Indiana University-Purdue University Indianapolis (IUPUI) / Heavy alcohol consumption and opioid overdose rates continue to increase in the United States (U.S.). Social workers provide approximately 70% of the behavioral healthcare in the U.S. Medication-assisted treatment (MAT) combines FDA-approved medications with psychosocial interventions to provide a comprehensive approach to recovery for alcohol use disorder (AUD) and opioid use disorder (OUD). However, stigmatized attitudes toward individuals with AUD, OUD, and MAT limit MAT’s use. Guided by critical social theory, this study explores factors that predict master’s-level social workers’ (MSWs) attitudes toward AUD and OUD and, by extension, factors that predict their acceptance of MAT. A repeated measures analysis of variance (ANOVA) identified MSWs from Indiana, Kentucky, and Ohio (N = 140) having more favorable statistically significant (p < 0.001) attitudes toward individuals with AUD than those with OUD. Multiple regression models used age, gender identity, political ideology, years working in addiction (tenure), social work licensure, and 12-step facilitation beliefs to predict AUD and OUD attitudes, with AUD and OUD attitudes included in the regression models for MAT acceptance. Increased years working in addiction (tenure) was a statistically significant predictor in elevating attitudes toward individuals with AUD (p < 0.05) and OUD (p < 0.01). A more liberal political ideology (p < 0.001), increased years working in addiction (tenure) (p < 0.05), and more favorable attitudes toward individuals with AUD and OUD (p < 0.001) were statistically significant predictors in MAT acceptance. These results warrant increasing MSWs’ education on addiction and research on factors that impact their acceptance of MAT. Increasing MSWs’ education on addiction may lower stigmatized attitudes toward individuals with AUD and OUD and increase MAT acceptance. MSWs’ increased acceptance of MAT could improve patient health outcomes.

No description available.

Experiencing maltreatment during childhood has been implicated in numerous and diverse developmental impairments, including problematic alcohol use and alcohol use disorders. However, little research examines the processes by which childhood maltreatment confers risk for alcohol use problems, or potential risk or protective factors in the emergence of problematic alcohol use among individuals experiencing childhood maltreatment. To address this gap, the current study investigated executive cognitive functions and emotion regulation as probable risk or protective factors linking childhood maltreatment and subsequent problematic alcohol use, given that deficits in both executive cognitive functions and emotion regulation are associated with maltreatment and problematic alcohol use. Participants were drawn from a longitudinal sample of children at both high and low risk for substance dependence, based on their paternal history of psychiatric or substance use disorder (N = 475; 70% male; 74% Caucasian, 23% African American, 3% multiracial; M = 11.38±.93 years at Time 1). Analyses involved both person- and variable-centered approaches. The person-centered approach identified groups of individuals based on maltreatment experiences, executive cognitive functions, and emotion regulation, and then examined whether and to what extent these classes differed on concurrent and longitudinal problematic alcohol use. Findings suggested that there are distinct risk groups consisting of abuse/neglect, neglect only, executive control function deficits, and emotion regulation deficits. These groups did not differ on levels of alcohol use, counter to prediction. Variable-centered approaches involved a longitudinal examination of pathways from childhood maltreatment to alcohol use frequency and symptoms of alcohol use disorder that included executive cognitive functioning and emotion regulation. Results of these variable-centered structural equation modeling analyses indicated that maltreatment, executive control function, and emotion regulation concurrently predicted problematic alcohol use. Investigating the current models allows for a better understanding of pathways to alcohol use in both adolescence and adulthood, which has implications for prevention and intervention, particularly in identifying groups at highest risk for problematic alcohol use outcomes and in treatment selection or modification. / Psychology

Alcohol use disorder (AUD) remains a major public health concern globally with substantially increased mortality and a significant economic burden. The low rates of treatment and the high rates of relapse mean that excessive alcohol consumption detrimentally affects many aspects of the user's life and the lives of those around them. One reason for the low efficacy of treatments for AUD could be an unclear understanding of the neural correlates of the disease. As such, the studies in this dissertation aim at elucidating the neural mechanisms undergirding AUD, which could lead to more efficacious treatment and rehabilitation strategies. The propensity for impulsive decision making (choosing smaller, sooner rewards over larger, later ones) also known as delay discounting (DD), is an established risk-factor for a variety of substance abuse disorders, including AUD. Brain mapping of DD routinely uses modalities such as blood-oxygenation-level-dependent functional magnetic resonance imaging (BOLD fMRI). However, the extent to which these brain activation maps reflect the characteristics of impulsive behavior has not been directly studied. To examine this, we used multi-voxel pattern analysis (MVPA) methods such as multivariate classification using Support Vector Machine (SVM) algorithms and trained accurate classifiers of high vs. low impulsivity with individual fMRI brain maps. Our results demonstrate that brain regions in the prefrontal cortex encode neuroeconomic decision making characterizing DD behavior and help classify individuals with low impulsivity from individuals with high impulsivity. Individuals suffering from addictive afflictions such as AUD are often unable to plan for the future and are trapped in a narrow temporal window, resulting in short-term, impulsive decision making. Episodic future thinking (EFT) or the ability to project oneself into the future and pre-experience an event, is a rapidly growing area of addiction research and individuals suffering from addictive disorders are often poor at it. However, it has been shown across healthy individuals and disease populations (addiction, obesity) that practicing EFT reduces impulsive decision making. We provided real-time fMRI neurofeedback to alcohol users while they performed EFT inside the MR scanner to aid them in successfully modulating their thoughts between the present and the future. After the scanning session, participants made more restrained choices when performing a behavioral task outside the scanner, demonstrating an improvement in impulsivity. These two neuroimaging studies interrogate the brain mechanisms of delay discounting and episodic future thinking in alcohol use disorder. Successful classification of impulsive behavior as demonstrated in the first study could lead to accurate prediction of treatment outcomes in AUD. The second study suggests that rtfMRI provides direct access to brain mechanisms regulating EFT and highlights its potential as an intervention for impulsivity in the context of AUD. The work in this dissertation thus investigates important cognitive process for the treatment of alcohol use disorder that could pave the way for novel therapeutic interventions not only for AUD, but also for a wide spectrum of other addictive disorders. / Doctor of Philosophy / Alcohol use disorder (AUD) remains a major public health concern globally with substantially increased mortality and a significant economic burden. The low rates of treatment and the high rates of relapse mean that excessive alcohol consumption detrimentally affects many aspects of the user’s life and the lives of those around them. One reason for the low efficacy of treatments for AUD could be an unclear understanding of the brain regions affected by it. As such, the studies in this dissertation aim at elucidating the neural mechanisms undergirding AUD, which could lead to more efficacious treatment and rehabilitation strategies. The propensity for impulsive decision making (choosing smaller, sooner rewards over larger, later ones) also known as delay discounting (DD), is an established risk-factor for a variety of substance abuse disorders, including AUD. Brain mapping of DD routinely uses modalities such as blood-oxygenation-level-dependent functional magnetic resonance imaging (BOLD fMRI). However, the extent to which these brain activation maps reflect the characteristics of impulsive behavior has not been directly studied. To examine this, we searched for highly reproducible spatial patterns of brain activation that differ across experimental conditions (multi-voxel pattern analysis) and trained accurate classifiers of high vs. low impulsivity with individual fMRI brain maps. Our results demonstrate that brain regions in the prefrontal cortex encode neuroeconomic decision making and help classify individuals with low impulsivity from individuals with high impulsivity. Individuals suffering from addictive afflictions such as AUD are often unable to plan for the future and are trapped in a narrow temporal window, resulting in short-term, impulsive decision making. Episodic future thinking (EFT) or the ability to project oneself into the future and pre-experience an event, is a rapidly growing area of addiction research. However, it has been shown across healthy individuals and disease populations (addiction, obesity) that practicing EFT reduces impulsive decision making. We provided v real-time fMRI neurofeedback to alcohol users while they performed EFT inside the MR scanner to aid them in successfully modulating their thoughts between the present and the future. After the scanning session, participants made more restrained choices when performing a behavioral task outside the scanner, demonstrating an improvement in impulsivity. These two neuroimaging studies interrogate the brain mechanisms of delay discounting and episodic future thinking in alcohol use disorder. Successful classification of impulsive behavior as demonstrated in the first study could lead to accurate prediction of treatment outcomes in AUD. The second study suggests that rtfMRI provides direct access to brain mechanisms regulating EFT and highlights its potential as an intervention for impulsivity in the context of AUD. The work in this dissertation thus investigates important cognitive process for the treatment of alcohol use disorder that could pave the way for novel therapeutic interventions not only for AUD, but also for a wide spectrum of other addictive disorders.

Submitted by Jamile Barbosa da Cruz (jamile.cruz@ucsal.br) on 2016-09-14T19:25:43Z No. of bitstreams: 1 DISSERTAÇÃO - REJANE PDF.pdf: 1306008 bytes, checksum: 05db98885e0fadfe6450902077fec13b (MD5) / Rejected by Rosemary Magalhães (rosemary.magalhaes@ucsal.br), reason: título on 2016-09-21T21:20:10Z (GMT) / Submitted by Jamile Barbosa da Cruz (jamile.cruz@ucsal.br) on 2016-09-29T17:39:17Z No. of bitstreams: 1 DISSERTAÇÃO - REJANE PDF.pdf: 1306008 bytes, checksum: 05db98885e0fadfe6450902077fec13b (MD5) / Approved for entry into archive by Rosemary Magalhães (rosemary.magalhaes@ucsal.br) on 2017-01-12T18:10:39Z (GMT) No. of bitstreams: 1 DISSERTAÇÃO - REJANE PDF.pdf: 1306008 bytes, checksum: 05db98885e0fadfe6450902077fec13b (MD5) / Made available in DSpace on 2017-01-12T18:10:39Z (GMT). No. of bitstreams: 1 DISSERTAÇÃO - REJANE PDF.pdf: 1306008 bytes, checksum: 05db98885e0fadfe6450902077fec13b (MD5) Previous issue date: 2016-04-29 / Nos últimos tempos, observamos cada vez mais a discussão teórica sobre o uso problemático de drogas, sendo oportuno enfatizar a diferença entre os gêneros,a superação do preconceito presente nas estruturas ideo-políticas erguidas historicamente, que dificultam a busca de ajuda pelas mulheres e o reconhecimento que o álcool é a droga que mais ocasiona danos no mundo.OBJETIVO: examinar os transtornos por uso de álcool e outras drogas na trajetória de mulheres assistidas por um CAPSad em Salvador, Bahia, percebendo os impactos ocasionados ao longo de suas vidas.MATERIAL & MÉTODOS: trata-se de uma pesquisa qualitativa de casos desenvolvida através da triangulação de dados, ou seja, da observação direta, da pesquisa documental (análise dos prontuários) e da realização de entrevistas, cujo formulário semiestruturado foi o instrumento elaborado pela pesquisadora. A análise dos dados coletados possibilitou a construção de oito categorias norteadoras, sendo que a interpretação dos dados requereu a revisitação às literaturas específicas para articular a discussão teórica com os achados empíricos. RESULTADOS: as especificidades do gênero, o espaço familiar e sociocultural, a ausência de apoio social e as vivências pregressas ao uso de drogas foram elementos determinantes para o surgimento dos transtornos por uso de álcool associado a outras drogas. CONCLUSÃO & RECOMENDAÇÕES FINAIS: os achados da pesquisa apontaram que a pauperização,a violência, a fragilidade dos laços familiares e as iniquidades sociais presentes na história de vida das mulheres estudadas foram condições objetivas para a exposição ao uso abusivo de substâncias psicoativas e que, em consonância a isto, é de suma importância o apoio e a articulação de variados segmentos sociais (família, CAPS,comunidade,Estado, igreja e outros atores sociais) na promoção de ações consistentes e resolutivas na prevenção e no enfrentamento deste fenômeno. / In recent times, there has been an increase in the theoretical discussion of the problematic about drug use. It is worth emphasizing the difference between the genders, overcoming this prejudice in the ideo-political structures historically erected that hinder women in search for help and for the recognition that alcohol is the drug that causes more damage in the world. OBJECTIVE: To examine the disorders of the alcohol and other drugs’ use in the path of women assisted by a CAPSad in Salvador, Bahia realizing the impacts caused over their lives. MATERIAL & METHODS: This is a qualitative case study developed through triangulation of data, i.e., direct observation, documents research (analysis of medical records) and interviews, which semi-structured form was the instrument developed by the researcher. The data analysis allowed the construction of eight guiding categories, and the interpretation of data required revisiting the specific literature to articulate the theoretical discussion with the empirical findings. RESULTS: the gender specificities of the family and socio-cultural space, lack of social support and stunted experiences with drug use were key elements for the development of disorders of the alcohol and other drugs’ use. CONCLUSION & FINAL RECOMMENDATIONS: The research findings showed that the impoverishment, violence, fragility of family ties and social iniquities present in the life story of the women who were studied were objective conditions for the exposure of the abuse of psychoactive substances.Along with this, the support and coordination of various social groups (family, CAPS, community, State, church and other social actors) is extremely important to promote consistent and resolute actions in preventing and confronting this phenomenon.

L’objectif principal de nos études a été de caractériser la pharmacocinétique du baclofène chez le patient alcoolo-dépendant et d’étudier la variation du craving en fonction de l'exposition au baclofène pour objectif de comprendre s’il existait des sujets répondeurs et des sujets non répondeurs. Nous nous sommes intéressés à la sécurité d’emploi du baclofène, à l’influence que pourraient avoir les paramètres démographiques et biologiques ainsi que la consommation de tabac concomitante. Nous avons pu mettre en évidence que le baclofène présentait une pharmacocinétique linéaire avec une relation proportionnelle de 30 à 240 mg par jour avec une importante variabilité interindividuelle. Une modélisation pharmacocinétique/pharmacodynamique par approche de population nous a permis de définir la relation entre l’exposition au baclofène et le craving à l’alcool. Nous avons constaté que le baclofène permettait de diminuer le craving à l’alcool pour l’ensemble des patients traités, et nous avons pu élaborer l’hypothèse qu’il existait deux sous-populations de patients différenciés par leur rapidité de réponse. Bien que chez les patients non-répondeurs (répondeurs tardifs) les taux sanguins de créatinine et de phosphatases alcalines étaient significativement plus élevés laissant supposer que les patients sévèrement malades répondaient moins au traitement, le faible nombre de patients (n=50) et l’absence de placebo ne permettent pas de conclure. Des analyses préliminaires des données de craving à l’alcool et de consommation d’alcool suggèrent qu’il existe une relation entre craving et consommation d’alcool. Des analyses complémentaires sont nécessaires pour confirmer ces résultats. / The main objective of our studies was to characterize the pharmacokinetics of baclofen in alcohol-dependent patients and to investigate the variation of craving as a function of exposure with a secondary objective which was to explore the possible existence of baclofen responders and non-responders. We investigated baclofen safety, the potential influence of demographic and biological parameters as well as the concomitant use of tobacco. We observed that baclofen showed linear pharmacokinetics with a proportional relationship from 30 to 240 mg per day with a high inter-individual variability. A pharmacokinetic/pharmacodynamic population approach has enabled us to define the relationship between baclofen exposure and alcohol craving. A wide inter-individual variability in response was depicted but could not be explained by any of the covariates studied. We found that baclofen could possibly reduce alcohol craving in all the patients treated, and we drew up the hypothesis of two subpopulations of patients differentiated by their speed of response. Although in non-responders (late responders) blood levels of creatinine and alkaline phosphatase were significantly higher than in responders, suggesting that seriously ill patients could be less responsive to baclofen treatment, the low number of patients (n = 50) and the absence of a placebo group renders this results inconclusive. Preliminary analyzes of alcohol craving and alcohol consumption data suggest that a relationship exists between craving and alcohol consumption. Additional analyzes are needed to confirm these results.

<div> <p>Historically, natural products from plants, fungi, bacteria and animals have played an important role in the discovery of new drugs. In fact, it has been found that 34% of new FDA-approved drugs over the last 30 years were derived from natural products or their derivatives. Because of the chemical and structural diversity of natural products, they continue to be one of the best options for discovering novel compounds and scaffolds; this is especially true for compounds targeting the µ-, δ-, and κ- opioid receptors. However, traditional opioids such as morphine cause many therapeutically limiting side effects. Therefore, there have been immense efforts to develop opioids that avoid these side effects, with “signal-biased” compounds being an intense area of interest. The research presented here investigates of the biased mechanisms of compounds found in and derived from <i>Mitragyna speciosa</i>, also known as kratom, and <i>Picralima nitida</i>, also known as akuamma. Kratom and akuamma compounds are examined for their therapeutic potential in treating alcohol abuse and pain, respectively, two prevalent conditions with extreme societal and economic costs.</p> </div> <br>

In the United States, one in every 100 adults is confined to a correctional facility. Approximately 60% of inmates have an alcohol use disorder (AUD). When compared to the general population, inmates are twice as likely to have AUD. As they are unable to readily access alcohol, inmates entering a correctional facility with AUD are at high risk for the lethal alcohol withdrawal syndrome (AWS). AWS is preventable and yet correctional nurses process new inmates without an evidence-based clinical practice guideline (CPG) to assess for AUD, the prerequisite for AWS. The purpose of this project was to develop an evidence-based CPG with implementation algorithm to guide the inmate assessment for AUD. The ACE star model of knowledge transformation guided the project, the AGREE II was used to develop the CPG, and the Delphi technique was used to evaluate the final CPG with algorithm. Nationally, 20 correctional health experts were identified and asked to participate in the Delphi expert panel, although 11 experts agreed to participate only 9 completed the evaluation. The experts were correctional health experts, nurses and physicians, from different regions of the United States. The resulting CPG satisfied all 23-items of the AGREE II. Through 2 Delphi panel rounds, all participants recommended the CPG with minor modifications (6 experts recommended as presented while the 3 recommended with modifications). At the project conclusion, all 9 experts agreed the CPG will help improve the identification, referral, and management of inmates with AUD. This project contributes to positive social change as the CPG addresses a serious problem, AUD with possible AWS, in a vulnerable population. The CPG may be generalizable for use in other correctional facilities.

Bakgrund Alkoholmissbruk är en av de främsta bestämningsfaktorerna för hälsa i världen. Globalt uppskattas 280 miljoner personer ha ett alkoholmissbruk och i Sverige antas antalet vara 350 000 personer. På grund av alkoholens negativa hälsoeffekter finns det en rad allvarliga följdsjukdomar, därmed är personer med alkoholmissbruk en grupp som personal inom hälso- och sjukvården kommer i kontakt med. Vid sjukdom påverkas anhöriga, ibland positivt men mestadels negativt. De negativa effekterna sammanfattas som anhörigbörda. Bördan påverkar de anhörigas hälsa vilket har konsekvenser för både dem och patienten. Syfte Syftet var att beskriva hur anhörigas hälsa påverkas av en närståendes alkoholmissbruk. Metod En icke-systematisk litteraturöversikt baserad på 20 vetenskapliga originalartiklar, av kvalitativ och kvantitativ ansats. Artiklarna samlades in från databaserna PubMed, CINAHL samt PsycInfo med hjälp av sökord. Artiklarna har därefter genomgått kvalitetsgranskning utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. Sammanställning och analys skedde med integrerad dataanalys.   Resultat Studien fann en rad faktorer som påverkade hälsan negativt hos anhöriga till personer som missbrukar alkohol. Dessa påverkansfaktorer fanns på individnivå, social nivå och påverkade de anhörigas hälsomedvetenhet och hantering. Den anhörigbörda detta innebar hade påverkan på fysisk, psykisk och social hälsa. Att växa upp i en familj drabbad av alkoholmissbruk ökade bland annat mortalitet och förekomst av psykisk sjukdom. Anhörigskapet hade för det mesta negativ inverkan på relationer. Stigmatisering och fördomar mot alkoholmissbruk isolerade generellt de anhöriga. Ett bifynd var att anhörigbörda hanterades på olika sätt. Vissa använde välanpassade copingstrategier, andra inte.   Slutsats Studien visar på vikten av att hälso- och sjukvården uppmärksammar och stödjer de anhöriga för att minska deras börda. De försämrade familjerelationerna som alkoholmissbruket skapar, kan även förklara och ge oss förståelse för anhörigas beteende och hur anhöriga kommunicerar med sina närstående. Stigmatiseringen av alkoholmissbruk ställer krav på ett fördomsfritt och öppet bemötande men också mod vid uppmärksammandet av dessa frågor. / Background Alcohol abuse is one of the main determinants of health in the world. Globally, it is estimated that 280 million people have an alcohol use disorder [AUD]. In Sweden the number is assumed to be 350,000. Due to the numerous negative health effects of alcohol, persons with AUD are encountered in healthcare contexts. Illness affects the family member's capacity for caring for the patient. In some cases, this is a positive experience. However most often it creates a caregiver burden. This burden has consequences in health for both caregivers and the patients. Aim The aim was to describe how alcohol abuse affects family members' health. Method  A non-systematic literature review based on 20 original scientific articles with qualitative or quantitative approach. The articles were obtained from PubMed, CINAHL and PsycInfo. The articles have subsequently undergone a quality review based on Sophiahemmet University's assessment basis. Compilation and analysis took place with integrated data analysis.  Results The study found factors that influenced family members’ health negatively that were linked to alcohol abuse on both an individual and social level. This caregiver burden had an impact on physical, mental, and social health. Growing up in a family affected by alcohol abuse increased mortality and the incidence of mental illness, among other things. Alcohol abuse had a negative impact on family relationships. Stigmatization and prejudice against alcohol abuse generally caused isolation. An incidental finding was that caregiver burden was handled in different ways. Some used well-adapted coping strategies, others did not. Conclusions The study shows the need for the healthcare system to support families to reduce their burden. The deteriorating effect from alcohol abuse on family relationships can also explain family communication and behaviour. The stigmatization of alcohol abuse demands a non-prejudiced and open approach, but also the courage to raise these issues.

BACKGROUND: Accurate clinical prediction supports the effective treatment of alcohol use disorder (AUD) and other psychiatric disorders. Traditional statistical techniques have identified patient characteristics associated with treatment outcomes. However, less work has focused on systematically leveraging these associations to create optimal predictive models. The current study demonstrates how machine learning can be used to predict clinical outcomes in people completing outpatient AUD treatment. METHOD: We used data from the COMBINE multisite clinical trial (n = 1383) to develop and test predictive models. We identified three priority prediction targets, including (1) heavy drinking during the first month of treatment, (2) heavy drinking during the last month of treatment, and (3) heavy drinking between weekly/bi-weekly sessions. Models were generated using the random forest algorithm. We used "leave sites out" partitioning to externally validate the models in trial sites that were not included in the model training. Stratified model development was used to test for sex differences in the relative importance of predictive features. RESULTS: Models predicting heavy alcohol use during the first and last months of treatment showed internal cross-validation area under the curve (AUC) scores ranging from 0.67 to 0.74. AUC was comparable in the external validation using data from held-out sites (AUC range = 0.69 to 0.72). The model predicting between-session heavy drinking showed strong classification accuracy in internal cross-validation (AUC = 0.89) and external test samples (AUC range = 0.80 to 0.87). Stratified analyses showed substantial sex differences in optimal feature sets. CONCLUSION: Machine learning techniques can predict alcohol treatment outcomes using routinely collected clinical data. This technique has the potential to greatly improve clinical prediction accuracy without requiring expensive or invasive assessment methods. More research is needed to understand how best to deploy these models.