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Cucciare MA, Benton C, Hildebrand D, Marchant K, Ghaus S, Han X, Williams JS, Thompson RG, Timko C. Adapting an Alcohol Care Linkage Intervention to US Military Veterans Presenting to Primary Care with Hazardous Drinking and PTSD and/or Depression Symptoms: A Qualitative Study. J Clin Psychol Med Settings 2024; 31:417-431. [PMID: 38100057 DOI: 10.1007/s10880-023-09986-w] [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] [Accepted: 10/29/2023] [Indexed: 02/04/2024]
Abstract
There is a critical need to improve linkage to alcohol care for veterans in primary care with hazardous drinking and PTSD and/or depression symptoms (A-MH). We adapted an alcohol care linkage intervention, "Connect to Care" (C2C), for this population. We conducted separate focus groups with veterans with A-MH, providers, and policy leaders. Feedback centered on how psychologists and other providers can optimally inform veterans about their care options and alcohol use, and how to ensure C2C is accessible. Participants reported that veterans with A-MH may not view alcohol use as their primary concern but rather as a symptom of a potential co-occurring mental health condition. Veterans have difficulty identifying and accessing existing alcohol care options within the Veterans Health Administration. C2C was modified to facilitate alcohol care linkage for this population specific to their locality, provide concrete support and education, and offer care options to preserve privacy.
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Affiliation(s)
- Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA.
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72205, USA.
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 West Markham Street (#755), Little Rock, AR, 72205, USA.
| | - Cristy Benton
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
| | - Deanna Hildebrand
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
| | - Kathy Marchant
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
| | - Sharfun Ghaus
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
| | - Xiaotong Han
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72205, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 West Markham Street (#755), Little Rock, AR, 72205, USA
| | - James S Williams
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
| | - Ronald G Thompson
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 West Markham Street (#755), Little Rock, AR, 72205, USA
| | - Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
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Thompson RG, Mullinax S, De Monte R, McBain S, Porter A, Eastin C, Landes SJ, Wilson MP. Effectiveness of a Self-Administered Computerized Mental Health Screening Tool in the Emergency Department. Psychiatr Serv 2023; 74:1180-1184. [PMID: 37161345 DOI: 10.1176/appi.ps.20220523] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The authors sought to determine the effectiveness of a self-administered computerized mental health screening tool in a general acute care emergency department (ED). METHODS Changes in patient care (diagnosis of a past-year psychiatric disorder, request for psychiatric consultation, psychiatric referral at discharge, or transfer to psychiatric facility) and patient ED return visits (3 months after discharge vs. 3 months before) were assessed among ED physicians (N=451) who received patients' computerized screening reports (N=207) and those who did not (N=244). All patients received copies of screening results. RESULTS The computerized mental health screening tool identified previously undiagnosed psychiatric problems. However, no statistically significant differences were found in physician care or patient ED return visits. CONCLUSIONS Computerized mental health screening did not result in further psychiatric diagnoses or treatment; it also did not significantly reduce patient ED return visits. Collaboration among EDs and mental health treatment agencies, organizations, and researchers is needed to facilitate appropriate treatment referrals and linkage.
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Affiliation(s)
- Ronald G Thompson
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Samuel Mullinax
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Robert De Monte
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Sacha McBain
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Austin Porter
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Carly Eastin
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Sara J Landes
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Michael P Wilson
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
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Cucciare MA, Marchant K, Benton C, Hildebrand D, Ghaus S, Han X, Thompson RG, Timko C. Connect To Care (C2C): protocol for two-site randomized controlled pilot trial to improve outcomes for patients with hazardous drinking and PTSD and/or depression symptoms. Addict Sci Clin Pract 2023; 18:50. [PMID: 37592359 PMCID: PMC10433540 DOI: 10.1186/s13722-023-00403-z] [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: 12/05/2022] [Accepted: 07/31/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND In studies of the general population and of military veterans, many primary care patients with hazardous drinking and PTSD and/or depression (abbreviated here as HD +) do not initiate or engage with alcohol-related care. To address this gap in care, we identified and will pilot test a promising evidence-based intervention, Connect To Care (C2C). C2C is a strengths-based approach, delivered by a Care Coach by telephone and/or video, with four components: (1) identifying and leveraging patient strengths to facilitate care initiation, (2) collaborative decision-making around a menu of care options, (3) identifying and resolving barriers to care, and (4) monitoring and facilitating progress toward care initiation by, for example, checking on barriers, identifying solutions, and revisiting care options. METHODS/DESIGN Aim 1 will involve adapting C2C for use in Veterans Affairs' (VA) primary care. We will use an iterative process that includes focus groups and semi-structured interviews with key stakeholders (patients, primary care providers, and VA national policy leaders). In Aim 2, we will conduct a two-site, pilot randomized controlled trial to determine the feasibility of conducting a larger scale trial to test C2C's effectiveness, ascertain the acceptability of C2C among primary care patients with HD + , and explore the efficacy of C2C to improve veteran patients' initiation of and engagement in alcohol care, and their alcohol and mental health (PTSD, depression) outcomes, at 3-month follow-up. We will explore explanatory mechanisms by which C2C is effective. DISCUSSION Study findings are likely to have implications for clinical practice to enhance current approaches to linking patients with HD + to alcohol care by applying a practical intervention such as C2C. The results may improve treatment outcomes for people with HD + by drawing on patients' strengths to problem-solve barriers to care following a process of shared decision-making with a coach. In addition to possibly accelerating the translation of C2C into practice, study findings will also support additional research in terms of a planned effectiveness-implementation hybrid trial, adding to this study's potential for high impact. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05023317.
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Affiliation(s)
- Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
- Education and Clinical Center, Veterans Affairs South Central Mental Illness Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72205, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Kathy Marchant
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
| | - Cristy Benton
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
| | - Deanna Hildebrand
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
| | - Sharfun Ghaus
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
| | - Xiaotong Han
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
- Education and Clinical Center, Veterans Affairs South Central Mental Illness Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72205, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Ronald G Thompson
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA.
- Center for Innovation to Implementation, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.
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Thompson RG, Bollinger M, Mancino MJ, Hasin D, Han X, Bush KA, Kilts CD, James GA. Smartphone intervention to optimize medication-assisted treatment outcomes for opioid use disorder: study protocol for a randomized controlled trial. Trials 2023; 24:255. [PMID: 37016394 PMCID: PMC10071730 DOI: 10.1186/s13063-023-07213-3] [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: 01/24/2023] [Accepted: 03/01/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Opioids accounted for 75% of drug overdoses in the USA in 2020, with rural states particularly impacted by the opioid crisis. While medication-assisted treatment (MAT) with Suboxone remains one of the more efficacious treatments for opioid use disorder (OUD), approximately 40% of people receiving Suboxone for outpatient MAT for OUD (MOUD) relapse within the first 6 months of treatment. We developed the smartphone app-based intervention OptiMAT as an adjunctive intervention to improve MOUD outcomes. The aims of this study are to (1) evaluate the efficacy of adjunctive OptiMAT use in reducing opioid misuse among people receiving MOUD and (2) evaluate the role of specific OptiMAT features in reducing opioid misuse, including the use of GPS-driven just-in-time intervention. METHODS We will conduct a two-arm, single-blind, randomized controlled trial of adults receiving outpatient MOUD in the greater Little Rock AR area. Participants are English-speaking adults ages 18 or older recently enrolled in outpatient MOUD at one of our participating study clinics. Participants will be allocated via 1:1 randomized block design to (1) MOUD with adjunctive use of OptiMAT (MOUD+OptiMAT) or (2) MOUD without OptiMAT (MOUD-only). Our blinded research statistician will evaluate differences between the two groups in opioid misuse (as determined by quantitative urinalysis conducted by clinical lab staff blinded to group membership) during the 6-months following study enrolment. Secondary analyses will evaluate if OptiMAT-usage patterns within the MOUD+OptiMAT group predict opioid misuse or continued abstinence. DISCUSSION This study will test if adjunctive use of OptiMAT improve MOUD outcomes. Study findings could lead to expansion of OptiMAT into rural clinical settings, and the identification of OptiMAT features which best predict positive clinical outcome could lead to refinement of this and similar smartphone app-based interventions. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05336188 , registered March 21, 2022.
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Affiliation(s)
- Ronald G Thompson
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mary Bollinger
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Michael J Mancino
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Deborah Hasin
- Department of Epidemiology, Columbia University, New York City, NY, USA
| | - Xiaotong Han
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Keith A Bush
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Clint D Kilts
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - G Andrew James
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Abstract
OBJECTIVE The emergency department (ED) is an important site for suicide prevention efforts, and safety planning has been identified as a best practice for suicide prevention among ED patients at increased suicide risk. However, few ED clinicians are prepared to assess suicide risk or guide patients in the creation of safety plans. This study was a pilot randomized controlled trial of the feasibility, acceptability, and preliminary effects of safety planning by individuals with lived experience of suicide attempt or of severe suicidal ideation but without medical training (i.e., peers) in the ED. METHODS Patients at risk for suicide in a general ED were randomly assigned to receive peer-delivered or mental health provider–delivered safety planning. Intervention feasibility measures included ED length of stay, safety plan completeness, and safety plan quality. Acceptability measures included patient satisfaction. Preliminary effects were assessed as number of ED returns within the 3 months after the ED visit. RESULTS Data from 31 participants were available for analysis. Compared with participants with provider-delivered safety planning, participants with peer-delivered safety planning had similar ED lengths of stay, higher safety plan completeness, and higher safety plan quality. Acceptability of the safety planning process was similar for the two groups. Compared with participants receiving provider-delivered safety planning, participants receiving peer-delivered planning had significantly fewer ED visits during the subsequent 3 months than during the 3 months preceding the ED visit. CONCLUSIONS Peer-delivered safety planning is feasible and acceptable and may result in fewer return ED visits. These findings provide preliminary support for peer-delivered safety planning in the ED.
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Affiliation(s)
- Michael P Wilson
- Division of Research and Evidence-Based Medicine and Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, Department of Emergency Medicine (Wilson), and Center for Health Services Research, Department of Psychiatry (Waliski, Thompson), University of Arkansas for Medical Sciences (UAMS), Little Rock; Department of Health Services Research and Development, Central Arkansas Veteran's Healthcare system, Little Rock (Waliski)
| | - Angie Waliski
- Division of Research and Evidence-Based Medicine and Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, Department of Emergency Medicine (Wilson), and Center for Health Services Research, Department of Psychiatry (Waliski, Thompson), University of Arkansas for Medical Sciences (UAMS), Little Rock; Department of Health Services Research and Development, Central Arkansas Veteran's Healthcare system, Little Rock (Waliski)
| | - Ronald G Thompson
- Division of Research and Evidence-Based Medicine and Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, Department of Emergency Medicine (Wilson), and Center for Health Services Research, Department of Psychiatry (Waliski, Thompson), University of Arkansas for Medical Sciences (UAMS), Little Rock; Department of Health Services Research and Development, Central Arkansas Veteran's Healthcare system, Little Rock (Waliski)
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Oliveto AH, Wright P, Kumar N, Gokarakonda S, Fischer-Laycock I, Williams J, Thompson RG. Acceptability of a Game-Based Intervention to Prevent Adolescent Prescription Opioid Misuse. Games Health J 2022; 11:104-116. [PMID: 35167352 PMCID: PMC9057874 DOI: 10.1089/g4h.2021.0243] [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: 11/13/2022] Open
Abstract
Objective: This study assessed the initial acceptability of SafeUse, a game-based opioid misuse prevention intervention for delivery via smartphone among adolescents. Evidence-based educational and refusal skills training materials were adapted, and game design elements were applied to clinically and scientifically informed scenarios in which opioids are typically introduced to adolescents using standard product development methods to create the SafeUse prototype. Materials and Methods: In a mixed-methods study, 14 adolescents were assessed on their knowledge and perceptions of opioids before and following 5-7 days of access to SafeUse. Participants provided feedback in focus groups on the acceptability, relevance, and understandability of SafeUse and made suggestions for its improvement. Feedback was coded and summarized as to playability, acceptability, appropriateness, content development, and knowledge transfer. Pre- and post-access quantitative data were analyzed using Wilcoxon matched pairs signed-rank tests. Results: Overall, participants liked SafeUse, its characters, graphics, and approach, finding it more appealing than lectures/reading materials and appropriate for school settings. They moderately to extremely "liked the game," "would like to play more game modules," "liked playing through the decisions," thought the game was realistic/relevant and fun, and they learned new information about opioids. Participants reported increased confidence to refuse opioids and decreased likelihood of accepting opioids from someone they know. Knowledge about opioids increased (P < 0.006), and adolescent perception that prescription drugs are safer than illegal drugs decreased (P < 0.003) after playing SafeUse. Conclusion: Findings suggest that SafeUse is acceptable and likely educational to adolescents and worthy of further development and research.
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Affiliation(s)
- Alison H Oliveto
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Patricia Wright
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nihit Kumar
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Srinivasa Gokarakonda
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ian Fischer-Laycock
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Ronald G Thompson
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Thompson RG, Oliveto A, Thostenson JD, Wilson MP, McGaugh J, Mancino MJ. Utility of a controlled amphetamine withdrawal paradigm among adults who use methamphetamine: A pilot clinical trial. J Psychopharmacol 2021; 35:1420-1430. [PMID: 34697965 PMCID: PMC10110391 DOI: 10.1177/02698811211050563] [Citation(s) in RCA: 3] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND The continued increase in prevalence of methamphetamine use in the United States has resulted in a significant increase in the number of patients entering treatment for methamphetamine use. However, no robustly efficacious pharmacologic treatment for methamphetamine use or withdrawal has been identified to date after stopping methamphetamine use. AIMS Given the association between methamphetamine withdrawal and relapse during early treatment, this study tested a controlled d-amphetamine withdrawal paradigm among methamphetamine-using individuals. METHODS Treatment-seeking adults who used methamphetamine (N = 34; 47% female; 100% white) were enrolled in a 4-week, randomized, double-blind, placebo-controlled trial in a residential setting, in which all participants were maintained on d-amphetamine (30 mg BID) during week 1, then half were switched to placebo during weeks 2-3. All participants received placebo during week 4. Outcomes included vital signs, withdrawal, cravings for methamphetamine, mood, and cognition. Bivariate analyses tested treatment group differences on baseline demographic and outcome variables. Repeated measures models examined main and interaction effects of treatment over time. RESULTS/OUTCOMES Participants were successfully randomized and safely stabilized on d-amphetamine. Craving for methamphetamine increased during weeks 2-3 in the placebo group relative to those on d-amphetamine. Interactions with age and heart rate were noted. CONCLUSIONS/INTERPRETATION To our knowledge, this is the first double-blind, placebo-controlled trial measuring pharmacologic effects of abruptly stopping controlled d-amphetamine administration in adults who use methamphetamine. Results support the potential of this withdrawal paradigm to further examine the efficacy of pharmacologic agents in ameliorating methamphetamine withdrawal symptoms.
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Affiliation(s)
- Ronald G Thompson
- Center for Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Alison Oliveto
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeff D Thostenson
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Michael P Wilson
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Janette McGaugh
- Ouachita Behavioral Health and Wellness, Hot Springs, AR, USA
| | - Michael J Mancino
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Wilson MP, Kaur J, Blake L, Oliveto AH, Thompson RG, Pyne JM, Wolf L, Walker AP, Waliski AD, Nordstrom K. Adherence to guideline creation recommendations for suicide prevention in the emergency department: A systematic review. Am J Emerg Med 2021; 50:553-560. [PMID: 34547697 DOI: 10.1016/j.ajem.2021.07.042] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/21/2021] [Accepted: 07/20/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Suicide rates in the United States rose 35.2% from 1999-2018. As emergency department (ED) providers often have limited training in management of suicidal patients and minimal access to mental health experts, clinical practice guidelines (CPGs) may improve care for these patients. However, clinical practice guidelines that do not adhere to quality standards for development may be harmful both to patients, if they promote practices based on flawed evidence, and to ED providers, if used in malpractice claims. In 2011, the Institute of Medicine created standards to determine the trustworthiness of CPGs. This review assessed the adherence of suicide prevention CPGs, intended for the ED, to these standards. Secondary objectives were to assess the association of adherence both with first author/organization specialty (ED vs non-ED) and with inclusion of recommendations on substance use, a potent risk factor for suicide. METHODS This is a systematic review of available suicide-prevention CPGs for the ED in both peer-reviewed and gray literature. This review followed the PRISMA standards for reporting systematic reviews. RESULTS Of 22 included CPGs, the 7 ED-sponsored CPGs had higher adherence to quality standards (3.1 vs 2.4) and included the highest-rated CPG (ICAR2E) identified by this review. Regardless of specialty, nearly all CPGs included some mention of identifying or managing substance use. CONCLUSIONS Most suicide prevention CPGs intended for the ED are written by non-ED first authors or organizations and have low adherence to quality standards. Future CPGs should be developed with more scientific rigor, include a multidisciplinary writing group, and be created by authors working in the practice environment to which the CPG applies.
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Affiliation(s)
- Michael P Wilson
- Division of Research and Evidence-Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
| | - Jaskiran Kaur
- Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Lindsay Blake
- Academic Affairs, UAMS Library, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Alison H Oliveto
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Ronald G Thompson
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Jeffrey M Pyne
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Lisa Wolf
- Emergency Nurses Association, Schaumburg, Illinois
| | - A Paige Walker
- Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Angela D Waliski
- Department of Health Services Research and Development, Central Arkansas Veteran's Healthcare System, Little Rock, AR, United States of America
| | - Kimberly Nordstrom
- Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States of America
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Moore R, Zielinski MJ, Thompson RG, Willis DE, Purvis RS, McElfish PA. "This Pandemic Is Making Me More Anxious about My Welfare and the Welfare of Others:" COVID-19 Stressors and Mental Health. Int J Environ Res Public Health 2021; 18:5680. [PMID: 34073187 PMCID: PMC8197875 DOI: 10.3390/ijerph18115680] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 12/19/2022]
Abstract
COVID-19 and subsequent social distancing guidelines have changed many aspects of people's daily lives including the way that they interact within their social environment. Pandemics are inherently social phenomena, and public health measures intended to curtail transmission of COVID-19 (e.g., quarantine and social distancing) have consequences for individuals with anxiety and depression. Using qualitative methods, respondents with previously diagnosed anxiety or depression identified ways in which COVID-19 affected their symptoms at multiple levels of the social ecological model (SEM). Key themes reported were organized following the SEM. Emergent themes at the individual level are isolation/loneliness, fear of contracting COVID-19, and uncertainty about the future. Themes at the interpersonal level are: fears of family contracting COVID-19, separation from family members, and domestic relationships. Themes at the level of community and societal stressors are: employment, community and societal systems, media, and the COVID-19 pandemic. Our findings demonstrate the ways that mental health, physical health/safety, and social environments are interrelated in the experience of COVID-19 for individuals diagnosed with anxiety or depression. These findings make a significant contribution to the literature as this is the first article to document mental health stressors related to the COVID-19 pandemic among individuals with diagnosed anxiety and depressive disorders.
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Affiliation(s)
- Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA; (R.M.); (D.E.W.); (R.S.P.)
| | - Melissa J. Zielinski
- Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (M.J.Z.); (R.G.T.J.)
- Department of Psychological Science, University of Arkansas, Fayetteville, AR 72703, USA
| | - Ronald G. Thompson
- Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (M.J.Z.); (R.G.T.J.)
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA; (R.M.); (D.E.W.); (R.S.P.)
| | - Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA; (R.M.); (D.E.W.); (R.S.P.)
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72703, USA; (R.M.); (D.E.W.); (R.S.P.)
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10
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Elliott JC, Greene AL, Thompson RG, Eaton NR, Hasin DS. Substance use in a sexual context: The association of sex-related substance use motives with substance choice and use behaviors. J Subst Use 2021; 26:212-217. [PMID: 33732094 DOI: 10.1080/14659891.2020.1807633] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Substance use before sex is associated with riskier behaviors. Sex-related substance use motives may explain pre-sex substance use. We explored what sex-related motives are associated with alcohol versus drug use, and which motives underlie heavier use. METHODS A sample of 936 participants (50% male, 80% White) completed an Internet survey about sexuality. Those who drank before sex (n=657) reported on six sex-related drinking motives; those who used drugs before sex (n=271) reported on six (parallel) sex-related drug use motives. The frequency of endorsement of each motive between drinkers and drug users was compared with z-distributions. Logistic regressions assessed whether motives were associated with substance use frequency and intoxication before sex. RESULTS Substance use to relax and to get a sex partner to use were more commonly endorsed for alcohol than drugs; substance use to improve performance and enhance experience were more commonly endorsed for drugs. Most motives were associated with alcohol frequency and intoxication before sex. None were associated with drug frequency; some were associated with drug intoxication. CONCLUSIONS Alcohol was generally used to facilitate sex, and drugs to enhance sex. Sex-related drinking motives were associated with drinking before sex; sex-related drug use motives were less predictive.
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Affiliation(s)
- Jennifer C Elliott
- New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Ashley L Greene
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Ronald G Thompson
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Deborah S Hasin
- New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
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11
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Thompson RG, Aivadyan C, Stohl M, Aharonovich E, Hasin DS. Smartphone application plus brief motivational intervention reduces substance use and sexual risk behaviors among homeless young adults: Results from a randomized controlled trial. Psychol Addict Behav 2020; 34:641-649. [PMID: 32175752 PMCID: PMC9997652 DOI: 10.1037/adb0000570] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Indexed: 11/08/2022]
Abstract
Homeless young adults are more likely than their never-homeless counterparts to abuse substances and engage in sexual risk behaviors. This study evaluated the feasibility and preliminary effectiveness of OnTrack, a smartphone application to self-monitor substance use and sexual risk behaviors, plus a brief motivational intervention (BMI), in reducing substance use and sexual risk among homeless young adults. A randomized controlled pilot trial (N = 60) compared OnTrack + BMI to treatment as usual (TAU) at an inner-city crisis shelter for homeless young adults (aged 18-21 years). Participants were assessed at baseline and 2 weeks, 4 weeks, and 6 weeks after baseline to evaluate substance use and sexual risk behaviors. Kruskal-Wallis tests determined differences between baseline and postintervention assessments. Logistic regression models examined treatment effect on change in outcomes between baseline and postintervention follow-up assessment, controlling for baseline levels. Participants in OnTrack + BMI significantly reduced past 2-week number of drinks (p = .023), times used marijuana (p = .046), times engaged in unprotected sex (p = .012), and times used drugs before sexual activity (p = .019). No reductions of substance use or sexual risk behaviors were found among participants in TAU (all ps > .05). After adjusting for baseline levels of substance use and sexual risk, participants in OnTrack + BMI had significantly lower odds than those in TAU for drinking alcohol (adjusted OR = 0.14; p = .01) and having unprotected sex (adjusted OR = 0.151; p = .032). OnTrack + BMI is feasible and effective in reducing past 2-week alcohol use and unprotected sex among homeless young adults. A larger randomized trial is warranted to replicate and extend present results. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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12
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Taggart TC, Rodriguez-Seijas C, Dyar C, Elliott JC, Thompson RG, Hasin DS, Eaton NR. Sexual orientation and sex-related substance use: The unexplored role of bisexuality. Behav Res Ther 2019; 115:55-63. [PMID: 30594299 PMCID: PMC6409130 DOI: 10.1016/j.brat.2018.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 09/14/2018] [Revised: 12/15/2018] [Accepted: 12/20/2018] [Indexed: 01/03/2023]
Abstract
Using alcohol and drugs in sexual contexts is associated with negative health consequences, including increased risk for HIV/STIs, sexual victimization, unplanned pregnancies, and overdose. Evidence suggests millions of adults regularly use alcohol in sexual contexts, thus increasing their risk for these consequences. However, no nationally representative estimates exist for rates of regular alcohol and/or drug use in sexual contexts. Additionally, previous studies suggest sexual minority individuals are more likely to use substances in sexual contexts than heterosexuals; however, none of these studies examined for multiple dimensions or subgroups of sexual orientation. Thus, using two distinct datasets-one large, nationally representative sample (N = 17,491) and an Internet-collected convenience sample (N = 1001)-we explored the associations between sexual orientation (dimensions and subgroups) and rates of regular sex-related alcohol and/or drug use in American adults. Results showed that sexual minority individuals were significantly more likely to report regularly using substances in sexual contexts compared to heterosexuals; however, results varied based on dimension of sexual orientation and by sex. Across both samples, bisexual individuals exhibited the highest rates of regular sex-related substance use. Findings suggest that sexual minorities, and bisexual individuals in particular, may be at increased risk for regular sex-related substance use and its associated negative health consequences. Future research should include nuanced and multidimensional assessments of sexual orientation to investigate sex-related alcohol and/or drug use and its associated risks, as well as examine the potential direct and indirect pathways by which these disparities may be conferred.
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Affiliation(s)
- Tenille C Taggart
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
| | | | - Christina Dyar
- Institute for Sexual and Gender Minority Health and Well-being, Northwestern University, USA
| | - Jennifer C Elliott
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Ronald G Thompson
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Deborah S Hasin
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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13
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Dyar C, Taggart TC, Rodriguez-Seijas C, Thompson RG, Elliott JC, Hasin DS, Eaton NR. Physical Health Disparities Across Dimensions of Sexual Orientation, Race/Ethnicity, and Sex: Evidence for Increased Risk Among Bisexual Adults. Arch Sex Behav 2019; 48:225-242. [PMID: 29633061 PMCID: PMC6382069 DOI: 10.1007/s10508-018-1169-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [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: 08/27/2017] [Revised: 12/16/2017] [Accepted: 01/31/2018] [Indexed: 05/18/2023]
Abstract
Accumulating evidence suggests that sexual minority individuals are at increased risk for physical health conditions compared to heterosexual individuals. However, we know little about physical health disparities affecting bisexual individuals, a population at increased risk for psychiatric and substance use conditions compared to both heterosexual and lesbian/gay populations. Using a large, nationally representative sample, we examined physical health disparities for bisexual individuals. To advance research on sexual minority health disparities, we further: (1) compared prevalence rates of physical health conditions across three dimensions of sexual orientation (i.e., identity, attractions, behavior) and (2) examined whether disparities differed by sex and race/ethnicity. Results indicated that sexual minority individuals were at increased risk for many physical health conditions. Notably, individuals with bisexual identity, attractions, and/or behavior were at increased risk for more physical health conditions than other sexual minority groups. The number and types of physical health disparities affecting bisexually identified individuals and individuals with same- and opposite-sex attractions and/or sexual partners varied across sex and race/ethnicity, with the most consistent disparities emerging for individuals who reported same- and opposite-sex sexual partners. Our findings highlight the substantial physical health disparities affecting sexual minorities and the heightened risk conferred by all facets of bisexuality.
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Affiliation(s)
- Christina Dyar
- Department of Psychology, University of Cincinnati, Cincinnati, OH, 45221, USA.
| | - Tenille C Taggart
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | | | - Ronald G Thompson
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jennifer C Elliott
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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Rodriguez-Seijas C, Arfer KB, Thompson RG, Hasin DS, Eaton NR. Sex-related substance use and the externalizing spectrum. Drug Alcohol Depend 2017; 174:39-46. [PMID: 28301821 DOI: 10.1016/j.drugalcdep.2017.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 05/09/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Substance use before and during sexual activity is associated with many negative health outcomes. Estimates suggest that at least 4.3 million American adults annually engage in regular sex-related alcohol consumption, indicating that the intersection of substance use and sexual behavior is of public health concern. However, it is likely that when considering broader sex-related substance use, estimates would be notably higher. While substance use disorders and antisocial personality disorder have been associated with sex-related alcohol consumption, no study has investigated how regular sex-related substance use is associated with the broader transdiagnostic externalizing spectrum. Further, no studies have assessed whether or not sexual risk-taking behaviors can be integrated into the externalizing spectrum. METHODS In a large internet sample (N=936), we used confirmatory factor analysis, item response theory, and logistic regression to link sex-related alcohol and drug use to an externalizing latent variable; identified psychometric characteristics of these behaviors; and determined the extent to which one's externalizing level was associated with changes in odds of regular sex-related substance use. We then replicated these findings in a nationally representative sample (N=34,653). RESULTS Results highlighted the close association between sex-related substance use and externalizing, with externalizing increases being associated with significantly increased odds of regular sex-related substance use. CONCLUSIONS These findings bear notable implications for conceptualization and treatment of sex-related substance use. Transdiagnostic intervention can be an efficient means of addressing this problematic behavior as well as other comorbid presentations. Results expand the current conceptualization of the externalizing spectrum.
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Affiliation(s)
| | - Kodi B Arfer
- UCLA Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, CA, USA
| | - Ronald G Thompson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, NY, USA
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, USA; New York State Psychiatric Institute, NY, USA
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15
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Thompson RG, Eaton NR, Hu MC, Hasin DS. Borderline personality disorder and regularly drinking alcohol before sex. Drug Alcohol Rev 2017; 36:540-545. [PMID: 28321919 DOI: 10.1111/dar.12476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 05/17/2016] [Revised: 07/26/2016] [Accepted: 07/29/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Drinking alcohol before sex increases the likelihood of engaging in unprotected intercourse, having multiple sexual partners and becoming infected with sexually transmitted infections. Borderline personality disorder (BPD), a complex psychiatric disorder characterised by pervasive instability in emotional regulation, self-image, interpersonal relationships and impulse control, is associated with substance use disorders and sexual risk behaviours. However, no study has examined the relationship between BPD and drinking alcohol before sex in the USA. This study examined the association between BPD and regularly drinking before sex in a nationally representative adult sample. DESIGN AND METHODS Participants were 17 491 sexually active drinkers from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regression models estimated effects of BPD diagnosis, specific borderline diagnostic criteria and BPD criterion count on the likelihood of regularly (mostly or always) drinking alcohol before sex, adjusted for controls. RESULTS Borderline personality disorder diagnosis doubled the odds of regularly drinking before sex [adjusted odds ratio (AOR) = 2.26; confidence interval (CI) = 1.63, 3.14]. Of nine diagnostic criteria, impulsivity in areas that are self-damaging remained a significant predictor of regularly drinking before sex (AOR = 1.82; CI = 1.42, 2.35). The odds of regularly drinking before sex increased by 20% for each endorsed criterion (AOR = 1.20; CI = 1.14, 1.27) DISCUSSION AND CONCLUSIONS: This is the first study to examine the relationship between BPD and regularly drinking alcohol before sex in the USA. Substance misuse treatment should assess regularly drinking before sex, particularly among patients with BPD, and BPD treatment should assess risk at the intersection of impulsivity, sexual behaviour and substance use. [Thompson Jr RG, Eaton NR, Hu M-C, Hasin DS Borderline personality disorder and regularly drinking alcohol before sex Drug Alcohol Rev 2017;36:540-545].
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Affiliation(s)
- Ronald G Thompson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA
| | | | - Mei-Chen Hu
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA.,New York State Psychiatric Institute, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
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16
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Thompson RG, Alonzo D, Hu MC, Hasin DS. The influences of parental divorce and maternal-versus-paternal alcohol abuse on offspring lifetime suicide attempt. Drug Alcohol Rev 2016; 36:408-414. [DOI: 10.1111/dar.12441] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/15/2016] [Accepted: 05/07/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Ronald G. Thompson
- Department of Psychiatry, College of Physicians and Surgeons; Columbia University; New York USA
| | - Dana Alonzo
- Graduate School of Social Service; Fordham University; West Harrison USA
| | - Mei-Chen Hu
- Department of Psychiatry, College of Physicians and Surgeons; Columbia University; New York USA
| | - Deborah S. Hasin
- Department of Psychiatry, College of Physicians and Surgeons; Columbia University; New York USA
- Department of Epidemiology, Mailman School of Public Health; Columbia University; New York USA
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Thompson RG, Elliott JC, Hu MC, Aivadyan C, Aharonovich E, Hasin DS. Short-term effects of a brief intervention to reduce alcohol use and sexual risk among homeless young adults: Results from a randomized controlled trial. Addict Res Theory 2016; 25:24-31. [PMID: 28620272 PMCID: PMC5467538 DOI: 10.1080/16066359.2016.1193165] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Homeless young adults are more likely than their never-homeless counterparts to abuse alcohol and engage in risky sexual behaviors, yet no interventions to simultaneously reduce both these behaviors among this vulnerable population have been systematically designed and evaluated. We therefore developed a brief intervention (BI) to reduce both alcohol use and sexual risk behaviors among homeless young adults. The results of a randomized trial testing the BI against an education comparison (EC) are presented. METHOD Young adults (N=61; age 17-22 years) from an urban, Northeastern crisis shelter were randomly assigned to either the 2-session, individual-level BI or a time-matched, 2-session, individual-level EC. Generalized linear mixed models for repeated measures determined effects of treatment condition on outcomes. RESULTS The BI significantly increased participant readiness to change alcohol use. However, it did not significantly decrease primary alcohol or HIV sexual risk outcomes, independently or relative to EC (all ps>.05). Participants in the EC reduced times engaged in unprotected sex between baseline and post-intervention to a significantly greater extent (p<.01) than those in the BI condition. Participants in both conditions reported satisfaction with respective interventions. CONCLUSIONS Findings suggest that the BI was acceptable and successful in getting participants to consider changing their drinking. However, lack of change in alcohol and sexual behavior outcomes indicates the need for further research to determine how to translate readiness to change into actual behavioral change among homeless young adults.
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Affiliation(s)
- Ronald G. Thompson
- Department of Psychiatry, Columbia University, New York, New York 10032, USA
- New York State Psychiatric Institute, New York, New York 10032, USA
| | - Jennifer C. Elliott
- Department of Psychiatry, Columbia University, New York, New York 10032, USA
- New York State Psychiatric Institute, New York, New York 10032, USA
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University, New York, New York 10032, USA
| | | | - Efrat Aharonovich
- Department of Psychiatry, Columbia University, New York, New York 10032, USA
- New York State Psychiatric Institute, New York, New York 10032, USA
| | - Deborah S. Hasin
- Department of Psychiatry, Columbia University, New York, New York 10032, USA
- New York State Psychiatric Institute, New York, New York 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA
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Affiliation(s)
- Nicholas R Eaton
- Nicholas R. Eaton is with the Department of Psychology, Stony Brook University, Stony Brook, NY. Ronald G. Thompson Jr and Deborah S. Hasin are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY. Deborah S. Hasin is also with the New York State Psychiatric Institute, New York
| | - Ronald G Thompson
- Nicholas R. Eaton is with the Department of Psychology, Stony Brook University, Stony Brook, NY. Ronald G. Thompson Jr and Deborah S. Hasin are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY. Deborah S. Hasin is also with the New York State Psychiatric Institute, New York
| | - Deborah S Hasin
- Nicholas R. Eaton is with the Department of Psychology, Stony Brook University, Stony Brook, NY. Ronald G. Thompson Jr and Deborah S. Hasin are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY. Deborah S. Hasin is also with the New York State Psychiatric Institute, New York
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Meyers JL, Shmulewitz D, Elliott JC, Thompson RG, Aharonovich E, Spivak B, Weizman A, Frisch A, Grant BF, Hasin DS. Parental alcohol history differentially predicts offspring disorders in distinct subgroups in Israel. J Stud Alcohol Drugs 2015; 75:859-69. [PMID: 25208204 DOI: 10.15288/jsad.2014.75.859] [Citation(s) in RCA: 5] [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 The association between alcoholism in parents and related disorders in their offspring is well established in cultures with intermediate/high alcohol consumption, but not in those with low consumption, such as Israel. This study investigated differences in parental transmission of alcohol problems and related psychopathology between immigrants from the former Soviet Union (FSU) to Israel and other Israelis-two Israeli subgroups with differing alcohol consumption behaviors and social norms. METHOD A total of 1,347 adults from a household sample were interviewed. Regression analyses were used to examine associations between parental alcohol problems and participant disorders: alcohol, nicotine, and cannabis use disorders (AUD, NUD, CUD); antisocial personality disorder (ASPD); major depressive disorder (MDD); and posttraumatic stress disorder (PTSD). We also examined the associations of parental alcohol problems with participant disorders characterized with two latent factors: externalizing (EXT: AUD, NUD, CUD, ASPD) and internalizing (INT: MDD, PTSD). Differential parental transmission of alcohol problems in FSU (n = 315) and non-FSU (n = 1,032) Israelis was examined with statistical interaction. RESULTS Among emigrants from the FSU, parental alcohol problems predicted AUD, NUD, CUD, ASPD, PTSD, EXT, and INT (mean ratios = 1.38-4.83). In non-FSU Israelis, parental alcohol problems predicted only ASPD and PTSD (mean ratios = 1.08-4.09). Significant interactions were observed for AUD, CUD, PTSD, and EXT; each relationship was stronger in FSU Israelis and null (AUD, CUD, EXT) or less robust (PTSD) in other Israelis. CONCLUSIONS Parental alcohol problems were related to substance use and psychiatric disorders differently in FSU and other Israelis, two groups with different alcohol consumption levels and drinking norms. We propose that, in social contexts that vary in the degree to which they constrain alcohol behavior, underlying genetic predispositions may manifest as different disorders.
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Affiliation(s)
- Jacquelyn L Meyers
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Dvora Shmulewitz
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, New York State Psychiatric Institute, New York, New York
| | - Jennifer C Elliott
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Ronald G Thompson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, New York State Psychiatric Institute, New York, New York
| | - Efrat Aharonovich
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, New York State Psychiatric Institute, New York, New York
| | - Baruch Spivak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, Felsenstein Medical Research Center, Petah Tikva, Israel, Research Unit, Geha Mental Health Center, Petah Tikva, Israel
| | - Amos Frisch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Bridget F Grant
- Laboratory of Epidemiology and Biometry, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Deborah S Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, New York State Psychiatric Institute, New York, New York
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Eaton NR, Thompson RG, Hu MC, Goldstein RB, Saha TD, Hasin DS. Regularly Drinking Alcohol Before Sexual Activity in a Nationally Representative Sample: Prevalence, Sociodemographics, and Associations With Psychiatric and Substance Use Disorders. Am J Public Health 2015; 105:1387-93. [PMID: 25973812 DOI: 10.2105/ajph.2015.302556] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We addressed regular drinking before sex and its associated risk factors. METHODS From the wave 2 National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative adult US sample (fielded 2004-2005), we determined the 12-month prevalence of regularly drinking alcohol before sexual activity. Among 17,491 sexually active drinkers, we determined the sociodemographic, psychiatric, and substance use correlates of regularly drinking before sex. RESULTS Regular presex drinking's 12-month prevalence was 1.8%. Significant bivariate sociodemographic correlates were age, gender, race/ethnicity, education, family income, marital status, and employment status. Generalized anxiety disorder and alcohol dependence were associated with significantly increased odds of being a regular presex drinker after controlling for covariates. CONCLUSIONS We estimate that 4.3 million American adults are regular presex drinkers. Future research should examine this public health issue at the population level, with particular focus on pathways that link it to psychopathology.
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Affiliation(s)
- Nicholas R Eaton
- Nicholas R. Eaton is with the Department of Psychology, Stony Brook University, Stony Brook, NY. Ronald G. Thompson Jr, Mei-Chen Hu, and Deborah S. Hasin are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY. Risë B. Goldstein and Tulshi D. Saha are with the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD
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Thompson RG, Eaton NR, Hu MC, Grant BF, Hasin DS. Regularly drinking alcohol before sex in the United States: effects of relationship status and alcohol use disorders. Drug Alcohol Depend 2014; 141:167-70. [PMID: 24950638 PMCID: PMC4110894 DOI: 10.1016/j.drugalcdep.2014.05.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 01/09/2014] [Revised: 05/12/2014] [Accepted: 05/24/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Drinking alcohol before sex increases the likelihood of engaging in sexual risk behaviors and risk for HIV infection. Relationship status (single versus partnered) and alcohol use disorders (AUD) are associated with each other and sexual risk behaviors, yet have not been examined as predictors of drinking alcohol before sex, using national data. This study examined whether relationship status and AUD increased the likelihood of regularly drinking alcohol before sex in a nationally representative sample. METHODS The main and additive interaction effects of relationship status and AUD on regularly drinking alcohol before sex were analyzed among sexually active drinkers (N=17,491) from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Regularly drinking alcohol before sex was defined as drinking alcohol most or all of the time before sex. RESULTS After adjustment for controls, relationship status (AOR=3.51; CI=2.59-4.75) and AUD (AOR=6.24; CI=5.16-7.53) increased the likelihood of regularly drinking alcohol before sex and interacted to differentially increase this risk, with the effect of being single on the likelihood of regularly drinking alcohol before sex increased among participants with AUD (p<.001). CONCLUSIONS This study reinforces the importance of relationship status and AUD to the risk for regularly drinking alcohol before sex. Public health efforts should target alcohol and HIV prevention messages to single adults, particularly those with AUD, highlighting their risk for regularly drinking alcohol before sex.
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Affiliation(s)
- Ronald G Thompson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive #123, New York, NY 10032, USA.
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, New York 11794, USA
| | - Mei-Chen Hu
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive #123, New York, NY 10032, USA
| | - Bridget F Grant
- Laboratory of Epidemiology and Biometry, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive #123, New York, NY 10032, USA; New York State Psychiatric Institute, New York, NY 10032, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
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Alonzo D, Thompson RG, Stohl M, Hasin D. The influence of parental divorce and alcohol abuse on adult offspring risk of lifetime suicide attempt in the United States. Am J Orthopsychiatry 2014; 84:316-320. [PMID: 24827026 DOI: 10.1037/h0099804] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The influences of parental divorce and alcohol abuse on adult offspring lifetime suicide attempt have not been examined in national data. This study analyzed data from the 2001-2002 NESARC to estimate main and interaction effects of parental divorce and alcohol abuse on lifetime suicide attempt. Adjusted for controls, parental divorce and parental alcohol abuse independently increased odds of lifetime suicide attempt. The effect of parental divorce was not significantly moderated by parental alcohol abuse. Further research is needed to examine whether additional parental and offspring psychiatric and substance use covariates attenuate the association between parental divorce and lifetime suicide attempt.
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Affiliation(s)
- Dana Alonzo
- Graduate School of Social Work, Columbia University
| | - Ronald G Thompson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University
| | | | - Deborah Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University
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Auslander WF, Thompson RG, Gerke DR. The Moderating Effect of Marijuana Use on the Relationship between Delinquent Behavior and HIV Risk among Adolescents in Foster Care. J HIV AIDS Soc Serv 2014; 13:179-197. [PMID: 25214818 PMCID: PMC4157673 DOI: 10.1080/15381501.2013.859112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Adolescents in foster care experience mental health and substance use problems that place them at risk for HIV, yet the exact nature of the relationship remains unclear. This study examined the co-occurring influences of mental health problems and substance use on HIV risk and determined whether substance use moderated the effect of mental health problems on HIV risk behaviors among adolescents in foster care. Regression analyses of cross-sectional data collected through structured interviews with 334 adolescents, aged 15-18 years, determined which mental health problems and substances increased HIV risk behaviors. Adolescents with delinquency and anxiety/depression engaged in significantly more HIV risk behaviors than their counterparts, controlling for race, gender, and type of childhood abuse. Further, any marijuana use significantly moderated the effects of delinquent behaviors on HIV risk, differentially increasing HIV risk among those who engaged in delinquent behaviors.
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Affiliation(s)
- Wendy F Auslander
- Brown School of Social Work, Washington University, St. Louis, Missouri
| | | | - Donald R Gerke
- Brown School of Social Work, Washington University, St. Louis, Missouri
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Thompson RG, Wall MM, Greenstein E, Grant BF, Hasin DS. Substance-use disorders and poverty as prospective predictors of first-time homelessness in the United States. Am J Public Health 2013; 103 Suppl 2:S282-8. [PMID: 24148043 DOI: 10.2105/ajph.2013.301302] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether substance-use disorders and poverty predicted first-time homelessness over 3 years. METHODS We analyzed longitudinal data from waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions to determine the main and interactive effects of wave 1 substance use disorders and poverty on first-time homelessness by wave 2, among those who were never homeless at wave 1 (n = 30,558). First-time homelessness was defined as having no regular place to live or having to live with others for 1 month or more as a result of having no place of one's own since wave 1. RESULTS Alcohol-use disorders (adjusted odds ratio [AOR] = 1.34), drug-use disorders (AOR = 2.51), and poverty (AOR = 1.34) independently increased prospective risk for first-time homelessness, after adjustment for ecological variables. Substance-use disorders and poverty interacted to differentially influence risk for first-time homelessness (P < .05), before, but not after, adjustment for controls. CONCLUSIONS This study reinforces the importance of both substance-use disorders and poverty in the risk for first-time homelessness, and can serve as a benchmark for future studies. Substance abuse treatment should address financial status and risk of future homelessness.
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Affiliation(s)
- Ronald G Thompson
- Ronald G. Thompson Jr, Melanie M. Wall, and Deborah S. Hasin are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY. Melanie M. Wall, Eliana Greenstein, and Deborah S. Hasin are with the New York State Psychiatric Institute, New York. Bridget F. Grant is with the Laboratory of Epidemiology and Biometry, Division of Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD
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Thompson RG, Alonzo D, Hasin DS. Parental Divorce, Maternal-Paternal Alcohol Problems, and Adult Offspring Lifetime Alcohol Dependence. J Soc Work Pract Addict 2013; 13:295-308. [PMID: 24678271 PMCID: PMC3963604 DOI: 10.1080/1533256x.2013.812909] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study examined the influences of parental divorce and maternal-paternal histories of alcohol problems on adult offspring lifetime alcohol dependence using data from the 2001-2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Parental divorce and maternal-paternal alcohol problems interacted to differentially influence the likelihood of offspring lifetime alcohol dependence. Experiencing parental divorce and either maternal or paternal alcohol problems doubled the likelihood of alcohol dependence. Divorce and history of alcohol problems for both parents tripled the likelihood. Offspring of parental divorce may be more vulnerable to developing alcohol dependence, particularly when one or both parents have alcohol problems.
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Affiliation(s)
| | - Dana Alonzo
- Columbia University, Psychiatry, New York, New York, USA
| | - Deborah S Hasin
- Columbia University, Public Health and Psychiatry, New York, New York, USA
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Abstract
OBJECTIVE Although foster care placement is often preceded by stressful events such as child abuse, foster care itself often exposes children to additional severe stressors. A history of foster care, as well as the childhood abuse that often precedes it, is common among homeless young adults. This study examined whether a history of foster care was associated with psychiatric disorders, prior psychiatric counseling, prescription of psychiatric medications, and prior psychiatric hospitalization among newly homeless young adults. METHODS A consecutive sample of 423 adults aged 18 to 21 years who sought emergency shelter for the first time between October 1, 2007, and February 29, 2008, were assessed at intake. Logistic regression analyses determined the associations between foster care and any psychiatric disorder (affective, anxiety, personality, and psychotic) and psychiatric treatment. The analyses adjusted for demographic characteristics, childhood abuse, substance use, prior arrest, unemployment, lack of high school diploma, and histories of psychiatric disorders and drug abuse among biological relatives. RESULTS Homeless young adults with histories of foster care were 70% more likely than those without such histories to report any psychiatric disorder. They were more than twice as likely to have received mental health counseling for a psychiatric disorder, to have been prescribed psychiatric medication, and to have been hospitalized for psychiatric problems. CONCLUSIONS Histories of foster care among homeless young adults should trigger screening for psychiatric disorders to aid in the provision of treatment (counseling, medication, and hospitalization) tailored to the psychiatric needs of this highly vulnerable population.
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Affiliation(s)
- Ronald G Thompson
- Department of Psychiatry, Columbia University, New York City, NY, USA
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Thompson RG, Auslander WF, Alonzo D. Individual-level predictors of nonparticipation and dropout in a life-skills HIV prevention program for adolescents in foster care. AIDS Educ Prev 2012; 24:257-269. [PMID: 22676464 PMCID: PMC3766366 DOI: 10.1521/aeap.2012.24.3.257] [Citation(s) in RCA: 4] [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: 06/01/2023]
Abstract
The purpose of this study is to identify individual-level characteristics of foster care adolescents who are more likely to not participate in, and drop out of, a life-skills HIV prevention program delivered over 8 months. Structured interviews were conducted with 320 foster care adolescents (15-18 years). Logistic regression and survival analyses (Cox Proportional Hazards Regression) determined the influence of demographics, HIV sexual risk behaviors, substance use, mental health problems, and other individual-level risk factors on nonparticipation and dropout. Older age and having vaginal intercourse without a condom were significant predictors of nonparticipation. Older age and marijuana use significantly increased the hazard of dropping out of the program. Foster care adolescents at increased risk for HIV infection were more likely to never participate in and drop out of the program. To improve initial and ongoing participation, HIV prevention efforts for adolescents in foster care should be tailored to individual-level HIV risk behaviors and incorporate early and ongoing engagement and retention strategies.
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Affiliation(s)
- Ronald G Thompson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 722 West 168th St., Suite 229-C, New York, NY 10032, USA.
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Thompson RG, Hasin DS. Cigarette, marijuana, and alcohol use and prior drug treatment among newly homeless young adults in New York City: Relationship to a history of foster care. Drug Alcohol Depend 2011; 117:66-9. [PMID: 21288659 PMCID: PMC3100368 DOI: 10.1016/j.drugalcdep.2010.12.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [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: 06/24/2010] [Revised: 12/13/2010] [Accepted: 12/14/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study examined whether a history of foster care was associated with the risk for substance use among newly homeless young adults, controlling for demographics and other risk factors. METHODS Multiple logistic regression analyses, adjusted for controls, among consecutive admissions of 424 newly homeless young adults (18-21 years), determined the association between foster care and substance use. RESULTS A history of foster care was reported by 35% of the sample. Alcohol, marijuana, and cigarettes were the most frequently used substances. After adjusting for demographics, childhood emotional, physical, and sexual abuse, prior arrest, unemployment, lack of high school diploma, and family drug use, homeless young adults with histories of foster care were: three times as likely to smoke cigarettes (AOR=3.09); more than three times as likely to use marijuana (AOR=3.30); and almost nine times as likely to have been in drug treatment (AOR=8.81) than those without such histories. CONCLUSIONS It is important to screen homeless young adults who exited foster care for substance use, particularly cigarettes and marijuana. Risk reduction interventions should be targeted and tailored to their substance prevention needs.
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Affiliation(s)
- Ronald G. Thompson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, United States, New York State Psychiatric Institute, New York, New York,Corresponding author: Ronald G. Thompson, Jr., Ph.D., Department of Psychiatry, College of Physicians and Surgeons, New York State Psychiatric Institute, Columbia University, 722 West 168th Street, Suite 241, New York, NY 10032, United States. Tel.: +1 212 543 5047; fax: +1 212 543 5913. . (R.G. Thompson)
| | - Deborah S. Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, United States, New York State Psychiatric Institute, New York, New York, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Thompson RG, Auslander WF. Substance use and mental health problems as predictors of HIV sexual risk behaviors among adolescents in foster care. Health Soc Work 2011; 36:33-43. [PMID: 21446607 PMCID: PMC3785296 DOI: 10.1093/hsw/36.1.33] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [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: 05/04/2023]
Abstract
This study examined the relationship between substance use, mental health problems, and HIV sexual risk behaviors among a sample of foster care adolescents. Data were collected through structured baseline interviews with 320 adolescents (ages 15 to 18 years) who resided in foster care placements and participated in a larger evaluation study of an HIV prevention program. Final logistic regression models indicated that delinquent behavior and marijuana use were the most significant predictors of engaging in any one HIV risk behavior. Adolescents who reported delinquent behaviors, alcohol use, and marijuana use and who were female were more likely than their counterparts to engage in vaginal sex without using a condom. Future research is needed to further identify risk and protective factors for substance use, mental health problems, and HIV sexual risk behaviors among adolescents in foster care. HIV prevention efforts for these vulnerable adolescents should target those with substance use and delinquent behaviors.
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Affiliation(s)
- Ronald G Thompson
- Department of Psychiatry, Columbia University, New York, NY 10032, USA.
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Abstract
Research suggests parental divorce during childhood increases risk of suicide attempt for male but not female offspring. The negative impact on offspring associated with parental divorce may be better explained by parental psychopathology, such as depression. We examined whether adult offspring of parental divorce experience elevated risk of suicide attempt, controlling for parental history of depression, and whether the risk varies by the gender of the offspring. Using the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), the sample consists of respondents who experienced parental divorce (N = 4895). Multivariable regressions controlled for age, race/ethnicity, income, marital status, and parental history of depression. Females living with their fathers were significantly more likely to report lifetime suicide attempts than females living with their mothers, even after controlling for parental depression. Findings suggest that childhood/adolescent parental divorce may have a stronger impact on suicide attempt risk in female offspring than previously recognized.
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Affiliation(s)
- Dana Lizardi
- Graduate School of Social Work, Columbia University, New York, NY 10027, USA.
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Thompson RG, Lizardi D, Keyes KM, Hasin DS. Childhood or adolescent parental divorce/separation, parental history of alcohol problems, and offspring lifetime alcohol dependence. Drug Alcohol Depend 2008; 98:264-9. [PMID: 18757141 PMCID: PMC3818521 DOI: 10.1016/j.drugalcdep.2008.06.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [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: 12/31/2007] [Revised: 06/16/2008] [Accepted: 06/24/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study examined whether the experiences of childhood or adolescent parental divorce/separation and parental alcohol problems affected the likelihood of offspring DSM-IV lifetime alcohol dependence, controlling for parental history of drug, depression, and antisocial behavior problems. METHOD Data were drawn from the 2001-2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC), a nationally representative United States survey of 43,093 civilian non-institutionalized participants aged 18 and older, interviewed in person. Logistic regression models were used to calculate the main and interaction effects of childhood or adolescent parental divorce/separation and parental history of alcohol problems on offspring lifetime alcohol dependence, after adjusting for parental history of drug, depression, and antisocial behavior problems. RESULTS Childhood or adolescent parental divorce/separation and parental history of alcohol problems were significantly related to offspring lifetime alcohol dependence, after adjusting for parental history of drug, depression, and antisocial behavior problems. Experiencing parental divorce/separation during childhood, even in the absence of parental history of alcohol problems, remained a significant predictor of lifetime alcohol dependence. Experiencing both childhood or adolescent parental divorce/separation and parental alcohol problems had a significantly stronger impact on the risk for DSM-IV alcohol dependence than the risk incurred by either parental risk factor alone. CONCLUSIONS Further research is needed to better identify the factors that increase the risk for lifetime alcohol dependence among those who experience childhood or adolescent parental divorce/separation.
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Affiliation(s)
| | - Dana Lizardi
- Columbia University School of Social Work, New York, NY
| | - Katherine M. Keyes
- Mailman School of Public Health, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
| | - Deborah S. Hasin
- Mailman School of Public Health, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
- College of Physicians and Surgeons, Columbia University, New York, NY
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Thompson RG, Auslander WF. Risk factors for alcohol and marijuana use among adolescents in foster care. J Subst Abuse Treat 2006; 32:61-9. [PMID: 17175399 DOI: 10.1016/j.jsat.2006.06.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [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: 12/13/2005] [Revised: 06/12/2006] [Accepted: 06/15/2006] [Indexed: 10/24/2022]
Abstract
This study examined the influences of individual and social risk factors on alcohol and marijuana use among a sample of foster care adolescents. Data were collected through baseline structured interviews with 320 adolescents (aged 15-18 years) who resided in foster care placements and participated in a larger evaluation study of an independent living program. Approximately 40% of the adolescents reported alcohol use, 36% reported marijuana use, and 25% reported both alcohol and marijuana use during the 6 months prior to the interview. Final logistic regression models indicated that having friends who used marijuana and other substances and having skipped school remained most predictive of using alcohol, marijuana, or both alcohol and marijuana. Recommendations for substance abuse prevention and treatment for these vulnerable adolescents are proposed.
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Abstract
Exposure to some music, in particular classical music, has been reported to produce transient increases in cognitive performance. The authors investigated the effect of listening to an excerpt of Vivaldi's Four Seasons on category fluency in healthy older adult controls and Alzheimer's disease patients. In a counterbalanced repeated-measure design, participants completed two, 1-min category fluency tasks whilst listening to an excerpt of Vivaldi and two, 1-min category fluency tasks without music. The authors report a positive effect of music on category fluency, with performance in the music condition exceeding performance without music in both the healthy older adult control participants and the Alzheimer's disease patients. In keeping with previous reports, the authors conclude that music enhances attentional processes, and that this can be demonstrated in Alzheimer's disease.
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Affiliation(s)
- R G Thompson
- The Research Institute for the Care of the Elderly, Bath, UK.
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Affiliation(s)
- R G Thompson
- The Research Institute for the Care of The Elderly, Bath, UK.
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Thompson RG, Moulin CJA, Ridel GL, Hayre S, Conway MA, Jones RW. Recall of 9.11 in Alzheimer's disease: further evidence for intact flashbulb memory. Int J Geriatr Psychiatry 2004; 19:495-6. [PMID: 15156553 DOI: 10.1002/gps.1080] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- R G Thompson
- The Research Institute for the Care of the Elderly, St. Martin's Hospital, Bath BA2 5RP, UK.
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Strauss SH, Silver ME, Long KM, Thompson RG, Hudgens RA, Spartalian K, Ibers JA. Comparison of the molecular and electronic structures of (2,3,7,8,12,13,17,18-octaethylporphyrinato)iron(II) and (trans-7,8-dihydro-2,3,7,8,12,13,17,18-octaethylporphyrinato)iron(II). J Am Chem Soc 2002. [DOI: 10.1021/ja00300a021] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Andersson LA, Loehr TM, Thompson RG, Strauss SH. Influence of symmetry on the vibrational spectra of Zn(TPP), Zn(TPC), and Zn(TPiBC). Inorg Chem 2002. [DOI: 10.1021/ic00336a021] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kellett PJ, Pawlik MJ, Taylor LF, Thompson RG, Levstik MA, Anderson OP, Strauss SH. Five- and six-coordinate high-spin iron(III) porphyrin complexes with teflate (OTeF5-) ligands. Inorg Chem 2002. [DOI: 10.1021/ic00302a014] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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D'Urso PS, Earwaker WJ, Barker TM, Redmond MJ, Thompson RG, Effeney DJ, Tomlinson FH. Custom cranioplasty using stereolithography and acrylic. Br J Plast Surg 2000; 53:200-4. [PMID: 10738323 DOI: 10.1054/bjps.1999.3268] [Citation(s) in RCA: 222] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Numerous methods of cranioplasty have been described. Customization and prefabrication have been reported to reduce operating time and improve cosmesis. An original technique for the manufacture of customized cranioplastic implants has been developed and tested in 30 patients.Thirty patients requiring cranioplasties were selected. Data acquired from computed tomography (CT) were used to manufacture exact plastic replicas (biomodels) of craniotomy defects and master cranioplastic implants using the rapid prototyping technology of stereolithography (SL). The three-dimensional (3D) imaging techniques of mirroring and interpolation were used to extrapolate on existing anatomy to design the master implants. The master implants were hand finished to fit the defect in the corresponding cranial biomodel exactly and were then used to create a cavity mould. The mould was used to cast thermally polymerised custom acrylic implants. The surgeons reported that the customized implants reduced operating time, afforded excellent cosmesis and were cost effective. The patients reported that the opportunity to see the biomodel and implant preoperatively improved their understanding of the procedure. Two complications were noted, one infection and one implant required significant trimming. The simultaneous manufacture of the master implant (male) and biomodel (female) components from SL allowed custom accurate implants to be manufactured. Disadvantages identified were the time required for computer manipulations of the CT data (up to 2 h), difficulty in assessing the accuracy of the computer generated master as a 3D rendering, the potential for SL parts to warp, manufacturing time (minimum 2 days) and the cost of approximately $1300 US per case ($1000 for the SL biomodel and $300 for the acrylic casting).
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Affiliation(s)
- P S D'Urso
- Department of Surgery, The University of Queensland, Australia
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D'Urso PS, Thompson RG, Atkinson RL, Weidmann MJ, Redmond MJ, Hall BI, Jeavons SJ, Benson MD, Earwaker WJ. Cerebrovascular biomodelling: a technical note. Surg Neurol 1999; 52:490-500. [PMID: 10595770 DOI: 10.1016/s0090-3019(99)00143-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recently computed tomographic angiography (CTA) and MR angiography (MRA) have been used to image cerebrovascular structures. Although CTA and MRA are accurate and sensitive imaging modalities, limitations have been identified in relation to image interpretation. Stereolithographic (SL) biomodelling is a new technology that allows three-dimensional (3D) CT and MR data to be used to accurately manufacture solid plastic replicas of anatomical structures. A prospective trial of SL biomodelling in cerebrovascular surgery has been performed to investigate the feasibility and clinical utility of this new display medium. METHODS Fifteen patients with cerebral aneurysms and 1 patient with a cerebral arteriovenous malformation (AVM) were selected. 3D CT and/or MR angiograms were acquired and 19 solid anatomical biomodels manufactured using the rapid prototyping technology of stereolithography. The biomodels were used for patient education, diagnosis, operative planning and surgical navigation. RESULTS The biomodels replicated the CTA and MRA source data. The accuracy of one biomodel was verified by comparison with a post mortem specimen, which corresponded exactly in the x and y planes but differed by 2 mm in the z plane. The ability to closely study an overview of complex cerebrovascular anatomy from any perspective on a solid biomodel was reported to enhance the surgeon's understanding, particularly when conventional images were equivocal. Cerebrovascular biomodels were found to be useful when positioning the patient's head for surgery, for selecting the best aneurysm clip and for the simulation of clipping. Patient informed consent was anecdotally improved. Disadvantages of the technology were the cost and manufacturing time. CONCLUSIONS Cerebrovascular biomodelling may have utility in complex cases or when the standard imaging is felt to be equivocal.
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Affiliation(s)
- P S D'Urso
- Department of Neurological Sciences, Princess Alexandra Hospital, Brisbane, Australia
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Abstract
STUDY DESIGN A prospective trial of stereolithographic biomodeling in complex spinal surgery. OBJECTIVES To investigate the use of stereolithographic biomodeling as an aid to complex spinal surgery. SUMMARY OF BACKGROUND DATA Of the array of imaging methods available to assist the spinal surgeon, no single method provides a complete overview of the anatomy, although three-dimensional imaging has been shown to have advantages. METHODS Stereolithographic biomodeling is a new technology that allows data from three-dimensional computed tomographic scans to be used to generate exact plastic replicas of anatomic structures. Five patients with complex deformities were selected: two children with congenital deformities, a patient with an osteoblastoma, a patient with basilar invagination caused by osteogenesis imperfecta, and a patient with a failed lumbar fusion. Computed tomographic scanning was performed and stereolithographic biomodels generated. The stereolithographic biomodels were used for patient education, operative planning, and surgical navigation. RESULTS The surgeons reported that biomodeling was useful in complex spinal surgery and was an effective technology. Stereolithographic biomodels were found to be particularly useful in morphologic assessment, in the planning and rehearsal of surgery, for intraoperative navigation, and for informing patients about surgical procedures. CONCLUSIONS Stereolithographic biomodeling allows imaging data to be displayed in a physical form. This intuitive medium may improve data display and allows surgical simulation on a proxy of the surgical site. Draw-backs of the technology were a minimum 24 hours' manufacturing time and the cost.
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Affiliation(s)
- P S D'Urso
- Department of Surgery, University of Queensland, Australia.
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Abstract
This paper reviews the law related to voluntary intoxication and criminal responsibility in the 50 United States, the District of Columbia, the US Virgin islands, and Puerto Rico. Statutory and case law citations are provided which govern the use of intoxication evidence in each jurisdiction to negate mens rea (i.e., to establish diminished capacity), to support an insanity defense, and to mitigate criminal sentencing. Factors that courts typically focus on when deciding whether to admit this evidence in a particular case are discussed, and these factors are related to clinically relevant criteria.
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Affiliation(s)
- D B Marlowe
- Treatment Research Institute at the University of Pennsylvania, One Commerce Square, 2005 Market Street, Suite 1120, Philadelphia, Pennsylvania 19103-7220, USA.
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D'Urso PS, Atkinson RL, Lanigan MW, Earwaker WJ, Bruce IJ, Holmes A, Barker TM, Effeney DJ, Thompson RG. Stereolithographic (SL) biomodelling in craniofacial surgery. Br J Plast Surg 1998; 51:522-30. [PMID: 9924405 DOI: 10.1054/bjps.1998.0026] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Stereolithographic (SL) biomodelling allows 3D CT to be used to generate solid plastic replicas of anatomical structures (biomodels). Case reports in the literature suggest that such biomodels may have a use in craniofacial surgery but no large series or assessment of utility has been reported. A prospective trial to assess the utility of biomodelling in craniofacial surgery has been performed. METHODS Forty patients with complex craniofacial abnormalities were selected and 3D CT scanning performed. The data of interest was used to guide a laser to selectively polymerise photosensitive resin to manufacture SL biomodels. The biomodels were used for patient education, diagnosis and operative planning. An assessment protocol was designed to test the hypothesis that biomodels in addition to standard imaging had greater utility in the surgery performed than the standard imaging alone. RESULTS Anecdotally surgeons found biomodelling useful in 40 complex craniofacial operations. The formal assessment of the first 10 cases suggested biomodels improved operative planning (image 76%, image with biomodel 97%, P < 0.01) and diagnosis (image 82.5%, image with biomodel 99.25%, P < 0.01). Surgeons estimated that the use of biomodels had reduced operating time by a mean of 16% and were cost effective at a mean price of $1100 AUS. CONCLUSION Biomodelling was reported as an intuitive, user-friendly technology that facilitated diagnosis, operative planning and communication between colleagues and patients. Limitations of the technology were manufacturing time and cost.
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Affiliation(s)
- P S D'Urso
- University of Queensland Department of Surgery, Brisbane, Australia
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Thompson RG, Pearson L, Schoenfeld SL, Kolterman OG. Pramlintide, a synthetic analog of human amylin, improves the metabolic profile of patients with type 2 diabetes using insulin. The Pramlintide in Type 2 Diabetes Group. Diabetes Care 1998; 21:987-93. [PMID: 9614619 DOI: 10.2337/diacare.21.6.987] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the effects of 4 weeks of subcutaneous administration of pramlintide, a synthetic analog of human amylin, on metabolic control in patients with type 2 diabetes using insulin. RESEARCH DESIGN AND METHODS Serum fructosamine, HbA1c, and fasting plasma lipids were measured in 203 patients in a randomized double-blind placebo-controlled parallel-group multicenter trial using doses of 30 micrograms q.i.d., 60 micrograms t.i.d., and 60 micrograms q.i.d. RESULTS Statistically significant reductions in serum fructosamine concentrations were observed in the pramlintide 30 micrograms q.i.d. group (17.5 +/- 4.9 mumol/l, P = 0.029), the pramlintide 60 micrograms t.i.d. group (24.1 +/- 4.9 mumol/l, P = 0.003), and the 60 micrograms q.i.d. group (22.6 +/- 4.1 mumol/l, P = 0.001) compared with the placebo group (3.5 +/- 3.8 mumol/l). There were also statistically significant shifts in the proportion of patients with an abnormal serum fructosamine concentration at baseline that normalized at week 4 within the pramlintide 60 micrograms t.i.d. group and the 60 micrograms q.i.d. group. Consistent with the fructosamine results, there were statistically significant reductions in HbA1c in the pramlintide 30 micrograms q.i.d. group (0.53 +/- 0.07%, P = 0.0447), the pramlintide 60 micrograms t.i.d. group (0.58 +/- 0.07%, P < 0.0217), and the pramlintide 60 micrograms q.i.d. group (0.51 +/- 0.08%, P = 0.0242) compared with the placebo group (0.27 +/- 0.08%). Total cholesterol concentrations were also statistically significantly reduced in both the pramlintide 60 micrograms t.i.d. group (8.4 mg/dl, P < 0.01) and 60 micrograms q.i.d. group (10.5 mg/dl, P < 0.01) compared with placebo (1.2 mg/dl). Body weight decreased in both of the pramlintide 60 micrograms groups, but the trend did not achieve statistical significance. The incidence of hypoglycemia was similar in all treatment groups. CONCLUSIONS Reductions in serum fructosamine, plasma total and LDL cholesterol concentrations, and HbA1c support the hypothesis that pramlintide may improve metabolic control in patients with type 2 diabetes using insulin.
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Affiliation(s)
- R G Thompson
- Amylin Pharmaceuticals, San Diego, California 92121, USA
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Abstract
A study has been performed to determine if a stereolithographic (SL) biomodel of a fetal face could be created from 3 dimensional (3D) ultrasound (US). 3D ultrasound images were acquired by Diasonics Gateway 2D Array ultrasound systems (Diasonics Ultrasound, San Jose, CA, USA) using an electromagnetic localizer (Tomtec Free Hand Scanning Device, Tomtec Imaging Systems, Middle Cove, Australia). 3D volumetric reconstruction of the fetal face was performed and the data was prepared to guide the construction of an exact solid biomodel by stereolithography (SLA 250 3D Systems, Valencia, CA, USA). A faithful solid representation of the fetal face was produced within 12 hours of the US scan. The fetal biomodel seemed to improve the display of the 3D data. The user-friendly nature of biomodelling may have clinical utility for fetal morphological assessment and as an aid when counselling parents.
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Affiliation(s)
- P S D'Urso
- The University of Queensland, Department of Surgery, Brisbane
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Thompson RG, Pearson L, Kolterman OG. Effects of 4 weeks' administration of pramlintide, a human amylin analogue, on glycaemia control in patients with IDDM: effects on plasma glucose profiles and serum fructosamine concentrations. Diabetologia 1997; 40:1278-85. [PMID: 9389419 DOI: 10.1007/s001250050821] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The effects of 4 weeks' administration of pramlintide, an analogue of the human hormone amylin, on blood glucose control in 215 patients with insulin-dependent diabetes mellitus were examined in a 4-week, randomized, double-blind, placebo-controlled, parallel-group trial. Pramlintide was administered subcutaneously prior to meals in four dosing regimens: 30 microg four times per day (breakfast, lunch, dinner, and evening snack), 30 microg three times per day (breakfast, lunch and dinner [BLD]), 30 microg three times per day (breakfast, dinner and evening snack [BDS]), and 60 microg twice per day (breakfast and dinner). After 4 weeks of pramlintide 30 microg four times per day administration, there was a statistically significant reduction in the mean 24 h plasma glucose concentration when compared to placebo (-1.4 +/- 0.5 vs 0.3 +/- 0.5 micromol/l, p = 0.009). Serum fructosamine concentrations were reduced 62 +/- 10 micromol/l in the pramlintide 30 mg four times per day group, 43 +/- 7 micromol/l in the pramlintide 30 microg three times per day (BLD) group, 47 +/- 6 micromol/l in the pramlintide 30 microg three times per day (BDS) group, 46 +/- 7 micromol/l in the pramlintide 60 microg twice per day group, and 29 +/- 8 micromol/l by placebo. The incidence of hypoglycaemia was not different in any pramlintide group compared to the placebo group. Nausea, the most frequent adverse event, subsided after the first week of treatment in the majority of patients. In conclusion, pramlintide improved blood glucose control over a 4-week period without increased hypoglycaemia and was well tolerated. Future studies using a longer period of pramlintide administration with assessment of HbA1c as the measurement of glycaemic control are warranted.
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Affiliation(s)
- R G Thompson
- Amylin Pharmaceuticals Inc., San Diego, California 92121, USA
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Thompson RG, Gottlieb A, Organ K, Koda J, Kisicki J, Kolterman OG. Pramlintide: a human amylin analogue reduced postprandial plasma glucose, insulin, and C-peptide concentrations in patients with type 2 diabetes. Diabet Med 1997; 14:547-55. [PMID: 9223392 DOI: 10.1002/(sici)1096-9136(199707)14:7<547::aid-dia390>3.0.co;2-u] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In order to determine the influence of a 5 h infusion of pramlintide compared to placebo on postprandial glucose, lactate, insulin, and C-peptide concentrations in patients with Type 2 diabetes, a single-blind, randomized, cross-over study was conducted in 24 patients; 12 treated with exogenous insulin and 12 managed with diet and/or oral hypoglycaemic agents. One hour after initiation of infusion, patients consumed a Sustacal test meal. The protocol was repeated on the following day with each patient receiving the alternate study medication. Pramlintide infusion in the insulin-treated patients resulted in statistically significant reductions in mean glucose, insulin, C-peptide, and lactate concentrations during the 4-h period after the Sustacal test meal. Pramlintide infusion also resulted in significant reductions of mean insulin, C-peptide, and lactate concentrations, but not glucose concentrations, in the patients treated with diet and/or oral hypoglycaemic agents. Within this latter group, reduction in postprandial glucose concentrations in individual patients correlated with glycated haemoglobin values. These results suggest that administration of pramlintide may improve glycaemic control in patients with Type 2 diabetes treated with insulin or poorly controlled on diet and/or oral hypoglycaemic agents.
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Affiliation(s)
- R G Thompson
- Amylin Pharmaceuticals, Inc., San Diego, California 92121, USA
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Thompson RG, Peterson J, Gottlieb A, Mullane J. Effects of pramlintide, an analog of human amylin, on plasma glucose profiles in patients with IDDM: results of a multicenter trial. Diabetes 1997; 46:632-6. [PMID: 9075803] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The effects of subcutaneous administration of 10, 30, or 100 microg q.i.d. pramlintide, an analog of human amylin, on plasma glucose regulation in patients with IDDM were evaluated in a multicenter trial. The plasma glucose response to a Sustacal test meal was significantly reduced compared with placebo both after 1 week and after 2 weeks of administration of 30 or 100 microg pramlintide. In addition, 24-h mean plasma glucose concentrations were significantly lowered in patients receiving 30 microg of pramlintide for 2 weeks compared with placebo, while the 100-microg pramlintide dose did not reach statistical significance for the 24-h glucose profiles. At 10 microg, pramlintide had no effect on the 24-h glucose profile or on the plasma glucose response to a Sustacal test meal. The reduction in 24-h glucose concentrations and glucose concentrations after the Sustacal test meal observed at the 30-microg pramlintide dose was not accompanied by an increased incidence of hypoglycemic events. The most frequent adverse events were dose-related and involved transient upper gastrointestinal symptoms. A majority (>80%) of the patients who reported these adverse events during week 1 did not report them in week 2. These data indicate that pramlintide effectively reduces plasma glucose concentrations as reflected in both a 24-h glucose profile and a Sustacal test meal while maintaining an acceptable safety profile.
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Affiliation(s)
- R G Thompson
- Amylin Pharmaceuticals, Inc., San Diego, California 92121, USA
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Abstract
A total of 194 mental health care providers in Arkansas, primarily from rural areas and small communities, participated in a four-hour training program designed to improve their knowledge about the psychosocial and neuropsychiatric aspects of HIV and AIDS. Participants' responses to questionnaires completed before and after training indicated that the program was successful in achieving its goal. However, only a minimal number of providers reported completing drug, alcohol, and sexual histories and AIDS risk assessments for any of their patients before the training occurred. The authors emphasize the importance of AIDS training for rural providers.
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Affiliation(s)
- J F Aruffo
- University of Arkansas for Medical Sciences, Little Rock
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Alford J, Aruffo JF, Thompson RG, Dobbins WN, Gottlieb AA. HIV and psychiatric clients with developmental disability. ACTA ACUST UNITED AC 1994. [DOI: 10.1037/h0095557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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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