This study examined the state of the literature on the effectiveness of medication assisted treatment (MAT; methadone, buprenorphine, naltrexone) delivered in prisons and jails on community substance use treatment engagement, opioid use, recidivism, and health risk behaviors following release from incarceration. Randomized controlled trials (RCTs) and quasi-experimental studies published through December 2017 that examined induction to or maintenance on methadone (n=18 studies), buprenorphine (n=3 studies), or naltrexone (n=3 studies) in correctional settings were identified from PsycINFO and PubMed databases. There were a sufficient number of methadone RCTs to meta-analyze; there were too few buprenorphine or naltrexone studies. All quasi-experimental studies were systematically reviewed. Data from RCTs involving 807 inmates (treatment n = 407, control n = 400) showed that methadone provided during incarceration increased community treatment engagement (n=3 studies; OR = 8.69, 95% CI = 2.46; 30.75), reduced illicit opioid use (n=4 studies; OR = 0.22, 95% CI = 0.15; 0.32) and injection drug use (n=3 studies; OR = 0.26, 95% CI = 0.12; 0.56), but did not reduce recidivism (n=4 studies; OR = 0.93, 95% CI = 0.51; 1.68). Data from observational studies of methadone showed consistent findings. Individual review of buprenorphine and naltrexone studies showed these medications were either superior to methadone or to placebo, or were as effective as methadone in reducing illicit opioid use post-release. Results provide the first meta-analytic summary of MATs delivered in correctional settings and support the use of MATs, especially with regard to community substance use treatment engagement and opioid use; additional work is needed to understand the reduction of recidivism and other health risk behaviors.

Increased intra-individual variability in response time (RTSD) has been observed reliably in ADHD and is often used as a measure of inattention. RTSD is assumed to reflect attentional lapses and distractibility, though evidence for the validity of this connection is lacking. We assessed whether RTSD is an indicator of inattention by comparing RTSD on the stop-signal task (SST) to performance on the Delayed Oculomotor Response (DOR) Task, a measure of distractibility. Participants included 30 adults with ADHD and 28 controls. Participants completed the SST and the DOR task, which measured subjects' ability to maintain attention and avoid distraction by inhibiting reflexive saccades toward distractors. On the SST, the ADHD group was slower to inhibit than controls, indicating poorer inhibitory control in ADHD. The ADHD group also displayed slower RTs, greater RTSD, and more omission errors. On the DOR task, the ADHD group displayed more premature saccades (i.e., greater distractibility) than controls. Greater variability in RT was associated with increased distraction on the DOR task but only in ADHD participants. Results suggest that RTSD is linked to distractibility among adults with ADHD and support the use of RTSD as a valid measure of inattention in ADHD. Keywords ADHD; adults; variable attention; eye movementsAlong with deficits in response inhibition, increased intra-individual variability in response time has been reliably observed among individuals with ADHD, leading some theorists to describe this inconsistency in responding as a hallmark of the disorder (Castellanos & Tannock, 2002). Whereas deficits in response inhibition are often linked to hyperactive/ impulsive symptoms of ADHD, variability in response time (RTSD) is frequently assumed to reflect inattention. More specifically, the greater RTSD values observed among Correspondence concerning this article should be addressed to Zachary W. Adams, 005 Kastle Hall, Department of Psychology, University of Kentucky, Lexington, Kentucky, 40506-0044. zack.adams@uky.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/pas NIH Public Access Author ManuscriptPsychol Assess. Author manuscript; available in PMC 2012 June 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript individuals with ADHD on tasks such as the stop-signal task are thought to be a result of lapses in attentional control or distractibility. Little work has been done to evaluate the validity of this theorized connection, however. Thus, the purpose of the present...

Background and Aims Attentional bias has been demonstrated to a variety of substances. Evidence suggests that fixation time is a more direct measure of attentional bias than response time. The aims of this experiment were to demonstrate that fixation time during the visual probe task is a sensitive and stable measure of cocaine cue attentional bias in cocaine using adults compared to controls. Design A between-subject, repeated-measures experiment. Setting An outpatient research unit. Participants Fifteen cocaine using and fifteen non-cocaine-using adults recruited from the community. Measurements Participants completed a visual probe task with eye tracking and a modified Stroop during two experimental sessions. Findings A significant interaction between cue type and group (F = 13.5; P = 0.001) indicated that cocaine users, but not controls, displayed an attentional bias to cocaine-related images as measured by fixation time. There were no changes in the magnitude of attentional bias across sessions (F = 3.4; P = 0.08) and attentional bias correlated with self-reported lifetime cocaine use (r = 0.64, P = 0.01). Response time on the visual probe (F = 1.1; P = 0.3) as well as on the modified Stroop (F = 0.1; P = 0.72) failed to detect an attentional bias. Conclusions Fixation time on cocaine-related stimuli (propensity to remain focused on the stimulus) is a sensitive and stable measure of cocaine cue attentional bias in cocaine-using adults.

Adults with attention-deficit/hyperactivity disorder (ADHD) are at higher risk to use substances than their nonclinical peers. Increased levels of impulsivity are generally thought to contribute to their increased levels of risk. Impulsivity is a multifaceted construct, however, and little research to date has attempted to identify which facets of impulsivity contribute to the increased rates of substance abuse among individuals with ADHD. The current study examined the relation among ADHD symptom clusters (i.e., hyperactivity/impulsivity and inattention), substance use rates (i.e., alcohol use, nicotine use, and marijuana use), and personality processes associated with impulsive behavior in a group of young adults. Participants were 361 undergraduate students. Both symptom clusters were positively associated with rates of substance use. Specifically, hyperactive/impulsive symptoms were associated with alcohol and nicotine use, and inattentive symptoms were associated with alcohol use. Several pathways from hyperactive/impulsive symptoms to alcohol, nicotine, and marijuana use via specific facets of impulsivity were identified. These findings have implications for understanding the relation between ADHD symptoms and substance use, as well as clinical implications for preventing and treating substance use problems in individuals with symptoms of ADHD.

Separate cognitive processes govern the inhibitory control of manual and oculomotor movements. Despite this fundamental distinction, little is known about how these inhibitory control processes relate to more complex domains of behavioral functioning. This study sought to determine how these inhibitory control mechanisms relate to broadly defined domains of impulsive behavior. Thirty adults with attention-deficit/hyperactivity disorder (ADHD) and 28 comparison adults performed behavioral measures of inhibitory control and completed impulsivity inventories. Results suggest that oculomotor inhibitory control, but not manual inhibitory control, is related to specific domains of self-reported impulsivity. This finding was limited to the ADHD group; no significant relations between inhibitory control and impulsivity were found in comparison adults. These results highlight the heterogeneity of inhibitory control processes and their differential relations to different facets of impulsivity.