Developing and testing the effectiveness of a novel online integrated treatment for problem gambling and tobacco smoking: a protocol for an open-label randomized controlled trial

BACKGROUND

Gambling and tobacco smoking are highly comorbid among North American adults. However, there is a paucity of treatment options that are integrated (i.e. targeting both gambling and tobacco smoking simultaneously), accessible, and evidence based.

METHODS

The aim of this two-arm open-label randomized controlled trial is to examine the effectiveness of an online, self-guided integrated treatment for problem gambling and tobacco smoking. A target sample of 214 participants will be recruited and be randomized into either an 8-week integrated or gambling only control condition. Both conditions will consist of seven online modules following cognitive behavioural therapy and motivational interviewing principles. Our three primary outcomes are (1) the number of days gambled, (2) money spent on gambling activities, and (3) time spent in gambling activities. Secondary outcomes include gambling disorder symptoms, cigarette use, and nicotine dependence symptoms. Assessments will be completed at baseline, at completion (i.e. 8 weeks from baseline), and at follow-up (i.e. 24 weeks from baseline). Generalized linear mixed modelling will be used to evaluate our primary and secondary outcomes. We expect that participants receiving online integrated treatment will show larger reductions in gambling relative to those receiving a control gambling only intervention. We further hypothesize that reductions in smoking will mediate these group differences.

DISCUSSION

The rates of problem gambling and tobacco smoking are high in North America; yet, the treatment options for both are limited, with no integrated treatments available. If supported, our pilot study will be a cost-effective and accessible way to improve treatments for co-occurring problem gambling and tobacco use.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03614884 . Registered on August 3, 2019.

Drinking to cope with the pandemic: The unique associations of COVID-19-related perceived threat and psychological distress to drinking behaviors in American men and women

The 2019 Coronavirus pandemic has brought about significant and unprecedented changes to the modern world, including stay-at-home orders, high rates of unemployment, and more than a hundred thousand deaths across the United States. Derived from the self-medication hypothesis, this research explored how perceived threat and psychological distress related to the COVID-19 pandemic are associated with drinking behavior among an American sample of adults. We also evaluated whether links between COVID-19-related perceived threat and psychological distress with drinking behavior are different for men and women. Participants (N = 754; 50% women) completed an online Qualtrics Panels study between April 17th and 23rd, 2020. Results suggested that psychological distress related to the COVID-19 pandemic was consistently related to alcohol use indices, and moderation results indicated this pattern was significant only among women for number of drinks consumed during the recent heaviest drinking occasion and number of drinks consumed on a typical evening. COVID-related distress' link to frequency of drinking and heavy drinking episodes was not different for men and women. Our results suggest that continued monitoring, particularly among women, should be conducted as this pandemic continues to evolve to identify the long-term public health impacts of drinking to cope with COVID-19 distress.

Self-isolation: A significant contributor to cannabis use during the COVID-19 pandemic

BACKGROUND

Emerging research suggests the COVID-19 pandemic has resulted in a significant increase in self-reported isolation and loneliness in a large proportion of the population. This is particularly concerning given that isolation and loneliness are associated with increased cannabis use, as well as using cannabis to cope with negative affect. Objective: We investigated whether self-isolation due to COVID-19 and using cannabis to cope with depression were unique and/or interactive predictors of cannabis use during the pandemic, after controlling for pre-pandemic levels of cannabis use. Method: A sample of 70 emerging adults (mean age = 23.03; 34.3% male) who used both alcohol and cannabis pre-pandemic completed measures of cannabis use (i.e., quantity x frequency) and a novel COVID-19 questionnaire between March 23 and June 15, 2020. Pre-pandemic cannabis use levels had been collected four months earlier. Results: Linear regressions indicated self-isolation and coping with depression motives for cannabis use during the pandemic were significant predictors of pandemic cannabis use levels after accounting for pre-pandemic use levels. There was no interaction between coping with depression motives and self-isolation on cannabis use during the pandemic. Conclusions: Those who engaged in self-isolation were found to use 20% more cannabis during the pandemic than those who did not. Our results suggest that self-isolation is a unique risk factor for escalating cannabis use levels during the pandemic. Thus, self-isolation may inadvertently lead to adverse public health consequences in the form of increased cannabis use.

The Effect of Cigarette Packaging and Illness Sensitivity on Attention to Graphic Health Warnings: A Controlled Study

INTRODUCTION

The social and health care costs of smoking are immense. To reduce these costs, several tobacco control policies have been introduced (eg, graphic health warnings [GHWs] on cigarette packs). Previous research has found plain packaging (a homogenized form of packaging), in comparison to branded packaging, effectively increases attention to GHWs using UK packaging prototypes. Past studies have also found that illness sensitivity (IS) protects against health-impairing behaviors. Building on this evidence, the goal of the current study was to assess the effect of packaging type (plain vs. branded), IS level, and their interaction on attention to GHWs on cigarette packages using proposed Canadian prototypes.

AIMS AND METHODS

We assessed the dwell time and fixations on the GHW component of 40 cigarette pack stimuli (20 branded; 20 plain). Stimuli were presented in random order to 50 smokers (60.8% male; mean age = 33.1; 92.2% daily smokers) using the EyeLink 1000 system. Participants were divided into low IS (n = 25) and high IS (n = 25) groups based on scores on the Illness Sensitivity Index.

RESULTS

Overall, plain packaging relative to branded packaging increased fixations (but not dwell time) on GHWs. Moreover, low IS (but not high IS) smokers showed more fixations to GHWs on plain versus branded packages.

CONCLUSIONS

These findings demonstrate that plain packaging is a promising intervention for daily smokers, particularly those low in IS, and contribute evidence in support of impending implementation of plain packaging in Canada.

IMPLICATIONS

Our findings have three important implications. First, our study provides controlled experimental evidence that plain packaging is a promising intervention for daily smokers. Second, the findings of this study contribute supportive evidence for the impending plain packaging policy in Canada, and can therefore aid in defense against anticipated challenges from the tobacco industry upon its implementation. Third, given its effects in increasing attention to GHWs, plain packaging is an intervention likely to provide smokers enhanced incentive for smoking cessation, particularly among those low in IS who may otherwise be less interested in seeking treatment for tobacco dependence.

Initial Usability and Feasibility of a Web-Based Behavioural Activation Program for Young Adults With Comorbid Depression and Problem Gambling: A Case Study and Case Series

Approximately 20%–32% of youth and adults with problem gambling also experience comorbid depression, yet treatment for this comorbidity is not readily accessible. We sought to extend and customize DoNamic, our existing web-based app for treating depression, to also treat young adults who experience comorbid problem gambling. We conducted a laboratory-based usability case study (Study 1) and a usability and feasibility clinical case series (Study 2). Study 1 involved an individual with problem gambling who tested the DoNamic version tailored to problem gambling (DoNamic-PG) in the laboratory. Changes based on participant feedback were implemented. Study 2 involved two cycles of testing in which five participants used the revised version of DoNamic-PG and provided feedback. Indicators of feasibility and usability of DoNamic-PG were predominately met; however, even with the increased accessibility and ease of use of DoNamic-PG, recruitment issues suggest it may not fully overcome the problem of attracting gamblers into treatment. This study highlights an existing concern in the field of problem gambling: Even when interventions are accessible for problem gambling populations, they are not necessarily used. Ultimately, the results of our case studies highlight how existing apps can be adjusted for specific subgroups. DoNamic-PG has the potential to be a feasible and usable app that could increase the accessibility, efficiency, and quality of care for younger adults with depression and problem gambling, if recruitment problems can be overcome. The next steps for developing DoNamic-PG include further feasibility testing, followed by trials to determine its efficacy and effectiveness.RésuméEntre 20 et 32 % des jeunes et des adultes aux prises avec une dépendance au jeu éprouvent aussi des problèmes de dépression. Et pourtant, il n’est pas facile d’obtenir un traitement pour ce trouble concomitant. Nous souhaitons donc adapter DoNamic, notre application web pour le traitement de la dépression, aux besoins des jeunes adultes qui éprouvent un trouble dépressif concomitant à leur dépendance au jeu. À cette fin, nous avons mené une étude d’utilisabilité en laboratoire (étude 1), puis une série d’essais cliniques sur l’utilisabilité et la faisabilité (étude 2). Dans l’étude 1, nous avons demandé à un joueur pathologique de mettre à l’essai en laboratoire une version de DoNamic adaptée aux problèmes de dépendance au jeu (DoNamic-PG), puis nous avons effectué des changements à l’application en fonction des commentaires du participant. L’étude 2 comprenait deux cycles d’essais cliniques au cours desquels cinq participants ont utilisé la version révisée de DoNamic-PG, puis ont fourni leurs commentaires. Les indicateurs de faisabilité et d’utilisabilité de DoNamic-PG ont été en bonne partie atteints; toutefois, même si l’application est plus accessible et facile à utiliser, les difficultés de recrutement suggèrent que cette solution ne suffit pas pour inciter les joueurs à se faire traiter. Cela met en évidence un enjeu actuel des traitements de la dépendance au jeu : même lorsqu’il existe des solutions de traitement accessibles, les joueurs compulsifs ne les utilisent pas nécessairement. Les résultats de nos études de cas révèlent par contre qu’il est possible d’adapter les applications existantes aux besoins de sous-groupes spécifiques et que DoNamic-PG constitue une application potentiellement utilisable pour accroître l’accessibilité, l’efficacité et la qualité des soins offerts aux jeunes adultes aux prises avec des problèmes concomitants de jeu et de dépression, à condition d’améliorer le recrutement. Les prochaines étapes du développement de DoNamic-PG comprennent d’autres études de faisabilité, suivies d’essais cliniques pour déterminer l’efficacité et la performance de l’application. 

Relationships on the rocks: A meta-analysis of romantic partner effects on alcohol use

The partner influence hypothesis postulates one partner's alcohol use influences the other partner's alcohol use over time. Although several studies have examined the partner influence hypothesis, the magnitude and gender-specific nature of partner influences on alcohol use are unclear and have yet to be examined meta-analytically. We addressed this by conducting a traditional bivariate meta-analysis and two-stage meta-analytic structural equation modeling across 17 studies (N = 10,553 couples). Studies that assessed both romantic partners' alcohol use at a minimum of two time-points were selected. Results suggest romantic partners do influence one another's drinking, to a small but meaningful degree, with women (β = .19) exerting a statistically stronger (p < .05) influence than men (β = .12). Results also suggest time lag between assessment, alcohol indicator, married, and year of publication may moderate partner influence. Thus, social influences on individual alcohol use include important partner influences. These influences can serve either risk or protective functions. Given the economic, social, and health consequences associated with alcohol misuse, advancing knowledge of social risk factors for alcohol misuse is essential. Therefore, assessment and treatment of alcohol misuse should extend beyond the person to the social context. We encourage clinicians to consider involving romantic partners when assessing and treating alcohol misuse. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Classification of Orthorexia Nervosa: Further evidence for placement within the eating disorders spectrum

PURPOSE

Orthorexia Nervosa (ON) may belong on the eating disorder (ED) or obsessive-compulsive (OC) spectrum. We sought to provide additional evidence regarding the working classification of ON as an ED.

METHODS

512 individuals completed a measure of ON symptoms (rBOT), ED symptoms (Eating Disorder Examination Questionnaire), OC symptoms (Obsessive-Compulsive Inventory Revised), food choice motives (Food Choice Questionnaire), and perfectionism (Multidimensional Perfectionism Scale).

RESULTS

ON symptoms were more strongly linked to ED symptoms than to OC symptoms. ON symptoms were related to body weight and shape concerns, and with prioritizing weight above health with respect to food selection. Both ED and ON symptoms were moderately related to perfectionism, while OC symptoms were strongly related to perfectionism.

CONCLUSION

Our results support ON being classified on the ED spectrum; however, whether ON represents a precursor to an ED, an ED with added health concerns, or a disorder that evolves from an ED is not certain. Future longitudinal research is necessary to test these alternate possibilities.

A Retrospective Study of the Clinical Characteristics Associated with Alcohol and Cannabis use in Early Phase Psychosis

OBJECTIVE

Alcohol and cannabis misuse are common in patients with early phase psychosis (EPP); however, research has tended to focus primarily on cannabis misuse and EPP outcomes, with a relative lack of data on alcohol misuse. This retrospective cross-sectional EPP study investigated the relationship between cannabis, alcohol, and cannabis combined with alcohol misuse, on age, gender, psychotic, depressive and anxiety symptom severity, and social/occupational functioning, at entry to service.

METHODS

Two-hundred and sixty-four EPP patients were divided into 4 groups based on substance use measured by the Alcohol, Smoking and Substance Involvement Screening Test: (1) no to low-level cannabis and alcohol misuse (LU), (2) moderate to high alcohol misuse only (AU), (3) moderate to high cannabis misuse only (CU), and (4) moderate to high alcohol and cannabis misuse (AU + CU).

RESULTS

We found significant between group differences in age (with the AU group being the oldest and AU + CU group the youngest) as well as gender (with the CU group having the highest percentage of men). There were also group differences in positive psychotic symptoms (lowest in AU group), trait anxiety (highest in AU + CU group), and social/occupational functioning (highest in AU group). Further regression analyses revealed a particularly strong relationship between AU + CU group and trait anxiety (3-fold increased odds of clinical trait anxiety for combined misuse of alcohol and cannabis compared to non/low users).

CONCLUSIONS

This study demonstrates the unique demographic and clinical characteristics found in the EPP population at entry to care associated with alcohol and cannabis misuse both separately and in combination. This work highlights the importance of including the assessment of alcohol misuse in addition to cannabis misuse in future treatment guidelines and research.

Gender differences in physical activity are partially explained by anxiety sensitivity in post-secondary students

Objective: Female post-secondary students typically engage in less physical activity than their male counterparts. Given that women have greater anxiety sensitivity (ie, fear of arousal-based body sensations) and anxiety sensitivity is inversely related to physical activity participation, this study sought to determine if anxiety sensitivity mediates gender differences in self-reported physical activity. Participants and methods: A sample of 802 post-secondary students completed the Anxiety Sensitivity Index-3 and a Lifestyles Questionnaire in September 2017. Results: Women reported significantly less physical activity and significantly greater anxiety sensitivity. Anxiety sensitivity was significantly and inversely related to self-reported physical activity. A significant indirect effect of gender on physical activity via anxiety sensitivity was shown (B = 5.56, SE = 2.81, p < .05, 95% CI [1.31, 12.78], P_M = .0843). Conclusions: Results suggest that anxiety sensitivity partially explains gender differences in physical activity. Anxiety sensitivity reduction interventions might increase physical activity participation and reduce the existing gender gap.

Social influences on binge drinking in emerging adults: Which social network members matter most?

BACKGROUND

Binge drinking peaks in emerging adulthood and is associated with a myriad of negative consequences. Research indicates that social network members have a significant influence on binge drinking. In particular, theory suggests that drinking habits of romantic partners and peers have a stronger influence on emerging-adult binge drinking than do drinking habits of siblings and parents. We investigated the relative influences of siblings, parents, romantic partners, and peers on emerging adults' binge drinking using a multisource design and a robust measure of binge drinking. We hypothesized peer and romantic partner binge drinking would more strongly predict emerging-adult (egos) binge drinking than would parent and sibling binge drinking. Methods: We recruited 321 participants (egos) aged 17-25 years, alongside 882 members of their social network (alters). Egos and alters completed self-report measures of binge drinking (frequency, quantity, and self-perception). Results: Structural equation modeling revealed that the direct positive effect from romantic partner binge drinking to ego binge drinking was significant. In contrast, the direct effects from peer, parent, and sibling binge drinking to ego binge drinking were nonsignificant. Conclusion: In emerging adulthood, romantic partners appear to have the strongest association with ego binge drinking.

Easing the disruption of COVID-19: supporting the mental health of the people of Canada—October 2020—an RSC Policy Briefing

The COVID-19 pandemic has had a significant impact on the mental health of the people of Canada. Most have found it challenging to cope with social distancing, isolation, anxiety about infection, financial security and the future, and balancing demands of work and home life. For some, especially those who have had to face pre-existing challenges such as structural racism, poverty, and discrimination and those with prior mental health problems, the pandemic has been a major impact.

The Policy Briefing Report focuses on the current situation, how the COVID-19 pandemic has exacerbated significant long-standing weaknesses in the mental health system and makes specific recommendations to meet these challenges to improve the well-being of the people of Canada.

The COVID-19 pandemic has had a detrimental effect on mental health of people in Canada but the impact has been variable, impacting those facing pre-existing structural inequities hardest. Those living in poverty, and in some socially stratified groups facing greater economic and social disadvantage, such as some racialized and some Indigenous groups and those with preexisting mental health problems, have suffered the most. Some occupational groups have been more exposed to the virus and to psychological stress with the pandemic. The mental health care system was already overextended and under resourced. The pandemic has exacerbated the problems. The care system responded by a massive move to virtual care. The future challenge is for Canada to strengthen our knowledge base in mental health, to learn from the pandemic, and to provide all in Canada the support they need to fully participate in and contribute to Canada’s recovery from the pandemic.

A qualitative study of the perceived effects of alcohol on depressive symptoms among undergraduates who drink to cope with depression

INTRODUCTION AND AIMS

Heavy drinking is prevalent among undergraduate students and is linked with drinking to cope with depression motives for drinking. Drinking to cope with depression remains poorly understood given that alcohol has been shown to have adverse effects on mood when consumed at high doses. Using semi-structured qualitative interviews, the present study examined the perceived effects of alcohol on depressive symptoms as reported by undergraduate students who endorse high levels of drinking to cope with depression.

DESIGN AND METHODS

Sixteen undergraduate coping-with-depression-motivated (CWDM) drinkers (nine women, seven men), identified using the Modified Drinking Motives Questionnaire-Revised [1], reported on their experiences of drinking to cope with depression. Thematic analysis was conducted to identify themes and subthemes in the data.

RESULTS

Undergraduate students reported several effects of alcohol on affective, cognitive and behavioural depressive symptoms. While most of the perceived alcohol effects they described involved relief from depressive symptoms, some perceived effects involved worsening depressive symptoms.

DISCUSSION AND CONCLUSIONS

The study generated several hypotheses to explain drinking to cope with depression, some of which might be testable in future experimental work. Overall, findings suggest the mood-altering effects of alcohol do not fully explain why depression and alcohol use are frequently co-morbid. Indeed, effects of alcohol on cognitive and behavioural depressive symptoms might be particularly reinforcing for CWDM drinkers. Interventions that target co-morbid depression and alcohol use might be improved by teaching CWDM drinkers skills to reduce depressive cognitions and to improve interpersonal interactions outside of drinking contexts.

Posttraumatic Stress Symptoms and Coping Motives Mediate the Association Between Childhood Maltreatment and Alcohol Problems

Childhood maltreatment is associated with increased risk of alcohol misuse. Posttraumatic stress symptoms (PTSS) and coping motives have both been identified, separately, as mediators of the relation between childhood maltreatment and alcohol misuse but have yet to be examined as serial mediators in a high-risk population. A total of 564 adolescents (53.7% female; M age = 15.9 years, SD = 1.1) in the care of child welfare services completed validated measures of childhood trauma, PTSS, drinking motives, and alcohol misuse across the first two waves (baseline and 6-month follow-up) of the Maltreatment and Adolescent Pathways (MAP) longitudinal study. Childhood maltreatment was associated with elevated PTSS, PTSS predicted higher coping motives, and coping motives were associated with higher levels of alcohol misuse, indirect effect (IE) = 0.03; 95% CI [0.00, 0.07]. Single mediator models with PTSS, IE = 0.03; 95% CI [-0.01, 0.05], and coping motives, IE = -0.02, 95% CI [-0.05, 0.03], as mediators were not statistically significant. The results suggest that PTSS and coping motives contribute sequentially to the association between childhood maltreatment and alcohol misuse and could thus both serve as intervention targets to prevent problem drinking in maltreated youth.

Drinking to keep pace: A study of the moderating influence of extraversion on alcohol consumption similarity in drinking buddy dyads

Heavy drinking in college remains a concerning issue due to its association with both health and social risks. While modelling contributes to college students' alcohol use, little work has identified who might be most susceptible to modelling effects. Peterson, Morey, and Higgins (2005) found males high in extraversion were more susceptible than others to matching strangers' drinking levels in a lab-based social drinking context. We sought to replicate and extend these findings by examining the impact of extraversion on social matching of alcohol consumption levels of a drinking buddy in college students' real lives. First, a significant relationship between buddy and target drinking levels was predicted in dyadic drinking situations. Additionally, we hypothesized that target extraversion would positively moderate this buddy- target drinking levels relationship. Data from 149 college student targets (74% F) and their same-sex drinking buddy were collected through online questionnaires examining targets' extraversion levels, and the drinking levels and social drinking context of both dyad members through a 30-day Timeline Followback measure. Linear mixed-effects modelling confirmed the study's first social matching hypothesis, while also revealing that target extraversion positively moderated the relationship between buddy and target daily drinking levels in dyadic drinking contexts. Findings extend those of Peterson et al. (2005) to a real-world (vs. lab-based) context, modelling of a buddy's (vs. stranger's) drinking levels, and a sample including women (vs. all-male). Results provide novel information on extraversion's contributions to modelling of alcohol use that may guide useful modifications to personality-based interventions for reducing college student heavy drinking.

Female informant-reports of male romantic partners' alcohol problems predict escalations in dyadic conflict in heterosexual couples

Alcohol problems are not just an individual concern; they have important negative impacts on romantic relationships. Perceiving one's romantic partner to have an alcohol problem is associated with lower relationship satisfaction and commitment. However, the utility of informant-reports of a partner's alcohol problems in predicting future dyadic conflict remains unknown. Our objective was to test the incremental validity of informant-reports of a partner's alcohol problems in predicting escalations in dyadic conflict over a one-month period beyond the partners' self-reported alcohol problems. One-hundred-eighty-seven opposite-sex couples participated in a one-month longitudinal study involving self- and informant-reports of alcohol problems at baseline and dyadic conflict measures at baseline and one-month follow-up. We hypothesized that, in both sexes, informant-reports of a partner's alcohol problems would predict escalations in dyadic conflict above and beyond the variance explained by self-reports of alcohol problems. This hypothesis was partially supported. Informant-reports of a partners' alcohol problems incrementally predicted future dyadic conflict, but only when women were informants. Women's self-reports of their own alcohol problems also predicted escalations in dyadic conflict whereas men's self-reports did not. Findings suggest that having women report on both their own and their male partners' levels of alcohol-related problems may help identify at-risk couples for early intervention to prevent escalating dyadic conflict. Though self-reported alcohol problems can be accurate, a person's position as expert on his or her alcohol problems can be compromised by biases (e.g., self-deception). Informant-reports may provide a more complete picture of the problem drinker in the romantic relationship context.

Drinking motives and drinking behaviors in romantic couples: A longitudinal actor-partner interdependence model

Excessive alcohol consumption is related to adverse physical and social consequences. Research shows an individual's own drinking motives (reasons for drinking alcohol) are linked to his or her specific drinking outcomes in a theoretically expected manner. Romantic couples often engage in a "drinking partnership," where partners reciprocally influence each other's drinking. Though alcohol consumption partner effects have been studied, partner effects of drinking motives on an individual's alcohol consumption have not been investigated in romantic couples. We investigated this topic. Romantic couples (N = 203) were assessed once weekly for four weeks using self-report questionnaires. Participants were on average 22.7 years old (SD = 5.5) and were in their relationship an average of 2.3 years (SD = 2.4). Actor-partner interdependence models using multilevel path-analysis with indistinguishable dyads were conducted, with each motive predicting drinking quantity and frequency. There were significant actor effects for social and enhancement motives; moreover, changes in a partner's enhancement and social motives predicted change in the individual's drinking quantity during any given week, but only averaged partners' enhancement motives predicted the individual's drinking frequency. Coping-with-anxiety motives had significant actor effects when predicting averaged quantity and frequency; moreover, changes in partners' coping-with-anxiety motives predicted changes in drinking quantity. Enhancement and social motives of the partner influenced the drinking quantity and frequency of the actor by way of influencing the actor's enhancement and social motives. Intervention efforts targeting both members of a romantic dyad on their reasons for drinking should be tested for preventing escalations in either member's drinking behavior. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Retrospective and prospective assessments of gambling-related behaviors across the female menstrual cycle

BACKGROUND AND AIMS

Despite increases in female gambling, little research investigates female-specific factors affecting gambling behavior (GB). Although research suggests that some addictive behaviors may fluctuate across menstrual cycle phase (MCP), gambling requires further investigation. In two studies, we examined associations between MCP and three risky GBs: time spent gambling, money spent gambling, and the probability of consuming alcohol while gambling. Associations between MCP and negative affect were also examined in Study 2. We predicted that, consistent with self-medication theory, increases in negative affect (Study 2) and risky GBs (Studies 1 and 2) would occur premenstrually/menstrually relative to other phases.

METHODS

Data were obtained from 33 female gamblers using a retrospective timeline followback procedure (Study 1) and from 20 female gamblers using a prospective 32-day, daily diary method (Study 2). In Study 2, salivary progesterone levels verified self-reported MCP validity.

RESULTS

Findings revealed significant, but somewhat inconsistent, MCP effects on GBs across studies. The self-medication hypothesis was partially supported. Increases relative to another MCP(s) were found for alcohol consumption while gambling premenstrually, time spent gambling menstrually/premenstrually, money spent gambling menstrually, and negative affect premenstrually. Unexpectedly, findings more consistently indicated that GBs increased during ovulation, suggestive of enhanced reward sensitivity. Progesterone assays validated self-reported MCP (Study 2).

DISCUSSION AND CONCLUSIONS

The results suggest a role of ovarian hormones on negative affect and GBs in females. This research could lead to the identification of female-specific factors affecting gambling and the development of more effective interventions for females with, or at risk for, problematic gambling.

Context matters: Characteristics of solitary versus social cannabis use

INTRODUCTION AND AIMS

Given the increase in cannabis availability and use in North America, identification of risk factors for cannabis use and dependence is paramount. One factor that may be associated with various cannabis-related adverse outcomes is the context in which it is used. This secondary analysis study sought to examine the extent to which the social context of cannabis use is related to patterns of use and associated harms.

DESIGN AND METHODS

One hundred and eighty-eight adult cannabis users were community-recruited in Halifax, Canada. Participants took part in a face-to-face structured interview where they provided information about the social context of their most recent cannabis-using occasion and about their patterns of, and motives for, cannabis use.

RESULTS

Compared to individuals reporting their most recent cannabis-using occasion as social, solitary users (n = 55) were significantly more likely to screen positive for psychosis, endorse more symptoms of cannabis abuse/dependence, report using cannabis to cope, and use cannabis on more days within the previous 30 days. On the other hand, social users were significantly more likely to report using alcohol in addition to cannabis during their most recent cannabis-using occasion (all P < 0.05).

DISCUSSION AND CONCLUSIONS

Results suggest that solitary cannabis use may be associated with specific motives for use and future adverse consequences. Findings from this study serve as a guide for future investigations which could ultimately inform public policy and the development of targeted harm-reduction strategies.

Solitary gambling mediates the risk pathway from anxiety sensitivity to excessive gambling: Evidence from a longitudinal ecological momentary assessment study

Anxiety and gambling problems co-occur at high rates. Social learning theory (SLT) suggests that people high in anxiety engage in excessive gambling to reduce negative affect. Because anxiety sensitivity (AS) is a vulnerability factor associated with addictive behaviors, it is important to identify mediators in this high-risk pathway. Emerging research shows that social context mediates associations between anxiety vulnerability and addictive behaviors. This literature shows that anxiety-prone people are at increased risk for substance problems because they engage in frequent solitary substance use. Theory would predict a similar pathway to gambling problems, but this remains to be tested. Accordingly, this study aimed to examine solitary gambling as an explanatory variable in the anxiety pathway to gambling problems. We used a longitudinal ecological momentary assessment (EMA) design. After completing baseline measures, young adults (N = 108) were asked to report daily on their gambling behavior over a 30-day period. Bias corrected bootstrapped confidence intervals (CI) supported 1 hypothesized indirect effect from baseline AS (Time 1) to EMA time spent gambling (Time 2) via EMA solitary gambling (Time 2; B = 0.019, 95% CI [0.002, 0.045]). This suggests that emerging adults with high levels of AS at baseline engaged in frequent solitary gambling over the 30-day EMA sampling period, which in turn predicted more time spent gambling over this same time period. Our results show that solitary gambling mediates the relation between anxiety vulnerability and excessive gambling. Understanding how social context relates to excessive gambling can help create interventions to reduce solitary gambling among anxiety-prone individuals. (PsycINFO Database Record

A Population-Based Analysis of the Relationship Between Substance Use and Adolescent Cognitive Development

OBJECTIVE

Alcohol and cannabis misuse are related to impaired cognition. When inferring causality, four nonexclusive theoretical models can account for this association: 1) a common underlying vulnerability model; 2) a neuroplasticity model in which impairment is concurrent with changes in substance use but temporary because of neuroplastic brain processes that restore function; 3) a neurotoxicity model of long-term impairment consequential to substance use; and 4) a developmental sensitivity hypothesis of age-specific effects. Using a developmentally sensitive design, the authors investigated relationships between year-to-year changes in substance use and cognitive development.

METHOD

A population-based sample of 3,826 seventh-grade students from 31 schools consisting of 5% of all students entering high school in 2012 and 2013 in the Greater Montreal region were assessed annually for 4 years on alcohol and cannabis use, recall memory, perceptual reasoning, inhibition, and working memory, using school-based computerized assessments. Multilevel regression models, performed separately for each substance, were used to simultaneously test vulnerability (between-subject) and concurrent and lagged within-subject effects on each cognitive domain.

RESULTS

Common vulnerability effects were detected for cannabis and alcohol on all domains. Cannabis use, but not alcohol consumption, showed lagged (neurotoxic) effects on inhibitory control and working memory and concurrent effects on delayed memory recall and perceptual reasoning (with some evidence of developmental sensitivity). Cannabis effects were independent of any alcohol effects.

CONCLUSIONS

Beyond the role of cognition in vulnerability to substance use, the concurrent and lasting effects of adolescent cannabis use can be observed on important cognitive functions and appear to be more pronounced than those observed for alcohol.

Comorbid anxiety, depression, and cognition in MS and other immune-mediated disorders

OBJECTIVE

To determine whether anxiety and depression are associated with cognition in multiple sclerosis (MS), and whether these associations are similar in other immune-mediated inflammatory diseases (IMID; including inflammatory bowel disease [IBD] and rheumatoid arthritis [RA]) and in anxious/depressed individuals (ANX/DEP) without an IMID.

METHODS

Participants (MS: n = 255; IBD: n = 247; RA: n = 154; ANX/DEP: n = 308) completed a structured psychiatric interview, the Hospital Anxiety and Depression Scale, and cognitive testing, including the Symbol Digit Modalities Test, the California Verbal Learning Test, and Letter Number Sequencing test. Test scores were converted to age-, sex-, and education-adjusted z scores. We evaluated associations of anxiety and depression with the cognitive z scores using multivariate linear models, adjusting for disease cohort.

RESULTS

All cohorts exhibited higher rates of impairment (i.e., z less than or equal to -1.5) in the domains of processing speed, verbal learning, and delayed recall memory relative to general population norms. Higher levels of anxiety symptoms were associated with slower processing speed, lower verbal learning, and lower working memory performance (all p < 0.001); higher levels of depression symptoms were associated with slower processing speed. These associations did not differ across cohorts.

CONCLUSION

Anxiety and depression are associated with lower cognitive function in MS, with a similar pattern observed in persons with other IMID, including IBD and RA, and persons without an IMID. Managing symptoms of anxiety and of depression in MS, as well as other IMIDs, is important to mitigate their effect on cognition.

Too little, too much or just right: Injury/illness sensitivity and intentions to drink as a basis for alcohol consumer segmentation

BACKGROUND

Although alcohol is the most socially accepted drug, little is known about the classification of alcohol consumers into clusters influencing drinking outcomes. Past research has demonstrated that injury/illness sensitivity predicts health protecting behaviors.

OBJECTIVES

The present study explored whether alcohol consumers can be classified based on injury/illness sensitivity and intentions to reduce drinking, and whether the identified clusters exhibited meaningful differences in negative affect and drinking levels.

METHODS

Four-hundred and eighty-six participants (54.3% male; mean [SD] age = 26.5 [7.2] years) completed online questionnaires between July and October of 2017. Questions were asked pertaining to injury/illness sensitivity, intentions to reduce drinking, negative affect, and heavy drinking behavior. A k-means cluster analysis was performed on illness/injury sensitivity and intentions to reduce drinking scores. We then examined whether clusters varied according to negative affect or drinking variables.

RESULTS

The k-means cluster analysis identified four clusters: Insensitive non-internalizers, Insensitive internalizers, Sensitive non-internalizers, and Sensitive internalizers. Sensitive internalizers reported the highest, whereas Insensitive non-internalizers reported the lowest, negative affect. Sensitive internalizers also had the lowest percentage of heavy drinkers. Conclusion/importance: Current findings add to the alcohol literature by indicating that high sensitivity to illnesses/injuries and the internalization of sensitivities via behavior change intentions may provide the best protection against high alcohol consumption levels.