This study investigated the relationship between selected adolescent characteristics and treatment completion in a large, national sample of adolescents receiving substance misuse treatment in 2011. Participants were de-identified adolescent entries between the ages of 12 and 17 in the Treatment Episode Dataset- Discharges (TEDS-D), which is a national census data system including persons discharged from public and private substance abuse treatment programs that received public funding. Chi-square tests of independence and logistic regressions were used to examine the relationships between adolescent characteristics and treatment completion. The results showed significant relationships between selected variables (sex, gender, primary substance problem, principal source of referral, frequency of use) and treatment completion, but with small to medium effect sizes. Implications, limitations and directions for future research are discussed. / School Psychology

Throughout history, the human race has been characterized by the use of physical and emotional aggression by individuals, particularly males, in their intimate relationships. Intimate abusiveness is particularly common among substance dependent males. As a result of male intimate abusiveness, victims suffer a variety of problems ranging from emotional trauma to death due to physical injury. Despite increased attention to this problem, our understanding of the process leading to intimate abusiveness is far from comprehensive. The primary purpose of the present study was to expand our understanding of intimate abusiveness through the application of a social-cognitive model of intimate abusiveness among substance dependent males. Fifty-seven males from an inpatient substance abuse treatment program participated. Subjects completed questionnaires indicating their level of intimate abusiveness. In addition, they completed partner-related attribution measures as well as coping response measures indicating how they would interpret and handle five ambiguous vignettes involving their partner. It was hypothesized that violent men would attribute greater negative intent and responsibility to their partner and that they would choose to handle the ambiguous vignettes in less competent ways compared with non-violent men. Further, it was predicted that the association between intimate abusiveness and competency of coping responses would be mediated by attributions made about the partner. Results of the study generally supported predictions. The implications of the results are discussed as well as suggestions for future research. / Ph. D.

Counseling professionals are committed to providing multiculturally competent services to the clients they serve. When clients first enter counseling, the therapeutic relationship typically begins by the counselor conducting an initial clinical interview. This initial clinical interview is a critical time to demonstrate cultural competence. Currently, there is no literature that has explored how counselors who work with the substance use population incorporate multicultural considerations during the initial clinical interview. The purpose of this study was to explore whether licensed professional counselors (LPCs) broach (Day-Vines et al., 2007) multicultural considerations during the initial clinical interview with clients who have substance use disorders (SUDs). The exploration of this phenomenon occurred through the use of a qualitative methodology. Semi-structured interviews were conducted with nine LPCs in Virginia. The LPCs shared their lived experiences conducting initial clinical interviews with members of the SUDs population. Four themes and a subtheme emerged related to how LPCs perceive the relevance of identifying multicultural factors in their work with the SUDs population: everyone has culture and it is all encompassing, culture is needed to understand clients (subtheme), multicultural factors impact substance use behavior and patterns, cultural identities emerge during the initial clinical interview, and multiculturalism was an important component in counselor preparation. Three themes emerged related to how LPCs describe the term and concept of broaching: no familiarity with the "broaching" term, broaching defined as initiating a topic, and some degree of understanding of the broaching concept. Five themes emerged related to whether and how LPCs introduce or broach multicultural considerations during the initial clinical interview: broaching approach varies, client introduces multicultural factors, appropriate timing, willingness to be open, and boundaries surrounding broaching. The themes that emerge from this data will help to fill gaps in the literature concerning how counselors broach multicultural considerations, particularly with the SUDs population. Implications for counselors and counselor education are discussed. The limitations of the study and recommendations for future research are provided. / Ph. D.

The transmission of emotion regulation from parent to adolescent as well as the relationship between adolescent emotion regulation and substance use is not clearly understood in extant psychological literature. The present study hypothesizes that parents transmit their emotion regulation skills to their adolescents via the mediator of parenting behaviors and that adolescents who are better emotion regulators are less likely to use substances. In the present study, cross-sectional and longitudinal structural equation modeling analyses were utilized to determine the relationship among these variables. In the cross-sectional analyses (n = 219), the sample was 55% male and were between the ages of 12 to 18 years (M = 15.12). In the longitudinal analyses (n = 129), the sample was 42% male and were between the ages of 13 to 21 years (M = 17.13). In both the cross-sectional and longitudinal models, adolescents with high negative parenting had higher levels of lability/negativity, whereas adolescents with high positive parenting had better emotion regulation skills and lower levels of substance use. In addition, in the longitudinal analyses, higher levels of suppression in parents were negatively related to adolescent emotion regulation. The findings of the present study highlight that parents transmit emotion regulation skills to their adolescents and that parenting behaviors may be a key point of intervention for promoting adolescent emotion regulation and demoting adolescent substance use. / Ph. D.

Several studies show that African-Americans are less likely than whites to use alcohol or drugs. However, if African-Americans use drugs then they are more likely to become heavy and persistent users. African-Americans are also more likely to have a current substance abuse disorder. There is not much in the literature to explain this phenomenon. The purpose of this study is to examine the alcohol and drug abuse, use and dependence of blacks and whites in order to explain the differences in the course of the substance disorder, using data from the National Comorbidity Survey. There are many variables thought to contribute to the racial difference, such as socio-economic status (measured by income and education), religion, insurance, employment status, and marital status. The data in this literature indicate that the aforementioned variables do not explain the racial difference in substance disorders. However, after performing interaction analyses, it is clear that the effects of treatment are different for blacks and whites. Treatment is more effective for whites, and it may even cause the substance disorder to become worse for blacks. Several studies indicate that this may be the result of cultural differences between the treatment staff and the clients. / Master of Science

No / Advances in antiemetic therapy for chemotherapy-induced emesis have resulted in improved protection against symptoms occurring within 24 h of chemotherapy. However, the vomiting which tends to occur beyond 24 h after chemotherapy (delayed-phase vomiting) is still relatively poorly controlled by the currently available drugs, suggesting that more than one mechanism may mediate these symptoms. The standard antiemetic regimen currently recommended for prevention of chemotherapy-induced emesis includes a serotonin (5-HT3) antagonist and a corticosteroid. The neurokinin-1 (NK1) antagonist aprepitant represents a new class of antiemetic currently in clinical development. Using data obtained in 2 Phase II clinical trials of aprepitant in patients receiving chemotherapy based on the highly emetogenic chemotherapeutic agent cisplatin, we compared the time course of antiemetic effect of aprepitant, a 5-HT3 antagonist, or a combination of both. Over the entire observation period (up to 7 days post-cisplatin), patients who received the NK1 antagonist had a superior prevention of emesis. However, in the first 24 h after cisplatin, emesis occurred in fewer patients who received the 5-HT3 antagonist than in patients who did not receive this class of drug. Furthermore, the majority of treatment failures in patients who received the NK1 antagonist occurred within the first 8¿12 h of chemotherapy, whereas the treatment failures in patients who received a 5-HT3 antagonist were more evenly distributed over time. Patients who received both drugs had superior control of symptoms compared with patients who received one or the other. The difference in the time course of emesis blockade observed with two different classes of receptor antagonists provides substantial evidence for involvement of separate pathophysiological mechanisms in chemotherapy-induced vomiting. Serotonin mediates the early vomiting process that occurs within 8¿12 h following cisplatin-based chemotherapy, after which time substance P acting at NK1 receptors becomes the dominant mediator of vomiting.

Background: Attention deficit and hyperactivity disorder (ADHD) is a neurodevelopmental disorder presenting with three core symptoms: inattention, hyperactivity, and impulsivity. The ADHD population is 3 times more susceptible to developing a cannabis use disorder compared to the general population. Psychostimulants are the first-line treatment for ADHD. There is currently no literature on the impact of cannabis on the psychostimulant response. Objectives: To compare the response to psychostimulant treatment in adults with ADHD between cannabis and non-cannabis users Methods: Sixty-five participants with a primary diagnosis of ADHD were recruited from the MacAnxiety Research Clinic and St. Joseph's Psychiatric Community Clinic. Participants were assigned to the cannabis, or non-cannabis group based on their cannabis status at baseline. The study was 8 weeks long and included 3 visits. The first visit of the study was called “Baseline” and would occur prior to the start of stimulant medication. Participants would be seen at two additional time points 4- and 8-weeks post-baseline visit at which point they would be taking their stimulant medication. At each study visit all participants would fill out the self-reported assessment battery conducted through REDCap. The study psychiatrist would assign a CGI-S score at the end of each visit and a CGI-I score at the end of week 4 and week 8. Results: Cannabis and non-cannabis users did not differ statistically in their BAARS-IV, CGI-S, and CGI-I scores over the study. Secondary outcomes investigating CUD, stimulant type, stimulant dosage, comorbidities, and responder rate did not produce significant outcomes. Conclusions: There was no difference in the treatment response to psychostimulants in adults with ADHD between cannabis and non-cannabis users. Further studies should continue exploring treatment response in populations with co-occurring adult ADHD and cannabis use. / Thesis / Master of Science (MSc) / Attention deficit and hyperactivity disorder (ADHD) has three main symptoms including inattention, hyperactivity, and impulsivity. Substance use disorder is commonly associated with ADHD. The ADHD population is at a 3 times greater risk for developing a cannabis use disorder compared to the general population. Psychostimulants are used to treat ADHD but there is currently no data looking at how cannabis use may affect the treatment response. This study aims to compare the response to ADHD treatment in adults with ADHD between cannabis and non-cannabis users. The study recruited forty participants who filled out a study questionnaire over 3 study visits for a total study length of 8 weeks. Study findings did not report a difference between cannabis and non-cannabis users in their ADHD symptoms, clinical severity, and clinical improvement throughout the study. Further studies should continue investigating populations with co-occurring ADHD and cannabis use in relation to treatment response.

No / This study aimed to enable a cohort of women to describe their personal experiences of motherhood in the context of problematic substance use and street-based prostitution. The study also aimed to describe the impact upon women of separation from their children. Findings that emerged from focus group data were organised into four over-arching themes: children and motherhood, personal accounts of drug use and street-based prostitution, risks to women and their children and supportive/unsupportive factors in the women’s lives. Each theme consisted of many categories that illustrated the impact of dependent drug use and involvement in prostitution on the lives of the women and their children. This article describes the theme of children and motherhood. Involvement in street-based prostitution is extremely risky, frequently characterised by calculated risk taking, with consequences for both the woman and her children. Parental responsibilities and lifestyle contribute to stress, which is typically compounded by problematic substance use. Risks are increased for both the woman and her children when timely and appropriate support is unavailable. Emphasis should be placed upon the proactive identification and implementation of positive supportive strategies. Ethical approval was obtained via the Local Research Ethics Committee to undertake this research study.

Suite à une lésion de la peau, des cellules spécialisées nommées myofibroblastes (Wmyo) apparaissent au niveau de la plaie pour participer au processus de cicatrisation. Ces Wmyo produisent des microvésicules (MV) comme signal paracrine. Les MV peuvent transférer des informations biologiques sur de courtes ou longues distances affectant des processus biologiques. Nous avons précédemment démontré que ces MV stimulent *in vitro* l'angiogenèse et le remodelage tissulaire, deux étapes clés de la cicatrisation. Par contre, les études *in vitro* ne prennent pas en compte les mécanismes de diffusion des MV dans les tissus solides. La matrice extracellulaire (MEC) et la barrière endothéliale (BE) sont deux obstacles qui peuvent affecter le transport des MV et donc moduler leur action. Nous avons énoncé l'hypothèse que la MEC peut être impliquée dans la diffusion des MV lors de la cicatrisation cutanée et que les MV pourront diffuser à travers la BE favorisant ainsi une signalisation endocrinienne. L'objectif de cette étude est d'explorer les mécanismes de diffusion des MV dans leur environnement cicatriciel, à travers différentes molécules de la MEC et la BE. Ici, nous présentons un modèle d'hydrogels et de Transwell® pour étudier la diffusion des MV. Le transport des MV ainsi que les mécanismes liés à ce phénomène ont été analysés. Nos résultats montrent que les MV diffusent librement à travers les hydrogels composés de fibrine ou de collagène de type III, deux molécules prédominantes au début de la cicatrisation. Par contre, elles lient le collagène de type I, molécule prédominante en fin de cicatrisation, grâce à l'intégrine α2β1 présente à leur surface. Nos résultats indiquent aussi que les MV peuvent traverser la BE dans des conditions semblables à celles d'une plaie cutanée. Nos résultats suggèrent que la biodisponibilité des MV ainsi que leur action lors de la cicatrisation normale de la peau pourraient être dictées par l'organisation locale de la MEC et l'état de la BE. Cette étude permet une meilleure compréhension du devenir des MV au cours du processus de la cicatrisation et pourrait aider au développement de vésicules modifiées utilisées pour l'administration de médicaments. / Myofibroblasts (Wmyo) are specialized cells that appear in the skin after a lesion to participate in the healing process. Wmyo produce microvesicles (MVs) as a signaling mechanism to transfer biological information and influence biological processes over both short and long distances. Our previous research has shown that these MVs can stimulate angiogenesis and tissue remodeling, which are crucial steps in wound healing. However, *in vitro* studies do not account for MV diffusion in solid tissues, where the extracellular matrix (ECM) and the endothelial barrier (EB) may impede MV transport and modulate their effects. We hypothesized that the ECM may be involved in MV diffusion during skin healing and that MVs may diffuse through the EB thus promoting endocrine signaling. The purpose of this study is to examine how MVs diffuse within their scar surroundings, through various ECM molecules and the EB. Here, we present a model of hydrogels and transwell to study the diffusion of MVs. The transport of MVs as well as the mechanisms related to this phenomenon have been analyzed. Our results show that MVs diffuse freely through hydrogels composed of fibrin or type III collagen, two predominant molecules during the early stages of healing. In contrast, they bind to type I collagen, the predominant molecule during the final stages of healing, due to the presence of integrin α2β1 on their surface. Additionally, our results suggest that MVs can cross the EB under conditions that resemble those found in skin wounds. Our results suggest that the bioavailability of MVs as well as their action during normal skin healing could be influenced by the local organization of the ECM and the state of the EB. This study allows a better understanding of the behavior of MVs during the healing process and could help the development of modified vesicles used for drug delivery.

Titre de l'écran-titre (visionné le 25 octobre 2023) / L'obésité est de plus en plus décrite comme une maladie neurocomportementale résultant d'une vulnérabilité neurologique combinée à un environnement obésogène. Depuis 2020, plusieurs organismes décrivent l'obésité comme une maladie chronique, complexe, évolutive et récidivante fort répandue se caractérisant par une accumulation anormale ou excessive de graisses corporelles nuisibles à la santé. De plus, il est maintenant connu que l'obésité est associée à des altérations de l'intégrité et de la densité des matières blanche et grise au niveau du cerveau. La chirurgie bariatrique est un bon modèle pour étudier ces altérations, puisqu'elle mène à une perte de poids significative et à des améliorations métaboliques. Nos études récentes ont démontré une augmentation de la densité de matière blanche et grise 4 et 12 mois après la chirurgie bariatrique dans plusieurs régions du cerveau. Nous avons aussi rapporté que la densité des matières blanche et grise dans ces régions est plus faible chez les participants présentant une obésité, suggérant une récupération des altérations de matière blanche et grise post-chirurgie. Il demeure toutefois incertain si ces changements persistent dans le temps. Le Chapitre 1 de ce mémoire présente les résultats d'une étude prospective visant entre autres à examiner la récupération de la densité des matières blanche et grise 24 mois après la chirurgie bariatrique. Nos résultats montrent des augmentations étendues de la densité des matières blanche et grise jusqu'à 24 mois après la chirurgie qui sont reliées à la perte de poids et à l'amélioration du profil métabolique. Nous avons aussi montré que des diamètres adipocytaires omentaux plus élevés sont significativement associés à de plus grandes augmentations de densité totale de matière blanche à 24 mois, et une tendance est observée avec le diamètre adipocytaire sous-cutané à 24 mois. Dans le futur, il sera intéressant d'étudier le lien entre les changements structuraux et la fonction cognitive, ainsi qu'examiner les changements à plus long terme après la chirurgie bariatrique. / Obesity is increasingly described as a neurobehavioral disease resulting from a neurological vulnerability combined with an obesogenic environment. Since 2020, several organizations have described obesity as a widespread, chronic, complex, progressive and relapsing disease characterized by abnormal or excessive accumulation of body fat that is detrimental to health. In addition, it is now known that obesity is associated with alterations in the integrity and density of white and grey matter in the brain. Bariatric surgery is a good model to study these alterations, since it leads to significant weight loss and metabolic improvements. Our recent studies have demonstrated widespread increases in white and gray matter density 4 and 12 months after bariatric surgery that spatially overlap with the brain alterations observed in participants with obesity, suggesting recovery from post-surgical white and gray matter alterations. However, it is not known whether these changes persist over time. Chapter 1 of this master thesis presents the results of a prospective study to examine among others the recovery of white and grey matter density 24 months after bariatric surgery. Our results show widespread increases in white and gray matter density up to 24 months after surgery that are related to weight loss and improved metabolic profile. We also show that higher omental adipocyte diameters are significantly associated with greater increases in total white matter density at 24 months, and a trend is observed for subcutaneous adipocyte diameter at 24 months. In the future, it will be interesting to study the relationship between structural changes and cognitive function, as well as examine longer-term changes after bariatric surgery.