Residential substance use treatment outcomes for pregnant and postpartum women: Distinct patterns for women enrolled before versus during the COVID-19 pandemic.

INTRODUCTION: Substance use among pregnant and postpartum women (PPW) is a serious public health concern. The COVID-19 pandemic has exacerbated substance use among the general population including pregnant women, and disrupted operations for substance use treatment centers. Little is known about the outcomes of substance use treatment for PPW before and during the COVID-19 pandemic. METHOD: Data from a longitudinal program evaluation were analyzed to examine outcomes among 136 PPW participating in a residential SUD treatment program, and to explore differences in treatment outcomes for women who enrolled in services before versus during the COVID-19 pandemic. Analyses were used to test the significance of change from treatment intake to 6-month post-intake on assessments of substance use, mental health symptoms, and functioning collected to evaluate the Healthy Families Program (HFP), a comprehensive program for PPW located within a gender-specific SUD treatment facility in the United States. RESULTS: Results indicated that from treatment intake to follow-up assessment, clients self-reported statistically significant improvements in family functioning and daily functioning as well as reduced days of substance use. Notably, the rate of treatment intakes declined during the COVID-19 pandemic. In separate analyses by subgroup, mental health indicators showed improvements only for clients engaged in treatment before the COVID-19 pandemic and not for clients served during the COVID-19 pandemic, but substance use decreased significantly for both pre-pandemic and pandemic enrollees. CONCLUSION: Specialized treatment considerations and implications for PPW are discussed, including a need for added emphasis on co-occurring mental health symptoms and family system stress during a pandemic, and the role of nurses in identifying and addressing these concerns. Additionally, potential relapse prevention efforts during COVID-19 for PPW with substance use disorders are examined. CLINICAL RELEVANCE: The present research continues to highlight the importance of specialized treatment programming for PPW with SUDs as well as the potential need for additional recovery support mechanisms to be utilized during the COVID-19 pandemic.

Don't drink and drive, it's a prime: Cognitive effects of priming alcohol-congruent and incongruent goals among heavy versus light drinkers.

The present experiment assessed implicit alcohol motivations and explicit alcohol expectancies following the interaction between alcohol-congruent (i.e. social drinking) versus incongruent (i.e. driving safety) goal primes and recent drinking habits among college students (n = 176). Heavy drinkers exhibited greater implicit alcohol approach and explicit tension reduction expectancies following social goal primes, while displaying greater implicit alcohol avoidance and explicit cognitive and behavioural impairment expectancies after driving safety goal primes. These findings indicate recent drinking habits interact with goal salience to influence explicit and implicit responses to alcohol, which has implications for the development of interventions to reduce college drinking.

Not by associations alone: The role of contextual factors, individual differences, and propositional learning in the malleability of implicit alcohol attitudes.

Alcohol attitudes predict unique variance in drinking behavior and have been the target of manipulations and interventions to reduce high-risk alcohol use among youth and adults. However, whether these manipulations create long-lasting changes in alcohol-related attitudes and drinking behavior is unclear. The current mini-review focuses on evaluative conditioning (EC), a manipulation which pairs alcohol-related stimuli repeatedly with affectively valanced stimuli to create new semantic associations in memory; such associations underlie reflexive or impulsive behaviors like high-risk alcohol use. Across experimental studies, EC has been shown to promote negative alcohol attitudes and reduce alcohol consumption. However, recent evidence suggests the effectiveness of EC may depend on the depth of learning facilitated during the task, which may strengthen the semantic associations through propositional learning. While researchers have experimentally promoted greater depth of learning through the manipulation of contextual factors, we review evidence that alcohol-related individual differences also impact the effectiveness of alcohol EC, particularly when these factors are explicitly linked to the stimuli used during the manipulation. This review provides future directions for researchers and practitioners aiming to shape alcohol-related attitudes and behaviors. Specifically, the malleability of alcohol-related attitudes may depend on propositional learning facilitated by contextual and individual factors. Researchers and practitioners should incorporate these factors into interventions like EC aiming to reduce high-risk alcohol consumption.

I'm tired and feel like drinking: Viewing alcohol cues after exerting self-control increases approach motivation among individuals lower in alcohol sensitivity.

Exerting self-control depletes capacity for future self-control, which can promote greater alcohol use. However, certain populations may be more susceptible to these effects of depleted self-control capacity. For example, individuals with lower alcohol sensitivity (i.e., requiring more drinks to experience the effects of alcohol) are a high-risk group who are likely to engage in hazardous alcohol use and develop an alcohol use disorder. Those lower in alcohol sensitivity also exhibit heightened motivational reactivity in response to alcohol-related cues, which may be enhanced following exertion of self-control. However, whether drinkers lower in alcohol sensitivity are at higher risk for exhibiting greater motivations toward alcohol-related cues after exerting self-control is unclear. The current research examined the role of alcohol sensitivity in predicting approach motivation following exertion of self-control. It was expected drinkers exerting self-control would exhibit greater orientation toward rewarding cues, particularly after viewing alcohol-related cues. However, we predicted this pattern would be most prominent among drinkers lower in alcohol sensitivity. Experiment 1 supported these hypotheses, with lower alcohol sensitivity predicting greater approach motivation among drinkers required to exert self-control prior to viewing alcohol-related compared to neutral cues. Experiment 2 aimed to replicate these findings by assessing asymmetrical frontal cortical activation, an index of approach motivation. Drinkers with lower alcohol sensitivity exhibited greater relative left frontal cortical activation, consistent with approach motivation, while viewing alcohol-related cues following exertion of self-control. Results have implications for interventions aimed at identifying those at risk for greater alcohol motivations during states of mental exhaustion. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Of two minds about alcohol: Specific effects of evaluative conditioning on implicit, but not explicit, alcohol cognitions among heavy versus light drinkers.

Heavy episodic drinking (HED) is a dangerous and pervasive problem in college populations. Two experiments examined the asymmetric effects of evaluative conditioning (EC) on cognitions underlying HED in a nonclinical, student sample. Based on the associative-propositional evaluation (APE) model, we predicted that negative EC would result in stronger implicit alcohol avoidance motivation compared to neutral EC but would not impact explicit alcohol expectancies; further, we hypothesized stronger negative EC effects among students reporting HED compared to light drinkers. Experiment 1 supported these hypotheses. In Experiment 2, participants were required to focus on either feelings or knowledge about alcohol following EC. Replicating Experiment 1, negative EC was effective in promoting implicit alcohol avoidance motivation among students reporting HED compared to neutral EC, whereas no differences in explicit alcohol expectations or urges emerged. However, greater implicit alcohol avoidance predicted lower explicit alcohol urges among participants instructed to focus on alcohol-related feelings, but not alcohol-related knowledge, regardless of condition. Findings suggest students reporting HED, but not light drinkers, may exhibit implicit alcohol avoidance following negative EC and that instructions to focus on alcohol-related feelings may align explicit and implicit responses. Results have implications for interventions aimed at retraining implicit alcohol cognitions among college students. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

In the eye of the drinker: Drinking motives influence the effectiveness of conditioning implicit alcohol attitudes.

Risky alcohol use is prevalent among college students. Pre-intervention research has established methods of influencing alcohol cognition and reducing short-term alcohol consumption among students using evaluative conditioning (EC), repeatedly pairing alcohol with emotionally valenced images. Specifically, negative EC promotes negative attitudes toward alcohol, but additional research is needed to understand the range of EC effects and conditions under which it is or is not effective. For example, whether pairing alcohol with positive images promotes positive alcohol attitudes has not been tested. Further, drinking motives may influence the effectiveness of conditioning alcohol attitudes, since these motives are strongly associated with emotional stimuli like those presented in EC. The current experiment tested the interaction of drinking motives (coping and enhancement) and EC valence (negative or positive) on implicit alcohol avoidance. Participants (N = 95) were undergraduate students reporting active alcohol use. Results indicated no main effect of EC condition on implicit alcohol avoidance. However, drinking motives interacted with EC procedures assigned to participants. Those reporting greater coping motives exhibited less implicit alcohol avoidance following negative EC, whereas those reporting greater enhancement motives exhibited less alcohol avoidance following positive EC. Findings indicate drinking motives may influence the effectiveness of EC for altering alcohol attitudes. Negative EC did not promote alcohol avoidance among college students reporting higher coping motives, and positive EC only reduced avoidance among students reporting higher enhancement motives. These results indicate drinking motives interact with situational cues to impact both positive and negative responses to alcohol.

Children's alcohol cognitions prior to drinking onset: discrepant patterns from implicit and explicit measures.

Prior to drinking onset, children report stronger negative versus positive beliefs on self-report alcohol expectancy questionnaires, with some attenuation of this negativity as they transition into adolescence. Traditional alcohol expectancy assessments, however, capture endorsement of deliberative propositions about drinking outcomes. Measurement of implicit alcohol associations may elucidate automatic evaluations, clarifying the role of nondeliberative cognition in the initiation of alcohol use among youth. Few studies have assessed implicit alcohol cognition among children and younger adolescents, with inconsistent findings regarding the nature of these automatic associations within and between age groups. Eighty-nine 3rd and 4th graders and 91 7th and 8th graders completed an alcohol expectancy measure and two unipolar alcohol Implicit Association Tests (IAT) measuring positive and negative alcohol associations independently. On the explicit measure older compared with younger participants rated positive drinking outcomes as more likely and negative outcomes as less likely. Older compared with younger students were also more neutral/moderate in their evaluations of positive drinking outcomes. On the IATs, scores for the full sample indicated negative alcohol associations, and Negative IAT scores were higher for older compared with younger participants. However, the valence of implicit alcohol associations was qualified by the order of explicit versus implicit assessment; for those who completed the IATs prior to the explicit expectancy measure, alcohol associations were positive. Findings replicate and extend prior research conducted with preonset youth. Implications regarding the role of automatic and controlled processes in drinking onset and directions for future work on children's alcohol cognition are discussed.

Stigmatization, discrimination, and mental health: the impact of multiple identity status.

The authors present the empirical characteristics of the Experience of Discrimination Scale (EDS) using baseline data from the Center for Mental Health Services-funded, multisite Consumer Operated Services Project. Specific hypotheses focused on the influence of multiple identity status on reports of discrimination. Data indicated that discrimination caused by mental disability was associated with level of psychiatric symptoms and perceived social rejection as a result of mental illness, whereas discrimination for other reasons was associated with broader quality of life and social interaction indicators. The clinical and policy implications of findings are discussed.

Perceptions of discrimination among persons with serious mental illness.

OBJECTIVES: The authors sought to gain further perspective on discrimination experienced by persons with mental illness by comparing self-reports of discrimination due to mental illness to self-reports of discrimination due to other group characteristics, such as race, gender, and sexual orientation. METHODS: A total of 1,824 persons with serious mental illness who participated in a baseline interview for a multistate study on consumer-operated services completed a two-part discrimination questionnaire. The first part of the questionnaire assessed participants' perceptions about discrimination due to mental illness as well as more than half a dozen other group characteristics. The second part of the questionnaire asked participants who reported some experience with discrimination to identify areas in which this discrimination occurred, such as employment, education, and housing. RESULTS: More than half of the study participants (949 participants, or 53 percent) reported some experience with discrimination. The most frequent sources of this discrimination were mental disability, race, sexual orientation, and physical disability. Areas in which discrimination frequently occurred included employment, housing, and interactions with law enforcement. Areas in which discrimination was experienced did not significantly differ among groups of study participants characterized by mental disability, race, gender, sexual orientation, or physical disability. CONCLUSIONS: Discrimination based on group characteristics other than mental illness does not diminish the impact of stigma associated with mental illness. Antistigma programs need to target not only discrimination related to mental illness but also that associated with other group characteristics, such as race, gender, sexual orientation, and physical disability.