abstract: Collegiate recovery programs (CRPs) are university-sanctioned initiatives for students in recovery from alcohol and other drug addiction. Given the ever-rising rates of alcohol and opioid use and misuse, a great need exists to understand how to provide support for those who are considering recovery or who choose a recovery lifestyle in college. The purpose of this action research study was to examine peer-to-peer support for students in recovery. The development of two training innovations, Recovery 101 and Recovery Ally, were delivered to health and wellness peer educators called the Well Devil Ambassadors (WDAs) with the goal of equipping them to better support their peers in recovery. Learning objectives for the training were to gain knowledge about addiction and recovery and to enhance positive attitudes toward students in recovery, which could thereby increase self-efficacy and behavior intention to work with their peers in recovery. Mindfulness was included in the trainings to enhance the WDAs’ experience and provide tools for a self-care skillset. Quantitative data included pre, post, and follow-up surveys for the Recovery 101 training. Qualitative data included short-answer questions following Recovery 101 training and in-depth interviews following Recovery Ally training. Findings indicated that the information provided in Recovery 101 built the WDAs’ knowledge on the topics of addiction and recovery; hearing multiple perspectives from students in recovery allowed the WDAs to increase empathy toward students in recovery; and the building of knowledge, empathy, and mindfulness allowed the WDAs to gain self-efficacy and behavior intention when supporting their peers in recovery. / Dissertation/Thesis / Doctoral Dissertation Leadership and Innovation 2018

Prescription ADHD medication has been shown to be on the rise as a drug of abuse among young people. Unlike other drugs that serve only the purpose of achieving a high, this particular substance can also be perceived as useful and beneficial by those who abuse it. It is these positive attributes given to the illicit use of these drugs that make them so dangerous, especially in the hands of youths. To date extant research has made little effort to contextualize this type of drug use within theories of deviance. This study looks to fill that void as well as bridge the gap between current epidemiological studies on this topic and future etiological studies looking to assess causation within a theoretical context. Examining a national sample of 12th grade students (N=2,384), this study looks at what risk factors and predictors exist for the illicit use of ADHD medication. By testing aspects of social bonding and social learning theories, the goal is to assess which theory can best predict this type of drug use. Due to the low proportion of users, a rare events logistic regression is utilized in the analysis. While social learning items were able to account for the greatest level of variance in use, many of the findings contradict the theory, and therefore no theoretically based conclusions can be made at this time. Overall, more research needed on this topic using better fitting data tailored for theoretical interpretation. Considerations for future studies are also discussed.

Commercial Sexual Exploitation of Children (CSEC) is the sexual exploitation of minors for commercial profit. The intersection between sex trafficking victimization and substance use has not yet been explored in clinical research and is not reflected in current clinical treatment of survivors when they exit their exploitation. The research question explored in this study focused on the substance use treatment considerations and challenges clinical social workers face when treating survivors of CSEC living in Massachusetts. Subquestions included understanding how cumulative trauma from CSEC impacts substance use treatment and how the coercive use of substances aimed at maintaining victim submission impacts substance use treatment. Contemporary trauma theory was the theoretical basis that informed this action research study. The sample included 5 clinical social work practitioners who had experience working with victims and survivors of CSEC. Data collected through a focus group was coded, compared, and analyzed for major and emergent themes using the constant comparison method. The key findings of the study include the lack of training and experience specific to the population, the impact of trauma, the effect of CSEC on substance use treatment, and the need for specialized treatment services. The findings of the study may create positive social change by increasing knowledge of the dynamics of substance use treatment with CSEC survivors, informing best practices for social worker professionals working with this population, and advising the development of trauma-informed substance use treatment for CSEC survivors.

Prescription opioids are associated with rising rates of overdose deaths and hepatitis C and HIV infection in the US, including in rural Central Appalachia. Yet there is a dearth of published ethnographic research examining rural opioid use. The aim of this dissertation is to document the gendered inequalities that situate women’s encounters with substance abuse treatment as well as additional state interventions targeted at women who use drugs. These results are based on ethnographic fieldwork completed from 2013 to 2016 and centered around one county seat in rural Central Appalachia. Data are ascertained through semi-structured interviews with women who have experiences with at least one of three types of substance abuse treatment offered in the area. Additional interviews were completed with program staff, institutional administrators, and community leaders. These data are supplemented with the collection of program documents, informal and follow-up communications, and participant observation in Eastern Kentucky communities, substance abuse treatment programs, and funding agencies. Social locations based on gender, income, access to quality health care, and place of residence contextualize women’s participation in illicit economies, entrance into and maintenance of drug use, particularly but not limited to opioids, and efforts to limit deleterious use. The state’s responses to drug use are manifested in these women’s lives through child protective services, incarceration, and substance abuse treatment. The sociopolitical and financial limitations on institutions often create instances in which policies exacerbate women’s marginalization. These policies are based on specific cultural understandings of women who use drugs, motherhood, Appalachia, and care. Women develop strategies, often based on care networks, to make it through these programs. Despite their navigations of marginalized and marginalizing programs, clients and institutional staff are materially and discursively constrained in their actions.

Healthcare big data are a growing source of real-world data with which to identify and validate medications with repurposing potential. Previously, we developed a claims-based workflow to evaluate medications with potential to treat stimulant use disorders. In order to test the workflow, the framework was applied in the context of opioid use disorders (OUDs), for which there are medications with known efficacy. Using the Truven Marketscan Commercial Claims Database, a nested case-control analysis was conducted to determine the association between OUD medications (buprenorphine, naltrexone) and remission. Cases were defined as enrollees with a remission diagnosis and matched (1:4) to controls (individuals without remission) using incidence density sampling, with age group, sex, region, and index year as additional matching variables. After adjusting for behavioral health visits, polysubstance use disorders, and psychiatric disorders using conditional logistic regression, the odds of OUD medication exposure were 3.8 (99% confidence interval: 3.0 – 4.9) times higher in cases than controls. Evaluation of angiotensin converting enzyme inhibitors (e.g. lisinopril) as a negative control revealed no significant association between the medication and remission. This work demonstrates the feasibility of using administrative health claims data to evaluate the effectiveness of medications to treat substance use disorders.

ABSTRACT Professors repeatedly warn students against burnout throughout the years of schooling that is required to earn a credential or license to work with persons who suffer from a substance use disorder. Despite these many warnings, burnout amongst practitioners continues to occur. There has been considerable research done over the years on the phenomenon of practitioner burnout, its causes and how to prevent it. Substance use disorder practitioners’ challenges often include high caseloads, difficult cases and lack of self-care. The data collected through an electronic server Survey Monkey allowed for a quantitative cross-sectional analysis which focused on participants’ perceptions of the causes of burnout and methods used for self-care. Respondents were recruited from two substance use disorder treatment programs, participation was voluntary. The analysis highlighted that the survey participants (n=30) view self-care as an appropriate intervention against burnout. These findings present: underlying causes of burnout; effective self-care practices for practitioners who are suffering from burnout; and how practitioners with higher education viewed self-care differently. Among the goals of the research done in this project was to bring awareness to; underlying causes of burnout; solutions to prevent burnout and effective techniques currently being used by practitioners that contributes additional knowledge to social work’s knowledge on burnout and self-care methods for practitioners experiencing burnout symptoms.

Numerous consequences of sexual assault have been identified, including psychological consequences such as posttraumatic stress disorder (PTSD) and health-risk behaviors such as substance misuse. Previous research has indicated that survivors of sexual assault may engage in substance misuse (i.e. alcohol and other illicit and prescription drug use) in attempt to suppress negative thoughts, memories, and flashbacks of the assault. The present study seeks to expand on and examine health-risk behaviors among undergraduate college women after the experience of sexual assault. Although many researchers have focused on the use of alcohol following sexual assault, less have studied non-medical use of prescription drugs (NMUPD) as an alternative method of maladaptive coping. NMUPD has recently been identified as the fastest rising recreational substance among college populations. With NMUPD becoming a norm among college students in recreational settings, exploring NMUPD for alternative uses seems like the next logical step in research. This study views sexual assault on a continuum starting from unwanted sexual contact and ending in completed rape. This study aims to bridge the gap in research by attempting to connect the risky behavior of NMUPD to coping with any experience on the sexual assault continuum among college undergraduate women. Participants with and without a history of sexual assault were recruited for the present study. Participants completed a measure of sexual assault history and severity, along with questionnaires assessing current alcohol, marijuana, and NMUPD use

There is convincing support for the link between family composition and adolescents’ problem behaviors. What is less clear is the extent to which these relations exist for African-American adolescents. Previous studies have demonstrated that this relation varies by gender. However, there is limited evidence to suggest the potential moderating influence of adult support. The purpose of this study was to examine the influence of family composition on adolescents’ physical aggression, delinquency, and substance use. The study comes from secondary analyses of a larger study that evaluated the effectiveness of a violence prevention program. The current study included 1,116 African-American middle school students from an urban setting who endorsed living with their biological mother and considered her to be their parent. Results indicated that among adolescents who identified their nonresidential biological father as their parent, those in stepfather families reported lower levels of delinquency than those in single-mother families. Support was not found for similar differences in self-report of delinquency and substance use, and teacher-report of adolescents’ physical aggression. No other differences in family composition were found for adolescent problem behavior. Support was also not found for the moderating roles of gender or adult support. However, self-report of delinquency and substance use, and teacher-report of physical aggression were negatively related to adult support. This was not the case for self-report of physical aggression. These findings suggest that interventions may need to provide additional resources that would help both parents and adolescents within single-parent families.

The prevalence of substance use and related problems increases during adolescence and peaks in young adulthood with substantial increases during the transition from high school to college (Johnston et al., 2018). However, these increases are not universal for all students (White et al., 2006), and there is substantial variation in rates of substance use during the first year of college (Borasri et al., 2007; Frisher et al., 2007). It is important to identify the individual and environmental factors that serve as risk factors for substance use as well as factors that may promote or protect against use during the high school to college transition. This prospective longitudinal investigated the impact of risk, promotive, and protective factors on the substance use outcomes of 150 high school seniors transitioning to college. The prevalence of alcohol and marijuana use substantially increased from high school to the first semester of college. Results indicate that ADHD symptoms at the end of high school predicted residualized change in alcohol and marijuana use during the first semester of college (i.e., controlling for the autoregressive effect of use during college). For alcohol use (but not marijuana), ADHD symptoms continued to predict subsequent use across the first year of college (from fall to spring of the first year). Promotive models revealed that adaptive social perceptions predicted decreased alcohol and marijuana use, and academic motivation predicted decreased alcohol use, after controlling for the role of ADHD symptoms. Adaptive social perceptions about each substance was protective against future alcohol and marijuana use both before and after the transition to college demonstrated by significant interaction effect with ADHD symptoms, after controlling for the direct risk and promotive effects in the model. These interactions illustrated that adolescents with elevated ADHD symptoms who have high friend disapproval of substances may experience resilience with respect to substance use outcomes. Academic motivation demonstrated promotive (direct) effects for reducing the risk for alcohol use but protective effects were not found. Future research should seek to elucidate more specific mechanisms through which youth and adolescents with elevated ADHD are protected against the high risk for substance use problems.