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1.  Contingency Management Improves Smoking Cessation Treatment Outcomes among Highly Impulsive Adolescent Smokers Relative to Cognitive Behavioral Therapy 
Addictive behaviors  2014;42:86-90.
Impulsive adolescents have difficulty quitting smoking. We examined if treatments that provide behavioral incentives for abstinence improve treatment outcomes among impulsive adolescent smokers, who have been shown to be highly sensitive to reward.
We ran secondary data analyses on 64 teen smokers (mean age = 16.36 [1.44]; cigarettes/day = 13.97 [6.61]; 53.1% female; 90.6% Caucasian) who completed a four-week smoking cessation trial to determine whether impulsive adolescents differentially benefit from receiving cognitive behavioral therapy (CBT), contingency management (CM), or the combination of the two (CM/CBT). Indices of treatment efficacy included self-report percent days abstinent and end of treatment biochemically-confirmed 7-day point prevalence abstinence (EOT abstinence). We assessed self-reported impulsivity using the Brief Barratt Impulsiveness Scale. We used univariate Generalized Linear Modeling to examine main effects and interactions of impulsivity and treatment condition as predictors of self-reported abstinence, and exact logistic regression to examine EOT abstinence.
CM/CBT and CM were comparably effective in promoting abstinence, so analyses were conducted comparing the efficacy of CBT to treatments with a CM component (i.e., CM and CM/CBT). CBT and deficient self-regulation predicted lower self-reported abstinence rates within the total analytic sample. Treatments containing CM were more effective than CBT in predicting 1) self-reported abstinence among behaviorally impulsive adolescents (% days abstinent: CM 77%; CM/CBT 81%; CBT 30%) and 2) EOT point prevalence abstinence among behaviorally impulsive adolescents and adolescents with significant deficits in self-regulation.
CM-based interventions may improve the low smoking cessation rates previously observed among impulsive adolescent smokers.
PMCID: PMC4285343  PMID: 25462659
adolescent; impulsivity; smoking cessation; cognitive behavioral therapy; contingency management
2.  Parent, Peer, and Executive Function Relationships to Early Adolescent E-Cigarette Use: A Substance Use Pathway? 
Addictive behaviors  2014;42:73-78.
Little is known about influences on e-cigarette use among early adolescents. This study examined influences that have been previously found to be associated with gateway drug use in adolescents: demographic (age, gender, ethnicity, free lunch), social contextual influences of parents and peers, and executive function deficits (EF).
A cross-sectional survey was administered to 410 7th grade students from two diverse school districts in Southern California (M age=12.4 years, 48.3% female, 34.9% on free lunch (low socioeconomic status), 45.1% White, 25.4% Hispanic/Latino, 14.9% Mixed/bi-racial.) Logistic regression analyses examined influences of demographic, parent e-cigarette ownership and peer use, and EF on lifetime e-cigarette, and gateway drug use (cigarette and/or alcohol use).
Lifetime use prevalence was 11.0% for e-cigarettes, 6.8% for cigarettes, and 38.1% for alcohol. Free lunch and age were marginally related to e-cigarette use (p<.10). Parent e-cigarette ownership was associated with use of all substances, while peer use was associated with gateway drug use (p’s<.05-.001). EF deficits were associated with use of all substances five times more likely than others to use e-cigarettes and over twice as likely to use gateway drugs.
E-cigarette and gateway drug use may have common underlying risk factors in early adolescence, including parent and peer modeling of substance use, as well as EF deficits. Future research is needed to examine longitudinal relationships of demographics, parent and peer modeling, and EF deficits to e-cigarette use in larger samples, trajectories of e-cigarette use compared to use of other substances, and the potential of EF skills training programs to prevent e-cigarette use.
PMCID: PMC4292878  PMID: 25462657
E-cigarette; adolescent; substance use; executive function; peer; parent
3.  Drinking Goal Choice and Outcomes in a Web-based Alcohol Intervention: Results from VetChange 
Addictive behaviors  2015;42:63-68.
To describe characteristics of participants who chose moderation and abstinence drinking goals, and to examine post-treatment drinking outcomes based on patterns of goal choice during a Web-based alcohol intervention for returning U.S. Veterans.
We conducted a descriptive secondary analysis of a subsample of 305 of 600 Veterans who participated in a clinical trial of VetChange, an 8-module, cognitive-behavioral intervention. Participants self-selected abstinence or moderation drinking goals, initially at Module 3, and weekly during subsequent modules. Alcohol use and alcohol-related problems were measured using the Alcohol Use Disorders Identification Test (AUDIT), Quick Drink Screen (QDS), and Short Inventory of Problems (SIP-2R).
Initial goal choices were 86.9% moderation and 13.1% abstinence. Approximately 20% of participants from each initial choice changed goals during the intervention; last goal choices were 68.6% moderation and 31.4% abstinence. Participants who initially chose moderation reported higher percent heavy drinking days at baseline; participants who initially chose abstinence were more likely to report recent substance abuse treatment and were older. Post-intervention levels of alcohol use and alcohol-related problems were significantly reduced in all goal-choice patterns (i.e., Moderation Only, Abstinence Only, Moderation to Abstinence, and Abstinence to Moderation; all measures p < 0.05 or less). Baseline drinking severity did not differentially relate to outcomes across goal-choice patterns.
Participants in a Web-based alcohol intervention for returning U.S. Veterans demonstrated improvements in drinking regardless of whether they chose an abstinence or moderation drinking goal, and whether the goal was maintained or changed over the course of the intervention.
PMCID: PMC4390170  PMID: 25671224
Alcohol; Veterans; Web intervention; Internet; Drinking goal; Outcomes
4.  Substance-use coping and self-rated health among US middle-aged and older adults 
Addictive behaviors  2014;42:96-100.
The prevalence of alcohol, drug, and tobacco use among US middle-aged and older adults is increasing. A subset of this population uses substances to cope with stress, but the characteristics of these individuals, and the association between substance-use coping and health outcomes remain unclear. We identified correlates of substance-use coping and measured its association with self-rated health in a community-based sample of adults aged 54–99 in the Health and Retirement Study (HRS). In the 2008 HRS, 1,351 participants reported their frequency of prescription/other drug-, alcohol-, and cigarette-use coping with stress and reported self-rated health (excellent/very good, good, or fair/poor); 1,201 of these participants also reported self-rated health in 2010. One in six participants frequently used substances to cope. The oldest participants were least likely to engage in frequent alcohol-use coping. Those with elevated depressive symptoms were more likely to frequently engage in cigarette- and prescription/other drug-use coping. In multivariable-adjusted analyses, participants who frequently used cigarettes (compared to participants who infrequently used cigarettes) to cope had 2.7 times (95% CI=1.1–6.7) the odds of poor (vs. excellent) self-rated health. Relative to participants who infrequently used prescription/other drugs to cope, participants who frequently used prescription/other drugs to cope had 2.4 times (95% CI=1.1–5.1) the odds of reporting poor self-rated health. The association between prescription/other drug-use coping in 2008 and self-rated health in 2010 was statistically significant (relative OR=3.5, 95% CI=1.7–7.2). Participants engaging in substance-use coping likely have particular demographic and clinical characteristics. Interventions to reduce substance-use coping may prevent adverse health outcomes.
PMCID: PMC4596550  PMID: 25437264
Older adults; self-rated health; substance use; coping
5.  Sexual Assault Related Distress and Drinking: The Influence of Daily Reports of Social Support and Coping Control 
Addictive behaviors  2014;42:108-113.
A history of sexual assault (SA) is often associated with increased distress and heavy drinking. One’s ability to cope with the distress and seek social support has been associated with drinking more generally. However, SA-related distress, drinking, and the extent to which a woman engages in adaptive coping or seeks social support is known to vary day-to-day. The goal of the present investigation was to examine the moderating influence of perceived coping control and social support on the event-level association between SA-related distress and drinking. This study included 133 college women with a history of SA who reported recent heavy drinking. Participants provided daily reports of their SA-related distress, perceived coping control, perceived social support, and alcohol consumption every day for 30-days. Results of generalized estimating equation models suggest that coping control moderated the association between distress and drinking such that those with less perceived coping control drank more as their SA-related distress increased from their average. Although social support did not moderate between distress and drinking, decreases in perceived social support were associated with more drinking on that day. Results suggest that daily deviations in SA-related distress may influence alcohol consumption more than average levels of distress, especially among women with low coping control. Interventions for women with SA histories should help them build coping skills as well as adequate social support in order to reduce drinking.
PMCID: PMC4620925  PMID: 25437266
sexual assault; distress; drinking; coping behavior; social support
6.  Brief Web-Based Intervention for College Students with Comorbid Risky Alcohol Use and Depressed Mood: Does It Work and for Whom? 
Addictive behaviors  2014;0:36-43.
College is a time of increased risk for problematic alcohol use and depressed mood. The comorbidity of these conditions is well documented, but is less well understood, with few interventions designed to prevent or reduce the related consequences. The current study evaluated a web-based personalized intervention for students (N=311) who reported an AUDIT score of 8 or more, a BDI-II score of 14 or more, and reported drinking four (women) or five (men) or more drinks on at least one occasion in the past month. Method: Invited participants were randomly selected from all enrolled undergraduates at a large, public, Pacific Northwestern university. Participants completed a screening and baseline assessment, and those who met study eligibility criteria were randomized to one of four conditions (alcohol only, depressed mood only, integrated, and referral-only control). Follow-up occurred one-month post-intervention. Results: While no main effects for the interventions were found, there were moderation effects, such that students in the alcohol only and integrated conditions who had lower levels of depressed mood or alcohol-related problems at baseline showed greater reductions in alcohol-related problems at follow-up compared to students in the control condition. Implications for interventions are discussed.
PMCID: PMC4272863  PMID: 25462652
depressed mood; alcohol use; college students
7.  On the Invariance of the Stimulant Craving Questionnaire (STCQ) across Cocaine and Methamphetamine Users 
Addictive behaviors  2014;0:144-147.
The rapid rise in the number of methamphetamine users, relative to cocaine users, has brought the number of each to nearly equal levels, making research on similarities and differences across these groups a needed area of exploration. Craving is postulated to play a significant role in relapse for both user types, yet group differences on observed scale scores have been reported without first assessing the prerequisite measurement equivalence (invariance) of the items, which is essential for meaningful group comparisons.
Baseline data from stimulant users in residential treatment (N=301; n=177 cocaine; n=124 methamphetamine) were used to assess the measurement invariance of the 10-item Stimulant Craving Questionnaire (STCQ), which was adapted from a cocaine-specific measure.
The unifactorial STCQ demonstrated measurement invariance across cocaine and methamphetamine users for factor loadings (metric), common residual covariances between item pairs, and item intercepts (scalar), as determined by fit indices (RMSEA<0.05; CFI & TLI>0.95; SRMR<0.10). The latent mean, as well as 5 (out of 10) item means and the overall composite scale score, were significantly greater for methamphetamine users compared to cocaine users.
Results indicate the STCQ is an invariant tool for the assessment of stimulant craving across the two most prevalent user types. Methamphetamine users had significantly higher levels of observed and latent craving than cocaine users, demonstrating a potentially meaningful difference in craving between users of these two stimulants. Future research will determine if treatments and statistical models need to account for craving variations across methamphetamine and cocaine users.
PMCID: PMC4272872  PMID: 25462663
Cocaine; Methamphetamine; Stimulant; Craving; Invariance
8.  Relations between Pain-Related Anxiety, Tobacco Dependence, and Barriers to Quitting among a Community-Based Sample of Daily Smokers 
Addictive behaviors  2014;0:130-135.
There is increasing recognition that complex and potentially bidirectional relations between pain and smoking may be relevant to the maintenance of tobacco addiction. Pain-related anxiety has been identified as a mechanism in the onset and progression of painful disorders, and initial evidence indicates that pain-related anxiety may be associated with essential features of tobacco dependence among smokers with chronic pain. However, there has not been an empirical study of pain-related anxiety in relation to tobacco dependence and self-reported barriers to quitting among a community-based sample of daily smokers. The current sample was comprised of 122 daily smokers who were recruited from the local community to participate in a larger study that included an initial assessment of pain, smoking history, and pain-related anxiety. Approximately 17% of our sample endorsed moderate or severe past-month pain, nearly half met criteria for current anxiety or mood disorder, and about 30% met criteria for a current substance use disorder, exclusive of tobacco dependence. Results indicated that pain-related anxiety was uniquely and positively associated with both tobacco dependence severity scores and self-reported barriers to quitting. These findings lend support to the notion that pain-related anxiety may contribute to the maintenance of tobacco addiction among smokers who experience varying levels of pain severity.
PMCID: PMC4272873  PMID: 25462660
pain; smoking; anxiety; dependence; cessation; tobacco; pain-related anxiety
9.  Mediators of interpersonal violence and drug addiction severity among methamphetamine users in Cape Town, South Africa 
Addictive behaviors  2014;0:167-171.
South Africa has high rates of interpersonal violence and a rapidly growing methamphetamine epidemic. Previous research has linked experiences of interpersonal violence to higher rates of substance use, and identified mental health constructs as potential mediators of this association. The aim of this study was to examine the relationship between interpersonal violence and addiction severity among active methamphetamine users in Cape Town, South Africa, and to explore symptoms of posttraumatic stress disorder (PTSD) and substance use coping as mediators of this relationship. A community sample of 360 methamphetamine users was recruited through respondent driven sampling and surveyed on their experiences of violence, mental health, coping, and drug use and severity. A series of one-way ANOVAs were conducted to examine the relationship of self-reported interpersonal violence with drug addiction severity, and multiple mediation analyses were used to determine if PTSD symptoms and substance use coping mediated this relationship. The majority (87%) of the sample reported experiencing at least one instance of interpersonal violence in their lifetime, and the number of violent experiences was associated with increased drug addiction severity. PTSD and substance use coping were significant mediators of this association. Only the indirect effect of substance use coping remained significant for the female sample when the mediation model was conducted separately for men and women. The findings point to the need for integrated treatments that address drug use and PTSD for methamphetamine users in South Africa and highlight the importance of coping interventions for women.
PMCID: PMC4272886  PMID: 25479528
South Africa; Methamphetamine; Interpersonal Violence; Addiction; PTSD; Coping
10.  Normative Perceptions of Non-medical Stimulant Use: Associations with Actual Use and Hazardous Drinking 
Addictive behaviors  2014;0:51-56.
Approximately 10% of US college students are engaged in non-medical use of prescription stimulants (NMUPS) and that use is linked to concerning health, educational, and societal consequences. Few studies have assessed normative perceptions surrounding NMUPS. Accordingly, we examined self-reported use and normative perceptions for NMUPS and demographic factors that may be associated with them. We also investigated whether higher normative perceptions for NMUPS were related to the most commonly used and abused substance among college students (alcohol).
1106 undergraduates participated in an online survey of normative perceptions of NMUPS and students’ own drinking and stimulant use habits.
Students overestimated NMUPS by other students and those normative estimates were associated with higher NMUPS. Living in a fraternity or sorority was related to higher NMUPS and perceived norms. Finally, higher normative perceptions of NMUPS were associated with higher hazardous drinking.
The large discrepancy between actual use (generally low) and students’ perceptions (generally high), and the relationship of these perceptions to both one’s own use of NMUPS and alcohol suggests that interventions aimed at correcting norms may be useful.
PMCID: PMC4272891  PMID: 25462654
stimulants; non-medical use; prescription drugs; alcohol; normative perceptions; college students
11.  Predictors of relapse among smokers: Transtheoretical effort variables, demographics, and smoking severity 
Addictive behaviors  2014;0:176-179.
The present longitudinal study investigates baseline assessments of static and dynamic variables, including demographic characteristics, smoking severity, and Transtheoretical Model of Behavior Change (TTM) effort variables (Decisional Balance (e.g. Pros and Cons), Situational Temptations, and Processes of Change) of relapse among individuals who were abstinent at 12-months. The study sample (N=521) was derived from an integrated dataset of four population-based smoking cessation interventions. Several key findings included: Participants who were aged 25–44 and 45–64 (OR = .43, p = .01 and OR = .40, p = .01, respectively) compared to being aged 18–24 were less likely to relapse at follow-up. Participants in the control group were more than twice as likely to relapse (OR = 2.17, p = .00) at follow-up compared to participants in the treatment group. Participants who reported higher Habit Strength scores were more likely to relapse (OR = 1.05, p = .02). Participants who had higher scores of Reinforcement Management (OR = 1.05, p = .04) and Self-Reevaluation (OR = 1.08, p = .01) were more likely to relapse Findings add to one assumption that relapsers tend to relapse not solely due to smoking addiction severity, but due to immediate precursor factors such as emotional distress. One approach would be to provide additional expert guidance on how smokers can manage stress effectively when they enroll in treatment at any stage of change.
PMCID: PMC4272892  PMID: 25481450
smoking; relapse; maintenance; stage of change; transtheoretical model; processes of change; pros and cons; self-efficacy; temptations
12.  Prepartying, Drinking Games, and Extreme Drinking among College Students: A Daily-Level Investigation 
Addictive behaviors  2014;0:91-95.
Daily data collected over 14 consecutive days were used to examine whether extreme drinking was more likely on days college students reported prepartying (i.e., drinking before going out) or playing drinking games in a multi-ethnic sample of college seniors (analysis subsample: N=399; 57% women; M age=21.48 years, SD=.40). Multilevel modeling with drinking occasions at Level 1 (1265 drinking days) nested within persons at Level 2 (399 drinkers) were used to predict four extreme drinking behavior outcomes at the daily level: consuming at least 8/10 (women/men) drinks, reaching an estimated blood alcohol concentration (eBAC) of .16% or greater, drinking enough to stumble, and drinking enough to pass out. Prepartying only (29% of drinking days) was more common than playing drinking games only (10%) or engaging in both behaviors on the same day (13%). Odds of extreme drinking were greater among students who frequently engaged in prepartying (ORs: 1.86-2.58) and drinking games (ORs: 1.95-4.16), except prepartying frequency did not predict drinking enough to pass out. On days students prepartied (ORs: 1.58-2.02) and on days they played drinking games (ORs: 1.68-1.78), odds of extreme drinking were elevated, except drinking games did not predict eBAC of .16% or greater. Extreme drinking is attributable to both person-level characteristics (e.g., preparty frequency) and specific drinking behaviors on a given day. Prepartying and drinking games confer elevated risk of extreme drinking and are important targets in alcohol interventions for college seniors.
PMCID: PMC4272894  PMID: 25437263
preparty; drinking games; extreme drinking; college; daily level
13.  Lifetime history of heroin use is associated with greater drug severity among prescription opioid abusers 
Addictive behaviors  2014;0:189-193.
While research suggests primary prescription opioid (PO) abusers may exhibit less severe demographic and drug use characteristics than primary heroin abusers, less is known about whether a lifetime history of heroin use confers greater severity among PO abusers.
In this secondary analysis, we examined demographic and drug use characteristics as a function of lifetime heroin use among 89 PO-dependent adults screened for a trial evaluating the relative efficacy of buprenorphine taper durations. Exploratory analyses also examined contribution of lifetime heroin use to treatment response among a subset of participants who received a uniform set of study procedures.
Baseline characteristics were compared between participants reporting lifetime heroin use ≥5 (H+; n=41) vs. <5 (H−; n=48) times. Treatment response (i.e., illicit opioid abstinence and treatment retention at end of study) was examined in the subset of H+ and H− participants randomized to receive the 4-week taper condition (N=22).
H+ participants were significantly older and more likely to be male. They reported longer durations of illicit opioid use, greater alcohol-related problems, more past-month cocaine use, greater lifetime IV drug use, and greater lifetime use of cigarettes, amphetamines and hallucinogens. H+ participants also had lower scores on the Positive Symptom Distress and Depression subscales of the Brief Symptom Inventory. Finally, there was a trend toward poorer treatment outcomes among H+ participants.
A lifetime history of heroin use may be associated with elevated drug severity and unique treatment needs among treatment-seeking PO abusers.
PMCID: PMC4272898  PMID: 25481453
Opioid; prescription opioid; heroin; abuse; dependence
14.  Smoking Cessation Abstinence Goal in Treatment-Seeking Smokers 
Addictive behaviors  2014;0:148-153.
Baseline abstinence goal is a robust predictor of cigarette abstinence. However, important questions about goal remain unanswered. These include variables correlating with goal, changes in goal, the relationship of goal and abstinence status over time, and predictors of change. The current study aimed to address these questions.
Participants were treatment-seeking volunteers in two clinical trials. In Clinical Trial 1 (N=402), participants smoked ≥10 cigarettes per day (CPD) and were ≥50 years of age. In Clinical Trial 2 (N=406), participants smoked ≥10 CPD, smoked within 30 minutes of arising, and were ≥18 years of age.
The outcome variables were biochemically verified 7-day abstinence from cigarettes at weeks 12, 24, 52, and 104. Abstinence goal, demographic, psychological, and smoking related variables were assessed via standard instruments.
At baseline, the greater the desire to quit and one’s expectations of success, and the lesser the educational level, the more likely participants were to have a quit forever goal. Throughout the two-year study, abstinence from cigarettes and a lower educational level were correlated with a goal of quit forever; 37% of participants changed goal. There were no predictors of goal change. Abstinence goal was related to abstinence status across the study period. Goal predicted abstinence status at subsequent assessments, even when status was controlled.
Lesser educational levels were consistent predictors of a more stringent goal. Abstinence goal changes over time. These findings suggest that repeated counseling about goal is advisable and participants would benefit from such counseling, independent of demographic characteristics and smoking status.
PMCID: PMC4273741  PMID: 25462664
tobacco; smoking cessation; abstinence goal
15.  Effects of alcohol intoxication and autonomic arousal on delay discounting and risky sex in young adult heterosexual men 
Addictive behaviors  2014;42:9-13.
The relationship between alcohol use and risky sexual behavior is complex and depends on psychological and environmental factors. The alcohol myopia model predicts that, due to alcohol’s impact on attention, the behavior of intoxicated individuals will become increasingly directed by salient cues. Autonomic arousal (AA) may have a similar effect on attention. Experiential delay discounting (DD) may be increased by both alcohol consumption and AA due to their common effects and may mediate the relationship between these conditions and risky sex.
This study employed a 3 (alcohol, placebo, control) x 2 (high, low arousal) experimental design to examine the effects of acute alcohol intoxication and AA on experiential delay discounting, subjective sexual arousal, and risky sex.
Path models revealed complex results that only partially supported study hypotheses. Ratings of subjective sexual arousal did not differ across either beverage or arousal conditions. DD was also unrelated to any study variable. However, subjective sexual arousal was positively related to risky sexual intentions. Alcohol intoxication was also positively associated with increased unprotected sex intentions, consistent with past studies.
These results affirm the role of subjective sexual arousal and alcohol intoxication in risky sexual decision-making, yielding effect sizes similar to comparable past studies. Lack of differences across autonomic arousal groups also suggests effects of attentional myopia may be behavior-specific. Failure to replicate effects of alcohol intoxication on DD also suggests reservation regarding its involvement in alcohol-involved risky sex.
PMCID: PMC4358774  PMID: 25462647
Alcohol; condoms; drinking behavior; sexual behavior; unsafe sex
16.  The Association Between Impulsivity and Alcohol/Drug Use Among Prison Inmates 
Addictive behaviors  2014;42:140-143.
Few studies have examined the relation between impulsivity and drug involvement with prison inmates, in spite of their heavy drug use. Among this small body of work, most studies look at clinically relevant drug dependence, rather than drug use specifically.
N=242 adult inmates (34.8% female, 52% White) with an average age of 35.58(SD=9.19) completed a modified version of the 15-item Barratt Impulsivity Scale (BIS) and measures assessing lifetime alcohol, opiates, benzodiazepines, cocaine, cannabis, hallucinogens, and polysubstance use. Lifetime users also reported the frequency of use for the 30 days prior to incarceration.
Impulsivity was higher among lifetime users (versus never users) of all substances other than cannabis. Thirty day drug use frequency was only related to impulsivity for opiates and alcohol.
This study extends prior work, by showing that a lifetime history of nonclinical substance use is positively associated with impulsivity among prison inmates. Implications for drug interventions are considered for this population, which is characterized by high rates of substance use and elevated impulsivity.
PMCID: PMC4369910  PMID: 25462662
impulsivity; alcohol; drugs; prison; inmates; substance use
17.  The effects of Brief Strategic Family Therapy (BSFT) on parent substance use and the association between parent and adolescent substance use 
Addictive behaviors  2014;42:44-50.
The effects of family therapy for adolescent substance use on parent substance use have not been explored.
To determine the effects of Brief Strategic Family Therapy® (BSFT®) on parent substance use, and the relationship between parent substance use and adolescent substance use.
480 adolescents and parents were randomized to BSFT or Treatment as Usual (TAU) across eight outpatient treatment programs.
Parent substance use was assessed at baseline and at 12 months post-randomization. Adolescent substance use was assessed at baseline and monthly for 12 months post-randomization. Family functioning was assessed at baseline, 4, 8, and 12 months post-randomization
Parents in BSFT significantly decreased their alcohol use as measured by the ASI composite score from baseline to 12 months (χ2(1) = 4.46, p = .04). Change in family functioning mediated the relationship between Treatment Condition and change in parent alcohol use. Children of parents who reported drug use at baseline had three times as many days of reported substance use at baseline compared with children of parents who did not use or only used alcohol (χ2(2) = 7.58, p = .02). Adolescents in BSFT had a significantly lower trajectory of substance use than those in TAU (β = −7.82, p< .001) if their parents used drugs at baseline.
BSFT is effective in reducing alcohol use in parents, and in reducing adolescents’ substance use in families where parents were using drugs at baseline. BSFT may also decrease alcohol use among parents by improving family functioning.
PMCID: PMC4370509  PMID: 25462653
parent substance use; adolescent substance use; family therapy; effectiveness research
18.  Gender Differences in Affective Response to Acute Nicotine Administration and Deprivation 
Addictive behaviors  2006;32(3):543-561.
Men and women may differ in their sensitivity to the mood-modulating properties of nicotine. Male and female adult smokers were exposed to four sessions crossing two nicotine deprivation conditions (12-hr deprived vs. nondeprived) with two drug conditions (nicotine vs. placebo nasal spray). Acoustic probes elicited startle eyeblink responses while viewing affective and cigarette-related slides. In-session mood ratings were collected to gauge self-reported negative affect, positive affect, and craving. Nicotine nasal spray reduced startle amplitude in both men and women following 12-hr deprivation compared with smoking nondeprivation. During nondeprivation, nicotine nasal spray increased startle amplitude in women compared with placebo spray, whereas no difference was found for men. The startle results suggest that both men and women are responsive to the hedonic properties of nicotine.
PMCID: PMC4760691  PMID: 16842931
nicotine; gender differences; startle; affect; smoking deprivation
19.  Hospitalized Smokers’ Expectancies for Electronic Cigarettes versus Tobacco Cigarettes 
Addictive behaviors  2014;41:106-111.
To compare hospitalized smokers’ expectancies for electronic cigarettes (e-cigarettes) against their expectancies for tobacco cigarettes and evaluate relationships between e-cigarette expectancies and intention to use e-cigarettes.
Analysis of baseline data from a one-year longitudinal observational study. The setting was a tertiary care academic center hospital in the Southeastern U.S. Participants were 958 hospitalized tobacco cigarette smokers. A questionnaire of e-cigarette expectancies based on the Brief Smoking Consequences Questionnaire-Adult (BSCQ-A) was developed and administered along with the original, tobacco-specific, BSCQ-A. Intention to use e-cigarettes was assessed with a single 10-point Likert scale item.
Participants reported significantly weaker expectancies for e-cigarettes relative to tobacco cigarettes on all 10 BSCQ-A scales. Participants held sizably weaker expectancies for the health risks of e-cigarettes (p < .001, Cohen's d = −2.07) as well as the ability of e-cigarettes to relieve negative affect (p < .001, Cohen's d = −1.01), satisfy the desire for nicotine (p < .001, Cohen's d = −.83), and taste pleasant (p < .001, Cohen's d = −.73). Among the strongest predictors of intention to use e-cigarettes were greater expectancies that e-cigarettes taste pleasant (p < .001, adjusted β = .34), relieve negative affect (p < .001, adjusted β = .32), and satisfy the desire for nicotine (p < .001, adjusted β = .31).
Hospitalizedtobacco smokers expect fewer negative and positive outcomes from e-cigarettes versus tobacco cigarettes. This suggests that e-cigarettes might be viable though imperfect substitutes for tobacco cigarettes.
PMCID: PMC4751041  PMID: 25452052
Electronic cigarettes; E-cigarettes; Expectancies; Smoking; Hospitalized smokers
20.  Veterans’ Attitudes toward Work and Disability Compensation: Associations with Substance Abuse 
Addictive behaviors  2013;39(2):445-448.
Veterans deemed disabled for conditions resulting from, or aggravated by, their service in the military are eligible for service-connected disability payments. Despite many positive effects of disability payments, one concern is that Veterans with psychiatric conditions who receive disability payments are less likely to be employed compared to those who are denied benefits. Little is known about the attitudes of substance using Veterans, for whom work is a particularly important part of recovery, toward work and disability compensation.
This study compared the responses of Veterans with (n=33) and without substance use problems (n=51) to questions about work's significance and its relationship to disability payments. T- and chi-square tests were conducted to determine if Veterans with substance use problems differed from the others on work-related attitudes and perceptions of the relation between work and Veterans' benefits.
Veterans endorsed high levels of agreement with statements that working would lead to loss of benefits. Veterans with substance use agreed more strongly that they would rather turn down a job offer than lose financial benefits.
The greater preference for disability payments among substance-using Veterans may reflect a realistic concern that they are particularly likely to have difficulty maintaining employment. The widespread concern among Veterans that work will lead to loss of VA disability payments is striking given the ambiguity about how likely loss of benefits actually is, and should be addressed during the service-connection application process.
PMCID: PMC4744469  PMID: 24090622
Service-Connected Disability; Substance Use; Substance Abuse; Veterans; Employment; VA Disability; Benefits; Work; Military; Service-Connection; Psychiatric Disability
21.  Reactivity to nicotine cues over repeated cue reactivity sessions 
Addictive behaviors  2007;32(12):2888-2899.
The present study investigated whether reactivity to nicotine-related cues would attenuate across four experimental sessions held one week apart. Participants were nineteen non-treatment seeking, nicotine-dependent males. Cue reactivity sessions were performed in an outpatient research center using in vivo cues consisting of standardized smoking-related paraphernalia (e.g., cigarettes) and neutral comparison paraphernalia (e.g., pencils). Craving ratings were collected before and after both cue presentations while physiological measures (heart rate, skin conductance) were collected before and during the cue presentations. Although craving levels decreased across sessions, smoking-related cues consistently evoked significantly greater increases in craving relative to neutral cues over all four experimental sessions. Skin conductance was higher in response to smoking cues, though this effect was not as robust as that observed for craving. Results suggest that, under the described experimental parameters, craving can be reliably elicited over repeated cue reactivity sessions.
PMCID: PMC4737433  PMID: 17537583
Cue reactivity; nicotine; repeated sessions
22.  Nicotine-Dependence-Varying Effects of Smoking Events on Momentary Mood Changes among Adolescents 
Addictive behaviors  2014;41:65-71.
Theories of nicotine addiction emphasize the initial role of positive reinforcement in the development of regular smoking behavior, and the role of negative reinforcement at later stages. These theories are tested here by examining the effects of amount smoked per smoking event on smoking-related mood changes, and how nicotine dependence (ND) moderates this effect. The current study examines these questions within a sample of light adolescent smokers drawn from the metropolitan Chicago area (N=151, 55.6% female, mean 17.7 years).
Ecological momentary assessment data were collected via handheld computers, and additional variables were drawn from a traditional questionnaire.
Effects of the amount smoked per event on changes in positive affect (PA) and negative affect (NA) after vs. before smoking were examined, while controlling for subject-averaged amount smoked, age, gender, and day of week. ND-varying effects were examined using varying effect models to elucidate their change across levels of ND.
The effect of the amount smoked per event was significantly associated with an increase in PA among adolescents with low-to-moderate levels of ND, and was not significant at high ND. Conversely, the effect of the amount smoked was significantly associated with a decrease in NA only for adolescents with low levels of ND,
These findings support that the role of positive reinforcement in early stages of dependent smoking, but do not support the role of negative reinforcement beyond early stages of smoking. Other potential contributing factors to the relationship between smoking behavior and PA/NA change are discussed.
PMCID: PMC4252301  PMID: 25306388
adolescents; nicotine dependence; smoking; varying-coefficient model
23.  Causal Pathways Between Impulsiveness, Cocaine Use Consequences, and Depression 
Addictive behaviors  2014;41:1-6.
The present study examined whether lifetime cocaine use consequences mediate the relationship between trait impulsiveness and current depression symptoms among regular cocaine users.
Regular cocaine users (N = 108) were assessed using: Barratt Impulsiveness Scale subscales (non-planning, attentional, motor sub-scales) to measure trait impulsiveness; a standardized Drug History and Use Questionnaire to measure cocaine use and related consequences; and Beck Depression Inventory to measure current depression symptoms.
All impulsiveness subscales were positively associated with an earlier age of first cocaine use, a higher degree of current depression symptoms and a greater number of lifetime cocaine use consequences. In three separate simple mediation tests, lifetime cocaine use consequences partially mediated the relationship between each of the impulsiveness subscales (non-planning: R2 = .42; attentional: R2 = .40; motor: R2 = .24) and current depression symptoms. Separate moderated mediation analyses failed to demonstrate an interaction between lifetime cocaine use and cocaine-related consequences predicting depression symptoms for the mediation models.
Cocaine-related consequences function in a more nuanced manner than just an outcome of impulsiveness or cocaine use, but as a pathway between trait impulsiveness and current depression symptoms.
PMCID: PMC4252393  PMID: 25280245
cocaine; impulsiveness; depression; cocaine use consequences; pathways
24.  Influences of behavior and academic problems at school entry on marijuana use transitions during adolescence in an African American sample 
Addictive behaviors  2014;41:51-57.
The aim of this study was to examine how patterns of academic and behavior problems in first grade relate to longitudinal transitions in marijuana use from middle school through entry into high school among African Americans.
Latent class and latent transition analyses were conducted on a community sample of 458 low-income, urban-dwelling African-Americans.
Two behavior problem classes emerged at school entry; externalizing and attention/concentration. Academic problems co-occurred with both problem behavior classes although more strongly with attention/concentration. Youth in the attention/ concentration problem class were more likely to transition from no marijuana involvement to use and problems beginning in 7th grade and to use and problems given the opportunity to use marijuana early in high school compared to youth with no problems. Youth in the externalizing behavior problem class were significantly more likely to transition from no involvement to having a marijuana opportunity during the transition to high school compared to youth in the attention/concentration problems class.
These findings highlight the importance of developing prevention programs and providing school services that address the co-occurrence of academic and behavior problems, as well as their subtype specific risks for marijuana involvement, particularly for low-income minority youth who may be entering school less ready than their non-minority peers. These findings also provide evidence for a need to continue to deliver interventions in middle and high school focused on factors that may protect youth during these critical transition periods when they may be especially vulnerable to opportunities to use marijuana based on their academic and behavioral risk profile.
PMCID: PMC4252502  PMID: 25305658
academic difficulties; African-American; behavior problems; latent class analysis; latent transition analysis; marijuana
25.  Opioid withdrawal, craving, and use during and after outpatient buprenorphine stabilization and taper: A discrete survival and growth mixture model 
Addictive behaviors  2014;41:20-28.
Most patients relapse to opioids within one month of opioid agonist detoxification, making the antecedents and parallel processes of first use critical for investigation. Craving and withdrawal are often studied in relationship to opioid outcomes, and a novel analytic strategy applied to these two phenomena may indicate targeted intervention strategies. Specifically, this secondary data analysis of the Prescription Opioid Addiction Treatment Study used a discrete-time mixture analysis with time-to-first opioid use (survival) simultaneously predicted by craving and withdrawal growth trajectories. This analysis characterized heterogeneity among prescription opioid-dependent individuals (N=653) into latent classes (i.e., latent class analysis [LCA]) during and after buprenorphine/naloxone stabilization and taper. A 4-latent class solution was selected for overall model fit and clinical parsimony. In order of shortest to longest time-to-first use, the 4 classes were characterized as 1) high craving and withdrawal 2) intermediate craving and withdrawal 3) high initial craving with low craving and withdrawal trajectories and 4) a low initial craving with low craving and withdrawal trajectories. Odds ratio calculations showed statistically significant differences in time-to-first use across classes. Generally, participants with lower baseline levels and greater decreases in craving and withdrawal during stabilization combined with slower craving and withdrawal rebound during buprenorphine taper remained opioid-free longer. This exploratory work expanded on the importance of monitoring craving and withdrawal during buprenorphine induction, stabilization, and taper. Future research may allow individually tailored and timely interventions to be developed to extend time-to-first opioid use.
PMCID: PMC4252696  PMID: 25282598
opioid; relapse; buprenorphine; latent class; craving; withdrawa

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