Impact of Psychosocial Stress & OUD on Cognitive Executive Functions
1. Assessing the Impact of Psychosocial
Stressors and Opioid Use Disorder on
Cognitive Executive Functions
Iowa Gambling and Stroop Tasks
Olga Scrivner1,2, Aaron M Kipp3, Kimberly Goodyear4
1Indiana University, 2 Harrisburg University of Science and Technology,
3 East Carolina University School of Medicine, 4 Brown University
Complexity and Cognition
December 9, 2020
Funding: This project is supported by funding from the Buffalo Innovation Lab (NIH/NCATS
UL1TR001412)
2. Background
Figure 1. 12 Month-ending Provisional
Counts of Drug Overdose
Deaths: United States [1]
1
The opioid epidemic in the United States is a
growing public health concern.
2 Physical and psychosocial stress can lead to
opioid use disorder (OUD) [2].
3
Substance misuse is shown to cause neurocognitive
impairment, e.g., cognitive executive functions (EF)
[3].
To obtain preliminary associations between psychosocial stressors
and executive cognitive functioning among individuals with OUD.
Goal
4
The role of psychosocial stress on EF in the
context of OUD is poorly understood.
3. Cognitive Functions
Hot Executive function Cold Executive function
Emotional
the experience of reward and
punishment, regulation of one’s own
social behavior, and decision-making
involving emotional and personal
interpretation [4]
Logic
problem-solving, planning,
sequencing, the ability to sustain
attention, utilization of feedback,
multitasking, cognitive flexibility [4]
Figure 4. The prefrontal cortex (PFC) supports cognitive and behavioral processes [5]
4. Data Collection
- Community-based recruitment via Craigslist,
flyers, referrals
- Screened by phone for inclusion criteria:
- 18 – 65 years old
- Diagnosis of OUD
- Opioid use in the past 90 days
- No medication assisted treatment in the past
30 days
- Demographic & psychosocial stress
questionnaire: substance use, social
stability, food security, stigma, social
support, perceived stress,
depression, anxiety, trauma
- Cognitive computerized tests: Iowa
Gambling Task and Opioid Word
Stroop
Participants Session
Figure 2. Flyer Figure 3. Iowa Gambling Test and Opioid Word
Stroop test
5. Methods
• Iowa Gambling Task (emotional EF)
○ Outcome: % advantageous decks selected (delayed reward)
○ Larger % = better EF
• Opioid Word Stroop (logic EF)
○ Outcome: mean difference in response time for neutral versus opioid
words
○ Smaller mean difference = better EF
• Robust linear regression for each psychosocial factor and each outcome,
adjusting for age, education, and opioid severity
○ Reported if p<0.20 for either outcome due to small sample size
6. Findings
46 participants: 64% male, 70% White non-Hispanic, 11% Black non-Hispanic, 19%
Hispanic, median age 43 yrs; 72% some Highschool education
89% weekly/daily opioids, 74% within 48 hours of study
45% weekly/daily cocaine; 40% weekly/daily cannabis
Mean (SD) % advantageous decks selected: 44.3% (15.3)
Mean (SD) difference in response time (milliseconds): 7.57 (45.27)
Mean opioid cue response time (ms): 1092.73 (230.35)
Mean neutral cue response time (ms): 1085.16 (246.06)
7. Findings
Hot EF
(Emotional; IGT)
Cold EF
(Logic; Opioid Stroop)
Social stability -
Food security - -
Cannabis frequency + +
Cannabis Severity +
Sedative frequency +
Sedative severity +
Cocaine severity +
Anticipated drug use stigma - +
Enacted drug use stigma +
Social support (emotional domain) +
8. Conclusions
Better social stability and food security associated with worse cognitive function
perhaps when these resources are scarce, choose less risky behavior
(delayed reward)
Among untreated individuals with OUD, concurrent polysubstance use associated
with better cognitive function
Small sample size is a limitation, but food security, cannabis use, and drug use
stigma should be further explored given their potential influence on both hot and
cold executive function.
9. References
[1] Farida B Ahmad, Lauren M Rossen and Paul Sutton. Provisional drug overdose death counts. National Center for Health
Statistics. 2020.
[2] George F Koob,. A role for brain stress systems in addiction. Neuron, 59(1), 11-34. 2008.
[3] Daniel E Gustavson, Michael E Stallings et al. Executive functions and substance use: Relations in late adolescence
and early adulthood. Journal of abnormal psychology, 126(2), 257. 2017.
[4] Raymond C.K. Chan, David Shum, Timothea Toulopoulou, and Eric Y.H. Chen. Assessment of executive functions:
Review of instruments and identification of critical issues. Archives of Clinical Neuropsychology, 23(2):201–216, mar 2008.
[3] Antoine Bechara, H. Damasio, D. Tranel, and A.R. Damasio. The Iowa Gambling Task and the somatic marker
hypothesis: some questions and answers. Trends in Cognitive Sciences, 9(4):159–162, 2005. doi: 10.1016/j.tics.2005.02.002.
[5] Berridge CW, Arnsten AF (2015). Catecholamine mechanisms in the prefrontal cortex: proven strategies for enhancing
higher cognitive function. Curr Opin Behav Sci 4: 33–40.
Funding: This project supported by funding from the Buffalo Innovation Lab (NIH/NCATS UL1TR001412)
Editor's Notes
The opioid epidemic in the United States is a growing public health concern.
Given the serious consequences associated with opioid misuse, there is an exigent need to discern how different variables may contribute to opioid use disorder (OUD).
physiological and emotional stress can lead to a wide range of health and psychiatric illnesses including opioid use disorder (OUD) (Koob, 2008).
Substance misuse has been shown to cause neurocognitive impairment including poor executive function (Gustavson et al, 2017).
This project aims to examine associations between psychosocial stressors and executive cognitive functioning among individuals with OUD.
Understanding the relationship between interpersonal trauma, opioid use disorder (OUD) and cognitive impairments is essential for the rehabilitation trajectory and consequent improvement of social life.
https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
Psychosocial stress is a common factor contributing to the increase in opioid misuse. Stressors as socio-environmental demands on individuals (e.g., trauma, adverse childhood events, unemployment, stigma, food insecurity) have been shown to also impact cognitive processes [1]. Particularly, the impact has been noted on executive functioning (EF) linked to reasoning, problem-solving, decision-making [2]. Understa nding the relationship between interpersonal trauma, opioid use disorder (OUD) and cognitive impairments is essential for the rehabilitation trajectory and consequent improvement of social life.
Ahmad FB, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2020.
EF refers to the psychological processes
Hot Executive Function controlling emotional cognitive processes that include “the experience of reward and punishment, regulation of one’s own social behavior, and decision-making involving emotional and personal interpretation” [2]. Cold Executive Function controlling logic, mechanic cognitive processes such as “verbal reasoning, problem-solving, planning, sequencing, the ability to sustain attention, resistance to interference, utilization of feedback, multitasking, cognitive flexibility, and the ability to deal with novelty” [2].
subjects are recruited from the community via flyers, craiglist and referrals
Eligibility included 18 years or older individual with Opoid use disorder who are not under any OUD treatment.
Eligible paarticipants completed two questionnaire about substance use, social instability, food insecurity, drug use stigma, social support, perceived stress, and other factorsdepression, anxiety, and trauma
We assess 10 psychosocial stressors using commonly established tests in
the literature: social stability, food insecurity, substance use and severity, drug use stigma, social support, perceived stress, depression, anxiety, adverse childhood experiences, and trauma.
Example results for cannabis use frequency:
IGT: beta=6.04 (p=0.03) comparing weekly use to no use. Interpretation: % selection of advantageous decks is 6 percentage points higher for weekly users compared to non-users; that is, more often selects delayed reward (no association for daily vs. no use)
Opioid stroop: beta=-24.71 (p=0.10) comparing weekly or daily use to no use. Interpretation: opioid cue words elicit less of a delayed reaction for marijuana users. The delay time between opioid and neutral cues is 24 ms shorter.
Example results for anticipated drug use stigma (stigma score ranges from 0 to 4; IQR is 1.3 to 3.0):
IGT: beta= -3.05 (p=0.01) for each point increase in stigma score. Interpretation: each one point increase in stigma score reduces the % selection of advantageous decks by 3 percentage points; that is, less often selects delayed reward
Opioid stroop: beta=1-4.54 (p=0.03) for each point increase in stigma score. Interpretation: each one point increase in stigma score associates with a decrease in delay time between opioid and neutral cues (14.5 ms shorter); opioid cue words elicit less of a delayed reaction for those reporting higher levels of stigma