Family history and antisocial traits moderate naltrexone's effects on heavy drinking in alcoholics.

Naltrexone's (NAL) effects on alcohol consumption are generally modest, so identifying patients likely to benefit would improve treatment utility. Several studies indicate that potentially significant moderators of NAL's effects might include family history of alcohol problems (FH), age of onset of alcohol problems, degree of antisocial traits, and comorbid drug use. Data from 128 alcoholic patients enrolled in a 12-week NAL treatment study (50 mg/day) were reanalyzed to determine the role of FH, age of onset, antisocial traits, and comorbid drug use in NAL's treatment effects on heavy drinking days. Dichotomized FH, age of onset of alcohol problems, and comorbid cocaine or marijuana use had no interaction effect with medication. Percentage of relatives with problem drinking (family history percentage [FHP]) moderated the effects of NAL on drinking such that NAL resulted in lower drinking rates only for patients with higher FHP. Antisocial traits also moderated the effects of medication on drinking for patients compliant with =70% of medication. Patients with more antisocial traits had less heavy drinking on NAL than on placebo, whereas patients low on antisocial traits had no benefit from NAL. Covarying antisociality in regressions of drinking outcome on FHP showed that the effects of FHP were not attributable to antisociality. Thus, NAL may selectively benefit alcoholics with antisocial traits or 20% or more relatives with problem drinking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of abstinence and family history for alcoholism on platelet adenylyl cyclase activity

Platelet adenylyl cyclase (AC) activity was measured in 32 alcohol-dependent subjects and 27 control subjects who were categorized as either family history-positive (FHP) or family history-negative (FHN) for alcoholism. The interview and blood sample collections were performed shortly after cessation of heavy drinking in the alcoholic group, and repeat blood samples were obtained at the end of the first and second weeks of monitored abstinence. Control subjects received the same interview and provided blood samples at the time of the interview. When subjects were not segregated for FHP or FHN status, there were no statistically significant differences in basal, cesium fluoride (CsF)-, or forskolin-stimulated mean AC activities between the controls and the alcoholics, at study entry or with 1 or 2 weeks of abstinence. On the other hand, over the 2-week course of sobriety from heavy drinking, the CsF-stimulated AC activity of FHP alcohol-dependent subjects decreased significantly (p = 0.03). FHP alcohol-dependent subjects after 2 weeks of sobriety had significantly lower mean CsF-stimulated AC activity than FHN controls (p = 0.04), whereas the FHN alcoholic subjects' CsF-stimulated AC activity did not differ significantly from FHN controls at this point in time. When all subjects were pooled and then categorized as either FHP or FHN, there was a significant difference in mean CsF-stimulated AC activity (p = 0.02) between the FHP and FHN subject groups. Genetic factors and abstinence appear to have roles in determining low platelet AC activity in alcoholic and nonalcoholic subjects. CsF-stimulated platelet AC activity, in particular, appears to act as a trait marker for a genetic vulnerability to developing alcoholism, but recent heavy drinking in male alcoholics is a factor that can mask differences between FHP and FHN subjects.     

The Intergenerational Transmission of Externalizing Behaviors in Adult Participants: The Mediating Role of Childhood Abuse.

Childhood abuse was investigated as a potential mediator of the intergenerational transmission of externalizing behaviors (EXT) in adulthood among a large general population sample drawn from the National Comorbidity Survey. Community participants (N = 5,424) underwent diagnostic and psychosocial interviews and reported on their own adult symptoms of antisocial behavior and substance dependence, parental symptoms, and childhood abuse history. Multiple group structural equation modeling revealed that (a) EXT in parents was associated with childhood abuse in offspring, particularly among mother- daughter dyads, (b) abuse had a unique influence on adult EXT in offspring above parental EXT, and (c) abuse accounted for the relationship between parental EXT and offspring EXT in female but not male participants. This article emphasizes the importance of examining different environmental processes which may explain familial transmission of destructive behaviors in men and women and highlights the importance of family interventions that target parental symptoms to ameliorate risk to offspring. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the discriminative validity of a family history of problem drinking index with a national sample of young adults

OBJECTIVE: This study used data from the National Longitudinal Survey of Youth (NLSY) to test hypotheses relevant to the discriminative validity of a trichotomous family history of problem drinking index. Early onset substance use, adolescent antisocial behaviors and lifetime alcohol and illicit drug use were used as criterion variables. METHOD: Prospective, longitudinal survey data from over 9,000 young adult subjects (ages 23-30 yrs) in the NLSY archive were used to evaluate several hypotheses regarding familial risk of alcoholism. RESULTS: General support for discriminant validity was indicated, as the high density familial risk group differed from the moderate (paternal or maternal problem drinking only) and low-risk groups with regard to a somewhat earlier onset of marijuana use, higher levels of antisocial behaviors in adolescence (especially substance-related offenses and property offenses) and higher levels of lifetime marijuana and cocaine use. The high- and moderate-risk groups differed from the low-risk group with regard to alcohol use and alcohol-disordered problems (e.g., negative consequences, dependency symptoms). CONCLUSIONS: Risk associated with high familial problem-drinking density includes an earlier onset of illicit substance use, higher rates of lifetime marijuana and cocaine use and more frequent adolescent antisocial behavior. The general pattern of the findings was robust for men and women and suggests that high-risk status may reflect both a high genetic loading and a high environmental risk loading.     

Modeling of alcohol use mediates the effect of family history of alcoholism on adolescent alcohol expectancies.

The relative impact of biological family history of alcoholism and exposure to abusive parental drinking on alcohol effect expectancies of adolescent offspring were investigated in the present study. Exposure to familial models of alcohol abuse and biological family history were both predictive of positive alcohol effect expectancies of adolescent offspring. Degree of exposure to an alcohol-abusing family member mediated the relationship between biological family history of alcoholism and adolescent alcohol outcome expectancies. These results support prior findings of expectancy differences between youths with and without a family background of alcoholism and provide evidence supporting the significance of family modeling influences in the development of adolescents' alcohol expectancies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primary early-onset dysthymia: Comparison with primary nonbipolar nonchronic major depression on demographic, clinical, familial, personality, and socioenvironmental characteristics and short-term outcome.

In order to explore the characteristics and validity of DSM-III-R primary early-onset dysthymia, we compared outpatients with primary early-onset dysthymia (n?=?32) and primary nonbipolar nonchronic major depression (n?=?35). Fifty-nine percent of the dysthymics were currently in a major depressive episode, and 97% had a history of major depression. Compared with the episodic major depressives, the early-onset dysthymics exhibited significantly higher rates of melancholia, greater global impairment, and an earlier age of onset of major depression; were more likely to have recurrent major depressive episodes; and had higher rates of personality and substance use disorders. In addition, significantly higher proportions of early-onset dysthymics than nonchronic major depressives had family histories of affective and antisocial personality disorders. The dysthymics also exhibited significantly higher levels of depressive personality traits and self-criticism, lower levels of extraversion and social support, and higher levels of chronic strain and perceived stress than did the major depressives. Finally, the early-onset dysthymics exhibited significantly greater depression and poorer social and global functioning over the course of a 6-month follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital interaction in alcoholic and nonalcoholic couples: Alcoholic subtype variations and wives' alcoholism status.

The authors examined problem-solving marital interactions of alcoholic and nonalcoholic couples (N = 132). Four alcoholic groups (husband alcoholic with antisocial personality disorder or not, paired with alcoholic or nonalcoholic wives) were compared with each other and with a both-spouses-nonalcoholic group. Consistent with the alcoholic subtypes hypothesis, couples with an antisocial alcoholic husband had higher levels of hostile behavior regardless of wives' alcoholism status. In contrast, rates of positive behaviors and the ratio of positive to negative behaviors were greatest among couples in which either both or neither of the spouses had alcoholic diagnoses and were lowest among alcoholic husbands with nonalcoholic wives. Discussion focuses on possible mechanisms linking antisocial alcoholism and discrepant alcoholic diagnoses to poorer marital outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of alcohol typologies using HIV risk behaviors among alcoholic inpatients.

Evaluated the strength of associations for HIV risk behavior and 5 typologies of alcoholism (gender, comorbid psychopathology, gamma–delta, family history, and drug abuse) among 802 inpatients (481 men and 321 women; mean age 34.4 yrs) at alcohol treatment centers. Findings suggest that some of the alcohol typologies describe subtypes with significant differences on rates and levels of HIV risk behaviors. Specifically, gender, depression, and anxiety subtypes were not consistently associated with HIV risk; however, the antisocial personality disorder and drug abuse subtypes had the strongest average effect size across a number of indicators of HIV risk behaviors (e.g., condom nonuse, multiple sex partners, and injection drug use). The gamma–delta and family history subtypes also resulted in elevated HIV risk behaviors, although with smaller effect sizes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temperamental and familial predictors of violent and nonviolent criminal convictions: Age 3 to age 18.

This study examined the relations between family characteristics, childhood temperament, and convictions for violent and nonviolent offenses at age 18 in a representative birth cohort of men who are part of a longitudinal study. Three groups of men were identified on the basis of their conviction status at age 18: Participants who had never been convicted (n?=?404), participants who had been convicted for nonviolent offenses only (n?=?50), and participants who had been convicted for violent offenses (n?=?21). Multivariate analysis of variance and logistic regression analyses indicated that family factors were associated with both types of conviction outcomes, whereas childhood temperament was associated primarily with convictions for violent offenses. The potentially distinct roles of social- and self-regulation in the development of antisocial behavior are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subtypes of cocaine abusers: Support for a Type A–Type B distinction.

The dysfunction and generalizability of a multidimensional alcoholism typological system was systematically assessed in 399 inpatient, outpatient, and non-treatment-seeking cocaine abusers. Two different cluster-analytic procedures supported the construct, concurrent, and predictive validity of the Type A–Type B distinction in cocaine abusers. Participants classified as Type B (33%) cocaine abusers exhibited higher rates of premorbid risk factors (family history, childhood behavior problems, personality, age of onset), more severe drug and alcohol abuse, more addiction-related psychosocial impairment, more antisocial behavior, and more comorbid psychiatric problems than Type A participants (67%). Multidimensional typological systems have had a major impact on the alcoholism field and may be equally important for the assessment, prevention, treatment, and theoretical understanding of other substance use disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological Executive Functioning in Children at Elevated Risk for Alcoholism: Findings in Early Adolescence.

One component of individual risk for alcoholism may involve cognitive vulnerabilities prodromal to alcoholism onset. This prospective study of 198 boys followed between 3 and 14 years of age evaluated neurocognitive functioning across three groups who varied in familial risk for future alcoholism. Measures of intelligence, reward-response, and a battery of neuropsychological executive and cognitive inhibitory measures were used. Executive functioning weaknesses were greater in families with alcoholism but no antisocial comorbidity. IQ and reward-response weaknesses were associated with familial antisocial alcoholism. Executive function effects were clearest for response inhibition, response speed, and symbol-digit modalities. Results suggest that executive deficits are not part of the highest risk, antisocial pathway to alcoholism but that some executive function weaknesses may contribute to a secondary risk pathway. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transitioning into and out of large-effect drinking in young adulthood.

As individuals age beyond the college years into young adulthood, many exhibit a tendency to moderate or "mature out of alcohol" involvement. The current study classified effect-drinking statuses in young adults and examined transitions among statuses using latent transition analysis, a latent variable state-sequential model for longitudinal data. At 3 occasions over 7 years (Years 1, 4, and 7), 443 men (47%) and women (mean age of both at baseline?=?18.5 years; 51% with family history of alcoholism) responded to 3 past-30-day items assessing drinking and subjective effects of drinking: whether the respondent drank alcohol, felt high, and felt drunk. Latent statuses included abstainers (14% at Year 1), limited-effect drinkers (8%), moderate-effect drinkers (23%), and large-effect drinkers (54%). Respondents with family history of alcoholism were less likely to transition out of large-effect drinking than those without family history. Men exhibited more severe initial effect-drinking statuses and lower transition probabilities into less severe effect-drinking statuses than women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A contrast of the three more common illnesses with the ten less common in a study and 18-month follow-up of 314 psychiatric emergency room patients. II. Characteristics of patients with the three more common illnesses

The three more common illnesses diagnosed in the sample of 314 emergency room patients were (in order of frequency) affective disorder (N = 135), alcoholism (N = 112), and antisocial personality (N = 57). This study describes the occurrence and frequency of affective disorders and evaluates the relative usefulness of three separate sets of diagnostic criteria for the depressive phase of the illness, which are considered in three self-evident, mutually exclusive groups, the definition of which depends on chronology of onset in relation to other diagnoses. Findings show a 3:2 ratio of primary affective disorder to secondary affective disorder. The 112 diagnoses of alcoholism were based on defined criteria that separated "definite" (N = 102) from probable (N = 10) alcoholism. A high incidence of secondary affective disorder (38%) in patients with a first diagnosis of alcoholism is noted. The third most common diagnosis, antisocial personality, was based on defined criteria requiring a specified number of manifestations both before and after age 15 years. Only 11% of the antisocial personality patients received a single diagnosis of antisocial personality. An additional diagnosis of alcoholism occurred in 61%. Besides antisocial symptoms, the 57 patients reported 74 different nonantisocial symptoms, supporting the conclusion that antisocial personality patients may be as susceptible to neurotic and psychotic symptoms as other patients.     

Meta-analysis of P300 amplitude from males at risk for alcoholism.

The P3(00) event-related brain potential (ERP) is used to study the development of alcoholism by comparing males who have a positive family history of alcoholism with control Ss who have no such familial history. Meta-analysis indicated that overall, P3 amplitudes were obtained from males with family histories of alcoholism compared to controls. Moderator analysis indicated that paradigms using difficult visual tasks yielded the most reliable effects. Furthermore, no differences in outcomes were obtained among studies that recruited positive family history Ss exclusively from among individuals whose fathers had received treatment for alcoholism as compared with other studies. These findings are discussed in the context of using ERPs as an evaluative tool in the study of psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding the role of impulsivity and externalizing psychopathology in alcohol abuse: Application of the UPPS Impulsive Behavior Scale.

The present study explores the relation among 4 personality traits associated with impulsive behavior and alcohol abuse. Personality traits were measured using the 4 subscales of the UPPS Impulsive Behavior Scale (UPPS: S. P. Whiteside & D. R. Lynam. 2001). The UPPS and measures of psychopathology were administered to clinical samples of alcohol abusers high in antisocial personality traits (AAPD), alcohol abusers low in antisocial personality traits (AA), and a control group (total N = 60). Separate analyses of variance indicated that AAPDs had significant elevations on all 4 UPPS scales, whereas the AAs and controls differed only on the Urgency subscale. However, when controlling for psychopathology, group differences on the UPPS scales disappeared. The results suggest that personality traits related to impulsive behavior are not directly related to alcohol abuse but rather are associated with the elevated levels of psychopathology found in a subtype of alcohol abusers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathy, antisocial personality, and suicide risk.

H. Cleckley (1976) maintained that psychopaths are relatively immune to suicide, but substantial evidence exists for a relationship between antisocial deviance and suicidal acts. This study was the first to explicitly examine suicidal history among psychopathic individuals as defined by R. D. Hare's (1991) Psychopathy Checklist—Revised (PCL—R). Male prison inmates (N?=?313) were assessed using the PCL—R and DSM-III R and DSM-IV criteria (American Psychiatric Association, 1987, 1994) for antisocial personality disorder (APD), and they completed A. Tellegen's (1982) Multidimensional Personality Questionnaire (MPQ). Presence or absence of prior suicide attempts was coded from structured interview and prison file records. Suicide history was significantly related to PCL—R Factor 2 (which reflects chronic antisocial deviance) and to APD diagnosis but was unrelated to PCL-R Factor 1, which encompasses affective and interpersonal features of psychopathy. Higher order MPQ dimensions of Negative Emotionality and low Constraint were found to account for the relationship between history of suicidal attempts and antisocial deviance, indicating that temperament traits may represent a common vulnerability for both. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential sensitivity to alcohol reinforcement in groups of men at risk for distinct alcoholism subtypes

The present study examines the relationship of familial and personality risk factors for alcoholism to individual differences in sensitivity to the positively and negatively reinforcing properties of alcohol. Sixteen sons of male alcoholics with multigenerational family histories of alcoholism (MFH) and 11 men who self-report heightened sensitivity to anxiety (HAS) were compared with 13 age-matched family history negative, low anxiety sensitive men (FH-LAS) on sober and alcohol-intoxicated response patterns. We were interested in the effects of alcohol on specific psychophysiological indices of "stimulus reactivity," anxiety, and incentive reward. Alcohol significantly dampened heart rate reactivity to aversive stimulation for the MFH and HAS men equally, yet did not for the FH-LAS group. HAS men evidenced idiosyncrasies with respect to alcohol-induced changes in electrodermal reactivity to aversive stimulation (an index of anxiety/fear-dampening), and MFH men demonstrated elevated alcohol-intoxicated resting heart rates (an index of psychostimulation) relative to the FH-LAS men. The results are interpreted as reflecting a sensitivity to the "stimulus reactivity-dampening" effects of alcohol in both high-risk groups, yet population-specific sensitivities to the fear-dampening and psychostimulant properties of alcohol in the HAS and MFH groups, respectively.     

Attachment, family dysfunction, parental alcoholism, and interpersonal distress in late adolescence: A structural model.

Parental attachment was hypothesized as a mediational variable, explaining the relationship between parental alcoholism, family dysfunction, and the expression of interpersonal distress. Undergraduate students (N?=?152) were administered questionnaires to assess parental attachment, parental alcoholism, family dysfunction, and interpersonal distress; structural analysis was used to specify the relations among measured constructs. Parental alcoholism was not a significant predictor of attachment to parents or interpersonal distress; however, the mediating role of parental attachment was evident when family dysfunction was examined. As the level of family dysfunction increased, participants reported less parental attachment and more interpersonal distress. Viewing parental attachment as a mediator has important implications for theory and clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of familial alcoholism on alcohol reactivity in female social drinkers.

Some individuals may have an inherent reactivity to alcohol that facilitates early development of characteristics associated with alcoholism. Although response to alcohol cues has been used to assess this reactivity, few studies have included women or investigated familial alcoholism as a variable. In this study, 23 female college students were divided into groups according to family history of alcoholism (positive or negative). Alcohol reactivity was measured by salivation, skin temperature, heart rate, mood state, and craving for alcohol following presentation of alcohol-related and neutral cues. Results indicate no correlation between salivary reactivity and alcohol craving, which suggests that these variables tap into different domains of cue reactivity. Findings demonstrate that alcohol cue reactivity can be assessed in female social drinkers and that familial alcoholism may influence salivary reactivity to alcohol-related cues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attribution of antisocial symptoms in coexistent antisocial personality disorder and substance abuse

Two methods for diagnosing antisocial personality disorder (ASPD) were compared based on whether antisocial symptoms that occurred when subjects also experienced alcohol- or other drug-related problems were counted toward the diagnosis of ASPD. From a family study of alcoholism and ASPD, 93 male subjects who met ASPD criteria in the absence of substance-related problems were contrasted with 312 subjects who were diagnosed with ASPD regardless of whether criterion symptoms occurred along with substance-related problems. Subjects did not differ in types of antisocial behaviors, age of onset of behaviors, or comorbid psychiatric disorders except for alcoholism and drug abuse. A subgroup was contrasted on family history of psychiatric illness, with no differences noted between groups. Counting antisocial symptoms toward the diagnosis of ASPD regardless of whether symptoms occur during periods of substance abuse increases the observed population prevalence of the disorder, but does not change the observed phenomenology of ASPD or affect commonly accepted indicators of validity of diagnosis.