This webinar will describe East Tennessee State University’s efforts to curb the opioid epidemic along the continuum of addiction. ETSU’s Academic Health Science Center has engaged multiple constituents to conduct federally funded research, community based practice and more importantly, to foster cross-sector engagement and education. The team hosts monthly meetings to facilitate partnerships across sectors with multiple aims. These aims include regional health improvement, research capacity development and community outreach. By the end of this webinar, participants will be able to: Describe multiple evidence-based approaches for the prevention and treatment of opioid use disorder. Describe techniques for engagement in community and cross-sector collaboration to address the opioid use disorder crisis.

The public health crisis surrounding opioid use is pronounced among justice-involved populations, who face high rates of overdose mortality as well as HIV, and hepatitis C due to injection drug use. The majority of opioid-related overdoses are due to polysubstance use (PSU), and a better understanding of the prevalence and patterns of PSU are necessary in order to inform interventions. This dissertation project has three aims: (1) understand the patterns of opioid PSU among a justice-involved population, (2) identify PSU patterns most at-risk for post-release relapse, and (3) examine engagement in post-release health service utilization. Post-release aims are guided by the Gelberg Behavioral Model of Vulnerable Populations. This project utilizes secondary data from the Criminal Justice Kentucky Treatment Outcome Study, a Kentucky Department of Corrections funded two-wave longitudinal study of individuals who participated in substance abuse treatment programming while incarcerated. Latent profile analysis is used to determine the patterns of pre-incarceration opioid PSU in aim 1. Analyses for aims 2 and 3 examine PSU profiles, along with variables drawn from the Behavioral Model for Vulnerable Populations, in order to predict important reentry outcomes of relapse and health service utilization 12-months post-release in a series of logistic regressions. Six unique profiles of opioid PSU were found among the current justice-involved population, which faced disproportionate risk of adverse outcomes at follow-up. Findings indicate heterogeneity of opioid use among a justice-involved population. The role of mental and physical health in PSU severity is also highlighted. Further, results from post-release analyses indicate that a continuum of risk exists among PSU such that PSU patterns are unique and important predictors of post-release outcomes which can be used to inform interventions during incarceration. The importance of accounting for vulnerability as conceptualized in the Behavioral Model for Vulnerable Populations is also discussed.

Healthcare big data are a growing source of real-world data with which to identify and validate medications with repurposing potential. Previously, we developed a claims-based workflow to evaluate medications with potential to treat stimulant use disorders. In order to test the workflow, the framework was applied in the context of opioid use disorders (OUDs), for which there are medications with known efficacy. Using the Truven Marketscan Commercial Claims Database, a nested case-control analysis was conducted to determine the association between OUD medications (buprenorphine, naltrexone) and remission. Cases were defined as enrollees with a remission diagnosis and matched (1:4) to controls (individuals without remission) using incidence density sampling, with age group, sex, region, and index year as additional matching variables. After adjusting for behavioral health visits, polysubstance use disorders, and psychiatric disorders using conditional logistic regression, the odds of OUD medication exposure were 3.8 (99% confidence interval: 3.0 – 4.9) times higher in cases than controls. Evaluation of angiotensin converting enzyme inhibitors (e.g. lisinopril) as a negative control revealed no significant association between the medication and remission. This work demonstrates the feasibility of using administrative health claims data to evaluate the effectiveness of medications to treat substance use disorders.

Substance abuse counseling has many counselors and supervisors who are in recovery from a personal history of substance abuse. Approximately 37% of supervisors in the substance abuse field reported being in personal recovery (Eby, Burke, & Birkelbach, 2009). Little is known about how a clinical supervisor’s personal recovery influences his or her clinical supervision. The purpose of this phenomenological research study was to investigate the perceived lived experiences of clinical supervisors’ in recovery during the clinical supervision of substance abuse counselors working towards a license or credential in Louisiana. A qualitative phenomenological methodology, Interpretative Phenomenological Analysis (IPA) was used to analyze data from six clinical supervisors in recovery using semi-structured interviews. Themes emerged from the data, which resulted in 13 categories: 1) functions of supervision; 2) factors influencing the supervision relationship; 3) insight into addiction; 4) factors pertaining to self-disclosure; 5) managing dual relationships; 6) recovery isn’t enough; 7) relapse potential and management; 8) stigma of addiction; 9) structure of supervision; 10) countertransference; 11) feelings about self-disclosure; 12) importance of self-care; and 13) supervisors need supervision and consultation The categories provide increased understanding and insight into how recovery influences and were used in supervision by supervisors in recovery. Implications for supervisors in recovery, supervisees of supervisors in recovery, and clinical supervisor educators are also addressed.

Treating people with co-occurring or dual diagnosis disorders requires an integrated treatment approach due to the complex health and social needs of people who suffer from mental illness and drug addiction. An integrated approach is not only necessary but crucial to treat both the drug addiction and mental illness concurrently. The aim of this study is to explore the impact that non- integrated care can have on the number of relapses that dually diagnosed people can have. The study found that there is no correlation between concurrent treatment and the number of relapses that dually diagnosed people may have. Social workers will need to be able to recognize mental illness that co-occurs with substance use in order to effectively treat clients to determine what treatment approach should be used. Social workers are trained to use a biopsychosocial approach to capture all aspects of the client’s life. This I especially important for clients that may be dually diagnosed.

Synthetic cathinones are stimulant drugs of abuse that act at monoamine transporters e.g. the dopamine transporter (DAT) as releasing agents or as reuptake inhibitors. More than >150 new synthetic cathinones have emerged on the clandestine market and have attracted considerable attention from the medical and law enforcement communities. threo-Methylphenidate (tMP) is an FDA approved drug for the treatment of ADHD and narcolepsy, which also acts as a DAT reuptake inhibitor and is widely abused. tMP and synthetic cathinones share some structural similarities and extensive structure-activity relationship (SAR) studies on tMP have been conducted. However, much less is known about the SAR of synthetic cathinones, and the available MP literature might assist in understanding it. The main focus of this research was to compare SAR between methylphenidate-cathinone hybrids and available methylphenidate SAR in order to identify some guiding principles that might allow
us to predict their abuse potential and to identify which cathinones should be
targeted for more extensive evaluation. In the present study, we evaluated eight 2-benzoylpiperidine analogs and a descarbonyl analog to determine if tMP SAR can be applied to cathinone SAR. We conducted molecular modeling and docking studies and predicted the order of potency to be tMP > 2-benzoylpiperidine > 2-benzylpiperidine based on the number of hydrogen bonds. The synthesized analogs were evaluated in a competition assay using live-cell imaging against APP+ in HEK293 cells stably expressing hDAT. All compounds were found to be DAT reuptake inhibitors and, as the modeling studies predicted, the order of potency in our functional studies was also found to be tMP > 2-benzoylpiperidine > 2- benzylpiperidine. A significant correlation was obtained between the potency of the benzoylpiperidines and tMP binding data (r = 0.91) suggesting that the SAR of tMP analogs might be applicable to the synthetic cathinones as DAT reuptake inhibitors.

Repeated exposure to drugs of abuse conditions individuals to anticipate the behavioral consequences of drug use specifically in the presence of a drug-associated context. In rodents, preferences and aversions for alcohol and cocaine have been conditioned; however, the mechanisms underlying the expression of these conditioned effects remain unknown. Given that alcohol and cocaine polysubstance abuse is prevalent in young individuals, with more than 50% of these polysubstance abusers reporting to be under the age of 21, it is important to understand the mechanisms contributing to the behavioral effects of alcohol and cocaine co-dependency. Aim 1 determined if age differentially impacted the effects of repeated alcohol exposure on conditioned cocaine preferences. Adolescent [postnatal day (PND) 30) and adult (PND 60) male Sprague-Dawley rats were administered ethanol (0.5 or 1.75 g/kg, i.p.) immediately before each cocaine conditioned place preference (CPP) session (20 mg/kg, i.p.; 15 minutes). Aim 2, Experiments 1 and 2, identified the role of NMDA receptors within the nucleus accumbens septi (NAcc) in conditioned ethanol/cocaine behavior. Adolescent and adult rats in Experiment 1 were administered the NMDA antagonist MK-801 (0.1 or 0.2 m/kg, i.p.) 30 minutes prior to cocaine conditioning. Adolescent and adult rats within Experiment 2 underwent bilateral cannulation for chronic implantation of the cannulae into the NAcc of both hemispheres. Rats administered 1mM MK-801 or saline into the NAcc prior to cocaine (20.0 mg/kg, i.p.) conditioning, completed additional testing to determine the role of NAcc NMDA receptors in the consolidation, reconsolidation and expression of cocaine conditioned behavior in a drug-induced reactivation manner. Findings show adolescent and adult rats responded similarly to co-administration of ethanol/cocaine with both ages showing a decrease in the rewarding properties of cocaine. What differed between the age groups were the aversive properties of ethanol, with adolescents being less sensitive to the aversive properties of ethanol and its modulating effects on cocaine reward. A role for the NAcc NMDA receptors was observed in contributing to the modulating effects of ethanol on cocaine reward. Lastly, the reconsolidation of cocaine reward was more sensitive to disruption in adolescent rats, as compared to their adult counterparts. These results suggest an increased vulnerability for adolescents to continue engaging in polysubstance abuse. However, this at-risk age group also appeared to be more responsive to pharmacological treatment in decreasing addictive behavior.

Changing lifestyles in today's world have resulted in the evolution of many human activities. One of them is recreational drug use. The purpose of this study was to explore the association between drug usage, mental well-being and felony convictions among a sample of adult recreational drug users. The primary purpose of this analysis was to develop a set of predictor variables from the DRUGNET data set (i.e., lifestyle, drug usage, GWBS) that were able to account for the criterion variables (i.e., drug-related felony vs. no drug- related felony and non-drug felony vs. no felony ). The analyses attempted to differentiate the smaller portion of drug users who have experienced felony offenses (i.e., cases) from the majority of users who have not been convicted of these offenses (i.e., controls). Epidemiological case-control analyses (discriminant analyses) were performed by drawing a matched sample of cases and controls using their gender and age (+/- 2 yrs.). Drug laws and policies differ from country to country. Therefore the present study was limited to the United States citizens of age 18 yrs. or older. The study results support the hypothesis that there is a subgroup of the drug consuming population (i.e., recreational drug users) who lead productive and successful lives. The results found suggest that punishing a relatively small portion of drug users for their personal habits of using/possessing drugs may be counter productive rather than focusing on controlling abuse. The implication is that drug use should be perceived as a public health problem, not a criminal activity. The national policy targets should focus on education, public health, treatment and rehabilitation rather than incarceration.

The purpose of this study was to investigate the influences of smoking on rural and urban pregnant women. More specifically, the variables of the knowledge of health effects, health provider recommendations, subscores from the Health Belief Model (HBM), and social support were explored in relation to the smoking behavior of pregnant women. A secondary purpose was to investigate the accuracy of self-reported smoking during pregnancy using biochemical validation. Pregnant women (N=71) completed an anonymous questionnaire, designed by the researcher, to identify variables that predicted smoking for urban and rural women. Participants also gave a saliva sample for cotinine testing. Approximately 47% of rural participants and 49% of urban participants were classified as smokers. The overall smoking deception rate for the current study was 5.6%. The deception rate for rural and urban participants in this study was 2.8% and 8.6%, respectively. Variables were entered into a standard multiple regression analysis to predict smoking status of the pregnant women. Participants reporting barriers (a component of the HBM) to stopping smoking during pregnancy were significantly less likely to be smokers. Through t-test and chi-square analyses, other variables related to smoking status during pregnancy included: Marital status, financial source for the pregnancy, living with husband or boyfriend, mean scores of the participants‘ knowledge of the health effects of smoking during pregnancy, susceptibility and benefits (constructs of the HBM). Many healthcare providers performed 1A, 2A, and 3A; however, few completed the last step of 4A and none completed 5A. Implications for health promotion specialists include an increase in the education of pregnant women about the health risks of maternal smoking. Additional training for pre-natal healthcare providers is necessary in order to increase the number of healthcare providers that implement all of the 5A‘s. It is important to include the husband/boyfriend in any smoking cessation interventions since they have daily influence on the smoking status of the pregnant woman. Money used to conduct biochemical verification of maternal smoking status could be better spent on patient education of the health risks of smoking during pregnancy and physician education in implementing all 5A‘s in daily practice.

The relationship between drinking patterns of college students and their measured level of assertiveness was examined in this study. The subjects were categorized into six groups based on their self-reported frequency and amount of drinking. They were also asked to record the number of drinks they had drunk in the prior week. The MacAndrews Alcoholism Scale and the Rathus Assertion Schedule were administered to all the subjects. Pearson Product-moment correlations were calculated to assess the relationship between levels of drinking, the number of drinks in the prior week and scores from the Rathus Assertion Schedule and the MacAndrews Alcoholism Scale. The subjects were divided into two groups based on their scores obtained on the MacAndrews Scale: those whose score was 26 or above (prealcoholics) and those whose score was below 26 (Non-prealcoholic). Pearson Product-moment correlations were calculated to assess the relationship between the variables for these two groups. The results of the analysis did not support previous research that heavy drinking is associated with lower levels of assertiveness in alcoholics. In contrast to previous findings with alcoholics, the results indicated a very limited positive relationship between these variables for the non-prealcoholics, particularly the males, and no relationship at all for the prealcoholic subjects. It is suggested that the lack of assertiveness observed in alcoholics may develop after the onset of their alcoholism. While it was expected that the drinking level of the subjects would be related to their scores on the MacAndrews Scale this was not the case. This finding suggests that drinking may not be a reliable predictor of alcoholism. Further research is suggested using a larger sample of only prealcoholics to determine what relationships exist between assertiveness, drinking and the prediction of alcoholism.