Momentary fluctuations in impulsivity domains: Associations with a history of childhood ADHD, heavy alcohol use, and alcohol problems

An examination of state and trait urgency in individuals with binge-eating disorder

OBJECTIVE

Negative urgency (i.e., acting rashly when experiencing negative affect; NU), is a theorised maintenance factor in binge-eating type eating disorders. This study examined the association between trait NU and eating disorder severity, momentary changes in state NU surrounding episodes of binge eating, and the momentary mechanistic link between affect, rash action, and binge-eating risk.

METHODS

Participants were 112 individuals with binge-eating disorder (BED). Baseline measures included the UPPS-P Impulsive Behaviour Scale to assess trait NU and the Eating Disorders Examination to assess binge-eating frequency and global eating disorder severity. Ecological momentary assessment captured real-time data on binge eating, negative affect, and state NU.

RESULTS

Multiple regression analysis revealed a strong association between trait NU and eating disorder severity. Generalised estimating equations showed that state NU increased before and decreased after binge-eating episodes, and that this pattern was not moderated by trait-level NU. Finally, a multilevel structural equation model indicated that increases in rash action mediated the momentary relationship between states of high negative affect and episodes of binge eating.

CONCLUSION

These findings underscore the importance of both trait and state NU in binge-eating type eating disorders, and suggest NU as a potential key target for intervention.

Too Tired to Think: Within and Between-Person Relations Among Impulsive Traits, Sleep Duration, and Mental Health Outcomes

Heavier drinking and depression are common mental health concerns in the USA, yet few studies have sought to understand transdiagnostic risk factors for both. Two health-focused risk factors are impulsive personality traits and sleep duration, but research typically separates the two, precluding additive and interactive relations. The current study sought to test a theoretical model where risk conferred from impulsive traits is heightened when individuals have reduced sleep. Public-access data from the National Longitudinal Study on Adolescent to Adult Health (Add Health) were used to test study hypotheses. Participants reported on impulsive traits (i.e., lack of premeditation, sensation seeking), sleep duration, depression, and drinking across three waves spanning adolescence, emerging adulthood, and adulthood. Multilevel models distinguished risk processes at the between- vs. within-person level. At the between-person level, sensation seeking predicted drinking whereas premeditation predicted depression. Additionally, within-person deviations in both traits were associated with drinking, whereas within-person deviations in premeditation were associated with depression. Sleep duration was protective against outcomes at both levels. However, main effects were qualified by interactions at both levels, such that having below average sleep duration heightened the effects of premeditation at the between-person level, whereas within-person decreases in sleep heightened the effects of sensation seeking at the within-person level. Findings support a theoretical model where poor sleep exacerbates risk conferred from impulsive traits. Risk conferred from impulsive traits diverged based upon level of analysis, suggesting that global and just-in-time interventions may benefit from targeting specific impulsive traits as well as sleep.

Attention-deficit hyperactivity symptoms and risk of alcohol use relapse

AIM

Alcohol use disorder (AUD) is frequently accompanied by comorbid attention-deficit hyperactivity disorder (ADHD). Comorbid ADHD has been reported to increase the severity of AUD. We investigated whether ADHD severity also influences AUD relapse risk at baseline and after inpatient treatment.

METHODS

In this study, 187 AUD patients admitted to Narimasu Kosei Hospital from October 2019 to March 2021 were included in the analysis. According to the Adult ADHD Self-Report Scale (ASRS), participants were divided into two groups: ASRS+ with ADHD characteristics (n = 43) and ASRS- with low/no ADHD characteristics (n = 144). Groups were compared for AUD relapse risk at the start of treatment (baseline) and before hospital discharge using the multidimensional Alcohol Relapse Risk Scale (ARRS). The change in relapse risk during hospitalization was also compared by assessment of the interaction between groups (ASRS+ vs. ASRS-) and time (at discharge vs. baseline).

RESULTS

The total ARRS score and dimension subscores for stimulus-induced vulnerability and emotionality problems were significantly higher in the ASRS+ group at baseline and before discharge compared to the ASRS- group. There was a significant group × time interaction indicating less improvement of stimulus-induced vulnerability during inpatient treatment among the ASRS+ group compared to the ASRS- group.

CONCLUSIONS

Our findings suggest that AUD patients with ADHD characteristics have a higher risk of relapse both at baseline and after inpatient treatment. Stimulus-induced vulnerability to relapse is less likely to improve with treatment in patients with ADHD characteristics.

Everyday Cognitive Control and Emotion Dysregulation in Young Adults With and Without ADHD: An Ecological Momentary Assessment Study

OBJECTIVE

This study examined the contribution of the temporal dynamics of two cognitive control mechanisms-inhibitory control (IC) and working memory (WM)-to emotion dysregulation (ED) in attention-deficit/hyperactivity disorder (ADHD) in ecological settings.

METHOD

One hundred twenty-two participants (age 18-33 years; 60 with ADHD) reported their ED at baseline, followed by a 5-day ecological momentary assessment (EMA) study, with short behavioral IC and WM tasks performed five times/day.

RESULTS

For IC, mean and lability of performance over EMA significantly accounted for differences in ED but not baseline performance. For WM, both baseline and mean of EMA, but not EMA lability, accounted for ED variance. ADHD status further contributed to the explained variance of ED.

CONCLUSIONS

Our results support the contribution of dynamic IC processes to ED in ADHD, in addition to WM performance level, and highlight the importance of dynamic and ecological investigation of different cognitive control components.

Daily impulsivity and alcohol expectancies: A multilevel examination of the acquired preparedness model

BACKGROUND

The acquired preparedness model (APM) integrates personality traits and psychosocial learning to posit amechanism whereby individuals initiate and continue alcohol use. The present study examined within-person associations between impulsivity, alcohol expectancies, alcohol use, and alcohol problems to inform daily process models of drinking and test the APM.

METHODS

Participants were 89 college student drinkers who completed momentary reports (three random and two user-initiated reports) for 14 days. Multilevel mediation analyses examined whether daily associations between impulsivity and alcohol use and problems were mediated by positive and negative expectancies.

RESULTS

Daily impulsivity was positively associated with daily positive expectancies, prior to drinking. Greater daily positive expectancies were associated with more alcohol consumed and alcohol problems that day. The indirect effects were significant, indicating greater than usual impulsivity was associated with greater alcohol use and alcohol problems through greater positive expectancies. Impulsivity was positively associated with negative expectancies at the within-subject and between-subject levels, but negative expectancies did not serve as a mediator between impulsivity and either alcohol outcome.

CONCLUSIONS

This is the first study to test the APM at the day level. Findings supported daily fluctuations in beliefs regarding the positive effects of alcohol as a salient mechanism explaining the link between daily impulsivity and level of alcohol use. Because impulsivity was linked to changes in expectancy states that were proximal to drinking that day, this information may be used to develop prevention and intervention programs to reduce alcohol harms.

The 24-hour rhythm in alcohol craving and individual differences in sleep characteristics and alcohol use frequency

BACKGROUND

Evidence implicates sleep/circadian factors in alcohol use, suggesting the existence of a 24-h rhythm in alcohol craving, which may vary by individual differences in sleep factors and alcohol use frequency. This study sought to (1) replicate prior findings of a 24-h rhythm in alcohol craving, and (2) examine whether individual differences in sleep timing, sleep duration, or alcohol use frequency are related to differences in the timing of the peak of the craving rhythm (i.e., the acrophase) or magnitude of fluctuation of the rhythm (i.e., amplitude). Finally, whether such associations varied by sex or racial identity was explored.

METHODS

Two-hundred fifteen adult drinkers (21 to 35 years of age, 72% male, 66% self-identified as White) completed a baseline assessment of alcohol use frequency and then smartphone reports of alcohol craving intensity six times a day across 10 days. Sleep timing was also recorded each morning of the 10-day period. Multilevel cosinor analysis was used to test the presence of a 24-h rhythm and to estimate acrophase and amplitude.

RESULTS

Multilevel cosinor analysis revealed a 24-h rhythm in alcohol craving. Individual differences in sleep timing or sleep duration did not predict rhythm acrophase or amplitude. However, alcohol use frequency moderated this rhythm wherein individuals who used alcohol more frequently in the 30 days prior to beginning the study had higher mean levels of craving and greater rhythm amplitudes (i.e., greater rhythmic fluctuations). Associations did not vary by sex or racial identity.

CONCLUSIONS

Results show that alcohol craving exhibits a systematic rhythm over the course of the 24 h and that the frequency of alcohol use may be relevant to the shape of this rhythm. Consideration of daily rhythms in alcohol craving may further our understanding of the mechanisms that drive alcohol use.

Daily impulsivity is associated with alcohol use and problems via coping motives, but not enhancement motives

BACKGROUND

The present study sought to determine daily associations between impulsivity, coping and enhancement motives, alcohol use, and alcohol problems in the natural environment.

METHODS

Participants were 89 (47 women) heavy drinking, college students from a university in the southeastern U.S. who completed a 14-day ecological momentary assessment study. Each day, participants completed three random reports of momentary impulsivity and indicators of drinking motives and two additional reports at the beginning and end of any drinking occasions.

RESULTS

A series of multilevel mediation models were tested to examine indirect effects from impulsivity to alcohol use and alcohol problems through coping and enhancement motives. At the within-person level, results revealed that greater than usual impulsivity experienced prior to drinking was associated with greater coping motives, and this in turn was associated with greater number of drinks consumed that day (all p values <0.001). A similar indirect effect was revealed when impulsivity predicted alcohol problems that day through coping motives (p values range: <0.001 to .01). Greater enhancement motives than usual were associated with greater number of drinks consumed and alcohol problems experienced that day (p values range: <0.001 to.001), but associations with impulsivity were nonsignificant.

CONCLUSIONS

Findings supported daily fluctuations in drinking to cope motives as a salient mechanism explaining the link between daily impulsivity and level of alcohol use and alcohol problems. Fluctuations in daily impulsivity were associated with changes in motivations to drink which may benefit efforts aimed at reducing alcohol harms among young adults.

Trajectories of state impulsivity domains before and after alcohol consumption in the naturalistic environment

BACKGROUND AND AIMS

Studies have demonstrated that ecological momentary assessment (EMA) can effectively capture within-person variations in impulsive states and that this relates to alcohol use. The current study aimed to examine the daily trajectories of five facets of impulsivity prior to and following drinking initiation. Additionally, we explored how race, sex, baseline trait impulsivity facets, and ADHD may moderate this relation.

DESIGN AND SETTING

EMA was used to collect real-time data at 6 semi-random time points and self-initiated reports of drinking onset throughout the day over a 10-day period Measurements Five state and trait impulsivity facets were assessed via the UPPS-P. Naturalistic alcohol use, ADHD history, and demographic characteristics were also assessed PARTICIPANTS: Participants were 135 adult drinkers from a larger study examining alcohol response for Black and White adults with and without a history of childhood ADHD FINDINGS: Generalized estimating equations showed that the linear trajectory of negative urgency significantly increased prior to drinking. Following drinking initiation, the linear trajectory of sensation seeking significantly decreased. There was not significant change in the trajectories of positive urgency, lack of premeditation and lack of perseverance before or after drinking initiation. Additionally, race and ADHD history moderated the trajectory of sensation seeking and race moderated the trajectory of lack of planning.

CONCLUSIONS

Findings highlight the possibility of identifying proximal changes in impulsivity facets prior to and after initiation of drinking. Results can be used to inform real-time interventions that target risk periods to ultimately decrease alcohol use.

Cognitive and personality differences between adolescents with and without attention deficit/hyperactivity disorder

BACKGROUND

The relationships between cognitive and personality profile in teenagers with and without ADHD were assessed.

METHOD

Two groups of teenagers, one with ADHD (N = 135; mean age = 13.93) and another group without ADHD (N = 199, mean age = 14.29) were evaluated using the K-BIT and 16PF-APQ tests.

RESULTS

In cognitive variables, the results revealed that the ADHD group returned higher scores in the Matrices subtest and the IQ test. In personality variables, the group with ADHD exhibited higher scores in Tough-Mindedness and lower scores in Self-Control than the group without the disorder. The canonical correlation analysis applied to each group revealed a differing pattern of interrelationships between the cognitive-personality variables in the two groups. In adolescents with ADHD, we observed that higher scores in cognitive variables were associated with a more extroverted personality and less self-control, while in adolescents without ADHD, higher scores in cognitive variables were associated with less tough-mindedness and lower levels of self-control.

CONCLUSIONS

The cognitive and personality variables of adolescents with and without ADHD differ. These results will be useful for establishing a cognitive and personality profile for this section of the population. The educational implications of the study are under discussion.

Alcohol use disorders and ADHD

Despite a growing literature on the complex bidirectional relationship of ADHD and substance use, reviews specifically focusing on alcohol are scarce. ADHD and AUD show a significant genetic overlap, including genes involved in gluatamatergic and catecholaminergic neurotransmission. ADHD drives risky behavior and negative experiences throughout the lifespan that subsequently enhance a genetically increased risk for Alcohol Use Disorders (AUD). Impulsive decisions and a maladaptive reward system make individuals with ADHD vulnerable for alcohol use and up to 43 % develop an AUD; in adults with AUD, ADHD occurs in about 20 %, but is vastly under-recognized and under-treated. Thus, routine screening and treatment procedures need to be implemented in AUD treatment. Long-acting stimulants or non-stimulants can be used to treat ADHD in individuals with AUD. However, it is crucial to combine medical treatment for ADHD with pharmacotherapy and psychotherapy for AUD, and other comorbid disorders. Identification of individuals at risk for AUD, especially those with ADHD and conduct disorder or oppositional defiant disorder, is a key factor to prevent negative outcomes.

Predictors of unplanned drinking in daily life: The influence of context, impulsivity, and craving in those with emotion dysregulation

OBJECTIVE

Unplanned drinking, or drinking that violates intentions, has been linked to significant alcohol-related consequences; however, little is known about what factors within individuals' daily lives predict whether unplanned drinking occurs. This study examines the influence of daily-life impulsivity, alcohol craving, and interpersonal contexts on unplanned drinking.

METHOD

Ecological Momentary Assessment (EMA) data were collected from 32 moderate drinkers. Participants were prompted six times per day for up to 21 days. Each morning participants reported whether they planned to drink that day. Multilevel and GEE models predicted drinking behaviors on days without intent to drink from daily-life interpersonal contexts, and pre-drinking ratings of impulsivity and craving.

RESULTS

Spending time in a bar and spending relatively more time with other people on days with no intention to drink was associated with drinking. Individuals who experienced higher craving prior to drinking were relatively more likely to engage in unplanned drinking. When participants reported relatively greater difficulties with premeditation, they were more likely to subsequently report initiating an unplanned drinking episode. Results also suggest that individuals generally higher on negative urgency may be less likely to engage in unplanned drinking but drink more when they do.

CONCLUSION

These results indicate the influence of daily-life contexts, craving, and impulsivity on unplanned drinking behavior. We highlight several possible avenues for intervention and prevention efforts including modifying social and interpersonal environments, screening for craving patterns, and targeting cognitive deficits in planning.

Using e-diaries to investigate ADHD - State-of-the-art and the promising feature of just-in-time-adaptive interventions

Attention-deficit/hyperactive disorder (ADHD) is characterized by symptoms which are dynamic in nature: states of hyperactivity, inattention and impulsivity as core symptoms, and emotion dysregulation as associated feature. Although tremendous work has been done to investigate between-subject differences (how patients with ADHD differ from healthy controls or patients with other disorders), little is known about the relationship between symptoms with triggers and contexts, that may allow us to better understand their causes and consequences. Understanding the temporal associations between symptoms and environmental triggers in an ecologically valid manner may be the basis to developing just-in-time adaptive interventions. Fortunately, recent years have seen advances in methodology, hardware and innovative statistical approaches to study dynamic processes in daily life. In this narrative review, we provide a description of the methodology (ambulatory assessment), summarize the existing literature in ADHD, and discuss future prospects for these methods, namely mobile sensing to assess contextual information, real-time analyses and just-in-time adaptive interventions.

Impulsive States and Impulsive Traits: A Study of the Multilevel Structure and Validity of a Multifaceted Measure of Impulsive States

Emerging evidence suggests impulsive states may be reliably measured in the moment using ecological momentary assessment (EMA); however, research has not investigated whether the multi-factor structure of impulsive traits also characterizes impulsive states. In two independent samples spanning adolescence through young adulthood (n = 211, n = 222), we adapted global self-report measures of impulsive traits to EMA and conducted multilevel confirmatory factor analyses to characterize the within- and between-person factor structure of five impulsive traits (negative urgency, planning, persistence, sensation seeking, and positive urgency). Across both studies, factor models with one factor for each UPPS-P facet fit the data well at both levels, though some latent factors were highly correlated. Aggregated impulsive states, especially negative urgency, predicted oppositional defiant disorder symptoms, emotional problems, alcohol problems, and attention deficit hyperactivity disorder symptoms. Our results suggest that EMA measures can capture a range of impulsive states that mirrors the heterogeneity seen in the trait literature.

The Digital Marshmallow Test (DMT) Diagnostic and Monitoring Mobile Health App for Impulsive Behavior: Development and Validation Study

Background

The classic Marshmallow Test, where children were offered a choice between one small but immediate reward (eg, one marshmallow) or a larger reward (eg, two marshmallows) if they waited for a period of time, instigated a wealth of research on the relationships among impulsive responding, self-regulation, and clinical and life outcomes. Impulsivity is a hallmark feature of self-regulation failures that lead to poor health decisions and outcomes, making understanding and treating impulsivity one of the most important constructs to tackle in building a culture of health. Despite a large literature base, impulsivity measurement remains difficult due to the multidimensional nature of the construct and limited methods of assessment in daily life. Mobile devices and the rise of mobile health (mHealth) have changed our ability to assess and intervene with individuals remotely, providing an avenue for ambulatory diagnostic testing and interventions. Longitudinal studies with mobile devices can further help to understand impulsive behaviors and variation in state impulsivity in daily life.

Objective

The aim of this study was to develop and validate an impulsivity mHealth diagnostics and monitoring app called Digital Marshmallow Test (DMT) using both the Apple and Android platforms for widespread dissemination to researchers, clinicians, and the general public.

Methods

The DMT app was developed using Apple’s ResearchKit (iOS) and Android’s ResearchStack open source frameworks for developing health research study apps. The DMT app consists of three main modules: self-report, ecological momentary assessment, and active behavioral and cognitive tasks. We conducted a study with a 21-day assessment period (N=116 participants) to validate the novel measures of the DMT app.

Results

We used a semantic differential scale to develop self-report trait and momentary state measures of impulsivity as part of the DMT app. We identified three state factors (inefficient, thrill seeking, and intentional) that correlated highly with established measures of impulsivity. We further leveraged momentary semantic differential questions to examine intraindividual variability, the effect of daily life, and the contextual effect of mood on state impulsivity and daily impulsive behaviors. Our results indicated validation of the self-report sematic differential and related results, and of the mobile behavioral tasks, including the Balloon Analogue Risk Task and Go-No-Go task, with relatively low validity of the mobile Delay Discounting task. We discuss the design implications of these results to mHealth research.

Conclusions

This study demonstrates the potential for assessing different facets of trait and state impulsivity during everyday life and in clinical settings using the DMT mobile app. The DMT app can be further used to enhance our understanding of the individual facets that underlie impulsive behaviors, as well as providing a promising avenue for digital interventions.

Trial Registration

ClinicalTrials.gov NCT03006653; https://www.clinicaltrials.gov/ct2/show/NCT03006653

Momentary patterns of impulsivity and alcohol use: A cause or consequence?

BACKGROUND

Impulsivity is a robust risk factor for alcohol use, but significant gaps remain in our understanding of the way that impulsivity relates to alcohol harms. Most prior research has been limited to between-level differences; thus, within-person variability in impulsivity at the momentary level and its bidirectional association with alcohol use has not been examined. The present research used a 14-day ecological momentary assessment (EMA) design to determine the bidirectionality of impulsivity and alcohol use and alcohol problems.

METHODS

Participants were 89 (47 women) heavy-drinking college students. The mean age was 19.80 (SD = 1.76) years. Participants completed a baseline questionnaire and 14 consecutive days of momentary reports sent in the morning, afternoon, and evening; participants also completed two user-initiated reports during a drinking occasion at the beginning and the end of their drinking.

RESULTS

Multilevel modeling results indicated that greater levels of impulsivity experienced during the day was not associated with alcohol use or problems experienced that night. However, level of alcohol use and the number of alcohol problems experienced predicted greater variability in impulsivity the next day.

CONCLUSIONS

Overall, this study was the first to examine the bidirectional relationship between impulsivity and alcohol use using EMA. Findings supported impulsivity's conceptualization as a state construct and fluctuations in alcohol use behaviors coinciding with states of impulsivity the next day after drinking. Findings from the present study contributed to conceptual daily process models of drinking by identifying how alcohol behaviors unfold in the real world.

Alcohol use in daily life: Examining the role of trait and state impulsivity facets

OBJECTIVES

Using ecological momentary assessment (EMA) methods we aimed to investigate the influence of trait and state (momentary) impulsivity on alcohol use behaviors in daily life. Facets of the UPPS trait model of impulsivity (Whiteside & Lynam, 2001) have been found to differentially relate to alcohol-related outcomes and behaviors in cross-sectional and longitudinal studies. The present work expands on this by assessing UPPS facets in daily life and examining the contributions of trait and state impulsivity facets to daily life drinking behavior.

METHOD

Forty-nine participants were prompted at least 6 times per day for 21 days. A total of 4,548 collected EMA reports were included in analyses. Multilevel models were computed predicting daily life alcohol use behaviors from state and trait impulsivity facets and relevant covariates.

RESULTS

Individual facets of momentary impulsivity differentially related to alcohol outcomes, such that (lack of) premeditation and, to a lesser extent, sensation seeking showed unique patterns of association with drinking and drinking quantity. Only trait levels of (lack of) premeditation were related to drinking behavior in daily life; no other trait UPPS scale significantly related to alcohol use.

CONCLUSIONS

These results highlight state difficulties with premeditation as particularly relevant to drinking behavior in daily life. Our results also support the incremental validity of state impulsivity facets over trait level measures in relation to drinking behavior in daily life. These findings offer important insight into the phenomenology of daily life alcohol use and highlight possible avenues for intervention and prevention efforts. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Translational approach to understanding momentary factors associated with alcohol consumption

Multiple interindividual and intra-individual factors underlie variability in drinking motives, challenging clinical translatability of animal research and limiting treatment success of substance use-related problems. Intra-individual variability refers to time-dependent continuous and discrete changes within the individual and in substance use research is studied as momentary variation in the internal states (craving, stressed, anxious, impulsive and tired) and response to external triggers (stressors, drug-associated environmental cues and social encounters). These momentary stimuli have a direct impact on behavioural decisions and may be triggers and predictors of substance consumption. They also present potential targets for real-time behavioural and pharmacological interventions. In this review, we provide an overview of the studies demonstrating different momentary risk factors associated with increased probability of alcohol drinking in humans and changes in alcohol seeking and consumption in animals. The review also provides an overview of pharmacological interventions related to every individual risk factor.