Marc N Potenza

Yale-New Haven Hospital, New Haven, Connecticut, United States

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Publications (337)1511.87 Total impact

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    ABSTRACT: Findings from uncontrolled studies suggest that the COMT Val108/158Met polymorphism may affect response to cognitive behavioral therapy (CBT) in some populations. Using data from a randomized controlled trial evaluating computerized CBT (CBT4CBT), we evaluated treatment response by COMT genotype, with the a priori hypothesis that Val carriers would have improved response to computerized delivery of CBT. 101 cocaine-dependent individuals, of whom 81 contributed analyzable genetic samples, were randomized to standard methadone maintenance treatment plus CBT4CBT or standard treatment alone in an 8 week trial. There was a significant genotype by time effect on frequency of cocaine use from baseline to the end of the 6 month follow-up, suggesting greater reductions over time for Val carriers relative to individuals with the Met/Met genotype. There was a significant treatment condition by genotype interactions for rates of participants attaining 21 or more days of continuous abstinence as well as self-reported percent days of abstinence, suggesting less cocaine use among Val carriers when assigned to CBT compared to standard treatment. Exploration of possible mechanisms using measures of attentional biased also pointed to greater change over time in these measures among the Val carriers assigned to CBT. These are the first data from a randomized controlled trial indicating significant interactions of COMT polymorphism and behavioral therapy condition on treatment outcome, where Val carriers appeared to respond particularly well to computerized CBT. These preliminary data point to a potential biomarker of response to CBT linked to its putative mechanism of action, enhanced cognitive control. (Am J Addict 2015;XX:XX -XX). © American Academy of Addiction Psychiatry.
    American Journal on Addictions 05/2015; DOI:10.1111/ajad.12238 · 1.74 Impact Factor
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    ABSTRACT: Impulsivity is a multifaceted construct that is a core feature of multiple psychiatric conditions and personality disorders. However, progress in understanding and treating impulsivity is limited by a lack of precision and consistency in its definition and assessment. Rapid-response impulsivity (RRI) represents a tendency toward immediate action that occurs with diminished forethought and is out of context with the present demands of the environment. Experts from the International Society for Research on Impulsivity (InSRI) met to discuss and evaluate RRI measures in terms of reliability, sensitivity, and validity, with the goal of helping researchers and clinicians make informed decisions about the use and interpretation of findings from RRI measures. Their recommendations are described in this article. Commonly used clinical and preclinical RRI tasks are described, and considerations are provided to guide task selection. Tasks measuring two conceptually and neurobiologically distinct types of RRI, "refraining from action initiation" (RAI) and "stopping an ongoing action" (SOA) are described. RAI and SOA tasks capture distinct aspects of RRI that may relate to distinct clinical outcomes. The InSRI group recommends that (a) selection of RRI measures should be informed by careful consideration of the strengths, limitations, and practical considerations of the available measures; (b) researchers use both RAI and SOA tasks in RRI studies to allow for direct comparison of RRI types and examination of their associations with clinically relevant measures; and (c) similar considerations be made for human and nonhuman studies in an effort to harmonize and integrate preclinical and clinical research. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Personality Disorders: Theory, Research, and Treatment 04/2015; 6(2):168-181. DOI:10.1037/per0000100 · 3.54 Impact Factor
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    ABSTRACT: "Food addiction" is an emerging area, and behavioral and biological overlaps have been observed between eating and addictive disorders. Potential misconceptions about applying an addiction framework to problematic eating behavior may inhibit scientific progress. Critiques of "food addiction" that focus on descriptive differences between overeating and illicit drugs are similar to early criticisms of the addictiveness of tobacco. Although food is necessary for survival, the highly processed foods associated with addictive-like eating may provide little health benefit. Individual differences are important in determining who develops an addiction. If certain foods are addictive, the identification of possible risk factors for "food addiction" is an important next step. Not all treatments for addiction require abstinence. Addiction interventions that focus on moderation or controlled use may lead to novel approaches to treating eating-related problems. Finally, addiction-related policies that focus on environmental (instead of educational) targets may have a larger public health impact in reducing overeating.
    Current Psychiatry Reports 04/2015; 17(4):563. DOI:10.1007/s11920-015-0563-3 · 3.05 Impact Factor
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    ABSTRACT: Impulsivity critically relates to many psychiatric disorders. Given the multifaceted construct that impulsivity represents, defining core aspects of impulsivity is vital for the assessment and understanding of clinical conditions. Choice impulsivity (CI), involving the preferential selection of smaller sooner rewards over larger later rewards, represents one important type of impulsivity. The International Society for Research on Impulsivity (InSRI) convened to discuss the definition and assessment of CI and provide recommendations regarding measurement across species. Commonly used preclinical and clinical CI behavioral tasks are described, and considerations for each task are provided to guide CI task selection. Differences in assessment of CI (self-report, behavioral) and calculating CI indices (e.g., area-under-the-curve, indifference point, and steepness of discounting curve) are discussed along with properties of specific behavioral tasks used in preclinical and clinical settings. The InSRI group recommends inclusion of measures of CI in human studies examining impulsivity. Animal studies examining impulsivity should also include assessments of CI and these measures should be harmonized in accordance with human studies of the disorders being modeled in the preclinical investigations. The choice of specific CI measures to be included should be based on the goals of the study and existing preclinical and clinical literature using established CI measures. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Personality Disorders: Theory, Research, and Treatment 04/2015; 6(2):182-198. DOI:10.1037/per0000099 · 3.54 Impact Factor
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    ABSTRACT: Compulsive sexual behavior (CSB) is generally characterized by inappropriate or excessive sexual fantasies or behaviors that lead to distress or impairment in a person’s daily functioning. Information will be presented on CSB and other psychopathology in two samples of adults recruited from the United States. In Sample 1, 103 men seeking treatment for CSB were assessed for psychopathology at a private and a public university clinic. In Sample 2, 626 male and female veterans were assessed for the prevalence of CSB and other co-occurring psychiatric disorders. Among treatment-seeking men, 94% met criteria for at least one Axis-I psychiatric disorder, and 57% of the sample met criteria for two or more psychiatric disorders. Among a national representative sample of returning veterans, approximately 11% (13.5% of men, 6.2% of women) endorsed symptoms associated with CSB. For the 71 veterans reporting problems managing their sexual behavior, high rates of co-occurring disorders such as PTSD (69%), insomnia (55%), depression (45%), panic (43%), alcohol dependence (17%), and drug dependence (17%) were observed. Areas in which additional research is needed to better understand the complex treatment needs of individuals seeking treatment for CSB will be discussed.
    2nd International Conference on Behavioral Addictions, Budapest, Hungary; 03/2015
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    ABSTRACT: Adults who abuse substances are at increased risk for contracting sexually transmitted infections, including HIV. Within this population, sexual risk behaviors have been associated with increased impulsivity. Studies in non-clinical populations showing gender-related differences in sexual decision-making and casual sexual partnering suggest impulsivity has a greater influence on men than women, but these differences have not been documented in substance-using patients. In a sample of 89 adults with recent cocaine use and receiving outpatient psychiatric treatment, we tested the hypothesis that gender moderates the effect of impulsivity on sexual risk-taking. Using logistic regression modeling, we tested the main and gender-moderated effects of task-related impulsivity on the probability of having a casual sexual partner and multiple sexual partners. Results confirmed a significant gender-by-impulsivity interaction; men who were more impulsive on a continuous performance task had significantly higher rates of sexual risk-taking than less impulsive men, but women’s impulsivity was unrelated to these outcomes. Impulsive men were over three times as likely as less impulsive men to have a recent casual partner. Implications of these results and suggestions for future research are discussed.
    Personality and Individual Differences 03/2015; 75:190-194. DOI:10.1016/j.paid.2014.11.035 · 1.86 Impact Factor
  • Guangheng Dong, Xiao Lin, Marc N. Potenza
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    ABSTRACT: Background: Resting brain spontaneous neural activities across cortical regions have been correlated with specific functional properties in psychiatric groups. Individuals with Internet gaming disorder (IGD) demonstrate impaired executive control. Thus, it is important to examine executive control networks (ECNs) during resting states and their relationships to executive control during task performance. Methods: Thirty-five IGD and 36 healthy control participants underwent a resting-state fMRI scan and performed a Stroop task inside and outside of the MRI scanner. Correlations between Stroop effect and functional connectivity among ECN regions of interest (ROIs) were calculated within and between groups. Results: IGD subjects show lower functional connectivity in ECNs than do HC participants during resting state; functional-connectivity-measures in ECN swere negatively correlated with Stroop effect and positively correlated with brain activations in executive-control regions across groups. Within groups, negative trends were found between Stroop effect and functional connectivity in ECNs in IGD and HC groups, separately; positive trends were found between functional connectivity in ECNs and brain activations in Stroop task in IGD and HC groups, separately. Conclusions: Higher functional connectivity in ECNs may underlie better executive control and may provide resilience with respect to IGD. Lower functional connectivity in ECNs may represent an important feature in understanding and treating IGD.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 03/2015; 57. DOI:10.1016/j.pnpbp.2014.10.012 · 4.03 Impact Factor
  • Yvonne H C Yau, Marc N Potenza
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    ABSTRACT: Addiction professionals and the public are recognizing that certain nonsubstance behaviors-such as gambling, Internet use, video-game playing, sex, eating, and shopping-bear resemblance to alcohol and drug dependence. Growing evidence suggests that these behaviors warrant consideration as nonsubstance or "behavioral" addictions and has led to the newly introduced diagnostic category "Substance-Related and Addictive Disorders" in DSM-5. At present, only gambling disorder has been placed in this category, with insufficient data for other proposed behavioral addictions to justify their inclusion. This review summarizes recent advances in our understanding of behavioral addictions, describes treatment considerations, and addresses future directions. Current evidence points to overlaps between behavioral and substance-related addictions in phenomenology, epidemiology, comorbidity, neurobiological mechanisms, genetic contributions, responses to treatments, and prevention efforts. Differences also exist. Recognizing behavioral addictions and developing appropriate diagnostic criteria are important in order to increase awareness of these disorders and to further prevention and treatment strategies.
    Harvard Review of Psychiatry 03/2015; 23(2):134-46. DOI:10.1097/HRP.0000000000000051 · 2.49 Impact Factor
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    ABSTRACT: Functional magnetic resonance imaging (fMRI) studies traditionally use general linear model-based analysis (GLM-BA) and regularly report task-related activation, deactivation, or no change in activation in separate brain regions. However, several recent fMRI studies using spatial independent component analysis (sICA) find extensive overlap of functional networks (FNs), each exhibiting different task-related modulation (e.g., activation vs. deactivation), different from the dominant findings of GLM-BA. This study used sICA to assess overlap of FNs extracted from four datasets, each related to a different cognitive task. FNs extracted from each dataset overlapped with each other extensively across most or all brain regions and showed task-related concurrent increases, decreases, or no changes in activity. These findings indicate that neural substrates showing task-related concurrent but different modulations in activity intermix with each other and distribute across most of the brain. Furthermore, spatial correlation analyses found that most FNs were highly consistent in spatial patterns across different datasets. This finding indicates that these FNs probably reflect large-scale patterns of task-related brain activity. We hypothesize that FN overlaps as revealed by sICA might relate to functional heterogeneity, balanced excitation and inhibition, and population sparseness of neuron activity, three fundamental properties of the brain. These possibilities deserve further investigation.
    PLoS ONE 02/2015; 10(2):e0117029. DOI:10.1371/journal.pone.0117029 · 3.53 Impact Factor
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    Marci R Mitchell, Marc N Potenza
    Frontiers in Psychiatry 02/2015; 6:24. DOI:10.3389/fpsyt.2015.00024
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    ABSTRACT: Objective: The current study evaluated several psychometric properties of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) [1] adapted for compulsive sexual behavior (CSB) in a sample of 103 men seeking treatment at a private and a public university clinic in the United States. Method: Measures of mental health functioning were collected from patients on two separate appointments: the initial screening and the follow-up appointment. Results: All patients reported using pornography compulsively, and approximately half of the sample also reported a history of having frequent anonymous sex with strangers. Results found that the adapted Y-BOCS had good internal consistency reliability, moderate mean inter-item correlations, and good test-retest reliability. Results from a multiple regression analysis also found that affect dysregulation (depression and anxiety), particularly among single, impaired men, was significantly associated with more severe sexual obsessive and compulsive features. Approximately 94% of the sample met criteria for at least one psychiatric disorder, and 57% of men met criteria for two or more psychiatric disorders. Conclusions: Findings from the current study suggest the CSB-Y-BOCS is a reliable measure of obsessive and compulsive symptoms associated with CSB, and clinicians and researchers could use this scale to aid in the assessment and treatment of problematic sexual behaviors.
    Comprehensive Psychiatry 02/2015; DOI:10.1016/j.comppsych.2015.02.007 · 2.26 Impact Factor
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    ABSTRACT: Because of shared characteristics, pathological gambling (PG) has been variously conceptualized as an obsessive-compulsive (OC) spectrum disorder or as an addictive disorder. Prior community-based studies have not systematically determined the association between PG and OC features and whether common genetic factors contribute to both conditions. To examine the association and genetic correlation between PG and OC features. We performed a latent class analysis (LCA) of OC features, cross-sectional tests of association, and classic twin genetic analysis using results of telephone interviews conducted from March 2002 through November 2003. Participants included 1675 male twin pairs from the Vietnam Era Twin Registry, aged 45 to 60 years. Ten OC features were queried and used to derive OC classes identified via LCA. The best-fitting LCA model identified the following 4 OC classes: unaffected (class 1), ritual/symmetry compulsions (class 2), germ/contamination obsessions (class 3), and severe OC (class 4). All PG symptoms were more common in class 4 OC and 6 of 10 PG symptoms were significantly more common in class 4 OC (P < .01). Participants in the severe class were most likely to have 4 or more DSM-IV or DSM-5 PG diagnostic criteria (odds ratio, 3.8 [95% CI, 1.8-8.2]). The genetic correlation between phenotypes was 0.44 (95% CI, 0.16-0.75). The association between OC features and diagnostic criteria for PG highlights a role of obsessions and compulsivity in PG, and the lifetime co-occurrence of these disorders results in part from common genetic variance. Phenotypic and genetic overlap between OC features and PG add to our understanding of the most appropriate classification of PG and offers insights for treatment development.
    JAMA Psychiatry 02/2015; DOI:10.1001/jamapsychiatry.2014.2497 · 12.01 Impact Factor
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    ABSTRACT: Smoking and gambling are two significant public health concerns. Little is known about the association of smoking and gambling in adolescents. The current study of high-school adolescents examined: (1) smoking behavior by problem-gambling severity and (2) health-related variables by problem-gambling severity and smoking status.
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    ABSTRACT: While the conceptualization of problematic Internet use (PIU) as a "behavioral addiction" resembling substance-use disorders is debated, the neurobiological underpinnings of PIU remain understudied. This study examined whether adolescents displaying features of PIU (at-risk PIU; ARPIU) are more impulsive and exhibit blunted responding in the neural mechanisms underlying feedback processing and outcome evaluation during risk-taking. Event-related potentials (ERPs) elicited by positive (i.e. reward) and negative (i.e. loss) feedback were recorded during performance on a modified version of the Balloon Analogue Risk Task (BART) among ARPIU (n=39) and non-ARPIU subjects (n=27). Compared to non-ARPIU, ARPIU adolescents displayed higher levels of urgency and lack of perseverance on the UPPS Impulsive Behavior Scale. Although no between-group difference in BART performance was observed, ERPs demonstrated overall decreased sensitivity to feedback in ARPIU compared to non-ARPIU adolescents, as indexed by blunted feedback-related negativity (FRN) and P300 amplitudes to both negative and positive feedback. The present study provides evidence for feedback processing during risk-taking as a neural correlate of ARPIU. Given recent concerns regarding the growing prevalence of PIU as a health concern, future work should examine the extent to which feedback processing may represent a risk factor for PIU, a consequence of PIU, or possibly both. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Addictive Behaviors 01/2015; 45C:156-163. DOI:10.1016/j.addbeh.2015.01.008 · 2.44 Impact Factor
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    ABSTRACT: Previous studies have found childhood trauma to be associated with functional and structural abnormalities in corticostriatal-limbic brain regions, which may explain associations between trauma and negative mental and physical health outcomes. However, functional neuroimaging of maltreatment-related trauma has been limited by largely using generic and predominantly aversive stimuli. Personalized stress, favorite-food and neutral/relaxing cues during fMRI were used to probe the neural correlates of emotional/motivational states in adolescents with varying exposure to maltreatment-related trauma. Sixty-four adolescents were stratified into high- or low-trauma-exposed groups. Cue-related measures of subjective anxiety and craving were collected. Relative to the low-trauma-exposed group, high-trauma-exposed adolescents displayed increased activation of insula, anterior cingulate and prefrontal cortex in response to stress cues. Activation in subcortical structures, including the hippocampus, was inversely correlated with subjective anxiety in the high- but not the low-trauma-exposed group. The high-trauma-exposed group displayed hypoactivity of cerebellar regions in response to neutral/relaxing cues. No group differences were observed in response to favorite-food cues. The relationship between trauma exposure and altered cortico-limbic circuitry may in part explain the association between childhood trauma and heightened vulnerability to emotional disturbances and risky behaviour. This may be particularly pertinent during adolescence when such difficulties often emerge. Further work is needed to elucidate the mechanism linking trauma to obesity.Neuropsychopharmacology accepted article preview online, 08 January 2015. doi:10.1038/npp.2015.6.
    Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 01/2015; DOI:10.1038/npp.2015.6 · 7.83 Impact Factor
  • Nicole M Avena, Marc N Potenza, Mark S Gold
    JAMA Internal Medicine 01/2015; 175(1):145-6. DOI:10.1001/jamainternmed.2014.6968 · 13.25 Impact Factor
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    ABSTRACT: Stress and prefrontal cognitive dysfunction have key roles in driving smoking; however, there are no therapeutics for smoking cessation that attenuate the effects of stress on smoking and enhance cognition. Central noradrenergic pathways are involved in stress-induced reinstatement to nicotine and in the prefrontal executive control of adaptive behaviors. We used a novel translational approach employing a validated laboratory analogue of stress-precipitated smoking, functional magnetic resonance imaging (fMRI), and a proof-of-concept treatment period to evaluate whether the noradrenergic α2a agonist guanfacine (3 mg/day) versus placebo (0 mg/day) reduced stress-precipitated smoking in the laboratory, altered cortico-striatal activation during the Stroop cognitive-control task, and reduced smoking following a quit attempt. In nicotine-deprived smokers (n=33), stress versus a neutral condition significantly decreased the latency to smoke, and increased tobacco craving, ad-libitum smoking, and systolic blood pressure in placebo-treated subjects, and these effects were absent or reduced in guanfacine-treated subjects. Following stress, placebo-treated subjects demonstrated decreased cortisol levels whereas guanfacine-treated subjects demonstrated increased levels. Guanfacine, compared with placebo, altered prefrontal activity during a cognitive-control task, and reduced cigarette use but did not increase complete abstinence during treatment. These preliminary laboratory, neuroimaging, and clinical outcome data were consistent and complementary and support further development of guanfacine for smoking cessation. © The Author(s) 2014.
    Journal of Psychopharmacology 12/2014; DOI:10.1177/0269881114562091 · 2.81 Impact Factor
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    ABSTRACT: Individuals with gambling or substance-use disorders exhibit similar functional alterations in reward circuitry suggestive of a shared underlying vulnerability in addictive disorders. Additional research into common and unique alterations in reward-processing in substance-related and non-substance-related addictions may identify neural factors that could be targeted in treatment development for these disorders. To investigate contextual reward-processing in pathological gambling, a slot-machine fMRI task was performed by three groups (with pathological gambling, cocaine dependence and neither disorder; N=24 each) to determine the extent to which two groups with addictions (non-substance-related and substance-related) showed similarities and differences with respect to each other and a non-addicted group during anticipatory periods and following the delivery of winning, losing and 'near-miss' outcomes. Individuals with pathological gambling or cocaine dependence compared to those with neither disorder exhibited exaggerated anticipatory activity in mesolimbic and ventrocortical regions, with pathological-gambling participants displaying greater positive possible-reward anticipation and cocaine-dependent participants displaying more negative certain-loss anticipation. Neither clinical sample exhibited medial frontal or striatal responses that were observed following near-miss outcomes in healthy comparison participants. Alterations in anticipatory processing may be sensitive to the valence of rewards and content-disorder-specific. Common and unique findings in pathological gambling and cocaine dependence with respect to anticipatory reward and near-miss loss processing suggest shared and unique elements that might be targeted through behavioral or pharmacological interventions in the treatment of addictions. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Drug and Alcohol Dependence 12/2014; 145:77-86. DOI:10.1016/j.drugalcdep.2014.09.013 · 3.28 Impact Factor
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    Marci R. Mitchell, Marc N. Potenza
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    ABSTRACT: Impulsivity is associated with various psychopathologies, and elevated impulsivity is typically disadvantageous. This manuscript reviews recent investigations into the neurobiology of impulsivity using human imaging techniques and animal models. Both human imaging and preclinical pharmacological manipulations have yielded important insights into the neurobiological underpinnings of impulsivity. A more thorough understanding of the complex neurobiology underlying aspects of impulsivity may provide insight into new treatment options that target elevated impulsivity and psychopathologies such as addictions.
    12/2014; 1(4). DOI:10.1007/s40429-014-0037-4
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    ABSTRACT: Background and aims: Compulsive sexual behavior (CSB) is highly prevalent among men, often co-occurring with psychiatric disorders and traumatic experiences. Psychiatric disorders and trauma are highly prevalent among military veterans, yet there is a paucity of research on CSB among military samples. The aim of this study was to examine the prevalence of and factors associated with CSB among male military veterans. Methods: Surveys were administered to veterans of Operations Iraqi Freedom, Enduring Freedom, or New Dawn at baseline (n = 258), 3 months (n = 194), and 6 months (n = 136). Bivariate analyses and Generalized Estimating Equations were utilized to estimate associations between CSB and the following variables: psychiatric co-morbidity, childhood physical or sexual trauma, pre- and post-deployment experiences, TV/ Internet usage, and sociodemographics. Associations between CSB and specific PTSD symptom clusters were also examined. Results: CSB was reported by 16.7% of the sample at baseline. Several variables were associated with CSB in bivariate analyses; however, only PTSD severity, childhood sexual trauma, and age remained significant in multivariable GEE models. The PTSD symptom cluster re-experiencing was most strongly associated with CSB. Discussion: This exploratory study suggests that CSB is prevalent amongst veterans returning from combat and is associated with childhood trauma and PTSD, particularly re-experiencing. Conclusions: Further study is needed to identify the mechanisms linking PTSD and CSB, define the context and severity of CSB in veterans, and examine the best ways to assess and treat CSB in VA clinical settings.
    Journal of Behavioural Addictions 12/2014; 3(4):214-22. DOI:10.1556/JBA.3.2014.4.2

Publication Stats

10k Citations
1,511.87 Total Impact Points

Institutions

  • 1992–2015
    • Yale-New Haven Hospital
      • Department of Laboratory Medicine
      New Haven, Connecticut, United States
  • 1991–2015
    • Yale University
      • • Department of Psychiatry
      • • Child Study Center
      • • Department of Cell Biology
      New Haven, Connecticut, United States
  • 2013
    • Texas State University
      San Marcos, Texas, United States
    • Texas Medical Center
      Houston, Texas, United States
  • 2012
    • University of New Haven
      New Haven, Connecticut, United States
  • 2007–2011
    • University of Minnesota Twin Cities
      • Department of Psychiatry
      Minneapolis, MN, United States
  • 2010
    • University of Chicago
      • Department of Psychiatry and Behavioral Neuroscience
      Chicago, Illinois, United States
  • 2006–2010
    • University of Pennsylvania
      • Department of Psychiatry
      Filadelfia, Pennsylvania, United States
    • New York College of Osteopathic Medicine
      New York City, New York, United States
  • 2008
    • Boston University
      • Department of Psychology
      Boston, Massachusetts, United States
  • 2004
    • Indiana University-Purdue University Indianapolis
      • Department of Psychiatry
      Indianapolis, Indiana, United States
    • Butler Hospital
      Providence, Rhode Island, United States
  • 2003
    • Vanderbilt University
      Нашвилл, Michigan, United States