Distress tolerance trajectories following substance use treatment

Abstract

Objective: Distress tolerance (DT), the ability to withstand aversive internal states, represents an important risk factor for substance use relapse and a potential treatment target. Neurobiological research in substance using populations suggests that continued substance use could erode DT, whereas abstinence could bolster it. The current study characterized trajectories of behavioral and self-reported indices of DT and examined the prospective effect of substance use on DT trajectories among those seeking treatment for substance use.

Method: Individuals (N = 263, Mage = 42.68, SD = 11.8, 70.7% male, 94.7% African American) in residential substance use treatment completed subjective (Distress Tolerance Scale) and behavioral (Mirror Tracing Persistence Task-computerized version) DT measures, as well as report of daily substance use (timeline follow-back) over 5 assessment time-points from pretreatment to 12 months posttreatment. Latent curve modeling estimated DT trajectories and their associations with substance use behavior, including abstinence duration (days until first use) and substance use frequency (percentage of substance use days between assessments).

Results: Self-reported and behavioral DT indicators both exhibited positive, nonlinear change over time (standardized slope parameter estimates: Distress Tolerance Scale β = 0.61, p < .01; Mirror Tracing Persistence Task β = 0.34, p < .01). Abstinence duration was associated with greater improvement in behavioral (β = .20, p = .03) DT specifically. Frequency of use was statistically significantly associated with attenuated behavioral DT at 6-month (β = -.12, p = .03) and 12-month follow-ups (β = -.08, p = .045).

Conclusions: DT appears to improve appreciably posttreatment, and return to substance use may shape the degree of this improvement. Collectively, these findings support the conceptualization of DT as a malleable treatment target and emphasize the benefit of abstinence on improvement in DT. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Trial registration: ClinicalTrials.gov NCT01189552.

Figure 1.

Path diagram depicting the conditional latent growth model testing the association of abstinence duration and behavioral DT latent factors while including gender as an added covariates. Note: MTPT-C = Mirror Tracing Persistence Task – Computerized Version; T₁ = pre-treatment assessment; T₂ = residential discharge assessment; T₃ = 3-month follow-up assessment; T₄ = 6-month follow-up assessment; T₅ = 12-month follow-up assessment; p < .05 = *, p < .01 = **, p < .001 = ***

Figure 2.

Path diagram depicting the conditional latent growth model testing the influence of time-specific frequency of use on the behavioral DT trajectory including gender as a covariate. Note: MTPT-C = Mirror Tracing Persistence Task – Computerized Version; T₁ = pre-treatment assessment; T₂ = residential discharge assessment; T₃ = 3-month follow-up assessment; T₄ = 6-month follow-up assessment; T₅ = 12-month follow-up assessment; p < .05 = *, p < .01 = **, p < .001 = ***