Digital Commons Network^™

Community Pharmacists And Substance Use Disorders: Attitudes, Knowledge And Practices, Deepika Rao

Electronic Theses and Dissertations

Background: Substance use disorder (SUD) is a serious health concern affecting a large proportion of the US population. Community pharmacists are well-positioned to prevent, screen, and provide appropriate treatment for SUD. Stigma towards these patients and SUD results in reduced quality of care as well as poor treatment outcomes. It is imperative that pharmacists have the appropriate knowledge of and attitude towards prevention, harm reduction and treatment to develop therapeutic relationships and improve their delivery of pharmacy services

Objective: To assess knowledge, practices (with an emphasis upon screening), stigma and general attitudes of community pharmacists towards SUD and evaluate the …

Sensory-Based Programming In Mental Health: Sense Of Self, Nikki Yeckel

Electronic Theses and Dissertations

The doctoral experiential component (DEC) for this Capstone was completed at the Veterans Affairs Healthcare System (VA) in Pittsburgh, Pennsylvania. The program, called Sense of Self, was implemented with the Veteran mental health (MH) population in an inpatient psychiatric rehabilitation unit at the VA. Sense of Self was a three-day educational program that educated Veterans on the sensory systems and sensory processing, provided calming or alerting strategies with use of sensory materials, and assisted the Veterans in creating sensory home programs based on personal goals. The goals of this Capstone were to inform the staff of the Veteran demographic population …

Island Of Harm Reduction, Trevor T. Boyer

Capstones

New York City's Rikers Island has a medically assisted treatment (MAT) program for detainees who are addicted to opioids, providing buprenorphine or methadone. For many locked up there, though, Rikers is only a way station before a trip upstate to prison. Even now, over 30 years after its treatment program began, only six other correctional facilities in New York offer pilot opioid treatment programs, which are available only to limited segments of their respective populations.

So for those taking medication in the form or methadone or buprenorphine on Rikers Island pretrial and awaiting sentencing, they're tapered off their doses to …

Dios, Drogas, Dinero: ¿QuiéN Gana Con El Traslado De Adictos De Puerto Rico A Ee.Uu.?, Claudia E. Irizarry Aponte, Eliana Y. Perez

Capstones

For the last 25 years, evangelical leaders have been shipping off opioid addicts in Puerto Rico to cities in the mainland US, mainly New York City, Chicago and Philadelphia--under the promise they’ll receive state-of-the-art rehabilitation treatment, only to end up in unregulated transitional homes and flophouses where they don’t receive proper medical care or psychotherapy. In turn, many of these unregulated transitional homes, also run by evangelical leaders, may charge Medicaid kickbacks from their “patients.”

While this so-called “air bridge” from Puerto Rico to the U.S. goes back decades, it gained momentum from 2005 to 2014, when evangelical leaders joined …

Accelerating An Opioid Safety Collaborative’S Efforts In Addressing Opioid Use And Misuse, Norma Cabriales Gutierrez

Capstone Projects and Master's Theses

Opioid dependency has skyrocketed since the 1990’s. Today, there is roughly 1 opioid prescription written for every 2 Monterey County residents according to the California Department of Public Health (2018). Individualized efforts to address the opioid crisis must become a smooth-running process to rectify the damage of over-prescribing. The Prescribe Safe Monterey County Initiative has been a leader in alleviating some damages the epidemic has brought upon our community since their work began in 2014. Accelerating their efforts to combat opioid misuse and abuse by utilizing Monterey County Health Department’s strategy maps is the focus of this capstone. The recommendation …

Cannabinoid Transmission In The Basolateral Amygdala Modulates Prefrontal Cortex And Ventral Hippocampal Activity, Brian J. Pereira

Electronic Thesis and Dissertation Repository

The cannabinoid system is important for maintaining neuron-to-neuron communication within the mammalian brain. One of the most commonly used substances to alter the cannabinoid system is cannabis. Individuals who are exposed to cannabis report having dissociable effects; both positive and negative. High amounts of THC have been commonly associated with the negative effects of cannabis, whereas CBD can be used to counter these. Pre-clinical evidence suggests that the combination of the two compounds can produce a therapeutic benefit for individuals who are susceptible to the effects of THC. The present study investigates whether the combination of THC+CBD can prevent electrophysiological …

Evaluation Of A Youth Emergency Room Enhancement Program For Behavioral Health, Anne Thatcher

Dissertations

Problem. Pediatric mental health complaints and subsequent hospitalizations have been steadily increasing. The Behavioral Health Network (BHN) developed an intensive outreach case management program aimed at reducing youth mental health emergency department (ED) visits and inpatient psychiatric admissions. The Youth Emergency Room Enhancement (YERE) program was a process improvement initiative to provide immediate case management to youth and caregivers for mental health care.

Methods. A Plan-Do-Study-Act (PDSA) method utilizing a retrospective case record review occurred over a six-month period. A convenience sample of youth aged 6-20 years presenting to one of eight healthcare facilities for either ED or inpatient hospitalization …

Exploring The Association Of Victimization And Alcohol And Marijuana Use Among American Indian Youth Living On Or Near Reservations: A Mixed Methods Study, Lindsay Nicole Merritt

Dissertations and Theses

Adolescent substance use research has yet to consider victimization as a potential risk factor contributing to alcohol and marijuana use among American Indian youth living on or near reservations, despite the presence of traumatic experiences, childhood adverse events, racism, and discrimination. Contribution to this lack of attention may be due to little being known about American Indian youth victimization. Even less is known about its association with alcohol and marijuana use in general and for those youth living on or near reservations in particular.

This study utilizes mixed methods with a nationally representative sample of American Indian youth living on …

The Association Between Medication Adherence In Mental Illness And Substance Use Disorder Relapse In Patients With Dual Diagnosis, Tyler Dunn

Electronic Theses and Dissertations

Objectives: The aims of the study were to (1) identify personal, social, and clinical history for patients with substance use disorder (SUD) and mental illness, (2) measure agreeance between patient self-report versus facility record history for mental illness, substance abuse, and psychotropic medication, (3) investigate the specific role of medication adherence and barriers to use for psychotropic medications upon SUD relapse, and (4) assess follow-up changes in mental illness severity and medication adherence in dual diagnosis patients enrolled in a substance abuse rehabilitation program.

Methods: The pilot study utilized a mixed methodology. Inclusion criteria included male patients at least 18 …

A Program Evaluation Of A Drug And Alcohol Family Treatment Program, Katrina Ramirez

Doctoral Dissertations

The current study is a program evaluation at John Muir Behavioral Health, Center for Recovery. The research determined the effectiveness of the program at Center for Recovery that is offered to patients that struggle with substance use disorder and their families. The purpose of this study is to assess patients’ behavioral, cognitive and social/environmental factors as it relates to their commitment to sobriety and examine how the involvement of family members influences the patient’s recovery process. I utilized a mixed methodology of quantitative and qualitative interviews of patients and family members. The findings suggest depressive symptoms were negatively correlated with …

The Effect Of A Mindfulness Intervention On The Depression Symptoms Of Mothers In Treatment For An Opioid Use Disorder, Karen Alexander

Electronic Theses and Dissertations

BACKGROUND: Mothers in treatment for an opioid use disorder experience a high prevalence of depression which may influence their relationship with their child. In the general population, mindfulness-based parenting intervention has been seen in the literature to have a clear positive effect on maternal depression. No research has been published regarding the effect of mindfulness intervention on maternal depression of women in treatment for an opioid use disorder.

OBJECTIVES: To describe the characteristics of mothers in treatment for opioid use disorder, including depression and adverse childhood experiences, and to evaluate the characteristics associated with participation in a mindfulness intervention. Lastly, …

Healthcare Utilization For Behavioral Health Disorders: Policy Implications On Nationwide Readmissions, And Outcomes In The States Of Nebraska And New York, Rajvi J. Wani

Theses & Dissertations

The main goal of this dissertation was to estimate national-level inpatient readmissions and state-level hospital-based emergency department (ED) visits with behavioral health (BH) conditions in the states of Nebraska and New York. The dissertation aims to assess the impact of the policy mandates under the Patient Protection and Affordable Care Act on these state and national estimates. The Nationwide Readmissions Database and the State Emergency Department databases maintained by the Healthcare Cost and Utilization Project were used for this dissertation. US Adult population with high-risk of readmissions in the inpatient departments for alcohol-related disorders (ARD) and of visiting ED for …

The Prospective Influence Of Religiousness On Alcohol Use: What Role Do Perceived Norms Play?, Corey Todd Brawner

Dissertations

Alcohol misuse is recognized as one of the most pressing health hazards for college students. Previous research has supported a protective relationship between religiousness and problematic alcohol use, but it is less clear what aspects of religiousness are protective and through what mechanisms its effect is exerted. The current study utilized a prospective design to accomplish three primary goals: (1) Delineate the protective effects of religious motivation and public participation on alcohol use and alcohol-related problems in a sample of undergraduates at a large public university in the southeastern United States, (2) determine whether effects were maintained long-term, and (3) …

Fear Of Missing Out, Social Media Abuse, And Parenting Styles, Kylie Richter

Electronic Theses and Dissertations

With the increasing rise in technology use, particularly engagement in social media, it is important for researchers to gain a better understanding of the usage patterns along with the antecedents and consequences of heavy social media usage. In addition to the rise in social media usage, a new anxiety driven phenomenon is storming the research world, FoMO (Fear of Missing Out). To date, there has been little empirical research on the relationship between social media usage and psychological adjustment. This study aimed to investigate the relationships between FoMO, social media abuse, and parenting styles. It is theorized that because FoMO …

A Multi-Faceted Intervention To Improve Naloxone Co-Prescription Rates Among Primary Care Providers, Jolane S. Conklin

Evidence-Based Practice Project Reports

It is estimated that 91 Americans die every day due to opioid overdoses, with at least half of those overdoses involving an opioid prescription (CDC, 2016d). To address this issue, the U.S. Department of Health and Human Services (USDHHS) has initiated an opioid initiative, and the Centers for Disease Control and Prevention (CDC) has released a clinical guideline, both of which include a focus on increasing use of naloxone. Despite these recommendations, providers often fail to co-prescribe naloxone to patients at increased risk of opioid overdose. The purpose of this evidence-based practice (EBP) project was to evaluate the effect of …

Analysis Of Opioid Hospitalizations In Michigan Counties, Stephanie George

Honors Theses

The escalating opioid epidemic has affected the United States on both national and local levels. In the state of Michigan, the opioid overdose death rate increased by 13.3% between 2014 and 2015 (Centers for Disease Control and Prevention, 2017). Due to a gap in the literature regarding opioid hospitalization rates, this study focused on the demographic correlates of unemployment, health insurance, and poverty level in relation to the Michigan counties that indicated the highest opioid hospitalization rates in the 2013-2015 time period. The five Michigan counties with the highest opioid hospitalization rates were Oscoda, Arenac, Roscommon, Clare, and Benzie County. …

The Predictors Of Juvenile Recidivism: Testimonies Of Adult Students 18 Years And Older Exiting From Alternative Education, La Toshia Palmer

Dissertations

Purpose: The purpose of this descriptive, qualitative study was to identify and describe the importance of the predictors of juvenile recidivism and the effectiveness of efforts to prevent/avoid juvenile recidivism as perceived by previously detained, arrested, convicted, and/or incarcerated adult students 18 years of age and older exiting from alternative education in Northern California. A second purpose was to explore the types of support provided by alternative schools and the perceived importance of the support to avoid recidivism according to adult students 18 years of age and older exiting from alternative education.

Methodology: This qualitative, descriptive research design identified …

Exploring An Expressive Arts Protocol In The Recovery Of Substance Use Disorders In An Intensive Outpatient Program, Joie De Bostock

Expressive Therapies Capstone Theses

Approaches in treatment of chemical dependency have focused primarily on psychoeducation in group therapy, with limited research involving expressive therapies. Literature has shown benefit in the use of expressive arts for those in mental health treatment, with a limited amount of research on expressive arts in the treatment of substance abuse disorders (SUDs), though it is uncommon for individuals in chemical dependency treatment to receive therapy in any expressive modality. This may be due to several factors, such as resources for supplies or limitations in funding, however, an outlet of expression could benefit this population and contribute to successful recovery …

Shelburne And Clark’S Harbour Quit Smoking: A Community-Based Smoking Cessation Initiative Process Evaluation, Georgeann Lois Macdonald Mn: Dnp, Anp, Rn, Accn, Np

Doctor of Nursing Practice Projects

Background: The prevalence of Canadian smokers is 14.6%. Clark’s Harbour and Shelburne’s rate of smoking increased from 15.6% in 2012 to 19.4% in 2015 (Propel Centre for Population Health Impact, 2015). It was imperative that innovative ways be found to reduce the smoking prevalence.

Objectives: 1) Identify a difference in the participants’ Stages of Change before and after completing the smoking cessation program. 2) Determine whether the participants quit smoking 3) Assess whether there was satisfaction with the program.

Methods: In this one group pre and post-test design, the participants completed a series of pre and post program questionnaires. The …

Path2 Services Court: A Process Evaluation, Octavio Jimenez

Master's Projects

In 2014, the Santa Clara County Superior Court received a Substance Abuse and Mental Health Services Administration (SAMHSA) grant to improve the efficacy of the Juvenile Treatment Court (JTC) and Court for the Individualized Treatment of Adolescents (CITA) programs by streamlining the referral, screening, and court hearing processes. Receipt of the grant allowed the Superior Court to integrate JTC and CITA to establish the Progress Achieved Through Hope and Holistic Services (PATH2 Services) Court.

This research analyzed whether the Santa Clara County Superior Court successfully integrated the JTC and CITA programs when it established PATH2 Services. In addition it determined …

Effectiveness Of The Socratic Method: A Comparative Analysis Of The Historical And Modern Invocations Of An Educational Method, Amanda J. Grondin

Senior Theses

This senior thesis evaluates the Socratic method by comparing its original form, used by Socrates with students such as Meno, to its modern invocations in institutions such as law or medical school. In order to gauge the actual efficacy of the Socratic method in teaching logicality, which is the primary goal of Socratic dialogues, a pilot study was run. The results and implications of this study are embedded in the central portion of the thesis. The study found a statistically significant correlation between the amount of Socratic instruction a student had and that student's performance on a syllogistic reasoning task. …

America's War On Drugs: Applying A Supply And Demand Framework For The Opioid Epidemic Through The Lens Of Federalism, Cari Librett

Senior Theses and Projects

For the past fifty years, American drug policy has been manipulated and enforced in a way that made it possible for drug epidemics to occur and has exaggerated their negative consequences on society. The War on Drugs policy initiatives first implemented in the 1970s created a drug law enforcement structure that has criminalized addiction and made it difficult for addicts to receive treatment. The United States is currently facing it's worst drug epidemic in history due to these policies. However, unlike previous epidemics, the opioid crisis is particularly unique not only because of the unparalleled nature of the issue, but …

Harm Reduction Programs: West Virginia Vs. United States, Morgan L. Belcher, Hannah Sayre

Theses, Dissertations and Capstones

Introduction: Harm reduction has been a movement for social justice built on a belief in, and respect for, the rights of people who use drugs. It has been defined as a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. The U.S. has been experiencing an opioid/heroin epidemic, with significant increases in overdose death among drug users with more than 72,000 Americans having died from drug overdoses in 2017.

Methodology: The methodology for this study was a literature review with a semi structured interview with Tina Rameriz of the Kanawha-Charleston Health Department …

Development And Preclinical Evaluation Of Long-Lasting Cocaine Hydrolases For Cocaine Overdose And Cocaine Use Disorder Treatment, Ting Zhang

Theses and Dissertations--Pharmacy

Cocaine is a plant-based illicit drug commonly involved in substance use disorder. Although cocaine overdose and cocaine use disorders cause adverse health consequences to individuals and the economic burden on their family and society, there are no FDA (Food and Drug Administration) approved medications for treatment. Recently, it has been recognized that delivery of cocaine hydrolase (CocH) is a promising therapeutic strategy. Human butyrylcholinesterase (hBChE), the primary enzyme involved in cocaine metabolism in human, have advantages over other candidates for the development of CocH. Previous studies in our laboratory have designed and characterized hBChE mutants that have ~4,000-fold improved catalytic …

Evaluation Of A Peer Mentor Program On Adult Heroin Overdose Patients In The Emergency Department, Christina Schipper

DNP Projects

Abstract

PURPOSE: According to the Centers for Disease Control and Prevention (CDC), the rate of heroin use and heroin overdoses has greatly increased in the last decade, regardless of sex, age, race or income. The emergency department (ED) is a common place heroin users present, often as an overdose or due to a complication from their drug use. To address the current opioid epidemic, the CDC calls for increased access to substance abuse treatment services. Peer Mentors placed in the ED serve as a link for the patient to recovery services. The purpose of this study is to evaluate the …

Evaluating The Relationship Between Phq9 And Global Pain Scale (Gps) Scores In Opioid Dependent Adults: A Retrospective Correlational Study, Lori Nolan

DNP Projects

Background: Depression, chronic pain and opioid dependence are conditions commonly encountered in primary care settings. These comorbidities create treatment challenges while negatively influencing outcomes of care. The Patient Health Questionnaire (PHQ9) and Global Pain Scale (GPS) are valid screening tools used to score depression and pain symptoms. The purpose of this study was to determine the relationship between the PHQ9 and Global Pain Scale (GPS) scores in opioid dependent adults with chronic pain to determine whether both tools are necessary.

Methods: This was a descriptive study using a retrospective correlational research design. Data was obtained from the electronic medical records …

Provider Adherence And Influencing Factors To Implementation Of An Alcohol Withdrawal Protocol, Ashley Sellers

DNP Projects

Abstract

PURPOSE: The purpose of this study was to assess provider adherence of an initial alcohol withdrawal protocol among adult inpatients, correlate outcome variables with protocol initiation, and examine the factors influencing provider decisions to implement all parts of the protocol.

METHODS: This multi-center descriptive evaluation utilized a retrospective medical record review and qualitative survey. A convenience sample of 313 inpatients represented 395 separate admissions between January and June 2018 in the four adult hospitals of a large health care system. Twenty-four providers participated in an anonymous online survey.

RESULTS: The protocol was implemented in its entirety three times (1%) …

5-Ht2b Receptor-Mediated Cardiac Valvulopathy, Pallavi Nistala

Theses and Dissertations

5-HT_2B receptor agonism causes cardiac valvulopathy, a condition characterized by thickening of the heart valves and as a result, regurgitation of blood within the heart. The anti-obesity drug fenfluramine, which was originally prescribed as an anorectic, was withdrawn from the market due to causing cardiac valvulopathy. Fenfluramine, after metabolism by N-dealkylation, produces the metabolite norfenfluramine, which acts as a more potent valvulopathogen. The same was seen with MDMA (ecstasy), a popular drug of abuse, which is metabolized by N-dealkylation to produce MDA, a more potent valvulopathogen. Glennon and co-workers. studied a series of 2,5-dimethoxy-4- substituted phenylisopropylamines (DOX type) hallucinogens …

A Qualitative Evaluation Of A Substance Abuse Treatment Program For Athletes, Megan K. Lavoy

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

The focus of this study was to examine the experiences of two past participants of an athlete­-specific drug and alcohol rehabilitation program. Researchers have discussed the vulnerability of an athlete population and prevalence of substance use among athletes ( e.g., Turrisi, Mastroleo, Mallett, Larimer, & Kilmer, 2007; Martens, Watson, Royland, & Beck, 2005). Some rehabilitation programs and specific approaches to treating substance abuse in athletes have started to emerge and are beginning to be discussed in the literature (Donahue et al., 2014). However, there remains a gap in the research of studies examining the experiences of these athletes who have …

Efforts To Reduce Concomitant Opioid And Benzodiazepine Prescribing At The Lexington Veterans Affairs Medical Center, Kaitlyn A. Staton

MPA/MPP/MPFM Capstone Projects

The United States is in the throes of an opioid epidemic. Any person who uses an opioid medication may experience an intentional or unintentional overdose. An overdose is more likely to occur when an individual ingests an opioid in combination with certain classes of medications, such as benzodiazepines or nonbenzodiazepines (Z-drugs). These medications are more likely to cause sedation and respiratory depression when taken together. Veterans, due to their unique mental and physical health challenges, are more likely to experience an overdose when they receive a combination of opioid therapy with benzodiazepine or Z-drug therapy as opposed to a single …