Testing the biosocial cognitive model of substance use in cannabis users referred to treatment

Abstract

Impulsivity associated with cannabis use and dependence via social cognition. Reward sensitivity associated with cannabis outcomes via positive expectancies. Rash impulsiveness associated with cannabis outcomes via refusal self-efficacy. Targeting social cognition may reduce risk conveyed by an impulsive personality.

Precision Mental Health Care for Cannabis Use Disorder: Utility of a bioSocial Cognitive Theory to Inform Treatment

“…Directly increasing it with refusal skills training will work for patients who need to learn skills in how to assertively say “no” when offered or pressured to use cannabis ( 87 , 88 ). But, according to bSCT, it is less likely to be effective in isolation for those high in rash impulsiveness and holding strong positive expectancies ( 51 , 64 ). Such patients would be likely to face more significant challenges saying “no” in the first place, because of the greater salience of expected short-term reinforcement (e.g., intoxication) and lesser salience of future negative consequences (e.g., negative urine drug test result at work).…”

“…Findings are encouraging and consistent with those previously reported in alcohol use disorder ( 61 , 90 – 92 ). Further examination of temporal dynamics and reciprocal causation would strengthen clinical application, as there is some evidence of differences in bSCT pathway strength across the continuum of addiction ( 51 , 64 ). The role of craving is also yet to be explicitly outlined, despite its importance to CUD.…”

“…Gullo et al ( 61 ) proposed that, when applied to substance use, biologically-based personality traits, specifically reward sensitivity/drive and rash impulsiveness, should act as important personal factors affecting social cognition and behavior ( 61 ). These traits are robust predictors of cannabis use ( 62 , 63 ) and studies have found selective associations between reward drive and positive cannabis expectancies on the 1 hand, and rash impulsiveness and cannabis refusal self-efficacy on the other ( 51 , 64 ). This bio Social Cognitive Theory (bSCT) of temperamental risk factors, outcome expectancies, and drug refusal self-efficacy is depicted in Figure 1 .…”

“…As a result, individuals high in reward drive are more likely to attend to, encode, and recall reinforcement from cannabis use, creating stronger positive outcome expectancies. Studies of young adults and cannabis users referred to treatment have indeed observed a selective association between individual differences in reward drive and positive cannabis expectancies ( 51 , 64 ). In moderate-severe CUD, positive expectancies are related to poorer treatment response because of their association with lower refusal self-efficacy ( 46 ).…”

“…This lowered self-efficacy, in turn, increases the likelihood of cannabis use, further exacerbating risk ( 48 ). Studies of young adults and cannabis users referred to treatment have indeed observed a selective association between individual differences in rash impulsiveness and lower refusal self-efficacy ( 51 , 64 ). In moderate-severe CUD, lower cannabis refusal self-efficacy predicts poorer response to treatment ( 46 , 58 ).…”