Research in social & administrative pharmacy : RSAP, Jan 8, 2015
Prescription opioid misuse is a major public health concern in the US. Few resources exist to sup... more Prescription opioid misuse is a major public health concern in the US. Few resources exist to support community pharmacists engaging patients who misuse or are at risk for misuse. This report describes the results of the execution of the ADAPT-ITT model (a model for modifying evidence-based behavioral interventions to new populations and service settings) to guide the development of a behavioral health framework for opioid medication misuse in the community pharmacy setting. Pharmacy, addiction, intervention, and treatment experts were convened to attend a one-day meeting to review the empirical knowledgebase and discuss adapting the screening, brief intervention, and referral to treatment (SBIRT) protocol for addressing opioid medication misuse in community pharmacy. Qualitative data gathered from the meeting were analyzed by 2 independent coders in a 2-cycle process using objective coding schemes. Percentage of agreement and Cohen's Kappa were calculated to assess coder agreem...
Longitudinal Research in the Social and Behavioral Sciences: An Interdisciplinary Series, 2002
... A common and accepted definition of resilience is Ithe property of a material that enables it... more ... A common and accepted definition of resilience is Ithe property of a material that enables it to resume its original shape or ... Traits such as hardiness, competence, ego resilience, and ego strength have been used synonymously to characterize individuals who have this abstruse ...
International journal of person centered medicine, 2013
Prevention of substance use disorder (SUD) is impeded by the large number, complexity and idiosyn... more Prevention of substance use disorder (SUD) is impeded by the large number, complexity and idiosyncratic configuration of etiological factors. Effective prevention of SUD is feasible however when intervention resources are prioritized to individuals who are objectively determined as high risk and tailored to their specific characteristics and circumstances. This study had the aim of developing a rapid accurate screening instrument for determining current presence of and future risk for SUD. The sample consisted of 182 girls recruited when they were 10-12 years of age and tracked to 22 years of age. From a large item pool the Drug Use Screening Inventory Quick Screen for Females (DQS-F) was derived consisting of the Substance Involvement Index and the Problem Severity Index. The DQS for Females (DQS-F) has high sensitivity for identifying girls who currently qualify for SUD diagnosis. Furthermore, accuracy of predicting future SUD with the DQS-F is in the good range at age 16 and in t...
International journal of person centered medicine, 2012
This article discusses human individuality within a lifespan developmental perspective. The pract... more This article discusses human individuality within a lifespan developmental perspective. The practical application of an individual differences framework for diagnosis, prevention and treatment of addiction is described. A brief overview of the methods conducive to knowledge development within the rubric of person-centered medicine that are available to practitioners working in office and clinic settings concludes the discussion.
Prevention science : the official journal of the Society for Prevention Research, 2001
Two child self-report scales were developed to measure parental neglect (emotional distance and p... more Two child self-report scales were developed to measure parental neglect (emotional distance and parental involvement) in a sample of 344 boys between 10 and 12 years of age. Psychometric analyses of the parental emotional distance and involvement scales demonstrated their unidimensionality; construct, concurrent, and predictive validity; and reliability. Cross-sectional analyses indicated that neglect was more severe among boys who had a parent with a DSM-III-R lifetime substance use disorder (SUD) compared to youth whose parents had no Axis I psychiatric disorder. In addition, children reported more severe neglect by the mother than the father. Longitudinal analyses of a subsample (n = 99) revealed that child neglect at ages 10-12 predicted significant variance on a composite measure of substance use involvement and severity of substance use as well as increased the risk for SUD at age 19.
We have conducted a population-based association study of substance abuse and a microsatellite at... more We have conducted a population-based association study of substance abuse and a microsatellite at the dopamine D5 receptor locus (DRD5) in a sample of European-American males and females with substance dependence (SA) or without any psychiatric disorder. Overrepresentation of the most frequent allele (148 bp) was found in males in the SA group (OR = 2.2, P = .02); this finding was reproduced in females (OR = 5.4, p < .001). The difference in the frequencies of this allele between SA males and SA females was statistically significant. The genotype coded in accordance with the dose of this allele correlated with substance abuse liability in males and females (stronger in females) and with novelty seeking in females. There was no evidence of correlation between the genotypes of spouses that could be induced by assortative mating for the liability to substance abuse. The data suggest that the DRD5 locus is involved in the variation and sex dimorphism of substance abuse liability.
Neuropsychologic tests of cerebral integrity recorded impairments in visuopractic and learning ca... more Neuropsychologic tests of cerebral integrity recorded impairments in visuopractic and learning capacity in patients with Wilson&#39;s disease. These psychometric findings point to the presence of a subclinical encephalopathy that is not otherwise revealed upon clinical examination.
Drug use disorders (DUD) have been theorized to share sources of risk variation with other consum... more Drug use disorders (DUD) have been theorized to share sources of risk variation with other consummatory behaviors. We hypothesized that common mechanisms exist for familial risk for DUD, physiological maturation and nutritional status in girls. Whereas body fat content must exceed a threshold to enable adrenarche and gonadarche, nutritional status may also be a behavior risk indicator. Impaired psychological self-regulation associated with DUD risk may manifest in early overeating, which could in turn accelerate reproductive maturation, resulting in a greater likelihood of affiliation with deviant/older peers and drug use. The sample consisted of families ascertained through the father who either had (N=95) or did not have (N=130) a DUD, and who had a 10-12 year old daughter and her mother available for study. Correlation, survival and path analyses of three consecutive assessments evaluated the relationships between parental DUD (number of affected parents, NAP), nutritional status (NS, subscapular skinfold measurements and body mass index), sexual maturation (Tanner stage), peer delinquency, and the daughter&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s lifetime DUD diagnosis. NAP was positively related to the girls&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; nutritional status. Longitudinal path analysis indicated mediation of the relationship between NAP and peer delinquency by sexual maturation. The relationship between NAP and sexual maturation is mediated by NS. The effect of sexual maturation at age ∼11 on the girls&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; DUD risk is mediated by peer delinquency. The data are consistent with mediation of intergenerational transmission of DUD risk in females by elevated nutrition, leading to accelerated maturation, and affiliation with deviant peers.
Journal of child & adolescent substance abuse, 2014
Studies are needed that examine neurobiological characteristics in high risk individuals prior to... more Studies are needed that examine neurobiological characteristics in high risk individuals prior to substance use disorder (SUD) development. In this pilot study, 4 adolescent subjects at high risk (having at least 1 parent with a SUD) for SUD were compared with 4 adolescent reference subjects on a corticolimbic reactivity paradigm, where they were presented with affect-laden faces or geometric shapes. FMRI was used to measure cortical activation in response to these stimuli. High risk subjects, compared to low risk, exhibited greater left amygdala activation (t=3.60, df=6, p=0.01), suggesting they may exhibit hyper-responsivity of the amygdala in response to emotional stimuli.
Psychological items discriminating children of fathers diagnosed with an illicit drug-related sub... more Psychological items discriminating children of fathers diagnosed with an illicit drug-related substance use disorder and normal controls are indicators of a unidimensional construct termed transmissible liability index (TLI) (Vanyukov et al., 2009). TLI is a highly heritable (Vanyukov et al., 2009; Hicks, Iacono, McGue, 2012) and valid (Vanyukov et al., 2009; Hicks et al., 2009; Kirisci et al., 2013a) measure of childhood liability to substance use disorders (SUDs). This longitudinal study determined whether TLI has incremental validity for predicting SUD beyond commonly measured psychological indicators of risk. TLI and measures of executive cognitive capacity, emotion dysregulation and externalizing disturbance were administered to boys at ages 10-12 and 16. SUD outcome determined at age 22 was assessed as (1) any SUD, (2) the number of drug-specific SUDs, and (3) SUD severity. TLI predicted SUD beyond the contribution of measures of emotion dysregulation, executive cognitive capacity and externalizing disturbance. The association of emotion dysregulation and externalizing behavior at ages 10-12 and 16 with SUD at age 22 was also reduced to non-significance after controlling for transmissible risk measured by TLI. TLI&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s incremental validity beyond these latter indicators of risk points to its utility for identifying vulnerable youths requiring intervention.
This study examined responses to peer provocation in boys ages 9-13 years who met symptomatic cri... more This study examined responses to peer provocation in boys ages 9-13 years who met symptomatic criteria for ADHD-only, ODD/CD-only, comorbid ADHD/ODD/CD, or no diagnosis. Boys participated in a reaction-time game that included standardized verbal and behavioral provocation. Their behavioral, physiological, and affective responses to this task were measured. Results showed that groups did not differ following high levels of provocation because all boys behaved aggressively. However, following low provocation boys with comorbid ADHD/ODD/CD had higher levels of behavioral aggression, had greater heart rate acceleration, and were rated as angrier than all other boys. In addition, boys with comorbid ADHD/ODD/CD held a grudge longer than other children. Results suggest that boys with comorbid ADHD/ODD/CD are especially reactive to provocation from their peers.
There is an urgent need for a reliable method of evaluating the severity of adolescent chemical a... more There is an urgent need for a reliable method of evaluating the severity of adolescent chemical abuse and problems related to chemical abuse. The lack of an appropriate rating scale to fill this objective hampers the design and the assessment of objective treatment outcome and follow-up of adolescent chemical abusers. The Teen-Addiction Severity Index (T-ASI) is a structured interview which was developed to assess the seven following domains: chemical use, school status, employment-support status, family relationships, peer-social relationships, legal status, and psychiatric status. This paper discusses the rationale for the design of the T-ASI and presents a preliminary study indicating satisfactory interrater reliability of the rating scale.
Journal of The American Academy of Child and Adolescent Psychiatry, 1992
The psychiatric and demographic characteristics that may distinguish treatment completers from no... more The psychiatric and demographic characteristics that may distinguish treatment completers from noncompleters among hospitalized adolescents with substance abuse and comorbid psychiatric disorders were examined. Affective and adjustment disorders were more prevalent among treatment completers whereas non-completers were more likely to be assigned a conduct disorder diagnosis. There were no differences between the groups with respect to demographic and legal status, education level and lifetime psychiatric diagnosis in the parents or caretakers, living arrangements, treatment history, and perception of treatment benefits. A higher percentage of treatment completers than noncompleters received psychotropic medications. The factors contributing to treatment termination as well as the clinical and research implications of the findings are discussed.
A battery of memory tests was administered to a group of patients with nonalcoholic cirrhosis and... more A battery of memory tests was administered to a group of patients with nonalcoholic cirrhosis and to a group of normals. Deficits observed in the former group indicate that there are detectable neuropsychological impairments on measures of higher cognitive functioning in persons who do not otherwise exhibit overt signs or symptoms of hepatic encephalopathy. These findings extend the range of impairments that have been documented to be present as part of the neuropsychiatric syndrome of portal-systemic encephalopathy.
Substance abuse : official publication of the Association for Medical Education and Research in Substance Abuse, 2014
ABSTRACT. Rapidly occurring changes in law enforcement and licensing of retail outlets to sell ma... more ABSTRACT. Rapidly occurring changes in law enforcement and licensing of retail outlets to sell marijuana raises the prospect that the population of consumers will expand and accordingly the prevalence of cannabis use disorder (CUD) will increase. This report presents a novel approach to researching CUD etiology joining multivariate and ontogenetic perspectives. CUD is conceptualized as a developmental outcome consisting of transmissible (intergenerational) and nontransmissible components. Partitioning the liability for CUD into these 2 dimensions enables implementing interventions targeted at the particular source and severity of risk. In addition, results showing that infant temperament disturbances predict transmissible risk leading to CUD 2 decades later underscore the importance of implementing early prevention.
Research in social & administrative pharmacy : RSAP, Jan 8, 2015
Prescription opioid misuse is a major public health concern in the US. Few resources exist to sup... more Prescription opioid misuse is a major public health concern in the US. Few resources exist to support community pharmacists engaging patients who misuse or are at risk for misuse. This report describes the results of the execution of the ADAPT-ITT model (a model for modifying evidence-based behavioral interventions to new populations and service settings) to guide the development of a behavioral health framework for opioid medication misuse in the community pharmacy setting. Pharmacy, addiction, intervention, and treatment experts were convened to attend a one-day meeting to review the empirical knowledgebase and discuss adapting the screening, brief intervention, and referral to treatment (SBIRT) protocol for addressing opioid medication misuse in community pharmacy. Qualitative data gathered from the meeting were analyzed by 2 independent coders in a 2-cycle process using objective coding schemes. Percentage of agreement and Cohen's Kappa were calculated to assess coder agreem...
Longitudinal Research in the Social and Behavioral Sciences: An Interdisciplinary Series, 2002
... A common and accepted definition of resilience is Ithe property of a material that enables it... more ... A common and accepted definition of resilience is Ithe property of a material that enables it to resume its original shape or ... Traits such as hardiness, competence, ego resilience, and ego strength have been used synonymously to characterize individuals who have this abstruse ...
International journal of person centered medicine, 2013
Prevention of substance use disorder (SUD) is impeded by the large number, complexity and idiosyn... more Prevention of substance use disorder (SUD) is impeded by the large number, complexity and idiosyncratic configuration of etiological factors. Effective prevention of SUD is feasible however when intervention resources are prioritized to individuals who are objectively determined as high risk and tailored to their specific characteristics and circumstances. This study had the aim of developing a rapid accurate screening instrument for determining current presence of and future risk for SUD. The sample consisted of 182 girls recruited when they were 10-12 years of age and tracked to 22 years of age. From a large item pool the Drug Use Screening Inventory Quick Screen for Females (DQS-F) was derived consisting of the Substance Involvement Index and the Problem Severity Index. The DQS for Females (DQS-F) has high sensitivity for identifying girls who currently qualify for SUD diagnosis. Furthermore, accuracy of predicting future SUD with the DQS-F is in the good range at age 16 and in t...
International journal of person centered medicine, 2012
This article discusses human individuality within a lifespan developmental perspective. The pract... more This article discusses human individuality within a lifespan developmental perspective. The practical application of an individual differences framework for diagnosis, prevention and treatment of addiction is described. A brief overview of the methods conducive to knowledge development within the rubric of person-centered medicine that are available to practitioners working in office and clinic settings concludes the discussion.
Prevention science : the official journal of the Society for Prevention Research, 2001
Two child self-report scales were developed to measure parental neglect (emotional distance and p... more Two child self-report scales were developed to measure parental neglect (emotional distance and parental involvement) in a sample of 344 boys between 10 and 12 years of age. Psychometric analyses of the parental emotional distance and involvement scales demonstrated their unidimensionality; construct, concurrent, and predictive validity; and reliability. Cross-sectional analyses indicated that neglect was more severe among boys who had a parent with a DSM-III-R lifetime substance use disorder (SUD) compared to youth whose parents had no Axis I psychiatric disorder. In addition, children reported more severe neglect by the mother than the father. Longitudinal analyses of a subsample (n = 99) revealed that child neglect at ages 10-12 predicted significant variance on a composite measure of substance use involvement and severity of substance use as well as increased the risk for SUD at age 19.
We have conducted a population-based association study of substance abuse and a microsatellite at... more We have conducted a population-based association study of substance abuse and a microsatellite at the dopamine D5 receptor locus (DRD5) in a sample of European-American males and females with substance dependence (SA) or without any psychiatric disorder. Overrepresentation of the most frequent allele (148 bp) was found in males in the SA group (OR = 2.2, P = .02); this finding was reproduced in females (OR = 5.4, p < .001). The difference in the frequencies of this allele between SA males and SA females was statistically significant. The genotype coded in accordance with the dose of this allele correlated with substance abuse liability in males and females (stronger in females) and with novelty seeking in females. There was no evidence of correlation between the genotypes of spouses that could be induced by assortative mating for the liability to substance abuse. The data suggest that the DRD5 locus is involved in the variation and sex dimorphism of substance abuse liability.
Neuropsychologic tests of cerebral integrity recorded impairments in visuopractic and learning ca... more Neuropsychologic tests of cerebral integrity recorded impairments in visuopractic and learning capacity in patients with Wilson&#39;s disease. These psychometric findings point to the presence of a subclinical encephalopathy that is not otherwise revealed upon clinical examination.
Drug use disorders (DUD) have been theorized to share sources of risk variation with other consum... more Drug use disorders (DUD) have been theorized to share sources of risk variation with other consummatory behaviors. We hypothesized that common mechanisms exist for familial risk for DUD, physiological maturation and nutritional status in girls. Whereas body fat content must exceed a threshold to enable adrenarche and gonadarche, nutritional status may also be a behavior risk indicator. Impaired psychological self-regulation associated with DUD risk may manifest in early overeating, which could in turn accelerate reproductive maturation, resulting in a greater likelihood of affiliation with deviant/older peers and drug use. The sample consisted of families ascertained through the father who either had (N=95) or did not have (N=130) a DUD, and who had a 10-12 year old daughter and her mother available for study. Correlation, survival and path analyses of three consecutive assessments evaluated the relationships between parental DUD (number of affected parents, NAP), nutritional status (NS, subscapular skinfold measurements and body mass index), sexual maturation (Tanner stage), peer delinquency, and the daughter&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s lifetime DUD diagnosis. NAP was positively related to the girls&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; nutritional status. Longitudinal path analysis indicated mediation of the relationship between NAP and peer delinquency by sexual maturation. The relationship between NAP and sexual maturation is mediated by NS. The effect of sexual maturation at age ∼11 on the girls&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; DUD risk is mediated by peer delinquency. The data are consistent with mediation of intergenerational transmission of DUD risk in females by elevated nutrition, leading to accelerated maturation, and affiliation with deviant peers.
Journal of child & adolescent substance abuse, 2014
Studies are needed that examine neurobiological characteristics in high risk individuals prior to... more Studies are needed that examine neurobiological characteristics in high risk individuals prior to substance use disorder (SUD) development. In this pilot study, 4 adolescent subjects at high risk (having at least 1 parent with a SUD) for SUD were compared with 4 adolescent reference subjects on a corticolimbic reactivity paradigm, where they were presented with affect-laden faces or geometric shapes. FMRI was used to measure cortical activation in response to these stimuli. High risk subjects, compared to low risk, exhibited greater left amygdala activation (t=3.60, df=6, p=0.01), suggesting they may exhibit hyper-responsivity of the amygdala in response to emotional stimuli.
Psychological items discriminating children of fathers diagnosed with an illicit drug-related sub... more Psychological items discriminating children of fathers diagnosed with an illicit drug-related substance use disorder and normal controls are indicators of a unidimensional construct termed transmissible liability index (TLI) (Vanyukov et al., 2009). TLI is a highly heritable (Vanyukov et al., 2009; Hicks, Iacono, McGue, 2012) and valid (Vanyukov et al., 2009; Hicks et al., 2009; Kirisci et al., 2013a) measure of childhood liability to substance use disorders (SUDs). This longitudinal study determined whether TLI has incremental validity for predicting SUD beyond commonly measured psychological indicators of risk. TLI and measures of executive cognitive capacity, emotion dysregulation and externalizing disturbance were administered to boys at ages 10-12 and 16. SUD outcome determined at age 22 was assessed as (1) any SUD, (2) the number of drug-specific SUDs, and (3) SUD severity. TLI predicted SUD beyond the contribution of measures of emotion dysregulation, executive cognitive capacity and externalizing disturbance. The association of emotion dysregulation and externalizing behavior at ages 10-12 and 16 with SUD at age 22 was also reduced to non-significance after controlling for transmissible risk measured by TLI. TLI&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s incremental validity beyond these latter indicators of risk points to its utility for identifying vulnerable youths requiring intervention.
This study examined responses to peer provocation in boys ages 9-13 years who met symptomatic cri... more This study examined responses to peer provocation in boys ages 9-13 years who met symptomatic criteria for ADHD-only, ODD/CD-only, comorbid ADHD/ODD/CD, or no diagnosis. Boys participated in a reaction-time game that included standardized verbal and behavioral provocation. Their behavioral, physiological, and affective responses to this task were measured. Results showed that groups did not differ following high levels of provocation because all boys behaved aggressively. However, following low provocation boys with comorbid ADHD/ODD/CD had higher levels of behavioral aggression, had greater heart rate acceleration, and were rated as angrier than all other boys. In addition, boys with comorbid ADHD/ODD/CD held a grudge longer than other children. Results suggest that boys with comorbid ADHD/ODD/CD are especially reactive to provocation from their peers.
There is an urgent need for a reliable method of evaluating the severity of adolescent chemical a... more There is an urgent need for a reliable method of evaluating the severity of adolescent chemical abuse and problems related to chemical abuse. The lack of an appropriate rating scale to fill this objective hampers the design and the assessment of objective treatment outcome and follow-up of adolescent chemical abusers. The Teen-Addiction Severity Index (T-ASI) is a structured interview which was developed to assess the seven following domains: chemical use, school status, employment-support status, family relationships, peer-social relationships, legal status, and psychiatric status. This paper discusses the rationale for the design of the T-ASI and presents a preliminary study indicating satisfactory interrater reliability of the rating scale.
Journal of The American Academy of Child and Adolescent Psychiatry, 1992
The psychiatric and demographic characteristics that may distinguish treatment completers from no... more The psychiatric and demographic characteristics that may distinguish treatment completers from noncompleters among hospitalized adolescents with substance abuse and comorbid psychiatric disorders were examined. Affective and adjustment disorders were more prevalent among treatment completers whereas non-completers were more likely to be assigned a conduct disorder diagnosis. There were no differences between the groups with respect to demographic and legal status, education level and lifetime psychiatric diagnosis in the parents or caretakers, living arrangements, treatment history, and perception of treatment benefits. A higher percentage of treatment completers than noncompleters received psychotropic medications. The factors contributing to treatment termination as well as the clinical and research implications of the findings are discussed.
A battery of memory tests was administered to a group of patients with nonalcoholic cirrhosis and... more A battery of memory tests was administered to a group of patients with nonalcoholic cirrhosis and to a group of normals. Deficits observed in the former group indicate that there are detectable neuropsychological impairments on measures of higher cognitive functioning in persons who do not otherwise exhibit overt signs or symptoms of hepatic encephalopathy. These findings extend the range of impairments that have been documented to be present as part of the neuropsychiatric syndrome of portal-systemic encephalopathy.
Substance abuse : official publication of the Association for Medical Education and Research in Substance Abuse, 2014
ABSTRACT. Rapidly occurring changes in law enforcement and licensing of retail outlets to sell ma... more ABSTRACT. Rapidly occurring changes in law enforcement and licensing of retail outlets to sell marijuana raises the prospect that the population of consumers will expand and accordingly the prevalence of cannabis use disorder (CUD) will increase. This report presents a novel approach to researching CUD etiology joining multivariate and ontogenetic perspectives. CUD is conceptualized as a developmental outcome consisting of transmissible (intergenerational) and nontransmissible components. Partitioning the liability for CUD into these 2 dimensions enables implementing interventions targeted at the particular source and severity of risk. In addition, results showing that infant temperament disturbances predict transmissible risk leading to CUD 2 decades later underscore the importance of implementing early prevention.
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