Adrienne J. Heinz

Cognitive and neurobiological mechanisms of alcohol-related aggression

Alcohol-related violence is a serious and common social problem. Moreover, violent behaviour is much more common in alcohol-dependent individuals. Animal experiments and human studies have provided insights into the acute effect of alcohol on aggressive behaviour and into common factors underlying acute and chronic alcohol intake and aggression. These studies have shown that environmental factors, such as early-life stress, interact with genetic variations in serotonin-related genes that affect serotonergic and GABAergic neurotransmission. This leads to increased amygdala activity and impaired prefrontal function that, together, predispose to both increased alcohol intake and impulsive aggression. In addition, acute and chronic alcohol intake can further impair executive control and thereby facilitate aggressive behaviour.

A review of opioid dependence treatment: Pharmacological and psychosocial interventions to treat opioid addiction

Opioid dependence is a problem of national concern, especially with dramatically increased rates of abuse and dependence of prescription opioids. The current article provides an up-to-date review of the literature on opioid dependence treatment, with a focus on conclusions drawn by experts in the field (e.g., Cochrane reviews and meta-analyses) and methodologically rigorous studies (e.g., randomized controlled trials). We describe the major classes of drug treatments available, including opioid agonist (e.g., methadone, buprenorphine, LAAM), antagonist (e.g., naltrexone) and non-opioid pharmacotherapies (e.g., alpha2 adrenergic agonists). These treatments are discussed in the context of detoxification and long term treatment options such as abstinence-based and maintenance strategies. We review the state of the literature as to prevention of opioid overdose and discuss the widespread problem of comorbidity among opioid-dependent populations. We also focus prominently on evidence for inclusion of psychosocial approaches in treatment regimens, either as stand-alone or in conjunction with psychopharmacological options.

A comprehensive examination of hookah smoking in college students: Use patterns and contexts, social norms and attitudes, harm perception, psychological correlates and co-occurring substance use

The practice of waterpipe smoking (hookah) has rapidly increased in popularity among young adults yet burgeoning research suggests that its use is associated with nicotine dependence and other negative smoking-related health consequences. Moreover, descriptive studies indicate that consumers may hold the belief that hookah smoking is safer than smoking cigarettes. The current study extended previous work by conducting a comprehensive assessment of patterns and contexts of hookah use, psychological correlates of use, co-occurring substance use as well as social norms and health perceptions surrounding the practice. Participants were 143 ethnically diverse undergraduate students at a large urban US university. Approximately half of the sample (48%) reported life-time use of hookah and 22% reported use within the past 30days. Relative to cigarette smoking, hookah smoking was associated with less perceived harm and addiction potential and higher social approval. Participants who reported life-time hookah use, as compared to those who did not, perceived less associated harm, had a greater number of friends who had tried and approved of hookah, were more likely to use cigarettes, marijuana, and alcohol and in higher frequencies and quantities and were at higher risk for problem tobacco and alcohol use. Among participants who were not current smokers, those with hookah experience were more likely to endorse intent to try a cigarette soon. Hookah users did not differ from non-users on measures of trait anxiety, depression and impulsivity though they were more likely to drink alcohol for coping, social and enhancement purposes than non-users. Implications are discussed for public health initiatives to educate young adults about the potential consequences of hookah smoking.

Adolescents’ expectancies for smoking to regulate affect predict smoking behavior and nicotine dependence over time

AIMS Mounting evidence suggests that individuals smoke, in part, to regulate affective experience (e.g., tension reduction, mood enhancement). Implicit in such motives is the expectancy or belief that smoking will decrease negative affect and increase positive affect. The contribution of cognitively-driven expectancies to the initiation and continuation of smoking during adolescence remains largely uninvestigated. The current study examined the influence of negative affect relief expectancies (NAREs) for smoking on smoking behavior and nicotine dependence using longitudinal data from a study on the emotional and social contexts of youth smoking. METHODS Participants were 568 adolescents with smoking experience (mean age 15.67, 56.7% female). Three separate mixed regression models were estimated to determine the relative contribution of NAREs to smoking behavior and nicotine dependence measured at 4 time points over 2 years. RESULTS NAREs for smoking influenced all smoking outcomes at baseline and predicted increases in smoking behavior and nicotine dependence over time, even after controlling for anxious and depressive symptoms and baseline nicotine dependence. CONCLUSIONS Outcome expectancies for affect management emerged as an important risk factor for smoking escalation and the development of nicotine dependence during adolescence. The present findings highlight the potential importance of cognitively-driven expectancies as a risk factor for smoking escalation during this critical developmental period.

Marriage and relationship closeness as predictors of cocaine and heroin use.

Marriage has been cited as a protective factor against drug use, but the relationship between marriage and drug use has not been explored longitudinally during addiction treatment. The current study assessed individual trajectories of substance use during treatment as a function of marital status and perceived closeness of the marital relationship. A parallel-process growth model was used to (1) estimate the rate of change in percentage of cocaine-positive and heroin-positive urine samples, and (2) examine the relationship between marital status and drug use trajectories over 35 weeks, during and after treatment. Percent days of use for both drugs were lowest for married participants across all time points. Among married participants, reporting a close relationship with ones partner predicted less cocaine and heroin use. These findings suggest that being married and having a close relationship with ones spouse are associated with better outcomes over time. The causal nature of the association is suggested by previous research that has demonstrated the effectiveness of couples therapy as an adjunct to methadone maintenance.

Spiritual/Religious Experiences and In-Treatment Outcome in an Inner-City Program for Heroin and Cocaine Dependence

Abstract Although spirituality is an integral component of some of the most popular approaches to substance abuse treatment, there is little empirical evidence for a causal relationship between spirituality and treatment success. In the present study, 169 (121 male) opiate- or cocaine-abusing treatment seekers completed the Index of Spiritual Experience (INSPIRIT), a questionnaire that assesses both spirituality and religiosity. Responses were analyzed in terms of demographic variables and in-treatment outcome, which was determined by treatment retention and drug screens from observed biweekly urine collections. Religious/spiritual beliefs were common in these participants and were associated with in-treatment outcome: total INSPIRIT score was weakly correlated (r = .16, p < .04) with number of subsequent cocaine-negative urines, and participants reporting that they frequently spent time on religious/spiritual activities showed significantly better outcomes in terms of subsequent drug use and treatment retention. Women and Mrican Americans were more likely than men and non-Arican Americans to report religious and spiritual beliefs or experiences on several individual items, and Mrican Americans had higher INSPIRIT scores than Caucasians. The results suggest that spiritual and religious experience plays a role in substance abuse recovery and that demographic characteristics should be considered in the design of spiritually oriented behavioral interventions for addiction.

HIV Medication Adherence and HIV Symptom Severity: The Roles of Sleep Quality and Memory

The purpose of the current study was to examine the extent to which self-reported sleep quality, a clinically malleable factor, is associated with both HIV medication adherence and self-reported HIV symptom severity. In addition, we sought to examine whether sleep quality may explain the association between HIV medication adherence and symptom severity, as well as the role of self-reported memory functioning in terms of the above relations. This study took place from April 2010 to March 2012. Participants were 129 HIV-positive individuals who completed an ART pill count and series of structured clinical interviews and self-report questionnaires on sleep, memory, and HIV symptom severity. A series of regressions were conducted to test study hypotheses. After accounting for covariates (i.e., problematic alcohol, nicotine, and cannabis use, and mood disorder diagnosis), results indicated that self-reported sleep quality was associated with HIV medication adherence and self-reported HIV symptom severity, and that sleep quality partially mediated the relation between medication adherence and self-reported HIV symptom severity. In addition, memory functioning moderated the relation between self-reported sleep quality and HIV symptom severity, such that the interaction of poor sleep quality and relatively good memory functioning was associated with heightened self-reported HIV symptom severity. This study highlights the importance of assessing sleep and memory among HIV-infected individuals as they may represent treatment targets for those experiencing poor medication adherence or particularly severe HIV symptoms. Such information could lead to the inclusion of adjunct brief interventions to target sleep and memory functioning in order to reduce symptom severity among HIV-positive individuals with poor medication adherence.

Cannabis use patterns and motives: A comparison of younger, middle-aged, and older medical cannabis dispensary patients

INTRODUCTION Medical cannabis is increasingly being used for a variety of health conditions as more states implement legislation permitting medical use of cannabis. Little is known about medical cannabis use patterns and motives among adults across the lifespan. METHODS The present study examined data collected at a medical cannabis dispensary in San Francisco, California. Participants included 217 medical cannabis patients who were grouped into age-defined cohorts (younger: 18-30, middle-aged: 31-50, and older: 51-72). The age groups were compared on several measures of cannabis use, motives and medical conditions using one-way ANOVAs, chi-square tests and linear regression analyses. RESULTS All three age groups had similar frequency of cannabis use over the past month; however, the quantity of cannabis used and rates of problematic cannabis use were higher among younger users relative to middle-aged and older adults. The association between age and problematic cannabis use was moderated by age of regular use initiation such that earlier age of regular cannabis use onset was associated with more problematic use in the younger users, but not among older users. Middle-aged adults were more likely to report using medical cannabis for insomnia, while older adults were more likely to use medical cannabis for chronic medical problems such as cancer, glaucoma and HIV/AIDS. Younger participants reported cannabis use when bored at a greater rate than middle-aged and older adults. CONCLUSIONS Findings suggest that there is an age-related risk for problematic cannabis use among medical cannabis users, such that younger users should be monitored for cannabis use patterns that may lead to deleterious consequences.

Translational Clinical Neuroscience Perspectives on the Cognitive and Neurobiological Mechanisms Underlying Alcohol-Related Aggression

Alcohol-related violence, a longstanding, serious, and pervasive social problem, has provided researchers from diverse disciplines with a model to study individual differences in aggressive and violent behavior. Of course, not all alcohol consumers will become aggressive after drinking and similarly, not all individuals with alcohol use disorders will exhibit such untoward behavior. Rather, the relationship is best conceptualized as complex and indirect and is influenced by a constellation of social, cognitive, and biological factors that differ greatly from one person to the next. Animal experiments and human studies have elucidated how these mechanisms and processes explain (i.e., mediate) the relation between acute and chronic alcohol consumption and aggressive behavior. Further, the rich body of literature on alcohol-related aggression has allowed for identification of several potential high-yield targets for clinical intervention, e.g., cognitive training for executive dysfunction; psychopharmacology targeting affect and threat perception, which may also generalize to other psychiatric conditions characterized by aggressive behavior. Here we aim to integrate pertinent findings, derived from different methodological approaches and theoretical models, which explain heterogeneity in aggressive responses to alcohol. A translational platform is provided, highlighting common factors linking alcohol and aggression that warrant further, interdisciplinary study in order to reduce the devastating social impact of this phenomenon.

The role of cognitive structure in college student problem drinking

Although motivational models of alcohol use often invoke constructs relevant to affective distress (e.g., depressive symptoms), to date, no study has assessed the potential role of cognitive structures (enduring cognitive belief systems) in promoting problematic drinking behavior. Thus, the current study evaluated the relationship between cognitive structure, specifically dysfunctional attitudes and automatic negative thoughts, and problem-related drinking, while controlling for the influence of alcohol consumption, drinking motives related to affect management, demographic variables, and depressive symptoms. Participants were 182 male and female (80%) college undergraduates, who completed a battery of self-report questionnaires on two occasions, separated by 8 weeks. Initial correlational analyses indicated strong (positive) associations among the cognitive structure variables, depressive symptoms, and problem drinking behavior. Findings from set-wise hierarchical regression analyses demonstrated that dysfunctional attitudes measured at Time 1 (T1) predicted problem drinking eight weeks later at Time 2 (T2) even after controlling for age and sex, alcohol consumption (T2), depressive symptoms (T2), and drinking motives linked to affect regulation (T1). These findings highlight the potential importance of cognitive structure as a risk factor for problem drinking, above and beyond the risk posed by more traditionally studied variables.