title: Neurocognitive and psychiatric dimensions of hot, but not cool, impulsivity predict HIV sexual risk behaviors among drug users in protracted abstinence.
abstract: BACKGROUND
  Impulsivity is an important risk factor for HIV risky drug and sexual behaviors. Research identifies hot (i.e. affectively-mediated, reward-based) and cool (motoric, attentional, independent of context) neurocognitive and psychiatric dimensions of impulsivity, though the impact of specific drugs of abuse on these varieties of impulsivity remains an open question.
  
  
  OBJECTIVE
  The present study examined the associations of neurocognitive and psychiatric varieties of hot and cool impulsivity with measures of lifetime and recent sexual risk behaviors among users of different classes of drugs.
  
  
  METHODS
  The study sample was comprised of drug users in protracted (> 1 year) abstinence: heroin mono-dependent (n = 61), amphetamine mono-dependent (n = 44), and polysubstance dependent (n = 73). Hot impulsivity was operationalized via neurocognitive tasks of reward-based decision-making and symptoms of psychopathy. Cool impulsivity was operationalized via neurocognitive tasks of response inhibition and symptoms of attention deficit/hyperactivity disorder (ADHD).
  
  
  RESULTS
  Hot impulsivity was associated with sexual risk behaviors among heroin and amphetamine users in protracted abstinence, whereas cool impulsivity was not associated with sexual risk behaviors among any drug-using group. Neurocognitive hot impulsivity was associated with recent (past 30-day) sexual risk behaviors, whereas psychopathy was associated with sexual risk behaviors during more remote time-periods (past 6 month and lifetime) and mediated the association between heroin dependence and past 6-month sexual risk behaviors.
  
  
  CONCLUSIONS
  Assessments and interventions aimed at reducing sexual risk behaviors among drug users should focus on hot neurocognitive and psychiatric dimensions of impulsivity, such as decision-making and psychopathy. Cool dimensions of impulsivity such as response inhibition and ADHD were not related to sexual risk behaviors among drug users in protracted abstinence.
authors.affiliation: a Department of Psychology , University of Illinois at Chicago , Chicago , IL , USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wilson
authors.affiliation: b Department of Psychiatry , Institute for Drug and Alcohol Studies, Virginia Commonwealth University School of Medicine , Richmond , VA , USA.
authors.forename: Jasmin
authors.initials: J
authors.lastname: Vassileva
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000523:psychology*; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006556:Heroin Dependence / Q000523:psychology*; D006801:Humans; D007175:Impulsive Behavior; D008297:Male; D009483:Neuropsychological Tests; D012309:Risk-Taking; D019966:Substance-Related Disorders / Q000523:psychology*; D047568:Unsafe Sex / Q000523:psychology*; D055815:Young Adult
keywords: HIV risk behavior; Impulsivity; decision-making; externalizing psychopathology; protracted abstinence; substance dependence
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