Longitudinal trajectories in recovery capital and associations with substance use among adult drug treatment court clients.

BACKGROUND: Recovery capital (RC) refers to the resources individuals use to support substance use disorder (SUD) recovery. Individuals with SUD who are involved with the criminal justice system often have limited RC. Drug treatment courts (DTCs), including traditional drug treatment courts (tDTCs) and opioid intervention courts (OICs), can link clients to important sources of RC in the short-term, but few studies have assessed RC longitudinally. METHODS: The current study analyzed five waves of data from a one-year longitudinal study on substance use and RC collected from clients of tDTCs and OICs (n=165, 52% male, 75% non-Hispanic White, Age=21-67 years). Mixed-effects models examined (1) within-person trends over time in RC, (2) individual characteristics associated with differences and changes in RC, and (3) patterns of relationships between RC and substance use over time. We also tested differences by court type. RESULTS: First, OIC participants had lower RC at baseline relative to tDTC participants, and there was considerable within-person variability in RC over time. Second, the effect of a high school diploma/GED at baseline on RC change over time was greater for OIC relative to tDTC participants. Third, there was a negative concurrent within-person association between drug use and RC that became stronger over time for OIC relative to tDTC participants. CONCLUSIONS: This study is among the first to examine longitudinal, within-person trajectories in RC. Results revealed important within-person variability over time in RC that was linked to education and drug use, particularly among OIC clients. Findings could help inform DTC treatment approaches.

Daily mindfulness homework completion is associated with reduced drinking during a mindfulness-enriched emotion regulation treatment for alcohol use disorder.

Homework is widely used in cognitive behavioral therapy (CBT) for alcohol use disorder (AUD). Theoretically, homework helps clients generalize skills acquired during treatment to their daily lives. However, clinical trials methodology has typically employed pre- and post-treatment assessments which has made evaluating the contribution of homework to behavior change a challenge. The current study leveraged daily diary data from a clinical trial of CBT for AUD to parse within- and between-person associations of mindfulness homework practice and alcohol consumption. Adults seeking treatment for AUD (N = 97) completed 12 treatment sessions and 84 consecutive daily smartphone surveys. Each day, participants reported on the frequency of prior day's formal and informal mindfulness homework practice, the duration of prior day's formal mindfulness practice, and prior day's alcohol consumption. Multilevel models tested within- and between-person associations of mindfulness homework practice with the odds of drinking and heavy drinking, accounting for prior day's alcohol use. Results revealed that greater-than-usual frequency and duration of formal daily mindfulness homework practice, but not informal mindfulness practice, were associated with lower odds of a drinking day. Further, greater-than-usual duration of formal daily mindfulness homework practice, but not frequency of mindfulness practice (formal or informal), was associated with lower odds of a heavy drinking day. Results suggest that formal daily mindfulness homework practice may be beneficial and extend the literature by demonstrating that it coincides with reduced drinking and heavy drinking odds within-persons during AUD treatment. Apprising AUD clients of the potential value of homework may help boost its uptake.

Emotion differentiation among individuals in a randomized clinical trial for alcohol use disorder: Within- and between-person associations with affect, craving, and alcohol use in daily life.

Emotion differentiation refers to cognitively distinguishing among discrete, same-valenced emotions. Negative emotion differentiation (NED) is a transdiagnostic indicator of emotional functioning. The role of positive emotion differentiation (PED) in clinical disorders, including alcohol use disorder (AUD), is less understood. Further, despite consensus that emotions are highly variable, little is known about within-person fluctuations in NED/PED. The current study leveraged 84 consecutive daily smartphone surveys from participants (N = 181) in a clinical trial of cognitive behavioral therapy for AUD to investigate whether between-person differences in overall NED/PED, or within-person variability in daily NED/PED, were associated with affect intensity, craving, drinking, and heavy drinking in daily life. Subsequent analyses explored whether associations were moderated by baseline alexithymia. At the between-persons level, greater average PED, but not NED, was associated with lower heavy drinking odds. At the within-persons level, higher-than-usual PED was associated with lower negative affect and odds of any drinking. Individuals with baseline alexithymia had stronger negative within-person associations between daily NED and both any and heavy drinking. PED is a skill linked to less alcohol use between- and within-persons irrespective of baseline alexithymia, whereas greater daily NED appears especially important for reduced alcohol use among individuals with co-morbid AUD and alexithymia.

Examining Within- and Between-Person Facets of Negative Affect and Associations with Daily Craving Among Young Adults in Substance Use Disorder Recovery.

The role of negative affect in precipitating drug craving and relapse among young adults in recovery from substance use disorder (SUD) is well documented. However, most studies focus on negative affect as a trait-level congregate of multiple negative emotion states. The present study examined the associations between specific facets of negative affect, college stressors, and craving among young adult college students in SUD recovery. Data were drawn from a three-week daily diary study of 50 students participating in a collegiate recovery community at a U.S. university (M age = 21.42, 76% males). At the within-person level, craving was higher on days when young adults experienced higher than usual anger, fear, and sadness, but not guilt. At the between-person level, individuals higher in agitation reported greater levels of craving on average. Moderation analyses further showed that college stressors heightened the within-person association between anger and craving. Findings demonstrate that negative affect is not monolithic and that its different aspects are uniquely associated with craving at both between- and within-person levels. Findings from this study could guide collegiate SUD recovery programs that wish to provide greater support to their members by helping them identify both individual- and time-specific relapse risks, such as generally high levels of agitation or days when anger, fear, or sadness are higher than usual for a particular individual. Our findings also suggest that future research should consider distinct features and implications of affective structures at between- and within-person levels, and how these may be uniquely associated with craving.

Using ecological momentary assessments of negative affect and craving during residential opioid use disorder treatment to predict patients' relapse to substance use.

BACKGROUND: Negative affect (NA) and craving are often independently examined as precipitators of relapse among individuals with substance use disorders, including opioid use disorder (OUD). Recent ecological momentary assessment (EMA) research has revealed that NA and craving frequently co-occur within individuals. Yet we know little about the general patterns of, and variability in, within-person associations between NA and craving, as well as whether the nature and degree of within-person NA-craving coupling predicts post-treatment time-to-relapse. METHODS: Seventy-three patients (77 % male, Mage = 30.10, Range = 19-61) in residential treatment for OUD took part in a 12-day, 4× daily smartphone-based EMA study. Linear mixed-effects models tested within-person, day-level associations between self-reported NA and craving during treatment. The study used Person-specific slopes (i.e., average within-person NA-craving coupling for each participant) estimated from the mixed-effects model in survival analyses with Cox proportional hazards regression models to determine if between-person differences in the within-person coupling predicted post-treatment time-to-relapse (operationalized as the return to problematic use of any substance except tobacco), and whether this prediction was similar across patients' average levels of NA and craving intensity. The study monitored relapse through a combination of hair samples and reports from patients or alternative contacts via a voice response system twice a month for up to 120 days or more following discharge. RESULTS: Among the 61 participants with time-to-relapse data, those with stronger positive within-person NA-craving coupling on average during residential OUD treatment had a lower hazard of relapsing (slower time to relapse) post-treatment than participants with weaker NA-craving slopes. The significant association held after controlling for interindividual differences in age, sex, and average levels of NA and craving intensity. Average NA and craving intensity did not moderate the association between NA-craving coupling and time-to-relapse. CONCLUSIONS: Interindividual differences in average within-person, day-level NA-craving coupling during residential treatment predict OUD patients' post-treatment time-to-relapse.

Non-engagement in substance use treatment among women with an unmet need for treatment: A latent class analysis on multidimensional barriers.

BACKGROUND: Women with substance use disorders experience multifaceted barriers in accessing substance use treatment. Little is known about how these barriers may aggregate. Using a person-centered approach, this study evaluates patterns of treatment barriers and the factors associated with experiencing distinct sets of barriers among women. METHODS: Data were from the NSDUH (2015-2019). 461 adult women with an unmet need for substance use treatment in the last year reported on 14 treatment barriers. Latent class analysis examined classes of barriers; multinomial logistic regression assessed predictors of class membership. RESULTS: Three classes were identified: just not ready to abstain (71.2%), logistical barriers and stigmatization (18.2%), and barriers across all dimensions (10.6%). Higher education (aOR:1.94, p = 0.03) and psychological distress (aOR:2.19, p = 0.02) predicted higher odds-and identifying as African American predicted lower odds (aOR:0.17, p = 0.02)-of belonging to the "Logistics and Stigma Barriers" class relative to the "Just Not Ready" class. Similarly, higher education (aOR: 2.57, p = 0.02) and having children (aOR:2.28, p = 0.03) predicted higher odds-and marriage predicted lower odds (aOR:0.22, p = 0.02)-of belonging to the "High and Diverse Barriers" class relative to the "Just Not Ready" class. Having children predicted higher odds (aOR: 2.93, p = .02), and marriage predicted lower odds (aOR:0.19, p = 0.02) of belonging to the "High and Diverse Barriers" class relative to the "Logistics and Stigma" class. CONCLUSION: A lack of readiness to abstain, socioeconomic circumstances, and family obligations are main barriers to SUD treatment among women. Interventions incorporating motivational interviewing, family systems, and social networks are needed.

Validation and Psychometric Properties of the Original Grit Scale (Grit-O) Among Cambodian Adolescents.

Background: Cambodian youth face many unique challenges, such as high instances of poverty and intergenerational trauma. Grit, a person-level trait defined as having "perseverance and passion for long-term goals", may be particularly important in helping Cambodian youth to succeed despite the extreme challenges they face. To date, the Original Grit Scale (Grit-O) has not been translated in Khmer or validated for a sample of Cambodian youth. Purpose: This study aimed to assess the reliability and validity of a Khmer translation of the Original Grit Scale (Grit-O) among urban Cambodian youth. Research Design: A cross-section survey battery -including Grit-O and other relevant covariates -was administered to Cambodian youth. Study Sample: Data were collected from 580 Cambodian adolescents (Mage = 15.85 years, SDage = 2.05, 63.7% female). Data Collection and Analysis: Paper and pencil surveys were sent home from school with each participant and returned to the study team the next day. Analyses included calculating Cronbach's alphas, interitem correlations, correlations with relevant covariates and both a confirmatory and exploratory factor analysis. Results: Cronbach's alphas and interitem correlations indicated that the full scale was not reliable for this sample, and that reliability improved when two items (I become interested in new pursuits every few months -reverse-scored and I finish whatever I begin) were excluded. The subscales Consistency of Interests and Perseverance of Effort were more reliable than the full scale. Correlations with relevant covariates indicated that the full scale was moderately valid. Factor analyses suggested that items 6 and 7 did not load well onto either identified factor. Conclusions: Investigators measuring grit in a sample of Cambodian youth should consider excluding items 6 and 7 of Grit-O, and assessing the two subscales on their own, rather than treating them as indicators of a single higher-order construct.

Prefrontal cortical response to natural rewards and self-reported anhedonia are associated with greater craving among recently withdrawn patients in residential treatment for opioid use disorder.

Both anhedonia and craving are common among patients with opioid use disorder (OUD), and are associated with vulnerability to relapse. Although these constructs are theoretically linked relatively few studies have examined them together. In the current study, recently withdrawn patients (N = 71) in residential treatment for prescription OUD underwent a cue reactivity paradigm while being monitored with functional near-infrared spectroscopy (fNIRS). Patients also self-reported symptoms of anhedonia via the Snaith-Hamilton Pleasure Scale (SHAPS), while smartphone-based ecological momentary assessments (EMA) were used to measure craving levels. On average, lower right prefrontal cortex (PFC) activity in response to positive social stimuli was associated with higher craving (ß = - 2.87; S.E. = 1.23; p = 0.02). Self-reported anhedonia moderated the association between PFC activity and craving (ß = - 1.02; S.E. = 0.48; p = 0.04), such that patients with two or more anhedonic symptoms had a significant and stronger negative association between PFC activation to hedonically positive images and craving, compared to patients with fewer than two anhedonic symptoms, among whom the association was not significant. This finding provides evidence that higher levels of anhedonia among patients in residential treatment for OUD are associated with a stronger link between lower PFC response to positive social experiences and higher levels of craving, potentially increasing overall vulnerability to relapse.

Profiles of future expectations among urban adolescents in Cambodia.

Adolescents are tasked with navigating competing priorities, including whether to marry, have children, pursue a job/career, go to college, and contribute to society. The developmental task of building expectations for the future is especially complex for Cambodian adolescents living within a society that strongly prioritizes family obligations yet increasingly provides educational and professional opportunities. The current study, guided by Seginer's (2003) future orientation model, applied latent profile analysis (LPA) to explore patterns of Cambodian adolescents' (N = 580, 64% female, Mage = 15.85) future expectations across key life domains and predictors of those patterns. LPA identified four profiles: Low Expectancy (low expectations across all domains; 12%), Family Focused (high expectations to get married and have children; 31%), Professional/Service Focused (high expectations across education, employment, and societal contribution domains; 27%), and High Expectancy (high expectations across all domains; 30%). Females were more likely than males to be in the Professional/Service Focused than High Expectancy profile. Adolescents with greater internal locus of control and family obligation were less likely to be in the Low Expectancy and Family Focused than High Expectancy profile, whereas adolescents in higher grade levels were more likely to be in the Family Focused than High Expectancy profile. Adolescents with closer relationships with mothers were less likely to be in the Professional/Service Focused than High Expectancy profile; adolescents with closer relationships with fathers were more likely to be in the Professional/Service Focused than High and Low Expectancy profiles. Findings elucidate configurations of adolescents' future expectations, and factors distinguishing among adolescents with different configurations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Using daily diary methods to understand how college students in recovery use social support.

Collegiate Recovery Communities (CRCs) are important sources of support for college students building and maintaining recovery from substance use disorders. The current study used daily diary data from members of a CRC to examine with which sources of social support students engaged daily, and whether students connected with these sources more on days when they indicated higher-than-usual recovery difficulty, negative affect, and/or school stress. Results indicate that on days when students reported having greater difficulty with recovery maintenance than usual, they had higher odds of being in contact with family members and were expected to talk or spend time with family for longer than usual. Students also had higher odds of having recovery-focused conversations with both 12-step sponsors and CRC peers on days of greater-than-usual recovery maintenance difficulty. Recovery maintenance difficulty was uniquely associated with longer duration of family contact, above and beyond negative affect and school stress. Thus, the occurrence, amount, and nature of CRC members' interactions with important social network members varied in relation to perceived recovery challenges that same day. Findings highlight the importance of providing college students with multiple sources of support that they can use to maintain their recoveries despite daily challenges.

Effectiveness and Utility of Mobile Device Assessment of Subjective Craving during Residential Opioid Dependence Treatment.

Background: Craving is a dynamic state that is both theoretically and empirically linked to relapse in addiction. Static measures cannot adequately capture the dynamic nature of craving, and research has shown that these measures are limited in their capacity to link craving to treatment outcomes. Methods: The current study reports on assessments of craving collected 4x-day across 12 days from 73 patients in residential treatment for opioid dependence. Analyses investigated whether the within-person assessments yielded expected across- and within-day variability, whether levels of craving changed across and within days, and, finally, whether individual differences in craving variability predicted post-residential treatment relapse. Results: Preliminary analyses found acceptable levels of data entry compliance and reliability. Consistent with expectations, craving varied both between (46%) and within persons, with most within-person variance (over 40%) existing within days. Other patterns that emerged indicated that, on average, craving declined across the 12-days of assessment, and was generally strongest at mid-day. Analyses also found that patients' person-level craving variability predicted post-treatment relapse, above and beyond their mean levels of craving. Conclusion: Analyses support the reliability, sensitivity, and potential utility of the 4x-day, 12-day assessment protocol for measuring craving during residential treatment.

Daily meaningfulness among patients with opioid use disorder: Examining the role of social experiences during residential treatment and links with post-treatment relapse.

BACKGROUND: A sense of meaningfulness is an important initial indicator of the successful treatment of addiction, and supports the larger recovery process. Most studies address meaningfulness as a static trait, and do not assess the extent to which meaningfulness might vary within an individual, or how it may vary in response to daily life events such as social experiences. METHODS: Ecological momentary assessment (EMA) was used to: 1) examine the amount of within-person variability in meaningfulness among patients in residential treatment for prescription opioid use disorder; 2) determine whether that variability was related to positive or negative social experiences on a daily basis; and 3) assess whether those day-to-day relationships were related to relapse at four months post-treatment. Participants (N = 73, 77% male, Mage = 30.10, Range = 19-61) completed smartphone-based assessments four times per day for 12 days. Associations among social experiences, meaningfulness, and relapse were examined using multilevel modeling. RESULTS: Between-person variability accounted for 52% (95% CI = 0.35, 0.67) of variance in end-of-day meaningfulness. End-of-day meaningfulness was higher on days when participants reported more positive social experiences (ß = 1.17, SE = 0.33, p < .05, ΔR2 = 0.041). On average, participants who relapsed within four months post-residential treatment exhibited greater within-day reactivity to negative social experiences (ß = -1.89, SE = 0.88, p < .05, ΔR2 = 0.024) during treatment than participants who remained abstinent. CONCLUSION: Individual differences in maintaining meaningfulness day by day when faced with negative social experiences may contribute to the risk of relapse in the early months following residential treatment.

Daily associations among craving, affect, and social interactions in the lives of patients during residential opioid use disorder treatment.

OBJECTIVE: This study captured the interrelationships among craving, negative affect, and positive and negative social exchanges in the daily lives of patients in residential treatment for opioid use disorders (OUDs). METHOD: Participants were 73 patients (77% male), age 19 to 61 (Mage = 30.10, SDage = 10.13) in residential treatment for OUD. Participants completed a smartphone-based survey 4 times per day for 12 consecutive days that measured positive and negative social exchanges (Test of Negative Social Exchange), negative affect (PA-NA scales), and craving (frequency and intensity). Within-person, day-level associations among daily positive and negative social exchanges, negative affect, and craving were examined using multilevel modeling. RESULTS: Daily negative social exchanges (M = 1.44, SD = 2.27) were much less frequent than positive social exchanges (M = 6.59, SD = 4.00) during residential treatment. Whereas negative social exchanges had a direct association with same-day craving (ß = 0.08; 95% CI = 0.01, 0.16, ΔR2 = 0.01), positive social exchanges related to craving indirectly via moderation of the within-person negative affect-craving link (ß = -0.01; 95% CI = -0.01, -0.001, ΔR2 = 0.002). Positive social exchanges decoupled the same-day linkage between negative affect and craving on days when individuals had at least four more positive social exchanges than usual. CONCLUSIONS: These results indicate that both negative affect and negative social exchanges are uniquely related to craving on a daily basis, and that extra positive social interactions can reduce the intraindividual coupling of negative affect and craving during residential treatment for OUD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Affective Lives of Doubled-Up Latinx Youth: Influences of School Experiences, Familism, and Ethnic Identity Exploration.

Doubled-up Latinx youth experience many daily challenges associated with ethnic minority status and residential instability. Doubled-up youth share housing with non-custodial caregivers such as friends and/or extended family members primarily because of economic hardship and a breakdown in available parental support. Using data from baseline and 10 days of twice-a-day surveys, this study examined how in-school positive experiences, familism (i.e., a perspective that gives precedence to the family), and ethnic identity (i.e. affirmation, exploration, and resolution) influence after school positive (e.g. feeling joyful/happy) and negative (e.g., feeling stressed/anxious) affect among doubled up Latinx youth (70% female; M age = 16.5). Results indicate that in-school positive experiences were associated with more after school positive affect and less after school negative affect. Additionally, youth with higher levels of familism reported experiencing less after school negative affect. However, gender moderated the relation of ethnic identity exploration and experiences of after school positive affect. Specifically, females with higher levels of ethnic identity exploration reported relatively lower levels of after school positive affect compared to males. Overall, study findings highlight the importance of both person-level and varying contextual influences on the affective lives of doubled-up Latinx youth.