Examining early adherence measures as predictors of subsequent adherence in an intensive longitudinal study of individuals in mutual help groups: One day at a time.

BACKGROUND: Individuals with a substance use disorder complete ecological momentary assessments (EMA) at lower rates than community samples. Previous research in tobacco users indicates that early log-in counts to smoking cessation websites predicted subsequent smoking cessation website usage. We extended this line of research to examine individuals who are seeking to change their drinking behaviors through mutual support groups. We examined whether adherence in the first 7 days (1487 observations) of an intensive longitudinal study design could predict subsequent EMA protocol adherence (50% and 80% adherence separately) at 30 (5700 observations) and 60 days (10,750 observations). METHODS: Participants (n = 132) attending mutual-help groups for alcohol use completed two assessments per day for 6 months. We trained four classification models (logistic regression, recursive partitioning, support vector machines, and neural networks) using a training dataset (80% of the data) with each of the first 7 days' cumulative EMA assessment completion. We then tested these models to predict the remaining 20% of the data and evaluated model classification accuracy. We also used univariate receiver operating characteristic curves to examine the minimal combination of days and completion percentage to best predict subsequent adherence. RESULTS: Different modeling techniques can be used with early assessment completion as predictors to accurately classify individuals that will meet minimal and optimal adherence rates later in the study. Models ranged in their performance from poor to outstanding classification, with no single model clearly outperforming other models. CONCLUSIONS: Traditional and machine learning approaches can be used concurrently to examine several methods of predicting EMA adherence based on early assessment completion. Future studies could investigate the use of several algorithms in real time to help improve participant adherence rates by monitoring early adherence and using early assessment completion as features in predictive modeling.

Using recursive partitioning to predict presence and severity of suicidal ideation amongst college students.

OBJECTIVE: Predicting the presence and severity of suicidal ideation in college students is important, as deaths by suicide amongst young adults have increased in the past 20 years. PARTICIPANTS: We recruited college students (N = 5494) from ten universities across eight states. METHOD: Participants answered three questionnaires related to lifetime and past month suicidal ideation, and an indicator of suicidal ideation in a DSM-5 symptom measure. We used recursive partitioning to predict the presence, absence, and severity, of suicidal ideation. RESULTS: Recursive partitioning models varied in their accuracy and performance. The best-performing model consisted of predictors and outcomes measured by the DSM-5 Level 1 Cross-Cutting Symptom Measure. Sexual orientation was also an important predictor in most models. CONCLUSIONS: A single measure of DSM-5 symptom severity may help universities understand suicide severity to promote targeted interventions. Though further work is needed, as similar scaling amongst predictors could have influenced the model.

Drug use and suicidal ideation in the daily lives of individuals in a dialectical behavior therapy program.

OBJECTIVES: Substance use disorders and borderline personality disorders (BPD) often co-occur and may be concurrently treated by Dialectical Behavior Therapy (DBT). However, there is limited information on how drug use and suicidal ideation may interact in the daily lives of individuals receiving DBT treatment. METHODS: This study examined the DBT diary cards of 47 individuals in a community mental health center's partial hospital and intensive outpatient program. Multilevel modeling techniques were used to examine the moderating effects of BPD symptom severity on the relationship between same day, 1-, 2-, and 3-day lagged drug use and suicidal ideation. RESULTS: Results indicated a significant relationship between same-day, 1-day lagged, 2-day lagged drug use and suicidal ideation. BPD was a moderator for the relationship between 1-day lagged drug use and suicidal ideation. CONCLUSION: Limitations of the study include the measure for BPD symptom severity was only collected pretreatment and the results are likely limited to the effects of cannabis use on suicidal ideation. Clinicians may need to consider the prolonged effects of drug use on suicidal ideation when conducting chain analyses on suicidal behaviors.

Dialectical Behavior Therapy Skills and Urges to Use Alcohol and Substances: An Examination of Diary Cards.

Background: Skills learned in Dialectical Behavior Therapy (DBT) are a proposed mechanism that prompts behavior change. Few studies have examined the effects of DBT skills on treatment outcomes. No published studies have examined the effects of DBT skills on alcohol and substance use outcomes. Objectives: This study examined 48 individuals in a community mental health facility that delivers DBT-adherent treatment. Utilizing intake data and diary cards, multilevel model analyses were conducted to examine the effects each DBT skills domain had on urges for participants that entered treatment with varying frequencies of alcohol and substance use. Results: Emotion regulation and mindfulness skills domains were related to decreased urges for individuals that entered treatment with high frequencies of alcohol and substance use. Previous-day distress tolerance skills were associated with decreased urges and previous-day interpersonal effectiveness skills were associated with decreased urges for individuals that entered treatment with high frequencies of substance use. Conclusions: DBT skills may be a helpful mechanism to decrease urges for individuals that use alcohol and other substances. However, more research on why certain skills domains may be more effective is needed.

Alcohol and other substance use by faculty, staff, and students in a university community during two hurricanes: Lessons for preventing risky misuse.

Communities commonly warn against heavy alcohol and other substance use during natural disasters like hurricanes, because such use may produce risk for individuals and communities, with studies showing deleterious effects persisting months or even years. Examining patterns and emotional correlates of use in the immediate presence of hurricanes may identify useful risk prevention targets. We assessed self-reported substance use and emotions in a university community (faculty, staff, and students) having the unlucky fate of experiencing hurricanes in early September 2 years in a row. Participants (403 in 2018, 76.0% female; M age 28.82; SD = 12.36 and 292 in 2019, 72.6% female; M age 30.63; SD = 13.96) reported typical weekly substance use and emotions and then the same data during each hurricane day. Results showed elevated use of alcohol, caffeine and tobacco before and during each hurricane, but a rapid drop-off of alcohol and caffeine (but not tobacco) use immediately after-although anxiety remained high. Findings are interpreted using both tension-reduction and stress-coping models and suggestions are made for future risk mitigation.

Applying adherent DBT Principles to treatment in a partial hospital setting: An analysis over 5-years of outcomes from intake to discharge.

OBJECTIVES: A small number of studies to date have examined Partial Hospital (PH) that utilize a Dialectical Behavior Therapy (DBT) model. Preliminary findings suggest DBT PH programs can be effective in various symptom reduction. METHODS: This study examined clinically relevant outcomes and included a heterogeneous clinical sample over a five-year period. Specifically, the present study assessed pre-post data to examine changes in symptoms of depression, anxiety, hopelessness, and overall degree of suffering from intake to discharge in a DBT PH. RESULTS: Findings showed symptom reduction from intake to discharge for depression, anxiety, hopelessness, and suffering for all 5 years. This DBT PH program was successful at reducing various symptoms in a sample of psychiatric patients. CONCLUSION: Clinicians might consider the advantages of placing patients in PH programs versus an inpatient stay or consider utilizing DBT-informed PH programs after an inpatient hospitalization as a form of step-down care.