Download Vermont Center on Behavior & Health: 2015 Annual Conference

Vermont Center on Behavior & Health: 2015 Annual Conference
General Poster Session
1.
Delay discounting predicts metabolic control in adolescents with type 1 diabetes.
A. H. Lansing, & C. Stanger
Department of Psychiatry, Geisel School of Medicine at Dartmouth
Optimal Type 1 diabetes management requires adolescents to engage in daily health promoting
adherence behaviors (e.g., multiple daily blood glucose testing, insulin dosing) in the face of
immediate pain or discomfort and generally resulting in delayed rewards (e.g., experiencing
anxiety about testing in front of friends vs. the long--‐term reward of good health as an older
adult). This study examines the hypothesis that delayed discounting (DD) and other
components of the cognitive self--‐ regulatory system would be associated with diabetes
management outcomes including blood glucose test (BGT) frequency and metabolic control
(HbA1C). Adolescents with type 1 diabetes (n= 57, Mage = 14.82, Male= 59%, M HbA1c=
9.14%) participating in a RCT (MAxIM; MET/CBT+Contingency Management+Working Memory
Training) completed a baseline assessment including a DD task, working memory (WM) index
(WISC--‐IV/WAIS--‐IV), and computerized cognitive tasks (Visuospatial WM, Paced Auditory
Serial Addition Test, CPT/Go--‐No Go, and Stroop), as well as 14--‐day BGT monitoring and a
HbA1c blood test. Results indicated that high DD of $1,000 was associated with higher HbA1c
(r=--‐.38, p=.004). None of the other self--‐regulation system variables were associated with
HbA1c (p’s>.05). Also, neither DD nor the self--‐regulation system variables were associated
with BGT frequency. These findings suggest that DD is important to understanding HbA1c in
adolescents with type 1 diabetes, perhaps more so than other components of the self--‐
regulatory system. Further research is needed to understand the behavioral choice process
through which DD influences HbA1c (e.g., pausing to make complex insulin dosing decisions) in
adolescents.
2.
Primary Care Screening for Health and Lifestyle Behaviors Using Interactive Voice Response.
G. L. Rose, J. M. Skelly, T. A. Ferraro, G. J. Badger, C. D. MacLean, T. L. Fazzino, J. E. Helzer.
Department of Psychiatry at the University of Vermont College of Medicine.
BACKGROUND: Managing behavioral health problems in the primary care setting relies upon a
system of case identification. Pre-visit screening of patients with Interactive Voice Response
(IVR) can overcome barriers of cost, privacy, literacy, compatibility with EMRs, and assessment
standardization. OBJECTIVE: To implement systematic pre-screening of primary care patients
for common preventive health issues on a large scale. METHODS: All patients registered for
non-acute visits to participating primary care clinics were contacted one- to three-days prior to
their visit and invited to complete a six-item IVR questionnaire that screened for smoking,
drinking, low mood, physical activity, concern about weight, and pain. Screening results were
sent immediately to the patient’s EMR. RESULTS: We contacted 70% of patients before their
scheduled visit, 64% of whom consented (N=8,490; mean age 56; 58% female). Item
endorsements were as follows: smoking 9%; unhealthy alcohol use 36%; low mood 20%;
physically inactive 64%; concern about weight 44%, and pain 23%. Most patients (87%)
screened positive on at least one item, and 59% endorsed multiple problems. CONCLUSIONS:
This is the first study of IVR-based, large-scale pre-appointment screening of primary care
patients, and results indicate such screening is feasible. Pre-screening of primary care patients
is valuable because it allows identified cases to participate in goal setting with their physicians,
who can determine when further assessment or treatment is needed.
Vermont Center on Behavior & Health: 2015 Annual Conference
General Poster Session
3.
A Model to Support Patient Decisions in Changing Health Behaviors
R. Kessler & C. Van Eeghen
Department of Family Medicine at the University of Vermont College of Medicine
Health behavior change is key to improving patient outcomes and reducing healthcare costs.
This is true for chronic conditions targeted by UVM Medical Center: diabetes, obesity and
smoking, as well as asthma, cardiac issues and others medical problems co-morbid with
behavioral issues. Chronic conditions are generally treated through multiple primary care visits,
ER visits and hospitalization that often do little to change clinical decision making or affect
clinical outcomes while being resource intensive. In one UVM Medical Center practice operating
within an integrated primary care behavioral health model, 58% of the 698 patients referred for
behavioral care in two years had one or more chronic disease diagnosis. We demonstrated that
integrating behavioral health services into primary care practices appears to increase treatment
initiation with rates of 75-90% for first arrived visit. Recently, supported by NIMH project R-03
99157, we used the My Own Health Report as part of an algorithm to assess behavioral risk and
assist in shared care decision-making for patients with uncontrolled Type 2 diabetes. This
generated a pilot workflow using the PRISM electronic health record to identify patients, webbased collection of patient reported behavioral risk, shared-care planning in PRISM, and
coordinated interventions with each step in the workflow driven by patient decisions. This
workflow was evaluated for its viability in primary care practice and its acceptability to patients.
We will present the initial results including workflow and algorithm underlying this model to
support patient engagement in changing health behaviors.
4.
Preventive care behaviors following an MI: differences by socioeconomic status
Z. H. Morford1, D. E. Gaalema1, R. J. Elliott1, S. T. Higgins1, P. A. Ades2
1
Vermont Center on Behavior and Health, 2University of Vermont Medical Center
Coronary heart disease is the leading cause of death in the United States, accounting for
roughly 14.3% of deaths annually. An estimated 635,000 Americans have a first coronary attack
each year, and an estimated 300,000 have recurrent attacks. Multiple studies have found that
both short and long-term mortality rates due to myocardial infarctions (MI) are higher among
those of a lower socioeconomic status (SES). Behavioral changes following an MI (e.g.,
increased physical activity and medical adherence) have been shown to reduce the risk of a
subsequent MI. In this poster we present data from an on-going literature review to determine if
behavioral changes occur following individuals’ first MI, and whether these behavioral changes
vary as a function of SES. Both PubMed and Google scholar databases were used to find
relevant articles published by August 31, 2015. In order for articles to be included in the review,
the title or abstract of the article had to include the term “myocardial infarction” and at least one
of the following terms: socioeconomic status, education, insurance, smoking, physical activity,
diet change, medication adherence, or behavioral change. Of the articles collected, only those
that included information about myocardial infarctions, some measure of SES (e.g., education or
insurance), and behavior following an MI were included for analysis. To date, 48 titles and
abstracts have been reviewed, with 12 addressing all three topics. The data appear to indicate a
negative correlation between SES and likelihood of engaging in preventative behaviors post-MI.
Vermont Center on Behavior & Health: 2015 Annual Conference
General Poster Session
5.
Food and Monetary Discounting: Relations to Fasting and Food Security
in Families with Dysregulated Children
R. Althoff
Department of Psychiatry at the University of Vermont College of Medicine
6.
Interim buprenorphine treatment for reducing illicit opioid use during delays to treatment:
Between- and within-group effects
T.A. Ochalek1 , S.C. Sigmon1, B. Hruska1 , S.H. Heil1, S.T. Higgins1, G. Rose1,
B.A. Moore2 and R.P. Schwartz3
University of Vermont1, Yale University2 and Friends Research Institute3
Despite the demonstrated effectiveness of agonist maintenance for opioid dependence, patients
can remain on waitlists for months before treatment becomes available. One effort to mitigate
the risks associated with these delays is to extend interim treatment (daily medication +
emergency counseling only) to waitlisted individuals. However, while interim methadone
treatment has been demonstrated efficacious, restrictive federal regulations on methadone have
limited its widespread use. Aim: To develop and evaluate a novel Interim Buprenorphine
Treatment (IBT) for waitlisted patients that includes buprenorphine (BUP) dispensed via a
computerized device (Med-O-Wheel Secure), daily monitoring via an Interactive Voice
Response (IVR) system, IVR-generated random call-backs for urinalysis and medication
adherence, and HIV+Hepatitis education delivered via iPad. Methods: Thus far, 38 opioiddependent adults have been randomized to one of two 12-week experimental conditions:
Interim Buprenorphine Treatment (IBT, n=18) wherein participants receive buprenorphine
maintenance without counseling or a Waitlist Control (WLC, n=20) wherein they remain on the
WL of their local clinic. Both groups complete assessments at intake, Study Week 4, 8 and 12.
WLC participants (WLCc; n=8) who have not entered treatment by Week 12 are offered IBT at
that time, providing an additional within-subject evaluation of IBT effects. We hypothesize that
IBT participants will demonstrate reduced illicit opioid use compared to WLC participants.
Among WLC participants who cross over to IBT at Week 12, we hypothesize that illicit opioid
use will be lower during their IBT vs. waitlist phase. Results: Thus far, participants randomized
to receive IBT are achieving greater biochemically-verified illicit opioid abstinence than WLC
participants. When data are collapsed across the monthly assessments, IBT and WLC
participants have submitted 85% vs. 0% illicit opioid negative urine specimens, respectively. At
the final visit of the 12-week study, 79% and 0% of IBT and WLC participants are abstinent from
illicit opioids, respectively. Among WLCc participants who have received both WLC and IBT
phases, illicit opioid abstinence is greater during their IBT than WLC phase (50% vs. 0%
negative specimens, respectively). Additional outcomes will be presented at the October
conference, including participants’ self-report frequency of illicit opioid use and IV use at each
follow-up and ASI measures of more general psychosocial functioning. Conclusions: Providing
interim buprenorphine maintenance with minimal psychosocial support to waitlisted patients
may significantly reduce individual and societal risks during delays to comprehensive opioid
treatment. This trial is funded through R34 DA3730385-01 and T32 DA007242 grants.
Vermont Center on Behavior & Health: 2015 Annual Conference
General Poster Session
7.
Changes in psychiatric symptoms among opioid-dependent individuals receiving Interim
Buprenorphine Treatment vs. waitlist control
J.M. Streck,1,3 B. J. Hruska,2,3 T. A. Ochalek,1,3 I. Zvorsky,1,3 S.C.Sigmon1-3
University of Vermont Department of Psychological Science1 and Psychiatry2, Vermont Center
on Behavior and Health3
Introduction: Prevalence of affective disorders among opioid abusers far exceed that of the
general population (Strain, 2002). While depression, anxiety and other symptoms often improve
upon entry into opioid treatment, this has typically been seen with treatments that involve
intensive psychosocial counseling (Shafer et al., 2011). Here we examine changes in
psychological symptoms during an Interim Buprenorphine Treatment whereby opioid-dependent
adults received buprenorphine maintenance with minimal monitoring and no counseling.
Methods: Opioid-dependent adults (n=28), all of whom were waitlisted for opioid treatment with
other programs, were randomized to one of two 12-week experimental conditions: Interim
Buprenorphine Treatment (IBT) wherein participants received buprenorphine maintenance
without counseling (N=14) or a Waitlist Control (WLC) wherein they remained on the WL of their
local clinic (N=14). Both groups completed assessments at intake, 4, 8 and 12 weeks that
included the Brief Symptom Inventory (BSI) and the Beck Depression Inventory (BDI-II), and we
examined between- and within-group differences on these measures at each timepoint. Results:
On the Global Severity Index (GSI) subscale of the BSI, there was a significant group x time
interaction (F (3,69)=3.24, p<.05), whereby participants randomized to the IBT condition
reported significantly lower levels of psychological distress at Weeks 4 and 8 vs. WLC
participants. Additionally, the IBT group’s GSI scores decreased significantly over time (p<.01),
whereas there was no change in the WLC group. There was also a significant group x time
interaction on the BDI (F (3,69)=6.22, p<.01), with significantly lower levels of depression at
Weeks 4 (p<.01), 8 (p<.01), and 12 (p=.01) in IBT vs. WLC participants. BDI scores also
significantly decreased over time in IBT participants (p<.01) vs. no change among WLC
participants. Conclusions: Preliminary data suggest that buprenorphine alone, without
counseling or psychosocial support, may be associated with reductions in psychological distress
among opioid-dependent adults. Funding: NIDA R34DA037385, T32 DA007242 and NIGMS
P20GM103644
8.
A Review of the Literature on Contingency Management in the Treatment of Substance Use
Disorders, 2009-2015
D. R. Davis1,2, A. N. Kurti1, R. Redner1, T. J. White1 & S. T. Higgins1,2
Vermont Center on Behavior & Health, University of Vermont
Departments of Psychiatry1 & Psychology2
Introduction: The current review is the third in a series of systematic reviews of the literature on
voucher-based contingency management (CM) for treatment of substance use disorders that
have spanned from 1991 to January 2015. Below we review growth and change in CM
interventions over the past 5.2 years (November 2009 to January 2015). Methods: Reports
were identified using the search engine PubMed and search terms and inclusion criteria detailed
below. Results: Level of growth in this area has remained consistent between the current and
immediately prior review, and has greatly increased since the first review in this series. The
literature could be categorized into 8 trends, one of which (Incorporating Technology in the
Intervention), was new to this most recent review. Of the 70 studies that met inclusion criteria, a
Vermont Center on Behavior & Health: 2015 Annual Conference
General Poster Session
majority reported significant treatment effects (89%) and the number of studies including followups increased between the current and prior reviews (57% v. 41%), as did the proportion of
studies showing significant treatment effects at follow up (33% v. 21%). Conclusions: The body
of literature on voucher-based CM targeting SUDs has remained similar in size and continues to
be highly efficacious even in the case of new drug targets and vulnerable populations.
9.
Does the efficacy of medications for treating alcohol abuse decrease over time?
Elias M. Klemperer1, John R. Hughes1 & Shelly J. Naud2
1
Vermont Center on Behavior and Health, University of Vermont; 2 Department of Medical
Biostatistics, University of Vermont
Aims: Prior research suggests the reported outcomes of some medications decline over time. The
present research aims to test this hypothesis for acamprosate and naltrexone use for alcohol
abuse. Methods: Data were acquired from RCTs in the Cochrane Database. The analyses
included 24 acamprosate trials from 1985 to 2006 (N=6,172), and 26 naltrexone trials from 1992
to 2008 (N=4,693).We examined the incidence of abstinence rate in the a) active conditions, and
b) control conditions, as well as c) the active vs placebo effect size via the odds ratios. Thus, we
conducted 6 fixed-effects meta-analyses (2 medications x 3 outcomes). Results: The rate of
abstinence from alcohol decreased over time in participants treated with acamprosate (15%/10yrs; p<.01) but did not change in the controls and the OR decreased over time (1.00/10yrs; p<.05). The rate of abstinence from heavy drinking in participants treated with
naltrexone appeared to decrease (-27%/10yrs; p<.10), but did not change in controls. The
naltrexone treatment OR also appeared to decrease (-.72/10yrs; p<.10). Conclusions: Our
hypothesis was partially supported. These findings suggest changes in the trials’ methodology,
changes in study populations or publication bias. Follow up analyses examining study
characteristics as mediators to explain these results will be discussed.
Financial Support This work was supported by NIDA 5 T32 DA 7242-23.
10.
Factors associated with contraceptive preferences among opioid-maintained women who do not
wish to become pregnant
A.K. Matusiewicz, H. Melbostad & S.H. Heil
Vermont Center on Behavior & Health and the Department of Psychiatry,
University of Vermont
Background: Eighty-five percent of births are unintended among women using licit and
illicit opioids. Given the risks associated with these pregnancies and the expenses associated
with the monitoring and treatment of neonatal abstinence syndrome, the
costs of unintended births to opioid-using mothers approaches $59,000 per birth or $700 million a
year in the United States.
Prescription contraceptives are a safe, effective way to reduce unintended pregnancies
and births. Intrauterine devices and contraceptive implants, often referred to as long acting
reversible contraceptive (LARC) methods, are the most effective forms of birth control and require
no effort on the part of the woman after placement of the device (Speidel et al., 2008). Despite
the safety and efficacy of these methods, only 5% of non-drug-using reproductive-aged women
Vermont Center on Behavior & Health: 2015 Annual Conference
General Poster Session
who do not wish to become pregnant use report use of LARCs (Dempsey et al., 2013; Chandra et
al., 2002; Mosher et al., 2010). Although several studies in the general population have identified
differences between LARC-users and women who choose other contraceptive methods (e.g.,
Dempsey et al., 2013; Moreau et al., 2013), little is known about potential barriers to LARC use
among women who use opioids and other drugs.
Current Study: The aim of this study is to characterize potential barriers to LARC use in a
sample of opioid-maintained women enrolled in a trial comparing different family planning
interventions. We will examine the following factors that may have interfered with LARC
utilization prior to study enrollment: 1) perceived and actual LARC knowledge and 2) attitudes
toward LARCs and alternate contraceptive methods.
Preliminary Results
Data collection for this study is ongoing. Currently, 13 participants are enrolled and we
anticipate presenting data for ~30 participants at the conference. Eighty-five percent of current
participants reported at least one unintended pregnancy and although 92% of participants had
used some type of contraception in the past, only 23% had used a LARC.
When asked to provide a self-assessment of their contraceptive knowledge, participants
indicated a low level of LARC knowledge (M=1.7 out of 5 points, SD=0.5) relative to birth control
pills (M=2.6, SD=0.7) and condoms (M=3.4, SD=1.1), yet participants demonstrated a similar
level of actual knowledge across contraceptive types (LARCs: M=67% correct, SD=19%; pills: M
= 74%, SD = 16%; condoms: M = 71%, SD = 18%). Eighty percent of participants indicated
(inaccurately) that birth control pills were more effective than IUDs and only 27% of participants
reported that they were likely to use an IUD. Of participants who indicated that they were unlikely
to use an IUD, 86% reported concerns about health effects and side effects and 43% reported
that friends or relatives had had negative experiences with the method. Forty percent of
participants in the full sample (i.e., those likely and unlikely to use an IUD) expressed concern
that the IUD would cause infection and 60% expressed concern about long-term fertility following
IUD removal.
Preliminary results provide insight into a variety of barriers to LARC use among opioidmaintained women. The vast majority of participants believed (incorrectly) that LARCs are less
effective than birth control pills, and participants were very concerned about the effect of LARCS
on health and future fertility. Because the perceived benefits of LARC use were very low and
apparent costs quite high, it is unsurprising that only a small proportion of participants had used
LARCs in the past, or had interest in starting a LARC method. Findings may have implications for
intervention development and improving utilization of highly effective contraceptive methods
among opioid-maintained women at increased risk of unintended pregnancy.
11.
Financial incentives plus behavioral weight management to target gestational
weight gain in obese women
J. Phillips
University of Vermont College of Medicine
Vermont Center on Behavior & Health: 2015 Annual Conference
General Poster Session
12.
Physical function of older cancer survivors
K. Dittus
Uniersity of Vermont College of Medicine
13.
Remote Alcohol Monitoring to Facilitate Abstinence Reinforcement
M. N. Koffarnus1, A. S. Kablinger2, A. E. Swallow1, W. K. Bickel1
1
Virginia Tech Carilion Research Institute, Virginia Tech Polytechnic Institute and State
University 2Dept. of Psychiatry & Behavioral Medicine, Virginia Tech Carilion School of Medicine
The delivery of monetary incentives contingent on verified abstinence is an effective treatment
for drug and alcohol abuse. However, technological barriers to accurate, frequent biochemical
verification of alcohol abstinence have limited the dissemination of this technique for the
treatment of alcohol dependence. In the present study, we are using a breathalyzer device that
allows remote collection of a breath alcohol sample while simultaneously taking a photograph of
the participant, a cellular data connection, and security features, all of which allow for the
verification of abstinence without an in-person contact with the participant. Along with this
breathalyzer device, we are employing text messaging and reloadable debit cards for remote
delivery of incentives to test a contingency management treatment for alcohol dependence that
can be delivered with no in-person contact. We are comparing two groups: a Contingent and
Noncontingent group. The Contingent group receives nearly immediate monetary payments
over the internet each day they remotely provide negative breathalyzer samples. The
Noncontingent group receives payments each day they successfully provide samples
independent of the alcohol content of those samples. Preliminary data tentatively support the
efficacy, acceptability, and feasibility of this intervention. We will discuss the potential of this
procedure to facilitate delivery of an effective treatment to groups of individuals (e.g., rural) who
are currently underserved by alcohol dependence treatment.
Supported by NIH/NIAAA grant R21 AA022727. No conflicts of interest to report.
14.
Do Barriers to Access to Long-Acting Reversible Contraceptives Differentially Impact Socioeconomically Disadvantaged Women?
T. M. Higgins, A. Dougherty, S. H. Heil
University of Vermont College of Medicine,
University of Vermont.
Introduction: Half of all pregnancies in the US are unplanned, which has substantial adverse
impacts on individual and population health. This problem is overly represented in more socioeconomically disadvantaged populations. Long-Acting Reversible Contraception (LARC) is the
most effective form of reversible contraception but is underutilized, with only 7% of reproductiveaged women using LARC. The literature identifies multiple contributors to this relatively low use
of LARC, including access barriers such as requiring multiple visits for device insertion. The
present study will examine if multiple visits are especially likely to undermine the efforts of more
socio-economically disadvantaged women to obtain LARC.
Methods: We will conduct a retrospective chart review of all women who submitted a LARC
insurance pre-certification application in 2013 in the University of Vermont Obstetrics &
Vermont Center on Behavior & Health: 2015 Annual Conference
General Poster Session
Gynecology clinic (~ 500 women). LARC insertion rates will be compared among women with
private versus public (i.e., Medicaid) health insurance, controlling for the influence of other
potential confounding variables (e.g., age, marital status).
Results: Preliminary results suggest that of those who sought LARC at the UVM Ob/Gyn clinic,
20% had public (Medicaid) insurance. Among patients seeking LARC, women with private
insurance were more likely to have a LARC placed compared to those with public insurance
(80% vs 60%, respectively). Of those who did receive a LARC, women with private insurance
averaged 2.4 office visits for LARC counseling and placement, and women with public
insurance averaged 1.6 visits. Further data analysis is underway.
Conclusion: The literature suggests that access barriers, including multiple visit insertion
protocols, lead to decreased LARC use. What is unclear, and the focus of the present study, is
the extent to which the adverse impacts of access barriers on insertion rates are differentially
borne by more disadvantaged women.
15.
Influence of Health Behavior on Mortality in Women Diagnosed with Ductal Carcinoma In Situ
Christopher Thomas Veal1, Vicki Hart1, John Hampton2, Amy Trentham-Dietz2, Brian Sprague1
1
Department of Surgery and Office of Health Promotion Research, University of Vermont,
Burlington, Vermont
2
Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin
Women diagnosed with Ductal Carcinoma In Situ (DCIS) of the breast represent a growing
cancer survivor population. The breast cancer specific survival rate for DCIS is very high, and
like the general population they are at greater risk of dying from cardiovascular disease and
other causes than from breast cancer. No studies have examined how specific health behaviors
are associated with mortality outcomes in women with a DCIS diagnosis. In this study, we are
evaluating the association of specific health-related behaviors (alcohol consumption, physical
activity, smoking frequency, and body mass index) with mortality using data on 1,925 women
with DCIS from the Wisconsin In Situ Cohort. Behaviors were self-reported through biennial
interviews and surveys beginning in 2003 and continuing through 2013. At baseline interview,
15.0% of DCIS cases were smokers, 49.1% were overweight or obese and 75.7% reported
spending less than 5 hours per week participating in strenuous physical activity. Over a mean of
6.7 years of follow-up, 196 deaths were reported, including 27 (13.8%) due to cardiovascular
disease, 22 (11.2%) due to breast cancer, and 20 (10.2%) due to lung cancer. In univariate
analysis, women who died during the follow-up period were more likely to have been a smoker
and be overweight or obese, and less likely to have participated in strenuous physical activity.
Multivariable regression analyses will be used to estimate the independent association between
health-related behaviors and the rate of death, with adjustment for patient, tumor, comorbidity,
and treatment factors. The results will inform our understanding of the relative importance of
adopting or maintaining healthy behaviors following an early stage breast cancer diagnosis.
Vermont Center on Behavior & Health: 2015 Annual Conference
General Poster Session
16.
Intra-bed nucleus of the stria terminalis (BNST) pituitary adenylate cyclase activating peptide
(PACAP) infusion reinstates cocaine seeking in rats
Olivia W. Miles1, Eric A. Thrailkill1, Victor May2, Mark E. Bouton1, Sayamwong E.
Hammack11Department of Psychological Science, University of Vermont, Burlington VT
2Department of Neurological Science, University of Vermont, Burlington VT
The tendency of users to relapse severely hinders adequate treatment of addiction. Physical
and psychological stressors often contribute to difficulties in maintaining behavior change, and
may play a significant role in relapse. We have previously shown that the activation of pituitary
adenylate cyclase activating peptide (PACAP) systems in the bed nucleus of the stria terminalis
(BNST) mediate many consequences of chronic stressor exposure. Hence, chronic stress
substantially increased BNST PACAP levels, intra-BNST PACAP infusions produced the
behavioral and endocrine consequences of stressor exposure, and BNST PACAP antagonism
blocked many of the consequences of chronic stress. In the present set of studies, we
investigated the role of BNST PACAP in stress-induced reinstatement of cocaine seeking. All
rats self-administered cocaine (3mg/ml; 0.5mg/ig/infusion, i.v.) for 1hr daily over 10 days
followed by extinction training in which lever pressing no longer resulted in cocaine delivery. In
the first experiment we showed that intra-BNST PACAP infusion (1 μg; 0.5 μl per side) could
reinstate previously extinguished cocaine seeking behavior. In the second experiment we found
that intra-BNST infusions of the PAC1/VPAC2 antagonist, PACAP 6-38 (1 μg; 0.5 μl per side)
blocked stress-induced reinstatement. Stressor exposure (5 sec 2mA footshock) caused
significant reinstatement on test day only in animals who received intra-BNST vehicle infusion.
Overall, these data suggest that BNST PACAP systems mediate stress-induced reinstatement
to drug seeking. Understanding the neuropharmacology of BNST PACAP in stress-induced
reinstatement and the role of PACAP systems may lead to viable targets for relapse prevention.
17.
Effectiveness and Acceptability of a Brief Intervention for Caffeine Use Disorder
Mary M. Sweeney, Steven E. Meredith, Laura M. Juliano,
Daniel P. Evatt, and Roland R. Griffiths.
Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral
Sciences, Behavioral Pharmacology Research Unit
Volunteers (current n = 34) participate in a randomized controlled clinical trial to promote
caffeine reduction and cessation using a brief intervention and treatment manual. Participants
meet diagnostic criteria for caffeine use disorder, which is a condition for further study in DSM-5.
Participants are randomly assigned to either an immediate treatment group or a group whose
treatment is delayed by seven weeks. During the treatment visit, the treatment manual, which
contains information about caffeine and a plan for reducing caffeine use gradually over six
weeks, is given to the volunteer in a brief meeting lasting less than four minutes. Initial results
from 18 volunteers who have completed the study (immediate and delayed groups combined)
indicate a significant reduction in average daily milligrams of caffeine use from pre-treatment (M
= 568.5, SD = 427.3) to seven weeks (M = 90.9; SD = 103.2, t(17) = 4.74, p = .0002); and 27
weeks post-treatment (M = 136.6, SD = 142.3, t(17) = 4.18, p = .0006). Treatment acceptability
of the intervention is also assessed at seven weeks post-treatment and is generally favorable.
Comparisons within and between immediate and delayed treatment groups suggest the
treatment manual intervention, and not spontaneous reductions in caffeine consumption
following screening, resulted in the reduction of caffeine intake. If the treatment manual
intervention continues to indicate its effectiveness and acceptability, it may serve as clinically
Vermont Center on Behavior & Health: 2015 Annual Conference
General Poster Session
valuable tool for healthcare providers who instruct patients to reduce caffeine intake as part of
treatment of medical disorders (e.g., insomnia, anxiety).
18.
The association between post-diagnosis health behaviors and quality of life in survivors of
ductal carcinoma in situ
Vicki Hart 1, Amy Berkman 1, Yi Ba 1, Mayo Fujii 1,2, Christopher Veal 1, John Hampton 2, Amy
Trentham-Dietz 2,3, Brian Sprague 1,3,4
1
Office of Health Promotion Research and Department of Surgery, University of Vermont,
Burlington, VT, 2 Department of Population Health Sciences and Carbone Cancer Center,
University of Wisconsin, Madison, WI, 3 Vermont Center on Behavior and Health, University of
Vermont, Burlington, VT, 4University of Vermont Cancer Center, Burlington, VT
Background: Survivors of ductal carcinoma in situ (DCIS), an early stage breast cancer, tend to
decrease physical activity, gain weight, and maintain alcohol use following treatment. However,
the impact of these health behaviors on long-term quality of life (QoL) has not been
investigated. Understanding factors that impact QoL in DCIS survivors may inform interventions
aimed at preventing negative health behavior following treatment. Methods: We examined the
association of post-diagnosis body mass index (BMI), physical activity, alcohol intake, and
smoking with QoL among 1,448 DCIS survivors. Health behaviors and QoL were self-reported
during biennial follow-up interviews. QoL was measured using the validated SF-36
questionnaire. Generalized linear regression was used to establish adjusted means in
preliminary cross-sectional analysis. Longitudinal analysis using cross-lagged regression is
underway to evaluate the temporal association between health behavior and QoL. Results:
Women reported 3,444 QoL observations over an average 7.9 years of follow-up. In crosssectional analysis, physical measures of QoL were significantly higher among women with
healthy BMI (46.5 for healthy weight versus 40.5 for obese) and those who were physically
active (45.9 for active women versus 42.6 for inactive). Mental measures of QoL were
significantly higher among non-smokers (51.2 for non-smokers versus 47.1 for current
smokers). These associations were consistent over increasing time since treatment (up to 15
years). Conclusion: Preliminary analysis suggests that maintaining healthy behaviors following
DCIS treatment is associated with improved long-term QoL. Longitudinal analysis will evaluate
the independent impact of behavior on QoL, since these factors are likely to influence each
other.
19.
The association between post-diagnosis health behaviors and quality of life in survivors of
ductal carcinoma in situ
V. Hart 1, A. Berkman 1, Y. Ba 1, M. Fujii 1,2, C. Veal 1, J. Hampton 2,
A. Trentham-Dietz 2,3, & B. Sprague 1,3,4
1
Office of Health Promotion Research and Department of Surgery, University of Vermont,
Burlington, VT, 2 Department of Population Health Sciences and Carbone Cancer Center,
University of Wisconsin, Madison, WI, 3 Vermont Center on Behavior and Health, University of
Vermont, Burlington, VT, 4 University of Vermont Cancer Center, Burlington, VT
Background: Survivors of ductal carcinoma in situ (DCIS), an early stage breast cancer, tend to
decrease physical activity, gain weight, and maintain alcohol use following treatment. However,
the impact of these health behaviors on long-term quality of life (QoL) has not been
Vermont Center on Behavior & Health: 2015 Annual Conference
General Poster Session
investigated. Understanding factors that impact QoL in DCIS survivors may inform interventions
aimed at preventing negative health behavior following treatment. Methods: We examined the
association of post-diagnosis body mass index (BMI), physical activity, alcohol intake, and
smoking with QoL among 1,448 DCIS survivors. Health behaviors and QoL were self-reported
during biennial follow-up interviews. QoL was measured using the validated SF-36
questionnaire. Generalized linear regression was used to establish adjusted means in
preliminary cross-sectional analysis. Longitudinal analysis using cross-lagged regression is
underway to evaluate the temporal association between health behavior and QoL. Results:
Women reported 3,444 QoL observations over an average 7.9 years of follow-up. In crosssectional analysis, physical measures of QoL were significantly higher among women with
healthy BMI (46.5 for healthy weight versus 40.5 for obese) and those who were physically
active (45.9 for active women versus 42.6 for inactive). Mental measures of QoL were
significantly higher among non-smokers (51.2 for non-smokers versus 47.1 for current
smokers). These associations were consistent over increasing time since treatment (up to 15
years). Conclusion: Preliminary analysis suggests that maintaining healthy behaviors following
DCIS treatment is associated with improved long-term QoL. Longitudinal analysis will evaluate
the independent impact of behavior on QoL, since these factors are likely to influence each
other.
20.
Relapse after the extinction of a heterogeneous behavior chain
E. A. Thrailkill, J. M. Trott, and M. E. Bouton
Department of Psychological Science, University of Vermont, Burlington, VT.
Behavior often occurs in the form of sequences, or chains, of responses that include
procurement leading to consumption. For example, a drug abuser or overeater must first
acquire drug or food before he or she can smoke or eat it. Treatments to reduce drug abuse or
overeating thus need to reduce behaviors that are part of a chain. Extinction is a process of
behavioral inhibition we have investigated in this laboratory for many years. We know that
extinction of simple operants and respondents is not unlearning, but is instead an especially
context-dependent form of new learning to stop making a response. Three experiments asked
whether the same is true of behaviors that are part of a chain. Rats learned to make a
procurement response (e.g., a chain pull) in the presence of a discriminative stimulus (SD),
which led to the presentation of a consumption SD and the opportunity to perform a
consumption response (e.g., lever press). Experiment 1 showed that extinguished procurement
and consumption responses return after noncontingent presentations of the reinforcer
(“reinstatement”). Experiment 2 demonstrated that extinguished procurement and consumption
responses also return when the extinction context is changed (“renewal”). Experiment 3 then
showed that when a consumption response is extinguished separate from its chain, a return to
the context of the chain (particularly preceding it with a procurement response) readily renews
extinguished consumption. The rules that govern extinction of simple operants and respondents
thus apply to operants in behavior chains: extinction depends on new context-dependent
inhibitory learning. The results emphasize the importance of context in treatments that inhibit
procurement and consumption.
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21.
Food-Seeking Inhibited While Hungry Can Renew in the Context of Satiation
S.T. Schepers and M. E. Bouton
Department of Psychological Science, University of Vermont
Recent research suggests that pathologies related to being overweight or obese are associated
with as many as 4 million deaths in a single year. Obesity is an especially salient issue in the
United States, as approximately 1/3 of US adults are considered obese. Accordingly, research
aimed to identify conditions that promote problem-eating behaviors is especially important.
Further, like other behaviors, dieting behavior that produces weight loss is often susceptible to
relapse. Several studies with rat subjects therefore examined whether food-seeking behavior
established while the rat is satiated can be renewed by satiation after it has been inhibited
(extinguished) in the context of hunger.
In two experiments, rats received unlimited access to food in their homecages (i.e., they were
sated) while they received 12 daily sessions in which lever pressing was reinforced with highly
palatable food pellets (i.e., sweet/fatty or sucrose pellets). Then, over the next 4 days, all rats
received restricted access to food in the home cage and a daily session of extinction training
(lever pressing no longer produced food pellets). Two test sessions then examined lever
responding when rats remained on food restriction and when they were again given unlimited
food access in the home cage. Counter-intuitively, the rats exhibited more food-seeking
behavior when they were sated than when they were food restricted. Apparently, satiation and
hunger can function as contexts (A and B, respectively) and support ABA renewal effects. Thus,
when individuals learn to eat junk food when they are not hungry and then inhibit the behavior
when they are hungry (e.g., while dieting), they may further lapse when the diet is broken and
they are in the state of satiation again. Additional experiments investigated whether satiety
produced pharmacologically with injection Cholecystokinin (CCK) can likewise create renewal of
food seeking after extinction in the context of hunger.
22.
Oral Cannabis Dose Effects and Pharmacokinetics
R. Vandrey1, E. J. Cone1, E. S. Herrmann1, G. E. Bigelow1,
J. M. Mitchell2, R. Flegel3, C. LoDico3
1
Johns Hopkins University School of Medicine, 2 Research Triangle Institute, 3 Substance
Abuse and Mental Health Services Administration
Background. Most controlled research on the acute effects of cannabis has used a smoked
route of administration, but “edible” cannabis products now represent a large segment of the
legal/medical cannabis market. Methods. Healthy adults were administered 100mg, 250mg, or
500mg cannabis containing approximately 10% THC baked into a brownie or placebo (0mg,
10mg, 25mg, or 50mg THC doses) in a controlled laboratory setting. Blood, oral fluid, and urine
specimens were obtained at baseline and for up to 9 days post-exposure to characterize the
pharmacokinetic profile of each dose. Measures of subjective, cardiovascular, and cognitive
performance effects were obtained at baseline and for 8 hours post-ingestion. Results. The
average Cmax for THC in whole blood was 0.67 ng/mL, 3.5 ng/mL, and 3.3 ng/mL; for THC in
oral fluid was 191.5 ng/mL, 477.5 ng/mL, and 597.5 ng/mL; and for THC-COOH in urine was
106 ng/mL, 335 ng/mL, and 713 ng/mL for the 100mg, 250mg, and 500mg doses respectively.
The window of detection ranged from 0-22, 1.5 – 22, and 74-216 hours for blood, oral fluid and
urine respectively. Subjective drug effects and cognitive performance effects generally were
dose dependent, though appeared to be driven by increased adverse effects at the 2 higher
doses. Peak drug effecs occurred 1.5 – 3 hours post exposure and effects typically lasted for 6-
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8 hours. Summary. Oral administration of cannabis results in dose-dependent effects.
Quantitative levels of cannabinoids in blood and oral fluid were low, variable across participants,
and did not parallel self-reported intoxication.
Acknowledgement. Support for this research was obtained from Substance Abuse and Mental
Health Services Administration (SAMHSA), U.S. Department of Health and Human Services
(HHS), NIH/NIDA training grant T32-DA07209
23.
Inactivation of the prelimbic cortex attenuates context-dependent
excitatory operant responding
M. L. Shipman, S. Trask, J. T. Green, and M. E. Bouton
Department of Psychology, University of Vermont
In operant renewal, extinguished operant behavior can recover when tested outside the
context in which it was extinguished. Previous work (Eddy et al., submitted) has shown that
inactivation of the prelimbic (PL) region of the medial prefrontal cortex (mPFC) by
baclofen/muscimol (B/M) during testing attenuates renewal of an extinguished response when
testing occurs in Context A (e.g., ABA renewal). One explanation for this attenuated renewal is
that the PL may play a role in context-dependent excitatory responding (e.g., Thrailkill & Bouton,
2015). Two experiments tested this prediction. In Experiment 1, rats learned to lever press for a
sucrose-pellet reward. Once the behavior was acquired, animals received an infusion of either
B/M or saline vehicle into the PL and were tested in the acquisition context, Context A, or a
different context, Context B. Although both groups showed a decrement in responding in
Context B (a typical context-switch effect), inactivation of the PL decreased responding in
Context A relative to the vehicle controls. Given that PL inactivation decreased behavioral
control by the acquisition context, other types of renewal in which testing occurs outside the
acquisition context should not be affected by PL inactivation. Therefore, in Experiment 2, the
same rats again responded for the sucrose reinforcer in Context A. Responding was then
extinguished in a new context, Context C. Animals then received an infusion of either B/M or
saline into the PL before being tested in the extinction context, Context C, or another context,
Context D. As predicted, both groups showed ACD renewal that was unaffected by PL
inactivation. A final test of ABA renewal verified that the cannulae were still functional and
replicated Eddy et al. (submitted). Rather than affecting renewal generally, inactivation of the
prelimbic cortex attenuates ABA renewal by reducing context-dependent excitatory responding
in the conditioning context.
24.
Working Memory Training in Adolescent Cannabis Users: Pilot Results
S. F. Babbin, C. Stanger, & A. J. Budney
Department of Psychiatry, Geisel School of Medicine at Dartmouth
Cannabis use in adolescence is associated with deficits in tasks involving executive functioning,
including working memory. Cogmed RM, an online working memory training (WMT) program
developed for school-age youth, was used as part of the pilot phase of a randomized clinical
trial of behavioral treatment for adolescent cannabis use. A total of N=19 adolescents were
enrolled, but 7 left treatment early and did not engage in Cogmed. The analytic sample was
n=12 (mean age=16.1, 91.7% male, 75.0% white). Training began during the second week of
substance use treatment and consisted of 25 sessions, each with 5-8 visuospatial and verbal
working memory span tasks, to be completed across 5 (or more) weeks. Tasks adapted to
Vermont Center on Behavior & Health: 2015 Annual Conference
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performance and became increasingly more challenging. Research staff served as Cogmed
coaches to facilitate training, and participants were compensated contingent on session
completion and task improvement. On average, participants completed 22.8 (SD=4.2) sessions,
with n=9 completing all 25, and participants improved on 60.2% of tasks. Participants completed
a battery of cognitive assessments at intake and at the end of treatment. Preliminary findings
suggest that training was associated with improved cognitive performance. Participants
demonstrated significant pre-post improvements in the WISC/WAIS working memory index and
the Paced Auditory Serial Addition Task, and non-significant improvements in delay discounting
and on the Stroop. Magnitude of Cogmed task improvement was positively correlated with
improvement in WISC/WAIS scores (r=0.65, p=0.03). As WMT may improve cognitive
processes involved in decision-making, enhancing working memory has potential to benefit
treatment of substance use disorders.
25.
Methods to Reduce Opioid-related Overdose
K. Dunn , C. Yepez-Laubach1, F.Barrett1, M. Fingerhood1, & G. Bigelow1
1
Johns Hopkins University School of Medicine
1
Unintentional drug poisonings are the leading cause of accidental death in adults aged 25-65
and are largely driven by fatal overdoses from opioids such as heroin, oxycodone, or
methadone. Current treatment strategies for opioid overdose are coordinated by public health
departments and largely focus on provision of the opioid antagonist naloxone for opioid
overdose reversal. While these programs are impressive, they generally only reach those
considered at greatest risk for experiencing an overdose (e.g., injection drug users), and there
are few efforts to reduce overdose in other populations in which it is increasing (chronic pain
patients, elderly, adolescents). Naloxone is also logistically complicated to prescribe and
expensive, which restricts its availability to patients. We know of no empirically-supported
educational interventions to reduce opioid overdose risk. This poster will present the results of a
series of studies to develop resources that reduce opioid overdose risk. This includes the
development of a brief overdose risk assessment tool and the standardized characterization of
risk profiles in different populations, as well as an opioid overdose computerized education
intervention being evaluated in a randomized controlled trial to increase knowledge of risk
factors and behavioral strategies for responding to an overdose in patients receiving a brief (3day) opioid detoxification. The results of this research will make available inexpensive, easilyaccessible, and empirically-supported resources to reduce risk of opioid overdose. The ultimate
aim of this research is to help reduce the societal consequences of opioids by reducing deaths
associated with opioid use and misuse.
26.
Vaping Cannabis: An Emerging Method of Cannabis Administration
D. C. Lee, J. T. Borodovsky, B. S. Crosier, J. D. Sargent & A. J. Budney
Geisel School of Medicine at Dartmouth
Along with changes in cannabis use laws in the United States, new methods for consuming
cannabis are emerging, with unclear public health implications. Similar to e-cigs, vaporizing or
“vaping” cannabis appears to be gaining popularity as one such alternative. This survey study
assessed current patterns of vaping among cannabis users, and examined whether legal status
of cannabis differentially impacts vaping. An anonymous online survey hosted on Qualtrics was
distributed through Facebook ads targeting pages focused on interests related to cannabis use.
The sample consisted of 2,932 cannabis users (32.5 +15.5 years of age, 84% male, 81%
Vermont Center on Behavior & Health: 2015 Annual Conference
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Caucasian). 61% endorsed a lifetime prevalence of ever vaping. However, less than 40%
reported vaping in the past 30 days, and less than 20% reported vaping more than 100 times in
their lives. Few participants (12.6%) endorsed vaping as their current preferred method of
cannabis use. Those who prefer vaping consider it to be a safer, more positive experience than
smoking, which raises potential concerns for increasing problematic cannabis use. Individuals
living in states with medical marijuana laws were more likely to report vaping and a preference
for vaping. In summary, many cannabis users have initiated vaping, but currently few are vaping
frequently and few indicate that it is has become their primary method of use. Changes in
marijuana legalization and concomitant increased availability of vaping devices may further
impact vaping prevalence and use patterns, underscoring the need for continued monitoring of
this alternative method of cannabis administration, and increased research on its impact.
27.
Variation in Screening Mammography Utilization According to Sociodemographics in Vermont
K. Olson1, B. L. Sprague2, T. A. James3
1
College of Medicine, University of Vermont, 2Department of Surgery and Office of Health
Promotion Research, University of Vermont, 3Division of Surgical Oncology, Department of
Surgery, University of Vermont
Since 1987, self-reported screening mammography rates in the US have risen, and breast
cancer related deaths decreased by 34% since 1990. Despite this favorable trend, there are still
population subgroups with sub-optimal screening rates. This study seeks to determine how
screening mammography rates in Vermont vary by sociodemographics. We calculated
screening mammography rates using the Vermont Breast Cancer Surveillance System
screening counts for 2009-2013 and the American Community Survey 2013 five year population
estimates. Based on 95% confidence intervals, screening rates varied significantly according to
ethnicity and education level. Compared to other ethnicities, Black women had lowest screening
mammography rates while Other/Multiethnic and Hispanic women had the highest
mammography screening rates. Women with a college or post graduate education had highest
screening utilization and women with only some college or technical degree had the lowest
screening mammography utilization, when comparing education groups. Weighted linear
regression on ZCTA level screening rates versus SES factors revealed that women in
communities with higher percentage of Medicaid enrollees or unemployed residents had lower
screening rates and women in communities with higher median income or higher percentage of
foreign born nationals had higher screening rates (p<0.05, Pearson correlation coefficient).
Within Chittenden County, however, lower rates of screening for women aged 50-74 were
observed in neighborhoods with a high percentage of foreign born nationals (p<0.10, Pearson
correlation coefficient). These results show there is variability in Vermont’s screening
mammography rates based on sociodemographics
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28
In- and Out-of-Session Assessment of Motivation and Self-Efficacy to Change Chronic Heavy
Drinking: Preliminary Findings from a Moderation-Based Psychotherapy Study
J. Houser1, A. Kuerbis2, P. Amrhein3, S. Shao1, & J. Morgenstern1
1
North Shore Long Island Jewish Health System, 2Hunter College, City University of New York,
3
Montclair State University
Motivational Interviewing (MI) is empirically based, widely disseminated, and has broad
applications for behavior change, including preventing the progression of chronic, heavy
drinking. Despite considerable support for the role of in-session statements of motivation and
self-efficacy on reducing drinking, the relationship between in-session statements and out-ofsession reports of commitment and confidence remains unknown.
The current study aims to characterize the relationship between in- and out-of-session
statements of commitment and confidence to change in the context of a psychotherapy study for
problem drinkers attempting to moderate. This study is nested within a larger disaggregation
study of MI in which participants were randomly assigned to one of three conditions: (1) Full MI,
(2) relational MI without directive elements, or (3) a self-change control condition. Both
treatment groups received 4 sessions of psychotherapy over 8 weeks. Data from both treatment
groups will be presented on in-session statements from the first two sessions of MI as well as
ecological momentary assessment ratings of out-of-session commitment and confidence to not
drink heavily.
We hypothesize that treatment condition will moderate the relationship between in- and out-ofsession statements of motivation and self-efficacy such that: 1) condition will predict in-session
statements, 2) condition will have no effect on out-of-session statements, 3) in- and out-ofsession statements will be positively correlated, and 4) in-session statements will predict out-ofsession statements only in the full MI condition. Findings are expected to further elucidate the
relationship between treatment, motivation, self-efficacy, and multimodal assessment in the
context of attempting to change problematic drinking behaviors.
29.
Aging and Substance Use
B. A. Kleykamp
Pinney Associates, Inc. Bethesda, MD
Disclosures: PinneyAssociates is a health-care consulting firm whose clients are predominantly
pharmaceutical companies across all stages of a medicine’s life-cycle—from early development,
through regulatory approval and post-marketing. We do work on prescription to over-thecounter switch, and on risk management and abuse liability support for psychoactive medicines
(such as ADHD stimulants and potent analgesics). We also work on tobacco harm minimization
(including nicotine replacement therapy and digital vapor products) for Niconovum USA, RJ
Reynolds Vapor Company, and RAI Services Company, all subsidiaries of Reynolds American
Inc. PA has consulted to GlaxoSmithKline Consumer Healthcare and NJOY in the past.
Abstract: The older adult population (> 65 years) is projected to nearly double between 2012
and 2050 (43.1 million to 83.7 million) (Ortman et al., 2014). Recent commentaries and reviews
have also noted that substance use and abuse among the older adult population is a growing
concern (Dowling et al., 2008; Han et al., 2009; Kleykamp and Heishman, 2011; Rosen et al.,
2013; Wu and Blazer, 2011). Indeed, despite declines in overall current cigarette smoking
prevalence between 2005 to 2013 for most age groups (18 – 24 years, 24.4% to 18.7%; 25-44
years, 24.1% to 20.1%; 45 to 64 years, 21.9% to 19.9%), rates among older smokers increased
Vermont Center on Behavior & Health: 2015 Annual Conference
General Poster Session
during the same time period (8.6% to 8.8%) (Jamal et al., 2014). Similar age cohort differences
have been reported for prescription opioids – rates of overdose deaths increased by more than
seven-fold between 1999 to 2013 for adults aged 55-64 (CDC, 2015) and inpatient
hospitalizations involving opioid overuse have increased by 9% yearly between 1993 to 2012
(Owens et al., 2014). A growing older adult population with increasing rates of substance use
and abuse presents a unique concern for researchers and clinicians. That is, this age cohort
includes unique characteristics that might complicate treatment including comorbid illnesses,
age-related changes in drug metabolism and cognitive function, and use of multiple prescription
drugs. This poster will provide an overview of these and other concerns in an effort to prompt
further research that can better guide clinical decision making with regards to older adults and
substance use.
30.
Learning not to make the response during operant extinction
M. E. Bouton, S. Trask, and R. Carranza-Jasso
Department of Psychological Science, University of Vermont
In operant extinction, an operant behavior decreases in strength or frequency when it is no
longer reinforced. Historically, the main explanations of operant extinction have emphasized the
loss of stimulus or motivational support when the reinforcer is withdrawn. Here we present
evidence, however, that operant extinction involves actively learning to inhibit the response. The
experiments used a discriminated operant procedure in which rats were reinforced for lever
pressing or chain pulling in the presence of a discriminative stimulus (S), but not in its absence.
In one experiment, extinction of the response (R) in the presence of S weakened responding in
S, but equivalent extinction exposure to S without the opportunity to make R did not. In other
experiments, rats learned to perform several different combinations of stimulus and response
(S1R1, S2R1, S3R2, and S4R2). Extinction of a response in one stimulus (i.e., S1R1)
transferred and weakened the same response, but not a different response, when it was tested
in another stimulus (i.e., S2R1 but not S3R2). The transfer of response inhibition also occurred
when S1 and S2 set the occasion for R’s association with different food reinforcers. The results
suggest that the organism needs to make the response in extinction to achieve effective operant
extinction, and that the response inhibition that results can inhibit the response when it is
occasioned by other discriminative stimuli.
31.
Predicting cannabis use in adolescence using multimodal brain and phenotype data
Philip A. Spechler1, Bader Chaarani1, Robert Whelan2, Stephen Higgins1,
Hugh Garavan1, & the IMAGEN consortium
1
Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont,
2
School of Psychology, University College Dublin, Ireland
Cannabis use in adolescence may be driven by a complex profile of biological, behavioral and
environmental measures. However, identifying generalizable predictors of future use is often
compromised due to overfitting regression models in studies with low sample sizes. In this large
sample of cannabis-naïve and future-cannabis users (N=1389), we applied ten-fold crossvalidated logistic regression with elastic-net regularization to numerous brain and phenotypic
measures to generate models that predict future cannabis use. All analyses were based on
data obtained at age 14 prior to cannabis use. The predictive value of the model was assessed
using an ROC curve, employing the area under the curve (AUC) as an index of the ability of a
Vermont Center on Behavior & Health: 2015 Annual Conference
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model to predict future cannabis use in the set-aside test data. The final models returned an
AUC=0.80, indicating relatively high predictive ability. Thirteen predictors were found in all ten
folds, and included various stressful life-event and personality measures, as well as being male,
lifetime alcohol and cigarette use, parental cannabis use and increased total gray matter
volume. Separate analyses conducted just on the neuroimaging data returned an AUC=0.58
and identified numerous functional and structural brain measures to predict future cannabis use.
In sum, we describe a machine learning technique to identify the predictors of adolescent
cannabis use from a large longitudinal study. Our analyses indicate that a range of phenotypic
variables obtained two years earlier can predict cannabis use at age 16. Identifying a predictive
profile suggests possible etiological mechanisms and targets for proactive intervention.
32.
Development and factor analysis of a comprehensive Behavioral Risk Assessment for Infectious
Diseases (BRAID)
E. Herrmann1, F. Barrett1, J. Plebani2, S. Sigmon3, M. Johnson1 and K. Dunn1
1
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 2Department of
Psychiatry, University of Pennsylvania, 3Departments of Psychiatry and Psychology, University
of Vermont
Substance users engage in infectious disease risk behaviors. The most frequently used risk
behavior assessments do not represent current knowledge about infectious disease risk. Our
aim is to develop a comprehensive Behavioral Risk Assessment for Infectious Diseases
(BRAID) that measures multiple domains of risk behavior. Participants in Sample 1 (n=270)
competed the BRAID and an infectious disease history questionnaire. Thirty core BRIAD items
were selected for factor analyses. We identified a 13-item solution based on five factors:
Unprotected sex with risky partners, Injection/opioid use, Sex on cocaine/crack, Condom
availability, and Intranasal drug use. Structural equation modeling demonstrated that scores on
injection/opioid use and intranasal drug use factors predicted the number of infectious diseases
participants had been diagnosed with. Data were collected from a second, larger sample
(n=728) using Amazon Mechanical Turk. Confirmatory factor analysis demonstrated the factor
structure was consistent across groups. In summary, we developed a brief, psychometricallysound measure of infectious disease risk that is valid across a broad spectrum of substance
users. The BRAID will significantly enhance efforts to assess risk behavior and will enable more
accurate assessment of the efficacy of risk reduction interventions, particularly among noninjectors. Support: R01DA032363, R21DA026967, T32DA07209
33.
Directly Measured Physical Function in Cardiac Rehabilitation
J. Rengo
University of Vermont Medical Center
Introduction: The Short Physical Performance Battery (SPPB) is a strong predictor for risk of
physical disability in older adults. Roughly half of participants in phase II cardiac rehabilitation
(CR) are > 65 years of age, many presenting with low aerobic capacities and may be at
increased risk for physical disability. Methods: Functional status, as measured by SPPB, and
the response to exercise training in older CR patients was assessed in 196 consecutive patients
aged >65 years entering CR. Aerobic fitness was directly measured (VO2peak, n=111) or
indirectly determined from exercise tolerance tests. Results: Baseline SPPB was 9.7+0.2 (out
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of 12). Follow-up data was obtained on 133 (68%) patients with a mean improvement of
0.8+0.1 (p<0.0001), which did not reach the threshold for clinical significance (>1 point).
When patients were stratified by baseline SPPB, 72 subjects scored below 10 (7.1+0.2).
Clinically meaningful improvements were found in gait speed (0.5+ 0.1, p<0.0001), chair-stand
(1.0+0.1, p<0.0001), and total SPPB (1.6+0.3, p<0.0001) (n=45). 124 patients scored 10 or
greater at baseline (11.2+0.1) with no meaningful improvements found at exit (n=88). VO2peak
was significantly lower in patients with SPPB below 10 (13.5+0.4 vs 17.5+0.4 ml/kg/min,
p<0.0001).VO2peak (R2=26%, p<0.0001) and sf-36 physical function score (R2= 5%, p=0.02)
were the only significant independent predictors of functional status at baseline. Conclusion:
37% of older CR patients have low SPPB scores and show improvements in walking speed and
chair-stand (leg strength) following exercise training. The SPPB is less useful in individuals with
good aerobic fitness as higher VO2peak was associated with high SPPB.
34.
Relapse after Incentivized Choice Treatment in a New Animal Model
C. Bergeria, D. Davis, E. Thrailkill, and M. E. Bouton
Department of Psychological Science, University of Vermont
Resurgence is the recovery of an extinguished operant behavior (R1) that occurs when a
second behavior (R2) that replaced R1 undergoes extinction. Laboratory studies of resurgence
can inform Contingency Management (CM) interventions, which similarly introduce an
alternative behavior to replace or suppress an unwanted behavior, by helping to identify
parameters of a CM intervention (length of intervention, leaning schedules of reinforcement at
the end of the intervention) that might lead to the lowest rates of relapse. Past laboratory
resurgence experiments have extinguished R1 when introducing the alternative behavior (R2).
This model may not be the most accurate representation of CM, however, since R1 (e.g., drug
taking) is not extinguished in the real world. Two laboratory experiments with rats were therefore
conducted using a modified model in which R2 was introduced and reinforced, but R1 was
never extinguished. To study relapse, we also examined the return to R1 that occurred when
reinforcement of R2 (“CM”) was discontinued. In the first experiment, R1 was reinforced on a
variable interval schedule. After R1 was acquired, R2 was introduced on a variable interval
schedule and was reinforced with different reinforcer magnitudes (none, small, medium, and
large) in different groups. In the second experiment, the procedure was identical, except that R1
was reinforced on a random ratio schedule of reinforcement. In both experiments, large
reinforcers for R2 in the treatment phase were effective at suppressing R1. The largest
magnitude was also effective at reducing the number of reinforcers earned for R1. When R2
reinforcement was discontinued, responding to R1 resurged (relapsed) after all reinforcement
magnitudes for R2. The increase in responding was arguably greatest for the group that had
received the largest R2 reinforcers, but the overall rate of R1 responding (though not R1’s
reinforcement rate) remained lower than that of the other magnitude conditions. The results
support previous findings favoring large magnitude reinforcers during CM interventions, even
though relapse may be inevitable. The new animal model may be useful in the future to study
other strategies that can influence the rate of relapse after CM treatments.