Intolerance of uncertainty in opioid dependency – Relationship with trait anxiety and impulsivity

Abstract

Intolerance of uncertainty (IU) is the tendency to interpret ambiguous situations as threatening and having negative consequences, resulting in feelings of distress and anxiety. IU has been linked to a number of anxiety disorders, and anxiety felt in the face of uncertainty may result in maladaptive behaviors such as impulsive decision making. Although there is strong evidence that anxiety and impulsivity are risk factors for addiction, there is a paucity of research examining the role of IU in this disorder. The rate of opioid addiction, in particular, has been rising steadily in recent years, which necessitates deeper understanding of risk factors in order to develop effective prevention and treatment methods. The current study tested for the first time whether opioid-dependent adults are less tolerant of uncertainty compared to a healthy comparison group. Opioid dependent patients undergoing methadone maintenance therapy (n = 114) and healthy comparisons (n = 69) completed the following scales: Intolerance of Uncertainty Scale, the Barrett Impulsivity Scale, and the State Trait Anxiety Inventory. Analysis revealed that these measures were positively correlated with each other and that opioid-dependent patients had significantly higher IU scores. Regression analysis revealed that anxiety mediated the relationship between IU and impulsivity. Hierarchical moderation regression found an interaction between addiction status and impulsivity on IU scores in that the relationship between these variables was only observed in the patient group. Findings suggest that IU is a feature of addiction but does not necessarily play a unique role. Further research is needed to explore the complex relationship between traits and how they may contribute to the development and maintenance of addiction.

Intolerance of uncertainty and conditioned place preference in opioid addiction

“…As expected, patients were also found to have greater IU than controls ( Table 1 ), which is consistent with past research ( Carleton, Norton & Asmundson, 2007 ; Nelson et al, 2016 ; Garami et al, 2017 ). However, neither of the two indicators of place preference (i.e., the first room entered and the room participants spent more time in during the post-training) was related to IU.…”

“…Thus, the current study adopted the CPP task of Radell et al (2016) to compare the potential behavioral effects of IU between individuals undergoing treatment for OUD and healthy controls. First, consistent with prior studies ( Carleton, Norton & Asmundson, 2007 ; Garami et al, 2017 ), we hypothesized that patients would report higher IU than controls. Second, we hypothesized that if patients have reduced reward sensitivity to non-drug reward, they would show reduced preference for the context associated with reward relative to controls.…”

“…As one example, the personality trait of intolerance of uncertainty (IU) involves the tendency to perceive uncertain situations as aversive, and can result in avoidance and negative expectations about the consequences of such situations ( Nelson et al, 2016 ). IU is higher in individuals with opioid use disorder (OUD), raising the possibility that it is a risk factor for this, and potentially other, substance abuse disorders ( Carleton, Norton & Asmundson, 2007 ; Garami et al, 2017 ).…”

Interrelationship of Opioid Dependence, Impaired Impulse Control, and Depressive Symptoms: An Open-Label Cross-Sectional Study of Patients in Maintenance Therapy

“…Using a former version of the test, Kirby et al [39] also found that patients addicted to heroin were more impulsive than healthy controls. The results of other studies that applied different psychological tests showed increased impulsivity in OD patients [14, 18, 40-43]. In heroin users, impulsiveness seems to be higher than in users of prescription opioids only [44].…”

“…Impaired impulse control can be a risk factor for drug misuse [15-18]. For example, a lack of control concerning dose and frequency of drug intake might result in overdoses and relapses.…”