Problematic Alcohol Use Research Articles

EMPOWERING ADULTS SEEKING RECOVERY FROM SUBSTANCE AND OPIOID USE DISORDER IN THE DEEP SOUTH

Abstract Substance and opioid use disorder may be missed due to lack of consideration of physical, social, and emotional changes in midlife and later adulthood. This presentation uses data from a Graduate Psychology Education grant to examine predictors of alcohol use and misuse among treatment-seeking and primary care patients. Across three sites, 237 individuals completed behavioral health assessments; a rural (n = 54) and an urban federally qualified health center (n = 59), and a state-certified residential rehabilitation facility (n = 124). Participants ranged from 18 to 70 years of age (M = 40.05, SD = 1.75). Approximately 49.4% were female and 72.2% were non-Hispanic White, 23.3% African American, and 4.6% other. More than 28% of individuals had less than a high school education, and 38.4% reported a high school education or GED. Using the TAPS-II, 34.2% of participants reported alcohol use, and 13.5% reported prescription opioid misuse. Logistic regression analyses revealed that older age, prescription opioid misuse, and depression were significantly associated with alcohol use, χ2 (7) = 18.04, p = 0.12, while gender, report of adverse childhood experiences, and anxiety were not. Holding age, gender, and experiences constant, prescription opioid misuse had a significant effect on the probability of alcohol use, B = 1.092, SE = .429; Wald = 6.496, p = 0.01. The odds of alcohol use increased by a factor of 2.98 for individuals misusing prescription opioids. Treatment for problematic alcohol use must consider contextual influences including age, prescription opioids, and depression to implement effective evidence-based treatment.

Adverse childhood experiences, discrimination, and substance use among Latino/a/Hispanic youth

Underserved racial/ethnic minoritized youth disproportionately experience adverse childhood experiences (ACEs) and discrimination, potentially leading to substance use disparities. Understanding the co-occurrence of ACEs and discrimination can identify predictors of substance use. Latino/a/Hispanic youth (N = 1,179) completed surveys from 2005-2016; ACEs and discrimination were assessed when participants were on average 21.6 and 23.9 years for substance use. Latent class analysis examined differential co-occurrence of ACEs and discrimination and regression analysis investigated their longitudinal associations with tobacco, alcohol, problematic alcohol, and marijuana use in young adulthood. A 4-class solution identified a “low adversity” (n = 378; 32.06%) group; next the “psychological abuse and discrimination” (n = 361; 30.62%); then “psychological, physical abuse and microaggressions” (n = 258; 21.88%) and “mainly microaggressions” (n = 182; 15.44%) groups. Compared to “mainly microaggressions,” the “psychological abuse and discrimination” group reported higher alcohol use (B=.316, p=.04) in young adulthood. Prevention should focus on reducing ACEs and discrimination exposure to lessen Latino/a/Hispanic youth behavioral health disparities.

Implications of intimate partner physical violence and substance misuse for parenting

AbstractApproximately 35%–45% of young married adults engage in intimate partner violence (IPV), and it is possible to reliably distinguish between general IPV and clinically significant IPV in a manner accepted both by DSM‐V & ICD‐11. IPV and alcohol misuse have been associated in many research designs, and experts now argue that alcohol misuse causes IPV. While less research exists on other substances like marijuana, there is clearly a moderate association between marijuana use and IPV, and that association appears to be dose‐dependent. Both IPV and substance use disorders (SUD), especially alcohol misuse, have been associated with a host of both internalizing and externalizing problems of children and adolescents. Research on the co‐morbid effects of IPV and substance misuse is relatively new but there are documented cumulative effects of IPV, problematic alcohol use, problematic drug use, and depressive symptoms on aggressive and neglectful parental disciplinary practices. Fortunately, research on the effects of both alcohol misuse and IPV shows that while both can have deleterious effects on children, the majority of children exposed to either IPV or alcohol misuse do not grow up to have diagnoses of emotional or behavioral problems. Support from one parent, a teacher, or extended family members, as well as the ability to maintain family rituals, serve as protective factors for children. Recommendations are made regarding reviews of assessment of IPV and substance misuse as well as a guide for conceptualizing and completing forensic evaluations involving IPV and substance misuse.

Wine-Mom Culture, Alcohol Use, and Drinking Motives: A Descriptive Study and Cross-Cultural Exploration of American and British Mothers

Objective: “Wine-mom” culture, which promotes the idea that women should use alcohol to cope with the stressors of parenting, is pervasive in modern society, yet remains an under-researched variable in the context of women’s alcohol use. The present investigation was a descriptive study and cross-cultural exploration (United States vs. United Kingdom) of the association between wine-mom culture (perceptions of wine-mom culture and related behaviors) and various alcohol-related outcomes, parenting experiences, and drinking motives. Methods: This study included 233 American and 233 British mothers recruited through Prolific. Participants completed the study questions/questionnaires in Qualtrics; they completed nine items measuring their perceptions of and engagement with wine-mom culture, the Alcohol Use Disorders Identification Test, the Parental Stress Scale, and the Drinking Motives Questionnaire-Revised, along with questions about their alcohol use and parenting experiences. Results: Our results indicated that although American mothers were more familiar with wine-mom culture than British mothers, the correlations observed were similar for both groups. Some of the wine-mom culture variables were associated with problematic alcohol use and parenting stress. Additionally, wine-mom culture-related behaviors had moderate to strong positive correlations with drinking to cope motives. Conclusion: Our findings suggest that future research should examine the role of wine-mom culture in the perception that alcohol can—or should—be used as a form of self-medication. Other future directions and considerations for this area of study are discussed.

A Longitudinal Examination of Multiple Forms of Stigma on Minority Stress, Belongingness, and Problematic Alcohol Use

A Longitudinal Examination of Multiple Forms of Stigma on Minority Stress, Belongingness, and Problematic Alcohol Use

Relationship quality, COVID stress, and mental health in sexual and gender minority young adults

Sexual and gender minority (SGM) individuals, particularly those assigned female at birth (AFAB), have shown poor mental health outcomes during the COVID-19 pandemic. This issue highlights the importance of identifying factors that may promote SGM-AFAB mental health during the pandemic and protect SGM-AFAB individuals against the negative psychological effects of COVID-related stress. Grounded in previous research and theory suggesting that high quality romantic relationships have promotive (i.e., main) and protective (i.e., stress-buffering) effects on partner’s mental health, we explored associations between relationship quality, COVID-related stress, and mental health among SGM-AFAB individuals. Specifically, we tested whether (1) higher relationship quality, as a promotive factor, was directly associated with fewer mental health problems (depressive and anxiety symptoms, problematic alcohol and cannabis use), and (2) relationship quality, as a protective factor, had a stress-buffering effect, reducing the negative effect of COVID stress on mental health within SGM-AFAB young people. Between May 2020-July 2021, 227 SGM-AFAB individuals (ages 19–35; M = 23.5) in current romantic relationships completed measures of pandemic-related stress, relationship quality, depressive and anxious symptoms, and problematic alcohol and cannabis use. As hypothesized, relationship quality was negatively associated with anxious and depressive symptoms and problematic cannabis use. Relationship quality attenuated the positive association between COVID stress and depression, but not the other mental health outcomes. Findings suggest that high-quality romantic relationships may promote mental health and have a stress-buffering effect for depressive symptoms among SGM-AFAB individuals during major society-wide stressors.

Service-level barriers to and facilitators of accessibility to treatment for problematic alcohol use: a scoping review.

Services to treat problematic alcohol use (PAU) should be highly accessible to optimize treatment engagement. We conducted a scoping review to map characteristics of services for the treatment of PAU that have been reported in the literature to be barriers to or facilitators of access to treatment from the perspective of individuals with PAU. A protocol was developed a priori, registered, and published. We searched MEDLINE®, Embase, the Cochrane Library, and additional grey literature sources from 2010 to April 2022 to identify primary qualitative research and surveys of adults with current or past PAU requiring treatment that were designed to identify modifiable characteristics of PAU treatment services (including psychosocial and pharmacologic interventions) that were perceived to be barriers to or facilitators of access to treatment. Studies of concurrent PAU and other substance use disorders were excluded. Study selection was performed by multiple review team members. Emergent barriers were coded and mapped to the accessibility dimensions of the Levesque framework of healthcare access, then descriptively summarized. One-hundred-and-nine included studies reported an extensive array of unique service-level barriers that could act alone or together to prevent treatment accessibility. These included but were not limited to lack of an obvious entry point, complexity of the care pathway, high financial cost, unacceptably long wait times, lack of geographically accessible treatment, inconvenient appointment hours, poor cultural/demographic sensitivity, lack of anonymity/privacy, lack of services to treat concurrent PAU and mental health problems. Barriers generally aligned with recent reviews of the substance use disorder literature. Ranking of barriers may be explored in a future discrete choice experiment of PAU service users. The rich qualitative findings of this review may support the design of new or modification of existing services for people with PAU to improve accessibility. Open Science Framework doi: 10.17605/OSF.IO/S849R.

Multi-ancestry study of the genetics of problematic alcohol use in over 1 million individuals

Problematic alcohol use (PAU), a trait that combines alcohol use disorder and alcohol-related problems assessed with a questionnaire, is a leading cause of death and morbidity worldwide. Here we conducted a large cross-ancestry meta-analysis of PAU in 1,079,947 individuals (European, N = 903,147; African, N = 122,571; Latin American, N = 38,962; East Asian, N = 13,551; and South Asian, N = 1,716 ancestries). We observed a high degree of cross-ancestral similarity in the genetic architecture of PAU and identified 110 independent risk variants in within- and cross-ancestry analyses. Cross-ancestry fine mapping improved the identification of likely causal variants. Prioritizing genes through gene expression and chromatin interaction in brain tissues identified multiple genes associated with PAU. We identified existing medications for potential pharmacological studies by a computational drug repurposing analysis. Cross-ancestry polygenic risk scores showed better performance of association in independent samples than single-ancestry polygenic risk scores. Genetic correlations between PAU and other traits were observed in multiple ancestries, with other substance use traits having the highest correlations. This study advances our knowledge of the genetic etiology of PAU, and these findings may bring possible clinical applicability of genetics insights—together with neuroscience, biology and data science—closer.

Structural Topic Modeling Suggests Importance of Relationships in Addiction Recovery

Despite the great deal of literature on the problem of heavy drinking and alcohol use, there is relatively little investigation into the lived experience of recovery. The current study addresses this gap through an exploratory thematic analysis of Personal Stories of recovery published in the Alcoholics Anonymous Grapevine magazine. Alcoholics Anonymous (AA) is an abstinence-oriented, social support based recovery program. Over 300 Personal Stories were transcribed and analyzed using the Structural Topic Modeling package for R. The model with optimal semantic coherence and exclusivity outlining the five most prevalent topics across all Personal Stories was selected. The five topics were conceptualized and labeled as Relationships and Spirituality, Positive Change, AA and The Fellowship, Addiction and Consequences, and Family. The results of this study suggest social connection to have a strong influence on the recovery process. The topic model also suggests that individuals who find success in sobriety through involvement with AA may truly adopt the principles of the program as their own. Considerations for future directions are discussed.

Transforming guided internet interventions into simplified and self-guided digital tools – Experiences from three recent projects

IntroductionTherapist-guided internet interventions are often more efficacious than unguided ones. However, the guidance itself requires clinician time, and some research suggests that self-guided interventions could potentially be equally effective. The concept of digital psychological self-care, self-guided internet interventions based on the use of digital tools and provided within a structured clinical process, is presented. MethodsThree new self-care interventions, a sleep diary-based intervention for insomnia, an alcohol diary-based intervention for problematic alcohol use and an intervention with exposure and mindfulness tools for atopic dermatitis (eczema), were developed. Newly developed digital self-care interventions were compared to the earlier therapist-guided interventions they were based on, using published results from three feasibility trials (n's = 30, 36 and 21) and three randomized trials (n's = 148, 166 and 102). The comparison included type of content, duration, length of written material and within-group effect-sizes. ResultsIn comparison to the guided interventions, clinician time was greatly reduced and the new interventions involved much less reading for participants. The digital self-care tools also showed within-group effect sizes and response rates on par with the more comprehensive guided internet interventions. DiscussionPreliminary results suggest that some guided internet interventions can be transformed into self-guided digital tools. These three examples show that digital psychological self-care, if provided with telephone interviews before and after the intervention, can be viable alternatives to more comprehensive guided internet interventions. Although these examples are promising, further studies, including randomized experiments, are needed to compare treatment efficacies, and to identify which groups of patients may need more comprehensive guided internet interventions.

Alcohol use among adolescents in Macao during COVID-19: a latent class analysis

ABSTRACT Objective The objective of this study was to estimate the prevalence of past alcohol use and to evaluate patterns of alcohol use among Chinese adolescents. Methods 1,707 students from 11 high schools in Macao (SAR) China self-reported their alcohol use measured by the Alcohol Use Disorder Identification Test (AUDIT). Latent class analysis and multinomial logistic regression were conducted to examine patterns of drinking and their correlates with alcohol-related use problems. Results The prevalence of past alcohol use and problematic alcohol use (AUDIT ≥8) was 26.0% and 3.2%, respectively. Latent class analysis demonstrated that a five-class model best fit the participants’ alcohol use patterns, including a heavy consumption group, two moderate consumption groups and two light consumption groups. Compared with the light consumption group, adolescents over the age of 15 (vs. 15 years or younger) were more likely to be classified into the moderate consumption group with mild negative consequences, and adolescents who smoked were more likely to be classified into all other groups vs. the reference group. Conclusion The results suggest a high prevalence of alcohol use and several sub-groups were at increased odds of alcohol related harms.

Microaggressions, perceptions of campus climate, mental health, and alcohol use among first-year college students of color.

Depressive and anxiety symptoms are increasingly common, and problematic alcohol use remains prevalent in college. To expand on prior research on mostly white samples, we surveyed first-year students of color from our predominately white university (Southeastern US) to identify risk factors for mental health symptoms and potentially co-occurring problematic alcohol use. Results showed significant associations between microaggressions and poor campus climate (hypothetical predictors) with depressive, anxiety, somatic symptoms (hypothetical outcomes) that were indirectly linked through perceived stress, poor sleep, and academic burnout (hypothetical mediators). Poor campus climate, academic burnout, and using alcohol to cope were the most relevant to alcohol use disorder symptoms. Results support efforts to address and reduce racial microaggressions and promote a positive campus climate for all.

Problem Gambling and Sexual Minority Individuals: Evaluating Influence of Age and Comorbid Mental Health and Substance Use Problems.

Little is known about the prevalence of problem gambling among sexual minority individuals. The present study utilized an epidemiological sample, including individuals identifying as lesbian, gay, bisexual, asexual, and pansexual, to explore gambling behavior and problems and associated mental health and comorbid conditions that may contribute to elevated risk. Bivariate comparisons found that sexual minority individuals had higher rates of problem gambling, alcohol and substance use problems, anxiety, depression, and a wide range of problem behaviors (e.g., binge eating, prostitution, excessive video gaming) than heterosexuals. In a logistic regression, age moderated the relationship between sexual minority status and problem gambling, such that the risk for high-risk problem gambling increased with age for sexual minority individuals while it decreased for heterosexuals. Additionally, a logistic regression of sexual minority individuals who gamble found anxiety (OR = 3.80, 95% CI = 1.03, 13.97) and drug problems (OR = 8.57, 95% CI = 1.79, 41.05) predicted high-risk problem gambling. Findings suggest that prevention and screening protocols are needed in systems accessed by sexual minority individuals, particularly those middle age and older, as well as in settings where anxiety and substance use disorders are treated.

Social media addiction as a mediator of the associations between fear of COVID-19, mental health symptoms, and problematic alcohol use.

Fear of COVID-19 is a risk factor for anxiety and depressive symptoms. During the COVID-19 pandemic, drinking to cope with psychological distress has been proposed as a key mechanism leading to problematic drinking. The goal of this study was to test social media addiction as a mediator linking fear of COVID-19 to mental health symptoms and problematic alcohol use. In between April 6 and July 2 of 2022, 250 participants completed an online survey as part of the National Institute on Alcohol Abuse and Alcoholism COVID-19 Pandemic Impact on Alcohol Study. Path analyses were conducted to test the mediational pathways. Using the polythetic classification scheme, 13.2% (n = 33) of participants were classified as having social media addiction. Compared with participants without social media addiction, participants with social media addiction spent significantly more time on social media platforms and on digital communications with a family member or friend. They also reported greater fear of COVID-19, higher anxiety symptoms, and higher depressive symptoms. Path analyses indicated that social media addiction mediated the associations of fear of COVID-19 with anxiety and depressive symptoms. Furthermore, there were indirect pathways linking fear of COVID-19 to problematic alcohol use through higher social media addiction and higher anxiety and depressive symptoms. Social media addiction may be a maladaptive coping mechanism that individuals with high fear of COVID-19 utilized to deal with uncertainty and perceived risks during the pandemic. Findings underscore the need to examine cognitions related to fear of COVID-19 and address excessive social media use in the context of mental health and alcohol interventions.

Multi-omics analysis of alcohol effects on the liver in young and aged mice.

Excessive alcohol consumption has detrimental effects on the entire organism, especially on the liver. The toxicity is partly dependent on age, as older individuals metabolize alcohol more slowly leading to increased cellular injury. This study aimed to investigate the effects of moderate binge drinking on the liver of young and aged mice in a genome-wide multi-omics approach. We determined DNA methylation (DNAm) using the Illumina MouseMethylation array and gene expression by RNA sequencing in 18 female Balb/c mice in a 2 × 2 design. The animals underwent three moderate binge drinking cycles (ethanol vs. vehicle) and liver tissue was harvested at 4 or 19 months of age. We tested differential gene expression (DE) and DNAm associated with ethanol intake in linear models separately in young and aged mice, performed enrichment analyses for pathways and GWAS signatures of problematic alcohol use, and analysed the overlap of DNAm and gene expression. We observed DE in young and aged animals and substantial overlap in genes such as Bhlhe40, Klf10, and Frmd8. DE genes in aged animals were enriched for biological processes related to alcohol metabolism, inflammation, liver fibrosis, and GWAS signatures of problematic alcohol use. We identified overlapping signatures from DNAm and gene expression, for example, Frmd8 in aged and St6galnac4 in young mice. This study offers converging evidence of novel age-related targets in a moderate alcohol consumption model highlighting dysregulations in genes related to alcohol metabolism, inflammation, and liver fibrosis. Future studies are needed to confirm these results and elucidate the underlying mechanisms.

A longitudinal test of problematic alcohol use and binge eating among college women: The moderating role of shame

Problematic alcohol use and binge eating frequently co-occur. High levels of negative affect, negative urgency, and/or shame may increase the likelihood that problematic alcohol use and binge eating co-occur over time. ObjectiveExamine 1) the temporal relationship between problematic alcohol use and binge eating among college women, who are at high risk for both, and 2) the additive and moderating effects of shared, emotion-based risk factors in models involving both problematic alcohol use and binge eating. MethodIn n = 302 college women assessed at two time points across 8 months, we used hierarchical linear regression to invstigate our objectives. ResultsBaseline problematic alcohol use and baseline shame independently predicted increases in follow-up binge eating, controlling for baseline binge eating. In addition, the interaction between problematic alcohol use and shame accounted for further variance in subsequent binge eating (the influence of baseline problematic alcohol use on follow-up binge eating was stronger at higher levels of baseline shame). The reciprocal relationship was not significant: baseline binge eating did not predict follow-up problematic alcohol use independently or in conjunction with risk factors. Neither negative affect nor negative urgency showed predictive effects beyond prior behavior and shame. Results support 1) problematic alcohol use as a prospective risk factor for binge eating, 2) shame as an additive predictor of binge eating, and 3) shame as a positive moderator of binge eating prediction from problem drinking. ConclusionAddressing shame and problematic alcohol use may be warranted in binge eating interventions for college women.

French validation of the Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS) in a university student sample

PurposeFood and Alcohol Disturbance (FAD) is characterized by the combination of problematic alcohol use and eating disorder symptoms to offset caloric intake associated with alcohol drinking and/or to enhance intoxication. The Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS) is a proven tool for measuring FAD, validated in English and Italian populations but never in the French population. The present study aims at validating a French version of the CEBRACS in a representative sample of university students and to determine its validity and reliability.Methods2267 university students completed the CEBRACS and measures of eating disorders, alcohol consumption and exercise.ResultsAn exploratory factor analysis revealed a 4-factor structure: enhancement of the effects of alcohol, dietary restraint and exercise, purging and vomiting and extreme fasting. The internal consistency for these subscales ranged from good to excellent. Correlations between the CEBRACS and eating disorders, alcohol and exercise measures revealed a good concurrent validity. No gender differences were found in the CEBRACS scores. Participants with a CEBRACS total score > 21 points were at higher risk for developing eating disorders and alcohol-related problems.ConclusionsThese findings highlight the reliability and validity of the French version of the CEBRACS. The distinct factors identified in the CEBRACS allow to distinguish between participants with different motives for engaging FAD behaviour and thus to prevent future development of eating and/or alcohol use disorders. The CEBRACS seems to be a relevant scale to capture FAD behaviors and thus to prevent negative and deleterious consequences.Level of evidence: Level III, evidence obtained from well-designed cohort or case–control analytic studies.

Prevalence and correlates of gambling disorder in Spain: findings from a national survey

ABSTRACT The aim of the study was to estimate the prevalence of gambling disorder (GD) in a sample of Spanish adults and analyze the sociodemographic variables, addictive behaviors (i.e. gambling-related characteristics, substance use, and problematic internet use), and lifetime clinical diagnoses related to the severity of GD. Participants from the 2020 Spanish Survey on Alcohol and Drugs (N = 17,105; 50.52% men; M age = 38.38 ± 13.07) were included. Individuals were classified as gamblers with GD when scored ≥4 points in the DSM-5 criteria. ANOVA and Pearson correlations were carried out to analyze differences in GD scores according to the variables noted above. The results showed that the rate of GD was 0.63% in the total sample and 1.05% in past-year gamblers. Characteristics which showed significantly higher GD scores were as follows: being a man, younger age, unmarried, greater gambling involvement both online and offline, gambling both online and offline, betting on both strategic and non-strategic games or on exclusively strategic games, lower gambling risk perception, greater substance use, higher problematic alcohol, cannabis, or internet use, or a lifetime diagnosis of anxiety, insomnia, or substance use disorder (all p-values ≤.001). The findings may guide future legal regulation policies and promote actions to prevent gambling-related problems.

Perceived psychological control relates to coping-related drinking motives via social anxiety among adolescents: A cross-sectional mediation analysis

Accumulating evidence suggests that particular parenting behaviors (e.g., elevated psychological control) may increase risk for both problematic social anxiety and alcohol use among youth; however, no work has yet examined these factors together in a single model. Building developmentally sensitive models of problematic alcohol use trajectories is key to developing effective prevention and intervention strategies. The present study includes 94 adolescents (ages 14–17 years; 53.3% girls; 89.2% White) entering a treatment facility for a variety of internalizing and externalizing forms of psychological distress. Levels of perceived parental psychological control, social anxiety, and coping-related drinking motives were assessed. Higher levels of perceived psychological control were associated with a greater endorsement of coping-related drinking motives; however, a significant proportion of that association was accounted for by elevated social anxiety symptoms. These data extend the existing literature and lay groundwork for more sophisticated experimental and longitudinal designs to corroborate the findings. Moreover, personality-targeted drinking interventions for adolescents may benefit from identifying elevated perceived psychological control as a developmentally relevant risk factor for social anxiety and problematic drinking motives and administering relevant interventions (e.g., personality-targeted coping skills training, parent-involved care) before drinking patterns are established.

The neurocognitive correlates of non-substance addictive behaviors

Neurocognitive deficits have been implicated as transdiagnostic risk markers of substance use disorders. However, these have yet to be comprehensively evaluated in other, non-substance addictions. In a large, general community sample (N = 475) the present study evaluated the neurocognitive correlates of problem alcohol use and three non-substance-related addictive behaviors: addictive eating (AE), problematic pornography use (PPU), and problematic use of the internet (PUI), to identify potential shared and distinct neurocognitive correlates. A sample of Australian residents (54.4 % female M[SD] age = 32.4[11.9] years) completed a comprehensive online assessment of neurocognitive tasks tapping into eight distinct expert-endorsed domains purportedly associated with addiction. Multiple linear regressions with bootstrapping were used to examine associations among each addictive behavior of interest and neurocognition, trait impulsivity, and compulsivity, as well as key covariates. Neurocognition was differentially associated with each addictive behavior. None of the neurocognitive domains were significantly associated with problematic alcohol use or AE (p >.05), poorer performance monitoring was significantly associated with higher levels of PPU and PUI (β = −0.10, p =.049; β = −0.09, p =.028), and a preference for delayed gratification was associated with more severe PUI (β = −0.10, p =.025). Our findings have theoretical implications for how we understand non-substance addiction and suggest the need for a more nuanced approach to studying addictive behaviors that take into account the underlying neurocognitive mechanisms associated with each type of addiction.