1
|
Kane L, Baucom DH, Daughters SB. Dual-substance use disorder couples: An integrative review and proposed theoretical model. Clin Psychol Rev 2024; 111:102447. [PMID: 38781717 DOI: 10.1016/j.cpr.2024.102447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/17/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
Committed romantic relationships between two individuals with Substance Use Disorder (or dual-SUD couples) are prevalent. Dual-SUD couples have poor treatment engagement and outcomes. Research has established a reciprocal link between relationship dynamics (e.g., conflict, intimacy) and substance use. Thus, the couple's relationship presents a distinct social context for both partner's substance use. Dual-SUD couples face unique challenges due to substance use being a shared behavior that may serve as a rewarding source of compatibility, closeness, and short-term relationship satisfaction despite it being at the cost of other alternative sources of substance-free reinforcement. Yet, treatment options for these couples are scarce. Dual-maladaptive health behaviors (e.g., dual-substance use) are challenging to treat; however, theory and preliminary research suggests that transformation of couple's joint motivation toward adaptive health behavior change may result in a more satisfying relationship and improved treatment outcomes for both individuals. The current paper reviews the extant literature on dual-SUD couples from theoretical, empirical, and treatment research and proposes an expanded paradigm regarding how we understand dual-SUD couples with the aim of informing basic research and treatment development.
Collapse
Affiliation(s)
- Louisa Kane
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, USA.
| | - Donald H Baucom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, USA
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, USA
| |
Collapse
|
2
|
Kane L, Benson K, Stewart ZJ, Daughters SB. The impact of spiritual well-being and social support on substance use treatment outcomes within a sample of predominantly Black/African American adults. J Subst Use Addict Treat 2024; 158:209238. [PMID: 38061630 PMCID: PMC10947916 DOI: 10.1016/j.josat.2023.209238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/22/2023] [Accepted: 11/30/2023] [Indexed: 03/18/2024]
Abstract
INTRO Substance use and associated problems often return following treatment for substance use disorder (SUD), which disproportionally impact Black/African American (AA) individuals. Social support and spiritual well-being are sources of recovery capital identified as particularly important among Black/AA adults. Social support and spiritual well-being are also posited mechanisms in 12-step; thus, this study tested the effects of social support and spiritual well-being on substance use outcomes over time, distinct from 12-step involvement, among Black/AA adults post-SUD treatment. The study hypothesized that social support and spiritual well-being would demonstrate significant interactions with time, respectively, on substance use frequency and substance use consequences, above the effect of 12-step involvement. METHOD The study drew data from a study of 262 adults (95.4 % Black/AA) entering residential SUD treatment (NCT#01189552). Assessments were completed at pretreatment and at 3-, 6-, and 12-months posttreatment. Two generalized linear mixed models (GLMM) tested the effects of social support and spiritual well-being, above the effect of 12-step involvement, on substance use frequency and substance use consequences over the course of 12-months posttreatment. RESULTS Higher spiritual well-being predicted significantly less frequent substance use during recovery (β = 0.00, p = .03). Greater 12-step involvement predicted significantly fewer substance use consequences during recovery (β = 0.00, p = .02). In post hoc analyses the effect of spiritual well-being and 12-step involvement dissipated by 3.5- and 6.6-months posttreatment, respectively. The study found no significant effects of social support over time. DISCUSSION Spiritual well-being and 12-step involvement are associated with lower substance use and substance use consequences, respectively, in the early months of posttreatment recovery among Black/AA adults. These findings contribute to the growing recovery capital literature informing paths to recovery and sources of support outside of 12-step affiliation. However, these effects diminish over time.
Collapse
Affiliation(s)
- Louisa Kane
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States of America.
| | - Katherine Benson
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States of America
| | - Zachary J Stewart
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States of America
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States of America
| |
Collapse
|
3
|
Hsu PC, Daughters SB, Bauer MA, Su LJ, Addicott MA. Association of DNA methylation signatures with cognitive performance among smokers and ex-smokers. Tob Induc Dis 2023; 21:106. [PMID: 37605769 PMCID: PMC10405227 DOI: 10.18332/tid/168568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Alterations in DNA methylation profiles have been associated with cancer, and can be influenced by environmental factors such as smoking. A small but growing literature indicates there are reproducible and robust differences in methylation levels among smokers, never smokers, and ex-smokers. Here, we compared differences in salivary DNA methylation levels among current and ex-smokers (at least 2 years abstinent). METHODS Smokers (n=26) and ex-smokers (n=30) provided detailed smoking histories, completed the Paced Auditory Serial Addition Test (PASAT), and submitted a saliva sample. Whole-genome DNA methylation from saliva was performed, and ANCOVA models and a receiver operating characteristic (ROC) curve were used for the differences between groups and the performance of significant CpG sites. RESULTS After controlling for race, age, and gender, smokers had significantly lower methylation levels than ex-smokers in two CpG sites: cg05575921 (AHRR) and cg21566642 (ALPPL2). Based on the ROC analyses, both CpGs had strong classification potentials (cg05575921 AUC=0.97 and cg21566642 AUC=0.93) in differentiating smoking status. Across all subjects, the percent methylation of cg05575921 (AHRR) and cg21566642 (ALPPL2) positively correlated with the length of the last quit attempt (r=0.65 and 0.64, respectively, p<0.001) and PASAT accuracy (r=0.29 and 0.30, respectively, p<0.05). CONCLUSIONS In spite of the small sample size and preliminary research, our results replicate previously reported differences in AHRR hypomethylation among smokers. Furthermore, we show that the duration of smoking abstinence is associated with a recovery of methylation in ex-smokers, which may be linked to a reduced risk of smoking-associated diseases. The association with cognitive performance suggests that the hypomethylation of AHRR in saliva may reflect systemic exposure to cigarette-related toxicants that negatively affect cognitive performance, and should be validated in larger studies.
Collapse
Affiliation(s)
- Ping-Ching Hsu
- Department of Environmental Health Sciences, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, United States
| | - Stacey B. Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Michael A. Bauer
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, United States
| | - L. Joseph Su
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, United States
| | - Merideth A. Addicott
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, United States
| |
Collapse
|
4
|
Belus JM, Tralka H, Satinsky EN, Seitz-Brown C, Daughters SB, Magidson JF. Substance Use Outcomes Among Sexual and Gender Minority Individuals Living with HIV Following Residential Substance Use Treatment in Washington, DC. Alcohol Treat Q 2023; 41:373-385. [PMID: 37886040 PMCID: PMC10601688 DOI: 10.1080/07347324.2023.2241419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
This study explored how sexual or gender minority (SGM) status influenced substance use (SU) treatment outcomes in a predominantly African American and unemployed sample of people with HIV. N = 60 participants were enrolled in an abstinence-focused inpatient SU treatment center, followed by outpatient treatment sessions. At 12-months follow-up, the survival rate (i.e. those who did not reuse substances) was 37.6% (non-SGM group) vs. 4.8% (SGM group). The impact of SGM status on reuse was .54 log odds, p = .11, which translates to a 71.8% increase in the hazard of reusing substances for SGM vs. non-SGM individuals. For both groups, frequency of reuse remained stable and problems associated with SU decreased over time. Results suggest a potentially clinically relevant finding that SGM individuals have possible heigh-tened risk of SU after a mixed inpatient-outpatient program. ClinicalTrials.gov trial registration number: NCT01351454.
Collapse
Affiliation(s)
- Jennifer M. Belus
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Hannah Tralka
- Department of Behavioural and Community Health, University of Maryland, College Park, MD, USA
| | - Emily N. Satinsky
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - C.J. Seitz-Brown
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Stacey B. Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jessica F. Magidson
- Department of Psychology, University of Maryland, College Park, MD, USA
- Center for Substance Use, Addiction & Health Research (CESAR), University of Maryland, College Park, MD, USA
| |
Collapse
|
5
|
Cernasov PM, Kinard JL, Walsh E, Kelley L, Phillips R, Pisoni A, Arnold M, Lowery SC, Ammirato M, Nagy GA, Oliver JA, Haworth K, Daughters SB, Dichter GS, Smoski M. Parsing within & between-person dynamics of therapy homework completion and clinical symptoms in two cognitive behavioral treatments for adults with anhedonia. Behav Res Ther 2023; 166:104322. [PMID: 37148652 PMCID: PMC10330658 DOI: 10.1016/j.brat.2023.104322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Homework is a key theoretical component of cognitive-behavioral therapies, however, the effects of homework on clinical outcomes have largely been evaluated between-persons rather than within-persons. METHODS The effects of homework completion on treatment response were examined in a randomized trial comparing Behavioral Activation Treatment for Anhedonia (BATA, n = 38), a novel psychotherapy, to Mindfulness-Based Cognitive Therapy (MBCT, n=35). The primary endpoint was consummatory reward sensitivity, measured weekly by the Snaith Hamilton Pleasure Scale (SHAPS), up to 15 weeks. Multilevel models evaluated change in SHAPS scores over time and the effects of clinician-reported and participant-reported homework. RESULTS BATA and MBCT resulted in significant, equivalent reductions in SHAPS scores. Unexpectedly, participants who completed greater mean total amounts of homework did not improve at a faster rate (i.e., no between-person effect). However, sessions with greater than average participant-reported homework completion were associated with greater than average reductions in SHAPS scores (i.e., a within-person effect). For clinician-reported homework, this effect was only evident within the BATA condition. CONCLUSION This study shows psychotherapy homework completion relates to symptomatic improvement in cognitive-behavioral treatments for anhedonia when session-to-session changes are examined within-person. On the contrary, we found no evidence that total homework completion predicted greater improvements between-person. When possible, psychotherapy researchers should evaluate their constructs of interest across multiple sessions (not just pre/post) to allow more direct tests of hypotheses predicted by theoretical models of individual change processes.
Collapse
Affiliation(s)
- Paul M Cernasov
- Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27514, USA.
| | - Jessica L Kinard
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, Chapel Hill, NC, 27510, USA; Division of Speech and Hearing Sciences, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27514, USA
| | - Erin Walsh
- Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, NC 27514, USA
| | - Lisalynn Kelley
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA
| | - Rachel Phillips
- Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27514, USA
| | - Angela Pisoni
- Department of Psychology and Neuroscience, Duke University, Durham, NC, 27505, USA
| | - Macey Arnold
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA
| | - Sarah C Lowery
- Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27514, USA
| | - Marcy Ammirato
- Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27514, USA
| | - Gabriela A Nagy
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
| | - Jason A Oliver
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Division of Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27705, USA
| | - Kevin Haworth
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27514, USA
| | - Gabriel S Dichter
- Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27514, USA; Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, Chapel Hill, NC, 27510, USA; Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, NC 27514, USA
| | - Moria Smoski
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC, 27505, USA
| |
Collapse
|
6
|
Addicott MA, Oliveto AH, Daughters SB. Smoking status affects cognitive, emotional and neural-connectivity response to distress-inducing auditory feedback. Drug Alcohol Depend 2023; 246:109855. [PMID: 37028104 PMCID: PMC10561527 DOI: 10.1016/j.drugalcdep.2023.109855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND An important motive for cigarette smoking and impediment to cessation success is the avoidance of affective distress. Low levels of distress tolerance have been linked to smoking behavior, cessation history, smoking characteristics, and risk of recurrence among people who smoke. A better understanding of the neural mechanisms underlying distress sensitivity could inform approaches to help reduce avoidance of affective distress during smoking cessation. Previously among healthy participants, low distress tolerance on an MRI version of the Paced Auditory Serial Addition Task (PASAT-M), which induces distress via negative auditory feedback, was associated with larger differences in task-based functional connectivity (TBFC) between the auditory seed region and the anterior insula. METHODS Here, we tested differences in task performance and TBFC during affective distress among people who smoke (Smoke; n = 31) and people who quit smoking (Ex-smoke; n = 31). RESULTS Smoke had poorer task accuracy and reported a steeper increase in negative mood from the easy to distress blocks. Smoke had a larger difference in connectivity (distress > easy condition) between the auditory seed region and the left inferior frontal gyrus and right anterior insula. Additionally, task accuracy positively correlated with the difference in connectivity (distress > easy condition) with the left inferior frontal gyrus and the right anterior insula among Smoke but not Ex-smoke. CONCLUSIONS These results are consistent with the idea that people who smoke are more sensitive to cognitive-affective distress and that the inferior frontal gyrus and anterior insula play important roles in the regulation of distress.
Collapse
Affiliation(s)
- Merideth A Addicott
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Alison H Oliveto
- Department of Psychiatry, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
7
|
Tsai APT, Youngstrom EA, Gadow KD, Horwitz SM, Fristad MA, Daughters SB, Young AS, Arnold LE, Birmaher B, Salcedo S, The Lams Group, Findling RL. Diagnostic accuracy of the Child and Adolescent Symptom Inventory (CASI-4R) substance use subscale in detecting substance use disorders in youth. Psychol Assess 2023; 35:178-187. [PMID: 36442043 DOI: 10.1037/pas0001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Identifying substance use disorders (SUDs) early and accurately improves case formulation and treatment. Previous studies have investigated validity and reliability of the Child and Adolescent Symptom Inventory (CASI) for anxiety, mood, and behavior problems. The present study's aim was to test if the embedded CASI Substance Use (SU) subscale can discriminate adolescents and young adults (AYA) with and without a SUD diagnosis accurately enough to justify clinical application within an evidence-based assessment framework. N = 479 outpatient AYA (age 14-21) and their caregivers completed K-SADS-PLW semistructured diagnostic interviews; caregivers completed the CASI and adolescents completed a parallel version, the Youth (self-report) Inventory (YI). K-SADS-PLW indicated that 33 youth met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for SUDs. Receiver Operating Characteristic (ROC) analyses found that both CASI and YI Substance Use subscale scores significantly identified K-SADS-diagnosed SUDs in AYA: Caregiver area under curve (AUC) = .91, p < .0005; YI(AUC) = .90, p < .0005. There was no significant difference in diagnostic accuracy between informants. Both subscales showed diagnostic and clinical utility in identifying AYA SUDs in outpatient mental health settings. Findings suggest that the CASI-4R subscale could be a helpful screening instrument for AYA SUDs. A case vignette illustrates the clinical application of study findings. Future research should examine rapport as a moderator of reporting accuracy, and replicate use of these measures under varying clinical scenarios. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
|
8
|
Paquette CE, Reese ED, Yi JY, Maccarone JM, Stewart ZJ, Daughters SB. Group behavioral activation with and without a smartphone app in intensive outpatient treatment for substance use disorder: A three-arm randomized controlled trial. Drug Alcohol Depend 2023; 243:109758. [PMID: 36634574 PMCID: PMC10026710 DOI: 10.1016/j.drugalcdep.2022.109758] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Reward deficits negatively impact recovery from substance use disorder (SUD). LETS ACT, a behavioral activation treatment targeting substance-free reward, has demonstrated effectiveness in reducing post treatment substance use. There remains room for modifications to extend recovery gains, and LETS ACT remains largely untested in outpatient treatment. We tested the effect of LETS ACT when delivered alongside intensive outpatient SUD treatment, with and without a smartphone app designed to extend access to treatment content outside of clinician-administered sessions. METHODS In this three-arm randomized controlled trial (N = 206; 54 % White, 67 % male), all participants received intensive outpatient SUD treatment as usual (TAU) and either LETS ACT (n = 56), smartphone-enhanced LETS ACT (n = 65), or assessments only (n = 61). Substance use days and substance related problems were assessed through 12 months posttreatment. RESULTS Generalized estimating equations indicated a significant condition*time interaction for substance use days; Days of substance use significantly declined from pretreatment until 1-month for TAU, 3-months for LETS ACT-SE, and 6-months for LETS ACT. Decreases in substance-related problems were maintained across all conditions through 12 months. CONCLUSIONS Adding LETS ACT to intensive outpatient treatment resulted in significant decreases in substance use through 6 months posttreatment, yet these gains were not sustained through 12 months posttreatment. A smartphone app did not facilitate superior treatment outcomes. Future studies should consider factors impacting treatment efficacy in outpatient settings and the utility of providing more than six sessions of behavioral activation.
Collapse
Affiliation(s)
- Catherine E Paquette
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States.
| | - Elizabeth D Reese
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Jennifer Y Yi
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Julianna M Maccarone
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Zachary J Stewart
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| |
Collapse
|
9
|
Qi S, Fu Z, Wu L, Calhoun VD, Zhang D, Daughters SB, Hsu PC, Jiang R, Vergara VM, Sui J, Addicott MA. Cognition, Aryl Hydrocarbon Receptor Repressor Methylation, and Abstinence Duration-Associated Multimodal Brain Networks in Smoking and Long-Term Smoking Cessation. Front Neurosci 2022; 16:923065. [PMID: 35968362 PMCID: PMC9363622 DOI: 10.3389/fnins.2022.923065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/20/2022] [Indexed: 02/04/2023] Open
Abstract
Cigarette smoking and smoking cessation are associated with changes in cognition and DNA methylation; however, the neurobiological correlates of these effects have not been fully elucidated, especially in long-term cessation. Cognitive performance, percent methylation of the aryl hydrocarbon receptor repressor (AHRR) gene, and abstinence duration were used as references to supervise a multimodal fusion analysis of functional, structural, and diffusion magnetic resonance imaging (MRI) data, in order to identify associated brain networks in smokers and ex-smokers. Correlations among these networks and with smoking-related measures were performed. Cognition-, methylation-, and abstinence duration-associated networks discriminated between smokers and ex-smokers and correlated with differences in fractional amplitude of low frequency fluctuations (fALFF) values, gray matter volume (GMV), and fractional anisotropy (FA) values. Long-term smoking cessation was associated with more accurate cognitive performance, as well as lower fALFF and more GMV in the hippocampus complex. The methylation- and abstinence duration-associated networks positively correlated with smoking-related measures of abstinence duration and percent methylation, respectively, suggesting they are complementary measures. This analysis revealed structural and functional co-alterations linked to smoking abstinence and cognitive performance in brain regions including the insula, frontal gyri, and lingual gyri. Furthermore, AHRR methylation, a promising epigenetic biomarker of smoking recency, may provide an important complement to self-reported abstinence duration.
Collapse
Affiliation(s)
- Shile Qi
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Zening Fu
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, United States
| | - Lei Wu
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, United States
| | - Vince D. Calhoun
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, United States
| | - Daoqiang Zhang
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Stacey B. Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ping-Ching Hsu
- Department of Environmental and Occupational Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Rongtao Jiang
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, United States
| | - Victor M. Vergara
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, United States
| | - Jing Sui
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Merideth A. Addicott
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| |
Collapse
|
10
|
Tsai APT, Smith RK, Gonzalez M, Youngstrom EA, Daughters SB, Youngstrom JK, Findling RL. Diagnostic accuracy of Achenbach scales in detecting youths' substance use disorders. Psychol Assess 2022; 34:570-582. [PMID: 35201823 DOI: 10.1037/pas0001115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is vital to identify substance use disorders (SUDs) in youths and adults early and accurately. Previous studies have investigated the validity and reliability of the Achenbach Child Behavior Checklist (CBCL) and Youth Self Report (YSR) for other related anxiety, mood, and behavior problems. The present study tested if the CBCL and YSR substance use items can discriminate adolescents with versus without a SUD diagnosis accurately enough to justify clinical application within an evidence-based assessment framework. N = 422 outpatient adolescents (age 9-18) and their caregivers completed semistructured diagnostic interviews. Caregivers completed CBCL, and adolescents completed the YSR. K-SADS-PL + diagnoses indicated that 34 youths met Diagnostic and Statistical Manual (DSM)-IV criteria for SUDs. Receiver Operating Characteristics (ROC) models estimated the likelihood of having Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime (KSADS-PL) + SUDs based on substance use scores of CBCL or YSR. Scores on all scales significantly identified KSADS-PL-diagnosed SUDs in adolescents: Area under the curve (AUCCBCL = .90, p < .0005; AUCYSR = .84, p < .0005). There was no significant difference in the accuracy comparing each informant used separately; CBCL showed incremental value above the YSR report when both were included in logistic regression models. CBCL and YSR substance items demonstrated diagnostic and clinical utility in identifying SUDs in adolescents. Findings suggest that Achenbach Scales could be a valuable intake instrument in detecting adolescents SUDs. A supplemental clinical vignette illustrates the clinical application of the study findings. It will be important for future research to replicate use of these measures across varying clinical scenarios and settings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
|
11
|
Magidson JF, Belus JM, Seitz-Brown CJ, Tralka H, Safren SA, Daughters SB. Act Healthy: A Randomized Clinical Trial Evaluating a Behavioral Activation Intervention to Address Substance Use and Medication Adherence Among Low-Income, Black/African American Individuals Living with HIV/AIDS. AIDS Behav 2022; 26:102-115. [PMID: 34173895 PMCID: PMC8808422 DOI: 10.1007/s10461-021-03354-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
There is a need for parsimonious behavioral interventions to support HIV and substance use treatment outcomes for low-income, Black/African American individuals living with HIV. This randomized clinical trial (N = 61) evaluated Act Healthy (AH), an integrated behavioral intervention to reduce substance use and improve medication adherence, compared to supportive counseling (SC) plus Life-Steps medication adherence counseling on substance use, craving, adherence-related outcomes, and depression over one year. Participants in AH had significantly steeper decreases in cravings compared to SC, but no significant differences in substance use. Across both groups, there was a significant increase in probability of being on antiretroviral therapy (ART) (86% on ART at 12 months vs. 56% at baseline), and a significant decrease in medication nonadherence. Findings provide preliminary support for an intervention to reduce cravings and strategies to improve ART use in a hard-to-reach, vulnerable population at high risk for poor treatment outcomes and ongoing HIV transmission. TRIAL REGISTRATION: ClinicalTrials.gov trial registration number: identifier: NCT01351454. Retrospectively registered on May 10, 2011.
Collapse
Affiliation(s)
- Jessica F Magidson
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, USA.
| | - Jennifer M Belus
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, USA
| | - C J Seitz-Brown
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, USA
| | - Hannah Tralka
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, UNC Chapel-Hill, Chapel Hill, NC, USA
| |
Collapse
|
12
|
Paquette CE, Rubalcava DT, Chen Y, Anand D, Daughters SB. A Mobile App to Enhance Behavioral Activation Treatment for Substance Use Disorder: App Design, Use, and Integration Into Treatment in the Context of a Randomized Controlled Trial. JMIR Form Res 2021; 5:e25749. [PMID: 34730535 PMCID: PMC8600431 DOI: 10.2196/25749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/14/2021] [Accepted: 08/01/2021] [Indexed: 01/22/2023] Open
Abstract
Background Group-based formats typically used in low-resource substance use disorder (SUD) treatment settings result in little individual attention to help reinforce and guide skill use, which may contribute to poor posttreatment outcomes. Smartphone apps offer a convenient, user-friendly, and cost-effective tool that can extend the reach of effective SUD treatments. A smartphone app was developed and integrated into a group-based, brief behavioral activation (BA) treatment for SUD to increase engagement in treatment skills outside clinician-administered sessions. Objective This study aims to describe the features of the app and its use and integration into treatment, report the participants’ self-reported feasibility and acceptability of the app, and discuss challenges and provide recommendations for future smartphone app integration into behavioral treatments for SUD. Methods A total of 56 individuals recruited from intensive outpatient SUD treatment received a smartphone-enhanced BA treatment, the Life Enhancement Treatment for Substance Use. Self-reported weekly app use and reasons for nonuse were assessed at posttreatment and at 1- and 3-month follow-ups. In addition, 2-tailed t tests and chi-square tests compared the self-reported use of each app component and overall app use over time. Results Participant feedback suggested that the integration of the smartphone app into the Life Enhancement Treatment for Substance Use was feasible and well accepted, and participants found the app useful for planning value-based activities outside of sessions. Self-reported app engagement decreased over the follow-up period: 72% (39/54) of participants reported using the app at posttreatment, decreasing to 69% (37/54) at the 1-month follow-up and 37% (20/54) at the 3-month follow-up. Participants reported forgetting to use the app as a primary reason for nonuse. Conclusions This study provides support for the feasibility and acceptability of smartphone-enhanced BA treatment, offering promise for future research testing the integration of technology into SUD treatment. Design decisions may help streamline smartphone integration into treatment, for example, allowing participants to download the treatment app on their own phones or use a low-cost study smartphone (or offering both options). Long-term app engagement may be increased via built-in reminders, alerts, and in-app messages. Trial Registration ClinicalTrials.gov NCT02707887; https://clinicaltrials.gov/ct2/show/study/NCT02707887
Collapse
Affiliation(s)
- Catherine E Paquette
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Dillon T Rubalcava
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Yun Chen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Deepika Anand
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,CBT Center of Chicago, Chicago, IL, United States
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
13
|
Reese ED, Kane LF, Paquette CE, Frohlich F, Daughters SB. Lost in Translation: the Gap Between Neurobiological Mechanisms and Psychosocial Treatment Research for Substance Use Disorders. Curr Addict Rep 2021. [DOI: 10.1007/s40429-021-00382-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
14
|
Chen Y, Anand D, Li H, Xu P, Daughters SB. Feasibility, acceptability and future adaptation of the Chinese translated Behavioural activation (C-BA) treatment for depression: A pilot study. Int J Psychol 2020; 56:238-248. [PMID: 32706123 DOI: 10.1002/ijop.12704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/25/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although depression is prevalent among Chinese international students (CIS), only 4% of CIS seek treatment. Behavioural activation (BA) has been suggested as a culturally sensitive treatment for depression that has the potential to meet the clinical needs of CIS. The current pilot study tested the feasibility, acceptability and themes for future cultural adaptations of a Chinese translated BA treatment (C-BA) among CIS. METHODS Six CIS with elevated depressive symptoms (Beck Depression Inventory, BDI ≥ 14) completed a six-session individual C-BA treatment and assessments at pre- and post-treatment and a 1-month follow-up. Primary outcome measures included treatment feasibility, acceptability and qualitative interview data informing future adaption of C-BA. Exploratory analyses examined group changes in depressive symptoms over time and clinically significant symptom changes on individual levels. RESULTS All participants found the treatment to be highly feasible and culturally acceptable, and were highly engaged in the treatment. Themes of future cultural adaptions were generated from the qualitative interviews. Significant decreases in depressive symptoms were observed at a one1-month post-treatment follow-up assessment. CONCLUSIONS Preliminary evidence suggests that C-BA has the potential to be a culturally sensitive treatment for depression among CIS. CIS demonstrated openness to psychotherapy and high treatment engagement.
Collapse
Affiliation(s)
- Yun Chen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Deepika Anand
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, USA
| | - Haolin Li
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Peng Xu
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, USA
| |
Collapse
|
15
|
Abstract
BACKGROUND Employment rates for people with HIV/AIDS are low, compared to the general population. One widespread barrier is fatigue, accompanied by daytime sleepiness and a lack of stamina. Previous pharmacological studies have demonstrated improvement of fatigue-related symptoms without affecting work-related goal attainmentOBJECTIVE:In this pilot study, we sought to determine whether a pharmacologic-behavioral two-phase combined approach could facilitate returning to work. METHODS HIV+ participants with fatigue were treated with armodafinil. If energy improved, 8 sessions of biweekly manualized Behavioral Activation (BA) counseling were added to medication maintenance. Outcome was assessed on a 3-point scale along with clinician and self-ratings. RESULTS Of the 46 participants enrolled in BA, 15 (33%) did not complete all 8 sessions: 6 got jobs so they no longer needed counseling; 4 did not like BA, and 5 dropped out for reasons such as moving away or substance use relapse. Of the 46, 29 (63%) attained their vocational goal and showed significant changes on self-report scales. CONCLUSIONS Our integrated treatment including armodafinil plus BA counseling significantly increased the success of achieving work-related goals. The two-phase medication plus counseling program was well-tolerated by participants and the manualized BA counseling was readily applied by counselors without advanced mental health training, making the method potentially feasible in community settings.
Collapse
Affiliation(s)
- Martin C McElhiney
- Department of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Judith G Rabkin
- Department of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Milton L Wainberg
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.,Department of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
| |
Collapse
|
16
|
Chen Y, Thissen D, Anand D, Chen LH, Liang H, Daughters SB. Evaluating Differential Item Functioning (DIF) of the Chinese Version of the Behavioral Activation for Depression Scale (C-BADS). European Journal of Psychological Assessment 2020. [DOI: 10.1027/1015-5759/a000525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Depression is prevalent in both China and Taiwan, and Behavioral Activation (BA), an Evidence-Based Treatment (EBT) for depression, is ideally suited for cross cultural implementation. As a first step, the current study examined cross cultural differences in the understanding of BA constructs, by investigating item level differences in functioning between the English and Chinese versions of Behavioral Activation for Depression Scale (BADS and C-BADS; Kanter, Mulick, Busch, Berlin, & Martell, 2007 ; Li, Ding, Kanter, Zeng, & Yang, 2014) . 752 college students were recruited from China, Taiwan, and the United States. Factorial invariance-based Differential Item Functioning (DIF) analysis was used to study item level differences in functioning for the BADS and C-BADS. Results. DIF was observed in the majority of BADS items, with items in the avoidance and impairment factors showing the greatest DIF. The constructs of avoidance and impairment demonstrate less cross-cultural generalizability compared to the activation construct. Suggestions for the implementation of DIF analysis for future cross cultural psychometric studies, and further modification of the C-BADS as a clinical assessment tool in China and Taiwan, are discussed.
Collapse
Affiliation(s)
- Yun Chen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, NC, USA
| | - David Thissen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, NC, USA
| | - Deepika Anand
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, NC, USA
| | - Lung Hung Chen
- Department of Positive Sport & Leisure Psychology, National Taiwan Sport University, Taiwan
| | - Hong Liang
- Department of Political Science, Huazhong University of Science and Technology, Wuhan, PR China
| | - Stacey B. Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, NC, USA
| |
Collapse
|
17
|
Reese ED, Yi JY, McKay KG, Stein EA, Ross TJ, Daughters SB. Triple Network Resting State Connectivity Predicts Distress Tolerance and Is Associated with Cocaine Use. J Clin Med 2019; 8:jcm8122135. [PMID: 31817047 PMCID: PMC6947426 DOI: 10.3390/jcm8122135] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 01/28/2023] Open
Abstract
Distress tolerance (DT), a predictor of substance use treatment retention and post-treatment relapse, is associated with task based neural activation in regions located within the salience (SN), default mode (DMN), and executive control networks (ECN). The impact of network connectivity on DT has yet to be investigated. The aim of the present study was to test within and between network resting-state functional connectivity (rsFC) associations with DT, and the impact of cocaine use on this relationship. Twenty-nine adults reporting regular cocaine use (CU) and 28 matched healthy control individuals (HC), underwent resting-state functional magnetic resonance imaging followed by the completion of two counterbalanced, computerized DT tasks. Dual-regression analysis was used to derive within and between network rsFC of the SN, DMN, and lateralized (left and right) ECN. Cox proportional-hazards survival models were used to test the interactive effect of rsFC and group on DT. The association between cocaine use severity, rsFC, and DT was tested within the CU group. Lower LECN and higher DMN-SN rsFC were associated with DT impairment. Greater amount of cocaine use per using day was associated with greater DMN-SN rsFC. The findings emphasize the role of neural resource allocation within the ECN and between DMN-SN on distress tolerance.
Collapse
Affiliation(s)
- Elizabeth D. Reese
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC 27514, USA; (E.D.R.); (J.Y.Y.); (K.G.M.)
| | - Jennifer Y. Yi
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC 27514, USA; (E.D.R.); (J.Y.Y.); (K.G.M.)
| | - Katlyn G. McKay
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC 27514, USA; (E.D.R.); (J.Y.Y.); (K.G.M.)
| | - Elliot A. Stein
- Neuroimaging Research Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, USA; (E.A.S.); (T.J.R.)
| | - Thomas J. Ross
- Neuroimaging Research Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, USA; (E.A.S.); (T.J.R.)
| | - Stacey B. Daughters
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC 27514, USA; (E.D.R.); (J.Y.Y.); (K.G.M.)
- Correspondence:
| |
Collapse
|
18
|
Ekhtiari H, Tavakoli H, Addolorato G, Baeken C, Bonci A, Campanella S, Castelo-Branco L, Challet-Bouju G, Clark VP, Claus E, Dannon PN, Del Felice A, den Uyl T, Diana M, di Giannantonio M, Fedota JR, Fitzgerald P, Gallimberti L, Grall-Bronnec M, Herremans SC, Herrmann MJ, Jamil A, Khedr E, Kouimtsidis C, Kozak K, Krupitsky E, Lamm C, Lechner WV, Madeo G, Malmir N, Martinotti G, McDonald WM, Montemitro C, Nakamura-Palacios EM, Nasehi M, Noël X, Nosratabadi M, Paulus M, Pettorruso M, Pradhan B, Praharaj SK, Rafferty H, Sahlem G, Salmeron BJ, Sauvaget A, Schluter RS, Sergiou C, Shahbabaie A, Sheffer C, Spagnolo PA, Steele VR, Yuan TF, van Dongen JDM, Van Waes V, Venkatasubramanian G, Verdejo-García A, Verveer I, Welsh JW, Wesley MJ, Witkiewitz K, Yavari F, Zarrindast MR, Zawertailo L, Zhang X, Cha YH, George TP, Frohlich F, Goudriaan AE, Fecteau S, Daughters SB, Stein EA, Fregni F, Nitsche MA, Zangen A, Bikson M, Hanlon CA. Transcranial electrical and magnetic stimulation (tES and TMS) for addiction medicine: A consensus paper on the present state of the science and the road ahead. Neurosci Biobehav Rev 2019; 104:118-140. [PMID: 31271802 PMCID: PMC7293143 DOI: 10.1016/j.neubiorev.2019.06.007] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/30/2019] [Accepted: 06/08/2019] [Indexed: 12/21/2022]
Abstract
There is growing interest in non-invasive brain stimulation (NIBS) as a novel treatment option for substance-use disorders (SUDs). Recent momentum stems from a foundation of preclinical neuroscience demonstrating links between neural circuits and drug consuming behavior, as well as recent FDA-approval of NIBS treatments for mental health disorders that share overlapping pathology with SUDs. As with any emerging field, enthusiasm must be tempered by reason; lessons learned from the past should be prudently applied to future therapies. Here, an international ensemble of experts provides an overview of the state of transcranial-electrical (tES) and transcranial-magnetic (TMS) stimulation applied in SUDs. This consensus paper provides a systematic literature review on published data - emphasizing the heterogeneity of methods and outcome measures while suggesting strategies to help bridge knowledge gaps. The goal of this effort is to provide the community with guidelines for best practices in tES/TMS SUD research. We hope this will accelerate the speed at which the community translates basic neuroscience into advanced neuromodulation tools for clinical practice in addiction medicine.
Collapse
Affiliation(s)
| | - Hosna Tavakoli
- Institute for Cognitive Science Studies (ICSS), Iran; Iranian National Center for Addiction Studies (INCAS), Iran
| | - Giovanni Addolorato
- Alcohol Use Disorder Unit, Division of Internal Medicine, Gastroenterology and Hepatology Unit, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy; Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, University Hospital Ghent, Ghent, Belgium
| | - Antonello Bonci
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA; Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Vincent P Clark
- University of New Mexico, USA; The Mind Research Network, USA
| | | | | | - Alessandra Del Felice
- University of Padova, Department of Neuroscience, Padova, Italy; Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
| | | | - Marco Diana
- 'G. Minardi' Laboratory of Cognitive Neuroscience, Department of Chemistry and Pharmacy, University of Sassari, Italy
| | | | - John R Fedota
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | | | - Luigi Gallimberti
- Novella Fronda Foundation, Human Science and Brain Research, Padua, Italy
| | | | - Sarah C Herremans
- Department of Psychiatry and Medical Psychology, University Hospital Ghent, Ghent, Belgium
| | - Martin J Herrmann
- Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Asif Jamil
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | | | | | - Karolina Kozak
- University of Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Canada
| | - Evgeny Krupitsky
- V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St.-Petersburg, Russia; St.-Petersburg First Pavlov State Medical University, Russia
| | - Claus Lamm
- Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of Vienna, Austria
| | | | - Graziella Madeo
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | | | | | - William M McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Chiara Montemitro
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA; University G.d'Annunzio of Chieti-Pescara, Italy
| | | | - Mohammad Nasehi
- Cognitive and Neuroscience Research Center (CNRC), Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Xavier Noël
- Université Libre de Bruxelles (ULB), Belgium
| | | | | | | | | | - Samir K Praharaj
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Haley Rafferty
- Spaulding Rehabilitation Hospital, Harvard Medical School, USA
| | | | - Betty Jo Salmeron
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Anne Sauvaget
- Laboratory «Movement, Interactions, Performance» (E.A. 4334), University of Nantes, 25 Bis Boulevard Guy Mollet, BP 72206, 44322, Nantes Cedex 3, France; CHU de Nantes Addictology and Liaison Psychiatry Department, University Hospital Nantes, Nantes Cedex 3, France
| | - Renée S Schluter
- Laureate Institute for Brain Research, USA; Institute for Cognitive Science Studies (ICSS), Iran
| | | | - Alireza Shahbabaie
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | | | | | - Vaughn R Steele
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Ti-Fei Yuan
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, China
| | | | - Vincent Van Waes
- Laboratoire de Neurosciences Intégratives et Cliniques EA481, Université Bourgogne Franche-Comté, Besançon, France
| | | | | | | | - Justine W Welsh
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Fatemeh Yavari
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Mohammad-Reza Zarrindast
- Department of Pharmacology School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Laurie Zawertailo
- University of Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Canada
| | - Xiaochu Zhang
- University of Science and Technology of China, China
| | | | - Tony P George
- University of Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Canada
| | | | - Anna E Goudriaan
- Department of Psychiatry, Amsterdam Institute for Addiction Research, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Arkin, Department of Research and Quality of Care, Amsterdam, The Netherlands
| | | | | | - Elliot A Stein
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Felipe Fregni
- Spaulding Rehabilitation Hospital, Harvard Medical School, USA
| | - Michael A Nitsche
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; University Medical Hospital Bergmannsheil, Dept. Neurology, Bochum, Germany
| | | | | | | |
Collapse
|
19
|
Chen Y, Daughters SB, Thissen D, Salcedo S, Anand D, Chen LH, Liang H, Niu X, Su L. Cultural Differences in Environmental Reward Across Individuals in China, Taiwan, and the United States. J Psychopathol Behav Assess 2019. [DOI: 10.1007/s10862-019-09743-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Abstract
OBJECTIVE Distress tolerance (DT), the ability to withstand aversive internal states, represents an important risk factor for substance use relapse and a potential treatment target. Neurobiological research in substance using populations suggests that continued substance use could erode DT, whereas abstinence could bolster it. The current study characterized trajectories of behavioral and self-reported indices of DT and examined the prospective effect of substance use on DT trajectories among those seeking treatment for substance use. METHOD Individuals (N = 263, Mage = 42.68, SD = 11.8, 70.7% male, 94.7% African American) in residential substance use treatment completed subjective (Distress Tolerance Scale) and behavioral (Mirror Tracing Persistence Task-computerized version) DT measures, as well as report of daily substance use (timeline follow-back) over 5 assessment time-points from pretreatment to 12 months posttreatment. Latent curve modeling estimated DT trajectories and their associations with substance use behavior, including abstinence duration (days until first use) and substance use frequency (percentage of substance use days between assessments). RESULTS Self-reported and behavioral DT indicators both exhibited positive, nonlinear change over time (standardized slope parameter estimates: Distress Tolerance Scale β = 0.61, p < .01; Mirror Tracing Persistence Task β = 0.34, p < .01). Abstinence duration was associated with greater improvement in behavioral (β = .20, p = .03) DT specifically. Frequency of use was statistically significantly associated with attenuated behavioral DT at 6-month (β = -.12, p = .03) and 12-month follow-ups (β = -.08, p = .045). CONCLUSIONS DT appears to improve appreciably posttreatment, and return to substance use may shape the degree of this improvement. Collectively, these findings support the conceptualization of DT as a malleable treatment target and emphasize the benefit of abstinence on improvement in DT. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
- Elizabeth D Reese
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | | | - Deepika Anand
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | - Daniel J Bauer
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| |
Collapse
|
21
|
Anand D, Paquette C, Bartuska A, Daughters SB. Substance type moderates the longitudinal association between depression and substance use from pre-treatment through a 1-year follow-up. Drug Alcohol Depend 2019; 197:87-94. [PMID: 30784954 PMCID: PMC8805280 DOI: 10.1016/j.drugalcdep.2019.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/27/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Research examining directionality of the relationship between depressive symptoms and substance use following treatment entry is limited. Furthermore, substances differ in their neurobiological effects on mood. The relationship between depression and substance use following treatment entry may be moderated by dependence on specific substances. The study tested (a) lagged effects between depressive symptoms and substance use frequency following substance use treatment entry through a 1-year post-treatment follow-up and (b) if substance dependence type moderates these effects. METHODS Participants (N = 263) entering residential treatment were assessed for DSM-IV substance dependence, depressive symptoms (Beck Depression Inventory), and percentage of substance use days at post-treatment, 1-, 3-, 6- and 12-month follow-up assessments (time t0 to t4). Linear mixed effects models tested lagged effects between depressive symptoms and substance use frequency and the impact of substance type (i.e., dependence on alcohol, cannabis, opioid, cocaine, hallucinogen/PCP) on this relationship. RESULTS After controlling for concurrent effects, substance type moderated each longitudinal relationship. Depressive symptoms significantly predicted substance use frequency at the subsequent follow-up assessment, only among individuals with pre-treatment opioid dependence (B = 5.55, SE = 0.89, z = 6.21, p < 0.01). Substance use frequency significantly predicted depressive symptoms at the subsequent follow-up assessment, but not among individuals with cannabis dependence at pre-treatment (B = 1.01, SE = 0.22, t (524) = 4.49, p < 0.01). CONCLUSIONS The directionality of depression-substance use comorbidity may differ based on the substance of dependence at pre-treatment. Opioid users may especially benefit from treating both depression and substance use.
Collapse
Affiliation(s)
| | | | | | - Stacey B. Daughters
- Corresponding author at: Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC 27514 USA. (S.B. Daughters)
| |
Collapse
|
22
|
Verdejo-Garcia A, Lorenzetti V, Manning V, Piercy H, Bruno R, Hester R, Pennington D, Tolomeo S, Arunogiri S, Bates ME, Bowden-Jones H, Campanella S, Daughters SB, Kouimtsidis C, Lubman DI, Meyerhoff DJ, Ralph A, Rezapour T, Tavakoli H, Zare-Bidoky M, Zilverstand A, Steele D, Moeller SJ, Paulus M, Baldacchino A, Ekhtiari H. A Roadmap for Integrating Neuroscience Into Addiction Treatment: A Consensus of the Neuroscience Interest Group of the International Society of Addiction Medicine. Front Psychiatry 2019; 10:877. [PMID: 31920740 PMCID: PMC6935942 DOI: 10.3389/fpsyt.2019.00877] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 11/06/2019] [Indexed: 01/01/2023] Open
Abstract
Although there is general consensus that altered brain structure and function underpins addictive disorders, clinicians working in addiction treatment rarely incorporate neuroscience-informed approaches into their practice. We recently launched the Neuroscience Interest Group within the International Society of Addiction Medicine (ISAM-NIG) to promote initiatives to bridge this gap. This article summarizes the ISAM-NIG key priorities and strategies to achieve implementation of addiction neuroscience knowledge and tools for the assessment and treatment of substance use disorders. We cover two assessment areas: cognitive assessment and neuroimaging, and two interventional areas: cognitive training/remediation and neuromodulation, where we identify key challenges and proposed solutions. We reason that incorporating cognitive assessment into clinical settings requires the identification of constructs that predict meaningful clinical outcomes. Other requirements are the development of measures that are easily-administered, reliable, and ecologically-valid. Translation of neuroimaging techniques requires the development of diagnostic and prognostic biomarkers and testing the cost-effectiveness of these biomarkers in individualized prediction algorithms for relapse prevention and treatment selection. Integration of cognitive assessments with neuroimaging can provide multilevel targets including neural, cognitive, and behavioral outcomes for neuroscience-informed interventions. Application of neuroscience-informed interventions including cognitive training/remediation and neuromodulation requires clear pathways to design treatments based on multilevel targets, additional evidence from randomized trials and subsequent clinical implementation, including evaluation of cost-effectiveness. We propose to address these challenges by promoting international collaboration between researchers and clinicians, developing harmonized protocols and data management systems, and prioritizing multi-site research that focuses on improving clinical outcomes.
Collapse
Affiliation(s)
- Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Valentina Lorenzetti
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Canberra, ACT, Australia
| | - Victoria Manning
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Hugh Piercy
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Raimondo Bruno
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Rob Hester
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - David Pennington
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Serenella Tolomeo
- School of Medicine, University of St Andrews, Medical and Biological Science Building, North Haugh, St Andrews, United Kingdom.,Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Shalini Arunogiri
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Marsha E Bates
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, United States
| | | | - Salvatore Campanella
- Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Christos Kouimtsidis
- Department of Psychiatry, Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, United Kingdom
| | - Dan I Lubman
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia
| | - Dieter J Meyerhoff
- DVA Medical Center and Department of Radiology and Biomedical Imaging, University of California San Francisco, School of Medicine, San Francisco, CA, United States
| | - Annaketurah Ralph
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Sciences Studies, Tehran, Iran
| | - Hosna Tavakoli
- Department of Cognitive Psychology, Institute for Cognitive Sciences Studies, Tehran, Iran.,Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Zare-Bidoky
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.,School of Medicine, Shahid-Sadoughi University of Medical Sciences, Yazd, Iran
| | - Anna Zilverstand
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Douglas Steele
- Medical School, University of Dundee, Ninewells Hospital, Scotland, United Kingdom
| | - Scott J Moeller
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Martin Paulus
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, OK, United States
| | - Alex Baldacchino
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, OK, United States
| |
Collapse
|
23
|
Addicott MA, Daughters SB, Strauman TJ, Appelbaum LG. Distress tolerance to auditory feedback and functional connectivity with the auditory cortex. Psychiatry Res Neuroimaging 2018; 282:1-10. [PMID: 30384144 PMCID: PMC6289788 DOI: 10.1016/j.pscychresns.2018.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 01/22/2023]
Abstract
Distress tolerance is the capacity to withstand negative affective states in pursuit of a goal. Low distress tolerance may bias an individual to avoid or escape experiences that induce affective distress, but the neural mechanisms underlying the bottom-up generation of distress and its relationship to behavioral avoidance are poorly understood. During a neuroimaging scan, healthy participants completed a mental arithmetic task with easy and distress phases, which differed in cognitive demands and positive versus negative auditory feedback. Then, participants were given the opportunity to continue playing the distress phase for a financial bonus and were allowed to quit at any time. The persistence duration was the measure of distress tolerance. The easy and distress phases activated auditory cortices and fronto-parietal regions. A task-based functional connectivity analysis using the left secondary auditory cortex (i.e., planum temporale) as the seed region revealed stronger connectivity to fronto-parietal regions and anterior insula during the distress phase. The distress-related connectivity between the seed region and the left anterior insula was negatively correlated with distress tolerance. The results provide initial evidence of the role of the anterior insula as a mediating link between the bottom-up generation of affective distress and top-down behavioral avoidance of distress.
Collapse
Affiliation(s)
- Merideth A Addicott
- Department of Psychiatry, University of Arkansas for Medical Science, 4301 W. Markham St., #843, Little Rock, AR 72205, USA.
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC 27516, USA
| | - Timothy J Strauman
- Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA
| | - L Gregory Appelbaum
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA
| |
Collapse
|
24
|
Daughters SB, Magidson JF, Anand D, Seitz-Brown C, Chen Y, Baker S. The effect of a behavioral activation treatment for substance use on post-treatment abstinence: a randomized controlled trial. Addiction 2018; 113:535-544. [PMID: 28963853 PMCID: PMC5807178 DOI: 10.1111/add.14049] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/12/2017] [Accepted: 09/27/2017] [Indexed: 12/23/2022]
Abstract
AIMS To compare outcomes for a behavioral activation group treatment for substance use [life enhancement treatment for substance use (LETS ACT)] versus a time and group size-matched control condition delivered in a residential treatment setting. DESIGN Single-site two-arm parallel-group randomized clinical trial with follow-up assessment at 3, 6 and 12 months post-treatment. SETTING Residential substance use treatment facility in the United States. PARTICIPANTS Participants were 263 adults [mean age 42.7 (11.8); 29.5% female; 95.4% African American; 73.2% court mandated] whose insurance dictated 30-day (65.9%) or 90-day (34.1%) treatment duration. INTERVENTION AND COMPARATOR LETS ACT (n = 142) is a treatment developed originally for depression and modified for substance use. It teaches participants to increase positively reinforcing value-driven activities in order to counter depression and relapse. The control group [supportive counseling (SC); n = 121] received time and group size-matched supportive counseling. Treatment was delivered in five or eight 1-hour sessions depending on patient length of stay. MEASUREMENTS Percentage abstinent at follow-up, percentage of substance use days among those reporting use, depressive symptoms [Beck Depression Inventory (BDI)] and adverse consequences of drug use [Short Inventory of Problems-Alcohol and Drug (SIP-AD)]. FINDINGS LETS ACT had significantly higher abstinence rates at 3 months [odds ratio (OR) = 2.2, 95% confidence interval (CI) = 1.3-3.7], 6 months (OR = 2.6, 95% CI= 1.3-5.0) and 12 months (OR = 2.9, 95% CI = 1.3-6.1) post-treatment compared with SC. LETS ACT participants reported significantly fewer adverse consequences from substance use at 12 months post-treatment [B = 4.50, standard error (SE) = 2.17, 95% CI = 0.22-8.78]. Treatment condition had no effect on percentage substance use days among those who resumed use or on change in depressive symptoms; the latter decreased over time only in those who remained abstinent after residential treatment irrespective of condition (B = 0.43, SE = 0.11, 95% confidence interval = 0.22-0.65). CONCLUSIONS A behavioral activation group treatment for substance use (LETS ACT) appears to increase the likelihood of abstinence and reduce adverse consequences from substance use up to 12 months post-treatment.
Collapse
Affiliation(s)
- Stacey B. Daughters
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, Chapel Hill, NC, USA
| | | | - Deepika Anand
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, Chapel Hill, NC, USA
| | - C.J. Seitz-Brown
- University of Maryland, College Park, Department of Psychology, College Park, MD, USA
| | - Yun Chen
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, Chapel Hill, NC, USA
| | - Sydney Baker
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, Chapel Hill, NC, USA
| |
Collapse
|
25
|
Moschak TM, Terry DR, Daughters SB, Carelli RM. Low distress tolerance predicts heightened drug seeking and taking after extended abstinence from cocaine self-administration. Addict Biol 2018; 23:130-141. [PMID: 28074543 DOI: 10.1111/adb.12488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/04/2016] [Accepted: 12/05/2016] [Indexed: 01/30/2023]
Abstract
Distress tolerance (DT), defined as the ability to persist in goal-directed behavior while experiencing psychological distress, is associated with greater frequency of substance use and poor treatment outcomes. To examine a potential causal role substance use may play in DT, we developed a rodent model of DT in which rats had to press a lever within a continuously decreasing time window for reward while receiving negative feedback on failure trials. DT was defined as the time rats continued to seek reward before quitting the task. We assessed the relationship of DT with cocaine seeking/taking by measuring DT before cocaine self-administration (SA), and after 1 week and 1 month of drug abstinence. We found that DT prior to cocaine SA did not predict cocaine seeking/taking, yet DT measured after 1 month abstinence significantly predicted subsequent high levels of early session cocaine taking. Additionally, high DT measured after abstinence protected against high cocaine seeking, but this protective effect was blocked in rats with high impulsivity. Finally, while a decrease in 1 month-abstinent DT was observed following SA across treatment conditions, among cocaine-exposed rats, greater cocaine SA correlated with a steeper decrease in DT. These results show that low DT after drug abstinence is associated with heightened levels of cocaine seeking and taking behavior and that impulsivity influences this effect. Collectively, these results support the validity of our rodent DT model while extending the human literature and set the foundation for future animal studies designed to determine neural mechanisms underlying DT.
Collapse
Affiliation(s)
- Travis M. Moschak
- Department of Psychology and Neuroscience; University of North Carolina; Chapel Hill NC USA
| | - Douglas R. Terry
- Department of Psychology and Neuroscience; University of North Carolina; Chapel Hill NC USA
| | - Stacey B. Daughters
- Department of Psychology and Neuroscience; University of North Carolina; Chapel Hill NC USA
| | - Regina M. Carelli
- Department of Psychology and Neuroscience; University of North Carolina; Chapel Hill NC USA
| |
Collapse
|
26
|
Anand D, Chen Y, Lindquist KA, Daughters SB. Emotion differentiation predicts likelihood of initial lapse following substance use treatment. Drug Alcohol Depend 2017; 180:439-444. [PMID: 28992486 PMCID: PMC5802350 DOI: 10.1016/j.drugalcdep.2017.09.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 08/03/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND An estimated 40% to 70% of individuals treated for a substance use disorder relapse within one year following treatment (Walitzer and Dearing, 2006). Relapse is often driven by the need to cope with intense negative affect (Koob, 2013). Emotion differentiation, defined as the ability to distinguish among various emotion states, has been linked to better behavioral control in the face of negative affect (Kashdan et al., 2015). The aim of the current study was to determine if higher levels of emotion differentiation are associated with the risk of experiencing an initial lapse following entry into residential substance use treatment. METHODS A total of 213 substance users (69.5% male, 94.4% African American, M age=43.01±11.35years) entering residential treatment were assessed on study variables at pre- and post-treatment, and at 1-, 3-, 6- and 12-month post-treatment. Emotion differentiation was calculated using ratings on five negative affect items derived from the Positive and Negative Affect Schedule (PANAS; Watson et al., 1988) at five assessment points. RESULTS A Cox proportional-hazards regression model adjusting for age and negative affect intensity demonstrates that for every unit increase in emotion differentiation, there is a 27% reduction in the likelihood of initial lapse on any given day (OR=0.73; 95% CIs [0.56, 0.95]). CONCLUSIONS The ability to differentiate among negative emotion states protects against initial lapse following treatment.
Collapse
Affiliation(s)
- Deepika Anand
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, Chapel Hill, NC, 27514, USA.
| | - Yun Chen
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, Chapel Hill, NC, 27514, USA.
| | - Kristen A Lindquist
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, Chapel Hill, NC, 27514, USA.
| | - Stacey B Daughters
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, Chapel Hill, NC, 27514, USA.
| |
Collapse
|
27
|
Ali B, Green KM, Daughters SB, Lejuez C. Distress tolerance interacts with circumstances, motivation, and readiness to predict substance abuse treatment retention. Addict Behav 2017; 73:99-104. [PMID: 28500908 DOI: 10.1016/j.addbeh.2017.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/24/2017] [Accepted: 04/26/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Our understanding of the conditions that influence substance abuse treatment retention in urban African American substance users is limited. This study examined the interacting effect of circumstances, motivation, and readiness (CMR) with distress tolerance to predict substance abuse treatment retention in a sample of urban African American treatment-seeking substance users. METHODS Data were collected from 81 African American substance users entering residential substance abuse treatment facility in an urban setting. Participants completed self-reported measures on CMR and distress tolerance. In addition, participants were assessed on psychiatric comorbidities, substance use severity, number of previous treatments, and demographic characteristics. Data on substance abuse treatment retention were obtained using administrative records of the treatment center. RESULTS Logistic regression analysis found that the interaction of CMR and distress tolerance was significant in predicting substance abuse treatment retention. Higher score on CMR was significantly associated with increased likelihood of treatment retention in substance users with higher distress tolerance, but not in substance users with lower distress tolerance. CONCLUSIONS Findings of the study indicate that at higher level of distress tolerance, favorable external circumstances, higher internal motivation, and greater readiness to treatment are important indicators of substance abuse treatment retention. The study highlights the need for assessing CMR and distress tolerance levels among substance users entering treatment, and providing targeted interventions to increase substance abuse treatment retention and subsequent recovery from substance abuse among urban African American substance users.
Collapse
|
28
|
Daughters SB, Ross TJ, Bell RP, Yi JY, Ryan J, Stein EA. Distress tolerance among substance users is associated with functional connectivity between prefrontal regions during a distress tolerance task. Addict Biol 2017; 22:1378-1390. [PMID: 27037525 PMCID: PMC5625840 DOI: 10.1111/adb.12396] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/19/2016] [Accepted: 02/24/2016] [Indexed: 11/28/2022]
Abstract
Distress tolerance (DT), defined as the ability to persist in goal directed behavior while experiencing affective distress, is implicated in the development and maintenance of substance use disorders. While theory and evidence indicate that cortico-limbic neural dysfunction may account for deficits in goal directed behavior while experiencing distress, the neurobiological mechanisms of DT have yet to be examined. We modified a computerized DT task for use in functional magnetic resonance imaging (fMRI), the Paced Auditory Serial Addition Task (PASAT-M), and examined the neural correlates and functional connectivity of DT among a cohort of substance users (n = 21; regular cocaine and nicotine users) and healthy controls (n = 25). In response to distress during the PASAT-M, we found greater activation in a priori cortico-limbic network ROIs, namely the right insula, anterior cingulate cortex (ACC), bilateral medial frontal gyrus (MFG), right inferior frontal gyrus (IFG) and right ventromedial prefrontal cortex (vmPFC) significantly predicted higher DT among substance users, but not healthy controls. In addition, greater task-specific functional connectivity during distress between the right MFG and bilateral vmPFC/sgACC was associated with higher DT among substance users, but not healthy controls. The observed positive relationship between DT and neural activation in cortico-limbic structures, as well as functional connectivity between the rMFG and vmPFC/sgACC, is in line with theory and research suggesting the importance of these structures for persisting in goal directed behavior while experiencing affective distress.
Collapse
Affiliation(s)
- Stacey B. Daughters
- Department of Psychology and Neuroscience, University of North Carolina – Chapel Hill
| | - Thomas J. Ross
- Neuroimaging Research Branch, National Institute on Drug Abuse, NIH
| | - Ryan P. Bell
- Department of Psychology and Neuroscience, University of North Carolina – Chapel Hill
| | - Jennifer Y. Yi
- Department of Psychology and Neuroscience, University of North Carolina – Chapel Hill
| | - Jonathan Ryan
- Department of Psychology and Neuroscience, University of North Carolina – Chapel Hill
| | - Elliot A. Stein
- Neuroimaging Research Branch, National Institute on Drug Abuse, NIH
| |
Collapse
|
29
|
Matalenas LA, McLaughlin AC, Chen Y, Daughters SB. Developing a smartphone application for the life enhancement treatment for substance use (lets act). ACTA ACUST UNITED AC 2016. [DOI: 10.1177/1541931215591158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Life Enhancement Treatment for Substance Use (LETS ACT) is a behavioral activation based treatment for comorbid depression and substance use (Daughters et al, 2008). We describe the iterative design process for including motivational and informational attributes in a smartphone application supporting treatment via LETS ACT and LETS ACT-SE (Daughters & Chen, 2014). Design of the app was uniquely constrained by the need to meet clinical requirements while serving a special population of substance users. The primary goal of LETS ACT is to motivate the user to identify, engage in, and continue engaging in rewarding activities that align with their important life areas, goals, and values, and thus extend the effects of treatment sessions through self-management. In support of this primary goal, the goal of the app is to motivate the user to continue to use the application, and thus to adhere to the primary goal: self- management of treatment. In efficacy studies of LETS ACT and LETS ACT-SE, users could see their progress on paper (Daughters et al, 2008; Magidson et al, 2011) or on a web based platform. How to capitalize on the additional interactive affordances of a standalone smartphone application for this user group was unknown. The two challenges of providing information and motivation were at the core of the app design.
Collapse
Affiliation(s)
| | | | - Yun Chen
- University of North Carolina, Chapel Hill, NC, 27599
| | | |
Collapse
|
30
|
Tull MT, Gratz KL, McDermott MJ, Bordieri MJ, Daughters SB, Lejuez CW. The Role of Emotion Regulation Difficulties in the Relation Between PTSD Symptoms and the Learned Association Between Trauma-Related and Cocaine Cues. Subst Use Misuse 2016; 51:1318-29. [PMID: 27224676 DOI: 10.3109/10826084.2016.1168445] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND PTSD and cocaine dependence frequently co-occur. However, few studies have specifically examined the functional relation between trauma-related distress and cocaine use and none have examined the extent to which PTSD is associated with a learned association between trauma cues and cocaine or the underlying role of emotion regulation difficulties in this relation. OBJECTIVES Thus, this study used a novel version of the Implicit Association Test (IAT) to examine the relation of PTSD symptoms to the strength of the trauma-cocaine cue association and the role of specific emotion regulation difficulties in this relation. METHODS A sample of 42 cocaine-dependent inpatients with a history of interpersonal traumatic exposure were recruited. Participants completed a series of questionnaires assessing PTSD symptom severity and emotion regulation difficulties. Participants then completed the IAT. RESULTS Results revealed a significant indirect relation of PTSD symptom severity to the strength of the trauma-cocaine cue association through the specific emotion regulation dimension of difficulties controlling impulsive behaviors when distressed. Conclusion/Importance: Results build upon extant research suggesting that factors related to emotional responding and regulation may underlie the relation between trauma-cue exposure and responses to cocaine cues among cocaine dependent patients with PTSD. The finding that PTSD symptom severity is associated with the strength of the trauma-cocaine cue association through one particular dimension of emotion regulation difficulties, difficulties controlling impulsive behaviors when distressed, highlight the potential utility of interventions focused on improving emotion regulation and impulse control abilities among trauma-exposed cocaine dependent patients.
Collapse
Affiliation(s)
- Matthew T Tull
- a Department of Psychiatry and Human Behavior , University of Mississippi Medical Center , Jackson , Mississippi , USA
| | - Kim L Gratz
- a Department of Psychiatry and Human Behavior , University of Mississippi Medical Center , Jackson , Mississippi , USA
| | - Michael J McDermott
- b Department of Psychology , University of Louisiana at Lafayette , Lafayette , Louisiana , USA
| | - Michael J Bordieri
- c Department of Psychology , Murray State University , Murray , Kentucky , USA
| | - Stacey B Daughters
- d Department of Psychology , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Carl W Lejuez
- e Department of Psychology , University of Maryland , College Park , Maryland , USA
| |
Collapse
|
31
|
Gorka SM, Liu H, Klein D, Daughters SB, Shankman SA. Is risk-taking propensity a familial vulnerability factor for alcohol use? An examination in two independent samples. J Psychiatr Res 2015; 68:54-60. [PMID: 26228401 PMCID: PMC4522043 DOI: 10.1016/j.jpsychires.2015.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 01/14/2023]
Abstract
Research indicates that increased risk-taking propensity (RTP) is associated with higher alcohol use. There is also some evidence to suggest that it is not just a state factor or 'scar,' but instead a vulnerability factor. If this is the case, increased RTP should be evident in healthy individuals that are at risk for alcohol use. To date, few studies have examined whether RTP is a familial vulnerability factor and thus, the aim of the current study was to test whether RTP aggregates within families and if increased RTP is evident in biological family members at risk for alcohol use. Sample 1 included 87 biological, adult sibling pairs and Sample 2 included 111 biological mother and adolescent dyads (total N = 396). All participants completed a behavioral measure of RTP and were assessed for alcohol use. Results in both samples were strikingly consistent. In Sample 1, RTP was correlated among siblings and greater frequency of proband alcohol use predicted greater sibling RTP, over and above sibling alcohol use. In Sample 2, RTP was correlated among mothers and their offspring and greater maternal alcohol use problems predicted greater adolescent RTP over and above adolescent substance use. Together, these findings suggest that RTP may be a familial vulnerability factor for alcohol use as it aggregates within families and is increased in relatives of individuals with higher levels of alcohol use.
Collapse
Affiliation(s)
- Stephanie M Gorka
- University of Illinois at Chicago, Department of Psychology, 1007 West Harrison St. (M/C 285), Chicago, IL 60657, USA
| | - Huiting Liu
- University of Illinois at Chicago, Department of Psychology, 1007 West Harrison St. (M/C 285), Chicago, IL 60657, USA
| | - Daniel Klein
- Stony Brook University, Department of Psychology, Stony Brook, NY 11794, USA
| | - Stacey B Daughters
- University of North Carolina, Chapel Hill, Department of Psychology, 247 Davie Hall, Chapel Hill, NC 27599, USA
| | - Stewart A Shankman
- University of Illinois at Chicago, Department of Psychology, 1007 West Harrison St. (M/C 285), Chicago, IL 60657, USA.
| |
Collapse
|
32
|
Ali B, Seitz-Brown CJ, Daughters SB. The interacting effect of depressive symptoms, gender, and distress tolerance on substance use problems among residential treatment-seeking substance users. Drug Alcohol Depend 2015; 148:21-6. [PMID: 25578252 PMCID: PMC4345141 DOI: 10.1016/j.drugalcdep.2014.11.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/29/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Depression is associated with substance use problems; however, the specific individual characteristics influencing this association are not well identified. Empirical evidence and theory suggest that gender and distress tolerance-defined behaviorally as an individual's ability to persist in goal-directed behavior while experiencing negative affective states-are important underlying factors in this relationship. Hence, the purpose of the current study was to examine whether gender and distress tolerance moderate the relationship between depressive symptoms and substance use problems. METHODS Participants included 189 substance users recruited from a residential substance abuse treatment center. The Short Inventory of Problems-Alcohol and Drugs scale was used to measure self-reported substance use problems. The Beck Depression Inventory was used to assess self-reported depressive symptoms. Gender was self-reported, and distress tolerance was behaviorally indexed by the Computerized Paced Auditory Serial Addition Task. RESULTS Hierarchical linear regression analysis indicated a significant three-way interaction of depressive symptoms, gender, and distress tolerance on substance use problems, adjusting for relevant demographic variables, anxiety symptoms, impulsivity, as well as DSM-IV psychiatric disorders. Probing of this three-way interaction demonstrated a significant positive association between depressive symptoms and substance use problems among females with low distress tolerance. CONCLUSION Findings indicate that female treatment-seeking substance users with high levels of depressive symptoms exhibit greater substance use problems if they also evidence low distress tolerance. Study implications are discussed, including the development of prevention and intervention programs that target distress tolerance skills.
Collapse
Affiliation(s)
- Bina Ali
- Department of Behavioral and Community Health, University of Maryland, College Park, MD 20742, USA.
| | - C. J. Seitz-Brown
- Department of Psychology, University of Maryland, College Park, MD 20742, USA
| | - Stacey B. Daughters
- Department of Psychology, University of North Carolina, Chapel Hill, NC 27599, USA
| |
Collapse
|
33
|
Abstract
Emotion regulation at treatment entry was evaluated among 115 patients in an inner-city substance use residential facility who either persisted (N = 94) or discontinued treatment (N = 21). Emotion regulation capacity including emotional clarity and the ability to engage in goal-directed behavior despite emotional distress, as well as lower scores on a measure of trait-negative emotionality, were associated with treatment persistence, whereas motivational variables were not. Findings indicate the importance of regulating negative emotions for treatment engagement among substance abusers.
Collapse
|
34
|
Nugent KL, Chiappelli J, Rowland LM, Daughters SB, Hong LE. Distress intolerance and clinical functioning in persons with schizophrenia. Psychiatry Res 2014; 220:31-6. [PMID: 25107316 PMCID: PMC4252749 DOI: 10.1016/j.psychres.2014.07.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/23/2014] [Accepted: 07/13/2014] [Indexed: 10/25/2022]
Abstract
Impaired tolerance to distress may help explain part of the cognitive and functional impairments in schizophrenia (SZ). This project investigated distress intolerance in SZ patients as compared to controls, and whether distress intolerance represented an independent domain in relationship to symptoms, cognition, and functional capacity. Healthy controls (n=43) and SZ (n=65) completed a psychological distress challenge experiment and their levels of intolerance to distress were estimated. SZ showed increased distress intolerance such that they were significantly more likely to terminate the distress challenge session early compared to controls. Greater distress intolerance was associated with reduced functional capacity and worse cognitive performance in SZ. Mediation analyses suggested that distress intolerance had an independent effect on functional capacity, while some of this effect was mediated by cognitive performance. Our results suggest that distress intolerance is a promising domain for treatment research, and functional capacity may be improved by targeting treatments towards SZ patient׳s ability to tolerate distress.
Collapse
Affiliation(s)
- Katie L. Nugent
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland USA 21228,Correspondence concerning this article should be addressed to: Dr. Nugent, Maryland Psychiatric Research Center, P.O. Box 21247, Baltimore, MD 21228; Tel: (410) 402-6859; Fax: (410) 402-6023;
| | - Joshua Chiappelli
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland USA 21228
| | - Laura M. Rowland
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland USA 21228
| | - Stacey B. Daughters
- Department of Psychology, The University of North Carolina at Chapel Hill, Chapel Hill, NC USA 27599
| | - L. Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland USA 21228
| |
Collapse
|
35
|
Ehrlich KB, Cassidy J, Lejuez CW, Daughters SB. Discrepancies About Adolescent Relationships as a Function of Informant Attachment and Depressive Symptoms. J Res Adolesc 2014; 24:654-666. [PMID: 36530208 PMCID: PMC9756933 DOI: 10.1111/jora.12057] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Developmental scientists studying interpersonal relationships often find that informants disagree in their reports, and two theoretical perspectives suggest that these discrepancies may be predictable. In two studies of adolescents' interpersonal relationships, we examined two factors that may predict the absolute magnitude and the direction of the discrepancies in reports about several types of relationships. Specifically, we examined informants' depressive symptoms and attachment as predictors of absolute and directional discrepancies in reports about (a) adolescents' relationships with peers, (b) parent-adolescent relationships, and (c) adolescents' friendships. Findings revealed that informant depressive symptoms sometimes were associated with discrepancies. In contrast, informant attachment more consistently accounted for absolute and directional discrepancies.
Collapse
Affiliation(s)
- Katherine B Ehrlich
- Institute for Policy Research, Northwestern University, 2040 Sheridan Rd, Evanston, IL 60208
| | - Jude Cassidy
- 1147 Biology/Psychology Building, Department of Psychology, University of Maryland, College Park, MD 20742
| | - Carl W Lejuez
- 1147 Biology/Psychology Building, Department of Psychology, University of Maryland, College Park, MD 20742
| | - Stacey B Daughters
- 247 Davie Hall, Department of Psychology, University of North Carolina, Chapel Hill, NC 27599
| |
Collapse
|
36
|
Magidson JF, Listhaus A, Seitz-Brown CJ, Safren SA, Lejuez CW, Daughters SB. Can behavioral theory inform the understanding of depression and medication nonadherence among HIV-positive substance users? J Behav Med 2014; 38:337-47. [PMID: 25381605 DOI: 10.1007/s10865-014-9606-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 10/30/2014] [Indexed: 01/05/2023]
Abstract
Medication adherence is highly predictive of health outcomes across chronic conditions, particularly HIV/AIDS. Depression is consistently associated with worse adherence, yet few studies have sought to understand how depression relates to adherence. This study tested three components of behavioral depression theory--goal-directed activation, positive reinforcement, and environmental punishment--as potential indirect effects in the relation between depressive symptoms and medication nonadherence among low-income, predominantly African American substance users (n = 83). Medication nonadherence was assessed as frequency of doses missed across common reasons for nonadherence. Non-parametric bootstrapping was used to evaluate the indirect effects. Of the three intermediary variables, there was only an indirect effect of environmental punishment; depressive symptoms were associated with greater nonadherence through greater environmental punishment. Goal-directed activation and positive reinforcement were unrelated to adherence. Findings suggest the importance of environmental punishment in the relation between depression and medication adherence and may inform future intervention efforts for this population.
Collapse
Affiliation(s)
- Jessica F Magidson
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA,
| | | | | | | | | | | |
Collapse
|
37
|
Magidson JF, Seitz-Brown CJ, Safren SA, Daughters SB. Implementing Behavioral Activation and Life-Steps for Depression and HIV Medication Adherence in a Community Health Center. Cogn Behav Pract 2014; 21:386-403. [PMID: 25419102 DOI: 10.1016/j.cbpra.2013.10.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Antiretroviral therapy to treat HIV/AIDS has substantially improved clinical outcomes among patients living with HIV/AIDS, but only in the presence of very consistent adherence. One of the most prevalent and impactful individual-level predictors of poor adherence is depressive symptoms, even at subthreshold levels. Evidence-based cognitive behavioral interventions exist to address improvements in depressive symptoms and adherence in this population, yet these techniques have largely been designed and tested as individual treatments for delivery in mental health settings. This presents a significant challenge when transporting these techniques to medical settings where other formats for delivery may be more appropriate (i.e., groups, less frequent visits) and few hands-on resources exist to guide this process. As such, primary aims of this study were to adapt and implement evidence-based cognitive behavioral techniques for depression (behavioral activation; BA) and HIV medication adherence (Life-Steps) that have potential for dissemination in an outpatient community health center. The intervention incorporated feedback from health center staff and utilized a modular, group format that did not rely on sequential session attendance. Feasibility was examined over 8 weeks (n = 13). Preliminary effects on depression, health-related quality of life, and medication adherence were examined and exit interviews were conducted with a subset of participants (n = 4) to inform future modifications. Treatment descriptions and recommendations for effective clinical implementation based on patient and clinician feedback are provided along with case material of two individual patients and an example group session. Current efforts are an important next step for disseminating evidence-based techniques for depression and HIV medication adherence to community health center or AIDS service organization settings.
Collapse
Affiliation(s)
- Jessica F Magidson
- Massachusetts General Hospital/Harvard Medical School and University of Maryland, College Park
| | | | | | - Stacey B Daughters
- University of Maryland, College Park, and University of North Carolina, Chapel Hill
| |
Collapse
|
38
|
Abstract
Distress tolerance is defined behaviorally as the ability to maintain goal-directed behavior while experiencing physical or psychological distress. Distress tolerance is closely related to emotion regulation and is a clinically relevant construct contributing to psychopathology across adults and adolescents, yet limited research has examined the development of this construct. A number of studies suggest the importance of parenting in the emergence of emotion regulation capacities in childhood and adolescence. In the current study, we utilize a behavioral measure of distress tolerance to examine whether maternal distress tolerance is related to adolescent distress tolerance, and whether this association differs as a function of gender. We also examine the influence of family emotional climate, namely maternal response to adolescent distress and adolescent attachment. Results indicate a significant maternal distress tolerance by adolescent gender interaction, such that maternal distress tolerance predicts adolescent distress tolerance in daughters, but not sons. The family emotional climate variables were unrelated to maternal or adolescent distress tolerance. Taken together, data indicate that maternal distress tolerance is significantly related to the distress tolerance of adolescent daughters and indicates the potential utility of addressing maternal distress tolerance in clinical work with adolescents.
Collapse
|
39
|
Abstract
OBJECTIVE The purpose of this investigation was to determine the relationship between distress tolerance and risky and aggressive driving. Distress tolerance, defined as an individual's capability to experience and endure negative emotional states, was hypothesized to be related negatively to aggressive driving and risky driving. METHODS An anonymous, web-based survey of 769 college students was conducted at a large East Coast university. RESULTS After controlling for age, gender, race, ethnicity, year in school, grade point average, and driving frequency, distress tolerance was significantly inversely related to reported risky driving and aggressive driving. CONCLUSION College drivers who have a diminished capacity to endure frustration without experiencing negative emotional states (i.e., low distress tolerance) tend to drive aggressively and in a risky manner. Traditional deterrence-based approaches to highway safety may benefit from inclusion of a wider array of prevention strategies that focus on emotion regulation while driving.
Collapse
Affiliation(s)
- Kenneth H Beck
- a Department of Behavioral and Community Health , University of Maryland School of Public Health , College Park , Maryland
| | | | | |
Collapse
|
40
|
Daughters SB, Gorka SM, Magidson JF, Macpherson L, Seitz-Brown CJ. The role of gender and race in the relation between adolescent distress tolerance and externalizing and internalizing psychopathology. J Adolesc 2013; 36:1053-65. [PMID: 24215952 PMCID: PMC4280012 DOI: 10.1016/j.adolescence.2013.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 08/05/2013] [Accepted: 08/07/2013] [Indexed: 10/26/2022]
Abstract
Distress tolerance (DT) is an established construct contributing to the onset and maintenance of psychopathology in adulthood; however, few studies have examined the role of DT in older adolescent psychopathology. Emerging data suggest that gender and race may influence this relation. Therefore, the current study examined the relation between gender, race, and DT on parent-reported internalizing and externalizing DSM-oriented symptoms among a community sample of 128, 14-18 year old adolescents. Results indicated a moderating effect of gender on affective problems, such that females with low DT, but not males, displayed significantly greater affective problems. Findings also indicated a significant moderating effect of race, such that Caucasians with low DT, but not African Americans, displayed significantly higher somatic, oppositional defiant, and conduct problems. These findings suggest that DT is an important clinical variable in older adolescence, particularly among Caucasians and females.
Collapse
Affiliation(s)
- Stacey B Daughters
- Department of Psychology, University of North Carolina-Chapel Hill, USA.
| | | | | | | | | |
Collapse
|
41
|
Daughters SB, Gorka SM, Matusiewicz A, Anderson K. Gender specific effect of psychological stress and cortisol reactivity on adolescent risk taking. J Abnorm Child Psychol 2013; 41:749-58. [PMID: 23338478 DOI: 10.1007/s10802-013-9713-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to evaluate how psychological stress, gender and cortisol response to stress relate to risk behavior among 132 14-18 year old adolescents. Participants completed a laboratory based risk task prior to and immediately after a computerized psychological stress task, and salivary cortisol was collected from pre-stress to 60 min following initial stress exposure. Results indicate that adolescent boys (n = 59) and girls (n = 73) demonstrate different patterns of risk taking (RT) in response to stress, such that boys evidenced an increase in RT following stress exposure, whereas girls evidenced a decrease in RT. In addition, a gender by cortisol interaction demonstrated that for boys, both a smaller total cortisol output (AUCg) and peak cortisol response to stress (PC) was associated with greater stress-induced RT. Both cortisol measures were unrelated to stress-induced RT among girls. Taken together, data suggest that among boys, a blunted cortisol response to stress underlies an increase in risk taking in the context of psychological stress. Further research with an additional behavioral stress task is needed prior to drawing conclusions regarding the relation between female gender, cortisol response to stress, and risk taking in the context of psychological stress.
Collapse
Affiliation(s)
- Stacey B Daughters
- Department of Psychology, University of North Carolina, Chapel Hill, NC, USA.
| | | | | | | |
Collapse
|
42
|
Ehrlich KB, Cassidy J, Gorka SM, Lejuez CW, Daughters SB. Adolescent friendships in the context of dual risk: the roles of low adolescent distress tolerance and harsh parental response to adolescent distress. Emotion 2013; 13:843-51. [PMID: 23795594 PMCID: PMC4017851 DOI: 10.1037/a0032587] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Given extensive evidence about the importance of relationships with friends during development, a large body of research has examined the correlates of these significant social experiences. Most of this research, however, has examined either individual characteristics (e.g., behavior, personality) or contextual factors (e.g., family), and most of the work has studied relationships during childhood. The present study extended previous research by examining how both an individual factor (adolescent distress tolerance) and a contextual factor (parental response to adolescent distress) are linked to adolescents' friendships. Adolescents (N = 161) completed two behavioral measures of distress tolerance, and parents reported about their responses to adolescent distress. Although distress tolerance and parental responses to distress were not directly associated with adolescents' positive or negative friendship experiences, for adolescents with low distress tolerance, harsh parental responses were negatively associated with adolescents' positive friendship quality. Further, for adolescents whose parents used harsh responses to distress, distress tolerance was negatively associated with adolescents' positive friendship quality. Results highlight the importance of studying both individual and familial factors related to adolescents' social functioning.
Collapse
|
43
|
Magidson JF, Seitz-Brown CJ, Listhaus A, Lindberg B, Anderson KE, Daughters SB. Distress tolerance and use of antiretroviral therapy among HIV-infected individuals in substance abuse treatment. AIDS Patient Care STDS 2013; 27:518-23. [PMID: 23991690 PMCID: PMC3760053 DOI: 10.1089/apc.2013.0120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite recent clinical guidelines recommending early initiation and widespread use of antiretroviral therapy (ART), many HIV-infected individuals are not receiving ART-in particular low-income, minority substance users. Few studies have examined psychological, as opposed to structural, factors related to not receiving ART in this population. Perceived capacity to tolerate physical and psychological distress, known as distress tolerance (DT), may be a particularly relevant yet understudied factor. The current study tested the relationship between self-reported physical and psychological DT and ART receipt among predominantly low-income, minority HIV-infected substance users (n=77). Psychiatric disorders, biological indicators of health status, ART use, structural barriers to health care, and self-reported physical and psychological DT were assessed. 61% of participants were receiving ART. The only factors that distinguished individuals not on ART were greater avoidance of physical discomfort, higher psychological DT, and higher CD4 count. Both DT measures remained associated with ART use after controlling for CD4 count and were associated with almost a two-fold decrease in likelihood of ART receipt. Current findings suggest higher perceived capacity to tolerate psychological distress and greater avoidance of physical discomfort are important factors associated with lower ART use among substance users and may be important intervention targets.
Collapse
Affiliation(s)
- Jessica F Magidson
- Department of Behavioral and Community Health, University of Maryland, College Park, MD, USA.
| | | | | | | | | | | |
Collapse
|
44
|
Ali B, Ryan JS, Beck KH, Daughters SB. Trait aggression and problematic alcohol use among college students: the moderating effect of distress tolerance. Alcohol Clin Exp Res 2013; 37:2138-44. [PMID: 23889266 DOI: 10.1111/acer.12198] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 04/24/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Trait aggression has been linked to alcohol-related problems among college students. However, the individual conditions underlying this association are unknown. Empirical evidence and theory suggest the importance of distress tolerance, defined as an individual's ability to withstand negative affective states, in the relationship between trait aggression and alcohol use. Therefore, the purpose of the current study was to examine whether distress tolerance moderates the relationship between trait aggression and problematic alcohol use. METHODS Participants were 646 undergraduate students in a large university, who reported any lifetime alcohol use. The dependent variable, problematic alcohol use, was measured using the Alcohol Use Disorders Identification Test total score. The main independent variable, trait aggression, was assessed on the negative emotionality scale of the Multidimensional Personality Questionnaire, and the moderator, distress tolerance, was determined using the Distress Tolerance Scale. RESULTS Hierarchical linear regression analyses indicated a significant interaction between trait aggression and distress tolerance in predicting problematic alcohol use, adjusting for demographic variables, regular substance use, depressive symptoms, and anxiety symptoms. Specifically, a significant positive relationship between trait aggression and problematic alcohol use was present among those with low, but not high, distress tolerance. CONCLUSIONS Results provide evidence that college students with high levels of trait aggression are more likely to engage in problematic alcohol use if they also evidence an inability to tolerate negative affective states. Study implications are discussed, including the development of prevention and intervention programs that target distress tolerance skills.
Collapse
Affiliation(s)
- Bina Ali
- Department of Behavioral and Community Health , University of Maryland School of Public Health, College Park, Maryland
| | | | | | | |
Collapse
|
45
|
Lechner WV, Dahne J, Chen KW, Pickover A, Richards JM, Daughters SB, Lejuez C. The prevalence of substance use disorders and psychiatric disorders as a function of psychotic symptoms. Drug Alcohol Depend 2013; 131:78-84. [PMID: 23291208 PMCID: PMC4523140 DOI: 10.1016/j.drugalcdep.2012.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 12/02/2012] [Accepted: 12/02/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Psychotic symptoms represent one of the most severe and functionally impairing components of several psychological disorders. One group with particularly high rates of psychotic symptoms is chronic substance users. However, the literature on psychotic symptoms and substance use is quite narrow and has focused almost exclusively on drug-induced psychosis, neglecting the population of substance users with psychotic symptoms occurring independently of acute drug effects. METHOD The current study examined demographics, substance dependence, and psychiatric comorbidities among substance users with current (CurrSx), past (PastSx), and no psychotic symptoms (NoSx). Patients (n=685) were sequential admissions to a residential substance use treatment center from 2006 to 2009. RESULTS Compared to NoSx, those who endorsed CurrSx were significantly more likely to meet criteria for lifetime alcohol dependence and lifetime amphetamine dependence. CurrSx were more likely than PastSx to meet for lifetime cannabis dependence. Additionally, CurrSx were more likely to meet criteria for a comorbid psychiatric disorder compared to NoSx, and evidenced a greater number of current psychiatric disorders. NoSx were less likely than both CurrSx and PastSx to meet criteria for Borderline Personality Disorder. CONCLUSION Individuals with non-substance induced psychotic symptoms appear to meet criteria for specific substance use disorders and psychiatric disorders at higher rates than those without psychotic symptoms; these effects were most evident for those with current as opposed to past symptoms. Findings suggest that these individuals may need specialized care to address potential psychiatric comorbidities and overall greater severity levels relative to substance users without psychotic symptoms.
Collapse
Affiliation(s)
- William V. Lechner
- Department of Psychology, Oklahoma State University, Stillwater, OK 74075, United States,Corresponding author. Tel.: +1 405 744 0326. (W.V. Lechner)
| | - Jennifer Dahne
- Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park, MD 20742, United States
| | - Kevin W. Chen
- Center for Integrative Medicine, and Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States
| | - Alison Pickover
- Department of Psychology, University of Memphis, Memphis, TN 38152, United States
| | - Jessica M. Richards
- Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park, MD 20742, United States
| | - Stacey B. Daughters
- Department of Psychology, University of North Carolina, Chapel Hill, NC 27599, United States
| | - C.W. Lejuez
- Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park, MD 20742, United States
| |
Collapse
|
46
|
Banducci AN, Dahne J, Magidson JF, Chen K, Daughters SB, Lejuez CW. Clinical characteristics as a function of referral status among substance users in residential treatment. Addict Behav 2013; 38:1924-30. [PMID: 23380487 PMCID: PMC3578165 DOI: 10.1016/j.addbeh.2012.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 10/31/2012] [Accepted: 12/18/2012] [Indexed: 11/23/2022]
Abstract
In the United States, substance users who voluntarily (VO) elect to receive treatment and substance users who are court-mandated (CM) to receive treatment typically obtain care within the same facilities. Little is known about the clinical characteristics that differentiate these individuals. The current study provides rates of specific DSM-IV Axis I and Axis II psychiatric and substance use disorders, comorbidities, childhood trauma, motivation, and other clinical and demographic characteristics as a function of referral status, among individuals in residential substance use treatment (463 participants, M age=43.3; 69.7% male; 88.4% African American). Participants were interviewed and diagnosed using the Structure Clinical Interview for DSM-IV and the Diagnostic Interview for Personality Disorders. Within our sample, VO individuals, as compared to CM individuals had significantly higher rates of psychiatric disorders (68.7% versus 55.2%, respectively), including mood disorders, major depressive disorder, generalized anxiety disorder, and borderline personality disorder. Additionally, they were significantly more likely to have alcohol dependence (43.0% versus 20.8%) and cocaine dependence (66.5% versus 48.9%). Elevated rates of comorbidities and childhood abuse were also observed among VO individuals, while motivation did not differ as a function of referral status. Overall, VO individuals appeared to have more severe problems than their CM counterparts which may suggest that they require more intensive or different types of treatment.
Collapse
Affiliation(s)
- Anne N Banducci
- Center for Addictions, Personality, and Emotion Research, , Department of Psychology, University of Maryland-College Park, MD 20742, United States.
| | | | | | | | | | | |
Collapse
|
47
|
MacPherson L, Calvin NT, Richards JM, Guller L, Mayes LC, Crowley MJ, Daughters SB, Lejuez CW. Development and preliminary validation of a behavioral task of negative reinforcement underlying risk-taking and its relation to problem alcohol use in college freshmen. Alcohol Clin Exp Res 2012; 36:950-7. [PMID: 22309846 PMCID: PMC3349772 DOI: 10.1111/j.1530-0277.2011.01703.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 09/19/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND A long line of theoretical and empirical evidence implicates negative reinforcement as a process underlying the etiology and maintenance of risky alcohol use behaviors from adolescence through emerging adulthood. However, the bulk of this literature has relied on self-report measures, and there is a notable absence of behavioral modes of assessments of negative reinforcement-based alcohol-related risk-taking. To address this clear gap in the literature, the current study presents the first published data on the reliability and validity of the Maryland Resource for the Behavioral Utilization of the Reinforcement of Negative Stimuli (MRBURNS), which is a modified version of the positive reinforcement-based Balloon Analogue Risk Task (BART). METHODS Participants included a convenience sample of 116 college freshmen ever regular drinkers (aged 18 to 19) who completed both behavioral tasks; self-report measures of negative reinforcement/avoidance constructs and of positive reinforcement/appetitive constructs to examine convergent validity and discriminant validity, respectively; and self-report measures of alcohol use, problems, and motives to examine criterion validity. RESULTS The MRBURNS evidenced sound experimental properties and reliability across task trials. In support of convergent validity, risk-taking on the MRBURNS correlated significantly with negative urgency, difficulties in emotion regulation, and depressive and anxiety-related symptoms. In support of discriminant validity, performance on the MRBURNS was unrelated to risk-taking on the BART, sensation seeking, and trait impulsivity. Finally, pertaining to criterion validity, risk-taking on the MRBURNS was related to alcohol-related problems but not heavy episodic alcohol use. Notably, risk-taking on the MRBURNS was associated with negative reinforcement-based but not with positive reinforcement-based drinking motives. CONCLUSIONS Data from this initial investigation suggest the utility of the MRBURNS as a behavioral measure of negative reinforcement-based risk-taking that can provide a useful complement to existing self-report measures to improve our understanding of the relationship between avoidant reinforcement processes and risky alcohol use.
Collapse
Affiliation(s)
- Laura MacPherson
- Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park, MD 20742, USA. ,
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Bornovalova MA, Gratz KL, Daughters SB, Hunt ED, Lejuez CW. Initial RCT of a distress tolerance treatment for individuals with substance use disorders. Drug Alcohol Depend 2012; 122:70-6. [PMID: 21983476 PMCID: PMC3288895 DOI: 10.1016/j.drugalcdep.2011.09.012] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 09/08/2011] [Accepted: 09/10/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Psychological distress tolerance, the ability to persist in goal directed activity when experiencing psychological distress, is associated with poor substance use treatment outcomes including drug and alcohol treatment dropout and relapse. OBJECTIVE The current study examines if a brief distress tolerance intervention that was specifically developed as an adjunctive treatment for patients in residential substance abuse treatment shows efficacy in improving the patients' distress tolerance. METHODS Seventy-six individuals who were receiving treatment at a residential substance use treatment facility and indexed low distress tolerance on laboratory distress tolerance measures were randomized into three conditions: treatment-as-usual (TAU), six sessions of Supportive Counseling (SC), or six sessions of the novel distress tolerance treatment, Skills for Improving Distress Intolerance (SIDI). MEASURES Patients were assessed at baseline for DSM-IV psychiatric diagnoses, DSM-IV substance use disorders, distress tolerance, and depressive symptoms. Patients were again assessed at posttreatment. Therapeutic alliance and treatment expectancies and credibility were also assessed at posttreatment. RESULTS Patients who received SIDI (n=28) evidenced significantly greater improvements than SC (n=24) and TAU participants (n=24) on the distress tolerance laboratory measures, even when controlling for changes in negative affect (in the form of depression). Additionally, a higher percentage of patients in SIDI reached clinically significant improvement compared to patients in SC and TAU. CONCLUSION This study supports the efficacy of SIDI in improving distress tolerance levels among individuals with drug and alcohol use disorders currently receiving residential substance use treatment. SIDI appears to be a brief and feasible intervention for use within inpatient substance use facilities.
Collapse
Affiliation(s)
- Marina A Bornovalova
- Department of Psychology, University of South Florida, 4202 East Fowler Ave, Tampa, FL 33620, United
| | | | | | | | | |
Collapse
|
49
|
Amstadter AB, Daughters SB, MacPherson L, Reynolds EK, Danielson CK, Wang F, Potenza MN, Gelernter J, Lejuez CW. Genetic associations with performance on a behavioral measure of distress intolerance. J Psychiatr Res 2012; 46:87-94. [PMID: 22024485 PMCID: PMC3687355 DOI: 10.1016/j.jpsychires.2011.09.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 09/11/2011] [Accepted: 09/29/2011] [Indexed: 01/31/2023]
Abstract
Both theory and empirical evidence support possible associations between two candidate genetic polymorphisms (SLC6A4 5-HTTLPR l/s and COMT Val(158)Met--rs4680 variants) and emotion-regulation difficulties. One particular form of emotion-regulation difficulty, distress intolerance, has been measured using a behavioral assessment in youth; data indicate a relationship with poor psychological functioning. No prior study has investigated genetic influences on emotion-regulation difficulties in youth. As part of a larger longitudinal study on adolescent risk behaviors, 218 10-14 year-old youths from the metropolitan Washington, D.C., area completed a measure of distress intolerance, the Behavioral Indicator of Resilience to Distress (BIRD), and provided saliva samples for DNA extraction and genotyping. Results indicate that those with one or two copies of the s allele of the 5-HTTLPR polymorphism were more likely to perform poorly on the task (i.e., choose to quit) than were those homozygous for the l allele. Participants who were Val allele carriers of the COMT Val(158)Met polymorphism were also more likely to quit the task compared to Met homozygotes. A summative risk allele score was created to combine the two polymorphisms, and each risk allele was associated with a 1.75 fold increased likelihood of quitting the task. Exploratory analyses revealed that emotional abuse moderated the relationship between the 5-HTTLPR and BIRD performance, as well as the genetic risk allele and the BIRD. This is the first investigation of genetic predictors of a behavioral measure of tolerance to distress. Results suggest that distress tolerance is at least partially regulated by specific genetic variants. Implications are discussed.
Collapse
|
50
|
Gorka SM, Ali B, Daughters SB. The role of distress tolerance in the relationship between depressive symptoms and problematic alcohol use. Psychol Addict Behav 2011; 26:621-6. [PMID: 22121919 DOI: 10.1037/a0026386] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Empirical evidence and theory implicate the role of distress tolerance in the relationship between negative affect and alcohol use. However, limited research has been conducted to explore these relationships. As such, the purpose of this study was to examine whether distress tolerance moderates the relationship between current depressive symptoms and problematic alcohol use in a community sample of adults. Participants included 150 adults, primarily female, recruited from the local community. Problematic alcohol use was measured using the Alcohol Use Disorders Identification Test (AUDIT) total score, which is a composite measure of harmful and hazardous patterns of alcohol use and several current alcohol dependence symptoms. Distress tolerance was measured using a computerized behavioral distress tolerance task, the Computerized Paced Auditory Serial Addition Task (PASAT-C). Tobit regression analyses indicated a significant interaction between distress tolerance and depressive symptoms in predicting alcohol problems, such that depressive symptoms were significantly associated with problematic alcohol use among adults with low, but not high, distress tolerance. Thus, alcohol use interventions with a focus on distress tolerance skills in the context of depressive symptoms may be particularly effective.
Collapse
Affiliation(s)
- Stephanie M Gorka
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA.
| | | | | |
Collapse
|