Rates of HIV infection continue to climb among minority populations and men who have sex with men (MSM), with African American/Black MSM being especially impacted. Numerous studies have found HIV transmission risk to be associated with many health and social disparities resulting from larger environmental and structural forces. Using anthropological and social environment-based theories of resilience that focus on individual agency and larger social and environmental structures, this dissertation employed a mixed methods design to investigate resilience processes among African American/Black MSM. Quantitative analyses compared African American/Black (N=108) and Caucasian/White (N=250) MSM who participated in a previously conducted randomized controlled trial (RCT) of sexual and substance use risk reduction interventions. At RCT study entry, using past 90 day recall periods, there were no differences in unprotected sex frequency, however African American/Black MSM reported higher frequencies of days high (P Qualitative data collected among a sub-sample of African American/Black MSM from the RCT (N=21) described the men’s experiences of living with multiple health and social disparities and the importance of RCT study assessments in facilitating reductions in risk behaviors. A cross-case analysis showed different resilience processes undertaken by men who experienced low socioeconomic status, little family support, and homophobia (N=16) compared to those who did not (N=5). The dissertation concludes that resilience processes to HIV transmission risk and related health and social disparities among African American/Black MSM varies and are dependent on specific social environmental factors, including social relationships, structural homophobia, and access to social, economic, and cultural capital. Men define for themselves what it means to be resilient within their social environment. These conclusions suggest that both individual and structural-level resilience-based HIV prevention interventions are needed.

Healthy maternal–infant attachment is the foundation on which a child’s physical, cognitive, psychological, and emotional development rests. This relationship between the dyad does not begin at birth but rather prior to conception or any time throughout pregnancy. Our understanding of how this relationship develops between a mother and her fetus remains largely intangible for researchers and clinicians alike as it is a highly complex process with many variables influencing the evolving bond. Situated within a poststructural critical feminist framework, the purpose of this qualitative study using a grounded theory approach was to gain a better understanding of how women who use substances during pregnancy experience the process of a developing relationship with their fetuses, and to identify intersecting variables that may influence their health behaviours. Five main categories emerged including choosing the mothering path, balancing the risks, needing safe passage, breaking the cycle, and mothering against all odds. All of the women in the study described feeling an increase in maternal–fetal attachment as the pregnancy progressed and demonstrated efforts to reduce substance use, engage with the health care system, and improve dietary choices to limit negative consequences for their developing fetuses. Barriers to changing health behaviours were identified by the participants as well as by health care providers working with this population. In gaining a deeper understanding of the variables that influence maternal–fetal attachment in women who use substances and development of a substantive theory, nursing practice may be informed by providing direction around how best to support harm reduction approaches in this population.

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

Since their introduction to the United States in 2008, synthetic cannabinoids became the most widely used recreational drug behind marijuana, then regressed to an estimated prevalence of less than 1%. Contrary to expectations for a drug declining in use, emergency department presentations and acute poisonings related to the use of synthetic cannabinoids are increasing. Alongside this phenomenon, a growing body of literature is beginning to uncover a relationship between psychosis and synthetic cannabinoid use. A current gap in the literature exists surrounding harm prevention methods and targeted intervention strategies for users of synthetic cannabinoids. To date, no known studies have examined individuals with a history of use of these substances and investigated the reasons they decided to discontinue recreational use. The purpose of the current study was to fill this gap in the literature while also further confirming and expanding existing research on the characterization of synthetic substance use, perceived harm of synthetic cannabinoids, and users’ knowledge about synthetic cannabinoids. Cross sectional survey methods in a non-experimental comparative design was utilized with participants recruited through the online crowd sourcing platform Amazon MTurk. Significant motivating factors for both discontinuation and continuation of synthetic cannabinoid use were found including personal experience, accessibility, preference towards other substance, and questions surrounding the source and purity of the synthetic cannabinoids. It was also found that individuals who currently use synthetic cannabinoids have less general knowledge about the substance class when compared to individuals who have discontinued use. These results suggest that psychoeducational campaigning surrounding general knowledge about the substance class as well as information on the physiological effects of synthetic cannabinoids may be an effective harm reduction method.

Magister Psychologiae - MPsych / Substance use and abuse has been a persistent challenge facing many communities around the world. In more recent times there has been particular focus on the gradual, yet alarming increase in the use and/or abuse of substance use among the students who are currently enrolled in institutions of higher learning. On the strength of such findings, relevant stakeholders and policy makers have since demarcated university students as being one of the most high-risk groups within a society when it comes to substance use and abuse. While substantial research has been done on the issue of alcohol use among adolescents on both a local and global scale, very little is known about the prevalence of substance use among university students in South Africa.

abstract: This study investigated low regulatory flexibility as a mechanism of the associations of rumination with affect, internalizing symptoms, and substance use and problems. 403 first-year college students completed an online baseline survey assessing rumination, regulatory flexibility, internalizing symptoms, alcohol use, cannabis use, alcohol problems, and cannabis problems. Roughly 2.67 months later, 261 of these participants completed a follow-up survey assessing internalizing symptoms and substance use and problems. Additionally, 71 of the 403 participants completed an experimental study. Thirty-three participants were randomly assigned to undergo a rumination induction, and 38 were assigned to a control condition. All lab participants underwent an interpersonal stress task during which regulatory flexibility was observed and completed pre-test and post-role-play measures of positive and negative affect. Experimental study results showed regulatory flexibility did not mediate effects of rumination induction on positive (indirect effect: standardized beta (β)=-0.01, unstandardized beta (b)=-0.12, 95% Confidence Interval (CI) [-0.64, 0.41], p=.66) or negative affect (indirect effect: β=0.01, b=0.17, 95% CI [-0.29, 0.63], p=.48). Longitudinal study results showed regulatory flexibility did not mediate associations between baseline rumination and follow-up internalizing symptoms (indirect effect: b=0.01, 95% CI [-0.03, 0.05], p=.57), alcohol use (indirect effect: b=-0.03, 95% CI [-0.09, 0.04], p=.39), cannabis use (indirect effect: b=0.10, 95% CI [-0.06, 0.26], p=.21), alcohol problems (indirect effect: b=-0.05, 95% CI [-0.18, 0.07], p=.40), or cannabis problems (indirect effect: b=-0.10, 95% CI [-0.36, 0.16], p=.43). However, rumination predicted greater internalizing symptoms (Incidence Rate Ratio (IRR)=1.26, b=0.23, 95% CI [0.08, 0.37], p=.003) and cannabis problems (IRR=1.73, b=0.55, 95% CI [0.23, 0.87], p=.001). Regulatory flexibility predicted fewer alcohol use days (IRR=0.76, b=-0.27, 95% CI [-0.49, -0.05], p=.015) and problems (IRR=0.58, b=-0.55, 95% CI [-0.95, -0.15], p=.007), and less cannabis use for women (IRR=0.59, b=-0.53, 95% CI [-0.92, -0.14], p=.007) and fewer cannabis problems for men (IRR=0.21, b=-1.55, 95% CI [-2.50, -0.60], p=.001). Lack of agreement about how best to measure regulatory flexibility makes it unclear whether null associations were due to measurement problems or actual null effects. Research on how best to measure this construct is a priority. Findings indicate rumination and regulatory flexibility may be promising intervention targets. / Dissertation/Thesis / Doctoral Dissertation Psychology 2020

Philosophiae Doctor - PhD / Adolescence, a critical developmental period, requires a certain level of adjustment and may negatively impact youth psychosocial development. Unsurprisingly, adolescent substance use continues to be a major public global health concern. Additionally, some adolescents are immersed in various interpersonal relationships and exposed to various stressors daily, which may affect their psychological well-being and developmental trajectories. This research aimed to explore the experiences of interpersonal relationships, stress and coping, and determine substance use patterns, symptoms of two common mental disorders (depression and generalized anxiety) amongst adolescents who report using substances (legal and illegal) in low-income communities in South Africa by employing Bronfenbrenner’s bio-ecological theory and the person-process-context-time model as a theoretical lens.

<p>Previous research has identified impulsive personality traits as significant risk factors for a wide range of risk-taking behavior, substance use, and clinical problems. Most work has been conducted in primarily White samples, leaving it unclear whether these patterns generalize to racial and ethnic minorities, who have higher rates of negative consequences of substance use behavior. The most widely used assessment of impulsive traits is the UPPS-P Impulsive Behavior scale, which has strong psychometric properties across demographic subgroups, such as gender and age; however, data supporting its use in racial and ethnic minorities is less well-developed. The aims of this study are to 1) examine the measurement invariance of the UPPS-P Impulsive Behavior Scale-Short Form (Cyders et al., 2014) across racial minority groups and 2) determine if impulsive personality traits differentially relate to substance use outcomes across racial groups. Participants were 1301young adults (ages 18-35, fluent in English), recruited through an online survey for both college students at a large public university and Mechanical Turk, a crowdsourcing online platform. Measurement invariance was assessed using multigroup confirmatory factor analysis. Differential validity was assessed using a structural equation modeling framework. I established model fit for each racial group (White group: RMSEA= .067, CFI= .94; Black group: RMSEA= .071, 90% CFI= .952; Asian American group: RMSEA= .073, CFI= .94; Hispanic group: RMSEA=.081, CFI=.934). Based on change in CFI/RMSEA indices, I concluded strong measurement invariance of the Short UPPS-P as a valid scale of impulsive behavior across racial groups. In the White group, findings indicated significant relationships between multiple SUPPS-P traits and alcohol and substance use. In the Asian American group, positive relationships were found between sensation and alcohol use (<i>p</i>=.015) and negative urgency and drug use (<i>p</i>=.020). I found that there were no differences in the relationships between the Short UPPS-P traits and substance use outcomes across White and the racial and ethnic groups studied (<i>p</i>’s>.06). </p>

BACKGROUND: Early initiation of alcohol and other substance use is considered one of the most important risk factors for the later development of an alcohol use disorder. However, it is not yet well understood to what extent this increased risk reflects neurobiological changes driven by the use itself, and to what extent it reflects pre-existing traits and patterns. This dissertation therefore aims to identify neurobiological and neuropsychological markers that exist prior to the initiation of substance use and may confer risk for earlier use onset. Specifically, the research places a focus on the domains of inhibitory control and learning and memory. METHODS: Adolescents (n=81) were enrolled into the study prior to the initiation of alcohol or other drug use at 13-14 years old to complete baseline brain imaging. Neuroimaging included acquisition of structural magnetic resonance imaging (MRI) and task functional magnetic resonance imaging (fMRI) during response inhibition (emotional Go-NoGo) and spatial memory (virtual Morris Water Task) tasks. Participants also completed a neuropsychological battery that included the California Verbal Learning Test Children’s Version (CVLT-C). Subjects were then followed for up to three years via quarterly online surveys in order to assess initiation of alcohol and substance use. Those who went on to endorse initiating substance use prior to reaching 16 years of age were included in an initiating group (IG, n=21) and those who turned 16 having continuously denied substance use were included in a non-initiating comparison group (CG, n=24). RESULTS: Performance measures on the emotional Go-NoGo (NoGo trial accuracy, Go trial accuracy, Go trial reaction time) showed no significant group differences between IG and CG. Functional brain activation differences, however, were observed in bilateral inferior frontal gyrus (IFG), with CG showing greater activation relative to IG on inhibitory (NoGo) trials with negative versus neutral emotional background images (Negative NoGo>Neutral NoGo). Performance on learning trials for the virtual Morris Water Task, completed offline prior to scanning, showed a subtle learning difference between groups, but no performance or functional brain activation differences were observed on Retrieval or Motor control trials completed during scanning. Performance on the neuropsychological test of verbal learning and memory (CVLT-C) indicated worse learning and memory in IG relative to CG (fewer correct responses on both the Long-Delay Free-Recall and the Recognition trials). CONCLUSIONS: These findings help characterize neurobiological and neuropsychological patterns that exist prior to exposure to substances, and thus may help differentiate adolescents who go on to initiate substance use earlier in adolescence from those who do not. Results suggest brain activation differences in frontal regions may predate use, while activation differences in hippocampal memory systems (observed in some cross-sectional studies of alcohol use) may not. These data help clarify questions of causality and provide a foundation for informing strategies for prevention and intervention efforts in maladaptive alcohol and substance use.

This study seeks to understand and document how people recovering from opioid addiction communicate about health and identity in the context of a methadone clinic. This project emerges in response to the rising incidence of opioid addiction and overdose death in the U.S. and suggests there is an urgent theoretical and practical calling for bringing forth the stories of people experiencing addiction and recovery. Guided by the structure-centered approach (SCA) to health communication, this study employs a thematic narrative analysis through interviews with 4 methadone maintenance treatment (MMT) patients about the meanings of health, recovery, and identity. With respect to how methadone patients communicate about health and identity, study findings reveal three key themes, which I distinguish as: 1) health as normalcy; 2) health as lack of resources; and 3) recovering the self, (be)longing, and health citizenship. It is through an understanding of these themes that this project contributes, in several meaningful ways, to research and praxis on health communication in addiction treatment spaces. Limitations of research design and considerations for future research projects on health and addiction are provided.