Misuse of prescription anxiolytic and sedative medication is a widespread phenomenon in Canada and a topic of increasing concern among health care providers. While anxiolytics and sedatives have important therapeutic uses in the treatment of anxiety and insomnia, these substances have psychoactive properties that render them vulnerable to misuse. Understanding the correlates and contexts of misuse is essential for developing targeted treatment and prevention strategies. This dissertation is comprised of a series of four studies conducted with adults in the Halifax Regional Municipality, recruited from the community and from a local substance use disorder treatment program. Study 1 investigated misuse of anxiolytics and sedatives among currently prescribed users of these medications in the general community. Misuse and diversion were associated with a more extensive history of other substance use and with personality dimensions, including hopelessness and impulsivity. Study 2 investigated motives for misuse among non-prescribed anxiolytic and sedative users recruited from the community. This study also included non-prescribed stimulant medication users to facilitate comparisons across differing classes of psychiatric medications. Non-therapeutic motives were associated with substance use history and, for anxiolytics and sedatives, with the personality dimension sensation-seeking. Study 3 involved an analysis of prescription regimens and misuse among all participants of Studies 1 and 2 who had ever held a prescription for an anxiolytic or sedative. Misuse of benzodiazepine anxiolytics and sedatives was more frequent than that of non-benzodiazepines, but was unrelated to prescription regimen. Study 4 examined the misuse of quetiapine, an atypical antipsychotic medication with anxiolytic and sedative effects, among clients of a methadone maintenance program. Misuse of quetiapine was widespread, but was typically associated with therapeutic motives. Quetiapine misuse was linked with a history of misusing other anxiolytic and sedative drugs. Collectively, these studies provide evidence that anxiolytic and sedative misuse is a heterogeneous phenomenon encompassing varying patterns of use and motives for misuse. Furthermore, these investigations suggest that anxiolytic and sedative misuse is linked to individual-level and medication-related variables. By providing a more comprehensive characterization of this important public health issue, these findings have practical implications in both clinical and research contexts.

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This webinar will describe East Tennessee State University’s efforts to curb the opioid epidemic along the continuum of addiction. ETSU’s Academic Health Science Center has engaged multiple constituents to conduct federally funded research, community based practice and more importantly, to foster cross-sector engagement and education. The team hosts monthly meetings to facilitate partnerships across sectors with multiple aims. These aims include regional health improvement, research capacity development and community outreach. By the end of this webinar, participants will be able to: Describe multiple evidence-based approaches for the prevention and treatment of opioid use disorder. Describe techniques for engagement in community and cross-sector collaboration to address the opioid use disorder crisis.

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Prescription drug misuse (PDM), defined as use without a prescription or solely for the feeling or experience caused by the drug, has become a popular topic among substance use researchers. While the vast majority of studies on the topic tackle epidemiological questions surrounding PDM, there is a notable lack of studies that look specifically at risk factors rooted in sociological/criminological theories. The current research seeks to bridge this gap in the literature by examining theoretically based explanations for PDM among college students utilizing three criminological theories commonly applied to other forms of substance use: Social Learning Theory, Social Bonding/Control theory, and General Strain Theory. In addition, this study also seeks to examine differences in user types characterized by motives for misuse as they relate to predictors stemming from these theories of interest. Utilizing an independently collected sample of 841 college undergraduates from a large southern university, the findings show that nearly one in four students misused prescription drugs in the past semester. Motivations for PDM were primarily instrumental in nature, with very few respondents misusing solely for recreational purposes. Furthermore, social learning based risk factors could best account for PDM within the sample with partial and indirect supports also found for strain based risk factors as well. Implications of these findings as well as theoretical and practical applications are presented.

Research suggests that non-medical prescription drug (NMPD) use is becoming increasingly prevalent, particularly among adolescents. A critical step towards developing effective intervention efforts requires identifying adolescents who are at risk for NMPD use. An extensive literature suggests that both adolescents and adults with elevated anxiety sensitivity (AS) are at greater risk for problematic substance use, and a small body of work has identified similar links with NMPD use specifically among adults. However, most of this literature combines all prescription drugs into a single category, and no work has evaluated the relation between AS and NMPD use among adolescents. The current study endeavors to further this area of research by examining the relation between AS (overall and subscales) and NMPD use among adolescents. The project evaluated 276 adolescents (age 9-19 years) enrolled in a residential treatment program on level of AS, including sub-dimensions (i.e., cognitive, physical, and social), and NMPD use across three categories of drugs: analgesic (e.g., Vicodin®), anxiolytic (e.g., Xanax®), and stimulant (e.g., Adderall®). A series of logistic regression models indicated that overall AS predicted nonmedical analgesic use, but not anxiolytic/sedative or stimulant use. A closer investigation of the AS subscales demonstrated that only the AS social subscale significantly predicted nonmedical analgesic and anxiolytic/sedative use. These results suggest that AS is related to NMPD use among adolescents, highlighting the need for future work to disaggregate the assessment of NMPD use into specific drug classes and explore the subscale dimensions of AS.

Juvenile misuse of prescription drugs in the United States has continuously increased over the last few decades, especially within rural regions of the country. Despite continuous increase in rates of misuse, limited research exists on elements of socialization that may function to prevent drug use. The current study utilized the Monitoring the Future Survey data to explore prescription drug misuse between different populations of juveniles. While using Hirschi’s (1969) theory of social bonds as a theoretical framework, different elements of socialization were explored to determine whether they work to contribute or prevent prescription drug misuse among rural and urban juveniles. Results indicated that parental attachment served as the most substantial protective factor among both populations of juveniles. Additionally, socialization differed in relation to prescription drug use among rural and urban youth. These findings could be implicated in future anti-drug programs that specifically target different regions of the country.

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