It has been argued that individuals receiving traditional alcohol treatment do not necessarily perceive life-long abstinence from alcohol as a favorable treatment outcome, and that negative expectations associated with this abstinence goal may have an adverse effect on treatment outcome. However, "abstinence expectancies" have never been systematically explored. This study used the Theory of Planned Behavior to investigate the relationship between the abstinence outcome expectancies of alcoholics beginning treatment and subsequent alcohol consumption. The independent and combined effects of abstinence outcome expectancies, alcohol outcome expectancies, self-efficacy expectancies (to abstain from alcohol use), and the normative beliefs of individuals beginning inpatient abstinence-oriented alcohol treatment were related to level of drinking during the 90 days following treatment. One hundred ten individuals receiving inpatient alcohol treatment were recruited for the main portion of this study. A questionnaire that included belief-based measures of attitude toward alcohol and abstinence, a belief-based measure of social normative pressure to either use or abstain from alcohol, a belief-based measure of one's perceived behavioral control to abstain from alcohol, and a measure of behavioral intention to use alcohol during the 3 months following treatment was developed for use in this study. The questionnaire was administered to all subjects. During the 90-day Follow-Up period, subjects were sent brief questionnaires and asked to report any alcohol or drug use. Eighty-nine percent of the subjects provided follow-up information for the first 30 days, while 76% provided information for the entire 90 days. An analysis of the data indicated that scores obtained from the belief-based measure of perceived behavioral control and scores from the belief-based measure of attitude toward abstinence were moderately correlated with intention to abstain from alcohol, while alcohol attitude scores and subjective norm scores were uncorrelated. Contrary to expectations, scores obtained from a measure of intention to use alcohol and the measure of perceived behavioral control were minimally predictive of scores from follow-up measures of drinking. However, intention and perceived behavioral control were minimally predictive of scores from follow-up measures of drinking. However, intention and perceived behavioral control scores were somewhat more predictive of drug use for the 90-day Follow-Up period. These results were discussed in light of the Theory of Planned Behavior and the similarities between alcohol expectancies and drug expectancies.

Indiana University-Purdue University Indianapolis (IUPUI) / Opioid misuse and addiction has been widely identified as a public health problem, contributing substantially to the nation’s morbidity and mortality. Over the past two decades, misuse of prescription opioids pain relievers has substantially increased; heroin use has resurged; and, more recently, abuse of high-potency synthetic opioids such as fentanyl have fueled the epidemic. Nearly 12 million Americans (or 4.4%) aged 12 and older misused some type of opioid (prescribed or illegal) in the past year. Furthermore, the percentage of substance use treatment admissions attributable to opioids nearly doubled in the U.S., from 20.8% in 2000 to 40.5% in 2015. The purpose of this dissertation research was to investigate associations between prescription pain reliever use and subsequent negative health outcomes, including opioid misuse or addiction, and neonatal abstinence syndrome. This research focused on three specific aims: Specific Aim #1: Examine heroin use among Indiana’s substance use treatment population to measure the extent, trends, and patterns of use, as well as to assess the relationship between prescription opioids and subsequent heroin use; Specific Aim #2: Analyze 2014 INSPECT (Indiana’s prescription drug monitoring program) data to identify factors that increase patients’ likelihood to engage in opioidrelated risk behaviors; and Specific Aim #3: Review U.S. trends in neonatal abstinence syndrome (NAS) incidence from 2008-2014, measure regional variability, and identify personal and environmental risk factors associated with NAS. / 2020-08-09

Indiana University-Purdue University Indianapolis (IUPUI) / Neonatal abstinence syndrome (NAS), the constellation of withdrawal symptoms experienced by neonates exposed to opioids prenatally, is an epidemic affecting an estimated 23,580 infants each year with an annual cost of $720 million. The purpose of this study was to examine factors associated with the incidence and severity of NAS as measured by the need for initiation of neonatal medication, peak medication dose, hospital length of stay (LOS), and hospital costs among newborns born to opioiddependent mothers. A retrospective review of medical records was conducted with two convenience samples: 204 infants born to mothers who used opioids during pregnancy; and 121 of these infants who required treatment with morphine to control symptoms of NAS. Data from April 2011 to September 2017 were collected from medical records of a large Midwestern hospital. Exploratory analysis and descriptive statistics were performed. Associations between independent variables and outcomes were examined using correlations, chi-square, t-tests, analyses of variance, and linear regression. Of the 204 neonates who were exposed to opioids prenatally, 121 (59%) developed symptoms of NAS requiring treatment with morphine. Neonates requiring morphine had significantly higher gestational ages than those who did not (37.7 vs 36.4 weeks; p = < .001) and their mothers were present at the neonates’ bedside a lower proportion of their total hospital stay (mean = 0.5684 of days vs 0.7384 of days; p = < .001). Compared to maternal use of buprenorphine, maternal methadone use was associated with higher peak morphine doses needed to control the neonate’s withdrawal symptoms (0.089 mg/kg versus 0.054 mg/kg; p = .023), and with longer hospital length of stay when compared to maternal use of buprenorphine and other opioid analgesics (34.2 vs. 20.8 vs. 22.5 days, respectively; p=0.02). Higher visitation time from the primary caregiver was correlated with lower hospital LOS (r = -0.421; p = < .001). Future research is needed to examine these relationships prospectively in a larger and more diverse sample. An effective response to the epidemics of opioid use during pregnancy and the incidence of NAS requires ongoing coordinated research and intervention in clinical care, public health, and health policy. / 2019-11-06

The aim of this diploma thesis is to study the effect of morphine withdrawal on catecholaminergic and serotonergic neurotransmitter system in rat brain. Theoretical part of this thesis summarizes basic information known about principles of neurotransmission with focus on the catecholaminergic and serotonergic system, metabolism of its components, their signaling, relevant receptors, their distribution, and especially their effect on morphine dependence and subsequent withdrawal. It also summarizes briefly principles of opioid signaling and outlines the findings yet known about neurochemical analysis of the transmitter systems mentioned above. Experimental part of this thesis is focused on the optimization of the method of high performance liquid chromatography with fluorescence detection and its subsequent use to determine basic components of catecholaminergic and serotonergic neurotransmitter system in samples of different part of brain of rats affected by intraperitoneal administration of morphine sulphate, and its subsequent withdrawal and correspondings unaffected control rats. The expression of selected catecholaminergic receptors in identical samples is also detected. This thesis succesfully implements gradient into the originally isocratic method of high performance liquid chromatography...

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Objectives Many addicted pregnant patients receiving buprenorphine medication-assisted therapy (MAT) wish to discontinue this medication while pregnant. This study was undertaken to determine whether outpatient detoxification from buprenorphine during pregnancy is safe and effective when confirmed with postdetoxification urine drug screens (UDSs). Methods This case series reports the maternal and neonatal outcomes for 21 patients who ended MAT with buprenorphine while pregnant. A retrospective chart review of both maternal and newborn electronic medical records was performed to obtain results. Newborn neonatal abstinence syndrome (NAS) diagnosis, need for morphine, maternal safety and fetal/newborn complications were assessed. Maternal sobriety was documented with UDSs at the time of admission for delivery. Umbilical cord blood also was assessed for substances of abuse. An additional 182 pregnant women who lowered their buprenorphine doses but did not decide to end MAT were assessed via routine quality assurance methods. Results None of the women who stopped buprenorphine during their pregnancy as confirmed by UDSs and umbilical cord sampling delivered neonates who had NAS. Eleven patients ended MAT with medical assistance and 10 ended MAT without medical assistance. No overdoses were reported for the 182 additional pregnant patients who indicated an intention to taper buprenorphine dosage while pregnant but who did not decide to end MAT; the neonatal benefits were obtained without any identified maternal harm. Conclusions The neonates of pregnant women enrolled in an outpatient buprenorphine MAT tapering program who are able to completely stop taking buprenorphine (as documented by negative urinary drug screen) are very unlikely to have NAS. Further research will be important.

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Neonatal abstinence syndrome (NAS) is a syndrome of withdrawal symptoms in newborn infants that have a history of prenatal exposure to certain substances. Affected infants may have gastrointestinal (GI) issues, such as gassiness and diarrhea. Although infants with known exposures may be monitored in the first few days of life, it is unclear how long these symptoms persist. This poster will examine GI issues in the first six months of life across four groups of infants: those with prenatal opioid exposure, those with prenatal substance exposure that does not include opioids, those with polysubstance exposure, and those without substance exposure in a pediatric clinic in northeast TN. A retrospective chart review of 600 charts of infants born from 2017—2020 was conducted with IRB approval in a pediatric clinic in rural middle Appalachia. Of these, 300 charts were selected based on known prenatal substance exposure, and the other 300 charts were randomly selected. A REDCap extraction manual was created, research assistants were trained, and % agreement was determined. Data was collected about type of prenatal substance exposure, growth, and medical conditions in the first three years of life. Infants were divided into groups by type of prenatal substance exposure for analysis. The opioid-only group included exposure to buprenorphine, methadone, or other opiates. The other (non-opioid) exposure group included exposure to marijuana, cocaine, benzodiazepines, methamphetamines, and prescription ADHD medications. The polysubstance exposure group included exposure to both opiate and non-opiate substances. The control group had no prenatal substance exposure. Analyses were performed using SAS version 9.4. Descriptive statistics showed the demographics of the sample were representative of the population in rural middle Appalachia, with a predominantly Caucasian sample of 121 females and 123 males, mostly receiving TennCare. Chi-square results showed there was only a statistically significant difference between the prenatal substance exposure groups at 2 months, X2 (3, N = 176) = 8.03, p = 0.045, but not at hospital discharge, within the first few days of life, at 1 month, 4 months, or 6 months. Infants in the opioid-only exposure group were most likely to have GI issues. These findings suggest that GI issues are more likely to occur in infants with certain prenatal substance exposures. This poster also shows a longitudinal perspective of these issues, indicating that the symptoms may persist in the first few months of life. Thus, caregivers of infants at risk for NAS may benefit with information about the long-term effects. Because the retrospective chart review is still in progress, this poster only analyzes a preliminary number of charts. Future research should also take into consideration other factors that may be associated with GI issues in this population, such as nutrition.

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Sex education policies and programs in Florida are largely dominated by the abstinence-only approach. This paper makes the case that abstinence-only education is a failing policy in Florida, and evaluates strategies advocates may use in order to accomplish reform. Three different strategies are evaluated: countywide school district reform, statewide rejection of federal abstinence-only funding, and statewide standardization of sex education via legislation. Contrasts are drawn between all three strategies with regard to their potential impact on sex education policy in Florida, viability, and the challenges they present to advocates. This paper concludes that statewide standardization of sex education in Florida represents the best way to remedy the problem of insufficient sex education, but is unlikely to occur without increased bipartisan support in the Florida legislature. Statewide rejection of Title V federal abstinence-only funds remains an important policy goal for the purpose of accomplishing an end to federal abstinence grants but would likely achieve very little for Florida's students. Countywide sex education changes are thus far the only substantive victory for sex education advocates in Florida and should be instituted across the state with advocates taking special care to engage teachers, medical professionals, parents and local community leaders.