Allison K. Labbe

The importance of age composition of 12-step meetings as a moderating factor in the relation between young adults' 12-step participation and abstinence

BACKGROUND Participation in 12-step mutual help organizations (MHO) is a common continuing care recommendation for adults; however, little is known about the effects of MHO participation among young adults (i.e., ages 18-25 years) for whom the typically older age composition at meetings may serve as a barrier to engagement and benefits. This study examined whether the age composition of 12-step meetings moderated the recovery benefits derived from attending MHOs. METHOD Young adults (n=302; 18-24 years; 26% female; 94% White) enrolled in a naturalistic study of residential treatment effectiveness were assessed at intake, and 3, 6, and 12 months later on 12-step attendance, age composition of attended 12-step groups, and treatment outcome (Percent Days Abstinent [PDA]). Hierarchical linear models (HLM) tested the moderating effect of age composition on PDA concurrently and in lagged models controlling for confounds. RESULTS A significant three-way interaction between attendance, age composition, and time was detected in the concurrent (p=0.002), but not lagged, model (b=0.38, p=0.46). Specifically, a similar age composition was helpful early post-treatment among low 12-step attendees, but became detrimental over time. CONCLUSIONS Treatment and other referral agencies might enhance the likelihood of successful remission and recovery among young adults by locating and initially linking such individuals to age appropriate groups. Once engaged, however, it may be prudent to encourage gradual integration into the broader mixed-age range of 12-step meetings, wherein it is possible that older members may provide the depth and length of sober experience needed to carry young adults forward into long-term recovery.

Toward Enhancing 12-Step Facilitation Among Young People: A Systematic Qualitative Investigation of Young Adults’ 12-Step Experiences

BACKGROUND 12-Step Facilitation (TSF) interventions designed to enhance rates of engagement with 12-step mutual-help organizations (MHOs) have shown efficacy among adults, but research provides little guidance on how to adapt TSF strategies for young people. METHODS To inform TSF strategies for youth, this study used qualitative methods to investigate the self-reported experiences of 12-step participation, and reasons for nonattendance and discontinuation among young adults (18-24 years; N = 302). Responses to open-ended questions following residential treatment were coded into rationally derived domains. RESULTS Young adults reported that cohesiveness, belonging, and instillation of hope were the most helpful aspects of attending 12-step groups; meeting structure and having to motivate oneself to attend meetings were the most common aspects young adults liked least; logistical barriers and low recovery motivation and interest were the most common reasons for discontinued attendance; and perceptions that one did not have a problem or needed treatment were cited most often as reasons for never attending. CONCLUSIONS Findings may inform and enhance strategies intended to engage young people with community-based recovery-focused 12-step MHOs and ultimately improve recovery outcomes.

Development of the Stimulant Medication Outcome Expectancies Questionnaire for College Students

Non-prescribed use of stimulant medication among college students has become a public health concern. Although it has been well-established that outcome expectancies play a prominent role in initiation and maintenance of drinking behaviors it is unknown if and how outcome expectancies influence non-prescribed use of stimulant medication among college students. The aim of this study was to develop a valid and reliable scale that assesses outcome expectancies of non-prescribed use of stimulant medication. A 16-item Stimulant Medication Outcome Expectancy Questionnaire (SMOEQ) was created using qualitative information given by introductory psychology students regarding their expectancies about misusing stimulant medication. An exploratory factor analysis (EFA) identified a three-factor solution: the Academic factor, Recreational factor, and Negative Physiological Effects factor, respectively. A confirmatory factor analysis (CFA) validated the factor structure identified in the EFA and indicated a modest fit of the hypothesized factor structure to the data. Correlation analyses provided support for the internal consistency and construct validity of the SMOEQ.

Cognitive and Behavioral Approaches for Treating Substance Use Disorders Among Behavioral Medicine Patients

Substance use and substance use disorders (SUD), including alcohol, are a serious public health concern. SUD presentation in clinical practice is highly heterogeneous and can be challenging to treat. Potentially complicating SUD treatment is the co-occurrence of a chronic medical condition. To illustrate these complications and how to address them effectively using cognitive–behavioral interventions, this chapter is divided into six sections: (1) the prevalence, clinical presentations, and complications of having a comorbid alcohol or other substance use disorder across five common medical conditions; (2) description of cognitive and behavioral approaches to addressing alcohol and other drug use disorders in medical settings; (3) a brief overview of the empirical support for CBT approaches for alcohol and other substance use disorders; (4) implementation of CBT in addressing these clinical challenges; (5) reducing harm caused by substances when abstinence is clinically unfeasible; and (6) a case example that highlights CBT principles and techniques in practice.

Depression CBT treatment gains among HIV-infected persons with a history of injection drug use varies as a function of baseline substance use

Depression and substance use, the most common comorbidities with HIV, are both associated with poor treatment outcomes and accelerated HIV disease progression. Though previous research has demonstrated short-term and follow-up success for cognitive behavioral therapy for adherence and depression (CBT-AD) on depression outcomes among patients with HIV in care and among patients with HIV in active substance abuse treatment for injection drug use (IDU), there is little information regarding possible moderating effects of active use versus abstinence on depression treatment gains. The present study aimed to examine recent substance use at treatment initiation as a moderator of the acute and maintenance effects of CBT-AD on depression. We used data from a two-arm, randomized controlled trial (N = 89) comparing CBT-AD to enhanced treatment as usual in individuals in treatment for IDU. To test whether depression at time of presentation affected outcomes, repeated-measures ANOVAs were conducted for two time frames: (1) acute phase (baseline to post-treatment) (acute) and (2) maintenance phase (baseline to 12-month follow-up). To further examine maintenance of gains, we additionally looked at post-treatment to 12-month follow-up. Depression scores derived from the clinical global impression for severity and the Montgomery–Asberg depression rating scale (MADRS) served as the primary outcome variables. Acute (baseline post treatment) moderation effects were found for those patients endorsing active drug use at baseline in the CBT-AD condition, who demonstrated the greatest reductions in MADRS scores at post-treatment (F[1,76] = 6.78, p = .01) and follow-up (F[1,61] = 5.46, p = .023). Baseline substance use did not moderate differences from post-treatment to 12-month follow-up as depression treatment gains that occurred acutely from baseline to post-treatment were maintained across both patients engaged in substance use and abstainers. We conclude that CBT-AD for triply diagnosed patients (i.e. HIV, depression, and substance dependence) is useful for treating depression for both patients with a history of substance use, as well as patients currently engaged in substance use.

A qualitative study of the feasibility and acceptability of a smoking cessation program for people living with HIV and emotional dysregulation

ABSTRACT Despite high rates of co-occurring tobacco use and anxiety among persons living with HIV, evidence-based interventions for these individuals are limited. An existing cognitive–behavioral treatment protocol for smoking cessation and anxiety (Norton, P. J., & Barrera, T. L. (2012). Transdiagnostic versus diagnosis-specific CBT for anxiety disorders: A preliminary randomized controlled noninferiority trial. Depression and Anxiety, 29(10), 874–882. https://doi.org/10.1002/da.21974) was modified to address transdiagnostic constructs, such as anxiety sensitivity, distress tolerance, and depressive symptomatology (Labbe, A. K., Wilner, J. G., Kosiba, J. D., Gonzalez, A., Smits, J. A., Zvolensky, M. J., … O’Cleirigh, C. (2017). Demonstration of an Integrated Treatment for Smoking Cessation and Anxiety Symptoms in People with HIV: A Clinical Case Study. Cognitive and Behavioral Practice, 24(2), 200–214. https://doi.org/10.1016/j.cbpra.2016.03.009). This study examines the feasibility and acceptability of the intervention as determined from qualitative data from structured exit interviews from 10 participants who completed treatment. Results demonstrated that participants were very motivated to quit smoking and enrolled in the program for health-related reasons and to be able to quit. Participants found nearly all the treatment components to be useful for reaching their smoking cessation goal and in managing emotional dysregulation. Last, all participants stated that they would strongly recommend the treatment program. This qualitative study provides initial evidence for the feasibility and acceptability of a modified smoking cessation treatment protocol for HIV+ individuals with anxiety and emotional dysregulation. Future research will focus on evaluating the efficacy of the protocol in a full-scale randomized controlled trial, as well as working to collect qualitative data from participants who discontinue treatment to better understand reasons for treatment attrition.

Cognitive Behavioral Approaches for Substance Use Disorders

Substance use disorders (SUDs) are prevalent, complex medical conditions that are frequently encountered in primary care, mental health, and specialty care settings. Individuals with SUDs vary considerably in clinical severity, accompanying medical sequelae, and degree of functional impairment, and often struggle with comorbid psychiatric conditions. Cognitive behavioral therapy (CBT) is an intuitive, theory-driven psychotherapeutic approach that has been shown to be effective in reducing the harm associated with substance use and increasing the chances of remission. This chapter highlights the theoretical rationale for cognitive behavioral interventions for SUD, describes how to implement CBT based on a simplified model of substance use behavior, and provides an illustrative case example of using CBT to treat SUD. As periods of relapse are common along the path to full remission and recovery from SUD, ongoing behavioral management and monitoring using cognitive behavioral approaches is likely to be helpful.