No description available.

No description available.

Contingency management (CM), an intervention that typically provides financial incentives for abstinence, has also been applied to treatment engagement. However, little is known about the magnitude of treatment effects when financial incentives are provided for attendance. A systematic search was conducted to identify studies that included incentives for attendance, either in isolation or in combination with incentives for abstinence. Meta-analysis was used to estimate the effect sizes on treatment attendance and abstinence. A total of 10 studies including 12 CM treatments (6 incentives for attendance only and 6 incentives for both attendance and abstinence) with 1,673 participants were identified. Results indicated a moderate effect (d = 0.47, 95% confidence interval (CI) [0.24, 0.68]) on attendance relative to non-reward active comparison conditions, p <.001. Frequency of incentives for attendance was significantly associated with larger effect sizes. Results also indicated a small effect (d = 0.22, 95% CI [0.11, 0.32]) on abstinence relative to non-reward comparisons, p <.001. Overall, this meta-analysis supported financial incentives for attendance to increase treatment engagement, with smaller effects on abstinence compared to those observed in meta-analyses on financial incentives for abstinence. Although financial incentives for attendance increased clients' attendance, the impact on abstinence was weaker than conditions that included both incentives for attendance and abstinence. Clinics implementing CM should consider these differential effects in the selection of reinforcement targets.

No description available.

This study sought to investigate fatal overdoses in Orange County, Florida during the years of 2019, 2020, and 2021. Data for this project was provided by the Orange County Medical Examiner's office. Each overdose death was coded for age, sex, race, and cause of death. The purpose of the study is to identify trends to inform policy reform. The results reveal that fentanyl overdose deaths are continuing to rise as heroin overdose deaths decrease. Additionally, there is greater upward trends in polysubstance opioid overdose deaths as compared to non-opioid polysubstance overdose deaths. Ultimately, a specific type of overdose death cannot be predicted by race or sex. The implications of this study are that awareness campaigns and treatment opportunities should highlight that an overdose death can happen to anyone.

While there is a substantial body of placed-based evaluations of drug enforcement strategies, little is known about the nature and effectiveness of the routine tactics used by local police to target individual drug offenders. This study used a mixed-method approach to build on existing research on the efficacy of drug enforcement by documenting the nature and consequences of street-level drug enforcement at the local level. First, a focus group of drug enforcement experts was conducted to identify the tactics used to generate arrests and various types of evidence believed to strengthen drug cases. Next, official data in the form of police reports and court records were coded from one year of proactive felony drug arrests in a large, urban police department. The relationship between offender-focused drug enforcement tactics and various court outcomes (e.g., felony prosecution, formal conviction, and incarceration) were examined through logistic regression analyses. Results indicate traffic stops were the most frequently used tactic to generate felony drug arrests. However, buy-walks were more effective than traffic stops at receiving felony prosecutions. In contrast, search warrants were significantly less likely to result in prosecution. Implications for research and policy are discussed.

This thesis attempts to document and illuminate the growing issue of prescription drug abuse among the elderly population. The average elder in the U.S. takes at least one prescription drug per day, depending upon their health status. Likewise, elders that suffer from multiple chronic conditions are more likely to take multiple prescription drugs. As the lifespan of humankind grows well into their 90's and older, even more elders will be placed on prescription drugs. As part of this study, a narrative literature review was conducted to summarize the topic of prescription drug abuse amongst the elderly. The findings suggest that elderly white women over the age of 80 years old are more likely to take prescription drugs that lead to a higher risk of bodily injuries and death. This study is critically important and essential since the current generation that meets the age requirement to be considered elderly is the "Baby Boomer" generation. The "Baby Boomer" generation, defined as individuals born between 1946 and 1964, is considered one of the largest generations recorded in modern times. This study will be useful for practitioners, residential care facilities, policymakers, and family members to have better oversight and communication with elders suffering from chronic conditions that take prescription drugs to cure their illnesses.

This thesis examines the possibilities of living an authentic life for an alcoholic, both in and out of Alcoholics Anonymous. Authenticity is explored using the existential models put forth by Jean-Paul Sartre and Soren Kierkegaard. Alcoholics Anonymous figures prominently in this analysis. It is suggested that A.A. acts inauthentically in its claims that it is not a religious organization. A.A. creates special problems for female alcoholics because of the sexist and masculinist nature of its primary literature. While A.A. claims that its message is the only way by which an alcoholic can recover, other treatment methods exist. Suggestions are made that A.A. revise its main texts, and two alternative organizations to A.A. are briefly discussed.

Substance use disorders are chronic brain disorders and must therefore be treated on an ongoing basis. Accordingly, the concept of recovery capital has been developed to account for the internal and external resources that an individual can mobilize in order to recover from a substance use disorder. However, the concept has scarcely been applied to emerging adults. Although they are at twice the risk of developing a substance use disorder relative to their adult or adolescent counterparts, emerging adults in addiction and recovery are understudied. This phenomenological study aims to explore and describe the experience of emerging adults in recovery and to identify the barriers and facilitators to their recovery. The informants (n=8) were 18-25 year olds in recovery from substance use disorders. Data was collected using semi-structured interviews and subsequently analyzed for emerging themes. The results from this study suggest that the developmental tasks facing emerging adults are exacerbated in addiction and recovery.

The aim of this thesis is to expand our understanding of the etiology of alcohol misuse and related disorders in African Americans using genetically informative study designs. Specifically, we take advantage of the candidate-gene approach and polygenic score analysis to extend the literature specific to African American populations. Chapter 2 explores gene x environment (GxE) interactions through the candidate gene approach to explore the relationship between two genes chosen on their potential relevance to stress response and adolescent alcohol use and misuse, among African American youth living in highly impoverished neighborhoods, as moderated by stressful life events. Chapter 3 implements polygenic score analyses to examine the effect of an aggregate of markers. We explore whether polygenic risk for alcohol dependence – derived from GWAS estimates in one discovery sample – predict alcohol use and broader externalizing behaviors and interact with stressful life events to predict alcohol use/misuse among high-risk African American youth.