On the Mismeasurement of Impulsivity: Trait, Behavioral, and Neural Models in Alcohol Research among Adolescents and Young Adults

Differential involvement of trait impulsivity, fluid intelligence, and executive function in creativity among euthymic patients with bipolar disorder

BACKGROUND

While anecdotal evidence suggests a link between bipolar disorder and heightened creativity, empirical studies are scarce, and the underlying cognitive mechanisms remain unclear. This study aimed to explore the association between trait impulsivity, executive function, fluid intelligence, and creativity among euthymic patients with bipolar disorder.

METHODS

Euthymic outpatients with bipolar disorder and age- and sex-matched healthy controls were enrolled in this cross-sectional study. Creativity was assessed using the Abbreviated Torrance Test for Adults and the Chinese Word Remote Associates Test, which examined divergent thinking and convergent thinking, respectively. Trait impulsivity was measured using the Barratt Impulsiveness Scale, while cognitive flexibility was evaluated using the Wisconsin Card Sorting Test. Fluid intelligence was assessed using Raven's Progressive Matrices. General linear models were used to assess the associations between these cognitive measures.

RESULTS

Fifty-seven euthymic patients with bipolar disorder and 56 controls were recruited. Euthymic patients with bipolar disorder exhibited comparable overall creativity to controls but underperformed in convergent thinking. General linear models confirmed a negative association between trait impulsivity and creativity, primarily observed in patients with bipolar disorder. Cognitive flexibility positively correlated with creativity among patients with bipolar disorder, independent of fluid intelligence.

CONCLUSION

Our study showed that euthymic patients with bipolar disorder do not have heightened creativity. The findings underscore the importance of considering trait impulsivity and cognitive factors in understanding creativity in bipolar disorder.

Cannabis Use Characteristics Associated with Self-Reported Cognitive Function in a Nationally Representative U.S. sample

BACKGROUND

With increases in cannabis use and potency, there is a need to improve our understanding of the impact of use on cognitive function. Previous research indicates long-term cannabis use may have a negative effect on executive function. Few studies have examined persistence of it in protracted abstinence, and there is limited evidence of predictors of worse cognitive function in current and former users. In this study, we aim to evaluate the associations between cannabis use status (current, former, and never use) and self-report cognition. Further, we investigate if cannabis use characteristics predict self-report cognitive function.

METHODS

Cross-sectional cannabis use data from the National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III), a national survey (N = 36,309) conducted in the USA between 2012 and 2013 were used alongside the Executive Function Index scales. The data were analyzed by using Ordinary Least Squares regression.

RESULTS

Current (N = 3,681, Female = 37.7%) and former users (N = 7,448, Female = 45.4%) reported poorer cognition than never users (N = 24,956, Female = 56.6%). Self-reported cognition of former users was in-between that of current and never users. Several cannabis use characteristics were associated with self-reported cognition in current and former users.

CONCLUSION

While prospective studies are required to confirm, findings suggest cannabis use is linked to worse cognition. There may be some limited recovery of cognition in former users and some cannabis use characteristics predict impairment. These findings add to our understanding of the cognitive impact of cannabis use. As worse cognitive function may impact relapse, findings have implications for personalization of cannabis use disorder treatment.

Initial evidence of delay discounting's predictive utility for alcohol self-administration in ecologically valid contexts among young adults who drink heavily

BACKGROUND

While delay discounting is robustly associated with alcohol use disorder, whether discounting predicts real-time alcohol use behaviors is unclear. Existing support comes from laboratory studies using intravenous alcohol self-administration methods, thus limiting ecological validity and generalizability. The present study evaluated whether delay discounting predicted real-time alcohol use in naturalistic settings with and without probabilistic negative consequences for consuming larger amounts of alcohol.

METHODS

This secondary analysis utilized data from three laboratory alcohol self-administration studies with young adults who engaged in frequent heavy drinking (N=206, 45% female). Participants completed a delay discounting measure before an alcohol self-administration session in an actual or simulated bar with (n=187) or without (n=19) probabilistic negative consequences (compensation loss) tied to performance on cognitive and psychomotor tasks after alcohol self-administration. Bootstrapped (unstandardized) coefficient estimates and 95% confidence intervals were utilized due to the sample size discrepancy.

RESULTS

Multiple regressions revealed that delay discounting did not significantly predict estimated blood alcohol concentration (eBAC) or number of drinks consumed when procedures included probabilistic negative consequences. Among participants who completed procedures without probabilistic negative consequences, delay discounting was positively associated with peak eBAC.

CONCLUSION

Counter to hypotheses, steeper delay discounting did not predict real-time alcohol use in contexts with probabilistic negative consequences, whereas preliminary evidence suggests that delay discounting predicts real-time alcohol use behaviors in contexts without probabilistic negative consequences. The specific discounting task may have impacted study findings, thus future research should consider how the sign (gain vs. loss), outcome certainty, and delay relate to alcohol consumption.

Measurement and Functional Equivalence of a Reduced Version of the UPPS Impulsivity Scale Among Hispanic, Non-Hispanic Black, and Non-Hispanic White Adolescents

The current study aimed to assess the measurement equivalence and functional equivalence of the UPPS (Urgency, Premeditation, Perseverance, Sensation Seeking) Impulsivity Scale among three ethnoracial adolescent samples in the U.S. seventh-grade students who self-identified as Hispanic (n = 472), non-Hispanic Black (n = 89), or non-Hispanic White (n = 90), and completed an English-language version of the Child version of the UPPS, which was shortened and modified to include positive urgency items. Through a series of confirmatory factor analyses, the UPPS demonstrated configural, metric, and partial threshold invariance. Fisher's r-to-z transformations were used to assess the functional equivalence of the UPPS against well-validated measures of self-regulation and mental health commonly associated with impulsivity. We found some group differences in the magnitude of associations. Yet, overall, this study provides evidence that the UPPS can be used to measure distinct factors of impulsivity among Hispanic, non-Hispanic Black, and non-Hispanic White adolescents.

Impulsivity and Alcohol Use during Pregnancy and Postpartum: Insights from Novel Methodological Approaches within the Context of the COVID-19 Pandemic

Impaired emotion regulation and impulsivity have been linked to substance use. This study evaluated the association between emotion regulation difficulties-specifically impulsivity-and substance use within the context of the COVID-19 pandemic among pregnant (n = 49) and postpartum (n = 20) women. Participants from a prospective cohort ENRICH-2 completed a baseline phone survey of COVID-19-related experiences and impulsivity followed by a 14-day (3x/day) mobile ecological momentary assessment (mEMA) of impulsivity and substance use. Between-subject (BS) and within-subject (WS) associations for baseline impulsivity and momentary impulsivity with respect to substance use were examined using mixed effects models. At the BS level, momentary impulsivity scores that were higher than the overall group average were positively associated with subsequent momentary reports of marijuana use (β = 1.25; p = 0.04) when controlling for pregnancy status and COVID-19-related stress. At the WS level, momentary impulsivity scores that were higher than an individual's average score were positively associated with subsequent reports of momentary alcohol use (β = 0.08; p = 0.04). This research supports the idea that impulsivity varies based on individual situations, such as stress associated with the COVID-19 pandemic, and may be an important correlate of substance use in pregnant and postpartum women. Future research might consider investigation of additional factors, which may serve to moderate or mediate the relationship between impulsivity and substance use.

Adolescent Neurodevelopment Within the Context of Impulsivity and Substance Use

Purpose of Review

The aim of the present review is to provide an update on recent studies examining adolescent neurodevelopment in the context of impulsivity and substance use. We provide a review of the neurodevelopmental changes in brain structure and function related to impulsivity, substance use, and their intersection.

Recent Findings

When examining brain structure, smaller gray matter volume coupled with lower white matter integrity is associated with greater impulsivity across three components: trait impulsivity, choice impulsivity, and response inhibition. Altered functional connectivity in networks including the inhibitory control network and reward processing network confers risk for greater impulsivity and substance use.

Summary

Across brain structure and function, there is evidence to suggest that overlapping areas involved in the rise in impulsivity during adolescence contribute to early substance use initiation and escalation. These overlapping neurodevelopmental correlates have promising implications for prevention and early intervention efforts for adolescent substance use.

Do Coping Motives and Perceived Impaired Control Mediate the Indirect Links from Childhood Trauma Facets to Alcohol-Related Problems?

INTRODUCTION

The Self-Medication Hypothesis suggests that individuals drink to alleviate undesirable affective states. Behavioral Economics Theory states that individuals deprived of resources (i.e., physically neglected) consume more reinforcing substances when they are available than others. Childhood trauma may indirectly increase impaired control over alcohol (IC; drinking beyond one's own intentions) and thereby increase alcohol use and problems through the employment of coping-motives.

METHOD

A structural equation model that included sex as a covariate examined mediated paths with 612 university students.

RESULTS

Men were less likely to be emotionally abused and were more likely to use greater amounts of alcohol than women did. Physical neglect was directly linked to both more IC and alcohol use. Emotional and sexual abuse were directly linked to more coping motives. Both emotional and sexual abuse were indirectly linked to more alcohol use and its related problems through increased coping motives and IC.

CONCLUSIONS

Consistent with Behavioral Economics Theory, there was a direct link between physical neglect and IC. We also found partial support for the Self-Medication Hypothesis regarding the emotional and sexual abuse trauma dimensions; they indirectly contributed to alcohol use and its related problems via the mediating mechanisms of more coping motives and IC. Our findings suggest coping motives could be a therapeutic target for intervention among those sexually or emotionally abused.

Impaired control over drinking predicts changes in alcohol-related consequences over and above alcohol use and facets of impulsivity

The Theory of Planned Behavior (Ajzen, 1991) states that behavioral intention is the strongest determinant of human behavior. Impaired control (IC; Heather et al., 1993) reflects an intentional failure to consume less alcohol. Cross-sectional studies suggest that IC may mediate relations between impulsivity facets and drinking outcomes but there is only one prospective study examining ICS-Failed-Control (Leeman et al., 2009) and it did not account for effects of impulsivity-facets. Our study sought to address this gap in the literature by examining ICS-Failed-Control as a mediator of relations between impulsivity facets and alcohol-related consequences. We fit a three-wave cross-lagged panel model in a sample of 448 young adults (21-23) from an alcohol challenge study with longitudinal follow-ups (6 and 12 months). Participants completed the UPPS-P, TLFB Interview, the ICS-Failed-Control scale and the YAACQ. Although IC did not mediate effects of impulsivity on alcohol consequences, IC significantly predicted changes in alcohol-related problems at the12-month follow-up, accounting for effects of UPPS-P constructs as well as alcohol use. Lack of premeditation predicted change in alcohol use from baseline to 6-month follow-up and alcohol use (at 6-months) mediated the effect of premeditation (at baseline) on alcohol consequences (at 12-months). Our findings suggest that ICS-Failed-Control is not a mediator of the effects of impulsivity but is a unique predictor of consequences. Future studies should assess UPPS-P constructs earlier in adolescence to identify potential prospective links between UPPS-P constructs and IC.

An examination of the acquired preparedness model among college student marijuana users

ObjectiveTo examine the Acquired Preparedness Model using a behavioral impulsivity facet and positive marijuana expectancies to examine direct and indirect effects on marijuana use and related problems. Participants: 250 college students (61.7% female, 54% white) recruited from a southeastern university. Methods: Participants completed an online survey of delay reward discounting, marijuana expectancies, consideration of future consequences, and marijuana-related outcomes. Results: Delay reward discounting and consideration of future consequences related to marijuana-related problems, but not marijuana use. However, positive marijuana expectancies did not mediate the relation between impulsivity and marijuana outcomes. Conclusions: These results emphasize delay reward discounting and consideration of future consequences as important factors associated with marijuana-related problems. Interventions aimed at decreasing delay reward discounting and augmenting future orientation may be effective in college students who report light to moderate marijuana use. Future studies would benefit from longitudinal study designs using multiple impulsivity measures among light and heavy users.

Neurobehavioral maturation of motor response inhibition in adolescence - A narrative review

Immature motor response inhibition in adolescence is considered contributory to adolescent risk-taking and externalizing behaviors. We review studies reporting age-related variations in motor response inhibition and MRI measurements from typically-developing adolescents. Reviewed studies measured response inhibition using one of three tasks-the Stop Signal Task, Go/No-Go, and Antisaccade Task. Task reliability appears to be particularly strong for the SST. Across tasks and study designs, results indicate that inhibitory control improves markedly through early adolescence. The trajectory of change in later adolescence and into young adulthood (i.e., linear or plateauing) varies depending on the task design. Neuroimaging studies identify adult-like response inhibition networks that are involved in behavioral development. The pros and cons of each task are discussed, including recommendations to guide future studies. Ongoing studies in large longitudinal datasets offer opportunities for further exploration of the shape of change in response inhibition, related neural regions, and associations with other affective and cognitive processes to identify potential impacts of motor response inhibition immaturities or individual differences on adolescent risk-taking behaviors.

Appropriately Tuning Stochastic-Psychometric Properties of the Balloon Analog Risk Task

The Balloon Analog Risk Task (BART) allows to experimentally assess individuals’ risk-taking profiles in an ecologically sound setting. Many psychological and neuroscientific studies implemented the BART for its simplicity and intuitive nature. However, some issues in the design of the BART are systematically unconsidered in experimental paradigms, which may bias the estimation of individual risk-taking profiles. Since there are no methodological guidelines for implementing the BART, many variables (e.g., the maximum explosion probabilities, the rationale underlying stochastic events) vary inconstantly across experiments, possibly producing contrasting results. Moreover, the standard version of the BART is affected by the interaction of an individual-dependent, unavoidable source of stochasticity with a trial-dependent, more ambiguous source of stochasticity (i.e., the probability of the balloon to explode). This paper shows the most appropriate experimental choices for having the lowest error in the approximation of risk-taking profiles. Performance tests of a series of simulated data suggest that a more controlled, eventually non-stochastic version of the BART, better approximates original risk-taking profiles. Selecting optimal BART parameters is particularly important in neuroscience experiments to optimize the number of trials in a time window appropriate for acquiring neuroimaging data. We also provide helpful suggestions to researchers in many fields to allow the implementation of optimized risk-taking experiments using the BART.

The Association Between Impulsivity and Relapse in Patients With Alcohol Use Disorder: A Literature Review

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.

Factors Predicting Trial Engagement, Treatment Satisfaction, and Health-Related Quality of Life During a Web-Based Treatment and Social Networking Trial for Binge Drinking and Depression in Young Adults: Secondary Analysis of a Randomized Controlled Trial

BACKGROUND

Mental health and alcohol use problems are among the most common causes of disease burden in young Australians, frequently co-occur (comorbidity), and lead to significant lifetime burden. However, comorbidities remain significantly underdetected and undertreated in health settings. Digital mental health tools designed to identify at-risk individuals, encourage help-seeking, or deliver treatment for comorbidity have the potential to address this service gap. However, despite a strong body of evidence that digital mental health programs provide an effective treatment option for a range of mental health and alcohol use problems in young adults, research shows that uptake rates can be low. Thus, it is important to understand the factors that influence treatment satisfaction and quality-of-life outcomes for young adults who access e-mental health interventions for comorbidity.

OBJECTIVE

In this study, we seek to understand the factors that influence treatment satisfaction and quality-of-life outcomes for young adults who access e-mental health interventions for comorbid alcohol and mood disorders. The aim is to determine the importance of personality (ie, Big Five personality traits and intervention attitudes), affective factors (ie, depression, anxiety, and stress levels), and baseline alcohol consumption in predicting intervention trial engagement at sign-up, satisfaction with the online tool, and quality of life at the end of the iTreAD (Internet Treatment for Alcohol and Depression) trial.

METHODS

Australian adults (N=411) aged between 18 and 30 years who screened positive for depression and alcohol use problems signed up for the iTreAD project between August 2014 and October 2015. During registration, participants provided information about their personality, current affective state, alcohol use, treatment expectations, and basic demographic information. Subsequent follow-up surveys were used to gauge the ongoing trial engagement. The last follow-up questionnaire, completed at 64 weeks, assessed participants' satisfaction with web-based treatment and quality-of-life outcomes.

RESULTS

Multiple linear regression analyses were used to assess the relative influence of predictor variables on trial engagement, treatment satisfaction, and quality-of-life outcomes. The analyses revealed that the overall predictive effects of personality and affective factors were 20% or lower. Neuroticism constituted a unique predictor of engagement with the iTreAD study in that neuroticism facilitated the return of web-based self-assessments during the study. The return of incentivized follow-up assessments predicted treatment satisfaction, and state-based depression predicted variance in quality-of-life reports at study completion.

CONCLUSIONS

Our findings suggest that traditional predictors of engagement observed in face-to-face research may not be easily transferable to digital health interventions, particularly those aimed at comorbid mental health concerns and alcohol misuse among young adults. More research is needed to identify what determines engagement in this population to optimally design and execute digital intervention studies with multiple treatment aims.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN): 12614000310662; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365137&isReview=true.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12889-015-2365-2.

Associations of developmental imbalance between sensation seeking and premeditation in adolescence and heavy episodic drinking in emerging adulthood

BACKGROUND

Dual systems theories suggest that greater imbalance between higher reward sensitivity and lower cognitive control across adolescence conveys risk for behaviors such as heavy episodic drinking (HED). Prior research demonstrated that psychological analogues of these systems, sensation seeking and premeditation, change from childhood through emerging adulthood, and each has been independently linked with HED. However, few studies have assessed whether change over time in these developing analogues is prospectively associated with HED. Moreover, we know of no research that has shown whether within-person differences between higher sensation seeking and relatively lower premeditation across the adolescent period predict HED in emerging adulthood.

METHODS

Prospective data from the National Consortium on Alcohol and NeuroDevelopment in Adolescence study (n = 715) were used to examine the association of sensation seeking and premeditation with HED among adolescents ages 16 to 20 years. We used novel applications of latent difference score modeling and growth curve analysis to test whether increasing sensation seeking, premeditation, and their imbalance over time are associated with HED across the study period, and whether these associations differed by sex.

RESULTS

Whereas premeditation increased linearly from adolescence through emerging adulthood across sexes, males reported growth and females reported decline in sensation seeking. Sensation seeking in adolescence (and not premeditation) was associated with higher levels of HED by emerging adulthood. Importantly, greater imbalance between sensation seeking and premeditation was associated with higher levels of HED by emerging adulthood though we note that variability capturing this imbalance correlated highly (r = 0.86) with baseline levels of sensation seeking.

CONCLUSIONS

Developmental imbalance between higher sensation seeking and lower premeditation in late adolescence may be a risk factor for greater HED in emerging adulthood.

A Systematic Review of the Balloon Analogue Risk Task (BART) in Alcohol Research

Risk-taking propensity has been crucial to the investigation of alcohol use and consequences. One measure, the balloon analogue risk task (BART), has been used consistently over the past two decades. However, it is unclear how this measure is related to alcohol outcomes. This paper systematically reviews the literature on the BART and alcohol outcomes. First, direct associations between the BART and alcohol use are reviewed including correlations, group comparisons, the BART's prediction of alcohol outcomes and BART performance after consuming alcohol. Then, potential moderators that explain when and for whom the BART is related to alcohol outcomes are reviewed. Finally, potential mechanisms that explain how the BART and alcohol outcomes are related are reviewed. This review reveals patterns in the BART suggesting risk-taking propensity may be related to changes in alcohol use over time; however, there is little evidence to suggest BART scores increase after consuming alcohol. Yet, additional research suggests adjusted average pump scores may be too simplistic for the amount of information the BART captures and understanding individual's patterns of responses on the BART is important for investigating its relation to alcohol outcomes. Finally, this review opens up several future directions for research to understand how risk-taking propensity is related to alcohol outcomes.

The Digital Marshmallow Test (DMT) Diagnostic and Monitoring Mobile Health App for Impulsive Behavior: Development and Validation Study

Background

The classic Marshmallow Test, where children were offered a choice between one small but immediate reward (eg, one marshmallow) or a larger reward (eg, two marshmallows) if they waited for a period of time, instigated a wealth of research on the relationships among impulsive responding, self-regulation, and clinical and life outcomes. Impulsivity is a hallmark feature of self-regulation failures that lead to poor health decisions and outcomes, making understanding and treating impulsivity one of the most important constructs to tackle in building a culture of health. Despite a large literature base, impulsivity measurement remains difficult due to the multidimensional nature of the construct and limited methods of assessment in daily life. Mobile devices and the rise of mobile health (mHealth) have changed our ability to assess and intervene with individuals remotely, providing an avenue for ambulatory diagnostic testing and interventions. Longitudinal studies with mobile devices can further help to understand impulsive behaviors and variation in state impulsivity in daily life.

Objective

The aim of this study was to develop and validate an impulsivity mHealth diagnostics and monitoring app called Digital Marshmallow Test (DMT) using both the Apple and Android platforms for widespread dissemination to researchers, clinicians, and the general public.

Methods

The DMT app was developed using Apple’s ResearchKit (iOS) and Android’s ResearchStack open source frameworks for developing health research study apps. The DMT app consists of three main modules: self-report, ecological momentary assessment, and active behavioral and cognitive tasks. We conducted a study with a 21-day assessment period (N=116 participants) to validate the novel measures of the DMT app.

Results

We used a semantic differential scale to develop self-report trait and momentary state measures of impulsivity as part of the DMT app. We identified three state factors (inefficient, thrill seeking, and intentional) that correlated highly with established measures of impulsivity. We further leveraged momentary semantic differential questions to examine intraindividual variability, the effect of daily life, and the contextual effect of mood on state impulsivity and daily impulsive behaviors. Our results indicated validation of the self-report sematic differential and related results, and of the mobile behavioral tasks, including the Balloon Analogue Risk Task and Go-No-Go task, with relatively low validity of the mobile Delay Discounting task. We discuss the design implications of these results to mHealth research.

Conclusions

This study demonstrates the potential for assessing different facets of trait and state impulsivity during everyday life and in clinical settings using the DMT mobile app. The DMT app can be further used to enhance our understanding of the individual facets that underlie impulsive behaviors, as well as providing a promising avenue for digital interventions.

Trial Registration

ClinicalTrials.gov NCT03006653; https://www.clinicaltrials.gov/ct2/show/NCT03006653

Momentary patterns of impulsivity and alcohol use: A cause or consequence?

BACKGROUND

Impulsivity is a robust risk factor for alcohol use, but significant gaps remain in our understanding of the way that impulsivity relates to alcohol harms. Most prior research has been limited to between-level differences; thus, within-person variability in impulsivity at the momentary level and its bidirectional association with alcohol use has not been examined. The present research used a 14-day ecological momentary assessment (EMA) design to determine the bidirectionality of impulsivity and alcohol use and alcohol problems.

METHODS

Participants were 89 (47 women) heavy-drinking college students. The mean age was 19.80 (SD = 1.76) years. Participants completed a baseline questionnaire and 14 consecutive days of momentary reports sent in the morning, afternoon, and evening; participants also completed two user-initiated reports during a drinking occasion at the beginning and the end of their drinking.

RESULTS

Multilevel modeling results indicated that greater levels of impulsivity experienced during the day was not associated with alcohol use or problems experienced that night. However, level of alcohol use and the number of alcohol problems experienced predicted greater variability in impulsivity the next day.

CONCLUSIONS

Overall, this study was the first to examine the bidirectional relationship between impulsivity and alcohol use using EMA. Findings supported impulsivity's conceptualization as a state construct and fluctuations in alcohol use behaviors coinciding with states of impulsivity the next day after drinking. Findings from the present study contributed to conceptual daily process models of drinking by identifying how alcohol behaviors unfold in the real world.

A State Model of Negative Urgency: Do Momentary Reports of Emotional Impulsivity Reflect Global Self-Report?

Negative urgency is a trait that is a risk factor for a range of psychopathology. Yet, little research has tested whether global self-report measures of negative urgency truly reflect a heightened association between real-world negative emotions and impulsive behaviors. In a sample of young adults (N = 222) assessed 3 times per day for 10 days, we tested whether negative emotions were associated with multiple facets of impulsivity at the state-level, and whether those associations were moderated by global self-report of negative urgency. Our findings suggest a robust within-person association between negative affect and acting on impulse. However, global self-report of negative urgency did not moderate any emotion-impulsivity association we tested.

Relations Between Acute Effects of Alcohol on Response Inhibition, Impaired Control over Alcohol Use, and Alcohol-Related Problems

BACKGROUND

Alcohol consistently impairs response inhibition in the laboratory, and alcohol impairment of response inhibition may lead to excess consumption or increases in intoxicated risk behavior, both of which contribute to risk for alcohol-related problems. To our knowledge, no prior studies have examined relations between alcohol impairment of response inhibition and either impaired control over alcohol (i.e., inability to adhere to predetermined drinking limits) or real-world alcohol-related problems. The current study addressed this gap in the literature.

METHODS

Young adult social drinkers (N = 215, 76% male) participated in a between-subjects, placebo-controlled alcohol challenge study and completed self-reports approximately 2 weeks later. Multilevel models were used to examine the hypothesis that alcohol impairment of response inhibition would indirectly lead to alcohol-related problems through impaired control over alcohol use.

RESULTS

Greater alcohol-induced impairment of response inhibition and impaired control over alcohol use were both significant predictors of alcohol-related problems. However, greater alcohol-induced response inhibition was not a significant predictor of impaired control over alcohol use.

CONCLUSIONS

To our knowledge, this is the first study demonstrating relationships between alcohol impairment of response inhibition and real-world alcohol-related problems and the first to address relationships between alcohol impairment of response inhibition and impaired control over alcohol use. These results suggest that impaired control over alcohol use may result from deficits in the trait ability to control behavior rather than deficits in alcohol-induced response inhibition. Regardless, results suggest that alcohol impairment of response inhibition and impaired control over alcohol are both worthwhile intervention targets.

Effect of Mindfulness-Based Relapse Prevention on Impulsivity Trajectories Among Young Adults in Residential Substance Use Disorder Treatment

Objectives

Impulsivity has been identified as an important construct in predicting the initiation and maintenance of substance use among at-risk populations. Interventions emphasizing mindfulness strategies appear particularly promising in reducing substance use and marking change in various aspects of impulsivity.

Methods

The current study used a rolling group mindfulness-based relapse prevention (MBRP) intervention for young adults in residential substance use disorder treatment. We examined change in impulsivity facets measured by the S-UPPS for youth randomly assigned to MBRP (n = 45) versus those assigned to treatment as usual plus 12 step/self-help (n = 34). We also examined how change in impulsivity mediated changes in substance use post-treatment.

Results

In general, results indicated that MBRP is effective at reducing facets of trait impulsivity in treatment-seeking individuals with SUDs. Only positive and negative urgency mediated the relation between treatment assignment and substance use.

Conclusions

MBRP is a viable and useful intervention for young adults in residential treatment for substance use disorders and can aid in marked change in facets of impulsivity. Both positive and negative urgency were significant mechanisms of change in reducing substance use following treatment. Results are discussed focused on the utility of MRBP as a clinical intervention for at-risk, marginalized, and young adults.

Testing Daily Associations between Impulsivity, Affect, and Alcohol Outcomes: A Pilot Study

BACKGROUND

Considerable research has examined impulsivity between individuals, but less research has focused on whether impulsivity fluctuates within a person. Although previous research supports trait levels of impulsivity as a risk factor for increased alcohol involvement, it is unclear whether daily (i.e., state) fluctuations in impulsivity coincide with same-day drinking behaviors. The present pilot study tested (1) the extent to which impulsivity fluctuates within-person; (2) the influence of daily impulsivity on alcohol use outcomes across all days (i.e., whether drinking occurred, the number of drinks consumed, and intentions to drink) and on drinking days only (i.e., whether heavy episodic drinking occurred and the number of problems experienced); and (3) daily affect as moderators of these relationships.

METHOD

Participants were 24 young adult drinkers without postsecondary education who completed a baseline plus 14 follow-up daily surveys. Each day, participants reported their impulsivity, affect, and drinking behavior.

RESULTS

Multilevel modeling revealed that 42.5% of the variability in daily impulsivity was due to within-person differences. Impulsivity was related to greater odds of heavy episodic drinking and more alcohol-related problems on drinking days. Positive affect moderated the relationship between impulsivity and alcohol-related problems, and the relationship between impulsivity and drinking intentions.

CONCLUSIONS

Findings suggest that changes in positive affect and impulsivity may be a risk factor for alcohol problems in a daily context. Future research examining within-person impulsivity and negative outcomes may benefit from considering positive affect.

Impulsive dispositions and alcohol: what we know, how we know it, and where to go from here

BACKGROUND

Relations between impulsigenic traits and alcohol-related outcomes have been the focus of much research, yet precise relations remain elusive. Historically, research used broadband conceptualizations of impulsivity, which yielded inconclusive findings. Attempts to ameliorate this problem led to more work on narrowband assessments of impulsivity. Despite that several narrowband self-report measures exist, few demonstrate adequate psychometric properties. Given the limits of self-report, researchers have also utilized laboratory-based measures of impulsive dispositions; however, this seems to have contributed more uncertainty to the literature.

REVIEW

We review commonly used self-report and laboratory-based measures of narrowband impulsivity, as well as assessments of alcohol-related constructs (e.g., consumption and consequences). We discuss remaining issues in impulsivity and alcohol assessment, which limit understanding of how impulsigenic traits influence alcohol-related behaviors. Cutting-edge conceptualizations and assessment of state-level impulsivity are also discussed.

CONCLUSIONS

More work is necessary to further this area of research, including establishing consistent nomenclature and a cohesive conceptualization of impulsigenic traits as they relate to alcohol use and alcohol use disorders.

Peer effects on self-regulation in adolescence depend on the nature and quality of the peer interaction

Adolescence is a critical period for the development of self-regulation, and peer interactions are thought to strongly influence regulation ability. Simple exposure to peers has been found to alter decisions about risky behaviors and increase sensitivity to rewards. The link between peer exposure and self-regulation is likely to vary as a function of the type and quality of peer interaction (e.g., rejection or acceptance). Little is known about how the nature of interactions with peers influences different dimensions of self-regulation. We examined how randomization to acceptance or rejection by online "virtual" peers influenced multiple dimensions of self-regulation in a multisite community sample of 273 adolescents aged 16-17 years. Compared to a neutral condition, exposure to peers produced increases in cold cognitive control, but decreased hot cognitive control. Relative to peer acceptance, peer rejection reduced distress tolerance and increased sensitivity to losses. These findings suggest that different dimensions of adolescent self-regulation are influenced by the nature of the peer context: basic cognitive functions are altered by mere exposure to peers, whereas more complex decision making and emotion regulation processes are influenced primarily by the quality of that exposure.

Out of harm's way: Secure versus insecure–disorganized attachment predicts less adolescent risk taking related to childhood poverty

Although some risk taking in adolescence is normative, evidence suggests that adolescents raised in conditions of socioeconomic disadvantage are disproportionately burdened with risk taking and its negative consequences. Using longitudinal data from the NICHD Study of Early Child Care and Youth Development, we investigated quality of the early caregiving environment as a potential prospective buffer against the long-term association between childhood poverty and adolescent risk taking. Multicategorical moderation model results indicated that if raised in poverty across age 1–54 months (average family income to needs ratio ≤ 1.02), relative to affluence (income to needs ratio ≥ 6.16), adolescents with histories of secure attachment to caregivers exhibited two times the number of risk behaviors at age 15, whereas adolescents with insecure–disorganized histories exhibited nearly five times the number of risk behaviors. Both early family economic hardship and history of insecure–disorganized attachment remained significant predictors of increased adolescent risk taking, alongside the interactive effect. Probing the interaction's region of significance revealed that history of secure (vs. insecure–disorganized) attachment is associated with protective reductions in risk taking below a family income to needs ratio of 2.24, or about 220% poverty level. Findings support a diathesis–stress model in which children with secure attachment histories are less deleteriously impacted by early socioeconomic adversity than their insecure–disorganized peers.

Do individuals higher in impulsivity drink more impulsively? A pilot study within a high risk sample of young adults

Extant literature has established a strong relation between individual differences in "impulsivity" and alcohol consumption. However, the relation between "impulsivity," intentions-to-drink, and alcohol consumption has remained understudied. As a part of a larger study, 77 participants (60.5% female, 76.3% White, M age=20.8) completed 10days of daily diary reports regarding their intention to use alcohol and alcohol consumption. Hierarchical linear modeling (HLM) was used to estimate within-person relations between intentions-to-drink and subsequent alcohol use. All models were adjusted for participant age, biological sex, and day of the week. Results showed a strong positive association between daily intention to consume alcohol and self-reported alcohol use (β=0.50, p<0.01). Importantly, tests of interactions indicated that individuals higher in impulsivity were not significantly more likely to engage in unplanned drinking. Multilevel mediation analyses indicated significant indirect effects between impulsivity-like constructs, including positive urgency, lack-of-planning, and self-report delay discounting, and reported daily alcohol consumption via higher overall (i.e., between-person) levels of intentions-to-drink; that is, individuals who reported higher levels of these impulsivity-related constructs were more likely to intend to drink across the 10-days and, in turn, consumed more alcohol. Findings from the study suggest that treatment providers could address drinking intentions among individuals higher in impulsivity and work to establish potential replacement behaviors to reduce alcohol consumption in this population.

Premeditation and Sensation Seeking Moderate the Reasoned Action and Social Reaction Pathways in the Prototype/Willingness Model of Alcohol Use

BACKGROUND

Drinking can occur because of expectations to drink (reasoned pathway) or because of willingness to drink under certain circumstances (reactive pathway). These pathways are thought to be influenced by different cognitions such as alcohol-related attitudes, norms, or drinking prototypes (Gerrard et al., 2008). Impulsive traits reflect individual differences in the influence of reasoned or reactive factors, however little research has investigated whether impulsivity moderates the effects of cognitive factors predicting alcohol use.

OBJECTIVES

We tested whether differences in three impulsivity traits (premeditation, sensation seeking and negative urgency) moderated associations of reasoned (risk/disapproval attitudes and social norms) and reactive (prototype) pathway variables on expectation/willingness to drink and recent alcohol use.

METHODS

We collected data from n = 409 college students; the sample was 67% female, 43% Asian American, with Mdnage = 19. Hypotheses were tested using multiple regression.

RESULTS

Premeditation and sensation seeking moderated reasoned variable effects on expectation and drinking. Among those low on premeditation, risk attitudes were most associated with drinking expectation, with alcohol prototypes most related to recent drinking. These effects declined at higher premeditation levels. Among those high on sensation seeking, risk attitudes were most associated with expectation and drinking, declining at lower sensation seeking levels. There was little evidence of moderation predicting drinking willingness.

CONCLUSIONS/IMPORTANCE

Findings imply personality differences may explain association strength between reasoned but not reactive risk behavior pathways with alcohol outcomes. They have ramifications for personalized prevention programs to reduce drinking through cognition change, as alcohol-related cognition influence may differ depending on personality characteristics.

Does drinking refusal self-efficacy mediate the impulsivity-problematic alcohol use relation?

There is consistent evidence that impulsivity-like traits relate to problematic alcohol involvement; however, identifying mechanisms that account for this relation remains an important area of research. Drinking refusal self-efficacy (or a person's ability to resist alcohol; DRSE) has been shown to predict alcohol use among college students and may be a relevant mediator of the impulsivity-alcohol relation. The current study examined the indirect effect of various constructs related to impulsivity (i.e., urgency, sensation seeking, and deficits in conscientiousness) via several facets of DRSE (i.e., social pressure, opportunistic, and emotional relief) on alcohol-related problems among a large sample of college students (N=891). Overall, results indicated that certain DRSE facets were significant mediators of the relation between impulsivity-related constructs and alcohol problems. More specifically, emotional-relief DRSE was a mediator for the respective relations between urgency and deficits in conscientiousness and alcohol problems, whereas social-DRSE was a significant mediator of the respective relations between urgency and sensation seeking with alcohol problems. Results from this study suggest particular types of DRSE are important mediators of the relations between specific impulsivity constructs and alcohol-related problems. These findings support prevention and intervention efforts that seek to enhance drinking refusal self-efficacy skills of college students, particularly those high in certain personality features, in order to reduce alcohol-related problems among this population.

Stability and change in multi-method measures of impulsivity across residential addictions treatment

INTRODUCTION

Although the relations between constructs related to impulsivity and substance use disorders (SUDs) are well established, recent research suggests that changes in impulsivity may be an important mechanism in the recovery process. However, this evidence is primarily based on studies that have examined the relation between changes in impulsivity and substance involvement across the span of several years using self-report measures; thus, it is unclear if these changes are linked across shorter time intervals or extend to behavioral methods of assessment.

METHODS

Using prospective data from 43 participants (mean age=35.06; 60% female) enrolled in residential substance abuse treatment, the extent to which seven facets of impulsivity (i.e., questionnaire-assessed delay discounting, lack of perseverance, lack of planning, negative urgency, positive urgency, sensation seeking, and behaviorally-assessed inhibitory control) changed across approximately 4 weeks of treatment was examined.

RESULTS

Dependent group t-tests suggested significant reductions in negative urgency and lack of planning, and significant improvements in inhibitory control.

CONCLUSIONS

Findings indicate that specific impulsivity facets show change across relatively short time frames and suggest nonspecific effects of residential treatment on levels of impulsivity. These results inform the functional relation between facets of impulsivity and substance involvement and have implications for assessment and treatment approaches for SUDs.

"Killing Two Birds with One Stone": Alcohol Use Reduction Interventions with Potential Efficacy in Enhancing Self-Control

We review interventions with empirical support for reducing alcohol use and enhancing self-control. While any intervention that decreases drinking could improve self-control, we focus here on interventions with evidence of direct benefit for both indications. Although no intervention yet shows strong evidence for dual efficacy, multiple interventions have strong evidence for one indication and solid or suggestive evidence for the other. Among pharmacotherapies, opioid antagonists currently have the best evidence for reducing alcohol use and enhancing self-control. Nicotinic partial agonist varenicline also appears to be efficacious for alcohol use and self-control. Many psychosocial and behavioral interventions (e.g., cognitive behavioral therapy, contingency management, mindfulness training) may have efficacy for both indications based on purported mechanisms of action and empirical evidence. Cognitive bias modification and neurophysiological interventions have promise for alcohol use and self-control as well and warrant further research. We offer several other suggestions for future research directions.

Impulsivity and Alcohol Involvement: Multiple, Distinct Constructs and Processes

Of all the personality traits associated with problematic alcohol involvement, traits related to impulsivity appear to show the most robust relations to alcohol use and alcohol-related problems. This article reviews both seminal articles that focus on broadband measures of impulsivity and newer research linking more specific impulsivity-related traits to the development and course of problematic alcohol involvement, with a specific focus on self-report measures of impulsivity-related traits. Specifically, empirical support for different theoretical models that account for the overlap between impulsivity-related traits and problematic alcohol involvement is discussed, including current limitations of existing research. Recent studies suggest that specific impulsivity constructs relate to distinct aspects of alcohol-related behavior. Further, there is emerging evidence that problematic alcohol use and impulsivity-related traits are dynamically related, such that changes in these constructs appear to correlate during specific developmental periods. We close by discussing potential research directions that may provide increased clarity in understanding the impulsivity-alcohol relation.