The protective role of valuing cultural activities on cannabis use in reserve-Dwelling First Nation youth.

Cannabis legalization and use across North America disproportionately negatively affects North American Indigenous (NAI) youth. Cultural activities may function as an alternative reinforcer to protect against substance use and promote engagement in substance-free activities. The present study explored the role of valuing cultural activities on positive cannabis expectancies and past-month cannabis use. This was a secondary data analysis of data from one NAI adolescent population reporting any past-month cannabis use. 106 NAI adolescents (50% female) from a Canadian reserve community completed surveys in spring 2017. The Institutional Review Board, tribal chief, and council approved this study and informed consent, assent, and parental permission were obtained from participants. Linear regression results revealed significant main effects of positive cannabis expectancies (b = 2.926, SE = 1.198, p = .017, 95%CI[0.542, 5.309]) and valuing cultural activities (b= -0.471,SE = 0.234, p=.048, 95%CI[-0.937, -0.005]) on cannabis use, but no significant interaction between cannabis expectancies and valuing cultural activities. Previous research found valuing cultural activities significantly moderates the relationship between positive alcohol expectancies and alcohol use. Divergent findings may relate to the different historical significance of alcohol versus cannabis. Alcohol was used as a method to colonize NAIs. Thus, our non-significant interaction may result from cannabis not holding the same historical significance in comparison to alcohol for First Nation people, although this is only a hypothesis and should be confirmed with a follow up study. Despite this, calls from Indigenous communities emphasize the need for strength-based approaches and our results indicate that valuing culture is still significantly related to reduced cannabis use, independent of cannabis expectancies.

Discrimination and school outcomes in first nation youth: The role of positive psychological characteristics.

INTRODUCTION: Positive psychological characteristics have been found to be associated with discrimination and school outcomes separately; however, no work has examined these associations together or in North American Indigenous (NAI) populations. NAI adolescents experience high rates of racial discrimination. Because discrimination has a detrimental impact on academic outcomes it is critical to identify factors that could buffer this impact. The purpose of this study was to examine the indirect effect of racial discrimination on three distinct school outcomes (i.e., attitudes toward school, grades, and educational attainment goals) through the pathway of three positive psychological characteristics (i.e., satisfaction with life, subjective happiness, and self-compassion). METHODS: First Nation adolescents living on a rural reserve in Eastern Canada (N = 106, Mage = 14.6 years, 50.0% female) completed a pencil-and-paper survey in Spring 2017 as part of a larger community-based participatory research study. RESULTS: In the model examining school attitudes, indirect effects through subjective happiness (b = -0.21, 95% confidence interval (CI): [-0.53, -0.03]) and self-compassion (b = -0.19, 95% CI: [-0.39, -0.04]), but not satisfaction with life, were significant. In the model examining grades, only the specific indirect effect through subjective happiness was significant (b = -0.27, 95% CI: [-0.59 -0.07]). Similarly, in the model examining school goals, only the indirect effect through subjective happiness was significant (b = -0.40, 95% CI: [-0.94, -0.08]). The direct effects of discrimination on school attitudes (b = 0.02, 95% CI: [-0.52, 0.56]), grades (b = 0.16, 95% CI: [-0.39, 0.71]), and school goals (b = -0.03, 95% CI: [-0.90, 0.84]) were not significant after controlling for positive psychological characteristics. DISCUSSION: Schools should foster positive emotions to enhance academic outcomes, especially for NAI youth who are more likely to experience racial discrimination.

Primary Socialization Theory and American Indian Adolescents' Intentions to Use Substances.

Intentions to use substances are a robust risk factor for future substance use. Primary Socialization Theory (PST), with its focus on relational factors, is well-suited to provide insight into American Indian adolescents' intentions to use substances given the importance of relationships in American Indian communities. The goal of the present study was to examine the role of PST-related factors (i.e., parental monitoring, peer pressure, attitudes toward school) on likelihood of intending to use substances (i.e., alcohol, cigarettes, cannabis, other drugs) among American Indian adolescents.American Indian participants (N = 8,950, 50.7% females) were recruited as a part of the Our Youth, Our Future survey, an ongoing surveillance of substance use among 7th-12th graders attending school on or near reservations.Parental monitoring was found to be associated with decreased likelihood of intending to use alcohol (aOR = 0.97, 95%CI [0.96, 0.99]), cigarettes (aOR = 0.96, 95%CI [0.94, 0.98]), cannabis (aOR = 0.95, 95%CI [0.94, 0.96]), and other drugs (aOR = 0.94, 95%CI [0.92, 0.96]). Peer pressure was associated with increased likelihood of intending to use alcohol (aOR = 1.68, 95%CI [1.59, 1.78]), cigarettes (aOR = 1.73, 95%CI [1.60, 1.86]), cannabis (aOR = 1.81, 95%CI [1.71, 1.92]), and other drugs (aOR = 1.40, 95%CI [1.26, 1.56]). More positive attitudes toward school were associated with decreased likelihood of intending to use alcohol (aOR = 0.93, 95%CI [0.91, 0.94]), cigarettes (aOR = 0.92, 95%CI [0.90, 0.94]), cannabis (aOR = 0.90, 95%CI [0.88, 0.91]), and other drugs (aOR = 0.96, 95%CI [0.93, 0.99]).Results support incorporating social relationships into interventions aiming to prevent substance use initiation, including promoting positive parental monitoring, peer interactions, and school attitudes.

A retrospective examination of changes in drinking motives during the early COVID-19 pandemic.

OBJECTIVE: The COVID-19 pandemic has led to substantial changes in college student alcohol use. Changes in drinking motives may explain some of these changes in drinking patterns. The purpose of the present study is to explore how drinking motives and alcohol use have changed amongst college students considering the timeframes before and after the onset of COVID-19 pandemic (i.e., March 2020) in the United States. We hypothesized that there would be significant changes in drinking motives after March 2020, which would be significantly related to changes in alcohol use. METHODS: Participants for the current study were undergraduate students reporting lifetime alcohol use (n = 198, Mage = 21.3, 66.7% female, 86.4% White) recruited through online advertisements in classes to complete an online survey in April 2020. Participants were asked to report on their drinking motives and alcohol use considering the timeframes before and after the onset of closures and stay-at-home orders during the COVID-19 pandemic (i.e., before and since March 2020). RESULTS: Paired samples t-tests revealed that endorsement of social (t[171) = 12.79, p < .001, d = 1.16) and conformity motives significantly decreased (t[170] = 4.46, p < .001, d = 0.31), while endorsement of coping motives significantly increased (t[172] = -2.70, p = .008, d = .15) after the onset of COVID-19. Linear regression analyses, controlling for drinking motives before March 2020, revealed that changes in enhancement (ß = -.47, p < .001) and coping motives (ß = -.22, p = .04) were significantly associated with changes in alcohol use quantity. CONCLUSIONS: Findings of the present study support the need for interventions to target coping and social drinking to reduce risk for alcohol use.

Depressive symptoms, alcohol use, and alcohol-related consequences: the moderating role of gender among American Indian adolescents.

OBJECTIVES: Depression, alcohol use, and alcohol-related consequences are experienced disproportionately by American Indian (AI) adolescents. The co-occurrence of depression and alcohol use is clinically relevant, as it is associated with increased risk for suicide, among other negative consequences. Understanding how the association between depressive symptoms and alcohol use and related consequences is influenced by gender is important to understand for whom intervention efforts might be particularly relevant. Thus, the present study seeks to evaluate gender differences in these associations among AI adolescents. METHODS: Participants were a representative sample of AI adolescents (N = 3,498, Mage=14.76, 47.8% female) residing on or near reservations who completed self-report questionnaires in school classrooms. Study activities were approved by IRB, school boards, and tribal authorities. RESULTS: The interaction of depressive symptoms and gender was significant in predicting past-year alcohol use frequency (b=.02, p=.02) and, among youth reporting lifetime alcohol use, alcohol-related consequences (b=.03, p=.001). Analysis of simple slopes revealed that, for females, depressive symptoms were significantly associated with past-year alcohol use frequency (b=.02, p<.001) and alcohol-related consequences (b=.05, p<.001). For males, depressive symptoms were only significantly associated with alcohol-related consequences (b=.02, p=.04), and this effect was weaker than for females. CONCLUSIONS: Results of the present study may inform the development of gender-sensitive recommendations for the assessment and treatment of alcohol use and alcohol-related consequences among AI adolescents. For instance, results suggest that treatments focusing on depressive symptoms may subsequently reduce alcohol use and related consequences for female AI adolescents.

Cultural identity affiliation and alcohol use and related consequences among American Indian and White adolescents: A latent profile analysis.

BACKGROUND: Adolescent alcohol use is a significant public health concern and rates of alcohol use are higher among American Indian (AI) adolescents than national samples of non-AI youth. A potential factor in understanding AI alcohol use is cultural identity, which can vary widely based on experiences of historical trauma. We used latent class analysis to examine cultural identity in AI and White adolescents and their alcohol use outcomes in relation to the latent class solutions. METHODS: The samples included 3189 AI adolescents (Mage  = 14.76, 48.9% female) and 1579 White adolescents (Mage  = 15.56, 48.7% female) living on or near a reservation. Participants completed self-report measures of AI and White cultural identity affiliation, alcohol use, and alcohol-related problems. We examined (1) the best-fitting latent class solution with respect to American Indian (AI) and White cultural identity; (2) equivalence of the latent class solution; and (3) alcohol use outcomes across the optimal latent class solution. RESULTS: Latent profile analyses indicated an optimal 3-class solution in both the AI and White samples, which differed by level of affiliation with AI and White cultural identity. While the optimal number of classes were similar across racial groups (configural profile similarity), the nature of the classes differed (structural profile dissimilarity). The three classes represented low overall scores on AI and White cultural identity (Marginalized), a mixture of high and low scores on AI and White cultural identity (Third Culture), and overall high scores on AI and White cultural identity (Bicultural). Alcohol-related problems predicted membership in the Third Culture class compared with the Marginalized class and the Bicultural class. Specifically, youth in the Third Culture class reported significantly fewer alcohol-related problems than youth in the Marginalized and Bicultural classes. Alcohol use did not predict latent class membership. CONCLUSIONS: The future-oriented nature of the Third Culture class may provide protection against adverse alcohol-related outcomes. Research is needed to test interventions that target greater future orientation and future plans to integrate culture into adolescents' lives.

Inclusion and reporting of sex, gender, and race/ethnicity in randomized controlled trials of nonpharmacological treatments for alcohol use disorder: A meta-epidemiologic review.

Alcohol use disorders (AUDs) are among the most prevalent behavioral and mental health diagnoses. Individuals with an AUD are at increased risk for numerous consequences across their social, health, and psychological functioning. Research suggests that differences may exist in the prevalence and consequences of AUD and in the efficacy of AUD treatment across demographic characteristics (i.e., sex/gender and race/ethnicity). This meta-epidemiologic review examined the inclusion of diverse groups (sex/gender and race/ethnicity) in published randomized controlled trials of nonpharmacological treatments for AUD since 1994, following passage of the National Institutes of Health Revitalization Act of 1993. We systematically searched databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement criteria. The initial search strategy yielded 7931 articles. After excluding ineligible articles, 155 were included in the present review for synthesis. Of the articles included in this review, only 57 (36.8%) fully reported on both their sample's sex/gender and racial/ethnic breakdown. Of the total sample, seven articles specifically examined one racial/ethnic group and 32 specifically examined one sex/gender group. Six articles (3.9%) reported no information regarding the racial/ethnic breakdown of their sample and five articles (3.2%) reported no information regarding the sex/gender breakdown of their participants. Only two articles (1.3%) reported on subgroup analyses that examined differences in treatment outcomes by both sex/gender and race/ethnicity, despite guidelines set forth by NIH. Only 46 articles (29.7%) described the failure to include diverse sex/gender or racial/ethnic groups or concerns about the generalizability of study findings given their sample's sex/gender or racial/ethnic composition as methodological limitations. These results indicate that substantial efforts must be put forth by the scientific community to ensure the inclusion, analysis, and reporting of data focused on women/females and members of minoritized racial/ethnic groups.

Depression and alcohol use in American Indian adolescents: The influence of family factors.

BACKGROUND: Rates of both depression and alcohol use are disproportionately higher among American Indian (AI) adolescents than adolescents in the general population. The co-occurrence of depression and alcohol use is common and clinically relevant given their reciprocal negative influences on outcomes. Family factors may be especially relevant because they could have a buffering effect on this relationship due to the importance of kinship and community in AI communities. The current study examines the roles of family warmth and parental monitoring in the association between depressive symptoms and alcohol use in a large, nationally representative sample of AI adolescents. METHODS: Data were collected from 3498 AI 7th to 12th graders (47.8% female) residing on or near a reservation during the period 2009 to 2013. Participants reported on their depressive symptoms, family factors, and alcohol use. RESULTS: There was a small, but statistically significant positive association between depressive symptoms and alcohol use (r = 0.11, p < 0.001). Greater depressive symptoms were associated with significantly less perceived family warmth (ß = -0.09, 95% CI [-0.13, -0.06]), which was associated with significantly greater alcohol use (ß = -0.39, 95% CI [-0.55, -0.23]). Family warmth significantly accounted for the association between depressive symptoms and alcohol use at high (ß = 0.04, SE = 0.02, 95% CI [0.004, 0.09]), but not low, levels of parental monitoring (ß = 0.02, SE = 0.02, 95% CI [-0.002, 0.06]). CONCLUSIONS: Results of the present study suggest that developing culturally sensitive prevention and treatment approaches focusing on increasing both family warmth and parental monitoring are important to address the co-occurrence of depression and alcohol misuse among AI adolescents.

Assaultive trauma, alcohol use, and alcohol-related consequences among American Indian adolescents.

BACKGROUND: American Indian (AI) adolescents report disproportionate higher rates of alcohol use and alcohol-related consequences than adolescents from other racial/ethnic groups. Trauma exposure is also reported at high rates among AI individuals and likely confers risk for alcohol use. The purpose of the present study was to examine the effects of assaultive trauma experiences (e.g., physical assault, sexual assault) on alcohol use and alcohol-related consequences in AI adolescents. METHODS: We conducted a secondary analysis of self-reported data on trauma exposure, alcohol consumption, and lifetime alcohol-related consequences provided by AI 7th to 12th graders residing on or near a reservation (n = 3498, Mage  = 14.8; 49.5% female). Institutional Review Boards, tribal authorities, and school boards approved the study protocols prior to beginning data collection. RESULTS: Nearly half (49.3%, n = 1498) of AI adolescents reported having experienced at least one assaultive trauma in their lifetime. Those who had experienced assaultive trauma were more likely to report lifetime alcohol use (χ2  = 111.84, p < 0.001) and experienced greater alcohol-related consequences (t(1746) = 12.21, p < 0.001) than those with no assaultive trauma exposure. Multilevel regression analyses indicated that a greater number of assaultive traumatic events was significantly associated with greater odds of lifetime alcohol use (p < 0.001, OR = 1.81, 95% CI [1.65, 2.00]) and having experienced a greater number of alcohol-related consequences (b = 0.36, SE = 0.04, t = 16.95, p < 0.001, 95% CI [0.31, 0.46]). CONCLUSIONS: Findings of the present study highlight the relevance of exposure to assaultive trauma to AI adolescents' use of alcohol and experiences of alcohol-related consequences. These findings support the need for trauma-informed interventions in addressing alcohol use among AI adolescents.

Drinking to Fit in: The Effects of Drinking Motives and Self-Esteem on Alcohol Use among Female College Students.

Over the past two decades, rates of alcohol use among female students have risen to meet or even surpass those seen among males. Yet, little is known about factors that play a role in the relationship between drinking motives and alcohol consumption for female college students. The present study examines self-esteem as a moderator in the association between categories of drinking motives and alcohol use in a sample of female college students.Participants included 196 female undergraduates who reported drinking alcohol at least once in the preceding month (Mage= 19.5 years, 88.8% White) at a northeastern public university. Participants completed an online questionnaire assessing self-esteem, drinking motives, and past month alcohol use.Self-esteem was significantly negatively correlated with coping (r=-.40, p<.001) and conformity motives (r=-.22, p=.002) but not enhancement or social motives. Main effects predicting alcohol use were detected for enhancement (b = 1.49, p<.001), coping (b = 1.73, p<.001), and social motives (b = 1.34, p<.001), but not conformity motives or self-esteem. The interaction of conformity motives and self-esteem was significant (b=-0.17, p=.04). Simple slopes analyses revealed that conformity motives were significantly positively related to alcohol consumption for at low (b = 1.53, p=.001), but not high levels (b=-0.39, p=.61) of self-esteem. No other interactions were significant.Assisting female college students with increasing their self-esteem may be an effective component of intervention programs targeting alcohol consumption, particularly among those who report drinking to fit in.

Positive Psychological Characteristics and Substance Use in First Nation Adolescents.

BackgroundNorth American Indigenous (NAI) adolescents experience disproportionate harm related to substance use compared to non-Indigenous adolescents. Strengths-based approaches to substance use prevention and treatment are consistent with Indigenous conceptualizations of health, which tend to be holistic and incorporate more spirituality and community than mainstream Western conceptualizations. Despite this, little is known about how positive psychological characteristics that might confer protection relate to substance use among NAI adolescents. Thus, the present study aims to examine the relations among life satisfaction, subjective happiness, self-compassion, and cigarette, marijuana, alcohol, and other drug use. MethodsParticipants were 106 reserve-dwelling First Nation adolescents located in Eastern Canada (Mage= 14.6 years, 50.0% female) who completed a paper-and-pencil survey regarding their substance use and psychological characteristics for a larger community-based participatory research project. ResultsGreater life satisfaction was significantly associated with decreased odds of lifetime (OR = 0.88, 95%CI [0.81, 0.96]) and current cigarette smoking (OR = 0.90, 95%CI [0.82, 0.99]). Greater subjective happiness was significantly associated with decreased odds of current marijuana use (OR = 0.83, 95%CI [0.71, 0.97]). Although significantly correlated with lower lifetime use of other drugs, self-compassion was not significantly associated with lifetime or current odds of substance use after controlling for age, gender, and other positive characteristics. DiscussionThis is one of the first studies to evaluate positive characteristics and substance use in NAI adolescents. Results point to positive characteristics that may be useful in substance use prevention and suggest the need for further research to further elucidate these associations.

Harm reduction acceptability and feasibility in a North American indigenous reserve community.

AIMS: The present study assessed community and culturally specific alcohol-related harm among North American Indigenous (NAI) individuals, as well as the acceptability and feasibility of harm reduction approaches in one reserve-based NAI community. METHODS: Participants lived on or near a NAI reserve in Canada. Semi-structured focus groups were conducted with health care workers (N = 8, 75% NAI) and community members (N = 9, 100% NAI). Self-report questionnaires were administered that measured acceptability and feasibility of harm reduction strategies. RESULTS: Conventional content analysis revealed loss of culture as culturally specific alcohol-related harm. Health care workers rated harm reduction approaches to be acceptable and feasible, while community participants were more mixed. Majority of participants felt that some harm reduction strategies could provide opportunities for individuals who use alcohol to connect to Indigenous culture and traditions. However, there were mixed findings on whether harm reduction strategies are consistent with Indigenous cultural traditions and values. CONCLUSION: Future research is needed to evaluate potential utility of harm-reduction approaches for NAI communities.

The protective effects of self-compassion on alcohol-related problems among First Nation adolescents.

Given the disproportionate alcohol-related consequences experienced by North American Indigenous youth, there is a critical need to identify related risk and protective factors. Self-compassion, which has been found to mitigate the effects of trauma exposure, may serve as one such protective factor given the high-degree of historical trauma and contemporary discrimination identified as contributing to the alcohol-related disparities experienced by Indigenous communities. However, no research has examined how self-compassion (i.e., the ability to be kind and accepting and to extend compassion towards oneself) plays a unique role in Indigenous peoples' experiences with alcohol. First Nation adolescents between the ages of 11 and 18 living on a reserve in Eastern Canada (N=106, M age =14.6, 50.0% female) completed a pencil-and-paper survey regarding their alcohol use, alcohol-related problems, and self-compassion. Self-compassion was significantly inversely associated with alcohol-related problems (b=-.51, p=.01, 95%CI [-.90, -.12], and significantly interacted with frequency of alcohol use in predicting alcohol-related problems (b=-.42, p=.04, 95%CI [-.82, -.03]). Simple slopes analyses revealed that the association between frequency of alcohol use and frequency of experiencing alcohol-related problems was significant and positive at low (b=4.68, p<.001, 95%CI [2.62, 6.73]), but was not significant at high (b=-.29, p=.89, 95%CI [-4.35, 3.77]) levels of self-compassion. Binary logistic regression revealed that higher scores of self-compassion were associated with a lower odds of being in the high-risk group for AUD (OR=0.90, 95%CI [0.83, 0.98], p=.02). Our results suggest self-compassion may be protective against experiencing alcohol problems in Indigenous youth and thus may be a target for behavioral interventions.

The use of substances in sexual offending in a United States sample.

Substance use is often involved in sexual offending. Understanding the ways in which substances are used in sexual offending is critical for developing prevention strategies. The present study explored the ways that substances are involved in the perpetration of sexual abuse against adults and minors, including intoxication and supplying substances to victims by individuals convicted of sexual offenses. Data were collected from the records of 2803 individuals convicted of sexual offenses in the United States. A series of binary logistic regressions found that offenses against adults were more likely to have alcohol or drugs involved than offenses against minors, while supplying substances to victims was less likely in intrafamilial than in extrafamilial offenses against minors. Findings suggest that implementing sexual violence prevention strategies (e.g. bystander intervention) in adult drinking contexts and integrating education about problematic substance use behaviors (e.g. grooming) during childhood prevention programs can aid in sexual abuse prevention.

Racial discrimination, racial identity affiliation, and heavy alcohol use among multiracial individuals.

BACKGROUND: Alcohol use is disproportionately higher among multiracial than monoracial adults; yet, associated risk and protective factors are underexplored. The present study compared levels of experienced racial discrimination, racial identity affiliation, and heavy alcohol use among multiracial and monoracial adults and tested whether racial identity affiliation, experienced racial discrimination, and their interaction were significantly associated with heavy alcohol use among multiracial individuals. METHODS: We conducted secondary analyses of data from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Participants are a nationally representative sample of all U.S. adults (N = 29,026; 56.4% female) and were interviewed for the study from 2012 to 2013. The sample includes 598multiracial individuals. RESULTS: Linear regression analyses showed that multiracial individuals experienced significantly greater racial discrimination than White (b = -1.26, 95% CI [-1.47, -1.05], p < 0.001) or Asian individuals (b = -0.30, 95% CI [-0.53, -0.06], p = 0.013) but less than Black individuals (b = 0.29, 95% CI [0.08, 0.50], p = 0.007). Furthermore, multiracial individuals reported less affiliation with their racial identity than Black (b = 4.92, 95% CI [4.23, 5.62], p < 0.001) or Asian individuals (b = 3.86, 95% CI [3.09, 4.63], p < 0.001) but did not differ significantly from White individuals. Logistic regression analysis showed that multiracial individuals were significantly more likely to report heavy drinking than Asian individuals (OR = 0.53, 95% CI [0.36, 0.78], p = 0.001) but did not differ significantly from White or Black individuals. Finally, experienced racial discrimination was significantly related to heavy alcohol use in multiracial adults (b = 0.11, 95% CI [0.01, 0.20], p = 0.031), though neither racial identity affiliation nor the interaction of racial identity affiliation with experienced racial discrimination were significantly related to heavy alcohol use. CONCLUSIONS: Our results suggest that multiracial individuals, as compared to other minoritized individuals who are monoracial, report high levels of experienced racial discrimination and heavy alcohol use and low levels of racial identity affiliation. Further understanding of the effects of racial identity affiliation and experienced racial discrimination on the risk for heavy alcohol use could help in the development of interventions aimed at reducing alcohol use disparities among multiracial individuals.

A Framework for the Adaptation of Positive Psychological Interventions to North American Indigenous Populations.

Positive psychology research has led to the development of brief interventions designed to promote positive emotions: positive psychological interventions (PPIs). Randomized controlled trials examining PPIs have found them to be effective in increasing well-being and decreasing depressive symptoms. PPIs have been studied in samples consisting primarily of White Americans; however, PPIs may be useful for members of North American Indigenous groups. PPIs align well with Indigenous views on health, which tend to be strengths-based, holistic, and encompassing the whole body (including the medicine wheel's four dimensions of spirit, mind, heart, and body). This paper provides a framework for the adaptation of PPIs for Indigenous communities and a review of preliminary data on the relationships between positive psychological characteristics and health outcomes including substance use. Implications include the potential widespread impact of culturally adapted PPIs given their alignment with Indigenous thoughts on health and relative ease of administration.

Positive emotional intensity and substance use: the underlying role of positive emotional avoidance in a community sample of military veterans.

Background: Military veterans are at greater risk for substance misuse. Positive emotional intensity is one well-established antecedent of substance misuse in this population. Positive emotional avoidance, or attempts to alter the form, frequency, or context of positive emotions, may help to explain this association. While clinical practice typically aims to increase positive emotions, such approaches may have iatrogenic effects, as high-intensity positive emotions may be experienced as distressing and prompt avoidance for some populations. This suggests a need to better understand responses to positive emotions to inform clinical practice.Objectives: The goal of the current study was to advance theory, research, and clinical practice by exploring the role of positive emotional avoidance in the associations between positive emotional intensity and both alcohol and drug misuse. We hypothesized that positive emotional intensity would indirectly influence alcohol and drug misuse through positive emotional avoidance.Methods: Participants were a community sample of United States military veterans recruited through Amazon's Mechanical Turk (n = 535, Mage = 37.45, 71.8% male, 69.5% White).Results: Correlations among positive emotional intensity, positive emotional avoidance, and alcohol and drug misuse were significant and positive (rs range from.13 to.41). Further, positive emotional avoidance was found to account for the relations of positive emotional intensity to alcohol (indirect effect: b =.04, 95%CI [.01,.08]) and drug misuse (indirect effect: b =.01, 95%CI [.01,.02]).Conclusions: Results provide preliminary support for the potential clinical utility of targeting avoidance responses to positive emotions in interventions targeting alcohol and drug misuse among military veterans.

A Call to Action: A Systematic Review Examining the Failure to Include Females and Members of Minoritized Racial/Ethnic Groups in Clinical Trials of Pharmacological Treatments for Alcohol Use Disorder.

Alcohol use disorder (AUD) presents a significant public health concern given the high prevalence estimates and numerous deleterious-associated consequences. The FDA currently has approved 3 pharmacological treatments for alcohol use disorder: acamprosate, naltrexone, and disulfiram. Previous research suggests that there may exist differences in the prevalence of and outcomes related to AUD across sex and racial/ethnic groups. Other work indicates that there may be differences in the efficacy of existing pharmacological treatments for AUD across demographic groups. The purpose of the present study was to examine the inclusion of women and members of minoritized racial/ethnic groups in published randomized clinical trials of pharmacological treatments for alcohol use disorder since 1994, in accordance with the NIH Revitalization Act of 1993. PubMed was systematically searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The initial search located 842 articles. After exclusion of ineligible articles, 102 remained for analysis. Of those included in the review, only 11.8% reported full sex and racial/ethnic characteristics of their study participants. Of the total sample, 6 articles were specifically examining 1 racial/ethnic group, and 11 were specifically examining 1 sex. Two articles (2.2%) did not report information regarding the sex breakdown of their participants, while 47 (49.0%) did not report any information regarding the racial/ethnic breakdown of their sample. Despite guidelines set forth by NIH, only 5.9% of articles conducted subgroup analyses to examine differences in treatment outcomes by sex or race/ethnicity, and only 16.7% of articles included considerations related to cultural inclusion when discussing study limitations. These results varied by medication type. Results suggest that considerably greater efforts must be put forth by the larger scientific community regarding the inclusion, analysis, and reporting of data focused on women and non-White racial and ethnic groups.

Difficulties Regulating Positive Emotions and Substance Misuse: The Influence of Sociodemographic Factors.

Background: Alcohol and drug misuse present significant public health concerns due to their high prevalence and deleterious outcomes. A growing body of research provides support for the role of difficulties regulating positive emotions in alcohol and drug misuse. However, research is needed to better understand for whom difficulties regulating positive emotions are most strongly associated with alcohol and drug misuse to inform assessment and treatment efforts. Objectives: The goal of the present study was to examine potential sociodemographic moderators (i.e. age, gender, ethnicity, race, income, and educational attainment) in the relations between difficulties regulating positive emotions and alcohol and drug misuse. Methods: Participants were 373 trauma-exposed adults (57.1% female, 75.8% White) recruited from the community. Results: Significant differences were identified across sociodemographic groups regarding difficulties regulating positive emotions (i.e. gender, ethnicity, race, and income) and alcohol use (i.e. gender). Moderation analyses revealed a significant interaction between difficulties regulating positive emotions and gender on drug misuse (b = 0.08, p < .001), such that the association was significant for females (b = 0.11, p < .001) but not males (b = .03, p = .05). Conclusions: Results suggest the importance of developing gender-sensitive recommendations for the assessment and treatment of substance misuse, and of incorporating techniques focused on addressing difficulties regulating positive emotions.

Structured and Unstructured Activities and Alcohol and Marijuana Use in Middle School: The Role of Availability and Engagement.

Background: Behavioral Theories of Choice applied to substance use suggests that use depends on availability of substances and alternative activities. Applying this theory to younger adolescents offers the possibility of investigating potentially malleable prevention and intervention targets. Objectives: The current study examines the role of perceived availability and engagement in structured and unstructured activities on adolescent alcohol and marijuana use controlling for substance availability. Methods: Data were collected as part of a longitudinal study of 6th-8th graders (N = 1023; 52% female; 76% White; Mage = 12.23 years). Multiple logistic regressions analyzed the impact of availability and engagement in structured and unstructured activities at Wave 1 on heavy drinking and marijuana use by study end in both unadjusted and adjusted models. Results: Availability of unstructured activities was associated with increased likelihood of both marijuana use (b* = .06, p = .04) and heavy drinking (OR = 1.20, p < .001), while availability of structured activities was not significantly associated with likelihood of either marijuana use (b* = -.10, p = .07) or heavy drinking (OR = 0.86, p = .16). Engagement in unstructured activities was significantly associated with increased likelihood of both marijuana use (b* = .06, p = .03) and heavy drinking (OR = 1.11, p = .003), while engagement in structured activities was significantly associated with decreased likelihood of both marijuana use (b* = -.25, p < .001) and heavy drinking (OR = 0.85, p = .046). Conclusions: Perceived availability of and engagement in unstructured activities may present a risk, while perceived availability of and engagement in structured activities may serve as a protective factor for youth substance use.