Presentations

Purpose: Our crisis stabilization unit (CSU) opened shortly before shelter-in-place orders were enacted due to the Covid-19 pandemic. We developed telehealth-based workflows that enabled patients to receive treatment on site and/or remotely. After transitioning to delivering remote services when possible, services that needed to be provided onsite (e.g., urine drug testing, injection services) continued in-person. Clinical assessments were done both remotely and on-site, and providers and patients worked together to maintain services uninterrupted. Methods: We report here on the key lessons learned by staff during this rapid implementation of a hybrid (in-person and telehealth) SUD treatment system. We also conducted a retrospective analysis of patient engagement among adult SUD patients (n=1,088) using a retrospective cohort design. Results: Many patients have technology available for telehealth, and telehealth was associated with reduced dropout / improved retention. However, staff adoption was slow: learning a new tool was perceived as burdensome to some staff. Hybrid care patients had a significantly lower hazard of dropout compared to in-person care (0.35, 95% CI [0.27, 0.45]). Conclusion: Preliminary analyses are promising, suggesting patients receiving care by telehealth are more likely to remain engaged in treatment compared to those who received services only in person. Hybrid care is a viable alternative/augmentation to traditional services, and related to greater engagement and retention in care, allowing patients to continue to receive recovery support in accessible ways and we were able to maintain services throughout the pandemic.

Background: The aim of this ongoing project is to develop and evaluate a virtual reality (VR) work environment for individuals with low vision. As VR gains in popularity for remote work, determining how it can be used as a reasonable accommodation is a growing priority. Additionally, these new technologies require novel approaches to ensure that developers include accessible design principals from the earliest stages. This project addresses both areas with expert insight from people with disabilities using VR to work remotely. Method: We recruited 20 individuals with albinism to evaluate the acceptability and effectiveness of VR for remote work. Four iterative tests of five participants each were conducted using a cohort model. Each cohort worked for six months in a variety of virtual environments and met monthly to discuss positive and negative experiences with the technology. Focus groups were also conducted with each cohort and participants provided suggestions for improving the accessibility of the virtual environments. During the study field vision tests were administered to track any change in visual acuity. Results: This presentation will cover preliminary finding from the first two years of the study. This will include a demonstration of the virtual environment created with input from participants, results of field vision testing (in and out of VR), and qualitative analysis of the participants experience with work and recreation in VR. Although this study is ongoing, there are no signs of negative effects from prolonged use of VR technology with this population, and we have had promising results.

Summary: The COVID pandemic catalyzed use of telehealth services across SUD treatment services, despite open questions about how telehealth care would impact patient engagement and treatment retention. This retrospective analysis examines patients (n=891) who received SUD treatment between October 2020 and April 2021. We aimed to identify differences among patients who received hybrid care (defined as telehealth, telephone, and in person) and to evaluate time to discharge or dropout between these groups. After adjusting for confounding variables, patients who received care via telehealth were 64% (CI, 51%-73%) less likely to drop out of care, as compared to the in-person group. This finding persisted among OUD, AUD and other drug patients in subgroup analyses, but not cannabis patients. These preliminary analyses suggest that a tech-enabled, hybrid care approach that offers flexibility to patients is related to greater engagement and retention in care. Background:During the Covid-19 pandemic, telehealth became a widely used method of delivering health care, including for SUDs. This analysis examines the impact of using telehealth (within a “hybrid” model) on patient engagement and retention rates. Methods: We conducted a retrospective analysis of patient engagement among adult SUD patients (n=891) between October 2020 - April 2021. We used a retrospective cohort design, where groups were defined as telehealth, telephone, and in-person. Survival curves were assessed, with a log-rank test of group differences. To analyze the influence of hybrid care and potential predictors on treatment retention, Cox proportional hazard regression analysis was conducted. A subgroup analysis based on primary SUD (opioid, alcohol, cannabis and other) was performed to assess the potentially differential effects of hybrid care on treatment outcomes. Results: Hybrid care patients had a statistically significant, lower hazard of dropout compared to in-person care during the follow up period [hazard ratio,95% CI: 0.36 (0.27, 0.49)]. Telehealth was also associated with a lower likelihood of dropout among OUD [0.33 (0.20, 0.54)], AUD [0.39 (0.20, 0.76)], and other drug [0.21 (0.08, 0.54)] patients, compared to TAU. Conclusion: Telehealth provides greater flexibility for patients accessing care. This study suggests that patients with SUDs who used telehealth were less likely to drop from care than those patients who did not use telehealth. These findings support the use of telehealth within SUD treatment models and advocacy for relaxation of regulations that govern telehealth for SUD treatment. Scientific Significance: The findings of these analyses enhance a growing body of research advocating that use of telehealth in SUD treatment yields positive treatment outcomes by improving access, decreasing barriers, reducing costs, circumventing stigma, and providing greater flexibility to both patients and clinical staff. This study adds to that list: use of telehealth in SUD treatment also yields positive outcomes by enhancing patient engagement and reducing time to dropout.

This presentation will showcase two online tools that are being piloted in several states. These tools have particular promise to improve the quality and accessibility of VR services for those who struggle to succeed in traditional settings and to reduce costs for agencies already struggling to deliver services to swelling caseloads. The first is a VR online portal system using secure web pages that permit access to online educational resources. Consumers and counselor can work together remotely in a variety of ways, while practicing skills for the jobs of tomorrow. Second, the ASL-STAR portal provides assessments in American Sign Language (ASL). There are few if any mental health, substance abuse and/or career assessment instruments available in ASL, and validated versions of translated instruments are rare. This contributes to an increased likelihood of inaccurate results when assessments are used. ASL-STAR is currently field testing a suite of instruments including the Satisfaction with Life Scale(SWLS), Rosenberg Self-Esteem Scale(RSES), Beck Depression Inventory(BDI), Alcohol Use Disorders Identification Test(AUDIT), Drug Abuse Screening Test(DAST), Global Appraisal of Individual Needs-Short Screener(GAIN-SS), the Patient Health Questionnaire(PHQ-9), the Generalized Anxiety Disorder- 7 item(GAD-7), Suicide Behavior Questionnaire-Revised (SBQ-R) and the Operational Network Evaluation Tool (O*NET) Interest Profiler. Objective 1: Identify barriers to traditional VR services for consumers with disabilities and examine potential effort saving tools that counselors can use to increase consumer contacts without increasing counselor workload. Objective 2: Demonstrate technology-enhanced alternatives to augment traditional services. These alternatives include a communication portal system with secure personal web pages, web-based videoconferencing between counselors and consumers, and accessible online educational resources. Objective 3: Describe the process that was used to complete the development and validation of assessments in ASl, and the training available online to use these tools.

The presentation will describe a NIDILRR grant focusing on the translation and validation from English to ASL of a number of substance abuse, mental health and career screening tools. In addition, training will occur on how to use the online portal and accompanying training modules. This presentation will describe the process being used to complete the validation and development of the online portal and training modules. A demonstration of the technology being used will be included as well as the ASL translated documents. There are few if any mental health, substance abuse and/or career assessment instruments available in American Sign Language (ASL). Validated versions of translated instruments are rare, contributing to an increased likelihood of inaccurate results when these assessments are used. The Substance Abuse Resources and Disability Issues (SARDI) Program in the Boonshoft School of Medicine at Wright State University (WSU) received a five year Disability and Rehabilitation Research Project (DRRP), the National Institute of Disability, Independent Living, and Rehabilitation Research (NIDILRR). The goals include: 1) translation and validation from English to ASL of substance abuse and mental health screeners, as well as a career interest profiler; 2) the development of an online portal for accessing and scoring the instruments; and 3) the provision of training on how to utilize the instruments on line. Instruments in this project included the Satisfaction with Life Scale(SWLS), Rosenberg Self-Esteem Scale(RSES), Beck Depression Inventory(BDI), Alcohol Use Disorders Identification Test(AUDIT), Drug Abuse Screening Test(DAST), Global Appraisal of Individual Needs-Short Screener(GAIN-SS), the Patient Health Questionnaire(PHQ-9), the Generalized Anxiety Disorder- 7 item(GAD-7), Suicide Behavior Questionnaire-Revised (SBQ-R) and the Operational Network Evaluation Tool (O*NET) Interest Profiler. Instruments were translated, into ASL video clips, followed by back translation (n-30), cognitive interviews (n = 20) and field-testing was conducted (n = 450+) for all instruments. This presentation will describe the process that was used to complete the validation and training will occur on how to use the online portal and accompanying training modules.

This presentation will showcases online tools and resources that are being piloted in several states. These tools have particular promise to improve the quality and accessibility of VR services for those who struggle to succeed in traditional settings and to reduce costs for agencies already struggling to deliver services to swelling caseloads. This technology-enhanced program is based on a communication portal system with secure web pages that permit access to a personal online videoconferencing between staff and consumer with access to online educational resources. Objective 1: Identify barriers to traditional VR services for consumers with disabilities and examine potential effort saving tools that counselors can use to increase consumer contacts without increasing counselor workload. Objective 2: Demonstrate technology-enhanced alternatives to augment traditional services. These alternatives include a communication portal system with secure personal web pages, web-based videoconferencing between counselors and consumers, and accessible online educational resources. Objective 3: Compare and contrast traditional services and technology-enhanced services to discuss feasibility, usability, and adoption of online services by VR counselors and consumers.

The goals of this research project are to improve access to Vocational Rehabilitation Guidance, Counseling and Services in order to enhance employment outcomes for individuals with disabilities and to test the efficacy and acceptability of VR guidance, counseling, and services that are accessed by VR counselors and consumers via individualized web portals. By being able to remotely provide some or all of the services traditionally done in-person, counselors can increase engagement with consumers in rural areas who may not have access to traditional services. In addition to reducing travel time for counselors and improving accessibility for consumers, remote services allow consumers who are deaf to communicate via videoconference with counselors in American Sign Language (ASL). Counselors who are proficient in ASL are few in number and cover wide geographic regions. By providing services remotely, counselors can augment traditional services and increase engagement without increasing travel time and associated costs. VR portals allow counselors to go online and conduct individual sessions with consumers; assign tasks to be completed using the web portal resources; discuss results of assigned tasks; provide feedback regarding successful completion of assignments; and provide feedback regarding areas needing improvement. Consumers are able to be more active in the vocational rehabilitation process; have a better understanding of VR services; increase their knowledge about what to expect of VR services; and be more accountable and involved in the progress and results of VR services. Although the current project focuses on improving access for rural populations and increasing accessibility for consumers with disabilities, the long-range goal is to improve access to Vocational Rehabilitation Guidance and counseling for all consumers; strengthen the counselor-consumer relationship; increase face-to-face contact with consumer; and to enhance employment outcomes. This presentation will showcase online tools and resources that are being piloted in several states. These tools have particular promise to improve the quality and accessibility of VR services for those who struggle to succeed in traditional settings and to reduce costs for agencies already struggling to deliver services to swelling caseloads. This technology-enhanced program is based on a communication portal system with secure web pages that permit access to a personal online videoconferencing between staff and consumer with access to online educational resources. Objective 1: Identify barriers to traditional VR services for consumers with disabilities and examine potential effort saving tools that counselors can use to increase consumer contacts without increasing counselor workload. Objective 2: Demonstrate technology-enhanced alternatives to augment traditional services. These alternatives include a communication portal system with secure personal web pages, web-based videoconferencing between counselors and consumers, and accessible online educational resources. Objective 3: Compare and contrast traditional services and technology-enhanced services to discuss feasibility, usability, and adoption of online services by VR counselors and consumers.

Problem Statement The American Psychological Association’s ethical principles cite the need to use assessments appropriate to an individual's language preference and competence. Unfortunately, the use of English language assessments with Deaf individuals whose first language is American Sign Language (ASL) is common, largely because few translated video-based ASL assessments exist. In an effort to provide the field with a screening instrument of mental health and substance use disorders appropriate for Deaf signing individuals, Titus and Guthmann completed a rigorous translation (English to ASL) of the Global Appraisal of Individual Needs-Short Screener (GAIN-SS). The GAIN-SS is a 23 item screening instrument that efficiently identifies individuals likely to have (or not have) a disorder along four dimensions: internalizing, externalizing, substance use, and crime/violence. Results allow clinicians to triage clients for referral for additional assessment or intervention. The English GAIN-SS has strong psychometric support. In early field testing of the ASL GAIN-SS, the internal consistency of the measures was equal to or superior to that found with the English version. Using data from a randomized design, the current study focuses on the measurement equivalence between the ASL and English versions of the GAIN-SS. Participants Data are from 117 bilingual (English/ASL) adult CODAs (children of deaf adults; 80% female; 93% White; 12% Hispanic; 47% deaf or hard of hearing). All participants were recruited from a CODA listserv and were from all regions of the United States. Participation was voluntary and the study was conducted under the supervision of the Wright State University Institutional Review Board. Procedures Bilingual CODAs were randomly assigned to complete either the English (N=60) or the ASL (N=57) version of the GAIN-SS screeners. Equivalence between the measures was examined using several methods: 1) inspection of the pattern of mean differences (using the independent t-test) between items and scale scores of the two language versions scored for each of the measure’s response time frames; 2) examination of differences between score distributions of the two language versions using the Mann-Whitney U test; 3) examination of any observed mean differences between language versions using logistic regression. Results Initial examination of mean scale scores showed no differences by language version when scored as a lifetime measure (i.e., did something ever happen to you). However, when scored as a past year measure (i.e., did something happen to you during the past year), differences appeared between the language versions, with those answering the ASL version endorsing a greater number of symptoms than those who answered the English version. Further analyses are currently being conducted to explain contributions to differences, including the interpretation of the measure’s response set. Conclusions The ASL version of the GAIN-SS has the potential to become a useful screening assessment for Deaf signing adults in multiple settings. Results from the equivalence analysis will provide insight on whether the cut-scores for score interpretation should be reconfigured for the ASL version of the measure.

Numerous barriers exist when Deaf individuals attempt to complete assessments that are only available in English rather than being developed in validated in American sign language. This costs time and money for providers, and may add to consumers increased disenfranchisement when seeking treatment. The lack of culturally and linguistically accessible instruments is in large part due to the complexity and high cost of producing such instruments. Participants will learn about a five-year federally funded NIDILRR project which is in the process of developing an online suite of mental health, substance-abuse, and career assessments that will be validated in American sign language. This presentation will describe the process being used to complete the translation, validation, field testing, and psychometrics for the project. Participants will also learn about the use of semantic textual similarity (STS) analysis, which combines distributional similarity and latent similarity analysis (LSA). The presentation also include a demonstration of the American sign language assessments and technology being used.

Specialized instruments in American Sign Language (ASL) are scarce and validated versions of ASL instruments are most rare. These two factors contribute to an increased likelihood of errors in screening and costs time and money for providers. Due to language and cultural barriers that exist, Deaf consumers are historically underserved, which leads to disfranchisement with pursuing treatment. During a study that adapted eight commonly used assessments into ASL, instruments were translated into ASL gloss by a team of Culturally Deaf experts. Thirty Bi-lingual Deaf and adult Children of Deaf Adults participated in back translation. Cognitive interviews (n = 20) and field-testing (n = 450+) were conducted with culturally Deaf people across the United States. Translations were compared to original text and ASL gloss using a semantic textual similarity (STS) analysis combining distributional similarity and latent similarity analysis. Results suggest that these scores accurately predict similarity (p < .05) between ASL gloss and final back translations, as well as agreement among back translators. The provided scores offer an objective way of comparing large samples of content and reducing subjectivity among researchers during the process of choosing the most linguistically appropriate items.

In recent years, tools have emerged for remotely screening and training vocational rehabilitation (VR) consumers, as well as providing treatment and support through technology. This study showcases online tools and resources that are being piloted in several midwestern states. These tools have particular promise to improve the quality and accessibility of VR services for those who struggle to succeed in traditional settings and to reduce costs for agencies already struggling to deliver services to swelling caseloads. This technology-enhanced program is based on a communication portal system with secure personal web pages that permit access to a personal online videoconferencing with staff and access to online educational resources. Initial feedback from counselors indicates some reluctance to take on unfamiliar tasks in an already busy schedule. In response, training graduate students in VR counseling is also being piloted as a way to train future counselors with the tools that they will encounter in the workplace. As with any tool, technology can have both positive and negative aspects. The drawbacks, limitations, and ethical considerations attendant with these new technologies also will be addressed, and the results of this study can assist administrators and counselors in addressing the needs of their consumers.

Numerous barriers exist when Deaf individuals attempt to complete assessments that are only available in English rather than being developed and validated in American Sign Language. Participants will learn about a five year NIDILRR federally-funded project which is in the process of developing an online suite of career, mental health and substance abuse assessments that will be validated in American Sign Language. This grant includes the translation and validation into ASL of the O*NET Interest Profiler, the directions for the WRIOT2, Global Appraisal of Individual Needs Short Screener (GAIN), Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST), Satisfaction with Life Scale (SWLS), Rosenberg Self-Esteem Scale (RSES), and the Beck Depression Inventory (BDI). This presentation will describe the process being used to complete the translation, validation, field testing and psychometrics for the project. The presentation will include a demonstration of the ASL assessments and technology being used as well as preliminary psychometrics.

Numerous barriers exist when attempting to provide culturally appropriate substance use disorder (SUD) treatment to persons who are Deaf. As with other low-incidence disabilities, Deaf consumers have traditionally been disenfranchised from local substance abuse programs or found culturally and linguistically accessible treatment lacking. To address these barriers, the Deaf Off Drugs & Alcohol (DODA) Program provides accessible cessation and recovery support services via a telemedicine program to Deaf individuals who are clinically diagnosed with a SUD. This study (n=95) was conducted to assess whether an online SUD treatment program is an effective way to serve the Deaf population. Effectiveness was analyzed using five outcome measures: the Substance Abuse Screener in American Sign Language, Addiction Severity Index, Satisfaction with Life Scale, Rosenberg Self-Esteem Scale, and Beck Depression Inventory. These measures were administered prior to SUD treatment and six months after SUD treatment began. The intake and follow-up scores were compared between Deaf individuals enrolled in the online DODA program (n=8) and Deaf individuals receiving SUD services in specialized residential treatment settings (n=87). Significant differences between intake and 6-month follow-up scores for all five outcome measures were found for both the online and residential treatment programs. In contrast, no significant differences were observed between outcome measures for the online and residential treatment programs. This suggests that the online treatment program may be as effective as the residential treatment programs, and that such programs hold particular promise for improving treatment accessibility for persons with low-incidence disabilities.

There are an estimated 1 billion people living with disability worldwide, including 100 million children. Despite these numbers, persons with disabilities are largely excluded from equitable access to resources such as education, employment, healthcare and social and legal support systems. Further, they experience disproportionately high rates of poverty and abuse. In response to the treatment of persons with disabilities, the United Nations (UN) formed the Convention on the Rights of Persons with Disabilities (CRPD) to encourage governments to commit to improving the safety and wellbeing of people with disabilities. Per the UN report, as of February 2013, 193 countries had ratified the CRC and 127 countries and the European Union had ratified the CRPD. The United States however, has not ratified CRPD. The opposition to CRPD within the US suggests a lack of awareness about pervasive disability inequities still present in the US despite the ADA and suggests a gross misunderstanding about CRPD and its specific articles. Disability rights activists claim that ratification of CRPD in the US has the potential to promote much needed advancement in disability justice within the US particularly in the areas of access to education, and healthcare as well as offering stronger protections against abuse of persons with disabilities. As we reflect on and celebrate the 25th anniversary of the passage of ADA, it is important to consider CRPD as a vital mechanism to strengthen and promote further advances in the utility of the ADA in the United States.

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Since 2008, the Deaf Off Drugs & Alcohol (DODA) Program has been providing culturally appropriate ATOD cessation and recovery support services via telemedicine to Deaf/HH individuals with a clinically diagnosed substance use disorder (SUD). In 2013, a NIDRR Research grant began evaluating the effectiveness of DODA compared with two residential treatment programs using four outcome measures in ASL. The residential programs are the Minnesota Chemical Dependency Program for Deaf and Hard of Hearing Individuals and the Awakenings Program in southern California. Consumers (n=78) are from across the United States and represent a wide range of age, racial, and socioeconomic backgrounds. Outcome measures include the Satisfaction With Life Scale (SWLS), the Rosenberg Self-Esteem Scale (RSES), the Beck Depression Inventory (BDI), and the Substance Abuse Screener in American Sign Language (SAS-ASL). Surveys were administered electronically in ASL, and while most consumers completed the self-directed survey online, approximately 20% did the survey by videophone. The latter often occurred as an accommodation when consumers did not have access to a computer during the window for follow-up. Analysis of baseline responses revealed that 43.6% abused alcohol, 23.1% abused marijuana, 20.5% abused cocaine, 11.5% abused prescription drugs, 10.3% abused methamphetamines, and 3.8% abused opiates. A preliminary examination shows consumers improving at all three sites with no significant difference in outcomes between consumers receiving in-person care and those receiving electronic services, and suggests that online SUD treatment can provide a cost-effective alternative to inpatient treatment and increase access to care.

In the last few years a number of computer and technological tools have emerged for screening, diagnosis, treatment, and support of mental health disorders and/or substance dependence. This overview of computer and electronic assisted recovery will address what is currently in use and what is on the horizon with a particular focus on the recovery needs of persons with difficult to serve conditions such as coexisting or low incidence disabilities. Several real world examples of tools for electronically assisted recovery will be presented. These tools have the particular promise to improve the quality and accessibility of recovery for those who struggle to succeed in traditional community-based programs, such as those with cognitive impairments, multiple or low incidence disabilities, minority status, or geographic or transportation inaccessibility. As with any tool, technology can have both positive and negative aspects. The drawbacks, limitations, and ethical considerations attendant with these new technologies also will be addressed.

This session will discuss the Deaf Off Drugs & Alcohol Program, which provides cessation and recovery services via telemedicine. The program uses technology to provide culturally appropriate and accessible services to Deaf consumers. This session will discuss the model of treatment developed and how they have been able to continue service provision post grant funding. This session will also include a discussion of current NIDRR Research looking at the effectiveness of DODA compared with two residential treatment programs using five outcome measures in ASL. Additionally, research on the lifetime prevalence of suicidal behavior among Deaf SUD consumers will be discussed.

No Abstract

The eCAM program is designed to address the barriers to SUD treatment faced by consumers with co-existing disabilities. The populations served include Deaf and low-literacy hearing consumers, making access to resources in ASL and audio formats a priority. This demonstration will allow participants to access various different personalized web portals.

The eCAM program makes every effort to meet eCAM consumers where they are, in terms of technology, accessibility, linguistics, and consumer preferences. To accomplish this, resources are available in a variety of formats and languages and optimized to work across platforms on multiple operating systems, desktop and mobile devices, and all major browsers. The use of existing technology will be emphasized to utilize resources already available to consumers. Some resources are available in text-based and non-text-based formats, based on the consumer’s preferences. In this demonstration, open source solutions are emphasized, but a variety of options exist and will be discussed.

Synchronous services included in the demonstration will include: accessing communication portals with personal web pages (desktop and mobile versions), text-based communication with counselors, connecting to online videoconference support groups, schedule reminders, and easy secure access to make meaningful use of electronic health record (EHR) information. Participants will be able to log in as one of several test consumers or as a provider and personalize the portal to fit their consumers’ specific needs and preferences.

Participants will leave the demonstration with knowledge of web standards related to accessibility, experience with a variety of products currently in use in the field, and experience with some of the exciting possibilities that lay ahead in health behavior research and clinical applications.

This presentation describes how Wright State University’s Deaf Off Drugs & Alcohol (DODA) program uses culturally appropriate communication through online conferencing and social and entertainment media to reduce substance abuse. It shows how technology holds particular promise for improving treatment accessibility for persons with low-incidence disabilities.

Persons with low-incidence disabilities have traditionally been disenfranchised from local substance abuse programs because of transportation barriers, behavioral/cognitive impairments, fragile medical conditions, or limited mobility. Technology holds particular promise for improving treatment accessibility for persons with low-incidence disabilities. This presentation will showcase a technology-assisted, SUD e-therapy program for the Deaf.

The sociocultural milieu of khat use in Ethiopia is highly complex, with multilevel interaction across religion, socioeconomic status, education, ethnicity, gender, and age. A recent exploration of issues surrounding khat use in Addis Ababa indicates existence of a strong “generation gap” between older and younger generations within the middle and upper classes that in many ways parallels that of the United States in the 1960s with increased marijuana use. We conducted field-based video documentary interviews with physicians, clergy, and urban citizens of various ages to learn about the khat market and use in Addis Ababa (May 2009). We learned that a large part of the urban youth culture (approximately <30 years) among Christians embraces casual use of khat as a central component of social interaction despite pre-existing religious and cultural prohibitions. Current consumption patterns include routine alcohol consumption as part of the khat use cycle. Set against the backdrop of increased geographic production and availability, as well as global changes in khat distribution, we argue the youth attitude might be attributed to many of the same emergent cultural factors as in the United States’ 1960s gap, including greater access to education and global communication as well as increased leisure time and disposable income. Older Ethiopian Christians (approximately 50+ years) expressed negative opinions of khat use based upon both religious grounds and perceived impact on economic productivity and family life. Moreover, prevailing beliefs of older professionals indicate that heavy khat use initiates or promotes ‘psychosis’ among some khat chewers. Factors promoting increased khat use among the working poor and unemployed might be different and may include escapism and social anesthesia. This presentation will include video and transcripts of key informant interviews.