The ReCoDe addiction research consortium: Losing and regaining control over drug intake-Findings and future perspectives.

Substance use disorders (SUDs) are seen as a continuum ranging from goal-directed and hedonic drug use to loss of control over drug intake with aversive consequences for mental and physical health and social functioning. The main goals of our interdisciplinary German collaborative research centre on Losing and Regaining Control over Drug Intake (ReCoDe) are (i) to study triggers (drug cues, stressors, drug priming) and modifying factors (age, gender, physical activity, cognitive functions, childhood adversity, social factors, such as loneliness and social contact/interaction) that longitudinally modulate the trajectories of losing and regaining control over drug consumption under real-life conditions. (ii) To study underlying behavioural, cognitive and neurobiological mechanisms of disease trajectories and drug-related behaviours and (iii) to provide non-invasive mechanism-based interventions. These goals are achieved by: (A) using innovative mHealth (mobile health) tools to longitudinally monitor the effects of triggers and modifying factors on drug consumption patterns in real life in a cohort of 900 patients with alcohol use disorder. This approach will be complemented by animal models of addiction with 24/7 automated behavioural monitoring across an entire disease trajectory; i.e. from a naïve state to a drug-taking state to an addiction or resilience-like state. (B) The identification and, if applicable, computational modelling of key molecular, neurobiological and psychological mechanisms (e.g., reduced cognitive flexibility) mediating the effects of such triggers and modifying factors on disease trajectories. (C) Developing and testing non-invasive interventions (e.g., Just-In-Time-Adaptive-Interventions (JITAIs), various non-invasive brain stimulations (NIBS), individualized physical activity) that specifically target the underlying mechanisms for regaining control over drug intake. Here, we will report on the most important results of the first funding period and outline our future research strategy.

Validation of the German long and short versions of the UPPS-P Impulsive Behavior Scale.

OBJECTIVE: The UPPS-P Impulsive Behavior Scale is a widely used self-report measure of impulsivity, but there is currently no validated German version that includes the Positive Urgency scale. METHODS: We combined existing German translations of UPPS scales and included the Positive Urgency dimension to validate the UPPS-P in a sample of 399 participants. In addition, we developed a revised short version of the UPPS-P (SUPPS-P) with 20 items and conducted a confirmatory factor analysis (CFA) to verify the structure in an independent validation sample with 349 participants. To determine evidence of convergent and discriminant validity, we used measures of impulsivity, depression, anxiety, stress, problematic alcohol and substance use. RESULTS: CFA of the five factorial structure of the UPPS-P demonstrated acceptable fits and evidence of validity and reliability for the subscales. Psychometric characteristics of the SUPPS-P using the original item configuration were not satisfactory. As a result, we developed a revised German version of the SUPPS-P and confirmed the five-factor structure using a CFA in the validation sample. For the revised version, model fits and evidence of validity and internal consistencies were good. Associations with other constructs were as expected. For example, whereas Sensation Seeking was associated moderately with problematic alcohol use, lacking associations of Lack of Premeditation to internalizing symptoms showed evidence of discriminant validity. DISCUSSION: The German translations of both UPPS-P and SUPPS-P are valid tools for measuring impulsive behaviors. They are well-suited for exploring the associations between different facets of impulsivity and psychopathological phenomena.

Corrigendum: Interaction between habits as action sequences and goal-directed behavior under time pressure.

[This corrects the article DOI: 10.3389/fnins.2022.996957.].

Risk-Taking Is Associated with Decreased Subjective Value Signals and Increased Prediction Error Signals in the Hot Columbia Card Task.

It remains a pressing concern to understand how neural computations relate to risky decisions. However, most observations of brain-behavior relationships in the risk-taking domain lack a rigorous computational basis or fail to emulate of the dynamic, sequential nature of real-life risky decision-making. Recent advances emphasize the role of neural prediction error (PE) signals. We modeled, according to prospect theory, the choices of n = 43 human participants (33 females, 10 males) performing an EEG version of the hot Columbia Card Task, featuring rounds of sequential decisions between stopping (safe option) and continuing with increasing odds of a high loss (risky option). Single-trial regression EEG analyses yielded a subjective value signal at centroparietal (300-700 ms) and frontocentral (>800 ms) electrodes and in the delta band, as well as PE signals tied to the feedback-related negativity, P3a, and P3b, and in the theta band. Higher risk preference (total number of risky choices) was linked to attenuated subjective value signals but increased PE signals. Higher P3-like activity associated with the most positive PE in each round predicted stopping in the present round but not risk-taking in the subsequent round. Our findings indicate that decreased representation of decision values and increased sensitivity to winning despite low odds (positive PE) facilitate risky choices at the subject level. Strong neural responses when gains are least expected (the most positive PE on each round) adaptively contribute to safer choices at the trial-by-trial level but do not affect risky choice at the round-by-round level.

Impulsivity mediates the association between narcissism and substance-related problems beyond the degree of substance use: a longitudinal observational study.

BACKGROUND: Narcissism has been implied as a putative risk factor for substance use disorders (SUDs). However, previous research did not disentangle the degree of substance use from substance-related problems, the symptoms of SUDs. This preregistered study addressed the open question whether grandiose and vulnerable narcissism and their constituent traits convey specific SUD risk, that is, explain substance-related problems beyond the degree of use. Furthermore, we tested whether impulsivity or substance use motives linked to narcissistic self-regulation mediate this association. METHODS: Narcissism, impulsivity, substance use motives, past-year substance use, and substance-related problems were assessed in 139 (poly-)substance users, 121 of whom completed a one-year follow-up. For significant longitudinal associations between narcissism factors and substance-related problems controlled for the degree of use, we tested impulsivity and substance use motives as mediators. RESULTS: Grandiose narcissism (r =.24, p =.007) and its constituent factors antagonistic (r =.27, p =.003) and agentic narcissism (r =.18, p =.050), but not vulnerable narcissism, prospectively predicted substance-related problems beyond the degree of substance use. Associations of grandiose narcissism and antagonistic narcissism with substance-related problems were fully mediated by impulsivity, but not substance use motives. Impulsivity explained roughly one third of the association of both grandiose (P̂M = 0.30) and antagonistic narcissism (P̂M = 0.26) with substance-related problems. DISCUSSION: We demonstrate that grandiose narcissism- particularly antagonistic but also agentic narcissism- is specifically linked to substance-related problems beyond the degree of substance use. The mediating effect of impulsivity but not substance use motives suggests that impulsivity may be a more important mechanism than narcissistic self-regulation in promoting SUD in narcissism. However, future studies may use more targeted measures than substance use motives to further probe the role of self-regulation. Similar result patterns for alcohol compared to all substances together indicate that mechanisms may be alike across substances. In conclusion, narcissistic individuals may not use substances more but have a higher SUD risk, informing prevention and treatment.

Exploring the relationship between context and obsessions in individuals with obsessive-compulsive disorder symptoms: a narrative review.

Obsessions in obsessive-compulsive disorder (OCD) have long been proposed to differ from intrusive thoughts in unaffected individuals based on appraisal of the thoughts. However, more recent research indicates that cognitive processes behind obsessions may differ significantly from those in healthy individuals concerning their contextual relationship. This narrative literature review summarizes current evidence for the role of context-relatedness for obsessions in OCD and intrusive thoughts in affected and unaffected individuals. The review encompasses a total of five studies, two of which include individuals diagnosed with OCD (one study also includes a group of unaffected control individuals), while the other three studies investigate the relationship between OCD symptoms and context in unaffected individuals. As assessed by mainly self-reports, the review examines the connection between thoughts and their context, shedding light on how the repetition and automaticity of thoughts, as well as their detachment from context over time contribute to defining obsessions in contrast to intrusive thoughts. However, the link with context depends on the content of the obsessions. We propose the term "decontextualization of thoughts" to describe the phenomenon that obsessions gradually lose their connection with external context during the development of OCD. Future research should investigate whether this hypothesis can be supported by experimental evidence and identify whether this shift might be more likely a cause or a consequence of the disorder.

Disentangling associations between impulsivity, compulsivity, and performance monitoring.

Disorders marked by high levels of impulsivity and compulsivity have been linked to changes in performance monitoring, specifically the error-related negativity (ERN). We investigated the relationship between performance monitoring and individual differences in impulsivity and compulsivity. A total of 142 participants were recruited into four groups, each with different combinations of impulsivity and compulsivity, and they performed a flanker task to assess error-related brain activity. We defined error-related brain activity as ERN amplitude and theta power. Single-trial regression was employed to analyze the amplitude differences between incorrect and correct trials within the ERN time window. The findings revealed that impulsivity, compulsivity, and different measures of response processing exhibited distinct interactions, which were influenced by the configuration of impulsivity and compulsivity, but also depended on the measure of response processing. Specifically, high compulsivity predicted larger ERN amplitudes in individuals with low impulsivity, whereas high impulsivity had no significant effect on ERN amplitude in individuals with low compulsivity. Furthermore, when both impulsivity and compulsivity were high, no significant increase in ERN amplitude was observed; instead, there was a reduced difference between incorrect and correct trials. No significant differences were found for theta power. While the association between error-related brain activity and transdiagnostic markers or psychopathology may be smaller than generally assumed, considering the interaction between different transdiagnostic markers and their facets can enhance our understanding of the complex associations that arise during the investigation of neural correlates of performance monitoring, specifically the ERN.

Unraveling the influence of trial-based motivational changes on performance monitoring stages in a flanker task.

Performance monitoring (PM) is a vital component of adaptive behavior and known to be influenced by motivation. We examined effects of potential gain (PG) and loss avoidance (LA) on neural correlates of PM at different processing stages, using a task with trial-based changes in these motivational contexts. Findings suggest more attention is allocated to the PG context, with higher amplitudes for respective correlates of stimulus and feedback processing. The PG context favored rapid responses, while the LA context emphasized accurate responses. Lower response thresholds in the PG context after correct responses derived from a drift-diffusion model also indicate a more approach-oriented response style in the PG context. This cognitive shift is mirrored in neural correlates: negative feedback in the PG context elicited a higher feedback-related negativity (FRN) and higher theta power, whereas positive feedback in the LA context elicited higher P3a and P3b amplitudes, as well as higher theta power. There was no effect of motivational context on response-locked brain activity. Given the similar frequency of negative feedback in both contexts, the elevated FRN and theta power in PG trials cannot be attributed to variations in reward prediction error. The observed variations in the FRN indicate that the effect of outcome valence is modulated by motivational salience.

Cognitive Symptoms Link Anxiety and Depression Within a Validation of the German State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA).

Background: In the present study we aimed to develop a German version of the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) and evaluate the psychometric properties. Associations of cognitive and somatic anxiety with other measures of anxiety, depression, and stress, elucidating possible underlying functional connections, were also examined, as symptoms of anxiety, depression and stress often overlap. Method: Two samples (n1 = 301; n2 = 303) were collected online and in the lab, respectively. Dynamic connections between somatic and cognitive anxiety, other measures of anxiety, depression, and stress, were analyzed using a network approach. Psychometric analyses were conducted using exploratory and confirmatory factor analyses. Results: We replicated and validated the two-factorial structure of the STICSA with the German translation. Network analyses revealed cognitive trait anxiety as the most central node, bridging anxiety and depression. Somatic trait anxiety exhibited the highest discriminant validity for distinguishing anxiety from depression. Conclusion: The central role of cognitive symptoms in these dynamic interactions suggests an overlap of these symptoms between anxiety and depression and that differential diagnostics should focus more on anxious somatic symptoms than on cognitive symptoms. The STICSA could therefore be useful in delineating differences between anxiety and depression and for differential assessment of mood and anxiety symptoms. Additional understanding of both cognitive and somatic aspects of anxiety might prove useful for therapeutic interventions.

Immediate and lasting effects of different regulation of craving strategies on cue-induced craving and the late positive potential in smokers.

Craving, induced by substance-related cues, contributes to continued substance use and relapse. Therefore, regulation of craving (ROC) is important for treatment success. Distraction involves disengaging from craving-inducing cues; whereas, reappraisal requires engaging with potential risks of substance use. Given this difference in elaboration, we addressed the question whether reappraisal entails lasting advantages over distraction in successful ROC. To elucidate how this is implemented neurally, we examined the late positive potential (LPP) as an electrocortical indicator of motivated attention to cues. N = 62 smokers viewed smoking-related pictures and indicated the degree of craving each picture induced. While viewing the pictures, EEG was recorded, and the participants focused on the long-term negative (LATER) or short-term positive (NOW) consequences of smoking or performed an arithmetic task to distract themselves from processing the pictures (DISTRACT). After a break, all pictures were presented again without regulation instruction (re-exposure). Results revealed that LATER and DISTRACT achieved similar degrees of immediate ROC success, but only LATER had a sustained effect during re-exposure. In contrast, LPP amplitudes were more prominently reduced during DISTRACT than LATER, and there was no difference in LPP amplitudes during re-exposure. These findings imply that it may be beneficial to engage with the risks of drug use (reappraisal) rather than avoiding triggers of craving (distraction). However, these effects do not seem to be mediated by lasting changes in cue-related motivated attention (LPP).

Dissociating the Link of Neural Correlates of Inhibition to the Degree of Substance Use and Substance-Related Problems: A Preregistered, Multimodal, Combined Cross-sectional and Longitudinal Study.

BACKGROUND: Frontal hypoactivation during inhibition is a promising phenotype for substance use disorders (SUDs), but studies comparing individuals with SUDs with unaffected individuals have reported inconsistent results. This may result from distinctive associations of neural correlates of inhibition with the degree of substance use and the severity of substance-related problems-two correlated but distinct facets of SUDs-reflecting a potentially disregarded confounding effect. This preregistered study tested whether frontal hypoactivation during inhibition is specifically linked to substance-related problems in SUDs beyond the degree of substance use. METHODS: A stop signal task during functional magnetic resonance imaging, trait self-control, substance use, and substance-related problems in the past 12 months were assessed in 121 (poly)substance users. One hundred seven participants completed a 1-year follow-up. We examined the association between multimodal indicators of inhibition (neural activation in regions of interest, inhibitory performance, trait self-control) and substance-related problems while controlling for the degree of substance use. RESULTS: Right inferior frontal gyrus hypoactivation explained variance in substance-related problems beyond the degree of substance use, while hyperactivation in the same region explained variance in the degree of substance use beyond the effects of substance-related problems, both cross-sectionally (problems: Bonferroni-Holm-corrected p = .048; use: p < .01) and prospectively (problems at trend level: p = .096; use: p = .01). Trait and behavioral inhibition were unrelated to problems beyond the effects of substance use (ps > .05). CONCLUSIONS: We demonstrated that frontal hypoactivation during inhibition specifically relates to substance-related problems. Interestingly, increased activity may even represent a resilience factor in substance use without SUDs. Future studies should distinguish between processes linked to the degree of substance use and substance-related problems to advance understanding of why some substance users develop SUDs and others do not.

Are electrophysiological correlates of response inhibition linked to impulsivity and compulsivity? A machine-learning analysis of a Go/Nogo task.

Heightened impulsivity and compulsivity are often found in association with both dysfunctional everyday behavior and with psychopathology. Impulsivity and compulsivity are also linked to alterations in behavioral response inhibition and its electrophysiological correlates. However, they are rarely examined jointly and their effect outside of clinical samples is still disputed. This study assesses the influence and interaction of impulsivity and compulsivity as measured by questionnaires (Barratt Impulsiveness Scale, UPPS Impulsive Behavior Scale, and Obsessive-Compulsive Inventory-Revised) on behavioral performance and event-related potentials (N2, P3a, and P3b) in a visual Go/Nogo task. Data from 250 participants from the general population (49% female; age M = 25.16, SD = 5.07) were collected. We used robust linear regression as well as regression tree analyses, a type of machine learning algorithm, to uncover potential non-linear effects. We did not find any significant relationship between the self-report measures and behavioral or neural inhibition effects in either type of analysis, with the exception of a linear effect of the lack of premeditation subscale of the UPPS Impulsive Behavior Scale on behavioral performance. The current sample size was large enough to uncover even small effects. One possibility is that inhibitory performance was unimpaired in a non-clinical sample, suggesting that the effect of these personality traits on inhibition and cognitive control may require a clinical sample or a more difficult task version. Further studies are needed to uncover possible associations and interactions to delineate when impulsivity and compulsivity lead to dysfunctional everyday behavior and psychopathology.

Goal-Directed and Habitual Control in Human Substance Use: State of the Art and Future Directions.

Theories of addiction posit a deficit in goal-directed behavior and an increased propensity toward habitual actions in individuals with substance use disorders. Control over drug intake is assumed to shift from goal-directed to automatic or habitual motivation as the disorder progresses. Several diagnostic criteria reflect the inability to pursue goals regarding reducing or controlling drug use and performing social or occupational functions. The current review gives an overview of the mechanisms underlying the goal-directed and habitual systems in humans, and the existing paradigms that aim to evaluate them. We further summarize the current state of research on habitual and goal-directed functioning in individuals with substance use disorders. Current evidence of alterations in addiction and substance use are mixed and need further investigation. Increased habitual responding has been observed in more severely affected groups with contingency degradation and some outcome devaluation tasks. Reduced model-based behavior has been mainly observed in alcohol use disorder and related to treatment outcomes. Motor sequence learning tasks might provide a promising new approach to examine the development of habitual behavior. In the final part of the review, we discuss possible implications and further developments regarding the influence of contextual factors, such as state and trait variations, and recent advances in task design.

Social Factors Predict Distress Development in Adults With Pre-existing Mental Disorders During the Coronavirus Disease 2019 Pandemic.

Physical distancing measures during the coronavirus pandemic are associated with increased psychological distress, especially in people with mental disorders. We investigated which social risk and resilience factors influence distress over time in people with pre-existing mental disorders. We conducted a longitudinal online survey with weekly follow-ups between April and July 2020 (n = 196 individuals with, and n = 545 individuals without pre-existing mental disorders at baseline). Our results show that individuals with, but not those without pre-existing mental disorders displayed higher distress levels when social resources and empathic disconnection are low and perceived social isolation is high. The distress development differed between participants with and without pre-existing mental disorders depending on their level of social resources, empathic disconnection, and perceived social isolation. These findings offer specific information for targeted social interventions to prevent an increase in incidence of mental disorders during physical distancing measures.

Neural correlates of emotional reactivity predict response to cognitive-behavioral therapy in obsessive-compulsive disorder.

BACKGROUND: Examining predictive biomarkers to identify individuals who will likely benefit from a specific treatment is important for the development of targeted interventions. The late positive potential (LPP) is a neural marker of attention and elaborated stimulus processing, and increased LPP responses to negative stimuli are characteristic of pathological anxiety. The present study investigated whether LPP reactivity would prospectively predict response to cognitive-behavioral therapy (CBT), the first-line treatment for obsessive-compulsive disorder (OCD). METHODS: To this end, the LPP in response to negative as compared to neutral pictures was examined in 45 patients with OCD, who underwent CBT in a naturalistic outpatient setting. LPP amplitudes were used as predictors of symptom reduction after CBT. RESULTS: We found that higher LPP amplitudes to negative relative to neutral stimuli were predictive of lower self-reported OCD symptoms after completion of CBT, controlling for pre-treatment symptoms. Further, LPP reactivity was negatively correlated with self-reported habitual use of suppression in everyday life. LIMITATIONS: Some participants had already begun treatment at the time of study participation. Overall, results need further replication in larger samples and standardized therapy settings. CONCLUSIONS: The current findings suggest that patients with increased emotional reactivity benefit more from CBT, possibly through less avoidance of anxiety-provoking stimuli during exposure with response prevention, a crucial component in CBT for OCD. Although its clinical utility still needs to be evaluated further, the LPP constitutes a promising candidate as a prognostic marker for CBT response in OCD.

Interaction between habits as action sequences and goal-directed behavior under time pressure.

Human behavior consists in large parts of action sequences that are often repeated in mostly the same way. Through extensive repetition, sequential responses become automatic or habitual, but our environment often confronts us with events to which we have to react flexibly and in a goal-directed manner. To assess how implicitly learned action sequences interfere with goal-directed control, we developed a novel behavioral paradigm in which we combined action sequence learning through repetition with a goal-directed task component. So-called dual-target trials require the goal-directed selection of the response with the highest reward probability in a fast succession of trials with short response deadlines. Importantly, the response primed by the learned action sequence is sometimes different from that required by the goal-directed task. As expected, we found that participants learned the action sequence through repetition, as evidenced by reduced reaction times (RT) and error rates (ER), while still acting in a goal-directed manner in dual-target trials. Specifically, we found that the learned action sequence biased choices in the goal-directed task toward the sequential response, and this effect was more pronounced the better individuals had learned the sequence. Our novel task may help shed light on the acquisition of automatic behavioral patterns and habits through extensive repetition, allows to assess positive features of habitual behavior (e.g., increased response speed and reduced error rates), and importantly also the interaction of habitual and goal-directed behaviors under time pressure.

More by stick than by carrot: A reinforcement learning style rooted in the medial frontal cortex in anorexia nervosa.

Anorexia nervosa (AN) is characterized by a relentless pursuit of thinness, despite serious implications for health and social relations. In a previous study wielding the power of computational psychiatry, we found alterations in learning from negative feedback and in neural activity in the posterior medial frontal cortex (pMFC) in young acutely underweight AN patients (acAN). Here we ask whether these abnormalities are merely a state-related consequence of the illness or whether they might constitute a trait marker predisposing individuals to AN. To address this question, we employed the same reinforcement learning paradigm during fMRI with 31 female former AN patients after complete weight-recovery (recAN) and 31 age-matched healthy volunteers (15-28 years). Participants performed a decision task that required adaptation to changing reward contingencies. Data were analyzed within a hierarchical Gaussian filter model, which captures interindividual variability in feedback learning and decision-making under uncertainty. Similar to acute patients, individuals recovered from AN appear to emphasize negative over positive feedback when updating expectations regarding changing reward-punishment contingencies (difference in learning rate between punished and rewarded trials was increased in recAN: p = .006, d = .70. This behavioral pattern was mirrored in hyperactivation of the pMFC following negative feedback (FWE p < .001). Because the previously observed alterations in acANs are also evident after recovery and do not correlate with state variables like weight, altered feedback learning might be a trait marker of AN. The neural underpinnings of these alterations may lie in the pMFC. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Neural correlates of inhibitory control in relation to the degree of substance use and substance-related problems - A systematic review and perspective.

Inhibitory control deficits are associated with substance use disorders (SUDs) and considered a risk factor. Most studies compare SUD groups with unaffected individuals, although the degree of substance use might relate to inhibitory control deficits and explain group differences. This raises the question to which extent these deficits are specifically linked to substance-related problems. We review studies reporting associations of inhibition-related neural activation (stop signal and go/nogo task) with continuous measures of the degree of substance use and substance-related problems, and with substance-related problems controlling for the degree of substance use. Results suggest negative associations between inhibition-related neural activation and the degree of substance use, but are inconclusive on the association with substance-related problems. Nonetheless, two studies reported significant associations of inhibition-related neural activation with substance-related problems controlling for the degree of substance use. Despite numerous studies showing alterations in inhibition-related neural activation in SUDs, the role of the degree of substance use needs further investigation and studies using dimensional approaches are necessary to uncover specific links to substance-related problems.