Impact of Residential Substance Abuse Treatment on Affect and Personality-Related Variables Across Inner-city Substance Abusers

Substance abuse treatment outcome studies have shown positive effects for a large number of drug users with regard to reduction in substance use and criminal activity, as well as improvement of general well-being. However, high rates of relapse following treatment have compelled researchers to elucidate the individual difference factors that change among those who receive substance abuse treatment. Affect- (depressive and anxiety symptoms) and disinhibition-related variables (impulsivity, risk taking) may be of particular relevance. These factors are related to the development and maintenance of substance use and distinguish between substance users with and without Axis I and II disorders that may interfere with treatment success, such as depression, anxiety disorders, or antisocial personality disorder. Consequently, these factors may be considered important treatment targets. However, there currently is a dearth of research focused on understanding whether these variables are affected by standard substance use treatments, and more specifically, which variables may change throughout the course of substance use treatment. Given that many of these variables are considered to be enduring aspects of an individual's personality, the extent to which they are malleable by treatment is an important consideration. Moreover, to enhance the generalizability of these findings, it is important to understand the extent to which changes occur in more standard substance use treatments as opposed to more elaborate and targeted treatments that rarely are disseminated in real world treatment settings. Therefore, the purpose of the current study was to examine the effect of a residential substance use treatment program on particular affect- (e.g., depressive and anxiety symptoms, stress reactivity) and disinhibition-related variables (e.g., risk taking). A sample of 81 inner-city substance abusers were assessed on self-reported and behavioral measures of the above affect- and disinhibition-related variables that have previously found to be implicated in substance use over a 30-day course of treatment. A residential treatment program provides an optimal setting for evaluating changes as behavioral confounds (i.e., substance use) can be controlled, and the natural changes during abstinence can be measured with both reliability and validity. A significant pre-post treatment decrease was found on scores of risk taking, as indexed by the Balloon Analogue Risk Task (BART); levels of depressive symptomatology and stress reactivity also evidenced a significant pre-post decrease. These data are discussed with respect to implications for understanding the factors that underlie mechanisms of change during treatment, thereby informing substance abuse prevention and treatment programs

Economics of household technology adoption in developing countries: evidence from solar technology adoption in rural India

Innovation is one of the most important drivers of economic development. Even in developing countries, households have access to a wide array of new technologies. However, factors affecting households’ technology adoption decisions remain poorly understood. Using data on solar microgrid adoption from rural India, we investigate the determinants of household technology adoption. We offer all households identical solar products to avoid bias from product differentiation. Households pay a monthly fee for technology use, allowing us to abstract away from credit constraints as a barrier to adoption. The results show that household expenditures and savings as well as the household head’s entrepreneurial attitude are strong predictors of adoption. In contrast, past fuel expenditures, risk acceptance, and community trust are not associated with technology adoption decisions. These findings suggest new directions for research on the microeconomics of household technology adoption, which is critical for sustainable development among the poor in developing countries

Inequality in policy implementation: caste and electrification in rural India

We examine unequal outcomes in the implementation of India's national rural electrification program in Uttar Pradesh. We ask two questions: (1) to what extent did Dalits, the lowest group in India's caste hierarchy, receive less attention when the state electrified rural communities? (2) Was BSP, the state's Dalit party, able to reduce this inequality? Using data from a hundred thousand villages, we provide robust evidence for unequal outcomes. Villages inhabited solely by Dalits were 20 percentage points less likely to be covered by the program than villages without any Dalits. Moreover, a regression discontinuity analysis shows that the electoral success of BSP failed to reduce such differences. These results highlight the magnitude and persistence of caste inequality in the implementation of democratic public policy, despite political representation

Workshop on the Development and Evaluation of Digital Therapeutics for Health Behavior Change: Science, Methods, and Projects

The health care field has integrated advances into digital technology at an accelerating pace to improve health behavior, health care delivery, and cost-effectiveness of care. The realm of behavioral science has embraced this evolution of digital health, allowing for an exciting roadmap for advancing care by addressing the many challenges to the field via technological innovations. Digital therapeutics offer the potential to extend the reach of effective interventions at reduced cost and patient burden and to increase the potency of existing interventions. Intervention models have included the use of digital tools as supplements to standard care models, as tools that can replace a portion of treatment as usual, or as stand-alone tools accessed outside of care settings or direct to the consumer. To advance the potential public health impact of this promising line of research, multiple areas warrant further development and investigation. The Center for Technology and Behavioral Health (CTBH), a P30 Center of Excellence supported by the National Institute on Drug Abuse at the National Institutes of Health, is an interdisciplinary research center at Dartmouth College focused on the goal of harnessing existing and emerging technologies to effectively develop and deliver evidence-based interventions for substance use and co-occurring disorders. The CTBH launched a series of workshops to encourage and expand multidisciplinary collaborations among Dartmouth scientists and international CTBH affiliates engaged in research related to digital technology and behavioral health (eg, addiction science, behavioral health intervention, technology development, computer science and engineering, digital security, health economics, and implementation science). This paper summarizes a workshop conducted on the Development and Evaluation of Digital Therapeutics for Behavior Change, which addressed (1) principles of behavior change, (2) methods of identifying and testing the underlying mechanisms of behavior change, (3) conceptual frameworks for optimizing applications for mental health and addictive behavior, and (4) the diversity of experimental methods and designs that are essential to the successful development and testing of digital therapeutics. Examples were presented of ongoing CTBH projects focused on identifying and improving the measurement of health behavior change mechanisms and the development and evaluation of digital therapeutics. In summary, the workshop showcased the myriad research targets that will be instrumental in promoting and accelerating progress in the field of digital health and health behavior change and illustrated how the CTBH provides a model of multidisciplinary leadership and collaboration that can facilitate innovative, science-based efforts to address the health behavior challenges afflicting our communities

Underdiagnosis and referral bias of autism in ethnic minorities

This study examined (1) the distribution of ethnic minorities among children referred to autism institutions and (2) referral bias in pediatric assessment of autism in ethnic minorities. It showed that compared to the known community prevalence, ethnic minorities were under-represented among 712 children referred to autism institutions. In addition, pediatricians (n = 81) more often referred to autism when judging clinical vignettes of European majority cases (Dutch) than vignettes including non-European minority cases (Moroccan or Turkish). However, when asked explicitly for ratings of the probability of autism, the effect of ethnic background on autism diagnosis disappeared. We conclude that the use of structured ratings may decrease the likelihood of ethnic bias in diagnostic decisions of autis

Experimental effects of climate messages vary geographically

Social science scholars routinely evaluate the efficacy of diverse climate frames using local convenience or nationally representative samples. For example, previous research has focused on communicating the scientific consensus on climate change, which has been identified as a ‘gateway’ cognition to other key beliefs about the issue6,7,8,9. Importantly, although these efforts reveal average public responsiveness to particular climate frames, they do not describe variation in message effectiveness at the spatial and political scales relevant for climate policymaking. Here we use a small-area estimation method to map geographical variation in public responsiveness to information about the scientific consensus as part of a large-scale randomized national experiment (n = 6,301). Our survey experiment finds that, on average, public perception of the consensus increases by 16 percentage points after message exposure. However, substantial spatial variation exists across the United States at state and local scales. Crucially, responsiveness is highest in more conservative parts of the country, leading to national convergence in perceptions of the climate science consensus across diverse political geographies. These findings not only advance a geographical understanding of how the public engages with information about scientific agreement, but will also prove useful for policymakers, practitioners and scientists engaged in climate change mitigation and adaptation.MacArhur Foundation, Energy Foundatio

Environmentalism in the EU-28 context: the impact of governance quality on environmental energy efficiency

Environmental policies are a significant cornerstone of a developed economy, but the question that arises is whether such policies lead to a sustainable growth path. It is clear that the energy sector plays a pivotal role in environmental policies, and although the current literature has focused on examining the link between energy consumption and economic growth through an abundance of studies, it does not explicitly consider the role of institutional or governance quality variables in the process. Both globalization and democracy are important drivers of sustainability, while environmentalism is essential for the objective of gaining a “better world.” Governance quality is expected to be the key, not only for economic purposes but also for the efficiency of environmental policies. To that end, the analysis in this paper explores the link between governance quality and energy efficiency for the EU-28 countries, spanning the period 1995 to 2014. The findings document that there is a nexus between energy efficiency and income they move together: the most efficient countries are in the group with higher GDP per capita. Furthermore, the results show that governance quality is an important driver of energy efficiency and, hence, of environmental policies.University of Granad

Geography, community, household: adoption of distributed solar power across India

We investigate the determinants of distributed solar technology adoption at the village and household level in India. Using spatial data on insolation, census records, and original surveys, we show that remote and poor but large villages with abundant sunshine have led the wave of solar technology adoption as an alternative to grid electricity. At the household level, however, wealth and financial access are positively associated with solar technology adoption, a result that holds for both solar lanterns and home systems. Moreover, remote villages are more likely to see solar technology adoption when households have access to finance through banks. We also find that the use of household solar technology is strongly associated with a household's subjective satisfaction with domestic lighting. These results demonstrate that understanding solar technology adoption requires considering both community and household characteristics. They also underscore the importance of financial access as a precondition for using distributed solar power as an alternative to grid connectivity