Women with Substance Use Disorders (SUD) have high rates of trauma and PTSD, which is linked to greater physical and mental health problems and poorer SUD treatment outcomes. While research affirms trauma should be addressed during SUD treatment, the majority of addiction programs do not offer such services. One promising intervention is Pennebaker’s expressive writing paradigm, which includes disclosure of traumatic/stressful experiences through 20-minute writing sessions over 3-5 consecutive days. While expressive writing has been linked to improvements in mental and physical health, the intervention has not been studied in persons with SUDs. The present study was a randomized clinical trial comparing expressive writing to control (neutral topic) writing. Conducted in a residential SUD program for women, the study: 1) compared psychological and physical health profiles in SUD women with and without co-morbid PTSD and/or trauma; 2) compared 2-week and 1-month outcomes for the experimental and control groups; and 3) examined immediate and more distal levels of psychological distress following expressive writing. Study participants were N=149 women randomized to either the expressive writing or control writing condition. All women completed 20-minute writing sessions daily for 4 consecutive days. As predicted, SUD women reported high rates of trauma and PTSD, and those with such co-morbidities had more severe psychological and physical health problems. At 2-week follow-up, expressive writing participants showed greater reductions in post-traumatic symptom severity and anxiety scores than control writing participants. While no group differences were found at 1-month follow-up, this was due largely to significant improvements for both groups over the course of residential treatment. Finally, expressive writing participants showed increased negative affect immediately after each writing session, but there were no differences in pre-writing negative affect scores between groups the following day. By the final writing session, participants were able to write about traumatic/stressful events without having a spike in negative affect. Study results suggest expressive writing may be a brief, cost effective, adjunct to SUD treatment. Furthermore, expressive writing, when implemented in a residential SUD setting, appears safe, and warrants further study as a strategy for addressing trauma and PTSD in tandem with SUD treatment.

Little research has examined the content of parent-adolescent communication about substance use and variables that may influence it. Using a grounded theory approach for secondary data analysis, qualitative data were drawn from a longitudinal study of coping and substance use in a sample of urban African American adolescents (N=132; M= 13.77 years) and their mothers in Richmond, VA. Transcripts of interviews with participants’ mothers regarding their conversations with their adolescent about alcohol, tobacco or other drugs were microanalyzed by two coders in three sets according to the youth participant’s maternal and familial history of substance abuse. Findings revealed considerable similarity in themes across groups, particularly in providing information, warning about the harms of use, and offering strategies to resist use. Differences in messages were most obvious in the expectations and attitudes conveyed. Future research should further address variables that influence message content and make links from these messages to later youth substance use or abstinence.

Eating disorders and substance use disorders both exhibit a clear sex-difference in prevalence. Eating disorders are more common in females while substance use disorders are more common in males. Previous research has also established a strong association between these two disorders, especially within females. Much less research has examined comorbity in males. The etiology and reasons for these sex-differences and for the comorbidity of eating and substance use disorders remain unclear. The present report aimed to examine disordered eating (DE), substance use (SU), and their comorbidity further, in both sexes, using disorder eating attitudes and behaviors and substance use rather than diagnoses. DE was examined with the Drive for Thinness, Bulimia, and Body Dissatisfaction subscales of the Eating Disorder Inventory-II. Nicotine, alcohol, and illicit drug use was also assessed. Male and female twin pairs from The Swedish Twin study of CHild and Adolescent Development will be used which includes 1,480 twin pairs assessed at three age points; 13-14, 16-17, and 19-20. A twin design was utilized to examine important aspects of the genetic and environmental risk factors for DE, SU, and their comorbidity within three distinct studies. In Study I multivariate twin designs were used and revealed that an underlying common factor was responsible for the three facets of DE in both sexes at age 16-17. Sex-differences were exhibited within these genetic influences such that only 50% of the genetic risk for the DE factor is shared between the sexes. Total heritabilities for the three subscales were higher for females. In Study II a longitudinal, multivariate twin design was used and revealed that an underlying common factor was responsible for SU at all three assessment ages. In general, genetic effects became more substance specific, and common shared environmental effects decreased across the age groups. In Study III, the genetic and environmental covariance between the DE and SU common factors at age 16-17 was examined. The covariance between DE and SU was partly mediated through familial factors, and these factors impacted covariance similarly in the sexes. Genetic and shared environmental factors each accounted for approximately 50% of covariance.

This research study examined the effects of high levels of sugar intake on mental health in marijuana smokers. Because the literature demonstrates a similarity between refined sugar and other commonly addictive drugs, those who ingest a higher percentage of dietary sugar will score more poorly on the DASS21, meaning that with higher levels of sugar ingestion, a greater deficit in mental health functioning will be measurable. Of 16 participants, nine were female and seven were male, and the participants ranged from a normal weight to obese. The results did support the hypothesis of sugar dependence. This has implications for future studies on the impact of sugar on mental health. The results to this study may provide insight into potential for greater understanding of eating disorders associated with sugar dependence, thereby potentially leading to the development of more effective treatment options.

Thesis advisor: Rebekah Levine Coley / Substance abuse and dependence are among the nation's leading health issues, leading to more illnesses, disabilities, and deaths than any other modifiable health condition. Substance use among youth is of particular concern, as rates are higher than among any other age group and because early use is associated with a higher risk of later abuse and dependence and a higher incidence of related risk-taking behavior. Thus, a better understanding of the causes of substance use problems is a central issue. The primary goal of this study was to examine genetic and environmental predictors of youth alcohol and drug abuse and dependence. This study expands upon extant research by being the first to utilize a genetic risk score (GRS) approach to examine the joint effect of four dopaminergic genetic polymorphisms on substance abuse and dependence, by incorporating cumulative measures of environmental risk and promotive factors, and by examining gene-environment interactions (GxEs) and gender differences in substance use predictors, thus allowing for a more comprehensive assessment of environmental and genetic influences than has previously been attempted. Analyses were conducted on a national longitudinal sample of 1,396 Caucasian youth who participated in surveys and DNA sampling in the National Longitudinal Study of Adolescent Health, with individuals followed from adolescence (ages 12-18) into early adulthood (ages 24-32). Logistic regression analyses examined main and interactive effects of cumulative environmental risk and promotive factors and genetic risk scores on clinically significant alcohol and drug abuse and dependence in early adulthood. Analyses were conducted separately for males and females to examine gender differences in substance use predictors. Results show that a dopaminergic GRS index significantly predicted the likelihood that female, but not male, youth will meet clinical criteria for substance abuse and dependence, even after accounting for cumulative environmental influences. No evidence of GxE was found. These results provide a better understanding of the etiology of substance abuse and dependence and provide evidence of the utility of GRS methods for studying genetic influences on substance use behaviors. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental, and Educational Psychology.

O apoio social consiste em recursos provenientes dos laços sociais estabelecidos por um indivíduo e que provém auxílio principalmente em situações adversas, possibilitando amenizar efeitos negativos do estresse, atenuar efeitos psicológicos inerentes às patologias crônicas e promover ações de solidariedade e cidadania. Trata-se de um recurso presente na vida de todos os indivíduos, incluindo usuários de crack, sendo que, nesse caso, a análise de redes sociais mostra-se relevante, tendo em vista as consequências que tal consumo provoca no envolvimento social desses sujeitos, repercutindo nas relações familiares, de trabalho e restrição de possibilidades de cultura, lazer e acesso à saúde. Entre os serviços existentes para atender a essa população está o Consultório na Rua, programa implantado em 2011 e pautado na lógica de redução de danos, o que leva a considerar que esse configura-se como importante fonte de apoio social aos indivíduos atendidos. Entretanto, investigar a percepção dos usuários em relação ao papel de tal serviço em sua rede de apoio social ainda se faz necessário. Dessa forma, objetivou-se analisar as características da rede de apoio social de usuários de crack e o papel do Consultório na Rua para esses indivíduos. Para tanto, foi desenvolvido estudo transversal qualitativo, descritivo-exploratório em uma cidade de médio porte do interior de Minas Gerais, tendo como participantes 17 usuários de crack acompanhados por um programa de Consultório na Rua, bem como os quatro profissionais que compõem tal equipe. A coleta de dados se deu por meio de observação participante, entrevistas semiestruturadas com os usuários de crack e grupo focal com os profissionais. A análise dos dados ocorreu através de análise dos aspectos estruturais da rede de apoio dos usuários, seguida de análise de conteúdo das informações transcritas a partir das diferentes fontes, e, para abordagem metodológica, foi adotada a Análise de Redes Sociais. O estudo foi aprovado pelo Comitê de Ética em Pesquisa, sob Protocolo nº 50051015.4.0000.5393, e foi financiado pela Fundação de Amparo à Pesquisa do Estado de São Paulo, Processo nº 2016/05135-0. Os resultados apontaram um grupo composto majoritariamente de indivíduos pretos ou pardos, do gênero feminino, solteiros, com ensino fundamental incompleto, sem profissão, sem renda, que professavam a religião católica e com idade média de 37,2 anos. No tocante à rede de apoio dos usuários, evidenciou-se que esta é composta de familiares, pares, membros da comunidade e da equipe do Consultório na Rua, que proveem apoio material, informacional e emocional. Também foi observado que o trabalho desenvolvido pelo Consultório na Rua apresenta potencialidades como o respeito às condições individuais dos usuários, a existência de uma relação de confiança entre usuários e profissionais e a interlocução com a Rede de Atenção Psicossocial. Por outro lado, o serviço enfrenta desafios como a falta de capacitação de profissionais de outras instituições de saúde e a existência de serviços não sensíveis às diferenças de gênero, orientação sexual e estilo de vida dos usuários. Portanto, recomenda-se que a rede de compartilhamento de influências desses sujeitos seja levada em consideração para a elaboração de ações de prevenção e promoção de saúde, ainda que os profissionais de diferentes instituições de saúde trabalhem de modo colaborativo, a fim de combater o estigma sobre os usuários de drogas, e que em estudos futuros se busque explorar profundamente a dinâmica das relações da população em situação de rua, com foco nos apoiadores informais, e que sejam pensadas estratégias de ampliação da perspectiva de atuação do Consultório na Rua, visando os eixos da reabilitação psicossocial / Social support consists in resources derived from social bonds established by an individual and which provides assistance in adverse situations, making it possible to alleviate negative effects of stress, attenuate the psychological effects inherent in chronic pathologies, and promote solidarity and citizenship actions. It is a resource present in the lives of all individuals, including users of crack, and in this case, the analysis of social networks is relevant, considering the consequences that such consumption causes in the social involvement of these subjects, reverberating on family relationships, work and restriction of possibilities of culture, leisure and access to health. Among the services available to attend this population, there is the Outreach Service, a program implemented in 2011 and based on the logic of harm reduction, which leads to consider that this is an important source of social support for the individuals attended by it. However, investigating users\' perceptions regarding the role of such service in their social support network is still necessary. The aim of this study was to analyze the characteristics of the social support network of crack users and the role of this Outreach Service for these individuals. For that, a qualitative, descriptive-exploratory cross-sectional study was carried out in a medium-sized city in the countryside of Minas Gerais, with 17 crack users accompanied in an Outreach Service program, as well as the four professionals that compose the team. Data collection was made through participant observation, semi-structured interviews with crack users and a focus group with professionals. Data analysis was performed through analysis of the structural aspects of the users\' support network, followed by content analysis of the information transcribed from the different sources and, for methodological approach, the Social Networks Analysis was adopted. The study was approved by the Research Ethics Committee, under protocol no. 50051015.4.0000.5393, and was funded by the Research Support Foundation of the State of São Paulo, process nº 2016/05135-0. The results showed a group composed mainly of black or brown individuals, female, single, with incomplete elementary school, without profession, without income, who professed the Catholic religion and with an average age of 37.2 years. Regarding to the user support network, it has been evidenced that it is composed of family members, peers, members of the community and the team of the Outreach Service, who provide material, informational and emotional support. It was also observed that the work developed by the Outreach Service presents potentialities such as respect for the individual conditions of users, the existence of a trust relationship between users and professionals and the interlocution with the Psychosocial Attention Network. On the other hand, the service faces challenges such as the lack of training of professionals from other health institutions and the existence of services that are not sensitive to the gender, sexual orientation and lifestyle of users. Therefore, it is recommended that the network of sharing of influences of these subjects could be taken into account for the elaboration of actions of prevention and health promotion, although the professionals of different health institutions work in a collaborative way, in order to combat stigma on drug users, and for future studies it is sought to explore deeply the dynamics of the relations of the population in a street situation, with a focus on informal supporters, and to devise strategies to expand the perspective of the Outreach Service, focusing on psychosocial rehabilitation

Thesis advisor: Thomas O'Hare / Substance use and suicide among adolescents is a pervasive problem in the United States. It is estimated that over 190,000 youth go to the emergency department each year as a result of alcohol related injuries and over 5,000 youth are estimated to die each year from alcohol related incidents. Moreover, suicide is the second leading cause of death for adolescents, resulting in more than one in ten deaths among adolescents. Research has demonstrated that a history of childhood abuse is a strong risk factor for suicidal ideation and alcohol misuse and related problems. It is estimated that 29% of maltreated youth engage in substance use with 9% reporting moderate to high levels of use and 5% reporting risky suicidal behavior. Although prior studies provide a foundation for understanding substance use and suicidal thoughts among maltreated youth, some significant gaps remain in the knowledge base including the use of older data, treating all maltreated youth as a homogenous group, and looking at substance use and suicidal thoughts as independent outcomes. This dissertation fills some of these gaps in the empirical literature by focusing on three specific aims: 1) examine the co-occurrence of substance use and suicidal thoughts among maltreated youth; 2) investigate the longitudinal predictors of substance use and suicidal thoughts among maltreated youth; and 3) assess whether the predictors of substance use and suicidal thoughts are similar or different across placement types (in-home care, kinship care, or foster care). The National Survey on Child and Adolescent Wellbeing (NSCAW II) restricted dataset is used as the primary source for the analyses to address each aim. Policy and practice implications are provided for the fields of addiction, mental health, and child welfare. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Thesis (M.S.)--Boston University / This study is concerned with eight alcoholic adult patients at the Washingtonian Hospital. The parent-child relationships of these adult patients, when they were children, will be investigated to gain some understanding as to the factors involved in their present alcoholism.

This evaluative study examined the impact of recreational therapy interventions on intrinsic motivation and holistic functioning among adults at a substance use treatment facility. West (2001) identified motivation as a key variable in treating substance use disorders, and self-determination theory, specifically intrinsic motivation, provided a useful framework for this study. Intrinsic motivation is grounded in self-determination theory and defines various motivation types and how to increase participants' engagement. Holistic functioning is another tool in assessing a participant's recovery. For this evaluation, four domains were specifically assessed: (a) physical, (b) leisure, (c) social, and (d) daily living functioning. These quality of life components are affected heavily during prolonged substance use. Results suggest that recreational therapy interventions utilizing a self-determination framework improves participants' intrinsic motivation and holistic functioning in a substance use treatment setting.

A large portion of U.S. inmates and parolees experience co-occurring substance use and mental health disorders (COD). Offenders with COD exhibit significantly poorer outcomes than offenders who do not have COD, including less time to rearrest and reincarceration. Research shows that transition services for substance use and mental health disorders improve parolee outcomes, yet a majority of offenders with COD do not receive transition services prior to discharge or upon release from correctional facilities. Using a nationally representative sample of offenders with COD (secondary data from the CJ-DATS; N=811), this study analyzes the treatment effects of Transition Case Management (TCM) on parolees' drug use, rearrest, and reincarceration during the first nine months of parole, on a sample of offenders with COD. Results indicate there are no statistically significant differences between TCM treatment and control groups when predicting likelihood of rearrest, reincarceration, and drug use.