The prevalence of opioid use disorder (OUD) has reached epidemic rates in the United States, and opioid-involved overdoses are the country’s leading cause of injury deaths. The natural history of OUD typically involves illegal behaviors which almost always lead to criminal justice involvement. Due to lack of tolerance, release from incarceration is associated with very high rates of drug-related death, with the greatest risk occurring within the first several weeks after reentry into the community. Although there is a high concentration of individuals with opioid use disorder in the criminal justice system, evidence-based substance use treatments are rarely employed in this setting. Medications for Opioid Use Disorder (MOUD), which involves the use of pharmacotherapy in combination with psychosocial support, is an evidence-based approach to treat OUD and reduce overdose risk. A growing body of work suggests that there are extensive benefits to providing MOUD in the correctional setting; yet, despite these advantages, access to treatment has been scarce for this high-risk and vulnerable segment of the population. The state of Rhode Island recently implemented a comprehensive MOUD program to be delivered at the unified jail and prison system. This program offers a unique opportunity to initiate treatment for OUD during incarceration with linkage to care after release. While this work is promising, individuals with criminal justice involvement face a number of challenges while transitioning back to the community, including poor social and family support, financial insecurity, and inadequate housing. This context is characterized by frequent exposure to drug cues and an increased occurrence of stressful life events; both of which are potential precipitants of relapse. Distress tolerance (DT), defined as the perceived or actual ability to handle aversive physical or emotional states, is a transdiagnostic vulnerability factor implicated in the development and maintenance of substance use. Targeting DT during substance use treatment may improve outcomes by promoting the ability to persist in goal directed activity (e.g., abstinence) even when experiencing physical or emotional distress. Personalized feedback interventions (PFI) represent a promising method to effectively motivate engagement in and adherence to MOUD. These interventions are generally brief, individually tailored, and have the potential to be delivered via mobile platforms (e.g., text message). The proposed study seeks to develop and pilot test a combined in-person (delivered by clinician in the two weeks prior to release) and text message-delivered PFI (administered by mobile phone during the initial three months following release), that incorporates DT skills training, for persons engaged in MOUD who are preparing for community reentry (PFI-DT). PFI-DT is designed to: (1) enhance motivation for continued engagement in MOUD; and (2) increase tolerance of distress to improve the ability to cope with stress associated with community reentry. In Phase 1 (Stage 1a), our team will develop and refine, through formative evaluation, the preliminary intervention. In Phase 2 (Stage 1b), we will conduct a pilot RCT to assess feasibility, acceptability and preliminary efficacy. Eighty patients with a history of OUD, actively engaged MOUD during incarceration, will be randomly assigned to PFI-DT or a Health Education (HE) condition using a 3:1 randomization ratio and will complete assessments during incarceration and following release (1-, 3-, and 6-month follow-ups) to evaluate linkage to community-based MOUD programs; use of alcohol and other illicit substances; adherence to MOUD and treatment retention; and prevalence of overdose risk behavior. Results of the current proposal will inform the develop of a R01 application to conduct a Stage II trial. The project seeks to address a major public health priority by improving treatment outcomes for a high-risk, vulnerable, segment of the population – individuals with criminal justice involvement. This work has the potential to reduce illicit opioid use, increase adherence/retention, and prevent future incidence of overdose.

Complete list of published work in MyBibliography:
https://www.ncbi.nlm.nih.gov/sites/myncbi/kirsten.langdon.1/bibliography/50250764/public/?sort=date&directio n=ascending

Langdon, K.J., Dove, K., & Ramsey, S. (2019). Comorbidity of opioid- and anxiety- related symptoms and disorders. Current Opinion in Psychology, 30, 17-23

Smit, T., Garey, L., Langdon, K. J., Ditre, J. W., Rogers, A. H., Orr, M. F., & Zvolensky, M. J. (2019). Differential effect of sex on pain severity and smoking behavior and processes. Addictive Behaviors, 90, 229-235.

Smit, T., Peraza, N., Garey, L., Langdon, K. J., Ditre, J. W., Rogers, A. H., Manning, K., & Zvolensky, M. J. (2018). Pain-related anxiety and smoking processes: The explanatory role of dysphoria. Addictive Behaviors, 88, 15-22.

Paulus, D.J., Garey, L., Gallagher, M.W., Derrick, J.L., Jardin, C., Langdon, K., Ditre, J.W., & Zvolensky, M.J. (2018). Pain severity as a predictor of negative affect following a self-guided quit attempt: An ecological momentary assessment study. The American Journal of Drug and Alcohol Abuse, 44, 543-550.

Rogers, A.H., Bakhshaie, J., Lam, H., Langdon, K.J., Ditre, J.W., Zvolensky, M.J. (2018). Pain-related anxiety and opioid misuse in a racially/ethnically diverse young adult sample with moderate/severe pain. Cognitive Behaviour Therapy, 47, 372-382.

Langdon, K.J., Bakhshaie, J., Lopez, A., Tavakoli, N., Garey, L., Raines, A. M., Kauffman, B. Y., Schmidt, N. B., & Zvolensky, M. J. (2018). Anxiety sensitivity physical and cognitive concerns in relation to smoking-oriented cognition: An examination among treatment-seeking adults who smoke. Journal of Addiction Medicine, 12, 212-219.

Zvolensky, M. J., Rosenfield, D., Garey, L., Kauffman, B. Y., Langdon, K. J., Powers, M. B., Otto, M. W., Davis, M. L., Marcus, B. H., Church, T. S., Frierson, G. M., Hopkins, L. B., Paulus, D. J., Baird, S. O., & Smits, J. A. J. (2018). Does exercise aid smoking cessation through reductions in anxiety sensitivity and dysphoria? Health Psychology, 37, 647-657.

Bakhshaie, J., Zvolensky, M. J., Langdon, K. J., Leventhal, A. M., & Schmidt, N. B. (2018). Reduction of anxiety sensitivity in relation to nicotine withdrawal symptoms during smoking cessation: An examination among successful quitters. Cognitive Behaviour Therapy, 47, 301-314.

Bakhshaie, J., Kulesz, P. A., Garey, L., Langdon, K. J., Businelle, M. S., Leventhal, A. M., Gallagher, M. W., Schmidt, N. B., Manning, K., Goodwin, R., & Zvolensky, M. J. (2018). A prospective investigation of the synergistic effect of change in anxiety sensitivity and dysphoria on tobacco withdrawal. Journal of Consulting and Clinical Psychology, 86, 69-80.

Paulus, D. J., Langdon, K. J., Wetter, D., & Zvolesnky, M. J. (2018). Dispositional mindful attention in relation to negative affect, and tobacco withdrawal, and expired carbon monoxide on and after quit day. Journal of Addiction Medicine, 12, 40-44.

LaRowe, L.R., Langdon, K.J., Zvolensky, M.J., Zale, E.L., & Ditre, J.W. (2017). Pain-related anxiety as a predictor of early lapse and relapse to cigarette smoking. Experimental and Clinical Psychopharmacology, 25, 255-264.

Robles, Z., Anjum, S., Garey, L., Kauffman, B., Rodriguez-Cano, R., Langdon, K., Neighbors, C., Reitzel, L.R., Zvolensky, M.J. (2017). Financial strain and cognitive-based smoking processes: The explanatory role of depressive symptoms among adult daily smokers. Addictive Behaviors, 70, 18-22.

Zvolensky, M. J., Paulus, D. J., Langdon, K., Robles, Z., Garey, L., Norton, P. J., & Businelle, M. S. (2017). Anxiety sensitivity explains associations between anxious arousal symptoms and smoking abstinence expectancies, perceived barriers to cessation, and problems experienced during past quit attempts among low-income smokers. Journal of Anxiety Disorders, 48, 70-77.

Zvolensky, M. J., Bakhshaie, J., Paulus, D. J., Langdon, K. J., Garza, M., Valdivieso, J., Ditre, J., Ochoa-Perez, M., Lemaire, C., Bogiaizian, D., Robles, Z., Rodriguez-Cano, R., & Manning, K. (2017). Exploring the mechanism underlying the association between pain intensity and mental health among Latinos. Journal of Nervous and Mental Disease, 205, 300-307.

Langdon, K. J., Rubin, A., Brief, D. J., Enggasser, J., Roy, M., Solhan, M., Helmuth, E., Rosenbloom, D., & Keane, T. M. (2017). Sexual traumatic event exposure, posttraumatic stress symptomatology, and alcohol misuse among women: A critical review of the empirical literature. Clinical Psychology: Science and Practice, 24, 5–22.

Wiltsey-Stirman, S., Gutner, C., Langdon, K., Graham, J. R. (2016). Bridging the gap between research and practice in mental health service settings: An overview of developments in implementation theory and research. Behavior Therapy, 47, 920-936.

Bakhshaie, J., Ditre, J. W., Langdon K. J., Zvolensky, M .J. (2016). Past-month pain and cognitive-affective smoking processes among daily smokers. Addictive Disorders & Their Treatment, 15, 34-41.

Garey, L., Bakhshaie, J., Brandt, C. P., Langdon, K. J., Kauffman, B. Y., Schmidt, N. B., Leventhal, A. M. & Zvolensky, M. J. (2016). Interplay of dysphoria and anxiety sensitivity in relation to emotion regulatory cognitions of smoking among treatment-seeking smokers. The American Journal on Addictions, 25, 267-274.

Bakhshaie, J., Zvolensky, M.J., Langdon, K.J., Leventhal, A.M., Smits, J.A., Allan, N., & Schmidt, N.B. (2016). Reduction in anxiety sensitivity and quit-day tobacco craving and withdrawal symptoms: Testing the moderating role of anxiety sensitivity class among treatment-seeking smokers. Journal of Anxiety Disorders, 39, 79-87.

Langdon, K. J., Fox, A. B., King, L. A., King, D. W., Eisen, S., & Vogt, D. (2016). Examination of the dynamic interplay between posttraumatic stress symptoms and alcohol misuse among combat-exposed Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) Veterans. Journal of Affective Disorders, 196, 234–242.

Langdon, K. J., Farris, S. G., Hogan, J. B. D., Grover, K. W., & Zvolensky, M. J. (2016). Anxiety sensitivity in relation to quit day dropout among adult daily smokers recruited to participate in a self-guided cessation attempt. Addictive Behaviors, 58, 12-15.

Bakhshaie, J., Ditre, J. W., Langdon K. J., Asmundson, G.J.G., Paulus, D.J., Zvolensky, M .J. (2016). Pain intensity and smoking behavior among treatment seeking smokers. Psychiatry Research, 237, 67-71.

Buckner, J.D., Langdon, K.J., Jeffries, E.R., & Zvolensky, M.J. (2016). Socially anxious smokers experience greater negative affect and withdrawal during self-quit attempts. Addictive Behaviors, 55, 46-49.

Langdon, K. J., Farris, S. G., Øverup, C. S., & Zvolensky, M. J. (2016). Associations between anxiety sensitivity, negative affect, and smoking during a self-guided smoking cessation attempt. Nicotine & Tobacco Research, 18, 1188-95.

Reitzel, L.R., Langdon, K.J., Nguyen, N., Zvolensky, M. J. (2015). Financial strain and smoking cessation among men and women within a self-guided quit attempt. Addictive Behaviors, 47, 66–69.

Ditre, J. W., Langdon, K. J., Kosiba, J. D., Zale, E. L., & Zvolensky, M. J. (2015). Relations between pain-related anxiety, tobacco dependence, and barriers to quitting among a community-based sample of daily smokers. Addictive Behaviors, 42, 130-135.

Foster, D. W., Langdon, K. J., Schmidt, N. B., & Zvolensky, M. J. (2015). Smoking processes, panic, and depressive symptoms among treatment-seeking smokers. Substance Use and Misuse, 50, 394-402.

Farris, S. G., Langdon, K. J., DiBello, A. M., & Zvolensky, M. J. (2015). Why do anxiety sensitive smokers perceive quitting as difficult? The role of expecting “interoceptive threat” during acute abstinence. Cognitive Therapy and Research, 39, 236-244.

Langdon, K.J. & Leventhal, A.M. (2014). Posttraumatic stress symptoms and tobacco abstinence effects in a non-clinical sample: Evaluating the mediating role of negative affect reduction smoking expectancies. Journal of Psychopharmacology, 28, 1009-1017.

Kimbrel, N.A., Morissette, S. B., Gulliver, S. B., Langdon, K. J., & Zvolensky, M. J. (2014). The effect of social anxiety on urge and craving among smokers with and without anxiety disorders. Drug and Alcohol Dependence, 135, 59-64.

Leventhal, A.M., Ameringer, K.J., Osborn, E., Zvolensky, M.J, & Langdon, K.J. (2013). Anxiety and depressive symptoms and affective patterns of tobacco withdrawal. Drug and Alcohol Dependence, 133, 324-329.

Langdon, K. J., Leventhal, A., Stewart, S., Rosenfield, D., Steeves, D., & Zvolensky, M. J. (2013). Anhedonia and anxiety sensitivity: Prospective relations to nicotine withdrawal symptoms during smoking cessation. Journal of Studies on Alcohol and Drugs, 74, 469-78.
**JSAD top-cited article in 2013**

Johnson, K. A., Farris, S. G., Schmidt, N. B., Smits, J. A. J., & Zvolensky, M. J. (2013). Panic attack history and anxiety sensitivity in relation to cognitive-based smoking processes among treatment-seeking daily smokers. Nicotine & Tobacco Research, 15, 1-10.

Johnson, K. A., Berenz, E. C., & Zvolensky, M. J. (2012). Nonclinical panic attack history and anxiety sensitivity: Testing the differential moderating role of self-report and behavioral indices of distress tolerance. Cognitive Therapy and Research, 36, 603-611.

Johnson, K. A., Stewart, S., Rosenfield, D., Steeves, D., & Zvolensky, M. J. (2012). Prospective evaluation of the effects of anxiety sensitivity and state anxiety in predicting acute nicotine withdrawal symptoms during smoking cessation. Psychology of Addictive Behaviors, 26, 289-297.

Johnson, K. A., Farris, S. G., Schmidt, N. B., & Zvolensky, M. J. (2012). Anxiety sensitivity and cognitive-based smoking processes: Testing the mediating role of emotion dysregulation among treatment-seeking daily smokers. Journal of Addictive Diseases, 31, 143-157.

Brandt, C. P., Johnson, K. A., Schmidt, N. B., & Zvolensky, M. J. (2012). Main and interactive effects of emotion dysregulation and breath-holding duration in relation to panic-relevant fear and expectancies about anxiety-related sensations among adult daily smokers. Journal of Anxiety Disorders, 26, 173-181.

Zvolensky, M. J., Jenkins, E. F., Johnson, K. A., & Goodwin, R. D. (2011). Personality disorders and cigarette smoking among Adults in the United States. Journal of Psychiatric Research, 45, 835-841.

Zvolensky, M. J., Cougle, J. R., Bonn-Miller, M. O., Norberg, M. M., Johnson, K. A., Kosiba, J., & Asmundson, G. J. G. (2011). Chronic pain and marijuana use among a nationally representative sample of adults. American Journal on Addictions, 20, 538-542.

Johnson, K. A., Mullin, J. L., Marshall, E. C., Bonn-Miller, M. O., & Zvolensky, M. J. (2010). Exploring the mediational role of coping motives for marijuana use in terms of the relation between anxiety sensitivity and marijuana dependence. American Journal on Addictions, 19, 277-282.

Zvolensky, M. J., Cougle, J. R., Johnson, K. A., Bonn-Miller, M. O., & Bernstein, A. (2010). Marijuana use and panic psychopathology among a representative sample of adults. Experimental and Clinical Psychopharmacology, 18, 129-134.

Leyro, T. M., Zvolensky, M. J., Vujanovic, A. A., Johnson, K., & Gregor, K. (2010). Perceived physical health and heart-focused anxiety among daily adult cigarette smokers: Associations with affect-relevant smoking motives and outcome expectancies. Cognitive Behaviour Therapy, 39, 11-23.

Bonn-Miller, M. O., Zvolensky, M. J., & Johnson, K. A. (2010). Uni-morbid and co-occurring marijuana and tobacco use: Examination of concurrent associations with negative mood states. Journal of Addictive Diseases, 29, 68-77.

Gonzalez, A., Vujanovic, A. A., Johnson, K. A., Leyro, T. M., & Zvolensky, M. J. (2009). The role of mindful attention in regard to the relation between negative affect reduction outcome expectancies and emotional vulnerability among adult cigarette smokers. Cognitive Therapy and Research, 33, 645-656.

Johnson, K. A., Stewart, S., Zvolensky, M. J., & Steeves, D. (2009). Evaluating the mediating role of coping-based smoking motives among treatment-seeking adult smokers. Nicotine and Tobacco Research, 11, 1296-1303.

Marshall, E. C., Johnson, K., Bergman, J., Gibson, L. E., & Zvolensky, M. J. (2009). Anxiety sensitivity and panic reactivity to bodily sensations: Relation to quit-day (acute) nicotine withdrawal symptom severity among daily smokers making a self-guided quit attempt. Experimental and Clinical Psychopharmacology, 17, 356-364.

Zvolensky, M, J., Johnson, K., Leyro, T. M., Hogan, J., & Tursi, L. (2009). Quit-attempt history: relation to current levels of emotional vulnerability among adult cigarette users. Journal of Studies on Alcohol and Drugs, 70, 551-554.

Johnson, K. A., Bonn-Miller, M. O., Leyro, T. M., & Zvolensky, M. J. (2009). Anxious arousal and anhedonic depression symptoms and the frequency of current (past 30 days) marijuana use: Testing the mediating role of marijuana use coping motives among active users. Journal of Studies on Alcohol and Drugs, 70, 543-550.

Zvolensky, M. J., Marshall, E. C., Johnson, K., Hogan, J., Bernstein, A., & Bonn-Miller, M. O. (2009). Relations between anxiety sensitivity, distress tolerance, and fear reactivity to bodily sensations to coping and conformity marijuana use motives among young adult marijuana users. Experimental and Clinical Psychopharmacology, 17, 31-42.

Vujanovic, A. A., Youngwirth, N. E., Johnson, K. A., & Zvolensky, M. J. (2009).
Mindfulness-based acceptance and posttraumatic stress symptoms among trauma-exposed adults without axis I psychopathology. Journal of Anxiety Disorders, 23, 297-303

Johnson, K. A., Zvolensky, M. J., Marshall, E. C., Gonzalez, A., Abrams, K., & Vujanovic, A. A. (2008). Linkages between cigarette smoking outcome expectancies and negative emotional vulnerability. Addictive Behaviors, 33, 1416-1424.

Book Chapters
Zvolensky, M., Farris, S. G., Leyro, T. M., Langdon, K. J., Bernstein, A., & Bonn-Miller, M. (in press). Cannabis: An overview of the empirical literature. In B. Johnson (Ed.), Addiction medicine: Science and practice (Vol. 2). New York: Springer.

Zvolensky, M. J., Forsyth, J. P., & Johnson, K. A. (2013). Laboratory methods in experimental psychopathology. In J. Comer and P. Kendall (Eds.), Oxford handbook of research strategies for clinical psychology. New York: Oxford University Press.

Zvolensky, M. J., Bonn-Miller, M. O., Leyro, T., Johnson, K., & Bernstein, A. (2010). Marijuana: An overview of the empirical literature. In B. Johnson (Ed.), Addiction medicine: Science and
practice. New York: Springer.

Zvolensky, M. J., Johnson, K., Yartz, A. R., & Leen-Feldner, E. W. (2010). Cigarette smoking: Nature, impact, and clinical care strategies. In M. Hersen & J. Thomas (Eds.), Handbook of Clinical Psychology Competencies. New York: Springer.

Zvolensky, M. J., Bernstein, A., & Johnson, K. (2009). Empirical approaches to the study and
classification of anxiety psychopathology. In D. McKay, J. Abramowitz, S. Taylor., & G. Asmundson. (Eds.), Current perspectives on the anxiety disorders: Implications for the DSM-V and beyond. New York: Springer.

Submitted/Under Review
Nillni, Y., Arditte Hall, K., Langdon, K., & Pineles, S. (submitted). Examination of the stability of the Anxiety Sensitivity Index across the menstrual cycle in trauma-exposed women with and without PTSD [Anxiety, Stress, & Coping].
Goedel, W., Marshall, B., Samuels, E., Brinkman, M., Dettor, D., Langdon, K., Mahoney, L., Merchant, R., Nizami, T., O’Toole, G., Ramsey, S., Yedinak, J., Beaudoin, F. (submitted). A randomized clinical trial of an emergency department-based peer recovery support intervention to increase treatment uptake and reduce recurrent overdose among individuals at high risk for opioid overdose: Study protocol [Addiction].

Susan Ramsey, PhD
Departments of Psychiatry and Human Behavior and Medicine
RI Hospital
sramsey@lifespan.org

Ongoing Research Support:

National Institute on Drug Abuse (R41 DA047837)
April, 2019
Title: Mobile Peer-Support for Opioid Use Disorders: Refinement of an Innovative Machine Learning Tool.
Role: Co-I

Laura and John Arnold Foundation
November, 2018
Title: ED-based Behavioral Interventions Following Opioid Overdose: The Impact of Peer Navigation on Treatment Engagement, Relapse and Recovery (The Navigator Trial).
Role: Co-I

National Institute on Drug Abuse (1R03DA043596-01A1)
September, 2018
Title: Acceptance and Commitment Therapy for Tobacco Cessation Initiated in a Psychiatric Partial Hospital.
Role: Co-I

National Institute of General Medical Sciences (U54GM115677)
August, 2018
Title: Novel Digital Health Intervention to Promote Engagement in and Adherence to Medication-Assisted Treatment.
Role: PI