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Pleasure as an Overlooked Target of Substance Use Disorder Research and Treatment
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.
... 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). ...
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.
... PREDICTING COLLEGE STUDENT STIMULANT MISUSE could benefit from increased exposure to nondrug reinforcers, including greater one-on-one attention from peer counselors or more on-campus programming, that increase PA and reduce PSM likelihood (Carroll, 1996). Greater availability of on-campus treatments fostering positive coping and nondrug PA should be considered (e.g., cognitive-behavioral and mindfulness-based therapies), although research on the PA-specific effects of substance use treatment is limited (Boden, Heinz, & Kashdan, 2017;Kang, Fairbairn, & Ariss, 2019). The EMA results for global and academic stress were less clear. ...
Prescription stimulant misuse (PSM) is common in young adult college students, at over 10% in the past year, and it is associated with other substance use and risk behaviors. Research focused on the real-time drivers of PSM is absent, impeding prevention and intervention. This research aimed to fill that gap by examining the relationships between affect, global stress, or academic stress and PSM via ecological momentary assessment (EMA); we also investigated baseline predictors of PSM frequency during the 21-day EMA period. Forty-one full-time college students (mean age: 20.5, 66% female) who endorsed current PSM (≥ 6 past-year episodes) participated. Participants were asked to complete EMA questions in response to 3 daily investigator-initiated prompts and after every PSM episode. Assessments were selected based on affect regulation (e.g., positive affect [PA], negative affect [NA]) and drug instrumentalization (e.g., academic stress and/or demands) theories of substance use. Mixed-effects linear models examined EMA data, and negative binomial regression analyses examined baseline predictors of PSM episode frequency. PA was higher on PSM days and increased post-PSM, whereas NA was unrelated to PSM. Although global and academic stress were largely unrelated to PSM, when the motive endorsed for PSM was "to study," pre-PSM ratings of academic demand and stress were significantly higher. Finally, a history of recreational motives (e.g., to get high) or higher levels of attention-deficit/hyperactivity disorder symptoms predicted a greater number of PSM episodes over the EMA period. The results offered mixed support for both affect regulation and instrumentalization as applied to PSM. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... 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]. ...
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]. ...
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]. ...
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]. ...
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). ...
Most research on the link between social anxiety and alcohol consumption has examined problematic outcomes without consideration of potential adaptive functions. Alcohol is an anxiolytic that has the short-term benefit of reducing anxiety; consumption may act as a social lubricant that facilitates higher quality social interactions. Using experience-sampling methodology, we examined how consuming alcohol attenuates the adverse effects of social anxiety in naturally occurring social interactions. Participants (N = 160) completed demographic and trait measures, then completed daily assessments for 14 consecutive days. Results from multilevel model analyses revealed that during face-to-face social interactions, state social anxiety was inversely related to 10 indicators of healthy social interactions (e.g., enjoyment, laughter, feelings of acceptance). Alcohol consumption moderated seven of these associations, such that when participants consumed alcohol in social situations, state social anxiety was no longer associated with social interaction quality. The quantity of alcoholic drinks consumed moderated two of these associations. Furthermore, we found evidence for directionality, such that social anxiety in a given social interaction predicted alcohol consumption in a subsequent social interaction, but not the reverse (i.e., alcohol consumption did not prospectively predict state social anxiety). In social situations that involved alcohol, experiences of social anxiety no longer thwarted one's ability to derive social benefits. These results should be interpreted in the context of a participant sample with relatively low levels of trait social anxiety and frequency of alcohol use. Nonetheless, obtaining social rewards may be a reinforcement mechanism that maintains the link between social anxiety and alcohol consumption.
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.
Introduction: 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 Fisher’s exact tests 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 = 0.0001), undernourishment (aOR = 1.78; p = 0.002), a decrease in waist circumference (aOR = 0.98; p = 0.023), a decrease in DBP (aOR = 0.97; p = 0.006), increase in the unit of SBP (aOR = 1.01; p = 0.017), and an increase in differential blood pressure (aOR = 1.01; p = 0.041). The co-use of alcohol was also a significant risk factor (aOR = 2.80; p = 0.0001). 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.
Measuring ultrasonic vocalizations (USVs) allows studying psychoactive drug use-related affective states in laboratory rats and may help understand changes underlying the progress of addictions. We aimed at finding an effective scheme for amphetamine self-administration training in rats, identifying factors affecting their anticipatory and drug-evoked, frequency-modulated 50-kHz USV responses, and verifying whether the rewarding action of amphetamine promotes current drug intake during the training. Therefore, we monitored amphetamine intake and anticipatory and drug-evoked USVs in two rat cohorts trained using two different training schemes. Then we retrospectively divided these cohorts into low-amphetamine and high-amphetamine intake subsets and analyzed their frequency-modulated 50-kHz USV responses accordingly. Anticipatory (i.e., drug-context-related) USVs as well as USVs induced by self-administration training-related non-pharmacological manipulations (tested in an additional rat group) showed surprisingly high call rates but faded spontaneously relatively quickly. Only the scheme employing short cycles of training sessions (two instead of six) and intermittent instead of continuous intra-session drug availability yielded long-lasting escalation of amphetamine intake in a sizable subset. This subset showed high initial amphetamine-evoked USV call rate, which suggests that a strong rewarding action of the drug early in the SA training favors intake escalation. A major decrease in the drug-evoked USVs during advanced training indicated the emergence of tolerance to the rewarding action in these rats, a phenomenon that is characteristic of addiction. Frequency-modulated 50-kHz rat USVs are a good index of the rewarding action of amphetamine at the absence of USVs induced by drug context and other training-related factors.
In the past decade, multiple studies have examined the effectiveness of Acceptance and Commitment Therapy (ACT) for substance use disorders relative to other active treatments. The current meta-analysis examined the aggregate effect size when comparing ACT to other treatments (e.g., CBT, pharmacotherapy, 12-step, treatment as usual) specifically on substance use outcomes.
A total of 10 randomized controlled trials were identified through systematic searches.
A significant small to medium effect size was found favoring ACT relative to active treatment comparisons following treatment. Effect sizes were comparable across studies for smoking cessation (k=5) and for other drug use disorders (k=5).
Based on these findings, ACT appears to be a promising intervention for substance use disorders. Limitations and future directions are discussed.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Mindfulness and flow are both beneficial states of mind, but are they difficult to experience simultaneously? After all, flow involves losing self-awareness within an activity, and mindfulness involves maintaining self-awareness throughout or even despite an activity. In three studies, we examine this potential antagonism, finding negative associations between mindfulness and flow as assessed in a variety of ways and contexts. These associations emerged within Global trait data and diary data concerning daily goal behavior (Study 1), experience-sampling data concerning behavior at the time of signaling (Study 2), and experimental data concerning the experience of playing the flow-conducive computer game, Tetris, after undergoing a mindfulness induction (Study 3). However, these associations only apply to the “absorption” aspect of flow, not the “sense of control” aspect.
Objective: Greater depressive symptoms and low positive affect (PA) are associated with poor smoking cessation outcomes. Smoking cessation approaches that incorporate a focus on PA may benefit smokers trying to quit. The purpose of this study was to conduct a pilot randomized clinical trial to compare standard smoking cessation treatment (ST) to smoking cessation treatment that targets positive affect, termed positive psychotherapy for smoking cessation (PPT-S). Method: Smokers who were seeking smoking cessation treatment were assigned by urn randomization to receive, along with 8 weeks of nicotine replacement therapy, either ST (n = 31) or PPT-S (n = 35). Seven-day point prevalence smoking abstinence was biochemically confirmed at 8, 16, and 26 weeks. Results: Compared to ST, a greater percentage of participants in PPT-S were abstinent at 8 weeks, 16 weeks, and 26 weeks, but these differences were nonsignificant. In a more statistically powerful longitudinal model, participants in PPT-S had a significantly higher odds of abstinence (adjusted odds ratio = 2.75; 95% confidence interval [CI] = 1.02, 7.42, p = .046) across follow-ups compared to those in ST. The positive effect of PPT-S was stronger for those higher in PA (OR = 6.69, 95% CI [1.16, 38.47], p = .03). Greater use of PPT-S strategies during the initial 8 weeks of quitting was associated with a less steep decline in smoking abstinence rates over time (OR = 2.64, 95% CI [1.06, 6.56], p =.04). Conclusion: This trial suggests substantial promise for incorporating PPT into smoking cessation treatment.
© The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Pleasure has long been implicated as an important aspect of happiness. Unfortunately, the study of pleasure in the science of happiness has largely been relegated to positive affective states. While pleasure and affect are difficult to disentangle there is, we argue, utility in examining pleasure on its own merits rather than using proxy measures such as those of positive affect. Relatively little research exists directly connecting sensual pleasures and similar pleasurable experiences with happiness. In this research, we used a large international sample (N = 229,728) to explore individual and cross-national differences in pleasure. In particular, we examined the dominant pleasure profiles of nations as well as the relations of personality, gender and age to pleasure variables. These pleasure profiles were drawn from an examination of distinct pleasure leanings including those associated with taste, touch, smell, sight, hearing, achievement, relaxation, social connection and thrills. Our findings reveal significant relationships between personality, gender, age and culture—respectively—with pleasure. The specific relationships are discussed in detail.
Background:
Epidemiological studies reveal that individuals who report risky substance use are generally less likely to meet physical activity guidelines (with the exception of certain population segments, such as adolescents and athletes). A growing body of evidence suggests that individuals with substance use disorders (SUDs) are interested in exercising and that they may derive benefits from regular exercise, in terms of both general health/fitness and SUD recovery.
Objectives:
The aims of this paper were to: (i) summarize the research examining the effects of exercise-based treatments for SUDs; (ii) discuss the theoretical mechanisms and practical reasons for investigating this topic; (iii) identify the outstanding relevant research questions that warrant further inquiry; and (iv) describe potential implications for practice.
Methods:
The following databases were searched for peer-reviewed original and review papers on the topic of substance use and exercise: PubMed Central, MEDLINE, EMBASE, PsycINFO, and CINAHL Plus. Reference lists of these publications were subsequently searched for any missed but relevant manuscripts. Identified papers were reviewed and summarized by both authors.
Results:
The limited research conducted suggests that exercise may be an effective adjunctive treatment for SUDs. In contrast to the scarce intervention trials to date, a relative abundance of literature on the theoretical and practical reasons supporting the investigation of this topic has been published.
Conclusions:
Definitive conclusions are difficult to draw due to diverse study protocols and low adherence to exercise programs, among other problems. Despite the currently limited and inconsistent evidence, numerous theoretical and practical reasons support exercise-based treatments for SUDs, including psychological, behavioral, neurobiological, nearly universal safety profile, and overall positive health effects.
Objective:
Although recovery increasingly guides substance use disorder services and policy, definitions of recovery continue to lack specificity, thereby hindering measure development and research. The goal of this study was to move the substance use disorders field beyond broad definitions by empirically identifying the domains and specific elements of recovery as experienced by persons in recovery from diverse pathways.
Method:
An Internet-based survey was completed by 9,341 individuals (54% female) who self-identified as being in recovery, recovered, in medication-assisted recovery, or as having had a problem with alcohol or drugs (but no longer do). Respondents were recruited via extensive outreach with treatment and recovery organizations, electronic media, and self-help groups. The survey included 47 recovery elements developed through qualitative work followed by an iterative reduction process. Exploratory and confirmatory factor analyses were conducted using split-half samples, followed by sensitivity analyses for key sample groupings.
Results:
Four recovery domains with 35 recovery elements emerged: abstinence in recovery, essentials of recovery, enriched recovery, and spirituality of recovery. The four-factor structure was robust regardless of length of recovery, 12-step or treatment exposure, and current substance use status. Four uncommon elements did not load on any factor but are presented to indicate the diversity of definitions.
Conclusions:
Our empirical findings offer specific items that can be used in evaluating recovery-oriented systems of care. Researchers studying recovery should include measures that extend beyond substance use and encompass elements such as those examined here--e.g., self-care, concern for others, personal growth, and developing ways of being that sustain change in substance use.
Low positive and high negative affect predict low rates of smoking abstinence among smokers making a quit attempt. Positive Psychotherapy can both increase positive affect and decrease negative affect and therefore may be a useful adjunct to behavioral smoking counseling. The purpose of the present study was to assess the feasibility and acceptability of a Positive Psychotherapy for Smoking Cessation (PPT-S) intervention that integrates standard smoking cessation counseling with nicotine patch and a package of positive psychology interventions. We delivered PPT-S to 19 smokers who were low in positive affect at baseline. Rates of session attendance and satisfaction with treatment were high, and most participants reported using and benefiting from the positive psychology interventions. Almost one-third of participants (31.6%) sustained smoking abstinence for 6 months after their quit date. Future studies to assess the relative efficacy of PPT-S compared to standard smoking cessation treatment are warranted.
Posttraumatic stress disorder (PTSD) and alcohol dependence (AD) frequently co-occur, although results of both cross-sectional and longitudinal studies evaluating the nature of their relationship have been mixed. There has been varied support for competing models explaining how these conditions influence one another. To assess both the self-medication and mutual maintenance models, as well as examine the potential moderating role of drinking motives, the current study used Generalized Estimating Equations to evaluate daily associations for an average of 7.3 days between PTSD symptoms and alcohol use in a mixed-gender sample of individuals who met criteria for both PTSD and AD. Results generally supported a self-medication model with elevated PTSD symptoms predictive of greater alcohol use on that same day and on the following day. Contrary to a mutual maintenance model prediction, drinking did not predict next-day PTSD symptoms. Results also indicated that both coping and enhancement drinking motives were significant moderators of the PTSD and drinking relationships, suggesting that these relationships may be more or less salient depending on an individual's particular drinking motivations. For example, among those higher on coping drinking motives, a 1-unit increase in PTSD symptom severity was associated with a 35% increase in amount of alcohol consumed the same day, while among those low on coping drinking motives, a 1-unit PTSD increase was associated with only a 10% increase in alcohol consumption. We discuss implications of these findings for the larger literature on the associations between PTSD and alcohol use as well as for clinical interventions. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Alcohol use can be understood as a strategic behavior, such that people choose to drink based on the anticipated affective changes produced by drinking relative to those produced by alternative behaviors. This study investigated whether people who report drinking for specific reasons via the Drinking Motives Questionnaire-Revised (DMQ-R; Cooper, 1994) actually experience the alcohol effects they purportedly seek. As a secondary goal, we examined relations between drinking motives and indices of the amount of alcohol consumed. Data were drawn from 3,272 drinking episodes logged by 393 community-recruited drinkers during a 21-day Ecological Momentary Assessment investigation. After accounting for selected covariates, DMQ-R enhancement motives uniquely predicted real-time reports of enhanced drinking pleasure. DMQ-R coping motives were associated with reports of increased drinking-contingent relief and punishment. Enhancement motives uniquely predicted consuming more drinks per episode and higher peak intra-episode estimated blood alcohol concentration. The findings extend the evidence for the validity of the DMQ-R motive scores by demonstrating that internal drinking motives (enhancement and coping) are related to the experienced outcomes of drinking in the manner anticipated by theory. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
What is the role and value of pleasure in addiction? Foddy and Savulescu (1) have claimed that substance use is just pleasure-oriented behavior. They describe addiction as "strong appetites toward pleasure" and argue that addicts suffer in significant part because of strong social and moral disapproval of lives dominated by pleasure seeking. But such lives, they claim, can be autonomous and rational. The view they offer is largely in line with the choice model and opposed to a disease model of addiction. Foddy and Savulescu are sceptical of self-reports that emphasize the ill effects of addiction such as loss of family and possessions, or that claim an absence of pleasure after tolerance sets in. Such reports they think are shaped by social stigma which makes available a limited set of socially approved addiction narratives. We will not question the claim that a life devoted to pleasure can be autonomously chosen. Nor do we question the claim that the social stigma attached to the use of certain drugs increases the harm suffered by the user. However our interviews with addicts (as philosophers rather than health professionals or peers) reveal a genuinely ambivalent and complex relationship between addiction, value, and pleasure. Our subjects did not shy away from discussing pleasure and its role in use. But though they usually valued the pleasurable properties of substances, and this played that did not mean that they valued an addictive life. Our interviews distinguished changing attitudes towards drug related pleasures across the course of substance use, including diminishing pleasure from use over time and increasing resentment at the effects of substance use on other valued activities. In this paper we consider the implications of what drug users say about pleasure and value over the course of addiction for models of addiction.
Factor-analytic evidence has led most psychologists to describe affect as a set of dimensions, such as displeasure, distress, depression, excitement, and so on, with each dimension varying independently of the others. However, there is other evidence that rather than being independent, these affective dimensions are interrelated in a highly systematic fashion. The evidence suggests that these interrelationships can be represented by a spatial model in which affective concepts fall in a circle in the following order: pleasure (0), excitement (45), arousal (90), distress (135), displeasure (180), depression (225), sleepiness (270), and relaxation (315). This model was offered both as a way psychologists can represent the structure of affective experience, as assessed through self-report, and as a representation of the cognitive structure that laymen utilize in conceptualizing affect. Supportive evidence was obtained by scaling 28 emotion-denoting adjectives in 4 different ways: R. T. Ross's (1938) technique for a circular ordering of variables, a multidimensional scaling procedure based on perceived similarity among the terms, a unidimensional scaling on hypothesized pleasure–displeasure and degree-of-arousal dimensions, and a principal-components analysis of 343 Ss' self-reports of their current affective states. (70 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Despite consistent evidence that alcohol can be used to cope with negative emotions or to enhance positive emotions, research on drinking motives has focused primarily on coping and social motives. This article reports on the development of a 3-factor measure that also assesses enhancement motives. Using confirmatory factor analysis, the authors demonstrated that enhancement motives are empirically distinct from coping and social motives and that a correlated 3-factor model fits the data equally well across race and gender groups in a large representative sample. Each drinking motive was also shown to predict distinct aspects of alcohol use and abuse. Finally, interaction analyses suggested that coping and enhancement motives differ in the magnitude of their effects on drinking behavior across Blacks and Whites and that enhancement motives differ in their effects across men and women. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
"The reward cascade" is the release of serotonin, which in turn at the hypothalamus stimulates enkephalin, which in turn inhibits gamma-aminobutyric acid (GABA) at the substantia nigra, which in turn fine tunes the amount of dopamine (DA) released at the nucleus accumbens or "reward site." When DA is released into the synapse, it stimulates a number of DA receptors which results in increased feelings of well-being and stress reduction. It is suggested that when there is a dysfunction in the brain reward cascade, especially in the DA system causing a hypodopaminergic trait, the brain of that person requires a DA fix to feel good. This trait leads to multiple drug-seeking behavior. This is so because alcohol, cocaine, heroin, marijuana, nicotine, and glucose all cause activation and neuronal release of brain DA, which could heal the abnormal cravings. The lack of D₂ receptors causes individuals to have a high risk of multiple addictive, impulsive and compulsive behavioral propensities, such as severe alcoholism, cocaine, heroin, marijuana and nicotine use, glucose bingeing, pathological gambling, sex addiction, attention deficit hyperactivity disorder (ADHD), Tourette's syndrome, autism, chronic violence, posttraumatic stress disorder (PTSD), schizoid/avoidant cluster, conduct disorder, and antisocial behavior. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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)
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)
Synopsis
Audio-taped interviews recorded in the Gottesman–Shields schizophrenic twin series (17 pairs of identical twins, 14 pairs of fraternal same-sex twins, and 12 unpaired twins) were rated for level of hedonic capacity. Schizophrenics who were not hospitalized at the time of their interview were rated significantly lower (more impaired) on hedonic capacity than their normal co-twins. A significant negative correlation was also found between hedonic capacity and severity of illness. Hedonic capacity was found to be genetically influenced, although it appeared to be less heritable than the global diagnosis of schizophrenia. These results are consistent with Meehl's suggestion that reduced hedonic capacity is a heritable personality trait which potentiates the development of schizophrenia among those who are genetically predisposed to the disorder. The results suggest that anhedonia is not a phenotypic vulnerability marker for schizophrenia.
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.
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.
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.
One of the great fears many of us face is that despite all our effort and striving, we will discover at the end that we have wasted our life. In A Guide to the Good Life, William B. Irvine plumbs the wisdom of Stoic philosophy, one of the most popular and successful schools of thought in ancient Rome, and shows how its insight and advice are still remarkably applicable to modern lives. In A Guide to the Good Life, Irvine offers a refreshing presentation of Stoicism, showing how this ancient philosophy can still direct us toward a better life. Using the psychological insights and the practical techniques of the Stoics, Irvine offers a roadmap for anyone seeking to avoid the feelings of chronic dissatisfaction that plague so many of us. Irvine looks at various Stoic techniques for attaining tranquility and shows how to put these techniques to work in our own life. As he does so, he describes his own experiences practicing Stoicism and offers valuable first-hand advice for anyone wishing to live better by following in the footsteps of these ancient philosophers. Readers learn how to minimize worry, how to let go of the past and focus our efforts on the things we can control, and how to deal with insults, grief, old age, and the distracting temptations of fame and fortune. We learn from Marcus Aurelius the importance of prizing only things of true value, and from Epictetus we learn how to be more content with what we have. Finally, A Guide to the Good Life shows readers how to become thoughtful observers of their own life. If we watch ourselves as we go about our daily business and later reflect on what we saw, we can better identify the sources of distress and eventually avoid that pain in our life. By doing this, the Stoics thought, we can hope to attain a truly joyful life.
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.
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.
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.
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.
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.
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
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.
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.
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
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.
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).
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.
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.
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.
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.
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.
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).
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.
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)
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.
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.
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.