Distress tolerance trajectories following substance use treatment.

Abstract

Objective: Distress tolerance (DT), the ability to withstand aversive internal states, represents an important risk factor for substance use relapse and a potential treatment target. Neurobiological research in substance using populations suggests that continued substance use could erode DT, whereas abstinence could bolster it. The current study characterized trajectories of behavioral and self-reported indices of DT and examined the prospective effect of substance use on DT trajectories among those seeking treatment for substance use. Method: Individuals (N = 263, Mage = 42.68, SD = 11.8, 70.7% male, 94.7% African American) in residential substance use treatment completed subjective (Distress Tolerance Scale) and behavioral (Mirror Tracing Persistence Task–computerized version) DT measures, as well as report of daily substance use (timeline follow-back) over 5 assessment time-points from pretreatment to 12 months posttreatment. Latent curve modeling estimated DT trajectories and their associations with substance use behavior, including abstinence duration (days until first use) and substance use frequency (percentage of substance use days between assessments). Results: Self-reported and behavioral DT indicators both exhibited positive, nonlinear change over time (standardized slope parameter estimates: Distress Tolerance Scale β = 0.61, p < .01; Mirror Tracing Persistence Task β = 0.34, p < .01). Abstinence duration was associated with greater improvement in behavioral (β = .20, p = .03) DT specifically. Frequency of use was statistically significantly associated with attenuated behavioral DT at 6-month (β = −.12, p = .03) and 12-month follow-ups (β = −.08, p = .045). Conclusions: DT appears to improve appreciably posttreatment, and return to substance use may shape the degree of this improvement. Collectively, these findings support the conceptualization of DT as a malleable treatment target and emphasize the benefit of abstinence on improvement in DT.

Triple Network Resting State Connectivity Predicts Distress Tolerance and Is Associated with Cocaine Use

“…Such findings suggest that allocation of attentional resources toward internally relevant stimuli at the expense of engagement in externally oriented actions results in DT impairments. Moreover, associations between cocaine use severity and DMN-SN rsFC suggest a potential mechanism through which substance use impacts DT (e.g., [9]). The existence of neural network functional connectivity indices of DT among non-treatment seeking adults sets the stage for a prospective test of the interactive relationship between rsFC, DT, and relapse within a treatment seeking sample.…”

“…Lower DT is associated with a greater frequency of substance use [1], early substance use treatment dropout [2][3][4], and higher rates of post treatment relapse to substance use [5][6][7][8]. In addition, longer abstinence duration following substance use treatment entry is associated with greater improvement in DT over time, whereas greater frequency of post treatment substance use predicts attenuations in DT improvement [9].…”

Distress tolerance among emergency department patients in acute pain: Associations with substance use treatment

“…Interventions based on cognitive‐behavioural and skill training components lead to improvements in DT levels among those with SUD (Bornovalova, Gratz, Daughters, Hunt, & Lejuez, 2012; Black & Amaro, 2019; McHugh et al., 2014). Similarly, both perceived and behavioural DT have been shown to improve over time among individuals receiving residential substance use treatment (Reese et al., 2019). Although DT has been evaluated in patients with chronic pain and SUDs, DT has yet to be studied in the context of acute pain or among ED patients.…”

“…Notably, lower DT is significantly associated with SUD relapse (Daughters, Lejuez, Kahler, Strong, & Brown, 2005a; Strong et al., 2012) and treatment dropout (Daughters et al., 2005b) within 3 months of treatment initiation or an abstinence attempt, and among patients with chronic pain, opioid misuse and affective response to pain (McHugh et al., 2016). Furthermore, greater abstinence duration during treatment is associated with improvements in behavioural DT (Reese, Conway, Anand, Bauer, & Daughters, 2019).…”

The Structure of Distress Tolerance and Neighboring Emotion Regulation Abilities

“…Considerable research now shows that it correlates with risk for a range of psychological disorders. For example, across various samples, there is a robust association between distress tolerance and trajectories of substance misuse (Daughters, Lejuez, Kahler, et al, 2005; Reese et al, 2019). It also protects from clinically significant anxiety, depression, and suicidal ideation (Michel et al, 2016; Peterson et al, 2014).…”