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Approximately 28 million individuals engage in alcohol-impaired driving (AID) every year. This study investigated individuals' AID decision making strategies under intoxication, their variability across the breath alcohol concentration (BrAC) curve, and the association between strategy and AID attitudes, intentions, and behavior.Seventy-nine adults (mean 23.9 years, 57% female) who drank alcohol ≥2 days per week and lived2 miles away from their typical drinking locations completed an alcohol administration protocol and AID decision making task. AID attitudes, intentions, and behaviors were assessed repeatedly across the BrAC curve. Bayesian cognitive modeling identified decision strategies used by individuals on the AID decision making task, revealing whether alcohol consumption level and/or ride service cost factored into individuals' decisions to drive while impaired or obtain a ride. Additional analyses tested whether AID attitudes and intentions were related to individuals' decision strategies.Two decision strategies were examined on the ascending and descending limbs of the BrAC curve: compensatory (both consumption level and ride service cost factored into AID decisions) and non-compensatory (only consumption level factored into AID decisions). Switching to a compensatory strategy on the descending limb was associated with lower perceived intoxication, perceiving AID as less dangerous, and being willing to drive above the legal BrAC limit.Results suggest that risk for engaging in AID is higher for those using a cost-sensitive, compensatory strategy when making AID decisions under intoxication. Future research is needed to test whether AID countermeasures (e.g., subsidized ride services) are differentially effective according to decision strategy type. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Associations between mood and drinking are part of many theoretical models of problematic alcohol use. Laboratory and ecological momentary assessment (EMA) research on associations between mood and drinking behavior has produced mixed findings, and these constructs are often measured using different methods depending on research context. The present study compares associations between mood and alcohol consumption across research contexts (laboratory vs. daily life) and measurement methods (breathalyzer vs. self-report).Forty-five young adults (53% women,We identified discrepant mood-BrAC associations across laboratory and EMA contexts. Momentary excitement was negatively associated with BrAC in the lab, but positively associated with BrAC during EMA (Studies testing theoretical models involving directional mood-alcohol associations (e.g., affective reinforcement models) need to carefully consider how research context and methods may influence findings of associations between mood and drinking. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The current study extends the psychometric support for the Child Sheehan Disability Scale (CSDS) as a measure of impairment associated with childhood anxiety disorders, including obsessive compulsive disorder. The CSDS was completed by 1,481 predominately Caucasian youth (55.4% female) ages 8 to 17 ( M = 12.68, SD = 2.78) from primarily two-parent households and a parent across community, outpatient, intensive outpatient treatment, and residential settings. The results replicated and extended the previously found strong convergent validity, discriminant validity, and treatment sensitivity with a revised parent-report item in the larger sample. Moreover, the CSDS successfully differentiated between patients receiving treatment of different levels of intensity. These data were used to develop preliminary qualitative descriptors associating individual scores with a likely level of indicated treatment to enhance the clinical applicability of the CSDS. This study establishes the CSDS as one of the briefest and most rigorously evaluated measures of impairment associated with child anxiety. However, the performance of the CSDS must be examined in more representative samples before being applied to diverse populations.

BACKGROUND: Alcohol demand, a measure of alcohol’s reinforcing value, is associated with greater alcohol consumption and alcohol-related problems. Although alcohol demand has primarily been evaluated as a “trait-like,” individual difference measure, recent evidence indicates that demand exhibits meaningful short-term fluctuations. AIMS: To test whether moment-to-moment fluctuations in alcohol demand in individuals’ natural drinking environments predicted drinking occurrence, drinking continuation, and drinking quantity. DESIGN: Baseline laboratory or Zoom session and 6 weeks of ecological momentary assessment (EMA). SETTING: Individuals’ natural drinking environments in Columbia, MO. PARTICIPANTS: 89 young adults (56% female; M age=24.8) participated from November 2018 through October 2020. Participants reported 14.5 drinking days (SD=8.1) and 4.1 drinks per occasion (SD=2.5) during EMA. MEASUREMENTS: Participants completed the Alcohol Purchase Task at baseline. Following, participants reported on their alcohol demand (breakpoint, O(max), intensity) and drinking behavior during EMA at daily, timed prompts from 6:00pm to 2:00am. They provided breathalyzer samples using a BACtrack Mobile(®) Pro. Models tested concurrent and prospective (lagged) associations between alcohol demand and drinking occurrence and drinking continuation after drinking initiation. Additional models tested concurrent associations between demand and breath alcohol concentrations (BrACs). FINDINGS: Higher alcohol demand was associated with higher odds of drinking and continued drinking for all demand indices at the momentary (ORs=1.27–1.56, ps≤.03) and day-level (ORs=2.14–3.39, ps

Mycophenolate Mofetil (MMF) is routinely used immunosuppressant in solid organ transplantation is commonly associated with several gastrointestinal (GI) side effects. Here we present a case of giant gastric ulcer of 5 cm from MMF use post cardiac transplant. Case Description A 56-year-old male with history of severe ischemic cardiomyopathy post heart transplant was on immunosuppression with MMF, tacrolimus and prednisone for 5 months. He presented with severe epigastric pain and intermittent episodes of melena for 1 month. His pain radiated to back that is worsened with eating. Associated with loss of appetite, vomiting and 16-pound weight loss in 3 months. He never smoked, drank alcohol or used over the counter pain medications. He was profoundly anemic requiring blood transfusions. EGD performed demonstrated very large clean-based ulcer of 5 cm diameter in the body, smaller ulcer of 8 mm diameter in pre-pyloric region and 5–10 small aphthous ulcers in the gastric body and fundus. Gastric biopsies taken from the ulcer were negative for Helicobacter pylori, cytomegalovirus and malignancy. Flexible sigmoidoscopy revealed non-bleeding inflamed internal hemorrhoids. Consequently, MMF was discontinued and switched to azathioprine. He was treated with twice daily proton pump inhibitor therapy with resolution of abdominal pain, improved appetite and weight gain. Discussion MMF is well known for common GI side-effects such as nausea, diarrhea, vomiting, ulcers, abdominal pain and rarely gastrointestinal bleeding. Few studies reported 3 to 8% incidence of ulcer perforation and GI bleeding within 6 months. Risk of gastroduodenal erosions is nearly 1.83 times for MMF, with the highest lesions associated with MMF-tacrolimus-corticosteroid combination treatment as seen in our patient. Hypothesis is that GI tract is vulnerable because of dependence of enterocytes on de novo synthesis of purines, which is disrupted by MMF. Typically, upper GI mucosal injuries of mucosal irritation leading to esophagitis, gastritis and/or ulcers are seen. Endoscopy is both diagnostic and therapeutic if bleeding gastric ulcers are noted. Minor complications improve with reduction of drug dose or use of enteric coated preparation if feasible. Discontinuation of the drug is main stay in the management of MMF related ulcer disease. Simple medical treatment with either H2-receptor antagonists, proton-pump inhibitors, coating agents, prostaglandins or combination has proven effective in most cases. Considering excellent results with medical management of ulcer, role of surgery is limited.

RATIONALE: Alcohol intoxication produces effects that can impair judgment and increase engagement in risky behaviors, including alcohol-impaired driving (AID). Real-world AID decisions are informed by contextual circumstances and judgments of associated risk. How individuals vary in their AID decision-making across contexts and whether subjective alcohol responses (stimulation, sedation, acute tolerance) differentially affect AID decisions are critical, but under-studied research questions. OBJECTIVES: We systematically investigated predictors of AID decisions at different hypothetical driving distances across the blood alcohol concentration (BAC) curve. METHODS: Young adults (n=40; 55% female) completed two laboratory sessions in a within-subjects alcohol/placebo design. At multiple points along the BAC curve (M peak BAC=0.101g%), participants rated their subjective intoxication, stimulation, sedation, and perceived dangerousness of driving prior to indicating their willingness to drive distances of 1, 3, and 10 miles. Multilevel mixed models assessed within- and between-person predictors of the maximum distance participants were willing to drive at matched BACs on the ascending and descending limb. RESULTS: Under intoxication (but not placebo), participants were willing to drive greater distances on the descending versus ascending limb. At the momentary level, participants were willing to drive further when they felt less intoxicated, stimulated, and sedated, and perceived driving as less dangerous. CONCLUSIONS: Individuals differed in the distance they were willing to drive as a function of indicators of intoxication, implicating driving distance as an important contextual factor relevant to AID decisions. Individuals may simultaneously perceive themselves as “unsafe” to drive, but “safe enough” to drive short distances, particularly when BAC is falling.

Human alcohol laboratory studies use two routes of alcohol administration: ingestion and infusion. The goal of this paper was to compare and contrast these alcohol administration methods. The work summarized in this report was the basis of a 2019 Research Society on Alcoholism Roundtable, "To Ingest or Infuse: A Comparison of Oral and Intravenous Alcohol Administration Methods for Human Alcohol Laboratory Designs." We review the methodological approaches of each and highlight strengths and weaknesses pertaining to different research questions. We summarize methodological considerations to aid researchers in choosing the most appropriate method for their inquiry, considering exposure variability, alcohol expectancy effects, safety, bandwidth, technical skills, documentation of alcohol exposure, experimental variety, ecological validity, and cost. Ingestion of alcohol remains a common and often a preferable, methodological practice in alcohol research. Nonetheless, the main problem with ingestion is that even the most careful calculation of dose and control of dosing procedures yields substantial and uncontrollable variability in the participants' brain exposures to alcohol. Infusion methodologies provide precise exposure control but are technically complex and may be limited in ecological validity. We suggest that alcohol ingestion research may not be the same thing as alcohol exposure research; investigators should be aware of the advantages and disadvantages that the choice between ingestion and infusion of alcohol invokes.

We report a 39-year-old Native American female with an almost 20-year history of dysphagia that had increased in the 6 months prior to the initial evaluation. Investigation revealed a number of distinct esophageal disorders including Plummer-Vinson syndrome, gastroesophageal reflux disease with esophagitis, distal esophageal stricture, esophageal intramural pseudo-diverticulosis, and recurrent esophageal Candida infections. Although prolonged therapy with proton pump inhibitors, fluconazole, nystatin, and repeated esophageal balloon dilations relieved her symptoms, her prognosis remains uncertain.

Multiple theoretical perspectives posit that drug use leads to biased valuation of drug-related reward, at the expense of naturally occurring rewarding activities (i.e., reward dysregulation). Recent research suggests that the comparative balance of drug-related and nondrug-related reward valuation is a powerful determinant of substance misuse and addiction. We examined differential neurophysiological responses-indexed with the P3 component of the event-related potential (ERP)-elicited by visual alcohol cues and cues depicting natural reward as a neurobiological indicator of problematic drinking. Nondependent, young adult drinkers (N = 143, aged 18-30 years) completed questionnaire measures assessing alcohol use and problems, and viewed alcohol cues (pictures of alcoholic beverages), high-arousing natural reward cues (erotica, adventure scenes), nonalcoholic beverage cues, and neutral scenes (e.g., household items) while ERPs were recorded. When examined separately, associations of P3-ERP reactivity to alcohol cues and natural reward cues with alcohol use and problems were weak. However, differential P3 response to the two types of cues (i.e., reward dysregulation P3) showed consistent and robust associations with all indices of alcohol use and problems and differentiated high-risk from lower-risk drinkers. The current results support the idea that the differential incentive-motivational value of alcohol, relative to naturally rewarding activities, is associated with increased risk for substance misuse and dependence, and highlight a novel neurophysiological indicator-the reward dysregulation P3-of this differential reward valuation.

Objective: Approximately 28 million individuals engage in alcohol-impaired driving (AID) every year. This study investigated individuals’ AID decision making strategies under intoxication, their variability across the breath alcohol concentration curve (BrAC), and the association between strategy and AID attitudes and intentions. Method: 79 adults (23.9 years, 57% women) who drank alcohol ≥2 days per week and lived >2 miles away from their typical drinking locations completed an alcohol administration protocol and AID decision making task. AID attitudes, intentions, and behaviors were assessed repeatedly across the BrAC curve. Bayesian cognitive modeling identified decision strategies used by individuals on the AID decision making task, revealing whether alcohol consumption level and/or ride service cost factored into individuals’ decisions to drive while impaired or obtain a ride. Additional analyses tested whether AID attitudes and intentions were related to individuals’ decision strategies. Results: Two decision strategies were examined on the ascending and descending limb of the BrAC curve: compensatory (both consumption level and ride service cost factored into AID decisions) and non-compensatory (only consumption level factored into AID decisions). Switching to a compensatory strategy on the descending limb was associated with lower perceived intoxication, perceiving AID as less dangerous, and being willing to drive above the legal BrAC limit. Conclusions: Results suggest that risk for engaging in AID is higher for those using a cost-sensitive, compensatory strategy when making AID decisions under intoxication. Future research is needed to test whether AID countermeasures (e.g., subsidized ride services) are differentially effective according to decision strategy type.

Many negative outcomes associated with alcohol consumption stem from individual decision making, such as the decision whether or not to drive after drinking. Understanding biases in decision making as they relate to alcohol, and measuring variability in decision strategies across individuals, can be a tool for improving policy. For alcohol-related policy, both addiction and the acute effects of intoxication are potential sources of bias or heterogeneity in decision strategy, and we provide a brief primer on how they can affect decision making. We then discuss two alcohol policy domains, alcohol impaired driving and excessive consumption. We review potential implications of major findings in decision-making research for each of these domains, and point out how policy could take account of biases and variability in decision making.

Alcohol intoxication is well known to impair a number of cognitive abilities required for sound decision making. We tested whether an intoxicating dose of alcohol altered whether individuals satisfied a basic property of rational decision making, transitivity of preference. Our study was within-subjects in design and our analysis teased apart stable, yet error-prone, preferences from variable, error-free preferences. We find that alcohol intoxication does not appear to play a major role in determining whether subjects violate transitivity. For a minority of individuals, we find that alcohol intoxication does impact how they select among and/or perceive lotteries with similar attribute values. This, in turn, can cause them to alter various aspects of their preference structure.

Background and aims Despite widespread negative perceptions, the prevalence of alcohol-impaired driving (AID) in the United States remains unacceptably high. This study used a novel decision task to evaluate whether individuals considered both ride service cost and alcohol consumption level when deciding whether or not to drive, and whether the resulting strategy was associated with engagement in AID. Design A two-sample study, where sample 1 developed a novel AID decision task to classify participants by decision strategy. Sample 2 was used to cross-validate the task and examine whether decision strategy classifications were predictive of prior reported AID behavior. Setting A laboratory setting at the University of Missouri, USA. Participants Sample 1 included 38 student participants from introductory psychology classes at the University of Missouri. Sample 2 included 67 young adult participants recruited from the local community. Measurements We developed a decision task that presented hypothetical drinking scenarios that varied in quantity of alcohol consumption (one to six drinks) and the cost of a ride service ($5-25). We applied a Bayesian computational model to classify choices as consistent with either: integrating both ride cost and consumption level (compensatory) or considering only consumption level (non-compensatory) when making hypothetical AID decisions. In sample 2, we assessed established AID risk factors (sex, recent alcohol consumption, perceived safe limit) and recent (past 3 months) engagement in AID. Findings In sample 1, the majority of participants were classified as using decision strategies consistent with either a compensatory or non-compensatory process. Results from sample 2 replicated the overall classification rate and demonstrated that participants who used a compensatory strategy were more likely to report recent AID, even after accounting for study covariates. Conclusions In a hypothetical alcohol-impaired driving (AID) decision task, individuals who considered both consumption level and ride service cost were more likely to report recent AID than those who made decisions based entirely on consumption level.

OBJECTIVE: Alcohol-impaired driving is a significant public safety concern and is highly prevalent among young adults. Considerable research has examined between-person predictors of alcohol-impaired driving, but there has been little research on factors that predict alcohol-impaired driving at the event-level. This pilot/feasibility study was designed to identify within-person, event-level predictors of alcohol-impaired driving intentions in the natural environment using an ecological momentary assessment (EMA) design. METHOD: Thirty-six young adult, moderate drinkers (M age = 22.9 years; 72.2% female; M drinks per occasion = 3.2) were recruited from a university area to complete 2 weeks of EMA. They reported on their subjective levels of intoxication, perceived dangerousness of driving, and driving intentions during real-world drinking episodes. Breath alcohol concentrations were collected with a portable breath alcohol analyzer. RESULTS: Event-level perceived danger and subjective intoxication most strongly predicted intentions to drive after drinking, such that higher perceived danger and intoxication predicted lower willingness to drive, after adjusting for baseline alcohol-impaired driving attitudes (ps < .001). When we accounted for perceived danger during drinking episodes at the event and person level, baseline attitudes were no longer predictive of willingness to drive. Higher event-level breath alcohol concentration also predicted lower willingness to drive (p = .003). CONCLUSIONS: This study is the first to demonstrate that event-level risks of alcohol-impaired driving can be collected during drinking episodes in the natural environment. Findings indicate that subjective perceptions of intoxication and risk more strongly predict alcohol-impaired driving intentions than objective intoxication. Findings also suggest that event-level perceptions of intoxication and driving risk may be fruitful targets for interventions to reduce alcohol-impaired driving.

Addiction is a growing public health crisis, yet comparatively very few health services psychology programs include formal training in addiction science (Dimoff, Sayette, Norcross, 2017). Health services psychologists (i.e., psychologists who integrate psychological science and practice to understand development and functioning; APA, 2015) are well-suited to study and treat addiction, and doctoral level training is an ideal time to prepare future health services psychologists to do so. One possible barrier to incorporating addiction science training is the necessity of a multidisciplinary approach to study and treat addiction and related health behaviors. We focus primarily on clinical science training and argue for a multi-faceted approach to doctoral training in addiction science that would prepare trainees for research careers. The proposed training model emphasizes the importance of mentorship, coursework, grant preparation, responsible conduct of research, prevention, intervention, and treatment, and invited speakers and conference attendance. Each of these components is discussed with an emphasis on addiction science. We offer suggestions for incorporating portions of this training model for programs with few addiction science related resources. We also discuss the importance of enhancing diversity and inclusion in addiction training and offer brief recommendations on this topic.

Background Attitudes toward driving after drinking are strongly predictive of drinking and driving behavior. This study tested working memory capacity (WMC) as a moderator of the association between attitudes and drinking and driving behavior. Consistent with dual process models of cognition, we hypothesized that the association between perceived danger and drinking and driving would be stronger for individuals with higher WMC. Methods Participants (N = 161) enrolled in larger alcohol administration study were randomly assigned to an alcohol (n = 57), placebol (n = 52), or control (n = 52, not included) beverage condition. Past-year frequency of driving after drinking and WMC were assessed at baseline. Attitudes were assessed by asking participants to rate the perceived danger of driving at their current level of intoxication twice on the ascending limb (AL1, AL2), at peak breath alcohol concentration (BrAC), and twice on the descending limb (DL1, DL2). Results Analyses across the BrAC curve indicated that the hypothesized interaction was observed for the alcohol but not placebo condition. Analyses for each assessment point indicated that the interaction was significant for the ascending limb and peak BrAC. In the alcohol condition, for those higher in WMC, lower perceived dangerousness was strongly associated with increased driving after drinking (AL1: incident rate ratios [IRR] = 5.87, Wald's χ2 = 12.39, p = 0.006, 95% CI [2.19, 15.75]; AL2: IRR = 8.17, Wald's χ2 = 11.39, p = 0.001, 95% CI [2.41, 27.66]; Peak: IRR = 5.11, Wald's χ2 = 9.84, p = 0.002, 95% CI [1.84, 14.16]). Associations were not significant at low WMC. Conclusions Results suggest that individuals higher in WMC are more likely to act consistently with their explicit attitudes toward drinking and driving. Findings may have implications for existing drinking and driving interventions and suggest the potential for novel interventions targeting implicit associations or WMC.

Background Riding with a drinking driver (RWDD) is a serious concern that leads to numerous preventable deaths every year. There is a significant gap in research on empirically tested predictors of RWDD that could be implemented in prevention efforts. College students are in need of such prevention efforts, as they have some of the highest rates of alcohol-related crash fatalities and may engage in RWDD more than their noncollege peers. This study utilized behavioral decision-making approach to examine predictors of RWDD and declining a ride from a drinking driver (Decline) in older college students. Methods Students (n = 791) in their third year of college were enrolled from 3 large and diverse universities. Psychosocial (e.g., expectancies, norms) and decision-making variables (willingness to RWDD and intentions to use alternatives) were assessed in the fall of their third year. One year later, RWDD and Decline behaviors were assessed. Zero-inflated Poisson analyses were used to assess how decision-making variables predicted RWDD and Decline behavior. Associations between psychosocial and decision-making variables were also assessed. Results Thirteen percent of students reported RWDD and ~28% reported Decline behavior. Willingness to RWDD and typical weekly drinking were both associated with increases in RWDD (odds ratio [OR] = 1.58 and 1.40, respectively), whereas intentions to use alternatives, sex, and ethnicity were not associated with RWDD. Only weekly drinking was associated with Decline, with an increase in drinking associated with increased Decline (OR = 1.48). All psychosocial variables were significantly associated with the decision-making variables except positive expectancies. Conclusions Results provide evidence that willingness to RWDD is a predictor of future RWDD, even if students intend to use safe alternatives. Future research is needed to better understand decision-making factors that influence Decline. Results also suggest prevention and interventions efforts, such as brief motivational intervention, Parent-Based Interventions, and normative feedback interventions could be adapted to reduce RWDD.

No abstract available Keywords: Acute-on-Chronic Liver Disease; Alpha 1 Antitrypsin Deficiency; Cirrhosis; Elevated Liver Enzymes.

OBJECTIVE: Elevated behavioral economic demand for alcohol has been shown to be associated with drinking and driving in college students. The present study sought to clarify the underlying mechanisms of this relationship by examining whether drinking-and-driving-related cognitions (e.g., attitudes, perceptions, and normative beliefs) mediate the association between alcohol demand and drinking and driving. METHOD: A total of 134 young adult social drinkers completed an alcohol purchase task and measures of perceived dangerousness of drinking and driving, normative beliefs about drinking and driving, and perceived driving limit (i.e., perceived number of drinks one could consume and still drive safely). The frequency of drinking and driving in the past year was assessed via self-report. RESULTS: Individuals who reported drinking and driving exhibited greater alcohol demand (intensity, Omax, and elasticity) compared with those who did not engage in drinking and driving. Increased demand was also correlated with more favorable drinking-and-driving cognitions. Indirect effects tests revealed that perceived driving limit partially mediated the relationship between alcohol demand and drinking-and-driving behavior, even after accounting for drinking level, sex, and delay discounting. CONCLUSIONS: These findings provide further support for the utility of behavioral economic theory in understanding drinking-and-driving behavior. In particular, they provide evidence for one mechanism-drinking-and-driving-related cognitions-by which alcohol demand influences drinking and driving. Additional research using longitudinal and experimental designs is required to confirm this model and to identify other potential mediators. Language: en

This paper describes the initial development of the Friendships and Social Skills Test (FASST), a clinically oriented 25-item parent report measure of child peer relationships and social skills in a community (N = 423) and clinical sample (N = 159) of elementary school age children. Confirmatory factor analyses supported five factors measuring pro-social skills, negative peer directed behavior, friendship interactions, peer victimization, and the level of concern expressed about a child’s social functioning. Internal consistency and test–retest reliability of the FASST factors predominately ranged from moderate to very good. Validity was supported through higher scores in at-risk and clinical groups compared to children in the community and through correlations with an existing measure of social skills and emotional and behavioral functioning. Cross-informant validity was supported by correlations with teacher-report. Moreover, the scales measuring negative social behaviors and pro-social skills predicted changes in peer victimization and concern expressed about the child over a 1-year duration. By assessing positive and negative aspects of peer-directed behaviors and relationships the FASST has the potential to facilitate the identification and treatment of childhood social deficits in mental health settings.

Gastrin exerts trophic effects on all cells of the gastric oxyntic mucosa including enterochromaffin-like (ECL) cells. Hypergastrinemia may result from hypoor achlorhydria due to chronic atrophic gastritis, from longterm drug-induced acid suppression or from gastrinoma occurring as part of the multiple endocrine neoplasia (MEN) 1 syndrome [1]. We describe here a man who developed an atypical, benign gastric carcinoid or neuroendocrine tumor (NET), after being treated with a proton pump inhibitor (PPI) for 20 years.