Seema L. Clifasefi

Mindfulness-Based Relapse Prevention for Substance Use Disorders: A Pilot Efficacy Trial

ABSTRACT The current study is the first randomized-controlled trial evaluating the feasibility and initial efficacy of an 8-week outpatient Mindfulness-Based Relapse Prevention (MBRP) program as compared to treatment as usual (TAU). Participants were 168 adults with substance use disorders who had recently completed intensive inpatient or outpatient treatment. Assessments were administered pre-intervention, post-intervention, and 2 and 4 months post-intervention. Feasibility of MBRP was demonstrated by consistent homework compliance, attendance, and participant satisfaction. Initial efficacy was supported by significantly lower rates of substance use in those who received MBRP as compared to those in TAU over the 4-month post-intervention period. Additionally, MBRP participants demonstrated greater decreases in craving, and increases in acceptance and acting with awareness as compared to TAU. Results from this initial trial support the feasibility and initial efficacy of MBRP as an aftercare approach for individuals who have recently completed an intensive treatment for substance use disorders.

Project-Based Housing First for Chronically Homeless Individuals With Alcohol Problems: Within-Subjects Analyses of 2-Year Alcohol Trajectories

OBJECTIVES Two-year alcohol use trajectories were documented among residents in a project-based Housing First program. Project-based Housing First provides immediate, low-barrier, nonabstinence-based, permanent supportive housing to chronically homeless individuals within a single housing project. The study aim was to address concerns that nonabstinence-based housing may enable alcohol use. METHODS A 2-year, within-subjects analysis was conducted among 95 chronically homeless individuals with alcohol problems who were allocated to project-based Housing First. Alcohol variables were assessed through self-report. Data on intervention exposure were extracted from agency records. RESULTS Multilevel growth models indicated significant within-subjects decreases across alcohol use outcomes over the study period. Intervention exposure, represented by months spent in housing, consistently predicted additional decreases in alcohol use outcomes. CONCLUSIONS Findings did not support the enabling hypothesis. Although the project-based Housing First program did not require abstinence or treatment attendance, participants decreased their alcohol use and alcohol-related problems as a function of time and intervention exposure.

Housing Retention in Single-Site Housing First for Chronically Homeless Individuals with Severe Alcohol Problems

OBJECTIVES We studied housing retention and its predictors in the single-site Housing First model. METHODS Participants (n = 111) were chronically homeless people with severe alcohol problems who lived in a single-site Housing First program and participated in a larger nonrandomized controlled trial (2005-2008) conducted in Seattle, Washington. At baseline, participants responded to self-report questionnaires assessing demographic, illness burden, alcohol and other drug use, and psychiatric variables. Housing status was recorded over 2 years. RESULTS Participants were interested in housing, although a sizable minority did not believe they would be able to maintain abstinence-based housing. Only 23% of participants returned to homelessness during the 2-year follow-up. Commonly cited risk factors--alcohol and other drug use, illness burden, psychiatric symptoms, and homelessness history--did not predict resumed homelessness. Active drinkers were more likely to stay in this housing project than nondrinkers. CONCLUSIONS We found that single-site Housing First programming fills a gap in housing options for chronically homeless people with severe alcohol problems.

Psychotropic placebos reduce the misinformation effect by increasing monitoring at test

A psychotropic placebo can help people resist the misinformation effect, an effect thought to be caused by a shift to more stringent source monitoring. When this shift occurs has been unclear. To address this issue we gave some people—but not others—a phoney cognitive-enhancing drug we called R273. Shortly afterwards, everyone took part in a misinformation effect experiment. To gather evidence about source monitoring we surreptitiously recorded time to read the misleading postevent narrative, and response time at test. Our findings suggest that people shifted to more stringent source monitoring at test. Moreover, people with higher working memory capacity (WMC) performed better than people with lower WMC—but only when they were told they had received R273, a finding that fits with research showing that WMC can confer advantages in situations demanding effortful control, but not when automatic heuristics suffice.

Housing First Is Associated with Reduced Use of Emergency Medical Services

Abstract Objective. Chronically homeless adults with severe alcohol problems are disproportionately burdened with health-care problems and are high utilizers of emergency medical services (EMS). Single-site Housing First (HF), which provides immediate, permanent, low-barrier, nonabstinence-based, supportive housing, has been associated with reduced publicly funded service utilization. The aims of the current study were to determine whether time spent in single-site HF predicted decreases in EMS contacts 2 years subsequent to single-site HF move-in, and to describe medical conditions and injuries associated with EMS contacts in a sample of chronically homeless individuals with severe alcohol problems. Methods. Participants were 91 chronically homeless adults with severe alcohol problems who were enrolled in a single-site HF program between December 2005 and March 2007 in Seattle, Washington. We obtained administrative data on exposure to HF and EMS utilization for the 2 years prior to and the 2 years subsequent to participants’ move-in date. EMS utilization variables included patient type (i.e., primary presenting problem), trauma/injury mechanism (i.e., EMS classification of the cause of the trauma or injury), level of care (i.e., basic life support, advanced life support), and transport destination. Results. After controlling for baseline EMS contacts, participants evinced 3% fewer EMS contacts for each additional month of single-site HF exposure. From the baseline to follow-up period, the mean number of EMS contacts declined from 15.85 (SD = 22.96) to 9.54 (SD = 15.08), representing a 54% reduction in the number of EMS contacts. Most calls were responded to by EMTs providing basic life support, and the majority resulted in transport to a local level I trauma center. The most common presenting difficulties were medical illness and trauma. Substance use and psychiatric difficulties were infrequently documented as the primary problem. Conclusions. Our findings support recent assertions that housing is health care and indicate that the amount of time spent in single-site HF is associated with significant reductions in EMS utilization for at least 2 years subsequent to move-in. These findings also underscore the high levels of medical illness and trauma exposure among chronically homeless adults with severe alcohol problems.

Psychotropic placebos create resistance to the misinformation effect

Can a placebo for a psychotropic drug help participants resist the misinformation effect? To answer this question, we gave participants a mixture of baking soda and water and told half of them that the mixture was a cognition-enhancing drug called R273 and told the other half that it was an inactive version of the drug. Shortly thereafter, all participants took part in a three-stage misinformation experiment. Compared with participants who were told that they had taken the placebo, the participants who were told that they had taken the drug reported improved cognitive abilities and were less susceptible to the misinformation effect. We provide sourcemonitoring and mindfulness accounts of our findings.

Exploring Transitions Within a Project-based Housing First Setting: Qualitative Evaluation and Practice Implications

The Housing First (HF) approach is a model of housing that entails the provision of immediate, permanent, low-barrier, supportive housing to chronically homeless individuals either in separate apartments within a larger community (known as scattered-site HF) or in a single building (known as project-based HF). One recent innovation is the application of project-based HF with chronically homeless individuals with alcohol problems. Although initial studies have shown its effectiveness, there is currently no research on residents’ and staff ’s experiences living and working in a project-based HF program. The purpose of this article was to document these experiences and highlight strengths and challenges of project-based HF programs. Using data collected from naturalistic observations, agency documentation, one-on-one resident interviews, and a staff focus group, we delineated transitional periods, including moving into project-based HF, community-building, managing day-to-day, and transitions from project-based HF. Findings are interpreted to help health care policymakers and providers envision the role of project-based HF in comprehensive public health efforts and to integrate lessons learned into their own clinical practice.

'Queasy Does It': False Alcohol Beliefs and Memories May Lead to Diminished Alcohol Preferences

Studies have shown that false memories can be implanted via innocuous suggestions, and that these memories can play a role in shaping peoples subsequent attitudes and preferences. The current study explored whether participants (N=147) who received a false suggestion that they had become ill drinking a particular type of alcohol would increase their confidence that the event had occurred, and whether their new-found belief would subsequently affect their alcohol preferences. Results indicated that participants who received a suggestion that they had gotten sick drinking rum or vodka before the age of 16 reported increased confidence that the suggested experience had occurred. Moreover, participants who received a false alcohol suggestion also showed a strong trend to report diminished preference for the specified type of alcohol after the false suggestion. Implantation of a false memory related to ones past drinking experiences may influence current drink preferences and could be an important avenue for further exploration in the development of alcohol interventions.

Religious coping and psychological functioning in a correctional population

The objective of this study was to examine main and interactive relationships between religious upbringing and coping (spirituality, participation, pleading, and discontentment), and mental health outcomes (depressive symptoms, anxiety symptoms, somatization, and hostility) among 305 incarcerated adults. Using hierarchical linear regression controlling for demographic variables and stressful life events, several significant relationships emerged. First, being raised with a formal religion was significantly predictive of both decreased depressive symptoms and reduced hostility. Second, there were significant interactions between religious discontentment and gender for all four outcomes, indicating that relationships between religious discontentment and depressive symptoms, anxiety symptoms, somatization and hostility were larger for females compared to males. Third, relationships between pleading and both depression symptoms and hostility were significantly moderated by stressful life events. And finally, there was a marginally significant relationship between religious pleading and increased somatization. These results are further described, and study limitations and implications are discussed.

Community-Based Participatory Research (CBPR): Towards Equitable Involvement of Community in Psychology Research.

Community-based participatory research (CBPR) answers the call for more patient-centered, community-driven research approaches to address growing health disparities. CBPR is a collaborative research approach that equitably involves community members, researchers, and other stakeholders in the research process and recognizes the unique strengths that each bring. The aim of CBPR is to combine knowledge and action to create positive and lasting social change. With its origins in psychology, sociology, and critical pedagogy, CBPR has become a common research approach in the fields of public health, medicine, and nursing. Although it is well aligned with psychology’s ethical principles and research aims, it has not been widely implemented in psychology research. The present article introduces CBPR to a general psychology audience while considering the unique aims of and challenges in conducting psychology research. In this article, we define CBPR principles, differentiate it from a more traditional psychology research approach, retrace its historical roots, provide concrete steps for its implementation, discuss its potential benefits, and explore practical and ethical challenges for its integration into psychology research. Finally, we provide a case study of CBPR in psychology to illustrate its key constructs and implementation. In sum, CBPR is a relevant, important, and promising research framework that may guide the implementation of more effective, culturally appropriate, socially just, and sustainable community-based psychology research.