Abstract
This study explored the clinical importance of latent impulsivity subtypes within a sample of individuals with substance use disorders (SUDs) and high rates of co-occurring disorders (CODs) receiving residential treatment, aiming to assess the heterogeneity of the associations between SUDs and CODs across such impulsivity subtypes. The abbreviated Barratt impulsiveness scale was used to assess motor and cognitive (attentional and nonplanning) impulsivity, a structured interview for diagnosis of SUD and CODs, and other clinimetric measures for severity of substance use. Latent class analysis was conducted to extract subgroups of impulsivity subtypes and Poisson regression to analyze effects of interactions of classes by CODs on severity of substance use. 568 participants were evaluated. Results featured a four-class model as the best-fitted solution: overall high impulsivity (OHI); overall low impulsivity; high cognitive-low motor impulsivity; and moderate cognitive-low motor impulsivity (MC-LMI). OHI and MC-LMI concentrated on most of the individuals with CODs, and individuals within OHI and MC-LMI showed more severity of substance use. The expression of this severity relative to the impulsivity subtypes was modified by their interaction with internalizing and externalizing CODs in very heterogeneous ways. Our findings suggest that knowing either the presence of trait-based subtypes or CODs in individuals with SUDs is not enough to characterize clinical outcomes, and that the analysis of interactions between psychiatric categories and behavioral traits is necessary to better understand the expressions of psychiatric disorders.
Highlights
Impulsivity is not a unitary construct; a well-founded body of evidence shows that it comprises several heterogeneous traits [1,2,3], which are helpful for describing and understanding different behavioral phenomena along the continuum from normality to pathology [4]
As useful as these findings are, they assume that the associations between impulsivity traits and co-occurring disorders (CODs) remain homogeneous across individuals and disorders, with little concern about the probable combinations of impulsivity traits and their mediated expression relative to specific disorders; for instance, individuals with low motor and high attentional impulsivity could show distinct outcomes when compared to individuals with overall high impulsivity (OHI); ; an individual with the former impulsivity profile diagnosed with major depression might show different clinical outcomes relative to an individual with the same impulsivity profile diagnosed with an anxiety disorder
The four-class model was retained in favor of theoretical parsimony, since clear recognizable patterns related to impulsivity traits could be identified (Figure 2)
Summary
Impulsivity is not a unitary construct; a well-founded body of evidence shows that it comprises several heterogeneous traits [1,2,3], which are helpful for describing and understanding different behavioral phenomena along the continuum from normality to pathology [4]. Published research tend to address the issue of impulsivity profiling by formation of groups based on levels of impulsivity derived from sum scores, or by linear associations between these sum scores of impulsivity and specific psychiatric variables, within usually small and single-diagnosed samples [4, 13, 14] As useful as these findings are, they assume that the associations between impulsivity traits and CODs remain homogeneous across individuals and disorders, with little concern about the probable combinations of impulsivity traits and their mediated expression relative to specific disorders; for instance, individuals with low motor and high attentional impulsivity could show distinct outcomes when compared to individuals with overall high impulsivity (OHI); ; an individual with the former impulsivity profile diagnosed with major depression might show different clinical outcomes relative to an individual with the same impulsivity profile diagnosed with an anxiety disorder. The common impulsivity findings do not account for the empirical recognition of the multiple interrelations of impulsivity traits across individuals, for the heterogeneous interactions between these patterns and psychiatric disorders, or for the effects of these interactions on the expression of multiple clinical outcomes
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