Background and Aims: Executive dysfunction is pervasive in substance-dependent individuals (Verdejo-García, Bechara, Recknor, & Perez-Garcia, 2006). As many as four-fifths of individuals in treatment for substance use disorders (SUDs) have co-existing lifetime psychopathology. Executive function deficits are tied to markers of decreased quality of life including increases in negative life events (Green, Kern, Braff, & Mintz, 2000), maladaptive social functioning (Kurtz, Moberg, Ragland, Gur, & Gur, 2005) and worsened treatment outcomes (Czuchry & Dansereau, 2003). Despite evidence of executive dysfunction across several mental disorders, few studies investigate how the co-occurrence of psychopathologies in SUDs impacts executive functioning. Methods: Here, we compare measures of executive function (i.e., the Iowa Gambling Test, Letter Number Sequencing Test, Stroop Test, Wisconsin Card Sorting Test, Continuous Performance Test, Towers Test, and Delay Discounting Test) in individuals with a) substance use disorder, b) substance use disorder and co-occurring major depressive disorder, c) substance use disorder and co-occurring antisocial personality disorder, d) substance use disorder and co-occurring major depressive disorder and antisocial personality disorder and e) no substance use disorder or co-occurring psychopathology. Results: Regression models of respective executive function measure outcomes as a function of education, income, age, and group membership indicated that the Delay Discounting Test and Continuous Performance Test were the only significant overall models (F(4, 313) = 12.699, p < 0.001 and F(4, 307) = 2.659, p = 0.033, respectively). Conclusions: Overall the Delay Discounting Test and Continuous Performance Test were the most sensitive to differences between substance use and psychopathology profiles assessed. / Master of Science

The mesolimbic dopamine (DA) system originates in the ventral tegmental area (VTA) and projects to the nucleus accumbens (NAc) and other areas including the basolateral amygdala (BLA), prefrontal cortex, and the hippocampus. Drug use induces reward and leads to dysregulation in these brain areas and eventually to substance use disorders (SUDs). Chapter 1 introduces the mesolimbic DA system and its relationship to drug use and their relevance to each chapter. Chapter 2 explores opioid effects on BLA circuitry which is known to play a role in the emotional response including anxiety and stress in SUDs. We showed that morphine induced an inhibitory effect on GABAergic lateral paracapsular cells (LPCs). These cells inhibit BLA principal neuron output and are influenced by opioids. Opioid activation in LPCs leads to upregulated BLA output, and activation in the NAc and central amygdala which may have important implications for stress/anxiety response for patients with SUDs. Chapter 3 explores the effect of interleukin-10 on the mesolimbic DA system. Specifically, cell-attached recordings of VTA DA neurons increase their firing rate in the presence of IL-10, and in vivo studies showed increased DA release in the NAc. Interleukin-10 receptors were expressed in VTA DA neurons and signals through the phosphoinositide 3-kinase. Surprisingly, IL-10 induced conditioned place aversion in mice which may be related to depression- and anxiety-like behaviors reported by others. Thus, IL-10 appears to be regulating the mesolimbic DA system and its association with reward which may be important in understanding the relationship between inflammation and SUDs. Chapter 4 explores the DA transporter (DAT) kinetics in the presence of psychostimulants using DA iontophoresis. We showed that iontophoretic DA delivery increased DA concentration and clearance rates compared to evoked release making it an important tool in measuring DAT kinetics. Cocaine was bath applied and slowed DAT reuptake at high concentrations and D2 stimulant quinpirole slowed the reuptake process but did not show any effect on DAT trafficking, and D2 antagonist eticlopride showed no change in reuptake or DAT trafficking. Cocaine-injected mice increased locomotion and reduced anxiety-like behavior, and iontophoresis experiments slowed reuptake with bath-applied cocaine. Thus, DA iontophoresis is useful in studying DAT blocker kinetics but has limitations in studying the effects of DAT trafficking. Chapter 5 discusses the impact these studies have on society, the limitations of each chapter, and future directions for this dissertation. Together these studies explore the reward system and its relationship with SUDs. The overarching aim has been to understand the involvement of DA in motivation and reward in the context of SUDs and the influence of opioids, cytokines, and psychostimulants.

Psychotherapy incorporating equine interaction (PIE) is emerging as an effective treatment for substance use disorder (SUD), but research is limited concerning physiological impacts during substance withdrawal. This study investigated impacts of PIE on salivary cortisol concentrations, heart rate, anxiety, and depression during SUD withdrawal. Heart rate and cortisol concentrations were measured in horses to determine potential human-horse coupling. Saliva samples and heart rates were collected pre and post PIE from residential SUD patients (n=18) and their therapy horses (n=4) during and following the withdrawal period. Participants (n=10) also completed a survey measuring anxiety and depression (P = 0.05). A strong negative correlation was found within the changes seen in human and horse cortisol concentrations during week two (r = -0.9, P < 0.01). Human heart rates decreased in week two (P = 0.01) and anxiety and depression decreased by week four (P ≤ 0.05). Results indicate psychotherapy incorporating equine interaction does not negatively impact stress parameters as the SUD patient progresses through the withdrawal period, and this intervention resulted in improved feelings of anxiety and depression.

<p dir="ltr">Background: Racial discrimination has been consistently associated with risk for alcohol use outcomes among racial/ethnic minority groups. This is particularly concerning given that engagement in alcohol use during adolescence has significant downstream effects on an individual's health into adulthood. Understanding factors that influence the relationship between racial discrimination and alcohol outcomes are needed to better understand the risk pathway and to identify malleable targets for interventions to reduce alcohol use among racial/ethnic minority adolescents. One potential candidate is emotion regulation as there is evidence that exposure to discrimination is associated with emotion regulation difficulties, and that emotion regulation difficulties are associated with alcohol outcomes. It is also plausible that emotion regulation is an external factor that strengthens or weakens to direct association between racial discrimination and alcohol use. Thus, the current study examined difficulties in emotion regulation (as measured by the State Difficulties in Emotion Regulation, S-DERS) as a mediator and moderator separately on the relationship between racial discrimination related stress (RDRS) and alcohol outcomes (i.e., use, quantity, frequency, alcohol use disorder, binge drinking, high intensity alcohol use) and risk for problems associated with substance use. To better understand the nuances within the emotion regulation construct, this study also examined the four subscales of the S-DERS (e.g., difficulties in nonacceptance, modulation, lack of awareness, lack of clarity) in a parallel mediation and moderation model to account for each domain’s unique effect on the racial discrimination-alcohol pathway. Methods: 714 self-identifying racial/ethnic minority adolescents aged 10-19 years old (62.9% male, mean age 16.21 years old, 58.1% African American/Black, 19% American, 9.9% Hispanic/Latino, 9.7% Asian American/Pacific Islander, 1.3% Middle Eastern/North African) completed an online questionnaire that included measures assessing experiences of racial discrimination related stress, state difficulties in emotion regulation, and alcohol outcomes. Results: Findings indicated a significant indirect effect of RDRS on alcohol outcomes through total state difficulties in emotion regulation (past year use b = 0.002, p <0.001; frequency b = 0.005, p <0.001; quantity b = 0.003, p <0.001; alcohol use disorder b = 0.056, p <0.001; binge drinking b = 0.004, p <0.001; high intensity alcohol use b = 0.003, p <0.001; risk for problems associated with substance use b = 0.007, p <0.001). When examining the subscales of emotion regulation, a significant indirect effect was found for difficulties in modulation within the relationship between RDRS and past year use, quantity, frequency, alcohol use disorder, binge drinking, and high-intensity alcohol use, but not for risk for problems associated with substance use. There were no significant indirect effects observed for the other subscales of emotion regulation. Additionally, when examining whether S-DERS or the S-DERS subscales moderated the relationship between RDRS and alcohol outcomes, no significant effects were found. Conclusion: These findings expand our understanding on potential mechanisms that underlie the racial discrimination-alcohol risk pathway among racial/ethnic minority adolescents, which may in turn help clarify the multifaceted nature of emotion regulation. As such, findings suggest that a unique effect was found for difficulties in modulation of emotions when accounting for the other domains of emotion regulation when examining the RDRS and alcohol outcomes relationship. Given that this study was cross-sectional, additional research utilizing a prospective study design can build off the current findings to confirm the proposed temporal pathway between RDRS, emotion regulation, and alcohol use outcomes. Moreover, findings suggest that difficulties in modulation and emotion regulation may be important constructs to include within treatments aimed at reducing alcohol use and prevention efforts among racial/ethnic minority adolescents experiencing racial discrimination related distress.</p>

Substance use is a growing concern among adolescents because it is a threat to their well-being and associated with negative outcomes in later life (NIH, 2014). Adolescence is a developmentally important time where independence grows, risks are taken, and some begin to experiment with substances (Burrow-Sanchez, 2006). Further, there is a high association between substance use and risk-taking behaviors, which can lead to involvement in the juvenile justice system. The rates of substance use are more alarming for juvenile delinquents (78%) (National Center on Addiction and Substance Abuse, 2004). Along with risk factors associated with early onset substance use, researchers have identified several protective factors including involvement in positive relationships with parents. In this dissertation, I studied gender-specific relationships between parent and child that were associated with lower rates of substance use among at-risk adolescents. I investigated if this relationship mitigated the effects of negative peer association on substance use among adolescents. Hierarchical logistic regression was used to complete analysis using secondary data. The sample consisted of 166 adolescents who were involved in the juvenile justice system. Results showed that higher relationship quality with mothers was found to be statistically significant in predicting lower substance use. Overall, gender was not found to predict substance use, nor did it moderate the relationship between negative peer association and substance use. Results from this study can inform prevention and intervention efforts by heightening awareness regarding the protective nature of relationships with parents, specifically with mothers for at-risk adolescents. Further research is needed to explore these gender differences more in-depth. It will be important to continue to explore gender-specific relationships and the various aspects of parenting that can lower the risk for substance use among at-risk adolescents. / Ph. D. / Gender-specific parent-child relationships were studied in this dissertation to explore protective relationships that are associated with lower rates of substance use among at-risk adolescents. This study included an investigation on relationships that mitigate the influence of negative peer association on substance use among adolescents. The sample included 166 adolescents who were involved in the juvenile justice system. Results showed that higher relationship quality with mothers predicted lower substance use for teens. These results can inform prevention and intervention efforts by improving awareness regarding relationships with parents that appear to be protective, specifically with mothers and at-risk adolescents. Further research is needed to explore these gender differences more in-depth. It will be important to continue to explore gender-specific relationships and the various aspects of parenting that can lower the risk for substance use among at-risk adolescents.

When adolescents enter residential treatment for difficulties experienced at school, with the juvenile justice system and/or their parent(s)r substance abuse is often not identified as a significant contributor to the presenting problem. However, the dynamics of adolescent substance abuse are described in the literature as interactive processes affected by family dysfunctions, inadequately learned coping skills and significant stressors. In this study, a treatment strategy was developed for families of adolescents in a residential treatment center setting, where adolescents, along with other identified problems were also determined to be actively abusing drugs and or alcohol. The treatment strategies focused on alcohol/drug abuse as a primary problem, and on relapse prevention through psycho education, family therapy and contingency contracting. Twelve adolescents and their families participated in the treatment program. A one year follow up was conducted. This thesis reports on four of these families indepth through the use of case studies. Comparisons and conclusions were drawn from the case studies which demonstrate that the treatment model is an effective auxiliary modality for use with substance abusing adolescents and their families. / Master of Science

The purpose of this phenomenological study is to describe participants' experiences in a monitoring program for impaired nurses in Virginia, determine what beliefs and attitudes underscore the participants' abilities to cope with the program, and uncover what meaning is made of the experiences. In Virginia, health care providers are supported through the Virginia Health Practitioners' Monitoring Program (HPMP). Limited research exists concerning the lived experiences of substance use nurses who are participating in a state monitoring agency. Research focuses on how a nurse copes with personal and job-related stress and the use of peer support as an important aspect of recovery. This study helps to uncover what policies are effective and ineffective and serves as valuable feedback to ensure the success of monitoring programs, the recovery of substance use nurses, and the safety of the public. In this phenomenological study, five participants were solicited, four females and one male. Three out of the five participants were near completion of the HPMP experience. Two participants were relatively new (over one year) to HPMP. The study focused on three primary research questions: (1) What has been the lived experience of the participant in HPMP?; (2) What beliefs/attitudes are used by the participants to cope with the monitoring experience?; (3) What meaning do the participants give to their experiences in the HPMP? Initially, a pre-interview was held on the phone. Then, two interviews were conducted in the participants' hometowns spaced one week to ten days apart. The first interview centered around gathering a focused life history and on the details of the experience. The second interview afforded the opportunity for reflection on the meaning of the experience in HPMP. Data analysis began with an immersion into the descriptive words of the lived experience of each participant. Through the compilation of textural and structural descriptions, three themes emerged from the rich data. The findings indicated that the participants felt overwhelmed with the program's requirements. Participants found the use of coping skills helped them work through the overwhelming rules and regulations. Finally, participants discovered that with acceptance of the program came accountability. / Ph. D. / A message on a t-shirt read, “I’m a nurse…what’s your superpower? Our society admires and respects the nursing profession. Nurses provide a service that is vital to patient comfort and recovery. Because of this responsibility, nurses are often under a tremendous amount of pressure. For relief, some nurses may turn to substance abuse. The discovery that a nurse has a substance abuse problem may lead to a sense of shame and dishonor and negatively impact the nurse’s career. This study focused on the experiences of nurses who were seeking treatment for substance abuse through the Virginia Health Practitioner’s Monitoring Program. The purpose of this study was to describe the experiences of impaired nurses who had been part of the Virginia Health Practitioner’s Monitoring Program and to find which policies were successful and which were not. Five participants were selected for this study. Two participants were new to the program and three had almost completed it. Three primary research questions were used in the study that focused on what participants had experienced in the program, their attitudes toward the program, and what meaning they gave their experiences. A phone interview was followed by two face-to-face interviews in which participants answered the research questions. The researcher analyzed the data by becoming immersed in the interview transcripts while looking for commonalities. The researcher discovered three themes that emerged. First, participants felt overwhelmed by the program’s requirements. Secondly, they all used coping skills to help them work through the rules and regulations of the program. Finally, they learned accountability and acceptance.

This study examines participant perspectives of medically assisted treatment (MAT) for opioid use disorder (OUD) in relation to critical factors such as overdose risk, stigma, housing, access, mental health, and criminal behavior. Nineteen participants were recruited from a residential treatment center for SUDs (substance use disorders) and asked about how MAT impacts these factors and their recovery. Findings indicate that MAT has positive impacts on perceptions of the ability to recover, overdose risk, mental health, and criminal behavior. However, there are significant flaws in the current system, including barriers to access and housing opportunities. These issues illustrate the need for changes in the current infrastructure of MAT and SUDs treatment that enable the many benefits of MAT.

This study examines the relationship between substance abuse and the need for parent skills training. Predicted is that adults in substance abuse treatment are likely to be in need of parent skills training. Previous research has associated the lack of parent skills with inept parenting practices that often leads to developmental problems in children.

Substance abuse is an expensive problem facing the American public and the criminal justice field. Using secondary data analysis this study examined 1,921 participants across five substance abuse programs within California and New York jail systems. Specifically this study explored the impact of location, demographic characteristics, offense committed, and previous drug treatment on successful completion of the treatment program. Descriptive analyses were used to examine the demographic characteristics of the sample and the types of drugs used by participants in the thirty days prior to jail admission. Results from bivariate analyses indicated that location, demographic characteristics, and previous drug treatment were all significantly related to successful completion. Implications for current correctional treatment programs and future research on this topic are discussed