Anhedonia and relapse in alcoholism

Operant novelty seeking predicts cue-induced reinstatement following cocaine but not water reinforcement in male rats

RATIONALE

An important facet of cocaine addiction is a high propensity to relapse, with increasing research investigating factors that predispose individuals toward uncontrolled drug use and relapse. A personality trait linked to drug addiction is high sensation seeking, i.e., a preference for novel sensations/experiences. In an animal model of sensation seeking, operant novelty seeking predicts the acquisition of drug self-administration.

OBJECTIVE

The primary goal of this research was to evaluate the hypothesis that sensitivity to the reinforcing effects of novel sensory stimuli predicts more intensive aspects of drug-taking behaviors, such as relapse.

METHODS

Rats were first tested for Operant Novelty Seeking, during which responses resulted in complex visual/auditory stimuli. Next, rats were trained to respond to water/cocaine reinforcers signaled by a cue light. Finally, rats were exposed to extinction in the absence of discrete cues and subsequently tested in a single session of cue-induced reinstatement, during which active responses resulted in cues previously paired with water/cocaine delivery.

RESULTS

The present study showed operant responses to produce novel sensory stimuli positively correlate with responding for cocaine during self-administration and during discrete cue-induced reinstatement, but no association with performance during extinction. A different pattern of associations was observed for a natural reward, in this case, water reinforcement. Here, the degree of novelty seeking also correlated with responding to water reinforcement and extinction responding; however, operant novelty seeking did not correlate with responding to water cues during testing of cue-induced reinstatement. Taken together, the incongruence of relationships indicates an underlying difference between natural and drug reinforcers.

CONCLUSION

In summary, we found a reinforcer-dependent relationship between operant novelty seeking (i.e., sensation seeking) and responsivity to extinction and discrete cues signaling availability for cocaine (i.e., craving), demonstrating the validity of the operant novelty seeking model to investigate drug seeking and relapse.

Anhedonia and impulsivity in college alcohol use: A path analysis

OBJECTIVE

Alcohol use is a substantial problem among college students and has several negative consequences. The current study examined the associations between anhedonia and alcohol use and related problems via impulsive behavior (e.g., negative urgency, sensation seeking). We parsed anhedonia into four specific facets: consummatory, anticipatory, recreational, and social anhedonia.

PARTICIPANTS

Six hundred and forty college students aged 18-25 were included in the final analysis.

METHOD

Data were collected via Amazon Mechanical Turk. Self-report inventories assessing for anhedonia, alcohol use, impulsive behavior, and depressed mood were utilized.

RESULTS

Recreational consummatory anhedonia was negatively associated with alcohol use and alcohol-related problems through negative urgency. Recreational consummatory anhedonia also had significant negative associations with alcohol consumption via sensation seeking. Further, social anticipatory anhedonia was positively associated with alcohol use and related problems via negative urgency.

CONCLUSIONS

This study highlights important associations between anhedonia, impulsivity, and alcohol use and related problems.

Link Between Anhedonia and Depression During Early Alcohol Abstinence: Gender Matters

AIMS

The aim of the present study was to evaluate the relation between anhedonia and depression in alcohol use disorders (AUD) during detoxification: Is trait anhedonia measured at the beginning of detoxification predictive of depressive symptoms observed at the end? Does state anhedonia recover during detoxification as depression does? Gender differences that have been previously observed for depression in AUD were also explored.

METHODS

81 AUD inpatients were tested at T1 (day 1) and T2 (day 14-18) of withdrawal with the trait Physical Anhedonia Scale, the state anhedonia Snaith-Hamilton Pleasure Scale, the Beck depression inventory and the Spielberger State Anxiety Inventory and compared to 34 control participants, matched for age and gender.

RESULTS

AUD patients scored significantly higher than controls on depression, anxiety and state and trait anhedonia when they just entered the detoxification unit. Depression, anxiety and state anhedonia decreased between T1 and T2 in AUD patients. In women, state anhedonia at T1 was predictive of depressive symptoms at T2 over and above anxiety and depression at T1.

CONCLUSION

In AUD, state anhedonia recovers during detoxification, concurrently to other affective-related symptoms. However, in women, trait anhedonia predicts the level of depression at the end of detoxification, above and beyond anxiety. This finding stresses the importance of addressing anhedonia in the treatment of AUD and emphasizes the need for targeted interventions within clinical settings in this gender. Clinical consequences are discussed.

Depressive symptom domains and alcohol use severity among Hispanic emerging adults: Examining moderating effects of gender

OBJECTIVE

A limited amount of research has examined the effects of unique depressive symptom domains on alcohol use behavior among Hispanics of any developmental stage. This study aimed to (a) examine the respective associations between depressive symptom domains (e.g., negative affect, anhedonia, interpersonal problems, and somatic complaints) and alcohol use severity among Hispanic emerging adults, and (b) examine if gender moderates each respective association.

METHOD

181 Hispanic emerging adults (ages 18-25) completed an anonymous cross-sectional online survey. Participants completed a demographic questionnaire, the Alcohol Use Disorder Identification Test, and the Center Epidemiological Studies Depression Scale. Hierarchical multiple regression was used to estimate respective associations of negative affect, anhedonia, interpersonal problems, and somatic complaints in relation to alcohol use severity. Moderation tests were also conducted to examine if gender functioned as an effect modifier between respective depressive symptom domains and alcohol use severity.

RESULTS

Findings indicated higher levels of anhedonia were associated with higher alcohol use severity (β=0.20, p=0.02). Moderation analyses indicated that somatic complaints (β=-0.41, p=0.02) and interpersonal problems were associated with greater alcohol use severity among men (β=-0.60, p<0.001), but not women.

CONCLUSIONS

Findings underscore the need to examine the relationship between specific depressive symptom domains and alcohol use; and the importance of accounting for potential gender differences in these associations.

Dimensional personality traits and alcohol treatment outcome: a systematic review and meta-analysis

AIMS

To identify dimensional personality traits associated with treatment outcome for patients with an alcohol use disorder (AUD).

METHODS

Systematic review and meta-analysis of clinical trials and longitudinal studies of ≥ 8 weeks in patients receiving treatment for AUD, in which the association between personality dimensions and treatment outcome was reported. Primary outcomes were relapse and alcohol consumption measures. Treatment retention was a secondary outcome.

RESULTS

Eighteen studies, including 4783 subjects, were identified. Twelve studies used Cloninger's Temperament and Personality Questionnaire (TPQ) or Temperament and Character Inventory (TCI). Remaining studies used a broad range of other personality measures. Compared with non-relapsers, patients who relapsed had higher novelty-seeking [standardized mean difference in novelty-seeking score 0.28; 95% confidence interval (CI) = 0.12, 0.44], lower persistence (-0.30, 95% = CI -0.48, -0.12), lower reward dependence (-0.16, 95% CI = -0.31, -0.01) and lower cooperativeness (-0.23, 95% CI = -0.41, -0.04). Few studies reported on alcohol consumption outcomes, therefore findings for those outcomes were inconclusive. Lower novelty-seeking predicted better retention in treatment in two of three studies. Most studies reported findings only for those retained in treatment, and did not attempt to account for missing data; therefore, findings for the primary outcomes cannot be generalized to patients who dropped out of treatment. Studies using personality instruments other than the TCI or TPQ reported no consistent findings on the association between personality variables and treatment outcome.

CONCLUSIONS

Among patients receiving treatment for an alcohol use disorder, those who relapse during follow-up have higher novelty-seeking, lower persistence, lower reward dependence and lower cooperativeness than those who do not relapse.

Anhedonia in substance use disorders: a systematic review of its nature, course and clinical correlates

OBJECTIVE

There is growing evidence that anhedonia is a commonly experienced symptom among substance-using populations. This systematic review synthesises findings across a range of substances to address questions regarding the time course of anhedonia, how anhedonia relates to other symptoms of substance dependence and whether it is similarly prevalent across all addictive drugs.

METHOD

A literature search was conducted on PubMed, PsycINFO and MEDLINE, yielding 32 studies that used self-report measures of anhedonia among participants with a history of a substance abuse, dependence or long-term daily use of addictive substances.

RESULTS

Findings from these studies indicate that anhedonia (1) is elevated in samples dependent on a range of substances; (2) typically appears as a consequence of substance abuse or dependence, and diminishes with abstinence; and (3) predicts increased drug cravings and the likelihood of relapse in those attempting abstinence.

CONCLUSIONS

The common experience of anhedonia in substance-dependent populations, and its relationship to relapse, emphasises the importance of developing therapeutic interventions that specifically target anhedonia in the treatment of all substance use disorders.

Patient predictors of alcohol treatment outcome: a systematic review

Patient characteristics as predictors of alcohol use disorder treatment outcome were examined on three levels, identifying whether or not variables were significant predictors of drinking-related outcome in univariate analysis, in multivariate analysis, and in multivariate analyses limited to studies including several "key predictors." Also, a model was developed to predict total percentage of variance in treatment outcome accounted for in each study using each of the key predictors and a range of methodological factors. The most consistent univariate predictors were baseline alcohol consumption, dependence severity, employment, gender, psychopathology rating, treatment history, neuropsychological functioning, alcohol-related self-efficacy, motivation, socioeconomic status/income, treatment goal, and religion. When these key predictors were combined into multivariate analyses, baseline alcohol consumption and gender showed substantial reductions in predictive consistency whereas the remaining variables were not greatly affected. The most consistent predictors overall were dependence severity, psychopathology ratings, alcohol-related self-efficacy, motivation, and treatment goal. The two predictor variables most associated with greater variance accounted for in predictive models, when controlling for broader methodological variables, were baseline alcohol consumption and dependence severity. Few predictor variables were examined in more than a third of studies reviewed, and few variables were found to be significant predictors in a clear majority of studies. However, a subset of variables was identified, which collectively could be considered to represent a consistent set of predictors. Too few studies controlled for other important predictor variables. Attempts to synthesize findings were often hampered by lack of agreement of the best measure for predictor variables.

Temperament and character inventory dimensions and anhedonia in detoxified substance-dependent subjects

In this study we aimed to investigate the relationship between anhedonia, craving and temperament and character dimensions in a sample of 50 patients with alcohol and opiate dependence recruited after a period of detoxification. The following scales were applied: Snaith-Hamilton Pleasure Scale (SHAPS), Bech-Rafaelsen Melancholia Scale (BRMS), Scale for the Assessment of Negative Symptoms (SANS), Visual Analogue Scales (VAS) for craving, and Temperament and Character Inventory (TCI). The temperament dimension of Novelty Seeking was positively correlated to craving and anhedonia (p < .01), with a higher score of Novelty Seeking in the subsample of anhedonic subjects with respect to both non-anhedonic and control subjects. In our study, the possibility that difficulty in experiencing pleasure in psychiatric disorders can lead to the use of psychoactive substances in an attempt to decrease anhedonia, is extended to subjects without psychiatric disorders who may try substances to counterbalance a tonic state of anhedonia.

Differences in impulsivity and sensation seeking between early- and late-onset alcoholics

The personality traits of impulsivity and sensation seeking have been proposed as important features of early-onset alcoholism. Early-onset (EOA, n=62) and late-onset (LOA, n=68 ) alcoholic inpatients were compared as to the severity of their substance use and related problems, and self-report scales measuring impulsivity (Barratt Impulsiveness Scale, version 11), sensation seeking (Sensation Seeking Scale), and aggressiveness (Buss Durkee Hostility Inventory). The symptom severity of the EOAs' alcohol-use disorder and related problems was higher than that of the LOAs. Furthermore, the EOAs had higher levels of impulsivity, sensation seeking, and aggression relative to the LOAs. The differences in impulsivity remained after an analysis controlling for the effect of aggressiveness. Finally, cigarette smoking was positively correlated with impulsiveness across alcoholic subgroups. Active screening for impulsive traits in treatment-seeking alcohol-abusing populations is recommended to improve treatment planning and prevent early drop-out.

Anhedonia and substance-related symptoms in detoxified substance-dependent subjects: a correlation study

Anhedonia is a condition in which the capacity of experiencing pleasure is totally or partially lost, frequently occurring in mood disorders, as a negative symptom in schizophrenia, and in substance use disorders. In order to test a set of instruments for anhedonia in a population of detoxified opiate, alcohol and multiple substance-dependent subjects, 70 individuals were recruited from three different clinical settings. The following scales were applied: Snaith-Hamilton Pleasure Scale (SHAPS), Bech-Rafaelsen Melancholia Scale (BRMS), Scale for the Assessment of Negative Symptoms (SANS), specific withdrawal scales, and visual analogue scales (VAS) for hedonic capability and substance craving. The scales measuring anhedonia either directly (SHAPS, VAS for hedonic capability) or in some key items (SANS, BRMS) were significantly correlated with each other. The period of time since detoxification was inversely correlated with anhedonia and withdrawal symptomatology. Craving was positively correlated with anhedonia. Out of the total sample, only 18.5% could be defined as psychometrically anhedonic. The same correlations were found in this subsample. The composite instrument employed for assessing anhedonia and hedonic capability was found to be sensitive enough to detect such a dimension in the population considered, with the single scales significantly interrelated. In conclusion, we found interrelations between hedonic capability, craving and protracted withdrawal, particularly in opiate-dependent subjects. The strongest association occurred between hedonic capability and craving.

Impulsivity in abstinent alcohol-dependent patients: relation to control subjects and type 1-/type 2-like traits

Extensive literature has linked behavior control problems in childhood to risk for alcoholism, but impulsivity in alcohol-dependent adults has not been well characterized. Using a variety of laboratory measures of impulsivity, we assessed whether detoxified alcohol-dependent patients [(ADP); n = 130] were more impulsive than control subjects [(CS); n = 41]. In comparison with CS, ADP demonstrated (1) increased rates of commission errors, but not omission errors, in a continuous performance test, (2) a more severe devaluation of delayed reward, (3) increased rates of risky responses in a new risk-taking paradigm, and (4) higher psychometric scores of impulsivity and aggression. Across all subjects, aggressiveness correlated significantly with severity of delay discounting. A post hoc analysis of data obtained for male ADP indicated that, in comparison with patients with late onset of problem drinking and no problem-drinking parent, those ADP with earlier age of problem drinking and who reported a problem-drinking father (type 2-like alcohol dependence) demonstrated faster response latencies and more responses to non-target stimuli (commission errors) in the continuous performance test, as well as higher psychometric aggression. In contrast, these subtypes of male ADP did not differ in delay discounting and risk taking. These findings collectively indicate that, in comparison with CS, ADP are more impulsive in several dimensions, with elevated impulsivity in a working memory task as well as aggressivity characteristic of alcohol-dependent men with type 2-like features.

The Italian version of the Obsessive-Compulsive Drinking Scale: validation, comparison with the other versions, and difference between type 1- and type 2-like alcoholics

The Obsessive-Compulsive Drinking Scale (OCDS) is a quick and reliable self-rating instrument for alcohol craving. Translated and validated versions are available and all of them have confirmed the utility of the scale in clinical situations. The purpose of this study was to translate and validate the Italian version of the OCDS, to assess its psychometric properties, to compare it with the other versions, and to search for possible differences between subgroups distinguished according to socio-demographic and clinical variables. The OCDS and a visual analogue scale (VAS) for alcohol craving were given to 103 Italian-speaking alcohol-dependent patients, who were assessed for their typology of alcoholism according to Cloninger's criteria. The reliability, the correlations between the variables and the influence of other factors were measured. Principal component analysis was performed to detect underlying dimensionality of the scale. The construct validity of the total scale and the subscales, as tested with Cronbach alpha analysis, was good. The r-values between total (TOT) and obsessive (OB) and compulsive (CP) subscales were comparable with those obtained in the other European studies. None of the socio-demographic parameters, nor the majority of the clinical factors significantly influenced the OCDS scores; however, there was a significant difference in total and subscale scores between Cloninger's "type 1-like" and "type 2-like" alcoholics, with the former having lower scores than the latter ones, whereas the VAS was not able to discriminate them. Principal component analysis of the 14 OCDS items showed that the scale is better described by a three-factor solution. The Italian version of the OCDS exhibited good reliability and construct validity, confirmed its psychometric properties, showed higher scores than in other studies, showed CP consistently higher than OB score, confirmed the validity of the French method for score calculation and was able to discriminate Cloninger's "type 1-like" and "type 2-like" alcoholics.

Psychological stress and cortisol secretion in anhedonic alcoholic men

We investigated plasma cortisol in a psychological stress paradigm in seven weaned anhedonic alcoholics in comparison with seven age-matched healthy controls. Alcoholics had significantly higher mean plasma cortisol at baseline and no increase following a psychological stress paradigm. Anhedonic alcoholics judged the experimental situation less agreeable than controls. Anhedonic alcoholics may have blunted cortisol response to psychological stress.

Factorial structure of the Sensation-Seeking Scale-Form V: confirmatory factorial analyses in nonclinical and clinical samples

OBJECTIVE

The factor structure of the Sensation-Seeking Scale (SSS)-Form V was studied in 2 large French samples, using confirmatory factorial analyses (CFA) to test the 4-dimensional model of sensation seeking postulated by Zuckerman.

METHOD

The study included 769 healthy subjects and 659 patients who met the DSM-IV criteria for substance use disorders or eating disorders and completed the SSS. The correlation matrices for each of the samples were analyzed using CFA.

RESULTS

In each sample, we found the 4-factor model to be replicable.

CONCLUSION

The multidimensionality of sensation seeking is supported by the results, and the 4-dimensional model of sensation seeking identified by Zuckerman can be explored in French-speaking people.

Which temperamental characteristics are associated with substance use in subjects with psychotic and mood disorders?

The aim of this study was to assess the associations between substance use disorders and temperamental characteristics in subjects with non-affective psychotic disorders or mood disorders. Consecutively hospitalized patients were interviewed with a structured diagnostic interview to define DSM-IV diagnoses, including those of substance use. Temperamental characteristics were measured using the Sensation-Seeking Scale (SSS), the Barratt Impulsivity Scale (BIS) and the Physical Anhedonia Scale. Inpatients (n=103) with non-affective psychotic disorders (n=45) or mood disorders (n=58) were included. Among these patients, 25.2% presented with a lifetime (LT) history of alcohol abuse/dependence and 23.3% presented with a LT history of cannabis abuse/dependence. A LT history of alcohol misuse was independently associated with higher scores at the 'experience seeking' and 'disinhibition' subscales of the SSS. A LT history of cannabis misuse was independently associated with higher scores on the 'disinhibition' subscale of the SSS and on the 'non-planning activity' subscale of the BIS. These results suggest that sensation-seeking and impulsivity are temperamental characteristics that may favor substance use in patients with psychotic or mood disorders, independently from categorical diagnoses.