Behavioral preference for viewing drug v. pleasant images predicts current and future opioid misuse among chronic pain patients

Abstract

BackgroundThe USA is currently enduring an opioid crisis. Identifying cost-effective, easy-to-implement behavioral measures that predict treatment outcomes in opioid misusers is a crucial scientific, therapeutic, and epidemiological goal.MethodsThe current study used a mixed cross-sectional and longitudinal design to test whether a behavioral choice task, previously validated in stimulant users, was associated with increased opioid misuse severity at baseline, and whether it predicted change in opioid misuse severity at follow-up. At baseline, data from 100 prescription opioid-treated chronic pain patients were analyzed; at follow-up, data were analyzed in 34 of these participants who were non-misusers at baseline. During the choice task, participants chose under probabilistic contingencies whether to view opioid-related images in comparison with affectively pleasant, unpleasant, and neutral images. Following previous procedures, we also assessed insight into choice behavior, operationalized as whether (yes/no) participants correctly self-reported the image category they chose most often.ResultsAt baseline, the higher choice for viewing opioid images in direct comparison with pleasant images was associated with opioid misuse and impaired insight into choice behavior; the combination of these produced especially elevated opioid-related choice behavior. In longitudinal analyses of individuals who were initially non-misusers, higher baseline opioid v. pleasant choice behavior predicted more opioid misuse behaviors at follow-up.ConclusionsThese results indicate that greater relative allocation of behavior toward opioid stimuli and away from stimuli depicting natural reinforcement is associated with concurrent opioid misuse and portends vulnerability toward future misuse. The choice task may provide important medical information to guide opioid-prescribing practices.

A neuroeconomic signature of opioid craving: How fluctuations in craving bias drug-related and nondrug-related value

“…The concept of "relative value" is central to theories of addiction grounded in behavioral economics [52,53] and has been the focus of much work in other pertinent domains in addiction such as diagnosis and prognosis [54][55][56][57][58][59][60][61][62][63][64][65]. However, the specific effect of craving in drug-vs. nondrug-related valuation has received comparatively less attention.…”

Mindfulness-Oriented Recovery Enhancement remediates hedonic dysregulation in opioid users: Neural and affective evidence of target engagement

“…A similar contrast, in which drug approach behavior is assessed in the context of a contemporaneously available natural reward, is used in drug choice paradigms in both humans and animals (31). This contrast was recently shown to predict opioid misuse following behavioral treatment (32) and parallels a key diagnostic criterion for substance use disorder: compulsive use of the drug of choice to the exclusion of other rewarding activities. When compared to those in the SG, participants treated with MORE exhibited significantly greater increases in the LPP measure of relative responsiveness to natural reward relative to drug reward from pretreatment to posttreatment (F 1,21 = 10.00, P = 0.005,  partial 2 = 0.32).…”

Neurophysiological error processing and addiction self‐awareness correlates of reduced insight in cannabis use disorder

“…In the probabilistic learning choice task (adapted from prior research in cocaine and opioid users) [13,27], participants selected from four face-down card decks, each of which contained mostly pleasant (e.g. adventure), negative (e.g.…”

“…At the end of the task, participants reported, which image type they believed they chose to view most often. As previously validated in cocaine and opioid-using samples [13,27], insight was assessed by comparing the perceived versus actual most chosen image type. Participants with congruent versus discrepant (defined as ≥1 actual-perceived image type selections) [13,27] selfreport/behavior were categorized as 'accurate insight' (aCUD, aControl) and 'reduced insight' (rCUD, rControl), respectively.…”

“…The present study had three aims. First, using a previously validated probabilistic learning simulated drug choice task [13,26,27] that we adapted for the first time in a CUD population, we hypothesized that, relative to a non-user control group, CUD participants would select more cannabis and less pleasant images, as well as show lower insight into their choice behavior (objectively assessed reduced insight). Our second aim was to test the hypothesis that reduced insight into choice behavior is associated with broader alterations in anterior cingulate cortex (ACC)-mediated error-processing in the brain.…”