The Canadian journal of clinical pharmacology = Journal canadien de pharmacologie clinique, 2008
A portion of children are born with Fetal Alcohol Spectrum Disorders (FASD). Most present with si... more A portion of children are born with Fetal Alcohol Spectrum Disorders (FASD). Most present with significant difficulties in attention, with attention-deficit/hyperactivity disorder (ADHD) being the most common psychiatric co-morbidity. The current study will describe behavioral and executive functioning (EF) deficits in attention in a group of children with FASD. Effects of gender and ADHD diagnosis will be explored. Existing data from the University of Minnesota's Pediatric Psychology clinic was utilized. Of 191 children with FASD in the database, 36 children (ages 6-16) had complete scores on measures of behavioral and EF attention deficits. Multivariate Analyses of Variance (MANOVA) were used to examine the impact of gender and ADHD diagnosis on behavioral checklist scores and on a variety of EF measures. FASD males were significantly more likely to be diagnosed with ADHD (68%) than FASD females (29%). No impact of gender or diagnosis was found for behavioral measures of atten...
Atchison J Aurilio C Baastrup C Barbarisi M Baron R Brett B Canavero S Coates B Cohrs R Connolly ... more Atchison J Aurilio C Baastrup C Barbarisi M Baron R Brett B Canavero S Coates B Cohrs R Connolly M Cope D Coyne P Davis K Dworkin R Erdek M Finnerup N ... Furlan A Gálvez R Gatchel R Ghiasi H Goodchild C Habib A Hans G Hayes K Higa K Hulsebosch C Job C Johnson R ...
Clinicians and researchers are increasingly using technology-based behavioral health intervention... more Clinicians and researchers are increasingly using technology-based behavioral health interventions to improve intervention effectiveness and to reach underserved populations. However, these interventions are rarely informed by evidence-based findings of how technology can be optimized to promote acquisition of key skills and information. At the same time, experts in multimedia learning generally do not apply their findings to health education or conduct research in clinical contexts. This paper presents an overview of some key aspects of multimedia learning research that may allow those developing health interventions to apply informational technology with the same rigor as behavioral science content. We synthesized empirical multimedia learning literature from 1992 to 2011. We identified key findings and suggested a framework for integrating technology with educational and behavioral science theory. A scientific, evidence-driven approach to developing technology-based interventions can yield greater effectiveness, improved fidelity, increased outcomes, and better client service.
"Nonmedical" (i.e., illicit) use of opioid analgesics has skyro... more "Nonmedical" (i.e., illicit) use of opioid analgesics has skyrocketed among the general population during the past decade, with similar increases observed among pain patients who take opioids by prescription. Because 1 in 3 opioid-maintained pain patients may be affected, it is essential that healthcare providers learn more about this subpopulation as a first step toward improved detection, brief intervention, referral, and general management. The authors examined baseline data for 40 chronic-pain patients in a treatment trial targeting opioid analgesic abuse. Abuse-disorder patients were dysfunctional and had high rates of psychiatric disorders and troublesome personality traits. Providers characterized patients as manipulative, drug-seeking, and noncompliant; patients complained that they were pharmacologically undertreated and were considered "addicts." Despite having severe pain and addiction, their average daily opioid dose was only 69% of that used to treat addiction in the same geographic region. Abuse-disorder patients had a similar physical but worse psychiatric/personality presentation than other chronic-pain patients, which suggests the need for increased psychiatric involvement.
Biomarkers such as carbon monoxide (CO) and cotinine (a nicotine metabolite) are used in tobacco ... more Biomarkers such as carbon monoxide (CO) and cotinine (a nicotine metabolite) are used in tobacco cessation studies to assess smoking status. CO is easy to assess, is inexpensive, and provides immediate results. However, the short half-life of CO may limit its ability to identify smokers who have abstained for several hours. Quantitative methods (e.g., gas chromatography/mass spectrometry, or GC/MS) for measuring urine cotinine, which has a longer half-life, are valid and reliable, though costly and time consuming. Recently developed semiquantitative urine cotinine measurement techniques (i.e., urine immunoassay test strips, or ITS) address these disadvantages, though the value of ITS as a means of identifying abstaining smokers has not been evaluated. The present study examined ITS as a measure of smoking status in temporarily abstaining smokers. A total of 236 breath and urine samples were collected from smokers who participated in two separate studies involving three independent, 96-hr (i.e., Monday-Friday), Latin-square-ordered, abstinence or smoking conditions; a minimum 72-hr washout separated each condition. Each urine sample was analyzed with GC/MS and ITS. Under these study conditions, CO demonstrated moderate sensitivity (83.1%) and strong specificity (100%), whereas ITS assessment showed strong sensitivity (98.5%) and weak specificity (58.5%). In this study of short-term abstinence, ITS classified as nonabstinent nearly half of the samples collected from abstaining smokers. However, it classified nearly all nonabstinent smokers as currently smoking. Validation of ITS using GC/MS results from smokers undergoing more than 96 hr of abstinence may be valuable.
... measures were employed to assess whether the statistical properties of the SCBE data derived ... more ... measures were employed to assess whether the statistical properties of the SCBE data derived from the current study were comparable to that of the stan-dardization sample reported in the manual (LaFreniere and Dumas, 1995) and in published reports (La Freniere et al ...
This study is the first experimental trial to evaluate the effectiveness of a Web-based behaviora... more This study is the first experimental trial to evaluate the effectiveness of a Web-based behavioral intervention when deployed in a model where it partially substituted for standard counseling in a community-based specialty addiction treatment program. New opioid-dependent intakes in methadone maintenance treatment (n=160) were randomly assigned for 12months to either: (1) standard treatment or (2) reduced standard treatment plus a Web-based psychosocial intervention, the Therapeutic Education System (TES). Results demonstrated that replacing a portion of standard treatment with TES resulted in significantly greater rates of objectively measured opioid abstinence (48% vs. 37% abstinence across all study weeks; F(1, 158)=5.90, p<.05 and 59% vs. 43% abstinence on weeks participants provided urine samples for testing; F(1, 158)=8.81, p<.01). This result was robust and was evident despite how opioid abstinence was operationally defined and evaluated. The potential implications for service delivery models within substance abuse treatment programs and other healthcare entities are discussed.
Development of working alliance was examined for 25 opioid-abusing pain patients and their therap... more Development of working alliance was examined for 25 opioid-abusing pain patients and their therapists. Patients participated in an eight-session intervention based on adherence strategies and employment of a supportive, psychoeducational approach; methadone was prescribed for pain. Treatment goals included opioid analgesic adherence and decreasing pain, functional interference, and substance abuse. Patients and therapists completed the Helping Alliance Questionnaire-II following each treatment session. At baseline, scores of patients and therapists indicated good alliance. Patient alliance grew significantly over time regardless of addiction severity and independent of treatment outcomes. In contrast, therapist alliance grew only for patients without substance abuse comorbidity and/or who had good outcomes. Patients' and therapists' alliance scores were consistent during sessions focused on emotional bonds but diverged during sessions that demanded behavior change, suggesting that therapists may have reacted negatively to patients' lack of progress. Whether therapists' reactions to poor performers impacted subsequent patient outcomes is unknown but should be investigated.
Deficits in cognitive functioning have been well-documented in persons with substance use disorde... more Deficits in cognitive functioning have been well-documented in persons with substance use disorders. In addition, some evidence suggests that poorer cognitive functioning predicts poorer engagement in substance abuse treatment and worse treatment outcomes. Non-blind, randomized clinical trial with parallel design. Clients were recruited from a local methadone maintenance clinic within the first 30 days of treatment. All participants completed a comprehensive, computerized neuropsychological assessment (MicroCog) at the time they entered the clinical trial. Participants were randomized to receive 12 months of either standard methadone maintenance treatment, or methadone maintenance treatment with an integrated web-based intervention as part of treatment. The aims of the current study were to (1) characterize the cognitive functioning of clients entering methadone maintenance treatment; (2) evaluate the impact of cognitive functioning on the primary outcomes of treatment retention and opioid abstinence; and (3) determine whether cognitive functioning had a differential impact on these outcomes across treatment conditions. Randomization was non-blind and participants were stratified on past month cocaine use, prior history of methadone, LAAM or buprenorphine treatment, and counselor. Eighty participants were randomized to each condition (total n=160). Mean scores on MicroCog scales fell in the average and low average ranges and there were no differences in scores between treatment groups. Lower scores on General Cognitive Proficiency predicted longer study retention (χ(2)=5.03, p < .05), though this effect was quite small. Generalized linear modeling showed that scores on all MicroCog scales except for Spatial Processing significantly predicted opioid abstinence (defined as percent of total weeks and percent of tested weeks with continuous abstinence), with lower scores predicting smaller percentages of continuous weeks of abstinence. This pattern was not evident in regression analyses in which abstinence was defined as number of total weeks of abstinence. An interaction effect was observed, whereby lower cognitive scores predicted lower levels of abstinence for participants in standard methadone maintenance treatment, but not for those who received the web-based intervention as part of methadone maintenance treatment. Technology-based interventions may hold promise for minimizing the impact of poorer cognitive functioning on treatment outcomes.
The Canadian journal of clinical pharmacology = Journal canadien de pharmacologie clinique, 2008
A portion of children are born with Fetal Alcohol Spectrum Disorders (FASD). Most present with si... more A portion of children are born with Fetal Alcohol Spectrum Disorders (FASD). Most present with significant difficulties in attention, with attention-deficit/hyperactivity disorder (ADHD) being the most common psychiatric co-morbidity. The current study will describe behavioral and executive functioning (EF) deficits in attention in a group of children with FASD. Effects of gender and ADHD diagnosis will be explored. Existing data from the University of Minnesota's Pediatric Psychology clinic was utilized. Of 191 children with FASD in the database, 36 children (ages 6-16) had complete scores on measures of behavioral and EF attention deficits. Multivariate Analyses of Variance (MANOVA) were used to examine the impact of gender and ADHD diagnosis on behavioral checklist scores and on a variety of EF measures. FASD males were significantly more likely to be diagnosed with ADHD (68%) than FASD females (29%). No impact of gender or diagnosis was found for behavioral measures of atten...
Atchison J Aurilio C Baastrup C Barbarisi M Baron R Brett B Canavero S Coates B Cohrs R Connolly ... more Atchison J Aurilio C Baastrup C Barbarisi M Baron R Brett B Canavero S Coates B Cohrs R Connolly M Cope D Coyne P Davis K Dworkin R Erdek M Finnerup N ... Furlan A Gálvez R Gatchel R Ghiasi H Goodchild C Habib A Hans G Hayes K Higa K Hulsebosch C Job C Johnson R ...
Clinicians and researchers are increasingly using technology-based behavioral health intervention... more Clinicians and researchers are increasingly using technology-based behavioral health interventions to improve intervention effectiveness and to reach underserved populations. However, these interventions are rarely informed by evidence-based findings of how technology can be optimized to promote acquisition of key skills and information. At the same time, experts in multimedia learning generally do not apply their findings to health education or conduct research in clinical contexts. This paper presents an overview of some key aspects of multimedia learning research that may allow those developing health interventions to apply informational technology with the same rigor as behavioral science content. We synthesized empirical multimedia learning literature from 1992 to 2011. We identified key findings and suggested a framework for integrating technology with educational and behavioral science theory. A scientific, evidence-driven approach to developing technology-based interventions can yield greater effectiveness, improved fidelity, increased outcomes, and better client service.
"Nonmedical" (i.e., illicit) use of opioid analgesics has skyro... more "Nonmedical" (i.e., illicit) use of opioid analgesics has skyrocketed among the general population during the past decade, with similar increases observed among pain patients who take opioids by prescription. Because 1 in 3 opioid-maintained pain patients may be affected, it is essential that healthcare providers learn more about this subpopulation as a first step toward improved detection, brief intervention, referral, and general management. The authors examined baseline data for 40 chronic-pain patients in a treatment trial targeting opioid analgesic abuse. Abuse-disorder patients were dysfunctional and had high rates of psychiatric disorders and troublesome personality traits. Providers characterized patients as manipulative, drug-seeking, and noncompliant; patients complained that they were pharmacologically undertreated and were considered "addicts." Despite having severe pain and addiction, their average daily opioid dose was only 69% of that used to treat addiction in the same geographic region. Abuse-disorder patients had a similar physical but worse psychiatric/personality presentation than other chronic-pain patients, which suggests the need for increased psychiatric involvement.
Biomarkers such as carbon monoxide (CO) and cotinine (a nicotine metabolite) are used in tobacco ... more Biomarkers such as carbon monoxide (CO) and cotinine (a nicotine metabolite) are used in tobacco cessation studies to assess smoking status. CO is easy to assess, is inexpensive, and provides immediate results. However, the short half-life of CO may limit its ability to identify smokers who have abstained for several hours. Quantitative methods (e.g., gas chromatography/mass spectrometry, or GC/MS) for measuring urine cotinine, which has a longer half-life, are valid and reliable, though costly and time consuming. Recently developed semiquantitative urine cotinine measurement techniques (i.e., urine immunoassay test strips, or ITS) address these disadvantages, though the value of ITS as a means of identifying abstaining smokers has not been evaluated. The present study examined ITS as a measure of smoking status in temporarily abstaining smokers. A total of 236 breath and urine samples were collected from smokers who participated in two separate studies involving three independent, 96-hr (i.e., Monday-Friday), Latin-square-ordered, abstinence or smoking conditions; a minimum 72-hr washout separated each condition. Each urine sample was analyzed with GC/MS and ITS. Under these study conditions, CO demonstrated moderate sensitivity (83.1%) and strong specificity (100%), whereas ITS assessment showed strong sensitivity (98.5%) and weak specificity (58.5%). In this study of short-term abstinence, ITS classified as nonabstinent nearly half of the samples collected from abstaining smokers. However, it classified nearly all nonabstinent smokers as currently smoking. Validation of ITS using GC/MS results from smokers undergoing more than 96 hr of abstinence may be valuable.
... measures were employed to assess whether the statistical properties of the SCBE data derived ... more ... measures were employed to assess whether the statistical properties of the SCBE data derived from the current study were comparable to that of the stan-dardization sample reported in the manual (LaFreniere and Dumas, 1995) and in published reports (La Freniere et al ...
This study is the first experimental trial to evaluate the effectiveness of a Web-based behaviora... more This study is the first experimental trial to evaluate the effectiveness of a Web-based behavioral intervention when deployed in a model where it partially substituted for standard counseling in a community-based specialty addiction treatment program. New opioid-dependent intakes in methadone maintenance treatment (n=160) were randomly assigned for 12months to either: (1) standard treatment or (2) reduced standard treatment plus a Web-based psychosocial intervention, the Therapeutic Education System (TES). Results demonstrated that replacing a portion of standard treatment with TES resulted in significantly greater rates of objectively measured opioid abstinence (48% vs. 37% abstinence across all study weeks; F(1, 158)=5.90, p<.05 and 59% vs. 43% abstinence on weeks participants provided urine samples for testing; F(1, 158)=8.81, p<.01). This result was robust and was evident despite how opioid abstinence was operationally defined and evaluated. The potential implications for service delivery models within substance abuse treatment programs and other healthcare entities are discussed.
Development of working alliance was examined for 25 opioid-abusing pain patients and their therap... more Development of working alliance was examined for 25 opioid-abusing pain patients and their therapists. Patients participated in an eight-session intervention based on adherence strategies and employment of a supportive, psychoeducational approach; methadone was prescribed for pain. Treatment goals included opioid analgesic adherence and decreasing pain, functional interference, and substance abuse. Patients and therapists completed the Helping Alliance Questionnaire-II following each treatment session. At baseline, scores of patients and therapists indicated good alliance. Patient alliance grew significantly over time regardless of addiction severity and independent of treatment outcomes. In contrast, therapist alliance grew only for patients without substance abuse comorbidity and/or who had good outcomes. Patients' and therapists' alliance scores were consistent during sessions focused on emotional bonds but diverged during sessions that demanded behavior change, suggesting that therapists may have reacted negatively to patients' lack of progress. Whether therapists' reactions to poor performers impacted subsequent patient outcomes is unknown but should be investigated.
Deficits in cognitive functioning have been well-documented in persons with substance use disorde... more Deficits in cognitive functioning have been well-documented in persons with substance use disorders. In addition, some evidence suggests that poorer cognitive functioning predicts poorer engagement in substance abuse treatment and worse treatment outcomes. Non-blind, randomized clinical trial with parallel design. Clients were recruited from a local methadone maintenance clinic within the first 30 days of treatment. All participants completed a comprehensive, computerized neuropsychological assessment (MicroCog) at the time they entered the clinical trial. Participants were randomized to receive 12 months of either standard methadone maintenance treatment, or methadone maintenance treatment with an integrated web-based intervention as part of treatment. The aims of the current study were to (1) characterize the cognitive functioning of clients entering methadone maintenance treatment; (2) evaluate the impact of cognitive functioning on the primary outcomes of treatment retention and opioid abstinence; and (3) determine whether cognitive functioning had a differential impact on these outcomes across treatment conditions. Randomization was non-blind and participants were stratified on past month cocaine use, prior history of methadone, LAAM or buprenorphine treatment, and counselor. Eighty participants were randomized to each condition (total n=160). Mean scores on MicroCog scales fell in the average and low average ranges and there were no differences in scores between treatment groups. Lower scores on General Cognitive Proficiency predicted longer study retention (χ(2)=5.03, p < .05), though this effect was quite small. Generalized linear modeling showed that scores on all MicroCog scales except for Spatial Processing significantly predicted opioid abstinence (defined as percent of total weeks and percent of tested weeks with continuous abstinence), with lower scores predicting smaller percentages of continuous weeks of abstinence. This pattern was not evident in regression analyses in which abstinence was defined as number of total weeks of abstinence. An interaction effect was observed, whereby lower cognitive scores predicted lower levels of abstinence for participants in standard methadone maintenance treatment, but not for those who received the web-based intervention as part of methadone maintenance treatment. Technology-based interventions may hold promise for minimizing the impact of poorer cognitive functioning on treatment outcomes.
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Papers by Michelle C Acosta