Alcohol use disorders (AUDs) among tuberculosis (TB) patients are associated with nonadherence and poor treatment outcomes. We developed a multidisciplinary model to manage AUDs among TB patients in Tomsk, Russia. First, we assessed current standards of care through stakeholder meetings and ethnographic work. The Alcohol Use Disorders Identification Test (AUDIT) was incorporated into routine assessment of all patients starting TB treatment. We established treatment algorithms based on AUDIT scores. We then hired specialists and addressed licensing requirements to provide on-site addictions care. Our experience offers a successful model in the management of co-occurring AUDs among patients with chronic medical problems.

This research project is intended to assist with the identification of relapse factors for alcoholics who have relapsed after their twelve‑step program. It is beneficial to understand relapse factors for alcoholics in order to provide effective treatment plans, services, and goals that will assist in attaining sobriety from alcohol. The research study used a qualitative approach; the data was collected through interviews from participants at the Cedar House agency in Bloomington, CA. The data was collected and then analyzed for possible themes of relapse factors. Themes that developed from interviews conducted with alcoholics that had relapsed after their twelve‑step programs were: commitment to therapy, unemployment, availability of healthy support, shame and guilt in seeking support, loneliness, and lack of support from family/peers and community. There are limitations to this study which, include a small sample size and interviews were held at only one agency that incorporated the twelve‑step process. Future studies should be implemented to confirm the results of this study.

abstract: Alcohol use disorders and internalizing disorders are highly comorbid in adults, but how this comorbidity unfolds over development is not well understood. Previous retrospective studies in adults have shown that internalizing problems are associated with a rapid transition from first drink and first regular drinking to the onset of alcohol dependence. Some results also suggest that internalizing is a stronger predictor of rapid transitions through later stages of alcohol involvement, but these stage-specific effects have not been explicitly tested. The present study utilized a prospective dataset to investigate effects of adolescent internalizing symptoms on speed of transition through multiple stages of alcohol involvement. Specifically, it was hypothesized that greater early internalizing symptoms would predict a later age of first drink, a slower transition from first drink to first binge, and a faster transition from first binge to first dependence symptom. The moderating effects of gender were also examined. Data were from a longitudinal study of children of alcoholics and matched controls (n = 454) followed from late childhood to mid-life. Linear regression and Cox regression were the primary analytic strategies. Covariates were externalizing symptoms, family history of alcohol use disorders, and gender. Analyses also controlled for age at which the participant entered each interval. Generally, stage-specific hypotheses concerning the effects of internalizing were not supported. Internalizing symptoms marginally predicted an earlier age of first drink and a faster transition from first binge to first dependence symptom, and significantly predicted a faster transition through the overall interval from first drink to first dependence symptom. Internalizing was a stronger predictor of rapid transitions for women, and the effects of internalizing were not specific to early or later stages of alcohol involvement among women. These results suggest that early internalizing problems are a general risk factor for a rapid transition through all stages of alcohol involvement, and this risk may be stronger for women than for men. These results have important implications for our theoretical understanding of the relationship between internalizing problems and alcohol use disorders as well as prevention and intervention efforts targeting these problems. / Dissertation/Thesis / Masters Thesis Psychology 2014

This secondary analysis describes the additional psychological symptoms experienced by women in substance abuse treatment who have an alcohol use disorder (AUD) in addition to a drug use disorder (DUD). Results show high levels of certain patterns of psychological symptoms, which include Paranoid Ideation, Phobic Anxiety, Anxiety, and Psychoticism, on the Brief Symptom Inventory (BSI) subscales. Also, age had an adverse effect, with Depression and Psychoticism scores higher with increasing age. Nurse practitioners are ideally situated to assess and screen for patterns of co-occurring psychological symptoms in women with an AUD, which can complicate treatment and lead to practice implications.

Background: While the integration of alcohol screening, treatment, and referral in primary care and other medical settings in the U.S. and worldwide has been recognized as a key health care priority, it is not routinely done. In spite of the high co-occurrence and excess mortality associated with alcohol use disorders (AUDs) among individuals with tuberculosis (TB), there are no studies evaluating effectiveness of integrating alcohol care into routine treatment for this disorder. Methods: We designed and implemented a randomized controlled trial (RCT) to determine the effectiveness of integrating pharmacotherapy and behavioral treatments for AUDs into routine medical care for TB in the Tomsk Oblast Tuberculosis Service (TOTBS) in Tomsk, Russia. Eligible patients are diagnosed with alcohol abuse or dependence, are newly diagnosed with TB, and initiating treatment in the TOTBS with Directly Observed Therapy-Short Course (DOTS) for TB. Utilizing a factorial design, the Integrated Management of Physician-delivered Alcohol Care for Tuberculosis Patients (IMPACT) study randomizes eligible patients who sign informed consent into 1 of 4 study arms: (1) Oral Naltrexone + Brief Behavioral Compliance Enhancement Therapy (BBCET) + treatment as usual (TAU), (2) Brief Counseling Intervention (BCI) + TAU, (3) Naltrexone + BBCET + BCI + TAU, or (4) TAU alone. Results: Utilizing an iterative, collaborative approach, a multi-disciplinary U.S. and Russian team has implemented a model of alcohol management that is culturally appropriate to the patient and TB physician community in Russia. Implementation to date has achieved the integration of routine alcohol screening into TB care in Tomsk; an ethnographic assessment of knowledge, attitudes, and practices of AUD management among TB physicians in Tomsk; translation and cultural adaptation of the BCI to Russia and the TB setting; and training and certification of TB physicians to deliver oral naltrexone and brief counseling interventions for alcohol abuse and dependence as part of routine TB care. The study is successfully enrolling eligible subjects in the RCT to evaluate the relationship of integrating effective pharmacotherapy and brief behavioral intervention on TB and alcohol outcomes, as well as reduction in HIV risk behaviors. Conclusions: The IMPACT study utilizes an innovative approach to adapt 2 effective therapies for treatment of alcohol use disorders to the TB clinical services setting in the Tomsk Oblast, Siberia, Russia, and to train TB physicians to deliver state of the art alcohol pharmacotherapy and behavioral treatments as an integrated part of routine TB care. The proposed treatment strategy could be applied elsewhere in Russia and in other settings where TB control is jeopardized by AUDs. If demonstrated to be effective, this model of integrating alcohol interventions into routine TB care has the potential for expanded applicability to other chronic co-occurring infectious and other medical conditions seen in medical care settings.

Previous research has suggested that forgiveness of self and forgiveness of others might function differently over the course of addiction recovery. However, we know little about the longitudinal process of these dimensions of forgiveness for individuals addressing alcohol-use disorders. Increased knowledge would inform the content and sequencing of intervention strategies. Three-hundred and sixty four individuals managing alcohol dependence participated in a 30-month longitudinal study, reporting their capacity to forgive self and to forgive others every 6 months. Findings indicated that (a) participants were more forgiving of others than themselves; (b) both types of forgiveness increased over time; (c) forgiveness of self increased more rapidly than forgiveness of others; and (d) while increases in both types of forgiveness predicted increases in the other type, the effect of forgiveness of others on forgiveness of self was twice as strong as the reverse effect. Implications for facilitating forgiveness in treatment are discussed.

Extending prior alcohol expectancy measurement research, this researcher (McMurray, 2013) recently developed the Pharmacological and Social Alcohol Expectancy Scale (PSAES). The PSAES is the only alcohol expectancy measure to date that provides adequate coverage of both social expectancies and the anticipated positive pharmacological effects resulting from alcohol consumption, and was developed and validated in a sample of young adults (aged 18-23). Research has shown that adolescents at high risk for alcohol use disorder (AUD) hold higher expectations of reward from alcohol, suggesting that expectancy patterns may help distinguish at-risk youth. Building upon the previous PSAES validation study, the primary purpose of the current study was to examine whether a version of the PSAES adapted for adolescents (the PSAES-A) provided a valid measure of pharmacological and social alcohol expectancies in adolescents. Results demonstrated that a respecified model of the PSAES-A adequately fit the proposed two-dimensional factor structure and provided justification for the items representing two distinguishable domains: social and pharmacological. The PSAES-A was then used to 1) examine patterns of alcohol expectancies and drinking behaviors in adolescents and 2) investigate whether risk (e.g., sensation seeking personality) was differentially associated with pharmacological and social expectancies in adolescents. Results indicated that pharmacological and social expectancies were differentially associated with various drinking behaviors (e.g., quantity, frequency) and that sensation seeking was significantly associated with both social and pharmacological expectancies in adolescents. The fact that alcohol expectancies differentially predicted quantity and frequency of drinking suggests that different expectancy processes affect adolescent’s decisions about how often they drink versus how much alcohol they consume on a given occasion. Implications and limitations are discussed.

No description available.

IMPACT (Integrated Management of Physician-Delivered Alcohol Care for Tuberculosis patients) is a randomized, controlled effectiveness trial based in Tomsk, Russia, that assesses the effect of oral naltrexone and brief behavioral counseling on tuberculosis outcomes and alcohol use in 200 patients. Tuberculosis physicians without addiction experience delivered interventions as part of routine care over a 6-month period, focusing on alcohol intake reduction to support successful tuberculosis treatment. We describe design, training, and fidelity monitoring using a Russian and American team of physicians, bilingual coders, and supervisors. Culturally appropriate adaptations, limitations, and implications for future trials are discussed. The clinical trial identification number is NCT00675961. Funding came from the National Institutes of Health and National Institute on Drug Abuse.

IMPACT (Integrated Management of Physician-Delivered Alcohol Care for Tuberculosis patients) is a randomized, controlled effectiveness trial based in Tomsk, Russia, that assesses the effect of oral naltrexone and brief behavioral counseling on tuberculosis outcomes and alcohol use in 200 patients. Tuberculosis physicians without addiction experience delivered interventions as part of routine care over a 6-month period, focusing on alcohol intake reduction to support successful tuberculosis treatment. We describe design, training, and fidelity monitoring using a Russian and American team of physicians, bilingual coders, and supervisors. Culturally appropriate adaptations, limitations, and implications for future trials are discussed. The clinical trial identification number is NCT00675961. Funding came from the National Institutes of Health and National Institute on Drug Abuse.