Correlates of Risky Alcohol Use Among Women from Appalachian Ohio.

Women from Appalachian regions of the United States (US) face a number of health related disparities, including mental health and substance misuse. Alcohol misuse is a significant public health concern among women in the US, associated with numerous adverse consequences for the woman, her unborn children, and any children in her care, yet data on correlates of risky alcohol use is limited among women from Appalachian Ohio. The current study examines the prevalence and predictors of risky alcohol use (e.g., heavy episodic drinking) in 2,349 women from 18 clinics in the Community Awareness Resources and Education I (CARE I) study in Appalachian Ohio. Alcohol use history was collected over the past 30 days. Regression models were employed to identify predictors of heavy episodic drinking. Results indicate that 20% of the current sample reported heavy episodic drinking. Being an emerging adult (18-26), single, a current smoker, and reporting a history of four or more partners were independently associated with heavy episodic drinking. Self-identifying as Appalachian was not protective or predictive of heavy episodic drinking. Further research identifying risk factors and enhancing protective factors will inform culturally competent preventive efforts, particularly for emerging adult women from Appalachian Ohio at risk for alcohol misuse and associated morbidities.

Developing a Tailored Texting Preventive Intervention: A Card Sort Methodology.

PURPOSE: Intervention content written by adults for youth can result in miscommunication due to generational and cultural differences. Inviting at-risk youth to participate in the creation of intervention material can augment acceptability for their peers. METHODS: To improve intervention messaging, the present study examines the utility of a card sort technique when creating cellular phone text messages to be used in a preventive substance use intervention. During focus groups with 24 youth who are exiting the foster care system - a population with distinct cultural attributes - participants were asked to rate stage of change-specific health messages rooted in Motivational Interviewing and the Transtheoretical Model. RESULTS: Participants unanimously favored content that encouraged autonomy and choice. Statements that invited a "look to the future" were also rated favorably. Messages that referenced the past were not rated well, as were suggestions for professional assistance. Finally, encouragement to receive social support for change was met with ambivalence. While some participants regarded support as helpful, many others felt a severe lack of support in their lives, possibly prompting further substance use. CONCLUSIONS: Youth exiting foster care constitute a unique population whose voice is paramount in the development of interventions. The content present in traditional approaches to substance use prevention (e.g., increasing social support) may not apply to this group of vulnerable youth. The card sort technique has strong potential to evoke youth-specific intervention content that is more readily understood and accepted by target audiences.

A Double-Blind Randomized Placebo-Controlled Trial of Oral Naltrexone for Heavy-Drinking Smokers Seeking Smoking Cessation Treatment.

BACKGROUND: Post hoc analyses of 2 randomized controlled trials suggest naltrexone may reduce alcohol use and improve smoking cessation outcomes among heavy drinkers receiving smoking cessation treatment. However, no studies have been conducted specifically to examine naltrexone for this purpose or to test whether naltrexone has benefit when added to smoking cessation counseling that explicitly addresses heavy drinking. METHODS: We recruited heavy-drinking smokers from the community and randomized them to receive 10 weeks of either (i) 50 mg naltrexone (n = 75) or (ii) placebo (n = 75) daily. Participants received 6 weeks of transdermal nicotine patch and 6 sessions of counseling that addressed both heavy drinking and smoking. Participants were followed for 26 weeks after their target quit smoking date. RESULTS: Across medication conditions, there were substantial reductions at follow-up in percent heavy drinking days (primary outcome) and average drinks per week (secondary outcome). However, participants receiving naltrexone did not differ significantly from those receiving placebo on percent heavy drinking days (effect size d = -0.04, 95% CI [-0.30, 0.22], p = 0.76) or average drinks per week (d = -0.09, 95% CI [-0.35, 0.18], p = 0.54) during follow-up. Naltrexone compared to placebo was not associated with a significant increase in smoking abstinence rates during follow-up, odds ratio = 0.93, 95% CI [0.46, 1.86], p = 0.83. The effect of naltrexone on these outcomes was not significantly moderated by current alcohol dependence or gender. CONCLUSIONS: Results indicate that heavy-drinking smokers, including those with current alcohol dependence, can make substantial reductions in drinking in the context of smoking cessation treatment. However, this study provided no evidence that naltrexone is efficacious for enhancing reductions in drinking or improving smoking cessation in this population. Limitations of this study included lower-than-desired sample size and modest adherence to study medication.

Mostly Smokers: Identifying Subtypes of Emerging Adult Substance Users.

BACKGROUND: The concurrent use of marijuana and other substances among emerging adults (ages 18-25) is a major public health problem. This study examined if there are distinct subtypes of emerging adult marijuana users and if these are associated with demographic and substance use variables. METHODS: The design was a cross-sectional interview with a community sample of 1,503 emerging adults in the northeastern U.S. who reported last month marijuana use. We used latent class analysis (LCA) to identify distinct subtypes of emerging adults who used additional substances and examined predictors of the latent classes. RESULTS: We identified three distinct classes of emerging adults who use substances: "mostly smokers" (those who primarily use marijuana and nicotine), "moderate users" (those who primarily use marijuana and/or heavy episodic alcohol), and "polysubstance users." Polysubstance users had higher probabilities of use of all assessed substances (e.g. cocaine, opiates, sleep medications, stimulants, synthetic marijuana, and inhalants) than the other two groups. Not being currently enrolled in school and male gender were associated with mostly smokers and polysubstance users group status. CONCLUSIONS: We identified a distinct group of emerging adult marijuana users who primarily smoke marijuana and cigarettes, suggesting that there could be a shared vulnerability for risk of co-occurrence.

Testing a Dynamic Automated Substance Use Intervention Model for Youths Exiting Foster Care.

With an ever increasing gap between need and availability for substance use services, more scalable and efficient interventions are needed. For youth in the foster care system, this gap is dramatic and expands as they leave care. Effective prevention services are strongly needed for this group of vulnerable young people. We propose a novel technology-driven intervention for preventing problematic substance use among youth receiving foster care services. This intervention approach would extend the work in brief computerized interventions by adding a text message-based booster, dynamically tailored to each individual's readiness to change. It also combats many barriers to service receipt. Dynamically tailored interventions delivered through technologies commonly used by adolescents and young adults have the strong potential to reduce the burden of problematic substance use.

A Randomized Controlled Trial to Compare Computer-assisted Motivational Intervention with Didactic Educational Counseling to Reduce Unprotected Sex in Female Adolescents.

STUDY OBJECTIVE: To examine a computer-assisted, counselor-guided motivational intervention (CAMI) aimed at reducing the risk of unprotected sexual intercourse. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a 9-month, longitudinal randomized controlled trial with a multisite recruitment strategy including clinic, university, and social referrals, and compared the CAMI with didactic educational counseling in 572 female adolescents with a mean age of 17 years (SD = 2.2 years; range = 13-21 years; 59% African American) who were at risk for pregnancy and sexually transmitted diseases. The primary outcome was the acceptability of the CAMI according to self-reported rating scales. The secondary outcome was the reduction of pregnancy and sexually transmitted disease risk using a 9-month, self-report timeline follow-back calendar of unprotected sex. RESULTS: The CAMI was rated easy to use. Compared with the didactic educational counseling, there was a significant effect of the intervention which suggested that the CAMI helped reduce unprotected sex among participants who completed the study. However, because of the high attrition rate, the intent to treat analysis did not demonstrate a significant effect of the CAMI on reducing the rate of unprotected sex. CONCLUSION: Among those who completed the intervention, the CAMI reduced unprotected sex among an at-risk, predominantly minority sample of female adolescents. Modification of the CAMI to address methodological issues that contributed to a high drop-out rate are needed to make the intervention more acceptable and feasible for use among sexually active predominantly minority, at-risk, female adolescents.

Computer-Delivered Screening and Brief Intervention for Alcohol Use in Pregnancy: A Pilot Randomized Trial.

BACKGROUND: Although screening and brief intervention (SBI) for unhealthy alcohol use has demonstrated efficacy in some trials, its implementation has been limited. Technology-delivered approaches are a promising alternative, particularly during pregnancy when the importance of alcohol use is amplified. The present trial evaluated the feasibility and acceptability of an interactive, empathic, video-enhanced, and computer-delivered SBI (e-SBI) plus 3 tailored mailings, and estimated intervention effects. METHODS: We recruited 48 pregnant women who screened positive for alcohol risk at an urban prenatal care clinic. Participants were randomly assigned to the e-SBI plus mailings or to a control session on infant nutrition, and were re-evaluated during their postpartum hospitalization. The primary outcome was 90-day period prevalence abstinence as measured by timeline follow-back interview. RESULTS: Participants rated the intervention as easy to use and helpful (4.7 to 5.0 on a 5-point scale). Blinded follow-up evaluation at childbirth revealed medium-size intervention effects on 90-day period prevalence abstinence (OR = 3.4); similarly, intervention effects on a combined healthy pregnancy outcome variable (live birth, normal birthweight, and no neonatal intensive care unit stay) were also of moderate magnitude in favor of e-SBI participants (OR = 3.3). As expected in this intentionally underpowered pilot trial, these effects were nonsignificant (p = 0.19 and 0.09, respectively). CONCLUSIONS: This pilot trial demonstrated the acceptability and preliminary efficacy of e-SBI plus tailored mailings for alcohol use in pregnancy. These findings mirror the promising results of other trials using a similar approach and should be confirmed in a fully powered trial.

General and religious coping predict drinking outcomes for alcohol dependent adults in treatment.

BACKGROUND: Religiosity is associated with improved treatment outcomes among adults with alcohol dependence; however, it is unknown whether religious coping predicts drinking outcomes above and beyond the effects of coping in general, and whether gender differences exist. METHODS: We assessed 116 alcohol-dependent adults (53% women; mean age = 37, SD = 8.6) for use of religious coping, general coping, and alcohol use within 2 weeks of entering outpatient treatment, and again 6 months after treatment. RESULTS: Religious coping at 6 months predicted fewer heavy alcohol use days and fewer drinks per day. This relationship was no longer significant after controlling for general coping at 6 months. CONCLUSIONS: The relationship between the use of religious coping strategies and drinking outcomes is not independent of general coping. Coping skills training that includes religious coping skills, as one of several coping methods, may be useful for a subset of adults early in recovery. SCIENTIFIC SIGNIFICANCE: This novel, prospective study assessed the relationship between religious coping strategies, general coping, and treatment outcomes for alcohol-dependent adults in treatment with results suggesting that the use of religious coping as one of several coping methods may be useful for a subset of adults early in recovery.

Acceptability of a computerized brief intervention for alcohol among abstinent but at-risk pregnant women.

BACKGROUND: Limitations in time and training have hindered widespread implementation of alcohol-based interventions in prenatal clinics. Also, despite the possibility of underreporting or relapse, many at-risk women report that they quit drinking after pregnancy confirmation so that interventions focusing on current drinking may seem unnecessary. The Computerized Brief Intervention for Alcohol Use in Pregnancy (C-BIAP) was designed to (a) be implemented via a handheld device in prenatal clinics, and (b) use a modified brief intervention strategy with women who screen at-risk but report no current drinking. METHODS: The authors administered the C-BIAP to 18 T-ACE (Tolerance, Annoyance, Cut Down, and Eye Opener)-positive pregnant African American women who provided quantitative and qualitative feedback. RESULTS: The C-BIAP received high ratings of acceptability; qualitative feedback was also positive overall and suggested good acceptance of abstinence themes. CONCLUSIONS: Technology may be a feasible and acceptable method for brief intervention delivery with pregnant women who do not report current drinking.

Getting higher: co-occurring drug use among marijuana-using emerging adults.

The most widely used illicit drug in the United States continues to be marijuana, and its use among emerging adults continues to increase. Marijuana use can result in a range of negative consequences and has been associated with other drug use in adolescents and emerging adults. This study examined the relationship between marijuana use frequency and the use of six other drug classes (opiates, cocaine, stimulants, hallucinogens, inhalants, and sleep medications) among emerging adults. A cross-sectional interview design was used with a community sample of 1,075 emerging adults in the northeastern United States. Using logistic regression analysis controlling for age, ethnicity, gender, and frequency of binge alcohol, daily marijuana use was found to be associated with a significant increase in the expected odds of opiate, cocaine, stimulant, hallucinogen, inhalant, and tobacco use. The findings identify a subgroup of emerging adult marijuana users-those who use daily-that may be vulnerable to additional negative consequences associated with polysubstance use.

Quit intention as a predictor of quit attempts over time in adolescents with psychiatric disorders.

BACKGROUND: Rates of smoking among adolescents with psychiatric comorbidity are high, despite the well-known health risks. The current longitudinal study examined patterns of quitting behavior in adolescent smokers with psychiatric comorbidity. METHODS: The study evaluated 191 inpatient adolescents who had been enrolled in a randomized controlled trial of motivational interviewing versus brief advice for smoking cessation, and assessed their intentions to quit smoking. RESULTS: Rates of quit attempts at post-hospital, 1-month, and 6-month assessments were 23%, 17%, and 17%, respectively. Adolescents who reported an intention to quit smoking (43%) were significantly more likely to report a quit attempt, regardless of psychiatric symptoms, cognitive factors, or substance use. CONCLUSIONS: Intention to quit smoking appears to translate to substantial quit behavior, even in a high-risk adolescent population that may otherwise be viewed as uninterested in quitting, suggesting the need to proactively connect this population with adequate services and follow-up support. (Am J Addict 2013;XX:1-6).

Psychosocial factors associated with depression severity in pregnant adolescents.

Adolescent depression during pregnancy is associated with increased morbidity for the teen and her infant. This cross-sectional study explored the relationships among the independent histories of alcohol use, drug use, depression, and abuse (physical or sexual) on depression severity in a diverse group of 116 pregnant adolescents (mean age = 16) who attended an urban prenatal clinic. Ever having had an alcoholic drink was a significant predictor of higher depressive scores on Children's Depression Rating Scale-Revised, ß = 3.3 (0.8, 5.7); p < 0.05. History of abuse was associated with a significant 4.3-point higher mean depressive score, ß = 4.3 (1.8, 6.7), p < 0.001, and remained a statistically significant predictor of more severe depressive symptoms after adjustment for history of alcohol use, history of drug use, and history of depression. This study identified that a history of physical or sexual abuse is a significant factor related to the severity of depressive symptoms in pregnant adolescents, independent of a history of alcohol, drug use, or depression. These findings suggest that an assessment of history of alcohol use, as well as abuse history, may increase the likelihood of identifying adolescents at risk for antenatal depression.

A randomized phase I trial of a brief computer-delivered intervention for alcohol use during pregnancy.

BACKGROUND: Drinking alcohol during pregnancy has a range of negative consequences for the developing fetus. Screening and brief intervention approaches have significant promise, but their population impact may be limited by a range of challenges to implementation. We, therefore, conducted preliminary acceptability and feasibility evaluation of a computer-delivered brief intervention for alcohol use during pregnancy. METHODS: Participants were 50 pregnant women who screened positive for risky drinking during a routine prenatal clinic visit and were randomly assigned to computer-delivered brief intervention or assessment-only conditions. RESULTS: Ratings of intervention ease of use, helpfulness, and other factors were high (4.7-5.0 on a 1-5 scale). Participants in both conditions significantly decreased alcohol use at follow-up, with no group differences; however, birth weights for infants born to women in the intervention group were significantly higher (p<0.05, d = 0.62). CONCLUSIONS: Further development and study of computer-delivered screening and intervention for alcohol use during pregnancy are warranted.

Psychotropic drug use among college students: patterns of use, misuse, and medical monitoring.

OBJECTIVE: To assess whether college students who use psychotropic drugs are (1) aware of potential side effects, (2) appropriately monitored by prescribing physicians, and (3) taking medications as prescribed. PARTICIPANTS: Fifty-five college students, currently taking psychotropic medications, were recruited between Summer 2008 and Fall 2009. METHODS: Participants were given interviews assessing (1) interactions with prescribing physicians, (2) patterns of psychotropic drug use, and (3) Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) substance use disorders. RESULTS: Twenty-five percent of participants did not remember being assessed for suicidal ideation. A large number of participants took their medications in different quantities or frequencies than prescribed and 35% of participants met DSM criteria for substance dependence. CONCLUSIONS: Many students are misusing psychotropic medications and this misuse is not being communicated with prescribing physicians.

Commission versus receipt of violence during pregnancy: associations with substance abuse variables.

The tendency for women to report both commission and receipt of violence is an understudied phenomenon. In particular, little is known about individual differences as a function of commission vs. receipt of partner violence among pregnant women. Using a sample of 78 cohabiting low-SES pregnant women, the current study examines three violence subtypes based on self-report (primarily commission of violence, primarily receipt of violence, and no report of violence) and investigated differences in a range of other risk factors among these subtypes. In this sample, 47% reported higher levels of intimate partner violence (IPV) perpetration than victimization; 14% reported more IPV victimization than perpetration; and 39% reported no IPV. Results demonstrate clear differences between women reporting IPV and those not reporting IPV and clear differences between IPV subtypes in terms of partner substance use, with women reporting primarily receipt of violence also reporting more drug and alcohol abuse by their partners. Although preliminary, these findings suggest that the commission of violence may be more common during pregnancy than the receipt of violence, but that risks for these two subgroups are similar.

Predicting cocaine group treatment outcome in cocaine-abusing methadone patients.

The authors examined predictors of cocaine group treatment outcome in methadone maintenance treatment (MMT) patients, including cocaine urinalysis at intake and demographic variables. Clinic policy is that patients identified as using cocaine must attend a weekly cocaine-focused, cognitive-behavioral therapy (CBT) group. Cocaine treatment is based on a behavioral (escape) contingency model whereby completers must attend group-counseling sessions and produce cocaine-negative urinalysis results. Among the 113 patients enrolled in the cocaine group, 43 (38%) were treatment completers (who attended 6 consecutive weeks of group and produced 6 consecutive weeks of cocaine-free urine tests) and 70 (62%) were treatment noncompleters. Treatment completion (i.e., cocaine abstinence) was significantly associated with baseline cocaine-free urinalysis and higher methadone dose.

Relationship between white matter volume and cognitive performance during adolescence: effects of age, sex and risk for drug use.

AIM: Familial drug abuse history has been shown to have an impact on cognitive development during adolescence. The present study examined the relationship between white matter volume and cognitive processing speed in adolescents with and without a familial substance abuse history. PARTICIPANTS: The sample comprised 33 female and male adolescents stratified by risk (family history positive, FH+) and low-risk (FH-) groups. MEASUREMENTS: Gray and white matter volumes were measured by segmenting magnetic resonance imaging (MRI) data. The neurocognitive test battery included tests that assessed processing speed, verbal ability and mental flexibility. FINDINGS: Age-related differences in neuropsychological functioning were seen but did not differ by risk group status, although there was some evidence for an age x gender effect. Information processing speed (digit symbol and Stroop word color naming) was correlated significantly with white matter volume; however, this pattern was observed only in FH- females. Cognitive performance and tissue volumes did not differ significantly between risk groups. CONCLUSIONS: Age-related differences in neuropsychological functioning were seen that might, in larger samples, prove to be related to risk for substance abuse in adolescents who have not yet initiated drug use.

Methadone maintenance improves cognitive performance after two months of treatment.

Methadone maintenance (MM) has received little scientific attention regarding neurocognitive effects. The present study examined cognitive function in 17 opiate-dependent subjects at baseline and after 2 months of MM treatment. Subjects demonstrated significant improvements from baseline on measures of verbal learning and memory, visuospatial memory, and psychomotor speed and reduced frequency of drug use (Addiction Severity Index) relative to baseline, although the total percentage of urine samples positive for additional illicit substances was slightly increased. No effect of illicit drug use was observed when the sample was stratified by urine toxicology results, suggesting that improvements in cognition were not associated with additional illicit drug use. Results suggest that opiate-dependent subjects exhibit significant improvement in cognitive function after MM treatment. Future investigations are needed to confirm these findings.

Lack of hippocampal volume change in long-term heavy cannabis users.

The effects of cannabis smoking on the morphology of the hippocampus are still unclear, especially because previous human studies have examined primarily younger, shorter-term users. We used magnetic resonance imaging to investigate these effects in a group of 22 older, long-term cannabis users (reporting a mean [SD] of 20,100 [13,900] lifetime episodes of smoking) and 26 comparison subjects with no history of cannabis abuse or dependence. When compared to control subjects, smokers displayed no significant adjusted differences in volumes of gray matter, white matter, cerebrospinal fluid, or left and right hippocampus. Moreover, hippocampal volume in cannabis users was not associated with age of onset of use not total lifetime episodes of use. These findings are consistent with recent literature suggesting that cannabis use is not associated with structural changes within the brain as a whole or the hippocampus in particular.

Trajectories of adolescent emotional and cognitive development: effects of sex and risk for drug use.

Adolescence has been widely accepted as a time for notable alterations in brain functioning. The objective of this longitudinal study was to compare trajectories of emotional and cognitive development in adolescent girls and boys with low- versus high-risk for future drug use. Nineteen healthy adolescents (aged 13.9 +/- 2.0 years; 10 girls), stratified into low- and high-risk groups based on family history of drug abuse, were examined at baseline and after one year. Emotional intelligence was assessed using the Bar-On Emotional Quotient Inventory, the Multidimensional Anxiety Scale for Children, and the Perceived Stress Scale. The neurocognitive test battery was designed to evaluate academic achievement, executive function, verbal memory and learning, and included the Wide Range Achievement Test, Stroop Color-Word Interference Test, Rey Auditory Verbal Learning Test, and Digit Span and Digit Symbol subtests of the Wechsler Adult Intelligence Scale-Revised. Improvements in academic achievement, executive function, and working memory were observed at the one-year follow-up. Notable sex differences also were evident in emotional intelligence, academic achievement, and memory. Interestingly, these sex-related differences interacted with risk status; improvement in cognitive performance in boys and low-risk girls was generally superior to high-risk girls, who tended to show modest, if any, improvement at the one-year follow-up. These preliminary findings provide evidence of sex differences in emotion intelligence and cognitive function. Furthermore, these data also suggest that history of familial drug abuse may have a more pronounced impact on emotional and cognitive development in adolescent girls than boys.