Bio


Dr. Osilla is an Associate Professor in Psychiatry and Behavioral Sciences at Stanford and a licensed clinical psychologist. She conducts health services research with a focus on delivering substance use services to underserved populations using innovative solutions that decrease health access disparities. Dr. Osilla has received funding from the National Institute on Drug Abuse (NIDA), National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the Patient-Centered Outcomes Research Institute (PCORI) and has published over 100 publications on this work. Dr. Osilla has been conducting addictions research since 2006 and has been involved in over a dozen clinical trials evaluating cognitive behavioral therapy, collaborative care, and motivational interviewing interventions (web and in-person) for mental health and substance use disorders among youth, adult, military, family members, and other hard-to-reach populations.

Currently, Dr. Osilla leads a large clinical trial called INSPIRE (Integrating Support Persons Into REcovery) in collaboration with 17 primary care clinics in California. This project evaluates a counseling program for people who support patients with opioid use disorder (OUD), including family members, spouses, and friends. INSPIRE draws from the Community Reinforcement and Family Training (CRAFT) approach and teaches support people effective ways to help a person with OUD change their behavior. This work is funded by PCORI.

Dr. Osilla is also leading another clinical trial to evaluate a brief online program called webCHAT that aims to reduce alcohol and cannabis-impaired driving among adolescents learning to drive. This study partners with two large driver education schools in Michigan and Colorado, and is funded by NIAAA. She is also an Investigator on two collaborative care studies. The first focuses on patients with OUD with co-occurring PTSD and/or depression being seen in primary care clinics in New Mexico, and the second is a multi-site study evaluating collaborative care with patients with OUD in the hospital. She is also an Investigator on a clinical trial evaluating an online social network intervention for young adults experiencing homelessness and substance misuse. On these projects, Dr. Osilla leads the intervention development and adaptation activities including qualitative interviews with stakeholders, facilitator training and supervision, and intervention fidelity monitoring.

Dr. Osilla teaches substance use disorder treatment (CLIN 711) in the PGSP-Stanford PsyD Consortium, and trains across the country on cognitive behavioral therapy and motivational interviewing approaches to prevent and reduce the harms associated with substance use. She also served on NIH's Interventions to Prevent and Treat Addictions scientific review committee for four years and has served on other NIH study section committees since 2013. Prior to joining Stanford, she conducted research at the RAND Corporation for 15 years. She maintains an Adjunct Behavioral Scientist appointment at RAND.

Clinical Focus


  • Psychology

Academic Appointments


  • Associate Professor - University Medical Line, Psychiatry and Behavioral Sciences

Boards, Advisory Committees, Professional Organizations


  • Study Section Member, NIH Center for Scientific Review, Interventions to Prevent and Treat Addictions (2017 - 2021)

Professional Education


  • Internship: VA Palo Alto Health Care Psychology Training (2006) CA
  • PhD Training: University of Washington Registration and Transcripts Office (2006) WA
  • PhD, University of Washington, Clinical Psychology (2006)
  • Clinical Internship, VA Palo Alto Healthcare System (2006)

Research Interests


  • Psychology
  • Race and Ethnicity

Current Research and Scholarly Interests


Dr. Osilla is an Associate Professor in Psychiatry and Behavioral Sciences at Stanford and an Adjunct Behavioral Scientist at the RAND Corporation. She conducts health services research with a focus on delivering substance use services to underserved populations using innovative solutions that decrease health access disparities. Dr. Osilla has received funding from the National Institute on Drug Abuse (NIDA), National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the Patient-Centered Outcomes Research Institute (PCORI) and has published over 100 publications on this work. Dr. Osilla has been conducting addictions research since 2006 and has been involved in over a dozen clinical trials evaluating cognitive behavioral therapy, collaborative care, and motivational interviewing interventions (web and in-person) for mental health and substance use disorders among youth, adult, military, family members, and other hard-to-reach populations.

Currently, Dr. Osilla leads a large clinical trial called INSPIRE (Integrating Support Persons Into REcovery) in collaboration with 17 primary care clinics in California. This project evaluates a counseling program for people who support patients with opioid use disorder (OUD), including family members, spouses, and friends. INSPIRE draws from the Community Reinforcement and Family Training, or CRAFT, approach and teaches support people effective ways to help a person with OUD change their behavior. This work is funded by PCORI.

Dr. Osilla is also leading another clinical trial to evaluate a brief online program called webCHAT that aims to reduce alcohol and cannabis-impaired driving among adolescents learning to drive. This study partners with two large driver education schools in Michigan and Colorado, and is funded by NIAAA. She is also an Investigator on two collaborative care studies. The first focuses on patients with OUD with co-occurring PTSD and/or depression being seen in primary care clinics in New Mexico, and the second is a multi-site study evaluating collaborative care with patients with OUD in the hospital. She is also an Investigator on a clinical trial evaluating an online social network intervention for young adults experiencing homelessness and substance misuse. On these projects, Dr. Osilla leads the intervention development and adaptation activities including qualitative interviews with stakeholders, facilitator training and supervision, and intervention fidelity monitoring.

Dr. Osilla teaches substance use disorder treatment (CLIN 711) in the PGSP-Stanford PsyD Consortium, and trains across the country on cognitive behavioral therapy and motivational interviewing approaches to prevent and reduce the harms associated with substance use. She also served on NIH's Interventions to Prevent and Treat Addictions scientific review committee. Prior to joining Stanford, she conducted research at the RAND Corporation for 15 years. She received her PhD in clinical psychology at the University of Washington and completed her clinical internship at the VA Palo Alto Health Care System in 2006.

Clinical Trials


  • Integrating Support Persons Into Recovery Recruiting

    INtegrated Support Persons Into Recovery (INSPIRE) is a 4-year research project that tests whether integrating a patient's support person into a patient's treatment with Buprenorphine/Naloxone can improve outcomes. The study will examine whether a counseling program called CRAFT for a support person, such as a family member, spouse or friend, can improve patient outcomes.

    View full details

  • Preventing Impaired Driving Among Adolescents Not Recruiting

    The primary goal of this project is to evaluate the efficacy of webCHAT, a single-session web-intervention, on reducing impaired driving among adolescents receiving behind-the-wheel training at driver education programs.

    Stanford is currently not accepting patients for this trial. For more information, please contact Karen Osilla, PhD, (650) 723-4000.

    View full details

All Publications


  • Value of family involvement in substance use disorder treatment: Aligning clinical and financing priorities. Journal of substance abuse treatment Dopp, A. R., Manuel, J. K., Breslau, J., Lodge, B., Hurley, B., Kase, C., Osilla, K. C. 2021: 108652

    Abstract

    BACKGROUND: Family members' support (e.g., informational, tangible, emotional) has important and lasting impacts on individuals' recovery from substance use disorders (SUDs). Unfortunately, SUD services in the United States do not consistently incorporate patients' family members effectively. One barrier to family involvement in SUD services is the mechanisms through which SUD services in the United States are commonly financed.METHOD: Using our recent experiences with developing a group intervention for support persons of patients with opioid use disorder, we illustrate how gaps in feasible financing models limit SUD service systems from effectively implementing and sustaining family services for individuals receiving SUD treatment.DISCUSSION: Long-term availability of family-inclusive interventions will require collaboration with payors and health systems. We offer two sets of recommendations for funding family involvement in SUD services; one set of immediately implementable recommendations and other longer-term goals requiring structural changes in SUD service delivery and financing.

    View details for DOI 10.1016/j.jsat.2021.108652

    View details for PubMedID 34742609

  • Longitudinal effects of social network changes on drinking outcomes for individuals with a first-time DUI. Journal of substance abuse treatment Matsuda, M., Osilla, K. C., Kennedy, D. P., Paddock, S. M. 2021; 131: 108392

    Abstract

    Social networks are important predictors of alcohol-related outcomes, especially among those with a DUI where riskier social networks are associated with increased risk of drinking and driving. Social networks are increasingly a target for intervention; however, no studies have examined and measured whether longitudinal changes in social networks are associated with reductions in impaired driving.The current study first examines longitudinal changes in social networks among participants receiving services following a first-time DUI, and then examines the association between network change and drinking outcomes at 4- and 10-month follow-up.The study surveyed a subsample of participants (N = 94) enrolled in a clinical trial of individuals randomized to cognitive behavioral therapy (CBT) or usual care (UC) on an iPad using EgoWeb 2.0-an egocentric social network data collection software-about pre-DUI and post-DUI networks and their short- and long-term drinking behaviors.Participants were 65% male, 48% Hispanic, and an average of 32.5 years old. Overall, participants significantly reduced the proportion of network members with whom they drank from 0.41 to 0.30 (p = .001) and with whom they drank more alcohol than they wanted to from 0.15 to 0.07 (p = .0001) from two weeks prior to the DUI (measured at baseline) to 4-month follow-up. Furthermore, decreases in proportion of drinking partners over time were associated with reduced drinks per week, self-reported driving after drinking, and intentions to drive after drinking at 4-month follow-up. Participants who reported decreases in proportion of drinking partners also reported significantly less binge drinking at 10-month follow-up. Finally, increases in emotional support were associated with decreases in binge drinking at 4-month follow-up. The study found no differences in the changes in composition of networks between CBT and UC groups.These results suggest that individuals receiving services in DUI programs significantly reduced risky network members over time and that these social network changes were associated with reduced drinking and other indicators of risk for DUI recidivism. Clinical interventions that target reductions in risky network members may improve outcomes for those enrolled in a DUI program.

    View details for DOI 10.1016/j.jsat.2021.108392

    View details for PubMedID 34098291

  • Motivational network intervention to reduce substance use and increase supportive connections among formerly homeless emerging adults transitioning to housing: study protocol for a pilot randomized controlled trial. Addiction science & clinical practice Tucker, J. S., Kennedy, D. P., Osilla, K. C., Golinelli, D. 2021; 16 (1): 18

    Abstract

    Studies indicate high rates of substance use among youth experiencing homelessness (YEH). Further, the social networks of YEH, although multi-dimensional in composition, are largely comprised of other YEH, substance users, and individuals who do not provide the youth with tangible or emotional support. For YEH who have the opportunity to enter a housing program, helping them to reduce their substance use and strengthen their prosocial supportive connections during this critical transition period may increase their stability and reduce their risk of re-entering homelessness. The goal of this study is to pilot test a brief motivational network intervention (MNI), delivered by case managers, to help former YEH who have recently transitioned to a housing program reduce their substance use and strengthen their prosocial supportive connections.Up to 60 residents of housing programs in the Los Angeles area will be randomized to receive four sessions of usual case manager support or four sessions of case manager support + MNI. Each MNI session consists of three parts: (1) identifying two goals that are most important for the resident over the next year (e.g., get or keep a job, finish or stay in school, reduce substance use); (2) a network interview with the resident to capture network data pertaining to their interactions in the past 2 weeks; and (3) a discussion between the case manager and the resident of the resulting network visualizations, conducted in a Motivational Interviewing (MI) style, and what role the resident's network may play in reaching their most important goals over the next year.This study addresses a critical gap by pilot testing a computer-assisted MNI, delivered using MI techniques, that can help case managers work with recent YEH to reduce substance use and increase permanent supportive connections during the critical transitional period from homelessness to housing. Trial registration ClinicalTrials.gov Identifier: NCT04637815. Registered November 10, 2020.

    View details for DOI 10.1186/s13722-021-00227-9

    View details for PubMedID 33726809

    View details for PubMedCentralID PMC7968154

  • Design of CLARO (Collaboration Leading to Addiction Treatment and Recovery from other Stresses): A randomized trial of collaborative care for opioid use disorder and co-occurring depression and/or posttraumatic stress disorder. Contemporary clinical trials Meredith, L. S., Komaromy, M. S., Cefalu, M., Murray-Krezan, C., Page, K., Osilla, K. C., Dopp, A. R., Leamon, I., Tarhuni, L., Hindmarch, G., Jacobsohn, V., Watkins, K. E. 2021; 104: 106354

    Abstract

    Opioid use disorder (OUD) co-occurring with depression and/or posttraumatic stress disorder (PTSD) is common and, if untreated, may lead to devastating consequences. Despite the availability of evidence-based treatments for these disorders, receipt of treatment is low. Even when treatment is provided, quality is variable. Primary care is an important and underutilized setting for treating co-occurring disorders (COD) because OUD, depression and PTSD are frequently co-morbid with medical conditions and most people visit a primary care provider at least once a year. With rising rates of OUD and opioid-related fatalities, this is a critical treatment and quality gap in a vulnerable and stigmatized population.CLARO (Collaboration Leading to Addiction Treatment and Recovery from Other Stresses) is a multi-site, randomized pragmatic trial of collaborative care (CC) for co-occurring disorders in 13 rural and urban primary care clinics in New Mexico to improve care for patients with OUD and co-occurring depression and/or PTSD. CC, a service delivery approach that uses multi-faceted interventions, has not been tested with COD. We will enroll and randomize 900 patients to either CC adapted for COD (CC-COD) or enhanced usual care (EUC) and will collect patient data at baseline, 3-, and 6-month follow-up. Our primary outcomes are medications for OUD (MOUD) access, MOUD continuity of care, depression symptoms, and PTSD symptoms.Although CC is effective for improving outcomes in primary care among patients with mental health conditions, it has not been tested for COD. This article describes the CLARO CC-COD intervention and clinical trial.

    View details for DOI 10.1016/j.cct.2021.106354

    View details for PubMedID 33713840

  • Group Cohesion and Climate in Cognitive Behavioral Therapy for Individuals with a First-Time DUI. Alcoholism treatment quarterly Cruz, M., Osilla, K. C., Paddock, S. M. 2020; 38 (1): 68-86

    Abstract

    Few studies have examined group cohesion and climate in the substance use disorder treatment literature. We examined whether group cohesion and climate are associated with increased self-efficacy outcomes and reduced drinks per week, binge drinking and DUI behaviors, in a sample of individuals with a first-time DUI receiving either cognitive behavioral therapy (CBT) or usual care. Additionally, we examined whether CBT moderates these relationships. Group measures and drinking outcomes were not significantly associated. This study is the first to provide an in-depth analysis on group processes in DUI settings, and as such, provides important insights into how group processes may differ in a mandated DUI context.

    View details for DOI 10.1080/07347324.2019.1613941

    View details for PubMedID 32952283

    View details for PubMedCentralID PMC7500184

  • Study design to evaluate a group-based therapy for support persons of adults on buprenorphine/naloxone. Addiction science & clinical practice Osilla, K. C., Becker, K., Ecola, L., Hurley, B., Manuel, J. K., Ober, A., Paddock, S. M., Watkins, K. E. 2020; 15 (1): 25

    Abstract

    Opioid use disorders (OUDs) have devastating effects on individuals, families, and communities. While medication treatments for OUD save lives and are increasingly utilized, rates of treatment dropout are very high. In addition, most existing medication treatments for OUD may often neglect the impact of untreated OUD on relationships and ignore the potential role support persons (SPs) could have on encouraging long-term recovery, which can also impact patient treatment retention.The current study adapts Community Reinforcement and Family Training (CRAFT) for use with SPs (family member, spouse or friend) of patients using buprenorphine/naloxone (buprenorphine) in an outpatient community clinic setting. The study will evaluate whether the adapted intervention, also known as integrating support persons into recovery (INSPIRE), is effective in increasing patient retention on buprenorphine when compared to usual care. We will utilize a two-group randomized design where patients starting or restarting buprenorphine will be screened for support person status and recruited with their support person if eligible. Support persons will be randomly assigned to the INSPIRE intervention, which will consist of 10 rolling group sessions led by two facilitators. Patients and SPs will each be assessed at baseline, 3 months post-baseline, and 12 months post-baseline. Patient electronic medical record data will be collected at six and 12 months post-baseline. We will examine mechanisms of intervention effectiveness and also conduct pre/post-implementation surveys with clinic staff to assess issues that would affect sustainability.Incorporating the patient's support system may be an important way to improve treatment retention in medication treatments for OUD. If SPs can serve to support patient retention, this study would significantly advance work to help support the delivery of effective treatments that prevent the devastating consequences associated with OUD. Trial registration This study was registered with ClinicalTrials.gov, NCT04239235. Registered 27 January 2020, https://clinicaltrials.gov/ct2/show/NCT04239235 .

    View details for DOI 10.1186/s13722-020-00199-2

    View details for PubMedID 32653029

    View details for PubMedCentralID PMC7353769

  • Randomized Clinical Trial Examining Cognitive Behavioral Therapy for Individuals With a First-Time DUI Offense. Alcoholism, clinical and experimental research Osilla, K. C., Paddock, S. M., McCullough, C. M., Jonsson, L., Watkins, K. E. 2019; 43 (10): 2222-2231

    Abstract

    Driving under the influence (DUI) programs are a unique setting to reduce disparities in treatment access to those who may not otherwise access treatment. Providing evidence-based therapy in these programs may help prevent DUI recidivism.We conducted a randomized clinical trial of 312 participants enrolled in 1 of 3 DUI programs in California. Participants were 21 and older with a first-time DUI offense who screened positive for at-risk drinking in the past year. Participants were randomly assigned to a 12-session manualized cognitive behavioral therapy (CBT) or usual care (UC) group and then surveyed 4 and 10 months later. We conducted intent-to-treat analyses to test the hypothesis that participants receiving CBT would report reduced impaired driving, alcohol consumption (drinks per week, abstinence, and binge drinking), and alcohol-related negative consequences. We also explored whether race/ethnicity and gender moderated CBT findings.Participants were 72.3% male and 51.7% Hispanic, with an average age of 33.2 (SD = 12.4). Relative to UC, participants receiving CBT had lower odds of driving after drinking at the 4- and 10-month follow-ups compared to participants receiving UC (odds ratio [OR] = 0.37, p = 0.032, and OR = 0.29, p = 0.065, respectively). This intervention effect was more pronounced for females at 10-month follow-up. The remaining 4 outcomes did not significantly differ between UC versus CBT at 4- and 10-month follow-ups. Participants in both UC and CBT reported significant within-group reductions in 2 of 5 outcomes, binge drinking and alcohol-related consequences, at 10-month follow-up (p < 0.001).In the short-term, individuals receiving CBT reported significantly lower rates of repeated DUI than individuals receiving UC, which may suggest that learning cognitive behavioral strategies to prevent impaired driving may be useful in achieving short-term reductions in impaired driving.

    View details for DOI 10.1111/acer.14161

    View details for PubMedID 31472028

    View details for PubMedCentralID PMC6779493

  • Associations between driving under the influence or riding with an impaired driver and future substance use among adolescents. Traffic injury prevention Osilla, K. C., Seelam, R., Parast, L., D'Amico, E. J. 2019; 20 (6): 563-569

    Abstract

    Objective: Risky driving behaviors among adolescents, such as riding with a drinking or impaired driver (RWID) or driving while under the influence (DUI) of alcohol or drugs, are significant public health concerns. Few studies have examined associations of RWID and DUI with future substance use and problems after controlling for baseline substance use. Given that the DUI/RWDD event may be a teachable moment to prevent future consequences (e.g., when injured or arrested), it is important to understand how this risk behavior relates to subsequent use and problems. This study therefore examined characteristics of adolescents who reported DUI and RWID and assessed their risk of future alcohol and marijuana use and consequences 6 months later. Methods: Participants were 668 adolescents aged 12 to 18 (inclusive) recruited at 1 of 4 primary care clinics in Pittsburgh and Los Angeles as part of a larger randomized controlled trial. They completed surveys about their health behaviors at baseline and 6 months after baseline. We examined baseline characteristics of adolescents who reported DUI and RWID and then assessed whether past-year DUI and RWID at baseline were associated with alcohol and marijuana use and consequences 6 months after baseline. Results: Fifty-eight percent of participants were female, 56% were Hispanic, 23% were Black, 14% were White, 7% were multiethnic or other, and the average age was 16 years (SD = 1.9). At baseline, participants who reported RWID or DUI were more likely to be older, report past-year use of alcohol and marijuana, and more likely to have an alcohol use disorder or cannabis use disorder versus those who did not report RWID or DUI, respectively. At 6-month follow-up and after controlling for baseline demographics and baseline alcohol use, RWID was associated with more frequent drinking episodes in the past 3 months and greater number of drinks in the past month when they drank heavily. DUI at baseline was associated with more frequent heavy drinking episodes and alcohol and marijuana consequences 6 months later. Conclusions: RWID and DUI are significantly associated with greater alcohol and marijuana use over time. This study highlights that teens may be at higher risk for problem substance use in the future even if they ride with someone who is impaired. Prevention and intervention efforts for adolescents need to address both driving under the influence and riding with an impaired driver to prevent downstream consequences.

    View details for DOI 10.1080/15389588.2019.1615620

    View details for PubMedID 31356125

    View details for PubMedCentralID PMC6728146

  • Understanding Which Teenagers Benefit Most From a Brief Primary Care Substance Use Intervention. Pediatrics D'Amico, E. J., Parast, L., Osilla, K. C., Seelam, R., Meredith, L. S., Shadel, W. G., Stein, B. D. 2019; 144 (2)

    Abstract

    The primary care (PC) setting provides an opportunity to address adolescent alcohol and marijuana use. We examined moderators of effectiveness for a PC brief motivational intervention on adolescents' alcohol and marijuana use and consequences 1 year later.We conducted a randomized controlled trial in 4 PC clinics from April 2013 to November 2015 and followed adolescents using Web-based surveys. We examined whether demographic factors and severity of use moderated 12-month outcomes. Adolescents aged 12 through 18 were screened by using the National Institute on Alcohol Abuse and Alcoholism Screening Guide. Those identified as at risk were randomly assigned to the intervention (CHAT) or to usual care (UC).The sample (n = 294) was 58% female, 66% Hispanic, 17% African American, 12% white, and 5% multiethnic or of other race with an average age of 16 years. After controlling for baseline values of outcomes, teens in CHAT who reported more negative consequences from drinking or had an alcohol use disorder at baseline reported less alcohol use, heavy drinking, and consequences 1 year later compared with teens in UC. Similarly, teens in CHAT with more negative consequences from marijuana use at baseline reported less marijuana use 1 year later compared with teens in UC; however, teens in CHAT who reported fewer marijuana consequences at baseline reported greater marijuana use 1 year later compared with teens in UC.A brief intervention can be efficacious over the long-term for adolescents who report problems from alcohol and marijuana use. Findings emphasize the importance of both screening and intervention in at-risk adolescents in PC.

    View details for DOI 10.1542/peds.2018-3014

    View details for PubMedID 31296568

    View details for PubMedCentralID PMC6746575

  • Exploring the association between changes in partner behaviors, perceived service member drinking, and relationship quality: Secondary analysis of a web-based intervention for military partners. Journal of substance abuse treatment Trail, T. E., Osilla, K. C., Rodriguez, L. M., Pedersen, E. R., Gore, K. L. 2019; 98: 66-72

    Abstract

    Problematic drinking is a serious and persistent problem among U.S. military service members and veterans, who face barriers to seeking help and are less likely to seek help than the civilian population. One way to reach this population is through spouses or partners who are concerned about the service members' drinking (concerned partners [CPs]). CPs of military service members were recruited for a web-based intervention, Partners Connect, that aimed to improve patterns of communication about the service members' drinking. Participants were 234 CPs (95% female; 71% White; 89% married; average age 32 years) who completed a baseline survey, were randomized to a four-session web-based intervention or a waitlist control group, and completed a follow-up assessment 5 months later. Three measures reported by CPs assessed perceived partner drinking (drinks per week, highest number of drinks across a typical week, and frequency of drinking in the past month) and CP behaviors were assessed using the Significant-other Behavior Questionnaire (SBQ) and the State-Trait Anger Expression Inventory (STAXI-2). Results demonstrated that the intervention did not have a main effect on CP behaviors relative to control. However, changes in CP punishment of partner drinking and behaviors supporting sobriety were significantly associated with decreased perceived partner drinking and improved relationship quality over time. Furthermore, compared to the control group, to the extent that CPs in the treatment group reduced their negative behaviors, perceived partner drinking declined and relationship quality improved. The results reinforce the importance of considering CP behaviors when designing interventions to reduce drinking.

    View details for DOI 10.1016/j.jsat.2019.01.002

    View details for PubMedID 30665606

    View details for PubMedCentralID PMC6363354

  • The longitudinal effects of military spouses' concern and behaviors over partner drinking on relationship functioning. Alcohol (Fayetteville, N.Y.) Rodriguez, L. M., Neighbors, C., Osilla, K. C., Trail, T. E. 2019; 76: 29-36

    Abstract

    Among those in close relationships, the perception that one's partner has a drinking problem is more strongly related to detriments in relationship quality than are the actual rates of the partner's drinking. The current study extends this work by examining the effects of this perception on relationship functioning longitudinally and whether this association is mediated by changes in how one behaves in response to their partner's drinking. Spouses and partners of military service members who were concerned about their partner's drinking (n = 234) completed a baseline survey and a follow-up assessment five months later. Structural equation modeling was used to prospectively examine the association between concern about partner drinking and relationship functioning (i.e., relationship quality, conflict, communication patterns), and the mediated effect of regulation strategies. Results suggested that changes in participant concern were related to changes in relationship functioning, and these changes were mediated by changes in punishment and rewarding sobriety regulation strategies. This research suggests that concern about partner drinking is linked with poorer relationship functioning partly because of the increased use of punishment and the decreased use of rewarding sobriety.

    View details for DOI 10.1016/j.alcohol.2018.07.004

    View details for PubMedID 30553122

  • Initiation and engagement as mechanisms for change caused by collaborative care in opioid and alcohol use disorders. Drug and alcohol dependence Setodji, C. M., Watkins, K. E., Hunter, S. B., McCullough, C., Stein, B. D., Osilla, K. C., Ober, A. J. 2018; 192: 67-73

    Abstract

    To assess the mechanism by which a collaborative care (CC) intervention improves self-reported abstinence among primary care patients with opioid and alcohol use disorders (OAUD) compared to treatment as usual.Secondary data analysis of SUMMIT, a randomized controlled trial of CC for OAUD. Participants were 258 patients with OAUD receiving primary care at a multi-site Federally Qualified Health Center. Using a mediation analysis decomposition of a total effect into a mediated and a direct effect, we examined the effect of CC on abstinence at six months, attributable to the HEDIS treatment initiation and engagement measures for the total sample, for individuals with alcohol use disorders alone, and for those with a co-morbid opioid use disorder.Although the CC intervention led to an increase in both initiation and engagement, among the full sample, only initiation mediated the effect of the intervention on abstinence (3.8%, CI=[0.4%, 8.3%]; 32% proportion of the total effect). In subgroup analyses, among individuals with comorbid alcohol and opioid use disorders, almost 100% of the total effect was mediated by engagement, but the effect was not significant. This was not observed among the alcohol use disorder only group.Among primary care patients with OAUDs, treatment initiation partially mediated the effect of CC on abstinence at 6-months. The current study emphasizes the importance of primary care patients returning for a second substance-use related visit after identification. CC may work differently for people with co-morbid opioid use disorders vs. alcohol use disorders alone.

    View details for DOI 10.1016/j.drugalcdep.2018.07.027

    View details for PubMedID 30223190

    View details for PubMedCentralID PMC6334843

  • The Feasibility of a Web Intervention for Military and Veteran Spouses Concerned About Their Partner's Alcohol Misuse. The journal of behavioral health services & research Osilla, K. C., Pedersen, E. R., Tolpadi, A., Howard, S. S., Phillips, J. L., Gore, K. L. 2018; 45 (1): 57-73

    Abstract

    Concerned partners (CPs) of military service members and veterans with alcohol misuse face significant help-seeking barriers. We adapted the Community Reinforcement and Family Training (CRAFT) intervention into a 4-session web-based intervention (WBI) called Partners Connect. The program aims to help the CP increase their own well-being, teach the CP how to manage his/her behavior (e.g., communication) toward their partner, and identify ways the CP can help their partner reduce drinking and seek treatment. We recruited CPs through social media, and then tested the feasibility and acceptance of the WBI by conducting qualitative interviews and post-WBI session surveys after their WBI sessions. CPs (n = 12) spontaneously reported improvements in communication and more effective management of their partner's drinking due to skills learned. They discussed how the online approach can help overcome barriers to seeking in-person help. This WBI fills an important gap in clinical services for military and veteran CPs and CPs in the general population who may not otherwise seek in-person counseling.

    View details for DOI 10.1007/s11414-016-9546-3

    View details for PubMedID 28039559

    View details for PubMedCentralID PMC5493506

  • Alcohol Use Among Concerned Partners of Heavy Drinking Service Members and Veterans. Journal of marital and family therapy Rodriguez, L. M., Osilla, K. C., Trail, T. E., Gore, K. L., Pedersen, E. R. 2018; 44 (2): 277-291

    Abstract

    Heavy drinking in relationships is complex and we focus on an understudied sample of concerned partners (CPs) worried about their U.S. service member/veteran partner's drinking. We evaluated the link between CP drinking and their own mental health, and how CP drinking moderated the efficacy of a web-based intervention designed to address CPs' mental health and communication. CPs (N = 234) were randomly assigned to intervention or control and completed assessments at baseline and 5 months later. CP drinking was associated with greater CP depression, anxiety, and anger independent of partner drinking. Moreover, the intervention was more efficacious in reducing depression for heavy drinking CPs. CPs are often an overlooked population and resources to help support them are needed.

    View details for DOI 10.1111/jmft.12261

    View details for PubMedID 28782116

    View details for PubMedCentralID PMC5803486

  • Efficacy of a Web-based Intervention for Concerned Spouses of Service Members and Veterans with Alcohol Misuse. Journal of marital and family therapy Osilla, K. C., Trail, T. E., Pedersen, E. R., Gore, K. L., Tolpadi, A., Rodriguez, L. M. 2018; 44 (2): 292-306

    Abstract

    Concerned partners (CPs) of service members and veterans who misuse alcohol face help-seeking barriers and mental health problems. We used multiple regression to evaluate the efficacy of Partners Connect, a four-session web-based intervention (WBI) to address military CPs' mental health and communication. We randomized 312 CPs to the WBI or a control group. Five months later, WBI CPs reported significant reductions in their anxiety and increases in their social support compared to control CPs. Intervention dose was also associated with improved WBI CP outcomes. Partners Connect appears to fill a need for families who face help-seeking barriers and provides an alternative to traditional care for those who may not otherwise seek help.

    View details for DOI 10.1111/jmft.12279

    View details for PubMedID 28972265

    View details for PubMedCentralID PMC5882610

  • Differences in alcohol cognitions, consumption, and consequences among first-time DUI offenders who co-use alcohol and marijuana. Drug and alcohol dependence Smart, R., Osilla, K. C., Jonsson, L., Paddock, S. M. 2018; 191: 187-194

    Abstract

    A significant portion of alcohol-related DUI offenders engage in co-use of alcohol and marijuana (AM). Given expanding marijuana legalization and the impaired driving risks associated with co-use, it is of increased importance to understand how characteristics of AM co-users compare to those who use alcohol only (AO) in order to inform DUI interventions and prevent recidivism.Participants were 277 first-time DUI offenders enrolled in a first-time DUI offender program across three locations. Using well-established measures, we evaluated differences in alcohol-related cognitions (positive expectancies and self-efficacy), frequency and quantity of alcohol consumption, and alcohol-related consequences between AO users and AM co-users by running a series of multivariate generalized linear models.Compared to AO users, AM co-users reported lower self-efficacy to achieve abstinence and avoid DUI. Differences in abstinence self-efficacy largely explain higher relative rates of average and peak drinking quantity and higher odds of binge drinking among AM co-user. Despite lower self-efficacy and higher drinking quantity, there were no significant differences between AM and AO-users on alcohol-related consequences and past month reports of drinking and driving.Our results provide preliminary evidence that DUI offenders who co-use alcohol and marijuana have higher alcohol use and lower self-efficacy than AO-users, and long-term consequences for this group should be monitored in future research. DUI programs may screen and identify co-users and consider tailoring their interventions to build self-efficacy to address the risks associated with AM co-use uniquely.

    View details for DOI 10.1016/j.drugalcdep.2018.07.005

    View details for PubMedID 30130715

    View details for PubMedCentralID PMC6309328

  • Patient predictors of substance use disorder treatment initiation in primary care. Journal of substance abuse treatment Ober, A. J., Watkins, K. E., McCullough, C. M., Setodji, C. M., Osilla, K., Hunter, S. B. 2018; 90: 64-72

    Abstract

    Primary care clinics are opportune settings in which to deliver substance use disorder (SUD) treatment, but little is known about which patients initiate treatment in these settings.Using secondary data from a RCT that aimed to integrate SUD treatment into a federally qualified health center (FQHC) using an organizational readiness and collaborative care (CC) intervention, we examined patient-level predictors of initiation of evidence-based practices for opioid and/or alcohol use disorders (OAUDs): a brief behavioral treatment (BT) based on motivational interviewing and cognitive behavioral therapy and medication-assisted treatment (MAT) (extended-release injectable naltrexone (XR-NTX) for patients with an alcohol use disorder or opioid use disorder and buprenorphine/naloxone (BUP/NX) for patients with an opioid use disorder). Using the Andersen model of health care access, we tested bivariate and multivariate logistic regression models to assess associations between patient factors and initiation of BT and MAT.Twenty-three percent of all participants (N = 392) received BT and 13% received MAT. In the multivariate model examining factors associated with initiation of BT, being of "other" or "multiple" races compared with being White (OR = 0.45, CI = 0.22, 0.92), being homeless (OR = 0.45, CI = 0.21, 0.97) and having been arrested within 90 days of baseline (OR = 0.21 CI = 0.63, 0.69) were associated with significantly lower odds of initiating BT. Greater self-stigma (OR = 1.60, CI = 1.06, 2.42), receiving MAT (OR = 5.52, CI = 2.34, 12.98), and having received the CC study intervention (OR = 12.95, CI = 5.91, 28.37) were associated with higher odds of initiating BT. In the multivariate model examining patient factors associated with initiating MAT, older age (OR = 1.07, CI = 1.03, 1.11), female gender (OR = 3.05, CI = 1.25, 7.46), having a diagnosis of heroin abuse or dependence (with or without alcohol abuse or dependence compared with have a diagnosis of alcohol dependence only (OR = 3.03, CI = 1.17, 7.86), and having received at least one session of BT (OR = 6.42, CI = 2.59, 15.94), were associated with higher odds of initiating MAT.Individuals who initiate BT for OAUDs in a FQHC are less likely to be homeless and more likely to have greater self-stigma. Those who receive MAT are more likely to be of older age, female, and to have a diagnosis of heroin abuse or dependence, with or without concomitant alcohol abuse or dependence, rather than alcohol abuse or dependence alone. Receiving collaborative care (e.g., a warm handoff, and follow-up by a care coordinator) may be critical to initiating BT. Receiving at least one session of BT is associated with higher odds of receiving MAT, and receiving MAT is associated with higher odds of receiving BT. The Andersen model of health care access provides some insight into who initiates BT and MAT for OAUD treatment in FQHC-based primary care; further research is needed to explore system-level factors that may also influence treatment initiation.

    View details for DOI 10.1016/j.jsat.2018.04.004

    View details for PubMedID 29866385

    View details for PubMedCentralID PMC6336395

  • Effects of motivational interviewing fidelity on substance use treatment engagement in primary care. Journal of substance abuse treatment Osilla, K. C., Watkins, K. E., D'Amico, E. J., McCullough, C. M., Ober, A. J. 2018; 87: 64-69

    Abstract

    Primary care (PC) may be an opportune setting to engage patients with opioid and alcohol use disorders (OAUDs) in treatment. We examined whether motivational interviewing (MI) fidelity was associated with engagement in primary care-based OAUD treatment in an integrated behavioral health setting.We coded 42 first session therapy recordings and examined whether therapist MI global ratings and behavior counts were associated with patient engagement, defined as the patient receiving one shot of extended-release injectable naltrexone or any combination of at least two additional behavioral therapy, sublingual buprenorphine/naloxone prescriptions, or OAUD-related medical visits within 30days of their initial behavioral therapy visit.Autonomy/support global ratings were higher in the non-engaged group (OR=0.28, 95%CI: 0.09-0.93; p=0.037). No other MI fidelity ratings were significantly associated with engagement.We did not find positive associations between MI fidelity and engagement in primary care-based OAUD treatment. More research with larger samples is needed to examine how providing autonomy/support to patients who are not ready to change may affect engagement.Training providers to strategically use MI to reinforce change as opposed to the status quo is needed. This may be especially important in primary care where patients may not be specifically seeking help for their OAUDs.

    View details for DOI 10.1016/j.jsat.2018.01.014

    View details for PubMedID 29471928

    View details for PubMedCentralID PMC5831199

  • A pilot test of a motivational interviewing social network intervention to reduce substance use among housing first residents. Journal of substance abuse treatment Kennedy, D. P., Osilla, K. C., Hunter, S. B., Golinelli, D., Maksabedian Hernandez, E., Tucker, J. S. 2018; 86: 36-44

    Abstract

    This article presents findings of a pilot test of a Motivational Interviewing social network intervention (MI-SNI) to enhance motivation to reduce high risk alcohol and other drug (AOD) use among formerly homeless individuals transitioning to housing. Delivered in-person by a facilitator trained in MI, this four-session computer-assisted intervention provides personalized social network visualization feedback to help participants understand the people in their network who trigger their alcohol and other drug (AOD) use and those who support abstinence. If ready, participants are encouraged to make changes to their social network to help reduce their own high-risk behavior. Participants were 41 individuals (33 male, 7 female, 1 other; 23 African-American, 5 non-Latino White, 6 Latino, 7 other, mean age 48) who were transitioning from homelessness to permanent supportive housing. They were randomly assigned to either the MI-SNI condition or usual care. Readiness to change AOD use, AOD abstinence self-efficacy, and AOD use were assessed at baseline and shortly after the final intervention session for the MI-SNI arm and around 3-months after baseline for the control arm. Acceptability of the intervention was also evaluated. MI-SNI participants reported increased readiness to change AOD use compared to control participants. We also conducted a subsample analysis for participants at one housing program and found a significant intervention effect on readiness to change AOD use, AOD abstinence self-efficacy, and alcohol use compared to control participants. Participants rated the intervention as highly acceptable. We conclude that a brief computer-assisted Motivational Interviewing social network intervention has potential to efficaciously impact readiness to change AOD use, AOD abstinence self-efficacy, and AOD use among formerly homeless individuals transitioning to permanent supportive housing, and warrants future study in larger clinical trials.

    View details for DOI 10.1016/j.jsat.2017.12.005

    View details for PubMedID 29415849

    View details for PubMedCentralID PMC5808606

  • Assessing and improving organizational readiness to implement substance use disorder treatment in primary care: findings from the SUMMIT study. BMC family practice Ober, A. J., Watkins, K. E., Hunter, S. B., Ewing, B., Lamp, K., Lind, M., Becker, K., Heinzerling, K., Osilla, K. C., Diamant, A. L., Setodji, C. M. 2017; 18 (1): 107

    Abstract

    Millions of people with substance use disorders (SUDs) need, but do not receive, treatment. Delivering SUD treatment in primary care settings could increase access to treatment because most people visit their primary care doctors at least once a year, but evidence-based SUD treatments are underutilized in primary care settings. We used an organizational readiness intervention comprised of a cluster of implementation strategies to prepare a federally qualified health center to deliver SUD screening and evidence-based treatments (extended-release injectable naltrexone (XR-NTX) for alcohol use disorders, buprenorphine/naloxone (BUP/NX) for opioid use disorders and a brief motivational interviewing/cognitive behavioral -based psychotherapy for both disorders). This article reports the effects of the intervention on key implementation outcomes.To assess changes in organizational readiness we conducted pre- and post-intervention surveys with prescribing medical providers, behavioral health providers and general clinic staff (N = 69). We report on changes in implementation outcomes: acceptability, perceptions of appropriateness and feasibility, and intention to adopt the evidence-based treatments. We used Wilcoxon signed rank tests to analyze pre- to post-intervention changes.After 18 months, prescribing medical providers agreed more that XR-NTX was easier to use for patients with alcohol use disorders than before the intervention, but their opinions about the effectiveness and ease of use of BUP/NX for patients with opioid use disorders did not improve. Prescribing medical providers also felt more strongly after the intervention that XR-NTX for alcohol use disorders was compatible with current practices. Opinions of general clinic staff about the appropriateness of SUD treatment in primary care improved significantly.Consistent with implementation theory, we found that an organizational readiness implementation intervention enhanced perceptions in some domains of practice acceptability and appropriateness. Further research will assess whether these factors, which focus on individual staff readiness, change over time and ultimately predict adoption of SUD treatments in primary care.

    View details for DOI 10.1186/s12875-017-0673-6

    View details for PubMedID 29268702

    View details for PubMedCentralID PMC5740845

  • Demographic and Mental Health Characteristics of Individuals Who Present to Community Health Clinics With Substance Misuse. Health services research and managerial epidemiology Iyiewuare, P. O., McCullough, C., Ober, A., Becker, K., Osilla, K., Watkins, K. E. 2017; 4: 2333392817734523

    Abstract

    Community health clinics (CHCs) are an opportune setting to identify and treat substance misuse. This study assessed the characteristics of patients who presented to a CHC with substance misuse.Personnel at a large CHC administered a 5-question screener to patients between June 3, 2014, and January 15, 2016, to assess past 3-month alcohol use, prescription opioid misuse, or illicit drug use. We stratified screen-positive patients into 4 diagnostic groups: (1) probable alcohol use disorder (AUD) and no comorbid opioid use disorder (OUD); (2) probable heroin use disorder; (3) probable prescription OUD, with or without comorbid AUD; and (4) no probable substance use disorder. We describe substance use and mental health characteristics of screen-positive patients and compare the characteristics of patients in the diagnostic groups.Compared to the clinic population, screen-positive patients (N = 733) included more males (P < .0001) and had a higher prevalence of probable bipolar disorder (P < .0001) and schizophrenia (P < .0001). Eighty-seven percent of screen-positive patients had probable AUD or OUD; only 7% were currently receiving substance use treatment. The prescription opioid and heroin groups had higher rates of past bipolar disorder and consequences of mental health conditions than the alcohol only or no diagnosis groups (P < .0001).Patients presenting to CHCs who screen positive for alcohol or opioid misuse have a high likelihood of having an AUD or OUD, with or without a comorbid serious mental illness. Community health clinics offering substance use treatment may be an important resource for addressing unmet need for substance use treatment and comorbid mental illness.

    View details for DOI 10.1177/2333392817734523

    View details for PubMedID 29124080

    View details for PubMedCentralID PMC5661753

  • Bringing alcohol treatment to driving under the influence programs: Perceptions from first-time offenders. Alcoholism treatment quarterly Osilla, K. C., Kulesza, M., Miranda, J. 2017; 35 (2): 113-129

    Abstract

    Alcohol use disorders (AUDs) are common among first-time driving under the influence (DUI) offenders. Individuals with a DUI arrest may attend a DUI alcohol education program for license reinstatement. We evaluated the acceptability of cognitive behavioral treatment (CBT) for AUDs adapted for DUI programs. Participants (N=35) were enrolled in one of two DUI programs in Los Angeles and were an average of 34.5 (SD=11.9) years old; 66% male; 37.1% African American, 34.2% Hispanic/Latino(a), and 20% non-Hispanic White. We analyzed data from ten focus groups and 35 self-report surveys that evaluated the nine-session CBT group protocol. Overall, participants stated that the CBT philosophy was acceptable and helpful in thinking about how to prevent future DUIs. They also found the coping skills in the sessions relevant to other life events and decisions. Participants valued the personal disclosure and interactive role-play and group exercises embedded within each session stating that these exercises helped with group cohesion and self-disclosure. Data from satisfaction surveys showed that participants reported high satisfaction ratings on the overall session, session content, and session facilitator. Future studies are needed to evaluate whether evidence-based treatment within DUI programs may increase access to evidence-base care among at-risk individuals who may not otherwise seek treatment for their AUDs.

    View details for DOI 10.1080/07347324.2017.1288484

    View details for PubMedID 28943712

    View details for PubMedCentralID PMC5606326

  • Internalized stigma as an independent risk factor for substance use problems among primary care patients: Rationale and preliminary support. Drug and alcohol dependence Kulesza, M., Watkins, K. E., Ober, A. J., Osilla, K. C., Ewing, B. 2017; 180: 52-55

    Abstract

    Little is known about internalized stigma among primary care patients, and whether the presence of internalized stigma is related to the severity of substance use problems independent of substance use-related variables. We sought to examine the relationship between internalized stigma and substance use problems among primary care patients with opioid or alcohol use disorders (OAUDs).We present baseline data from 393 primary care patients who were enrolled in a study of collaborative care for OAUDs. Regression analyses examined the relationship between internalized stigma and substance use problems, controlling for demographics, psychiatric comorbidity, and quantity/frequency of use.The majority of participants reported thinking, at least sometimes, that they "have permanently screwed up" their lives (60%), and felt "ashamed" (60%), and "out of place in the world" (51%) as a result of their opioid or alcohol use. Higher internalized stigma was significantly related to more substance use problems (β=2.68, p<0.01), even after the effects of covariates were accounted for. Stigma added 22%, out of 51% total variance explained, leading to a significant improvement in prediction of substance use problems.Among this group of primary care patients with OAUDs, rates of internalized stigma were comparable to those reported in specialty substance use treatment settings. Consistent with extant specialty care literature, our results suggest that internalized stigma may be a unique contributor that is associated with treatment outcomes, such as substance use problems, among primary care patients with OAUDs.

    View details for DOI 10.1016/j.drugalcdep.2017.08.002

    View details for PubMedID 28869858

    View details for PubMedCentralID PMC5648632

  • Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care: The SUMMIT Randomized Clinical Trial. JAMA internal medicine Watkins, K. E., Ober, A. J., Lamp, K., Lind, M., Setodji, C., Osilla, K. C., Hunter, S. B., McCullough, C. M., Becker, K., Iyiewuare, P. O., Diamant, A., Heinzerling, K., Pincus, H. A. 2017; 177 (10): 1480-1488

    Abstract

    Primary care offers an important and underutilized setting to deliver treatment for opioid and/or alcohol use disorders (OAUD). Collaborative care (CC) is effective but has not been tested for OAUD.To determine whether CC for OAUD improves delivery of evidence-based treatments for OAUD and increases self-reported abstinence compared with usual primary care.A randomized clinical trial of 377 primary care patients with OAUD was conducted in 2 clinics in a federally qualified health center. Participants were recruited from June 3, 2014, to January 15, 2016, and followed for 6 months.Of the 377 participants, 187 were randomized to CC and 190 were randomized to usual care; 77 (20.4%) of the participants were female, of whom 39 (20.9%) were randomized to CC and 38 (20.0%) were randomized to UC. The mean (SD) age of all respondents at baseline was 42 (12.0) years, 41(11.7) years for the CC group, and 43 (12.2) yearsfor the UC group. Collaborative care was a system-level intervention, designed to increase the delivery of either a 6-session brief psychotherapy treatment and/or medication-assisted treatment with either sublingual buprenorphine/naloxone for opioid use disorders or long-acting injectable naltrexone for alcohol use disorders. Usual care participants were told that the clinic provided OAUD treatment and given a number for appointment scheduling and list of community referrals.The primary outcomes were use of any evidence-based treatment for OAUD and self-reported abstinence from opioids or alcohol at 6 months. The secondary outcomes included the Healthcare Effectiveness Data and Information Set (HEDIS) initiation and engagement measures, abstinence from other substances, heavy drinking, health-related quality of life, and consequences from OAUD.At 6 months, the proportion of participants who received any OAUD treatment was higher in the CC group compared with usual care (73 [39.0%] vs 32 [16.8%]; logistic model adjusted OR, 3.97; 95% CI, 2.32-6.79; P < .001). A higher proportion of CC participants reported abstinence from opioids or alcohol at 6 months (32.8% vs 22.3%); after linear probability model adjustment for covariates (β = 0.12; 95% CI, 0.01-0.23; P = .03). In secondary analyses, the proportion meeting the HEDIS initiation and engagement measures was also higher among CC participants (initiation, 31.6% vs 13.7%; adjusted OR, 3.54; 95% CI, 2.02-6.20; P < .001; engagement, 15.5% vs 4.2%; adjusted OR, 5.89; 95% CI, 2.43-14.32; P < .001) as was abstinence from opioids, cocaine, methamphetamines, marijuana, and any alcohol (26.3% vs 15.6%; effect estimate, β = 0.13; 95% CI, 0.03-0.23; P = .01).Among adults with OAUD in primary care, the SUMMIT collaborative care intervention resulted in significantly more access to treatment and abstinence from alcohol and drugs at 6 months, than usual care.clinicaltrials.gov Identifier: NCT01810159.

    View details for DOI 10.1001/jamainternmed.2017.3947

    View details for PubMedID 28846769

    View details for PubMedCentralID PMC5710213

  • The role of perceived injunctive alcohol norms in adolescent drinking behavior. Addictive behaviors Pedersen, E. R., Osilla, K. C., Miles, J. N., Tucker, J. S., Ewing, B. A., Shih, R. A., D'Amico, E. J. 2017; 67: 1-7

    Abstract

    Peers have a major influence on youth during adolescence, and perceptions about peer alcohol use (perceived norms) are often associated with personal drinking behavior among youth. Most of the research on perceived norms among adolescents focuses on perceived descriptive norms only, or perceptions about peers' behavior, and correcting these perceptions are a major focus of many prevention programs with adolescents. In contrast, perceived injunctive norms, which are personal perceptions about peers' attitudes regarding the acceptability of behaviors, have been minimally examined in the adolescent drinking literature. Yet correcting perceptions about these perceived peer attitudes may be an important component to include in prevention programs with youth. Using a sample of 2493 high school-aged youth (mean age=17.3), we assessed drinking behavior (past year use; past month frequency, quantity, and peak drinks), drinking consequences, and perceived descriptive and injunctive norms to examine the relationships of perceived injunctive and descriptive norms on adolescent drinking behavior. Findings indicated that although perceived descriptive norms were associated with some drinking outcomes (past year use; past month frequency; past month quantity; peak drinks), perceived injunctive norms were associated with all drinking outcomes, including outcomes of consequences, even after controlling for perceived descriptive norms. Findings suggest that consideration of perceived injunctive norms may be important in models of adolescent drinking. Prevention programs that do not include injunctive norms feedback may miss an important opportunity to enhance effectiveness of such prevention programs targeting adolescent alcohol use.

    View details for DOI 10.1016/j.addbeh.2016.11.022

    View details for PubMedID 27978424

    View details for PubMedCentralID PMC5411362

  • Feasibility of a computer-assisted social network motivational interviewing intervention for substance use and HIV risk behaviors for housing first residents. Addiction science & clinical practice Osilla, K. C., Kennedy, D. P., Hunter, S. B., Maksabedian, E. 2016; 11 (1): 14

    Abstract

    Social networks play positive and negative roles in the lives of homeless people influencing their alcohol and/or other drug (AOD) and HIV risk behaviors.We developed a four-session computer-assisted social network motivational interviewing intervention for homeless adults transitioning into housing. We examined the acceptability of the intervention among staff and residents at an organization that provides permanent supportive housing through iterative rounds of beta testing. Staff were 3 men and 3 women who were residential support staff (i.e., case managers and administrators). Residents were 8 men (7 African American, 1 Hispanic) and 3 women (2 African American, 1 Hispanic) who had histories of AOD and HIV risk behaviors. We conducted a focus group with staff who gave input on how to improve the delivery of the intervention to enhance understanding and receptivity among new residents. We conducted semi-structured qualitative interviews and collected self-report satisfaction data from residents.Three themes emerged over the course of the resident interviews. Residents reported that the intervention was helpful in discussing their social network, that seeing the visualizations was more impactful than just talking about their network, and that the intervention prompted thoughts about changing their AOD use and HIV risk networks.This study is the first of its kind that has developed, with input from Housing First staff and residents, a motivational interviewing intervention that targets both the structure and composition of one's social network. These results suggest that providing visual network feedback with a guided motivational interviewing discussion is a promising approach to supporting network change. ClinicalTrials.gov Identifier NCT02140359.

    View details for DOI 10.1186/s13722-016-0061-x

    View details for PubMedID 27604543

    View details for PubMedCentralID PMC5015231

  • A Systematic Review of the Prevention and Treatment of Prescription Drug Misuse. Military medicine Blanchard, J., Hunter, S. B., Osilla, K. C., Stewart, W., Walters, J., Pacula, R. L. 2016; 181 (5): 410-23

    Abstract

    This is a review and evaluation of the current clinical guidelines and empirical literature in relation to the Department of Defense (DoD) policies and directives regarding prescription drug misuse (PDM).Sources were 11 clinical guidelines and consensus statements, 20 DoD Directives and the published literature from 2000 to 2012. Articles were included if they specifically focused on the prevention or treatment of PDM.DoD directives were evaluated in relation to the clinical guidelines and the relevant research literature. Empirical evidence supporting the directives was limited.There is little empirical evidence for the prevention and treatment of PDM and the majority of published guidelines and studies focus on prescription opioids. Important limitations include the lack of information about appropriately identifying and managing persons at risk for PDM. More research is needed to identify and recommend effective mechanisms for the prevention and treatment of PDM.

    View details for DOI 10.7205/MILMED-D-15-00009

    View details for PubMedID 27136647

  • It is time to develop appropriate tools for assessing minimal clinically important differences, performance bias and quality of evidence in reviews of behavioral interventions. Addiction (Abingdon, England) Grant, S., Pedersen, E. R., Osilla, K. C., Kulesza, M., D'Amico, E. J. 2016; 111 (9): 1533-5

    View details for DOI 10.1111/add.13380

    View details for PubMedID 27095296

  • Factors Affecting Mental Health Service Utilization Among California Public College and University Students. Psychiatric services (Washington, D.C.) Sontag-Padilla, L., Woodbridge, M. W., Mendelsohn, J., D'Amico, E. J., Osilla, K. C., Jaycox, L. H., Eberhart, N. K., Burnam, A. M., Stein, B. D. 2016; 67 (8): 890-7

    Abstract

    Unmet need for mental health treatment among college students is a significant public health issue. Despite having access to campus mental health providers and insurance to cover services, many college students do not receive necessary services. This study examined factors influencing college students' use of mental health services.Online survey data for 33,943 students and 14,018 staff and faculty at 39 college campuses in California were analyzed by using logistic regressions examining the association between students' use of mental health services and student characteristics, campus environment, and the presence of a formal network of campus mental health clinics.Nineteen percent of students reported current serious psychological distress in the past 30 days, and 11% reported significant mental health-related academic impairment in the past year. Twenty percent reported using mental health services while at their current college, 10% by using campus services and 10% off-campus services. Students on campuses with a formal network of mental health clinics were more likely than students at community colleges to receive mental health services (odds ratio [OR] range=1.68-1.69), particularly campus services (OR=3.47-5.72). Students on campuses that are supportive of mental health issues were more likely to receive mental health services (OR=1.22), particularly on campus (OR=1.65). Students with active (versus low) coping skills were consistently more likely to use mental health services.Establishing more campus mental health clinics, fostering supportive campus environments, and increasing students' coping skills may reduce unmet need for mental health services among college students.

    View details for DOI 10.1176/appi.ps.201500307

    View details for PubMedID 27032662

  • Reviewing and interpreting the effects of brief alcohol interventions: comment on a Cochrane review about motivational interviewing for young adults. Addiction (Abingdon, England) Grant, S., Pedersen, E. R., Osilla, K. C., Kulesza, M., D'Amico, E. J. 2016; 111 (9): 1521-7

    Abstract

    Cochrane recently published a systematic review on motivational interviewing (MI) for alcohol misuse in young adults. The review authors concluded that 'there are no substantive, meaningful benefits of MI interventions for the prevention of alcohol misuse' (p. 2), as effect sizes were 'small and unlikely to be of any meaningful benefit in practice' (p. 27). As most of these interventions were quite brief, we wish to open a dialogue about interpreting effect sizes in this review and of (brief) alcohol interventions more generally.We analyze four methodological aspects of the review that likely influenced the author's conclusions about intervention effects: (1) risk of bias assessments, (2) search strategies, (3) assessing the quality of the body of evidence and (4) definitions of sustainability and clinical significance.We interpret the effect sizes found in this review to indicate modest yet beneficial and potentially meaningful effects of these interventions, given their brevity and low cost. This interpretation is consistent with other reviews on brief, MI-based interventions and brief interventions more generally. We therefore encourage the field to re-open dialogue about the clinical importance of the effects of MI on alcohol misuse by young adults. Rather than dismissing interventions with small effects, we believe a more fruitful way forward for the field would be to catalogue effect sizes for various alcohol interventions. Such a catalogue would help stakeholders themselves to choose which interventions meet their minimum desired impact, and thus may be suitable given their targeted populations, setting and resources.

    View details for DOI 10.1111/add.13136

    View details for PubMedID 26508301

    View details for PubMedCentralID PMC5057341

  • The longitudinal relationship between employment and substance use among at-risk adolescents. Journal of child and adolescent behavior Osilla, K. C., Miles, J. N., Hunter, S. B., D'Amico, E. J. 2015; 3 (3)

    Abstract

    This paper explores the longitudinal association between employment and alcohol/other drug (AOD) use and consequences among an at-risk youth sample with a first-time AOD offense. This study extends previous research by examining the effects of more stable employment over time. Participants were adolescents referred to a diversion program (N=193) for a first-time AOD offense. Mean age was 16.6 (SD=1.1), 67% of the sample was male; and 45% Hispanic or Latino/a, 45% white; 10% other. We examined work intensity at program intake with AOD use, AOD-related consequences and risky social environment 180 days after the first survey. Greater work intensity was associated with greater peak drinks per occasion 180 days later and time spent around teens who use alcohol and marijuana; when controlling for age, gender, and race/ethnicity, work intensity was only associated with increased contact with teens who use marijuana. Work stability was not found to be associated with AOD-related use, outcomes, or reports of a risky social environment. Understanding how employment uniquely affects at-risk youth can help us determine policies and practices that may be needed to monitor the amount of time teens work.

    View details for DOI 10.4172/2375-4494.1000202

    View details for PubMedID 26448969

    View details for PubMedCentralID PMC4593323

  • A pilot study comparing in-person and web-based motivational interviewing among adults with a first-time DUI offense. Addiction science & clinical practice Osilla, K. C., Paddock, S. M., Leininger, T. J., D'Amico, E. J., Ewing, B. A., Watkins, K. E. 2015; 10: 18

    Abstract

    Driving under the influence (DUI) is a significant problem, and there is a pressing need to develop interventions that reduce future risk.We pilot-tested the acceptance and efficacy of web-motivational interviewing (MI) and in-person MI interventions among a diverse sample of individuals with a first-time DUI offense. Participants (N = 159) were 65 percent male, 40 percent Hispanic, and an average age of 30 (SD = 9.8). They were enrolled at one of three participating 3-month DUI programs in Los Angeles County and randomized to usual care (UC)-only (36-h program), in-person MI plus UC, or a web-based intervention using MI (web-MI) plus UC. Participants were assessed at intake and program completion. We examined intervention acceptance and preliminary efficacy of the interventions on alcohol consumption, DUI, and alcohol-related consequences.Web-MI and in-person MI participants rated the quality of and satisfaction with their sessions significantly higher than participants in the UC-only condition. However, there were no significant group differences between the MI conditions and the UC-only condition in alcohol consumption, DUI, and alcohol-related consequences. Further, 67 percent of our sample met criteria for alcohol dependence, and the majority of participants in all three study conditions continued to report alcohol-related consequences at follow-up.Participants receiving MI plus UC and UC-only had similar improvements, and a large proportion had symptoms of alcohol dependence. Receiving a DUI and having to deal with the numerous consequences related to this type of event may be significant enough to reduce short-term behaviors, but future research should explore whether more intensive interventions are needed to sustain long-term changes.

    View details for DOI 10.1186/s13722-015-0039-0

    View details for PubMedID 26334629

    View details for PubMedCentralID PMC4636762

  • The effects of mental health symptoms and marijuana expectancies on marijuana use and consequences among at-risk adolescents. Journal of drug issues Pedersen, E. R., Miles, J. N., Osilla, K. C., Ewing, B. A., Hunter, S. B., D'Amico, E. J. 2015; 45 (2): 151-165

    Abstract

    Based on expectancy theory, adolescents at risk for mental health symptoms, such as those involved in the juvenile court system, may use marijuana due to the belief that use will attenuate anxiety and depressive symptoms. In a diverse sample of youth involved in the Santa Barbara Teen Court system (N = 193), we examined the association between mental health symptoms and marijuana expectancies on marijuana use and consequences. In general, stronger positive expectancies and weaker negative expectancies were both associated with increased marijuana use. Youth that reported more symptoms of both anxiety and depression and stronger positive expectancies for marijuana also reported more consequences. We found that youth experiencing the greatest level of consequences from marijuana were those that reported more depressive symptoms and stronger positive expectancies for marijuana. Findings suggest that these symptoms, combined with strong positive expectancies about marijuana's effects, have implications for consequences among at-risk youth.

    View details for DOI 10.1177/0022042614559843

    View details for PubMedID 25977590

    View details for PubMedCentralID PMC4428682

  • How group factors affect adolescent change talk and substance use outcomes: implications for motivational interviewing training. Journal of counseling psychology Osilla, K. C., Ortiz, J. A., Miles, J. N., Pedersen, E. R., Houck, J. M., D'Amico, E. J. 2015; 62 (1): 79-86

    Abstract

    Clients who verbalize statements arguing for change (change talk [CT]) in psychotherapy are more likely to decrease alcohol and other drug use (AOD) compared with clients who voice statements in opposition of change (sustain talk [ST]). Little is known about how CT and ST are expressed in groups in which adolescents may vary in their AOD use severity and readiness to change. First, we examined how session content was associated with CT/ST, and then we looked at whether different subtypes of CT/ST were associated with subsequent AOD outcomes 3 months later. Audio recordings (N = 129 sessions) of a 6-session group motivational interviewing (MI) intervention, Free Talk, were coded. Session content was not associated with CT; however, some session content was associated with higher percentages of ST (e.g., normative feedback). Subtypes of CT (Commitment and Reason) were associated with improved AOD outcomes, whereas Ability subtype remarks were related to increased marijuana use, intentions, and consequences. Findings offer helpful guidance for clinical training and narrow in on the type of CT to try to elicit in Group MI sessions. Regardless of session content, adolescents can benefit from hearing CT during the group.

    View details for DOI 10.1037/cou0000049

    View details for PubMedID 25602608

    View details for PubMedCentralID PMC4300532

  • Longitudinal family effects on substance use among an at-risk adolescent sample. Addictive behaviors Ewing, B. A., Osilla, K. C., Pedersen, E. R., Hunter, S. B., Miles, J. N., D'Amico, E. J. 2015; 41: 185-91

    Abstract

    Adult and peer factors may influence whether adolescents use alcohol and other drugs (AOD). This longitudinal study examined the direct effects of adult monitoring, perceived adult AOD use, and cultural values on adolescent AOD use.Participants were 193 at-risk adolescents referred to a California diversion program called Teen Court for a first-time AOD offense. We assessed youth reports of past 30day AOD use (any alcohol use, heavy drinking, marijuana use), demographics, changes in parental monitoring and family values (from baseline to follow-up 180days later), as well as family structure and perceived adult substance use at follow-up.Adolescents who reported that a significant adult in their life used marijuana were more likely to have increased days of drinking, heavy drinking, and marijuana use at follow-up. Higher levels of familism (importance the teen places on their family's needs over their own needs) and being in a nuclear family served as protective factors for future alcohol use. Additionally, poor family management was associated with increased alcohol use and heavy drinking.Findings highlight how family management and perceptions of adult marijuana use influence subsequent adolescent AOD use, and how an increase in familism over time is associated with a decrease in adolescent drinking. Tailoring interventions, by including the teen's family and/or providing support to adults who use AOD may be crucial for improving interventions for adolescent AOD use.

    View details for DOI 10.1016/j.addbeh.2014.10.017

    View details for PubMedID 25452064

    View details for PubMedCentralID PMC4314308

  • Group motivational interviewing for adolescents: change talk and alcohol and marijuana outcomes. Journal of consulting and clinical psychology D'Amico, E. J., Houck, J. M., Hunter, S. B., Miles, J. N., Osilla, K. C., Ewing, B. A. 2015; 83 (1): 68-80

    Abstract

    Little is known about what may distinguish effective and ineffective group interventions. Group motivational interviewing (MI) is a promising intervention for adolescent alcohol and other drug use; however, the mechanisms of change for group MI are unknown. One potential mechanism is change talk, which is client speech arguing for change. The present study describes the group process in adolescent group MI and effects of group-level change talk on individual alcohol and marijuana outcomes.We analyzed 129 group session audio recordings from a randomized clinical trial of adolescent group MI. Sequential coding was performed with the Motivational Interviewing Skill Code (MISC) and the CASAA Application for Coding Treatment Interactions software application. Outcomes included past-month intentions, frequency, and consequences of alcohol and marijuana use; motivation to change; and positive expectancies.Sequential analysis indicated that facilitator open-ended questions and reflections of change talk increased group change talk. Group change talk was then followed by more change talk. Multilevel models accounting for rolling group enrollment revealed group change talk was associated with decreased alcohol intentions, alcohol use, and heavy drinking 3 months later; group sustain talk was associated with decreased motivation to change, increased intentions to use marijuana, and increased positive alcohol and marijuana expectancies.Facilitator speech and peer responses each had effects on change and sustain talk in the group setting, which were then associated with individual changes. Selective reflection of change talk in adolescent group MI is suggested as a strategy to manage group dynamics and increase behavioral change.

    View details for DOI 10.1037/a0038155

    View details for PubMedID 25365779

    View details for PubMedCentralID PMC4324015

  • The effects of purchasing alcohol and marijuana among adolescents at-risk for future substance use. Substance abuse treatment, prevention, and policy Osilla, K. C., Pedersen, E. R., Ewing, B. A., Miles, J. N., Ramchand, R., D'Amico, E. J. 2014; 9: 38

    Abstract

    Among high-risk youth, those who may be at increased risk for adverse alcohol and other drug (AOD) use outcomes may benefit from targeted prevention efforts; how youth acquire AOD may provide an objective means of identifying youth at elevated risk.We assessed how youth acquired alcohol and marijuana (purchasing vs. other means), demographics, AOD behaviors/consequences, and environment among adolescents referred to a diversion program called Teen Court (N = 180) at two time points (prior to the program and 180 days from baseline). Participants were predominantly White and Hispanic/Latino(a).In cross-sectional analyses among alcohol and marijuana users, purchasing marijuana was associated with more frequent marijuana use and consequences, time spent around teens who use marijuana, higher likelihood of substance use disorders, and lower resistance self-efficacy compared to non-purchasers. Teens who purchased both alcohol and marijuana experienced similar outcomes to those who purchased only marijuana, and also reported more frequent and higher quantity of drinking, greater alcohol-related consequences, time spent around teens who use other drugs, and prescription drug misuse. Longitudinally, purchasing alcohol and marijuana at baseline was associated with more frequent and higher quantity of drinking compared to non-purchasers at follow-up. Marijuana only purchasers had a greater likelihood of substance use disorders at follow-up compared to non-purchasers.In an era where drinking is commonplace and attitudes towards marijuana use are becoming more tolerant, it is essential to evaluate how accessibility to AOD and subsequent purchasing behaviors affect youth consumption and intervene accordingly to prevent future consequences.

    View details for DOI 10.1186/1747-597X-9-38

    View details for PubMedID 25231097

    View details for PubMedCentralID PMC4177688

  • Evaluating the impact of getting to outcomes-underage drinking on prevention capacity and alcohol merchant attitudes and selling behaviors. Prevention science : the official journal of the Society for Prevention Research Chinman, M., Ebener, P., Burkhart, Q., Osilla, K. C., Imm, P., Paddock, S. M., Wright, P. A. 2014; 15 (4): 485-96

    Abstract

    Underage drinking is a significant problem facing US communities. Several environmental alcohol prevention (EAP) strategies (laws, regulations, responsible beverage service training and practices) successfully address underage drinking. Communities, however, face challenges carrying out these EAP strategies effectively. This small-scale, 3-year, randomized controlled trial assessed whether providing prevention coalitions with Getting To Outcomes-Underage Drinking (GTO-UD), a tool kit and implementation support intervention, helped improve implementation of two common EAP strategies, responsible beverage service training (RBS) and compliance checks. Three coalitions in South Carolina and their RBS and compliance check programs received the 16-month GTO-UD intervention, including the GTO-UD manual, training, and onsite technical assistance, while another three in South Carolina maintained routine operations. The measures, collected at baseline and after the intervention, were a structured interview assessing how well coalitions carried out their work and a survey of merchant attitudes and practices in the six counties served by the participating coalitions. Over time, the quality of some RBS and compliance check activities improved more in GTO-UD coalitions than in the control sites. No changes in merchant practices or attitudes significantly differed between the GTO-UD and control groups, although merchants in the GTO-UD counties did significantly improve on refusing sales to minors while control merchants did not.

    View details for DOI 10.1007/s11121-013-0389-3

    View details for PubMedID 23564504

    View details for PubMedCentralID PMC5642289

  • Study design to develop and pilot-test a web intervention for partners of military service members with alcohol misuse. Addiction science & clinical practice Osilla, K. C., Pedersen, E. R., Gore, K., Trail, T., Howard, S. S. 2014; 9 (1): 18

    Abstract

    Alcohol misuse among military service members from the recent conflicts in Iraq and Afghanistan is over two times higher compared to misuse in the civilian population. Unfortunately, in addition to experiencing personal consequences from alcohol misuse, partners and family members of alcohol-misusing service members also suffer in negative ways from their loved one's drinking. These family members represent important catalysts for helping their loved ones identify problem drinking and overcoming the barriers to seeking care. This paper describes the protocol to a pilot study evaluating a 4-session, web-based intervention (WBI) for concerned partners (CPs) of service members with alcohol misuse.The WBI will be adapted from the Community Reinforcement and Family Training (CRAFT) intervention. In the first phase, we will develop and beta-test the WBI with 15-20 CPs. In the second phase, we will randomize CPs to WBI (n = 50) or to delayed-WBI (n = 50) and evaluate the impact of the WBI on CPs' perceptions of service member help-seeking and drinking, as well as the CP's well-being and relationship satisfaction 3 months after the intervention. In the third phase, we will recruit 15-20 service members whose partners have completed the study. We will interview the service members to learn how the CP-focused WBI affected them and to assess whether they would be receptive to a follow-on WBI module to help them.This project has the potential to benefit a large population of military service members who may be disproportionately affected by recent conflicts and whose drinking misuse would otherwise go undetected and untreated. It also develops a new prevention model that does not rely on service members or partners attending a hospital or clinical facility to access care.NCT02073825.

    View details for DOI 10.1186/1940-0640-9-18

    View details for PubMedID 25179672

    View details for PubMedCentralID PMC4159379

  • Perceived norms moderate the association between mental health symptoms and drinking outcomes among at-risk adolescents. Journal of studies on alcohol and drugs Pedersen, E. R., Miles, J. N., Hunter, S. B., Osilla, K. C., Ewing, B. A., D'Amico, E. J. 2013; 74 (5): 736-45

    Abstract

    There has been limited research examining the association between mental health symptoms, perceived peer alcohol norms, and alcohol use and consequences among samples of adolescents. The current study used a sample of 193 at-risk youths with a first-time alcohol and/or other drug offense in the California Teen Court system to explore the moderating role of perceived peer alcohol norms on the association between mental health symptoms and drinking outcomes.Measures of drinking, consequences, mental health symptoms, and perceived peer alcohol norms were taken at baseline, with measures of drinking and consequences assessed again 6 months later. Regression analyses examined the association of perceived norms and mental health symptoms with concurrent and future drinking and consequences.We found that higher perceived drinking peer norms were associated with heavy drinking behavior at baseline and with negative alcohol consequences both at baseline and 6 months later. Also, perceived drinking norms moderated the association between mental health symptoms and alcohol-related consequences such that better mental health was related to increased risk for alcohol-related consequences both concurrently and 6 months later among those with higher baseline perceptions of peer drinking norms.Findings demonstrate the value of norms-based interventions, especially among adolescents with few mental health problems who are at risk for heavy drinking.

    View details for DOI 10.15288/jsad.2013.74.736

    View details for PubMedID 23948533

    View details for PubMedCentralID PMC3749317

  • The Carrot and the Stick: A Cross-Sectional Study of the Influences on Responsible Merchant Practices to Reduce Underage Drinking. Journal of community psychology Ebener, P., Malone, P., Imm, P., Osilla, K. C., Paddock, S. M., Wright, P. A., Burkhart, Q. 2013; 41 (4): 463-470

    Abstract

    Alcohol merchants (N=331) completed a cross-sectional survey assessing their attitudes and beliefs about underage drinking, its likely consequences, requirements for responsible beverage service (RBS) training, and performance of RBS practices and checking IDs. Merchants requiring more rigorous RBS training (i.e., state-approved versus in-house or none) have stronger beliefs that outlets who sell to minors will get cited and that their employees know RBS practices. Also, merchants who engage in more RBS practices require more rigorous RBS training, and believe more strongly that outlets who sell to minors are more likely to face, and deserve, stricter sanctions. Merchants who check IDs more strictly conduct more RBS practices and believe more strongly that underage drinking is serious and will result in stronger consequences if caught selling to minors. These findings about the attitudes, practices, and enforcement of alcohol merchants suggests ways communities can better target their limited resources to prevent underage drinking.

    View details for DOI 10.1002/jcop.21550

    View details for PubMedID 29051676

    View details for PubMedCentralID PMC5645047

  • The effects of employment among adolescents at-risk for future substance use. Addictive behaviors Osilla, K. C., Hunter, S. B., Ewing, B. A., Ramchand, R., Miles, J. N., D'Amico, E. J. 2013; 38 (3): 1616-9

    Abstract

    This paper explores the association between work intensity, alcohol and/or other drug (AOD) use, and related risk factors and consequences among an at-risk youth sample that has received a first-time AOD offense. This study extends previous research focused primarily on school-based samples.We examined the association between work intensity, AOD use, AOD-related consequences, and social environment among adolescents referred to a diversion program called Teen Court (N=193). Participants were surveyed prior to the start of the Teen Court program. Mean age was 17 (SD=1.1), 67% of the sample was male; 45% Hispanic or Latino/a; 45.1% White; 10% Other.Greater work intensity among these youth was related to greater alcohol-related negative consequences and greater contact with co-workers who engaged in risky behaviors, but it was not significantly associated with past month AOD use.Understanding the relationship between work intensity and AOD use among youth who are at-risk is critical to informing clinicians and public officials about the potential effects of employment in this population. Findings suggest that work intensity may be associated with negative consequences from alcohol use and increased contact with risky co-workers, all of which could contribute to the development of problems in the future.

    View details for DOI 10.1016/j.addbeh.2012.09.012

    View details for PubMedID 23254207

    View details for PubMedCentralID PMC3558640

  • Assessing motivational interviewing integrity for group interventions with adolescents. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors D'Amico, E. J., Osilla, K. C., Miles, J. N., Ewing, B., Sullivan, K., Katz, K., Hunter, S. B. 2012; 26 (4): 994-1000

    Abstract

    The group format is commonly used in alcohol and other drug (AOD) adolescent treatment settings, but little research exists on the use of motivational interviewing (MI) in groups. Further, little work has assessed the integrity of MI delivered in group settings. This study describes an approach to evaluate MI integrity using data from a group MI intervention for at-risk youth. Using the Motivational Interviewing Treatment Integrity (MITI) scale, version 3.1, we coded 140 group sessions led by 3 different facilitators. Four trained coders assessed the group sessions. Agreement between raters was evaluated using a method based on limits of agreement, and key decisions used to monitor and calculate group MI integrity are discussed. Results indicated that there was adequate agreement between raters; we also found differences on use of MI between the MI-intervention group and a usual-care group on MI global ratings and behavioral counts. This study demonstrates that it is possible to determine whether group MI is implemented with integrity in the group setting and that MI in this setting is different from what takes place in usual care.

    View details for DOI 10.1037/a0027987

    View details for PubMedID 22642853

    View details for PubMedCentralID PMC3540190

  • Multicultural web-based motivational interviewing for clients with a first-time DUI offense. Cultural diversity & ethnic minority psychology Osilla, K. C., D'Amico, E. J., Díaz-Fuentes, C. M., Lara, M., Watkins, K. E. 2012; 18 (2): 192-202

    Abstract

    Culturally and linguistically appropriate interventions are needed to reduce the risk of driving under the influence (DUI) recidivism among diverse populations. Using core elements of Motivational Interviewing, we developed a culturally relevant web-MI intervention (web-MI) in English and Spanish to serve as a standalone or adjunctive program in DUI educational settings and evaluated its feasibility and acceptability among clients with first-time DUI offenses. We conducted an iterative formative assessment using focus groups with staff (n = 8) and clients (n = 27), and usability interviews with clients (n = 21). Adapting MI for the web was widely accepted by staff and clients. Clients stated the web-MI was engaging, interactive and personal, and felt more comfortable than past classes and programs. Spanish-speaking clients felt less shame, embarrassment, and discomfort with the web-MI compared to other in-person groups. Results support the viability of web-MI for DUI clients at risk for recidivism and highlight the importance of adapting the intervention for diverse populations. Key decisions used to develop the web-MI are discussed.

    View details for DOI 10.1037/a0027751

    View details for PubMedID 22506822

    View details for PubMedCentralID PMC3335756

  • Patient and provider characteristics associated with the decision of HIV coinfected patients to start hepatitis C treatment. AIDS patient care and STDs Osilla, K. C., Wagner, G., Garnett, J., Ghosh-Dastidar, B., Witt, M., Bhatti, L., Goetz, M. B. 2011; 25 (9): 533-8

    Abstract

    Hepatitis C (HCV) and HIV coinfection is common and liver disease is a leading cause of morbidity and mortality among coinfected patients. Despite advances in HCV treatment, few HIV coinfected patients actually initiate treatment. We examined patient and provider characteristics associated with a patient's decision to accept or refuse HCV treatment once offered. We conducted patient chart abstraction and surveys with 127 HIV coinfected patients who were offered HCV treatment by their provider and surveys of their HCV care providers at three HIV clinics. Participants were mostly male (87%), minority (66%), and had a history of injection drug use (60%). Most had been diagnosed with HIV for several years (X=13.7 years) and reported HIV transmission through unprotected sex (47%). Of the 127 patients, 79 accepted treatment. In multivariate analysis, patients who had a CD4 greater than 200 cells/mm(3) and a provider with more confidence about HCV treatment were more likely to accept the recommendation to start treatment; younger age was marginally associated with treatment acceptance. In bivariate analysis, added correlates of treatment acceptance included male gender, no recent drug use, and several provider attitudes regarding treatment and philosophy about determination of patient treatment readiness. Patient and provider characteristics are important when understanding a patient's decision to start or defer HCV treatment. Further research is needed to better understand barriers to treatment uptake as new and more effective HCV treatments will soon be available.

    View details for DOI 10.1089/apc.2011.0048

    View details for PubMedID 21823907

    View details for PubMedCentralID PMC3157303

  • The premises is the premise: understanding off- and on-premises alcohol sales outlets to improve environmental alcohol prevention strategies. Prevention science : the official journal of the Society for Prevention Research Chinman, M., Burkhart, Q., Ebener, P., Fan, C. C., Imm, P., Osilla, K. C., Paddock, S. M., Wright, A. 2011; 12 (2): 181-91

    Abstract

    Environmental strategies to prevent the misuse of alcohol among youth--e.g., use of public policies to restrict minors' access to alcohol--have been shown to reduce underage drinking. However, implementation of policy changes often requires public and private partnerships. One way to support these partnerships is to better understand the target of many of the environmental strategies, which is the alcohol sales outlet. Knowing more about how off-premises outlets (e.g., liquor and convenience stores) and on-premises outlets (e.g., bars and restaurants) are alike and different could help community-based organizations better tailor, plan, and implement their environmental strategies and strengthen partnerships between the public and commercial sectors. We conducted a survey of managerial or supervisory staff and/or owners of 336 off- and on-premises alcohol outlets in six counties in South Carolina, comparing these two outlet types on their preferences regarding certain alcohol sales practices, beliefs toward underage drinking, alcohol sales practices, and outcomes. Multilevel logistic regression showed that while off- and on-premises outlets did have many similarities, off-premises outlets appear to engage in more practices designed to prevent sales of alcohol to minors than on-premises outlets. The relationship between certain Responsible Beverage Service (RBS) practices and outcomes varied by outlet type. This study furthers the understanding of the differences between off- and on-premises alcohol sales outlets and offers options for increasing and tailoring environmental prevention efforts to specific settings.

    View details for DOI 10.1007/s11121-011-0203-z

    View details for PubMedID 21373877

    View details for PubMedCentralID PMC5642269

  • Disparate prevalence estimates of PTSD among service members who served in Iraq and Afghanistan: possible explanations. Journal of traumatic stress Ramchand, R., Schell, T. L., Karney, B. R., Osilla, K. C., Burns, R. M., Caldarone, L. B. 2010; 23 (1): 59-68

    Abstract

    The authors reviewed 29 studies that provide prevalence estimates of posttraumatic stress disorder (PTSD) among service members previously deployed to Operations Enduring and Iraqi Freedom and their non-U.S. military counterparts. Studies vary widely, particularly in their representativeness and the way PTSD is defined. Among previously deployed personnel not seeking treatment, most prevalence estimates range from 5 to 20%. Prevalence estimates are generally higher among those seeking treatment: As many as 50% of veterans seeking treatment screen positive for PTSD, though much fewer receive a PTSD diagnosis. Combat exposure is the only correlate consistently associated with PTSD. When evaluating PTSD prevalence estimates among this population, researchers and policymakers should carefully consider the method used to define PTSD and the population the study sample represents.

    View details for DOI 10.1002/jts.20486

    View details for PubMedID 20135699

  • Exploring productivity outcomes from a brief intervention for at-risk drinking in an employee assistance program. Addictive behaviors Osilla, K. C., dela Cruz, E., Miles, J. N., Zellmer, S., Watkins, K., Larimer, M. E., Marlatt, G. A. 2010; 35 (3): 194-200

    Abstract

    Brief intervention (BI) research has traditionally examined alcohol and drug use outcomes; however it is unknown whether BIs can also impact on-the-job productivity. This exploratory study examines changes in workplace productivity and related costs for clients receiving a BI for at-risk drinking in the employee assistance program (EAP). Participants were 44 clients attending the EAP for behavioral health concerns, screened for at-risk drinking, assigned to BI+Usual Care (n=25) or UC alone (n=19), and who completed 3-month follow-up. Absenteeism, presenteeism, and productivity costs were derived as outcomes. At follow-up, participants in the BI+UC group had improved productivity when at work (presenteeism) compared to the UC group. The estimated cost savings from improved productivity for the BI+UC group was $1200 per client over the UC group. Groups did not differ by absenteeism (missed days of work). Preliminary evidence suggests the broad impact BIs may have. Implications for future BI research are discussed.

    View details for DOI 10.1016/j.addbeh.2009.10.001

    View details for PubMedID 19897312

    View details for PubMedCentralID PMC2821832

  • Factors that influence an HIV coinfected patient's decision to start hepatitis C treatment. AIDS patient care and STDs Osilla, K. C., Ryan, G., Bhatti, L., Goetz, M., Witt, M., Wagner, G. 2009; 23 (12): 993-9

    Abstract

    Liver disease is a leading cause of morbidity and mortality among patients coinfected with HIV and hepatitis C (HCV), yet few HIV coinfected patients actually receive HCV treatment. Providers must first be willing to prescribe treatment, but the patient ultimately makes the decision to accept or decline a treatment recommendation. We used a process model framework to explore the factors influencing patients' treatment decision-making. We conducted semistructured interviews with 35 HIV coinfected patients and 11 primary care providers at three HIV clinics in Los Angeles, California. Patients reported that stability of HIV disease, perceived need for HCV treatment, treatment readiness, willingness to deal with side effects, absence of substance abuse, and stability of mental health and overall life circumstances are key factors influencing treatment decision-making. Patients also spoke of the influence of the trusting relationship that many had with their provider, and providers acknowledged an awareness of the influence of how they present the risks and benefits of HCV treatment and the overall tone of their recommendation (encouraging, dissuasive, or neutral). These results speak to a social decision-making process between the patient and provider-a partnership that involves sequential interactions whereby both the patient and provider may influence the other's evaluation of the patient's readiness for treatment, with treatment initiation dependent on both agreeing on the need for treatment and the patient's readiness for treatment.

    View details for DOI 10.1089/apc.2009.0153

    View details for PubMedID 19929229

    View details for PubMedCentralID PMC2832645

  • Treat early or wait and monitor? A qualitative analysis of provider hepatitis C virus treatment decision-making in the context of HIV coinfection. AIDS patient care and STDs Wagner, G., Ryan, G., Osilla, K. C., Bhatti, L., Goetz, M., Witt, M. 2009; 23 (9): 715-25

    Abstract

    Liver disease is a leading cause of death among patients with HIV coinfected with hepatitis C (HCV); yet, studies show that less than 10% receive HCV treatment, in part because of limited treatment response, high treatment toxicity, and psychosocial barriers to treatment readiness. Using a process model framework, we sought to explore the factors and processes by which providers make HCV treatment decisions for HIV-coinfected patients. We conducted 22 semistructured interviews with primary care providers and support staff at three HIV clinics in Los Angeles, California, in which rates of HCV treatment uptake varied from 10% to 38%. Providers agreed that stable HIV disease, favorable genotype, and significant signs of liver disease progression are all signs of need for treatment. However, two divergent treatment approaches emerged for genotype 1 and 4 patients with minimal disease, and in definitions of patient readiness. Providers with lower treatment rates preferred to delay treatment in hopes of better future treatment options, and were more conservative in requiring complete mental health screens and treatment and abstinence from substance use. Conversely, providers with higher treatment rates viewed all patients as needing treatment as soon as possible, and defined readiness more leniently, with some willing to treat even in the context of untreated depression and drug use, so long as ability to adhere well was demonstrated. Regardless of whether an aggressive or cautious approach to treatment is used, development of effective programs for promoting patient treatment readiness is critical to ensuring greater treatment uptake.

    View details for DOI 10.1089/apc.2009.0049

    View details for PubMedID 19663714

    View details for PubMedCentralID PMC2832644

  • Developing an integrated treatment for substance use and depression using cognitive-behavioral therapy. Journal of substance abuse treatment Osilla, K. C., Hepner, K. A., Muñoz, R. F., Woo, S., Watkins, K. 2009; 37 (4): 412-20

    Abstract

    Providing a unified treatment approach to meet the substance abuse and mental health needs of clients is the preferred model for addressing co-occurring disorders. We developed a group-based cognitive-behavioral (CBT) integrated treatment for depression and substance use disorders (SUD) that could be delivered by counselors in SUD treatment settings and evaluated its feasibility and acceptability. We conducted an in-depth case study examining one implementation of the treatment using 15 focus groups with clients (n = 7) and semistructured interviews with counselors (n = 2) and administrators (n = 3). Using CBT as a treatment approach to integrate the treatment was widely accepted by clients, counselors, and administrators. Clients stated the treatment was applicable to multiple aspects of their lives and allowed them to recognize their clinical improvements over time. Counselors and administrators discussed challenges for long-term feasibility. Key decisions used to develop the treatment and recommendations for implementing integrated care in SUD settings are discussed.

    View details for DOI 10.1016/j.jsat.2009.04.006

    View details for PubMedID 19540701

    View details for PubMedCentralID PMC2855309

  • Further validity evidence for the dimensions of change in therapeutic community treatment instrument. The American journal of drug and alcohol abuse Edelen, M. O., Miles, J. N., Osilla, K. C., Wenzel, S. L. 2008; 34 (3): 285-92

    Abstract

    Recent research efforts have focused on assessing the therapeutic community (TC) treatment process. The current article examines the validity of the client self-report Dimensions of Change Instrument (DCI) treatment process measure, by confirming its factor structure and examining each subscale's relationship with time in treatment, scales from an existing process assessment, and mental and physical health status. Participants were 511 adult and adolescent residential TC clients. The factor structure of the DCI replicated with satisfactory fit. The pattern of associations between DCI subscales and criterion measures was largely as expected, providing initial concurrent and discriminant validity evidence for the DCI.

    View details for DOI 10.1080/00952990802013482

    View details for PubMedID 18428071

  • A brief intervention for at-risk drinking in an employee assistance program. Journal of studies on alcohol and drugs Osilla, K. C., Zellmer, S. P., Larimer, M. E., Neighbors, C., Marlatt, G. A. 2008; 69 (1): 14-20

    Abstract

    The current pilot study examined the preliminary efficacy of a brief intervention (BI) for at-risk drinking in an employee assistance program.Clients (N = 107) entering the employee assistance program (EAP) for mental health services were screened and met criteria for at-risk drinking. EAP therapists were randomly assigned to deliver either the BI plus EAP services as usual (SAU) or SAU only. Participants in the final analyses consisted of 44 BI + SAU (30 women, 14 men) and 30 SAU (21 women, 9 men) EAP clients who completed a 3-month follow-up.Results suggested that participants in the BI + SAU group had significant reductions in peak blood alcohol concentration, peak quantity, and alcohol-related consequences compared with the SAU group. Men in the BI + SAU group had greater reductions in alcohol-related problems compared with men in the SAU group. Groups did not differ by number of total EAP sessions attended or rates of presenting problem resolution.Results provide preliminary evidence to support the integration of alcohol screening and BI as a low-cost method of intervening with clients with at-risk drinking in the context of co-occurring presenting problems.

    View details for DOI 10.15288/jsad.2008.69.14

    View details for PubMedID 18080060

  • Regular tobacco use among American Indian and Alaska native adolescents: an examination of protective mechanisms. Journal of ethnicity in substance abuse Osilla, K. C., Lonczak, H. S., Mail, P. D., Larimer, M. E., Marlatt, G. A. 2007; 6 (3-4): 143-53

    Abstract

    American Indian and Alaska Native (AIAN) adolescents use tobacco at earlier ages and in larger quantities compared to non-AIAN peers. Regular tobacco use was examined against five protective factors (peer networks supportive of not using drugs, college aspirations, team sports, playing music, and volunteerism). Participants consisted of 112 adolescents between the ages of 13 and 19 who participated in a study testing the efficacy of a life-skills program aimed at reducing substance-related consequences. Findings indicated that, with the exception of prosocial peer networks and volunteerism, each of the above factors was significantly associated with a reduced probability of being a regular tobacco user. Gender differences were notable. These results hold important treatment implications regarding the reduction and prevention of tobacco use among AIAN youth.

    View details for DOI 10.1300/J233v06n03_06

    View details for PubMedID 19842310