Peter M Monti

Brown University, Providence, Rhode Island, United States

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Publications (289)758.51 Total impact

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    ABSTRACT: Objective: Sexual behavior that incurs increased risk for sexually transmitted infections and HIV incidence is associated with both heavy alcohol and marijuana use. Whereas detrimental effects of alcohol on increased sexual risk have been documented in event-level and laboratory studies, less is known about the combined use of alcohol and marijuana and their relative impact on sexual risk behavior. We examined the degree to which both heavy drinking and marijuana use were associated with condomless sexual intercourse with casual versus main partners in a sample of weekly marijuana smokers. Method: Participants reported substance use and sexual activity using a 60-day Timeline Followback interview method (n = 112). Results: Results of generalized estimating equations indicated that both alcohol and marijuana use were independently associated with greater odds of having sexual intercourse but were not associated with greater odds of unprotected sex with a casual partner. Heavy drinking on a given day was associated with increased odds of having casual protected sex. Using both substances synergistically increased the likelihood of unprotected sex with a main partner. Conclusions: Findings suggest that behaviors posing higher sexual risk (condomless intercourse or sex with casual partners) occur on days when alcohol use exceeds moderate drinking guidelines. Interventions designed to reduce sexual risk behaviors may need to specifically target heavy drinking alone or when used with marijuana.
    No preview · Article · Jan 2016 · Journal of studies on alcohol and drugs
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    ABSTRACT: Cannabis misuse accounts for nearly all of the substance abuse treatment admissions among youth in the United States. Most youth do not experience sustained benefit from existing psychosocial treatments; however, medication development research for treating adolescent cannabis misuse is almost nonexistent. We conducted a double-blind, placebo-controlled, pilot study to test the potential efficacy of topiramate plus motivational enhancement therapy (MET) for treating cannabis use among adolescents. Sixty-six heavy cannabis users, ages 15 to 24 years, were randomized to one of two 6-week treatment conditions: topiramate plus MET or placebo plus MET. Topiramate was titrated over 4 weeks then stabilized at 200 mg/day for 2 weeks. MET was delivered biweekly for a total of three sessions. Only 48 percent of youths randomized to topiramate completed the 6-week trial (n = 19), compared with 77 percent of youths in the placebo condition (n = 20). Adverse medication side effects were the most common reason for withdrawal among participants in the topiramate group. Latent growth models showed that topiramate was superior to placebo for reducing the number of grams smoked per use day, but it did not improve abstinence rates. The same pattern of results was found when values for missing outcomes were imputed. We show that topiramate combined with MET demonstrated efficacy for reducing how much cannabis adolescents smoked when they used but did not affect abstinence rates. The magnitude of this effect was modest, however, and topiramate was poorly tolerated by youths, which calls into question the clinical importance of these findings.
    No preview · Article · Jan 2016 · Addiction Biology
  • Tyler B. Wray · Christopher W. Kahler · Peter M. Monti
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    ABSTRACT: MSM continue to represent the largest share of new HIV infections in the United States each year due to high infectivity associated with unprotected anal sex. Ecological momentary assessment (EMA) has the potential to provide a unique view of how high-risk sexual events occur in the real world and can impart detailed information about aspects of decision-making, antecedents, and consequences that accompany these events. EMA may also produce more accurate data on sexual behavior by assessing it soon after its occurrence. We conducted a study involving 12 high-risk MSM to explore the acceptability and feasibility of a 30 day, intensive EMA procedure. Results suggest this intensive assessment strategy was both acceptable and feasible to participants. All participants provided response rates to various assessments that approached or were in excess of their targets: 81.0 % of experience sampling assessments and 93.1 % of daily diary assessments were completed. However, comparing EMA reports with a Timeline Followback (TLFB) of the same 30 day period suggested that participants reported fewer sexual risk events on the TLFB compared to EMA, and reported a number of discrepancies about specific behaviors and partner characteristics across the two methods. Overall, results support the acceptability, feasibility, and utility of using EMA to understand sexual risk events among high-risk MSM. Findings also suggest that EMA and other intensive longitudinal assessment approaches could yield more accurate data about sex events.
    No preview · Article · Jan 2016 · AIDS and Behavior
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    ABSTRACT: Background: Few prospective studies have evaluated theory-driven approaches to the implementation of evidence-based opioid treatment. This study compared the effectiveness of an implementation model (Science to Service Laboratory; SSL) to training as usual (TAU) in promoting the adoption of contingency management across a multi-site opiate addiction treatment program. We also examined whether the SSL affected putative mediators of contingency management adoption (perceived innovation characteristics and organizational readiness to change). Methods: Sixty treatment providers (39 SSL, 21 TAU) from 15 geographically diverse satellite clinics (7 SSL, 8 TAU) participated in the 12-month study. Both conditions received didactic contingency management training and those in the pre-determined experimental region received 9 months of SSL-enhanced training. Contingency management adoption was monitored biweekly, while putative mediators were measured at baseline, 3-, and 12-months. Results: Relative to providers in the TAU region, treatment providers in the SSL region had comparable likelihood of contingency management adoption in the first 20 weeks of the study, and then significantly higher likelihood of adoption (odds ratios = 2.4-13.5) for the remainder of the study. SSL providers also reported higher levels of one perceived innovation characteristic (Observability) and one aspect of organizational readiness to change (Adequacy of Training Resources), although there was no evidence that the SSL affected these putative mediators over time. Conclusions: Results of this study indicate that a fully powered randomized trial of the SSL is warranted. Considerations for a future evaluation are discussed.
    No preview · Article · Dec 2015 · Substance Abuse
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    ABSTRACT: Background: Binge drinking is associated with numerous negative consequences. The prevalence and intensity of binge drinking is highest among young adults. This randomized trial tested the efficacy of a 12-week interactive text message intervention to reduce binge drinking up to 6 months after intervention completion among young adults. Methods and findings: Young adult participants (18-25 y; n = 765) drinking above the low-risk limits (AUDIT-C score >3/4 women/men), but not seeking alcohol treatment, were enrolled from 4 Emergency Departments (EDs) in Pittsburgh, PA. Participants were randomized to one of three conditions in a 2:1:1 allocation ratio: SMS Assessments + Feedback (SA+F), SMS Assessments (SA), or control. For 12 weeks, SA+F participants received texts each Thursday querying weekend drinking plans and prompting drinking limit goal commitment and each Sunday querying weekend drinking quantity. SA+F participants received tailored feedback based on their text responses. To contrast the effects of SA+F with self-monitoring, SA participants received texts on Sundays querying drinking quantity, but did not receive alcohol-specific feedback. The control arm received standard care. Follow-up outcome data collected through web-based surveys were provided by 78% of participants at 3- months, 63% at 6-months and 55% at 9-months. Multiple imputation-derived, intent-to-treat models were used for primary analysis. At 9-months, participants in the SA+F group reported greater reductions in the number of binge drinking days than participants in the control group (incident rate ratio [IRR] 0.69; 95% CI .59 to.79), lower binge drinking prevalence (odds ratio [OR] 0.52; 95% CI 0.26 to 0.98]), less drinks per drinking day (beta -.62; 95% CI -1.10 to -0.15) and lower alcohol-related injury prevalence (OR 0.42; 95% CI 0.21 to 0.88). Participants in the SA group did not reduce drinking or alcohol-related injury relative to controls. Findings were similar using complete case analyses. Conclusions: An interactive text-message intervention was more effective than self-monitoring or controls in reducing alcohol consumption and alcohol-related injury prevalence up to 6 months after intervention completion. These findings, if replicated, suggest a scalable approach to help achieve sustained reductions in binge drinking and accompanying injuries among young adults. Trial registration: NCT01688245.
    Preview · Article · Nov 2015 · PLoS ONE
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    ABSTRACT: Title: Cost-effectiveness of motivational intervention with significant others for patients with alcohol misuse AIMS: To estimate the incremental cost, cost-effectiveness, and benefit-cost ratio of incorporating a significant other (SO) into motivational intervention for alcohol misuse. Design: We obtained economic data from the one year with the intervention in full operation for patients in a recent randomized trial. Setting: The underlying trial took place at a major urban hospital in the USA. Participants: The trial randomized 406 (68.7% male) eligible hazardous drinkers (196 during the economic study) admitted to the emergency department or trauma unit. Intervention: The motivational interview condition consisted of one in-person session featuring personalized normative feedback. The significant other motivational interview condition comprised one joint session with the participant and SO in which the SO's perspective and support were elicited. Measurements: We ascertained activities across 445 representative time segments through work sampling (including staff idle time), calculated the incremental cost in per patient of incorporating an SO, expressed the results in 2014 U.S. dollars, incorporated quality and mortality effects from a closely related trial, and derived the cost per quality-adjusted life year (QALY) gained. Findings: From a health system perspective, the incremental cost per patient of adding an SO was $341 [95% confidence interval (CI): $244 to $438]. The incremental cost per year per hazardous drinker averted was $3,623 (CI: $1,777 to $22,709), the cost per QALY gained $32,200 (CI: $15,800 to $201,700), and the benefit-cost ratio was 4.73 (95% CI: 0.75 to 9.66). If adding an SO into the intervention strategy were concentrated during the hours with highest risk or in the trauma unit, it would become even more cost-beneficial. Conclusions: Using criteria established by the World Health Organization (cost-effectiveness below the country's GDP per capita), incorporating a significant other into a patient's motivational intervention for alcohol misuse is highly cost effective.
    No preview · Article · Nov 2015 · Addiction

  • No preview · Article · Nov 2015

  • No preview · Article · Nov 2015
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    ABSTRACT: Objective: Students referred to school administration for alcohol policies violations currently receive a wide variety of interventions. This study examined predictors of response to 2 interventions delivered to mandated college students (N = 598) using a stepped care approach incorporating a peer-delivered 15-min brief advice (BA) session (Step 1) and a 60- to 90-min brief motivational intervention (BMI) delivered by trained interventionists (Step 2). Method: Analyses were completed in 2 stages. First, 3 types of variables (screening variables, alcohol-related cognitions, mandated student profile) were examined in a logistic regression model as putative predictors of lower risk drinking (defined as 3 or fewer heavy episodic drinking [HED] episodes and/or 4 or fewer alcohol-related consequences in the past month) 6 weeks following the BA session. Second, we used generalized estimating equations to examine putative moderators of BMI effects on HED and peak blood alcohol content compared with assessment only (AO) control over the 3-, 6-, and 9-month follow-ups. Results: Participants reporting lower scores on the Alcohol Use Disorders Identification Test, more benefits to changing alcohol use, and those who fit the "Bad Incident" profile at baseline were more likely to report lower risk drinking 6 weeks after the BA session. Moderation analyses revealed that Bad Incident students who received the BMI reported more HED at 9-month follow-up than those who received AO. Conclusion: Current alcohol use as well as personal reaction to the referral event may have clinical utility in identifying which mandated students benefit from treatments of varying content and intensity. (PsycINFO Database Record
    Full-text · Article · Oct 2015 · Journal of Consulting and Clinical Psychology
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    ABSTRACT: High rates of cognitive impairment persist in human immunodeficiency virus (HIV) infection, despite improved health outcomes and reduced mortality through widespread use of antiretroviral therapy (ART). Heavy alcohol use and cigarette smoking are potential contributors to neurocognitive impairment in people living with HIV (PLWH), yet few studies have examined their influence concurrently. Here we investigated the effects of self-reported alcohol use and smoking on learning, memory, processing speed, verbal fluency, and executive function in 124 HIV-positive men who have sex with men [age (mean ± SD) = 42.8 ± 10.4 years], engaged with medical care. All participants were heavy drinkers. Duration of HIV infection averaged 9.9 ± 7.6 years, and 92.7% were on a stable ART regimen. Participants completed a neuropsychological battery and assessment of past 30-day substance use. Average number of drinks per drinking day (DPDD) was 5.6 ± 3.5, and 33.1% of participants were daily smokers. Rates of neurocognitive impairment were the highest in learning (50.8%), executive function (41.9%), and memory (38.0%). Multiple regression models tested DPDD and smoking status as predictors of neurocognitive performance, controlling for age and premorbid intelligence. Smoking was significantly, negatively related to verbal learning (p = .046) and processing speed (p = .001). DPDD was a significant predictor of learning (p = .047) in a model that accounted for the interaction of DPDD and smoking status. As expected, premorbid intelligence significantly predicted all neurocognitive scores (ps < .01), and older age was associated with slower processing speed (ps < .01). In conclusion, smoking appears to be associated with neurocognitive functioning deficits in PLWH beyond the effects of heavy drinking, aging, and premorbid intelligence. Smoking cessation interventions have the potential to be an important target for improving functional outcomes in heavy drinking PLWH.
    No preview · Article · Oct 2015 · AIDS Care
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    ABSTRACT: Substance use among adolescents with one or more psychiatric disorders is a significant public health concern. In this study, 151 psychiatrically hospitalized adolescents, ages 13-17 with comorbid psychiatric and substance use disorders, were randomized to a two-session Motivational Interviewing intervention to reduce substance use plus treatment as usual (MI) vs. treatment as usual only (TAU). Results indicated that the MI group had a longer latency to first use of any substance following hospital discharge relative to TAU (36days versus 11days). Adolescents who received MI also reported less total use of substances and less use of marijuana during the first 6months post-discharge, although this effect was not significant across 12months. Finally, MI was associated with a significant reduction in rule-breaking behaviors at 6-month follow-up. Future directions are discussed, including means of extending effects beyond 6months and dissemination of the intervention to community-based settings.
    No preview · Article · Sep 2015 · Journal of substance abuse treatment
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    ABSTRACT: Background The study aim was to assess the prevalence and co-occurrence of alcohol and sexual risk behaviors among emergency department (ED) patients in community hospitals.Methods Systematic screening of ED patients (N = 6,486; 56.5% female) was conducted in 2 community hospitals in the northeast during times with high patient volume, generally between the hours of 10 AM to 8 PM, Monday through Saturday. Screening occurred from May 2011 through November 2013. Assessment included validated measures of alcohol use and sexual risk behavior.ResultsOverall results identified high rates of alcohol use, sexual risk behaviors, and their co-occurrence in this sample of ED patients. Specifically, ED patients in between the ages of 18 and 35 were consistently highest in hazardous alcohol use (positive on the Alcohol Use Disorders Identification Test or endorsing heavy episodic drinking [HED]), sexual risk behaviors, and the co-occurrence of alcohol and sex-risk behaviors.Conclusions Findings show a high co-occurrence of hazardous drinking and unprotected sex among ED patients and highlight the role of HED as a factor associated with sexual risk behavior. Efforts to integrate universal screening for the co-occurrence of alcohol and sexual risk behavior in ED settings are warranted; brief interventions delivered to ED patients addressing the co-occurrence of alcohol and sexual risk behaviors have the potential to decrease the risk of sexually transmitted infections and HIV among a large number of patients.
    No preview · Article · Sep 2015 · Alcoholism Clinical and Experimental Research
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    ABSTRACT: Animal and human data suggest that adolescents experience hangover effects that are distinct from adults. The present study used ecological momentary assessment (EMA) methods to examine the temporal relationships between drinking and hangovers, and how this varied by age and sex. We hypothesized that alcohol's dose-dependent effects on hangover severity are more pronounced among adolescents and young adults than older drinkers. We also explored whether greater hangover severity would lead to a lower likelihood and volume of alcohol use later the same day. Data were pooled from 4 studies of drinkers (N = 274; ages 15 to 66 years) who completed a 4- to 14-day (M = 7.46, SD = 1.13) EMA monitoring period. Each morning, participants recorded how much alcohol they consumed the day before and rated their hangover severity. Participants who consumed a greater quantity of alcohol the prior day reported more severe hangover symptoms; however, there was an interaction between drinking volume and age, such that hangover was more severe among younger drinkers, especially at higher drinking levels. More severe hangover symptoms did not predict the likelihood of drinking later that day; however, on drinking days, more severe hangover symptoms predicted lower quantities of alcohol use later that day. This event-level effect did not vary as a function of age. Study outcomes did not vary by sex. Our findings suggest that younger drinkers experience more severe hangovers, and that greater hangover results in lighter drinking later that same day regardless of age. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    No preview · Article · Aug 2015 · Experimental and Clinical Psychopharmacology
  • Tyler B. Wray · Jennifer E. Merrill · Peter M. Monti
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    ABSTRACT: Ecological momentary assessment (EMA) has afforded several important advances in the field of alcohol research, including testing prominent models of alcohol abuse etiology in “high resolution.” Using high-tech methods for signaling and/or assessment, such as mobile electronic diaries, personal data assistants, and smartphones, EMA approaches potentially can improve understanding of precipitants of drinking, drinking patterns, and consequences. For example, EMA has been used to study complex drinking patterns and dynamic predictors of drinking in near–real time. Compared with other methods, EMA can better sample and capture changes in these phenomena that occur in relatively short time frames. EMA also has several potential applications in studying the consequences of alcohol use, including physical, interpersonal, behavioral, and legal problems. However, even with all these potential capabilities, EMA research in the alcohol field still is associated with some limitations, including the potential for measurement reactivity and problems with acceptability and compliance. Despite these limitations, electronically based EMA methods are versatile and are capable of capturing data relevant to a variety of momentary influences on both alcohol use and consequences. Therefore, it will be exciting to fully realize the potential of future applications of EMA technologies, particularly if the associated costs can be reduced.
    No preview · Article · Aug 2015 · Alcohol research : current reviews
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    ABSTRACT: Introduction: Misreporting smoking behavior is common among younger smokers participating in clinical trials for smoking cessation. This study focused on the prevalence of and factors associated with adolescent misreporting of smoking behaviors within the context of a randomized clinical trial for smoking cessation. Methods: Adolescent smokers (N=129) participated in a randomized clinical trial that compared two brief interventions for smoking cessation. Following the final (6-month) follow-up, a confidential, self-administered exit questionnaire examined the extent to which participants admitted to having misreported smoking quantity, frequency and/or consequences during the study. Factors associated with under- and over-reporting were compared to accurate-reporting. Results: One in 4 adolescent smokers (25.6%) admitted to under-reporting during the study and 14.7% admitted to over-reporting; 10.9% of the adolescents admitted to both under- and over-reporting. Rates of admitted misreporting did not differ between treatment conditions or recruitment site. Compared to accurate-reporting, under- and over-reporting were significantly associated with home smoking environment and the belief among adolescents that the baseline interviewer wanted them to report smoking more or less than they actually smoked. Compared to accurate reporters, over-reporters were more likely to be non-White and to report being concerned with the confidentiality of their responses. Conclusions: A post-study confidential debriefing questionnaire can be a useful tool for estimating rates of misreporting and examining whether potential differences in misreporting might bias the interpretation of treatment effects. Future studies are needed to thoroughly examine potentially addressable reasons that adolescents misreport their smoking behavior and to develop methods for reducing misreporting.
    No preview · Article · Jun 2015 · Addictive Behaviors
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    ABSTRACT: Stepped care approaches for mandated college students provide individual brief motivational interventions (BMI) only for individuals who do not respond to an initial, low-intensity level of treatment such as Brief Advice (BA). However, how BMIs facilitate change in this higher-risk group of mandated students remains unclear. Perceived descriptive norms and alcohol-related expectancies are the most commonly examined mediators of BMI efficacy but have yet to be examined in the context of stepped care. Participants were mandated college students (N = 598) participating in a stepped care trial in which mandated students first received BA. Those who reported continued risky drinking 6 weeks following a BA session were randomized to either a single-session BMI (N = 163) or an assessment-only comparison condition (AO; N = 165). BMI participants reduced alcohol-related problems at the 9 month follow up significantly more than AO participants. Multiple mediation analyses using bootstrapping techniques examined whether perceived descriptive norms and alcohol-related expectancies mediated the observed outcomes. Reductions in perceptions of average student drinking (B = -.24; 95% CI [-.61, -.04]) and negative expectancies (B = -.13; 95% CI [-.38, -.01]) mediated the BMI effects. Furthermore, perceived average student norms were reduced after the BMI to levels approximating those of students who had exhibited lower risk drinking following the BA session. Findings highlight the utility of addressing perceived norms and expectancies in BMIs, especially for students who have not responded to less intensive prevention efforts. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    No preview · Article · Jun 2015 · Psychology of Addictive Behaviors

  • No preview · Conference Paper · Jun 2015
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    Jason J Ramirez · Peter M Monti · Ruth M Colwill
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    ABSTRACT: Past research has shown that underage college-student drinkers (UCSDs) report increased subjective craving and exhibit stronger attentional biases to alcohol following alcohol-cue exposure. To date, less research has examined whether momentary decreases in alcohol craving are associated with reductions in attentional bias. One experimental manipulation that has been used to produce within-session decreases in alcohol craving is to extend the duration of laboratory-based alcohol-cue exposure protocols. The aim of this study was to examine the effects of both brief and extended alcohol-cue exposure on subjective craving and attentional bias among UCSDs. Eighty participants were randomized either to a group that received a short, in vivo, alcohol-cue-exposure period (short-exposure group [SE], 2 3-min blocks) or to a group that received a long-exposure period (long-exposure group [LE], 6 3-min blocks). Both groups completed a visual probe task before and after cue exposure to assess changes in attentional bias. Analyses revealed no group differences in mean craving or mean attentional bias before or after cue exposure. Further, exploratory analyses revealed no sex differences in our measures of craving or attentional bias. For Group LE, but not Group SE, within-session changes in craving positively predicted within-session changes in attentional bias. However, further analyses revealed that this relationship was significant only for women in the LE group. Implications for treatments that aim to reduce craving and/or attentional bias are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Full-text · Article · Jun 2015 · Experimental and Clinical Psychopharmacology

  • No preview · Conference Paper · Jun 2015
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    ABSTRACT: Global association and experimental studies suggest that alcohol use may increase sexual behavior that poses risk for exposure to sexually transmitted infections (STI) among heterosexual men and women. However, results from longitudinal and daily recall studies exploring the co-occurrence of alcohol use with various sexual risk outcomes in more naturalistic contexts have been mixed, and the bulk of this research has focused on college students. The current study enrolled heavy-drinking emergency department (ED) patients and used a cross-sectional, 30-day Timeline Followback (TLFB) method to examine the daily co-occurrence between alcohol use and three sexual behavior outcomes: Any sex, unprotected intercourse (UI), and UI with casual partners (versus protected intercourse [PI] with casual partners, or UI/PI with steady partners). Results indicated that increasing levels of alcohol use on a given day increased the odds of engaging in any sexual activity and that heavy drinking (but not very heavy drinking) on a given day was associated with an increased odds of engaging in UI with either steady or casual partners. However, day-level alcohol use was not associated with an increased odds of UI with casual partners. These findings suggest that alcohol may play an important role in increasing risk for HIV/STIs among heterosexuals, and support the continued need to target heavy drinking in sex risk reduction interventions. However, our results also suggest that alcohol may not universally result in unprotected sex with casual partners, a behavior posing perhaps the highest risk for HIV/STI transmission. Copyright © 2015. Published by Elsevier Ireland Ltd.
    No preview · Article · Apr 2015 · Drug and alcohol dependence

Publication Stats

9k Citations
758.51 Total Impact Points


  • 1980-2015
    • Brown University
      • • Center for Alcohol and Addiction Studies
      • • Department of Behavioral and Social Sciences
      • • Department of Medicine
      Providence, Rhode Island, United States
  • 2011
    • George Mason University
      • Department of Psychology
      페어팩스, Virginia, United States
    • Social Science Research Council
      New York City, New York, United States
  • 2008-2011
    • University of Rhode Island
      • Cancer Prevention Research Center
      Кингстон, Rhode Island, United States
  • 1998-2011
    • Butler Hospital
      Providence, Rhode Island, United States
  • 2010
    • University of Texas Health Science Center at Houston
      Houston, Texas, United States
    • Columbia University
      New York, New York, United States
  • 1994-2008
    • University of Pittsburgh
      • Psychology
      Pittsburgh, Pennsylvania, United States
  • 1981-2008
    • Alpert Medical School - Brown University
      • Department of Psychiatry and Human Behavior
      Providence, Rhode Island, United States
  • 2007
    • United States Department of Veterans Affairs
      Бедфорд, Massachusetts, United States
  • 2005-2007
    • Rhode Island Hospital
      Providence, Rhode Island, United States
    • University of Wisconsin, Madison
      • Department of Psychology
      Madison, MS, United States
  • 2006
    • Risk Management Solutions, Inc.
      Ньюарк, California, United States
  • 2004
    • Boston University
      • Department of Psychiatry
      Boston, MA, United States
  • 2003
    • Johns Hopkins University
      • Department of Psychiatry and Behavioral Sciences
      Baltimore, MD, United States
  • 1982-2003
    • Jesse Brown VA Medical Center
      Chicago, Illinois, United States
  • 2002
    • University of California, San Diego
      • Department of Psychology
      San Diego, California, United States
    • Western Psychiatric Institute and Clinic
      Pittsburgh, Pennsylvania, United States
  • 1977-2002
    • Providence Hospital
      Mobile, Alabama, United States
  • 1997
    • University of Massachusetts Boston
      • Department of Psychology
      Boston, Massachusetts, United States
  • 1984
    • Rhode Island College
      • Department of Psychology
      Providence, Rhode Island, United States