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Full-Text Articles in Psychology

Learning To Be Trauma-Informed: An Examination Of Individual-Level Factors Predicting Perceptions Of And Response To Trauma-Informed Practice Trainings, Kelly Daniel Dec 2025

Learning To Be Trauma-Informed: An Examination Of Individual-Level Factors Predicting Perceptions Of And Response To Trauma-Informed Practice Trainings, Kelly Daniel

Electronic Theses and Dissertations

Trauma is a substantial threat to public health. As such, significant effort has been exerted into developing interventions which mitigate the consequences of trauma. Trauma-informed practice (TIP) aims to alleviate the effects of trauma by building policies and practices focused on safety, trust, transparency, support, collaboration, and empowerment. This study investigated how individual-level factors, including readiness for organizational change, perceived benefit of TIP training, and personal trauma history affect one’s ability to apply a TIP lens in a sample (n =100) of members of a graduate-level college. Further, it explored if one’s perceptions of and response to trauma-informed practice training …


How Art Therapy And Emdr Help Asylum Seekers And Refugees Move Towards Healing Trauma: A Literature Review, Anna Mogilevsky May 2025

How Art Therapy And Emdr Help Asylum Seekers And Refugees Move Towards Healing Trauma: A Literature Review, Anna Mogilevsky

Expressive Therapies Capstone Theses

In the past ten years, there has been a significant rise in the number of asylum seekers and refugee populations worldwide (UNHCR, 2022). Displaced individuals are extremely vulnerable to mental illness because of the compounded trauma experienced in their countries of origin with the stress of immigration, asylum seeking, culture shock, and language barriers. PTSD is affecting 500 million individuals globally, and refugees are especially susceptible to having these symptoms (Farrell, 2020). Art therapy and EMDR are identified as the most promising modalities for treating such trauma.

This literature review examines the various ways EMDR and art therapy have been …


South Asian American Experiences Of Microaggressions And Wellbeing: The Moderating Role Of Social Support, Archita Birla Jan 2025

South Asian American Experiences Of Microaggressions And Wellbeing: The Moderating Role Of Social Support, Archita Birla

Electronic Theses and Dissertations

Although the South Asian American community is rapidly expanding in the United States (South Asian Americans Leading Together [SAALT], 2015), there remains a dearth of psychological research regarding the impacts on mental health and wellbeing affecting this diverse community. Racial microaggressions, or verbal or behavioral actions indicating hostile or negative attitudes toward marginalized individuals (Sue et al., 2007), negatively impact People of Color (POC) mental health and wellbeing (Forrest-Bank & Jenson, 2015a; Nadal, Wong, et al., 2015). Some research exists on South Asian American communities and microaggressions (Houshmand et al., 2014; Poolokasingham et al., 2014) but there is limited research …


Perceived Credibility Of Allegations Of Sexual Assault Across Victim Race And Mental Health History, Liyah C. Morgan Jan 2025

Perceived Credibility Of Allegations Of Sexual Assault Across Victim Race And Mental Health History, Liyah C. Morgan

Electronic Theses and Dissertations

Previous research examined the effect of victim gender and rape myth acceptance (RMA) on perceptions of victim credibility; however, little attention has been given to the impact of victim race and mental health history, and even fewer studies have explored the intersection of these two identities. The primary purpose of the current study was to identify factors affecting understanding of perceived credibility of victims of sexual assault, specifically in terms of victim race and mental health history. The study also examined the role of RMA on perceptions of credibility and explored participant attitudes related to color-blind racial attitudes and mental …


Substance Misuse And Suicidal Behaviors In An Lgbtqia+ Sample: Examining The Buffering Effects Of Psychological Flexibility And Emotional Regulation, Mariano Ottone Jan 2025

Substance Misuse And Suicidal Behaviors In An Lgbtqia+ Sample: Examining The Buffering Effects Of Psychological Flexibility And Emotional Regulation, Mariano Ottone

Electronic Theses and Dissertations

Suicidal behaviors among LGBTQIA+ individuals, particularly in the context of substance misuse, present a significant area of exploration for mental health research and intervention. It is particularly important to evaluate factors capable of moderating this relationship, to promote more culturally affirming prevention models. This study aimed to explore the moderating roles of emotion regulation (ER) and psychological flexibility in the relationship between substance misuse and suicidal behaviors within the LGBTQIA+ community. Data were collected from 537 LGBTQIA+ adults through an online survey platform. Participants were asked to self-report on measures assessing the constructs of interest. The analysis focused on understanding …


How Does Psychopathology Impact The Trajectory From State To Trait Mindfulness?, Veronica O'Brien Jan 2025

How Does Psychopathology Impact The Trajectory From State To Trait Mindfulness?, Veronica O'Brien

Electronic Theses and Dissertations

Previous research has found that higher levels of trait mindfulness protect against psychopathology (e.g., Chiesa & Serretti, 2013; Desrosiers et al., 2013; Sevilla-Llewellyn-Jones et al., 2018); however, the research on state mindfulness and psychopathology is more mixed. These mixed findings suggest that some clients with higher levels of psychopathology may have greater difficulty engaging with mindfulness practice thereby hampering their progression towards trait mindfulness and its associated benefits. The present study sought to explore how psychopathology (i.e., anxiety, trauma, alcohol use, and depression) relates to the growth of state and trait mindfulness. The present study recruited 274 participants from a …


An Exploration Of The Contributions Of Parenting Styles And Peer Relationships On The Emotional Expression Of Second-Generation Indian-Americans, Smitha M. Kashi Dec 2024

An Exploration Of The Contributions Of Parenting Styles And Peer Relationships On The Emotional Expression Of Second-Generation Indian-Americans, Smitha M. Kashi

Doctoral Dissertations

This dissertation used a qualitative analysis methodology to study the contributions of parenting styles and peer relationships on the emotional expressivity of second generation Asian Indian-Americans. Seven participants participated in a 60 - 90 minute long semi-structured interview and the content was analyzed using a thematic analysis approach. Most previous research regarding this topic has been conducted on White American or European individuals and does not take into consideration the many intersectionalities that second-generation Indian-Americans hold. Many participants discussed the lack of direction they experienced in regards to learning about their emotions and disclosed that college and young adulthood provided …


Does Self-Care Moderate The Association Between Adverse Childhood Experiences, Trauma Symptoms, And Parental Reflective Functioning?, Vinaya Thomas Dec 2024

Does Self-Care Moderate The Association Between Adverse Childhood Experiences, Trauma Symptoms, And Parental Reflective Functioning?, Vinaya Thomas

Electronic Theses and Dissertations

Unresolved adverse and traumatic experiences in parents can amplify the risk of perpetuating intergenerational transmission of trauma. Parents’ positive and adaptive practices such as self-care might act as a protective factor against this ripple effect. This study investigated whether self-care moderated the relationship between parental ACEs, post-traumatic stress symptoms, and parental reflective functioning in mothers who are experiencing high psychosocial stress (n = 59) residing in rural Appalachia. Within our sample, there was no statistically significant linear relationship between our predictors, ACE score and PTSD symptoms, and our outcome of interest, maternal pre-mentalizing. We did not find empirical support for …


An Exploration Of Adult Children’S Attachment To Their Parents Across Two Cultural Groups: Indians In India And Indians Who Immigrated To The United States, Vilasini Meenakshi Arun Aug 2024

An Exploration Of Adult Children’S Attachment To Their Parents Across Two Cultural Groups: Indians In India And Indians Who Immigrated To The United States, Vilasini Meenakshi Arun

Doctoral Dissertations

Typically, attachment theory has been studied and explored with western populations. Individuals seeking mental health treatment within the United States include western and nonwestern cultural groups and research, theories and interventions that apply to diverse populations are necessary. Attachment relationships are often a part of, or reasons for clients to seek therapy either overtly or covertly, thus allowing research on attachment to better inform treatment plans and practice. An attachment relationship between a parent and child can be influenced by several factors and may change over the course of development, but little is known about this process among Indians …


Derogatory, Racist, And Discriminatory Speech (Drds) In Video Gaming, Sean Woodford Aug 2024

Derogatory, Racist, And Discriminatory Speech (Drds) In Video Gaming, Sean Woodford

Dissertations

Video games have been examined for their effects on cognition, learning, health, and physiological arousal, yet research on social dynamics within video gaming is limited. Studies have documented the presence of derogation, racism, and discrimination in this anonymous medium. However, gamers‟ firsthand experiences are typically examined qualitatively. Thus, this study aimed to establish a quantitative baseline for the frequency of derogatory, racist, and discriminatory speech (DRDS) in gaming. DRDS frequency, sexual harassment, and hate speech measures were administered to 150 individuals from online forums and social media groups. Descriptive and inferential analyses were used to gauge which factors affected DRDS …


Drug Use And Harm Reduction: Community Readiness As Pathway To Well-Being And Reintegration, Lauretta Ekanem Omale Jun 2024

Drug Use And Harm Reduction: Community Readiness As Pathway To Well-Being And Reintegration, Lauretta Ekanem Omale

Dissertations

Drug abuse negatively impacts the life and well-being of those who use drugs; this harm often extends to their loved ones, communities, and society. One presumptive set of psychological explanations for drug abuse is an addictive personality, a psychological susceptibility resulting from challenging family relationships, inadequate reinforcement, the absence of healthy role models, conflicting parental expectations, and a lack of love and respect. Harm reduction is a public health approach that focuses on minimizing the harmful effects of drugs and reducing judgment. It aims to meet people where they are in life and provide judgment-free, empathetic, supportive, and needed medical …


Music Therapy As A Support Model In Massachusetts Special Education: A Literature Review, Bonnie Diamond May 2024

Music Therapy As A Support Model In Massachusetts Special Education: A Literature Review, Bonnie Diamond

Expressive Therapies Capstone Theses

Mental health directly impacts student propensity for making academic progress in the public education system. For children with disabilities, it is especially vital to develop and implement techniques within special education that deliver personally tailored benefits. According to the United States Department of Education, music therapy offers highly effective support to a wide range of students within the school setting so that they may achieve academic success and be supported in their social/emotional development (U.S Department of Education, 2011; AMTA, 2021). In examining the multifaceted ways that music therapy can offer support within the structure of education and mental health, …


Feldenkrais And Music Informed Listening: A Neurophenomenological Perspective On Autism, Arona Primalani May 2024

Feldenkrais And Music Informed Listening: A Neurophenomenological Perspective On Autism, Arona Primalani

Expressive Therapies Capstone Theses

Phenomenologists identify the subjective body and its felt-senses as the basis for human development and consciousness, including mental health. Several mental health disorders, when viewed from a phenomenological perspective, share common symptomology related to varying extents of fractured selves, which in turn hinders dynamic interaction between individuals, their actions, and their relationships with their social and material worlds. Autism is one such condition. Hence, I created an intervention to investigate how listening, which foster subjective and intersubjective experiences, lies at the heart of somatic and arts-based interventions. This thesis, first, begins with a summary of the presenting symptoms observed in …


Aligning With Adolescents: A Literature Review Of Art Therapy In Residential Treatment Programs, Olivia Moore May 2024

Aligning With Adolescents: A Literature Review Of Art Therapy In Residential Treatment Programs, Olivia Moore

Expressive Therapies Capstone Theses

Adolescents in residential treatment programs throughout the United States are a specialized population that demonstrate resiliency and hope every day. Many adolescents in these programs have experienced prominent levels of trauma that impact their ability to function in lower-level programs, foster homes, and in their communities. Residential treatment approaches may look like locked facilities with trauma-informed staff who provide programming options, mental health care, and safe living conditions for adolescents. Without strength-based approaches to treatment, this population may struggle to overcome their trauma, mental health challenges, and developmental needs. In this literature review, art therapy was offered to provide developmentally …


A Music Therapist’S Clinical Improvised Songwriting To Explore Countertransference In The Therapeutic Relationship For An Individual With Multiple Disabilities, Isabella Sances May 2024

A Music Therapist’S Clinical Improvised Songwriting To Explore Countertransference In The Therapeutic Relationship For An Individual With Multiple Disabilities, Isabella Sances

Expressive Therapies Capstone Theses

This qualitative and arts-based capstone thesis discusses working with individuals with multiple disabilities, songwriting in music therapy, intersubjective communication and theory, and countertransference in music therapy, by sharing the literature and presenting a method of how a music therapist’s own clinical improvised songwriting explores countertransference in the therapeutic relationship for an individual with multiple disabilities. Music therapy is used to treat individuals with multiple disabilities. The literature demonstrates that music therapy and improvisation can support communication development in clients with multiple disabilities. However, there is little research regarding countertransference and reflections by music therapists. This thesis explored post-session improvised songwriting …


Creating Whole Inclusive Worlds: The Impact Of Social Media Usage On Black Gender Expansive Millennials’ Experiences Of Social Support And Identity Development Processes, Meredith J. Holmes May 2024

Creating Whole Inclusive Worlds: The Impact Of Social Media Usage On Black Gender Expansive Millennials’ Experiences Of Social Support And Identity Development Processes, Meredith J. Holmes

Doctoral Dissertations

This qualitative study explored the processes of finding community and developing one’s own intersectional racial and gender identity through the social media (SM) experiences of 8 Black gender expansive (GE) adults located around the United States. Using Interpretative Phenomenological Analysis (IPA) methodology and an intersectional theoretical framework, the research questions guiding the study were: “What is the relationship between Black gender expansive people, social media, and community?” and “What is the relationship between Black gender expansive people, social media, and identity development?” The researcher’s findings from in-depth interviews with participants included three major themes: A) Positive Resilience-Supporting Experiences on SM, …


Antagonism Attenuates The Relationship Between Childhood Polyvictimization And Distress In Adulthood, Benjamin D. Carsten May 2024

Antagonism Attenuates The Relationship Between Childhood Polyvictimization And Distress In Adulthood, Benjamin D. Carsten

Honors Capstones

The cumulative effects of childhood polyvictimization, including incremental increases in experiences of childhood maltreatment (CM) types, such as sexual abuse and emotional neglect are associated with an increase in psychological distress. Personality trait domains as measured by the Personality Inventory of the DSM-5, are independently associated with psychological distress, and are thought to moderate the association between traumatic events and distress. The present study was conducted with a sample of undergraduate students (N = 485) who were administered a battery of questionnaires including the Childhood Trauma Questionnaire (CTQ), Inventory of Depression and Anxiety Symptoms (IDAS-II) and the Personality Inventory for …


Childhood Sexual Abuse And The Role Of Experiential Avoidance In College Alcohol Use, Regina Montes May 2024

Childhood Sexual Abuse And The Role Of Experiential Avoidance In College Alcohol Use, Regina Montes

Honors Capstones

Childhood trauma has been related in numerous studies to maladaptive behavior as well as risky behaviors in adulthood, such as alcohol use. However, few studies have focused specifically on the relationship between childhood sexual abuse (CSA) and alcohol use. Moreover, experiential avoidance has been shown to be an important factor in poor behavioral outcomes in young adults with a history of childhood trauma. The present study explores experiential avoidance as a mediating factor of the relationship between CSA and alcohol severity in college students. Data for this current investigation was collected as a part of a larger study of undergraduate …


Trauma Type, Resilience And Sense Of Self, Caitlin R. Callahan May 2024

Trauma Type, Resilience And Sense Of Self, Caitlin R. Callahan

Honors Capstones

Most individuals will experience at least one traumatic event in their lifetime (Alim et al., 2008), potentially leading to a diagnosis of Post-Traumatic Stress Disorder. PTSD can have significant psychological and physical repercussions (Brady et al., 1997). Experiencing trauma, such as interpersonal or non-interpersonal, can negatively impact resiliency and sense of self. The current study hypothesized that participants who reported interpersonal trauma as their worst event would report lower resilience and sense of self compared to participants reporting a non-interpersonal trauma. Four hundred and twenty-nine undergraduate students were given questionnaires to assess traumatic experiences, resiliency, and sense of self using …


Sexological Ecosystemic Assessment: A Systems Approach To Understanding Sexual Issues In Individuals And Couples, Stephanie Buehler May 2024

Sexological Ecosystemic Assessment: A Systems Approach To Understanding Sexual Issues In Individuals And Couples, Stephanie Buehler

Journal of Counseling Sexology & Sexual Wellness: Research, Practice, and Education

Sexuality is a complex construct made up of the influence of systems upon the individual and counterinfluence of the individual upon systems, which can make sexual history taking problematic. The adaptation of Bronfenbrenner’s developmental ecological systems model has been employed to create a Sexological Ecosystemic Assessment. The Sexological Ecosystemic Assessment is described as a means of gathering and organizing information about an individual’s sexual development and current sexual expression across five subsystems that range from the microsystem, wherein interactions take place among and between family members and close caregivers, to the chronosystem, which is the effect of time across the …


Unwanted Pursuit Behaviors & Emotional Reactivity To Former Romantic Partners: An Eeg Study, Ameer Abdel-Muhsin May 2024

Unwanted Pursuit Behaviors & Emotional Reactivity To Former Romantic Partners: An Eeg Study, Ameer Abdel-Muhsin

Student Research Submissions

Romantic relationships are extremely important connections for humans to make. When these relationships end, one partner will sometimes engage in unwanted pursuit behaviors (UPBs) to attempt to continue communication the other. Although previous research has demonstrated that these UPBs can result in psychological distress among victims, little is known about how they influence one’s emotional reactivity to the perpetrator. This study therefore sought to investigate the link between cyber and in-person UPBs and neural indicators of emotional reactivity when viewing photos of an ex-partner. Participants (n = 18) who experienced a breakup were asked to view pictures of their …


Attachment To Diagnostic Labels: Social Media, Over Identification, And Self-Efficacy For Personal Recovery, Robert Oehler May 2024

Attachment To Diagnostic Labels: Social Media, Over Identification, And Self-Efficacy For Personal Recovery, Robert Oehler

Student Research Submissions

This study explored the relationship between self-diagnosis, social media exposure, and how individuals interpret a diagnostic label. Different attitudes toward one’s diagnosis impact an individual’s attitudes toward therapy, compliance with care, and general psychological well-being. One such attitude is over-identification, how attached an individual is to their diagnostic label and how they see a diagnosis as a part of themselves, as this could have implications for their self-concept and attitudes toward therapy. We will ask the following questions: Firstly, do individuals with different diagnoses show meaningfully different levels of attachment to their diagnosis? Secondly, do individuals vary in their social …


The Role Of Social Support And Emotional Regulation In Relationship With Adverse Childhood Experiences And Food Addiction, Negin Ghaffari May 2024

The Role Of Social Support And Emotional Regulation In Relationship With Adverse Childhood Experiences And Food Addiction, Negin Ghaffari

Electronic Theses, Projects, and Dissertations

Adverse childhood experiences (ACEs) are potentially traumatic experiences that occur before the age of 18 and can have long-standing impacts on mental and physical health. Individuals with high exposure to ACEs may be at increased risk for depression, substance use disorders, and cardiovascular disease (Hughes et al., 2017). Social support has been shown to play an essential role in reducing the likelihood of adverse outcomes, such as substance dependence following exposure to adverse experiences. Furthermore, emotional regulation difficulties have been shown to mediate the relationship between childhood trauma and food addiction. There has been little research on adverse events in …


Adverse Childhood Experiences And Sexual Functioning: A Mediation Analysis Of Difficulties In Emotional Regulation, Haven Travis May 2024

Adverse Childhood Experiences And Sexual Functioning: A Mediation Analysis Of Difficulties In Emotional Regulation, Haven Travis

Undergraduate Honors Theses

Sexual dysfunction can lead to a negative impact upon a person’s mental and relational health, including relational and overall distress, poor relationship and sexual satisfaction, and clinical mood disorders such as depression. Moving upstream to identify factors that may predict sexual dysfunction would therefore be beneficial for early intervention in at-risk populations. History of childhood trauma is one such factor that may influence sexual functioning later in life. While adverse childhood experiences (ACEs) have been less studied in association with sexual dysfunction, there is some evidence to indicate that they may be related. ACEs have been shown to increase the …


An Experimental Test Of Mental Health Help-Seeking Intentions As A Function Of Demographics And Disorder Type, Alyssa Hartley May 2024

An Experimental Test Of Mental Health Help-Seeking Intentions As A Function Of Demographics And Disorder Type, Alyssa Hartley

Psychological Science Undergraduate Honors Theses

The current study sought to understand help-seeking behaviors for diverse psychological disorders across different demographic groups. Previous literature finds that help-seeking behaviors are greater in non-minority women in higher socioeconomic statuses, and greater for neurocognitive disorders. This study focuses specifically on university students (N= 276). Participants took diagnostic measures and then were told their scores were clinically elevated for either anxiety or ADHD. Participants were then asked qualitative questions regarding their help-seeking intentions. Findings that were consistent with previous literature are that women were more likely to help-seek than men, and participants in the ADHD condition were more likely to …


Effectiveness Of A Peer-Supported Digital Brief Intervention: Reducing Alcohol Use & Related Harms In Young Adults With Histories Of Interpersonal Trauma, Caitlin Mcgettrick May 2024

Effectiveness Of A Peer-Supported Digital Brief Intervention: Reducing Alcohol Use & Related Harms In Young Adults With Histories Of Interpersonal Trauma, Caitlin Mcgettrick

Masters Theses & Specialist Projects

Alcohol is the most frequently used substance in the United States, and young adults ages 18-25 have the highest rates of heavy alcohol use. Heavy and persistent alcohol use is associated with a host of negative outcomes in young adults, including poor mental health, lower life satisfaction, cognitive impairments, poor academic performance, increased risk for motor vehicle accidents, and substance use disorders. Brief interventions (BI) are low-resource, short-term interventions designed to reduce problematic substance use and mitigate the substantial harms posed by heavy and persistent use of substances such as alcohol. BIs have limited effectiveness in trauma survivors despite trauma …


Meaning In Life And Metacognition: Application Of The Self-Validation Hypothesis, Liam Hill May 2024

Meaning In Life And Metacognition: Application Of The Self-Validation Hypothesis, Liam Hill

Masters Theses & Specialist Projects

Meaning in Life is a robust predictor of various positive outcomes, and provides a buffer against a host of negative outcomes. Due to this fact, it becomes important to examine all the facets of a meaningful life. One consistent predictor of Meaning in Life (MIL) in the literature is one’s sense of positive affect. I tested the idea that it is possible to doubt (or have confidence in) one’s affect, such that under conditions of doubt, positive affect is less strongly related to MIL. It may be the case that positive affect predicts MIL because of what we think of …


The Effect Of Animal-Assisted Therapy On Prosocial Behaviors In Children With Autism Spectrum Disorders And Developmental Delay: A Pilot Study, Emma Mitchell May 2024

The Effect Of Animal-Assisted Therapy On Prosocial Behaviors In Children With Autism Spectrum Disorders And Developmental Delay: A Pilot Study, Emma Mitchell

Psychological Science Undergraduate Honors Theses

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by difficulties in social interaction, nonverbal communication, and repetitive patterns (American Psychiatric Association [APA], 2013). Indeed, autistic individuals have been shown to have greater challenges with developing, maintaining, and understanding social relationships which can persist over their lifetime. Early intervention services are recommended for autistic children when they are young to help promote positive skills to enhance their functioning within society and increase their wellbeing over time. This is an especially pressing issue as ASD rates are rising – with the latest data now suggesting 1 in 36 children have the …


The Role Of Impulsivity In Relation To The Co-Occurrence Of Binge Eating And Binge Drinking, Hannah Holst May 2024

The Role Of Impulsivity In Relation To The Co-Occurrence Of Binge Eating And Binge Drinking, Hannah Holst

Electronic Theses and Dissertations

Binge eating and binge drinking often co-occur, but the role of impulsivity in accounting for this relationship is under-investigated. Existing research acknowledges shared risk factors, yet the specific impact of impulsivity is a critical gap. Impulsivity, characterized by impulsive decision-making, is known in addictive behaviors. This research with a sample of college and community participants assessed binge eating, binge drinking, and impulsivity. Overall, binge eating and binge drinking were uncorrelated, contrary to previous research. However, impulsivity was associated with both binge eating and binge drinking. Gender differences were also noted, along with differences between the community and college samples. The …


The Implications, Magnitude, And Development Of Traumatic Brain Injury For Individuals Undergoing Treatment For Opioid Use Disorder, Hannah G. Mitchell May 2024

The Implications, Magnitude, And Development Of Traumatic Brain Injury For Individuals Undergoing Treatment For Opioid Use Disorder, Hannah G. Mitchell

Electronic Theses and Dissertations

There is an established bidirectional relation between substance use and traumatic brain injuries (TBIs). Despite the high rate of prescribing opioids for pain management following a TBI and the epidemic of opioid use disorder (OUD) in the United States, scarce research has specifically analyzed the association between TBI and OUD. In a series of three interrelated manuscripts, the present study will first examine the prevalence and features of TBIs among persons seeking treatment for OUD. Next, the present study will evaluate the association between TBI and indicators of risky health behaviors and OUD severity, including the risk of overdose and …