Medicine and Health Sciences Commons^™

Innovative Virtual Role Play Simulations For Managing Substance Use Conversations: Pilot Study Results And Relevance During And After Covid-19, Glenn Albright, Nikita Khalid, Kristen Shockley, Kelsey Robinson, Kevin Hughes, Bethany Pace-Danley

Publications and Research

Background: Substance use places a substantial burden on our communities, both economically and socially. In light of COVID-19, it is predicted that as many as 75,000 more people will die from alcohol and other substance use and suicide as a result of isolation, new mental health concerns, and various other stressors related to the pandemic. Public awareness campaigns that aim to destigmatize substance use and help individuals have meaningful conversations with friends, coworkers, or family members to address substance use concerns are a timely and cost-effective means of augmenting existing behavioral health efforts related to substance use. These types of …

Frontal Alpha Asymmetry And Inhibitory Control Among Individuals With Cannabis Use Disorders, Alina Shevorykin, Lesia M. Ruglass, Robert D. Melara

Publications and Research

To better understand the biopsychosocial mechanisms associated with development and maintenance of cannabis use disorder (CUD), we examined frontal alpha asymmetry (FAA) as a measure of approach bias and inhibitory control in cannabis users versus healthy nonusers. We investigated: (1) whether FAA could distinguish cannabis users from healthy controls; (2) whether there are cue-specific FAA effects in cannabis users versus controls; and (3) the time course of cue-specific approach motivation and inhibitory control processes. EEG data were analyzed from forty participants (CUD (n = 20) and controls (n = 20)) who completed a modified visual attention task. Results showed controls …

Just Culture: It's More Than Policy, Linda Ann Paradiso, Nancy Sweeney

Publications and Research

Any healthcare organization’s top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they’re a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. When errors are identified, the events and impact on safe care need to be shared. Just culture is a safe haven that supports reporting. In a just …

Examining Motivational Interviewing's Effect On Confidence And Commitment Using Daily Data, Alexis Kuerbis, Kevin Lynch, Sijing Shao, Jon Morgenstern

Publications and Research

Mechanisms of behavior change (MOBC) within Motivational Interviewing (MI) are thought to operate via both relational and technical elements. These elements are hypothesized to increase client motivation and self-efficacy for change and subsequently decrease drinking. Only partial support for this causal chain exists, particularly when using within-session change talk as the primary intervening variable. This study explored whether commitment to moderate or abstain from drinking and confidence to moderate drinking in the next day measured via ecological momentary assessment (EMA) provided alternative support for the theory. Data were from a pilot randomized controlled trial testing active ingredients of MI. Problem …

Daily Factors Driving Daily Substance Use And Chronic Pain Among Older Adults With Hiv: A Study Using Ecological Momentary Assessment, Alexis Kuerbis, M. Carrington Reid, Jordan Lake, Suzanne Glasner-Edwards, Jessica Jenkins, Diana Liao, Jury Candelario, Alison A. Moore

Publications and Research

Background: Adults 50 and older make up approximately 50% of persons living with HIV. Multiple co-morbidities are common among this group, including chronic pain and substance abuse, yet little is known about the daily factors that either enhance or inhibit these experiences or behaviors. This study explored daily drivers of substance use, pain, and relief from pain among older adults living with HIV utilizing ecological momentary assessment (EMA). Method: Participants (N=55), ages 49–71, completed seven consecutive days of daily EMA online surveys prior to treatment initiation within a randomized controlled trial. Multilevel modeling tested predictors of pain, substance use, and …

The Relationship Between In-Session Commitment Language And Daily Self-Reported Commitment To Reduce Or Abstain From Drinking, Alexis Kuerbis, Jessica Houser, Paul Amrhein, Hayley Treloar Padovano, Jon Morgenstern

Publications and Research

Background: Motivational interviewing is hypothesized to operate by enhancing a client’s internal motivation to change. Past research operationalizes this process by measuring in-session statements for change (i.e., change talk), yet relationships between change talk and other measures of motivation have yet to be substantiated. This study tested whether in-session change talk predicted subsequent reports of commitment to abstain or moderate drinking assessed via ecological momentary assessment (EMA), and explored each of their contributions to drinking outcomes. Method: Secondary data analysis was performed on data from 48 study participants who received therapy within a randomized controlled trial testing mechanisms of actions …

Comparing Daily Drivers Of Problem Drinking Among Older And Younger Adults: An Electronic Daily Diary Study Using Smartphones, Alexis Kuerbis, Hayley Treloar Padovano, Sijing Shao, Jessica Houser, Frederick Muench, Jon Morgenstern

Publications and Research

Background—By 2030, numbers and proportions of older adults with substance-use problems are expected to increase. While risk factors for problem drinking in late life have been identified, it remains unknown whether these factors drive daily drinking among older problem drinkers. This study examined the daily drivers of drinking among problem drinkers, moderated by age, utilizing ecological momentary assessment (EMA). Method—Participants (N=139), ages 20–73, received daily EMA online surveys completed via a smartphone prior to initiation of treatment. Multilevel modeling tested the moderating impact of age on within- and between-person relationships between drinking and focal predictors (mood, loneliness, boredom, stress, poor …

More Than Taking A Chair: The Perceived Group Social Dynamics Of Alcoholics Anonymous Related To Changes In Spiritual Practices, Alexis Kuerbis, J. Scott Tonigan

Publications and Research

Alcoholics Anonymous (AA) meeting attendance and spiritual practices are established predictors of abstinence. This study utilized longitudinal data from two studies of AA to investigate 1) how perceived within meeting social dynamics in AA meetings affect later AA attendance, and thus exposure to the emphasis of spiritual practices and 2) influence the extent that spiritual gains are mobilized, beyond AA attendance. Findings revealed that greater group cohesion was associated with lower AA attrition, and that expressiveness, or openness, of the group predicted reported practice of spiritual behaviors. Findings reveal distinct group dynamics may foster distinct mechanism of change of AA …

Exploration Of Treatment Matching To Problem Drinker Characteristics With Motivational Interviewing And Non-Directive Client-Centered Psychotherapy For Problem Drinkers, Alexis Kuerbis, Jessica Houser, Svetlana Levak, Sijing Shao, Jon Morgenstern

Publications and Research

Motivational Interviewing (MI) is a known effective intervention for alcohol use disorder (AUD). MI's mechanisms of action remain inconsistently substantiated, and research in this area has been reliant on identifying relationships through strength of association rather than experimental manipulation of active ingredients. In two previous studies, a pilot and a larger replication study, we disaggregated MI into its hypothesized active ingredients by creating three conditions: MI, Spirit Only MI (SOMI, in which evocation of change talk was proscribed), and a non-therapy condition (NTC). Results from both studies yielded equivalent findings across all three conditions. In the current analyses, data from …

Characteristics Of Online Treatment Seekers Interested In A Text Messaging Intervention For Problem Drinking: Adults 51 And Older Versus Middle-Aged And Younger Adults, Alexis Kuerbis, Katherine Van Stolk-Cooke, Frederick J. Muench

Publications and Research

According to the Institute of Medicine, the vast older adult population is estimated to have mental health and substance use disorders at unprecedented rates and will place high demand on an unprepared healthcare system. Online and mobile health interventions, such as text messaging, could provide an alternative form of frontline intervention that could alleviate some of the burden on the healthcare system; however, it remains unknown what are characteristics of adults over 50 who might be interested in a mobile health behavioral intervention and how they may differ from their younger counterparts. To explore the characteristics of those interested in …

Impact Of Cannabis Use On Treatment Outcomes Among Adults Receiving Cognitive-Behavioral Treatment For Ptsd And Substance Use Disorders, Lesia M. Ruglass, Alina Shevorykin, Vanja Radoncic, Kathryn M. Z. Smith, Philip H. Smith, Isaac R. Galatzer-Levy, Santiago Papini, Denise A. Hien

Publications and Research

Background: Research has demonstrated a strong link between trauma, posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) in general and cannabis use disorders in particular. Yet, few studies have examined the impact of cannabis use on treatment outcomes for individuals with co-occurring PTSD and SUDs. Methods: Participants were 136 individuals who received cognitive-behavioral therapies for co-occurring PTSD and SUD. Multivariate regressions were utilized to examine the associations between baseline cannabis use and end-of-treatment outcomes. Multilevel linear growth models were fit to the data to examine the cross-lagged associations between weekly cannabis use and weekly PTSD symptom severity and primary …

A Randomized Controlled Pilot Trial Of Different Mobile Messaging Interventions For Problem Drinking, Frederick Muench, Katherine Van Stolk-Cooke, Alexis Kuerbis, Gertraud Stadler, Amit Baumel, Sijing Shao, James R. Mckay, Jon Morgenstern

Publications and Research

Introduction
Recent evidence suggests that text messaging may help to reduce problem drinking as an extension to in-person services, but very little is known about the effectiveness of remote messaging on problem drinking as a stand-alone intervention, or how different types of messages may improve drinking outcomes in those seeking to moderate their alcohol consumption.

Methods
We conducted an exploratory, single-blind randomized controlled pilot study comparing four different types of alcohol reduction-themed text messages sent daily to weekly drink self-tracking texts in order to determine their impact on drinking outcomes over a 12-week period in 152 participants (≈ 30 per …

Dismantling Motivational Interviewing: Effects On Initiation Of Behavior Change Among Problem Drinkers Seeking Treatment, Jon Morgenstern, Alexis Kuerbis, Jessica Houser, Sijing Shao, James R. Mckay

Publications and Research

Motivational Interviewing (MI) is an efficacious treatment for alcohol use disorders (AUD). MI is thought to enhance motivation via a combination of two therapeutic strategies or active ingredients: one relational and one directional. The primary aim of this study was to examine MI’s hypothesized active ingredients using a dismantling design. Problem drinkers (N=139) seeking treatment were randomized to one of three conditions: MI, relational MI without the directional elements labeled spirit-only MI (SOMI) or a non-therapy control (NTC) condition and followed for eight weeks. Those assigned to MI or SOMI received four sessions of treatment over eight weeks. All participants …

A Pilot Study Of Online Feedback For Adult Drinkers 50 And Older: Feasibility, Efficacy, And Preferences For Intervention, Alexis Kuerbis, Lisa Hail, Alison A. Moore, Frederick Muench

Publications and Research

Normative (NF) and personalized feedback (PF) are moderately effective brief interventions for at-risk drinking middle-aged and older adults. This study tested the feasibility of online feedback for drinkers 50 and older. This study’s aims were to identify whether there is differential effectiveness of PF over NF in prompting drinkers 50 years old and older to plan for change and to determine potential preferences for intervention among adult drinkers 50 and older with practical knowledge about computers. Method—Using Amazon’s Mechanical Turk, 138 male and female drinkers aged 50 to 75+ were recruited to complete an online survey that asked about their: …

Testing Cross-Sectional And Prospective Mediators Of Internalized Heterosexism On Heavy Drinking, Alcohol Problems, And Psychological Distress Among Heavy Drinking Men Who Have Sex With Men, Alexis Kuerbis, Ethan Mereish, Marie Hayes, Christine Davis, Sijing Shao, Jon Morgenstern

Publications and Research

Objective: Minority stress theory is often used as a causal explanation for substance use among lesbian, gay, and bisexual populations. This study tested whether drinking to cope with stress (DTC), loneliness, and gay community participation (GCP) mediated the relationship between one type of minority stress (i.e., internalized heterosexism, IH) and behavioral health outcomes. Method: Utilizing secondary data analysis and the PROCESS procedure, relationships between IH, the mediators (DTC, loneliness, and GCP), and outcomes (heavy drinking, alcohol problems, and psychological distress) were explored, both cross-sectionally and in a lagged manner, among both treatment seeking and non-treatment seeking problem drinking men who …

Dynamical Systems Modeling To Identify A Cohort Of Problem Drinkers With Similar Mechanisms Of Behavior Change, Kidist Maxwell, Rebecca Everett, Sijing Shao, Alexis Kuerbis, Lyric Stephenson, H. T. Banks, Jon Morgenstern

Publications and Research

One challenge to understanding mechanisms of behavior change (MOBC) completely among individuals with alcohol use disorder is that processes of change are theorized to be complex, dynamic (time varying), and at times non-linear, and they interact with each other to influence alcohol consumption. We used dynamical systems modeling to better understand MOBC within a cohort of problem drinkers undergoing treatment. We fit a mathematical model to ecological momentary assessment data from individual patients who successfully reduced their drinking by the end of the treatment. The model solutions agreed with the trend of the data reasonably well, suggesting the cohort patients …

A Randomized Controlled Trial Of A Videoconferencing Smoking Cessation Intervention For Korean American Women: Preliminary Findings, Sun S. Kim, Somporn Sitthisongkram, Kunsook Bernstein, Hua Fang, Won S. Choi, Douglas Ziedonis

Publications and Research

Introduction: Korean women are reluctant to pursue in-person smoking cessation treatment due to stigma attached to women smokers and prefer treatment such as telephone and online smoking cessation programs that they can access secretively at home. However, there is some evidence that face-to-face interaction is the most helpful intervention component for them to quit smoking.

Methods: This study is a pilot clinical trial that examined the acceptability and feasibility of a videoconferencing smoking cessation intervention for Korean American women and compared its preliminary efficacy with a telephone-based intervention. Women of Korean ethnicity were recruited nationwide in the United States and …

Within-Person Associations Between Daily Motivation And Self-Efficacy And Drinking Among Problem Drinkers In Treatment, Jon Morgenstern, Alexis Kuerbis, Jessica Houser, Frederick Muench, Sijing Shao, Hayley Treloar Padovano

Publications and Research

Gaining a better understanding of the change process holds promise to improve alcohol treatment. Ecological momentary assessment (EMA) coupled with intensive longitudinal data (ILD) approaches have been proposed as promising methods that can advance change process research but have been used infrequently in AUD treatment research. The current study used these approaches to examine the within-person associations of motivation and self-efficacy and drinking among treatment seeking problem drinkers. Participants (N=96) received daily EMA surveys before, during, and after treatment for seven weeks spread over a nine month period. Multi-level modeling was used to test the within-person relationships between the change …

Hot And Cold Executive Functions In Pure Opioid Users Undergoing Methadone Maintenance Treatment: Effects Of Methadone Dose, Treatment Duration, And Time Between Last Methadone Administration And Testing, Usha Barahmand, E. Tavakolian, A. Khazaee, K. Mohammadi

Publications and Research

Context: Methadone maintenance is a standard treatment for opiate‑dependent individuals. However, deficits in cognitive functioning have been associated with this treatment.

Aim: This study aimed to determine the dose and treatment duration‑related effects of methadone on executive functions.

Setting and Design: Pure male opioid users with no considerable history of other drug abuse, undergoing methadone maintenance treatment (MMT) were recruited from a major government‑run de‑addiction center.

Methods: Hot executive functions including decision‑making and emotion recognition were assessed using the Iowa gambling task and Ekman faces test, whereas cold executive functions including working memory (WM), cognitive flexibility, and response inhibition were …

When Free Is Not For Me: Confronting The Barriers To Use Of Free Quitline Telephone Counseling For Tobacco Dependence, Christine Sheffer, Sharon Brackman, Charnette Lercara, Naomi Cottoms, Mary Olson, Luana Panissidi, Jami Pittman, Helen Stayna

Publications and Research

Remarkable disparities in smoking rates in the United States contribute significantly to socioeconomic and minority health disparities. Access to treatment for tobacco use can help address these disparities, but quitlines, our most ubiquitous treatment resource, reach just 1%–2% of smokers. We used community-based participatory methods to develop a survey instrument to assess barriers to use of the quitline in the Arkansas Mississippi delta. Barriers were quitline specific and barriers to cessation more broadly. Over one-third (34.9%) of respondents (n = 799) did not have access to a telephone that they could use for the quitline. Respondents reported low levels of …

Prenatal Cocaine Exposure Increases Synaptic Localization Of A Neuronal Rasgef, Grasp-1 Via Hyperphosphorylation Of Ampar Anchoring Protein, Grip, Kalindi Bakshi, Mary Kosciuk, Robert G. Nagele, Eitan Friedman, Hoau-Yan Wang

Publications and Research

Prenatal cocaine exposure causes sustained phosphorylation of the synaptic anchoring protein, glutamate receptor interacting protein (GRIP1/2), preventing synaptic targeting of the GluR2/3-containing alpha-amino-3-hydroxy-5-methyl-4- isoxazolepropionic acid-type glutamate receptors (AMPARs; J. Neurosci. 29: 6308–6319, 2009). Because overexpression of GRIP-associated neuronal rasGEF protein (GRASP-1) specifically reduces the synaptic targeting of AMPARs, we hypothesized that prenatal cocaine exposure enhances GRASP-1 synaptic membrane localization leading to hyper-activation of ras family proteins and heightened actin polymerization. Our results show a markedly increased GRIP1-associated GRASP-1 content with approximately 40% reduction in its rasGEF activity in frontal cortices (FCX) of 21-day-old (P21) prenatal cocaineexposed rats. This cocaine effect …

Moderate Alcohol Use And Mortality From Ischaemic Heart Disease: A Prospective Study In Older Chinese People, Mary Schooling, Sun Wenji, Sai Yin Ho, Wai Man Chan, May Ked Tham, Kin Sang Ho, Gabriel M. Leung, Tai Hing Lam

Publications and Research

Abstract
Background: Moderate alcohol use is generally associated with lower ischaemic heart disease (IHD) mortality but it is difficult to ascertain whether this is due to attributes of moderate alcohol users or the properties of alcohol itself. Evidence from populations with different patterns of alcohol use and IHD can provide crucial evidence. We assessed the association of moderate alcohol use with IHD mortality in older Chinese people from Hong Kong.

Methodology
We used Cox regression to determine whether moderate alcohol use was associated with IHD mortality in a prospective, population-based cohort study of all 56167 attendees, aged 65 years or …