Neurocognitive and psychiatric dimensions of hot, but not cool, impulsivity predict HIV sexual risk behaviors among drug users in protracted abstinence

ABSTRACT

Background: Impulsivity is an important risk factor for HIV risky drug and sexual behaviors. Research identifies hot (i.e. affectively-mediated, reward-based) and cool (motoric, attentional, independent of context) neurocognitive and psychiatric dimensions of impulsivity, though the impact of specific drugs of abuse on these varieties of impulsivity remains an open question. Objectives: The present study examined the associations of neurocognitive and psychiatric varieties of hot and cool impulsivity with measures of lifetime and recent sexual risk behaviors among users of different classes of drugs. Methods: The study sample was comprised of drug users in protracted (> 1 year) abstinence: heroin mono-dependent (n = 61), amphetamine mono-dependent (n = 44), and polysubstance dependent (n = 73). Hot impulsivity was operationalized via neurocognitive tasks of reward-based decision-making and symptoms of psychopathy. Cool impulsivity was operationalized via neurocognitive tasks of response inhibition and symptoms of attention deficit/hyperactivity disorder (ADHD). Results: Hot impulsivity was associated with sexual risk behaviors among heroin and amphetamine users in protracted abstinence, whereas cool impulsivity was not associated with sexual risk behaviors among any drug-using group. Neurocognitive hot impulsivity was associated with recent (past 30-day) sexual risk behaviors, whereas psychopathy was associated with sexual risk behaviors during more remote time-periods (past 6 month and lifetime) and mediated the association between heroin dependence and past 6-month sexual risk behaviors. Conclusion: Assessments and interventions aimed at reducing sexual risk behaviors among drug users should focus on hot neurocognitive and psychiatric dimensions of impulsivity, such as decision-making and psychopathy. Cool dimensions of impulsivity such as response inhibition and ADHD were not related to sexual risk behaviors among drug users in protracted abstinence.

KEYWORDS:

• Impulsivity
• substance dependence
• protracted abstinence
• HIV risk behavior
• externalizing psychopathology
• decision-making

Acknowledgements

The authors thank all volunteers for their participation in this study and KB, RN, IR and GV for their assistance with data collection. Special thanks to RG for providing helpful feedback on the first draft of this manuscript.

Funding

This study was completed with financial assistance from the Fogarty International Center (FIC) and the National Institute on Drug Abuse (NIDA) under award number R01DA021421 (J.V.). There was no involvement of a pharmaceutical or other private company in the funding of this research. Article sponsors (FIC/NIDA) played no role in the preparation of this manuscript. Study authors did not utilize any third party writing or editorial assistance in the preparation of this manuscript.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.

Additional information

Funding

This study was completed with financial assistance from the Fogarty International Center (FIC) and the National Institute on Drug Abuse (NIDA) under award number R01DA021421 (J.V.). There was no involvement of a pharmaceutical or other private company in the funding of this research. Article sponsors (FIC/NIDA) played no role in the preparation of this manuscript. Study authors did not utilize any third party writing or editorial assistance in the preparation of this manuscript.