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)     

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)     

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)     

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.     

Emotion-focused coping as a mediator of maternal cocaine abuse and antisocial behavior.

A great deal of data implicate parental drug use as a potential risk factor for child abuse, however, theories for understanding the links between maternal drug use and antisocial behavior have yet to be examined empirically. This case-control study investigated correlates of adult antisocial behavior among 279 inner-city mothers in 3 comparison groups: drug abusers, (n = 112), depressed mothers (n = 73), and nonsubstance abusing controls (n = 94). Using hierarchical regression techniques and mediational analyses controlling for ethnicity, current depression, and family history of substance abuse, support was provided for an emotion-focused coping style as a link between addictive and antisocial behavior. These results highlight the importance of focusing on emotion regulation models in the prevention and treatment of violence in drug-abusing women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinician assessment of psychiatric comorbidity and alcoholism severity in adult alcoholic inpatients

Although psychiatric comorbidity and alcoholism severity are risk factors for poor outcomes in treating alcoholism, little is known about whether clinicians assess these conditions accurately. In this study we evaluated four clinicians' assessments of two indicators of alcoholism severity and three psychiatric co-morbidities in 78 inpatients in their third to seventh day of hospitalization in alcohol treatment programs. Clinicians overestimated the number of days drinking in 28% of subjects, and the number of drinks per drinking day in 37% of subjects. Clinicians underestimated alcohol consumption for patients with higher incomes. Clinicians correctly diagnosed 67% of 18 subjects with antisocial personality disorder, 65% of 26 with major depression, and 89% of 28 with drug abuse. These preliminary results need to be replicated in larger samples of clinicians to determine whether interventions are needed to improve the recognition of important prognostic factors in the treatment of alcoholic patients.     

Are there inherited behavioral traits that predispose to substance abuse?

Research findings suggest that alcoholism and drug abuse may be predisposed by inherited behavioral propensities or temperaments. These inherited predispositions, through interaction with the physical and social environments, shape the development of personality. As discussed herein, there is strong evidence linking certain personality characteristics, specifically antisocial and neurotic traits, with the risk for substance abuse. Thus, personality and its precursor, temperament, comprise an important diathesis. However, an adverse outcome also depends on a variety of developmental and environmental factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol and drug abuse-dependence disorders in psychopathic and nonpsychopathic criminal offenders.

Co-occurrence of psychopathy (assessed with the Revised Psychopathy Checklist [R. D. Hare, 1985]) and lifetime Diagnostic and Statistical Manual of Mental Disorders (DSM-III) alcohol and drug disorders (assessed with the Diagnostic Interview Schedule; National Institute of Mental Health) was examined in a sample of 360 male inmates. Consistent with previous research that used diagnoses of antisocial personality disorder, psychopaths were more likely than nonpsychopaths to have lifetime diagnoses of alcoholism, any drug disorder, and multiple drug disorder. The relation between substance abuse and the 2 factors of the Revised Psychopathy Checklist was also examined. Substance abuse was significantly related to general social deviance (Factor 2) but was unrelated to core personality features of psychopathy (Factor 1). Two possible models of psychopathy (unitary syndrome vs dual-diathesis model) are presented that may account for the association between psychopathy and substance abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Etiology, personality and alcoholism.

Personality is a necessary component of an adequate theory of problem drinking/alcoholism. The role of personality in the etiology of alcoholism is examined in terms of prediction, explanation, and causal inference. Issues are reviewed that support multivariate conceptions of alcohol abuse, and the necessity of a multivariate theoretical framework for personality research is emphasized. In the development of theory, it is important to recognize that alcohol abuse is both unique and consistent with other phenomena. Despite conceptual and methodological inadequacies, the literature supports the relevance, in alcohol problems, of dependency, defensive denial, depression, sex-role identity confusion, inadequate impulse control, and subjective dissatisfaction. Reciprocal interaction systems of personality, environment, and behavior are needed for an understanding of the temporally dynamic process of alcohol abuse. (French abstract) (5 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcoholism and alcohol abuse among women: report of the Council on Scientific Affairs. American Medical Association

We describe characteristics of women alcohol abusers, risk factors for alcoholism in women, barriers to treatment, and implications and strategies for physicians dealing with alcohol abuse in women patients, including risk assessments and intervention strategies. Alcohol abuse and alcoholism have a different physiologic effect on women than on men. Societal attitudes about women and alcohol and internal (self-perception) and external (environmental) factors can create barriers to the detection and treatment of female alcohol abusers. Physicians are in an excellent position to address the medical, psychologic, and social concomitants of alcoholism and alcohol abuse. The Council on Scientific Affairs recommends that physicians become more active in the prevention, diagnosis, and treatment of alcohol-related problems in women, including the diseases that may be associated with chronic alcohol abuse and the effect of alcohol on the developing fetus. Specific American Medical Association policy and recommendations for physician practice are included.     

Alcoholism and drug abuse in three groups--bipolar I, unipolars and their acquaintances

OBJECTIVE: Previous work has shown that manic-depressive illness and alcohol abuse are linked. This study further explores the relationship of alcohol and drug abuse in bipolar I patients and unipolar depressives and a comparison group obtained through the acquaintance method. METHOD: Diagnosis was accomplished according to Research Diagnostic Criteria (RDC): controls = 469; bipolars = 277; unipolar depressives = 678. Systematic data were gathered using the SADS on lifetime and current drug abuse and alcoholism. Both patients and comparison subjects were then followed prospectively for 10 years. First degree family members were interviewed using the RDC family history method. RESULTS: The group of bipolar patients and the group of unipolar patients had higher rates of drug and alcohol abuse than the comparison group when primary and secondary affective disorder patients were combined. However, primary unipolar patients did not have higher rates of alcohol or drug abuse than the comparison group. In contrast, primary bipolar patients had higher rates of alcoholism, stimulant abuse, and ever having abused a drug than the primary unipolar group and the control group. In an evaluation of the bipolar patients, drug abusers were significantly younger at intake and had a significantly younger age of onset of bipolar disorder. There was a significant increase in family history of mania or schizoaffective mania in the drug-abusing bipolar patients as compared to the non-abusing bipolar patients. LIMITATION: As in all adult samples of patients with affective illness, the chronology of alcohol and substance problems vis-à-vis the onset of illness was determined retrospectively. CONCLUSIONS: (1) Alcoholism and drug abuse are more frequent in bipolar than unipolar patients. (2) The drug abuse of bipolar patients tends toward the abuse of stimulant drugs. (3) In a bipolar patient, familial diathesis for mania is significantly associated with the abuse of alcohol and drugs. (4) More provocatively, these findings suggest the hypothesis of a common familial-genetic diathesis for a subtype of bipolar I, alcohol and stimulant abuse. CLINICAL IMPLICATIONS: The present analyses, coupled with two previous ones from the CDS, suggest that drug abuse may precipitate an earlier onset of bipolar I disorder in those who already have a familial predisposition for mania. Furthermore, in dually diagnosed patients with manic-depressive and alcohol/stimulant abuse history, mood stabilization of the bipolar disorder represents a rational approach to control concurrent alcohol and drug problems, and should be studied in systematic controlled trials.     

Heterogeneity in the families of sons of alcoholics: The impact of familial vulnerability type on offspring characteristics.

In 2 samples of sons of alcoholics (family history positive for alcoholism; FHP: N?=?74 & N?=?72), cluster analyses identified 3 subtypes of familial vulnerability: 1 with low levels of familial psychopathology (FHP-LP) and moderate levels of familial alcoholism; a 2nd with high levels of familial antisocial personality (FHP-ASP), violence, and alcoholism; and a 3rd with high levels of familial depression (FHP-DEP), mania, anxiety disorder, and alcoholism. Compared with family history negative (FHN) participants (N?=?106), FHP offspring had higher levels of alcohol problems. FHP-ASP offspring had elevated levels of antisocial traits and negative affect. Compared with FHN participants, FHP-DEP offspring elevated levels of antisocial traits, hypomania, and experience seeking. FHP-LP offspring had moderate levels of antisocial traits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Study of the biosynthesis of fumonisins B1, B2 and B3 by different strains of Fusarium moniliforme

The relation between childhood behavior disorders (CBD), attentional difficulties (ADD), and antisocial personality disorder (ASP) was examined in a clinical population of alcoholics and polysubstance abusers. Polysubstance abusers reported increased CBD symptomatology, increased attentional problems, a higher rate of ASP, and a greater number of both current and lifetime ASP symptoms relative to alcoholics without polysubstance abuse. An examination of gender effects revealed significant differences on self-reported adult attentional problems, with females endorsing a greater number of items. As a group, females exhibited the highest rate of ASP. Males showed a significant correlation between current ASP symptoms and both attention and conduct problems in early childhood.     

Perceived victimization moderates self-reports of workplace aggression and conflict.

A sample of 489 employed men between 32 and 36 years old responded to questions concerning rates of having engaged in workplace aggression and conflict. These individuals also completed a personality inventory and questionnaires related to past antisocial behavior and alcohol abuse. Consistent with prior research, workplace aggression and conflict were significantly correlated with particular personality variables (stress reaction, aggression, and control) as well as with general past antisocial behavior and alcohol abuse. Furthermore, these relationships were moderated by the perception of being victimized by others (alienation), with such perceptions strengthening associations between workplace aggression and other risk factors. These interaction effects, which cannot plausibly be attributed to the use of a self-report criterion, could have important implications for understanding and predicting aggression and conflict behavior within organizations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pathways of risk for accelerated heavy alcohol use among adolescent children of alcoholic parents

The current study examined two questions. First, do internalizing symptoms and externalizing behavior each mediate the relations between parent psychopathology (alcoholism, antisocial personality disorder, and affective disorder) and growth in adolescent heavy alcohol use? Second, are there gender differences in these mediated pathways? Using latent curve analyses, we examined these questions in a high-risk sample of 439 families (53% children of alcoholic parents; 47% female). Collapsing across gender, adolescent-reported externalizing behavior mediated both the relation between parent alcoholism and growth in heavy alcohol use and the relation between parent antisociality and growth in heavy alcohol use. Parent-reported externalizing behavior only mediated the relation between parent antisociality and growth in heavy alcohol use in males. No support was found for internalizing symptoms as a mediator of these relations. Avenues are suggested for further exploring and integrating information about different mediating processes accounting for children of alcoholics' risk for heavy alcohol use.     

The developmental interface between nature and nurture: A mutual influence model of child antisocial behavior and parent behaviors.

Using an adoption design to collect data on biological and adoptive parents of children adopted at birth, this study explored a possible mechanism through which heritable characteristics of adopted children evoke adoptive parent responses and lead to reciprocal influences between adoptive parent and adopted child behavior. Participants were 25 male and 20 female adoptees, 12-18 years of age, having either a biological parent with substance abuse/dependency or antisocial personality or a biological parent with no such history. The study found that psychiatric disorders of biological parents were significantly related to children's antisocial/hostile behaviors and that biological parents' psychiatric disorders were associated with adoptive parents' behaviors. This genotype-environment association was largely mediated by adoptees' antisocial/hostile behaviors. Results also suggest that the adoptee's antisocial/hostile behavior and adoptive mother's parenting practices affect each other. (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 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.     

The comorbidity of alcoholism and personality disorders in a clinical population: Prevalence and relation to alcohol typology variables.

This study assessed prevalence rates and overlap among Diagnostic and Statistical Manual of Mental Disorders ( 3rd ed., revised; DSM-III—R; American Psychiatric Association, 1987) personality disorders in a multisite sample of 366 substance abusers in treatment. In addition, the relation of antisocial personality disorder (APD), borderline personality disorder (BPD), and paranoid personality disorder (PPD) to alcohol typology variables was examined. Structured diagnostic interviews and other measures were administered to participants at least 14 days after entry into treatment. Results indicated high prevalence rates for APD and non-APD disorders. There was extensive overlap between Axis I disorders and personality disorders, and among personality disorders themselves. APD, BPD, and PPD were linked to more severe symptomatology of alcoholism and other clinical problems. However, only APD and BPD satisfied subtyping criteria, after controlling for other comorbidity. Implications for classifying alcoholics by comorbid disorders are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)