Steve Martino's research while affiliated with Yale University and other places
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Publications (147)
Objective:
Cognitive behavioral therapy for chronic pain (CBT-CP) is an evidence-based treatment for improving functioning and pain intensity for people with chronic pain with extensive evidence of effectiveness. However, there has been relatively little investigation of the factors associated with successful implementation and uptake of CBT-CP, p...
Obesity and alcohol use disorder (AUD) are two of the most prevalent and costly clinical conditions among U.S. military veterans, and these conditions often co-occur. However, little is known about the clinical correlates of co-occurring obesity and AUD, which is critical to informing effective interventions. The current study analyzed data from a...
Patients with kidney disease must implement and sustain nutritional and other lifestyle changes and adhere to prescribed medical treatments to best manage their health. An important strategy for health-care providers to promote these activities is to activate the patients’ motivation for behavior change. This chapter describes an approach for talki...
Introduction
Veterans with chronic pain may be vulnerable during the COVID-19 pandemic. We qualitatively explored the impact of the COVID-19 pandemic on a sample of Veterans receiving brief counseling focused on pain management in an ongoing clinical trial and discuss how the pandemic affected the process of motivating Veterans with chronic pain to...
Pragmatic clinical trials (PCTs) are well-suited to address unmet healthcare needs, such as those arising from the dual public health crises of chronic pain and opioid misuse, recently exacerbated by the COVID-19 pandemic. These overlapping epidemics have complex, multifactorial etiologies, and PCTs can be used to investigate the effectiveness of i...
Digital interventions delivering Cognitive Behavioral Therapy for insomnia (Digital CBTi) may increase utilization of effective care for a common and serious condition. A low-intensity implementation strategy may facilitate digital CBTi use in healthcare settings. This pilot study assessed the feasibility of implementing a digital CBTi in Veterans...
Objective
We describe the most frequently used musculoskeletal diagnoses in Veterans Health Administration (VHA) care. We report the number of visits and patients associated with common musculoskeletal ICD-10 codes and compare trends across primary and specialty care settings.
Design
Secondary analysis of a longitudinal cohort study.
Subjects
Vet...
Objectives:
Musculoskeletal disorders often lead to chronic pain in Veterans. Chronic pain puts sufferers at risk for substance misuse, and early intervention is needed for both conditions. This pilot study tested the feasibility and acceptability of a Screening, Brief Intervention, and Referral to Treatment for Pain Management intervention (SBIRT...
Background:
Motivational interviewing delivered in a group format is understudied yet promising as a treatment for substance use disorders (SUD). We evaluated the efficacy of group motivational interviewing (GMI) relative to a treatment-control (TCC) for enhancing treatment and self-help engagement and decreasing alcohol and drug use among veteran...
Objective
To estimate the impact of screening, brief intervention, and referral to treatment (SBIRT) administered in reproductive health care settings on a variety of economic outcomes, including general health care utilization, criminal activity, and motor vehicle crashes. Whether and by how much SBIRT affects economic outcomes are important unans...
Background
Veterans with significant chronic pain from musculoskeletal disorders are at risk of substance misuse. Veterans whose condition is the result of military service may be eligible for a disability pension. Department of Veterans Affairs compensation examinations, which determine the degree of disability and whether it was connected to mili...
Background
Given access barriers to cognitive behavioral therapy for chronic pain (CBT-CP), this pragmatic superiority trial will determine whether a remotely delivered CBT-CP intervention that addresses these barriers outperforms in-person and other synchronous forms of CBT-CP for veterans with musculoskeletal pain.
Design
This pragmatic trial co...
Background
The NIH-DOD-VA Pain Management Collaboratory (PMC) supports 11 pragmatic clinical trials (PCTs) on nonpharmacological approaches to management of pain and co-occurring conditions in U.S. military and veteran health organizations. The Stakeholder Engagement Work Group is supported by a separately funded Coordinating Center and was formed...
Background
The prevalence of substance use disorders is higher among medical inpatients than in the general population, placing inpatient providers in a prime position to detect these patients and intervene.
Objective
To assess provider detection rates of substance use disorders among medical inpatients and to identify patient characteristics asso...
Purpose:
Motivational interviewing (MI) weight-loss interventions have garnered much attention, particularly in primary care. Few studies, however, have examined long-term outcomes of MI for weight loss in primary care. This study sought to examine the longer-term outcomes of a combination approach comprising MI and nutrition psychoeducation (MINP...
Background
Substance use disorders (SUDs) among people with HIV are both prevalent and problematic. The Substance Abuse Treatment to HIV care project was funded to test the Implementation and Sustainment Facilitation (ISF) strategy as an adjunct to the Addiction Technology Transfer Center (ATTC) strategy for integrating a motivational interviewing-...
Background and aims:
To address current gaps around screening for problematic pornography use (PPU), we initially developed and tested a six-item Brief Pornography Screen (BPS) that asked about PPU in the past six months.
Methods and participants:
We recruited five independent samples from the U.S. and Poland to evaluate the psychometric propert...
Background:
The Compensation and Pension (C&P) determination process is a potential gateway to accessing pain treatment in the Veterans Health Administration (VHA). However, attitudes about C&P as a gateway and about collaboration with C&P clinics among VHA staff are unknown.
Methods:
In preparation for an initiative to link veterans seeking com...
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...
Background Substance use disorders (SUD) among people with HIV are both prevalent and problematic. In 2014, the Substance Abuse Treatment to HIV care (SAT2HIV) Project was funded to test the team-focused Implementation & Sustainment Facilitation (ISF) strategy as an adjunct to the staff-focused Addiction Technology Transfer Center (ATTC) strategy f...
Background Substance use disorders (SUD) among people with HIV are both prevalent and problematic. In 2014, the Substance Abuse Treatment to HIV care (SAT2HIV) Project was funded to test the team-focused Implementation & Sustainment Facilitation (ISF) strategy as an adjunct to the staff-focused Addiction Technology Transfer Center (ATTC) strategy f...
Treatment of substance use in women seeking reproductive healthcare is crucial for the health of both women and their offspring. Although abstinence from all substance use during pregnancy is optimal, it is difficult to achieve. This secondary analysis reports abstinence outcomes from a randomized clinical trial of screening, brief intervention, an...
Objective:
Over the past decade, the Department of Veterans Affairs (VA) has experienced a sizeable shift in its approach to pain. The VA's 2009 Pain Management Directive introduced the Stepped Care Model, which emphasizes an interdisciplinary approach to pain management involving pain referrals and management from primary to specialty care provid...
Emotion dysregulation, a risk factor for suicide ideation and attempts, has not been studied in U.S. veterans of Operations Enduring and Iraqi Freedom and New Dawn (OEF/OIF/OND). Data were collected through standardized telephone interviews and computer-based surveys from 278 OEF/OIF/OND veterans (70.6% male, 29.4% female).
Bivariate analyses indic...
Background
General medical hospitals provide care for a disproportionate share of patients who misuse substances. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance misuse.
Objective
To determine the effectiveness of three strategies for implementing motivational interviewing for substance mi...
Aims
To determine the cost‐effectiveness of electronic‐ and clinician‐delivered SBIRT (Screening, Brief Intervention and Referral to Treatment) for reducing primary substance use among women treated in reproductive health centers.
Design
Cost‐effectiveness analysis based on a randomized controlled trial.
Setting
New Haven, Connecticut, USA.
Part...
Behavioral intervention technologies (BITs) are online programs or mobile applications that deliver behavioral health interventions for self-care. The dissemination and implementation of such programs in U.S. healthcare systems has not been widely undertaken. To better understand these phenomena, we explored perspectives on BIT deployment in the Ve...
Background:
Women are at highest risk for development of a substance use disorder during their reproductive years. We recently evaluated the efficacy of an electronic screening, brief intervention and referral to treatment (e-SBIRT) and a clinician-delivered SBIRT (SBIRT) compared with enhanced usual care (EUC) for reducing overall substance use a...
Electronic delivery of Screening, Brief Intervention, and Referral to Treatment (e-SBIRT) may be a low-cost and high-reach method for screening and brief intervention in health care settings. However, its relative acceptability, ability to build a therapeutic alliance, and delivery of key intervention components compared to in-person SBIRT (SBIRT)...
Background
Veterans are at high risk for suicide; emotion dysregulation may confer additional risk. Dialectical behaviour therapy (DBT) is a well-supported intervention for suicide attempt reduction in individuals with emotion dysregulation, but is complex and multi-component. The skills group component of DBT (DBT-SG) has been associated with redu...
Upon publication of the original article.
Background
Dissemination of evidence-based practices that can reduce morbidity and mortality is important to combat the growing opioid overdose crisis in the USA. Research and expert consensus support reducing high-dose opioid therapy, avoiding risky opioid-benzodiazepine combination therapy, and promoting multi-modal, collaborative models of pain...
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...
Abstract
Objective
High proportions of post-9/11 veterans have musculoskeletal disorders (MSDs), but engaging them in care early in their course of illness has been challenging. The service connection application is an ideal point of contact for referring veterans to early interventions for their conditions.
Design
Among MSD claimants who reported...
Background:
Access to evidence-based interventions for common mental health conditions is limited due to geographic distance, scheduling, stigma, and provider availability. Internet-based self-care programs may mitigate these barriers. However, little is known about internet-based self-care program implementation in US health care systems.
Object...
Introduction:
Opioid prescribing and subsequent rates of serious harms have dramatically increased in the past two decades, yet there are still significant barriers to reduction of risky opioid regimens. This formative evaluation utilized a mixed-methods approach to identify barriers and factors that may facilitate the successful implementation of...
This study explored patients’ perspectives about taking the new direct-acting antivirals (DAAs) for the treatment of Hepatitis C (i.e., sofosbuvir, simeprevir, ledipasvir/sofosbuvir, ombitasvir/paritraprevir/ritonavir and dasabuvir) to identify facilitators of medication adherence. The project was conducted using semistructured interviews with 12 V...
Background:
Screening, Brief Intervention, and Referral to Treatment may reduce substance misuse but has received minimal study among women treated in reproductive health settings.
Objective:
To determine whether Screening, Brief Intervention and Referral to Treatment delivered either electronically or by clinician is more effective than enhance...
Background:
In 2010, the first comprehensive National HIV/AIDS Strategy for the United States was released and included three goals: (1) reducing the number of people who become infected with HIV, (2) increasing access to care and improving health outcomes for people living with HIV, and (3) reducing HIV-related health disparities and health inequ...
Background:
Improving the extent to which evidence-based practices (EBPs)-treatments that have been empirically shown to be efficacious or effective-are integrated within routine practice is a well-documented challenge across numerous areas of health. In 2014, the National Institute on Drug Abuse funded a type 2 effectiveness-implementation hybrid...
Objective:
Our previous randomized controlled trial found that nutrition psychoeducation (NP), an attention-control condition, produced statistically significantly more weight loss than usual care (UC), whereas motivational interviewing (MI) did not. NP, MI, and UC resulted in medium-large, medium, and negligible effects on weight loss, respective...
Objective:
Weight loss interventions have begun to receive increasing attention in primary care. Motivational interviewing (MI) is compatible with primary care because it requires relatively limited time and resources. Few studies, however, have examined the long-term impact of MI for weight loss in primary care, and none have used attention-contr...
Background and aims
This study employed a newly developed questionnaire to evaluate whether men’s self-efficacy to avoid using pornography in each of 18 emotional, social, or sexually arousing situations was associated with either their typical frequency of pornography use or their hypersexuality.
Methods
Using an Internet-based data collection pr...
Victimization from physical and sexual violence presents global health challenges. Partner violence is higher in Kenya than Africa. Violence against drinkers and HIV-infected individuals is typically elevated, so dual vulnerabilities may further augment risk. Understanding violence risks can improve interventions. Participants were 614 HIV-infected...
Introduction: Research suggests that a blunted response to nondrug rewards, especially under conditions associated with strong cigarette cravings, is associated with reduced abstinence motivation in daily smokers. One limitation of previous studies is that they have largely focused on monetary rewards as broad representative of nondrug rewards. It...
Compulsive sexual behavior (CSB) is defined as difficulties in controlling inappropriate or excessive sexual fantasies, urges, or behaviors that cause subjective distress or impairment in important areas of daily functioning. Using data from a baseline telephone interview, we examined the prevalence of CSB in a convenience sample of 820 post-deploy...
Introduction: Digital social media platforms represent outlets through which individuals may find partners for sexual encounters. Using a sample of US post-deployment military veterans, the current study evaluated the prevalence of digital sex seeking with clinical correlates of psychopathology, suicidal ideation, and sexually transmitted infection...
Compulsive sexual behavior (CSB) is often characterized by inappropriate or excessive sexual fantasies or behaviors that cause impairment in one or more important areas of daily functioning. The present study examined the prevalence of CSB in a national sample of US male Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and/or Operat...
Background:
To counteract the syndemics of HIV and alcohol in Sub-Saharan Africa, international collaborations have developed interventions to reduce alcohol consumption. Reliable and accurate methods are needed to estimate alcohol use outcomes. A direct alcohol biomarker called phosphatidylethanol (PEth) has been shown to validate heavy, daily dr...
Background and aims
This study examined the prevalence of, and factors associated with, men’s interest in seeking treatment for use of pornography.
Methods
Using an Internet-based data-collection procedure, we recruited 1,298 male pornography users to complete questionnaires assessing demographic and sexual behaviors, hypersexuality, pornography-u...
The effectiveness of a competency-based supervision approach called Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA: STEP) was compared to Supervision-As-Usual (SAU) for increasing clinicians' motivational interviewing (MI) adherence and competence and client retention and primary substance abstinence in a mul...
Background and aims: The current study investigated the prevalence of, and factors associated with, men’s interest in seeking treatment for use of pornography. Methods: Using the Internet, we recruited 1298 male pornography users to complete questionnaires assessing demographic and sexual behaviors, hypersexuality, pornography-use characteristics,...
Background and Aims: The current study examined the mediational role of two types of “passionate attachment” in the relationship of pornography use and sexual compulsivity. Harmonious passion refers to when a person’s sexual behavior is in harmony with other areas of his or her life. Obsessive passion refers to an “uncontrollable urge” to engage in...
Background
General medical hospitals provide care for a disproportionate share of patients who abuse or are dependent upon substances. This group is among the most costly to treat and has the poorest medical and addiction recovery outcomes. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance us...
Motivational enhancement approaches for substance use and psychiatric disorders have become increasingly popular during the past two decades. Foremost among them is motivational interviewing (MI), developed by William Miller and Stephen Rollnick. This chapter describes what MI is and is not, its four main processes and associated practices, sustain...
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 pa...
There have been steady advances in psychotherapy for substance-related disorders. Several of these treatments are empirically supported and considered evidence based. This chapter presents four well-recognized evidence-based psychosocial treatments for substance-related disorders: motivational interviewing, cognitive behavioral therapy, contingency...
Objective:
This study evaluated whether tobacco quitline telephone coaches can be trained to counsel hazardous-drinking smokers to improve smoking cessation success and to limit or abstain from alcohol use.
Method:
Smokers (N = 1,948) who called the New York State Smokers' Quitline and reported hazardous drinking (exceeding sex-specific weekly l...
Change talk (CT), or client speech in favor of change, is a hypothesized mechanism of action in motivational interviewing (MI) for substance use disorders. Although group-based treatment is the primary treatment modality for the majority of clients seeking substance use treatment, limited research has examined group motivational interviewing (GMI)...
Objective
Primary-care (PC) settings may be an opportune place to deliver obesity interventions. Scalable interventions utilizing motivational interviewing (MI), supported by internet resources, may overcome obstacles to effective obesity treatment dissemination. This study was a randomized controlled trial testing two web-supported interventions,...
Objective:
This study's objective was to determine the efficacy of benefits counseling in a clinical trial. There has been concern that disability payments for psychiatric disorders reduce incentives for employment and rehabilitation. Benefits counseling, with education about opportunities to work and the financial implications of work on receipt...
Patients with kidney disease must implement and sustain nutritional and other lifestyle changes and adhere to prescribed medical treatments to best manage their health. An important strategy for healthcare providers to promote these activities is to activate the patients’ motivation for behavior change. This chapter describes an approach for talkin...
A variety of obstacles (e.g., lack of transportation, less availability of treatment in rural districts) contribute to underutilization of treatment among patients with substance use disorders, warranting the need to develop innovative strategies for enhancing access to treatment for these patients. The telehealth in-home-messaging-device is a smal...
Background:
Improving clinicians' interest, confidence, and commitment in using evidence-based treatment (EBT) is often an aim of training clinicians in EBT. However, the degree to which these areas actually improve through training and what their relationship is to treatment integrity is unknown.
Method:
Using data from a multi-site study (Mart...
Background: Few measures exist to examine therapist empathy as it occurs in session. Aims: A 9-item observer rating scale, called the Therapist Empathy Scale (TES), was developed based on Watson's (1999) work to assess affective, cognitive, attitudinal, and attunement aspects of therapist empathy. The aim of this study was to evaluate the inter-rat...
Treatment integrity ratings (adherence and competence) are frequently used as outcome measures in clinician training studies, drawn from recorded real client or role-played client sessions. However, it is unknown whether clinician adherence and competence are similar in real client and role-played sessions or whether real and role-play clients prov...
Brief intervention (BI) can reduce harmful and hazardous drinking among emergency department patients. However, no psychometrically-validated instrument for evaluating the extent to which practitioners correctly implement BIs in clinical practice (e.g., adherence) exists. We developed and subsequently examined the psychometric properties of a scale...
