Treatment approaches and costs associated with diabetes clinical metrics as measured by Healthcare Effectiveness Data and Information Set (HEDIS).

BACKGROUND: The clinical outcomes of diabetes can be influenced by primary care providers' (PCP) treatment approaches. This study explores the association between PCP approaches to management and performance measured by established diabetes metrics and related costs. METHODS: In phase one, Electronic Medical Records were used to extract diabetes related metrics using Healthcare Effectiveness Data and Information Set (HEDIS), for patients with diabetes who had office visits to 44 PCP practices from April 2019 to March 2020. Using those metrics and scoring system, PCP practices were ranked and then categorized into high- and low-performing groups (top and bottom 25%, n = 11 each), with a total of 19,059 clinic visits by patients with a diagnosis of diabetes. Then extensive analysis was performed to evaluate a correlation between treatment approaches and diabetes outcomes across the top and bottom performing practices. In phase 2, patients with diabetes who were attributed to the aforementioned PCP practices were identified in a local health plan claims data base (a total of 3,221 patients), and the allowed amounts from their claims were used to evaluate differences in total and diabetes-related healthcare costs by providers' performance. RESULTS: Comparing 10,834 visits in high-performing practices to 8,235 visits in low-performing practices, referrals to certified diabetes care and education specialists and provider-to-provider electronic consults (e-consults) were higher in high-performing practices (Z = 6.06, p < .0001), while traditional referrals were higher in low-performing practices (Z = -6.94, p < .0001). The patient-to-provider ratio was higher in the low-performing group (M = 235.23) than in the high-performing group (M = 153.26) (Z = -2.82, p = .0048). Claims data analysis included 1,825 and 1,396 patients from high- and low-performing providers, respectively. The patient-to-provider ratio was again higher in the low-performing group (p = .009, V = 0.62). Patients receiving care from lower-performing practices were more likely to have had a diabetes-related hospital observation (5.7% vs. 3.9%, p = .02; V = 0.04) and higher diabetes-related care costs (p = .002; d = - 0.07); these differences by performance status persisted when controlling for differences in patient and physician characteristics. Patients seeing low-performing providers had higher Charlson Comorbidity Index scores (Mdn = 3) than those seeing high-performing providers (Mdn = 2). CONCLUSIONS: Referrals to the CDCES and e-Consult were associated with better measured diabetes outcomes, as were certain aspects of cost and types of hospital utilization. Higher patients to providers ratio and patients with more comorbidities were observed in low performing group.

Initial evidence of delay discounting's predictive utility for alcohol self-administration in ecologically valid contexts among young adults who drink heavily.

BACKGROUND: While delay discounting is robustly associated with alcohol use disorder, whether discounting predicts real-time alcohol use behaviors is unclear. Existing support comes from laboratory studies using intravenous alcohol self-administration methods, thus limiting ecological validity and generalizability. The present study evaluated whether delay discounting predicted real-time alcohol use in naturalistic settings with and without probabilistic negative consequences for consuming larger amounts of alcohol. METHODS: This secondary analysis utilized data from three laboratory alcohol self-administration studies with young adults who engaged in frequent heavy drinking (N=206, 45% female). Participants completed a delay discounting measure before an alcohol self-administration session in an actual or simulated bar with (n=187) or without (n=19) probabilistic negative consequences (compensation loss) tied to performance on cognitive and psychomotor tasks after alcohol self-administration. Bootstrapped (unstandardized) coefficient estimates and 95% confidence intervals were utilized due to the sample size discrepancy. RESULTS: Multiple regressions revealed that delay discounting did not significantly predict estimated blood alcohol concentration (eBAC) or number of drinks consumed when procedures included probabilistic negative consequences. Among participants who completed procedures without probabilistic negative consequences, delay discounting was positively associated with peak eBAC. CONCLUSION: Counter to hypotheses, steeper delay discounting did not predict real-time alcohol use in contexts with probabilistic negative consequences, whereas preliminary evidence suggests that delay discounting predicts real-time alcohol use behaviors in contexts without probabilistic negative consequences. The specific discounting task may have impacted study findings, thus future research should consider how the sign (gain vs. loss), outcome certainty, and delay relate to alcohol consumption.

Prevalence and Cost of Routine Preoperative Care for Low-Risk Cataract Surgery a Decade after Choosing Wisely.

PURPOSE: Examine the frequency and cost of procedural clearance tests and examinations in preparation for low-risk cataract surgery among members of a commercial healthcare organization in the United States. Determine what characteristics most strongly predict receipt of preoperative care and the probability that preoperative care impacts postsurgical adverse events. DESIGN: Retrospective healthcare claims analysis and medical records review from a large, blended-health organization headquartered in Western Pennsylvania. PARTICIPANTS: Members aged ≥ 65 years who were continuously enrolled 6 months before and after undergoing cataract surgery from 2018 to 2021 and had approved surgery claims. METHODS: Preoperative exams or tests occurring in the 30 days before surgery were identified via procedural and diagnosis codes on claims of eligible members (e.g., Current Procedural Terminology codes for blood panels and preprocedural International Classification of Diseases, 10th Revision, Clinical Modification codes). Prevalence and cost were directly estimated from claims; variables predictive of preoperative care receipt and adverse events were tested using mixed effects modeling. MAIN OUTCOME MEASURES: Total costs, prevalence, and strength of association as indicated by odds ratios. RESULTS: Up to 42% of members undergoing cataract surgery had a physician office visit for surgical clearance, and up to 23% of members had testing performed in isolation or along with clearance visits. The combined costs for the preoperative visits and tests were $4.3 million (approximately $107-$114 per impacted member). There was little difference in member characteristics between those receiving and not receiving preoperative testing or exams. Mixed effects models showed that the most impactful determinants of preoperative care were the surgical facility and member's care teams; for preoperative testing, facilities were a stronger predictor than care teams. Adverse events were rare and unassociated with receipt of preoperative testing, exams, or a combination of the two. CONCLUSIONS: Rates of routine preoperative testing before cataract surgery appear similar to those prior to the implementation of the Choosing Wisely campaign, which was meant to reduce this use. Additionally, preoperative evaluations, many likely unnecessary, were common. Further attention to and reconsideration of current policies and practice for preoperative care may be warranted, especially at the facility level. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Are the attention checks embedded in delay discounting tasks a valid marker for data quality?

To ensure good quality delay discounting (DD) data in research recruiting via crowdsourcing platforms, including attention checks within DD tasks have become common. These attention checks are typically identical in format to the task questions but have one sensical answer (e.g., "Would you prefer $0 now or $100 in a month?"). However, the validity of these attention checks as a marker for DD or overall survey data quality has not been directly examined. To address this gap, using data from two studies (total N = 700), the validity of these DD attention checks was tested by assessing performance on other non-DD attention checks and data quality measures both specific to DD and overall survey data (e.g., providing nonsystematic DD data, responding inconsistently in questionnaires). We also tested whether failing the attention checks was associated with degree of discounting or other participant characteristics to screen for potential bias. While failing the DD attention checks was associated with a greater likelihood of nonsystematic DD data, their discriminability was inadequate, and failure was sometimes associated with individual differences (suggesting that data exclusion might introduce bias). Failing the DD attention checks was also not associated with failing other attention checks or data quality indicators. Overall, the DD attention checks do not appear to be an adequate indicator of data quality on their own, for either the DD task or surveys overall. Strategies to enhance the validity of DD attention checks and data cleaning procedures are suggested, which should be evaluated in future research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Bidirectional prospective associations between behavioral economic indicators and drinking patterns during alcohol use disorder natural recovery attempts.

OBJECTIVES: Behavioral economic (BE) theory posits that harmful alcohol use is a joint product of elevated alcohol demand and preference for immediate over delayed rewards. Despite cross-sectional research support, whether expected bidirectional relations exist between BE indicators and drinking during recovery attempts is unknown. Therefore, this prospective research investigated quarter-by-quarter cross-lagged associations between BE simulation tasks and drinking following a natural recovery attempt. Higher demand and discounting in a given quarter should predict subsequent drinking. Conversely, drinking in a given quarter should predict subsequent higher demand and discounting. METHOD: Community-dwelling problem drinkers were enrolled shortly after stopping heavy drinking without treatment (N = 191). Drinking practices, problems, delay discounting, and alcohol demand (intensity, Omax, Pmax, elasticity) were assessed at baseline and 3-, 6-, 9-, and 12-month follow-ups. Longitudinal cross-lagged models related each BE indicator in the previous quarter to drinking status in the next quarter, and vice versa. RESULTS: Higher demand intensity (consumption when drinks are free) at Quarter 1 distinguished participants who drank heavily in Quarter 2 from those who abstained. In turn, heavy drinking participants in Quarter 2 had higher intensity at Quarter 3 than abstainers and moderate drinkers in Quarter 2, and higher intensity at Quarter 3 distinguished heavy drinkers in Quarter 4 from moderate drinkers (ps < .05). Hypothesized associations for other BE indices were inconsistent or partially supported. CONCLUSIONS: Alcohol purchase task metrics showed some hypothesized prospective associations with drinking during a natural recovery attempt, which supports their ecological validity as relapse risk indicators. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The association between adverse childhood experiences and treatment response for adults with alcohol and other drug use disorders.

BACKGROUND AND OBJECTIVES: Adverse events during childhood increase the risk for the development of substance use disorders (SUDs). This study examined the association between adverse childhood experiences (ACEs) and SUD treatment response. METHODS: This cohort analysis included data from longitudinal clinical assessments extracted from the records of 438 consenting individuals undergoing SUD treatment (63% male; 88.8% White). Mixed effects models evaluated the relationship between scores on the ACE questionnaire and indicators of treatment response (i.e., alcohol and drug abstinence self-efficacy; symptoms of depression, anxiety, and posttraumatic stress disorder) for individuals with alcohol-related (n = 332) and other drug-related (n = 275) diagnoses, with some participants included in both groups. RESULTS: Treatment response varied as a function of ACEs, with the magnitude of differences varying across time in treatment. Relative to those with no ACE history, those who experienced ≥2 ACEs reported worse depression, anxiety, PTSD symptoms, and alcohol/drug abstinence self-efficacy at baseline, with many differences remaining at the 30-day assessment. All differences abated by discharge, with the exception of PTSD symptoms among those in the drug use group with a history of ≥4 ACEs. Male gender and older age were generally associated with lower symptomology and higher abstinence self-efficacy. DISCUSSION AND CONCLUSIONS: Assessing ACE history early in SUD treatment may improve treatment planning and prognosis. Future studies should evaluate the role of trauma-informed programming and individual interventions to improve treatment response. SCIENTIFIC SIGNIFICANCE: This study demonstrates the association between adverse childhood experiences and symptom severity among patients across participation in SUD treatment.

Spending Time in Nature Serves as a Protective Factor against Problematic Alcohol Use: A Structural Equation Modeling Approach.

Alcohol use in the U.S. continues to be a prevalent behavior with the potential for far-reaching personal and public health consequences. Risk factors for problematic drinking include negative affect and impulsive decision-making. Research suggests exposure to nature reduces negative affect, increases positive affect, and reduces impulsive choice. The purpose of the current study was to explore the relationships between exposure to nature (actively going out to nature and the level of greenness around the participant's daily life), affect, impulsive decision-making, and alcohol use, using structural equation modeling. Cross-sectional data (N = 340) collected online on Amazon MTurk were used to test the hypothesized relationships separately for alcohol consumption and alcohol-related problems. Actively spending time in nature was associated with lower negative affect and higher positive affect, while passive exposure to nature was only associated with higher positive affect. In turn, negative affect was positively related to both alcohol measures, while positive affect was related to increased alcohol consumption, but not alcohol-related problems. Impulsive decision-making was not related to nature or alcohol measures. Findings suggest that intentionally spending time in nature may protect against problematic alcohol use by reducing negative affect. These results warrant further research on nature as an adjunct treatment for reducing alcohol and substance-related harms and carry implications for public education and increasing accessibility to natural spaces.

Independent and concurrent cannabis use with alcohol, cigarettes, and other substances among college students: Rates and consequences.

Objective: The purpose of this study was to examine patterns of concurrent cannabis and other substance use and their differential associations with cannabis-related problems and academic outcomes in college students. Participants: Participants were undergraduate students (N = 263; M age = 19.1 years; 61.2% female) who were eligible if they used cannabis at least 3 days in the past month (M = 10.1 days). Method: Substance use, academic-related outcomes, and measures of Cannabis Use Disorder (CUD) severity and problems were obtained in an online survey. Results: The five groups evaluated were cannabis-only users (5.3%), cannabis and alcohol (47.1%), cannabis, alcohol and cigarettes (16.7%), cannabis, alcohol and other substances (14.8%), or all-substances (16%). Cannabis-only and all-substance users reported using cannabis most frequently (ps ≤ .034), but only the latter reported greater CUD severity, problems, and poorer academic outcomes. Discussion: College student polysubstance users may be at increased risk for poorer outcomes compared to cannabis-only users and other groups.

The Effects of the Opioid Crisis on Agricultural Industries.

Opioid use remains a significant public health crisis. However, few quantitative or qualitative data exist on the prevalence of opioid use and associated mental health conditions in agricultural industries and how it affects the industries themselves. Data on opioid use and associated consequences were collected among agricultural business owners and workers using both quantitative (n = 129) and qualitative assessment (n = 7). The prevalence of opioid use, pain, stress, and depressive symptoms as well as associated hazards were characterized among individuals who work in horticulture (nursery and landscape) and those who work in food production (livestock and crops). Qualitative interviews were also conducted to better understand individual experiences with opioid use. Opioid use was significantly higher among horticultural industries compared to food production. Pain and depressive scores were higher among those who had used opioids although stress did not differ. Importantly, substantial percentages of participants who reported opioid use also reported consequences associated with their use, including missing work, being injured at work while using, and having difficulty in completing daily tasks. These results provide initial evidence that opioid use is substantially affecting agricultural industries in terms of mental health, personal health, labor availability, and productivity.

Using Crowdsourcing for Alcohol and Nicotine Use Research: Prevalence, Data Quality, and Attrition on Amazon Mechanical Turk.

BackgroundGauging the feasibility of using Amazon Mechanical Turk ® (MTurk) for various types of substance use research is precluded by a lack of information pertaining to the recruitment process in published studies utilizing it and concurrent information on data quality. ObjectiveThe present report addressed this gap by documenting the prevalence of alcohol and nicotine use, self-reported major health conditions, and information on data quality and retention on MTurk. Individuals 21 to 90 years old (N = 1101, Mdn age = 30) with United States-based MTurk accounts completed a stand-alone screening survey. The screening consisted of basic demographic, substance use, and physical/mental health questions, as well as items to gauge language proficiency/attention (i.e., data quality). ResultsPoor quality data was infrequent (6.5% of participants) and associated with self-reported non-United States residence, affirmative responding (e.g., currently pregnant, using both alcohol and nicotine), and other response characteristics (e.g., not disclosing health conditions). Among those passing quality checks, alcohol and nicotine use were relatively common (71.5% and 24.8%). Major physical (6.3%) and mental health conditions (14.8%) were less common. Despite not sending direct invitations, most eligible participants returned to and completed the main study (81.7%). Conclusions/Importance: Alcohol and nicotine use were relatively common among MTurk workers and retention rates were high. Together with the low prevalence of poor quality data, MTurk appears to remain a fruitful platform for substance use research; although researchers must be diligent in using appropriate screening tools, as substance use was sometimes associated with poor data quality and MTurk account information may not be reliable.

Associations between alcohol use and peripheral, genetic, and epigenetic markers of oxytocin in a general sample of young and older adults.

INTRODUCTION: Human and nonhuman animal research suggests that greater oxytocin (OT) activity is protective against harmful substance use. Most research on this topic is preclinical, with few studies evaluating the association between substance use and individual differences in the human OT system. The present study sought to fill this gap by evaluating the relationship between alcohol use and multiple biological measures of OT activity in an overall low to moderate-drinking sample. METHOD: As part of a larger study, generally healthy young (n = 51) and older (n = 53) adults self-reported whether they regularly used alcohol and how much alcohol they consumed per week. Participants also provided blood samples from which peripheral OT, and in an age-heterogeneous subset of participants (n = 56) variation in the oxytocin receptor gene (the OXTR rs53576 polymorphism) and OXTR DNA methylation levels (at cytosine-guanine dinucleotide sites -860, -924, -934), were obtained. RESULTS: A-allele carriers of the OXTR rs53579 polymorphism were less likely to regularly consume alcohol. Among regular alcohol consumers, number of alcoholic drinks per week was positively associated with peripheral OT in regression models excluding observations of high influence (postdiagnostic models). Number of alcoholic drinks per week was consistently negatively associated with OXTR DNA methylation at site -860; and with OXTR DNA methylation at site -924 in postdiagnostic models. CONCLUSIONS: The significant associations between alcohol use and individual differences in OT activity support the involvement of the OT system in alcohol use, which most likely reflect the role of OT when alcohol use is under control of its rewarding properties and/or the acute impacts of alcohol on the OT system. Additional research with markers of OT activity and alcohol use, particularly longitudinal, is needed to clarify the bidirectional effects of OT and alcohol use in moderate to harmful drinking and dependence.

Evaluating Extinction, Renewal, and Resurgence of Operant Behavior in Humans with Amazon Mechanical Turk.

Amazon Mechanical Turk (MTurk) is a crowdsourcing marketplace providing researchers with the opportunity to collect behavioral data from remote participants at a low cost. Recent research demonstrated reliable extinction effects, as well as renewal and resurgence of button pressing with MTurk participants. To further examine the generality of these findings, we replicated and extended these methods across six experiments arranging reinforcement and extinction of a target button press. In contrast to previous findings, we did not observe as reliable of decreases in button pressing during extinction (1) after training with VR or VI schedules of reinforcement, (2) in the presence or absence of context changes, or (3) with an added response cost for button pressing. However, we found that that a 1-point response cost for all button presses facilitated extinction to a greater extent than the absence of response cost. Nevertheless, we observed ABA renewal of button pressing when changing background contexts across phases and resurgence when extinguishing presses on an alternative button. Our findings suggest that MTurk could be a viable platform from which to ask and address questions about extinction and relapse processes, but further procedural refinements will be necessary to improve the replicability of control by experimental contingencies.

Safety and tolerability of chronic intranasal oxytocin in older men: results from a randomized controlled trial.

RATIONALE: Most studies evaluating the safety and tolerability of intranasal oxytocin (OT) have not reported consistent adverse events (AEs), but they have largely focused on young men and single-dose administration. Thus, it is unclear whether these findings translate to older individuals and with longer administration periods. OBJECTIVE: Extending previous work, this study investigated the safety and tolerability of chronic intranasal OT in generally healthy older men. METHODS: Data were from a randomized, placebo (P)-controlled, double-blind clinical trial evaluating the effects of 4 weeks of self-administered intranasal OT (24 IU twice daily) in older adults with no major physical or cognitive impairments. Heart rate, blood pressure, urine osmolality, and serum metabolic biomarkers were obtained before and at the end of the intervention. AEs were collected during the first 3 weeks and 1 week after cessation of treatment. RESULTS: Of 103 participants recruited, 95 were randomized and received the intervention (OT = 49, P = 46). OT had no significant impact on cardiovascular, urine, or serum measures. The AEs reported for both treatments were generally mild and few in number, though one participant assigned to OT and two assigned to P dropped out due to AEs. Relative to P, OT did not significantly increase the likelihood of reporting AEs, nor the number or severity of AEs reported. CONCLUSION: Chronic intranasal OT appears safe and well-tolerated in generally healthy older men. These findings provide support for continued human research on potential benefits of chronic OT in older adult populations.

Using greenspace and nature exposure as an adjunctive treatment for opioid and substance use disorders: Preliminary evidence and potential mechanisms.

The demand for opioid medication to effectively treat pain has contributed to the surging opioid crisis, which is a major source of morbidity and mortality in the U.S. More than 100,000 people begin opioid maintenance treatment (OMT) annually, the standard pharmacotherapy for opioid use disorder (OUD). Although OMT is the standard care for OUD, patients often experience or develop a heightened sensitivity to pain (hyperalgesia) as a result of the opioid medication, and also have high rates of stress, affective, and anxiety-related conditions. These conditions are interactive with other behavioral and environmental correlates of opioid and other substance use disorders including impulsive decision-making (e.g., harmful opioid use associated with increased delay discounting), and a lack of alternative (i.e., substance-free) and social reinforcement. Collectively these complex and multifaceted factors constitute significant predictors of lack of adherence to OMT (and other pharmacotherapies) and relapse. There is an urgent need, therefore, to develop novel adjunctive treatments that preserve the benefits of OMT and various pharmacotherapies, and simultaneously diminish continued pain and hyperalgesia, reduce stress and anxiety-related conditions, target relevant behavioral mechanism such as impulsive choice, and also serve to enhance the value of alternative and substance free activities. Here, we discuss evidence that an environmental manipulation - access to greenspace and nature - could serve as a potential adjunctive treatment to standard pharmacotherapies by targeting multiple biological and behavioral mechanisms that standard pharmacotherapies do not address.

Reducing impulsive choice VII: effects of duration of delay-exposure training.

Impulsive choice is related to substance use disorders, obesity, and other behaviors that negatively impact human health. Reducing impulsive choice may prove beneficial in ameliorating these maladaptive behaviors. Preclinical research in rats indicates that one reliable method for producing large and lasting reductions in impulsive choice is delay-exposure (DE) training. In all six of the prior DE-training experiments, rats were given extensive experience (~ 120 training sessions) with a delayed reinforcement contingency. The present experiment evaluated if similar large and lasting reductions in impulsive choice could be achieved with less training. The duration of DE training between groups of male Wistar rats was 0 sessions (training ended after a lever-pressing acquisition criterion was met), 30, 60, or 120 sessions. Comparison groups were given the same durations of training with immediate reinforcement. A post-training assessment of impulsive choice was completed using an increasing-delay procedure. For rats assigned to the 60-session condition, impulsive choice was reassessed at a 120-day follow-up. DE training reduced impulsive choice but, contrary to expectation, reductions in impulsive choice did not increase with DE-training duration (no significant training-duration by group interaction). Importantly, 60 sessions of DE training produced reductions in impulsive choice that were comparable to prior published findings and this effect remained significant at the 120-day follow-up. Procedural elements that may be responsible for the DE-training effect, and how they could be improved in future experiments, are discussed.

Translating episodic future thinking manipulations for clinical use: Development of a clinical control.

Many studies support that Episodic Future Thinking (EFT) reduces maladaptive health behaviors and how much individuals devalue the future (steepness of delay discounting). In order to understand the clinical utility of EFT, a control procedure that equates groups in non-specific treatment factors (e.g., expectancy of change, perceived connection of content to health behavior) is needed. The present research evaluated the effects of EFT relative to a novel control (health information thinking; HIT), which was designed to be structurally similar to EFT while incorporating elements from existing clinical controls. In a sample of Amazon Mechanical Turk workers (N = 254), we found that EFT reduced discounting relative to the HIT procedure and a standard EFT control. There were some affective differences across groups and differences in adherence to the intervention content, but these were unrelated to discounting. Delay discounting was not equivalent across the control groups, but this may not be a necessary condition to fulfill for a clinical control. Future research will need to identify whether the HIT procedure serves as a good control for other dependent variables when studying EFT and develop controls analogous to usual care or a "wait-list" in clinical contexts.

Reducing impulsive choice: VI. Delay-exposure training reduces aversion to delay-signaling stimuli.

Delay-exposure (DE) training consistently and robustly reduces impulsive choice in rats, but the behavioral mechanisms behind this effect are not yet understood. The present study evaluated if DE training works by mitigating aversion to delay-signaling stimuli-those encountered when rats chose the larger-later reward in impulsive choice assessments. Fifty-seven rats were randomly assigned to 120 days of training with delayed reinforcement, training with immediate reinforcement (IE), or to a no-training Control group. Consistent with prior experiments, DE rats made significantly fewer impulsive choices than IE or Control rats. Subsequently, in a separate assessment of delay aversion, rats were given the opportunity to press a lever to temporarily escape from stimuli correlated with long or short time-intervals to food. When these escape opportunities terminated delay-signaling stimuli in the impulsive-choice task, DE rats escaped significantly less than IE and Control rats. When escapes terminated FI-signaling stimuli (a procedure in which there is no response-reinforcer delay), the difference only approached significance. These results support the hypothesis that DE training reduces impulsive choice, in part, by reducing aversion to delay-signaling stimuli. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Aerobic Exercise Interventions for Patients in Opioid Maintenance Treatment: A Systematic Review.

BACKGROUND: Opioid maintenance treatment (OMT) is the standard for treatment of opioid use disorder, but some individuals on OMT experience disrupted sleep, heightened sensitivity to pain, and continued relapse to non-medical opioid use. An adjunctive treatment that has potential to address these shortcomings of OMT is aerobic exercise. OBJECTIVE: The aim of the present review was to identify and evaluate components of aerobic exercise interventions targeting OMT patients. METHODS: For this PROSPERO-registered review (ID CRD42020139626), studies were identified via electronic bibliographic databases, funded research (NIH RePORTER) and clinical trials databases (ClinicalTrials.gov), and reference sections of relevant manuscripts. Studies that evaluated the effects of an aerobic exercise intervention using a comparison condition or pretest-posttest design in adult OMT patients were included. RESULTS: Of 2971 unique records, three primary studies and one supplemental manuscript comprised the final sample. All studies were randomized trials involving supervised exercise interventions enrolling small samples of middle-aged OMT patients. Exercise interventions included a variety of aerobic and non-aerobic activities (e.g. flexibility exercises), and none controlled the dose of aerobic exercise. Few studies used objective measures of physical activity or cardiorespiratory fitness and there were no significant effects of adjunctive exercise on substance use outcomes, but tests of the latter were likely underpowered. CONCLUSIONS: Though early in the accumulation of evidence, interventions targeting aerobic exercise for OMT patients appear feasible, acceptable to patients, and beneficial. Longer-term studies that employ larger samples, include assessments of behavioral and biological mechanisms of change, more rigorous measurement of physical activity, and controlled doses of aerobic activity are warranted.

Evaluating the effect of delay spacing on delay discounting: carry-over effects on steepness and the form of the discounting function.

Most delay discounting studies use tasks that arrange delay progressions in which the spacing between consecutive delays becomes progressively larger. To date, little research has examined delay discounting using other progressions. The present study assessed whether the form or steepness of discounting varied across different delay progressions. Human participants completed three discounting tasks with delay progressions that varied in the time between consecutive delays: a standard (increasing duration between delays), linear (equal duration between delays), and an inverse progression (decreasing duration between delays). Steepness of discounting was generally reduced, and remained so, following experience with the inverse progression. Effects of the delay progression on the best fitting equation were order-dependent. Overall the hyperbola model provided better fits, but the exponential model performed better with data from the inverse progression. Regardless, differences in which model fit best were often small. The finding that the best fitting model was dependent, in some cases, on the delay progression suggests that a single quantitative model of discounting may not be applicable to describe discounting across all procedural contexts. Ultimately, changes in steepness of discounting following experience with the inverse progression appeared similar to anchoring effects, whose mechanism will require further study to delineate.

Changing Delay Discounting and Impulsive Choice: Implications for Addictions, Prevention, and Human Health.

Delay discounting describes the tendency to devalue delayed consequences or future prospects. The degree to which an individual discounts delayed events appears trait-like in that it is stable over time and across functionally similar situations. Steeply discounting delayed rewards is correlated with most substance-use disorders, the severity of these disorders, rates of relapse to drug use, and a host of other maladaptive decisions impacting human health. Longitudinal data suggest steep delay discounting and high levels of impulsive choice are predictive of subsequent drug taking, which suggests (though does not establish) that reducing delay discounting could have a preventive health-promoting effect. Experimental manipulations that produce momentary or long-lasting reductions in delay discounting or impulsive choice are reviewed, and behavioral mechanisms that may underlie these effects are discussed. Shortcomings of each manipulation technique are discussed and areas for future research are identified. While much work remains, it is clear that impulsive decision-making can be reduced, despite its otherwise trait-like qualities. Such findings invite technique refinement, translational research, and hope.