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Zaso MJ, Hendershot CS, Wardell JD, Bagby RM, Pollock BG, Quilty LC. Characterizing the role of impaired control over alcohol in associations of impulsive personality traits with alcohol use as a function of depressive disorder. Addict Behav 2021; 112:106633. [PMID: 32949836 DOI: 10.1016/j.addbeh.2020.106633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 11/25/2022]
Abstract
Impulsive personality traits have well-documented associations with at-risk drinking, although the role of impaired control over alcohol in these associations requires further study. Additionally, it remains unknown whether such relationships differ in the context of concurrent depressive disorder, which is a priority due to the high rates of mood dysregulation particularly in clinical samples. This project examined associations of impulsivity, impaired control over alcohol, and alcohol use within 201 adult general outpatients recruited from specialty mental health and addictions clinics at a psychiatric hospital. Outpatients completed the Structured Clinical Interview for DSM-IV Patient version (SCID) and assessments of impulsivity, impaired control over alcohol, and alcohol use. Over 35% of outpatients met criteria for a current depressive disorder. Path models supported associations of impulsivity with impaired control over alcohol and, in turn, at-risk drinking that differed significantly as a function of current depression. Among individuals with current depression, greater tendency to act rashly when experiencing negative affect (negative urgency) was associated with more frequent failures to control drinking (failed control) and, in turn, more at-risk drinking. In contrast, among individuals without current depression, greater positive urgency and lower sensation seeking were associated with greater failed control and, in turn, more at-risk drinking. Findings represent an important step toward clarifying the role of impaired control over alcohol in impulsivity and alcohol use associations and suggest divergent associations of negative urgency, positive urgency, and sensation seeking with at-risk drinking across clinical presentations.
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Emery NN, Carpenter RW, Treloar Padovano H, Miranda R. Why don't they stop? Understanding unplanned marijuana use among adolescents and young adults. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 34:579-589. [PMID: 32039620 DOI: 10.1037/adb0000561] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Difficulty regulating substance use is a core feature of addiction that can manifest as unplanned use. This study sought to identify internal and situational influences on unplanned marijuana use among youth ages 15 to 24 years (N = 85; 48% female; 27% age <18 years). Additionally, we disentangled person-level associations from within-person day-to-day influences. Ecological momentary assessment methods captured affective (positive: energized, excited, sociable, happy, relaxed; negative: bored, tense, sad, stressed) and situational factors in real-world settings during a 1-week monitoring period. Participants reported no plan to use on 51% of days (269/527), and youth ultimately used marijuana on 35% of these unplanned days. At the day level, on days when youth spent more time in the presence of marijuana-related cues than they typically do, they used more grams on planned days and less on unplanned days. Regardless of use plans, youth were more likely to use on days when they spent more time with using friends and if they reported greater availability of marijuana in general across the monitoring period. At the person level, youth who generally reported higher positive affect, relative to other participants, used more on planned days and less on unplanned days. Regardless of use plans, youth who generally reported greater craving and time in the presence of marijuana-related cues used more grams, whereas youth who generally reported greater negative affect used less. Together, findings revealed several factors, with clear clinical relevance, which may explain why some youth struggle to control their marijuana use. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Noah N Emery
- Center for Alcohol and Addiction Studies, Brown University
| | | | | | - Robert Miranda
- Center for Alcohol and Addiction Studies, Brown University
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Wardell JD, Quilty LC, Hendershot CS. Impulsivity, working memory, and impaired control over alcohol: A latent variable analysis. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2016; 30:544-554. [PMID: 27269291 PMCID: PMC5266597 DOI: 10.1037/adb0000186] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Impaired control over alcohol is an important risk factor for heavy drinking among young adults and may mediate, in part, the association between personality risk and alcohol problems. Research suggests that trait impulsivity is associated with impaired control over alcohol; however, few studies of this association have included a range of impulsivity facets. The purpose of this study was to examine specific pathways from higher order impulsivity factors to alcohol problems mediated via impaired control over alcohol. We also examined the moderating role of working memory in these associations. Young heavy drinkers (N = 300) completed 2 multidimensional impulsivity measures along with self-report measures of impaired control over alcohol, alcohol use, and alcohol problems. Working memory was assessed using a computerized digit span task. Results showed that the impulsivity facets loaded onto 2 higher order factors that were labeled Response and Reflection Impulsivity. Response impulsivity predicted unique variance in self-reported impaired control and alcohol problems, whereas reflection impulsivity predicted unique variance in heavy drinking frequency only. Further, significant indirect associations were observed from response and reflection impulsivity to alcohol problems mediated via impaired control and heavy drinking frequency, respectively. Working memory and sensation seeking were not uniquely associated with the alcohol variables, and no support was found for the moderating role of working memory. The results help to clarify associations among impulsivity, impaired control, and alcohol problems, suggesting that impaired control may play a specific role in the pathway to alcohol problems from response impulsivity but not from reflection impulsivity. (PsycINFO Database Record
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Affiliation(s)
- Jeffrey D. Wardell
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Lena C. Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Departments of Psychology and Psychiatry, University of Toronto
| | - Christian S. Hendershot
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Departments of Psychology and Psychiatry, University of Toronto
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Menary KR, Corbin WR, Leeman RF, Fucito LM, Toll BA, DeMartini K, O'Malley SS. Interactive and Indirect Effects of Anxiety and Negative Urgency on Alcohol-Related Problems. Alcohol Clin Exp Res 2015; 39:1267-74. [PMID: 26031346 DOI: 10.1111/acer.12762] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although drinking for tension reduction has long been posited as a risk factor for alcohol-related problems, studies investigating anxiety in relation to risk for alcohol problems have returned inconsistent results, leading researchers to search for potential moderators. Negative urgency (the tendency to become behaviorally dysregulated when experiencing negative affect) is a potential moderator of theoretical interest because it may increase risk for alcohol problems among those high in negative affect. This study tested a cross-sectional mediated moderation hypothesis whereby an interactive effect of anxiety and negative urgency on alcohol problems is mediated through coping-related drinking motives. METHODS The study utilized baseline data from a hazardously drinking sample of young adults (N = 193) evaluated for participation in a randomized controlled trial of naltrexone and motivational interviewing for drinking reduction. RESULTS The direct effect of anxiety on physiological dependence symptoms was moderated by negative urgency such that the positive association between anxiety and physiological dependence symptoms became stronger as negative urgency increased. Indirect effects of anxiety and negative urgency on alcohol problems (operating through coping motives) were also observed. CONCLUSIONS Although results of the current cross-sectional study require replication using longitudinal data, the findings suggest that the simultaneous presence of anxiety and negative urgency may be an important indicator of risk for alcohol use disorders via both direct interactive effects and indirect additive effects operating through coping motives. These findings have potentially important implications for prevention/intervention efforts for individuals who become disinhibited in the context of negative emotional states.
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Affiliation(s)
- Kyle R Menary
- Department of Psychology, Arizona State University, Tempe, Arizona
| | - William R Corbin
- Department of Psychology, Arizona State University, Tempe, Arizona
| | | | | | - Benjamin A Toll
- Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut.,Smilow Cancer Hospital at Yale-New Haven, New Haven, Connecticut
| | | | - Stephanie S O'Malley
- Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
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Wardell JD, Quilty LC, Hendershot CS. Alcohol sensitivity moderates the indirect associations between impulsive traits, impaired control over drinking, and drinking outcomes. J Stud Alcohol Drugs 2015; 76:278-86. [PMID: 25785803 PMCID: PMC5295842 DOI: 10.15288/jsad.2015.76.278] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine impaired control over drinking behavior as a mediator of unique pathways from impulsive traits to alcohol outcomes in young adults. We also sought to investigate the moderating influence of self-reported sensitivity to alcohol on these pathways. METHOD Young adult heavy drinkers (N = 172; 82 women) recruited from the community completed self-report measures of impulsive traits (positive urgency, negative urgency, sensation seeking), alcohol sensitivity (Self-Rating of the Effects of Alcohol scale), impaired control over drinking, and alcohol use and problems. Multiple-groups path analysis was used to analyze the data. RESULTS Path coefficients between urgency and impaired control were larger for individuals with lower versus higher self-reported sensitivity to alcohol. The same was true for the association between impaired control and alcohol problems. For participants lower on alcohol sensitivity, significant indirect paths were observed from both positive and negative urgency to all alcohol outcomes (quantity, frequency, and problems) mediated via impaired control. For participants higher on alcohol sensitivity, only the paths from negative urgency (but not positive urgency) to the three alcohol outcomes via impaired control were statistically significant. Sensation seeking was not uniquely associated with impaired control. CONCLUSIONS The findings indicate that relatively low sensitivity to the pharmacological effects of alcohol may strengthen the association between urgency--especially positive urgency--and impaired control, supporting the notion that personality and level of response to alcohol may interact to increase risk for impaired control over drinking.
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Affiliation(s)
- Jeffrey D. Wardell
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes St., 3 Floor, Toronto ON, Canada, M6J 1H4
| | - Lena C. Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes St., 3 Floor, Toronto ON, Canada, M6J 1H4
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Christian S. Hendershot
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes St., 3 Floor, Toronto ON, Canada, M6J 1H4
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Leeman RF, Beseler CL, Helms CM, Patock-Peckham JA, Wakeling VA, Kahler CW. A brief, critical review of research on impaired control over alcohol use and suggestions for future studies. Alcohol Clin Exp Res 2014; 38:301-8. [PMID: 24117468 PMCID: PMC3946792 DOI: 10.1111/acer.12269] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 07/12/2013] [Indexed: 11/30/2022]
Abstract
Impaired control, defined as "a breakdown of an intention to limit consumption" (Heather et al. J Stud Alcohol 1993; 54, 701), has historically been considered an important aspect of addiction. Despite recognition of its importance to addiction and potential value as an early indicator of problem drinking risk, we argue that impaired control over alcohol use has not received sufficient research attention. In an effort to spark further research, the present critical review offers brief discussion of the current state of knowledge regarding impaired control and avenues for future research. Three main research areas are addressed: (i) epidemiology; (ii) measurement issues; and (iii) potential mechanisms underlying relationships between impaired control and subsequent problem drinking. Measurement issues include complexities involved in self-report assessment of impaired control, development and validation of human and animal laboratory models, and impaired control's relationship to other constructs (i.e., impulsivity and other difficulties with self-control; symptoms of dependence such as craving). We discuss briefly 2 potential mechanisms that may help to explain why some drinkers experience impaired control while others do not: neurobiological dysfunction and family history/genetics. Suggestions for future research are focused on ways in which the impaired control construct may enhance prediction of who might be at particular risk of subsequent problem drinking and to facilitate intervention to reduce problem alcohol use.
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Affiliation(s)
- Robert F Leeman
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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Leeman RF, Corbin WR, Nogueira C, Krishnan-Sarin S, Potenza MN, O'Malley SS. A human alcohol self-administration paradigm to model individual differences in impaired control over alcohol use. Exp Clin Psychopharmacol 2013; 21:303-14. [PMID: 23937598 PMCID: PMC4131292 DOI: 10.1037/a0033438] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We developed an alcohol self-administration paradigm to model individual differences in impaired control. The paradigm includes moderate drinking guidelines meant to model limits on alcohol consumption, which are typically exceeded by people with impaired control. Possible payment reductions provided a disincentive for excessive drinking. Alcohol use above the guideline, despite possible pay reductions, was considered to be indicative of impaired control. Heavy-drinking 21- to 25-year-olds (n = 39) were randomized to an experimental condition including the elements of the impaired control paradigm or to a free-drinking condition without these elements. Alcohol self-administration was compared between these two conditions to establish the internal validity of the experimental paradigm. In both conditions, participants self-administered beer and nonalcoholic beverages for 3 hours in a bar setting with 1-3 other participants. Experimental condition participants self-administered significantly fewer beers and drank to lower blood-alcohol concentrations (BACs) on average than those in the free-drinking condition. Experimental condition participants were more likely than free-drinking condition participants to intersperse nonalcoholic beverages with beer and to drink at a slower pace. Although experimental condition participants drank more moderately than those in the free-drinking condition overall, their range of drinking was considerable (BAC range = .024-.097), with several participants drinking excessively. A lower initial subjective response to alcohol and earlier age of alcohol use onset were associated with greater alcohol self-administration in the experimental condition. Given the variability in response, the impaired control laboratory paradigm may have utility for preliminary tests of novel interventions in future studies and for identifying individual differences in problem-drinking risk.
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Affiliation(s)
- Robert F Leeman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
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Petit G, Kornreich C, Noël X, Verbanck P, Campanella S. Alcohol-related context modulates performance of social drinkers in a visual Go/No-Go task: a preliminary assessment of event-related potentials. PLoS One 2012; 7:e37466. [PMID: 22616012 PMCID: PMC3355129 DOI: 10.1371/journal.pone.0037466] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 04/22/2012] [Indexed: 12/05/2022] Open
Abstract
Background Increased alcohol cue-reactivity and altered inhibitory processing have been reported in heavy social drinkers and alcohol-dependent patients, and are associated with relapse. In social drinkers, these two processes have been usually studied separately by recording event-related potentials (ERPs) during rapid picture presentation. The aim of our study was to confront social drinkers to a task triggering high alcohol cue-reactivity, to verify whether it specifically altered inhibitory performance, by using long-lasting background picture presentation. Methods ERP were recorded during visual Go/No-Go tasks performed by social drinkers, in which a frequent Go signal (letter “M”), and a rare No-Go signal (letter “W”) were superimposed on three different types of background pictures: neutral (black background), alcohol-related and non alcohol-related. Results Our data suggested that heavy social drinkers made more commission errors than light drinkers, but only in the alcohol-related context. Neurophysiologically, this was reflected by a delayed No-Go P3 component. Conclusions Elevated alcohol cue-reactivity may lead to poorer inhibitory performance in heavy social drinkers, and may be considered as an important vulnerability factor in developing alcohol misuse. Prevention programs should be designed to decrease the high arousal of alcohol stimuli and strengthen cognitive control in young, at-risk individuals.
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Affiliation(s)
| | | | | | | | - Salvatore Campanella
- Laboratory of Psychological Medicine, Free University of Brussels, Brussels, Belgium
- * E-mail:
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Leeman RF, Patock-Peckham JA, Potenza MN. Impaired control over alcohol use: An under-addressed risk factor for problem drinking in young adults? Exp Clin Psychopharmacol 2012; 20:92-106. [PMID: 22182417 PMCID: PMC3613490 DOI: 10.1037/a0026463] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Impaired control over alcohol use may be defined as "a breakdown of an intention to limit consumption in a particular situation" (Heather, Tebbutt, Mattick, & Zamir, 1993, p. 701) and has long been considered an important feature of alcohol dependence. Evidence suggests impaired control is highly relevant to young adult problem drinking. In the natural history of problem drinking, impaired control tends to develop early and may predict alcohol-related problems prospectively in undergraduates. Impaired control over alcohol use may be a facet of generalized behavioral undercontrol specifically related to drinking. In particular, impaired control is theoretically and empirically related to impulsivity. The question of whether impaired control represents a facet of impulsivity or a related but separate construct requires further study. However, theoretical arguments and empirical evidence suggest that there are unique qualities to the constructs. Specifically, existing data suggest that self-report measures of impaired control and impulsivity over alcohol use relate distinctly to problem drinking indices in young adults. Several lines of future research concerning impaired control are suggested, using the impulsivity literature as a guide. We conclude that impaired control is a valuable construct to the study of young adult problem drinking and that measures of impaired control should be included in more young adult alcohol studies. The extent to which impaired control over the use of other substances and impaired control over engagement in other addictive behaviors are clinically relevant constructs requires additional study.
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Affiliation(s)
- Robert F Leeman
- Department of Psychiatry, Yale University School of Medicine, Substance Abuse Center, CMHC, 34 Park Street, Room S200, New Haven, CT 06519, USA.
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Walsh SL, Donny EC, Nuzzo PA, Umbricht A, Bigelow GE. Cocaine abuse versus cocaine dependence: cocaine self-administration and pharmacodynamic response in the human laboratory. Drug Alcohol Depend 2010; 106:28-37. [PMID: 19717246 PMCID: PMC2815181 DOI: 10.1016/j.drugalcdep.2009.07.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Revised: 07/28/2009] [Accepted: 07/29/2009] [Indexed: 10/20/2022]
Abstract
Cocaine has high abuse liability but only a subset of individuals who experiment with it develop dependence. The DSM-IV (APA. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-R. American Psychiatric Association, Washington, DC, 2000) provides criteria for diagnosing cocaine abuse and cocaine dependence as distinct disorders- the latter characterized by additional symptoms related to loss of control over drug use. In this study, two groups of cocaine users (n=8/group), matched on demographic factors and length of cocaine use history and meeting criteria for either cocaine abuse (CocAb) or cocaine dependence (CocDep), were compared on (1) measures related to impulsivity and sensation seeking, (2) response to experimenter-administered cocaine (0, 12.5, 25 and 50mg/70 kg, i.v.), and (3) cocaine self-administration using a Relapse Choice and a Progressive Ratio Procedure (0, 12.5 and 25mg/70 kg, i.v.). Groups did not differ on impulsivity or sensation seeking scores. After experimenter-administered cocaine, the CocAb group reported feeling more suspicious and observers rated them significantly higher on unpleasant effects (e.g., irritability, difficulty concentrating). In contrast, the CocDep group reported significantly greater desire for cocaine, which was sustained over the course of the study, and gave higher street value estimates for cocaine (p<0.05). While cocaine self-administration was dose-related and generally comparable across the two procedures, the CocDep users chose to take significantly more cocaine than the CocAb users. These data suggest that, while regular long-term users of cocaine with cocaine abuse or dependence diagnoses cannot be distinguished by trait measures related to impulsivity, they do exhibit significant differences with regard to cocaine-directed behavior and response to cocaine administration.
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Affiliation(s)
- Sharon L. Walsh
- University of Kentucky College of Medicine, Center on Drug and Alcohol Research, Department of Behavioral Science, 515 Oldham Court, Lexington, KY 40502
| | - Eric C. Donny
- University of Pittsburgh, Department of Psychology, 4119 Sennott Square, Pittsburgh, PA 15260
| | - Paul A. Nuzzo
- University of Kentucky College of Medicine, Center on Drug and Alcohol Research, Department of Behavioral Science, 515 Oldham Court, Lexington, KY 40502
| | - Annie Umbricht
- Johns Hopkins University School of Medicine, Behavioral Pharmacology Research Unit, 5510 Nathan Shock Drive, Baltimore, MD 21224
| | - George E. Bigelow
- Johns Hopkins University School of Medicine, Behavioral Pharmacology Research Unit, 5510 Nathan Shock Drive, Baltimore, MD 21224
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