Stephen Maisto

Stephen Maisto
Syracuse University | SU · Department of Psychology

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463
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Publications

Publications (463)
Article
Rationale: Alcohol use disorder (AUD) is highly prevalent among adults in the US and is associated with substantial personal and societal costs. Yet only a small percentage of adults with AUD initiate treatment, including those with severe AUD symptoms who are most in need of treatment. In this paper we use latent profile analysis (LPA) to describ...
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People with HIV (PWH) frequently engage in unhealthy alcohol use, which can adversely affect antiretroviral adherence and HIV disease progression. Brief interventions based on Motivational Interviewing (MI), including the Brief Negotiated Interview (BNI), can help to reduce drinking. This study examines MI processes observed during a single 15–20 m...
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Helping people with HIV (PWH) and without HIV (PWoH) understand the relationship between physical symptoms and alcohol use might help motivate them to decrease use. In surveys collected in the Veterans Aging Cohort Study from 2002 to 2018, PWH and PWoH were asked about 20 common symptoms and whether they thought any were caused by alcohol use. Anal...
Article
Objective: The purpose of this study was to investigate the extent to which two of the more salient characteristics of a treatment research assessment protocol (i.e., the comprehensiveness of the assessment battery and the frequency of its administration) for alcohol use disorder contribute to reductions in substance use and related negative conse...
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Alcohol consumption is one of the strongest predictors of suboptimal adherence to antiretroviral therapy (ART), however, there is little research that has investigated both within- and between-person associations of alcohol consumption and ART adherence at the event-level. In this secondary data-analysis, (N = 22) HIV-positive MSM prospectively rep...
Article
Introduction Research on treatment utilization for alcohol use disorder (AUD) is based primarily on clinical samples and community samples of low AUD severity that may not need formal care. Using a community sample of adults with untreated but severe AUD symptoms, we tested the hypothesis that alcohol-related consequences, but not alcohol consumpti...
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Alcohol use among people living with HIV (PWH) has been increasingly recognized as an important component of HIV care. Transdiagnostic treatments, such as Acceptance and Commitment Therapy (ACT), that target core processes common to multiple mental health and substance-related problems, may be ideal in HIV treatment settings where psychological and...
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AimTo determine whether statistically distinct classes of smokers exist according to mental health (MH) diagnoses within primary care and to evaluate whether class membership is associated with healthcare utilization.Subject and methodsData were obtained from the US Department of Veterans Affairs (VA) electronic medical record for encounters betwee...
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The timeline followback (TLFB) takes more resources to collect than the Alcohol Use Disorder Identification Test (AUDIT-C). We assessed agreement of TLFB and AUDIT-C with the biomarker phosphatidylethanol (PEth) and compared changes in TLFB and PEth among persons with HIV (PWH) using secondary data from randomized trials. We calculated operating ch...
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Rationale Alcohol-induced executive function deficits may underlie associations between alcohol, self-regulation, and hazardous behaviors. Studies examining the effects of alcohol administration on working memory, an important executive functioning component, have produced mixed findings. Acute alcohol effects on working memory remain unclear. Obj...
Article
Anxiety is undertreated in primary care, and most treatment provided is pharmacological rather than behavioral. Integrating behavioral health providers (BHPs) using the Primary Care Behavioral Health (PCBH) model can help address this treatment gap, but brief interventions suitable for use in PCBH practice are needed. We developed a modular, cognit...
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Background Condomless anal intercourse (CAI) is the major risk factor for HIV transmission among men who have sex with men (MSM). MSM who are heavier cannabis users engage in CAI more frequently. However, little is known about the processes that may underlie this association. This study sought to understand the potential role of condom attitudes an...
Article
This article presents data on the external validity of an alcohol administration study of sexual decision-making in men who have sex with men (MSM) ages 21-50. Men (N = 135) randomized to alcohol (blood alcohol concentration [BAC] = .075%) or water control conditions reported intentions to engage in condomless anal intercourse (CAI) in response to...
Article
Background and Objectives Expectancies for alcohol analgesia (i.e., expectations that drinking alcohol will reduce pain) have been associated with greater alcohol consumption among individuals with chronic pain, and there is reason to believe that such expectancies may also contribute to drinking behavior among alcohol users without a current chron...
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The purpose of this paper is to provide a brief introduction to and description of the contents of this special issue of AIDS and Behavior. The article begins with a description of the rationale for the special issue and the origin of its compilation. This background information is followed by a brief description of the main articles that are inclu...
Article
Family history of alcohol use disorder (AUD) is frequently endorsed by persons with chronic pain. Although individuals with a family history of AUD have demonstrated enhanced sensitivity to painful stimulation, previous research has not examined endogenous pain modulation in this population. The goal of this study was to test family history of AUD...
Chapter
Alcohol use disorder is by far the most prevalent substance use disorder in the general population and is a major contributor to disease worldwide. Recovery from the disorder is a dynamic process of change, and individuals take many different routes to resolve their alcohol problems and seek to achieve a life worth living. Total abstention is not t...
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Objectives: The purpose of this study was to examine associations between psychotherapy session attendance, alcohol treatment outcomes, and Alcoholics Anonymous (AA) attendance. Method: Using data from Project MATCH, repeated measures latent class analyses of psychotherapy session attendance were conducted among participants in the outpatient ar...
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Objective Quantitative sensory testing is an expanding pain research domain with numerous clinical and research applications. There is a recognized need for brief reliable quantitative sensory testing protocols that enhance assessment feasibility. This study aimed to integrate static (pain threshold, tolerance, suprathreshold) and dynamic (conditio...
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The purpose of this study was to examine the effects of alcohol intoxication and its interaction with contextual or situation (partner familiarity) and individual differences variables (effortful control, urgency, and whether taking pre-exposure prophylaxis (PrEP) medication) on sexual behaviors in men who have sex with men (MSM), a subgroup for wh...
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Alcohol and tobacco are the 2 most frequently used drugs in the United States and represent the highest co-occurrence of polysubstance use. The objective of this study was to refine an intervention combining mobile contingency management with cognitive-behavioral telephone counseling for concurrent treatment of alcohol and tobacco use disorders. Tw...
Article
Posttraumatic Stress Disorder (PTSD) and hazardous drinking are highly comorbid, and often more severe than PTSD or hazardous drinking alone. Integrated, web-based interventions for PTSD/hazardous drinking may increase access to care, but have demonstrated equivocal results in reducing PTSD and hazardous drinking. One factor that may explain treatm...
Article
Objective: Many individuals who smoke tobacco or consume alcohol at hazardous levels have chronic conditions that are caused or exacerbated by these behaviors. The objective of this survey study was to obtain data on the health care concerns, barriers, and readiness to change indicators of smokers/risky drinkers with related health conditions who h...
Article
Objectives The purpose of this study was to examine whether changes in heavy drinking occurring within alcohol treatment predict long-term functioning. Method Latent profile analyses were conducted using data from Project MATCH and COMBINE. Observed changes in heavy and nonheavy drinking within consecutive 2-week periods over the respective treatm...
Article
Introduction Heavy episodic drinking poses a risk for HIV-infection, particularly among men who have sex with men (MSM). Previous research suggests implicit associations may play a role in heavy episodic drinking and that various executive functions (EF) may moderate the relation between implicit associations and heavy episodic drinking. This study...
Article
The objective was to estimate the efficacy of peer-delivered Whole Health Coaching with individual veterans with PTSD in primary care. This study examined changes in goal attainment before, during, and after peer-delivered Whole Health Coaching using a concurrent multiple-baseline design across participants with replication across cohorts. Ten prim...
Article
This systematic review provides a synthesis of the literature on brief alcohol intervention (BAI) implementation in medical settings. We utilized the Proctor et al. (2011) taxonomy of eight implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability) to organize and...
Article
Despite its frequent use for pain relief, no experimental pain research has tested the analgesic effects of cannabidiol (CBD) in humans. The goal of this study was to experimentally test the effects of CBD and expectancies for receiving CBD on human pain reactivity. Using a crossover, 2 × 2 factorial balanced placebo design, drug administration (gi...
Article
To describe the process of peer-delivered Whole Health Coaching, a primary care-based intervention in which peers provide patients with individualized support to set and work toward wellness goals. Fifteen primary care Veterans with PTSD participated in peer-delivered Whole Health Coaching during a multiple baseline design study. This is a planned...
Article
Background Self-Monitoring (SM), the act of observing ones’ own behavior, has been used in substance use treatment because SM may bring conscious awareness to automatized substance use behaviors. Empirical findings regarding SM’s effectiveness are mixed. The aim of this study was to synthesize the literature for the efficacy of SM on substance use....
Article
Background: Behavioral activation is ideal for embedded behavioral health providers (BHPs) working in primary care settings treating patients reporting a range of depressive symptoms. The current study tested whether a brief version of Behavioral Activation (two 30-minute appointments, 2 boosters) designed for primary care (BA-PC) was more effecti...
Article
Rates of alcohol consumption are substantially higher among persons with pain, and recent research has focused on elucidating bidirectional pain-alcohol effects. Expectancies for alcohol analgesia could influence the degree to which alcohol confers acute pain-relieving effects, and may amplify the propensity to respond to pain with drinking behavio...
Article
This outcomes assessment was implemented to evaluate a web-based alcohol use recovery program, Tempest Sobriety School (TSS), and to provide a model for outcome evaluation. Adults (N= 541) enrolled in TSS were assessed at pre-program start and Month 2, 6, and 12. Participants reported decreased alcohol use, drug use, craving for alcohol, and alcoho...
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Background: At-risk levels of alcohol use threaten the health of patients with HIV (PWH), yet evidence-based strategies to decrease alcohol use and improve HIV-related outcomes in this population are lacking. We examined the effectiveness of integrated stepped alcohol treatment (ISAT) on alcohol use and HIV outcomes among PWH and at-risk alcohol u...
Article
Objectives: Studying clinical course after alcohol use disorder (AUD) treatment is central to understanding longer-term recovery. This study's two main objectives were to (a) replicate a recent study that identified heterogeneity in patterns of remission from/relapse to heavy drinking during the first year after outpatient treatment in an independ...
Article
Objective: Developmental theory posits interacting individual and contextual factors that contribute to alcohol use across adolescence. Despite the well-documented salience of peer environmental influences on adolescent drinking, it is not known whether peer environments moderate polygenic risks for trajectories of alcohol use. The current theoret...
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Objective: Four decades ago, the "controlled drinking" controversy roiled the alcohol field. Data have subsequently accumulated indicating that nonabstinent alcohol use disorder (AUD) recovery is achievable, but questions remain whether it is sustainable long-term. This study examined whether nonabstinent recovery at 3 years after AUD treatment is...
Article
Background: As the nature of the association between Alcohol Use Disorder (AUD) and other disorders is not well understood, the ways in which psychological distress changes during the course of treatment for AUD are relatively unknown. Existing literatures posit two competing hypotheses such that treatment for AUD concurrently decreases alcohol us...
Article
Alcohol consumption is one of the most prevalent correlates of antiretroviral therapy (ART) adherence, yet causal processes underlying this association remain largely unexplored. The goal of this systematic review was to develop a conceptual model that describes the causal effect of alcohol consumption on ART nonadherence. We reviewed 230 studies t...
Article
Tobacco smokers with co-occurring pain report greater difficulty quitting, face unique cessation challenges, and may benefit from targeted smoking interventions. We developed and tested a brief motivational intervention aimed at increasing knowledge of pain-smoking interrelations, motivation to quit, and cessation treatment engagement among smokers...
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Background Recent research indicates some individuals who engage in heavy drinking following treatment for alcohol use disorder fare as well as those who abstain with respect to psychosocial functioning, employment, life satisfaction, and mental health. The current study evaluated whether these findings replicated in an independent sample and exami...
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Objective We sought to quantify the extent to which a depression screening instrument commonly used in primary care settings provides additional information regarding pain interference symptoms, anxiety, and substance use. Methods Veterans Aging Cohort Study (VACS) data collected from 2003 through 2015 was used to calculate odds ratios (OR) for as...
Article
Background We sought to compare self‐reported alcohol consumption using Timeline Followback (TLFB) to biomarker‐based evidence of significant alcohol use (phosphatidylethanol (PEth) >20 ng/mL). Using data from patients with HIV (PWH) entering a clinical trial, we asked whether TLFB could predict PEth >20 ng/mL and assessed the magnitude of associat...
Article
As the number of adolescents seeking treatment for marijuana use increases, it is important to identify factors that mediate marijuana treatment outcomes. Alcohol consumption is highly prevalent in clinical samples of adolescents but has been neglected as a potential mediator of marijuana use treatment outcomes. In this study, we sought to examine...
Preprint
Objective: Four decades ago the “controlled drinking” controversy roiled the alcohol field. Data have subsequently accumulated indicating that non-abstinent alcohol use disorder (AUD) recovery is achievable, but questions remain whether it is sustainable long-term. This study examined whether non-abstinent recovery at three years following AUD trea...
Article
Urgency, the tendency to act rashly under extreme emotions, has been associated with higher rates of hazardous/harmful drinking. Moreover, previous work suggests that the association between urgency and hazardous/harmful drinking may be mediated by drinking motives. The current study sought to replicate and extend this research to men who have sex...
Article
Background and aims Culturally relevant and feasible interventions are needed to address limited professional resources in sub‐Saharan Africa for behaviorally treating the dual epidemics of HIV and alcohol use disorder. This study tested the efficacy of a cognitive‐behavioral therapy (CBT) intervention to reduce alcohol use among HIV‐infected outpa...
Article
Objective The ability to predict suicide outcomes is limited by the lack of consideration of protective factors. This study examined the validity of the Living Ladder, a measure of readiness to continue living among individuals thinking of suicide. Methods The Living Ladder consists of one item that assesses an individual’s readiness to continue l...
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Importance Alcohol screening may be associated with health outcomes that cluster with alcohol use (ie, alcohol-clustering conditions), including depression, anxiety, and use of tobacco, marijuana, and illicit drugs. Objective To quantify the extent to which alcohol screening provides additional information regarding alcohol-clustering conditions a...
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Objectives Experimental findings have shown that pain increased alcohol urge and intention to use alcohol, and that this relation was mediated by pain-induced negative affect. We sought to extend this research by examining (a) whether dispositional mindfulness moderates the indirect effect of experimental pain induction on alcohol use proxies via n...
Article
Background: It is widely accepted that the therapeutic alliance (TA) is a mediator of psychotherapy effects, but evidence is sparse that the TA is an actual mechanism of behavior change. The purpose of this study was to provide the first systematic evidence regarding the TA as a mechanism of change in the treatment of alcohol use disorder (AUD)....
Article
Self-regulation theory (SRT) posits that individuals make decisions regarding behavior change based on a comparison of their actual (e.g., excessive alcohol use) and desired (e.g., abstinence) behaviors. This comparison must result in a discrepancy of sufficient magnitude to motivate an individual toward behavior change. It appears that this purpor...
Article
Objective: Tobacco and excessive alcohol use are 2 of the top 3 preventable causes of death in the United States, yet most patients using these substances do not pursue treatment. Most patients do visit their primary care provider (PCP) annually, but PCPs report that they are not very effective in addressing behavior change with patients. Brief in...
Article
Among men who have sex with men (MSM), acute alcohol consumption is associated with higher rates of condomless anal intercourse, which is linked with a greater likelihood of exposure to HIV and other sexually transmitted infections. While pre-exposure prophylaxis (PrEP) to prevent HIV infection has become more widespread in this population in recen...
Article
Toward the goal of advancing understanding of rates of HIV transmission among men who have sex with men (MSM) populations, this article provides preliminary data on the use of the experience sampling method (ESM) in a sample of 165 MSM. Participants completed 6 weeks of experience sampling in two 3-week measurement bursts with a 3-week rest interva...
Article
Men who have sex with men (MSM) are a high-risk population for HIV infection and this risk is increased for those who consume alcohol. Condomless anal intercourse (CAI) is the central transmission risk factor for this population. This study examined whether individual differences in working memory moderated the association between intentions to use...
Article
Objective: Although the months following discharge from psychiatric hospitalization are a period of acute risk for veterans, there is a dearth of empirically supported treatments tailored to veterans in acute psychiatric hospitalization. Method: We conducted a randomized controlled trial to test the efficacy of Motivational Interviewing to Addre...
Article
Background: There is no known safe level of alcohol use among patients with HIV and liver disease. We examined the effectiveness of integrated stepped alcohol treatment (ISAT) on alcohol use, HIV, and liver outcomes among patients with HIV and liver disease. Methods: In this multi-site, randomized trial conducted between January 28, 2013 through...
Article
Negative reinforcement has been cited in many prominent theories as a process by which problematic alcohol use develops. According to negative reinforcement theories, alcohol is used to alleviate aversive physical and psychological states. Distress tolerance (DT) has been suggested as a construct that may represent individual differences in ability...
Article
Rationale: Certifications for medical cannabis are generally restricted to a small number of specific medical conditions, yet patients frequently report symptoms of pain, anxiety, and depression as reasons for use. This is a critical concern for researchers, healthcare providers, and policymakers, yet research in this area is currently obstructed...
Article
Objective: During a trial, standardization can lock in a treatment that researchers learn is flawed and may be ineffective. In such cases, researchers typically decide between two options, continue the trial and monitor for iatrogenic effects or stop the trial. When faced with this dilemma while testing an adaptation of Motivational Interviewing to...
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Behavioral interventions remain the preferred strategy for reducing HIV-related risk behavior among men who have sex with men (MSM), one of the populations most affected by HIV. To improve intervention efforts, research is needed to identify cognitive-motivational factors that may play a role in sexual risk behaviors among MSM. This study sought to...
Article
Background: We examined the effectiveness of integrated stepped alcohol treatment (ISAT) on alcohol use and HIV outcomes among patients living with HIV and alcohol use disorder. Methods: In this multisite, randomised controlled trial, conducted in five Veterans Affairs-based HIV clinics in the USA (Atlanta, GA; Brooklyn-Manhattan, NY; Dallas and...
Article
Background: The current study aimed to contribute to the understanding of the session to session relationship between craving and drinking during the course of treatment via the incorporation into the analysis of both a) motivation to avoid alcohol and 2) pretreatment change, given that half of all individuals entering treatment change their drink...
Article
Background: Over 100 million Americans live with chronic pain, and adults with chronic pain may be more likely to experience alcohol-related problems or Alcohol Use Disorder. An evolving conceptual model posits that bidirectional effects between pain and alcohol exacerbate both pain and drinking. Pain has been shown to motivate alcohol urge and con...
Article
Depressive symptoms are the most common reason for referral to integrated behavioral health providers in primary care. Although evidence-based brief psychotherapies for depression in primary care exist, treatment duration is a significant barrier to implementation. In this open trial, we examined the patient experience of receiving a brief behavior...
Article
The pack-years formula is a widely used estimate of lifetime tobacco smoking exposure, and greater pack-years have been associated with greater risk of chronic pain development and poorer pain-related outcomes among smokers with chronic pain. The pathophysiology underlying these associations is poorly understood. Regular tobacco smoking exposure ma...
Article
Objective: Many combat veterans struggle with posttraumatic stress disorder (PTSD) and hazardous alcohol use and are hesitant to engage in behavioral health services. Combining peer support with an eHealth intervention may overcome many barriers to care. This pilot study investigated the feasibility of adding peer support to a web-based cognitive...
Article
Alcohol use is a significant problem in HIV care, and clinical trials of alcohol interventions for people living with HIV infection (PLWH) have produced mixed results. The purpose of this qualitative study was to collect preliminary data on the practical feasibility and acceptability of Acceptance and Commitment Therapy (ACT) as a treatment for PLW...
Article
Importance: Cannabinoid drugs are widely used as analgesics, but experimental pain studies have produced mixed findings. The analgesic properties of cannabinoids remain unclear. Objective: To conduct a systematic review and meta-analysis of the association between cannabinoid drug administration and experimental pain outcomes in studies of healthy...
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Approximately 71% of HIV-infected individuals live in sub-Saharan Africa. Alcohol use increases unprotected sex, which can lead to HIV transmission. Little research examines risky sex among HIV-infected individuals in East Africa who are not sex workers. The study purpose was to examine associations with unprotected sex in a high-risk sample of 507...
Article
Abstinence from alcohol is often considered a critical element of recovery from alcohol use disorder. Yet, low risk drinking may be more desirable for some patients. There is mixed literature on whether low risk drinking is achievable and stable. Low risk drinking outcomes during treatment and outcomes 3 years after treatment were examined using da...
Article
Background and Aims Recovery from alcohol use disorder (AUD) is often narrowly defined by abstinence from alcohol and improvements in functioning (e.g., mental health, social functioning, employment). This study used latent profile analysis to examine variability in recovery outcomes, defined by alcohol use, alcohol‐related problems, and psychosoci...