Neural patterns associated with mixed valence feelings differ in consistency and predictability throughout the brain.

Mixed feelings, the simultaneous presence of feelings with positive and negative valence, remain an understudied topic. They pose a specific set of challenges due to individual variation, and their investigation requires analtyic approaches focusing on individually self-reported states. We used functional magnetic resonance imaging (fMRI) to scan 27 subjects watching an animated short film chosen to induce bittersweet mixed feelings. The same subjects labeled when they had experienced positive, negative, and mixed feelings. Using hidden-Markov models, we found that various brain regions could predict the onsets of new feeling states as determined by self-report. The ability of the models to identify these transitions suggests that these states may exhibit unique and consistent neural signatures. We next used the subjects' self-reports to evaluate the spatiotemporal consistency of neural patterns for positive, negative, and mixed states. The insula had unique and consistent neural signatures for univalent states, but not for mixed valence states. The anterior cingulate and ventral medial prefrontal cortex had consistent neural signatures for both univalent and mixed states. This study is the first to demonstrate that subjectively reported changes in feelings induced by naturalistic stimuli can be predicted from fMRI and the first to show direct evidence for a neurally consistent representation of mixed feelings.

Pain Trajectories among U.S. Veterans During COVID-19.

Physical pain is highly prevalent among military veterans. As stress can impact pain, COVID-19-related stressors may have heightened pain among veterans. A prospective analysis of pain could advance understanding of how veterans fared during COVID-19 and lend knowledge of risk factors important beyond the pandemic. The present study employs growth mixture modeling with a sample of U.S. veterans high in pain (N = 1,230) followed from just before COVID-19 (February 2020) to 12 months later (February 2021; 81.7% retention). We explored heterogeneous pain trajectories as well as baseline and COVID-19-related predictors of pain. Results revealed 4 pain trajectory classes: 1) Chronic Pain (17.3% of the sample); 2) Decreasing Pain (57.2% of the sample); 3) Stable Mild Pain (19.8% of the sample); and 4) Increasing Pain (5.7% of the sample). Those with childhood trauma exposure were especially likely to report chronic pain. Female and racial/ethnic minority veterans were also relatively likely to fare poorly in pain. Loneliness was associated with subsequent pain among several classes. Most veterans in our sample fared better than expected in terms of pain. However, as those with childhood trauma and certain disadvantaged groups were less likely to fare well, we add to the important literature on disparities in pain. Clinicians should identify whether loneliness and other factors impacted pain during COVID-19 among their patients to inform ongoing, person-centered pain management approaches. PERSPECTIVE: This article presents pain trajectories and correlates of pain among a high-pain sample of U.S. veterans surveyed prior to and during COVID-19. Pain clinicians should screen for childhood trauma and remain vigilant in addressing health disparities.

Influences of poly-victimization on adolescents' pre-treatment cognitive motivations and post-treatment outcomes.

INTRODUCTION: Substance use treatment outcomes are challenging to predict: myriad potentially relevant factors influence outcomes, including age, sex, motivations, and history of victimization. METHODS: The current study seeks to assess these factors in adolescents through an evaluation of the relationship between distinct victimization profiles, sex, and cognitive factors related to substance use treatment outcomes-specifically motivation, self-efficacy, and reasons for quitting-and the relationship between these factors and posttreatment outcomes. We report sex differences in the prevalence of specific types of victimization; females are more likely than males to report poly-victimization alongside higher levels of traumagenic characteristics such as fearing for your life, chronic abuse, abuse by a trusted individual, or negative reactions to disclosure. RESULTS: Adolescents who endorsed high levels of poly-victimization and high traumagenic characteristics reported a) higher motivation for treatment, b) more reasons for quitting substance use, c) lower self-efficacy, and d) fewer adjusted days abstinent posttreatment relative to their peers. We report several sex differences: emergent poly-victimization profiles are different for males and females, class membership has a differential proportion, and, last, associations between class membership and pre-treatment cognitive motivations and posttreatment outcomes vary by sex. CONCLUSION: Clinicians working with adolescents who report poly-victimization should aim to leverage their motivation and reasons for quitting, as these factors are traditionally associated with positive outcomes. Last, interventions aimed at fostering self-efficacy may also be particularly important to improve long-term outcomes, specifically among adolescents with a history of poly-victimization.

A mobile-based pregaming drinking prevention intervention for college students: study protocol for a randomized controlled trial.

BACKGROUND: Pregaming is a high-drink context popular among college students that often leads to elevated blood alcohol levels and negative consequences. Over 15 years of research studies have demonstrated that pregaming represents one of the riskiest known behaviors among college students, yet no pregaming-specific interventions have been developed to help prevent this behavior. General brief interventions for students do not reduce pregaming behavior and may not be appropriate, as they do not help students develop skills unique to the pregaming context that could help them drink less. We developed a brief, mobile-based intervention that is proposed to prevent heavy drinking during pregaming for college students, with the ultimate goal that behavioral reductions in this risky practice will ultimately affect global drinking and prevent consequences. METHODS/DESIGN: The intervention, Pregaming Awareness in College Environments (PACE), was developed by combining two innovations to facilitate behavior change: (1) a mobile-based application that increases accessibility, is easy and engaging to use, and broadens the reach of the intervention content and (2) personalized pregaming-specific intervention content with harm reduction and cognitive behavioral skills proven to be mechanisms preventing and reducing heavy drinking among college students. After a develop and beta-test phase, we propose to test the efficacy of PACE in a preliminary randomized controlled trial with 500 college students who pregame at least once per week. Pregaming, general drinking, and alcohol-related consequences outcomes will be examined in the immediate (2 weeks post-intervention) and short-terms (six and 14-week post-intervention). We will also evaluate moderator effects for age, sex, and heaviness of drinking to allow for more refined information for a planned larger test of the intervention to follow this initial trial of PACE. DISCUSSION: This pregaming intervention clinical trial, if found to be efficacious, will culminate with an easily-disseminated mobile-based intervention for college student drinkers. It has the potential to reach millions of college students, perhaps as a clinical tool used by college counseling centers as an adjunct to formal care or as a preventive tool for first-year students or other high-risk groups on campus. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT04016766.

Identifying individual and environmental predictors of opioid and psychostimulant use among adolescents and young adults following outpatient treatment.

BACKGROUND: The United States (US) continues to grapple with a drug overdose crisis. While opioids remain the main driver of overdose deaths, deaths involving psychostimulants such as methamphetamine are increasing with and without opioid involvement. Recent treatment admission data reflect overdose fatality trends suggesting greater psychostimulant use, both alone and in combination with opioids. Adolescents and young adults are particularly vulnerable with generational trends showing that these populations have particularly high relapse rates following treatment. METHODS: We assessed demographic, psychosocial, psychological comorbidity, and environmental factors (percent below the poverty line, percent unemployed, neighborhood homicide rate, population density) that confer risk for opioid and/or psychostimulant use following substance use disorder treatment using two complementary machine learning approaches-random forest and least absolute shrinkage and selection operator (LASSO) modelling-with latency to opioid and/or psychostimulant as the outcome variable. RESULTS: Individual level predictors varied by substance use disorder severity, with age, tobacco use, criminal justice involvement, race/ethnicity, and mental health diagnoses emerging at top predictors. Environmental variabels including US region, neighborhood poverty, population, and homicide rate around patients' treatment facility emerged as either protective or risk factors for latency to opioid and/or psychostimulant use. CONCLUSIONS: Environmental variables emerged as one of the top predictors of latency to use across all levels of substance use disorder severity. Results highlight the need for tailored treatments based on severity, and implicate environmental variables as important factors influencing treatment outcomes.

Changes in Social, Romantic, and General Life Satisfaction Over the Course of a Substance Use Disorder.

Background: The pandemic has highlighted the importance of social connection for health and well-being. Satisfaction across domains of life is associated with substance use outcomes, such as risk of relapse and mortality. Previous work has delineated the relationship between substance use and social connections, yet there is a lack of research exploring the relationship between substance use and satisfaction with domains of life over time. Methods: We retrospectively assessed satisfaction with social life, romantic life, and general life across five phases of substance use among 339 adults, of whom 289 identify as formerly having a problem with substance use, and a comparison group of 50 who report no history of problematic drug use. We compared those whose primary drug of choice was alcohol, marijuana, methamphetamine, non-prescription opioids, and prescription opioids. Results: Those who used prescription opioids reported a larger drop in satisfaction in social life, romantic life, and general life during the course of substance use than those who used other drugs. However, we report no significant differences in current satisfaction, social well-being, or quality of life between people in recovery and people with no history of problematic substance use. Conclusions: These findings-alongside neuropsychological work on the opioid system and sociality-paint a picture that those who formerly used prescription opioids may experience lower satisfaction across life domains during the course of their substance use than those who used other substances. However, people in prolonged recovery-regardless of their drug of choice-all show similar levels of satisfaction compared to people with no history of problematic substance use.

Temporal, Sex-Specific, Social Media-Based Alcohol Influences during the Transition to College.

BACKGROUND: The transition to college is an important developmental phase, usually met with increased social desirability, access to alcohol, and new peer groups. Recently, research has utilized social media as a predictor of events during college, but few have assessed how social media can influence alcohol use during the transition to college. Methods: Participants (N = 320) were recruited prior to entering their first year of college. Participants were 18 years old, 60.7% were women, with 46.3% identifying as White, 16.5% Hispanic, 14.9% Asian, 9.5% Black, and 7.6% other. Each participant was assessed three times: prior to matriculation, first semester, and second semester of their freshman year. We assessed the effect of exposure to alcohol content via social media on long-term trajectories of alcohol use. We also assessed self-reported sex as a moderator. Results: Exposure to alcohol content (over and above one's own posting of alcohol content) was associated with greater frequency of drinking during the transition to college. In the multi-group model, exposure to alcohol content was associated with greater drinking prior to matriculation for men. However, for women, exposure to alcohol content was associated with greater alcohol use in the first semester of college. Conclusion: Our results indicate exposure to alcohol-related media content is a strong predictor, over and above one's own positing, of increased drinking, and this effect varies by sex and point in time. Our results lend support for more tailored and time-specific prevention programming for incoming freshmen that should integrate social media normative feedback.

Adolescent emotional disorder symptoms and transdiagnostic vulnerabilities as predictors of young adult substance use during the COVID-19 pandemic: mediation by substance-related coping behaviors.

The COVID-19 pandemic presents unique stressors (e.g. social isolation) that may increase substance use risk among young adults with a history of emotional disturbance. This study examined whether emotional disorder symptoms and transdiagnostic vulnerabilities during adolescence predicted young adult substance use during COVID-19, and whether using substances to cope with the pandemic's social conditions mediated these associations. Adolescents (N = 2,120) completed baseline surveys assessing transdiagnostic emotional vulnerabilities (anhedonia, distress intolerance, anxiety sensitivity, negative urgency) and symptoms (major depression[MD], generalized anxiety[GAD], panic disorder[PD], social phobia[SP], obsessive-compulsive disorder[OCD]) in adolescence (September-December 2016; M[SD] age = 17.45[0.38]). At follow-up (May-August 2020; M[SD] age = 21.16[0.39]), past 30-day substance use and using substances to cope with social isolation during the pandemic were reported. Adjusted models showed that baseline distress intolerance, anxiety sensitivity, negative urgency, and MD symptoms each significantly predicted higher number of past-month single-substance using days and number of substances used at follow-up (ßs = 0.04-0.06). In each case, associations were mediated by tendency to use substances to cope with the pandemic (ßindirect range: 0.028-0.061). To mitigate disproportionate escalation of substance use in young adults with a history of certain types of emotional disturbance, interventions promoting healthy coping strategies to deal with the pandemic's social conditions warrant consideration.

The role of social isolation in opioid addiction.

Humans are social animals: social isolation hurts people both psychologically and physically. Strong, positive social bonds help people to live longer and healthier lives compared with their more isolated peers. Opioid use disorder is associated with feelings of social isolation, an increased risk of suicide and, at the community level, lower social capital. I propose a psychobiological mechanistic explanation that contributes to the association between opioid use and social isolation. The endogenous opioid system plays a central role in the formation and maintenance of social bonds across the life span and has been investigated primarily through the framework of the brain opioid theory of social attachment. In primates, maternal-infant bonding and social play are both impaired by the administration of naltrexone (an opioid antagonist), and in humans, the chronic use of opioids appears to be particularly (relative to other drugs) corrosive to close relationships. Social isolation may play a role in the development and exacerbation of opioid use disorder. Taken together, work on the brain's opioid system suggests a possible mechanistic basis for bidirectional causal links between social isolation and opioid use disorder. Evaluation of this hypothesis would benefit from longitudinal psychosocial and neuropsychopharmacological investigations.

The Early Impact of Social Distancing Measures on Drug Use.

BACKGROUND AND OBJECTIVES: Social distancing policies have been widely adopted in response to the COVID-19 pandemic. High levels of social connection are positively associated with beneficial health outcomes, while social isolation is associated with poor long-term health outcomes including reduced life expectancy. The present study evaluates the impact of social distancing measures during the early period of COVID-19 on substance use behaviors among those in the United States. Methods: We used an internet-based survey with participants (n = 157; 86 male) reporting a history of problems related to drug use. We relied on ANOVA and logistic regression techniques to assess the associations between social connection and substance use. Results: People with more severe drug use problems reported feeling more socially isolated during social distancing. Those who primarily use alcohol reported higher global feelings of social connection than those who primarily use opioids. During social distancing, participants reported an increase in alcohol and cigarette consumption, and a decrease in cocaine use. Lastly, those who reported using drugs for social reasons were less likely to have decreased substance use during social distancing. Conclusions: The current study provides evidence that social distancing guidelines have impacted both substance use behaviors and feelings of social and physical connection. Further, there are differential impacts based on drug of choice. These results advance delineation of the connection between sociality and drug use.

Sex differences in factors predicting post-treatment opioid use.

BACKGROUND AND AIMS: Several reports have documented risk factors for opioid use following treatment discharge, yet few have assessed sex differences, and no study has assessed risk using contemporary machine learning approaches. The goal of the present paper was to inform treatments for opioid use disorder (OUD) by exploring individual factors for each sex that are most strongly associated with opioid use following treatment. DESIGN: Secondary analysis of Global Appraisal of Individual Needs (GAIN) database with follow-ups at 3, 6 and 12 months post-OUD treatment discharge, exploring demographic, psychological and behavioral variables that predict post-treatment opioid use. SETTING: One hundred and thity-seven treatment sites across the United States. PARTICIPANTS: Adolescents (26.9%), young adults (40.8%) and adults (32.3%) in treatment for OUD. The sample (n = 1,126) was 54.9% male, 66.1% white, 20% Hispanic, 9.8% multi-race/ethnicity, 2.8% African American and 1.3% other. MEASUREMENT: Primary outcome was latency to opioid use over 1 year following treatment admission. RESULTS: For women, regularized Cox regression indicated that greater withdrawal symptoms [hazard ratio (HR) = 1.31], younger age (HR = 0.88), prior substance use disorder (SUD) treatment (HR = 1.11) and treatment resistance (HR = 1.11) presented the largest hazard for post-treatment opioid use, while a random survival forest identified and ranked substance use problems [variable importance (VI) = 0.007], criminal justice involvement (VI = 0.006), younger age (VI = 0.005) and greater withdrawal symptoms (VI = 0.004) as the greatest risk factors. For men, Cox regression indicated greater conduct disorder symptoms (HR = 1.34), younger age (HR = 0.76) and multiple SUDs (HR = 1.27) were most strongly associated with post-treatment opioid use, while a random survival forests ranked younger age (VI = 0.023), greater conduct disorder symptoms (VI = 0.010), having multiple substance use disorders (VI = 0.010) and criminal justice involvement (VI = 0.006) as the greatest risk factors. CONCLUSION: Risk factors for relapse to opioid use following opioid use disorder treatment appear to be, for women, greater substance use problems and withdrawal symptoms and, for men, younger age and histories of conduct disorder and multiple substance use disorder.

Multifaceted impulsivity as a moderator of social anxiety and cannabis use during pregaming.

Individuals may drink or use cannabis to cope with social anxiety, and drinking or using cannabis prior to social situations (e.g., pregaming) may be a way to limit the experience of anxiety when entering social settings. However, theoretical and empirical work has reported mixed associations between social anxiety and substance use, specifically alcohol and cannabis. Little work has looked at how other variables, such as impulsivity (a central component to high risk drinking such as pregaming), may shed light onto these mixed findings. College students who reported past year pregaming (n = 363) completed self-report surveys. Supporting prior work, we found that social anxiety was associated with fewer pregaming days, even among those high in sensation seeking. However, those reporting higher social anxiety also reported higher cannabis use during pregaming, specifically among those who reported high sensation seeking and high positive urgency. Results suggest specific facets of impulsivity may affect the association between social anxiety and cannabis use during high risk drinking events.

Polysubstance use among youth experiencing homelessness: The role of trauma, mental health, and social network composition.

BACKGROUND: Substance use is common among youth experiencing homelessness (YEH). However, less is known about the use of multiple substances (polysubstance use), or factors associated with polysubstance use among YEH. The present study sought to identify subgroups of YEH based on their recent polysubstance use behavior, and investigate traumatic experiences, mental health and social network composition as predictors. METHODS: YEH (N = 1,032; Mage = 21.3) from three drop-in centers in Los Angeles completed an in-person survey and social network interview between October 2011 and June 2013. Latent class analysis (LCA) was used to identify subgroups of youth based on nine types of substance use in the past 30 days; latent class logistic regression was used to identify variables associated with class membership. RESULTS: Five polysubstance use classes were identified: heavy alcohol and marijuana (33.6 %), illicit drug use (4.9 %), high all polysubstance use (14.9 %), primarily marijuana (18.1 %), and low use (28.5 %). Relative to the low use class, traumatic experiences were associated with membership in every polysubstance use class. Suicide attempts were associated with membership in the high all class (OR = 9.41). Number of substance-using, homeless network members was associated with membership in the heavy alcohol and marijuana use class (OR = 1.35). Number of non-substance-using network members (homeless [OR = 0.29] and housed [OR = 0.73]) was associated with lower odds of membership in the high all class. CONCLUSIONS: Distinct groups of YEH can be identified by their recent polysubstance use patterns. Traumatic experiences, suicidality, and social network composition are important correlates of polysubstance use among YEH.

Influences of victimization and comorbid conditions on latency to illicit drug use among adolescents and young adults.

OBJECTIVE: Exposure to violent victimization is associated with higher rates of mental health and substance use disorders (SUD). Some youth who experience multiple victimizations and associated characteristics (i.e. poly-victims) are at heightened risk for long term problems. Thus, we conducted the first study to examine how heterogeneity in experiences of victimization vary in terms of latency to illicit drug use following treatment completion. We also examined if victimization profiles vary across gender and if comorbid conditions (e.g., posttraumatic stress disorder and major depressive disorder) differentially predict latentcy to illicit drug use across groups. METHODS: Adolescents and young adults (N = 5956; Mage  = 17.5 years; 64.0% male) with SUDs in treatment for illicit drug use completed a battery of measures at baseline. At 3-, 6- and 12-month follow-ups, they reported on the number of days before they used any illicit drug following their last assessment. RESULTS: Continuous time survival mixture modeling revealed that, as hypothesized, females who experienced high rates of all victimization and related characteristics had a higher hazard for latency to first illicit drug use as compared to females in the low victimization group. This was not the case for males; rather, those who experienced high rates of sexual abuse were quickest to return to illicit drug use. Finally, comorbid conditions led to a higher hazard rate, but only for certain profiles across females. DISCUSSION: Findings emphasize the necessity for professionals to more fully integrate poly-victimization research and theory into their clinical practices and research.

Addressing the opioid epidemic with behavioral interventions for adolescents and young adults: A quasi-experimental design.

OBJECTIVE: While several behavioral interventions have shown efficacy in opioid use disorder treatment, little is known regarding which behavioral interventions work best for youth, and if treatment responses vary by developmental age or sex. We explored latency to first episode of opioid use among adolescents and young adults following opioid use disorder treatment initiation with: (a) adolescent community reinforcement approach (A-CRA), (b) motivational enhancement therapy (MET) combined with cognitive-behavioral therapy (CBT) or CBT alone (MET/CBT or CBT alone), or (c) treatment as usual (TAU; 12-step facilitation, supportive therapy). METHOD: Adolescents and young adults (N = 785) entering treatment for opioid use disorder were followed for 1 year. Survival analysis was used to assess variation in latency to first episode of opioid use by treatment received, as well as moderation by age group and sex. RESULTS: Those receiving MET/CBT or CBT alone, and TAU fared better than those receiving A-CRA. For adolescent males, those receiving TAU or A-CRA had poorer outcomes compared with those receiving MET/CBT or CBT alone, while no differences were found between treatments for female adolescents. Female young adults receiving TAU had lower hazard of opioid use compared with those receiving A-CRA, and MET/CBT or CBT alone, and male young adults receiving A-CRA had higher hazard than those receiving TAU, and MET/CBT or CBT alone. CONCLUSIONS: Findings highlight different treatments may be more efficacious for youth based on developmental age and sex. Clinicians working with young people with opioid use disorder should consider patients' developmental stage and sex when considering treatment approaches. (PsycINFO Database Record (c) 2019 APA, all rights reserved).