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Houseboat is the first part of a novel-in-progress set in the coastal town of Apollo, Maine during the Opioid Epidemic.

Edie Meidav convinced me to start a new project. Work on something longer, she suggested. Full of faith, she challenged me to write about what felt most urgent. I thought of Will—a main character who asks questions. My intention became to interrogate the mid-senior-year mindset of a high school student. Barely adults, on the cusp of making the most significant choices of their lives, feeling both that they have all the information they need and that the world is a farce to be retooled as desired, individuals at this age possess all the budding versions of the same neuroses people carry into their nineties. For my own trajectory as a young adult, this stage coincided with the adaptation of the internet. The world’s variety then became more accessible, much faster to find, and without limits. Taking authority and norms at face value seemed like one of the most ignorant things anyone could do. In the early days of the writing, I saw a major conflict developing in Will: not wanting to jump through the hoops laid out for him, but wanting the prizes—love, recognition, and friendship—found on the other side. Ultimately, I want to remind the reader of their ability to hold two conflicting ideas simultaneously, like the feeling that accompanies the death of someone close: in an instant, despite us all being equally human, all the prior needs of the deceased suddenly hold so much more significance, and all our personal prior needs seem suddenly selfish, worth nothing at all. To be transparent: you are reading work realized from elements of my own experiences to create composite characters and events I hope still ring true. Despite the loose strings to reality, I want to be clear: this is entirely a work of fiction.

Two approaches to smoking cessation were evaluated. One approach, the standard condition, utilized a nicotine fading procedure, group support, and an attendance contingent monetary contract. The other approach, the maintenance condition, utilized nicotine fading, group support, and a smoking-contingent monetary contract. The maintenance condition also received two additional post-cessation sessions and additional instructions for cessation. Both conditions significantly improved over the course of the study. The maintenance condition achieved significantly better outcome on the reported average cigarettes per day, cessation rates, and CO levels for the follow-up periods. The maintenance condition also had significantly lower SCN levels at the three month follow-up. The maintenance condition also had significantly lower diastolic and systolic blood pressure at the six month follow-up when compared to the standard condition. However, few other significant health differences emerged when smoking subjects were compared with reduced smoking or nonsmoking subjects for this study. The maintenance condition was shown to be more cost effective than the standard condition. The results were interpreted as indicating the promise of nicotine fading and behavioral contracting procedures. Limitations of the wide-scale application of these methods was noted, however. In particular, group smoking cessation projects reach limited subjects, successful projects still have only moderate success rates, and the wide-spread application of these methods would strain available resources. It is recommended that further research and clinical efforts continue with nicotine fading, behavioral contracting and rapid smoking cessation programs. In addition, efforts at applying behavioral contracting principles without therapeutic support was suggested. Finally, more research on the functional determinants of tobacco smoking was recommended. / Ph. D.

The major purpose of this study was to test the effectiveness of a relapse prevention program which was designed to help smokers anticipate and avoid relapse. To do this, twenty-three male and thirty-seven female smokers who volunteered for an experimental stop smoking clinic were randomly assigned to one of four treatments: (NF) a nicotine fading treatment in which smokers were required to gradually reduce the nicotine content of their brand prior to quitting; (ACS) an abbreviated American Cancer Society Stop Smoking Program; (NFACS) a treatment which combined the nicotine fading program with the American Cancer Society program; (NFRPT) a treatment which combined nicotine fading with a relapse prevention training program designed from the suggestions of Marlatt and Gordon (1978). A pre-test, post-test factorial design was used in which daily smoking rate, tar and nicotine levels, alveolar carbon monoxide levels, smoking topography measures, feelings of self-efficacy regarding quitting smoking, and attitude regarding health were assessed at baseline, end of treatment, 2-month follow-up, 3-month follow-up and 6-month follow-up. Contrary to expectations, the NFRPT group failed to exhibit superior outcome over controls on any dependent variable measuring smoking consumption. Further, the NFRPT group exhibited the poorest 6-month abstinence rate and had significantly higher 6-month daily smoking rates than the NF and ACS controls. As such, these findings fail to support the recent arguments of Marlatt and Gordon (1978) and others regarding the efficacy of relapse prevention training as a means of improving treatment outcome in smoking cessation programs. These results are also consistent with other recent studies which have failed to demonstrate the unique effectiveness of maintenance procedures. A secondary purpose of this study was to replicate the findings of Foxx and Brown (1979) and Prue, Krapfl, and Martin (1981) regarding the effectiveness of nicotine fading as an easy to administer, nonaversive smoking cessation treatment. As expected, the NF group exhibited significant decreases from baseline in daily cigarette rate and total nicotine intake at the 6-month follow-up. However, only moderate abstinence rates and carbon monoxide reductions were achieved. Compared to the data presented by Foxx and Brown (1979), the NF group of the present study achieved superior decreases in daily cigarette rate and tar and nicotine intake but poorer overall abstinence rates. Further, the present NF group did not exhibit superiority of the ACS control group. As such, these results are encouraging but only partially replicate the findings of Foxx and Brown (1979). / Ph. D.

Health behaviors, positive and negative, can support or reduce risk for multiple chronic diseases, such as substance use disorder and obesity. These diseases are marked by overconsuming commodities that offer predictable short-term benefits, and neglecting other behaviors with variable long-term benefits (e.g., fast food is enjoyable in the moment; exercise may have delayed benefits, but moment-to-moment may not be as reinforcing as fast food). An individual's valuation of these fast food or exercise may depend on how far out into the future these benefits are considered, their temporal window. The first study shows that the temporal window is constricted among high-risk substance users than people who do not have substance problems, especially when considering higher-value choices. The second study shows that the temporal window can change depending on the environment. Specifically, engaging with stories of job loss can constrict the temporal window. The third study shows that engaging with job loss can specifically constrict the temporal window and increase the value of fast food among obese individuals. The final study shows that a similar hardship scenario, natural disasters, can constrict the temporal window, increase demand for alcohol and cigarettes, and decrease the valuation of more temporally extended reinforcers (e.g., employment, savings, and seatbelt wearing) among smoking drinkers. Together, these studies support a model, reinforcer pathology; wherein the temporal window, which can differ both between individuals and environments, drives valuation of reinforcers that impact health. / Doctor of Philosophy / Health behaviors, positive and negative, can support or reduce risk for multiple chronic diseases, such as substance use disorder and obesity. These diseases are marked by overconsuming commodities that offer predictable short-term benefits, and neglecting other behaviors with variable long-term benefits (e.g., fast food is enjoyable in the moment; exercise may have delayed benefits, but moment-to-moment may not be as reinforcing as fast food). An individual’s valuation of these fast food or exercise may depend on how far out into the future these benefits are considered, their temporal window. The first study shows that the temporal window is constricted among high-risk substance users than people who do not have substance problems, especially when considering higher-value choices. The second study shows that the temporal window can change depending on the environment. Specifically, engaging with stories of job loss can constrict the temporal window. The third study shows that engaging with job loss can specifically constrict the temporal window and increase the value of fast food among obese individuals. The final study shows that a similar hardship scenario, natural disasters, can constrict the temporal window, increase demand for alcohol and cigarettes, and decrease the valuation of more temporally extended reinforcers (e.g., employment, savings, and seatbelt wearing) among smoking drinkers. Together, these studies support a model, reinforcer pathology; wherein the temporal window, which can differ both between individuals and environments, drives valuation of reinforcers that impact health.

No / We previously reported that music-assisted systematic desensitization can counter-condition substance-related cues and reduce the implicated craving responses, as well as improve cognitive and psychopathological components of substance addiction. This follow-up study investigated the therapeutic contribution of listening to recorded New Age relaxing music in counterconditioning external substance-conditioned cues, as well as in the amelioration of everyday life craving reactivity, craving beliefs and depression. Twenty-one substance addicted individuals participated in a three-week randomized controlled trial consisting of two therapeutic sessions per week. Participants were randomly assigned to one of the two study groups, systematic desensitization combined with listening to New Age relaxing music recorded in individual MP3 devices, and systematic desensitization without music. Measurements of craving in response to external substance-conditioned cues, craving beliefs, everyday craving reactivity and depression took place at baseline, post-treatment and one month after the end of treatment. No significant group differences in the outcome measures were observed between both arms of the study but within group and time results suggest that listening to New Age relaxing music significantly enhances systematic desensitization and accounts for significant reductions of craving responses to external substance-conditioned cues and of craving beliefs associated with compulsive behaviour in the music group. Our study provides the first evidence on the potential therapeutic contribution of music to cue counterconditioning in substance addiction treatment. Further investigation on the capacity of music to increase the effectiveness of systematic desensitization seems warranted.

Föreliggande studie har genom kvalitativ forskning med utgång i systemteorin syftat till att kartlägga den enskilda missbrukarens väg till missbruksbehandling. Tre semistrukturerade intervjuer har genomförts och sedermera analyserats. Missbrukare utgör en särskild kategori i socialtjänstlagen. Därtill står det att finna i lagrum 3 kap 1 § (SFS 2001:453) att socialtjänsten genom uppsökande verksamhet ska göra sig väl förtrogen med levnadsförhållandena i kommunen. Därtill även informera om socialtjänsten i kommunen och genom uppsökande verksamhet och på annat sätt främja förutsättningarna för goda levnadsförhållanden. Resultat har påvisat att det i första hand är missbrukarens anhöriga som stöttar dem till kontaktsökande vad gällande behandling. Studien har därtill även påvisat att missbrukaren i första hand inte vänt sig till socialtjänsten utan sökt sig till andra instanser. Respondenterna i studien har samtliga haft enskilda agendor vad gällande uppnådd drogfrihet. Vad som dock förefallit signifikant bland deltagarna har varit en strävan om bättre relationer med sin familj. Ytterligare en av studiens slutsatser är att socialtjänsten bör utöka sin informationsspridning till kommuninvånare om att missbruksbehandling finns att tillgå och hur hjälpen är utformad. / The present study has the qualitative research with the output of systems theory aimed to identify the individual abuser path to addiction treatment. Three semi-structured interviews have been conducted and subsequently analyzed. Addicts constitute a special category in the Social Services Act. In addition, it is to be found in the section of the law Chapter 3, 1 § (SFS 2001: 453) that the social outreach should make themselves familiar with the living conditions in the municipality. In addition, also provide information on social services in the municipality and through outreach activities and other means to promote conditions for good living conditions. Results have demonstrated that it is primarily the abuser's family members who support them to contact applicants as current treatment. The study has also revealed that although the addict in the first place not turned to social services, but turned to other instances. Respondents in the study all had individual agendas as applicable achieved abstinence. What, however, seemed significant among the participants has been a quest for better relationships with their family. Another of the study's conclusions is that social services should expand its dissemination of information to local residents about drug treatment are available and how the aid is designed.

Stress is associated with poor mental health, specifically anxiety and depression, and stress and mental health problems are predictors of substance dependence and relapse. Social characteristics, such as racial/ethnic minority status, female gender, and low socioeconomic status, are often associated with increased psychological distress and substance use disorders. Pearlin’s social stress theory postulates that this association is due to increased exposure to stress and subsequent experiences of distress related to social disadvantage and decreased access to resources for coping with stress. This project uses a social stress theoretical perspective to examine predictors of substance use after treatment entry and follow-up addiction severity in a large sample of Kentucky substance abuse treatment participants (N = 1123). A conceptual model is tested to determine if social characteristics along with psychological distress, perceived stress, and economic hardship are predictors of substance use and follow-up addiction severity. In addition, since recovery support, efficacy, and self-control have been previously identified as mediators in the stress and relapse processes these factors were included as mediators in the model tested. The conceptual model was tested with three outcome variables, substance use between baseline and 12-month follow-up, follow-up alcohol addiction severity, and follow-up drug addiction severity. Bivariate and multivariate analyses, including logistic regression and ordinary least squares regression, were used to test conceptual models with the full sample and also with a subsample with baseline substance use indicative of potential substance dependence. Findings indicated that significance of predictors varied depending on outcome variable, although recovery support, efficacy, and self-control were significant predictors of all three dependent variables. Findings for each outcome variable are discussed, as well as limitations of the present study, implications for social work practice, and implications for future research.