Therapist and computer‐based brief interventions for drug use within a randomized controlled trial: effects on parallel trajectories of alcohol use, cannabis use and anxiety symptoms

Background and AimsDespite their high comorbidity, the effects of brief interventions (BI) to reduce cannabis use, alcohol use and anxiety symptoms have received little empirical attention. The aims of this study were to examine whether a therapist‐delivered BI (TBI) or computer‐guided BI (CBI) to address drug use, alcohol consumption (when relevant) and HIV risk behaviors, relative to enhanced usual care (EUC), was associated with reductions in parallel trajectories of alcohol use, cannabis use and anxiety symptoms, and whether demographic characteristics moderated reductions over time.DesignLatent growth curve modeling was used to examine joint trajectories of alcohol use, cannabis use and anxiety symptoms assessed at 3, 6 and 12 months after baseline enrollment.SettingHurley Medical Center Emergency Department (ED) in Flint, MI, USA.ParticipantsThe sample was 780 drug‐using adults (aged 18–60 years; 44% male; 52% black) randomly assigned to receive either a TBI, CBI or EUC through the HealthiER You study.Interventions and comparatorED‐delivered TBI and CBIs involved touchscreen‐delivered and audio‐assisted content. The TBI was administered by a Master’s‐level therapist, whereas the CBI was self‐administered using a virtual health counselor. EUC included a review of health resources brochures in the ED.MeasurementsAssessments of alcohol use (10‐item Alcohol Use Disorders Identification Test), cannabis use (past 30‐day frequency) and anxiety symptoms (Brief Symptom Inventory‐18) occurred at baseline and 3‐, 6‐ and 12‐month follow‐up.FindingsTBI, relative to EUC, was associated with significant reductions in cannabis use [B = –0.49, standard error (SE) = 0.20, P < 0.05) and anxiety (B = –0.04, SE = 0.02, P < 0.05), but no main effect for alcohol use. Two of 18 moderation tests were significant: TBI significantly reduced alcohol use among males (B = –0.60, SE = 0.19, P < 0.01) and patients aged 18–25 years in the TBI condition showed significantly greater reductions in cannabis use relative to older patients (B = –0.78, SE = 0.31, P < 0.05). Results for CBI were non‐significant.ConclusionsEmergency department‐based therapist‐delivered brief interventions to address drug use, alcohol consumption (when relevant) and HIV risk behaviors may also reduce alcohol use, cannabis use and anxiety over time, accounting for the overlap of these processes.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152851/1/add14781.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152851/2/add14781_am.pd

Les progrès dans la réalisation de la classification quantitative de la psychopathologie

Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level'' dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity'' by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach. (C) 2020 Published by Elsevier Masson SAS

Elucidating the Construct Validity of the Psychopathic Personality Inventory Triarchic Scales

This study sought to replicate and extend Hall and colleagues’ (2014) work on developing and validating scales from the Psychopathic Personality Inventory (PPI) to index the triarchic psychopathy constructs of boldness, meanness, and disinhibition. Thi

Increasing support for alternatives to incarceration for drug use: is the brain disease model of addiction effective?

The National Institute of Drug Addiction has promoted the Brain Disease Model of Addiction (BDMA) for several decades, believing it will have a positive impact on drug-related social policies. Per research, neither understanding nor accepting the BDMA positively influences social behavior and decision making related to decreased stigma or increased support for treatment and funding for substance use disorders. An alternative model, the Malleability Model, focuses on the changeability of psychopathology associated with psychiatric disorders, and is associated with decreased hopelessness and increased prognostic optimism. The Moral Weakness Model focuses on moral character as the reason for addiction and is associated with punitive responses to use disorders. The current study sought to identify whether Malleability values were more predictive of willingness to vote for harm reduction (HR) policies than BDMA and Moral values (H1); and if agreement with Malleability values were more predictive of willingness to fund such policies than agreement with BDMA and Moral values (H2). Contrary to hypotheses, results indicated the Malleability Model failed to predict votes and donations, while agreement with the Moral Weakness Model and conservative political affiliation was predictive of lower HR donations. Agreement with the BDMA did not reliably predict votes and donations to policies; the associations reflected were tenuous and should be interpreted with caution. Overall, results indicated the Malleability Model did not increase votes and donations to HR policies, while agreement with Moral Weakness Model and conservative affiliation consistently predicted votes and donations

Further Evidence for Reliability and Validity of the Triarchic Psychopathy Measure in a Forensic Sample and a Community Sample

textabstractPsychopathy is often described as a constellation of personality characteristics encompassing features such as impulsivity and antisociality, and a lack of empathy and guilt. Although the use of self-reports to assess psychopathy is still debated, there are distinct advantages to such measures and recent research suggests that they may not be as problematic as previously thought. This study further examined the reliability and validity of the Triarchic Psychopathy Measure (TriPM) in a community sample (N = 496) and forensic psychiatric patient sample (N = 217). Results indicated excellent internal consistencies. Additionally, the TriPM total and subscale scores related as expected to different subscales of the Psychopathic Personality Inventory –Revised (PPI-R) and to the Reactive and Proactive Aggression Questionnaire, reflecting good construct validity. Most importantly, ROC curve analyses showed that the TriPM evidenced better discrimination between the community sample and forensic psychiatric patients than the PPI-R. The current study extends the existent evidence demonstrating that the TriPM can be used as an efficient self-report instrument

Examining triarchic psychopathy constructs in a Dutch forensic treatment sample using a forensic version of the Schedule for Nonadaptive and Adaptive Personality

Psychopathy, as described by the triarchic model, encompasses three distinct phenotypes: boldness, meanness, and disinhibition. The current study sought to operationalize these in a sample of 100 Dutch male forensic-psychiatric patients with differing forms of personality pathology who participated in a multi-site randomized clinical trial. Using an established construct-rating approach, triarchic scales were created using items from clinician-rated and self-report versions of the Schedule for Nonadaptive and Adaptive Personality (SNAP) adapted for forensic populations, the SNAP-F. Internal psychometric properties and criterion-related validity were evaluated. SNAP-F-Triarchic Meanness and Disinhibition scales showed acceptable internal consistencies, whereas the Boldness scales (which comprised fewer items) showed lower numbers. The scales showed associations with self-report and interview-based criterion measures largely in line with predictions, with higher validity for criteria assessed in the same measurement domain. Implications of findings for prediction of key outcomes in clinical settings are discussed, along with promising directions for future research

Latent variable model of triarchic psychopathy constructs in an incarcerated offender sample: Factor reliability and validity

The triarchic model of psychopathy posits that three distinct trait dispositions-disinhibition, meanness, and boldness-contribute to the interpersonal, affective, and impulsive-unrestrained features of this condition and is represented to varying degrees in all conceptualizations and measures of psychopathy. Using data for incarcerated males (n = 273) and females (n = 83) from 10 different prisons in Italy, we specified a latent variable model of the triarchic trait constructs in which scale measures of disinhibition, meanness, and boldness composed of items from the following inventories served as indicators: Triarchic Psychopathy Measure, Psychopathic Personality Inventory-Revised, Minnesota Multiphasic Personality Inventory-2 Restructured Form, and NEO Five Factor Inventory. A correlated three-factor solution evidenced adequate model fit, with individual triarchic trait scales loading strongly onto their target factors. The model exhibited comparable fit and factor loadings when specified using data for males only, and its factors showed expected relations with pertinent criterion variables, including measures of normative personality and clinical dysfunction along with staff ratings of prison behavior and release prognosis. Extending prior research with nonclinical participants from the U.S., present study results demonstrate the viability of a latent variable model of the triarchic traits in an incarcerated offender sample from a separate culture (Italy). The significance of this work lies in the potential of the triarchic traits to serve as conceptual-empirical points of reference for integrating findings across studies of psychopathy employing diverse samples and assessment measures.Public Significance Statement Interpreting results from different psychopathy studies require integration of data across diverse samples and measures. The triarchic model addresses this challenge by focusing on psychopathy-related traits that transcend measurement methods. This study validated a latent variable model of the triarchic trait constructs in a prisoner sample from Italy. Latent variable representations of the triarchic traits can serve as conceptual-empirical referents for integrating new and existing findings in this research area