The cultural equivalence of measurement in substance use research

How can we build structural resilience? Integration of social-ecological and minority stress models

As the United States contends with racism and a social justice reckoning, the need to advance our understanding of how to build structural resilience continues to be pressing. This article proposes a culturally and structurally informed model of resilience for individuals with minoritized identities that integrates social-ecological and minority stress models. First, common stressors and traumas experienced by minoritized individuals at multiple levels of proximal/distal influence are reviewed: microsystem (e.g., family rejection), mesosystem (e.g., community-based discrimination), exosystem (e.g., barriers to health care), macrosystem (e.g., harmful legal policies), and chronosystem (e.g., historical legacy). Next, how these exposures have cascading effects on minority stress processes (e.g., discriminatory policies in the macrosystem affect how a child is socialized in the microsystem) are considered. Then, modifiable factors (e.g., community cohesion) that promote resiliency in the face of ongoing exposures are discussed. To conclude, guidelines are offered for advancing the psychological science of resilience in minoritized groups including mixed methods to reflect participants' experiences, ecological approaches to assess resilience, and multilevel modeling to understand the interplay between the social-ecological context and individual factors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Experiences of Discrimination and Alcohol Involvement Among Young Adults at the Intersection of Race/Ethnicity and Gender

Although discrimination is an important social determinant of alcohol involvement, there is a dearth of research testing these associations across race/ethnicity and gender. This is an important research gap given that experiences of discrimination and therefore links with alcohol involvement may vary as a function race/ethnicity and gender intersectional identities. We tested for measurement invariance in discrimination and alcohol involvement and examined group differences in means and covariances. The sample consisted of n = 1187 young adults (ages 18-26; n = 193 Black women, n = 209 Latina women, n = 186 White women, n = 198 Black men, n = 203 Latino men, and n = 198 White men). We found evidence for differential item functioning for discrimination and alcohol involvement that violated assumptions needed to make manifest between-group comparisons. To model the source and degree of differential item functioning, we used partial measurement invariance and dropped a discrimination item that did not reliably overlap with the latent factor for White women. After accounting for differential item functioning, Black women and men reported the highest discrimination, followed by Latinx women and men, and then White women and men. White women reported the most alcohol involvement, followed by White men, Latina women, Latino men, Black men, and Black women. Discrimination and alcohol involvement were positively associated for all groups except White women, though effect sizes varied with Black men exhibiting the largest effect. An intersectionally valid understanding of discrimination and alcohol involvement may necessitate statistical approaches that can test for (and model) differential item functioning prior to making between-group quantitative comparisons.

A proof-of-concept study testing the factor structure of the Stop Signal Task: overlap with substance use and mental health symptoms

Background: Research utilizing experimental tasks usually does not report estimates of internal reliability of measurement. However, modern measurement theories conceptualize reliability as sample dependent indicating that reliability should be empirically demonstrated in the samples used to make inferences.Objectives: Test whether confirmatory factor analytic (CFA) estimates of reliability can be applied to a commonly used task measuring response inhibition (the Stop Signal Task) to predict substance use (alcohol and cannabis) and mental health symptoms.Methods: Thirty-seven participants between the ages of 18-20 (72% female; 16% Asian, 3% Native American, 11% Black or African American, 59% White; 32% Latino/a/x) were recruited via social media advertisement and attended a laboratory visit. The Stop Signal Reaction Time (SSRT) was calculated as the outcome for three experimental blocks and used as indicators in a CFA.Results: CFA suggests the task yields reliable scores; factor loadings were statistically significant (p < .05) and substantial (standardized loadings ranged from .74 to .94). However, reliability increased across experimental blocks and error was non-trivial (ranging from 50% to 12% of the variance). The inhibition factor predicted higher maximum number of drinks consumed (β = .37, p < .05), higher frequency of cannabis use (β = .39, p < .05), and more cannabis use occasions within using days (β = .40, p < .05), as well as facets of mental health (anxious/depression, attention, and anxiety problems; all p's < .05).Conclusion: Results support the utility of CFA to test for reliability of measurement, with the ability to inhibit dominant responses serving as a transdiagnostic correlate of substance use and mental health problems.

A clinical science guide for reviewing the cross-cultural rigor of assessments in an alcohol training clinic

A standard component of service delivery in alcohol treatment clinics is evidence-based assessment (EBA). Although EBA is essential for selecting appropriate treatment modalities for alcohol use and associated problems, there are limitations in existing EBAs concerning evidence of cultural equivalence and utility among individuals seeking alcohol treatment. However, training in EBA, addictions, and clinical applications with diverse populations all are gaps in clinical training in doctoral programs in clinical psychology. The present work used the clinical science model to review the psychometric properties, cross-cultural utility, and measurement invariance of measures in an assessment battery used in an alcohol treatment training clinic. This article describes the results of that review, recommendations for retaining or replacing common assessment measures used in alcohol treatment clinics, and recommendations for alcohol treatment clinics interested in engaging in similar processes. Findings suggested that more research is needed to evaluate the psychometric properties of EBAs utilized in an alcohol treatment assessment battery, particularly among American Indian and Alaska Native people, and to test measurement invariance across race/ethnicity and other identity groups in alcohol treatment-seeking populations. Overall, routine reviews of cultural relevance are needed in clinical settings to stay current with the emerging literature. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Designing and testing treatments for alcohol use disorder

This chapter provides a succinct overview of several recommendations for the design and analysis of treatments for AUD with a specific focus on increasing rigor and generalizability of treatment studies in order to increase the reach of AUD treatment. We recommend that researchers always register their trials in a clinical trial registry and make the protocol accessible so that the trial can be replicated in future work, follow CONSORT reporting guidelines when reporting the results of the trial, carefully describe all inclusion and exclusion criteria as well as the randomization scheme, and always use an intent to treat design with attention to analysis of missing data. In addition, we recommend that researchers pay closer attention to recruitment and engagement strategies that increase enrollment and retention of historically marginalized and understudied populations, and we end with a plea for more consideration of implementation science approaches to increase the dissemination and implementation of AUD treatment in real-world settings.

Assessment of simultaneous alcohol and cannabis use and its related consequences and cognitions in college students: A narrative review

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 for future directions of assessment. We conclude that the assessment of SAM use is limited by difficulties in the assessment of cannabis quantity and potency. However, and the lack of a psychometrically validated measure of SAM consequences. However, measures of SAM motives and expectancies have been published with support from psychometric examinations such as exploratory factor analysis, confirmatory factor analysis, and measurement invariance. Research is needed that incorporates qualitative approaches in the development of SAM use measures so that unique items specific to SAM use rather than single-substance use can be identified. Additionally, validation of these measures is needed across different samples that vary demographically, such as by race and gender or sex. Future research should consider the development of a measure of protective behavioral strategies  specific to SAM use to inform interventions that target the reduction of negative consequences of SAM use.

Cultural considerations for substance use and substance use disorders among Black men

There are complex cultural considerations for understanding, assessing, and treating substance use disorders (SUD) among Black men, from the initiation of substance use through SUD-related outcomes. This narrative review provides insight into some of these factors, including the individual, interpersonal, and community-level risk and protective factors (e.g., family and social roles, religiosity, racism and discrimination, exposure to trauma and adversity) underlying relative risk for substance use and disparities in SUD-related outcomes. This article also highlights the ways that public attitudes and policies related to substance use have contributed to ongoing inequities in SUD treatment access for Black men. Recommendations for clinical research and practice include increasing focus on measurement equivalence, creating pathways for access to community-based and specialty treatment, and providing services that are culturally affirming, relevant, and appropriate. Comprehensive efforts are needed to reduce SUD-related inequities and promote positive well-being among Black men and their communities.

Unpacking disparities in substance-related outcomes among racial, ethnic, sexual, and gender minoritized groups during adolescence and emerging adulthood

OBJECTIVE

Alcohol and other drug (AOD) use increases substantially from adolescence to emerging adulthood, and recent longitudinal studies show disparities in AOD-related outcomes by racial and ethnic, as well as sexual and gender minority (SGM), identities. Greater insight is needed into how individual, social, and environmental contexts interact and affect such disparities, as well as why disparate outcomes are found across different domains (e.g., social, educational, economic), even after accounting for intensity of use. This commentary addresses these important and timely issues.

METHOD

We provide a brief overview of the literature, including our own team's work over the last 14 years, to identify and understand disparities in AOD-related outcomes during adolescence and emerging adulthood across individuals with different racial and ethnic, and sexual and gender, identities. We then discuss paths forward to advance research and build a stronger evidence base, leading to the development and identification of effective interventions that can help mitigate disparities among historically marginalized adolescents and emerging adults.

RESULTS

Existing research highlights the need for further longitudinal work in several areas, including addressing contextual factors at various levels (e.g., individual, social, environmental) that may contribute to outcomes for different groups of individuals, developing and testing culturally appropriate AOD-related services, giving greater consideration to intersectionality of multiple minority identities, and using novel statistical approaches to help improve the estimation of differences across smaller subgroups of individuals in existing cohorts.

CONCLUSIONS

To inform prevention programming and policy for improving health and well-being of historically marginalized populations, it is important to continue our efforts to understand disparities in AOD-related outcomes using multidisciplinary, equity, and intersectionality lenses. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Factor Structure of the Brief Addiction Monitor in a Non-Veteran Substance Use Disorder Outpatient Treatment Sample

Background

The Brief Addiction Monitor (BAM) was developed as a comprehensive substance use disorder (SUD) outcome metric to fill a gap in quality measurement. Research to date has only examined the psychometric performance of this measure in veteran SUD populations. The purpose of the current research is to examine the factor structure and validity in a non-veteran SUD population.

Methods

Non-veteran patients admitted to a SUD treatment program (N = 2,227) completed BAM at intake. After confirmatory factor analysis (CFA) was performed to evaluate the measurement model validity of previously defined latent structures, exploratory factor analysis (EFA) was used to assess the factor structure and psychometric properties of the BAM within the full sample and within subgroups, specifically racial, referral source (mandated vs. not), and primary SUD diagnosis.

Results

Exploratory factor analyses in the full sample supported a 4-factor model (representing Stressors, Alcohol Use, Risk Factors, and Protective Factors) derived from 13 items. Subsequent EFAs conducted separately in each subgroup revealed variability in the number of resulting factors and pattern matrices. The internal consistency also varied among factors and between subgroups; in general, reliability was greatest for the Alcohol Use scale and either poor or questionable for pattern matrices resulting in scales reflecting Risk or Protective Factors.

Conclusion

Findings from our study suggest that the BAM might not be a reliable and valid instrument for all populations. More research is needed to develop and validate tools that are clinically meaningful and allow clinicians to track recovery progress over time.

Intersection of minority health, health disparities, and social determinants of health with psychopharmacology and substance use

These articles provide a window into the breadth of issues at the intersection of MHDS with psychopharmacology and substance use. Integrating the fields of psychopharmacology and basic behavioral addictions science with research on MHDS is not only of public health importance, but can help further elucidate our understanding of human behavior in all of its complexity. As demonstrated here, a better understanding of the synergy between societal context(s) and individual-level processes can lead to interventions tailored to specific risk and resilience factors; interventions that are personalized and contextualized have the potential to improve the health of our society. We are very grateful to the authors for their contributions to this special issue. We hope that professionals from various disciplines who read this special issue become inspired to bridge psychopharmacological and social determinants perspectives in their own work, and, in turn, accelerate scientific progress within each field. (PsycInfo Database Record (c) 2021 APA, all rights reserved).