Psy. D., Antioch University, 2019, Antioch Santa Barbara: Clinical Psychology

While psychiatric medications have been categorized as the same as substances of abuse in Alcoholics Anonymous (AA), medications for common medical disorders were not affected by this disapproval of medication. It may be time for a new dialogue (Woody, 2015). According to Gjersing and Bretteville (2018), there has been a concerning increase in overdose deaths in the last decade. This includes a threefold increase in overdose deaths from prescription narcotics and six-fold increase in overdose deaths from heroin in the United States. When prescription opioid users find difficulty in obtaining pills, they may move on to heroin, which is much more readily available on the streets, in an effort to avoid painful opioid withdrawal. For this study, individuals who had previously achieved long-term abstinence from alcohol or substance use but relapsed after a significant amount of time sober were interviewed in order to better understand their experience with relapse as well as their experience returning to at least partial remission. Thematic analysis was conducted on interview data. The results from this phenomenological analysis of interviews with eight participants identified several themes regarding the experience of being a long-timer, relapsing after a substantial amount of time abstinent, and challenges to as well as factors in returning to AA. These themes are organized as long-term recovery, relapse, and a new beginning. Long-term recovery is further explored as acute treatment only, treatment did not utilize evidence-based interventions, treatment did not address emotional issues, contact with mental health, long-timer, and complacency and drifting. Relapse is further explored as medical issues, new trauma, and justification of the use of medication or marijuana. A new beginning is further explored as recovery challenges such as feelings of ostracism, age-related issues, and shame as well as recovery factors such as finding acceptance and love within the fellowsh (open full item for complete abstract)

Committee: Brett Kia-Keating Ed.D (Committee Chair); Ron Pilato Psy.D (Committee Member); Janice Stimson Psy.D (Committee Member) Subjects: Behavioral Psychology; Clinical Psychology; Cognitive Psychology; Health Care Management; Medical Ethics; Mental Health; Psychology; Psychotherapy

Doctor of Philosophy, Case Western Reserve University, 2018, Epidemiology and Biostatistics

Background: Legalization of medical and recreational marijuana can lead to increases in marijuana use disorder (MUD). Many studies have found that substance use disorders and alcohol use disorders exacerbate negative symptoms in patients with schizophrenia spectrum disorder (SSD) and bipolar disorder (BPD). Few studies have examined the relationship between hospital related outcomes and comorbid MUD separate from alcohol and other substances in patients with SSD or BPD. Aim: The goal of this research was to examine the association between MUD and hospital related outcomes for patients with SSD and BPD. We examined hospital readmissions, suicide attempts, costs and length of stays. Furthermore, we sought to examine interactions between substance use disorders and other mental health comorbidities in patients with BPD. Methods: We used data from the Healthcare Utilization Project from California to identify patients with a primary diagnosis of SSD or BPD. Substance use disorders were identified using ICD-9-CM diagnostic codes at the time of SSD or BPD visit or 90 days prior. Patients were censored at the end of 2011 if they did not have a readmission or suicide attempt. We used Cox Proportional Hazards models to estimate readmission and suicide attempt risk and general linear models to model cost and length of stay. Results: Comorbid alcohol and other drug use disorders apart from marijuana increased risk for readmission in both patients with SSD and BPD. Suicide attempt risks were also elevated in BPD patients with comorbid non-marijuana substance use disorders. Patients with SSD and comorbid MUD had a lower readmission risk, however sensitivity analyses did not sustain this effect. Patients with BPD and anxiety disorder had a lower risk of readmission if they had comorbid MUD. This effect was sustained in sensitivity analyses. Length of stay and costs were lower for patients with any comorbid substance use disorder. Conclusions: Patients with SSD and BPD who hav (open full item for complete abstract)

Committee: Mendel Singer Ph.D. (Advisor); Siran Koroukian Ph.D. (Committee Chair); Mark Singer Ph.D. (Committee Member); Kathleen Smyth Ph.D. (Committee Member); Coreen Farris Ph.D. (Committee Member) Subjects: Epidemiology; Mental Health

Master of Arts (MA), Bowling Green State University, 2024, Psychology

Shared reward pathways in the brain unveil the potential for the development of dependence on a variety of substances, including commonly recognized drugs of abuse and, more insidiously, sugar. Sugar overconsumption has been associated with compulsivity and impulsivity repetitive behaviors which are predictors of later substance abuse. Furthermore, previous research has shown that rats can develop symptoms mirroring addiction such as binging, craving, tolerance, and withdrawal in response to sugar alone. Motivation research has indicated that impaired reward relativity is a key component of vulnerability to addiction. The ability of an animal to discriminate between differing levels of rewards for the amount of work exerted to receive that reward may predict later addictive behavior to a variety of substances. This thesis examined the appetitive and consummatory behavior of non-food restricted female Wistar rats in self-administration tasks of sucrose and ethanol solutions. Relative reward effects were evaluated by using trials that differ in time of access to the reward (20s vs 10s vs 5s). The results suggest that non-food restricted Wistar rats show discrimination between substance and length of trial, as well as some sensitivity to intra-session alterations in ethanol reward. They exhibit diminished sensitivity to sucrose in consumption and lick rate. Behavioral measures like consumption and nosepoke latency had some predictive potential in regard to behavioral response to ethanol. The incentive contrast paradigm used in this project allows a closer examination of the motivational processes shared by alcohol and sugar that could result in addiction. Using natural reward sensitivity to predict future addiction could aid significantly in preventing and treating substance use disorders.

Committee: Howard Casey Cromwell Ph.D. (Committee Chair); Melissa Keith Ph.D. (Committee Member); Jari Willing Ph.D. (Committee Member) Subjects: Animals; Neurosciences; Psychology

Master of Arts in Psychology, Cleveland State University, 2023, College of Sciences and Health Professions

The COVID-19 pandemic is a collective trauma that caused profound disruptions in day-to-day life and negatively impacted the psychological well-being of many emerging adults. Existing research shows that experiencing quarantine due to disease exposure or illness exacerbates psychological distress, particularly among people with existing symptoms of posttraumatic stress disorder (Solomon et al., 2021). Research points to problematic alcohol and other substance use as a mechanism in the development and maintenance of PTSD (Tripp et al., 2020). However, alcohol and other substance use has yet to be implicated in the exacerbation of PTSD symptoms among emerging adults in the context of the COVID-19 pandemic. The present study attempts to address these gaps in the scientific literature. It was hypothesized that A) pre-pandemic PTSD symptoms will positively associate with PTSD symptoms measured during the pandemic, B) problematic alcohol and other substance use will mediate the relationship between pre-pandemic PTSD symptoms and PTSD symptoms during the pandemic, and C) emerging adults who experience quarantine due to COVID-19 exposure or illness will report elevated symptoms of PTSD relative to those who did not. Participants (N=39) from the first wave of the study completed measures for the second wave of the study via an online survey between December 2021 and March 2022. Participants reported on their symptoms of psychological distress, use of alcohol and other substances, and quarantine experience. As expected, symptoms of PTSD at wave 1 predicted symptoms of PTSD at wave 2. However, no mediating effects of problematic alcohol or other substance use on the association between PTSD symptoms at waves 1 and 2 were detected. Similarly, quarantine experience was not found to moderate the relationship between PTSD symptoms at waves 1 and 2. These results suggest that symptoms of PTSD among young adults worsened under the conditions of the COVID-19 pandemic, but there was n (open full item for complete abstract)

Committee: Elizabeth Goncy (Advisor); Kathleen Reardon (Committee Member); Ilya Yaroslavsky (Committee Member) Subjects: Psychology; Public Health

MA, University of Cincinnati, 2023, Education, Criminal Justice, and Human Services: Counseling, Mental Health

Alcohol use disorders (AUDs) among lesbian, gay, and bisexual (LGB) populations continue to persist. The need for treatment for alcohol use disorders among the LGB population is greater than the general population, and utilization among LGB individuals is well below the indicated treatment need due in part to the existence of interpersonal and structural barriers. Moreover, the impact of untreated AUD on the mental health and welfare of LGB individuals can be detrimental to overall quality of life and, thus, warrants further investigation and intervention. Therefore, it is critical to better understand the interpersonal and structural factors that influence treatment utilization among the LGB population. The current study aims to examine predisposing factors, including sexual orientation identity, perceived public discrimination, and perceived interpersonal discrimination, as well as enabling factors, including perceived healthcare discrimination as it relates to treatment utilization for alcohol use disorders among the LGB population. These relationships were analyzed using hierarchical logistic regression and secondary data from a subsample of the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III which included individuals aged 18 years and older who identify as lesbian, gay, or bisexual (n = 1,152). Findings indicate that increased experiences of public and interpersonal discrimination were associated with a higher likelihood of encountering healthcare discrimination in treatment usage. Moreover, healthcare discrimination was a predictor of higher AUD treatment utilization among this population. The results of this study suggest that the measured variables influence AUD treatment use among LGB individuals and highlight a need for additional exploration. The findings of the study also offer implications for clinicians to mitigate the effects of discrimination on healthcare outcomes.

Committee: Michael Brubaker Ph.D. (Committee Chair); George Richardson Ph.D. (Committee Member); Shauna Acquavita Ph.D. (Committee Member) Subjects: Mental Health

Doctor of Philosophy (Ph.D.), Bowling Green State University, 2022, Psychology

Addiction disorders, majorly governed by the mesolimbic dopamine system, constitute a global health crisis, with alcoholism being particularly prevalent and pernicious. Alterations of the gut microbiome correlate with alterations in addiction pathologies, both physiological and behavioral. Fecal Microbial Transfer is an established research and clinical technique for manipulating the Brain-Gut-Microbiome Axis in many conditions. Ethanol is known to have massive impacts on both the gut and dopamine systems, potentially producing impacts on the latter via some action on the former. The Alcohol Preferring and Non-Preferring rat models are well suited for investigating neuropsychological processes related to alcohol addiction. We performed FMT between P and NP rats during chronic ethanol exposure to investigate the effect on drinking behaviors, and then we examined the expression of dopamine receptors 1 (D1R) and 2 (D2R) in three brain regions related to addiction (hippocampus, prefrontal cortex, and nucleus accumbens). We found that NP rats drank and preferred alcohol significantly less than P rats before, during, and after the FMT treatment during chronic ethanol exposure. Differences in drinking behaviors were not statistically significant between weeks, though there were slight patterns of a bi-directional influence, with P rats decreasing and NP rats increasing drinking during FMT. Levels of the two receptor types correlated positively with each other in each brain region. D1R in hippocampus and nucleus accumbens correlated positively with preference for the weaker concentration of ethanol, and both D1R and D2R correlated positively with intake of the stronger concentration after the FMT treatment. We also found that in P rats, FMT reduced alpha diversity of the gut microbiome, and reduced abundance of Akkermancia municiphila, and Bifidobacterium animalis; these gut conditions are associated with healthier outcomes, which may suggest that FMT impacted drinking beha (open full item for complete abstract)

Committee: Howard Casey Cromwell Ph.D. (Committee Chair); Verner Bingman Ph.D. (Committee Member); Sherri Horner Ph.D. (Other); Michael Zickar Ph.D. (Committee Member); Daniel Weigmann Ph.D. (Committee Member) Subjects: Neurosciences; Psychology

Doctor of Philosophy, Miami University, 2022, Psychology

Introduction: This study applies positive emotion regulation models to identify within-person and between-person mechanisms that contribute to co-occurrence of Alcohol Use Disorder (AUD) and Social Anxiety Disorder (SAD) symptoms. SAD is a risk factor for the development of AUD, and comorbid SAD and AUD confer greater detrimental effects than either disorder alone. People high in social anxiety have difficulties regulating positive emotions, including difficulty accepting positive emotions. Although people with AUD symptoms often experience trait-level difficulties regulating positive emotions, in the short term, alcohol use may facilitate adaptive positive emotion regulation. Thus, an understudied area of research is whether alcohol consumption temporarily allows people experiencing elevated social anxiety symptoms to accept positive emotions, which, in the long term, could lead to alcohol-related problems. To address this gap in research, the present study (1): Tested whether alcohol consumption moderated within-person relations between state social anxiety and positive emotion acceptance in emerging adult hazardous drinkers, and (2): Tested whether, on a between-person level, the extent to which alcohol helped people accept positive emotions was associated with alcohol-related problems. Method: 104 young adults (aged 18-25) who reported hazardous drinking participated in a baseline session and a 14-day ecological momentary assessment (EMA) data collection period. During the EMA data collection period, participants initiated EMA reports about each social interaction they experienced, which assessed their social anxiety, positive emotion acceptance, and alcohol use. Results: Social anxiety was associated with lower positive emotion acceptance during social interactions. Alcohol consumption occurrence, but not quantity, was associated with lower positive emotion acceptance. Alcohol consumption did not moderate the relation between state social anxiety and positive e (open full item for complete abstract)

Committee: Elise Clerkin (Committee Chair); Joshua Magee (Committee Member); Elizabeth Kiel (Committee Member); Philip Smith (Committee Member) Subjects: Clinical Psychology

Doctor of Psychology (PsyD), Wright State University, 2020, School of Professional Psychology

Sexual minority women demonstrate higher rates of Alcohol Use Disorder, or AUD, compared to their heterosexual counterparts. Factors that potentially impact how likely a sexual minority woman is to develop an AUD during her lifetime has received limited attention in existing research. These include sexual minority stress, stress and cognitive appraisal, and hardiness theories. While many factors are suggested, and some supported, no consistent risk or protective factors have emerged. This study sought to change that by testing whether proposed risk and protective factors for stress, both in general and unique to sexual minority individuals, impacted the likelihood of the development of an AUD. Sexual minority stress was explored as a potential risk factor while hardiness was proposed as a potential protective factor. Stress appraisal was explored as both a potential risk and protective factor. Quantitative data was collected from a previously conducted study that utilized self-report surveys. Participants were recruited by distributing the online survey via email to LBGT+ organizations and listservs across North America. Data was collected from lesbian and bisexual identified women (n = 344) from a larger study on substance use in sexual minority individuals. Correlational and regressional analyses were conducted. Of the proposed risk and protective factors (hardiness, bisexual minority stress, stress appraisal, and sexual minority stress), none were found to significantly impact lifetime AUD risk (as measured by the AUDIT). Strengths, limitations, clinical implications, and research recommendations are presented in the discussion section.

Committee: Michelle Vaughan Ph.D. (Committee Chair); Jeremiah Schumm Ph.D. (Committee Member); Daniela Burnworth Ph.D. (Committee Member) Subjects: Psychology

Doctor of Philosophy, University of Akron, 2019, Counseling Psychology

Seminal research on perfectionism identifies a relationship between maladaptive perfectionism and alcohol use disorder (AUD), a diagnosis directly impacting millions of Americans each year (NIH, 2017). Despite seminal research identifying this relationship (Pacht, 1984), contemporary research specific to perfectionism and AUD is lacking. Similarly, perfectionism measures are often normed on college students and rarely include alcohol addicted participants in their development, making it necessary to examine potential tools efficacious in assessment specific to this population. Exploratory factor analysis using the Measure of Constructs Underlying Perfectionism (MCUP; Stairs et al., 2012) revealed an 8-factor structure when utilized among an alcohol-addicted population (N = 357). Mean differences were compared for each of the five factors identically retained from the original study, with significant differences on each the Black and White Thinking and Details and Checking subscales, such that those with AUD scored higher than the original college student sample. The presence of comorbid psychological symptoms was also explored. Greater than 50% of participants endorsed experiencing psychological symptoms during a typical two week period of active addiction, including experiences of anxiety, depression, obsessive compulsive thoughts and behaviors, and anger. Attempts to explore gender related differences in the relationship between AUD and perfectionism did not yield significant results, and the requisite level of racial and ethnic diversity was not reached in order to explore a research question centering on differences in this relationship, as well.

Committee: Weigold Ingrid PhD (Committee Chair); Speight Suzette PhD (Committee Member); Queener John PhD (Committee Member); Patton Rikki PhD (Committee Member); Baker David PhD (Committee Member) Subjects: Counseling Psychology; Psychology