Summar Reslan

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”).

Implementing Trauma-Informed Treatment for Youth in a Residential Facility: First-Year Outcomes

Training in the Fairy Tale model of trauma-informed treatment was provided to clinical and direct care staff working with 53 youth in a residential treatment facility. Compared to the year prior to training, in the year of the training the average improvement in presenting problems was increased by 34%, time to discharge was reduced by 39%, and rate of discharge to lower level of care was doubled. The inclusion of numerous interventions, along with limitations in implementation and evaluation, make it difficult to precisely identify the cause(s) of the improvement.

Traumatic Incident Reduction for Urban At-Risk Youth and Unaccompanied Minor Refugees: Two Open Trials

Traumatic incident reduction (TIR) is a trauma resolution method that appears to be well tolerated and has yielded relatively rapid benefit in two adult treatment studies. This article reports on two open trials using TIR with 33 urban at-risk youth and 31 unaccompanied refugee minors. In both studies, participants consistently responded positively. In the second study, nearly all participants who began treatment with post-traumatic stress disorder ended without it, with an average of at least one significant trauma memory being treated per session. TIR’s apparent efficiency and effectiveness in these preliminary studies indicates its promise in child and adolescent treatment.

Validating a behavioral economic approach to assess food demand: effects of body mass index, dietary restraint, and impulsivity.

Behavioral economic theory is a useful framework for analyzing factors influencing choice, but the majority of human behavioral economic research has focused on drug choice. The behavioral economic choice paradigm may also be valuable for understanding food-maintained behavior. Our primary objective was two-fold: (1) Validate a human laboratory model of food-appetitive behavior, and (2) Assess the contribution of individual level factors that may differentially impact food choice behavior. Two studies were conducted. In Study 1, female subjects (N=17) participated in two consecutive food choice experimental sessions, whereas in Study 2, female subjects (N=21) participated in one concurrent food choice experimental session. During consecutive choice sessions (Study 1), demand for the more palatable food (i.e., high-sugar/high-fat) was more inelastic than the less palatable (i.e., low-sugar/low-fat) option. During concurrent choice sessions, demand for the more palatable food (i.e., high-sugar/high-fat) was more inelastic for restrained vs. unrestrained eaters, and for those who were overweight vs. normal weight. Demand for both palatable and less palatable choices was more elastic for high-impulsive vs. low-impulsive subjects. These findings suggest that the behavioral economic framework can be used successfully to develop a human laboratory model of food-appetitive behavior.

Validation of an online questionnaire measure of the relative reinforcing value of food.

Laboratory methods and questionnaires to assess the relative reinforcing value of food (RRV-F) have been developed, but this is the first study to validate an online questionnaire measure of the RRV-F. Participants (281 college students) completed an online survey assessing demographic variables, food preferences, and the RRV-F. A subsample (n=21) also completed a laboratory food choice session. The online RRV-F instrument showed strong predictive validity for laboratory food choice behavior, convergent validity with overweight status, and discriminant validity with unrelated constructs (age, gender, height). Results suggest that online methodology is appropriate for assessing the RRV-F in a manner that is cost-effective, time-efficient, affords greater anonymity, and enables recruitment from larger samples over a broader geographic region.

Factors associated with alcohol-related problems following moderate to severe traumatic brain injury.

PURPOSE/OBJECTIVE Postinjury alcohol use is a common problem within the traumatic brain injury (TBI) population. Given the association between heavy drinking and the development of alcohol-related consequences, we attempted to understand the contribution of postinjury coping strategies and other risk factors to alcohol-related problems following moderate to severe TBI. RESEARCH METHOD/DESIGN Participants were enrolled in a longitudinal study and followed up to 15 years following TBI; only persons with moderate to severe TBI (N = 278) were recruited. Participants completed questionnaires assessing preinjury alcohol use, demographic variables, postinjury alcohol-related problems (Short Michigan Alcohol Screening Test; SMAST; Selzer, Vinokus, & Van Rooijan, 1975), and postinjury coping strategies (Coping Inventory for Stressful Situations; CISS; Endler & Parker, 1990). Only those who completed the SMAST were included in this investigation. RESULTS The overall regression model, with time to follow commands, age at the time of TBI, education, time since injury, and task-oriented coping style, was statistically significant. After accounting for other factors, specific postinjury coping strategies were not associated with post-TBI alcohol-related problems. Time to follow commands, education, and time since injury independently explained a unique portion of the variance in SMAST score. A second multiple regression analysis was conducted for a subset of the sample that provided information about premorbid binge drinking (n = 95). The overall model was not significant, likely due to the reduced power to detect an effect, but premorbid binge drinking explained 4% of the variance in SMAST scores. CONCLUSION/IMPLICATIONS Injury severity, education, and time since injury should be assessed, and at-risk patients should be informed of the consequences of alcohol use among those with TBI.