Behavioral and neurological foundations for the moral and legal implications of intoxication, addictive behaviors and disinhibition

Increasing awareness of the severity of female victimization by opportunistic drug-facilitated sexual assault: A new viewpoint

The victimization of women by opportunistic drug-facilitated sexual assault in leisure contexts was studied in this work by applying a novel approximation. A multifocal analytical strategy based on an intersectional gender-sensitive approach was used to analyse the evidence coming from both forensic case studies and contextual studies about sexual interrelation and drug use. The process of victimization comprises social changes affecting consumption patterns and sexual interaction, intersecting in the hegemonic recreational nightlife model. However, victims experience a range of situations that make it difficult for them to self-acknowledge themselves as such. Widespread myths about the victimization process add to the social questioning faced by victims, stemming from gender-based double standards which condition the expected female behaviors regarding the use of drugs and sexual interaction. The victims usually experience amnesia, lack of injuries and emotional harm, which make difficult the self-acknowledgement as a victim of sexual assault and the reporting of the episode suffered. Consequently, it is an urgent public health need to implement a new viewpoint about the victimization of women by opportunistic drug-facilitated sexual assault in leisure contexts, able to increase awareness of the severity of this form of sexual violence. Society must recognize the existence of this problem within itself to help victims to acknowledge themselves as such, lodge a complaint and seek adequate help. The lack of this social support feeds the perpetuation of the victimization process, which exacerbates the risk of locking victims into spirals of cyclical re-victimization and favors both the underreporting as well as inadequate coping strategies. In addition to focusing on the need to increase awareness of the severity of female victimization by opportunistic drug-facilitated sexual assault in leisure contexts, other recommendations include the use of the term "take advantage", the development of specific criminal approaches, and the in-depth knowledge of the phenomenon via victimization surveys. These steps are necessary for developing well-targeted and evidence-based preventive measures consistent-with-reality.

Dropout rates of in-person psychosocial substance use disorder treatments: a systematic review and meta-analysis

BACKGROUND AND AIMS

Relapse rates for psychosocial substance use disorder (SUD) treatments are high, and dropout is a robust predictor of relapse. This study aimed to estimate average dropout rates of in-person psychosocial SUD treatments and to assess predictors of dropout.

DESIGN

A comprehensive meta-analysis of dropout rates of studies of in-person psychosocial SUD treatment. Studies included randomized controlled trials (RCTs) and cohort studies.

SETTING

Studies conducted anywhere in the world that examined SUD treatment and were published from 1965 to 2016, inclusive.

PARTICIPANTS/CASES

One hundred and fifty-one studies, 338 study arms and 299 dropout rates including 26 243 participants.

MEASUREMENTS

Databases were searched for studies of SUD treatment that included an in-person psychosocial component. Meta-analyses and meta-regressions were conducted to estimate dropout rates and identify predictors of dropout, including participant characteristics, facilitator characteristics and treatment characteristics. Pooled estimates were calculated with random-effects analyses accounting for the hierarchical structure of study arms nested within studies.

FINDINGS

The average dropout rate across all studies and study arms was 30.4% [95% confidence interval (CI) = 27.2-33.8 and 95% prediction interval (PI) = 6.25-74.15], with substantial heterogeneity (I²  = 93.7%, P < 0.0001). Studies including a higher percentage of African Americans and lower-income individuals were associated with higher dropout rates. At intake, more cigarettes/day and a greater percentage of heroin use days were associated with lower dropout rates, whereas heavier cocaine use was associated with higher dropout rates. Dropout rates were highest for studies targeting cocaine, methamphetamines and major stimulants (broadly defined) and lowest for studies targeting alcohol, tobacco and heroin, although there were few studies on methamphetamines, major stimulants and heroin. Programs characterized by more treatment sessions and greater average session length were associated with higher dropout rates. Facilitator characteristics were not significantly associated with dropout.

CONCLUSIONS

On average, approximately 30% of participants drop out of in-person psychosocial SUD treatment studies, but there is wide variability. Drop-out rates vary with the treated population, the substance being targeted, and the characteristics of the treatment.

Relationships between generalized impulsivity and subjective stimulant and sedative responses following alcohol administration

Impulsivity and subjective response (SR) to alcohol (i.e., individual differences in sensitivity to pharmacologic alcohol effects) are both empirically supported risk factors for alcohol use disorder; however, these constructs have been infrequently studied as related risk factors. The present investigation examined a self-report measure of impulsivity (i.e., the Barratt Impulsiveness Scale, Version 11) in relation to acute alcohol effects (i.e., stimulant and sedative SR). Participants came from 2 cohorts of the Chicago Social Drinking Project. Heavy and light drinkers from Cohort 1 (n = 156) and heavy social drinkers from Cohort 2 (n = 104) were examined using identical laboratory protocols following oral alcohol administration using a within-subject, double-blind, placebo-controlled laboratory study design. Self-reported impulsivity and, for comparison purposes, sensation seeking were measured at baseline, and SR was measured once prior to and 4 times following alcohol administration. More impulsive light, but not heavy, drinkers reported heightened stimulant SR following alcohol administration. High impulsive, light drinkers reported stimulant SR at a magnitude similar to that for heavy drinkers, whereas low impulsive, light drinkers reported limited stimulant SR. The interaction between impulsivity and sensation seeking did not statistically predict stimulant SR, and overall, impulsivity was a stronger predictor than was sensation seeking. However, impulsivity was not statistically predictive of dampened sedative SR among light or heavy drinkers. These findings partially replicate and extend the recent literature linking self-reported impulsivity to heightened stimulant SR from alcohol. Future directions include longitudinal studies and research relating multiple facets of impulsivity to SR. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Gambling disorder

Gambling disorder is characterized by a persistent, recurrent pattern of gambling that is associated with substantial distress or impairment. The prevalence of gambling disorder has been estimated at 0.5% of the adult population in the United States, with comparable or slightly higher estimates in other countries. The aetiology of gambling disorder is complex, with implicated genetic and environmental factors. Neurobiological studies have implicated cortico-striato-limbic structures and circuits in the pathophysiology of this disorder. Individuals with gambling disorder often go unrecognized and untreated, including within clinical settings. Gambling disorder frequently co-occurs with other conditions, particularly other psychiatric disorders. Behavioural interventions, particularly cognitive-behavioural therapy but also motivational interviewing and Gamblers Anonymous, are supported in the treatment of gambling disorder. No pharmacological therapy has a formal indication for the treatment of gambling disorder, although placebo-controlled trials suggest that some medications, such as opioid-receptor antagonists, may be helpful. Given the associations with poor quality of life and suicide, improved identification, prevention, policy and treatment efforts are needed to help people with gambling disorder.

Cingulate cortex functional connectivity predicts future relapse in alcohol dependent individuals

Alcohol dependence is a chronic relapsing illness. Alcohol and stress cues have consistently been shown to increase craving and relapse risk in recovering alcohol dependent (AUD) patients. However, differences in functional connectivity in response to these cues have not been studied using data-driven approaches. Here, voxel-wise connectivity is used in a whole-brain investigation of functional connectivity differences associated with alcohol and stress cues and to examine whether these differences are related to subsequent relapse. In Study 1, 45, 4- to 8-week abstinent, recovering AUD patients underwent functional magnetic resonance imaging during individualized imagery of alcohol, stress, and neutral cues. Relapse measures were collected prospectively for 90 days post-discharge from inpatient treatment. AUD patients showed blunted anterior (ACC), mid (MCC) and posterior cingulate cortex (PCC), voxel-wise connectivity responses to stress compared to neutral cues and blunted PCC response to alcohol compared to neutral cues. Using Cox proportional hazard regression, weaker connectivity in ACC and MCC during neutral exposure was associated with longer time to relapse (better recovery outcome). Similarly, greater connectivity in PCC during alcohol-cue compared to stress cue was associated with longer time to relapse. In Study 2, a sub-group of 30 AUD patients were demographically-matched to 30 healthy control (HC) participants for group comparisons. AUD compared to HC participants showed reduced cingulate connectivity during alcohol and stress cues. Using novel data-driven approaches, the cingulate cortex emerged as a key region in the disruption of functional connectivity during alcohol and stress-cue processing in AUD patients and as a marker of subsequent alcohol relapse.

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AUD patients showed blunted cingulate connectivity to alcohol and stress cues.

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Cingulate connectivity predicted time to relapse in AUD patients.

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Greater PCC connectivity during alcohol cues predicted longer time to relapse.

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AUD vs. HC subjects showed less cingulate connectivity to alcohol and stress cues.

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The cingulate cortex emerged as a marker of subsequent alcohol relapse.

Impaired Recognition and Regulation of Disgust Is Associated with Distinct but Partially Overlapping Patterns of Decreased Gray Matter Volume in the Ventroanterior Insula

BACKGROUND

The ventroanterior insula is implicated in the experience, expression, and recognition of disgust; however, whether this brain region is required for recognizing disgust or regulating disgusting behaviors remains unknown.

METHODS

We examined the brain correlates of the presence of disgusting behavior and impaired recognition of disgust using voxel-based morphometry in a sample of 305 patients with heterogeneous patterns of neurodegeneration. Permutation-based analyses were used to determine regions of decreased gray matter volume at a significance level p <= .05 corrected for family-wise error across the whole brain and within the insula.

RESULTS

Patients with behavioral variant frontotemporal dementia and semantic variant primary progressive aphasia were most likely to exhibit disgusting behaviors and were, on average, the most impaired at recognizing disgust in others. Imaging analysis revealed that patients who exhibited disgusting behaviors had significantly less gray matter volume bilaterally in the ventral anterior insula. A region of interest analysis restricted to behavioral variant frontotemporal dementia and semantic variant primary progressive aphasia patients alone confirmed this result. Moreover, impaired recognition of disgust was associated with decreased gray matter volume in the bilateral ventroanterior and ventral middle regions of the insula. There was an area of overlap in the bilateral anterior insula where decreased gray matter volume was associated with both the presence of disgusting behavior and impairments in recognizing disgust.

CONCLUSIONS

These findings suggest that regulating disgusting behaviors and recognizing disgust in others involve two partially overlapping neural systems within the insula. Moreover, the ventral anterior insula is required for both processes.

Relationships between impulsivity and subjective response in an IV ethanol paradigm

RATIONALE

Impulsivity and individual differences in subjective response to alcohol are risk factors for alcohol problems and possibly endophenotypes for alcohol dependence. Few prior studies have addressed relationships between the two constructs.

OBJECTIVES

To predict subjective responses to ethanol, we tested self-reported impulsiveness, ethanol dose condition (high dose, low dose, or placebo), and time (seven time points) along with interactions among these variables.

METHODS

The present study is a secondary analysis of data from a within-subject, placebo-controlled, dose-ranging ethanol administration study using IV infusion with a clamping technique to maintain steady-state breath alcohol concentration. The sample consisted of healthy, non-alcohol dependent social alcohol drinkers between the ages of 21 and 30 (N=105). Participants at varying levels of impulsivity were compared with regard to stimulant and subjective responses to three ethanol dose conditions over time.

RESULTS

Individuals with higher impulsivity reported elavated stimulant and dampened sedative response to alcohol, particularly at the higher dose. Higher impulsivity was associated with a steeper increase in stimulant effects during the first half of clamped ethanol infusion with the higher dose.

CONCLUSIONS

These results suggest that impulsive individuals may experience enhanced reinforcing, stimulant effects, and relatively muted aversive sedative effects from alcohol. These subjective responses may relate to enhanced risk of alcohol problems among more impulsive individuals.

Impulsivity, risk taking, and cortisol reactivity as a function of psychosocial stress and personality in adolescents

Although adolescence is characterized by hormonal changes and increased disinhibited behaviors, explanations for these developmental changes that include personality and environmental factors have not been fully elucidated. We examined the interactions between psychosocial stress and the traits of negative emotionality and constraint on impulsive and risk-taking behaviors as well as salivary cortisol reactivity in 88 adolescents. In terms of behavioral outcomes, analyses revealed that negative emotionality and constraint were protective of impulsivity and risk taking, respectively, for adolescents in the no-stress condition; personality did not relate to either behavior in the stress condition. Low-constraint adolescents in the stress condition engaged in less risk taking than low-constraint adolescents in the no-stress condition, whereas there was no effect of stress group for high-constraint adolescents. In terms of cortisol reactivity, analyses revealed that low-constraint adolescents in the stress condition exhibited greater cortisol reactivity compared to high-constraint adolescents, which suggests that low-constraint adolescents mobilize greater resources (e.g., increased cognitive control, heightened attention to threat) in stressful situations relative to nonstressful ones. These results demonstrate that two facets of disinhibition and cortisol reactivity are differentially affected by psychosocial stress and personality (and their interactions) in adolescents.

Neurobiological considerations in understanding behavioral treatments for pathological gambling

Pathological gambling (PG), a disorder currently categorized as an impulse-control disorder but being considered as a nonsubstance addiction in Diagnostic and Statistical Manual of Mental Disorders (5th ed.) discussions, represents a significant public health concern. Over the past decade, considerable advances have been made with respect to understanding the biological underpinnings of PG. Research has also demonstrated the efficacies of multiple treatments, particularly behavioral therapies, for treating PG. Despite these advances, relatively little is known regarding how biological measures, particularly those assessing brain function, relate to treatments for PG. In this article, we present a conceptual review focusing on the neurobiology of behavioral therapies for PG. To illustrate issues related to study design, we present proof-of-concept preliminary data that link Stroop-related brain activations prior to treatment onset to treatment outcome in individuals with PG receiving a cognitive-behavioral treatment incorporating aspects of imaginal desensitization and motivational interviewing. We conclude with recommendations about current and future directions regarding how to incorporate and translate biological findings into improved therapies for individuals with nonsubstance and substance addictions.

Cluster analysis of undergraduate drinkers based on alcohol expectancy scores

OBJECTIVE

Expectancies of alcohol's effects have been associated with problem drinking in undergraduates. If subgroups can be classified based on expectancies, this may facilitate identifying those at highest risk for problem drinking.

METHOD

Undergraduates (N = 612) from two state universities completed a web-based survey. Responses to the Comprehensive Effects of Alcohol scale were analyzed using k-means cluster analysis separately within each university sample.

RESULTS

Hartigan's heuristic was used to determine that five was the optimal number of clusters in each sample. Clusters were distinguishable based on their overall magnitude of expectancy endorsement and by a tendency to endorse stronger positive than negative expectancies. Subsequent analyses were conducted to compare clusters on alcohol involvement and trait disinhibition. A cluster characterized by endorsement of positive and negative expectancies ("strong expectancy") was associated with a particularly problematic risk profile, specifically concerning difficulties with self-control (i.e., trait disinhibition and impaired control over alcohol use). A cluster with higher positive and lower negative expectancies reported frequent heavy drinking but appeared to be at lower risk than the strong expectancy cluster in a number of respects. Negative expectancy endorsement appeared to represent added risk above and beyond positive expectancies.

CONCLUSIONS

Results suggest that both the magnitude and combination of expectancies endorsed by subgroups of undergraduate drinkers may relate to their risk level in terms of alcohol involvement and personality traits. These findings may have implications for interventions with young adult drinkers.

Similarities and differences between pathological gambling and substance use disorders: a focus on impulsivity and compulsivity

RATIONALE

Pathological gambling (PG) has recently been considered as a "behavioral" or nonsubstance addiction. A comparison of the characteristics of PG and substance use disorders (SUDs) has clinical ramifications and could help advance future research on these conditions. Specific relationships with impulsivity and compulsivity may be central to understanding PG and SUDs.

OBJECTIVES

This review was conducted to compare and contrast research findings in PG and SUDs pertaining to neurocognitive tasks, brain function, and neurochemistry, with a focus on impulsivity and compulsivity.

RESULTS

Multiple similarities were found between PG and SUDs, including poor performance on neurocognitive tasks, specifically with respect to impulsive choice and response tendencies and compulsive features (e.g., response perseveration and action with diminished relationship to goals or reward). Findings suggest dysfunction involving similar brain regions, including the ventromedial prefrontal cortex and striatum and similar neurotransmitter systems, including dopaminergic and serotonergic. Unique features exist which may in part reflect influences of acute or chronic exposures to specific substances.

CONCLUSIONS

Both similarities and differences exist between PG and SUDs. Understanding these similarities more precisely may facilitate treatment development across addictions, whereas understanding differences may provide insight into treatment development for specific disorders. Individual differences in features of impulsivity and compulsivity may represent important endophenotypic targets for prevention and treatment strategies.

A latent class analysis of DSM-IV alcohol use disorder criteria and binge drinking in undergraduates

BACKGROUND

Adolescent and adult samples have shown that the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) abuse and dependence criteria lie on a continuum of alcohol problem severity, but information on criteria functioning in college students is lacking. Prior factor analyses in a college sample (Beseler et al., 2010) indicated that a 2-factor solution fit the data better than a single-factor solution after a binge drinking criterion was included. The second dimension may indicate a clustering of criteria related to excessive alcohol use in this college sample.

METHODS

The present study was an analysis of data from an anonymous, online survey of undergraduates (N = 361) that included items pertaining to the DSM-IV alcohol use disorder (AUD) diagnostic criteria and binge drinking. Latent class analysis (LCA) was used to determine whether the criteria best fit a categorical model, with and without a binge drinking criterion.

RESULTS

In an LCA including the AUD criteria only, a 3-class solution was the best fit. Binge drinking worsened the fit of the models. The largest class (class 1, n = 217) primarily endorsed tolerance (18.4%); none were alcohol dependent. The middle class (class 2, n = 114) endorsed primarily tolerance (81.6%) and drinking more than intended (74.6%); 34.2% met criteria for dependence. The smallest class (class 3, n = 30) endorsed all criteria with high probabilities (30 to 100%); all met criteria for dependence. Alcohol consumption patterns did not differ significantly between classes 2 and 3. Class 3 was characterized by higher levels on several variables thought to predict risk of alcohol-related problems (e.g., enhancement motives for drinking, impulsivity, and aggression).

CONCLUSIONS

Two classes of heavy-drinking college students were identified, one of which appeared to be at higher risk than the other. The highest risk group may be less likely to "mature out" of high-risk drinking after college.