In 2019, 20.4 million people in the United States were diagnosed with SUDs, and only 10.3 percent of those diagnosed received SUD treatment [1]. Addiction Consult Services in the inpatient setting provide an opportunity for diagnosis and treatment. An ACS is a multidisciplinary team which offers specialized care for those with SUDs, often including initiation of medication treatment, linkage to outpatient clinics and resources, and patient counseling [2]. We sought to conduct a systematic review and partial meta-analysis on the impact of Addiction Medicine Consult services in the inpatient setting on patients with SUDs.

Before the introduction of mobile/online forms of gambling, “brick and mortar” gambling was the typical form of gambling. Now, the use of mobile phones allows for greater accessibility and convenience to gambling. This modern method of gambling has attracted newer younger audiences such as college students which poses an increasing concern about problem gambling among younger individuals. Since alcohol use problems tend to co-occur with problem gambling, it is important to consider alcohol use as a predictor of problem gambling. Other factors that could potentially influence the relation between alcohol use problems and problem gambling are financial stress (as an indicator of socioeconomic status) and sensation seeking; however, the potential interactive effects of these variables with problem alcohol use in predicting problems remain unclear. The main goals of the current study were to examine the unique and interactive influences of alcohol use problems, sensation seeking, and financial stress in relation to problem gambling. The sample for the current study was taken from the Psychology participant pool enrolled at Arizona State University and met the minimum age requirement of 18 (N = 793, 64.1% Male). All analyses were conducted using R Studio (R Core Team, 2023). I ran a a series of logistic regression models for my covariates only, main effects (alcohol use problems and financial stress or alcohol use and sensation seeking) models while controlling for covariates, and interaction models (alcohol use problems multiplied by financial stress and alcohol use problems multiplied by sensation seeking). Results showed that alcohol use problems and sensation seeking were not significant predictors of problem gambling. However, financial stress (SES), sex (male), and age proved to be significant predictors of problem gambling. There were no interactions found between alcohol use problems and socioeconomic status or sensation seeking on problem gambling outcomes. Although some results from the current study are inconsistent with existing literature, the significant findings provide insight into potential future directions and treatment programs for problem gambling among college students. Further studies are needed to develop a more comprehensive understanding of the complex interactions between alcohol use problems, socioeconomic status, and sensation seeking in relation to problem gambling.

The topic of this dissertation is the sustainable disposal of waste materials in a way that mitigates risk to human health and the environment. A meta-analysis of organic contaminant concentrations in U.S. sewage sludge highlights the known analytes detected across 106 studies, and juxtaposes these data with a Chinese sludge analysis covering 159 studies, finding that U.S. average concentrations were higher than Chinese concentrations in 26 out of 34 tested organic chemicals. To further investigate the risk that sewage sludge poses when applied on agricultural land mixed with fertilizer as a soil amendment, a sewage sludge risk assessment that for the first time utilized Monte-Carlo simulations was performed to quantify the human health risk of metals present in sewage sludge applied on soils subject to involuntarily ingestion. This study found that while hazard indexes did not indicate a risk to humans for the metals studied, hundreds of other inorganic and organic chemicals are known to be present whose human health risks remain uncertain due to a lack of toxicological data. Among these contaminants are micro- and nanoplastics which contaminate not just sewage sludge but the entire globe. Application of existing models to the world’s oceans showed micro- and nanoplastics to constitute an important component of the total global plastic waste inventory, forecasting peak exposures of aquatic organisms (and by extension human populations) to occur in future years irrespective of what policy options will be implemented. A review of disposal options for sewage sludge illustrates the challenge of dealing with waste streams containing persistent or even indestructible contaminants such as perfluorinated organics, mass-produced fossil-fuel derived consumer plastics, and extensively mined toxic metals. The work presented here details the risks, both avoidable and unavoidable, that are present in the disposal of sewage sludge and plastics. The information presented in this dissertation may inform regulatory actions to promote environmentally responsible disposal and reuse of sewage sludge and highlights the need for industry to transition to the production of more sustainable plastics in order to reduce and ultimately eliminate sources of persistent long-term environmental pollution and their associated adverse human health and ecosystem impacts.

Adult use of cannabis was legalized in Arizona on November 3, 2020. The goal of this thesis was to assess the distribution of licensed adult use (recreational) cannabis dispensaries in Arizona as it relates to area deprivation in the state. On June 30, 2021, the vast majority of licensed adult ust dispensaries (n=92/143) were located in Maricopa County, so our analyses focused only on Maricopa County. ArcGIS Pro was used to map the dispensaries and determine the local density of dispensaries in each Maricopa County block group. We used three complementary statistical analyses, which collectively showed that adult use cannabis dispensaries were disproportionately located in areas of higher socioeconomic deprivation in Maricopa County. These results may have implications for existing health disparities.The study was limited because we did not account for geospatial autocorrelation, we did not assess unlicensed dispensaries, and we did not control for zoning laws. In future studies we plan to account for all three of these limitations to better understand the placement of adult-use cannabis dispensaries within Arizona. Future studies will also compare these results to the distribution of off-premise alcohol outlets and cannabis-related hospitalizations in Arizona.

Alcohol use disorder (AUD) causes immense global burden and has a significant impact on economic and societal functioning. Efficacious treatments for AUDs have been well-established within the literature, however the most commonly accessed treatments for AUD are alcohol-related services, such as self-help groups, outpatient clinics, and detoxification centers. Though studies suggest these services are effective at treating AUDs, there are numerous differences between individuals who receive alcohol-related services and individuals who do not, causing selection bias. Furthermore, current studies of alcohol-related services frequently define recovery outcomes as abstinence, which reduces variability in viable recovery outcomes, such as reduction of drinking behaviors. In addition, reduction in drinking and alcohol-related problems should theoretically have an impact on broader aspects of functioning, such as familial functioning. Improved familial context may reduce risk to family members, who are otherwise at heightened risk for emotional and behavioral problems when living with a family member with AUD. The current study investigated the effect of alcohol-related services on binary and continuous drinking outcomes after eliminating selection bias using multiple propensity score approaches, to identify the best methodology for a high-risk community sample of individuals with AUD. Propensity scores were created using logistic regression approaches and boosted regression trees. Matching, weighting, and subclassification were used, and matching was performed both using greedy and global approaches. Results suggested subclassification was the most successful method for real world alcohol-related services samples with moderate sample size. Moreover, findings demonstrated that boosted regression approaches were less successful than logistic regression approaches at minimizing the effects of selection bias on known confounding variables that are highly related to group selection. In addition, after removing the effects of selection bias, there were no significant difference between participants who received alcohol-related services and the comparison control group on drinking or family functioning, though both groups reduced drinking from pre- to post-alcohol-related services receipt. Findings suggest careful selection of quasi-experimental methods is warranted in real-world samples, to ensure optimal removal of selection bias. Moreover, future studies should continue to clarify the profile of individual that benefits from alcohol-related services to inform intervention efforts.

Despite the established co-prevalence of substance use (SU) and disordered eating (DE), few longitudinal studies have sought to examine their shared development. Findings have been inconsistent within the extant literature. This may be attributable in part to several methodological aspects, including overlooking distinct psychopharmacological properties of common substances of abuse, examining only between-person relations, and failing to account for shared risk factors. The current study sought to address these gaps by applying latent curve models with structured residuals (LCM-SR) to a preexisting, national sample of adolescent girls followed into adulthood, Add Health. In Aim 1, between-person effects examined the simultaneous development of alcohol, tobacco, and marijuana use and DE behaviors in substance-specific models. In Aim 2, bivariate latent curve models were expanded to account for within-person effects (LCM-SR) in order to examine the potentially bidirectional, prospective relationship between use of a specific substance and DE. Lastly, models accounted for shared developmental risk factors. Findings of the current study demonstrate preliminary evidence of substance-specific effects with DE emerging in adolescence. Across model-building steps, DE engagement in early adolescence was significantly associated with growth in tobacco use and marginally associated with marijuana use. Appetitive side-effects of both substances may link use with DE behaviors and enhance instrumental use for weight control. Significant associations did not emerge between alcohol and DE, and results of the conditional model indicate this co-occurrence is best explained by third variable mechanisms. Implications for prevention are discussed.