Lisa J Merlo

University of Florida | UF · Department of Psychiatry

Objectives: Chronic pain is both an important antecedent and consequence of substance use. Although evidence suggests healthcare professionals may be uniquely vulnerable to chronic pain, this vulnerability remains largely unexamined in the context of recovery from substance use disorders (SUDs). We characterized pain in a sample of treatment-seekin...

Background: Relapse prevention for those with substance use disorder (SUD) is an evolving practice. Initiatives focused on relapse prevention from other populations may provide the foundation for future considerations and recommendations for recovering anesthesia providers in the workplace. The purpose of this scoping review was to examine what is...

Background and objectives: There is increasing focus on physician burnout, psychiatric problems, and substance use disorders. Costs of recovery for physicians enrolled in Physician Health Programs (PHPs) remain unexamined with little known regarding funding resources. We sought to elucidate perceived costs of recovery from impairing conditions and...

Objectives: In 2019, the Centers for Medicare & Medicaid Services began implementing the Patients Over Paperwork (POP) initiative in response to clinicians reporting burdensome documentation regulations. To date, no study has evaluated how these policy changes have influenced documentation burden. Methods: Our data came from the electronic healt...

The prevalence of substance use disorders is relatively high among physicians (Oreskovich et al., Am J Addict 24(1):30–8, 2015). Various factors are believed to contribute to this phenomenon, including the intense demands and stress of the job, access to highly potent medications, personality factors, and tendency to self-medicate and/or avoid seek...

Background and objectives: Adverse events during childhood increase the risk for the development of substance use disorders (SUDs). This study examined the association between adverse childhood experiences (ACEs) and SUD treatment response. Methods: This cohort analysis included data from longitudinal clinical assessments extracted from the reco...

Background: After-hours documentation burden among US clinicians is often uncompensated work and has been associated with burnout, leading health systems to identify root causes and seek interventions to reduce this. A few studies have suggested quality programme participation (e.g., Merit-Based Incentive Payment System [MIPS]) was associated with...

Tobacco use and related mortality remain disproportionately high among individuals with substance use disorders (SUDs). Though engagement in tobacco cessation interventions is associated with improved long-term recovery, many individuals in SUD treatment do not participate. The goal of the present study was to better understand patient views regard...

Introduction: Medical students list stigma and lack of time as reasons to avoid seeking mental health care. Many patients do not receive appropriate mental health care due to a lack of knowledge regarding available treatments among their medical providers. We created this activity to enhance medical student knowledge and well-being by introducing...

Background The national opioid crisis has disproportionately burdened rural White populations and American Indian/Alaska Native (AI/AN) populations. Therefore, Cherokee Nation and Emory University public health scientists have designed an opioid prevention trial to be conducted in rural communities in the Cherokee Nation (northeast Oklahoma) with A...

Background and Objectives Physician health programs (PHPs) have demonstrated efficacy, but their mechanism of influence is unclear. This study sought to identify essential components of PHP care management for substance use disorder (SUD), and to assess whether positive outcomes are sustained over time. Methods Physicians with DSM-IV diagnoses of...

Objective This study aimed to understand the association between primary care physician (PCP) proficiency with the electronic health record (EHR) system and time spent interacting with the EHR. Materials and Methods We examined the use of EHR proficiency tools among PCPs at one large academic health system using EHR-derived measures of clinician E...

Retention and recruitment of clinical faculty is crucial for the success of quality veterinary education. Clinical faculty in busy teaching hospital environments have the potential to experience significant burnout, though few studies have focused on identifying stressors in this group. The objective of this study was to measure burnout and profess...

Michelle K Williams,1 Monica R Butcher,2 Lisa J Merlo3 1Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA; 2Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA; 3Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, USACorrespondence: Lisa J MerloUniversit...

Purpose Helping medical students maintain wellbeing has become an important concern, as many medical students report a decline in their mental health during the course of their training. To improve students’ wellbeing, some schools have implemented wellness programs into their curricula. While there is growing research about the effectiveness of th...

Objective A lack of universal definitions for response and remission in pediatric obsessive-compulsive disorder (OCD) has hampered the comparability of results across trials. To address this problem, we conducted an individual participant data diagnostic test accuracy meta-analysis to evaluate the discriminative ability of the Children’s Yale-Brown...

Background: The national opioid crisis has disproportionately burdened rural White populations and American Indian/Alaska Native (AI/AN) populations. Therefore, Cherokee Nation and Emory University public health scientists have designed an opioid prevention trial to be conducted in rural communities in the Cherokee Nation (northeast Oklahoma) with...

Background: The national opioid crisis has disproportionately burdened rural White populations and American Indian/Alaska Native (AI/AN) populations. Therefore, Cherokee Nation and Emory University public health scientists have designed an opioid prevention trial to be conducted in rural communities in the Cherokee Nation (northeast Oklahoma) with...

Objectives: Alcohol biomarkers are used to detect alcohol exposure in clinical and forensic settings. This includes professional health program (PHP) monitoring of healthcare workers in recovery from substance use disorders. Here we present the case of a physician whose positive alcohol biomarker test result was complicated by a traumatic stress r...

Objective Physicians often describe the electronic health record (EHR) as a cumbersome impediment to meaningful work, which has important implications for physician well-being. This systematic review (1) assesses organizational, physician, and information technology factors associated with EHR-related impacts on physician well-being; and (2) highli...

Background We assessed the feasibility and acceptability of a sequential approach of parent-targeted HPV vaccine reminders and phone-based Motivation Interviewing (MI). Methods In 2016, we selected all 11- to 12-year-old boys and girls seen in one clinic whose vaccine records did not include the HPV vaccine ( n =286). By gender, we individually ra...

Objective Although nurses comprise the largest group of health professionals and electronic health record (EHR) user base, it is unclear how EHR use has affected nurse well-being. This systematic review assesses the multivariable (ie, organizational, nurse, and health information technology [IT]) factors associated with EHR-related nurse well-being...

Interest in food addiction (FA) has increased, but little is known about its clinical implications or potential treatments. Using secondary analyses from a randomized controlled trial, we evaluated the associations between changes in FA, body weight, and “problem food” consumption during a 22-month behavioral weight-loss program consisting of an in...

Background Over the past decade, the use of electronic nicotine delivery system (ENDS) devices such as ecigarettes has increased dramatically, particularly among students and other transitional-age youth. Societal norms and the variety of ENDS devices available have also evolved dramatically in recent years. Objective. This article provides a compr...

Purpose of review: Controversy surrounds the construct of food addiction. The current review examines neurobiological evidence for the existence of food addiction as a valid diagnosis. Recent findings: Recent neuroimaging studies suggest significant overlap in the areas of the brain that are activated in relation to both food and drug addiction....

Objectives: Although medical students report relatively high levels of substance use, little is known about the risk and protective factors associated with substance use in this population. This study sought to examine the link between spirituality and substance use among medical students. Methods: As part of a larger study, medical students fro...

Background Poor mental health is common among medical students. In response, some medical schools have implemented wellness interventions. The University of Florida College of Medicine recently introduced a mind–body medicine elective, Promoting Resilience in Medicine (PRIMe), based on the Georgetown University School of Medicine course. PRIMe teac...

The N-methyl-D-aspartate receptor (NMDAr) system is critically involved in the pathogenesis and neurobehavioral sequelae of alcohol use disorder (AUD), and constitutes a potential pharmacotherapeutic target. Memantine (Namenda) is an FDA-approved NMDAr antagonist with suggested utility in AUD, however its safety and tolerability during long-term ad...

Physicians and other healthcare professionals are at increased risk for the development of substance use disorders when compared to the general population. Substance use is associated with impairment in neuropsychological functioning, which may impact physicians' ability to practice with reasonable skill and safety. This review describes common neu...

Background: There is growing optimism regarding the use of screening and brief intervention (SBI) to identify and reduce risk behaviors during adolescence. However, understanding successful SBI implementation remains unclear. We previously reported the effects of CONNECT, a school-based SBI, on reducing the primary outcome, the rate of monthly alc...

Background: Medical student exposure to stressors is associated with depression, burnout, somatic distress, decreases in empathy, serious thoughts about dropping out of medical school, suicidal ideation, and poor academic performance. Despite this, there have been no recent, multicenter, qualitative studies assessing medical students’ perceptions o...

The diagnostic construct of “food addiction” is a highly controversial subject. The current systematic review is the first to evaluate empirical studies examining the construct of “food addiction” in humans and animals. Studies were included if they were quantitative, peer-reviewed, and in the English language. The 52 identified studies (35 article...

Background: Medical student wellness has emerged as an important issue in medical education. The purpose of the present study was to obtain a comprehensive assessment of substance use, psychological distress, and help-seeking among male and female medical students in order to identify targets for continued intervention efforts. Methods: Medical...

Last fall, I sat in a group therapy room listening as a new patient introduced himself and timidly described his recent daily routine. He explained that after work each evening, he stopped at a convenience store to purchase alcohol, then sat in the parking lot, drinking in his car so he could cope with going home to his family. The patients sitting...

Introduction Medical settings are critical access points for behavior change counseling, and lifestyle behavior change is considered a key component of chronic disease management. The Association of American Medical Colleges recommends that future physicians be competent in shared decision making and patient-centered behavioral guidance to prevent...

Aims: To compare treatment outcome among substance dependent physicians enrolled in a physician health program (PHP) who have a history of alcohol use only, any opioid use, or non-opioid drug use, in order to determine whether the distinctive PHP system of care management is as effective for individuals with opioid use disorders as for those with...

Glycogen storage disease (GSD) is an inherited disorder that requires a complex medical regimen to maintain appropriate metabolic control. Previous research has suggested the disease is associated with decreased quality of life, and clinical experience suggests that patients are at risk for disordered eating behaviors that may significantly comprom...

Overweight and obesity have risen substantially in the last few decades. Recently, food addiction has gained attention as a possible explanation for this increase. The purpose of this paper is to review the evidence for food addiction and its role in the rise of overweight and obesity in youth. Diagnostic symptoms, prevalence, and neurobiology of f...

Background: Secondhand smoke (SHS) exposure may lead to the development of various diseases and conditions. One way to reduce SHS exposure is to screen for it within each primary care examination so that appropriate counseling can be directed to affected individuals. There has been little attention to improving medical education about SHS exposure...

Substance-related impairment among healthcare professionals has significant public health implications, but little is known regarding factors associated with substance use initiation in this group. In this study, 105 healthcare professionals (80% male), who ranged in age from 24 to 68 years (M = 47.1 years, SD = 10.2) completed a self-report questi...

Substance-related impairment of physicians is a small but serious problem, with significant consequences for patient safety and public health. The purpose of this study was to identify reasons for prescription drug misuse among physicians referred to a physician health program for monitoring because of substance-related impairment, to develop bette...

Objective: Hookah smoking is a popular form of tobacco use on university campuses. This study documented use, attitudes, and knowledge of hookah smoking among college students. Participants: The sample included 943 university students recruited between February 2009 and January 2010. Respondents (M age = 20.02) included 376 males, 533 females, a...

Background and Objectives Prescription drug addiction is a significant problem affecting healthcare professionals. The purpose of the present study was to identify common mechanisms of prescription drug diversion by pharmacists, in order to facilitate the development of effective prevention programs and policies for this high-risk group. MethodsA t...

Young people represent the largest number of new HIV infections, thus youth living with HIV (YLH) are likely to be the largest group to initiate antiretroviral treatment (ART). Adherence patterns for behaviorally infected YLH are not adequate to effectively manage the disease; therefore, novel interventions are needed to improve medication adherenc...

Objectives: The prevalence of substance abuse and other psychiatric disorders among physicians is not well-established. We determined differences in lifetime substance use, and abuse/dependence as well as other psychiatric disorders, comparing physicians undergoing monitoring with a general population that had sought treatment for substance use....

This study aimed to develop and assess the psychometric properties of an English language measure of problematic mobile phone use. Participants were recruited from a university campus, health science center, and other public locations. The sample included 244 individuals (68.4% female) aged 18–75. Results supported a unidimensional factor structure...

Aim: This paper describes the goals and current practice of school-based random student drug testing (RSDT) as part of an overall drug prevention strategy, briefly explores the available literature evaluating its effectiveness and discusses the controversies related to RSDT. Method: The authors describe the rationale for RSDT programs and the pr...

Food and Addiction: A Comprehensive Handbook brings scientific order to the issue of food and addiction, spanning multiple disciplines to create the foundation for what is a rapidly advancing field and to highlight needed advances in science and public policy. It assembles leading scientists and policy makers from fields such as nutrition, addictio...

Misuse of prescription psychiatric medications is increasing on college campuses. Sources of medications include friends or family, obtaining prescriptions fraudulently or from multiple physicians, and buying drugs online. This study assessed psychosocial correlates of medication-seeking behaviors in college students to identify characteristics of...

To better understand the occupational risks for substance use disorders among pharmacists and possibilities for improved prevention. Descriptive, nonexperimental, cross-sectional study. A southeastern state from December 2008 to April 2009. 32 participants (72.7% men) from the impaired professionals monitoring groups in the geographic regions withi...

Anesthesiologists with opioid use disorders are at high risk for relapse. In 2005, the impaired professionals monitoring program of the State of Florida implemented a policy whereby anesthesiologists referred for opiate use disorders were contractually obligated to take naltrexone for 2 years. Naltrexone ingestion was witnessed and verified via ran...

To examine human brain function related to the perception of short time intervals before and after ingesting a low dosage of alcohol (0.25 g/kg). The experiment used a novel paradigm that required participants to view a virtual traffic-light (TL) stimulus while estimating the length of a short time interval (Timing task) and counting several flashe...

: Sexual addiction is estimated to afflict up to 3% to 6% of the population. However, many clinicians lack clear criteria for detecting potential cases. : The present studies were conducted to assess the effectiveness of a brief sexual addiction screening instrument (ie, PATHOS Questionnaire) to correctly classify patients being treated for sex add...

The diversion of medications by physicians is a seldom discussed problem in the United States. A better understanding of the mechanisms of diversion could assist decision makers as they develop preventive policies. To identify these mechanisms, nine focus groups of physicians undergoing monitoring for substance abuse by a state-based physician heal...

Internationally, sporting events represent a specific context in which heavy episodic drinking is common. The current study assessed determinants of heavy episodic drinking among tailgaters (i.e., individuals engaging in pre-game social festivities) prior to American football games at two large universities. A total of 466 individuals at two univer...

Over the past few decades, pediatric obesity has become a national epidemic. Up to one third of American children and adolescents currently meet criteria as overweight or obese, placing them at risk for obesity into adulthood. Multiple acute and chronic medical conditions are increasing in prevalence among youth due to their overweight status. In a...

Physician Health Programs (PHPs) safeguard the public by monitoring impaired physicians, but participation is not always voluntary, and many physicians resist referral. In this study, 80 physicians (85.1% male) who were referred to a state PHP for substance use-related problems completed an anonymous online survey regarding their experiences in the...

To the Editor: The survey study by Dr DesRoches and colleagues1 reported data regarding physicians' experiences with impaired colleagues. Although the authors concluded that a large number of practicing physicians do not support the current process of self-regulation, we believe that the discussion lacked consideration of relevant issues that would...

Mental illness stigma remains a significant barrier to treatment. However, the recent increase in the medical and nonmedical use of prescription psychiatric medications among college students seems to contradict this phenomenon. This study explored students' attitudes and experiences related to psychiatric medications, as well as correlates of psyc...

OverviewClinical PrevalenceClinical DiagnosisClinical ComorbidityClinical CoursePsychological Treatment of Alcohol and Drug Use DisordersConclusions References

Prescription opioid abuse is a major public health problem in the United States. Physicians who prescribe opioid analgesics are sometimes confronted with patients who request early refills, claiming that they have been "shorted" by their pharmacy. While a substantial differential diagnosis exists for apparent opioid overuse, the underfilling of opi...

Pharmacotherapy for substance use disorders (SUDs) may include interventions to assist with recovery from overdose, detoxification and relapse prevention. Multiple medications have been identified as potential treatments to help patients who suffer from an SUD. As a result, much research has been conducted to test the efficacy of these intervention...

A sample of 904 physicians consecutively admitted to 16 state Physicians' Health Programs (PHPs) was studied for 5 years or longer to characterize the outcomes of this episode of care and to explore the elements of these programs that could improve the care of other addicted populations. The study consisted of two phases: the first characterized th...

Current methods of selecting future residents for anesthesiology training programs do not adequately distinguish those who will succeed from the pool of seemingly well-qualified applicants. Some residents, despite high exam scores, may struggle in the operating room (OR) in stressful situations. This study examined whether specific neuropsychologic...

This report describes the development and psychometric properties of the Children’s Florida Obsessive Compulsive Inventory (C-FOCI). Designed specifically as a brief measure for assessing obsessive–compulsive symptoms, the C-FOCI was created for use in both clinical and community settings. Study 1 included 82 children and adolescents diagnosed with...

Lack of motivation may negatively impact cognitive behavioral therapy (CBT) response for pediatric patients with obsessive-compulsive disorder (OCD). Motivational interviewing is a method for interacting with patients in order to decrease their ambivalence and support their self-efficacy in their efforts at behavior change. The authors present a pr...

Binge drinking has been tied to specific occasions, such as certain holidays and sporting events. However, previous research has relied almost exclusively upon self-reports of university students to document these associations. In order to address this limitation, the present study examined patterns of alcohol-related offenses occurring within the...

Binge drinking is associated with social, occupational, academic, health-related, and legal difficulties. Given that it is particularly problematic on college campuses and during sporting events, the goal of this study was to examine characteristics of individuals who drink alcohol, binge drink alcohol, or abstain from alcohol use during pre-footba...

The use of methamphetamine (METH) is a growing public health problem, because its abuse is associated with long-term biochemical and structural effects on the human brain. Neurodegeneration is often observed in humans, because of mechanical injuries (e.g., traumatic brain injury [TBI]) and ischemic damage (strokes). In this review, we discuss recen...

Management of type 1 diabetes (T1D) involves balancing several components including diet, exercise, and medication. Peer involvement in management tasks is an important, but understudied, issue in T1D. This study presents results of a preliminary examination of perceptions of disease management in youth with T1D and their peers. Data were collected...

The article by Morse et al¹ titled “Missed Opportunities for Interval Empathy in Lung Cancer Communication” addressed an interesting and important topic in medical care. The researchers examined empathic opportunity statements made by patients and the responses provided by their physicians, as well as racial differences in empathy responses. Physic...

A sample of 904 physicians consecutively admitted to 16 state Physicians' Health Programs (PHPs) was studied for 5 years or longer to characterize the outcomes of this episode of care and to explore the elements of these programs that could improve the care of other addicted populations. The study consisted of two phases: the first characterized th...

Pediatric obsessive-compulsive disorder (OCD) is a chronic, disabling condition that affects both patients and their families. Despite the identification of efficacious treatments (e.g., cognitive-behavioral therapy and selective serotonin reuptake inhibitor medications), not all patients respond fully. The purpose of the present study was to exami...

This pilot study assessed the quality of life and psychosocial functioning of pediatric patients with Barth Syndrome. Thirty-four boys with Barth Syndrome and 22 healthy male controls were administered a measure of verbal ability and completed measures of quality of life, loneliness, perceived peer support, and sibling relationship quality. Parents...

The goals of the present study were to explore the possibility that symptoms of food addiction may exist for some children and to identify factors that may be associated with pediatric food addiction. Participants were 50 children (aged 8-19), recruited from the Pediatric Lipid Clinic at a large southeastern teaching hospital, and their parent/guar...

Noncompliance with medical regimens for type 1 diabetes (T1D) may lead to serious consequences. The most life-threatening is diabetic ketoacidosis (DKA). Little is known about how DKA affects cognitive abilities in youth with T1D. We examined the impact of multiple DKA episodes and gender differences on cognitive abilities. Sixty-four youth (aged 8...