Neural Bases of Affect-Based Impulsivity: A Decision Neuroscience Account.

Affect-based impulsivity describes the tendency to behave impulsively while experiencing negative or positive affective states. In the context of psychiatric disorders, the consequences of affect-based impulsivity can be dire, including suicidal behavior and harmful substance use. Here, we articulate a decision neuroscience account, recasting affect-based impulsivity in terms of Pavlovian and goal-directed decision systems. We consider how negative affect influences whether to act, what actions to consider, which action to select, and how vigorously to engage in a selected action. Further, we describe the neural and neuroendocrine bases of these computations. Specifically, we propose that modulation of norepinephrine and glucocorticoids during negative affective states enhances the pursuit of rewards by reducing goal-directed computations and increasing appetitive Pavlovian computations.

Affect-based impulsivity describes the tendency to behave impulsively while experiencing negative or positive affective states. In the context of psychiatric disorders, the consequences of affect-based impulsivity can be dire, including suicidal behavior and harmful substance use. Here, we articulate a decision neuroscience account, recasting affect-based impulsivity in terms of Pavlovian and goal-directed decision systems. We consider how negative affect influences whether to act, what actions to consider, which action to select, and how vigorously to engage in a selected action. Further, we describe the neural and neuroendocrine bases of these computations. Specifically, we propose that modulation of norepinephrine and glucocorticoids during negative affective states enhances the pursuit of rewards by reducing goal-directed computations and increasing appetitive Pavlovian computations.

The association between eating disorders (EDs) and harmful substance use (substance use that causes psychosocial impairment) is well recognized in the literature, and military veterans may be at heightened risk for both issues due to deployment-related stressors. However, little is known about which ED-related symptoms are associated with harmful substance use in veterans, and whether gender plays a differential role in this relationship. Our aims were to: (1) examine gender differences in ED-related symptoms; and (2) examine whether ED-related symptoms differentially predict harmful substance use in US veteran men and women who had recently separated from service. This study was based on a nationally representative four-wave longitudinal sample of post-9/11 veterans (N = 835; 61.2% female). Longitudinal mixed modeling was used to test whether specific ED-related behaviors at baseline predicted harmful substance use at follow-ups. We replicated gendered patterns of ED-related symptoms observed in civilian populations, wherein men had higher weight-and-body-related concerns (including excessive exercise and muscle building) and negative attitude toward obesity, and women had higher bulimic and restricting symptoms. For women, alcohol, drug, and marijuana problems were predicted by higher bulimic symptoms, whereas for men, these problems were predicted by higher restricting symptoms. Gender played a differential role in the relationship between EDs and harmful substance use. Bulimic symptoms were the most robust predictor for harmful substance use among veteran women, whereas restricting was the most robust predictor for harmful substance use among veteran men. The current study found that veteran women had higher bulimic symptoms (characterized by binge eating and purging) and restricting than veteran men. In women, bulimic symptoms predicted future harmful use of alcohol, marijuana, and other drugs. In contrast, veteran men had higher weight-and-body-related concerns (characterized by excessive exercise and muscle building) than veteran women. In men, restricting symptoms predicted future harmful use of alcohol, marijuana, and other drugs.

Objective: Binge eating, characterized by eating a large amount of food accompanied by a sense of loss of control over eating, is a public health crisis. The affect regulation model of binge eating posits that elevated negative affect increases momentary risk for binge eating, as engaging in binge eating alleviates negative affect and reinforces the behavior. However, the field's existing capacity to identify moments of elevated negative affect, and thus risk for binge eating, has exclusively relied on ecological momentary assessment (EMA), which involves the completion of surveys in real time on one's smartphone to report behavioral, cognitive, and emotional symptoms. EMA surveys are often delivered only 5-6 times per day, involve self-report of affect intensity only, and are unable to assess affect-related physiological arousal. Wearable, psychophysiological sensors that measure markers of affect arousal (e.g., heart rate, heart rate variability, and electrodermal activity) may augment EMA surveys to improve our capacity to accurately detect risk for binge eating in real time. However, it is unknown whether data from these sensors can adequately distinguish between positive and negative affect states, as physiological arousal may occur during both negative and positive affect states. The aims of this study were: 1) test the hypothesis that sensor features can distinguish positive and negative affect states in individuals with binge eating with > 60% accuracy, 2) test the hypothesis that a machine learning algorithm using sensor data and EMA-reported negative affect data to predict binge eating episodes can predict binge eating with greater accuracy than an algorithm using EMA-reported negative affect alone, 3) evaluate the feasibility and acceptability of using sensors among adults with binge eating. The study also involved an exploratory aim to evaluate user design preferences for a sensor-powered ecological momentary intervention system for adults with binge eating. Method: The study recruited 30 individuals with clinically significant binge eating who wore Fitbit Sense 2 smartwatches to passively measure heart rate and electrodermal activity and reported affect and binge eating on EMA surveys for four weeks. The participants and 6 community eating disorder clinicians completed self-report surveys and qualitative interviews on the feasibility, acceptability, and user design preferences for a future sensor-integrated momentary intervention. Results: The best performing model using sensor data to distinguish positive and negative affect demonstrated accuracy of 0.63, sensitivity of 0.20, and specificity of 0.93; the model's accuracy exceeded 0.60 indicating adequate accuracy. The best performing model using EMA data alone for predicting binge eating had accuracy of 0.65, sensitivity of 0.53, and specificity of 0.69. The optimal model combining EMA data and sensors data for the predicting binge eating demonstrated accuracy of 0.58, sensitivity of 0.90, and specificity of 0.48. Mixed methods data from both participants with binge eating and eating disorder clinicians substantiated the feasibility and acceptability of smartwatches and a future sensor-integrated digital intervention for binge eating. Participants with binge eating and community eating disorder clinicians preferred the just-in-time adaptive intervention format. Conclusions: Findings from the present study indicate that data from psychophysiological sensors included in commercial smartwatches can distinguish between instances of positive and negative affect among individuals with binge eating and that these data augment EMA data for accurate prediction of binge eating episodes. Individuals with binge eating and eating disorder clinicians are enthusiastic about the potential for a digital intervention to augment outpatient therapy and data collected in this study set the stage for the future user-centered design of such an intervention.

Violence, poor mental health, and harmful substance use are commonly experienced by female sex workers (FSWs) in sub-Saharan Africa, all of which are associated with increased HIV susceptibility. We aimed to investigate the associations between violence, poor mental health and harmful alcohol/substance use with hair cortisol concentration (HCC) levels as a potential biological pathway linking the experiences of these stressors and HIV vulnerability. We used the baseline data of the Maisha Fiti study of FSWs in Nairobi, Kenya. Participants reported recent violence, poor mental health, and harmful alcohol/substance use. Hair samples proximal to the scalp were collected to measure cortisol levels determined by ELISA. We analysed the data of 425 HIV-negative respondents who provided at least 2 cm of hair sample. The prevalence of recent violence was 89.3% (physical 54.6%; sexual 49.4%; emotional 77.0% and financial 66.5%), and 29.1% had been arrested due to sex work. 23.7% of participants reported moderate/severe depression, 11.6% moderate/severe anxiety, 13.5% PTSD and 10.8% recent suicidal thoughts and/or attempts. About half of the participants (48.8%) reported recent harmful alcohol and/or other substance use. In multivariable linear regression analyses, both physical and/or sexual violence (adjusted geometric mean ratio (aGMR) = 1.28; 95% CI 1.01–1.62) and harmful alcohol and/or other substance use (aGMR = 1.31; 95% CI 1.03–1.65) were positively and independently associated with increased HCC levels. Findings suggest a role of violence and substance use in elevated HCC levels, which could increase HIV risk due to cortisol-related T cell activation. However, longitudinal and mechanistic studies are needed to confirm this hypothesis.

Objective: Appetitive risk behaviors (ARB), including tobacco use, alcohol consumption, consumption of calorie dense/nutrient-poor foods, and sexual risk behavior contribute substantially to morbidity and mortality. Affective states that arise from a wide array of unrelated circumstances (i.e., incidental affect) may carry over to influence ARB. A meta-analysis is needed to systematically examine causal evidence for the role of incidental affect (including specific emotions) in influencing ARB. Method: Integrating effect sizes from 91 published and unpublished experimental studies that include both an incidental-affect induction and neutral-control condition (k = 271 effect sizes: k = 183 negative affect, k = 78 positive affect), this meta-analysis examines how negative and positive affective states influenced ARB and related health cognitions (e.g., intentions, evaluations, craving, perceived control). Results: Negative affective states reliably increased ARB, in analyses where all negative affective states were analyzed (d = .29) and in stratified analyses of just negative mood (d = .30) and stress (d = .48). These effects were stronger among study populations coded as clinically at risk. Positive affective states generally did not influence ARB or related health cognitions, except in the presence of a craving cue. Design issues of extant literature largely precluded conclusions about the effects of specific positive and negative affective states. Conclusion: Taken together, findings suggest the importance of strategies to attenuate negative affect incidental to ARB to facilitate healthier behavioral patterns, especially among clinically at-risk individuals. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Exercise is increasingly understood as an important resource for people who engage in harmful substance use, including those in prison. Little is known about how inmates adopt various health behaviors during incarceration, without interventions. This cross-sectional study analyzed self-reports from 1464 inmates in Norwegian prisons in 2013–2014, compared them according to harmful substance use pre-incarceration, and explored changes in exercise and nicotine use during incarceration. Results were presented in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Inmates with harmful substance use reported higher rates of smoking, smokeless tobacco, and physical inactivity pre-incarceration than inmates without harmful use. However, inmates with harmful use also exhibited more behavioral changes: they adopted exercise, ceased smoking, and adopted smokeless tobacco at higher rates during incarceration than the non-harmful group, to the extent that inmates with harmful use exercised during incarceration more. Exercise is being taken up by a significant proportion of inmates, and may in particular be a replacement behavior for substance use. However, unhealthy behaviors also begin or are maintained. If prisons were used as an arena to facilitate healthy behaviors, the public health benefits to a marginalized group such as substance-using inmates could be substantial.

Purpose: How to detect early harmful and hazardous substance use in workplace: a qualitative study. Background: Workers under the influence of psychoactive substances are more likely to commit unsafe acts which damage themselves, others’ lives, and the organization. A question is how to detect substance misuse early in the workplace, without punitive or coercive actions. This study evaluated the implementation of a screening (S) and brief intervention (BI) of substance misuse through (1) the barriers faced and the solutions presented by occupational health professionals when implementing SBI, and (2) the feasibility to use the SBI in this environment for such a preventive procedure. Methods: An action research methodology was used in this study in a City Hall in a southern city of Brazil. First, 26 professionals of the Occupational Health Service were trained in a 20 h course about: psychoactive substances’ effects, how screening (S) using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), and how doing BI. After training, they received supervision in doing the task goal of applying SBI in their routine in a random sample of 5% of the employees (the total was 26,129). One year later, two focus group meetings were held with all professionals. Results: The trained professionals were 11 psychologists, 12 social workers, one organizational development analyst, one occupational therapist, and one cultural promoter; 99.2% female; 46 ± 4 years old; 80.6% married. During a one-year period, they detected, in a representative sample of employees (n=1,310), 144 individuals in risky use and 139 dependents on tobacco, alcohol and/or other substances. At three-month follow-up they observed a significant reduction in ASSIST scores. The action research improved the implementation of SBI for substance use in their routine. Professionals agreed that SBI facilitates talking about substances without prejudice or stigma, enabling earlier detection, intervention, and treatment referral. Conclusion: SBI was feasible in this workplace to prevent hazardous/ harmful substance use.

Florez-Salamanca and colleagues’ study1 of transitioning from DSM-IV substance abuse to dependence in this issue of The American Journal of Drug and Alcohol Abuse is important, in part, because the topic represents the juncture of several contemporary unresolved issues that are critical to healthcare. Harmful compulsive substance use, termed substance use disorder (SUD) in Diagnostic and Statistical Manuals (DSM), is among the most prevalent medical conditions. Lifetime DSM-IV SUD prevalence in the U.S. consequent to habitual use of tobacco, alcohol and illegal drugs, respectively, is 24%, 20% and 10%.2–4 Globally, smoking is the 4th leading contributor to disease burden, alcoholism is the 5th leading cause and illegal drug use is the 15th.5In the U.S. alone, harmful substance use costs the nation well over $400 billion annually6 due to consequences such as SUD treatment, crime, traffic accidents, medical and psychiatric disorder, domestic violence, child abuse/neglect, underemployment and job-related injury, suicide, traumatic injuries, and sexually transmitted disease including HIV/AIDS. Thus, research on SUD etiology and developmental transitions has tremendous potential to benefit at-risk individuals, their families and society.

Epidemiological literature suggests that urbanization is potentially linked to a number of stressors that could be associated with harmful substance use and mental disorders. This may vary by country. This review gives attention to emergent literature examining the pathways between urbanization and harmful substance use. Studies examining the links between urbanization, mental health and substance use suggest complex pathways between urbanization and substance use as well as a range of modifying variables that could contribute to these associations. Such variables include increased supply of illicit and licit substances brought about by economic development, globalization and technology as well as an increased demand for particular substances. Rural areas may also have unique factors associated with harmful substance use but these are beyond the scope of this review. We have presented evidence to suggest potential associations between urbanization and harmful substance use. We acknowledge that data are limited because of a paucity of longitudinal studies elucidating these relationships.

IntroductionClimate change is increasing the frequency and intensity of severe heatwaves, storms, floods, droughts, and wildfires. These events cause widespread economic and social disruption and are undermining population health worldwide. Despite a growing literature on how climate change threatens mental health, its influence on harmful substance use has not been systematically addressed.ObjectivesWe propose an explanatory framework explicating the plausible links between climate change-related stressors and an increase in harmful substance use.MethodsWe critically review and synthesise literature documenting the pathways, processes and mechanisms linking climate change to increased substance use vulnerability.ResultsSeveral plausible pathways link climate change to increased risk of harmful substance use worldwide. These include: (1) anxiety about the impacts of unchecked climate change, (2) destabilisation of psychosocial and economic support systems, (3) increasing rates of mental disorders, and (4) increased physical health burden. Children may face disproportionate risk due to their vulnerability to both mental disorders and substance use, particularly during adolescence. We argue that a developmental life-course perspective situated within a broader ‘systems thinking’ approach provides a coherent framework for understanding how climate change is aggravating the multiple, persistent, interacting risks that influence harmful substance use pathways.ConclusionsClimate change is already undermining health and wellbeing of global populations. By inference, it is also aggravating pathway to harmful substance use. This is a critical psychosocial problem for individuals and communities alike. Conceptual and methodological work is urgently needed so that effective adaptive and preventive action can be taken.DisclosureNo significant relationships.

ABSTRACTNightshift workers experience circadian misalignment thus negatively impacting many physiological systems which can change subjective states such as affect. The current study examined change in affect and affective state across a simulated first nightshift. Ninety sleep‐deprived college students (33% female) completed a series of surveys and tasks across four testing sessions during the night. The participants completed the Positive and Negative Affect Schedule at the beginning of each testing session. Using these affect scores, we derived four affective state types defined by high and low positive and negative affect (Self‐actualizing‐high positive affect with low negative affect, High affective‐high positive affect with high negative affect, Self‐destructive‐low positive affect with high negative affect, Low affective‐low positive affect with low negative affect). A 2 (positive affect/negative affect) x 4 (time) repeated measures ANOVA was used to examine change over time in the positive and negative affect scores. A Friedman test with a Wilcoxon Signed Ranks test was performed to determine if there was a significant change in affective state across the four testing sessions. The current results indicate that positive affect decreased across the night while negative affect remained low and stable. The four derived affective states changed across the night with decreases in the high positive affective states, and increases in low positive affective states. These results suggests that nightshift workers experience stress‐inducing conditions that negatively impact positive affect and affective state. Workers and organisations should anticipate decreased positive affect and positive affective states during nightshifts and consider appropriate mitigation strategies.

Harmful substance use is prevalent among bisexual emerging adults, due in part to their unique minority stressors. The goals of this study were (a) to classify cisgender bisexual emerging adults, ages 18–29 years, based on their substance (i.e., alcohol and other drug) use and (b) to identify modifiable psychosocial variables associated with substance use group membership. Bisexual women (N = 249, M age=23.35) and men (N = 201, M age=23.31) were recruited on the Internet via the CloudResearch platform. Participants answered a 20-minute survey assessing substance use, lifetime traumas, romantic relationships, sexual-minority related stressors, and structural influences on interpersonal violence exposure. Self-reported substance use was used to classify participants using Ward’s method cluster analysis. Among bisexual women, self-esteem was the only variable that differed significantly between the low and high substance use clusters. Among bisexual men, significant differences in mean scores were documented for sexual identity disclosure, felt sexual stigma, everyday discrimination, internalized sexual stigma, and self-esteem across three substance use clusters. Our findings provide important information for tailoring selected prevention initiatives among bisexual men and emphasize the importance of screening bisexual emerging adults for both harmful substance use and sexual minority stressors.

Despite evidence that affect shapes perceptions of workplace relationships, the role of affect in the reciprocal exchange process of leader–member exchange (LMX) theory is often overlooked. We argue that this is likely due to a continued focus on global assessments of LMX quality, rather than examination of the reciprocal, interlocked actions and reactions that take place daily between members of the dyad. A leader's affective state may indeed spark this reciprocal exchange process on a daily level and ultimately shape the state of the leader–follower relationship. In this study, we integrate LMX theory and emotions‐as‐social‐information (EASI) theory to examine how the leader's negative and positive affective states uniquely contribute to the reciprocal exchange process. In doing so, we advance understanding of the distinction of state LMX as well as the unique process for leader's negative affective state within the reciprocal exchange process. Using a 15‐day experience sampling methodology study of 76 leader–follower dyads, we find that a leader's positive and negative affective states transmit effects along the affective and inferential paths posited in EASI theory to influence follower performance on a daily basis. Interestingly, a leader's positive affective state is stronger along the affective path and a leader's negative affective state is stronger along the inferential path. We also find that leaders reciprocate the daily shift in follower performance with OCBI directed toward the follower. Finally, as expected, the reciprocal exchange process alters state LMX (leader rated).

The Module ”Self-Control and Avoiding Harmful Substance Use” highlights key aspects of parental education, where the educator will explain to parents why discussing harmful substance use is essential. It emphasizes that an informed and attentive parent is far more likely to prevent their child from using harmful substances than a parent who dismisses the topic with statements like, "This can't happen to me" or "My child would never do that." In the first part of the module, the parental educator will introduce participants to the concept of harmful substance use, what harmful substances are and their various types, through practical activities, participants will explore why teenagers may turn to harmful substances. The module will include case studies and examples, providing a basis for group discussions. In the second part, topics will focus on: identifying signs of substance use among teenagers, understanding different types of users practical advice for parents on prevention and steps to take in case of emergencies, including where to seek help. The module includes brainstorming exercises and hands-on activities to enhance understanding and practical application. This module is part of the materials dedicated to the training of parental educators.