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1.  Development of an Evidence-based, Gay-specific Cognitive Behavioral Therapy Intervention for Methamphetamine-abusing Gay and Bisexual Men 
Addictive behaviors  2011;39(8):1286-1291.
This study compared outcomes in methamphetamine use and sexual risk behaviors from a modified gay-specific, cognitive behavioral therapy (GCBT) combined with a low-cost contingency management (CM; [GCBT+CM]) intervention to prior findings from clinical trials of the original GCBT. Effect sizes for primary outcomes were compared using meta analysis. Comparisons of effect sizes at end of treatment showed the modified GCBT+CM produced significantly fewer consecutive weeks of methamphetamine abstinence (−0.44, CI: −0.79, −0.09) and fewer male sexual partners (−0.36, CI: −0.71, −0.02) than the first trial of GCBT, and more days of methamphetamine use (0.35, CI: 0.02, 0.68) than the second trial of GCBT. At 26-week follow-up, the modified GCBT+CM produced greater effects in reducing the number of male sexual partners (−0.54, CI: −0.89, −0.19; −0.51, CI: −0.84, −0.18). The original GCBT produced more and mostly short-term beneficial drug use outcomes, though sexual behavior changes consistently favored the modified GCBT+CM. On balance, most benefits are retained with the modified GCBT+CM intervention.
PMCID: PMC3326187  PMID: 22169619
methamphetamine abuse treatment; gay and bisexual men; sexual risk behavior; cognitive behavioral therapy; contingency management
2.  Laboratory-Induced Cue Reactivity among Individuals with Prescription Opioid Dependence 
Addictive behaviors  2014;39(8):1217-1223.
Prescription opioid (PO) dependence is a critical health problem. Although examination of drug cue reactivity paradigms has advanced the understanding of risk factors for relapse for a variety of substances (e.g., cocaine, alcohol, nicotine), no PO specific drug cue paradigm has been developed. The current study addressed this gap in the literature and evaluated the ability of a newly developed PO drug cue paradigm to elicit subjective, physiological, and neuroendocrine changes among PO-dependent participants (n = 20) as compared to controls (n = 17). The drug cue paradigm included an induction script, viewing and handling paraphernalia (e.g., bottle of oxycontin pills, pill crusher) and watching a video depicting people using POs as well as places related to POs (e.g., pharmacies). Consistent with hypotheses, the PO group demonstrated significant pre- to post-cue increases on subjective ratings of craving, difficulty resisting POs, stress, and anger. The control group did not demonstrate significant changes on any of the subjective measures. Both the PO group and the control group evidenced significant pre- to post-cue increases in physiological responses (e.g., blood pressure, skin conductance), as expected given the arousing nature of the drug cue stimuli. The PO group, but not the control group, evidenced a significant pre- to post-cue increase in heart rate and salivary cortisol levels. The development and validation of a drug cue paradigm for POs may help inform future research and treatment development efforts for patients with PO dependence.
PMCID: PMC4059191  PMID: 24813546
Prescription opioids; opiates; prescription drugs; drug cue reactivity; drug cue paradigm
3.  Attention-Deficit/Hyperactivity Disorder subtypes and substance use and use disorders in NESARC 
Addictive behaviors  2014;39(8):1278-1285.
Attention-deficit /hyperactivity disorder (ADHD) is associated with substance use and substance use disorders (SUD). However, relatively little is known about the relationship between DSM-IV ADHD subtypes and substance use or DSM-IV abuse/dependence in epidemiological samples.
Data were obtained from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC, N=33,588). Respondents reported on ADHD symptoms (DSM-IV) for the period of time when they were 17 years or younger. Lifetime use and DSM-IV abuse/dependence of alcohol, nicotine, cannabis, cocaine, sedatives, stimulants and heroin/opiates were compared across those with ADHD symptoms but no diagnosis (ADHDsx; N=17,009), the Combined (ADHD-C; N=361), Predominantly Inattentive (ADHD-I; N=325), and the Predominantly Hyperactive-Impulsive (ADHD-HI; N=279) ADHD subtypes. Taking a more dimensional approach, inattentive and hyperactive-impulsive symptom counts and their associations with substance use and misuse were also examined.
After adjustments for conduct disorder, major depressive disorder, any anxiety disorder and other socio-demographic covariates, substance use and SUD were associated with ADHDsx, ADHD-C, ADHD-I and ADHD-HI. Overall, substance use and SUD were more weakly associated with the ADHDsx group compared to the three ADHD diagnostic groups. Statistically significant differences were not evident across the three diagnostic groups. Hyperactive-impulsive symptoms were more consistently associated with substance use and SUD compared to inattentive symptoms.
ADHD subtypes are consistently associated with substance use and SUD. The relatively stronger association of hyperactive/impulsive symptoms with substance use and abuse/dependence is consistent with the extant literature noting impulsivity as a precursor of substance use and SUD.
PMCID: PMC4135513  PMID: 24821471
ADHD subtypes; substance use; substance use disorders
4.  Identifying the facets of impulsivity that explain the relation between ADHD symptoms and substance use in a nonclinical sample 
Addictive behaviors  2014;39(8):1272-1277.
Adults with attention-deficit/hyperactivity disorder (ADHD) are at higher risk to use substances than their nonclinical peers. Increased levels of impulsivity are generally thought to contribute to their increased levels of risk. Impulsivity is a multifaceted construct, however, and little research to date has attempted to identify which facets of impulsivity contribute to the increased rates of substance abuse among individuals with ADHD. The current study examined the relation among ADHD symptom clusters (i.e., hyperactivity/impulsivity and inattention), substance use rates (i.e., alcohol use, nicotine use, and marijuana use), and personality processes associated with impulsive behavior in a group of young adults. Participants were 361 undergraduate students. Both symptom clusters were positively associated with rates of substance use. Specifically, hyperactive/impulsive symptoms were associated with alcohol and nicotine use, and inattentive symptoms were associated with alcohol use. Several pathways from hyperactive/impulsive symptoms to alcohol, nicotine, and marijuana use via specific facets of impulsivity were identified. These findings have implications for understanding the relation between ADHD symptoms and substance use, as well as clinical implications for preventing and treating substance use problems in individuals with symptoms of ADHD.
PMCID: PMC4036519  PMID: 24813555
ADHD; impulsivity; alcohol; nicotine; marijuana
5.  The predictive utility of micro indicators of concern about smoking: Findings from the International Tobacco Control 4-country study 
Addictive behaviors  2014;39(8):1235-1242.
This study explored the association between six “micro indicators” of concern about smoking (1. stubbing out cigarettes before finishing; 2. forgoing cigarettes due to packet warning labels; thinking about... 3. the harms to oneself of smoking; 4. the harms to others of one’s smoking; 5. the bad conduct of tobacco companies; and 6. money spent on cigarettes) and cessation outcomes (making quit attempts, and achieving at least six months of sustained abstinence) among adult smokers from Australia, Canada, the United Kingdom, and the United States of America. Participants were 12049 individuals from five survey waves of the International Tobacco Control Four Country Survey (interviewed between 2002 and 2006, and followed-up approximately one year later). Generalized estimating equation logistic regression analysis was used, enabling us to control for within-participant correlations due to possible multiple responses by the same individual over different survey waves. The frequency of micro indicators predicted making quit attempts, with premature stubbing out, forgoing, and thinking about the harms to oneself of smoking being particularly strong predictors. An interaction effect with expressed intention to quit was observed, such that stubbing out and thinking about the harms to oneself predicted quit attempts more strongly among smokers with no expressed plans to quit. In contrast, there was a negative association between some micro indicators and sustained abstinence, with more frequent stubbing out, forgoing, and thinking about money spent on cigarettes associated with a reduced likelihood of subsequently achieving sustained abstinence. In countries with long-established tobacco control programs, micro indicators index both high motivation by smokers to do something about their smoking at least partly independent of espoused intention and, especially those indicators not part of a direct pathway to quitting, reduced capacity to quit successfully.
PMCID: PMC4043837  PMID: 24813549
tobacco; prospective study; smoking cessation; relapse; maintenance
6.  Treatment Models for Targeting Tobacco Use During Treatment for Cannabis Use Disorder: Case Series 
Addictive behaviors  2014;39(8):1224-1230.
Approximately 50% of individuals seeking treatment for cannabis use disorders (CUD) also smoke tobacco, and tobacco smoking is a predictor of poor outcomes for those in treatment for CUD. Quitting tobacco is associated with long-term abstinence from alcohol and illicit drugs, yet there are no established treatments for CUD that also target tobacco smoking. This report highlights issues related to cannabis and tobacco co-use and discusses potential treatment approaches targeting both substances. Data is shared from the first six participants enrolled in an intervention designed to simultaneously target tobacco use in individuals seeking treatment for CUD. The twelve-week program comprised computer-assisted delivery of Motivational Enhancement Therapy, Cognitive-Behavioral Therapy, and Contingency Management, i.e., abstinence-based incentives for CUD. In addition, participants were encouraged to complete an optional tobacco intervention consisting of nicotine-replacement therapy and computer-assisted delivery of a behavioral treatment tailored for tobacco and cannabis users. All participants completed the cannabis intervention and at least a portion of the tobacco intervention: all completed at least one tobacco computer module (mean = 2.5 modules) and 50% initiated nicotine replacement therapy. Five of six participants achieved abstinence from cannabis. The number of tobacco quit attempts was lower than expected, however all participants attempted to reduce tobacco use during treatment. Simultaneously targeting tobacco during treatment for CUD did not negatively impact cannabis outcomes. Participation in the tobacco intervention was high, but cessation outcomes were poor suggesting that alternative strategies might be needed to more effectively prompt quit attempts and enhance quit rates.
PMCID: PMC4066896  PMID: 24813547
Tobacco; Cannabis; Dependence; Co-Use; Behavior; Treatment
7.  The Mediating Role of Depression in the Relationship between Anxiety Sensitivity and Alcohol Dependence 
Addictive behaviors  2014;39(8):1243-1248.
Many studies have reported that Anxiety Sensitivity (AS) is positively associated with alcohol use or other alcohol-related variables. More recent mediator and moderator models have shown promise in elucidating mechanisms within this relationship; the literature to date suggests that the relationship between AS and alcohol is likely mediated by problematic coping motives. However, few studies have considered the effects of depression within the AS – alcohol use relationship, despite a strong body of evidence linking AS to subsequent depression and depression to subsequent alcohol use problems, independently. Therefore, the current study assessed depression as a potential mediator of this relationship.
Participants were 418 sequential admissions to a substance abuse treatment facility. A mediation analysis using bootstrapping was utilized in order to estimate indirect effects of AS on alcohol dependence through depression.
Results reveal an indirect effect suggesting that the effects of anxiety sensitivity on alcohol dependence are mediated by symptoms of depression. More specifically, the effects of AS total score and AS somatic sensations on alcohol dependence were mediated by symptoms of depression. Lastly, a dual mediator model demonstrated that both depression and problematic coping uniquely mediate the relationship between AS and alcohol dependence.
While preliminary in nature, the current study provides evidence supporting the hypothesis that depression is an important factor to consider when examining the relationship between AS and alcohol dependence.
PMCID: PMC4071347  PMID: 24813550
8.  Factors related to Psychosocial Barriers to Drug Treatment among Chinese Drug Users 
Addictive behaviors  2014;39(8):1265-1271.
Although substance abuse treatment has been considerably scaled up in China, impediments to accessing these services remain among drug users. The authors examine the primary psychosocial barriers to drug treatment in this population and evaluate factors associated with these barriers. Barriers to accessing drug treatment were measured using the Barriers to Treatment Inventory (BTI). A Structural Equation Model was used to examine whether the internal barriers were associated with treatment history and frequent methamphetamine use as well as how demographic characteristics influence such barriers. We found four primary factors of internal barriers to drug treatment – absence of problem, negative social support, fear of treatment, and privacy concerns – to fit well. Demographic factors, notably age and employment status, indirectly influence barriers to treatment via other factors. Frequency of methamphetamine use and drug treatment history are directly associated with the absence of problem and negative social support dimensions of the BTI, and it is through these pathways that demographic factors such as age and employment status shape barriers to treatment. The findings indicate that perceived absence of a problem and negative social support are the barriers most influenced by the personal domains of Chinese drug users’ lives. Efforts to engage drug users in China about drug treatment options may consider how these barriers are differentially perceived in order to effectively reach this population.
PMCID: PMC4075974  PMID: 24813554
drug treatment; barriers; China
9.  PTSD Symptomatology and Readiness to Quit Smoking among Women with Serious Mental Illness 
Addictive behaviors  2014;39(8):1231-1234.
Posttraumatic stress disorder (PTSD) is a risk factor for tobacco addiction. The majority of research on PTSD and smoking has been conducted with men, particularly combat veterans, and little is known about the association among women. In a clinical sample of women civilian smokers with serious mental illness (SMI), we examined the prevalence of PTSD symptomatology and associations with physical and mental health functioning, co-occurring substance use, nicotine dependence, and readiness to quit smoking.
376 adult women smokers aged 18–73 were recruited from 7 acute inpatient psychiatry units and screened by diagnostic interview for current PTSD symptomatology (PTSD+). In multiple regressions, we examined the associations of screening PTSD+ with physical and mental health functioning; past-month drug use; past-year substance use disorders; nicotine dependence and readiness to quit smoking.
Nearly half the sample (43%) screened PTSD+, which was significantly associated with use of stimulants (OR = 1.26) and opiates (OR = 1.98), drug use disorders (OR = 2.01), and poorer mental health (B = −2.78) but not physical health functioning. PTSD+ status was unrelated to nicotine dependence, but predicted greater desire to quit smoking (B = 2.13) and intention to stop smoking in the next month (OR = 2.21). In multivariate models that adjusted for substance use disorders, physical and mental health functioning, and nicotine dependence, screening PTSD+ remained predictive of greater desire and intention to quit smoking.
PTSD symptomatology was common in our sample of women smokers with SMI and associated with worse substance use and mental health, but also greater readiness to quit smoking, suggesting the need for and potential interest in integrative PTSD-addiction treatment among women.
PMCID: PMC4211597  PMID: 24813548
PTSD; women; mental illness; smoking; substance use; stage of change
10.  The Relation between Interpersonal Violence and Substance Use among a Sample of University Students: Examination of the Role of Victim and Perpetrator Substance Use 
Addictive behaviors  2008;34(3):316-318.
To examine the relation between interpersonal violence and substance use and to describe the role of victim and perpetrator substance use within such incidents among university students.
A random sample of students (N=1197) participating in this cross-sectional study completed an online survey. Logistic regression models assessed the relation between substance use and sexual and physical victimization. Victim and perpetrator substance use at the time of incident were described.
Females were more likely to report sexual violence compared to males, whereas males were more likely to report physical victimization (p’s<0.05). In logistic regression models, all forms of substance use were significantly associated with physical victimization among males (OR’s=2.0–5.1). Among females, most forms of substance use were associated with sexual victimization (OR’s=2.4–4.7). Both males and females reported high rates of perpetrator and own substance use during victimization incidents.
Findings suggest that previous documentation among victimization studies of a relation between substance use and subsequent risk for victimization may also be attributable to the substance use behavior of the perpetrator.
PMCID: PMC4497789  PMID: 19028021
substance use; college students; violence perpetration; interpersonal violence
Addictive behaviors  1993;18(6):659-670.
Two motives for alcohol consumption have been emphasized in the etiological and the reasons-for-drinking literature: (a) people drink alcohol to cope with stress, and (b) people drink alcohol because of social influences. There is support for both of these hypotheses, but the results are usually modest and most authors agree that more complex theories of alcohol consumption are needed. This study examined the interactional effects of reasons for drinking alcohol and situational factors on alcohol consumption. Standardized telephone interviews were conducted with 781 randomly selected Michigan drinkers. Hierarchical multiple regression analyses indicated that gender, friends’ alcohol consumption, coping, and social motives for drinking were significant predictors of study participants’ alcohol consumption. As predicted, there was a significant interaction between drinking to cope with stress and perceived stress, and there was also a significant interaction between drinking for social reasons and friends’ alcohol consumption. Similarities and differences in the results for women, men, Blacks, and Whites are described.
PMCID: PMC4493891  PMID: 8178704
12.  Children’s Exposure to Parental Conflict after Father’s Treatment for Alcoholism 
Addictive behaviors  2014;39(7):1168-1171.
This study investigated children of alcoholics’ (COAs’) exposure to inter-parental conflict before and after their fathers received alcohol treatment and compared exposure levels to a community comparison sample.
This study included 67 couples with a treatment-seeking male alcoholic partner and children aged 4–16. The alcoholic fathers and their relationship partners provided data at baseline and at six and twelve months follow-up. A community comparison sample of 78 couples with children in the target age range completed similar longitudinal assessments. It was hypothesized that treatment of paternal alcoholism would be associated with a decrease in COAs’ exposure to conflict, and that among remitted patients exposure to conflict would decrease to the level found in the community sample.
Prior to the father’s alcohol treatment, the children of the treatment sample were exposed to significantly more conflict between their parents than in the community comparison sample. After the fathers received alcohol treatment, COAs’ exposure to conflict significantly decreased at both the six and twelve month follow-ups compared to baseline. Children of remitted alcoholics did not differ significantly in levels of exposure to conflict at six months follow-up compared with the community sample as predicted. However, at twelve months remitted alcoholics reported significantly more exposure to conflict compared to the community sample.
Decreased child exposure to parental conflict is a benefit associated with the father’s treatment for alcoholism, and it may lead to improvements in COAs’ functioning after parental treatment.
PMCID: PMC4019326  PMID: 24727114
Children of alcoholics (COA); parental conflict
13.  Do Ethnicity and Gender Moderate the Influence of Posttraumatic Stress Disorder on Time to Smoking Lapse? 
Addictive behaviors  2014;39(7):1163-1167.
Following a smoking cessation attempt, smokers with posttraumatic stress disorder (PTSD) experience smoking relapse at a higher and faster rate. Black ethnicity and female gender are also associated with lower success rates following smoking cessation. No study to date has prospectively examined how ethnicity and gender may moderate the effect of PTSD on smoking relapse. It was hypothesized that female gender and Black ethnicity would significantly predict early lapse after quitting; further, it was predicted that ethnicity and gender would moderate the effect of PTSD on relapse rate. Smokers with PTSD (n = 48) and without PTSD (n = 56) completed ecological momentary assessment (EMA) the week after a quit date, and self-initiated EMA entries after smoking lapse. Smoking abstinence was biologically verified. The sample included Black (62%) and White (38%) participants, and was 50% female. Study hypotheses were tested with Cox proportional hazards regression modeling time to first smoking lapse. Study results confirmed the main hypothesis, with a significant PTSD X Ethnicity interaction emerging. The effect of PTSD on smoking relapse was significant for White participants but not for Black participants. No significant gender moderation was found. Taken together, study results support previous research, and suggest that the relationship between smoking and PTSD is stronger for White smokers than for minorities. This study has significant implications for research in smoking and mental disease, as well as for smoking cessation treatments for Black smokers.
PMCID: PMC4064680  PMID: 24727113
Tobacco control; smoking cessation; ethnic minorities; African Americans; posttraumatic stress disorder = PTSD; health disparities
14.  Sex Differences in Response to Reduced Nicotine Content Cigarettes 
Addictive behaviors  2014;39(7):1197-1204.
When switching from usual brand cigarettes, very low nicotine content (VLNC) cigarettes lead to a reduction in the number of cigarettes smoked, toxicant exposure, withdrawal symptoms and dependence. One area that has been relatively unexplored is what factors might moderate the effects of VLNC cigarettes. This exploratory analysis focuses on sex differences in responses to VLNC cigarettes and nicotine replacement therapy (NRT).
An exploratory secondary analysis of a randomized trial of 235 participants (58% female, mean age 47 years) comparing a) 0.05–0.09 mg nicotine yield cigarettes; b) 21 mg nicotine patch and 3) 0.05–0.09 nicotine yield cigarettes with 21 mg nicotine patch was conducted. We focused on sex differences in product use, and impact of products on withdrawal response from usual brand cigarettes and abstinence by randomized group.
The combination of VLNC cigarettes and nicotine patch was more effective in reducing use of VLNC cigarettes and withdrawal symptoms among males than females, whereas females were equally responsive to VLNC cigarettes with and without the nicotine patch. Females were more likely to quit smoking than males when assigned to either of the conditions that incorporated the VLNC cigarettes; however, males were more likely to quit smoking in the nicotine patch alone condition than females.
Sex of the smoker may be an important determinant for effects of VLNC cigarettes and nicotine patch. Future large randomized trials to confirm these results are needed.
PMCID: PMC4084708  PMID: 24746485
reduced nicotine cigarettes; tobacco addiction; cigarette consumption; sex differences
15.  What are Young Adults Smoking in their Hookahs? A Latent Class Analysis of Substances Smoked 
Addictive behaviors  2014;39(7):1191-1196.
Hookah smoking continues to be a popular form of tobacco use, especially among college students. Although hookahs are commonly used to smoke tobacco, anecdotal evidence suggests other substances, including herbal shisha, marijuana and hashish may be used. However, little is known about the variety of substances smoked in hookahs, or correlates associated with different substances smoked.
In fall 2010, 3,447 students from 8 colleges in N.C. completed an online survey.
44% of students reported ever smoking tobacco from a hookah. Of those ever users, 90% reported smoking flavored tobacco in a hookah, 45% marijuana, 37% herbal (non-tobacco) shisha, and 18% hashish. Latent class analysis revealed two distinct classes. The most prevalent class (77%) primarily smoked flavored tobacco, with minimal use of herbal shisha and marijuana and virtually no use of hashish. The second class (23%) primarily smoked marijuana, hashish and flavored tobacco with moderate use of herbal shisha. Logistic regression analysis adjusting for clustering within-schools revealed that males, illicit drug users, daily, nondaily and former cigarette smokers and those whose mothers had higher levels of education were significantly more likely to be in the second class compared to the first.
Rates of lifetime use of hookah were high in our sample of college students. While the majority of hookah users smoked tobacco in hookahs, they also smoked other substances, notably marijuana and herbal shisha. Prevention efforts should recognize that students are using hookahs to smoke a variety of substances.
PMCID: PMC4091668  PMID: 24746345
hookah; tobacco; college students
16.  Trends in Medical Use, Diversion, and Nonmedical Use of Prescription Medications among College Students from 2003 to 2013: Connecting the Dots 
Addictive behaviors  2014;39(7):1176-1182.
To examine trends in the lifetime and past-year prevalence of medical use, diversion, and nonmedical use of four prescription medication classes (i.e., sedative/anxiety, opioid, sleeping, and stimulant) among college students between 2003 and 2013; and to identify demographic and background characteristics associated with trends in past-year nonmedical use of prescription medications.
A self-administered, cross-sectional Web survey was conducted in 2003, 2005, 2007, 2009, 2011, and 2013 at a large public four-year university in the Midwest United States.
Approximately one in every five individuals reported nonmedical use of at least one prescription medication class in their lifetime. The past-year prevalence of medical use, diversion and nonmedical use of prescription stimulants increased significantly between 2003 and 2013 while the past-year prevalence of medical use, diversion and nonmedical use of prescription opioids decreased significantly over this same time period. The odds of past-year nonmedical use of each prescription medication class were generally greater among males, Whites, members of social fraternities and sororities, and those with a lifetime history of medical use of prescription medications or a past-year history of being approached to divert their prescription medications.
The present study represents the first investigation to demonstrate that trends in medical use of controlled medications parallel changes in diversion and nonmedical use of the same medication class among college students. The findings reinforce the importance of continued monitoring of prescription medication use at colleges to help guide prevention and intervention efforts.
PMCID: PMC4349373  PMID: 24727278
Trend; Prescription Medication; College students; Anxiolytic; Opioid; Sleeping; Stimulant; Nonmedical use; Substance abuse; Diversion; Epidemiology
17.  Time perspective as a determinant of smoking cessation in four countries: Direct and mediated effects from the International Tobacco Control (ITC) 4-Country Surveys 
Addictive behaviors  2014;39(7):1183-1190.
Future oriented time perspective predicts a number of important health behaviors and outcomes, including smoking cessation. However, it is not known how future orientation exerts its effects on such outcomes, and no large scale cross-national studies have examined the question prospectively. The aim of the current investigation was to examine the relationship between time perspective and success in smoking cessation, and social cognitive mediators of the association.
The ITC-4 is a multi-wave, four country survey (Australia, Canada, United States, United Kingdom) of current smokers (N=9,772); the survey includes baseline measurements of time perspective, intentions, quit attempts, and self-reported quit status at follow-up over 8 years. We examined the predictive power of time perspective for smoking cessation, as mediated through strength of quit intentions and prior history of quit attempts.
Findings indicated that those smokers with a stronger future orientation at baseline were more likely to have successfully quit at follow-up. This effect was partially explained by intention-mediated effects of future orientation on quit attempts.
Future orientation predicts smoking cessation across four English-speaking countries; the cessation-facilitating effects of future orientation may be primarily due to future oriented individuals’ motivated and sustained involvement in the quit cycle over time.
PMCID: PMC4458068  PMID: 24747807
time perspective; health behavior; intention; smoking; smoking cessation; temporal
18.  Different associations of alcohol cue reactivity with negative alcohol expectancies in mandated and inpatient samples of young adults 
Addictive behaviors  2013;38(4):2040-2043.
Alcohol cue reactivity, operationalized as a classically conditioned response to an alcohol related stimulus, can be assessed by changes in physiological functions such as heart rate variability (HRV), which reflect real time regulation of emotional and cognitive processes. Although ample evidence links drinking histories to cue reactivity, it is unclear whether in-the-moment cue reactivity becomes coupled to a set of consolidated beliefs about the effects of alcohol (i.e., expectancies) and whether treatment helps dissociate the relation of positive versus negative expectancies to cue reactivity. This study examined the relationship between reactivity to alcohol picture cues and alcohol expectancies in two groups of emerging adults: an inpatient sample with alcohol use disorders (n=28) and a college student sample who previously were mandated to a brief intervention for violating university policies about alcohol use in residence halls (n=43). Sequential regression analysis was conducted using several HRV indices and self-report arousal ratings as cue reactivity measures. Results indicated that the relationship between cue reactivity and negative alcohol outcome expectancies differed for the two groups. Greater cue reactivity, assessed using HRV indices, was associated with more negative expectancies in the inpatient sample but with less negative expectancies in the mandated student sample, while an opposite trend was found for subjective arousal. The present findings highlight the importance of characterizing cue reactivity through multi-dimensional assessment modalities that include physiological markers such as HRV.
PMCID: PMC4454376  PMID: 23396175
Alcohol outcome expectancie; Heart rate variability; Cue reactivity; Alcohol use disorders
19.  Temporal associations between substance use and delinquency among youth with a first time offense 
Addictive behaviors  2014;39(6):1081-1086.
Substance use and delinquency among adolescents has been shown to be positively associated; however, the temporal relationship is not well understood. Examining the association between delinquency and substance use is especially relevant among adolescents with a first-time substance use related offense as they are at-risk for future problems.
Data from 193 adolescents at time of diversion program entry and six months later was examined using cross-lagged path analysis to determine whether substance use and related consequences were associated with other types of delinquency across time.
Results demonstrated that delinquency at program entry was related to subsequent reports of heavy drinking and alcohol consequences, but not marijuana use or its consequences. In contrast, alcohol and marijuana use at program entry was not related to future reports of delinquency.
Findings emphasize the need to build in comprehensive assessments and interventions for youth with a first time offense in order to prevent further escalation of substance use and criminal behaviors.
PMCID: PMC4023540  PMID: 24656642
adolescents; delinquency; alcohol use; marijuana use; temporal associations
20.  Preliminary evidence for normalization of risk taking by modafinil in chronic cocaine users 
Addictive behaviors  2014;39(6):1057-1061.
Modafinil, a wake-promoting agent used to treat sleep disorders, is thought to enhance cognition. Although modafinil has shown promise as a pharmacotherapy for the treatment of cocaine dependence, it is unknown to what extent cognitive effects may play a role in such treatment. We examined the effect of modafinil on the Balloon Analogue Risk Task (BART), a behavioral measure in which higher scores are purported to reflect a greater propensity for risk-taking. Thirty cocaine dependent individuals, enrolled in a randomized clinical trial of modafinil 400mg (n=12) versus placebo (n=18), were administered the BART during the second week of inpatient treatment for cocaine dependence. A comparison cohort of healthy participants (n=19) performed the BART under similar conditions. Modafinil treatment was associated with significantly higher BART scores (p=0.01), which were comparable to scores in healthy persons. BART scores in placebo treated participants were much lower than previously reported in healthy participants, and lower than those observed in the comparison cohort. As propensity toward risk taking is typically associated with higher BART scores as well as increased risk for substance use, our findings may reflect a novel aspect of cognitive impairment related to chronic cocaine use. Notably, the low BART scores reflect highly suboptimal performance on the task, and the observed effect of modafinil may indicate a normalization of this impairment and have implications for treatment outcome.
PMCID: PMC4026273  PMID: 24642345
cocaine dependence; modafinil; cognition; risk taking; Balloon Analogue Risk Task
21.  Compulsive Use of Internet-based Sexually Explicit Media: Adaptation and Validation of the Compulsive Internet Use Scale (CIUS) 
Addictive behaviors  2014;39(6):1126-1130.
Despite evidence that viewing sexually explicit media (SEM) may contribute to greater numbers of sexual partners, sexual risk taking, greater interest in group sex, and lower self-esteem among men who have sex with men (MSM), research has not addressed compulsive use of Internet-based SEM due to the lack of a validated measure for this population. This report investigates the psychometric properties of the 14-item Compulsive Internet Use Scale (CIUS; Meerkerk, van den Eijnden, Vermulst, & Garretsen, 2009) adapted to assess the severity of compulsive Internet SEM use. A total of 265 Internet SEM-viewing MSM participated in an online survey about their SEM preferences, viewing habits, and recent sexual behaviors. A principal components analysis revealed a single-component, 13-item scale to adequately assess the cognitive, emotional, and behavioral aspects of this phenomenon, with a high internal consistency (α = .92). Greater compulsive use of Internet SEM was positively correlated with several relevant variables including boredom, sexual frustration, time spent viewing Internet SEM, and number of recent male sexual partners. The results offer preliminary evidence for the reliability and validity of using an adapted version of the CIUS to understand compulsive Internet SEM use, and allow for more research into the potential negative consequences of compulsive SEM use.
PMCID: PMC4071449  PMID: 24679612
compulsivity; Internet; pornography; sexually explicit media
22.  Perceived Discrimination, Depressive Symptoms, and Substance Use in Young Adulthood 
Addictive behaviors  2014;39(6):1021-1025.
Perceived discrimination is an important health-related stressor. As suggested by the stress-coping model, substance use often serves as a means to reduce the negative effects of perceived discrimination. This study uses data from the National Survey of American Life-Adults to examine the structural relationship of perceived discrimination and depressive symptoms with lifetime and recent substance use among African American and African Caribbean young adults. Respondents (N = 1,910) were18–35 years old. Compared with African Caribbeans, African Americans report significantly higher levels of depressive symptoms and both lifetime and recent substance use. Multiple-group structural equation modeling is used to evaluate model fit and test hypothesized models. Results show good fit of the hypothesized models in both African Americans and African Caribbeans. Full measurement and structural invariance is found across ethnicity. Mediation models explain 18.5% and 47.4% of the variance in lifetime substance use for African Americans and African Caribbeans, respectively, and 23.5% and 35.0% of the variance in recent substance use for African Americans and African Caribbeans, respectively. Mediation tests indicate depressive symptoms partially mediate the relationship between perceived discrimination and lifetime substance use and fully mediated this relationship for recent substance use. This study is the first to demonstrate a positive association between perceived racial discrimination and substance use among African Caribbean young adults. Study findings illuminate the influence of perceived discrimination on substance use and the mechanisms of this relationship among African American and African Caribbean young adults.
PMCID: PMC4020515  PMID: 24629325
Black; drug; cigarette; alcohol; marijuana; depression
23.  Newcomers to Al-Anon Family Groups: Who Stays and Who Drops Out? 
Addictive behaviors  2014;39(6):1042-1049.
Al-Anon Family Groups (Al-Anon), a 12-step mutual-help program for people concerned about another's drinking, is the most widely used form of help for concerned others (COs) in the US. This study assessed the prevalence of dropout, and predictors of dropout, in the six months following newcomers' initial attendance at Al-Anon meetings. Al-Anon's World Service Office mailed a random sample of groups, which subsequently yielded a sample of 251 newcomers who completed surveys at baseline and 6 months later. At the 6-month follow-up, 57% of newcomers at baseline had dropped out (had not attended any Al-Anon meetings during the past month). At baseline, individuals who later dropped out of Al-Anon were less likely to have been referred to Al-Anon by their drinker's health care provider, and reported less severe problems than individuals who continued to attend, but dropouts were more often concerned about their drinker's psychological health; newcomers with these concerns may have found them incompatible with Al-Anon's philosophy. Dropouts reported high rates of problems, suggesting that COs who drop out of Al-Anon would benefit from ongoing help and support.
PMCID: PMC4120873  PMID: 24630826
Al-Anon Family Groups; mutual-help; 12-step groups; alcohol use disorders; addiction; family; recovery
24.  Behavioral cessation treatment of waterpipe smoking: The first pilot randomized controlled trial 
Addictive behaviors  2014;39(6):1066-1074.
Waterpipe use has increased dramatically in the Middle East and other parts of the world. Many users exhibit signs of dependence, including withdrawal and difficulty quitting, but there is no evidence base to guide cessation efforts.
We developed a behavioral cessation program for willing-to-quit waterpipe users, and evaluated its feasibility and efficacy in a pilot, two arm, parallel group, randomized, open label trial in Aleppo, Syria. Fifty adults who smoked waterpipe ≥3 times per week in the last year, did not smoke cigarettes, and were interested in quitting were randomized to receive either brief (1 in-person session and 3 phone calls) or intensive (3 in-person sessions and 5 phone calls) behavioral cessation treatment delivered by a trained physician in a clinical setting. The primary efficacy end point of the developed interventions was prolonged abstinence at three months post-quit day, assessed by self-report and exhaled carbon monoxide levels of <10 ppm. Secondary end points were 7 day point-prevalent abstinence and adherence to treatment.
Thirty percent of participants were fully adherent to treatment, which did not vary by treatment group. The proportions of participants in the brief and intensive interventions with prolonged abstinence at the 3-month assessment were 30.4% and 44.4%, respectively. Previous success in quitting (OR = 3.57; 95% CI = 1.03–12.43) predicted cessation. Higher baseline readiness to quit, more confidence in quitting, and being unemployed predicted a better adherence to treatment (all p-values <0.05).
Brief behavioral cessation treatment for waterpipe users appears to be feasible and effective.
PMCID: PMC4141480  PMID: 24629480
Waterpipe; Cessation; Behavioral treatment; Randomized controlled trial
25.  Does non-smoker identity following quitting predict long-term abstinence? Evidence from a population survey in England 
Addictive Behaviors  2015;45:99-103.
‘Categorical self-labels’ (e.g. thinking of oneself as a smoker or non-smoker) are important aspects of identity that can have a fundamental influence on behaviour. To explore the role identity aspects relating to smoking can play in smoking cessation and relapse, this study assessed the prospective associations between taking on a non-smoker identity following quitting and long-term abstinence.
A representative sample of 574 ex-smokers in England who quit smoking in the past year was followed-up at three (N = 179) and six months (N = 163). Post-quit identity relating to smoking (‘I still think of myself as a smoker’ or ‘I think of myself as a non-smoker’), and demographic and smoking-related characteristics were assessed at baseline. Self-reported smoking abstinence was assessed at follow-ups.
Non-smoker identity was reported by 80.3% (95%CI 76.8–83.4) of recent ex-smokers. Younger age (p = 0.017) and longer abstinence (p < 0.001) were independently associated with a post-quit non-smoker identity. After adjusting for covariates, non-smoker identity (p = 0.032) and length of abstinence at baseline (p < 0.001) were associated with continued abstinence at three month follow-up, and baseline length of abstinence (p = 0.003) predicted continued abstinence at six months.
The majority of people who quit smoking recently consider themselves as non-smokers. Younger people and those who have been abstinent for longer are more likely to take on a non-smoker identity. Ex-smokers who make this mental transition following a quit attempt appear more likely to remain abstinent in the medium term than those who still think of themselves as smokers.
•Smoker identities have been proposed to influence the success of quit attempts.•Prospective associations were assessed in a representative sample of ex-smokers.•The majority of people who quit in the past year consider themselves as non-smokers.•Younger age and longer abstinence associated with a post-quit non-smoker identity.•Adopting a non-smoker identity after quitting can predict medium-term abstinence.
PMCID: PMC4376294  PMID: 25658770
Smoking cessation; Smoker identity; Ex-smokers; Smoking Toolkit Study; Representative sample

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