Defining Prescription Drug Misuse: A Naturalistic Evaluation of National Survey on Drug Use and Health Data From 2012-2014 to 2015-2017.

OBJECTIVES: Prescription drug misuse (PDM) is a significant public health problem. As research has evolved, the definitions of misuse have varied over time, yet the implications of this variability have not been systematically studied. The objective of this study was to leverage a change in the measurement of PDM in a large population survey to identify its impact on the prevalence and correlates of this behavior. METHODS: Data from the National Survey on Drug Use and Health were compared before and after a change in the definition of PDM from one that restricted the source and motive for use to one that captured any misuse other than directed by a prescriber. Three-year cohorts were constructed, representing a restricted definition of PDM (2012-2014) and a broad definition of PDM (2015-2017). RESULTS: Segmented logistic regression models indicated a significant increase in PDM prevalence for all 3 drug types examined (opioids, tranquilizers, and sedatives). Although the magnitude of differences varied somewhat based on drug type, the broader definition was generally associated with older age, higher prevalence of health insurance, and higher odds of misusing one's own prescription. Some worsening of mental health indicators was observed, but results indicated few other clinical or substance use differences. CONCLUSIONS: Definitions of prescription drug misuse have a substantial impact on the prevalence of misuse and some impact on the characteristics of the population. Further research is needed to understand the optimal strategy for measuring this behavior, based on the scientific or public health question or interest.

Prevalence and correlates of the misuse of z-drugs and benzodiazepines in the National Survey on Drug Use and Health.

Background: Benzodiazepines and non-benzodiazepine hypnotics (z-drugs) are commonly prescribed for their anxiolytic and hypnotic properties, though they can also be misused. In studies examining the epidemiology of prescription drug misuse, these medication classes are commonly combined, rendering inadequate knowledge of their patterns of misuse. The objective of this study was to characterize the population prevalence, conditional dependence, and sociodemographic and clinical correlates of the misuse of benzodiazepines and z-drugs. Methods: Data from the National Survey on Drug Use and Health from 2015 to 2019 were used to estimate population-level prevalence and characteristics of benzodiazepine and z-drug misuse. Groups were derived based on past-year misuse of benzodiazepines alone, z-drugs alone, or both drug types. Unadjusted regression analyses were used to compare groups on characteristics of interest. Results: Exposure to benzodiazepines and/or z-drugs via prescription or misuse was common; however, only 2% of the population was estimated to have misused a benzodiazepine in the past year, and less than 0.5% misused z-drugs. People who misused only z-drugs were generally older, more likely to have health insurance, more educated, and had less severe psychiatric symptoms. This group was also more likely to report misuse to cope with sleep difficulty. Although concurrent substance use was highly prevalent in all groups, people who misused z-drugs alone generally reported less concurrent substance use than the other groups. Conclusion: The misuse of z-drugs is less common than benzodiazepines, and people who misuse only z-drugs appear to generally have lower clinical severity. Nonetheless, a substantial subgroup of people exposed to z-drugs report concurrent, past-year use of other substances. Further research on z-drug misuse, including consideration of whether it should be grouped with other anxiolytic/hypnotic drugs, is needed.

A pilot study of benzodiazepine cue-induced craving.

OBJECTIVES: The misuse of benzodiazepines is a growing concern due to increases in both access to these medications and their associated public health harms, most concerningly risk for overdose when combined with other substances. Although cue reactivity-the subjective and physiological response to cues or reminders of substance use-has been identified for most major classes of substances, it has yet to be studied with benzodiazepines. In this preliminary study, our objective was to assess whether images of benzodiazepines were associated with greater craving and anxiety than neutral images in adults who reported misuse of benzodiazepines. METHODS: We recruited a sample of 38 adults from a substance use disorder treatment setting and administered a standard cue reactivity task using pictorial images along with a battery of self-report measures. RESULTS: Results indicated significantly higher craving and anxiety in response to benzodiazepine relative to neutral cues, with cues eliciting a moderate to high level of craving, on average. Craving was associated with several risk factors for benzodiazepine misuse, including insomnia and distress intolerance. CONCLUSIONS: This preliminary study suggests that benzodiazepine cues can become conditioned to elicit craving responses and that the degree of cue reactivity is correlated with known risk factors for benzodiazepine misuse.

A Pilot Study of a Stress Management Program for Incarcerated Veterans.

INTRODUCTION: Veterans involved in the justice system are an understudied population warranting attention given their higher risk of mental health concerns and psychosocial challenges. Thus, there is a need for programs to support the psychological health of incarcerated veterans. The present study sought to determine the acceptability and effectiveness of a mind-body stress reduction program for incarcerated veterans. MATERIALS AND METHODS: Twenty-four incarcerated veterans (100% male; Mage = 44.87 (SD = 13.84)) completed a 6 week mind-body stress reduction course, or Resilient Warrior. Participants completed validated, self-report assessments of mood, functioning, mindfulness, and coping at pre- and post-program as well as having post-program qualitative feedback surveys. RESULTS: Results showed improvement in depressive symptom severity, self-efficacy, and resilience over the study duration (P < .05), but not stress reactivity, mindfulness, sleep disturbance, or perceived stress. The intervention was reported as helpful by 96% of participants, with 86% of participants stating they would recommend the course to others. CONCLUSIONS: The Resilient Warrior program is acceptable and well-tolerated for incarcerated veterans as well as may improve aspects of psychological health. Future studies could examine how stress reductions program might improve recidivism rates and quality of life after the release of incarcerated veterans.

A pilot study of a mind-body stress management program for student veterans.

BACKGROUND: Student veterans are an at-risk population given the challenges of military experience, reintegration to civilian life, and attending college. Therefore, there is a need for innovative programs to support student veterans. The present study sought to determine the acceptability and effectiveness of a 10-week mind-body stress reduction intervention for student veterans, or Resilient Student Warrior. MATERIALS AND METHODS: Eighty-six student veterans took part in the 10-week mind-body stress reduction course, Resilient Student Warrior. RESULTS: Results showed a significant improvement in reports of stress reactivity, mindfulness, sleep disturbance and coping skills for stress (p < 0.05), but not self-efficacy, perceived stress, depressive or post-traumatic stress disorder symptoms. The intervention was reported as helpful by 96% of participants, with 95% of participants stating they would recommend the course to others. CONCLUSION: Future studies should further assess the effectiveness of mind-body interventions among the student veteran population.

Collaborative Songwriting Intervention for Veterans with Post-Traumatic Stress Disorder.

Objectives: Given that veterans are significantly more likely to suffer from post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, and anxiety than civilians, yet current gold-standard treatments for PTSD are not effective for all patients, the present study sought to examine the feasibility and acceptability of a collaborative songwriting intervention (CSI) while exploring its potential effectiveness in improving physical and mental health outcomes for veterans with PTSD. Design: Ten veterans took part in the CSI. A variety of pre- and postintervention measures were administered, including the Measurement of Current Status (MOCS), the Coping Expectancies Scale (CES), the Post-traumatic Stress Disorder Checklist-Military (PCL-M), and the Patient Health Questionnaire-9 (PHQ-9). Participants also wore a Fitbit to track average heart rate, sleep, and step count. Intervention: The CSI consisted of each veteran meeting with a professional songwriter, trained specifically for co-writing original material with the veteran population. There were three phases of songwriting that took about an hour and 15 min total. Veterans were instructed to listen to their song daily for 5 weeks. Results: Participants reported that the intervention was helpful and relevant to them, and most participants (95%) would refer others to this treatment. We found that the CSI reduced participant's PTSD symptoms (d = 0.869), specifically the Numbing (d = 0.853) and Hyperarousal (d = 1.077) subscales. Depressive symptoms (d = 0.72) and stress reactivity (d = 0.785) also marginally decreased. There was no significant change in physiological data (i.e., sleep, no. of steps) from pre- to postintervention. Conclusion: These data suggest that a CSI is an acceptable intervention for veterans with PTSD that may also improve their PTSD symptoms.

Predictors of Prescription Stimulant Misuse in U.S. College Graduates.

Background: Research has shown that prescription stimulant misuse (PSM) is prevalent among college students and that full-time college attendance is associated with PSM following graduation. Few studies, however, have examined predictors of PSM in college graduates. Objectives: We examined constructs from the Theory of Triadic Influence (TTI) to determine predictors of PSM in this population. Methods: We utilized Amazon's Mechanical Turk and snowball sampling in 2018-2019 to anonymously survey 219 adults in the United States (56% male, Mage = 32.5) with a college degree and history of college PSM. We assessed sensation seeking, ADHD symptoms, negative affect, social norms, workload, positive beliefs and perceived safety, other substance use, PSM motivations, and source(s) of prescription stimulants. Measures were administered online. Results: Over half (55%) of participants reported PSM after college; 36% used in the previous year. Ordinal logistic regressions for each domain of the TTI (i.e. intrapersonal, social/normative, cultural/attitudinal) showed that college graduates engaging in PSM in the previous year were younger and reported higher sensation seeking, more friends/coworkers who engaged in PSM, a heavier workload, and more positive beliefs about PSM. Chi-square analyses showed that college graduates engaging in PSM in the previous year also were more likely to use other substances (e.g. prescription opioids, tobacco/nicotine, cocaine) and to have misused stimulants in college to socialize or to get high. Conclusions: Preventive interventions could target college students and recent graduates who engage in PSM and who demonstrate the aforementioned risk factors, with the goal of curbing PSM and possibly other substance use.