Impulsive decision-making predicts the course of substance-related and addictive disorders

Self-Control Abilities in Specific Types of Problematic Usage of the Internet: Findings From Clinically Validated Samples With Neurocognitive Tasks

OBJECTIVE

Reduced cognitive functions are commonly associated with diminished self-control abilities. Research on cognitive functions in gaming disorder and other specific types of problematic usage of the Internet (PUI) remains rare. The aim of this study was to compare performance in different cognitive domains between clinically validated groups of individuals with and without specific PUI.

METHODS

The data, from a large-scale multicenter study in Germany, were collected between October 2021 and August 2024. The study compared three groups: Internet users with pathological use (N=284), risky use (N=305), and nonproblematic use (N=424). Grouping was based on structured interviews for four types of specific PUI (gaming, buying-shopping, pornography use, social network use). All participants underwent extensive laboratory testing, including self-report scales and standard cognitive tasks: Modified Card Sorting Test, Stroop test, a logical reasoning test, Game of Dice Task, a delay discounting task, and a go/no-go task with Internet-related stimuli.

RESULTS

The groups differed significantly regarding both behavioral (partial eta2 ≤0.06) and self-report measures (partial eta2 ≤0.14) of self-control abilities. The group with pathological use showed the weakest mean performance in all tasks. The groups with risky and nonproblematic use barely differed in behavioral measures but did differ in self-reported self-directedness and attentional impulsivity. Post hoc analyses revealed significant (interaction) effects of PUI type.

CONCLUSIONS

PUI is associated with deficits in general executive functions, decision making, and stimulus-specific inhibitory control that may evolve in later stages of addiction development. Potential PUI-specific differences should be considered when designing trainings and interventions that target improving self-control abilities.

Methamphetamine related cues impact impulsive choice by decreasing loss aversion

BACKGROUND

We investigated alterations in impulsive choice and impulsive action among individuals with methamphetamine use disorder (MUD) compared to a control group after exposure to cues associated with methamphetamine (METH).

METHODS

Thirty-four participants with MUD and 31 healthy participants were instructed to experience a METH-related virtual reality (VR) social environment and to perform the go/no-go task as well as the balloon analog risk task (BART) before (the baseline condition) and after (the cue-induced condition) watching a VR video.

RESULTS

There were no significant differences between groups for go/no-go task both in the baseline condition and cue-induced condition. The METH group exhibited more adjusted pumps in the cue-induced condition than in the baseline condition. The λ (loss aversion) of the METH group was significantly lower in the cue-induced condition than in the baseline condition. In the correlation analysis of behavioral data and the exponential-weight mean-variance (EWMV) parameters, λ was the only parameter related to adjusted pumps both in the baseline condition and the cue-induced condition, reflected by a strong negative correlation.

CONCLUSIONS

These findings suggest that METH related cues may impact impulsive choice, but not impulsive action, by decreasing loss aversion.

Impulsivity facets and substance use involvement: insights from genomic structural equation modeling

BACKGROUND

Impulsivity is a multidimensional trait associated with substance use disorders (SUDs), but the relationship between distinct impulsivity facets and stages of substance use involvement remains unclear.

METHODS

We used genomic structural equation modeling and genome-wide association studies (N = 79,729-903,147) to examine the latent genetic architecture of nine impulsivity traits and seven substance use (SU) and SUD traits.

RESULTS

We found that the SU and SUD factors were strongly genetically inter-correlated (rG=0.77) but their associations with impulsivity facets differed. Lack of premeditation, negative and positive urgency were equally positively genetically correlated with both the SU (rG=.0.30-0.50) and SUD (rG=0.38-0.46) factors; sensation seeking was more strongly genetically correlated with the SU factor (rG=0.27 versus rG=0.10); delay discounting was more strongly genetically correlated with the SUD factor (rG=0.31 versus rG=0.21); and lack of perseverance was only weakly genetically correlated with the SU factor (rG=0.10). After controlling for the genetic correlation between SU/SUD, we found that lack of premeditation was independently genetically associated with both the SU (β=0.42) and SUD factors (β=0.21); sensation seeking and positive urgency were independently genetically associated with the SU factor (β=0.48, β=0.33, respectively); and negative urgency and delay discounting were independently genetically associated with the SUD factor (β=0.33, β=0.36, respectively).

CONCLUSIONS

Our findings show that specific impulsivity facets confer risk for distinct stages of substance use involvement, with potential implications for SUDs prevention and treatment.

The phenotype of recovery XII: A reinforcer pathology perspective on associations between delay discounting and pain catastrophizing in substance use disorder recovery

BACKGROUND

Substance use disorder (SUD) and pain are highly comorbid conditions and several pain indices (e.g., pain intensity) are associated with an increased risk of relapse. However, the cognitive-emotional experience of pain (i.e., pain catastrophizing) is understudied in SUD recovery. Further, how the association between pain catastrophizing and delay discounting - a posited biomarker of addiction, impacts multidimensional aspects of SUD recovery, including remission and quality of life (QOL), has yet to be examined.

METHODS

Individuals (n = 170) in SUD recovery reporting pain were asked about their chronic pain status, completed the Brief Pain Inventory, the Pain Catastrophizing Scale, an Adjusting Amount Delay Discounting Task, and the World Health Organization QOL-BREF scale. Univariate logistic and linear regressions examined associations between delay discounting and several pain indices with remission and QOL. Mediation analyses were investigated whether pain catastrophizing mediates the relationship between delay discounting and 1) sustained remission and 2) QOL.

RESULTS

Significant negative associations were found between delay discounting (p < .001) and pain catastrophizing (p = .001) with sustained remission. Pain catastrophizing significantly mediated the relationship between delay discounting and physical QOL (p = .044), psychological QOL (p = .009), social (p = .018), and environmental QOL (p = .014). Pain catastrophizing did not mediate the relationship between DD and sustained remission.

CONCLUSION

Individuals with greater DD exhibited greater pain catastrophizing, contributing to poorer QOL in SUD recovery. Our findings support that a Reinforcer Pathology framework is useful to understanding the cognitive-emotional experience of pain within the context of SUD recovery. Interventions that target both delay discounting and maladaptive cognitive and emotional responses to pain may lessen the negative impact of pain on SUD recovery and improve SUD outcomes.

A comprehensive evaluation of the neurocognitive predictors of problematic alcohol use, eating, pornography, and internet use: A 6-month longitudinal study

Background and aims

Cognitive control and reward-related abnormalities are centrally implicated in addiction. However, findings from longitudinal studies addressing neurocognitive predictors of addictive behaviors are mixed. Further, little work has been conducted predicting non-substance-related addictive behaviors. Our study aimed to assess predictors of substance and non-substance addictive behaviors in a community sample, systematically evaluating each neurocognitive function's independent influence on addictive behavior.

Methods

Australians (N = 294; 51.7% female; M[SD] age = 24.8[4.7] years) completed online neurocognitive tasks and surveys at baseline and 3-month follow-up. Self-report scales assessed problematic alcohol use, addictive eating (AE), problematic pornography use (PPU), and problematic internet use (PUI) at 3- and 6-month follow-ups. Linear regressions with bootstrapping assessed neurocognitive predictors for each addictive behavior across a 6-month period.

Results

Neurocognition at baseline did not predict AE or PUI severity at 6-month follow-up. Less delay discounting at baseline predicted higher PPU at 6-month follow-up (β = -0.16, p = 0.005). Poorer performance monitoring at baseline predicted higher AE at 3-month follow-up (β = -0.16, p = 0.004), and more reward-related attentional capture at 3-months predicted higher AE at 6-month follow-up (β = 0.14, p = 0.033). Less reward-related attentional capture (β = -0.14, p = 0.003) and less risk-taking under ambiguity (β = -0.11, p = 0.029) at baseline predicted higher PUI at 3-month follow-up. All findings were of small effect size. None of the neurocognitive variables predicted problematic alcohol use.

Discussion and conclusions

We were unable to identify a core set of specific neurocognitive functions that reliably predict multiple addictive behavior types. However, our findings indicate both cognitive control and reward-related functions predict non-substance addictive behaviors in different ways. Findings suggest that there may be partially distinct neurocognitive mechanisms contributing to addiction depending on the specific addictive behavior.

No evidence for a reciprocal relationship between daily self-control failures and addictive behavior in a longitudinal study

Introduction

We all experience occasional self-control failures (SCFs) in our daily lives, where we enact behaviors that stand in conflict with our superordinate or long-term goals. Based on the assumption that SCFs share common underlying mechanisms with addictive disorders, we tested the hypothesis that a generally higher susceptibility to daily SCFs predicts more addictive behavior, or vice versa.

Methods

At baseline, 338 individuals (19-27 years, 59% female) from a community sample participated in multi-component assessments. These included among others (1) a clinical interview on addictive behaviors (quantity of use, frequency of use, DSM-5 criteria; n = 338) and (2) ecological momentary assessment of SCFs (n = 329, 97%). At the 3-year and 6 year follow-up, participation rates for both assessment parts were 71% (n = 240) and 50% (n = 170), respectively.

Results

Controlling for age, gender, IQ, and baseline addiction level, random-intercept cross-lagged panel models revealed that participants who reported more SCFs also showed pronounced addictive behavior at the between-person level, but we found no evidence of a predictive relationship at the within-person level over time.

Discussion

A higher rate of SCFs is associated with more addictive behavior, while there is no evidence of an intraindividual predictive relationship. Novel hypotheses suggested by additional exploratory results are that (1) only addiction-related SCFs in daily life are early markers of an escalation of use and thus for addictive disorders and that (2) an explicit monitoring of SCFs increases self-reflection and thereby promotes the mobilization of cognitive control in response to goal-desire conflicts.

Financial incentive interventions for smoking cessation among Chinese smokers: study protocol for a cluster randomised controlled trial

INTRODUCTION

There is an urgent issue to relieve the burdens caused by tobacco use through feasible and effective smoking cessation interventions, particularly in a middle-income country with less accessible smoking cessation services and high demand for quitting smoking. Financial incentives have shown effective in changing health behaviours, thus needing to test its portability to a wider implementation and effectiveness of increasing smoking cessation rates.

METHODS AND ANALYSIS

This is a three-arm cluster randomised controlled trial. 462 eligible participants will be assigned to 2 financial incentive groups-rewards or deposits, or the control group. All participants including those in the control group will receive text messages to help quitting smoking developed by the US National Cancer Institute over a 3-month intervention period. In addition to text messages, reward group participants will be rewarded with CNY200 and CNY400 (CNY100 approximately US$15) for sustained smoking abstinence at 1 month and 3 months follow-up assessments; participants in the deposit group will accumulate CNY200 and CNY600 in the deposit accounts after verified smoking abstinence at 1 month and 3 months follow-up assessments, and all the deposits will be given at once right after the 3-month follow-up visit. The primary outcome is biochemically verified smoking abstinence rate sustained for 6 months after enrolment.

ETHICS AND DISSEMINATION

This trial protocol has been approved by the Ethics Committee of Peking University Health Science Centre (date: 23 February 2023; ethical approval number: IRB00001052-22172). Results and findings of this trial will be disseminated in peer-reviewed journals and professional conferences.

TRIAL REGISTRATION NUMBER

ChiCTR-IOR-2300069631.

Dopaminergic modulation of sensitivity to immediate and delayed punishment during decision-making

Effective decision-making involves careful consideration of all rewarding and aversive outcomes. Importantly, negative outcomes often occur later in time, leading to underestimation, or "discounting," of these consequences. Despite the frequent occurrence of delayed outcomes, little is known about the neurobiology underlying sensitivity to delayed punishment during decision-making. The Delayed Punishment Decision-making Task (DPDT) addresses this by assessing sensitivity to delayed versus immediate punishment in rats. Rats initially avoid punished reinforcers, then select this option more frequently when delay precedes punishment. We used DPDT to examine effects of acute systemic administration of catecholaminergic drugs on sensitivity to delayed punishment in male and female adult rats. Cocaine did not affect choice of rewards with immediate punishment but caused a dose-dependent reduction in choice of delayed punishment. Neither activation nor blockade of D1-like dopamine receptor affected decision-making, but activation of D2-like dopamine receptors reduced choice of delayed punishment. D2 blockade did not attenuate cocaine's effects on decision-making, suggesting that cocaine's effects are not dependent on D2 receptor activation. Increasing synaptic norepinephrine via atomoxetine also reduced choice of delayed (but not immediate) punishment. Notably, when DPDT was modified from ascending to descending pre-punishment delays, these drugs did not affect choice of delayed or immediate punishment, although high-dose quinpirole impaired behavioral flexibility. In summary, sensitivity to delayed punishment is regulated by both dopamine and norepinephrine transmission in task-specific fashion. Understanding the neurochemical modulation of decision-making with delayed punishment is a critical step toward treating disorders characterized by aberrant sensitivity to negative consequences.

The neuropsychological profile of work addiction

The objective of this study was to examine, for the first time, the neuropsychological aspects of work addiction, with a specific emphasis on the cognitive factors identified by theoretical models. While previous research has highlighted self-reported obsessiveness and impulsiveness in work addiction, this study sought to go beyond self-report measures by employing also neuropsychological reaction time tasks to assess executive functions. A total of 101 participants were categorized into two groups based on their Work Addiction Risk Test scores: a high-risk group (HWA; n = 39) and a low-risk group (LWA; n = 62) for work addiction. Executive functions were assessed using Go/No-Go, Digit Span, Counting Span, N-back, and Card Sorting Tasks. The findings revealed that the HWA group had poorer inhibitory control and achieved lower scores on the more complex working memory task involving updating (2-back). However, they exhibited unaltered cognitive flexibility and outperformed the LWA group on the 1-back task associated with maintenance and storage of information and sustained attention. Higher levels of impulsiveness and compulsiveness were observed in the HWA group, consistent with previous studies. These findings highlight the role of inhibition and working memory in work addiction, potentially contributing to challenges such as inefficient working strategies and impaired social functioning. This study offers valuable insights into the neurocognitive aspects of work addiction, deepening our understanding of this phenomenon.

Selective chemogenetic inactivation of corticoaccumbal projections disrupts trait choice impulsivity

Impulsive choice has enduring trait-like characteristics and is defined by preference for small immediate rewards over larger delayed ones. Importantly, it is a determining factor in the development and persistence of substance use disorder (SUD). Emerging evidence from human and animal studies suggests frontal cortical regions exert influence over striatal reward processing areas during decision-making in impulsive choice or delay discounting (DD) tasks. The goal of this study was to examine how these circuits are involved in decision-making in animals with defined trait impulsivity. To this end, we trained adolescent male rats to stable behavior on a DD procedure and then re-trained them in adulthood to assess trait-like, conserved impulsive choice across development. We then used chemogenetic tools to selectively and reversibly target corticostriatal projections during performance of the DD task. The prelimbic region of the medial prefrontal cortex (mPFC) was injected with a viral vector expressing inhibitory designer receptors exclusively activated by designer drugs (Gi-DREADD), and then mPFC projections to the nucleus accumbens core (NAc) were selectively suppressed by intra-NAc administration of the Gi-DREADD actuator clozapine-n-oxide (CNO). Inactivation of the mPFC-NAc projection elicited a robust increase in impulsive choice in rats with lower vs. higher baseline impulsivity. This demonstrates a fundamental role for mPFC afferents to the NAc during choice impulsivity and suggests that maladaptive hypofrontality may underlie decreased executive control in animals with higher levels of choice impulsivity. Results such as these may have important implications for the pathophysiology and treatment of impulse control, SUDs, and related psychiatric disorders.

Neurocognitive predictors of addiction-related outcomes: A systematic review of longitudinal studies

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.

Loss Aversion and Current, Former, and Never-Smoking Status

INTRODUCTION

Loss aversion (LA) is a bias in decision-making wherein potential losses have a greater influence on choices than equivalent gains. Such a bias may protect individuals from harm. Consistent with this idea, lower LA has been measured in individuals who endorse current cigarette smoking as well as other substance use compared to controls matched on important sociodemographic variables (age, gender, and educational attainment). The goal of the present study was to systematically replicate and extend this association between LA and smoking status by comparing those meeting criteria for current-, former-, and never-smoking status.

AIMS AND METHODS

In total, 984 individuals (N = 984) that endorsed current cigarette smoking (past 30-day use; n = 361), former-smoking (no past 30-day use, >100 cigarettes lifetime; n = 317), and never-smoking (no past 30-day use, <100 cigarettes lifetime; n = 306) were recruited using standard crowdsourcing methods and completed measures of LA (50-50 gambles) and delay discounting (DD) (monetary choice questionnaire), an important decision-making bias with an established relationship to cigarette-smoking status.

RESULTS

Lower LA was observed in those endorsing current smoking compared to former smoking (t[952] = -9.57, Bonferroni corrected p < .0001), and never-smoking (t[952] = -3.99, Bonferroni corrected p = .0002). LA was also greater in former- compared to the never-smoking (t[952] = -5.26, Bonferroni corrected p < .0001). This pattern did not change when accounting for DD and sociodemographics. DD results replicated prior findings.

CONCLUSIONS

The results support LA as a decision-making bias related to the risk of cigarette smoking and other substance use. Further research is needed to understand the causal contributions of LA and DD and their potential intersections.

IMPLICATIONS

Low LA is a risk factor for cigarette smoking. This study reports higher LA among individuals that endorsed never-smoking and former-smoking status in comparison to those endorsing current cigarette smoking. LA may influence or be influenced by a change in smoking status.

The relationship between executive functioning and addictive behavior: new insights from a longitudinal community study

RATIONALE

Although there is evidence that impaired executive functioning plays a role in addictive behavior, the longitudinal relationship between the two remains relatively unknown.

OBJECTIVES

In a prospective-longitudinal community study, we tested the hypothesis that lower executive functioning is associated with more addictive behavior at one point in time and over time.

METHODS

Three hundred and thirty-eight individuals (19-27 years, 59% female) from a random community sample were recruited into three groups: addictive disorders related to substances (n = 100) or to behaviors (n = 118), or healthy controls (n = 120). At baseline, participants completed nine executive function tasks from which a latent variable of general executive functioning (GEF) was derived. Addictive behavior (i.e., quantity and frequency of use, and number of DSM-5 criteria met) were assessed using standardized clinical interviews at baseline and three annual follow-ups. The trajectories of addictive behaviors were examined using latent growth curve modeling.

RESULTS

At baseline, we found weak to no evidence of an associations between GEF and addictive behavior. We found evidence for an association between a lower GEF at baseline and a higher increase in the quantity of use and a smaller decrease in frequency of use over time, but no evidence for an association with an increase in the number of DSM-5 criteria met.

CONCLUSIONS

Lower EFs appear to lead to a continuing loss of control over use, whereas addictive disorders may develop secondarily after a long period of risky use. Previous etiological models assuming lower EF as a direct vulnerability factor for addictive disorders need to be refined.

Contrasting effects of DOI and lisuride on impulsive decision-making in delay discounting task

RATIONALE

The 5-HT2A receptor is the major target of classic hallucinogens. Both DOI (2,5-dimethoxy-4-iodoamphetamine) and lisuride act at 5-HT2A receptors, and lisuride shares comparable affinity with DOI and acts as a partial agonist at 5-HT2A receptors. However, not like DOI, lisuride lacks hallucinogenic properties. Impulsive decision-making refers to the preference for an immediate small reinforcer (SR) over a delayed large reinforcer (LR).

OBJECTIVES

The current study aims to compare the effects of DOI and lisuride on impulsive decision-making and further to investigate the possible receptor mechanisms responsible for the actions of the two drugs.

METHODS

Impulsive decision-making was evaluated in male Sprague-Dawley rats by the percentage of choice for the LR in delay discounting task (DDT). Delay to the LR changed in an ascending order (0, 4, 8, 16, and 32 s) across one session.

RESULTS

DOI (0.5 and 1.0 mg/kg) increased impulsive decision-making, and the effects of DOI (1.0 mg/kg) were blocked by the 5-HT2A receptor antagonist ketanserin (1.0 mg/kg) rather than the 5-HT2C receptor antagonist SB-242084 (1.0 mg/kg). Contrarily, lisuride (0.1, 0.3, and 0.5 mg/kg) decreased impulsive decision-making. The effects of lisuride (0.3 mg/kg) were not antagonized by ketanserin (1.0 mg/kg), selective 5-HT1A antagonist WAY-100635 (1.0 mg/kg), or selective dopamine D4 receptor antagonist L-745870 (1.0 mg/kg) but were attenuated by the selective dopamine D2/D3 receptor antagonist tiapride (40 mg/kg).

CONCLUSIONS

DOI and lisuride have contrasting effects on impulsive decision-making via distinct receptors. DOI-induced increase of impulsivity is mediated by the 5-HT2A receptor, while lisuride-induced inhibition of impulsivity is regulated by the dopamine D2/D3 receptor.

Underlying mechanisms in the relationship between stress and alcohol consumption in regular and risky drinkers (MESA): methods and design of a randomized laboratory study

BACKGROUND

Excessive alcohol consumption and alcohol use disorders (AUD) are among the leading preventable causes of premature morbidity and mortality and are considered a major public health concern. In order to reduce the individual and societal burden of excessive alcohol use, it is crucial to identify high-risk individuals at earlier stages and to provide effective interventions to prevent further progression. Stressful experiences are important risk factors for excessive alcohol consumption and AUDs. However, the underlying biological and psychological mechanisms are still poorly understood.

METHODS

The project "Underlying mechanisms in the relationship between stress and alcohol consumption in regular and risky drinkers (MESA)" is a randomized controlled study that started in December 2018 and is conducted in a laboratory setting, which aims to identify moderators and mediators of the relationship between acute stress and alcohol consumption among regular and risky drinkers. Regular and risky drinkers are randomly assigned to a stress induction or a control condition. Several processes that may mediate (emotional distress, endocrine and autonomic stress reactivity, impulsivity, inhibitory control, motivational sensitization) or moderate (trait impulsivity, childhood maltreatment, basal HPA-axis activity) the relation between stress and alcohol consumption are investigated. As primary dependent variable, the motivation to consume alcohol following psychosocial stress is measured.

DISCUSSION

The results of this study could help to provide valuable targets for future research on tailored interventions to prevent stress-related alcohol consumption.

Decision Making in Addictive Behaviors Based on Prospect Theory: A Systematic Review

Traditionally, research on addictive behaviors has been based on the study of their risk factors, with impulsivity being the main risk factor. However, this study aims to approach this topic from the analysis of decision making. According to the prospect theory, low levels of loss and risk aversion will increase the probability of showing addictive behaviors. A systematic review of the possible relationships between these behaviors and prospect theory was carried out. To this end, the works that have studied loss and risk aversion in populations with addictive behaviors to date (N = 15) were compiled. Apart from other eligibility criteria, the selection process was only performed with studies that included the prospect theory or cumulative prospect theory, in English or Spanish, since 1979. WoS, Scopus, Dialnet and PsycInfo were the information sources selected. For this purpose, PRISMA guidelines have been followed. It was found that users of addictive substances show less loss aversion than nonusers. These results cannot be transferred to pathological gamblers. The significance of this work for future research and the implementation of prevention and intervention programs is highlighted. The results show an approach to addictions from a novel perspective.

Associations of delay discounting and drinking trajectories from ages 14 to 22

BACKGROUND

While drinking alcohol, one must choose between the immediate rewarding effects and the delayed reward of a healthier lifestyle. Individuals differ in their devaluation of a delayed reward based on the time required to receive it, i.e., delay discounting (DD). Previous studies have shown that adolescents discount more steeply than adults and that steeper DD is associated with heavier alcohol use in both groups.

METHODS

In a large-scale longitudinal study, we investigated whether higher rates of DD are an antecedent or a consequence of alcohol use during adolescent development. As part of the IMAGEN project, 2220 adolescents completed the Monetary Choice Questionnaire as a DD measure, the Alcohol Use Disorders Identification Test, and the Timeline Follow Back interview at ages 14, 16, 18, and 22. Bivariate latent growth curve models were applied to investigate the relationship between DD and drinking. To explore the consequences of drinking, we computed the cumulative alcohol consumption and correlated it with the development of discounting. A subsample of 221 participants completed an intertemporal choice task (iTeCh) during functional magnetic resonance imaging at ages 14, 16, and 18. Repeated-measures ANOVA was used to differentiate between high-risk and low-risk drinkers on the development of neural processing during intertemporal choices.

RESULTS

Overall, high rates of DD at age 14 predicted a greater increase in drinking over 8 years. In contrast, on average, moderate alcohol use did not affect DD from ages 14 to 22. Of note, we found indicators for less brain activity in top-down control areas during intertemporal choices in the participants who drank more.

CONCLUSIONS

Steep DD was shown to be a predictor rather than a consequence of alcohol use in low-level drinking adolescents. Important considerations for future longitudinal studies are the sampling strategies to be used and the reliability of the assessments.

Delay Discounting in Established and Proposed Behavioral Addictions: A Systematic Review and Meta-Analysis

Steep delay discounting, or a greater preference for smaller-immediate rewards over larger-delayed rewards, is a common phenomenon across a range of substance use and psychiatric disorders. Non-substance behavioral addictions (e.g., gambling disorder, internet gaming disorder, food addiction) are of increasing interest in delay discounting research. Individual studies have reported steeper discounting in people exhibiting various behavioral addictions compared to controls or significant correlations between discounting and behavioral addiction scales; however, not all studies have found significant effects. To synthesize the published research in this area and identify priorities for future research, we conducted a pre-registered systematic review and meta-analysis (following PRISMA guidelines) of delay discounting studies across a range of behavioral addiction categories. The final sample included 78 studies, yielding 87 effect sizes for the meta-analysis. For studies with categorical designs, we found statistically significant, medium-to-large effect sizes for gambling disorder (Cohen’s d = 0.82) and IGD (d = 0.89), although the IGD effect size was disproportionately influenced by a single study (adjusted d = 0.53 after removal). Categorical internet/smartphone studies were non-significant (d = 0.16, p = 0.06). Aggregate correlations in dimensional studies were statistically significant, but generally small magnitude for gambling (r = 0.22), internet/smartphone (r = 0.13) and food addiction (r = 0.12). Heterogeneity statistics suggested substantial variability across studies, and publication bias indices indicated moderate impact of unpublished or small sample studies. These findings generally suggest that some behavioral addictions are associated with steeper discounting, with the most robust evidence for gambling disorder. Importantly, this review also highlighted several categories with notably smaller effect sizes or categories with too few studies to be included (e.g., compulsive buying, exercise addiction). Further research on delay discounting in behavioral addictions is warranted, particularly for categories with relatively few studies.

Treating posttraumatic stress disorder in substance use disorder patients with co-occurring posttraumatic stress disorder: study protocol for a randomized controlled trial to compare the effectiveness of different types and timings of treatment

BACKGROUND

Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) have high comorbidity. Although prior research indicated that PTSD can effectively be treated with Prolonged Exposure (PE) in these patients, reported effects are small and treatment dropout rates high. Eye Movement Desensitization and Reprocessing (EMDR) and Imagery Rescripting (ImRs) are other promising treatment options for PTSD, that have not yet been examined in this patient group. Furthermore, it is unclear whether PTSD treatment is most effective when offered simultaneous to or after SUD treatment.

METHODS

In this article, the Treatment Of PTSD and Addiction (TOPA) study is described: a Dutch randomized controlled trial (RCT) that studies the effectiveness of PTSD treatment as an add-on to regular SUD treatment in patients with SUD and co-occurring PTSD. Effects of PE, EMDR, ImRs, and a 3-month SUD treatment only condition will be compared, as well as simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment. The primary outcome measure is PTSD symptoms. Secondary outcomes are: treatment completion, psychological distress, substance use, interpersonal problems, emotion dysregulation, and trauma-related emotions guilt, shame, and anger.

DISCUSSION

This study is the first to compare effects of PE, EMDR, and ImRs in one study and to compare simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment as well. This RCT will provide more knowledge about the effectiveness of different treatment strategies for PTSD in patients with co-occurring SUD and will ultimately improve treatment outcomes for patients with this common co-morbidity worldwide.

TRIAL REGISTRATION

Netherlands Trial Register (NTR), Identifier: NL7885 . Registered 22 July 2019.

No evidence of the clinical utility of single-item breakpoint to inform on tobacco demand in persons with substance use disorders

RATIONALE

Behavioral economics has shown that single-item demand indicators are promising for capturing crucial aspects of nicotine reinforcement. It is suggested that brief breakpoint measures perform comparably to full-length demand indices in characterizing nicotine dependence; however, there have been no thorough assessments of their validity in clinical settings.

OBJECTIVES

This study aimed to assess the validity and accuracy of a single-item breakpoint in informing on tobacco demand.

METHODS

The sample consisted of 88 treatment-seeking smokers (% males = 70.5%) enrolled in substance use treatment. Participants provided data on smoking characteristics and completed the Fagerström Test for Nicotine Dependence, a single-item breakpoint measure and a 14-item cigarette purchase task (CPT). Hierarchical regressions were performed to compare the predictive capability of a single-item breakpoint and full-length tobacco demand indicators in determining nicotine addiction severity.

RESULTS

The single-item breakpoint was significantly correlated with all indices stemmed from the CPT and both latent factors (all r values = .250-.368). Neither the brief breakpoint nor the full-length breakpoint significantly predicted nicotine dependence. After controlling for sex and smoking variables, factor 2 [β = .565, p < .001] and its observed variables Omax [β = .279, p = .006], 1/elasticity [β = .340, p = .001], and intensity [β = .551, p < .001], robustly predicted nicotine dependence severity.

CONCLUSIONS

Our findings do not support the validity of single-item breakpoint measures for characterizing nicotine dependence in substance users. In a bid to foster translational research, brief demand measures capturing Omax, intensity, and elasticity should be developed.

Real-Life Self-Control is Predicted by Parietal Activity During Preference Decision Making: A Brain Decoding Analysis

Despite its relevance for health and education, the neurocognitive mechanism of real-life self-control is largely unknown. While recent research revealed a prominent role of the ventromedial prefrontal cortex in the computation of an integrative value signal, the contribution and relevance of other brain regions for real-life self-control remains unclear. To investigate neural correlates of decisions in line with long-term consequences and to assess the potential of brain decoding methods for the individual prediction of real-life self-control, we combined functional magnetic resonance imaging during preference decision making with ecological momentary assessment of daily self-control in a large community sample (N = 266). Decisions in line with long-term consequences were associated with increased activity in bilateral angular gyrus and precuneus, regions involved in different forms of perspective taking, such as imagining one’s own future and the perspective of others. Applying multivariate pattern analysis to the same clusters revealed that individual patterns of activity predicted the probability of real-life self-control. Brain activations are discussed in relation to episodic future thinking and mentalizing as potential mechanisms mediating real-life self-control.

The role of inhibitory control and decision-making in the course of Internet gaming disorder

BACKGROUND AND AIMS

Internet gaming disorder (IGD) is associated with impaired inhibitory control and more impulsive decision-making. However, it remains unclear whether these associations are cross-sectional or predictive. We aimed to test the hypotheses that lower inhibitory control and more impulsive decision-making correlate with, are predicted by and predict more time spent on gaming and higher IGD severity.

METHODS

A stratified convenience sample of 70 male participants (18-21 years) was recruited to achieve broad data variability for hours spent on gaming and IGD severity. In three annual assessments (T1, T2, T3), we measured gaming behaviour and IGD severity using the Video Game Dependency Scale (CSAS-II). Both gaming-related measures were correlates (T1), predictors (T2), or outcomes (T3) of inhibitory control and decision making, which were assessed at T2 using a go/no-go task and an intertemporal-choice task, respectively.

RESULTS

Higher IGD severity at T1 predicted more impulsive decision-making at T2 (β = 0.45, 95% CI = 0.14-0.76). Lower inhibitory control at T2 predicted more hours spent on gaming at T3 (β = -0.13, 95% CI = -0.25 to -0.02). We found weak or no evidence for the other associations.

DISCUSSION AND CONCLUSIONS

Lower inhibitory control predicts more time spent gaming, possibly due to insufficient top-down regulation of the behaviour. Impulsive decision-making is rather a consequence of IGD than a predictor, which may be due to altered reward learning. One-dimensional etiological assumptions about the relationship between neurocognitive impairments and IGD seem not to be appropriate for the complexity of the disorder.

Dispositional cognitive effort investment and behavioral demand avoidance: Are they related?

Individuals tend to avoid cognitive demand, yet, individual differences appear to exist. Recent evidence from two studies suggests that individuals high in the personality traits Self-Control and Need for Cognition that are related to the broader construct Cognitive Effort Investment are less prone to avoid cognitive demand and show less effort discounting. These findings suggest that cost-benefit models of decision-making that integrate the costs due to effort should consider individual differences in the willingness to exert mental effort. However, to date, there are almost no replication attempts of the above findings. For the present conceptual replication, we concentrated on the avoidance of cognitive demand and used a longitudinal design and latent state-trait modeling. This approach enabled us to separate the trait-specific variance in our measures of Cognitive Effort Investment and Demand Avoidance that is due to stable, individual differences from the variance that is due to the measurement occasion, the methods used, and measurement error. Doing so allowed us to test the assumption that self-reported Cognitive Effort Investment is related to behavioral Demand Avoidance more directly by relating their trait-like features to each other. In a sample of N = 217 participants, we observed both self-reported Cognitive Effort Investment and behavioral Demand Avoidance to exhibit considerable portions of trait variance. However, these trait variances were not significantly related to each other. Thus, our results call into question previous findings of a relationship between self-reported effort investment and demand avoidance. We suggest that novel paradigms are needed to emulate real-world effortful situations and enable better mapping between self-reported measures and behavioral markers of the willingness to exert cognitive effort.