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Yeh YH, Zheng MH, Tegge AN, Athamneh LN, Freitas-Lemos R, Dwyer CL, Bickel WK. The phenotype of recovery XI: associations of sleep quality and perceived stress with discounting and quality of life in substance use recovery. Qual Life Res 2024; 33:1621-1632. [PMID: 38504067 PMCID: PMC11116204 DOI: 10.1007/s11136-024-03625-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE Sleep and stress show an interdependent relationship in physiology, and both are known risk factors for relapse in substance use disorder (SUD) recovery. However, sleep and stress are often investigated independently in addiction research. In this exploratory study, the associations of sleep quality and perceived stress with delay discounting (DD), effort discounting (ED), and quality of life (QOL) were examined concomitantly to determine their role in addiction recovery. DD has been proposed as a prognostic indicator of SUD treatment response, ED is hypothesized to be relevant to the effort to overcome addiction, and QOL is an important component in addiction recovery. METHOD An online sample of 118 individuals recovering from SUDs was collected through the International Quit and Recovery Registry. Exhaustive model selection, using the Bayesian Information Criterion to determine the optimal multiple linear model, was conducted to identify variables (i.e., sleep quality, perceived stress, and demographics) contributing to the total variance in DD, ED, and QOL. RESULTS After model selection, sleep was found to be significantly associated with DD. Stress was found to be significantly associated with psychological health, social relationships, and environment QOL. Both sleep and stress were found to be significantly associated with physical health QOL. Neither sleep nor stress was supported as an explanatory variable of ED. CONCLUSION Together, these findings suggest sleep and stress contribute uniquely to the process of addiction recovery. Considering both factors when designing interventions and planning for future research is recommended.
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Affiliation(s)
| | - Michelle H Zheng
- Civil and Environmental Engineering Department, University of California, Los Angeles, CA, USA
| | - Allison N Tegge
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
- Department of Statistics, Virginia Tech, Blacksburg, VA, USA
| | - Liqa N Athamneh
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
| | | | - Candice L Dwyer
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
- Department of Psychology, Virginia Tech, Blacksburg, VA, USA
| | - Warren K Bickel
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA.
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2
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Wenzel JM, Zlebnik NE, Patton MH, Smethells JR, Ayvazian VM, Dantrassy HM, Zhang LY, Mathur BN, Cheer JF. Selective chemogenetic inactivation of corticoaccumbal projections disrupts trait choice impulsivity. Neuropsychopharmacology 2023; 48:1821-1831. [PMID: 37208501 PMCID: PMC10579332 DOI: 10.1038/s41386-023-01604-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/21/2023]
Abstract
Impulsive choice has enduring trait-like characteristics and is defined by preference for small immediate rewards over larger delayed ones. Importantly, it is a determining factor in the development and persistence of substance use disorder (SUD). Emerging evidence from human and animal studies suggests frontal cortical regions exert influence over striatal reward processing areas during decision-making in impulsive choice or delay discounting (DD) tasks. The goal of this study was to examine how these circuits are involved in decision-making in animals with defined trait impulsivity. To this end, we trained adolescent male rats to stable behavior on a DD procedure and then re-trained them in adulthood to assess trait-like, conserved impulsive choice across development. We then used chemogenetic tools to selectively and reversibly target corticostriatal projections during performance of the DD task. The prelimbic region of the medial prefrontal cortex (mPFC) was injected with a viral vector expressing inhibitory designer receptors exclusively activated by designer drugs (Gi-DREADD), and then mPFC projections to the nucleus accumbens core (NAc) were selectively suppressed by intra-NAc administration of the Gi-DREADD actuator clozapine-n-oxide (CNO). Inactivation of the mPFC-NAc projection elicited a robust increase in impulsive choice in rats with lower vs. higher baseline impulsivity. This demonstrates a fundamental role for mPFC afferents to the NAc during choice impulsivity and suggests that maladaptive hypofrontality may underlie decreased executive control in animals with higher levels of choice impulsivity. Results such as these may have important implications for the pathophysiology and treatment of impulse control, SUDs, and related psychiatric disorders.
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Affiliation(s)
- Jennifer M Wenzel
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
- Department of Psychological Sciences, University of San Diego, San Diego, CA, 92110, USA.
| | - Natalie E Zlebnik
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
- Division of Biomedical Sciences, University of California, Riverside School of Medicine, Riverside, CA, 92521, USA.
| | - Mary H Patton
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - John R Smethells
- Hennepin Healthcare Research Institute, Minneapolis, MN, 55404, USA
| | - Victoria M Ayvazian
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Hannah M Dantrassy
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Lan-Yuan Zhang
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Brian N Mathur
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Joseph F Cheer
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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Athamneh LN, King MJ, Craft WH, Freitas-Lemos R, Tomlinson DC, Yeh YH, Bickel WK. The Associations between Remission Status, Discounting Rates, and Recovery from Substance Use Disorders. Subst Use Misuse 2023; 58:275-282. [PMID: 36622296 DOI: 10.1080/10826084.2022.2161312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Recovery from substance use disorders (SUDs) requires sustained and purposeful support to maintain long-term remission. Methods: This study investigated the association between assessment of recovery capital, household chaos, delay discounting (DD) and probability discounting (PD), and remission status among individuals in recovery from SUD. Data from 281 participants from the International Quit & Recovery Registry (IQRR), an ongoing online registry that aims to study the recovery process, were included in the analysis. Results: Lower DD rates and higher recovery capital were found among those in remission compared to those not in remission after controlling for demographics. In contrast, the association of household chaos and PD with remission status were insignificant. Overall, DD accounted for 20% of the total effect between the recovery capital and the remission status. Conclusion: This study contributes to the understanding of recovery as a multidimensional process, supports DD as a behavioral marker of addiction, and suggests areas for future research.
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Affiliation(s)
- Liqa N Athamneh
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Michele J King
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - William H Craft
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Roberta Freitas-Lemos
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Devin C Tomlinson
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Yu-Hua Yeh
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Warren K Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
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4
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Craft WH, Shin H, Tegge AN, Keith DR, Athamneh LN, Stein JS, Ferreira MAR, Chilcoat HD, Le Moigne A, DeVeaugh-Geiss A, Bickel WK. Long-term recovery from opioid use disorder: recovery subgroups, transition states and their association with substance use, treatment and quality of life. Addiction 2022; 118:890-900. [PMID: 36524904 DOI: 10.1111/add.16115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Limited information exists regarding individual subgroups of recovery from opioid use disorder (OUD) following treatment and how these subgroups may relate to recovery trajectories. We used multi-dimensional criteria to identify OUD recovery subgroups and longitudinal transitions across subgroups. DESIGN, SETTING AND PARTICIPANTS In a national longitudinal observational study in the United States, individuals who previously participated in a clinical trial for subcutaneous buprenorphine injections for treatment of OUD were enrolled and followed for an average of 4.2 years after participation in the clinical trial. MEASUREMENTS We identified recovery subgroups based on psychosocial outcomes including depression, opioid withdrawal and pain. We compared opioid use, treatment utilization and quality of life among these subgroups. FINDINGS Three dimensions of the recovery process were identified: depression, opioid withdrawal and pain. Using these three dimensions, participants were classified into four recovery subgroups: high-functioning (minimal depression, mild withdrawal and no/mild pain), pain/physical health (minimal depression, mild withdrawal and moderate pain), depression (moderate depression, mild withdrawal and mild/moderate pain) and low-functioning (moderate/severe withdrawal, moderate depression and moderate/severe pain). Significant differences among subgroups were observed for DSM-5 criteria (P < 0.001) and remission status (P < 0.001), as well as with opioid use (P < 0.001), treatment utilization (P < 0.001) and quality of life domains (physical health, psychological, environment and social relationships; Ps < 0.001, Cohen's fs ≥ 0.62). Recovery subgroup assignments were dynamic, with individuals transitioning across subgroups during the observational period. Moreover, the initial recovery subgroup assignment was minimally predictive of long-term outcomes. CONCLUSIONS There appear to be four distinct subgroups among individuals in recovery from OUD. Recovery subgroup assignments are dynamic and predictive of contemporaneous, but not long-term, substance use, substance use treatment utilization or quality of life outcomes.
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Affiliation(s)
- William H Craft
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA.,Graduate Program in Translation Biology, Medicine, and Health, Virginia Tech, Blacksburg, VA, USA
| | - Hwasoo Shin
- Department of Statistics, Virginia Tech, Blacksburg, VA, USA
| | - Allison N Tegge
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA.,Department of Statistics, Virginia Tech, Blacksburg, VA, USA
| | - Diana R Keith
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Liqa N Athamneh
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Jeffrey S Stein
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | | | - Howard D Chilcoat
- Indivior, Inc., North Chesterfield, VA, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Warren K Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
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5
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Athamneh LN, Freitas-Lemos R, Basso JC, Keith DR, King MJ, Bickel WK. The phenotype of recovery VI: The association between life-history strategies, delay discounting, and maladaptive health and financial behaviors among individuals in recovery from alcohol use disorders. Alcohol Res 2022; 46:129-140. [PMID: 35076945 DOI: 10.1111/acer.14747] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/13/2021] [Accepted: 11/12/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The life-history theory is a well-established framework that predicts behaviors and explains how and why organisms allocate effort and resources to different life goals. Delay discounting (DD) is associated with risky behaviors and has been suggested as a candidate behavioral marker of addiction. Thus, we investigated the relationship between DD, life-history strategies, and engagement in risky behaviors among individuals in recovery from alcohol use disorder (AUD). METHODS Data from 110 individuals in recovery from addiction from The International Quit & Recovery Registry, an ongoing online registry designed to understand recovery phenotype, were included in the analysis. The association between life-history strategies, DD, engagement in risky behaviors, and remission status were assessed. RESULTS Life-history strategy scores were significantly associated with DD rates and finance, health, and personal development behaviors after controlling for age, sex, race, ethnicity, years of education, marital status, smoking status, and history of other substance use. Remission status was significantly associated with life-history strategy, DD, drug use, fitness, health, and safe driving after controlling for age, sex, race, years of education, marital status, and smoking status. In addition, a mediation analysis using Hayes' methods revealed that the discounting rates partially mediated the association between remission status and life-history strategy scores. CONCLUSIONS Life-history strategies and remission status are both significantly associated with DD and various health and finance behaviors among individuals in recovery from AUD. This finding supports the characterizations of DD as a candidate behavioral marker of addiction that could help differentiate subgroups needing special attention or specific interventions to improve the outcomes of their recovery. Future longitudinal studies are warranted to understand the relationships between changes in life-history strategies, DD, maladaptive health behaviors, and remission status over time.
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Affiliation(s)
- Liqa N Athamneh
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Roberta Freitas-Lemos
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Julia C Basso
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Diana R Keith
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Michele J King
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Warren K Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
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6
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The phenotype of recovery VII: Delay discounting mediates the relationship between time in recovery and recovery progress. J Subst Abuse Treat 2021; 136:108665. [PMID: 34895955 PMCID: PMC8940660 DOI: 10.1016/j.jsat.2021.108665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/02/2021] [Accepted: 11/10/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Substance use disorders (SUDs) remain challenging maladies to treat in the United States and impose significant societal costs. Despite these challenges, a significant number of individuals endorse being in recovery from SUD. The scientific understanding of SUD recovery has evolved to include not only improvements in substance use but also improvements in personal wellness and psychosocial functioning. The devaluation of future rewards (delay discounting; DD) is broadly associated with SUD inception and outcomes. We sought to investigate the relationship between DD, time in recovery, and recovery progress. METHODS We conducted an online assessment of 127 individuals in recovery from SUD who the study recruited via the International Quit and Recovery Registry (IQRR). The research team obtained measures of recovery progress via the Addiction Recovery Questionnaire (ARQ) and the Treatment Effectiveness Assessment (TEA). Additionally, the study collected measures of DD, time in recovery, and endorsement of abstinence in recovery (i.e., requiring abstinence vs. not). We utilized linear regression to test for associations among these variables and performed a mediation analysis to test the role of DD in mediating the relationship between time in recovery and measures of recovery progress. RESULTS Time in recovery was positively associated with the ARQ (p < .001) and TEA (p < .001). Furthermore, an individual's delay discounting rate mediated the relationship between time in recovery and ARQ/TEA. Of the participants, 66% endorsed recovery requiring total abstinence from alcohol and drugs. Last, through an exhaustive model selection, the study did not find an individual's endorsement of abstinence in recovery to be a primary predictor of recovery progress. CONCLUSIONS This study presents evidence that, for individuals in recovery, the temporal view (i.e., focus on immediate vs. future rewards) is a significant influence on recovery progress. Additionally, an individual's endorsement of abstinence in recovery was not significantly associated with recovery progress, suggesting the importance of a holistic view of SUD recovery. These findings contribute to the understanding of recovery as a multidimensional process and provide further support for DD as a behavioral marker of addiction.
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7
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Bailey AJ, Romeu RJ, Finn PR. The problems with delay discounting: a critical review of current practices and clinical applications. Psychol Med 2021; 51:1799-1806. [PMID: 34184631 PMCID: PMC8381235 DOI: 10.1017/s0033291721002282] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/25/2021] [Accepted: 05/21/2021] [Indexed: 12/30/2022]
Abstract
Delay discounting paradigms have gained widespread popularity across clinical research. Given the prevalence in the field, researchers have set lofty expectations for the importance of delay discounting as a key transdiagnostic process and a 'core' process underlying specific domains of dysfunction (e.g. addiction). We believe delay discounting has been prematurely reified as, in and of itself, a core process underlying psychological dysfunction, despite significant concerns with the construct validity of discounting rates. Specifically, high delay discounting rates are only modestly related to measures of psychological dysfunction and therefore are not 'core' to these more complex behavioral problems. Furthermore, discounting rates do not appear to be specifically related to any disorder(s) or dimension(s) of psychopathology. This raises fundamental concerns about the utility of discounting, if the measure is only loosely associated with most forms of psychopathology. This stands in striking contrast to claims that discounting can serve as a 'marker' for specific disorders, despite never demonstrating adequate sensitivity or specificity for any disorder that we are aware of. Finally, empirical evidence does not support the generalizability of discounting rates to other decisions made either in the lab or in the real-world, and therefore discounting rates cannot and should not serve as a summary measure of an individual's decision-making patterns. We provide recommendations for improving future delay discounting research, but also strongly encourage researchers to consider whether the empirical evidence supports the field's hyper-focus on discounting.
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Affiliation(s)
- Allen J. Bailey
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Ricardo J. Romeu
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Peter R. Finn
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
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