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

Published online by Cambridge University Press:  15 April 2019

Scott J. Moeller ,
Adam W. Hanley  and
Eric L. Garland
Scott J. Moeller
Affiliation:
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY
Adam W. Hanley
Affiliation:
University of Utah Center on Mindfulness and Integrative Health Intervention Development, Salt Lake City, UT College of Social Work, University of Utah, Salt Lake City, UT
Eric L. Garland*
Affiliation:
University of Utah Center on Mindfulness and Integrative Health Intervention Development, Salt Lake City, UT College of Social Work, University of Utah, Salt Lake City, UT
*
Author for correspondence: Eric L. Garland, E-mail: [email protected]
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Abstract

Background

The 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.

Methods

The 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.

Results

At 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.

Conclusions

These 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.

Keywords

Allostasischoice behaviorchronic paininsightopioid misuserewardtreatment outcome
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 4 , March 2020 , pp. 644 - 652
Copyright
Copyright © Cambridge University Press 2019

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