Reducing craving and lapse risk in alcohol and stimulants dependence using mobile app involving ecological momentary assessment and self-guided psychological interventions: Protocol for a randomized controlled trial

BackgroundThe prevalence of alcohol consumption in Poland is estimated to be as high as 80% of the adult population. The use of stimulants is the second most common reason for seeking addiction treatment. However, treatment outcomes remain unsatisfactory, as 40–85% of individuals who complete various treatment programs relapse and fall back into addiction within 2 years following program completion.MethodsThe 13-armed randomized controlled trial aimed to assess the effectiveness of a mobile app-based self-guided psychological intervention delivered via a smartphone app (Nałogometr) in reducing craving and lapse risk in problematic alcohol or stimulants use. Participant recruitment and data collection will be performed from June 2022 to September 2022. The 4-week mobile intervention program will include short-term and long-term intervention modules based mainly on mindfulness and cognitive-behavioral therapy. Intervention effectiveness assessment will include Ecological Momentary Assessment. That is, we will collect longitudinal data on a set of characteristics of day-to-day functioning. The primary outcomes will include a self-reported number of lapses and addiction craving level. In contrast, the secondary outcomes will be the severity of problematic substance use, anxiety and depression scores, and life satisfaction scores.ConclusionThis study will establish how mobile app-based self-guided psychological interventions can help reduce craving and lapse risk in alcohol and stimulant dependence. If successful, this randomized controlled trial (RCT) may provide an innovative, easily available, and cost-effective mHealth approach for craving and lapse risk in substance addictions.Clinical trial registration[https://clinicaltrials.gov/], identifier [NCT054 34429]

Globalization - nutrition transition: aspects of contemporary changes in consumption trends

W swojej pracy, autor pragnie udzielić odpowiedzi na postawione pytanie: czy współczesne trendy konsumpcji można w jakiś sposób wiązać z globalizacją gospodarki światowej, a także towarzyszącym jej procesom i przemianom? Przytoczone informacje pozwalają na stwierdzenie, iż zjawisko przejścia żywienia oraz nierówności stanu odżywienia wśród populacji można częściowo przypisać procesom globalizacji, gdyż wpływają one – pośrednio lub bezpośrednio – na podaż i popyt na artykuły spożywcze, związane właśnie z przejściem żywienia. W prezentowanej pracy przeprowadzono przegląd literatury oraz studium przypadków wybranych krajów świata, oparte o przyjęte kryteria i ramy pojęciowe.Kluczowym czynnikiem po stronie podaży jest ekspansja międzynarodowych korporacji spożywczych, liberalizacja międzynarodowego handlu żywnością, globalne sieci reklamy i promocji żywności, rozwój transnarodowych sieci supermarketów, nasilenie się bezpośrednich inwestycji zagranicznych, rozwój technologiczny oraz liberalizacja krajowej polityki rolnej i, co nie mniej istotne, związane z globalizacją wpływy kulturowe. Po stronie popytu, kluczowe czynniki przemian stanowią zmiany struktury zatrudnienia i związanych z tym dochodów – szczególnie w perspektywie postępu urbanizacji. W wielu przypadkach, czynniki te uczyniły produkty wysokokaloryczne, ubogie w substancje odżywcze, a zwłaszcza wysoko przetworzone, znacznie łatwiej dostępnymi i pożądanymi przez coraz większą część ludności świata – szczególnie na obszarach miejskich.Przedstawione dane wskazują, że nierówności stanu odżywienia – pomiędzy i wewnątrz społeczeństw – można po części przypisać procesom napędzającym globalizację. Po pierwsze, w związku z niedożywieniem, ludność już ciesząca się bardziej korzystnymi warunkami – jak posiadanie znacznej ilości ziemi lub kapitału wystarczającego do inwestowania w technologie rolnicze – posiada większą szansę przechwytywania potencjalnych korzyści żywieniowych, dostarczanych przez globalizację; ci natomiast w niekorzystnej sytuacji – ludność bez gruntów oraz kobiety na wsi – mają znacznie mniejsze szanse dostępu do tych korzyści. Tak więc wewnątrz oraz pomiędzy społeczeństwami odnajdujemy zarówno zwycięzców jak i przegranych.Po drugie, istnieją związane z globalizacją nierówności pomiędzy osobami narażonymi na niewystarczające i nadmierne spożycie żywności. We wczesnych etapach przejścia żywienia, grupy bardziej zamożne posiadają większe możliwości spożywania produktów związanych z rozwojem dietozależnych chorób przewlekłych w ilości odpowiedniej lub zawyżonej, podczas gdy biedniejsze grupy pozostają wobec ryzyka niedożywienia. W późniejszym okresie, bogatsze grupy zaczynają zgłaszać popyt na zdrowszą żywności, a mniej pożywne, gęste energetycznie produkty stają się bardziej pożądane i dostępne wśród grup o niższym statusie społeczno-ekonomicznym.Staje się oczywiste, że nie sposób rozdzielić globalizacji jako siły homogenizującej i dywersyfikującej sposoby żywienia, ponieważ procesy globalizacyjne związane są oboma procesami. Różnicujący charakter procesów globalizacyjnych ma pozytywny wpływ, aczkolwiek budzi także obawy o nierównomierność rozwoju nowych nawyków żywieniowych między bogatymi i ubogimi, do którego warunki w wielu przypadkach stwarza globalizacja. Wraz z korzyściami bardziej dynamicznego rynku, przypadającymi na grupy wysokiego poziomu dochodów w krajach rozwijających, grupy o niższych dochodach stają wobec alternatyw borykania się z niedostatecznym dostępem do żywności, a przyjęciem niskiej jakości diety, przyczyniającej się do powstawania otyłości, jak ma to miejsce w krajach zachodnich.Wobec tych powodów, tak wiele z relacji między globalizacją, a sposobami żywienia zależne będzie od kontekstu, w którym zachodzą dane procesy.In his work, the author seeks to answer the question: are the contemporary trends in consumption in some way linked to the globalization of world economy and its accompanying processes and transformations? The elaborated information allows the conclusion that the phenomenon of diet transition and nutritional inequities among populations can be partly attributed to processes of globalization, because they affect – directly or indirectly – the supply and demand for food associated with the nutrition transition. The following paper consists of a literature review, as well as case studies of selected countries – based on selected criteria and conceptual framework.A key factor on the supply side is the expansion of international food corporations, the liberalization of international food trade, global network of food advertising and promotion, development of transnational supermarket chains, the increase in foreign direct investment, technological development and liberalization of domestic agricultural policy and, last but not least important, globalization related cultural influences. On the demand side, key drivers of change is the shift in the employment structure and related income – especially in the context of the progressing urbanization. In many cases, these factors have made high-calorie, nutrient-poor and highly processed products much more accessible and desirable for an increasing proportion of the world's population – particularly in urban areas.The data presented indicate that the inequities – between and within societies – can be partly attributed to processes driving globalization. Firstly, in relation to malnutrition, the population already in more favorable conditions – like having a considerable amount of land or sufficient capital to invest in agricultural technologies – have a better chance of capturing the potential nutritional benefits provided by globalization, while those at a disadvantage – population without land and women in rural areas – are substantially less likely to access these benefits. So, within and between societies, both winners and losers can be found.Secondly, there are globalization related inequities in populations among people exposed to insufficient or excessive food intake. In the early stages of the nutrition transition, the more affluent groups have more opportunities to consume products (in an adequate or excessive amount) associated with the development of diet-related chronic diseases, while the poorer groups are facing the risk of malnutrition. Later during the transition, wealthier groups begin to report demand for healthier food, as the less nutritious, energy-dense products become more desirable and accessible to groups of lower socio-economic status.Therefore it becomes obvious that it is impossible to separate the consumption homogenizing and diversifying forces of globalization, since it facilitates them both. The differentiatory nature of globalization has a positive effect, but also raises concerns about the uneven development of new dietary habits between rich and poor, to which conditions in many cases are created by globalization. Along with a large part of the benefits of a more dynamic market system, attributable to the high level of income in developing countries, lower income groups are faced with an alternative to either cope with the insufficient access to food, or adopt a low-quality diet, contributing to the emergence of obesity, such as it is in Western countries. The people of lower socio-economic status are in the long run more susceptible to the consumption homogenizing impact of the global market, while those more affluent and better educated tend to shift to more healthy and more expensive products.For these reasons, therefore, so much of the relationship between globalization and the nutritional patterns will depend on the context in which the relation occur

Path Dependency in the Discounting of Delayed and Probabilistic Gains and Losses

Published in: Białaszek, W., & Marcowski, P. (2019). Path Dependency in the Discounting of Delayed and probabilistic Gains and Losses. Scientific Reports, 9(1), 8738

Physical and cognitive effort discounting across different reward magnitudes: Tests of discounting models.

The effort required to obtain a rewarding outcome is an important factor in decision-making. Describing the reward devaluation by increasing effort intensity is substantial to understanding human preferences, because every action and choice that we make is in itself effortful. To investigate how reward valuation is affected by physical and cognitive effort, we compared mathematical discounting functions derived from research on discounting. Seven discounting models were tested across three different reward magnitudes. To test the models, data were collected from a total of 114 participants recruited from the general population. For one-parameter models (hyperbolic, exponential, and parabolic), the data were explained best by the exponential model as given by a percentage of explained variance. However, after introducing an additional parameter, data obtained in the cognitive and physical effort conditions were best described by the power function model. Further analysis, using the second order Akaike and Bayesian Information Criteria, which account for model complexity, allowed us to identify the best model among all tested. We found that the power function best described the data, which corresponds to conventional analyses based on the R2 measure. This supports the conclusion that the function best describing reward devaluation by physical and cognitive effort is a concave one and is different from those that describe delay or probability discounting. In addition, consistent magnitude effects were observed that correspond to those in delay discounting research

Positive time preference for monetary sequences of rewards: the role of temporal spacing

It is widely recognized that people have a general preference for improvement. In our study we demonstrate that the opposite can be observed if the consequences of our choices are dispersed over time. We address the problem of discounting of delayed sequences, in which hypothetical monetary rewards are arranged in deteriorating, flat, or improving sequences – in which the payments are separated from one another by a short (one month) or long (five years) internal delay. One hundred and twenty graduate students completed a dynamic multiple-staircase discounting procedure in a mixed factorial design. We predicted that deteriorating sequences of rewards would be preferred over their improving and flat counterparts. This prediction was confirmed when the internal delay between rewards was long. Participants not always chose the best for first, however. If the consequences of their choices were separated by small internal delay, participants were indifferent between three types of sequenc

Effort can have positive and negative impact on outcome value within an individual, across individuals, and across choice contexts

Performance of virtually every action requires some degree of effort. Thus, effort plays a role in motivation and decision-making processes. Recent works suggest that effort-based choice might not always follow the law of less work, i.e., effort decreasing valuation of effort-contingent outcomes. Instead, effort can also have a positive impact on evaluation. To test this proposition, recently termed the effort paradox, we introduce a novel model that allows effort to have both negative and positive effects, and accounts for effort effects on outcome evaluation within an individual, across individuals, and across different choice contexts. Our participants performed a series of choices between money and a common item linked to different levels of physical effort. The effort involved real or hypothetical stair climbing and was prospective (choosing between potential outcomes before effort exertion) or retrospective (choosing between outcomes obtained after effort exertion). Behaviorally we found that, with real effort and real choices, effort decreased outcome value when decisions were prospective and increased outcome value when decisions were retrospective. These results demonstrate the effort paradox within a single experiment using real effort and incentivized decisions. To explore choice dynamics beyond average trends, we then applied a novel computational model to participants’ choices and found that our model explained individual decisions better compared to previous models. Importantly, upon inspecting these explanations, we observed that even under the same circumstances some individuals exhibit a positive relation between effort and value, some negative, and yet others exhibit non-monotonic preference profiles

Gambling with Lives and Money: Evidence for Conformity in Moral and Monetary Decisions under Risk

Many consider moral decisions to follow an internal “moral compass”, resistant to social pressures. Here we examine if social influence shapes moral decisions under uncertainty. Further, we examine if decision-making and social influence operate similarly in moral and non-moral domains and domains of gains versus losses. We employed an adapted Asian Disease Paradigm in which participants chose between certain losses/gains and probabilistic losses/gains in a series of moral (lives) or financial (money) decisions. Participants first indicated their baseline risk preferences. Then, in a series of trials, they guessed preferences of a group and were given trial-by-trial feedback suggesting that the group is either risk-seeking or risk-averse. Subsequently, participants’ risk preferences were assessed again. We found that after exposure to group norms, participants shifted their own moral choices towards the observed group’s risk preferences, for both gain and losses. Unlike for moral decisions, for monetary decisions group norms shifted participants’ risk preferences only when norms ran against to participants’ default behavior -- risk seeking for gains and risk averse for losses (as predicted by prospect theory). Such effects on moral and monetary preferences persisted after three days. Taken together, our results demonstrate that moral decisions under risk are susceptible to social influence in the domains of losses and gains, and that moral decisions, and their susceptibility to social influence, differ from decisions in monetary domain

Comparison of multiplicative and additive hyperbolic and hyperboloid discounting models in delayed lotteries involving gains and losses.

Many day-to-day decisions may involve risky outcomes that occur at some delay after a decision has been made. We refer to such scenarios as delayed lotteries. Despite human choice often involves delayed lotteries, past research has primarily focused on decisions with delayed or risky outcomes. Comparatively, less research has explored how delay and probability interact to influence decisions. Within research on delayed lotteries, rigorous comparisons of models that describe choice from the discounting framework have not been conducted. We performed two experiments to determine how gain or loss outcomes are devalued when delayed and risky. Experiment 1 used delay and probability ranges similar to past research on delayed lotteries. Experiment 2 used individually calibrated delay and probability ranges. Ten discounting models were fit to the data using a genetic algorithm. Candidate models were derived from past research on discounting delayed or probabilistic outcomes. We found that participants' behavior was best described primarily by a three-parameter multiplicative model. Measures based on information criteria pointed to a solution in which only delay and probability were psychophysically scaled. Absolute measures based on residuals pointed to a solution in which amount, delay, and probability are simultaneously scaled. Our research suggests that separate scaling parameters for different discounting factors may not be necessary with delayed lotteries