The Role of Impulsivity in the Association Between Posttraumatic Stress Disorder Symptom Severity and Substance Use in Male Military Veterans

Mahoney, Colin T.; Cole, Hannah; Gilbar, Ora; Taft, Casey T.

doi:10.1002/jts.22508

Cited by 12 publications

(9 citation statements)

References 53 publications

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“…In a recent study of 145 patients with EDs, those with alcohol and drug abuse symptoms represented a specific phenotype characterized by greater impulsive personality, emotion dysregulation, and problems with executive functioning [ 103 ]. Among male military veterans ( n = 106), impulsivity moderated the relationship between PTSD symptoms and alcohol consumption [ 104 ], with relevance discussed in more detail below. In addition to higher levels of impulsivity, individuals with FA are more likely to report a family history of addiction [ 105 ] which may be consistent with genetic underpinnings.…”

Section: Substance Use Disordersmentioning

confidence: 99%

Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint

Wiss

Brewerton

2020

Nutrients

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Converging evidence from both animal and human studies have implicated hedonic eating as a driver of both binge eating and obesity. The construct of food addiction has been used to capture pathological eating across clinical and non-clinical populations. There is an ongoing debate regarding the value of a food addiction “diagnosis” among those with eating disorders such as anorexia nervosa binge/purge-type, bulimia nervosa, and binge eating disorder. Much of the food addiction research in eating disorder populations has failed to account for dietary restraint, which can increase addiction-like eating behaviors and may even lead to false positives. Some have argued that the concept of food addiction does more harm than good by encouraging restrictive approaches to eating. Others have shown that a better understanding of the food addiction model can reduce stigma associated with obesity. What is lacking in the literature is a description of a more comprehensive approach to the assessment of food addiction. This should include consideration of dietary restraint, and the presence of symptoms of other psychiatric disorders (substance use, posttraumatic stress, depressive, anxiety, attention deficit hyperactivity) to guide treatments including nutrition interventions. The purpose of this review is to help clinicians identify the symptoms of food addiction (true positives, or “the signal”) from the more classic eating pathology (true negatives, or “restraint”) that can potentially elevate food addiction scores (false positives, or “the noise”). Three clinical vignettes are presented, designed to aid with the assessment process, case conceptualization, and treatment strategies. The review summarizes logical steps that clinicians can take to contextualize elevated food addiction scores, even when the use of validated research instruments is not practical.

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Section: Substance Use Disordersmentioning

confidence: 99%

Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint

Wiss

Brewerton

2020

Nutrients

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“…One point that must not be forgotten here is that past research has also identified impulsivity as a mediator of the PTSD–substance use relationship (Mahoney et al, 2020; Morris et al, 2020). A novel finding here is that the inclusion of risk-seeking as a concurrent mediator seemingly attenuates this relationship to some degree due to collinearity.…”

Section: Discussionmentioning

confidence: 98%

“…As impulsivity is symptomatic of the disorder, it would seem that this construct may be a particularly salient mediator of the PTSD–polydrug use relationship because of research indicating that impulsivity is a risk factor for drug use (Hentges et al, 2018; Kozak et al, 2019; Oshri et al, 2018). Indeed, past research has found impulsivity helps to explain the PTSD–substance use relationship (Mahoney et al, 2020; Morris et al, 2020). However, there is a dearth of research that has sought to delineate self-control into the dual systems concepts.…”

Section: Introductionmentioning

confidence: 99%

PTSD as a Risk Factor Predicting Polydrug Use: A Dual Systems of Self-Control Mediation Model

Wojciechowski

2020

Journal of Drug Issues

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Post-traumatic stress disorder (PTSD) is associated with increased risk for polydrug use. Low self-control is a key characteristic of the disorder and is predictive of polydrug use. However, there is a dearth of research focused on the relevance of a dual systems model delineation of self-control into the constructs of risk-seeking and impulsivity as it pertains to polydrug use and PTSD. This study tested dual systems mediation of this relationship. Generalized structural equation modeling was used to test for mediation effects. Results indicated that more PTSD symptoms predicted increased drug use variety (coefficient = 0.024; confidence interval [CI] = [0.001, 0.046]). Inclusion of dual systems constructs fully attenuated this relationship. The total indirect effect achieved marginal significance (coefficient = 0.005; CI = [>−0.001, 0.009]). Sensitivity analyses of the specific indirect effect of impulsivity as the sole mediator indicated significant mediation. These results provide some indication that impulsivity-based programming may help to treat polydrug use among those with severe PTSD.

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“…Behavioral impulsivity is a multifaceted personality disposition related to deficient emotional or behavioral self-control in everyday life decisions (Duckworth and Kern, 2011;Whiteside and Lynam, 2001), whereas inhibitory control represents the ability to override impulses to accomplish a goal-directed task (Sadeh et al 2015). Behavioral impulsivity is consistently related to higher alcohol use (e.g., in Veterans with PTSD symptoms, see Mahoney et al 2020) and several aspects of behavioral impulsivity could also play a role in maintaining PTSD symptoms, such as difficulty with emotional regulation and a propensity towards risky behavior (a PTSD diagnostic item in the DSM-5). Additionally, PTSD symptoms such as hyperarousal could further contribute to aspects of behavioral impulsivity, especially through negative urgency, or the tendency to act impulsively under negative affect (Roley et al 2017).…”

Section: Running Head: Inhibitory Control and Alcohol Predict Ptsd Ch...mentioning

confidence: 99%

Inhibitory Control and Alcohol Use History Predict Changes in Post-traumatic Stress Disorder Symptoms

DeGutis¹,

Agnoli²,

Gaudet³

et al. 2022

Preprint

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Post-traumatic stress disorder (PTSD) is a prevalent and disabling condition occurring frequently among Veterans. However, among those diagnosed with PTSD, predictors of changes in PTSD symptoms over time remain incompletely characterized. In the current study, we examined 187 post-9/11 Veterans (Mean baseline age = 32.8 years, 87% male) diagnosed with PTSD who participated in two extensive clinical and cognitive evaluations approximately two years apart. Our analyses focused on the association between baseline measures predicting both continuous changes in PTSD symptoms and differences between groups with Improved, Chronic, and Worsened PTSD symptoms, defined by applying clinically meaningful and reliable change approaches. We found that better baseline inhibitory control (Color-Word Inhibition and Inhibition/Switching) and lower lifetime drinking history independently predicted greater PTSD symptom improvements over the two-year period, though current drinking and other clinical and cognitive variables were not significant predictors. Consistent with this, the Improved, Worsened, and Chronic PTSD groups demonstrated significant differences in baseline inhibitory control performance and lifetime drinking history, with the largest differences in drinking behavior in the early-to-mid 20s. We also found that PTSD symptom improvements were not significantly associated with improvements in inhibitory control or appreciable reductions in alcohol use. Together, these findings suggest that alcohol use and inhibitory control may reflect clinically important pre-existing factors rather than effects of PTSD symptomatology. These findings have implications for the treatment of PTSD, including monitoring vulnerable individuals at risk for more chronic PTSD and novel interventions targeting inhibitory control.

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The Role of Impulsivity in the Association Between Posttraumatic Stress Disorder Symptom Severity and Substance Use in Male Military Veterans

Cited by 12 publications

References 53 publications

Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint

Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint

PTSD as a Risk Factor Predicting Polydrug Use: A Dual Systems of Self-Control Mediation Model

Inhibitory Control and Alcohol Use History Predict Changes in Post-traumatic Stress Disorder Symptoms

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