Doctor of Education , University of Dayton, 2022, Educational Leadership

Millions of individuals in the United States experience problematic substance use that progresses to Substance Use Disorder (SUD). Many people who eventually achieve remission of their SUD symptoms seek vocational and personal fulfillment through pursuing a career in behavioral health counseling with a specific focus in counseling for addictions. The demanding nature of the behavioral health profession can present numerous unique challenges and risks to a person who is in recovery from SUD, and educational institutions that train professionals for this field play a vital role in preparing their students for the realities of their future work. In this study, the author conducted qualitative critical participatory action research using a descriptive case study design to explore the specific strategies that educators at a community college in the Midwestern United States utilized to support and empower their counseling students who are in recovery from SUD. The author used critical theory and critical feminist theory to develop the investigative framework and explore the power structures of the organization. In this study, seven students and two educators participated in semi-structured interviews and classroom observations. Utilizing a grounded theory approach, the author coded the qualitative data to identify themes that guided the development of a corresponding action plan. While participants identified that some supportive strategies were utilized by the college, students and educators identified ongoing student challenges around self-driven perfectionist ideals, external and internal stigma against SUD, and polarized opinions on self-disclosure of SUD recovery status. Additional related subthemes were also identified and explored in this study. In the final chapter of this work, the author included an action plan for the site of study that was developed to address the specific challenges identified by the study participants. Built around the existing research o (open full item for complete abstract)

Committee: Corinne Brion, PhD (Committee Chair); Matthew Witenstein, PhD (Committee Member); Kimm Cynkar, LISW-S (Committee Member) Subjects: Adult Education; Community College Education; Community Colleges; Counseling Education; Health Care; Higher Education; Social Work

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

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

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, The Ohio State University, 2020, Psychology

Major depressive disorder (MDD) is one of the most prevalent and debilitating psychiatric disorders worldwide. Cognitive therapy (CT) is an evidence-based treatment that primarily helps patients with MDD modify their negative and dysfunctional thinking patterns in order to reduce their depressive symptoms. One important cognitive style in MDD is cognitive vulnerability, or the attributions that people make about the experience of negative life events. The reformulated learned helplessness theory posits that people with a tendency to make global, stable, and internal causal attributions for negative life events are more likely to become depressed (Abramson, Seligman, & Teasdale, 1978). The revised hopelessness theory suggests that, in addition to these three causal attributions, perceived consequences and inferred low self-worth are also key attributions that may lead to developing depression (Abramson, Metalsky, & Alloy, 1989). The present study investigates these two theories of cognitive vulnerability as predictors of acute symptom reductions, dropout, and relapse in CT for depression. Moreover, whether the revised hopelessness theory predicts acute and long-term treatment outcomes above and beyond the older reformulated learned helplessness theory is tested. In this study, 126 patients diagnosed with MDD participated in 16 weeks of CT and cognitive vulnerability was assessed pre- and post-treatment. First, cognitive vulnerability decreased during an acute course of CT and these reductions were associated with concurrent improvements in depressive symptoms. Second, greater pre-treatment cognitive vulnerability emerged as a prognostic indicator of faster depressive symptom reductions during CT. Third, cognitive vulnerability was not predictive of risk of treatment dropout. Finally, a composite measure of the three causal attributions outlined by the reformulated learned helplessness theory predicted relapse during a one-year follow-up period. When testing these tw (open full item for complete abstract)

Committee: Daniel Strunk Dr. (Advisor); Jennifer Cheavens Dr. (Committee Member); Michael Vasey Dr. (Committee Member); John Casterline Dr. (Committee Member) Subjects: Clinical Psychology

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, 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

Master of Science, The Ohio State University, 2017, Public Health

Colon cancers are second only to lung cancers in the number of cancer deaths in the United States per annum. Common treatment regimens are surgical resection, optionally followed by adjuvant chemotherapy. Successful outcomes are measured by lack of progression to advanced stages at the primary tumor site and the absence of recurrence elsewhere in the body. Stage 3 cancer patients relapse at 50%, while stage 2 cancer patients relapse 25-40%. The most common site of distant metastasis is the liver; about 11% of patients who relapse survive 5 years. Unfortunately, there are no clear means to predict which patients will relapse following treatment. Subtyping of colon cancers is detailed in literature, although no clear translation to predicting clinical outcome has occurred. A 2014 meta-analysis by the Agency for Healthcare Research and Quality showed existing commercial means of predicting relapse provided dubious benefits to patients. This thesis details a method to create a predictive model of relapse in colon cancer patients that is an improvement over existing standards of care using gene expression patterns in specific stages coordinated with histopathological subtypes to be examined in vitro. We conducted a retrospective analysis of mRNA expression in colon cancer patients at the time of treatment, integrating genomic data from microarray and RNA-seq platforms with matching clinical data. The main focus of this research was genes with bimodal gene expression due to the ability of bimodal genes to fall along tumor subtypes with unique biological, clinical, and prognostic characteristics. Our results successfully identified bimodal genes through a novel ensemble testing system that recognizes clusters of gene expression values that decompose a single Gaussian distribution into two component Gaussian distributions. The utility and efficacy of the method was demonstrated with known bimodal gene markers in breast cancer patients as a positive contro (open full item for complete abstract)

Committee: Kun Huang PhD (Advisor); Randall Harris MD,PhD (Committee Member); James Chen MD (Committee Member); Joanna Groden PhD (Committee Member) Subjects: Bioinformatics; Biostatistics; Medicine; Public Health

Doctor of Philosophy, Case Western Reserve University, 2017, Social Welfare

This dissertation investigates interrelated constructs vital to substance use disorder recovery among a population of low-income women with a history of trauma. The women in this study were viewed within the nested socioeconomic dynamics affecting their early sobriety post-treatment intake. Recognizing that this sample was exposed to multiple vulnerabilities, had a significant history of trauma and the presence of co-occurring disorders, this study focused on the influential roles of abstinence self-efficacy (ASE) and social support for recovery (SSR) on post-treatment substance use outcomes. There is a well-established connection between the experience of trauma and subsequent substance abuse among female survivors (Min, et al., 2014; Najavits, et al., 1998; Ullman, et al., 2013). Moreover, the effects of trauma are associated with lower abstinence self-efficacy, a decreased capacity to access social support for recovery and poorer treatment outcomes (Lopez-Castro, et al., 2015). Attempting to clarify these relationships, this study evaluated the mediating effects of ASE and SSR on the relationship between trauma symptomatology and post-treatment relapse. Data for this examination were collected from a NIDA funded longitudinal study. 62% of the women identified as Black; 88% of the women did not have more than a high school education; 74% were dependent on government subsidies; and 73% had a co-occurring mental health disorder. Structural equation modeling (SEM), was used to examine the direct and indirect effects of trauma symptomatology, ASE, and SSR on post-treatment intake substance use outcomes. Primary findings indicated that higher trauma symptomatology was significantly associated with lower levels of ASE. Moreover, ASE was shown to mediate the relationship between trauma and relapse. These results suggest that clinicians may want to utilize interventions aimed at increasing ASE, that may increase a woman's ability to develop resiliency in early rec (open full item for complete abstract)

Committee: Elizabeth Tracy Dr. (Committee Chair); Meeyoung Min Dr. (Committee Member); Kathleen Farkas Dr. (Committee Member); Darcy Freedman Dr. (Committee Member) Subjects: Social Work

EdD, University of Cincinnati, 2016, Education, Criminal Justice, and Human Services: Counselor Education

Research has shown that the majority of sex offender treatment programs in the United States and Canada use a combination of cognitive-behavioral treatment and relapse prevention designed to help sex offenders maintain behavioral changes by anticipating and coping with relapse (Bynum, 2001). The previous studies examined the perceived effectiveness of the treatment modalities but it was unknown about the utilization of these modalities. This study investigated the utilization of 48 treatment modalities among 46 sex offender treatment providers and the factors that influenced their choice. Descriptive statistics revealed that the participants chose cognitive behavioral treatment approaches with higher frequency. The multiple regression analyses were conducted to examine if providers' age, education and years of experience would influence the treatment modality choices. The results show that the regression model for seven treatment modalities was significant and that education contributed to the variances at a statistically significant level. A large proportion of the participants indicated that they would consider a treatment modality because it is an evidence-based approach and they have professional training on the area. The findings of this study illustrate that sex offender treatment providers more often choose cognitive behavioral approaches and rely on evidence-based treatment modalities.

Committee: Mei Tang Ph.D. (Committee Chair); Gary Dick Ph.D. (Committee Member); Geoffrey Yager Ph.D. (Committee Member) Subjects: Counseling Psychology

Master of Arts, The Ohio State University, 2015, Psychology

Cognitive Therapy (CT) is an evidence-based treatment for depression with a substantial supporting literature. Numerous clinical trials support its efficacy in producing acute symptom reduction. Follow-up studies also suggest that CT produces an enduring effect of reduced risk for subsequent relapse or recurrence relative to discontinued antidepressant medication (ADM). However, the mechanism that produces this enduring effect remains unclear. Although some researchers have suggested that skills learned in CT to identify and reduce negative biases may be the mechanism of CT's enduring effect, there has not yet been a test of whether post-treatment skills account for the reduced risk of relapse and recurrence observed in CT compared to ADM. In the current study, I test this hypothesis in a sample of 104 patients with moderate to severe depression who responded to one of three randomly assigned treatment conditions: CT, continued ADM, or ADM withdrawn to placebo (DeRubeis et al., 2005; Hollon et al., 2005). Results are mixed, with evidence supporting some elements of a mediation hypothesis but not all. Treatment condition predicted risk of relapse/recurrence in this trial, although there was a significant site by treatment interaction such that the magnitude of treatment effects differed between sites. There was also a significant treatment condition by site interaction predicting post-treatment CT skills, and one CT skill score significantly predicted reduced risk of relapse/recurrence. However, results also showed that post-treatment skills did not significantly mediate the effect of treatment condition on risk of relapse/recurrence. These findings do not support a straightforward mediation hypothesis for CT skills, with some indications that site differences in patient characteristics or treatment procedures may have played a role. I discuss the roles of both treatment condition and site in these analyses, explore the possibility of patient characteristics as a pot (open full item for complete abstract)

Committee: Daniel Strunk (Advisor); Amelia Aldao (Committee Member); Jennifer Cheavens (Committee Member) Subjects: Clinical Psychology; Psychology; Psychotherapy

Master of Science in Pharmaceutical Science (MSP), University of Toledo, 2012, College of Pharmacy

Relapse to alcohol use after prolonged withdrawal periods is a major problem in the treatment of alcohol addiction in humans. Recent preclinical research has focused on identifying long-term neuroadaptive changes and identifying the behavioral, environmental, and neuronal mechanisms underlying drug relapse. By doing so, potential new avenues for relapse prevention may be developed. Current research suggests that changes in glutamatergic neurotransmission may significantly contribute to alcohol relapse and alcohol addiction. Alcohol dependence has been linked specifically to the increased extracellular glutamate levels in key regions of neurocircuits mainly the mesocorticolimbic circuit. Based on the fact that glutamate transporter1 (GLT1) is responsible for the removal of the majority of extracellular glutamate, we hypothesized that the activation of GLT1 by the use of ceftriaxone, a β-lactam antibiotic, known to elevate GLT1 expression, would attenuate alcohol consumption in alcohol-preferring (P) rats and ultimately prevent relapse to alcohol-seeking behavior. Statistical analyses showed that P rats treated intraperitoneally with ceftriaxone, exhibited a significant reduction in alcohol consumption followed by a period of alcohol deprivation as compared to saline-treated P rats. Preliminary data with Western blot suggests that activation of GLT1 may play a key role in preventing relapse to alcohol-seeking behavior, and ultimately implicate its potential role as a therapeutic-target for treatment of alcohol dependence.

Committee: Youssef Sari PhD (Committee Chair); Ming-Cheh Liu PhD (Committee Member); Zahoor Shah PhD (Committee Member) Subjects: Pharmacology

Master of Arts (MA), Bowling Green State University, 2006, Sociology

In recent decades the number of women under criminal justice supervision has increased considerably. Approximately a quarter of all women under the care or custody of adult criminal justice authorities have been convicted of a drug offense. Additionally, beyond being arrested and convicted for a drug offense, women in prison are more likely than their non-institutionalized counterparts to suffer from a substance abuse disorder. While there is a growing body of research concerning women offenders' drug abuse and treatment needs, few studies have examined the substance abuse treatment outcomes of women in the criminal justice system. The purpose of this thesis was to assess the following hypotheses: (1) Women offenders with higher treatment motivation at intake into prison-based treatment will be more likely to participate in substance abuse aftercare following release; (2) Women who receive more community-based aftercare following in-prison substance abuse treatment will be less likely to relapse; (3) Participation in community aftercare will be more negatively related to substance abuse relapse at high levels of social support; and (4) Participation in community aftercare will be more positively related to better psychological functioning at higher levels of social support. Using data from the Forever Free Residential Substance Abuse Treatment Program at the California Institution for Women, these hypotheses were analyzed using a variety of statistical iii modeling strategies: four linear regressions, estimated with ordinary least squares, one binary logistic regression, and one negative binomial regression. Multivariate analyses revealed that levels of treatment motivation were significantly, and positively, related participation in post-prison aftercare. However, the results of these regressions did not provide support for the claim that increased participation in community-based aftercare leads to lower levels of relapse and more positive psychological functionin (open full item for complete abstract)

Committee: Joseph Jacoby (Advisor) Subjects: Sociology, Criminology and Penology

Doctor of Philosophy (Ph.D.), Bowling Green State University, 2005, Psychology/Clinical

My study was designed to develop and evaluate a measure to assess harm reduction self- efficacy in intravenous (IV) opiate users. Using Marlatt and Gordon's (1985) Cognitive Behavioral Model of Relapse, I developed the Harm Reduction Self-Efficacy Questionnaire (HRSEQ) to examine drug users' perceived confidence in their ability to utilize specific harm reduction strategies in select high-risk situations. The study consisted of two major phases: 1) instrument development using focus groups of drug-takers and expert feedback and 2) experimental study of the influence of type of high-risk situation on self-efficacy to use harm reduction coping skills using a different sample of active or recently active drug users. In addition, I examined the reliability and construct/discriminant validity of the HRSEQ measure. After the HRSEQ was designed, I administered it along with other drug use measures, to 101 IV opiate users. Results indicated that harm reduction self-efficacy varied as predicted depending on type of high-risk situation. The HRSEQ demonstrated high internal consistency and was reliable across a one-week time period. The three HRSEQ scales were significantly associated (at a moderate to strong level) with the Harm Reduction Use Measure (HRUM), a scale that assessed use of harm reduction coping behaviors, thus providing support for construct validity. In addition, weak correlations and lack of associations between the HRSEQ scales and measures examining health self-efficacy, exercise self-efficacy, and self-efficacy to resist heavy drug use provided support for the discriminant validity of the HRSEQ. After further development, the HRSEQ could be a useful tool to gain a better understanding of clients' confidence to utilize harm reduction interventions that will improve their health and well-being.

Committee: Harold Rosenberg (Advisor) Subjects: