The prevalence of addiction in society has called researchers, educators, policy makers, and clinicians to examine and research causes and treatment approaches to address the manifold problems addictions present individuals and society alike. There are many theoretical approaches to understanding addiction and the behavior change processes that lead from addiction to recovery. Religiosity and spirituality have been identified as important factors in addiction, though the exact nature of the relationship is yet to be determined. This dissertation explores the relationship between religiosity and the known treatment outcome mediator. The purpose of this dissertation is to inform theory, training, and practice in the area of addictions counseling. This exploratory study investigated the relationship of religiosity to readiness to change in addictive behaviors. The database from Project MATCH was used which included participant scores from the aftercare arm of the clinical trial. A total of 772 scores were used from responses to the RBB and URICA. Stepwise multiple regression revealed that there were no significant differences detected across variables regarding the relationship of religiosity to readiness to change. / Graduation date: 2003

This study was designed to assess the relationship of selected factors to the developmental outcome of fundamental motor skill performance in young children ages 3 to 6 years residing in foster or adoptive care, and have a documented history of prenatal exposure to cocaine and other drugs. Using an ecological theory of child development and the person-process-context model, the study focused on the child's development in selected gross motor skills. Through multiple regression analysis, the study considered the contributions of the following on motor skill performance as measured by the Test of Gross Motor Development: child effortful control as measured by the Children's Behavior Questionnaire, the nonbiological mother's parental attitude as measured by the adapted Parent Attitude Survey, the amount of early intervention services as recorded in the child's medical chart. Participants included 28 children (15 males and 13 females) and their foster or adoptive mother. There is suggestive but inconclusive evidence for the hypothesis that fundamental motor skill performance is predicted by the interaction of the child's effortful control, the nonbiological mother's understanding and confidence, and the amount of early intervention service the child received, [F (7, 20)=2.24, p<0.07 ]. Trends in the data suggest gross motor performance increases with high levels of early intervention, given children with low effortful control and low levels of parental confidence and understanding. In addition, early gross motor scores did not predict fundamental motor skills, r=.10. Despite a 38% rate of identified early gross motor delay, no child was delayed in fundamental motor skill at ages 3 to 6 years. Fundamental motor skill performance ranged from average to superior, M=121.54. Motor performance was assessed in a clinical setting and caution is recommended when considering skill performance within group settings. Based on this study, children with prenatal exposure to cocaine/polydrugs are viewed as variable in temperamental control and gross motor performance, but perform at an average to above average level in gross motor skill. Further research is needed to validate trends, specifically regarding the interactive effects of child effortful control, parental attitude, and the amount of early intervention service received. / Graduation date: 1997

The Edmonton Drug Treatment and Community Restoration Court (EDTC) diverts substance-addicted offenders from the criminal justice system and provides intensive court supervision, case management, and links to social, employment and education support. This thesis aimed to generate a grounded theory of the process of participant engagement with the EDTC, drawing on staff and participant interviews and observation of EDTC operations. Criteria of engagement included meeting expectations, communicating openly and honestly, and forming bonds. Internal engagement was described as feeling hopeful and willing, and perceiving expectations as helpful rather than controlling. Perceptions underlying internal engagement involved motivation and openness to socialization and trust; feeling engaged resulting in the act of confronting issues rather than avoiding them. The process of engagement was a positive cycle, instigated and perpetuated through interaction with expectations and discipline, realizing and experiencing specific reasons to change, forming trust and accessing internal and external resources to address barriers.

This study was undertaken to evaluate gender differences in predictors of substance use in clinic-referred, Hispanic American adolescents with substance use disorders. Individual (disruptive behavior disorders, depression) and family variables (family conflict, parental monitoring) were evaluated as predictors of the initial level and change over time in marijuana use, and gender was evaluated as a moderator of the associations. The study involved an analysis of an existing dataset of 113 Hispanic American adolescents (93 boys; age 12 to 17) referred for outpatient treatment for substance abuse and their parental guardian. Participants and parental guardians completed questionnaires and a structured interview to report on predictor variables at baseline and marijuana use at baseline and 3-, 6-, 12-, and 18-months post-baseline. Latent growth curve modeling was conducted to evaluate the study hypotheses. Adolescents reported high levels of marijuana use at baseline and relatively stable levels of marijuana use over time. Treatment and gender effects influenced the marijuana use trajectory. Girls exhibited more impaired psychosocial functioning than boys, including worse disruptive behavior problems and depression and lower levels of parental monitoring. Depression was negatively associated with marijuana use longitudinally. Overall, individual and family risk factors are associated with adolescent marijuana use in complex ways. Implications for intervention are discussed.

The purpose of this study was to investigate concurrent and prospective relationships between psychological distress and social support and substance abuse in a convenience sample of predominantly minority women with HIV in substance use recovery. This study involved a secondary analysis of data from a randomized controlled trial comparing a family therapy intervention and a group health intervention. Participants completed the Hamilton Depression and Anxiety Scales (psychological distress) and the Social Support Questionnaire (social support) at baseline and 4 months, 8 months, and 12 months post-baseline. Substance use over a 30-day period was measured by the Addiction Severity Index Lite, which was completed at baseline and at 2-month intervals post-baseline. A series of path analyses was used to test hypotheses generated from theory and empirical research. Results of the current investigation failed to reject the null hypothesis for the 6 hypotheses, and found only partial support for 2 hypotheses. Psychological distress was concurrently related to change in substance use only at 12 months (Hypotheses 1 and 2). Psychological distress was not related to social support, so there was no mediation of concurrent relationships (Hypothesis 3). Psychological distress was prospectively related to change in substance use that was measured 2 months after psychological distress was measured, but not change in substance use that was measured 4 months after psychological distress was measured (Hypothesis 4). Social support was not prospectively related to change in substance use that was measured either 2 months or 4 months after social support (Hypothesis 5). There was no evidence of mediation of prospective relationships (Hypothesis 6). These results were discussed within the context of relevant literature.

The purpose of this study was to investigate relationships between four personality styles and two important indications of HIV risk behavior, at intake and 3-month follow-up, among a sample of adolescents participating in court-mandated substance abuse treatment in conjunction with an HIV prevention intervention. This study involved a secondary analysis of data from a NIDA funded project (1R01DA011875-01, R. Malow, PI). Predictor variables included levels of antisocial (unruly), dependent(submissive), avoidant (inhibited), and borderline (borderline tendency) personality styles drawn from scales of the Million Adolescent Clinical Inventory (MACI). Criterion variables included number of sexual partners and percentage of sex acts unprotected, derived from the Risk Behavior Assessment (RBA). A series of hierarchical regression analyses were conducted to test study hypotheses. Analyses controlled for age, ethnicity, education, gender, intervention status, the three personality variables not central to the hypothesis being tested, and baseline values of sexual risk behavior, when relevant. Results from the multiple regression analyses failed to support study hypotheses,indicating that adolescent personality styles were not important predictors of HIV risk behavior. Results are discussed within the context of the relevant literature. Study limitations and recommendations for future research are noted.

Current theoretical models of ADHD (i.e., Disinhibition Model: Barkley, 1997; Working Memory Model: Rapport et al., 2001) conceptualize ADHD as the disorder of executive function (EF) with some variation in their emphases on particular components of the broadly-defined EF (e.g., working memory vs. inhibition) and in their postulated relationships with ADHD symptoms. Although these models provide systematic accounts of the manifestation of ADHD, they have not been extensively tested from an empirical standpoint. Moreover, despite the fact that ADHD is highly comorbid with other additional conditions such as learning and behavioral problems and EF deficits are found in individuals with these conditions as well as in those with ADHD, current EF models have not specified the developmental relationship between ADHD and its comorbid conditions. This study was: (1) to examine the extent to which two current models of ADHD are supported in a sample of 102 adults; (2) to present an ??integrated?? model by combining two current models of ADHD and linking them to recent research findings on two common comorbid conditions with ADHD (i.e., reading difficulty and substance abuse); and (3) to test and revise such an integrated model in the light of data using a latent variable analysis. Major findings provided a strong support for the Working Memory Model with a lesser degree of support for the Disinhibition Model. Preliminary evidence of working memory as the primary deficit in ADHD was also obtained in the present sample. Finally, the integrated EF model and its revised model (final model) demonstrated a very good fit to the data. These findings suggest that the integrated model provides a unified account of how EF deficits contribute to the manifestation of ADHD symptoms and comorbid conditions with ADHD. Given some limitations (e.g., sample size and scope) of the present study, current findings need to be replicated.

Anabolic Androgenic Steroids (AAS) have been associated with adverse psychiatric effects, aggression and violent behaviour. The use of them has spread to a larger subpopulation, and the use has been connected to different risk behaviours, such as use of other illicit substances and carrying a gun. Case reports tell about a connection between AAS use and violent crimes, including homicide. The aim of this thesis is to investigate the proposed connection between AAS and crime, focusing on violent crimes, and to inquire into whether this proposed connection between AAS and criminality is affected by other risk factors for criminal behaviour. The first two studies of this thesis investigated the registered criminality of individuals testing positively for AAS, with individuals testing negatively serving as control groups. In the two last studies individuals at a clinic for substance abuse treatment (Paper III) and in a prison (Paper IV) were asked about their use of AAS, and their history was assessed using the Addiction Severity Index. The main finding of Paper I was the development of criminal patterns over time, with a clear increase of the proportion of violent crimes and weapons offences seen only among the pure AAS users. In Paper II an increased risk for weapons offences among AAS users was reported. In Paper III an increased risk of having been prosecuted for violent crimes and of having been physically abused was seen among the AAS users. In Paper IV, the main finding was the close resemblance of users and non users. In summary, this thesis have concluded that the violence previously reported as connected to use of AAS can, to a large extent, be accounted for by other risk factors. There seems, however, to be a connection between use of AAS and a heavy, more planned form of criminality.

The use of anabolic androgenic steroids (AAS) has been associated with use of illegal or unprescribed prescription drugs, as well as different adverse psychiatric effects, such as ma-nia, psychosis and hostility. Further, there is an association between use of AAS and other different risk behaviours, including carrying guns and reckless driving. Taken together, these data suggest that there is a group of AAS users that are not elite athletes, but rather young men at risk for psychiatric illness and criminality, and who use AAS primarily for their aes-thetic effects and possibly for their psychoactive effects. The aim of this thesis is to investi-gate further the connection between use of AAS and use of other drugs, and to investigate whether the proposed side effects of AAS cause an increase in morbidity and mortality. The first study (Paper I) investigates morbidity and mortality in persons testing positive for AAS compared to persons testing negative for AAS at a doping laboratory. Paper II of this thesis studies the presence of psychoactive drugs in diseased men who tested positive for AAS upon autopsy and whether there is any difference between deceased users of AAS and deceased users of heroin or amphetamine (control group). The third article (Paper III) dis-cusses a surprising finding in paper I of increased seizures NOS in users of AAS. Paper IV and V are interview studies from an out-patient substance abuse clinic. The main findings in Paper I was that the majority of deceased users of AAS were also positive for other drugs and/or alcohol on autopsy, and that users of AAS more often than the control group had died from intentional death (suicide or homicide). The main finding of Paper II was that users of AAS were severely at risk for premature death compared to both the control group and the general population. Paper III concluded that the high prevalence of Convulsion NOS in users of AAS most likely was the result of concomitant substance abuse and withdrawal from such use. Paper IV concluded that twelve percent of the patients at the substance abuse clinic had used AAS for at least one cycle. Users of AAS had a higher risk of having been convicted of a violent offence, and users of AAS more often reported having been physically abused. In Paper V, long-terme users of AAS were found to have an increased risk for developing depression in connection with cessation of AAS use. AAS was also re-ported to be used in preparation for crime. In summary, this thesis concludes that there is a solid association between use of AAS and use of other psychotropic drugs in certain subpopulations, and that users of AAS are at risk for premature death due to unnatural causes that may be secondary to use of AAS.

Despite high rates of alcohol and marijuana use and dating violence among individuals between the ages of 15 and 24, limited research has examined a link between substance use and dating violence within adolescent samples. Moreover, although both problem drinking and dating violence perpetration have been linked to a history of childhood maltreatment (CM), few studies have examined the potential mechanisms of a relationship between these variables. The current study tested the predictive role of CM in adolescent alcohol and cannabis use and dating violence perpetration in a sample of youth with CM histories; in particular, we were interested in predicting the temporal co-occurrence of these behaviours. It was hypothesized that trauma symptomatology would play a mediating role in this relationship. Results demonstrated that only witnessing emotional domestic violence predicted the co-occurrence of substance use and dating violence; in general, trauma symptomatology was not found to be a significant mediator.