Centering culture in the treatment of opioid use disorder with American Indian and Alaska Native Communities: Contributions from a National Collaborative Board

American Indian/Alaska Native (AI/AN) communities are disproportionally impacted by the opioid overdose epidemic. There remains a dearth of research evaluating methods for effectively implementing treatments for opioid use disorder (OUD) within these communities. We describe proceedings from a 2-day Collaborative Board (CB) meeting tasked with developing an implementation intervention for AI/AN clinical programs to improve the delivery of medications to treat OUD (MOUD). The CB was comprised of Elders, cultural leaders, providers, individuals with lived experience with OUD, and researchers from over 25 communities, organizations, and academic institutions. Conversations were audio-recorded, transcribed, and coded by two academic researchers with interpretation oversight provided by the CB. These proceedings provided a foundation for ongoing CB work and a frame for developing the program-level implementation intervention using a strength-based and holistic model of OUD recovery and wellbeing. Topics of discussion posed to the CB included engagement and recovery strategies, integration of extended family traditions, and addressing stigma and building trust with providers and clients. Integration of traditional healing practices, ceremonies, and other cultural practices was recommended. The importance of centering AI/AN culture and involving family were highlighted as priorities for the intervention.     

Fixed-interval limited-hold avoidance with and without signalled reinforcement

Rats trained to lever press on a fixed-interval limited-hold avoidance schedule maintained a pattern of responding similar to that maintained by fixed-interval limited-hold schedules of positive reinforcement. But this positively accelerated pattern of behavior was maintained only when the occurrence of reinforcement was signalled by the presentation of a brief flash of light. This result suggests that the discriminative function of the reinforcer in avoidance is less pronounced than the discriminative function of the reinforcer in escape or positive reinforcement. It also suggests that the distinction between positive reinforcement and avoidance is not superfluous. Although the schedule of reinforcement is an important variable in determining the pattern of behavior, other variables, such as the nature (i.e., stimulus presentation, termination, or omission) of the reinforcer, are also potent determinants of behavior.     

Semantic satiation in healthy young and older adults

In four experiments, semantic satiation was investigated in young and old adults. In the first two experiments, subjects were repeatedly presented a word (e.g.,dog) and then were presented a pair of words (e.g.,dog-cat ordog-chair) for a relatedness decision. The results of both experiments indicated that for the young adults, the relatedness effect (the difference between response latency on related and unrelated trials) decreased as a function of the number of times the satiated word was repeated, whereas for the older adults, there was no evidence of a decrease in the relatedness effect across repetitions of the satiated word. In the third experiment, we investigated whether phonological codes are also susceptible to satiation. This experiment was similar to the first two experiments with the exception that subjects made rhyme decisions (same-claim vs.same-dime) instead of semantic relatedness decisions. The results of this experiment did not yield any evidence of satiation for either the young adults or the older adults. The final experiment eliminated a simple decrease in attentional alertness or fatigue account of the semantic satiation effects found in the first two experiments. In this experiment, the repeated word was always unrelated to the pair of words presented for the relatedness decision. The results of this experiment did not yield any evidence of semantic satiation for either the young or the older adults. The discussion focuses on the mechanisms underlying semantic satiation and the implications of age-related changes in these mechanisms.     

Effects of Acute Stress or Centrally Injected Interleukin-1beta on Neuropeptide Expression in the Immune System

Acute stress stimulates the expression and release of corticotropin-releasing hormone (CRH) and arginine vasopressin (AVP) from the hypothalamus, and the pro-opiomelanocortin products beta-endorphin and ACTH from the anterior pituitary. These neuropeptides are also expressed in immune tissues, and it has been proposed that they may modulate immune responses to stress through paracrine mechanisms. We subjected rats to restraint stress or central injection of interleukin (IL)-1beta to determine whether these acute stimuli can alter the expression of neuropeptides in the spleen and thymus. Restraint stress significantly increased the contents of all these neuropeptides in thymic, but not splenic, extracts. A single icv injection of IL-1beta increased contents of CRH, AVP, ACTH and beta-endorphin in the spleens of both sham-operated and adrenalectomised (ADX) rats. IL-1beta increased thymic contents of CRH and ACTH in sham-operated rats but these increases were not observed in ADX rats. These results suggest that the effects of IL-1beta on neuropeptide expression in the spleen are independent of glucocorticoids, whereas IL-1beta stimulation of neuropeptide expression in the thymus is dependent on circulating glucocorticoids. There were significant correlations between increases in CRH, ACTH and beta-endorphin in the spleen, and between CRH and ACTH in the thymus, consistent with the suggestion that IL-1beta-induced increases in ACTH and beta-endorphin may be mediated through CRH. These results provide evidence that stressors can directly influence neuropeptide expression in immune tissues. Thus stress may influence immune functions through paracrine mechanisms involving locally synthesised neuropeptides as well as through activation of the hypothalamo-pituitary-adrenal axis.     

Anticipatory grief: The search for destiny

This paper explores the dynamics between a woman dying of cancer, the man she lived with for 37 years, and the clinician who worked with them during the final months of the woman's life. Psychoanalytic perspectives on transformational and transitional object-seeking as natural processes which aid the internalization of attachment to the one who is approaching death, the creation of a primary maternal preoccupation in the caretaker, the hospice as a holding environment, and the search for destiny as a metaphor for the work of anticipatory grief are integrated with the case-material.Presented at the American Academy of Religion Annual Meeting,Person, Culture and Religion Pre-session, November, 1991.     

A comparison of operant licking and lever pressing in the rat

Two groups of rats were trained on a signaled, free-operant, avoidance procedure to lick or to lever press in order to avoid shock while water-deprived or satiated and, in the case of licking, while ingesting deionized water, isotonic saline, or 10% sucrose. The most effective avoidance licking occurred while the rats were water-deprived and ingesting 10% sucrose. Water deprivation level had no effect on lever pressing for shock avoidance. Two other groups of rats were operantly conditioned to lick or to lever press for food pellets while waterdeprived or satiated and, in the case of licking, while ingesting deionized water or 10% sucrose. The most effective licking for food reinforcement occurred while the rats were water-deprived and ingesting 10% sucrose. Water deprivation level had no effect on lever pressing for food reinforcement. The data indicated that effective operant licking must be supported by factors related to water regulation and taste palatability.