Co-Locating Obstetrics and Addiction Medicine Clinics to Improve Attendance in Services for Pregnant People with Opioid Use Disorder.

Objective: Pregnant people receiving treatment for opioid use disorders (OUD) are at significant risk of return to use during the postpartum period. Recently, practice groups and other national organizations have called for the co-location of addiction medicine and obstetric care to reduce the burden on pregnant and postpartum people with OUD associated with engaging in treatment. This paper examines the effectiveness of co-locating services in retaining pregnant people with OUD in care following childbirth. Methods: A records review of pregnant people receiving medication for OUD between 2012 and 2017 in stand-alone addiction medicine clinic (n = 23) and from 2017 to 2021 following the creation of an integrated addiction medicine-obstetric care clinic (n = 67) was conducted to compared rates of attendance in both obstetric and addiction medicine services. Results: Findings from this study suggest that individuals receiving services in a co-located clinic had significantly fewer missed appointments during the postpartum period relative to individuals who sought care at separate addiction medicine and obstetric care clinics. Conclusions: Results from this study support the potential for co-locating clinics to reduce barriers to accessing obstetric and addiction medicine services, as well as support continued attendance in care across a vulnerable period.

Specific Pathways from Parental Distress Reactions to Adolescent Depressive Symptoms: The Mediating Role of Youths' Reactions to Negative Life Events.

The current multimethod longitudinal study examines how parents' distress reactions to adolescents' negative emotions may shape youths' own perceptions of negative life events and subsequent increases in depressive symptomology. Ninety adolescents (41 girls, 49 boys, average age = 16.5 years old) and their parents were assessed over three timepoints. We found that greater parent-reported distress reactions to adolescents' emotions predicted subsequent increase in youths' own self-reported negative reactions to stressful experiences over a two-week period, which in turn predicted steeper increases in youth-reported depressive symptoms across this same two-week period. Moreover, youths' negative reactions mediated the relation between parent emotion socialization and increases in adolescent depressive symptoms. These findings support the use of interventions that simultaneously target parent and child distress to prevent the onset of adolescent depression.

Impulsivity Moderates the Relation between Depressive Symptoms and Substance Use across Adolescence.

Adolescence is characterized by significant increases in substance use problems. Although early depressive symptoms have been linked to adolescent substance use, recent literature reviews highlight important inconsistencies in these relations that may be accounted for by behavioral disinhibition factors. The current study aims to examine impulsivity as a specific moderator of the relation between early depressive symptoms and trajectories of substance use using a 6-year, prospective longitudinal design. Participants included 247 male and female adolescents (52.5% White, 45% female) who were, on average, 13 years of age at baseline (SD age = 0.90). They completed self-report inventories of depressive symptoms, impulsivity, substance use, and externalizing symptoms. Using a latent growth modeling approach, we found main effects for depressive symptoms and impulsivity, such that youth with lower initial levels of depressive symptoms and higher levels of impulsivity at baseline evidenced greater increases in substance use. Moreover, the interaction between impulsivity and depressive symptoms significantly predicted substance use, indicating that depressive symptoms were more positively related to substance use for youth reporting higher levels of impulsivity. Findings suggest that impulsivity is an important moderator of the relation between depressive symptoms and the development of substance use during adolescence and highlight the need for interventions focusing on both impulsivity and depression in minimizing risk of substance use.

Distress Tolerance Interacts With Negative Life Events to Predict Depressive Symptoms Across Adolescence.

Adolescence is a vulnerable period for the development of depressive disorders. Recent research has demonstrated the importance of distress tolerance in the onset and maintenance of depression during adulthood; however, little is known about its role in predicting depressive symptoms among adolescents. The current study examines the effect of distress tolerance and co-occurring negative life events on the developmental trajectory of depressive symptoms from middle to late adolescence. Our sample included 117 adolescent boys and girls (44.4% female, 54.6% White). Participants were, on average, 16 years old at baseline (SD = 0.90) and completed self-report inventories of negative life events and depressive symptoms; distress tolerance was assessed using a behavioral measure. Utilizing a latent growth curve approach, we found a significant interaction between distress tolerance and negative life events in predicting increases in depressive symptoms over time. Follow-up analyses suggest that negative life events were associated with greater increases in depressive symptoms over time for adolescents with lower levels of distress tolerance only. The study highlights the moderating role of distress intolerance in the relation between negative life events and depressive symptoms, and underscores the importance of targeting distress tolerance for treating depression among youth.

Conceptualization and Measurement of Parent Emotion Socialization among Mothers in Substance Abuse Treatment.

The current study examined emotion socialization behaviors within a clinical sample of substance-dependent mothers. Interviews were conducted with N=74 mothers in substance abuse treatment (outpatient and residential with or without opiate agonist medication). Each mother had a biological child between the ages of 3-8 years. We examined the factor structure of a widely-used emotion socialization measure (Coping with Children's Negative Emotions Scale) and included a novel subscale to capture the level of consistency of maternal reactions to children's emotions as a unique and salient component of emotion socialization. We found that, overall, mothers reported engaging in "emotion-coaching" styles of socialization, involving more consistent and supportive than non-supportive reactions to children's negative emotions, consistent with general population studies. However, compared to community sample mothers, substance-dependent mothers reported significantly greater levels of both supportive and non-supportive reactions to children's negative emotions, perhaps reflecting over-involved emotion socialization behaviors. The context of maternal drug use negatively impacted how well mothers balanced these types of reactions, such that mothers engaged in significantly higher levels of non-supportive and inconsistent reactions during periods of problematic drug use compared to periods of sobriety. These findings underscore the need to consider contextual risk as a predictor of emotion socialization and suggest that emotion socialization behaviors vary both within and across such contexts. Implications of this work highlight the importance of examining consistency as a characteristic of emotion socialization in its own right, particularly within families impacted by parental drug use and related contexts of high risk.

The prospective relationship between distress tolerance and cigarette smoking expectancies in adolescence.

The current study examined the prospective relationship between distress tolerance (DT) and positive and negative cigarette smoking outcome expectancies, which are reliable predictors of the onset and maintenance of smoking behaviors. Data from a longitudinal study (N = 204) examining risk behaviors in adolescence were used to assess whether DT predicts individual differences in rate of change in smoking outcome expectancies over 4 annual assessment waves through adolescence. Adolescents (mean age at first wave: 13.03 years; SD = 0.88 years) completed a behavioral task assessing DT at baseline and a self-report measure of adolescent smoking expectancies annually across 4 years. Latent growth curve models were estimated to test our hypotheses. Results showed that DT at baseline did not significantly predict initial levels of negative affect reduction (NAR) expectancies, but NAR expectancies increased more quickly over time for adolescents with lower DT. Moreover, as hypothesized, DT did not prospectively predict significant changes in smoking expectancies outside of the domain of NAR, including negative physical feelings, negative social impression, and boredom reduction expectancies. These findings suggest that DT is a useful indicator of adolescent expectancies about the consequences of cigarette smoking, particularly those focused on reducing negative affect. Thus, DT may be an important target for preventing smoking initiation among adolescents via this putative mechanism. Theoretical and clinical implications are discussed within the context of observed effect sizes. (PsycINFO Database Record

The developmental trajectory of perceived stress mediates the relations between distress tolerance and internalizing symptoms among youth.

The current study examines the relation between distress tolerance, perceived stress, and internalizing symptoms across adolescence. Participants included 331 youth, ages 10 to 14 at the first wave of the study, assessed annually over 5 years. A latent growth curve approach was used to test three research questions, including whether perceived stress would increase across adolescence, whether distress tolerance (as measured by a behavioral task) would predict changes in perceived stress, and whether changes in perceived stress would mediate the relation between distress tolerance and internalizing symptoms. Results suggest that, consistent with previous findings, rates of perceived stress do increase across adolescence. Further, findings indicate that distress intolerance at baseline predicted increases in perceived stress, which in turn drove increases in internalizing symptoms. These findings point to the critical role of distress tolerance in bringing about changes in depression and anxiety symptoms and suggest support for utilizing a negative reinforcement framework to understand the emergence of internalizing symptomology.

A Comparison of Reinforcement Based Treatment (RBT) versus RBT plus Recovery Housing (RBTRH).

OBJECTIVES: Reinforcement-based treatment (RBT) plus recovery housing (RBTRH) improves outcomes for individuals with opioid use disorders. No studies have examined the efficacy of RBT in the absence of abstinent-contingent housing. METHODS: We compared highly similar participants from a study of outpatient RBT (RBT, n=55) and the RBTRH (n=80) arm of a randomized trial wherein participants received abstinent-contingent payment for recovery housing sponsored by the research program. Abstinence and employment outcomes were assessed at one, three, and six months. Regression was used to identify predictors of abstinence. Sensitivity analyses explored the impact of housing on outcomes. RESULTS: RBT and RBTRH participants had similar abstinence and employment outcomes. Predictors of abstinence in the sample included recovery housing residence and employment. However, a distinct RBT sub-group emerged, as 33% of the sample accessed self-pay RH (RBTSPRH). Sensitivity analyses compared the two RH groups (self-pay and program-supported) to RBT outpatient treatment (RBT). The RBTSPRH and RBTRH groups had similar abstinence outcomes, and both groups had superior abstinence outcomes compared to RBT. The RBTSPRH group had the most sustained effects relative to RBT, including higher abstinence rates, and more favorable employment outcomes at six months (ps<.05). The RBTSPRH group reported more days of employment compared to both the RBT and RBTRH groups at three months (ps<.05). CONCLUSIONS: Findings highlight the importance of recovery housing for promoting improved outcomes among RBT participants. Research is needed to explore the aspects of recovery housing versus outpatient treatment that are associated with improved outcomes in the population.

Sex differences in self-report and behavioral measures of disinhibition predicting marijuana use across adolescence.

Disinhibition has been consistently linked to substance use across development. Recent research suggests, however, that these relations may be influenced by both sex and measurement approach. The current study examined the moderating effect of sex on the association between behavioral and self-report measures of disinhibition and marijuana use across adolescence. Participants were 115 boys and 89 girls initially evaluated at Grade 8 using a laboratory behavioral assessment and self-report questionnaires of disinhibitory variables. Marijuana use was measured annually from Grades 9 through 12. Results suggest that boys and girls did not differ on either self-reported or behaviorally assessed levels of disinhibition, and that disinhibition measured using both approaches was associated with increases in marijuana use over time. There was a significant interaction between sex and disinhibition, suggesting that boys (but not girls) who self-reported elevations in disinhibition evidenced greater increases in marijuana use. The current findings add to a growing literature supporting the importance of using multiple methods to assess disinhibition and highlight the critical role of biological sex in understanding these relations.

Negative affect variability and adolescent self-medication: The role of the peer context.

INTRODUCTION: Findings in the literature show mixed support for adolescent self-medication. Following recent reformulations of the self-medication hypothesis, we tested within-person effects of daily fluctuations in sadness and worry on daily substance use, and explored the moderating role of the peer context on self-medication. We hypothesized that greater daily fluctuations in mood would predict greater daily substance use, and lower levels of peer social support and higher levels of peer drug use would further increase this risk. DESIGN AND METHODS: Experience sampling methods captured within-person daily variations in mood and substance use over 21 days among 73 adolescents. An observational coding system was employed to characterize enacted peer social support. Multilevel modeling was used to parse between- versus within-person differences in risk for daily substance use. RESULTS: Greater within-person daily fluctuations in feelings of worry (but not sadness) significantly predicted increased daily substance use, consistent with self-medication. Moreover, greater daily fluctuations in negative affect were a stronger predictor of daily use than total level of daily negative affect. Peer social support moderated this relationship such that those with more supportive friendships were less likely to engage in self-medication. DISCUSSION: This is the first reported study to examine within-person processes of adolescent self-medication related to daily variability in mood and the peer context. Adolescent self-medication processes appear to differ depending on the type of negative affect and whether daily affective experiences are chronic or fluctuating, suggesting that the affective processes that cue adolescents to engage in substance use are quite nuanced.

Adolescent Substance Use and Comorbid Psychopathology: Emotion Regulation Deficits as a Transdiagnostic Risk Factor.

Rates of substance use and comorbid psychopathology peak during adolescence, highlighting the need to identify transdiagnostic risk processes that cut across conditions and elucidate early embedded risk factors for comorbidity across development. The current review highlights emotion regulation deficits as a core transdiagnostic risk factor underlying the development of substance use, addiction, and comorbid psychopathology in adolescence. We present the dual systems model of neurological development to highlight adolescence as a critical period of increased risk for emotion regulation difficulties, corresponding risk behaviors, and psychopathology. We describe malfunction in the neurobiological regulation system underlying the relationship between emotion regulation and risk for addiction and comorbidity. We pull from two established developmental theories including both the externalizing pathway and the internalizing pathway to substance use disorders, which together highlight how early embedded risk in the form of emotion regulation deficits can explain mechanisms underlying the development of addiction and comorbid psychiatric disorders.

The mediating role of depression in the relationship between anxiety sensitivity and alcohol dependence.

BACKGROUND: Many studies have reported that Anxiety Sensitivity (AS) is positively associated with alcohol use or other alcohol-related variables. More recent mediator and moderator models have shown promise in elucidating mechanisms within this relationship; the literature to date suggests that the relationship between AS and alcohol is likely mediated by problematic coping motives. However, few studies have considered the effects of depression within the AS-alcohol use relationship, despite a strong body of evidence linking AS to subsequent depression and depression to subsequent alcohol use problems, independently. Therefore, the current study assessed depression as a potential mediator of this relationship. METHOD: Participants were 418 sequential admissions to a substance abuse treatment facility. A mediation analysis using bootstrapping was utilized in order to estimate indirect effects of AS on alcohol dependence through depression. RESULTS: Results reveal an indirect effect suggesting that the effects of anxiety sensitivity on alcohol dependence are mediated by symptoms of depression. More specifically, the effects of AS total score and AS somatic sensations on alcohol dependence were mediated by symptoms of depression. Lastly, a dual mediator model demonstrated that both depression and problematic coping uniquely mediate the relationship between AS and alcohol dependence. CONCLUSIONS: While preliminary in nature, the current study provides evidence supporting the hypothesis that depression is an important factor to consider when examining the relationship between AS and alcohol dependence.

Comparing Psychiatric Symptoms among Children of Substance-Abusing Parents With Different Treatment Histories.

It appears that no studies to date have compared the psychiatric functioning of children of substance-abusing parents (COSs) across substance abuse treatment histories (e.g., inpatient, outpatient, residential). Different treatment histories may reflect differences in the severity of drug use, degree of impairment, or drug of choice, which may result in different symptomatology among COSs. Moreover, this information may be important for family-based treatment and prevention planning. In the current study, we examine psychiatric symptoms experienced by children whose parents have different addiction treatment histories. Eighty-one parents in treatment for a substance use disorder who had a 2-8 year old child completed an anonymous, computerized assessment. Respondents reported on their child's symptomatology as well as their own treatment history and current substance use. Overall, children were remarkably similar in psychiatric functioning and demographic characteristics across parent's treatment histories. However, children whose parents had only received medication management or detoxification had significantly higher somatization scores, more social withdrawal, and greater attention problems than children whose parents received outpatient treatment (but not inpatient/residential treatment). Children whose parents had been treated in an inpatient or residential setting had marginally higher attention problems than children whose parents received outpatient treatment (but not inpatient/residential treatment). Differences across treatment histories were reflected in the severity of psychiatric symptomatology in the young children of parents in treatment. However, given the modest size of these differences, prevention and intervention programs with children of substance-abusing parents may not need to be tailored as a function of parental treatment history as recruitment from various treatment centers may provide a sample with similar characteristics and risk profiles.

Understanding the diverse needs of children whose parents abuse substances.

In this review, we consider the potential service needs of children of substance abusing parents based on what we know about the risk outcomes faced by these children and the parenting deficits often present in these families. Importantly, our review does not address the etiological role of parental substance abuse in children's negative outcomes but instead we discuss the complex inter-related risk factors that often co-occur with and exacerbate risk associated with parental alcohol and drug use. We first review studies showing the elevated risk that children of substance abusing parents face in general for poorer academic functioning; emotional, behavioral, and social problems; and an earlier onset of substance use, faster acceleration in substance use patterns, and higher rates of alcohol and drug use disorders. We then review studies showing contextual risk factors for children of substance abusing parents, including parenting deficits (less warmth, responsiveness, and physical and verbal engagement as well as harsher and more over-involved interaction styles), greater risk for child maltreatment, and less secure attachment patterns. We conclude with a discussion of future directions for research and guidelines for professionals working with children and their families where parental substance abuse is present.