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

Resultado de la investigación: Contribución a RevistaResumen en Conferencia

Resumen

Antecedentes: La impulsividad es una característica central del consumo de sustancias
desórdenes. Los paradigmas de descuento temporal (TD) proporcionan un
enfoque basado en modelos para el estudio de la dinámica de los impulsos de la toma de decisiones como individuos con uso de sustancias
se someten a tratamiento. Aquí examinamos cómo TD
cambia a medida que los sujetos con trastorno por uso de opiáceos (TEA) se estabilizan en
terapia de mantenimiento y evaluamos cómo se predice la TD mediante
(o es predictivo de) resultados clínicos relevantes, como los ilícitos
el uso de drogas, la adherencia al tratamiento y los estados clínicos como el ansia.
Métodos: Individuos que inician un tratamiento asistido por medicamentos
para el OUD se evaluaron semanalmente y luego quincenalmente (para un período de hasta
a siete meses) en una simple tarea de TD. Para cada sesión, (1)
derivamos un parámetro computacional específico del sujeto para
la tasa de TD así como una medida sin modelo: la proporción
de las recompensas inmediatas elegidas; (2) monitoreamos las drogas ilícitas
uso a través de una administración aleatoria semanal de toxicología urinaria
y autoinforme directo; (3) establecimos su nivel de
el cumplimiento de su plan de tratamiento individual, así como su
dosis actual de medicación; y (4) calificamos su dosis actual de medicación
niveles de antojo, síntomas de abstinencia y ansiedad del estado.
Un grupo de la comunidad libre de drogas de acuerdo con los datos demográficos
los controles (CC) fueron evaluados repetidamente de forma similar con el fin de
establecer la fiabilidad de las pruebas y pruebas de nuestras mediciones y
descartar los efectos de la práctica y la repetición.
Además, los sujetos elegibles de ambos grupos completaron el
mientras adquiríamos resonancia magnética funcional
datos de imágenes (RM) en dos sesiones: una al principio
del estudio y las otras 8-12 semanas después. Durante este período
en el intervalo, los sujetos continuaron con sus evaluaciones regulares fuera de la escuela.
del escáner.
Resultados: Como se informó anteriormente, los pacientes con DIU tienen
tasas de descuento significativamente más altas en comparación con los controles
pero en nuestros grupos demográficamente emparejados la diferencia
parece ser más pequeño de lo que se ha informado anteriormente. Nuestros resultados
indican que las mediciones de TD tienen un alto grado de repetición de la prueba
fiabilidad. Mientras que estable en nuestro grupo de control, en OUD
los pacientes las tasas de TD son una función dinámica del tiempo en
tratamiento. Curiosamente, las tasas de TD también se correlacionan con las tasas de uso ilícito de las drogas.
acontecimientos relacionados con el consumo de drogas, que alcanzan su punto máximo en el momento en que se producen.
Por otra parte, la trayectoria individual de TD que condujo a estas
se correlaciona con el grado de uso general durante el periodo de
nuestro seguimiento, sugiriendo que el curso de la vida de un paciente
la impulsividad podría ser predictiva de su éxito relativo en
mantener la abstinencia durante el tratamiento.
Conclusiones: Concluimos que la TD, cuando se evalúa repetidamente
en el transcurso del tratamiento, podría ser utilizado como un
firma conductual de la evolución clínica de un paciente y
potencialmente servir como un predictor útil de pronóstico y
adherencia al tratamiento para el OUD. Nuestra tarea de TD es fácil de
automatizar y administrar y, por lo tanto, se presta a su uso en
estudios clínicos más grandes y podría ser útil incorporarlos en
la monitorización de la progresión de estos pacientes. Nuestro programa
los esfuerzos se centran en la investigación del sustrato(s) neural(es) de
el cambio observado en la DT con el tratamiento del DIU. Estamos
explorar cómo la actividad de las regiones involucradas en la
los cálculos necesarios para la toma de decisiones impulsivas (es decir, el
la corteza prefrontal ventromedial prefrontal, el estrato ventral y el
córtex cingular posterior) contribuye a la eficacia del tratamiento.
Idioma originalEnglish (US)
Páginas (desde-hasta)S116-S288
PublicaciónNeuropsychopharmacology
Volumen41
N.ºS1
DOI
EstadoPublished - dic 2016

Citar esto

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. En: Neuropsychopharmacology. 2016 ; Vol. 41, N.º 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",
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}

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.

En: Neuropsychopharmacology, Vol. 41, N.º S1, 12.2016, p. S116-S288.

Resultado de la investigación: Contribución a RevistaResumen en Conferencia

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 -