Browsing by Author "Trestman, Robert L."
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- Almost Everything We Need to Better Serve Children of the Opioid Crisis We Learned in the 80s and 90sHorn, Kimberly A.; Pack, Robert P.; Trestman, Robert L.; Lawson, Gerard F. (Frontiers, 2018-10-16)Opioid use disorder impedes dependent parents' abilities to care for their children. In turn, children may languish in unpredictability and persistent chaos. Societal responses to these children are often guided by a belief that unless the drug dependent parent receives treatment, there is little help for the child. While a preponderance of the drug dependence research is adult-centric, a significant body of research demonstrates the importance of not only addressing the immediate well being of the children of drug dependent caregivers but preventing the continuing cycle of drug dependence. The present commentary demonstrates through a brief review of the US history of drug dependence crises and research from the 1980s and 1990s, a range of "tried and true" family, school, and community interventions centered on children. We already know that these children are at high risk of maladjustment and early onset of drug dependence; early intervention is critical; multiple risk factors are likely to occur simultaneously; comprehensive strategies are optimal; and multiple risk-focused strategies are most protective. Where we need now to turn our efforts is on how to effectively implement and disseminate best practices, many of which we learned in the 1980s and 1990s. The greatest opportunity in both changing the nature of the opioid epidemic at scale and influencing rapid translation of existing research findings into policy and practice is not in asking what to do, but in asking how to do the right things well, and quickly.
- Cognitive and Affective Pathways to Nonsuicidal Self-Injury Among Youth in the Adolescent Brain Cognitive Development (ABCD) StudyAntezana, Ligia Danitsa (Virginia Tech, 2022-07-07)Nonsuicidal self-injury (NSSI) is the deliberate destruction of one's own body tissue (e.g., cutting, skin picking, biting, hitting) without conscious suicidal intent. Cognitive and affective difficulties may contribute to the development and maintenance of NSSI, such that emotion regulation may mediate the link between cognitive control difficulties and NSSI in youth. This study examined developmental links between cognitive control and emotion regulation on several facets of self-injurious thoughts and behaviors in a large sample of youth, collected via the ABCD Study (N=6447). Although a mediation of emotion regulation on cognitive control and self-injurious thoughts and behaviors was not supported, important direct effects were found between neural correlates of inhibition (at ages 9-10 years) on NSSI at 11-12 years, and behavioral measures of cognitive flexibility (at 10-11 years) and inhibition (at 9-10 years) on suicidality at 11-12 years. Further, links between poorer cognitive control and poorer emotion regulation were found. An exploratory aim of this study was examining the potential moderating role of autistic traits on significant associations. Although greater autistic traits significantly predicted presence of self-injurious thoughts and behaviors, this study did not find a moderation of autistic traits. These results provide developmental risk markers for NSSI and suicidality in youth.
- Cumulative Vulnerabilities: Substance Use in Adolescence and in RecoveryTomlinson, Devin Christine (Virginia Tech, 2023-07-27)Substance use and substance use disorders (SUDs) pose a significant health and economic concern in the United States. Conditions and comorbidities exist that are associated with substance use onset, continuation, and outcomes. In the theory of Reinforcer Pathology, we can categorize these conditions into vulnerabilities, or factors that may be associated with susceptibility to substance use onset and poorer outcomes in substance use recovery. The theory of vulnerabilities and reinforcer pathology is tested through three investigations. The first investigation sought to establish the relationship between cumulative vulnerabilities and adolescent substance use in a cross-sectional analysis. The second investigation evaluates the temporal relationship of cumulative vulnerabilities and substance use among adolescents. The final investigation establishes the relationship of cumulative vulnerabilities and substance use among individuals in recovery from Opioid Use Disorder. Collectively, these reports suggest that the intersection and cumulation of vulnerabilities to substance use and substance use disorders are directly related to substance use outcomes. Future research and reports in the substance use domain should consider these constructs, their accumulation, and their co-occurrence patterns.
- The Impact of Pain on Key Outcomes in Opioid Use Disorder RecoveryCraft III, William Hugh (Virginia Tech, 2023-07-24)Opioid misuse and addiction constitute a significant public health challenge in the 21st century, with opioids involved in the majority of drug overdose deaths since 1999. A vigorously researched area that contributes substantially to the opioid misuse and addiction challenge is pain. The impact of pain, however, on important health outcomes for individuals in recovery from opioid use is less well understood. The effects of pain on substance use and mental health outcomes was investigated among individuals in recovery from opioid use disorder. Two studies are reported. First, the relationships between pain status and severity on substance use, treatment utilization, and mental health outcomes (e.g., depressive symptoms) was characterized cross-sectionally. Second, subgroups of OUD recovery defined by depression, opioid withdrawal, and pain were identified. Relationships between recovery subgroups, OUD symptoms, remission, opioid use, and quality of life were assessed. Finally, transitions among subgroups across 4 years of recovery were characterized. The present findings support pain as a key dimension of opioid use disorder recovery, highlighting the distinction between acute and chronic pain, the dynamic nature of opioid use disorder recovery, and emphasizing the necessity of integrating pain into opioid use disorder treatment.
- Low availability, long wait times, and high geographic disparity of psychiatric outpatient care in the USSun, Ching-Fang; Correll, Christoph U.; Trestman, Robert L.; Lin, Yezhe; Xie, Hui; Hankey, Maria Stack; Uymatiao, Raymond Paglinawan; Patel, Riya T.; Metsutnan, Vemmy L.; McDaid, Erin Corinne; Saha, Atreyi; Kuo, Chin; Lewis, Paula; Bhatt, Shyam H.; Lipphard, Lauren Elizabeth; Kablinger, Anita S. (Elsevier, 2023-09-01)Objective: To identify potential barriers to care, this study examined the general psychiatry outpatient new appointment availability in the US, including in-person and telepsychiatry appointments, comparing results between insurance types (Medicaid vs. private insurance), states, and urbanization levels. Method: This mystery shopper study investigated 5 US states selected according to Mental Health America Adult Ranking and geography to represent the US mental health care system. Clinics across five selected states were stratified sampled by county urbanization levels. Calls were made during 05/2022–07/2022. Collected data included contact information accuracy, appointment availability, wait time (days), and related information. Results: Altogether, 948 psychiatrists were sampled in New York, California, North Dakota, Virginia, and Wyoming. Overall contact information accuracy averaged 85.3%. Altogether, 18.5% of psychiatrists were available to see new patients with a significantly longer wait time for in-person than telepsychiatry appointments (median = 67.0 days vs median = 43.0 days, p < 0.01). The most frequent reason for unavailability was provider not taking new patients (53.9%). Mental health resources were unevenly distributed, favoring urban areas. Conclusion: Psychiatric care has been severely restricted in the US with low accessibility and long wait times. Transitioning to telepsychiatry represents a potential solution for rural disparities in access.
- New-Onset Psychotic Symptoms Following Abrupt Buprenorphine/Naloxone Discontinuation in a Female Patient with Bipolar Disorder: A Case ReportLin, Yezhe; Zhang, Alexander D.; Sun, Ching-Fang; White, Justin B.; Qi, Ansi; Farrell, Jessica A.; Trestman, Robert L.; Martin, Rachel K.; Kablinger, Anita S. (2022)Buprenorphine and naloxone (Suboxone) is a combination medication-assisted treatment (MAT) for opioid use disorder. MAT withdrawal-induced psychosis is a rare clinical presentation. To our best knowledge, only three reports have summarized the characteristic manifestations of buprenorphine withdrawal psychosis, yet all of them were male. In this case report, we present a 41-year-old female patient with bipolar disorder and comorbid substance use disorder who developed new-onset psychosis and relapse of manic symptoms following abrupt discontinuation of Suboxone. Manic and psychotic symptoms remitted after a short-term hospitalization with the treatment of an antipsychotic and a mood stabilizer. In addition to discussing this case presentation and treatment approach, we review existing literature and discuss possible underlying mechanisms to enhance understanding of this clinical phenomenon. Psychopharmacology Bulletin.
- Psychiatric comorbidities in children with conduct disorder: a descriptive analysis of real-world dataBrown, Tashalee R.; Kablinger, Anita S.; Trestman, Robert L.; Bath, Eraka; Rogers, Cynthia; Lin, Binx Yezhe; Xu, Kevin Young (BMJ, 2024-04-18)
- START NOW: An Effective Mental Health InterventionTrestman, Robert L.; Truong, Albert Y.; Kablinger, Anita S.; Hartman, David W.; McNamara, Robert S.; Seidel, Richard W.; Hartman, Cheri W.; Sylvester-Johnson, Anders (Scientia, 2021-10-28)Dr. Robert Trestman, at the Carilion Clinic and Virginia Tech Carilion School of Medicine, has co-developed START NOW, a successful group psychotherapy intervention specifically targeting mental health issues in prisoners. It combines elements of cognitive behavioral therapy to form skills-based learning. Furthermore, START NOW is easily accessible, cost-effective, and designed for use in settings with limited resources. Due to its success within correctional institutions, START NOW is being adapted for use in fields such as adolescent conduct issues and opioid misuse.
- Systematic content analysis of patient evaluations of START NOW psychotherapy reveals practical strategies for improving the treatment of opioid use disorderTruong, Albert Y.; Saway, Brian F.; Bouzaher, Malek H.; Rasheed, Mustafa N.; Monjazeb, Sanaz; Everest, Soleille D.; Giampalmo, Susan L.; Hartman, David; Hartman, Cheryl; Kablinger, Anita S.; Trestman, Robert L. (2021-01-10)Background Clinical trials provide consistent evidence for buprenorphine’s efficacy in treating opioid use disorder (OUD). While the Drug Addiction Treatment Act of 2000 requires physicians to combine medication-assisted treatment (MAT) with behavioral intervention, there is no clear evidence for what form or elements of psychotherapy are most effective when coupled with MAT to treat OUD. This investigation involves focus groups designed to collect patient opinions about a specific psychotherapy, called START NOW, as well as general beliefs about various elements of psychotherapy for treating OUD. Our analysis reveals trends about patient preferences and strategies for improving OUD treatment. Methods Subjects included patients enrolled in buprenorphine/naloxone MAT at our institution’s office-based opioid treatment program. All subjects participated in a single START NOW group session, which was led by a provider (physician or nurse practitioner trained and standardized in delivering START NOW). Consented subjects participated in satisfaction surveys and audio-recorded focus groups assessing individual beliefs about various elements of psychotherapy for treating OUD. Results Overall, 38 different focus groups, 92 participation events, and 44 unique subjects participated in 1-to-6 different START NOW session/audio-recorded focus group sessions led by a certified moderator. Demographic data from 36/44 subjects was collected. Seventy-five percent (33/44) completed the START NOW Assessment Protocol, which revealed self-reported behavioral trends. Analysis of all 92 START NOW Satisfaction Questionnaire results suggests that subjects’ opinions about START NOW improved with increased participation. Our analysis of audio-recorded focus groups is divided into three subsections: content strategies for new psychotherapies, implementation strategies, and other observations. For example, participants request psychotherapies to target impulsivity and to teach future planning and build positive relationships. Conclusions The results of this study may guide implementation of psychotherapy and improve the treatment of OUD, especially as it relates to improving the modified START NOW program for treating OUD. Our study also reveals a favorable outlook of START NOW with increased participation, suggesting that any initial reticence to this program can be overcome to allow for effective implementation.