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Boness CL, Votaw VR, Stein ER, Hallgren KA, Witkiewitz K. Longitudinal measurement invariance of constructs derived from the addiction cycle. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2024; 38:649-655. [PMID: 38059947 PMCID: PMC11156788 DOI: 10.1037/adb0000976] [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] [Indexed: 12/08/2023]
Abstract
OBJECTIVE The Alcohol Addiction Research Domain Criteria (AARDoC) is an organizational framework for assessing heterogeneity in addictive disorders organized across the addiction cycle domains of incentive salience, negative emotionality, and executive functioning and may have benefits for precision medicine. Recent work found pretreatment self-report items mapped onto the addiction cycle domains and predicted 1- and 3-year alcohol use disorder treatment outcomes. Given the potential utility of the addiction cycle domains for predicting relevant treatment outcomes, this study sought to evaluate the longitudinal measurement invariance of the domains. METHOD We conducted a secondary analysis of individuals with alcohol use disorder (n = 1,383, 30.9% female, 76.8% non-Hispanic White, 11.2% Hispanic) who participated in the COMBINE study. Eleven items assessed at pre- and posttreatment were included in exploratory structural equation modeling (ESEM) and longitudinal invariance analyses. RESULTS The pre- and posttreatment ESEM models had factor loadings consistent with the three addiction cycle domains and fit the data well. The ESEM factor structure was invariant from pre- to posttreatment (representing configural invariance) and metric invariance (factor loadings) was largely supported, but analyses failed to support scalar invariance (item-level thresholds) of the addiction cycle domains. CONCLUSIONS A three-factor structure representing addiction cycle domains can be modeled using brief self-report measures pre- and posttreatment. Individuals demonstrated a downward shift in the level of item endorsement, indicating improvement with treatment. Although this 11-item measure might be useful at baseline for informing treatment decisions, results indicate the need to exercise caution in comparing the addiction cycle domains pre- to posttreatment within persons. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Cassandra L. Boness
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, Albuquerque, NM
| | - Victoria R. Votaw
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, Albuquerque, NM
- University of New Mexico, Department of Psychology, Albuquerque, NM
| | - Elena R. Stein
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA
| | - Kevin A. Hallgren
- University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle, WA
| | - Katie Witkiewitz
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, Albuquerque, NM
- University of New Mexico, Department of Psychology, Albuquerque, NM
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Esteban-Rodríguez L, Pérez-López M, Sion A, Olmos-Espinosa R, Jurado-Barba R, Maldonado-Sánchez D, León-Gayo M, Armada V, Rubio G. Agreement for Recovery: First Spanish Consensus on the Concept of Alcohol Addiction Recovery. ACTAS ESPANOLAS DE PSIQUIATRIA 2024; 52:382-393. [PMID: 39129690 PMCID: PMC11319745 DOI: 10.62641/aep.v52i4.1633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
INTRODUCTION Current literature does not dispose from a widely accepted definition of recovery in alcohol use disorder (AUD), and most proposals originate from anglophone countries. This study introduces a pioneering consensus in Spain on the definition of recovery in AUD. METHOD The Delphi method was used. The expert panel, comprising 54 multidisciplinary professionals from the Community of Madrid. RESULTS A high level of consensus (≥80% agreement) was reached for 45% of the items and majority (≥60%) for 84%. Recovery is understood as a dynamic, personalized, and voluntary process, potentially enduring throughout one's lifespan. It entails a transformative lifestyle shift aimed at achieving a significant improvement in overall quality of life, encompassing physical and mental health, interpersonal relationships, and environmental factors. The journey of recovery is marked by heightened psychological well-being, is characterized by empowerment, personal growth, existential purpose, and positive identity reconstruction. Recovery is supported by substance use management, requires proactive individual agency and involves both personal and societal responsibilities. CONCLUSIONS This study represents a milestone as it is the first consensus in the Community of Madrid on the meaning of recovery in AUD. The proposed definition of recovery could be a potential reference for similar regions within Spain or even for other countries with cultural similarities. The elucidation of a clear framework of recovery provides a solid basis for future research efforts and clinical interventions in the Spanish AUD landscape.
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Affiliation(s)
- Laura Esteban-Rodríguez
- Institute for Biomedical Research, Hospital 12 de Octubre, 28041 Madrid, Spain
- Faculty of Psychology, Complutense University of Madrid, 28223 Madrid, Spain
| | | | - Ana Sion
- Institute for Biomedical Research, Hospital 12 de Octubre, 28041 Madrid, Spain
- Faculty of Psychology, Complutense University of Madrid, 28223 Madrid, Spain
- Red de Investigación en Atención Primaria de Adicciones (RIAPAd), 08003 Barcelona, Spain
| | | | - Rosa Jurado-Barba
- Faculty of Health Sciences - HM Hospitales, Camilo José Cela University, 28692 Madrid, Spain
| | - Daniel Maldonado-Sánchez
- Institute for Biomedical Research, Hospital 12 de Octubre, 28041 Madrid, Spain
- Faculty of Psychology, Complutense University of Madrid, 28223 Madrid, Spain
| | | | - Víctor Armada
- Institute for Biomedical Research, Hospital 12 de Octubre, 28041 Madrid, Spain
- Faculty of Health Sciences - HM Hospitales, Camilo José Cela University, 28692 Madrid, Spain
| | - Gabriel Rubio
- Institute for Biomedical Research, Hospital 12 de Octubre, 28041 Madrid, Spain
- Red de Investigación en Atención Primaria de Adicciones (RIAPAd), 08003 Barcelona, Spain
- In Recovery, 28045 Madrid, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
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Hartwell EE, Schwandt M, Nunez YZ, Wetherill RR, Kember RL, Wiers CE, Gelernter J, Kranzler HR. Identifying neurofunctional domains across substance use disorders. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024:1-11. [PMID: 39018668 DOI: 10.1080/00952990.2024.2368180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 06/11/2024] [Indexed: 07/19/2024]
Abstract
Background: Substance use disorders (SUDs) are heterogeneous across multiple functional domains. Various frameworks posit that domains (e.g., executive function) contribute to the persistence of SUDs; however, the domains identified in different studies vary.Objectives: We used factor analysis to identify the underlying latent domains present in a large sample (N = 5,244, 55.8% male) with a variety of SUDs to yield findings more generalizable than studies with a narrower focus.Method: Participants (1,384 controls and 3,860 participants with one or more SUDs including alcohol, cocaine, cannabis, and/or opioid use disorders) completed the Semi-Structured Assessment for Drug Dependence and Alcoholism, the NEO Personality Inventory, and the Wisconsin Card Sorting Test. Exploratory factor analysis (EFA) and fit indices (root mean-squared error of approximation (RMSEA), Comparative Fit Index (CFI), and Tucker-Lewis Index (TLI)) were used to examine different latent variable models. A multiple indicators, multiple causes (MIMIC) approach-tested associations of the latent variables with sociodemographics, substance use, and a history of abuse/neglect.Results: A six-factor model (predominant alcohol, predominant cocaine, predominant opioid, externalizing, personality, and executive function) provided the best fit [RMSEA = 0.063 (90% CI 0.060, 0.066), CFI = 0.98, TLI = 0.96]. All factors were moderately correlated (coefficient = 0.25-0.55, p < .05) with the exception of executive function. MIMIC analysis revealed different patterns of associations (all p < .0001) with sociodemographics, substance use, and a history of abuse/neglect among the factors.Conclusions: The domains identified, particularly executive function, were parallel to those observed previously. These factors underscore the heterogeneous nature of SUDs and may be useful in developing more targeted clinical interventions.
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Affiliation(s)
- Emily E Hartwell
- Mental Illness Research, Education and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Melanie Schwandt
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Yaira Z Nunez
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Reagan R Wetherill
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel L Kember
- Mental Illness Research, Education and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Corinde E Wiers
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Henry R Kranzler
- Mental Illness Research, Education and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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Pettorruso M, Di Lorenzo G, De Risio L, Di Carlo F, d'Andrea G, Martinotti G. Addiction biotypes: a paradigm shift for future treatment strategies? Mol Psychiatry 2024; 29:1450-1452. [PMID: 38243073 DOI: 10.1038/s41380-024-02423-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 01/01/2024] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Affiliation(s)
- Mauro Pettorruso
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy.
| | - Giorgio Di Lorenzo
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Luisa De Risio
- Department of Psychiatry and Addiction, ASL Roma 5, Colleferro (Rome), Italy
| | - Francesco Di Carlo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Giacomo d'Andrea
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
- Department of Pharmacy, Pharmacology, Clinical Science, University of Hertfordshire, Herts, UK
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Votaw VR, Boness CL, Stein ER, Watts AL, Sher KJ, Witkiewitz K. Examining the validity of the addictions neuroclinical assessment domains in a crowdsourced sample of adults with current alcohol use. Exp Clin Psychopharmacol 2024; 32:68-83. [PMID: 37227882 PMCID: PMC11088344 DOI: 10.1037/pha0000648] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Several dimensional frameworks for characterizing heterogeneity in alcohol use disorder (AUD) have been proposed, including the Addictions Neuroclinical Assessment (ANA). The ANA is a framework for assessing individual variability within AUD across three domains corresponding to the proposed stages of the addiction cycle: reward (binge-intoxication stage), negative emotionality (withdrawal-negative affect stage), and cognitive control (preoccupation-anticipation stage). Recent work has evaluated the ANA's three-factor structure and construct validity, primarily in treatment-seekers with AUD. We extended this research by examining the factor structure, bias across alcohol use severity, longitudinal invariance, and concurrent and predictive validity of a novel assessment of the ANA domains in adults with past 12-month regular (10 + alcohol units/week) alcohol use. Participants recruited from Prolific (N = 732), a crowdsourced data collection platform, completed various self-report measures. A test-retest subsample (n = 234) completed these measures 30 days later. Split-half exploratory factor analysis and confirmatory factor analysis supported the three-factor structure of the ANA. The overall factor structure was invariant across 30 days. Concurrently and prospectively, ANA domains demonstrated convergent validity concerning theoretically aligned alcohol-related, psychological, and personality measures. However, there was evidence of poor discriminant validity, and several cognitive control and reward items demonstrated bias across alcohol use severity. Future research is needed to improve the measurement of ANA domains using multimodal indicators, examine longitudinal changes in domains and their relationship with alcohol use severity, characterize phenotypic subgroups based on relative levels of domains, and compare the utility of the ANA with other proposed frameworks for measuring AUD heterogeneity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | - Cassandra L Boness
- Center on Alcohol, Substance use, And Addictions, University of New Mexico
| | | | - Ashley L Watts
- Department of Psychological Sciences, Vanderbilt University
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri
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Koob GF. Alcohol Use Disorder Treatment: Problems and Solutions. Annu Rev Pharmacol Toxicol 2024; 64:255-275. [PMID: 38261428 DOI: 10.1146/annurev-pharmtox-031323-115847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Alcohol use disorder (AUD) afflicts over 29 million individuals and causes more than 140,000 deaths annually in the United States. A heuristic framework for AUD includes a three-stage cycle-binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation-that provides a starting point for exploring the heterogeneity of AUD with regard to treatment. Effective behavioral health treatments and US Food and Drug Administration-approved medications are available but greatly underutilized, creating a major treatment gap. This review outlines challenges that face the alcohol field in closing this treatment gap and offers solutions, including broadening end points for the approval of medications for the treatment of AUD; increasing the uptake of screening, brief intervention, and referral to treatment; addressing stigma; implementing a heuristic definition of recovery; engaging early treatment; and educating health-care professionals and the public about challenges that are associated with alcohol misuse. Additionally, this review focuses on broadening potential targets for the development of medications for AUD by utilizing the three-stage heuristic model of addiction that outlines domains of dysfunction in AUD and the mediating neurobiology of AUD.
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Affiliation(s)
- George F Koob
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA;
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Johnstone S, Sorkhou M, Zhang M, Dermody SS, Rabin RA, George TP. Cannabis cravings predict cigarette use in schizophrenia: a secondary analysis from two cannabis abstinence studies. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:95-105. [PMID: 38214479 DOI: 10.1080/00952990.2023.2292010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/03/2023] [Indexed: 01/13/2024]
Abstract
CLINICAL TRIAL NAME Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on Cannabis Use and Cognitive Outcomes in SchizophreniaURL: www.clinicaltrials.gov; Registration Number: NCT03189810.
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Affiliation(s)
- Samantha Johnstone
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Maryam Sorkhou
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Molly Zhang
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Sarah S Dermody
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Rachel A Rabin
- Department of Psychiatry, McGill University and Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Tony P George
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Witkiewitz K, Kirouac M, Baurley JW, McMahan CS. Patterns of drinking behavior around a treatment episode for alcohol use disorder: Predictions from pre-treatment measures. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2138-2148. [PMID: 38226755 PMCID: PMC11164067 DOI: 10.1111/acer.15183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/26/2023] [Accepted: 08/27/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Alcohol use disorder (AUD) has been described as a chronic disease given the high rates that affected individuals have in returning to drinking after a change attempt. Many studies have characterized predictors of aggregated alcohol use (e.g., percent heavy drinking days) following treatment for AUD. However, to inform future research on predicting drinking as an AUD outcome measure, a better understanding is needed of the patterns of drinking that surround a treatment episode and which clinical measures predict patterns of drinking. METHODS We analyzed data from the Project MATCH and COMBINE studies (MATCH: n = 1726; 24.3% female, 20.0% non-White; COMBINE: n = 1383; 30.9% female, 23.2% non-White). Daily drinking was measured in the 90 days prior to treatment, 90 days (MATCH) and 120 days (COMBINE) during treatment, and 365 days following treatment. Gradient boosting machine learning methods were used to explore baseline predictors of drinking patterns. RESULTS Drinking patterns during a prior time period were the most consistent predictors of future drinking patterns. Social network drinking, AUD severity, mental health symptoms, and constructs based on the addiction cycle (incentive salience, negative emotionality, and executive function) were associated with patterns of drinking prior to treatment. Addiction cycle constructs, AUD severity, purpose in life, social network, legal history, craving, and motivation were associated with drinking during the treatment period and following treatment. CONCLUSIONS There is heterogeneity in drinking patterns around an AUD treatment episode. This study provides novel information about variables that may be important to measure to improve the prediction of drinking patterns during and following treatment. Future research should consider which patterns of drinking they aim to predict and which period of drinking is most important to predict. The current findings could guide the selection of predictor variables and generate hypotheses for those predictors.
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Affiliation(s)
- Katie Witkiewitz
- Center on Alcohol, Substance Use, and Addictions (CASAA), University of New Mexico, Albuquerque, New Mexico, USA
| | - Megan Kirouac
- Center on Alcohol, Substance Use, and Addictions (CASAA), University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Christopher S McMahan
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, South Carolina, USA
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Watts AL, Watson D, Heath AC, Sher KJ. Alcohol use disorder criteria exhibit different comorbidity patterns. Addiction 2023. [PMID: 36606740 DOI: 10.1111/add.16121] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Alcohol use disorder is comorbid with numerous other forms of psychopathology, including externalizing disorders (e.g. conduct disorder) and, to a lesser extent, internalizing conditions (e.g. depression, anxiety). Much of the time, overlap among alcohol use disorder and other conditions is explored at the disorder level, assuming that criteria are co-equal indicators of other psychopathology, even though alcohol use disorder criteria span numerous varied domains. Emerging evidence suggests that there are symptom clusters within the construct of alcohol use disorder that relate differentially with important external criteria, including psychopathology and allied personality traits (e.g. impulsivity, novelty-seeking). The present study mapped individual alcohol use disorder criteria onto internalizing and externalizing dimensions. DESIGN AND PARTICIPANTS We used multivariate and factor analytical modeling and data from two large nationally representative samples of past year drinkers (n = 25 604; 19 454). SETTING United States. MEASUREMENTS Psychopathology was assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule, yielding alcohol use disorder criteria, internalizing diagnoses (i.e. major depressive disorder, dysthymia, social anxiety disorder, generalized anxiety disorder, specific phobia, agoraphobia and panic disorder) and externalizing diagnoses and symptoms (i.e. antisocial personality disorder, conduct disorder and three impulsivity items drawn from borderline personality disorder criteria). Alcohol consumption was assessed in terms of past-year drinking frequency, usual amount of alcohol consumed on drinking days, binge drinking frequency, intoxication frequency, and maximum number of drinks in a 24-hour period. FINDINGS Four different patterns emerged. First, several alcohol use disorder criteria were relatively weakly associated with externalizing and internalizing. Secondly, withdrawal was associated with internalizing, but this association was not specific to distress. Thirdly, there was a general lack of specificity between alcohol use disorder criteria and narrower forms of internalizing, despite what might be predicted by modern models of addiction. Fourthly, recurrent use in hazardous situations reflected higher degrees of externalizing and lower internalizing liability. CONCLUSIONS Different symptom combinations appear to yield differential expressions of alcohol use disorder that are disorder-specific, or reflect broader tendencies toward externalizing, internalizing or both.
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Affiliation(s)
- Ashley L Watts
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Andrew C Heath
- School of Medicine, Department of Psychiatry, Washington University, St Louis, MI, USA
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
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