Trajectories of Impulsivity in Opioid Use Disorder Treatment: A Longitudinal Study of Temporal Discounting and its Dynamic Relation to Drug Use and Treatment Efficacy

Silvia Lopez-Guzman, Anna B Konova, Adelya Urmanche, John Messinger, Soteri Polydorou, Stephen Ross, Kenway Louie, John Rotrosen, Paul W Glimcher

Research output: Contribution to journalMeeting Abstract

Abstract

Background: Impulsivity is a core feature of substance use
disorders. Temporal discounting (TD) paradigms provide a
model-based approach to studying the dynamics of impulsive
decision-making as individuals with substance use
disorder undergo treatment. Here, we examine how TD
changes as opioid use disorder (OUD) subjects stabilize on
maintenance therapy and we assess how TD is predicted by
(or is predictive of) relevant clinical outcomes such as illicit
drug use, treatment adherence and clinical states like craving.
Methods: Individuals initiating medication-assisted treatment
for OUD were assessed weekly then bi-weekly (for up
to seven months) on a simple TD task. For each session, (1)
we derived a computational subject-specific parameter for
the TD rate as well as a model-free measure: the proportion
of immediate rewards chosen; (2) we monitored illicit drug
use through randomly administered weekly urine toxicology
and direct self-report; (3) we established their level of
adherence to their individual treatment plan as well as their
current medication dose; and (4) we scored their current
levels of craving, withdrawal symptoms and state anxiety.
A group of demographically matched drug-free community
controls (CC) were similarly assessed repeatedly in order to
establish the test-retest reliability of our measurement and
discard effects of practice and repetition.
In addition, eligible subjects from both groups completed the
tasks while we acquired functional magnetic resonance
imaging (MRI) data in two sessions: one at the beginning
of the study and the other 8-12 weeks later. During this
interval, subjects continued their regular assessments outside
of the scanner.
Results: As previously reported, OUD patients have
significantly higher discount rates compared to controls
but in our demographically matched groups the difference
appears to be smaller than previously reported. Our results
indicate that TD measurements have high test-retest
reliability. While stable in our control group, in OUD
patients the TD rates are a dynamic function of time in
treatment. Interestingly, TD rates also correlate with illicit
drug use events, peaking around the time that these occur.
Moreover, the individual trajectory of TD leading up to these
lapse events correlates with the degree of overall use during
our follow up, suggesting that the course of a patient's
impulsivity might be predictive of their relative success at
maintaining abstinence during treatment.
Conclusions: We conclude that TD, when assessed repeatedly
over the course of treatment, could be used as a
behavioral signature of a patient's clinical evolution and
potentially serve as a useful predictor of prognosis and
treatment adherence for OUD. Our TD task is easy to
automate and administer and therefore lends itself to use in
larger clinical studies and might be useful to incorporate into
the monitoring of these patients' progression. Our ongoing
efforts focus on the investigation of the neural substrate(s) of
the observed change in TD with treatment for OUD. We are
exploring how the activity of regions involved in the
computations necessary for impulsive decision-making (i.e.
the ventromedial prefrontal cortex, ventral striatum and
posterior cingulate cortex) contributes to treatment efficacy
Original languageEnglish (US)
Pages (from-to)S116-S288
JournalNeuropsychopharmacology
Volume41
Issue numberS1
DOIs
StatePublished - Dec 2016

Cite this

Lopez-Guzman, Silvia ; Konova, Anna B ; Urmanche, Adelya ; Messinger, John ; Polydorou, Soteri ; Ross, Stephen ; Louie, Kenway ; Rotrosen, John ; Glimcher, Paul W. / Trajectories of Impulsivity in Opioid Use Disorder Treatment: A Longitudinal Study of Temporal Discounting and its Dynamic Relation to Drug Use and Treatment Efficacy. In: Neuropsychopharmacology. 2016 ; Vol. 41, No. S1. pp. S116-S288.
@article{f5d079f9c4cf4021b2a4c047779c644f,
title = "Trajectories of Impulsivity in Opioid Use Disorder Treatment: A Longitudinal Study of Temporal Discounting and its Dynamic Relation to Drug Use and Treatment Efficacy",
abstract = "Background: Impulsivity is a core feature of substance usedisorders. Temporal discounting (TD) paradigms provide amodel-based approach to studying the dynamics of impulsivedecision-making as individuals with substance usedisorder undergo treatment. Here, we examine how TDchanges as opioid use disorder (OUD) subjects stabilize onmaintenance therapy and we assess how TD is predicted by(or is predictive of) relevant clinical outcomes such as illicitdrug use, treatment adherence and clinical states like craving.Methods: Individuals initiating medication-assisted treatmentfor OUD were assessed weekly then bi-weekly (for upto seven months) on a simple TD task. For each session, (1)we derived a computational subject-specific parameter forthe TD rate as well as a model-free measure: the proportionof immediate rewards chosen; (2) we monitored illicit druguse through randomly administered weekly urine toxicologyand direct self-report; (3) we established their level ofadherence to their individual treatment plan as well as theircurrent medication dose; and (4) we scored their currentlevels of craving, withdrawal symptoms and state anxiety.A group of demographically matched drug-free communitycontrols (CC) were similarly assessed repeatedly in order toestablish the test-retest reliability of our measurement anddiscard effects of practice and repetition.In addition, eligible subjects from both groups completed thetasks while we acquired functional magnetic resonanceimaging (MRI) data in two sessions: one at the beginningof the study and the other 8-12 weeks later. During thisinterval, subjects continued their regular assessments outsideof the scanner.Results: As previously reported, OUD patients havesignificantly higher discount rates compared to controlsbut in our demographically matched groups the differenceappears to be smaller than previously reported. Our resultsindicate that TD measurements have high test-retestreliability. While stable in our control group, in OUDpatients the TD rates are a dynamic function of time intreatment. Interestingly, TD rates also correlate with illicitdrug use events, peaking around the time that these occur.Moreover, the individual trajectory of TD leading up to theselapse events correlates with the degree of overall use duringour follow up, suggesting that the course of a patient'simpulsivity might be predictive of their relative success atmaintaining abstinence during treatment.Conclusions: We conclude that TD, when assessed repeatedlyover the course of treatment, could be used as abehavioral signature of a patient's clinical evolution andpotentially serve as a useful predictor of prognosis andtreatment adherence for OUD. Our TD task is easy toautomate and administer and therefore lends itself to use inlarger clinical studies and might be useful to incorporate intothe monitoring of these patients' progression. Our ongoingefforts focus on the investigation of the neural substrate(s) ofthe observed change in TD with treatment for OUD. We areexploring how the activity of regions involved in thecomputations necessary for impulsive decision-making (i.e.the ventromedial prefrontal cortex, ventral striatum andposterior cingulate cortex) contributes to treatment efficacy",
author = "Silvia Lopez-Guzman and Konova, {Anna B} and Adelya Urmanche and John Messinger and Soteri Polydorou and Stephen Ross and Kenway Louie and John Rotrosen and Glimcher, {Paul W}",
year = "2016",
month = "12",
doi = "doi.org/10.1038/npp.2016.240",
language = "English (US)",
volume = "41",
pages = "S116--S288",
journal = "Neuropsychopharmacology",
issn = "0893-133X",
publisher = "Nature Publishing Group",
number = "S1",

}

Trajectories of Impulsivity in Opioid Use Disorder Treatment: A Longitudinal Study of Temporal Discounting and its Dynamic Relation to Drug Use and Treatment Efficacy. / Lopez-Guzman, Silvia; Konova, Anna B; Urmanche, Adelya; Messinger, John; Polydorou, Soteri; Ross, Stephen; Louie, Kenway; Rotrosen, John; Glimcher, Paul W.

In: Neuropsychopharmacology, Vol. 41, No. S1, 12.2016, p. S116-S288.

Research output: Contribution to journalMeeting Abstract

TY - JOUR

T1 - Trajectories of Impulsivity in Opioid Use Disorder Treatment: A Longitudinal Study of Temporal Discounting and its Dynamic Relation to Drug Use and Treatment Efficacy

AU - Lopez-Guzman, Silvia

AU - Konova, Anna B

AU - Urmanche, Adelya

AU - Messinger, John

AU - Polydorou, Soteri

AU - Ross, Stephen

AU - Louie, Kenway

AU - Rotrosen, John

AU - Glimcher, Paul W

PY - 2016/12

Y1 - 2016/12

N2 - Background: Impulsivity is a core feature of substance usedisorders. Temporal discounting (TD) paradigms provide amodel-based approach to studying the dynamics of impulsivedecision-making as individuals with substance usedisorder undergo treatment. Here, we examine how TDchanges as opioid use disorder (OUD) subjects stabilize onmaintenance therapy and we assess how TD is predicted by(or is predictive of) relevant clinical outcomes such as illicitdrug use, treatment adherence and clinical states like craving.Methods: Individuals initiating medication-assisted treatmentfor OUD were assessed weekly then bi-weekly (for upto seven months) on a simple TD task. For each session, (1)we derived a computational subject-specific parameter forthe TD rate as well as a model-free measure: the proportionof immediate rewards chosen; (2) we monitored illicit druguse through randomly administered weekly urine toxicologyand direct self-report; (3) we established their level ofadherence to their individual treatment plan as well as theircurrent medication dose; and (4) we scored their currentlevels of craving, withdrawal symptoms and state anxiety.A group of demographically matched drug-free communitycontrols (CC) were similarly assessed repeatedly in order toestablish the test-retest reliability of our measurement anddiscard effects of practice and repetition.In addition, eligible subjects from both groups completed thetasks while we acquired functional magnetic resonanceimaging (MRI) data in two sessions: one at the beginningof the study and the other 8-12 weeks later. During thisinterval, subjects continued their regular assessments outsideof the scanner.Results: As previously reported, OUD patients havesignificantly higher discount rates compared to controlsbut in our demographically matched groups the differenceappears to be smaller than previously reported. Our resultsindicate that TD measurements have high test-retestreliability. While stable in our control group, in OUDpatients the TD rates are a dynamic function of time intreatment. Interestingly, TD rates also correlate with illicitdrug use events, peaking around the time that these occur.Moreover, the individual trajectory of TD leading up to theselapse events correlates with the degree of overall use duringour follow up, suggesting that the course of a patient'simpulsivity might be predictive of their relative success atmaintaining abstinence during treatment.Conclusions: We conclude that TD, when assessed repeatedlyover the course of treatment, could be used as abehavioral signature of a patient's clinical evolution andpotentially serve as a useful predictor of prognosis andtreatment adherence for OUD. Our TD task is easy toautomate and administer and therefore lends itself to use inlarger clinical studies and might be useful to incorporate intothe monitoring of these patients' progression. Our ongoingefforts focus on the investigation of the neural substrate(s) ofthe observed change in TD with treatment for OUD. We areexploring how the activity of regions involved in thecomputations necessary for impulsive decision-making (i.e.the ventromedial prefrontal cortex, ventral striatum andposterior cingulate cortex) contributes to treatment efficacy

AB - Background: Impulsivity is a core feature of substance usedisorders. Temporal discounting (TD) paradigms provide amodel-based approach to studying the dynamics of impulsivedecision-making as individuals with substance usedisorder undergo treatment. Here, we examine how TDchanges as opioid use disorder (OUD) subjects stabilize onmaintenance therapy and we assess how TD is predicted by(or is predictive of) relevant clinical outcomes such as illicitdrug use, treatment adherence and clinical states like craving.Methods: Individuals initiating medication-assisted treatmentfor OUD were assessed weekly then bi-weekly (for upto seven months) on a simple TD task. For each session, (1)we derived a computational subject-specific parameter forthe TD rate as well as a model-free measure: the proportionof immediate rewards chosen; (2) we monitored illicit druguse through randomly administered weekly urine toxicologyand direct self-report; (3) we established their level ofadherence to their individual treatment plan as well as theircurrent medication dose; and (4) we scored their currentlevels of craving, withdrawal symptoms and state anxiety.A group of demographically matched drug-free communitycontrols (CC) were similarly assessed repeatedly in order toestablish the test-retest reliability of our measurement anddiscard effects of practice and repetition.In addition, eligible subjects from both groups completed thetasks while we acquired functional magnetic resonanceimaging (MRI) data in two sessions: one at the beginningof the study and the other 8-12 weeks later. During thisinterval, subjects continued their regular assessments outsideof the scanner.Results: As previously reported, OUD patients havesignificantly higher discount rates compared to controlsbut in our demographically matched groups the differenceappears to be smaller than previously reported. Our resultsindicate that TD measurements have high test-retestreliability. While stable in our control group, in OUDpatients the TD rates are a dynamic function of time intreatment. Interestingly, TD rates also correlate with illicitdrug use events, peaking around the time that these occur.Moreover, the individual trajectory of TD leading up to theselapse events correlates with the degree of overall use duringour follow up, suggesting that the course of a patient'simpulsivity might be predictive of their relative success atmaintaining abstinence during treatment.Conclusions: We conclude that TD, when assessed repeatedlyover the course of treatment, could be used as abehavioral signature of a patient's clinical evolution andpotentially serve as a useful predictor of prognosis andtreatment adherence for OUD. Our TD task is easy toautomate and administer and therefore lends itself to use inlarger clinical studies and might be useful to incorporate intothe monitoring of these patients' progression. Our ongoingefforts focus on the investigation of the neural substrate(s) ofthe observed change in TD with treatment for OUD. We areexploring how the activity of regions involved in thecomputations necessary for impulsive decision-making (i.e.the ventromedial prefrontal cortex, ventral striatum andposterior cingulate cortex) contributes to treatment efficacy

U2 - doi.org/10.1038/npp.2016.240

DO - doi.org/10.1038/npp.2016.240

M3 - Meeting Abstract

VL - 41

SP - S116-S288

JO - Neuropsychopharmacology

JF - Neuropsychopharmacology

SN - 0893-133X

IS - S1

ER -