Development and initial findings from the Peer Recovery Coach (PRC) checklist: a new tool to assess the nature of peer recovery coaching service delivery.

Background: Peer recovery coaching is recovery support service for Substance Use Disorder (SUD) that emphasizes shared lived experience and social support. Though a promising intervention for SUD, differences in the roles, responsibilities, and operationalization of peer recovery coaching across studies make objective implementation and evaluation of this service a challenge.Objective: This study sought to develop a tool to better guide and operationalize peer recovery coaching service delivery. This study describes the initial development, acceptability, feasibility, and validity of this tool: The PRC Checklist.Methods: The PRC Checklist was conceptualized and operationalized by drawing from social support theory and recovery capital research. The PRC Checklist was utilized by PRCs in a pilot randomized controlled trial to demonstrate feasibility and acceptability. To further validate the PRC Checklist, recovery coaches (N = 16; 56% female) were recruited to complete a survey about their responsibilities and their perspectives on the content and potential utility of the PRC Checklist.Results: The PRC checklist used in the pilot study delineates personalized from generalized support and tracks 25 specific activities across three domains of support (i.e. socioemotional, informational, and instrumental). PRCs in the pilot study were able to use the PRC Checklist in all in-person initial baseline encounters and 96.4% of follow-up encounters. Qualitative information collected during project meetings was generally positive but also identified potential limitations to its use. All PRCs surveyed reported that they agreed that the PRC Checklist was helpful, encompassed the services they provided, represented a good idea, provided meaningful information, and would be easy to use. All five of the most common activities PRCs engaged in were reflected in the PRC Checklist.Conclusion: Capturing both personal and generalized support provided by PRCs, this work suggests that the PRC Checklist captures key activities engaged in and is a helpful tool for use in healthcare settings.

Acute Care Utilization After Recovery Coaching Linkage During Substance-Related Inpatient Admission: Results of Two Randomized Controlled Trials.

BACKGROUND: For patients with substance use disorder (SUD), a peer recovery coach (PRC) intervention increases engagement in recovery services; effective support services interventions have occasionally demonstrated cost savings through decreased acute care utilization. OBJECTIVE: Examine effect of PRCs on acute care utilization. DESIGN: Combined results of 2 parallel 1:1 randomized controlled trials. PARTICIPANTS: Inpatient adults with substance use disorder INTERVENTIONS: Inpatient PRC linkage and follow-up contact for 6 months vs usual care (providing contact information for SUD resources and PRCs) MAIN MEASURES: Acute care encounters (emergency and inpatient) 6 months before and after enrollment; encounter type by primary diagnosis code category (mental/behavioral vs medical); 30-day readmissions with Lace+ readmission risk scores. KEY RESULTS: A total of 193 patients were randomized: 95 PRC; 98 control. In the PRC intervention, 66 patients had a pre-enrollment acute care encounter and 56 had an encounter post-enrollment, compared to the control group with 59 pre- and 62 post-enrollment (odds ratio [OR] = -0.79, P = 0.11); there was no significant effect for sub-groups by encounter location (emergency vs inpatient). There was a significant decrease in mental/behavioral ED visits (PRC: pre-enrollment 17 vs post-enrollment 10; control: pre-enrollment 13 vs post-enrollment 16 (OR = -2.62, P = 0.02)) but not mental/behavioral inpatient encounters or medical emergency or inpatient encounters. There was no significant difference in 30-day readmissions corrected for Lace+ scores (15.8% PRC vs 17.3% control, OR = 0.19, P = 0.65). CONCLUSIONS: PRCs did not decrease overall acute care utilization but may decrease emergency encounters related to substance use. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04098601, NCT04098614).

Substance use is associated with reduced devaluation sensitivity.

Substance use has been linked to impairments in reward processing and decision-making, yet empirical research on the relationship between substance use and devaluation of reward in humans is limited. We report findings from two studies that tested whether individual differences in substance use behavior predicted reward learning strategies and devaluation sensitivity in a nonclinical sample. Participants in Experiment 1 (N = 66) and Experiment 2 (N = 91) completed subscales of the Externalizing Spectrum Inventory and then performed a two-stage reinforcement learning task that included a devaluation procedure. Spontaneous eye blink rate was used as an indirect proxy for dopamine functioning. In Experiment 1, correlational analysis revealed a negative relationship between substance use and devaluation sensitivity. In Experiment 2, regression modeling revealed that while spontaneous eyeblink rate moderated the relationship between substance use and reward learning strategies, substance use alone was related to devaluation sensitivity. These results suggest that once reward-action associations are established during reinforcement learning, substance use predicted reduced sensitivity to devaluation independently of variation in eyeblink rate. Thus, substance use is not only related to increased habit formation but also to difficulty disengaging from learned habits. Implications for the role of the dopaminergic system in habitual responding in individuals with substance use problems are discussed.

Acute stress improves long-term reward maximization in decision-making under uncertainty.

Acute stress influences reward-seeking tendencies and risky decision-making. However, it is unclear how acute stress influences decision-making in situations in which individuals must learn to either maximize long-term or immediate rewards from experience. Consequently, this study sought to investigate whether acute stress enhances salience of small, immediate or large, delayed rewards on decision-making under uncertainty. The Socially Evaluated Cold Pressor Task (SECPT) was used to induce acute stress. Participants in Experiment 1 (N = 50) were exposed to either the SECPT or a warm-water control condition and then completed a decision-making task in which participants needed to learn to forego immediate rewards in favor of larger delayed rewards. The results demonstrated that acute stress enhanced decisions that maximized long-term, large rewards over immediate, small rewards. Experiment 2 (N = 50) included an assessment of salivary cortisol. Results replicated the behavioral findings in Experiment 1 and demonstrated that the acute stress manipulation increased salivary cortisol, thus providing a potential physiological mechanism for these results. This work suggests that moderate acute stress can improve decision-making under uncertainty that depends on learning to maximize long-term rewards from experience.

Gender differences in preference for reward frequency versus reward magnitude in decision-making under uncertainty.

Extensive research has focused on gender differences in intertemporal choices made from description in which participants must choose from multiple options that are specified without ambiguity. However, there has been limited work examining gender differences in intertemporal choices made from experience in which the possible payoffs among choice alternatives are not initially known and can only be gained from experience. Other work suggests that females attend more to reward frequency, whereas males attend more to reward magnitude. However, the tasks used in this research have been complex and did not examine intertemporal decision-making. To specifically test whether females are more sensitive to reward frequency and males are more sensitive to reward magnitude on intertemporal decisions made from experience, we designed a simple choice task in which participants pressed a response button at a time of their own choosing on each of many trials. Faster responses led to smaller, but more frequent rewards, whereas slower responses led to larger, but less frequently given rewards. As predicted, females tended to respond quicker for more certain, smaller rewards than males, supporting our prediction that women attend more to reward frequency whereas men attend more to reward magnitude.

Dopaminergic Genetic Polymorphisms Predict Rule-based Category Learning.

Dopaminergic genes play an important role in cognitive function. DRD2 and DARPP-32 dopamine receptor gene polymorphisms affect striatal dopamine binding potential, and the Val158Met single-nucleotide polymorphism of the COMT gene moderates dopamine availability in the pFC. Our study assesses the role of these gene polymorphisms on performance in two rule-based category learning tasks. Participants completed unidimensional and conjunctive rule-based tasks. In the unidimensional task, a rule along a single stimulus dimension can be used to distinguish category members. In contrast, a conjunctive rule utilizes a combination of two dimensions to distinguish category members. DRD2 C957T TT homozygotes outperformed C allele carriers on both tasks, and DARPP-32 AA homozygotes outperformed G allele carriers on both tasks. However, we found an interaction between COMT and task type where Met allele carriers outperformed Val homozygotes in the conjunctive rule task, but both groups performed equally well in the unidimensional task. Thus, striatal dopamine binding may play a critical role in both types of rule-based tasks, whereas prefrontal dopamine binding is important for learning more complex conjunctive rule tasks. Modeling results suggest that striatal dopaminergic genes influence selective attention processes whereas cortical genes mediate the ability to update complex rule representations.

Dopamine, depressive symptoms, and decision-making: the relationship between spontaneous eye blink rate and depressive symptoms predicts Iowa Gambling Task performance.

Depressive symptomatology has been associated with alterations in decision-making, although conclusions have been mixed, with depressed individuals showing impairments in some contexts but advantages in others. The dopaminergic system may link depressive symptoms with decision-making performance. We assessed the role of striatal dopamine D2 receptor density, using spontaneous eye blink rates, in moderating the relationship between depressive symptoms and decision-making performance in a large undergraduate sample that had not been screened for mental illness (N = 104). The regression results revealed that eye blink rate moderated the relationship between depressive symptoms and advantageous decisions on the Iowa Gambling Task, in which individuals with more depressive symptomatology and high blink rates (higher striatal dopamine D2 receptor density) performed better on the task. Our computational modeling results demonstrated that depressive symptoms alone were associated with enhanced loss-aversive behavior, whereas individuals with high blink rates and elevated depressive symptoms tended to persevere in selecting options that led to net gains (avoiding options with net losses). These findings suggest that variation in striatal dopamine D2 receptor availability in individuals with depressive symptoms may contribute to differences in decision-making behavior.

Who Chokes Under Pressure? The Big Five Personality Traits and Decision-Making under Pressure.

The purpose of the present study was to examine whether the Big Five personality factors could predict who thrives or chokes under pressure during decision-making. The effects of the Big Five personality factors on decision-making ability and performance under social (Experiment 1) and combined social and time pressure (Experiment 2) were examined using the Big Five Personality Inventory and a dynamic decision-making task that required participants to learn an optimal strategy. In Experiment 1, a hierarchical multiple regression analysis showed an interaction between neuroticism and pressure condition. Neuroticism negatively predicted performance under social pressure, but did not affect decision-making under low pressure. Additionally, the negative effect of neuroticism under pressure was replicated using a combined social and time pressure manipulation in Experiment 2. These results support distraction theory whereby pressure taxes highly neurotic individuals' cognitive resources, leading to sub-optimal performance. Agreeableness also negatively predicted performance in both experiments.

State-based versus reward-based motivation in younger and older adults.

Recent decision-making work has focused on a distinction between a habitual, model-free neural system that is motivated toward actions that lead directly to reward and a more computationally demanding goal-directed, model-based system that is motivated toward actions that improve one's future state. In this article, we examine how aging affects motivation toward reward-based versus state-based decision making. Participants performed tasks in which one type of option provided larger immediate rewards but the alternative type of option led to larger rewards on future trials, or improvements in state. We predicted that older adults would show a reduced preference for choices that led to improvements in state and a greater preference for choices that maximized immediate reward. We also predicted that fits from a hybrid reinforcement-learning model would indicate greater model-based strategy use in younger than in older adults. In line with these predictions, older adults selected the options that maximized reward more often than did younger adults in three of the four tasks, and modeling results suggested reduced model-based strategy use. In the task where older adults showed similar behavior to younger adults, our model-fitting results suggested that this was due to the utilization of a win-stay-lose-shift heuristic rather than a more complex model-based strategy. Additionally, within older adults, we found that model-based strategy use was positively correlated with memory measures from our neuropsychological test battery. We suggest that this shift from state-based to reward-based motivation may be due to age related declines in the neural structures needed for more computationally demanding model-based decision making.

Can Stress Put Digital Privacy at Risk? Evidence from a Controlled Experiment Examining the Impact of Acute Stress on Privacy Decisions on a Simulated Social Network Site.

Internet and Communication Technologies (ICTs) can foster efficient communication and knowledge acquisition, but there are also tradeoffs in terms of risks to one's privacy. Previous research, including work with the privacy calculus framework, indicates that factors such as perceived risks and benefits of using ICTs, ICT trust, and general privacy concerns can influence individuals' digital privacy-related decisions. One pervasive psychological factor that may potentially alter such privacy-related behaviors is acute stress. Acute stress can promote risk-seeking behaviors and a tendency to prefer immediate rewards over delayed, greater value rewards. However, the effect of acute stress in the applied context of privacy decision making is relatively unknown. Participants (N = 143) in this study were randomly assigned to either an acute stress task (socially evaluated cold pressor task) or an active control task (lukewarm water alone). Results revealed that acute stress condition increased information disclosure, as indexed by accepting more online cookies, sharing one's location more frequently, and revealing greater willingness to self-disclose personal information. In addition, the impact of individuals' levels of perceived risk and benefits, trust, and privacy concern on privacy decision making was examined. However, none of these constructs consistently influenced privacy decisions over and above the effect of stress. Overall, our findings suggest that acute stress has robust, independent influence on privacy decision making.

Anxiety sensitivity is associated with heightened intolerance of uncertainty in individuals with alcohol use disorder.

Alcohol use disorder (AUD) is a highly prevalent, yet heterogenous condition linked to anxiety, reward sensitivity, and cognitive biases. Understanding cognitive mechanisms of specific AUD symptoms is crucial for developing tailored, effective interventions. This pilot study sought to assess whether two potential cognitive correlates of AUD-intolerance of uncertainty and delay discounting-differentially influence the relationship between AUD, anxiety sensitivity, and drinking motives. Individuals with mild-to-moderate AUD (n = 31) and healthy control participants (n = 31) completed a single-session lab study in which they performed a decision making under uncertainty task as a behavioral measure of uncertainty tolerance, completed a delay discounting task as a measure of reward sensitivity, and responded to surveys related to anxiety sensitivity, state and trait anxiety, intolerance of uncertainty, and drinking motives. Hierarchical regression results demonstrated a significant interaction between AUD status (AUD vs. control) on both self-reported (ß = 0.687, p = .020) and behavioral (ß = 0.777, p = .012) intolerance of uncertainty. Greater anxiety sensitivity was associated with heightened intolerance of uncertainty in those with AUD but not controls. Correlations showed that the coping drinking motive was significantly positively associated with anxiety sensitivity (r = 0.462, p = .010), self-reported (r = 0.535, p = .002), and behavioral intolerance of uncertainty (r = 0.396, p < .027) in participants with AUD but not controls. No significant associations between anxiety sensitivity, drinking motives, and delay discounting were observed in either the AUD or the control group. Intolerance of uncertainty may therefore represent a cognitive bias in which individuals with AUD and anxiety sensitivity drink to cope with environmental and internal uncertainty. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Recovery Barrier Characterizations by Hospitalized Patients with Substance Use Disorders: Results from a Randomized Clinical Study on Inpatient Peer Recovery Coaching.

Patients hospitalized with medical complications from substance use disorder (SUD) encounter unique health problems that may complicate their recovery. Recovery barriers are not well understood in this population. The study objective is to characterize recovery barriers in this patient population. Participants (n = 96) in this six-month longitudinal study were randomized to a peer recovery coaching intervention or standard of care. The primary outcome measures were qualitative, open-ended questions addressing factors interfering with participants' recovery. Data were analyzed using content analysis. Themes were identified a priori using past research on recovery capital domains; these seven barriers were (1) psychological health difficulties, (2) physical health challenges, (3) lack of social support, (4) insufficient treatment or recovery support to maintain sobriety, (5) environmental and housing concerns, (6) deficits in coping skills, and (7) lack of meaningful activities. At baseline, the most common recovery barriers were in the environment and housing (28.1%), psychological health (27.1%), and social support (22.9%) domains. At six-month follow-up, participants were asked to describe barriers they felt they had made improvement in over the last six months. The primary themes that participants reported improvements in were treatment and recovery support to maintain sobriety (52.1%), coping skills (35.4%), and social support (27.1%). Hospitalization and participation in a randomized controlled trial may be a turning point in which to address recovery barriers for patients hospitalized with complications from SUD.

Age Differences in Prosocial Behavior Depend on Effort Costs.

OBJECTIVES: This study examined age differences in willingness to engage in effortful and effortless prosocial behavior for a fully anonymous recipient. METHOD: Participants were recruited through the Prolific online recruitment platform. In Experiment 1, older (N = 46) and younger (N = 65) adults completed the "pay-it-forward" effortful decision-making task with fixed effort demands and a version of the Dictator Game, an effortless prosocial decision-making task. In Experiment 2, older (N = 38) and younger (N = 42) adults completed the Dictator Game and a modified pay-it-forward decision-making task in which effort demands were calibrated to one's ability. RESULTS: In both Experiments 1 and 2, older adults were more prosocial than younger adults on the effortless Dictator Game. In Experiment 1, older adults were less prosocial across all trials of the effortful pay-it-forward task. However, when the task was more achievable in Experiment 2, older adults were only less prosocial when the probability of a reward was low. DISCUSSION: In everyday life, many prosocial contexts depend on effort expenditure. When prosocial activities are effortful, older adults are less willing to engage in prosocial behavior, particularly when reward likelihood is low, and instead focus on resource conservation. In the absence of such effort costs, older adults are more prosocial than younger adults. This work suggests that older adults may prefer to engage in prosocial behavior more than younger adults, but physical resource constraints may limit their ability to engage in such effortful prosocial activities.

Effects of short-term nicotine deprivation on delay discounting among young, experienced, exclusive ENDS users: An initial study.

Delay discounting describes how rapidly delayed rewards lose value as a function of delay and serves as one measure of impulsive decision-making. Nicotine deprivation among combustible cigarette smokers can increase delay discounting. We aimed to explore changes in discounting following nicotine deprivation among electronic nicotine delivery systems (ENDS) users. Thirty young adults (aged 18-24 years) that exclusively used ENDS participated in two laboratory sessions: one with vaping as usual and another after 16 hr of nicotine deprivation (biochemically assessed). At each session, participants completed a craving measure and three hypothetical delay discounting tasks presenting choices between small, immediate rewards and large, delayed ones (money-money; e-liquid-e-liquid; e-liquid-money). Craving for ENDS significantly increased during short-term nicotine deprivation relative to normal vaping. Delay discounting rates in the e-liquid now versus money later task increased (indicating a shift in preference for smaller, immediate rewards) following short-term nicotine deprivation relative to vaping as usual, but no changes were observed in the other two discounting tasks. Short-term nicotine deprivation increased the preference for smaller amounts of e-liquid delivered immediately over larger, monetary awards available after a delay in this first study of its kind. As similar preference shifts for drug now versus money later have been shown to be indicative of increased desire to use drug as well as relapse risk, the findings support the utility of the current model as a platform to explore interventions that can mitigate these preference shifts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Preliminary Evidence of the Association between Time on Buprenorphine and Cognitive Performance among Individuals with Opioid Use Disorder Maintained on Buprenorphine: A Pilot Study.

People on buprenorphine maintenance treatment (BMT) commonly present cognitive deficits that have been associated with illicit drug use and dropout from buprenorphine treatment. This study has compared cognitive responses to the Stroop Task and the Continuous Performance Task (CPT) among individuals on BMT, with recent drug use, and healthy controls and explored the associations between cognitive responses and drug use, craving, and buprenorphine use among participants on BMT. The participants were 16 individuals on BMT and 23 healthy controls. All participants completed a 60 min laboratory session in which they completed the Stroop Task and the CPT, a saliva drug test, a brief clinical history that collected substance-use- and treatment-related information, and the Opioid Craving Scale. The results showed that the BMT participants presented more commission errors (MBMT participants = 2.49; Mhealthy controls = 1.38; p = 0.048) and longer reaction times (MBMT participants = 798.09; Mhealthy controls = 699.09; p = 0.047) in the Stroop Task than did the healthy controls. More days on buprenorphine were negatively associated with reaction time in the CPT (-0.52) and the number of commission errors (-0.53), simple reaction time (-0.54), and reaction time correct (-0.57) in the Stroop Task. Neither drug use nor craving was significantly associated with the results for the cognitive tasks. Relative to the control participants, the BMT individuals performed worse in terms of longer reaction times and more commission errors in the Stroop Task. Within the BMT participants, longer times on buprenorphine were associated with better cognitive results in terms of faster reaction times for both tasks and lower commission errors for the Stroop Task.

Identifying Racial and Rural Disparities of Cognitive Functioning Among Older Adults: The Role of Social Isolation and Social Technology Use.

OBJECTIVES: Social isolation is associated with poorer cognitive outcomes among older adults. The use of online social technology platforms may provide a means to reduce social isolation. However, research examining whether social technology can mitigate the negative effects of social isolation on cognitive functioning is limited. This study investigates the interaction between social isolation and social technology use on cognitive functioning among older adults and seeks to identify racial and rural-urban differences in this relationship. METHOD: Data were obtained from the Health and Retirement Study 2014-2018 waves (N = 5,358). Participants (aged 50-102) completed self-report measures of social isolation, loneliness, and frequency of online social communication and completed the modified Telephone Interview for Cognitive Status, which assesses cognitive functioning. Examinations of race focused on differences between Black/African American and White/Caucasian groups; rurality was operationalized using Beale Rural-Urban Continuum Codes. Data were analyzed using structural equation models. RESULTS: Social technology use moderated the negative relationship between social isolation and cognitive functioning, controlling for age, education, gender, wealth, and general computer usage. Greater social technology use was associated with better cognitive functioning among socially isolated older adults. Results showed evidence of racial, but not rural-urban, differences in the relationship between social technology use and cognitive functioning. Regardless of the degree of social isolation, frequent social technology use was associated with improved cognitive functioning in Black/African American older adults but not White/Caucasians older adults. DISCUSSION: Social technology may represent a way to mitigate cognitive decline, particularly among Black/African American older adults.

Effects of categorical and numerical feedback on category learning.

Real-world learning signals often come in the form of a continuous range of rewards or punishments, such as receiving more or less money or other reward. However, in laboratory studies, feedback used to examine how humans learn new categories has almost invariably been categorical in nature (i.e. Correct/Incorrect, or A/Not-A). Whether numerical or categorical feedback leads to better learning is an open question. One possibility is that numerical feedback could give more fine-grained information about a category. Alternatively, categorical feedback is more dichotomous, potentially leading to larger error signals. Here we test how feedback impacts category learning by having participants learn to categorize novel line stimuli from either numerical, categorical, or a combination of both types of feedback. Performance was better for categorical relative to the more variable numerical feedback. However, participants were able to learn to effectively categorize from numerical feedback, and providing larger numerical rewards for easier, more representative stimuli was more successful in promoting learning than providing larger rewards for harder to classify stimuli. Simulations and fits of a connectionist model to participants' performance data suggest that categorical feedback promotes better learning by eliciting larger prediction errors than numerical feedback.

The Effect of Mental Health App Customization on Depressive Symptoms in College Students: Randomized Controlled Trial.

BACKGROUND: Mental health apps have shown promise in improving mental health symptoms, including depressive symptoms. However, limited research has been aimed at understanding how specific app features and designs can optimize the therapeutic benefits and adherence to such mental health apps. OBJECTIVE: The primary purpose of this study is to investigate the effect of avatar customization on depressive symptoms and adherence to use a novel cognitive behavioral therapy (CBT)-based mental health app. The secondary aim is to examine whether specific app features, including journaling, mood tracking, and reminders, affect the usability of the mental health app. METHODS: College students were recruited from a university study recruitment pool website and via flyer advertisements throughout campus. A total of 94 participants completed a randomized controlled trial in which they were randomized to either customization or no customization version of the app. Customization involved personalizing a virtual avatar and a travel vehicle to one's own preferences and use of one's name throughout the app. Participants completed a 14-day trial using a novel CBT-based mental health app called AirHeart. Self-report scores for depressive symptoms, anxiety, and stress were measured at baseline and after the intervention. Postintervention survey measures also included usability and avatar identification questionnaires. RESULTS: Of the 94 enrolled participants, 83 (88%) completed the intervention and postintervention assessments. AirHeart app use significantly reduced symptoms of depression (P=.006) from baseline to the end of the 2-week intervention period for all participants, regardless of the customization condition. However, no differences in depressive symptoms (P=.17) or adherence (P=.80) were observed between the customization (39/83, 47%) and no customization (44/83, 53%) conditions. The frequency of journaling, usefulness of mood tracking, and helpfulness of reminders were not associated with changes in depressive symptoms or adherence (P>.05). Exploratory analyses showed that there were 3 moderate positive correlations between avatar identification and depressive symptoms (identification: r=-0.312, P=.02; connection: r=-0.305, P=.02; and lack of relatability: r=0.338, P=.01). CONCLUSIONS: These results indicate that CBT mental health apps, such as AirHeart, have the potential to reduce depressive symptoms over a short intervention period. The randomized controlled trial results demonstrated that customization of app features, such as avatars, does not further reduce depressive symptoms over and above the CBT modules and standard app features, including journal, reminders, and mood tracking. However, further research elucidating the relationship between virtual avatar identification and mental health systems is needed as society becomes increasingly more digitized. These findings have potential implications for improving the optimization of mental health app designs. TRIAL REGISTRATION: Open Science Framework t28gm; https://osf.io/t28gm.

Examining Internalizing Mental Health Correlates of Addiction Severity in Patients Hospitalized With Medical Complications From Substance Use Disorder.

Background: Comorbidities between Substance Use Disorder (SUD) and mental health disorders are highly prevalent, yet there remains a lack of information regarding how mental health conditions may affect addiction severity. Consequently, this study sought to investigate the relationship between internalizing disorders (anxiety and mood disorders) and addiction severity in patients hospitalized for SUD-related medical complications. Individual difference predictors and history of prior treatment for SUD were also examined. Methods: Participants (N = 200) were hospitalized patients who consented to receive peer-based recovery support services for their SUD. To be eligible for the study, participants needed to have a SUD diagnosis due to alcohol, opioids, methamphetamine, cocaine, or a combination of these substances (polysubstance use). Participants completed self-report questionnaires regarding demographics, mental health history, prior SUD treatment, and addiction severity (Drug and Alcohol Screening Test; DAST-10) during their hospitalization. Results: Results showed that patients with Generalized Anxiety Disorder (GAD) (M = 6.68, SD = 2.97) had greater addiction severity compared to those without GAD (M = 5.41, SD = 3.34), P = .016. Addiction severity results stratified by SUD type showed that the relationship was significant among patients with Alcohol Use Disorder (P = .014), but not among those with other SUD types (Ps > .27). Major Depressive Disorder (MDD) and Post-Traumatic Stress Disorder (PTSD) were not linked to addiction severity. Among those with GAD, 81.4% had previously been to treatment compared to only 53.1% of those without GAD, P = .010. The only participant characteristic linked with addiction severity was insurance status. Conclusions: GAD may represent a risk factor for advanced alcohol addiction trajectories, including greater addiction severity and severe health complications requiring inpatient hospitalization.

Examining the relationship between substance use and exploration-exploitation behavior in young adults.

Substance use is characterized by reward processing dysregulation and cognitive control deficits. One area of research that remains relatively unexplored is the relationship between substance use and exploration-exploitation trade-offs, which involve a continuum from switching (exploration) to perseverative (exploitation). In dynamic, volatile environments, exploitation of well-known options can lead to habit-driven perseveration, and exploration of new opportunities can produce new information that may enhance one's future state. The primary aim was to investigate the relationship between regular substance use and spontaneous eyeblink rate (EBR) on exploration-exploitation behavior. Young adults (N = 83) aged 18-23 completed a single laboratory session. A dynamic foraging task was used to characterize exploration/exploitation behavior. Substance use was defined using the Externalizing Spectrum Inventory-Brief Form. Dopamine levels were operationalized using spontaneous EBR. The primary outcome was proportion of switch choices on the foraging task, which reflects a continuum of exploitation (low values) to exploration (high values) behavior. A linear mixed-effects regression was conducted to examine the effect of substance use and EBR on the proportion of switch trials. Results demonstrated a significant negative interaction between substance use and EBR on proportion of switch trials (p < .001). Participants with regular substance use and low EBR showed decreased switch choices, indicative of increased exploitation, compared to those with higher EBR. EBR was positively associated with proportion of switch trials (p = .032) and thus greater exploration. The relationship between substance use and increased exploitation in young adults appears specific to those with low EBR. (PsycInfo Database Record (c) 2022 APA, all rights reserved).