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Access Type

WSU Access

Date of Award

January 2011

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Psychology

First Advisor

Mark A. Lumley

Second Advisor

Emily R. Grekin

Abstract

There are currently few factors guiding physicians' decisions as to whether an individual patient may need additional regulation of pain medications because of risks. The limited predictive factors applied to prescription opioid abuse in chronic pain patients is surprising given the breadth of personal, cognitive, and emotional factors explored in both chronic pain and substance abuse literatures broadly. The present study had two purposes. First, concurrent risk factors for prescription misuse and substance abuse in chronic pain patients were explored, specifically examining whether the addition of emotional factors to the traditionally used risk factors improves prediction of prescription and substance misuse. The present study also experimentally examined whether an enhanced interview condition would lead to increased disclosure of prescription misuse, other drug use, and traumatic events, by normalizing the experience of substance use and trauma, and engaging in a conversation about confidentiality of the information. Participants completed one session in which they were assigned to report their prescription misuse, substance use, and trauma in one of the following formats: written/private, standard interview, enhanced interview. In the enhanced condition, the interviewer followed an initial script addressing participants' potential concerns about disclosure prior to questions regarding substance use and trauma. In addition to replicating the role of personal and family history of substance use problems, this study provided new evidence for the role of emotional ambivalence as a risk factor for prescription misuse, prescription abuse and dependence symptoms, and alcohol use. Interestingly, only younger age was predictive of cannabis use. This study also provided evidence that further development in assessment methods, focused on understanding the role of meta-communication, normalizing of problematic behaviors, and probing unclear responses, could lead to better identification of patients already engaging in problematic prescription related behaviors.