Dynamic Changes in Risky Decision-Making Predict Imminent Heroin Use in Opioid Users Studied Longitudinally Through the First Months of Treatment

Anna Konova, Silvia Lopez-Guzman, Adelya Urmanche, Stephen Ross, Kenway Louie, John Rotrosen, Paul Glimcher

Resultado de la investigación: Contribución a RevistaResumen en Conferencia

Resumen

Antecedentes El uso de opiáceos durante el tratamiento aumenta el riesgo de sobredosis; por lo tanto, la identificación de predictores del uso de opiáceos en quienes buscan tratamiento a una escala de tiempo susceptible de intervención es una prioridad. Aquí probamos la hipótesis de que el valor de las perspectivas de riesgo aumenta cuando las personas son más vulnerables al consumo de heroína. Métodos 79 buscadores de tratamiento completaron de 1 a 15 sesiones durante 7 meses (media/sujeto=6, DE=3.9). En cada sesión, los sujetos tomaban decisiones sobre los riesgos y las recompensas, y vigilábamos objetivamente el consumo de heroína. Se modelaron las decisiones de los sujetos como dos parámetros: tolerancia al riesgo y tolerancia a la ambigüedad, capturando el comportamiento que involucra riesgo conocido y desconocido, respectivamente. Esto nos permitió predecir el consumo de heroína a partir del cambio de sesión en sesión de los parámetros mediante la regresión logística de efectos mixtos con desfase temporal. 12 sujetos (estudio en curso) adicionalmente completaron los mismos procedimientos durante la RMNf multibanda. Resultados De un total de 605 sesiones, 288 (47%) fueron positivas a la heroína. Sólo un aumento en la tolerancia a la ambigüedad fue predictivo del posible consumo de heroína en la escala de tiempo examinada[t(577)=3,39, P<0,001], lo que respalda nuestra hipótesis de que el valor de las perspectivas (más) riesgosas aumenta cuando los individuos son más vulnerables. Los datos de la fMRI revelaron actividad en el estrato y la VMPFC codificó el valor de las perspectivas ambiguas. Esto a su vez se correlacionó con la conectividad estriatum-VMPFC en reposo, lo que sugiere que la actividad coordinada en el sistema de valoración del cerebro podría ser la base tanto del cambio de comportamiento observado como de la vulnerabilidad al consumo de heroína. 4. Conclusiones La vigilancia del tratamiento y los esfuerzos de intervención dirigidos a la toma de decisiones (y por lo tanto al sistema de valoración) pueden ayudar a reducir la incidencia de recaídas en una población en riesgo de muerte por sobredosis.
Idioma originalEnglish (US)
Páginas (desde-hasta)S31
PublicaciónBiological Psychiatry
Volumen83
N.º9
DOI
EstadoPublished - may 1 2018

Citar esto

Konova, Anna ; Lopez-Guzman, Silvia ; Urmanche, Adelya ; Ross, Stephen ; Louie, Kenway ; Rotrosen, John ; Glimcher, Paul. / Dynamic Changes in Risky Decision-Making Predict Imminent Heroin Use in Opioid Users Studied Longitudinally Through the First Months of Treatment. En: Biological Psychiatry. 2018 ; Vol. 83, N.º 9. pp. S31.
@article{5203b6eda9b14978879535e983c40b31,
title = "Dynamic Changes in Risky Decision-Making Predict Imminent Heroin Use in Opioid Users Studied Longitudinally Through the First Months of Treatment",
abstract = "Background Opioid overdose is now the leading cause of accidental death in the U.S. Opioid use during treatment increases overdose risk; thus, identifying predictors of opioid use in treatment-seekers at a timescale amenable to intervention is a priority. Here we tested the hypothesis that the value of risky prospects is enhanced when individuals are most vulnerable to use heroin. Methods 79 treatment-seekers completed 1-15 sessions over 7 months (mean/subject=6, SD=3.9). At each session, subjects made decisions about risks and rewards, and we objectively monitored heroin use. We modeled subjects' decisions as two parameters: risk tolerance and ambiguity tolerance, capturing behavior involving known and unknown risk, respectively. This allowed us to predict heroin use from session-to-session change in the parameters via time-lagged mixed-effects logistic regression. 12 subjects (study ongoing) additionally completed the same procedures during multi-band fMRI. Results Of 605 total sessions, 288 (47{\%}) were heroin positive. Only an increase in ambiguity tolerance was predictive of prospective heroin use at the timescale examined [t(577)=3.39, P<0.001], supporting our hypothesis that the value of the (more) risky prospects is enhanced when individuals are most vulnerable. The fMRI data revealed activity in the striatum and VMPFC encoded the value of the ambiguous prospects. This in turn correlated with striatum-VMPFC connectivity at rest, together suggesting coordinated activity in the brain’s valuation system might underlie both the observed behavior change and heroin use vulnerability. Conclusions Treatment-monitoring and -intervention efforts targeting decision-making (and thus the valuation system) may help reduce incidence of relapse in a population at risk for overdose death.",
author = "Anna Konova and Silvia Lopez-Guzman and Adelya Urmanche and Stephen Ross and Kenway Louie and John Rotrosen and Paul Glimcher",
year = "2018",
month = "5",
day = "1",
doi = "10.1016/j.biopsych.2018.02.093",
language = "English (US)",
volume = "83",
pages = "S31",
journal = "Biological Psychiatry",
issn = "0006-3223",
publisher = "Elsevier USA",
number = "9",

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Dynamic Changes in Risky Decision-Making Predict Imminent Heroin Use in Opioid Users Studied Longitudinally Through the First Months of Treatment. / Konova, Anna; Lopez-Guzman, Silvia; Urmanche, Adelya; Ross, Stephen; Louie, Kenway; Rotrosen, John; Glimcher, Paul.

En: Biological Psychiatry, Vol. 83, N.º 9, 01.05.2018, p. S31.

Resultado de la investigación: Contribución a RevistaResumen en Conferencia

TY - JOUR

T1 - Dynamic Changes in Risky Decision-Making Predict Imminent Heroin Use in Opioid Users Studied Longitudinally Through the First Months of Treatment

AU - Konova, Anna

AU - Lopez-Guzman, Silvia

AU - Urmanche, Adelya

AU - Ross, Stephen

AU - Louie, Kenway

AU - Rotrosen, John

AU - Glimcher, Paul

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Background Opioid overdose is now the leading cause of accidental death in the U.S. Opioid use during treatment increases overdose risk; thus, identifying predictors of opioid use in treatment-seekers at a timescale amenable to intervention is a priority. Here we tested the hypothesis that the value of risky prospects is enhanced when individuals are most vulnerable to use heroin. Methods 79 treatment-seekers completed 1-15 sessions over 7 months (mean/subject=6, SD=3.9). At each session, subjects made decisions about risks and rewards, and we objectively monitored heroin use. We modeled subjects' decisions as two parameters: risk tolerance and ambiguity tolerance, capturing behavior involving known and unknown risk, respectively. This allowed us to predict heroin use from session-to-session change in the parameters via time-lagged mixed-effects logistic regression. 12 subjects (study ongoing) additionally completed the same procedures during multi-band fMRI. Results Of 605 total sessions, 288 (47%) were heroin positive. Only an increase in ambiguity tolerance was predictive of prospective heroin use at the timescale examined [t(577)=3.39, P<0.001], supporting our hypothesis that the value of the (more) risky prospects is enhanced when individuals are most vulnerable. The fMRI data revealed activity in the striatum and VMPFC encoded the value of the ambiguous prospects. This in turn correlated with striatum-VMPFC connectivity at rest, together suggesting coordinated activity in the brain’s valuation system might underlie both the observed behavior change and heroin use vulnerability. Conclusions Treatment-monitoring and -intervention efforts targeting decision-making (and thus the valuation system) may help reduce incidence of relapse in a population at risk for overdose death.

AB - Background Opioid overdose is now the leading cause of accidental death in the U.S. Opioid use during treatment increases overdose risk; thus, identifying predictors of opioid use in treatment-seekers at a timescale amenable to intervention is a priority. Here we tested the hypothesis that the value of risky prospects is enhanced when individuals are most vulnerable to use heroin. Methods 79 treatment-seekers completed 1-15 sessions over 7 months (mean/subject=6, SD=3.9). At each session, subjects made decisions about risks and rewards, and we objectively monitored heroin use. We modeled subjects' decisions as two parameters: risk tolerance and ambiguity tolerance, capturing behavior involving known and unknown risk, respectively. This allowed us to predict heroin use from session-to-session change in the parameters via time-lagged mixed-effects logistic regression. 12 subjects (study ongoing) additionally completed the same procedures during multi-band fMRI. Results Of 605 total sessions, 288 (47%) were heroin positive. Only an increase in ambiguity tolerance was predictive of prospective heroin use at the timescale examined [t(577)=3.39, P<0.001], supporting our hypothesis that the value of the (more) risky prospects is enhanced when individuals are most vulnerable. The fMRI data revealed activity in the striatum and VMPFC encoded the value of the ambiguous prospects. This in turn correlated with striatum-VMPFC connectivity at rest, together suggesting coordinated activity in the brain’s valuation system might underlie both the observed behavior change and heroin use vulnerability. Conclusions Treatment-monitoring and -intervention efforts targeting decision-making (and thus the valuation system) may help reduce incidence of relapse in a population at risk for overdose death.

U2 - 10.1016/j.biopsych.2018.02.093

DO - 10.1016/j.biopsych.2018.02.093

M3 - Meeting Abstract

VL - 83

SP - S31

JO - Biological Psychiatry

JF - Biological Psychiatry

SN - 0006-3223

IS - 9

ER -