Jennifer C. Veilleux

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.

The Acute Effects of Nicotine on Positive and Negative Affect in Adolescent Smokers

Although adolescent cigarette smoking remains a critical public health concern, little is known about the reinforcing mechanisms governing smoking in this vulnerable population. To assess predictions derived from both positive and negative reinforcement models of drug use, the authors measured the acute effects of nicotine, as administered via tobacco cigarettes, on both positive and negative affect in a group of 15- to 18-year-old smokers. A matched group of nonsmokers served as a comparison group. Findings revealed that whereas adolescents who smoked a cigarette experienced reductions in both positive and negative affect, the observed reductions in negative affect were moderated by nicotine content of the cigarette (high yield vs. denicotinized), level of nicotine dependence, level of baseline craving, and smoking expectancies pertinent to negative affect regulation. Nonsmokers experienced no change in affect over the 10-min assessment period, and no interaction effects were observed for positive affect. Overall, the findings conform to a negative reinforcement model of nicotine effects and strongly suggest that, even among young light smokers, nicotine dependence and resultant withdrawal symptomatology may serve as motivating factors governing smoking behavior.

Development and validation of the Specific Loss of Interest and Pleasure Scale (SLIPS)

BACKGROUND Anhedonia, or loss of pleasure and/or interest in people or things, is a key component of many forms of psychopathology. Extant anhedonia measures only assess current state or longstanding trait anhedonia, which risks discounting recent changes. Thus, we created the Specific Loss of Interest and Pleasure Scale (SLIPS), to assess recent changes in anhedonia. METHODS Four studies assessed the reliability and validity of the SLIPS through factor and internal consistency analyses, convergent and divergent validity analyses, and incremental validity analyses in individuals reporting non-clinical and clinical levels of psychopathology. RESULTS The SLIPS was internally consistent, converged with existing state measures of anhedonia and depression, and diverged from general measures of affect and trait anticipatory and consummatory pleasure. Furthermore, the SLIPS predicted recent changes in anhedonia independent of existing measures. Moreover, in respondents reporting moderate or severe symptoms of depression, only the SLIPS was associated with recent changes in anhedonia. LIMITATIONS Prospective limitations included a resulting one factor solution and the potential that the method of scaling influenced results. However, these limitations were offset by empirical verification and the unique strength of the scaling of the SLIPS. CONCLUSIONS The SLIPS is the first validated measure that allows for the assessment of recent changes in anhedonia in non-clinical and clinical samples. Results suggest that the SLIPS offers unique clinical utility by discriminating changes in anhedonia within at-risk and clinically depressed groups.

Negative Affect and Addiction

Publisher Summary Once an individual has crossed the line at which withdrawal symptomatology emerges in the absence of drug self-administration, that person is deemed addicted; his/her drug use is then believed to be motivated predominantly by the need to stave off the uncomfortable symptoms of withdrawal, which almost universally—across virtually all drugs of abuse and even nonpharmacological addictive behaviors—include various forms of negative affect (NA). Noting that virtually all drug users attribute their use to its purported ability to assuage NA, this chapter reviews the empirical literature in an effort to try to address the veracity of this claim. First, it explains what comprises NA and reviews several influential theoretical models of drug addiction, all of which make a strong case for the important role played by negative affect in promoting addictive substance use. It then considers the potentially important role played by expectancies in shaping and influencing the relationship between affect and drug use. Next, it argues that a meaningful delineation of the complex relationship between NA and drug addiction is a must.

The Association between Anhedonia, Suicidal Ideation, and Suicide Attempts in a Large Student Sample

Depression is a significant risk factor for suicide. Evidence suggests that anhedonia may be a symptom of depression that is uniquely associated with suicidality. However, exactly how anhedonia is related to suicide is unclear. To provide more specific evidence regarding this association, we investigated relationships between anhedonia, suicidal ideation, and suicide attempts. A large combined undergraduate sample completed the novel Specific Loss of Interest and Pleasure Scale (SLIPS), the Center of Epidemiological Studies Depression Scale (CES-D), and the Suicidal Behaviors Questionnaire—Revised (SBQ-R). Anhedonia was associated with suicidal ideation, even when accounting for depressive symptoms. Additionally, anhedonia was not associated with suicide attempts when symptoms of depression were held constant. The current study provides novel evidence regarding the relationship between anhedonia and risk of attempting suicide. Future research can examine the role anhedonia plays in the unfolding of suicidal behavior over time.

Smoking, food, and alcohol cues on subsequent behavior: a qualitative systematic review.

Although craving is a frequent phenomenon in addictive behaviors, and laboratory paradigms have robustly established that presentation of cues can elicit self-reported craving responses, extant work has not established whether cue exposure influences subsequent behavior. We systematically review extant literature assessing the effects of cue exposure to smoking, food, and alcohol cues on behavioral outcomes framed by three questions: (1) Is there value in distinguishing between the effects of cue exposure on behavior from the responses to cues (e.g., self-reported craving) predicting behavior?; (2) What are the effect of cues on behavior beyond lapse, such as broadly considering both target-syntonic (e.g., do cigarette cues predict smoking-related behaviors) and target-dystonic behaviors (e.g., do cigarette cues predict other outcomes besides smoking)?; (3) What are the lessons to be learned from examining cue exposure studies across smoking, food and alcohol domains? Evidence generally indicates an effect of cue exposure on both target-syntonic and target-dystonic behavior, and that self-report cue-reactivity predicts immediate target-syntonic outcomes. Effects of smoking, food and alcohol cues on behavior are compared to elucidate generalizations about the effects of cue exposure as well as methodological differences that may serve the study of craving in the future.

Cue-induced cigarette craving and mixed emotions: a role for positive affect in the craving process.

Craving is an important component of nicotine addiction, and extant research has demonstrated a clear link between cue-induced craving and negative affect, with mixed results in the positive affect domain. The current study was designed to test the idea that cue-reactive craving might be associated with a mixed emotional process, or the simultaneous experience of positive and negative affect. Participants were 86 non-deprived regular smokers and tobacco chippers who provided simultaneous ratings of positive and negative affect during cue exposure to pleasant, unpleasant, neutral and cigarette cues. Results indicated that self-reported craving was elevated in response to cigarette cues compared to other valenced cue types and craving was higher to pleasant cues than either neutral or unpleasant cues. Mixed emotional responses were higher to cigarette cues than other cue types. In addition, mixed emotional responses to cigarette cues predicted craving even after controlling for smoker type, difficulties regulating negative emotion, baseline craving level and mixed emotional responses to neutral cues. As the first study to investigate mixed emotions and cigarette craving, our results highlight the importance of examining the relationship between cue-reactive craving and emotional response using models of emotion that allow for measurement of nuanced emotional experience. In addition, our findings suggest that positive affect processes may indeed play a role in craving among non-deprived smokers.

Clinical PhD Graduate Student Views of Their Scientist-Practitioner Training

OBJECTIVES The goal of the scientist-practitioner (S-P) training model is to produce clinical psychologists equipped to integrate and utilize both science and practice in the clinical and research domains. However, much has been written regarding the possible shortcomings of S-P training and whether clinical psychology graduate students are actually gaining the knowledge and skills to integrate science and practice during graduate training and beyond (Chang, Lee, & Hargreaves, 2008; Gelso, 2006; Merlo, Collins, & Bernstein, 2008; Phillips, 1993). METHODS As such, the present study assessed ratings of satisfaction, perception of ability, and use of the S-P training model within 653 clinical psychology graduate students enrolled in programs that are members of the Council of University Directors of Clinical Psychology. RESULTS Findings suggest that students are consistently trained in the integration of science and practice and have confidence in their abilities to apply the S-P integration to research and clinical work. However, despite understanding the ways in which science can influence practice, over one third of students reported that they rarely use science-based decisions when informing clients of the clinical services they will be providing. CONCLUSIONS The implications of these results support the need for a more detailed evaluation of clinical psychology graduate students as well as the use of research-informed practice and the process of providing clients with information they need to make informed choices about treatment.

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.