Personality correlates of past-year alcohol use in individuals with severe alcohol use disorder and a lifetime history of involvement in alcoholics anonymous.

BACKGROUND: Alcohol use disorder (AUD) is a highly impairing condition with important public health impacts. Despite the availability of treatment options for AUD, research shows that few people receive treatment, and even fewer can maintain abstinence/low-drinking levels. This study investigated the role of personality traits in past-year alcohol use among individuals with severe AUD who ever attended Alcoholics Anonymous (AA), a widespread and easily accessible self-help group for alcohol problems. METHODS: Univariable and multivariable regressions were performed separately in females and males with alcohol consumption as an outcome. Socioeconomic factors, genetic liability, and psychopathology were included as covariates in the analyses. RESULTS: Results from the multivariable model indicated that in females who attended AA, greater alcohol use was related to both positive and negative urgency and low sensation seeking, while in males, greater alcohol use was related to positive urgency. Results also showed that, in both sexes, younger age and lower educational levels were associated with greater alcohol use. Moreover, single males and individuals with lower AUD severity were at higher risk of using alcohol in the past year. CONCLUSIONS: These findings highlight sex-specific correlates of drinking in individuals with AUD who engaged in self-help groups. These findings may help to improve treatment options, as personality encompasses modifiable traits that can be targeted in psychological interventions.

Personality correlates of past-year alcohol use in individuals with severe alcohol use disorder and a lifetime history of involvement in Alcoholics Anonymous.

BACKGROUND: Alcohol Use Disorder (AUD) is a highly impairing condition with important public health impacts. Despite the availability of treatment options for AUD, research shows that few people receive treatment, and even fewer can maintain abstinence/low drinking levels. This study investigated the role of personality traits in current alcohol use among individuals with severe AUD who ever attended Alcoholics Anonymous (AA), a widespread and easily accessible self-help group for alcohol problems. METHODS: Univariable and multivariable regressions were performed separately in females and males with alcohol consumption as an outcome. Socioeconomic factors, genetic liability, and psychopathology were included as covariates. RESULTS: Results from the multivariable model indicated that in females who attended AA, higher alcohol use was related to both positive and negative urgency as well as low sensation seeking, while in males, higher alcohol use was related to positive urgency. Results also indicated an important role of younger age and lower educational levels in higher alcohol use in both sexes. Moreover, single males and those with lower AUD severity were at higher risk of using alcohol in the past year. CONCLUSIONS: These findings highlighted sex-specific correlates of drinking in individuals with AUD who engaged in self-help groups. Findings may be useful to improve treatment options, as personality encompasses modifiable traits that can be targeted in psychological interventions.

Substance Use Disorders in Women.

Substance use disorder (SUD) is among the leading causes of premature morbidity and mortality and imposes significant health, economic, and social burdens. Gender differences have been found in the development, course, and treatment of SUD, with women at increased risk for physiologic and psychosocial consequences compared with men. Reasons for these differences are multifold and include biological, genetic, environmental, and behavioral factors. This article discusses SUD among women, emphasizing clinical considerations for care. Specific topics include epidemiology, sex and gender differences, common comorbidities, screening, diagnosis, treatment, pregnancy, and sociocultural factors.

Rapid induction onto extended-release injectable buprenorphine following opioid overdose: A case series.

Background: Buprenorphine treatment has been associated with reduced non-prescribed opioid use and opioid related overdose (OD). We evaluated initial outcomes of rapid induction onto extended-release injectable buprenorphine (BUP-XR) within 7 days of emergency department presentation for unintentional OD. Methods: Between February 2019-February 2021, N = 19 patients with opioid use disorder received buprenorphine/naloxone (4/1 mg), followed by BUP-XR (300 mg) at induction and continued BUP-XR outpatient for 6 months. Primary outcomes included adverse events, repeat OD, and death. Results: For patients who received at least one dose of BUP-XR, there were no treatment related serious adverse events or symptoms of precipitated withdrawal. In addition, there were no repeat visits for ODs or deaths within 6 months of the initial OD. Discussion: These preliminary findings support the need for larger controlled clinical trials to examine the safety and efficacy of rapid induction of BUP-XR in patients with opioid use disorder at high risk of opioid OD. Rapid induction onto long-lasting injectable buprenorphine may be a promising and protective treatment approach in the future.

Licit Substance Use and Premenstrual Syndrome Symptom Severity in Female College Students.

Introduction: Premenstrual syndrome (PMS) affects the majority of women and is characterized by physical, behavioral, and mood symptoms, which can have a profound impact on quality of life. PMS symptoms have also been linked to licit substance use. This study examined the relationships between daily/problem use (DPU) of caffeine (Caf+), alcohol (Alc+), and tobacco (Cig+) and PMS symptomology in a sample of college women. Methods: Participants (N = 196) completed an anonymous one-time health survey. Demographic, PMS symptomatology, and DPU of licit substance variables were examined. Independent t-tests compared PMS symptom scores in women with and without Caf+, Cig+, and Alc+ use. One-way analysis of variances examined the associations between PMS symptom severity and number of DPU-positive substances. Results: PMS subscale severity (pain [F(2,190) = 4.47, p = 0.013], affective [F(2,192) = 8.21, p < 0.001], and water retention [F(2,191) = 13.37, p < 0.001]) and total PMS symptom severity [F(2,189) = 10.22, p < 0.001] showed a dose response effect, with the number of licit substances with DPU significantly associated with PMS symptom severity. Conclusions: This study findings provide important new information about the relationship between PMS symptoms and at-risk substance use. These are cross-sectional data, however, and affirm a need for longitudinal research to better understand the associations, with a focus on potential benefits of education and intervention.

Coffee and energy drink use patterns in college freshmen: associations with adverse health behaviors and risk factors.

BACKGROUND: Public health concern over college students mixing caffeine-containing energy drinks (EDs) and alcohol has contributed to an array of ED-focused research studies. One review found consistent associations between ED use and heavy/problem drinking as well as other drug use and risky behaviors (Nutr Rev 72:87-97, 2014). The extent to which similar patterns exist for other sources of caffeine is not known. The present study examined associations between coffee and ED consumption and alcohol, tobacco and other drug use; alcohol use problems; and parental substance abuse and mental health problems in a sample of college freshmen. METHODS: Subjects were N = 1986 freshmen at an urban university who completed an on-line survey about demographics; caffeine; alcohol, tobacco and other drug use; and family history. The sample was 61% female and 53% White. Chi-square analyses and multivariable binary or ordinal logistic regression were used to compare substance use, problem alcohol behavior, and familial risk measures across 3 caffeine use groups: ED (with or without Coffee) (ED + Co; N = 350); Coffee but no ED (Co; N = 761); and neither coffee nor ED (NoCE; N = 875) use. RESULTS: After adjusting for gender and race, the 3 caffeine use groups differed on 8 of 9 symptoms for alcohol dependence. In all cases, the ED + Co group was most likely to endorse the symptom, followed by the Co group and finally the NoCE group (all p < .002). A similar pattern was found for: use 6+ times of 5 other classes of drugs (all p < .05); extent of personal and peer smoking (all p < .001); and paternal problems with alcohol, drugs and anxiety/depression as well as maternal alcohol problems and depression/anxiety (p < .04). CONCLUSIONS: The response pattern was ubiquitous, with ED + Co most likely, Co intermediate, and NoCE least likely to endorse a broad range of substance use, problem alcohol behaviors, and familial risk factors. The finding that the Co group differed from both the ED + Co and NoCE groups on 8 measures and from the NoCE group on one additional measure underscores the importance of looking at coffee in addition to EDs when considering associations between caffeine and other risky behaviors.

Gender-specific correlates of nonmedical use of prescription medications in a diverse primary care sample.

BACKGROUND: Nonmedical use of prescription medications (NUPM) is a growing problem but little is known about its gender-specific mechanisms despite NIDA's call for gender-stratified research over a decade ago. We explored gender differences in NUPM in a diverse sample of primary care patients. METHODS: N = 4458 participants participated in an anonymous health survey in urban primary care clinics. The primary outcome was past month NUPM. All analyses were stratified by gender. Bivariate relationships among NUPM and demographic, medical, psychological, and substance use-related variables were analyzed. Stepwise multivariate logistic regression models (LRMs) were estimated by gender. RESULTS: More men (9.5%) reported NUPM than women (7.4%). The final LRM among men included age (OR=0.98), race (OR=0.49), chronic pain diagnosis (OR=1.73), hepatitis (OR=1.78), depression diagnosis (OR=1.77), positive alcohol misuse screen (OR=1.58), and mood disturbance (OR=1.04). Among women, the model included mood disturbance (OR=1.04), illicit drug use (OR=2.22), family history of drug problems (OR=1.41), and heart disease diagnosis (OR=0.48). Effect sizes ranged from small to moderate. CONCLUSIONS: Among a sample of primary care patients, gender-stratified analyses indicated differential presentation of NUPM by gender. Demographic factors were more relevant correlates among men, with younger, White men at higher risk. Chronic pain and depression were more notable risk factors for men. Recent illicit drug use and family history of drug problems were uniquely associated among women, while recent distress was a strong correlate among both men and women. A better understanding of gender-specific correlates of NUPM can inform gender-tailored prevention and treatment efforts.

Patterns and Correlates of Polysubstance Use Among Individuals With Severe Alcohol Use Disorder.

AIM: The present study examined patterns and correlates of polysubstance use among individuals with severe alcohol use disorder (AUD). METHODS: Participants were 2785 individuals (63% female; mean age = 43 years, range = 18-78 years) from the Genes, Addiction and Personality Study. All participants met lifetime criteria for severe AUD (6+ symptoms). We used latent class analysis to identify patterns of frequency of lifetime use for cigarettes, marijuana, cocaine, stimulants, sedatives, opioids and hallucinogens. A variety of demographic and behavioral correlates of latent class membership were tested in univariable and multivariable models. RESULTS: A five-class solution was selected: extended range polysubstance use (24.5%); cigarette and marijuana use (18.8%); 'testers,' characterized by high probabilities of smoking 100 or more cigarettes, using marijuana 6+ times, and trying the remaining substances 1-5 times (12.3%); moderate range polysubstance use (17.1%) and minimal use (reference class; 27.3%). In univariable analyses, all potential correlates were related to latent class membership. In the multivariable model, associations with gender, race/ethnicity, age of onset for alcohol problems, dimensions of impulsivity, depressive symptoms, antisocial behavior and family history density of alcohol problems remained significant, though the pattern and strength of associations differed across classes. For instance, sensation-seeking, lack of premeditation and family history were uniquely associated with membership in the extended range polysubstance use class. CONCLUSION: Patterns of polysubstance use are differentially related to demographic and behavioral factors among individuals with severe AUD. Assessing use across multiple substances may inform the selection of targets for treatment and prevention.

Transcending self therapy: Four-session individual integrative cognitive-behavioral treatment: A case report.

Effective treatments for Substance Use Disorders (SUDs) are of critical importance, particularly among veterans. We present a successful application of Transcending Self Therapy: Four-Session Individual Integrative Cognitive Behavioral Treatment (Individual TST-I-CBT), that helped a male combat veteran with Alcohol Use Disorder, Severe, and PTSD enter recovery and reduce depressive symptoms. Session 1 focused on problem solving and behaviors; Session 2 centered on checking and changing thoughts; Session 3 emphasized behaviors, thoughts, and coping; and Session 4 consisted of review and finalizing the recovery plan. After the second Individual TST-I-CBT session, he was abstinent from alcohol use and remained abstinent throughout the remainder of treatment. At the end of treatment, his depressive symptoms declined substantially from pretreatment (from severe to low), his desire to stop using alcohol was 10/10, and his confidence in his ability to stop using alcohol was 10/10. He demonstrated personal growth and accomplishments throughout the course of treatment, such as improving his self-concept and relationships; living in accordance with his values; developing the passionate pursuit of being a productive member of society by holding a job; looking for a job; and taking steps to continue his education. Accordingly, he accomplished all of his identified treatment goals. This case suggests Individual TST-I-CBT is a potentially effective adjunctive treatment for SUD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Program Evaluation of Group Transcending Self Therapy: An Integrative Modular Cognitive-Behavioral Therapy for Substance Use Disorders.

OBJECTIVES: Substance Use Disorders (SUDs) are increasingly prevalent among Veterans. Effective interventions for SUDs that also meet the clinical reality of open treatment groups are needed. Transcending Self Therapy: Group Integrative Cognitive Behavioral Treatment (Group TST-I-CBT) was developed to address this need. Group TST-I-CBT is a four-module, 20-session treatment designed so that a person can enter at any point in the treatment. We conducted a program evaluation of Group TST-I-CBT for veterans with SUDs. METHODS: Participants were N = 68 veterans enrolled in the 28-day Substance Abuse Residential Rehabilitation Treatment Program at an urban Veterans Administration Medical Center who received either Group TST-I-CBT (N = 34) or treatment-as-usual (TAU; N = 34). Medical records were reviewed and participant treatment outcome data was retrieved. Group TST-I-CBT clients completed a knowledge and feedback form at treatment completion. RESULTS: Compared to TAU participants, Group TST-I-CBT participants were significantly less likely to have a positive urine drug screen (UDS) during treatment (17.6% versus 0%; P = .01) and within one month post-discharge (50% versus 17.6%; P = .04). Among Group TST-I-CBT clients, Quality of Life Inventory scores significantly increased by an average of 14 points from pre- to post-treatment, t(15) = -3.31, P = .005, d = 0.83. Group TST-I-CBT clients displayed cognitive-behavioral therapy knowledge (mean correct answers ranged from 92%-100%) and rated Group TST-I-CBT as helpful, understandable, and useful (mean scores ranged from 9.3-9.6 out of 10). CONCLUSIONS: These preliminary data indicate that Group TST-I-CBT may be an effective group therapy as part of SUD treatment. A formal randomized controlled trial of Group TST-I-CBT may be warranted.

Comparison of timeline follow-back self-report and oral fluid testing to detect substance use in adult primary care patients.

BACKGROUND: Timeline Follow-back (TLFB) interviews using self-report are often used to assess substance use. Oral fluid testing (OFT) offers an objective measure of substance use. There are limited data on the agreement between TLFB and OFT. METHODS: In this secondary analysis from a multisite study in five primary care sites, self-reported TLFB and OFT data collected under confidential conditions were compared to assess concordance (N=1799). OFT samples were analyzed for marijuana, heroin, cocaine, and non-medical use of prescription opioids. Demographic differences in discordance relative to TLFB and OFT concordant results for marijuana, the only substance with an adequate sample size in this analysis, were examined using multinomial logistic regression. RESULTS: Overall concordance rates between TLFB and OFT were 94.9 % or higher for each substance, driven by large subgroups with no use. Among participants with discordant use, marijuana was the only substance with lower detection on OFT than self-report (27.6 % OFT-positive only vs 32.2 % TLFB-positive only), whereas cocaine (65.6 % vs 8.6 %), prescription opioids (90.4 % vs 6.0 %), and heroin (40.7 % vs 26.0 %) all had higher detection via OFT than TLFB. Participants who reported marijuana use but had a negative OFT were more likely to be younger, Hispanic, and White compared to those with TLFB and OFT concordant positive results. CONCLUSIONS: TLFB and OFT show disparate detection of different substances. Researchers should consider the implications of using either self-report or oral fluid testing in isolation, depending on the substance and collection setting. Triangulating multiple sources of information may improve detection of drug use.

Lessons Learned from Building a Pediatric-to-Adult Sickle Cell Transition Program.

OBJECTIVE: More effective transitions and transfers of young people with sickle cell disease (SCD) into the adult healthcare setting is a focus of both primary care and specialty care medical organizations. Effective transition and transfer requires six core elements: establishing a policy, tracking progress, administering transition readiness assessments, planning for adult care, transferring to adult care, and integrating into an adult practice. We developed a program using these six core elements. The objective of our report was to assess the development and implementation of this program. METHODS: We used the six core elements to develop and implement a program at Virginia Commonwealth University for children and adolescents with SCD to transition to adult health care. RESULTS: We assessed individuals' differences by age and grade, their independent living skills, their feelings about moving to adult care; tallied and analyzed several assessment scales; and assessed transfer success and patient retention. CONCLUSIONS: The principles and lessons we learned in developing and implementing this program over 5 years, accompanied by caring, flexible, and dedicated care team members, often can overcome even severe barriers to care transitions.

Screening for Psychotherapeutic Medication Misuse in Primary Care Patients: Comparing Two Instruments.

INTRODUCTION: Prescription psychotherapeutic medication misuse is a growing problem in the United States, but no method exists to routinely screen for this in primary care. Our study sought to (1) describe the prevalence of prescription psychotherapeutic medication misuse in primary care and the characteristics of patients who misuse and (2) compare 2 screening instruments modified to identify prescription medication misuse in primary care. METHODS: Primary care patients from underserved, urban clinics within a health system completed anonymous computer-directed health screens that included standard questions about prescription medication misuse. They were also administered the 4-item Cut down, Annoyed, Guilty, and Eye-opener questionnaire modified to focus on prescription medications (RxCAGE) and a 6-item Prescription Opioid Misuse Index (POMI-e) expanded to include other prescription medications. RESULTS: Of 2,339 respondents, 15.3% were positive for at least 2 items on the RxCAGE and 18.6% were positive for at least 2 items on the POMI-e. Using our computer-directed health screen as a comparison, we found that POMI-e had a higher area under the curve (0.63). A positive POMI-e was associated with being male, white and unemployed, having depression and anxiety, and currently using illicit substances, smoking, and misusing alcohol. CONCLUSIONS: Rates of prescription medication misuse were substantial with both RxCAGE and POMI-e showing promise as screening instruments. Future studies are needed to test prescription medication misuse screening tools in broader populations and pilot interventions for those screening positive.

Screening for substance use in pregnancy and the newborn.

Substance use during pregnancy is common, costly and associated with maternal and newborn health consequences. Assessment of substance use should be integrated into prenatal care. Substance use identification methods include patient interview, screening instruments, and biological testing. In this review, we critically evaluate screening and testing for substance use during pregnancy, highlighting the benefits and barriers of integrated assessment into prenatal care. We also discuss the limitations and negative consequences that should be considered when implementing screening and/or testing procedures. Lastly, we provide recommendations for the ethical implementation of screening and testing for substance use in the context of prenatal care.

Energy drink use is associated with alcohol and substance use in eighth, tenth, and twelfth graders.

The increasing prevalence of energy drink (ED) use and its link with negative behaviors and adverse health outcomes has garnered much attention. Use of EDs combined with alcohol among college students has been of particular interest. It is unclear if these relationships develop in the context of college, or if similar associations exist in younger individuals. The present study examined associations between ED consumption patterns and other substance use in an adolescent, school-based sample. Participants were N = 3743 students attending 8th, 10th or 12th grade in a suburban central Virginia public school system who completed a prevention needs assessment survey in 2012. Chi-square analyses and logistic regressions were used to compare rates of alcohol, tobacco and other drug use across three ED use groups: moderate/heavy (12.6%), light (30.5%), and non-users (57%). Over 40% of the sample reported recent (past month) ED use, with males more likely to report moderate/heavy ED use than females (14.0% and 11.1%, respectively; p = 0.02). After adjusting for gender and grade, ED use group predicted lifetime alcohol, tobacco and other drug use (all p < 0.001). Moderate/heavy ED users were most likely and ED non-users were least likely to report using each of the 13 substances in the survey, with light ED users intermediate to the other two groups. Moderate/heavy ED users were consistently most likely to report licit and illicit substance use. Additional research is needed to better understand which adolescents are at greatest risk for adverse health behaviors associated with ED use.

Sex difference in Onuf's nucleus homologue in the Asian musk shrew.

Perineal muscles essential for copulatory functioning are innervated by Onuf's nucleus in humans and the spinal nucleus of the bulbocavernosus (SNB) and dorsolateral nucleus (DLN) in rats. These structures sexually differentiate as a result of developmental androgen exposure in most species examined. The homologous structure in the Asian musk shrew (Suncus murinus) is a single cluster in the lateral DLN/Onuf's position in the ventral horn of the spinal cord; these motoneurons innervate both the bulbocavernosus and ischiocavernosus muscles of the musk shrew. We found the expected sex difference in motoneuron number in the shrew DLN, but not in two neighboring motoneuron clusters, the retrodorsolateral nucleus (RDLN) and ventrolateral nucleus (VLN). Male musk shrews also have significantly larger soma areas in the VLN and DLN than females, and male DLN motoneurons have significantly larger nuclei than female. The sex difference in DLN motoneuron number was evident both in raw counts and after accounting for split nuclei error.