Karen K. Saules

Self-injury, substance use, and associated risk factors in a multi-campus probability sample of college students.

This research examined two questions: (1) What is the prevalence of self-injurious behavior (SIB) among college students, overall and by gender, academic level, and sexual orientation? (2) To what extent is SIB associated with different forms of substance use and other risk behaviors? A probability sample of 5,689 students completed an Internet survey on self-injury, mental health, and substance use. Past-year prevalence of SIB was 14.3%, with undergraduates significantly more likely than graduate students to engage in SIB. Drug use and frequent binge drinking were associated with higher rates of SIB. Among those who engaged in any SIB, those who used drugs had higher depression scores, higher prevalence of cigarette smoking, and higher rates of binge eating. In a multiple logistic regression model predicting SIB, depression, cigarette smoking, gambling, and drug use were significant predictors. Information about those at risk for SIB is critical for the design of prevention and intervention efforts as colleges continue to grapple with risky behaviors.

The predictive validity of the university of rhode island change assessment questionnaire in a heroin-addicted polysubstance abuse sample.

The purpose of this investigation was to examine the predictive utility of the stages-of-change scales of the University of Rhode Island Change Assessment (URICA; E. A. McConnaughy, J. O. Prochaska, & W. F. Velicer, 1983) questionnaire in a heroin-addicted polysubstance-abusing treatment sample. Ninety-six participants completed the URICA at the beginning of a 29-week treatment period that required thrice-weekly urine drug screens. Multivariate multiple regression analysis indicated that after controlling for demographic variables, substance abuse severity, and treatment assignment, the stages-of- change scales added significant variance to the prediction of heroin- and cocaine-free urine samples. The Maintenance scale was positively related to cocaine-free urines and length in treatment. The implications of these findings for treatment and for measuring readiness among individuals using multiple substances while taking maintenance medications are discussed.

Substance misuse following roux-en-y gastric bypass surgery

Post-bariatric surgery patients are overrepresented in substance abuse treatment, particularly those who have had the Roux-en-Y gastric bypass (RYGB) procedure. The severity of the substance use disorder (SUD; i.e., warranting inpatient treatment) and related consequences necessitate a better understanding of the variables associated with post-RYGB SUDs. This investigation assessed factors associated with post-RYGB substance misuse. Post-RYGB patients (N = 141; at least 24 months postsurgery) completed an online survey assessing variables hypothesized to contribute to post-RYGB SUDs. Fourteen percent of participants met criteria for postoperative substance misuse. Those with a lower percent total weight loss (%TWL) were more likely to endorse substance misuse. Family history of substance misuse was strongly associated with postoperative substance misuse. Eating-related variables including presurgical food addiction and postsurgical nocturnal eating, subjective hunger, and environmental responsiveness to food cues were also associated with a probable postoperative SUD. These findings have clinical utility in that family history of substance misuse can be easily assessed, and at-risk patients can be advised accordingly. In addition, those who endorse post-RYGB substance misuse appear to have stronger cognitive and behavioral responses to food, providing some support for the theory of behavioral substitution (or “addiction transfer”).

Substance use by college students : The role of intrinsic versus extrinsic motivation for athletic involvement

Certain types of athletic involvement may confer risk for substance use by college students. This study investigated whether motivational factors play a role in the relationship between athletic involvement and substance use. Intercollegiate athletes (n=98) and exercisers (n=120) were surveyed about substance use and motivation for athletic involvement. Athletes and exercisers who were extrinsically motivated had significantly higher rates of alcohol use than their intrinsically motivated counterparts. Results suggest that college students who are extrinsically motivated for involvement in physical activity/athletics--particularly those involved in team sports--may be in need of targeted prevention efforts.

The relationship between binge eating and weight status on depression, anxiety, and body image among a diverse college sample: A focus on Bi/Multiracial women

Binge eating is associated with a host of adverse outcomes, but little is known about sex and racial differences among those who binge eat. The present study examined sex and racial group differences in binge eating based on weight status within a college-student population. It was hypothesized that White women would endorse higher rates of binge eating, depression, anxiety, and body image dissatisfaction than other groups. Participants completed a web-based survey assessing depression, anxiety, body image, weight history, physical activity, smoking, and body mass index. Participants included White, Black, and Bi/Multiracial college students. Findings highlighted sex and racial differences based on binge eating and weight status. Notably, Bi/Multiracial women who endorsed binge eating behavior and who were overweight reported greater levels of anxiety than all other groups and greater levels of depression than White women and White men. Additionally, Bi/Multiracial women and White women who endorsed binge eating behavior and who were overweight reported greater body image dissatisfaction relative to Black women and White men. Future research should further explore the nature and impact of sex and race differences on binge eating.

Prolonged nicotine patch use in quitters with past abstinence-induced depressed mood

To test the efficacy of sustained nicotine patch use among at-risk smokers, 55 smokers with a history of abstinence-induced depressed mood were randomly assigned to either Nicotine Maintenance or Standard Treatment following preliminary high-dose patch treatment. The Nicotine Maintenance group received 21 mg transdermal nicotine for 8 additional weeks; the Standard Treatment group followed a tapered dosing regimen. Significant differences favoring the Nicotine Maintenance group were found in self-reported craving but not withdrawal. No difference was observed in continuous abstinence or in relapse rates. When dropouts who did not relapse during patch use were classified as successful, however, the Nicotine Maintenance group had significantly lower relapse rates. Rate of lapse in the Nicotine Maintenance group during post-trial tapering did not differ significantly from that in the Standard Treatment group during tapering in the trial, suggesting that the benefits of sustained dosing may persist only as long as dosing continues.

Patterns of Inattentive and Hyperactive Symptomatology in Cocaine-Addicted and Non-Cocaine-Addicted Smokers Diagnosed with Adult Attention Deficit Hyperactivity Disorder

Abstract Despite a robust relationship between Attention Deficit Hyperactivity Disorder (ADHD) and cigarette smoking, as well as increased prevalence of other substance use disorders in these individuals, little is known about the particular patterns of ADHD symptomatology associated with different forms of drug abuse. The present study compared ADHD adults with and without cocaine dependence (COCDEP) on severity of ADHD symptomatology. Groups did not differ in smoking rate or degree of nicotine dependence. COCDEP ADHD smokers reported significantly more childhood and adult hyperactive/impulsive symptoms, and a higher number of symptoms overall, during adulthood, even after controlling for group differences in age and sex. Our finding of a more severe adult ADHD symptom profile among ADHD smokers with cocaine dependence, accounted for by elevated hyperactive/impulsive but not inattentive features, suggests that cocaine use in smokers with ADHD may be driven by excesses in hyperactivity. These findings have important implications for research, since similarities and differences in patterns and severity of ADHD symptomatology may shed light on drug-specific mechanisms. Our results may also point to improved approaches for treatment of substance abuse based on attention to patterns of ADHD symptomatology specific to different drugs.

Emergence of New Onset substance use disorders among post-weight loss surgery patients

Elevated rates of substance use disorders (SUDs), particularly (but not only) alcohol use, are observed among post‐weight loss surgery (WLS) patients. The development of SUDs among post‐WLS patients typically occurs 1–2 years post‐surgery. Post‐WLS patients are developing SUD at a much later time of life than is typical of SUDs in the general population, suggesting they constitute a distinct SUD phenotype that is directly related to having undergone WLS.

Relationship between tridimensional personality questionnaire scores and clinic attendance among cocaine abusing, buprenorphine maintained outpatients

With the recent approval of buprenorphine for the treatment of opiate dependence in the United States it has become important to develop an understanding of the factors that influence the likelihood of successful treatment outcomes when using buprenorphine. This study examined, in a convenience sample, the relationship between novelty-seeking behaviors, as determined by Cloningers Tridimensional Personality Questionnaire (TPQ), and attendance variables during participation in a buprenorphine-based treatment program for 21 heroin-dependent cocaine users that took place in the late 1990s. Approximately two-thirds of the participants were male and primarily African-American. About half of them were employed and had at least a high school education. Approximately one-third of them were married or cohabitating and they all resided in the greater Detroit, Michigan area of the United States. The Tridimensional Personality Questionnaire (TPQ) was administered to the participants prior to entering the treatment program. Demographic variables, psychiatric distress, and substance use severity were also evaluated. Variables with significant bivariate relationships with poor attendance measures were entered into a regression analysis predicting attendance measures. Participants who scored high on the TPQ Novelty Seeking Scale attended significantly fewer regularly scheduled visits, had a greater overall number of missed visits, and shorter treatment retention times. Demographics, substance use severity, and psychiatric distress did not have significant relationships with these attendance measures.

Associations between relationship stability, relationship quality, and weight loss outcomes among bariatric surgery patients.

After weight loss surgery (WLS), psychosocial functioning, including the quality of social relationships, generally improves, but for a minority, relationships worsen. We examined how changes in relationship stability and quality from pre- to post-WLS relate to long-term weight loss outcomes. Postoperative patients (N=361) completed surveys which queried relationship changes and weight loss. The sample was 95.9% Caucasian, 80.1% female, averaged 7.7years post-WLS, with a mean age at surgery of 47.7years (range 21-72); 87.3% had a Roux-en-Y gastric bypass. Four relationship status groups were created: Not in a relationship at surgery or follow-up (No-Rel, n=66; 18.2%); Post-WLS relationship only (New-Rel, n=23; 6%); Pre-WLS relationship only (Lost-Rel, n=17; 5%); and Pre-Post Relationship (Maintainer, n=255; 70.6%). Current BMI was 34.5 for No-Rel; 40.5 for New-Rel; 37.4 for Lost-Rel; 33.3 for Maintainers (p<.05 for Maintainers and No-Rel vs. New-Rel). These same group differences were significant for weight loss, which was not associated with gender, time since surgery, or age at time of surgery, but was associated with pre-WLS BMI (lower pre-WLS BMI was associated with greater %EWL). Analyses were repeated with pre-WLS BMI as a covariate; group differences remained significant [F (3, 355)=3.09, p=.03], as did pre-WLS BMI, [F (1, 355)=9.12, p=.003]. Among Maintainers, relationship quality was associated with weight loss outcomes: those with improved relationships post-WLS had significantly greater %EWL [F (2, 234)=15.82, p<0.000; p<.05 for Improved>(Stayed Same=Got Worse)]. Findings support the importance of assessing relationship stability and quality in pre-WLS candidates, as healthy and stable relationships may support improved long-term outcomes. Interventions to improve relationships pre-and post-WLS may increase both quality of life and weight loss outcomes.