Doctor of Psychology (Psy.D.), Xavier University, 2018, Psychology

Nonmedical use of prescription stimulants is increasingly common among college students (Schulenberg, Johnston, O'Malley, Bachman, Miech, & Patrick, 2017). Research into the motives behind this behavior indicates that students most often use prescription stimulants to enhance academic performance in response to academic stress, although there is little empirical data to suggest that using stimulants leads to positive academic outcomes. Factors that appear to perpetuate prescription stimulant use on college campuses include low perceived risk and high social acceptability associated with using diverted stimulants to improve academic functioning. The current study used experimental and self-report methods to compare perceptions stimulant use for academic purposes to other types of drug use for utilitarian and recreational purposes in a sample (N = 243 ; 79% Caucasian; 65.4% women) of college students. In general, approval of all forms of drug use, with the exception of recreational marijuana and alcohol use, was low. Consistent with hypotheses, results indicated that college students rated a peer who used Adderall for academic purposes significantly more favorably than a peer who used Adderall, Vicodin, or marijuana for recreation. However, overall social acceptability ratings for all types of diverted prescription drug use were low. This suggests that although students view using prescription stimulants as a study aid more favorably than other types of drug use, they still do believe that this is a socially unacceptable behavior.

Committee: Susan Kenford Ph.D. (Advisor) Subjects: Psychology

PhD, University of Cincinnati, 2004, Arts and Sciences : Psychology

Previous studies have demonstrated a relationship between family drug use and child drug outcomes (Burcu, 2003; Martino-McAllister, 1999). However, research in other areas has shown strong influences of family members in addition to the parents (NHSDA, 1997). Moreover, the relationship between family drug use and child drug outcomes has not been examined separately for males and females. This study extends the existing research by examining gender differences in the relationship between family drug use (including the extended family) and the child's drug outcomes. This study was conducted in a sample of 139 families in which at least one parent participated in drug treatment sometime during the past 12 months. Research assistants collected data from both children (child's perceived harmfulness of drug use, child refusal skills, and child drug use) and their parents (parent drug use, parental drug attitudes, parental perceived risk of drug use, and extended family drug use). The overall findings suggest that for families who communicate that drug use is unacceptable, the children do not have significantly lower future drug risk. However among males, family communication that drug use is unacceptable is associated with less future drug risk. The unexpected direct relationship between more family drug use and higher future drug risk relationship in females is not completely theoretically interpretable. The implications for this study suggest that in clinical situations with boys, it is important to gather information about family drug use to determine the degree of impact on the adolescent.

Committee: Ann Kathleen Burlew (Advisor) Subjects:

Ph.D., Antioch University, 2019, Leadership and Change

The purpose of this study was to unearth how adolescents with substance use disorders achieve the task of identity formation and the construction of self-concept in the midst of the drug culture and society that exists. It sought to uncover the social constructs designed to ignore and/or remove human complexities and allow an intersectional approach to be brought to a study on this population. Historically, there has been a failure to investigate the underlying social attitudes and behaviors that impact the very delicate and vulnerable process of finding self. Psychosocial and relational adjustment are strongly influenced by the extent to which adolescents successfully develop a coherent and structured sense of identity. One's life pathways and decisions are guided by a consolidated sense of self. An understanding of key identity literature led to a methodological design using both Grounded Theory Methodology and Situational Analysis to provide a thorough description and understanding of the entire situation around identity development for adolescents with substance use disorders. The detailed analysis of the interviews provided by 20 adolescent females served as the basis for the development of a theoretical model depicting the findings from both the dimensional analysis and situational analysis. The research provided empirical evidence that adolescents in this situation form a pseudo-identity to achieve a sense of belonging that has pervaded their existence due to familial, social, and cultural factors. This pseudo-identity is reinforced by acceptance into drug-seeking and substance-using groups, as well as by leadership and practices in treatment, therapy, healthcare, criminal justice, and other macro forces. The research provides practical implications for prevention and intervention practices, as well as leadership practice. Recommendations for future research invite further exploration into whether the situation for the participants in this study hold true acr (open full item for complete abstract)

Committee: Lize Booysen DBL (Committee Chair); Elizabeth Holloway PhD (Committee Member); Karsten Lunze PhD, MD (Committee Member) Subjects: Behavioral Psychology; Behavioral Sciences; Clinical Psychology; Counseling Education; Criminology; Curriculum Development; Demographics; Developmental Psychology; Early Childhood Education; Education Policy; Educational Leadership; Families and Family Life; Health Care; Mental Health; Personality Psychology; Pharmacology; Psychotherapy; Public Health; Public Health Education; Public Policy; Social Work; Teacher Education; Therapy

PhD, University of Cincinnati, 2023, Arts and Sciences: Psychology

Background: In 2020, 16.1 million individuals ages 12 and over endorsed past-year prescription drug misuse (PDM); opioids were the most misused prescription drug class (i.e., 9.3 million people). According to the Center for Disease Control and Prevention, prescription opioid misuse resulted in an average of 38 deaths per day in 2019, making pain relievers responsible for 28% of all opioid-related fatalities. The “opioid epidemic” was declared a public health emergency due to the widespread impact of drug overdose deaths in rural and suburban communities across the United States. This epidemic has traditionally been depicted as a crisis devastating non-Hispanic White populations, however, as opioid overdose deaths decrease within these communities, deaths among African Americans have increased over time. The prevalence and correlates associated with misusing prescription drugs have been outlined in the extant literature and the deleterious effects of PDM in the African American community have been observed, yet research investigating misuse among this population remains limited. A primary aim of this study was to examine the psychosocial factors (i.e., mental health, substance use) that increase the risk of PDM among African Americans. PDM trends were also analyzed to evaluate misuse over time. Method: Using pooled cross-sectional data (2015-2019) from the National Survey on Drug Use and Health (NSDUH), this study examined trends and correlates (i.e., mental health [major depressive episode, suicidal ideation, serious psychological distress], substance use [alcohol, marijuana, tobacco, illicit substances]) of PDM among African American adults (ages 18 and older) who endorsed lifetime misuse of prescription drugs. Results: Trend analyses revealed that lifetime PDM among African Americans was significantly lower in 2017 and 2018, relative to 2015. A similar relationship was observed for past 12-month PDM with significant differences indicating lower prev (open full item for complete abstract)

Committee: Monica Mitchell Ph.D. (Committee Chair); LaTrice Montgomery Ph.D. (Committee Member); Dale Mantey Ph.D. (Committee Member); Quintino Mano Ph.D. (Committee Member) Subjects: Psychology

Doctor of Psychology (PsyD), Wright State University, 2021, School of Professional Psychology

Women who use illicit substances and misuse prescription drugs and become involved in the criminal justice system due to drug-related offenses are likely to experience high rates of relapse to drug use and recidivism, even after engaging in treatment. However, there has been little research, either qualitatively or quantitatively, to explain this trend. Of the available research, some stressors unique to women that may impact return to use were noted. Those stressors included dysfunctional adult and intimate partner relationships, untreated mental health problems, and problems with child custody (Bonta et al., 1995; Lambert & Madden, 1976; Long, Sultan, Kiefer, & Schrum, 1983; Neale et al., 2014). The primary goal of this study was to interview women sentenced to in-jail drug diversion for a second time within the previous year to determine what factors may have contributed to a return to drug use after engaging in treatment. Results of this qualitative study indicated that women endorsed dysfunctional adult and intimate partner relationships and untreated mental health concerns as contributing to relapse to drug use. Participants also noted that lack of resources and revictimization contributed to relapse to drug use. Little support was found for the involvement of Child Protective Services (CPS) as contributing to relapse to drug use. However, support was found for child-rearing concerns and relationships as contributing to relapse to drug use and recidivism.

Committee: Jeffery Cigrang Ph.D., ABPP (Committee Chair); Jeremiah Schumm Ph.D., ABPP (Committee Member); Sharon Sherlock R.N., D.H.A (Committee Member) Subjects: Behavioral Psychology; Behavioral Sciences; Behaviorial Sciences; Clinical Psychology; Gender; Psychology; Public Health; Public Health Education; Rehabilitation; Welfare

MA, University of Cincinnati, 2020, Arts and Sciences: Psychology

In the U.S., approximately 2.3 million individuals ages 16-24 have not attained a high school diploma (National Center for Education Statistics [NCES], 2017). Those who drop out are three times more likely to be unemployed and earn incomes 27% less than those who graduate (Bureau of Labor Statistics [BLS], 2018, 2019). Academic failure is associated with higher rates of substance abuse (Trenz, Harrell, Scherer, Mancha, & Latimer, 2012), which can have a causal effect on academic performance. Prescription drug misuse (PDM), or taking drugs that are not prescribed to you or as intended, is the second most commonly abused drug class among teens after marijuana (excluding alcohol/cigarettes; NIDA, 2018). Nearly a quarter (23%) of adolescents report a lifetime history of PDM (MetLife Foundation, 2013). The current study evaluated the lifetime misuse of four different drug classes (i.e., sedatives, stimulants, tranquilizers, opioids) to understand the prevalence and correlates of PDM among this at-risk group. Results revealed that lifetime PDM among adolescents was at 8%, with the highest rates of use found among White youth, females, and individuals with family incomes at or above $75,000. Age and alcohol use were both significantly associated with lifetime PDM among youth. The odds of PDM were highest among 13-year-olds (B = .30, p = .05, OR = 1.36 [95% CI: 1.01, 1.83), indicating an increase in risk for this age group. There were decreased odds of PDM for youth engaging in alcohol use (B = -.28, p<.05, OR = .75 [95% CI: .69, 1.23). In terms of academic performance, youth who earned a D or less than D average had the highest odds of PDM (B = .52, p< .05, OR = 1.70 [95% CI: 1.16, 2.45]). Findings suggest that early adolescence and academic failure increase the risk for lifetime PDM among youth.

Committee: Monica Mitchell Ph.D. (Committee Chair); Quintino Mano Ph.D. (Committee Member); LaTrice Montgomery Ph.D. (Committee Member) Subjects: Psychology

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

Doctor of Philosophy, The Ohio State University, 2004, Physical Activity and Educational Services

The focus of this study was to report and analyze the responses of students, grades 6 - 12, who had Specific Learning Disabilities (SLD) and attended schools in 17 public school districts and 12 parochial and private schools in and surrounding a major Midwestern city. The data were collected through the Primary Prevention, Attitude and Use Survey (PPAAUS, 2000) that was administered every 3 years to all students in Grades 6 - 12 in these schools. A random sample of 470 students with SLD, selected from a database of approximately 3,760 students, reported that they participate in classes for students with SLD. The independent variables established were Gender (Male and Female) and Grade Level (Middle School and High School), and the dependent variables were the responses to the items of Feelings; Perceptions of School Climate; Willingness to Use Alcohol, Tobacco, and Other Drugs; Frequency of Use; Age of First Use; and Location of Use. The results of the Feelings items indicated that Middle School students reported feeling more stressed and anxious about their school work than did High School students. Males reported being more sad and depressed, more angry, and more nervous and anxious than did females. Males also reported that they felt worse about their schoolwork. Middle School students with SLD had more positive perceptions of school climate than did High School students, and there was no difference between males and females and their reported perceptions of school climate. There was no difference between males and females and their reported use of alcohol, tobacco, and other drugs. High School students reported more actively using alcohol, tobacco, and other drugs than did Middle School students. No differences were found by Gender or Grade Level for locations of substance use. An examination of the age of first substance use indicated that students with SLD who used generally began using substances between the ages of 12 to 15 years. Recommendations for program (open full item for complete abstract)

Committee: Michael Klein (Advisor) Subjects:

Master of Arts (MA), Ohio University, 2007, Sociology (Arts and Sciences)

Illicit prescription drug use among young adults is a growing concern on college campuses, although there are only few studies empirically examining this phenomenon. The purpose of this study is to examine the use of illicit prescription drugs for recreational purposes among college students and to evaluate the applicability of Akers' Social Learning Theory to this phenomenon. A survey was conducted to obtain a sample size of approximately 465 students from a large Midwestern university. This study demonstrates that illicit prescription drug use is relatively prevalent in this college sample. Students in the sample who reported illicit prescription drug use were more likely to engage in other risky behavior, such as binge drinking, driving under the influence of drugs or alcohol, attending parties where alcohol is consumed, and mixing prescription drugs with alcohol. These students are also more likely to smoke tobacco and report lifetime use of other drugs besides marijuana. More importantly, the results of this study indicate that there is general support for social learning theory as a valuable explanation for this behavior, with peer association as the best predictor for this behavior.

Committee: Michelle Brown (Advisor) Subjects:

PHD, Kent State University, 2024, College of Arts and Sciences / School of Biomedical Sciences

As of 2022, three million people in the US, and sixteen million worldwide were estimated to suffer from opioid use disorder (OUD). Despite widespread efforts to increase the public availability of medical therapies for OUD, only 2.28% of people suffering from OUD will seek out and be able to sustain abstinence for at least five years. The core objectives of this work were to 1) evaluate the dose- and sex-dependent effects of fentanyl to induce rewarding states, 2) the extent to which D-Cysteine ethylester (D-CYSee) alters affective state and the acquisition of fentanyl-induced reward seeking, 3) how the timing and concentration of fentanyl administration impacts the intrinsic Ca2+ activity of neurons and astroglia from the prefrontal cortex (PFC), and 4) the extent to which D-CYSee alters intrinsic Ca2+ activity in both the presence and absence of fentanyl. To evaluate the effects of fentanyl in the presence and absence of D-CYSee on Ca2+ signaling dynamics in PFC neurons and astrocytes, this work details the development of new methods in real-time fluorescent imaging of intrinsic Ca2+ activity using a non-genetic chemical indicator in cells isolated from the rat PFC in combination with post-hoc live-cell labeling for neurons and astroglia, and a customizable cell-type informed statistical analysis pipeline with backend support for data visualization and meta-analysis. Furthermore, a general characterization of the intrinsic Ca2+ activity in this PFC preparation was conducted; first by examining the involvement of extracellular Ca2+ sources and sodium channel conductance's, followed by a deeper evaluation of the role(s) of voltage-gated L, T, & N/P/Q-Type Ca2+ channels and an assessment of NMDA, AMPA receptor, and GABAA receptor signaling in the expression of intrinsic Ca2+ activity. The findings here support: 1) that fentanyl induces reward seeking in a concentration- and sex-dependent manner, 2) that D-CYSee could be an effective co-treatment with prescribed opioi (open full item for complete abstract)

Committee: Devin Mueller, Ph.D. (Advisor); Derek S. Damron, Ph.D. (Advisor); Stephen J. Lewis, Ph.D. (Committee Member); Colleen Novak, Ph.D. (Committee Member); Robert Clements, Ph.D. (Committee Member); Rafaela S. C. Takeshita, D.Sc., (Other) Subjects: Behavioral Psychology; Behavioral Sciences; Cellular Biology; Neurosciences

MA, Kent State University, 2023, College of Arts and Sciences / Department of Sociology and Criminology

Poly-victimization refers to the experience of multiple victimizations of different kinds, such as bullying, sexual or physical assault, physically abusive punishment, and intimate partner violence, among others. Much attention has been given to the relationship between poly-victimization and adolescent outcomes, especially substance use, but little research attention has been given to the relationship between poly-victimization and adult substance use. This relationship, along with social support as a potential moderator, is important to explore for the sake of implementing non-punitive interventions and reducing our reliance on incarceration. The present study examines the relationship between adolescent poly-victimization and subsequent substance use in adulthood, as well as the potential moderating effect of social support. Publicly available data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) are used to assess the impact of multiple measures of violent victimization, as well as multiple measures of social support, such as religiosity and school and parental support, on adult substance use. Past-year marijuana and hard drug use are assessed as outcome variables. Findings suggest that adolescent poly-victimization is positively associated with the odds of using marijuana and hard drugs during adulthood, while higher levels of social support are negatively associated with the odds of using these substances during adulthood. Avenues for future research and policy implications are discussed.

Committee: Starr Solomon (Advisor); Katrina Bloch (Committee Member); Christopher Dum (Committee Member) Subjects: Criminology; Sociology

Doctor of Philosophy, The Ohio State University, 2021, Comparative Studies

‘Deviant Patients with Fuzzy Valves' examines the practices found within the treatment and diagnosing of infective endocarditis in the acute care hospital, particularly among the patient demographic of intravenous drug use patients. Although infective endocarditis was first described in the late 17th century, the recent opioid epidemic in the U.S. has categorically changed the terrain of this disease. Healthcare providers often have misperceptions about effective treatment options for substance users with infective endocarditis that are based on misguided value judgements concerning a patient's lifestyle, choices, and responsibility. These misperceptions are materialized and reified within practices such as AMA discharges, the prescribing of antibiotics, and assessments of eligibility for a valve-replacement procedure. These misperceptions and practices are neither empirical in nature nor ethically justified. They nonetheless serve to capture substance use patients with infective endocarditis in ways that result in suboptimal medical care and not respecting the dignity or worth of this vulnerable patient population.

Committee: David Horn Dr. (Committee Chair) Subjects: Comparative; Medical Ethics; Sociology

Psy. D., Antioch University, 2021, Antioch Santa Barbara: Clinical Psychology

This literature review provides a general overview of the relative effectiveness of different treatment modalities that are available to therapists for the treatment of substance abuse. Some of these models include Cognitive Behavioral Therapy, Relapse Prevention, Mindfulness-Based Stress Reduction, Contingency Management, The 12-Step Approach, Motivational Interviewing, and Harm Reduction. While investigating the effectiveness of these treatment strategies, it was discovered that the conditions under which recovery from substance abuse are likely to occur involves several components. These concepts are common to nearly all of the evidenced-based strategies that were reviewed and include the development of coping and social skills. The promotion of self-awareness, self-efficacy, and interpersonal communication are common themes throughout the literature. This review provides meaningful data that supports the assumption that the application of evidenced-based treatment modalities positively impacts the lives of adult substance abusers and can be used effectively with a wide range of substance use disorders (Killuk, 2014). Cognitive Behavioral Therapy is currently the most widely used and researched treatment strategy. Treatments that help substance abusers gain awareness of the relationship between their thoughts, behaviors, and emotions tend to create desired outcomes. This literature review also explores the effectiveness of spirituality and religion as a part of treatment. This dissertation is available in open access at AURA (https://aura.antioch.edu/) and OhioLINK ETD Center (https://etd.ohiolink.edu).

Committee: Brett Kia-Keating EdD (Committee Chair); Sandra Kenny PhD, MBA (Committee Member); Steve Kadin PhD (Committee Member) Subjects: Clinical Psychology; Cognitive Therapy; Psychotherapy

Master of Arts (MA), Wright State University, 2020, Applied Behavioral Science: Criminal Justice and Social Problems

The study examines adverse childhood experiences among individual who use illicit opioids, focusing on emotional, physical, and sexual abuse. The study uses data collected from a sample of 357 individuals with opioid use disorder who were recruited in the Dayton area between May 2017 and October 2018. The study builds on the life course and social learning theories to examine the association between childhood experiences and drug use behaviors in later life. The key aims of the study are to: 1) assess the prevalence of adverse childhood experiences in the community-recruited sample of individuals with opioid use disorder; 2) analyze the relationship between adverse childhood experiences and family history when growing up, including economic hardship and parental history of mental and substance use problems, and 3) analyze the associations between adverse childhood experiences and selected drug use characteristics, such as age of first use, frequency of use, and whether or not they inject. Participants were recruited used targeted and respondent-driven sampling. Structured interviews were conducted by trained interviewers and covered history and patterns of drug use, sociodemographic characteristics, and adverse childhood experiences (ACE). Descriptive statistics and univariate analyses were used to characterize the sample. Chi-square test was used for categorical variables. One-way ANOVA was used to assess differences in drug use characteristics (continuous variables) between those who experienced childhood abuse and those who did not. Multiple linear regression analysis was used to assess the relationships between age heroin initiation (dependent variable) and childhood abuse experiences (independent variable), controlling for socio-demographics and family history when growing up. Multivariate Logistic Regression analyses were used to assess the association between a) early initiation of alcohol use (dependent variable) and childhood abuse experiences (independent) (open full item for complete abstract)

Committee: Raminta Daniulaityte Ph.D. (Advisor); La Fleur Small Ph.D. (Committee Member); Karen Lahm Ph.D. (Committee Member) Subjects: Behavioral Sciences; Early Childhood Education; Families and Family Life; Health Education; Mental Health

PHD, Kent State University, 2020, College of Arts and Sciences / Department of Sociology and Criminology

Prevalence of nonmedical use of prescription drugs (NMUPD) has risen dramatically during the past two decades. Studies meeting the demand for empirical research on this phenomenon have mainly identified individual-level drivers of NMUPD. While such identification assists in understanding these trends, few studies have considered the social drivers of NMUPD. This is surprising given 1) prevalence varies according to neighborhood type (i.e., rural, urban, suburban) and 2) the wealth of empirical and theoretical literature connecting social factors to health behaviors, deviant behavior, and use of other illicit substances. The goal of this dissertation is to situate the NMUPD as a social problem by investigating its structural sources and social determinants. I use social disorganization theory (Sampson and Groves 1989; Shaw and McKay 1942) and associated “neighborhood effects” frameworks (Brooks-Gunn et al. 1993; Gephart 1997; Leventhal and Brooks-Gunn 2000), to frame the NMUPD epidemic as a product of social-structural (i.e., macro) forces that are mitigated by community-level mechanisms. Using two waves of data from the National Longitudinal Study of Adolescent Health (Add Health), I generate logistic regression models testing the effects of macro-level predictors on individual odds of NMUPD, as well as the intervening roles of collective efficacy (Fagan, Wright, and Pinchevsky 2014; Sampson, Raudenbush, and Earls 1997; Theall et al. 2009), depressive symptoms (Aneshensel and Sucoff 1996; Ross 2000), and access to healthcare (Browning and Cagney 2002; Ross and Mirowsky 2001) in this relationship. Findings highlight the neighborhood context as a source of variation in NMUPD. Results indicate that living in a disorganized neighborhood is associated with increased odds of engaging in NMUPD and highlight neighborhood residential instability as an important risk factor. Further analyses reveal that this association is stratified, with female residents bearing the most su (open full item for complete abstract)

Committee: Robert L. Peralta Ph.D. (Committee Chair); Richard E. Adams Ph.D. (Committee Member); Kele Ding Ph.D. (Committee Member); Stacey Nofziger Ph.D. (Committee Member); Starr Solomon Ph.D. (Committee Member); Peggy C. Stephens Ph.D. (Committee Member) Subjects: Sociology

Doctor of Psychology (Psy.D.), Xavier University, 2020, Psychology

Research on emotion regulation while in residential substance abuse treatment is scarce, and even more so within the veteran population. This present data analysis examined the relation between emotion regulation and various aspects of residential substance abuse treatment. First, it was found that difficulties with emotion regulation significantly decreased from admission to post-completion of a veteran residential substance abuse program. In addition, treatment persistence, or the act of remaining in treatment for the recommended duration, was examined. This data analysis tested the hypothesis that fewer difficulties regulating emotions would increase the chances veterans would remain in the 21-day program. This hypothesis, however, was not supported. In addition to veterans voluntarily leaving the program earlier than recommended, some veterans are involuntarily asked to leave due to violating program rules. As such, it was hypothesized that fewer emotion regulation difficulties upon admission would lessen the likelihood of committing rule infractions; this hypothesis was not supported. Lastly, it was found that the greater the change in DERS scores from admission to discharge, the lower the likelihood of returning to aftercare treatment (e.g., outpatient follow-up appointments); these results were contrary to what was hypothesized. Although emotion regulation difficulties can significantly decrease after a 21-day program, further research is needed to determine variables associated with remaining in treatment, following program rules, and attending recommended follow-up care.

Committee: Nicholas Salsman Ph.D. (Committee Chair) Subjects: Psychology

Doctor of Philosophy (PhD), Ohio University, 2020, Counselor Education (Education)

The misuse of alcohol and other drugs has a significant negative impact worldwide, in the United States, and particularly among vulnerable young adults. Undergraduate college students face additional risks for alcohol or drug use due to the significant transitions occurring in their personal, social, and environmental lives. The consequences of alcohol or drug use to the college student population and relevant stakeholders are well documented. To prevent and mitigate the negative consequences of college students' alcohol or drug use, it is essential to understand factors that predict those behaviors. More specifically, it imperative to understand factors that predict alcohol or drug use that results in negative consequences, or problematic use. Psychological distress and impulsivity have been identified as predictors of other high-risk behaviors among college students, but their predictability of problematic alcohol or drug use among the undergraduate college student is not yet fully understood. Gaps in the literature regarding the psychological distress, impulsivity, and substance-using behaviors among this population include a lack of focus on drugs other than alcohol, a lack of differentiation between problematic and non-problematic use, and significant variability in the definitions and operationalization of alcohol and drug use related variables. The primary purpose of the present study with 481 participants was to investigate whether psychological distress (i.e., depression, anxiety, and stress) and impulsivity among undergraduate college students between the ages of 18 and 25 could predict problematic alcohol or drug use. A secondary aim of this study was to determine whether there was a relationship between problematic alcohol use and problematic drug use. Findings indicated that impulsivity was predictive of problematic alcohol use, and depression and impulsivity were predictive of problematic drug use. Neither anxiety nor stress were predictive of problema (open full item for complete abstract)

Committee: Christine Bhat (Committee Chair); Gordon Brooks (Committee Member); Tamarine Foreman (Committee Member); Yegan Pillay (Committee Member) Subjects: Behaviorial Sciences; Counseling Education; Higher Education

Doctor of Philosophy, University of Toledo, 2019, Health Education

Introduction: The use of psychoactive drugs can have detrimental effects, especially on youth, since their bodies are still developing (National Institute of Health, 2014). This drug use can have a negative impact on student academic performance since marijuana use impairs critical thinking and memory functions, especially in teens (NIH, 2014). Effective drug prevention strategies are important because not only do drugs have an impact on youth health and academics, but substance use is also one of the costliest health problems in the United States: illicit drug abuse alone costs the nation approximately 151 billion dollars annually (U.S. Department of Health and Human Services, 2009). Drug use remains a prevalent public health problem among adolescents. According to the Monitoring the Future Study (2017), about 45% of high school students have used marijuana. High school students also report using the following illicit drugs in their lifetime: amphetamines (9.2%), tranquilizers (7.5%), hallucinogens (5.0%), ecstasy (4.9%), inhalants (4.9%), cocaine (4.2%), steroids (1.6%), and heroin (0.7%). Schools vary in the extent to which they implement drug prevention programs and student drug testing. Superintendent and parental support are imperative to initiate Random Student Drug Testing (RSDT). One way to assess whether these stakeholders support drug testing in high schools is to assess their attitudes and perceptions through the use of the Integrated Behavioral Model (IBM). Therefore, the purpose of this study is to investigate parent and superintendent support for RSDT, using the IBM, and to determine what, if any, similarities or differences exist between these two key stakeholders. Indeed, parent support may influence superintendents' intentions to implement a RSDT program in their school districts. In turn, knowing superintendents' support for this issue may help citizens and public officials implement this unique prevention strategy. Methods: A cross- (open full item for complete abstract)

Committee: Tavis Glassman (Advisor); Joseph Dake (Committee Member); Susan Telljohann (Committee Member); Cynthia Beekley (Committee Member) Subjects: Health Education; School Administration

Doctor of Philosophy, University of Akron, 2019, Nursing

As the heroin epidemic continues to grow, understanding the meaning of recovery is crucial. The recovery process for a heroin abuser is not completely understood and has numerous cycles of abstinence and relapses of up to 70-80%. With each relapse comes the risk of overdose and death. Better understanding of the experiences of those who live in recovery can be used to more effectively help those currently entering recovery and to educate health care workers. Critical social theory was the philosophical premise used to guide the research study and create an environment optimal for understanding the experiences of recovery. Taped, individual, semi-structured, in-depth interviews were used to gather data from a sample of 10 participants from a Midwest state in the U.S. Data were analyzed using Diekelmann's framework to explore the lived experiences of heroin abusers in recovery. Findings included the relational theme of the lived experience of recovery: “As normal as you can get,” supported by four categories of (a) Being ready: You have to want this; (b) Structure: I need to do certain things through my week and I need to let you know why; (c) Obligation: You realize death was at your door, so many people are dying and you've been granted this gift; and (d) Acceptance: I am who I am today. Recovery was described as a life-long commitment with daily responsibilities that need to be consistently taken care of to prevent relapse and to give back to those who have died from heroin addiction. Findings can be used to develop more effective education for those at risk for relapse and guide selection of treatment and recovery options that have contributed to success in others. Even persons with addictions who are not ready for treatment and recovery, should still be given information since readiness seems to be reached based on accumulation of experiences and information. Finally, findings can be used to increase awareness in healthcare workers to better treat thos (open full item for complete abstract)

Committee: Christine Graor PhD (Committee Chair); Carolyn Murrock PhD (Committee Member); Lori Kidd PhD (Committee Member); Rikki Patton PhD (Committee Member); Pamela Stephenson PhD (Committee Member) Subjects: Nursing

MS, University of Cincinnati, 2019, Pharmacy: Pharmaceutical Sciences

Objective: Diabetes is one of the most prevalent chronic diseases. This study aimed to examine geographic variation and temporal trends in the utilization of antihyperglycemic therapies among the U.S. Medicaid population compared to diabetes prevalence at state-level using Geographic Information system. Methods: A descriptive, retrospective study design was performed for 2011,2014, and 2016. Study drugs were categorized into biguanides, sulfonylureas-meglitinides, DPP-4 inhibitors, SGLT2-inhibitors, GLP-1 receptor agonists, insulins, and others. The annual number of prescriptions for antihyperglycemic therapies were extracted from the national Medicaid pharmacy database provided by the Centers for Medicare & Medicaid Services. Spatial analysis using ArcMap 10.5.1 was performed to create choropleth maps for diabetes prevalence and point maps for the total number of prescriptions for each antihyperglycemic therapy. The percent change in drug utilization during the study period was calculated per therapeutic class per state. Pearson's correlation test was also performed to evaluate the correlation between diabetes prevalence and antihyperglycemic therapies' usage at state level. Results: Utilization of most antihyperglycemic therapies were increased from 2011 to 2016. States with high utilization trends were NY, CA, PA, NJ, AZ, FL, IL, OH, MA, and TX, ranging from 1-fold to 50-fold overall. The five most prescribed antihyperglycemic therapies in 2016 were biguanides (41.95%), long and intermediate-acting insulins (18.9%), short and rapid-acting insulins (12.87%), sulfonylureas-meglitinides (11.37%), and DPP-4-inhibitors (7.87%). Rapidly increasing utilization trends were for GLP-1-receptor agonists, DPP-4-inhibitors, and SGLT2-inhibitors around all states. SGLT2-inhibitors usage in the northeastern states increased by 4 to 26-fold higher than its use in 2014. Sulfonylureas-meglitinides usage decreased in the southeast part of the US by 20%-58% in 2016. There is (open full item for complete abstract)

Committee: Jianfei (Jeff) Guo Ph.D. (Committee Chair); Diego Cuadros Ph.D. (Committee Member); Nicholas Messinger (Committee Member) Subjects: Pharmaceuticals