Alvarez Emmanuel E, Hafezi Sahar, Bonagura Darla, Kleiman Evan M, Konova Anna B
Department of Neuroscience, Robert Wood Johnson Medical School, Rutgers University-New Brunswick, Piscataway, NJ, United States.
Department of Psychiatry, Brain Health Institute, University Behavioral Health Care, Rutgers University-New Brunswick, Piscataway, NJ, United States.
Front Psychiatry. 2022 May 17;13:817979. doi: 10.3389/fpsyt.2022.817979. eCollection 2022.
Drug addiction is thought to be characterized by risky and impulsive behavior despite harmful consequences. Whether these aspects of value-based decision-making in people with addiction are stable and trait-like, and the degree to which they vary within-person and are sensitive to changes in psychological state, remains unknown. In this pilot study, we examined the feasibility of distinguishing these state- vs. trait-like components by probing day-level dynamics of risk and time preferences in patients with opioid use disorder (OUD) as they engaged with their natural environment.
Twenty-three individuals with OUD receiving outpatient treatment (40% female; = 45.67 [ = 13.16] years of age) and twenty-one matched healthy community controls (47% female; = 49.67 [ = 14.38] years of age) participated in a 28-day smartphone-based ecological momentary assessment study (1085 person days; = 24.66, = 5.84). Random prompts administered daily assessed subjects' psychological state (e.g., mood) and economic preferences for real delayed and risky monetary rewards.
Subjects demonstrated dynamic decision-making preferences, with 40-53% of the variation in known risk and ambiguity tolerance, and 67% in discounting, attributable to between-person vs. within-person (day-to-day) differences. We found that changes in psychological state were related to changes in risk preferences, with patients preferring riskier offers on days they reported being in a better mood but no differences between groups in aggregate level behavior. By contrast, temporal discounting was increased overall in patients compared to controls and was unrelated to global mood. The study was well-tolerated, but compliance rates were moderate and lower in patients.
Our data support the idea that decision-making preferences in drug addiction exhibit substantial within-person variability and that this variability can be well-captured using remote data collection methods. Preliminary findings suggested that aspects of decision-making related to consideration of risk may be more sensitive to within-person change in global psychological state while those related to consideration of delay to reward, despite also being somewhat variable, stably differ from healthy levels. Identifying the cognitive factors that contribute to opioid use risk in a "real-world" setting may be important for identifying unique, time-sensitive targets for intervention.
药物成瘾被认为具有不顾有害后果而进行冒险和冲动行为的特征。成瘾者基于价值的决策的这些方面是否稳定且类似特质，以及它们在个体内部的变化程度以及对心理状态变化的敏感程度，仍然未知。在这项试点研究中，我们通过探究阿片类物质使用障碍（OUD）患者在融入其自然环境时风险和时间偏好的日水平动态变化，来检验区分这些状态与特质成分的可行性。
23名接受门诊治疗的OUD患者（40%为女性；年龄 = 45.67 [标准差 = 13.16]岁）和21名匹配的健康社区对照者（47%为女性；年龄 = 49.67 [标准差 = 14.38]岁）参与了一项为期28天的基于智能手机的生态瞬时评估研究（1085人日；均值 = 24.66，标准差 = 5.84）。每天随机发出的提示评估了受试者的心理状态（如情绪）以及对实际延迟和有风险货币奖励的经济偏好。
受试者表现出动态决策偏好，已知风险和模糊容忍度变化的40 - 53%，以及折扣变化的67%，可归因于个体间与个体内（每日）差异。我们发现心理状态的变化与风险偏好的变化相关，患者在报告心情较好的日子里更倾向于接受风险更高的提议，但两组在总体行为水平上没有差异。相比之下，与对照组相比，患者总体上时间折扣增加，且与总体情绪无关。该研究耐受性良好，但患者的依从率中等且较低。
我们的数据支持这样一种观点，即药物成瘾中的决策偏好表现出显著的个体内变异性，并且这种变异性可以通过远程数据收集方法很好地捕捉到。初步研究结果表明，与风险考虑相关的决策方面可能对总体心理状态的个体内变化更敏感，而与奖励延迟考虑相关的方面，尽管也有些变化，但与健康水平稳定不同。在“现实世界”环境中确定导致阿片类物质使用风险的认知因素，对于确定独特的、对时间敏感的干预目标可能很重要。
