Aims: Forgiveness, a motivationally and volitionally unique method of coping, has been argued to be relevant to addiction and recovery. However, little empirical evidence exists in support thereof. Methods: As such, cross-sectional associations between dimensions of forgiveness (Fetzer) and drinking (AUDIT) were examined among college students (n = 721; ♀ = 516; Mage = 23) from the rural southern Appalachian region of the United States. Results: Using multiple regression analyses and independent of demographic variables and religiousness, while no forgiveness dimension was predictive of drinking in the first place (yesno), Feeling Forgiven by God predicted a decreased likelihood of problematic drinking (NonOK drinking vs. problematic drinking). Further, among problematic drinkers (n = 126; ♀ = 75; Mage = 22), Feeling Forgiven by God predicted fewer alcohol-related problems and Forgiveness of Self predicted lower HALT scores, all with medium effect sizes. Forgiveness of Others was not associated with the alcohol-related variables. Conclusions: Of the dimensions of forgiveness measured, it appears that Feeling Forgiven by God may be most important in the context of drinking and problems therewith, while Forgiveness of Self may be most important in the context of relapse prevention.

In recent years, the Russian Federation has seen a dramatic rise in morbidity and mortality from tuberculosis (TB), attributed in part to an increase in alcohol use disorders (AUDs), which are associated with worse TB treatment outcomes. This study describes the knowledge, attitudes and practices of physicians who treat TB patients in Tomsk, Russia. We conducted semistructured interviews with 16 TB physicians and 1 addiction specialist. Interviews were audiorecorded, transcribed, translated and systematically analyzed. We identified four key domains: Definitions of alcohol use and abuse and physicians' knowledge, attitudes and practices regarding these problems. Physicians described patients as largely precontemplative and reluctant to seek treatment. Physicians recognized their limited knowledge in diagnosing and treating AUDs but expressed interest in acquiring these skills. Few options are currently available for treatment of AUDs in TB patients in Tomsk. These findings suggest that Tomsk physicians are aware of the need to engage AUDs in TB patients but identify a knowledge gap that restricts their ability to do so. Training TB physicians to use simple screening instruments and deliver evidence-based alcohol interventions improves TB outcomes among patients with co-occurring AUDs.

The use of a designated driver (DD) is reportedly a successful and cost effective way to reduce the number of injuries resulting from driving under the influence of alcohol. Benefits of using a DD are that it promotes the social norm of drinking abstinence, legitimizes the non-drinking role, offers a specific and modest behavior change to avoid DUI, and encourages planning ahead in drinking situations. However, DD programs have been criticized by those who feel these programs ignore the negative implications of drinking as distinct from drinking anddriving, and may actually encourage excessive drinking among passengers. Furthermore, whether the DD actually abstains from alcohol has remained an empirical question. The current study examined the blood alcohol concentration (BAC) levels of male and female designated drivers and passengers of designated drivers leaving drinking establishments in a university town. A 2 (Male vs. Female) x 2 (DD vs. Non-DD) ANOVA indicated a main effect for gender, a main effect for driver type, and a significant interaction for gender and driver type. The interaction was due to a greater reduction in BACs for female than male DDs. The mean BAC for male DDs (n = 46) was .074, and the mean BAC for male non-DDs (n = 140) was .085. In contrast, the mean BAC for female DDs (n = 20) was .022, whereas the mean BAC for female non-DDs (n = 55) was .068. On average, vehicle passengers interviewed had BAC levels above the legal limit of .08 in Virginia. A direct relationship was found between the size of the social group and the probability of the group having a DD. More specifically, 79 % of groups (n = 69) with four or more drinkers had a DD, whereas only 57 % of groups (n = 184) with three or fewer drinkers had a DD. Implications for the future development of DD programs are also discussed. / Master of Science

Indiana University-Purdue University Indianapolis (IUPUI) / The medial prefrontal cortex (mPFC) is a cortical brain region involved in the evaluation and selection of motivationally relevant outcomes. mPFC-mediated cognitive functions are impaired following acute alcohol exposure. In rodent models, ethanol (EtOH) doses as low as 0.75 g/kg yield deficits in cognitive functions. These deficits following acute EtOH are thought to be mediated, at least in part, by decreases in mPFC firing rates. However, these data have been generated exclusively in anesthetized rodents. To eliminate the potentially confounding role of anesthesia on EtOH modulated mPFC activity, the present study investigated the effects of acute EtOH injections on mPFC neural activity in awake-behaving rodents. We utilized three groups: the first group received 2 saline injections during the recording. The second group received a saline injection followed 30 minutes later by a 1.0 g/kg EtOH injection. The last group received a saline injection followed 30 minutes later by a 2.0 g/kg EtOH injection. One week following the awake-behaving recording, an anesthetized recording was performed using one dose of saline followed 30 minutes later by one dose of 1.0 g/kg EtOH in order to replicate previous studies. Firing rates were normalized to a baseline period that occurred 5 minutes prior to each injection. A 5-minute time period 30 minutes following the injection was used to compare across groups. There were no significant differences across the awake-behaving saline-saline group, indicating no major effect on mPFC neural activity as a result of repeated injections. There was a significant main effect across treatment & behavioral groups in the saline-EtOH 1.0 g/kg group with reductions in the EtOH & Sleep condition. In the saline-EtOH 2.0 g/kg, mPFC neural activity was only reduced in lowered states of vigilance. This suggests that EtOH only causes gross changes on neural activity when the animal is not active and behaving. Ultimately this means that EtOH’s impact on decision making is not due to gross changes in mPFC neural activity and future work should investigate its mechanism.

PhD, Faculty of Health Sciences, University of the Witwatersrand / Substance use is associated with mining accidents, increased health care utilisation, and economic loss. Although South Africa is a major mining country, paucity of data exists on substance use among mineworkers. To determine the prevalence of alcohol and cannabis use among mineworkers, the prevalence of accidents associated with substance use, and factors influencing substance use among this population, structured interviews of 1571 participants (involving breathalyser tests for alcohol and urine tests for cannabis), focus group discussions, and a record review of post-accident substance tests were carried out in seven mines. While structured interviews were carried out between March & October 2002, focus group discussions were carried out between May & June 2003, and record review was done between March & September 2004. Between 10.7% to 24.4% of participants across study mines, with a mean of 15.3%, are likely to be dependent on alcohol, while 4.6% to 21.5% of participants, with a mean of 9.1%, use cannabis. Between 0% and 5.9% of all breath samples, with a mean of 1.9%, contained alcohol ≥ 0.10mg/1000ml of breath, the legal limit for professional drivers. However, the majority of positive samples were collected on a Monday and day of sample collection was found to be a confounding factor. In mine P1 in 2003, 1% of samples tested in cases of accidents were positive for alcohol, and in 2002 and 2003, cannabis tests were positive in 4.9% and 3.9% of accident cases tested, respectively. v Low levels of education (p=0.020), low job categories (p=0.004) and lack of awareness of link between cannabis use and accidents (p=0.0001) were found to be positively associated with cannabis use. Being a full-time worker compared to a contract worker (p=0.004) was protective from cannabis use. While being married (p=0.001) was protective from alcohol use, there was no significant difference in the alcohol and cannabis use status of those who were married and lived with their wives at the mines and those who didn‟t live with their wives but visited them periodically. Findings of this study where alcohol use for fun (p=0.046) and relaxation (p=0.018) were associated with alcohol dependence, and where misconceptions about the energy-boosting attribute of cannabis, and perception that work is „most-times to always dangerous‟ (p=0.012) were associated with cannabis use and alcohol dependence, suggest the use of substances as a coping mechanism and highlight the link between social factors and substance use. Industry regulations employing a holistic approach and incorporating essential components, such as clear written individual mine policy, health promotion, monitoring and surveillance, Employee Assistance Programmes, disciplinary procedures and wellness programmes, can contribute towards substance use control among this population.

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Introduction: Substance use disorders are often associated with widespread structural and functional abnormalities in the brain. The primary aim of this thesis was to reduce existing ambiguity and explore novel topics in the field of addictions neuroscience by conducting three human neuroimaging studies. Results: In the first study, individuals who used alcohol were found to have significant inverse associations between drinks in past week, frequency of heavy drinking, and cortical thickness in a majority of regions examined via MRI. These regions included the dorsolateral prefrontal cortex, the inferior frontal gyrus, and the precentral gyrus. In the second study, when we employed a novel MRI pulse sequence to examine intracortical myelin (ICM) in people with alcohol use disorder, we found that the alcohol use disorder group in fact had greater ICM signal than the control participants, leading us to hypothesize a potential inflammation response in the brain from the prolonged use of alcohol. Finally, in the third study, when we explored large-scale brain activity in a sample of people who use alcohol alone or in combination with other substances, we found that those who used three or more substances displayed the least amount of activation in the salience and temporal networks of the brain. A peculiar finding, however, was that dual users of alcohol and cannabis were found to have the most activation in these networks. Conclusions: Results demonstrate that, indeed, alcohol use is associated with structural and functional abnormalities in the brain. These studies have demonstrated cortical thinning and increased ICM signal in relation to alcohol use broadly. As well, this work has shown that polysubstance use is associated with alterations in various large-scale resting state brain networks. Future research should seek to conduct longitudinal work in order to clarify whether structural and functional brain abnormalities are a cause or a consequence of substance use. / Thesis / Doctor of Philosophy (PhD) / The aim of this thesis was to add to the existing literature surrounding neuroimaging in alcohol use disorder. First, we sought to expand the structural neuroimaging literature by conducting a study with a large sample size and examining the cortical thickness of a variety of brain regions in relation to characteristics of alcohol use. Second, we aimed to add to the structural neuroimaging literature again by examining a particular brain tissue in chronic alcohol users via a novel MRI pulse sequence. Finally, we sought to add to the functional neuroimaging literature by examining large-scale resting state brain networks in a sample of people who use alcohol alone or in combination with tobacco or other drugs (i.e., polysubstance users). Together, these studies have contributed new findings to the addictions neuroscience literature by revealing anatomical and functional brain correlates of alcohol and other substance misuse.

PURPOSE: Previous studies have established an association between pre-treatment drinking goals (abstinence vs. non-abstinence) and alcohol treatment outcome. The purpose of this study is to better understand that characteristics of individuals who choose abstinence compared to non-abstinence as a drinking goal prior to treatment. This study explores the characteristics as predictor variables of drinking goal choice prior to entering a Phase II research study in Boston, Massachusetts. METHODS: The participant population consisted ot individuals who called about entry into a Phase II alcohol dependence research study and completes a telephone screening questionnaire (n=608). Desired drinking goal was measured in the telephone screening form and categorized as either abstinence (n=206) or non-abstinence (n=308). Differences between the 2 goal groups were explored by univariate calculations. In the final stage of the analysis potential predictor variables were entered into a backwards elimination logistic regression model to determine significant relationships between predictor variables and drinking goal choice. RESULTS: A total of 206 (40.1%) participants selected abstinence and 308 (59.9%) selected non-abstinence as a pre-treatment drinking goal. In the univariate analysis, participants' selecting a goal of abstinence were significantly more likely to have had previous alcohol treatment (including rehabilitation, outpatient counseling, detoxification, and Alcoholics Anonymous), have had alcohol related seizures, were currently on probation or parole, had higher average of drinks per drinking day, and more heavy drinking days as compared to the non-abstinence group. In the logistic regression model the strongest predictors of a participant choosing a goal of abstinence are previous alcohol treatment, previous detoxification, current probation or parole, and absence of recreational drug use. CONCLUSIONS: Several predictor variables were found to be associated with an individual choosing a drinking goal of abstinence prior to entry into an alcohol research study. These results can be helpful for researchers conducting future clinical trials. Based on the strongest predictors, those variables can be used in stratification to prevent confounding in future research studies.

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