Lack of Premeditation Mediates the Relationship Between Adverse Childhood Experiences and Posttraumatic Stress Disorder in Individuals in Residential Treatment for Substance Use Disorder

Roberts N.P., Lotzin A., Schäfer I.

Swedo E.A., Aslam M.V., Dahlberg L.L., Niolon P.H., Guinn A.S., Simon T.R., Mercy J.A.

Adverse childhood experiences (ACEs) are defined as preventable, potentially traumatic events that occur among persons aged

Kempeneers P., Mreyen K., Pallincourt R., Remacle F., Wildemeersch G., Simon J.

Background: Impulsivity is a multifaceted construct that plays a prominent role in substance use disorder (SUD). The UPPS-P model distinguishes five impulsivity components (positive urgency, negative urgency, lack of perseverance, lack of premeditation, and sensation seeking). This study aimed to explore the structure of the UPPS-P in patients hospitalized for SUDs and to investigate the relationship between the dimensions of impulsivity and clinical variables. Method: Inpatients of a residential detoxification service ( n = 125) were recruited. A confirmatory factor analysis was performed, and associations were assessed between the components of impulsivity and clinical indexes. Results: The factor analysis supported a model of impulsivity with five interrelated latent variables. Good internal consistency was found. External validity was supported by relationships with psychological difficulties. Multiple correlations (Kendall) suggested that, except for its sensation-seeking component, impulsivity is a significant risk factor for both the severity of addictive problems and their comorbidities. Conclusion: This study provides further evidence in favor of the 5-dimensional model of impulsivity. It highlights impulsivity as a transdiagnostic risk factor that should be considered in the management of SUD.

Hien D.A., Morgan-López A.A., Saavedra L.M., Ruglass L.M., Ye A., López-Castro T., Fitzpatrick S., Killeen T.K., Norman S.B., Ebrahimi C.T., Back S.E.

Treatment efficacy for co-occurring posttraumatic stress disorder (PTSD) and substance use disorders is well established, yet direct evidence for comparative effectiveness across treatments is lacking. The present study compared the effectiveness of several behavioral and pharmacological therapies for adults with co-occurring PTSD and alcohol or other drug use disorders.A systematic search of PsycINFO, MEDLINE, and ClinicalTrials.gov was conducted through December 2020 for trials targeting PTSD, alcohol or other drug use disorders, or both disorders (36 studies, N=4,046). Primary outcomes were severity scores for PTSD, alcohol use, and drug use, estimated via moderated nonlinear factor analysis. Propensity score weight-adjusted multilevel models were used. Model-predicted effect sizes were estimated for each treatment, and comparative effect sizes for each active arm against treatment as usual, at end of treatment and at 12-month follow-up.Compared with treatment as usual, combining trauma-focused therapy and pharmacotherapy for substance use disorders showed the largest comparative effect sizes for PTSD severity (d=-0.92, 95% CI=-1.57, -0.30) and alcohol use severity (d=-1.10, 95% CI=-1.54, -0.68) at end of treatment. Other treatments with large comparative effect sizes included pharmacotherapies for alcohol or other drug use disorders, trauma-focused integrated therapies, and trauma-focused nonintegrated therapies. Reductions in outcomes for PTSD symptoms and alcohol use were observed for nearly all treatments.The findings provide support for treating comorbid PTSD and substance use disorders using a variety of approaches, with alcohol-targeted pharmacotherapies and trauma-focused behavioral therapies as a combination of treatments that lead to early and sustained improvements in PTSD and alcohol use severity. Further treatment development is indicated for combining behavioral and pharmacological treatments for synergized impact and understanding the mechanisms of action and conditions under which each treatment type is optimized.

Lund J.I., Boles K., Radford A., Toombs E., Mushquash C.J.

Abstract Objective Exposure to adverse childhood experiences (ACEs) is linked to disruptions in typical neurodevelopment of brain structures and functioning, including changes in executive functions. Although the relationships among ACEs, executive functions, and psychopathology are well documented in pediatric samples, a systematic review is needed to examine these relationships in adulthood. Method A systematic review examining the link between ACEs and executive functions among adult clinical and nonclinical samples was conducted across 33 scientific and grey literature databases. Among reviewed studies, 17 sources met review criteria, with 11 involving clinical samples and six involving nonclinical samples. Results Among clinical samples, evidence suggested that ACEs increased risk for executive function difficulties among those diagnosed with bipolar disorder, schizophrenia, post-traumatic stress disorder, and those experiencing a first episode of psychosis, however not within those diagnosed with major depressive disorder. Among nonclinical samples, executive function difficulties associated with ACEs were found among those in early and middle adulthood. Not all retrieved sources showed consistent findings, and two studies described better executive function outcomes among those who experienced childhood sexual abuse and emotional abuse. Conclusions Executive function difficulties associated with ACEs appear to persist into adulthood, though inconsistently. Future research may further explore distinct differences among specific ACEs and executive function difficulties to further inform ongoing prevention and treatment efforts.

American Psychiatric Association

Webster E.M.

In recent years, there have been advances in research regarding the prevalence of Adverse Childhood Experiences (ACEs) and resulting poor outcomes for children who have experiences ACES. ACE exposure has been connected with poor academic performance, poor health outcomes, and certain diseases. However, there is still relatively little known about the prevalence and impact of ACE exposure in early childhood. Using the 2016 National Survey of Children’s Health, this study assessed the prevalence of adverse childhood experiences for children under the age of six years. This research measured the impact of individual ACEs on health and developmental outcomes and found that financial hardship and parental mental illness both had increased odds of having health and developmental difficulties. Furthermore, this work finds that there is a dose-response relationship between ACE count and increased risk of health and developmental difficulties. Conversely, children who were reported as affectionate with their parent had decreased risk for health and developmental problems. Programs supporting families with young children should focus efforts on enhancing quality of attachment, especially for children experiencing ACEs.

Kim J.H., Choi J.Y.

Smith T., Panfil K., Bailey C., Kirkpatrick K.

This review article discusses various cognitive and behavioral interventions that have been developed with the goal of promoting self-controlled responding. Self-control can exert a significant impact on human health and impulsive behaviors are associated with a wide range of diseases and disorders, leading to the suggestion that impulsivity is a trans-disease process. The self-control interventions include effort exposure, reward discrimination, reward bundling, interval schedules of reinforcement, impulse control training, and mindfulness training. Most of the interventions have been consistently shown to increase self-control, except for mindfulness training. Some of the successful interventions are long-lasting, whereas others may be transient. Most interventions are domain-specific, targeting specific cognitive and behavioral processes that relate to self-control rather than targeting overall self-control. For example, effort exposure appears to primarily increase effort tolerance, which in turn can improve self-control. Similarly, interval schedules primarily target interval timing, which promotes self-controlled responses. A diagram outlining a proposed set of intervention effects on self-control is introduced to motivate further research in this area. The diagram suggests that the individual target processes of the interventions may potentially summate to produce general self-control, or perhaps even produce synergistic effects. In addition, it is suggested that developing a self-control profile may be advantageous for aligning specific interventions to mitigate specific deficits. Overall, the results indicate that interventions are a promising avenue for promoting self-control and may help to contribute to changing health outcomes associated with a wide variety of diseases and disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Junglen A., Hruska B., Jensen T., Boros A., Delahanty D.L.

Dugré J.R., Giguére C., Percie du Sert O., Potvin S., Dumais A.

Objective: Impulsivity is a multidimensional construct that has an important role for the understanding of diverse psychopathologies and problematic behaviors. The UPPS-P impulsive behavior scale, measuring five distinct facets of impulsivity, has been subject to several studies. No study has investigated the clinical utility of this questionnaire amongst an unstable psychiatric population. The aim of the current study is to examine the psychometric properties of the short version of this scale in a psychiatric emergency unit. Method: The S-UPPS-P was administered to 1097 psychiatric patients in an emergency setting, where a subgroup of 148 participants completed a follow-up. The internal consistency, the construct validity, the test-retest reliability and the convergent validity of the scale were examined. Results: Confirmatory factor analyses supported a five-factor solution. Results indicated good psychometric properties across psychiatric diagnoses and gender. The S-UPPS-P was partially invariant across sexes. The authors have found differences on the loading of one item and on the thresholds of two items from lack of premeditation and positive urgency subscales. Conclusion: This validation study showed that the UPPS-P conserved good psychometric properties in an unstable psychiatric sample, indicating that the instrument can be utilized in such settings.

Uhl G.R., Koob G.F., Cable J.

Substance and alcohol use disorders impose large health and economic burdens on individuals, families, communities, and society. Neither prevention nor treatment efforts are effective in all individuals. Results are often modest. Advances in neuroscience and addiction research have helped to describe the neurobiological changes that occur when a person transitions from recreational substance use to a substance use disorder or addiction. Understanding both the drivers and consequences of substance use in vulnerable populations, including those whose brains are still maturing, has revealed behavioral and biological characteristics that can increase risks of addiction. These findings are particularly timely, as law- and policymakers are tasked to reverse the ongoing opioid epidemic, as more states legalize marijuana, as new products including electronic cigarettes and newly designed abused substances enter the legal and illegal markets, and as "deaths of despair" from alcohol and drug misuse continue.

Mulhauser K., Weinstock J., Van Patten R., McGrath A.B., Merz Z.C., White C.N.

Impulsivity reflects a pattern of rapid behavioral responses to internal or external cues with little planning or consideration of consequences. Impulsive personality is purported to be a largely stable, trait-based quality, while impulsive choice has been shown to respond to interventions aimed at reducing impulsivity. We sought to evaluate the stability of impulsive personality and examine reductions in impulsivity during short-term residential substance use disorder (SUD) treatment. The temporal stability of the UPPS-P Impulsive Behavior Scale (UPPS-P) and discounting rates on a measure of impulsive choice (i.e., Monetary Choice Questionnaire-27 [MCQ-27]) were assessed over a brief 10-day period in a sample of individuals engaged in 14-day residential SUD treatment (N = 28). Although all five UPPS-P scales exhibited adequate to good test-retest reliability (rs > .78), Negative Urgency and (lack of) Premeditation decreased over time with large and moderate effects, respectively. Discounting rates on the MCQ-27 also declined (i.e., reduced impulsivity) during treatment. While impulsive personality is broadly understood to be trait-like and largely resistant to treatment effects, our results add to emerging evidence that two scales on the UPPS-P (i.e., Negative Urgency and [lack of] Premeditation) measure aspects of impulsive personality that respond to treatment. These findings have significant implications for understanding and conceptualizing impulsivity during initial SUD treatment and suggest opportunities for additional interventions targeting aspects of impulsive personality. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Shin S.H., McDonald S.E., Conley D.

The influence of adverse childhood experiences (ACEs), which often include childhood exposure to maltreatment and household dysfunction, on health risk behaviors during young adulthood has been widely documented. A vulnerability marker for the increased risky behaviors among young ACEs victims such as impulsivity remains to be explored. The present study investigated how different profiles of ACEs influence impulsivity in young adulthood. Respondents were young people (N = 336; ages 18-25) who were recruited from the community. Latent class analysis (LCA) was used to identify subpopulations of individuals based on varying exposure to 13 types of ACEs, including childhood maltreatment, household dysfunction, and community violence. Four distinct classes emerged: Low ACEs (56%), Household Dysfunction/Community Violence (14%), Emotional ACEs (14%), and High/Multiple ACEs (16%). Multiple regression analyses found that compared to those in the Low ACEs class, young adults in the Emotional ACEs and High/Multiple ACEs respectively, reported increased levels of negative urgency, controlling for sociodemographic characteristics and other impulsivity traits. This result suggests that childhood exposure to multiple ACEs at high levels is particularly related to impulsive self-control in the context of intense negative emotionality.

Kozak K., Lucatch A.M., Lowe D.J., Balodis I.M., MacKillop J., George T.P.

Impulsivity is strongly associated with substance use disorders (SUDs). Our review discusses impulsivity as an underlying vulnerability marker for SUDs, and treatment of co-occurring impulsivity in SUDs. Three factors should be considered for the complex relationship between impulsivity and a SUD: (1) the trait effect of impulsivity, centering on decreased cognitive and response inhibition, (2) the state effect resulting from either acute or chronic substance use on brain structure and function, and (3) the genetic and environmental factors (e.g., age and sex) may influence impulsive behavior associated with SUDs. Both subjective and objective measures are used to assess impulsivity. Together, treatment developments (pharmacological, behavioral, and neurophysiological) should consider these clinically relevant dimensions assessed by a variety of measures, which have implications for treatment matching in individuals with SUD. Despite its heterogeneity, impulsivity is a marker associated with SUDs and may be understood as an imbalance of bottom-up and top-down neural systems. Further investigation of these relationships may lead to more effective SUD treatments.