Joshua P. Smith

Postinjury estrogen treatment of chronic spinal cord injury improves locomotor function in rats

Spinal cord injury (SCI) causes loss of neurological function and, depending on serverity, may cause paralysis. The only recommended pharmacotherapy for the treatment of SCI is high‐dose methylprednisolone, and its use is controversial. We have previously shown that estrogen treatment attenuated cell death, axonal and myelin damage, calpain and caspase activities, and inflammation in acute SCI. The aim of this study was to examine whether posttreatment of SCI with estrogen would improve locomotor function by protecting cells and axons and reducing inflammation during the chronic phase following injury. Moderately severe injury (40 g · cm force) was induced in male Sprague‐Dawley rats following laminectomy at T10. Three groups of animals were used: sham (laminectomy only), vehicle (dimethyl sulfoxide; DMSO)‐treated injury group, and estrogen‐treated injury group. Animals were treated with 4 mg/kg estrogen at 15 min and 24 hr postnjury, followed by 2 mg/kg estrogen daily for the next 5 days. After treatment, animals were sacrificed at the end of 6 weeks following injury, and 1‐cm segments of spinal cord (lesion, rostral to lesion, and caudal to lesion) were removed for biochemical analyses. Estrogen treatment reduced COX‐2 activity, blocked nuclear factor‐κB translocation, prevented glial reactivity, attenuated neuron death, inhibited activation and activity of calpain and caspase‐3, decreased axonal damage, reduced myelin loss in the lesion and penumbra, and improved locomotor function compared with vehicle‐treated animals. These findings suggest that estrogen may be useful as a promising therapeutic agent for prevention of damage and improvement of locomotor function in chronic SCI.

Comorbidity of generalized anxiety disorder and alcohol use disorders among individuals seeking outpatient substance abuse treatment

The present study sought to address a gap in the literature by providing preliminary evidence of the prevalence and clinical characteristics of comorbid generalized anxiety disorder (GAD) and alcohol use disorders (AUD) in a front-line outpatient substance abuse clinic. Of 39 outpatients meeting criteria for an AUD, nearly half (46%) also met criteria for current GAD. The onset of GAD occurred prior to AUD in 67% of comorbid cases, with an average time lag of 12.5 years among individuals with primary GAD. Participants with comorbid GAD-AUD endorsed higher levels of worry severity and worry-reduction alcohol expectancies, and 55.6% of comorbid participants had a history of suicide attempts. Groups did not differ on anxiety sensitivity, social anxiety, or depression. Comorbid participants were more likely to indicate that worry interfered with their substance abuse treatment, and to indicate interest in concurrent treatment targeting their worry. Study findings provide initial evidence that GAD may be a prevalent and relevant factor among individuals with AUD seeking outpatient substance abuse treatment.

Alcohol expectancies and drinking motives in college drinkers: Mediating effects on the relationship between generalized anxiety and heavy drinking in negative-affect situations

The current study tested the hypotheses that drinking to cope motives and alcohol expectancies of tension- and worry-reduction mediate the relationship between generalized anxiety (GA) and negative-affect heavy drinking in a cross-sectional sample of 782 college drinkers. As expected, structural equation modeling results indicated that alcohol expectancies mediated the relationship between GA and drinking to cope motives, and drinking to cope motives mediated the relationship between alcohol expectancies and heavy drinking in negative-affect situations. Unexpectedly, drinking to cope motives also mediated the relationship between GA and negative-affect heavy drinking. The model predicting negative-affect heavy drinking was tested in subsamples of 413 hazardous and 366 nonhazardous drinkers and did not differ structurally; however, omnibus measurement of model indirect effects was stronger for hazardous than nonhazardous drinkers. Finally, the results of a similar post-hoc model to predict general problem drinking support the specificity of the interrelationships among GA, cognitive mediators and to negative-affect drinking. These results inform cognitive-behavioral theories and interventions for comorbid GA and alcohol use problems.

Drinking refusal self-efficacy and tension-reduction alcohol expectancies moderating the relationship between generalized anxiety and drinking behaviors in young adult drinkers.

Despite the substantial comorbidity between generalized anxiety disorder (GAD) and alcohol use disorders (AUD), little is known about contributing factors to this relationship. This lack of knowledge has limited the development of theoretical models explicating the interesting yet complex relationship between GAD and AUD. The current study examined the roles of generalized anxiety, tension-reduction alcohol expectancies, and drinking refusal self-efficacy in accounting for the variance of alcohol consumption and alcohol-related consequences in a sample of young adult drinkers (N = 474; 18-25 years of age, median age 19, 66% female) from a large, urban Midwestern university. Results showed that generalized anxiety level interacted with both tension-reduction alcohol expectancies and drinking refusal self-efficacy to predict alcohol consumption and alcohol-related consequences. Findings support the assessment of both alcohol-related consequences and alcohol consumption, and highlight the importance of drinking refusal self-efficacy, which is a currently underexamined variable. Study results also enhance the knowledge about the underlining mechanisms of GAD and AUD comorbidity, which facilitates the development of an empirically based theoretical paradigm for their relationship.

12-Step Therapy and Women with and without Social Phobia: A Study of the Effectiveness of 12-Step Therapy to Facilitate AA Engagement

Alcoholism treatment often encourages involvement in Alcoholics Anonymous (AA). Little provision is made for women with social phobia (SP), who have been reported to have worse outcomes in 12-step facilitation (TSF) relative to cognitive behavioral therapy. This study examined whether SP moderated the effects of gender for these women in TSF. One hundred thirty-three SP alcoholics assigned to TSF (35 females and 98 males) in Project MATCH were compared to a no-SP control group. SP women drank earlier and more intensely than no-SP women and all males, had equivalent completion of Step 5, and were less likely to acquire a sponsor during TSF.

The potential utility of drinking motive questions to screen at-risk drinking in socially anxious patients

Abstract Background: Drinking motives are thought to be important mediators of the relationship between social anxiety and alcohol use. This project evaluates whether specific drinking motives accurately reflect alcohol dependence. If so, brief questions about drinking motives could serve as valuable alcohol screening tools with socially anxious patients. Methods: This investigation was a secondary analysis of an existing data set of 83 subjects with social anxiety disorder and at-risk alcohol use. The relationship between Drinking Motives Questionnaire (DMQ-R-5) subscales and alcohol dependence was evaluated. Results: Coping-Depression was the only subscale that contributed to the unique prediction of a diagnosis of alcohol dependence. Additionally, two items (i.e. “to cheer up when you’re in a bad mood” and “to forget painful memories”) predicted a diagnosis of alcohol dependence above and beyond their association with each other. Conclusions: Among patients with social anxiety, two specific questions on the DMQ-R-5 could provide a useful screen for health professionals to predict alcohol dependence. It may be fruitful to specifically target the motives of “to cheer up when you’re in a bad mood” and “to forget painful memories” when providing advice during brief interventions.

Brief Motivational Feedback May Enhance Treatment Entry in Veterans with Comorbid Substance Use and Psychiatric Disorders

BACKGROUND AND OBJECTIVES There are limited investigations of brief interventions to facilitate treatment entry among individuals with substance use disorders. This study investigated the effectiveness of brief motivational feedback (BMF) for increasing entry into intensive substance abuse treatment in veteran patients. METHODS Veteran patients (N = 84) with substance use disorders referred for an intake assessment in a substance abuse specialty clinic received either (i) intake assessment plus BMF or (ii) intake assessment as usual (AAU). BMF consisted of brief motivational enhancement feedback pertaining to estimates of alcohol and drug consumption, money spent on drugs and alcohol, and self-reported problems due to substance abuse. Primary outcome was entry in treatment groups in an intensive outpatient program for substance abuse. RESULTS Patients in BMF and AAU conditions did not significantly differ on indices of treatment entry. However, among patients with comorbid substance dependence and psychiatric disorders, those who received BMF were significantly more likely to enter outpatient treatment groups. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE The addition of motivational feedback to a standard intake assessment enhanced substance abuse treatment entry among veteran patients with comorbid substance use disorders and psychiatric disorders. These preliminary findings extend the use of motivational feedback to facilitate entry into substance abuse treatment among veteran patients with comorbid substance use and psychiatric disorders. Furthermore, they suggest opportunity for more effective patient-treatment matching based on initial motivation and other individual factors such as psychiatric comorbidity.

Treating individuals with social anxiety disorder and at-risk drinking: Phasing in a brief alcohol intervention following paroxetine

Paroxetine alone is not sufficient to decrease alcohol use in socially anxious alcoholics seeking anxiety treatment. We tested the hypothesis that adding a brief-alcohol-intervention (BI) to paroxetine would decrease alcohol use. All subjects (N=83) had a diagnosis of social anxiety disorder, endorsed drinking to cope with anxiety, were NIAAA-defined at-risk drinkers, and were randomized to either paroxetine alone, or paroxetine plus BI. Both groups showed significant improvement in both social anxiety severity (F(5,83)=61.5, p<0.0001) and drinking to cope (e.g. F(4,79)=23, p<0.0001) and these two constructs correlated with each other (B=3.39, SE=0.696, t(71)=4.88, p<0.001). BI was not effective at decreasing alcohol use (e.g. no main effect of group, all p values >0.3). Paroxetine decreased social anxiety severity in the face of heavy drinking and decreasing the anxiety was related to a concurrent decrease in coping related drinking. BI was not effective at decreasing drinking or drinking to cope.

Severity of anxiety in mental health versus addiction treatment settings when social anxiety and substance abuse are comorbid

There is increasing interest in the co-occurrence of social anxiety and addiction. Each investigation has a specific vantage point, e.g., the effect social anxiety has in a population with addiction or that of addiction in a population with social anxiety, which could create unique findings. Among comorbid individuals, is social anxiety more severe in people seeking treatment for anxiety, as compared to those seeking treatment for addiction? This report compares social anxiety severity between subjects in two studies--one involving socially anxious individuals (n=38) seeking treatment for addictions; the other (n=41) subjects with social anxiety and an alcohol use disorder, seeking treatment for social anxiety. Baseline severity scores on the Liebowitz Social Anxiety Scale for social anxiety were compared between the groups. No significant differences were found. For both groups, social anxiety was largely in the severe range. The results suggest that clinicians should attend to social anxiety symptom severity in patients with co-occurring social anxiety and addiction, regardless of the condition for which treatment is sought.

Interrelated effects of substance use diagnosis, race, and smoking severity on abstinence initiation in dually dependent male smokers: results of a retrospective chart review.

Purpose:Study goals were 2-fold: 1) to examine differences in demographic and clinical characteristics of smokers who fell into 3 diagnostic groups: alcohol abuse/dependence only (ALC), cocaine abuse/dependence only (COC), and mixed alcohol and cocaine abuse/dependence (ALC + COC); and 2) to determine the degree to which diagnostic grouping predicted short-term abstinence from smoking. Methods:Retrospective chart reviews were conducted by using the treatment records of male veterans (N = 175) who participated in a voluntary smoking cessation program during their stay in residential substance dependence treatment. Results:The ALC group smoked more heavily, had higher levels of nicotine dependence, and reported more emotional problems than the other 2 groups. Short-term abstinence rates were high across the 3 groups (38%, 58%, and 57% for the ALC, COC, and ALC + COC groups, respectively). Lighter smoking at treatment entry, non-white race, and a diagnosis of cocaine abuse/dependence (with or without alcohol abuse/dependence) predicted short-term abstinence in the program. Conclusions:Substance misusers motivated to quit smoking can initiate smoking abstinence at relatively high rates with the aid of combined pharmacotherapy and intensive group counseling. White subjects who smoke more heavily and have a diagnosis of alcohol abuse/dependence only have lower success rates for abstinence initiation.