Background: Symptoms often play an important role in the scientific inquiry of psychological disorders and have been theorized to play a functional role in the disorders themselves. However, little is known about the course of specific symptoms and individual differences in course. Understanding the course of specific symptoms and factors influencing symptom course can inform psychological theory and future research on course and treatment.Methods: The current study examined alcohol use disorder (AUD) criteria to explore how etiologically relevant covariates differentially affected the course of individual criteria. The study examined 34,653 participants from Wave 1 (2001-2002) and Wave 2 (2003-2004) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), to analyze the extent to which AUD symptom course is predicted by alcohol consumption patterns, family history of alcoholism, the presence of internalizing and externalizing disorders, and race.Results: The course of all AUD criteria was significantly influenced by these predictors, with the magnitude of the influence varying across different criteria and different aspects of the course (i.e., onset, persistence, recurrence). The strength of the relationship is partially related to the theoretical proximity of a given covariate to AUD symptomatology, with heavy drinking being the strongest and family history of AUD being the weakest. The course of all criteria was strongly associated with the prevalence of the criterion in the overall sample.Conclusions: The course of AUD criteria is heterogeneous, appearing to be influenced by conceptually proximal predictors, the prevalence of the criterion, and perhaps an underlying common factor. Diagnostic accuracy may be improved by including a criterion related to alcohol consumption. Future work should include exploring the interchangeability of criteria and alternative operationalization of them.

Nonmedical use of prescription opioids (NUPO) is widely believed to be a causal influence on heroin initiation. This dissertation aimed to explore the NUPO-heroin relationship by examining heroin use outcomes among subtypes of NUPO initiates; estimating the degree of common genetic liability across NUPO and heroin use; and examining specificity in etiologic influences on NUPO, heroin use, and other drug use. Longitudinal panel data were used to identify NUPO typologies via mixture modeling and predict subsequent heroin initiation. Genomic data were used to estimate genetic correlations between NUPO, heroin use, and other illicit drug use. Twin data were used to test a multivariate model that incorporated NUPO, heroin use, and other nonmedical prescription drug and illicit drug use. NUPO only increased odds of later heroin initiation in the context of nonoral administration and motives other than pain relief. Common liability for drug use was unidimensional and accounted for most of the variance in heroin use. Genetic variance in heroin use was fully attributable to liability shared across drug types. NUPO displayed some drug-specific genetic influence. Common liability for drug use (e.g., genetic predisposition, availability, opportunity for use) may explain most of the NUPO-heroin association. Understanding of the common and unique behavioral and genetic mechanisms underlying risk for NUPO versus heroin use can help to better identify factors contributing to the opioid crisis and inform multipronged public health approaches to mitigating the impact of opioids at the population level.

Background: Previous research has established that certain features of personality and psychopathology (e.g., impulsivity, mood disorder, thought disorder) are associated with an increased likelihood of having sipped alcohol in youth, and substance involvement and problems into adolescence and adulthood. What is less clear from the existing literature is whether well-established risk factors of substance use are consistent across varied sociodemographic factors (i.e., gender, race/ethnicity, religious affiliation, income, parental education). Methods: We used a large, community sample of 9- and 10-year-olds (N = 11,872; 53% female) and examined whether various sociodemographic characteristics moderate the associations between sipping behavior and its various well-established correlates (e.g., impulsivity, behavioral inhibition and activation, psychopathology, parenting, and family conflict). Results: There were small mean level differences in sipping across sociodemographic characteristics. Across sociodemographic characteristics, however, sipping was fairly uniformly associated with youth-reported impulsivity, behavioral activation, prodromal psychosis symptoms, mood and externalizing disorder diagnoses, and parenting indices. Effects were sometimes slightly more pronounced among groups for which alcohol consumption is relatively nonnormative: Sipping among female youth was slightly more associated with thought disorder psychopathology than with male youth (D = .07), and was slightly more associated with some aspects of psychopathology and impulsivity for Black youth compared with White and Hispanic youth (Ds were .07 and .09). Conclusions: In broad brush, our findings suggest that the psychosocial correlates of precocious alcohol use are relatively consistent across sociodemographic factors.

Modern theoretical models of Alcohol Use Disorder (AUD) highlight the different functional roles played by various mechanisms associated with different symptoms. Symptom network models (SNMs) offer one approach to modeling AUD symptomatology in a way that could reflect these processes and provide important information on the progression and persistence of disorder. However, much of the research conducted using SNMs relies on cross-sectional data, which has raised questions regarding the extent they reflect dynamic processes. The current study aimed to (a) examine symptom networks of AUD and (b) compare the extent to which cross-sectional network models had similar structures and interpretations as longitudinal network models. 17,360 participants from Wave 1 (2001-2002) and Wave 2 (2003-2004) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were used to model cross-sectional and longitudinal AUD symptom networks. The cross-sectional analyses demonstrate high replicability across waves and central symptoms consistent with other cross-sectional studies on addiction networks. The longitudinal network shared much less similarity than the cross-sectional networks and had a substantially different structure. Given the increasing attention given to the network perspective in psychopathology research, the results of this study raise concerns about interpreting cross-sectional symptom networks as representative of temporal changes occurring within a psychological disorder. We conclude that the psychological symptom network literature should be bolstered with additional research on longitudinal network models.

As the demands of professional psychology can be taxing, psychotherapists are not immune to the development of mental health and substance use disorders. One estimate indicates that roughly 30-40% of psychologists know of a colleague with a current substance abuse problem (Good et al., 1995). 12-step mutual self-help groups, particularly Alcoholics Anonymous (AA), are the most widely used form of treatment for addiction in the United States. AA has empirically demonstrated effectiveness at fostering long-term treatment success, and is widely accessible throughout the world. However, psychotherapist participation in AA raises a number of ethical concerns, particularly regarding the potential for extra-therapy contact with clients and the development of multiple relationships. This article attempts to review the precarious ethical and practical situations that psychotherapists, either in long-term recovery or newly sober, may find themselves in during AA involvement. Moreover, this article provides suggestions for psychotherapists in AA regarding how to best adhere to both the principles of AA (i.e., the 12-steps and 12-traditions) and the American Psychological Association's Ethical Principles of Psychologists and Code of Conduct.

The Old Order Amish are the fastest growing religious subpopulation in the United States. The Amish population, most recently estimated at 340,000, is expected to double in size during the next 20 years. While still relatively few in number, their growing population and increasing interaction with American society will likely result in more Amish individuals seeking mental health treatment. Despite the call for culturally competent mental health professionals, this population has been underrepresented in the psychotherapy literature. To the best of the author's knowledge, this article is the first known attempt to review the ethical considerations that may arise when working with members of the Old Order Amish. This article uses the American Psychological Association'sEthical Principles of Psychologists and Code of Conductto frame the discussion of ethical mental health treatment with Amish individuals.

With rising rates of misinformation, psychotherapists are likely to encounter clients with distorted beliefs that are scientifically unsound. In situations where these beliefs are harmful (e.g., vaccination refusal, misunderstanding of sexual consent), psychotherapists may face an ethical dilemma regarding how to proceed with psychotherapy. This is especially true if such beliefs are impairing treatment progress or resulting in safety concerns for the client or society. Questions about whether and how the psychotherapist should address these distorted beliefs are therefore likely to arise. In such cases, psychotherapists are tasked with respecting the client's autonomy, while simultaneously being of maximum benefit to the client and to society at large. Not all distorted beliefs warrant therapeutic intervention, but this judgment requires careful consideration. The current article addresses the relevant ethical considerations for navigating and addressing distorted beliefs in psychotherapy. A vignette is offered, and relevant sections of the American Psychological Association's Ethics Code are discussed, both as they pertain to this scenario and as they apply more generally to the practice of psychotherapy. The article concludes with questions for psychotherapists to consider and recommendations for how to proceed when confronted with harmful distorted beliefs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).