Dimensions of impulsivity among heavy drinkers, smokers, and heavy drinking smokers: Singular and combined effects

Abstract

Alcohol use and cigarette smoking commonly co-occur. The role impulsivity may play as a common underlying mechanism in alcohol use and cigarette smoking is of particular interest due to emerging evidence of it being a critical component across multiple forms of addiction. Impulsivity can be examined through several constructs including, risky decision-making, response inhibition, and delay reward discounting. Impulsivity and each of these specific constructs play significant roles in the initiation of drug use, continued use despite negative consequences, and potential to relapse. This study used three behavioral tasks to measure risky decision-making (Balloon Analog Risk Test; BART), response inhibition (Stop Signal Task (SST), and delay reward discounting (Delay Discounting Task; DDT). This study advances research on impulsivity and substance use by parsing out the various components of impulsivity and examining them across three groups, heavy drinkers only (HD) (N =107), smokers only (S) (N=67), and heavy drinking smokers (HDS) (N=213). Participants completed questionnaires, interviews, and neurocognitive tasks including the SST, BART, and DDT. Analyses supported an additive effect of alcohol and nicotine use in delay reward discounting. Heavy drinking smokers displayed steeper delay discounting of small rewards than did smokers only (p < .05) and heavy drinkers only (p < .05). This additive effect of smoking and drinking was not observed for risky decision-making and response inhibition, suggesting specificity of the effects for delay reward discounting. These findings indicate that those who both drink heavily and smoke cigarettes daily have increased delay reward discounting, than those in the S and HD groups. Future studies should examine these constructs longitudinally, as well as incorporate genetic and/or a neuroimaging component to these group comparisons in order to ascertain the biological bases of these behavioral findings.

Impulsivity and polysubstance use: A systematic comparison of delay discounting in mono-, dual-, and trisubstance use.

“…On one hand, when heavy smoking was present, dual-substance use was associated with greater discounting than cigarette smoking alone. This observation indicates an additive effect of dual-substance use with regard to cigarette smoking populations, consistent with the findings of García-Rodríguez et al (2013) and Moallem and Ray (2012). On the other hand, dual-substance use of alcohol and cocaine was not associated with significantly different rates of discounting than the mono use of any substance.…”

“…Specifically, Moallem and Ray (2012) found additive discounting effects of smoking and alcohol use whereas García-Rodríguez et al (2013) and Businelle et al (2010) did not find an increase in discounting effects in combined smoking and cocaine dependence or combined smoking and substance dependence, respectively. Moreover, Businelle's design allowed for all substance dependencies other than nicotine dependence for inclusion in a “substance use disorder’ group.…”

Time-discounting and tobacco smoking: a systematic review and network analysis

“…Seven studies reported results that varied according to gender and cigarette consumption levels, with stronger associations of time-discounting with smoking among men and more dependent smokers 57–63 . Seven studies found that people with other substance use or mental health problems had stronger associations of smoking and time-discounting, including cocaine-dependent smokers, 64 those with depressive symptoms, 65 heavy drinkers, 66 obese persons 67 and individuals with gambling problems, 68 compared with smokers without these symptoms 69–73 …”

Recent Translational Findings on Impulsivity in Relation to Drug Abuse

“…One study found an association in African Americans but not European Americans [29], and another study found that discounting predicted drinking in females but not males [30]. In studies of cigarette smokers, discounting was also related to severity of nicotine dependence [31–35], but see [36], and individuals who were both drinkers and smokers discounted more than drinkers or smokers only [37]. Similarly, both cocaine- and opiate-dependent individuals discounted more than healthy controls [21, 38–40], although see [41], and delay discounting was greater for early or intermediate onset opiate dependence compared with late-onset [42].…”