The shame spiral of addiction: Negative self-conscious emotion and substance use

Abigail W. Batchelder; Tiffany R. Glynn; Judith T. Moskowitz; Torsten B. Neilands; Samantha Dilworth; Sara L. Rodriguez; Adam W. Carrico

doi:10.1371/journal.pone.0265480

Peer Review History

Original SubmissionApril 14, 2021
13 Dec 2021 Decision Letter - Matthew J. Gullo, Editor PONE-D-21-12470The shame spiral of addiction: Negative self-conscious emotion and substance usePLOS ONE Dear Dr. Batchelder, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. In addition to addressing the reviewer comments below, please provide more information on the pattern of missingness in the data, especially with respect to attrition. Any variables predictive of missingness should be included as auxiliary variables in the latent growth models to correct for any potential bias. Please submit your revised manuscript by Jan 27 2022 11:59PM. 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Gullo Academic Editor PLOS ONE Additional Editor Comments (if provided): More information on the pattern of missingness in the data is required, especially with respect to attrition. Any variables predictive of missingness should be included as auxiliary variables in the latent growth models to correct for any potential bias. Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. 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For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized. Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access. We will update your Data Availability statement to reflect the information you provide in your cover letter. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Using parallel process latent growth curve modeling, the investigators assessed bidirectional associations between shame and guilt and substance use (i.e., number of days in the past 30 used stimulants, alcohol to intoxication, other substances, or injected drugs) as well as the moderating role of positive emotion. The sample included 110 sexual minority cisgender men with biologically confirmed recent methamphetamine use, enrolled in a randomized controlled trial in San Francisco, CA. The paper is well written and the models were well explained. Also the results appear to support the conclusions, most notably, the findings indicate that high levels of shame may delay the pace of stimulant use reduction and guilt may sustain stimulant use, identifying these emotions as prominent barriers to stimulant use recovery. Often with the use of latent models one wonders about the adequacy of the sample of 110 with the number of paths established. The authors should comment on the statistical adequacy of the sample size in this context. Reviewer #2: This study addresses the important topic of the bidirectional relationships among shame, guilt, and substance use. The introduction provides a comprehensive literature review of the topic and clearly sets up the gaps in the literature that this study will address. However, this section would be strengthened by stronger motivation of the clinical significance of this question. How will delineating the relationships among shame, guilt, and substance use inform interventions and improve patient care? Were substance use, emotions and depressive symptoms measured at each time point (baseline, 3, 6, 12, 15 months)? It seems the answer is yes from the description of the analysis, but this should be made clear in the measures section. The point about the follow-up rates in the 110 participants randomized is repeated at two points in the manuscript; one can be removed. The latent growth curve models used individuals randomized to the intervention or control group in the parent study. Given that the intervention group received a positive emotion intervention, could this introduce bias into the present analysis, even with the covariate for the slopes? It is not entirely clear to me what this covariate accomplishes. Page 14, “Of note, in the original analysis, there were no treatment effects found for stimulant use…” is unclear; does this mean that the positive emotion intervention tested in the original study had no effects on stimulant use (but did increase parallel emotion?)? Clarify so that readers aren’t forced to go to the study cited to understand this point. How do the authors interpret the differential relationships by type of substance use – why would these relationships differ across substances? Are these meaningful, or related to low statistical power? ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0265480.r001
Revision 1
19 Feb 2022 Author Response Dear Drs. Matthew Gullo and Emily Chenette, Thank you for considering our revised enclosed research article, “The Shame Spiral of Addiction: Negative Self-Conscious Emotion and Substance Use” for publication in PLOS ONE. We appreciate the reviewers’ comments and suggestions and have addressed each below. We believe this manuscript is stronger because of these edits. Editor’s Comment: 1. More information on the pattern of missingness in the data is required, especially with respect to attrition. Any variables predictive of missingness should be included as auxiliary variables in the latent growth models to correct for any potential bias. -In addition to the current sentences indicating attrition on page 9 (“Among the 110 participants randomized, follow-up rates at 3 (89%) 6 (88%), 12 (80%), and 15 (71%) months were acceptable with no significant differences in attrition between the experimental conditions.”) we expanded the sentence on page 11 to explain our approach to missing data more thoroughly, “Missing data were handled using full information maximum likelihood estimation (FIML); cases with both complete and incomplete data were included in the analysis via direct robust maximum likelihood estimation, thus all available observations were used in all models.”). Further, we clarified that part of our a prior covariate choice included testing to see if they were predictive of missingness which supported including them in the models (see bottom of page 11 and top of page 12 for text). We have also added text to our Figure note to clarify that models controlled for these auxiliary variables. Reviewer 1: 2. The paper is well written and the models were well explained. Also the results appear to support the conclusions, most notably, the findings indicate that high levels of shame may delay the pace of stimulant use reduction and guilt may sustain stimulant use, identifying these emotions as prominent barriers to stimulant use recovery. - We thank this reviewer for these comments. 3. Often with the use of latent models one wonders about the adequacy of the sample of 110 with the number of paths established. The authors should comment on the statistical adequacy of the sample size in this context. - We appreciate this comment and have expanded our comment in the discussion about the adequacy of the sample size and the related limitations of using this method. On page 19, we added: “Samples between 100-150 are frequently considered the minimum for conducting structural equation models (e.g., Tabachnick & Fidell, 2001); while our sample meets this minimum recommendation, we acknowledge its relatively modest size. Although, recent work suggests that when using robust maximum likelihood estimation for latent growth curves, as the current study did, even small samples of N<100 provide accurate estimates even in the context of non-normality and missing data (Shi et al., 2021). “ Reviewer 2: 4. This study addresses the important topic of the bidirectional relationships among shame, guilt, and substance use. The introduction provides a comprehensive literature review of the topic and clearly sets up the gaps in the literature that this study will address. However, this section would be strengthened by stronger motivation of the clinical significance of this question. How will delineating the relationships among shame, guilt, and substance use inform interventions and improve patient care? - We have added a stronger rationale for the clinical significance of delineating the relationships between shame and guilt in relation to substance use to the introduction. On page 7-8 we have added: “We examine shame and guilt separately given the literature indicating their unique psychological experiences (5) and behavioral sequelae (6,10,11) as well as their differential associations with addiction-related behaviors (16, 17,18)… Investigating the causes, consequences, and moderators of shame and guilt separately in relation to substance use represents a critical step in clarifying the conflicting relationships identified previously in the literature and related clinical implications.” 5. Were substance use, emotions and depressive symptoms measured at each time point (baseline, 3, 6, 12, 15 months)? It seems the answer is yes from the description of the analysis, but this should be made clear in the measures section. - We have clarified that substance use, shame, and guilt were measured at all time points and that positive emotion and depressive symptoms were measured at time 1 in the measures section. 6. The point about the follow-up rates in the 110 participants randomized is repeated at two points in the manuscript; one can be removed. - We have removed the second sentence related to follow up rates on page 11. 7. The latent growth curve models used individuals randomized to the intervention or control group in the parent study. Given that the intervention group received a positive emotion intervention, could this introduce bias into the present analysis, even with the covariate for the slopes? It is not entirely clear to me what this covariate accomplishes. - To minimize the potential impact of the positive emotion intervention on the results, we only included positive emotion at the initial timepoint (prior to randomization) as a moderator in our models. Further, we included the treatment group as a covariate for the slopes to account for the variance in change over time related to being in the intervention. We believe this is an important covariate to include given that these data were collected as part of a parent RCT. We have further emphasized this in the limitations section on page 19. 8. Page 14, “Of note, in the original analysis, there were no treatment effects found for stimulant use…” is unclear; does this mean that the positive emotion intervention tested in the original study had no effects on stimulant use (but did increase parallel emotion?)? Clarify so that readers aren’t forced to go to the study cited to understand this point. -We have clarified this point on page 15. 9. How do the authors interpret the differential relationships by type of substance use – why would these relationships differ across substances? Are these meaningful, or related to low statistical power? -We appreciate this inquiry and have added details to the discussion related to our cautious interpretation of these differences in the context of the existing literature. On page 17 we have explicitly indicated that our results were both “consistent and inconsistent with the existing literature” and have added the following to the limitations section on page 19, “First, the sample is relatively modest, which may have influenced our results (e.g., the differential findings across substances). Samples between 100-150 are frequently considered the minimum for conducting structural equation models (e.g., Tabachnick & Fidell, 2001); while our sample meets this minimum recommendation, we acknowledge its relatively modest size.” Journal Comments: 10. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf - We have reviewed the PLOS ONE style requirements, including those for file naming and have confirmed that this submission is consistent with the requirements. 11. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. -We have corrected these inconsistencies. 12. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. - We have confirmed this. 13. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. -We have specified in greater detail where the minimal data set underlying the results can be found. Thank you for considering this manuscript for PLOS ONE. Sincerely, Abigail Batchelder, Ph.D., M.P.H. Behavioral Medicine, Department of Psychiatry Massachusetts General Hospital Harvard Medical School One Bowdoin Square, 7th Floor Boston, Massachusetts Phone: (917) 940-1283 Fax: (617) 724-3726 Email: ABatchelder@mgh.harvard.edu Alternative email: abby.batchelder@gmail.com Attachments Attachment Submitted filename: Response to Reviewers 1.19.22.docx https://doi.org/10.1371/journal.pone.0265480.r002
3 Mar 2022 Decision Letter - Matthew J. Gullo, Editor The shame spiral of addiction: Negative self-conscious emotion and substance use PONE-D-21-12470R1 Dear Dr. Batchelder, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Matthew J. Gullo Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0265480.r003
Formally Accepted
10 Mar 2022 Acceptance Letter - Matthew J. Gullo, Editor PONE-D-21-12470R1 The shame spiral of addiction: Negative self-conscious emotion and substance use Dear Dr. Batchelder: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Assoc. Prof. Matthew J. Gullo Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0265480.r004

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