The opioid epidemic in Philadelphia has evolved into a complex polysubstance crisis with the emergence of xylazine alongside fentanyl, reshaping substance use dynamics. Xylazine's rising prevalence introduces unique health risks due to its sedative properties, compounded when combined with fentanyl, leading to heightened potency and toxicity. This combination contributes to severe medical complications, notably injection-related infections driving hospitalizations. Ethical care for individuals with substance use disorder necessitates prioritizing patient autonomy in healthcare decision-making. Critical discussions on care goals with hospitalized drug users are imperative, encompassing pain management, withdrawal mitigation, and medication for opioid use disorder, aligning with patient preferences. Open and transparent communication fosters trust, enabling healthcare providers to effectively support substance use disorder patients and enhance their overall quality of life. / Urban Bioethics

Cannabis use in the United States has generally increased over the past decade as more States have legalized recreational use. In conjunction with changes to the chemical makeup, which has made available cannabis more potent, the long-term effects experienced by cannabis users may have changed, and more individuals may be effected. The current study replicated the methods used in Schreiner & Dunn (2012) and Grant et al. (2003) to conduct a meta-analysis examining the neurocognitive effects of cannabis after abstinence lasting a period of at least 25 days. Previous research has found mixed results, with some studies finding significant differences between abstinent cannabis users and matched healthy controls, and others finding no evidence of significant differences. Results of the current meta-analytical study found no significant effects within the domains of overall effects, attention, forgetting/retrieval, learning, or verbal/language. Results identified a significant small effect size within the domain of abstraction/executive function. Results continue to add to the growing evidence there are no significant long-term neurocognitive effects associated with cannabis use.

Substance use is characterized by use of licit and illicit substances, paired with adverse consequences. Substance use and abuse are major concerns among the adolescent population. Some of the most popular substances used among adolescents include alcohol and marijuana. Adolescents who use substances have often demonstrated risky behaviors. These risky behaviors include delinquency and antisocial behaviors, such as decreased commitment to school, burglary, and theft. Behaviors such as unprotected sexual intercourse while under the influence of substances places the adolescent at risk for pregnancy and STis. Adolescents may develop depressive symptoms related to substance use, as well as attempt to commit suicide while using substances when feeling sad. Effective nursing interventions are needed to target these adolescents and prevent or cease substance use. The purpose of this integrated literature review was to explore current nursing interventions for adolescent substance use. Another aim was to determine the need for improvement on these interventions or the need for a new action plan. Findings showed that brief motivational interviewing is an effective intervention method for adolescent substance use. The advantage to brief motivational interviewing is - that it is non-confrontational, short in duration, promotes reduced substance use, and leads to complete cessation. With the use of evidence-based interventions, nurses and other health care providers can take part 1~ early preveritioh and cessation of adolescent substance use.

The purpose of this research project was to explore the family structural variables of cohesion and adaptability as well as extracurricular activities, peer influences, and personal attitudes as they were manifested in adolescents classified as nonusers, users, and/or abusers of alcohol/drugs. Two hundred and thirty-seven adolescents responded to written questionnaires including the Alcohol and Drug Use Index, a reduced form of the Family Adaptability and Cohesion Evaluation Scales (FACES III), the Student Attitude and Behavior Questionnaire, and a Demographic Questionnaire. Information was obtained on age and grade level, gender and ethnicity, parental characteristics, and student's educational aspirations in an effort to identify factors associated with teenage alcohol/drug use. Some of the major findings suggested that the users/abusers groups reported less involvement with their families, educational pursuits, and extracurricular activities when compared to their nondrug using counterparts. The statistical analysis also confirmed some aspects of structural family therapy theory and refuted other aspects. The results of this study were also compared to prior research on adolescent substance use. These results further expanded the understanding of factors associated with adolescent use/abuse of alcohol/drugs. / Ph. D.

Over the past two decades, cigarette smoking has decreased among teenagers and young adults, but nicotine vaping has increased dramatically. Liquid vape products contain harmful chemicals ingested when vapor is inhaled, and vaping is associated with lung damage and chronic obstructive pulmonary disease. There has been relatively little research on nicotine vaping and effective prevention and intervention methods have yet to be developed. Changing expectancy processes has been successful in preventing early alcohol use and cigarette smoking, but little is known about nicotine vaping expectancies. An appropriately developed nicotine vaping expectancy measure is necessary to better understand vaping behavior and to provide a foundation for the development of effective prevention and intervention methods. In the present study, the Nicotine Vaping Expectancy Questionnaire (NVEQ) was developed using items collected from 8th graders, 12th graders, and college students. Exploratory and confirmatory factor analysis and Rash analysis were used to select items and create subscales. The NVEQ was found to have good internal consistency, test-retest reliability, convergent, discriminant, and predictive validity.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Objectives: (1) To examine whether homelessness predicted earlier resumption of substance use after inpatient detoxification; and (2) to seek evidence concerning the impact of post-detoxification stabilization programs on homeless and housed persons in relation to recurrent substance use. Data Sources/Study Setting: Prospective six-month cohort of 470 addicted persons entering a publicly-funded urban detoxification program. Study Design: Survival analysis methods were used to determine the association between homelessness, stabilization program use, and time to recurrent substance use. Data Collection/Extraction Methods: The main analyses rely on baseline and six month interviews using standardized instruments. Additional analyses include interviews obtained after six months, and statewide administrative records of recurrent detoxification. Principal Findings: Among 254 persons available at six months, 76% reported recurrent substance use. Homeless persons not using stabilization programs experienced the greatest hazard of return to substance use after detoxification, Hazard Ratio (HR) 1.26, 95% CI (0.88,1.80). Homeless persons using these programs had the lowest rate of return to substance use: HR 0.61, 95% CI (0.40,0.94). A similar impact of stabilization programs was not seen among housed subjects. Analyses suggest that subjects available at six months were representative of the entire cohort. Conclusions: Post-detoxification stabilization programs were associated with improved outcomes for homeless addicted persons. / 2999-01-01

Maladaptive habits, such as substance use, that are highly ingrained and automatized behaviors with negative long-term health consequences need effective interventions to promote change towards more healthful behaviors. Implementation intentions, the structured linking of critical situations and alternative, healthier responses, have been shown to improve health-benefiting behaviors such as eating more fruits and vegetables and being more physically active (Sheeran, Milne, Webb, and Gollwitzer, 2005). Here, a laboratory analogue for smoking relapse and a pilot clinical trial of alcohol use are assessed using implementation intention interventions to reduce these health risk behaviors. In Study 1, heavy smokers completed a smoking resistance task that is a candidate analogue for smoking relapse. Participants were exposed to an in-laboratory implementation intention and/or monetary incentive condition during each of four experimental sessions. The combined implementation intention and monetary incentive condition resulted in the greatest delay to smoking initiation. In Study 2, individuals with alcohol use disorder completed an active or control implementation intention treatment condition. Remotely, both treatment groups received a daily ecological momentary intervention, thrice daily biologic breath alcohol ecological momentary assessments, and once daily self-report ecological momentary assessment of alcohol consumption during the intervention period. The active implementation intention group was associated with a greater reduction in alcohol consumption compared to the control group. Together, these studies provide experimental and initial clinical evidence for implementation intentions, in conjunction with other effective treatments (Study 1) and technological advancements (Study 2), to intervene on and reduce substance use. This project is the first to use implementation intentions in a laboratory evaluation of smoking resistance and in an initial clinical trial to reduce alcohol consumption in a naturalistic community sample using both ecological momentary assessments and ecological momentary interventions. / Ph. D. / The following studies provide evidence for the use of implementation intentions, a planning-based intervention, to reduce health risk behaviors. Implementation intentions are structured if-then statements that help individuals to identify critical situations where health risk behaviors are likely and to predetermine alternative and healthier responses when these situations are encountered. In the first study, nicotine-deprived cigarette smokers completed a laboratory task where they were asked to resist smoking. The participants were exposed to different conditions (implementation intentions and monetary incentives) to help them to resist smoking. The study found that the combination of both implementation intentions and monetary incentives were associated with the longest time to smoking reinitiation; however, the combination of both interventions was not significantly greater than monetary incentives alone. The second study employed implementation intentions as a strategy to reduce alcohol use over a two-week period in individuals with alcohol use disorder. The study found that implementation intentions reduced the amount of alcohol consumed on days where participants were drinking and these reductions were maintained at one-month follow-up. Together, these two studies provide support for translational work that evaluates interventions in the laboratory and then also in clinical trials. Furthermore, these studies show the trans-disease applications of interventions such as implementation intentions across health risk behaviors.

Youth violence has garnered the attention of researchers and policy makers alike, because of the unique risk factors associated with victimization and the poor physical, mental, and educational outcomes that stem from such experiences. In particular, sexual minority youth--those who identify as gay, lesbian, or bisexual or who have sexual contact with persons of the same or both sexes (CDC, 2016)--are among those most at risk for victimization. Research that highlights and addresses these issues is crucial. This study utilizes the 2013 Youth Risk Behavior Surveillance System (YRBSS) data in order to investigate different forms of victimization and their consequences in lesbian, gay, bisexual and questioning (LGBQ) youth. Drawing from a sample of 12,642 9th-12th grade youth, this study investigates the prevalence of bullying, homophobic bullying, dating violence and sexual assault, as well their effects on school avoidance, poor mental health, and substance use outcomes. Results reveal that differences do, in fact, exist between sexual minority and heterosexual youth, where LGBQ youth experience higher rates of every type of victimization, and are more likely to report school avoidance, depression, suicidality, and substance use. Furthermore, this study also investigates the intersections of sexual orientation and gender, and finds that females who identify as lesbian, gay, bisexual, or questioning are most at risk for every type of victimization. Findings highlight the need for recognition of the importance of sexual orientation and gender in youth victimization, and the need for policy that explicitly outlines protections for sexual minority youth within the school environment, as well as services extended to victims of IPV. / Ph. D. / Youth violence is a problem throughout the United States, and is a widely researched topic because of the risk factors linked to victimization. In particular, sexual minority youth—those who identify as gay, lesbian, or bisexual or who have sexual contact with persons of the same or both sexes (CDC, 2016)— are among those most at risk for youth violence. This study used the 2013 Youth Risk Behavior Surveillance System (YRBSS) data in order to investigate different forms of youth violence victimization and their consequences among lesbian, gay, bisexual and questioning (LGBQ) youth. Drawing from a sample of 12,642 9th-12th graders, this study investigates bullying, homophobic bullying, dating violence and sexual assault, as well their effects on school avoidance, poor mental health, and substance use outcomes. Results show that differences do, in fact, exist between sexual minority and heterosexual youth, where LGBQ youth experience higher rates of every type of victimization, and are also more likely to report school avoidance, depression, suicidality, and substance use. Furthermore, this study also investigates sexual orientation and gender, and finds that females who identify as LGBQ are most at risk for every type of victimization. These findings highlight the need for recognition of the important role that sexual orientation and gender plays in youth victimization, as well as the need for school policy that explicitly outlines protections for these youth.

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. / Drug and alcohol addiction is characterized by seemingly illogical decisions to forgo important benefits associated with abstinence or moderated use (e.g., maintaining employment) in favor of the immediate gratification of intoxication. The tendency to favor instant gratification and devalue delayed rewards explains impulsive decision making typical of substance use disorders and other impulse control problems. The present study evaluated whether vividly imagining positive future events reduced this tendency toward instant gratification. College students at high risk for an alcohol use disorder participated in the study. Participants were randomly assigned to one of three groups: one in which they were asked to imagine positive events they anticipated in the future, one in which they were asked to imagine positive events from their past, and one in which they were asked to recall events described in a provided travel blog. Immediately after imagining the events, participants in both the past and future conditions were less oriented towards instant gratification than participants who were asked to recall events from a travel blog. When measured a week later, participants in the future condition reported less devaluation of future rewards, as well as less alcohol use, than participants in the other two groups. Overall, the results of the study provide evidence that vividly imagining positive future events reduces impulsivity among at-risk college student drinkers. As such, imagining future events may be an effective component of future treatment efforts for substance use disorders and other impulse control problems.

Substance Use Disorders (SUD) continue to be a significant public health concern as drug use reaches a worldwide high. Research has consistently shown that lesbian, gay, and bisexual (LGB) individuals are at a heightened risk of having an SUD than their heterosexual counterparts. While notable work has been done to understand the factors contributing to SUD among LGB populations, there is a substantial gap in research regarding the intersection of race/ethnicity and sexual identity. This study aims to address this gap by investigating the disparities in SUD among sexual minorities across different racial/ethnic and sex groups and the determinants that underlie these disparities. This research involves a statistical analysis of combined data from the 2021-2022 National Survey on Drug Use and Health (NSDUH) to explore prevalence rates and identify demographic and socioeconomic factors associated with disparities in SUD among sexual minority adults (ages 18 and older) in the United States, considering factors such as race/ethnicity, gender, socioeconomic status, religiosity, familism, and language. By understanding the prevalence and determinants of SUD within this population, healthcare providers, policymakers, and advocates can work together to develop prevention and intervention strategies to reduce these disparities and improve the overall well-being of LGB individuals in the United States.