ArticleLiterature Review

Pleasure as an Overlooked Target of Substance Use Disorder Research and Treatment

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Abstract

Background: People commonly use psychoactive substances to increase physical and psychological pleasure. Neuroadaptations in the brain's reward system coupled with changes in social functioning and networking resulting from chronic substance use impede the ability to derive pleasure from non-substance related activities. Objective: We elucidate and validate the hypothesis that treatments for substance use disorders would potentially have a stronger and broader impact by helping recipients to experience pleasure as part of an expansive focus of increasing adaptive functioning, well-being, and personal fulfillment and actualization. Method: We have organized and integrated the relatively sparse and disparate theory and research to describe a multi-stage model linking pleasure and substance use. We review research on pleasure in the context of treatment for substance use, and describe future research directions. Results: Our model integrates several independent research programs with prominent theories and models of substance dependence that together provide evidence that pleasure, or lack thereof, is a risk or protective factor for initiating, escalating and maintaining substance use and substance use disorders. Pleasure is an overlooked but potentially high-yield target of existing evidence-based treatments. Conclusion: Research is needed to investigate the relation between pleasure and substance use, and existing and newly developed treatments that have the potential to increase the pleasure. By increasing pleasure such treatments have the potential to help recipients to live fuller and richer lives. Integration of pleasure into existing treatments has compelling transdiagnostic implications for individuals at any point along a substance use severity continuum.

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... Second, given that different drinking motives predicted different consequences (e.g., affiliation motives were associated with increased sociability), it might be helpful to explore how motives maintain alcohol use through positive consequences. Pleasure and reward are common targets in alcohol use treatment and people sometimes describe "honeymoon periods" of pleasure during early stages of use (Boden et al., 2016). Positive consequences strengthen expectations of positive outcomes in future drinking (e.g., Lee et al., 2018), and expectancies of positive social outcomes may mediate relationships between social anxiety and problematic drinking (e.g., Ham, 2009;Ham et al., 2016). ...
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People with social anxiety disorder (SAD) are at increased risk for alcohol-related problems. Most research exploring social anxiety and alcohol use has examined negative drinking consequences, with less consideration of positive consequences—namely positive social experiences—that may reinforce alcohol use. In this daily diary study, we examined how adults diagnosed with SAD (N = 26) and a psychologically healthy control group (N = 28) experienced positive drinking consequences in naturally occurring drinking episodes during the study period. For 14 consecutive days, participants answered questions about alcohol use, motives for drinking, and positive consequences of drinking. On days when participants drank, those with SAD were more likely than healthy controls to perceive a reduction in anxiety, but the two groups did not differ in their likelihood of experiencing positive social drinking consequences. For both groups, on days when they were more motivated to drink to enhance social experiences (affiliation motives) or cope with distress (coping motives), they were more likely to obtain positive consequences from drinking. Compared to controls, participants with SAD endorsed stronger trait and daily coping motives (anxiety-coping, social anxiety-coping, and depression-coping). Results are discussed in the context of reinforcement mechanisms that may maintain social anxiety and alcohol use.
... p < 0.05) were significantly associated with SLT use those with alcohol experience; aOR = 4.84; p = 0.007 for episodic binge drinkers) [21]. SLT and alcohol are both psychoactive substances containing nicotine and ethanol molecules, respectively [27], and their synergistic interactive effects potentiate physical and psychological pleasure [28]. Therefore, polyconsumption of both tobacco and alcohol was not surprising [29]. ...
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BACKGROUND: Sub-Saharan women use smokeless tobacco (SLT) more than smoked tobacco. Among Western African countries, the estimated weighted prevalence of SLT use in rural women was found to be the highest in Burkina Faso (after Sierra Leone). This study aimed to assess the prevalence of SLT use and its associated factors among rural women in Burkina Faso by using nationally representative data. METHODS: We used data from the 2013 STEPwise approach to Surveillance (STEPS) study, which provided sociodemographic, clinical (anthropometric, systolic blood pressure [SBP], diastolic blood pressure [DBP] and dental symptoms), biological (total and high-density lipoprotein cholesterol and fasting blood sugar), and tobacco and alcohol consumption data. Data for 1730 rural women were used, and we performed Student's chi-squared and logistic regression analyses. RESULTS: The prevalence of current SLT use was 13.8% (95% CI: 12.2-15.5). Significant risks for SLT use were the presence of dental symptoms (adjusted odds ratio [aOR] = 2.59; p < 0.001), undernourishment (aOR = 1.78; p < 0.01), decreased waist circumference (aOR = 0.98; p < 0.05), decreased DBP (aOR = 0.97; p < 0.01), increased SBP (aOR = 1.01; p < 0.05), and increased differential blood pressure (aOR = 1.01; p < 0.05). The co-use of alcohol was also a significant risk factor (aOR = 2.80; p < 0.001). CONCLUSION: The prevalence of current SLT use was high among rural women in Burkina Faso, and significant concerns for users included alcohol co-use, the occurrence of dental symptoms, undernourishment, and an increase in differential blood pressure. National Public Health interventions are needed to reduce SLT use and its health-related concerns.
... [26] and in Kenya (aOR = 2.58; p = 0.001 for those with alcohol experience; aOR = 4.84; p = 0.007 for episodic binge drinkers) [21]. SLT and alcohol are both psychoactive substances containing nicotine and ethanol molecules, respectively [27] and their synergistic interactive effects potentiate physical and psychological pleasure [28]. That explains why polyconsumption consisting in combining tobacco and alcohol was not surprising [29]. ...
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Background: Sub-Saharan women use smokeless tobacco (SLT) more than smoked tobacco. Among Western Africa countries, the estimated weighted prevalence of SLT use in rural women was the highest in Burkina Faso (after Sierra Leone). This study aimed to assess the prevalence of SLT use and its associated factors among rural women in Burkina Faso by using nationally representative data. Methods : We used data from the 2013 STEPwise approach to Surveillance (STEPS) study, which provided sociodemographic, clinical (anthropometric, systolic blood pressure [SBP], diastolic blood pressure [DBP], dental symptoms), biological (total and high-density lipoprotein cholesterol and fasting blood sugar), and tobacco and alcohol consumption data. Data for 1730 rural women were used, and we performed Student’s, chi-squared and logistic regression. Results : The prevalence of current SLT use was 13.8% (95% CI: 12.2-15.5). Significant risks for SLT use were the presence of dental symptoms (adjusted odds ratio [aOR] = 2.59; p<0.001), undernourishment (aOR = 1.78; p<0.01), a decrease in waist circumference (aOR = 0.98; p<0.05), a decrease in DBP (aOR = 0.97; p<0.01), increase in SBP (aOR = 1.01; p<0.05), and an increase in differential blood pressure (aOR = 1.01; p<0.05). The co-use of alcohol was also a significant risk factor (aOR = 2.80; p<0.001). Conclusion : The prevalence of current SLT use was high among rural women in Burkina Faso, and significant concerns for users included alcohol co-use, the occurrence of dental symptoms, undernourishment, and an increase in differential blood pressure. National Public Health interventions are needed to reduce SLT use and its health-related concerns. KEYWORDS: smokeless tobacco, alcohol co-use, dental symptoms, undernourishment, blood pressure, rural women, Burkina Faso
... [26] and in Kenya (aOR = 2.58; p = 0.001 for those with alcohol experience; aOR = 4.84; p = 0.007 for episodic binge drinkers) [21]. SLT and alcohol are both psychoactive substances containing nicotine and ethanol molecules, respectively [27] and their synergistic interactive effects potentiate physical and psychological pleasure [28]. That explains why polyconsumption consisting in combining tobacco and alcohol was not surprising [29]. ...
Preprint
Background: Sub-Saharan women use smokeless tobacco (SLT) more than smoked tobacco. Among Western Africa countries, the estimated weighted prevalence of SLT use in rural women was the highest in Burkina Faso (after Sierra Leone). This study aimed to assess the prevalence of SLT use and its associated factors among rural women in Burkina Faso by using nationally representative data. Methods : We used data from the 2013 STEPwise approach to Surveillance (STEPS) study, which provided sociodemographic, clinical (anthropometric, systolic blood pressure [SBP], diastolic blood pressure [DBP], dental symptoms), biological (total and high-density lipoprotein cholesterol and fasting blood sugar), and tobacco and alcohol consumption data. Data for 1730 rural women were used, and we performed Student’s, chi-squared and logistic regression. Results : The prevalence of current SLT use was 13.8% (95% CI: 12.2-15.5). Significant risks for SLT use were the presence of dental symptoms (adjusted odds ratio [aOR] = 2.59; p<0.001), undernourishment (aOR = 1.78; p<0.01), a decrease in waist circumference (aOR = 0.98; p<0.05), a decrease in DBP (aOR = 0.97; p<0.01), increase in SBP (aOR = 1.01; p<0.05), and an increase in differential blood pressure (aOR = 1.01; p<0.05). The co-use of alcohol was also a significant risk factor (aOR = 2.80; p<0.001). Conclusion : The prevalence of current SLT use was high among rural women in Burkina Faso, and significant concerns for users included alcohol co-use, the occurrence of dental symptoms, undernourishment, and an increase in differential blood pressure. National Public Health interventions are needed to reduce SLT use and its health-related concerns.
... [26] and in Kenya (aOR = 2.58; p = 0.001 for those with alcohol experience; aOR = 4.84; p = 0.007 for episodic binge drinkers) [21]. SLT and alcohol are both psychoactive substances containing nicotine and ethanol molecules, respectively [27] and their synergistic interactive effects potentiate physical and psychological pleasure [28]. That explains why polyconsumption consisting in combining tobacco and alcohol was not surprising [29]. ...
Preprint
Full-text available
Background: Sub-Saharan women use smokeless tobacco (SLT) more than smoked tobacco. Among Western Africa countries, the estimated weighted prevalence of SLT use in rural women was the highest in Burkina Faso (after Sierra Leone). This study aimed to assess the prevalence of SLT use and its associated factors among rural women in Burkina Faso by using nationally representative data. Methods : We used data from the 2013 STEPwise approach to Surveillance (STEPS) study, which provided sociodemographic, clinical (anthropometric, systolic blood pressure [SBP], diastolic blood pressure [DBP], dental symptoms), biological (total and high-density lipoprotein cholesterol and fasting blood sugar), and tobacco and alcohol consumption data. Data for 1730 rural women were used, and we performed Student’s, chi-squared and logistic regression. Results : The prevalence of current SLT use was 13.8% (95% CI: 12.2-15.5). Significant risks for SLT use were the presence of dental symptoms (adjusted odds ratio [aOR] = 2.59; p<0.001), undernourishment (aOR = 1.78; p<0.01), a decrease in waist circumference (aOR = 0.98; p<0.05), a decrease in DBP (aOR = 0.97; p<0.01), increase in SBP (aOR = 1.01; p<0.05), and an increase in differential blood pressure (aOR = 1.01; p<0.05). The co-use of alcohol was also a significant risk factor (aOR = 2.80; p<0.001). Conclusion : The prevalence of current SLT use was high among rural women in Burkina Faso, and significant concerns for users included alcohol co-use, the occurrence of dental symptoms, undernourishment, and an increase in differential blood pressure. National Public Health interventions are needed to reduce SLT use and its health-related concerns.
... Nonetheless, short-term benefits of alcohol consumption (e.g., improvement in social interaction quality) often occur at the expense of long-term problems and impairment (e.g., Lazareck et al., 2012;Robinson et al., 2011). To illustrate, a person may begin using alcohol primarily as means to experience pleasure and positive social experiences (e.g., Boden, Heinz, & Kashdan, 2017). When they drink in social settings, they experience a reduction in social anxiety and obtain social rewards (e.g., strengthening friendships, feeling more self-assured). ...
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The Journal of Positive Psychology: Dedicated to furthering research and promoting good practice Publication details, including instructions for authors and subscription information: (2012): Positive living: A pilot study of group positive psychotherapy for people with schizophrenia, The Journal of Positive Psychology: Dedicated to furthering research and promoting good practice, 7:3, 239-248page/terms-and-conditions This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.
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The focus of this review is on the associations of alcohol use and aspects of romantic relationships. The review covers concepts and methods, partner drinking associations, effects of relationships on drinking, and drinking effects on relationships. Several conclusions were reached. People are attracted to similarly drinking others. With greater relationship commitment there is greater desistance from drinking. Across time and relationship commitment levels, socialization influences vary by gender. A thread throughout the review was the identification of congruent and discrepant drinking among relationship partners. Congruent drinking, even at higher levels, was associated with more positive outcomes whereas discrepant drinking was associated with more negative outcomes. Needed for the future are greater theory development and longitudinal and laboratory studies that include diverse samples and both parties to the relationship.
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In an attempt to resolve controversy regarding the causal contributions of mesolimbic dopamine (DA) systems to reward, we evaluate the three main competing explanatory categories: "liking,"learning," and "wanting" [1]. That is, DA may mediate (a) the hedonic impact of reward (liking), (b) learned predictions about rewarding effects (learning), or (c) the pursuit of rewards by attributing incentive salience to reward-related stimuli (wanting). We evaluate these hypotheses, especially as they relate to the Reward Deficiency Syndrome (RDS), and we find that the incentive salience or "wanting" hypothesis of DA function is supported by a majority of the evidence. Neuroimaging studies have shown that drugs of abuse, palatable foods, and anticipated behaviors such as sex and gaming affect brain regions involving reward circuitry, and may not be unidirectional. Drugs of abuse enhance DA signaling and sensitize mesolimbic mechanisms that evolved to attribute incentive salience to rewards. Addictive drugs have in common that they are voluntarily selfadministered, they enhance (directly or indirectly) dopaminergic synaptic function in the nucleus accumbens (NAC), and they stimulate the functioning of brain reward circuitry (producing the "high" that drug users seek). Although originally believed simply to encode the set point of hedonic tone, these circuits now are believed to be functionally more complex, also encoding attention, reward expectancy, disconfirmation of reward expectancy, and incentive motivation. Elevated stress levels, together with polymorphisms of dopaminergic genes and other neurotransmitter genetic variants, may have a cumulative effect on vulnerability to addiction. The RDS model of etiology holds very well for a variety of chemical and behavioral addictions.
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Emotional processes influence a wide range of mental and physical systems, which makes them difficult to understand from a single perspective. In this special issue of the Review of General Psychology, contributing authors present 4 articles that draw from several areas within psychology in the service of understanding a topic relevant to emotion. In this overview, the authors argue that the long neglect of the scientific study of complex processes such as emotion might be linked, in part, to the fractionation of the field into specialized subdisciplines. Just as emotions were of central concern in the early years of psychology (which was a generalist's era), as psychology moves toward more integration in the late 20th century broad phenomena such as emotions are once again central interests. The 4 articles of this special issue are briefly reviewed as exemplars of an integrated approach to understanding emotional phenomena.
Article
Rewards are both “liked” and “wanted,” and those 2 words seem almost interchangeable. However, the brain circuitry that mediates the psychological process of “wanting” a particular reward is dissociable from circuitry that mediates the degree to which it is “liked.” Incentive salience or “wanting,” a form of motivation, is generated by large and robust neural systems that include mesolimbic dopamine. By comparison, “liking,” or the actual pleasurable impact of reward consumption, is mediated by smaller and fragile neural systems, and is not dependent on dopamine. The incentive-sensitization theory posits the essence of drug addiction to be excessive amplification specifically of psychological “wanting,” especially triggered by cues, without necessarily an amplification of “liking.” This is because of long-lasting changes in dopamine-related motivation systems of susceptible individuals, called “neural sensitization.” A quarter-century after its proposal, evidence has continued to grow in support the incentive-sensitization theory. Further, its scope is now expanding to include diverse behavioral addictions and other psychopathologies.
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This study examined how the structure of friendship networks influences two risk behaviours in tandem (drinking and sexual intercourse) among a sample of US adolescents (7th–12th grades, n = 901; 2 schools) from Wave I of the Add Health data. For one school, adolescents in denser and smaller networks were at higher risk for engaging in sexual intercourse and drinking alcohol simultaneously. In that school, network attributes (out-degree and betweenness) and adolescents’ age were associated with an increased risk. In the other school, more diffused friendship networks posed less risk of engaging in these two behaviours in tandem. Moreover, engagement in risky behaviours was significantly predicted by teens’ age and gender. We conclude that friendships’ influence on adolescents’ risk behaviours varies, depending on size and composition of the networks and adolescents’ characteristics. Moreover, understanding adolescents’ social ties can be useful for health promoters, thus research on adolescent networks remains warranted.
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Researchers and clinicians assume a strong, positive correlation between anxiety symptoms and functional impairment. That assumption may be well-justified since diagnostic criteria typically include functional impairment. Still, the relationship remains largely unavailable in any systematic review. Our aim with this paper was to provide empirical evidence for this assumed relationship and to document the observed correlations between anxiety symptom measures and functional impairment measures. Correlations existed for symptoms of six anxiety disorders (Panic Disorder, Agoraphobia, Social Anxiety Disorder, Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder) across four functional domains (global, social, occupational, and physical). Overall, the mean of 497 correlations across all disorders and functional domains was modest (r=.34); since the variability between disorders and functional domains tended to be rather large, we explored these correlations further. We presented these results and the potential explanations for unexpected findings along with the clinical and research implications.
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This paper presents a biopsychological theory of drug addiction, the 'Incentive-Sensitization Theory'. The theory addresses three fundamental questions. The first is: why do addicts crave drugs? That is, what is the psychological and neurobiological basis of drug craving? The second is: why does drug craving persist even after long periods of abstinence? The third is whether 'wanting' drugs (drug craving) is attributable to 'liking' drugs (to the subjective pleasurable effects of drugs)? The theory posits the following. (1) Addictive drugs share the ability to enhance mesotelencephalic dopamine neurotransmission. (2) One psychological function of this neural system is to attribute 'incentive salience' to the perception and mental representation of events associated with activation of the system. Incentive salience is a psychological process that transforms the perception of stimuli, imbuing them with salience, making them attractive, 'wanted', incentive stimuli. (3) In some individuals the repeated use of addictive drugs produces incremental neuroadaptations in this neural system, rendering it increasingly and perhaps permanently, hypersensitive ('sensitized') to drugs and drug-associated stimuli. The sensitization of dopamine systems is gated by associative learning, which causes excessive incentive salience to be attributed to the act of drug taking and to stimuli associated with drug taking. It is specifically the sensitization of incentive salience, therefore, that transforms ordinary 'wanting' into excessive drug craving. (4) It is further proposed that sensitization of the neural systems responsible for incentive salience ('for wanting') can occur independently of changes in neural systems that mediate the subjective pleasurable effects of drugs (drug 'liking') and of neural systems that mediate withdrawal. Thus, sensitization of incentive salience can produce addictive behavior (compulsive drug seeking and drug taking) even if the expectation of drug pleasure or the aversive properties of withdrawal are diminished and even in the face of strong disincentives, including the loss of reputation, job, home and family. We review evidence for this view of addiction and discuss its implications for understanding the psychology and neurobiology of addiction.
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A large international sample was used to test whether hedonia (the experience of positive emotional states and satisfaction of desires) and eudaimonia (the presence of meaning and development of one's potentials) represent 1 overarching well-being construct or 2 related dimensions. A latent correlation of .96 presents negligible evidence for the discriminant validity between Diener's (1984) subjective well-being model of hedonia and Ryff's (1989) psychological well-being model of eudaimonia. When compared with known correlates of well-being (e.g., curiosity, gratitude), eudaimonia and hedonia showed very similar relationships, save goal-directed will and ways (i.e., hope), a meaning orientation to happiness, and grit. Identical analyses in subsamples of 7 geographical world regions revealed similar results around the globe. A single overarching construct more accurately reflects hedonia and eudaimonia when measured as self-reported subjective and psychological well-being. Nevertheless, measures of eudaimonia may contain aspects of meaningful goal-directedness unique from hedonia. (PsycINFO Database Record
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Emotion regulation involves the pursuit of desired emotional states (i.e., emotion goals) in the service of superordinate motives. The nature and consequences of emotion regulation, therefore, are likely to depend on the motives it is intended to serve. Nonetheless, limited attention has been devoted to studying what motivates emotion regulation. By mapping the potential benefits of emotion to key human motives, this review identifies key classes of motives in emotion regulation. The proposed taxonomy distinguishes between hedonic motives that target the immediate phenomenology of emotions, and instrumental motives that target other potential benefits of emotions. Instrumental motives include behavioral, epistemic, social, and eudaimonic motives. The proposed taxonomy offers important implications for understanding the mechanism of emotion regulation, variation across individuals and contexts, and psychological function and dysfunction, and points to novel research directions. © 2015 by the Society for Personality and Social Psychology, Inc.
Article
This mixed methods pilot study examined the feasibility, acceptability, and impact of a web-based gratitude exercise (the ‘Three Good Things’ exercise (TGT)) among 23 adults in outpatient treatment for alcohol use disorder. Participants were randomized to TGT or a placebo condition. The intervention was feasible with high rates of completion. Participants found TGT acceptable and welcomed the structure of daily e-mails; however, they found it difficult at times and discontinued TGT when the study ended. Participants associated TGT with gratitude, although there were no observed changes in grateful disposition over time. TGT had a significant effect on decreasing negative affect and increasing unactivated (e.g. feeling calm, at ease) positive affect, although there were no differences between groups at the 8 week follow-up. Qualitative results converged on quantitative findings that TGT was convenient, feasible, and acceptable and additionally suggested that TGT was beneficial for engendering positive cognitions and reinforcing recovery.
Book
An ACT Approach Chapter 1. What is Acceptance and Commitment Therapy? Steven C. Hayes, Kirk D. Strosahl, Kara Bunting, Michael Twohig, and Kelly G. Wilson Chapter 2. An ACT Primer: Core Therapy Processes, Intervention Strategies, and Therapist Competencies. Kirk D. Strosahl, Steven C. Hayes, Kelly G. Wilson and Elizabeth V. Gifford Chapter 3. ACT Case Formulation. Steven C. Hayes, Kirk D. Strosahl, Jayson Luoma, Alethea A. Smith, and Kelly G. Wilson ACT with Behavior Problems Chapter 4. ACT with Affective Disorders. Robert D. Zettle Chapter 5. ACT with Anxiety Disorders. Susan M. Orsillo, Lizabeth Roemer, Jennifer Block-Lerner, Chad LeJeune, and James D. Herbert Chapter 6. ACT with Posttraumatic Stress Disorder. Alethea A. Smith and Victoria M. Follette Chapter 7. ACT for Substance Abuse and Dependence. Kelly G. Wilson and Michelle R. Byrd Chapter 8. ACT with the Seriously Mentally Ill. Patricia Bach Chapter 9. ACT with the Multi-Problem Patient. Kirk D. Strosahl ACT with Special Populations, Settings, and Methods Chapter 10. ACT with Children, Adolescents, and their Parents. Amy R. Murrell, Lisa W. Coyne, & Kelly G. Wilson Chapter 11. ACT for Stress. Frank Bond. Chapter 12. ACT in Medical Settings. Patricia Robinson, Jennifer Gregg, JoAnne Dahl, & Tobias Lundgren Chapter 13. ACT with Chronic Pain Patients. Patricia Robinson, Rikard K. Wicksell, Gunnar L. Olsson Chapter 14. ACT in Group Format. Robyn D. Walser and Jacqueline Pistorello
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The therapeutic impact of exercise interventions in psychiatric diseases such as depression, anxiety and schizophrenia has already been proven through several reviews whereas substance use disorders such as alcohol use disorders (AUD) have so far less frequently been a matter of investigation. Although several publications have summarized studies focusing on physical activities in substance use disorders, no systematic review exists summarizing the evidence of exercise interventions in AUD. A total of 14 studies using the Medline Database, CCMed, Cochrane Library and PsychINFO were identified and met the inclusion criteria. In order to evaluate the evidence, we used the evaluation system of the Oxford Centre for Evidence-Based Medicine (2011). Due to methodological flaws the overall evidence of the studies is rated level "3" but primarily findings confirm that exercise interventions as a complementary treatment component in AUD are feasible and safe. No adverse events were reported. This systematic review indicates that exercise may have beneficial effects on certain domains of physical functioning including VO2max, basal heart rate, physical activity level and strength. Inconsistent effects with a slight trend towards a positive effect on anxiety, mood management, craving, and drinking behavior have been shown and need to be verified. Results must be interpreted cautiously due to the numerous methodological flaws and the heterogeneity of the interventions and measures. However, according to preclinical studies several mechanisms of action are conceivable, especially as to alcohol-related outcomes and additionally seem to be promising. RCTs with high methodological quality are urgently needed in future research to establish evidence-based exercise recommendations for the treatment of AUD. Copyright © 2014 Elsevier Inc. All rights reserved.
Article
Animal research suggests that anhedonia is a tobacco withdrawal symptom, but this topic has not been addressed definitively in research with humans. This research sought to determine whether anhedonia is (a) an element of the tobacco withdrawal syndrome in humans and (b) an impediment to successful tobacco cessation. Data were from 1,175 smokers (58.3% women; 85.5% White) participating in a randomized double-blind, placebo-controlled trial of smoking cessation pharmacotherapies. Ecological momentary assessments for 5 days before and 10 days after the target quit day were used to assess anhedonia and other established withdrawal symptoms. Consistent with drug withdrawal, anhedonia showed an inverted-U pattern of change in response to tobacco cessation and was associated with the severity of other withdrawal symptoms and tobacco dependence. Postquit anhedonia was associated with decreased latency to relapse (hazard ratio = 1.09, 95% confidence interval [CI] [1.02, 1.17]) and with lower 8-week point-prevalence abstinence (odds ratio = .91, 95% CI [.86, .97])-relations that remained significant when other withdrawal symptoms were included as predictors. Finally, nicotine replacement therapy nearly fully suppressed the increase in abstinence-related anhedonia (β = -.66, p < .001), suggesting agonist suppression of withdrawal. Results suggest that anhedonia is a unique and motivationally significant element of the tobacco withdrawal syndrome in humans. These results have implications for defining and assessing tobacco use disorder and for understanding and treating tobacco addiction. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Article
Interventions targeting physical activity may be valuable as an adjunct to alcohol treatment, but have been relative untested. In the current study, alcohol dependent, physically sedentary patients were randomized to: a 12-week moderate-intensity, group aerobic exercise intervention (AE; n = 25) or a brief advice to exercise intervention (BA-E; n = 23). Results showed that individuals in AE reported significantly fewer drinking and heavy drinking days, relative to BA-E during treatment. Furthermore adherence to AE strengthened the beneficial effect of intervention on alcohol use outcomes. While high levels of moderate-intensity exercise appeared to facilitate alcohol recovery regardless of intervention arm, attending the group-based AE intervention seemed to further enhance the positive effects of exercise on alcohol use. Study findings indicate that a moderate intensity, group aerobic exercise intervention is an efficacious adjunct to alcohol treatment. Improving adherence to the intervention may enhance its beneficial effects on alcohol use.
Article
This study addresses not only influence and selection of friends as sources of similarity in alcohol use, but also peer processes leading drinkers to be chosen as friends more often than non-drinkers, which increases the number of adolescents subject to their influence. Analyses apply a stochastic actor-based model to friendship networks assessed five times from 6(th) through 9(th) grades for 50 grade cohort networks in Iowa and Pennsylvania, which include 13,214 individuals. Results show definite influence and selection for similarity in alcohol use, as well as reciprocal influences between drinking and frequently being chosen as a friend. These findings suggest that adolescents view alcohol use as an attractive, high status activity and that friendships expose adolescents to opportunities for drinking.
Article
This study examined the motivations for using cocaine and alcohol comparing those who primarily smoked crack and those who primarily used cocaine powder when using simultaneously with alcohol. Motivations examined included: 1) to cope with a negative affect, 2) enhancement, 3) to be social and 4) to conform. The research design was a cross-sectional study in which clients in treatment for cocaine and alcohol problems completed a self-administered questionnaire about their substance use. Among those who primarily smoked crack or snorted cocaine when also using alcohol (n=153), there were 93 participants who reported primarily snorting cocaine and 60 participants who primarily reported smoking crack. Bivariate analyses found that those who primarily smoked crack reported lower social motivations to use alcohol and cocaine. When adjusting for other covariates in a multivariate analysis, social motivation was still significantly different between groups. Additionally, those who primarily smoked crack were more likely to be older, report higher cocaine dependence severity, be unemployed and were less likely to have completed some post-secondary education, than those who primarily snorted cocaine. No differences were found in enhancement, coping or conformity motivations between the two groups. These results suggest that simultaneous cocaine and alcohol use may have social importance to those who primarily snort cocaine, but that this importance is less evident to those who smoke crack. Consequently, future studies examining motivations for simultaneous cocaine and alcohol use should distinguish between different routes of cocaine administration.
Article
Objective: Although the relation between lifetime depression and smoking cessation outcome has been well studied, the proposition that different symptomatic expressions of depression exert disparate predictive effects on risk of smoking cessation failure has largely gone uninvestigated. This study analyzed the individual contributions of depression's 2 hallmark affective symptoms, anhedonia (i.e., diminished interest in normally enjoyable activities) and depressed mood (i.e., elevated sadness), to the prediction of smoking cessation outcome. Method: Participants were adult daily smokers (N = 1,469; mean age = 45 years, 58% female, 84% White) enrolled in a smoking cessation treatment study. Lifetime history of anhedonia and depressed mood were classified via structured interview prior to quit day. Seven-day point prevalence smoking abstinence was assessed at 8 weeks and 6 months postquit. Results: When examined separately, both lifetime anhedonia, OR (95% CI) = 1.42 (1.16, 1.73), p = .004, and depressed mood, OR (95% CI) = 1.35 (1.11, 1.63), p = .002, predicted increased odds of relapse. These relations remained after adjusting for covariates, including lifetime depressive disorder, which did not predict outcome. After controlling for the covariation between lifetime anhedonia and depressed mood, anhedonia predicted cessation outcome, OR (95% CI) = 1.31 (1.05, 1.62), p = .02, while depressed mood did not (p = .19). Symptom duration (>2 weeks), treatment, and substance use disorder did not modify relations of lifetime anhedonia and depressed mood with cessation outcome. Conclusions: Results suggest that (1) symptoms of affective disturbance capture depression-relevant risk of cessation failure, which is not adequately demarcated by the lifetime depressive disorder diagnosis, and (2) anhedonia is a more sensitive index of this affective disturbance than depressed mood per se. Clinical attention to anhedonia may facilitate smoking cessation.
Article
Motivational interviewing has become widely adopted as a counseling style for promoting behavior change; however, as yet it lacks a coherent theoretical framework for understanding its processes and efficacy. This article proposes that self-determination theory (SDT) can offer such a framework. The principles of motivational interviewing and SDT are outlined and the parallels between them are drawn out. We show how both motivational interviewing and SDT are based on the assumption that humans have an innate tendency for personal growth toward psychological integration, and that motivational interviewing provides the social-environmental facilitating factors suggested by SDT to promote this tendency. We propose that adopting an SDT perspective could help in furthering our understanding of the psychological processes involved in motivational interviewing.
Article
Recent acceptance- and mindfulness-based cognitive-behavioral interventions explicitly target the clarification and commitment to a purpose in life. Yet, scant empirical evidence exists on the value of purpose as a mechanism relevant to psychopathology or well-being. The present research explored daily (within-person) fluctuations in purposeful pursuits and well-being in a community sample of 84 adults with (n = 41) and without (n = 43) the generalized subtype of social anxiety disorder (SAD). After completing an idiographic measure of purpose in life, participants monitored their effort and progress toward this purpose, along with their well-being each day. Across 2 weeks of daily reports, we found that healthy controls reported increased self-esteem, meaning in life, positive emotions, and decreased negative emotions. People with SAD experienced substantial boosts in well-being indicators on days characterized by significant effort or progress toward their life purpose. We found no evidence for the reverse direction (with well-being boosting the amount of effort or progress that people with SAD devote to their purpose), and effects could not be attributed to comorbid mood or anxiety disorders. Results provide evidence for how commitment to a purpose in life enriches the daily existence of people with SAD. The current study supports principles that underlie what many clinicians are already doing with clients for SAD. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Article
Introduction: This study explored the hypothesis that impulsive reactions to heightened emotion may reflect a transdiagnostic vulnerability to both externalizing and internalizing symptoms. Methods: A sample of undergraduates completed self-report measures of aggression, borderline personality disorder symptoms, anxiety symptoms, and alcohol problems, and a subset completed interviews that assessed suicidality. All participants also completed self-report measures relating to impulsivity. We predicted that emotion-reactive impulsivity, but not other aspects of impulsivity, would be related to the set of psychopathology symptoms. Results: Multiple regression analyses found that emotion-reactive impulsivity was uniquely related to each of the psychopathology scales, whereas non-emotion-relevant impulsivity was uniquely related only to alcohol problems. Conclusion: Discussion focuses on limitations and clinical implications.
Article
Surveyed 5,639 high school students regarding their drug use and participation in extracurricular activities. Ss reported varying levels of drug and alcohol experimentation and use. Ss in all extracurricular activities used drugs; however, the substance and extent of use varied with the activity. Differences in experimentation and use among participating and nonparticipating Ss were more extreme when specific substances were examined. Expected values for Ss not participating in extracurricular activities exceeded the anticipated value for alcohol, marijuana, stimulants, depressants, inhalants, hallucinogens, over-the-counter drugs, and cocaine. Extracurricular participation cannot be heralded as a prevention against experimentation and use; however, Ss involved in extracurricular activities were not using tobacco, alcohol, and other drug substances to the extent of their nonparticipating counterparts. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The Pleasant Events Schedule is a behavioral self-report inventory of potentially reinforcing events. The test–retest method, involving 181 Ss of various ages and social classes, demonstrated good to excellent stability for the 8 most used scales of the schedule across periods of 1, 2, and 3 mo. Concurrent validity was assessed by comparison with peer and observer ratings. Predictive validity of the test's frequency ratings was studied in relation to subsequent self-monitoring data, while predictive validity of test enjoyability ratings was determined by comparison with subsequent choice behavior. Construct validity was inferred from the results of other research. Adequate validity of all types was found. Scale intercorrelations are also reported, and the question of response bias is addressed. (29 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Contributions of bidimensional affect measures to adolescent substance (tobacco, alcohol, and marijuana) use were measured. Participants (baseline N = 1,702) were surveyed at age 12.4 years and followed longitudinally through age 15.4 years. Multiple regression indicated negative affect related to higher levels of substance use and positive affect related to lower levels of substance use. Buffer interactions indicated that the relationship of negative affect to substance use was reduced among persons with higher positive affect. Clustering analyses indicated 5 different patterns of affect over time; affect patterns were systematically related to change in substance use over time. Structural modeling analysis indicated that relationships of affect to substance use were mediated through coping motives. The findings are discussed with respect to resiliency research and affect-regulation models of substance use. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Behavioral economics is an emerging cross-disciplinary field that is providing an exciting new contextual framework for researchers to study addictive processes. New initiatives to study addiction under a behavioral economic rubric have yielded variable terminology and differing methods and theoretical approaches that are consistent with the multidimensional nature of addiction. The present article is intended to provide an integrative overview of the behavioral economic nomenclature and to describe relevant theoretical models, principles and concepts. Additionally, we present measures derived from behavioral economic theories that quantify demand for substances and assess decision making processes surrounding substance use. The sensitivity of these measures to different contextual elements (e.g., drug use status, acute drug effects, deprivation) is also addressed. The review concludes with discussion of the validity of these approaches and their potential for clinical application and highlights areas that warrant further research. Overall, behavioral economics offers a compelling framework to help explicate complex addictive processes and it is likely to provide a translational platform for clinical intervention.
Article
Purpose-a cognitive process that defines life goals and provides personal meaning-may help explain disparate empirical social science findings. Devoting effort and making progress toward life goals provides a significant, renewable source of engagement and meaning. Purpose offers a testable, causal system that synthesizes outcomes including life expectancy, satisfaction, and mental and physical health. These outcomes may be explained best by considering the motivation of the individual-a motivation that comes from having a purpose. We provide a detailed definition with specific hypotheses derived from a synthesis of relevant findings from social, behavioral, biological, and cognitive literatures. To illustrate the uniqueness of the purpose model, we compared purpose with competing contemporary models that offer similar predictions. Addressing the structural features unique to purpose opens opportunities to build upon existing causal models of "how and why" health and well-being develop and change over time.
Article
Hedonic capacity is a dispositional ability to experience pleasure in response to stimuli that are typically rewarding. The ability to derive pleasure from natural reinforcers has been relatively overlooked as a risk factor for adolescent smoking. The present study sought to provide initial evidence for a relationship between hedonic capacity and adolescent smoking onset and escalation. The sample was composed of 1,106 adolescents participating in a prospective longitudinal survey study of adolescent health behaviors. Variables were measured via self-report every 6 months for 4 waves of data spanning 18 months. We hypothesized that adolescents with lower hedonic capacity may be less responsive to natural reinforcers and therefore be prone to take up and rely on smoking as a reinforcer. A two-part latent growth curve model indicated that adolescents low in hedonic capacity were over two and a half times more likely to have smoked a cigarette in the past month at age 15.5 years (odds ratio = 2.64, 95% CI = 1.08-6.45) and to show a 90% increase (β = 0.9, z = 2.28, p = .02) in the rate of smoking escalation every 6 months across the following 18 months compared with adolescents with high hedonic capacity. Conclusions: This study provides the first evidence implicating hedonic capacity as a risk factor for adolescent smoking initiation and progression. Adolescents low in hedonic capacity may be an important population to target for smoking prevention and smoking cessation efforts possibly through behavioral skills to enhance pleasure derived through natural reinforcers.