Self-Reported Reasons for Abstinence from Illicit Drugs.

OBJECTIVE: To provide a more balanced understanding of the initiation and restraint of substance use, educators, clinicians, and researchers would benefit from a review of research assessing the reasons nonusers report for having abstained from drugs. METHOD: Based on searches of computerized databases and the reference sections of relevant articles, we identified 15 relevant studies that assessed and quantified participants' expressed reasons for having abstained from (a) one or more named substances or (b) drugs (or alcohol and drugs) with little or no further specification. We defined as more salient those 25% of reasons in each study that were endorsed most frequently, ranked highest, or rated most influential. RESULTS: Five reasons - concerns about physical health, lack of interest, harmful psychological consequences, personal beliefs/morals, and peer/family disapproval - were most frequently identified as salient across studies and substances. CONCLUSION: These salient reasons are consistent with outcome expectancy and social learning models that have been proposed to explain drug initiation. To enhance the value of future research, we recommend testing whether importance ratings differ across contexts; repeatedly assessing within-subject variability of reasons across time; evaluating the association of psychological characteristics with reasons for abstaining; and continuing to evaluate which reasons for abstaining vary by type of drug, gender, ethnicity, and religiosity. We also recommend additional research comparing which reasons predict continued abstinence and which predict initiation of use during follow-up.

University students' attributions for abstinence from synthetic cannabinoids and synthetic cathinones.

BACKGROUND: Synthetic cannabinoids and synthetic cathinones are two increasingly available and potentially dangerous classes of substances. OBJECTIVE: We designed this study to test whether university students rated the influence of different types of reasons for abstaining differently as a function of type of drug (synthetic cannabinoids vs. synthetic cathinones) and gender (male vs. female). METHOD: Using a web-based survey, 176 male and 437 female undergraduate university students rated the degree to which each of 42 reasons for not taking drugs influenced their abstinence from those two classes of substances. RESULTS: Exploratory factor analyses suggested four subscales of reasons applicable to both substances: (1) psychological and behavioral impairment, (2) somatic and physiological concerns, (3) social approval and self-image concerns, and (4) insufficient knowledge and limited access. Both men and women rated all four subscales of reasons as having more influence on their abstinence from synthetic cathinones than synthetic cannabinoids, and women rated each subscale except somatic and physiological concerns as having more influence than did men. CONCLUSIONS: Although there were main effects for type of drug, because students typically reported the same types of reasons as being more or less influential for both classes of substances, prevention interventions could focus simultaneously on reasons to avoid or delay use of both types of substances.

Comparison of outcome expectancies for synthetic cannabinoids and botanical marijuana.

BACKGROUND: Although initially developed for medical purposes, synthetic cannabinoids have also been consumed for recreational purposes. OBJECTIVE: To evaluate whether agreement with positive and negative outcome expectancies differed for synthetic cannabinoids versus botanical marijuana, and assess reported reasons for using synthetic cannabinoids. METHOD: Using a web-based recruitment and data collection procedure, 186 adults who had used both synthetic cannabinoids and botanical marijuana and 181 adults who had used botanical marijuana but not synthetic cannabinoids, completed measures of outcome expectancies and other relevant questionnaires. RESULTS: A significant interaction revealed that participants who had used both synthetic cannabinoids and botanical marijuana indicated lower agreement with positive expectancies for synthetic cannabinoids, and higher agreement with positive expectancies for botanical marijuana, than did those participants who used only botanical marijuana. There was no interaction between type of drug and use history on agreement with negative expectancies, and participants agreed more strongly with negative outcome expectancies for synthetic cannabinoids than for botanical marijuana whether they had used one or both types of these drugs. The most frequently provided reasons for using synthetic cannabinoids included availability, perceived legality, cost, curiosity, and social interaction. CONCLUSION: Given growing public acceptance of recreational and medical marijuana, coupled with negative perceptions and increasing regulation of synthetic cannabinoid compounds, botanical marijuana is likely to remain more available and more popular than synthetic cannabinoids.

Application of the Passionate Attachment Model to Recreational Use of MDMA/Ecstasy.

Those who are not addicted to ecstasy, but who use it persistently over time, could be viewed as having a "passionate attachment" to a highly valued activity. To evaluate the associations of obsessive and harmonious passion with psychological and behavioral aspects of ecstasy consumption, we recruited a community sample of ecstasy users to complete a modified version of the Passion Scale (Vallerand et al. 2003) and other questionnaires assessing their substance use history, self-efficacy to refuse ecstasy, and use of ecstasy to cope with worries and problems. Both Obsessive and Harmonious passion scores were negatively correlated with self-efficacy to refuse ecstasy and positively correlated with using ecstasy to cope with worries and problems. The findings also provided partial support for our hypotheses that scores on the Obsessive Passion subscale would be associated with number of times participants had used ecstasy, the frequency of use, and the typical number of pills consumed. Participants agreed more strongly with statements indicative of Harmonious Passion to consume ecstasy, but Harmonious subscale scores were not associated with several measures of consumption. As a supplemental measure, the modified questionnaire could provide a more comprehensive picture of the psychology of one's ecstasy use.

Self-Medication of Somatic and Psychiatric Conditions Using Botanical Marijuana.

As a complement to research evaluating botanical marijuana as a medical therapy for various somatic and psychiatric conditions, there is a growing body of research assessing marijuana users' self-reports of the symptoms and conditions for which they use marijuana without a physician's recommendation. As part of two larger web-based surveys and one in-situ survey at an outdoor marijuana festival, we asked regular marijuana users if they consumed the drug without a physician's recommendation and, if so, to describe (or select from a checklist) the conditions for which they used marijuana as a medication. Participants reported using marijuana to self-medicate a wide variety of both somatic conditions (such as pain, diabetes, and irritable bowel syndrome) and psychiatric conditions (such as depression, anxiety, and insomnia). Because fewer than half of the American states, and only a few countries, allow physicians to recommend medicinal marijuana, these findings may be of interest to clinicians as they treat patients, to lawmakers and policymakers as they consider legislation allowing physicians to recommend botanical marijuana for somatic and psychiatric conditions, and to researchers evaluating conditions that individuals elect to self-medicate using botanical marijuana.

The pornography craving questionnaire: psychometric properties.

Despite the prevalence of pornography use, and recent conceptualization of problematic use as an addiction, we could find no published scale to measure craving for pornography. Therefore, we conducted three studies employing young male pornography users to develop and evaluate such a questionnaire. In Study 1, we had participants rate their agreement with 20 potential craving items after reading a control script or a script designed to induce craving to watch pornography. We dropped eight items because of low endorsement. In Study 2, we revised both the questionnaire and cue exposure stimuli and then evaluated several psychometric properties of the modified questionnaire. Item loadings from a principal components analysis, a high internal consistency reliability coefficient, and a moderate mean inter-item correlation supported interpreting the 12 revised items as a single scale. Correlations of craving scores with preoccupation with pornography, sexual history, compulsive internet use, and sensation seeking provided support for convergent validity, criterion validity, and discriminant validity, respectively. The enhanced imagery script did not impact reported craving; however, more frequent users of pornography reported higher craving than less frequent users regardless of script condition. In Study 3, craving scores demonstrated good one-week test-retest reliability and predicted the number of times participants used pornography during the following week. This questionnaire could be applied in clinical settings to plan and evaluate therapy for problematic users of pornography and as a research tool to assess the prevalence and contextual triggers of craving among different types of pornography users.

The prevalence, intensity, and assessment of craving for MDMA/ecstasy in recreational users.

This study evaluated the prevalence, intensity, and correlates of craving for MDMA/ecstasy among recreational users employing a new multi-item, self-report questionnaire reflecting experiences of desire, intention to use, and anticipated loss of control. Using a web-based data collection procedure, we recruited MDMA/ecstasy users (n = 240) to rate their agreement with eight craving statements immediately before and immediately following 90 seconds of exposure to either ecstasy-related or control stimuli. Participants then completed questionnaires to measure ecstasy refusal self-efficacy, passionate engagement in ecstasy use, substance use history, and demographic information. Fifty percent of participants indicated some level of agreement with at least two (out of eight) statements indicative of craving and 30% agreed at some level with six or more such statements. The questionnaire used to assess craving was internally consistent, unidimensional, and had excellent one-week test-retest reliability. Craving scores varied as a function of both cue exposure and frequency of ecstasy use, and were significantly associated with ecstasy-related attitudes. Recreational users of MDMA/ecstasy endorse some experiences indicative of craving for this drug, even though only a minority report intense craving following explicit cue exposure.

Injection Drug Users' Perceived Barriers to Using Self-Initiated Harm Reduction Strategies.

INTRODUCTION AND AIMS: Increasing the frequency with which injecting drug users (IDUs) engage in self-initiated harm reduction strategies could improve their health, but few investigations have examined IDUs' perceived barriers to engaging in these behaviors. METHOD: We interviewed 90 IDUs recruited from needle exchanges to assess: a) perceived obstacles to their use of two specific harm reduction strategies (i.e., test shots and pre-injection skin cleaning) designed to reduce two unhealthy outcomes (i.e., overdose and bacterial infections, respectively) and b) their use of other risk-reduction practices. RESULTS: The most frequently cited barrier for both test shots and skin cleaning was being in a rush to inject one's drugs. Other, less commonly cited barriers were strategy-specific (e.g., buying drugs from a known dealer as a reason not to do a test shot; not having access to cleaning supplies as a reason not to clean skin). Regarding other risk reduction practices, participants' most frequently reported using new or clean injecting supplies and avoiding sharing needles and injecting supplies. DISCUSSION AND CONCLUSIONS: Some, but not all, of the barriers generated by participants in our study were similar to those frequently reported in other investigations, perhaps due to differences in the type of sample recruited or in the harm reduction behaviors investigated.

Further evaluation of the construct, convergent and criterion validity of the Gambling Urge Scale with university-student gamblers.

BACKGROUND: Research has documented the prevalence of problem gambling among university students, and craving is one factor that may provoke and maintain episodes of gambling. OBJECTIVES: We designed this study to assess elements of construct, convergent and criterion validity of the Gambling Urge Scale (GUS) when administered to regularly gambling university students. METHODS: Students (n = 250) recruited from three universities during the spring semester, 2012, were randomly assigned to one of four conditions to test the impact of cue exposure to one of two types of stimuli (gambling versus non-gambling activity), and two types of presentation format (photographic versus imagery scripts), on current craving to gamble. RESULTS: Self-reported craving increased significantly following exposure to gambling cues, but not following exposure to engaging non-gambling cues, regardless of the format by which cues were presented. Among those exposed to gambling cues, GUS craving scores were significantly correlated with all three subscales of another measure of craving to gamble, gambling-related problems, passionate attachment to gambling, distorted gambling beliefs and gambling refusal self-efficacy. CONCLUSIONS: These findings provide further support for the construct, convergent and criterion validity of the GUS as a measure of subjective craving in university student gamblers.

Intervene to moderate pandemic drinking by university students.

Increases and decreases in university students' drinking during and after the pandemic will be influenced by multiple factors, including their access to alcohol, COVID-related stress, social support, and whether they live with parents or on campus. Many will engage in elevated drinking, especially upon return to the campus environment. It is our view that abstinence-oriented advice and interventions are unlikely to attract and assist the full range of pandemic drinkers. This viewpoint outlines advantages of supporting moderate drinking, provides examples of self-assessment methods that could enhance motivation to change, and describes self-initiated tactics that university students can employ to moderate their drinking. Students who have a more serious drinking problem or find it difficult to limit or quit drinking on their own may be encouraged to seek professional counseling or attend a mutual help group, either on campus or at home, depending on where they are residing.

Assessing self-efficacy to reduce one's drinking: further evaluation of the Alcohol Reduction Strategies-Current Confidence questionnaire.

AIMS: To evaluate the psychometric properties of a previously published questionnaire designed to assess young drinkers' self-efficacy to employ 31 cognitive-behavioral alcohol reduction strategies. METHODS: Undergraduates (n = 353) recruited from a large Midwestern university completed the previously published Alcohol Reduction Strategies-Current Confidence questionnaire (and other measures) for a self-selected heavy drinking setting. RESULTS: Item loadings from a principal components analysis, a high internal consistency reliability coefficient, and a moderate mean inter-item correlation suggested that all 31 items comprised a single scale. Correlations of questionnaire scores with selected aspects of drinking history and personality provided support for criterion and discriminant validity, respectively. Women reported higher current confidence to use these strategies than did men, but current confidence did not vary as a function of recent binge status. CONCLUSION: Given this further demonstration of its psychometric qualities, this questionnaire holds promise as a clinical tool to identify clients who lack confidence in their ability to employ cognitive-behavioral coping strategies to reduce their drinking.

Assessing the impact of cue exposure on craving to gamble in university students.

We recruited a sample of university student gamblers (n = 48) to complete a web-based battery of instruments in a study designed to assess the impact of imagery-based versus photographic cue exposure on acute craving to gamble using the multi-item Gambling Urge Scale (GUS; Raylu and Oei 2004). Although self-reported craving increased following both forms of cue exposure, the imagery script had a more pronounced impact than did examination of photographs of gambling-related stimuli. We also evaluated the association of the post-cue exposure GUS with other relevant measures, and found it correlated highly both with other questionnaires assessing craving to gamble and with other gambling-relevant characteristics (e.g., gambling-related problems, preoccupation with gambling, distorted gambling beliefs, gambling refusal self-efficacy, sensation seeking), but was not associated with social desirability bias. These findings support the use of the GUS-a brief multi-item scale that shows several key elements of construct, convergent, criterion and discriminant validity-to study the experience of craving in university student gamblers.

Emergency management of a traumatic tooth avulsion.

Emergency department visits for dental complaints are a common occurrence, and tooth avulsion is one of the most serious of these presentations. In this case report, we describe the use of 2-octyl cyanoacrylate and a pliable metal nasal bridge from a respirator mask to replant the tooth and stabilize it during the patient's clinical course. Reassessment of the tooth confirmed that successful replantation had been accomplished. Given the limitations of a single case report, the described method of tooth replantation may be a useful approach that emergency medicine practitioners may add to their dental emergency repertoire.

Assessing adolescents' anticipated behavioral and emotional responses to offers of alcohol and marijuana.

The Adolescent Responses to Alcohol and Drug Offers Scale (ARADOS) is a self-report questionnaire designed to assess a respondent's anticipated emotional reactions and intended use of cognitive-behavioral refusal skills in response to an offer of alcohol or other drug. A sample of 267 students enrolled in the 11th and 12th grades of four public high schools located in northwest Ohio completed four versions of the ARADOS. Factor analyses of the 27 listed resistance responses suggested five clusters of items comprising internally consistent though inter-correlated subscales (Inform others, Aggression, Verbal or nonverbal refusal, Deflection, Deception). Psychometric analyses revealed that ARADOS subscale scores often differed significantly as a function of drug type (alcohol or marijuana) and offerer (close friend or acquaintance), that resistance scores were generally consistent with participants' pre-existing decision to accept or reject offers of alcohol or marijuana, and that anticipated use of resistance responses was significantly correlated with resistance responses used in the past. The ARADOS is a relatively short, easily-scored, contextually-sensitive, self-administered questionnaire that could be used to evaluate education/prevention programs (and clinical interventions) designed to enhance adolescents' refusal of alcohol and drugs.

Evaluation of computer-aided learning in orthodontics.

INTRODUCTION: Studies of computer-aided learning (CAL) in orthodontics have documented both objective and subjective outcomes; however, to date, no studies have attempted to correlate these 2 outcome measures. METHODS: The main objective outcome measured was performance on a written test covering material in the orthodontic diagnosis electronic tutorial (ODET) administered to 92 fourth-year undergraduate dental students. The main subjective outcome measured was a 12-statement questionnaire to elicit students' perception of the ODET and CAL as teaching modalities. RESULTS: In the male and female subgroups, a statistically significant difference in mean lecture test scores favoring women (72.46%) over men (67.08%) was observed (P = 0.05). This difference was not observed for mean ODET test scores (P = 0.52). Although responses to the questionnaire were mostly positive, the students are not prepared to replace lectures with CAL tutorials. Responses showed that male students preferred self-instruction as a mode of learning more than female students did (P = 0.05). When linking objective and subjective outcomes, the mean ODET test score had a statistically significant (P = 0.025), but weak, positive correlation (r = 0.243) with self-reported time spent reviewing the ODET but not with any other statement in the questionnaire. CONCLUSIONS: Despite a difference in lecture test scores between male and female students, there was no difference in mean ODET test scores between the 2 subgroups. This might be explained by sex differences: male students preferred self-instruction more than female students did. Improved performance on the ODET test was noted for students who reported longer times spent reviewing the tutorial. Because students are not prepared to replace lectures with CAL tutorials, from their perspective, the ODET should continue to be used with traditional modes of learning.

A systematic review of reasons for abstinence from alcohol reported by lifelong abstainers, current abstainers and former problem-drinkers.

ISSUES: Numerous studies have been conducted to assess non-drinkers' reported reasons for abstinence, and this review summarises and compares the reasons for abstinence reported by lifelong abstainers, current abstainers and former problem-drinkers. APPROACH: Based on a search of four computerised databases, we identified 31 relevant studies, each of which included a sample of at least 20 individuals who had been abstinent from alcohol for at least 14 days and reported a numerical summary of participants' self-reported reasons for not drinking. To identify the most salient reasons for abstinence among each group of abstainers, we calculated a z-score to represent the level of endorsement of each reason in each investigation, assigned listed reasons to one of 13 categories, and calculated average z-scores (weighted by study quality ratings) for each of the categories. KEY FINDINGS: Having no interest in drinking and disliking the effects of alcohol were the most salient categories of reasons for lifelong abstainers; having no interest in drinking and health reasons were the most salient categories of reasons for current abstainers; and health reasons was the most salient category of reasons for former problem-drinkers. IMPLICATIONS AND CONCLUSIONS: Understanding the reasons that motivate abstinence from alcohol may help refine theoretical explanations of drinking and abstinence. In addition, understanding the reasons that lifelong abstainers report for not beginning to drink, and that current abstainers and former problem-drinkers report for no longer drinking, may help inform interventions designed either to delay the initiation of alcohol use or help individuals stop drinking.

Acceptance of Non-Abstinence as an Outcome Goal for Individuals Diagnosed With Substance Use Disorders: A Narrative Review of Published Research.

OBJECTIVE: Natural recovery and treatment outcome studies published over the past four decades indicate that some individuals with substance use problems moderate their consumption of alcohol and other drugs. Concurrently, a growing number of investigations have assessed service providers' attitudes regarding non-abstinence goals. METHOD: To provide a summary of that research, we identified 25 articles published between 1981 and 2019 that reported agency and/ or clinician acceptance of non-abstinence treatment goals, often as a function of severity of the client condition, finality of the outcome goal, type of substance consumed, and/or treatment setting. RESULTS: Although acceptance rates varied considerably across studies, respondents more often endorsed non-abstinence as an outcome goal (a) for less severely impaired rather than for more severely impaired clients; (b) as an intermediate goal on the way to achieving abstinence rather than as the final outcome goal; and (c) when the target substance is alcohol or cannabis rather than drugs such as cocaine, heroin/opioids, hallucinogens, amphetamines, and MDMA/Ecstasy (3,4-methylenedioxymethamphetamine). Acceptance also varied by treatment setting, with more acceptance of non-abstinence goals in outpatient settings than residential settings, and by geographic location, with larger proportions of service providers in Australia and European countries endorsing non-abstinence goals than those working in the United States and Canada. CONCLUSIONS: We anticipate that acceptance will increase or remain high as research continues to demonstrate improved functioning by those who achieve non-abstinence outcomes, and we recommend further evaluation of other client and clinician characteristics that might influence acceptance and rejection of non-abstinence outcome goals.

Acceptance and therapeutic practice of controlled drinking as an outcome goal by Swiss alcohol treatment programmes.

Sixty-one percent (138/226) of Swiss inpatient and outpatient alcohol treatment programmes responded to a postal survey designed to assess the definition and acceptance of controlled drinking (CD) as a treatment objective, the degree to which a client's severity of dependence and finality of CD as an outcome goal were associated with acceptance, and the perceived value of selected client characteristics when making treatment recommendations. CD was acceptable to large proportions of both outpatient services and inpatient programmes, although willingness to recommend CD was associated with client characteristics such as selecting CD as intermediate versus final outcome goal, lower severity of dependence, not being pregnant and higher social stability. Information and individual therapy to help clients pursue a CD goal are commonly available in outpatient agencies and some inpatient programmes, but group counseling, cue exposure and wet house services are not typically available from Swiss programmes.

University students' self-reported reasons for abstinence from prescription and non-prescription stimulants and depressants.

BACKGROUND: No previous publication has evaluated whether the importance of university students' reasons for abstinence differs across prescription stimulants, prescription opioids, and two illicit forms of those medications (cocaine and heroin). METHODS: In response to a recruitment email sent to all enrolled undergraduates at a large public university, 768 students who reported no prior recreational use of these four substances rated the importance of 17 reasons for lifelong abstention from each of the four drugs. RESULTS: Based on factor analyses, 16 of the 17 reasons comprised four subscales (Negative Consequences, Difficult to Acquire, Not Enjoyable, Social Disapproval). With few exceptions, importance ratings for each of the four subscales and the single non-loading reason (Against My Beliefs) were highest for heroin, followed in descending order by cocaine and the two prescription medications. Female students rated three types of reasons as more important than did males, but previous use of other illicit drugs and past medical use of prescription stimulants or prescription opioids were not typically associated with importance of reasons for abstaining. CONCLUSION: Each type of reason was rated a more important influence on abstention from street drugs than from comparable prescription drugs. Reasons reflecting harmful consequences were rated most important and reasons reflecting acquisition difficulties were rated least important for each drug. To the degree that importance ratings are associated with continued abstinence, education and prevention messages could emphasize negative consequences as one means to reinforce continued abstinence from these drugs.

PTSD Symptoms Experienced and Coping Tactics Used by Crime Scene Investigators in the United States.

Few investigations have assessed the prevalence of posttraumatic stress experiences among Crime Scene Investigators (CSIs). We recruited a nationwide sample of 225 CSIs to complete online questionnaires assessing PTSD symptoms, use of specific coping tactics, perceived social support, trait resilience, and demographics. Seven symptoms had been experienced by at least 50% of participants during the previous month, and 9.3% had total checklist scores suggestive of PTSD. A significant regression analysis revealed that higher PTSD scores were associated with drinking alcohol more frequently to deal with stress, admitting more frequently one could not deal with stress and not trying to do so, lower social support, getting angry and letting emotions out more frequently, lower resilience, and finding comfort in one's religious beliefs. Given the proportions of CSIs that experience exposure-related stress, more should be done to mitigate the prevalence and severity of these symptoms.