No description available.

No description available.

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.

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.

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.

Background: Poor inhibitory control is a hallmark of problem gambling (PG), which is characterised by frequent gambling and unsuccessful efforts to control/stop gambling. Stress and PG demonstrate a cyclical relationship, whereby gambling can act as a coping mechanism for dealing with stressful life events, while consistent gambling engagement can increase stress. To date, few studies examine acute stress effects on inhibitory control (IC) in this group. Purpose: This study compares acute stress effects on IC in PG and healthy control (HC) populations. Methods: Twenty participants with PG and twenty HCs completed self-report measures of mood disturbance (Profile of Mood States; POMS) and impulsivity (Barratt Impulsiveness Scale); saliva samples were collected to measure cortisol. The Trier Social Stress Test was administered to induce an acute stress response, followed by the Stop-Signal Task (SST), a validated measure of IC. Results: Subjective stress responses increased over time in both groups, with the PG group demonstrating significantly higher POMS ratings (p<.05), however, no differences in cortisol levels were observed between groups (p>.05). Moreover, no group differences were observed on the SST (p>.05). Exploratory correlations revealed significant positive and negative correlations between cortisol levels and ‘go’ reaction time and ‘stop’ signal reaction time on the SST, respectively (p<.05). Conclusion: This study is the first, to our knowledge, to directly examine acute psychosocial stress effects on IC in individuals with PG. Our findings show that while both groups display similar cortisol levels, individuals with PG report increased subjective stress relative to HCs. Despite no stress-induced impairments on SST performance, significant correlations were observed between task reaction time and cortisol levels in the PG group. This study helps to better inform clinical practice by providing a comprehensive understanding of the implications of stress and IC on gambling behaviours. / Thesis / Master of Health Sciences (MSc) / Problem gambling (PG) is characterised by problems with impulsivity and inhibitory control. Stress affects inhibitory control and appears heightened in PG, but few studies examine this relationship. This study examined acute stress effects on inhibitory control task performance, which may underlie the loss of control during gambling episodes that is often experienced by those with PG. Participants with PG and healthy controls (HCs) completed questionnaires relating to impulsivity and stress, and were exposed to an acute stressor and provided saliva samples to measure physiological stress (cortisol). Later participants completed a task examining reaction time as a measure of inhibitory control. Results showed that individuals with PG reported increased stress relative to HCs, despite having similar cortisol levels. While acute stress did not impair inhibitory control on the task, significant correlations were observed between task reaction time and cortisol levels, which suggests a strong relationship between inhibitory control and physiological stress response.

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.

The opioid epidemic is an issue that has ravaged much of the United States, and specifically Appalachia. Many different academic disciplines have attempted to provide a solution to no avail. This ethnographic study investigates the social nature of addiction & recovery related to problematic opiate use. Through semi-structured interviews and participant observation with clients at a drop-in mental health and addiction services center, the study explores the social conditions which facilitate problematic substance use in addition to vetted strategies to reach and maintain active recovery from opiate misuse. The conclusion focuses on how addiction and recovery are inherently social exercises that are heavily influenced by one's social network and the social contexts they live or have lived in. Using an anthropological perspective, this study shows the value that social science and an anthropological perspective in particular, can provide on such a pervasive and unsettling issue.