Changing cannabis legislation in Canada and a longitudinal look at "regular" cannabis use in patients with eating disorders.

Regular cannabis use (CU), defined as "weekly or more often", is associated with a number of negative mental health outcomes. In the last decade, Canada legalized first medical and then recreational CU. Despite higher prevalence in mental health populations, little research has documented changes in frequency of CU with progressive legalization of cannabis. This study examined rates of CU in a sample of 843 treatment-seeking patients with eating disorders (ED) in an outpatient setting between 2004 and 2020. Across ED diagnoses, segmented regression indicated a significant break-point in regular CU in 2014, commensurate with the relaxation of medical cannabis laws. Regular CU increased from 4.9 % to 23.7 % from 2014 to 2020; well above the stable 6 % found in the general population. No significant break-point was observed in either alcohol or illicit substance use over the same time period. Significant increases in regular CU were found in patients with anorexia nervosa and binge eating disorder, while regular use remained stable in patients with bulimia nervosa. Comorbid psychiatric diagnoses did not increase odds of regular CU. Findings suggest certain patient groups with mental illness may be at risk of engaging in high frequency use in the context of legislation implying medical benefits of cannabis.

Neurobiological foundations and clinical relevance of effort-based decision-making.

Applying effort-based decision-making tasks provides insights into specific variables influencing choice behaviors. The current review summarizes the structural and functional neuroanatomy of effort-based decision-making. Across 39 examined studies, the review highlights the ventromedial prefrontal cortex in forming reward-based predictions, the ventral striatum encoding expected subjective values driven by reward size, the dorsal anterior cingulate cortex for monitoring choices to maximize rewards, and specific motor areas preparing for effort expenditure. Neuromodulation techniques, along with shifting environmental and internal states, are promising novel treatment interventions for altering neural alterations underlying decision-making. Our review further articulates the translational promise of this construct into the development, maintenance and treatment of psychiatric conditions, particularly those characterized by reward-, effort- and valuation-related deficits.

Reward learning capacity in a community sample of individuals who use cannabis.

Cannabis use has been linked to deficient reward processing; however, little is known about its relation to the specific construct of reward learning, in which behavior is modified through associating novel stimuli with a positive outcome. The probabilistic reward task was used to objectively evaluate reward learning in 38 individuals who use recreational cannabis and 34 control comparison participants from the community. Reward learning was evidenced by the development of a response bias, which indicates the propensity to modulate behavior as a function of prior reinforcement. Both cannabis and control groups demonstrated reward learning, with no group differences in response bias development. Among cannabis participants, trending significant relationships between greater chronicity, r(36) = -.30, p = .077, self-reported potency, r(19) = -.33, p = .052, and poorer reward learning were found. Nonsignificant relationships were found between reward learning and frequency, age of initiation, weekly quantity or Cannabis Use Disorder Identification Test-Revised (CUDIT-R) scores (all p > .05). The ability to form noncannabis reward associations is promising for the success of therapeutic interventions for problematic cannabis use; however, indications of severity of use in relation to poorer reward learning suggests a need for a better pharmacological and pharmacokinetic understanding of cannabis. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Anti-craving medications for alcohol use disorder treatment in the emergency department: A systematic review of direct evidence for SAEM GRACE.

OBJECTIVES: Alcohol-related concerns commonly present to the emergency department (ED), with a subset of individuals experiencing the symptoms of an alcohol use disorder (AUD). As such, examining the efficacy of pharmacological anti-craving treatment for AUD in the ED is of increasing interest. The objective of this systematic review was to evaluate the direct evidence assessing the efficacy of providing anti-craving medications for AUD treatment in the ED. METHODS: A systematic search was conducted according to the patient-intervention-control-outcome question: (P) adults (≥18 years old) presenting to the ED with an AUD (including suspected AUD); (I) anti-craving medications (i.e., naltrexone, acamprosate, gabapentin); (C) no prescription or placebo; (O) reduction of repeat ED visits, engagement in addiction services, reductions in heavy drinking days, reductions in any drinking and amount consumed (or abstinence), and in relapse. Two reviewers independently assessed articles for inclusion and conducted risk of bias assessments for included studies. RESULTS: From 143 potentially relevant articles, 6 met inclusion criteria: 3 clinical trials, and 3 case studies. The clinical trials identified evaluated oral versus extended-release naltrexone, monthly extended-release naltrexone injections, and disulfiram. Both oral and extended-release naltrexone resulted in decreased alcohol consumption. Monthly extended-release naltrexone injections resulted in significant improvements in drinking and quality of life. Although out of scope, the disulfiram studies identified did not result in an improvement in drinking in comparison to no medication. CONCLUSIONS: Overall, there are few studies directly examining the efficacy of anti-craving medications for AUD in the ED, although the limited evidence that exists is supportive of naltrexone pharmacotherapy, particularly extended-release injection formulation. Additional randomized controlled trials are necessary for substantive direct evidence on anti-craving medication initiation in the ED.

Phenobarbital for alcohol withdrawal management in the emergency department: A systematic review of direct evidence for the SAEM GRACE initiative.

OBJECTIVES: Alcohol withdrawal syndrome (AWS) is a commonly presenting condition in the emergency department (ED) and can have severe complications, including mortality. Benzodiazepines are first-line medications for treating AWS but may be unavailable or insufficient. This systematic review evaluates the direct evidence assessing the utility of phenobarbital for treating AWS in the ED. METHODS: A systematic search was conducted and designed according to the patient-intervention-comparator-outcome (PICO) question: (P) adults (≥18 years old) presenting to the ED with alcohol withdrawal; (I) phenobarbital (including adjunctive); (C) benzodiazepines or no intervention; and (O) AWS complications, admission to a monitored setting, control of symptoms, adverse effects, and adjunctive medications. Two reviewers independently assessed articles for inclusion and conducted risk of bias assessments for included studies. RESULTS: From 70 potentially relevant articles, seven studies met inclusion criteria: three retrospective cohort studies, two retrospective chart reviews, and two randomized controlled trials (RCTs), one examining phenobarbital monotherapy and one examining adjunctive phenobarbital. Across the retrospective cohort studies, treatment of AWS with phenobarbital resulted in lower odds of a subsequent ED visit. The retrospective chart reviews indicated that phenobarbital was associated with higher discharge rate compared to benzodiazepine-only treatments. For the two RCTs, phenobarbital did not differ significantly from benzodiazepine for most outcomes, although concomitant treatment with phenobarbital was associated with lower benzodiazepine use and intensive care unit admission. The heterogeneous designs and small number of studies prevented quantitative synthesis. CONCLUSIONS: Relatively few studies provide direct evidence on the utility of phenobarbital for AWS in the ED, but the evidence that exists generally suggests that it is a reasonable and appropriate approach. Additional RCTs and other methodologically rigorous investigations are needed for more definitive direct evidence.

SAEM GRACE: Dopamine antagonists and topical capsaicin for cannabis hyperemesis syndrome in the emergency department: A systematic review of direct evidence.

BACKGROUND: Adults with cannabis hyperemesis syndrome (CHS) are increasingly presenting to the emergency department (ED), and this systematic review will evaluate the direct evidence on the effectiveness of capsaicin and dopamine antagonists in its clinical management. METHODS: A bibliographic search was conducted to address the following population-intervention-control-outcome (PICO) question: (P) adults >18 years old with a diagnosis of acute CHS presenting to the ED; (I) dopamine antagonists (e.g., haloperidol, droperidol) and topical capsaicin; (C) usual care or no active comparator; and (O) symptoms improvement/resolution in ED, ED length of stay, admission rate, ED recidivism, need for rescue medication, and adverse events. This systematic review was conducted in accordance with PRISMA reporting recommendations. RESULTS: From 53 potentially relevant articles, seven articles were included: five observational studies and two randomized controlled trials, including a total of 492 patients. Five of these studies evaluated the efficacy of capsaicin cream (n = 386), and two examined dopamine antagonists (haloperidol, droperidol; n = 106). There was mixed evidence for the efficacy of capsaicin for reducing nausea and emesis. Both studies evaluating dopamine antagonists detected clinical benefit to usual care or no active comparator. CONCLUSIONS: There is limited direct evidence on the efficacy of dopamine antagonists or capsaicin for treating CHS in the ED. Current evidence is mixed for capsaicin and potentially beneficial for dopamine antagonists. Because of the small number of studies, small number of participants, lack of standardization of treatment administration, and risk of bias of the included studies, methodologically rigorous trials on both types of intervention are needed to directly inform ED management of CHS.

Disgust sensitivity and behavioural inhibitory systems in binge eating disorder: associations with eating pathology.

Disgust sensitivity refers to how unpleasant a disgusting experience is to an individual and is involved in the development of many psychiatric conditions. Given its link with food ingestion, there is an interest in understanding how an individual's susceptibility to disgust relates to dietary habits. One possible mechanism giving rise to this association is through the effects negative emotions have on high-order cognitive processes, but few studies take this model into account. The aim of this study was to characterize general disgust sensitivity in a clinical binge eating disorder (BED) population, and explore whether disgust sensitivity relates to inhibitory control and eating pathology. Following a case-controlled study design, our results show that: (1) disgust sensitivity and its subscales do not differ between BED and healthy controls, (2) higher disgust sensitivity in BED relates to greater behavioural inhibition, (3) inhibitory control reaction times relate to aspects of eating pathology, and (4) inhibitory control does not mediate relationships between disgust sensitivity and BMI among participants with BED. Understanding the role of disgust sensitivity in BED may allow us to understand how negative emotion systems maintain dysregulated eating behaviours with the potential to inform emotion-regulation treatment approaches. Level of evidence: Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Concurrent validity of the marijuana purchase task: a meta-analysis of trait-level cannabis demand and cannabis involvement.

BACKGROUND AND AIMS: The Marijuana Purchase Task (MPT) is increasingly used to measure cannabis reinforcing value and has potential use for cannabis etiological and regulatory research. This meta-analysis sought to evaluate for the first time the MPT's concurrent validity in relation to cannabis involvement. METHODS: Electronic databases and pre-print repositories were searched for MPT studies that examined the cross-sectional relationship between frequency and quantity of cannabis use, problems, dependence, and five MPT indicators: intensity (i.e. unrestricted consumption), Omax (i.e. maximum consumption), Pmax (i.e. price at which demand becomes elastic), breakpoint (i.e. first price at which consumption ceases), and elasticity (i.e. sensitivity to rising costs). Random effects meta-analyses of cross-sectional effect sizes were conducted, with Q tests for examining differences by cannabis variables, meta-regression to test quantitative moderators, and publication bias assessment. Moderators included sex, number of MPT prices, variable transformations, and year of publication. Populations included community and clinical samples. RESULTS: The searches yielded 14 studies (n = 4077, median % females: 44.8%: weighted average age = 29.08 [SD = 6.82]), published between 2015 and 2022. Intensity, Omax , and elasticity showed the most robust concurrent validity (|r's| = 0.147-325, ps < 0.014) with the largest significant effect sizes for quantity (|r| intensity = 0.325) and cannabis dependence (|r| Omax = 0.320, |r| intensity = 0.305, |r| elasticity = 0.303). Higher proportion of males was associated with increased estimates for elasticity-quantity and Pmax -problems. Higher number of MPT prices significantly altered magnitude of effects sizes for Pmax and problems, suggesting biased estimations if excessively low prices are considered. Methodological quality was generally good, and minimal evidence of publication bias was observed. CONCLUSIONS: The marijuana purchase task presents adequate concurrent validity to measure cannabis demand, most robustly for intensity, Omax , and elasticity. Moderating effects by sex suggest potentially meaningful sex differences in the reinforcing value of cannabis.

Getting High or Getting By? An Examination of Cannabis Motives, Cannabis Misuse, and Concurrent Psychopathology in a Sample of General Community Adults.

OBJECTIVE: Few studies have examined cannabis motives in adults and, although associations between cannabis use and psychiatric conditions are well documented, there has been limited investigation of the intersection of cannabis use, cannabis motives, and psychopathology. In a sample of community adults, the present study examined cannabis motives in relation to cannabis misuse, and investigated whether motives linked cannabis misuse with concurrent psychiatric symptoms. METHOD: Participants (N = 395; M age = 34.8; %F = 47.6; % White = 81.3%) completed assessments related to cannabis misuse, cannabis use motives, and symptoms of depression, anxiety, PTSD, and somatic experiences. Bivariate correlations, hierarchical regressions, and indirect effect analyses were performed to examine associations between motives and cannabis misuse and to investigate mechanistic relationships between psychiatric symptoms and cannabis misuse. RESULTS: Regressions revealed significant associations between cannabis misuse and social (ß = .13, P < .02), enhancement (ß = .12, P < .02), and coping motives (ß = .48, P < .001). Indirect effects were present such that coping motives consistently linked psychiatric and somatic symptoms with cannabis misuse (anxiety: unstandardized effect = 0.26,and 95% CI = 0.17-0.37; depression: unstandardized effect = 0.12, CI = 0.11-0.25; PTSD: unstandardized effect = 0.07, CI = 0.04-0.10; somatic symptoms: unstandardized effect = 0.20, CI = 0.11-0.30). In addition, enhancement motives exhibited an indirect effect (unstandardized effect = 0.02, CI = 0.002-0.04) between depressive symptoms and cannabis misuse. CONCLUSION: These results support a negative reinforcement motivational profile as the predominant pattern in adult cannabis users, albeit with links to enhancement and social motives. This motivational profile is especially pronounced with regard to comorbid psychopathology and cannabis misuse. These results support the importance of treatment strategies targeting maladaptive coping to address cannabis misuse and co-occurring psychopathology.

Mental Health Over Time and Financial Concerns Predict Change in Online Gambling During COVID-19.

This study examined online gambling behavior during COVID-19 land-based gambling restrictions and associations with changes in mental health, impacts on household income due to the pandemic, financially focused motivations, and symptoms of gambling problems. A repeated online survey was administered to adult gamblers in Ontario, Canada. Wave 1 was conducted at the beginning of the first COVID-19 lockdown (April 2020) and wave 2 in August 2020. Respondents (N = 940) completed validated self-report questionnaires related to depression and anxiety, financial motivation, financial impacts due to the pandemic, online gambling behaviors, and problem gambling symptomatology. A cluster analysis identified three subgroups: no online gambling (subgroup 1), engagement in a range of gambling games online and change in gambling involvement (i.e., some increased and some decreased gambling; subgroup 2), and predominantly online lottery play with no change in online gambling (subgroup 3). Respondents who reported increased anxiety and depression symptom severity between the two waves and those who experienced greater symptoms of problem gambling and negative impacts on household income due to COVID-19 were most likely to be found in subgroup 2. Greater financial focus was also noted in this group. Results indicate a link between change in online gambling involvement during COVID-19 and increased mental health problems, elevated problem gambling severity, negative impacts on household income, and a greater financially focused self-concept. These results may help generate novel research questions examining short and long-term effects of the pandemic on online behaviors that inform policy and practice.

A reinforcer pathology approach to cannabis misuse: Evaluation of independent and interactive roles of cannabis demand and delay discounting in a sample of community adults.

Cannabis use is prevalent and concerns about cannabis misuse are increasing. A reinforcer pathology approach emphasizes the roles of drug reinforcing value (demand) and overvaluation of immediate rewards (delay discounting [DD]) in drug use but has been applied to a lesser extent to cannabis. The present study investigated the independent and interactive roles of these processes in relation to cannabis misuse in a community sample of adult cannabis users (N = 324; 44.8% female; Mage = 33.25). Participants completed a Marijuana Purchase Task (MPT), the Monetary Choice Questionnaire (MCQ), and the Cannabis Use Disorder Identification Test-Revised (CUDIT-R) to assess demand, DD, and cannabis misuse, respectively. Zero-order correlations revealed significant associations between CUDIT-R scores and both the demand indices (|rs | = .21-.56, p < .01-.001) and DD (r = .21, p < .01). In multivariate analyses, lower elasticity (i.e., price insensitivity) was robustly associated with higher CUDIT-R scores, while other demand indicators did not explain additional unique variance. However, as elasticity, intensity, and Omax exhibited robust zero-order intercorrelations, shared variance appeared to drive the association. An interactive relationship between elasticity and DD was not significant. These findings indicate that cannabis misuse is associated with both cannabis demand, particularly as measured by insensitivity to escalating costs, and immediate reward orientation, but the relationship was not synergistic. These results support a reinforcer pathology approach to cannabis misuse and, although causality cannot be inferred cross-sectionally, suggest that evaluating the longitudinal significance of these indicators is warranted. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Attitudes and Beliefs Toward Cannabis Before Recreational Legalization: A Cross-Sectional Study of Community Adults in Ontario.

Objectives: To characterize attitudes and perceptions regarding risks and benefits of cannabis before Canadian legalization for recreational use, both in general and between cannabis users and nonusers. Methods: A cross-sectional sample of community adults assessed in the month before legalization (September 17 to October 17, 2018). Overall, 1,480 individuals (60% female) of an average age of 34.5 years (±13.92) were included in the analysis; 48% reported cannabis use in the past 6 months. Attitudes and perceptions were assessed using a subset of items from the Canadian Cannabis Survey, the National Survey on Drug Use and Health, and the Risks and Benefits of Cannabis Use. Results: Most commonly identified risks of cannabis were impaired memory (67%) and legal problems (54%). Most also identified addiction as a risk (52%), although 25% reported that cannabis was not addictive. The most commonly identified benefits were for pain relief (94%) and management of stress, anxiety, or depression (80%). Active cannabis users systematically reported lower endorsement of risks and higher endorsement of benefits. Only 6% of respondents anticipated increasing cannabis use postlegalization. Among other legal substances, medical cannabis was considered the most socially acceptable, followed by alcohol, recreational cannabis, electronic cigarettes, and then combustible cigarettes. Conclusion: Before legalization, attitudes toward cannabis in this sample of Canadian adults were generally favorable, particularly for medical cannabis. Perceptions of risk were often compatible with existing evidence, but notable proportions underendorsed risk of cannabis use disorder and overendorsed benefits for mental health. These results suggest priorities for public health messaging and provide benchmarks for understanding attitudinal changes postlegalization.

Delay Discounting in Established and Proposed Behavioral Addictions: A Systematic Review and Meta-Analysis.

Steep delay discounting, or a greater preference for smaller-immediate rewards over larger-delayed rewards, is a common phenomenon across a range of substance use and psychiatric disorders. Non-substance behavioral addictions (e.g., gambling disorder, internet gaming disorder, food addiction) are of increasing interest in delay discounting research. Individual studies have reported steeper discounting in people exhibiting various behavioral addictions compared to controls or significant correlations between discounting and behavioral addiction scales; however, not all studies have found significant effects. To synthesize the published research in this area and identify priorities for future research, we conducted a pre-registered systematic review and meta-analysis (following PRISMA guidelines) of delay discounting studies across a range of behavioral addiction categories. The final sample included 78 studies, yielding 87 effect sizes for the meta-analysis. For studies with categorical designs, we found statistically significant, medium-to-large effect sizes for gambling disorder (Cohen's d = 0.82) and IGD (d = 0.89), although the IGD effect size was disproportionately influenced by a single study (adjusted d = 0.53 after removal). Categorical internet/smartphone studies were non-significant (d = 0.16, p = 0.06). Aggregate correlations in dimensional studies were statistically significant, but generally small magnitude for gambling (r = 0.22), internet/smartphone (r = 0.13) and food addiction (r = 0.12). Heterogeneity statistics suggested substantial variability across studies, and publication bias indices indicated moderate impact of unpublished or small sample studies. These findings generally suggest that some behavioral addictions are associated with steeper discounting, with the most robust evidence for gambling disorder. Importantly, this review also highlighted several categories with notably smaller effect sizes or categories with too few studies to be included (e.g., compulsive buying, exercise addiction). Further research on delay discounting in behavioral addictions is warranted, particularly for categories with relatively few studies.

Discrete Roles for Impulsivity and Compulsivity in Gambling Disorder.

Background and Objective: Complex associations between gambling disorder (GD) and impulsivity have been identified. However, little is known regarding how compulsivity associates with different impulsivity domains in GD. In this study, we examined associations between self-reported and behavioral measures of impulsivity-assessed through the Barratt Impulsiveness Scale (BIS-11) and the Experiential Discounting Task (EDT), respectively- and compulsivity-measured using the Padua Inventory and the Wisconsin Card Sorting Test (WCST), respectively-, in an adult sample with GD (N = 132, 94 men and 38 women, ages ranging from 18 to 69 years). GD severity was assessed using the South Oaks Gambling Screen. Methods: Structural Equation Modeling was used to examine relationships between impulsivity and compulsivity measures, age, and GD severity. Results: BIS-11 non-planning and BIS-11 total scores positively correlated with GD severity. The standardized coefficients for the SEM showed direct positive contributions of BIS-11 non-planning, Padua and EDT scores to GD severity. Only participants' ages directly contributed to WCST perseverative errors, and no direct or indirect effects were found with respect to GD severity. Conclusion: The findings suggest that specific aspects of impulsivity and compulsivity contribute to GD severity. Interventions specifically targeting domains that are most relevant to GD severity may improve treatment outcomes.

Using an Optimized Marijuana Purchase Task to Examine Cannabis Demand in Relation to Cannabis Misuse in Heavy Drinking Emerging Adults.

OBJECTIVE: A behavioral economic approach to cannabis misuse emphasizes a crucial role of high drug demand (i.e., reinforcing value), which may be measured using a marijuana purchase task (MPT). The multiple indices from this measure have been associated with cannabis misuse, but somewhat inconsistently, possibly because of task variability across studies. Based on recent qualitative research, the current study implemented an optimized MPT to examine the underlying factor structure and the relationship between cannabis demand and both cannabis misuse and motivation to change. METHOD: Participants were two independent samples of emerging adults who reported cannabis use and heavy episodic drinking in the last month, one Canadian (n = 396) and the other American (n = 275). Both were assessed using an MPT, the Cannabis Use Disorder Identification Test (CUDIT), the Marijuana Adverse Consequences Questionnaire (MACQ), and readiness to change items. RESULTS: Principal component analyses of the MPT indices revealed the same two-factor latent structure in both samples, interpreted as Amplitude (intensity, Omax, elasticity) and Persistence (breakpoint, Pmax). Regressions revealed that Amplitude was significantly associated with CUDIT and MACQ in both samples. In the Canadian sample, Persistence was also significantly associated with CUDIT and MACQ, and both factors were associated with motivation to change. CONCLUSIONS: The optimized MPT generated a two-factor latent structure that was parallel across samples, and the Amplitude factor was consistently associated with cannabis misuse. The current findings indicate the robust relevance of behavioral economic demand for cannabis in relation to cannabis misuse but suggest that links to motivation may be sample-specific.

Cannabis use and misuse in the year following recreational cannabis legalization in Canada: A longitudinal observational cohort study of community adults in Ontario.

BACKGROUND: Canada legalized cannabis for non-medical purposes federally in October 2018. This study examined changes in cannabis use over the following year in a sample of general community adults. A secondary aim was to examine forecasted cannabis use following legalization in relation to actual post-legalization cannabis use. METHODS: Participants were 1502 community adults (61 % female; age M = 34.60 ± 13.95), with approximately half reporting any cannabis use in the six months prior to legalization (Cannabis+ group [48 %]/Cannabis- group [52 %]). Self-report assessments were conducted in the month before cannabis legalization, 6-months post-legalization and 12-months post-legalization. Primary outcomes were frequency of cannabis use, grams of dried flower cannabis on days used, and level of misuse (Cannabis Use Disorder Identification Test - Revised). Secondary analyses examined pre-legalization personal forecasts in relation to post-legalization cannabis use. RESULTS: Statistically significant main effects of time (ps<.001), cannabis use status (ps<.001), and time × cannabis use status interactions (ps<.001) were present for cannabis frequency, quantity, and level of misuse. In each case, the interactions reflected significant decreases in the Cannabis+ group, but significant increases in the Cannabis- group. Approximately 15 % of participants erroneously forecasted their personal post-legalization cannabis use, with discrepancies most commonly being individuals who were not using prior to legalization subsequently using cannabis. CONCLUSIONS: In this cohort of community adults, we observed significant changes over the first year following Canadian legalization, with divergent trajectories based on pre-legalization cannabis use. These findings suggest multifarious impacts of legalization in adults, with meaningfully different trajectories among subgroups.

Food addiction in a large community sample of Canadian adults: prevalence and relationship with obesity, body composition, quality of life and impulsivity.

BACKGROUND AND AIMS: Parallels between the persistent overconsumption of food and addictive drugs have given rise to the notion of food addiction. In a large community sample of Canadian adults, the current study examined the prevalence of food addiction and its relationship with obesity, quality of life and multiple indicators of impulsivity. A secondary goal was to analyze differences between obese and non-obese individuals with and without food addiction. DESIGN: Cross-sectional in-person assessment. SETTING: Hamilton, Ontario, Canada. PARTICIPANTS: A total of 1432 community adults (age = mean ± standard deviation = 38.93 ± 13.7; 42% male) recruited from the general community using print, bus and internet advertisements. MEASUREMENTS: Yale Food Addiction Scale 2.0, anthropometrics (including body mass index), body composition (e.g. body fat, muscle mass, body water), World Health Organization Quality of Life scale and impulsivity measures, including impulsive personality traits, delay discounting and behavioral inhibition. FINDINGS: The prevalence of food addiction was 9.3% and substantially below that of obesity (32.7%), although food addiction was significantly more common among obese individuals (18.5%, P < 0.001). Food addiction was associated with significantly lower quality of life in all domains (ßs = -0.21 to -0.34, Ps < 0.001) and significantly higher impulsive personality traits, particularly negative and positive urgency (ßs = 0.37 and 0.30, Ps < 0.001). Subgroup contrasts within both the obese and non-obese strata revealed that food addiction was associated with significantly lower quality of life in all domains (Ps < 0.001). Food addiction among non-obese individuals was also associated with higher body mass index (P < 0.001). CONCLUSION: In a general community sample, food addiction was present in slightly fewer than one in 10 individuals, approximately one-third the prevalence of obesity, but with twice the prevalence among obese individuals. Food addiction appears to be associated with substantively lower quality of life and elevations in impulsivity, particularly in deficits in emotional regulation.

A review of effort-based decision-making in eating and weight disorders.

Effort-based decision-making provides a framework to understand the mental computations estimating the amount of work ("effort") required to obtain a reward. The aim of the current review is to systematically synthesize the available literature on effort-based decision-making across the spectrum of eating and weight disorders. More specifically, the current review summarises the literature examining whether 1) individuals with eating disorders and overweight/obesity are willing to expend more effort for rewards compared to healthy controls, 2) if particular components of effort-based decision-making (i.e. risk, discounting) relate to specific binge eating conditions, and 3) how individual differences in effort and reward -processing measures relate to eating pathology and treatment measures. A total of 96 studies were included in our review, following PRISMA guidelines. The review suggests that individuals with binge eating behaviours 1) are more likely to expend greater effort for food rewards, but not monetary rewards, 2) demonstrate greater decision-making impairments under risk and uncertainty, 3) prefer sooner rather than delayed rewards for both food and money, and 4) demonstrate increased implicit 'wanting' for high fat sweet foods. Finally, individual differences in effort and reward -processing measures relating to eating pathology and treatment measures are also discussed.

Multidimensional elements of impulsivity as shared and unique risk factors for food addiction and alcohol misuse.

Food addiction (FA) and alcohol misuse tend to co-occur, which suggests shared factors in the etiology and persistence of these health behaviors. One shared factor that has been linked to both is impulsivity, a multidimensional construct reflecting multiple facets of self-regulatory capacity. However, co-occurrence also raises issues of possible confounding if both domains are not considered concurrently, and the intersection between FA, alcohol misuse, and impulsivity has not been well characterized empirically. Therefore, the current study examined the intersection of FA, alcohol consequences, and multiple indicators of impulsivity. Participants were emerging adults reporting regular heavy episodic drinking recruited from Hamilton, Ontario (N = 730; ages 19.5-23). Participants completed measures of FA, alcohol problems, impulsive personality traits (i.e., Barratt Impulsiveness Scales, UPPS-P Impulsive Behavior Scales), impulsive choice (i.e., delay discounting), impulsive action (i.e., Go/NoGo task). Findings revealed a significant association between FA and alcohol-related consequences and both shared similar associations with specific impulsive personality traits (Positive and Negative Urgency, Lack of Premeditation, Motor and Attentional Impulsivity). However, alcohol-related consequences were uniquely associated with other impulsive personality traits (Lack of Perseverance, Sensation Seeking, Non-planning impulsivity) and impulsive choice, and FA was uniquely associated with impulsive action. Beyond alcohol-related consequences, FA was associated with additional variance in measures of impulsive personality traits (Positive and Negative Urgency, Lack of Premeditation, Motor Impulsivity, and Attentional Impulsivity) and impulsive action, but not impulsive choice. Overall, the current study reveals several common self-regulatory processes associated with both adverse drinking consequences and FA, and that the risk of inadvertent confounding appears to be limited.