Precision medicine in alcohol use disorder: Mapping etiologic and maintenance mechanisms to mechanisms of behavior change to improve patient outcomes

Learning & motivational talk in smoking cessation interventions: An examination of session language in two randomized trials

OBJECTIVES

Motivational Interviewing (MI), a client-centered approach that seeks to evoke and resolve ambivalence, and health education (HE), which provides health information and advice, may both provide some benefit to unmotivated smokers. In HE, it is possible that client language reflective of new learning, or "learning talk" (LT), and rejection of health advice, or "rejection talk," (RT), may uniquely reflect intent of subsequent behavior change.

METHODS

This project utilized MI and HE sessions from two randomized clinical trials (RCTs), one in a low-income, diverse community civilian sample of 255 unmotivated smokers, and the other in a sample of Veterans with mental illness who were unmotivated smokers (n = 55). Mixed methods approaches were utilized to reliably code sessions using the Motivational Interviewing Skill Code 2.5 (MISC 2.5)1 and a refined Learning Talk coding system2.

RESULTS

Reliability of LT and RT codes ranged from fair to excellent (ICCs from 0.43-0.93).

CONCLUSION

LT appears to be a unique construct and its impact on post-session changes in smoking is warranted.

PRACTICE IMPLICATIONS

This system can be used in a study to code existing interventions for smokers using both MI and HE techniques and relate in-session client LT to subsequent smoking behaviors.

The mindful resiliency in recovery model: empowering the transcendence of stigma

Introduction

Mindfulness-based interventions show unique promise in treating substance use disorders among marginalized populations who face heightened stigma. The Mindful Resiliency in Recovery Model is introduced as a novel theoretical framework articulating how mindfulness training can mitigate the adverse effects of stigma, enhance psychological resilience, and facilitate sustained recovery from addiction.

Methods

The current manuscript synthesizes various models of mindfulness processes, stigma, and substance use disorder recovery to propose an integrated theoretical framework on the promise of mindfulness-based interventions in supporting recovery. Further, the current manuscript draws upon empirical literature to establish preliminary support for the premises and hypotheses of the Mindful Resiliency in Recovery Model concerning the mechanisms influencing the efficacy of mindfulness-based interventions among marginalized individuals.

Results

Preliminary evidence supports the premises of the proposed model. There is evidence to suggest that specific processes like increased present-moment awareness, acceptance, decentering, reappraisal, and savoring may be especially salient in mitigating internalized stigma and fostering resiliency in recovery. There is a need for additional research on these processes, and contextual factors that may moderate their efficacy.

Discussion

The Mindful Resiliency in Recovery Model has significant implications for optimizing mindfulness-based interventions to empower marginalized individuals to transcend stigma and actualize their capacity for wellbeing in substance use disorder recovery. It provides a roadmap for future research on the mechanisms and contextual factors affecting the efficacy of mindfulness-based interventions for marginalized and stigmatized communities. It further offers guidance to clinicians utilizing mindfulness-based interventions to support individuals experiencing stigma.

Validation of predicted individual treatment effects in out of sample respondents

Personalized medicine promises the ability to improve patient outcomes by tailoring treatment recommendations to the likelihood that any given patient will respond well to a given treatment. It is important that predictions of treatment response be validated and replicated in independent data to support their use in clinical practice. In this paper, we propose and test an approach for validating predictions of individual treatment effects with continuous outcomes across samples that uses matching in a test (validation) sample to match individuals in the treatment and control arms based on their predicted treatment response and their predicted response under control. To examine the proposed validation approach, we conducted simulations where test data is generated from either an identical, similar, or unrelated process to the training data. We also examined the impact of nuisance variables. To demonstrate the use of this validation procedure in the context of predicting individual treatment effects in the treatment of alcohol use disorder, we apply our validation procedure using data from a clinical trial of combined behavioral and pharmacotherapy treatments. We find that the validation algorithm accurately confirms validation and lack of validation, and also provides insights into cases where test data were generated under similar, but not identical conditions. We also show that the presence of nuisance variables detrimentally impacts algorithm performance, which can be partially reduced though the use of variable selection methods. An advantage of the approach is that it can be widely applied to different predictive methods.

Longitudinal measurement invariance of constructs derived from the addiction cycle

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).

The role of resilience in the relationship between stress and alcohol

Stress plays a well-documented role in alcohol consumption and the risk for developing alcohol use disorder. The concept of resilience - coping with and successfully adapting to stressful life experiences - has received increasing attention in the field of addiction research in recent decades, and there has been an accumulation of evidence for resilience as a protective factor against problematic alcohol consumption, risk for alcohol use disorder, disorder severity, and relapse. The conceptual and methodological approaches used in the generation of this evidence vary considerably across investigations, however. In light of this, we carried out this review in order to provide a more thorough understanding of the meaning and scope of resilience, what factors contribute to resilience, how it is measured, and how it relates to alcohol-associated phenotypes. Implications for treatment through the use of resilience-building interventions are likewise discussed, as well as implications for future research on the role of resilience in the etiology and clinical outcomes of alcohol use disorder.

Examining the validity of the addictions neuroclinical assessment domains in a crowdsourced sample of adults with current alcohol use

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).

Beyond mediators: A critical review and methodological path forward for studying mechanisms in alcohol use treatment research

Understanding how treatments for alcohol use disorder (AUD) facilitate behavior change has long been recognized as an important area of research for advancing clinical care. However, despite decades of research, the specific mechanisms of change for most AUD treatments remain largely unknown because most prior work in the field has focused only on statistical mediation. Statistical mediation is a necessary but not sufficient condition to establish evidence for a mechanism of change. Mediators are intermediate variables that account statistically for the relationship between independent and dependent variables, whereas mechanisms provide more detailed explanations of how an intervention leads to a desired outcome. Thus, mediators and mechanisms are not equivalent. To advance mechanisms of behavior change research, in this critical review we provide an overview of methodological shortfalls of existing AUD treatment mechanism research and introduce an etiologically informed precision medicine approach that facilitates the testing of mechanisms of behavior change rather than treatment mediators. We propose a framework for studying mechanisms in alcohol treatment research that promises to facilitate our understanding of behavior change and precision medicine (i.e., for whom a given mechanism of behavior change operates and under what conditions). The framework presented in this review has several overarching goals, one of which is to provide a methodological roadmap for testing AUD recovery mechanisms. We provide two examples of our framework, one pharmacological and one behavioral, to facilitate future efforts to implement this methodological approach to mechanism research. The framework proposed in this critical review facilitates the alignment of AUD treatment mechanism research with current theories of etiologic mechanisms, precision medicine efforts, and cross-disciplinary approaches to testing mechanisms. Although no framework can address all the challenges related to mechanisms research, our goal is to help facilitate a shift toward more rigorous and falsifiable behavior change research.

Examining the validity of the drinking motives questionnaire for identifying reward and relief drinking subgroups in college students

BACKGROUND

Heavy alcohol use in college is associated with a risk of developing alcohol use disorder. Characterizing variability in individual risk factors for alcohol use could help mitigate risk by informing personalized approaches to prevention. This study examined the validity of a brief measure for identifying reward/relief drinking phenotypes in non-treatment-seeking young adults.

METHODS

College students (n = 454) who reported binge drinking completed the Drinking Motives Questionnaire-Revised-Short Form (DMQ-R-SF). Confirmatory factor and latent profile analyses (CFA; LPA) of the DMQ-R-SF were performed to assess structural validity and identify reward/relief drinking subgroups. We compared models measuring reward drinking with the DMQ-R-SF enhancement motives (reward-enhancement) subscale to models measuring reward drinking with enhancement and social motives (reward-enhancement/social). Across models, relief drinking was measured with coping motives. We examined associations between reward/relief drinking subgroups and alcohol and personality variables concurrently and prospectively at a 6-week follow-up.

RESULTS

A two-factor reward and relief structure of the DMQ-R-SF was supported. Three latent profiles were identified (low reward/low relief: n = 133, high reward/low relief: n = 249; high reward/high relief: n = 72). Both CFA and LPA models that utilized reward-enhancement/social items indicated a better fit than reward-enhancement items alone. At baseline, individuals in the high-reward/high-relief profile demonstrated the poorest alcohol use outcomes and higher negative affect. Those in the high-reward/low-relief profile demonstrated greater alcohol use severity than those in the low-reward/low-relief profile. Prospectively, individuals classified in the high-reward/low-relief subgroup reported greater binge drinking frequency and those in the high-reward/high-relief profile reported greater alcohol consequences.

CONCLUSIONS

The DMQ-R-SF is a valid measure for identifying reward and relief drinking subgroups in college students with binge drinking and could have utility for precision prevention efforts that target individuals in the high-reward/low-relief and high-reward/high-relief subgroups.

Cognitive-behavioral treatment for gambling harm: Umbrella review and meta-analysis

The aim of the current umbrella review and meta-analysis was to evaluate the methodological rigor of existing meta-analyses on cognitive-behavioral treatment (CBT) for gambling harm. The Cochrane Database of Systematic Reviews, PsycINFO, and PubMed were searched for meta-analyses of CBT for gambling harm among individuals aged 18 years and older. The search yielded five meta-analyses that met inclusion criteria, representing 56 unique studies and 5389 participants. The methodological rigor for one meta-analyses was rated high, two were moderate, and two were critically low. Including only moderate- to high-quality meta-analyses, a robust variance estimation meta-analysis indicated that CBT significantly reduced gambling disorder severity (g = -0.91), gambling frequency (g = -0.52), and gambling intensity (g = -0.32) relative to minimal and no treatment control at posttreatment, suggesting 65%-82% of participants receiving CBT will show greater reductions in these outcomes than minimal or no treatment controls. Overall, there is strong evidence for CBT in reducing gambling harm and gambling behavior, and this evidence provides individuals, clinicians, managed care companies, and policymakers with clear recommendations about treatment selection.

Associations Between Latent Classes of Trauma Exposure and Minority Stressors and Substance Use Among Cisgender Sexual Minority Women

Psychosocial stressors (e.g., minority stressors, trauma exposure) profoundly impact sexual minority women's (SMW's) risk of alcohol and other drug (AOD) use. However, research has not examined whether there are distinct typologies (i.e., patterns) of psychosocial stressors and whether these vary based on sociodemographic characteristics or are differentially associated with AOD outcomes (e.g., alcohol dependence) among SMW. This study aimed to identify latent classes of SMW reporting distinct typologies of psychosocial stressors and examine predictors and outcomes of latent classes of psychosocial stressors among SMW. Participants included a community sample of 602 SMW (Mage = 39.9, SD = 14.0; 74.0% lesbian; 37.4% White, 36.6% Black, 22.3% Latinx; 26.6% annual income ≤$14,999). Latent class analysis was used to identify typologies of psychosocial stressors. Regression analyses were employed to examine sociodemographic predictors and AOD outcomes of class membership. Three classes of psychosocial stressors emerged. Participants in Class 1 were likely to report relatively low adversity. SMW in Class 2, who reported childhood physical abuse (CPA), severe childhood sexual abuse, and adult physical assault, were vulnerable to discrimination and stigma consciousness. A distinct subgroup of SMW (Class 3) was at heightened risk of CPA, adult sexual assault (ASA), and stigma consciousness. Older SMW, Black SMW, and SMW with lower social support were more likely to be in classes characterized by higher adversity. Older SMW were at disproportionate risk of CPA and ASA. Different combinations of psychosocial stressors were uniquely associated with AOD outcomes. Findings underscore the importance of considering within-group heterogeneity in SMW's differential risk of psychosocial stressors and AOD outcomes. Routine screening of psychosocial stressors across several dimensions, brief interventions targeting AOD outcomes, and policies mitigating structural drivers of SMW's increased risk of trauma and minority stressors may be especially important for older SMW, Black SMW, and SMW who lack social support.

Improving Social Recovery Capital Research To Enhance Clinical Utility: A Proposed Agenda

Social recovery capital (SRC) is the combination of social resources that can be used to initiate and sustain addiction recovery through friends, family, and peers. Broadly, understanding one's SRC allows us to get a sense of where one has social support for recovery and where there may be social barriers to their recovery process. SRC is often a vital component of many people's recovery journey, yet our understanding of how best to use this concept in research and practice remains underdeveloped. To improve understanding of the role of social recovery capital and strategies to measure and increase it, we present a roadmap involving a five-pronged research agenda to: (1) Refine the measurement of social recovery capital; (2) Model the complexity of social recovery capital empirically; (3) Integrate personality science with social recovery capital research; (4) Optimize evidence-based behavior change techniques of social recovery capital; and (5) Incorporate an intersectional framework when examining or applying social recovery capital. Overall, this five-pronged research agenda seeks to enhance the clinical utility of SRC research to maximize the impact of SRC on one's recovery.