The Appalachian region faces wide scale drug use and opioid addiction that exceeds the national average, and the crisis needs more attention in order to properly address the epidemic. Many previous studies have documented the problems Appalachian residents face regarding opioid addiction and other diseases of despair. However, this study focuses on two specific contributing causes of the opioid crisis: a lack of access to medical care and over-prescription of opioids. Additionally, while the problems of substance abuse, particularly opioid abuse, are well represented in media accounts, there is an under-representation of drug recovery and the positive aspects of the fight against drug abuse in media. Pervading stereotypes and a focus on the negative aspects of the crisis within the media continue to uphold and prolong the image of an unsurmountable problem that is no closer to being solved than when preventive efforts were first initiated. This study seeks to examine what factors contribute to opioid use in the Appalachian region, with a specific focus on lack of healthcare, over-prescription and media misrepresentation.

In this exploratory study, 35 male professionals who had successfully completed residential sex addiction treatment were surveyed. Respondents’ median age was 47.5, and reported ethnicities were White (89%), Asian, (9%) and Hispanic (2%). Prior to intake, 17 respondents had reportedly violated sexual boundaries with patients, clients, or staff (BV group) and 18 reportedly had not (NBV group). Respondents completed a demographic information form and two validated instruments: (a) Sexual Symptom Assessment Scale (S-SAS), measuring symptom severity of Compulsive Sexual Behavior (CSB); and (b) Boundary Violation Index (BVI), assessing frequency of risk factors for Sexual Boundary Violation (SBV). Respondents reported a very large decrease in CSB symptom severity over time (partial 2 = .856), change that was statistically equal for respondents in the BV and NBV groups. Furthermore, respondents reported a large decrease in SBV risk over time (partial 2 = .620); however, the BV group reported a greater decrease in SBV risk than the NBV group (partial 2 = .221). Reductions in both CSB symptoms and SBV risk were stable over time, up to five years post discharge. CSB symptoms and SBV risk were not correlated at retrospective pre-treatment, but for practical purposes, were moderately correlated at post treatment (r = 0.386, n = 25, p = 0.057). Although not significant, correlation at pre-treatment was more than twice as strong for the BV group than for the NBV group. Days of Treatment was a meaningful, although non-significant, contributor to decreases in CSB symptom severity (? = -.323). Similarly, Days of Treatment (? = -.785), Counseling (? = -.303), Recovery Support (? = -.292), and Continuing Education (? = -.259) were meaningful, although non-significant, contributors to decrease in SBV risk. At study participation, 77.1% of respondents had reportedly retained their professional licenses, although 15.4% reported having received a new licensing board complaint. Clinical and professional implications, limitations, and areas for future research are discussed.

The word addiction is almost immediately associated with notions of drug dependency and alcoholism, and drug addiction is often referred to as a pandemic that affects individuals, families, communities and society at large. Aetiological approaches to understanding and treating addiction have changed dramatically throughout history, and currently the most contemporary approach is that of the disease model which views addiction as an illness rather than as a ‘badness’. While the underpinnings of Narcotics Anonymous’ 12 step philosophy employs non-specific drug language as it views all drugs as having the capacity to become addictive, and while it does not distinguish between the capacity for substances and certain behaviours to become addictive, activities such as overeating, having sex and gambling are yet to be classified as legitimate addictions by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). As a result, it appears as if some confusion exists as to whether these behaviours should be classified as impulse control disorders or as genuine addictions due to the various similarities they share in common with substance based disorders. The research conducted explored how people recovering from addiction, as well as how people working with addiction understand addiction and multiple dependency, together with the factors that contribute to relapse and the ability to abstain. Various 12 Step meetings from a variety of 12 Step Fellowships were attended and members were invited to participate in the study. Ultimately seventy eight participants completed a self developed questionnaire which was utilised to assess how people recovering from addiction understood addiction and multiple dependency and the factors that contribute to relapse and the ability to abstain. Quantitative data were analysed via descriptive and inferential statistics. Furthermore twenty participants working with addiction were interviewed with the use of a semi structured interview schedule in order to explore their perceptions around addiction and the factors that contribute to relapse and sobriety. Qualitative data were analysed using thematic content analysis. Results indicated that the majority of recovering addicts and professionals working with addiction understand addiction as a disease. However, discrepancy was apparent with regards to whether or not all recovering addicts have the same disease and subsequently whether all addictions can be treated in the same manner. The above result suggested that there was no standardised, uniform way in which the disease model is understood and interpreted. Factors such as cross addiction, resistance to change and issues relating to the maintenance of change were identified as issues that contribute to relapse, while factors such as aftercare, following the 12 step programme and support were identified as the main aspects that contribute to sobriety. No statistical significance was noted between participants who had relapsed as opposed to those who had not for variables of sensation seeking, impulsivity and perceived stress (which may have been as a result of small sample size). Deeper understanding of the disease model together with broader application of it, and a focus on appropriate training and more comprehensive assessment could perhaps see a reduction in high rates of relapse and recidivism more commonly known as the ‘revolving door syndrome’.

Individuals and societies have long struggled to understand and confront, by constructive means, the nemesis of addiction. No other human ill has provoked more concern, accounted for more suffering, or elicited greater consequence than addiction in all its diverse forms. Although alcoholism and drug abuse symbolize the traditional essence of addiction; compulsive sexuality, pathological gambling, eating disorders, tobacco use, etc., are also believed to have addictive properties according to contemporary concepts. Numerous commendable theories and therapies have been offered down through history to explain and mediate addictions conceptually enigmatic and therapeutically resistant nature. As this paper will clarify, many of these time-honored conceptions and resultant treatments of addiction have been inclined to proceed from a particular philosophical perspective known as abstractionism. The first purpose of this dissertation, therefore, is to explore and analyze the influence of abstractionist ideologies in addiction theory and therapy. Further on, this paper will suggest an alternate theory of addiction that derives its meaning and significance from a philosophical basis known as relationality. A relational perspective of addiction theory and treatment will be proposed along with a number of therapeutic suggestions.

This inspiring resource presents theories, findings, and interventions from Positive Suicidology, an emerging strengths-based approach to suicide prevention. Its synthesis of positive psychology and suicidology theories offers a science-based framework for promoting wellbeing to complement or, if appropriate, replace traditional deficit-driven theories and therapies used in reducing suicidal thoughts and behaviors. Coverage reviews interpersonal, intrapersonal, and societal risk factors for suicide, and identifies protective factors, such as hope and resilience, that can be enhanced in therapy. From there, chapters detail a palette of approaches and applications of Positive Suicidology, from the powerful motivating forces described in Self-Determination Theory to meaning-building physical and social activities. Among the topics covered: Future-oriented constructs and their role in suicidal ideation and enactment. Gratitude as a protective factor for suicidal ideation and behavior: theory and evidence. Considering race and ethnicity in the use of positive psychological approaches to suicide. The Six R’s framework as mindfulness for suicide prevention. Community-based participatory research and empowerment for suicide prevention. Applied resiliency and suicide prevention: a strengths-based, risk-reduction framework. Psychotherapists, counselors, social workers, psychiatrists, and health psychologists, as well as educators, clergy and healthcare professionals, will find A Positive Psychological Approach to Suicide an invaluable source of contemporary evidence-based strategies for their prevention and intervention efforts with suicidal clients. / https://dc.etsu.edu/etsu_books/1213/thumbnail.jpg

Background and Objectives: Opioid addiction is a major contributor to the global burden of disease and carries a significant risk of morbidity and mortality. Individuals with opioid addiction are subject to numerous adverse consequences including infectious diseases, medical complications, psychiatric disorders, and social disintegration. Women especially experience a heightened vulnerability to the adverse medical and social consequences of opioid addiction as a result of biological sex characteristics and socially-defined gender roles, which increases their risk for poor treatment outcomes. The general objective of this thesis if to investigate sex and gender differences in the management and treatment of opioid addiction with a focus on hormonal influences, genetic variation, and sociobehavioral characteristics including substance use behavior, health status, and social functioning. Methods: Using various methodologies, we compared the biological and social characteristics of men and women with opioid addiction in the context of methadone treatment. We assessed sex and gender differences in methadone treatment outcomes using a systematic review of the literature and a meta-analysis, which was developed based on published protocol. Next, we used data from the multi-centre GENOA cross-sectional study including 250 patients with opioid addiction recruited from Ontario methadone clinics to measure testosterone levels among men and women compared to non-opioid using controls; total serum testosterone was assayed using ELISA and RIA techniques. Following this study, we conducted a systematic review and meta-analysis to test the effect of opioid use on testosterone levels, performing subgroup analyses by sex and type of opioid used. Using the previous GENOA sample, we then completed genotype analysis on variants of BDNF and DRD2 genes to test the genetic effect on continued opioid use, measured through urine drug screening. Finally, we recruited an additional 503 participants meeting criteria for opioid use disorder who were receiving treatment with methadone, from which we obtained information on drug use patterns and addiction severity using the Maudsley Addiction Profile (MAP) tool to evaluate sex and gender differences. Results: In our initial systematic review, we found 20 studies collectively showing that women were less likely than men to report alcohol use, employment, or legal involvement, but were more likely to misuse amphetamines. Using the GENOA dataset of methadone patients, we found a significant reduction in testosterone level among men but not women, which was associated with methadone dose. We also determined that testosterone did not fluctuate significantly between menstrual cycle phases. In line with these findings, our systematic review showed a significant suppression in mean testosterone level among men that use opioids compared to controls, but not in women. Our results also showed that methadone did not affect testosterone differently than other opioids. Among GENOA participants, BDNF rs6265 and DRD2 rs1799978 genetic variants were not significantly associated with continued opioid use while in methadone maintenance treatment. Our final study identified sex and gender differences in substance use, health status, and social functioning. Women were younger, had children, were current smokers, had higher rates of benzodiazepine use, more frequent physical and psychological health problems, family history of psychiatric disorders, more partner conflict, and began regular use of opioids through a physician prescription. In comparison, men were more likely to be employed and to report cannabis and amphetamine use. Conclusions: This thesis has demonstrated that men and women are differentially affected by opioid addiction and experience sex- and gender-specific challenges throughout the course of methadone treatment that are likely to impact treatment outcomes. The identification of clinically-relevant sex and gender differences is important to our understanding of the addiction profile, and can therefore be used to promote strategies for effective treatment and management of opioid addiction among men and women incorporating both biological and social perspectives. / Thesis / Doctor of Philosophy (PhD)

Many varieties of consumption are often mischaracterized as “addictive,” such as social media use, chocolate consumption, shopping, and viewing pornography, even though considerable evidence indicates that they are not intrinsically addictive. This research examines whether labeling everyday products and activities as “addictive,” a common occurrence in modern media, popular culture, and marketing, can actually influence consumption. Given the consistent use of warning-based interventions related to established addictions (e.g., cigarettes, drugs, gambling), there exists an implicit assumption that warning consumers about the addictiveness of freely available products and generally socially acceptable activities will reduce the behavior. However, the potentially negative consequences of labeling non-addictive behaviors as addictive remain unclear. It was predicted and found that explicitly framing everyday consumption behavior as being addictive reduces consumers’ perceived control over the focal behavior resulting in increased consumption. Specifically, across twelve studies, consumers led to believe that consumption activities including eating chocolate and granola, shopping, using social media, and viewing pornography are addictive increases that behavior due to a decrease in perceived control. The effect of the addictive frame was not found to occur for purely virtuous and arguably less desirable and enjoyable foods (e.g., peas). Further, the effect does not spillover to other similar foods (e.g., M&Ms versus Skittles), meaning the effect is not simply a result of inducing a general lack of perceived control over all activities. Finally, boosting control by reminding consumers of situations where they had control over their own food consumption attenuated the effect of existing addictive beliefs. Alternative explanations such as the influence of a diminished sense of personal responsibility (via guilt), the forbidden fruit effect (via desire and excitement), affect regulation, and descriptive social norms were also tested and ruled out. This research has implications for how these behaviors are portrayed in marketing communications, the media, and public policy, and can be used to develop more effective interventions for at-risk consumers. / 2019-06-06T00:00:00Z

Addiction and its staggering impact on today’s society is well established in literature. The existence of co-occuring addictions has been well documented by various researchers. Researchers found that the presence of co-occurring addictions in alcoholics predicted relapse and readmission to treatment for alcohol dependence, reinforcing the need to study the problems created by co-occuring addictions. In college students, there appears to be a clear tendency for addictions to occur together, with alcohol and high risk sexual behavior appearing to co-exist in this population. Today’s college students are deemed as technology savvy students; therefore, the Internet serves as a primary medium for their communication which means more time spent online. The Internet has been known for its sexual saturation, and today college students constantly use the computer, thus being exposed to this saturation. Current research found that students are online more often and are beginning to engage in online sexual behavior. Researchers found a tendency for college students to engage in cybersex related activity ranging from chatting to masturbation and even the development of offline relationships. The primary purpose of this study was to determine the prevalence of cybersex and alcohol addiction in a sample of college students. In order to investigate the statement of the problem, several research questions existed for this study. This study examined prevalence rates of alcohol and cybersex addiction in this sample of college students and determined if a relationship existed between alcohol and cybersex addiction. The results of the research suggested that in this sample of college students, minimal participants met criterion for cybersex addiction and alcohol addiction. Findings show that these behaviors seemed to exist at some level in this sample of college students with 7.6% of the sample reporting that they felt that their online sexual behavior is out of control. This research demonstrated a more significant existence of alcohol abuse with 40% of the sample meeting criterion for alcohol abuse which validated that alcohol continues to be a prevalent problem with college students as previously determined by the existing research in the literature review.

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Cognitive behavior theory indicates that situational determinants may have a substantial impact on substance use and relapse into use. The present study described situational use of marijuana in dependent individuals, analyzed relationships among various constructs in existing theory, determined their effects on treatment outcomes, and explored interactions with self-efficacy. Results were generally consistent with hypotheses. Use in negative affective situations was independently associated with psychological distress, maladaptive coping strategies, and poorer outcomes post-treatment. Additionally, negative affective use interacted with self-efficacy for psychologically distressing situations to produce differential outcomes. This study adds to the existing literature on situational marijuana use by establishing relationships with motives for use and lending support to the cognitive behavioral theory model. / Master of Science