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Women with Alcohol use disorder (AUD) are more likely than men to have co-occurring depression, drink to cope with negative affect (NA), and cite negative affect as a contributor to relapse. Among AUD treatment seekers, low behavioral activation, NA, and reduced self-efficacy in abstaining from alcohol (e.g., in tempting situations) are relapse risk factors. This study investigated the association between behavioral activation, affective states, and self-efficacy among treatment-seeking women. Participants were 70 women (M = 40.50, SD = 11.59 years of age) with elevated depressive symptoms seeking AUD treatment. The Behavioral Activation for Depression Scale (BADS) was used to assess environmental engagement. The Alcohol Abstinence Self-Efficacy (AASE) scale was used to assess temptation to drink in contexts of positive and negative affect, and general positive and negative affect were assessed with the Positive and Negative Affect Schedule. Results indicated that behavioral activation was directly correlated with positive affect (PA; r = .62, p < .001) and inversely correlated with depression (r = -.35, p = .004), negative affect (r = -.39, p = .001), and temptation to drink in the context of negative affect (r = -.33, p = .006). After controlling for depressive symptoms, behavioral activation continued to be associated with greater general positive affect (β = .595, p < .001) and lower temptation to drink in the context of negative affect (β = -.348 p = .008). Our results suggest a nuanced association between behavioral activation, negative affect, and temptations to drink that is not accounted by depressive symptoms. Self-efficacy to abstain from drinking in a negative affect context should be considered when designing AUD interventions for women. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background Prescription opioids remain a primary treatment option for patients with chronic low back pain. However, little research has examined how patients take opioids in daily life. Behavioral economics suggest that the environmental context may contribute to patients’ decisions around opioid use. Purpose This study examined the association of self-reported environmental factors and physical activity with likelihood of taking opioids, opioid dosage, and physical pain. Method Patients with chronic low back pain on long-term opioid therapy (n = 34) without significant past-year opioid-related problems completed a two-week ecological momentary assessment protocol (nobservations = 1,714). Results Initial multilevel models revealed multiple associations for different specific contexts with opioid use and pain. In models that collapsed specific contexts into categories (where, with whom, doing what), greater occasion-level physical activity was associated with a greater likelihood of taking opioids and greater pain, and being somewhere (v. at home) was associated with taking a smaller opioid dose. At any given occasion, being with someone (v. alone) was associated with taking a larger opioid dose, but patients who spent more time with others over the entire study took fewer opioids overall. Multilevel mediation found that pain did not mediate the association of physical activity and opioid use. Conclusion Results suggest that prescribed opioid use in patients with chronic low back pain is not solely determined by pain, but influenced by environmental factors, including physical activity. Psychoeducation regarding environmental factors, including how factors may be associated with both increased and decreased use of opioids, may help patients take fewer opioids more effectively.

Depression is strongly implicated in drinking to cope and the development of alcohol use disorders (AUD) in women, particularly among women with a history of sexual assault victimization (SAV). Alcohol use in women is heavily stigmatized, and substance use stigma is associated with depression. This study examined the link between internalized alcohol stigma (AS) and depression and tested whether self-compassion buffered (i.e., moderated) this association in a sample of women with a history of SAV and unhealthy drinking to cope.Women sexual assault survivors (N = 288; 82 % White, 91.2 % Non-Hispanic, 20.2 % sexual minority) reporting unhealthy drinking (Alcohol Use Disorders Inventory Test-C ≥ 4) and drinking to cope (Drinking Coping Motives Questionnaire-Revised ≥ 2) completed online self-report surveys. Hierarchical regression analyses tested associations between internalized-AS and self-compassion with depression after controlling for covariates (age, income, education, AUD symptoms, and posttraumatic stress disorder) and then, whether self-compassion moderated the Internalized-AS and depression link.Internalized-AS accounted for 1.4 % of variance in depression (p .01); self-compassion accounted for added variance when subsequently modeled (8.2 %, p .001). Moderation analyses revealed self-compassion to buffer the internalized-AS and depression link. Among participants reporting high levels of self-compassion, there was no association between internalized-AS and depression (p = .894).While findings are modest, they align with the previously observed link between internalized-AS and depression and extend these findings to women with a history of SAV endorsing elevated coping motives and unhealthy drinking. Self-compassion may protect against this link, pending further research sampling greater diversity of participants and longitudinal and controlled designs.

The marijuana purchase task (MPT) is a behavioral economic measure of individualized cannabis value (i.e., demand). The MPT follows purchase tasks for other substances (e.g., alcohol, tobacco), though presents with unique caveats due to its mixed illicit status, non-uniform units of purchase and use, and substantial within substance variability in strain, potency, and quality. As the regulatory climate surrounding purchase and use of cannabis continues to evolve in the USA and globally, rigorous assessment of cannabis use and value are of the utmost importance. This study represents the first comprehensive review of investigations utilizing the MPT. Searches through PubMed and Web of Science databases by two independent coders identified 15 empirical articles referencing the use of an MPT and were published through the year 2019. Articles were coded for demographic and procedural characteristics, structural characteristics of the MPT itself, data analytic characteristics, and relationships with cannabis-related outcomes. Rigorous assessment of demand for cannabis is essential with respect to the broad public health issues surrounding cannabis legalization. We have synthesized the research presented herein and comment on vital considerations for subsequent MPT work, including recommendations for a unified approach to using the MPT in subsequent research.

Introduction Experiences of childhood sexual abuse (CSA) and childhood physical abuse (CPA) are associated with poor mental health outcomes including substance use in subsequent years. Marijuana use motives (i.e., coping with negative affect, enhancing positive affect, or improving social interactions) may influence problematic substance use among young adults. Specifically, motives may be associated with severity of marijuana use outcomes among individuals who have experienced CSA or CPA. This study investigated the indirect effect of marijuana use motives between experiences of CSA or CPA and marijuana use and problems among emerging adults. Method Participants were 397 young adults (50.1% male, 66.2% White) between ages 18–25 years, who reported 15.85 (SD = 11.66) days of marijuana use in the past month. Participants reported on history of childhood abuse, marijuana use days, problems, and motives for use. Results Findings suggest a significant indirect effect of coping motives in the association between CPA and marijuana use days and marijuana problems. Further, both coping motives and marijuana use days indicated a significant indirect effect between CPA and problems. Motives of socializing or enhancement did not have a significant indirect effect between CPA and marijuana use or problems. There were no significant findings with CSA and marijuana use outcomes. Discussion Coping motives might be an important potential target for future marijuana interventions in persons with childhood physical abuse.

Background Alcohol use disorder (AUD) is a significant public health concern worldwide. Alcohol consumption is a leading cause of death in the United States and has a significant negative impact on individuals and society. Relapse following treatment is common, and adjunct intervention approaches to improve alcohol outcomes during early recovery continue to be critical. Interventions focused on increasing physical activity (PA) may improve AUD treatment outcomes. Given the ubiquity of smartphones and activity trackers, integrating this technology into a mobile app may be a feasible, acceptable, and scalable approach for increasing PA in individuals with AUD. Objective This study aims to test the Fit&Sober app developed for patients with AUD. The goals of the app were to facilitate self-monitoring of PA engagement and daily mood and alcohol cravings, increase awareness of immediate benefits of PA on mood and cravings, encourage setting and adjusting PA goals, provide resources and increase knowledge for increasing PA, and serve as a resource for alcohol relapse prevention strategies. Methods To preliminarily test the Fit&Sober app, we conducted an open pilot trial of patients with AUD in early recovery (N=22; 13/22, 59% women; mean age 43.6, SD 11.6 years). At the time of hospital admission, participants drank 72% of the days in the last 3 months, averaging 9 drinks per drinking day. The extent to which the Fit&Sober app was feasible and acceptable among patients with AUD during early recovery was examined. Changes in alcohol consumption, PA, anxiety, depression, alcohol craving, and quality of life were also examined after 12 weeks of app use. Results Participants reported high levels of satisfaction with the Fit&Sober app. App metadata suggested that participants were still using the app approximately 2.5 days per week by the end of the intervention. Pre-post analyses revealed small-to-moderate effects on increase in PA, from a mean of 5784 (SD 2511) steps per day at baseline to 7236 (SD 3130) steps per day at 12 weeks (Cohen d=0.35). Moderate-to-large effects were observed for increases in percentage of abstinent days (Cohen d=2.17) and quality of life (Cohen d=0.58) as well as decreases in anxiety (Cohen d=−0.71) and depression symptoms (Cohen d=−0.58). Conclusions The Fit&Sober app is an acceptable and feasible approach for increasing PA in patients with AUD during early recovery. A future randomized controlled trial is necessary to determine the efficacy of the Fit&Sober app for long-term maintenance of PA, ancillary mental health, and alcohol outcomes. If the efficacy of the Fit&Sober app could be established, patients with AUD would have a valuable adjunct to traditional alcohol treatment that can be delivered in any setting and at any time, thereby improving the overall health and well-being of this population. Trial Registration ClinicalTrials.gov NCT02958280; https://www.clinicaltrials.gov/ct2/show/NCT02958280

Background Alcohol use disorder (AUD) is associated with severe chronic medical conditions and premature mortality. Expanding the reach or access to effective evidence-based treatments to help persons with AUD is a public health objective. Mobile phone or smartphone technology has the potential to increase the dissemination of clinical and behavioral interventions (mobile health interventions) that increase the initiation and maintenance of sobriety among individuals with AUD. Studies about how this group uses their mobile phone and their attitudes toward technology may have meaningful implications for participant engagement with these interventions. Objective This exploratory study examined the potential relationships among demographic characteristics (race, gender, age, marital status, and income), substance use characteristics (frequency of alcohol and cannabis use), and clinical variables (anxiety and depression symptoms) with indicators of mobile phone use behaviors and attitudes toward technology. Methods A sample of 71 adults with AUD (mean age 42.9, SD 10.9 years) engaged in an alcohol partial hospitalization program completed 4 subscales from the Media Technology Usage and Attitudes assessment: Smartphone Usage measures various mobile phone behaviors and activities, Positive Attitudes and Negative Attitudes measure attitudes toward technology, and the Technological Anxiety/Dependence measure assesses level of anxiety when individuals are separated from their phone and dependence on this device. Participants also provided demographic information and completed the Epidemiologic Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder (GAD-7) scale. Lastly, participants reported their frequency of alcohol use over the past 3 months using the Drug Use Frequency Scale. Results Results for the demographic factors showed a significant main effect for age, Smartphone Usage (P=.003; ηp2=0.14), and Positive Attitudes (P=.01; ηp2=0.07). Marital status (P=.03; ηp2=0.13) and income (P=.03; ηp2=0.14) were associated only with the Technological Anxiety and Dependence subscale. Moreover, a significant trend was found for alcohol use and the Technological Anxiety/Dependence subscale (P=.06; R2=0.02). Lastly, CES-D scores (P=.03; R2=0.08) and GAD symptoms (P=.004; R2=0.13) were significant predictors only of the Technological Anxiety/Dependence subscale. Conclusions Findings indicate differences in mobile phone use patterns and attitudes toward technology across demographic, substance use, and clinical measures among patients with AUD. These results may help inform the development of future mHealth interventions among this population.

Background: Cannabis is the most commonly used illicit drug on college campuses. Research suggests that Student Service Members/Veterans (SSM/V) may be more likely to use alcohol than civilian students, but little research has focused on cannabis use in these two samples. Objectives: The purpose of the current study was to compare cannabis use frequency, cannabis use disorder (CUD) symptoms, and cannabis-related problems between civilian students and SSM/V. A second aim was to determine if group differences in these outcomes were moderated by symptoms of depression, stress, or anxiety. Methods: The sample included 164 college SSM/V (80.4% female, 19.6% male) and 456 civilian (78% female, 22% male) college students. Participants completed an online survey assessing demographics, number of days of past month cannabis use, cannabis-related problems, CUD symptoms, and a measure of anxiety, depression, and stress. Results: Negative binomial regressions indicated no significant differences in number of days of past-month cannabis use or past-year cannabis-related problems between civilian students and SSM/V, although SSM/V reported more past-year CUD symptoms. Moderation analyses revealed that at elevated levels of anxiety, SSM/V students used cannabis more frequently than civilian students. Conclusion: These findings indicate that when experiencing elevated levels of anxiety, SSM/V use cannabis more frequently than civilian students, suggesting that anxiety may be a more prominent risk factor for frequency of cannabis use for SSM/V compared to civilian students. Education, prevention, and intervention efforts specifically addressing anxiety in this demographic are needed.

Behavioral economic theories of substance abuse posit that deficits in substance-free reward increase risk for substance misuse, but little research has examined potential moderators of this relationship, including dispositional risk factors. Here, we tested the hypothesis that young adult heavy drinkers with family histories of alcohol misuse would show a stronger association specifically between low evening substance-free reinforcement and alcohol problems compared to those without a family history of alcohol misuse. Participants were 317 college students reporting heavy episodic drinking (Mage = 18.8, SD = 1.1, 61% female, 79% White) who completed a questionnaire about engagement and enjoyment in rewarding activities not involving substance use after 7 p.m., along with measures of personal and parental alcohol use/problems. Evening substance-free reinforcement was negatively associated with typical drinking level for women, but not for men. Family history status did not show a significant association with typical alcohol consumption or evening substance-free reinforcement (operationalized as activity participation × enjoyment), but did show a significant association with alcohol problems. Evening substance-free reinforcement was significantly negatively related to alcohol problems for both men and women. However, the presence of a family history of alcohol misuse moderated this relationship, such that only individuals with familial risk for alcohol misuse who reported lower evening substance-free reinforcement evidenced greater alcohol-related problems. These findings suggest that lower evening substance-free reinforcement is associated with alcohol misuse among young adults, and that this association is exacerbated among individuals with familial risk for developing alcohol problems. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Heavy drinking among college students in the United States is common and results in a wide range of problems. Symptoms of depression are also common among college students and may exacerbate problems associated with heavy drinking, but to date most studies have been cross sectional and relied on an aggregate measure of alcohol problems. Further, depressive symptoms may also predict other elements of risk among heavy drinkers, including greater experience of substance-related reinforcement, and diminished experience of substance-free reinforcement. The current study examines depressive symptoms as a prospective predictor of changes in alcohol problem domains and reward variables in a sample of heavy drinking college students. Heavy drinking college students (N = 138) completed a survey assessing depressive symptoms, alcohol problems, and reinforcement at baseline and after a 12-month follow-up period. Multiple regressions examined the utility of depressive symptoms (DASS-21) in predicting alcohol problems, substance-related reinforcement, and substance-free reinforcement at the 12-month follow-up after controlling for baseline drinking level and the baseline level of the relevant outcome variable. Baseline depressive symptoms predicted 12-month alcohol problems related to impaired control (i.e., drinking more than planned), self-perception, and self-care. Depressive symptoms also predicted lower 12-month substance-free, but not substance-related, reinforcement. Finally, change in depressive symptoms was associated with total alcohol problems, impaired control, self-perception, self-care, academic/occupational, and physiological dependence problems at 12-month follow-up. Heavy drinkers with depressive symptoms may benefit from interventions targeting alcohol problems that also increase access to and engagement in rewarding alternative activities. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Objective Behavioral economic models predict that deficits in substance-free reward and future time orientation are associated with greater drug involvement, but this hypothesis has not been systematically investigated among young adult heavy drinkers. This study evaluated the association between drug use levels (heavy drinking (HD) only, HD + marijuana use, and HD + polysubstance use) and substance-free activity engagement, future orientation, and reward deprivation (comprised of reward experience and environmental suppressors of reward) among heavy drinkers. Method Participants were 358 college students who reported two or more past-month heavy drinking episodes (5/4 or more drinks in one occasion for a man/woman). The sample was 60% women, 79% Caucasian, and the average age was 18.76 (SD = 1.07) years. Participants completed measures of alcohol and drug use, weekly time allocation to various activities, future time orientation, and reward deprivation. Results Overall, any drug use was associated with less time spent engaged in academics and exercise, and lower future time orientation compared to HD only. Any drug use was associated with reward deprivation and HD + polysubstance use was associated with lower reward experience and environmental suppressors. Conclusion Drug use among heavy drinkers is associated with lower academic engagement and exercise, future orientation, and reward deprivation. These results provide support for behavioral economic models of drug abuse and suggest that prevention approaches should attempt to increase future orientation and availability of drug-free reward.

Objective Behavioral economic theory suggests that a reduction in alcohol use is most likely when there is an increase in rewarding substance-free activities. Anxiety has also been linked to heavy drinking, and strategies to reduce anxiety may enhance alcohol interventions. The goal of this 2-site randomized controlled clinical trial was to evaluate the efficacy of a brief alcohol intervention that was supplemented with either a behavioral economic substance-free activity session (SFAS) or a relaxation training (Relaxation training [RT]) session. Method Participants were 393 college students (61% female, mean age = 18.77 years) who reported 2 or more past-month heavy drinking episodes. Participants were randomized to 1 of 3 conditions: (a) assessment; (b) alcohol brief motivational intervention (BMI) plus SFAS; or (c) BMI plus RT. Both treatment conditions included 2 in-person sessions plus a phone booster session. Outcomes were evaluated 1-, 6-, 12-, and 16-months postintervention. Results Generalized linear mixed models indicated that the combination of a BMI plus either the SFAS or RT was associated with significant reductions in alcohol use and problems across the 16-month follow-up compared with assessment only. There were no significant differences between the two active treatment conditions. Changes in proportional reinforcement from substance-related activities, and protective behavioral strategies mediated treatment effects. Conclusion Two-session (plus booster) interventions that combine BMI and either substance-free activity enhancement or RT can result in enduring reductions in alcohol misuse among college drinkers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

INTRODUCTION Behavioral economic theory views addiction as a reinforcer pathology characterized by excessive demand for drugs relative to alternatives. Complementary to this theory, Lamb and Ginsburg (Pharmacology Biochemistry and Behavior, 164, 2018, 62) describe addiction as a behavioral allocation disorder and predict that decisions to drink under increasingly stringent constraints are a central indicator of addiction. This study used a modified demand-curve paradigm to examine alcohol demand in the context of a next-day contingency (high opportunity cost demand) as a specific indicator of a severe pattern of alcohol problems. METHODS Participants were 370 undergraduates (61.1% female, 86.5% white, Mage = 18.8) reporting multiple past-month heavy drinking episodes (5/4 drinks per occasion for men/women) who completed 2 versions of an alcohol purchase task (APT), along with measures of past-month alcohol use and problems. In 1 APT (low opportunity cost), students imagined they had no next-day responsibilities, and in the other APT (high opportunity cost), they imagined having a 10:00 am test the next day. Item-response theory analyses were used to determine mild and severe alcohol problems from the Young Adult Alcohol Consequences Questionnaire (Journal of Studies on Alcohol, 67, 2006, 169), and the most and least severe binge drinking days throughout the week. RESULTS Low opportunity cost demand (β = 0.15, p = 0.02) significantly predicted beyond high opportunity cost demand for the least severe problems, and high opportunity cost demand (β = 0.17, p = 0.009) significantly predicted beyond low opportunity cost demand for the most severe problems. Similarly, low opportunity cost demand (β = 0.26, p

Objective Behavioral economic research suggests that increasing the salience of a delayed reward may improve capacity for delaying gratification and increase behavior allocated toward obtaining larger, delayed substance-free reward rather than smaller, more immediate reward such as alcohol use. This study aimed to improve the efficacy of outpatient alcohol use disorder (AUD) treatment by adding elements that target behavioral economic mechanisms of change. Method Forty-one (N = 41) adults in outpatient AUD treatment were recruited and 37 participants were retained at follow-up. Following baseline assessment, participants received either the Substance Free Activity Session (SFAS), a single-session behavioral economic–informed intervention focused on increasing future orientation and engagement in values-based substance-free activities or a health education control intervention. Participants in both conditions received weekly prompts (via text or email) relevant to their respective intervention for four weeks. Participants (68.3% male; 70.7% Caucasian, M age = 38.24, SD = 12.69) reported an average of 3.95 (SD = 4.72) binge drinking episodes (4/5 drinks per occasion for a woman/man) and 5.05 (SD = 5.32) drinks per drinking day 30-days prior to treatment entry. Results The study provided initial support for the feasibility and acceptability of implementing the SFAS within a treatment setting. Participants reported high levels of satisfaction with the SFAS (M = 9.08 (SD = 0.94), on a scale of 1–10). At 3-month follow-up, the SFAS was associated with reductions in the proportion of activity participation and enjoyment (reinforcement) related to substance-use relative to substance-free activities and in alcohol demand compared to control. Conclusion These preliminary results provide initial support for targeting behavioral economic mechanisms of change in an outpatient AUD treatment with a single-session intervention plus remote delivery of booster prompts.

Objective Cannabis users with a dysregulatory risk factor may be particularly vulnerable to engaging in more frequent and problematic cannabis use. Contemporary models of dysregulated behavior suggest that dysregulation emerges due to distinct mechanisms. The current study seeks to examine the dysregulatory correlates of cannabis involvement, including working memory capacity, delay discounting, impulsivity, and reward sensitivity. Method Participants were 104 non-treatment seeking frequent cannabis users (the average participant used cannabis 71% of the days/past 60 days [SD = 22%], with an average of two uses per day [SD = 1.2]). Mean age was 21.3 (SD = 4.3); 36.5% were female. Working memory was assessed via the Trail-Making Test-B and the Digit Span subtests of the WAIS-III, delay discounting was assessed via a computer-based task, trait impulsivity was self-reported via the Barratt Impulsiveness Scale, and reward sensitivity was self-reported via the Reward Dependence Scale and the Snaith-Hamilton Pleasure Scale. Results Structural equation modeling estimated the associations between different facets of dysregulation and cannabis involvement. Results suggest that poor working memory capacity and high trait impulsivity were associated with both use and problem use. Greater delay discounting was associated with problem use, but not with frequency of use. Low reward sensitivity was associated with more frequent cannabis use, but not with problem use. Conclusions Results confirm that the dysregulatory correlates of cannabis involvement consist of multiple dimensions of functioning. Prospective studies that assess the multidimensional structure of dysregulation and cannabis involvement are needed in order to disaggregate the dysregulatory antecedents and consequences of cannabis involvement.

Behavioral economic demand curves measure alcohol consumption as a function of price and may capture clinically relevant individual differences in alcohol-reinforcing efficacy. This study used a novel, behavioral-economic, hypothetical demand-curve paradigm to examine the association between family history of alcohol misuse and individual differences in both alcohol demand and the relative sensitivity of alcohol demand to next-day responsibilities.Participants were 207 college students (47% male, 68.5% White, 27.4% African American, Mage = 19.5 years) who reported at least one heavy drinking episode (5/4 or more drinks on one occasion for a man/woman) in the past month and completed two versions of an alcohol purchase task (APT) that assessed hypothetical alcohol consumption across 17 drink prices. In one APT (standard), students imagined they had no next-day responsibilities, and in the other, they imagined having a 10:00 a.m. test the next day.A series of analyses of covariance indicated that participants with at least one biological parent or grandparent who had misused alcohol reported similar levels of alcohol demand on the standard APT but significantly less sensitivity to the next-day academic responsibility as measured by the percentage of reduction in demand intensity and breakpoint across the no-responsibility and next-day-test conditions.These findings provide initial evidence that APTs might clarify one potential mechanism of risk conferred by family history. Young adult heavy drinkers with a family history of problematic drinking may be less sensitive to next-day responsibilities that might modulate drinking in drinkers without a family history of alcohol problems.

This study examined associations between substance use behaviors and self-reported health among hospitalized heroin users. Of the 112 participants, 53 (47%) reported good or better health. In multivariable logistic regression models, each day of heroin use in the last month was associated with an 8% lower odds of reporting health as good or better (OR=.92; 95%CI 0.87, 0.97, p < .05). Cocaine, cannabis, cigarettes, alcohol use, unintentional overdose, nor injection drug use were associated with health status.

Objective. No evidence-based methods exist to identify prescription drug use disorder (PDUD) in primary care (PC) patients prescribed controlled substances. Aberrant drug-related behaviors (ADRBs) are suggested as a proxy. Our objective was to determine whether ADRBs documented in electronic medical records (EMRs) of patients prescribed opioids and benzodiazepines could serve as a proxy for identifying PDUD. Design. A cross-sectional study of PC patients at an urban, academic medical center. Subjects. Two hundred sixty-four English-speaking patients (ages 18–60) with chronic pain (≥3 months), receiving ≥1 opioid analgesic or benzodiazepine prescription in the past year, were recruited during outpatient PC visits. Outcome Measures. Composite International Diagnostic Interview defined Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses of past year PDUD and no disorder. EMRs were reviewed for 15 prespecified ADRBs (e.g., early refill, stolen medications) in the year before and after study entry. Fisher's exact test compared frequencies of each ADRB between participants with and without PDUD. Results. Sixty-one participants (23%) met DSM-IV PDUD criteria and 203 (77%) had no disorder; 85% had one or more ADRB documented. Few differences in frequencies of individual behaviors were noted between groups, with only “appearing intoxicated or high” documented more frequently among participants with PDUD (N = 10, 16%) vs no disorder (N = 8, 4%), P = 0.002. The only common ADRB, “emergency visit for pain,” did not discriminate between those with and without the disorder (82% PDUD vs 78% no disorder, P = 0.6). Conclusions. EMR documentation of ADRBs is common among PC patients prescribed opioids or benzodiazepines, but unsystematic clinician documentation does not identify PDUDs. Evidence-based approaches are needed.

Posttraumatic stress (PTS) symptoms are associated with alcohol-related consequences, but there is a need to understand mediators that may help explain the reasons for this relationship. Individuals with PTS may experience elevated craving and alcohol reward value (demand), which may contribute to risk for alcohol-related consequences. We examined relationships between PTS status, craving, alcohol demand, and alcohol-related consequences in PTS-positive (n = 64) and PTS-negative (n = 200) college students (M age = 21.7; 77% women; 54% Caucasian; 34% African American) who endorsed past-month alcohol use. We tested craving and alcohol demand as mediators of the relation between PTS status and alcohol-related consequences. Craving (B = .04, SE = .02, 95% CI [.01, .10]), demand intensity (B = .02, SE = .02, 95% CI [.001, .07]), and demand elasticity (B = .05, SE = .03, 95% CI [.006, .12]) significantly mediated the association between PTS symptoms and alcohol-related consequences. Craving remained a significant mediator in a multiple mediators model (B = .08, SE = .04, 95% CI [.03, .19]). Craving and alcohol demand may partially explain the relation between PTS status and alcohol-related consequences. Craving may be especially salient for individuals with PTS symptoms, as it may lead to more severe alcohol-related consequences even in the absence of elevated alcohol consumption.

Diminished availability of substance-free reinforcement is a behavioral economic risk factor for dependence. The goal of this study was to determine the incremental effects of increasing levels of substance use (heavy drinking [HD], heavy drinking and marijuana use [HD + MJ], and polysubstance use) on levels of reinforcement related to substance-free activities and related constructs among college students.Participants were 205 college students (53% female; 65% White, 26% African American; Mage = 19.5 years) who reported at least one heavy drinking episode (five/four or more drinks on one occasion for a man/woman) in the past month. Participants reported on past-month illicit drug use and substance-free activity reinforcement, time allocation, and depression.A series of analyses of covariance indicated that heavy drinking, marijuana use, and other illicit drug (polysubstance) use was associated with lower total and peer-related substance-free reinforcement; less time spent exercising, studying or completing homework, and participating in extracurricular activities; and greater depression compared with HD alone. Polysubstance use was also associated with lower peer-related substance-free reinforcement compared with HD + MJ. Furthermore, those who engaged in HD + MJ use allocated less time to exercise and studying/homework compared with HD-alone participants.Illicit drug use is associated with incremental deficits in substance-free reinforcement above and beyond heavy drinking. In particular, students who use illicit drugs other than marijuana may be at high risk and require intervention approaches that explicitly increase engagement in developmentally important substance-free activities such as academics.

Importance Buprenorphine opioid agonist treatment (OAT) has established efficacy for treating opioid dependency among persons seeking addiction treatment. However, effectiveness for out-of-treatment, hospitalized patients is not known. Objective To determine whether buprenorphine administration during medical hospitalization and linkage to office-based buprenorphine OAT after discharge increase entry into office-based OAT, increase sustained engagement in OAT, and decrease illicit opioid use at 6 months after hospitalization. Design, Setting, and Participants From August 1, 2009, through October 31, 2012, a total of 663 hospitalized, opioid-dependent patients in a general medical hospital were identified. Of these, 369 did not meet eligibility criteria. A total of 145 eligible patients consented to participation in the randomized clinical trial. Of these, 139 completed the baseline interview and were assigned to the detoxification (n = 67) or linkage (n = 72) group. Interventions Five-day buprenorphine detoxification protocol or buprenorphine induction, intrahospital dose stabilization, and postdischarge transition to maintenance buprenorphine OAT affiliated with the hospital’s primary care clinic (linkage). Main Outcomes and Measures Entry and sustained engagement with buprenorphine OAT at 1, 3, and 6 months (medical record verified) and prior 30-day use of illicit opioids (self-report). Results During follow-up, linkage participants were more likely to enter buprenorphine OAT than those in the detoxification group (52 [72.2%] vs 8 [11.9%], P P = .007). Compared with those in the detoxification group, participants randomized to the linkage group reported less illicit opioid use in the 30 days before the 6-month interview (incidence rate ratio, 0.60; 95% CI, 0.46-0.73; P Conclusions and Relevance Compared with an inpatient detoxification protocol, initiation of and linkage to buprenorphine treatment is an effective means for engaging medically hospitalized patients who are not seeking addiction treatment and reduces illicit opioid use 6 months after hospitalization. However, maintaining engagement in treatment remains a challenge. Trial Registration clinicaltrials.gov Identifier:NCT00987961

s / Drug and Alcohol Dependence 140 (2014) e86–e168 e123 with superior side-effect profiles. The present study involved the synthesis of new selective GABABR PAMs, and the assessment of their effects in animal models of nicotine dependence. Methods: New derivatives of BHF177, a selective and potent GABABR PAM with efficacy in animal models of nicotine dependence, were synthesized. In vitro pharmacology using a CHO-K1 cell line expressing the heterodimeric GABABR comprised of human GABAB(1b) and rat GABAB2 subunits; in vivo drugmetabolism and pharmacokinetics (DMPK) of these compoundswere characterized to prioritize the candidates. One of the high priority compounds, KK-92A,was assessed in thenicotine self-administrationprocedure in rats. Results: Nine active molecules were selected from 240 analogues of BHF-177 based on in vitro microsomal stability and efficacy in multiple cell-based functional assays, including cAMP accumulation, Ca2+ mobilization, ERK activation and a cellular impedance-based (CellKey) assay. Among these compounds, KK92A showed improved efficacy in the cAMP and Cellkey assays compared to BHF177, and had a similar in vivo DMPK profile. KK-92A (2, 5, 10, 20mg/kg, intraperitoneal) significantly decreased intravenous nicotine self-administration under fixedand progressive-ratio schedules of reinforcement in rats, indicating that this compound inhibited both the primary reinforcing and incentive motivational effects of nicotine. Conclusions: KK-92A, a novel selective GABABR PAM, attenuates the rewarding effects of nicotine in rats. The present results further confirm that GABABR PAMs may be useful antismoking medications. Financial support: 2U19DA026838. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.350 Initiating buprenorphine maintenance for opiate-dependent hospitalized patients: A randomized trial Jane M. Liebschutz1, M. Stein2, D. Crooks1, D. Herman2, B. Anderson2, L. Meshesha1, S. Dossabhoy1 1 Boston Medical Center, Boston, MA, United States 2 Butler Hospital, Providence, RI, United States Aims: To determine whether offering opiate-dependent persons hospitalized for medical conditions initiation and linkage to opioid agonist treatment (OAT) with buprenorphine/naloxone (Bupe) would increase engagement in Bupe OAT at 6 months. Methods: Opiate-dependent patients not currently in addiction treatment who were admitted to a general medical hospital were identified by daily chart review of all hospital admissions and clinical interview by addiction specialist nurse or physician. Eligible, consenting patients (not alcohol dependent, no benzodiazepine mis-use) were randomized to 5-day Bupe detoxification protocol (DETOX) or Bupe induction, intra-hospital dose stabilization, and post-discharge transition to maintenance Bupe OAT (LINKAGE). Intention to treat outcomes at 6months included entry into outpatient OAT, days receiving OAT, and OAT retention at 6-months. Results: Among 119 participants, mean age was 40.1 (±11.8), 85 (71.4%) were male, 50 (42.0%) were non-Hispanic Caucasian, 35 (29.4%) were African-American, and 25 (21.0%) were Latino. LINKAGE and DETOX arms did not differ significantly (all p values >.4) on demographic characteristics. Compared to those in the DETOX (n=58), participants randomized to LINK-AGE (n=61) were significantly ( 2 =43.3, p< .001) more likely toenterBupe (73.8%vs13.8%)by6-months.Amongpersons who entered outpatient OAT, mean buprenorphine treatment days were 93.2 (±57.0) and 57.0 (±56.7) in the LINKAGE (n=45) and DETOX (n=8) arms, respectively. 14 (31.1%) of the persons in LINKAGE who initiated suboxone treatment were still engaged in treatment at the end of 6-months. Conclusions: LINKAGE was able to enroll 75% of these out-oftreatment opiate dependent persons in OAT. Compared to standard inpatient detox, initiation of and linkage to Bupe treatment is an effective means for engaging medically hospitalized patients who are not specifically seeking care for their addictions in long-term opiate Bupe treatment. Financial support: NIH/NIDA Award number R01DA02622301. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.351 Separate and combined effects of gabapentin and 9-THC doses in cannabis users discriminating 9-THC Joshua A. Lile, T. Kelly, L. Hays University of Kentucky, Lexington, KY, United States Aims: The aimof the present study is to determine the influence of gabapentin on the interoceptive effects of 9-THC in cannabis users. Gabapentin is being tested because recent clinical trial data indicate that it is effective at reducing cannabis use in dependent individuals seeking treatment. Methods: The interoceptive effects of 9-THC are measured using a pharmacologically specific and sensitive drugdiscrimination procedure. During a sampling phase, subjects receive 30mg 9-THC, which is identified by a unique letter code (e.g., Drug X). During a control phase, subjects are required to correctly identify when they received Drug X or Not Drug X (i.e., placebo). Finally, a test phase is conducted in which 9-THC (0, 5, 15 and 30mg) is administered alone and in combination with gabapentin (0, 600 and 1200mg). We hypothesize that gabapentin will substitute for the 9-THC discriminative stimulus, and shift the discriminative-stimulus effects of 9-THC leftward/upward. Data are analyzed using ANOVA. In addition to the drug-discrimination task, several other measures are collected to determine a profile of 9-THC and gabapentin effects, including heart rate, blood pressure, temperature, self-report questionnaires, time estimation, and performance on psychomotor tasks. Five subjects who reported regular cannabis use have completed the protocol; three are enrolled. Recruitment will continue until the target number of subjects have completed. Results: Drug doses and combinations have beenwell tolerated in all subjects. To date, 9-THC is functioning as a discriminative stimulus and producing effects typical of cannabinoids in humans. Initial results arealso consistentwith thehypothesis that theeffects of gabapentin overlap with 9-THC, and that 9-THC effects are enhanced when given in combination with gabapentin. Conclusions: These results suggest that one mechanism by whichgabapentinmight facilitate cannabis abstinence is producing effects that overlapwith cannabinoids, thereby addressing some of the signs and symptoms that reportedly make abstinence difficult. Financial support: Supported by NIH grants DA025605, DA031766 and UL1TR000117. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.352