Mark Beitel

Making the shift from ‘addict self ’ to ‘spiritual self ’: Results from a Stage I study of Spiritual Self-Schema (3-S) therapy for the treatment of addiction and HIV risk behavior

A manual-guided intervention, Spiritual Self-Schema (3-S) therapy, for the treatment of addiction and HIV risk behavior is being developed in a Stage I behavioral therapies development project. 3-S therapy integrates a cognitive model of self with a non-sectarian Buddhist framework suitable for people of all faiths. Data are presented on a sample of 29 cocaine- and opioid-dependent clients. Seventy-nine percent completed the 8-week intervention. Drug use and other HIV risk behaviors decreased with treatment. Evidence of a shift in self-schema from ‘addict self ’ to ‘spiritual self ’ is presented. Reaction time to endorse spiritual qualities as ‘me’ and addict qualities as ‘not me’ decreased, and self-report of daily spiritual experiences and practices, and the perceived influence of spirituality on behavior increased. A shift in self-schema was correlated with change in drug use and other HIV risk behaviors.

Relations among psychopathology, substance use, and physical pain experiences in methadone-maintained patients.

OBJECTIVE Differences in psychiatric distress and substance use (licit and illicit) were examined in methadone maintenance treatment (MMT) patients with a variety of pain experiences. METHOD Parametric and nonparametric statistical tests were performed on data obtained from 150 patients currently enrolled in MMT. Assessments were carried out at the 3 opioid agonist treatment programs operated by the APT Foundation, New Haven, Connecticut. Participants were recruited between March 2007 and March 2008. RESULTS In comparison to MMT patients reporting no pain in the previous week, those with chronic severe pain (CSP) (ie, pain lasting at least 6 months with moderate to severe pain intensity or significant pain interference) exhibited significantly higher (P < .01) levels of depression, anxiety, somatization, overall psychiatric distress, and personality disorder criteria but reported comparable rates of substance use. A third group, ie, non-CSP MMT patients reporting some pain in the past week, differed significantly (P < .05) from the other 2 pain groups on somatization and global psychiatric distress but reported comparable rates of substance use. CONCLUSIONS Pain-related differences in psychiatric problems exist in MMT patients and may have implications for program planning and outreach efforts.

Exploring the relationships among early maladaptive schemas, psychological mindedness and self-reported college adjustment

OBJECTIVES The primary aim of this research was to study the statistical effects of psychological mindedness (PM) upon the relationship between early maladaptive schemas (EMS) and self-reported college adjustment. DESIGN A cross-sectional design was employed to assess correlations among study variables and to assess the role of PM as moderator or mediator in the relationship between EMS and adjustment. METHODS Into this study, 264 undergraduate students were recruited in partial fulfilment of research requirements in introductory psychology class. Participants completed the Young Schema Questionnaire, the Psychological Mindedness Scale and the Student Adaptation to College Questionnaire. RESULTS At the level of bivariate correlations, EMS were inversely associated with college adjustment and with PM, and PM was positively associated with adjustment. In a multiple regression equation with PM and EMS entered separately and then as an interaction term as predictors of adjustment, PM was not a significant moderator. However, in a path analysis, the indirect effect of EMS on adjustment through PM was significant, suggesting that PM is a significant mediator. CONCLUSIONS These findings suggest that the assessment of EMS and PM may enhance an understanding of problems with college adjustment and that interventions to reduce the negative effects of EMS may indeed benefit from efforts to improve PM and its correlates.

Conventional and nonconventional pain treatment utilization among opioid dependent individuals with pain seeking methadone maintenance treatment: a needs assessment study.

Objective and Methods:We surveyed 293 individuals seeking methadone maintenance treatment (MMT) for opioid dependence about pain, pain treatment utilization, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment while in MMT. Results:Among the 213 respondents reporting recent pain of at least moderate typical pain intensity, those with and those without a lifetime history of chronic pain endorsed similar rates of conventional (with the exception of past-week medical use of nonopiate medication), complementary, and alternative medicine utilization for pain reduction and a numerically smaller proportion endorsed last-week utilization of complementary and alternative medicine when compared with conventional medicine. The most frequently endorsed lifetime conventional pain treatments included opiate and over-the-counter medications, whereas the most frequently endorsed lifetime complementary and alternative medicine pain treatments included stretching, physical exercise, physical therapy, heat therapy, and prayer. Perceived efficacy of prior pain treatment but not interest in pain treatment was associated with chronic pain history status. Conclusion:These findings may have implications for resource and program planning in MMT programs.

Counselors' Experiences Treating Methadone-maintained Patients with Chronic Pain: A Needs Assessment Study.

Purpose:This study was designed to conduct a needs assessment concerning methadone counselors’ experiences working with methadone-maintained patients with chronic pain and measure counselors’ interest in receiving specialized training to treat such patients. Methods:A survey, developed by the authors, was administered to 25 counselors with a combined caseload of 956 patients at 3 opioid agonist treatment programs. Results:Patients with chronic pain comprised 27% of counselors’ overall caseloads. Counselors believed that, on average, 46% of these patients’ pain had a psychologic component and 56% exhibited continued drug use, which patients attributed to ongoing pain. Twenty-three counselors reported an interest in receiving specialized training in treating chronic pain. A variety of management issues, including monitoring the use of pain medications and providing pain management referrals, were reported. Conclusions:Findings from this needs assessment study suggest specific targets, which may be important to consider, in prospective specialized methadone maintenance treatment (MMT) counselor training and counseling for MMT patients with chronic pain.

Sex Role Ideology Among East Asian Immigrants in the United States

Although sex role ideology (i.e., beliefs about the proper roles for men and women) is linked with self-definition and male-female interactions, researchers have rarely examined such beliefs among U.S. immigrants. This study examined the cultural (ethnic identity, self-construal) and demographic (gender, age, years in United States) correlates of sex role ideology among 170 (88 male, 82 female) East Asian immigrants using psychometrically established measures. Male participants who endorsed ethnic identity and interdependent self-construal were more likely to report traditional sex roles; female participants who lived for a longer period of time in the United States and who endorsed independent self-construal were more likely to report sex role equality. Clinicians should consider assessing sex role ideology to reduce the likelihood of stereotyping their immigrant clients.

Use of conventional, complementary, and alternative treatments for pain among individuals seeking primary care treatment with buprenorphine-naloxone

&NA;Previous studies have not examined patterns of pain treatment use among patients seeking office-based buprenorphine-naloxone treatment (BNT) for opioid dependence. Objectives:To examine, among individuals with pain seeking BNT for opioid dependence, the use of pain treatment modalities, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment while in BNT. Methods:A total of 244 patients seeking office-based BNT for opioid dependence completed measures of demographics, pain status (ie, “chronic pain (CP)” [pain lasting at least 3 months] vs “some pain (SP)” [pain in the past week not meeting the duration criteria for chronic pain]), pain treatment use, perceived efficacy of prior pain treatment, and interest in receiving pain treatment while in BNT. Results:In comparison with the SP group (N = 87), the CP group (N = 88) was more likely to report past-week medical use of opioid medication (adjusted odds ratio [AOR] = 3.2; 95% CI, 1.2–8.4), lifetime medical use of nonopioid prescribed medication (AOR = 2.2; 95% CI, 1.1–4.7), and lifetime use of prayer (AOR = 2.8; 95% CI, 1.2–6.5) and was less likely to report lifetime use of yoga (AOR = 0.2; 95% CI, 0.1–0.7) to treat pain. Although the 2 pain groups did not differ on levels of perceived efficacy of prior lifetime pain treatments, in comparison with the SP group, the CP group was more likely to report interest in receiving pain treatment while in BNT (P < 0.001). Conclusions:Individuals with pain seeking BNT for opioid dependence report a wide range of conventional, complementary, and alternative pain-related treatments and are interested (especially those with CP) in receiving pain management services along with BNT.

A pilot trial of a videogame-based exercise program for methadone maintained patients

Few studies have examined exercise as a substance use disorder treatment. This pilot study investigated the feasibility and acceptability of an exercise intervention comprising the Wii Fit Plus™ and of a time-and-attention sedentary control comprising Wii™ videogames. We also explored their impact on physical activity levels, substance use, and psychological wellness. Twenty-nine methadone-maintained patients enrolled in an 8-week trial were randomly assigned to either Active Game Play (Wii Fit Plus™ videogames involving physical exertion) or Sedentary Game Play (Wii™ videogames played while sitting). Participants had high satisfaction and study completion rates. Active Game Play participants reported greater physical activity outside the intervention than Sedentary Game Play participants despite no such differences at baseline. Substance use decreased and stress and optimism improved in both conditions. Active Game Play is a feasible and acceptable exercise intervention, and Sedentary Game Play is a promising time-and-attention control. Further investigations of these interventions are warranted.

Exploring Relations Among Traumatic, Posttraumatic, and Physical Pain Experiences in Methadone-Maintained Patients

UNLABELLED Differences in lifetime trauma exposure and screened symptoms of posttraumatic stress disorder (PTSD) were examined in methadone maintenance treatment (MMT) patients with a variety of pain experiences. Parametric and nonparametric statistical tests were performed on data obtained from 150 patients currently enrolled in MMT. In comparison to MMT patients reporting no pain in the previous week, those with chronic severe pain (CSP) (ie, pain lasting at least 6 months with moderate to severe pain intensity or significant pain interference) exhibited comparable levels of trauma involving sexual assault but reported significantly higher levels of trauma involving physical assault, number of traumatic events, and screened symptoms of PTSD. A third group, non-CSP MMT patients reporting some pain in the past week, differed significantly from the CSP group on number of traumatic events but reported comparable levels of sexual assault and physical assault. In comparison to men, women reported higher levels of sexual assault and were more likely to score above the cutoff on the PTSD screener but reported comparable levels of physical assault and number of traumatic events. Pain-related differences in trauma and screened symptoms of PTSD exist in MMT patients and may have implications for program planning and outreach efforts. PERSPECTIVE This article demonstrates that trauma and screened symptoms of PTSD vary as a function of sex and pain status in methadone-maintained patients. Future studies may benefit from developing and assessing interventions that address chronic pain, PTSD, and opioid dependence in MMT.

The feasibility and acceptability of groups for pain management in methadone maintenance treatment.

Objectives:Effective and safe pain management interventions in methadone maintenance treatment are needed. Methods:We examined the feasibility (ie, single-session attendance) and acceptability (ie, patient satisfaction and booster session attendance) of cognitive-behavioral therapy–informed groups for pain management—Coping With Pain, Relaxation Training, Group Singing, and Mindful Walking. Pre- and postsession measures were collected. Results:A total of 349 (out of a census of approximately 800) methadone-maintained patients attended at least 1 of the groups. Group satisfaction was high. Booster session attendance was numerically lower in Mindful Walking (14%) than in the other groups (at least 40%). Repeat attendance at Coping With Pain was associated with reduced characteristic pain intensity and depression, whereas repeat attendance at Relaxation Training was associated with decreased anxiety. Conclusions:Coping With Pain, Relaxation Training, and Group Singing are transportable, affordable, adaptable, and tolerated well by patients with pain and show promise as components of a multimodal pain management approach in methadone maintenance treatment.