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Scholarly Works (4 results)

  • Thesis
  • Peer Reviewed
UCLA Electronic Theses and Dissertations (2018)

Mental health in young adulthood is the strongest predictor of mental health in adulthood. Mental health vulnerabilities present in young adulthood can be exacerbated by marijuana use, thus potentially hindering or delaying a successful transition to adulthood. Considering motives of marijuana use may provide insight into the associations between marijuana use and mental health in young adults.

The purpose of this dissertation was to: 1) understand the associations between motives of marijuana use and symptoms of depression, symptoms of anxiety, and overall psychological distress in young adults, and 2) examine whether these associations vary by gender. Data come from the Cannabis, Health and Young Adult Study (N=366), a longitudinal study of young adults, in Los Angeles, who use marijuana for medical and/or recreational purposes.

Exploratory and confirmatory analyses were performed to validate the factor structure of the instrument used to operationalize motives of marijuana use for the study. Multiple linear regressions were used to determine how motives of use are associated to mental health outcomes. Indirect effects between motives of use and mental health outcomes through frequency of use were also assessed. Finally, gender was tested as a moderator for both direct and indirect associations between motives of use and mental health outcomes.

Results validate the factor structure of the amended Comprehensive Marijuana Motive Questionnaire. Furthermore, results indicate that the coping motive of use is positively, significantly associated with mental health outcomes. The motives of conformity, pain, and attention are indirectly associated with symptoms of depression through frequency of use. Gender influences the association between the motive of social anxiety with symptoms of depression and overall psychological distress whereas women who endorse this motive of use report more symptoms of depression and overall psychological distress than men. None of the moderated mediation analyses were significant.

These results emphasize the importance of considering motive of use in the development of interventions targeting marijuana use and mental health in young adults. These findings also highlight the need for gender specific interventions as men and women engage in use differently, and with different consequences to their mental health.

    Cover page: How are Motives of Marijuana Use Associated with Symptoms of Depression, Symptoms of Anxiety, and Overall Psychological Distress in Young Adults of Los Angeles?
    • Article
    • Peer Reviewed
    UCLA Previously Published Works (2018)
    Alcohol consumption is a major risk factor for the acquisition of HIV/AIDS and is associated with greater disease burden and mortality among those who become HIV-infected. Of the extant pharmacological treatments for alcohol use disorders, naltrexone is recognized as one of the most efficacious, producing robust reductions in alcohol craving and use. Given that treatment with oral naltrexone has been limited by problems with adherence, which are particularly prevalent among individuals with multiple chronic, co-occurring conditions, long-acting formulations may be a promising approach for HIV-infected substance users. However, little is known about the barriers to initiation of extended-release naltrexone (XR-NTX) treatment among alcohol users living with HIV. In this report we present and discuss the content analysis of open-ended survey questions, as well as lessons learned, with regards to barriers to initiation and maintenance of XR-NTX treatment collected as part of an RCT evaluating a cognitive behavioral text messaging intervention for HIV-infected adults with alcohol use disorders. Barriers to initiation and maintenance of XR-NTX pharmacotherapy among HIV+ individuals with alcohol use disorders seem to fall in one of two categories: [1] barriers that are amenable to change, which include distance and transportation issues, fear of injections, and belief that alcohol use does not warrant pharmacotherapy, and [2] barriers that are not amenable to change, such as the potential interaction of XR-NTX with another medication regimen.
      Cover page: Barriers to initiation of extended release naltrexone among HIV-infected adults with alcohol use disorders.
      • Article
      • Peer Reviewed
      UCLA Previously Published Works (2016)

      Background

      Evidence-based psychosocial interventions for addictions and related conditions such as cognitive behavioral therapy (CBT) are underutilized. Obstacles to implementation of CBT in clinical settings include limited availability of quality training, supervision, and certification in CBT for clinicians; high rates of clinician turnover and high caseloads; and limited qualifications of the workforce to facilitate CBT expertise.

      Objective

      Mobile phone-based delivery of CBT, if demonstrated to be feasible and effective, could be transformative in broadening its application and improving the quality of addiction treatment. No experimental interventions that deliver CBT targeting both drug use and medication adherence using text messaging have been previously reported; as such, the objective of this study is to develop and test an SMS-based treatment program for HIV-positive adults with comorbid substance use disorders.

      Methods

      With user input, we developed a 12-week CBT-based text messaging intervention (TXT-CBT) targeting antiretroviral (ART) adherence, risk behaviors, and drug use in a population of HIV-infected substance users.

      Results

      The intervention has been developed and is presently being tested in a pilot randomized clinical trial. Results will be reported later this year.

      Conclusions

      This investigation will yield valuable knowledge about the utility of a cost-effective, readily deployable text messaging behavioral intervention for HIV-infected drug users.
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2020)

        Background

        Integrating behavioral health in primary care is a widespread endeavor. Yet rampant variation exists in models and approaches. One significant question is whether frontline providers perceive that behavioral health includes substance use. The current study examined front line providers': 1. definition of behavioral health, and 2. levels of comfort treating patients who use alcohol and other drugs. Frontline providers at two primary care clinics were surveyed using a 28-item instrument designed to assess their comfort and knowledge of behavioral health, including substance use. Two questions from the Integrated Behavioral Health Staff Perceptions Survey pertaining to confidence in clinics' ability to care for patients' behavioral health needs and comfort dealing with patients with behavioral health needs were used for the purposes of this report. Participants also self-reported their clinic role. Responses to these two items were assessed and then compared across roles. Chi square estimates and analysis of variance tests were used to examine relationships between clinic roles and comfort of substance use care delivery.

        Results

        Physicians, nurses/nurse practitioners, medical assistants, and other staff (N = 59) participated. Forty-nine participants included substance use in their definition of behavioral health. Participants reported the least comfort caring for patients who use substances (M = 3.5, SD = 1.0) compared to those with mental health concerns (M = 4.1, SD = 0.7), chronic medical conditions (M = 4.2, SD = 0.7), and general health concerns (M = 4.2, SD = 0.7) (p < 0.001). Physicians (M = 3.0, SD = 0.7) reported significantly lower levels of comfort than medical assistants (M = 4.2, SD = 0.9) (p < 0.001) caring for patients who use substances.

        Conclusions

        In a small sample of key stakeholders from two primary care clinics who participated in this survey, most considered substance use part of the broad umbrella of behavioral health. Compared to other conditions, primary care providers reported being less comfortable addressing patients' substance use. Level of comfort varied by role, where physicians were least comfortable, and medical assistants most comfortable.
          Cover page: What constitutes “behavioral health”? Perceptions of substance-related problems and their treatment in primary care
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