Disentangling Substance Use and Disorder: Urgency, But Not Sensation Seeking, Predicts Substance-Related Problems Above and Beyond The Degree of Substance Use.

Disentangling Substance Use and Disorder: Urgency, But Not Sensation Seeking, Predicts Substance-Related Problems Above and Beyond The Degree of Substance Use. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Disentangling Substance Use and Disorder: Urgency, But Not Sensation Seeking, Predicts Substance-Related Problems Above and Beyond The Degree of Substance Use. Malin Hildebrandt, Raoul Dieterich, Tanja Endrass This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-108038/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background: Substance use disorders are reliably associated with high impulsivity and sensation seeking. Importantly, both precede problematic substance use, implicating them as risk factors. Individuals with substance use disorders show variable degrees of substance use (combined quantity and frequency) and substance-related problems and differ in both aspects from healthy controls. Dimensional research has indicated differential associations of impulsivity-related traits as well as sensation seeking with the degree of substance use and substance-related problems. The current study aimed to clarify whether impulsivity-related traits and sensation seeking predict substance-related problems above and beyond the degree of substance use and are thus specifically linked to problems, the dimension that characterizes substance use disorders. Method: We assessed impulsivity-related traits and sensation seeking using self-report, as well as delay discounting, a behavioral indicator of impulsivity, in a sample of 258 substance-using adults. Results: Sensation seeking and impulsivity-related traits significantly predicted the degree of substance use, with sensation seeking explaining the largest portion of variance. In contrast, self-reported impulsivity, in particular when experiencing negative emotions (urgency), but not sensation seeking or delay discounting, predicted substance-related problems when controlling for the degree of substance use. Conclusions: This suggests that urgency, but not sensation seeking, may be specifically linked to substance-related problems and thus especially relevant for substance use disorders. Taken together, this study underlines the necessity to assess and control for the degree of substance use in risk factor research concerning substance-related problems. Thus, it may inform future research improving targeted prevention and therapy. Psychiatry substance use impulsivity sensation seeking dimensional urgency Background Substance use disorders (SUDs) are characterized not only by substance use itself but by problems related to substance use (1), such as the inability to control substance intake, or the failure to comply with social responsibilities. Not all frequent substance users develop these problems to the same extent. It is crucial for targeted prevention and treatment to identify factors that specifically influence the development of problems. Most of the literature on SUDs relies on comparisons of individuals diagnosed with SUDs and healthy controls in order to do so. Here, the patients differ from healthy controls in both the degree of substance use (quantity and frequency) and substance-related problems. This hinders evaluating whether the examined potential risk factors are truly associated with the development of substance-related problems, the dimension that is critical for the diagnosis of SUDs. The specific associations of potential risk factors with the degree of substance use and substance-related problems remain unclear. Here, we are proposing a dimensional approach examining the associations of potential risk factors with substance-related problems while statistically controlling for the degree of substance use. Consequently, we assessed both variables separately and dimensionally in a population of substance users of varying degrees of substance use. Using this approach, we aimed to take a first step in re-evaluating the role of impulsivity-related traits as risk factors for SUDs. High levels of impulsivity-related traits are robustly found in individuals with SUDs (2-5). So far, it has never been tested whether this is driven by the association of these factors with the degree of substance use or whether they are, beyond that, incrementally relevant for substance-related problems across different substances. Particularly, controlling for the degree of use has been neglected in previous work. Overall, impulsivity is robustly associated with SUDs (for a review see e.g. 6). Factor analyses of questionnaires assessing impulsivity repeatedly suggested that it may be divided into four distinct, yet related facets: urgency, (lack of) premeditation, (lack of) perseverance and sensation seeking (UPPS model; 7, 8). The first three facets conform with a narrow definition of impulsivity, understood as the propensity to act quickly while disregarding long-term negative consequences (9) and we will therefore subsume them as impulsivity-related traits. Sensation seeking does not conform with this definition and has recently been pinpointed as a separate construct (10) that correlates only weakly with impulsivity-related traits (between r = 0.00 and r = 0.18; 7, 11), suggesting that the tendency to seek excitement is to a large extent independent of the tendency to act rashly. Longitudinal studies suggest that sensation seeking prospectively predicts the risk to develop SUDs (e.g. 4). Further studies indicate impulsivity-related traits as risk factor for SUDs by showing that impulsivity-related traits prospectively predict the degree of substance use as well as related problems with similar (12, 13) or higher (14) associations of impulsivity-related traits with problems than with the degree of substance use. Notably, substance use and problems do not prospectively predict impulsivity-related traits (15). One study provides first evidence that a composite score that included impulsivity-related measures, sensation seeking and emotional control prospectively predicts substance-related problems even when controlling for substance use (with a medium effect size; 13). Research further suggests that impulsivity-related traits as well as sensation seeking are differentially related to the degree of substance use and problems. Sensation seeking and premeditation are associated with the degree of substance use (Lynam & Miller, 2004; Magid & Colder, 2007; Miller et al., 2003). A meta-analysis that assigned various measures to the UPPS model found that all traits were similarly related to the degree of use, while urgency was the facet most strongly related to problems (16). Urgency, specifically when experiencing negative emotions, has also been linked to other types of problem behavior (e.g. bulimic symptoms; 17). Moreover, although the evidence is so far restricted to alcohol use, urgency and perseverance were shown to be associated with problems, even when controlling for the degree of substance use (Magid & Colder, 2007). Importantly, the association of sensation seeking with problems disappeared when the degree of substance use was statistically controlled for. These findings underline that the approach we propose here is suitable for identifying factors specifically associated with substance-related problems. One widely studied behavioral indicator of impulsivity is delay discounting, the subjective devaluation of rewards based on how far in the future they become available (18). This index of the preference for smaller sooner over larger later rewards is of high conceptual relevance to SUD research, as it closely resembles behavior observed in individuals with SUDs, i.e., choosing immediate drug effects over long-term goals (e.g., taking care of family or school/job etc.). Empirically, higher delay discounting in individuals with SUDs (19) and associations of delay discounting with substance use frequency (20) and SUD severity (indicating substance-related problems) are consistently observed (21-23). Delay discounting correlates with premeditation (24-27), but also urgency (25) and sensation seeking (27), but a meta-analysis suggests that these associations are overall rather weak. The goal of this study was to extend the finding that impulsivity-related traits, but not sensation seeking, predict alcohol-related problems above and beyond the degree of substance use (28) by investigating this relationship in a sample of (poly)substance users. Thereby, we aimed to examine if impulsivity-related traits, but not sensation seeking, may be specifically linked to substance-related problems (and thus truly be relevant for SUDs) across different substances. Furthermore, we assessed delay discounting to examine whether self-reported and behavioral impulsivity-related traits distinctly relate to substance use variables. We expected that impulsivity-related traits (self-report and delay discounting) as well as sensation seeking would predict the degree of substance use, while only impulsivity-related traits (more specifically urgency, perseverance and delay discounting), but not sensation seeking, would predict substance-related problems when controlling for the degree of substance use. Methods 2.1 Participants The final sample consisted of 258 participants who indicated that they were using at least one substance at least once a month. See Table 1 for sociodemographic and substance use-related characteristics of participants. Further details are available in the supplementary material. Inclusion criteria were (1) age between 18 and 40 years, (2) native German speakers, (3) no reported use of any substance (except for nicotine) on the day of the survey. We excluded these participants to avoid effects of acute intoxication on questionnaire responses. Participants were recruited mainly through advertisements in clubs, webpages associated with the techno music scene, and counseling centers as well as through postings and flyers. Participants gave informed consent prior to participation. Participants could earn course credit (six participants) or take part in a lottery to win one of three 10 euro vouchers. The study protocol was approved by the local ethics committee (EK 146042019) and followed the guidelines stated by the Declaration of Helsinki. 2.2 Procedure Participants completed an online-survey (approx. 20 minutes) comprising sociodemographic information and the measures described below. Table 1 Sociodemographic and substance use-related characteristics of participants Characteristic N % Gender female 148 57.4 male 109 42.2 not specified 1 0.4 Highest secondary school degree upper 226 87.6 intermediate 28 10.9 lower 2 0.8 Current use of alcohol 236 91.5 nicotine 159 61.6 cannabis 117 45.3 stimulants 79 30.6 hallucinogenic substances 29 11.2 opioids 14 5.4 misused medication 5 1.9 inhalants 4 1.6 other substances 3 1.2 M MD SD range age 26.1 25.0 5.0 18-40 currently used substance classes 2.5 2.0 1.3 1-6 substance classes used lifetime 4.7 5.0 2.0 1- 9 Note. M and SD represent mean and standard deviation, respectively. 2.3 Material 2.3.1 Substance Use Questionnaire This questionnaire measured the frequency and quantity of substance use for the following substance classes from the DSM-5: alcohol, tobacco, cannabis, stimulants, opioids, hallucinogenic substances, misused medication, inhalants, other substances. Participants were first asked whether they had ever used any of the substances from the respective substance class. If they answered ‘yes’, participants indicated, among other variables not relevant here, their average frequency of use within the past three months on a 6-point Likert scale ranging from 1 to 6 ( almost daily , 3-4 times a week, 1-2 times a week, 1-2 times a month, less than once a month, never ) and the average subjective quantity of use on a standard occasion within the past three months on a 5-point Likert scale ranging from 1 ( very little ) to 5 ( very much ) [1] . We computed individual degree of substance use scores for each substance class (product of quantity and frequency values, possible maximum: 30) and a total degree of substance use score (sum of the individual degree of substance use scores, possible maximum: 270). 2.3.2 Substance-Related Problems Questionnaire This questionnaire measured substance-related problems operationalized by the number of DSM-5 SUD symptoms from the A criterion participants reported to have experienced within the past 12 months (range 0 - 11). Questions were based on the German version of the Structured Clinical Interview for DSM-5 Disorders – Clinician Version (29) and adapted to the online application. Participants were instructed to consider all substances when judging whether they had experienced each symptom. Thus, this index does not equal a diagnosis of a specific substance use disorder, but rather an index of problem severity across substances as experienced symptoms may be attributable to different substances. 2.3.3 UPPS Impulsive Behavior Scale This 45-item self-report questionnaire assesses four subscales representing facets of impulsivity as identified by Whiteside and Lynam (30): (1) negative urgency (e.g., “In the heat of an argument, I will often say things that I later regret.”; possible range: 12 - 48), (2) (lack of ) premeditation (e.g., “I usually make up my mind through careful reasoning.”; possible range: 11 - 44), (3) (lack of) perseverance (e.g., “Once I start a project, I almost always finish it.”; possible range: 10 - 40), and (4) sensation seeking (e.g., “I welcome new and exciting experiences and sensations, even if they are a little frightening and unconventional.”; possible range: 11 - 44). Items are rated on a 4-point Likert scale ranging from 1 ( strongly agree ) to 4 ( strongly disagree ). If necessary, items are reverse coded so that higher values on a subscale always indicate higher impulsivity/sensation seeking. The subscales of the German version (31) have good internal consistency (cronbachs α = .81 - .85) and external validity (32). 2.3.4 Monetary Choice Questionnaire (MCQ) The MCQ (German version; 33) assesses delay discounting. It comprises 27 binary choices between varying amounts of money (8 - 66 Euros) available either now or with a delay (7 - 238 days). Values and delays of the options are predefined to cover a high range of discounting rates for low, medium, and high values of delayed rewards, respectively. The discounting rate k can be modeled assuming a hyperbolic function (34) [1] For reasons of brevity of the online survey and our decision to combine individual substances to substance classes, we did not assess objective quantities of substance use. The results of this study do not change when using only total frequency rather than the total degree of substance use score as a control variable (see supplementary material for further details). where V is the subjective value of a delayed reward with the amount A after the delay D . The parameter k is estimated based on the proportion of choices that are consistent with every possible value of k (for a thorouh description please refer to 35). As k is dependent on value (36), k is estimated for small, medium and large delayed rewards, respectively, and the geometric mean of these values constitutes an individual’s k -value. 2.4 Data analysis All analyses were conducted in R (37). We log-transformed the k -parameter due to skewedness. Pearson’s correlations were computed to examine bivariate associations. Two-tailed tests of the difference between two dependent correlations with one variable in common were conducted to test whether correlations differed significantly. Subsequently, we computed partial correlations of all predictor variables with substance-related problems controlled for the degree of substance use to explore their respective contribution outside the context of other predictor variables. Last, we conducted two hierarchical linear regressions for the degree of substance use and substance-related problems to identify the unique variance explained by sensation seeking, impulsivity-related traits, and log( k ). For both regression models, we entered gender as a covariate in the first step, because it was significantly related to both outcome variables, while age was not (ps > .05). We excluded the group “gender not specified” from these regression analyses (n = 1). For the model predicting the degree of substance use, we added the UPPS subscales in the second and log( k ) in the third step. For the model predicting substance-related problems, we added the degree of substance use as a covariate in the second step, the UPPS subscales in the third step and log( k ) in the fourth step. To test on an exploratory basis whether a regressor explained more variance in the criterion variable than another regressor, we computed finite-sample F-statistics using the “linearHypothesis” function from the car package (38). We applied a significance level of α = .05 for all analyses. Results 3.1 Bivariate correlations Discounting rates ranged from 0.000158 to 0.24853, with some choosing exclusively the smaller sooner or the larger later option, and were not significantly associated with any of the UPPS subscales (all p s > .05), except for a small positive correlation with urgency (see Table 2 for an overview of correlations). Delay discounting and (lack of) premeditation were significantly, but weakly, correlated with both the degree of substance use and problems. (Lack of) perseverance displayed stronger correlations (small to moderate) with both substance use variables. Sensation seeking correlated significantly stronger with the degree of substance use than with problems, r= .38 vs. r= .23, t (256) = 2.72, p = .01. In turn, urgency correlated significantly stronger with substance-related problems than with the degree of substance use, r = .33, vs. r = .18, t (256) = 2.67, p = .01. The degree of substance use and substance-related problems were strongly correlated. Table 2 Means, Standard Deviations, and Correlations with Confidence Intervals for UPPS subscales, Delay Discounting (log(k)), the Degree of Substance Use and Substance-Related Problems Variable M SD 1 2 3 4 5 6 UPPS 1. Urgency 26.77 5.96 2. Premeditation 23.59 4.50 .32** [.20, .42] 3. Persistence 20.40 4.41 .40** .26** [.29, .50] [.14, .37] 4. Sensation Seeking 32.00 7.26 -.00 .32** .01 [-.12, .12] [.21, .43] [-.12, .13] MCQ 5. log ( k ) -2.28 0.75 .14* -.00 .04 -.01 [.01, .25] [-.12, .12] [-.08, .16] [-.14, .11] Substance use variables 6. Degree of use 35.89 19.36 .18** .16* .22** .38** .18** [.05, .29] [.04, .28] [.10, .34] [.27, .48] [.06, .30] 7. Problems 4.15 2.85 .33** .13* .29** .23** .15* .55** [.22, .43] [.01, .25] [.17, .39] [.11, .35] [.03, .27] [.46, .63] Note. M and SD represent mean and standard deviation, respectively. Values in square brackets indicate the 95% confidence interval. UPPS = Urgency Premeditation Perseverance Sensation Seeking Impulsive Behavior Scale, MCQ = Monetary Choice Questionnaire, k = delay discounting. * p < .05. ** p < .01. 3.2 Partial correlations When controlling for the degree of substance use, urgency ( r (256)= .28, p .05). 3.3 Relative contributions of UPPS subscales and delay discounting to substance use outcomes 3.3.1 The degree of substance use In the first model, we regressed the degree of substance use on the UPPS subscales and log( k ) while controlling for gender (see Table 3). The hierarchical multiple regression revealed that all UPPS subscales (except for premeditation) as well as log( k ) explained significant unique variance in the degree of substance use, such that higher levels of urgency, perseverance, sensation seeking and delay discounting were associated with more substance use. In the complete model, sensation seeking had a significantly stronger effect on the degree of substance use than all other impulsivity-related predictors respectively, all F s > 4.13, all p s < .05. The complete model accounted for 25 percent of the variance in the degree of substance use. 3.3.2 Substance-related problems In the second model, we regressed substance-related problems on the UPPS subscales and log( k ) while controlling for age and the degree of substance use (see Table 3). The hierarchical multiple regression revealed that the UPPS urgency subscale explained significant unique variance in substance-related problems, such that higher levels of urgency were associated with more problems above and beyond the degree of substance use, which also predicted substance-related problems. None of the other predictors were significantly associated with substance-related problems. In the complete model, urgency had a significantly stronger effect on substance-related problems than premeditation and log(k) (all F s > 5.57, all p s > .05) and sensation seeking, but this difference was only a marginally significant ( F = 2.96, p = .09). The complete model accounted for 39 percent of the variance in substance-related problems. Table 3 Hierarchical Multiple Regression Analyses with the UPPS Subscales and Delay Discounting predicting the Degree of Substance Use and Substance-Related Problems Predictors Degree of substance use Substance-related problems ΔR 2 F B SE β ΔR 2 F B SE β Step 1 .087** 24.45 .017* 4.432 4 Male gender 11.57 2.34 .30** 0.75 0.35 .13* Step 2 .305** 114.22 Male gender -0.23 0.31 -.04 Degree of substance use 0.08 0.01 .58** Step 3 - UPPS .144** 11.70 .068** 6.99 Male gender 7.38 2.52 .19** -0.06 0.33 -.01 Degree of substance use 0.07 0.01 .49** Urgency 0.52 0.21 .16* 0.11 0.03 .23** Premeditation -0.09 0.28 -.02 -0.04 0.04 -.06 Perseverance 0.64 0.28 .15* 0.06 0.04 .10 Sensation seeking 0.83 0.18 .31** 0.03 0.02 .07 Step 4 - MCQ .022** 7.26 .001 0.30 Male gender 6.40 2.51 .16* -0.08 0.34 -.01 Degree of substance use 0.07 0.01 .48** Urgency 0.43 0.21 .13* 0.11 0.03 .22** Premeditation -0.08 0.27 -.02 -0.04 0.04 -.06 Perseverance 0.67 0.27 .15* 0.07 0.04 .10 Sensation seeking 0.86 0.17 .32** 0.03 0.02 .08 Log( k ) 3.88 1.44 .15** 0.10 0.19 .03 Total R 2 .253** 14.08 .391** 22.83 Note. ΔR 2 = change in proportion of explained variance; B = unstandardized estimate; SE = standard error of B, β = standardized estimate. * p < .05. ** p < .01. Discussion This study examined the differential associations of impulsivity-related traits, sensation seeking, and delay discounting with the degree of substance use (combined quantity and frequency) and substance-related problems in a sample of (poly-)substance users. Thereby, we aimed to disentangle which of these potential risk factors were associated with the degree of substance use and which ones were specifically relevant for substance-related problems and thus for the diagnosis of SUDs. First, sensation seeking, self-reported urgency and perseverance, as well as delay discounting, explained unique variance in the degree of substance use. Sensation seeking was the strongest predictor, explaining significantly more variance in the degree of substance use than all other predictors. This conforms with the reviewed literature (8, 28, 39) and indicates that high expressions of both impulsivity and sensation seeking independently, and more so combined, may increase the risk to engage in pronounced substance use. This may already be harmful, e.g. in terms of bodily consequences, but does not necessarily go along with substance-related problems. Second, the impulsivity-related trait of negative urgency explained significant unique variance in substance-related problems above and beyond the degree of substance use, while sensation seeking did not. This finding is in line with prior research (28) but extends the evidence beyond alcohol use and shows that urgency is specifically linked to substance-related problems, the dimension critical for SUDs, even when controlling for substance use and across substances. Building on evidence showing that high levels of urgency precede problematic substance use (e.g. 39), this finding underlines the role of urgency as a potential general risk factor for substance-related problems. Furthermore, this is the first study to combine self-report with behavioral measures of impulsivity using the approach to SUD risk factor research we propose here. This highlights the special role of urgency for SUDs, as this trait was associated with problems even when controlling for the degree of use as well as behavioral impulsivity (delay discounting) and other impulsivity-related traits. Delay discounting, a behavioral measure of impulsivity, was weakly associated with both the degree of substance use and problems, but the association with problems disappeared when controlling for the degree of use. This is not surprising, considering that delay discounting was only weakly related to substance-related problems in the first place, closely resembling the effect size found in a meta-analysis (21). This finding indicates that the consistent associations of delay discounting and SUDs described in the literature may be best explained by underlying and confounding differences in the degree of substance use. Although a high degree of use may be inherently harmful, this contradicts the role of delay discounting as a specific risk factor for substance-related problems and thus SUDs discussed in the literature (e.g. 3). However, as this is the first study to examine associations of delay discounting with substance-related problems controlling for the degree of use, this finding needs replication before drawing final conclusions. 4.1 Limitations and future directions The dimensional approach we applied in this study proved suitable for identifying differential associations of potential SUD risk factors with substance-related problems controlling for the degree of use. Nonetheless, it requires a longitudinal approach to test whether these factors truly constitute specific risk factors for developing substance-related problems. Furthermore, the delay discounting questionnaire we used in this study uses relatively low monetary rewards. Research suggests that high monetary offers better distinguish substance users from controls (40). Hence, tasks using higher monetary offers may be more suitable for substance-using populations and delay discounting assessed with such tasks may show a specific association with substance-related problems. Importantly, our sample was predominantly highly educated. It is possible that this acted as a protective factor buffering effects of e.g. delay discounting on substance-related problems. Thus, further studies including more representative samples are warranted to consolidate the generalizability of the associations described in this study. Due to temporal restraints in the online-survey, we did not assess substance-related problems separately for each substance or substance class. Therefore, we could not directly test whether the examined associations differed between substances but rather demonstrated that they were overall significant when all substances were combined. Also, the assessment of substance-related problems was purely based on self-report, while clinical interviews may provide a more nuanced and comparable picture. Future studies may include positive urgency, as this facet shows unique associations with substance use outcomes (17) and may thus contribute additional insights. Conclusion This study showed that the impulsivity-related traits of urgency and to some extent perseverance, but not sensation seeking, were specifically linked to substance-related problems, the dimension that is crucial for SUDs. We applied a dimensional approach to SUD risk factor research examining the associations of potential risk factors with substance-related problems while statistically controlling for the degree of substance use. The present study demonstrated that this approach is suitable for identifying factors specifically linked to substance-related problems and thus SUDs. Hence, future longitudinal studies using this approach may clarify the role of impulsivity-related traits, alongside others, as risk factors for SUDs. To identify risk factors specifically linked to the development of substance-related problems, rather than predominantly a high degree of use, would convey important implications for practice. A focus on these factors may help to identify individuals within substance using populations who are more in need for preventive measures in order to avoid a transition to problematic substance use. However, longitudinal studies are needed to substantiate the current finding. Furthermore, they may be relevant target points for therapeutic interventions. Taken together, the approach applied in this study may pose a starting point for further research advancing targeted prevention and therapy. Declarations Ethical approval and consent to participate The study protocol was approved by the local ethics committee (Ethikkommission an der Technischen Universität Dresden; EK 146042019) and followed the guidelines stated by the Declaration of Helsinki. Participants were thoroughly informed and indicated consent to participate (informed consent) by a button press in the beginning of the online survey. Consent for publication Not applicable. Availability of data and materials The dataset supporting the conclusions of this article is available in the OSF repository, DOI 10.17605/OSF.IO/CWNRG, https://mfr.de-1.osf.io/render?url=https://osf.io/8wgts/?direct%26mode=render%26action=download%26mode=render. Competing interests The authors declare that they have no competing interests. Funding This work was supported by a PhD scholarship for Malin Hildebrandt from the Claussen-Simon Stiftung and by the German Research Foundation (Deutsche Forschungsgemeinschaft, grant numbers TRR 265 B01 and EN 906/6). The funding sources had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. Authors' contributions M.H. : Conceptualization, Methodology, Investigation, Formal Analysis, Writing – Original Draft, Project Administration, Funding Acquisition. R. D. : Conceptualization, Methodology, Writing – Review and Editing, Supervision. T. E. : Conceptualization, Resources, Methodology, Writing – Review and Editing, Funding Acquisition, Supervision. All authors contributed to and have approved the final manuscript. Acknowledgements Not applicable. References Diagnostic and statistical manual of mental disorders: DSM-5. 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Claus ED, Kiehl KA, Hutchison KE. Neural and behavioral mechanisms of impulsive choice in alcohol use disorder. Alcohol Clin Exp Res. 2011;35(7):1209-19. Lim AC, Cservenka A, Ray LA. Effects of Alcohol Dependence Severity on Neural Correlates of Delay Discounting. Alcohol and Alcoholism. 2017;52(4):506-15. Lynam DR, Miller JD. Personality Pathways to Impulsive Behavior and Their Relations to Deviance: Results from Three Samples. Journal of Quantitative Criminology. 2004;20(4):319-41. Steward T, Mestre-Bach G, Fernández-Aranda F, Granero R, Perales JC, Navas JF, et al. Delay discounting and impulsivity traits in young and older gambling disorder patients. Addictive Behaviors. 2017;71:96-103. Murphy C, Mackillop J. Living in the here and now: interrelationships between impulsivity, mindfulness, and alcohol misuse. Psychopharmacology (Berl). 2012;219(2):527-36. Cyders MA, Coskunpinar A. 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Supplementary Files HildebrandtSupplements.docx HildebrandtSupplements.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 16 Mar, 2021 Reviewers agreed at journal 11 Feb, 2021 Reviews received at journal 25 Jan, 2021 Reviewers agreed at journal 18 Jan, 2021 Reviewers invited by journal 18 Nov, 2020 Editor assigned by journal 18 Nov, 2020 Editor invited by journal 17 Nov, 2020 Submission checks completed at journal 17 Nov, 2020 First submitted to journal 13 Nov, 2020 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-108038","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":4886035,"identity":"aa04f320-f914-41ae-9341-a43eb7170e18","order_by":0,"name":"Malin Hildebrandt","email":"data:image/png;base64,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","orcid":"","institution":"TU Dresden","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Malin","middleName":"","lastName":"Hildebrandt","suffix":""},{"id":4886036,"identity":"e1bf0f69-0bcd-49df-baa5-2bee11f196f9","order_by":1,"name":"Raoul Dieterich","email":"","orcid":"","institution":"TU Dresden","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Raoul","middleName":"","lastName":"Dieterich","suffix":""},{"id":4886037,"identity":"13a96d0b-09d8-4c1d-a5f5-8c3b4450be56","order_by":2,"name":"Tanja Endrass","email":"","orcid":"","institution":"TU Dresden","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tanja","middleName":"","lastName":"Endrass","suffix":""}],"badges":[],"createdAt":"2020-11-13 16:53:01","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-108038/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-108038/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13620721,"identity":"5c936f2c-f162-45b4-b8ef-9b9e0537115d","added_by":"auto","created_at":"2021-09-17 07:07:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":294580,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-108038/v1/46c36aba-9f46-42fc-9a08-e23aeed21c0d.pdf"},{"id":3799462,"identity":"522e8b97-45f9-49dd-bf6a-49ec77a81f0c","added_by":"auto","created_at":"2020-11-24 18:01:00","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":31698,"visible":true,"origin":"","legend":"","description":"","filename":"HildebrandtSupplements.docx","url":"https://assets-eu.researchsquare.com/files/rs-108038/v1/d72fd6caa2b9e35b11c76449.docx"},{"id":3799429,"identity":"33c4d551-a72b-438c-b34b-ab465abe3780","added_by":"auto","created_at":"2020-11-24 18:00:54","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":31698,"visible":true,"origin":"","legend":"","description":"","filename":"HildebrandtSupplements.docx","url":"https://assets-eu.researchsquare.com/files/rs-108038/v1/0ff047151571c1ed3c8ae67c.docx"}],"financialInterests":"","formattedTitle":"\u003cp\u003eDisentangling Substance Use and Disorder: Urgency, But Not Sensation Seeking, Predicts Substance-Related Problems Above and Beyond The Degree of Substance Use.\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eSubstance use disorders (SUDs) are characterized not only by substance use itself but by problems related to substance use (1), such as the inability to control substance intake, or the failure to comply with social responsibilities. Not all frequent substance users develop these problems to the same extent. It is crucial for targeted prevention and treatment to identify factors that specifically influence the development of problems. Most of the literature on SUDs relies on comparisons of individuals diagnosed with SUDs and healthy controls in order to do so. Here, the patients differ from healthy controls in both the degree of substance use (quantity and frequency) and substance-related problems. This hinders evaluating whether the examined potential risk factors are truly associated with the development of substance-related problems, the dimension that is critical for the diagnosis of SUDs. The specific associations of potential risk factors with the degree of substance use and substance-related problems remain unclear. Here, we are proposing a dimensional approach examining the associations of potential risk factors with substance-related problems while statistically controlling for the degree of substance use. Consequently, we assessed both variables separately and dimensionally in a population of substance users of varying degrees of substance use. Using this approach, we aimed to take a first step in re-evaluating the role of impulsivity-related traits as risk factors for SUDs. High levels of impulsivity-related traits are robustly found in individuals with SUDs (2-5). So far, it has never been tested whether this is driven by the association of these factors with the degree of substance use or whether they are, beyond that, incrementally relevant for substance-related problems across different substances. Particularly, controlling for the degree of use has been neglected in previous work.\u003c/p\u003e\n\u003cp\u003eOverall, impulsivity is robustly associated with SUDs (for a review see e.g. 6). Factor analyses of questionnaires assessing impulsivity repeatedly suggested that it may be divided into four distinct, yet related facets: urgency, (lack of) premeditation, (lack of) perseverance and sensation seeking (UPPS model; 7, 8). The first three facets conform with a narrow definition of impulsivity, understood as the propensity to act quickly while disregarding long-term negative consequences (9) and we will therefore subsume them as impulsivity-related traits. Sensation seeking does not conform with this definition and has recently been pinpointed as a separate construct (10) that correlates only weakly with impulsivity-related traits (between r = 0.00 and r = 0.18; 7, 11), suggesting that the tendency to seek excitement is to a large extent independent of the tendency to act rashly.\u003c/p\u003e\n\u003cp\u003eLongitudinal studies suggest that sensation seeking prospectively predicts the risk to develop SUDs (e.g. 4). Further studies indicate impulsivity-related traits as risk factor for SUDs by showing that impulsivity-related traits prospectively predict the degree of substance use as well as related problems with similar (12, 13) or higher (14) associations of impulsivity-related traits with problems than with the degree of substance use. Notably, substance use and problems do not prospectively predict impulsivity-related traits (15). One study provides first evidence that a composite score that included impulsivity-related measures, sensation seeking and emotional control prospectively predicts substance-related problems even when controlling for substance use (with a medium effect size; 13).\u003c/p\u003e\n\u003cp\u003eResearch further suggests that impulsivity-related traits as well as sensation seeking are differentially related to the degree of substance use and problems. Sensation seeking and premeditation are associated with the degree of substance use (Lynam \u0026amp; Miller, 2004; Magid \u0026amp; Colder, 2007; Miller et al., 2003). A meta-analysis that assigned various measures to the UPPS model found that all traits were similarly related to the degree of use, while urgency was the facet most strongly related to problems (16). Urgency, specifically when experiencing negative emotions, has also been linked to other types of problem behavior (e.g. bulimic symptoms; 17). Moreover, although the evidence is so far restricted to alcohol use, urgency and perseverance were shown to be associated with problems, even when controlling for the degree of substance use (Magid \u0026amp; Colder, 2007). Importantly, the association of sensation seeking with problems disappeared when the degree of substance use was statistically controlled for. These findings underline that the approach we propose here is suitable for identifying factors specifically associated with substance-related problems.\u003c/p\u003e\n\u003cp\u003eOne widely studied behavioral indicator of impulsivity is delay discounting, the subjective devaluation of rewards based on how far in the future they become available (18). This index of the preference for smaller sooner over larger later rewards is of high conceptual relevance to SUD research, as it closely resembles behavior observed in individuals with SUDs, i.e., choosing immediate drug effects over long-term goals (e.g., taking care of family or school/job etc.). Empirically, higher delay discounting in individuals with SUDs (19) and associations of delay discounting with substance use frequency (20) and SUD severity (indicating substance-related problems) are consistently observed (21-23). Delay discounting correlates with premeditation (24-27), but also urgency (25) and sensation seeking (27), but a meta-analysis suggests that these associations are overall rather weak.\u003c/p\u003e\n\u003cp\u003eThe goal of this study was to extend the finding that impulsivity-related traits, but not sensation seeking, predict alcohol-related problems above and beyond the degree of substance use (28) by investigating this relationship in a sample of (poly)substance users. Thereby, we aimed to examine if impulsivity-related traits, but not sensation seeking, may be specifically linked to substance-related problems (and thus truly be relevant for SUDs) across different substances. Furthermore, we assessed delay discounting to examine whether self-reported and behavioral impulsivity-related traits distinctly relate to substance use variables. We expected that impulsivity-related traits (self-report and delay discounting) as well as sensation seeking would predict the degree of substance use, while only impulsivity-related traits (more specifically urgency, perseverance and delay discounting), but not sensation seeking, would predict substance-related problems when controlling for the degree of substance use.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e2.1 Participants\u003c/p\u003e\n\u003cp\u003eThe final sample consisted of 258 participants who indicated that they were using at least one substance at least once a month. See Table 1 for sociodemographic and substance use-related characteristics of participants. Further details are available in the supplementary material. Inclusion criteria were (1) age between 18 and 40 years, (2) native German speakers, (3) no reported use of any substance (except for nicotine) on the day of the survey. We excluded these participants to avoid effects of acute intoxication on questionnaire responses. Participants were recruited mainly through advertisements in clubs, webpages associated with the techno music scene, and counseling centers as well as through postings and flyers. Participants gave informed consent prior to participation. Participants could earn course credit (six participants) or take part in a lottery to win one of three 10 euro vouchers. The study protocol was approved by the local ethics committee (EK 146042019) and followed the guidelines stated by the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e2.2 Procedure\u003c/p\u003e\n\u003cp\u003eParticipants completed an online-survey (approx. 20 minutes) comprising sociodemographic information and the measures described below.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSociodemographic and substance use-related characteristics of participants\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003eCharacteristic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cem\u003e%\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; female\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e148\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e57.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; male\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e109\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e42.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; not specified\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e0.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003e\u003cstrong\u003eHighest secondary school degree\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; upper\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e226\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e87.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; intermediate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e10.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; lower\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003e\u003cstrong\u003eCurrent use of\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; alcohol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e236\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e91.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; nicotine\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e159\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e61.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; cannabis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e117\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e45.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; stimulants\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e30.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; hallucinogenic substances\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e11.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; opioids\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e5.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; misused medication\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; inhalants\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"397\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; other substances\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eM\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eMD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eSD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003erange\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003eage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e26.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e25.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e5.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e18-40\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003ecurrently used substance classes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e2.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1-6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003esubstance classes used lifetime\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e4.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e5.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e2.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1- 9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u003cbr /\u003eNote.\u003c/em\u003e \u003cem\u003eM\u003c/em\u003e and \u003cem\u003eSD\u003c/em\u003e represent mean and standard deviation, respectively.\u003c/p\u003e\n\u003cp\u003e2.3 Material\u003c/p\u003e\n\u003cp\u003e2.3.1 Substance Use Questionnaire\u003c/p\u003e\n\u003cp\u003eThis questionnaire measured the frequency and quantity of substance use for the following substance classes from the DSM-5: alcohol, tobacco, cannabis, stimulants, opioids, hallucinogenic substances, misused medication, inhalants, other substances. Participants were first asked whether they had ever used any of the substances from the respective substance class. If they answered \u0026lsquo;yes\u0026rsquo;, participants indicated, among other variables not relevant here, their average frequency of use within the past three months on a 6-point Likert scale ranging from 1 to 6 (\u003cem\u003ealmost daily\u003c/em\u003e, \u003cem\u003e3-4 times a week, 1-2 times a week, 1-2 times a month, less than once a month, never\u003c/em\u003e) and the average subjective quantity of use on a standard occasion within the past three months on a 5-point Likert scale ranging from 1 (\u003cem\u003every little\u003c/em\u003e) to 5 (\u003cem\u003every much\u003c/em\u003e)\u003ca href=\"#_ftn1\" name=\"_ftnref1\"\u003e[1]\u003c/a\u003e. We computed individual degree of substance use scores for each substance class (product of quantity and frequency values, possible maximum: 30) and a total degree of substance use score (sum of the individual degree of substance use scores, possible maximum: 270).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;2.3.2 Substance-Related Problems Questionnaire\u003c/p\u003e\n\u003cp\u003eThis questionnaire measured substance-related problems operationalized by the number of DSM-5 SUD symptoms from the A criterion participants reported to have experienced within the past 12 months (range 0 - 11). Questions were based on the German version of the Structured Clinical Interview for DSM-5 Disorders \u0026ndash; Clinician Version (29) and adapted to the online application. Participants were instructed to consider all substances when judging whether they had experienced each symptom. Thus, this index does not equal a diagnosis of a specific substance use disorder, but rather an index of problem severity across substances as experienced symptoms may be attributable to different substances.\u003c/p\u003e\n\u003cp\u003e2.3.3 UPPS Impulsive Behavior Scale\u003c/p\u003e\n\u003cp\u003eThis 45-item self-report questionnaire assesses four subscales representing facets of impulsivity as identified by Whiteside and Lynam (30): (1) negative urgency (e.g., \u0026ldquo;In the heat of an argument, I will often say things that I later regret.\u0026rdquo;; possible range: 12 - 48), (2) (lack of ) premeditation (e.g., \u0026ldquo;I usually make up my mind through careful reasoning.\u0026rdquo;; possible range: 11 - 44), (3) (lack of) perseverance (e.g., \u0026ldquo;Once I start a project, I almost always finish it.\u0026rdquo;; possible range: 10 - 40), and (4) sensation seeking (e.g., \u0026ldquo;I welcome new and exciting experiences and sensations, even if they are a little frightening and unconventional.\u0026rdquo;; possible range: 11 - 44). Items are rated on a 4-point Likert scale ranging from 1 (\u003cem\u003estrongly agree\u003c/em\u003e) to 4 (\u003cem\u003estrongly disagree\u003c/em\u003e). If necessary, items are reverse coded so that higher values on a subscale always indicate higher impulsivity/sensation seeking. The subscales of the German version (31) have good internal consistency (cronbachs \u0026alpha; = .81 - .85) and external validity (32).\u003c/p\u003e\n\u003cp\u003e2.3.4 Monetary Choice Questionnaire (MCQ)\u003c/p\u003e\n\u003cp\u003eThe MCQ (German version; 33) assesses delay discounting. It comprises 27 binary choices between varying amounts of money (8 - 66 Euros) available either now or with a delay (7 - 238 days). Values and delays of the options are predefined to cover a high range of discounting rates for low, medium, and high values of delayed rewards, respectively. The discounting rate\u003cem\u003e k\u003c/em\u003e can be modeled assuming a hyperbolic function (34)\u003c/p\u003e\n\u003cp\u003e\u003ca href=\"#_ftnref1\" name=\"_ftn1\"\u003e[1]\u003c/a\u003e For reasons of brevity of the online survey and our decision to combine individual substances to substance classes, we did not assess objective quantities of substance use. The results of this study do not change when using only total frequency rather than the total degree of substance use score as a control variable (see supplementary material for further details).\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/69519_bce2c0439cd956a6/69519_custom_files/img1606200809.PNG\"\u003e\u003c/p\u003e\n\u003cp\u003ewhere \u003cem\u003eV \u003c/em\u003eis the subjective value of a delayed reward with the amount \u003cem\u003eA\u003c/em\u003e after the delay \u003cem\u003eD\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003eThe parameter \u003cem\u003ek\u003c/em\u003e is estimated based on the proportion of choices that are consistent with every possible value of \u003cem\u003ek\u003c/em\u003e (for a thorouh description please refer to 35). As \u003cem\u003ek\u003c/em\u003e is dependent on value (36), \u003cem\u003ek\u003c/em\u003e is estimated for small, medium and large delayed rewards, respectively, and the geometric mean of these values constitutes an individual\u0026rsquo;s \u003cem\u003ek\u003c/em\u003e-value.\u003c/p\u003e\n\u003cp\u003e2.4 Data analysis\u003c/p\u003e\n\u003cp\u003eAll analyses were conducted in R (37). We log-transformed the \u003cem\u003ek\u003c/em\u003e-parameter due to skewedness. Pearson\u0026rsquo;s correlations were computed to examine bivariate associations. Two-tailed tests of the difference between two dependent correlations with one variable in common were conducted to test whether correlations differed significantly. Subsequently, we computed partial correlations of all predictor variables with substance-related problems controlled for the degree of substance use to explore their respective contribution outside the context of other predictor variables. Last, we conducted two hierarchical linear regressions for the degree of substance use and substance-related problems to identify the unique variance explained by sensation seeking, impulsivity-related traits, and log(\u003cem\u003ek\u003c/em\u003e). For both regression models, we entered gender as a covariate in the first step, because it was significantly related to both outcome variables, while age was not (ps \u0026gt; .05). We excluded the group \u0026ldquo;gender not specified\u0026rdquo; from these regression analyses (n = 1). For the model predicting the degree of substance use, we added the UPPS subscales in the second and log(\u003cem\u003ek\u003c/em\u003e) in the third step. For the model predicting substance-related problems, we added the degree of substance use as a covariate in the second step, the UPPS subscales in the third step and log(\u003cem\u003ek\u003c/em\u003e) in the fourth step. To test on an exploratory basis whether a regressor explained more variance in the criterion variable than another regressor, we computed finite-sample F-statistics using the \u0026ldquo;linearHypothesis\u0026rdquo; function from the car package (38). We applied a significance level of \u0026alpha; = .05 for all analyses.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e3.1 Bivariate correlations\u003c/p\u003e\n\u003cp\u003eDiscounting rates ranged from 0.000158 to 0.24853, with some choosing exclusively the smaller sooner or the larger later option, and were not significantly associated with any of the UPPS subscales (all \u003cem\u003ep\u003c/em\u003es \u0026gt; .05), except for a small positive correlation with urgency (see Table 2 for an overview of correlations). Delay discounting and (lack of) premeditation were significantly, but weakly, correlated with both the degree of substance use and problems. (Lack of) perseverance displayed stronger correlations (small to moderate) with both substance use variables. Sensation seeking correlated significantly stronger with the degree of substance use than with problems, r= .38 vs. r= .23, \u003cem\u003et\u003c/em\u003e(256) = 2.72, \u003cem\u003ep\u003c/em\u003e = .01. In turn, urgency correlated significantly stronger with substance-related problems than with the degree of substance use, r = .33, vs. r = .18, \u003cem\u003et\u003c/em\u003e(256) = 2.67, \u003cem\u003ep\u003c/em\u003e = .01. The degree of substance use and substance-related problems were strongly correlated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMeans, Standard Deviations, and Correlations with Confidence Intervals for UPPS subscales, Delay Discounting (log(k)), the Degree of Substance Use and Substance-Related Problems\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"14\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"14\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003e\u003cstrong\u003eUPPS\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"14\"\u003e\n\u003cp\u003e1.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003eUrgency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e26.77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e5.96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"14\"\u003e\n\u003cp\u003e2.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003ePremeditation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e23.59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e4.50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e.32**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"14\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[.20, .42]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"14\"\u003e\n\u003cp\u003e3.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003ePersistence\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e20.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e4.41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e.40**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e.26**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"14\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[.29, .50]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[.14, .37]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"14\"\u003e\n\u003cp\u003e4.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003eSensation Seeking\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e32.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e7.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e-.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e.32**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"14\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[-.12, .12]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[.21, .43]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[-.12, .13]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"14\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003e\u003cstrong\u003eMCQ\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"14\"\u003e\n\u003cp\u003e5.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003elog (\u003cem\u003ek\u003c/em\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e-2.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e0.75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e.14*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e-.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e-.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"14\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[.01, .25]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[-.12, .12]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[-.08, .16]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[-.14, .11]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"14\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"162\"\u003e\n\u003cp\u003e\u003cstrong\u003eSubstance use variables\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"14\"\u003e\n\u003cp\u003e6.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003eDegree of use\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e35.89\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e19.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e.18**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e.16*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e.22**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e.38**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e.18**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"14\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[.05, .29]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[.04, .28]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[.10, .34]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[.27, .48]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[.06, .30]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"14\"\u003e\n\u003cp\u003e7.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003eProblems\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e4.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e2.85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e.33**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e.13*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e.29**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e.23**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e.15*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e.55**\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"14\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[.22, .43]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[.01, .25]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[.17, .39]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[.11, .35]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[.03, .27]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e[.46, .63]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote.\u003c/em\u003e \u003cem\u003eM\u003c/em\u003e and \u003cem\u003eSD\u003c/em\u003e represent mean and standard deviation, respectively. Values in square brackets indicate the 95% confidence interval. UPPS = Urgency Premeditation Perseverance Sensation Seeking Impulsive Behavior Scale, MCQ = Monetary Choice Questionnaire, \u003cem\u003ek\u003c/em\u003e = delay discounting. * \u003cem\u003ep\u003c/em\u003e \u0026lt; .05. ** \u003cem\u003ep\u003c/em\u003e \u0026lt; .01.\u003c/p\u003e\n\u003cp\u003e3.2 Partial correlations\u003c/p\u003e\n\u003cp\u003eWhen controlling for the degree of substance use, urgency (\u003cem\u003er\u003c/em\u003e(256)= .28, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001) and perseverance (\u003cem\u003er\u003c/em\u003e(256)= .20, \u003cem\u003ep\u003c/em\u003e = .001) significantly correlated with substance-related problems, while premeditation, sensation seeking and log(\u003cem\u003ek\u003c/em\u003e) did not (all \u003cem\u003ep\u003c/em\u003es \u0026gt;.05).\u003c/p\u003e\n\u003cp\u003e3.3 Relative contributions of UPPS subscales and delay discounting to substance use outcomes\u003c/p\u003e\n\u003cp\u003e3.3.1 The degree of substance use\u003c/p\u003e\n\u003cp\u003eIn the first model, we regressed the degree of substance use on the UPPS subscales and log(\u003cem\u003ek\u003c/em\u003e) while controlling for gender (see Table 3). The hierarchical multiple regression revealed that all UPPS subscales (except for premeditation) as well as log(\u003cem\u003ek\u003c/em\u003e) explained significant unique variance in the degree of substance use, such that higher levels of urgency, perseverance, sensation seeking and delay discounting were associated with more substance use. In the complete model, sensation seeking had a significantly stronger effect on the degree of substance use than all other impulsivity-related predictors respectively, all \u003cem\u003eF\u003c/em\u003es \u0026gt; 4.13, all \u003cem\u003ep\u003c/em\u003es \u0026lt; .05. The complete model accounted for 25 percent of the variance in the degree of substance use.\u003c/p\u003e\n\u003cp\u003e3.3.2 Substance-related problems\u003c/p\u003e\n\u003cp\u003eIn the second model, we regressed substance-related problems on the UPPS subscales and log(\u003cem\u003ek\u003c/em\u003e) while controlling for age and the degree of substance use (see Table 3). The hierarchical multiple regression revealed that the UPPS urgency subscale explained significant unique variance in substance-related problems, such that higher levels of urgency were associated with more problems above and beyond the degree of substance use, which also predicted substance-related problems. None of the other predictors were significantly associated with substance-related problems. In the complete model, urgency had a significantly stronger effect on substance-related problems than premeditation and log(k) (all \u003cem\u003eF\u003c/em\u003es \u0026gt; 5.57, all \u003cem\u003ep\u003c/em\u003es \u0026gt; .05) and sensation seeking, but this difference was only a marginally significant (\u003cem\u003eF\u003c/em\u003e = 2.96, \u003cem\u003ep\u003c/em\u003e = .09). The complete model accounted for 39 percent of the variance in substance-related problems.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHierarchical Multiple Regression Analyses with the UPPS Subscales and Delay Discounting predicting the Degree of Substance Use and Substance-Related Problems \u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"86\"\u003e\n\u003cp\u003ePredictors\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" colspan=\"5\" width=\"257\"\u003e\n\u003cp\u003eDegree of substance use\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" colspan=\"5\" width=\"275\"\u003e\n\u003cp\u003eSubstance-related problems\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 38px;\"\u003e\n\u003ctd style=\"height: 38px;\" width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026Delta;R\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38px;\" width=\"55\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38px;\" width=\"55\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38px;\" width=\"27\"\u003e\n\u003cp\u003eSE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38px;\" width=\"42\"\u003e\n\u003cp\u003e\u0026beta;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026Delta;R\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38px;\" width=\"55\"\u003e\n\u003cp\u003eF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38px;\" width=\"55\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38px;\" width=\"36\"\u003e\n\u003cp\u003eSE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38px;\" width=\"51\"\u003e\n\u003cp\u003e\u0026beta;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"86\"\u003e\n\u003cp\u003e\u003cem\u003eStep 1\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e.087**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e24.45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"27\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"42\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e.017*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e4.432\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"36\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"51\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"86\"\u003e\n\u003cp\u003eMale gender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e11.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"27\"\u003e\n\u003cp\u003e2.34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"42\"\u003e\n\u003cp\u003e.30**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e0.75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"36\"\u003e\n\u003cp\u003e0.35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"51\"\u003e\n\u003cp\u003e.13*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"86\"\u003e\n\u003cp\u003e\u003cem\u003eStep 2\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"27\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"42\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e.305**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e114.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"36\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"51\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"86\"\u003e\n\u003cp\u003eMale gender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"27\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"42\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e-0.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"36\"\u003e\n\u003cp\u003e0.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"51\"\u003e\n\u003cp\u003e-.04\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 49px;\"\u003e\n\u003ctd style=\"height: 49px;\" width=\"86\"\u003e\n\u003cp\u003eDegree of substance use\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"27\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"42\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"36\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"51\"\u003e\n\u003cp\u003e.58**\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"86\"\u003e\n\u003cp\u003e\u003cem\u003eStep 3 - UPPS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e.144**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e11.70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"27\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"42\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e.068**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e6.99\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"36\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"51\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"86\"\u003e\n\u003cp\u003eMale gender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e7.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"27\"\u003e\n\u003cp\u003e2.52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"42\"\u003e\n\u003cp\u003e.19**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e-0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"36\"\u003e\n\u003cp\u003e0.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"51\"\u003e\n\u003cp\u003e-.01\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 49px;\"\u003e\n\u003ctd style=\"height: 49px;\" width=\"86\"\u003e\n\u003cp\u003eDegree of substance use\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"27\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"42\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"36\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"51\"\u003e\n\u003cp\u003e.49**\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"86\"\u003e\n\u003cp\u003eUrgency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e0.52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"27\"\u003e\n\u003cp\u003e0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"42\"\u003e\n\u003cp\u003e.16*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"36\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"51\"\u003e\n\u003cp\u003e.23**\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"86\"\u003e\n\u003cp\u003ePremeditation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e-0.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"27\"\u003e\n\u003cp\u003e0.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"42\"\u003e\n\u003cp\u003e-.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e-0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"36\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"51\"\u003e\n\u003cp\u003e-.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"86\"\u003e\n\u003cp\u003ePerseverance\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e0.64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"27\"\u003e\n\u003cp\u003e0.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"42\"\u003e\n\u003cp\u003e.15*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"36\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"51\"\u003e\n\u003cp\u003e.10\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 49px;\"\u003e\n\u003ctd style=\"height: 49px;\" width=\"86\"\u003e\n\u003cp\u003eSensation seeking\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e0.83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"27\"\u003e\n\u003cp\u003e0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"42\"\u003e\n\u003cp\u003e.31**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"36\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"51\"\u003e\n\u003cp\u003e.07\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"86\"\u003e\n\u003cp\u003e\u003cem\u003eStep 4 - MCQ\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e.022**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e7.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"27\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"42\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e0.30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"36\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"51\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"86\"\u003e\n\u003cp\u003eMale gender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e6.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"27\"\u003e\n\u003cp\u003e2.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"42\"\u003e\n\u003cp\u003e.16*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e-0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"36\"\u003e\n\u003cp\u003e0.34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"51\"\u003e\n\u003cp\u003e-.01\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 49px;\"\u003e\n\u003ctd style=\"height: 49px;\" width=\"86\"\u003e\n\u003cp\u003eDegree of substance use\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"27\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"42\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"36\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"51\"\u003e\n\u003cp\u003e.48**\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"86\"\u003e\n\u003cp\u003eUrgency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e0.43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"27\"\u003e\n\u003cp\u003e0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"42\"\u003e\n\u003cp\u003e.13*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"36\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"51\"\u003e\n\u003cp\u003e.22**\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"86\"\u003e\n\u003cp\u003ePremeditation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e-0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"27\"\u003e\n\u003cp\u003e0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"42\"\u003e\n\u003cp\u003e-.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e-0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"36\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"51\"\u003e\n\u003cp\u003e-.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"86\"\u003e\n\u003cp\u003ePerseverance\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e0.67\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"27\"\u003e\n\u003cp\u003e0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"42\"\u003e\n\u003cp\u003e.15*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"36\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"51\"\u003e\n\u003cp\u003e.10\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 49px;\"\u003e\n\u003ctd style=\"height: 49px;\" width=\"86\"\u003e\n\u003cp\u003eSensation seeking\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e0.86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"27\"\u003e\n\u003cp\u003e0.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"42\"\u003e\n\u003cp\u003e.32**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"55\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"36\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 49px;\" width=\"51\"\u003e\n\u003cp\u003e.08\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"86\"\u003e\n\u003cp\u003eLog(\u003cem\u003ek\u003c/em\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e3.88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"27\"\u003e\n\u003cp\u003e1.44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"42\"\u003e\n\u003cp\u003e.15**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"77\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"55\"\u003e\n\u003cp\u003e0.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"36\"\u003e\n\u003cp\u003e0.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"51\"\u003e\n\u003cp\u003e.03\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 38.7272px;\"\u003e\n\u003ctd style=\"height: 38.7272px;\" width=\"86\"\u003e\n\u003cp\u003eTotal R\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38.7272px;\" width=\"77\"\u003e\n\u003cp\u003e.253**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38.7272px;\" width=\"55\"\u003e\n\u003cp\u003e14.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38.7272px;\" width=\"55\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38.7272px;\" width=\"27\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38.7272px;\" width=\"42\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38.7272px;\" width=\"77\"\u003e\n\u003cp\u003e.391**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38.7272px;\" width=\"55\"\u003e\n\u003cp\u003e22.83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38.7272px;\" width=\"55\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38.7272px;\" width=\"36\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 38.7272px;\" width=\"51\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote.\u003c/em\u003e \u003cem\u003e\u0026Delta;R\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = change in proportion of explained variance; B = unstandardized estimate; SE = standard error of B, \u0026beta; = standardized estimate. * \u003cem\u003ep\u003c/em\u003e \u0026lt; .05. ** \u003cem\u003ep\u003c/em\u003e \u0026lt; .01.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined the differential associations of impulsivity-related traits, sensation seeking, and delay discounting with the degree of substance use (combined quantity and frequency) and substance-related problems in a sample of (poly-)substance users. Thereby, we aimed to disentangle which of these potential risk factors were associated with the degree of substance use and which ones were specifically relevant for substance-related problems and thus for the diagnosis of SUDs.\u003c/p\u003e\n\u003cp\u003eFirst, sensation seeking, self-reported urgency and perseverance, as well as delay discounting, explained unique variance in the degree of substance use. Sensation seeking was the strongest predictor, explaining significantly more variance in the degree of substance use than all other predictors. This conforms with the reviewed literature (8, 28, 39) and indicates that high expressions of both impulsivity and sensation seeking independently, and more so combined, may increase the risk to engage in pronounced substance use. This may already be harmful, e.g. in terms of bodily consequences, but does not necessarily go along with substance-related problems.\u003c/p\u003e\n\u003cp\u003eSecond, the impulsivity-related trait of negative urgency explained significant unique variance in substance-related problems above and beyond the degree of substance use, while sensation seeking did not. This finding is in line with prior research (28) but extends the evidence beyond alcohol use and shows that urgency is specifically linked to substance-related problems, the dimension critical for SUDs, even when controlling for substance use and across substances. Building on evidence showing that high levels of urgency precede problematic substance use (e.g. 39), this finding underlines the role of urgency as a potential general risk factor for substance-related problems. Furthermore, this is the first study to combine self-report with behavioral measures of impulsivity using the approach to SUD risk factor research we propose here. This highlights the special role of urgency for SUDs, as this trait was associated with problems even when controlling for the degree of use as well as behavioral impulsivity (delay discounting) and other impulsivity-related traits.\u003c/p\u003e\n\u003cp\u003eDelay discounting, a behavioral measure of impulsivity, was weakly associated with both the degree of substance use and problems, but the association with problems disappeared when controlling for the degree of use. This is not surprising, considering that delay discounting was only weakly related to substance-related problems in the first place, closely resembling the effect size found in a meta-analysis (21). This finding indicates that the consistent associations of delay discounting and SUDs described in the literature may be best explained by underlying and confounding differences in the degree of substance use. Although a high degree of use may be inherently harmful, this contradicts the role of delay discounting as a specific risk factor for substance-related problems and thus SUDs discussed in the literature (e.g. 3). However, as this is the first study to examine associations of delay discounting with substance-related problems controlling for the degree of use, this finding needs replication before drawing final conclusions.\u003c/p\u003e\n\u003cp\u003e4.1 Limitations and future directions\u003c/p\u003e\n\u003cp\u003eThe dimensional approach we applied in this study proved suitable for identifying differential associations of potential SUD risk factors with substance-related problems controlling for the degree of use. Nonetheless, it requires a longitudinal approach to test whether these factors truly constitute specific risk factors for developing substance-related problems. Furthermore, the delay discounting questionnaire we used in this study uses relatively low monetary rewards. Research suggests that high monetary offers better distinguish substance users from controls (40). Hence, tasks using higher monetary offers may be more suitable for substance-using populations and delay discounting assessed with such tasks may show a specific association with substance-related problems. Importantly, our sample was predominantly highly educated. It is possible that this acted as a protective factor buffering effects of e.g. delay discounting on substance-related problems. Thus, further studies including more representative samples are warranted to consolidate the generalizability of the associations described in this study. Due to temporal restraints in the online-survey, we did not assess substance-related problems separately for each substance or substance class. Therefore, we could not directly test whether the examined associations differed between substances but rather demonstrated that they were overall significant when all substances were combined. Also, the assessment of substance-related problems was purely based on self-report, while clinical interviews may provide a more nuanced and comparable picture. Future studies may include positive urgency, as this facet shows unique associations with substance use outcomes (17) and may thus contribute additional insights.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study showed that the impulsivity-related traits of urgency and to some extent perseverance, but not sensation seeking, were specifically linked to substance-related problems, the dimension that is crucial for SUDs. We applied a dimensional approach to SUD risk factor research examining the associations of potential risk factors with substance-related problems while statistically controlling for the degree of substance use. The present study demonstrated that this approach is suitable for identifying factors specifically linked to substance-related problems and thus SUDs. Hence, future longitudinal studies using this approach may clarify the role of impulsivity-related traits, alongside others, as risk factors for SUDs. To identify risk factors specifically linked to the development of substance-related problems, rather than predominantly a high degree of use, would convey important implications for practice. A focus on these factors may help to identify individuals within substance using populations who are more in need for preventive measures in order to avoid a transition to problematic substance use. However, longitudinal studies are needed to substantiate the current finding. Furthermore, they may be relevant target points for therapeutic interventions. Taken together, the approach applied in this study may pose a starting point for further research advancing targeted prevention and therapy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the local ethics committee (Ethikkommission an der Technischen Universit\u0026auml;t Dresden; EK 146042019) and followed the guidelines stated by the Declaration of Helsinki. Participants were thoroughly informed and indicated consent to participate (informed consent) by a button press in the beginning of the online survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset supporting the conclusions of this article is available in the OSF repository, DOI 10.17605/OSF.IO/CWNRG, https://mfr.de-1.osf.io/render?url=https://osf.io/8wgts/?direct%26mode=render%26action=download%26mode=render.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by a PhD scholarship for Malin Hildebrandt from the Claussen-Simon Stiftung and by the German Research Foundation (Deutsche Forschungsgemeinschaft, grant numbers TRR 265 B01 and EN 906/6). The funding sources had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eM.H.\u003c/strong\u003e: Conceptualization, Methodology, Investigation, Formal Analysis, Writing \u0026ndash; Original Draft, Project Administration, Funding Acquisition. \u003cstrong\u003eR. D.\u003c/strong\u003e: Conceptualization, Methodology, Writing \u0026ndash; Review and Editing, Supervision. \u003cstrong\u003eT. E.\u003c/strong\u003e: Conceptualization, Resources, Methodology, Writing \u0026ndash; Review and Editing, Funding Acquisition, Supervision. All authors contributed to and have approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDiagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric A, American Psychiatric Association DSMTF, editors. Arlington, VA: American Psychiatric Association; 2013.\u003c/li\u003e\n\u003cli\u003eVerdejo-Garc\u0026iacute;a A, Lawrence AJ, Clark L. Impulsivity as a vulnerability marker for substance-use disorders: Review of findings from high-risk research, problem gamblers and genetic association studies. Neuroscience \u0026amp; Biobehavioral Reviews. 2008;32(4):777-810.\u003c/li\u003e\n\u003cli\u003ePoulton A, Hester R. Transition to substance use disorders: Impulsivity for reward and learning from reward. 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Journal of the Experimental Analysis of Behavior. 2017;107:151-60.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"substance use, impulsivity, sensation seeking, dimensional, urgency","lastPublishedDoi":"10.21203/rs.3.rs-108038/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-108038/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Substance use disorders are reliably associated with high impulsivity and sensation seeking. Importantly, both precede problematic substance use, implicating them as risk factors. Individuals with substance use disorders show variable degrees of substance use (combined quantity and frequency) and substance-related problems and differ in both aspects from healthy controls. Dimensional research has indicated differential associations of impulsivity-related traits as well as sensation seeking with the degree of substance use and substance-related problems. The current study aimed to clarify whether impulsivity-related traits and sensation seeking predict substance-related problems above and beyond the degree of substance use and are thus specifically linked to problems, the dimension that characterizes substance use disorders. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e We assessed impulsivity-related traits and sensation seeking using self-report, as well as delay discounting, a behavioral indicator of impulsivity, in a sample of 258 substance-using adults. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Sensation seeking and impulsivity-related traits significantly predicted the degree of substance use, with sensation seeking explaining the largest portion of variance. In contrast, self-reported impulsivity, in particular when experiencing negative emotions (urgency), but not sensation seeking or delay discounting, predicted substance-related problems when controlling for the degree of substance use. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e This suggests that urgency, but not sensation seeking, may be specifically linked to substance-related problems and thus especially relevant for substance use disorders. Taken together, this study underlines the necessity to assess and control for the degree of substance use in risk factor research concerning substance-related problems. Thus, it may inform future research improving targeted prevention and therapy.\u003c/p\u003e","manuscriptTitle":"Disentangling Substance Use and Disorder: Urgency, But Not Sensation Seeking, Predicts Substance-Related Problems Above and Beyond The Degree of Substance Use.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-11-24 18:00:52","doi":"10.21203/rs.3.rs-108038/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2021-03-17T03:44:37+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"eb4ea29b-5e2b-4e00-929e-13ca87aef906","date":"2021-02-12T02:36:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-01-25T15:36:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"b0fd0ccd-b532-4d26-b1a2-f234bd65ac01","date":"2021-01-18T07:59:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-11-18T20:40:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-11-18T20:28:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-11-17T11:55:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-11-17T11:49:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2020-11-13T15:33:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8f70ae25-63ff-4e26-83f9-e18e26c3b61c","owner":[],"postedDate":"November 24th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":1187954,"name":"Psychiatry"}],"tags":[],"updatedAt":"2021-04-26T08:59:07+00:00","versionOfRecord":[],"versionCreatedAt":"2020-11-24 18:00:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-108038","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-108038","identity":"rs-108038","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}