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1
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Galkin SA. The Effects of Cognitive Impulsivity on the Duration of Remission in Alcohol-Dependent Patients. CONSORTIUM PSYCHIATRICUM 2023; 4:29-38. [PMID: 38618631 PMCID: PMC11009976 DOI: 10.17816/cp13627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/08/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Cognitive impulsivity manifesting in impaired inhibitory control and decision-making impulsivity is observed both in alcohol-dependent and substance-dependent individuals and may affect the ability to maintain long-term (persistent) remission. AIM To evaluate the effects of cognitive parameters of impulsivity on the duration of remission in alcohol-dependent patients. METHODS The study included 83 patients with alcohol dependence and 51 mentally healthy study subjects as the control group. The distribution of patients by duration of remission was based on the DSM-5 criteria. Patients were divided into two groups according to the duration of their most recent remission: patients with early remission (n=48) and patients with sustained remission (n=35). Impulsivity was assessed using the Go/No-Go task, which included a response inhibition component (inhibitory control). Choice impulsivity was assessed using two cognitive tests that encompass its separate components: decision-making under risk (Cambridge Gambling Task, CGT), and decision making under uncertainty (Iowa Gambling Task, IGT). RESULTS The study groups (patients and the controls) differed significantly in all domains of impulsivity: decision making under risk [GT: decision making quality (H(2, N=134)=30.233, p <0.001) and decision-making time (H(2, N=134)=18.433, p <0.001)] and decision making under uncertainty [IGT: selecting cards from "losing" decks (H(2, N=134)=9.291, p=0.009)]. The group of patients with sustained alcohol remission was characterized by longer decision times in CGT compared to the group of patients with early remission (z=2.398, p=0.049). Decision quality in CGT (z=0.673, p=0.999) and IGT scores (z=1.202, p=0.687) were not statistically significantly different between the groups of patients with sustained and early remission from alcohol dependence. The assessment of impulsive actions showed that the study groups were significantly different in terms of their ability to suppress their dominant behavioral response when performing the GNG task [false presses when seeing the "No-Go" signal (H(2, N=134)=28.851, p <0.001)]. The group of patients in sustained remission from alcohol dependence was characterized by better suppression of the behavioral response to the "No-Go" signal relative to the patients in early remission [H(2, N=134)=2.743, p=0.044)]. The regression analysis showed that the decision-making quality (t=2.507, р =0.049) and decision-making time (t=3.237, р=0.031) and the number of false presses when seeing the "No-Go" signal in the GNC task had a statistically significant impact on the duration of remission (t=3.091, р =0.043). CONCLUSION The results of this study indicate that impaired decision-making processes and the ability to inhibit the dominant behavioral response have a significant impact on the ability of alcohol-dependent patients to maintain long-term remission.
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Affiliation(s)
- Stanislav A. Galkin
- Mental Health Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
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2
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Christensen E, Brydevall M, Albertella L, Samarawickrama SK, Yücel M, Lee RSC. Neurocognitive predictors of addiction-related outcomes: A systematic review of longitudinal studies. Neurosci Biobehav Rev 2023; 152:105295. [PMID: 37391111 DOI: 10.1016/j.neubiorev.2023.105295] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/09/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023]
Abstract
It is well-established that addiction is typically associated with a distinct pattern of neurocognitive functioning with a consensus that it is typified by impaired top-down executive control and aberrant risk-reward processing. Despite a consensus that neurocognition plays an important role in characterizing and maintaining addictive disorders, there is a lack of systematic, bottom-up synthesis of quantitative evidence showing that neurocognition predicts addictive behaviors, and which neurocognitive constructs have the best predictive validity. This systematic review aimed to assess whether cognitive control and risk-reward processes as defined by the Research Domain Criteria (RDoC) predict the development and maintenance of addictive behaviors specifically, consumption, severity, and relapse. The findings from this review expose the substantial lack of evidence for neurocognition predicting addiction outcomes. However, there is evidence that suggests reward-related neurocognitive processes may be important for the detection of early risk for addiction, as well as a potentially viable target for designing novel, more effective interventions.
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Affiliation(s)
- Erynn Christensen
- BrainPark, Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia.
| | - Maja Brydevall
- BrainPark, Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Lucy Albertella
- BrainPark, Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Sashka K Samarawickrama
- BrainPark, Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Child Development and Digital Technologies Lab, Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Murat Yücel
- BrainPark, Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Rico S C Lee
- BrainPark, Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
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3
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Psederska E, Vassileva J. Neurocognitive Impulsivity in Opiate Users at Different Lengths of Abstinence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1236. [PMID: 36674000 PMCID: PMC9859339 DOI: 10.3390/ijerph20021236] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 06/17/2023]
Abstract
The aim of the current study was to examine the effects of length of abstinence on decision making (impulsive choice) and response inhibition (impulsive action) in former opiate users (OU). Participants included 45 OU in early remission [0−12 months of abstinence], 68 OU in sustained remission [>12 months of abstinence], and 68 control participants. Decision making was assessed with the Iowa Gambling Task (IGT), the Cambridge Gambling Task (CGT), and the Monetary Choice Questionnaire (MCQ). Response inhibition was examined with the Stop Signal Task (SST), and the Go/No-Go Task (GNG). Results revealed group differences in decision making under risk (CGT) and ambiguity (IGT), where control participants displayed better decision making compared to OU in early remission. Both groups of former OU were also characterized by higher discounting of delayed rewards (MCQ). Regression analyses revealed minimal effects of length of abstinence on performance on decision-making tasks and no effects on delay discounting. In addition, both OU groups showed reduced action inhibition (GNG) relative to controls and there were no group differences in action cancellation (SST). Length of abstinence had no effect on response inhibition. Overall, our findings suggest that neurocognitive function may not fully recover even with protracted abstinence, which should be addressed by relapse prevention and cognitive remediation programs for OU.
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Affiliation(s)
- Elena Psederska
- Bulgarian Addictions Institute, 93 Antim I Str., 1303 Sofia, Bulgaria
- Department of Cognitive Science and Psychology, New Bulgarian University, 1618 Sofia, Bulgaria
| | - Jasmin Vassileva
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23219, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA 23219, USA
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Halcomb M, Dzemidzic M, Shen YI, Lin Z, Butcher TJ, Yoder KK, Oberlin B. Delay discounting and alcohol consumption correlate with dorsal anterior insula activation during choice in nontreatment-seeking heavy drinkers. Alcohol Clin Exp Res 2022; 46:1397-1407. [PMID: 35707988 PMCID: PMC9427725 DOI: 10.1111/acer.14888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The anterior insular cortex (AIC), a prominent salience network node, integrates interoceptive information and emotional states into decision making. While AIC activation during delay discounting (DD) in alcohol use disorder (AUD) has been previously reported, the associations between AIC activation, impulsive choice, alcohol consumption, and connectivity remain unknown. We therefore tested AIC brain responses during DD in heavy drinkers and their association with DD performance, alcohol drinking, and task-based connectivity. METHODS Twenty-nine heavy drinkers (12 females; mean (SD) age=31.5 ± 6.1 years; mean (SD)=40.8 ± 23.4 drinks/week) completed a DD task during functional MRI. Regions activated during DD decision making were tested for correlation with DD behavior and alcohol drinking. Psychophysiological interaction (PPI) models assessed the task-dependent functional connectivity (FC) of activation during choice. RESULTS Delay discounting choice activated bilateral anterior insular cortex, anterior cingulate cortex, and left precentral gyrus. Right dorsal (d) AIC activation during choice negatively correlated withdiscounting of delayed rewards and alcohol consumption. PPI analysis revealed FC of the right dAIC to both the anterior and posterior cingulate cortices-key nodes in the midline default mode network. CONCLUSIONS Greater dAIC involvement in intertemporal choice may confer more adaptive behavior (lower impulsivity and alcohol consumption). Moreover, salience network processes governing discounting may require midline default mode (precuneus/posterior cingulate cortex) recruitment. These findings supporta key adaptive role for right dAIC in decision making involving future rewards and risky drinking.
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Affiliation(s)
- Meredith Halcomb
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
| | - Mario Dzemidzic
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
- Department of NeurologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Yitong I. Shen
- Addiction Neuroscience Graduate ProgramIndiana University – Purdue University IndianapolisIndianapolisIndianaUSA
- Department of PsychiatryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Zikai Lin
- Department of PsychiatryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Tarah J. Butcher
- Addiction Neuroscience Graduate ProgramIndiana University – Purdue University IndianapolisIndianapolisIndianaUSA
| | - Karmen K. Yoder
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
| | - Brandon Oberlin
- Department of NeurologyIndiana University School of MedicineIndianapolisIndianaUSA
- Addiction Neuroscience Graduate ProgramIndiana University – Purdue University IndianapolisIndianapolisIndianaUSA
- Department of PsychiatryIndiana University School of MedicineIndianapolisIndianaUSA
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5
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The phenotype of recovery VII: Delay discounting mediates the relationship between time in recovery and recovery progress. J Subst Abuse Treat 2021; 136:108665. [PMID: 34895955 PMCID: PMC8940660 DOI: 10.1016/j.jsat.2021.108665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/02/2021] [Accepted: 11/10/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Substance use disorders (SUDs) remain challenging maladies to treat in the United States and impose significant societal costs. Despite these challenges, a significant number of individuals endorse being in recovery from SUD. The scientific understanding of SUD recovery has evolved to include not only improvements in substance use but also improvements in personal wellness and psychosocial functioning. The devaluation of future rewards (delay discounting; DD) is broadly associated with SUD inception and outcomes. We sought to investigate the relationship between DD, time in recovery, and recovery progress. METHODS We conducted an online assessment of 127 individuals in recovery from SUD who the study recruited via the International Quit and Recovery Registry (IQRR). The research team obtained measures of recovery progress via the Addiction Recovery Questionnaire (ARQ) and the Treatment Effectiveness Assessment (TEA). Additionally, the study collected measures of DD, time in recovery, and endorsement of abstinence in recovery (i.e., requiring abstinence vs. not). We utilized linear regression to test for associations among these variables and performed a mediation analysis to test the role of DD in mediating the relationship between time in recovery and measures of recovery progress. RESULTS Time in recovery was positively associated with the ARQ (p < .001) and TEA (p < .001). Furthermore, an individual's delay discounting rate mediated the relationship between time in recovery and ARQ/TEA. Of the participants, 66% endorsed recovery requiring total abstinence from alcohol and drugs. Last, through an exhaustive model selection, the study did not find an individual's endorsement of abstinence in recovery to be a primary predictor of recovery progress. CONCLUSIONS This study presents evidence that, for individuals in recovery, the temporal view (i.e., focus on immediate vs. future rewards) is a significant influence on recovery progress. Additionally, an individual's endorsement of abstinence in recovery was not significantly associated with recovery progress, suggesting the importance of a holistic view of SUD recovery. These findings contribute to the understanding of recovery as a multidimensional process and provide further support for DD as a behavioral marker of addiction.
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Sliedrecht W, Roozen HG, Witkiewitz K, de Waart R, Dom G. The Association Between Impulsivity and Relapse in Patients With Alcohol Use Disorder: A Literature Review. Alcohol Alcohol 2021; 56:637-650. [PMID: 33382416 DOI: 10.1093/alcalc/agaa132] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/13/2020] [Accepted: 11/07/2020] [Indexed: 01/14/2023] Open
Abstract
AIM Impulsivity has been identified as a key relapse risk factor in patients with alcohol use disorder (AUD); however, the inherent characteristics of this relationship have been largely understudied. The heterogeneity of AUD and variation in impulsivity constructs require careful consideration to inform future work examining the relationship. This study sought to review empirical findings examining facets of impulsivity and AUD relapse. METHODS A systematic search strategy was employed to capture studies on impulsivity measures related to AUD relapse. Impulsivity measures were qualitatively organized in terms of 'trait impulsivity'-typically measured by self-report questionnaires-and 'behavioural impulsivity', i.e. 'motor impulsivity', 'impulsive choice' and 'reflection impulsivity, assessed with cognitive-behavioural tasks. RESULTS Seventeen peer-reviewed papers were identified. Relapse outcomes varied substantially in relation to impulsivity measures. Twelve papers included aspects of 'trait impulsivity', and nine studies included 'behavioural impulsivity' measures, from which five studies dealt with the 'impulsive choice' subcategory. The Barratt Impulsivity Scale was the self-report questionnaire that was most frequently used. CONCLUSIONS All three included facets of impulsivity ('trait-, motor- and impulsive choice impulsivity') were associated with AUD relapse, but none seemed to be superior to another. This study confirmed that research on the relation between impulsivity and AUD relapse is relatively scarce. Future research and treatment options are proposed.
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Affiliation(s)
- Wilco Sliedrecht
- De Hoop GGZ, Provincialeweg 70, 3329 KP Dordrecht, The Netherlands
| | - Hendrik G Roozen
- Center on Alcoholism, Substance Abuse, and Addictions (CASAA), The University of New Mexico (UNM), MSC 11 6280, Albuquerque, NM 87106, USA
| | - Katie Witkiewitz
- The University of New Mexico, MSC 03-2220, Albuquerque, NM 87131, USA
| | - Ranne de Waart
- Mentrum/Arkin, Domselaerstraat 126, 1093 MB Amsterdam, The Netherlands
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Universiteitsplein 1, 2610 Antwerp, Belgium
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Powell A, Tommerdahl M, Abbasi Y, Sumnall H, Montgomery C. A pilot study assessing the brain gauge as an indicator of cognitive recovery in alcohol dependence. Hum Psychopharmacol 2021; 36:e2782. [PMID: 33682954 DOI: 10.1002/hup.2782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 11/11/2022]
Abstract
UNLABELLED Alcohol dependence (AD) is associated with multiple cognitive deficits, which can affect treatment outcomes. Current measures of tracking brain recovery (e.g., functional magnetic resonance imaging) can be less accessible for practitioners. This study pilots a novel device (the brain gauge; BG) to assess its utility, and track recovery of cognitive function in residential alcohol treatment. METHODS A repeated measures design assessed changes in cognitive function during detoxification. Twenty-one participants with AD (16 Male; Mean age 43.85 ± 6.21) completed a battery of alcohol and memory questionnaires and BG tasks at two time-points (∼days 4 and 10) during a single managed detoxification episode. RESULTS Repeated measures ANCOVA revealed that some BG metrics significantly improved, with medium to large effect sizes - processing speed, focus, temporal order judgement and overall cortical metric. However, differences in subjective cognitive function were non-significant after controlling for depression and anxiety change scores. Anxiety change emerged as a significant factor in subjective cognitive function. CONCLUSIONS We conclude it is possible that the prefrontal cortex (PFC) recovers more slowly compared to other brain areas, and there are compounding effects of improvements in anxiety and depression, and metacognitive deficits on subjective EF assessments. Future research should seek to validate the clinical utility of the BG by comparing against established neuroimaging methods.
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Affiliation(s)
- Anna Powell
- Research Centre for Brain and Behaviour, School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Mark Tommerdahl
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yasir Abbasi
- Maudsley Health - Al Amal Psychiatric Hospital, Dubai
| | - Harry Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool, UK.,Liverpool Centre for Alcohol Research, Liverpool, UK
| | - Catharine Montgomery
- Research Centre for Brain and Behaviour, School of Psychology, Liverpool John Moores University, Liverpool, UK.,Liverpool Centre for Alcohol Research, Liverpool, UK
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8
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Salvatore MF, Soto I, Alphonso H, Cunningham R, James R, Nejtek VA. Is there a Neurobiological Rationale for the Utility of the Iowa Gambling Task in Parkinson's Disease? JOURNAL OF PARKINSONS DISEASE 2021; 11:405-419. [PMID: 33361612 PMCID: PMC8150623 DOI: 10.3233/jpd-202449] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Up to 23% of newly diagnosed, non-demented, Parkinson’s disease (PD) patients experience deficits in executive functioning (EF). In fact, EF deficits may occur up to 39-months prior to the onset of motor decline. Optimal EF requires working memory, attention, cognitive flexibility, and response inhibition underlying appropriate decision-making. The capacity for making strategic decisions requires inhibiting imprudent decisions and are associated with noradrenergic and dopaminergic signaling in prefrontal and orbitofrontal cortex. Catecholaminergic dysfunction and the loss of noradrenergic and dopaminergic cell bodies early in PD progression in the aforementioned cortical areas likely contribute to EF deficits resulting in non-strategic decision-making. Thus, detecting these deficits early in the disease process could help identify a significant portion of individuals with PD pathology (14–60%) before frank motor impairment. A task to evaluate EF in the domain of non-strategic decision-making might be useful to indicate the moderate loss of catecholamines that occurs early in PD pathology prior to motor decline and cognitive impairment. In this review, we focus on the potential utility of the Iowa Gambling Task (IGT) for this purpose, given significant overlap between in loss of dopaminergic and noradrenergic cells bodies in early PD and the deficits in catecholamine function associated with decreased EF. As such, given the loss of catecholamines already well-underway after PD diagnosis, we evaluate the potential utility of the IGT to identify the risk of therapeutic non-compliance and a potential companion approach to detect PD in premotor stages.
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Affiliation(s)
- Michael F Salvatore
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Isabel Soto
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Helene Alphonso
- John Peter Smith Health Network, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Rebecca Cunningham
- College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Rachael James
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Vicki A Nejtek
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, USA
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Noël X, Dubuson M, Rougier M, Lelard T, Mouras H, Kornreich C, Wyckmans F, Pereira M, Chatard A, Jaafari N, Campanella S. Distinct Whole-Body Movements in Response to Alcohol and Sexual Content in Alcohol Use Disorder. Alcohol Clin Exp Res 2021; 45:620-629. [PMID: 33486791 DOI: 10.1111/acer.14557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spontaneous motor responses of approach and avoidance toward stimuli are important in characterizing psychopathological conditions, including alcohol use disorder (AUD). However, divergent results have been reported, possibly due to confounded parameters (e.g., using a symbolic vs. a sensorimotor task, implementation of approach-avoidance as a measure vs. a manipulation). METHODS We studied whole-body/posturometric changes by using a sensorimotor measure relying on embodied cognition principles to assess forward (approach) and backward (avoidance) spontaneous leaning movements. Over a 12-second period, 51 male patients with AUD and 29 male control participants were instructed to stand still in response to both alcohol and sexual visual content. Patients with AUD were then divided into "abstainers" and "relapsers," depending on their continuous abstinence at 2 weeks postdischarge (obtained via a telephone follow-up interview). The effects of the group, the stimulus type, the experimental period, and their interactions on the posturometric changes were tested using mixed Analyses of variance (ANOVAs), with a significance threshold set at 0.05. RESULTS Contrary to our expectations, patients and controls did not show significant difference in their forward/backward micromovements while passively viewing alcohol or sexual content (p > 0.1). However, in line with our hypothesis, patients who relapsed several weeks following discharge from the rehabilitation program were significantly more reactive and more likely to lean back during the first seconds of viewing alcohol cues (p = 0.002). Further, "relapsers" were more likely to lean forward during exposure to sexual content than participants who remained abstinent (p < 0.001). CONCLUSIONS Among individuals with AUD, there are distinct pattern of spontaneous movements that differentiate "abstainers" and "relapsers," findings that can be understood in light of existing data and theories on action tendencies.
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Affiliation(s)
- Xavier Noël
- Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann, Université Libre de Bruxelles (U.L.B.), Bruxelles, Belgium
| | - Macha Dubuson
- Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann, Université Libre de Bruxelles (U.L.B.), Bruxelles, Belgium
| | - Marine Rougier
- IPSY, Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Thierry Lelard
- UR-UPJV: APERE 3300, Adaptations Physiologiques à l'Exercice et Réadaptation à l'Effort, UFR des Sciences du Sport, Université de Picardie-Jules-Verne, Amiens, France
| | - Harold Mouras
- UR-UPJV: LNFP 4559, Laboratoire de Neurosciences Fonctionnelles et Pathologies, Centre Universitaire de Recherche en Santé, Amiens Cedex 1, France
| | - Charles Kornreich
- Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann, Université Libre de Bruxelles (U.L.B.), Bruxelles, Belgium
| | - Florent Wyckmans
- Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann, Université Libre de Bruxelles (U.L.B.), Bruxelles, Belgium
| | - Maylis Pereira
- Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann, Université Libre de Bruxelles (U.L.B.), Bruxelles, Belgium
| | - Armand Chatard
- UMR-7295 CNRS, Faculté de Psychologie, Université de Poitiers, Poitiers, France
| | - Némat Jaafari
- Unité de Recherche Clinique Pierre Deniker du Centre Hospitalier Henri Laborit, INSERM CIC-P 1402, Poitiers, France.,INSERM U 1084, Laboratoire Expérimental et Clinique en Neurosciences, University of Poitiers, Poitiers, France
| | - Salvatore Campanella
- Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann, Université Libre de Bruxelles (U.L.B.), Bruxelles, Belgium
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10
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Dacosta-Sánchez D, González-Ponce BM, Fernández-Calderón F, Rojas-Tejada AJ, Ordóñez-Carrasco JL, Lozano-Rojas OM. Profiles of patients with cocaine and alcohol use disorder based on cognitive domains and their relationship with relapse. Drug Alcohol Depend 2021; 218:108349. [PMID: 33342513 DOI: 10.1016/j.drugalcdep.2020.108349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/07/2020] [Accepted: 09/28/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Relapse in drug use constitutes a research topic on addiction that is relevant for understanding both the addictive process and its clinical implications. The objective of this study was to explore if it is possible to identify patient profiles according to their performance on cognitive tasks whilst examining the relationship between such profiles and relapse. METHODS The sample consisted of 222 patients with dependence on cocaine and / or alcohol, of which 86 % were men. Cognitive domains related to salience, decision- making, and emotional processing were measured. RESULTS Latent class analysis revealed three patient profiles that differ in terms of performance on cognitive tasks. Two of these profiles are clearly differentiated in terms of their execution of the impulsive decision-making task. The third patient profile, unlike the latter two, is composed of patients with severe alterations in the three domains evaluated. Analysis revealed that patients in Profile 3 are those with the highest rates of relapse in cocaine (Profile 1 = 40.3 %; Profile 2 = 35.6 %; Profile 3 = 69.2 %; Chi2 = 9.169; p < .05) and cocaine and alcohol use (Profile 1 = 55.1 %; Profile 2 = 54.1 %; Profile 3 = 80 %; Chi2 = 6.698; p < .05). CONCLUSIONS The results support the postulates of the I-RISA model. From a clinical perspective, these findings highlight the need for a comprehensive evaluation of the cognitive domains involved in addiction.
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Affiliation(s)
- Daniel Dacosta-Sánchez
- Department of Clinical and Experimental Psychology. University of Huelva, Avda. Fuerzas Armadas s/n. 21071, Huelva, Spain
| | - Bella M González-Ponce
- Department of Clinical and Experimental Psychology. University of Huelva, Avda. Fuerzas Armadas s/n. 21071, Huelva, Spain
| | - Fermín Fernández-Calderón
- Department of Clinical and Experimental Psychology. University of Huelva, Avda. Fuerzas Armadas s/n. 21071, Huelva, Spain; Research Center on Natural Resources, Health and the Environment, University of Huelva, Ed. Experimental Sciences, 21071, Huelva, Spain
| | - Antonio J Rojas-Tejada
- Department of Psychology, University of Almeria, Crta. Sacramento s/n. 04120, Almeria, Spain
| | | | - Oscar M Lozano-Rojas
- Department of Clinical and Experimental Psychology. University of Huelva, Avda. Fuerzas Armadas s/n. 21071, Huelva, Spain; Research Center on Natural Resources, Health and the Environment, University of Huelva, Ed. Experimental Sciences, 21071, Huelva, Spain.
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11
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Psederska E, Thomson ND, Bozgunov K, Nedelchev D, Vasilev G, Vassileva J. Effects of Psychopathy on Neurocognitive Domains of Impulsivity in Abstinent Opiate and Stimulant Users. Front Psychiatry 2021; 12:660810. [PMID: 34177649 PMCID: PMC8219927 DOI: 10.3389/fpsyt.2021.660810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/03/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Psychopathy and substance use disorders (SUDs) are both characterized by neurocognitive impairments reflecting higher levels of impulsivity such as reward-driven decision-making and deficient inhibitory control. Previous studies suggest that psychopathy may exacerbate decision-making deficits, but it may be unrelated to other neurocognitive impairments among substance dependent individuals (SDIs). The aim of the present study was to examine the role of psychopathy and its interpersonal-affective and impulsive-antisocial dimensions in moderating the relationships between dependence on different classes of drugs and neurocognitive domains of impulsivity. Method: We tested 693 participants (112 heroin mono-dependent individuals, 71 heroin polysubstance dependent individuals, 115 amphetamine mono-dependent individuals, 76 amphetamine polysubstance dependent individuals, and 319 non-substance dependent control individuals). Participants were administered the Psychopathy Checklist: Screening Version (PCL:SV) and seven neurocognitive tasks measuring impulsive choice/decision-making (Iowa Gambling Task; Cambridge Gambling Task; Kirby Delay Discounting Task; Balloon Analog Risk Task), and impulsive action/response inhibition (Go/No-Go Task, Immediate Memory Task, and Stop Signal Task). Results: A series of hierarchical multiple regressions revealed that the interpersonal-affective dimension of psychopathy moderated the association between decision-making, response inhibition and both amphetamine and heroin dependence, albeit differently. For amphetamine users, low levels of interpersonal-affective traits predicted poor decision-making on the Iowa Gambling Task and better response inhibition on the Stop Signal task. In contrast, in heroin users high interpersonal-affective psychopathy traits predicted lower risk taking on the Cambridge Gambling Task and better response inhibition on the Go/No-Go task. The impulsive-antisocial dimension of psychopathy predicted poor response inhibition in both amphetamine and heroin users. Conclusions: Our findings reveal that psychopathy and its dimensions had both common and unique effects on neurocognitive function in heroin and amphetamine dependent individuals. Our results suggest that the specific interactions between psychopathy dimensions and dependence on different classes of drugs may lead to either deficient or superior decision-making and response inhibition performance in SDIs, suggesting that psychopathy may paradoxically play a protective role for some neurocognitive functions in specific subtypes of substance users.
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Affiliation(s)
- Elena Psederska
- Bulgarian Addictions Institute, Sofia, Bulgaria.,Department of Cognitive Science and Psychology, New Bulgarian University, Sofia, Bulgaria
| | - Nicholas D Thomson
- Division of Acute Care Surgical Services, Department of Surgery, Virginia Commonwealth University Health, Richmond, VA, United States.,Department of Psychology, University of Durham, Durham, United Kingdom
| | | | | | | | - Jasmin Vassileva
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States.,Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States
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12
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Psederska E, Yankov GP, Bozgunov K, Popov V, Vasilev G, Vassileva J. Validation of the Levenson Self-Report Psychopathy Scale in Bulgarian Substance-Dependent Individuals. Front Psychol 2020; 11:1110. [PMID: 32581949 PMCID: PMC7296064 DOI: 10.3389/fpsyg.2020.01110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/30/2020] [Indexed: 11/13/2022] Open
Abstract
The co-occurrence of psychopathy and substance use disorders (SUDs) is associated with higher relapse rates and increased risk of violent offending. Studies on the validity of psychopathy measures in community samples and substance-dependent individuals (SDIs) are scarce. The aim of the current study was to examine the psychometric properties of the Levenson Self-Report Psychopathy Scale (LSRP) in a sample of Bulgarian SDIs and non-dependent controls. We tested 615 participants: 106 heroin users, 91 amphetamine users, 123 polysubstance users, and 295 controls. Confirmatory factor analyses replicated the tri-factor structure of the LSRP (egocentric, antisocial, callous). The scale demonstrated acceptable reliability and validity. SDIs scored significantly higher than controls on the total scale and subscales of the LSRP, indicating good discriminant validity. Overall, results indicate that the LSRP is a valid instrument for measuring psychopathy in Bulgarian community samples.
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Affiliation(s)
- Elena Psederska
- Bulgarian Addictions Institute, Sofia, Bulgaria
- Department of Cognitive Science and Psychology, New Bulgarian University, Sofia, Bulgaria
| | - Georgi P. Yankov
- Department of Psychology, Bowling Green State University, Bowling Green, OH, United States
| | | | - Vencislav Popov
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, United States
| | | | - Jasmin Vassileva
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States
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13
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Fitzpatrick RE, Rubenis AJ, Lubman DI, Verdejo-Garcia A. Cognitive deficits in methamphetamine addiction: Independent contributions of dependence and intelligence. Drug Alcohol Depend 2020; 209:107891. [PMID: 32061948 DOI: 10.1016/j.drugalcdep.2020.107891] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Methamphetamine's effects on brain function have been associated with cognitive deficits, which have a negative impact on clinical outcomes. However, it remains unclear if cognitive deficits relate to methamphetamine dependence (potentially amenable to abstinence and retraining) or background characteristics, mental health and other drug use. We tested the association between methamphetamine dependence and cognitive performance, while factoring in the impact of background characteristics, depressive symptoms and tobacco, alcohol and cannabis use. METHOD The sample comprised 108 treatment-seeking participants who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV TR) criteria for methamphetamine dependence and 50 socio-demographically matched controls. We administered a comprehensive neuropsychological test battery (delay discounting, decision making, disinhibition, episodic and working memory) and examined cognitive deficits in methamphetamine users after taking into account socio-demographic characteristics, tobacco, alcohol and cannabis use, and depressive symptoms. RESULTS Hierarchical multiple regression analyses showed that methamphetamine dependence was associated with poorer performance in decision-making and disinhibition over and above other predictors, while IQ better explained performance in episodic and working memory. Although duration of methamphetamine use was linked to disinhibition, other patterns of methamphetamine use (including dose and frequency) were not consistently related to performance. CONCLUSIONS Methamphetamine dependence impacts inhibitory control and decision-making, whereas lower IQ associates with memory/working memory deficits among methamphetamine users. Findings suggest the need to target disinhibition and impulsive decision-making as part of methamphetamine dependence treatment, while buffering the impact of IQ on memory systems.
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Affiliation(s)
- Rebecca E Fitzpatrick
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, 3800, Australia
| | - Adam J Rubenis
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, 3800, Australia; Turning Point, Eastern Health Australia
| | - Dan I Lubman
- Turning Point, Eastern Health Australia; Eastern Health Clinical School, Monash University, Fitzroy, Victoria, 3065, Australia
| | - Antonio Verdejo-Garcia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, 3800, Australia; Turning Point, Eastern Health Australia.
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14
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Kluwe-Schiavon B, Viola TW, Sanvicente-Vieira B, Lumertz FS, Salum GA, Grassi-Oliveira R, Quednow BB. Substance related disorders are associated with impaired valuation of delayed gratification and feedback processing: A multilevel meta-analysis and meta-regression. Neurosci Biobehav Rev 2019; 108:295-307. [PMID: 31778679 DOI: 10.1016/j.neubiorev.2019.11.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 11/13/2019] [Accepted: 11/23/2019] [Indexed: 02/08/2023]
Abstract
Across numerous studies, individuals with substance use disorders (SUDs) differed from non-using controls regarding valuation of delayed gratification and feedback processing. However, it remains unclear whether the magnitude of the effect sizes is different across these two cognitive processes and how specific SUDs as well as demographic and clinical moderators influence these effects. In this study we thus performed multilevel linear mixed-effects meta-analyses and meta-regressions to examine the effects of SUDs on the Delay Discounting Task (DD) and on the Iowa Gambling Task (IGT). We found a moderate to large effect for SUD on both, the IGT and DD. While the effect on the DD was generalized to all substance classes, a smaller effect for cannabis-related disorder when compared to other SUDs was found with regard to the IGT. Early onset of substance use and psychiatric comorbidities were associated with stronger effects on the DD. Our findings suggest that feedback processing is more vulnerable to specific substance effects, while valuation of delayed gratification depends more on developmental and clinical factors.
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Affiliation(s)
- B Kluwe-Schiavon
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, CH-8032, Zurich, Switzerland; Developmental Cognitive Neuroscience Laboratory, Brain Institute, Pontifical Catholic University of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Ipiranga Avenue, 6681, 11, 936. Partenon, 90619-900, Porto Alegre, RS, Brazil.
| | - T W Viola
- Developmental Cognitive Neuroscience Laboratory, Brain Institute, Pontifical Catholic University of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Ipiranga Avenue, 6681, 11, 936. Partenon, 90619-900, Porto Alegre, RS, Brazil.
| | - B Sanvicente-Vieira
- Developmental Cognitive Neuroscience Laboratory, Brain Institute, Pontifical Catholic University of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Ipiranga Avenue, 6681, 11, 936. Partenon, 90619-900, Porto Alegre, RS, Brazil.
| | - F S Lumertz
- Developmental Cognitive Neuroscience Laboratory, Brain Institute, Pontifical Catholic University of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Ipiranga Avenue, 6681, 11, 936. Partenon, 90619-900, Porto Alegre, RS, Brazil.
| | - G A Salum
- Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos Street, 2350 - Santa Cecilia, Porto Alegre, RS 90035-007, Brazil.
| | - R Grassi-Oliveira
- Developmental Cognitive Neuroscience Laboratory, Brain Institute, Pontifical Catholic University of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Ipiranga Avenue, 6681, 11, 936. Partenon, 90619-900, Porto Alegre, RS, Brazil.
| | - B B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, CH-8032, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Rämistrasse 101, CH-8092 Zürich, Switzerland.
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15
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Sliedrecht W, de Waart R, Witkiewitz K, Roozen HG. Alcohol use disorder relapse factors: A systematic review. Psychiatry Res 2019; 278:97-115. [PMID: 31174033 DOI: 10.1016/j.psychres.2019.05.038] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022]
Abstract
A relapsing-remitting course is very common in patients with an Alcohol Use Disorder (AUD). Understanding the determinants associated with alcohol resumption remains a formidable task. This paper examines relapse determinants based on a systematic review of recent alcohol literature (2000-2019). Relevant databases were consulted for articles that contained information about specific relapse determinants and reported statistical significance of each relapse determinant in predicting relapse. Relapse was broadly defined based on the characterization in the included articles. From the initial identified 4613 papers, a total of 321 articles were included. Results encompass multiple relapse determinants, which were ordered according to biopsychosocial and spiritual categories, and presented, using a descriptive methodology. Psychiatric co-morbidity, AUD severity, craving, use of other substances, health and social factors were consistently significantly associated with AUD relapse. Conversely, supportive social network factors, self efficacy, and factors related to purpose and meaning in life, were protective against AUD relapse. Despite heterogeneity in different methods, measures, and sample characteristics, these findings may contribute to a better therapeutic understanding in which specific factors are associated with relapse and those that prevent relapse. Such factors may have a role in a personalized medicine framework to improve patient outcomes.
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Affiliation(s)
- Wilco Sliedrecht
- De Hoop GGZ, Provincialeweg 70, 3329 KP Dordrecht, the Netherlands.
| | - Ranne de Waart
- Mentrum/Arkin, Wisselwerking 46-48, 1112 XR Diemen, the Netherlands.
| | - Katie Witkiewitz
- The University of New Mexico (UNM), MSC 03-2220, Univ of New Mexico, Albuquerque, NM 87131, USA.
| | - Hendrik G Roozen
- The University of New Mexico (UNM), Center on Alcoholism, Substance Abuse, and Addictions (CASAA), MSC 11 6280, 1 Univ of New Mexico, Albuquerque, NM 87106, USA.
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16
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Maurage P, Lannoy S, Dormal V, Blanco M, Trabut JB. Clinical Usefulness of the Iowa Gambling Task in Severe Alcohol Use Disorders: Link with Relapse and Cognitive-Physiological Deficits. Alcohol Clin Exp Res 2018; 42:2266-2273. [PMID: 30120833 DOI: 10.1111/acer.13873] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/10/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Decision-making impairments have been repeatedly evaluated in severe alcohol use disorders (SAUD) using the Iowa Gambling Task (IGT). The IGT, capitalizing on strong theoretical background and ecological significance, allowed identifying large-scale deficits in this population and is now a standard decision-making assessment in therapeutic settings. However, the clinical usefulness of the IGT, particularly regarding its ability to predict relapse and its link with key cognitive-physiological deficits, remains to be clarified. METHODS Thirty-eight recently detoxified patients with SAUD and 38 matched healthy controls performed the IGT, a neuropsychological task using monetary rewards to assess decision making under uncertainty and under risk. Disease characteristics (e.g., duration and intensity), cognitive abilities, psychopathological comorbidities, and physiological damage were also measured, as well as relapse rates 6 months later. RESULTS Compared to controls, patients with SAUD presented a dissociation between preserved decision making under uncertainty and impaired decision making under risk. In the SAUD group, while relapsers (55% of the sample) presented lower global cognitive functioning and stronger liver damage than nonrelapsers at detoxification time, no difference was found between these subgroups for the IGT. IGT results were not related to alcohol-consumption characteristics or cognitive-physiological deficits. CONCLUSIONS SAUD is not related to a global IGT deficit, as suggested earlier, but rather to a specific impairment for decision making under risk. This deficit is not associated with other disease-related variables and has no relapse prediction power. These results question the clinical usefulness of the IGT as a tool identifying key treatment levers and guiding (neuro)psychological rehabilitation.
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Affiliation(s)
- Pierre Maurage
- Laboratory for Experimental Psychopathology (LEP) , Psychological Science Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Séverine Lannoy
- Laboratory for Experimental Psychopathology (LEP) , Psychological Science Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Valérie Dormal
- Laboratory for Experimental Psychopathology (LEP) , Psychological Science Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Marine Blanco
- Service d'Addictologie , Hôpitaux Universitaires Henri-Mondor, Assistance Publique Hôpitaux de Paris (APHP), Créteil, France
| | - Jean-Baptiste Trabut
- Service d'Addictologie , Hôpitaux Universitaires Henri-Mondor, Assistance Publique Hôpitaux de Paris (APHP), Créteil, France.,INSERM U841 , Créteil, France
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17
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Wang J, Fan Y, Dong Y, Ma M, Dong Y, Niu Y, Jiang Y, Wang H, Wang Z, Wu L, Sun H, Cui C. Combining gray matter volume in the cuneus and the cuneus-prefrontal connectivity may predict early relapse in abstinent alcohol-dependent patients. PLoS One 2018; 13:e0196860. [PMID: 29734343 PMCID: PMC5937790 DOI: 10.1371/journal.pone.0196860] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 04/21/2018] [Indexed: 01/19/2023] Open
Abstract
Background Developing more effective strategies to prevent relapse remains one of the major challenges of treating substance dependence. Previous studies have identified brain abnormalities in abstinent alcoholics. However, whether these persistent brain deficits in abstinence could predict early relapse to alcohol use has not been well established. This study aimed to identify biomarkers of relapse vulnerability by investigating persistent brain abnormalities in abstinent alcohol-dependent patients. Methods Brain imaging and impulsive behavior data were collected from 56 abstinent alcohol-dependent male inpatients and 33 age-matched male healthy controls. Voxel-based morphometry was used to investigate the differences of grey matter volume between the groups. The resting-state functional connectivity was examined using brain areas with gray matter deficits as seed regions. A preliminary prospective study design was used to classify patients into abstainers and relapsers after a 62-day average abstinence period. Results Compared with healthy controls, both relapsers and abstainers exhibited significantly reduced gray matter volume in the cuneus. Functional connectivity analysis revealed that relapsers relative to abstainers demonstrated increased cuneus-centered negative functional connectivity within a network of brain regions which are involved in executive control and salience. Abnormal gray matter volume in the left cuneus and the functional connectivity between the right cuneus and bilateral dorsolateral prefrontal cortex could successfully predict relapse during the 3-month follow-up period. Conclusions Findings suggest that the abnormal gray matter volume in the cuneus and resting-state cuneus-prefrontal functional connectivity may play an important role in poor treatment outcomes in alcoholics and serve as useful neural markers of relapse vulnerability.
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Affiliation(s)
- Junkai Wang
- Neuroscience Research Institute, Peking University, Beijing, China
- Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, China
- Key Laboratory of Neuroscience, The Ministry of Education and Ministry of Public Health, Beijing, China
| | - Yunli Fan
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
| | - Yue Dong
- Department of Magnetic Resonance, General Hospital of Armed Police Forces, Beijing, China
| | - Mengying Ma
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
| | - Yuru Dong
- Department of Magnetic Resonance, General Hospital of Armed Police Forces, Beijing, China
| | - Yajuan Niu
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
| | - Yin Jiang
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Hong Wang
- Department of Magnetic Resonance, General Hospital of Armed Police Forces, Beijing, China
| | - Zhiyan Wang
- Neuroscience Research Institute, Peking University, Beijing, China
- Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, China
- Key Laboratory of Neuroscience, The Ministry of Education and Ministry of Public Health, Beijing, China
| | - Liuzhen Wu
- Neuroscience Research Institute, Peking University, Beijing, China
- Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, China
- Key Laboratory of Neuroscience, The Ministry of Education and Ministry of Public Health, Beijing, China
| | - Hongqiang Sun
- Peking University Sixth Hospital/Institute of Mental Health and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Cailian Cui
- Neuroscience Research Institute, Peking University, Beijing, China
- Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, China
- Key Laboratory of Neuroscience, The Ministry of Education and Ministry of Public Health, Beijing, China
- * E-mail:
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18
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Dom G. Work is Important. Commentary on Finn et al. (2017) Decisions to Attend and Drink at Party Events: The Effects of Incentives and Disincentives and Lifetime Alcohol and Antisocial Problems. Alcohol Clin Exp Res 2017; 42:9-11. [PMID: 29044564 DOI: 10.1111/acer.13530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerp, Belgium.,Antwerp University Hospital (UZA), Edegem, Belgium
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19
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Bernhardt N, Nebe S, Pooseh S, Sebold M, Sommer C, Birkenstock J, Zimmermann US, Heinz A, Smolka MN. Impulsive Decision Making in Young Adult Social Drinkers and Detoxified Alcohol-Dependent Patients: A Cross-Sectional and Longitudinal Study. Alcohol Clin Exp Res 2017; 41:1794-1807. [DOI: 10.1111/acer.13481] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 08/11/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Nadine Bernhardt
- Department of Psychiatry and Psychotherapy; Technische Universität Dresden; Dresden Germany
| | - Stephan Nebe
- Department of Psychiatry and Psychotherapy; Technische Universität Dresden; Dresden Germany
| | - Shakoor Pooseh
- Department of Psychiatry and Psychotherapy; Technische Universität Dresden; Dresden Germany
| | - Miriam Sebold
- Department of Psychiatry and Psychotherapy; Charité - Universitätsmedizin Berlin; corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - Christian Sommer
- Department of Psychiatry and Psychotherapy; Technische Universität Dresden; Dresden Germany
| | - Julian Birkenstock
- Department of Psychiatry and Psychotherapy; Technische Universität Dresden; Dresden Germany
| | - Ulrich S. Zimmermann
- Department of Psychiatry and Psychotherapy; Technische Universität Dresden; Dresden Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy; Charité - Universitätsmedizin Berlin; corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - Michael N. Smolka
- Department of Psychiatry and Psychotherapy; Technische Universität Dresden; Dresden Germany
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20
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Ferland JMN, Winstanley CA. Risk-preferring rats make worse decisions and show increased incubation of craving after cocaine self-administration. Addict Biol 2017; 22:991-1001. [PMID: 27002211 DOI: 10.1111/adb.12388] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/07/2016] [Accepted: 02/10/2016] [Indexed: 02/03/2023]
Abstract
Maladaptive decision-making may play an integral role in the development and maintenance of an addiction. Substance-dependent individuals make riskier choices on the Iowa Gambling Task, and these deficits persist during withdrawal and are predictive of relapse. However, it is unclear from clinical studies whether this cognitive impairment is a cause or consequence of drug use. We trained male Long-Evans rats on the rat Gambling Task, a rodent analogue of the Iowa Gambling Task, to determine how choice preference influenced, and was influenced by, cocaine self-administration, withdrawal and incubation of craving. Rats that exhibited a preference for the risky, disadvantageous options at baseline were uniquely and adversely affected by cocaine self-administration. Risky choice was exacerbated in these rats when decision-making was assessed during the same diurnal period as cocaine self-administration, whereas the choice pattern of optimal decision-makers was unaffected. This decision-making deficit was maintained during 30 days of withdrawal and correlated with greater cue-induced incubation of craving. Risk-preferring rats also made more drug-seeking responses during cocaine self-administration. These data demonstrate that poor decision-making prior to contact with addictive drugs is associated with a pro-addictive behavioural phenotype, characterized by further increased risky choice and heightened responding for drug both during cocaine self-administration and withdrawal. Such findings indicate that the elevated risky decision-making observed in substance-dependent populations is not merely circumstantial, but makes an important contribution to addiction vulnerability and severity that can now be effectively modelled in laboratory rats.
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Affiliation(s)
- Jacqueline-Marie N. Ferland
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health; University of British Columbia; Canada
| | - Catharine A. Winstanley
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health; University of British Columbia; Canada
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21
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Iowa Gambling Task Performance Prospectively Predicts Changes in Glycemic Control among Adolescents with Type 1 Diabetes. J Int Neuropsychol Soc 2017; 23:204-213. [PMID: 28065206 DOI: 10.1017/s135561771600103x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Good glycemic control is an important goal of diabetes management. Late adolescents with type 1 diabetes (T1D) are at risk for poor glycemic control as they move into young adulthood. For a subset of these patients, this dysregulation is extreme, placing them at risk for life-threatening health complications and permanent cognitive declines. The present study examined whether deficiency in emotional decision making (as measured by the Iowa Gambling Task; IGT) among teens with T1D may represent a neurocognitive risk factor for subsequent glycemic dysregulation. METHODS As part of a larger longitudinal study, a total of 241 high-school seniors (147 females, 94 males) diagnosed with T1D underwent baseline assessment that included the IGT. Glycated hemoglobin (HbA1c), which reflects glycemic control over the course of the past 2 to 3 months, was also assessed at baseline. Of the 241,189 (127 females, 62 males, mean age=17.76, mean HbA1c=8.11) completed HbA1c measurement 1 year later. RESULTS Baseline IGT performance in the impaired range (per norms) was associated with greater dysregulation in glycemic control 1 year later, as evidenced by an average increase in HbA1c of 2%. Those with normal IGT scores (per norms) exhibited a more moderate increase in glycemic control, with an HbA1c increase of 0.7%. Several IGT scoring approaches were compared, showing that the total scores collapsed across all trials was most sensitive to change in glycemic control. CONCLUSIONS IGT assessment offers promise as a tool for identifying late adolescents at increased risk for glycemic dysregulation. (JINS, 2017, 23, 204-213).
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Domínguez-Salas S, Díaz-Batanero C, Lozano-Rojas OM, Verdejo-García A. Impact of general cognition and executive function deficits on addiction treatment outcomes: Systematic review and discussion of neurocognitive pathways. Neurosci Biobehav Rev 2016; 71:772-801. [PMID: 27793597 DOI: 10.1016/j.neubiorev.2016.09.030] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 09/29/2016] [Accepted: 09/30/2016] [Indexed: 02/07/2023]
Abstract
This systematic review aims to examine growing evidence linking cognitive-executive functions with addiction treatment outcomes, and to discuss significant cognitive predictors drawing upon addiction neuroscience theory. We conducted a systematic search to identify studies using measures of general cognition and executive functions in patients with substance use disorders for the purpose of predicting two treatment outcomes: therapeutic adherence and relapse. Forty-six studies were selected, and sample characteristics, timing of assessments, and cognitive measures were analyzed. We observed significant methodological differences across studies, resulting in substantial variability in the relationships between cognitive-executive domains and treatment outcomes. Notwithstanding this variability, we found evidence of associations, of medium effect size, between general cognition and treatment adherence, and between reward-based decision-making and relapse. The link between general cognition and treatment adherence is consistent with emerging evidence linking limited cognitive-executive resources with less ability to benefit from talk therapies. The link between reward-based decision-making and relapse accords with decision neuroscience models of addiction. Findings may inform preclinical and clinical research concerning addiction treatment mechanisms.
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Affiliation(s)
- Sara Domínguez-Salas
- Department of Clinical & Experimental Psychology, University of Huelva, Avda. Fuerzas Armadas, 21017 Huelva, Spain
| | - Carmen Díaz-Batanero
- Department of Clinical & Experimental Psychology, University of Huelva, Avda. Fuerzas Armadas, 21017 Huelva, Spain
| | - Oscar Martin Lozano-Rojas
- Department of Clinical & Experimental Psychology, University of Huelva, Avda. Fuerzas Armadas, 21017 Huelva, Spain; Red de Trastornos Adictivos, University of Granada, Campus de Cartuja S/N, 18071 Granada, Spain
| | - Antonio Verdejo-García
- Red de Trastornos Adictivos, University of Granada, Campus de Cartuja S/N, 18071 Granada, Spain; School of Psychological Sciences & Monash Institute of Cognitive and Clinical Neurosciences, Monash University, 18 Innovation Walk, 3800 Melbourne, Australia.
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Manning V, Staiger PK, Hall K, Garfield JB, Flaks G, Leung D, Hughes LK, Lum JAG, Lubman DI, Verdejo-Garcia A. Cognitive Bias Modification Training During Inpatient Alcohol Detoxification Reduces Early Relapse: A Randomized Controlled Trial. Alcohol Clin Exp Res 2016; 40:2011-9. [DOI: 10.1111/acer.13163] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/24/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Victoria Manning
- Turning Point; Eastern Health; Fitzroy Victoria Australia
- Eastern Health Clinical School; Monash University; Box Hill Victoria Australia
| | - Petra K. Staiger
- School of Psychology; Deakin University; Burwood Victoria Australia
| | - Kate Hall
- School of Psychology; Deakin University; Burwood Victoria Australia
- Centre for Youth AOD Practice Development; Youth Support and Advocacy Service; Fitzroy Victoria Australia
| | - Joshua B.B. Garfield
- Turning Point; Eastern Health; Fitzroy Victoria Australia
- Eastern Health Clinical School; Monash University; Box Hill Victoria Australia
| | | | - Daniel Leung
- School of Psychology; Deakin University; Burwood Victoria Australia
| | - Laura K. Hughes
- School of Psychology; Deakin University; Burwood Victoria Australia
| | - Jarrad A. G. Lum
- School of Psychology; Deakin University; Burwood Victoria Australia
| | - Dan I. Lubman
- Turning Point; Eastern Health; Fitzroy Victoria Australia
- Eastern Health Clinical School; Monash University; Box Hill Victoria Australia
| | - Antonio Verdejo-Garcia
- Turning Point; Eastern Health; Fitzroy Victoria Australia
- School of Psychological Sciences & Monash Institute of Cognitive and Clinical Neurosciences; Monash University; Clayton Victoria Australia
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24
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Khemiri L, Kuja-Halkola R, Larsson H, Jayaram-Lindström N. Genetic overlap between impulsivity and alcohol dependence: a large-scale national twin study. Psychol Med 2016; 46:1091-1102. [PMID: 26671289 DOI: 10.1017/s0033291715002652] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Alcohol dependence is associated with increased levels of impulsivity, but the genetic and environmental underpinnings of this overlap remain unclear. The purpose of the current study was to investigate the degree to which genetic and environmental factors contribute to the overlap between alcohol dependence and impulsivity. METHOD Univariate and bivariate twin model fitting was conducted for alcohol dependence and impulsivity in a national sample of 16 819 twins born in Sweden from 1959 to 1985. RESULTS The heritability estimate for alcohol dependence was 44% [95% confidence interval (CI) 31-57%] for males and 62% (95% CI 52-72%) for females. For impulsivity, the heritability was 33% (95% CI 30-36%) in males and females. The bivariate twin analysis indicated a statistically significant genetic correlation between alcohol dependence and impulsivity of 0.40 (95% CI 0.23-0.58) in males and 0.20 (95% CI 0.07-0.33) in females. The phenotypic correlation between alcohol dependence and impulsivity was 0.20 and 0.17 for males and females, respectively, and the bivariate heritability was 80% (95% CI 47-117%) for males and 53% (95% CI 19-86%) for females. The remaining variance in all models was accounted for by non-shared environmental factors. CONCLUSIONS The association between alcohol dependence and impulsivity can be partially accounted for by shared genetic factors. The genetic correlation was greater in men compared with women, which may indicate different pathways to the development of alcohol dependence between sexes. The observed genetic overlap has clinical implications regarding treatment and prevention, and partially explains the substantial co-morbidity between alcohol dependence and psychiatric disorders characterized by impulsive behaviour.
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Affiliation(s)
- L Khemiri
- Department of Clinical Neuroscience,Centre for Psychiatric Research,Karolinska Institutet,Stockholm,Sweden
| | - R Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden
| | - H Larsson
- Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden
| | - N Jayaram-Lindström
- Department of Clinical Neuroscience,Centre for Psychiatric Research,Karolinska Institutet,Stockholm,Sweden
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25
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Adinoff B, Carmody TJ, Walker R, Donovan DM, Brigham GS, Winhusen TM. Decision-making processes as predictors of relapse and subsequent use in stimulant-dependent patients. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:88-97. [PMID: 26743586 PMCID: PMC4817850 DOI: 10.3109/00952990.2015.1106550] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Decision-making processes have been posited to affect treatment outcome in addicted patients. OBJECTIVE The present multi-site study assessed whether two measures of decision-making predicted relapse and subsequent use in stimulant-dependent patients. METHODS A total of 160 methamphetamine- or cocaine-dependent patients participating in a multi-site clinical trial evaluating a modified 12-step facilitation intervention for stimulant-dependent patients (STAGE-12) were assessed. Decision-making processes of risk and delay (Iowa Gambling Task [IGT]) and response reversal (Wisconsin Card Sorting Task [WCST]) were obtained shortly after treatment admission followed by assessment of stimulant use over the next six months. The relationships of the IGT and WCST (Perseverative Errors) with relapse (yes/no) and days of stimulant use during the 6-month period following post-randomization were evaluated. RESULTS Performance on the IGT and WCST did not significantly predict relapse status or time to relapse. Unexpectedly, worse performance on the IGT was associated with a fewer number of stimulant use days (p = 0.001). In contrast, worse performance on the WCST (more perseverative errors) was associated with a greater number of stimulant use days (p = 0.0003). The predictive effects of perseverative errors on subsequent use were confined to methamphetamine-dependent and Minority participants. CONCLUSIONS Decision-making processes, as measured in the current study, do not uniformly predict relapse or subsequent use. A decrease in the salience attribution of non-drug reinforcers may explain the positive relationship between IGT performance and post-relapse use. More comprehensive and global measures of impulsiveness may better assess relapse risk and use.
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Affiliation(s)
- Bryon Adinoff
- a VA North Texas Health Care System, Dallas VAMC , Dallas , TX , USA
- b Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Thomas J Carmody
- b Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Robrina Walker
- b Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Dennis M Donovan
- c Alcohol & Drug Abuse Institute, University of Washington , Seattle , WA , USA
- d Department of Psychiatry & Behavioral Sciences , University of Washington , Seattle , WA , USA
| | - Gregory S Brigham
- e Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience , University of Cincinnati College of Medicine , Cincinnati , OH , USA
- f Maryhaven , Columbus , OH , USA
| | - Theresa M Winhusen
- e Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience , University of Cincinnati College of Medicine , Cincinnati , OH , USA
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26
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Rupp CI, Beck JK, Heinz A, Kemmler G, Manz S, Tempel K, Fleischhacker WW. Impulsivity and Alcohol Dependence Treatment Completion: Is There a Neurocognitive Risk Factor at Treatment Entry? Alcohol Clin Exp Res 2015; 40:152-60. [DOI: 10.1111/acer.12924] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 09/30/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Claudia I. Rupp
- Division of Biological Psychiatry; Department of Psychiatry and Psychotherapy; Medical University Innsbruck; Innsbruck Austria
| | - J. Katharina Beck
- Division of Biological Psychiatry; Department of Psychiatry and Psychotherapy; Medical University Innsbruck; Innsbruck Austria
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Georg Kemmler
- Division of General and Social Psychiatry; Department of Psychiatry and Psychotherapy; Medical University Innsbruck; Innsbruck Austria
| | - Sarah Manz
- Division of Biological Psychiatry; Department of Psychiatry and Psychotherapy; Medical University Innsbruck; Innsbruck Austria
| | - Katharina Tempel
- Division of Biological Psychiatry; Department of Psychiatry and Psychotherapy; Medical University Innsbruck; Innsbruck Austria
| | - W. Wolfgang Fleischhacker
- Division of Biological Psychiatry; Department of Psychiatry and Psychotherapy; Medical University Innsbruck; Innsbruck Austria
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27
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Orsini CA, Willis ML, Gilbert RJ, Bizon JL, Setlow B. Sex differences in a rat model of risky decision making. Behav Neurosci 2015; 130:50-61. [PMID: 26653713 DOI: 10.1037/bne0000111] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many debilitating psychiatric conditions, including drug addiction, are characterized by poor decision making and maladaptive risk-taking. Recent research has begun to probe this relationship to determine how brain mechanisms mediating risk-taking become compromised after chronic drug use. Currently, however, the majority of work in this field has used male subjects. Given the well-established sex differences in drug addiction, it is conceivable that such differences are also evident in risk-based decision making. To test this possibility, male and female adult rats were trained in a risky decision making task (RDT), in which they chose between a small, "safe" food reward and a large, "risky" food reward accompanied by an increasing probability of mild footshock punishment. Consistent with findings in human subjects, females were more risk averse, choosing the large, risky reward significantly less than males. This effect was not due to differences in shock reactivity or body weight, and risk-taking in females was not modulated by estrous phase. Systemic amphetamine administration decreased risk-taking in both males and females; however, females exhibited greater sensitivity to amphetamine, suggesting that dopaminergic signaling may partially account for sex differences in risk-taking. Finally, although males displayed greater instrumental responding for food reward, reward choice in the RDT was not affected by satiation, indicating that differences in motivation to obtain food reward cannot fully account for sex differences in risk-taking. These results should prove useful for developing targeted treatments for psychiatric conditions in which risk-taking is altered and that are known to differentially affect males and females.
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Affiliation(s)
- Caitlin A Orsini
- Department of Psychiatry, University of Florida College of Medicine
| | - Markie L Willis
- Department of Psychiatry, University of Florida College of Medicine
| | - Ryan J Gilbert
- Department of Neuroscience, University of Florida College of Medicine
| | - Jennifer L Bizon
- Department of Psychiatry, University of Florida College of Medicine
| | - Barry Setlow
- Department of Psychiatry, University of Florida College of Medicine
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28
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Dom G, Peuskens H. Addiction specialist's role in liver transplantation procedures for alcoholic liver disease. World J Hepatol 2015; 7:2091-2099. [PMID: 26301051 PMCID: PMC4539402 DOI: 10.4254/wjh.v7.i17.2091] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/09/2015] [Accepted: 08/11/2015] [Indexed: 02/06/2023] Open
Abstract
Although liver transplantation (LT) is performed increasingly for patients with end-stage alcoholic liver disease (ALD), the topic remains controversial. Traditionally, the role of an addiction specialist focused on the screening and identification of patients with a high risk on relapse in heavy alcohol use. These patients were in many cases subsequently excluded from a further LT procedure. Recently, awareness is growing that not only screening of patients but also offering treatment, helping patients regain and maintain abstinence is essential, opening up a broader role for the addiction specialist (team) within the whole of the transplant procedure. Within this context, high-risk assessment is proposed to be an indication of increasing addiction treatment intensity, instead of being an exclusion criterion. In this review we present an overview regarding the state of the art on alcohol relapse assessment and treatment in patients with alcohol use disorders, both with and without ALD. Screening, treatment and monitoring is suggested as central roles for the addiction specialist (team) integrated within transplant centers.
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29
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Stevens L, Goudriaan AE, Verdejo-Garcia A, Dom G, Roeyers H, Vanderplasschen W. Impulsive choice predicts short-term relapse in substance-dependent individuals attending an in-patient detoxification programme. Psychol Med 2015; 45:2083-2093. [PMID: 25640022 DOI: 10.1017/s003329171500001x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Impulsivity is a hallmark characteristic of substance use disorders. Recently, studies have begun to explore whether increased impulsivity in substance-dependent individuals (SDIs) is associated with a greater propensity to relapse following treatment. Despite growing recognition of its multidimensional nature, however, most studies have treated impulsivity unilaterally. Accordingly, it remains unclear whether certain facets of impulsivity are more relevant to relapse than others. The aim of the current study was to examine the relationship between multiple facets of impulsivity and short-term relapse in SDIs. As a secondary aim, we explored the role of treatment retention in this relationship. METHOD A personality-based impulsivity questionnaire (UPPS) and three neurocognitive tasks of impulsivity [stop-signal task (SST), delay discounting task (DDT) and Iowa gambling task (IGT)] were administered in a heterogeneous sample of 70 SDIs shortly following their entry in an in-patient detoxification programme. Mediation analyses were performed to explore whether the effects of impulsivity on relapse were mediated by treatment retention. RESULTS Performance on two neurocognitive indices of impulsive choice (i.e. delay discounting and impulsive decision-making) significantly predicted short-term relapse. The effects of delay discounting and impulsive decision-making on relapse propensity were mediated by treatment retention. CONCLUSIONS Neurocognitive indices of impulsivity may be more sensitive to the prediction of relapse than trait-based self-report questionnaires. Post-treatment relapse in SDIs may be reduced by targeting the processes involved in impulsive choice and by improving treatment retention in SDIs with inflated impulsivity.
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Affiliation(s)
- L Stevens
- Department of Special Education,University of Ghent,Ghent,Belgium
| | - A E Goudriaan
- Amsterdam Institute for Addiction Research,Department of Psychiatry,Academic Medical Centre, University of Amsterdam,Amsterdam,the Netherlands
| | - A Verdejo-Garcia
- School of Psychological Sciences, Monash University,Melbourne,Victoria,Australia
| | - G Dom
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp,Antwerp,Belgium
| | - H Roeyers
- Department of Experimental Clinical and Health Psychology,University of Ghent,Ghent,Belgium
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30
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Körner N, Schmidt P, Soyka M. Decision making and impulsiveness in abstinent alcohol-dependent people and healthy individuals: a neuropsychological examination. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2015; 10:24. [PMID: 26082020 PMCID: PMC4477592 DOI: 10.1186/s13011-015-0020-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 06/10/2015] [Indexed: 11/25/2022]
Abstract
Background Alcohol dependence is associated with deficits in decision making and increased impulsiveness. Therefore, we compared decision making in abstinent alcohol-dependent people (“abstainers”) and matched healthy individuals (“comparison group”) to determine whether impulsiveness or personality traits play a role in decision making. Methods Abstainers (n = 40) were recruited from treatment facilities in and around Munich, Germany, and the comparison group (n = 40) through personal contacts and social media. We assessed decision making with the Iowa Gambling Task (IGT), impulsiveness with the Barratt Impulsiveness Scale (BIS-11) and personality traits with the NEO Five-Factor Inventory (NEO-FFI). Results The comparison group performed significantly better in the IGT (mean profit € 159.50, SD 977.92) than the abstainers (mean loss - € 1,400.13, SD 1,362.10; p < .001) and showed significantly less impulsiveness in the BIS-11 (comparison group: mean 56.03, SD 7.80; abstainers: mean 63.55, SD 11.47; p < .001). None of the five personality traits assessed with the NEO-FFI differed significantly between the groups. Conclusion The results confirm that abstinent alcohol-dependent people do not perform as well as healthy individuals in decision-making tasks and show greater impulsiveness, but in this study did not affect their decision-making ability.
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Affiliation(s)
- Natalie Körner
- Algesiologikum GmbH, Heßstrasse 22, 80799, Munich, Germany.
| | - Peggy Schmidt
- Privatklinik Meiringen, Postfach 612, Willigen, CH-3680, Meiringen, Switzerland.
| | - Michael Soyka
- Privatklinik Meiringen, Postfach 612, Willigen, CH-3680, Meiringen, Switzerland. .,Department of Psychiatry, Ludwig Maximilian University, Nussbaumstr. 7, 80336, Munich, Germany.
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31
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Murray DE, Durazzo TC, Mon A, Schmidt TP, Meyerhoff DJ. Brain perfusion in polysubstance users: relationship to substance and tobacco use, cognition, and self-regulation. Drug Alcohol Depend 2015; 150:120-8. [PMID: 25772434 PMCID: PMC4387082 DOI: 10.1016/j.drugalcdep.2015.02.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 02/17/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Brain perfusion is altered in both alcohol dependence and stimulant dependence. Although most substance users also abuse/depend on alcohol concurrently (polysubstance users; PSU), rigorous perfusion research in PSU is limited. Also, the relationships of perfusion abnormalities with cognition, impulsivity, or decision making are not well known. METHODS Arterial spin labeling MRI and neuropsychological measures assessed perfusion levels and neurocognition in 20 alcohol-dependent individuals with comorbid-stimulant dependence (PSU), 26 individuals dependent on alcohol only (ALC), and 31 light/non-drinking controls (LD). The patient groups included smokers and non-smokers. RESULTS ALC had lower perfusion than LD in subcortical and cortical brain regions including the brain reward/executive oversight system (BREOS). Contrary to our hypothesis, regional perfusion was generally not lower in PSU than ALC. However, smoking PSU had lower perfusion than smoking ALC in several regions, including BREOS. Lower BREOS perfusion related to greater drinking severity in smoking substance users and to greater smoking severity in smoking ALC. Lower regional perfusion in ALC and PSU correlated with worse performance in different cognitive domains; smoking status affected perfusion-cognition relationships in ALC only. Lower BREOS perfusion in both substance using groups related to higher impulsivity. CONCLUSION Although regional perfusion was not decreased in PSU as a group, the combination of cigarette smoking and polysubstance use is strongly related to hypoperfusion in important cortical and subcortical regions. As lower perfusion relates to greater smoking severity, worse cognition and higher impulsivity, smoking cessation is warranted for treatment-seeking PSU and ALC.
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Affiliation(s)
- Donna E. Murray
- Center for Imaging of Neurodegenerative Diseases (CIND), San Francisco VA Medical Center, San Francisco, CA,Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA,Please send correspondence to: Donna E. Murray, Center for Imaging of Neurodegenerative Diseases (114M), San Francisco VA Medical Center, 4150 Clement Street (114M), San Francisco, CA 94121, USA, Office: 415-221-4810 x2553, Fax: 415-668-2864,
| | - Timothy C. Durazzo
- Center for Imaging of Neurodegenerative Diseases (CIND), San Francisco VA Medical Center, San Francisco, CA,Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Anderson Mon
- School of Applied Sciences and Statistics, Koforidua Polytechnic, Ghana
| | - Thomas P. Schmidt
- Center for Imaging of Neurodegenerative Diseases (CIND), San Francisco VA Medical Center, San Francisco, CA,Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Dieter J. Meyerhoff
- Center for Imaging of Neurodegenerative Diseases (CIND), San Francisco VA Medical Center, San Francisco, CA,Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
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32
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Delay Discounting, Treatment Motivation and Treatment Retention Among Substance-Dependent Individuals Attending an in Inpatient Detoxification Program. J Subst Abuse Treat 2015; 49:58-64. [DOI: 10.1016/j.jsat.2014.08.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/20/2014] [Accepted: 08/25/2014] [Indexed: 11/22/2022]
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Dom G, Wojnar M, Crunelle CL, Thon N, Bobes J, Preuss UW, Addolorato G, Seitz HK, Wurst FM. Assessing and treating alcohol relapse risk in liver transplantation candidates. Alcohol Alcohol 2015; 50:164-72. [PMID: 25557607 DOI: 10.1093/alcalc/agu096] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In Europe between 30 and 50% of all liver transplantations (LTX) are done within the context of chronic end-stage alcoholic liver disease (ALD). However, post-operatively 20-25% of these patients lapse or relapse into heavy alcohol use. Thus, assessment of alcohol relapse risk before enlisting and therapeutic follow-up during and after LTX is of utmost importance. However, as yet there are enormous differences between European countries and between transplant centers, with regard to the assessment methods and criteria and the implementation of therapeutic follow-up. Only the so-called '6-month abstinence' rule is widely used. However, there are not much scientific data validating its use in predicting relapse. Thus, there is a clear need of a more homogeneous approach, which was the focus of a symposium of the European Federation of Addiction Societies during the 14th conference of the European Society for Biomedical Research on Alcoholism, 2013 (ESBRA), entitled 'Liver transplantation: A European perspective'. In a follow-up on this symposium, the authors aim to sum up the evidence of psychiatric assessment criteria and psychiatric treatment interventions relevant in the context of patient selection and patient follow-up within ALD transplantation procedures. Based upon these findings, we propose elements of a procedure that can serve as a first step toward a model of good practice regarding addiction-specialist input within the pre- and post-transplantation period.
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Affiliation(s)
- G Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerpen, Belgium
| | - M Wojnar
- Medical University of Warsaw, Warszawa, Poland
| | - C L Crunelle
- Collaborative Antwerp Psychiatric Research Institute (CAPRI) & Department of Toxicology, Antwerp University (UA), Antwerpen, Belgium
| | - N Thon
- Universitätsklinik für Psychiatrie und Psychotherapie II, Salzburg, Austria
| | - J Bobes
- University of Oviedo, CIBERSAM, Oviedo, Spain
| | - U W Preuss
- Hospital of Prignitz, Perleberg, Germany
| | - G Addolorato
- Catholic University of Rome & Gemelli Hospital, Rome, Italy
| | - H K Seitz
- Center of Alcohol Research, Liver Disease and Nutrition, Salem Medical Center, Heidelberg, Germany
| | - F M Wurst
- Universitätsklinik für Psychiatrie und Psychotherapie II, Christian-Doppler-Klinik & Gemeinnützige Salzburger Landeskliniken Betriebsgesellschaft mbH, Salzburg, Austria
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Stevens L, Roeyers H, Dom G, Joos L, Vanderplasschen W. Impulsivity in cocaine-dependent individuals with and without attention-deficit/hyperactivity disorder. Eur Addict Res 2015; 21:131-43. [PMID: 25675959 DOI: 10.1159/000369008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 10/12/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cocaine-dependent individuals (CDI) display increased impulsivity. However, despite its multifactorial nature most studies in CDI have treated impulsivity monolithically. Moreover, the impact of attention-deficit/hyperactivity disorder (ADHD) has often not been taken into account. This study investigates whether CDI with ADHD (CDI+ADHD) differ from CDI without an ADHD diagnosis and healthy controls (HC) on several impulsivity measures. METHODS Thirty-four CDI, 25 CDI+ADHD and 28 HC participated in this study. Trait impulsivity was assessed with the motor, attentional and non-planning subscales of the Barratt Impulsiveness Scale (BIS-11). Neurocognitive dimensions of impulsivity were examined with the stop signal task (SST), delay discounting task (DDT) and information sampling task (IST). RESULTS Relative to HC, both CDI and CDI+ADHD scored higher on all BIS-11 subscales, required more time to inhibit their responses (SST) and sampled less information before making a decision (IST). Greater discounting of delayed rewards (DDT) was only found among CDI+ADHD. Compared to CDI without ADHD, CDI+ADHD scored higher on the BIS-11 non-planning and total scale and showed higher discounting rates. CONCLUSION CDI score higher on several indices of impulsivity relative to HC, regardless of whether they have concomitant ADHD or not. CDI+ADHD are specifically characterized by a lack of future orientation compared to CDI without ADHD. © 2015 S. Karger AG, Basel.
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Affiliation(s)
- Laura Stevens
- Department of Orthopedagogics, Ghent University, Ghent, Belgium
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35
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Temperament and impulsivity predictors of smoking cessation outcomes. PLoS One 2014; 9:e112440. [PMID: 25474540 PMCID: PMC4256301 DOI: 10.1371/journal.pone.0112440] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 10/15/2014] [Indexed: 11/19/2022] Open
Abstract
AIMS Temperament and impulsivity are powerful predictors of addiction treatment outcomes. However, a comprehensive assessment of these features has not been examined in relation to smoking cessation outcomes. METHODS Naturalistic prospective study. Treatment-seeking smokers (n = 140) were recruited as they engaged in an occupational health clinic providing smoking cessation treatment between 2009 and 2013. Participants were assessed at baseline with measures of temperament (Temperament and Character Inventory), trait impulsivity (Barratt Impulsivity Scale), and cognitive impulsivity (Go/No Go, Delay Discounting and Iowa Gambling Task). The outcome measure was treatment status, coded as "dropout" versus "relapse" versus "abstinence" at 3, 6, and 12 months endpoints. Participants were telephonically contacted and reminded of follow-up face to face assessments at each endpoint. The participants that failed to answer the phone calls or self-reported discontinuation of treatment and failed to attend the upcoming follow-up session were coded as dropouts. The participants that self-reported continuing treatment, and successfully attended the upcoming follow-up session were coded as either "relapse" or "abstinence", based on the results of smoking behavior self-reports cross-validated with co-oximetry hemoglobin levels. Multinomial regression models were conducted to test whether temperament and impulsivity measures predicted dropout and relapse relative to abstinence outcomes. RESULTS Higher scores on temperament dimensions of novelty seeking and reward dependence predicted poorer retention across endpoints, whereas only higher scores on persistence predicted greater relapse. Higher scores on the trait dimension of non-planning impulsivity but not performance on cognitive impulsivity predicted poorer retention. Higher non-planning impulsivity and poorer performance in the Iowa Gambling Task predicted greater relapse at 3 and 6 months and 6 months respectively. CONCLUSION Temperament measures, and specifically novelty seeking and reward dependence, predict smoking cessation treatment retention, whereas persistence, non-planning impulsivity and poor decision-making predict smoking relapse.
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Decision-making impairment predicts 3-month hair-indexed cocaine relapse. Psychopharmacology (Berl) 2014; 231:4179-87. [PMID: 24728653 DOI: 10.1007/s00213-014-3563-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/24/2014] [Indexed: 01/18/2023]
Abstract
RATIONALE One of the key outstanding challenges in cocaine dependence research is determining who is at risk of relapsing during treatment. OBJECTIVES We examined whether cognitive decision-making profiles predict objectively (hair) indexed cocaine relapse at 3-month follow-up. METHODS Thirty-three cocaine-dependent patients commencing outpatient treatment in a public clinic performed baseline decision-making assessments with the original and variant versions of the Iowa Gambling Task, and provided a 3-cm hair sample 3 months afterwards. Based on Iowa Gambling Tasks' performance cut-offs, 5 patients had intact decision-making skills, 17 patients showed impaired sensitivity to reward or punishment (impairment in one of the tasks), and 9 patients showed insensitivity to future consequences (impairment in both tasks). Based on a 0.3 ng/mg cocaine cut-off, 23 patients were classified as relapsers and 10 as non-relapsers at the 3-month follow-up. RESULTS Eighty percent of patients with intact decision-making were abstinent at follow-up, whereas 90% of patients with insensitivity to future consequences had relapsed. The two subgroups (relapsers and non-relapsers) showed no significant differences on drug use, comorbidities, or psychosocial function, and significantly differed on verbal but not performance IQ. A regression model including decision-making scores and verbal IQ predicted abstinence status with high sensitivity (95%) and moderately high specificity (81%). CONCLUSION These preliminary findings demonstrate that decision-making profiles are associated with cocaine relapse. Moreover, combined decision-making and IQ assessments provide optimal predictive values over stimulant relapse, yielding significant opportunities for clinical translation.
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Stevens L, Verdejo-García A, Goudriaan AE, Roeyers H, Dom G, Vanderplasschen W. Impulsivity as a vulnerability factor for poor addiction treatment outcomes: a review of neurocognitive findings among individuals with substance use disorders. J Subst Abuse Treat 2014; 47:58-72. [PMID: 24629886 DOI: 10.1016/j.jsat.2014.01.008] [Citation(s) in RCA: 213] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 12/20/2013] [Accepted: 01/21/2014] [Indexed: 01/10/2023]
Abstract
With the current review, we explore the hypothesis that individual differences in neurocognitive aspects of impulsivity (i.e., cognitive and motor disinhibition, delay discounting and impulsive decision-making) among individuals with a substance use disorder are linked to unfavorable addiction treatment outcomes, including high drop-out rates and difficulties in achieving and maintaining abstinence. A systematic review of the literature was carried out using PubMed, PsycINFO and Web of Knowledge searches. Twenty-five unique empirical papers were identified and findings were considered in relation to the different impulsivity dimensions. Although conceptual/methodological heterogeneity and lack of replication are key limitations of studies in this area, findings speak for a prominent role of cognitive disinhibition, delay discounting and impulsive decision-making in the ability to successfully achieve and maintain abstinence during and following addiction treatment. In contrast, indices of motor disinhibition appear to be unrelated to abstinence levels. Whereas the relationship between impulsivity and treatment retention needs to be examined more extensively, preliminary evidence suggests that impulsive/risky decision-making is unrelated to premature treatment drop-out among individuals with a substance use disorder. The reviewed findings are discussed in terms of their clinical implications.
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Affiliation(s)
- Laura Stevens
- Department of Orthopedagogics, Ghent University, Belgium.
| | - Antonio Verdejo-García
- Department of Clinical Psychology, Universidad de Granada, Spain; Institute of Neuroscience F. Olóriz, Universidad de Granada, Spain; School of Psychology and Psychiatry, Monash University, Melbourne, Victoria
| | - Anna E Goudriaan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands; Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Herbert Roeyers
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | - Geert Dom
- Psychiatric Centre Alexian Brothers, Boechout, Belgium; Collaborative Antwerp Psychiatry Research Institute (CAPRI), Antwerp, Belgium
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Moreno-López L, Albein-Urios N, Martinez-Gonzalez JM, Soriano-Mas C, Verdejo-García A. Prefrontal Gray Matter and Motivation for Treatment in Cocaine-Dependent Individuals with and without Personality Disorders. Front Psychiatry 2014; 5:52. [PMID: 24904436 PMCID: PMC4032993 DOI: 10.3389/fpsyt.2014.00052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 04/29/2014] [Indexed: 11/13/2022] Open
Abstract
Addiction treatment is a long-term goal and therefore prefrontal-striatal regions regulating goal-directed behavior are to be associated with individual differences on treatment motivation. We aimed at examining the association between gray matter volumes in prefrontal cortices and striatum and readiness to change at treatment onset in cocaine users with and without personality disorders. Participants included 17 cocaine users without psychiatric comorbidities, 17 cocaine users with Cluster B disorders, and 12 cocaine users with Cluster C disorders. They completed the University of Rhode Island Change Assessment Scale, which measures four stages of treatment change (precontemplation, contemplation, action, and maintenance) and overall readiness to change, and were scanned in a 3 T MRI scanner. We defined three regions of interest (ROIs): the ventromedial prefrontal cortex (including medial orbitofrontal cortex and subgenual and rostral anterior cingulate cortex), the dorsomedial prefrontal cortex (i.e., superior medial frontal cortex), and the neostriatum (caudate and putamen). We found that readiness to change correlated with different aspects of ventromedial prefrontal gray matter as a function of diagnosis. In cocaine users with Cluster C comorbidities, readiness to change positively correlated with gyrus rectus gray matter, whereas in cocaine users without comorbidities it negatively correlated with rostral anterior cingulate cortex gray matter. Moreover, maintenance scores positively correlated with dorsomedial prefrontal gray matter in cocaine users with Cluster C comorbidities, but negatively correlated with this region in cocaine users with Cluster B and cocaine users without comorbidities. Maintenance scores also negatively correlated with dorsal striatum gray matter in cocaine users with Cluster C comorbidities. We conclude that the link between prefrontal-striatal gray matter and treatment motivation is modulated by co-existence of personality disorders.
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Affiliation(s)
- Laura Moreno-López
- Department of Personality, Evaluation and Psychological Treatment, University of Granada , Granada , Spain
| | - Natalia Albein-Urios
- Department of Personality, Evaluation and Psychological Treatment, University of Granada , Granada , Spain
| | - José Miguel Martinez-Gonzalez
- Red de Trastornos Adictivos, University of Granada , Granada , Spain ; Centro Provincial de Drogodependencias, Diputación de Granada , Granada , Spain
| | - Carles Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona , Spain ; Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) , Madrid , Spain
| | - Antonio Verdejo-García
- Department of Personality, Evaluation and Psychological Treatment, University of Granada , Granada , Spain ; Red de Trastornos Adictivos, University of Granada , Granada , Spain ; Institute of Neurosciences Federico Olóriz, University of Granada , Granada , Spain ; School of Psychological Sciences, Monash University , Melbourne, VIC , Australia
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40
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Xiao L, Koritzky G, Johnson CA, Bechara A. The cognitive processes underlying affective decision-making predicting adolescent smoking behaviors in a longitudinal study. Front Psychol 2013; 4:685. [PMID: 24101911 PMCID: PMC3787307 DOI: 10.3389/fpsyg.2013.00685] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/11/2013] [Indexed: 11/13/2022] Open
Abstract
This study investigates the relationship between three different cognitive processes underlying the Iowa Gambling Task (IGT) and adolescent smoking behaviors in a longitudinal study. We conducted a longitudinal study of 181 Chinese adolescents in Chengdu City, China. The participants were followed from 10th to 11th grade. When they were in the 10th grade (Time 1), we tested these adolescents' decision-making using the IGT and working memory capacity using the Self-ordered Pointing Test (SOPT). Self-report questionnaires were used to assess school academic performance and smoking behaviors. The same questionnaires were completed again at the 1-year follow-up (Time 2). The Expectancy-Valence (EV) Model was applied to distill the IGT performance into three different underlying psychological components: (i) a motivational component which indicates the subjective weight the adolescents assign to gains vs. losses; (ii) a learning-rate component which indicates the sensitivity to recent outcomes vs. past experiences; and (iii) a response component which indicates how consistent the adolescents are between learning and responding. The subjective weight to gains vs. losses at Time 1 significantly predicted current smokers and current smoking levels at Time 2, controlling for demographic variables and baseline smoking behaviors. Therefore, by decomposing the IGT into three different psychological components, we found that the motivational process of weight gain vs. losses may serve as a neuropsychological marker to predict adolescent smoking behaviors in a general youth population.
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Affiliation(s)
- Lin Xiao
- Department of Psychology, Dana and David Dornsife Cognitive Neuroscience Imaging Center, Brain and Creativity Institute, University of Southern California Los Angeles, CA, USA
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De Wilde B, Goudriaan A, Sabbe B, Hulstijn W, Dom G. Relapse in pathological gamblers: A pilot study on the predictive value of different impulsivity measures. J Behav Addict 2013; 2:23-30. [PMID: 26165768 DOI: 10.1556/jba.2.2013.1.4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Backgrounds and aims Pathological gambling, a common psychiatric disorder, has many similarities with substance use disorders. Relapse, an important element in addictive disorders, however, has seldom been studied in pathological gambling. Hence, in analogy with previous research studies examining the role of self-report and neurocognitive measures on relapse in substance dependent patients, the present pilot study was executed. Methods Twenty-two pathological gamblers and 31 healthy controls took part in this research. They filled in self-report questionnaires measuring impulsive personality (Barratt Impulsiveness Scale, Sensitivity to Punishment and Sensitivity to Reward Questionnaires) and performed neurocognitive tasks measuring impulsivity, decision-making and attentional bias (Iowa Gambling Task, Delay Discounting Task, Stroop Gambling Task). Twelve months later gambling activity was re-examined. Results Analyses showed that PGs who relapsed (n = 13) did not differ on self-report and neurocognitive measures of impulsivity with PGs who did not relapse (n = 9). However, both groups did differ in age at onset. Finally, healthy controls and PGs differed in some (Barratt Impulsiveness Scale, Stroop Gambling Task), but not all impulsivity measures (Delay Discounting Task, Iowa Gambling Task, Sensitivity to Punishment and Sensitivity to Reward Questionnaires). Conclusions One-year relapse in pathological gamblers is not predicted by self-report and or neurocognitive measures of impulsivity and decision-making. The similarities in performances between pathological gamblers and healthy controls illustrate the relative health of the examined pathological gamblers. This last finding supports the idea that subtypes of pathological gamblers exist so that different treatment strategies might be necessary.
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Stevens L, Betanzos-Espinosa P, Crunelle CL, Vergara-Moragues E, Roeyers H, Lozano O, Dom G, Gonzalez-Saiz F, Vanderplasschen W, Verdejo-García A, Pérez-García M. Disadvantageous Decision-Making as a Predictor of Drop-Out among Cocaine-Dependent Individuals in Long-Term Residential Treatment. Front Psychiatry 2013; 4:149. [PMID: 24298260 PMCID: PMC3828507 DOI: 10.3389/fpsyt.2013.00149] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 11/02/2013] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The treatment of cocaine-dependent individuals (CDI) is substantially challenged by high drop-out rates, raising questions regarding contributing factors. Recently, a number of studies have highlighted the potential of greater focus on the clinical significance of neurocognitive impairments in treatment-seeking cocaine users. In the present study, we hypothesized that disadvantageous decision-making would be one such factor placing CDI at greater risk for treatment drop-out. METHODS In order to explore this hypothesis, the present study contrasted baseline performance (at treatment onset) on two validated tasks of decision-making, the Iowa Gambling Task (IGT) and the Cambridge Gamble Task (CGT) in CDI who completed treatment in a residential Therapeutic Community (TC) (N = 66) and those who dropped out of TC prematurely (N = 84). RESULTS Compared to treatment completers, CDI who dropped out of TC prematurely did not establish a consistent and advantageous response pattern as the IGT progressed and exhibited a poorer ability to choose the most likely outcome on the CGT. There were no group differences in betting behavior. CONCLUSION Our findings suggest that neurocognitive rehabilitation of disadvantageous decision-making may have clinical benefits in CDI admitted to long-term residential treatment programs.
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Affiliation(s)
- Laura Stevens
- Department of Orthopedagogics, Ghent University , Ghent , Belgium
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De Wilde B, Bechara A, Sabbe B, Hulstijn W, Dom G. Risky Decision-Making but Not Delay Discounting Improves during Inpatient Treatment of Polysubstance Dependent Alcoholics. Front Psychiatry 2013; 4:91. [PMID: 24027538 PMCID: PMC3760441 DOI: 10.3389/fpsyt.2013.00091] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 08/08/2013] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND High levels of impulsivity, characteristics of addicted patients, are known to be important predictors of relapse. However, so far, little is known about the stability or variability of two main components of impulsivity (delay discounting and decision-making). The present study examined the changes in impulsivity during the first week of an abstinence based, behavioral orientated inpatient treatment program. METHOD Thirty-seven polysubstance dependent alcoholics completed the Delay Discounting Task (DDT), and the Iowa Gambling Task (IGT) using the original version with decks A'B'C'D', and an alternative version with decks K'L'M'N', for measuring decision-making, after 2 and 6 weeks of active treatment. RESULTS It was found that performances on the IGT changed during treatment while performances on the DDT did not (test-retest period: 4 weeks). CONCLUSION The results provide preliminary evidence that improvements in decision-making might be related to treatment effects. All patients followed a highly structured cognitive-behavioral treatment program, which might have enhanced their executive functioning (coping skills training).
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Affiliation(s)
- Bieke De Wilde
- Psychiatrisch Centrum Broeders Alexianen , Boechout , Belgium ; Collaborative Antwerp Psychiatric Research Institute, Universiteit Antwerpen , Antwerp , Belgium ; Universiteit Antwerpen , Antwerp , Belgium
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