HIV-Risk Behavior Among Adults with Opioid Use Disorder During 12 Months Following Pre-trial Detention: Results from a Randomized Trial of Methadone Treatment

This was a three group randomized clinical trial of interim methadone and patient navigation involving 225 pre-trial detainees with opioid use disorder in Baltimore. The HIV Risk Assessment Battery (RAB) was administered at baseline (in jail), and at 6 and 12 months post-release. Generalized linear mixed model analyses indicated the condition × time interaction effect failed to reach significance (ps > .05) for both the drug risk and sex risk subscale scores. Therefore, findings suggest that there were no intervention effects on drug or sex risk behaviors. However, increased use of cocaine at baseline was associated with increases in drug- (b = .04, SE = .02) and sex-risk (b = .01, SE = .003) behaviors. These results suggest that interventions targeting cocaine use among pre-trial detainees may serve as a means of reducing HIV risk associated with drug- and sex-risk behaviors.Clinical Trials Registration: Clinicaltrials.gov NCT02334215.

Identifying substance misuse in primary care: TAPS Tool compared to the WHO ASSIST

BACKGROUND

There is a need for screening and brief assessment instruments to identify primary care patients with substance use problems. This study's aim was to examine the performance of a two-step screening and brief assessment instrument, the TAPS Tool, compared to the WHO ASSIST.

METHODS

Two thousand adult primary care patients recruited from five primary care clinics in four Eastern US states completed the TAPS Tool followed by the ASSIST. The ability of the TAPS Tool to identify moderate- and high-risk use scores on the ASSIST was examined using sensitivity and specificity analyses.

RESULTS

The interviewer and self-administered computer tablet versions of the TAPS Tool generated similar results. The interviewer-administered version (at cut-off of 2), had acceptable sensitivity and specificity for high-risk tobacco (0.90 and 0.77) and alcohol (0.87 and 0.80) use. For illicit drugs, sensitivities were >0.82 and specificities >0.92. The TAPS (at a cut-off of 1) had good sensitivity and specificity for moderate-risk tobacco use (0.83 and 0.97) and alcohol (0.83 and 0.74). Among illicit drugs, sensitivity was acceptable for moderate-risk of marijuana (0.71), while it was low for all other illicit drugs and non-medical use of prescription medications. Specificities were 0.97 or higher for all illicit drugs and prescription medications.

CONCLUSIONS

The TAPS Tool identified adult primary care patients with high-risk ASSIST scores for all substances as well moderate-risk users of tobacco, alcohol, and marijuana, although it did not perform well in identifying patients with moderate-risk use of other drugs or non-medical use of prescription medications. The advantages of the TAPS Tool over the ASSIST are its more limited number of items and focus solely on substance use in the past 3months.

Longitudinal predictors of past-year non-suicidal self-injury and motives among college students

BACKGROUND

Non-suicidal self-injury (NSSI) is the deliberate and direct injuring of body tissue without suicidal intent for purposes not socially sanctioned. Few studies have examined the correlates of NSSI among young adults. This study aimed to identify predictors of lifetime and past-year NSSI, and describe motives for NSSI and disclosure of NSSI to others.

METHOD

Interviews were conducted annually with 1081 students enrolled in the College Life Study, a prospective longitudinal study conducted at a large public mid-Atlantic university. NSSI characteristics were assessed at Year 4. Demographic and predictor variables were assessed during Years 1 to 4. Multivariate logistic regression models were used to identify correlates of lifetime NSSI and predictors of past-year NSSI.

RESULTS

The prevalence of past-year and lifetime NSSI was 2% and 7% respectively (>70% were female for both lifetime and past-year NSSI). Seven percent of NSSI cases self-injured once, whereas almost half self-injured six or more times. Independent predictors of past-year NSSI were maternal depression, non-heterosexual orientation, affective dysregulation and depression. Independent predictors of lifetime NSSI were depression, non-heterosexual orientation, paternal depression and female sex. One in six participants with NSSI had attempted suicide by young adulthood. The three most commonly reported motives for NSSI were mental distress, coping and situational stressors. Most (89%) told someone about their NSSI, most commonly a friend (68%).

CONCLUSIONS

This study identified unique predictors of NSSI, which should help to elucidate its etiology and has implications for early identification and interventions.

Smoking in pregnant women screened for an opioid agonist medication study compared to related pregnant and non-pregnant patient samples

BACKGROUND

Little is known about the prevalence and severity of smoking in pregnant opioid dependent patients.

OBJECTIVES

To first characterize the prevalence and severity of smoking in pregnant patients screened for a randomized controlled trial, Maternal Opioid Treatment: Human Experimental Research (MOTHER), comparing two agonist medications; and second, to compare the MOTHER screening sample to published samples of other pregnant and/or patients with substances use disorders.

METHODS

Pregnant women (N = 108) screened for entry into an agonist medication comparison study were retrospectively compared on smoking variables to samples of pregnant methadone-maintained patients (N = 50), pregnant opioid or cocaine dependent patients (N = 240), non-pregnant methadone-maintained women (N = 75), and pregnant non-drug-addicted patients (N = 1,516).

RESULTS

Of screened patients, 88% (n = 95) smoked for a mean of 140 months (SD = 79.0) starting at a mean age of 14 (SD = 3.5). This rate was similar to substance use disordered patients and significantly higher compared to general pregnant patients (88% vs. 22%, p < .001).

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

Aggressive efforts are needed to reduce/eliminate smoking in substance-abusing pregnant women.

Addiction severity index composite scores as predictors for sexual-risk behaviors and drug-use behaviors in drug-using pregnant patients

BACKGROUND

HIV sexual-risk and drug-use behavior predictors have been studied in non-pregnant but not pregnant drug-dependent populations.

OBJECTIVE

Examine the ability of the ASI composite scores to predict HIV sexual- and drug-risk scores as well as the individual items of a modified version of the Risk Assessment Battery in drug-using pregnant women.

METHODS

Pregnant women (N = 76) completing pretreatment ASI and HIV-risk questionnaires.

RESULTS

The Legal composite score was the sole significant predictor of the sexual-risk score, with a 1 SD increase in the Legal composite score resulting in a 24% increase in sexual-risk, p < .001. The Medical, Drug, and Legal composite scores were each significant predictors of the drug-risk score, with a 1 SD increase resulting in a 31% decrease, and 121% and 73% increases, respectively, in drug-risk, all ps < .05.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Drug-using pregnant women and their fetuses are vulnerable to the consequences of both sexual-risk behaviors and drug-use. The ASI may help screen such patients for HIV sexual-risk and drug-use behaviors as a first step in tailoring treatment to address these issues.

Effectiveness of a stand-alone aftercare program for drug-involved offenders

A study was made of the effectiveness of an aftercare program operating in conjunction with area outpatient drug free treatment programs while organizationally independent of those programs. Parolees and probationers mandated to treatment were assigned to aftercare on the basis of residence in the catchment areas in which aftercare facilities were located (n = 32) and randomly to aftercare (n = 62) and control (n = 51) when not a resident in a catchment area. No outcome differences were found between aftercare groups based on proximity to facility. At 6 months postbaseline the combined aftercare group showed significantly lower levels of criminal activity and frequent drug use as compared to controls. At 12 months postbaseline there was an attenuation of group differences with only tendencies toward significance obtained for lower levels of frequent drug use by the aftercare group. The findings are discussed in terms of the relevance of community variables for programming and for understanding long-term treatment outcomes.

Factors associated with frequent and infrequent HIV testing

Drug user treatment clients with 5 or more HIV tests (frequent testees N=43) and 0-2 HIV tests (infrequent testees-N = 56) were compared on demographic characteristics, risk behaviors, perceived risk of HIV infection to self, involvement with family members, and psychological functioning. Extreme groups of HIV testees did not differ on any variables other than an index of perceived vulnerability to HIV infection (e.g., " You think that you really could get AIDS"). That measure of felt vulnerability was not correlated significantly with needle or sexual risk behaviors, family involvement, psychological functioning or other measures of perceived risk. It was reasoned that, in a community in which both dangers and protective behaviors are widely understood, frequent testees experience a generalized and heightened concern unrelated to specific behaviors or characteristics.

Factors associated with frequency of 12-Step attendance by drug abuse clients

Comparison was made of treatment clients attending Narcotics Anonymous and/or Alcoholics Anonymous meetings less than weekly (n = 41) with treatment clients attending meetings at least three times a week (n = 30). The frequent attenders (attending an average of 30.6 meetings monthly) differed from non- and infrequent attenders (attending an average of 0.4 meetings monthly) in terms of histories of greater lifetime drug use, more arrests and treatment experiences, and an earlier age of first use of alcohol. Although the frequent attender was also older, age was not found to influence the differences found between groups. Measures of religiosity, use of community services, and support from others for recovery and psychological functioning, other than ratings of the helpfulness of 12-Step, were not differentiated among groups. The findings suggest that 12-Step groups are more likely to be selected by clients with more severe histories of drug use and criminal activity, i.e., those most in need of the support to behavior change those groups provide. The role of treatment programs in facilitating the use of 12-Step groups is discussed.

Early deviance and related risk factors in the children of narcotic addicts

This descriptive study examines the self-reported behaviors of 285 male and female adolescent children (ages 12-17) of narcotic addicts participating in methadone maintenance programs. These children responded to an extensive 2.5-hour interview questionnaire focusing on current and past activities, including criminal activities prior to age 12. The findings revealed that early deviance, assessed by self-report measures of both severity and variety, is related to current adolescent drug and alcohol use, association with deviant peers, a negative view of home atmosphere, and psychological symptomatology. These results are contrasted with the retrospective reports of adolescent behavior obtained from adult male narcotic addicts in a prior study of vulnerability to addiction. The comparability of study results is discussed in the context of developmental risk factors, prevention and treatment strategies, and other considerations specifically related to the development of children of narcotic addicts.

Differential contributions of family and peer factors to the etiology of narcotic addiction

This retrospective study investigated relationships among early family circumstances, peer associations, and narcotic addiction in a sample of 601 urban males. Results of logistic regression analyses indicated that the extent of deviant behavior among close friends at ages 12-14 and disruption in family structure (parental divorce/separation) prior to age 11 were significantly associated with narcotic addiction. Additional regression analyses indicated that deviant behavior among family members, as well as family disruption, experienced prior to age 11, also increased the probability of association with deviant peers and a negative home atmosphere at ages 12-14. Implications of these findings for preventive interventions and for future research are presented.

The family experiences of narcotic addicts and their subsequent parenting practices

This survey study of male and female narcotic addicts participating in methadone maintenance programs examined self-reported retrospective data on parental behavior experienced by addicts during their adolescent years. These findings were contrasted with the addicts' self-report of their current parenting practices with their own adolescent children. Results showed addicts as perceiving their mothers as significantly more functional in their parenting practices than their fathers on indices of parental involvement, attachment, and responsibility. Significant parenting differences between addicts and their parents were reported for the three indices mentioned, as well as for parent discipline and punitive actions, with the addicts rating their current parenting practices as more effective than those of their parents. Reported parenting practices were further analyzed in the context of how the ratings of parental functioning were related to problems of drug and alcohol abuse exhibited in the home. Findings are discussed in terms of the implications for prevention and treatment approaches for addicts and their children.

The early emergence of narcotic addict types

Providing retrospective self-reports of their activities, perceptions, and experiences during their early adolescent years (ages 12 to 14), 255 narcotic addicts were classified into four distinct types on the basis of a clustering technique applied to risk factor information derived from five major descriptive domains: family; peer deviance; personal deviance; psychological status; and protective factors. Differentiations among the types largely involved the extent of early drug and other behavioral deviance and family dysfunction. The predictive utility of the typology was examined in terms of outcome over the first ten years of the addiction career, including age at first narcotic addiction, amount of time incarcerated, and percentage of time addicted while in the community. The implications of the typology for both substance abuse prevention and treatment are discussed.

Early family adversity as a precursor to narcotic addiction

This retrospective study examined differences among three groups of urban males in the prevalence of various family risk factors occurring before age 11 and their independent contributions to subsequent deviance. The groups included: narcotic addicts; never-addicted peer controls who were associates of the addicts at age 11; and never-addicted community controls not associated with the addicts. Sixty-four percent of the addicts, compared to slightly under 40% of both control groups, reportedly experienced one or more family risk factors involving deviant behavior among family members and family disruption before age 11. While community controls differed from addicts on both family deviance and disruption in family structure, peer controls differed from addicts only on disruption of family structure. For the total sample, both family deviance and family disruption experienced before age 11 were significantly associated with crime severity level at age 11. Implications of these findings for future substance abuse research and intervention are discussed.

Applying the Collaborative Study Psychotherapy Rating Scale to rate therapist adherence in cognitive-behavior therapy, interpersonal therapy, and clinical management

Adherence of therapists to behaviors specified in cognitive-behavior therapy, interpersonal therapy, and clinical management manuals was studied. Raters used the Collaborative Study Psychotherapy Rating Scale (CSPRS) to rate therapist adherence in each of four sessions from 180 patients in the treatment phase of the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP). Results indicate that therapists exhibited more behaviors appropriate to their own respective treatment approaches than to other treatment approaches. In fact, the three treatments could be discriminated almost perfectly using the CSPRS. Analysis of the psychometric properties of the CSPRS revealed high interrater reliability and high internal consistency. However, a five-component structure extracted from the intercorrelations of the CSPRS items was substantially different from a five-factor structure found in an earlier study.

Applying the Collaborative Study Psychotherapy Rating Scale to rate therapist adherence in cognitive-behavior therapy, interpersonal therapy, and clinical management

Adherence of therapists to behaviors specified in cognitive-behavior therapy, interpersonal therapy, and clinical management manuals was studied. Raters used the Collaborative Study Psychotherapy Rating Scale (CSPRS) to rate therapist adherence in each of four sessions from 180 patients in the treatment phase of the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP). Results indicate that therapists exhibited more behaviors appropriate to their own respective treatment approaches than to other treatment approaches. In fact, the three treatments could be discriminated almost perfectly using the CSPRS. Analysis of the psychometric properties of the CSPRS revealed high interrater reliability and high internal consistency. However, a five-component structure extracted from the intercorrelations of the CSPRS items was substantially different from a five-factor structure found in an earlier study.

Rater Reliability: A Maximum Likelihood Confirmatory Factor-Analytic Approach

A procedure for evaluating a variety of rater reliability models is presented. A multivariate linear model is utilized to describe and assess a set of ratings. The parameters of such a model are reexpressed in terms of a factor-analytic model. Maximum likelihood methods are employed to estimate and test the parameters in this factor-analytic model. The approach is related to the use of the intraclass correlation coefficient to estimate reliability. Two examples are presented, and the results contrasted to those found with an intraclass correlation approach. Extensions of the procedure to multiple sets of judges, multiple measures, and multiple groups is introduced.

Factor Structure of the WISC-R

A simultaneous maximum likelihood confirmatory factor analysis was performed on the 12 subtests the WISC-R in the 11 age groups of normative sample. Several models were fit to the data and compared, including: a single-factor model; orthogonal and oblique two-factor models, comprised of the Virbal and Performance subtests, respectively; and orthogonal and two oblique three-factor models, the third factor involving the Digit Span, Arthmetic, and Coding subtests. These analyses were subsequentlyb replicated in 11 samples in reported in 9 separate published articles. Results of the analyses in the normative sample suggest: 1) the single-factor model fits the data fairly well, although there is clearly some misspecification in this model; 2) the oblique multi-factor models do fit the data better than the single-factor model, though these models are also misspecified; and, 3) the single-factor, oblique two-factor and oblique three-factor structures are fairly consistent across the age groups. Results of the re-analyses of the published studies are quite similar to the results found in the normative sample, regardless of the population studied. It is concluded: 1) that the WISC-R largly consists of a general intellectual factor; and 2) all the critical models proposed in the literature to explain WISC-R performance are only partially correct.

Categorical Variables in Multiple Regression: Some Cautions

Various methods of coding categorical variables for use as predictors in multiple regression analyses have been presented in the literature. The limitations of two oft-discussed methods -- dummy coding and nonsense coding -- are detailed for several frequently-used regression designs. Two examples involving potentially inappropriate interpretations of the results of analyses involving dummy coding are presented. Researchers are cautioned that the parameter estimate or estimates and test of significance associated with a predictor variable or set of predictor variables in an equation which involves dummy- and/or nonsense-coded predictors represent an effect of interest only in a limited set of circumstances.

The Marlowe-Crowne and Edwards Social Desirability Scales: A Psychometric Perspective

Various psychometric characteristics of the Marlowe-Crowne and Edwards Social Desirability scales were assessed in a sample of 108 male and 189 female undergraduates. Major questions of interest focused on the degree of overlap of the two measures and the equivalency of the two measures for males and females. Means, standard deviations, intercorrelations, and internal consistency α were computed by least-squares methods. Results of these analyses were compared to those based on confirmatory maximum likelihood factor analysis. Results suggested that males and females show different means and similar internal consistency reliability and intercorrelation on these scales. The degree of association between the two measures in both males and females, corrected for attenuation, was approximately .4. Similar conclusions would have been reached with either statistical approach.

Sexuality among Mexican Americans: a case of sexual stereotyping

The purpose of this study was to establish an empirical base for the comprehensive study of sexual preferences and practices among Mexican Americans. The sample consisted of 165 Mexican-American (86 male, 79 female) and 99 Anglo (47 male, 52 female) undergraduates. The instrument used was the Sexual Knowledge and Attitude Test (SKAT; Lief & Reed, 1972). The first section of the SKAT consists of four attitudes subscales dealing with autoeroticism, abortion, heterosexual relations, and sexual myths. The second section includes 50 true-false items testing knowledge of the biological, psychological, and social facts of human sexuality. The last section focuses on the respondent's sexual value system and practices. The design was a 2 (ethnicity) X 2 (gender) X 4 (religion) X 3 (socioeconomic status) incomplete factorial, in which the effect of interest was ethnicity. This effect was assessed controlling for subjects' age, gender, religious preference, and socioeconomic status. The dependent variables were subjects' sexual attitudes, knowledge, sexual value system, and sexual practices. Tests of significance were undertaken separately for each set of dependent variables, with a correspondingly reduced alpha level. Significant differences were obtained between Mexican Americans and Anglos, in attitudes, knowledge, value system, and practices, in clear support of the hypotheses.

Sexuality among Mexican Americans: A case of sexual stereotyping

The purpose of this study was to establish an empirical base for the comprehensive study of sexual preferences and practices among Mexican Americans. The sample consisted of 165 Mexican-American (86 male, 79 female) and 99 Anglo (47 male, 52 female) undergraduates. The instrument used was the Sexual Knowledge and Attitude Test (SKAT; Lief & Reed, 1972). The first section of the SKAT consists of four attitudes subscales dealing with autoeroticism, abortion, heterosexual relations, and sexual myths. The second section includes 50 true-false items testing knowledge of the biological, psychological, and social facts of human sexuality. The last section focuses on the respondent's sexual value system and practices. The design was a 2 (ethnicity) X 2 (gender) X 4 (religion) X 3 (socioeconomic status) incomplete factorial, in which the effect of interest was ethnicity. This effect was assessed controlling for subjects' age, gender, religious preference, and socioeconomic status. The dependent variables were subjects' sexual attitudes, knowledge, sexual value system, and sexual practices. Tests of significance were undertaken separately for each set of dependent variables, with a correspondingly reduced alpha level. Significant differences were obtained between Mexican Americans and Anglos, in attitudes, knowledge, value system, and practices, in clear support of the hypotheses.

Sex, physical attractiveness, and perceived risk for mental illness

This study investigated the relationship between sex, physical attractiveness, and perceived risk for mental illness. A random sample consisting of 120 males and 120 females was recruited at various locations on a large Northeastern university campus and asked to fill out a questionnaire that dealth with "how they might behave in the future." This questionnaire contained brief descriptions of 12 mental disorders. Each description was written to be consistent with a type of mental disorder discussed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980). The questionnaire was developed through prior scaling in two separate samples and included disorders that differed in their rated severity as well as in their reported differential incidence in males and females. Results of multiple regression analyses, in which sex, rated physical attractiveness of the subject, type of mental disorder, and their interactions served as predictors, and perceived risk for mental illness served as the criterion indicated that decreased attractiveness was associated with an increasing belief in susceptibility to mental illness (p less than .05). Several additional predicted effects did not emerge. Results were interpreted to indicate another link between physical attractiveness and mental illness. Limitations to the study are discussed and suggestions for future research are offered.

Hostility-guilt, guilt over aggression, and self-punishment

48 men were randomly assigned to experimental and control groups and partitioned at the median on hostility-guilt in a 2X2 factorial design. Subjects in the experimental condition were induced to aggress verbally by severely derogating a stranger in a study of first impressions. Before and after participating in the first impressions study, the subjects participated in a pain tolerance procedure involving receiving a series of increasingly painful electric shocks. Affect adjective checklists measured guilt and other affects at four times before and after each pain tolerance procedure. As expected, high-hostility-guilt men increased in affective guilt following participation in the experimental condition in which they unfairly distressed a stranger. As expected, the affective guilt of these same high-hostility-guilt men declined after submitting to a procedure measuring pain tolerance. Contrary to expectations, low-hostility-guilt men tolerated more pain in the experimental condition than did high-hostility-guilt men.

A Multidimensional Scaling Analysis Of Sex Guilt

Sixty males and sixty females, divided into groups of high and low sex-guilt, made all possible comparisons between fifteen descriptions of individuals. These descriptions were written to reflect characteristics felt to be important to the concept of sex guilt. Ratings of dissimilarity were analyzed by INDSCAL and an unfolding method, both of which are multidimensional scaling techniques. Results indicated that: 1) low sex guilt and high sex guilt subjects perceived the stimulus "individuals" quite similarly along the two major dimensions (sociability and positive-negative) underlying their comparisons; 2) that males and high sex guilt subjects utilized less of both the sociability and positive-negative dimensions in making their judgments concerning the interrelationships of the stimulus "individuals"; 3) that low sex guilt and high sex guilt subjects differ in evaluating themselves in relation to the stimulus "individuals"; and 4) high sex guilt subjects rated themselves as more similar to a trait sex guilty description than to descriptions dealing with trait sex anxiety, or general guilt or anxiety. It was concluded that: 1) low sex guilt and high sex guilt subjects differ in the value they place on different personal attributes; and 2) D. L. Mosher's model of preservation of self-esteem best explained the behavior of high sex guilt individuals.

A Comparison Of The Adjective Check List, Bem Sex Role Inventory, And Personal Attributes Questionnaire Masculinity And Femininity Subscales

Ninety-two male and 131 female undergraduate psychology students were administered the Adjective Check List (ACL), Bem Sex Role Inventory (BSRI), and Personal Attributes Questionnaire (PAQ). The masculinity (M) and femininity (F) subscale scores for each of these three measures were correlated and subjected to a principal factor analysis with varimax rotation separately for males and females. Results indicated that: (1) the ACL-F shared only a modest amount of variance with the BSRI and PAQ-F subscales, and was not responded to in the same manner by males and females; (2) the ACL-M subscale tended to be more strongly negatively related to F subscales than did the BSRI and PAQ-M subscales; (3) the BSRI and PAQ-M and F subscales shared a substantial proportion of variance between themselves, for both males and females; and (4) a masculine factor and a feminine factor, accounting for approximately the same amount of the entire common variance, emerged for both males and females.