Dependent heroin use and associated risky behaviour: The role of rash impulsiveness and reward sensitivity

Impulsive temperament has long been considered as a risk factor for substance use disorders (SUD). Considering the heterogeneity of impulsivity, a biologically-based 2-factor model incorporating reward sensitivity and rash impulsiveness facets, has been proposed. Here we report how these two facets of impulsiveness could be associated with different aspects of dependent heroin use and associated risky behaviour. Two hundred and ninety three dependent heroin users and 232 non-users were assessed on reward sensitivity, rash impulsivity, and the related trait of punishment sensitivity. After adjusting for multiple comparisons, heroin users were found to be more rash-impulsive and reward-sensitive than non-users (p < 0.001). Within users, rash impulsivity was associated with high risk behaviour including escalating heroin consumption, injecting heroin use, hazardous drinking, low treatment-seeking and risky sexual behaviour. Reward sensitivity was uniquely associated with early onset of drug use. While greater impulsivity is a common trait in drug users compared with non-users, the use of a 2-factor model of impulsivity provides additional information regarding specific aspects of drug initiation and maintenance that can be targeted in the prevention and treatment of heroin dependence.     

Mediational pathways among trait impulsivity,heroin-use consequences,and current mood state

Background: This study examined whether lifetime heroin-use consequences mediate the relationship between trait impulsivity and three current mood outcomes: depression symptoms, stress levels, and perception of life events.

Method: Regular heroin users (N?=?163) were assessed using the Barratt Impulsiveness Scale (BIS-11) to measure trait impulsivity; a standardized Drug History and Use Questionnaire to measure lifetime adverse consequences of heroin use; Beck Depression Inventory II to measure current depression symptoms; Stress subscale of the Depression Anxiety Stress scale; and Hassles and Uplifts scale to measure perception of life events.

Results: BIS-11 Attentional and Motor impulsivity were positively related to number of adverse heroin-use consequences, depression symptoms, and stress level, and negatively associated with positive perception of events. A greater number of heroin-use consequences was related to more depression symptoms, higher stress, more negative perception of events, injection heroin use, and earlier ages of first and regular heroin use. In six mediation models, lifetime heroin-use consequences partially mediated relationships between two trait impulsivity domains (Attentional, Motor) and current mood measures (depression symptoms, stress, perception of events).

Conclusions: The present findings suggest that current negative mood can be a response to the accumulated burden of heroin-use consequences, particularly in the presence of high trait impulsivity.     

Negative emotion-driven impulsivity predicts substance dependence problems

Impulsivity is predominant among users of several drugs of abuse including alcohol, cocaine, and amphetamines, and it is considered a risk factor for later development of alcohol and substance abuse and dependence. However, there is little consensus on how impulsivity should be defined and measured, and there are few studies on the relationship between separate dimensions of impulsivity and substance dependence. We used a multidimensional measure of impulsivity (the UPPS scale) to examine differences between 36 individuals with substance dependence (ISD) and 36 drug-free controls on the dimensions of urgency, lack of premeditation, lack of perseverance, and sensation seeking. In addition, we examined which dimensions of impulsivity better predicted addiction-related problems as measured with the addiction severity index. Results revealed that ISD show high scores on dimensions of urgency, lack of perseverance, and lack of premeditation (effect sizes ranging from 1.10 to 1.96), but not on sensation seeking. Among the different impulsivity dimensions, urgency was the best predictor of severity of medical, employment, alcohol, drug, family/social, legal and psychiatric problems in ISD, explaining 13-48% of the total variance of these indices. Furthermore, urgency scores alone correctly classified 83% of the participants in the ISD group. Urgency is characterized by a tendency to act impulsively in response to negative emotional states. Thus, our results could have important implications for novel treatment approaches for substance dependence focused on emotional regulation.     

Molly users versus nonusers in a sample of college alcohol drinkers: Differences in substance-related harms and sensation seeking

ABSTRACT

Background: Molly is one form of MDMA (3,4-methylenedioxymethamphetamine) that is touted to be more “pure” and potentially less harmful than other forms, such as ecstasy. Media reports and case studies suggest that this drug is popular among college students and is related to adverse health problems. The current study sought to address the knowledge gaps about Molly by examining whether users differ in substance use outcomes and sensation seeking than nonusers. Specifically, this study tested whether Molly users engaged in heavier use of other substances and experienced more substance-related harms in general than nonusers. Further, the current study investigated whether Molly users exhibited higher levels of sensation seeking than nonusers. Lastly, this study examined whether Molly user status would be associated with substance-related harms beyond the confounding influence of other substance use and trait sensation seeking. Methods: Participants were 710 (71.9% female) college alcohol drinkers who completed self-report surveys about substance use (i.e., Molly, alcohol, and other drug use), substance-related problems, and sensation seeking. Results: Results revealed that approximately 12% of the sample reported lifetime Molly use. Molly users compared with nonusers reported higher levels of other drug use, alcohol use, substance-related problems, and sensation seeking. Further, Molly users reported experiencing poorer substance use outcomes (e.g., blacking out, academic/occupational problems, and withdrawal symptoms) after accounting for sensation seeking and other substance use. Conclusions: These findings indicate that Molly users are higher in sensation seeking and that use is uniquely related to greater risk for substance-related harms. These preliminary findings demonstrate a need for correcting possible misperceptions regarding the purity of Molly and educating users on the potential for experiencing associated harms. Such information could be used to develop efficacious prevention programming for college students.     

The intervening role of urgency on the association between childhood maltreatment,PTSD, and substance-related problems

A range of risk factors lead to opioid use and substance-related problems (SRP) including childhood maltreatment, elevated impulsivity, and psychopathology. These constructs are highly interrelated such that childhood maltreatment is associated with elevated impulsivity and trauma-related psychopathology such as posttraumatic stress disorder (PTSD), and impulsivity—particularly urgency—and PTSD are related. Prior work has examined the association between these constructs and substance-related problems independently and it is unclear how these multi-faceted constructs (i.e., maltreatment types and positive and negative urgency) are associated with one another and SRP. The current study used structural equation modeling (SEM) to examine the relations among childhood maltreatment, trait urgency, PTSD symptoms, and SRP in a sample of individuals with a history of opioid use. An initial model that included paths from each type of childhood maltreatment, positive and negative urgency, PTSD and SRP did not fit the data well. A pruned model with excellent fit was identified that suggested emotional abuse, positive urgency, and negative urgency were directly related to PTSD symptoms and only PTSD symptoms were directly related to SRP. Furthermore, significant indirect effects suggested that emotional abuse and negative urgency were related to SRP via PTSD symptom severity. These results suggest that PTSD plays an important role in the severity of SRP.     

Pathological personality traits among patients with absent, current, and remitted substance use disorders

Personality traits may provide underlying risk factors for and/or sequelae to substance use disorders (SUDs). In this study Schedule for Nonadaptive and Adaptive Personality (SNAP) traits were compared in a clinical sample (N=704, age 18-45) with current, past, or no historical alcohol or non-alcohol substance use disorders (AUD and NASUD) as assessed by DSM-IV semi-structured interview. Results corroborated previous research in showing associations of negative temperament and disinhibition to SUD, highlighting the importance of these traits for indicating substance use proclivity or the chronic effects of substance use. Certain traits (manipulativeness, self-harm, disinhibition, and impulsivity for AUD, and disinhibition and exhibitionism for NASUD) were higher among individuals with current relative to past diagnoses, perhaps indicating concurrent effects of substance abuse on personality. The positive temperament characteristics detachment and entitlement distinguished AUDs and NASUDs, respectively, perhaps clarifying why this higher order trait tends to show limited relations to SUD generally. These findings suggest the importance of systematically integrating pathological and normative traits in reference to substance-related diagnosis.     

HIV risk behavior among patients with co-occurring bipolar and substance use disorders: associations with mania and drug abuse

BACKGROUND: Bipolar and substance use disorders frequently co-occur, and both are associated with impulsivity, impaired judgment, and risk-taking. OBJECTIVES: This study aimed to: (1) describe the rates of HIV sexual and drug risk behaviors among patients with co-occurring bipolar and substance use disorders, (2) test whether acute mania, psychiatric severity, and drug severity independently predict HIV risk, and (3) examine the relationship between specific substance dependencies and sexual risk behaviors. METHOD: Participants (N=101) were assessed for psychiatric diagnoses, substance abuse, and HIV risk behavior using structured clinical interviews and self-report questionnaires. RESULTS: The majority (75%) were sexually active in the past 6 months and reported high rates of sexual risk behaviors, including unprotected intercourse (69%), multiple partners (39%), sex with prostitutes (24%, men only), and sex trading (10%). In a multivariate linear regression model, recent manic episode, lower psychiatric severity, and greater drug severity were independent predictors of total HIV risk. Cocaine dependence was associated with increased risk of sex trading. CONCLUSIONS: Results underscore the importance of HIV prevention for this population.     

Reward-related decision-making deficits and elevated impulsivity among MDMA and other drug users

BACKGROUND: The recreational drug, 3,4-methylenedioxymethamphetamine (MDMA; 'Ecstasy'), is a synthetic amphetamine derivative and a serotonin neurotoxin. MDMA use is associated with cognitive dysfunction and impulsivity, but since polydrug abuse is common among users it is difficult to attribute these problems specifically to MDMA. Moreover, few studies have examined reward-related cognitive processes. Our aim was to examine reward-related decision-making and impulsivity among MDMA users while controlling for polydrug use via appropriate comparison groups. METHODS: We examined decision-making [Iowa Gambling Task, IGT; Bechara, A., Damasio, A.R., Damasio, H., Anderson, S.W., 1994. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition 50, 7-15], self-reported impulsivity (Multidimensional Personality Questionnaire-Brief Form [constraint subscale]; Barratt Impulsiveness Scale; Zuckerman Sensation Seeking Scale), and drug use among 22 abstinent MDMA users, 30 other drug users, and 29 healthy non-drug controls. RESULTS: MDMA and other drug users showed comparable patterns of decision-making and impulsivity. However, both drug groups demonstrated poorer IGT performance and elevated self-reported impulsivity relative to controls. Poorer decision-making was related to heavier drug use in the past year, heavier weekly alcohol use, and meeting lifetime substance use disorder (SUD) criteria for more drug classes. Elevated impulsivity was associated with heavier drug use, heavier weekly alcohol use, more lifetime SUDs, and higher self-reported depression levels. CONCLUSIONS: These findings contradict the idea that MDMA is specifically associated with deficient decision-making. Drug users, in general, may be at risk for decision-making deficits and elevated impulsivity. Such behaviors may represent trait factors that lead to the initiation of drug and alcohol use, and/or they may represent behavior patterns that are exacerbated by extensive use.     

Heroin and amphetamine users display opposite relationships between trait and neurobehavioral dimensions of impulsivity

The multidimensional construct of impulsivity is implicated in all phases of the addiction cycle. Substance dependent individuals (SDIs) demonstrate elevated impulsivity on both trait and laboratory tests of neurobehavioral impulsivity; however our understanding of the relationship between these different aspects of impulsivity in users of different classes of drugs remains rudimentary. The goal of this study was to assess for commonalities and differences in the relationships between trait and neurobehavioral impulsivity in heroin and amphetamine addicts. Participants included 58 amphetamine dependent (ADIs) and 74 heroin dependent individuals (HDIs) in protracted abstinence. We conducted Principal Component Analyses (PCA) on two self-report trait and six neurobehavioral measures of impulsivity, which resulted in two trait impulsivity (action, planning) and four neurobehavioral impulsivity composites (discriminability, response inhibition efficiency, decision-making efficiency, quality of decision-making). Multiple regression analyses were used to determine whether neurobehavioral impulsivity is predicted by trait impulsivity and drug type. The analyses revealed a significant interaction between drug type and trait action impulsivity on response inhibition efficiency, which showed opposite relationships for ADIs and HDIs. Specifically, increased trait action impulsivity was associated with worse response inhibition efficiency in ADIs, but with better efficiency in HDIs. These results challenge the unitary account of drug addiction and contribute to a growing body of literature that reveals important behavioral, cognitive, and neurobiological differences between users of different classes of drugs.     

Cocaine abuse versus cocaine dependence: Cocaine self-administration and pharmacodynamic response in the human laboratory

Cocaine has high abuse liability but only a subset of individuals who experiment with it develop dependence. The DSM-IV (APA. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-R. American Psychiatric Association, Washington, DC, 2000) provides criteria for diagnosing cocaine abuse and cocaine dependence as distinct disorders- the latter characterized by additional symptoms related to loss of control over drug use. In this study, two groups of cocaine users (n = 8/group), matched on demographic factors and length of cocaine use history and meeting criteria for either cocaine abuse (CocAb) or cocaine dependence (CocDep), were compared on (1) measures related to impulsivity and sensation seeking, (2) response to experimenter-administered cocaine (0, 12.5, 25 and 50 mg/70 kg, i.v.), and (3) cocaine self-administration using a Relapse Choice and a Progressive Ratio Procedure (0, 12.5 and 25 mg/70 kg, i.v.). Groups did not differ on impulsivity or sensation seeking scores. After experimenter-administered cocaine, the CocAb group reported feeling more suspicious and observers rated them significantly higher on unpleasant effects (e.g., irritability, difficulty concentrating). In contrast, the CocDep group reported significantly greater desire for cocaine, which was sustained over the course of the study, and gave higher street value estimates for cocaine (p < 0.05). While cocaine self-administration was dose-related and generally comparable across the two procedures, the CocDep users chose to take significantly more cocaine than the CocAb users. These data suggest that, while regular long-term users of cocaine with cocaine abuse or dependence diagnoses cannot be distinguished by trait measures related to impulsivity, they do exhibit significant differences with regard to cocaine-directed behavior and response to cocaine administration.     

Further Examination of the Association Between Heavy Marijuana Use and Crime Among Youths Entering a Juvenile Detention Center

ABSTRACT

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms of hyperactivity, inattention, and impulsivity. As shown in the literature, this disorder is frequently associated with alcohol and drug abuse. Patients affected by ADHD show high levels of impulsivity and sensation seeking. These characteristics can significantly increase the risk of alcohol abuse, which is itself a clinical condition associated with high levels of impulsivity. Clinical studies suggest that atomoxetine is effective and safe in patients affected by both ADHD and alcohol dependence; however, information focused specifically on impulsivity is very limited. In an open-label study, we evaluated the difference in impulsivity level between alcohol-dependent patients with and without a diagnosis of ADHD. Furthermore, we hypothesized that, in patients with ADHD, atomoxetine could reduce the impulsivity trait.     

Expectancies and self-efficacy mediate the effects of impulsivity on marijuana use outcomes: an application of the acquired preparedness model

This study tests the acquired preparedness model (APM) to explain associations among trait impulsivity, social learning principles, and marijuana use outcomes in a community sample of female marijuana users. The APM states that individuals with high-risk dispositions are more likely to acquire certain types of learning that, in turn, instigate problematic substance use behaviors. In this study, three domains of psychosocial learning were tested: positive and negative marijuana use expectancies, and marijuana refusal self-efficacy. Participants were 332 community-recruited women aged 18-24 enrolled in a study of motivational interviewing for marijuana use reduction. The present analysis is based on participant self-reports of their impulsivity, marijuana use expectancies, marijuana refusal self-efficacy, marijuana use frequency, marijuana use-related problems, and marijuana dependence. In this sample, impulsivity was significantly associated with marijuana use frequency, marijuana-related problems, and marijuana dependence. Results also indicate that the effect of impulsivity on all three marijuana outcomes was fully mediated by the three principles of psychosocial learning tested in the model, namely, positive and negative marijuana expectancies, and marijuana refusal self-efficacy. These findings lend support to the APM as it relates to marijuana use. In particular, they extend the applicability of the theory to include marijuana refusal self-efficacy, suggesting that, among high-impulsives, those who lack appropriate strategies to resist the temptation to use marijuana are more likely to exhibit more frequent marijuana use and use-related negative consequences.     

Inhalant use among incarcerated adolescents in the United States: prevalence, characteristics, and correlates of use

OBJECTIVE: To characterize patterns and correlates of inhalant use among incarcerated youth. METHOD: Residents (N=723) of 27 Missouri Division of Youth Services facilities completed interviews assessing substance use, psychiatric symptoms, antisocial traits, trauma, suicidality, and criminality. RESULTS: Participants averaged 15.5 (S.D.=1.2) years of age, were ethnically diverse, and predominantly male. More than one-third (36.9%) reported lifetime inhalant use; 47.9% of users had tried four or more inhalant products. Comparatively high rates of use were observed for Hispanic and small town/rural youth. Commonly abused agents included gasoline (22%), permanent markers (15%), computer "air duster," (15%) and spray paint (12%). Inhalant users evidenced significantly higher levels of criminal behavior, antisocial attitudes, current psychiatric symptoms, earlier onset of offending and substance use, and more extensive histories of head injury, kidney disease, hormonal problems, mental illness, suicidality, trauma, and substance-related problems than nonusers. In multiple logistic regression models, race/ethnicity, geographic area of residence, fearlessness, suicidality, and polydrug use distinguished inhalant users and nonusers. Measures of cognitive impairment, impulsivity, fearlessness, blame externalization, polydrug use, and substance-related problems were positively associated with lifetime frequency of inhalant use. CONCLUSIONS: Inhalant use was widespread in this sample and associated with serious physical and mental health impairments.     

Risk factors in the relationship between gender and crack/cocaine

Female inner-city substance users evidence greater crack/cocaine use and are more likely to be dependent on this drug than on any other drug. Additionally, female inner-city substance users evidence greater crack/cocaine use and are more likely to be dependent on this drug than their male counterparts, despite no consistent difference demonstrated in use and dependence across other drugs. Because no published work has empirically examined the factors underlying this link between females and crack/cocaine, the current study examined the role of theoretically relevant personality and environmental variables. Among 152 (37% female) individuals in a residential substance-use treatment program, females evidenced greater use of crack/cocaine (current and lifetime heaviest) and were significantly more likely to evidence crack/cocaine dependence than their male counterparts. In contrast, no gender differences were found for any other substance across alcohol, cannabis, and hallucinogens (including PCP). Surprisingly, females were more impulsive than their male counterparts, with impulsivity serving as a risk factor in the relationship between gender and crack/cocaine dependence and lifetime heaviest use. Females also evidenced higher levels of negative emotionality and childhood abuse, but neither variable served as a risk factor in the relationship between gender and crack/cocaine dependence or use. Limitations and future directions are discussed, including the need for further exploration of impulsivity across its various dimensions as well as the inclusion of additional variables such as social context variables to account more fully for this complex link between gender and crack/cocaine.     

The relationship between cannabis use and other substance use in the general population.

This study examined if (1) there is an association in the general population between cannabis use, DSM-IV abuse and dependence, and other substance use and DSM-IV substance abuse/dependence; (2) if so, is it explained by demographic characteristics or levels of neuroticism? It used data from the Australian National Survey of Mental Health and Well-Being (NSMHWB), a stratified, multistage probability sample of 10 641 adults, representative of the general population. DSM-IV diagnoses of substance abuse and dependence were derived using the Composite International Diagnostic Interview (CIDI). There was a strong bivariate association between involvement with cannabis use in the past 12 months and other substance use, abuse and dependence. In particular, cannabis abuse and dependence were highly associated with increased risks of other substance dependence. These associations remained after including other variables in multiple regression. Cannabis use without disorder was strongly related to other drug use, an association that was not explained by other variables considered here. The high likelihood of other substance use and substance use disorders needs to be considered among persons seeking treatment for cannabis use problems.     

Measures of Substance Consumption Among Substance Users, DSM-IV Abusers, and Those With DSM-IV Dependence Disorders in a Nationally Representative Sample

ABSTRACT. Objective: Neither the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R), nor the DSM-IV uses measures of substance consumption as part of the diagnostic criteria for substance use disorders. Therefore, this report examined the extent to which frequency and/or quantity of consumption across a broad spectrum of substances are associated with DSM-IV diagnoses of specific substance use disorders and whether there are informative hierarchical levels of consumption among users, abusers, and those who are substance dependent in the U.S. general population. Method: The analyses focused on consumption data from respondents of the 2001-2002 National Epidemiologic Survey of Alcohol and Related Disorders. Multinomial logistic regression was used to predict DSM-IV diagnoses of dependence or abuse based on the continuous consumption measures. Results: Among individuals who used substances, the substances with the greatest liability for dependence were nicotine first and cocaine second. For nearly all substances investigated, users without specific substance use disorders demonstrated lower levels of quantity and frequency of consumption relative to those with DSM-IV abuse and dependence disorders. Dose-response curves for the log odds of abuse and dependence suggested unidimensionality of abuse and dependence for frequency of alcohol drinking; frequency of cannabis use; frequency of opioid use; frequency of hallucinogen use; and, to a lesser extent, frequency of amphetamine use. However, the dose-response curves for the quantity of alcohol consumed demonstrated differential patterns for abuse and dependence such that alcohol dependence has a distinctly greater "quantity of use" relationship than that found among alcohol-abusing individuals. Conclusions: These results confirm the findings of others concerning the unidimensionality of abuse and dependence diagnoses when consumption variables alone are examined and suggest that consumption measures may be useful metrics gauging severity. (J. Stud. Alcohol Drugs, 73, 820-828, 2012).     

Personality, drug of choice, and comorbid psychopathology among substance abusers

The current study investigated the association between substance abuse/dependence, drug of choice, and the personality traits of negative emotionality, positive emotionality, and constraint (disinhibition) as measured by the Multidimensional Personality Questionnaire. The sample comprises 325 subjects from the Yale Family Study, a family study investigating the relation between substance-use disorders and anxiety disorders and their transmission in families. A total of 205 (63%) met criteria for lifetime substance abuse/dependence, with the remainder comprising the comparison group. The substance abusers were placed into one of four predominant drug of abuse/dependence categories (opioid, cocaine or stimulants, marijuana or sedatives, or alcohol) based upon best-estimate diagnoses and one of five self-reported drug of preference groups (polysubstance, opioid, cocaine or stimulants, marijuana or sedatives, and alcohol). First, findings demonstrate that individuals with substance abuse/dependence, compared to those without, scored lower on constraint even after adjusting for socio-demographic factors, comorbid psychiatric disorder, and current/remitted substance-use disorder. Individuals with substance abuse/dependence scored marginally higher on negative emotionality, but this difference was statistically significant only when comorbid psychopathology was not controlled. Second, findings show that individuals who differ with respect to drug of choice-whether defined in terms of the predominant drug of abuse/dependence or self-reported drug of preference-vary in terms of constraint. After controlling for socio-demographic indicators and comorbid psychopathology, scores on constraint generally decreased with the social deviance of the drug of choice, thereby underscoring a potentially important link between disinhibition and drug selection.     

Methamphetamine and alcohol abuse and dependence symptoms: associations with affect lability and impulsivity in a rural treatment population

The present study examined associations between impulsivity and affect lability and methamphetamine and alcohol abuse and dependence symptoms in a rural inpatient treatment population (N=235). Thirty-two percent of participants reported methamphetamine use in the past 90 days prior to admission. Amphetamine use disorders were found to be more common among younger participants whereas alcohol use disorders were more common among older and Native American participants. After controlling for age, gender, use frequency, and injection use, impulsivity but not affect lability was associated with methamphetamine abuse but not dependence symptoms. Lability but not impulsivity was associated with alcohol dependence but not abuse symptoms after controlling for age, gender, and use frequency. Consistent with past epidemiological studies, results indicate that methamphetamine use is a prominent problem facing rural substance use treatment facilities. Affect lability and impulsivity are associated with methamphetamine and alcohol-related problems in this population.     

Criminality and Sexual Behaviours in Substance Dependents Seeking Treatment

The aim of this study was to investigate the link between violence, crime, and sexual behavior among patients with substance-related disorder admitted to a specialized inpatient care unit. This was a cross-sectional study using a questionnaire on socio-demographic characteristics, drug of choice (DOC), questions about sexual behavior, and instruments to evaluate the severity of dependence (SADD, DAST, FTND), level of impulsivity (BIS-11), and a screening sex addiction scale. The sample consisted of 587 adult subjects, of which 82.3% were men, 66.4% had used cocaine (sniffed and smoked) as their DOC, 24.4% had a history with the criminal justice system, 26.8% had committed crimes, 19.3% had engaged in violent behavior, and 12.2% had been involved in drug trafficking. In this sample, crime was strongly associated with various sexual behaviors and the severity of substance dependence.