The opioid crisis has had devastating effects on individuals and communities, and it has rapidly increased in severity. However, we still lack nationally representative information on the diversity of comorbidity patterns among prescription opioid use disorder (P-OUD), other substance use disorders (SUDs), and psychopathology using the newest edition of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). This impedes planning for multiple aspects of intervention, including society-wide allocation of treatment resources, program design at individual treatment centers, and personalized care to individual patients. Method: To address this critical gap in information, we evaluated clinical profiles of American adults via latent class analysis in a large, recently collected epidemiological dataset that uses structured diagnostic assessment for DSM-5 psychopathology (National Epidemiologic Survey on Alcohol and Related Conditions-III; N ϭ 36,309). Variables considered for profiles included lifetime diagnosis for multiple SUDs, various externalizing and internalizing conditions, and demographic variables. We then associated clinical profiles with demographic variables and functional impairment. Results: Comorbid psychopathology and other SUDs were common in latent classes with elevated and very high rates of P-OUD. To illustrate, alcohol use disorder rates were greater than 45%, and posttraumatic stress disorder rates were greater than 28% in classes with higher P-OUD rates. Higher P-OUD rates were associated with White/non-Hispanic and American Indian/Alaska Native populations. Relationships between P-OUD rates and functional impairment were inconsistent. Conclusion: Many current treatment delivery systems are not designed to accommodate the heterogeneous profiles associated with high P-OUD rates. We provide specific suggestions for improvements to the mental health service system, individual clinical care programs, and future research approaches. What is the public health significance of this article?A number of distinct clinical profiles are associated with elevated rates of prescription opioid use disorder. We highlight specific profiles that can include other substance use disorders, depression, anxiety, posttraumatic stress disorder, and externalizing conditions. These profiles can be used to guide public policy, resource allocation, and the design of personalized care strategies for patients in need.

Background: Most prenatal preventive interventions for unmarried mothers do not integrate fathers or help the parents plan for the development of a functional coparenting alliance after the baby’s arrival. Furthermore, properly trained professionals have only rarely examined the fidelity of these interventions. Purpose: This report examines whether experienced community interventionists (home visitors, health educators, fatherhood service personnel) with no formal couples’ therapy training are capable of pairing together to deliver with adequate fidelity a manualized dyadic intervention designed for expectant unmarried mothers and fathers. Methods: Three male and four female mentors (home visitors, health educators, fatherhood personnel) working in paired male–female co-mentor teams delivered a seven-session “Figuring It Out for the Child” curriculum (six prenatal sessions, one booster) to 14 multirisk, unmarried African American families (parent age ranging from 14 to 40). Parental well-being and views of fatherhood were assessed before the intervention and again 3 months after the baby’s birth. Quality assurance analysts evaluated mentor fidelity (adherence to the curriculum, competence in engaging couples with specified curricular content) through a review of the transcripts and audiotapes from the sessions. Mentors also rated their own adherence. Results: Although the mentors overestimated adherence, quality assurance analyst ratings found acceptable levels of adherence and competence, with no significant male–female differences in fidelity. Adherence and competence were marginally higher in sessions that required fewer direct couples’ interventions. Parents reported satisfaction with the interventions and showed statistically significant improvement in the family dimensions of interest at 3–4 months posttreatment. Conclusions/Implications for Practice: Findings support the wisdom of engaging men both as interventionists and as recipients of prenatal coparenting interventions—even in families where the parents are uncoupled and non-co-residential.

The purpose of this qualitative study was to identify recurring themes about impending coparenthood common among prenatal dyadic conversations shared between unmarried parents. Forty Black mothers and fathers expecting a first baby together met with a male-female mentor team for facilitated dialogues six times during the pregnancy, with sessions audiotaped and transcribed. Guided by basic elements of grounded theory, coders identified five cross-cutting themes discussed by coparents relevant to their coparenting expectancies: establishing the baby’s family system, supports and threats to coparenting efforts, reflecting on fatherhood—Connecting past with future father legacies, acculturating the child/ handling parenting differences, and effects of relationship status on coparenting. These themes underscored a common commitment fathers and mothers shared in figuring circumstances out for their child. Analyses portray a rich, generative, and introspective set of dialogues reflecting shared deliberation about family dynamics after the baby’s arrival. This study’s findings address a significant gap in the literature and highlight the value of narrative methodologies to understand joint narratives of unmarried Black coparents more thoroughly as they transition to new parenthood.

The objective of this study was to measure the effects of a 90-day mindful rational living (MRL) program on the experience of destructive emotions—anger, anxiety, depression, guilt—among a normal population in a pilot trial. The MRL program combines mindfulness meditation techniques with rational emotive behavior therapy (REBT) strategies. Participants were 17 adults who completed the MRL program. Participants completed pre- and post-intervention assessments, which included scales measuring anger, anxiety, depression, guilt, rumination, shame, and subjective happiness. As hypothesized, participants showed significant decreases in anger, rumination, anxiety, depression, and shame after participating in the MRL program. There were no significant increases in subjective happiness. Findings from this pilot study provide preliminary support for the potential utility of interventions that combine mindfulness meditation with REBT strategies and can be used as the basis of future studies.

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