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Roos CR, Kiluk B, Carroll KM, Bricker JB, Mun CJ, Sala M, Kirouac M, Stein E, John M, Palmer R, DeBenedictis A, Frisbie J, Haeny AM, Barry D, Fucito LM, Bowen S, Witkiewitz K, Kober H. Development and initial testing of mindful journey: a digital mindfulness-based intervention for promoting recovery from Substance use disorder. Ann Med 2024; 56:2315228. [PMID: 38382111 PMCID: PMC10883107 DOI: 10.1080/07853890.2024.2315228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND/OBJECTIVES There is a great unmet need for accessible adjunctive interventions to promote long-term recovery from substance use disorder (SUD). This study aimed to iteratively develop and test the initial feasibility and acceptability of Mindful Journey, a novel digital mindfulness-based intervention for promoting recovery among individuals with SUD. PATIENTS/MATERIALS Ten adults receiving outpatient treatment for SUD. METHODS Phase 1 (n = 5) involved developing and testing a single introductory digital lesson. Phase 2 included a separate sample (n = 5) and involved testing all 15 digital lessons (each 30- to 45-minutes) over a 6-week period, while also receiving weekly brief phone coaching for motivational/technical support. RESULTS Across both phases, quantitative ratings (rated on a 5-point scale) were all at or above a 4 (corresponding with 'agree') for key acceptability dimensions, such as usability, understandability, appeal of visual content, how engaging the content was, and helpfulness for recovery. Additionally, in both phases, qualitative feedback indicated that participants particularly appreciated the BOAT (Breath, Observe, Accept, Take a Moment) tool for breaking down mindfulness into steps. Qualitative feedback was used to iteratively refine the intervention. For example, based on feedback, we added a second core mindfulness tool, the SOAK (Stop, Observe, Appreciate, Keep Curious), and we added more example clients and group therapy videos. In Phase 2, 4 out of 5 participants completed all 15 lessons, providing initial evidence of feasibility. Participants reported that the phone coaching motivated them to use the app. The final version of Mindful Journey was a smartphone app with additional features, including brief on-the-go audio exercises and a library of mindfulness practices. Although, participants used these additional features infrequently. CONCLUSIONS Based on promising initial findings, future acceptability and feasibility testing in a larger sample is warranted. Future versions might include push notifications to facilitate engagement in the additional app features.
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Affiliation(s)
- Corey R. Roos
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Brian Kiluk
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Kathleen M. Carroll
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | - Chung Jung Mun
- Edson College of Nursing and Health Innovation, AZ State University, Tempe, AZ, USA
| | - Margarita Sala
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Megan Kirouac
- Center on Alcohol, Substance Use, and Addiction, Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Elena Stein
- Medical Center, VA Puget Sound Health Care System, Seattle, VA, USA
| | - Maya John
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Robert Palmer
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Andrew DeBenedictis
- Department of Mental Health Counseling, Boston College, Chestnut Hill, MA, USA
| | | | - Angela M. Haeny
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Declan Barry
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Lisa M. Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah Bowen
- Department of Psychology, Pacific University
| | - Katie Witkiewitz
- Center on Alcohol, Substance Use, and Addiction, Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Hedy Kober
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Roos CR, Bricker J, Kiluk B, Trull TJ, Bowen S, Witkiewitz K, Kober H. A smartphone app-based mindfulness intervention to enhance recovery from substance use disorders: Protocol for a pilot feasibility randomized controlled trial. Contemp Clin Trials Commun 2024; 41:101338. [PMID: 39233850 PMCID: PMC11372603 DOI: 10.1016/j.conctc.2024.101338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 06/21/2024] [Accepted: 07/23/2024] [Indexed: 09/06/2024] Open
Abstract
Background Poor long-term recovery outcomes after treatment (e.g., readmission to inpatient treatment) are common among individuals with substance use disorders (SUDs). In-person mindfulness-based treatments (MBTs) are efficacious for SUDs and may improve recovery outcomes. However, existing MBTs for SUD have limited public health reach, and thus scalable delivery methods are needed. A digitally-delivered MBT for SUDs may hold promise. Methods We recently developed Mindful Journey, a smartphone app-based adjunctive MBT for improving long-term recovery outcomes. In this paper, we present details on the app and describe the protocol for a single-site pilot feasibility randomized controlled trial of Mindful Journey. In this trial, individuals (n = 34) in an early phase of outpatient treatment for SUDs will be randomized to either treatment-as-usual (TAU) plus Mindful Journey, or TAU only. The trial will focus on testing the feasibility (e.g., engagement) and acceptability of the app (e.g., perceived usability and helpfulness for recovery), as well as feasibility of study procedures (e.g., assessment completion). The trial will incorporate ecological momentary assessment before and after treatment to assess mechanisms in real-time, including mindfulness, craving, difficulties with negative emotion regulation, and savoring. To examine the sensitivity to change of outcomes (substance use, substance-related problems, and psychological distress) and mechanism variables (noted above), we will test within-treatment-condition changes over time. Discussion The proposed pilot trial will provide important preliminary data on whether Mindful Journey is feasible and acceptable among individuals with SUDs. Trial registration ClinicalTrials.gov NCT05109507.
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Affiliation(s)
- Corey R Roos
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | - Brian Kiluk
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri, USA
| | - Sarah Bowen
- Department of Psychology, Pacific University, USA
| | - Katie Witkiewitz
- Center on Alcohol, Substance Use, and Addiction, Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Hedy Kober
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
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Lancaster JH, Apsley HB, Brick TR, Ren W, Cleveland HH. The day-level effects of recovery community center attendance on indicators of recovery wellbeing and risk. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 165:209459. [PMID: 39067768 PMCID: PMC11347110 DOI: 10.1016/j.josat.2024.209459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/10/2024] [Accepted: 07/11/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Recovery community centers (RCCs) are a relatively new resource in the recovery support landscape aimed at building their members' recovery capital. In recent years, interest in the value of RCCs has grown, however, no studies have used within-person methods to consider how RCCs may impact the day-to-day lives of their attendees. Using within-person data drawn from members of RCCs, this study examined how visiting RCCs was associated with several same-day indicators of recovery wellbeing and risk: daily sense of meaningfulness, recovery identity, negative affect, and positive affect. METHODS Participants were 94 visitors of six RCCs in western Pennsylvania. Daily diary methods collected 10 nightly reports of daily RCC attendance and end-of-day meaningfulness, recovery identity, negative affect, and positive affect. Multilevel modeling accounted for nesting in the intensive longitudinal data. In independent models, the study regressed meaningfulness, recovery identity, negative affect, and positive affect onto day- and person-level RCC attendance. RESULTS Within-person associations between RCC attendance and meaningfulness (b = 6.96, SE = 1.66, p < .001), recovery identity (b = 4.75, SE = 1.08, p < .001), and PA (b = 3.82, SE = 1.45, p < .01) were significant, although NA was not (b = -2.41, SE = 1.34, n.s.). All day- by person-level RCC attendance interactions (in preliminary models) and between-person associations were non-significant across recovery outcomes. CONCLUSIONS The results indicated that on days participants visited RCCs, they reported significantly higher levels of meaningfulness, recovery identity, and positive affect, although negative affect levels did not significantly differ. Also, those who attended RCCs more frequently did not generally report different levels of recovery wellbeing and risk. Taken together, results suggest visiting RCCs works on a daily basis to support interpersonal processes related to positive recovery outcomes. That RCC visits do not appear to reduce negative affect suggests that additional programs may be needed to address negative affect. The within-person design provided insight into the dynamic processes that contribute to the intrapersonal states that support recovery and a practical approach to examining whether and how RCCs might support recovery. By using individuals as their own controls, the study design provided strong counterfactual inference.
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Affiliation(s)
- Joseph H Lancaster
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA.
| | - Hannah B Apsley
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA.
| | - Timothy R Brick
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA; Institute for Computational and Data Sciences, The Pennsylvania State University, University Park, PA, USA.
| | - Wen Ren
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA.
| | - H Harrington Cleveland
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA.
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Crawford AD, Slavin R, Tabar M, Radhakrishnan K, Wang M, Estrada A, McGrath JM. Methodological approaches in developing and implementing digital health interventions amongst underserved women. Public Health Nurs 2024. [PMID: 39221663 DOI: 10.1111/phn.13410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 07/12/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Minority populations are utilizing mobile health applications more frequently to access health information. One group that may benefit from using mHealth technology is underserved women, specifically those on community supervision. OBJECTIVE Discuss methodological approaches for navigating digital health strategies to address underserved women's health disparities. DESCRIPTION OF THE INNOVATIVE METHOD Using an intersectional lens, we identified strategies for conducting research using digital health technology and artificial intelligence amongst the underserved, particularly those with community supervision. DESCRIPTION OF ITS EFFECTIVENESS We explore (1) methodological approaches that combine traditional research methods with precision medicine, digital phenotyping, and ecological momentary assessment; (2) implications for artificial intelligence; and (3) ethical considerations with data collection, storage, and engagement. DISCUSSION Researchers must address gendered differences related to health, social, and economic disparities concurrently with an unwavering focus on the protection of human subjects when addressing the unique needs of underserved women while utilizing digital health methodologies. PUBLIC CONTRIBUTION Women on community supervision in South Central Texas helped inform the design of JUN, the mHealth app we reported in the case exemplar. JUN is named after the Junonia shell, a native shell to South Texas, which means strength, power, and self-sufficiency, like the participants in our preliminary studies.
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Affiliation(s)
- Allison D Crawford
- School of Nursing, The University of Texas Health at San Antonio, San Antonio, Texas, USA
| | - Rocky Slavin
- Department of Computer Science, The University of Texas San Antonio, San Antonio, Texas, USA
| | - Maryam Tabar
- Department of Computer Science, The University of Texas San Antonio, San Antonio, Texas, USA
| | | | - Min Wang
- Department of Management Science and Statistics, The University of Texas San Antonio, San Antonio, Texas, USA
| | - Ashlynn Estrada
- School of Nursing, The University of Texas Health at San Antonio, San Antonio, Texas, USA
| | - Jacqueline M McGrath
- School of Nursing, The University of Texas Health at San Antonio, San Antonio, Texas, USA
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Serre F, Gauld C, Lambert L, Baillet E, Beltran V, Daulouede JP, Micoulaud-Franchi JA, Auriacombe M. Predictors of substance use during treatment for addiction: A network analysis of ecological momentary assessment data. Addiction 2024. [PMID: 39210697 DOI: 10.1111/add.16658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 08/02/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND AIMS Ecological momentary assessment (EMA) studies have previously demonstrated a prospective influence of craving on substance use in the following hours. Conceptualizing substance use as a dynamic system of causal elements could provide valuable insights into the interaction of craving with other symptoms in the process of relapse. The aim of this study was to improve the understanding of these daily life dynamic inter-relationships by applying dynamic networks analyses to EMA data sets. DESIGN, SETTING AND PARTICIPANTS Secondary analyses were conducted on time-series data from two 2-week EMA studies. Data were collected in French outpatient addiction treatment centres. A total of 211 outpatients beginning treatment for alcohol, tobacco, cannabis, stimulants and opiate addiction took part. MEASUREMENTS Using mobile technologies, participants were questioned four times per day relative to substance use, craving, exposure to cues, mood, self-efficacy and pharmacological addiction treatment use. Multi-level vector auto-regression models were used to explore contemporaneous, temporal and between-subjects networks. FINDINGS Among the 8260 daily evaluations, the temporal network model, which depicts the lagged associations of symptoms within participants, demonstrated a unidirectional association between craving intensity at one time (T0) and primary substance use at the next assessment (T1, r = 0.1), after controlling for the effect of all other variables. A greater self-efficacy at T0 was associated with fewer cues (r = -0.04), less craving (r = -0.1) and less substance use at T1 (r = -0.07), and craving presented a negative feedback loop with self-efficacy (r = -0.09). CONCLUSIONS Dynamic network analyses showed that, among outpatients beginning treatment for addiction, high craving, together with low self-efficacy, appear to predict substance use more strongly than low mood or high exposure to cues.
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Affiliation(s)
- Fuschia Serre
- University of Bordeaux, Bordeaux, France
- CNRS, SANPSY, UMR 6033, Bordeaux, France
- Pôle Interétablissement d'Addictologie, CH Ch. Perrens and CHU de Bordeaux, Bordeaux, France
| | - Christophe Gauld
- University of Bordeaux, Bordeaux, France
- CNRS, SANPSY, UMR 6033, Bordeaux, France
- Department of Child Psychiatry, Université de Lyon, Lyon, France
- Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS and Université Claude Bernard Lyon 1, Lyon, France
| | - Laura Lambert
- University of Bordeaux, Bordeaux, France
- CNRS, SANPSY, UMR 6033, Bordeaux, France
| | - Emmanuelle Baillet
- University of Bordeaux, Bordeaux, France
- CNRS, SANPSY, UMR 6033, Bordeaux, France
| | - Virginie Beltran
- CNRS, SANPSY, UMR 6033, Bordeaux, France
- Centre de Soins et d'Accompagnement et de Prévention en Addictologie (CSAPA), BIZIA, Médecins du Monde, Centre Hospitalier de la côte Basque, Bayonne, France
| | - Jean-Pierre Daulouede
- CNRS, SANPSY, UMR 6033, Bordeaux, France
- Centre de Soins et d'Accompagnement et de Prévention en Addictologie (CSAPA), BIZIA, Médecins du Monde, Centre Hospitalier de la côte Basque, Bayonne, France
| | - Jean-Arthur Micoulaud-Franchi
- University of Bordeaux, Bordeaux, France
- CNRS, SANPSY, UMR 6033, Bordeaux, France
- University Sleep Clinic Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Marc Auriacombe
- University of Bordeaux, Bordeaux, France
- CNRS, SANPSY, UMR 6033, Bordeaux, France
- Pôle Interétablissement d'Addictologie, CH Ch. Perrens and CHU de Bordeaux, Bordeaux, France
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Zheng M, Hong T, Zhou H, Garland EL, Hu Y. The acute effect of mindfulness-based regulation on neural indices of cue-induced craving in smokers. Addict Behav 2024; 159:108134. [PMID: 39178637 DOI: 10.1016/j.addbeh.2024.108134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/19/2024] [Accepted: 08/15/2024] [Indexed: 08/26/2024]
Abstract
Mindfulness has garnered attention for its potential in alleviating cigarette cravings; however, the neural mechanisms underlying its efficacy remain inadequately understood. This study (N=46, all men) aims to examine the impact of a mindfulness strategy on regulating cue-induced craving and associated brain activity. Twenty-three smokers, consuming over 10 cigarettes daily for at least 2 years, were compared to twenty-three non-smokers. During a regulation of craving task, participants were asked to practice mindfulness during smoking cue-exposure or passively view smoking cues while fMRI scans were completed. A 2 (condition: mindfulness-cigarette and look-cigarette) × 2 (phase: early, late of whole smoking cue-exposure period) repeated measures ANOVA showed a significant interaction of the craving scores between condition and phase, indicating that the mindfulness strategy dampened late-phase craving. Additionally, within the smoker group, the fMRI analyses revealed a significant main effect of mindfulness condition and its interaction with time in several brain networks involving reward, emotion, and interoception. Specifically, the bilateral insula, ventral striatum, and amygdala showed lower activation in the mindfulness condition, whereas the activation of right orbitofrontal cortex mirrored the strategy-time interaction effect of the craving change. This study illuminates the dynamic interplay between mindfulness, smoking cue-induced craving, and neural activity, offering insights into how mindfulness may effectively regulate cigarette cravings.
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Affiliation(s)
- Ming Zheng
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310058, China
| | - Tiantian Hong
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310058, China
| | - Hui Zhou
- The State Key Lab of Brain-Machine Intelligence, Zhejiang University, Hangzhou 310058, China
| | - Eric L Garland
- Sanford Institute for Empathy and Compassion, University of California San Diego, La Jolla, CA; Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Yuzheng Hu
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310058, China; The State Key Lab of Brain-Machine Intelligence, Zhejiang University, Hangzhou 310058, China; MOE Frontiers Science Center for Brain Science & Brain-Machine Integration, Zhejiang University, Hangzhou 310058, China.
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Zoob Carter BN, Boardley ID. Development and validation of dependence and craving measures specific to athletes who use anabolic-androgenic steroids. Front Psychol 2024; 15:1347211. [PMID: 39176050 PMCID: PMC11339692 DOI: 10.3389/fpsyg.2024.1347211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 07/11/2024] [Indexed: 08/24/2024] Open
Abstract
Background Anabolic-androgenic steroid (AAS) dependence affects approximately 30% of people who use AAS. Presently, measures to assess and diagnose AAS dependence are adapted from scales specific to other forms of drug misuse (e.g., alcohol), containing issues with internal consistency and breadth of construct capture. Additionally, there are no measures available to assess AAS craving, which represents a potentially important coeval factor to AAS dependence. Therefore, this study aimed to develop and provide evidence of validity for measures of AAS dependence and AAS craving. Methods Data were collected from male and female strength athletes who use AAS across two samples (n sample 1 = 206; n sample 2 = 224). Sample 1 completed the new measures alongside instruments assessing theoretically related constructs (Doping Moral Disengagement, Doping Self-Regulatory Efficacy Scale, craving items from the Wisconsin Smoking Withdrawal Scale, AAS adapted Diagnostic and Statistical Manual for Mental Disorder 4th Edition), whereas Sample 2 completed the new instruments. Results Exploratory and Confirmatory Factor Analyses (CFA) with Sample 1 data were used to finalize the item sets for both measures and determine the factorial structures of the AAS Dependence Scale (AASDS) and AAS Craving Scale (AASCS). The AASDS consists of 15-items across five first-order factors that are represented by one second-order factor. The AASCS consists of 16-items across four first-order factors that are represented by one second-order factor. Evidence supporting the concurrent, convergent and discriminant validity of scores obtained with both scales was provided through their associations with the theoretically related variables. CFA with the data from Sample 2 confirmed the factor structures for both scales. Conclusion The AASDS and AASCS represent valid and reliable measures of AAS dependence and AAS craving for use in research with strength athletes who use AAS.
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Zeganadin L, Lopez-Castroman J, Auriacombe M, Luquiens A. Systematic review of patient contribution to the development of alcohol craving measurements. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024. [PMID: 39090768 DOI: 10.1111/acer.15409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/02/2024] [Indexed: 08/04/2024]
Abstract
Craving is considered one of the defining characteristics for alcohol or substance use disorders. There is no consensus on the underlying processes of craving, although multiple models exist. Craving is a very individualistic symptom and has to be self-reported. Several instruments have been developed to measure craving, without a recognized gold standard. The patient's perspective appears critical to determine the relevance of the numerous existing tools. We assessed the contribution of patients to the development of these instruments. We performed a systematic review of instruments measuring alcohol craving published from 2012 to 2023 from three databases (PubMed, PsycInfo, and Embase) in addition to those identified in a previous review by Kavanagh et al. from 1990 to 2012. We included all articles related to the development or validation of instruments for the assessment of alcohol craving. We identified and included in this review the corresponding instruments. Articles translating existing instruments without validation or on single-item instruments were excluded. We analyzed the articles in accordance with COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) recommendations to assess patient involvement in the creation of patient-reported outcome measures (PROM). Two key aspects were investigated: (1) the general design, encompassing the quality of construct description, identification of elements pertinent to a PROM, particularly the inclusion of concepts provided by patients, and (2) the quality of cognitive interviews (when conducted), to evaluate the comprehensiveness and comprehensibility of the PROM. We included 22 articles identifying 16 instruments for measuring alcohol craving. Patients only contributed to item development for one instrument and its short version (QAU and AUQ). None of the instruments met all of the developmental quality criteria, with 14 classed as "inadequate" and two as "doubtful." The current instruments measuring alcohol craving were developed with poor patient contribution, although most articles did not adequately report patient involvement. Patients' perspectives on craving should be explored for future patient-centered approach.
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Affiliation(s)
- Lionel Zeganadin
- Department of Addictology, CHU Nîmes, Univ Montpellier, Nîmes, France
- CH de Sète, Sète, France
| | - Jorge Lopez-Castroman
- Department of Psychiatry, CHU Nîmes, Univ Montpellier, Nimes, France
- Institut de Génomique Fonctionnelle, University of Montpellier, CNRS-INSERM, Montpellier, France
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- Department of Signal Theory and Communications, Carlos III University, Madrid, Spain
| | - Marc Auriacombe
- Addiction Psychiatry Research, SANPSY, CNRS UMR 6033 and University of Bordeaux, Bordeaux, France
- Addiction Clinic (Pôle Interétablissement d'Addictologie), CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Amandine Luquiens
- Department of Addictology, CHU Nîmes, Univ Montpellier, Nîmes, France
- CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
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Groen RN, Wigman JTW, Vos M, Schreuder MJ, Wichers M, Hartman CA. How a general vulnerability for psychopathology during adolescence manifests in young adults' daily lives. J Child Psychol Psychiatry 2024; 65:998-1009. [PMID: 38494734 DOI: 10.1111/jcpp.13953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND There is widespread interest in the general factor of psychopathology or 'p factor', which has been proposed to reflect vulnerability to psychopathology. We examined to what extent this 'vulnerability' is associated with dysregulations in affect and behavior that occur in daily life. As such we hoped to provide an account of how this vulnerability may be maintained. METHODS We used data from the Tracking Adolescents' Individual Lives Survey (TRAILS; N = 2,772) collected at ages 11, 14, 16, 19, and 22 years to fit a bifactor model with a general psychopathology factor, alongside internalizing, externalizing (EXT), attention-deficit/hyperactivity, and autism spectrum problem domains. Following the fifth TRAILS assessment, a subsample of participants (n = 133, age = 22.6, 43% women) with heightened risk for psychopathology completed a 6-month daily diary protocol with one assessment each day. Using a dynamic structural equation approach, we examined to what extent mean intensity, variability, inertia, and within-day co-occurrence of EXT, anxious-tense, and depressed-withdrawn affects and behaviors were associated with general factor scores. RESULTS Unexpectedly, higher general factor scores were not associated with higher mean intensity of any of the three types of daily negative affects and behaviors, but were associated with higher variability and less carryover (inertia) EXT affects and behaviors. CONCLUSIONS We showed that individual differences in general factor scores do not manifest as differences in average levels of daily affects and behaviors, but instead were related to a type of EXT reactivity to the environment. Future research is necessary to investigate whether reactive irritable moods may be involved in or signal vulnerability sustained psychopathology.
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Affiliation(s)
- Robin N Groen
- Department of Psychiatry (UCP), Interdisciplinary Center for Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - Johanna T W Wigman
- Department of Psychiatry (UCP), Interdisciplinary Center for Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - Melissa Vos
- Department of Psychiatry (UCP), Interdisciplinary Center for Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - Marieke J Schreuder
- Department of Psychiatry (UCP), Interdisciplinary Center for Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - Marieke Wichers
- Department of Psychiatry (UCP), Interdisciplinary Center for Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - Catharina A Hartman
- Department of Psychiatry (UCP), Interdisciplinary Center for Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
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Gallinat C, Moessner M, Wilhelm M, Keuthen N, Bauer S. Patterns of Skin Picking in Skin Picking Disorder: Ecological Momentary Assessment Study. Interact J Med Res 2024; 13:e53831. [PMID: 39024568 PMCID: PMC11294777 DOI: 10.2196/53831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/12/2023] [Accepted: 05/03/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Skin picking disorder (SPD) is an understudied mental illness that is classified as a body-focused repetitive behavior disorder. Literature suggests that pathological skin picking is strongly integrated into the daily lives of affected individuals and may involve a high degree of variability in terms of episode characteristics, frequency, and intensity. However, existing data on the phenomenology of SPD are limited and typically involve retrospective assessments, which may fail to accurately capture the behavior's variability. OBJECTIVE This study aimed to investigate skin picking in the daily lives of individuals with SPD by using ecological momentary assessment (EMA). The first aim focused on the description of skin picking patterns (eg, characteristics, intensity, and distribution of episodes and urges), and the second aim explored differences in characteristics and patterns between automatic and focused skin picking. METHODS Participants were recruited online and underwent a web-based screening, a diagnostic telephone interview, and a comprehensive online self-report questionnaire before participating in an EMA protocol. The latter included 10 consecutive days with 7 pseudorandom, time-contingent assessments per day between 8 AM and 10 PM. The EMA questionnaire assessed the current skin picking urge, the occurrence of the behavior, and a detailed assessment of the episodes' characteristics (eg, length, intensity, and consciousness) if applicable. RESULTS The final sample consisted of 57 participants, who completed at least 70% of the scheduled assessments (n=54, 94.7% female: mean age 29.3, SD 6.77 years). They completed 3758 EMAs and reported 1467 skin picking episodes. Skin picking occurred frequently (mean 2.57, SD 1.12 episodes per day and person) in relatively short episodes (10-30 min; 10 min: nepisodes=642, 43.8%; 20 min: nepisodes=312, 21.3%; 30 min: nepisodes=217, 14.8%), and it was distributed quite evenly throughout the day and across different days of the week. Focused and automatic episodes were relatively balanced across all reported episodes (focused: nepisodes=806, 54.9%) and over the course of the day. The analyses showed statistically significant differences between self-reported triggers for the different styles. Visual or tactile cues and the desire to pick the skin were more important for the focused style (visual or tactile cues: mean focused style [Mf]=4.01, SD 0.69 vs mean automatic style [Ma]=3.47, SD 0.99; P<.001; SMD=0.64; desire to pick: Mf=2.61, SD 1.06 vs Ma=1.94, SD 1.03; P<.001; SMD=0.82), while boredom and concentration problems were more prominent in automatic skin picking (boredom: Mf=1.69, SD 0.89 vs Ma=1.84, SD 0.89; P=.03; SMD=-0.31; concentration problems: Mf=2.06, SD 0.87 vs Ma=2.31, SD 1.06; P=.006; SMD=-0.41). CONCLUSIONS These results contribute to an enhanced understanding of the phenomenology of SPD using a more rigorous assessment methodology. Our findings underscore that picking can impact affected persons multiple times throughout their daily lives. TRIAL REGISTRATION German Clinical Trials Register DRKS00025168; https://tinyurl.com/mr35pdwh.
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Affiliation(s)
- Christina Gallinat
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Maximilian Wilhelm
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Mental Health (DZPG), partner site Mannheim-Heidelberg-Ulm, Heidelberg, Germany
| | - Nancy Keuthen
- Trichotillomania and Excoriation Disorder Program, Center for OCD and Related Disorders, Massachusetts General Hospital, Boston, MA, United States
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Mental Health (DZPG), partner site Mannheim-Heidelberg-Ulm, Heidelberg, Germany
- Heidelberg University, Heidelberg, Germany
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11
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McAnulty C, Bastien G, Ledjiar O, Eugenia Socias M, Le Foll B, Lim R, Jutras-Aswad D. Mediating effect of craving on the impact of buprenorphine/naloxone and methadone treatment on opioid use: Results from a randomized controlled trial. Addict Behav 2024; 154:108023. [PMID: 38579594 DOI: 10.1016/j.addbeh.2024.108023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND The relationship between opioid craving and opioid use is unclear. We sought to determine to what extent craving mediated the relationship between opioid agonist therapy and changes in opioid use. METHODS Data came from a pragmatic, 24-week, pan-Canadian, multi-centric, open-label, randomized controlled trial comparing flexible buprenorphine/naloxone take-home doses to standard supervised methadone models of care for the treatment of prescription-type opioid use disorder. Participants were randomly allocated to buprenorphine/naloxone or methadone models of care. 270 people with prescription-type opioid use disorder were included in analyses. There were 93 women (34.4%) and 2 transgender (0.7%) participants. Most participants were white (67.4%), 45.9% reported unstable living conditions, and 44.8% had psychiatric comorbidities. Generalized linear mixed models followed by mediation analysis estimated the direct effect of treatment group on Timeline Followback-reported next-week opioid use and the indirect effect through past 24-hour opioid craving measured using the Brief Substance Craving Scale at week 2, 6, 10, 14, 18 and 22. RESULTS Upon mediation analysis, the average direct effect of treatment on opioid use was 0.465 (95 % CI = 0.183 to 0.751, p < 0.001). The average causal mediated effect was 0.144 (95 % CI = 0.021 to 0.110; p < 0.001). Craving accounted for 23.6 % of the effect of treatment on opioid use (p < 0.001). CONCLUSIONS Past 24-hour craving was associated with increased next-week opioid use; however, craving only partially mediated the effect of buprenorphine/naloxone and methadone on next-week opioid use. Research is needed to develop a comprehensive understanding of factors mediating opioid use during opioid agonist therapy.
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Affiliation(s)
- Christina McAnulty
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - Gabriel Bastien
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - Omar Ledjiar
- Unité de recherche Clinique appliquée (URCA), Research Centre, Centre Hospitalier Ste-Justine, 3175 chemin de la Côte Ste-Catherine, Montréal, Québec H3T 1C5, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, 1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada
| | - Bernard Le Foll
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada; Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, 500 Church Street, Penetanguishene, Ontario L9M 1G3, Canada
| | - Ron Lim
- Department of Psychiatry and Family Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada.
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12
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Chirokoff V, Berthoz S, Fatseas M, Misdrahi D, Dupuy M, Abdallah M, Serre F, Auriacombe M, Pfefferbaum A, Sullivan EV, Chanraud S. Identifying the role of (dis)inhibition in the vicious cycle of substance use through ecological momentary assessment and resting-state fMRI. Transl Psychiatry 2024; 14:260. [PMID: 38897999 PMCID: PMC11186821 DOI: 10.1038/s41398-024-02949-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Functional inhibition is known to improve treatment outcomes in substance use disorder (SUD), potentially through craving management enabled by underlying cerebral integrity. Whereas treatment is challenged by a multitude of substances that patients often use, no study has yet unraveled if inhibition and related cerebral integrity could prevent relapse from multiples substances, that is, one's primary drug of choice and secondary ones. Individuals with primary alcohol, cannabis, or tobacco use disorders completed intensive Ecological Momentary Assessment (EMA) coupled with resting-state functional MRI (rs-fMRI) to characterize the extent to which inhibition and cerebral substrates interact with craving and use of primary and any substances. Participants were 64 patients with SUD and 35 healthy controls who completed one week EMA using Smartphones to report 5 times daily their craving intensity and substance use and to complete Stroop inhibition testing twice daily. Subsamples of 40 patients with SUD and 34 control individuals underwent rs-fMRI. Mixed Model Analysis revealed that reported use of any substance by SUD individuals predicted later use of any and primary substance, whereas use of the primary substance only predicted higher use of that same substances. Craving and inhibition level independently predicted later use but did not significantly interact. Preserved inhibition performance additionally influenced use indirectly by mediating the link between subsequent uses and by being linked to rs-fMRI connectivity strength in fronto-frontal and cerebello-occipital connections. As hypothesized, preserved inhibition performance, reinforced by the integrity of inhibitory neurofunctional substrates, may partake in breaking an unhealthy substance use pattern for a primary substance but may not generalize to non-target substances or to craving management.
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Affiliation(s)
- Valentine Chirokoff
- Univ. Bordeaux, INCIA CNRS-UMR 5287, Bordeaux, France
- EPHE, PSL Research University, Paris, France
| | - Sylvie Berthoz
- Univ. Bordeaux, INCIA CNRS-UMR 5287, Bordeaux, France
- Institut Mutualiste Montsouris, Department of Psychiatry for Adolescents and Young Adults, Paris, France
| | - Melina Fatseas
- Univ. Bordeaux, INCIA CNRS-UMR 5287, Bordeaux, France.
- CH Charles Perrens, Bordeaux, France.
- CHU Bordeaux, Bordeaux, France.
| | - David Misdrahi
- Univ. Bordeaux, INCIA CNRS-UMR 5287, Bordeaux, France
- CH Charles Perrens, Bordeaux, France
| | - Maud Dupuy
- Univ. Bordeaux, INCIA CNRS-UMR 5287, Bordeaux, France
| | - Majd Abdallah
- Bordeaux University, CNRS, Bordeaux Bioinformatics Center, IBGC UMR 5095, Bordeaux, France
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives-UMR 5293, CNRS, University of Bordeaux, Bordeaux, France
| | - Fuschia Serre
- University of Bordeaux, CNRS UMR 6033- Sleep, Addiction and Neuropsychiatry (SANPSY), Bordeaux, France
| | - Marc Auriacombe
- CH Charles Perrens, Bordeaux, France
- University of Bordeaux, CNRS UMR 6033- Sleep, Addiction and Neuropsychiatry (SANPSY), Bordeaux, France
| | - Adolf Pfefferbaum
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Edith V Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Sandra Chanraud
- Univ. Bordeaux, INCIA CNRS-UMR 5287, Bordeaux, France
- EPHE, PSL Research University, Paris, France
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13
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Collombat J, Chapron SA, Sarram S, Fatseas M, Serre F, Auriacombe M. [Anorexia nervosa: An addiction? Application of the addiction model to eating disorders. A narrative commented review]. L'ENCEPHALE 2024:S0013-7006(24)00068-X. [PMID: 38755028 DOI: 10.1016/j.encep.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES Addiction offers a framework for the understanding of eating disorders, particularly those characterized by hyperphagia, with growing interest in food addiction. However, the application of the addiction model to anorexia nervosa remains more controversial. In this commented narrative review, we examine and discuss the addictive features of anorexia nervosa. METHODS Commented narrative review of the literature. RESULTS Anorexia nervosa could be the consequence of the loss of control of several objects of positive reinforcement: food restriction, physical hyperactivity, and food itself. Craving has been little studied in the field of eating disorders. When investigated, studies mainly focus on food cravings and tend to highlight food cravings that are inversely correlated with the restrictive nature of the disorder. This would thus be less found in anorexia nervosa, in which it is nevertheless reported. The existence of a pre-existing food craving, or its appearance secondary to food restriction, is currently under discussion. In the meantime, the question of a craving for food restriction, underpinned by the gratifying effect of fasting, is raised. CONCLUSIONS The management of eating disorders has its place within the addiction care sectors. An integrative approach should be favored, for anorexia nervosa, combining, on the one hand, classic nutritional care, and, on the other hand, care within the framework of addiction treatment. Finally, in people with an eating disorder, the search for an addiction to food, food restriction and physical activity, including a systematic assessment of craving, should be systematized.
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Affiliation(s)
- Julie Collombat
- Laboratoire sommeil, addiction et neuropsychiatrie (SANPSY), CNRS UMR 6033, université de Bordeaux, 33076 Bordeaux, France; Pôle interétablissement d'addictologie, CH Charles-Perrens et CHU de Bordeaux, 33076 Bordeaux, France
| | - Sophie-Athéna Chapron
- Université de Bordeaux, 33076 Bordeaux, France; Laboratoire sommeil, addiction et neuropsychiatrie (SANPSY), CNRS UMR 6033, université de Bordeaux, 33076 Bordeaux, France; Pôle interétablissement d'addictologie, CH Charles-Perrens et CHU de Bordeaux, 33076 Bordeaux, France; Service d'addictologie, CH de la Côte Basque, 64109 Bayonne, France
| | - Saman Sarram
- Laboratoire sommeil, addiction et neuropsychiatrie (SANPSY), CNRS UMR 6033, université de Bordeaux, 33076 Bordeaux, France; Pôle interétablissement d'addictologie, CH Charles-Perrens et CHU de Bordeaux, 33076 Bordeaux, France
| | - Mélina Fatseas
- Université de Bordeaux, 33076 Bordeaux, France; Pôle interétablissement d'addictologie, CH Charles-Perrens et CHU de Bordeaux, 33076 Bordeaux, France; Institut de neurosciences cognitives et intégratives d'Aquitaine (INCIA), CNRS UMR 5287, 33076 Bordeaux, France
| | - Fuschia Serre
- Université de Bordeaux, 33076 Bordeaux, France; Laboratoire sommeil, addiction et neuropsychiatrie (SANPSY), CNRS UMR 6033, université de Bordeaux, 33076 Bordeaux, France; Pôle interétablissement d'addictologie, CH Charles-Perrens et CHU de Bordeaux, 33076 Bordeaux, France
| | - Marc Auriacombe
- Université de Bordeaux, 33076 Bordeaux, France; Laboratoire sommeil, addiction et neuropsychiatrie (SANPSY), CNRS UMR 6033, université de Bordeaux, 33076 Bordeaux, France; Pôle interétablissement d'addictologie, CH Charles-Perrens et CHU de Bordeaux, 33076 Bordeaux, France.
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14
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Winterlind EL, Malone SG, Setzer MR, Murphy MA, Saunders D, Gray JC. N-acetylcysteine as a treatment for substance use cravings: A meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.13.24306839. [PMID: 38798604 PMCID: PMC11118593 DOI: 10.1101/2024.05.13.24306839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
N-acetylcysteine (NAC) may serve as a novel pharmacotherapy for substance use and substance craving in individuals with substance use disorders (SUDs), possibly through its potential to regulate glutamate. Though prior meta-analyses generally support NAC's efficacy in reducing symptoms of craving, individual trials have found mixed results. The aims of the this updated meta-analysis were to (1) examine the efficacy of NAC in treating symptoms of craving in individuals with a SUD and (2) explore subgroup differences, risk of bias, and publication bias across trials. Database searches of PubMed, Cochrane Library, and ClinicalTrials.gov were conducted to identify relevant randomized control trials (RCTs). The meta-analysis consisted of 9 trials which analyzed data from a total of 623 participants. The most targeted substance in the clinical trials was alcohol (3/9; 33.3%), followed by tobacco (2/9; 22.2%) and multiple substances (2/9; 22.2%). Meta-analysis, subgroup analyses, and leave-one-out analyses were conducted to examine treatment effect on craving symptoms and adverse events (AEs). Risk of bias assessments, Egger's tests, and funnel plot tests were conducted to examine risk of bias and publication bias. NAC did not significantly outperform placebo in reducing symptoms of craving in the meta-analysis (SMD = 0.189, 95% CI = -0.015 - 0.393). Heterogeneity was very high in the meta-analysis (99.26%), indicating that findings may have been influenced by clinical or methodological differences in the study protocols. Additionally, results indicate that there may be publication bias present. There were no between-group differences in risk of AEs. Overall, our findings are contrary to those of prior meta-analyses, suggesting limited impact of NAC on substance craving. However, the high heterogeneity and presence of publication bias identified warrants cautious interpretation of the meta-analytic outcomes.
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Hochheimer M, Strickland JC, Ellis JD, Rabinowitz JA, Hobelmann JG, Ford M, Huhn AS. Age moderates the association of optimism on craving during substance use disorder treatment. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 160:209297. [PMID: 38281707 PMCID: PMC11060931 DOI: 10.1016/j.josat.2024.209297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/25/2023] [Accepted: 01/17/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Optimism, characterized by a positive expectancy toward future outcomes, has garnered attention for its potential role in influencing well-being and may be a protective factor in substance use disorder (SUD) treatment. This study evaluated the relationship of optimism and craving among those in substance use disorder SUD treatment. METHODS Drawing from a cohort of 4201 individuals in residential SUD treatment programs, this study used both cross-sectional and longitudinal assessment to examine tonic (steady-state) and cue-induced (phasic) cravings across individuals primarily using eight classes of substances. Previous research established that optimism increases during adulthood and peaks during an individual's 50s. This study sought to establish if the association between optimism and craving is moderated by age during the first week of treatment and if that relationship changes over the course of treatment both within and between-person. RESULTS This study found a negative correlation between optimism and craving intensity. Elevated optimism scores correlated with substantially reduced levels of both tonic (β = -0.31, p < 0.001) and cue-induced (β = -0.29, p < 0.001) cravings. Age was a significant moderator of the relationship between optimism and craving such that as individuals age, the potency of optimism in mitigating cravings gradually attenuates (interaction for tonic craving: β = 0.06, p < 0.001; interaction for cue-induced craving: β = 0.05, p < 0.001). Reflected in the fact that in older individuals' cravings tended to converge toward lower or moderate levels, regardless of their optimism scores. CONCLUSIONS By delineating the contemporaneous association between high optimism and lower cravings, the study suggests that interventions aimed at fostering optimism may represent an avenue to improve the effectiveness of SUD treatment, especially in emerging adults.
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Affiliation(s)
- Martin Hochheimer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer D Ellis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Maggie Ford
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Gehlenborg J, Göritz AS, Kempken J, Wirtz J, Schuurmans L, Moritz S, Kühn S. Randomized Controlled Trial on Imaginal Retraining for Problematic Alcohol Use: A Dismantling Study. Clin Psychol Psychother 2024; 31:e3010. [PMID: 38785407 DOI: 10.1002/cpp.3010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/19/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
Imaginal retraining (IR) is an approach-avoidance procedure that has shown promising results in previous studies. The aim of the present study was to dismantle the efficacy of IR's components in a randomized controlled trial (RCT). We conducted a RCT with nine conditions comprising eight intervention groups and a waitlist control group (WLC). Alcohol craving (primary outcome), consumption, depressive symptoms, quality of life, subjective appraisal, and side effects were assessed online at baseline, post intervention (6 weeks), and follow-up (12 weeks). The sample consisted of 426 participants (age: M = 47.22, SD = 11.82, women: 50.5%). The intervention groups received instructions for four different components of IR (mood induction, mental avoidance of unhealthy stimuli, motor avoidance of unhealthy stimuli, approach to healthy stimuli) that were each conveyed with or without prior psychoeducation (PE). The intervention was delivered online. At total of 163 individuals (42.9%) used the intervention at least once. No group differences were found for any primary or secondary outcome after Šidák correction. Uncorrected statistics showed effects of significantly decreased alcohol consumption for the approach + PE group in the intention-to-treat and the merged motor avoidance group in the per-protocol analyses at post assessment compared with the WLC. Exploratory moderation analyses revealed that individuals with high visualization skills benefited most. The authors conclude that visualization training and motivational components may increase the efficacy and adherence of IR.
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Affiliation(s)
- Josefine Gehlenborg
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anja S Göritz
- Behavioral Health Technology, University of Augsburg, Augsburg, Germany
| | - Joana Kempken
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Janina Wirtz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Lea Schuurmans
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
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Betts JM, Dowd AN, Motschman CA, Tiffany ST. An Evaluation of the Contextual Factors Associated With the Use of Either Tobacco or Electronic Cigarettes in Individuals Who Dual Use. Nicotine Tob Res 2024; 26:561-570. [PMID: 37831904 DOI: 10.1093/ntr/ntad203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 08/14/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Little is known about patterns of dual use of tobacco and electronic cigarettes (e-cigarettes), especially regarding the factors that lead people to choose either product in particular situations. Identifying contextual factors that are associated with product use would enhance understanding of the maintenance of dual product use. METHODS Individuals who dual use (N = 102) completed ecological momentary assessment surveys via text message regarding the recent use of tobacco and e-cigarettes for 2 weeks. Product legality, availability, craving, the presence of other people who smoke/vape, and social disapproval were assessed. Data were analyzed using hierarchical logistic regression to identify factors associated with the likelihood of tobacco versus e-cigarette use. RESULTS Contexts associated with increased likelihood of using tobacco rather than e-cigarettes included being in the presence of other people who smoke (odds ratio [OR] = 3.50, p < .0001) and experiencing elevated tobacco cigarette craving (OR = 3.51, p < .0001). Decreased likelihood of tobacco over e-cigarette use was associated with smoking restrictions (OR = 0.26, p = .003), the presence of other people who vape (OR = 0.38, p < .001), and experiencing elevated e-cigarette craving (OR = 0.23, p < .0001). The legality of e-cigarettes, social disapproval, and the availability of the alternative product were not significantly associated with the use of one product over the other. An individual difference score of relative tobacco (vs. e-cigarette) use pattern did not significantly moderate these effects. CONCLUSIONS This study provided essential information regarding behavioral patterns of dual use, which informs our understanding of people who dual use. Contexts such as smoking restrictions, craving, and social context significantly differentiated between the use of tobacco and e-cigarettes. This suggests product-specific motivations for dual use of tobacco and e-cigarettes in people who use both. IMPLICATIONS This study assessed the relationship between momentary contextual factors and dual use in a nationally recruited sample of people who dual use. Assessments of dual use in daily life provided novel information regarding patterns of dual use as well as differential use-motivations for each product. This information will be essential to build a theoretical framework of dual use of tobacco and e-cigarettes.
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Affiliation(s)
- Jennifer M Betts
- Department of Psychology, University of Buffalo, State University of New York, Buffalo, NY, USA
- Center for Tobacco Research and Intervention, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, USA
- William S. Middleton Memorial Veterans' Hospital, Madison, WI, USA
| | - Ashley N Dowd
- Department of Psychology, University of Buffalo, State University of New York, Buffalo, NY, USA
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Courtney A Motschman
- Department of Psychology, University of Buffalo, State University of New York, Buffalo, NY, USA
| | - Stephen T Tiffany
- Department of Psychology, University of Buffalo, State University of New York, Buffalo, NY, USA
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Viera A, Ondrusek A, Tengatenga C, McBurney E, Lauckner J, Tran E, Muilenburg J, Kershaw T, Lauckner C. A Qualitative Exploration of Attitudes Toward Global Positioning System Tracking and Ecological Momentary Assessment Among Individuals in Substance Use Treatment. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:260-267. [PMID: 38258809 DOI: 10.1177/29767342231218514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND The use of tracking technology in substance use research can uncover the role of contextual factors, such as social networks and environmental cues, in triggering cravings and precipitating return to use. Few studies have explored the opinions of individuals in substance use treatment related to tracking technology. METHODS We conducted 30 semi-structured interviews with individuals in substance use treatment facilities in Connecticut and Georgia. Interviews were not limited to individuals with any specific substance use disorder. Interviewers described a hypothetical study involving ecological momentary assessment and global positioning system tracking to examine place-based predictors of substance use. Participants were invited to share reactions to this description. We used thematic analysis to identify themes in participant perceptions of this hypothetical research study. RESULTS Most participants shared positive opinions about study participation and expressed little to no concern about the tracking components. Participant concerns focused on the security of their information and the potential burden of responding to study questions. Participants largely understood the importance of study participation for promoting greater understanding of substance use and identified potential therapeutic effects of study participation on their own recovery. CONCLUSIONS Individuals in substance use treatment expressed little concern with research studies or interventions incorporating mobile-tracking elements. Future studies should explore the responsible use of tracking elements in recovery support interventions.
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Affiliation(s)
- Adam Viera
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Ashlin Ondrusek
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Cecil Tengatenga
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Erin McBurney
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - John Lauckner
- Substance Use Research Priority Area, University of Kentucky, Lexington, KY, USA
| | - Emma Tran
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Jessica Muilenburg
- Department of Health Promotion and Behavior, University of Georgia College of Public Health, Athens, GA, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Carolyn Lauckner
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
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Chen J, Wang DM, Tian Y, Zhu R, Li Y, Jia L, Fu F, Tang S, Wang X, Wang L, Zhang XY. Childhood abuse and craving in methamphetamine-dependent individuals: the mediating role of alexithymia. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01775-2. [PMID: 38530443 DOI: 10.1007/s00406-024-01775-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/02/2024] [Indexed: 03/28/2024]
Abstract
Individuals with a history of childhood abuse (CA, including neglect and abuse by caregivers before the age of 18 years) have more severe substance dependence problems than those without a history of childhood abuse. However, whether a history of CA exacerbates craving and the mechanism of this effect remain largely unknown. The aim of this study was to explore the role of alexithymia in the effects of CA on craving in a large sample of methamphetamine-dependent individuals based on latent vulnerability theory. A total of 324 methamphetamine-dependent individuals who met DSM-5 criteria for substance use disorder were recruited. CA, alexithymia, and craving data were collected from the Childhood Trauma Questionnaire, the Toronto Alexithymia Scale-20, and the Obsessive Compulsive Drug Use Scale, respectively. t tests and ANCOVA were conducted to compare variables between the CA and non-CA groups, while partial correlation and mediation analyses were conducted to examine the potential mediating role of alexithymia in the relationship between CA and craving. Abused methamphetamine-dependent individuals reported higher levels of craving and higher levels of alexithymia than those of non-abused methamphetamine-dependent individuals. Alexithymia partially mediated the link between CA and craving, especially the effect of CA on craving frequency was fully mediated by alexithymia. Our findings reveal that a history of childhood abuse has a lasting effect on craving in stimulant-dependent individuals, and alexithymia contributes to some extent to the severity of substance abuse problems in abused methamphetamine-dependent individuals.
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Affiliation(s)
- Jiajing Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dong Mei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yang Tian
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Rongrong Zhu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuqing Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Lianglun Jia
- Xin Hua Drug Rehabilitation Center, Sichuan, China
| | - Fabing Fu
- Xin Hua Drug Rehabilitation Center, Sichuan, China
| | | | - Xiaotao Wang
- Xin Hua Drug Rehabilitation Center, Sichuan, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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20
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Davis CN, Gex KS, Squeglia LM, Trull TJ, McCarthy DM, Baker NL, Gray KM, McRae-Clark AL, Tomko RL. Development and Initial Validation of a Momentary Cannabis Craving Scale Within a Homogeneous Sample of U.S. Emerging Adults. Assessment 2024:10731911241237055. [PMID: 38515003 DOI: 10.1177/10731911241237055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Given the popularity and ease of single-item craving assessments, we developed a multi-item measure and compared it to common single-item assessments in an ecological momentary assessment (EMA) context. Two weeks of EMA data were collected from 48 emerging adults (56.25% female, 85.42% White) who frequently used cannabis. Eight craving items were administered, and multilevel factor analyses were used to identify the best fitting model. The resulting scale's factors represented purposefulness/general desire and emotionality/negative affect craving. Convergent validity was examined using measures of craving, cannabis use disorder symptoms, frequency of use, cannabis cue reactivity, cannabis use, negative affect, and impulsivity. The scale factors were associated with cue-reactivity craving, negative affect, impulsivity, and subfactors of existing craving measures. For researchers interested in using a single item to capture craving, one item performed particularly well. However, the new scale may provide a more nuanced assessment of mechanisms underlying craving.
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Affiliation(s)
- Christal N Davis
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, USA
| | - Kathryn S Gex
- Medical University of South Carolina, Charleston, USA
| | | | | | | | | | - Kevin M Gray
- Medical University of South Carolina, Charleston, USA
| | - Aimee L McRae-Clark
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, USA
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21
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Röttger M, van Alebeek H, Aulbach MB, Blechert J. Imagine chocolate: The craving experience questionnaire in the food domain. Appetite 2024; 194:107173. [PMID: 38142857 DOI: 10.1016/j.appet.2023.107173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/03/2023] [Accepted: 12/14/2023] [Indexed: 12/26/2023]
Abstract
Measurement of food craving has gained relevance in the current obesity epidemic. The Craving Experience Questionnaire (CEQ) considers not only craving intensity but also cognitive intrusiveness and imagery vividness as separate craving factors and could thus refine food craving assessment. It is available in two versions with ten items each. The CEQ-F assesses craving frequency across specific time periods and the CEQ-S time-point specific craving strength. Across three independent studies, N = 533 participants completed the German chocolate CEQ-F referenced at the past year to operationalise trait-like craving. Among them, N = 402 also completed the German chocolate CEQ-S referenced at the current moment to operationalise state-like craving. Four-week test-retest reliability was measured. For external validity, we assessed self-reported chocolate consumption, body-mass-index, trait approach motivation, general imagery vividness, and the most widely used food craving questionnaire, namely the Food Cravings Questionnaires in a trait (FCQ-T-r) and state version (FCQ-S), as well as behavioural approach bias (reaction time-based measurement). The three-factor structure was replicated with excellent internal consistency for both CEQ-F and CEQ-S. Test-retest reliability was moderate for both CEQ versions. CEQ-F scores were related to higher levels of chocolate consumption, approach motivation, and FCQ-T-r scores, but not to body-mass-index, imagery vividness, or approach bias. CEQ-S scores were associated with FCQ-S scores and partly with approach bias, but not with approach motivation and imagery vividness. The current results support the factor structure, validity and reliability of the German chocolate CEQ-S and CEQ-F with questions remaining regarding the ability of the CEQ-S to measure state craving. Thus, CEQ-F and CEQ-S usefully contribute to food craving assessment.
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Affiliation(s)
- Mareike Röttger
- Department of Psychology, Paris Lodron University Salzburg, Salzburg, Austria.
| | - Hannah van Alebeek
- Department of Psychology, Paris Lodron University Salzburg, Salzburg, Austria; Center for Cognitive Neuroscience, Paris Lodron University Salzburg, Salzburg, Austria
| | - Matthias Burkard Aulbach
- Department of Psychology, Paris Lodron University Salzburg, Salzburg, Austria; Center for Cognitive Neuroscience, Paris Lodron University Salzburg, Salzburg, Austria
| | - Jens Blechert
- Department of Psychology, Paris Lodron University Salzburg, Salzburg, Austria; Center for Cognitive Neuroscience, Paris Lodron University Salzburg, Salzburg, Austria
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22
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Li D, Wang D, Tian Y, Chen J, Zhu R, Li Y, Wang L, Zhang XY. Association between drug craving and aggression in Chinese male methamphetamine-dependent patients with and without depressive symptoms. Eur Arch Psychiatry Clin Neurosci 2024; 274:461-469. [PMID: 36913004 DOI: 10.1007/s00406-023-01585-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/26/2023] [Indexed: 03/14/2023]
Abstract
Depressive symptoms and aggression are common in patients with substance use disorder. Drug craving is one of the main drivers of drug-seeking behavior. This study aimed to explore the relationship between drug craving and aggression in methamphetamine use disorder (MAUD) patients with and without depressive symptoms. Totally, 613 male patients with MAUD were recruited in this study. Patients with depressive symptoms were identified by the 13-item Beck Depression Inventory (BDI-13). Drug craving and aggression were assessed by the Desires for Drug Questionnaire (DDQ) and the Buss & Perry Aggression Questionnaire (BPAQ), respectively. 374 patients (61.01%) were confirmed to meet the criteria of depressive symptoms. Patients with depressive symptoms had significantly higher DDQ and BPAQ total scores than those without depressive symptoms. DDQ desire and intention were positively correlated with verbal aggression and hostility in patients with depressive symptoms, whereas they were correlated with self-directed aggression in patients without depressive symptoms. In patients with depressive symptoms, DDQ negative reinforcement and a history of suicide attempts were independently associated with BPAQ total score. Our study suggests that male MAUD patients have a high incidence of depressive symptoms and that patients with depressive symptoms may have greater drug cravings and aggression. Depressive symptoms may play a role in the association between drug craving and aggression in patients with MAUD.
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Affiliation(s)
- Deyang Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| | - Yang Tian
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Jiajing Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Rongrong Zhu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuqing Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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23
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Runyan JD, Vermilya S, St Pierre M, Brooks NW, Fowler A, Brewer T. A mixed methods experience sampling study of a posttraumatic growth model for addiction recovery. Sci Rep 2024; 14:3511. [PMID: 38383566 PMCID: PMC10881473 DOI: 10.1038/s41598-024-53740-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/04/2024] [Indexed: 02/23/2024] Open
Abstract
Problematic substance use and addiction is a growing crisis in the United States. As a result, identifying factors that effectively promote addiction recovery is, currently, of particular societal importance. Informed by evidence that-while addiction can be perpetuated by stress-related impulsivity and decreased self-regulation-perceived social support is protective against addiction, we test a model for addiction recovery as a form of posttraumatic growth (PTG), focused specifically on close relationships and personal strength-two domains of PTG. In an initial study, we found that perceived social support and impulsivity predicted number of relapses in individuals in a substance use disorder recovery program. Using experience sampling, we then observed that experiencing a stressful event predicted impulsive behavior. However, experiencing closeness with others-a domain of PTG-was directly associated with perceived social support, and both predicted positive emotional states, which were, in turn, inversely associated with experiencing a stressful event. Further, when experiencing a stressful event, personal strength-also a domain of PTG-was inversely associated with impulsive behavior and was predicted by both perceived social support and positive emotional states. Finally, in a follow-up experiment, we found that an ecological momentary intervention targeting perceived social support decreased impulsivity and increased self-regulation-an aspect of personal strength-in a dose-dependent fashion. Taken together, our findings: (1) support a PTG model for recovery; (2) provide evidence for processes by which close supportive relationships are protective against addiction and relapse; and (3) indicate that self-regulation is responsive to a short in-the-moment perceived social support intervention. We suggest that these findings support the theory that addiction is a social disease in the sense that close personal interactions and supportive relationships: (a) buffer against stress-related impulsivity, thereby protecting against addiction and relapse; and (b) increase personal strength, thereby decreasing the probability of impulsive-including addictive-behavior and promoting recovery.
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24
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Tuchman FR, Hallgren KA, Richards DK, Aldridge A, Anton RK, Aubin HJ, Kranzler HR, Mann K, O’Malley SS, Witkiewitz K. Reductions in WHO risk drinking levels correlate with alcohol craving among individuals with alcohol use disorder. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:420-429. [PMID: 38149364 PMCID: PMC10922776 DOI: 10.1111/acer.15257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/26/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Abstinence has historically been considered the preferred goal of alcohol use disorder (AUD) treatment. However, most individuals with AUD do not want to abstain and many are able to reduce their drinking successfully. Craving is often a target of pharmacological and behavioral interventions for AUD, and reductions in craving may signal recovery. Whether reductions in drinking during AUD treatment are associated with reductions in craving has not been well examined. METHODS We conducted secondary analyses of data from three AUD clinical trials (N's= 1327, 346, and 200). Drinking reductions from baseline to the end of treatment were measured as changes in World Health Organization (WHO) risk drinking levels; alcohol craving was measured using validated self-report measures. Regression analyses tested whether drinking reductions were associated with end-of-treatment craving reductions; moderation analyses tested whether associations between drinking reduction and end-of-treatment craving differed across AUD severity. RESULTS Reductions of at least 1 or at least 2 WHO risk drinking levels were associated with lower craving (all p's < 0.05). Results were substantively similar after removing abstainers at the end-of-treatment. Associations between drinking reductions and craving were generally not moderated by AUD severity. CONCLUSIONS Individuals with WHO risk drinking level reductions reported significantly lower craving, as compared to those who did not achieve meaningful reductions in drinking. The results demonstrate the utility of WHO risk drinking levels as AUD clinical trial endpoints and provide evidence that drinking reductions mitigate craving.
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Affiliation(s)
- Felicia R. Tuchman
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM, USA
| | - Kevin A. Hallgren
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA
| | - Dylan K. Richards
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, MSC11-6280, Albuquerque, NM, USA
| | - Arnie Aldridge
- Behavioral Health Financing, Economics and Evaluation Department, Research Triangle Institute (RTI) International, Durham, NC, USA
| | - Raymond K. Anton
- Psychiatry and Behavioral Sciences Department, Medical University of South Carolina, Charleston, SC, USA
| | - Henri-Jean Aubin
- AP-HP. Université Paris Saclay, French Institute of Health and Medical Research (INSERM), Paris, Île-de-France, FRANCE
| | - Henry R. Kranzler
- Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Karl Mann
- Central Institute for Mental Health Mannheim, Heidelberg University, Heidelberg, DE
| | - Stephanie S. O’Malley
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM, USA
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, MSC11-6280, Albuquerque, NM, USA
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25
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Shenoy AA, Praharaj SK, Rai S, Nayak KR, Sasidharan A, Suryavanshi CA. Development and standardization of Indian Alcohol Photo Stimuli (IAPS) for cue-reactivity paradigms in patients with alcohol use disorder. Indian J Psychiatry 2024; 66:135-141. [PMID: 38523756 PMCID: PMC10956586 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_233_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 11/05/2023] [Accepted: 12/25/2023] [Indexed: 03/26/2024] Open
Abstract
Background The availability of appropriate alcohol-related stimuli is a crucial concern for the evaluation and treatment of patients with alcohol dependence syndrome. The study aimed to standardize alcohol-related images with cultural relevance to the Indian setting. Methods We produced an extensive database of 203 pictures, the Indian Alcohol Photo Stimuli (IAPS), portraying different categories and types of alcoholic beverages, after removing the confounding effects of low-level stimulus parameters (e.g. brightness and blurriness). Thirty patients with alcohol dependence syndrome, currently abstinent, rated each image on visual analog scale (VAS) ranging from 0 (no craving) to 10 (extreme), to determine how typical the stimuli served as craving-relevant stimuli. Results The mean VAS scores across beverages (ordered from highest to lowest) were whiskey >rum >beer >wine >vodka. Repeated-measures analysis of variance (ANOVA) showed a significant difference in mean VAS scores across beverages (F = 2.93, df = 2.9/86.3, P = 0.039, Greenhouse-Geisser corrected); the effect size for the difference was small (ηp2 = 0.092). A post hoc Bonferroni shows significantly higher VAS scores with whiskey compared with vodka (P = 0.029), whereas the scores were similar across other beverages. A two-way repeated-measures ANOVA for interaction between type of alcoholic beverages and activity was not significant (F = 2.67, df = 2.6/76.6, P = 0.061, Greenhouse-Geisser corrected). Conclusions We created a standardized alcohol-related image database for studying cue-reactivity paradigms in individuals with alcohol use disorder (AUD). Further research is needed to validate the impact of image features on cue reactivity.
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Affiliation(s)
- Anupa A. Shenoy
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Samir Kumar Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shweta Rai
- Department of Clinical Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kirtana R. Nayak
- Department of Physiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Arun Sasidharan
- Center for Consciousness Studies, Department of Neurophysiology, NIMHANS, Bengaluru, Karnataka, India
| | - Chinmay Ajit Suryavanshi
- Department of Physiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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26
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Reichenberger J, van Alebeek H, Messer T, Blechert J. Excess after stress-A three-study validation of the salzburg stress drinking scale as a new tool to measure the stress-drinking relationship. Stress Health 2024; 40:e3293. [PMID: 37462153 DOI: 10.1002/smi.3293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/23/2023] [Accepted: 07/09/2023] [Indexed: 02/08/2024]
Abstract
Stress frequently influences a person's propensity to drink alcohol. Inter-individual differences in such stress-related drinking can be assessed through psychometric scales; however, available questionnaires conflate stress- with emotion-related reasons to drink and ignore evidence of decreased alcohol consumption in response to stress. Therefore, we developed a genuine stress-drinking scale (Salzburg Stress Drinking Scale; SSDS), adapted from the Salzburg Stress Eating Scale, and assessed its psychometric properties. In study 1 (n = 639), the SSDS was found to have a one-factor structure, excellent internal consistency, and acceptable test-retest reliability. SSDS scores were significantly correlated with other measures assessing emotional drinking, but uncorrelated with general alcohol pathology and other health-relevant consummatory behaviors such as stress-related eating or nicotine consumption. In addition, no significant sex differences arose. In study 2 (n = 42) patients with an alcohol use disorder or addiction scored significantly higher on the SSDS compared to healthy controls. In an Ecological Momentary Assessment study 3 (n = 67), the SSDS showed partial ecological validity through significant relationships with daily alcohol consumption, but not daily stress-drinking relationships. In sum, the SSDS represents a psychometrically sound tool for the measurement of stress-related drinking and complements a battery of stress-related changes in health-relevant behaviors.
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Affiliation(s)
- Julia Reichenberger
- Department of Psychology, Paris-Lodron-University of Salzburg, Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Hannah van Alebeek
- Department of Psychology, Paris-Lodron-University of Salzburg, Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Thomas Messer
- Danuvius Clinic Pfaffenhofen, Clinic for Psychiatry, Psychotherapy and Psychosomatics, Pfaffenhofen an der Ilm, Germany
| | - Jens Blechert
- Department of Psychology, Paris-Lodron-University of Salzburg, Centre for Cognitive Neuroscience, Salzburg, Austria
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27
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Piccirillo ML, Enkema MC, Foster KT. Using the experience sampling method to support clinical practice: An illustration with problematic cannabis use. Psychother Res 2024; 34:241-260. [PMID: 36976153 PMCID: PMC10533735 DOI: 10.1080/10503307.2023.2184284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 03/29/2023] Open
Abstract
The experience sampling method (ESM) has been frequently used in clinical research; however, there is low translational uptake in clinical practice. This may be due to challenges with interpreting individual-level data at granular intervals. We provide an illustrative example of how ESM can be leveraged to generate personalized cognitive-behavioral strategies for problematic cannabis use. We conducted a descriptive case series analysis using ESM data from 30 individuals reporting on problematic cannabis use, craving, affect, and coping four times daily for 16-days (t = 64, T = 1,920). Analyzing ESM data using descriptive statistics and visualizations from individuals with similar clinical and demographic profiles supported a diverse array of personalized clinical insights and recommendations for each case. These recommendations included psychoeducation regarding affect- and boredom-regulation strategies, functional analyses of occasions during which cannabis was not used, and discussions on how cannabis use intersects with one's personal values. While many clinicians utilize measurement-based care, barriers have limited the incorporation of ESM towards personalized, data-informed approaches to treatment. We provide an illustrative example of how ESM data can be used to generate actionable treatment strategies for problematic cannabis use and highlight continued challenges with interpreting time-series data.
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Affiliation(s)
- Marilyn L. Piccirillo
- University of Washington, Department of Psychology
- University of Washington, Department of Psychiatry and Behavioral Sciences
| | | | - Katherine T. Foster
- University of Washington, Department of Psychology
- University of Washington, Department of Global Health
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28
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Peavy KM, Klipsch A, Soma CS, Pace B, Imel ZE, Tanana MJ, Soth S, Ricardo-Bulis E, Atkins DC. Improving the quality of counseling and clinical supervision in opioid treatment programs: how can technology help? Addict Sci Clin Pract 2024; 19:8. [PMID: 38245783 PMCID: PMC10799386 DOI: 10.1186/s13722-024-00435-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/05/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The opioid epidemic has resulted in expanded substance use treatment services and strained the clinical workforce serving people with opioid use disorder. Focusing on evidence-based counseling practices like motivational interviewing may be of interest to counselors and their supervisors, but time-intensive adherence tasks like recording and feedback are aspirational in busy community-based opioid treatment programs. The need to improve and systematize clinical training and supervision might be addressed by the growing field of machine learning and natural language-based technology, which can promote counseling skill via self- and supervisor-monitoring of counseling session recordings. METHODS Counselors in an opioid treatment program were provided with an opportunity to use an artificial intelligence based, HIPAA compliant recording and supervision platform (Lyssn.io) to record counseling sessions. We then conducted four focus groups-two with counselors and two with supervisors-to understand the integration of technology with practice and supervision. Questions centered on the acceptability of the clinical supervision software and its potential in an OTP setting; we conducted a thematic coding of the responses. RESULTS The clinical supervision software was experienced by counselors and clinical supervisors as beneficial to counselor training, professional development, and clinical supervision. Focus group participants reported that the clinical supervision software could help counselors learn and improve motivational interviewing skills. Counselors said that using the technology highlights the value of counseling encounters (versus paperwork). Clinical supervisors noted that the clinical supervision software could help meet national clinical supervision guidelines and local requirements. Counselors and clinical supervisors alike talked about some of the potential challenges of requiring session recording. CONCLUSIONS Implementing evidence-based counseling practices can help the population served in OTPs; another benefit of focusing on clinical skills is to emphasize and hold up counselors' roles as worthy. Machine learning technology can have a positive impact on clinical practices among counselors and clinical supervisors in opioid treatment programs, settings whose clinical workforce continues to be challenged by the opioid epidemic. Using technology to focus on clinical skill building may enhance counselors' and clinical supervisors' overall experiences in their places of work.
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Affiliation(s)
- K Michelle Peavy
- PRISM, Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | | | | | | | - Zac E Imel
- Lyssn.Io, Seattle, Washington, USA
- University of Utah, Salt Lake City, UT, USA
| | | | - Sean Soth
- Evergreen Treatment Services, Seattle, Washington, USA
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Henry LM, Hansen E, Chimoff J, Pokstis K, Kiderman M, Naim R, Kossowsky J, Byrne ME, Lopez-Guzman S, Kircanski K, Pine DS, Brotman MA. Selecting an Ecological Momentary Assessment Platform: Tutorial for Researchers. J Med Internet Res 2024; 26:e51125. [PMID: 38175682 PMCID: PMC10797510 DOI: 10.2196/51125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/25/2023] [Accepted: 10/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Although ecological momentary assessment (EMA) has been applied in psychological research for decades, delivery methods have evolved with the proliferation of digital technology. Technological advances have engendered opportunities for enhanced accessibility, convenience, measurement precision, and integration with wearable sensors. Notwithstanding, researchers must navigate novel complexities in EMA research design and implementation. OBJECTIVE In this paper, we aimed to provide guidance on platform selection for clinical scientists launching EMA studies. METHODS Our team includes diverse specialties in child and adolescent behavioral and mental health with varying expertise on EMA platforms (eg, users and developers). We (2 research sites) evaluated EMA platforms with the goal of identifying the platform or platforms with the best fit for our research. We created a list of extant EMA platforms; conducted a web-based review; considered institutional security, privacy, and data management requirements; met with developers; and evaluated each of the candidate EMA platforms for 1 week. RESULTS We selected 2 different EMA platforms, rather than a single platform, for use at our 2 research sites. Our results underscore the importance of platform selection driven by individualized and prioritized laboratory needs; there is no single, ideal platform for EMA researchers. In addition, our project generated 11 considerations for researchers in selecting an EMA platform: (1) location; (2) developer involvement; (3) sample characteristics; (4) onboarding; (5) survey design features; (6) sampling scheme and scheduling; (7) viewing results; (8) dashboards; (9) security, privacy, and data management; (10) pricing and cost structure; and (11) future directions. Furthermore, our project yielded a suggested timeline for the EMA platform selection process. CONCLUSIONS This study will guide scientists initiating studies using EMA, an in vivo, real-time research tool with tremendous promise for facilitating advances in psychological assessment and intervention.
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Affiliation(s)
- Lauren M Henry
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, United States
| | - Eleanor Hansen
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, United States
| | - Justin Chimoff
- Department of Anesthesiology, Critical Care and Pain Medicine Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Kimberly Pokstis
- Department of Anesthesiology, Critical Care and Pain Medicine Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Miryam Kiderman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, United States
| | - Reut Naim
- The School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Joe Kossowsky
- Department of Anesthesiology, Critical Care and Pain Medicine Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Meghan E Byrne
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, United States
| | - Silvia Lopez-Guzman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, United States
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, United States
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, United States
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, United States
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Yang M, Schick MR, Sullivan TP, Weiss NH. Predicting Completion of Ecological Momentary Assessments Among Substance-Using Women Experiencing Intimate Partner Violence. Assessment 2024:10731911231216948. [PMID: 38174693 DOI: 10.1177/10731911231216948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Noncompletion of ecological momentary assessment (EMA) surveys is a common issue and may yield bias in results if not properly handled. Using data observed at scheduled times as well as data retrieved later to fill missing responses, this study aims to investigate predictors of EMA completion, including demographic characteristics, time-related factors, and momentary experiences/behaviors. Data were from a 30-day EMA study including 145 women currently experiencing intimate partner violence (IPV) and using substances. The average rate of EMA completion was initially 51.4% at the scheduled times and increased to 72.6% after incorporating data from later-retrieved surveys. Participants who were younger, had more children, or had lower mean levels of negative affect dysregulation showed lower completion rates. At the momentary survey level, more days into the study and afternoon/evening reports (vs. morning reports) were associated with lower completion; lower levels of negative affect dysregulation, less smoking or alcohol use, and experiencing IPV were linked to lower momentary completion. Implications of the results for handling missing data in EMA are discussed and have important ramifications for future research, practice, and theory.
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Boness CL, Carlos Gonzalez J, Sleep C, Venner KL, Witkiewitz K. Evidence-Based Assessment of Substance Use Disorder. Assessment 2024; 31:168-190. [PMID: 37322848 PMCID: PMC11059671 DOI: 10.1177/10731911231177252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The current review describes updated information on the evidence-based assessment of substance use disorder. We offer an overview of the state of the science for substance-related assessment targets, instruments (screening, diagnosis, outcome and treatment monitoring, and psychosocial functioning and wellbeing) and processes (relational and technical) as well as recommendations for each of these three components. We encourage assessors to reflect on their own biases, beliefs, and values, including how those relate to people that use substances, and to view the individual as a whole person. It is important to consider a person's profile of symptoms and functioning inclusive of strengths, comorbidities, and social and cultural determinants. Collaborating with the patient to select the assessment target that best fits their goals and integration of assessment information in a holistic manner is critical. We conclude by providing recommendations for assessment targets, instruments, and processes as well as recommendations for comprehensive substance use disorder assessment, and describe future directions for research.
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Affiliation(s)
- Cassandra L Boness
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, Albuquerque, NM, USA
| | | | - Chelsea Sleep
- Cincinnati VA Medical Center, OH, USA
- University of Cincinnati, OH, USA
| | - Kamilla L Venner
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, Albuquerque, NM, USA
| | - Katie Witkiewitz
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, Albuquerque, NM, USA
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Chirokoff V, Dupuy M, Abdallah M, Fatseas M, Serre F, Auriacombe M, Misdrahi D, Berthoz S, Swendsen J, Sullivan EV, Chanraud S. Craving dynamics and related cerebral substrates predict timing of use in alcohol, tobacco, and cannabis use disorders. ADDICTION NEUROSCIENCE 2023; 9:100138. [PMID: 38389954 PMCID: PMC10883348 DOI: 10.1016/j.addicn.2023.100138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Background Patients treated for Substance Use Disorders exhibit highly fluctuating patterns of craving that could reveal novel prognostic markers of use. Accordingly, we 1) measured fluctuations within intensively repeated measures of craving and 2) linked fluctuations of craving to connectivity indices within resting-state (rs) brain regions to assess their relation to use among patients undergoing treatment for Alcohol, Tobacco and Cannabis Use Disorders. Method Participants -64 individuals with SUD for tobacco, alcohol, or cannabis and 35 healthy controls-completed a week of Ecological Momentary Assessment (EMA) during which they reported craving intensity and substance use five times daily. Before EMA, a subsample of 50 patients, and 34 healthy controls also completed resting-state (rs)-MRI acquisitions. Craving temporal dynamics within each day were characterized using Standard Deviation (SD), Auto-Correlation Factor (ACF), and Mean Successive Square Difference (MSSD). Absolute Difference (AD) in craving between assessments was a prospective prediction measure. Results Within-day, higher MSSD predicted greater substance use while controlling for mean craving. Prospectively higher AD predicted later increased substance use independently of previous use or craving level. Moreover, MSSD was linked to strength in five functional neural connections, most involving frontotemporal systems. Cerebello-thalamic and thalamo-frontal connectivity were also linked to substance use and distinguished the SUD from the controls. Conclusion To the best of our knowledge, this is the first study to indicate that instability in craving may be a trigger for use in several SUD types, beyond the known effect of craving intensity.
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Affiliation(s)
- Valentine Chirokoff
- University of Bordeaux, CNRS-UMR 5287 - Institut de Neurosciences Cognitives et Intégratives d'Aquitaine (INCIA), Bordeaux, France
- EPHE, PSL Research University, Paris, France
| | - Maud Dupuy
- University of Bordeaux, CNRS-UMR 5287 - Institut de Neurosciences Cognitives et Intégratives d'Aquitaine (INCIA), Bordeaux, France
| | - Majd Abdallah
- Bordeaux University, CNRS, Bordeaux Bioinformatics Center, IBGC UMR 5095, Bordeaux, France
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives-UMR 5293, CNRS, Univeristy of Bordeaux, Bordeaux, France
| | - Melina Fatseas
- University of Bordeaux, CNRS-UMR 5287 - Institut de Neurosciences Cognitives et Intégratives d'Aquitaine (INCIA), Bordeaux, France
- CH Charles Perrens, Bordeaux, France
- CHU Bordeaux, Bordeaux, France
| | - Fuschia Serre
- University of Bordeaux, CNRS UMR 6033- Sleep, Addiction and Neuropsychiatry (SANPSY), Bordeaux, France
| | - Marc Auriacombe
- CH Charles Perrens, Bordeaux, France
- University of Bordeaux, CNRS UMR 6033- Sleep, Addiction and Neuropsychiatry (SANPSY), Bordeaux, France
| | - David Misdrahi
- University of Bordeaux, CNRS-UMR 5287 - Institut de Neurosciences Cognitives et Intégratives d'Aquitaine (INCIA), Bordeaux, France
- CH Charles Perrens, Bordeaux, France
| | - Sylvie Berthoz
- University of Bordeaux, CNRS-UMR 5287 - Institut de Neurosciences Cognitives et Intégratives d'Aquitaine (INCIA), Bordeaux, France
- Institut Mutualiste Montsouris, Department of Psychiatry for Adolescents and Young Adults, Paris, France
| | - Joel Swendsen
- University of Bordeaux, CNRS-UMR 5287 - Institut de Neurosciences Cognitives et Intégratives d'Aquitaine (INCIA), Bordeaux, France
- EPHE, PSL Research University, Paris, France
| | - Edith V Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Sandra Chanraud
- University of Bordeaux, CNRS-UMR 5287 - Institut de Neurosciences Cognitives et Intégratives d'Aquitaine (INCIA), Bordeaux, France
- EPHE, PSL Research University, Paris, France
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Franken IHA. Is sexual craving a sign of sex addiction? Addiction 2023; 118:2315-2316. [PMID: 37788826 DOI: 10.1111/add.16362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023]
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Pistre N, Schreck B, Grall-Bronnec M, Fatseas M. Should problematic sexual behavior be viewed under the scope of addiction? A systematic review based on DSM-5 substance use disorder criteria. Addict Behav Rep 2023; 18:100510. [PMID: 37519859 PMCID: PMC10374865 DOI: 10.1016/j.abrep.2023.100510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/19/2023] [Accepted: 07/15/2023] [Indexed: 08/01/2023] Open
Abstract
Despite similarities between compulsive sexual disorder and substance use disorder, the issue whether problematic sexual behavior should be viewed within an addiction framework continues to be a subject of debate with no consensus regarding its conceptualization and diagnosis criteria. Examining the presence of addiction criteria among clinical and no clinical samples in the existing literature could permit to ascertain clinical validity of sex addiction diagnosis and support its overlapping feature with other addictive disorders. The aim of this systematic review was to examine this issue by assessing DSM-5 criteria of substance use disorder among individuals engaged in problematic sexual activity. Methods: Using PRISMA criteria, three databases were comprehensively searched up to April 2022, in order to identify all candidate studies based on broad key words. Resulting studies were then selected if they examined problematic sexual behavior within the framework of DSM-5 addiction criteria. Results: Twenty articles matched the selection criteria and were included in this review. DSM-5 criteria of addictive disorders were found to be highly prevalent among problematic sex users, particularly craving, loss of control over sex use, and negative consequences related to sexual behavior. Exposition to sexual cues was also shown to trigger craving, with an association to problematic use and symptom severity. Conclusions: More studies should been done to assess homogeneously according to the DSM-5 criteria the addiction-like features of problematic sexual behaviors in clinical and no-clinical populations. Furthermore, this work argues for the need of further research to examine the extent to which anti-craving interventions could be effective in improving clinical outcomes.
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Affiliation(s)
- Natasha Pistre
- Department of Addictology, CHU Bordeaux, F-33000 Bordeaux, France
| | - Benoît Schreck
- Nantes Université, CHU Nantes, UIC Psychiatrie et Santé Mentale, F-44000 Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, F-44000 Nantes, France
| | - Marie Grall-Bronnec
- Nantes Université, CHU Nantes, UIC Psychiatrie et Santé Mentale, F-44000 Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, F-44000 Nantes, France
| | - Melina Fatseas
- Department of Addictology, CHU Bordeaux, F-33000 Bordeaux, France
- Department of Addictology, CH Charles Perrens, F-33000 Bordeaux, France
- Univ. Bordeaux, CNRS, INCIA, UMR 5287, F-33000 Bordeaux, France
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Wycoff AM, Rogers K, Parlette B, Miranda R, Padovano HT. Cannabis craving in response to alcohol cues in the laboratory and in daily life among adolescents ages 15-17 years. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2366-2374. [PMID: 38151781 PMCID: PMC10756637 DOI: 10.1111/acer.15215] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Most adolescents who drink alcohol also use cannabis, and adolescents who use both substances experience worse long-term outcomes than adolescents who use only one or the other. Recent clinical trials with adolescents and emerging adults show that alcohol cues are associated with elevated cannabis craving in the natural environment but not in the laboratory, highlighting cross-cue reactivity as a potential intervention target. This study extends this work to a younger sample of adolescents at an earlier stage of substance use to examine the generalizability of prior findings and inform etiological mechanisms. METHODS Participants were 81 adolescents aged 15-17 years who endorsed past-month alcohol and lifetime cannabis use. They completed a laboratory cue reactivity protocol where they rated their cannabis craving during alcohol cue and control conditions. They also completed 24 days of ecological momentary assessment where they reported multiple times per day on their cannabis craving and whether alcohol cues were visible. RESULTS Mixed models demonstrated lower cannabis craving following alcohol cue presentation in the laboratory compared to control cues, but higher cannabis craving during moments when alcohol was visible in daily life compared to moments when alcohol was not visible. Frequency of cannabis use at baseline was associated with greater cannabis craving in the laboratory and in daily life regardless of cue type or alcohol visibility, and cannabis craving following alcohol cue presentation in the laboratory was positively related to daily life cannabis craving across contexts. CONCLUSIONS This study adds to prior work suggesting that daily life cannabis craving is elevated when alcohol cues are visible. This cross-cue reactivity may be one factor that drives and maintains alcohol and cannabis use in adolescence.
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Affiliation(s)
- Andrea M. Wycoff
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02912
| | - Kristin Rogers
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02912
| | - Brianna Parlette
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02912
| | - Robert Miranda
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02912
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02906
| | - Hayley Treloar Padovano
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02912
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02906
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Antons S, Yip SW, Lacadie CM, Dadashkarimi J, Scheinost D, Brand M, Potenza MN. Connectome-based prediction of craving in gambling disorder and cocaine use disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2023; 25:33-42. [PMID: 37190759 PMCID: PMC10190201 DOI: 10.1080/19585969.2023.2208586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Craving, involving intense and urgent desires to engage in specific behaviours, is a feature of addictions. Multiple studies implicate regions of salience/limbic networks and basal ganglia, fronto-parietal, medial frontal regions in craving in addictions. However, prior studies have not identified common neural networks that reliably predict craving across substance and behavioural addictions. METHODS Functional magnetic resonance imaging during an audiovisual cue-reactivity task and connectome-based predictive modelling (CPM), a data-driven method for generating brain-behavioural models, were used to study individuals with cocaine-use disorder and gambling disorder. Functions of nodes and networks relevant to craving were identified and interpreted based on meta-analytic data. RESULTS Craving was predicted by neural connectivity across disorders. The highest degree nodes were mostly located in the prefrontal cortex. Overall, the prediction model included complex networks including motor/sensory, fronto-parietal, and default-mode networks. The decoding revealed high functional associations with components of memory, valence ratings, physiological responses, and finger movement/motor imagery. CONCLUSIONS Craving could be predicted across substance and behavioural addictions. The model may reflect general neural mechanisms of craving despite specificities of individual disorders. Prefrontal regions associated with working memory and autobiographical memory seem important in predicting craving. For further validation, the model should be tested in diverse samples and contexts.
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Affiliation(s)
- Stephanie Antons
- General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany
| | - Sarah W. Yip
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Cheryl M. Lacadie
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | | | - Dustin Scheinost
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Matthias Brand
- General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany
| | - Marc N. Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
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Cless MM, Courchesne-Krak NS, Bhatt KV, Mittal ML, Marienfeld CB. Craving among patients seeking treatment for substance use disorder. DISCOVER MENTAL HEALTH 2023; 3:23. [PMID: 37935934 PMCID: PMC10630178 DOI: 10.1007/s44192-023-00049-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Craving has been implicated as a central feature of addiction and a predictor of relapse. However, a complete understanding of how craving varies across patient populations is lacking. This study aimed to better inform the effective and accurate use of craving as a clinical prognostic tool for patients with substance use disorders (SUD). METHODS This cross-sectional study utilized information gathered on patients (n = 112) entering specialty treatment for a SUD. Craving in the prior 30 days was assessed with a single item with other intake questionnaires. RESULTS Patients who reported substance use in the last 30 days were more likely to report craving compared to patients who did not report substance use in the last 30 days (AOR = 6.86 [95% CI 2.17-21.7], p-value = 0.001). Patients who reported Hispanic/Latinx ethnicity were less likely to report craving compared to patients who did not report Hispanic/Latinx ethnicity (AOR = 0.28 [95% CI 0.08-0.95], p-value = 0.04). There was no association between craving and Adverse Childhood Events (OR = 1.03 [95% CI 0.84-1.25], p-value = 0.81). CONCLUSION The association between recent substance use and craving supports previous findings. The observed variation in craving among patients who report Hispanic/Latinx ethnicity is novel and suggests socio-cultural influences and possibly genetic factors influencing reported craving amongst patients. Additional research is needed to further understand the underlying factors leading to this finding, in order for better utilization of craving as a clinical indicator across patient populations.
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Affiliation(s)
- Mallory M Cless
- Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C101, La Jolla, CA, 92037, USA
| | - Natasia S Courchesne-Krak
- Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C101, La Jolla, CA, 92037, USA
| | - Kush V Bhatt
- Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C101, La Jolla, CA, 92037, USA
| | - Maria Luisa Mittal
- Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C101, La Jolla, CA, 92037, USA
| | - Carla B Marienfeld
- Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C101, La Jolla, CA, 92037, USA.
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Reed BW, Doran N, Courtney KE. Associations between nicotine product use and craving among stable daily and non-daily users. Addict Behav 2023; 146:107803. [PMID: 37423069 PMCID: PMC10827279 DOI: 10.1016/j.addbeh.2023.107803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
Nicotine craving typically develops shortly after last use and is conceptualized as essential to the development, maintenance, and treatment of nicotine dependence. Previous research has primarily examined the relationship between craving and use among individuals trying to quit smoking, and less is known about this relationship among active users, particularly e-cigarette users. The current study evaluated the association between craving and use by assessing both constructs twice daily over 7 days in a sample of daily (n = 80) and non-daily (n = 34) users of combustible tobacco and e-cigarette products. We used negative binomial regression modeling to analyze the relationship between nicotine craving and use in two ways. First, we evaluated a lagged model in which craving at the time of assessment predicted use during the next time period. Next, we evaluated a model in which maximum craving since the last assessment predicted use during the same time period. Maximum craving was significantly and positively associated with nicotine product use (p <.05) while craving at the time of assessment was not. These associations did not differ depending on use frequency or on specific products used. Findings provide evidence that self-report ratings of craving are associated with greater nicotine and tobacco product use for both frequent and intermittent users. Furthermore, these results may be useful in developing or modifying interventions for a wide variety of nicotine users, including those who are not yet intending to make a change to their nicotine use.
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Affiliation(s)
- Brandon W Reed
- Mental Health Care Line, VA San Diego Healthcare System, San Diego, CA 92161, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA 920093, USA.
| | - Neal Doran
- Mental Health Care Line, VA San Diego Healthcare System, San Diego, CA 92161, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA 920093, USA.
| | - Kelly E Courtney
- Department of Psychiatry, University of California San Diego, La Jolla, CA 920093, USA.
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Demina A, Petit B, Meille V, Trojak B. Mindfulness interventions for craving reduction in substance use disorders and behavioral addictions: systematic review and meta-analysis of randomized controlled trials. BMC Neurosci 2023; 24:55. [PMID: 37853315 PMCID: PMC10583418 DOI: 10.1186/s12868-023-00821-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND High-quality evidence is still required to affirm the efficacy of mindfulness-based interventions (MBIs) in craving reduction. MBIs may be particularly appropriate for this purpose given the neurobiological mechanisms of addiction with automatic behavior in response to the negative affect. In this systematic review and meta-analysis, we aimed to study the efficacy of MBIs in craving reduction and to synthetize the newly published data. METHODS We searched four databases and three clinical trial registries for randomized controlled trials (RCTs) up to August 2023, including studies with MBIs in all types of substance use disorders or behavioral addictions. We chose as our outcome of interest the change from the baseline of craving measures at posttreatment. Standardized mean difference was used as an effect size estimator. RESULTS We included 17 RCTs with 1228 participants. The overall effect size was estimated at -0.70 (95% CI -1.15, -0.26) in favor of MBIs. CONCLUSION Due to the high inconsistency (I2 = 92%), we were unable to conclude that there is a medium to large effect size. Overall risk of bias was high for most studies, and the GRADE approach detected a low quality of evidence. Previous clinical and fundamental research suggest that MBIs have a promising potential in addiction medicine. However, further investigation of whether MBIs effectively reduce craving is needed, and innovative solutions for resolving methodological limitations in MBI research are warranted. TRIAL REGISTRATION PROSPERO registration ID CRD42020221141.
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Affiliation(s)
- Anastasia Demina
- Dijon University Hospital, Bâtiment Marion 14 rue Paul Gaffarel, 21079, BP77908, Dijon Cedex, France.
- INSERM U1093, CAPS, Université de Bourgogne, UFR STAPS, BP 27877, F-21078, Dijon, France.
| | - Benjamin Petit
- Dijon University Hospital, Bâtiment Marion 14 rue Paul Gaffarel, 21079, BP77908, Dijon Cedex, France
| | - Vincent Meille
- Dijon University Hospital, Bâtiment Marion 14 rue Paul Gaffarel, 21079, BP77908, Dijon Cedex, France
| | - Benoit Trojak
- Dijon University Hospital, Bâtiment Marion 14 rue Paul Gaffarel, 21079, BP77908, Dijon Cedex, France
- INSERM U1093, CAPS, Université de Bourgogne, UFR STAPS, BP 27877, F-21078, Dijon, France
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Everett RA, Lewis AL, Kuerbis A, Peace A, Li J, Morgenstern J. Data driven mixed effects modeling of the dual process framework of addiction among individuals with alcohol use disorder. PLoS One 2023; 18:e0265168. [PMID: 37549160 PMCID: PMC10406226 DOI: 10.1371/journal.pone.0265168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 02/27/2022] [Indexed: 08/09/2023] Open
Abstract
Alcohol use disorder (AUD) comprises a continuum of symptoms and associated problems that has led AUD to be a leading cause of morbidity and mortality across the globe. Given the heterogeneity of AUD from mild to severe, consideration is being given to providing a spectrum of interventions that offer goal choice to match this heterogeneity, including helping individuals with AUD to moderate or control their drinking at low-risk levels. Because so much remains unknown about the factors that contribute to successful moderated drinking, we use dynamical systems modeling to identify mechanisms of behavior change. Daily alcohol consumption and daily desire (i.e., craving) are modeled using a system of delayed difference equations. Employing a mixed effects implementation of this system allows us to garner information about these mechanisms at both the population and individual levels. Use of this mixed effects framework first requires a parameter set reduction via identifiability analysis. The model calibration is then performed using Bayesian parameter estimation techniques. Finally, we demonstrate how conducting a parameter sensitivity analysis can assist in identifying optimal targets of intervention at the patient-specific level. This proof-of-concept analysis provides a foundation for future modeling to describe mechanisms of behavior change and determine potential treatment strategies in patients with AUD.
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Affiliation(s)
- Rebecca A. Everett
- Department of Mathematics and Statistics, Haverford College, Haverford, PA, United States of America
| | - Allison L. Lewis
- Department of Mathematics, Lafayette College, Easton, PA, United States of America
| | - Alexis Kuerbis
- Silberman School of Social Work, Hunter College, CUNY, New York, NY, United States of America
| | - Angela Peace
- Department of Mathematics and Statistics, Texas Tech University, Lubbock, TX, United States of America
| | - Jing Li
- Department of Mathematics, California State University, Northridge, CA, United States of America
| | - Jon Morgenstern
- Center for Addiction Services and Psychotherapy Research, Northwell Health, Great Neck, NY, United States of America
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Diers M, Müller SM, Mallon L, Schmid AM, Thomas TA, Klein L, Krikova K, Stark R, Wegmann E, Steins-Loeber S, Brand M, Antons S. Cue-reactivity to distal cues in individuals at risk for gaming disorder. Compr Psychiatry 2023; 125:152399. [PMID: 37437451 DOI: 10.1016/j.comppsych.2023.152399] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Gaming disorder (GD) is a disorder due to addictive behaviors (ICD-11). Cue-reactivity and craving are relevant mechanisms in the development and maintenance of addictive behaviors. When confronted with cues showing in-game content (proximal cues) individuals with higher symptom severity show increased cue-reactivity. Based on conditioning and addiction theories on incentive sensitization, cue-reactivity responses may generalize to more distal cues, e.g. when individuals at risk of developing a GD are confronted with a starting page of an online game. In cue-reactivity paradigms so far, only proximal gaming cues have been used. METHODS We investigated the effect of distal gaming cues compared to gaming-unrelated control cues on cue-reactivity and craving in 88 individuals with non-problematic use of online games (nPGU) and 69 individuals at risk for GD (rGD). The distal cues showed the use of an electronic device (e.g., desktop PC or smartphone) whose screen showed starting pages of either games (target cues), shopping- or pornography sites (control cues) from a first-person perspective. FINDINGS We found significantly higher urge and arousal ratings as well as longer viewing times for gaming-related compared to gaming-unrelated control cues in rGD compared to nPGU. Valence ratings did not differ between groups. INTERPRETATION The results demonstrate that already distal gaming-specific cues lead to cue-reactivity and craving in rGD. This finding indicates that based on conditioning processes, cue-reactivity and craving develop during the course of GD and generalize to cues that are only moderately related to the specific gaming activity.
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Affiliation(s)
- Martin Diers
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum, Germany.
| | - Silke M Müller
- General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg, Germany; Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany
| | - Lukas Mallon
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Anna M Schmid
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University of Bamberg, Bamberg, Germany
| | - Tobias A Thomas
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Lena Klein
- General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg, Germany
| | - Kseniya Krikova
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University, Giessen, Germany; Clinical Psychology and Psychotherapy, University Siegen, Siegen, Germany; Bender Institute for Neuroimaging, Justus Liebig University, Giessen, Germany
| | - Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University, Giessen, Germany; Bender Institute for Neuroimaging, Justus Liebig University, Giessen, Germany; Center for Mind, Brain and Behavior, Phillips University Marburg and Justus Liebig University Giessen, Germany
| | - Elisa Wegmann
- General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg, Germany
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University of Bamberg, Bamberg, Germany
| | - Matthias Brand
- General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg, Germany; Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany
| | - Stephanie Antons
- General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg, Germany; Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany
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Walters KJ, Gray KM, Gex KS, McClure EA. The Role of Emotion Differentiation in the Association Between Momentary Affect and Tobacco/Nicotine Craving in Young Adults. Nicotine Tob Res 2023; 25:1261-1268. [PMID: 36610804 PMCID: PMC10256884 DOI: 10.1093/ntr/ntad001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/13/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Tobacco/nicotine use is commonly initiated during adolescence or young adulthood, which increases the likelihood of continued use into adulthood and related adverse health outcomes. Despite interest in cessation, achieving and maintaining abstinence is difficult among this population. Cravings are often a barrier to abstinence, which have been associated with intensity of affect at the moment level. Emotion differentiation involves the ability to distinguish between discrete emotion states, and previous work suggests it may moderate the effect of momentary affect on craving, which has never been explored among young adults who are smoking or vaping nicotine. AIMS AND METHODS In a sample of young adults (N = 37, observations = 2020, ages 18-25, 51% female, and 78% white) interested in quitting smoking or vaping, we used real-time, naturalistic data capture via mobile phones to examine the interaction of momentary affect and trait emotion differentiation on nicotine craving. Participants were prompted with four surveys per day for 35 days and asked to make a 48-h quit attempt on day 7. RESULTS Multilevel models showed moments of higher-than-average momentary negative affect (NA; b = 0.39, p < .001), and positive affect (PA; b = 0.26, p = .001) were associated with greater levels of craving. NA emotion differentiation significantly moderated the associations between PA and craving (b = -0.63, p = .031) and NA and craving (b = -0.67, p = .003). CONCLUSIONS Findings from this exploratory analysis suggest that for young adults engaging in a nicotine quit attempt, greater ability to differentiate NA weakens the momentary association between intense affect and craving. IMPLICATIONS Results of this study show that the ability to differentiate between discrete emotional experiences may protect young adults against nicotine craving during moments of intense affective experience. These preliminary findings suggest that emotion differentiation, a modifiable construct, could be an important treatment target for individuals engaged in treatment for nicotine dependence.
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Affiliation(s)
- Kyle J Walters
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kathryn S Gex
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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Hanson JD, Harris A, Gilbertson RJ, Charboneau M, O'Leary M. Feasibility and Acceptability of Using Ecological Momentary Assessment to Evaluate Alcohol Use with American Indian Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6071. [PMID: 37372658 DOI: 10.3390/ijerph20126071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Ecological momentary assessments (EMA) are one way to collect timely and accurate alcohol use data, as they involve signaling participants via cell phones to report on daily behaviors in real-time and in a participant's natural environment. EMA has never been used with American Indian populations to evaluate alcohol consumption. The purpose of this project was to determine the feasibility and acceptability of EMA for American Indian women. METHODS Eligible participants were American Indian women between the ages of 18 and 44 who were not pregnant and had consumed more than one drink within the past month. All participants received a TracFone and weekly automated messages. Self-reported measures of daily quantity and frequency of alcohol consumption, alcohol type, and context were assessed once per week for four weeks. Baseline measurements also included the Drinking Motives Questionnaire-Revised (DMQ-R) and the Interpersonal Support Evaluation List (ISEL). RESULTS Fifteen participants were enrolled in the study. All but one participant completed all data collection time points, and drinking patterns were consistent across the study period. A total of 420 records were completed across 86 drinking days and 334 non-drinking days. Participants reported drinking an average of 5.7 days over the 30-day period and typically consumed 3.99 drinks per drinking occasion. Sixty-six percent of participants met gender-specific cut-points for heavy episodic drinking, with an average of 2.46 binge drinking occasions across the four week study period. CONCLUSIONS This proof-of-concept project showed that EMA was both feasible and acceptable for collecting alcohol data from American Indian women. Additional studies are necessary to fully implement EMA with American Indian women to better understand the drinking motives, contexts, patterns, and risk factors in this population.
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Affiliation(s)
- Jessica D Hanson
- Department of Applied Human Sciences, University of Minnesota Duluth, 1216 Ordean Court, Duluth, MN 55812, USA
| | - Amy Harris
- Department of Applied Human Sciences, University of Minnesota Duluth, 1216 Ordean Court, Duluth, MN 55812, USA
| | - Rebecca J Gilbertson
- Department of Psychology, University of Minnesota Duluth, 1216 Ordean Court, Duluth, MN 55812, USA
| | - Megan Charboneau
- Missouri Breaks Industries Research Inc, 118 Willow Street, Eagle Butte, SD 57625, USA
| | - Marcia O'Leary
- Missouri Breaks Industries Research Inc, 118 Willow Street, Eagle Butte, SD 57625, USA
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Serre F, Moriceau S, Donnadieu L, Forcier C, Garnier H, Alexandre JM, Dupuy L, Philip P, Levavasseur Y, De Sevin E, Auriacombe M. The Craving-Manager smartphone app designed to diagnose substance use/addictive disorders, and manage craving and individual predictors of relapse: a study protocol for a multicenter randomized controlled trial. Front Psychiatry 2023; 14:1143167. [PMID: 37255691 PMCID: PMC10226427 DOI: 10.3389/fpsyt.2023.1143167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/18/2023] [Indexed: 06/01/2023] Open
Abstract
Background The rate of individuals with addiction who are currently treated are low, and this can be explained by barriers such as stigma, desire to cope alone, and difficulty to access treatment. These barriers could be overcome by mobile technologies. EMI (Ecological Momentary Intervention) is a treatment procedure characterized by the delivery of interventions (messages on smartphones) to people in their daily lives. EMI presents opportunities for treatments to be available to people during times and in situations when they are most needed. Craving is a strong predictor of relapse and a key target for addiction treatment. Studies using Ecological Momentary Assessment (EMA) method have revealed that, in daily life, person-specific cues could precipitate craving, that in turn, is associated with a higher probability to report substance use and relapse in the following hours. Assessment and management of these specific situations in daily life could help to decrease addictive use and avoid relapse. The Craving-Manager smartphone app has been designed to diagnose addictive disorders, and assess and manage craving as well as individual predictors of use/relapse. It delivers specific and individualized interventions (counseling messages) composed of evidence-based addiction treatments approaches (cognitive behavioral therapy and mindfulness). The Craving-Manager app can be used for any addiction (substance or behavior). The objective of this protocol is to evaluate the efficacy of the Craving-Manager app in decreasing use (of primary substance(s)/addictive behavior(s)) over 4 weeks, among individuals on a waiting list for outpatient addiction treatment. Methods/design This multicenter double-blind randomized controlled trial (RCT) will compare two parallel groups: experimental group (full interventional version of the app, 4 weeks, EMA + EMI), versus control group (restricted version of the app, 4 weeks, only EMA). Two hundred and seventy-four participants will be recruited in 6 addiction treatment centers in France. Discussion This RCT will provide indication on how the Craving-Manager app will reduce addictive use (e.g., better craving management, better stimulus control) in both substance and behavioral addictions. If its efficacy is confirmed, the app could offer the possibility of an easy to use and personalized intervention accessible to the greatest number of individuals with addiction. Clinical Trial Registration ClinicalTrials.gov: NCT04732676.
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Affiliation(s)
- Fuschia Serre
- University of Bordeaux, Bordeaux, France
- SANPSY, UMR 6033, CNRS, Bordeaux, France
- Pôle Inter-établissement d’Addictologie, CH Ch. Perrens and CHU de Bordeaux, Bordeaux, France
| | - Sarah Moriceau
- University of Bordeaux, Bordeaux, France
- SANPSY, UMR 6033, CNRS, Bordeaux, France
- Pôle Inter-établissement d’Addictologie, CH Ch. Perrens and CHU de Bordeaux, Bordeaux, France
| | - Léa Donnadieu
- University of Bordeaux, Bordeaux, France
- SANPSY, UMR 6033, CNRS, Bordeaux, France
- Pôle Inter-établissement d’Addictologie, CH Ch. Perrens and CHU de Bordeaux, Bordeaux, France
| | - Camille Forcier
- University of Bordeaux, Bordeaux, France
- SANPSY, UMR 6033, CNRS, Bordeaux, France
- Pôle Inter-établissement d’Addictologie, CH Ch. Perrens and CHU de Bordeaux, Bordeaux, France
| | - Hélène Garnier
- University of Bordeaux, Bordeaux, France
- SANPSY, UMR 6033, CNRS, Bordeaux, France
- Pôle Inter-établissement d’Addictologie, CH Ch. Perrens and CHU de Bordeaux, Bordeaux, France
| | - Jean-Marc Alexandre
- University of Bordeaux, Bordeaux, France
- SANPSY, UMR 6033, CNRS, Bordeaux, France
- Pôle Inter-établissement d’Addictologie, CH Ch. Perrens and CHU de Bordeaux, Bordeaux, France
| | - Lucile Dupuy
- University of Bordeaux, Bordeaux, France
- SANPSY, UMR 6033, CNRS, Bordeaux, France
| | - Pierre Philip
- University of Bordeaux, Bordeaux, France
- SANPSY, UMR 6033, CNRS, Bordeaux, France
| | - Yannick Levavasseur
- University of Bordeaux, Bordeaux, France
- SANPSY, UMR 6033, CNRS, Bordeaux, France
| | - Etienne De Sevin
- University of Bordeaux, Bordeaux, France
- SANPSY, UMR 6033, CNRS, Bordeaux, France
| | - Marc Auriacombe
- University of Bordeaux, Bordeaux, France
- SANPSY, UMR 6033, CNRS, Bordeaux, France
- Pôle Inter-établissement d’Addictologie, CH Ch. Perrens and CHU de Bordeaux, Bordeaux, France
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Kappen M, Vanderhasselt MA, Slavich GM. Speech as a promising biosignal in precision psychiatry. Neurosci Biobehav Rev 2023; 148:105121. [PMID: 36914080 PMCID: PMC11219249 DOI: 10.1016/j.neubiorev.2023.105121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023]
Abstract
Health research and health care alike are presently based on infrequent assessments that provide an incomplete picture of clinical functioning. Consequently, opportunities to identify and prevent health events before they occur are missed. New health technologies are addressing these critical issues by enabling the continual monitoring of health-related processes using speech. These technologies are a great match for the healthcare environment because they make high-frequency assessments non-invasive and highly scalable. Indeed, existing tools can now extract a wide variety of health-relevant biosignals from smartphones by analyzing a person's voice and speech. These biosignals are linked to health-relevant biological pathways and have shown promise in detecting several disorders, including depression and schizophrenia. However, more research is needed to identify the speech signals that matter most, validate these signals against ground-truth outcomes, and translate these data into biomarkers and just-in-time adaptive interventions. We discuss these issues herein by describing how assessing everyday psychological stress through speech can help both researchers and health care providers monitor the impact that stress has on a wide variety of mental and physical health outcomes, such as self-harm, suicide, substance abuse, depression, and disease recurrence. If done appropriately and securely, speech is a novel digital biosignal that could play a key role in predicting high-priority clinical outcomes and delivering tailored interventions that help people when they need it most.
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Affiliation(s)
- Mitchel Kappen
- Department of Head and Skin, Ghent University, University Hospital Ghent (UZ Ghent), Department of Psychiatry and Medical Psychology, Ghent, Belgium
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Ghent University, University Hospital Ghent (UZ Ghent), Department of Psychiatry and Medical Psychology, Ghent, Belgium
| | - George M Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA.
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Shmulewitz D, Stohl M, Greenstein E, Roncone S, Walsh C, Aharonovich E, Wall MM, Hasin DS. Validity of the DSM-5 craving criterion for alcohol, tobacco, cannabis, cocaine, heroin, and non-prescription use of prescription painkillers (opioids). Psychol Med 2023; 53:1955-1969. [PMID: 35506791 PMCID: PMC9096712 DOI: 10.1017/s0033291721003652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although the DSM-5 was adopted in 2013, the validity of the new substance use disorder (SUD) diagnosis and craving criterion has not been investigated systematically across substances. METHODS Adults (N = 588) who engaged in binge drinking or illicit drug use and endorsed at least one DSM-5 SUD criterion were included. DSM-5 SUD criteria were assessed for alcohol, tobacco, cannabis, cocaine, heroin, and opioids. Craving was considered positive if "wanted to use so badly that could not think of anything else" (severe craving) or "felt a very strong desire or urge to use" (moderate craving) was endorsed. Baseline information on substance-related variables and psychopathology was collected, and electronic daily assessment queried substance use for the following 90 days. For each substance, logistic regression estimated the association between craving and validators, i.e. variables expected to be related to craving/SUD, and whether association with the validators differed for DSM-5 SUD diagnosed with craving as a criterion v. without. RESULTS Across substances, craving was associated with most baseline validators (p values<0.05); neither moderate nor severe craving consistently showed greater associations. Baseline craving predicted subsequent use [odds ratios (OR): 4.2 (alcohol) - 234.3 (heroin); p's ⩽ 0.0001], with stronger associations for moderate than severe craving (p's < 0.05). Baseline DSM-5 SUD showed stronger associations with subsequent use when diagnosed with craving than without (p's < 0.05). CONCLUSION The DSM-5 craving criterion as operationalized in this study is valid. Including craving improves the validity of DSM-5 SUD diagnoses, and clinical relevance, since craving may cause impaired control over use and development and maintenance of SUD.
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Affiliation(s)
- D Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - M Stohl
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - E Greenstein
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - S Roncone
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - C Walsh
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - E Aharonovich
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - MM Wall
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - DS Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
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Gauld C, Baillet E, Micoulaud-Franchi JA, Kervran C, Serre F, Auriacombe M. The centrality of craving in network analysis of five substance use disorders. Drug Alcohol Depend 2023; 245:109828. [PMID: 36868091 DOI: 10.1016/j.drugalcdep.2023.109828] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/26/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND AND AIMS Among the 11 current diagnostic criteria, craving is a potential central marker for understanding and for treatment of Substance Use Disorders (SUD). Our objective was to explore craving centrality across SUD based on the study of symptom interactions in cross-sectional network analyses of DSM-5 SUD diagnostic criteria. We hypothesized the centrality of "Craving" in SUD across substance types. DESIGN Participants from the ADDICTAQUI clinical cohort with regular use (2 times per week threshold for a substance) and at least one DSM-5 SUD. SETTING Outpatient substance use treatment services in Bordeaux, France. PARTICIPANTS The sample of 1359 participants, had a mean age of 39 years old and 67% were males. The prevalence of SUD over the time course of the study was: 93% for alcohol, 98% for opioids, 94% for cocaine, 94% for cannabis and 91% tobacco. MEASUREMENTS Construction of a Symptom Network Model conducted on the DSM-5 SUD criteria evaluated over the past 12 months for Alcohol-, Cocaine-, Tobacco-, Opioid- and Cannabis Use disorder. FINDINGS The only symptom that consistently remained in terms of centrality was "Craving" [3.96 - 6.17] (z-scores), indicating that it exhibits a high degree of connections in the entire symptom network regardless of the substance. CONCLUSION Identifying craving as central in SUD symptoms network confirms the role of craving as a marker of addiction. This constitutes a major avenue in the understanding of the mechanisms of addiction, with implications to ameliorate diagnostic validity and clarify treatment targets.
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Affiliation(s)
- Christophe Gauld
- Department of Child Psychiatry, CHU de Lyon, F-69000 Lyon, France; Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS & Université Claude Bernard Lyon 1, F-69000 Lyon, France
| | - Emmanuelle Baillet
- University of Bordeaux, F-33076 Bordeaux, France; SANPSY, CNRS, UMR 6033, F-33076 Bordeaux, France; Pôle Interétablissement d'Addictologie, CH Ch. Perrens and CHU de Bordeaux, F-33076 Bordeaux, France
| | - Jean-Arthur Micoulaud-Franchi
- University of Bordeaux, F-33076 Bordeaux, France; SANPSY, CNRS, UMR 6033, F-33076 Bordeaux, France; University Sleep Clinic, University Hospital of Bordeaux (CHU Bordeaux), Place Amélie Raba-Leon, F-33076 Bordeaux, France
| | - Charlotte Kervran
- University of Bordeaux, F-33076 Bordeaux, France; I-prev, MéRISP/PHARES, CIC 1401, Inserm U1219, Bordeaux Population Health Research Center (BPH), F-33076 Bordeaux, France
| | - Fuschia Serre
- University of Bordeaux, F-33076 Bordeaux, France; SANPSY, CNRS, UMR 6033, F-33076 Bordeaux, France; Pôle Interétablissement d'Addictologie, CH Ch. Perrens and CHU de Bordeaux, F-33076 Bordeaux, France
| | - Marc Auriacombe
- University of Bordeaux, F-33076 Bordeaux, France; SANPSY, CNRS, UMR 6033, F-33076 Bordeaux, France; Pôle Interétablissement d'Addictologie, CH Ch. Perrens and CHU de Bordeaux, F-33076 Bordeaux, France.
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48
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Yin Q, Wilks CR. Untangling the temporal association between daily urges to die by suicide and to use substances. Psychiatry Res 2023; 323:115178. [PMID: 37012190 DOI: 10.1016/j.psychres.2023.115178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Abstract
The current study examined the potential bi-directional associations between urges to die by suicide and to use alcohol or drugs as well as sadness and anger in relation to these urges. Forty individuals with suicidal thoughts, binge drinking behaviors, and emotion regulation difficulties, who were recruited for a clinical trial of internet-delivered Dialectical Behavior Therapy skills training, completed daily diaries on suicide and substance use urges and emotions over twenty-one days. Results indicated that higher daily peak substance use urges were associated with a greater likelihood of reporting suicide urges on the next day. Participants with higher and an increase in peak substance use urges (relative to their daily average) were both more likely to report suicide urges on the same day. Furthermore, both daily peak sadness and anger ratings predicted next-day suicide urges while accounting for substance use urges, though sadness may be a stronger predictor. These findings suggested a possible unidirectional pathway from urges to use substances to subsequent urges to die by suicide and a unique role of sadness.
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Affiliation(s)
- Qingqing Yin
- Department of Psychology, Rutgers University, 152 Frelinghuysen Road, Piscataway, NJ 08854, USA.
| | - Chelsey R Wilks
- Department of Psychological Sciences, University of Missouri-St. Louis, One University Blvd, St. Louis, MO 63121, USA
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Cleveland HH, Knapp KS, Cleveland MJ, Deneke E, Bunce SC. Using ecological momentary assessments of negative affect and craving during residential opioid use disorder treatment to predict patients' relapse to substance use. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 146:208931. [PMID: 36880896 PMCID: PMC10127152 DOI: 10.1016/j.josat.2022.208931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 09/13/2022] [Accepted: 12/30/2022] [Indexed: 04/27/2023]
Abstract
BACKGROUND Negative affect (NA) and craving are often independently examined as precipitators of relapse among individuals with substance use disorders, including opioid use disorder (OUD). Recent ecological momentary assessment (EMA) research has revealed that NA and craving frequently co-occur within individuals. Yet we know little about the general patterns of, and variability in, within-person associations between NA and craving, as well as whether the nature and degree of within-person NA-craving coupling predicts post-treatment time-to-relapse. METHODS Seventy-three patients (77 % male, Mage = 30.10, Range = 19-61) in residential treatment for OUD took part in a 12-day, 4× daily smartphone-based EMA study. Linear mixed-effects models tested within-person, day-level associations between self-reported NA and craving during treatment. The study used Person-specific slopes (i.e., average within-person NA-craving coupling for each participant) estimated from the mixed-effects model in survival analyses with Cox proportional hazards regression models to determine if between-person differences in the within-person coupling predicted post-treatment time-to-relapse (operationalized as the return to problematic use of any substance except tobacco), and whether this prediction was similar across patients' average levels of NA and craving intensity. The study monitored relapse through a combination of hair samples and reports from patients or alternative contacts via a voice response system twice a month for up to 120 days or more following discharge. RESULTS Among the 61 participants with time-to-relapse data, those with stronger positive within-person NA-craving coupling on average during residential OUD treatment had a lower hazard of relapsing (slower time to relapse) post-treatment than participants with weaker NA-craving slopes. The significant association held after controlling for interindividual differences in age, sex, and average levels of NA and craving intensity. Average NA and craving intensity did not moderate the association between NA-craving coupling and time-to-relapse. CONCLUSIONS Interindividual differences in average within-person, day-level NA-craving coupling during residential treatment predict OUD patients' post-treatment time-to-relapse.
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Affiliation(s)
- H Harrington Cleveland
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States.
| | - Kyler S Knapp
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States; Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, United States.
| | - Michael J Cleveland
- Department of Human Development, Washington State University, Pullman, WA, United States.
| | - Erin Deneke
- Caron Treatment Centers, Wernersville, PA, United States.
| | - Scott C Bunce
- Department of Psychiatry, The Pennsylvania State University, Hershey, PA, United States.
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Helle AC, Freeman LK, Pellegrini AM, Wycoff AM, Winograd R, Trull TJ. Implementing an EMA burst design in community-engaged research: participant and researcher perspectives and recommendations. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:53-62. [PMID: 36755381 PMCID: PMC10317063 DOI: 10.1080/00952990.2022.2160340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/27/2022] [Accepted: 12/14/2022] [Indexed: 02/10/2023]
Abstract
Background: Implementing ecological momentary assessment (EMA) methodology to evaluate the substance use disorder (SUD) treatment pipeline has clear advantages, including learning about participants' day-to-day experiences to aid in the improvement of services and accessibility for those seeking treatment. Given that the SUD treatment pipeline spans long periods of time, EMA burst designs (deployment of multiple short EMA periods spread over time) can be advantageous for evaluating the treatment pipeline over time while keeping participant burden low.Objectives: This feasibility study describes (1) the process and study design of implementing EMA burst methodology to evaluate the SUD treatment pipeline experience; (2) study implementation from the perspective of researchers, including discussion of collaboration with community partners; and (3) participant feedback on the experience of engaging with this type of research.Method: EMA metrics, feasibility ratings, and general experience ratings in the study are presented from 22 participants (64% women) who participated in a parent EMA study evaluating the SUD treatment pipeline and 8 who provided feedback in a follow-up survey.Results: Participants found the EMA burst design to be acceptable and not burdensome, although technology issues were present for some participants. Steps to partnering with community treatment programs and implementation of a burst design are outlined.Conclusions: Strategies and recommendations for implementation of an EMA burst study with community partners are provided, including aspects of study design, technology issues, retention, and funding.
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Affiliation(s)
- Ashley C. Helle
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Lindsey K. Freeman
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | | | - Andrea M. Wycoff
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Rachel Winograd
- Department of Psychological Sciences and Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Timothy J. Trull
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
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