The Phenotype of Recovery X: Associations between delay discounting, regulatory flexibility, and remission from substance use disorder

Food for thought: The relationship between poor eating habits, delay discounting, and quality of life in substance use recovery

BACKGROUND

Research on poor eating habits among individuals recovering from substance use disorders (SUD) is limited. This study examines the relationship between poor eating habits, delay discounting (DD), quality of life (QOL), and remission status, in addition to examining DD as a mediator of the relationship between poor eating and QOL.

METHODS

Participants (n = 257) in recovery from SUD, completed the Health Behaviors Questionnaire (poor eating was measured using the food domain), a DD task, the World Health Organization QOL questionnaire, demographics, and SUD-related questions. Multivariate linear regression was used to test associations between poor eating and DD, as well as each QOL domain. Mediation analyses were conducted to evaluate the role of DD in the relationship between poor eating and QOL. A binary logistic regression was used to test associations between poor eating and remission status, as well as DD and remission status.

RESULTS

Poor eating habits were significantly associated with higher rates of DD (β = 0.08, p < .001) and lower QOL across psychological (β = -0.88, p < .001, only for those in remission), physical (β = -0.58, p < .001), and environmental (β = -0.75, p < .001) domains. Additionally, DD significantly mediated the relationship between poor eating habits and reduced QOL in these domains (ꞵs < -0.08, ps < 0.003). Poor eating (ꞵ = 0.05, p = .014; OR = 1.05, p = .012) and high DD rates (ꞵ = 0.12, p = .049; OR = 1.12, p = .038) were associated with a lower likelihood of remission from SUD.

CONCLUSIONS

Our findings highlight the integral role of dietary habits in the recovery trajectory of individuals with SUD. The study supports the need for holistic treatment approaches that consider the impacts of nutrition on both psychological and physiological aspects of recovery.

Beyond the first try: How many quit attempts are necessary to achieve substance use cessation?

Substance use disorder (SUD) is a chronically relapsing disorder; thus, individuals with SUD may require several attempts before achieving abstinence. The goal of the present study was to investigate what variables are associated with the number of quit attempts before successful abstinence was achieved. Data were collected from 421 International Quit & Recovery Registry participants. Participants answered several questions for each substance they reported being in recovery, including how many times they had attempted to quit that substance and whether they still used that substance. The results showed that the number of quit attempts was associated with the substance one was trying to quit, SUD severity (i.e., mild, moderate, severe SUD) for that substance, the number of years using that substance, and the age of use onset. Pairwise comparisons among substances indicated that pain medication and opioids had a significantly higher number of quit attempts than all other substances (ps < .001) but were not different from each other (p = 1.0). Pairwise comparisons across levels of SUD severity showed a significantly higher number of attempts for those with moderate than mild SUD (p < .001) and for those with severe than mild or moderate SUD (ps < .001). Overall, the results indicate that individuals who use opioids and pain medication, have more severe SUD, and more years of use need significantly more attempts before achieving successful abstinence. Thus, those might benefit from more targeted and effective interventions.

BACKGROUND AND AIMS

Substance use disorder (SUD) is a chronically relapsing disorder. Thus, individuals with SUD may need several attempts before achieving abstinence. The present study investigated the variables associated with the number of quit attempts before achieving successful abstinence.

METHODS

Data were collected from 421 International Quit & Recovery Registry participants. Participants answered several questions for each substance they reported being in recovery from, such as the age of first use, how many times they had attempted to quit that substance, and whether they still used that substance.

RESULTS

The number of quit attempts was associated with the substance one was trying to quit, SUD severity (i.e., mild, moderate, severe SUD) for that substance, the number of years using that substance, and the age of use onset. Pairwise comparisons among substances indicated that pain medication and opioids had a significantly higher number of quit attempts than all other substances (ps < .001) but were not different from each other (p = 1.0). Pairwise comparisons across levels of SUD severity showed a significantly higher number of attempts for those with moderate than mild SUD (p < .001) and for those with severe than mild or moderate SUD (ps < .001).

CONCLUSIONS

Opioids and pain medication require significantly more attempts than all other substances, according to our findings. Thus, such substances might need more targeted and effective interventions. Additionally, more severe SUD and more years of use were also associated with more quit attempts. Such findings suggest the need for more effective early interventions to decrease the number of attempts before successful abstinence.

Running toward substance use recovery: Does delay discounting mediate the relationship between physical activity and quality of life?

Background

Recovery from substance use disorders is multifactorial with psychosocial functioning, such as quality of life (QOL), playing a particularly important role. Delay discounting, the degree to which individuals devaluate a reinforcer as a function of the delay to its receipt, is associated with QOL. Moreover, evidence shows that physical activity may decrease delay discounting rates. The present study aims to examine associations among physical activity, delay discounting, and QOL, and investigate the mediating role of delay discounting in the relationship between physical activity and QOL domains.

Methods

Data was collected from the International Quit & Recovery Registry (IQRR), and comprised of 267 participants (67% women) who reported being in recovery from substance use disorders. Participants completed the Health Behaviors Questionnaire (physical activity was measured using the fitness domain), a delay discounting minute task (higher delay discounting rates indicate a preference for smaller, sooner rewards), the World Health Organization QOL questionnaire, as well as demographics and substance use disorders-related questions. Multivariate linear regression was used to test associations between physical activity with delay discounting, and physical activity with each QOL domain. Mediation analyses were conducted to evaluate the mediating role of delay discounting in the relationship between physical activity and QOL domain.

Results

Higher levels of physical activity were associated with greater valuation of the future (lower delay discounting rates; p<.001) and higher levels of physical (p < .001), and environmental (p=.001) QOL. Delay discounting mediated the relationship between physical activity and physical (p=.004), and environmental (p<.001) QOL.

Conclusion

Physical activity can be an important tool in the treatment and recovery of substance use disorders, as it is associated with future-oriented choices, which in turn contributes to improving the QOL of those individuals.

Associations between delay discounting and unhealthy behaviors in substance use recovery

BACKGROUND

Research on delay discounting (DD) is mixed on whether DD is a domain-specific component related to specific behaviors or a domain-general process that cuts across various behaviors. A pivotal group to test the associations between DD and unhealthy behaviors is individuals in recovery from substance use disorders (SUD), as they are moving away from a disorder toward a healthier state.

METHODS

Individuals in SUD recovery (n = 317) completed the Temptation Scale, the Health Behaviors Questionnaire, and an Adjusting Delay Discounting Task. An exhaustive model space search was performed using linear regression to examine associations between DD with temptation, engagement in unhealthy behaviors, and the total number of unhealthy behaviors participants engage in. We also tested whether remission status is associated with the total number of unhealthy behaviors participants engage in.

RESULTS

Results revealed that DD was positively associated with poor eating (p<.001), physical inactivity (p=.003), financial irresponsibility (p<.001), risky behaviors (p<.001), lack of personal development goals (p<.001), lack of household savings (p=.004), and lack of health behaviors (p=.003). DD was also positively associated with the total number of unhealthy behaviors participants engage in (p<.001). Participants who were not in remission engaged in more unhealthy behaviors compared to those who were in remission (p<.001).

CONCLUSION

In a sample of individuals in recovery from SUD, DD is not domain-specific and undergirds engagement in several maladaptive health behaviors that can negatively impact recovery. Thus, DD can be a target for interventions aiming to reduce other maladaptive behaviors in SUD recovery.

Context matters: Exploring the adaptive nature of self-regulation skills in predicting abstinence among veterans with alcohol use disorder

BACKGROUND

Alcohol use disorder (AUD) is highly prevalent among veterans in the United States. Self-regulation skills (e.g., coping and emotion regulation) are important biopsychosocial factors for preventing relapse. However, how variation in self-regulation skills supports abstinence based on contextual demands is understudied in veterans with AUD.

METHODS

In a prospective longitudinal design, treatment-seeking veterans (n = 120; 29 females) aged 23-91 with AUD completed the Alcohol Abstinence Self-Efficacy Scale to assess temptation to drink across several high-risk situations (i.e., negative affect, social/positive emotions, physical concerns, and craving/urges) as well as the Brief-COPE and Emotion Regulation Questionnaire to assess self-regulation skills. Abstinence status was assessed at 6 months. T-tests were used to identify self-regulation skills that differed between abstinent and non-abstinent individuals. Multivariate regression with model selection was performed using all possible interactions between each high-risk situation and the self-regulation skills that significantly differed between groups.

RESULTS

Overall, 33.3% of participants (n = 40; nine females) were abstinent at 6 months. Abstinent individuals reported significantly higher use of suppression (p = 0.015), acceptance (p = 0.005), and planning (p = 0.045). Multivariate regression identified significant interactions between (1) planning and physical concerns (p = 0.010) and (2) acceptance, suppression, and craving/urges (p = 0.007). Greater planning predicted abstinence in participants with higher temptation to drink due to physical concerns (e.g., pain). For individuals with lower temptation to drink due to cravings/urges, simultaneous higher suppression and acceptance increased the likelihood of abstinence. Conversely, for participants with higher cravings, greater acceptance with lower suppression was linked to a higher probability of abstinence.

CONCLUSIONS

Results suggest that the adaptiveness of self-regulation skills in predicting AUD recovery is dependent on contextual demands and highlight the need for culturally sensitive treatments. Collectively, these findings indicate that further research on coping and regulatory flexibility may be an important avenue for tailoring AUD treatment for veterans.