Ambulatory assessment of physiological arousal, emotion, and alcohol use

Research examining whether negative affect leads to drinking has produced mixed results (Greeley and Oei, 1999; Sher and Grekin, 2007). The current project enlisted participants (n=43) oversampled for affective instability, arguably making them at higher risk for negative affect-driven alcohol consumption. The goals of this study were to 1) validate an ambulatory device for measuring electrodermal activity (EDA) and to 2) examine the relations between emotion, EDA, and alcohol use in real-time. Multiple self-reports of emotion, alcohol use, and behavior were obtained from participants each day over the course of one week using electronic diaries. EDA was assessed continuously during waking hours. The results suggested that ambulatory measurement of EDA is feasible, and agreement between ambulatory measures and traditional laboratory measures was moderate to high for number of skin conductance responses per minute. Skin conductance level was less consistent across measures. With regard to ambulatory findings, high negative affect and high arousal states during the day were generally related to decreased likelihood of same-day drinking and decreased estimated blood alcohol concentration, while positive affect was related to increased likelihood of drinking. Hostility and number of skin conductance responses interacted, such that low hostility and low arousal was related to greater amounts of alcohol consumed. In sum, negative affect and arousal were related to alcohol use in real-time, but effects were small and both were generally protective against alcohol consumption at the day-level. This study helps to clarify the role of arousal in affect-related drinking, while also adding to accumulating evidence that suggests negative affect-related drinking may not be an immediate coping response. Positive-affect drinking may be most relevant in early stages of alcohol use, even in an emotionally dysregulated sample

A Randomized Placebo-Controlled Trial of \u3cem\u3eN\u3c/em\u3e-Acetylcysteine for Cannabis Use Disorder in Adults

Background—Cannabis use disorder (CUD) is a prevalent and impairing condition, and established psychosocial treatments convey limited efficacy. In light of recent findings supporting the efficacy of N-acetylcysteine (NAC) for CUD in adolescents, the objective of this trial was to evaluate its efficacy in adults. Methods—In a 12-week double-blind randomized placebo-controlled trial, treatment-seeking adults ages 18–50 with CUD (N=302), enrolled across six National Drug Abuse Treatment Clinical Trials Network-affiliated clinical sites, were randomized in a 1:1 ratio to a 12-week course of NAC 1200 mg (n=153) or placebo (n=149) twice daily. All participants received contingency management (CM) and medical management. The primary efficacy measure was the odds of negative urine cannabinoid tests during treatment, compared between NAC and placebo participants. Results—There was not statistically significant evidence that the NAC and placebo groups differed in cannabis abstinence (odds ratio = 1.00, 95% confidence interval 0.63 – 1.59; p=0.984). Overall, 22.3% of urine cannabinoid tests in the NAC group were negative, compared with 22.4% in the placebo group. Many participants were medication non-adherent; exploratory analysis within medication-adherent subgroups revealed no significant differential abstinence outcomes by treatment group. Conclusions—In contrast with prior findings in adolescents, there is no evidence that NAC 1200 mg twice daily plus CM is differentially efficacious for CUD in adults when compared to placebo plus CM. This discrepant finding between adolescents and adults with CUD may have been influenced by differences in development, cannabis use profiles, responses to embedded behavioral treatment, medication adherence, and other factors

Correspondence Between Perceived Pubertal Development and Hormone Levels in 9-10 Year-Olds From the Adolescent Brain Cognitive Development Study.

Aim: To examine individual variability between perceived physical features and hormones of pubertal maturation in 9-10-year-old children as a function of sociodemographic characteristics. Methods: Cross-sectional metrics of puberty were utilized from the baseline assessment of the Adolescent Brain Cognitive Development (ABCD) Study—a multi-site sample of 9–10 year-olds (n = 11,875)—and included perceived physical features via the pubertal development scale (PDS) and child salivary hormone levels (dehydroepiandrosterone and testosterone in all, and estradiol in females). Multi-level models examined the relationships among sociodemographic measures, physical features, and hormone levels. A group factor analysis (GFA) was implemented to extract latent variables of pubertal maturation that integrated both measures of perceived physical features and hormone levels. Results: PDS summary scores indicated more males (70%) than females (31%) were prepubertal. Perceived physical features and hormone levels were significantly associated with child\u27s weight status and income, such that more mature scores were observed among children that were overweight/obese or from households with low-income. Results from the GFA identified two latent factors that described individual differences in pubertal maturation among both females and males, with factor 1 driven by higher hormone levels, and factor 2 driven by perceived physical maturation. The correspondence between latent factor 1 scores (hormones) and latent factor 2 scores (perceived physical maturation) revealed synchronous and asynchronous relationships between hormones and concomitant physical features in this large young adolescent sample. Conclusions: Sociodemographic measures were associated with both objective hormone and self-report physical measures of pubertal maturation in a large, diverse sample of 9-10 year-olds. The latent variables of pubertal maturation described a complex interplay between perceived physical changes and hormone levels that hallmark sexual maturation, which future studies can examine in relation to trajectories of brain maturation, risk/resilience to substance use, and other mental health outcomes

Correlates of affective instability in borderline personality disorder : an assessment using the electronically activated recorder (EAR)

Title from PDF of title page (University of Missouri--Columbia, viewed on August 22, 2012).The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file.Thesis advisor: Dr. Timothy J. TrullIncludes bibliographical references.M. A. University of Missouri--Columbia 2011."May 2011"[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT REQUEST OF AUTHOR.] Affective instability (AI) is a key feature of borderline personality disorder (BPD). Given the dynamic nature of affective instability, it is ideally studied using ambulatory assessment (AA). Recently, several major studies have examined affective instability via momentary self-report, using electronic diaries, which participants can use throughout their daily routine. However, all of these studies are based on the assumption that an individual is an accurate reporter of his/her emotional experience. In the present study, an Electronically Activated Recorder (EAR) designed to capture ambient sounds and interpersonal interactions was worn by 25 participants with BPD who also met the specific AI criterion as well as 13 participants with major depressive disorder (who did not meet criteria for AI or BPD) for three days. After listening to the recordings, trained coders rated the affect of each participant across three days in various social contexts. We found little to no agreement between traditional self-report measures of BPD and EAR ratings of affect. Also, there were no significant differences between the BPD group and depressed group on EAR measures of negative affect and affective instability. However, there were significant associations between being in the presence of other people and negative affect, which varied by group status. The EAR offers an alternative to self-report and gives us insight into the expression of emotions in BPD. Given that the EAR provides new information, this may supplement our knowledge of BPD and affective instability

The estimand framework and its application in substance use disorder clinical trials: a case study

Relapse rates among individuals with substance use disorder (SUD) remain high and new treatment approaches are needed, which require evaluation in randomized controlled trials (RCTs). Measurement and interpretation challenges for SUD RCT data are often ignored or presented only in statistical analysis plans. Since different analytic approaches may result in different estimates and thus interpretations of the treatment effect, it is important to present this clearly throughout the trial. Inconsistencies between study analyses and objectives present further challenges for interpretation and cross-study comparisons. The recent International Council for Harmonization (ICH) addendum provides standardized language and a common framework for aligning trial objectives, design, conduct, and analysis. The framework focuses on estimands, which describe the treatment effect and link the trial objective with the scientific question and the analytic approach. The use of estimands offers SUD researchers and clinicians the opportunity to explicitly address events that affect measurement and interpretation at the outset of the trial. Furthermore, the use of standard terminology can lead to clearer interpretations of SUD trials and the treatments evaluated in SUD trials. Resources for understanding and applying estimands are needed to optimize the use of this new, helpful framework. This Perspective provides this resource for SUD researchers. Specifically, it highlights the relevance of estimands for SUD trials. Furthermore, it demonstrates how estimands can be used to develop clinically relevant analyses to address challenges in SUD trials. It also shows how a standardized framework can be employed to improve the interpretation and presentation of SUD study findings.the National Institutes of Health12 month embargo; published online: 26 October 2021This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

LONGITUDINAL ASSOCIATIONS IN BORDERLINE PERSONALITY DISORDER FEATURES: DIAGNOSTIC INTERVIEW FOR BORDERLINES—REVISED (DIB-R) SCORES OVER TIME

The Revised Diagnostic Interview for Borderlines (DIB-R; Zanarini, Gunderson, Frankenburg, & Chauncey, 1989) measures four major aspects of borderline personality disorder (BPD): Affect, Cognition, Impulse Action Patterns, and Interpersonal Relationships. In the present study, 353 young adults completed the DIB-R at age 18 (Wave 1) and again two years later (Wave 2) at age 20. Concerning the prediction of future BPD features, three models were compared: (a) Wave 1 Affect scores predicting all Wave 2 BPD features (NA model); (b) Wave 1 Impulse Action Patterns scores predicting all Wave 2 BPD features (IMP model); and (c) both Wave 1 Affect and Impulse Action Patterns scores predicting all Wave 2 BPD features (NA-IMP model). Each model controlled for stabilities over time and within-time covariances. Results indicated that the NA model provided the best fit to the data, and improved model fit over a baseline stabilities model and the other models tested. However, even within the NA model there was some evidence that the impulsivity scores were not accounted for by other BPD features. These results suggest that although negative affect is predictive of most BPD symptoms, it does not fully predict future impulsive behavior

Modeling Cannabis Use Disorder Treatment Progression: Evidence of Differential Mechanisms Underlying Functional Improvements

The exclusive focus on abstinence, rigid parameters, and lack of population moderation studies limits evidence of mechanisms of behavior change (MOBCs) that explain functional improvements in cannabis use disorder (CUD) treatments. We aimed to surpass these limitations by examining: 1) two untested non-abstinent MOBCs, 2) end-of-treatment (EOT; i.e., proximal) outcomes simultaneously functioning as MOBCs for follow-up (i.e., distal) outcomes, and 3) gender-moderated outcome predictors and MOBCs. Treatment-seeking individuals with CUD (n = 186; 70.1% male; 57.2% White) between ages 18-50 (M = 30.90, SD = 8.95) participated in a 12-week multi-site clinical trial with a four-week follow-up. We collected self-reported data and creatinine-corrected cannabinoid urine concentrations. We modeled treatment progression using moderated multigroup longitudinal path analyses to examine: H1) if mid-treatment, non-abstinent MOBCs (craving and use reductions) mediated the direct effect of CUD severity at the screening visit on proximal outcomes (anxiety, depression, and cannabis-related problems), H2) if proximal outcomes mediated the direct effect of mid-treatment MOBCs on a four-week distal outcome (quality of life challenges), and H3) if gender moderated these effects. We found that craving reduction may be a MOBC for the full and men samples. In women, depression may concurrently function as a proximal outcome and MOBC for quality of life challenges (distal outcome). Further, gender-moderated outcome predictors and MOBCs; for men, it may be craving reduction, and for women, reduced cannabis use. These nontraditional, differential explanations of functional improvements suggest that our understanding of CUD treatments may be more nuanced than currently indicated in the literature

Pharmacological treatment of youth substance use disorders.

While the majority of youth who experiment with alcohol and drugs do not develop problematic levels of use, 5% of adolescents and 15% of young adults meet criteria for a substance use disorder (SUD). Pharmacotherapy, in combination with behavioral interventions, has the potential to increase the likelihood of successful treatment for youth struggling with SUD; however, the literature in this area is limited. To date, there are no Food and Drug Administration (FDA)-approved medications for adolescent SUD, other than buprenorphine, which has been approved down to 16 years of age for opioid use disorder. Despite alcohol and cannabis being the most commonly used substances during adolescence, only three medications have been tested among this demographic, and only two have warranted further study (i.e., naltrexone for alcohol and -acetylcysteine for cannabis use disorder). Although less common in adolescents and young adults, the most promising pharmacological findings for this age group are for opioid (buprenorphine) and tobacco (bupropion and varenicline) use disorders. In addition, despite the recent marked increases in electronic nicotine delivery systems (i.e., vaping) among youth, treatment strategies are still in their infancy and no recommendation exists for how to promote cessation for youth vaping. Current findings are limited by: small, demographically homogeneous samples; few trials, including a substantial number of youth younger than 18; low retention; medication adherence rates; and minimal information on effective dosing levels and long-term outcomes. Overall, pharmacotherapy may be a potentially effective strategy to increase treatment effects; however, more rigorous research trials are warranted before FDA approval would be granted for any of the potential adjunctive medications in this age group