Psychosocial predictors of impulsivity in alcohol-dependent patients

High peak drinking levels mediate the relation between impulsive personality and injury risk in emerging adults

BACKGROUND

Alcohol-induced injury is one of the leading causes of preventable morbidity and mortality. We investigated the relationship between impulsive personality and physical injury (e.g. falls, sports), and whether peak drinking quantity specifically, and/or risky behaviour more generally, mediates the relationship between impulsivity and injury in undergraduates.

METHOD

We used data from the winter 2021 UniVenture survey with 1316 first- and second-year undergraduate students aged 18-25 years (79.5% female) from five Canadian Universities. Students completed an online survey regarding their demographics, personality, alcohol use, risky behaviours, and injury experiences. Impulsivity was measured with the substance use risk profile scale, past 30-day peak alcohol use with the quantity-frequency-peak Alcohol Use Index, general risky behaviour with the risky behaviour questionnaire, and past 6-month injury experience with the World Health Organization's (2017) injury measurement questionnaire.

RESULTS

Of 1316 total participants, 12.9% (n = 170) reported having sustained a physical injury in the past 6 months. Mean impulsivity, peak drinking quantity, and risky behaviour scores were significantly higher among those who reported vs. did not report injury. Impulsivity and peak drinking quantity, but not general risky behaviour, predicted injury in a multi-level generalized mixed model. Mediation analyses supported impulsivity as both a direct predictor of physical injury and an indirect predictor through increased peak drinking (both p < .05), but not through general risky behaviour.

CONCLUSION

Results imply emerging adults with impulsive tendencies should be identified for selective injury prevention programs and suggest targeting their heavy drinking to decrease their risk for physical injury.

Correlates of impulsivity among female sex workers in Mexico

Impulsivity is a trait characteristic that is associated with sexual risk behavior. We examined correlates of impulsivity among 602 female sex workers (FSWs) enrolled in a sexual risk reduction intervention in Mexico (2016-2020). Impulsivity was positively associated with condomless sex with clients. Higher levels of impulsivity were associated with greater use of alcohol and heavy drugs, use of illicit drugs with clients, sexual/physical abuse history, and clinical depression. Global public health policy that supports free substance abuse treatment in combination with psychotherapeutic treatments (e.g. regulation management skills) and behavioral-focused therapy may help to reduce HIV/STI incidence in this vulnerable population.

Validation of a short Italian version of the Barratt Impulsiveness Scale (BIS-15) in non-clinical subjects: psychometric properties and normative data

INTRODUCTION

The Barratt Impulsiveness Scale (BIS) is a questionnaire employed to measure impulsivity, which is associated with risky behaviors and mental disorders. We aimed to assess the psychometric properties of the BIS in the Italian general population and provide normative data for clinical use.

MATERIALS AND METHODS

A cross-sectional survey methodology was employed to collect data. Then, 534 participants of different ages and educational levels completed the BIS, PHQ-9, GAD-7, and S-UPPS-P. We designed an ad hoc data-driven outcome checklist to identify which items deserved to be retained. Furthermore, internal consistency, convergent and divergent validity, and factorial structure were evaluated. A regression-based procedure was used to explore the influence of demographic variables on the BIS score and to provide adjusting factors and a sensitive cutoff.

RESULTS

Item analysis suggested removing 15 items. Consequently, we tested the psychometric properties of a shorter version of the BIS (BIS-15). IRT test information functions indicated an almost identical measurement precision of the BIS-15 as compared to the original BIS. The BIS-15 demonstrated reliable internal consistency and good convergent and divergent validity. The PCA revealed a four-factor solution: "pure impulsivity," "planning and thinking," "lack of attention and concentration," and "impulsive buying." A significant effect of sex and years of education was found. Norms for the adjustment of raw scores were provided (cutoff = 37.39).

CONCLUSIONS

The BIS-15 showed almost identical psychometric properties as compared with the original scale, reducing the administration time. Our norms may allow identifying individuals with impulsivity of clinical interest.

Delta resting-state functional connectivity in the cognitive control network as a prognostic factor for maintaining abstinence: An eLORETA preliminary study

BACKGROUND

Cortical regions that support cognitive control are increasingly well recognized, but the functional mechanisms that promote such control over emotional and behavioral hyperreactivity to alcohol in recently abstinent alcohol-dependent patients are still insufficiently understood. This study aimed to identify neurophysiological biomarkers of maintaining abstinence in alcohol-dependent individuals after alcohol treatment by investigating the resting-state EEG-based functional connectivity in the cognitive control network (CCN).

METHODS

Lagged phase synchronization between CCN areas by means of eLORETA as well as the Barratt Impulsiveness Scale (BIS-11) and Beck Depression Inventory (BDI) were assessed in abstinent alcohol-dependent patients recruited from treatment centers. A preliminary prospective study design was used to classify participants into those who did and did not maintain abstinence during a follow-up period (median 12 months) after discharge from residential treatment.

RESULTS

Alcohol-dependent individuals, who maintained abstinence (N = 18), showed significantly increased lagged phase synchronization between the left dorsolateral prefrontal cortex (DLPFC) and the left posterior parietal cortex (IPL) as well as between the right anterior insula cortex/frontal operculum (IA/FO) and the right inferior frontal junction (IFJ) in the delta band compared to those who later relapsed (N = 16). Regression analysis showed that the increased left frontoparietal delta connectivity in the early period of abstinence significantly predicted maintaining abstinence over the ensuing 12 months. Furthermore, right frontoinsular delta connectivity correlated negatively with impulsivity and depression measures.

CONCLUSIONS

These results suggest that the increased delta resting-state functional connectivity in the CCN may be a promising neurophysiological predictor of maintaining abstinence in individuals with alcohol dependence.

The Neural Processes Interlinking Social Isolation, Social Support, and Problem Alcohol Use

BACKGROUND

Subjective feeling of social isolation, as can be measured by perceived burdensomeness (PB), is a major risk factor for alcohol misuse. Heightened PB is associated with elevated stress response and diminished cognitive control, both of which contribute to problem drinking. Here, we sought to identify the neural substrates underlying the relationship between PB and alcohol misuse.

METHODS

We employed resting-state functional magnetic resonance imaging data collected from 61 problem drinkers to characterize the functional connectivity of the hypothalamus and ventral striatum (VS) in relation to PB. We specifically examined whether the connectivities of the hypothalamus and VS were differentially influenced by PB to produce contrasting effects on alcohol use. Finally, we evaluated how individual differences in social support modulate the inter-relationships of social isolation, neural connectivity, and the severity of problem drinking.

RESULTS

Whole-brain multiple regressions show a positive relationship between PB and hypothalamic connectivity with the hippocampus and an inverse pattern for VS connectivity with the middle frontal gyrus. Difference in strength between the 2 connectivities predicted the severity of problem drinking, suggesting an imbalance involving elevated hypothalamic and diminished prefrontal cortical modulation in socially isolated problem drinkers. A path analysis further revealed that the lack of social support was associated with a bias toward low prefrontal connectivity, which in turn increased PB and facilitated problem drinking.

CONCLUSIONS

Altered hypothalamus and VS connectivity may underlie problem drinking induced by social isolation. The current findings also highlight the important role of social support as a potential protective factor against alcohol misuse.

Childhood Maltreatment and Impulsivity: A Meta-Analysis and Recommendations for Future Study

Both childhood maltreatment and impulsivity have been implicated in a broad array of negative public health outcomes and have been much studied in relation to each other. Characterizing this relationship, and the processes underlying it, are important for informing intervention efforts targeting this association and its psychopathological sequelae. The current review presented a systematic meta-analysis of the empirical literature on childhood maltreatment and impulsivity. In all, 55 eligible studies were identified and included in this review. General support was found for a positive association between childhood maltreatment, including its specific subtypes, and general trait impulsivity, with pooled effect sizes ranging from small in the case of childhood sexual abuse (OR = 1.59 [95% CI = 1.38-1.84]) to medium-to-large in the case of childhood emotional abuse (OR = 3.10 [95% CI = 2.27-4.23]). Support for a relationship between childhood maltreatment and laboratory-based measures of impulsive behavior was generally lacking. The current findings must be interpreted with a degree of caution, given several methodological limitations characterizing much of the empirical literature. Recommendations for addressing these limitations and directions for future research are provided.

Ethanol induces maladaptive impulse control and decreased seeking behaviors in mice

Waiting impulsivity is a risk factor for many psychiatric disorders including alcohol use disorder (AUD). Highly impulsive individuals are vulnerable to alcohol abuse. However, it is not well understood whether chronic alcohol use increases the propensity for impulsive behavior. Here, we establish a novel experimental paradigm demonstrating that continuous binge-like ethanol exposure progressively leads to maladaptive impulsive behavior. To test waiting impulsivity, we employed the 5-choice serial reaction time task (5-CSRTT) in C57BL/6J male mice. We assessed premature responses in the fixed and variable intertrial interval (ITI) 5-CSRTT sessions. We further characterized our ethanol-induced impulsive mice using Open Field, y-maze, two-bottle choice, and an action-outcome task. Our results indicate that continuous binge-like ethanol exposure significantly increased premature responses when mice were tested in variable ITI sessions even during a prolonged abstinent period. Ethanol-induced impulsive mice exhibited anxiety-like behavior during chronic exposures. This behavior was also observed in a separate cohort that was subjected to 20 days of abstinence. Ethanol-treated mice were less motivated for a sucrose reward compared with air-exposed control mice, while also demonstrating reduced responding during action-outcome testing. Overall, ethanol-treated mice demonstrated increased impulsive behavior, but a reduced motivation for a sucrose reward. Although waiting impulsivity has been hypothesized to be a trait or risk factor for AUD, our findings indicate that maladaptive impulse control can also be potentiated or induced by continuous chronic ethanol exposure in mice.

The Role of Impulsivity Facets on the Incidence and Development of Alcohol Use Disorders

Alcohol Use Disorder (AUD) is a chronic relapsing disorder defined according to the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5; American Psychiatric Association 2013), "by a cluster of behavioural and physical symptoms, which can include, withdrawal, tolerance and craving". Social, emotional, behavioural and cognitive factors are important contributors to AUD. Impulsivity, a multifaceted behavioural concept, defined as a predisposition for rapid and unplanned actions, without considering potential negative consequences of these actions, represents an important such factor. In this chapter, research on the role of distinct impulsivity dimensions in different severity stages of alcohol use is presented.Increased self-reported (trait) impulsivity and an inability to wait, as well as difficulty to adjust behaviour appropriately following a failure to withhold a response are observed across the spectrum of alcohol-use severities. Research on temporal impulsivity (inability to delay gratification) consistently shows deficits in more severe alcohol users. Data on temporal impulsivity in early stages of alcohol use are less consistent, with some studies showing no differences between high and moderate drinkers, while others indicating increased impulsivity in high alcohol users. Data on reflexion impulsivity are currently limited to draw conclusions. Recent research is also presented suggesting the importance of perception and interpretation of physiological and emotional signals on alcohol use behaviour highlighting the necessity of comprehensive integration of the field of the study of emotion and interoception with impulsivity research.

Influence of socio-cultural factors on the emotional problems among college going young-adult children of parents with alcoholism: A study from South India

Young-adult children of parents with alcoholism are vulnerable to anxiety and depression. We studied the prevalence of emotional psychopathology and examined the mediating role of environmental factors (family support, community support and participation in religious rituals) in relation to psychopathology. College students (N = 1555), aged 18-24 years, from urban and rural domicile were screened on Children of Alcoholics Screening Test (CAST) and those who were positive were assessed for emotional psychopathology on Depression, Anxiety and Stress Scale (DASS-21). Young-adult children of alcoholics with emotional psychopathology were compared with those without emotional psychopathology on demographic characteristics, quality of life, and a questionnaire which measured the role of socio-cultural factors. 33% (N = 512) of 1555 participants screened were found to be Young-adult children of alcoholics. Among them, 35% (N = 181) reported experiencing emotional psychopathology. Participants with high emotional psychopathology reported receiving less support from the family (8.44 ± 1.19 vs 9.57 ± 1.26, p = 0.003), community (6.97 ± 1.08 vs 8.88 ± 1.19, p = 0.001); they participated less in religious rituals (5 ± 0.18 vs 6.56 ± 0.41, p = 0.008) compared to those without psychopathology. Quality of life was significantly lower among Young-adult children of alcoholics with emotional psychopathology. A considerable proportion of Young-adult children of alcoholics reported emotional psychopathology and their quality of life was poor. The modifiable socio-cultural factors such as family, community support and participation in religious rituals were associated with emotional psychopathology. A better utilization of these factors may mitigate the burden of emotional psychopathology and improve quality of life in this vulnerable group.

Validation of the Barratt Impulsiveness Scale- short form among Indian adolescents

BACKGROUND

Impulsivity is widely assessed with a 30 item self-report measure known as the Barrratt Impulsiveness Scale (BIS-11). Further development involved creation of an abbreviated version, called Barratt Impulsiveness Scale- short form (BIS-15; Spinella, 2007) from the original BIS-11. Unlike the original BIS-11, BIS-15 has not undergone sufficient cross cultural validation especially among the adolescent population.

AIM

To evaluate the factor structure and psychometric properties of BIS-15 among school and college attending Indian adolescents.

METHOD

A total of 1806 adolescents (females = 48%, mean age = 17.14 years) completed BIS-15 questionnaire, strengths and difficulties questionnaire (SDQ) and a risk taking questionnaire that assessed adolescents level of involvement in two protypical risky behaviours- substance use and unsafe sexual behaviours.

RESULTS

The results of the principal component analysis of BIS-15 items revealed a three factor structure: attentional, motor and non-planning impulsivity. The internal consistency of BIS-15 was 0.79. The total score on BIS-15 was significantly associated with the externalizing, internalizing and total difficulty score on SDQ. Significant associations were observed between BIS-15 total impulsivity score and the level of risk taking among adolescents. Further, the results also revealed gender variance in impulsivity scores where male adolescents scored higher on attentional and non-planning impulsivity as compared to female adolescents.

CONCLUSION

BIS-15 is a reliable measure of impulsivity that can be used with Indian adolescent population. It would be particularly more suitable for use in settings that require comprehensive assessment of trait impulsivity in shorter time duration and without burdening the participants.

Impulsivity and its relationship with anxiety, depression and stress

We aimed to assess the association between depression, anxiety, stress and impulsivity with respect to age. The Depression, Anxiety and Stress Scale (DASS-42) and the Barratt Impulsiveness Scale (BIS-11) were administered to 145 individuals. Due to a negative correlation between age, BIS-11 and DASS-42 subscales, participants were divided into three groups: young-aged (18-30years), middle-aged (31-49years) and old-aged (≥50years). Subjects from old-aged group had significantly lower scores of depression, anxiety, stress and impulsivity compared to those from younger groups. Anxiety, followed by stress and depression, was the strongest predictor of BIS-11 total score in young-aged and middle-aged individuals. There were no significant differences in the correlations between BIS-11 total score, depression, anxiety and stress in old-aged individuals. Our results indicate that the levels of depression, anxiety, stress and impulsivity decrease with age. Additionally, age might moderate the effect of depression, anxiety and stress on impulsivity.

Impulsive behavior and its correlates among patients with schizophrenia in a tertiary care psychiatry setting in Mansoura

BACKGROUND AND OBJECTIVES

Impulsive behavior has been repeatedly identified as a major problem in schizophrenia. Our objective was to examine the possible demographical and clinical correlates for impulsive behavior in patients with schizophrenia.

METHODS

Fifty-eight patients with schizophrenia and Seventy-seven healthy controls were recruited. Sociodemographic data were collected and they were subjected to the Barratt Impulsiveness Scale (BIS), Positive and Negative Syndrome scale (PANSS), and Trauma Assessment for Adults-Brief Revised Version (TAA).

RESULTS

Correlations between impulsive behavior and psychosocial variables were examined. A significant association between level of impulsive behavior and severity of psychopathological symptoms was observed (P=0.0001). Young age (P=0.001), male patients (P=0.0001) and those with history of childhood sexual or physical abuse (P=0.0001), were more impulsive. Linear regression (step wise) analysis model showed that male sex (P=0.001), positive symptoms (P=0.006), and childhood physical abuse (P=0.001) were significant associations.

CONCLUSION

Male gender, positive symptoms as well as history of physical and sexual abuse before 18 years of age are important predictors for high levels of impulsive behavior in schizophrenia patients.

Genetic Polymorphism in the Promoter Region of Serotonin Transporter: Implications for Ethanol Abuse in Children and Adolescents

OBJECTIVES

To provide a review of published literature regarding genetic polymorphism of serotonin transporter gene, named as 5-HTTLPR, and its potential role as a susceptibility marker for ethanol abuse in childhood and adolescence.

METHODS

A literature review of several databases was conducted with the following keywords: 5-HTTLPR, children or adolescents or teenagers, susceptibility, alcohol or ethanol, abuse or misuse.

RESULTS

Alcohol interacts with serotonergic synaptic transmission in several ways, and the reduced availability of serotonin transporters might foster brain dysfunction, driving to alcohol abuse. The initial use of ethanol in children and adolescents is determined primarily by environmental influences, whereas the establishment of drinking patterns is strongly controlled by genetic factors. Functional polymorphic variants in the promoter region of the 5-HTTLPR gene have age-dependent effects in alcohol abuse. This polymorphism, mapped to the 5' region of the SLC6A4, is a variable number of tandem repeats (VNTR) and involves a direct repeat of 20-23 base pairs GC-rich sequences, comprising a short (S) allele, consisting of 14 repeats, and a long (L) allele, with 16 repeats. Additional variants have been described, although their influences on childhood and adolescence ethanol use are not clear.

CONCLUSION

The influence of the 5-HTTLPR allelic variants in children and adolescent misuse of alcohol might be considered for clinical management, preventing long-term behavior problem. Identifying genetic markers associated to the potential alcohol misuse or abuse could be useful in guiding management and formulating effective coping strategies.

Impulsive choice and anxiety-like behavior in adult rats exposed to chronic intermittent ethanol during adolescence and adulthood

Binge drinking during adolescence and adulthood may have differential long-term effects on the brain. We investigated the long-term effects of chronic intermittent ethanol (CIE) exposure during adolescence and adulthood on impulsivity and anxiety-like behavior. Adolescent (adolescent-exposed) and adult (adult-exposed) rats were exposed to CIE/water on postnatal days (PND) 28-53 and PND146-171, respectively, and a 4-day ethanol/water binge on PND181-184 and PND271-274, respectively. During withdrawal from CIE and 4-day binge exposures, anxiety-like behavior and arousal were measured in the light-potentiated startle (LPS) and acoustic startle (ASR) procedures, respectively. Impulsive choice was evaluated in the delay discounting task (DDT) at baseline and after ethanol challenges. Independent of age, ASR and LPS were decreased during withdrawal from CIE exposure. In contrast, LPS was increased in adult-exposed, but not adolescent-exposed, rats during withdrawal from the 4-day ethanol binge. CIE exposure had no effect on preference for the large delayed reward at baseline, independent of age. During DDT acquisition, CIE-exposed, compared with water-exposed rats, omitted more responses, independent of age, suggesting the CIE-induced disruption of cognitive processes. Ethanol challenges decreased preference for the large reward in younger adolescent-exposed rats but had no effect in older adult-exposed rats, independent of previous CIE/water exposure. Taken together, the present studies demonstrate that CIE withdrawal-induced decreases in anxiety and arousal were not age-specific. CIE exposure had no long-term effects on baseline impulsive choice. Subsequent ethanol exposure produced age-dependent effects on impulsivity (increased impulsivity in younger adolescent-exposed rats) and anxiety-like behavior (increased anxiety-like behavior in older adult-exposed rats).

The impact of self-reported life stress on current impulsivity in cocaine dependent adults

Current cocaine treatments may be enhanced with a better understanding of the underlying mechanisms that contribute to the onset and maintenance of the disease, such as life stress and impulsivity. Life stress and impulsivity have previously been studied independently as contributors to drug use, and the current study expands upon past research by examining how these factors interact with one another. The aim of the current study was to evaluate the role of life stress in predicting impulsivity in a non-treatment seeking cocaine-dependent sample (N=112). Analyses revealed that trait impulsivity (as measured by the Barratt Impulsiveness Scale) was associated with education (r=-3.09, p<0.01), as those who had higher educational attainment also reported lower rates of trait impulsivity. In addition, those over the age of 30 demonstrated lower impulsivity in decision-making (as measured by delay discounting) than those under 30 (t=2.21, p=0.03). Overall exposure to life stress was not significantly correlated to either aspect of impulsivity. However several specific life stressors were significantly related to greater impulsivity including having been put up for adoption or in foster care (t=-2.96, p<0.01), and having a child taken away against their will (t=-2.68, p=0.01). These findings suggest that age and education relate to impulsivity; and that while an overall compilation of life stress scores was not related to impulsivity, specific types of stress related to either being taken away from a parent or having a child taken away were. Future studies should assess these constructs longitudinally to restrict response bias.