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

A mobile phone intervention to reduce heavy drinking: a preliminary analysis of anchoring heuristics

BACKGROUND

Preliminary evidence has been presented for interventions focused on preventing alcohol consumption or reducing the occurrence of episodes of excessive drinking. The anchoring text message intervention is a newly proposed theory-based approach to reducing heavy drinking among youth. The current study tests the preliminary efficacy of this intervention for reducing heavy drinking among Mexican youth.

METHODS

Focusing on a sample of sixteen Mexican youths-nine not-heavy drinkers and seven heavy drinkers-the participants completed a survey on alcohol consumption and anchoring heuristics. Pretest and post-test questionnaire data were collected to evaluate the effectiveness of the intervention. The anchoring text messages consisted of strategies to limit alcohol use and feedback reminder messages. Assessments were conducted at baseline, four weeks of intervention, and post-intervention.

RESULTS

Logistic regression analyses indicated a significant effect on heavy drinking episodes post-intervention. The post-intervention anchoring effects among the heavy drinker participants were different from those among the non-heavy drinkers in terms of reporting heavy drinking and future drinking. The anchoring heuristic-based intervention reduced the quantity of drinking and the future estimation of drinking and improved the ability to reject alcohol in the heavy drinker group.

CONCLUSIONS

These findings provide preliminary support for the effectiveness of the anchoring heuristic-based intervention, conducted through text messages sent by mobile phone to reduce alcohol consumption. The intervention promoted a reduction in alcohol consumption. Future research should be directed toward investigating the anchoring effects among heavy drinkers.

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.

Psychosocial Intervention for Youth With High Externalizing Behaviors and Aggression Is Associated With Improvement in Impulsivity and Brain Gray Matter Volume Changes

Background: Stop, Now And Plan (SNAP) is a cognitive behavioral-based psychosocial intervention that has a strong evidence base for treating youth with high aggression and externalizing behaviors, many of whom have disruptive behavior disorders. In a pre-post design, we tested whether SNAP could improve externalizing behaviors, assessed by the parent-rated Child Behavior Checklist (CBCL) and also improve behavioral measures of impulsivity in children with high aggression and impulsivity. We then investigated whether any improvement in externalizing behavior or impulsivity was associated with gray matter volume (GMV) changes assessed using structural magnetic resonance imaging (sMRI). We also recruited typically developing youth who were assessed twice without undergoing the SNAP intervention. Methods: Ten children who were participating in SNAP treatment completed the entire study protocol. CBCL measures, behavioral measures of impulsivity, and sMRI scanning was conducted pre-SNAP and then 13 weeks later post-SNAP. Twelve healthy controls also completed the study; they were rated on the CBCL, performed the same behavioral measure of impulsivity, and underwent sMRI twice, separated by 13 weeks. They did not receive the SNAP intervention. Result: At baseline, SNAP participants had higher CBCL scores and performed worse on the impulsivity task compared with the healthy controls. At the second visit, SNAP participants still had higher scores on the CBCL compared with normally-developing controls, but their performance on the impulsivity task had improved to the point where their results were indistinguishable from the healthy controls. Structural magnetic resonance imaging in the SNAP participants further revealed that improvements in impulsivity were associated with GMV changes in the frontotemporal region. Conclusion: These results suggest that SNAP led to improvement in behavioral measures of impulsivity in a cohort of boys with high externalizing behavior. Improvement in impulsivity was also associated with increased GMV changes. The mechanism behind these brain changes is unknown but could relate to cognitive behavioral therapy and contingency management interventions, important components of SNAP, that target frontotemporal brain regions. Clinically, this study offers new evidence for the potential targeting of brain regions by non-invasive modalities, such as repetitive transcranial magnetic stimulation, to improve externalizing behavior and impulsivity.

The role of impulsivity as predisposing behavioural trait in different aspects of alcohol self-administration in rats

BACKGROUND

Therapeutic interventions to promote abstinence and prevent relapse in alcohol use disorder (AUD) are limitedly available. Therefore, targeting risk factors in the onset and maintenance of AUD could pose an interesting alternative treatment strategy. In this regard, over the last decade trait impulsivity has received considerable attention as such a risk factor predisposing substance dependence both in clinical populations and preclinical rodent studies. This study investigated whether different forms of impulsivity (action versus choice) predict distinct stages of instrumental alcohol self-administration, extinction and cue-induced relapse.

METHODS

Two cohorts of n = 48 rats each were trained in an operant tasks for either impulsive action or impulsive choice. Subsequently, high and low impulsive rats were then tested in an alcohol self-administration and relapse model and following this retested in the impulsivity tasks to evaluate possible changes in impulsivity levels.

RESULTS

The current data show that neither impulsive action, nor impulsive choice predict the extent to which rats consume alcohol and the extent to which rats are motivated to self-administer alcohol. Moreover, extinction of responding for alcohol and cue-induced relapse was not predicted by impulsivity. Interestingly, rats and most prominently low impulsive rats became more impulsive after the alcohol self-administration procedure. Although due to employed experimental design it is not clear whether this resulted from alcohol consumption or alcohol abstinence.

CONCLUSION

Together, these findings lend further support for the notion of a unidirectional relationship between self-administration of the depressant drug alcohol and impulsivity.

Personality driven alcohol and drug abuse: New mechanisms revealed

While the majority of the regular consumers of alcohol controls their consumption well over life span and even takes instrumentalization benefits from it, a minority, but yet high total number of users develops an alcohol addiction. It has long been known that particular personality types are more addiction prone than others. Here we review recent progress in the understanding of neurobiological pathways that determine personality and facilitate drug abuse. Novel approaches to characterize personality traits leading to addiction proneness in social settings in mice are discussed. A common genetic and neurobiological base for the behavioural traits of sensation seeking or a depressed phenotype and escalating alcohol consumption are reviewed. Furthermore, recent progress on how social and cognitive factors, including impulsivity and decision making, act at brain level to make an individual more vulnerable to alcohol abuse, are discussed. Altogether, this review provides an update on brain mechanisms underlying a broad spectrum of personality traits that make an individual more prone to alcohol and drug abuse and addiction.

Changes in the elimination and resurgence of alcohol-maintained behavior in rats and the effects of naltrexone

Resurgence may be a mechanism of relapse in alcohol use disorder patients upon discharge from treatment as part of an abuse-treatment-relapse cycle. Adjunctive pharmacotherapies may be a means to facilitate behavioral treatments and block resurgence. Experiments were conducted using a model of alcohol self-administration to assess the repeatability of the elimination and resurgence of alcohol-maintained behavior and the effects of naltrexone. Experiments had three phases. In Phase 1, behavior was maintained by oral alcohol under a fixed-ratio schedule. In Phase 2, behavior was extinguished via condensed milk delivery under a differential-reinforcement-of-other-behavior (DRO) schedule. In Phase 3, the DRO schedule was eliminated. In Experiment 1, this 3-phase cycle was replicated 4 times. Across replications, response rates and dose of alcohol consumed did not differ in Phase 1, alcohol-maintained behavior was eliminated more rapidly in Phase 2, and the resurgence effect was generally stable in Phase 3. In Experiment 2, naltrexone was administered in Phase 2, Phase 3, or both Phases 2 and 3, to separate groups of rats. Naltrexone facilitated the elimination of alcohol-maintained behavior in Phase 2 and, the resurgence of alcohol-maintained behavior was reduced only for those rats that received naltrexone in both phases. Together, these experiments demonstrate that the resurgence of alcohol-maintained behavior is replicable within-subjects and, further, resurgence of alcohol-maintained behavior may be a useful model to evaluate pharmacological interventions to facilitate behavioral treatments and reduce the likelihood of relapse. Results with naltrexone support the use of medication-assisted therapy approaches to reduce relapse risk in patients. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The Use of Functional Magnetic Resonance Imaging to Test Pharmacotherapies for Alcohol Use Disorder: A Systematic Review

Alcohol use disorder (AUD) is a chronic relapsing condition that represents a significant public health concern. Pharmacological treatment development for AUD is a top research priority, and many studies are being conducted to evaluate potential AUD treatments. Understanding the brain circuitry impacted by addiction is crucial for the development of efficacious pharmacological interventions. These neuroadaptations can be probed noninvasively using functional magnetic resonance neuroimaging (fMRI). fMRI may be an effective tool to identify biomarkers for AUD pharmacotherapies, evaluating changes associated with pharmacological treatment. Thus, the present qualitative review of the literature focuses on the role of fMRI as a tool for medication development for AUD. The aim of this review was to assemble research across a range of fMRI paradigms to study the effectiveness of pharmacological treatments of adult AUD. First, we present a qualitative review of fMRI AUD pharmacotherapy studies, differentiating studies based on their dosing regimen. Second, we provide recommendations for the field to improve the use of fMRI as a biomarker for AUD pharmacotherapy.

Pharmacotherapies for decreasing maladaptive choice in drug addiction: Targeting the behavior and the drug

Drug addiction can be conceptualized as a disorder of maladaptive decision making in which drugs are chosen at the expense of pro-social, nondrug alternatives. The study of decision making in drug addiction has focused largely on the role of impulsivity as a facilitator of addiction, in particular the tendency for drug abusers to choose small, immediate gains over larger but delayed outcomes (i.e., delay discounting). A parallel line of work, also focused on decision making in drug addiction, has focused on identifying the determinants underlying the choice to take drugs over nondrug alternatives (i.e., drug vs. nondrug choice). Both tracks of research have been valuable tools in the development of pharmacotherapies for treating maladaptive decision making in drug addiction, and a number of common drugs have been studied in both designs. However, we have observed that there is little uniformity in the administration regimens of potential treatments between the designs, which hinders congruence in the development of single treatment strategies to reduce both impulsive behavior and drug choice. The current review provides an overview of the drugs that have been tested in both delay-discounting and drug-choice designs, and focuses on drugs that reduced the maladaptive choice in both designs. Suggestions to enhance congruence between the findings in future studies are provided. Finally, we propose the use of a hybridized, experimental approach that may enable researchers to test the effectiveness of therapeutics at decreasing impulsive and drug choice in a single design.

Killing two birds with one stone? Association between tobacco and alcohol consumption

OBJECTIVES

Tobacco and excessive alcohol consumption are addictive behaviours, listed among the 10 leading risk factors that cause death and disability in the world, and health consequences are greater if their consumption is combined. There is sparse empirical evidence on the variables that influence the simultaneous consumption of tobacco and alcohol. This study aims to identify the variables that influence the joint decision to consume alcohol and tobacco, and that encourage drinkers to smoke.

STUDY DESIGN

The sample includes Portuguese adults, mainly aged 50 years and over, extracted from the Survey of Health, Ageing and Retirement in Europe, covering the year 2011.

METHODS

We propose a bivariate probit model, which allows us to model simultaneously the two goods, accounting for potential correlation between smoking and drinking decisions.

RESULTS

We identified the variables that influence joint consumption, and tobacco consumption among drinkers, which could be used as policy instruments to develop concerted policies. Prevention policies should focus on males, younger and more educated individuals, as well as on individuals with unhealthy eating habits, because these variables were statistically significant and increased joint consumption. In addition, these characteristics also should be regarded if we want to control tobacco consumption among alcohol consumers.

CONCLUSIONS

The analysis of the interdependence between alcohol and tobacco use presented in this article may allow reducing their consumption with a common intervention, enabling policymakers to 'kill two birds with one stone' and to achieve extended health and economic gains.

Event-Related Potentials as Biomarkers of Behavior Change Mechanisms in Substance Use Disorder Treatment

Substance use disorders (SUDs) are one of the most prevalent psychiatric conditions and represent a significant public health concern. Substantial research has identified key processes related to reinforcement and cognition for the development and maintenance of SUDs, and these processes represent viable treatment targets for psychosocial and pharmacological interventions. Research on SUD treatments has suggested that most approaches are comparable in effectiveness. As a result, recent work has focused on delineating the underlying mechanisms of behavior change that drive SUD treatment outcome. Given the rapid fluctuations associated with the key neurocognitive processes associated with SUDs, high-temporal-resolution measures of human brain processing, namely event-related potentials (ERPs), are uniquely suited to expand our understanding of the underlying neural mechanisms of change during and after SUD treatment. The value of ERPs in the context of SUD treatment are discussed along with work demonstrating the predictive validity of ERPs as biomarkers of SUD treatment response. Example associations between multiple ERP components and psychosocial and/or pharmacological treatment outcome include the P3a and P3b (in response to neutral and substance-related cues), the attention-related negativities (e.g., N170, N200), the late positive potential, and the error-related negativity. Also addressed are limitations of the biomarker approach to underscore the need for research programs evaluating mechanisms of change. Finally, we emphasize the advantages of ERPs as indices of behavior change in SUD treatment and outline issues relevant for future directions in this context.

Meta-analysis of the relationship between impulsivity and substance-related cognitive biases

BACKGROUND

Evidence indicates that substance-related cognitive biases (attentional, memory, and approach bias) contribute to the maintenance and development of substance misuse. Impulsivity has been suggested to influence how cognitive biases contribute to substance misuse, possibly by biasing incentive salience attribution processes. However, the strength and moderators of the relationship between impulsivity and substance-related cognitive biases has yet to be empirically examined.

METHODS

A meta-analysis using random-effects models was completed assessing 19 studies that reported a quantitative relationship between an impulsivity measure and a substance-related cognitive bias. Two-component conceptualisation of impulsivity, impulsivity measurement type, gender, and age were assessed as moderators.

RESULTS

A small, significant positive relationship (r=0.10) was observed between impulsivity and substance-related attentional, memory, and approach biases. No moderators examined had a significant influence on this relationship.

CONCLUSIONS

Results are consistent with incentive sensitisation theories of addiction and suggests a weak synergistic relationship between impulsivity and substance-related cognitive biases. This relationship holds across different measures and components of impulsivity. Results provide some support for the viability of impulsivity and cognitive bias interaction models which may warrant further investigation of these factors in relation to predicting addiction treatment outcomes.

Neural Systems Underlying Individual Differences in Intertemporal Decision-making

Excessively choosing immediate over larger future rewards, or delay discounting (DD), associates with multiple clinical conditions. Individual differences in DD likely depend on variations in the activation of and functional interactions between networks, representing possible endophenotypes for associated disorders, including alcohol use disorders (AUDs). Numerous fMRI studies have probed the neural bases of DD, but investigations of large-scale networks remain scant. We addressed this gap by testing whether activation within large-scale networks during Now/Later decision-making predicts individual differences in DD. To do so, we scanned 95 social drinkers (18-40 years old; 50 women) using fMRI during hypothetical choices between small monetary amounts available "today" or larger amounts available later. We identified neural networks engaged during Now/Later choice using independent component analysis and tested the relationship between component activation and degree of DD. The activity of two components during Now/Later choice correlated with individual DD rates: A temporal lobe network positively correlated with DD, whereas a frontoparietal-striatal network negatively correlated with DD. Activation differences between these networks predicted individual differences in DD, and their negative correlation during Now/Later choice suggests functional competition. A generalized psychophysiological interactions analysis confirmed a decrease in their functional connectivity during decision-making. The functional connectivity of these two networks negatively correlates with alcohol-related harm, potentially implicating these networks in AUDs. These findings provide novel insight into the neural underpinnings of individual differences in impulsive decision-making with potential implications for addiction and related disorders in which impulsivity is a defining feature.

The Effectiveness of Cognitive Bias Modification Interventions for Substance Addictions: A Meta-Analysis

Background and Aims

Cognitive bias modification (CBM) interventions, presumably targeting automatic processes, are considered particularly promising for addictions. We conducted a meta-analysis examining randomized controlled trials (RCTs) of CBM for substance addiction outcomes.

Methods

Studies were identified through systematic searches in bibliographical databases. We included RCTs of CBM interventions, alone or in combination with other treatments, for any type of addiction. We examined trial risk of bias, publication bias and possible moderators. Effects sizes were computed for post-test and follow-up, using a random-effects model. We grouped outcome measures and reported results for addiction (all related measures), craving and cognitive bias.

Results

We identified 25 trials, 18 for alcohol problems, and 7 for smoking. At post-test, there was no significant effect of CBM for addiction, g = 0.08 (95% CI -0.02 to 0.18) or craving, g = 0.05 (95% CI -0.06 to 0.16), but there was a significant, moderate effect on cognitive bias, g = 0.60 (95% CI 0.39 to 0.79). Results were similar for alcohol and smoking outcomes taken separately. Follow-up addiction outcomes were reported in 7 trials, resulting in a small but significant effect of CBM, g = 0.18 (95% CI 0.03 to 0.32). Results for addiction and craving did not differ by substance type, sample type, delivery setting, bias targeted or number of sessions. Risk of bias was high or uncertain in most trials, for most criteria considered. Meta-regression analyses revealed significant inverse relationships between risk of bias and effect sizes for addiction outcomes and craving. The relationship between cognitive bias and respectively addiction ESs was not significant. There was consistent evidence of publication bias in the form of funnel plot asymmetry.

Conclusions

Our results cast serious doubts on the clinical utility of CBM interventions for addiction problems, but sounder methodological trials are necessary before this issue can be settled. We found no indication that positive effects on biases translate into effects on addiction outcomes.

Neuroscience of attentional processes for addiction medicine: from brain mechanisms to practical considerations

The present chapter first argues how having a goal for procuring alcohol or other substances leads to the development of a time-binding, dynamic, and goal oriented motivational state termed current concern, as the origin of substance-related attentional bias. Next, it discusses the importance of attentional bias in the development, continuation of, and relapsing to substance abuse. It further proceeds with a review of selective evidence from cognitive psychology that helps account for making decisions about using an addictive substance or refraining from using it. A discussion on the various brain loci that are involved in attentional bias and other kinds of cue reactivity is followed by presenting findings from neurocognitive research. Finally, from an interdisciplinary perspective, the chapter presents new trends and ideas that can be applied to addiction-related cognitive measurement and training.

Alcohol Consumption in Healthy OPRM1 G Allele Carriers and Its Association with Impulsive Behavior

AIMS

A link between alcohol use disorders (AUD) and impulsivity is well established. As there is evidence for the heritability of AUD, the investigation of the underlying genetic disposition for both conditions is an important issue. An association between AUD and a coding single nucleotide polymorphism (SNP) (rs1799971 encoding an Asn40Asp amino acid substitution, A118G) within the µ-opioid receptor 1 gene (OPRM1) has been reported. Therefore we tested the association between the OPRM1 A118G polymorphism and drinking as well as impulsive behavior in social drinkers.

METHODS

A total of 214 healthy male social drinkers were recruited. Each participant was genotyped for the OPRM1 A118G variant. Alcohol use was assessed with items of the Alcohol Use Disorders Identification Test (AUDIT). Impulsivity was assessed using the UPPS impulsive behavior scale. For statistical analyses, we considered correlations, t-tests and ordinal regression models using SPSS V21.

RESULTS

In total, 49 out of 214 participants were carriers of the OPRM1 118G allele. On average the OPRM1 118G carriers showed a slightly higher propensity for alcohol drinking. Higher drinking frequency among the G allele carriers was linked with higher urgency and perseveration subscores of impulsivity.

CONCLUSION

Our results suggest a genetically influenced higher propensity for alcohol drinking among social drinkers carrying the 118G allele of the OPRM1 gene. The positive correlation between urgency and a higher drinking frequency among the OPRM1 118G hint towards a functional meaning of the opioid system in the regulation of impulsivity.

A perfect match: noninvasive brain stimulation and psychotherapy

One out of four patients with a psychiatric disorder does not tolerate or sufficiently respond to standard treatments, leading to impaired quality of life, significant morbidity and mortality, as well as high socioeconomic costs. There is increasing evidence that-apart from psychopharmacologic and psychotherapeutic interventions-targeted modulation of neural networks by brain stimulation techniques might serve as a third treatment modality. In the whole spectrum of treatment modalities, combined approaches are often used for difficult-to-treat patients. They may be superior strategies compared to monotherapy and could possible also include brain stimulation interventions. However, systematic research is lacking for the latter issue. Particularly, noninvasive brain stimulation (NIBS), e.g., transcranial direct current stimulation (tDCS) can be easily combined with psychotherapy approaches. Here, we introduce NIBS techniques for priming and augmenting psychotherapy, review preliminary data and propose a future research strategy. Interestingly, this strategy parallels the promising development in neurology and neurorehabilitation where tDCS is currently combined with functional training tasks to enhance motor or cognitive performance.

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.