Psy. D., Antioch University, 2023, Antioch Seattle: Clinical Psychology

This study utilized Primary Care Provider (PCP) perspectives to unveil major barriers to prescribing buprenorphine to youth (ages 16-25) with opioid use disorder (OUD). Semi-structured interviews were conducted with seven PCPs recruited through convenience and snowball sampling. Interviews were conducted and recorded via Zoom video conferencing. Transcripts were generated and analyzed for themes using a Constructivist Grounded Theory (CGT) approach. The CGT of the present study describes four major barriers that limit PCP prescription of buprenorphine to youth: 1) PCPs Feel Overwhelmed, 2) PCPs Feel Ill Equipped to Treat Youth Patients with OUD, 3) PCPs Hold and Observe Stigma toward Patients with OUD—Especially Youth, and 4) Structural and Systemic Barriers. Each major barrier consists of related subcategories and sub-subcategories. Findings offer stakeholders suggestions for targeting individual, relational, clinical, and systemic level changes to increase primary care access to buprenorphine for youth ages 16-25.

Committee: Michael J. Toohey PhD, ABPP (Committee Chair); Michelle Peavy PhD, MAC, SUDP (Committee Member); Melissa Kennedy PhD (Committee Member) Subjects: Behavioral Sciences; Health; Health Care; Medicine; Mental Health; Psychology; Public Health

PhD, University of Cincinnati, 2022, Arts and Sciences: Psychology

Opioid use disorder (OUD) is a critical public health concern. Medication for opioid use disorder (MOUD), including buprenorphine, is essential for treating OUD. Patients with OUD often present with complex treatment needs and multiple risk factors for adverse treatment outcomes. Previous research suggests that OUD severity, polysubstance use, negative emotionality, and stress levels may be associated with poor treatment outcomes. Lacking are studies to identify patient profiles (subgroupings based on co-occurring patient-level risk factors) associated with adverse outcomes for patients in buprenorphine treatment. Thus, the aim of the current study was to identify patient risk factor profiles and to examine associations with adverse treatment outcomes among OUD patients admitted to outpatient buprenorphine treatment (N = 298). Participants were patients admitted to non-intensive outpatient (OP) or intensive outpatient (IOP) buprenorphine treatment at UC Health's Addiction Sciences Division (ASD) clinic between December 1, 2016, and October 1, 2019. Only patients with a primary OUD diagnosis who completed standardized intake assessment measures were eligible for inclusion. Using chart abstraction of electronic medical records, this study examined intake risk factors of OUD severity, polysubstance use, negative emotionality, and stress levels to create a clustering/subgrouping risk-level variable and examine subgroup membership in association with adverse treatment outcomes. Treatment outcomes included: (a) non-initiation of treatment programming following admission (e.g., reduced odds of initiating buprenorphine); (b) non-responsiveness to treatment while engaged in treatment (e.g., elevated rate of continued substance use); (c) treatment disengagement (e.g., lower proportion of required treatment encounters attended among patients retained in treatment at one-month); and (d) attrition (e.g., greater odds of not being retained in treatment one-month and six-months fo (open full item for complete abstract)

Committee: Jennifer Brown Ph.D. (Committee Member); T. Winhusen Ph.D. (Committee Member); Kristen Jastrowski Mano Ph.D. (Committee Member) Subjects: Psychology

Doctor of Nursing Practice, Mount St. Joseph University , 2023, Department of Nursing

Historically, a visit to the medical director was not consistently provided to each new patient at the TriHealth Outpatient Alcohol Drug Treatment Program (TOADTP). This resulted in patients being dispossessed of access to care such as evaluation and comprehensive treatment of co-occurring mental health diagnoses, the initiation of pharmacotherapy, and initiation of medication-assisted treatment for persons living with substance use disorders. This project centered on development and implementation of a standardized intake process for TOADTP patients with the goal of increasing referrals to the medical director to expand access to these lifesaving interventions. Over an eight-week period, pre-intervention data were collected. During this pre-intervention period, only one of the 12 new patients was referred to the medical director. Development, education, and mobilization of the new standardized intake process included: analyzing the old intake process for variances, educating the direct care team about the benefits of practicing from an evidence-based platform, developing a new intake process that included a hard stop in the electronic health record, and educating the TOADTP team about it. The process then was mobilized. Post-intervention outcome measures were collected over an 8-week period. These measures revealed that 17 out the 24 new patients were referred to the medical director. In sum, the implementation of a standardized referral process to the medical director increased referrals from 8.4% to 70.8%, thus expanding access to life-saving evidence-based care for people living with substance use disorders.

Committee: Rachel Baker Dr. (Advisor) Subjects: Mental Health; Nursing

Doctor of Philosophy (PhD), Ohio University, 2020, Translational Biomedical Sciences

More than 47,000 people died in 2017 due to opioid-involved overdoses. In addition, fatal overdoses from non-methadone synthetic opioids like fentanyl have risen dramatically over the past 7 years. The heavy flow of opioid-related overdoses in hospitals have pressured healthcare professionals to adapt to new treatment modalities while following state and federally mandated prescribing guidelines. However, even when evidence-based practices are followed, patients may be negatively affected by opioid and opioid use disorder (OUD) stigma. The importance of addressing opioid-related stigma among healthcare providers has emerged during this time as a way to decrease barriers faced by patients in need of treatment for substance use disorders (SUDs) and improve general patient outcomes. Health professional students will, one day, be on the front line of the opioid epidemic, and thus, multidisciplinary opioid-focused education is needed. Developing education to address opioid-related stigma early in training may be valuable, though limited research has focused on this approach. The research detailed in this dissertation aimed to address the opioid epidemic by leveraging health professional students' opioid-related knowledge, perceptions, beliefs, and experiences toward the development of an educational intervention to reduce opioid and OUD stigma. The first study provided a quantitative analysis of health professional students' opioid-related beliefs, experiences, and postgraduate intentions. In general, nurse practitioner (NP) students perceived the epidemic as more severe compared to other health professional students. NP students had more clinical experiences than their physician assistant (PA) and doctor of osteopathy (DO) student counterparts, and these experiences were associated with increased confidence in caring for patients with OUD. The second study aimed to explore health professional students' perceived impact of the opioid epidemic on their future profes (open full item for complete abstract)

Committee: Elizabeth Beverly PhD (Advisor); Dawn Graham PhD (Advisor); Sebastian Diaz PhD, JD (Committee Member); Holly Raffle PhD (Committee Member); Janet Simon PhD (Committee Chair); Charman Miller DNP (Committee Member) Subjects: Behavioral Sciences; Education; Educational Evaluation; Health Care; Medicine

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 (PhD), Ohio University, 2024, Counselor Education (Education)

Society and researchers acknowledge that substance use disorders impact the entire family, not just the user. Most research focuses on alcoholism within families and rarely deviates specifically to other substances such as opioids, cocaine, meth, or marijuana. At times, parents with substance use disorders, such as opioids, are not present, whether physically or emotionally, for their children. The parents' absences can impact their children's experiences, such as how they create and maintain interpersonal relationships during childhood and adulthood. Despite this acknowledgment, little research exists on the experiences of children living with parental opioid use disorders from their perspective, instead utilizing the user's perspective of how they believe their substance use disorder impacts their children. To better understand the resulting impact of parental opioid use disorders, the researcher used a phenomenological research design to explore the first-hand experiences of adults who lived with parental opioid use disorders and the different interpersonal relationships experienced during childhood and adolescence. This study identified patterns of shared experiences and encouraged more research related to the long-term effects of parental opioid use disorders in adults, its impact on their interpersonal relationships, and identifying and understanding the counseling needs of clients affected by their parent's opioid use disorder.

Committee: Bilal Urkmez (Committee Chair); Yuchun Zhou (Committee Member); Tamarine Foreman (Committee Member); Christine S. Bhat (Committee Member) Subjects: Cognitive Therapy; Counseling Education; Counseling Psychology; Developmental Psychology; Families and Family Life; Mental Health; Social Research; Sociology

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

Doctor of Philosophy, University of Toledo, 2023, Psychology - Clinical

Posttraumatic stress disorder (PTSD) and substance use disorders frequently co-occur. There is also evidence that emotion dysregulation underlies the development and maintenance of co-occurring PTSD and substance use disorders, including opioid use disorder (OUD). Thus, interventions designed to specifically target emotion dysregulation may have utility in addressing this co-occurrence. The aim of this study was to adapt an existing treatment that targets emotion dysregulation (emotion regulation group therapy) to a brief individualized protocol and assess its preliminary efficacy for reducing PTSD symptoms, emotion regulation difficulties, negative affect, and substance-use related outcomes. Using a multiple baseline experimental design, the intervention was evaluated in a patient sample of adults in medication-assisted treatment for OUD (N = 4) with probable PTSD. Participants completed daily assessments during a 2- or 4-week baseline phase, a 4-week treatment phase, and 4-week post-intervention phase. Results demonstrate that by the end of the treatment phase, two participants demonstrated reliable decreases in emotion regulation difficulties, two participants demonstrated reliable decreases in negative affect, two participants demonstrated reliable decreases in craving, and one participant demonstrated a reliable increase in medication adherence self-efficacy. By the end of the follow-up period, three participants demonstrated reliable decreases in PTSD symptoms, one participant demonstrated a further reliable decrease in emotion regulation difficulties, one participant demonstrated a reliable improvement in medication adherence, one participant demonstrated a reliable improvement in medication adherence self-efficacy, two participants demonstrated further reliable decreases in negative affect, one participant demonstrated a further reliable decrease in craving, and one participant demonstrated a reliable decrease in substance use. Results provide preliminary e (open full item for complete abstract)

Committee: Kamala London-Newton (Committee Chair); Matthew Tull (Committee Member); Kim Gratz (Committee Member); Wesley Bullock (Committee Member); Jason Rose (Committee Member); Shannon Sauer-Zavala (Committee Member) Subjects: Clinical Psychology

BS, Kent State University, 2023, College of Arts and Sciences / Department of Biological Sciences

The opioid epidemic is a major health crisis in the U.S., resulting in an estimated 80,816 deaths in 2021. Overdose results in Opioid-Induced Respiratory Depression (OIRD) often treated by administration of competitive opioid receptor antagonists such as naloxone. However, these drugs are not effective against highly potent synthetic opioids (e.g., fentanyl) and are poorly suited for the prevention and/or treatment of opioid-craving or addiction. D-cysteine ethyl ester (D-CYSee) has been shown to prevent OIRD and disrupt the acquisition of fentanyl-induced seeking behaviors in rats. The Hippocampus (Hipp) has been established as a vital region for the encoding of drug-associated cues and contexts. Thus, the effects of D-CYSee and fentanyl on intrinsic calcium activity in heterogeneous cell cultures derived from the Hipp of P0 Sprague Dawley rat pups were observed. Males and females were cultured separately so sex differences in the cellular response to fentanyl and D-CYSee could be determined. Cells were cultured for 12-days, loaded with a fluorescent Ca2+ probe, Cal-520 AM, and imaged on an inverted microscope. It was found that fentanyl induced a transient Ca2+ peak in neurons derived from males but not females and in astrocytes derived from both sexes. Pretreatment with D-CYSee prevented this peak in neurons but only modulated it in astrocytes. This demonstrated not only a cellular basis for D-CYSee's ability to prevent drug seeking behavior, but also a clear sexual dimorphism in cellular responding to exogenous opioids within the hippocampus.

Committee: Derek Damron (Advisor); Elda Hegmann (Committee Member); Aleisha Moore (Committee Member); Soumitra Basu (Committee Member) Subjects: Biology; Cellular Biology; Neurosciences; Pharmacology

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

Substance use disorder (SUD) is a debilitating chronic disorder with enormous social and economic impact. According to the brain disease model of addiction (BDMA), this affliction progresses following three recurring stages: binge and intoxication, withdrawal and negative affect, and preoccupation. Each stage is hallmarked by changes in particular brain circuits, mediated by specific molecular effectors, and results in distinct behavioral characteristics. The opioid epidemic is a global health concern and opioid use disorder (OUD) leads all other types of SUD in drug overdose deaths. Human imaging studies in patients with OUD, along with preclinical research in animal models, continue to expand our understanding of the pathophysiology and etiology of this disorder. While treatments are available, their efficacy and availability are limited. Most addictive drugs are plant secondary metabolites (PSM) that evolved as chemical defenses against insect herbivory. PSMs interfere with reward, learning, and feeding mechanisms in insects, the same mechanisms hijacked in humans with SUD. In this study, we examine Drosophila's sensitivity to morphine, in efforts to establish this valuable model organism for the study of OUD. Indeed, flies show a dose-dependent behavioral sensitivity to morphine,measured by feeding, activity, and choice assays. In this study, we highlight the sequence similarities between two related families of receptors - human somatostatin/opioid receptors and Allatostatin C (AstC) receptors in Drosophila.s. Using the Gal4/UAS system, we show that neuronal knockdown of AstC receptors modulates the behavioral sensitivities of flies to morphine. This study demonstrates proof-of-concept evidence on the importance of taking a phylogenetic approach in SUD research. Our results suggest that Drosophila offers a useful model for the study of OUD, and that allatostatin C receptors, as their phylogenetic ancestral forms, play a key role in a flies' sensitivity to opioi (open full item for complete abstract)

Committee: Robert Huber Ph.D. (Committee Chair); Jessica Kiss M.Ed., Ph.D. (Other); Raymond Larsen Ph.D. (Committee Member); Jon Sprague Ph.D. (Committee Member); Moira Van Staaden Ph.D. (Committee Member) Subjects: Behaviorial Sciences; Biology; Genetics; Medicine; Neurosciences; Physiology; Psychobiology

Doctor of Philosophy, Case Western Reserve University, 2021, Nursing

The Impact of Resilience, Spirituality, and Self-Regulation on the Quality of Life of Adults with Opioid Use Disorder in the Gulf State of Oman Abstract By HAMED MUBARAK AL BATTASHI Substance use is currently recognized as a chronic brain disease and a significant public health concern. In Oman, the percentage of individuals seeking substance use treatment in 2017 increased by 44% when compared to 2016. A total of 64% of the individuals who reported substance use problems are below 35 years old. Easy access to alcohol and other substances, family histories of substance use, and traumatic experiences during childhood were some of the primary risk factors reported by individuals in Oman who are substance users. Individual and family self-management theory and the bio-psycho-social-spiritual model of addiction were used as theoretical frameworks to guide the development and implementation of the study. The study addressed the following aims: (1) explore the variability and extent of resilience, spirituality, self-regulation, and quality of life (QOL), (2) investigate the impact of resilience and spirituality on self-regulation, (3) examine the impact of self-regulation on QOL, and (4) assess how does self-regulation mediates how resilience and spirituality predict QOL. This descriptive, cross-sectional study utilized a convenience sampling technique to recruit 109 adult participants diagnosed with opioid use disorder or polysubstance use including opioids. The study was implemented in two treatment centers in Oman. Data xiii were collected using the Resilience Research Center-Adult Resilience Measure (PRCARM), Spiritual Involvement and Beliefs Scale (SIBS), Cognitive-Emotion Regulation Questionnaire (CERQ), Emotional Self-Efficacy Scale (ESES), and the World Health Organization Quality of Life (WHOQOL) Scale (WHOQOL-BREF). The SPSS 25 statistical package was used to analyze descriptive data and conduct various multiple linear regressions. The le (open full item for complete abstract)

Committee: Faye Gary Dr. (Committee Chair); Christopher Burant Dr. (Committee Member); Dianna Morris Dr. (Committee Member); Mary Dolansky Dr. (Committee Member); Sharon Milligan Dr. (Committee Member) Subjects: Behaviorial Sciences; Cognitive Psychology; Cognitive Therapy; Counseling Psychology; Health Care; Mental Health; Nursing

Master of Arts in Medical Ethics and Humanities, Northeast Ohio Medical University, 2021, College of Graduate Studies

Despite the Anti-Drug Abuse Act of 1986 that declared a “war on drugs”, criminalized substance abuse, and opened up treatment programs specific to pregnant women, the number of pregnant women using opioids increased five-fold from 2000 to 2009, skyrocketing the related costs for state Medicaid programs (Patrick et al., 2012). Unfortunately, this law has had a pervasive effect on the public's attitudes and clinicians' treatment toward opioid use disorder (OUD) in pregnancy. My analysis according to the principles of biomedical ethics has outlined several ethical dilemmas that have been created by criminalization of substance abuse, mandatory reporting laws, stigma toward OUD and its treatments, and little understanding of the social determinants of health. This ethical framework alone does not emphasize the relational aspect of pregnancy, support patient-centered care, or address the intersectionality of this patient population. I will argue how using a care and justice ethics approach to treatment of women with OUD who would like to carry a fetus to birth is the preferable ethical approach to guide physician and public health treatment of this issue. I will discuss how this framework revives the idea of using Ulysses contracts for this patient population and how Ohio has successfully implemented caring structures already. Finally, I will envision how Ohio can continue to expand its wraparound services and fight stigma against OUD in pregnancy, which stymies clinicians' potential to form caring relationships.

Committee: Rebecca Fischbein (Advisor); Julie Aultman (Committee Member) Subjects: Ethics; Medicine; Neurosciences; Psychobiology; Public Health; Public Policy; Womens Studies

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, University of Cincinnati, 2020, Medicine: Epidemiology (Environmental Health)

The association between opioid prescribing and opioid use disorder (OUD) is complex, not well characterized, and yet the need to treat pain remains high. This is particularly true for emergency departments (EDs), that have 136.9 million visits annually (43% for pain) and prescribe opioids to 17% of discharged patients. My objectives were to use clinically obtained data in electronic medical records (EMRs) and apply modern machine learning techniques to 1) evaluate the effect of an ED opioid prescription on diagnosis of OUD and 2) develop a predictive model to identify those at risk for OUD in an ED patient population. Objective 1 Case-control study of adult (=18 years), non-cancer, discharged ED patients without pre-existing OUD. Each patient's first ED visit (10/2014-9/2019) was identified and designated as “index”. Propensity score (PS) weights were calculated using machine learning to simulate random treatment assignment. OUD was defined as diagnosis of an opioid use disorder or unintentional opioid overdose. A Cox proportional hazards model was used to estimate the PS weighted, adjusted hazard ratio (aHR) of OUD (adjusted for: age, sex, race, history of non-opioid substance use disorder and mental health condition), in patients prescribed an opioid at index compared to those who were not, and then stratified by other medical exposures to evaluate modifying effects. Objective 2 Develop and test an OUD predictive model in adult emergency department (ED) patients (1/2013-10/2019). Medications and diagnostic codes were used to construct two machine learning models (random forest and LASSO regression). Potential predictors included: age, race, sex, insurance type, number of opioid prescriptions, and 161 diagnostic codes (ICD-10 code categories, excluding OUD outcome codes and categories occurring in < 1% of patients). Only medications and diagnoses that occurred prior to first OUD diagnosis or last ED visit in the system (for those without an OUD diagnosis) we (open full item for complete abstract)

Committee: Jane Khoury Ph.D. (Committee Chair); Scott Langevin Ph.D. (Committee Member); Michael Lyons M.D. (Committee Member) Subjects: Epidemiology

PhD, University of Cincinnati, 2019, Education, Criminal Justice, and Human Services: Health Education

In the last decade, we have witnessed a marked shift in the value placed on vocational services in treatment planning for substance use disorder because of the “opioid epidemic in the Midwest.”(Center for Substance Abuse Services (2000). Because of this, the welfare reform act has placed stricter requirements to obtain public assistance for those with disabilities, along with the elimination of federal disability benefits for addiction alone. As a result, employment has become increasingly important. Recovery can work and people in recovery want to work. Studies show that people with chronic disorders specifically “substance use disorders” can and do often want to work if for no other reason than maintaining their basic needs and social interaction to maintain sobriety in spite of the addiction. Employment is an essential element for most individuals and sometimes for people with substance use disorders (Platt & Metzger, 1985). Unemployed clients in substance abuse treatment programs face many challenges and barriers in getting and keeping jobs after recovery. These clients will need help identifying these barriers that may prevent them from gaining employment and solving stresses in the work environment to maintain employment. Nevertheless, services such vocational services are not available in treatment programs (Goldenburg, 1972). Vocational services for individuals with a disability is a mandate, to empower individuals with disabilities to maximize employment, economic self-sufficiency, independence, and inclusion and integration into society (Rehabilitation Act of 1973). According to a survey sponsored by the National Institute on Drug Abuse (NIDA), most treatment programs provide no vocational services; half of the programs reported had no full-time vocational staff and no budget for vocational services (Hubbard & Hardwood, 1981). Employment before or during substance use disorder treatment could be related to both longer retention in treatment and (open full item for complete abstract)

Committee: Rebecca Vidourek Ph.D. (Committee Chair); Keith King Ph.D. (Committee Member); Ashley Merianos Ph.D. (Committee Member) Subjects: Health Education

PHD, Kent State University, 2017, College of Public Health

This study evaluates the acceptability of pharmacy based opioid misuse and abuse interventions by surveying practicing pharmacists and patients in treatment for substance use disorders. The survey instrument examines five specific pharmacy-based interventions using a Likert scale to measure acceptability: (1) Pharmacists counseling patients on the risks associated with opioid misuse and abuse, (2) pharmacists referring patients to drug treatment programs within the community, (3) pharmacists utilizing Prescription Drug Monitoring Programs (PDMPs) to validate prescriptions, (4) pharmacists providing emergency opioid overdose treatments such as naloxone with opioid prescriptions, and (5) pharmacists providing naloxone without a prescription. The goal of this study is to answer three research questions: which interventions are most acceptable to pharmacists, which interventions are most acceptable to patients, and which interventions produce statistically significant agreement on acceptability when both pharmacist and patient attitudes are compared. These data are used to identify a subset of interventions with high acceptability within and across the two groups. These findings are, in turn, used as an indication of professional and patient receptivity to specific interventions. The interventions with the greatest acceptability within each group and the strongest agreement across groups are identified, and changes to State regulations, organizational policy, and professional training that foster these interventions, as supported by the literature, are proposed.

Committee: Sonia Alemagno PhD (Committee Chair); VanGeest Jonathan PhD (Committee Member); Phillips Lynette PhD (Committee Member); Deric Kenne PhD (Committee Member); Mark James PhD (Other) Subjects: Pharmacy Sciences; Public Health Education; Public Policy

DNP, Otterbein University, 2017, Nursing

The opioid overdose epidemic continues to escalate in the United States. Some of the morbidity and mortality associated with opioid overdose can be prevented with the timely administration of naloxone, an opioid reversal agent. The literature emphasized that the emergency department (ED) venue and registered nurses are well positioned to screen and identify high risk individuals whether they present as a result of an overdose or for other medical reasons. The literature also pointed to the importance of providing naloxone to high risk individuals and those who would be most likely to be at the scene of an overdose. This is critical because most overdoses occur at home. Additionally, negative attitudes and stigmatization towards individuals with substance use disorders (SUD) can result in provision of suboptimal patient care for this population. The literature demonstrated that education can improve knowledge gaps and negative attitudes towards patients with SUD. The purpose of this evidence-based practice improvement project (EBPI) was to address the knowledge gaps and attitudes of Emergency Department Registered Nurses (EDRNs) about the scope of the opioid overdose epidemic, SUDs as a disease, pathways from prescription opioids to heroin, treatment, recovery, harm reduction education, and nasal naloxone spray. The goal of the EBPI was to use evidence to increase the EDRNs' knowledge and improve attitudes to facilitate delivery of evidence-based care. The clinical question guiding the EBPI was “In EDRNs caring for patients at high risk for opioid overdose, how does providing a standardized education intervention about harm reduction education and naloxone nasal spray (HRENNS), compared to not providing standardized education, affect the EDRNs' knowledge and attitudes about providing HRENNS to patients at high risk for opioid overdose, measured immediately and 30 days following completion of the education intervention.” The project framework included Plan, D (open full item for complete abstract)

Committee: Eva Fried DNP, WHNP (Committee Chair); John Chovan PhD, DNP, RN, CNP, CNS (Committee Member); Jennifer Biddinger Mpsy (Committee Member) Subjects: Health Care; Mental Health; Nursing

PHD, Kent State University, 2014, College of Arts and Sciences / Department of Psychological Sciences

Prescriptions for opioid painkillers increased from 40 million in 1991 to 257 million in 2009 and a significant increase in abuse of these medications has paralleled their greater availability (National Institute on Drug Abuse [NIDA], 2013). Although the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Graham, Ben-Porath, Tellegen, & Dahlstrom, 2001) is the most widely used clinical personality assessment instrument for addictions counselors working with adults (Juhnke, 2002), it contains no scale to specifically assist in assessing opioid use disorder. This study utilized MMPI-2 protocols produced by participants at a Midwestern court psychiatric clinic (n=1,545) to develop scales to aid in assessing opioid use disorder. The sample was split in half randomly, one half serving as a derivation sample (n=799) and the other as a cross-validation sample (n=742). Item selection for the 66-item rationally derived opioid scale was guided by characteristics of opioid abusers identified by literature review. Item selection for the 20-item empirically derived opioid scale resulted from chi-square analyses identifying MMPI-2 items that differentiated opioid abusers from those who abused other drugs or no drugs. Principal component analysis with oblique rotation was used to examine the factor structure of the empirically derived scale. Independent samples t-tests determined that only mean raw scores on the empirically derived opioid scale significantly differentiated among the two groups within the cross-validation sample. Hierarchical logistic regression analyses determined that the empirically derived opioid scale added incrementally to the existing MMPI-2 substance abuse scales in their ability to identify opioid abusers. Comparison of classification accuracies indicated that, compared with the MAC-R, AAS, and APS, the empirically derived opioid scale yielded the greatest overall classification hit rate (86%) and demonstrated particular utility in rul (open full item for complete abstract)

Committee: John Graham (Committee Chair); Yossef Ben-Porath (Committee Member); John Updegraff (Committee Member); Donald Bubenzer (Committee Member); Richard Adams (Committee Member) Subjects: Mental Health; Personality; Personality Psychology; Psychological Tests; Psychology