The relationship of pain intensity and opioid craving with delayed methadone dose: A preliminary study of individuals with opioid use disorder

AIMS

Despite a strong theoretical link between opioid craving and pain, little is known about the temporal relationship between pain and craving and the acute experience of pain in the context of methadone treatment. Using a cross-over design, the current study evaluated the time course of pain and craving and objective experience of pain as a function of the last methadone dose.

METHODS

Participants (n = 20) presented for the study in the morning and either received methadone dose as scheduled or delayed dose until the afternoon. During the 4-h study visit, participants completed a series of tasks, including repeated assessment of pain and craving at 0, +40, +70, +130, +160 and +240 min and a cold pressor test (CPT) at +15 and +220 min.

RESULTS

Separate mixed model results demonstrated no effect of dosing condition on craving; however, there was a significant dosing condition by time interaction (F(5,209) = 3.38, P = .006) such that pain increased over time in the delayed methadone condition but decreased in time in the scheduled methadone condition. A mixed model predicting self-reported pain revealed a three-way interaction between dosing condition, craving and time (F(5,197) = 2.39, P = .039) explained by a positive association between craving and pain at each time point (except 240 min) in delayed condition (P-range = .004-.0001). A separate mixed model on CPT data indicated a significant condition by time interaction such that pain threshold decreased in the delayed, but not scheduled, condition (F(1,57) = 4.01, P = .050).

CONCLUSIONS

These preliminary findings highlight the potential for increased risks after even a short delay in receiving a methadone dose.

The influence of negative urgency and mood inductions on alcohol cognitions

BACKGROUND

Negative urgency (NU), the tendency to act rashly during negative emotional states, is a robust risk factor for alcohol misuse that is posited to function in part through alcohol-related cognitions. Nonetheless, relatively little research has examined mood-based fluctuations in such cognitions, which could help to explain how the trait of NU translates to impulsive alcohol-related behaviors. We examined how NU impacted several alcohol cognitions (positive/negative alcohol expectancies, positive/negative alcohol valuations, and alcohol craving for positive/negative emotional reinforcement) before and after negative, neutral, or positive mood inductions. We hypothesized that NU would predict greater and more favorable endorsement of alcohol and its effects following negative (vs. positive or neutral) mood induction.

METHODS

Participants (N = 428) were southern-midwestern college students recruited for an online experiment. Following the provision of consent, participants rated NU and preinduction alcohol cognitions, and were then randomly assigned to one of three (negative, neutral, or positive) mood inductions; subsequently, postinduction alcohol-cognition ratings were immediately obtained. We conducted six robust multilevel linear models (one per DV) examining NU's influence on within-person changes in alcohol cognitions across each mood induction.

RESULTS

No three-way interactions were identified and only one two-way interaction involving NU was identified. There were main effects across mood induction conditions and time points for NU predicting greater endorsement of positive and negative alcohol outcome expectancies, and greater alcohol craving for positive and negative emotional reinforcement.

CONCLUSIONS

Greater NU predicts greater perceived likelihood of alcohol's effects, alongside greater desire for mood improvement from alcohol. The absence of three-way interactive effects indicates NU's influence on mood-dependent fluctuations in alcohol cognitions may manifest over longer timescales (e.g., months and years), involve alternative cognitive processes (e.g., drinking motives and implicit alcohol cognitions), and apply more broadly to desires for mood improvement than purely negative emotional reinforcement.

Weight change in a national cohort of U.S. Military Veterans engaged in medication treatment for opioid use disorder

Medication treatments for opioid use disorder (MOUD) save lives and improve outcomes for countless individuals. However, data suggest the potential for significant weight gain during methadone treatment and little is known about weight change during buprenorphine treatment. Using Veteran Health Administration administrative data from fiscal year 2017 to fiscal year 2019, two cohorts were created: 1) Veterans diagnosed with opioid use disorder (OUD) taking methadone (N = 1425); and 2) Veterans diagnosed with OUD taking buprenorphine (N = 3756). Linear mixed models were used to analyze weight change during the first MOUD treatment episode in the observation period. Random slopes and intercepts were included in the model to estimate variation in BMI across individuals and time. The data revealed a slight upward trend in BMI over the course of treatment. Specifically, a daily increase of 0.004 for Veterans in methadone treatment and 0.002 for Veterans in buprenorphine treatment was observed. This translates to a gain of about 10 pounds over the course of 1 year of methadone treatment and 5 pounds for 1 year of buprenorphine treatment for a Veteran of average height and weight. The amount of weight gain in methadone treatment is significantly less than other published findings, but nonetheless indicates that assessment and discussions between patients and providers related to weight may be warranted.

Distress tolerance, coping motives, and alcohol craving and consumption: Two experiments testing momentary responses to a mood induction

BACKGROUND

The current studies examined the relationship between state and trait distress tolerance (DT), drinking-related variables (alcohol craving and consumption), and the moderating role of drinking to cope with negative affect (i.e., coping motives).

METHODS

Study 1 was a laboratory-based experiment. Participants (n=71) completed measures of trait DT, craving, coping motives, and affect valence prior to a negative mood induction task. Post-mood induction, participants completed measures of affect valence, alcohol craving, and state DT. Next, participants completed an alcohol taste task, measuring alcohol consumption. Study 2 was completed online. Participants (n=592) completed the same pre- and post-mood induction measures as study 1, but were randomized to a mood condition (neutral, negative, or positive). Study 2 did not include alcohol consumption.

RESULTS

Negative mood induction lowered reported affect in both studies. In study 1, higher coping motives predicted increased craving in response to negative mood induction but state and trait DT did not predict craving change alone. Contrary to our hypothesis, individuals with higher coping motives showed a positive relationship between trait DT and craving. Analyses predicting alcohol consumption were not significant. In study 2, lower trait DT predicted post-mood induction craving prior to inclusion of interactions in the model. Higher coping motives were the strongest and most consistent predictor of craving. Other predictors (state DT, mood condition) and interaction terms were not significant.

CONCLUSIONS

Findings broadly align with previous research suggesting that coping motives are predictive of craving and indicate that trait DT may also impact craving.

Trait- and State-Fear of Missing Out: Influences on Alcohol Craving and Drinking Likelihood

OBJECTIVE

A growing body of research implicates Fear of Missing Out (FoMO) as a risk factor for collegiate alcohol use. However, little research has explored the causal mechanisms of this association, which may depend on examining FoMO at both trait and state levels. We therefore examined how predispositions toward experiencing FoMO (i.e., trait-FoMO) interacted with state-level cues indicating that one was "missing out" (i.e., state-FoMO) and cues indicating the presence or absence of alcohol.

METHOD

College students (n = 544) participating in an online experiment completed a measure of trait-FoMO and were then randomly assigned to one of four guided-imagery script conditions (FoMO/Alcohol cue, FoMO/No Alcohol cue, No FoMO/Alcohol cue, No FoMO/No Alcohol cue). Participants then completed measures of alcohol craving and drinking likelihood for the given scenario.

RESULTS

Two hierarchical regressions (one per dependent variable) revealed significant two-way interactions. Greater trait-FoMO demonstrated the strongest, positive associations with alcohol craving following scenarios with FoMO cues present. Reported drinking likelihood was strongest when state-level cues for FoMO and alcohol were both present, moderate when either cue was independently present, and lowest when both cues were absent.

CONCLUSIONS

FoMO's impact on alcohol craving and drinking likelihood varied across trait/state levels. Although trait-FoMO was associated with alcohol craving, state-level cues indicating "missing out" affected both alcohol-related variables and interacted with alcohol cues in imagery scenarios to predict drinking likelihood. Although additional research is needed, targeting psychological variables related to meaningful social connection may reduce collegiate alcohol use with respect to FoMO.

Chronic pain and problematic substance use for veterans during COVID-19: the moderating role of psychological flexibility

Background

Chronic pain and problematic substance use are commonly co-occurring and highly detrimental issues that are especially prevalent in U.S. veteran populations. Although COVID-19 made clinical management of these conditions potentially difficult, some research suggests that certain veterans with these conditions did not experience this period as negatively as others. It is thus important to consider whether resilience factors, such as the increasingly-studied process of psychological flexibility, might have led to better outcomes for veterans managing pain and problematic substance use during this time of global crisis.

Methods

This planned sub-analysis of a larger cross-sectional, anonymous, and nationally-distributed survey (N = 409) was collected during the first year of the COVID-19 pandemic. Veteran participants completed a short screener and battery of online surveys assessing pain severity and interference, substance use, psychological flexibility, mental health functioning, and pandemic-related quality of life.

Results

For veterans with chronic pain and problematic substance use, the pandemic resulted in a significant lowering of their quality of life related to meeting basic needs, emotional health, and physical health compared to veterans with problematic substance use but no chronic pain diagnosis. However, moderation analyses revealed that veterans with these comorbid conditions experienced less negative impacts from the pandemic on quality of life and mental health when they reported greater psychological flexibility. For veterans with problematic substance use only, psychological flexibility was also related to better mental health functioning, but did not significantly correlate with their quality of life.

Conclusion

Results highlight how COVID-19 differentially impacted veterans with both problematic substance use and chronic pain, such that this group reported particularly negative impacts of the pandemic on multiple areas of quality of life. However, our findings further emphasize that psychological flexibility, a modifiable resiliency process, also buffered against some of the negative impacts of the pandemic on mental health and quality of life. Given this, future research into the impact of natural crises and healthcare management should investigate how psychological flexibility can be targeted to help increase resiliency for veterans with chronic pain and problematic substance use.

Bystander Intoxication and Appraisal of Sexual Assault Risk: A Field Study of Emerging Adult Bargoers

Emerging adults are especially vulnerable to experiencing alcohol-related sexual assault. While bystanders play a critical role in preventing sexual assault, little is known about how bystander alcohol intoxication affects the intervention process-particularly in naturalistic settings. We recruited 315 emerging adult bargoers ages 21-29 (46% women; 28% non-college attending; 81% White) from a high-density bar area to provide responses to a sexual assault vignette and complete a breath alcohol concentration test. In this field-based study, we found a negative direct association between intoxication and appraisal of risk in the hypothetical sexual assault situation. We also found a negative indirect relation of intoxication on perceptions of personal responsibility to intervene and confidence in the ability to intervene, statistically mediated through reduced risk appraisal. Findings add to the limited literature in laboratory-based settings suggesting that bystander intoxication interferes with sexual assault intervention and help inform effective bystander intervention programming for emerging adults.

Cocaine Use Disorder (CUD): Current Clinical Perspectives

Cocaine use disorder (CUD) is a devastating disorder, impacting both individuals and society. Individuals with CUD face many barriers in accessing treatment for CUD, and most individuals with CUD never receive treatment. In this review, we provide an overview of CUD, including risk factors for CUD, common co-occurring disorders, acute and chronic effects of cocaine use, and currently available pharmacological and behavioral treatments. There are no FDA-approved pharmacological treatments for CUD. Future studies with larger sample sizes and testing treatment combinations are warranted. However, individuals with CUD and co-occurring disorders (eg, a mood or anxiety disorder) may benefit from medication treatments. There are behavioral interventions that have demonstrated efficacy in treating CUD – contingency management (CM) and cognitive-behavioral therapy for substance use disorders (CBT-SUD) in particular – however many barriers remain in delivering these treatments to patients. Following the discussion of current treatments, we highlight some promising emerging treatments, as well as offer a framework that can be used in building a treatment plan for individuals with CUD.

Subjective stress and alcohol use among young adult and adult drinkers: Systematic review of studies using Intensive Longitudinal Designs

Background: Understanding how stress dynamically associates with alcohol use could provide a finer-grain resolution of drinking behavior, facilitating development of more effective and personalized interventions. The primary aim of this systematic review was to examine research using Intensive Longitudinal Designs (ILDs) to determine if greater naturalistic reports of subjective stress (e.g., those assessed moment-to-moment, day-to-day) in alcohol-drinkers associated with a) greater frequency of subsequent drinking, b) greater quantity of subsequent drinking, and c) whether between-/within-person variables moderate or mediate any relationships between stress and alcohol use. Methods: Using PRISMA guidelines, we searched EMBASE, PubMed, PsycINFO, and Web of Science databases in December 2020, ultimately identifying 18 eligible articles, representing 14 distinct studies, from a potential pool of 2,065 studies. Results: Results suggested subjective stress equivocally predicted subsequent alcohol use; in contrast, alcohol use consistently demonstrated an inverse relationship with subsequent subjective stress. These findings remained across ILD sampling strategy and most study characteristics, except for sample type (treatment-seeking vs. community/collegiate). Conclusions: Results appear to emphasize the stress-dampening effects of alcohol on subsequent stress levels and reactivity. Classic tension-reduction models may instead be most applicable to heavier-drinking samples and appear nuanced in lighter-drinking populations, and may depend on specific moderators/mediators (e.g., race/ethnicity, sex, relative coping-strategy use). Notably, a preponderance of studies utilized once-daily, concurrent assessments of subjective stress and alcohol use. Future studies may find greater consistency by implementing ILDs that integrate multiple within-day signal-based assessments, theoretically-relevant event-contingent prompts (e.g., stressor-occurrence, consumption initiation/cessation), and ecological context (e.g., weekday, alcohol availability).

Negative urgency as a risk factor for hazardous alcohol use: Dual influences of cognitive control and reinforcement processing

Negative Urgency (NU) is a prominent risk factor for hazardous alcohol use. While research has helped elucidate how NU relates to neurobiological functioning with respect to alcohol use, no known work has contextualized such functioning within existing neurobiological theories in addiction. Therefore, we elucidated mechanisms contributing to the NU-hazardous alcohol use relationship by combining NU theories with neurobiological dual models of addiction, which posit addiction is related to cognitive control and reinforcement processing. Fifty-five undergraduates self-reported NU and hazardous alcohol use. We recorded EEG while participants performed a reinforced flanker task. We measured cognitive control using N2 activation time-locked to the incongruent flanker stimulus, and we measured reinforcement processing using the feedback-related negativity (FRN) time-locked to better-than-expected negative reinforcement feedback. We modeled hazardous drinking using hierarchical regression, with NU, N2, and FRN plus their interactions as predictors. The regression model significantly predicted hazardous alcohol use, and the three-way interaction (NU × N2 × FRN) significantly improved model fit. In the context of inefficient processing (i.e., larger N2s and FRNs), NU demonstrated a strong relationship with hazardous alcohol use. In the context of efficient processing (i.e., smaller N2s and FRNs), NU was unrelated to hazardous alcohol use. Control analyses ruled out the potential impact of other impulsivity subscales, individual differences in dimensional negative affect or anxiety, and use of substances other than alcohol, and post hoc specificity analyses showed that this effect was driven primarily by heavy drinking, rather than frequency of drinking. This analysis provides preliminary evidence that brain mechanisms of cognitive control and reinforcement processing influence the relationship between NU and hazardous alcohol use, and confirms a specific influence of negative reinforcement processing. Future clinical research could leverage these neurobiological moderators for substance misuse treatment.

Negative urgency and alcohol-related problems: indirect links with alcohol expectancies and drinking motives

BACKGROUND

Negative Urgency (NU), the tendency to act rashly during negative emotional states, is associated with alcohol misuse through various alcohol cognitions; however, these relationships are often examined in isolation and exclude certain alcohol cognitions. Objective: This study simultaneously modeled NU's association with alcohol-related problems through (a) beliefs about the likelihood of experiencing positive or negative effects from alcohol (i.e., expectancies), (b) desirability of alcohol's positive or negative effects (i.e., valuations), and (c) reasons for consuming alcohol (i.e., drinking motives). Methods: Participants (N = 565) completed measures of NU, expectancies, valuations, drinking motives, and alcohol problems online. Results: NU was indirectly associated with alcohol-related problems through coping motives, positive expectancies, and enhancement motives. Despite a positive association between NU and negative valuations, NU was not associated with alcohol-related problems through valuations. Conclusions: These results further researchers' understanding of how NU is associated with modifiable alcohol cognitions, with clear implications for informing treatment and future research.

Incorporating telehealth into health service psychology training: A mixed-method study of student perspectives

OBJECTIVE

Telehealth is increasingly recognized as an avenue for enhancing psychologists' capacities to meet the mental health needs of a diverse and underserved (due to barriers e.g., distance, transportation) public. The present study sought to inform training in telepsychology (i.e., telehealth delivery of psychological services) by using both quantitative and qualitative methods to explore the perspectives of doctoral students who have already been involved in such training.

METHOD

A total of 19 predoctoral students from two universities, with at least some experience in telepsychology training, provided their perspectives on two complementary research questions: (1) How do students perceive their level of competence in various domains of telepsychology?; and (2) What are students' perspectives on the process of telepsychology competency development during their doctoral training?

RESULTS

The results of our study provide early evidence that doctoral trainees are able to develop telepsychology competencies and suggest that a supportive, training-oriented environment and fit between telepsychology and existing programmatic areas of emphasis are likely key to success.

CONCLUSIONS

Continued efforts to enhance training in providing telepsychology services should focus on how to best define, measure, and promote competency development in this emerging specialty area.

Effect of Alcohol Intoxication on Bystander Intervention in a Vignette Depiction of Sexual Assault

OBJECTIVE

Alcohol-related sexual violence remains a public health problem. Despite the popularity of sexual assault bystander intervention programs, these may be limited in addressing bystander intoxication because the effects of intoxication on intervening in a sexual assault are unknown. Therefore, we tested the effects of alcohol intoxication on the five steps of bystander intervention in a sexual assault vignette.

METHOD

Young adults (N = 128; 50% women) were randomly assigned to consume alcohol (target blood alcohol concentration = 0.08%; n = 64) or a nonalcoholic control beverage (n = 64) in a bar-laboratory. Next, participants were presented with a vignette describing events occurring in a convivial drinking context that ends with nonconsensual sexual behavior. Latané and Darley's bystander intervention model steps were assessed in a semistructured interview.

RESULTS

Participants in the control condition recalled the story more accurately (Step 1: notice the event) and reported greater risk/need for intervention (Step 2), but they did not differ on the latter three steps of bystander intervention compared with alcohol-condition participants. Intoxication effects were similar for men and women. Furthermore, risk/need for intervention (Step 2) partially mediated the effect of alcohol condition on personal responsibility (Step 3) and relative benefits versus costs from intervening (Step 4).

CONCLUSIONS

Prevention programs should consider the effects of alcohol on detecting a sexual assault and the need to intervene. If intoxicated bystanders do not detect a sexual assault, then bystanders will not reach the crucial steps (i.e., taking responsibility for intervening; willingness and ability to intervene) required to intervene successfully.

Effect of Alcohol Intoxication on Bystander Intervention in a Vignette Depiction of Sexual Assault

OBJECTIVE

Alcohol-related sexual violence remains a public health problem. Despite the popularity of sexual assault bystander intervention programs, these may be limited in addressing bystander intoxication because the effects of intoxication on intervening in a sexual assault are unknown. Therefore, we tested the effects of alcohol intoxication on the five steps of bystander intervention in a sexual assault vignette.

METHOD

Young adults (N = 128; 50% women) were randomly assigned to consume alcohol (target blood alcohol concentration = 0.08%; n = 64) or a nonalcoholic control beverage (n = 64) in a bar-laboratory. Next, participants were presented with a vignette describing events occurring in a convivial drinking context that ends with nonconsensual sexual behavior. Latané and Darley's bystander intervention model steps were assessed in a semistructured interview.

RESULTS

Participants in the control condition recalled the story more accurately (Step 1: notice the event) and reported greater risk/need for intervention (Step 2), but they did not differ on the latter three steps of bystander intervention compared with alcohol-condition participants. Intoxication effects were similar for men and women. Furthermore, risk/need for intervention (Step 2) partially mediated the effect of alcohol condition on personal responsibility (Step 3) and relative benefits versus costs from intervening (Step 4).

CONCLUSIONS

Prevention programs should consider the effects of alcohol on detecting a sexual assault and the need to intervene. If intoxicated bystanders do not detect a sexual assault, then bystanders will not reach the crucial steps (i.e., taking responsibility for intervening; willingness and ability to intervene) required to intervene successfully.