Weaknesses in executive functioning predict the initiating of adolescents' alcohol use

Cognitive inflexibility moderates the relationship between relief-driven drinking motives and alcohol use

Introduction

Drinking motives and neurocognition play significant roles in predicting alcohol use. There is limited research examining how relief-driven drinking motives interact with neurocognition in alcohol use, which would help to elucidate the neurocognitive-motivational profiles most susceptible to harmful drinking. This study investigated the interactions between neurocognition (response inhibition and cognitive flexibility) and relief-driven drinking, in predicting problem drinking.

Methods

Participants completed the Alcohol Use Disorders Identification Test - Consumption items (AUDIT-C) to measure drinking behaviour, and online cognitive tasks, including the Value-Modulated Attentional Capture and Reversal Task (VMAC-R) and the Stop Signal Task (SST). The sample (N = 368) were individuals who drink alcohol, which included a subsample (N = 52) with problematic drinking, as defined by self-identifying as having a primary drinking problem. Drinking motives were assessed using a binary coping question in the overall sample, and the Habit, Reward, and Fear Scale (HRFS) in the subsample. Moderation analyses were conducted to investigate whether cognitive flexibility and response inhibition moderated relationships between relief-driven motives and drinking.

Results

Cognitive flexibility moderated the relationship between relief-driven motives and drinking (overall sample: β = 13.69, p = 0.017; subsample: β = 1.45, p = 0.013). Greater relief-driven motives were associated with heavier drinking for individuals with low cognitive flexibility. There was no significant interaction between response inhibition and relief-driven motives.

Conclusions

Relief-driven drinking motives interact with cognitive inflexibility to drive heavier drinking. Greater understanding of these neurocognitive-motivational mechanisms may help to develop more targeted and effective interventions for reducing harmful drinking.

Neurocognitive Latent Factors Associate With Early Tobacco and Alcohol Use Among Adolescent Brain Cognitive Development Study Youth

PURPOSE

Prospective associations between preadolescent neurocognitive structure and onset of substance use in adolescence have not been examined. This study investigated associations between cognitive structure among youth aged 9 - 10 years and the likelihood of experimentation with tobacco and alcohol by ages 13-14 years.

METHODS

A principal component (PC) analysis of nine neurocognitive assessments was used to identify the cognitive structure of unrelated adolescent brain cognitive development study participants (n = 9,655). We modeled associations between neurocognitive PCs and odds of tobacco or alcohol use by ages 13-14 years using generalized linear mixed models with a logit link and random intercept for recruitment sites. Demographics, family conflict, neighborhood safety, and externalizing and internalizing behavior were considered covariates.

RESULTS

Four neurocognitive PCs were identified and labeled general ability, executive function, learning and memory, and mental rotation. Mental rotation [odds ratio [OR] = 0.88, p-value = .013] was associated with lower odds of youth tobacco use; the association was stronger among female youth. General ability [OR = 1.20, p-value < .0001] among both males and females, and learning and memory [OR = 1.11, p-value = .024] among females, were associated with increased odds of youth alcohol use.

DISCUSSION

Among youth, higher neurocognitive performance was protective for tobacco use but increased the likelihood of alcohol use. Potential sex differences were identified. The role of cognition in processing the social contexts surrounding tobacco and alcohol use in the United States may contribute to the formation of disparate youth expectancies for tobacco and alcohol use.

Examining neurobehavioral differences that support success in recovery from alcohol and other substance use disorders

OBJECTIVE

Substance use disorders (SUDs) are brain disorders associated with impairments resulting from the recurrent use of alcohol, drugs, or both. Though recovery is possible, SUDs are chronic, relapsing-remitting disorders, with estimates of SUD relapse at 40-60%. Currently, we know little about the mechanisms underlying successful recovery processes and whether substance-specific mechanisms exist. The current study sought to examine delay discounting (a measure of future valuation), executive skills, abstinence duration, and health behaviors in a population of individuals in recovery from alcohol, stimulants, opioids, and other substances.

METHODS

In this observational study, we utilized a cohort of individuals (n = 238) from the International Quit and Recovery Registry, an online registry for those in recovery from SUDs around the world. We assessed delay discounting through a neurobehavioral task, and assessed abstinence duration, executive skills, and engagement in positive health behaviors through self-report measures.

RESULTS

We found that delay discounting, executive skills, and engagement in positive health behaviors were similar among individuals in recovery from different substances. Abstinence duration was associated with delay discounting and engagement in health behaviors. Additionally, executive skills and engagement in health behaviors were positively associated.

CONCLUSION

These findings suggest that common behavioral mechanisms support recovery from misuse of various substances. As both delay discounting and executive skills are dependent upon executive brain centers, such as the prefrontal cortex, strategies that target executive functioning, such as episodic future thinking, meditation, or exercise, may be efficient strategies for optimizing recovery from SUDs.

Longitudinal change of inhibitory control functional connectivity associated with the development of heavy alcohol drinking

Introduction

Heavy drinking (HD) prevalent pattern of alcohol consumption among adolescents, particularly concerning because of their critical vulnerability to the neurotoxic effects of ethanol. Adolescent neurodevelopment is characterized by critical neurobiological changes of the prefrontal, temporal and parietal regions, important for the development of executive control processes, such as inhibitory control (IC). In the present Magnetoencephalography (MEG) study, we aimed to describe the relationship between electrophysiological Functional Connectivity (FC) during an IC task and HD development, as well as its impact on functional neuromaturation.

Methods

We performed a two-year longitudinal protocol with two stages. In the first stage, before the onset of HD, we recorded brain electrophysiological activity from a sample of 67 adolescents (mean age = 14.6 ± 0.7) during an IC task. Alcohol consumption was measured using the AUDIT test and a semi-structured interview. Two years later, in the second stage, 32 of the 67 participants (mean age 16.7 ± 0.7) completed a similar protocol. As for the analysis in the first stage, the source-space FC matrix was calculated, and then, using a cluster-based permutation test (CBPT) based on Spearman's correlation, we calculated the correlation between the FC of each cortical source and the number of standard alcohol units consumed two years later. For the analysis of longitudinal change, we followed a similar approach. We calculated the symmetrized percentage change (SPC) between FC at both stages and performed a CBPT analysis, analyzing the correlation between FC change and the level of alcohol consumed in a regular session.

Results

The results revealed an association between higher beta-band FC in the prefrontal and temporal regions and higher consumption years later. Longitudinal results showed that greater future alcohol consumption was associated with an exacerbated reduction in the FC of the same areas.

Discussion

These results underline the existence of several brain functional differences prior to alcohol misuse and their impact on functional neuromaturation.

Childhood executive control and adolescent substance use initiation: the mediating roles of physical and relational aggression and prosocial behavior

Although predictive associations between childhood executive control (EC) and adolescent substance use have been established in prior research, the developmental pathways involved in these long-term links have not been well understood. The goal of the current study was to investigate the degree to which aggressive behaviors, including both physical and relational aggression, and prosocial behaviors in elementary school operate as developmental pathways between preschool EC and adolescent substance use, while accounting for participants' age, sex, family history of substance use, and family socioeconomic status. Participants were 329 youth (49% male; 63.6% European American) who were recruited to participate in a study between 2006 and 2012 while youth were in preschool and elementary school and followed into adolescence. The sample was recruited from a small Midwestern city in the United States. EC was assessed with performance-based tasks when children were 5 years 3 months. Youth behaviors with peers were reported by teachers when participants were in elementary school. Self-reports of the substance use initiation (e-cigarettes, cigarettes, alcohol, and marijuana) were obtained in adolescence via phone surveys. Mediation analyses revealed a statistically significant indirect effect from preschool EC to adolescent substance use through youth's engagement in relational aggression in elementary school (b = > -0.22 [-0.51; -0.08]; β = > -0.18). Our results suggest that developmental pathways to adolescent substance use may begin in preschool, setting the stage for susceptibility to engagement in relational aggression, which increases, in turn, youth's likelihood for substance use initiation in adolescence.

The relationship between executive functioning and addictive behavior: new insights from a longitudinal community study

RATIONALE

Although there is evidence that impaired executive functioning plays a role in addictive behavior, the longitudinal relationship between the two remains relatively unknown.

OBJECTIVES

In a prospective-longitudinal community study, we tested the hypothesis that lower executive functioning is associated with more addictive behavior at one point in time and over time.

METHODS

Three hundred and thirty-eight individuals (19-27 years, 59% female) from a random community sample were recruited into three groups: addictive disorders related to substances (n = 100) or to behaviors (n = 118), or healthy controls (n = 120). At baseline, participants completed nine executive function tasks from which a latent variable of general executive functioning (GEF) was derived. Addictive behavior (i.e., quantity and frequency of use, and number of DSM-5 criteria met) were assessed using standardized clinical interviews at baseline and three annual follow-ups. The trajectories of addictive behaviors were examined using latent growth curve modeling.

RESULTS

At baseline, we found weak to no evidence of an associations between GEF and addictive behavior. We found evidence for an association between a lower GEF at baseline and a higher increase in the quantity of use and a smaller decrease in frequency of use over time, but no evidence for an association with an increase in the number of DSM-5 criteria met.

CONCLUSIONS

Lower EFs appear to lead to a continuing loss of control over use, whereas addictive disorders may develop secondarily after a long period of risky use. Previous etiological models assuming lower EF as a direct vulnerability factor for addictive disorders need to be refined.

Alcohol, age at first sexual intercourse and number of sexual partners in young Mexican women

AIM

To identify the relationship between use of alcohol, number of sexual partners and age of sexual initiation.

METHOD

Descriptive-correlational study. A random sample of 319 young women (age 18-25) from Nuevo Laredo, Mexico was recruited. A sociodemographic data sheet and the AUDIT questionnaire were used. Non-parametric Spearman's rank correlation coefficient and Kruskal-Wallis H test were selected.

RESULTS

On average the participants were 20.70 years old (±2.1), had 1.86 sexual partners (±1.27), started drinking alcohol at the age of 16.82 (±1.79), and their first sexual intercourse was at the age of 17.38 (±1.65). There was a decrease in the age of onset of alcohol use (H=16.646, p<.001) and the age at first sexual intercourse (H=26.749, p<.001) on the lower their current age. The overall AUDIT score negatively correlated with the age of the participants on their first sexual intercourse (r_s=-.168, p<.001) and positively correlated with the number of sexual partners (r_s=.243, p<.001). The aforementioned correlations were more intense among the younger participants (18- and 19-year olds; p<.01).

CONCLUSIONS

There was an association between higher use of alcohol, early age of sexual initiation and number of sexual partners. Nursing professionals may address such variables simultaneously through preventive strategies directed specifically at young women.

Associations between cognition and polygenic liability to substance involvement in middle childhood: Results from the ABCD study

BACKGROUND

Cognition is robustly associated with substance involvement. This relationship is attributable to multiple factors, including genetics, though such contributions show inconsistent patterns in the literature. For instance, genome-wide association studies point to potential positive relationships between educational achievement and common substance use but negative relationships with heavy and/or problematic substance use.

METHODS

We estimated associations between polygenic risk for substance involvement (i.e., alcohol, tobacco, and cannabis use and problematic use) and cognition subfacets (i.e., general ability, executive function, learning/memory) derived from confirmatory factor analysis among 3205 substance naïve children (ages 9-10) of European ancestry who completed the baseline session of the Adolescent Brain Cognitive Development (ABCD) Study.

FINDINGS

Polygenic risk for lifetime cannabis use was positively associated with all three facets of cognitive ability (Bs ≥ 0.045, qs ≤ 0.044). No other substance polygenic risk scores showed significant associations with cognition after adjustment for multiple testing (|Bs|≤0.033, qs ≥ 0.118).

CONCLUSIONS

Polygenic liability to lifetime cannabis use, but not use disorder, was positively associated with cognitive performance among substance-naïve children, possibly reflecting shared genetic overlap with openness to experience or the influence of genetic variance associated with socioeconomic status. Our lack of findings for the other polygenic scores may reflect ascertainment differences between the genome-wide association study (GWAS) samples and the current sample and/or the young age of the present sample. As longitudinal data in ABCD are collected, this sample may be useful for disentangling putatively causal or predispositional influences of substance use and misuse on cognition.

Prenatal drug exposure and executive function in early adolescence

PURPOSE

Study of the relationship between prenatal cocaine exposure (PCE) and executive function (EF) has yielded inconsistent results. The purpose of the current study is to examine whether PCE, biological sex, environmental risk, and their interaction predicted EF in early adolescence.

METHODS

135 12-year-old adolescents (40.7% with PCE), who were followed prospectively from birth, attempted up to 8 Tower of Hanoi (ToH) puzzle trials of increasing complexity. The number of correctly completed puzzles served as the main outcome measure. Survival analysis was used to examine predictors of the number of successfully completed trials.

RESULTS

As trial difficulty increased, fewer adolescents were able to solve the TOH puzzle. Adolescents from high risk environments and with either prenatal alcohol or prenatal cannabis exposure completed fewer puzzles (p < .05). In addition, a hypothesized 3-way interaction of PCE x sex x environmental risk was found such that cocaine-exposed males with high environmental risk had the worst performance (p < .01).

CONCLUSIONS

The current findings are consistent with prior research indicating that males with PCE may be at particular risk of poorer functioning and highlight the potential importance of examining adolescent's sex and environmental risk as moderators of PCE effects.

Reaction Time and Visual Memory in Connection to Alcohol Use in Persons with Bipolar Disorder

The purpose of this study was to explore the association of cognition with hazardous drinking and alcohol-related disorder in persons with bipolar disorder (BD). The study population included 1268 persons from Finland with bipolar disorder. Alcohol use was assessed through hazardous drinking and alcohol-related disorder including alcohol use disorder (AUD). Hazardous drinking was screened with the Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) screening tool. Alcohol-related disorder diagnoses were obtained from the national registrar data. Participants performed two computerized tasks from the Cambridge Automated Neuropsychological Test Battery (CANTAB) on A tablet computer: the 5-choice serial reaction time task, or reaction time (RT) test and the Paired Associative Learning (PAL) test. Depressive symptoms were assessed with the Mental Health Inventory with five items (MHI-5). However, no assessment of current manic symptoms was available. Association between RT-test and alcohol use was analyzed with log-linear regression, and eβ with 95% confidence intervals (CI) are reported. PAL first trial memory score was analyzed with linear regression, and β with 95% CI are reported. PAL total errors adjusted was analyzed with logistic regression and odds ratios (OR) with 95% CI are reported. After adjustment of age, education, housing status and depression, hazardous drinking was associated with lower median and less variable RT in females while AUD was associated with a poorer PAL test performance in terms of the total errors adjusted scores in females. Our findings of positive associations between alcohol use and cognition in persons with bipolar disorder are difficult to explain because of the methodological flaw of not being able to separately assess only participants in euthymic phase.

Discounting, Cognitive Inflexibility, and Antisocial Traits as Predictors of Adolescent Drug Involvement

Cognitive impairments, such as steep delay discounting, have been correlated with substance-related disorders. However, antisocial traits, cognitive inflexibility, and loss discounting have been barely considered despite having a high relationship with problematic consumption. This study aims to identify the predictive power of these variables in four types of drug use. Fifty-two adolescents (age range of 13 to 19 years) were assessed with a substance involvement test, four discounting tasks using $3,000, a card sorting test, and antisocial screening. Discriminant analysis with simultaneous estimation and varimax rotation was carried out. Function one included discounting of both losses, function two AT and CI, and function three probabilistic gains. The three functions explained 60.1% of the variance. The results show that preference for small and soon punishments and larger and unlikely punishments distinguished non-use and experimental use of moderate consumption and problematic consumption. High antisocial traits and low cognitive inflexibility distinguished experimental use groups of non-use. Risk-taking did not discriminate effectively between moderate consumption and problematic consumption. A replication of this study with a larger sample size is recommended to verify the results.

Multimodal indicators of risk for and consequences of substance use disorders: Executive functions and trait disconstraint assessed from preadolescence into early adulthood

Risk for substance use disorders (SUDs) is hypothesized to include behavioral disinhibition, a genetically mediated inability to inhibit or regulate behavior given task demands or motivational drives. In the present study, we examined developmental trajectories of multiple indicators of behavioral disinhibition assessed from preadolescence into early adulthood among individuals with versus without alcohol, tobacco, and cannabis use disorders. Participants were a population-based sample of 1512 male and female twins from the Minnesota Twin Family Study, prospectively assessed at ages 11, 14, 17, 20, and 24. Multimodal indicators of behavioral disinhibition included measures of executive function (visuospatial working memory accuracy, antisaccade task performance) and mother- and self-reported trait disconstraint. Multilevel modeling analyses that accounted for the repeated measures and nested nature of the twin family data were used to examine premorbid (age 11) indicators of executive function and trait disconstraint prior to the onset of any SUD symptoms, as well as changes from preadolescence into early adulthood (ages 11 to 24). Premorbid deviations evident at age 11 among individuals who subsequently developed SUDs included poorer performance on the visuospatial working memory test and higher levels of trait disconstraint. In addition, individuals with SUDs did not demonstrate developmentally normative improvements in inhibitory control (i.e., antisaccade performance did not improve) or in their levels of trait disconstraint. We conclude that these deviations in both neurocognitive and dispositional correlates of behavioral disinhibition precede onset of SUDs and may confer risk for their development, and in addition, problematic substance use may exacerbate preexisting deviations and interfere with normative developmental trajectories of executive function and trait disconstraint, with deleterious consequences for functioning.

Promising vulnerability markers of substance use and misuse: A review of human neurobehavioral studies

Substance use often begins, and noticeably escalates, during adolescence. Identifying predictive neurobehavioral vulnerability markers of substance use and related problems may improve targeted prevention and early intervention initiatives. This review synthesizes 44 longitudinal studies and explores the utility of developmental imbalance models and neurobehavioral addiction frameworks in predicting neural and cognitive patterns that are associated with prospective substance use initiation and escalation among young people. A total of 234 effect sizes were calculated and compared. Findings suggest that aberrant neural structure and function of regions implicated in reward processing, cognitive control, and impulsivity can predate substance use initiation, escalation, and disorder. Functional vulnerability markers of substance use include hyperactivation during reward feedback and risk evaluation in prefrontal and ventral striatal regions, fronto-parietal hypoactivation during working memory, distinctive neural patterns during successful (fronto-parietal hyperactivation) and failed response inhibition (frontal hypoactivation), and related cognitive deficits. Structurally, smaller fronto-parietal and amygdala volume and larger ventral striatal volume predicts prospective substance misuse. Taken together, the findings of this review suggest that neurobehavioral data can be useful in predicting future substance use behaviors. Notably, little to no research has empirically tested the underlying assumptions of widely used theoretical frameworks. To improve the reliability and utility of neurobehavioral data in predicting future substance use behaviors, recommendations for future research are provided. This article is part of the special issue on 'Vulnerabilities to Substance Abuse.'

Alcohol use and cognitive functioning in young adults: improving causal inference

BACKGROUND AND AIMS

There have been few longitudinal studies of association between alcohol use and cognitive functioning in young people. We aimed to examine whether alcohol use is a causal risk factor for deficient cognitive functioning in young adults.

DESIGN

Linear regression was used to examine the relationship between longitudinal latent class patterns of binge drinking and subsequent cognitive functioning. Two-sample Mendelian randomization (MR) tested evidence for the causal relationship between alcohol use and cognitive functioning.

SETTING

South West England.

PARTICIPANTS

The observational study included 3155 adolescents and their parents (fully adjusted models) from the Avon Longitudinal Study of Parents and Children (ALSPAC). Genetic instruments for alcohol use were based on almost 1 000 000 individuals from the genome-wide association studies (GWAS) and Sequencing Consortium of Alcohol and Nicotine use (GSCAN). Genome-wide association studies for cognitive outcomes were based on 2500 individuals from ALSPAC.

MEASUREMENTS

Binge drinking was assessed at approximately 16, 17, 18, 21 and 23 years. Cognitive functioning comprised working memory, response inhibition and emotion recognition assessed at 24 years of age. Ninety-nine independent genome-wide significant single nucleotide polymorphisms (SNPs) associated with 'number of drinks per week' were used as the genetic instrument for alcohol consumption. Potential confounders were included in the observational analyses.

FINDINGS

Four binge drinking classes were identified: 'low-risk' (41.3%), 'early-onset monthly' (19.1%), 'adult frequent' (22.5%) and 'early-onset frequent' (17.0%). The association between early-onset frequent binge drinking and cognitive functioning: working memory (b = -0.42, 95% confidence interval (CI) = -1.24 to 0.41), response inhibition (b = 31.9, 95% CI = -25.3 to 89.2), and emotion recognition (b = 0.02, 95% CI = -0.07 to 0.10) in comparison to low-risk drinkers were inconclusive as to whether a difference was present. Two-sample MR analyses similarly provided little evidence that alcohol use is associated with deficits in working memory using the inverse variance weight (b = 0.29, 95% CI = -0.42 to 0.99), response inhibition (b = -0.32, 95% CI = -1.04 to 0.39) and emotion recognition (b = 0.03, 95% CI = -0.55 to 0.61).

CONCLUSIONS

Binge drinking in adolescence and early adulthood may not be causally related to deficiencies in working memory, response inhibition or emotion recognition in youths.

Risks versus consequences of adolescent and young adult substance use: A focus on executive control

PURPOSE OF REVIEW

This review examines the role of executive control processes in the liability for substance misuse and whether substance use, once initiated, leads to subsequent decrements as proposed by neurotoxicity models of substance use disorder (SUD).

RECENT FINDINGS

As indicated by a number of recent meta-analyses, executive control processes, which include working memory, cognitive flexibility and numerous aspects of attentional, behavioral and emotional control, are impaired in the context of active SUD. Longitudinal studies of behaviorally disinhibited children, individuals with familial risks for SUD, and twins within whom genetic versus environmental influences on behavior can be modeled robustly indicate that relatively poor control is a vulnerability factor for early substance use initiation, binge patterns of use, and subsequent SUD. Evidence of further declines in executive control, once substance use is initiated, is mixed, although a growing number of neuroimaging studies indicate that frontostriatal, frontolimbic, and frontocerebellar systems are altered as a consequence of use.

SUMMARY

Together these patterns suggest strategies for identifying children and adolescents at high risk for SUD, avenues through which substance-related neurotoxicities can be more reliably detected, and the need to structure prevention efforts in a manner that is developmentally appropriate and perhaps personalized to individual vulnerabilities.

Beyond Their HIV Status: the Occurrence of Multiple Health Risk Behavior Among Adolescents from a Rural Setting of Sub-Saharan Africa

Background

Health risk behaviors during adolescence may cluster into patterns that might be predicted by specific factors, among which HIV may have an important role.

Method

In a cross-sectional study conducted between 2017 and 2018, clustering of HRB and its associated factors was investigated in rural Kenya among 588 adolescents (36% perinatally HIV infected; 28% perinatally HIV exposed but uninfected; and 36% HIV unexposed/uninfected). Latent class analysis of 22 behaviors followed by multinomial logistic regression were conducted. Four risk behavior classes were identified.

Results

No significant differences were found in behavioral class membership across the three HIV groups (p = 0.366). The risk of membership to the higher risk behavioral classes relative to class 1 (the substance and drug abstinent low risk takers) increased with older adolescent age (p = 0.047), increased among adolescent who experienced mental distress (p < 0.001), and those who felt unsafe in their neighborhood (p < 0.002). Better working memory (p = 0.0037) was found to be protective.

Conclusion

The results highlight a need to include screening and interventions for internalizing mental health problems and deficits in executive functioning, as well as steps to involve family members and communities to address psychosocial risk factors in adolescents in Kenya.

Adolescent risk substance use behavior, posttraumatic stress, depression, and resilience: Innovative considerations for disaster recovery

Natural and technological disasters cause long-term psychological trauma and increase substance use in adults. It is unclear whether these problems also occur in children and whether trauma influences long-term psychological outcomes due to developmental stages at the time of trauma. One community of interest is located in southeastern Louisiana, where, as children, many locals were exposed to Hurricane Katrina in 2005 and the Deepwater Horizon Oil Spill in 2010. We hypothesized individuals exposed to these disasters in early childhood would exhibit higher rates of anxiety, depression, and alcohol use as adolescents than the general population. To test this, we developed a questionnaire with a focus on severity of disaster exposure, indicators of psychological resilience, and current levels of anxiety, depression, and alcohol use. This survey was administered to over 1000 adolescents in local high schools throughout southeastern Louisiana. Structural equation modeling was performed to test correlations and moderation effects. We found disaster exposure was positively associated with trauma-like symptoms and substance use and psychological resilience was negatively related to these outcomes. These findings demonstrate childhood disaster exposure has the potential to cause chronic psychological distress and predispose individuals to substance use later in life. They also suggest resilience may be protective for disaster survivors. Future studies should expand these concepts to other age groups and types of disasters. Whether resilience-focused psychotherapy may be beneficial in these populations is also a relevant topic for exploration.

Exploring the complex inter-relations between internalising symptoms, executive functioning and alcohol use in young adults

OBJECTIVE

Globally, the prevalence of hazardous drinking peaks in young adulthood, and there is mixed evidence on whether internalising symptoms and executive functioning deficits are associated with this increased risk. This study tested whether internalising symptoms in interaction with executive functioning deficits are associated with high alcohol use disorder symptoms in emerging adulthood, via drinking motives to cope with negative affect and alcohol consumption.

METHOD

An Australian sample of 155 young adults aged 17 to 24 years (M = 20.97, SD = 2.40) provided self-report data on internalising symptom severity and alcohol-related outcomes (n = 155), and neuropsychological data measuring executive functioning (n = 104). Confirmatory factor analyses were conducted to identify two latent variables representing internalising symptoms and executive functions. A series of latent moderated structural equation models and a latent mediated moderation structural equation model examined the inter-relations between internalising symptoms, executive functions and alcohol measures.

RESULTS

High levels of internalising symptoms in interaction with executive functioning deficits were associated with strong drinking motives to cope with negative affect, high past month alcohol consumption and greater alcohol use disorder symptoms. Drinking motives to cope with negative affect and alcohol consumption mediated the relationship between the internalising symptoms and executive functioning latent interaction term with alcohol use disorder symptoms.

CONCLUSIONS

This research highlights greater executive functioning resources are associated with low desires to drink hazardous amounts of alcohol as a maladaptive way to cope with negative feelings among young people. It therefore may be useful to target executive functioning ability alongside internalising symptomology in alcohol prevention and intervention initiatives.

Alcohol, age at first sexual intercourse and number of sexual partners in young Mexican women

AIM

To identify the relationship between use of alcohol, number of sexual partners and age of sexual initiation.

METHOD

Descriptive-correlational study. A random sample of 319 young women (age 18-25) from Nuevo Laredo, Mexico was recruited. A sociodemographic data sheet and the AUDIT questionnaire were used. Non-parametric Spearman's rank correlation coefficient and Kruskal-Wallis H test were selected.

RESULTS

On average the participants were 20.70 years old (±2.1), had had 1.86 sexual partners (±1.27), started drinking alcohol at the age of 16.82 (±1.79), and their first sexual intercourse was at the age of 17.38 (±1.65). There was a decrease in the age of onset of alcohol use (H=16.646, p <.001) and the age at first sexual intercourse (H=26.749, P<.001) on the lower their current age. The overall AUDIT score negatively correlated with the age of the participants on their first sexual intercourse (rs=-.168, P<.001) and positively correlated with the number of sexual partners (rs=.243, P<.001). The aforementioned correlations were more intense among the younger participants (18- and 19-year olds; P<.01).

CONCLUSIONS

There was an association between higher use of alcohol, early age of sexual initiation and number of sexual partners. Nursing professionals may address such variables simultaneously through preventive strategies directed specifically at young women.

Disentangling the role of social cognition processes at early steps of alcohol abuse: The influence of affective theory of mind

Excessive alcohol use among adolescents has become a pressing challenge among Western societies. Accordingly, one of the current research objectives is to identify the processes associated with this harmful habit. Although numerous studies have underlined the role of executive and motivational processes, few have explored emotional and interpersonal abilities at early steps of alcohol abuse. The present study evaluated the role of two social cognition processes, namely theory of mind (ability to infer others' mental states at cognitive and affective levels) and empathy (ability to understand others' feelings at cognitive and affective levels) in adolescents' alcohol consumption. Two hundred and two adolescents (13-20 years old) performed a behavioral task evaluating theory of mind and filled in questionnaires measuring personal data, empathy, alcohol consumption (alcohol abuse and specific binge drinking), as well as depressive and anxiety symptoms. Findings showed that cognitive and affective empathy were negatively associated with alcohol consumption in youth whereas affective theory of mind was related to specific binge drinking. Importantly, affective theory of mind predicted binge drinking in adolescents, even after controlling for age, gender, and education level. These results emphasized the role of social cognition in early alcohol abuse and showed that, beyond inhibition, interpersonal abilities might precipitate excessive drinking in youth.

Inflammatory Biomarkers, Microbiome, Depression, and Executive Dysfunction in Alcohol Users

Alcohol-related disorders (ARD) are highly prevalent among Latin American-Caribbean countries. Mental disorders are common comorbidities in individuals with ARD. However, the etiology of the association between ARD and mental disorders remains unclear. We examined the association of inflammatory cytokines, microbiome, and other biomakers with measures of depression, social anxiety, and executive functions. We observed a significant increase in cytokine and chemokine expression levels in saliva and plasma in the alcohol group (AG) samples. Also, the salivary bacterial composition in the AG revealed an abundance of Prevotella. Depression symptomatology was markedly higher in the AG, but social anxiety levels were negligible. AG also exhibited executive dysfunctions, which negatively correlated with increased plasma levels of pro-inflammatory cytokines and increased salivary concentrations of Prevotella bacteria. Our study suggests that chronic alcohol use correlates with executive dysfunction, immune system dysregulation, and dysbiosis of the salivary microbiota. Additional studies are needed to understand the role of the microbiome and inflammation in alcohol use and mental comorbidities.

Alcohol Consumption, Drinking Patterns, and Cognitive Performance in Young Adults: A Cross-Sectional and Longitudinal Analysis

Long-term alcohol abuse is associated with poorer cognitive performance. However, the associations between light and moderate drinking and cognitive performance are less clear. We assessed this association via cross-sectional and longitudinal analyses in a sample of 702 Dutch students. At baseline, alcohol consumption was assessed using questionnaires and ecological momentary assessment (EMA) across four weeks (‘Wave 1’). Subsequently, cognitive performance, including memory, planning, and reasoning, was assessed at home using six standard cognition tests presented through an online platform. A year later, 436 students completed the four weeks of EMA and online cognitive testing (‘Wave 2’). In both waves, there was no association between alcohol consumption and cognitive performance. Further, alcohol consumption during Wave 1 was not related to cognitive performance at Wave 2. In addition, EMA-data-based drinking patterns, which varied widely between persons but were relatively consistent over time within persons, were also not associated with cognitive performance. Post-hoc analyses of cognitive performance revealed higher within-person variance scores (from Wave 1 to Wave 2) than between-person variance scores (both Wave 1 and Wave 2). In conclusion, no association was observed between alcohol consumption and cognitive performance in a large Dutch student sample. However, the online cognitive tests performed at home may not have been sensitive enough to pick up differences in cognitive performance associated with alcohol consumption.

Specificity of expectancies prospectively predicting alcohol and marijuana use in adulthood in the Pittsburgh ADHD longitudinal study

Alcohol and marijuana use expectancies are presumed to be drug-specific, but prospective study of this assumption is lacking. In addition, these associations may operate differently for adults with attention-deficit/hyperactivity disorder (ADHD) histories, as expectancies have been found to be less associated with alcohol and marijuana use among this population. The first aim of the present study was to investigate whether associations between alcohol and marijuana expectancies and substance use were specific to the substances they assess. The second aim was to determine whether these associations differed as a function of ADHD history. Participants (N = 491; 281 ADHD, 210 non-ADHD) were young adults followed longitudinally between ages 21 to 23 and 29 as part of the Pittsburgh ADHD Longitudinal Study (PALS). Autoregressive models were estimated separately for positive and negative expectancies for frequency of alcohol and marijuana use and compared between ADHD groups. Although there were exceptions, results generally support the specificity of associations between outcome expectancies and respective substance use both concurrently and prospectively, but this specificity was primarily present for those without a history of ADHD. These findings suggest that young adults perceive and respond distinctly to the effects of alcohol and marijuana, but a history of ADHD may interfere with this process. These findings also extend our prior cross-sectional findings that expectancies are less associated with alcohol and marijuana use for individuals with ADHD histories. Additional research examining implicit cognitions is needed to further examine risk for substance use among those with ADHD histories. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Executive Control and Adolescent Health: Toward A Conceptual Framework

Executive control is a set of cognitive abilities that may impact a variety of adolescent health behaviors and outcomes; however, research on executive control as a contributor to the physical health of youth is relatively limited. Therefore, the current article explores the possible role of executive control in adolescent health by reviewing relevant literature and proposing a conceptual framework to guide future research in this area. The development of executive control from preschool through adolescence is described, with particular attention to executive control in the unique health context of adolescence. A new conceptual model is proposed, focusing on how executive control may play a critical role in supporting health in adolescence and beyond through the mechanisms of attentional, behavioral, and emotional control. Literature exploring associations between youth executive control and key health behaviors (including diet, physical activity, sleep and substance use) is reviewed. Researchers and clinicians are encouraged to consider executive control as an important cross-cutting contributor to health during adolescence and beyond and to incorporate this construct into longitudinal studies of health.

Adolescent Risk Behavior: Differentiating Reasoned And Reactive Risk-taking

Although explanatory models of adolescent risk behavior have predominantly focused on adolescents' limited ability to self-regulate impulsive and/or reward-driven behavior (reactive risk behavior), recent arguments suggest that a significant proportion of adolescent risk behavior may actually be strategic and planned in advance (reasoned risk behavior). The present study evaluates hypothesized predictors of reasoned versus reactive risk behavior using self-reported and neurocognitive task data from a large, diverse adolescent sample (N = 1266 participants; N = 3894 risk behaviors). Participants' mean age was 16.5 years (SD = 1.1); 56.9% were female, 61.9% White, 17.1% Black, 7.0% Hispanic, and 14.1% other race/ethnicity; 40% were in 10th grade, 60% in 12th grade. As hypothesized, reasoned risk behavior (compared to reactive risk behavior) was associated with higher levels of sensation seeking, better working memory, greater future orientation, and perceiving risk behavior to be more beneficial than risky. These results support the distinction between reasoned and reactive risk behavior as meaningful subtypes of adolescent risk behavior and challenge prevailing frameworks that attribute adolescent risk behavior primarily to poor response inhibition.

Transition to drug co-use among adolescent cannabis users: The role of decision-making and mental health

BACKGROUND

Co-use of cannabis and drugs other than cannabis (DOTC) influences the risk of experiencing cannabis disorders. Accordingly, we explored whether speed of transition to drug co-use, the number of DOTC used, and/or being an experimental cannabis-only user, a regular cannabis-only user, or a regular cannabis user who co-uses DOTC (i.e., cannabis-plus user) were associated with decision-making (DM), mental health disorder symptoms, or cannabis use-related characteristics.

METHODS

We analyzed baseline data from a sub-sample of 266 adolescent (ages 14 to 16) cannabis users (CU) participating in an ongoing longitudinal study. Assessments included semi-structured interviews, self-report questionnaires, and measures of drug use, DM (measured via the Iowa Gambling Task), mental health disorders, and cannabis use-related problems.

RESULTS

Endorsing a larger number of mood disorders symptoms was associated with being a regular cannabis-plus user rather than a regular cannabis-only user (AOR = 1.08, C.I.95% 1.01, 1.15). Poorer DM was associated with a faster transition to co-use, such that for each one unit increase in DM performance, the years to onset of drug co-use increased by 1% (p = 0.032). Endorsing a larger number of cannabis use-related problems was positively associated with endorsing a larger number of DOTC used (p = 0.001).

CONCLUSIONS

This study provides new evidence on the process of drug co-use among CU. Specifically, mood disorder symptoms were associated with use of DOTC among regular CU. Furthermore, poorer DM was associated with a faster transition to drug co-use. Poorer DM and mood disorder symptoms may aggravate or accelerate the onset of adverse consequences among adolescent CU.

Alcohol Use in Adolescence and Later Working Memory: Findings From a Large Population-Based Birth Cohort

Aims

The study aimed to examine the association between adolescent alcohol use and working memory (WM) using a large population sample.

Methods

Data from the Avon Longitudinal Study of Parents and Children were used to investigate the association between alcohol use at age 15 years and WM 3 years later, assessed using the N-back task (N ~ 3300). A three-category ordinal variable captured mutually exclusive alcohol groupings ranging in order of severity (i.e. low alcohol users, frequent drinkers and frequent/binge drinkers). Differential dropout was accounted for using multiple imputation and inverse probability weighting. Adjustment was made for potential confounders.

Results

There was evidence of an association between frequent/binge drinking (compared to the low alcohol group) and poorer performance on the 3-back task after adjusting for sociodemographic confounding variables, WM at age 11 years, and experience of a head injury/unconsciousness before age 11 years (β = −0.23, 95% CI = −0.37 to −0.09, P = 0.001). However, this association was attenuated (β = −0.12, 95% CI = −0.27 to 0.03, P = 0.11) when further adjusted for baseline measures of weekly cigarette tobacco and cannabis use. Weaker associations were found for the less demanding 2-back task. We found no evidence to suggest frequent drinking was associated with performance on either task.

Conclusions

We found weak evidence of an association between sustained heavy alcohol use in mid-adolescence and impaired WM 3 years later. Although we cannot fully rule out the possibility of reverse causation, several potential confounding variables were included to address the directionality of the relationship between WM and alcohol use problems.

Adolescent neurocognitive development and impacts of substance use: Overview of the adolescent brain cognitive development (ABCD) baseline neurocognition battery

Adolescence is characterized by numerous social, hormonal and physical changes, as well as a marked increase in risk-taking behaviors. Dual systems models attribute adolescent risk-taking to tensions between developing capacities for cognitive control and motivational strivings, which may peak at this time. A comprehensive understanding of neurocognitive development during the adolescent period is necessary to permit the distinction between premorbid vulnerabilities and consequences of behaviors such as substance use. Thus, the prospective assessment of cognitive development is fundamental to the aims of the newly launched Adolescent Brain and Cognitive Development (ABCD) Consortium. This paper details the rationale for ABC'lected measures of neurocognition, presents preliminary descriptive data on an initial sample of 2299 participants, and provides a context for how this large-scale project can inform our understanding of adolescent neurodevelopment.

A Newly Designed Mobile-Based Computerized Cognitive Addiction Therapy App for the Improvement of Cognition Impairments and Risk Decision Making in Methamphetamine Use Disorder: Randomized Controlled Trial

Background

Cognitive rehabilitation therapy has been found to improve cognitive deficits and impulse control problems in methamphetamine use disorder (MUD). However, there is limited research regarding this therapy’s feasibility when using mobile-based health technologies in supporting recovery from MUD in China.

Objective

The main aim of this study was to test whether 4 weeks of a newly designed computerized cognitive addiction therapy (CCAT) app can improve cognitive impairments, eliminate drug-related attention bias, and attenuate risk decision-making behaviors in participants with MUD.

Methods

Forty MUD participants were assigned randomly to either the CCAT group (n=20), who received 4 weeks of CCAT plus regular detoxification treatment as usual, or the control group (n=20), who only received the regular detoxification treatment as usual, in drug rehabilitation centers in Shanghai. The CCAT was designed by combine methamphetamine use-related picture stimuli with cognitive training with the aim of improving cognitive function and eliminating drug-related attention bias. The CogState Battery, Delay Discounting Task (DDT), Iowa Gambling Task (IGT), and Balloon Analog Risk Task (BART) were administered face-to-face to all participants before and after CCAT interventions.

Results

Forty male patients were recruited. The mean age was 32.70 (SD 5.27) years in the CCAT group and mean 35.05 (SD 8.02) years in the control group. Compared to the control group, CCAT improved working memory in the CCAT group (P=.01). Group×time interactions were observed among DDT, IGT, and BART tasks, with rates of discounting delayed rewards, IGT, and BART scores (P<.001) being reduced among those who received CCAT, whereas no changes were found in the control group.

Conclusions

The newly designed CCAT can help to improve cognitive impairment and impulsive control in MUD. Further study is needed to understand the underlying brain mechanisms of the cognitive therapy.

Trial Registration

ClinicalTrials.gov NCT03318081; https://clinicaltrials.gov/ct2/show/NCT03318081 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT03318081)

A Combination of Impulsivity Subdomains Predict Alcohol Intoxication Frequency

BACKGROUND

Impulsivity, broadly characterized as the tendency to act prematurely without foresight, is linked to alcohol misuse in college students. However, impulsivity is a multidimensional construct and different subdomains likely underlie different patterns of alcohol misuse. Here, we quantified the association between alcohol intoxication frequency and alcohol consumption frequency and choice, action, cognitive, and trait domains of impulsivity.

METHODS

University student drinkers (n = 106) completed a battery of demographic and alcohol-related items, as well as self-report and task-based measures indexing different facets of impulsivity. Two orthogonal latent factors, intoxication frequency and alcohol consumption frequency, were generated. Their validity was demonstrated with respect to adverse consequences of alcohol use. Machine learning with penalized regression and feature selection was then utilized to predict intoxication and alcohol consumption frequency using all impulsivity subdomains. Out-of-sample validation was used to quantify model performance.

RESULTS

Impulsivity measures alone were significant predictors of intoxication frequency, but not consumption frequency. Propensity for increased intoxication frequency was characterized by increased trait impulsivity, including the Disinhibition subscale of the Sensation Seeking Scale, Attentional and Non-planning subscales of the Barratt Impulsiveness Scale, increased task-based cognitive impulsivity (response time variability), and increased choice impulsivity (steeper delay discounting on a delay discounting questionnaire). A model combining impulsivity domains with other risk factors (gender; nicotine, cannabis, and other drug use; executive functioning; and learning processes) was also significant but did not outperform the model comprising of impulsivity alone.

CONCLUSIONS

Intoxication frequency, but not consumption frequency, was characterized by a number of impulsivity subdomains.

WM in Adolescence: What Is the Relationship With Emotional Regulation and Behavioral Outcomes?

Adolescence is a fundamental transition phase, marked by physical, social, cognitive and emotional changes. At this stage in development two contrasting phenomena take place: brain changes cause a sensitivity to emotional aspects (Dahl, 2004); while also control processes register as well impressive improvements (e.g., Hooper et al., 2004; Best and Miller, 2010). The study is aimed to investigate the relationship between a core cognitive feature such as working memory (WM) (Diamond, 2013) and complex abilities such as emotion regulation (ER) and behavioral self-reported outcomes using a structural equation model approach. A sample of 227 typically developed adolescents between 14 and19 years of age (148 females; mean age in months 202.8, SD 18.57) participated in this study. The following tasks and self-reports were administered in a 45-min test session at school: Symmetry Span task (Kane et al., 2004). Reading Span task (Daneman and Carpenter, 1980), Mr. Cucumber (Case, 1985); Youth Self-Report (YSR, 11-18 years, Achenbach and Rescorla, 2001); Difficulties ER Scale (DERS, Gratz and Roemer, 2004; Italian version by Giromini et al., 2012). Results showed that difficulties in ER correlated with WM: high levels of ER difficulties are associated with low WM efficiency while no significant contributions of these predictors was observed on externalizing or internalizing symptoms. This study showed a significant relationship between self-reported difficulties in ER and WM, while no significant contribution of the considered predictors was showed on the outcomes, adding knowledge about how behavioral and emotional self-reported outcomes may relate to these processes.

Training Working Memory in Adolescents Using Serious Game Elements: Pilot Randomized Controlled Trial

BACKGROUND

Working memory capacity has been found to be impaired in adolescents with various psychological problems, such as addictive behaviors. Training of working memory capacity can lead to significant behavioral improvements, but it is usually long and tedious, taxing participants' motivation to train.

OBJECTIVE

This study aimed to evaluate whether adding game elements to the training could help improve adolescents' motivation to train while improving cognition.

METHODS

A total of 84 high school students were allocated to a working memory capacity training, a gamified working memory capacity training, or a placebo condition. Working memory capacity, motivation to train, and drinking habits were assessed before and after training.

RESULTS

Self-reported evaluations did not show a self-reported preference for the game, but participants in the gamified working memory capacity training condition did train significantly longer. The game successfully increased motivation to train, but this effect faded over time. Working memory capacity increased equally in all conditions but did not lead to significantly lower drinking, which may be due to low drinking levels at baseline.

CONCLUSIONS

We recommend that future studies attempt to prolong this motivational effect, as it appeared to fade over time.

Changes in Executive Function Following a Stressful Interpersonal Task Are Associated With Condomless Anal Intercourse Among Men Who Have Sex With Men

Background

Executive functioning (EF) describes a set of neurocognitive processes critical to enacting complex health behaviors. However, theoretical frameworks for understanding sexual risk behavior have generally neglected neurocognitive constructs, and beyond a few studies of individuals selected for high substance use, the literature contains virtually no research on this topic with other adults at risk for HIV infection, such as men who have sex with men (MSM).

Purpose

This study tested whether EF was associated with condomless anal intercourse (CAI) among MSM.

Methods

Seventy MSM completed cognitive tests assessing EF at two time points-baseline, and approximately 30 min later after engaging in a stressful interpersonal task. Men also reported their sexual behaviors over the past 3 months, including the frequency of CAI.

Results

Baseline EF was unrelated to CAI. However, CAI was associated with the degree to which performance improved from baseline to post-stressor administration. Compared with norms for practice effects, men who reported CAI improved less than expected from baseline to post-stressor EF performance, whereas men who reported no CAI exhibited a more normative practice effect.

Conclusions

MSM with histories of greater sexual risk improved less than anticipated from baseline to post-stressor on tests of EF, suggesting that they might be more cognitively depleted by the stressful interpersonal task they engaged in between administrations. It is possible that certain individuals struggle to maintain executive control in stressful interpersonal situations, a finding that could contribute to the difficulty some individuals face executing precautionary behaviors during a sexual encounter.

Trends in alcohol use among young people according to the pattern of consumption on starting university: A 9-year follow-up study

AIM

To identify differences in Risky Consumption (RC) and Binge drinking (BD) trends in students who already followed these patterns of alcohol consumption on starting university and those who did not, and also to try to understand what leads students to engage in these types of behaviour at university.

MATERIAL AND METHODS

Cohort study among university students in Spain (n = 1382). BD and RC were measured with the Alcohol Use Disorders Identification Test at ages 18, 20, 22, 24 and 27 years. Multilevel logistic regression for repeated measures was used to calculate the adjusted Odds Ratios (ORs).

RESULTS

The prevalence rates of RC and BD were lower throughout the study in students who did not follow these patterns of consumption at age 18. For RC and BD, the differences at age 27 years, expressed as percentage points (pp), were respectively 24 pp and 15 pp in women and 29 pp and 25 pp in men. Early age of onset of alcohol use increased the risk of engaging in RC and BD patterns at university, for men (OR = 2.91 & 2.80) and women (OR = 8.14 & 5.53). The same was observed in students living away from the parental home for BD (OR = 3.43 for men & 1.77 for women). Only women were influenced by having positive expectancies for engaging in RC (OR = 1.82) and BD (OR = 1.96).

CONCLUSIONS

The prevalence rates of both RC and BD at age 27 years were much higher among university students who already followed these patterns of consumption at age 18 years, with the differences being proportionally higher among women. Focusing on the age of onset of alcohol consumption and hindering access to alcohol by minors should be priority objectives aimed at preventing students from engaging in these patterns of alcohol consumption at university.

Associations between executive functioning, affect-regulation drinking motives, and alcohol use and problems

Motivation to use alcohol to regulate positive and negative affect and deficits in cognitive control (i.e., executive functions [EFs]) have both been associated with increased alcohol involvement and alcohol-related consequences. Although dual-process models predict that affect-driven motivations and cognitive control should interact to determine alcohol involvement and alcohol-related consequences, this intersection has remained largely unexplored. The present study examined the extent to which effects of enhancement and coping drinking motives on alcohol use, heavy drinking, and alcohol-related consequences are moderated by individual differences in three theorized components of EF. We anticipated, in general, that drinking motives would more strongly predict alcohol use, heavy drinking, and alcohol-related consequences among individuals low versus high in cognitive control-EF. Participants (N = 801) completed a battery of nine EF tasks, as well as measures of drinking motives, alcohol use, heavy drinking, and alcohol-related negative consequences. A baseline structural model indicated that (a) both enhancement motives and coping motives predicted alcohol use and heavy drinking, (b) both enhancement and coping motives exerted their effects on alcohol-related consequences both directly and indirectly via alcohol use, and (c) shifting-specific abilities were modestly positively associated with heavy drinking. Most important for the aims of the study, latent variable interaction analyses failed to provide consistent evidence that better EF abilities attenuate the effects of drinking motives on alcohol use, heavy drinking, and alcohol-related consequences, as predicted. (PsycINFO Database Record

Insomnia moderates the association between alcohol use and consequences among young adult veterans

OBJECTIVE

Symptoms of insomnia and heavy alcohol use tend to co-occur among military and veteran samples. The current study examined insomnia as a moderator of the association between alcohol use and related consequences among young adult veterans in an effort to extend and replicate findings observed in samples of civilian young adults.

METHOD

Young adult veterans (N=622; 83% male; age M=29.0, SD=3.4) reporting alcohol use in the past year completed measures of insomnia severity, alcohol use, and alcohol-related consequences as part of a larger intervention trial. Participants were classified as screening 'positive' (n=383, 62%) or 'negative' (n=239, 38%) for insomnia using the Insomnia Severity Index. Hierarchical regression was used to examine the interaction between drinking quantity and insomnia on alcohol-related consequences. Predictor and outcome variables were measured concurrently.

RESULTS

Both a greater number of drinks per week and a positive insomnia screen were associated with more alcohol-related consequences. Drinks per week and insomnia screen interacted to predict alcohol-related consequences, such that the effect of drinking on alcohol-related consequences was stronger in the context of a positive versus negative insomnia screen.

CONCLUSION

Drinking is associated with more alcohol-related consequences in the presence of clinically significant insomnia symptoms. These findings replicate those documented in civilian young adults and indicate that insomnia may be an appropriate target for alcohol prevention and intervention efforts among young adult veterans.

The Role of Working Memory for Cognitive Control in Anorexia Nervosa versus Substance Use Disorder

Prefrontal cortex executive functions, such as working memory (WM) interact with limbic processes to foster impulse control. Such an interaction is referred to in a growing body of publications by terms such as cognitive control, cognitive inhibition, affect regulation, self-regulation, top-down control, and cognitive–emotion interaction. The rising trend of research into cognitive control of impulsivity, using various related terms reflects the importance of research into impulse control, as failure to employ cognitions optimally may eventually result in mental disorder. Against this background, we take a novel approach using an impulse control spectrum model – where anorexia nervosa (AN) and substance use disorder (SUD) are at opposite extremes – to examine the role of WM for cognitive control. With this aim, we first summarize WM processes in the healthy brain in order to frame a systematic review of the neuropsychological, neural and genetic findings of AN and SUD. In our systematic review of WM/cognitive control, we found n = 15 studies of AN with a total of n = 582 AN and n = 365 HC participants; and n = 93 studies of SUD with n = 9106 SUD and n = 3028 HC participants. In particular, we consider how WM load/capacity may support the neural process of excessive epistemic foraging (cognitive sampling of the environment to test predictions about the world) in AN that reduces distraction from salient stimuli. We also consider the link between WM and cognitive control in people with SUD who are prone to ‘jumping to conclusions’ and reduced epistemic foraging. Finally, in light of our review, we consider WM training as a novel research tool and an adjunct to enhance treatment that improves cognitive control of impulsivity.

The efficacy of a working memory training in substance use patients: A randomized double-blind placebo-controlled clinical trial

INTRODUCTION

Substance use disorder patients show impairments in working memory (WM) functioning. Previous findings indicate that a WM training results in improvements of working memory capacity (WMC) and in decreased clinical symptoms in a range of mental disorders, including alcohol use disorder.

METHOD

The aim of the current study is to investigate the efficacy of a 24-session WM training in addition to treatment as usual on craving, WMC, substance use, impulsivity, attention bias, and psychopathology using a randomized double-blind placebo-controlled trial. Inpatients (n = 180) diagnosed with an alcohol, cocaine, or cannabis use disorder were included.

RESULTS

Although the WM training resulted in better scores on the trained tasks in both groups, the placebo training resulted in a better or equal WMC compared to the experimental training, as measured with two nontrained transfer tasks. The WM training had no effect on craving, substance use, impulsivity, attention bias, and psychopathology.

CONCLUSION

Overall, we did not find evidence for the efficacy of WM training on WMC or clinical symptoms as compared to a placebo training in a population of substance use disorder patients. Future research needs to investigate further whether WMC is an important factor that is associated with substance-abuse-related behavior, and whether working memory training could be useful in substance use disorders.

Training Behavioral Control in Adolescents Using a Serious Game

OBJECTIVE

Risk taking, such as heavy alcohol use, is commonplace among adolescents. Nevertheless, prolonged alcohol use at this age can lead to severe health problems. The goal of this study was to develop and evaluate a serious game training ("The Fling"), aimed at increasing behavioral control in adolescents and thereby helping them to improve control over their alcohol use. The game training was compared to a game placebo and a nongame training version in a randomized controlled trial.

MATERIALS AND METHODS

A sample of 185 adolescents (mean age 14.9 years) in secondary education participated in the study. They performed four sessions of training, as well as a set of questionnaires and cognitive assessment tasks before and after the training. The basis for the training was the stop-signal paradigm, aimed at increasing behavioral control.

RESULTS

The game variants were shown to motivate adolescents beyond the level of the nongame version. Behavioral control improved significantly over time, but this effect was also present in the game placebo, suggesting that the game activities alone may have had a beneficial effect on our measures of behavioral control. As baseline drinking levels were low, no significant training effects on drinking behavior were found.

CONCLUSIONS

Although the current results are not yet conclusive as to whether "The Fling" is effective as a cognitive training, they do warrant further research in this direction. This study also shows that serious games may be uniquely suitable to bridge the gap between an evidence-based training paradigm and an attractive, motivating training environment.

Working memory capacity and addiction treatment outcomes in adolescents

BACKGROUND

Brief addiction treatments including motivational interviewing (MI) have shown promise with adolescents, but the factors that influence treatment efficacy in this population remain unknown. One candidate is working memory, the ability to hold a fact or thought in mind. This is relevant, as in therapy, a client must maintain and manipulate ideas while working with a clinician. Working memory depends upon brain structures and functions that change markedly during neurodevelopment and that can be negatively impacted by substance use.

OBJECTIVES

In a secondary analysis of data from a clinical trial for adolescent substance use comparing alcohol/marijuana education and MI, we evaluated the relationship between working memory and three-month treatment-outcomes with the hypothesis that the relationship between intervention conditions and outcome would be moderated by working memory.

METHODS

With a diverse sample of adolescents currently using alcohol and/or marijuana (N = 153, 64.7% male, 70.6% Hispanic), we examined the relationship between baseline measures of working memory and alcohol and cannabis-related problem scores measured at the three-month follow-up.

RESULTS

The results showed that lower working memory scores were associated with poorer treatment response only for alcohol use, and only within the education group. No relationship was found between working memory and treatment outcomes in the MI group.

CONCLUSION

The results suggest that issues with working memory capacity may interfere with adolescents' ability to process and implement didactic alcohol and marijuana content in standard education interventions. These results also suggest that MI can be implemented equally effectively across the range of working memory functioning in youth.

Working memory over a six-year period in young binge drinkers

Adolescence and early adulthood are periods of particular vulnerability to the neurotoxic effects of alcohol. Young people with alcohol-use disorders display deficits in working memory (WM). This function is supported by the prefrontal cortex, a late-maturing brain region. However, little is known about the progression of cognitive dysfunctions associated with a binge-drinking (BD) pattern of alcohol consumption among non-clinical adolescents. The objective of this study was to analyze the relationship between BD trajectory and WM in university students. An initial sample of 155 male and female first-year university students was followed prospectively over 6 years. The participants were classified as stable non-BDs, stable BDs, and ex-BDs, according to the third item of the Alcohol Use Disorders Identification Test (AUDIT). WM was assessed using the Self-Ordered Pointing Task. Generalized linear mixed models were applied. The results showed that stable BDs committed more total perseverative errors and showed a lower WM span in the difficult blocks than stable non-BDs. Difficulties in WM span showed some improvement, whereas perseveration errors remained constant throughout the follow-ups in the stable BDs. There were no significant differences between ex-BDs and non-BDs. In conclusion, stable BD is associated with WM deficits, particularly perseverations and low WM span in demanding trials, when compensatory mechanisms may no longer be successful. The partial improvement in WM span may support the notion of a neuromaturational delay, whereas the temporal stability of perseveration deficits may reflect either neurotoxic effects of alcohol or premorbid characteristics. Abandoning the BD pattern of alcohol consumption may lead to partial recovery.

Executive functioning and substance use in adolescence: Neurobiological and behavioral perspectives

The current review is guided by the theoretical perspective that emphasizes the regulating role of executive functioning (Carver et al., 2009) and presents studies that elucidate the ways that executive functioning (inhibition and working memory) explain individual differences in adolescent substance use independently or by regulating the reactive system (reward and punishment sensitivity). Behavioral studies indicate that main effects of executive functioning on adolescent substance use are often nonsignificant or weak in effect sizes. In contrast, emerging evidence suggests consistent and stronger regulating effects of executive functioning over reward and punishment sensitivity. Functional neuroimaging studies reveal significant associations between executive functioning task-related hemodynamic responses and substance use with strong effect sizes. There is also direct evidence from studies testing statistical interactions of the regulating effects of EF-related brain activation, and indirect evidence in studies examining functional connectivity, temporal discounting, and reinforced control. We note key future directions and ways to address limitations in existing work.

Effects of early life stress and adolescent ethanol exposure on adult cognitive performance in the 5-choice serial reaction time task in Wistar male rats

RATIONALE

Early life stress combined with heavy adolescent alcohol use predicts impaired neuropsychological functioning in adulthood. We investigated whether adolescent intermittent ethanol (AIE) exposure combined with neonatal maternal separation in rats altered attentional processes and impulsivity in adulthood.

METHODS

Male Wistar rat pups were exposed to maternal separation (postnatal days (PNDs) 1-14) and moderate AIE exposure (PNDs 28-57). Adult rats were tested in the five-choice serial reaction time task, which provides separate measures of attention, motor impulsivity, and compulsivity. Rats were tested under baseline conditions and in response to task manipulations that increased attentional load and impulsive behaviors, and after acute ethanol administration.

RESULTS

Short stimulus and short intertrial interval (ITI) durations disrupted attention while long ITI durations impaired impulsivity in all rats. Moderate- and high-dose ethanol challenges impaired attention in all rats. Rats exposed to maternal separation and/or AIE exposure had significantly decreased omissions than non-handled water-exposed rats at baseline and tended to retain this effect in response to task challenges (i.e., the shorter stimulus and ITI durations, longer test session) and ethanol challenges, indicating moderate improvement of attentional performance. Maternal separation significantly increased perseverative responses at baseline and in response to decreased stimulus duration challenge, suggesting increased compulsivity.

CONCLUSIONS

Separate or combined exposure to early life stress and AIE exposure moderately disrupts some aspects of adult executive control functions (e.g., increased compulsivity) but improves others (e.g., increased attention). The relative intensity of either manipulation during neonatal and adolescent periods may influence the direction in which cognitive behaviors are affected in adulthood.

Do Executive Functions Predict Binge-Drinking Patterns? Evidence from a Longitudinal Study in Young Adulthood

Background: Impairments in executive functions (EFs) are related to binge drinking in young adulthood, but research on how EFs influence future binge drinking is lacking. The aim of the current report is therefore to investigate the association between various EFs and later severity of, and change in, binge drinking over a prolonged period during young adulthood.

Methods: At baseline, 121 students reported on their alcohol habits (Alcohol use disorder identification test; Alcohol use questionnaire). Concurrently, EFs [working memory, reversal, set-shifting, response inhibition, response monitoring and decision-making (with ambiguity and implicit risk)] were assessed. Eighteen months later, information on alcohol habits for 103 of the participants were gathered. Data were analyzed by means of multilevel regression modeling.

Results: Future severity of binge drinking was uniquely predicted by performance on the Information sampling task, assessing risky decision-making (β = -1.86, 95% CI: -3.69, -0.04). None of the study variables predicted severity or change in binge drinking.

Conclusion: Future severity of binge drinking was associated with making risky decisions in the prospect for gain, suggesting reward hypersensitivity. Future studies should aim at clarifying whether there is a causal association between decision-making style and binge drinking. Performance on all executive tasks was unrelated to change in binge drinking patterns; however, the finding was limited by overall small changes, and needs to be confirmed with longer follow-up periods.

Acute alcohol effects on set-shifting and its moderation by baseline individual differences: a latent variable analysis

AIMS

To compare the acute effects of alcohol on set-shifting task performance (relative to sober baseline performance) during ascending and descending limb breath alcohol concentration (BrAC), as well as possible moderation of these effects by baseline individual differences.

DESIGN

Shifting performance was tested during an initial baseline and a subsequent drinking session, during which participants were assigned randomly to one of three beverage conditions (alcohol, placebo or control) and one of two BrAC limb conditions [ascending and descending (A/D) or descending-only (D-only)].

SETTING

A human experimental laboratory on the University of Missouri campus in Columbia, MO, USA.

PARTICIPANTS

A total of 222 moderate-drinking adults (ages 21-30 years) recruited from Columbia, MO and tested between 2010 and 2013.

MEASUREMENTS

The outcome measure was performance on set-shifting tasks under the different beverage and limb conditions. Shifting performance assessed at baseline was a key moderator.

FINDINGS

Although performance improved across sessions, this improvement was reduced in the alcohol compared with no-alcohol groups (post-drink latent mean comparison across groups, all Ps ≤ 0.05), and this effect was more pronounced in individuals with lower pre-drink performance (comparison of pre- to post-drink path coefficients across groups, all Ps ≤ 0.05). In the alcohol group, performance was better on descending compared with ascending limb (P ≤ 0.001), but descending limb performance did not differ across the A/D and D-only groups.

CONCLUSIONS

Practising tasks before drinking moderates the acute effects of alcohol on the ability to switch between tasks. Greater impairment in shifting ability on descending compared with ascending breath alcohol concentration is not related to task practice.

Behavioral Control and Reward Sensitivity in Adolescents' Risk Taking Behavior: A Longitudinal TRAILS Study

Neurodevelopmental theories of risk behavior hypothesize that low behavioral control in combination with high reward sensitivity explains adolescents’ risk behavior. However, empirical studies examining this hypothesis while including actual risk taking behavior in adolescence are lacking. In this study we tested whether the imbalance between behavioral control and reward sensitivity underlies risk taking behavior in adolescence, using a nationally representative longitudinal sample of 715 adolescents, of which 66% revealed an increased risk for mental health problems. To assess behavioral control at age 11 we used both self-report (effortful control) as well as behavioral measures of cognitive control (i.e., working memory and response inhibition). Reward sensitivity was assessed with the Bangor Gambling Task. The main finding of this study was that effortful control at age 11 was the best predictor of risk taking behavior (alcohol and cannabis use) at age 16, particularly among adolescents who were more reward sensitive. Risk taking behavior in adolescents might be explained by relatively weak behavioral control functioning combined with high sensitivity for reward.