Matthew J. Gullo

Impulsivity and adolescent substance use: rashly dismissed as "all-bad"?

The initial use of illicit drugs and alcohol typically occurs during adolescence. Individual differences in impulsivity and related constructs are consistently identified as key factors in the initiation and later problematic use of substances. Consequently, impulsivity is generally regarded as a negative trait; one that conveys only risk. However, what is often overlooked in addiction science is the positive role facets of trait impulsivity can play in everyday life and adaptive functioning. The following review aims to summarize recent advances in the psychobiology of impulsivity, including current perspectives on how it can convey risk for substance misuse. The review will also consider the importance of adolescence as a phase of life characterized by substantial neurodevelopment and natural increases in impulsivity. Uniquely, the review aims to reframe thinking on adolescent impulsivity to include the positive with the negative, and discuss how such thinking can benefit efforts for early intervention and future research.

Multiple behavioural impulsivity tasks predict prospective alcohol involvement in adolescents

Aims We investigated reciprocal prospective relationships between multiple behavioural impulsivity tasks (assessing delay discounting, risk-taking and disinhibition) and alcohol involvement (consumption, drunkenness and problems) among adolescents. We hypothesized that performance on the tasks would predict subsequent alcohol involvement, and that alcohol involvement would lead to increases in behavioural impulsivity over time. Design Cross-lagged prospective design in which impulsivity and alcohol involvement were assessed five times over 2 years (once every 6 months, on average). Setting Classrooms in secondary schools in North West England. Participants Two hundred and eighty-seven adolescents (51.2% male) who were aged 12 or 13 years at study enrolment. Measurements Participants reported their alcohol involvement and completed computerized tasks of disinhibition, delay discounting and risk-taking at each assessment. Cross-sectional and prospective relationships between the variables of interest were investigated using cross-lagged analyses. Findings All behavioural impulsivity tasks predicted a composite index of alcohol involvement 6 months later (all Ps < 0.01), and these prospective relationships were reliable across the majority of time-points. Importantly, we did not observe the converse relationship across time: alcohol involvement did not predict performance on behavioural impulsivity tasks at any subsequent time point. Conclusions Several measures of impulsivity predict escalation in alcohol involvement in young adolescents, but alcohol use does not appear to alter impulsivity.

Polysubstance use: diagnostic challenges, patterns of use and health

Purpose of review Polysubstance use is common, particularly amongst some age groups and subcultures. It is also associated with elevated risk of psychiatric and physical health problems. We review the recent research findings, comment on changes to polysubstance diagnoses, report on contemporary clinical and epidemiological polysubstance trends, and examine the efficacy of preventive and treatment approaches. Recent findings Approaches to describing polysubstance use profiles are becoming more sophisticated. Models over the last 18 months that employ latent class analysis typically report a no use or limited-range cluster (alcohol, tobacco and marijuana), a moderate-range cluster (limited range and amphetamine derivatives), and an extended-range cluster (moderate range, and nonmedical use of prescription drugs and other illicit drugs). Prevalence rates vary as a function of the population surveyed. Wide-ranging polysubstance users carry higher risk of comorbid psychopathology, health problems, and deficits in cognitive functioning. Summary Wide-ranging polysubstance use is more prevalent in subcultures such as ‘ravers’ (dance club attendees) and those already dependent on substances. Health risks are elevated in these groups. Research into the prevention and treatment of polysubstance use is underdeveloped. There may be benefit in targeting specific polysubstance use and risk profiles in prevention and clinical research.

A prospective study of alcohol expectancies and self-efficacy as predictors of young adolescent alcohol misuse.

AIMS To test the relative contribution of two key Social Learning Theory constructs, alcohol expectancies (AEs) and drinking refusal self-efficacy (DRSE), in predicting early adolescent drinking behavior and examine the possible mediational role of DRSE over AE. METHODS High school students (N = 192, mean age 14) were administered measures assessing AE (Drinking Expectancy Questionnaire--Adolescent version; DEQ-A), DRSE (Drinking Refusal Self-Efficacy Questionnaire--Revised Adolescent version; DRSEQ-RA) and indices of alcohol consumption and problem drinking. Age, gender, peer drinking, tobacco use and positive and negative behavioral characteristics were included in the statistical models as known predictors of alcohol misuse. Subjects were followed up at 12 months, with 88.5% retention. RESULTS Initial confirmatory factor analyses verified factor structures of the DEQ-A and DRSEQ-RA. Prospective structural models controlling for Time 1 drinking behavior, age, gender, peer alcohol use, tobacco use and behavior problems identified that DRSE but not AE was associated with problem drinking 12-month post-initial assessment. DRSE mediated AE in predicting problem drinking. CONCLUSION Results suggest that DRSE is a more salient cognitive construct than AE in early adolescence alcohol use. In this age group, prevention and treatment strategies that build refusal self-efficacy may be more effective than strategies that challenge AEs.

Predictors of prospective memory in adults with traumatic brain injury

Previous studies have established that prospective memory is commonly affected following traumatic brain injury (TBI). This study examines whether demographic factors, injury severity and site, executive function, and metacognitive factors predict prospective memory performance in adults with TBI, using a cross-sectional multivariate correlational model. Prospective memory of 44 adults (mean age = 30 years) with severe TBI was measured by the Cambridge Prospective Memory Test (CAMPROMPT) time-based and event-based scores. Using stepwise multiple regression, the time-based score was predicted by the Controlled Oral Word Association Test (COWAT) Animals subtest score, length of post-traumatic amnesia (PTA) and use of note-taking on the CAMPROMPT. The event-based score was predicted by length of PTA and COWAT Animals score. Therefore, patients with longer periods of PTA and executive function impairment may be expected to display poorer prospective memory. Note-taking was associated with improved performance on time-based prospective memory tasks.

Polysubstance use in cannabis users referred for treatment: drug use profiles, psychiatric comorbidity and cannabis-related beliefs.

Background: Population-based surveys demonstrate cannabis users are more likely to use both illicit and licit substances, compared with non-cannabis users. Few studies have examined the substance use profiles of cannabis users referred for treatment. Co-existing mental health symptoms and underlying cannabis-related beliefs associated with these profiles remains unexplored. Methods: Comprehensive drug use and dependence severity (Severity of Dependence Scale-Cannabis) data were collected on a sample of 826 cannabis users referred for treatment. Patients completed the General Health Questionnaire, Cannabis Expectancy Questionnaire, Cannabis Refusal Self-Efficacy Questionnaire, and Positive Symptoms and Manic-Excitement subscales of the Brief Psychiatric Rating Scale. Latent class analysis was performed on last month use of drugs to identify patterns of multiple drug use. Mental health comorbidity and cannabis beliefs were examined by identified drug use pattern. Results: A three-class solution provided the best fit to the data: (1) cannabis and tobacco users (n = 176), (2) cannabis, tobacco, and alcohol users (n = 498), and (3) wide-ranging substance users (n = 132). Wide-ranging substance users (3) reported higher levels of cannabis dependence severity, negative cannabis expectancies, lower opportunistic, and emotional relief self-efficacy, higher levels of depression and anxiety and higher manic-excitement and positive psychotic symptoms. Conclusion: In a sample of cannabis users referred for treatment, wide-ranging substance use was associated with elevated risk on measures of cannabis dependence, co-morbid psychopathology, and dysfunctional cannabis cognitions. These findings have implications for cognitive-behavioral assessment and treatment.

Independence of Hot and Cold Executive Function Deficits in High-Functioning Adults with Autism Spectrum Disorder

Individuals with autistic spectrum disorder (ASD) display diverse deficits in social, cognitive and behavioral functioning. To date, there has been mixed findings on the profile of executive function deficits for high-functioning adults (IQ > 70) with ASD. A conceptual distinction is commonly made between “cold” and “hot” executive functions. Cold executive functions refer to mechanistic higher-order cognitive operations (e.g., working memory), whereas hot executive functions entail cognitive abilities supported by emotional awareness and social perception (e.g., social cognition). This study aimed to determine the independence of deficits in hot and cold executive functions for high-functioning adults with ASD. Forty-two adults with ASD (64% male, aged 18–66 years) and 40 age and gender matched controls were administered The Awareness of Social Inference Test (TASIT; emotion recognition and social inference), Letter Number Sequencing (working memory) and Hayling Sentence Completion Test (response initiation and suppression). Between-group analyses identified that the ASD group performed significantly worse than matched controls on all measures of cold and hot executive functions (d = 0.54 − 1.5). Hierarchical multiple regression analyses revealed that the ASD sample performed more poorly on emotion recognition and social inference tasks than matched controls after controlling for cold executive functions and employment status. The findings also indicated that the ability to recognize emotions and make social inferences was supported by working memory and response initiation and suppression processes. Overall, this study supports the distinction between hot and cold executive function impairments for adults with ASD. Moreover, it advances understanding of higher-order impairments underlying social interaction difficulties for this population which, in turn, may assist with diagnosis and inform intervention programs.

Impulsivity: mechanisms, moderators and implications for addictive behaviors

Addictions are among the most burdensome neuropsychiatric disorders, costing the United States over

The role of impulsive personality traits in the initiation, development, and treatment of substance misuse problems

500 billion per annum (Uhl & Grow, 2004). Reduced impulse control, or impulsivity, is a characteristic feature of addiction (Kotov, Gamez, Schmidt, & Watson, 2010; Maclaren, Fugelsang, Harrigan, & Dixon, 2011; Potenza, 2013). Impulsivity has been defined as, “a predisposition toward rapid, unplanned reactions to internal or external stimuli without regard to the negative consequences of these reactions to the impulsive individual or to others” (Moeller, Barratt, Dougherty, Schmitz, & Swann, 2001). It is a construct of great interest to researchers because of its robustness as a premorbid marker of risk, normal distribution within the population, and clear biological basis (Gullo & Dawe, 2008; Moffitt et al., 2011; Tarter et al., 2003; Zuckerman, 1993). It is now widely accepted that impulsivity is a multidimensional construct, with two or more core components emerging across biological, behavioral, and trait-based studies of addiction (Bechara, 2005; Dawe & Loxton, 2004; Fineberg et al., 2014; Potenza & Taylor, 2009). The majority of articles in this special issue focus on impulsivity at behavioral and self-report tendency (“trait”) levels. At the behavioral level, choice impulsivity refers to the selection of smaller, sooner rewards over larger, later rewards. Response impulsivity refers to immediate action that is out of context with the present demands of the environment (e.g., prepotent response disinhibition), and which occurs with diminished forethought. Choice impulsivity and response impulsivity are typically assessed with an objective measure of relevant behaviors performed at a single time-point (e.g., intertemporal choices and stopsignal reactions, respectively). At the trait level, reward sensitivity/drive refers to individual differences in the strength of approach motivation in response to internally or externally generated cues for reward. Rash impulsiveness refers to individual differences in the ability to modify or inhibit prepotent approach behavior in light of poten tial negative consequences. Reward drive and rash impulsiveness may be assessed with self-report measures of behavioral tendencies that are averaged across situations and across time (e.g., Sensitivity to Reward scale and Barratt Impulsiveness Scale [BIS-11], respectively; Patton, Stanford, & Barratt, 1995; Torrubia, Avila, Molto, & Caseras, 2001). Like most personality traits, they may give a more ‘complete’ picture of stable patterns in behavior, but may also be less predictive of specific behaviors in specific situations (Funder & Colvin, 1991; Nettle & Penke, 2010).

Differential segmentation responses to an alcohol social marketing program

Recent advances in the understanding of the genetic, neurochemical, behavioral and cultural underpinnings of addiction have led to rapid advances in the understanding of addiction as a disease. In fact, advances in basic science and the development of new pharmacological and behavioral therapies associated with them are appearing faster than can be assimilated not only by clinical researchers but practitioners and policy makers as well. Translation of science-based addictions knowledge into improved prevention, assessment and treatment, and communication of these changes to researchers and practitioners are significant challenges to the field. The general aim of this book is to summarize current and potential linkages between advances in addiction science and innovations in clinical practice. Whilst this book is primarily focused on translation, it also encompasses some scientific advances that are relevant to dissemination, and the book is itself a tool for disseminating innovative thinking. The goal is to generate interest in application opportunities from both recent research and theoretical advances.