Examining Social Influences on Why We Drink: Perceived Drinking Motives in the Social Network Impact Individuals' Own Drinking Motives and Alcohol Use.

Introduction: A significant body of research has investigated the impacts of social influence and social selection on binge drinking and risk factors for binge drinking in emerging adults; however, one risk factor for binge drinking that has yet to be thoroughly investigated in this regard is drinking motives. Preliminary research suggests the motives of others may impact emerging adults' own alcohol use indirectly through their own motives (i.e., social influence). While these are important findings, research to date has been only conducted with adolescents or dyads and has not examined selection (i.e., selecting social network members with similar motives). We filled these gaps with a longitudinal egocentric social network design. Methods: Emerging adults (N = 177) completed measures on their alcohol use, drinking motives, and social networks at baseline (T1) and four-month follow-up (T2). Results: A cross-lagged panel model indicated T1 perceived network drinking motives predicted T2 participant drinking motives (for all motives but social), but T1 participant drinking motives did not predict T2 perceived network drinking motives. Path analysis indicated T1 perceived network drinking motives predicted T2 participant binge drinking frequency indirectly through T2 participant drinking motives for enhancement, coping-with-anxiety, and conformity, but not social or coping-with-depression, motives. Discussion: Results suggests drinking motives of those around emerging adults impact their own drinking motives, and indirectly, their own alcohol use. We found evidence of social influence, but not social selection. Conclusion: It appears that those around emerging adults have the capacity to influence their drinking behaviors and drinking motives.

Morality in autism spectrum disorder: A systematic review.

Moral reasoning and decision making help guide behavior and facilitate interpersonal relationships. Accounts of morality that position commonsense psychology as the foundation of moral development, (i.e., rationalist theories) have dominated research in morality in autism spectrum disorder (ASD). Given the well-documented differences in commonsense psychology among autistic individuals, researchers have investigated whether the development and execution of moral judgement and reasoning differs in this population compared with neurotypical individuals. In light of the diverse findings of investigations of moral development and reasoning in ASD, a summation and critical evaluation of the literature could help make sense of what is known about this important social-cognitive skill in ASD. To that end, we conducted a systematic review of the literature investigating moral decision making among autistic children and adults. Our search identified 29 studies. In this review, we synthesize the research in the area and provide suggestions for future research. Such research could include the application of an alternative theoretical framework to studying morality in autism spectrum disorder that does not assume a deficits-based perspective.

Self-isolation: A significant contributor to cannabis use during the COVID-19 pandemic.

BACKGROUND: Emerging research suggests the COVID-19 pandemic has resulted in a significant increase in self-reported isolation and loneliness in a large proportion of the population. This is particularly concerning given that isolation and loneliness are associated with increased cannabis use, as well as using cannabis to cope with negative affect. Objective: We investigated whether self-isolation due to COVID-19 and using cannabis to cope with depression were unique and/or interactive predictors of cannabis use during the pandemic, after controlling for pre-pandemic levels of cannabis use. Method: A sample of 70 emerging adults (mean age = 23.03; 34.3% male) who used both alcohol and cannabis pre-pandemic completed measures of cannabis use (i.e., quantity x frequency) and a novel COVID-19 questionnaire between March 23 and June 15, 2020. Pre-pandemic cannabis use levels had been collected four months earlier. Results: Linear regressions indicated self-isolation and coping with depression motives for cannabis use during the pandemic were significant predictors of pandemic cannabis use levels after accounting for pre-pandemic use levels. There was no interaction between coping with depression motives and self-isolation on cannabis use during the pandemic. Conclusions: Those who engaged in self-isolation were found to use 20% more cannabis during the pandemic than those who did not. Our results suggest that self-isolation is a unique risk factor for escalating cannabis use levels during the pandemic. Thus, self-isolation may inadvertently lead to adverse public health consequences in the form of increased cannabis use.

Neurotic Personality Traits and Risk for Adverse Alcohol Outcomes: Chained Mediation through Emotional Disorder Symptoms and Drinking to Cope.

BACKGROUND: Rates of alcohol abuse are high on Canadian postsecondary campuses. Individual trait differences have been linked to indices of alcohol use/misuse, including neurotic traits like anxiety sensitivity (AS) and hopelessness (HOP). We know little, though, about how these traits confer vulnerability. AS and HOP are related to anxiety and depression, respectively, and to drinking to cope with symptoms of those disorders. Neurotic personality may therefore increase risk of alcohol use/abuse via (1) emotional disorder symptoms and/or (2) coping drinking motives. OBJECTIVES: Allan and colleagues (2014) found chained mediation through AS-generalized anxiety-coping motives-alcohol problems and AS-depression-coping motives-alcohol problems. We sought to expand their research by investigating how emotional disorder symptoms (anxiety, depression) and specific coping motives (drinking to cope with anxiety, depression) may sequentially mediate the AS/HOP-to-hazardous alcohol use/drinking harms relationships among university students. METHODS: This study used cross-sectional data collected in Fall 2014 as part of the Movember-funded Caring Campus Project (N = 1,883). The survey included the SURPS, adapted DMQ-R SF, and AUDIT-3. RESULTS: AS and HOP were both related to hazardous alcohol and drinking harms via emotional disorder symptoms and, in turn, coping drinking motives. All indirect pathways incorporating both mediators were statistically significant, and additional evidence of partial specificity was found. Conclusions/Importance: The study's results have important implications for personality-matched interventions for addictive disorders.

Do trauma cue exposure and/or PTSD symptom severity intensify selective approach bias toward cannabis cues in regular cannabis users with trauma histories?

Trauma cue-elicited activation of automatic cannabis-related cognitive biases are theorized to contribute to comorbid posttraumatic stress disorder and cannabis use disorder. This phenomenon can be studied experimentally by combining the trauma cue reactivity paradigm (CRP) with cannabis-related cognitive processing tasks. In this study, we used a computerized cannabis approach-avoidance task (AAT) to assess automatic cannabis (vs. neutral) approach bias following personalized trauma (vs. neutral) CRP exposure. We hypothesized that selective cannabis (vs. neutral) approach biases on the AAT would be larger among participants with higher PTSD symptom severity, particularly following trauma (vs. neutral) cue exposure. We used a within-subjects experimental design with a continuous between-subjects moderator (PTSD symptom severity). Participants were exposed to both a trauma and neutral CRP in random order, completing a cannabis AAT (cannabis vs. neutral stimuli) following each cue exposure. Current cannabis users with histories of psychological trauma (n = 50; 34% male; mean age = 37.8 years) described their most traumatic lifetime event, and a similarly-detailed neutral event, according to an established interview protocol that served as the CRP. As hypothesized, an AAT stimulus type x PTSD symptom severity interaction emerged (p = .042) with approach bias greater to cannabis than neutral stimuli for participants with higher (p = .006), but not lower (p = .36), PTSD symptom severity. Contrasting expectations, the stimulus type x PTSD symptoms effect was not intensified by trauma cue exposure (p = .19). Selective cannabis approach bias may be chronically activated in cannabis users with higher PTSD symptom severity and may serve as an automatic cognitive mechanism to help explain PTSD-CUD co-morbidity.

Trauma-informed Approaches to Substance Use Interventions with Indigenous Peoples: A Scoping Review.

Indigenous Peoples experience disproportionately higher rates of problematic substance use. These problems are situated in a context of individual and intergenerational trauma from colonization, residential schools, and racist and discriminatory practices, policies, and services. Therefore, substance use interventions need to adopt a trauma-informed approach. We aimed to synthesize and report the current literature exploring the intersection of trauma and substance use interventions for Indigenous Peoples. Fourteen databases were searched using keywords for Indigenous Peoples, trauma, and substance use. Of the 1373 sources identified, 117 met inclusion criteria. Literature on trauma and substance use with Indigenous Peoples has increased in the last 5 years (2012-2016, n = 29; 2017-2021, n = 48), with most literature coming from the United States and Canada and focusing on historical or intergenerational trauma. Few articles focused on intersectional identities such as 2SLGBTQIA+ (n = 4), and none focused on veterans. There were limited sources (n = 25) that reported specific interventions at the intersection of trauma and substance use. These sources advocate for multi-faceted, trauma-informed, and culturally safe interventions for use with Indigenous Peoples. This scoping review illuminates gaps in the literature and highlights a need for research reporting on trauma-informed interventions for substance use with Indigenous Peoples.

Classification of Orthorexia Nervosa: Further evidence for placement within the eating disorders spectrum.

PURPOSE: Orthorexia Nervosa (ON) may belong on the eating disorder (ED) or obsessive-compulsive (OC) spectrum. We sought to provide additional evidence regarding the working classification of ON as an ED. METHODS: 512 individuals completed a measure of ON symptoms (rBOT), ED symptoms (Eating Disorder Examination Questionnaire), OC symptoms (Obsessive-Compulsive Inventory Revised), food choice motives (Food Choice Questionnaire), and perfectionism (Multidimensional Perfectionism Scale). RESULTS: ON symptoms were more strongly linked to ED symptoms than to OC symptoms. ON symptoms were related to body weight and shape concerns, and with prioritizing weight above health with respect to food selection. Both ED and ON symptoms were moderately related to perfectionism, while OC symptoms were strongly related to perfectionism. CONCLUSION: Our results support ON being classified on the ED spectrum; however, whether ON represents a precursor to an ED, an ED with added health concerns, or a disorder that evolves from an ED is not certain. Future longitudinal research is necessary to test these alternate possibilities.

Specificity of personality relationships to particular forms of concurrent substance use among methadone maintenance therapy clients.

OBJECTIVE: A mainstay treatment for opioid addiction in North America is methadone maintenance therapy (MMT) - a form of opiate agonist therapy (OAT). While efficacious for treating opioid addiction, MMT fails to address the concurrent polysubstance use that is common among opioid dependent clients. Moreover, psychosocial approaches for addressing polysubstance use during MMT are lacking. Our study's goals were to validate the use of the four-factor personality model of substance use vulnerability in MMT clients, and to demonstrate theoretically-relevant relationships of personality to concurrent substance use while receiving MMT. METHOD: Respondents included 138 daily-witnessed MMT clients (65.9% male, 79.7% Caucasian), mean age (SD) 40.18 (11.56), recruited across four Canadian MMT clinics. Bayesian confirmatory factor analysis was used to establish the structural validity of the four-factor personality model of substance use vulnerability (operationalized with the Substance Use Risk Profile Scale [SURPS]) in MMT clients. SURPS personality scores were then used as predictors for specific forms of recent (past 30-day) substance use. RESULTS: Using a latent hierarchal model, hopelessness was associated with recent opioid use; anxiety sensitivity with recent tranquilizer use; and sensation seeking with recent alcohol, cannabis, and stimulant use. CONCLUSION: Personality is associated with substance use patterns and may be an appropriate target for intervention for those undergoing MMT to reduce opioid use, and potentially dangerous concurrent use of other drugs, while receiving methadone.

Personality and prescription drug use/misuse among first year undergraduates.

Emerging adults (18-25 year olds) endorse the highest rates of prescription drug misuse. Attending college or university may confer additional risk. Previous research suggests that personality is an important predictor of many addictive behaviours. Four traits have been consistently implicated: anxiety sensitivity, hopelessness, sensation seeking, and impulsivity. Published studies on personality as a predictor of prescription drug abuse are limited, however, by a primary focus on overall prescription drug use, inconsistent operationalisation of misuse, and failure to control for alcohol use. Sample sizes have been small and non-specific. We sought to better understand how personality predicted the overall use, the medically-sanctioned use, and the misuse of prescription sedatives/tranquilizers, opioids, and stimulants. A large (N = 1755) sample of first year Canadian undergraduate students (mean age = 18.6 years; 68.9% female) was used. We predicted that: anxiety sensitivity would be related to sedatives/tranquilizers, hopelessness to opioids, sensation seeking to stimulants, and impulsivity to all three. Save for the impulsivity to opioid use path, predictions were fully supported in our "any use" model. For medically-sanctioned use: anxiety sensitivity predicted sedative/tranquilizers, hopelessness predicted opioids, and impulsivity predicted stimulants. For misuse: anxiety sensitivity (marginally) predicted sedatives/tranquilizers, sensation seeking predicted stimulants, and impulsivity predicted all three. Our models support using personality-matched interventions. Specifically, results suggest targeting anxiety sensitivity for sedative/tranquilizer misuse, sensation seeking for stimulant misuse, and impulsivity for unconstrained prescription drug misuse. Interventions with early coping skills that pertain to all four traits might be useful for preventing prescription drug uptake and later misuse.

Benzodiazepine side-effects: from the bench to the clinic.

This article introduces a special issue of Current Pharmaceutical Design focusing on the various side effects of benzodiazepine medications. We argue that an increased awareness of the risk of dependence, withdrawal symptoms upon discontinuation, and cognitive side effects of the benzodiazepines has likely contributed to the decline in their prescription rate over the last two decades, as has increased availability of alternative pharmacologic and non-pharmacologic treatments for anxiety and insomnia. The present special issue consists of series of five papers covering current issues in the area of benzodiazepine side effects. These reviews cover a wide range of topics pertaining to adverse, unintended consequences of this class of pharmacologic agents including their potential for tolerance and withdrawal, their profile of associated cognitive impairments, as well as current understanding of means for minimizing these unintended effects. The reviews also cover a variety of methodologies and disciplines from laboratory-based research findings with animals, to laboratory-based studies with healthy human volunteers, to findings obtained in the clinic with anxious patients. All reviews are timely contributions, covering highly relevant topics for consideration of benzodiazepine side effects at present. The papers presented herein should serve to stimulate future research that may ultimately help improve the quality of life of those patients living with debilitating anxiety-related conditions.

As-needed use of benzodiazepines in managing clinical anxiety: incidence and implications.

Benzodiazepines (BZs) have been widely investigated in terms of clinical efficacy, factors underlying dependence, associated cognitive impairments, and interactions with psychotherapy for anxiety control. However, few studies have systematically considered manner of BZ administration in relation to these variables. Studies of chronic BZ users indicate that as-needed or p.r.n. use is a very common practice, increases with chronicity of BZ use, and is preferred compared to regularly scheduled BZ administration. Moreover, a recent study of physician prescription practices indicated that p.r.n. BZ use is a commonly recommended BZ use regimen for anxiety disorder management. Physician advocates of p.r.n. BZ prescriptions for anxiety disorders cite enhanced patient control over symptoms, facilitation of exposure to fear-provoking situations, and reduced frequency of use as rationales supporting this practice. Available data however, do not consistently support these hypothesized advantages of p.r.n. BZ use. And in general, findings from different investigations relevant to this question suggest that p.r.n. BZ administration may be associated with increased patient preference for BZs over placebo, continued use, and greater impairment on cognitive factors associated with positive long-term anxiety management. Ironically, p.r.n. BZ administration may also be associated with reduced anxiolytic efficacy over time. These suggestive findings argue for greater systematic investigation of manner of BZ administration as an important medication use parameter. Such investigations may also yield practical guidelines for navigating BZ discontinuation and promoting more successful long-term management of anxiety.

Cognitive and sedative effects of benzodiazepine use.

This paper reviews the effects of benzodiazepines (BZs) on the performance of tasks measuring human cognitive abilities. The paper reviews the most common cognitive side effects of BZs: increased sedation, decreased attention, and anterograde amnesia. In particular, this paper focuses on recent findings regarding time course-related effects on BZ-induced deficits in explicit and implicit human memory performance. Specifically, we reviewed recent research indicating that both explicit memory and priming are impaired by BZs if the encoding task takes place near the time of the theoretical peak plasma concentrations of the drug. Although BZs also appear to increase objective and subjective sedation, as well as to impair attentional processing, these other cognitive impairments do not appear to fully account for the widespread memory deficits caused by BZ administration. The theoretical and clinical implications of benzodiazepine-induced memory impairments are discussed.

Alcohol abuse in individuals exposed to trauma: a critical review.

In this article, the author critically reviews studies on the relationship between exposure to trauma, posttraumatic stress disorder (PTSD), and alcohol abuse. After establishing that strong relationships exist between exposure to traumatic events and alcohol problems, and particularly between the diagnoses of PTSD and alcoholism, the author discusses various factors, theories, and possible mechanisms to account for these associations. Moreover, she discusses applications of these findings to the assessment and treatment of people exposed to trauma who abuse alcohol. Finally, the author outlines novel methods for testing theoretical hypotheses and makes suggestions for methodological improvements in future research.

A dose-response study of the effects of alcohol on the perceptions of pain and discomfort due to electric shock in men at high familial-genetic risk for alcoholism.

Alcoholics have previously been found to be more sensitive to painful stimulation than controls, and more sensitive to the pain-reducing effects of alcohol. The present study was designed to examine these effects in men at high familial-genetic risk for alcoholism and controls. Subjects were assigned to one of four alcohol doses [0.135 (active placebo), 0.50, 0.75, or 1.00 ml 95% USP alcohol/kg body weight]. Ratings of the amount of discomfort and pain experienced during an aversive shock procedure were taken immediately post-shock, both while subjects were sober and after they had consumed one of the four alcohol doses. High risk men were found to rate the experience of the shock as more uncomfortable and painful overall than the low risk controls. Pharmacologically significant levels of alcohol were found to reduce or eliminate these group differences, suggesting that alcohol has a "normalizing" effect on pain and discomfort perceptions in high risk men. Only the higher doses of alcohol were found significantly to dampen subjects' shock rating scores. High risk males' increased sensitivity to pain and discomfort, combined with the negatively reinforcing effects of reducing these perceptions at moderate to high alcohol doses, may play a role in predisposing high risk males for the development of alcoholism.

A further examination of the time-dependent effects of oxazepam and lorazepam on implicit and explicit memory.

Until recently, research indicated that all benzodiazepines impair explicit memory, while only lorazepam impairs priming. Stewart and associates provided preliminary data which indicated that both oxazepam and lorazepam may impair implicit memory, but in a time-dependent fashion. The present study was designed to replicate Stewart et al.'s findings after overcoming several limitations of the original study. Thirty subjects were administered an acute dose of lorazepam (2 mg), oxazepam (30 mg) or a placebo and were tested with an implicit (word-stem completion) test and an explicit (cued recall) test. However, subjects were only tested at 170 min post-drug (close to oxazepam's theoretical peak concentration) to rule out the possible "explicit memory contamination" explanation of the Stewart et al. implicit memory findings. Consistent with previous research, both drugs impaired explicit memory relative to placebo. Also, both lorazepam and oxazepam impaired priming performance, supporting the "time-dependence" interpretation of the Stewart et al. findings. The results also indicate that episodic memory is impaired by both benzodiazepines in a time-dependent fashion even when the research methodology used involves everyday memory demands.

Effects of oxazepam and lorazepam on implicit and explicit memory: evidence for possible influences of time course.

The effects of oxazepam (30 mg), lorazepam (2 mg), and placebo on implicit and explicit memory were studied in two testing cycles, 100 and 170 min after drug administration. Thirty healthy volunteers were randomly assigned to one of three groups (placebo, oxazepam, or lorazepam) in a double-blind, independent groups design. Drug groups were equivalent prior to drug administration on a variety of cognitive measures. Following drug administration, both oxazepam and lorazepam equally impaired performance on a cued-recall explicit memory task relative to placebo, at both testing cycles. Relative to placebo, lorazepam markedly impaired priming on a word-stem completion implicit memory task, at both testing cycles. Consistent with previous work, oxazepam failed to produce impairments in priming on the word-stem completion task at 100 min post-drug administration. However, oxazepam was found significantly to impair priming on this latter task relative to placebo, at close to theoretical peak plasma concentration (i.e., 170 min post-drug administration). Explanations for the observed detrimental effect of oxazepam on implicit memory task performance are considered, including: possible time-dependent effects related to the relative rate of absorption of these two benzodiazepines (BZs); and potential contamination of the implicit memory task by explicit memory strategies during the second testing cycle.

Cognitive behavioural therapy and pharmacotherapy: complementary or contradictory approaches to the treatment of anxiety?

Considerable controversy exists regarding the practice of combining Cognitive Behavioural Therapy (CBT) with Pharmacotherapy (PT) in the management of anxiety. This paper considers whether these two forms of treating anxiety disorders can be effectively combined to enhance treatment outcome. Despite the theoretical appeal of a combined approach, a critical review of treatment outcome findings across CBT and various anxiolytic medications and their combination, suggests a failure of these treatments to operate in a complementary fashion. A detrimental impact of anxiolytic medication on CBT outcome is particularly salient for high potency benzodiazepines. Low potency benzodiazepines and antidepressants generally have a negligible impact with no clear evidence of treatment enhancement and some negative combined treatment effects on medication withdrawal and at long-term follow-up. Thus, we address potential mechanisms that may explain this treatment noncomplementarity and in some cases, treatment incompatibility. Cognitive factors influencing treatment outcome (catastrophic beliefs, self-efficacy, selective attention, and memory) are highlighted in view of the empirically supported mediating role of these variables in accounting for treatment responsiveness. Potential effects of anxiolytic medication on cognitive change in CBT are postulated. A number of suggestions for future research and clinical practice are proposed on the basis of this review.

An examination of differences in the time course of oxazepam's effects on implicit vs explicit memory.

The present study was designed to examine the effects of oxazepam on implicit vs explicit memory processes, as a function of this drug's time course. The effects of oxazepam (30 mg) or placebo on directly comparable tests of implicit memory (word stem completion) and explicit memory (cued recall) were examined at three time points: 100 min post-drug administration (prior to the theoretical peak plasma concentration of oxazepam; i.e.'pre-peak' condition), 170 min post-drug (close to theoretical peak; i.e. 'peak' condition) or 240 min post-drug (following theoretical peak: i.e. 'post-peak' condition). Sixty healthy volunteers were randomly assigned to either the drug condition or the placebo condition in a double-blind design and were tested on both memory tests at one of the three time points. In the 'pre-peak' condition, oxazepam impaired cued recall performance relative to placebo but did not impair priming. In the 'peak' condition, oxazepam impaired performance on both memory tasks. In the 'post-peak' condition, cued recall performance in the oxazepam group remained significantly impaired relative to placebo. However, oxazepam-induced impairments in priming were only marginal, suggesting that oxazepam-induced impairments in implicit memory processes begin to wane following theoretical peak drug concentrations. The fact that oxazepam-induced priming impairments were significant only when the word stem completion task was administered close to peak plasma concentrations, supports the hypothesis that benzodiazepines exert time-dependent effects on implicit memory processes. The results also support the theoretical distinction between implicit and explicit memory processes, since the directly comparable implicit and explicit tasks showed different impairment curves over time.

Anxiety sensitivity mediates the relationships between childhood learning experiences and elevated hypochondriacal concerns in young adulthood.

OBJECTIVE: the present study investigated childhood learning experiences potentially associated with the development of elevated hypochondriacal concerns in a non-clinical young adult sample, and examined the possible mediating roles of anxiety sensitivity (i.e., fear of anxiety-related symptoms) and trait anxiety (i.e., frequency of anxiety symptoms) in explaining these relationships. METHOD: 197 university students participated in a retrospective assessment of their childhood instrumental (i.e., parental reinforcement) and vicarious (i.e., parental modeling) learning experiences with respect to arousal-reactive (e.g., dizziness) and arousal-non-reactive (e.g., lumps) bodily symptoms, respectively. Childhood learning experiences were assessed using a revised version of the Learning History Questionnaire (LHQ), anxiety sensitivity levels with the Anxiety Sensitivity Index (ASI), trait anxiety levels with the State-Trait Anxiety Inventory-Trait (STAI-T) scale, and degree of hypochondriacal concerns with the Illness Attitudes Scale (IAS)-Total score. RESULTS: consistent with earlier findings [Watt MC, Stewart SH, Cox BJ. A retrospective study of the learning history origins of anxiety sensitivity. Behav Res Ther 1998; 36: 505-525.], elevated anxiety sensitivity levels were associated with increased instrumental and vicarious learning experiences related to both arousal-reactive and arousal-non-reactive bodily symptoms. Similarly, individuals with elevated hypochondriacal concerns also reported both more instrumental and vicarious learning experiences around bodily symptoms than did students with lower levels of such concerns. However, contrary to the hypothesis, the childhood learning experiences related to hypochondriacal concerns were not specific to arousal-non-reactive symptoms, but instead involved parental reinforcement and modeling of bodily symptoms in general (arousal-reactive and -non-reactive symptoms alike). Anxiety sensitivity, but not trait anxiety, partially mediated the relationships between childhood learning experiences and elevated hypochondriacal concerns in young adulthood. CONCLUSIONS: elevated anxiety sensitivity appears to be a risk factor for the development of hypochondriasis when learning experiences have involved both arousal-reactive and arousal-non-reactive bodily symptoms.