Reactivity of alcoholics and nonalcoholics to drinking cues.

An interest in reducing relapse among alcoholics has led to a consideration of stimulus control factors in drinking. Research suggests that through classical conditioning alcoholics may develop reactions to cues previously associated with drinking and that these reactions might be an important determinant of relapse. Although this model indicates the potential for cue exposure treatment methods to alter conditioned reactions, data on reactivity to alcohol cues by alcoholics and nonalcoholics are scarce. Two studies are presented that address this issue and provide evidence for the validity of salivation as a measure of cue reactivity. Alcoholics and nonalcoholics were presented with the sight and smell of their preferred brand of alcohol and a control beverage. Self-report, behavioral, and psychophysiological data were collected. Alcoholics salivated more than nonalcoholics to alcohol cues and more to alcohol than to the control beverage. Alcoholics salivated differentially to cues, whereas nonalcoholics did not. Patterns of reactivity were consistent with a conditioning model. Both groups reported greater urges to drink alcohol in the presence of alcohol, but neither group reported more thoughts about alcohol in the presence of alcohol as compared with the control beverage. Implications of salivary reactivity for theory and treatment are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol cue reactivity and mood induction in male and female alcoholics

The purpose of this study was twofold: to investigate gender differences in alcohol cue reactivity, and to study the effect of individualized mood induction on cue reactivity. Male (n = 38) and female (n = 19) alcoholics were exposed to an alcoholic beverage before and after mood induction to assess their reactivity to the beverage cues. The mood induction was based on a situation the subject had identified as being high risk for relapse. Subjects showed urge and salivary reactivity in response to alcohol beverage cues prior to mood induction, and the induction of mood enhanced urge reactivity in both men and women. Analyses with alcohol urge reactors (subjects that demonstrate an increased urge to drink alcohol in response to an alcoholic beverage cue) suggested that women show more urge reactivity in response to negative moods than do men. No gender differences were seen in reactivity to beverage cues alone. These results identify an important gender difference in the effect of negative moods on cue reactivity and suggest that negative mood situations may place women at a higher risk for relapse than men.     

Leaky gut in alcoholic cirrhosis: a possible mechanism for alcohol-induced liver damage

OBJECTIVE: Only 30% of alcoholics develop cirrhosis, suggesting that the development of alcohol-induced liver injury requires one or more additional factors. Animal studies have shown that gut-derived endotoxin is one such factor. Because increased intestinal permeability has been shown to cause endotoxemia, we hypothesized that increased gastrointestinal permeability contributes to the pathogenesis of alcoholic liver disease. This study aimed to measure gastroduodenal and intestinal permeability in alcoholics with and without chronic liver disease and in nonalcoholic subjects with chronic liver disease. METHODS: Gastroduodenal permeability was assessed by measurement of urinary excretion of sucrose after oral administration. Intestinal permeability was assessed by measurement of urinary lactulose and mannitol after oral administration of these sugars. RESULTS: Alcoholics with no liver disease showed a small but significant increase in sucrose excretion. Alcoholics with chronic liver disease demonstrated a marked and highly significant increase in urinary sucrose excretion relative to the controls, to the alcoholics with no liver disease, and to the nonalcoholics with liver disease. Alcoholics with chronic liver disease demonstrated a marked and highly significant increase in both lactulose absorption and in the urinary lactulose/mannitol ratio (alcoholics 0.703 vs controls 0.019, p = 0.01). In contrast, alcoholics with no liver disease and nonalcoholics with liver disease showed normal lactulose absorption and normal lactulose/mannitol ratio. CONCLUSION: Because only the alcoholics with chronic liver disease had increased intestinal permeability, we conclude that a "leaky" gut may be a necessary cofactor for the development of chronic liver injury in heavy drinkers.     

Internal and external cues relating to fluid intake in obese and alcoholic persons.

A study of fluid intake using a preferred nonalcoholic beverage was modeled on previous studies of food intake in the obese. Groups of hospitalized alcoholics, nonalcoholics, and nonalcoholic nonpatients (N = 60) were composed of half obese and half normal-weight Ss. The degree to which drinking behavior was affected by internal and external cues was related to diagnosis but not to obesity. Preloading (internal cue) inhibited drinking by nonalcoholics, but it did not affect the alcoholics' intake. Alcoholics drank significantly more of the blend of tea they ranked as most preferred (external cue) and less of a nonpreferred drink (water) than nonalcoholics. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Loss of control drinking in alcoholics: An experimental analogue.

Presented 2 groups of 32 male 23-65 yr old nonabstinent alcoholics and social drinkers with an ad-lib supply of either alcoholic or nonalcoholic beverages in a taste-rating task. Ss were assigned to 1 of 2 instructional set conditions in which they were led to expect that the beverage to be rated contained alcohol (vodka and tonic) or consisted only of tonic. The actual beverage administered consisted of either vodka and tonic or tonic only. Results show that instructional set is a significant determinant of the amount of beverage consumed and posttask estimates of the alcoholic content of the drinks. The actual beverage administered did not significantly affect the drinking rates of either alcoholics or social drinkers. Loss-of-control drinking, in the form of increased consumption by alcoholics who were administered alcohol, did not occur during the drinking task. Results are discussed in terms of implications for treatment and for the conception of alcoholism as a disease. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Searching for an environmental effect of parental alcoholism on offspring alcohol use disorder: A genetically informed study of children of alcoholics.

The children-of-twins design was used to isolate a potentially causal environmental impact of having an alcoholic parent on offspring alcohol use disorder, by an examination of whether the children of alcoholics were at a higher risk for alcohol use disorders than were the children of nonalcoholic parents, even after correlated familial factors were controlled. Participants were 1,224 male and female twins from 836 twin pairs selected from the Australian Twin Registry, 2,334 of the twins' 18-39-year-old offspring, and 983 spouses of the twins. Lifetime histories of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) alcohol use disorders were obtained by structured, psychiatric, telephone interviews conducted individually with each of the family members. Comparisons of the offspring of twins who were discordant for alcoholism indicated that there was no longer a statistically significant difference between the children of alcoholics and the children of nonalcoholics after genetic and family environmental factors correlated with having an alcoholic parent were controlled. The results of this study suggest that the direct causal effect of being exposed to an alcoholic parent on offspring alcohol use disorder is modest at best. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonalcoholic steatohepatitis. Clinicopathological comparison with alcoholic hepatitis in ambulatory and hospitalized patients

This study reports a clinicopathological analysis of 105 patients whose liver histology showed a pattern of alcohol-like steatohepatitis. There were 32 nonalcoholic, 21 asymptomatic ambulatory, and 52 hospitalized alcoholic hepatitis patients. Female sex, obesity, and diabetes predominated in nonalcoholics. Clinical and laboratory presentation were similar in nonalcoholics and ambulatory alcoholics, but different from the hospitalized alcoholics. Histology showed an increasing degree of severity of hepatocellular damage, Mallory bodies, neutrophil and mononuclear infiltration, and pericellular and portal fibrosis from the nonalcoholics to the hospitalized alcoholics, with ambulatory alcoholics displaying an intermediate degree of severity. Steatosis and glycogenated nuclei were prevalent in the obese, diabetic nonalcoholics, of whom 47% had significant fibrosis and 8% cirrhosis, the latter present in 38% and 89% of ambulatory and hospitalized alcoholic hepatitis (P = 0.0001), respectively. In asymptomatic subjects with suspected liver disease, a liver biopsy is the only way of establishing the type and severity of liver lesions.     

Racial variations on the MacAndrew Alcoholism Scale of the MMPI.

The present investigation examined the effect of race on the MacAndrew Alcoholism Scale (MAC) performance of alcoholic and nonalcoholic inpatients in an active-duty military sample. Black and white alcoholics performed similarly on the MAC in terms of mean score and accuracy of identification by cutting scores. Black nonalcoholics scored significantly higher than white nonalcoholics on the MAC. The MAC was found to discriminate successfully between white alcoholics and nonalcoholics (66.3%) but not between black alcoholics and nonalcoholics (55.5%). The inability of the MAC to discriminate between black alcoholics and nonalcoholics in an active-duty military sample suggests caution in its use with black patients in this setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Naltrexone's effects on reactivity to alcohol cues among alcoholic men.

The mechanisms of naltrexone's effects on urges to drink during abstinence are unclear. Naltrexone may suppress either urges to drink specifically or appetitive responses in general. The effects of naltrexone on cue reactivity to alcoholic and sweet nonalcoholic beverages were investigated. Alcohol-dependent men (N ?=?53) in treatment received naltrexone (50 mg) or placebo. Four hours later, they received baseline assessment, exposure to fruit juice, and exposure to their usual alcoholic beverage in 3-min trials. Naltrexone reduced urge to drink and self-reported attention to the alcohol cues, not at the initial exposure but after repeated exposures to alcohol cues. Naltrexone reduced negative affect across baseline and alcohol trials. No effects of naltrexone on responses to the nonalcoholic appetitive beverage cues were found, suggesting that general appetite suppression does not mediate the effects of naltrexone on urges. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do alcohol expectancies mediate drinking patterns of adults?

Compared the reinforcement expectancies of adult alcoholics with beliefs of 2 other adult populations. 171 participants (mean age 42.8 yrs) in alcohol treatment programs, 65 hospitalized medical patients (mean age 42.6 yrs), and 344 college students (mean age 24 yrs) identified their beliefs about the consequences of alcohol consumption through an alcohol expectancy questionnaire (AEQ). Results indicate that the previously defined AEQ beliefs among nonalcoholic populations identified by S. A. Brown et al (1980) and B. A. Christiansen et al (see record 1982-25609-001) are applicable to alcoholic populations. In the present study, nonalcoholics and alcoholics differed significantly in terms of their alcohol expectancies. In general, alcoholics were found to maintain strong alcohol expectancies, and expectancies increased across and within populations as a function of drinking patterns. Theoretical, research, and clinical implications of these findings and the AEQ are discussed. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hormonal (ACTH, cortisol, beta-endorphin, and met-enkephalin) and cardiovascular responses to hyperthermic stress in chronic alcoholics

Chronic alcohol drinking causes profound alterations in hypothalamic-pituitary function. In the present study, endocrine [corticotropin (ACTH), beta-endorphin, cortisol, and met-enkephalin] and cardiovascular (blood pressure) changes in response to hyperthermic stress (sauna at 90 degrees C for 30 min) were evaluated in 25 normal men (25 to 50 years old) and in 48 male alcoholic subjects (34 to 56 years old) after 5 weeks of abstinence. Significantly lower increments in systolic blood pressure were observed in alcoholics than in control subjects. Furthermore, alcoholics showed lower ACTH, beta-endorphin, and cortisol increments in response to sauna than normal controls. In contrast, sauna-induced hyperthermia did not change significantly the circulating met-enkephalin levels in either normal controls or chronic alcoholics. These data suggest that an impairment in the adaptive response to stress affects alcoholic men even after a few weeks of abstinence from alcohol.     

Alcohol cue reactivity, negative-mood reactivity, and relapse in treated alcoholic men.

Relapsed alcoholic individuals frequently report that negative emotional states trigger their return to drinking. A parametric laboratory study was conducted to assess the separate and combined effects of exposure to alcohol-related stimuli and induced negative moods in abstinent alcoholic persons. The authors also sought to determine if reactivity to alcohol cues or reactivity to negative mood induction predicted relapse soon after treatment. Men with alcoholism (N?=?50) undergoing inpatient treatment participated in a guided imagery procedure designed to induce negative moods and were then exposed to either their favorite alcoholic beverage or to spring water. Results indicated that both alcoholic beverage presentation and negative affect imagery led to increased subjective reporting of desire to drink. These effects were additive but not multiplicative (i.e., the interaction of mood state with beverage type was not significant). Reported urge to drink during the trial that combined negative mood imagery with alcoholic beverage exposure predicted time to relapse after inpatient discharge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrated behavior change techniques for alcoholics.

42 chronic hospitalized alcoholics were Ss in a study designed to evaluate the effectiveness of a combination of behavior modification techniques in changing drinking and related behaviors and achieving moderation. The following procedures were studied: videotaped self-confrontation of drunken behavior, discrimination training for blood alcohol concentration, aversion training for overconsumption, discriminated avoidance practice, alcohol education, alternatives training, and behavior counseling. All of the techniques were applied to Group 1, and only the last 3 techniques were applied to Group 2. After 1 yr of follow-up, significant decreases in alcohol intake were observed for both groups, but Group 1 decreased significantly more than Group 2. Favorable changes were also observed in drinking companions, choice of alcoholic beverage, and drinking environment. It is concluded that some chronic alcoholics learned to drink in a controlled manner as a result of the techniques used and the program orientation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Death expectancies in alcoholic and nonalcoholic persons

The Do-It-Yourself Death Certificate (DIYDC) was administered to a group of alcoholic inpatients (N = 39) and to a group of university employees (N = 39). The groups were matched on age, sex, and race. Both alcoholics and nonalcoholics projected unrealistic expectations about their deaths when compared with actuarial cause of death data, but this was somewhat more true of those in the alcoholic group, who expected to live longer than would be expected and who only infrequently attributed their deaths to drinking. Strong preferences were expressed for a quick death, and some differences were observed between the groups with regard to seasonal expectations of time of death and attitudes toward life-prolonging techniques. The DIYDC appears to be a useful adjunct to existing methods of death research, and it may have practical applications with some clinical groups, provided that certain ethical considerations are observed.     

Child sexual and physical abuse and alcoholism: a review

OBJECTIVE: To examine possible relations between child sexual or physical abuse and adult alcoholism. METHOD: Studies reviewed included prospective studies, retrospective studies on the prevalence of child sexual or physical abuse in alcoholics and nonalcoholics, and retrospective studies in mental health clients and in population samples comparing the prevalence of alcohol use disorders in abused and nonabused subjects. RESULTS: Prospective studies do not indicate a significant association between child sexual or physical abuse and alcoholism. In contrast, studies among alcoholic women do suggest a relationship. Also, a significantly higher prevalence of alcohol problems in abused women than in nonabused women is found in population samples. The results of studies among mental health clients are inconclusive. In addition, several methodological limitations should be taken into consideration when evaluating results of the available studies. CONCLUSIONS: Current evidence is insufficient to draw conclusions about relationships between child sexual or physical abuse and alcoholism among men. Among females, however, there is a higher likelihood of alcohol problems if they were sexually or physically abused as children.     

The effects of familial risk, personality, and expectancies on alcohol use and abuse.

This study tested a structural model of the association between familial risk, personality risk, alcohol expectancies, and alcohol abuse in a sample of 224 young adult offspring of alcoholics and 209 offspring of nonalcoholics. The results provided support for 2 personality-risk pathways, a social deviance proneness and an excitement/pleasure seeking path, that accounted for a significant portion of the association between a familial alcoholism and alcohol abuse. The path from familial alcoholism to social deviance proneness lead directly to alcohol problems. The path from familial alcoholism to excitement/ pleasure seeking was associated with increased drinking, which, in turn, was associated with alcohol problems. Positive alcohol expectancies accounted for part of the association between excitement seeking and alcohol use. The results suggest 2 different biopsychosocial mechanisms that elevate risk for abuse in the offspring of alcoholics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The self-control costs of fighting the temptation to drink.

Being exposed to the sight and smell of an alcoholic beverage and not drinking it should require self-control. On the basis of the self-control strength model (M. Muraven & R. F. Baumeister, 2000), exerting self-control should lead to poorer performance on subsequent self-control tasks. Using a cue exposure paradigm, the authors had 160 social drinkers alternately sniff water and alcohol. After each trial, the drinkers engaged in 2 self-control tasks: squeezing a handgrip and a self-stopping task. Performance on these tasks was worse after sniffing alcohol than after sniffing water. Mood and arousal did not mediate the effects; urge to drink was negatively related to outcomes. The effects were stronger for individuals high in trait temptation to drink. Resisting the temptation of drinking appears to undermine self-control capacity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of two-segmented logistic regression to estimate change-points in epidemiologic studies

The effects of exposure to an alcohol-related cue (drinking low-alcohol beer) and a musical depression/elation mood induction procedure, on craving, motivation and liking for alcohol, were studied in male and female recreational drinkers. Alcohol craving was assessed using the multidimensional desires for alcohol questionnaire (DAQ), motivation for alcohol was assessed by performance on a progressive ratio (PR) task reinforced with small volumes (25 ml) of low-alcohol beer, and liking for the reinforcers earned in the PR task was assessed using a visual analogue scale. Consumption of a half-pint of low-alcohol beer increased alcohol craving in male subjects but had no effect or decreased craving in female subjects. Subsequent induction of a depressed mood increased craving scores, relative to elated or neutral mood groups, but these effects were confined to abstinent (non-cued) subjects, both male and female. Performance on the PR task correlated significantly with one of the four factors of the DAQ, negative reinforcement, and was increased by induction of a depressed mood in abstinent female and cued male subjects. Reinforcer liking was unchanged following mood induction in male subjects, but decreased in both groups of female subjects. To summarize, the cue of drinking low-alcohol beer increased alcohol craving in men but not in women, and induction of a depressed mood increased alcohol craving and motivation, but also decreased alcohol liking. These effects were present to different extents in different cue/gender subgroups, and were partially independent.     

Decreases in dopamine receptors but not in dopamine transporters in alcoholics

It has been hypothesized that ethanol's actions on the dopamine (DA) system may participate in addiction. The purpose of this study was to evaluate the DA system in the brain of alcoholics. We evaluated 10 alcoholics and 17 nonalcoholics using positron emission tomography and [11C]raclopride to measure DA D2 receptors. In addition, in 5 of the alcoholics and 16 of the nonalcoholics, we also measured DA transporters with [11C]d-threo methylphenidate. The ratio of the distribution volumes in striatum to that in cerebellum, which corresponds to Bmax/Kd + 1, was used as model parameter of DA D2 receptor and transporter availability. Dopamine D2 receptor availability (Bmax/Kd) was significantly lower in alcoholics (2.1 +/- 0.5) than in nonalcoholics (2.7 +/- 0.6) (p < 0.05) and was not correlated with days since last alcohol use. Alcoholics showed DA transporter values similar to those in nonalcoholics. The ratio of DA D2 receptor to transporter availability was significantly higher in nonalcoholics (1.4 +/- 0.1) than in alcoholics (1.1 +/- 0.1) (p < 0.005). Alcoholics showed significant reductions in D2 receptors (postsynaptic marker) but not in DA transporter availability (presynaptic marker) when compared with nonalcoholics. Because D2 receptors in striatum are mainly localized in gamma-aminobutyric acid (GABA) cells these results provide evidence of GABAergic involvement in the dopaminergic abnormalities seen in alcoholics.     

Relationships among aging, IQ, and intracranial volume in alcoholics and control subjects.

The current article examined the relationships among aging, intelligence, intracranial volume, and brain shrinkage in alcoholics and nonalcoholic controls. Magnetic resonance imaging was used to measure intracranial and cerebral volumes in 146 subjects with alcohol use disorders and 42 comparison subjects who were not alcoholic. The authors' findings show that performance on Block Design decreases as alcoholics age, and this decrease is predicted by brain shrinkage. This is consistent with a process of cumulative brain damage related to alcohol use. However, the authors' data also show that vocabulary does not decrease with age and is correlated with premorbid brain size as measured by intracranial volume, suggesting that lower verbal ability precedes heavy alcohol use and may be a risk factor for alcoholism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)