HOW CAN WE USE THIS #2

Jessica Cavalli, et al. (2023) linked poor executive functioning (EF) and parental cannabis use as predictive factors to the heavier use of cannabis and the use of alcohol in later adolescence (https://psycnet.apa.org/doiLanding?doi=10.1037%2Fadb0000891). While this supports EF as a prevention target in early adolescence my thoughts turned to the idea that it may also serve as a treatment and support for recovery target for adolescents and young adults that develop a substance use disorder (SUD).  I did a further literature search and found correlational work linking EF with other factors including parenting, intergenerational transmission, environmental conditions, Traumatic brain injury (TBI), anxiety and depression, academic performance, and several studies linking EF, to include impulsivity, to SUD, both in early adolescence concurrently and Leading to SUD problems in later adolescence and early adulthood (e.g., Kim-Spoon, et al., 2017, and Jones, et al., 2021 respectively).  These EF- SUD linkages suggest that targeting EF as a component of adolescent SUD treatment may serve as a fruitful pursuit and there were no studies identified that directly took this approach.  There were however approaches to improving EF in adolescents and young adults that may be promising if applied to SUD treatment.  These include ThinkSMART® (Ellis, et al., 2023); Learning to Breathe (L2B, Frank et al., 2021); and, aspects of Cognitive Behavioral and dialectical behavior therapies (e.g., emotional control, shifting, monitoring, and global executive functioning; Smith et al., 2019). Chaku, et al., also identified differences in EF with heterogeneous groups that call for approaches to skill building targeting specific deficits.  His ideas fit well into SUD treatments that are, in some respects individualized.      

There were also instruments identified that would serve as initial assessment, progress tracking, and outcome measures.  These include the BRIEF-SR (https://psycnet.apa.org/record/2013-32429-001), and the TEXI (https://psycnet.apa.org/record/2020-13810-001). 

 HOW CAN WE USE THIS? 

Katie Witkiewitz, et.al. (2023) returned to the databases of foundational research, COMBINE (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945872/) and Project MATCH (https://www.niaaa.nih.gov/news-events/news-releases/niaaa-reports-project-match-main-findings), to view it through the lens of the Alcohol and Addiction Research Domain Criteria (AARDoC, Litten, et.al. 2015). This was an attempt to see if the criteria can predict outcomes and inform the development of a pragmatic instrument to guide alcohol use disorder treatment planning.  Their efforts are in the spirit of precision medicine, or identifying treatments that target elements specific to the person in treatment.  The domains, that fall on a trajectory of severity (reward/incentive salience, relief/negative emotionality, and loss of control/executive functioning), also speak to the motivations for alcohol use and suggest potential targets for intervention; e.g. alternatives for rewards, emotional improvement, and cognitive behavioral functioning respectively.  The domains may also be relevant to the trajectory of other use disorders and thus have applicability that is more general.  The self-report items that mapped to the domains are in the Witkiewitz, et.al. (2023) article (https://psycnet.apa.org/doiLanding?doi=10.1037%2Fadb0000871) and they might serve to draft an instrument for trying out the concept and perhaps eventual validation.      

 A special issue of the Psychology of Addictive Behaviors (February 2023) features articles focusing on “addictive behavior as behavioral allocation;” that is how shifts and the balance in molar (extended or continuous) behavioral investments contribute to recovery or the worsening of substance use problems and life difficulties (https://pubmed.ncbi.nlm.nih.gov/35787099/). This was a déjà vu of sorts for me as I proposed a not-dissimilar hypothesis related to the intersection of work dysfunction and addiction as having common roots in the Journal of Substance Abuse Treatment (Comerford, 1999; https://pubmed.ncbi.nlm.nih.gov/10194742/).  In short and in combination, all of these articles speak to the role that context, change, and the development of self-efficacy play in whether someone moves toward a stable recovery or the reverse over time. The implications for treatment and the role that social determinants and having opportunities for rewarding alternatives for substance use from which to choose.  Tough problems today as I was recently reminded by a counselor who stopped by to ask if I had ideas to help an older woman with no resources and few if any options; I had nothing to add to the great work that had been done.  Once yet again, the tough decisions we guide with empathy, and all the continued support we can bring to bear in the face of the limited resources we often have to work with.  By the way, I am often awestruck by some of the miracles we pull off in the face of these persistent challenges.  The full text of the two articles noted above and the complete journal are available at the links provided and may spark some ideas for crafting continuing care plans as we continue to advocate for more ways to help.