Substance Abuse and Addiction Commons^™

Assessment Of Simultaneous Alcohol And Cannabis Use And Its Related Consequences And Cognitions In College Students: A Narrative Review, Jennifer L. Shipley, Abby L. Braitman

Psychology Faculty Publications

As rates of students using cannabis continue to rise, simultaneous use of alcohol and cannabis (such that their effects overlap; commonly referred to as simultaneous alcohol and marijuana [SAM] use) is prevalent among college students who use both substances. Although research focusing on SAM use and related cognitions and consequences continues to grow, there are no common established measures, as approaches vary across studies. This narrative review identifies current methods for assessing SAM use and measures of SAM-related consequences and cognitions (motives and expectancies) among college students, evaluates how they were developed, identifies gaps in the literature, and provides recommendations …

Get It In Writing: How To Make Medications For Opioid Use Disorder Available During Incarceration, Margaret J. Mcgladrey, Jordan Kelsch, Michelle R. Lofwall, Laura C. Fanucchi, Sharon L. Walsh, Carrie B. Oser

Center on Drug and Alcohol Research Faculty Publications

In a case example from the Kentucky HEALing Communities Study, extensive resources were deployed to address structural barriers and facilitate the provision of medication for opioid use disorder (OUD) in an urban county jail. However, implementation was unsuccessful, and this case example emphasizes the importance of including evidence-based medication for OUD (MOUD) treatment in the scope of work of jails’ contracted medical providers. The privatization of correctional health care services allows local governments with opioid abatement funds to incorporate requirements into medical provider contracts to screen all people entering jails for OUD and to offer MOUD at intake, throughout incarceration, …

Screening Incarcerated Women For Opioid Use Disorder, Michele Staton, Martha Tillson, Mary M. Levi, Matthew Webster, Carrie B. Oser, Carl Leukefeld

Behavioral Science Faculty Publications

The overall aim of the present study is to examine the utility of the DSM OUD Checklist and the NM-ASSIST screening tools to identify symptoms consistent with OUD among incarcerated women in county jails. This study contributes to the existing literature because research on screening and assessment approaches for incarcerated women has been limited. The focus of the current study is to describe the screening procedures and study recruitment for a larger parent study focused on increasing treatment linkages. Study findings indicate a positive correlation between indicators of OUD using the two screening tools, as well as a high degree …

Extended-Release Injection Vs Sublingual Buprenorphine For Opioid Use Disorder With Fentanyl Use, Edward V. Nunes, Sandra D. Comer, Michelle R. Lofwall, Sharon L. Walsh, Stefan Peterson, Fredrik Tiberg, Peter Hjelmstrom, Natalie R. Budilovsky-Kelley

Behavioral Science Faculty Publications

Importance: Fentanyl has exacerbated the opioid use disorder (OUD) and opioid overdose epidemic. Data on the effectiveness of medications for OUD among patients using fentanyl are limited.

Objective: To assess the effectiveness of sublingual or extended-release injection formulations of buprenorphine for the treatment of OUD among patients with and without fentanyl use.

Design, Setting, and Participants: Post hoc analysis of a 24-week, randomized, double-blind clinical trial conducted at 35 outpatient sites in the US from December 2015 to November 2016 of sublingual buprenorphine-naloxone vs extended-release subcutaneous injection buprenorphine (CAM2038) for patients with OUD subgrouped by presence vs absence of fentanyl …

The Influence Of Flavor On The Abuse Liability Of A Heated Tobacco Product And Its Feasibility As A Menthol Cigarette Substitute, Augustus White

Theses and Dissertations

Heated Tobacco Products (HTPs) purport to expose people that use cigarettes to fewer of the harmful or potentially harmful constituents of tobacco while still delivering reinforcing amounts of nicotine (Auer, Concha-Lozano et al., 2017). An exemplar of the HTP class, IQOS, and its three varieties of “HeatSticks” have been authorized by the Food and Drug Administration (FDA) as “Modified Risk Tobacco Products” (MRTP). However, as the FDA is planning to ban menthol as a characterizing flavor in cigarettes, questions remain regarding whether characterizing flavors should be permitted in HTPs (FDA, 2022e). New evidence regarding HTP abuse liability (i.e., the likelihood …

Reconceptualizing Complex Post-Traumatic Stress Disorder: An Evolutionary Concept Analysis And Clinical Guide, Jessica Livingston

Doctoral Projects

Conflicting models of how trauma manifests into identifiable symptoms have been a source of controversy and perplexity among practicing mental health clinicians and diagnosticians. Complex post-traumatic stress disorder (CPTSD) is now an internationally recognized diagnosis since its inclusion in the 11^th version of the World Health Organization’s (WHO) International Classification of Diseases (ICD-11) in 2018. The American Psychological Association (APA) does not share this recognition of CPTSD as an individual diagnosis and instead opted to update the diagnostic criteria for PTSD to include DSO and a 4^th category of dissociative features rather than include CPTSD as a separate …

Electrophysiological Responses To Emotional And Cocaine Cues Reveal Individual Neuroaffective Profiles In Cocaine Users, Heather E Webber, Constanza De Dios, Margaret C Wardle, Robert Suchting, Charles E Green, Joy M Schmitz, Scott D Lane, Francesco Versace

Faculty, Staff and Student Publications

Smokers with stronger neuroaffective responses to drug-related cues compared to non-drug-related pleasant images (C>P) are more vulnerable to compulsive smoking than individuals with the opposite brain reactivity profile (P>C). However, it is unknown if these neurobehavioral profiles exist in individuals abusing other drugs. We tested whether individuals with cocaine use disorder (CUD) show similar neuroaffective profiles to smokers. We also monitored eye movements to assess attentional bias toward cues and we further performed exploratory analyses on demographics, personality, and drug use between profiles. Participants with CUD (n=43) viewed pleasant, unpleasant, cocaine, and neutral images while we recorded electroencephalogram. …

Adverse Childhood Experiences And Resilience In Medical School Students: A Scope Of Medical Literature, Andrea Soto Abarca, Yvette Cortino, Juan Carlos Lopez Alvarenga, Maya Guevara

Research Symposium

Background: Adverse childhood experiences (ACEs) represent types of childhood trauma that are associated with long-term negative effects on health and wellbeing. An elevated number of ACEs can lead to depression, suicidality, alcoholism, and substance use. Factors that can protect a person from increased health risks include resilience, which is broadly defined as the ability to bounce back from adversity. Few studies have analyzed the exposure of ACEs in medical students, however, there is extensive literature on how low levels of resilience are linked to higher rates of depression, fatigue, and burnout among medical students. Little is known about the …

To Produce Or Not To Produce? Contrasting The Effect Of Substance Abuse In Social Decision-Making Situations, Laurent Avila-Chauvet, Diana Mejía Cruz, Óscar García-Leal, Bruno Kluwe-Schiavon

Faculty, Staff and Student Publications

Substance use disorders (SUD) have been related to high criminal justice costs, expensive healthcare, social impairment, and decision-making deficits. In non-social decision-making tasks, people with SUD tend to take more risks and choose small immediate rewards than controls. However, few studies have explored how people with SUD behave in social decision-making situations where the resources and profits depend directly on participants' real-time interaction, i.e., social foraging situations. To fulfill this gap, we developed a real-time interaction task to (a) compare the proportion of producers (individuals who tend to search for food sources) and scroungers (individuals who tend to steal or …

Effects Of Sex And Estrous Cycle On Intravenous Oxycodone Self-Administration And The Reinstatement Of Oxycodone-Seeking Behavior In Rats, Nicole M. Hinds, Ireneusz D. Wojtas, Corinne A. Gallagher, Claire M. Corbett, Daniel F. Manvich

Rowan-Virtua School of Osteopathic Medicine Departmental Research

The increasing misuse of both prescription and illicit opioids has culminated in a national healthcare crisis in the United States. Oxycodone is among the most widely prescribed and misused opioid pain relievers and has been associated with a high risk for transition to compulsive opioid use. Here, we sought to examine potential sex differences and estrous cycle-dependent effects on the reinforcing efficacy of oxycodone, as well as on stress-induced or cue-induced oxycodone-seeking behavior, using intravenous (IV) oxycodone self-administration and reinstatement procedures. In experiment 1, adult male and female Long-Evans rats were trained to self-administer 0.03 mg/kg/inf oxycodone according to a …

Exenatide As An Adjunct To Nicotine Patch For Smoking Cessation And Prevention Of Postcessation Weight Gain Among Treatment-Seeking Smokers With Pre-Diabetes And/Or Overweight: Study Protocol For A Randomised, Placebo-Controlled Clinical Trial, Luba Yammine, Christopher D Verrico, Francesco Versace, Heather E Webber, Robert Suchting, Michael F Weaver, Thomas R Kosten, Husein Alibhai, Paul M Cinciripini, Scott D Lane, Joy M Schmitz

Faculty, Staff and Student Publications

INTRODUCTION: Obesity and smoking are the two leading causes of preventable death in the USA. Unfortunately, most smokers gain weight after quitting. Postcessation weight gain (PCWG) is frequently cited as one of the primary barriers to a quit attempt and a common cause of relapse. Further, excessive PCWG may contribute to the onset or progression of metabolic conditions, such as hyperglycaemia and obesity. The efficacy of the current treatments for smoking cessation is modest, and these treatments have no clinically meaningful impact on mitigating PCWG. Here, we outline a novel approach using glucagon-like peptide 1 receptor agonists (GLP-1RA), which have …

Effects Of Short-Term Nicotine Deprivation On Delay Discounting Among Young, Experienced, Exclusive Ends Users: An Initial Study, Irene Pericot-Valverde, Jin H Yoon, Kaileigh A Byrne, Moonseong Heo, Jiajing Niu, Alain H Litwin, Diann E Gaalema

Faculty, Staff and Student Publications

Delay discounting describes how rapidly delayed rewards lose value as a function of delay and serves as one measure of impulsive decision-making. Nicotine deprivation among combustible cigarette smokers can increase delay discounting. We aimed to explore changes in discounting following nicotine deprivation among electronic nicotine delivery systems (ENDS) users. Thirty young adults (aged 18-24 years) that exclusively used ENDS participated in two laboratory sessions: one with vaping as usual and another after 16 hr of nicotine deprivation (biochemically assessed). At each session, participants completed a craving measure and three hypothetical delay discounting tasks presenting choices between small, immediate rewards and …

Evidence-Based Practices And Self-Efficacy: A Quantitative Study Of Mental Health Counselors Treating Clients With Substance Use Disorder, Carl Bastien

Dissertations

Substance use disorder affects a substantial number of individuals in the United States. The specific problem of this research is that it was not known to what extent their use of evidence-based practices is driven by their sense of self-efficacy. The purpose of this quantitative correlational research was to examine to what extent the use of evidence-based practices covary with a sense of self-efficacy for mental health counselors treating individuals diagnosed with a substance use disorder. The study population was 121 mental health counselors who specialized in substance use disorder treatment who completed a digital survey. The study findings did …

Anxiety And Agitation In Adult Patients Admitted To An Emergency Room During The Covid-19 Pandemic, Doris L. Asombrado

Dissertations

Purpose: The purpose of this retrospective correlational study was to identify the relationship between COVID-19 status and the prevalence of anxiety-agitation with select sociodemographic and clinical characteristics in adults admitted to the ED during the pandemic (03/01/2020 through 12/31/2020).

Background: COVID-19 infections combined with the WHO and CDC recommendations to mitigate spread have had deleterious psychosocial and economic outcomes with the risk of subsequent COVID-19 related mental illness. Studies indicate one in three adults experience anxiety or depression.

Methods: This retrospective correlational study reviewed 2,572 psychiatric admissions from a Southern California ED during the pandemic from March 1, 2020 through …

Therapeutic Gardening For Addiction Recovery, Hugo A. Rivera Lopez

Master's Projects and Capstones

Problem: The use of evidence-based alternative forms of therapy like horticulture therapy and therapeutic gardening is underutilized in substance use recovery programs in the United States. As the country continues to struggle with addiction, it is important that recovery programs look to and incorporate these alternative therapies into official curricula. Currently, 46.3 million individuals living in the United States are living with a substance use disorder (U.S Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration, 2022).

Context: The intervention was implemented at an all-male substance use treatment facility in San Jose, CA that houses up …

Analysis Of Implementing Best Practices For Co-Prescribing Naloxone In Your Agency Online Cme Training Module Via Pre- And Post- Knowledge Assessment., Alicia Podwojniak, Arvind Venkataraman, Richard Jermyn

Rowan-Virtua Research Day

The opioid epidemic poses substantial risk to society. Providers must ensure that their patients understand the uses and risks of both opioids and naloxone. One way to analyze this concept is via metacognition. This refers to a person’s knowledge about cognitive phenomena, and thus it regulates self-awareness abilities in decision making, such as planning and evaluating. It is not only important for providers to have knowledge on best practices, but also to have self-awareness, and confidence in their decision making to ensure optimal patient outcomes. True-false confidence weighted scoring can be utilized, whereby various levels of confidence are assessed from …

Characterization Of Differential Rearing And Sex On 5-Ht2ar Receptor Activation, Kelsey Lowe

Theses/Capstones/Creative Projects

The prevalence of substance use disorders (SUDs) continues to rise while the number of medications to combat this deadly disorder remains stagnant. Entirely new thinking about what exemplifies a possible therapeutic is needed. Hallucinogens are continually being studied more as possible treatments for many psychological conditions, including SUDs. Classic hallucinogens engage many serotonin and monoamine systems, but the hallucinogenic effects are driven by serotonin 5-HT_2A receptor (5-HT_2AR) activation. Forced social isolation induces chronic stress, increases 5-HT_2AR expression in the cortex and have been suggested to play a role in the comorbidity between stress, maladaptive coping, …

A Retrospective Comparison Of The Effectiveness Of Buprenorphine Versus Baclofen For Acute Opioid Withdrawal, Matthew Hermenau, Benton Stamper, Kitty Leung, Raymond Pomm, Christina Guerrier, Joseph Cammilleri, Brittany Johnson

HCA Healthcare Journal of Medicine

Background

A significant impediment to opioid cessation or dose reduction is mitigating withdrawal severity that has been shown to affect the course of opioid dependence. Current guidelines recommend the use of buprenorphine and methadone over alpha-2 adrenergic agonists. Baclofen, a GABA-B agonist, has promising results as an adjunct agent for opioid withdrawal but has not been compared to buprenorphine. This study compared the ability of buprenorphine and baclofen to mitigate acute opioid withdrawal.

Methods

This was a single-center, retrospective chart review of 63 patients with diagnosed opioid use disorder that received scheduled buprenorphine or baclofen for 3 days, in addition …

Sexual Health And Relationship Abuse Interventions In Pediatric Primary Care: A Systematic Review, Susheel Kant Khetarpal, Sarah Tiffany-Appleton, Erin E Mickievicz, Romina L Barral, Kimberly A Randell, Jeff R Temple, Elizabeth Miller, Maya I Ragavan

Faculty, Staff and Student Publications

PURPOSE: Supporting adolescents in developing healthy relationships and promoting sexual and reproductive health (SRH) is an important responsibility of pediatric primary care providers. Less is known about evidence-based interventions in pediatric settings focused on healthy relationships and SRH.

METHODS: We conducted a systematic review to describe SRH and healthy relationship/adolescent relationship abuse (ARA) interventions for pediatric primary care over the past 20 years. Eligible articles were original research on an SRH-focused or ARA-focused intervention, conducted in-person within pediatric primary care or school-based health centers specifically for middle or high school-aged adolescents. Data abstracted from included articles included intervention description, content, …

Evaluating The Causal Effect Of Tobacco Smoking On White Matter Brain Aging: A Two-Sample Mendelian Randomization Analysis In Uk Biobank, Chen Mo, Jingtao Wang, Zhenyao Ye, Hongjie Ke, Song Liu, Kathryn Hatch, Si Gao, Jessica Magidson, Chixiang Chen, Braxton D Mitchell, Peter Kochunov, L Elliot Hong, Tianzhou Ma, Shuo Chen

Faculty, Staff and Student Publications

BACKGROUND AND AIMS: Tobacco smoking is a risk factor for impaired brain function, but its causal effect on white matter brain aging remains unclear. This study aimed to measure the causal effect of tobacco smoking on white matter brain aging.

DESIGN: Mendelian randomization (MR) analysis using two non-overlapping data sets (with and without neuroimaging data) from UK Biobank (UKB). The group exposed to smoking and control group consisted of current smokers and never smokers, respectively. Our main method was generalized weighted linear regression with other methods also included as sensitivity analysis.

SETTING: United Kingdom.

PARTICIPANTS: The study cohort included 23 …

Childhood-Onset Attention-Deficit/Hyperactivity Disorder Exacerbates Opioid Use Disorder Consequences: Mediation By Impulsive Phenotypes, Liam R. Browning, Ciara Cannoy, Tabitha E. H. Moses, Leslie H. Lundahl Phd, David M. Ledgerwood Phd, Mark K. Greenwald Phd

Medical Student Research Symposium

Background: Attention deficit hyperactivity disorder (ADHD) is highly prevalent and associated with opioid use disorder (OUD). Yet, little is known about the mechanisms by which ADHD (which is a heterogeneous construct/diagnosis) might alter the trajectory of OUD outcomes.

Aim: This cross-sectional study examines relationships between childhood ADHD (inferred as predating substance use) and the extent to which the effects of ADHD on lifetime heroin-use consequences are mediated by foreshortened time perspective and drug-use impulsivity.

Methods: Individuals who report heroin use (N=214) were screened using the Assessment of Hyperactivity and Attention (AHA), Impulsive Relapse Questionnaire (IRQ), Stanford Time Perception Inventory (STPI), …

Naltrexone-Bupropion Combinations Do Not Affect Cocaine Self-Administration In Humans, Sean D. Regnier, William W. Stoops, Joshua A. Lile, Joseph L. Alcorn Iii, B. Levi Bolin, Anna R. Reynolds, Lon R. Hays, Abner O. Rayapati, Craig R. Rush

Behavioral Science Faculty Publications

The FDA has not yet approved a pharmacotherapy for cocaine use disorder despite nearly four decades of research. This study determined the initial efficacy, safety, and tolerability of naltrexone-bupropion combinations as a putative pharmacotherapy for cocaine use disorder.

Thirty-one (31) non-treatment seeking participants with cocaine use disorder completed a mixed-design human laboratory study. Participants were randomly assigned to the naltrexone conditions (i.e., 0, 50 mg/ day; between-subject factor) and maintained on escalating doses of bupropion (i.e., 0, 100, 200, 400 mg/day; within-subject factor) for at least four days prior to the conduct of experimental sessions. Cocaine self-administration (IN, 0, 40, …

Cannabinoid Poisoning-Related Emergency Department Visits And Inpatient Hospitalizations In Kentucky, 2017 To 2019, Stevie C. Britch, Sharon L. Walsh, Rachel Vickers-Smith, Shanna Babalonis, Svetla Slavova

Center on Drug and Alcohol Research Faculty Publications

Background and objectives: Cannabis is the most used federally illicit substance. Due to widespread medicinal use and state-level legalization, public perceptions of cannabis have shifted toward the assumption that cannabis is safe. However, cannabinoids can cause adverse medical complications that may lead people to seek treatment. This study characterized cannabinoid poisoning-related medical encounters, poisoning involving cannabinoids and other psychoactive substances, and cannabinoid poisoning-related cardiac complications. Methods: Administrative billing data for emergency department visits and inpatient hospitalizations in acute care facilities with a discharge date from January 1, 2017 to December 31, 2019 were used to characterize cannabinoid poisoning events in …

Changes In Mental Health As A Predictor Of Cannabis Coping Motives And Consequences: Examining The Impact Of Covid-19 Among College Students, Rebecca Dunaief, Adrian Jorge Bravo, James Henson

Psychology Faculty Publications

Objective: Cannabis use is common among college students and many students use cannabis to cope with negative affect. The COVID-19 pandemic was a particularly stressful time for college students. Subsequently, the present study compared college students who reported increases in anxiety/depression symptoms since COVID-19 stay at home orders to those who reported no change in anxiety/depression symptoms on cannabis coping motives, use frequency, and negative consequences. Specifically, we examined whether self-reported changes (i.e., group that indicated increases) in poor mental health during COVID-19 were associated with problematic cannabis use via higher cannabis coping motives. Method: College students (analytic n = …

Genetic Associations Between Alcohol Phenotypes And Life Satisfaction: A Genomic Structural Equation Modeling Approach, Kaitlin E. Bountress, Shannon E. Cusack, Sage E. Hawn, Andrew Grotzinger, Daniel Bustamante, Robert M. Kirkpatrick, Howard J. Edenberg, Ananda B. Amstadter

Psychology Faculty Publications

Alcohol use (i.e., quantity, frequency) and alcohol use disorder (AUD) are common, associated with adverse outcomes, and genetically-influenced. Genome-wide association studies (GWAS) identified genetic loci associated with both. AUD is positively genetically associated with psychopathology, while alcohol use (e.g., drinks per week) is negatively associated or NS related to psychopathology. We wanted to test if these genetic associations extended to life satisfaction, as there is an interest in understanding the associations between psychopathology-related traits and constructs that are not just the absence of psychopathology, but positive outcomes (e.g., well-being variables). Thus, we used Genomic Structural Equation Modeling (gSEM) to analyze …

Criterion Validity Of Protective Behavioral Strategies For Alcohol Consumption Among College Students, Abby L. Braitman, Amy Stamates, Melissa Colangelo, Sarah J. Ehlke, Jordan Ortman, Kristin E. Heron, Kate B. Carey

Psychology Faculty Publications

Background: Protective behavioral strategies (PBS), or behaviors used to reduce harm associated with alcohol use, are often associated with lower levels of alcohol consumption, lower engagement in high-risk drinking behaviors, and fewer alcohol-related consequences. Although the majority of studies have found significant associations between higher PBS use and lower consumption or consequences, some studies have found nonsignificant or even positive associations. One explanatory hypothesis is that the mixed findings are due to differential content in PBS measures. Objectives: The current study examined the criterion validity of two widely-used PBS measures, the PBSS and the SQ. In a multi-institution online …

Utilizing Outpatient Telehealth As A Treatment Approach For Patients With Substance Use Disorder: A Quality Improvement Project, Veronica Kwegyir-Afful

DNP Scholarly Projects

Background: The issue of substance use disorder (SUD) has demonstrated a growing prevalence both in the United States (U.S.) and globally. Effective treatment modalities have been devised for individuals afflicted by SUD, thereby enabling their post-treatment prognosis to be parallel to that of patients with other chronic diseases, such as diabetes. However, several factors or barriers impede individuals with SUD from assessing treatment. These barriers encompass financial constraints stemming from inadequate insurance coverage and high cost, the stigma surrounding SUD, which results in patient's hesitancy to seek treatment treat, adverse societal attitudes, collateral social percussions like work hour losses and …

Cumulative Risk For Children’S Behavior Problems And Child Abuse Potential Among Mothers Receiving Substance Use Treatment: The Unique Role Of Parenting Stress, Stephanie Gusler, Angela Moreland

Psychiatry Faculty Publications

There is a high prevalence of children whose parents suffer with a substance use disorder (SUD), which is associated with negative outcomes for children such as behavior problems and parents’ child abuse potential. To understand negative consequences for children, it is important to consider a cumulative risk model, examining the impact of multiple co-occurring risks, as well as examine unique singular risk factors, such as parenting stress, which may have a direct effect on outcomes as well as mediate an association between cumulative risk and outcomes. Data came from 99 mothers with SUD, engaged in a substance treatment program. Results …

Cannabidiol And Delta-9-Tetrahydrocannabinol Interactions In Male And Female Rats With Persistent Inflammatory Pain, Stevie C. Britch, Rebecca M. Craft

Behavioral Science Faculty Publications

Cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC), 2 of the primary constituents of cannabis, are used by some individuals to self-treat chronic pain. It is unclear whether the painrelieving effects of CBD alone and in combination with THC are consistent across genders and among types of pain. The present study compared the effects of CBD and THC given alone and in combination in male and female rats with Complete Freund’s adjuvant-induced inflammatory pain. After induction of hindpaw inflammation, vehicle, CBD (0.05−2.5 mg/kg), THC (0.05−2.0 mg/kg), or a CBD: THC combination (3:1, 1:1, or 1:3 dose ratio) was administered i.p. twice daily for …

Binge Drinking In College: A Phenomenological Study, Kristin Andrews

Murray State Theses and Dissertations

This phenomenological research study examined the personal experiences, habits, and perceptions of post-secondary students who binge drink. This study was guided by 3 research questions as well as pre-existing research into collegiate binge drinking. The experiences shared by participants showed that despite serious negative outcomes, students binge drink because they feel negatives are far outweighed by the positive social interactions and fun drinking creates. While all of the participants in this study are considered binge drinkers who abuse alcohol, none of the participants considered their drinking to be problematic. The participants shared their intent to stop their current drinking patters …