Behavioral economic and wellness-based approaches for reducing alcohol use and consequences among diverse non-student emerging adults: study protocol for Project BLUE, a randomized controlled trial.

BACKGROUND: Emerging adults (EAs) who are not 4-year college students nor graduates are at elevated risk for lifetime alcohol use disorder, comorbid drug use, and mental health symptoms, compared to college graduates. There is a need for tailored brief alcohol intervention (BAI) approaches to reduce alcohol risk and to facilitate healthy development in this high-risk population. Most BAIs include a single session focused on discussing risks associated with drinking and correcting normative beliefs about drinking rates. EAs may benefit from additional elements that enhance general wellness. The substance-free activity session (SFAS) aims to clarify life goals and values and increase goal-directed activities that provide alternatives to alcohol use, and the relaxation training (RT) session teaches relaxation and stress reduction skills. METHODS: The present study is a randomized 3-group (BAI + SFAS vs. RT + SFAS vs. education control) trial with 525 EAs (175 per group; estimated 50% women and 50% African American) who report recent risky drinking and who are not students or graduates of 4-year colleges. Participants will have the option of completing the intervention sessions in person or via a secure video teleconference. Levels of drinking and alcohol-related problems will be evaluated at baseline and 1, 3, 6, and 12 months post-intervention. The primary hypothesis is that both BAI + SFAS and RT + SFAS participants will report significantly greater reductions in alcohol use and problems relative to education control participants, with no differences in outcomes between the two active treatment conditions. DISCUSSION: The results of this study will inform alcohol prevention efforts for high-risk community dwelling emerging adults. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04776278.

Posttraumatic stress and delay discounting: a meta-analytic review.

Delay discounting-the extent to which individuals show a preference for smaller immediate rewards over larger delayed rewards-has been proposed as a transdiagnostic neurocognitive process across mental health conditions, but its examination in relation to posttraumatic stress disorder (PTSD) is comparatively recent. To assess the aggregated evidence for elevated delay discounting in relation to posttraumatic stress, we conducted a meta-analysis on existing empirical literature. Bibliographic searches identified 209 candidate articles, of which 13 articles with 14 independent effect sizes were eligible for meta-analysis, reflecting a combined sample size of N = 6897. Individual study designs included case-control (e.g. examination of differences in delay discounting between individuals with and without PTSD) and continuous association studies (e.g. relationship between posttraumatic stress symptom severity and delay discounting). In a combined analysis of all studies, the overall relationship was a small but statistically significant positive association between posttraumatic stress and delay discounting (r = .135, p < .0001). The same relationship was statistically significant for continuous association studies (r = .092, p = .027) and case-control designs (r = .179, p < .001). Evidence of publication bias was minimal. The included studies were limited in that many did not concurrently incorporate other psychiatric conditions in the analyses, leaving the specificity of the relationship to posttraumatic stress less clear. Nonetheless, these findings are broadly consistent with previous meta-analyses of delayed reward discounting in relation to other mental health conditions and provide further evidence for the transdiagnostic utility of this construct.

Psychometric Properties of the Self-Injurious Thoughts and Behaviors Interview-Short Form Among U.S. Active Duty Military Service Members and Veterans.

We assessed the interrater reliability, convergent validity, and discriminant validity of the Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF) in a sample of 1,944 active duty service members and veterans seeking services for posttraumatic stress disorder (PTSD) and related conditions. The SITBI-SF demonstrated high interrater reliability and good convergent and discriminant validity. The measurement properties of the SITBI-SF were comparable across service members and veterans. Approximately 8% of participants who denied a history of suicidal ideation on the SITBI-SF reported suicidal ideation on a separate self-report questionnaire (i.e., discordant responders). Discordant responders reported significantly higher levels of PTSD symptoms than those who denied suicidal ideation on both response formats. Findings suggest that the SITBI-SF is a reliable and valid interview-based measure of suicide-related thoughts and behaviors for use with military service members and veterans. Suicide risk assessment might be optimized if the SITBI-SF interview is combined with a self-report measure of related constructs.

The Utility of Assessing Alexithymia, in Addition to Coping, in the Context of Posttraumatic Stress.

ABSTRACT: The distinction between alexithymia and coping in relation to posttraumatic stress has not been fully explored. The present study examined the extent to which alexithymia explained unique variance in posttraumatic stress, beyond the variance explained by coping, in a sample of trauma-exposed adults ( N = 706; M age = 19.41 years, SD = 1.5; 77.1% female). Then, we explored the effect of race on these associations, comparing participants who identified as Black ( n = 275) to those who identified as White ( n = 337). Avoidant-emotional coping showed stronger correlations (compared with problem-focused and active-emotional coping) with total alexithymia, difficulty identifying feelings, and difficulty describing feelings. In regression analyses, we found alexithymia explained unique variance in posttraumatic stress severity beyond the effect of coping. Results did not differ by racial identity. These findings suggest that despite some overlap between alexithymia and coping, each shows unique relations with posttraumatic stress.

A randomized pilot trial of a mobile delivered brief motivational interviewing and behavioral economic alcohol intervention for emerging adults.

OBJECTIVE: Mobile health (mHealth) interventions show potential to broaden the reach of efficacious alcohol brief motivational interventions (BMIs). However, efficacy is mixed and may be limited by low participant attention and engagement. The present study examined the feasibility, acceptability, and preliminary efficacy of a live text-message delivered BMI in a pilot randomized clinical trial. METHOD: Participants were 66 college students (63.6% women; 61.9% White; Mage = 19.95, SD = 1.66) reporting an average of 11.88 (SD = 8.74) drinks per week, 4.42 (SD = 3.59) heavy drinking episodes (HDEs), and 8.44 (SD = 5.62) alcohol-related problems in the past month. Participants were randomized to receive either (a) education or (b) an alcohol BMI plus behavioral economic substance-free activity session (SFAS), each followed by 4 weeks of mini sessions. All sessions were administered via live text-message. Participants completed assessments postintervention (after the 4th mini session) and at 3-month follow-up. RESULTS: 90.9% completed both initial full-length sessions and at least two of the four mini sessions with 87.9% retention at 3-month follow-up. Participants found the interventions useful, interesting, relevant, and effective, with no between-group differences. There were no statistically significant group differences in drinks per week or alcohol-related problems at follow-up, but BMI + SFAS participants reported fewer past-month HDEs than those who received education. CONCLUSIONS: Live text-messaging to deliver the BMI + SFAS is feasible and well-received. The preliminary efficacy results should be interpreted cautiously due to the small sample size but support further investigation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Racial and Ethnic Disparities in HIV Testing in People Who Use Drugs Admitted to a Tertiary Care Hospital.

Ending the HIV epidemic requires increased testing, diagnosis, and linkage to care. In the past 10 years, rates of HIV have increased among people with substance use disorder (SUD). HIV testing is recommended during hospitalization. Despite rising rates of infections and recommendations, HIV testing remains suboptimal. This study sought to detect differences in HIV testing by race and ethnicity in people who use drugs (PWUD) admitted to Tufts Medical Center (TuftsMC). This study is a retrospective review of hospitalized PWUD admitted from January 1, 2017 to December 31, 2020. PWUD were identified through toxicology results, medication prescribed for SUD, and nursing intake questions. The primary outcome of interest was whether an HIV test was ordered during hospitalization. The indicator of interest was race and ethnicity. Of 13,486 PWUD admitted to TuftsMC, only 10% had an HIV test ordered. Compared with White patients, Black patients [adjusted odds ratio (AOR): 0.69, 95% confidence interval (CI) (0.59-0.83)] and Hispanic patients [AOR: 0.68, 95% CI (0.55-0.84)] had decreased odds of receiving an HIV test. Our report is the first to show racial and ethnic differences in HIV testing ordering for hospitalized PWUD. Without access to harm reduction tools and expanded systems-based testing strategies, the HIV epidemic will continue and disproportionately impact minoritized communities.

Open trial of a personalized feedback intervention and substance-free activity supplement for veterans with PTSD and hazardous drinking.

This study reports findings from an open trial of a two-session intervention for veterans with symptoms of PTSD and hazardous drinking. Rooted in behavioral economic theory, this intervention aimed to decrease alcohol use and increase alcohol-free activities through personalized and normative feedback. This trial assessed the feasibility and acceptability of the intervention in a sample of 15 veterans. Participants completed assessments at baseline and post-intervention (1-month and 3-months). Thirteen participants (86.6%) were retained between the baseline assessment and second intervention session. Acceptability data indicated that veterans overwhelmingly viewed the intervention positively with little dropout between the two sessions. Further, participants in our study reduced alcohol consumption from 37.30 (SD = 17.30) drinks per week at baseline to 22.50 (SD = 27.75) drinks per week at the 1-month assessment and then to 14.60 (SD = 18.64) at the 3-months assessment, representing medium to large effects. PTSD severity also decreased from 57.20 (SD = 16.72) at baseline to 48.90 (SD = 18.99) at the 1-month assessment, representing a small effect. Though effect sizes from pilot trials should be interpreted with caution, findings suggest that this intervention was well-received, feasible to deliver, and may have resulted in improvements in intervention targets.

Wanting, Liking, and Missing Out: Exploring the Role of Reward Functioning in the Overlap Between PTSD and Depression.

ABSTRACT: Diminished reward functioning (anhedonia) is an aspect of multiple psychiatric diagnoses and is a critical component of depression, yet it has rarely been examined in the context of posttraumatic stress disorder (PTSD). Deficits in reward function may be a transdiagnostic factor contributing to the high rate of comorbidity between PTSD and depression. The present study examined the commonality and distinction between PTSD and depression and their relationship to reward functioning using a bifactor model in a sample of 106 trauma-exposed undergraduates. Results indicated a strong commonality factor between PTSD and depression. Of three indices of reward functioning (i.e., hedonic pleasure, reward motivation, and environmental reward availability), environmental reward availability alone was related to unique latent factors for PTSD and depression, and their commonality. Findings suggest that environmental context may be the key to understanding the role of reward in PTSD, depression, and psychopathology broadly.

Posttraumatic stress disorder, drinking to cope, and harmful alcohol use: A multivariate meta-analysis of the self-medication hypothesis.

The association between posttraumatic stress disorder (PTSD) and harmful alcohol use has often been explained through the self-medication hypothesis via coping-related drinking motives. However, the magnitude of the indirect effect of PTSD on harmful alcohol use through coping motives is unclear. This study aggregated this indirect effect using a meta-analytic structural equation modeling approach and explored moderators that influenced the indirect effect. We identified articles from PsycINFO, PubMed/MEDLINE, and PROQUEST (through June 22, 2021) containing measures of (a) PTSD symptoms, (b) coping-related drinking, and (c) harmful alcohol use. Thirty-four studies yielding 69 effect sizes were included (mean N = 387.26 participants; median N = 303.5; range = 42-1,896; aggregate sample n = 15,128). Coping motives mediated the relation between PTSD and harmful alcohol use, accounting for 80% of the variance in the total effect. Moderating variables and evidence of publication bias were also found. Findings suggest that coping-related drinking is a strong mediator in the relation between PTSD and harmful alcohol use and that the strength of the indirect effect is meaningfully influenced by measurement approach, sample characteristics, and study design. Additional longitudinal and multivariate studies are needed to establish directionality and account for additional variance. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The associations between posttraumatic stress disorder and delay discounting, future orientation, and reward availability: A behavioral economic model.

The theoretical framework of behavioral economics, a metatheory that integrates operant learning and economic theory, has only recently been applied to posttraumatic stress disorder (PTSD). A behavioral economic theory of PTSD reflects an expansion of prior behavioral conceptualization of PTSD, which described PTSD in terms of respondent and operant conditioning. In the behavioral economic framework of PTSD, negatively reinforced avoidance behavior is overvalued, in part due to deficits in environmental reward, and may be conceptualized as a form of reinforcer pathology (i.e., excessive preference for and valuation of an immediate reinforcer). We investigated cross-sectional relationships between PTSD severity and several constructs rooted in this behavioral economic framework, including future orientation, reward availability, and delay discounting in a sample of 110 military personnel/veterans (87.2% male) who had served combat deployments following September 11, 2001. Total PTSD severity was inversely related to environmental reward availability, ß = -.49, ΔR2 = 0.24, p < .001; hedonic reward availability, ß = -.32, ΔR2 = 0.10, p = .001; and future orientation, ß = -.20, ΔR2 = 0.04, p = .032, but not delay discounting, r = -.05, p = .633. An examination of individual symptom clusters did not suggest that avoidance symptoms were uniquely associated with these behavioral economic constructs. The findings offer support for a behavioral economic model of PTSD in which there is a lack of positive reinforcement as well as a myopic focus on the present.

Validity of the alcohol purchase task with United States military personnel.

Alcohol use is common among military personnel. However, alcohol use and problems are challenging to measure because military personnel do not have similar levels of confidentiality as civilians and can face sanctions for reporting illegal behavior (e.g., underage drinking) or for drinking during prohibited times (e.g., during basic training). The current study aimed to determine if the use of the alcohol purchase task (APT), which has previously been associated with alcohol use and alcohol-related problems in civilian populations, is a valid measure of alcohol-related risk in the military when asking about alcohol consumption is less feasible. Participants were 26,231 Air Force airmen who completed surveys including questions about sensation seeking, alcohol expectancies, perception of peer drinking, intent to drink, and family history of alcohol misuse, which are known predictors of alcohol use, and the APT, from which demand indices of intensity and Omax were derived. Individuals who were single, male, White, and had a high school diploma/GED had higher intensity and Omax scores, and non-Hispanic individuals had higher intensity scores. Age was negatively correlated with intensity and Omax. Regressions were used to determine if intensity and Omax were associated with known predictors of alcohol use and risk. Intensity and Omax showed significant but small associations with all included predictors of alcohol consumption and alcohol risk. Effect sizes were larger for individuals ages 21+ compared to individuals under 21. Thus, this study provides initial support for the validity of the APT as an index of alcohol-related risk among military personnel. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Posttraumatic Stress Disorder and Aggression Among Post-9/11 Veterans: The Role of Shame.

Posttraumatic stress disorder (PTSD) is often accompanied by elevated aggression. PTSD and combat exposure alone do not fully explain the reliable finding of heightened aggression among trauma-exposed veterans. Shame may be an important affective feature in this relationship. The present study examined the role of shame from a social hierarchy theoretical perspective in a sample of 52 combat veterans from the post-9/11 era. Correlational analyses indicated moderately strong positive relationships among PTSD, shame, and aggression. Trait shame was found to significantly mediate the relationship between total PTSD severity and physical aggression, but not other forms of aggression. For veterans within the context of a hierarchical military culture, separation from the military and PTSD diagnosis may be very salient markers of social loss and social exclusion. Aggression may operate to reduce the negative affective experience associated with shame and to regain social standing. Findings implicate shame as an important emotional component in the relationship between PTSD and aggression.

STRONG STAR and the Consortium to Alleviate PTSD: Shaping the future of combat PTSD and related conditions in military and veteran populations.

The STRONG STAR Consortium (South Texas Research Organizational Network Guiding Studies on Trauma and Resilience) and the Consortium to Alleviate PTSD are interdisciplinary and multi-institutional research consortia focused on the detection, diagnosis, prevention, and treatment of combat-related posttraumatic stress disorder (PTSD) and comorbid conditions in military personnel and veterans. This manuscript outlines the consortia's state-of-the-science collaborative research model and how this can be used as a roadmap for future trauma-related research. STRONG STAR was initially funded for 5 years in 2008 by the U.S. Department of Defense's (DoD) Psychological Health and Traumatic Brain Injury Research Program. Since the initial funding of STRONG STAR, almost 50 additional peer-reviewed STRONG STAR-affiliated projects have been funded through the DoD, the U.S. Department of Veterans Affairs (VA), the National Institutes of Health, and private organizations. In 2013, STRONG STAR investigators partnered with the VA's National Center for PTSD and were selected for joint DoD/VA funding to establish the Consortium to Alleviate PTSD. STRONG STAR and the Consortium to Alleviate PTSD have assembled a critical mass of investigators and institutions with the synergy required to make major scientific and public health advances in the prevention and treatment of combat PTSD and related conditions. This manuscript provides an overview of the establishment of these two research consortia, including their history, vision, mission, goals, and accomplishments. Comprehensive tables provide descriptions of over 70 projects supported by the consortia. Examples are provided of collaborations among over 50 worldwide academic research institutions and over 150 investigators.

Alcohol use and coping in a cross-sectional study of African American homicide survivors.

The loss of a loved one to homicide is associated with considerable distress, often in the form of posttraumatic stress disorder (PTSD) and complicated grief (CG), and alcohol misuse. Yet alcohol-related problems and loss from a homicide are issues that disproportionally affect African Americans. The present study investigated alcohol use in a sample of 54 African American homicide survivors. Although there was a low prevalence of hazardous drinking, alcohol use was associated with higher levels of PTSD, complicated grief, and depression severity. In addition, scores on the Alcohol Use Disorders Identification Test (AUDIT) were correlated with active emotional coping and avoidant emotional coping. In analyses of PTSD symptom clusters, emotional numbing and hyperarousal symptoms were significantly correlated with AUDIT total score.

MEF2c-Dependent Downregulation of Myocilin Mediates Cancer-Induced Muscle Wasting and Associates with Cachexia in Patients with Cancer.

Skeletal muscle wasting is a devastating consequence of cancer that contributes to increased complications and poor survival, but is not well understood at the molecular level. Herein, we investigated the role of Myocilin (Myoc), a skeletal muscle hypertrophy-promoting protein that we showed is downregulated in multiple mouse models of cancer cachexia. Loss of Myoc alone was sufficient to induce phenotypes identified in mouse models of cancer cachexia, including muscle fiber atrophy, sarcolemmal fragility, and impaired muscle regeneration. By 18 months of age, mice deficient in Myoc showed significant skeletal muscle remodeling, characterized by increased fat and collagen deposition compared with wild-type mice, thus also supporting Myoc as a regulator of muscle quality. In cancer cachexia models, maintaining skeletal muscle expression of Myoc significantly attenuated muscle loss, while mice lacking Myoc showed enhanced muscle wasting. Furthermore, we identified the myocyte enhancer factor 2 C (MEF2C) transcription factor as a key upstream activator of Myoc whose gain of function significantly deterred cancer-induced muscle wasting and dysfunction in a preclinical model of pancreatic ductal adenocarcinoma (PDAC). Finally, compared with noncancer control patients, MYOC was significantly reduced in skeletal muscle of patients with PDAC defined as cachectic and correlated with MEF2c. These data therefore identify disruptions in MEF2c-dependent transcription of Myoc as a novel mechanism of cancer-associated muscle wasting that is similarly disrupted in muscle of patients with cachectic cancer. SIGNIFICANCE: This work identifies a novel transcriptional mechanism that mediates skeletal muscle wasting in murine models of cancer cachexia that is disrupted in skeletal muscle of patients with cancer exhibiting cachexia.

Behavioral economics and coping-related drinking motives in trauma exposed drinkers: Implications for the self-medication hypothesis.

Behavioral economic theory can help researchers understand complex behavior by considering the availability and economic value associated with an individual's choices. This study explored how behavioral economic constructs relate to alcohol consumption and alcohol problems in a sample of trauma-exposed young adults. We further explored whether these behavioral economic constructs explained unique variance in alcohol outcomes beyond coping-related drinking motives. Participants were 91 trauma-exposed young adults who reported recent alcohol consumption (Mage = 26.53, female = 36.26%, non-White = 41.75%). Participants were recruited through Amazon Mechanical Turk. Questionnaires measured alcohol consumption, problems, and motives for use, as well as alcohol demand, delay discounting, future orientation, and access to environmental reward. Future orientation (ΔR2 = .05, p = .03) and delay discounting (ΔR2 = .04, p = .05) explained unique variance in alcohol problems after controlling for coping-related drinking motives. Further, alcohol demand indices (ΔR2s = .04-.10, ps = .00-.05) explained unique variance in alcohol consumption after controlling for coping-related drinking. Both coping motives and behavioral economic variables contribute to alcohol consumption and alcohol-related consequences among trauma-exposed young adults. Findings suggest that, beyond coping motives, behavioral economics may play a meaningful role in understanding alcohol misuse. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Natural history of untreated unruptured intracranial aneurysms in the elderly.

BACKGROUND: The effect of age on risk of intracranial aneurysm rupture is not well understood. We investigated the clinical course of patients 65 years and older with conservatively managed unruptured intracranial aneurysms (UIA) and determined risk factors for rupture in this population. METHODS: We reviewed prospectively collected data on baseline characteristics and long-term follow-up for patients aged 65 years and older with an UIA that were initially managed with observation. The association between patient and aneurysmal characteristics and risk of rupture was performed using a multivariate Cox proportional hazard regression model. RESULTS: There were 214 patients (mean age: 74.7 years, SD: 6.0) included in our study. The median follow-up time was 3.7 years, with a cumulative follow-up time of 883.7 person-years. During the study period, seven patients (3.3%) received interventional treatment of their UIA and eight patients (3.7%) experienced aneurysmal subarachnoid hemorrhage, yielding an annual risk of rupture of 0.9%. All aneurysms that ruptured were at least 10 mm in size. Increasing patient age [unit relative risk (RR) 1.19, 95% CI: 1.07-1.36, P=0.002], larger aneurysmal size (unit RR 1.10, 95% CI: 1.02-1.17, P=0.021), and increasing PHASES Score (unit RR 1.62, 95% CI: 1.32-2.06, P<0.001) were associated with higher risk of rupture. CONCLUSIONS: Our data do not suggest that UIA in older patients carry a high risk of rupture. A conservative approach appears justified in these patients, with the exception of selected patients with larger aneurysms (>10 mm in diameter) and low risk of interventional procedure.

Adverse childhood experiences predict opioid relapse during treatment among rural adults.

Adverse childhood experiences (ACE) are a public health concern and strong predictor of substance abuse, but no studies to date have explored the association between ACE and opioid relapse during medication-assisted treatment. Using an observational design, we examined this relationship using archived medical records of 87 patients who attended opioid use disorder treatment (buprenorphine-naloxone and group counseling) at a rural medical clinic. All variables were collected from medical files. ACE scores were derived from a 10-item screening questionnaire administered at intake, a regular procedure for this clinic. The primary outcome was opioid relapse observed at each visit, as indicated by self-reported opioid use, positive urine drug screen for opioids, or prescription drug database results for opioid acquisition. The sample was 100% Caucasian and 75% male. A total of 2052 visit observations from the 87 patients were extracted from the medical records. Patients had an average of 23.6 (SD = 22) treatment visits. Opioid relapse occurred in 54% of patients. Results indicated that for every unit increase in ACE score, there was an increase of 17% in the odds of relapse (95% CI: 1.05-1.30, p = .005). Additionally, each treatment visit was associated with a 2% reduction in the odds of opioid relapse (95% CI: 0.97-0.99, p = .008). We conclude that ACE may increase the risk for poor response to buprenorphine-naloxone treatment due to high rates of opioid relapse during the first treatment visits. However, consistent adherence to treatment is likely to reduce the odds of opioid relapse.

Near-Fatal Acute Giant Intracranial Aneurysm Rerupture In 7-Month-Old Infant.

BACKGROUND: Aneurysm rerupture and bilateral fixed and dilated pupils (bFDPs) typically have a poor prognosis across all age groups. The synchronous occurrence of both features in the infantile demographic has not been previously reported. CASE DESCRIPTION: We describe the near-fatal clinical course of a 7-month-old infant who experienced an acute giant aneurysm rerupture with signs of bFDPs. The patient was rapidly managed with neurosurgical intervention and has achieved a favorable outcome 1 year later. CONCLUSIONS: This case highlights that survival of infants who present with intracranial aneurysmal rerupture and bFDPs is amenable to rapid neurosurgical intervention and should be remembered in clinical practice.

Using Latent Variable Mixture Modeling to Understand Trauma-Related Outcomes in Undergraduate Women.

Posttraumatic stress disorder (PTSD) and sexual functioning problems often co-occur after trauma. Researchers have linked certain factors (e.g., depression, relationship satisfaction) to PTSD and sexual functioning, but it is unclear how these variables interact. Adult undergraduate female trauma survivors (N = 280) completed self-report measures via an online survey. Latent variable mixture modeling generated four groups that differed in terms of their PTSD symptom severity, sexual functioning, sexual pain, relationship status, and relationship functioning. ANOVAs explored group differences. Classes were not differentiated by trauma, relationship satisfaction, or drug use. Results highlight the complex relations between sexual functioning and post-trauma symptomology.