Behavioral economic and wellness-based approaches for reducing alcohol use and consequences among diverse non-student emerging adults: study protocol for Project BLUE, a randomized controlled trial.

BACKGROUND: Emerging adults (EAs) who are not 4-year college students nor graduates are at elevated risk for lifetime alcohol use disorder, comorbid drug use, and mental health symptoms, compared to college graduates. There is a need for tailored brief alcohol intervention (BAI) approaches to reduce alcohol risk and to facilitate healthy development in this high-risk population. Most BAIs include a single session focused on discussing risks associated with drinking and correcting normative beliefs about drinking rates. EAs may benefit from additional elements that enhance general wellness. The substance-free activity session (SFAS) aims to clarify life goals and values and increase goal-directed activities that provide alternatives to alcohol use, and the relaxation training (RT) session teaches relaxation and stress reduction skills. METHODS: The present study is a randomized 3-group (BAI + SFAS vs. RT + SFAS vs. education control) trial with 525 EAs (175 per group; estimated 50% women and 50% African American) who report recent risky drinking and who are not students or graduates of 4-year colleges. Participants will have the option of completing the intervention sessions in person or via a secure video teleconference. Levels of drinking and alcohol-related problems will be evaluated at baseline and 1, 3, 6, and 12 months post-intervention. The primary hypothesis is that both BAI + SFAS and RT + SFAS participants will report significantly greater reductions in alcohol use and problems relative to education control participants, with no differences in outcomes between the two active treatment conditions. DISCUSSION: The results of this study will inform alcohol prevention efforts for high-risk community dwelling emerging adults. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04776278.

Behavioral Economic and Wellness-based Approaches for Reducing Alcohol Use and Consequences Among Diverse Non-Student Emerging Adults: Study Protocol for Project BLUE, a Randomized Controlled Trial.

Background: Emerging adults (EAs) who are not 4-year college students nor graduates are at elevated risk for lifetime alcohol use disorder, comorbid drug use, and mental health symptoms, compared to college graduates. There is a need for tailored brief alcohol intervention (BAI) approaches to reduce alcohol risk and to facilitate healthy development in this high-risk population. Most BAIs include a single session focused on discussing risks associated with drinking and correcting normative beliefs about drinking rates. EAs may benefit from additional elements that enhance general wellness. The Substance-Free Activity Session (SFAS) aims to clarify life goals and values and increase goal-directed activities that provide alternatives to alcohol use, and the Relaxation Training (RT) session teaches relaxation and stress reduction skills. Methods: The present study is a randomized 3-group (BAI+SFAS vs. RT+SFAS vs. education control) trial with 525 EAs (175 per group; estimated 50% women & 50% African American) who report recent risky drinking and who are not students or graduates of 4-year colleges. Participants will have the option of completing the intervention sessions in person or via a secure video teleconference. Levels of drinking and alcohol-related problems will be evaluated at baseline and 1, 3, 6, and 12-months post-intervention. The primary hypothesis is that both BAI+SFAS and RT+SFAS participants will report significantly greater reductions in alcohol use and problems relative to education control participants, with no differences in outcomes between the two active treatment conditions. Discussion: The results of this study will inform alcohol prevention efforts for high-risk community dwelling emerging adults. ClinicalTrialsgov Identifier: NCT04776278.

A pilot trial of a brief intervention for cannabis use supplemented with a substance-free activity session or relaxation training.

OBJECTIVE: Cannabis use is increasing among college students and commonly co-occurs with anxiety symptoms in this age group. Interventions that reduce anxiety may also reduce cannabis use. Behavioral economic theory suggests that substance use reductions are most likely when there is an increase in substance-free reinforcement. This randomized pilot trial evaluated the efficacy of a brief motivational intervention (BMI) for cannabis supplemented by either a substance-free activity session (SFAS) or a relaxation training (RT) session for reducing cannabis use, problems, craving, and anxiety symptoms. METHOD: One hundred thirty-two college students (Mage = 19.9; 54% female; 67% White, 31% Black) who reported five or more past-month cannabis use days were randomized to: (a) assessment-only (AO); (b) BMI plus SFAS; or (c) BMI plus RT. Participants in the BMI conditions received two individual counselor-administered sessions plus a brief phone booster session. Outcomes were evaluated 1- and 6-months postintervention. RESULTS: Relative to assessment, both BMI + SFAS and BMI + RT were associated with significant reductions in cannabis problems and craving at 1-month follow-up, and significant reductions in anxiety at 6-month follow-up. Relative to AO, BMI + RT was associated with significant reductions in cannabis use at 1-month follow-up. There were no differences between BMI conditions. CONCLUSIONS: This pilot trial was not adequately powered to conclusively evaluate relative efficacy but provides preliminary support for the short-term efficacy of both two-session interventions for reducing anxiety and cannabis-related risk among nontreatment seeking emerging adults. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Impact of Cognitive Behavioral Therapy for Substance Use Disorders on Veterans' Interpersonal Difficulties.

Background: Substance use disorders (SUDs) negatively impact veterans and their relationships with others. Although there are several evidence-based treatments for SUD symptoms, there is less research on whether reduction in SUD symptoms coincides with reduction in interpersonal difficulties. Methods: In this study we examined the relationship between SUD and relationships in a national sample of 458 veterans who received approximately 12 sessions of Cognitive Behavioral Therapy for Substance Use Disorders (CBT-SUD) through the Veterans Health Administration (VHA). Results: Parallel latent growth curve modeling (LGCM) indicated that self-reported alcohol use, drug use, and interpersonal difficulties decreased over the course of treatment. Alcohol and drug use were positively associated with each other and with interpersonal difficulties at each time point, and baseline alcohol and drug use were negatively associated with the reduction of use over time. However, there was little evidence that reductions in substance use led to a reduction in interpersonal difficulties (or vice-versa). Conclusions: Findings highlight promising strategies to further understand how CBT-SUD may enhance reductions in substance use as well as improve relationships with family and friends.

Qualitative Analysis of Bystander Intervention Among Young Adult Male Soldiers Who Engage in At-Risk Drinking.

Bystander intervention-when someone intervenes to help in situations that pose a risk for harm-is a promising strategy for sexual violence prevention. In the current study, a sample of U.S. Army male soldiers (N = 10; ages 18-24) who engaged in at-risk drinking completed a 90-min individual semi-structured interview to understand the ways in which soldiers intervene to address risk for sexual violence. Two independent raters coded soldier responses using thematic analysis and identified eight main themes: (a) recognizing risk for sexual violence; (b) labeling situations as problematic and taking responsibility; (c) facilitators of intervention; (d) barriers to intervention; (e) intervention strategies; (f) reactions and consequences to intervention; (g) alcohol's influence on intervention; and (h) using bystander intervention to shift cultural norms. As soldiers reported noticing more extreme risks for violence, prevention interventions may help service members identify situations earlier in the continuum of harm. Soldiers anticipated intervening in a way that was physical and aggressive, which could facilitate physical altercation and result in collateral misconduct. Results from the present study reveal ways that bystander intervention programs for civilians can be tailored to address the unique individual, situational, and contextual factors relevant to the military. These findings also highlight the importance of teaching soldiers indirect and nonaggressive strategies for intervention.

Development and Initial Testing of a Brief, Integrated Intervention Aimed at Reducing Heavy Alcohol Use and PTSD among Military Veterans in Primary Care.

There is a need for integrated treatment approaches that address heavy alcohol use and posttraumatic stress disorder (PTSD) concurrently among Veterans as interactions between heavy drinking and PTSD are frequent. Veteran engagement in specialty mental health services after referral is limited with poorer outcomes following empirically-supported, exposure-based PTSD treatments that do not explicitly address alcohol use. The current project aimed to incorporate two evidenced-based interventions: Brief Motivational Intervention (BMI) with Prolonged Exposure for Primary Care (PE-PC) for Veterans with heavy drinking and PTSD. Delphi methodology was applied to adapt an intervention protocol using subject matter expert (SME) feedback to guide the refinement of a preliminary treatment manual. The newly developed brief intervention (PC-TIME) was then tested in an open trial (n=9) to gather Veteran participant feedback to modify the treatment manual.Two rounds of SME feedback resulted in 80% agreement that manual content was "acceptable as-is" across all intervention domains. The resulting protocol is a five-session, integrated intervention with session 1 primarily focused on alcohol use reduction and sessions 2-5 consisting of narrative exposure and in-vivo exercises for PTSD symptoms with brief alcohol use check-ins. Open trial results indicated high Veteran acceptance of PC-TIME structure and content, and reductions in heavy drinking and PTSD symptoms. Preliminary data suggest PC-TIME to be a promising approach for treatment of heavy alcohol use and PTSD. A pilot randomized controlled trial is necessary to demonstrate the intervention's efficacy with Veterans in a PC setting.

The Intersection between Alcohol use and Sexual Activity among Young Adult Male U.S. Service Members.

Aims: The current study explores drinking habits, preferences for alcohol use before sexual activity, and alcohol-related sexual behavior among young adult male active duty service members in the United States. Background: Hazardous alcohol use is a significant problem among United States military service members. Whereas the association between alcohol use and sexual assault is well documented in civilian samples, less is known regarding the intersection of alcohol use and sexual activity among soldiers. Objective: Descriptive statistics were utilized to summarize drinking habits, preferences for alcohol use before sexual activity, and alcohol-related sexual behavior. Methods: A sample of 338 active-duty male service members between the ages of 18 and 24 were recruited from a large military post in the Southeastern United States. Constructs were assessed using self-report surveys. Results: Participants reported consuming alcohol, on average, 5.6 times over the prior month. Average alcohol consumption was reported to be 7.8 beverages per drinking occasion. Participants reported engaging in heavy drinking an average of 2.9 times over the past 30 days. On average, service members reported a preference for 1.3 drinks before sexual activity. Furthermore, 75.2% of participants preferred to be sober during sex, and 82.1% preferred to engage in sexual activity with a sober partner. Approximately 14% of the sample reported using alcohol to improve their chances of having sex. Conclusion: These findings highlight high rates of alcohol use among soldiers. Nonetheless, young adult male soldiers report a preference for sexual activity while sober. Understanding the co-occurrence of alcohol use and sexual activity has the potential to inform the development of integrated alcohol and sexual assault prevention programs for service members.

Integrated Alcohol Use and Sexual Assault Prevention Program for College Men Who Engage in Heavy Drinking: Randomized Pilot Study.

BACKGROUND: Sexual assault is prevalent on college campuses and most commonly is perpetrated by men. Problematically, there is a dearth of evidence-based prevention programs targeting men as perpetrators of sexual aggression. The Sexual Assault and Alcohol Feedback and Education (SAFE) program is an integrated alcohol and sexual assault prevention intervention for college men who engage in heavy drinking that aims to address sexual aggression proclivity and alcohol use outcomes by incorporating social norms theory, bystander intervention, and motivational interviewing. OBJECTIVE: This study aims to examine the initial feasibility-, acceptability-, and efficacy-related outcomes of a randomized pilot trial of an integrated alcohol and sexual assault prevention program for college men who engage in heavy drinking. METHODS: This study included 115 college men who engaged in heavy drinking, who were randomly assigned to the SAFE program or a mindfulness-based control condition (MBCC). The feasibility of implementation, adequacy of participant retention, fidelity and competency of program administration, and satisfaction and utility of the intervention were evaluated. The primary outcomes of alcohol use and sexual aggression were evaluated at 2 and 6 months after baseline. The secondary outcomes of perceived peer norms, risks for sexual aggression, and bystander intervention were also assessed. The extent to which the motivational interviewing session with personalized normative feedback facilitated changes in the proximal outcomes of drinking intentions, motivation to change, and self-efficacy was also examined. RESULTS: The study procedures resulted in high program completion and retention (>80%), high fidelity to the program manual (>80% of the content included), high competency in program administration, and high ratings of satisfaction and program utility in addressing sexual relationships and alcohol use. Both groups reported declines in the number of drinks per week and number of heavy drinking days. Compared with the MBCC participants, the SAFE participants reported higher motivation to change alcohol use after the program, as well as greater use of alcohol protective behavioral strategies at 6 months. Compared with the MBCC participants, the SAFE participants also reported lower perceived peer engagement in sexual coercion, perceived peer comfort with sexism, and peer drinking norms at 2 and 6 months. However, no group differences were observed in sexual aggression severity, rape myth acceptance, or the labeling of sexual consent. Results regarding bystander intervention intentions were mixed, with the MBCC group showing decreased intentions at 2 months and the SAFE group reporting increased intentions at both 2 and 6 months. CONCLUSIONS: The findings provide promising evidence for the feasibility, acceptability, utility, and preliminary efficacy of the SAFE program in reducing alcohol use and positively influencing perceived peer norms and intentions for bystander intervention among college men who drink. TRIAL REGISTRATION: ClinicalTrials.gov NCT05773027; https://clinicaltrials.gov/study/NCT05773027.

Perpetuating and protective factors in insomnia across racial/ethnic groups of veterans.

Few studies have examined racial/ethnic differences in rates and correlates of insomnia among veterans. This study compared rates of insomnia and interest in sleep treatment among veterans of diverse racial/ethnic backgrounds. Consistent with the 3P model, we tested racial discrimination as a predictor of insomnia, with post-traumatic stress disorder symptoms and romantic partners as perpetuating and protective moderators of this association, respectively. A total of 325 veterans (N = 236 veterans of colour; 12% Asian, 36% Black, 14% Hispanic/Latine) completed questionnaires online from remote locations. Descriptive statistics were used to compare patterns across racial/ethnic groups. Linear regression was used to test moderators of the association between racial discrimination and insomnia severity. Overall, 68% of participants screened positive for insomnia: 90% of Asian; 79% of Hispanic/Latine; 65% of Black; and 58% of White participants. Of those, 74% reported interest in sleep treatment, and 76% of those with partners reported interest in including their partner in treatment. Racial discrimination and post-traumatic stress disorder were correlated with more severe insomnia, while romantic partners were correlated with less severe insomnia. Only post-traumatic stress disorder moderated the association between racial discrimination and insomnia severity. Rates of insomnia were highest among Asian and Hispanic/Latine participants, yet these groups were among the least likely to express interest in sleep treatment. Racial discrimination may exacerbate insomnia symptoms among veterans, but only among those who do not already have disturbed sleep in the context of post-traumatic stress disorder. Romantic partners may serve as a protective factor in insomnia, but do not seem to mitigate the impact of racial discrimination.

A Family-Based Mental Health Navigator Intervention for Youth in the Child Welfare System: Protocol for a Randomized Controlled Trial.

BACKGROUND: Youth in the child welfare system (child welfare-involved [CWI] youth) have high documented rates of mental health symptoms and experience significant disparities in mental health care services access and engagement. Adolescence is a developmental stage that confers increased likelihood of experiencing mental health symptoms and the emergence of disorders that can persist into adulthood. Despite a high documented need for evidence-based mental health services for CWI youth, coordination between child welfare and mental health service systems to increase access to care remains inadequate, and engagement in mental health services is low. Navigator models developed in the health care field to address challenges of service access, fragmentation, and continuity that affect the quality of care provide a promising approach to increase linkage to, and engagement in, mental health services for CWI youth. However, at present, there is no empirically supported mental health navigator model to address the unique and complex mental health needs of CWI youth and their families. OBJECTIVE: Using a randomized controlled trial, this study aims to develop and test a foster care family navigator (FCFN) model to improve mental health service outcomes for CWI adolescents (aged 12-17 years). METHODS: The navigator model leverages an in-person navigator and use of adjunctive digital health technology to engage with, and improve, care coordination, tracking, and monitoring of mental health service needs for CWI youth and families. In total, 80 caregiver-youth dyads will be randomized to receive either the FCFN intervention or standard of care (clinical case management services): 40 (50%) to FCFN and 40 (50%) to control. Qualitative exit interviews will inform the feasibility and acceptability of the services received during the 6-month period. The primary trial outcomes are mental health treatment initiation and engagement. Other pre- and postservice outcomes, such as proportion screened and time to screening, will also be evaluated. We hypothesize that youth receiving the FCFN intervention will have higher rates of mental health treatment initiation and engagement than youth receiving standard of care. RESULTS: We propose enrollment of 80 dyads by March 2024, final data collection by September 2024, and the publication of main findings in March 2025. After final data analysis and writing of the results, the resulting manuscripts will be submitted to journals for dissemination. CONCLUSIONS: This study will be the first to produce empirically driven conclusions and recommendations for implementing a family mental health navigation model for CWI youth with long-standing and unaddressed disparities in behavioral health services access. The study findings have potential to have large-scale trial applicability and be feasible and acceptable for eventual system implementation and adoption. TRIAL REGISTRATION: ClinicalTrials.gov NCT04506437; https://www.clinicaltrials.gov/study/NCT04506437. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/49999.

Reducing Alcohol Use Before and After Surgery: Qualitative Study of Two Treatment Approaches.

BACKGROUND: High-risk alcohol use is a common preventable risk factor for postoperative complications, admission to intensive care, and longer hospital stays. Short-term abstinence from alcohol use (2 to 4 weeks) prior to surgery is linked to a lower likelihood of postoperative complications. OBJECTIVE: The study aimed to explore the acceptability and feasibility of 2 brief counseling approaches to reduce alcohol use in elective surgical patients with high-risk alcohol use in the perioperative period. METHODS: A semistructured interview study was conducted with a group of "high responders" (who reduced alcohol use ≥50% postbaseline) and "low responders" (who reduced alcohol use by ≤25% postbaseline) after their completion of a pilot trial to explore the acceptability and perceived impacts on drinking behaviors of the 2 counseling interventions delivered remotely by phone or video call. Interview transcripts were analyzed using thematic analysis. RESULTS: In total, 19 participants (10 high responders and 9 low responders) from the parent trial took part in interviews. Three main themes were identified: (1) the intervention content was novel and impactful, (2) the choice of intervention modality enhanced participant engagement in the intervention, and (3) factors external to the interventions also influenced alcohol use. CONCLUSIONS: The findings support the acceptability of both high- and low-intensity brief counseling approaches. Elective surgical patients are interested in receiving alcohol-focused education, and further research is needed to test the effectiveness of these interventions in reducing drinking before and after surgery. TRIAL REGISTRATION: ClinicalTrials.gov NCT03929562; https://clinicaltrials.gov/ct2/show/NCT03929562.

Effect of Cognitive Behavioral Therapy for Insomnia on Alcohol Treatment Outcomes Among US Veterans: A Randomized Clinical Trial.

Importance: Three of 4 adults in treatment for alcohol use disorder (AUD) report symptoms of insomnia. Yet the first-line treatment for insomnia (cognitive behavioral therapy for insomnia, CBT-I) is often delayed until abstinence is established. Objective: To test the feasibility, acceptability, and preliminary efficacy of CBT-I among veterans early in their AUD treatment and to examine improvement in insomnia as a mechanism for improvement in alcohol use outcomes. Design, Setting, and Participants: For this randomized clinical trial, participants were recruited through the Addictions Treatment Program at a Veterans Health Administration hospital between 2019 and 2022. Patients in treatment for AUD were eligible if they met criteria for insomnia disorder and reported alcohol use in the past 2 months at baseline. Follow-up visits occurred posttreatment and at 6 weeks. Interventions: Participants were randomly assigned to receive 5 weekly sessions of CBT-I or a single session about sleep hygiene (control). Participants were asked to complete sleep diaries for 7 days at each assessment. Main Outcomes and Measures: Primary outcomes included posttreatment insomnia severity (assessed using the Insomnia Severity Index) and follow-up frequency of any drinking and heavy drinking (4 drinks for women, ≥5 drinks for men; number of days via Timeline Followback) and alcohol-related problems (Short Inventory of Problems). Posttreatment insomnia severity was tested as a mediator of CBT-I effects on alcohol use outcomes at the 6-week follow-up. Results: The study cohort included 67 veterans with a mean (SD) age of 46.3 years (11.8); 61 (91%) were male and 6 (9%) female. The CBT-I group included 32 participants, and the sleep hygiene control group 35 participants. Of those randomized, 59 (88%) provided posttreatment or follow-up data (31 CBT-I, 28 sleep hygiene). Relative to sleep hygiene, CBT-I participants reported greater decreases in insomnia severity at posttreatment (group × time interaction: -3.70; 95% CI, -6.79 to -0.61) and follow-up (-3.34; 95% CI, -6.46 to -0.23) and greater improvements in sleep efficiency (posttreatment, 8.31; 95% CI, 1.35 to 15.26; follow-up, 18.03; 95% CI, 10.46 to 25.60). They also reported greater decreases in alcohol problems at follow-up (group × time interaction: -0.84; 95% CI, -1.66 to -0.02), and this effect was mediated by posttreatment change in insomnia severity. No group differences emerged for abstinence or heavy-drinking frequency. Conclusions and Relevance: In this randomized clinical trial, CBT-I outperformed sleep hygiene in reducing insomnia symptoms and alcohol-related problems over time but had no effect on frequency of heavy drinking. CBT-I should be considered a first-line treatment for insomnia, regardless of abstinence. Trial Registration: ClinicalTrials.gov Identifier: NCT03806491.

N-acetylcysteine for smoking cessation among dual users of tobacco and cannabis: Protocol and rationale for a randomized controlled trial.

BACKGROUND: Tobacco and cannabis co-use is a growing public health problem. The synergistic effects of cannabis and nicotine on neurobiological systems that mediate reward and shared environmental cues reinforcing use may make tobacco smoking cessation more difficult. N-acetylcysteine (NAC), an FDA-approved medication and over-the-counter supplement, has shown promise in animal studies and randomized controlled trials (RCTs) in reducing tobacco and cannabis craving and use. NAC's potential efficacy in treating addiction may be attributable to its central nervous system effects in reducing excessive glutamatergic activity, oxidative stress, and inflammation. To date, no RCT has examined NAC for smoking cessation among dual users of tobacco and cannabis. METHOD: In a double-blind, placebo-controlled RCT, we will examine NAC for smoking cessation among dual users of tobacco and cannabis. Sixty adult cigarette-cannabis co-users are randomized to receive NAC 3600 mg per day or placebo over 8 weeks. Participants in both groups receive 8 weekly cognitive behavioral therapy sessions addressing smoking cessation and cannabis reduction. Outcomes are assessed at Weeks 0, 4, 8, and 12. Primary aims are to determine NAC's efficacy in decreasing cigarette craving, nicotine dependence, and use; and cannabis craving and use. Exploratory aims include examination of changes in neurocognition with NAC and their potential mediational effects on cigarette and cannabis use outcomes. CONCLUSION: Results will inform smoking cessation treatment among dual users of tobacco and cannabis. CLINICALTRIALS: gov Identifier: NCT04627922.

Prospective Associations Between Anxiety Sensitivity, Distress Intolerance, Depressive Symptoms, and Indices of Alcohol and Cannabis Use Among Veterans.

OBJECTIVE: There is substantial evidence linking anxiety sensitivity and distress intolerance to depressive symptoms, and further evidence linking depressive symptoms to alcohol and cannabis use. However, the prospective indirect associations of anxiety sensitivity and distress intolerance with alcohol and cannabis use through depressive symptoms remain uncertain. Thus, the current study examined whether depressive symptoms mediated the associations between anxiety sensitivity and distress intolerance with alcohol and cannabis use frequency, quantity, and problems in a longitudinal sample of veterans. METHOD: Participants (N = 361; 93% male; 80% White) were military veterans with lifetime cannabis use recruited from a Veterans Health Administration in the Northeastern United States. Eligible veterans completed three semi-annual assessments. Prospective mediation models were used to test for the effects of baseline anxiety sensitivity and distress intolerance on alcohol and cannabis use quantity, frequency and problems at 12 months via depressive symptoms at 6 months. RESULTS: Baseline anxiety sensitivity was positively associated with 12-month alcohol problems. Baseline distress intolerance was positively associated with 12-month cannabis use frequency and quantity. Baseline anxiety sensitivity and distress intolerance significantly predicted increased alcohol problems and cannabis use frequency at 12 months through depressive symptoms at 6 months. There were no significant indirect effects of anxiety sensitivity and distress intolerance on alcohol use frequency or quantity, cannabis use quantity, or cannabis problems. CONCLUSIONS: Anxiety sensitivity and distress intolerance share a common pathway to alcohol problems and cannabis use frequency through depressive symptoms. Interventions focused on modulating negative affectivity may reduce cannabis use frequency and alcohol problems.

Cannabis demand and use among veterans: A prospective examination.

OBJECTIVE: Cannabis demand (i.e., relative value), assessed cross-sectionally via a hypothetical marijuana purchase task (MPT), has been associated with use, problems, and dependence symptoms, among others. However, limited work exists on the prospective stability of the MPT. Furthermore, cannabis demand among veterans endorsing cannabis use, and the prospective cyclical relationship between demand and use over time, have yet to be investigated. METHOD: Two waves of data from a veteran sample (N = 133) reporting current (past 6-month) cannabis use were analyzed to assess stability in cannabis demand over 6 months. Autoregressive cross-lagged panel models (CLPMs) assessed the longitudinal associations between demand indices (i.e., intensity, Omax, Pmax, breakpoint) and cannabis use. RESULTS: Baseline cannabis use predicted greater intensity (ß = .32, p < .001), Omax (ß = .37, p < .001), breakpoint (ß = .28, p < .001), and Pmax (ß = .21, p = .017) at 6 months. Conversely, baseline intensity (ß = .14, p = .028), breakpoint (ß = .12, p = .038), and Pmax (ß = .12, p = .043), but not Omax, predicted greater use at 6 months. Only intensity demonstrated acceptable prospective reliability. CONCLUSIONS: Cannabis demand demonstrated stability over 6 months in CLPM models, varying along with natural changes in cannabis use. Importantly, intensity, Pmax, and breakpoint displayed bidirectional predictive associations with cannabis use, and the prospective pathway from use to demand was consistently stronger. Test-retest reliability ranged from good to poor across indices. Findings highlight the value of assessing cannabis demand longitudinally, particularly among clinical samples, to determine how demand fluctuates in response to experimental manipulation, intervention, and treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Development of a mobile mindfulness smartphone app for post-traumatic stress disorder and alcohol use problems for veterans: Beta test results and study protocol for a pilot randomized controlled trial.

BACKGROUND: Post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) are highly prevalent, and co-occurring among post-9/11 veterans. Mobile health (mHealth) applications, specifically those focused on mindfulness-based techniques, may be an effective avenue to intervene with veterans who cannot or will not seek care at traditional in-person settings. Thus, to address areas of improvement in mHealth for veterans, we developed Mind Guide and prepared it for testing in a pilot randomized controlled trial (RCT) with veterans. METHODS: We have completed phase 1 (treatment development) and Phase 2 (beta test) of our mobile mHealth app, Mind Guide. In this paper we describe the methods for Phase 1 as well as results for our beta test (n = 16; inclusion criteria included screen for PTSD, AUD, a post-9/11 veteran, and not currently receiving treatment) for Mind Guide as well as outline procedures for our pilot RCT of Mind Guide (Phase 3). The PTSD Checklist, self-reported alcohol use, the Perceived Stress Scale, Penn Alcohol Craving Scale, and the Emotion Regulation Questionnaire were used. RESULTS: Results of our beta test of Mind Guide show promising past 30 day effects on PTSD (d = -1.12), frequency of alcohol use (d = -0.54), and alcohol problems (d = -0.44), and related mechanisms of craving (d = -0.53), perceived stress (d = -0.88), and emotion regulation (d = -1.22). CONCLUSION: Our initial beta-test of Mind Guide shows promise for reducing PTSD and alcohol related problems among veterans. Recruitment is ongoing for our pilot RCT in which 200 veterans will be recruited and followed up for 3 months. CLINICALTRIALS: gov Identifier: NCT04769986.

Addictions treatment mechanisms of change science and implementation science: A critical review.

This manuscript aims to contribute to the next phase of mechanisms of behavior change (MOBC) science on alcohol or other drug use. Specifically, we encourage the transition from a basic science orientation (i.e., knowledge generation) to a translational science orientation (i.e., knowledge application or Translational MOBC Science). To inform that transition, we examine MOBC science and implementation science and consider how these two research areas can intersect to capitalize on the goals, strengths, and key methodologies of each. First, we define MOBC science and implementation science and offer a brief historical rationale for these two areas of clinical research. Second, we summarize similarities in rationale and discuss two scenarios where one draws from the other-MOBC science on implementation strategy outcomes and implementation science on MOBC. We then focus on the latter scenario, and briefly review the MOBC knowledge base to consider its readiness for knowledge translation. Finally, we provide a series of research recommendations to facilitate the translation of MOBC science. These recommendations include: (1) identifying and targeting MOBC that are well suited for implementation, (2) use of MOBC research results to inform broader health behavior change theory, and (3) triangulation of a more diverse set of research methodologies to build a translational MOBC knowledge base. Ultimately, it is important for gains borne from MOBC science to affect direct patient care, while basic MOBC research continues to be developed and refined over time. Potential implications of these developments include greater clinical significance for MOBC science, an efficient feedback loop between clinical research methodologies, a multi-level approach to understanding behavioral change, and reduced or eliminated siloes between MOBC science and implementation science.

An Application of the Confluence Model of Sexual Aggression Among Young Adult Male Soldiers.

Sexual violence in the U.S. military is a serious concern. Whereas numerous studies document the prevalence of sexual violence among service members, far less research has examined etiological risk factors for sexual aggression perpetration among service members. The present study sought to evaluate the applicability of the Confluence Model of Sexual Aggression among a sample of young adult men engaged in active-duty military service within the U.S. Army. Anonymous surveys were completed by 326 male soldiers between the ages of 18 and 24 at a large military installation in the Southeastern region of the United tStates. Men's likelihood to engage in sexual aggression was operationalized as men's perceived likelihood to persist with sexual activity despite a partner's resistance. Aligning with the Confluence Model of Sexual Aggression, two composite variables reflecting hostile masculinity and tendency toward impersonal sex were created. A linear regression indicated that the main effects of hostile masculinity and impersonal sex were significantly associated with greater perceived likelihood of sexual aggression perpetration. Results also revealed that while the interaction term between hostile masculinity and impersonal sex was significant, the direction of the relationship suggests that the effect of impersonal sex is weaker at higher levels of hostile masculinity. These findings lend evidence to help identify those at elevated risk for perpetrating sexual aggression, as well as informing programmatic efforts to prevent sexual assault within the military.

Rationale and design of a multisite randomized clinical trial examining an integrated behavioral treatment for veterans with co-occurring chronic pain and opioid use disorder: The pain and opioids integrated treatment in veterans (POSITIVE) trial.

BACKGROUND: Chronic pain and opioid use disorder (OUD) individually represent a risk to health and well-being. Concerningly, there is evidence that they are frequently co-morbid. While few treatments exist that simultaneously target both conditions, preliminary work has supported the feasibility of an integrated behavioral treatment targeting pain interference and opioid misuse. This treatment combined Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Relapse Prevention (ACT+MBRP). This paper describes the protocol for the adequately powered efficacy study of this integrated treatment. METHODS: A multisite randomized controlled trial will examine the efficacy of ACT+MBRP in comparison to a parallel education control condition, focusing on opioid safety and pain education. Participants include veterans (n = 160; 21-75 years old) recruited from three Veterans Administration (VA) Healthcare Systems with chronic pain who are on a stable dose of buprenorphine. Both conditions include twelve weekly 90 min group sessions delivered via telehealth. Primary outcomes include pain interference (Patient Reported Outcome Measurement Information System - Pain Interference) and hazardous opioid use (Current Opioid Misuse Measure), which will be examined at the end of the active treatment phase and through 12 months post-intervention. Secondary analyses will evaluate outcomes including pain intensity, depression, pain-related fear, and substance use, as well as treatment mechanisms. CONCLUSION: This study will determine the efficacy of an integrated behavioral treatment program for pain interference and hazardous opioid use among veterans with chronic pain and OUD who are prescribed buprenorphine, addressing a critical need for more integrated treatments for chronic pain and OUD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04648228.

Cultural adaptations of motivational interviewing: A systematic review.

Motivational interviewing (MI; Miller & Rollnick, 2012) has expanded from treating substance use disorders to other health concerns across a range of racial-ethnic groups and ages. The spirit of MI lends itself well to working with culturally diverse populations by eliciting the client's values and goals in a collaborative and client-centered approach in pursuit of behavior change. Additionally, MI has been further adapted for use with racial-ethnic minority groups to enhance its effectiveness with specific populations. The aim of this review was to investigate existing cultural adaptations of MI (CAMI), their effectiveness, and to provide directions for future cultural adaptations in both research and clinical settings. This systematic review identified studies of CAMI over the past 20 years using MEDLINE/Pubmed and Embase. The final dataset consisted of 25 peer review studies. In the randomized controlled trial (RCT) studies that utilized a control condition (n = 17), 10 studies showed that the CAMI condition performed significantly better on at least the primary outcome measure than the control condition. All 10 studies adapted Context, Content, and Concepts-three of the dimensions of cultural adaptation defined by the ecological validity framework used in this study (Bernal et al., 1995). (PsycInfo Database Record (c) 2023 APA, all rights reserved).