Drinking Patterns and Health Status in Smoking and Nonsmoking Alcoholics

Alcoholics who smoked also reported that they drank more frequently and consumed more alcohol on drinking occasions than alcoholics who did not smoke, a practice that resulted in a substantially greater lifetime alcohol consumption in the smokers. Smoking alcoholics also consumed more cigarettes and reported more smoking-related physical symptoms than social drinkers who smoked. The heart rates (HRs) of smoking and nonsmoking alcoholics were similar and both exceeded the HRs for the smoking social drinkers by ∼13 beats/min (bpm) in males and by ∼7 bpm in females. Surprisingly, correlations between HR and lifetime alcohol consumption were higher and slopes were steeper in controls than in alcoholics. HRs in a subset of the male alcoholics fell only ∼3 bpm after 24 weeks of abstinence, but changed no further over an additional 24-week period. Taken together, the findings suggest that HRs may have been higher in this group of alcoholics before the onset of alcohol abuse and that alcohol intake contributed only slightly to the high HR.     

Mood-Related Drinking Motives Mediate the Familial Association Between Major Depression and Alcohol Dependence

Background:  Major depression and alcohol dependence co-occur within individuals and families to a higher than expected degree. This study investigated whether mood-related drinking motives mediate the association between major depression and alcohol dependence, and what the genetic and environmental bases are for this relationship.
Methods:  The sample included 5,181 individuals from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders, aged 30 and older. Participants completed a clinical interview which assessed lifetime major depression, alcohol dependence, and mood-related drinking motives.
Results:  Mood-related drinking motives significantly explained the depression-alcohol dependence relationship at both the phenotypic and familial levels. Results from twin analyses indicated that for both males and females, the familial factors underlying mood-related drinking motives accounted for virtually all of the familial variance that overlaps between depression and alcohol dependence.
Conclusions:  The results are consistent with an indirect role for mood-related drinking motives in the etiology of depression and alcohol dependence, and suggest that mood-related drinking motives may be a useful index of vulnerability for these conditions.     

Disinhibited Personality and Sensitivity to Alcohol Reinforcement: Independent Correlates of Drinking Behavior in Sons of Alcoholics

Thirty nonalcoholic young (18 to 30 years) males with extensive multigenerational family histories of male alcoholism and 29 age-matched, family history-negative controls completed a variety of trait personality questionnaires, participated in a competitive stress task (while sober and alcohol-intoxicated), and were assessed for self-report and laboratory drinking behavior. Low academic achievement, disinhibited personality (as measured by the P Scale of the Eysenck Personality Questionnaire), and sensitivity to alcohol reinforcement were significant and powerful independent predictors of self-report (approximate R ²= 0.40, p < 0.0001) and laboratory (approximate R ²= 0.20, p < 0.0001) drinking behavior. There seemed to be some specificity with respect to the facets of drinking behavior accounted for by each independent variable: low academic achievement and sensitivity to alcohol reinforcement were more related to quantity of alcohol consumption and frequency of excessive consumption, whereas psychoticism was more related to self-reported negative consequences with alcohol. A cluster analysis on three identified correlates of drinking behavior indicated that the two experimental groups could be more accurately subdivided into three homogeneous types. Multigenerational family history males were disproportionately represented in two of these groups: one characterized by enhanced sensitivity to alcohol reinforcement and the other characterized by high psychoticism scores and alcohol-related problems.     

Hormone Levels and Personality Traits in Abusive and Suicidal Male Alcoholics

This study presents personality and biochemical correlates to abusive and suicidal behavior in 49 male alcoholics. Our hypothesis was that neuroendocrine and personality characteristics reflect a postulated regulatory mechanism that determines the direction of aggression either outward (abusive) or inward (suicidal). Eleven patients (22%) had physically abused someone on one occasion and 15 (31%) constituted a more violent subgroup with repeated instances of abuse. Thirteen (27%) had attempted suicide at least once. There was a significant positive correlation between the number of abusive and suicidal events (r=0.33). The violent subgroup with repeated episodes of physical abuse had elevated levels of serum testosterone and low levels of cortisol when compared with the rest of the sample. Aggressive, antisocial, and impulsive personality traits were common. Suicidal alcoholics did not differ from the rest regarding hormone levels, but exhibited high impulsivity and muscular tension on the personality test. It is suggested that the high impulsivity without aggressive traits makes them exhibit autoaggressive rather than abusive behavior. Both the abusive and suicidal alcoholics partly had a history typical of the type 2 alcoholic. We propose that these two categories constitute subgroups of the type 2 alcoholic determined by a combination of genetic predisposition to alcoholism, certain personality traits, and, with regard to the violent group, also hormone disturbances. We find it highly justified to identify and treat these subgroups because of their harmful acting-out behavior.     

Violence, Suicidality, and Alcohol/Drug Use Involvement in Adolescent Females with a Psychoactive Substance Use Disorder and Controls

This study had three aims: (1) to determine the relations between behavioral dysregulation, negative affectivity, and familial impairment with violence and suicidality (i.e., severity of ideation and attempts) in a sample of adolescent females with a psychoactive substance use disorder and controls; (2) to determine whether these relations are mediated by internalizing (depression/anxiety) and externalizing (nonviolent antisocial behavior) symptomatology; and (3) to determine whether severity of alcohol/drug use involvement moderates the relations between the mediating variables with violence and suicidality. Multiple behavioral, psychiatric interview, and self-report measures were used to index behavioral dysregulation, negative affectivity, familial impairment, internalizing and externalizing symptomatology, and violence and suicidality in one hundred sixty-one 14- to 18-year-old adolescent females with a psychoactive substance use disorder and in 80 controls. Structural equation modeling was used to determine the proposed relations. Results indicated that behavioral dysregulation, negative affectivity, and familial impairment were related to violence, whereas only familial impairment was related to suicidality. Internalizing symptomatology mediated the relation between familial impairment and suicidality, and was related to violence, whereas externalizing symptomatology mediated the relations between behavioral dysregulation, negative affectivity, and familial impairment with violence. Severity of alcohol/drug use involvement did not moderate the relations between internalizing or externalizing symptomatology with suicidality or violence. Nevertheless, the relation between internalizing symptomatology and suicidality was stronger in females with a greater degree of alcohol/drug use involvement, compared with those with a milder degree of involvement Therefore, from a prevention standpoint, behavioral dysregulation, negative affectivity, familial impairment, as well as internalizing and externalizing symptoms, may serve as clinical ?points of intervention” for altering the development of violence and suicidality in high risk and substance abusing youth.     

Cognitive Performance of Alcoholics: A Longitudinal Evaluation of the Role of Drinking History, Depression, Liver Function, Nutrition, and Family History

To assess the role of drinking history, depression, liver function, nutrition, and family history on cognitive performance, 171 detoxified male alcoholics were administered a brief neuropsychological examination at admission and discharge from an inpatient treatment program and at a 3-month follow-up evaluation. Regression analyses showed that at admission, depression and liver function were significant predictors of neuropsychological performance, whereas at discharge 3 to 4 weeks later only age and an estimate of premorbid intelligence were significant predictors. At the 3-month follow-up, estimates of drinking following discharge and severity of depressive symptoms were major significant predictors of neuropsychological performance. Indices of drinking prior to admission to the treatment program, nutrition, and family history for alcoholism did not predict performance on any of the three test occasions. These findings indicate that in addition to the chronic neurotoxic effect of alcohol a number of different medical and psychiatric factors, as well as the acute effects of alcohol, contribute to the cognitive scores of patients at various points in the clinical course.     

The Influence of Alcohol Drinking and Alcohol Use Disorders on Psychiatric Disorders and Suicidal Behavior

The present review reports on the influence of alcohol drinking and alcohol use disorders on psychiatric disorders and suicidal behaviour. The base of the study was previous reviews of the National Institute on Alcohol Abuse and Alcoholism publication Alcohol and Health in 1993 and by Helgason in 1996. Using a defined search strategy in Medline, another 42 articles from 1994 to 1996 were included in the comorbidity part and 19 in the suicidal part. Epidemio-logical and clinical studies confirm high comorbidity of substance use disorders and other mental disorders. Alcohol abuse worsens the course of psychiatric disorders. Light to moderate alcohol consumption has no documented positive effect on the course. Levels of risk consumption of alcohol in psychiatric disorders have not been well defined. One-fifth to one-third of increased deaths rate among alcoholics is explained by suicide. In countries with high alcohol consumption, the suicide rate is also high and is increasing with total increased alcohol consumption. Comorbidity is common among suicide victims, and substance use disorders is most frequently combined with depressive disorders. Interpersonal loss within 6 weeks before suicide is more often present among alcoholics than nonalcoholic suicide victims.     

Dose-Response Studies with Thyrotropin-Releasing Hormone: Evidence for Differential Pituitary Responses in Men with Major Depression, Alcoholism, or No Psychopathology

A reduced thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) has been reported in both alcoholic and depressed men. To discern whether the pathophysiological basis of a reduced TSH response is similar in these two disorders, the present study compares the dose-response patterns of TSH and prolactin (PRL) to TRH in depressed, alcoholic, and control men. Four doses of TRH (25, 100, 500, and 800 μg) were given at several day intervals to 6 men with major depression, 8 men with alcohol dependence, and 7 control men. Examination of the pattern of TRH-induced TSH and PRL response revealed differences for each paired group comparison: depressed versus control, depressed versus alcoholic, and alcoholic versus control. Compared with controls, depressed men had low TSH and low PRL responses to TRH, whereas alcoholic men had low TSH responses and normal PRL responses. Levels of neither thyroid hormones, cortisol, or sex steroids, nor age or body size, explained these differences. These findings suggest that the pathophysiological basis of a reduced TSH response to TRH is different in alcoholism, compared with depression.     

Axis I and Axis II Comorbidity in Alcohol Dependence and the Two Types of Alcoholism

Background: Although high prevalence rates of psychiatric comorbidity were reported in alcoholism, there is a lack of studies covering the whole spectrum of DSM Axes I and II disorders. The relation of comorbid psychopathology and Cloninger's and Babor's types of alcoholism still remained unclear. Methods: Psychiatric comorbidity in 250 hospitalized alcohol-dependent patients without additional substance-related disorders was assessed by the Composite International Diagnostic Interview and the International Personality Disorder Examination. Information about the course and severity of alcoholism was obtained from several sources. Results: Additional Axis I disorders only were found in 24.0%, Axis II disorders only in 16.4%, and concurrent Axis I and Axis II disorders in 17.2% (total comorbidity rate: 57.6%). Two clusters of alcohol dependence were found that substantially overlap with Cloninger's and Babor's types of alcoholism. The majority of type A subjects were found to be either not comorbid at all, or to be Axis I comorbid only. Type B, on the other hand, was preferably associated with personality disorders (mainly Clusters A and B) and dimensional scores of personality pathology (schizoid, schizotypal, all Cluster B, and passive-aggressive). Conclusions: The entire spectrum of personality pathology should be assessed in the comorbidity research of alcoholism. The two types of alcoholism differ on a variety of alcohol-related and comorbid personality characteristics, but further research is needed to clarify the underlying psychological and biological associations.     

The Relationships of the Level of Response to Alcohol and Additional Characteristics to Alcohol Use Disorders Across Adulthood: A Discrete-Time Survival Analysis

Background:  A low level of response (LR) to alcohol has been shown to relate to a higher risk for alcohol use disorders (AUDs). However, no previous research has examined the association between LR and the development of AUDs in the context of additional robust risk factors for AUDs. This study evaluated whether LR and other related characteristics predicted the occurrence of AUDs across adulthood using discrete-time survival analysis (DTSA).
Methods:  A total of 297 probands from the San Diego Prospective Study reported on the LR to alcohol, a family history (FH) of AUDs, the typical drinking quantity, the age of drinking onset, the body mass index and the age at the baseline (T1) assessment. Alcohol use disorders (AUDs) were evaluated at the 10-year (T10), T15, T20, and T25 follow-ups.
Results:  A low LR to alcohol predicted AUD occurrence over the course of adulthood even after controlling for the effects of other robust risk factors. Interaction effects revealed that the impact of FH on AUDs was only observed for subjects with high T1 drinking levels, and probands with high T1 drinking were at high risk for AUDs regardless of their age of onset.
Conclusions:  The findings illustrate that LR is a unique risk factor for AUDs across adulthood, and not simply a reflection of a broader range of risk factors. The continued investigation of how LR is related to AUD onset later in life will help inform treatment providers about this high-risk population, and future longitudinal evaluations will utilize DTSA to assess rates of AUD remission as well as the onset of drinking outcomes in adolescent samples.     

Impact of depressive symptoms on future alcohol use in patients with co-occurring bipolar disorder and alcohol dependence: a prospective analysis in an 8-week randomized controlled trial of acamprosate

Background: Bipolar disorders and alcohol use disorders commonly co‐occur, yet little is known about the proximal impact of bipolar symptoms on alcohol use in patients with this comorbidity. The present study examined the impact of depressive symptoms and alcohol craving on proximal alcohol use in patients with co‐occurring bipolar disorder and alcohol dependence. Methods: Data were collected during an 8‐week randomized controlled trial of acamprosate for individuals with co‐occurring bipolar disorder and alcohol dependence (n = 30). Depressive symptoms and alcohol craving were assessed biweekly using the Montgomery Asberg Depression Rating Scale (MADRS) and the Obsessive Compulsive Drinking Scale (OCDS), respectively. Daily alcohol use data were available via administration of the Time‐line Follow‐back interview at baseline and at subsequent weekly study visits. Correlational analyses and hidden Markov modeling were used to examine the prospective relationships between depressive symptoms, alcohol craving, and alcohol use. Results: Depressive symptoms and alcohol craving were significantly correlated with proximal (i.e., 1 week later) alcohol use across a variety of alcohol consumption summary measures. In hidden Markov models, depressive symptoms (OR = 1.3, 95% credible interval = [1.1, 1.5]) and alcohol craving (OR = 1.6, 95% credible interval = [1.4, 1.9]) significantly predicted transitioning from a light to a heavy drinking state, or remaining in a heavy drinking state. Conclusions: The results from the present study suggest that depressive symptoms and alcohol craving increase proximal risk for alcohol use in individuals with co‐occurring bipolar and alcohol use disorders.