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Jessica L Bourdon,1 Sidney Judson,1 Taylor Fields,1 Sabrina Verdecanna,1 Nehal P Vadhan,2 Jon Morgenstern3 1Wellbridge Addiction Treatment and Research, Calverton, NY, USA; 2Institute of Behavioral Science, Feinstein Institutes for Medical Research. Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempsted, NY, USA; 3Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempsted, NY, USACorrespondence: Jessica L Bourdon, Email jbourdon@wellbridge.orgBackground: There is a lack of consensus in the addiction field as to how to refer to alumni of residential treatment who no longer use substances or who reduce their use. In the literature, this label and broader identity are typically discussed in technical (amount and frequency of use) or social terms (environment and social network changes).Objective: The current paper seeks to simplify the discussion by focusing on personal labels without complex technical or social considerations. Alumni of an inpatient addiction treatment facility were asked how they refer to themselves regarding their sobriety status post-discharge.Methods: Forty-nine patients were contacted 3 months post-discharge from a residential inpatient addiction treatment (men = 67%; Mage = 47.75 years). The patients completed a post-discharge assessment that was conducted by a trained research assistant over a 20-minute video call. The current study focused on a “sobriety label” measure in which patients indicated what they want to be called. Patients also explained why they chose their answer in an open-ended question.Results: Most patients identified as in recovery (n = 29; 59.18%) followed by a sober person (n = 7; 14.29%) and four other responses. No alum selected the in remission option, which is notably a common way to refer to patients who no longer use substances.Conclusion: The current study adds a critical patient/alumni perspective to the existing body of literature and serves as a call to action for researchers to add a similar “sobriety label” measure to future assessments, studies, and batteries in effort to bring consistency to the labels, definitions, and identities that are published. This methodology of understanding how this population identifies will create uniformity in future literature and decrease the stigma surrounding addiction.Plain Language Summary: There is a history of inconsistent use of labels, definitions, and identities in the addiction treatment field. Few past studies have directly asked patients how they self-label, and it is important to ask those who use substances or who have reduced their use what they preferred to be called. This study asked a simple question to alumni of an inpatient treatment facility what they want to be called. We then asked them to explain why they chose that answer. Most alumni identified as “in recovery” or “a sober person”. This simple tool can be utilized by other facilities and also highlights that many research studies are referring to individuals by terms they do not prefer (eg, “in remission”).Keywords: sobriety, identity, label, addiction, discharge, recovery, sober person, inpatient

Jessica L Bourdon,1 Sidney Judson,1 Gabriella Caporaso,1 Monica F Wright,2 Taylor Fields,1 Nehal P Vadhan,3 Jon Morgenstern4 1Center for Addiction Science, Wellbridge Addiction Treatment and Research, Calverton, NY, USA; 2Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; 3Institute of Behavioral Science, Feinstein Institutes for Medical Research, Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempsted, NY, USA; 4Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempsted, NY, USACorrespondence: Jessica L Bourdon, Center for Addiction Science, Wellbridge Addiction Treatment and Research, 525 Jan Way, Calverton, NY, 11933, USA, Email jbourdon@wellbridge.orgBackground: Quality training is an oft-cited barrier to effective implementation and ongoing delivery of high-quality evidence-based practice (EBP) across fields. This is especially true in the addiction field, but there is little cited evidence for optimal methods to improve EBP in inpatient addiction facilities with minimal resources.Objective: The current paper focuses on evaluating the state of our facility’s group CBT manual and clinical training on the manual in a “realistic” (ie, non-RCT, non-grant-funded) inpatient addiction treatment setting.Methods: Five full-time clinicians volunteered to take part in the study (woman = 60%; Mage = 36.20 years). The study involved a mix of semi-structured interviews and surveys designed to measure seven outcomes (barriers, feasibility, useability, appropriateness, acceptability, burden, trialability).Results: Three themes emerged from the data that impacted the group CBT manual: training, timing, and functionality. Addressing these themes allowed for a new, optimal manual and training procedure to be put into place.Conclusion: The current study highlights that under-resourced inpatient addiction facilities can still methodically utilize implementation approaches to study their EBP, namely CBT. Such an approach will ensure that the highest quality care is being delivered to patients and actively addresses known training barriers that prevent proper EBP delivery.Plain Language Summary: Quality training is a barrier when implementing evidenced-based practice to treat substance use disorders.CBT is a manualized evidence-based practice that is performed at inpatient addiction facilities.An evaluation of the CBT manual was made by an inpatient addiction facility to identify barriers of implementation of EBPs.Identified barriers included training, timing, and functionality.Keywords: cognitive behavioral therapy, addiction, evidence-based practice, inpatient, substance use disorders

AIMS: To examine the social triggers of sexual compulsivity amongst a diverse sample of gay and bisexual men. DESIGN AND PARTICIPANTS: Qualitative interviews were conducted with 180 gay and bisexual men in the United States who self-identified that their sex lives were spinning out of control. The data were analyzed using a grounded theory approach to explore the range of social triggers that were driving sexual compulsions. MEASUREMENT: An open-ended interview and a structured clinical interview were conducted with each participant. The interviews examined their experiences with sexual compulsivity over time and the impact of their problematic sexual behaviors on their lives. FINDINGS: Two types of social triggers emerged from the data: event-centered triggers and contextual triggers. Event-centered triggers arise from sudden, unforeseen events. Two major event-centered triggers were identified: relationship turmoil and catastrophes. Contextual triggers, on the other hand, have a certain element of predictability, and included such things as location, people, the use of drugs, and pornography. CONCLUSIONS: This framework of triggers has clinical implications for the prevention and treatment of sexual compulsivity. Clinicians can utilize the framework of social triggers in the therapeutic process to provide insight into ways to effectively work through symptoms of sexual compulsivity. Awareness of the contextual aspects of sexual compulsivity may be critical to understanding the behaviors of sexually compulsive clients. Thus, therapeutic assessments should focus upon the social context in addition to the psychological components of the disorder. [ABSTRACT FROM AUTHOR]

Parathyroid hormone-related protein (PTHrP) plays a primary role in the development of humoral hypercalcemia of malignancy (HHM) that occurs in the majority of patients with adult T-cell leukemia/lymphoma (ATLL) due to human T-cell lymphotropic virus type-1 (HTLV-1) infection. We previously showed that ATLL cells constitutively express high levels of PTHrP via activation of promoters P2 and P3, resulting in HHM. In this study, we characterized a nuclear factor-kappaB (NF-kappaB) binding site in the P2 promoter of human PTHrP. Using electrophoretic mobility shift assays, we detected a specific complex in Tax-expressing human T cells composed of p50/c-Rel, and two distinct complexes in ATLL cells consisting of p50/p50 homodimers and a second unidentified protein(s). Chromatin immunoprecipitation assays confirmed in vivo binding of p50 and c-Rel on the PTHrP P2 promoter. Using transient co-transfection with NF-kappaB expression plasmids and PTHrP P2 luciferase reporter-plasmid, we showed that NF-kappaB p50/p50 alone and p50/c-Rel or p50/Bcl-3 cooperatively upregulated the PTHrP P2 promoter. Furthermore, inhibition of NF-kappaB activity by Bay 11-7082 reduced PTHrP P2 promoter-initiated transcripts in HTLV-1-infected T cells. In summary, the data demonstrated that transcriptional regulation of PTHrP in ATLL cells can be controlled by NF-kappaB activation and also suggest a Tax-independent mechanism of activation of PTHrP in ATLL. [ABSTRACT FROM AUTHOR]

This analysis sought to explore the role the Internet played in the lives and behaviors of 183 gay and bisexual men who identified their sex lives as "spinning out of control." Participants for this study had enrolled in a multi-method community study of compulsive sexual behavior whose purpose was to investigate the nature, course and antecedents of sexual compulsivity among gay and bisexual men. Most men in the sample reported using the Internet and, the greater their reported use, the more likely they were to identify their use as a problem. Moreover, men who identified their Internet use as a problem were more likely to have sought help through 12-step programs. Data from the current study suggest the Internet may play a role in sexual risk-taking behaviors of sexually compulsive gay and bisexual men. It seems this connection to risk-taking behaviors may be different for HIV-positive and HIV-negative men. Understanding the role of the Internet in the sexual lives of sexually compulsive gay and bisexual men and the relationships between HIV-risk taking and Internet use in this population provides a foundation to better design/implement effective HIV education and prevention. Although the Internet is a potential problem or trigger for sexually compulsive men, it also provides researchers, public health professionals, and clinicians with a powerful tool for HIV educational outreach, interventions, and prevention. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We tested the effectiveness of a long-term coordinated care strategy--intensive case management (ICM)--compared with usual care (UC) among a group of substance-dependent women receiving Temporary Assistance for Needy Families (TANF). METHODS: Substance-dependent women on TANF (N=302) were recruited from welfare offices. They were assessed and randomly assigned to ICM or UC; follow-up was at 3, 9, and 15 months. UC consisted of a health assessment at the welfare office and a referral to substance abuse treatment and TANF services. ICM clients received ICM services in addition to UC services. RESULTS: ICM clients had significantly higher levels of substance abuse treatment initiation, engagement, and retention compared with UC clients. In some cases, ICM treatment attendance rates were double those of UC rates. Additionally, almost twice as many ICM clients were abstinent at the 15 month follow-up compared with UC clients (P<.0025). CONCLUSIONS: ICM is a promising intervention for managing the chronic nature of substance dependence among women receiving TANF. Future research should refine long-term care strategies-such as ICM-that address the chronic nature of substance dependence among low-income populations. [ABSTRACT FROM AUTHOR]

Excess drinking poses multiple substantial health risks to HIV-infected individuals. However, no published intervention studies have focused on drinking reduction as the main outcome in HIV primary care patients. An intervention in this setting must place minimal demands on pressured staff and resources. This pilot study tested such an intervention, which consisted of brief Motivational Interviewing (MI) and HealthCall, an automated daily telephone self-monitoring system based on Interactive Voice Response (IVR), designed to extend and enhance the effects of brief MI . Thirty-one patients entered the study, received a 30-minute MI and were instructed in daily use of the IVR system. They received graphical feedback on their daily drinking from the HealthCall database after 30 days. A statistically significant decrease in drinking was found over time, both as reported in daily IVR calls (β = - 0.01, se 0.01, p =.03) and in follow-up interviews (β = - 0.04, se 0.12, p =.02) at 60 days. The proportion of daily calls made supported the feasibility of the intervention. The results indicate that HealthCall is acceptable to a disadvantaged HIV patient population, and preliminary data support the efficacy of this intervention in reducing harmful drinking among HIV primary care patients. [ABSTRACT FROM AUTHOR]

The present study sought to characterize well-being indicators for a sample of children of substance dependent TANF women. Participants were 372 mothers meeting DSM-IV criteria for substance dependence and 156 non-substance abusing women from two urban counties in New Jersey. Children of substance dependent TANF mothers experienced significant vulnerabilities, as demonstrated by higher levels of contextual risk factors and negative behavioral and emotional and school outcomes. Overall, these rates were about double those found in children of non-substance abusing mothers. Results highlight the need for multi-systemic services to address the problems experienced by substance abusing TANF women and their children. [ABSTRACT FROM AUTHOR]

This article summarizes the proceedings of a symposium that was organized and chaired by Richard Longabaugh and presented at the 2004 Research Society on Alcoholism meeting in Vancouver, British Columbia, Canada. The aim of the presentation was to focus on evidence for the active ingredients of behavioral therapies for patients with alcohol use disorders. Dennis M. Donovan, PhD, reviewed evidence for the active ingredients of cognitive behavioral therapy. Barbara S. McCrady, PhD, presented a conceptual model for mechanisms of change in alcohol behavior couples therapy and reviewed evidence for this model. J. Scott Tonigan, PhD, presented data testing three hypothesized mechanisms of change in twelve-step facilitation treatment. Mitchell P. Karno, PhD, presented therapy process data that tested whether matching therapist behaviors to client attribute across three therapies affected drinking outcomes. Jon Morgenstern served as discussant. [ABSTRACT FROM AUTHOR]

Long-form leptin receptor (OB-R(L)) is a signal-transducing member of the cytokine receptor superfamily that is essential for mediating the effects of leptin on mammalian body weight homeostasis. At present, the range of transcriptional targets responsive to OB-R(L) activation, and consequently, the likely mediators of leptin action, remain undefined. In this report, we have used cDNA subtractive hybridization to identify transcripts induced by leptin in immortalized hypothalamic neurons expressing OB-R(L). Differential expression of the identified transcripts in these cells was confirmed by both array technology and Northern blotting. In situ hybridization studies indicate that these transcripts are expressed in the mouse central nervous system, including nuclei of the hypothalamus that coexpress OB-R(L). Comparative in situ analysis of slices of hypothalami generated from control and leptin-injected ob/ob mice demonstrates that a subset of the identified transcripts is induced in vivo after leptin injection. The potential role of the proteins encoded by these transcripts in mediating the effects of leptin on body weight and energy homeostasis are discussed. [ABSTRACT FROM AUTHOR]

Canis familiaris allergen 1 (Can f 1) and Canis familiaris allergen 2 (Can f 2) are the two major allergens present in dog dander extracts. We now report the isolation of cDNAs encoding both proteins and present their nucleotide and deduced amino acid sequences. Can f 1, produced by tongue epithelial tissue, has homology with the von Ebner's gland (VEG) protein, a salivary protein not previously thought to have allergenic properties. Can f 2, produced by tongue and parotid gland, has homology with mouse urinary protein (MUP), a known allergen. Both VEG protein and MUP are members of the lipocalin family of small ligand-binding proteins. Recombinant forms of Can f 1 and Can f 2 were produced and tested for immunoglobulin E (IgE) reactivity. Among dog-allergic subjects, 45% had IgE directed exclusively to rCan f 1, and 25% had IgE to both rCan f 1 and rCan f 2. In addition, both recombinant proteins were able to cross-link IgE and elicit histamine release from peripheral blood leucocytes in vitro. These findings confirm that Can f 1 and Can f 2 are major and minor dog allergens, respectively, and demonstrate that recombinant forms of dog allergens retain at least some IgE-binding epitopes. [ABSTRACT FROM AUTHOR]