Objective Opioid pharmacotherapy is now the leading treatment for chronic pain, a problem that affects nearly one-third of the United States population. Given the dramatic rise in prescription opioid misuse and opioid-related mortality, novel behavioral interventions are needed. The purpose of this study was to conduct an early stage randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), a multimodal intervention designed to simultaneously target mechanisms underpinning chronic pain and opioid misuse. Method Chronic pain patients (N=115; mean age = 48±14; 68% female) were randomized to 8 weeks of MORE or a Support Group (SG). Outcomes were measured at pre- and post-treatment, and at 3-month follow-up. The Brief Pain Inventory assessed changes in pain severity and interference. Changes in opioid use disorder status were measured by the Current Opioid Misuse Measure. Desire for opioids, stress, nonreactivity, reinterpretation of pain sensations, and reappraisal were also evaluated. Results MORE participants reported significantly greater reductions in pain severity (p = .038) and interference (p = .003) than SG participants, which were maintained by 3-month follow-up and mediated by increased nonreactivity and reinterpretation of pain sensations. Compared with SG participants, participants in MORE evidenced significantly less stress arousal (p = .034) and desire for opioids (p = .027), and were significantly more likely to no longer meet criteria for opioid use disorder immediately following treatment (p = .05); however, these effects were not sustained at follow-up. Conclusions Findings demonstrate preliminary feasibility and efficacy of MORE as a treatment for co-occurring prescription opioid misuse and chronic pain.

Mindfulness training may disrupt the risk chain of stress-precipitated alcohol relapse. In 2008, 53 alcohol-dependent adults (mean age = 40.3) recruited from a therapeutic community located in the urban southeastern U.S. were randomized to mindfulness training or a support group. Most participants were male (79.2%), African American (60.4%), and earned < $20,000 annually (52.8%). Self-report measures, psychophysiological cue-reactivity, and alcohol attentional bias were analyzed via repeated measures ANOVA. 37 participants completed the interventions. Mindfulness training significantly reduced stress and thought suppression, increased physiological recovery from alcohol cues, and modulated alcohol attentional bias. Hence, mindfulness training appears to target key mechanisms implicated in alcohol dependence, and therefore may hold promise as an alternative treatment for stress-precipitated relapse among vulnerable members of society.

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Prescription opioid misuse and addiction among chronic pain patients are emerging public health concerns of considerable significance. Estimates suggest that more than 10% of chronic pain patients misuse opioid analgesics, and the number of fatalities related to nonmedical or inappropriate use of prescription opioids is climbing. Because the prevalence and adverse consequences of this threat are increasing, there is a pressing need for research that identifies the biobehavioral risk chain linking chronic pain, opioid analgesia, and addictive behaviors. To that end, the current manuscript draws upon current neuropsychopharmacologic research to provide a conceptual framework of the downward spiral leading to prescription opioid misuse and addiction among chronic pain patients receiving opioid analgesic pharmacotherapy. Addictive use of opioids is described as the outcome of a cycle initiated by chronic pain and negative affect and reinforced by opioidergic-dopamingeric interactions, leading to attentional hypervigilance for pain and drug cues, dysfunctional connectivity between self-referential and cognitive control networks in the brain, and allostatic dysregulation of stress and reward circuitry. Implications for clinical practice are discussed; multimodal, mindfulness-oriented treatment is introduced as a potentially effective approach to disrupting the downward spiral and facilitating recovery from chronic pain and opioid addiction.

There has been considerable interest in the identification of putative subtypes of psychopathy over the past several years although none of this research has focused on juveniles who are high in psychopathic traits. Using a statewide sample of juvenile offenders, the present study sought to identify subtypes consistent with theoretical notions of primary and secondary psychopathy. Among those youths high in psychopathic traits ( n = 132), finite mixture modeling of various indicators of psychological distress resulted in a two-class solution. Consistent with theory, one subtype was characterized by higher levels of distress (e.g., anxiety, depression, suicidal ideation), whereas the other subgroup was lower on these dimensions and generally similar to nonpsychopathic control juveniles ( n = 135). Analyses of theoretically relevant external correlates (e.g., offense history, drug use, victimization) suggested that the two subtypes differed from each other on certain key variables as well as differed from the nonpsychopathic controls.

The scientific literature relevant to social work practice has grown expansively in recent years. Corollary developments, including the widespread availability of electronic bibliographic databases, improved indexing services, and increased acceptance of systematic reviews and evidence-based practice guidelines, have made research findings increasingly accessible to practitioners. For the first time in the history of the profession, social work educators are confronted with the challenges posed, and opportunities afforded, by this accumulating body of practice-relevant scientific information. Evidence-based practice is a new paradigm that promotes more effective social interventions by encouraging the conscientious, judicious, and explicit use of the best available scientific evidence in professional decision making. Pedagogically, evidence-based practice involves teaching students the values and skills they need to identify, critically appraise, and apply practice-relevant scientific evidence over the course of their professional careers. This article describes the potential benefits of evidence-based social work professional education and ongoing efforts of the George Warren Brown School of Social Work at Washington University to implement curriculum-wide changes supportive of evidencebased professional practice education.The last generation of the 20th century-the "information age"-witnessed an unprecedented expansion of the research base and technologies supporting social service interventions (Howard, Bricout

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Studies have identified high rates and severe consequences of Internet Addiction/Pathological Internet Use (IA/PIU) in university students. However, most research concerning IA/PIU in U.S. university students has been conducted within a quantitative research paradigm, and frequently fails to contextualize the problem of IA/PIU. To address this gap, we conducted an exploratory qualitative study using the focus group approach and examined 27 U.S. university students who self-identified as intensive Internet users, spent more than 25 hours/week on the Internet for non-school or non-work-related activities and who reported Internet-associated health and/or psychosocial problems. Students completed two IA/PIU measures (Young’s Diagnostic Questionnaire and the Compulsive Internet Use Scale) and participated in focus groups exploring the natural history of their Internet use; preferred online activities; emotional, interpersonal, and situational triggers for intensive Internet use; and health and/or psychosocial consequences of their Internet overuse. Students’ self-reports of Internet overuse problems were consistent with results of standardized measures. Students first accessed the Internet at an average age of 9 (SD = 2.7), and first had a problem with Internet overuse at an average age of 16 (SD = 4.3). Sadness and depression, boredom, and stress were common triggers of intensive Internet use. Social media use was nearly universal and pervasive in participants’ lives. Sleep deprivation, academic under-achievement, failure to exercise and to engage in face-to-face social activities, negative affective states, and decreased ability to concentrate were frequently reported consequences of intensive Internet use/Internet overuse. IA/PIU may be an underappreciated problem among U.S. university students and warrants additional research.