Association Between Clinician-Level Factors and Patient Outcomes in Virtual and In-Person Outpatient Treatment for Substance Use Disorders: Multilevel Analysis.

BACKGROUND: The use of virtual treatment services increased dramatically during the COVID-19 pandemic. Unfortunately, large-scale research on virtual treatment for substance use disorder (SUD), including factors that may influence outcomes, has not advanced with the rapidly changing landscape. OBJECTIVE: This study aims to evaluate the link between clinician-level factors and patient outcomes in populations receiving virtual and in-person intensive outpatient services. METHODS: Data came from patients (n=1410) treated in a virtual intensive outpatient program (VIOP) and an in-person intensive outpatient program (IOP), who were discharged between January 2020 and March 2021 from a national treatment organization. Patient data were nested by treatment providers (n=58) examining associations with no-shows and discharge with staff approval. Empathy, comfort with technology, perceived stress, resistance to change, and demographic covariates were examined at the clinician level. RESULTS: The VIOP (ß=-5.71; P=.03) and the personal distress subscale measure (ß=-6.31; P=.003) were negatively associated with the percentage of no-shows. The VIOP was positively associated with discharges with staff approval (odds ratio [OR] 2.38, 95% CI 1.50-3.76). Clinician scores on perspective taking (ß=-9.22; P=.02), personal distress (ß=-9.44; P=.02), and male clinician gender (ß=-6.43; P=.04) were negatively associated with in-person no-shows. Patient load was positively associated with discharge with staff approval (OR 1.04, 95% CI 1.02-1.06). CONCLUSIONS: Overall, patients in the VIOP had fewer no-shows and a higher rate of successful discharge. Few clinician-level characteristics were significantly associated with patient outcomes. Further research is necessary to understand the relationships among factors such as clinician gender, patient load, personal distress, and patient retention.

Nonpartner Violence Perpetration Among Emerging Adults: Associations With Polysubstance Use and Trait Mindfulness.

Objective: Violence is a leading cause of death among individuals ages 18-25, with alcohol misuse consistently linked with violence perpetration. However, the association between polysubstance use and violence perpetration is less clear, despite the frequency of use of alcohol with other drugs. Additionally, protective factors such as mindfulness that may reduce violence perpetration among emerging adults have been understudied. This cross-sectional study examined the association between substance use, trait mindfulness, and violence perpetration outside of romantic relationships, utilizing a compensatory model of resilience. Methods: Data were drawn from a sample of 665 emerging adults ages 18-25, recruited from an urban Emergency Department (68% men). Participants self-administered a computer survey that assessed non-partner violence perpetration (NPV), alcohol use, marijuana use, prescription drug misuse, and trait mindfulness. Fifteen percent reported non-partner violence perpetration over the past six months. Results: Multivariate logistic regression tested associations between violence perpetration, substance use, trait mindfulness, and demographic characteristics. Results showed that alcohol use alone (OR= 3.04), prescription opioid use alone (OR = 3.58), alcohol and marijuana use (OR = 3.75), and use of all three substances (OR= 7.78) were positively associated with violence perpetration. Post-hoc contrasts demonstrated the polysubstance use significantly increased risk over single substance use. Trait mindfulness (OR= 0.97) was negatively associated with violence perpetration after controlling for substance use. Conclusions: Findings suggest that polysubstance use may increase risk for violence. Interventions that address polysubstance use, potentially including mindfulness, could reduce non-partner violence perpetration among emerging adults and requires further study.

In-Person Versus Telehealth Setting for the Delivery of Substance Use Disorder Treatment: Ecologically Valid Comparison Study.

BACKGROUND: The COVID-19 pandemic has profoundly transformed substance use disorder (SUD) treatment in the United States, with many web-based treatment services being used for this purpose. However, little is known about the long-term treatment effectiveness of SUD interventions delivered through digital technologies compared with in-person treatment, and even less is known about how patients, clinicians, and clinical characteristics may predict treatment outcomes. OBJECTIVE: This study aims to analyze baseline differences in patient demographics and clinical characteristics across traditional and telehealth settings in a sample of participants (N=3642) who received intensive outpatient program (IOP) substance use treatment from January 2020 to March 2021. METHODS: The virtual IOP (VIOP) study is a prospective longitudinal cohort design that follows adult (aged ≥18 years) patients who were discharged from IOP care for alcohol and substance use-related treatment at a large national SUD treatment provider between January 2020 and March 2021. Data were collected at baseline and up to 1 year after discharge from both in-person and VIOP services through phone- and web-based surveys to assess recent substance use and general functioning across several domains. RESULTS: Initial baseline descriptive data were collected on patient demographics and clinical inventories. No differences in IOP setting were detected by race (χ22=0.1; P=.96), ethnicity (χ22=0.8; P=.66), employment status (χ22=2.5; P=.29), education level (χ24=7.9; P=.10), or whether participants presented with multiple SUDs (χ28=11.4; P=.18). Significant differences emerged for biological sex (χ22=8.5; P=.05), age (χ26=26.8; P<.001), marital status (χ24=20.5; P<.001), length of stay (F2,3639=148.67; P<.001), and discharge against staff advice (χ22=10.6; P<.01). More differences emerged by developmental stage, with emerging adults more likely to be women (χ23=40.5; P<.001), non-White (χ23=15.8; P<.001), have multiple SUDs (χ23=453.6; P<.001), have longer lengths of stay (F3,3638=13.51; P<.001), and more likely to be discharged against staff advice (χ23=13.3; P<.01). CONCLUSIONS: The findings aim to deepen our understanding of SUD treatment efficacy across traditional and telehealth settings and its associated correlates and predictors of patient-centered outcomes. The results of this study will inform the effective development of data-driven benchmarks and protocols for routine outcome data practices in treatment settings.

Telehealth Services for Substance Use Disorders During the COVID-19 Pandemic: Longitudinal Assessment of Intensive Outpatient Programming and Data Collection Practices.

BACKGROUND: The onset of the COVID-19 pandemic necessitated the rapid transition of many types of substance use disorder (SUD) treatments to telehealth formats, despite limited information about what makes treatment effective in this novel format. OBJECTIVE: This study aims to examine the feasibility and effectiveness of virtual intensive outpatient programming (IOP) treatment for SUD in the context of a global pandemic, while considering the unique challenges posed to data collection during an unprecedented public health crisis. METHODS: The study is based on a longitudinal study with a baseline sample of 3642 patients who enrolled in intensive outpatient addiction treatment (in-person, hybrid, or virtual care) from January 2020 to March 2021 at a large substance use treatment center in the United States. The analytical sample consisted of patients who completed the 3-month postdischarge outcome survey as part of routine outcome monitoring (n=1060, 29.1% response rate). RESULTS: No significant differences were detected by delivery format in continuous abstinence (χ22=0.4, P=.81), overall quality of life (F2,826=2.06, P=.13), financial well-being (F2,767=2.30, P=.10), psychological well-being (F2,918=0.72, P=.49), and confidence in one's ability to stay sober (F2,941=0.21, P=.81). Individuals in hybrid programming were more likely to report a higher level of general health than those in virtual IOP (F2,917=4.19, P=.01). CONCLUSIONS: Virtual outpatient care for the treatment of SUD is a feasible alternative to in-person-only programming, leading to similar self-reported outcomes at 3 months postdischarge. Given the many obstacles presented throughout data collection during a pandemic, further research is needed to better understand under what conditions telehealth is an acceptable alternative to in-person care.

Prevention of sexual violence among college students: Current challenges and future directions.

Objective Preventing sexual violence among college students is a public health priority. This paper was catalyzed by a summit convened in 2018 to review the state of the science on campus sexual violence prevention. We summarize key risk and vulnerability factors and campus-based interventions, and provide directions for future research pertaining to campus sexual violence. Results and Conclusions: Although studies have identified risk factors for campus sexual violence, longitudinal research is needed to examine time-varying risk factors across social ecological levels (individual, relationship, campus context/broader community and culture) and data are particularly needed to identify protective factors. In terms of prevention, promising individual and relational level interventions exist, including active bystander, resistance, and gender transformative approaches; however, further evidence-based interventions are needed, particularly at the community-level, with attention to vulnerability factors and inclusion for marginalized students.

The Dynamics of Interpersonal Relationships: Understanding Power and Control Tactics Among College Students.

Intimate partner violence (IPV) is a significant public health problem among college students and many students have difficulty identifying unhealthy and abusive behaviors. The aims of this mixed methods study are to: (a) create an inclusive tool that illustrates the power and control experiences of a diverse group of young adult college students, (b) ensure a broad scope of tactics are illustrated (related to technology and different types of relationships), and (c) measure the experience of these tactics, including how IPV knowledge, attitudes, and self-efficacy are influenced by a more inclusive tool. In Phase I, semi-structured interviews were conducted with students (n = 33) and staff (n = 10) at campus sexual assault centers at the three University of Michigan (UM) campuses to explore power and control tactics utilized by perpetrators on college campuses. Content analysis revealed 13 categories of tactics in college relationships. A draft tool was created and assessed for accuracy using cognitive interviews with students (n = 20) from all three campuses in Phase II. Cognitive interviews resulted in the following changes to the final tool: (a) new presentation of the Socioecological Model, (b) identification of substance use as a facilitator for multiple forms of violence, and (c) edits to tactic descriptions. In Phase III, 250 students at UM-Ann Arbor participated in a quasi-experimental evaluation in which 133 interacted with the tool and 117 received access to usual care (campus sexual misconduct policy). Both groups answered survey questions about IPV knowledge, attitudes, self-efficacy, and experiences at baseline, and after one month and five months. Among all college participants in Phase III, 33.5% had experienced lifetime IPV and 25.2% had experienced IPV in the past year. There were no significant differences among IPV knowledge, attitudes, or self-efficacy by group. The Dynamics of Interpersonal Coercion Among College Students tool was created by incorporating current tactics utilized among a diverse college population.

Adapting to the Pandemic: Protocol of a Web-Based Perinatal Health Study to Improve Maternal and Infant Outcomes.

BACKGROUND: The identification of interconnected health risks during the perinatal period offers an opportunity to prevent negative maternal and infant health outcomes. Marijuana, opioid, and other substance use during pregnancy is a rapidly growing public health concern with significant and costly health consequences for the woman and the developing fetus. Pregnant persons who misuse substances are disproportionately more likely to engage in risky sexual behaviors resulting in sexually transmitted infections (STIs), which are on the rise in this population and can lead to adverse effects on maternal health and on fetal development. OBJECTIVE: Our goal is to continue testing an innovative and low-cost technology-delivered intervention, the Health Check-Up for Expectant Moms (HCEM), which simultaneously targets alcohol and drug use and STI risk during pregnancy, both of which are on the rise during the COVID-19 pandemic. METHODS: We describe the ways in which we have adapted the web-based HCEM intervention to continue recruitment and study enrollment during the pandemic. RESULTS: Study recruitment, visits, and participant safety assessments were all successfully modified during the initial year of the COVID-19 pandemic. Compared to in-person recruitment that occurred prepandemic, remote recruitment yielded a greater proportion of women enrolled in the study (83/136, 61.0% vs 43/52, 83%) in a shorter period (12 months vs 7 months). CONCLUSIONS: Despite study challenges related to the pandemic, including time and effort adapting to a remote protocol, remote recruitment and visits for this study were found to constitute a successful approach. TRIAL REGISTRATION: ClinicalTrials.gov NCT03826342; https://clinicaltrials.gov/ct2/show/NCT03826342. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30367.

Stealthing Perpetration and Victimization: Prevalence and Correlates Among Emerging Adults.

"Stealthing" is a form of sexual violence wherein a sexual partner purposefully removes a condom during penetration without the receptive partner's knowledge. Given the role of substance use in sexual violence broadly, we examined demographic and substance use correlates of stealthing perpetration (SP) and victimization (SV) among emerging adults. Participants comprised 2,550 18- to 25-year-olds (M age = 20.8, SD = 2.3), recruited via social media (48% female; 53.9% non-Hispanic White; 46.0% had another racial/ethnic identity; 67.4% heterosexual; 85.3% had some college education). Unadjusted analyses (t tests, χ2 analysis) and adjusted logistic regression analyses examined associations between demographics (age, education, race/ethnicity, sexual orientation) and substance use (binge drinking, marijuana use, other illegal drug use, and prescription drug misuse) with male SP and male and female SV. Five percent of males and 18.9% of females reported SV; 6.1% of males reported SP. In adjusted analyses, significant correlates of SP were: non-Hispanic White race/ethnicity (odds ratio [OR] = 0.39), binge drinking (OR = 1.39), cannabis use (OR = 1.37), and other drug use (OR = 1.43). Significant correlates of male SV were: non-Hispanic White race/ethnicity (OR = 0.28), non-heterosexual orientation (OR = 0.24), binge drinking (OR = 1.49), and other illegal drug use (OR = 1.79). Significant correlates of female SV were: older age (OR = 1.13), non-Hispanic White race/ethnicity (OR = 0.57), binge drinking (OR = 1.28), cannabis use (OR = 1.29), and other drug use (OR = 1.22). Consistent with literature linking alcohol to sexual violence, binge drinking correlated with both SV and SP, with other substance use also playing a role. Data are needed to explore these relationships using longitudinal, event-level assessments to investigate the influence of acute intoxication. Interventions to reduce sexually transmitted infections, unintended pregnancy, and sexual assault should include content on stealthing and substance use.

State of the science: a scoping review of primary prevention of firearm injuries among children and adolescents.

Intentional and unintentional firearm injury is the second leading cause of death for youth, underscoring the need for effective primary prevention approaches that focus on increasing safe storage by caregivers and decreasing handling/carriage among youth. This article describes the state of the science for prevention of firearm injuries among children and adolescents. We applied PRISMA guidelines to present results from a scoping review using PubMed, Scopus, CINAHL, and CJ Abstracts for original research articles published between January 1, 1985 and March 1, 2018 in the U.S. focusing on primary screening or interventions for primary prevention of pediatric firearm injuries. In total, 46 articles met inclusion criteria: safe storage (23), screening (2), firearm handling/carriage/use (21). Across school, healthcare, and community settings, few evidenced-based programs exist, and data on firearm safety technologies are lacking. Programs have generally not employed rigorous designs, and/or assessed behavioral (e.g., carriage) or injury-related firearm outcomes. Evidenced-based prevention programs are needed to mitigate firearm morbidity and mortality among youth.

A randomized controlled trial for aggression and substance use involvement among Veterans: Impact of combining Motivational Interviewing, Cognitive Behavioral Treatment and telephone-based Continuing Care.

Physical aggression (towards partners or non-partners) is common among patients in treatment for substance use disorders (SUDs), including among Veteran samples; however, few treatment programs provide adjunct intervention approaches targeting reduction or prevention of aggression. The primary objectives of this comparative efficacy study were to examine the impact of adjunct aggression interventions delivered during treatment on aggression and substance use outcomes, including: a) an acute treatment phase 6-session integrated Motivational Interviewing-Cognitive Behavioral Treatment intervention (MI-CBT) for aggression and substance use prevention, b) MI-CBT plus a 12-week telephone-based Continuing Care (MI-CBT + CC) intervention, and c) an acute phase single session control condition [including some discussion of violence prevention and local violence prevention resources (Enhanced Treatment as Usual (E-TAU))]. Participants (N = 180; 165 males and 15 females) were Veterans with SUD problems and past-year severe aggression who were randomized to one of three conditions: MI-CBT, MI-CBT + CC, or E-TAU. Primary 12-month outcomes included physical aggression and injury to partners, non-partners, and total aggression (collapsing across partner and non-partner relationships). Substance use outcomes included heavy drinking, marijuana use, cocaine use, and overall illicit substance use. Due to low representation in the sample (n = 4 women in each group at follow-up), women were excluded from primary analyses. According to unadjusted analyses of male participants, all groups showed similar significant declines in aggression over time, with the MI-CBT and MI-CBT + CC groups showing significant reductions in more substance use outcomes (heavy drinking, cocaine use, overall illicit drug use) than the E-TAU group. The only significant group x time interaction was for partner physical aggression by men (those in the MI-CBT + CC group showed a significantly greater decrease from baseline to follow-up). Also, neither the MI-CBT nor MI-CBT + CC groups reported any injuring of partners during the follow-up. For heavy drinking, cocaine, marijuana and overall illicit drug use, there were significant reductions over time, but no group by time interaction effects. The findings illustrate significant reductions in aggression and substance use over time for those involved in VA SUD treatment, and a potential modest benefit of additional integrated treatment approaches (MI-CBT, MI-CBT + CC) on reducing aggression. Future studies should examine dissemination efforts in the VA, cost-effectiveness, and moderators of outcome.

Tracking Assault-injured, Drug-using Youth in Longitudinal Research: Follow-up Methods.

OBJECTIVES: Violence is one of the leading causes of death among youth ages 14 to 24. Hospital- and emergency department (ED)-based violence prevention programs are increasingly becoming a critical part of public health efforts; however, evaluation of prevention efforts is needed to create evidence-based best practices. Retention of study participants is key to evaluations, although little literature exists regarding optimizing follow-up methods for violently injured youth. This study aims to describe the methods for retention in youth violence studies and the characteristics of hard-to-reach participants. METHODS: The Flint Youth Injury (FYI) Study is a prospective study following a cohort of assault-injured, drug-using youth recruited in an urban ED, and a comparison population of drug-using youth seeking medical or non-violence-related injury care. Validated survey instruments were administered at baseline and four follow-up time points (6, 12, 18, and 24 months). Follow-up contacts used a variety of strategies and all attempts were coded by type and level of success. Regression analysis was used to predict contact difficulty and follow-up interview completion at 24 months. RESULTS: A total of 599 patients (ages 14-24) were recruited from the ED (mean ± SD age = 20.1 ± 2.4 years, 41.2% female, 58.2% African American), with follow-up rates at 6, 12, 18, and 24 months of 85.3%, 83.7% 84.2%, and 85.3%, respectively. Participant contact efforts ranged from two to 53 times per follow-up time frame to complete a follow-up appointment, and more than 20% of appointments were completed off site at community locations (e.g., participants' homes, jail/prison). Participants who were younger (p < 0.05) and female (p < 0.01) were more likely to complete their 24-month follow-up interview. Participants who sought care in the ED for assault injury (p < 0.05) and had a substance use disorder (p < 0.01) at baseline required fewer contact attempts to complete their 24-month follow-up, while participants reporting a fight within the immediate 3 months before their 24-month follow-up (p < 0.01) required more intensive contact efforts. CONCLUSIONS: The FYI study demonstrated that achieving high follow-up rates for a difficult-to-track, violently-injured ED population is feasible through the use of established contact strategies and a variety of interview locations. Results have implications for follow-up strategies planned as part of other violence prevention studies.

Adolescent sexual violence: Prevalence, adolescent risks, and violence characteristics.

The purpose of this research is to investigate peer-to-peer sexual violence victimization and perpetration among male and female adolescents in a large, racially and economically diverse, community-based sample. Using cross-sectional data over a four-year period (2009-2013) from a regional sample of middle school and high school students in southeastern Michigan, we examined the prevalence and correlates of peer-to-peer sexual violence victimization and perpetration among adolescents. 33.9% of males and 53.5% of females reported sexual violence victimization, while 22.8% of males and 12.6% of females reported sexual violence perpetration. The majority of peer-to-peer sexual victimization and perpetration occurred by someone of the opposite sex, however, same-sex victimization and perpetration were not uncommon. Substance use, depression, Attention Deficit Hyperactivity Disorder (ADHD), and conduct disorder were associated with peer-to-peer sexual violence (victimization or perpetration) for both males and females, with few differences in the patterns of associations by sex. These findings are an important step in better understanding the types of peer-to-peer sexual violence that adolescents experience and risk factors for both male and female youth.

Understanding the Role of Alcohol, Anxiety, and Trait Mindfulness in the Perpetration of Physical and Sexual Dating Violence in Emerging Adults.

This study examines alcohol consumption, anxiety, trait mindfulness, and physical and sexual dating violence aggression (PDV and SDV) among 735 emerging adults (18-25 years) in an urban emergency department. Of the total sample, 27.2% perpetrated PDV and 16.5% perpetrated SDV. Alcohol was positively associated with PDV/SDV. Anxiety was positively associated with PDV. Mindfulness was negatively associated with PDV/SDV. Interaction analyses revealed women had lower PDV with higher nonjudgment facet of mindfulness. Higher act aware was associated with lower PDV regardless of high versus low alcohol. Findings indicate different contributing factors among perpetrators of PDV/SDV; some factors may be attenuated by mindfulness.

Emergency Department Alcohol Intervention: Effects on Dating Violence and Depression.

OBJECTIVES: With this study, we examined secondary outcomes of an emergency department (ED)-based brief intervention (BI) on dating violence perpetration and victimization and depression symptoms over 3, 6, and 12 months. METHODS: ED patients (14-20 years) were screened for risk drinking. Patients who received positive screen results were randomly assigned to a computer BI (n = 277), therapist BI (n = 278), or control condition (n = 281). After the 3-month assessment, participants were randomly assigned to receive the post-ED BI or control condition. BIs were used to address alcohol consumption and consequences (eg, dating violence and depression symptoms) by using motivational interviewing. RESULTS: A total of 836 patients were enrolled in the randomized controlled trial of 4389 patients screened and 1054 who reported risky drinking. Regression models were used to examine longitudinal effects of the alcohol BI on dating violence perpetration, dating violence victimization, and depression symptoms. The therapist BI resulted in a significant reduction of dating violence perpetration up to 12 months (incidence rate ratio [IRR] = 0.53; 95% confidence interval [CI]: 0.37-0.77) and depression symptoms up to 3 months (IRR = 0.85; 95% CI: 0.72-1.00) after the intervention. Computer BI resulted in a reduction of dating violence perpetration (IRR = 0.52; 95% CI: 0.35-0.76) and depression symptoms (IRR = 0.78; 95% CI: 0.66-0.94) 6 months postintervention. Post-ED BIs were associated with lower perpetration at 12 months and lower victimization at 6 and 12 months, irrespective of BI intervention randomization at baseline; however, they did not affect depression symptoms. CONCLUSIONS: A single-session ED BI revealed previously to show promise in reducing underage drinking also demonstrates promise in preventing dating violence perpetration and depression symptoms. These technology-enhanced BIs could be particularly helpful given the potential for more efficient resource usage and ease of future implementation.

Sexual Violence Victimization Among Youth Presenting to an Urban Emergency Department: The Role of Violence Exposure in Predicting Risk.

Sexual violence (SV) is a widespread public health problem among adolescents and emerging adults with significant short- and long-term consequences. Young people living in urban, disadvantaged communities with high rates of violence may be especially at risk for SV victimization. Understanding interconnections between different forms of violence is critical to reducing SV risk among youth. Participants were youth ( N = 599) ages 14 to 24 years ( M = 20.05, SD = 2.42) presenting to an urban emergency department with a Level 1 trauma designation as part of a prospective cohort study and followed-up for 24 months. We used logistic regression to examine the probability of reporting SV during the 24-month follow-up based on baseline reports of community and peer violence exposure, accounting for previous SV victimization, substance use, and sociodemographic characteristics. Among youth presenting to an urban emergency department, 22% of youth not seeking care for a sexual assault reported any lifetime SV (forced and/or substance-induced sexual intercourse) at baseline. During the 24-month follow-up, 12% reported SV victimization. We found high community violence exposure (odds ratio [OR] = 2.96, 95% confidence interval [CI] [1.01, 8.68]) and peer violence exposure (OR = 1.58, 95% CI [1.19, 2.08]) were associated with increased odds of reporting SV during follow-up in addition to previous SV victimization (OR = 2.71, 95% CI [1.45, 5.09]). Sex, age, parent education, and alcohol or other drug use at baseline were not associated with odds of SV during follow-up. Investigating interconnections between SV victimization and other forms of violence across socioecological levels provides an opportunity to advance SV research and identify promising avenues for prevention based on other violence prevention research. Future strategies for SV prevention that incorporate community and peer components as well as SV-specific content may help reduce SV victimization among youth living in urban, disadvantaged communities.

The Clinical Relevance of Divergence in Adolescent-Parent Reports of Adolescent Depression and Anxiety.

This study examines associations between adolescent problem behaviors and adolescent-parent disagreement in ratings of adolescent depression and anxiety symptoms. Adolescent-parent dyads (N = 463; mean age = 12.68 years; 48.5% female; 78.2% White and 21.8% non-White) reported on adolescent depression and anxiety using parallel scales from the Youth Self Report (Achenbach et al., J Emot Behav Disord 10:194-203, 2002) and the Child Behavior Checklist (Achenbach and Rescorla, The manual for the ASEBA school-age forms & profiles, University of Vermont, Research Center for Children, Youth, and Families, Burlington, 2001) across four waves. Generalized estimating equations were used to examine the relationship between discrepancy scores and adolescent behavioral outcomes: incidence of adolescent past-year substance use (alcohol use, binge drinking, marijuana use, and nonmedical use of controlled medications), delinquency, self-harm behavior, and aggression. Findings showed that larger adolescent-parent divergence scores of depression were associated with higher odds of marijuana use, non-medical use of controlled medications, alcohol use, binge drinking, in-school delinquency, illegal behavior, self-harm behavior, and clinically significant levels of aggressive behavior. Results further revealed that larger divergence scores on anxiety were associated with higher odds of in-school delinquency, illegal behavior, self-harm behavior, and clinically significant levels of aggressive behavior. Adolescent-parent reporting discrepancy on adolescent's depression and anxiety symptoms may be indicative of adolescent's social, emotional, and behavioral problems, and the disagreement may signal further need for assessment of the adolescent.

Understanding Mechanisms of Change for Brief Alcohol Interventions Among Youth: Examination of Within-Session Interactions.

OBJECTIVE: Alcohol brief interventions (BIs) for youth are efficacious, but effect sizes found have been modest. This article presents secondary data analyses from a randomized controlled trial of motivational interviewing-based (MI) alcohol BIs among youth in an emergency department, examining within-session predictors of alcohol outcomes at 3 months among those receiving BIs. METHOD: Risky drinkers (ages 14-20) received either a computer BI (n = 277) or therapist BI (n = 278). Within-session measures were obtained via computer metrics (therapist and computer BIs) and coding of audiotapes (therapist BI only). Parallel structural equation models examined direct and indirect effects of BI components on 3-month alcohol consumption and consequences, with posttest precursors of behavior change (e.g., importance, readiness, and intentions) as potential mediators. Components examined included reasons to avoid or reduce drinking, strengths, strategies for change, benefits of change, and leisure activities (computer BI only), and MI global ratings and MI-adherent behaviors (therapist BI only). RESULTS: For both BIs, greater number of strategies directly predicted greater posttest scores, with posttest scores mediating the relationship between strategies and alcohol consumption at 3 months. Greater number of strengths directly predicted fewer alcohol-related consequences at 3 months for both BIs; however, strengths also indirectly predicted greater consumption, mediated by posttest scores. Greater number of reasons to avoid or reduce drinking directly predicted greater alcohol consumption for the therapist BI only. CONCLUSIONS: These findings suggest ways to optimize the content and efficacy of alcohol BIs. Reviews of strategies such as refusal skills, protective behavioral strategies, and coping with negative affect may be particularly salient for reducing alcohol misuse.

Violent firearm-related conflicts among high-risk youth: An event-level and daily calendar analysis.

Firearm homicide is the leading cause of violence-related youth mortality. To inform prevention efforts, we analyzed event-level data to identify unique precursors to firearm conflicts. Youth (ages:14-24) seeking Emergency Department (ED) treatment for assault or for other reasons and reporting past 6-month drug use were enrolled in a 2-year longitudinal study. Time-line follow-back substance use/aggression modules were administered at baseline and each 6-month follow-up. Violent non-partner conflicts were combined across time-points. Regression analyzed: a)antecedents of firearm-related conflicts (i.e., threats/use) as compared to non-firearm conflicts; and b)substance use on conflict (vs. non-conflict) days for those engaged in firearm conflict. During the 24-months, we found that 421-youth reported involvement in violent non-partner conflict (n=829-conflicts;197-firearm/632-non-firearm). Among firearm conflicts, 24.9% involved aggression and 92.9% involved victimization. Retaliation was the most common motivation for firearm-aggression (51.0%), while "shot for no reason" (29.5%) and conflicts motivated by arguments over "personal belongings" (24.0%) were most common for firearm-victimization. Male sex (AOR=5.14), Black race (AOR=2.75), a ED visit for assault (AOR=3.46), marijuana use before the conflict (AOR=2.02), and conflicts motivated by retaliation (AOR=4.57) or personal belongings (AOR=2.28) increased the odds that a conflict involved firearms. Alcohol (AOR=2.80), marijuana (AOR=1.63), and prescription drugs (AOR=4.06) had a higher association with conflict (vs. non-conflict) days among youth reporting firearm conflict. Overall, we found that firearm conflicts are differentially associated with substance use and violence motivations. Addressing substance use, interrupting the cycle of retaliatory violence, and developing conflict resolution strategies that address escalation over infringement on personal belongings may aid in decreasing and preventing adolescent firearm violence.

A Latent Profile Analysis of Aggression and Victimization Across Relationship Types Among Veterans Who Use Substances.

OBJECTIVE: This study examined patterns of violence victimization and aggression in both intimate partner and nonpartner relationships among U.S. military veterans using latent profile analysis to identify subtypes of violence involvement. METHOD: Participants were 839 substance use treatment-seeking veterans (93% male) from a large Veterans Affairs Medical Center who completed screening measures for a randomized controlled trial. RESULTS: Past-year violence involvement, including both intimate partner violence (IPV) and nonpartner violence (NPV), was common in the sample, although NPV occurred at somewhat higher rates. When we included either IPV or NPV aggression or victimization, more than 40% reported involvement with physical violence, 30% with violence involving injury, and 86% with psychological aggression. Latent profile analysis including both aggression and victimization in partner and nonpartner relationships indicated a four-profile solution: no/low violence (NLV; n = 377), predominantly IPV (n = 219), predominantly NPV (n = 134), and high general violence (HGV; n = 109). Multinomial logistic regression analyses revealed that, compared with the NLV group, the remaining three groups differed in age, cocaine use, posttraumatic stress disorder (PTSD) symptoms, and legal involvement. Legal issues appeared to differentiate the profiles most, with the predominantly NPV and HGV profiles reporting more instances of driving under the influence and the HGV profile reporting legal problems related to aggression. CONCLUSIONS: IPV and NPV are fairly common among veterans seeking substance use treatment. The clinical characteristics of violence profiles indicate that cocaine use, PTSD symptoms, and legal involvement are treatment needs that vary with violence profile and may be useful for clinical decision making.

Associations between PTSD and intimate partner and non-partner aggression among substance using veterans in specialty mental health.

BACKGROUND: Risk factors of violence perpetration in veterans include substance use and posttraumatic stress disorder (PTSD); however, it is unknown whether these factors are associated with greater risk for partner or non-partner violence. This study investigated the associations between probable PTSD, heavy drinking, marijuana use, cocaine use, and partner and non-partner violence perpetration. METHODS: Self-report questionnaires assessing past-year partner and non-partner aggression (CTS2) as well as past-month substance use (SAOM), probable PTSD (PCL-C), and probable depression (PHQ-9) were administered to 810 substance using veterans entering VA mental health treatment. RESULTS: In bivariate analyses, probable PTSD in substance using veterans was associated with violence perpetration (partner physical, χ2=11.46, p=0.001, φ=0.12; non-partner physical, χ2=50.64, p<0.001, φ=0.25; partner injury, χ2=6.41, p=0.011, φ=0.09; non-partner injury, χ2=42.71, p<0.001, φ=0.23). In multiple logistic regression analyses that adjusted for sociodemographic characteristics, probable PTSD was independently associated with non-partner physical (odds ratio [OR], 2.82; 95% confidence interval [CI], 1.97-4.05) and injury aggression (OR, 3.96; CI, 2.56-6.13). Cocaine and heavy drinking were independently associated with non-partner physical and injury aggression and non-partner injury aggression respectively. CONCLUSIONS: The results provide evidence that probable PTSD, heavy drinking, and cocaine use are associated with increased risk of non-partner violence perpetration in substance using veterans. These results underscore the importance of screening for PTSD symptoms and violence perpetration towards non-partners in substance using veterans presenting for treatment.