[Show abstract][Hide abstract] ABSTRACT: Adults who abuse substances are at increased risk for contracting sexually transmitted infections, including HIV. Within this population, sexual risk behaviors have been associated with increased impulsivity. Studies in non-clinical populations showing gender-related differences in sexual decision-making and casual sexual partnering suggest impulsivity has a greater influence on men than women, but these differences have not been documented in substance-using patients. In a sample of 89 adults with recent cocaine use and receiving outpatient psychiatric treatment, we tested the hypothesis that gender moderates the effect of impulsivity on sexual risk-taking. Using logistic regression modeling, we tested the main and gender-moderated effects of task-related impulsivity on the probability of having a casual sexual partner and multiple sexual partners. Results confirmed a significant gender-by-impulsivity interaction; men who were more impulsive on a continuous performance task had significantly higher rates of sexual risk-taking than less impulsive men, but women’s impulsivity was unrelated to these outcomes. Impulsive men were over three times as likely as less impulsive men to have a recent casual partner. Implications of these results and suggestions for future research are discussed.
Personality and Individual Differences 03/2015; 75:190-194. · 1.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Lower FC in ECNs in IGD than in HC•Positive trends between FC in ECNs and brain activations in Stroop task•The FC in ECNs may represent an important feature in IGD.
Progress in Neuro-Psychopharmacology and Biological Psychiatry 03/2015; 57. · 3.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Impulsivity is associated with various psychopathologies, and elevated impulsivity is typically disadvantageous. This manuscript reviews recent investigations into the neurobiology of impulsivity using human imaging techniques and animal models. Both human imaging and preclinical pharmacological manipulations have yielded important insights into the neurobiological underpinnings of impulsivity. A more thorough understanding of the complex neurobiology underlying aspects of impulsivity may provide insight into new treatment options that target elevated impulsivity and psychopathologies such as addictions.
[Show abstract][Hide abstract] ABSTRACT: Cognitive contributions to the behaviors observed in substance and non-substance addictions have been investigated and characterized. Based on models of drug addictions and the extant literature on Internet gaming disorder (IGD), we propose a cognitive-behavioral model for conceptualizing IGD. The model focuses on three domains and their roles in addictive behaviors. The three domains include motivational drives related to reward-seeking and stress-reduction, behavioral control relating to executive inhibition, and decision-making that involves weighing the pros and cons of engaging in motivated behaviors. Based on this model, we propose how behavioral therapies might target these domains in the treatment of IGD.
Journal of Psychiatric Research 11/2014; · 4.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To identify subtypes of adolescent gamblers based on the 10 Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria for pathological gambling and the 9 Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria for gambling disorder and to examine associations between identified subtypes with gambling, other risk behaviors, and health/functioning characteristics.
Journal of Addiction Medicine 10/2014; · 1.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Although tobacco-smoking is associated with relatively leaner body mass and smoking cessation with weight gain, the brain mechanisms underlying these relationships are not well understood. Smokers compared to non-smokers have shown diminished neural responses to non-tobacco rewarding stimuli (e.g., monetary rewards), but brain responses to favorite-food cues have not been investigated relative to smoking status. We hypothesized that smokers would exhibit diminished neural responses compared to non-smokers in response to favorite-food cues in motivation-reward and emotion-regulating regions of the brain
Twenty-three smokers and 23 non-smokers matched based on body mass index (BMI), age, and gender listened to personalized favorite-food-cue, stress, and neutral-relaxing audiotapes during fMRI.
During favorite-food-cue exposure, smokers versus non-smokers exhibited diminished activations in the caudate, putamen, insula, and thalamus. Neural responses during stress and neutral-relaxing conditions were similar across groups. Subjective food-craving ratings were similar across groups
The relatively diminished neural responses to favorite-food cues in smokers may contribute to lower BMI.
[Show abstract][Hide abstract] ABSTRACT: Advances in brain imaging techniques have allowed neurobiological research to temporally analyze signals coding for the anticipation of rewards. In addicted populations, both hypo- and hyper-responsiveness of brain regions (e.g., ventral striatum) implicated in drug effects and reward system processing have been reported during anticipation of generalized reward. Here, we discuss the current state of knowledge of reward processing in addictive disorders from a widely used and validated task: the Monetary Incentive Delay Task (MIDT). The current paper constrains review to those studies applying the MIDT in addicted and at-risk adult populations, with a focus on anticipatory processing and striatal regions activated during task performance, as well as the relationship of these regions with individual difference (e.g., impulsivity) and treatment outcome variables. We further review drug influences in challenge studies as a means to examine acute influences on reward processing in abstinent, recreationally using and addicted populations. Here, we discuss that generalized reward processing in addicted and at-risk populations is often characterized by divergent anticipatory signaling in the ventral striatum. Although methodological/task variations may underlie some discrepant findings, anticipatory signaling in the ventral striatum may also be influenced by smoking status, drug metabolites and treatment status in addicted populations. Divergent results across abstinent, recreationally using and addicted populations demonstrate complexities in interpreting findings. Future studies will benefit from focusing on characterizing how impulsivity and other addiction-related features relate to anticipatory striatal signaling over time. Additionally, identifying how anticipatory signals recover/adjust following protracted abstinence will be important in understanding recovery processes.
[Show abstract][Hide abstract] ABSTRACT: ABSTRACT Background: To determine the relationship between the frequency of current marijuana and alcohol use and cigarette-quit attempts in male and female adolescent smokers. Methods: Data from a cross-sectional survey of health behaviors in high-school-age adolescents were analyzed. Current cigarette smokers (n = 804) who reported use of at least 1 cigarette in the past month were divided into those with and without a history of at least 1 quit attempt (a self-reported episode of trying to "stop smoking"). Logistic regression models were fit to describe the association between the frequency of marijuana/alcohol use and a history of cigarette-quit attempts. Results: Among the total sample, higher frequency marijuana use (more than six times in the past 30 days) and frequent binge drinking (more than 5 days of binge drinking in the past 30 days) decreased the odds of having a past cigarette-quit attempt (higher frequency marijuana adjusted odds ratio (AOR) = 0.56; 95% confidence interval (CI) = 0.36-0.86) (frequent binge drinking AOR = 0.49; 95%CI = 0.29-0.83). A significant gender interaction was observed for the relationship between higher frequency marijuana use and a history of cigarette-quit attempts (p = 0.03), with decreased odds in boys (AOR = 0.41; 95% CI = 0.22-0.77) but not in girls (AOR = 0.71; 95% CI = 0.37-1.33). Conclusions: Adolescent smokers who report higher frequency marijuana use or frequent binge drinking have a decreased likelihood of a history of a cigarette-quit attempt. The gender-related association between higher frequency marijuana use and a history of quit attempts suggests that boys with greater substance use may need particularly intensive support to initiate quit attempts.
Substance abuse : official publication of the Association for Medical Education and Research in Substance Abuse. 08/2014;
[Show abstract][Hide abstract] ABSTRACT: ABSTRACT Background: To examine in adolescents how alcohol-drinking frequency relates to gambling-related attitudes and behaviors and their perceptions of both problem-gambling prevention strategies and adult (including parental) behaviors/attitudes. Methods: A survey assessing alcohol, gambling and health and functioning measures in 1609 high-school students. Students were stratified into low-frequency/non-drinking and high-frequency drinking groups, and into low-risk and at-risk/problematic gambling groups. Results: High-frequency drinking was associated with at-risk/problematic gambling (χ2(1, N = 1842) = 49.22, p<.0001). High-frequency-drinking versus low-frequency/non-drinking adolescents exhibited more permissive attitudes towards gambling (e.g., less likely to report multiple problem-gambling prevention efforts to be important). At-risk problematic gamblers exhibited more severe drinking patterns and greater likelihood of acknowledging parental approval of drinking (χ2(1, N = 1842) = 31.58, p<.0001). Problem-gambling severity was more strongly related to gambling with adults among high-frequency-drinking adolescents (odds ratio [OR] = 3.17, 95% confidence interval [95%CI] = [1.97, 5.09]) versus low-frequency/non-drinking (OR = 1.86, 95%CI = [0.61, 2.68]) adolescents (Interaction OR = 1.78, 95%CI = [1.05, 3.02]). Conclusions: Inter-relationships between problematic drinking and gambling in youth may relate to more permissive attitudes across these domains. Stronger links between at-risk/problem gambling and gambling with adults in the high-frequency-drinking group raises the possibility that interventions targeting adults may help mitigate youth gambling and drinking.
[Show abstract][Hide abstract] ABSTRACT: Elevated levels of both pathological gambling (PG) and problem shopping (PS) have been reported among adolescents, and each is associated with a range of other negative health/functioning measures. However, relationships between PS and PG, particularly during adolescence, are not well understood. In this study, we explored the relationship between different levels of problem-gambling severity and health/functioning characteristics, gambling-related social experiences, gambling behaviors and motivations among adolescents with and without at-risk/problematic shopping (ARPS). Survey data from Connecticut high school students (n = 2,100) were analyzed using bivariate analyses and logistic regression modeling. Although at-risk/problematic gambling (ARPG) was not increased among adolescents with ARPS, adolescents with ARPG (vs non-gamblers) were more likely to report having experienced a growing tension or anxiety that could only be relieved by shopping and missing other obligations due to shopping. In comparison to the non-ARPS group, a smaller proportion of respondents in the ARPS group reported paid part-time employment, whereas a greater proportion of respondents reported excessive gambling by peers and feeling concerned over the gambling of a close family member. In general, similar associations between problem-gambling severity and measures of health/functioning and gambling-related behaviors and motivations were observed across ARPS and non-ARPS adolescents. However, associations were weaker among ARPS adolescents for several variables: engagement in extracurricular activities, alcohol and caffeine use and gambling for financial reasons. These findings suggest a complex relationship between problem-gambling severity and ARPS. They highlight the importance of considering co-occurring risk behaviors such as ARPS when treating adolescents with at-risk/problem gambling.
Journal of Gambling Studies 08/2014; · 1.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Functional imaging is offering powerful new tools to investigate the neurobiology of cognitive functioning in people with and without psychiatric conditions like gambling disorder. Based on similarities between gambling and substance-use disorders in neurocognitive and other domains, gambling disorder has recently been classified in the Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5) as a behavioral addiction. Despite the advances in understanding, there exist multiple unanswered questions about the pathophysiology underlying gambling disorder and the promise for translating the neurobiological understanding into treatment advances remains largely unrealized. Here we review the neurocognitive underpinnings of gambling disorder with a view to improving prevention, treatment, and policy efforts.
Trends in Cognitive Sciences 06/2014; · 16.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: IMPORTANCE Substance use disorders (SUDs) are among the most common sequelae of childhood maltreatment, yet the independent contributions of SUDs and childhood maltreatment to neurobiological changes and the effect of the latter on relapse risk (a critical variable in addiction treatment) are relatively unknown. OBJECTIVES To identify structural neural characteristics independently associated with childhood maltreatment (CM; a common type of childhood adversity), comparing a sample with SUD with a demographically comparable control sample, and to examine the relationship between CM-related structural brain changes and subsequent relapse. DESIGN, SETTING, AND PARTICIPANTS Structural magnetic resonance imaging study comparing 79 treatment-engaged participants with SUD in acute remission in inpatient treatment at a community mental health center vs 98 healthy control participants at an outpatient research center at an academic medical center. Both groups included individuals with a range of CM experiences. Participants with SUD were followed up prospectively for 90 days to assess relapse and relapse severity. INTERVENTION Standard 12-step, recovery-based, inpatient addiction treatment for all participants with SUD. MAIN OUTCOMES AND MEASURES Gray matter volume (GMV), subsequent substance use relapse, days to relapse, and severity of relapse. RESULTS Controlling for SUD and psychiatric comorbidity, CM (dichotomously classified) was uniquely associated with lower GMV across all participants in the left hippocampus (cornu ammonis 1-3, dentate gyrus), parahippocampus (presubiculum, parasubiculum, prosubiculum, subiculum, and entorhinal cortex), and anterior fusiform gyrus (corrected P < .05; uncorrected P = .001). Among the sample with SUD, CM prospectively predicted a shorter relapse to use of any drug (P = .048), while CM-related GMV reductions predicted severity of substance use relapse (P = .04). CONCLUSIONS AND RELEVANCE Findings indicate that CM was related to decreased GMV in limbic regions, which in turn predicted increased risk of relapse in SUD. These results suggest that CM may significantly affect the course of SUD treatment outcomes and that SUD treatment planning may benefit from identifying and addressing CM.
[Show abstract][Hide abstract] ABSTRACT: Preclinical research has demonstrated effects of prenatal cocaine exposure (PCE) on brain regions involved in emotional regulation, motivational control and addiction vulnerability - e.g., the ventral striatum (VS), anterior cingulate (ACC) and prefrontal cortex (PFC). However, little is known about the function of these regions in human adolescents with PCE. Twenty-two adolescents with PCE and 22 age-, gender-, and IQ-matched non-cocaine exposed (NCE) adolescents underwent functional magnetic resonance imaging (fMRI) during exposure to individually personalized neutral/relaxing, stressful and favorite-food cues. fMRI data were compared using group-level two-tailed t-tests in BioImage Suite. In comparison to NCE adolescents, PCE adolescents had reduced activity within cortical and subcortical brain regions including the VS, ACC and medial and dorslolateral PFC during exposure to favorite-food cues, but did not differ in neural responses to stress cues. Subjective food craving was inversely related to dorsolateral PFC activation among PCE adolescents. Among PCE adolescents, subjective anxiety ratings correlated inversely with activations in the orbitofrontal cortex and brainstem during the stress condition, and with ACC, dorsolateral PFC and hippocampus activity during the neutral-relaxing condition. Thus, adolescents with PCE display hypoactivation of brain regions involved in appetitive processing, with subjective intensities of craving and anxiety correlating inversely with extent of activation. These findings suggest possible mechanisms by which PCE might predispose to the development of addictions and related disorders; e.g., substance-use disorders, binge-eating.Neuropsychopharmacology accepted article preview online, 6 June 2014; doi:10.1038/npp.2014.133.
Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 06/2014; · 8.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Perceived parental permissiveness toward gambling may relate to adolescents' engagement in various risky behaviors. To examine this possibility, we analyzed data from a high-school based risk-behavior survey to assess relationships between perceived parental permissiveness toward gambling and adolescent gambling behavior, substance use and related problems. We also evaluated predictions that relationships between perceived parental permissiveness toward gambling and risky behaviors would be particularly strong amongst adolescents reporting high sensation-seeking or impulsivity.
Journal of Behavioural Addictions 06/2014; 3(2):115-23.
[Show abstract][Hide abstract] ABSTRACT: Preclinical and clinical research implicate several neurotransmitter systems in the pathophysiology of gambling disorder (GD). In particular, neurobiological research suggests alterations in serotonergic, dopaminergic, glutamatergic and opioidergic functioning. The relative efficacy of medications targeting these systems remains a topic of ongoing research, and there is currently no Food and Drug Administration (FDA) approved medication with an indication for GD. Considering co-occurring disorders may be particularly important when devising a treatment plan for GD: extant data suggest that the opioid antagonist naltrexone may by the most effective form of current pharmacotherapy for GD, particularly for individuals with a co-occurring substance-use disorder (SUD) or with a family history of alcoholism. In contrast, lithium or other mood stabilizers may be most effective for GD for patients presenting with a co-occurring bipolar spectrum disorder (BSD). Further, serotonin reuptake inhibitors (SRIs) may be efficacious in reducing GD symptoms for individuals also presenting with a (non-BSD) mood or anxiety disorder. Finally, elevated rates of GD (and other impulse control disorders; ICDs) have been noted among individuals with Parkinson’s disease (PD), and clinicians should assess for vulnerability to GD when considering treatment options for PD. Reducing levodopa or dopamine agonist (DA) dosages may partially reduce GD symptoms among patients with co-occurring PD. For GD patients not willing to consider drug treatment, n-acetyl cysteine or behavioral therapies may be effective. Ongoing research into the effectiveness of combined behavioral and pharmacotherapies is being conducted; thus combined treatments should also be considered.
Current Treatment Options in Psychiatry. 06/2014; 1(2).
[Show abstract][Hide abstract] ABSTRACT: Gambling is common in adolescents and at-risk and problem/pathological gambling (ARPG) is associated with adverse measures of health and functioning in this population. Although ARPG commonly co-occurs with marijuana use, little is known how marijuana use influences the relationship between problem-gambling severity and health- and gambling-related measures.
Journal of Behavioural Addictions 06/2014; 3(2):90-101.
[Show abstract][Hide abstract] ABSTRACT: Attentional bias to threat is a key endophenotype that contributes to the chronicity of trauma-related psychopathology. However, little is known about the neurobiology of this endophenotype and no known in vivo molecular imaging study has been conducted to evaluate candidate receptor systems that may be implicated in this endophenotype or the phenotypic expression of trauma-related psychopathology, which is comprised of threat (i.e., re-experiencing, avoidance, and hyperarousal) and loss (i.e., emotional numbing, depression/dysphoria, generalized anxiety) symptomatology. Using the radioligand [(11)C]OMAR and positron emission tomography (PET), we evaluated the relationship between in vivo cannabinoid receptor type 1 (CB1) receptor availability in the amygdala, and performance on a dot-probe measure of attentional bias to threat, and clinician interview-based measures of trauma-related psychopathology. The sample was comprised of adults presenting with a broad spectrum of trauma-related psychopathology, ranging from non-trauma-exposed, psychiatrically healthy adults to trauma-exposed adults with severe trauma-related psychopathology. Results revealed that increased CB1 receptor availability in the amygdala was associated with increased attentional bias to threat, as well as increased severity of threat, but not loss, symptomatology; greater peripheral anandamide levels were associated with decreased attentional bias to threat. A mediation analysis further suggested that attentional bias to threat mediated the relationship between CB1 receptor availability in the amygdala and severity of threat symptomatology. These data substantiate a key role for compromised endocannabinoid function in mediating both the endophenotypic and phenotypic expression of threat symptomatology in humans. They further suggest that novel pharmacotherapies that target the CB1 system may provide a more focused, mechanism-based approach to mitigating this core aspect of trauma-related psychopathology.Neuropsychopharmacology accepted article preview online, 13 May 2014; doi:10.1038/npp.2014.110.
Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 05/2014; · 8.68 Impact Factor