Distinct Facets of Impulsivity Exhibit Differential Associations with Substance Use Disorder Treatment Processes: A Cross-Sectional and Prospective Investigation Among Military Veterans

Abstract

Impulsivity, a multi-faceted construct characterized by rash, unplanned actions and a disregard for long-term consequences, is associated with poor substance use disorder (SUD) treatment outcomes. Little is known though about the influence of impulsivity on treatment process variables critical for initiating and maintaining behavioral change. This knowledge gap is important as different aspects of impulsivity may be susceptible to diverse cognitive, behavioral and pharmacological influences. The present study examined two distinct facets of impulsivity (lack of planning and immoderation -a proxy of urgency) as predictors of processes that impact SUD treatment success (active coping, avoidant coping, self-efficacy, and interpersonal problems). Participants were 200 Veterans who completed impulsivity and treatment process assessments upon entering a SUD treatment program and treatment process assessments at treatment discharge. Results from multivariate models revealed that lack of planning was associated with lower active coping and higher avoidant coping and interpersonal problems at intake, though not with lower self-efficacy to abstain from substances. Immoderation was associated with higher avoidant coping and lower self-efficacy to abstain from substances at intake, but not with lower active coping or higher interpersonal problems. Higher immoderation, but not lack of planning, predicted lower self-efficacy to abstain from substances at treatment discharge. These findings suggest that different facets of impulsivity confer risk for different SUD treatment process indicators and that clinicians should consider the behavioral expression of patients' impulse control problems in treatment planning and delivery.

Recommendations for applying a multi-dimensional model of impulsive personality to diagnosis and treatment

“…Although “impulsivity,” generally defined, is highly represented in clinical disorder criteria, our review of the DSM-5 diagnostic criteria concluded that most criteria are not written to map well onto specific UPPS-P traits. Our review also concluded that although the application of the UPPS-P traits to treatment is still in its infancy, recent work does suggest that specific UPPS-P traits negatively influence the effectiveness of substance use treatment response [ 109 , 138 ].…”

Using Dual Process Models to Examine Impulsivity Throughout Neural Maturation

“…Identification and study of the distinct processes that underlie these two types of impulsivity is clinically important as these processes likely recruit different brain circuitries and may be susceptible to different behavioral, cognitive, and pharmacological influences. Heinz, Bui, Thomas, and Blonigen (2015), for example, examined two distinct components of impulsivity (Whiteside & Lynam, 2001) as predictors of treatment success in substance use disorders among substance-using military veterans. The impulsivity components included lack of planning, which can be considered a product of the executive processes underlying action/cognitive impulsivity, and immoderation (i.e., difficulty resisting strong impulses and tendency to act rashly when experiencing negative urgency or positive urgency affect), which can be considered a product of the executive processes underlying affective impulsivity.…”

Impulsive Personality Traits Mediate the Relationship Between Attention-Deficit/Hyperactivity Disorder Symptoms and Psychiatric Comorbidity among Patients with Severe Alcohol Use Disorder

“…Our results provide further support for paying close attention to the expression of specific impulsive personality traits, particularly low perseverance and high emotion-driven impulsivity, in individuals with SUD and ADHD. This differentiated view on impulsivity in research may be particularly fruitful to decipher the underlying mechanisms of the association between AUD/SUD-ADHD comorbidity with increased addiction severity, more psychiatric diagnoses, increased suicide risk, and poorer treatment outcome/response (Heinz et al., 2015 ; Hershberger et al., 2017 ). Such findings may support clinicians in improving the prediction of psychopathology and corresponding risk behaviors (Berg et al., 2015 ; Coskunpinar et al., 2013 ).…”