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Roos CR, Kiluk B, Carroll KM, Bricker JB, Mun CJ, Sala M, Kirouac M, Stein E, John M, Palmer R, DeBenedictis A, Frisbie J, Haeny AM, Barry D, Fucito LM, Bowen S, Witkiewitz K, Kober H. Development and initial testing of mindful journey: a digital mindfulness-based intervention for promoting recovery from Substance use disorder. Ann Med 2024; 56:2315228. [PMID: 38382111 PMCID: PMC10883107 DOI: 10.1080/07853890.2024.2315228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND/OBJECTIVES There is a great unmet need for accessible adjunctive interventions to promote long-term recovery from substance use disorder (SUD). This study aimed to iteratively develop and test the initial feasibility and acceptability of Mindful Journey, a novel digital mindfulness-based intervention for promoting recovery among individuals with SUD. PATIENTS/MATERIALS Ten adults receiving outpatient treatment for SUD. METHODS Phase 1 (n = 5) involved developing and testing a single introductory digital lesson. Phase 2 included a separate sample (n = 5) and involved testing all 15 digital lessons (each 30- to 45-minutes) over a 6-week period, while also receiving weekly brief phone coaching for motivational/technical support. RESULTS Across both phases, quantitative ratings (rated on a 5-point scale) were all at or above a 4 (corresponding with 'agree') for key acceptability dimensions, such as usability, understandability, appeal of visual content, how engaging the content was, and helpfulness for recovery. Additionally, in both phases, qualitative feedback indicated that participants particularly appreciated the BOAT (Breath, Observe, Accept, Take a Moment) tool for breaking down mindfulness into steps. Qualitative feedback was used to iteratively refine the intervention. For example, based on feedback, we added a second core mindfulness tool, the SOAK (Stop, Observe, Appreciate, Keep Curious), and we added more example clients and group therapy videos. In Phase 2, 4 out of 5 participants completed all 15 lessons, providing initial evidence of feasibility. Participants reported that the phone coaching motivated them to use the app. The final version of Mindful Journey was a smartphone app with additional features, including brief on-the-go audio exercises and a library of mindfulness practices. Although, participants used these additional features infrequently. CONCLUSIONS Based on promising initial findings, future acceptability and feasibility testing in a larger sample is warranted. Future versions might include push notifications to facilitate engagement in the additional app features.
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Affiliation(s)
- Corey R. Roos
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Brian Kiluk
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Kathleen M. Carroll
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | - Chung Jung Mun
- Edson College of Nursing and Health Innovation, AZ State University, Tempe, AZ, USA
| | - Margarita Sala
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Megan Kirouac
- Center on Alcohol, Substance Use, and Addiction, Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Elena Stein
- Medical Center, VA Puget Sound Health Care System, Seattle, VA, USA
| | - Maya John
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Robert Palmer
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Andrew DeBenedictis
- Department of Mental Health Counseling, Boston College, Chestnut Hill, MA, USA
| | | | - Angela M. Haeny
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Declan Barry
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Lisa M. Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah Bowen
- Department of Psychology, Pacific University
| | - Katie Witkiewitz
- Center on Alcohol, Substance Use, and Addiction, Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Hedy Kober
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Goldstein SC, Newberger NG, Schick MR, Ferguson JJ, Collins SE, Haeny AM, Weiss NH. A systematic meta-epidemiologic review on nonabstinence-inclusive interventions for substance use: inclusion of race/ethnicity and sex assigned at birth/gender. Am J Drug Alcohol Abuse 2024:1-15. [PMID: 38411974 DOI: 10.1080/00952990.2024.2308087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/16/2024] [Indexed: 02/28/2024]
Abstract
Background: Minoritized racial/ethnic and sex assigned at birth/gender groups experience disproportionate substance-related harm. Focusing on reducing substance-related harm without requiring abstinence is a promising approach.Objectives: The purpose of this meta-epidemiologic systematic review was to examine inclusion of racial/ethnic and sex assigned at birth/gender in published studies of nonabstinence-inclusive interventions for substance use.Methods: We systematically searched databases (PubMed and PsycINFO) on May 26, 2022 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Articles were eligible for inclusion if they: 1) reported in English language, 2) had a primary goal of investigating a nonabstinence-inclusive intervention to address substance use, 3) used human subjects, and 4) only included adults aged 18 or older. Two coders screened initial articles and assessed eligibility criteria of full text articles. A third consensus rater reviewed all coding discrepancies. For the remaining full-length articles, an independent rater extracted information relevant to study goalsResults: The search strategy yielded 5,759 records. 235 included articles remained. Only 73 articles (31.1%) fully reported on both racial/ethnic and sex assigned at birth/gender, and only seven articles (3.0%) reported subgroup analyses examining treatment efficacy across minoritized groups. Nine articles (3.8%) mentioned inclusion and diversity regarding both racial/ethnic and sex assigned at birth/gender in their discussion and four articles (1.7%) broadly mentioned a lack of diversity in their limitationsConclusion: Findings highlight that little is known about nonabstinence-inclusive interventions to address substance use for individuals from minoritized racial/ethnic and sex assigned at birth/gender groups.
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Affiliation(s)
- Silvi C Goldstein
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Noam G Newberger
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Melissa R Schick
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Susan E Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Department of Psychology, Washington State University, Pullman, WA, USA
| | - Angela M Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
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Holmes SC, Zare M, Haeny AM, Williams MT. Racial Stress, Racial Trauma, and Evidence-Based Strategies for Coping and Empowerment. Annu Rev Clin Psychol 2024; 20. [PMID: 38346289 DOI: 10.1146/annurev-clinpsy-081122-020235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Racial stress and racial trauma refer to psychological, physiological, and behavioral responses to race-based threats and discriminatory experiences. This article reviews the evidence base regarding techniques for coping with racial stress and trauma. These techniques include self-care, self-compassion, social support, mindfulness, cognitive restructuring, cognitive defusion, identity-affirming practices and development of racial/ethnic identity, expressive writing, social action and activism, and psychedelics. These strategies have shown the potential to mitigate psychological symptoms and foster a sense of empowerment among individuals affected by racial stress and trauma. While the ultimate goal should undoubtedly be to address the root cause of racism, it is imperative to acknowledge that until then, implementing these strategies can effectively provide much-needed support for individuals affected by racism. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 20 is May 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Samantha C Holmes
- Department of Psychology, College of Staten Island, City University of New York, New York, NY, USA;
| | - Manzar Zare
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; ,
| | - Angela M Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA;
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Haeny AM, Chowdhary A, King J, Sypher I, O'Malley SS, Sinha R. A thematic analysis of stress, substance-cue, and neutral/relaxing events to inform approaches for improving treatment among Black adults who use substances. J Subst Use Addict Treat 2024; 156:209184. [PMID: 37866439 DOI: 10.1016/j.josat.2023.209184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION To inform approaches for adapting substance use treatment for Black adults, the aim of this study was to thematically analyze the stressors, triggers for substance use, and neutral/relaxing events reported among Black adults who participated in a lab paradigm. METHODS The sample included 36 Black adults (mean age [years] = 37.47, SD = 7.30; 53 % male, 12 (33 %) with alcohol use disorder, 12 (33 %) with cocaine use disorder, and 12 (33 %) healthy controls). All participants provided detailed stimulus and response context information on the most stressful event they experienced in the past year, an event that involved substance use, and a neutral/relaxing event in a structured interview using a scene development questionnaire, and this information was utilized to generate a personalized imagery script for each event using standardized procedures. Thematic analyses identified the key themes reported within scripts. RESULTS Consistent with a prior thematic analysis on a majority White sample, we found the following themes for the stress scripts: Relational (Violation, Loss, Parenting, Betrayal, Isolation vs. support), Environmental (Housing, Legal), and Achievement (Employment, Role in household). However, our analyses also resulted in new stress themes: Relational (Violation-Racial Microaggressions) and Institutional (Time Wasted). The substance use scripts consisted of the following trigger themes: Social (Social Facilitation, Socially-Sanctioned Substance Use Event, Exposure to Substance Use Friends/Associates), Internal (Free Time, Boredom, Thoughts of Using Substance, Frustration, Reward), and Environment (Availability of Substance, Celebration, Party Environment, Food, Hot Day, Money/Payday). The neutral/relaxing scripts themes were: Outdoor Activities (Admiring Nature, People Watching, Observing Surroundings, Enjoying the Sun, Playing in the Sand, Walking), Quiet Activities (Silence/Quiet, Prayer, Reading), and Indoor Activities (Radio, Television, Bath/Shower, Bed/Chair, Observing from a Window). We found sex differences across scripts. CONCLUSIONS The results suggest that Black people experience unique stressors (e.g., institutional and racial stressors) that are important to consider when modifying treatment to improve outcomes among this group. In addition to stressors, this study also identified high-risk situations involving triggers for use. Taken together these findings suggest targets for the tailoring of coping strategies that could be incorporated for the development of culturally relevant behavioral treatment for SUD.
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Affiliation(s)
- Angela M Haeny
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA; Race Equity and Addiction Lab at Yale, New Haven, New Haven, CT 06519, USA.
| | - Aishwarya Chowdhary
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA; Yale Stress Center, New Haven, CT 06511, USA
| | - Jaelen King
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA; Race Equity and Addiction Lab at Yale, New Haven, New Haven, CT 06519, USA
| | - Isaiah Sypher
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA; Race Equity and Addiction Lab at Yale, New Haven, New Haven, CT 06519, USA
| | | | - Rajita Sinha
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA; Yale Stress Center, New Haven, CT 06511, USA
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Jackson AB, Gibbons FX, Fleischli ME, Haeny AM, Bold KW, Suttiratana SC, Fagan P, Krishnan-Sarin S, Gerrard M. Association of racial discrimination in health care settings and use of electronic cigarettes to quit smoking among Black adults. J Subst Use Addict Treat 2023; 155:208985. [PMID: 36822270 PMCID: PMC10442461 DOI: 10.1016/j.josat.2023.208985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/28/2022] [Accepted: 02/12/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Black people are disproportionately burdened by tobacco-related diseases and are less successful at cigarette cessation with current treatments. We know little about the effectiveness of e-cigarettes as a smoking cessation method compared to currently approved methods in Black adults who smoke. Many Black adults report experiencing racial discrimination in health care, but if discrimination is related to utilization of smoking cessation aids including e-cigarettes and success with smoking cessation in this population is unclear. Therefore, this exploratory study aimed to understand how negative experiences and racial discrimination in health care influence use of e-cigarettes for cigarette cessation and success with cigarette cessation among Black adults. METHODS The study interviewed 201 Black adults who used cigarettes and tried to quit in their lifetime from the Family and Community Health Study in 2016. The study asked if they had tried and successfully quit cigarettes with e-cigarettes vs. other methods (support groups, medications, nicotine replacement therapies, call-in help lines, cold turkey [quit on their own], counseling) and asked about their negative experiences and racial discrimination in health care. We performed separate logistic regressions that evaluated the association of negative experiences and racial discrimination in health care with 1) use of e-cigarettes for cigarette cessation vs. other quitting methods and 2) success with cigarette cessation using any method among Black adults while controlling for age, sex, socioeconomic status, health insurance status, and age of onset of cigarette use. RESULTS More reported negative experiences and racial discrimination in health care were associated with ever trying to quit with e-cigarettes compared to other methods (OR:1.75, 95 % CI [1.05-2.91]), but negative experiences and racial discrimination in health care were not associated with cigarette quitting success. Interestingly, trying e-cigarettes was associated with being less successful at quitting compared to using other methods to quit smoking (OR: 0.40, 95 % CI [0.20, 0.81]). CONCLUSIONS These results suggest that educating health care professionals that anticipated discrimination in health care settings may be driving Black adults who smoke to engage in non-evidence-based smoking cessation practices, such as e-cigarettes instead of those that are evidence-based, and may be more effective in this population.
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Affiliation(s)
- Asti B Jackson
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America.
| | - Frederick X Gibbons
- Department of Psychological Sciences, University of Connecticut, United States of America
| | - Mary E Fleischli
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, United States of America
| | - Angela M Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Sakinah C Suttiratana
- Department of Chronic Disease Epidemiology, Yale School of Public Health, United States of America
| | - Pebbles Fagan
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, United States of America
| | | | - Meg Gerrard
- Department of Psychological Sciences, University of Connecticut, United States of America
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Holmes SC, Zalewa D, Wetterneck CT, Haeny AM, Williams MT. Development of the oppression-based traumatic stress inventory: a novel and intersectional approach to measuring traumatic stress. Front Psychol 2023; 14:1232561. [PMID: 37941761 PMCID: PMC10629001 DOI: 10.3389/fpsyg.2023.1232561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023] Open
Abstract
There is a growing body of literature demonstrating that experiences of oppression (e.g., racism, sexism, heterosexism, poverty) are associated with posttraumatic stress disorder symptoms. Traditional trauma assessments do not assess experiences of oppression and it is therefore imperative to develop instruments that do. To assess oppression-based traumatic stress broadly, and in an intersectional manner, we have developed the oppression-based traumatic stress inventory (OBTSI). The OBTSI includes two parts. Part A comprises open-ended questions asking participants to describe experiences of oppression as well as a set of questions to determine whether Criterion A for PTSD is met. Part B assesses specific posttraumatic stress symptoms anchored to the previously described experiences of oppression and also asks participants to identify the various types of discrimination they have experienced (e.g., based on racial group, sex/gender, sexual orientation, etc.). Clients from a mental health clinic and an undergraduate sample responded to the OBTSI and other self-report measures of depression, anxiety, and traditional posttraumatic stress (N = 90). Preliminary analyses demonstrate strong internal consistency reliability for the overall symptom inventory (α = 0.97) as well as for the four symptom clusters of posttraumatic stress symptoms in the DSM-5 (α ranging from 0.86 to 0.94). In addition to providing descriptive information, we also assess the convergent validity between the OBTSI and measures of anxiety, depression, and traditional posttraumatic stress and examine the factor structure. This study provides preliminary evidence that the OBTSI is a reliable and valid method of assessing oppression-based traumatic stress symptoms.
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Affiliation(s)
- Samantha C. Holmes
- College of Staten Island, City University of New York, Staten Island, NY, United States
| | - Daniel Zalewa
- Behavioral Wellness Clinic, Tolland, CT, United States
| | | | - Angela M. Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Monnica T. Williams
- Behavioral Wellness Clinic, Tolland, CT, United States
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
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Sypher I, Pavlo A, King J, Youins R, Shumake A, Lopez J, Haeny AM. What's race got to do with it? Factors contributing to self-change from cocaine use disorder among Black adults. J Subst Use Addict Treat 2023; 153:208945. [PMID: 37654008 DOI: 10.1016/j.josat.2022.208945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/09/2022] [Accepted: 12/30/2022] [Indexed: 09/02/2023]
Abstract
INTRODUCTION A substantial number of people with substance use disorders recover without formal treatment, though we know little about the process of self-change among Black adults with cocaine use disorder (CUD) and whether racism contributes to the development of CUD and these adults' process of self-change. METHODS The study team conducted qualitative interviews with 29 Black adults using a narrative and phenomenological approach. At the time of the interview, all participants met criteria for DSM-5 CUD prior to the past year but did not meet criteria for CUD in the past year and reported that they reduced their cocaine use without formal treatment. Participants completed a qualitative interview followed by the UConn Racial/Ethnic Stress & Trauma Survey. Thematic analyses informed key themes from the qualitative interviews. RESULTS Qualitative analyses indicated several major factors that contributed to self-change from CUD: racial identity, responsibility to family, social regard, spirituality, turning point for change, and changing one's environment. These results highlight that self-change from CUD is a complex, ongoing, and multifaceted process. The identified themes align with several theories of recovery, including social control theory and the theory of stress and coping. Furthermore, the results suggest that experiences of racism are common among Black adults recovering from CUD, and that the multiple strategies employed for coping with racism may be consistent with the process of self-change. CONCLUSIONS This study shows that multiple race-related factors contribute to the development of, maintenance of, and self-change from CUD among Black adults. Better understanding these factors can help to inform drug treatment.
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Affiliation(s)
- Isaiah Sypher
- Yale School of Medicine, Yale University, New Haven, CT, United States of America.
| | - Anthony Pavlo
- Yale School of Medicine, Yale University, New Haven, CT, United States of America.
| | - Jaelen King
- Yale College, Yale University, New Haven, CT, United States of America.
| | - Richard Youins
- Yale School of Medicine, Yale University, New Haven, CT, United States of America.
| | - Amina Shumake
- Yale Divinity School, Yale University, New Haven, CT, United States of America.
| | - Joel Lopez
- Yale School of Medicine, Yale University, New Haven, CT, United States of America.
| | - Angela M Haeny
- Yale School of Medicine, Yale University, New Haven, CT, United States of America.
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Haeny AM, McCuistian C, Burlew AK, Ruglass LM, Espinosa A, Jordan A, Roundtree C, Lopez J, Morgan-López AA. Integrative data analysis of clinical trials network studies to examine the impact of psychosocial treatments for black people who use cocaine: Study protocol. Contemp Clin Trials 2023; 133:107329. [PMID: 37652354 PMCID: PMC10635737 DOI: 10.1016/j.cct.2023.107329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Cocaine overdose death rates among Black people are higher than that of any other racial/ethnic group, attributable to synthetic opioids in the cocaine supply. Understanding the most effective psychostimulant use treatment interventions for Black people is a high priority. While some interventions have proven effective for the general population, their comparative effectiveness among Black people remains unknown. To address this gap, our NIDA-funded Clinical Trials Network (CTN) study (0125), will use Integrative Data Analysis (IDA) to examine treatment effectiveness across 9 CTN studies. This manuscript describes the study protocol for CTN-0125. METHODS Of the 59 completed randomized clinical trials in the CTN with available datasets, nine met our inclusion criteria: 1) behavioral intervention, 2) targeted cocaine use or use disorder, 3) included sub-samples of participants who self-identified as Black and 4) included outcome measures of cocaine and psychostimulant use and consequences. We aim to 1) estimate scale scores of cocaine use severity while considering study-level measurement non-invariance, 2) compare the effectiveness of psychosocial treatments for psychostimulant use, and 3) explore individual (e.g., concomitant opioid use, age, sex, employment, pre-treatment psychiatric status) and study-level moderators (e.g., attendance/retention) to evaluate subgroup differences in treatment effectiveness. CONCLUSION The NIDA CTN provides a unique collection of studies that can offer insight into what interventions are most efficacious for Black people. Findings from our CTN-0125 study have the potential to substantially inform treatment approaches specifically designed for Black people who use psychostimulants.
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Affiliation(s)
- Angela M Haeny
- Department of Psychiatry, Yale School of Medicine, United States of America
| | - Caravella McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, United States of America.
| | - A Kathleen Burlew
- Department of Psychology, University of Cincinnati, United States of America
| | - Lesia M Ruglass
- Department of Psychology, The City College of New York and The Graduate Center, CUNY, United States of America
| | - Adriana Espinosa
- Department of Psychology, The City College of New York and The Graduate Center, CUNY, United States of America
| | - Ayana Jordan
- Department of Psychiatry, Department of Population Health, NYU Grossman School of Medicine, United States of America
| | | | - Joel Lopez
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, United States of America
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Crouch MC, Venner KL, Wendt DC, Burlew AK, Baukol P, Funaro MC, Sorrell T, Haeny AM. Lessons learned and future directions: A scoping review of American Indian and Alaska Native participants in the National Drug Abuse Treatment Clinical Trials Network. J Subst Use Addict Treat 2023; 153:209081. [PMID: 37230391 PMCID: PMC10529616 DOI: 10.1016/j.josat.2023.209081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/09/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION American Indian and Alaska Native (AI/AN) populations are disproportionately affected by substance use disorders (SUDs) and related health disparities in contrast to other ethnoracial groups in the United States. Over the past 20 years, substantial resources have been allocated to the National Institute on Drug Abuse Clinical Trials Network (CTN) to disseminate and implement effective SUD treatments in communities. However, we know little about how these resources have benefitted AI/AN peoples with SUD who arguably experience the greatest burden of SUDs. This review aims to determine lessons learned about AI/AN substance use and treatment outcomes in the CTN and the role of racism and Tribal identity. METHOD We conducted a scoping review informed by the Joanna Briggs framework and PRISMA Extension for Scoping Reviews checklist and explanation. The study team conducted the search strategy within the CTN Dissemination Library and nine additional databases for articles published between 2000 and 2021. The review included studies if they reported results for AI/AN participants. Two reviewers determined study eligibility. RESULTS A systematic search yielded 13 empirical articles and six conceptual articles. Themes from the 13 empirical articles included: (1) Tribal Identity: Race, Culture, and Discrimination; (2) Treatment Engagement: Access and Retention; (3) Comorbid Conditions; (4) HIV/Risky Sexual Behaviors; and (5) Dissemination. The most salient theme was Tribal Identity: Race, Culture, and Discrimination, which was present in all articles that included a primary AI/AN sample (k = 8). Themes assessed but not identified for AI/AN peoples were Harm Reduction, Measurement Equivalence, Pharmacotherapy, and Substance Use Outcomes. The conceptual contributions used AI/AN CTN studies as exemplars of community-based and Tribal participatory research (CBPR/TPR). CONCLUSION CTN studies conducted with AI/AN communities demonstrate culturally congruent methods, including CBPR/TPR strategies; consideration/assessment of cultural identity, racism, and discrimination; and CBPR/TPR informed dissemination plans. Although important efforts are underway to increase AI/AN participation in the CTN, future research would benefit from strategies to increase participation of this population. Such strategies include reporting AI/AN subgroup data; addressing issues of cultural identity and experiences of racism; and adopting an overall effort for research aimed at understanding barriers to treatment access, engagement, utilization, retention, and outcomes for both treatment and research disparities for AI/AN populations.
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Affiliation(s)
- Maria C Crouch
- Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, United States.
| | - Kamilla L Venner
- University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131-0001, United States
| | - Dennis C Wendt
- McGill University, 3700 McTavish St., Room 614, Montreal, QC H3A 1Y2, Canada
| | - Ann Kathleen Burlew
- University of Cincinnati, 2600 Clifton Ave., Cincinnati, OH 45220, United States
| | - Paulette Baukol
- Berman Center for Outcomes & Clinical Research, 701 Park Ave., Suite PP7.700, Minneapolis, MN 55415, United States
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, 333 Cedar St, New Haven, CT 06510, United States
| | - Tanya Sorrell
- Rush University Medical Center, 1645 W Jackson Blvd, Westgate Building, Suite 600, Chicago, IL 60612, United States
| | - Angela M Haeny
- Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, United States
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Haeny AM, Lopez JA, Colón Grigas PA, Crouch MC, Davis AK, Williams M. Investigating the associations of acute psychedelic experiences and changes in racial trauma symptoms, psychological flexibility, and substance use among People with Racial and Ethnic Minoritized Identities in the United States and Canada. J Subst Use Addict Treat 2023; 149:209035. [PMID: 37019336 DOI: 10.1016/j.josat.2023.209035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/03/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Evidence suggests that psychedelics may serve as a therapeutic approach to reduce substance use; however, people with racial and ethnic minoritized (REM) identities are often excluded from this research. We investigated whether psychedelic use affects other substance use among REM people and whether perceived changes in psychological flexibility and racial trauma mediates this association. METHODS REM people in the United States and Canada (N = 211; 32 % Black, 29 % Asian, 18 % American Indian/Indigenous Canadian, 21 % Native Hawaiian/Pacific Islander; 57 % female; mean age = 33.1, SD = 11.2) completed an online survey retrospectively reporting their substance use, psychological flexibility, and racial trauma symptoms 30 days before and after their most memorable psychedelic experience. RESULTS Analyses showed a significant perceived reduction in alcohol (p < .0001, d = 0.54) and drug use (p = .0001, d = 0.23) from before to after the psychedelic experience. Preliminary associations found perceived reductions in racial trauma symptoms were associated with perceived reductions in alcohol use and this association varied by race, dose, ethnic identity, and change in depressive symptoms. Specifically, Indigenous participants experienced greater perceived reductions in alcohol use relative to participants who identified as Asian, Black, or other. Those who took a high dose of psychedelics experienced greater perceived reductions in alcohol use relative to those who took a low dose. Participants with a stronger ethnic identity and those with a perceived reduction in depressive symptoms experienced a perceived reduction in alcohol use. Serial mediation indicated a perceived increase in psychological flexibility and reduction in racial trauma symptoms mediated the association between acute psychedelic effects and perceived reductions in alcohol and drug use. CONCLUSION These findings suggest that psychedelic experiences may contribute to an increase in psychological flexibility and reduction in racial trauma symptoms and alcohol and drug use among REM people. REM people have been largely excluded from psychedelic treatment research even though psychedelic use is considered a traditional healing practice in many communities of color. Longitudinal studies of REM people should replicate our findings.
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Affiliation(s)
- Angela M Haeny
- Yale School of Medicine, 34 Park St, New Haven, CT 06519, USA.
| | - Joel A Lopez
- University of Connecticut, Department of Psychological Sciences, 406 Unit 1020, Babbidge Rd., Storrs, CT 06269, USA
| | - Pamela A Colón Grigas
- University of Connecticut, Department of Psychological Sciences, 406 Unit 1020, Babbidge Rd., Storrs, CT 06269, USA
| | - Maria C Crouch
- Yale School of Medicine, 34 Park St, New Haven, CT 06519, USA
| | - Alan K Davis
- Center for Psychedelic Drug Research and Education, The Ohio State University, College of Social Work, 1947 College Rd N., Columbus, OH 43210, USA; The Ohio State University, Department of Psychiatry, 370 W. 9th Avenue, Columbus, OH 43210, USA; Center for Psychedelic and Consciousness Research, Johns Hopkins University, 5510 Nathan Shock Rd., Baltimore, MD, USA
| | - Monnica Williams
- University of Ottawa, Faculty of Social Sciences, 120 University Private Social Sciences Building, Ottawa, Ontario K1N 6N5, Canada
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11
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Haeny AM, Holmes SC, Woerner J, Hicks TA, Ahuja M, Overstreet C, Amstadter A, Sartor CE. The Associations of Racial Discrimination and Neighborhood Disadvantage With World Assumptions Among Black, Latine, and Asian Young Adults. J Interpers Violence 2023; 38:6798-6818. [PMID: 36433838 PMCID: PMC10211824 DOI: 10.1177/08862605221137701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The theory of shattered assumptions proposes that experiencing traumatic events can change how people view themselves and the world. Most adults experience a traumatic event during their lifetime, and some subsequently develop post-traumatic stress disorder (PTSD). However, the current conceptualization of trauma (i.e., Criterion A PTSD) may be too narrow to adequately capture the range of potentially traumatizing events that People of Color experience, including racial discrimination and neighborhood disadvantage. This study investigated the association of racial discrimination and neighborhood disadvantage with core beliefs about the world being safe and predictable (i.e., world assumptions) among a sample of Black, Latine, and Asian young adults. Multi-step analyses of covariance tested associations between racial discrimination and neighborhood disadvantage with world assumptions and whether these held in the context of other traumatic exposures. Results indicated that racial discrimination negatively impacted world assumptions among Asian young adults only and this effect remained in the context of trauma. In addition, low neighborhood support negatively impacted world assumptions across all racial groups and neighborhood violence negatively impacted world assumptions among Latine young adults only; however, this effect did not remain in the context of trauma. This study indicates it is worthwhile to consider other adverse events in the conceptualization of trauma, such as racial discrimination and neighborhood disadvantage, that may impact world assumptions and contribute to subsequent post-trauma psychopathology.
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Affiliation(s)
| | | | | | | | - Manik Ahuja
- East Tennessee State University, Johnson City, USA
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12
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Cox JM, Toussaint A, Woerner J, Smith A, Haeny AM. Coping While Black: Comparing Coping Strategies Across COVID-19 and the Killing of Black People. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01600-x. [PMID: 37099239 PMCID: PMC10132418 DOI: 10.1007/s40615-023-01600-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/27/2023]
Abstract
In the same year the world was thrown into turmoil with COVID-19, the USA also experienced a surge in attention given to the plight of Black people in the policing system, following the killing of George Floyd. Both the COVID-19 pandemic and the ongoing "pandemic" of police and White violence against Black people in the USA cause significant amounts of stress, disproportionately affecting Black people. Utilizing qualitative analysis of responses from 128 Black-identifying participants to an online survey, this investigation seeks to understand how the coping strategies of Black people in the USA compare between the racism-related stressor of police killings of Black people and the generalized stressor of the COVID-19 pandemic. Findings demonstrate that while Black people use overlapping strategies to deal with stress, clear patterns exist with regard to differences across racism-related and non-racism-related stressors. We report important implications for understanding the impact of COVID-19 on Black people, cultural understandings of research on coping, and Black mental health more broadly.
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Affiliation(s)
- Jonathan M Cox
- Department of Sociology, University of Central Florida, Orlando, FL, USA.
| | - Anaïs Toussaint
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Jacqueline Woerner
- Department of Sociology, University of Central Florida, Orlando, FL, USA
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Andrea Smith
- Department of Sociology and Criminology, The University of Iowa, Iowa City, IA, USA
| | - Angela M Haeny
- Department of Psychiatry, Yale University, New Haven, CT, USA
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13
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Jackson A, Fleischli ME, Haeny AM, Rose SW, Fagan P, Krishnan-Sarin S, Gerrard M, Gibbons FX. Association of Non-Cigarette Tobacco Advertisements and Racial Discrimination With Non-Cigarette Tobacco Product Use Among Black Adults. Nicotine Tob Res 2023; 25:781-787. [PMID: 36169563 PMCID: PMC10032198 DOI: 10.1093/ntr/ntac226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 09/11/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Black communities are targeted by more cigarette advertisements than White communities and racial discrimination among Black people is related to cigarette use. However, little is known about these factors with non-cigarette tobacco product use among Black adults. Therefore, this study assessed the association of non-cigarette advertisement exposure and racial discrimination with use of non-cigarette tobacco products among Black adults. AIMS AND METHODS Black adults (n = 533) from The Family and Community Health Study in 2016 were asked if they had seen advertisements for e-cigarettes, snus pouches, filtered cigars, large cigars, cigarillos, dissolvable tobacco, smokeless tobacco, hookah, and tobacco pipe and if they used these in the past month. For products with the highest past month use and significant correlations with advertisement exposure, separate logistic regression models were performed that evaluated the association between advertisement exposure, racial discrimination, and non-cigarette tobacco product use while controlling for cigarette use, sex, socioeconomic status, and age. RESULTS Use of cigarillos, large cigars, and hookah were higher than other non-cigarette tobacco products assessed. Logistic regressions revealed that more advertisement exposure in the past month was associated with higher odds of using cigarillos, large cigars, and hookah (p < .01). More experiences of racial discrimination were associated with past month cigarillo use, but not hookah or large cigars (p < .01). CONCLUSIONS Non-cigarette tobacco advertisement exposure was associated with the use of non-cigarette tobacco products. Experiences of racial discrimination were associated with the most used non-cigarette tobacco product among Black adults, cigarillos. IMPLICATIONS This is the first time that a specific type of cigar (ie cigarillos) has been associated with experiences of racial discrimination among Black adults. Efforts to reduce non-cigarette tobacco marketing and eradicate exposure to racial discrimination among Black adults may aid in eliminating tobacco-related health disparities.
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Affiliation(s)
- Asti Jackson
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Mary E Fleischli
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Angela M Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Shyanika W Rose
- Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA
| | - Pebbles Fagan
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Meg Gerrard
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Frederick X Gibbons
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
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14
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De Leon AN, Woerner J, Dvorak RD, Cox J, Magri TD, Hayden ER, Ahuja M, Haeny AM. An Examination of Discrimination on Stress, Depression, and Oppression-Based Trauma During the COVID-19 Pandemic and the Racial Awakening of 2020. Chronic Stress (Thousand Oaks) 2023; 7:24705470231152953. [PMID: 36726452 PMCID: PMC9884951 DOI: 10.1177/24705470231152953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023]
Abstract
Background Discrimination is a pervasive societal issue that monumentally impacts people of color (POC). Many Black, Asian, and Hispanic/Latinx individuals report experiencing race-based discrimination in their lifetime. Discrimination has previously been linked to adverse health outcomes among POC, including stress, depressive, and posttraumatic stress disorder symptoms. These health disparities are posited to have become exacerbated by COVID-19 and the racial awakening of 2020. The current study examined the short- and long-term effects of discrimination on stress, depression, and oppression-based trauma among POC. Methods Participants were (n = 398) who identified as Black, Indigenous, Hispanic/Latinx, and Asian completed an online self-report survey assessing discrimination, depression, stress, and oppression-based trauma collected at 3 time points: (T1) beginning of the COVID-19 pandemic (May 2020), (T2) 6 weeks later during the racial awakening of 2020 (June 2020), (T3) one year later (June 2021). Results Significant positive paths were revealed from T1 discrimination to T2 depression, T2 stress, and T3 oppression-based trauma. The association between T1 discrimination and T3 oppression-based trauma was partially mediated by T2 depression, but not by stress; total and total indirect effects remained significant. The final model accounted for a significant proportion of the variance in T3 oppression-based trauma, T2 depression, and T2 stress. Conclusion Findings are consistent with prior research linking discriminatory experiences with mental health symptomatology and provide evidence that race-based discrimination poses harmful short-and long-term mental health consequences. Further research is necessary to better understand oppression-based trauma to improve the accuracy of clinical diagnosis and treatment of POC.
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Affiliation(s)
- Ardhys N. De Leon
- University of Central
Florida, Orlando, FL, USA
- Ardhys De Leon, University of Central
Florida, Orlando, FL 32816, USA.
| | | | | | | | | | | | - Manik Ahuja
- East Tennessee State
University, Johnson City, TN, USA
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15
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Haeny AM, Gibbons FX, Fleischli ME, Gerrard M, Lopez J, Beach SRH. Racial centrality mediates the association between adolescent racial discrimination and adult cigarette smoking outcomes among Black Americans. Soc Sci Med 2023; 316:115225. [PMID: 35931591 PMCID: PMC10163899 DOI: 10.1016/j.socscimed.2022.115225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 07/01/2022] [Accepted: 07/15/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The objective of this study was to investigate racial centrality as a mediator of the association between Black adolescents' racial discrimination experiences and their cigarette use in early adulthood. METHODS The data were drawn from the Family and Community Health Study, which is a longitudinal study of Black American families that began in 1996. Families with a child in 5th grade who identified as Black or African American were recruited from Iowa and Georgia. At baseline, there were 838 Black American children. Hierarchical regressions and bootstrap tests of the indirect effects were used to investigate whether racial centrality at Wave 5 (mean age = 21.6 years) mediated the association between adolescent discrimination at Waves 1-4 (mean ages = 10.5-18.8 years) and adult cigarette use at wave 6 (mean age = 23.5 years). RESULTS Bivariate associations indicated racial discrimination was significantly associated positively with racial centrality and adult use of cigarettes. Racial centrality indirectly affected the association between racial discrimination and cigarette use such that greater racial centrality was associated with less cigarette use. Further, racial centrality predicted cessation among those who had smoked. Finally, racial centrality was higher among those who never smoked and those who had smoked and quit, relative to those who currently smoke. CONCLUSIONS These findings suggest that having strong Black racial centrality is a mediator that reduces the risk of cigarette use among young adults who experience racial discrimination in adolescence. In addition, racial centrality also predicts smoking cessation among young Black Americans who smoke. Translational implications of these findings are discussed.
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16
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Jegede O, Na PJ, Haeny AM, Krystal JH, Pietrzak RH. Association of Distress Due to Systemic Racism and Racial Disparities With Psychopathology and Suicidal Ideation Among US Veterans During the COVID-19 Pandemic. J Clin Psychiatry 2022; 83. [PMID: 35921504 PMCID: PMC10228546 DOI: 10.4088/jcp.22br14410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Oluwole Jegede
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Connecticut Mental Health Center, New Haven, Connecticut.,*Corresponding author: Oluwole Jegede, MD, MPH, Yale University School of Medicine, 300 George St #901, New Haven, CT 06511
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,VA Connecticut Healthcare System, New Haven, Connecticut
| | - Angela M Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - John H Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
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17
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Haeny AM, Polimanti R. From Evolutionary History to the Concepts of Race and Ancestry: Shifting Our Perspective in Clinical Research. Biol Psychiatry 2022; 91:e51-e52. [PMID: 35483984 PMCID: PMC9527646 DOI: 10.1016/j.biopsych.2022.02.953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Angela M Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Veteran Affairs CT Healthcare System, West Haven, Connecticut
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18
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Ahuja M, Haeny AM, Sartor CE, Bucholz KK. Perceived racial and social class discrimination and cannabis involvement among Black youth and young adults. Drug Alcohol Depend 2022; 232:109304. [PMID: 35124388 DOI: 10.1016/j.drugalcdep.2022.109304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/09/2021] [Accepted: 12/10/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The current study examines the association of perceived racial and social class discrimination with cannabis involvement among Black youth and young adults. METHODS This secondary analysis used data from the Missouri Family Study (MOFAM), a high-risk longitudinal family study of alcohol use disorder, oversampled for Black families. Offspring (n = 806) and their mothers were interviewed by telephone. Cox proportional hazards regression analyzes were used to examine associations of racial and social class discrimination (experienced by offspring and their mothers) with offspring cannabis involvement. Two stages of cannabis involvement were analyzed: timing of 1) initiation and 2) transition from initiation to first cannabis use disorder (CUD) symptom. RESULTS The study found that offspring report of experiencing racial (HR: 1.28, CI: 1.01-1.62) and social class discrimination (HR: 1.45, CI: 1.14-1.84) were associated with cannabis initiation in our fully adjusted model. Mothers' report of discrimination predicted a lower hazard of cannabis initiation among offspring (HR: 0.79, CI: 0.64-0.98). Offspring social class discrimination (HR: 2.45, CI: 1.71-3.51) predicted an increased hazard of transition from initiation to first CUD symptom, while offspring racial discrimination (HR: 0.57, CI: 0.39-0.85) was associated with lower hazard of transition in our fully adjusted model. CONCLUSIONS As rates for cannabis use among Black youth are disproportionately rising, there is a critical need to identify pathways to its use among Black youth. These findings suggest racial and social class discrimination may be important targets in efforts to prevent cannabis involvement among Black youth and emerging adults.
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Affiliation(s)
- Manik Ahuja
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, United States.
| | - Angela M Haeny
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Carolyn E Sartor
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Department of Psychiatry, Washington University School of Medicine, United States
| | - Kathleen K Bucholz
- Department of Psychiatry, Washington University School of Medicine, United States
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19
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Haeny AM, Oluwoye O, Cruz R, Iheanacho T, Jackson AB, Fisher S, Crouch M, O'Malley S. Drug and alcohol treatment utilization and barriers among Black, American Indian/Alaskan Native, Latine, Asian/Pacific Islander/Native Hawaiian, and White adults: Findings from NESARC-III. J Subst Abuse Treat 2021; 131:108569. [PMID: 34393011 PMCID: PMC9084614 DOI: 10.1016/j.jsat.2021.108569] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/24/2021] [Accepted: 07/14/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Existing epidemiological data suggest differences across racial/ethnic groups in drug and alcohol treatment utilization and barriers to treatment and typically include only Black, Latine, and White adults. The objective of this study was to examine whether disparities remain for DSM-5 lifetime alcohol use disorder (AUD) and drug use disorder (DUD) treatment utilization and barriers across Black, American Indian/Alaska Native (AI/AN), Latine, Asian/Pacific Islander/Native Hawaiian (Asian/PI/NH), and White adults. METHODS The current study conducted secondary analyses on data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III). Regression analyses, followed by pairwise comparisons, investigated differences across racial/ethnic groups. RESULTS Analyses indicated differences across racial/ethnic groups in AUD treatment utilization. White and AI/AN adults were more likely to utilize a health care professional than were Black adults. Asian/PI/NH and Latine adults were more likely to endorse language as a barrier to AUD treatment than were White adults. Black adults were more likely to use 12-step programs for DUD treatment utilization than were White and Latine adults, and Black and White adults were more likely to use outpatient programs than were Latine adults. Further, Black adults were more likely than Asian/PI/NH and Latine adults to use specialty DUD treatment. AI/AN, Asian/PI/NH, and White adults were more likely to endorse fear of what others would think as a barrier to DUD treatment relative to Black adults. AI/AN adults were more likely to endorse fear of being hospitalized relative to Black, Latine, and White adults. Asian/PI/NH and Latine adults were more likely to indicate that the hours were inconvenient relative to Black and White adults. White adults were more likely to endorse a family member objected relative to Black adults. AI/AN and White adults were more likely to endorse they stopped on their own relative to Black, Asian/PI/NH, and Latine adults. Further, AI/AN and White adults reported the greatest number of barriers to DUD treatment. CONCLUSIONS Differences remain across racial/ethnic group in drug and alcohol treatment utilization and barriers to treatment. Future research aimed at increasing treatment utilization across racial/ethnic groups should focus on social determinants of health.
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Affiliation(s)
- Angela M Haeny
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States.
| | | | - Rick Cruz
- Utah State University, United States
| | - Theddeus Iheanacho
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
| | - Asti B Jackson
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
| | | | - Maria Crouch
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States; University of Alaska Anchorage, United States
| | - Stephanie O'Malley
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
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20
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Affiliation(s)
- Angela M. Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Samantha C. Holmes
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; and Department of Psychology, City University of New York, College of Staten Island, Staten Island
| | - Monnica T. Williams
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; and Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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21
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Abstract
With the increased desire to engage in antiracist clinical research, there is a need for shared nomenclature on racism and related constructs to help move the science forward. This article breaks down the factors that contributed to the development and maintenance of racism (including racial microaggressions), provides examples of the many forms of racism, and describes the impact of racism for all. Specifically, in the United States, racism is based on race, a social construct that has been used to categorize people on the basis of shared physical and social features with the assumption of a racial hierarchy presumed to delineate inherent differences between groups. Racism is a system of beliefs, practices, and policies that operate to advantage those at the top of the racial hierarchy. Individual factors that contribute to racism include racial prejudices and racial discrimination. Racism can be manifested in multiple forms (e.g., cultural, scientific, social) and is both explicit and implicit. Because of the negative impact of racism on health, understanding racism informs effective approaches for eliminating racial health disparities, including a focus on the social determinants of health. Providing shared nomenclature on racism and related terminology will strengthen clinical research and practice and contribute to building a cumulative science.
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Affiliation(s)
| | - Samantha C Holmes
- Department of Psychiatry, Yale School of Medicine.,Department of Psychology, College of Staten Island, The City University of New York
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22
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Haeny AM, Woerner J, Overstreet C, Hicks TA, Ahuja M, Amstadter AB, Sartor CE. Measurement invariance of the World Assumptions Questionnaire across race/ethnic group, sex, and sexual orientation. Psychol Trauma 2021; 13:522-527. [PMID: 33539161 PMCID: PMC8805146 DOI: 10.1037/tra0001001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The World Assumptions Questionnaire (WAQ) was developed to assess optimism and assumptions about the world, which often shift after traumatic events. However, no known study has investigated whether the WAQ holds similar meaning across demographic groups. The objective of this study was to investigate measurement invariance of the WAQ across race/ethnic group, sex, and sexual orientation. METHOD Participants consisted of 1,181 college students (75% female; 25% Black, 13% Latinx, 18% Asian, 45% White; 90% heterosexual) who completed an online survey on stress, personality, substance use, and mental health. We investigated a unidimensional and the 4-factor structure of the WAQ using confirmatory factor analysis, and configural, metric, and scalar invariance using multigroup confirmatory factor analysis. RESULTS After dropping 3 items, a 4-factor structure fit the data well (comparative fit index = .92; root mean square error of approximation =.05; 95% confidence interval [.045, .054]; standardized root mean square residual = .06). Mean WAQ scores were higher for participants with probable posttraumatic stress disorder on 2 of the 4 factors. We also identified multiple items that were not invariant across race/ethnic group, sex, and sexual orientation. However, after invariant items were removed, evidence of configural, scalar, and metric invariance was found. CONCLUSIONS This study replicated the 4-factor structure, mapping onto the 4 WAQ subscales, and indicated that a unidimensional measure of world assumptions should not be used. After making the adjustments recommended herein, the WAQ can be used to investigate differences across race/ethnic group, sex, and sexual orientation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Angela M. Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Jacqueline Woerner
- Department of Psychology and Sociology, University of Central Florida, Orlando, FL, United States
| | - Cassie Overstreet
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, United States
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Terrell A. Hicks
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, United States
| | - Manik Ahuja
- College of Public Health, East Tennessee State University, Johnson City, TN, United States
| | - Ananda B. Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, United States
| | - Carolyn E. Sartor
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
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23
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Haeny AM, Gueorguieva R, Jackson A, Morean ME, Krishnan-Sarin S, DeMartini KS, Pearlson GD, Anticevic A, Krystal JH, O'Malley SS. Individual differences in the associations between risk factors for alcohol use disorder and alcohol use-related outcomes. Psychol Addict Behav 2021; 35:501-513. [PMID: 34110841 PMCID: PMC9211405 DOI: 10.1037/adb0000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Family history of alcohol use disorder; AUD (FH +) and impulsivity-related traits are known risk factors for problem drinking that have been investigated in predominately White samples. This cross-sectional study examined whether these risk factors vary by sex in the overall, majority White sample and in a Black subsample. METHOD A model building regression procedure was used to investigate the combined effect of FH + and impulsivity-related traits on alcohol quantity, frequency, and problems by sex (overall sample: N = 757, 50% female, 73% White, agemean = 33.74, SD = 11.60; Black subsample: n = 138, 47% female, agemean = 33.60, SD = 9.87). RESULTS Overall Sample. No sex differences were found in the compounding effects of FH + and impulsivity-related traits on alcohol outcomes. Males reported more physical, social, and overall alcohol-related problems than females. FH + was positively associated with all alcohol-related consequences. Poor self-regulation was the only trait associated with all alcohol outcomes. Black Subsample: A three-way interaction suggested a negative association between inhibition and frequency of alcohol use among FH + males only. A two-way interaction also suggested impulse control was associated with more interpersonal alcohol-related problems among males only. Main effects were also found in the expected direction such that higher impulsivity and FH + were associated with poorer alcohol outcomes. CONCLUSION These findings suggest no sex differences in the overall sample in the interactive effects of established risk factors for AUD on alcohol outcomes, and that poor self-regulation may be key for personality-targeted alcohol prevention and intervention programs. Preliminary findings of sex differences in the Black subsample should be replicated. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Sartor CE, Haeny AM, Ahuja M, Bucholz KK. Social class discrimination as a predictor of first cigarette use and transition to nicotine use disorder in Black and White youth. Soc Psychiatry Psychiatr Epidemiol 2021; 56:981-992. [PMID: 33386872 PMCID: PMC8453663 DOI: 10.1007/s00127-020-01984-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To characterize the association of social class discrimination with the timing of first cigarette use and progression to DSM-IV nicotine dependence (ND) in Black and White youth, examining variation by race, parent vs. youth experiences of discrimination, socioeconomic status (SES), and stage of smoking. METHODS Data were drawn from 1461 youth (55.2% Black, 44.8% White; 50.2% female) and mothers in a high-risk family study of alcohol use disorder and related conditions. Cox proportional hazard regression analyses were conducted, using youth's and mother's social class discrimination to predict first cigarette use and progression to ND, stratifying by race. Interactions between discrimination and SES indicators (parental education and household income) were tested. Adjusted models included psychiatric covariates. RESULTS In the adjusted first cigarette use models, neither youth's nor mother's social class discrimination was a significant predictor among Black youth, but mother's discrimination was associated with increased risk [HR = 1.53 (1.18-1.99)] among White youth. In the adjusted ND models, mother's discrimination was associated with reduced ND risk for Black youth in middle-income families [HR = 0.29 (CI 0.13-0.63)], but neither youth's nor mother's discrimination predicted transition to ND among White youth. CONCLUSIONS The observed race and smoking stage-specific effects suggest that social class discrimination is more impactful on early stages of smoking for White youth and later stages for Black youth. The robustness of links with mother's discrimination experiences further suggests the importance of considering family-level effects and the need to explore possible mechanisms, such as socialization processes.
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Affiliation(s)
- Carolyn E Sartor
- Department of Psychiatry, Yale School of Medicine, 389 Whitney Avenue, New Haven, CT, 06511, USA.
- Department of Psychiatry, Washington University School of Medicine, 660 Euclid Avenue, St. Louis, MO, 63116, USA.
| | - Angela M Haeny
- Department of Psychiatry, Yale School of Medicine, 389 Whitney Avenue, New Haven, CT, 06511, USA
| | - Manik Ahuja
- Department of Health Services Management and Policy, East Tennessee State University, College of Public Health, J1276 Gilbreath Drive, Johnson City, TN, 37614, USA
| | - Kathleen K Bucholz
- Department of Psychiatry, Washington University School of Medicine, 660 Euclid Avenue, St. Louis, MO, 63116, USA
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Haeny AM, Kiluk BD, Nich C, LaPaglia DM, Carroll KM. Measurement invariance of the Barratt Impulsiveness Scale across black and white adults with cocaine use disorder. Addict Behav 2021; 114:106721. [PMID: 33162231 DOI: 10.1016/j.addbeh.2020.106721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022]
Abstract
This study tests for measurement invariance of impulsivity assessed by the Barratt Impulsiveness Scale (BIS) across Black and White adults with cocaine use disorder and examines the association of BIS impulsivity with treatment retention and outcomes. Data from four clinical trials were combined providing a total sample of 302 participants with cocaine abuse/dependence (42% Black, 58% White, 44% female, agemean = 40.22, SD = 9.26). We used multi-group confirmatory factor analyses to test for measurement invariance across race and examined bivariate correlations between BIS impulsivity and treatment retention and outcomes by race. Factor analyses indicated a 22-item, two-factor (motor impulsiveness and nonplanning impulsiveness) brief BIS fit the data best (RMSEA = 0.073 [90% CI: 0.065-0.080]; CFI = 0.904; TLI = 0.893; SRMR = 0.073) and was configural, metric, and scalar invariant across race. Higher motor impulsiveness was associated with higher percentage cocaine negative urines in the overall sample (r = -0.15, p = .01), but this association only remained in the Black subsample when examined across race (r = 0.28, p < .001). Higher motor impulsiveness was also associated with increased days abstinent from cocaine in the Black subsample only (r = 0.28, p < .001). Nonplanning impulsiveness was associated with lower percentage of treatment days abstinent from cocaine in the White subsample only (r = -0.16, p = .045). These findings 1) provide evidence for a 21-item, two-factor brief BIS that is invariant across Black and White adults with cocaine use disorder, and 2) suggest that BIS impulsivity may be associated with poorer cocaine treatment outcomes among White but not Black adults.
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Affiliation(s)
- Angela M Haeny
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States.
| | - Brian D Kiluk
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
| | - Charla Nich
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
| | - Donna M LaPaglia
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
| | - Kathleen M Carroll
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
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Sartor CE, Woerner J, Haeny AM. The contributions of everyday and major experiences of racial discrimination to current alcohol use and regular smoking in Black adults: Considering variation by demographic characteristics and family history. Addict Behav 2021; 114:106711. [PMID: 33153774 DOI: 10.1016/j.addbeh.2020.106711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/25/2020] [Accepted: 10/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Racial discrimination has consistently been linked to elevated alcohol use and smoking in Black adults, but the independent contributions of everyday and major experiences of discrimination have rarely been investigated. The present study aimed to identify variation in magnitude of the links between each type of racial discrimination with current frequency of alcohol use and regular smoking by demographic characteristics and family history of problem drinking/regular smoking in Black adults in the U.S. METHODS Data were drawn from 4462 adults (29.40% Afro Caribbean, 70.60% African American; 63.20% female) in a nationally representative sample of Black Americans. Logistic regression analyses were conducted to predict current frequency of alcohol use and regular smoking using the Everyday Discrimination Scale (EDS) and Major Experiences of Discrimination Scale (MEDS), testing for interactions with demographic characteristics and family history. RESULTS In the alcohol model, an EDS by education level interaction was observed: OR = 1.04 (CI:1.02-1.07) for < high school; OR = 0.95 (CI:0.92-0.98) for ≥ high school. MEDS was independently associated with alcohol use (OR = 1.11, CI:1.04-1.18). In the smoking model, EDS was associated with elevated risk (OR = 1.03, CI:1.01-1.04) and a MEDS by age cohort interaction was observed: OR = 1.24 (CI:1.11-1.38) for <age 45; OR = 1.07 (CI:0.97-1.19) for ages 45-65. CONCLUSIONS Everyday and major experiences of racial discrimination contribute independently to both alcohol use and regular smoking in Black adults, with some variation by education level and age. Differentiating everyday from major experiences of discrimination in studies of mechanisms linking racial discrimination to substance use will enhance their informativeness for intervention development.
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Affiliation(s)
- Carolyn E Sartor
- Department of Psychiatry, Yale School of Medicine, 389 Whitney Avenue, New Haven, CT 06511, USA.
| | - Jacqueline Woerner
- Departments of Psychology and Sociology, University of Central Florida, 4297 Andromeda Loop N., Orlando, FL 32816, USA.
| | - Angela M Haeny
- Department of Psychiatry, Yale School of Medicine, 389 Whitney Avenue, New Haven, CT 06511, USA.
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Ahuja M, Records K, Haeny AM, Gavares EM, Mamudu HM. The association between experiencing police arrest and suicide ideation among emerging young adults: Does race matter? Health Psychol Open 2021; 8:20551029211026027. [PMID: 34221440 PMCID: PMC8221685 DOI: 10.1177/20551029211026027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of the study was to examine the association between lifetime arrest and marijuana-related first arrest with past-year suicide ideation among Black and White people. We used data from Wave-IV (2008-2009; N = 5114) of the publicly available National Adolescent Health Study (Add Health) data. A total of 4313 Non-Hispanic Black and White participants were selected for this study. Logistic regression was used to assess whether lifetime arrest and marijuana-related arrests were associated with past year suicide. Overall, 28.8% of the sample reported lifetime arrest, 6.3% reported lifetime suicide ideation, and 3.7% reported marijuana-related arrest. A significantly higher percentage of Black people (32.3%) in comparison to White people (27.4%) reported lifetime arrest (χ2 = 9.91; p < 0.001; df = 1). Among Black people, lifetime arrest (AOR = 2.98; 95% CI, 1.66-5.35; p < 0.001) and marijuana-related arrest (AOR = 4.09; 95% CI, 1.47-11.35; p < 0.001) were both associated with lifetime suicide ideation. Given the rate of death by suicide among Black people has been rising for two decades, further efforts are needed to educate and inform key stakeholders including law enforcement and policymakers regarding racial disparities in arrests, which may contribute to reducing risk for death by suicide among Black people.
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Williams MT, Davis AK, Xin Y, Sepeda ND, Grigas PC, Sinnott S, Haeny AM. People of color in North America report improvements in racial trauma and mental health symptoms following psychedelic experiences. Drugs (Abingdon Engl) 2020; 28:215-226. [PMID: 34349358 PMCID: PMC8330400 DOI: 10.1080/09687637.2020.1854688] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This study examined how psychedelics reduced symptoms of racial trauma among black, indigenous, and people of color (BIPOC) subsequent to an experience of racism. A cross-sectional internet-based survey included questions about experiences with racism, mental health symptoms, and acute and enduring psychedelic effects. Changes in mental health were assessed by retrospective report of symptoms in the 30 days before and 30 days after an experience with psilocybin, Lysergic acid diethylamide (LSD), or 3,4-Methylenedioxymethamphetamine (MDMA). We recruited 313 diverse BIPOC in the US and Canada. Results revealed a significant (p < .001) and moderate (d = −.45) reduction in traumatic stress symptoms from before-to-after the psychedelic experience. Similarly, participants reported decreases in depression (p < .001; d = −.52), anxiety (p < .001; d = −.53), and stress (p < .001; d = −.32). There was also a significant relationship (Rc = 0.52, p < .001) between the dimension of acute psychedelic effects (mystical-type, insight, and challenging experiences) and decreases in a cluster of subsequent psychopathology (traumatic stress, depression, anxiety, and stress), while controlling for the frequency of prior discrimination and the time since the psychedelic experience. BIPOC have been underrepresented in psychedelic studies. Psychedelics may decrease the negative impact of racial trauma. Future studies should examine the efficacy of psychedelic-assisted therapy for individuals with a history of race-based trauma.
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Affiliation(s)
- Monnica T Williams
- School of Psychology, University of Ottawa, Ottawa, Canada.,Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Alan K Davis
- College of Social Work, The Ohio State University, Columbus, OH, USA.,Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Yitong Xin
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Nathan D Sepeda
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Pamela Colόn Grigas
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Sinead Sinnott
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Angela M Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Haeny AM, Montgomery L, Burlew AK, Campbell ANC, Scodes J, Pavlicova M, Rotrosen J, Nunes E. Extended-release naltrexone versus buprenorphine-naloxone to treat opioid use disorder among black adults. Addict Behav 2020; 110:106514. [PMID: 32619868 PMCID: PMC7433932 DOI: 10.1016/j.addbeh.2020.106514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/16/2020] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
Abstract
Few studies examine the effectiveness of treatments for opioid use disorder (OUD) among Black individuals despite recent evidence suggesting opioid overdose death rates are, in some cases, highest and increasing at a faster rate among Black people compared to other racial/ethnic groups. This secondary analysis study investigated treatment preference, retention, and relapse rates amongst a subgroup of 73 Black participants with OUD (81% male, mean age 39.05, SD = 11.80) participating in a 24-week multisite randomized clinical trial ("X:BOT") comparing the effectiveness of extended-release naltrexone (XR-NTX) and sublingual buprenorphine-naloxone (BUP-NX) between 2014 and 2017. Chi-square analyses were used to investigate treatment preference assessed at baseline, and logistic regression analyses were used to investigate differences in the odds of retention and relapse assessed over the 24-week course of treatment between treatment groups. Our findings suggest no differences in preference for XR-NTX versus BUP-NX. However, similar to the parent trial, there was an induction hurdle such that only 59.5% of those randomized to XR-NTX successfully initiated medication compared to 91.6% of those randomized to BUP-NX (OR = 0.13, 95% CI = 0.04, 0.52). No significant differences were found in treatment retention (intention-to-treat: OR = 1.19, 95% CI = 0.43, 3.28; per-protocol [i.e., those who initiated medication]: OR = 0.60, 95% CI = 0.20, 1.82) or relapse rates between treatment groups (intention-to-treat: OR = 1.53, 95% CI = 0.57, 4.13; per-protocol: OR = 0.69, 95% CI = 0.23, 2.06). Although there is a significant initiation hurdle with XR-NTX, once inducted, both medications appear similar in effectiveness, but as in the main study, dropout rates were high. Future research is needed on how to improve adherence.
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Affiliation(s)
- Angela M Haeny
- Yale School of Medicine, Department of Psychiatry, 34 Park St., New Haven, CT 06511, United States.
| | - LaTrice Montgomery
- University of Cincinnati, Department of Psychiatry and Behavioral Neuroscience, 3131 Harvey Avenue., Cincinnati, OH 45229, United States
| | - A Kathleen Burlew
- University of Cincinnati, Department of Psychology, 2600 Clifton Ave., Cincinnati, OH 45221, United States
| | - Aimee N C Campbell
- Columbia University Irving Medical Center, Department of Psychiatry and New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY 10032, United States
| | - Jennifer Scodes
- Columbia University Irving Medical Center, Department of Psychiatry and New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY 10032, United States
| | - Martina Pavlicova
- Columbia University Irving Medical Center, Department of Psychiatry and New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY 10032, United States
| | - John Rotrosen
- New York University Grossman School of Medicine, One Park Ave., New York, NY 10016, United States
| | - Edward Nunes
- Columbia University Irving Medical Center, Department of Psychiatry and New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY 10032, United States
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Ahuja M, Haeny AM, Sartor CE, Bucholz KK. Gender discrimination and illicit drug use among African American and European American adolescents and emerging adults. Psychol Addict Behav 2020; 35:310-319. [PMID: 32914989 DOI: 10.1037/adb0000683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: The present study aimed to characterize the association of perceived gender discrimination and illicit drug use among a sample of African American (AA) and European American (EA) adolescent girls and young women. Method: Data were drawn from a high-risk family study of alcohol use disorder of mothers and their offspring (N = 735). Multinomial regressions were used to examine whether experience of offspring and maternal gender discrimination were associated with offspring illicit drug use (cannabis, cocaine, ecstasy, PCP, opiates, hallucinogens, solvents, sedatives, or inhalants). Outcomes included offspring age of drug use initiation (age ≤ 14) and lifetime heavy drug use (≥ 50 times) of 1 or more illicit substances. Interactions between race and offspring gender discrimination were modeled to assess for race differences. Results: Results revealed that gender discrimination was associated with a greater likelihood of offspring early initiation (relative risk ratio [RRR] = 2.57, 95% CI [1.31, 5.03]) versus later initiation (RRR = 1.33, 95% CI [0.80, 2.24]). Offspring gender discrimination was associated with offspring heavy drug use (RRR = 2.09, 95% CI [1.07, 4.06]) and not associated with moderate/light use (RRR = 1.44, 95% CI [0.86, 2.42]), but post hoc tests revealed no significant group differences. Conclusions: Findings suggest that perceived offspring gender discrimination is associated with early drug use initiation. Gender discrimination, particularly at an early age, has a potential to cause harm, including drug use. Implementation of policies that foster environments that eliminate gender bias and discrimination at an early age should be prioritized. Gender-responsive treatment merits consideration by substance use treatment providers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Manik Ahuja
- Department of Health Services Management and Policy
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31
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Haeny AM, Woerner J, Ahuja M, Hicks TA, Overstreet C, Amstadter A, Sartor CE. The impact of world assumptions on the association between discrimination and internalizing and substance use outcomes. J Health Psychol 2020; 26:2688-2698. [PMID: 32498568 DOI: 10.1177/1359105320931185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study investigated whether core beliefs about the world being safe and predictable (i.e. world assumptions) mediated the association between discrimination and internalizing and substance use problems among individuals from marginalized groups. Path analyses tested mediating effects of four types of world assumptions on the association between discrimination (race-, gender-, and sexual orientation-based) and anxiety, depression, alcohol and cannabis problems in college students (N = 1,181, agemean = 19.50, SD = 1.67). Limited support for mediation by world assumptions was found: among Asian students, race-based discrimination indirectly impacted anxiety symptoms through low perceived controllability of events. Direct effects across groups and discrimination types were also found.
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Affiliation(s)
| | | | | | | | - Cassie Overstreet
- Yale School of Medicine, USA.,Virginia Commonwealth University, USA.,VA Connecticut Healthcare System, USA
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Eghaneyan BH, Sanchez K, Haeny AM, Montgomery L, Lopez-Castro T, Burlew AK, Rezaeizadeh A, Killian MO. Hispanic participants in the National Institute on Drug Abuse's Clinical Trials Network: A scoping review of two decades of research. Addict Behav Rep 2020; 12:100287. [PMID: 32637563 PMCID: PMC7330873 DOI: 10.1016/j.abrep.2020.100287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/10/2020] [Accepted: 05/25/2020] [Indexed: 01/08/2023] Open
Abstract
Hispanics experience multiple structural barriers to adequate substance use treatment. Effective interventions for Hispanic populations exist. Measurement equivalence and culturally-tailored programs are essential.
Introduction Hispanics significantly underutilize substance abuse treatment and are at greater risk for poor treatment outcomes and dropout. Two decades of research from the National Drug Abuse Treatment Clinical Trials Network (CTN) offers an opportunity to increase our understanding in how to address the disparities experienced by Hispanics in substance abuse treatment. Methods A scoping review was utilized to determine what has been learned from the CTN about Hispanic populations with substance use disorder. A systematic search was conducted within the CTN Dissemination Library and nine databases. Potentially relevant studies were independently assessed by two reviewers for inclusion. Results Twenty-four studies were included in the review. Results identified issues in measurement, characteristics of Hispanic substance use, effective interventions, and gaps for future research. Characteristics that interfere with treatment participation were also identified including low employment rates, less likelihood of having insurance, lower rates of internet access, and increased travel time to services, as were treatment issues such as high rates of alcohol and tobacco use. Effective interventions were identified; however, the effectiveness of these interventions may be limited to specific factors. Conclusions Despite efforts to improve inclusion of minority populations, Hispanics remain underrepresented in clinical trials. Future research including Hispanic populations should examine measurement equivalence and consider how cultural and historical experiences, as well as patient characteristics, influence utilization of services. Finally, more studies are needed that examine the impact of structural factors that act as barriers to treatment access and engagement and result in significant disparities in treatment outcomes.
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Affiliation(s)
- Brittany H Eghaneyan
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Box 19129, Arlington, TX 76019, United States
| | - Katherine Sanchez
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Box 19129, Arlington, TX 76019, United States.,Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States
| | - Angela M Haeny
- Yale School of Medicine, 34 Park St., New Haven, CT 06519, United States
| | - LaTrice Montgomery
- Center for Addiction Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Suite 204, Cincinnati, Ohio 45221, United States
| | - Teresa Lopez-Castro
- The City College of New York, 160 Convent Ave., New York, NY 10031, United States
| | - A Kathleen Burlew
- University of Cincinnati, 2600 Clifton Ave., Cincinnati, OH 45220, United States
| | - Afsaneh Rezaeizadeh
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States
| | - Michael O Killian
- College of Social Work, Florida State University, 296 Champions Way, UCC 3407, Tallahassee, FL 32309, United States
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Jackson A, Wu R, Kong G, Camenga DR, Morean M, Simon P, Bold KW, Haeny AM, Krishnan-Sarin S. Association between preference for using alcohol beverage-named e-liquids and alcohol use among high school youth. Drug Alcohol Depend 2020; 209:107903. [PMID: 32078976 PMCID: PMC7265357 DOI: 10.1016/j.drugalcdep.2020.107903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are thousands of e-liquid flavors available, and some are named after alcohol beverages (e.g., "pina colada"). It is unclear whether use of e-liquids with alcohol beverage names is associated with adolescent alcohol use. E-cigarettes and alcohol are co-used in adolescents; therefore, it is important to investigate these associations. METHODS Eight Southeastern Connecticut high schools were surveyed in Spring 2015 (N = 7045). We examined the association between preference for using e-liquid flavors and alcohol drinking status (i.e., no past month alcohol use, past month alcohol use but no binge drinking, and past month binge drinking) in ever e-cigarette users (N = 1311). RESULTS Among ever e-cigarette users who preferred using e-liquids with alcohol beverage names (N = 111), 30.6 % had no past month alcohol use, 19.8 % had past month alcohol use but did not binge drink in the past month, and 49.5 % binge drank in the past month. Multinomial logistic regression (controlling for demographics and including other e-cigarette flavors that were highly endorsed, i.e., fruit and candy) revealed that the preferences of alcohol beverage-named-e-liquid (OR: 2.84, CI: 1.70-4.75) and fruit flavored e-liquids (OR: 1.55, CI: 1.14-2.11), but not candy flavored e-liquids was associated with past-month binge drinking compared to no past-month alcohol use. CONCLUSION This evidence suggests that the preference for using alcohol beverage- and fruit-named e-liquid flavors is associated with past-month binge drinking among adolescents. Understanding the associations between alcohol beverage-named e-liquids and alcohol use in adolescents may help inform tobacco regulatory strategies that aim to decrease the use/appeal of e-cigarettes.
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Affiliation(s)
- Asti Jackson
- Department of Psychiatry, Yale School of Medicine, CMHC, 34 Park Street, New Haven, CT, 06519, USA.
| | - Ran Wu
- Department of Psychiatry, Yale School of Medicine, CMHC, 34 Park Street, New Haven, CT, 06519, USA
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, CMHC, 34 Park Street, New Haven, CT, 06519, USA
| | - Deepa R. Camenga
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave, Ste 260, New Haven, CT, 06514, USA
| | - Meghan Morean
- Department of Psychiatry, Yale School of Medicine, CMHC, 34 Park Street, New Haven, CT, 06519, USA,Department of Psychology, Oberlin College, 120 W. Lorain St., Oberlin, OH, 44074, USA
| | - Patricia Simon
- Department of Psychiatry, Yale School of Medicine, CMHC, 34 Park Street, New Haven, CT, 06519, USA
| | - Krysten W. Bold
- Department of Psychiatry, Yale School of Medicine, CMHC, 34 Park Street, New Haven, CT, 06519, USA
| | - Angela M. Haeny
- Department of Psychiatry, Yale School of Medicine, CMHC, 34 Park Street, New Haven, CT, 06519, USA
| | - Suchitra Krishnan-Sarin
- Department of Psychiatry, Yale School of Medicine, CMHC, 34 Park Street, New Haven, CT, 06519, USA
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Abstract
PURPOSE OF REVIEW Approximately 77% of HIV-infected adults report lifetime marijuana use. Given the high rates and social acceptability of marijuana use among HIV-infected individuals, it is important to gain a stronger understanding of if, and how, marijuana impacts HIV care cascade outcomes. The purpose of this study is to systematically review recent articles that assess the relationship between marijuana use and HIV continuum of care outcomes. RECENT FINDINGS One hundred and ninety articles from PubMed were considered for inclusion, and 15 were included in the review. The studies focus on marijuana use among HIV-infected individuals aware of their serostatus (k = 4), individuals engaged in treatment (k = 1), marijuana use in association with adherence to antiretroviral medications (k = 6), and marijuana use in relation to multiple stages of the HIV care cascade (k = 4). Preliminary findings from the small number of studies revealed an association between marijuana use, especially current heavy use, and HIV seropositivity. However, results from studies assessing marijuana use and treatment engagement and adherence to antiretroviral medications were inconsistent and inconclusive. Additional research is needed to assess the nuanced relationship between marijuana use and HIV continuum of care outcomes, especially among subgroups of HIV-infected individuals, such as men who have sex with men and young adults.
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Affiliation(s)
- LaTrice Montgomery
- Addiction Sciences Division, Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Suite 104, Cincinnati, OH, 45229, USA.
| | - Kara Bagot
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, MC 0405, La Jolla, CA, 92093, USA
| | - Jennifer L Brown
- Addiction Sciences Division, Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Suite 104, Cincinnati, OH, 45229, USA
| | - Angela M Haeny
- Division of Prevention and Community Research, Yale School of Medicine, The Consultation Center, 389 Whitney Avenue, New Haven, CT, 06511, USA
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Haeny AM, Gueorguieva R, Morean ME, Krishnan-Sarin S, DeMartini KS, Pearlson GD, Anticevic A, Krystal JH, O’Malley SS. The Association of Impulsivity and Family History of Alcohol Use Disorder on Alcohol Use and Consequences. Alcohol Clin Exp Res 2020; 44:159-167. [PMID: 31693193 PMCID: PMC6981005 DOI: 10.1111/acer.14230] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Extensive research indicates that having a positive family history of alcohol use disorder (FHP) and impulsivity are 2 risk factors for problem drinking. To our knowledge, no study has investigated which facets of impulsivity interact with family history to increase risk for problem drinking. The goal of this study was to: (i) examine whether FHP individuals with higher levels of impulsivity are more likely to engage in problematic drinking, and (ii) identify which facets of impulsivity interact with FHP to increase risk for problems. METHODS The data consisted of a combined sample of 757 participants (50% female, 73% White, mean age = 32.85, SD = 11.31) drawn from the Transdisciplinary Tobacco Use Research Center and the Center for the Translational Neuroscience of Alcohol. Analyses of covariance and cumulative logistic regression models investigated the association of family history and impulsivity-related traits with drinking quantity, frequency, and alcohol-related problems. Models were adjusted for age, sex, race, ethnic group, education level, and data source. RESULTS Significant interactions between impulsivity and family history were found for measures of alcohol-related problems. Specifically, there was a stronger positive association of Barratt Impulsiveness Scale (BIS) poor self-regulation with interpersonal, F(1, 504) = 6.27, p = 0.01, and impulse control alcohol-related problems, F(1, 504) = 6.00, p = 0.01, among FHP compared to FHN individuals. Main effects of family history and impulsivity on alcohol quantity and frequency of use and problems were also found. CONCLUSIONS These findings suggest that having both a family history of AUD and high BIS poor self-regulation is more strongly associated with alcohol-related consequences in the interpersonal and impulse control domains. Given the heterogeneity of impulsivity, these findings highlight the need for additional research to examine which facets of impulsivity are associated with which alcohol outcomes to narrow phenotypic risk for alcohol misuse.
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Affiliation(s)
- Angela M. Haeny
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
| | - Ralitza Gueorguieva
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
| | - Meghan E. Morean
- Oberlin College and Conservatory, Department of Psychology, Oberlin, OH 44074, United States
| | | | - Kelly S. DeMartini
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
| | - Godfrey D. Pearlson
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
| | - Alan Anticevic
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
| | - John H. Krystal
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
| | - Stephanie S. O’Malley
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
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Ransome Y, Haeny AM, McDowell YE, Jordan A. Religious involvement and racial disparities in opioid use disorder between 2004-2005 and 2012-2013: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug Alcohol Depend 2019; 205:107615. [PMID: 31704384 PMCID: PMC6927538 DOI: 10.1016/j.drugalcdep.2019.107615] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Psychosocial factors have rarely been studied to understand racial differences in opioid use disorders (OUD). We investigate religious involvement and Black-White differences in OUD risk between 2004-05 and 2012-13. METHODS We use Non-Hispanic Black and White adults from the National Epidemiologic Survey on Alcohol and Related Conditions (wave 2, N = 26,661 and NESARC-III, N = 26,960) (NESARC). We conducted survey-weighted logistic regression to examine whether race moderates the association between religious involvement and lifetime DSM-IV and -5 OUD and whether those differences change (i.e., are modified) by time, adjusted for covariates such as age, education, and urbanicity. Religious involvement measures were service attendance, social interaction, and subjective religiosity/spirituality. RESULTS The prevalence of lifetime DSM-IV (3.82 vs 1.66) and DSM-5 (2.49 vs 1.32) OUD in NESARC-III was higher among White compared to Black respondents. Never attending services declined for both races over time. Race moderated the association between service attendance (F(4,65) = 14.9, p = 0.000), social interaction (F(4,65) = 34.4, p = 0.000) and subjective religiosity/spirituality (F(2,65) = 7.03, p = 0.000) on DSM-IV OUD in wave 2 and using DSM-5 OUD in NESARC-III (F(1,113) = 2.79, p = 0.066). Race differences in religion and DSM-IV OUD risk was modified by time (i.e., survey year) (all p < 0.000). For instance, higher service attendance was associated with lower DSM-IV risk for Black respondents in wave 2 but higher risk in NESARC-III. There were no changes in regression slopes among White respondents. CONCLUSIONS Religious involvement may be important for prevention and treatment practices that respond to racial differences in risk of OUD. Replicate studies should examine other religious factors and specific types of opioids.
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Affiliation(s)
- Yusuf Ransome
- Yale School of Public Health, Department of Social and Behavioral Sciences, Studies of Religion Ethnicity Technology and Contextual Influences on Health (STRETCH)-Lab, 60 College Street, New Haven, CT 06510.
| | - Angela M Haeny
- Yale School of Medicine, Department of Psychiatry, Division of Prevention and Community Research, and The Consultation Center 389 Whitney Avenue, New Haven, CT 06511
| | - Yoanna E McDowell
- University of Missouri, Alcohol, Health, and Behavior Lab, Department of Psychological Sciences, 146 Psychology Building, Columbia, MO 65211
| | - Ayana Jordan
- Yale School of Medicine, Department of Psychiatry, and Connecticut Mental Health Center 40 Temple Street, New Haven, CT 06510
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Montgomery L, Burlew AK, Haeny AM, Jones CA. A systematic scoping review of research on Black participants in the National Drug Abuse Treatment Clinical Trials Network. Psychol Addict Behav 2019; 34:117-127. [PMID: 31246072 DOI: 10.1037/adb0000483] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Black individuals experience a disproportionate burden of substance-related disabilities and premature death relative to other racial/ethnic groups, highlighting the need for additional research. The National Drug Abuse Treatment Clinical Trials Network (CTN), a research platform for multisite behavioral, pharmacological, and integrated trials designed to evaluate the effectiveness of substance use treatments in community settings with diversified patient populations, provides a wealth of research knowledge on substance use. Although CTN trials have enrolled over 5,000 Black individuals since its inception in 2000, there has been no synthesis of the findings, discussion of the implications, or suggestions for future research for Black individuals. Members of the Minority Interest Group of the CTN conducted a scoping review of published research on Black participants in CTN trials. Studies were included if the sample was more than 75% Black and/or specific findings pertaining to Black participants were reported. The review yielded 50 articles, with studies that mostly focused on baseline characteristics, followed by substance use treatment outcomes, HIV/risky sex behaviors, retention, comorbid conditions and measurement issues. This review highlighted the importance of several issues that are critical to understanding and treating substance misuse among Black people, such as the characteristics of Black people entering treatment, measurement equivalence, and engaging/retaining adolescents and young adults in treatment. There is still a continued need to identify the most effective treatments for Black individuals who use substances. The CTN offers several untapped opportunities to further advance research on Black individuals who use substances (e.g., secondary analyses of publicly available data). (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Haeny AM, Sartor CE, Arshanapally S, Ahuja M, Werner KB, Bucholz KK. The association between racial and socioeconomic discrimination and two stages of alcohol use in blacks. Drug Alcohol Depend 2019; 199:129-135. [PMID: 31048089 PMCID: PMC6684260 DOI: 10.1016/j.drugalcdep.2019.02.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 02/13/2019] [Accepted: 02/16/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study aimed to characterize the associations of racial and socioeconomic discrimination with timing of alcohol initiation and progression from initiation to problem drinking in Black youth. METHODS Data were drawn from a high-risk family study of alcohol use disorder. Mothers and their offspring (N = 806; Mage = 17.87, SDage = 3.91; 50% female) were assessed via telephone interview. Cox proportional hazards regression analyses were used to examine associations between discrimination and timing of first drink and progression from first drink to problem drinking in two separate models. Predictor variables were considered in a step-wise fashion, starting with offspring racial and socioeconomic discrimination, then adding (2) maternal racial and/or socioeconomic discrimination experiences; (3) religious service attendance and social support as potential moderators; and (4) psychiatric and psychosocial risk factors and other substance use. RESULTS Offspring racial discrimination (HR: 2.01, CI: 1.17-3.46 ≤ age 13) and maternal experiences of discrimination (HR: 0.79, CI: 0.67-0.93) were associated with timing of initiation in the unadjusted model only; offspring socioeconomic discrimination predicted timing of initiation among female offspring, even after adjusting for all covariates (HR: 1.49, CI: 1.14-1.93). Socioeconomic discrimination predicted a quicker transition from first use to problem drinking exclusively in the unadjusted model (HR: 1.70, CI: 1.12-2.58 ≤ age 18). No moderating effects of religious service attendance or social support were observed for either alcohol outcome. CONCLUSIONS Findings suggest socioeconomic discrimination is a robust risk factor for initiating alcohol use in young Black female youth and should be considered in the development of targeted prevention programs.
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Affiliation(s)
- Angela M. Haeny
- Department of Psychiatry, Yale School of Medicine, 389 Whitney Avenue New Haven, CT 06511, United States
| | - Carolyn E. Sartor
- Department of Psychiatry, Yale School of Medicine, 389 Whitney Avenue New Haven, CT 06511, United States,Alcoholism Research Center, Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, United States
| | - Suraj Arshanapally
- Yale School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Manik Ahuja
- Brown School of Social Work, Washington University, 1 Brookings Dr., St. Louis, MO 63130, United States
| | - Kimberly B. Werner
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 4633 World Pkwy Cir, St. Louis, MO 63134, United States
| | - Kathleen K. Bucholz
- Alcoholism Research Center, Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, United States
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Haeny AM, Littlefield AK, Wood PK, Sher KJ. Method effects of the relation between family history of alcoholism and parent reports of offspring impulsive behavior. Addict Behav 2018; 87:251-259. [PMID: 30096656 PMCID: PMC6148351 DOI: 10.1016/j.addbeh.2018.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/27/2018] [Accepted: 07/29/2018] [Indexed: 10/28/2022]
Abstract
There is an extensive, albeit inconsistent, literature on the relation between parental alcoholism and offspring impulsive behavior. The reasons for this inconsistency are likely multiple but it seems probable that method effects due to different methodological approaches might explain some of the inconsistencies. Offspring behavior is typically assessed based on informant reports. However, no specific method has been demonstrated as optimal for analyzing informant reports, and conclusions may differ depending on the method used. The present study compared findings derived from a multi-informant method proposed by Bauer et al. (2013) to other structural equation models. Participants came from Wave 7 of the Alcohol, Health and Behavior study and included mother and father reports of offspring impulsive behavior on the Health and Behavior Questionnaire (Armstrong, Goldstein, & the MacArthur Working Group on Outcome Assessment, 2003). There were 368 offspring (50% female, age range 3-17 years, meanage = 6.78, SDage = 3.07) from 205 families. The multi-informant model and the single-reporter models each provided a good fit of the data; however, findings differed based on the approach employed. Specifically, the mother-only report model found that offspring with a family history of alcoholism (FHA) were more impulsive compared to offspring without a FHA; no effect of FHA was found in the other single-reporter models. Ratings of offspring impulsive behavior were higher on the father perspective factor suggesting alcoholic fathers were biased in their reports. These findings highlight the relation between FHA and impulsive behavior varies depending on the analytic method used.
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Affiliation(s)
- Angela M Haeny
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.
| | - Andrew K Littlefield
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, United States
| | - Phillip K Wood
- Department of Psychological Sciences, University of Missouri, The Midwest Alcohol Research Center, United States
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri, The Midwest Alcohol Research Center, United States
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Montgomery L, Robinson C, Seaman EL, Haeny AM. A scoping review and meta-analysis of psychosocial and pharmacological treatments for cannabis and tobacco use among African Americans. Psychol Addict Behav 2018; 31:922-943. [PMID: 29199844 DOI: 10.1037/adb0000326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The rates of co-occurring cannabis and tobacco use are higher among African Americans relative to other racial/ethnic groups. One plausible approach to treating co-use among African Americans is to examine the effectiveness of treatments for the sole use of cannabis and tobacco to identify effective approaches that might be combined to treat the dual use of these substances. The current meta-analysis sought to include studies that reported cannabis and/or tobacco use outcomes from randomized clinical trials (RCTs) with 100% African American samples. A total of 843 articles were considered for inclusion, 29 were reviewed by independent qualitative coders, and 22 were included in the review. There were no articles on cannabis use treatment with a 100% African American sample, resulting in a need to lower the threshold (60%) and conduct a scoping review of cannabis studies. Preliminary evidence from a small number of studies (k = 7) supports the use of Motivational Interviewing and Cognitive-Behavioral Therapy to treat cannabis use among African Americans, but not Contingency Management. Results from a meta-analysis of 15 tobacco studies found higher rates of smoking abstinence in the treatment condition relative to control conditions overall and across short and long-term follow-up periods. Significant differences in smoking abstinence were also found when examining the effects of pharmacological treatments relative to their control conditions. The clinical and research implications of these findings for future psychosocial and pharmacological trials for cannabis and tobacco use and co-use among African Americans are described. (PsycINFO Database Record
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Affiliation(s)
- LaTrice Montgomery
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine
| | - Cendrine Robinson
- Division Cancer Prevention, Cancer Control and Population Sciences, National Cancer Institute
| | - Elizabeth L Seaman
- Department of Behavioral and Community Health, University of Maryland School of Public Health
| | - Angela M Haeny
- Department of Psychological Sciences, University of Missouri
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Haeny AM, Weaver CC, Martinez JA, Steinley D, Sher KJ. Is the deliberate self-induction of alcohol tolerance associated with negative alcohol outcomes? Addict Behav 2017; 65:98-101. [PMID: 27816046 DOI: 10.1016/j.addbeh.2016.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 10/01/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Abstract
Research indicates 10% of college student drinkers report deliberately training to increase alcohol tolerance (a diagnostic criterion for alcohol use disorder) to avoid passing out early or to keep up with peers. Given that tolerance training may be considered a harm reduction technique designed to reduce acute aversive consequences, we examined the associations between tolerance training and the use of protective behavioral strategies (PBS) more generally. A cross-sectional survey of 1080 lifetime drinkers was conducted at a large Midwestern university. Of this sample, 5.6% (n=60) reported training to increase their tolerance. Drinkers who endorsed having trained to increase tolerance reported notably more alcohol-related problems than those who reported never training (Madj=51.80 versus Madj=39.30; p<0.0001). Further, participants who endorsed tolerance training reported utilizing significantly fewer PBS (e.g., avoid drinking games) on the Protective Behavioral Strategies Scale (PBSS, Martens et al., 2005) than participants who had never trained (Madj=16.89 versus Madj=18.90; p<0.01). An exception was that drinkers who trained to avoid passing out early used significantly more PBS (e.g., using a designated driver, knowing where your drink is at all times). Despite this, these trainers consumed more alcohol and experienced more alcohol-related harms. The present findings support previous research demonstrating that trainers consume more alcohol than non-trainers, and provide further evidence that deliberately training to increase tolerance is indicative of problematic drinking behavior. Prevention efforts might aim to inform drinkers of the problems associated with deliberately inducing alcohol tolerance, and focus on developing alternative strategies for minimizing acute harm from drinking.
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Haeny AM, Littlefield AK, Sher KJ. Limitations of lifetime alcohol use disorder assessments: A criterion-validation study. Addict Behav 2016; 59:95-9. [PMID: 27082748 DOI: 10.1016/j.addbeh.2016.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 02/01/2016] [Accepted: 03/29/2016] [Indexed: 11/30/2022]
Abstract
The goal of the present study was to compare etiologically and clinically relevant correlates of lifetime AUD (e.g., alcohol consumption, personality traits, psychiatric disorders) based on a single assessment compared to a cumulative, prospective assessment of lifetime AUD. Data were drawn from the Alcohol, Health and Behavior (AHB; baseline N=489) study, which consisted of a prospective cohort of college students assessed seven times over a 16-year period ([M(SD) age at baseline=18.56 (.97)] and [M(SD) age at final assessment=34.33 (.82)]). The participants were assessed using the Diagnostic Interview Schedule (DIS) for DSM-III at Waves 1-7 and for DSM-IV at Waves 6-7. A single assessment and cumulative assessments of DSM-III lifetime AUD at Wave 6 (M[SD] age=28.98 [1.03]) were used to predict past-year alcohol related variables (e.g., alcohol consumption, drinking motives, drinking expectancies), personality variables, general functioning, lifetime substance use, and lifetime psychiatric disorders at Wave 7. Significantly larger correlations were found between the cumulative assessment and eight of the 25 etiologically relevant correlates of AUD compared to the single assessment. Further, significant incremental validity of cumulative assessment over single, retrospective assessment was observed for 16 of the 25 covariates. Overall, this study provides further support for the value of using prospective data with multiple assessments when determining lifetime history of disorder.
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Affiliation(s)
- Angela M Haeny
- Department of Psychological Sciences, University of Missouri, and The Midwest Alcohol Research Center, United States.
| | - Andrew K Littlefield
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, United States
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri, and The Midwest Alcohol Research Center, United States
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Haeny AM, Littlefield AK, Sher KJ. False negatives in the assessment of lifetime alcohol use disorders: a serious but unappreciated problem. J Stud Alcohol Drugs 2014; 75:530-5. [PMID: 24766765 DOI: 10.15288/jsad.2014.75.530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Some individuals will not meet criteria for a lifetime alcohol use disorder (AUD) at a baseline assessment but will at a follow-up measurement, but not because the disorder began after the initial evaluation. Despite several research implications, this type of unreliability of lifetime AUD estimates has not been studied extensively. The present study investigated the extent of false negatives in the assessment of lifetime AUDs using longitudinal data. METHOD A prospective cohort of college freshmen (baseline N = 489) were assessed seven times between ages 18 and 34 years using the Diagnostic Interview Schedule. Individuals were categorized as false negatives at the index assessment using a retrospective (using Diagnostic and Statistical Manual of Mental Disorders, Third Edition [DSM-III], and DSM-IV data), a prospective (using DSM-III data only), and a combined approach (using DSM-III data only). RESULTS For DSM-IV, of the 29 ostensible new onsets at a follow-up 5 years later (age approximately 34 years), 28 (96%) reported meeting AUD criteria before the index assessment (age approximately 29 years). For DSM-III, of the 25 ostensible new onsets, the retrospective, prospective, and combined approaches categorized 18 (72%) individuals as false negatives at the index assessment. CONCLUSIONS These findings further demonstrate sensitivity issues with lifetime AUD assessments and call into question the validity of "onset" cases that rely on only two waves of data, especially when the follow-up assessment fails to reassess lifetime fully (i.e., across the entire drinking history).
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Affiliation(s)
- Angela M Haeny
- Midwest Alcoholism Research Center and Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
| | | | - Kenneth J Sher
- Midwest Alcoholism Research Center and Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
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Cadigan JM, Haeny AM, Martens MP, Weaver CC, Takamatsu SK, Arterberry BJ. Personalized drinking feedback: A meta-analysis of in-person versus computer-delivered interventions. J Consult Clin Psychol 2014; 83:430-7. [PMID: 25486373 DOI: 10.1037/a0038394] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Alcohol misuse is a significant public health concern. Personalized feedback interventions (PFIs) involve the use of personalized information about one's drinking behaviors and can be delivered in person or via computer. The relative efficacy of these delivery methods remains an unanswered question. The primary aim of the current meta-analysis was to identify and directly compare randomized clinical trials of in-person PFIs and computer-delivered PFIs. METHOD A total of 14 intervention comparisons from 13 manuscripts, of which 9 were college samples, were examined: in-person PFIs (N = 1,240; 49% female; 74% White) and computer-delivered PFIs (N = 1,201; 53% female; 73% White). Independent coders rated sample characteristics, study information, study design, intervention content, and study outcomes. RESULTS Weighted mean effect sizes were calculated using random-effects models. At short follow-up (≤4 months), there were no differences between in-person PFIs and computer-delivered PFIs on any alcohol use variable or alcohol-related problems. At long follow-up (>4 months), in-person PFIs were more effective than computer-delivered PFIs at impacting overall drinking quantity (d = .18) and drinks per week (d = .19). These effects were not moderated by sample characteristics. CONCLUSIONS For assessing alcohol outcomes at shorter follow-ups, there were no differences between delivery modality. At longer follow-ups, in-person PFIs demonstrated some advantages over computer-delivered PFIs. We encourage researchers to continue to examine direct comparisons between these delivery modalities and to further examine the efficacy of in-person PFIs at longer follow-ups. (PsycINFO Database Record
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Affiliation(s)
| | - Angela M Haeny
- Department of Psychological Sciences, University of Missouri
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Abstract
Previous literature has documented the general issues psychologists often face while balancing their personal and professional lives. The struggle stems from attempting to satisfy the need to maintain a life outside of work while having the professional obligation to follow the American Psychological Association's (APA's) Ethical Principles of Psychologists and Code of Conduct (Ethics Code) to prevent their personal lives from interfering with their professional roles and relationships. The present paper analyzes the subject of psychologists taking a public position on controversial public issues. Although the APA Ethics Code does not restrict how psychologists conduct themselves during their personal time, taking a public stance on a controversial issue could potentially strain professional relationships and inadvertently reflect negatively on the profession. The present paper examines ethical issues that a) should be taken into account before psychologists take a public position on a controversial issue, and b) are in conflict with APA's Ethics Code or current research.
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Affiliation(s)
- Angela M Haeny
- Department of Psychological Sciences, University of Missouri - Columbia
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Haeny AM, Littlefield AK, Sher KJ. Repeated diagnoses of lifetime alcohol use disorders in a prospective study: insights into the extent and nature of the reliability and validity problem. Alcohol Clin Exp Res 2014; 38:489-500. [PMID: 24033811 PMCID: PMC4066878 DOI: 10.1111/acer.12237] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 07/02/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Prior research indicates that assessments of lifetime alcohol use disorders (AUDs) show low sensitivity and are unreliable when assessed by a single, retrospective interview. This study sought to replicate and extend previous research by calculating the lifetime prevalence rate of AUDs using both single retrospective assessments of lifetime diagnosis and repeated assessments of both lifetime and past-year diagnoses over a 16-year period within the same high-risk sample. In addition, this study examined factors that contributed to the consistency in reporting lifetime AUDs over time. METHODS Using prospective data, the reliability and validity of lifetime estimates of alcohol dependence and AUD were examined in several ways. Data were drawn from a cohort of young adults at high and low risk for alcoholism, originally ascertained as first-time college freshmen (N = 489 at baseline) at a large, public university and assessed over 16 years. RESULTS Compared with using a single, lifetime retrospective assessment of DSM-III disorders assessed at approximately age 34, lifetime estimates derived from using multiple, prospective assessments of both past-year and lifetime AUD were substantially higher (25% single lifetime vs. 41% cumulative past-year vs. 46% cumulative lifetime). This pattern of findings was also found when conducting these comparisons at the symptom level. Further, these results suggest that some factors (e.g., symptoms endorsed, prior consistency in reporting of a lifetime AUD, and family history status) are associated with the consistency in reporting lifetime AUDs over time. CONCLUSIONS Based on these findings, lifetime diagnoses using a single measurement occasion should be interpreted with considerable caution given they appear to produce potentially large prevalence underestimates. These results provide further insight into the extent and nature of the reliability and validity problem with lifetime AUDs.
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Affiliation(s)
- Angela M Haeny
- Midwest Alcoholism Research Center and the University of Missouri, Columbia, Missouri
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Vergés A, Haeny AM, Jackson KM, Bucholz KK, Grant JD, Trull TJ, Wood PK, Sher KJ. Refining the notion of maturing out: results from the national epidemiologic survey on alcohol and related conditions. Am J Public Health 2013; 103:e67-73. [PMID: 24134383 DOI: 10.2105/ajph.2013.301358] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Our aim was to determine if the decrease in drug use disorders with age is attributable to changes in persistence, as implied by the notion of maturing out. Also, we examined the association between role transitions and persistence, recurrence, and new onset of drug use disorders. METHODS We performed secondary analysis of the 2 waves of the National Epidemiologic Survey on Alcohol and Related Conditions data (baseline assessment 2001-2002, follow-up conducted 2004-2005). We conducted logistic regressions and multinomial logistic regression to determine the effect of age on wave 2 diagnosis status, as well as the interaction between age and role transitions. RESULTS Rates of persistence were stable over the life span, whereas rates of new onset and recurrence decreased with age. Changes in parenthood, marital, and employment status were associated with persistence, new onset, and recurrence. We found an interaction between marital status and age. CONCLUSIONS Our findings challenge commonly held notions that the age-related decrease in drug use disorders is attributable to an increase in persistence, and that the effects of role transitions are stronger during young, compared with middle and older, adulthood.
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Affiliation(s)
- Alvaro Vergés
- Alvaro Vergés, Angela M. Haeny, Timothy J. Trull, Phillip K. Wood, and Kenneth J. Sher are with the Department of Psychological Sciences, University of Missouri-Columbia. Kristina M. Jackson is with the Department of Community Health, Brown University, Providence, RI. Kathleen K. Bucholz and Julia D. Grant are with the School of Medicine, Washington University, St Louis, MO
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Kushner MG, Maurer EW, Thuras P, Donahue C, Frye B, Menary KR, Hobbs J, Haeny AM, Van Demark J. "Hybrid cognitive behavioral therapy versus relaxation training for co-occurring anxiety and alcohol disorder: A randomized clinical trial": Correction to Kushner et al. (2012). J Consult Clin Psychol 2013. [DOI: 10.1037/a0031948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kushner MG, Maurer EW, Thuras P, Donahue C, Frye B, Menary KR, Hobbs J, Haeny AM, Van Demark J. Hybrid cognitive behavioral therapy versus relaxation training for co-occurring anxiety and alcohol disorder: a randomized clinical trial. J Consult Clin Psychol 2013; 81:429-42. [PMID: 23276124 PMCID: PMC3756682 DOI: 10.1037/a0031301] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Treatment for alcohol use disorder (AUD) is far less effective for those with a co-occurring anxiety disorder. Surprisingly, adding an independent anxiety treatment to AUD treatment does not substantially improve the poor alcohol outcomes of these patients. This may reflect the lack of attention from independent treatments to the dynamic interaction of anxiety symptoms with alcohol use and drinking motivation. On the basis of this view, we assembled a cognitive behavioral therapy (CBT) program designed to both reduce anxiety symptoms and weaken the links between the experience of anxiety and the motivation to drink. METHOD 344 patients undergoing residential AUD treatment with current social phobia, generalized anxiety disorder, or panic disorder were randomly assigned to receive either the CBT or an active comparison treatment, progressive muscle relaxation training (PMRT). Assessments took place immediately following treatment and 4 months later (n = 247). RESULTS As predicted, the CBT group demonstrated significantly better alcohol outcomes 4 months following treatment than did the PMRT group. Although both groups experienced a substantial degree of anxiety reduction following treatment, there were no significant group differences immediately after treatment and only a slight advantage for the CBT group 4 months after treatment. CONCLUSIONS These findings suggest that specific interventions aimed at weakening the association between the experience of anxiety and drinking motivation play an important role in improving the alcohol outcomes of these difficult-to-treat patients beyond that of anxiety reduction alone.
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Affiliation(s)
- Matt G Kushner
- Department of Psychiary, University of Minnesota, MN 55454, USA.
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