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PubMed1985

Two versions of dependence: D.S.M.-III and the alcohol Dependence Syndrome.

This paper reviews the concepts of dependence on alcohol as embodied by the Alcohol Dependence Syndrome and as proposed in the Diagnostic and Statistical Manual of the American Psychiatric Association (D.S.M.-III). Evidence in support of the unidimensionality of this concept is still controversial, and the elements necessary to diagnose dependence under each of these two proposals are different. Alcohol Dependence in the D.S.M.-III has indicators of social and occupational impairment which are not part of the Alcohol Dependence Syndrome. Knowledge on the concept of dependence will advance more rapidly if researchers begin to develop comparative studies of these two models. Future work should also include studies in the general population, with women, ethnic minorities and cross-cultural research. Longitudinal research to establish the evolution of dependence both in clinical and general populations should also be developed.

Alcoholism↗

PubMed2002

Mutation analysis of the retinoid X receptor beta, nuclear-related receptor 1, and peroxisome proliferator-activated receptor alpha genes in schizophrenia and alcohol dependence: possible haplotype association of nuclear-related receptor 1 gene to alcohol dependence.

Because retinoid cascades are involved in the regulation and development of the central nervous system, including dopaminergic neurons, retinoic acid signaling defects may contribute to schizophrenia and substances dependence. Retinoid X receptors (RXRs) form heterodimer complexes with nuclear-related receptor 1 (NURR1) or with peroxisome proliferator-activated receptors (PPARs). We examined 48 Japanese patients with schizophrenia and 32 patients with alcohol dependence to detect mutations in the retinoid X receptor beta gene (RXRB) on chromosome 6p21.3, the NURR1 gene (NR4A2) on chromosome 2q22-q23, and the PPAR alpha gene (PPARA) on chromosome 22q12.2-13.1. A Val95Ala polymorphism of the RXRB gene, a Val227Ala polymorphism in the PPARA gene, and two synonymous single-nucleotide and CA repeat polymorphisms in the 5' region and 3' untranslated region of the NR4A2 gene were identified. Extended case control samples did not suggest an association between the diseases and the RXRB or PPARA polymorphisms. However, they revealed a significant association between the NR4A2 gene haplotype and alcohol dependence, indicating that 2q22-q23 including the NR4A2 gene locus is a possible genomic region contributing to genetic susceptibility to alcohol dependence.

Adolescent↗

PubMed2002

Alcohol dependence symptoms and alcohol dehydrogenase 2 polymorphism: Israeli Ashkenazis, Sephardics, and recent Russian immigrants.

BACKGROUND: Jews have lower rates of alcohol-related problems than other Caucasians. The ADH2*2 allele of the alcohol dehydrogenase 2 (ADH2 ) gene protects against alcoholism in Asians and is found in approximately 20% of Jews. We studied the relationship of ADH2*2 to DSM-IV dependence severity in a random community sample of Israeli Ashkenazis, recent Russian immigrants (also Ashkenazis), and Sephardics. METHODS: Subjects participated in a structured interview that included highly reliable questions on DSM-IV alcohol dependence symptoms. ADH2 genotype was determined for 68 subjects. RESULTS: Recent Russian immigrants had more past and lifetime DSM-IV dependence symptoms. Sephardics had a higher prevalence of ADH2*2 than Ashkenazis. Controlling for group and other potentially confounding factors, ADH2*2 was associated with a lower lifetime DSM-IV alcohol dependence severity, although this differed somewhat within groups. CONCLUSIONS: ADH2*2 protects against dependence severity in Jewish samples. Future work in larger samples should address genetic and environmental factors that affect the relationship of ADH2*2 to alcohol consumption and dependence.

Adult↗

PubMed2005

Retained risk-taking behaviors among past alcohol dependent trauma patients.

Alcohol dependence has been associated with behavioral risk factors and risk-taking tendencies. We investigated whether past alcohol dependent trauma center patients (n=42) retain the characteristics of current alcohol dependent patients (n=67) or whether they resemble patients without history of alcohol dependence (n=262). We found that past alcohol dependence patients retain some of the risk-taking tendencies (impulsivity and sensation seeking) and risk-taking behaviors (drinking and driving, riding with a drunk driver, binge drinking, speeding for the thrill) common to current alcohol dependent patients and they remain at a higher injury risk than the non alcohol dependent population.

Accidents, Traffic↗

PubMed2005

Differences in the peripheral levels of beta-endorphin in response to alcohol and stress as a function of alcohol dependence and family history of alcoholism.

BACKGROUND: Evidence indicates that both genetic and environmental factors, such as stress, may play an important role for the development of alcoholism, while beta-endorphin may be implicated in the control of alcohol consumption. The objective of the present studies was to test the hypothesis that there are differences in the response of the pituitary beta-endorphin system to stress as a function of family history of alcoholism and alcohol dependence. METHODS: The response of the pituitary beta-endorphin to a placebo or an alcohol (0.50 g ethanol/kg) drink and to a stress task performed 30 min following ingestion of either the placebo or the alcohol drink was measured in social and heavy drinkers with [high risk (HR)] and without [low risk (LR)] a family history of alcoholism. Thus, each subject participated in 4 experimental sessions given on different days in a randomized order. Four groups of subjects were investigated: 1) low risk nonalcoholics (LRNA); 2) high risk nonalcoholics (HRNA), 3) low risk alcoholics (LRA); and 4) high risk alcoholics (HRA). Plasma beta-endorphin was estimated prior to and for 3.5 hr post-stress. Changes in the concentration of plasma beta-endorphin following ingestion of either the placebo or alcohol drink without performance of the stress task served as controls to compare the stress-induced changes. RESULTS: Basal plasma beta-endorphin levels were higher in LRNA than LRA, HRNA and HRA participants, while basal plasma beta-endorphin levels were higher in LRA than those in HRNA and HRA participants. Furthermore, there was no significant difference in the plasma beta-endorphin levels between HRNA and HRA participants. Stress, induced a significant increase in plasma beta-endorphin concentration in all four groups of participants. However, the stress-induced increase in plasma beta-endorphin levels was more pronounced in LRNA than HRNA, LRA and HRA participants. Thus, alcohol dependence decreased the basal plasma beta-endorphin levels in LR only, as well as the stress induced increase in plasma beta-endorphin levels of participants without, but not of those with, a family history of alcoholism. Alcohol prior to stress attenuated the stress-induced increase in plasma beta-endorphin levels of all four groups of participants. CONCLUSIONS: The present data indicates that there are differences in both, the basal plasma beta-endorphin levels as well as the response of the pituitary beta-endorphin to stress as a function of family history of alcoholism and alcohol dependence. Thus, in HR individuals a dysfunction in the activity of the pituitary beta-endorphin system predates the development of alcoholism, while in LR individuals it develops following alcohol dependence. Furthermore, alcohol dependence did not alter the alcohol-induced attenuation of beta-endorphin response to stress.

Adult↗

PubMedDate not supplied

Strength of the relationship between tobacco smoking, nicotine dependence and the severity of alcohol dependence syndrome criteria in a population-based sample.

AIMS: Little is known about the relationship between current and past smoking behaviour and the severity of alcohol dependence. The purpose was to explore the strength of this relationship. METHODS: A random population sample of 18 to 64 year-olds from northern Germany was used (n = 4075; participation rate: 70%). It included 761 cigarette smokers fulfilling at least one alcohol-dependence criterion. The severity of alcohol dependence according to the alcohol-dependence syndrome criteria frequency (ASF) was estimated by a standardized questionnaire based on diagnostic instruments of the alcohol dependence syndrome and which included five response categories, from 'never' to 'daily'. Nicotine dependence was diagnosed according to the Diagnostic and Statistical Manual of mental disorders (DSM-IV) with the Composite International Diagnostic Interview (CIDI). As a second measure, the Fagerström Test of Nicotine Dependence (FTND) was used. RESULTS: The number of cigarettes and years of daily smoking, nicotine dependence, and the number of nicotine dependence symptoms each showed a relationship with the ASF. Effect size (w) were 0.17-0.21 for chi-squared (chi(2)) tests. In a general linear regression model with the ASF as the dependent variable (R(2) = 0.17), number of years of daily smoking, age at onset of smoking, number of attempts to reduce or quit, the number of nicotine-dependence symptoms according to DSM-IV and the FTND sum score were retained as independent variables. CONCLUSIONS: Long-term smoking, a large number of nicotine-dependence symptoms according to DSM and a strong urge to smoke according to the FTND are related with a high ASF.

Adolescent↗

PubMed2004

Alcohol dependence and the alcohol Stroop paradigm: evidence and issues.

AIMS: Firstly to test alcohol abusers attentional bias towards alcohol-related stimuli. Secondly, to shed light onto other factors that may influence the alcohol Stroop effect by considering variables including mood status in the analyses. Finally, to examine severity of dependence on Stroop performance. DESIGN: Repeated measures with alcohol versus control group as the between participant factors and within participant factors were the reaction times to different types of stimuli. Standard multiple regression was used to determine predictors of Stroop performance. A repeated measures design was used with severity of dependence as the between participant factors and Stroop reaction times as the within participant factors. SETTING: South and East London, UK. PARTICIPANTS: Sixty-four alcoholics in treatment and 64 community controls from general practice participated in the study. MEASUREMENTS: Alcohol dependence severity was measured using the SADQ, mood was measured with the POMS-SF and a computerised emotional Stroop task was employed to measure attentional bias. FINDINGS: Regardless of demographic factors and mood status, alcoholics responded significantly slower to alcohol-related than neutral words when compared to controls. When severity of alcohol dependence was used as between participant factors, no significant differences were found with Stroop performance between high and low alcohol severity groups. CONCLUSIONS: Alcohol-related stimuli are distracting to heavy users of alcohol, independent of demographic, mood and dependence status. Findings offer insight into the development of alcohol dependence and the issues that surround the alcohol Stroop paradigm.

Adult↗

PubMed1993

Severely dependent alcohol abusers may be vulnerable to alcohol cues in television programs.

The self-reported ability of 96 alcohol abusers to resist the urge to drink heavily was assessed after they viewed a videotape of a popular prime time television program complete with advertisements. Different versions of the videotape were used to evaluate the effects of a television program with and without alcohol scenes as crossed with the effects of three different types of commercials (i.e., beer, nonalcoholic beverages, food). Before and after viewing the videotape, subjects, who were led to believe that they were participating in two separate and unrelated sets of experimental procedures, completed several drinking questionnaires. Responses to one of the questionnaires provided an unobtrusive measure of self-reported ability to resist the urge to drink heavily. Results indicated that alcohol cues in a television program affected some alcohol abusers' perceived ability to resist the urge to drink heavily. In particular, those with higher alcohol dependence scores showed a decrease in confidence after viewing a television program with alcohol cues compared to subjects who watched the same program but without the alcohol scenes. The clinical implications of these findings are discussed. Until further research is forthcoming, given the artificial nature of the study setting, the results of this study must be viewed with some caution.

Adult↗

PubMed2001

Confirmation that offspring from families with alcohol-dependent individuals have greater hypothalamic-pituitary-adrenal axis activation induced by naloxone compared with offspring without a family history of alcohol dependence.

BACKGROUND: This study was designed to confirm our previous findings that nonalcoholic offspring from families with alcohol-dependent individuals have greater hypothalamic-pituitary-adrenal axis activation induced by opioid blockade compared with nonalcoholic subjects without a family history of alcohol dependence. METHODS: Sixty-four nonalcoholic subjects aged 18 to 25 years were enrolled in the protocol. Twenty-seven subjects were offspring from families with alcohol dependence and were designated as family history-positive subjects (FHP). Thirty-seven subjects were biological offspring of non-alcohol-dependent parents and were designated as family history-negative subjects (FHN). Subjects received naloxone hydrochloride (0, 50, 125, 375, and 500 microg/kg) in double-blind, randomized order; adrenocorticotropin (ACTH) and cortisol were monitored over 120 min. RESULTS: No hormone differences at baseline or during placebo administration were identified between FHP and FHN subjects. FHP subjects had greater ACTH and cortisol response to opioid receptor blockade induced by naloxone hydrochloride compared with FHN subjects. CONCLUSIONS: These observations confirm previous findings that differences in ACTH and cortisol dynamics between FHP and FHN subjects can be unmasked by opioid receptor blockade.

Adolescent↗

PubMed2000

Immunological parameters in patients suffering from alcohol-dependence syndrome.

Alcohol abuse is a major cause of abnormal liver development and activity. In addition to enzymatic malfunction, alcohol and its metabolites induce changes in the levels of some liver antigens, resulting in immunological disturbance. The purpose of the present study is to correlate the severity of liver function impairment with the length of alcohol abuse, in order to be able to use such tests as indicative of the severity of Alcohol Dependence Syndrome. Thirty-one alcohol abusers were allocated to three groups on the basis of the levels of their liver enzymes, and were tested for a variety of immunological parameters and skin reactions. The data indicate that even though not all immunological values measured differed significantly from the control values, in those that did (granulocytes, lymphocytes, CD4/CD8 ratio, C3, IgG, IgM and some skin positive reactions), the biggest difference was between the healthy volunteers and the group with the longest abuse period. It is suggested that changes in selected immunological parameters in alcohol abusers may indicate the severity of their liver dysfunction.

Adult↗

PubMed2004

Drinking restraint, alcohol consumption and alcohol dependence among children of alcoholics.

OBJECTIVE: Previous research has found drinking restraint to be a risk factor for alcohol use and alcohol-related problems in normative populations, but has not tested these relations in high-risk populations. The current study tested whether drinking restraint predicted alcohol-related outcomes in the same way for high-risk and low-risk individuals and tested whether there was a quadratic effect of drinking restraint on alcohol-related outcomes. METHOD: Data from an ongoing longitudinal study of children of alcoholics (COAs; n = 189) and controls (n = 192) were collected at two time points 5 years apart. RESULTS: The prospective findings extended previous cross-sectional literature by replicating the main effects of drinking restraint as a risk factor for subsequent drinking for controls. For COAs, however, higher levels of drinking restraint were associated with lower levels of later drinking. There was also a quadratic effect of drinking restraint in the prediction of alcohol dependence diagnoses, suggesting that those at the extreme levels of drinking restraint were least likely to develop alcohol dependence. CONCLUSIONS: The relation of drinking restraint to alcohol-related outcomes may be more complex than previously hypothesized because it may work in different directions for high- and low-risk individuals and may have a nonlinear relationship to diagnostic outcomes.

Adolescent↗

PubMed2006

Neurocognitive functions in pathological gambling: a comparison with alcohol dependence, Tourette syndrome and normal controls.

AIMS: Neurocognitive functions in pathological gambling have relevance for the aetiology and treatment of this disorder, yet are poorly understood. This study therefore investigated neurocognitive impairments of executive functions in a group of carefully screened Diagnostic and Statistical Manual version IV (DSM-IV-TR) pathological gamblers. Performance was compared to a group of normal control participants. To study the specificity of these neurocognitive deficits, a substance dependence group (alcohol dependence) and an impulse control disorder group (Tourette syndrome) were included. DESIGN: Cross-sectional study. SETTING: Addiction and general mental health treatment centres. PARTICIPANTS: Forty-nine pathological gamblers, 48 abstinent alcohol-dependent patients, 46 participants with Tourette syndrome and 49 normal control participants. MEASUREMENTS: A comprehensive neuropsychological battery measuring executive functions as well as basic cognitive functions. FINDINGS: Both the pathological gambling and the alcohol dependent groups were characterized by diminished performance on inhibition, time estimation, cognitive flexibility and planning tasks. The Tourette syndrome group showed deficits only on inhibition tasks. Basic cognitive functions were intact in all clinical groups. Comorbid attention deficit hyperactivity disorder, antisocial personality disorder and nicotine dependence influenced the impaired functions of the clinical groups only minimally. CONCLUSIONS: Carefully screened groups of pathological gamblers and alcohol dependents were characterized by diminished executive functioning, suggesting a dysfunction of frontal lobe circuitry in these disorders. The resemblance between the pathological gambling group and the alcohol dependence group suggests a common neurocognitive aetiology for these disorders. Psychosocial treatment of these disorders could benefit from assessing and targeting deficits in executive functions, as they probably influence the course of these disorders negatively.

Adult↗

PubMed1993

The relationship between alcohol dependence and depression.

Alcohol dependence is not a unitary or homogeneous disorder. There is substantial evidence to suggest that in both community and particularly in clinical samples, additional psychopathology is common. Although estimates of additional psychopathology differ according to the samples studied and the instruments used to classify disorders, up to two-thirds of clinical samples of patients with alcohol dependence are likely to have a lifetime diagnosis of another psychiatric disorder. Affective disorder and antisocial personality disorder appear to be the most commonly and consistently reported additional disorders. Women more than men appear to suffer from additional psychopathology, including secondary and primary depression, although this evidence is weakened by there being fewer studies carried out on mixed gender populations. Having an additional psychiatric diagnosis appears to alter the course of alcohol dependence: it may hasten the development of dependence on alcohol and may bring individuals to the attention of treatment agencies more quickly. More recent studies have examined the relationship between alcohol dependence and affective disorder in the current episode. There is consistent evidence to suggest that a diagnosis of depression in the current episode may change to one of alcohol dependence alone, once detoxification or abstinence has been achieved. The prognosis of those who continue to be depressed remains unclear.

Affect↗

PubMed2006

Combining psychosocial treatment with pharmacotherapy for alcohol dependence.

Pharmacotherapy for alcohol dependence is always delivered in a psychosocial context that may affect the outcome of the treatment. The rigorous study of different psychotherapeutic treatments for alcohol dependence has shown several distinct approaches to be effective. This article reviews the combination of alcohol dependence pharmacotherapies, including disulfiram, naltrexone, and acamprosate, with different psychosocial interventions. Many psychosocial interventions for alcohol dependence, including Alcoholics Anonymous, can be integrated successfully with pharmacotherapy. Psychosocial interventions, ranging from brief medical management to more intensive manualized psychotherapies, have all been shown to produce positive outcomes in certain studies, depending on the specific medication and the study context. Particularly successful combinations may include the use of behavioral marital therapy plus a disulfiram contract for patients taking that medication, and the combination of naltrexone or acamprosate with cognitive-behavioral therapy or psychosocial support. Ongoing research examining the optimal combinations of medications with different psychosocial treatments for alcohol dependence may further inform the field.

Alcohol Deterrents↗

PubMed1981

Genetic factors in determining susceptibility to alcohol dependence and development of alcohol-induced liver disease.

There is considerable evidence in favour of genetic factors influencing excessive drinking behaviour and development of alcohol dependence (alcoholism), although readily identified markers of these genes have not been established. In addition, environmental factors undoubtedly play an important role. Although the probability of developing a significant liver disease (alcohol-induced hepatitis with or without cirrhosis) is related to the amount of alcohol ingested, there is a great variation in susceptibility which presumably stems from either genetic or additional environmental influences. The probable linkage of development of severe alcohol-induced liver disease with alleles of the HLA-B locus would suggest the influence of a gene(s) on chromosome 6. Such a gene may determine the rate or type of metabolism of alcohol or, since the immune response genes are present on chromosome 6, may indicate genetically controlled variation in the level of the immune and inflammatory response to alcohol-induced changes in liver membrane antigenicity. Further studies are needed to confirm these associations and to determine the type of factor involved.

Alcohol Oxidoreductases↗

PubMed2004

Pharmacogenetic insights to monoaminergic dysfunction in alcohol dependence.

RATIONALE: Alcohol dependence is characterized by the development of tolerance, withdrawal symptoms, and craving for alcohol. Chronic alcohol consumption causes neuroadaptive changes in the central dopaminergic and serotonergic system, which are partially reversible after detoxification. The severity and time-course of recovery of these neuroadaptive changes may depend on the genetic constitution of monoamine transporters and receptors and contribute to the relapse risk of alcoholics. OBJECTIVES: To assess the interaction between the genetic constitution and the in vivo availability of dopamine and serotonin transporters and receptors, chronic alcohol intake, alcohol craving and withdrawal. METHODS: Review of brain imaging studies that assess the genotype and availability of dopamine and serotonin transporters in detoxified alcoholics and healthy control subjects. RESULTS: Chronic alcohol intake induced neuroadaptive reductions in striatal dopamine transporter (DAT) availability, which were reversible during early abstinence. A polymorphism of the DAT gene (SLC6A3) was associated with the in vivo transporter availability and with the severity of alcohol withdrawal. Neurotoxic reductions in 5-HTT protein expression were limited to homozygous carriers of the long allele in the 5-HTT gene (SCL6A4) regulatory region and correlated with negative mood states. CONCLUSION: Genetic constitution interacts with the in vivo availability of central dopamine and serotonin transporters during alcohol detoxification and may affect the severity of alcohol withdrawal and clinical depression.

Alcoholism↗

PubMed2000

Alcohol dependence among Alaska Natives entering alcoholism treatment: a gender comparison.

OBJECTIVE: An ongoing study of phenotypes of alcohol dependence among Alaska Natives provides an opportunity to investigate the nature and patterns of alcohol problems among Alaska Native men and women admitted to treatment in three residential programs in Anchorage, Alaska. METHOD: A comprehensive, standardized clinical assessment (including the SSAGA-I diagnostic interview, family history information, personality traits and cognitive functioning) of consecutive admissions to each of the three programs is being undertaken by trained interviewers. To date, 200 (103 male) subjects have been assessed. The mean (+/- SD) age of the sample is 32+/-8.5 years old. The development of alcohol problems, the psychological and physical consequences of chronic drinking, the flushing response, withdrawal symptoms and comorbid lifetime psychiatric conditions were examined. RESULTS: The sample was characterized by an early onset of drinking and an acute exacerbation and clustering of drinking problems during late adolescence, followed by the development of severe alcohol dependence. A high lifetime prevalence of DSM-III-R major depressive disorder was found, typically complicated by chronic drinking. The rates of other substance dependencies were relatively low, except for cannabis and cocaine dependence among female subjects. CONCLUSIONS: This sample of treatment-seeking Alaska Natives was found to have an early onset and severe form of DSM-III-R alcohol dependence, with few gender differences noted. While the prevalence of alcohol abuse and alcohol dependence among Native American populations has been reported to be quite high, the onset and patterning of symptoms among this sample of treated Alaska Natives has revealed more similarities with treated alcoholics from the majority population than important differences specific to Alaska Natives.

Adult↗

PubMedDate not supplied

The effects of ritanserin on mood, sleep, vigilance, clinical impression, and social functioning in alcohol-dependent individuals. Ritanserin in Alcoholism Work Group.

In an international double-blind placebo-controlled trial with 493 detoxified alcohol-dependent individuals, ritanserin, a specific 5-hydroxytryptamine, antagonist, was tested in three different dosages (2.5, 5, and 10 mg/day) against placebo over a period of 6 months. Data on changes in mood state, sleep quality, morning vigilance, clinical impression, and social functioning were analysed. None of the three dosages of ritanserin given revealed any significant effect against placebo on the above-mentioned parameters either at the end of treatment or upon relapse. Therefore, we conclude that patients suffering from alcohol dependence without concomitant psychiatric disorders do not benefit from additional treatment with (2.5, 5, or 10 mg/day) ritanserin.

Adult↗