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Cornerstone of Recovery is committed to helping patients achieve treatment success by following the most up-to-date scientific research on substance use disorders. As such, we are also committed to bridging the gap that sometimes exists between science and practice by conducting research with our patient populations.  

Teaming with researchers from the University of Tennessee, Ohio University, and other institutions across the country, we have published over 30 empirical articles on correlates of substance misuse and changes in mental health during the course of treatment. Our research has focused on identifying and examining potential risk factors for substance misuse, including early maladaptive schemas and mental health symptoms (e.g., depression, post-traumatic stress), as well as protective factors for substance use (e.g., mindfulness, spirituality).

The research conducted at Cornerstone of Recovery helps to guide the selection of treatment foci for our patients, which is crucial to helping our patients achieve successful recovery. 

The integration of empirically-supported treatment principals is essential to the mission of Cornerstone of Recovery, and it is our hope that these efforts will also assist other professionals who are working to improve the chances of long term recovery for individuals suffering from the disease of addiction.

We have produced:

  • Twenty-five papers that have been accepted for publication in several peer-reviewed journals (including two papers at one of the most highly regarded substance use journals, Journal of Substance Abuse Treatment)
  • Nine additional papers that are either under review or in preparation for submission;
  • Six national conference presentations and two abstracts accepted for presentation at national conferences (American Psychological Association and Association for Cognitive Behavioral Therapies)

Additionally, we have worked to:

  • Improve the recovery monitoring assessment and initial intake assessments;
  • Involve family members in research;
  • Improve clinical information gained for family therapy; and Implement an innovative treatment adjunct study that involves Mindfulness and Acceptance. This study is providing us with information regarding the long-term outcome of standard care and whether our intervention improves long-term outcomes.
  • Create a database from 2008 forward of all client data collected including critical ASI information (including occupation, length of use and education level) to simplify the data cleaning process for future research projects;
  • Create and maintain a database of all WebNeuro assessments to utilize for future research projects.

IMPORTANCE: Through our research, we have accomplished the following:

  • We have improved the assessment process of patients upon treatment admission. This helps to shape treatment and focus on the most relevant problems.
  • We have provided empirical evidence that early maladaptive schemas are a prevalent and relevant problem among substance users. This is important because it speaks to the appropriateness of the treatment model at Cornerstone of Recovery (i.e., a dual focus on substance use and early maladaptive schemas).
  • We have improved the process of collecting follow-up information from patients. This is important because it provides Cornerstone with long-term information that can be used to determine treatment outcomes.
  • We have successfully disseminated our research to the broader psychological/addictions treatment readership through peer-reviewed publications and presentations at national conferences. This is important because it helps to (1) show how the treatment approach at Cornerstone of Recovery is useful and (2) increase the dissemination of this approach in general.

 

PUBLISHED IN PEER-REVIEWED JOURNALS

Shorey, R. C., Lookatch, S.J., Moore, T.M., Anderson, S., & Stuart, G. L. The relation between moment-to-moment mindful attention and anxiety among young adults seeking substance use treatment. Substance Abuse, 36(3), 374-379. http://www.tandfonline.com/doi/abs/10.1080/08897077.2014.935841#.VvWE91JTa7Y

The current study examined the relation between trait mindfulness and anxiety among young adult substance use treatment seekers, in addition to exploring differences in trait mindfulness between gender differences. Results demonstrated that trait mindfulness was associated with symptoms of panic disorder and generalized anxiety disorder even after controlling for gender, age, education, alcohol use, drug use, and comorbid anxiety symptoms. These findings provide preliminary evidence that trait mindfulness is associated with mental health in young adults seeking substance use treatment.

Shorey, R. C., Brasfield, H., Anderson, S., & Stuart, G. L. (2014). Differences in trait
mindfulness across mental health symptoms among adults in substance abuse treatment. Substance Use and Misuse, 49, 595-600. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990007/

This manuscript is the first study to examine trait mindfulness among ARP patients and whether those with a comorbid diagnosis of depression or PTSD reported lower trait mindfulness than those without a comorbid diagnosis. Results indicated that lower trait mindfulness was associated with increased substance use, depression, and PTSD. Those with probable diagnoses of depression or PTSD reported lower mindfulness than patients without these disorders.

Shorey, R. C., Brasfield, H., Anderson, S., & Stuart, G. L. (2014). Mindfulness deficits in a
sample of substance abuse treatment seeking adults: A descriptive investigation. Journal
of Substance Use, 19, 194-198. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972764/

This manuscript is the first study to examine differences in mindfulness between a sample of substance abuse treatment seeking adults and normative data on mindfulness from healthy adults. Results indicated that substance users seeking residential treatment may have lower levels of mindfulness relative to their healthy counterparts, thus supporting the implementation of mindfulness-based interventions with this population.

Shorey, R. C., Anderson, S., & Stuart, G. L. (2013). The relation between antisocial and
borderline personality symptoms and early maladaptive schemas in a treatment seeking sample of male substance users. Journal of Clinical Psychology & Psychotherapy Online First. DOI: 10.1002/cpp.1843. http://europepmc.org/articles/pmc4092040

This manuscript has found that, among male ARP patients, early maladaptive schema significantly predict ASPD and BPD symptomatology even after controlling for other personality traits, substance use, and age. These findings indicate that early maladaptive schemas likely underlie personality symptoms, which future supports targeting early maladaptive schemas in treatment.

Shorey, R. C., Brasfield, H. Anderson, S., & Stuart, G. L. (2013). Early maladaptive schemas of substance users and their intimate partners. Journal of Psychoactive Drugs, 45, 266-275. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3971914/

This manuscript is the first study to examine the early maladaptive schemas of airline pilots seeking substance use treatment. In this study, we compared pilots to demographically matched patients on early maladaptive schemas. Results indicated that pilots scored higher than non-pilots on the early maladaptive schema of unrelenting standards, whereas non-pilots scored higher on insufficient self-control. These results support the focus on early maladaptive schemas within this population.

Shorey, R. C., Stuart, G. L., Anderson, S., & Strong, D. R. (2013). Changes in early maladaptive schemas after residential treatment for substance use. Journal of Clinical Psychology, 69, 912-922. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049341/

This manuscript found that at the end of ARP treatment, male patients are reporting reductions in 13 of the 18 early maladaptive schemas, and this does not vary by type of substance use diagnosis (alcohol or opioid).

Shorey, R. C., Stuart, G. L., & Anderson, S. (2013). Early maladaptive schemas among young
adult male substance users: A comparison with a non-clinical group. Journal of Substance Abuse Treatment, 44, 522-527. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602221/

This manuscript, similar to its female counterpart paper, is examining whether male YA patients score higher on early maladaptive schemas than a non-clinical control group of UT male college students.

Shorey, R. C., Anderson, S., & Stuart, G. L. (2011). Early maladaptive schemas in substance use
patients and their intimate partners: A preliminary investigation. Addictive Disorders & Their Treatment, 10, 169-179. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3382969/

This study found that ARP patients scored higher than their intimate partners (e.g., husbands, wives, girlfriends, boyfriends) on 5 of the 18 schemas, with intimate partners scoring higher on self-sacrifice. This study suggests that family therapists should discuss schemas with intimate partners and determine how schemas interact to create dynamics in couples.

Shorey, R. C., Anderson, S., & Stuart, G. L. (2012). Gender differences in early maladaptive
schemas in a treatment seeking sample of alcohol dependent adults. Substance Use and Misuse, 47, 108-116. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3382082/

This study found that ARP female alcohol-dependent patients scored higher than ARP male alcohol-dependent patients on 14 of the 18 early maladaptive schemas. This suggests that schemas may be more relevant for female alcohol patients than male alcohol patients. Self-sacrifice, unrelenting standards, insufficient self-control, and punitiveness were the most common schemas.

Shorey, R. C., Stuart, G. L., & Anderson, S. (2012). The early maladaptive schemas of an opioid
dependent sample of treatment seeking young adults: A descriptive investigation. Journal of Substance Abuse Treatment, 42, 271-278. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3265617/

This study found that YA opioid dependent women scored higher than YA opioid dependent men on 11 of the 18 early maladaptive schemas. Insufficient self-control was the most common schema. These findings indicate schemas may be more relevant for YA women and that insufficient self-control may be an important treatment target.

Shorey, R. C., Anderson, S., & Stuart, G. L. (2012). Gambling and early maladaptive schemas
in a treatment seeking sample of male substance users: A preliminary investigation. Addictive Disorders & Their Treatment, 11, 173-182. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3595176/

This study found that male ARP patients with a potential gambling problem scored higher than ARP male patients without a gambling problem on 11 of the 18 early maladaptive schemas. These findings suggest that as the number of addiction problems increases, the worse one’s early maladaptive schemas. Dual-diagnosis patients (substance use and gambling) may need more intensive focus on schemas.

Shorey, R. C., Stuart, G. L., & Anderson, S. (2013). Do gender differences in depression remain after controlling for early maladaptive schemas? An examination in a sample of opioid dependent treatment seeking adults. Clinical Psychology & Psychotherapy, 20, 401-410. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463763/

This study found that early maladaptive schemas were a better predictor of depression than gender in a sample of ARP opioid dependent men and women. This suggests that schemas are an important correlate of depression, in addition to substance use, in substance use patients.

Shorey, R. C., Stuart, G. L., & Anderson, S. (2013). Differences in early maladaptive schemas
in a sample of alcohol and opioid dependent women: Do schemas vary across disorders? Addiction Research and Theory, 21, 132-140. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3593736/

This study found that ARP opioid dependent women scored higher than ARP alcohol dependent women on only two schemas. This suggests that the schemas that are most problematic are similar across diagnostic groups, and that specific substances may not be related to specific schemas. This speaks to the need to individually tailor treatment.

Shorey, R. C., Stuart, G. L., & Anderson, S. (2012) Differences in early maladaptive schemas
among a sample of young adult female substance users and non-clinical controls. Clinical Psychology & Psychotherapy. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463747/

This paper found YA female patients score higher on almost every schema than non-clinical college students. This suggests that schemas may be a cause of, or maintenance of, problematic substance use.

Shorey, R. C., Stuart, G. L., & Anderson, S. (2012). An examination of early maladaptive
schemas among substance use treatment seekers and their parents. Contemporary Family Therapy, 34, 429-441. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3496288/

This manuscript has found that patients scored higher on 17 of the 18 early maladaptive schemas, with the only schema not differing between patients and parents being self-sacrifice. These differences were quite large in magnitude, suggesting that early maladaptive schemas may not have a large intergenerational component.

Shorey, R.C., Elmquist, J., Strauss, C., Anderson, S., & Stuart, G.L. (In Press). Research reactions following participation in intimate partner violence research: An examination with men in substance use treatment. Journal of Interpersonal Violence, 0886260515584345. http://jiv.sagepub.com/content/early/2015/04/30/0886260515584345.abstract

The current study examined the research reactions of men in substance use treatment who completed a self-report measure of IPV perpetration and victimization. We also examined whether distress tolerance moderated the relationship between reports of IPV and negative emotional research reactions. Consistent with previous research, after accounting for distress tolerance, substance use, and demographic control variables, IPV was unrelated to negative emotional research reactions. Distress tolerance did not moderate the association between IPV and research reactions. Findings add to a growing body of literature suggesting that IPV research meets IRB requirements for minimal risk research.

Elmquist, J., Shorey, R.C., Anderson, S.E., & Stuart, G.L. (In Press). The relationship between early maladaptive schemas and eating disorder symptomatology among individuals seeking treatment for substance dependence. Addiction Research & Theory,23(5), 429-436. http://www.tandfonline.com/doi/abs/10.3109/16066359.2015.1025063#.VvWFmVJTa7Y

This manuscript is the first investigation of the relationship between early maladaptive schemas (EMS) and eating disorder symptomatology among men and women in residential treatment for substance use disorders. Results demonstrated that 11 of the 18 EMS were significantly associated with ED. Moreover, patients with a probable ED scored significantly higher than patients without a probable ED on 8 of the 18 EMS.

Elmquist, J., Shorey, R.C., Anderson, S.E., & Stuart, G.L. (In Press). A preliminary investigation of the relationship between early maladaptive schemas and compulsive sexual behaviors n a substance-dependent population. Journal of Substance Use, 1-6. http://www.tandfonline.com/doi/abs/10.3109/14659891.2015.1029021#.VvWFqVJTa7Y

This study examine the relationship between compulsive sexual behaviors and early maladaptive schemas (EMS) among men and women seeking residential treatment for substance use disorders. Findings demonstrated that the five EMS domains were positively associated with CSBs. Results further demonstrated that patients meeting the cutoff score for CSBs scored significantly higher than patients not meeting the cutoff score for CSBs on 3 of the 5 EMS domains.

Shorey, R. C., Brasfield, H., Anderson, S., & Stuart, G. L. (In Press). The relation between trait mindfulness and early maladaptive schemas in men seeking substance use treatment. Mindfulness, 6(2), 348-355. http://link.springer.com/article/10.1007/s12671-013-0268-9

In this manuscript, we present the first study to have examined the relationship between male substance users’ mindfulness and early maladaptive schemas. Results indicated strong relationships between mindfulness and 15 of the 18 early maladaptive schemas. Further, individuals who endorsed many early maladaptive schemas were less mindful than those who endorsed fewer.

Shorey, R.C., Elmquist, J., Anderson, S., & Stuart, G.L. (In Press). Dispositional mindfulness and aggression among women in residential substance use treatment. Substance Use and Misuse, 50(14), 1840-1844. http://www.tandfonline.com/doi/abs/10.3109/10826084.2015.1050112
The current study examined whether dispositional mindfulness was associated with aggression, above and beyond substance use and demographic characteristics, in women in residential substance misuse treatment. Results showed that lower dispositional mindfulness was associated with increased aggression (physical, verbal, and aggressive attitude). Moreover, this relationship between dispositional mindfulness and aggression remained even after controlling for alcohol use, drug use, and age, all known predictors of aggression. Our results provide the first empirical evidence that dispositional mindfulness is negatively associated with aggression in women in treatment for substance misuse.

Shorey, R.C., Elmquist, J., Anderson, S., & Stuart, G.L. (In Press). Early maladaptive schemas and aggression in men seeking residential substance use treatment. Personality and Individual Differences, 83, 6-12. http://www.sciencedirect.com/science/article/pii/S0191886915002184

Social-cognitive theories of aggression postulate that individuals who perpetrate aggression are likely to have high levels of maladaptive cognitive schemas that increase risk for aggression. Indeed, recent research has begun to examine whether early maladaptive schemas may increase the risk for aggression. However, no known research has examined this among individuals in substance use treatment, despite aggression and early maladaptive schemas being more prevalent among individuals with a substance use disorder than the general population. Toward this end, we examined the relationship between early maladaptive schemas and aggression in men in a residential substance use treatment facility (N = 106). Results demonstrated unique associations between early maladaptive schema domains and aggression depending on the type of aggression and schema domain examined, even after controlling for substance use, antisocial personality, age, and education. The Impaired Limits domain was positively associated with verbal aggression, aggressive attitude, and overall aggression, whereas the Disconnection and Rejection domain was positively associated with physical aggression.

Shorey, R.C., Elmquist, J., Anderson, S., & Stuart, G.L .(In Press ). The relationship between early maladaptive schemas, depression, and generalized anxiety among adults seeking residential treatment for substance dependence. Journal of Psychoactive Drugs, 47(3), 230-238. http://www.tandfonline.com/doi/abs/10.1080/02791072.2015.1050133
This manuscript is the first examination of the relationship between symptoms of generalized anxiety disorder, major depressive disorder, and early maladaptive schemas among adults with a primary diagnosis of alcohol dependence. Findings demonstrated that the EMS domains of disconnection and rejection and impaired limits were associated with symptoms of MDD and the domain of impaired autonomy and performance was associated with symptoms of GAD even after controlling for age, gender, years of education, alcohol use, drug use, and symptoms of MDD (when predicting GAD) and GAD (when predicting MDD).

Elmquist, J., Shorey, R.C., Anderson, S.E., & Stuart, G.L. (In Press). Eating disorder symptoms and length of stay in residential treatment for substance use: A brief report. Journal of Dual Diagnosis, 11, 233-237. http://www.tandfonline.com/doi/abs/10.1080/15504263.2015.1104480
In the current study, we examine the relationship between eating disorder symptoms and the length of stay and/or decisions to leave treatment against medical advice among women in residential treatment for substance use disorders. Results demonstrated that ED symptoms were associated with a shorter length of treatment and decisions to leave treatment AMA after controlling for age, years of education, alcohol problems, and drug problems.

Elmquist, J., Shorey, R.C., Anderson, S.E., & Stuart, G.L. (In Press). The relation between compulsive sexual behaviors and aggression in a substance-dependent population. Journal of Aggression, Maltreatment, & Trauma, 1-15. http://www.tandfonline.com/doi/abs/10.1080/10926771.2015.1081664#.VvWGXVJTa7Y
In the current study, we examined the relationship between compulsive sexual behaviors and aggression in men and women in treatment for substance dependence. Results indicated that even after controlling for alcohol and drug use and problems, gender, age, and years of education, CSBs were significantly associated with total aggression, aggressive attitudes, and physical aggression.

Shorey, R. C., Strauss, C., Elmquist, J., Anderson, S., & Stuart, G. L. (In Press). Examining the reactions to intimate partner violence research participation among women in substance use treatment: Does shame-proneness matter? Partner Abuse.

This study examines the research reactions of women N = 64) in substance use treatment who completed a self-report measure on their psychological, physical, and sexual IPV victimization. We also examined whether shame-proneness moderated the association between reports of IPV and negative emotional research reactions. This information is important for Institutional Review Boards (IRBs) and researchers in determining the most ethical and appropriate protections for participants of IPV research.

Findings demonstrated victims of all three types of IPV did not differ from non-victims on negative emotional research reactions. Victims of psychological aggression reported more positive research experiences than non-victims. More frequent psychological victimization was associated with more negative emotional reactions.

Shame-proneness did not moderate the relationship between IPV reports and negative emotional reactions, although shame-proneness did exert a main effect on negative emotional research reactions.

Elmquist, J., Shorey, R.C., Anderson, S., & Stuart, G.L. (In Press). The relationship between generalized anxiety symptoms and treatment dropout among women in residential treatment. Substance Use and Misuse.

In the current study, we examined the relationship between leaving treatment against medical advice (AMA) and symptoms of generalized anxiety disorder (GAD) in a sample of women seeking treatment for substance use disorders. Results demonstrated that GAD symptoms were significantly associated with the decision to leave treatment AMA after controlling for age, education, alcohol use, and drug use. Our finding indicates the importance of assessing and targeting GAD and the comorbidity between GAD and SUDs in treatment for substance dependence, which may increase treatment compliance.

Shorey, R. C., Elmquist, J., Anderson, S., & Stuart, G. L. (In Press). The relationship between antisocial and borderline features and aggression in young adult men in treatment for substance use. Journal of Psychoactive Drugs, 1-9. http://www.tandfonline.com/doi/abs/10.1080/02791072.2015.1130885#.VvWGhlJTa7Y

This study examined the associations between antisocial and borderline features and aggression in young adult men in treatment for substance use (N = 79). Controlling for age, education, alcohol and drug use, antisocial features was positively associated with various indicators of aggression (e.g., physical, verbal, attitudinal), whereas borderline features was only associated with physical aggression. These findings suggest that substance use treatment centers have the difficult task of not only treating substance use disorders, but should also focus attention on ASPD and BPD features as a means to reduce aggressive behavior. Continued research in this area is needed, including research on effective interventions for aggression among young adult men in substance use treatment.

Elmquist, J., Shorey, R., Anderson, S., & Stuart, G.L. (In Press). Are borderline features associated with compulsive sexual behaviors among women in treatment for substance use disorders? Journal of Clinical Psychology

In this study, we examined the relationship between compulsive sexual behaviors (CSBs) and borderline features in a sample of women seeking residential treatment for substance use disorders ( N = 120). Hierarchical regression analysis demonstrated that borderline features were significantly associated with CSBs after controlling for alcohol use, drug use, age, and impression management. Results from this study provide potentially important research and clinical implications, which could ultimately aid treatment and reduce relapse. However, continued research is needed to further examine the relationship between borderline features and CSBs.

Shorey, R.C., Elmquist, J., Wolford-Clevenger, C., Gawrysiak, M.J., Anderson, S., & Stuart, G.L. (Under Review). The relationship between dispositional mindfulness, borderline personality features, and suicidal ideation: An examination in a sample of women in residential substance use treatment. Psychiatry Research, 238, 122-128. http://www.sciencedirect.com/science/article/pii/S016517811630292X

Efforts to treat substance use in this population are made difficult due to the severity of BPD, and it is possible that mindfulness-based interventions specific to substance use could be an effective approach for this population. However, basic research is needed on the relationship between dispositional mindfulness, BPD, and suicidal ideation to support their associations, which was the purpose of the present study. Findings demonstrated dispositional mindfulness to be negatively associated with BPD features (affective instability, identity problems, negative relationships, and self-harm) and suicidal ideation. With the exception of self-harm, this negative relationship was found even after controlling for age, substance use, and impression management. These findings add to the growing body of literature on dispositional mindfulness and BPD features and suicidal ideation. This was the first study to examine these relationships in a substance use sample. Future research should replicate and extend these findings, and examine whether mindfulness-based interventions are an effective treatment for comorbid substance use and BPD.

Shorey, R. C., Elmquist, J., Gawrysiak, M. J., Anderson, S., & Stuart, G. L. (In Press). The relationship between mindfulness and compulsive sexual behavior in a sample of men in treatment for substance use. Mindfulness.

Substance use is a serious worldwide problem. One factor that may complicate substance use treatment for some patients is compulsive sexual behavior. Factors that are related to both substance use and compulsive sexual behavior could be targeted in substance use treatment. In the current study, we examined dispositional mindfulness, a protective factor for a range of mental health problems, and its relationship to compulsive sexual behavior in a substance use treatment sample. Findings demonstrated dispositional mindfulness to be negatively associated with a variety of indicators of compulsive sexual behavior. After controlling for alcohol and drug use, which were both associated with compulsive sexual behaviors, dispositional mindfulness remained negatively associated with all of the compulsive sexual behavior indicators. findings may suggest that substance use treatment for individuals with comorbid compulsive sexual behavior may want to include mindfulness-based interventions as part of treatment.

Elmquist, J., Shorey, R.C., Anderson, S., & Stuart, G.L. (In Press). The relationship between eating disorder symptoms and treatment rejection among young adult men in residential substance use treatment. Substance Abuse: Research and Treatment.

This manuscript examined the relationship between eating disorder symptoms and treatment rejection among a sample of 68 young adult men in residential substance use treatment. Results from hierarchical regression analyses indicated that eating disorder symptoms were significantly associated with treatment rejection after controlling for alcohol and drug use and problems. Although this a preliminary study, results add to a growing body of research examining the comorbidity between substance use disorders and eating disorder symptomatology. Future research examining this relationship is needed to further elucidate treatment patterns among individuals with comorbid eating disorder symptoms and substance use diagnoses.

UNDER REVIEW AT PEER-REVIEWED JOURNALS

Shorey, R.C., Strauss, C., Elmquist, J., Anderson, S., Cornelius, T.L., & Stuart, G.L. (Under Review). Distress tolerance and intimate partner violence among men in substance use treatment.

The current study examined the relationship between distress tolerance and intimate partner violence among men in substance use treatment. Results demonstrated that distress tolerance was negatively associated with physical and psychological IPV perpetration. After controlling for age and substance use and problems, distress tolerance remained associated with psychological, but not physical, IPV perpetration. These findings suggest that distress tolerance may be an important component of treatments for IPV, particularly for psychological aggression.

Elmquist, J., Shorey, R.C., Anderson, S., & Stuart, G.L. (Under Review). The relationship between mindfulness and comorbid eating disorder symptoms and substance use disorders among men in residential treatment.

We examined the relationship between dispositional mindfulness and eating disorder symptoms among men in residential treatment for substance use disorders. Medical records from 152 men were included in the current study. Hierarchical regression analysis indicated that dispositional mindfulness was inversely related to ED symptoms after controlling for alcohol and drug use and problems, as well as age and years of education. Although results are preliminary and continued research in this area is needed, our findings suggest that there may be potential usefulness in targeting and enhancing mindfulness among patients in residential treatment for SUDs with co-occurring psychiatric symptoms (e.g., EDs).

IN PREPARATION FOR SUBMISSION TO PEER-REVIEWED JOURNALS

Lookatch, S.J., Shorey, R.C., Moore, T.M., Anderson, S. & Stuart, G.L. (In Preparation) Pre- to Post-neuropsychological changes during residential substance use treatment.

This manuscript aims to understand the neuropsychological changes inpatient clients experience from intake to residential treatment completion in Thinking, Emotions, Self-Regulation and Feelings as measured by WebNeuro, an online assessment program. Finding revealed significant differences from Time 1 to Time 2 across all four domains with factors including drug of choice, age and years of education having varying impacts by domain

PRESENTATIONS AT NATIONAL CONFERENCES

PRESENTED

Lookatch, S.J., Katz. E.C., Moore, T.M., Anderson, S., & Stuart, G. L. (2014). Neuropsychological changes during residential substance use treatment. Poster presented at the 46th annual convention of The College on Problems of Drug Dependence, San Juan, Puerto Rico.
Brasfield, H., Shorey, R. C., Anderson, S., & Stuart, G. L. (2013).

Alcohol use, anxiety, and depression among adults seeking residential treatment for alcohol dependence: The importance of early maladaptive schemas. Poster presented at the 47th annual convention of the Association for Behavioral and Cognitive Therapies, Nashville, Tennessee.

Shorey, R. C., Anderson, S., & Stuart, G. L. (2011). Early maladaptive schemas in an
alcohol dependent treatment seeking sample. Poster presented at the 34th annual convention of the Research Society on Alcoholism, Atlanta, GA.

Shorey, R. C., Stuart, G. L., & Anderson, S. (2011). The early maladaptive schemas of
opioid dependent treatment seeking adults: Does controlling for psychopathology reduce gender differences in schemas? Poster presented at the 45th annual convention of the Association for Behavioral and Cognitive Therapies, Toronto, Canada.

Elmquist, J., Shorey, R.C., Anderson, S., & Stuart, G.L.(2015). The relationship between early maladaptive schemas and eating disorder symptomatology among individuals seeking treatment for substance dependence. Poster presented at the 38th annual meeting of the Research Society on Alcoholism.

Elmquist, J., Shorey, R.C., Anderson, S., & Stuart, G.L. (August 2015). Are early maladaptive schemas associated with eating disorder symptoms in a substance dependent Population. Poster presented at the 123rd annual meeting of the American Psychological Association.

Elmquist, J., Shorey, R.C., Anderson, S., & Stuart, G.L. (November 2015). The relationship between eating disorder symptoms and length of stay in residential treatment for substance use. Poster presented at the 49th annual meeting of the Association for Behavioral and Cognitive Therapies.

SUBMITTED

Elmquist, J., Shorey, R.C., Anderson, S., & Stuart, G.L. (August 2016). Relationship Between Generalized Anxiety Disorder and Length of Stay in Substance Use Treatment. Poster accepted to the 124th Annual Convention of the American Psychological Association, Denver, CO.

Elmquist, J., Shorey, R.C., Anderson, S., & Stuart, G.L. (June 2016). Are Borderline Features Associated with Compulsive Sexual Behaviors Among Substance Dependent Women? Poster accepted to the 39th annual meeting of the Research Society on Alcoholism.

Elmquist, J., Shorey, R.C., Anderson, S., & Stuart, G.L. (October 2016). The relationship between dispositional mindfulness and eating disorder symptoms among men in residential substance use treatment. Poster submitted to the 50th annual meeting of the Association for Behavioral and Cognitive Therapies, New York, NY.

ADDITIONAL ACTIVITIES

MINDFULNESS AND ACCEPTANCE GROUP

We have implemented a one-month, two sessions per week, rolling, and open group designed to increase patients’ mindfulness and acceptance. This is a highly innovative and important area of work, as preliminary research suggests that mindfulness may help reduce relapse risk and improve overall psychological functioning. Unfortunately, there is no known research on whether an inpatient, rolling and open mindfulness group is effective in reducing substance use and relapse above and beyond treatment as usual.

This study will provide Cornerstone with information regarding:

  • the outcome of their standard treatment for ARP patients, such as information on substance use and quality of life;
  • whether this additional group results in improved outcomes above and beyond standard treatment; and whether this type of group will be feasible for Cornerstone to implement long-term.
  • If this novel intervention is associated with better clinical outcomes, we will examine how this group could be modified for YA, RR, and IOP. A total of 119 patients have participated in the study; they were randomized to receive treatment as usual or treatment as usual plus the mindfulness/ACT group. We have begun to collect three- and six-month follow-up data from those participants and anticipate completing data collection in Fall 2013. The information we obtain will allow us to determine, preliminary, whether this group improves treatment outcomes.

GENETICS

We are continuing to collect DNA from all patients who agree to participate in this ongoing study. This is a unique area of investigation that will allow us to examine a number of questions.

First, we will be able to examine genetic predictors of medical detoxification. That is, are their specific genetic predispositions that make it more likely individuals will need medical detoxification? This information is important because medical detoxification costs billions of dollars each year, and knowing who is most at risk for withdrawal symptoms could help to improve detoxification treatment.

Second, we can also examine genetic predictors of changes in early maladaptive schemas, spirituality, and mental health functioning. In the long term, this information could help to determine, on the basis of one’s genetics, the treatment modalities that may be most beneficial.

We currently have DNA from approximately 200 patients, and hope to recruit an additional 100+ patients.

RECOVERY MONITORING

We have continued to improve the Recovery Monitoring assessment protocol at Cornerstone of Recovery. We have implemented valid and reliable measures for alcohol and drug use (AUDIT, DUDIT), and overall quality of life (WHOQOL); these will be administered to patients at each follow-up point. This longitudinal information will allow us to examine whether the treatment they received at Cornerstone of Recovery is resulting in: 1) abstinence from alcohol and drugs; and 2) improved quality of life. This is an ongoing study.

SOCIAL SUPPORT AND INTIMATE PARTNER VIOLENCE

We collected data from ARP, YA, IOP, and RR patients for our cross-sectional study that is looking at social support and violence primarily. We recently completed all data collection for this project and will have research assistants prepare the data for analyses. The major goal of this study is to validate a new measure of social support specifically for alcohol and drug abstinence, which will allow us to better assess whether patients have a social support network that is supportive of a lifestyle free from alcohol/drugs. Since physical aggression occurs in upwards of 50% of substance use treatment patients, we also will examine the prevalence of domestic violence and its association to substance use.

NEW ASSESSMENT MEASURES FOR PATIENTS

Following preliminary WebNeuro data analyses, it is planned to evaluate the utility of implementing an impulsivity measure at intake to help assess specific subtypes of impulsivity that may be correlated with different drug seeking and relapse behaviors including the UPPS-P. In the past, implementation of new assessment instruments for patients has led to fruitful information gathering to better assess a number of life domains that may impact treatment.

Patients now complete the Alcohol Use Disorders Identification Test (AUDIT), Drug Use Disorders Identification Test (DUDIT), Alcohol Dependence Scale (ADS), Daily Spiritual Experiences Survey (DSES), World Health Organization Quality of Life Measure (WHO-QOL), the Mindful Attention Awareness Scale (MAAS), the Toronto Mindfulness Scale (TMS), and the Stuart Lab Violence Assessment (SLVA). Additionally, we have modified the Mood Disorders Questionnaire to be consistent with the standardized scoring procedures.

We plan to investigate a number of useful clinical questions with these measures, such as, but not limited to, the following:

  •  What is the relationship between mindfulness, substance use, and Axis I and II disorders?
  •  What is the prevalence of domestic violence in this population?
  •  What types of impulsivity are linked to specific drugs of choice or relapse behaviors?

A number of other questions will be able to be answered with these measures, which could help to improve and focus treatment on the most relevant issues.

DISCHARGE ASSESSMENTS FOR PATIENTS

At the end of residential treatment, or transfer to a new program, patients complete the YSQ-L3 and a measure of spirituality (DSES). Our preliminary research suggests that patients’ maladaptive schemas are significantly reduced by the end of treatment in ARP. We plan to collect additional data so as to enable us to assess whether spirituality is increased by the end of treatment at the end of treatment. We also recently implemented discharge assessments of mindfulness (MAAS and TMS), which will allow us to examine the impact of treatment on patients’ mindfulness.

FAMILY MEMBER ASSESSMENTS

We have implemented a new assessment packet for family members, which is now included in each family member packet. Family members are asked to complete the following questionnaires: The Young Schema Questionnaire (YSQ-L3), AUDIT, DUDIT; assesses problems in communication, problem-solving, affection, and family roles), Short Marital Adjustment Test (SMAT; assesses relationship satisfaction), and the Stuart Lab Violence Assessment (SLVA; assesses domestic violence). Once family members complete this information, results are sent to their family therapist and used to help inform family sessions. Moreover, this information is de-identified and then stored for research purposes. We have one paper in press and another paper in preparation using this data set.

UTK COLLEGE STUDENT SCHEMA STUDY UT

We have recently finished collecting schema data from UT college students, which we are using to compare schemas with the YA population. There is no research on whether YA patients score higher on schemas than non-clinical controls (i.e., college students). This study is important because it will allow us to say definitively that schemas are more prevalent among YA substance users than non-clinical YAs. We currently have one paper under review with this data set comparing YA males to UT males, and we have had accepted for publication a paper comparing YA females to YA males.

OTHER AREAS

We have discussed a number of other areas for research activities. For instance:

  • We have discussed whether we should conduct an experiment with accudetox (assign some patients to receive the treatment or a placebo, or a control).
  •  We have discussed looking at executive functioning in patients and whether deficits in executive functioning predict poorer treatment outcomes.
  •  We have also discussed additional assessment measures we could have patients complete to inform treatment, and potentially provide us with data for grant funding. This includes HIV risk, child functioning, emotion regulation, and social support. Preliminary data with this information may provide the necessary information for us to write federally funded grants to conduct broad, in-depth, treatment outcome studies.
  •  We have also recently discussed changing the YSQ-L3 from the long to the short version, and potentially including the Young Parenting Index, a measure designed to capture the childhood experiences that theoretically underlie the development of schemas, and the Young coping questionnaires, which examine avoidance and overcompensation with schemas.

WEBNEURO

We have discussed a number of areas for research activities utilizing the WebNeuro data including:

  •  Potential gains and differences between individuals in changes across treatment on webneuro performance based on demographic differences (education level, occupation, length of use, drug of choice).
  •  Are WebNeuro changes in residential treatment any different from gains/changes seen in IOP treatment?
  •  If “emotion training” is provided in a group format, do we see significant changes in this specific domain of WebNeuro functioning?