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The PReventing Opioid Misuse In the SouthEast (PROMISE) Initiative team conducted a needs assessment to explore Mississippians' perceptions of the emerging issue of opioid misuse and to identify ways Extension professionals can assist in opioid misuse prevention. In this article, we describe the assessment process that included a series of community forums and a statewide electronic survey. Additionally, we explain how we used the assessment findings to define participants' involvement in opioid misuse prevention and to develop messages to be disseminated by Extension professionals. Information presented here may be of use to Extension personnel in other states interested in engaging in opioid misuse prevention.

Background: Smoking prevalence among Hispanic/Latino construction workers in the United States is very high (31%). Aims: To investigate tobacco use profiles in these minority workers and explore their management's views about implementing sustainable worksite smoking cessation services. Methods: Analysis of baseline data from a smoking cessation trial among Hispanic/Latino construction workers (n = 134; adult men =18 years), and semistructured, 45-minute interviews with 24 key personnel at six construction companies in south Florida were conducted. Interviews were recorded, transcribed, and analyzed thematically. Results: Overall, 43.3% of workers were Cuban, and 81.3% had low acculturation level. Nicotine dependence levels were "high" in 61.8% of workers. Half of the workers had a successful quit attempt but only 9.9% received advice from a physician to quit smoking, 16.7% used medication to quit, and 79.2% did not receive assistance. Participants in the interviews stated that nothing was provided to help smokers quit smoking and considered distributing self-help materials with free medications as the most appropriate service. Challenges to integrating the service were time restriction and cost. Recommendations for implementing the service were local/state government mandate. Discussion: Tailoring tobacco treatment to Hispanic/Latino construction workers' job circumstances and culture is essential to support their cessation efforts. Integrating worksite tobacco treatment services into other available health promotion programs (e.g., safety) and enforcing smoke-free legislation in the construction sector can facilitate its adoption. Conclusion: Involving key stakeholders and mandating the service by the State and local government are necessary to integrate sustainable worksite smoking cessation services in the construction sector.

Stimuli conditioned with a substance can generate drug-approach behaviors due to their acquired motivational properties. According to implicit theories of addiction, these stimuli can decrease cognitive control automatically. The present study (n = 49) examined whether reward-associated stimuli can interfere with cognitive processes in the absence of knowledge about stimulus--outcome contingencies. Conditioned stimuli (CS) were paired with high-reward (HR) or low-reward (LR) probabilities of monetary reward using a Pavlovian learning task. Participants were categorized as Aware or Unaware of contingencies using a Bayesian analysis. CS were then used as task-irrelevant distractors in modified flanker and N-back tasks. Results show HR CS can generate increased interference in the flanker task for participants Unaware of contingencies, contributing further evidence for the existence of implicit Pavlovian conditioning. For the N-back task, working memory performance was affected by HR CS, albeit only for Aware participants. These results suggest that CS can interfere implicitly with cognitive processes in a similar way to drug-related stimuli. Such an effect could occur in a stimulus-driven fashion, devoid of top-down goal-directedness. These findings have implications for the conceptualization and study of implicit processes in addiction and highlights the necessity to reconsider the measurement of such phenomena.

The high rates of comorbidity with substance use disorders in general psychiatry patients demand enhanced competences from psychiatry residents in addiction medicine. The aim of this article is to improve knowledge, skills and attitudes in psychiatric residents in treating patients with comorbid substance-related disorders (SUD). Four seminars with all residents on relevant and actual knowledge on substance-related disorders and a small group experience of five sessions on improving skills and attitudes in dealing with patients are described and evaluated quantitatively and qualitatively. Both quantitative evaluations show that seminars and small group experiences are highly appreciated. Concerning the seminar, residents appreciated, in particular, to study and present selected up-to-date literature and the positive learning environment. The small group experience resulted in sharing feelings and thoughts about patients with SUD and mutual support. The results show that the goals of these two methods of education have been met. This means that these two methods can be integrated in the training of residents in psychiatry to increase knowledge, skills and attitudes concerning addiction.

Rehabilitation for persons who use drugs in the Philippines is premised on a multidisciplinary team approach to treatment, where delivery of services is collaboratively undertaken by physicians and rehabilitation practitioners. In 2013, a government-academe-civil society collaborative developed a customized training program for nurses, psychologists, social workers and other personnel involved in rehabilitation work. This 10-day accreditation course covered modules on understanding drug dependence, assessment, management of drug abuse and dependence, and drug rehabilitation work. Participants also had the opportunity to handle cases through a practicum. Between 2013 and 2016, eight training sessions were implemented for 252 rehabilitation practitioners from almost all of the Philippines' administrative regions. A paired-samples t-test showed that there was a significant difference in the pre-test (24.58 ± 4.08) and post-test scores (30.37 ± 4.66) of participants to the training, t(152) = 16.5949, p = <0.0001.

Heroin users are a stigmatized group of learners on the edge of society, whose struggle for recognition remains largely ignored. Drug treatment in the form of methadone and prescription drugs has only served to further stigmatize and disrespect their rights. Adult education aspires to be a discourse of resistance and a social movement for the creation of a diverse and just society. The work of Axel Honneth and his "Theory of Recognition" can help to advance those aspirations and radically shift our understanding of the drug user and the recovery process.

Those who are addicted to substances face increased psychological emotional, social and economic problems which can potentially have negative impacts on marital satisfaction and sexual self-esteem and efficacy. Routine activities are often displaced by the need to satisfy the physiological urges. Within a marital union, this along with other variables can distract many from their expected marital responsibilities and daily activities. This study investigated quality of life, marital satisfaction, and sexual self-efficacy in couples who were both addicted to substances within an identified treatment period. The number of participants was 40 ("N" = 40). Participants were randomly assigned to two of four treatment conditions. Each group was comprised of 10 people undergoing treatment for addiction. All participants were couples entering treatment together who agreed to participate in a treatment program in Qazvin city. Instruments utilized in this investigation included the Enrich marital satisfaction questionnaire (short form) and the Reynolds' sexual self-efficacy scale. Treatments consisted of eight sessions of training in the form of group therapy, which were conducted by trained clinicians. The control group consisted of those who were waiting for training. No treatment/ training was given. After intervention both groups were tested. Descriptive and inferential statistics were used to analyze data. The results indicated that training significantly improved marital satisfaction and sexual self-efficacy. Scores obtained in the treatment and control group showed a significant difference (p less than 0.05). The conclusion of this study suggests that couples where both partners are addicted to substances can increase their levels of satisfaction and efficacy within the marital union. Quality of life therapy empowers people to actualize their knowledge, attitudes and values. These skills can enable partners to have increased motivation for starting healthy behaviors which will have significant impacts on their marital satisfaction and sexual function. Trainings designed to enhance communication and collaboration can improve the quality of the marital union despite the influence of substance and addiction within both marital partners.

The Minnesota Indian Women's Resource Center offers harm reduction programming to at-risk adolescent American Indian girls, including outreach, case management, advocacy, healthy sexuality education, and support groups. To evaluate program impact, participants are assessed at intake and every 6 months afterward for current vulnerability to commercial sexual exploitation, violence, and addiction. Evaluation results indicate frequent exposure to sex traffickers and suggest that harm reduction methods can help girls reduce risk of commercial sexual exploitation. (Contains 1 table.)

Since the early 1970s, neuroscientists recognized that it was possible for patients to re-regulate brain wave activity. Much of this early work focused on helping persons with epilepsy control their seizures and was later extended toward helping children with attention deficit hyperactivity disorder (ADHD) with concentration. This brainwave training is called quantitative electroencephalography (QEEG) biofeedback or neurofeedback. Today, there is increasing scientific evidence that neurofeedback training can help address a variety of cognitive and behavioral issues in children and adults; particularly in the area of ADHD. In addition, neurofeedback is being employed in the treatment of those persons with alcohol and drug dependency, anxiety disorders, traumatic brain injury, chronic pain, depression, and autism spectrum disorders. Further, there appears to be a growing public awareness and support of this technology. This article explores the history of QEEG, reviews the biological basis for neurofeedback training, identifies how this technology appears to help clients with a variety of psychological and physiological disorders, and offers a critique concerning the state-of-research regarding neurofeedback efficacy. Strategies on the part of health educators to responsibly engage emergent developments in the field of neurofeedback are offered. (Contains 2 tables.)

Health care researchers and practitioners are increasingly asked to work across disciplines (or, in keeping with the conference theme, "Between the Tides") to deal with complex health issues. But working with individuals from different fields is more challenging than it sounds. Working across disciplines can result in tension and miscommunications. Furthermore, to explore interactions among disciplines requires breaking down disciplinary boundaries and creating a common framework and language to define, analyze, and develop new approaches. This paper explores the benefits and challenges of teaching transdisciplinarity in a discipline-centred world, including a description of the journey of one post-graduate research training program as it strives to help student researchers break down disciplinary borders and develop a common framework to approach a particular health issue--in this case, the problem of substance misuse and addictions.

In this investigation, the authors surveyed graduate students (n = 129) in counseling and psychology regarding the extent to which addiction was present in their families. A high percentage of respondents, particularly females, reported that their families had alcoholism/drug addiction present. A statistically significant difference was yielded between the self-reported presence of alcoholism/drug addiction between Hispanic and Anglo females. Hispanic females reported a higher percentage of their families having alcoholism/drug addiction (86%) than was reported by Anglo females (78%). Implications of these findings are discussed.

This article is an account of a return to education course set up to cater to the needs of recovering heroin addicts in a Dublin rehabilitation project in the summer of 2008. It begins with a brief outline of the HSE Soilse rehabilitation and recovery programme and the rationale for seeking association with the Department of Adult and Community Education NUI Maynooth as a way of bridging both the structural and individual gaps that recovering people have en route to educational progression. A full account is presented of the actual Return to Learning (RtL) course, which employed a functional context education methodology and integrated literacy approach, from the refections of the tutors who delivered the course. The Soilse/NUIM RtL is unique in terms of an adult education programme in Ireland in that it tried to grapple with two distinct yet interrelated issues; recovery from drug addiction and educational progression. The following article attempts to give a full and honest account of the programme and its outcomes. (Contains 4 footnotes and 2 figures.)

Objective: Treatment of older adults in methadone maintenance treatment (MMT) with comorbid mood disorders presents many challenges. The goal of this randomized controlled trial was to assess the combined effect of problem-solving therapy (PST) with treatment as usual (TAU) compared to TAU alone on decreasing depressive symptoms in opioid-addicted older adults in MMT. Methods: Sixty-four methadone clinic attendees, at least 50 years old, with moderate depressive symptom were randomized to PST + TAU (n = 29) or TAU (n = 35). PST is an intervention for depressed older adults with a focus on teaching problem-solving skills. Results: There was not a statistically significant difference in depression scores between the two treatment groups. However, there is evidence for a clinically meaningful decrease in symptoms in the PST + TAU group 7 months post treatment (Cohen's d = 0.57) Conclusion: Clinical implications of PST + TAU in comparison to TAU on depressive symptom seemed to have lasting benefits at 6-month post treatment.

The last decade has seen an exponential increase in the use of illicit and prescription opioids during pregnancy. Opioid dependency during pregnancy increases the risks of obstetric complications for mothers and potential dangers for newborns during infancy and later in life. The mother-child dyad faces specific hurdles when it comes to getting their medical and psychosocial needs met. The purpose of this article is to identify gaps in care of families affected by opiate abuse and review how the Mother and Child Dependency Program at the MetroHealth System in Cleveland, Ohio, is trying to bridge these gaps through comprehensive, multidisciplinary, and standardized treatment for this vulnerable population.

Opioid use in pregnancy and the postpartum period increases the vulnerability of the newborn in many ways. No single system can appropriately meet all the needs of this population. Due to the variety of systems that are involved, there are multiple opportunities for gaps in care. Thus, the systems of care must collaborate, communicate, and share information in an effective manner in order to provide optimal care. This article uses the metaphor of driving on a long journey with many twists and turns to illustrate the various aspects of opioid use in pregnancy, the challenges to intervention, and how to effectively support children and families in recovery.

New developments in the treatment of mothers and infants affected by opioid addiction point to the promising effects of interventions that adopt a developmental perspective, occur concurrently with addiction treatment, and target the parent-infant relationship as early as possible. In this article, the authors provide general guidelines for clinicians who wish to use attachment-informed, mentalization-based approaches to support mother-child relationships during a mother's recovery from addiction. They share an update on research from "Mothering From the Inside Out (MIO)," an evidence-based individual parenting therapy developed for mothers in addiction treatment.

Objectives: Anxiety sensitivity (AS) is associated with cannabis use. People high in AS may use cannabis to cope with elevated anxiety. This association is consistently supported in the literature. However, we have much to learn about the mechanisms of the AS pathway to cannabis use. We aimed to examine negative urgency--the tendency to act impulsively when distressed--as a mediator of the association of AS with cannabis problems and cannabis dependence symptoms. We hypothesized that negative urgency would uniquely mediate the association of AS with cannabis outcomes after controlling for other facets of impulsivity. Participants and Methods: Postsecondary students (N = 91; Fall 2012) completed online self-reports. To participate, students needed to be =18 years old, enrolled in postsecondary studies, and needed to report current cannabis use. Results: Negative urgency uniquely mediated associations between AS and cannabis problems and dependence symptoms. Conclusions: Our findings suggest a mechanistic role of negative urgency in the AS pathway to cannabis misuse.

We compared two strategies of prize-based contingency management (CM) in methadone-maintained outpatients. Urine was tested thrice weekly for 5 weeks pre-CM, 12 weeks CM, and 8 weeks post-CM. Participants were randomly assigned to a cocaine contingency (four prize draws for each cocaine-negative urine, N = 29) or an opiate-cocaine contingency (one draw for each urine negative for opiates or cocaine, four draws if negative for both, N = 38). There were no group differences in cocaine abstinence during CM or post-CM and no differences in opiate abstinence during CM. Opiate abstinence was greater in the opiate-cocaine group post-CM, and heroin craving was reduced in this group during and post-CM. Draws earned per cocaine-negative urine (four vs. one) did not affect cocaine use. (Contains 1 table and 3 figures.)

This article describes the process by which one study utilized qualitative methods to create items for a multi dimensional scale to measure twelve step program affiliation. The process included interviewing fourteen addicted persons while in twelve step focused treatment about specific pros (things they like or would miss out on by not being involved in twelve-step programs) and cons (things they dislike or would benefit from if they did not engage in twelve-step programs). The triangular process used in qualitative research is described, which generated items for the subsequent instrument to measure ambivalence toward recovery programs. Mixed-method strategies included qualitative interviewing to inform scale development and three analytical approaches to produce specific codes, themes, and domains. (Contains 1 table.)

High-magnitude and long-duration abstinence reinforcement can promote drug abstinence but can be difficult to finance. Employment may be a vehicle for arranging high-magnitude and long-duration abstinence reinforcement. This study determined if employment-based abstinence reinforcement could increase cocaine abstinence in adults who inject drugs and use cocaine during methadone treatment. Participants could work 4 hours every weekday in a workplace where they could earn about $10.00 per hour in vouchers; they were required to provide routine urine samples. Participants who attended the workplace and provided cocaine-positive urine samples during the initial 4 weeks were invited to work 26 weeks and were randomly assigned to an abstinence-and-work (n = 28) or work-only (n = 28) group. Abstinence-and-work participants had to provide urine samples showing cocaine abstinence to work and maintain maximum pay. Work-only participants could work independent of their urinalysis results. Abstinence-and-work participants provided more (p = 0.004; OR = 5.80, 95% CI = 2.03-16.56) cocaine-negative urine samples (29%) than did work-only participants (10%). Employment-based abstinence reinforcement can increase cocaine abstinence. (Contains 4 tables and 5 figures.)

Introduction: There is scarcity of Indian data on substance dependence in children and adolescents. Methods: Case records of 85 adolescents with the final diagnosis of substance dependence were analyzed (out of 115 registrations during 1978-2003). Results: Time trends showed an increase in individuals with good social support and higher family income, a decrease in individuals with psychiatric comorbidity. Intravenous drug use was prominent during 1988-1997. Conclusions: Clinic attendance may reflect secular trends in the community. (Contains 1 table.)

This paper critically examines methadone treatment from the perspective of adult and community education and questions the absence of rehabilitation. It identifies biomedicine and the methodology of evidence based medicine as the discourses that determine our understanding of addiction and treatment. It is especially critical of psychiatry for the over medicalisation of addiction treatment and the communities uncritical acceptance of the assumptions of medicine. The paper then looks at the Crinan project, as a model of good practice in drug treatment and asks what makes adult and community education an effective component of treatment that works uniquely in a way that medical model does not?