Episodic foresight deficits in long-term opiate users

Drinking to Cope is Uniquely Associated with Less Specific and Bleaker Future Goal Generation in Young Hazardous Drinkers

Groups with mental health and/or substance use problems generate less detailed descriptions of their future goals. As substance use to cope with negative affect is common to both groups, this characteristic might be uniquely associated with less specific goal descriptions. To test this prediction, 229 past year hazardous drinking undergraduates aged 18-25 years wrote about three positive future life goals in an open-ended survey, before reporting their internalizing (anxiety and depression) symptoms, alcohol dependence severity and motivations for drinking: coping, conformity, enhancement and social. Future goal descriptions were experimenter-rated for detail specificity, and participant-self-rated for positivity, vividness, achievability, and importance. Effort in goal writing was indexed by time spent writing and total word count. Multiple regression analyses revealed that drinking to cope was uniquely associated with the production of less detailed goals, and lower self-rated positivity and vividness of goals (achievability and importance were also marginally lower), over and above internalizing symptoms, alcohol dependence severity, drinking for conformity, enhancement and social motives, age, and gender. However, drinking to cope was not uniquely associated with reduced effort in writing goals: time spent and word count. In sum, drinking to cope with negative affect is a unique characteristic predicting the generation of less detailed and bleaker (less positive and vivid) future goals, and this is not due to lower effort in reporting. Future goal generation may play a role in the aetiology of comorbidity of mental health and substance use problems, and therapeutic targeting of goal generation might benefit both conditions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10862-023-10032-0.

Prospective Memory, Sustained Attention and Response Inhibition in Poly-Substance Users Stable on Methadone Maintenance Treatment

Background: Prospective memory and response inhibition are interrelated constructs, though studied separately in the drug addiction literature. Also, although sustained attention underlies response inhibition, its role in the relation between these functions has been largely neglected. The limited research on the cognitive effects of methadone-maintenance treatment (MMT) further stresses the importance of investigating these effects. Objective: Therefore, the current study focused on possible effects of MMT combined with long-term drug abuse on all these functions. Thirty five long term opiate/poly-substance users in MMT and thirty four drug-free controls were screened for socioeconomic status, anxiety, depression and general, non-verbal intelligence and then tested on a self-report measure of prospective memory and on the Go/No-Go task. Results: Compared to controls, the MMT group scored worse in all functions assessed. Prospective memory scores were also negatively related to Go/NoGo accuracy scores. Conclusion: As predicted, (a) the MMT participants show impairments in prospective memory, sustained attention and response inhibition and (b) prospective memory, response inhibition and sustained attention are related constructs. The results of this study could inform current rehabilitation and relapse prevention cognitive training practices.

How do cannabis users mentally travel in time? Evidence from an fMRI study of episodic future thinking

RATIONALE

Episodic future thinking (EFT) is a cognitive function that allows individuals to imagine novel experiences that may happen in the future. Prior studies show that EFT is impaired in different groups of substance users. However, there is no evidence regarding the neurobiological mechanisms of EFT in cannabis users.

OBJECTIVES

We aimed to compare brain activations of regular cannabis users and non-using controls during an EFT fMRI task. Exploratory analyses were also conducted to investigate the association between EFT and cannabis use variables (e.g., duration of use, age onset, frequency of use).

METHODS

Twenty current cannabis users and 22 drug-naïve controls underwent an fMRI scanning session while completing a task involving envisioning future-related events and retrieval of past memories as a control condition. The EFT fMRI task was adapted from the autobiographical interview and composed of 20 auditory cue sentences (10 cues for past and 10 cues for future events). Participants were asked to recall a past or generate a future event, in response to the cues, and then rate their vividness after each response.

RESULTS

We found that cannabis users compared to non-user controls had lower activation within the cerebellum, medial and superior temporal gyrus, lateral occipital cortex, and occipital fusiform gyrus while envisioning future events. Cannabis users rated the vividness of past events significantly lower than non-users (P < 0.005). There were marginal group differences for rating the vividness of future events (P = 0.052). Significant correlations were also found between the medial and superior temporal gyrus activities and behavioral measures of EFT and episodic memory.

CONCLUSIONS

Cannabis users, compared to drug-naïve controls, have lower brain activation in EFT relevant regions. Thus, any attempts to improve aberrant EFT performance in cannabis users may benefit from EFT training.

Effects of episodic future thinking on reinforcement pathology during smoking cessation treatment among individuals with substance use disorders

RATIONALE

Reinforcer pathology (RP) is a theoretical model based on two processes: delay discounting (DD) and drug demand. Given that RP has been shown to have a predictive value on smoking behaviors, several studies have explored which interventions can reduce RP. Consistent with the RP framework, episodic future thinking (EFT) has shown effects on treatment outcomes and RP processes. The vast majority of studies that assess the effects of EFT on RP consist of experimental studies, and no previous research has tested these effects in a clinical sample of smokers.

OBJECTIVES

The primary aim of this study was to assess the effects of EFT on RP throughout the course of a smoking cessation intervention in smokers with substance use disorders (SUDs).

METHODS

Participants were randomized to cognitive behavior therapy (CBT) + EFT (n = 39) or CBT + EFT + contingency management (n = 33). Cotinine, frequency of EFT practices, cigarette purchase task (CPT), and DD were evaluated in treatment sessions. Mixed-effects model repeated measures analysis was used to explore DD and CPT in-treatment changes as a function of EFT practices and cotinine levels.

RESULTS

Greater practice of the EFT component significantly reduced cigarette demand (p < .020) as well as DD (p = .003). Additionally, a greater reduction in cotinine levels coupled with greater EFT practice led to a greater decrease in cigarette demand (p < .014).

CONCLUSIONS

EFT reduced the two facets of RP in treatment-seeking smokers with SUDs.

Deficits in episodic future thinking following acute alcohol consumption

RATIONALE

Acute alcohol consumption adversely affects many cognitive abilities, including episodic memory and executive functioning. However, no study to date has tested whether these acute effects of alcohol also extend to episodic future thinking (EFT). This is a surprising omission given that EFT refers to the ability to imagine oneself experiencing the future, a highly adaptive ability that has been implicated in many important functional behaviours. EFT is also thought to impose demands on episodic memory and executive control.

OBJECTIVES

The current study was designed to provide the first test of whether a moderate dose of alcohol influences EFT and whether any observed EFT difficulties are secondary to broader problems in episodic memory and executive functioning. Sex differences in EFT following acute alcohol consumption were also examined.

METHODS

One hundred and twenty-four healthy adult social drinkers were recruited and randomly assigned to either the alcohol (n = 61) or placebo (n = 63) condition. Participants were administered a dose of 0.6 g/kg alcohol or a matched placebo drink.

RESULTS

Relative to the placebo condition, EFT was impaired by acute alcohol consumption. This impairment was underpinned by broader difficulties with episodic memory, but not executive functioning. There were no sex differences in EFT performance following acute alcohol use.

CONCLUSION

These data provide novel insights into the effects of acute alcohol consumption on EFT and the broader cognitive mechanisms that contribute to these difficulties. The results are discussed in relation to their implications for understanding many of the maladaptive behaviours commonly associated with acute alcohol use.

Alcohol use disorder and cannabis use disorder symptomatology in adolescents is associated with dysfunction in neural processing of future events

Two of the most commonly used substances by adolescents in the United States are cannabis and alcohol. Cannabis use disorder (CUD) and alcohol use disorder (AUD) are associated with impairments in decision-making processes. One mechanism for impaired decision-making in these individuals is thought to be an inability to adequately represent future events during decision-making. In the current study involving 112 adolescents, we used a comparative optimism task to examine the relationship between relative severity of CUD/AUD (as indexed by the CUD/AUD Identification Tests [CUDIT/AUDIT]) and atypical function within neural systems underlying affect-based neural represenation future events. Greater CUDIT scores were negatively related to responses within subgenual anterior and posterior cingulate cortex when processing high-intensity potential future positive and negative events. There was also a particularly marked negative relationship between CUD symptoms and blood oxygen level-dependent (BOLD) responses within visual and premotor cortices to high-intensity, negatively valenced potential future events. However, AUD symptom severity was not associated with dysfunction within these brain regions. These data indicate that relative risk/severity of CUD is associated with reduced responsiveness to future high-intensity events. This may impair decision-making where future significant consequences should guide response choice.

Classification of general and personal semantic details in the Autobiographical Interview

The Autobiographical Interview (AI) separates internal (episodic) and external (non-episodic) details from transcribed protocols using an exhaustive and reliable scoring system. While the details comprising the internal composite are centered on elements of episodic memory, external details are more heterogeneous as they are meant to capture a variety of non-episodic utterances: general semantics, different types of personal semantics details, metacognitive statements, repetitions, and details about off topic events. Elevated external details are consistently observed in aging and in neurodegenerative diseases. In the present study, we augmented the AI scoring system to differentiate subtypes of external details to test whether the elevation of these details in aging and in frontotemporal lobar degeneration (including mixed frontotemporal/semantic dementia [FTD/SD] and progressive non-fluent aphasia [PNFA]) would be specific to general and personal semantics or would concern all subtypes. Specifically, we separated general semantic details from personal semantic details (including autobiographical facts, self-knowledge, and repeated events). With aging, external detail elevation was observed for general and personal semantic details but not for other types of external details. In frontotemporal lobar degeneration, patients with FTD/SD (but not PNFA) generated an excess of personal semantic details but not general semantic details. The increase in personal but not general semantic details in FTD/SD is consistent with prevalent impairment of general semantic memory in SD, and with the personalization of concepts in this condition. Under standard AI instructions, external details were intended to capture off-topic utterances and were not intended as a direct measure of semantic abilities. Future investigations concerned with semantic processing in aging and in dementia could modify standard instructions of the AI to directly probe semantic content.

Let's Open the Decision-Making Umbrella: A Framework for Conceptualizing and Assessing Features of Impaired Decision Making in Addiction

Decision-making impairments play a pivotal role in the emergence and maintenance of addictive disorders. However, a sound conceptualization of decision making as an umbrella construct, encompassing its cognitive, affective, motivational, and physiological subcomponents, is still lacking. This prevents an efficient evaluation of the heterogeneity of decision-making impairments and the development of tailored treatment. This paper thus unfolds the various processes involved in decision making by adopting a critical approach of prominent dual- or triadic-process models, which postulate that decision making is influenced by the interplay of impulsive-automatic, reflective-controlled, and interoceptive processes. Our approach also focuses on social cognition processes, which play a crucial role in decision making and addictive disorders but were largely ignored in previous dual- or triadic-process models. We propose here a theoretical framework in which a range of coordinated processes are first identified on the basis of their theoretical and clinical relevance. Each selected process is then defined before reviewing available results underlining its role in addictive disorders (i.e., substance use, gambling, and gaming disorders). Laboratory tasks for measuring each process are also proposed, initiating a preliminary process-based decision-making assessment battery. This original approach may offer an especially informative view of the constitutive features of decision-making impairments in addiction. As prior research has implicated these features as risk factors for the development and maintenance of addictive disorders, our processual approach sets the scene for novel and transdiagnostic experimental and applied research avenues.

Not all drugs are created equal: impaired future thinking in opiate, but not alcohol, users

Episodic future thinking refers to the ability to travel forward in time to pre-experience an event. Although future thinking has been intimately linked with self and identity, to our knowledge, no prior research has compared episodic future thinking in populations with different substance use disorders. This study investigates whether there are differences in episodic future thinking between these alcohol and opiate users. The study recruited participants who were on the opiate substitution program (n = 31) and individuals who had been diagnosed with alcohol dependence (n = 21) from the Royal Prince Alfred Hospital Drug and Health Services. Healthy controls (n = 23) were recruited via Royal Prince Alfred Hospital databases and the general community. Past and future thinking was measured using four cue words. After each cue word, participants rated their phenomenological experience (e.g. emotion, reliving experience). Results indicated that alcohol-dependent individuals performed significantly higher in episodic future thinking compared to opiate users. These findings indicate that not all substance use disorder groups share similar episodic thinking capabilities. Our results suggest that the self-projection component of rehabilitation programs may have to be tailored to the different episodic construction abilities found in substance use disorder groups.

Episodic foresight deficits in regular, but not recreational, cannabis users

BACKGROUND

Cannabis use is associated with a range of neurocognitive deficits, including impaired episodic memory. However, no study to date has assessed whether these difficulties extend to episodic foresight, a core component of which is the ability to mentally travel into one's personal future. This is a particularly surprising omission given that episodic memory is considered to be critical to engage episodic foresight.

AIMS

In the present study, we provide the first test of how episodic foresight is affected in the context of differing levels of cannabis use, and the degree to which performance on a measure of this construct is related to episodic memory.

RESULTS

Fifty-seven regular cannabis users (23 recreational, 34 regular) and 57 controls were assessed using an adapted version of the Autobiographical Interview. The results showed that regular-users exhibited greater impairment of episodic foresight and episodic memory than both recreational-users and cannabis-naïve controls.

CONCLUSIONS

These data therefore show for the first time that cannabis-related disruption of cognitive functioning extends to the capacity for episodic foresight, and they are discussed in relation to their potential implications for functional outcomes in this group.

Addictive behaviors: Why and how impaired mental time matters?

Mental time travel (MTT) allows navigation into the past, the future, and the minds of others, and it subserves future-oriented decision-making. Impaired MTT has been associated with a tendency to over-rely on the present, which is a characteristic of addictive behaviors. We here discuss the possible relationship between impaired autographical memory, future-oriented MTT, shortened time horizons, suboptimal social cognition, and poor decision-making in individuals with drug and gambling use disorders. We elaborate on how impaired MTT could compromise the process of change in addiction recovery and the effectiveness of psychotherapy. We argue that facilitating MTT represents, for individuals with addictive behaviors, an important process to enhance readiness to change, and to improve the quality and the efficiency of psychosocial interventions that focus on "emotional correction."

Episodic Tags Enhance Striatal Valuation Signals during Temporal Discounting in pathological Gamblers

Similar to many addiction disorders, pathological gambling is associated with an increased preference for immediate rewards (steep temporal discounting). In healthy participants, episodic future thinking has been shown to reduce impulsivity during intertemporal choice. Here, we examine for the first time a modulation of temporal discounting via episodic future thinking in a group of pathological gamblers. We investigated a sample of 24 pathological gamblers and 24 matched healthy controls with functional magnetic resonance imaging (fMRI). Participants made intertemporal choices in two experimental conditions. In the control condition, delayed monetary rewards were offered with the respective amount and delay. In the episodic condition, rewards were additionally associated with participant-specific personal future events. We replicated previous findings of increased temporal discounting in pathological gambling. On a trend level, episodic future thinking attenuated discounting across all participants. We found that pathological gamblers could successfully recruit a prospection related network during decision-making in the presence of episodic information. The episodic condition modulated the functional connection between ventromedial prefrontal cortex (vmPFC) and ventral striatum, a mechanism that might support the increase in striatal value coding observed in the episodic condition in gamblers. However, in controls, but not in gamblers, valuation signal changes in the hippocampus were associated with less impulsive behavior. We provide first evidence that by episodic cues during intertemporal decision-making striatal valuation signals can be enhanced in pathological gamblers. Further research is needed to explore interventions that reliably reduce impulsive choice behavior in pathological gambling.

Future-oriented mental time travel in individuals with disordered gambling

This study investigated the ability of individuals with disordered gambling to imagine future events. Problem gamblers (n=35) and control participants (n=35) were asked to imagine positive and negative future events for three temporal distances (one week, one year, 5-10years). Then, a variety of phenomenological aspects of their future thoughts (e.g., sensory and contextual details, autonoetic consciousness) were rated. Compared to control subjects, problem gamblers generated fewer positive and negative events across all temporal distances, an impairment that was correlated to verbal fluency scores. Furthermore, problem gamblers rated imagined events as containing fewer sensory and contextual details, and lacking autonoetic consciousness. These findings demonstrate that problem gambling is associated with a reduced future-oriented mental time travel ability and, in particular, with diminished autonoetic consciousness when imagining future events.

Acting with the future in mind is impaired in long-term opiate users

RATIONALE

Episodic foresight is a fundamental human capacity. It refers to the ability to simulate future situations and organise current actions accordingly. While there is some evidence that opiate users have a reduced capacity to imagine themselves in future situations, no study to date has assessed whether opiate users show deficits in the ability to take steps in the present in anticipation of future needs.

OBJECTIVE

In this study, we assessed whether this functional aspect of episodic foresight is impaired in chronic opiate users and the extent to which any deficits are associated with executive dysfunction.

METHODS AND RESULTS

Participants were 33 long-term opiate users enrolled in an opiate substitution program and 34 controls. Relative to controls, the opiate users displayed significant impairment (medium effect size η ²_p = 0.08) in the two behavioural measures of episodic foresight used (items acquired and items used in the VW Foresight task). Furthermore, executive functioning was associated with foresight ability, although this was restricted to items acquired, and the associations were generally stronger for the control group.

CONCLUSIONS

These data provide important evidence suggesting that the functional aspect of episodic foresight is disrupted in long-term opiate users. While these deficits appear to have some links to impaired executive control, additional work is needed to gain a more complete understanding of the underlying cognitive and neural mechanisms involved. This, in turn, will have important implications for tailoring interventions with opiate users to maximise the likelihood of successful independent functioning.

Prospection and the Present Moment: The Role of Episodic Foresight in Intertemporal Choices between Immediate and Delayed Rewards

Humans are capable of imagining future rewards and the contexts in which they may be obtained. Functionally, intertemporal choices between smaller but immediate and larger but delayed rewards may be made without such episodic foresight. However, we propose that explicit simulations of this sort enable more flexible and adaptive intertemporal decision-making. Emotions triggered through the simulation of future situations can motivate people to forego immediate pleasures in the pursuit of long-term rewards. However, we stress that the most adaptive option need not always be a larger later reward. When the future is anticipated to be uncertain, for instance, it may make sense for preferences to shift toward more immediate rewards, instead. Imagining potential future scenarios and assessment of their likelihood and affective consequences allows humans to determine when it is more adaptive to delay gratification in pursuit of a larger later reward, and when the better strategy is to indulge in a present temptation. We discuss clinical studies that highlight when and how the effect of episodic foresight on intertemporal decision-making can be altered, and consider the relevance of this perspective to understanding the nature of self-control.

The Role of Prospection in Steep Temporal Reward Discounting in Gambling Addiction

Addiction and pathological gambling (PG) have been consistently associated with high impulsivity and a steep devaluation of delayed rewards, a process that is known as temporal discounting (TD). Recent studies indicated that enhanced episodic future thinking (EFT) results in less impulsive TD in healthy controls (HCs). In a separate line of research, it has been suggested that non-linearities in time perception might contribute to reward devaluation during inter-temporal choice. Therefore, in addition to deficits in valuation processes and executive control, impairments in EFT and non-linearities in time perception have been hypothesized to contribute to steep TD in addiction. In this study, we explore such a potential association of impairments in EFT and time perception with steep TD in PG. We investigated 20 PGs and 20 matched HCs. TD was assessed via a standard computerized binary choice task. EFT was measured using a variation of the Autobiographical Memory Interview by Levine et al. (1). Time perception was assessed with a novel task, utilizing a non-linear rating procedure via circle-size adjustments. Groups did not differ in baseline EFT. In both groups, a power law accounted time perception best, and the degree of non-linearity in time perception correlated with discounting across groups. A multiple regression analysis across all predictors and covariates revealed that only group status (PG/HC) and depression were significantly associated with discounting behavior such that PG increased TD and depression attenuated TD. Our findings speak against the idea that steep TD in PG is due to a skewed perception of time or impairments in EFT, at least under the present task conditions. The lack of overall group differences in EFT does not rule out the possibility of more complex interactions of EFT and decision-making. These interactions might be diminished in pathological gambling or addiction more generally, when other task configurations are used.