This study examined the impact of psychosocial stressors and opioid use disorder on cognitive executive functions in 46 participants with opioid use disorder. The Iowa Gambling Task and Opioid Word Stroop test assessed emotional and logic executive functions. Better social stability and food security were associated with worse cognitive performance, while cannabis use was linked to better performance. Concurrent polysubstance use was also tied to enhanced cognitive function. The small sample size limited conclusions, but food security, cannabis use, and drug stigma warrant further study regarding their influence on executive function.

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)