Jumi Hayaki

Testing the effectiveness of cognitive-behavioral treatment for substance abuse in a community setting: within treatment and posttreatment findings.

This study evaluated the short-term effectiveness of cognitive-behavioral treatment (CBT) for substance abuse delivered in a community setting. At entry into outpatient community substance abuse treatment, participants (N = 252) were randomly assigned to 3 conditions: high-standardization CBT, low-standardization CBT, and treatment as usual. Treatment consisted of 12 weekly individual therapy sessions. There was a significant decrease in substance use from baseline, with participants reporting being abstinent on 90% of within-treatment days and 85% of days during the 6 months posttreatment. However, there were no significant differences in outcomes across conditions. Findings do not support the hypothesis that disseminating CBT to community settings will improve outcomes and suggest that standard substance abuse counseling may be more effective than previously thought.

Shame and severity of bulimic symptoms

Initial research suggests that self-conscious affect such as shame may perpetuate bulimic symptoms among individuals suffering from bulimia nervosa (BN). This investigation reports findings from two studies that examine the relation of shame to bulimic symptoms. In the first study, the relation of shame to bulimic symptoms was examined among 137 female college undergraduates. Shame accounted for a significant portion of variance in bulimic symptoms after controlling for age, weight status, guilt, and depressed mood. A second study examined the severity of shame in 30 bulimic patients compared to 28 eating-disordered patients with subclinical symptoms. Although patients with more severe bulimic symptoms exhibited higher levels of shame, this relation was not independent of the shared relation with depression and guilt. Findings are discussed in terms of the role of shame in bulimic symptoms.

Negative reinforcement eating expectancies, emotion dysregulation, and symptoms of bulimia nervosa.

OBJECTIVE Research suggests that emotion dysregulation or difficulties in the modulation of emotional experience constitute risk for eating disorders. Recent work has also highlighted the role of certain eating-related cognitions, specifically expectations of negative emotional reinforcement from eating, in the development of disturbed eating patterns. However, it is unclear whether these expectancies are merely a dimension of a general inability to regulate emotions effectively or rather a unique cognitive-affective risk factor for the development of an eating disorder. This study examines the unique contribution of eating expectancies to symptoms of bulimia nervosa (BN) after controlling for two dimensions of emotion dysregulation (alexithymia and experiential avoidance) previously implicated in the phenomenology of eating disorders. METHOD Participants were 115 undergraduate women who self-reported demographics, alexithymia, experiential avoidance, eating expectancies, and symptoms of BN. RESULTS Eating expectancies uniquely contributed 12.4% of the variance in symptoms of BN, F(2, 108) = 11.74, p < .001. The final model was statistically significant, F(6, 108) = 13.62, p < .001, and accounted for 40.0% of the variance in symptoms of BN. DISCUSSION These results suggest that individuals who expect eating to provide emotional relief may be especially susceptible to disordered eating. Findings are discussed in terms of emotional risk models and clinical interventions for BN.

Motivations for running and eating attitudes in obligatory versus nonobligatory runners

OBJECTIVE This study examined the association between motivations to run and eating disturbances in a sample of obligatory and nonobligatory runners. METHOD 240 males and 84 females were evaluated for running habits, motivations for running, and eating and weight concerns. 26.2% of the men and 25% of the women were classified as obligatory runners. RESULTS Obligatory runners were more motivated to run by negative factors such as guilt for stopping, scored significantly higher on the Eating Attitudes Test (EAT), and had lower weights. These effects were strongest in women. DISCUSSION The results suggest that female obligatory runners may be at increased risk for eating disorders.

Sexual risk behaviors among substance users: Relationship to impulsivity.

Recent research has suggested that trait impulsivity may predict sexual risk behavior. Few studies have examined this association directly in substance users at risk for HIV transmission. Participants were 330 primarily heroin and/or cocaine users who underwent a structured interview regarding their drug use, sexual behaviors, and impulsivity. Results from an iteratively reweighted least squares regression analysis indicate that impulsivity remained a statistically significant predictor of sexual risk after adjusting for the effects of demographic variables and substance use frequency (b=.179, p < .01). Frequency of cocaine use (b=.186, p < .01) was also significantly associated with sexual risk. These findings suggest that trait impulsivity may be an independent risk factor for sexual risk behavior among substance users, thus identifying potential targets for future interventions.

Expectancies and marijuana use frequency and severity among young females

This study examined associations between the endorsement of drug use expectancies and the frequency and severity of marijuana use in a community sample of 332 women aged 18-24years who were not explicitly seeking treatment for their marijuana use. Participants were enrolled in a larger intervention study of motivational interviewing for various health behaviors and provided self-reports of their current and past marijuana use, marijuana abuse/dependence symptoms, and marijuana use expectancies. Marijuana use expectancies were measured using the six subscales of the Marijuana Effects Expectancy Questionnaire (MEEQ). Use frequency was defined as the number of use days in the past month, severity as the total number of DSM-IV marijuana abuse or dependence symptom criteria met. Replicating and extending prior research, expectations regarding Relaxation and Tension Reduction emerged as a robust belief in this cohort, predicting not only frequency (p<.01) but also severity (p<.01) of marijuana use in multivariate analyses. Severity of marijuana use was further predicted by expectations regarding loss of control, affective changes following marijuana use, and other aspects of emotion dysregulation (Global Negative Effects, p<.01). These findings document meaningful associations between substance-related cognitions and use behavior and suggest that marijuana users who hold certain beliefs regarding marijuana use may be particularly susceptible to clinically significant problems associated with their substance use. As such, marijuana use expectancies may represent a clinical target that could be incorporated into future interventions.

Expectancies and self-efficacy mediate the effects of impulsivity on marijuana use outcomes: An application of the acquired preparedness model

This study tests the acquired preparedness model (APM) to explain associations among trait impulsivity, social learning principles, and marijuana use outcomes in a community sample of female marijuana users. The APM states that individuals with high-risk dispositions are more likely to acquire certain types of learning that, in turn, instigate problematic substance use behaviors. In this study, three domains of psychosocial learning were tested: positive and negative marijuana use expectancies, and marijuana refusal self-efficacy. Participants were 332 community-recruited women aged 18-24 enrolled in a study of motivational interviewing for marijuana use reduction. The present analysis is based on participant self-reports of their impulsivity, marijuana use expectancies, marijuana refusal self-efficacy, marijuana use frequency, marijuana use-related problems, and marijuana dependence. In this sample, impulsivity was significantly associated with marijuana use frequency, marijuana-related problems, and marijuana dependence. Results also indicate that the effect of impulsivity on all three marijuana outcomes was fully mediated by the three principles of psychosocial learning tested in the model, namely, positive and negative marijuana expectancies, and marijuana refusal self-efficacy. These findings lend support to the APM as it relates to marijuana use. In particular, they extend the applicability of the theory to include marijuana refusal self-efficacy, suggesting that, among high-impulsives, those who lack appropriate strategies to resist the temptation to use marijuana are more likely to exhibit more frequent marijuana use and use-related negative consequences.

General Anxiety Disorder Symptoms, Tension Reduction, and Marijuana Use Among Young Adult Females

BACKGROUND The current study tested the hypothesis that tension reduction expectancies mediate the relationship between anxiety symptoms and marijuana use. METHODS Interview data for 332 young adult females from Southern New England were collected from 2004 to 2009. RESULTS In structural equation modeling, anxiety symptoms had a significant direct effect (b(yx) = 0.227, 95% confidence interval [CI] 0.086-0.369, p < 0.05) on tension reduction expectancies and a significant indirect effect (b(yx) = 0.026, 95% CI 0.010-0.046, p < 0.05) on marijuana use. CONCLUSIONS The effect of anxiety symptoms on marijuana use was fully mediated by tension reduction expectancies. Implications for tension reduction as a possible component of treatment interventions are discussed.

Training Primary Care Clinicians in Maintenance Care for Moderated Alcohol Use

AbstractOBJECTIVE: To evaluate whether training primary care clinicians in maintenance care for patients who have changed their drinking influences practice behavior. DESIGN: We randomized 15 physician and 3 mid-level clinicians in 2 primary care offices in a 2:1 design. The 12 intervention clinicians received a total of 2 1/4 hours of training in the maintenance care of alcohol problems in remission, a booster session, study materials and chart-based prompts at eligible patients’ visits. Six controls provided usual care. Screening forms in the waiting rooms identified eligible patients, defined as those who endorsed: 1 or more items on the CAGE questionnaire or that they had an alcohol problem in the past; that they have ‘made a change in their drinking and are trying to keep it that way’; and that they drank <15 (men) or <10 (women) drinks per week in the past month. Exit interviews with patients evaluated the clinician’s actions during the visit. RESULTS: Of the 164 patients, 62% saw intervention clinicians. Compared with patients of control clinicians, intervention patients were more likely to report that their clinician asked about their alcohol history (odds ratio, 2.8; 95% confidence interval, 1.3, 5.8). Intervention clinicians who asked about the alcohol history were more likely to assess prior and planned alcohol treatment, assist through offers for prescriptions and treatment referral, and receive higher satisfaction ratings for the visit. CONCLUSIONS: Systemic prompts and training in the maintenance care of alcohol use disorders in remission might increase primary care clinicians’ inquiries about the alcohol history as well as appropriate assessment and intervention after an initial inquiry.

Self‐Efficacy and Motivation to Quit Marijuana Use among Young Women

BACKGROUND AND OBJECTIVES Assessing motivation to quit substance use is recommended as part of brief interventions. The purpose of this study was to determine correlates of desire to quit marijuana use among young adult women enrolled in a brief motivational intervention trial. METHODS Participants were 332 female marijuana users, aged 18-24, who rated their current desire to quit using a single item change ladder. We hypothesized self-efficacy and prior quit attempts will interact in this population to increase motivation to quit. RESULTS Participants had a mean age of 20.5 years, 67.7% were non-Hispanic Caucasian, and 60% had some desire to quit marijuana use. Using multivariate linear regression, quit desire was significantly lower among Caucasians (b = -.256; 95% CI -.489; -.037) and more frequent marijuana users (b = -.268; 95% CI -.372; -.166), and higher among those with previous quit attempts (b = .454; 95% CI .235; .671), and greater marijuana problem severity (b = .408; 95% CI .302; .514). Greater refusal self-efficacy was associated with greater quit desire among participants with previous quit attempts, but not among those without prior quit attempts (b = .241; 95% CI .050; .440). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Understanding the factors relating to quit desire among marijuana users may allow clinicians to tailor counseling so as to increase readiness to quit and decrease use and its associated consequences.