE frequency was associated with greater drive for thinness, body dissatisfaction, and bulimic symptoms. Discomfort in response to a visual in vivo NJRE task was positively associated with drive for thinness and body dissatisfaction. The present study provides initial evidence for NJREs in eating pathology. Theoretical implications are discussed.

Grit in patients with substance use disorders.

BACKGROUND AND OBJECTIVES: Grit is an emerging concept in positive psychology, defined as the ability to be persistent and focused in pursuit of long-term goals. This concept has received a great deal of interest recently because of its robust ability to predict success and well-being across a wide variety of domains. The study aim was to examine the clinical relevance of the construct of grit among patients with substance use disorders. METHODS: Inpatients on a detoxification unit were enrolled from September 2013 to August 2015 (N = 673). Psychometric properties of the Short Grit Scale (Grit-S) were reported. We then examined sociodemographic and clinical variables that might be associated with grit in this population. RESULTS: In this sample of patients with substance use disorders, the total Grit-S demonstrated strong psychometric properties. Grit-S scores were higher among older patients and those who were employed; scores were lower among those never married, diagnosed with a co-occurring psychiatric disorder, or who had used heroin during the past month, according to bivariate analyses. Grit-S scores remained associated with age, employment, and presence of a co-occurring psychiatric disorder in adjusted analysis. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: This study provides initial support for the utility of the Grit-S among those with substance use disorders; this novel measure has not been previously reported in clinical populations. Research examining grit prospectively is needed to determine whether the links between grit and outcomes observed in other populations apply to patients with substance use disorders. (Am J Addict 2016;25:652-658).

Identifying patients with problematic drug use in the emergency department: results of a multisite study.

STUDY OBJECTIVE: Drug-related emergency department (ED) visits have steadily increased, with substance users relying heavily on the ED for medical care. The present study aims to identify clinical correlates of problematic drug use that would facilitate identification of ED patients in need of substance use treatment. METHODS: Using previously validated tests, 15,224 adult ED patients across 6 academic institutions were prescreened for drug use as part of a large randomized prospective trial. Data for 3,240 participants who reported drug use in the past 30 days were included. Self-reported variables related to demographics, substance use, and ED visit were examined to determine their correlative value for problematic drug use. RESULTS: Of the 3,240 patients, 2,084 (64.3%) met criteria for problematic drug use (Drug Abuse Screening Test score ≥ 3). Age greater than or equal to 30 years, tobacco smoking, daily or binge alcohol drinking, daily drug use, primary noncannabis drug use, resource-intense ED triage level, and perceived drug-relatedness of ED visit were highly correlated with problematic drug use. Among primary cannabis users, correlates of problematic drug use were age younger than 30 years, tobacco smoking, binge drinking, daily drug use, and perceived relatedness of the ED visit to drug use. CONCLUSION: Clinical correlates of drug use problems may assist the identification of ED patients who would benefit from comprehensive screening, intervention, and referral to treatment. A clinical decision rule is proposed. The correlation between problematic drug use and resource-intense ED triage levels suggests that ED-based efforts to reduce the unmet need for substance use treatment may help decrease overall health care costs.

Improving multimodal physical function in adults with heterogeneous chronic pain; Protocol for a multisite feasibility RCT.

BACKGROUND: Chronic pain is associated with substantial impairment in physical function, which has been identified as a top concern among persons with pain. GetActive-Fitbit, a mind-body activity program, is feasible, acceptable, and associated with improvement in physical function among primarily White, sedentary individuals with pain. In preparation for a multisite efficacy trial, we must examine feasibility across multiple sites with diverse patient populations. Here we describe the protocol of a multisite, feasibility RCT comparing GetActive-Fitbit with a time- and attention-matched educational comparison (Healthy Living for Pain). We aim to 1) test multisite fidelity of clinician training; 2) evaluate multisite feasibility benchmarks, including recruitment of chronic pain patients taking <5000 steps/day and racial and ethnic minorities; and 3) optimize fidelity and study protocol in preparation for a future multisite efficacy trial. METHODS: Clinician training fidelity was assessed via roleplays and mock group sessions. Feasibility (i.e., recruitment, acceptability, credibility, adherence, satisfaction), multimodal physical function (e.g., self-report, 6-Minute Walk Test, step-count), and other psychosocial outcomes are assessed at baseline, posttest, and 6 months. Protocol optimization will be assessed using exit interviews and cross-site meetings. RESULTS: The trial is ongoing. Clinician training is complete. 87 participants have been recruited. 54 completed baseline assessments and randomization, 44 are mid-intervention, and 9 have completed the intervention and posttest. CONCLUSIONS: This study addresses the critical need for feasible, acceptable mind-body-activity interventions for chronic pain that follow evidence-based guidelines and improve all aspects of physical function across diverse populations. Results will inform a future fully-powered multisite efficacy trial. CLINICAL TRIAL REGISTRATION: NCT05700383.

Functional and structural social support in DSM-5 mood and anxiety disorders: A population-based study.

BACKGROUND: Social support has been found to be a key correlate of many psychiatric disorders including several mood and anxiety disorders. However, research on social support is largely investigated in individual disorders, despite the high co-occurrence of these diagnoses, and has typically relied on pre-DSM-5 diagnostic criteria. Additionally, differences in structural and functional social support are rarely explored. Thus, the present study investigated the unique association between these two aspects of social support and past-year DSM-5 mood and anxiety disorders while adjusting for comorbidity and socio-demographic variables. METHODS: Multivariate regression and relative weights analyses were conducted to determine the association of functional and structural social support with these disorders in the National Epidemiologic Survey on Alcohol and Related Conditions consisting of 36,309 participants. RESULTS: Results indicated depression, bipolar I, social anxiety, generalized anxiety, and posttraumatic stress disorder were significantly associated with functional support, while depression and agoraphobia were uniquely associated with structural support. Major depression and persistent depression were the two most important predictors of functional social support. LIMITATIONS: The current study utilized cross-sectional data and does not allow for causal or directional conclusions. Further, additional studies with diverse samples are needed to determine the generalizability of the current results. CONCLUSIONS: This study highlights differences in functional and structural social support in various disorders and explores how this varies when accounting for comorbidity. A deeper understanding of how specific aspects of social support relate to individual psychiatric disorders could inform future prevention and treatment efforts.

Disengagement Training for the Treatment of Pathological Worry: A Preliminary Test.

Pathological worry is characterized by an inability to distract or disengage from worry, and this uncontrollability is the defining feature of generalized anxiety disorder (GAD). The present study assessed a novel computerized strategy that targets these attention difficulties. Worry Disengagement Training (WDT), which involves alternating between writing about one's worry and positive topics, was evaluated in a sample with elevated worry (N = 50), most of whom met for GAD diagnosis (66%). Compared to waitlist, WDT led to increased ability to disengage from in vivo worry on a breath focus task, resulting in fewer negative intrusions (ß = -.29, p = .02; sr2 = .08). Relative to waitlist, WDT also led to lower self-reported general worry (ß = -.36, p = .001, sr2 = .14) and depressive symptoms (ß = -.25, p = .02, sr2 = .07). These effects remained in the subset of participants meeting criteria for GAD. WDT did not impact anxious arousal, suggesting some specificity of effects. These findings provide preliminary support for WDT as an effective strategy to increase disengagement ability and reduce worry and depression. Limitations and future directions are discussed.

Personality disorders and social support in cannabis dependence: A comparison with alcohol dependence.

BACKGROUND: Cannabis use disorder (CUD) has been linked to personality disorders (PDs) and interpersonal problems, though these relationships have been understudied. We examined PDs and social support associated with cannabis dependence and how it may be distinguishable from alcohol dependence on these indices in a large representative sample. METHOD: Data on social support and Diagnostic and Statistical Manual of Mental Disorders-IV substance dependence and PDs were assessed in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N > 34,500). RESULTS: Cannabis dependence was associated with higher rates of personality disorders and lower social support. Lifetime cannabis dependence without alcohol dependence was associated with higher rates of all PDs than alcohol dependence without cannabis dependence (with the exception of borderline PD). Cannabis dependence alone was also associated with lower social support than alcohol dependence alone. LIMITATIONS: The survey was conducted in 2004-2005 and relied on DSM-IV criteria. CONCLUSIONS: These findings highlight a broad range of PDs as well as deficits in social support in cannabis dependence. The potential interrelationships between interpersonal dysfunction and CUD as well as the relevance of PDs to treatment for CUD warrant further research.

Text message safety behavior reduction for social anxiety: A randomized controlled trial.

OBJECTIVE: Cognitive models of social anxiety disorder propose that maladaptive safety behaviors (SBs; i.e., behaviors intended to avoid, prevent, or manage threat) play an important maintaining role in the disorder. Though targeting these behaviors for elimination is one component of contemporary cognitive-behavioral therapies for social anxiety, it has rarely been examined as a specific treatment strategy, and, to our knowledge, it has not yet been examined in isolation as an intervention for social anxiety. The current study evaluated an SB reduction intervention for social anxiety that consisted of brief text message reminders. METHOD: Individuals with elevated social anxiety (N = 94) were recruited from across the United States and randomized to receive one of two 1-month text message interventions consisting of 16 text message reminders to avoid SBs or focus on the present. Symptoms were assessed at pre- and posttreatment, as well as at 1-month follow-up. RESULTS: Both treatments were associated with substantial symptom reduction. Compared to the present-focused text message condition, SB elimination led to lower SB frequency at posttreatment (sr² = .044, p = .048) and lower social anxiety at follow-up (sr² = .096, p = .005). CONCLUSIONS: These preliminary findings provide novel evidence for the importance of SBs in social anxiety and suggest text message SB reduction may be an effective, highly accessible intervention for individuals with social anxiety. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Interrelations Among Biologically Relevant Personality Traits, Emotion Regulation Strategies, and Clinical Symptoms.

Biologically relevant personality traits of weak inhibitory control (disinhibition) and threat sensitivity confer vulnerability to various clinical problems. Difficulties with emotion regulation have also been studied extensively in relation to risk for and maintenance of psychopathology. However, it remains unclear how emotion regulation strategies interface with dispositional vulnerabilities in affecting clinical symptomatology. The current study provided an initial examination of the roles of disinhibition, threat sensitivity, and use of key emotion regulation strategies (cognitive reappraisal, expressive suppression) in the occurrence of distress-related symptoms (i.e., depressivity, anxiousness, and borderline personality features). Analyses revealed that trait disinhibition and lowered use of cognitive reappraisal were related to each form of distress symptomatology, with the predictive relationship for disinhibition accounting entirely for that of reappraisal. This finding suggests that deficient top-down control capacity (i.e., disinhibition) is integral to failures in the use of an adaptive but cognitively demanding regulation strategy (i.e., reappraisal). By contrast, threat sensitivity was related both to anxiousness and use of expressive suppression, with the latter two variables unrelated to one another. Anxious individuals may avoid emotionally evocative situations, negating the downstream need to engage in the maladaptive strategy of expressive suppression. Despite certain study limitations (a cross-sectional, self-report design; modest sample size), the current study yielded evidence in line with study hypotheses, indicating a pivotal role for dispositional traits in associations between cognitive-behavioral processes and clinical problems.

Predictors of Symptom Outcome in Interpretation Bias Modification for Dysphoria.

Interpretation Bias Modification (IBM) interventions have been effective in reducing negative interpretation biases theorized to underlie depressive psychopathology. Although these programs have been highlighted as potential short-term interventions for depression, mixed evidence has been found for their effects on depressive symptoms. There is a need to examine attitudes towards training as well as individual difference factors that may impact symptom outcomes for IBM depression interventions. Seventy-two dysphoric young adults were randomly assigned to receive either an IBM targeting negative interpretation bias in personal evaluations or interpersonal situations or a healthy video control (HVC) condition. Compared to those who received HVC, participants in the IBM condition reported lower negative interpretation bias at posttreatment. No differences between conditions were found for symptom outcomes. Greater perceived treatment credibility and expectancy were associated with better treatment outcomes for both the IBM and HVC groups. Within the IBM group, a greater tendency toward assimilation with treatment scenarios was significantly associated with better treatment outcomes for both depressive and anger symptoms. This effect was unique from treatment credibility and expectancy. Pretreatment psychological reactance did not predict treatment response for either condition. Implications and future research directions are discussed.

Mental Contamination in Obsessive-Compulsive Disorder: Associations With Contamination Symptoms and Treatment Response.

The most common symptom of obsessive-compulsive disorder (OCD) is contamination fear. Feelings of contamination can be provoked through contact with a physical contaminant, referred to as contact contamination (CC), as well as in the absence of one, referred to as mental contamination (MC). Prior research indicates that CC and MC are distinct, and MC may interfere with treatment for CC. However, no study to date has examined how MC may be associated with responses to physical contaminants and treatment response for CC. This study examined the relationships between CC and MC in a sample of individuals with elevated contamination symptoms (N = 88), half of whom met diagnostic criteria for OCD. Participants engaged in three sessions of exposure and response prevention (ERP) for CC and completed self-report measures and behavioral tasks assessing CC and MC at pretreatment, posttreatment, and follow-up. As hypothesized, at pretreatment, MC was positively associated with reactivity to physical contaminants, even after participants washed their hands. ERP for CC was associated with unique changes in CC and MC across self-report and behavioral measures, and greater pretreatment MC predicted greater posttreatment CC, though this effect was evident in only one of two CC measures. Additionally, specificity analyses indicated changes in MC were independent of changes in disgust propensity, a related construct. Pretreatment disgust propensity also predicted treatment outcome, though the addition of pretreatment disgust propensity as a covariate reduced the relationship between pretreatment MC and posttreatment CC to nonsignificance. Results suggest MC plays an important role in the manifestation and treatment of CC symptoms and may represent a manifestation of disgust proneness. Theoretical and clinical implications are discussed.

Long-term naturalistic follow-up of chronic pain in adults with prescription opioid use disorder.

BACKGROUND: Chronic pain is common in patients with prescription opioid use disorder (OUD), and pain severity has been shown to predict opioid use for those with chronic pain. However, recent research suggests that focusing on pain status (i.e., the presence or absence of chronic pain) at treatment initiation may not reflect the clinical significance of pain over the long-term course of OUD. Reports of variability in chronic pain and its clinical significance over time have yet to be investigated in patients with prescription OUD. The present study examined variability in chronic pain status from entry into prescription OUD treatment through 3.5-year follow-up. Additionally, we examined the association between concurrent chronic pain and opioid use at three follow-up time points. METHODS: This secondary analysis (N = 309) of a national, randomized, controlled trial of prescription OUD treatment used generalized estimating equations to assess variability in the prevalence of chronic pain from study entry to 3.5-year follow-up, and the association between chronic pain status and concurrent opioid use. RESULTS: Fifty-three percent of participants reported variability in chronic pain status over time. The prevalence of chronic pain decreased from study entry through follow-up (aOR = 0.47, p < 0.001). Chronic pain was associated with increased opioid use at each follow-up assessment (aOR = 3.56, p < 0.001). CONCLUSIONS: Chronic pain status may vary over time in those with prescription OUD, and chronic pain appears to be associated with concurrent opioid use. The present findings highlight the importance of assessing chronic pain throughout the course of prescription OUD.

Pain interference and alcohol, nicotine, and cannabis use disorder in a national sample of substance users.

BACKGROUND: Pain interference is associated with substance use, but has yet to be considered as a potential indicator of SUDs among substance users. We sought to examine whether moderate and high pain interference would confer risk for SUDs in ever and weekly users. METHODS: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions, logistic regression analyses were conducted to examine the association between pain interference and concurrent and prospective alcohol and nicotine dependence, as well as concurrent cannabis use disorder. Those with no/low pain were used as the reference group. Gender was examined as a moderator. RESULTS: Controlling for relevant covariates, moderate pain interference was associated with past year alcohol (odds ratio [OR] = 1.33, 95% CI, 1.16-1.52, p < .001) and nicotine (OR = 1.41, 95% CI 1.27-1.56, p < .001) dependence among ever users. In prospective analyses, moderate pain interference predicted the development of alcohol (Moderate: OR = 1.56, 95% CI, 1.39-1.75, p < .001) and nicotine (OR = 1.37, 95% CI, 1.14-1.65, p < .001) dependence. Similar results were found with high pain and for weekly users. Both moderate and high pain interference were associated with past-year occurrence of cannabis use disorder for women but not men. High pain predicted the development of nicotine dependence exclusively among males. CONCLUSION: Pain interference may confer risk for the occurrence of cannabis use disorder among female cannabis users and the occurrence and development of alcohol and nicotine dependence among users of both genders. Pain interference may be an important factor to monitor in these populations.

Pain and multiple facets of anger and hostility in a sample seeking treatment for problematic anger.

A number of studies have reported associations between pain and anger in samples with chronic pain, but research has mostly overlooked associations between pain and anger in those with problematic anger. The present study explored associations between pain severity and a variety of anger and hostility constructs in a sample seeking anger treatment (n =131). Zero-order correlations and partial correlations were used to examine associations between pain, anger, and hostility, controlling for depressive symptoms. Hierarchical regression models examined potential interaction effects of gender on associations between pain and these outcomes. Pain severity was positively associated with trait anger, outward anger expression, hostile interpretation bias, hostile ideation, and inability to forgive others. These associations were independent of co-occurring depressive symptoms, with some exceptions. Gender moderated the association between pain and hostile ideation such that pain was positively associated with hostile ideation in women but not men. Pain severity was uniquely associated with multiple outcomes of relevance to individuals undergoing treatment for problematic anger. Clinical implications will be discussed.

Longitudinal association between pain severity and subsequent opioid use in prescription opioid dependent patients with chronic pain.

BACKGROUND: Patients with prescription opioid use disorder commonly report relief of chronic pain as the chief reason for first opioid use; indeed, the prevalence of chronic pain is high in this population. Understanding the association between pain severity and subsequent opioid use is crucial for understanding how to manage these conditions simultaneously and has not been examined in this population. The aim of this analysis was to examine the proximal effect of pain severity on opioid use during 12 weeks of buprenorphine-naloxone therapy for patients with chronic pain and prescription opioid use disorder. METHODS: This study is a secondary analysis of a national, randomized, controlled trial of buprenorphine-naloxone plus counseling for prescription opioid dependent patients. The association between past-week pain severity and opioid use in the subsequent week was examined in 148 patients presenting with chronic pain at baseline. RESULTS: Results from a multivariable logistic regression model showed that greater pain severity in a given week was significantly associated with increased odds of opioid use in the following week over the 12-week treatment, even after adjusting for covariates associated with opioid use (aOR=1.15, p<0.001). CONCLUSIONS: Despite previous reports of no association between baseline pain and subsequent opioid use, our findings suggest that patients who experience flare-ups of pain during treatment are prone to relapse to opioid use. Future studies may identify those who are at risk to use opioids by carefully monitoring patterns of their pain intensity over time.

Denial of urinalysis-confirmed opioid use in prescription opioid dependence.

Although research has generally supported the validity of substance use self-reports, some patients deny urine-verified substance use. We examined the prevalence and patterns of denying urinalysis-confirmed opioid use in a sample of prescription opioid dependent patients. We also identified characteristics associated with denial in this population of increasing public health concern. Opioid use self-reports were compared with weekly urinalysis results in a 12-week multi-site treatment study for prescription opioid dependence. Among those who used opioids during the trial (n=246/360), 44.3% (n=109) denied urinalysis-confirmed opioid use, although usually only once (78%). Overall, 22.9% of opioid-positive urine tests (149/650) were denied on self-report. Multivariable analysis found that initially using opioids to relieve pain was associated with denying opioid use. These findings support the use of both self-reports and urine testing in treating prescription opioid dependence.

Initial response as a predictor of 12-week buprenorphine-naloxone treatment response in a prescription opioid-dependent population.

OBJECTIVE: Initial medication response has been shown to predict treatment outcome across a variety of substance use disorders, but no studies have examined the predictive power of initial response to buprenorphine-naloxone in the treatment of prescription opioid dependence. We therefore conducted a secondary analysis of data from the Prescription Opioid Addiction Treatment Study to determine whether initial response to buprenorphine-naloxone predicted 12-week treatment outcome in a prescription opioid-dependent population. METHOD: Using data from a multisite, randomized controlled trial of buprenorphine-naloxone plus counseling for DSM-IV prescription opioid dependence (June 2006-July 2009), we conducted a secondary analysis to investigate the relationship between initial medication response and 12-week treatment outcome to establish how soon the efficacy of buprenorphine-naloxone could be predicted (N = 360). Outcomes were determined from the Substance Use Report, a self-report measure of substance use, and confirmatory urinalysis. Predictive values were calculated to determine the importance of abstinence versus use at various time points within the first month of treatment (week 1, weeks 1-2, 1-3, or 1-4) in predicting successful versus unsuccessful treatment outcome (based on abstinence or near-abstinence from opioids) in the last 4 weeks of buprenorphine-naloxone treatment (weeks 9-12). RESULTS: Outcome was best predicted by medication response after 2 weeks of treatment. Two weeks of initial abstinence was moderately predictive of treatment success (positive predictive value = 71%), while opioid use in both of the first 2 weeks was strongly predictive of unsuccessful treatment outcome (negative predictive value [NPV] = 84%), especially when successful outcome was defined as total abstinence from opioids in weeks 9-12 (NPV = 94%). CONCLUSIONS: Evaluating prescription opioid-dependent patients after 2 weeks of buprenorphine-naloxone treatment may help determine the likelihood of successful outcome at completion of the current treatment regimen. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00316277.