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Wardle MC, Webber HE, Yoon JH, Heads AM, Stotts AL, Lane SD, Schmitz JM. Behavioral therapies targeting reward mechanisms in substance use disorders. Pharmacol Biochem Behav 2024; 240:173787. [PMID: 38705285 DOI: 10.1016/j.pbb.2024.173787] [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: 01/17/2024] [Revised: 04/04/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
Behavioral therapies are considered best practices in the treatment of substance use disorders (SUD) and used as first-line approaches for SUDs without FDA-approved pharmacotherapies. Decades of research on the neuroscience of drug reward and addiction have informed the development of current leading behavioral therapies that, while differing in focus and technique, have in common the overarching goal of shifting reward responding away from drug and toward natural non-drug rewards. This review begins by describing key neurobiological processes of reward in addiction, followed by a description of how various behavioral therapies address specific reward processes. Based on this review, a conceptual 'map' is crafted to pinpoint gaps and areas of overlap, serving as a guide for selecting and integrating behavioral therapies.
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Affiliation(s)
- Margaret C Wardle
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Heather E Webber
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Jin H Yoon
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Angela M Heads
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Angela L Stotts
- Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, United States of America
| | - Scott D Lane
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Joy M Schmitz
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America.
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Krentzman AR, Hoeppner SS, Hoeppner BB, Barnett NP. A randomized feasibility study of a positive psychology journaling intervention to support recovery from substance-use disorders. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209410. [PMID: 38802048 DOI: 10.1016/j.josat.2024.209410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/02/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Individuals in early recovery face significant biopsychosocial stressors causing a preponderance of negative affect. Novel interventions are needed to improve mood and well-being to support recovery. Positive Recovery Journaling (PRJ) combines elements of positive psychology, behavioral activation, and journaling to emphasize what is going right and to encourage small, positive steps that align with an individual's values to make life in recovery more rewarding and therefore more reinforcing. Our objective was to determine PRJ's feasibility, acceptability, and impact on a set of strengths-based, multidimensional aspects of recovery, including satisfaction with life, happiness with recovery, and commitment to sobriety. METHODS The study randomized adults in substance-use disorder treatment (N = 81) to PRJ or control. Those in PRJ were asked to practice PRJ daily and complete online surveys for four weeks; those in the control group completed online surveys for four weeks. We used multi-level modelling to determine intercept and slope for feasibility and acceptability outcomes as well as to compare differences in recovery indicators between treatment and control at baseline and Weeks 2, 4, and 8. We conducted intention-to-treat and per-protocol analyses for each recovery indicator. RESULTS Participants were 53 % female, and 26 % Black, Indigenous, People of Color (BIPOC) and mean age of 39 years. PRJ participants attended 71 % of groups and completed 56 % of the daily PRJ entries. Treatment and control groups rated their study tasks (PRJ for the treatment group, surveys for the control group) as equally easy; however, the PRJ group rated PRJ as significantly more satisfying, helpful, and pleasant. Treatment and control were not significantly different on any recovery indicator. In post hoc analyses, we found that for those with <90 days sobriety at baseline (51 %), PRJ had a statistically significant beneficial effect for satisfaction with life, happiness with recovery, and numerous secondary recovery indicators. DISCUSSION Results suggest a positive impact of PRJ on numerous recovery indices for those in earliest recovery. Integrating PRJ into support services among those with <90 days sobriety could reinforce what is going well in recovery to encourage its continued maintenance and thereby improve treatment outcomes.
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Affiliation(s)
- Amy R Krentzman
- School of Social Work, University of Minnesota, United States.
| | - Susanne S Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States
| | - Nancy P Barnett
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, United States
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Fazzino TL, Kunkel A, Bellitti J, Romine RS, Yi R, McDaniel C, Lejuez CW. Engagement with Activity Monitoring During a Behavioral Activation Intervention: A Randomized Test of Monitoring Format and Qualitative Evaluation of Participant Experiences. BEHAVIOUR CHANGE 2023; 40:103-116. [PMID: 37583941 PMCID: PMC10424774 DOI: 10.1017/bec.2022.7] [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: 11/07/2022]
Abstract
Behavioural activation (BA) is an efficacious treatment approach. Activity monitoring is a key component of brief BA treatments; however, no studies have examined the most efficacious format for monitoring. The present pilot study tested brief versus intensive activity monitoring approaches during a BA intervention administered in a college orientation course. Outcomes characterised (1) engagement with the treatment protocol via activity monitoring and (2) participant qualitative experiences with monitoring and the intervention as reported during focus group interviews. Four course sections were randomly assigned to receive monitoring forms that were brief (assessed activities three times daily) or intensive (assessed activities hourly). Forms were provided electronically to students via a web-based platform which tracked completion. There were no significant differences in monitoring frequency (38.0 vs. 23.0 days; p = .154) or the duration of monitoring engagement (62.0 vs. 36.0 days; p = .054) between the brief and intensive conditions. Qualitative findings suggested that participants in both conditions found utility in activity monitoring, particularly during the first month as they transitioned to college. Overall, findings indicated that participants may find utility in monitoring during the first month of a BA intervention using either brief or intensive monitoring forms.
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Affiliation(s)
- Tera L. Fazzino
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, Kansas, USA
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Adrianne Kunkel
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, Kansas, USA
- Department of Communication Studies, University of Kansas, Lawrence, Kansas, USA
| | - Joseph Bellitti
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, Kansas, USA
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | | | - Richard Yi
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, Kansas, USA
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Courtney McDaniel
- Department of Communication Studies, University of Kansas, Lawrence, Kansas, USA
| | - Carl W. Lejuez
- Office of the Provost and Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
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Peter SC, Murphy JG, Witkiewitz K, Hand SB, Thomas F, Johnson KC, Cowan R, Harris M, Derefinko KJ. Use of a sequential multiple assignment randomized trial to test contingency management and an integrated behavioral economic and mindfulness intervention for buprenorphine-naloxone medication adherence for opioid use disorder. Trials 2023; 24:237. [PMID: 36991453 DOI: 10.1186/s13063-023-07102-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/18/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Buprenorphine-naloxone is a medication shown to improve outcomes for individuals seeking treatment for opioid use disorder (OUD); however, outcomes are limited by low medication adherence rates. This is especially true during the early stages of treatment. METHODS The present study proposes to utilize a sequential multiple assignment randomized trial design to compare two psychological interventions targeting buprenorphine-naloxone adherence: (1) contingency management (CM) and (2) brief motivational interviewing plus substance-free activities session plus mindfulness (BSM). Participants will be N = 280 adults who present to a university-based addictions clinic seeking treatment for OUD. Participants will be randomized to condition to receive 4 sessions of their assigned intervention (CM or BSM). Participants who are adherent, defined as attending physician appointments and having buprenorphine present in urine toxicology, will enter maintenance intervention for an additional 6 months. Those who are not adherent will be re-randomized to receive either the other intervention or both interventions. Follow-up will occur at 8 months post-randomization. CONCLUSIONS This novel design will examine the benefit of sequential treatment decisions following non-adherence. The primary outcome of this study is buprenorphine-naloxone medication adherence, as assessed by physician visit attendance and presence of buprenorphine in urine. Results will elicit the relative efficacy of CM and BSM compared to one another and whether keeping the initial treatment approach when adding the alternative approach for initially non-adherent individuals is beneficial. TRIAL REGISTRATION ClinicalTrials.gov NCT04080180.
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Affiliation(s)
- Samuel C Peter
- Department of Psychology, Durham VA Medical Center, 508 Fulton Street, Durham, NC, 27705, USA
| | - James G Murphy
- Department of Psychology, The University of Memphis, 400 Innovation Drive, Memphis, TN, 38152-6400, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Logan Hall, Albuquerque, NM, 87131-0001, USA
| | - Sarah B Hand
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline St, Memphis, TN, 38163, USA
| | - Fridtjof Thomas
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline St, Memphis, TN, 38163, USA
| | - Karen Chandler Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline St, Memphis, TN, 38163, USA
| | - Ronald Cowan
- Department of Psychiatry, University of Tennessee Health Science Center, 920 Madison Avenue, Memphis, TN, 38163, USA
| | - Matt Harris
- Boyd Center for Business and Economic Research, University of Tennessee, 1000 Volunteer Boulevard, Knoxville, TN, 37996, USA
| | - Karen J Derefinko
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline St, Memphis, TN, 38163, USA.
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Jun D, Fazzino TL. Associations between Alcohol-Free Sources of Reinforcement and the Frequency of Alcohol and Cannabis Co-Use among College Freshmen. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2884. [PMID: 36833579 PMCID: PMC9957030 DOI: 10.3390/ijerph20042884] [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: 01/10/2023] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
Co-use of alcohol and cannabis is common among young adults in the United States. A behavioral economics framework indicates that greater engagement in substance-free sources of reinforcement may be protective against co-use frequency. The current study tested the association between proportionate alcohol-free reinforcement and the frequency of co-use among college freshmen. Participants (N = 86) were freshmen who enrolled in a freshman orientation course and completed surveys at the beginning of the semester. Past month alcohol use, cannabis use, and reinforcement from alcohol-free and alcohol-involved activities were assessed. A zero-inflated Poisson regression was used to test the association between proportionate alcohol-free reinforcement and days of co-use. The results indicated that proportionate alcohol-free reinforcement was negatively associated with co-use days in the count model when controlling for alcohol use days and gender as covariates (β: -3.28, p = 0.016). Proportionate alcohol-free reinforcement did not significantly differentiate individuals who did not engage in co-use in the zero-inflated model (β: -1.68, p = 0.497). The study suggested that greater proportionate alcohol-free reinforcement may be associated with lower engagement in the co-use of alcohol and cannabis among young adults. Increasing engagement in alcohol-free sources of reinforcement may be considered a target for co-use prevention or harm reduction efforts.
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Affiliation(s)
- Daiil Jun
- Department of Psychology, University of Kansas, Lawrence, KS 66045, USA
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS 66045, USA
| | - Tera L. Fazzino
- Department of Psychology, University of Kansas, Lawrence, KS 66045, USA
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS 66045, USA
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Paquette CE, Reese ED, Yi JY, Maccarone JM, Stewart ZJ, Daughters SB. Group behavioral activation with and without a smartphone app in intensive outpatient treatment for substance use disorder: A three-arm randomized controlled trial. Drug Alcohol Depend 2023; 243:109758. [PMID: 36634574 PMCID: PMC10026710 DOI: 10.1016/j.drugalcdep.2022.109758] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Reward deficits negatively impact recovery from substance use disorder (SUD). LETS ACT, a behavioral activation treatment targeting substance-free reward, has demonstrated effectiveness in reducing post treatment substance use. There remains room for modifications to extend recovery gains, and LETS ACT remains largely untested in outpatient treatment. We tested the effect of LETS ACT when delivered alongside intensive outpatient SUD treatment, with and without a smartphone app designed to extend access to treatment content outside of clinician-administered sessions. METHODS In this three-arm randomized controlled trial (N = 206; 54 % White, 67 % male), all participants received intensive outpatient SUD treatment as usual (TAU) and either LETS ACT (n = 56), smartphone-enhanced LETS ACT (n = 65), or assessments only (n = 61). Substance use days and substance related problems were assessed through 12 months posttreatment. RESULTS Generalized estimating equations indicated a significant condition*time interaction for substance use days; Days of substance use significantly declined from pretreatment until 1-month for TAU, 3-months for LETS ACT-SE, and 6-months for LETS ACT. Decreases in substance-related problems were maintained across all conditions through 12 months. CONCLUSIONS Adding LETS ACT to intensive outpatient treatment resulted in significant decreases in substance use through 6 months posttreatment, yet these gains were not sustained through 12 months posttreatment. A smartphone app did not facilitate superior treatment outcomes. Future studies should consider factors impacting treatment efficacy in outpatient settings and the utility of providing more than six sessions of behavioral activation.
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Affiliation(s)
- Catherine E Paquette
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States.
| | - Elizabeth D Reese
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Jennifer Y Yi
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Julianna M Maccarone
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Zachary J Stewart
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
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Vuchinich RE, Tucker JA, Acuff SF, Reed DD, Buscemi J, Murphy JG. Matching, behavioral economics, and teleological behaviorism: Final cause analysis of substance use and health behavior. J Exp Anal Behav 2023; 119:240-258. [PMID: 36541360 DOI: 10.1002/jeab.815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
Howard Rachlin and his contemporaries pioneered basic behavioral science innovations that have been usefully applied to advance understanding of human substance use disorder and related health behaviors. We briefly summarize the innovations of molar behaviorism (the matching law), behavioral economics, and teleological behaviorism. Behavioral economics and teleological behaviorism's focus on final causes are especially illuminating for these applied fields. Translational and applied research are summarized for laboratory studies of temporal discounting and economic demand, cohort studies of alcohol and other drug use in the natural environment, and experimental behavioral economic modeling of health behavior-related public health policies. We argue that the teleological behavioral perspective on health behavior is conducive to and merges seamlessly with the contemporary socioecological model of health behavior, which broadens the contextual influences (e.g., community, economic, infrastructure, health care access and policy) of individuals' substance use and other health risk behaviors. Basic-to-applied translations to date have been successful and bode well for continued applications of basic science areas pioneered by Howard Rachlin and his contemporaries.
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Affiliation(s)
| | - Jalie A Tucker
- University of Florida and Center for Behavioral Economic Health Research, Gainesville, FL
| | | | - Derek D Reed
- University of Kansas and Cofrin Logan Center for Addiction Research and Treatment, Lawrence, KS
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Weinsztok SC, Reed DD, Amlung M. Identifying Substitute Activities for Alcohol Consumption: A Preliminary Analysis. ADDICTION RESEARCH & THEORY 2022; 31:209-219. [PMID: 37303833 PMCID: PMC10254569 DOI: 10.1080/16066359.2022.2135704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 06/13/2023]
Abstract
Individuals with alcohol use disorder may excessively value alcohol reinforcement over other types of rewards and may seek out environments supportive of alcohol consumption despite negative consequences. Therefore, examining ways to increase engagement in substance-free activities may be useful in treating alcohol use disorder. Past research has focused on preference and frequency of engagement in alcohol-related versus alcohol-free activities. However, no study to-date has examine the incompatibility of such activities with alcohol consumption, an important step in preventing possible adverse consequences during treatment for alcohol use disorder and for ensuring that activities do not function in a complementary fashion with alcohol consumption. The present study was a preliminary analysis comparing a modified activity reinforcement survey with the inclusion of a suitability question to determine the incompatibility of common survey activities with alcohol consumption. Participants recruited from Amazon's Mechanical Turk (N=146) were administered an established activity reinforcement survey, questions regarding the incompatibility of the activities with alcohol consumption, and measures of alcohol-related problems. We found that activity surveys may identify activities that are enjoyable without alcohol, but that some of these activities were still compatible with alcohol. For many of the activities examined, participants who rated those activities as suitable with alcohol also reported higher alcohol severity, with the largest effect size differences for physical activity, school or work, and religious activities. The results of this study are an important preliminary analysis for determining how activities may function as substitutes, and may hold implications for harm reduction interventions and public policy.
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Luciano MT, McDevitt-Murphy ME, Murphy JG, Zakarian RJ, Olin CC. Open trial of a personalized feedback intervention and substance-free activity supplement for veterans with PTSD and hazardous drinking. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2022; 32:136-144. [PMID: 35872748 PMCID: PMC9307063 DOI: 10.1016/j.jbct.2022.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study reports findings from an open trial of a two-session intervention for veterans with symptoms of PTSD and hazardous drinking. Rooted in behavioral economic theory, this intervention aimed to decrease alcohol use and increase alcohol-free activities through personalized and normative feedback. This trial assessed the feasibility and acceptability of the intervention in a sample of 15 veterans. Participants completed assessments at baseline and post-intervention (1-month and 3-months). Thirteen participants (86.6%) were retained between the baseline assessment and second intervention session. Acceptability data indicated that veterans overwhelmingly viewed the intervention positively with little dropout between the two sessions. Further, participants in our study reduced alcohol consumption from 37.30 (SD = 17.30) drinks per week at baseline to 22.50 (SD = 27.75) drinks per week at the 1-month assessment and then to 14.60 (SD = 18.64) at the 3-months assessment, representing medium to large effects. PTSD severity also decreased from 57.20 (SD = 16.72) at baseline to 48.90 (SD = 18.99) at the 1-month assessment, representing a small effect. Though effect sizes from pilot trials should be interpreted with caution, findings suggest that this intervention was well-received, feasible to deliver, and may have resulted in improvements in intervention targets.
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Affiliation(s)
- Matthew T. Luciano
- The University of Memphis, Memphis, TN 38152, United States
- San Diego State University, San Diego, CA 92104, United States
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Giusto A, Mootz JJ, Korir M, Jaguga F, Mellins CA, Wainberg ML, Puffer ES. “When my children see their father is sober, they are happy”: A qualitative exploration of family system impacts following men's engagement in an alcohol misuse intervention in peri-urban Kenya. SSM - MENTAL HEALTH 2021; 1. [PMID: 35647569 PMCID: PMC9137329 DOI: 10.1016/j.ssmmh.2021.100019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ali Giusto
- New York State Psychiatric Institute, Columbia University, Department of Psychiatry, New York, NY, 10032, USA
- Corresponding author. Columbia University Medical Center/New York State Psychiatric Institute, 40 Haven Ave, #171, New York, NY, 10032. (A. Giusto)
| | - Jennifer J. Mootz
- New York State Psychiatric Institute, Columbia University, Department of Psychiatry, New York, NY, 10032, USA
| | - Mercy Korir
- Moi University Teaching and Referral Hospital, Eldoret, Kenya
| | - Florence Jaguga
- Moi Teaching and Referral Hospital, P.O. Box 3-30100, Eldoret, Kenya
| | - Claude Ann Mellins
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health and Columbia University Medical Center, New York, NY, USA
| | - Milton L. Wainberg
- New York State Psychiatric Institute, Columbia University, Department of Psychiatry, New York, NY, 10032, USA
| | - Eve S. Puffer
- Department of Neuroscience and Psychology, Duke University. Duke Global Health Institute, Durham, NC, USA
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Murphy JG, Campbell KW, Joyner KJ, Dennhardt AA, Martens MP, Borsari B. Trajectories of reward availability moderate the impact of brief alcohol interventions on alcohol severity in heavy-drinking young adults. Alcohol Clin Exp Res 2021; 45:2147-2159. [PMID: 34342015 DOI: 10.1111/acer.14681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/18/2021] [Accepted: 07/21/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Behavioral economic theory predicts that low access to environmental reward is a risk factor for alcohol use disorder (AUD). The Substance-Free Activity Session (SFAS) is a behavioral economic supplement to standard brief alcohol interventions that attempts to increase environmental reward and may therefore have beneficial effects, particularly for individuals with low levels of environmental reward. METHODS Participants were 393 college students who reported at least 2 heavy-drinking episodes in the past month. Participants were randomly assigned to 1 of 3 conditions following a baseline assessment: a standard alcohol-focused brief motivational intervention plus relaxation training session (BMI + RT), BMI plus Substance-Free Activity Session (BMI + SFAS), or an assessment-only control condition (AO). In a secondary analysis of the data from this study, we used person-centered statistical techniques to describe trajectories of alcohol severity and environmental reward over a 16-month follow-up and examined whether environmental reward levels moderated the effectiveness of the interventions. RESULTS Piecewise growth mixture modeling identified 2 trajectories of reward availability: low increasing (LR; n = 120) and high stable (HR; n = 273). Depressive symptoms, cannabis use, sensation seeking, and low life satisfaction were associated with a greater probability of classification in the LR trajectory. Alcohol severity was greater in the LR trajectory than the HR trajectory. For students in the LR trajectory, at 1, 6, and 12 months, BMI + SFAS led to greater increases in reward availability and reduced levels of alcohol severity compared with the BMI + RT and AO conditions and at 16 months compared with AO. CONCLUSIONS Young adults with low levels of environmental reward are at heightened risk for greater alcohol severity and may show greater benefit from brief alcohol interventions that focus on increasing substance-free reward than individuals who are not deficient in reward availability.
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Affiliation(s)
- James G Murphy
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Kevin W Campbell
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Keanan J Joyner
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Ashley A Dennhardt
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Matthew P Martens
- Department of Educational, School, and Counseling Psychology, University of Missouri, Columbia, Missouri, USA
| | - Brian Borsari
- Mental Health Service (116B, San Francisco VA Health Care System, San Francisco, California, USA.,Department of Psychiatry, University of California, San Francisco, California, USA
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Voss AT, Floyd RG, Campbell KW, Dennhardt AA, MacKillop J, Murphy JG. Psychometric evaluation of the Reward Probability Index in emerging adult drinkers. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:432-443. [PMID: 33764088 PMCID: PMC8184582 DOI: 10.1037/adb0000712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Diminished access to environmental rewards is an established risk factor for addiction and a focus of many effective treatment approaches. Nevertheless, there is inconsistency in measurement approaches and a need for a psychometrically sound measure. The Reward Probability Index (RPI; Carvalho, Behavior Therapy, 42, 2011, pp. 249-262) is a 20-item self-report rating scale that measures access to and ability to experience psychosocial reward. METHOD The current studies sought to evaluate the psychometric properties of the RPI in 2 samples of emerging adult heavy drinkers. RESULTS In Study 1, exploratory factor analysis in a sample of 393 college student drinkers supported a 2-factor model of the RPI (Reward Probability and Environmental Suppressors) after removal of redundant items, and corresponding subscales demonstrated good internal consistency. In Study 2, confirmatory factor analysis with 602 emerging adult drinkers recruited from the community supported the 2-factor model as best fitting after removal of one poor indicator, although absolute fit was only adequate. This 2-factor model demonstrated configural, metric, and scalar invariance across non-college and college subgroups as well as Black and White subgroups. Study 2 also demonstrated that the revised RPI subscales showed significant associations with measures of substance-free activity participation and enjoyment, anhedonia, and depressive symptoms. Furthermore, the study revealed the RPI Environmental Suppressors subscale predicted alcohol-related problems (β = .25, p < .001) beyond demographic covariates, weekly drinking, and depressive symptoms. CONCLUSIONS These studies provide evidence for the validity of the RPI as an efficient measure of access to reward among emerging adult heavy drinkers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Andrew T. Voss
- University of Memphis, Department of Psychology, 400 Innovation Dr., Memphis, TN 38152, USA
| | - Randy G. Floyd
- University of Memphis, Department of Psychology, 400 Innovation Dr., Memphis, TN 38152, USA
| | - Kevin W. Campbell
- University of Memphis, Department of Psychology, 400 Innovation Dr., Memphis, TN 38152, USA
| | - Ashley A. Dennhardt
- University of Memphis, Department of Psychology, 400 Innovation Dr., Memphis, TN 38152, USA
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph’s Healthcare Hamilton, Hamilton, Canada
| | - James G. Murphy
- University of Memphis, Department of Psychology, 400 Innovation Dr., Memphis, TN 38152, USA
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Buscemi J, Acuff SF, Minhas M, MacKillop J, Murphy JG. Identifying Patterns of Alcohol Use and Obesity-Related Factors Among Emerging Adults: A Behavioral Economic Analysis. Alcohol Clin Exp Res 2021; 45:828-840. [PMID: 33724488 PMCID: PMC8076087 DOI: 10.1111/acer.14569] [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: 07/24/2020] [Accepted: 01/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although heavy alcohol consumption and maladaptive eating behaviors have been shown to co-occur among college students, less is known about the co-occurrence of these behaviors in a more diverse community-dwelling, emerging adult sample. The purpose of this study was to: (i) identify classes of emerging adults by their reported alcohol consumption patterns, food addiction symptoms, and body mass index; and (ii) determine whether these classes differed on indices of behavioral economic reinforcer pathology (e.g., environmental reward deprivation, impulsivity, alcohol demand). METHOD Emerging adult participants were recruited as part of a study on risky alcohol use (n = 602; 47% white, 41.5% Black; mean age = 22.63, SD = 1.03). Participants completed questionnaires on alcohol and food-related risk factors and underwent anthropometric assessment. RESULTS Latent profile analysis suggested a four-profile solution: a moderate alcohol severity, overweight profile (Profile 1; n = 424, 70.4%), a moderate alcohol severity, moderate food addiction + obese profile (Profile 2; n = 93, 15.4%), a high alcohol severity, high food addiction + obese profile (Profile 3; n = 44, 7.3%), and a high alcohol severity, overweight profile (Profile 4; n = 41, 6.8%). Individuals in Profile 1 reported significantly lower levels of environmental reward deprivation than either Profile 2 or 3, and participants in Profile 3 reported significantly higher environmental reward deprivation than those in Profile 4 (p < 0.001). Profile 4 demonstrated significantly higher alcohol demand intensity and Omax and lower demand elasticity than Profile 1, Profile 2, or Profile 3. Profile 4 also demonstrated significantly greater proportionate substance-related reinforcement than Profile 1 (p < 0.001) and Profile 2 (p = 0.004). CONCLUSION Maladaptive eating patterns and alcohol consumption may share common risk factors for reinforcer pathology including environmental reward deprivation, impulsivity, and elevated alcohol demand.
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Affiliation(s)
| | | | - Meenu Minhas
- Peter Boris Centre for Addictions Research, Department of Psychiatry and Behavioural Neurosciences, McMaster University/St Joseph’s Healthcare Hamilton
| | - James MacKillop
- Peter Boris Centre for Addictions Research, Department of Psychiatry and Behavioural Neurosciences, McMaster University/St Joseph’s Healthcare Hamilton
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Success Rates of Monitoring for Healthcare Professionals with a Substance Use Disorder: A Meta-Analysis. J Clin Med 2021; 10:jcm10020264. [PMID: 33450803 PMCID: PMC7828295 DOI: 10.3390/jcm10020264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 11/17/2022] Open
Abstract
In the past decades, monitoring programs have been developed for healthcare professionals with substance use disorders. We aimed to explore estimates of abstinence and work retention rates after participation in such monitoring programs. A literature search was performed using PubMed, Embase, PsycINFO, and CINAHL. Twenty-nine observational studies reporting on success rates (abstinence and work retention) of monitoring for healthcare professionals with a substance use disorder were included in the meta-analysis. Quality-effects models calculated pooled success rates and corresponding 95%-Confidence Intervals (CI), with subgroup analyses on monitoring elements and patient characteristics. Pooled success rates were 72% for abstinence (95%-CI = 63–80%) and 77% for work retention (95%-CI = 61–90%). Heterogeneity across studies was partly explained by the starting moment of monitoring, showing higher abstinence rates for studies that started monitoring after treatment completion (79%; 95%-CI = 72–85%) compared to studies that started monitoring with treatment initiation (61%; 95%-CI = 50–72%). About three-quarters of healthcare professionals with substance use disorders participating in monitoring programs are abstinent during follow-up and working at the end of the follow-up period. Due to selection and publication bias, no firm conclusions can be drawn about the effectiveness of monitoring for healthcare professionals with SUD.
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15
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Hogarth L, Field M. Relative expected value of drugs versus competing rewards underpins vulnerability to and recovery from addiction. Behav Brain Res 2020; 394:112815. [PMID: 32707138 PMCID: PMC7495042 DOI: 10.1016/j.bbr.2020.112815] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/13/2022]
Abstract
Behavioural economic theories of addiction contend that greater expected value of drug relative to alternative non-drug rewards is the core mechanism underpinning vulnerability to and recovery from addiction. To evaluate this claim, we exhaustively review studies with human drug users that have measured concurrent choice between drugs vs. alternative rewards, and explored individual differences. These studies show that drug choice can be modulated by drug cues, drug devaluation, imposition of costs/punishment and negative mood induction. Regarding individual differences, dependence severity was reliably associated with overall drug preference, and self-reported drug use to cope with negative affect was reliably associated with greater sensitivity to mood induced increases in drug choice. By contrast, there were no reliable individual differences in sensitivity to the effect of drug cues, drug devaluation or punishment on drug choice. These findings provide insight into the mechanisms that underpin vulnerability to dependence: vulnerability is conferred by greater relative value ascribed to drugs, and relative drug value is further augmented by negative affective states in those who report drug use coping motives. However, dependence does not appear to be characterised by abnormal cue-reactivity, habit learning or compulsion. We then briefly review emerging literature which demonstrates that therapeutic interventions and recovery from addiction might be attributed to changes in the expected relative value of drug versus alternative rewards. Finally, we outline a speculative computational account of the distortions in decision-making that precede action selection in addiction, and we explain how this account provides a blueprint for future research on the determinants of drug choice, and mechanisms of treatment and recovery from addiction. We conclude that a unified economic decision-making account of addiction has great promise in reconciling diverse addiction theories, and neuropsychological evaluation of the underlying decision mechanisms is a fruitful area for future research and treatment.
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Affiliation(s)
- Lee Hogarth
- Lee Hogarth, School of Psychology, University of Exeter, Washington Singer Building, Perry Road, Exeter EX4 4QG, UK.
| | - Matt Field
- Department of Psychology, University of Sheffield
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16
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Fazzino TL, Lejuez CW, Yi R. A behavioral activation intervention administered in a 16-week freshman orientation course: Study protocol. Contemp Clin Trials 2020; 90:105950. [PMID: 31982647 PMCID: PMC7279510 DOI: 10.1016/j.cct.2020.105950] [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: 10/21/2019] [Revised: 01/13/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The transition from high school to college is a developmentally sensitive period that is high-risk for the escalation of alcohol use. Although risky drinking is a common problem among freshmen, engagement in treatment services is very low. College alcohol interventions target drinking directly at a time when students may be uninterested in changing their drinking. Approaches that indirectly target drinking may be particularly effective. Behavioral activation (BA) is an intervention that indirectly addresses mental health conditions by guiding individuals to engage in reinforcing activities that align with their values (Lejuez et al., 2001). A pilot study of a BA intervention administered in a semester-long freshman orientation course reported a significant decrease in drinking-related problems compared to students in standard orientation course (Reynolds et al., 2011). METHODS The cluster-randomized trial will test the efficacy of BA administered in a semester-long (16 week) freshman orientation course, compared to a standard orientation course in 540 freshmen spread over 36 course sections (18 sections each). A 5-month post-treatment assessment will measure durability of effects. DISCUSSION The study will test a promising BA intervention that addresses factors limiting participation in other programs by targeting alcohol use indirectly and by integrating an intervention into college curriculum. This study represents a first step toward developing an intervention course that could be widely disseminated to address the persistent college drinking problem and its consequences. CLINICAL TRIALS REGISTRATION NUMBER NCT04038190.
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Affiliation(s)
- Tera L Fazzino
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, United States of America; Department of Psychology, University of Kansas, United States of America.
| | - Carl W Lejuez
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, United States of America; Department of Psychology, University of Kansas, United States of America
| | - Richard Yi
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, United States of America; Department of Psychology, University of Kansas, United States of America
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