Substance Use Disorder (SUD) is a chronic relapsing disease that afflicts 10% of the US population. Recidivism rates for SUD treatment in the United States (US) remain high. Couple therapy has be shown to be an effective treatment modality for SUD, and research consistently indicates that couple therapy is more effective than individual therapy in treating SUD. Still, most US treatment centers do not use couple therapy as a primary treatment modality. To explore the underuse of couple therapy and the barriers that prevent its use, individual, semi-structured interviews were conducted with twenty (N = 20) clinical directors of SUD treatment centers across the US. A theoretical thematic analysis was used incorporating Everett Rogers’ diffusion of innovations theory to assess barriers that hinder the use of couple therapy to treat SUD in addiction treatment centers. Issues related to observability, compatibility, and complexity of couple treatment were found to severely impede the implementation of couple therapy in addiction treatment centers. Recommendations include ongoing research to determine influences on agency programming, fostering pro-research environments in universities and agencies, removing barriers to access to evidence-based practice information, and promoting the federal initiative of technology transfer in SUD treatment. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2020. / FAU Electronic Theses and Dissertations Collection

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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.

This investigation examined multidimensional perfectionism, shame and maltreatment in 45 women with bulimia nervosa, 14 women with binge eating disorder and 26 women with anorexia nervosa, purging type, all of whom suffered from comorbid substance use disorders. Participants completed three perfectionism scales, one shame scale and one maltreatment scale. Results revealed that in the bulimia nervosa and binge eating disorder group, perfectionistic self-promotion and bodily shame were significant predictors of eating disorder severity while other-oriented perfectionism was a significant predictor of alcohol use severity. In the anorexia group, other-oriented perfectionism and bodily shame were significant predictors of eating disorder severity and nondisplay of imperfection was a significant predictor of drug use severity. All participants experienced elevated levels on all types of shame and maltreatment and on most perfectionism dimensions compared to normative samples. Findings should be utilized in developing treatment programs for those with comorbid eating and substance use disorders.

This investigation examined multidimensional perfectionism, shame and maltreatment in 45 women with bulimia nervosa, 14 women with binge eating disorder and 26 women with anorexia nervosa, purging type, all of whom suffered from comorbid substance use disorders. Participants completed three perfectionism scales, one shame scale and one maltreatment scale. Results revealed that in the bulimia nervosa and binge eating disorder group, perfectionistic self-promotion and bodily shame were significant predictors of eating disorder severity while other-oriented perfectionism was a significant predictor of alcohol use severity. In the anorexia group, other-oriented perfectionism and bodily shame were significant predictors of eating disorder severity and nondisplay of imperfection was a significant predictor of drug use severity. All participants experienced elevated levels on all types of shame and maltreatment and on most perfectionism dimensions compared to normative samples. Findings should be utilized in developing treatment programs for those with comorbid eating and substance use disorders.

abstract: Juvenile offenders suffer from substance use disorders at higher rates than adolescents in the general public. Substance use disorders also predict an increased risk for re-offending. Therefore, it is important that these juveniles, in particular, receive the appropriate substance use disorder treatment. The present study used logistic regression to test whether race/ethnicity would moderate the match between substance use disorder diagnosis and the receipt of a substance use disorder related service in a sample of male, serious juvenile offenders. Results showed that among those with a substance use disorder diagnosis, there were no race/ethnicity differences in the receipt of the appropriate service. However, among those without a substance use disorder diagnosis, non-Hispanic Caucasians were more likely to receive substance use service than were Hispanics or African-Americans. Post-hoc analyses revealed that when using a broader definition of substance use problems, significant differences by race/ethnicity in the prediction of service receipt were only observed at low levels of substance use problems. These findings shed light on how race/ethnicity may play a role in the recommendation of substance use disorder services in the juvenile justice system. / Dissertation/Thesis / M.A. Psychology 2013

In general, scholars agree that there are several contextual factors influencing immigrants in the UK to use alcohol and other drugs. Not much is known however about how and to what extend acculturative changes are influencing substance use in immigrants and members of minority ethnic groups. This study aims to develop a better understanding of the predictors of substance use by exploring the impact that acculturative changes have in patterns of substance use amongst Brazilian immigrants in the UK. A combination of quantitative and qualitative methods was adopted in a cross-national research sample compromised of Brazilian participants residing in the UK (n=164) and Brazilian participants residing in Brazil (n=161). Initially, quantitative analysis was carried out to explore country differences in types, frequency, and predictors of substance use. The quantitative analysis was followed by qualitative data collection to explore in-depth complex issues related to social and cultural factors that underlie the susceptibility of Brazilian immigrants to use alcohol and other drugs. Thematic Analysis was adopted to analyse the qualitative data. It was observed that Brazilians who had immigrated to the UK showed an overall increase in the frequency with which they used substances, however, significant differences were only found in recreational drug use, poly-substance use, and binge drinking. Such shifts were influenced by attitudes, values, and behavioural changes, and were strongly predicted by the stress caused by threat to cultural identity. Both drinking for social motives and gender differences predicted involvement in substance use in Brazilians in the UK and in Brazil, whereas resilience, impulsivity, positive and negative affect, and reasons for drinking motivated by conformity and coping where found to have no effect on patterns of substance use in either of the samples. Overall, it seems that, whilst Brazilians in the UK are motivated by negative reinforcement processes to use substances (e.g. coping), in Brazil participants are motivated by positive reinforcement processes (e.g. enhancement). High contact with both British and Brazilian cultures will only predict substance use when threat to cultural identity moderates this relationship. Brazilian immigrants new to the UK are at greater risk for substance use independent of any acculturative strategies or stresses. Length of residence in the UK does not predict the adoption of integration strategies and the stresses caused by acculturation can be experienced throughout the life course of the Brazilian immigrants in the UK.

abstract: Serotonin 1B receptor (5-HT1BR) agonists enhance cocaine intake in rats during daily self-administration (SA) sessions, yet decrease cocaine intake after prolonged abstinence. The goal of my dissertation was to examine if 5-HT1BRs are suitable targets for treatment development to attenuate psychostimulant intake. I first investigated if 5-HT1BR agonist effects that had been observed with cocaine generalize across psychostimulants, i.e., methamphetamine. Rats trained to self-administer methamphetamine received either CP 94,253 or the clinically-available but less selective 5-HT1D/1BR agonist, zolmitriptan, prior to tests for effects on SA both before and after a 21-day abstinence period. I found that CP 94,253 and zolmitriptan decreased the reinforcing and incentive motivational effects of methamphetamine, regardless of abstinence, unlike the pre-abstinence increase in cocaine SA observed previously with 5-HT1BR agonists. The attenuating effects of CP 94,253 on methamphetamine were antagonized in a 5-HT1BR-mediated manner. Subsequently, I investigated the efficacy and mechanism involved in effects of zolmitriptan on cocaine SA in male and female rats. Rats trained to self-administer cocaine received zolmitriptan prior to tests for effects on SA before a 21-day abstinence period. I found that zolmitriptan decreased cocaine intake in both sexes regardless of abstinence and without altering sucrose intake. I further demonstrated that the zolmitriptan effects on cocaine SA were mediated by both 5-HT1BRs and 5-HT1DRs. Finally, I examined if the abstinence-induced decrease in cocaine intake observed with the selective 5-HT1BR agonist, CP 94,253, persists during relapse after abstinence or reverts to enhancing cocaine intake, similar to effects observed without an abstinence period. Rats trained to self-administer cocaine resumed daily cocaine SA sessions after the forced abstinence period to investigate the effects of CP 94,253 on cocaine relapse. I found that CP 94,253 attenuated cocaine intake in relapse tests, suggesting that the abstinence-dependent attenuation of CP 94,253 on cocaine SA remains even after resumption of daily cocaine intake. The findings suggest that 5-HT1BR agonists like CP 94,253 and zolmitriptan have clinical potential as treatments for psychostimulant use disorders. / Dissertation/Thesis / Doctoral Dissertation Neuroscience 2020

This study aimed to gain insight into the clinical practices and attitudes of currently practicing play therapists working with children with a parent with a substance use disorder. Participants in the study were play therapists credentialed by the Association for Play Therapy, either as a Registered Play Therapist™ or Registered Play Therapist-Supervisor™. A total of 198 play therapists participated in the study. Results demonstrated that variables including prior education, caseload of children affected by parental substance use, and the number of years since obtaining a mental health licensure explained 16% of the variance in participant attitude scores on the Drug and Drug Problems Perceptions Questionnaire (DDPPQ). Specifically, education (β = -.335, rs2 = .884, p < .001) was found to be a significant predictor of play therapist attitudes towards substance users as it explained 88% of the variance accounted for in the effect. Additionally, although not found to be significant, caseload (β = -.134, rs2 = .325, p = .058) was found to explain 33% of the variance accounted for in the effect. This initial exploration of play therapists' attitudes towards substance users provides strong evidence towards the importance of education and training in substance use disorders. Further exploration of play therapists' educational backgrounds in substance use and clinical experiences of working with children affected by parental substance use.

Positive, but distal consequences of reducing alcohol use among at-risk users may have little impact on behavior due to temporal discounting (Mazur, 1987), in which delayed rewards are devalued relative to more proximal rewards, even if such distal rewards actually provide considerably more value. Delay discounting may be manipulated using a variety of means, one of which involves utilizing prospective thinking about future autobiographical events and is termed Episodic Future Thinking (Atance and ONeill, 2001). Episodic future thinking (EFT) has been demonstrated in previous studies to be effective in reducing delay discounting relative to a variety of control conditions (Benoit, Gilbert, and Burgess, 2011; Daniel, Stanton, and Epstein, 2013a, 2013b; Lin and Epstein, 2014; Peters and Büchel, 2010) and recently among substance-abusing populations (Snider, LaConte, and Bickel, 2016; Stein et al., 2016). The present study examined EFT in a novel sample of at-risk alcohol users. Participants were randomized to EFT, episodic past thinking (EPT), or a control condition in which non-autobiographical events were recalled (CET). Immediately following intervention, results demonstrated significantly less discounting in EFT and EPT, relative to CET. At follow-up, EFT demonstrated significantly less temporal discounting and alcohol use, when compared to both EPT and CET. No differences among conditions in alcohol demand or alcohol use intentions were observed. The present study contributes a number of novel findings to the literature, most notably that engaging in EFT predicts reductions in alcohol use prospectively and that reductions in delay discounting associated with EFT persist at least a week later, without any additional intervention. Such findings suggest that EFT manipulations influence the valuation of future rewards. Additionally, findings support EFT as a useful supplement to existing empirically-supported treatments or a component of novel substance use disorder treatments. / Ph. D.