Extended-release medications for opioid use disorder (XR-MOUD) with young adults have shown promise to increase treatment adherence, though dropout remains high. Recovery capital factors like relationship quality and recovery attitudes may influence treatment outcomes in young adults with OUD. This study examined the relationship between initial opioid use, recovery capital, and treatment outcomes among 52 young adults (11.5% female) receiving MOUD in a novel treatment program. Recovery capital factors were self-reported pre- and post-treatment, and treatment outcomes (opioid use days and MOUD dosages) were assessed via self-report and urinary screens. Recovery attitudes buffered the association between baseline opioid use and days used during the study and were found to change non-uniformly longitudinally. Moreover, more frequent negative relationship events buffered the association between initial opioid use severity and days used. This study adds novel information to the literature regarding recovery attitudes and factors involved in young adult opioid use treatment.

Objective: Research has shown a positive relationship between alcohol use and physical activity. Although little is known about the factors that give rise to this association, evidence suggests intrinsic and extrinsic motivations underlie it. Participants: University students (N = 1691, 79% female, Age: M = 20.36, SD = 1.89) who completed an online assessment. Methods: A literature review identified five putative motives underlying the alcohol use ↔ physical activity relation: (1) Work Hard, Play Hard (WHPH), (2) Stress, (3) Social, (4) Body Image (BI), and (5) Guilt, all domains assessed by the Drinking and Physical Activity Motives (DPAM) scale. Results: Confirmatory factor analysis followed by tests of measurement invariance across gender and race/ethnicity supported a partially invariant factor structure across all subgroups and associations with measures of drinking and physical activity. Conclusions: The DPAM will facilitate a better understanding the alcohol use ↔ physical activity relationship, ultimately enhancing intervention efforts to reduce drinking among college students.

OBJECTIVE:Changing Academic Support in the Home for Adolescents with ADHD (CASH-AA) and Medication Integration Protocol (MIP) are two family-based behavioral protocols designed to promote family solutions to academic problems and medication decision-making. Building on a randomized control trial examining these protocols, the current study examined how protocol dose, an indicator of treatment adherence, was associated with treatment outcomes. METHOD:The sample consisted of 145 adolescent clients (M age = 14.8, 72% male, 42% White, 37% Hispanic, 15% Black) and 49 community and hospital-based therapists (82% female, 63% White, 29% Hispanic). Latent growth curve models examined how therapist reports of minutes adolescents and their caregivers received CASH-AA and MIP predicted levels and change in inattentive and hyperactive symptoms (MINI-International Neuropsychiatric Interview); co-occurring symptoms (Youth Self Report/Child Behavior Checklist); homework problems (Homework Problems Checklist); and medication compliance at baseline, 3, 6, and 12-month follow-ups. RESULTS:MIP minutes were prospectively associated with lower caregiver-reported inattentive and hyperactive symptoms, adolescent- and caregiver-reported externalizing symptoms and caregiver-reported homework problems at the 12-month follow-up (ẞ range = -.16 to -.39, p < .05), as well as faster decline in caregiver-reported inattentive symptoms (ẞ = -.29, p < .001). CASH-AA minutes were associated with greater caregiver-reported inattentive symptoms (ẞ = .11, p = .049) at 12-month follow-up and slower declines in homework problems (ẞ = -.39, p < .001). Neither MIP nor CASH-AA minutes were associated with internalizing symptoms or medication use. CONCLUSIONS:Findings further support MIP as an effective behavioral protocol for adolescent ADHD and indicate the need for increasing MIP implementation efforts in community settings.

OBJECTIVE:This systematic review (1) updates the evidence base on outpatient behavioral treatments for adolescent substance use (ASU) since publication of the previous review completed for this journal by Hogue, Henderson, Becker, and Knight (2018); and (2) addresses public health concerns related to youth marijuana and opioid use. METHOD:We first summarize the earlier updates, along with those from recent literature reviews and meta-analytic studies, of ASU treatments. We then present study design and methods criteria used to identify five comparative studies subjected to JCCAP level of support evaluation. We detail these five studies in terms of their sample characteristics, quality of evidence, and substance use outcomes. Cumulative level of support designations are then made for each identified treatment approach. RESULTS:These cumulative designations are identical to those of the previous review: ecological family-based treatment, individual cognitive-behavioral therapy, and group cognitive-behavioral therapy are Well-Established; behavioral family-based treatment and motivational interviewing are Probably Efficacious; drug counseling is Possibly Efficacious; and five multicomponent treatments (three of which include contingency management) are Well-Established or Probably Efficacious. CONCLUSIONS:To address pressing issues in ASU treatment, we discuss best practices and promising research on behavioral and medication interventions for marijuana use and opioid use. We conclude with opportunities for advancing ASU treatment science in the areas of technology-based intervention, co-occurring disorders, addiction recovery, and access to and delivery of evidence-based approaches.

Introduction:Research, clinical wisdom, and government policy recommend family involvement in services for young adult (YA) opioid use disorder (OUD) to improve treatment outcomes. Moreover, research suggests YAs believe that family involvement is essential to OUD treatment and prefer greater involvement of their concerned significant others (CSOs), such as family members, romantic partners, and family-of-choice members in their care. Yet, CSOs are not routinely involved in OUD services for YAs. The main aim of this qualitative study is to learn from CSOs and YAs directly about their thoughts, beliefs, attitudes, and experiences with family-involved services. Method:We used convenience sampling to recruit 10 YAs (ages 24-36 years) who were in treatment for OUD and their CSOs (5 mothers, 2 grandmothers, 2 partners, 1 aunt) from two urban treatment centers. Using semi-structured interview guides, we conducted qualitative interviews with YAs and their CSOs to explore their experiences, feelings, and attitudes toward family involvement in services. Thematic content analysis started with deductive-dominant group consensus coding followed by matrix analysis to analyze themes in the context of CSO-YA dyads. Results:We identified five main themes: (1) CSO-YA relationships were resilient and motivated treatment and recovery, (2) CSOs believed in the importance of family involvement in services and experienced personal benefits by participating, (3) CSO involvement occurred on a continuum from facilitating treatment entry to systemic family therapy, (4) YAs identified CSOs who were supportive and encouraging of treatment even in the face of CSO barriers and challenges, and (5) YAs held accurate perceptions of their CSOs' MOUD attitudes and beliefs. Discussion:In this qualitative study we learned from YAs and CSOs themselves about the individual and relational benefits of family integration in services and replicated findings from previous research highlighting preferences for greater family involvement in OUD services. Clinical implications and recommendations for challenging barriers to relationship-oriented services and recovery planning for OUD are discussed.

ObjectiveWe used longitudinal youth- and caregiver-reports of adolescent psychological symptoms from three samples of youth receiving mental health services in routine treatment settings to derive expected change trajectories and identify cases at risk for treatment failure.MethodParticipants were 1906 youth (1053 caregivers) receiving treatment in community mental health settings, merged across three samples. The Symptoms and Functioning Severity Scale (SFSS) was used as an indicator of weekly clinical change. Multilevel modeling methods were used to develop expected change trajectories and identify cases at risk for treatment failure (not on track; NOT). Logistic regression was used to predict client improvement as a function of NOT status.ResultsThe SFSS was a reliable indicator of therapeutic change according to youth-reported symptoms. Caregiver reports were not as robust. Whereas predictive accuracy of NOT status yielded moderately high sensitivity in detecting improvement according to youth report, caregiver reports were not as predictive.ConclusionsThe youth-reported version of the SFSS-based algorithm seems appropriate for implementation in clinical care. Future studies should search for similarly predictive measures for caregivers.

Frequently mentioned anecdotally, hangovers are under-investigated within the scientific study of alcohol, as is the role of physical activity (PA) on hangovers. The well-established positive association between PA and AC (AC) suggests that PA may buffer negative physiological consequences of AC, including hangovers. The present study was therefore conducted in order to determine whether PA influences hangovers. Undergraduates (N=1676) from two large universities in the United States who experienced at least one hangover in the past three months and who engaged in at least 30 min of moderate PA per week were recruited to participate. Participants completed online questionnaires about their AC, PA, and frequency and severity of hangover symptoms. Both between- and within-person associations between AC and hangover were examined, factoring in the potential moderating effects of both moderate and vigorous PA. Small effects were observed for correlations between PA and outcomes assessing AC and hangovers (rs ranged from 0.09 to 0.15). Results also revealed that individuals who consumed more alcohol per month experienced hangovers more frequently and had more severe symptoms. These associations were attenuated among individuals who spent more hours engaging in vigorous but not moderate PA. The current study is the first to show PA influences the experience of hangovers, and we posit this may be a mechanism underlying the positive relationship between PA and AC. Our findings advance the growing literature on alcohol use and PA and may contribute to the development of interventions for alcohol-related problems and alcohol use disorders.

Background Internalizing disorders (IDs), primarily depression and anxiety, are highly prevalent among adolescents receiving community-based treatment for substance use disorders (SUDs). For such clients, interventions that do not holistically address both SUDs and IDs are less effective. Objective This pilot treatment development study aims to develop and test a modular treatment protocol for addressing cooccurring IDs among adolescents (aged 13 to 18 years) enrolled in routine care for substance use problems: Family Support Protocol for Adolescent Internalizing Disorders (Fam-AID). As an adjunctive protocol, Fam-AID will not require clinicians to markedly alter existing base practices for SUD. It will be anchored by 3 evidence-based foundations for treating cooccurring adolescent IDs: family engagement techniques, transdiagnostic individual cognitive behavioral therapy techniques, and family psychoeducation and safety planning. Methods This quasi-experimental study will proceed in 2 stages. The pilot stage will use rapid-cycle prototyping methods in collaboration with end-user stakeholders to draft protocol delivery and fidelity guidelines adapted from existing resources, solicit provider and client input on protocol content and delivery via cognitive interviewing, and pilot prototype components on 4 to 6 cases. The second stage will be an interrupted time series study for 60 comorbid SUD+ID cases across 2 sites serving diverse adolescents: 30 will receive treatment as usual (TAU); following clinician training in the protocol, 30 new cases will receive TAU enhanced by Fam-AID. For aim 1, the focus is on evaluating the acceptability of the Fam-AID protocol through therapist and client interviews as well as assessing fidelity benchmarks using therapist- and observer-reported protocol fidelity data. For aim 2, the plan is to compare the effects of TAU only cases versus TAU+Fam-AID cases on family treatment attendance and on adolescent ID and substance use symptoms, with measurements taken at baseline and at 3-month and 6-month follow-ups. Results Study recruitment will begin in April 2025. Conclusions We anticipate that Fam-AID will contain 5 treatment modules that can be delivered in any sequence to meet client needs: family engagement of primary supports in treatment planning and services; relational reframing of family constraints, resiliencies, and social capital connected to the adolescent’s ID symptoms; functional analysis of the adolescent’s ID symptoms and related behaviors; cognitive behavioral therapy to address the adolescent’s ID symptoms and functional needs, featuring 3 core techniques (emotion acceptance, emotional exposure, and behavioral activation) to address negative affect and emotional dysregulation; and family psychoeducation and safety planning focused on education about comorbid SUD+ID and prevention of adolescent self-harm. If the abovementioned modules are found to be feasible and effective, Fam-AID will offer a set of pragmatic interventions to SUD clinicians for treating cooccurring IDs in adolescent clients. Trial Registration ClinicalTrials.gov NCT06413979; https://www.clinicaltrials.gov/study/NCT06413979 International Registered Report Identifier (IRRID) PRR1-10.2196/64332

Research suggests that religious activity and spiritual experiences are associated with well-being among emerging adults. This research is primarily evaluated on the between-person level, leaving within-person effects largely unexplored. We examined relations between religious activity and spiritual experiences and their relation to life satisfaction and alcohol use among 383 college students at a moderately large university in the southwest USA. Participants completed daily reports of study measures. Multilevel regression indicated that daily religious activities and spiritual experiences were directly, and indirectly through moral emotions, associated with satisfaction with life. Results suggest that students who engage in regular religious activity and spiritual experience see a concomitant increase in life satisfaction.

OBJECTIVE:Evidence indicates a counterintuitive positive relationship between physical activity and alcohol consumption, suggesting that people who engage in more physical activity consume more alcohol. Impulsivity, which has a well-documented role in alcohol use disorders, has been shown to moderate the between-person physical activity-drinking association among emerging adults. However, only a handful of studies have explored within-person associations of physical activity and drinking and potential moderators of this relationship. The current study evaluated the effects of both subjective and behavioral impulsivity on the within- and between-person association between physical activity and alcohol consumption among college students.METHOD:Undergraduate students (N = 250) between ages 18 and 25 years were asked to report their daily physical activity and drinking over 21 days. Physical activity was also recorded objectively through Pacer, a smartphone app. Subjective impulsivity was assessed using the UPPS-P Impulsive Behavior Scale, and behavioral impulsivity was evaluated using the Balloon Analogue Risk Task.RESULTS:Within- and between-subject physical activity-drinking associations were differentially moderated by behavioral impulsivity and self-reported impulsivity. For instance, behavioral impulsivity moderated the within-person association between drinking and self-reported vigorous physical activity, whereas negative urgency moderated the between-person association between drinking and objective physical activity.CONCLUSIONS:Impulsivity, whether measured subjectively or behaviorally, significantly moderates the physical activity-alcohol consumption association. Importantly, this effect operates differently when predicting variation in behavior within individuals as compared with predicting differences in behavior between individuals.

Public Health Significance Statement This longitudinal study indicated that changes in physical activity were positively associated with alcohol use over the same 9-month period but did not predict changes over the subsequent year. The association between concurrent changes suggests that the linkage of alcohol use with exercise may become a lasting connection given that the college years are a period in which lifelong health habits form. Objective: Recent research has revealed positive associations between alcohol use and physical activity. However, findings from these studies have been inconsistent, and longitudinal designs have been underutilized. Therefore, the present study examined longitudinal associations between physical activity and alcohol use in a sample of young adults. Method: This study is a secondary analysis of 383 college students (57% female) who reported their drinking behaviors at 3-month assessments over an approximately 2-year period. Self-reported physical activity was examined for the first 9 months, and drinking was assessed over 21 months. Results: Analyses revealed that increases in the intensity of physical activity over the first 9 months predicted increases in drinking over the same time period; however, predictions over the subsequent year were nonsignificant. Conversely, increases in alcohol use over the first 9 months were associated with concurrent increases in duration of physical activity. Conclusions: Results extend previous cross-sectional research findings by indicating that positive associations between physical activity and alcohol use also are found longitudinally.

Caregiver engagement and participation in community-based outpatient treatment services for adolescents is generally poor, which is problematic given the integral role of caregivers prescribed by evidence-based treatments across orientations. The current study explores the psychometric and predictive properties of a set of caregiver engagement techniques distilled from family therapy, used by community clinicians in routine care. It highlights relational engagement interventions and adds to growing work distilling core elements of family therapy. The study examined caregiver engagement techniques observed in 320 recorded sessions and outcome data from 152 cases treated by 45 therapists participating in one of three randomized trials investigating delivery of family therapy for adolescent behavior problems in community settings. Construct and predictive validity of caregiver engagement coding items were analyzed to understand the degree to which they cohered as a single factor and predicted outcomes in predictable ways. Results demonstrated item reliability and construct validity of a Caregiver Engagement Techniques factor. Greater use of these techniques was associated with decreased adolescent substance use. Unexpected results suggested greater use of techniques was associated with worsening internalizing symptoms and family cohesion per youth-report only. Post-hoc analyses revealed additional complexities in the association between engagement techniques and outcomes. Caregiver engagement practices tested in the current study represent a unified treatment factor that may contribute to positive therapeutic outcomes for adolescents in some clinical domains. Further research is needed to understand predictive effects.

Background. Continued illicit opioid use (IOU) following interventions for opioid use disorder (OUD) is a significant barrier to recovery. The cognitive-behavioral relapse prevention (CB-RP) model may be an important framework for understanding the relation between positive psychology and IOU for methadone as a medication for opioid use disorder (MOUD) and promote abstinence and treatment adherence. Aim. It was hypothesized individuals who are at risk for IOU but demonstrate effective coping and self-efficacy will have lower rates of IOU and increased treatment attendance. Methods. Individuals receiving methadone MOUD (N = 298; 57% male) were recruited from the metropolitan area of a United States city through convenience sampling. IOU risk factors (amount used, length of use, criminal involvement, and intravenous use) were accessed through participant records, and measures included the Coping Strategies Index and the General Self-Efficacy Scale. Results. Researchers ran moderator analyses to determine the effect of coping and self-efficacy on the relation between risk factors and IOU or treatment attendance. Time in treatment is related to drug screenings positive (DS+) for illicit opioids, other substances, and increased treatment attendance. Coping is a predictor of DS+ for illicit opioids. Black/African American individuals had lower treatment attendance. Conclusions. Individuals with effective coping strategies use illicit opioids less often and interventions that increase coping should be explored in this population. Racial differences in treatment attendance point to the need for additional resources for Black/African American individuals. Increasing treatment retention is important to improve outcomes and adherence.

Objective Emerging adulthood is characterized by maturation of executive functions (EF) and changes in health behaviors (HB). Interestingly, EF are bi-directionally related to many specific HB; yet how EF performs in relation to overall patterns of HB engagement is unclear. Groupings of HB and the relationship between these HB groupings and EF were examined. Participants. Full-time college students were recruited from three large Mid- and Southwest universities (N = 1,387). Methods. Online self-report questionnaires assessing demographics, HB, and EF were completed. Results. Latent class analysis of HB revealed three classes: (1) High Substance Use, (2) Moderately Healthy, (3) Healthy. In general, the Healthy class had significantly greater EF compared to no significant differences between the other two classes. Conclusions. Collective engagement in HB is associated with EF. Interventions targeting both HB and EF simultaneously may be most efficacious.

ObjectiveThis pilot study tested pragmatic methods for training therapists in core techniques of two evidence-based interventions (EBIs) for adolescent externalizing problems: cognitive-behavioral therapy (CBT) or family therapy (FT). Training methods were designed to help therapists accurately self-monitor their use of EBIs and increase delivery of EBIs with current clients. The study compared coder training only versus coder training plus fidelity-focused consultation.MethodTherapists (N = 42) from seven behavioral health clinics reported on 65 youth clients; four clinics elected to train in CBT and three in FT. Therapists were randomized to either coder training only, consisting of a 25-week observational coder training course (didactic instruction and mock session coding exercises in core EBI techniques); or coder training plus fidelity-focused consultation, consisting of direct-to-therapist fidelity measurement feedback along with fidelity-focused expert consultation. During the 25 weeks of training, therapists submitted self-report data on EBI use along with companion session audiotapes subsequently coded by observational raters.ResultsCompared to coder training only, coder training plus fidelity-focused consultation produced superior effects in therapist ability to judge the extensiveness of EBI techniques in online coding sessions, as well as therapist ability to self-rate use of EBI techniques with their own cases. In both conditions, therapists who trained in CBT showed a significant, though modest, increase in real-world delivery of core CBT techniques; this did not occur for FT.ConclusionsPragmatic training and consultation methods show promise as viable and effective options for enhancing EBI fidelity monitoring and, for CBT, increasing EBI delivery.

The present study explored the acceptability, feasibility, fidelity, and outcomes of a young adult adaptation of multidimensional family therapy (MDFT), an evidence-based family treatment originally developed for adolescents. Participants included 22 individuals between the ages of 19 to 25 who were enrolled in a criminal drug court program. MDFT was found to be feasible and was delivered with strong fidelity to young adults and their families. Participants reported high satisfaction with MDFT, and 95% completed treatment. Analyses revealed statistically significant decreases in substance use on all indicators from baseline to the 6-month follow-up. Significant improvements were also noted in vocational functioning, including a 73% increase in full-time employment from baseline to 6-month follow-up. Criminal justice outcomes included a significant decrease in legal risk, and 86% of study participants had no rearrests from baseline through the 18-month follow-up period. The article concludes with recommendations for implementing family-based interventions with young adults, as well as future research directions in this important area.

The National Institute of Drug Addiction has promoted the Brain Disease Model of Addiction (BDMA) for several decades, believing it will have a positive impact on drug-related social policies. Per research, neither understanding nor accepting the BDMA positively influences social behavior and decision making related to decreased stigma or increased support for treatment and funding for substance use disorders. An alternative model, the Malleability Model, focuses on the changeability of psychopathology associated with psychiatric disorders, and is associated with decreased hopelessness and increased prognostic optimism. The Moral Weakness Model focuses on moral character as the reason for addiction and is associated with punitive responses to use disorders. The current study sought to identify whether Malleability values were more predictive of willingness to vote for harm reduction (HR) policies than BDMA and Moral values (H1); and if agreement with Malleability values were more predictive of willingness to fund such policies than agreement with BDMA and Moral values (H2). Contrary to hypotheses, results indicated the Malleability Model failed to predict votes and donations, while agreement with the Moral Weakness Model and conservative political affiliation was predictive of lower HR donations. Agreement with the BDMA did not reliably predict votes and donations to policies; the associations reflected were tenuous and should be interpreted with caution. Overall, results indicated the Malleability Model did not increase votes and donations to HR policies, while agreement with Moral Weakness Model and conservative affiliation consistently predicted votes and donations.

Healthy family functioning is important for successful adolescent development and serves as a protective factor against adolescent behavior problems. When adolescent behavior problems exist, family therapy can help promote warmth and cohesiveness in the family, which results in healthier family functioning. Furthermore, family therapy is the gold standard for treating adolescent behavior problems. However, most of the research on family therapy for adolescents are with manualized models that have difficulty being implemented in usual care. The purpose of this study was to compare the effectiveness of family therapy in improving family functioning as compared to individually-based treatments, all of which were offered in usual care settings. Participants were 205 adolescents and their caregivers living in a large, metropolitan area. Data were collected at four time points (baseline, 3-, 6-, and 12-month follow-up) and analyzed using latent growth curve modeling. Family functioning was assessed by separate caregiver and adolescent reports of cohesion and conflict subscales on the Family Environment Scale and caregiver-reported parent-adolescent domain of the Stress Index for Parents of Adolescents. Across treatments, caregivers reported improvement in family cohesion and decreases in family conflict and parental stress. Similarly, adolescents across treatments reported a decrease in family conflict but no concomitant increase in family cohesion. Overall, there was no between-treatment differences in overall change with both conditions showing improvement in family functioning. Results indicate that both family therapy and non-family treatment in usual care for adolescent behavior problems are effective for improving family functioning, suggesting that existing treatment services are viable options for adolescent behavioral health when offered under monitored conditions.

BACKGROUND:Perinatal substance use (SU) is prevalent during pregnancy and the postpartum period and may increase the risks to maternal and child health. Many pregnant and postpartum women do not seek treatment for SU because of fear of child removal. Home visiting (HV), a voluntary supportive program for high-risk families during the perinatal period, is a promising avenue for addressing unmet SU needs. Confidential delivery of screening and brief intervention (BI) for SU via computers has demonstrated high user satisfaction among pregnant and postpartum women as well as efficacy in reducing perinatal SU. This study describes the development of the electronic screening and BI for HV (e-SBI-HV), a digital screening and BI program that is adapted from an existing electronic screening and BI (e-SBI) for perinatal SU and tailored to the HV context. OBJECTIVE:This study aimed to describe the user-centered intervention development process that informed the adaptation of the original e-SBI into the e-SBI-HV, present specific themes extracted from the user-centered design process that directly informed the e-SBI-HV prototype and describe the e-SBI-HV prototype. METHODS:Adaptation of the original e-SBI into the e-SBI-HV followed a user-centered design process that included 2 phases of interviews with home visitors and clients. The first phase focused on adaptation and the second phase focused on refinement. Themes were extracted from the interviews using inductive coding methods and systematically used to inform e-SBI-HV adaptations. Participants included 17 home visitors and 7 clients across 3 Healthy Families America programs in New Jersey. RESULTS:The e-SBI-HV is based on an existing e-SBI for perinatal SU that includes screening participants for SU followed by a brief motivational intervention. On the basis of the themes extracted from the user-centered design process, the original e-SBI was adapted to address population-specific motivating factors, address co-occurring problems, address concerns about confidentiality, acknowledge fear of child protective services, capitalize on the home visitor-client relationship, and provide information about SU treatment while acknowledging that many clients prefer not to access the formal treatment system. The full e-SBI-HV prototype included 2 digital intervention sessions and home visitor facilitation protocols. CONCLUSIONS:This study describes a user-centered approach for adapting an existing e-SBI for SU for use in the HV context. Despite the described challenges, home visitors and clients generally reacted favorably to the e-SBI-HV, noting that it has the potential to fill a significant gap in HV services. If proven effective, the e-SBI-HV could provide a way for clients to receive help with SU within HV, while maintaining their privacy and avoiding the overburdening of home visitors. The next step in this study would be to test the feasibility and preliminary efficacy of the e-SBI-HV.