e218 Abstracts / Drug and Alcohol Dependence 146 (2015) e202–e284

and PTSD (13%). After controlling for demographic characteristics,the odds of meeting criteria for a mental health disorder were 3.6times higher among those exposed to CT compared to those whonever experienced trauma.

Conclusions: This is the first epidemiological investigation ofsubstance use and mental health consequences of CT in the Aus-tralian general population. Exposure to CT is common and putsindividuals at risk of developing serious psychological illness. Thesefindings underscore the importance of early intervention for indi-viduals who have been exposed to trauma during childhood.

Financial support: This research received no financial support.The NSMHWB was funded by the Australian Government Depart-ment of Health and Ageing.

http://dx.doi.org/10.1016/j.drugalcdep.2014.09.059

The challenging experience questionnaire:Characterization of acute adverse reactions topsilocybin

Frederick S. Barrett 1, Matthew P. Bradstreet 1,Jeannie-Marie S. Leoutsakos 1, Matthew W.Johnson 1, Katherine A. MacLean 1, RobertJesse 1,3, Roland R. Griffiths 1,2

1 Psychiatry and Behavioral Sciences, Johns HopkinsSchool of Medicine, Baltimore, MD, United States2 Neuroscience, Johns Hopkins School of Medicine,Baltimore, MD, United States3 Council on Spiritual Practices, San Francisco, CA,United States

Aims: Acute adverse psychological reactions (“bad trips”) toclassic hallucinogens (such as psilocybin and LSD), while usuallybenign with proper preparation before and support during thetime of drug action, remain a clinical concern for human research,and a safety concern for recreational use. Anecdotal and clinicalevidence suggests that anxiety, panic, depression, and confusionare potential adverse reactions to classic hallucinogens. We applypsychometric analysis to investigate the profile of challengingexperiences with psychedelics, and relate this profile to ratings ofthe overall impact of the experiences.

Methods: We analyzed responses (N = 1853) to an online sur-vey study of “bad trips” with psilocybin, and used exploratoryand confirmatory factor analysis of stratified subsamples to con-struct and validate a Challenging Experience Questionnaire (CEQ)from responses to items from the Hallucinogen Rating Scale(HRS), the States of Consciousness Questionnaire (SOCQ), andthe 5-Dimensional Altered States of Consciousness questionnaire(5DASC).

Results: Scores from 29 items of the HRS, SOCQ, and 5DASCloaded onto a 6 factors of the CEQ (grief, fear, death, insanity,isolation, and physical distress). These factors differentially pre-dicted the rated difficulty, meaningfulness, spiritual significance,and change in well-being attributed to the challenging effects.

Conclusions: Scores on CEQ factors form a phenomenologicalprofile of challenging experiences with psilocybin, and may providea framework within which to investigate predictors and persistingeffects of these experiences.

Financial support: This work was supported in part by NIHgrants T32DA007209 and R01DA003889, and a grant from theHeffter Research Institute.

http://dx.doi.org/10.1016/j.drugalcdep.2014.09.060

Willingness to enter drug treatment: The role oftreatment models, copays and financialincentives

Colleen Barry 1, S. Busch 2, Andrew Epstein 3,David Fiellin 2

1 Johns Hopkins, Baltimore, MD, United States2 Yale, New Haven, CT, United States3 University of Pennsylvania, Philadelphia, PA,United States

Aims: The low proportion of individuals with drug use disor-ders (DUD) who receive treatment has led to the consideration ofalternative treatment models, in addition to addiction treatmentcenter-based care (ATC), to attract patients. These include primarycare (PC), and primary care/collaborative care (PC/CC). In addition,out-of-pocket copays and financial incentives may impact will-ingness to enter treatment. We sought to assess the willingnessof out-of-treatment individuals with DUD to enter various drugtreatment models and their responsiveness to copays and financialincentives.

Methods: We conducted a nationally representative random-ized internet-based survey experiment of individuals screeningpositive for DUD. Respondents not in treatment were randomizedto receive one of 3 treatment vignettes describing key componentsof ATC, PC or PC/CC. Outcomes included willingness to enter treat-ment based on treatment model, copays (re-randomized) and, forthose not willing to enter treatment, whether financial incentivesincreased respondents’ willingness to enter treatment.

Results: Of 231 respondents with DUD, 26% indicated willing-ness to enter treatment when it was described as ATC, 42% whendescribed as PC, and 37% when described as PC/CC; p = .04 for ATC vs.PC. Among respondents expressing willingness to enter treatmentwithout a copay, a smaller proportion would enter treatment wheneach visit incurred a copay: $10 copay (84%); $30 copay (48%); $50copay (20%). Of the 154 DUD respondents not willing to enter treat-ment, 62% indicated they did not feel the need for treatment. Thepercentage of respondents originally unwilling to enter treatmentthe size of the financial incentive offered per visit impacted willing-ness to enter treatment: $5 incentive (15%); $10 incentive (23%);$15 incentive (34%); $20 incentive (28%); $25 incentive (29%).

Conclusions: Treatment models, copays and financial incen-tives should be considered when designing strategies to addresswillingness to enter drug treatment.

Financial support: R01 DA 026414.

http://dx.doi.org/10.1016/j.drugalcdep.2014.09.061

Cognitive-behavioral therapy and educationalcounseling for chronic pain and opioiddependence

Declan T. Barry 1,2, Christopher J. Cutter 1,2, MarkBeitel 1,2, Christopher Liong 2, Richard S.Schottenfeld 1

1 Psychiatry, Yale School of Medicine, New Haven,CT, United States2 APT Foundation Pain Treatment Services, NewHaven, CT, United States

Aims: To examine the efficacy of cognitive behavioral therapy(CBT) and educational counseling (EC)—the educational componentof CBT augmented by additional psychoeducation on chronic painand addiction—for co-occurring chronic low-back pain and opioiddependence (POD).

Abstracts / Drug and Alcohol Dependence 146 (2015) e202–e284 e219

Methods: 90 POD patients received a standard protocolof buprenorphine/naloxone (BUP/NLX) and were assigned to:physician management (PM) alone, consisting of six 10–15 minmedically focused sessions; PM plus psychologist-delivered CBT(10 sessions over 12 weeks); or PM plus nurse-delivered EC (10sessions over 12 weeks). Primary outcomes were pain interference,pain intensity, and percentage of opioid-negative urines.

Results: The majority were men (68%), Caucasian (89%), andnever married (60%). Completion rates (>90%) and PM attendance(mean of 5.6 of 6 planned sessions) did not vary across conditions.There was a significant overall decrease in average pain interfer-ence from 4.6 at baseline to 3.4 at month 3 (p < .05) and a significantinteraction between condition and time (p < .05), favoring PM plusCBT or EC over PM alone: The mean (SD) reductions in pain inter-ference (scored on 0–10 scales) in the CBT, EC, and PM alone groupswere 1.7 (1.7), 1.4 (1.6), and 0.6 (1.6), respectively. Pain inten-sity decreased over time (p < .05) but did not differ by group norwas there a significant interaction with group by time. Overall,the proportion of urine samples indicating nonmedical opioid usedecreased from 100% at baseline to 31% (95% CI 23–40%) at month 1,36% (95% CI 27–46%) at month 2, and 39% (95% CI 30–50%) at month3. Covarying for nonmedical opioid use during BUP/NLX induction,there was a significant interaction between counseling and time(p < .05): reductions from baseline were sustained in both CBT andEC groups, while nonmedical opioiduse increased in the PM alonegroup.

Conclusions: Our findings support the efficacy of PM enhancedby CBT or EC for patients with POD treated with BUP/NLX.

Financial support: NIDA: K23 DA024050, K24 DA00445, andR01 DA024695.

http://dx.doi.org/10.1016/j.drugalcdep.2014.09.062

Significantly lower prevalence ofpsychopathology in Asian compared tonon-Asian methadone maintained patients

Gavin Bart, Scott Lenz

Medicine, Hennepin County Medical Center,Minneapolis, MN, United States

Aims: Comorbid psychiatric illness may affect up to 50% ofmethadone maintained patients. Previous work has not found sig-nificant differences in prevalence of psychiatric illness betweenCaucasian, Hispanic, and African American methadone maintainedpatients. Little is known about the prevalence of psychopathologyin Asian methadone maintained patients.

Methods: Hmong and non-Hmong subjects who had been onmethadone for at least 2 months were recruited from a singleurban methadone clinic. Those who were pregnant, had end stageliver disease, or were taking medications known to interact withmethadone were excluded. To determine Axis I psychiatric diag-noses, a trained masters level interviewer completed the StructuredClinical Interview for DSM-IV and subjects also completed theSymptom Checklist-90 (SCL-90) to assess levels of psychopathol-ogy. Descriptive statistics using chi-square for categorical variables,t-tests and analysis of variance for continuous variables evaluateddifferences between ethnicities.

Results: 206 subjects mean age 47.2 years (61.7% male) par-ticipated. Ethnic distribution was 30.6% Caucasian, 21.4% AfricanAmerican, 9.2% American Indian, Hmong 36.9%. The Hmongwere significantly older (56.6 years) and more likely to be male(71.1%). SCL-90 global severity did not differ between groupsand methadone dose did not differ between those with normalversus borderline and abnormal scores. The Hmong had more

somatization but less interpersonal sensitivity, depression, andparanoid ideation than non-Hmong. Overall the Hmong were lesslikely to have a DSM-IV diagnosis than non-Hmong (67% versus29% without). Of those with diagnoses, there was a significantlylower prevalence of anxiety and mood disorder diagnoses but nodifference in substance use disorder diagnoses.

Conclusions: Asian methadone maintained subjects have asignificantly lower prevalence of DSM-IV axis I diagnoses thannon-Asian subjects. We have previously documented superiormethadone treatment outcome in Hmong, whether this is influ-enced by the reduced prevalence in comorbid psychiatric illnessremains unknown.

Financial support: NIH-NIDA K23 DA024663.

http://dx.doi.org/10.1016/j.drugalcdep.2014.09.063

Overexpression of miR-495 in nucleusaccumbens attenuates cocaine intake on aprogressive ratio schedule of reinforcement

Ryan M. Bastle 1, Robert J. Oliver 2, Nathan S.Pentkowski 1, Amy S. Gardiner 2, Nora I.Perrone-Bizzozero 2, Janet L. Neisewander 1

1 Arizona State University, Tempe, AZ, United States2 Univ. New Mexico, Albuquerque, NM, United States

Aims: MicroRNAs regulate translation of multiple functionallyrelated genes. We found that the microRNA, miR-495, has severalpredicted target genes in the Knowledgebase of Addiction-RelatedGenes database (http://karg.cbi.pku.edu.cn) and is downregulatedin the nucleus accumbens (NAc) by acute cocaine administration.Using a lentiviral vector (LV-miR-495) to increase miR-495 expres-sion in the NAc in drug naïve rats, we found an increase in miR-495and a corresponding decrease in several predicted targets com-pared to LV-GFP controls, suggesting that these genes are regulatedby miR-495 in vivo. In this study, we tested the effects of increasingmiR-495 expression on cocaine self-administration (SA).

Methods: Rats were initially trained to self-administer cocaine(0.75 mg/kg/0.1 ml) on a fixed ratio (FR) 5 schedule of rein-forcement and then were trained to self-administer 4 differentdoses of cocaine each available for 30 min within a given sessionwith a 10 min time out between doses. Once stable cocaine SAdose–response functions were established, we infused either LV-miR-495 or LV-GFP into the medial NAc. Testing began 4 dayslater, including both within- and between-session cocaine SAdose–response tests (0, 0.03, 0.1, 0.3, 1.0 mg/kg, IV; FR5) and testson a progressive ratio (PR) schedule of cocaine reinforcement usingtwo cocaine doses (0.375 and 0.75 mg/kg).

Results: LV-miR-495 slightly altered the dose–response func-tion for cocaine intake on an FR5 in a manner consistent with aright-ward shift, and produced a more pronounced attenuation ofresponse rates and intake at the high cocaine dose on the PR.

Conclusions: Collectively, these findings suggest that miR-495may regulate expression of genes in the NAc that are involved inmotivation for cocaine. Understanding the role of microRNAs inaddiction-related changes in gene expression may offer a novelapproach to simultaneously normalize a number of genes that aredysregulated in cocaine addicts.

Financial support: Supported by DA034097 and DA025992.

http://dx.doi.org/10.1016/j.drugalcdep.2014.09.064