Anhedonia and Substance Use Disorders by Type, Severity, and With Mental Health Disorders

Abstract

ObjectivesAnhedonia can accompany substance use disorders (SUDs); its severity may vary by substance type, severity of SUD symptoms, or psychiatric comorbidity. The goal of this study was to clarify the contribution of each.MethodsData were from participants aged 18 to 65 years in the National Epidemiologic Survey on Alcohol and Related Conditions III (n = 30,999; 51% women), a cross-sectional, nationally representative sample reporting lifetime DSM-5 symptoms and lifetime anhedonia. We used logistic regression to test how anhedonia was associated with specific SUDs and psychiatric disorders in respondents with one lifetime diagnosis. We used latent class analysis to assess the association of anhedonia with patterns of comorbidity in all respondents.ResultsOpioid use disorder (OUD) had the greatest odds of anhedonia relative to other SUDs (ORs [95% CIs]): mild alcohol use disorder (AUD) (3.33 [1.74, 6.38]), moderate/severe AUD (2.73 [1.41, 5.30]), and cannabis use disorder (3.21 [1.43, 7.19]), though not significantly greater than stimulant use disorder (2.44 [.88, 6.73]). Anhedonia was more likely in mood disorders and posttraumatic stress disorder (PTSD) than in any SUD, except for PTSD versus OUD (OR [95% CIs] = .98 [.47, 2.02]). In latent class analysis analyses, the poly disorder class, which included SUDs and other diagnoses, had greater odds of anhedonia than the Poly SUD (ORs [95% CIs] = 1.62 [1.25, 2.09] and AUD 2.89 [2.40, 3.48]) classes.ConclusionsPeople with OUD or a lifetime history of mood disorder or PTSD may be most likely to present to SUD treatment with anhedonia.

Variability in intensively assessed mood: Systematic sources and factor structure in outpatients with opioid use disorder.

“…We suspect that if it does, it will be mostly for other clinical populations. In particular, it may be important to test our MCFA result among people with major depressive disorder, given the commonness of fatigue in depression and because aspects of reduced positive moods have some similarities between people with opioid addiction and people with depression (Denollet & De Vries, 2006; Stull et al, 2022). Next steps include criterion-validity tests with structural equation models to see how the factors resulting from our MCFA relate to important treatment outcomes in addiction.…”

“…This was an important step forward for measuring mood with ILD, but the factor structure of mood should be investigated across more measurement occasions and in other samples, particularly where there is reason to believe that mood variance and/or factor structure may be different for people with psychiatric disorders (e.g., Trull et al, 2008). For example, people with addictions may have elevated negative mood and reduced positive mood, with important implications for the variance and covariance of mood items (Baker et al, 2004; Garfield et al, 2014; Stull et al, 2022).…”

“…Apart from the psychomotor stimulant or sedative effects of drug use itself, people with psychiatric disorders sometimes deny experiences of negative moods but report feelings of fatigue or malaise; sometimes lower positive moods can be mistaken or conflated with feelings of lethargy (Billones et al, 2020; Chen, 1986). For these reasons, it is important to more fully understand the factor structure of mood for people with addictions, including those with OUD, because issues with reduced positive moods and/or lower energy in this population may be especially prominent (Garfield et al, 2014; Stull et al, 2022) and may confer risk for negative outcomes such as return to use or addiction treatment dropout (Panlilio et al, 2019).…”

Continuing the conversation around opioid use disorder and post-traumatic stress disorder comorbidity

“…We are delighted to see several very recent publications about OUD-PTSD comorbidity, which were available in press after the acceptance of our manuscript. [5][6][7][8][9][10] Furthermore, it can be argued that considering the prevalence of OUD-PTSD, much more work is warranted towards understanding this comorbidity or even the effect of trauma exposure on the development of OUD. In our opinion, more emphasis on probing the behavioural and neurobiological processes active in patients with OUD-PTSD could further the understanding of this illness.…”

Exploring the harm reduction paradigm: the role of Board-Certified Psychiatric Pharmacists

“…In the absence of the substance of choice, people who use drugs (PWUD) may develop uncomfortable and potentially dangerous withdrawal symptoms that often lead to a return to use. As the SUD progresses and increases in severity, the ability to experience pleasure without the substance declines and may result in the development of anhedonia, 3 , 4 a lack of pleasure in activities that were previously enjoyed. Chronic substance use changes the brain, demonstrating that addiction is a medical disorder rather than moral ineptitude.…”