The effect of stress on craving for methadone depends on the timing of last methadone dose

Background

This study examined the extent to which the timing of last methadone dose moderates the influence of a laboratory stressor on craving for methadone in a sample of methadone maintenance patients.

Methods

Methadone maintenance patients (N = 41) completed a computerized stress manipulation with two levels (low and high stress) on two separate days: (1) immediately following the administration of their standard daily methadone dose and (2) immediately prior to receiving their standard daily dose. The impact of stress, timing of methadone dose and their interaction were examined on self-report measures of stress and craving for methadone.

Results

Craving ratings varied according to the timing of last methadone dose. Immediately following methadone dose (i.e., day 1), there was no effect for stress on craving (0.12; p = 0.30). However, prior to receiving methadone dose (i.e., day 2), the high stress effect on craving was significant (1.51; p < 0.001).

Discussion

The present findings indicate that patients currently receiving methadone maintenance treatment may be particularly vulnerable to stress-related relapse immediately prior to daily methadone dosing.     

What Happens After the Demonstration Phase? The Sustainability of Canada's At Home/Chez Soi Housing First Programs for Homeless Persons with Mental Illness

This research examined the sustainability of Canada's At Home/Chez Soi Housing First (HF) programs for homeless persons with mental illness 2 years after the end of the demonstration phase of a large (more than 2000 participants enrolled), five‐site, randomized controlled trial. Qualitative interviews were conducted with 142 participants (key informants, HF staff, and persons with lived experience) to understand sustainability outcomes and factors that influenced those outcomes. Also, a self‐report HF fidelity measure was completed for nine HF programs that continued after the demonstration project. A cross‐site analysis was performed, using the five sites as case studies. The findings revealed that nine of the 12 HF programs (75%) were sustained, and that seven of the nine programs reported a high level of fidelity (achieving an overall score of 3.5 or higher on a 4‐point scale). The sites varied in terms of the level of systems integration and expansion of HF that were achieved. Factors that promoted or impeded sustainability were observed at multiple ecological levels: broad contextual (i.e., dissemination of research evidence, the policy context), community (i.e., partnerships, the presence of HF champions), organizational (i.e., leadership, ongoing training, and technical assistance), and individual (i.e., staff turnover, changes, and capacity). The findings are discussed in terms of the implementation science literature and their implications for how evidence‐based programs like HF can be sustained.     

How do women experience myocardial infarction? A qualitative exploration of illness perceptions, adjustment and coping

While UK Department of Health policy recognizes the importance of secondary prevention and rehabilitation following a cardiac event, there still appears a dearth of research addressing women's needs. This study aimed to explore adjustment in terms of women's perception of their cardiac event, impact on relationships and coping strategies employed. Five women suffering first time MI were interviewed, using a semi-structured format and were telephoned 2 months later. Data were analysed using Interpretative Phenomenological Analysis. Perceptions included: Making Sense of the Event, Cognitive and Emotional Responses and Self-beliefs. Relationships issues were: Others' Reactions and Change in Relationships and Roles. Cognitive and Behavioural strategies and Support from others (including cardiac rehabilitation) formed coping strategies. For most participants, the event was unexpected evoking uncertainty and later, emotions extending beyond the more widely accepted depression and anxiety. Women tended to minimize severity of symptoms and impact of event (perhaps as a way of coping and protecting others), displaying a strong sense of optimism and hope that life would soon return to "normal". However, it appeared this was difficult to maintain and the experience seemed to challenge relationships and roles. The findings suggest recommendations for further research with possible implications for clinical practice.     

Symptoms Among Partners,Family, and Friends of Individuals with Posttraumatic Stress Disorder: Associations with Social Support Behaviors,Gender, and Relationship Status

Social support represents an important recovery factor for individuals with posttraumatic stress disorder (PTSD). Nevertheless, partners, family, and friends who take on the role of caregiver for individuals with PTSD might face multiple difficulties. For example, they are at risk for developing anxiety and depressive symptoms, which could negatively affect their ability to offer support. This study examined the associations between the difficulties of individuals with PTSD (i.e., symptoms and level of functioning), their caregivers’ (partners, family, and friends) anxiety and depressive symptoms, and social support behaviors according to 2 variables: relationship status and gender. Sixty-five individuals with PTSD and either their partner, family member, or friend filled out questionnaires and participated in a trauma-oriented discussion. Social support behaviors were coded. Results revealed no associations between the difficulties of individuals with PTSD and their caregivers’ symptoms. However, caregivers’ depressive symptoms were negatively associated with the quality of some of their social support behaviors. Moreover, relationship status and gender were significant moderators, indicating stronger negative associations between anxiety and depressive symptoms and some social support behaviors of men and caregiving partners. Male caregivers could have difficulties offering appropriate support and responding to traditional masculine roles (e.g., being strong and self-reliant) when they report symptoms themselves. Partners are particularly involved in the everyday life of individuals with PTSD. Thus, they could have difficulties keeping an optimal emotional distance to offer support when they report symptoms themselves. Future directions as well as clinical implications are discussed.     

Changing the focus of attention: The interacting effect of valence and arousal

We examined how valence and arousal of an image influence visual attention. “Spotlight of attention” theory suggests that positive affect broadens, and negative affect narrows, one's aperture of attention, whereas the arousal theory literature suggests that arousal level is what modulates attentional focus, with highly arousing affect capturing attention, regardless of valence. In two experiments, a digit parity task was used to index the influence of valence, and arousal, on visual attention. Positive or negative images were displayed centrally on each trial, with single digits presented more peripherally (Experiment 1) or more centrally (Experiment 2) to the image. In both Experiments participants were slower, and less accurate at making parity decisions (e.g., both digits odd or both even) when the image was negative relative to positive, and of high arousal. For low arousal images, positive, relative to negative, valence images led to greater impairment of the digit parity task. Findings suggest that arousal level of images modulates the influence of valence on distribution of visual attention. Highly negative emotional images may command or capture attention, but there are other factors that can lead to attention capture, even in low arousing positive stimuli.     

Age-Related Changes in the use of Study Context to Increase Recollection

ABSTRACT

We examined how context presented at study affects recollection of words in younger and older adults. In Experiment 1, participants studied words presented with a picture of a face (context-rich condition) or a rectangle (context-weak condition), and subsequently made ‘Remember’, ‘Know’, or ‘New’ judgments to words presented alone. Younger, but not older, adults showed higher Remember accuracy following rich- than weak-context trials. In Experiment 2, we manipulated the type of processing engaged during the encoding of context–word pairs. Younger and older adults studied words presented with a picture of a face under a surface feature (gender) or binding feature (match) instruction condition. Both age groups showed higher Remember accuracy in the binding than surface instruction condition. Results suggest that providing rich contextual detail at encoding boosts later item recollection in younger adults. Older adults, however, do not spontaneously engage in the processes required to boost recollection, though instructional manipulation during encoding lessens this deficit.