Future research that investigates whether each of these putative mechanisms mediates intervention effects on adolescent outcomes would strengthen support for the hypothesis that family-based interventions help parents build skills for supporting their children’s substance use abstinence or reduction. Further research is also needed to better understand why adolescent-focused intervention was more beneficial than family-based intervention in reducing alcohol use when parents had low-level distress. We observed that in FAMI, families focused discussion on youth marijuana use during parent adolescent communication role plays, whereas HPI delivered a fixed amount of didactic material about each substance. This plausibly resulted in delivering more alcohol-related content in HPI than in FAMI, and adolescents with low-distress parents might have been better able to learn and apply this content to abstain from alcohol. This working hypothesis requires testing in future studies. Our study also had several strengths. We measured a range of behavioral health outcomes and targeted a specific adolescent population with urgent behavioral health needs. Effects of both adolescent and family-based substance use interventions are smaller for juvenile offenders than for non-offenders , likely due to additional challenges that can inhibit treatment progress. To our knowledge, plant bench indoor this is the only study assessing pre-existing parent distress as a moderator of interventions targeting substance use, sexual risk, and mental health outcomes among justice-involved adolescents.
Identifying moderators can inform the creation of screening tools to match adolescents with their optimally effective intervention, which may be enhanced by considering multiple moderators for each adolescent—a current direction in research to personalize mental health interventions . We hope that our findings will inform clinical applications to improve behavioral health services for justice-involved adolescents.In the USA, gastrointestinal symptoms affect over 60% of adults and are associated with a significantly lower quality of life. In a national survey, GI symptoms such as heartburn, abdominal pain, bloating, diarrhea, and constipation were most common. Optimal treatment involves a biopsychosocial model approach. However, treatments are not always effective, and some first-line medications like proton pump inhibitors may introduce new symptoms like nausea or bloating. Increasingly, some patients are trialing medical marijuana for GI symptoms, but the literature is conflicted regarding the potential benefits of its use and whether symptom relief endures long-term. This observational study seeks to describe patterns of MMJ use in patients with self-reported GI symptoms and to evaluate if changes in GI symptom severity occurred at each time point over 1 year.This was a 12-month retrospective, survey-based study of patients who self-described as suffering from refractory GI and non-GI symptoms despite previous medical management and who were certified to use MMJ. The inclusion criterion was at least one GI symptom reported at the first survey such as anorexia, nausea, vomiting, constipation, diarrhea, stomach bloating, stomach pain, and heartburn. Exclusion criteria were pregnancy, lactation, active substance abuse, and GI symptoms appearing after the first survey.
Recruitment occurred between May and October 2020 through public advertisements and an MMJ dispensary in Pennsylvania, USA. Participants completed phone surveys at 0 days, 1 month, 6 months, and 12 months after study initiation. The baseline survey queried the participant’s demographics, qualifying medical conditions for MMJ use , additional medical conditions, medications, and patterns of MMJ use. Participants self-reported their current symptoms and rated each symptom severity “while not using medical marijuana,” abbreviated as SnoMMJ, and “while using medical marijuana,” abbreviated as SyesMMJ, on a scale from 1 to 3 . The difference in symptom severity when using and when not using MMJ, SyesMMJ minus SnoMMJ, is denoted as ΔS. Follow-up surveys documented self-reported side effects of MMJ use and changes in MMJ use behavior . Statistical analyses were conducted with SPSS 28 . The Thomas Jefferson University Institutional Review Board approved this study.This is the first study to examine MMJ’s longitudinal effects on GI symptoms in patients with refractory GI and non-GI MMJ-certified conditions. Overall, participants reported significant, enduring moderate GI symptom relief when using MMJ. Importantly, there were no differences in GI symptom relief based on age, sex, the number of medical conditions, and the number of patient medications. Notably, age-associated differences in MMJ efficacy have been reported in patients with GI and pelvic pain symptoms secondary to endometriosis. Inhalation was the most popular administration method, followed by oral administration, consistent with other studies. The bio-availability of drugs is generally higher with inhalation than with ingestion, increasing both the speed of onset and the drug effect size. Differences in symptom severity improvement based on the route of administration were not assessed due to sample size constraints. Availability was the most common reason for discontinuing an MMJ product, and it is notable that data collection occurred during the COVID-19 pandemic when product shortages were a frequent occurrence. No participants discontinued taking MMJ products entirely. Instead, participants either continued existing MMJ products or tried a new MMJ product. Most participants continued to report reductions in GI symptom severity after trying new products. This is a surprising result. Either most MMJ products share similarly effective compounds or there is a profound placebo effect. Strengths of the study include the longitudinal followup over 1 year and information regarding patterns of MMJ use.
Limitations of the study include reliance on self-report and lack of controls and formal GI diagnoses . Overall, this study suggests there may be a role for MMJ to treat GI symptoms. Importantly, MMJ use is associated with adverse effects, including dry mouth, diarrhea, nausea, and vomiting. Also, inhaling MMJ products increases the risk of cardiovascular events. Therefore, patients considering MMJ for GI symptoms off-label should be counseled accordingly. Additional studies are required to confirm the association between MMJ use and GI symptom relief. Specifically, studies should assess the effects of different CBD/THC ratios, dosing, and methods of administration on GI symptom relief.Attachment theory was first introduced by psychiatrist John Bowlby in the 1950s to explain the infants’ relationship with their mother and gradually developed to study attachment . It was tested by psychologist Mary Ainsworth. The theory initially focused on the attachment between infants and their primary caregivers. Ainsworth used “the Baltimore Project”, or more broadly referred as Strange Situation, a procedure to test how infants react when their primary caregivers are away for a period of time and then come back to them, to observe the attachment style of these infants and further develop the attachment theory . The brief version of the strange situation is described as follows: infant and primary caregiver are introduced in a strange room and left alone. Experimenters observe how the infant reacts when her mother is in the room with her. Then experimenters ask the mother to leave the room when the infant’s attention is away and observe how the infant reacts after she realizes her mother is gone. After a while, greenhouse rolling racks the experimenters re-introduce the mother into the room and observe how the infant will react to the return of the mother. The experiment initially concludes three types of attachment styles and associating behaviors. Secure babies are explorative in the strange situation when their mothers are around, which means they feel safe in a strange situation as long as they are accompanied by their mothers. They express clear negative emotions such as upset and sadness when they realize their mothers are missing. Upon reunion with their mothers, they are happy and welcoming and can quickly go back to explore the strange room. In a word, their mothers are their secure bases. Anxious-ambivalent type babies are clingy and demanding in a strange situation even when the mothers are with them. They do not explore the strange room that much and they tend to stay with their mothers as close as possible. They are usually angry and resentful when they realize their mothers are gone. They show mixed signs such as welcoming and resisting when they reunite with their mothers. Anxious-avoidant type babies show very little interest in exploring the room, act aloofly when their mothers are away, and have no sign of welcoming when their mothers are coming back to them. A group of babies who have tense movements that were initially hard for Ainsworth to categorize, are later classified as disoriented by Main and Hesse and further approved by Ainsworth . The theory quickly extends to explain adult attachment which can apply to various forms of intimacy such as friendships, romantic relationships, and kinships . Although later psychology studies in adult attachment conceptualize attachment styles into a continuous two-dimensional space, it still has four regions and for the purpose of this paper, we use categorized name to describe the attachment styles . Let us have a quick look at the personality traits of these four different styles in adults, which can help us to develop the hypothesis in the following section. Hazen and Shaver argued that adult love styles are closely following infant attachment style Ainsworth concluded. Thus, we present the following four adult attachment style: secure anxious, avoidant anxious-avoidant , and each of four types associates with different behaviors. Secure adults usually have almost no or very little problems to become close with other people and form social bonds. They look at both themselves and other people with positive opinions. Anxious adults are preoccupied by relationships and need constant reassurance from others to affirm their relationship. They tend to have negative opinions about themselves and positive opinions of others, which also amplifies their anxiety. They care about how they are looked at by their closed social bonds. Avoidant adults, however, tend to have positive views of themselves and negative views of others, and often avoid building close interaction with other people. They usually use rejection as a defense mechanism. Bakermans-Kranenburg and IJzendoorn conducted research to study the distribution of different attachment style in population. Albeit there’s more or less differences across the age, language, culture, sex, clinical data or non-clinical data, and other factors, they studied parental relationship and concluded that “58% of the mothers in norm group are secure, with less than a quarter being classified as insecure-dismissing, and almost one-fifth as insecure-preoccupied.” They also mentioned 18% of non-clinical mother has unresolved attachment style. In addition, to break the stereotypes, the distribution doesn’t vary too much across different sex, which means male and female have very similar distribution of the attachment style. In addition, the distribution is independent of culture and language . Many studies tried to decipher the general distribution of attachment style across the population and have similar conclusion. Thus, we safely assume that 50% of the population have secure style and the other half of the population have insecure style, which breaks down to 20-25% anxious and 20-25% avoidant, with 5% unresolved, or we call it anxious-avoidant style. Our focus will be on anxious adults and avoidant adults since they tend to have the most different personalities .Our experimental design addresses the following objectives: to determine the impacts of different attachment style on cooperative behaviors, and to evaluate how attachment can influence subjects’ behaviors in different level of intimate environment by implementing the ultimatum game along with several simple games. We test attachment theory starting from a complete stranger situation and build up the intimacy level by introducing a chat room. The experiment was conducted on oTree .We re-do the stranger case to see if we can replicate Almakias and Weiss did and if the results align with their hypothesis in a somewhat different setting. The reason we hope to build up the intimacy level is that attachment theory is studying people’s behaviors in close relationship, so that an all-stranger setting is not the most ideal situation to learn the impact of attachment styles, though the easiest to achieve in a lab setting. The experiment is done by oTree coding. We start off with the general case and an all-stranger situation, then gradually build up the intimacy level by introducing ice-breaker technology before the experiment starts. The experiment contains 1 control and 1 treatment. During the experiment, we first conducted ECR questionnaire to decide subjects’ anxious and avoidance level. We then randomly pair two subjects together to run three phases of simple games including prisoner’s dilemma, simple trust game, and ultimatum game , naturally, under anonymity and the pair will last until the end of the experiment.