The drug dependence syndrome concept as an organizing principle in the explanation and prediction of relapse.
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Biomedical subjects
Publications and source records attributed to T F Babor.
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Implicit in what has come to be called the loss of control concept is the notion that the environment, or the context within which drinking occurs, exerts little influence on the quantity of alcohol consumed by an alcoholic. In contrast, recent formulations of the alcohol dependence syndrome have argued that dependence arises from an interaction among personality, pharmacological and contextual variables. The present study investigated the relationship between contextual factors and alcohol consumption in 231 men and 90 women alcoholics. Self-report questionnaire data were obtained describing social pressures to drink more or less than usual, and the usual quantity of drinking in a variety of situations (e.g., at home alone, in bars or in family settings). The findings indicate clear differences in the quantities that alcoholics drink when alone, with friends or with family. Even the dependent drinker is apparently able to discriminate the relative quantity of drinking that will be socially sanctioned in a given situation and modify consumption accordingly. In situations in which constraints are absent or minimal (e.g., alone), drinking tends to be greater than in situations in which social controls are more pronounced (e.g., with friends and family).
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A study was conducted to investigate the effects of acute alcohol administration on affective states and verbal behavior during the ascending and descending limbs of the blood alcohol curve. Sixteen male social drinkers were given alcohol (1.0 g/kg) or placebo in a double-blind crossover research design. Subjects tested while blood alcohol levels (BAL) were ascending close to peak concentration (0.11 g%) described themselves as more elated, friendly, and vigorous than when tested under placebo conditions. As BAL declined, subjects described themselves as more angry, depressed, and fatigued. Cognitive confusion, hostile verbal interaction, and aggressive thematic content were also greater during alcohol intoxication, but these measures were unrelated to direction of change in the BAL curve. It was concluded that (1) the effects of alcohol on affect are biphasic and are closely related to direction of change in the BAL curve, (2) the disinhibition of certain types of verbal behavior is related neither to affective state or to direction of the BAL curve, and (3) the perception of cognitive disorientation may mediate the effects of alcohol on those behaviors normally suppressed by various controlling influences.
The conceptual foundation and structural development of a major secondary prevention program established in France to screen, diagnose and treat persons in the prodromal stages of alcoholism are described. Also discussed are the application and validity of a simple examination procedure used to identify alcoholics in this program.
There seems to be a growing consensus that the differential outcome associated with alcoholism suggests different prognoses of specific subgroupings of alcoholic patients. This paper is a review of the literature of proposed typologies based upon drinking history, psychopathology, neuropsychological assessment, and family pedigree, with implications for theories of etiology, approaches to treatment, and research methodology. It should serve as an introduction to the series of papers which will follow.
A study of 114 male and female alcoholics was conducted to evaluate the validity of information obtained by means of self-report questionnaires. Factor analysis was used to derive composite measures of alcohol dependence, withdrawal symptomatology, pathological intoxication, and alcoholic psychosis. Validation was conducted by comparing these measures with independent and external criteria; that is drinking estimates made by collateral informants, measures of general alcohol involvement, and drinking behavior 6 months after treatment. The results support each type of validity, and thereby contradict the assumption that the alcoholics' self-reports were not accurate. The question of unreliable self-report data due to the demand characteristics of the situation under which the information is obtained is also addressed.
1. The course and consequences of alcohol abuse were examined in male and female patients being treated for alcoholism. 2. Demographic characteristics, family history for alcoholism, psychopathology, drinking history and social and physical consequences of alcohol abuse were assessed. 3. Probands with alcoholism on both the maternal and paternal sides of their pedigree experience greater psychosocial and physical consequences of alcohol abuse than other alcoholic patients. 4. Sex of the proband and type of family pedigree for alcoholism were found not to be interactive but to contribute separate additive effects.
A discount drink policy ("happy hour") was related to increases in the frequency of drinking and amounts of alcohol consumed by casual and heavy drinkers in experimental and barroom settings.
Self-report questionnaires assessing various drinking behaviors and constructs were administered to subjects in two separate empirical studies of longitudinal drinking patterns. The results suggest that self-report measures of both specific and general drinking behavior accurately differentiate drinkers who vary in frequency and intensity of alcohol consumption.
An experimental analogue of a discount drink policy known as the "happy hour" was used to study the effects of purchase price on drinking behavior. Male volunteers with a prior history of either casual (N=20) or heavy (N=14) drinking were given free access to beverage alcohol during a 20-day period. Approximately half the subjects could purchase alcohol under a single-price condition (50 cents/drink), while a matched group was given a price reduction daily (25 cents/drink) during a three-hour period in the afternoon. The results demonstrated that the afternoon price reduction significantly increased alcohol consumption in both casual and heavy drinkers. Reinstatement of the standard purchase price effectively suppressed drinking in both groups. The findings are discussed in terms of the theoretical and research implications of environmental influences on drinking.
Four-person groups of moderate and heavy marijuana users were studied in a group discussion situation during marijuana intoxication. Amount of participation and role behavior were compared to nonintoxicated baseline performance and to that of a no-drug control group. During intoxication, moderate users were less task-oriented and participated less in group discussion. These findings were interpreted in terms of cognitive, motivational, and physiological reactions to marijuana. The lack of any social effect on heavy users suggested the existence of behavioral tolerance.
Adult male volunteers with a prior history of either moderate (N = 12) or heavy (N = 14) marijuana use were systematically observed before, during, and after a 21-day period of free access to marijuana cigarettes. Data relevant to social interaction and recreational preferences were collected at hourly intervals. Moderate users consumed an average of 2.6 cigarettes per day and showed both acute and persistent (21-day) decrements in social interaction. Heavy users consumed 5.7 cigarettes per day but indicated fewer social reactions. The results suggested that marijuana inhibits social interaction in moderate users but behavioral tolerance in heavy users may mitigate this effect.
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Adult male volunteers with a prior history of either moderate (N = 12) or heavy (N = 14) marihuana use were systematically observed before, during and after a 21-day period of free access to 1 g 2% delta-9 THC marihuana cigarettes. A matched sample of casual alcohol drinkers (N = 11) served as a control group. Sleep and other molar behaviors were observed hourly to obtain a representative sample of daily activity. Both moderate and heavy users were less active immediately after marihuana use and slept more on days following heavier consumption. Heavy users reduced their waking activity on days following heavier consumption, as well as during the entire period of marihuana availability. These reactions did not persist beyond the period of availability for either group. The findings suggest a dose-related delayed reaction to heavy marihuana consumption which disappears following the cessation of regular use. However, changes in activity following single doses of marihuana may be related more to the social circumstances of its use than to its pharmacological action.
Behavioral and social reactions to intravenously administered heroin were studied during a 33-day experimental addiction cycle. Three groups of four subject volunteers were allowed to self-administer heroin for a ten-day period as part of a longer study of oplate antagonists. Data relevant to sleep patterns, energy expenditure, social interaction, and other observable behaviors were collected during hourly observations. Comparison of behavioral differences before and after drug administration indicated few significant acute reactions. Reactions to long-term heroin self-administration were most pronounced in the areas of sleep behavior and social interaction. Subjects tended to sleep less, especially during the initial period of acquisition, and to withdraw more from social contact. No changes were noted in energy expenditure during waking hours. The results were interpreted in terms of physiological tolerance, central nervous system arousal, and sleep deprivation.
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